Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE FEMORAL R DIS LAT 627640

Facility

$4,707.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,635.92
Max. Negotiated Rate	$4,565.79
Rate for Payer: Cash Price	$2,824.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,294.90
Rate for Payer: Health Management Network Commercial	$4,000.95
Rate for Payer: Kaiser Permanente Commercial	$4,236.30
Rate for Payer: MDX Hawaii PPO	$4,565.79
Rate for Payer: University Health Alliance Commercial	$2,635.92

PLATE FEMORAL RT DISTAL 627634

Facility

$5,925.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,318.00
Max. Negotiated Rate	$5,747.25
Rate for Payer: Cash Price	$3,555.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,147.50
Rate for Payer: Health Management Network Commercial	$5,036.25
Rate for Payer: Kaiser Permanente Commercial	$5,332.50
Rate for Payer: MDX Hawaii PPO	$5,747.25
Rate for Payer: University Health Alliance Commercial	$3,318.00

PLATE FEMORAL RT DISTAL 627634

Facility

$5,925.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,962.50
Max. Negotiated Rate	$5,747.25
Rate for Payer: AlohaCare Medicaid	$2,962.50
Rate for Payer: AlohaCare Medicare	$4,503.00
Rate for Payer: Cash Price	$3,555.00
Rate for Payer: Devoted Health Medicare	$4,977.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,503.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,147.50
Rate for Payer: Health Management Network Commercial	$5,036.25
Rate for Payer: Humana Medicare	$4,503.00
Rate for Payer: Kaiser Permanente Commercial	$5,332.50
Rate for Payer: Kaiser Permanente Medicaid	$3,021.75
Rate for Payer: Kaiser Permanente Medicare	$4,503.00
Rate for Payer: MDX Hawaii PPO	$5,747.25
Rate for Payer: Ohana Health Plan Medicaid	$4,503.00
Rate for Payer: Ohana Health Plan Medicare	$4,503.00
Rate for Payer: UnitedHealthcare Medicare	$4,503.00
Rate for Payer: University Health Alliance Commercial	$3,318.00

PLATE FEMUR 379MM 18H 627648S

Facility

$7,026.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,934.56
Max. Negotiated Rate	$6,815.22
Rate for Payer: Cash Price	$4,215.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,918.20
Rate for Payer: Health Management Network Commercial	$5,972.10
Rate for Payer: Kaiser Permanente Commercial	$6,323.40
Rate for Payer: MDX Hawaii PPO	$6,815.22
Rate for Payer: University Health Alliance Commercial	$3,934.56

PLATE FEMUR 379MM 18H 627648S

Facility

$7,026.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,513.00
Max. Negotiated Rate	$6,815.22
Rate for Payer: AlohaCare Medicaid	$3,513.00
Rate for Payer: AlohaCare Medicare	$5,339.76
Rate for Payer: Cash Price	$4,215.60
Rate for Payer: Devoted Health Medicare	$5,901.84
Rate for Payer: Hawaii Medical Service Association Medicare	$5,339.76
Rate for Payer: Hawaii Western Management Group Commercial	$4,918.20
Rate for Payer: Health Management Network Commercial	$5,972.10
Rate for Payer: Humana Medicare	$5,339.76
Rate for Payer: Kaiser Permanente Commercial	$6,323.40
Rate for Payer: Kaiser Permanente Medicaid	$3,583.26
Rate for Payer: Kaiser Permanente Medicare	$5,339.76
Rate for Payer: MDX Hawaii PPO	$6,815.22
Rate for Payer: Ohana Health Plan Medicaid	$5,339.76
Rate for Payer: Ohana Health Plan Medicare	$5,339.76
Rate for Payer: UnitedHealthcare Medicare	$5,339.76
Rate for Payer: University Health Alliance Commercial	$3,934.56

PLATE FIB 3H RT 85MM 336-5203

Facility

$2,884.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,615.04
Max. Negotiated Rate	$2,797.48
Rate for Payer: Cash Price	$1,730.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,018.80
Rate for Payer: Health Management Network Commercial	$2,451.40
Rate for Payer: Kaiser Permanente Commercial	$2,595.60
Rate for Payer: MDX Hawaii PPO	$2,797.48
Rate for Payer: University Health Alliance Commercial	$1,615.04

PLATE FIB 3H RT 85MM 336-5203

Facility

$2,884.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,442.00
Max. Negotiated Rate	$2,797.48
Rate for Payer: AlohaCare Medicaid	$1,442.00
Rate for Payer: AlohaCare Medicare	$2,191.84
Rate for Payer: Cash Price	$1,730.40
Rate for Payer: Devoted Health Medicare	$2,422.56
Rate for Payer: Hawaii Medical Service Association Medicare	$2,191.84
Rate for Payer: Hawaii Western Management Group Commercial	$2,018.80
Rate for Payer: Health Management Network Commercial	$2,451.40
Rate for Payer: Humana Medicare	$2,191.84
Rate for Payer: Kaiser Permanente Commercial	$2,595.60
Rate for Payer: Kaiser Permanente Medicaid	$1,470.84
Rate for Payer: Kaiser Permanente Medicare	$2,191.84
Rate for Payer: MDX Hawaii PPO	$2,797.48
Rate for Payer: Ohana Health Plan Medicaid	$2,191.84
Rate for Payer: Ohana Health Plan Medicare	$2,191.84
Rate for Payer: UnitedHealthcare Medicare	$2,191.84
Rate for Payer: University Health Alliance Commercial	$1,615.04

PLATE FIBULA 40-20906

Facility

$2,237.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,118.50
Max. Negotiated Rate	$2,169.89
Rate for Payer: AlohaCare Medicaid	$1,118.50
Rate for Payer: AlohaCare Medicare	$1,700.12
Rate for Payer: Cash Price	$1,342.20
Rate for Payer: Devoted Health Medicare	$1,879.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,700.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,565.90
Rate for Payer: Health Management Network Commercial	$1,901.45
Rate for Payer: Humana Medicare	$1,700.12
Rate for Payer: Kaiser Permanente Commercial	$2,013.30
Rate for Payer: Kaiser Permanente Medicaid	$1,140.87
Rate for Payer: Kaiser Permanente Medicare	$1,700.12
Rate for Payer: MDX Hawaii PPO	$2,169.89
Rate for Payer: Ohana Health Plan Medicaid	$1,700.12
Rate for Payer: Ohana Health Plan Medicare	$1,700.12
Rate for Payer: UnitedHealthcare Medicare	$1,700.12
Rate for Payer: University Health Alliance Commercial	$1,252.72

PLATE FIBULA 40-20906

Facility

$2,237.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.72
Max. Negotiated Rate	$2,169.89
Rate for Payer: Cash Price	$1,342.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,565.90
Rate for Payer: Health Management Network Commercial	$1,901.45
Rate for Payer: Kaiser Permanente Commercial	$2,013.30
Rate for Payer: MDX Hawaii PPO	$2,169.89
Rate for Payer: University Health Alliance Commercial	$1,252.72

PLATE FIBULA 6H LEFT 336-5106

Facility

$2,884.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,442.00
Max. Negotiated Rate	$2,797.48
Rate for Payer: AlohaCare Medicaid	$1,442.00
Rate for Payer: AlohaCare Medicare	$2,191.84
Rate for Payer: Cash Price	$1,730.40
Rate for Payer: Devoted Health Medicare	$2,422.56
Rate for Payer: Hawaii Medical Service Association Medicare	$2,191.84
Rate for Payer: Hawaii Western Management Group Commercial	$2,018.80
Rate for Payer: Health Management Network Commercial	$2,451.40
Rate for Payer: Humana Medicare	$2,191.84
Rate for Payer: Kaiser Permanente Commercial	$2,595.60
Rate for Payer: Kaiser Permanente Medicaid	$1,470.84
Rate for Payer: Kaiser Permanente Medicare	$2,191.84
Rate for Payer: MDX Hawaii PPO	$2,797.48
Rate for Payer: Ohana Health Plan Medicaid	$2,191.84
Rate for Payer: Ohana Health Plan Medicare	$2,191.84
Rate for Payer: UnitedHealthcare Medicare	$2,191.84
Rate for Payer: University Health Alliance Commercial	$1,615.04

PLATE FIBULA 6H LEFT 336-5106

Facility

$2,884.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,615.04
Max. Negotiated Rate	$2,797.48
Rate for Payer: Cash Price	$1,730.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,018.80
Rate for Payer: Health Management Network Commercial	$2,451.40
Rate for Payer: Kaiser Permanente Commercial	$2,595.60
Rate for Payer: MDX Hawaii PPO	$2,797.48
Rate for Payer: University Health Alliance Commercial	$1,615.04

PLATE FIBULA ANTMC LCKING L 4H

Facility

$2,320.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,160.00
Max. Negotiated Rate	$2,250.40
Rate for Payer: AlohaCare Medicaid	$1,160.00
Rate for Payer: AlohaCare Medicare	$1,763.20
Rate for Payer: Cash Price	$1,392.00
Rate for Payer: Devoted Health Medicare	$1,948.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,763.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,624.00
Rate for Payer: Health Management Network Commercial	$1,972.00
Rate for Payer: Humana Medicare	$1,763.20
Rate for Payer: Kaiser Permanente Commercial	$2,088.00
Rate for Payer: Kaiser Permanente Medicaid	$1,183.20
Rate for Payer: Kaiser Permanente Medicare	$1,763.20
Rate for Payer: MDX Hawaii PPO	$2,250.40
Rate for Payer: Ohana Health Plan Medicaid	$1,763.20
Rate for Payer: Ohana Health Plan Medicare	$1,763.20
Rate for Payer: UnitedHealthcare Medicare	$1,763.20
Rate for Payer: University Health Alliance Commercial	$1,299.20

PLATE FIBULA ANTMC LCKING L 4H

Facility

$2,320.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.20
Max. Negotiated Rate	$2,250.40
Rate for Payer: Cash Price	$1,392.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,624.00
Rate for Payer: Health Management Network Commercial	$1,972.00
Rate for Payer: Kaiser Permanente Commercial	$2,088.00
Rate for Payer: MDX Hawaii PPO	$2,250.40
Rate for Payer: University Health Alliance Commercial	$1,299.20

PLATE FIBULA L 4H AR-8943DL-04

Facility

$1,845.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$922.50
Max. Negotiated Rate	$1,789.65
Rate for Payer: AlohaCare Medicaid	$922.50
Rate for Payer: AlohaCare Medicare	$1,402.20
Rate for Payer: Cash Price	$1,107.00
Rate for Payer: Devoted Health Medicare	$1,549.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,402.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,291.50
Rate for Payer: Health Management Network Commercial	$1,568.25
Rate for Payer: Humana Medicare	$1,402.20
Rate for Payer: Kaiser Permanente Commercial	$1,660.50
Rate for Payer: Kaiser Permanente Medicaid	$940.95
Rate for Payer: Kaiser Permanente Medicare	$1,402.20
Rate for Payer: MDX Hawaii PPO	$1,789.65
Rate for Payer: Ohana Health Plan Medicaid	$1,402.20
Rate for Payer: Ohana Health Plan Medicare	$1,402.20
Rate for Payer: UnitedHealthcare Medicare	$1,402.20
Rate for Payer: University Health Alliance Commercial	$1,033.20

PLATE FIBULA L 4H AR-8943DL-04

Facility

$1,845.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,033.20
Max. Negotiated Rate	$1,789.65
Rate for Payer: Cash Price	$1,107.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,291.50
Rate for Payer: Health Management Network Commercial	$1,568.25
Rate for Payer: Kaiser Permanente Commercial	$1,660.50
Rate for Payer: MDX Hawaii PPO	$1,789.65
Rate for Payer: University Health Alliance Commercial	$1,033.20

PLATE FIBULA L 5H AR-8943DL-05

Facility

$2,284.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,279.04
Max. Negotiated Rate	$2,215.48
Rate for Payer: Cash Price	$1,370.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,598.80
Rate for Payer: Health Management Network Commercial	$1,941.40
Rate for Payer: Kaiser Permanente Commercial	$2,055.60
Rate for Payer: MDX Hawaii PPO	$2,215.48
Rate for Payer: University Health Alliance Commercial	$1,279.04

PLATE FIBULA L 5H AR-8943DL-05

Facility

$2,284.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,142.00
Max. Negotiated Rate	$2,215.48
Rate for Payer: AlohaCare Medicaid	$1,142.00
Rate for Payer: AlohaCare Medicare	$1,735.84
Rate for Payer: Cash Price	$1,370.40
Rate for Payer: Devoted Health Medicare	$1,918.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,735.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,598.80
Rate for Payer: Health Management Network Commercial	$1,941.40
Rate for Payer: Humana Medicare	$1,735.84
Rate for Payer: Kaiser Permanente Commercial	$2,055.60
Rate for Payer: Kaiser Permanente Medicaid	$1,164.84
Rate for Payer: Kaiser Permanente Medicare	$1,735.84
Rate for Payer: MDX Hawaii PPO	$2,215.48
Rate for Payer: Ohana Health Plan Medicaid	$1,735.84
Rate for Payer: Ohana Health Plan Medicare	$1,735.84
Rate for Payer: UnitedHealthcare Medicare	$1,735.84
Rate for Payer: University Health Alliance Commercial	$1,279.04

PLATE FIBULA L 6H AR-8943DL-06

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

PLATE FIBULA L 6H AR-8943DL-06

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: AlohaCare Medicaid	$1,200.00
Rate for Payer: AlohaCare Medicare	$1,824.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Devoted Health Medicare	$2,016.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,824.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Humana Medicare	$1,824.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: Kaiser Permanente Medicaid	$1,224.00
Rate for Payer: Kaiser Permanente Medicare	$1,824.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: Ohana Health Plan Medicaid	$1,824.00
Rate for Payer: Ohana Health Plan Medicare	$1,824.00
Rate for Payer: UnitedHealthcare Medicare	$1,824.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

PLATE FIBULA L 8H AR-8943DL-08

Facility

$2,756.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,543.36
Max. Negotiated Rate	$2,673.32
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,929.20
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Kaiser Permanente Commercial	$2,480.40
Rate for Payer: MDX Hawaii PPO	$2,673.32
Rate for Payer: University Health Alliance Commercial	$1,543.36

PLATE FIBULA L 8H AR-8943DL-08

Facility

$2,756.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,378.00
Max. Negotiated Rate	$2,673.32
Rate for Payer: AlohaCare Medicaid	$1,378.00
Rate for Payer: AlohaCare Medicare	$2,094.56
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Devoted Health Medicare	$2,315.04
Rate for Payer: Hawaii Medical Service Association Medicare	$2,094.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,929.20
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Humana Medicare	$2,094.56
Rate for Payer: Kaiser Permanente Commercial	$2,480.40
Rate for Payer: Kaiser Permanente Medicaid	$1,405.56
Rate for Payer: Kaiser Permanente Medicare	$2,094.56
Rate for Payer: MDX Hawaii PPO	$2,673.32
Rate for Payer: Ohana Health Plan Medicaid	$2,094.56
Rate for Payer: Ohana Health Plan Medicare	$2,094.56
Rate for Payer: UnitedHealthcare Medicare	$2,094.56
Rate for Payer: University Health Alliance Commercial	$1,543.36

PLATE FIBULAR 5H 40-20905

Facility

$2,156.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,207.36
Max. Negotiated Rate	$2,091.32
Rate for Payer: Cash Price	$1,293.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,509.20
Rate for Payer: Health Management Network Commercial	$1,832.60
Rate for Payer: Kaiser Permanente Commercial	$1,940.40
Rate for Payer: MDX Hawaii PPO	$2,091.32
Rate for Payer: University Health Alliance Commercial	$1,207.36

PLATE FIBULAR 5H 40-20905

Facility

$2,156.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,078.00
Max. Negotiated Rate	$2,091.32
Rate for Payer: AlohaCare Medicaid	$1,078.00
Rate for Payer: AlohaCare Medicare	$1,638.56
Rate for Payer: Cash Price	$1,293.60
Rate for Payer: Devoted Health Medicare	$1,811.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1,638.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,509.20
Rate for Payer: Health Management Network Commercial	$1,832.60
Rate for Payer: Humana Medicare	$1,638.56
Rate for Payer: Kaiser Permanente Commercial	$1,940.40
Rate for Payer: Kaiser Permanente Medicaid	$1,099.56
Rate for Payer: Kaiser Permanente Medicare	$1,638.56
Rate for Payer: MDX Hawaii PPO	$2,091.32
Rate for Payer: Ohana Health Plan Medicaid	$1,638.56
Rate for Payer: Ohana Health Plan Medicare	$1,638.56
Rate for Payer: UnitedHealthcare Medicare	$1,638.56
Rate for Payer: University Health Alliance Commercial	$1,207.36

PLATE FIBULAR AR-8943DR-04

Facility

$1,937.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,084.72
Max. Negotiated Rate	$1,878.89
Rate for Payer: Cash Price	$1,162.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,355.90
Rate for Payer: Health Management Network Commercial	$1,646.45
Rate for Payer: Kaiser Permanente Commercial	$1,743.30
Rate for Payer: MDX Hawaii PPO	$1,878.89
Rate for Payer: University Health Alliance Commercial	$1,084.72

PLATE FIBULAR AR-8943DR-04

Facility

$1,937.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$968.50
Max. Negotiated Rate	$1,878.89
Rate for Payer: AlohaCare Medicaid	$968.50
Rate for Payer: AlohaCare Medicare	$1,472.12
Rate for Payer: Cash Price	$1,162.20
Rate for Payer: Devoted Health Medicare	$1,627.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,472.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,355.90
Rate for Payer: Health Management Network Commercial	$1,646.45
Rate for Payer: Humana Medicare	$1,472.12
Rate for Payer: Kaiser Permanente Commercial	$1,743.30
Rate for Payer: Kaiser Permanente Medicaid	$987.87
Rate for Payer: Kaiser Permanente Medicare	$1,472.12
Rate for Payer: MDX Hawaii PPO	$1,878.89
Rate for Payer: Ohana Health Plan Medicaid	$1,472.12
Rate for Payer: Ohana Health Plan Medicare	$1,472.12
Rate for Payer: UnitedHealthcare Medicare	$1,472.12
Rate for Payer: University Health Alliance Commercial	$1,084.72

Know your out-of-pocket cost for care.

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