Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE FIBULA RT 6HOLE 336-5206

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 RT 6HOLE 336-5206

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 FOOT 220MM 99-56-22100

Facility

$5,700.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,850.00
Max. Negotiated Rate	$5,529.00
Rate for Payer: AlohaCare Medicaid	$2,850.00
Rate for Payer: AlohaCare Medicare	$4,332.00
Rate for Payer: Cash Price	$3,420.00
Rate for Payer: Devoted Health Medicare	$4,788.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,332.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,990.00
Rate for Payer: Health Management Network Commercial	$4,845.00
Rate for Payer: Humana Medicare	$4,332.00
Rate for Payer: Kaiser Permanente Commercial	$5,130.00
Rate for Payer: Kaiser Permanente Medicaid	$2,907.00
Rate for Payer: Kaiser Permanente Medicare	$4,332.00
Rate for Payer: MDX Hawaii PPO	$5,529.00
Rate for Payer: Ohana Health Plan Medicaid	$4,332.00
Rate for Payer: Ohana Health Plan Medicare	$4,332.00
Rate for Payer: UnitedHealthcare Medicare	$4,332.00
Rate for Payer: University Health Alliance Commercial	$3,192.00

PLATE FOOT 220MM 99-56-22100

Facility

$5,700.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,192.00
Max. Negotiated Rate	$5,529.00
Rate for Payer: Cash Price	$3,420.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,990.00
Rate for Payer: Health Management Network Commercial	$4,845.00
Rate for Payer: Kaiser Permanente Commercial	$5,130.00
Rate for Payer: MDX Hawaii PPO	$5,529.00
Rate for Payer: University Health Alliance Commercial	$3,192.00

PLATE FOOT DBL 160MM 56-13635

Facility

$2,565.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,436.40
Max. Negotiated Rate	$2,488.05
Rate for Payer: Cash Price	$1,539.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,795.50
Rate for Payer: Health Management Network Commercial	$2,180.25
Rate for Payer: Kaiser Permanente Commercial	$2,308.50
Rate for Payer: MDX Hawaii PPO	$2,488.05
Rate for Payer: University Health Alliance Commercial	$1,436.40

PLATE FOOT DBL 160MM 56-13635

Facility

$2,565.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,282.50
Max. Negotiated Rate	$2,488.05
Rate for Payer: AlohaCare Medicaid	$1,282.50
Rate for Payer: AlohaCare Medicare	$1,949.40
Rate for Payer: Cash Price	$1,539.00
Rate for Payer: Devoted Health Medicare	$2,154.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,949.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,795.50
Rate for Payer: Health Management Network Commercial	$2,180.25
Rate for Payer: Humana Medicare	$1,949.40
Rate for Payer: Kaiser Permanente Commercial	$2,308.50
Rate for Payer: Kaiser Permanente Medicaid	$1,308.15
Rate for Payer: Kaiser Permanente Medicare	$1,949.40
Rate for Payer: MDX Hawaii PPO	$2,488.05
Rate for Payer: Ohana Health Plan Medicaid	$1,949.40
Rate for Payer: Ohana Health Plan Medicare	$1,949.40
Rate for Payer: UnitedHealthcare Medicare	$1,949.40
Rate for Payer: University Health Alliance Commercial	$1,436.40

PLATE FOOT TL 100MM 56-13580

Facility

$1,339.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$669.50
Max. Negotiated Rate	$1,298.83
Rate for Payer: AlohaCare Medicaid	$669.50
Rate for Payer: AlohaCare Medicare	$1,017.64
Rate for Payer: Cash Price	$803.40
Rate for Payer: Devoted Health Medicare	$1,124.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,017.64
Rate for Payer: Hawaii Western Management Group Commercial	$937.30
Rate for Payer: Health Management Network Commercial	$1,138.15
Rate for Payer: Humana Medicare	$1,017.64
Rate for Payer: Kaiser Permanente Commercial	$1,205.10
Rate for Payer: Kaiser Permanente Medicaid	$682.89
Rate for Payer: Kaiser Permanente Medicare	$1,017.64
Rate for Payer: MDX Hawaii PPO	$1,298.83
Rate for Payer: Ohana Health Plan Medicaid	$1,017.64
Rate for Payer: Ohana Health Plan Medicare	$1,017.64
Rate for Payer: UnitedHealthcare Medicare	$1,017.64
Rate for Payer: University Health Alliance Commercial	$749.84

PLATE FOOT TL 100MM 56-13580

Facility

$1,339.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$749.84
Max. Negotiated Rate	$1,298.83
Rate for Payer: Cash Price	$803.40
Rate for Payer: Hawaii Western Management Group Commercial	$937.30
Rate for Payer: Health Management Network Commercial	$1,138.15
Rate for Payer: Kaiser Permanente Commercial	$1,205.10
Rate for Payer: MDX Hawaii PPO	$1,298.83
Rate for Payer: University Health Alliance Commercial	$749.84

PLATE FOOT TL 120MM 56-13590

Facility

$1,496.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$748.00
Max. Negotiated Rate	$1,451.12
Rate for Payer: AlohaCare Medicaid	$748.00
Rate for Payer: AlohaCare Medicare	$1,136.96
Rate for Payer: Cash Price	$897.60
Rate for Payer: Devoted Health Medicare	$1,256.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,136.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,047.20
Rate for Payer: Health Management Network Commercial	$1,271.60
Rate for Payer: Humana Medicare	$1,136.96
Rate for Payer: Kaiser Permanente Commercial	$1,346.40
Rate for Payer: Kaiser Permanente Medicaid	$762.96
Rate for Payer: Kaiser Permanente Medicare	$1,136.96
Rate for Payer: MDX Hawaii PPO	$1,451.12
Rate for Payer: Ohana Health Plan Medicaid	$1,136.96
Rate for Payer: Ohana Health Plan Medicare	$1,136.96
Rate for Payer: UnitedHealthcare Medicare	$1,136.96
Rate for Payer: University Health Alliance Commercial	$837.76

PLATE FOOT TL 120MM 56-13590

Facility

$1,496.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$837.76
Max. Negotiated Rate	$1,451.12
Rate for Payer: Cash Price	$897.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,047.20
Rate for Payer: Health Management Network Commercial	$1,271.60
Rate for Payer: Kaiser Permanente Commercial	$1,346.40
Rate for Payer: MDX Hawaii PPO	$1,451.12
Rate for Payer: University Health Alliance Commercial	$837.76

PLATE FOOT TL 130MM 56-13600

Facility

$1,496.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$748.00
Max. Negotiated Rate	$1,451.12
Rate for Payer: AlohaCare Medicaid	$748.00
Rate for Payer: AlohaCare Medicare	$1,136.96
Rate for Payer: Cash Price	$897.60
Rate for Payer: Devoted Health Medicare	$1,256.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,136.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,047.20
Rate for Payer: Health Management Network Commercial	$1,271.60
Rate for Payer: Humana Medicare	$1,136.96
Rate for Payer: Kaiser Permanente Commercial	$1,346.40
Rate for Payer: Kaiser Permanente Medicaid	$762.96
Rate for Payer: Kaiser Permanente Medicare	$1,136.96
Rate for Payer: MDX Hawaii PPO	$1,451.12
Rate for Payer: Ohana Health Plan Medicaid	$1,136.96
Rate for Payer: Ohana Health Plan Medicare	$1,136.96
Rate for Payer: UnitedHealthcare Medicare	$1,136.96
Rate for Payer: University Health Alliance Commercial	$837.76

PLATE FOOT TL 130MM 56-13600

Facility

$1,496.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$837.76
Max. Negotiated Rate	$1,451.12
Rate for Payer: Cash Price	$897.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,047.20
Rate for Payer: Health Management Network Commercial	$1,271.60
Rate for Payer: Kaiser Permanente Commercial	$1,346.40
Rate for Payer: MDX Hawaii PPO	$1,451.12
Rate for Payer: University Health Alliance Commercial	$837.76

PLATE FOOT TL 140MM 56-13610

Facility

$1,575.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$1,527.75
Rate for Payer: Cash Price	$945.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,102.50
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: MDX Hawaii PPO	$1,527.75
Rate for Payer: University Health Alliance Commercial	$882.00

PLATE FOOT TL 140MM 56-13610

Facility

$1,575.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,527.75
Rate for Payer: AlohaCare Medicaid	$787.50
Rate for Payer: AlohaCare Medicare	$1,197.00
Rate for Payer: Cash Price	$945.00
Rate for Payer: Devoted Health Medicare	$1,323.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,197.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,102.50
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: Humana Medicare	$1,197.00
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: Kaiser Permanente Medicaid	$803.25
Rate for Payer: Kaiser Permanente Medicare	$1,197.00
Rate for Payer: MDX Hawaii PPO	$1,527.75
Rate for Payer: Ohana Health Plan Medicaid	$1,197.00
Rate for Payer: Ohana Health Plan Medicare	$1,197.00
Rate for Payer: UnitedHealthcare Medicare	$1,197.00
Rate for Payer: University Health Alliance Commercial	$882.00

PLATE FOOT TL+ 160MM 56-13630

Facility

$1,553.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$869.68
Max. Negotiated Rate	$1,506.41
Rate for Payer: Cash Price	$931.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,087.10
Rate for Payer: Health Management Network Commercial	$1,320.05
Rate for Payer: Kaiser Permanente Commercial	$1,397.70
Rate for Payer: MDX Hawaii PPO	$1,506.41
Rate for Payer: University Health Alliance Commercial	$869.68

PLATE FOOT TL+ 160MM 56-13630

Facility

$1,553.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$776.50
Max. Negotiated Rate	$1,506.41
Rate for Payer: AlohaCare Medicaid	$776.50
Rate for Payer: AlohaCare Medicare	$1,180.28
Rate for Payer: Cash Price	$931.80
Rate for Payer: Devoted Health Medicare	$1,304.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,180.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,087.10
Rate for Payer: Health Management Network Commercial	$1,320.05
Rate for Payer: Humana Medicare	$1,180.28
Rate for Payer: Kaiser Permanente Commercial	$1,397.70
Rate for Payer: Kaiser Permanente Medicaid	$792.03
Rate for Payer: Kaiser Permanente Medicare	$1,180.28
Rate for Payer: MDX Hawaii PPO	$1,506.41
Rate for Payer: Ohana Health Plan Medicaid	$1,180.28
Rate for Payer: Ohana Health Plan Medicare	$1,180.28
Rate for Payer: UnitedHealthcare Medicare	$1,180.28
Rate for Payer: University Health Alliance Commercial	$869.68

PLATE FOOT TL+ 170MM 56-13640

Facility

$1,620.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$907.20
Max. Negotiated Rate	$1,571.40
Rate for Payer: Cash Price	$972.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,134.00
Rate for Payer: Health Management Network Commercial	$1,377.00
Rate for Payer: Kaiser Permanente Commercial	$1,458.00
Rate for Payer: MDX Hawaii PPO	$1,571.40
Rate for Payer: University Health Alliance Commercial	$907.20

PLATE FOOT TL+ 170MM 56-13640

Facility

$1,620.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$1,571.40
Rate for Payer: AlohaCare Medicaid	$810.00
Rate for Payer: AlohaCare Medicare	$1,231.20
Rate for Payer: Cash Price	$972.00
Rate for Payer: Devoted Health Medicare	$1,360.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,231.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,134.00
Rate for Payer: Health Management Network Commercial	$1,377.00
Rate for Payer: Humana Medicare	$1,231.20
Rate for Payer: Kaiser Permanente Commercial	$1,458.00
Rate for Payer: Kaiser Permanente Medicaid	$826.20
Rate for Payer: Kaiser Permanente Medicare	$1,231.20
Rate for Payer: MDX Hawaii PPO	$1,571.40
Rate for Payer: Ohana Health Plan Medicaid	$1,231.20
Rate for Payer: Ohana Health Plan Medicare	$1,231.20
Rate for Payer: UnitedHealthcare Medicare	$1,231.20
Rate for Payer: University Health Alliance Commercial	$907.20

PLATE FOOT TL+ 180MM 56-13650

Facility

$1,688.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$945.28
Max. Negotiated Rate	$1,637.36
Rate for Payer: Cash Price	$1,012.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,181.60
Rate for Payer: Health Management Network Commercial	$1,434.80
Rate for Payer: Kaiser Permanente Commercial	$1,519.20
Rate for Payer: MDX Hawaii PPO	$1,637.36
Rate for Payer: University Health Alliance Commercial	$945.28

PLATE FOOT TL+ 180MM 56-13650

Facility

$1,688.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$844.00
Max. Negotiated Rate	$1,637.36
Rate for Payer: AlohaCare Medicaid	$844.00
Rate for Payer: AlohaCare Medicare	$1,282.88
Rate for Payer: Cash Price	$1,012.80
Rate for Payer: Devoted Health Medicare	$1,417.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,282.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,181.60
Rate for Payer: Health Management Network Commercial	$1,434.80
Rate for Payer: Humana Medicare	$1,282.88
Rate for Payer: Kaiser Permanente Commercial	$1,519.20
Rate for Payer: Kaiser Permanente Medicaid	$860.88
Rate for Payer: Kaiser Permanente Medicare	$1,282.88
Rate for Payer: MDX Hawaii PPO	$1,637.36
Rate for Payer: Ohana Health Plan Medicaid	$1,282.88
Rate for Payer: Ohana Health Plan Medicare	$1,282.88
Rate for Payer: UnitedHealthcare Medicare	$1,282.88
Rate for Payer: University Health Alliance Commercial	$945.28

PLATE FOOT TL+ 200MM 56-13660

Facility

$1,755.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$877.50
Max. Negotiated Rate	$1,702.35
Rate for Payer: AlohaCare Medicaid	$877.50
Rate for Payer: AlohaCare Medicare	$1,333.80
Rate for Payer: Cash Price	$1,053.00
Rate for Payer: Devoted Health Medicare	$1,474.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,333.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,228.50
Rate for Payer: Health Management Network Commercial	$1,491.75
Rate for Payer: Humana Medicare	$1,333.80
Rate for Payer: Kaiser Permanente Commercial	$1,579.50
Rate for Payer: Kaiser Permanente Medicaid	$895.05
Rate for Payer: Kaiser Permanente Medicare	$1,333.80
Rate for Payer: MDX Hawaii PPO	$1,702.35
Rate for Payer: Ohana Health Plan Medicaid	$1,333.80
Rate for Payer: Ohana Health Plan Medicare	$1,333.80
Rate for Payer: UnitedHealthcare Medicare	$1,333.80
Rate for Payer: University Health Alliance Commercial	$982.80

PLATE FOOT TL+ 200MM 56-13660

Facility

$1,755.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$982.80
Max. Negotiated Rate	$1,702.35
Rate for Payer: Cash Price	$1,053.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,228.50
Rate for Payer: Health Management Network Commercial	$1,491.75
Rate for Payer: Kaiser Permanente Commercial	$1,579.50
Rate for Payer: MDX Hawaii PPO	$1,702.35
Rate for Payer: University Health Alliance Commercial	$982.80

PLATE FUSION 4.0 LONG 336-3564

Facility

$3,640.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,038.40
Max. Negotiated Rate	$3,530.80
Rate for Payer: Cash Price	$2,184.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,548.00
Rate for Payer: Health Management Network Commercial	$3,094.00
Rate for Payer: Kaiser Permanente Commercial	$3,276.00
Rate for Payer: MDX Hawaii PPO	$3,530.80
Rate for Payer: University Health Alliance Commercial	$2,038.40

PLATE FUSION 4.0 LONG 336-3564

Facility

$3,640.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,820.00
Max. Negotiated Rate	$3,530.80
Rate for Payer: AlohaCare Medicaid	$1,820.00
Rate for Payer: AlohaCare Medicare	$2,766.40
Rate for Payer: Cash Price	$2,184.00
Rate for Payer: Devoted Health Medicare	$3,057.60
Rate for Payer: Hawaii Medical Service Association Medicare	$2,766.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,548.00
Rate for Payer: Health Management Network Commercial	$3,094.00
Rate for Payer: Humana Medicare	$2,766.40
Rate for Payer: Kaiser Permanente Commercial	$3,276.00
Rate for Payer: Kaiser Permanente Medicaid	$1,856.40
Rate for Payer: Kaiser Permanente Medicare	$2,766.40
Rate for Payer: MDX Hawaii PPO	$3,530.80
Rate for Payer: Ohana Health Plan Medicaid	$2,766.40
Rate for Payer: Ohana Health Plan Medicare	$2,766.40
Rate for Payer: UnitedHealthcare Medicare	$2,766.40
Rate for Payer: University Health Alliance Commercial	$2,038.40

PLATE FUSION 4.0 MED 336-3563

Facility

$3,640.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,038.40
Max. Negotiated Rate	$3,530.80
Rate for Payer: Cash Price	$2,184.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,548.00
Rate for Payer: Health Management Network Commercial	$3,094.00
Rate for Payer: Kaiser Permanente Commercial	$3,276.00
Rate for Payer: MDX Hawaii PPO	$3,530.80
Rate for Payer: University Health Alliance Commercial	$2,038.40

Know your out-of-pocket cost for care.

All Charges