Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE FUSION 4.0 MED 336-3563

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 GLENOID AS 01.04223.200

Facility

$4,064.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,032.00
Max. Negotiated Rate	$3,942.08
Rate for Payer: AlohaCare Medicaid	$2,032.00
Rate for Payer: AlohaCare Medicare	$3,088.64
Rate for Payer: Cash Price	$2,438.40
Rate for Payer: Devoted Health Medicare	$3,413.76
Rate for Payer: Hawaii Medical Service Association Medicare	$3,088.64
Rate for Payer: Hawaii Western Management Group Commercial	$2,844.80
Rate for Payer: Health Management Network Commercial	$3,454.40
Rate for Payer: Humana Medicare	$3,088.64
Rate for Payer: Kaiser Permanente Commercial	$3,657.60
Rate for Payer: Kaiser Permanente Medicaid	$2,072.64
Rate for Payer: Kaiser Permanente Medicare	$3,088.64
Rate for Payer: MDX Hawaii PPO	$3,942.08
Rate for Payer: Ohana Health Plan Medicaid	$3,088.64
Rate for Payer: Ohana Health Plan Medicare	$3,088.64
Rate for Payer: UnitedHealthcare Medicare	$3,088.64
Rate for Payer: University Health Alliance Commercial	$2,275.84

PLATE GLENOID AS 01.04223.200

Facility

$4,064.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,275.84
Max. Negotiated Rate	$3,942.08
Rate for Payer: Cash Price	$2,438.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,844.80
Rate for Payer: Health Management Network Commercial	$3,454.40
Rate for Payer: Kaiser Permanente Commercial	$3,657.60
Rate for Payer: MDX Hawaii PPO	$3,942.08
Rate for Payer: University Health Alliance Commercial	$2,275.84

PLATE H 3.5X15MM 336-3500

Facility

$2,667.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.50
Max. Negotiated Rate	$2,586.99
Rate for Payer: AlohaCare Medicaid	$1,333.50
Rate for Payer: AlohaCare Medicare	$2,026.92
Rate for Payer: Cash Price	$1,600.20
Rate for Payer: Devoted Health Medicare	$2,240.28
Rate for Payer: Hawaii Medical Service Association Medicare	$2,026.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,866.90
Rate for Payer: Health Management Network Commercial	$2,266.95
Rate for Payer: Humana Medicare	$2,026.92
Rate for Payer: Kaiser Permanente Commercial	$2,400.30
Rate for Payer: Kaiser Permanente Medicaid	$1,360.17
Rate for Payer: Kaiser Permanente Medicare	$2,026.92
Rate for Payer: MDX Hawaii PPO	$2,586.99
Rate for Payer: Ohana Health Plan Medicaid	$2,026.92
Rate for Payer: Ohana Health Plan Medicare	$2,026.92
Rate for Payer: UnitedHealthcare Medicare	$2,026.92
Rate for Payer: University Health Alliance Commercial	$1,493.52

PLATE H 3.5X15MM 336-3500

Facility

$2,667.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,493.52
Max. Negotiated Rate	$2,586.99
Rate for Payer: Cash Price	$1,600.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,866.90
Rate for Payer: Health Management Network Commercial	$2,266.95
Rate for Payer: Kaiser Permanente Commercial	$2,400.30
Rate for Payer: MDX Hawaii PPO	$2,586.99
Rate for Payer: University Health Alliance Commercial	$1,493.52

PLATE H 3.5X30MM 336-3502

Facility

$2,667.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.50
Max. Negotiated Rate	$2,586.99
Rate for Payer: AlohaCare Medicaid	$1,333.50
Rate for Payer: AlohaCare Medicare	$2,026.92
Rate for Payer: Cash Price	$1,600.20
Rate for Payer: Devoted Health Medicare	$2,240.28
Rate for Payer: Hawaii Medical Service Association Medicare	$2,026.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,866.90
Rate for Payer: Health Management Network Commercial	$2,266.95
Rate for Payer: Humana Medicare	$2,026.92
Rate for Payer: Kaiser Permanente Commercial	$2,400.30
Rate for Payer: Kaiser Permanente Medicaid	$1,360.17
Rate for Payer: Kaiser Permanente Medicare	$2,026.92
Rate for Payer: MDX Hawaii PPO	$2,586.99
Rate for Payer: Ohana Health Plan Medicaid	$2,026.92
Rate for Payer: Ohana Health Plan Medicare	$2,026.92
Rate for Payer: UnitedHealthcare Medicare	$2,026.92
Rate for Payer: University Health Alliance Commercial	$1,493.52

PLATE H 3.5X30MM 336-3502

Facility

$2,667.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,493.52
Max. Negotiated Rate	$2,586.99
Rate for Payer: Cash Price	$1,600.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,866.90
Rate for Payer: Health Management Network Commercial	$2,266.95
Rate for Payer: Kaiser Permanente Commercial	$2,400.30
Rate for Payer: MDX Hawaii PPO	$2,586.99
Rate for Payer: University Health Alliance Commercial	$1,493.52

PLATE HOLDING TAKS 16 337-0001

Facility

$252.00

Hospital Revenue Code	272
Min. Negotiated Rate	$214.20
Max. Negotiated Rate	$244.44
Rate for Payer: Cash Price	$151.20
Rate for Payer: Health Management Network Commercial	$214.20
Rate for Payer: Kaiser Permanente Commercial	$226.80
Rate for Payer: MDX Hawaii PPO	$244.44

PLATE HOLDING TAKS 16 337-0001

Facility

$252.00

Hospital Revenue Code	272
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$244.44
Rate for Payer: AlohaCare Medicaid	$126.00
Rate for Payer: AlohaCare Medicare	$191.52
Rate for Payer: Cash Price	$151.20
Rate for Payer: Devoted Health Medicare	$211.68
Rate for Payer: Hawaii Medical Service Association Medicare	$191.52
Rate for Payer: Hawaii Western Management Group Commercial	$239.40
Rate for Payer: Health Management Network Commercial	$214.20
Rate for Payer: Humana Medicare	$191.52
Rate for Payer: Kaiser Permanente Commercial	$226.80
Rate for Payer: Kaiser Permanente Medicaid	$128.52
Rate for Payer: Kaiser Permanente Medicare	$191.52
Rate for Payer: MDX Hawaii PPO	$244.44
Rate for Payer: Ohana Health Plan Medicaid	$191.52
Rate for Payer: Ohana Health Plan Medicare	$191.52
Rate for Payer: UnitedHealthcare Medicare	$191.52
Rate for Payer: University Health Alliance Commercial	$183.68

PLATE HOOK DORS WRIST 4H WHD-4

Facility

$2,775.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,554.00
Max. Negotiated Rate	$2,691.75
Rate for Payer: Cash Price	$1,665.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,942.50
Rate for Payer: Health Management Network Commercial	$2,358.75
Rate for Payer: Kaiser Permanente Commercial	$2,497.50
Rate for Payer: MDX Hawaii PPO	$2,691.75
Rate for Payer: University Health Alliance Commercial	$1,554.00

PLATE HOOK DORS WRIST 4H WHD-4

Facility

$2,775.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,691.75
Rate for Payer: AlohaCare Medicaid	$1,387.50
Rate for Payer: AlohaCare Medicare	$2,109.00
Rate for Payer: Cash Price	$1,665.00
Rate for Payer: Devoted Health Medicare	$2,331.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,109.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,942.50
Rate for Payer: Health Management Network Commercial	$2,358.75
Rate for Payer: Humana Medicare	$2,109.00
Rate for Payer: Kaiser Permanente Commercial	$2,497.50
Rate for Payer: Kaiser Permanente Medicaid	$1,415.25
Rate for Payer: Kaiser Permanente Medicare	$2,109.00
Rate for Payer: MDX Hawaii PPO	$2,691.75
Rate for Payer: Ohana Health Plan Medicaid	$2,109.00
Rate for Payer: Ohana Health Plan Medicare	$2,109.00
Rate for Payer: UnitedHealthcare Medicare	$2,109.00
Rate for Payer: University Health Alliance Commercial	$1,554.00

PLATE HOOK DORS WRIST 6H WHD-6

Facility

$2,120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,187.20
Max. Negotiated Rate	$2,056.40
Rate for Payer: Cash Price	$1,272.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,484.00
Rate for Payer: Health Management Network Commercial	$1,802.00
Rate for Payer: Kaiser Permanente Commercial	$1,908.00
Rate for Payer: MDX Hawaii PPO	$2,056.40
Rate for Payer: University Health Alliance Commercial	$1,187.20

PLATE HOOK DORS WRIST 6H WHD-6

Facility

$2,120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,060.00
Max. Negotiated Rate	$2,056.40
Rate for Payer: AlohaCare Medicaid	$1,060.00
Rate for Payer: AlohaCare Medicare	$1,611.20
Rate for Payer: Cash Price	$1,272.00
Rate for Payer: Devoted Health Medicare	$1,780.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,611.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,484.00
Rate for Payer: Health Management Network Commercial	$1,802.00
Rate for Payer: Humana Medicare	$1,611.20
Rate for Payer: Kaiser Permanente Commercial	$1,908.00
Rate for Payer: Kaiser Permanente Medicaid	$1,081.20
Rate for Payer: Kaiser Permanente Medicare	$1,611.20
Rate for Payer: MDX Hawaii PPO	$2,056.40
Rate for Payer: Ohana Health Plan Medicaid	$1,611.20
Rate for Payer: Ohana Health Plan Medicare	$1,611.20
Rate for Payer: UnitedHealthcare Medicare	$1,611.20
Rate for Payer: University Health Alliance Commercial	$1,187.20

PLATE HOOK VOLA WRIST 4H WHV-4

Facility

$2,775.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,691.75
Rate for Payer: AlohaCare Medicaid	$1,387.50
Rate for Payer: AlohaCare Medicare	$2,109.00
Rate for Payer: Cash Price	$1,665.00
Rate for Payer: Devoted Health Medicare	$2,331.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,109.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,942.50
Rate for Payer: Health Management Network Commercial	$2,358.75
Rate for Payer: Humana Medicare	$2,109.00
Rate for Payer: Kaiser Permanente Commercial	$2,497.50
Rate for Payer: Kaiser Permanente Medicaid	$1,415.25
Rate for Payer: Kaiser Permanente Medicare	$2,109.00
Rate for Payer: MDX Hawaii PPO	$2,691.75
Rate for Payer: Ohana Health Plan Medicaid	$2,109.00
Rate for Payer: Ohana Health Plan Medicare	$2,109.00
Rate for Payer: UnitedHealthcare Medicare	$2,109.00
Rate for Payer: University Health Alliance Commercial	$1,554.00

PLATE HOOK VOLA WRIST 4H WHV-4

Facility

$2,775.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,554.00
Max. Negotiated Rate	$2,691.75
Rate for Payer: Cash Price	$1,665.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,942.50
Rate for Payer: Health Management Network Commercial	$2,358.75
Rate for Payer: Kaiser Permanente Commercial	$2,497.50
Rate for Payer: MDX Hawaii PPO	$2,691.75
Rate for Payer: University Health Alliance Commercial	$1,554.00

PLATE HOOK VOLA WRIST 6H WHV-6

Facility

$2,120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,060.00
Max. Negotiated Rate	$2,056.40
Rate for Payer: AlohaCare Medicaid	$1,060.00
Rate for Payer: AlohaCare Medicare	$1,611.20
Rate for Payer: Cash Price	$1,272.00
Rate for Payer: Devoted Health Medicare	$1,780.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,611.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,484.00
Rate for Payer: Health Management Network Commercial	$1,802.00
Rate for Payer: Humana Medicare	$1,611.20
Rate for Payer: Kaiser Permanente Commercial	$1,908.00
Rate for Payer: Kaiser Permanente Medicaid	$1,081.20
Rate for Payer: Kaiser Permanente Medicare	$1,611.20
Rate for Payer: MDX Hawaii PPO	$2,056.40
Rate for Payer: Ohana Health Plan Medicaid	$1,611.20
Rate for Payer: Ohana Health Plan Medicare	$1,611.20
Rate for Payer: UnitedHealthcare Medicare	$1,611.20
Rate for Payer: University Health Alliance Commercial	$1,187.20

PLATE HOOK VOLA WRIST 6H WHV-6

Facility

$2,120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,187.20
Max. Negotiated Rate	$2,056.40
Rate for Payer: Cash Price	$1,272.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,484.00
Rate for Payer: Health Management Network Commercial	$1,802.00
Rate for Payer: Kaiser Permanente Commercial	$1,908.00
Rate for Payer: MDX Hawaii PPO	$2,056.40
Rate for Payer: University Health Alliance Commercial	$1,187.20

PLATE HUMERAL 2.7MM

Facility

$2,749.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,374.50
Max. Negotiated Rate	$2,666.53
Rate for Payer: AlohaCare Medicaid	$1,374.50
Rate for Payer: AlohaCare Medicare	$2,089.24
Rate for Payer: Cash Price	$1,649.40
Rate for Payer: Devoted Health Medicare	$2,309.16
Rate for Payer: Hawaii Medical Service Association Medicare	$2,089.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.30
Rate for Payer: Health Management Network Commercial	$2,336.65
Rate for Payer: Humana Medicare	$2,089.24
Rate for Payer: Kaiser Permanente Commercial	$2,474.10
Rate for Payer: Kaiser Permanente Medicaid	$1,401.99
Rate for Payer: Kaiser Permanente Medicare	$2,089.24
Rate for Payer: MDX Hawaii PPO	$2,666.53
Rate for Payer: Ohana Health Plan Medicaid	$2,089.24
Rate for Payer: Ohana Health Plan Medicare	$2,089.24
Rate for Payer: UnitedHealthcare Medicare	$2,089.24
Rate for Payer: University Health Alliance Commercial	$1,539.44

PLATE HUMERAL 2.7MM

Facility

$2,749.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,539.44
Max. Negotiated Rate	$2,666.53
Rate for Payer: Cash Price	$1,649.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.30
Rate for Payer: Health Management Network Commercial	$2,336.65
Rate for Payer: Kaiser Permanente Commercial	$2,474.10
Rate for Payer: MDX Hawaii PPO	$2,666.53
Rate for Payer: University Health Alliance Commercial	$1,539.44

PLATE HUMERAL 3.5MM 241.919

Facility

$3,692.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,846.00
Max. Negotiated Rate	$3,581.24
Rate for Payer: AlohaCare Medicaid	$1,846.00
Rate for Payer: AlohaCare Medicare	$2,805.92
Rate for Payer: Cash Price	$2,215.20
Rate for Payer: Devoted Health Medicare	$3,101.28
Rate for Payer: Hawaii Medical Service Association Medicare	$2,805.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,584.40
Rate for Payer: Health Management Network Commercial	$3,138.20
Rate for Payer: Humana Medicare	$2,805.92
Rate for Payer: Kaiser Permanente Commercial	$3,322.80
Rate for Payer: Kaiser Permanente Medicaid	$1,882.92
Rate for Payer: Kaiser Permanente Medicare	$2,805.92
Rate for Payer: MDX Hawaii PPO	$3,581.24
Rate for Payer: Ohana Health Plan Medicaid	$2,805.92
Rate for Payer: Ohana Health Plan Medicare	$2,805.92
Rate for Payer: UnitedHealthcare Medicare	$2,805.92
Rate for Payer: University Health Alliance Commercial	$2,067.52

PLATE HUMERAL 3.5MM 241.919

Facility

$3,692.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,067.52
Max. Negotiated Rate	$3,581.24
Rate for Payer: Cash Price	$2,215.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,584.40
Rate for Payer: Health Management Network Commercial	$3,138.20
Rate for Payer: Kaiser Permanente Commercial	$3,322.80
Rate for Payer: MDX Hawaii PPO	$3,581.24
Rate for Payer: University Health Alliance Commercial	$2,067.52

PLATE HUMERAL PROXIMAL LF

Facility

$6,560.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,280.00
Max. Negotiated Rate	$6,363.20
Rate for Payer: AlohaCare Medicaid	$3,280.00
Rate for Payer: AlohaCare Medicare	$4,985.60
Rate for Payer: Cash Price	$3,936.00
Rate for Payer: Devoted Health Medicare	$5,510.40
Rate for Payer: Hawaii Medical Service Association Medicare	$4,985.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,592.00
Rate for Payer: Health Management Network Commercial	$5,576.00
Rate for Payer: Humana Medicare	$4,985.60
Rate for Payer: Kaiser Permanente Commercial	$5,904.00
Rate for Payer: Kaiser Permanente Medicaid	$3,345.60
Rate for Payer: Kaiser Permanente Medicare	$4,985.60
Rate for Payer: MDX Hawaii PPO	$6,363.20
Rate for Payer: Ohana Health Plan Medicaid	$4,985.60
Rate for Payer: Ohana Health Plan Medicare	$4,985.60
Rate for Payer: UnitedHealthcare Medicare	$4,985.60
Rate for Payer: University Health Alliance Commercial	$3,673.60

PLATE HUMERAL PROXIMAL LF

Facility

$6,560.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,673.60
Max. Negotiated Rate	$6,363.20
Rate for Payer: Cash Price	$3,936.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,592.00
Rate for Payer: Health Management Network Commercial	$5,576.00
Rate for Payer: Kaiser Permanente Commercial	$5,904.00
Rate for Payer: MDX Hawaii PPO	$6,363.20
Rate for Payer: University Health Alliance Commercial	$3,673.60

PLATE HUMERUS DIST 4H

Facility

$2,418.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,209.00
Max. Negotiated Rate	$2,345.46
Rate for Payer: AlohaCare Medicaid	$1,209.00
Rate for Payer: AlohaCare Medicare	$1,837.68
Rate for Payer: Cash Price	$1,450.80
Rate for Payer: Devoted Health Medicare	$2,031.12
Rate for Payer: Hawaii Medical Service Association Medicare	$1,837.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,692.60
Rate for Payer: Health Management Network Commercial	$2,055.30
Rate for Payer: Humana Medicare	$1,837.68
Rate for Payer: Kaiser Permanente Commercial	$2,176.20
Rate for Payer: Kaiser Permanente Medicaid	$1,233.18
Rate for Payer: Kaiser Permanente Medicare	$1,837.68
Rate for Payer: MDX Hawaii PPO	$2,345.46
Rate for Payer: Ohana Health Plan Medicaid	$1,837.68
Rate for Payer: Ohana Health Plan Medicare	$1,837.68
Rate for Payer: UnitedHealthcare Medicare	$1,837.68
Rate for Payer: University Health Alliance Commercial	$1,354.08

PLATE HUMERUS DIST 4H

Facility

$2,418.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,354.08
Max. Negotiated Rate	$2,345.46
Rate for Payer: Cash Price	$1,450.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,692.60
Rate for Payer: Health Management Network Commercial	$2,055.30
Rate for Payer: Kaiser Permanente Commercial	$2,176.20
Rate for Payer: MDX Hawaii PPO	$2,345.46
Rate for Payer: University Health Alliance Commercial	$1,354.08

Know your out-of-pocket cost for care.

All Charges