Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE KNOTLESS DIS AR-2658TR

Facility

$2,069.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,034.50
Max. Negotiated Rate	$2,006.93
Rate for Payer: AlohaCare Medicaid	$1,034.50
Rate for Payer: AlohaCare Medicare	$1,572.44
Rate for Payer: Cash Price	$1,241.40
Rate for Payer: Devoted Health Medicare	$1,737.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,572.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,448.30
Rate for Payer: Health Management Network Commercial	$1,758.65
Rate for Payer: Humana Medicare	$1,572.44
Rate for Payer: Kaiser Permanente Commercial	$1,862.10
Rate for Payer: Kaiser Permanente Medicaid	$1,055.19
Rate for Payer: Kaiser Permanente Medicare	$1,572.44
Rate for Payer: MDX Hawaii PPO	$2,006.93
Rate for Payer: Ohana Health Plan Medicaid	$1,572.44
Rate for Payer: Ohana Health Plan Medicare	$1,572.44
Rate for Payer: UnitedHealthcare Medicare	$1,572.44
Rate for Payer: University Health Alliance Commercial	$1,158.64

PLATE KNOTLESS DIS AR-2658TR

Facility

$2,069.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,158.64
Max. Negotiated Rate	$2,006.93
Rate for Payer: Cash Price	$1,241.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,448.30
Rate for Payer: Health Management Network Commercial	$1,758.65
Rate for Payer: Kaiser Permanente Commercial	$1,862.10
Rate for Payer: MDX Hawaii PPO	$2,006.93
Rate for Payer: University Health Alliance Commercial	$1,158.64

PLATE LAT DIS HUMER 02.117.901

Facility

$2,942.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,647.52
Max. Negotiated Rate	$2,853.74
Rate for Payer: Cash Price	$1,765.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,059.40
Rate for Payer: Health Management Network Commercial	$2,500.70
Rate for Payer: Kaiser Permanente Commercial	$2,647.80
Rate for Payer: MDX Hawaii PPO	$2,853.74
Rate for Payer: University Health Alliance Commercial	$1,647.52

PLATE LAT DIS HUMER 02.117.901

Facility

$2,942.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,471.00
Max. Negotiated Rate	$2,853.74
Rate for Payer: AlohaCare Medicaid	$1,471.00
Rate for Payer: AlohaCare Medicare	$2,235.92
Rate for Payer: Cash Price	$1,765.20
Rate for Payer: Devoted Health Medicare	$2,471.28
Rate for Payer: Hawaii Medical Service Association Medicare	$2,235.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,059.40
Rate for Payer: Health Management Network Commercial	$2,500.70
Rate for Payer: Humana Medicare	$2,235.92
Rate for Payer: Kaiser Permanente Commercial	$2,647.80
Rate for Payer: Kaiser Permanente Medicaid	$1,500.42
Rate for Payer: Kaiser Permanente Medicare	$2,235.92
Rate for Payer: MDX Hawaii PPO	$2,853.74
Rate for Payer: Ohana Health Plan Medicaid	$2,235.92
Rate for Payer: Ohana Health Plan Medicare	$2,235.92
Rate for Payer: UnitedHealthcare Medicare	$2,235.92
Rate for Payer: University Health Alliance Commercial	$1,647.52

PLATE LATERAL 6HOLE 2347-17-06

Facility

$1,633.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$914.48
Max. Negotiated Rate	$1,584.01
Rate for Payer: Cash Price	$979.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,143.10
Rate for Payer: Health Management Network Commercial	$1,388.05
Rate for Payer: Kaiser Permanente Commercial	$1,469.70
Rate for Payer: MDX Hawaii PPO	$1,584.01
Rate for Payer: University Health Alliance Commercial	$914.48

PLATE LATERAL 6HOLE 2347-17-06

Facility

$1,633.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$816.50
Max. Negotiated Rate	$1,584.01
Rate for Payer: Kaiser Permanente Medicare	$1,241.08
Rate for Payer: AlohaCare Medicaid	$816.50
Rate for Payer: AlohaCare Medicare	$1,241.08
Rate for Payer: Cash Price	$979.80
Rate for Payer: Devoted Health Medicare	$1,371.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,241.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,143.10
Rate for Payer: Health Management Network Commercial	$1,388.05
Rate for Payer: Humana Medicare	$1,241.08
Rate for Payer: Kaiser Permanente Commercial	$1,469.70
Rate for Payer: Kaiser Permanente Medicaid	$832.83
Rate for Payer: MDX Hawaii PPO	$1,584.01
Rate for Payer: Ohana Health Plan Medicaid	$1,241.08
Rate for Payer: Ohana Health Plan Medicare	$1,241.08
Rate for Payer: UnitedHealthcare Medicare	$1,241.08
Rate for Payer: University Health Alliance Commercial	$914.48

PLATE LATERAL 8HOLE 2347-18-08

Facility

$1,686.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$843.00
Max. Negotiated Rate	$1,635.42
Rate for Payer: AlohaCare Medicaid	$843.00
Rate for Payer: AlohaCare Medicare	$1,281.36
Rate for Payer: Cash Price	$1,011.60
Rate for Payer: Devoted Health Medicare	$1,416.24
Rate for Payer: Hawaii Medical Service Association Medicare	$1,281.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,180.20
Rate for Payer: Health Management Network Commercial	$1,433.10
Rate for Payer: Humana Medicare	$1,281.36
Rate for Payer: Kaiser Permanente Commercial	$1,517.40
Rate for Payer: Kaiser Permanente Medicaid	$859.86
Rate for Payer: Kaiser Permanente Medicare	$1,281.36
Rate for Payer: MDX Hawaii PPO	$1,635.42
Rate for Payer: Ohana Health Plan Medicaid	$1,281.36
Rate for Payer: Ohana Health Plan Medicare	$1,281.36
Rate for Payer: UnitedHealthcare Medicare	$1,281.36
Rate for Payer: University Health Alliance Commercial	$944.16

PLATE LATERAL 8HOLE 2347-18-08

Facility

$1,686.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$944.16
Max. Negotiated Rate	$1,635.42
Rate for Payer: Cash Price	$1,011.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,180.20
Rate for Payer: Health Management Network Commercial	$1,433.10
Rate for Payer: Kaiser Permanente Commercial	$1,517.40
Rate for Payer: MDX Hawaii PPO	$1,635.42
Rate for Payer: University Health Alliance Commercial	$944.16

PLATE LATERAL TIBIA 540304

Facility

$6,710.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,757.60
Max. Negotiated Rate	$6,508.70
Rate for Payer: Cash Price	$4,026.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,697.00
Rate for Payer: Health Management Network Commercial	$5,703.50
Rate for Payer: Kaiser Permanente Commercial	$6,039.00
Rate for Payer: MDX Hawaii PPO	$6,508.70
Rate for Payer: University Health Alliance Commercial	$3,757.60

PLATE LATERAL TIBIA 540304

Facility

$6,710.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,355.00
Max. Negotiated Rate	$6,508.70
Rate for Payer: AlohaCare Medicaid	$3,355.00
Rate for Payer: AlohaCare Medicare	$5,099.60
Rate for Payer: Cash Price	$4,026.00
Rate for Payer: Devoted Health Medicare	$5,636.40
Rate for Payer: Hawaii Medical Service Association Medicare	$5,099.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,697.00
Rate for Payer: Health Management Network Commercial	$5,703.50
Rate for Payer: Humana Medicare	$5,099.60
Rate for Payer: Kaiser Permanente Commercial	$6,039.00
Rate for Payer: Kaiser Permanente Medicaid	$3,422.10
Rate for Payer: Kaiser Permanente Medicare	$5,099.60
Rate for Payer: MDX Hawaii PPO	$6,508.70
Rate for Payer: Ohana Health Plan Medicaid	$5,099.60
Rate for Payer: Ohana Health Plan Medicare	$5,099.60
Rate for Payer: UnitedHealthcare Medicare	$5,099.60
Rate for Payer: University Health Alliance Commercial	$3,757.60

PLATE LCDCP 3.5/6H/77MM 223.56

Facility

$1,369.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$684.50
Max. Negotiated Rate	$1,327.93
Rate for Payer: AlohaCare Medicaid	$684.50
Rate for Payer: AlohaCare Medicare	$1,040.44
Rate for Payer: Cash Price	$821.40
Rate for Payer: Devoted Health Medicare	$1,149.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,040.44
Rate for Payer: Hawaii Western Management Group Commercial	$958.30
Rate for Payer: Health Management Network Commercial	$1,163.65
Rate for Payer: Humana Medicare	$1,040.44
Rate for Payer: Kaiser Permanente Commercial	$1,232.10
Rate for Payer: Kaiser Permanente Medicaid	$698.19
Rate for Payer: Kaiser Permanente Medicare	$1,040.44
Rate for Payer: MDX Hawaii PPO	$1,327.93
Rate for Payer: Ohana Health Plan Medicaid	$1,040.44
Rate for Payer: Ohana Health Plan Medicare	$1,040.44
Rate for Payer: UnitedHealthcare Medicare	$1,040.44
Rate for Payer: University Health Alliance Commercial	$766.64

PLATE LCDCP 3.5/6H/77MM 223.56

Facility

$1,369.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$766.64
Max. Negotiated Rate	$1,327.93
Rate for Payer: Cash Price	$821.40
Rate for Payer: Hawaii Western Management Group Commercial	$958.30
Rate for Payer: Health Management Network Commercial	$1,163.65
Rate for Payer: Kaiser Permanente Commercial	$1,232.10
Rate for Payer: MDX Hawaii PPO	$1,327.93
Rate for Payer: University Health Alliance Commercial	$766.64

PLATE LC-DCP 3.5MM/10-H 223.60

Facility

$1,594.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$892.64
Max. Negotiated Rate	$1,546.18
Rate for Payer: Cash Price	$956.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,115.80
Rate for Payer: Health Management Network Commercial	$1,354.90
Rate for Payer: Kaiser Permanente Commercial	$1,434.60
Rate for Payer: MDX Hawaii PPO	$1,546.18
Rate for Payer: University Health Alliance Commercial	$892.64

PLATE LC-DCP 3.5MM/10-H 223.60

Facility

$1,594.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$797.00
Max. Negotiated Rate	$1,546.18
Rate for Payer: AlohaCare Medicaid	$797.00
Rate for Payer: AlohaCare Medicare	$1,211.44
Rate for Payer: Cash Price	$956.40
Rate for Payer: Devoted Health Medicare	$1,338.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,211.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,115.80
Rate for Payer: Health Management Network Commercial	$1,354.90
Rate for Payer: Humana Medicare	$1,211.44
Rate for Payer: Kaiser Permanente Commercial	$1,434.60
Rate for Payer: Kaiser Permanente Medicaid	$812.94
Rate for Payer: Kaiser Permanente Medicare	$1,211.44
Rate for Payer: MDX Hawaii PPO	$1,546.18
Rate for Payer: Ohana Health Plan Medicaid	$1,211.44
Rate for Payer: Ohana Health Plan Medicare	$1,211.44
Rate for Payer: UnitedHealthcare Medicare	$1,211.44
Rate for Payer: University Health Alliance Commercial	$892.64

PLATE LC-DCP 3.5MM/8-HL 223.58

Facility

$1,495.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$747.50
Max. Negotiated Rate	$1,450.15
Rate for Payer: AlohaCare Medicaid	$747.50
Rate for Payer: AlohaCare Medicare	$1,136.20
Rate for Payer: Cash Price	$897.00
Rate for Payer: Devoted Health Medicare	$1,255.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,136.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,046.50
Rate for Payer: Health Management Network Commercial	$1,270.75
Rate for Payer: Humana Medicare	$1,136.20
Rate for Payer: Kaiser Permanente Commercial	$1,345.50
Rate for Payer: Kaiser Permanente Medicaid	$762.45
Rate for Payer: Kaiser Permanente Medicare	$1,136.20
Rate for Payer: MDX Hawaii PPO	$1,450.15
Rate for Payer: Ohana Health Plan Medicaid	$1,136.20
Rate for Payer: Ohana Health Plan Medicare	$1,136.20
Rate for Payer: UnitedHealthcare Medicare	$1,136.20
Rate for Payer: University Health Alliance Commercial	$837.20

PLATE LC-DCP 3.5MM/8-HL 223.58

Facility

$1,495.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$837.20
Max. Negotiated Rate	$1,450.15
Rate for Payer: Cash Price	$897.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,046.50
Rate for Payer: Health Management Network Commercial	$1,270.75
Rate for Payer: Kaiser Permanente Commercial	$1,345.50
Rate for Payer: MDX Hawaii PPO	$1,450.15
Rate for Payer: University Health Alliance Commercial	$837.20

PLATE LC-DCP 3.5MM/9-HL 223.59

Facility

$660.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$330.00
Max. Negotiated Rate	$640.20
Rate for Payer: AlohaCare Medicaid	$330.00
Rate for Payer: AlohaCare Medicare	$501.60
Rate for Payer: Cash Price	$396.00
Rate for Payer: Devoted Health Medicare	$554.40
Rate for Payer: Hawaii Medical Service Association Medicare	$501.60
Rate for Payer: Hawaii Western Management Group Commercial	$462.00
Rate for Payer: Health Management Network Commercial	$561.00
Rate for Payer: Humana Medicare	$501.60
Rate for Payer: Kaiser Permanente Commercial	$594.00
Rate for Payer: Kaiser Permanente Medicaid	$336.60
Rate for Payer: Kaiser Permanente Medicare	$501.60
Rate for Payer: MDX Hawaii PPO	$640.20
Rate for Payer: Ohana Health Plan Medicaid	$501.60
Rate for Payer: Ohana Health Plan Medicare	$501.60
Rate for Payer: UnitedHealthcare Medicare	$501.60
Rate for Payer: University Health Alliance Commercial	$369.60

PLATE LC-DCP 3.5MM/9-HL 223.59

Facility

$660.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$369.60
Max. Negotiated Rate	$640.20
Rate for Payer: Cash Price	$396.00
Rate for Payer: Hawaii Western Management Group Commercial	$462.00
Rate for Payer: Health Management Network Commercial	$561.00
Rate for Payer: Kaiser Permanente Commercial	$594.00
Rate for Payer: MDX Hawaii PPO	$640.20
Rate for Payer: University Health Alliance Commercial	$369.60

PLATE LCK 1.7MM 57-10395

Facility

$2,335.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,307.60
Max. Negotiated Rate	$2,264.95
Rate for Payer: Cash Price	$1,401.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,634.50
Rate for Payer: Health Management Network Commercial	$1,984.75
Rate for Payer: Kaiser Permanente Commercial	$2,101.50
Rate for Payer: MDX Hawaii PPO	$2,264.95
Rate for Payer: University Health Alliance Commercial	$1,307.60

PLATE LCK 1.7MM 57-10395

Facility

$2,335.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,167.50
Max. Negotiated Rate	$2,264.95
Rate for Payer: AlohaCare Medicaid	$1,167.50
Rate for Payer: AlohaCare Medicare	$1,774.60
Rate for Payer: Cash Price	$1,401.00
Rate for Payer: Devoted Health Medicare	$1,961.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,774.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,634.50
Rate for Payer: Health Management Network Commercial	$1,984.75
Rate for Payer: Humana Medicare	$1,774.60
Rate for Payer: Kaiser Permanente Commercial	$2,101.50
Rate for Payer: Kaiser Permanente Medicaid	$1,190.85
Rate for Payer: Kaiser Permanente Medicare	$1,774.60
Rate for Payer: MDX Hawaii PPO	$2,264.95
Rate for Payer: Ohana Health Plan Medicaid	$1,774.60
Rate for Payer: Ohana Health Plan Medicare	$1,774.60
Rate for Payer: UnitedHealthcare Medicare	$1,774.60
Rate for Payer: University Health Alliance Commercial	$1,307.60

PLATE LCK 2.7MM 6H

Facility

$2,614.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,307.00
Max. Negotiated Rate	$2,535.58
Rate for Payer: AlohaCare Medicaid	$1,307.00
Rate for Payer: AlohaCare Medicare	$1,986.64
Rate for Payer: Cash Price	$1,568.40
Rate for Payer: Devoted Health Medicare	$2,195.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,986.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,829.80
Rate for Payer: Health Management Network Commercial	$2,221.90
Rate for Payer: Humana Medicare	$1,986.64
Rate for Payer: Kaiser Permanente Commercial	$2,352.60
Rate for Payer: Kaiser Permanente Medicaid	$1,333.14
Rate for Payer: Kaiser Permanente Medicare	$1,986.64
Rate for Payer: MDX Hawaii PPO	$2,535.58
Rate for Payer: Ohana Health Plan Medicaid	$1,986.64
Rate for Payer: Ohana Health Plan Medicare	$1,986.64
Rate for Payer: UnitedHealthcare Medicare	$1,986.64
Rate for Payer: University Health Alliance Commercial	$1,463.84

PLATE LCK 2.7MM 6H

Facility

$2,614.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,463.84
Max. Negotiated Rate	$2,535.58
Rate for Payer: Cash Price	$1,568.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,829.80
Rate for Payer: Health Management Network Commercial	$2,221.90
Rate for Payer: Kaiser Permanente Commercial	$2,352.60
Rate for Payer: MDX Hawaii PPO	$2,535.58
Rate for Payer: University Health Alliance Commercial	$1,463.84

PLATE LCK 3RD TUB AR-8943T-06

Facility

$882.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$441.00
Max. Negotiated Rate	$855.54
Rate for Payer: AlohaCare Medicaid	$441.00
Rate for Payer: AlohaCare Medicare	$670.32
Rate for Payer: Cash Price	$529.20
Rate for Payer: Devoted Health Medicare	$740.88
Rate for Payer: Hawaii Medical Service Association Medicare	$670.32
Rate for Payer: Hawaii Western Management Group Commercial	$617.40
Rate for Payer: Health Management Network Commercial	$749.70
Rate for Payer: Humana Medicare	$670.32
Rate for Payer: Kaiser Permanente Commercial	$793.80
Rate for Payer: Kaiser Permanente Medicaid	$449.82
Rate for Payer: Kaiser Permanente Medicare	$670.32
Rate for Payer: MDX Hawaii PPO	$855.54
Rate for Payer: Ohana Health Plan Medicaid	$670.32
Rate for Payer: Ohana Health Plan Medicare	$670.32
Rate for Payer: UnitedHealthcare Medicare	$670.32
Rate for Payer: University Health Alliance Commercial	$493.92

PLATE LCK 3RD TUB AR-8943T-06

Facility

$882.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$493.92
Max. Negotiated Rate	$855.54
Rate for Payer: Cash Price	$529.20
Rate for Payer: Hawaii Western Management Group Commercial	$617.40
Rate for Payer: Health Management Network Commercial	$749.70
Rate for Payer: Kaiser Permanente Commercial	$793.80
Rate for Payer: MDX Hawaii PPO	$855.54
Rate for Payer: University Health Alliance Commercial	$493.92

PLATE LCK 4H NARRW 32MM 629724

Facility

$2,291.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,145.50
Max. Negotiated Rate	$2,222.27
Rate for Payer: AlohaCare Medicaid	$1,145.50
Rate for Payer: AlohaCare Medicare	$1,741.16
Rate for Payer: Cash Price	$1,374.60
Rate for Payer: Devoted Health Medicare	$1,924.44
Rate for Payer: Hawaii Medical Service Association Medicare	$1,741.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,603.70
Rate for Payer: Health Management Network Commercial	$1,947.35
Rate for Payer: Humana Medicare	$1,741.16
Rate for Payer: Kaiser Permanente Commercial	$2,061.90
Rate for Payer: Kaiser Permanente Medicaid	$1,168.41
Rate for Payer: Kaiser Permanente Medicare	$1,741.16
Rate for Payer: MDX Hawaii PPO	$2,222.27
Rate for Payer: Ohana Health Plan Medicaid	$1,741.16
Rate for Payer: Ohana Health Plan Medicare	$1,741.16
Rate for Payer: UnitedHealthcare Medicare	$1,741.16
Rate for Payer: University Health Alliance Commercial	$1,282.96

Know your out-of-pocket cost for care.

All Charges