Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE LCK 4H NARRW 32MM 629724

Facility

$2,291.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,282.96
Max. Negotiated Rate	$2,222.27
Rate for Payer: Cash Price	$1,374.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,603.70
Rate for Payer: Health Management Network Commercial	$1,947.35
Rate for Payer: Kaiser Permanente Commercial	$2,061.90
Rate for Payer: MDX Hawaii PPO	$2,222.27
Rate for Payer: University Health Alliance Commercial	$1,282.96

PLATE LCK DIST RT AR-8943DR-06

Facility

$2,520.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,411.20
Max. Negotiated Rate	$2,444.40
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,764.00
Rate for Payer: Health Management Network Commercial	$2,142.00
Rate for Payer: Kaiser Permanente Commercial	$2,268.00
Rate for Payer: MDX Hawaii PPO	$2,444.40
Rate for Payer: University Health Alliance Commercial	$1,411.20

PLATE LCK DIST RT AR-8943DR-06

Facility

$2,520.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,260.00
Max. Negotiated Rate	$2,444.40
Rate for Payer: AlohaCare Medicaid	$1,260.00
Rate for Payer: AlohaCare Medicare	$1,915.20
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Devoted Health Medicare	$2,116.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,915.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,764.00
Rate for Payer: Health Management Network Commercial	$2,142.00
Rate for Payer: Humana Medicare	$1,915.20
Rate for Payer: Kaiser Permanente Commercial	$2,268.00
Rate for Payer: Kaiser Permanente Medicaid	$1,285.20
Rate for Payer: Kaiser Permanente Medicare	$1,915.20
Rate for Payer: MDX Hawaii PPO	$2,444.40
Rate for Payer: Ohana Health Plan Medicaid	$1,915.20
Rate for Payer: Ohana Health Plan Medicare	$1,915.20
Rate for Payer: UnitedHealthcare Medicare	$1,915.20
Rate for Payer: University Health Alliance Commercial	$1,411.20

PLATE LCK ELBOW LT DIST 629248

Facility

$4,020.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,010.00
Max. Negotiated Rate	$3,899.40
Rate for Payer: AlohaCare Medicaid	$2,010.00
Rate for Payer: AlohaCare Medicare	$3,055.20
Rate for Payer: Cash Price	$2,412.00
Rate for Payer: Devoted Health Medicare	$3,376.80
Rate for Payer: Hawaii Medical Service Association Medicare	$3,055.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,814.00
Rate for Payer: Health Management Network Commercial	$3,417.00
Rate for Payer: Humana Medicare	$3,055.20
Rate for Payer: Kaiser Permanente Commercial	$3,618.00
Rate for Payer: Kaiser Permanente Medicaid	$2,050.20
Rate for Payer: Kaiser Permanente Medicare	$3,055.20
Rate for Payer: MDX Hawaii PPO	$3,899.40
Rate for Payer: Ohana Health Plan Medicaid	$3,055.20
Rate for Payer: Ohana Health Plan Medicare	$3,055.20
Rate for Payer: UnitedHealthcare Medicare	$3,055.20
Rate for Payer: University Health Alliance Commercial	$2,251.20

PLATE LCK ELBOW LT DIST 629248

Facility

$4,020.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,251.20
Max. Negotiated Rate	$3,899.40
Rate for Payer: Cash Price	$2,412.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,814.00
Rate for Payer: Health Management Network Commercial	$3,417.00
Rate for Payer: Kaiser Permanente Commercial	$3,618.00
Rate for Payer: MDX Hawaii PPO	$3,899.40
Rate for Payer: University Health Alliance Commercial	$2,251.20

PLATE LCK HOOK 3H AR-8943H-03

Facility

$2,599.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,455.44
Max. Negotiated Rate	$2,521.03
Rate for Payer: Cash Price	$1,559.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,819.30
Rate for Payer: Health Management Network Commercial	$2,209.15
Rate for Payer: Kaiser Permanente Commercial	$2,339.10
Rate for Payer: MDX Hawaii PPO	$2,521.03
Rate for Payer: University Health Alliance Commercial	$1,455.44

PLATE LCK HOOK 3H AR-8943H-03

Facility

$2,599.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,299.50
Max. Negotiated Rate	$2,521.03
Rate for Payer: AlohaCare Medicaid	$1,299.50
Rate for Payer: AlohaCare Medicare	$1,975.24
Rate for Payer: Cash Price	$1,559.40
Rate for Payer: Devoted Health Medicare	$2,183.16
Rate for Payer: Hawaii Medical Service Association Medicare	$1,975.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,819.30
Rate for Payer: Health Management Network Commercial	$2,209.15
Rate for Payer: Humana Medicare	$1,975.24
Rate for Payer: Kaiser Permanente Commercial	$2,339.10
Rate for Payer: Kaiser Permanente Medicaid	$1,325.49
Rate for Payer: Kaiser Permanente Medicare	$1,975.24
Rate for Payer: MDX Hawaii PPO	$2,521.03
Rate for Payer: Ohana Health Plan Medicaid	$1,975.24
Rate for Payer: Ohana Health Plan Medicare	$1,975.24
Rate for Payer: UnitedHealthcare Medicare	$1,975.24
Rate for Payer: University Health Alliance Commercial	$1,455.44

PLATE LCK HUMERAL LF 627208

Facility

$5,866.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,933.00
Max. Negotiated Rate	$5,690.02
Rate for Payer: AlohaCare Medicaid	$2,933.00
Rate for Payer: AlohaCare Medicare	$4,458.16
Rate for Payer: Cash Price	$3,519.60
Rate for Payer: Devoted Health Medicare	$4,927.44
Rate for Payer: Hawaii Medical Service Association Medicare	$4,458.16
Rate for Payer: Hawaii Western Management Group Commercial	$4,106.20
Rate for Payer: Health Management Network Commercial	$4,986.10
Rate for Payer: Humana Medicare	$4,458.16
Rate for Payer: Kaiser Permanente Commercial	$5,279.40
Rate for Payer: Kaiser Permanente Medicaid	$2,991.66
Rate for Payer: Kaiser Permanente Medicare	$4,458.16
Rate for Payer: MDX Hawaii PPO	$5,690.02
Rate for Payer: Ohana Health Plan Medicaid	$4,458.16
Rate for Payer: Ohana Health Plan Medicare	$4,458.16
Rate for Payer: UnitedHealthcare Medicare	$4,458.16
Rate for Payer: University Health Alliance Commercial	$3,284.96

PLATE LCK HUMERAL LF 627208

Facility

$5,866.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,284.96
Max. Negotiated Rate	$5,690.02
Rate for Payer: Cash Price	$3,519.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,106.20
Rate for Payer: Health Management Network Commercial	$4,986.10
Rate for Payer: Kaiser Permanente Commercial	$5,279.40
Rate for Payer: MDX Hawaii PPO	$5,690.02
Rate for Payer: University Health Alliance Commercial	$3,284.96

PLATE LCKIGN 3.5, 7 HOLE

Facility

$774.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$433.44
Max. Negotiated Rate	$750.78
Rate for Payer: Cash Price	$464.40
Rate for Payer: Hawaii Western Management Group Commercial	$541.80
Rate for Payer: Health Management Network Commercial	$657.90
Rate for Payer: Kaiser Permanente Commercial	$696.60
Rate for Payer: MDX Hawaii PPO	$750.78
Rate for Payer: University Health Alliance Commercial	$433.44

PLATE LCKIGN 3.5, 7 HOLE

Facility

$774.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$387.00
Max. Negotiated Rate	$750.78
Rate for Payer: AlohaCare Medicaid	$387.00
Rate for Payer: AlohaCare Medicare	$588.24
Rate for Payer: Cash Price	$464.40
Rate for Payer: Devoted Health Medicare	$650.16
Rate for Payer: Hawaii Medical Service Association Medicare	$588.24
Rate for Payer: Hawaii Western Management Group Commercial	$541.80
Rate for Payer: Health Management Network Commercial	$657.90
Rate for Payer: Humana Medicare	$588.24
Rate for Payer: Kaiser Permanente Commercial	$696.60
Rate for Payer: Kaiser Permanente Medicaid	$394.74
Rate for Payer: Kaiser Permanente Medicare	$588.24
Rate for Payer: MDX Hawaii PPO	$750.78
Rate for Payer: Ohana Health Plan Medicaid	$588.24
Rate for Payer: Ohana Health Plan Medicare	$588.24
Rate for Payer: UnitedHealthcare Medicare	$588.24
Rate for Payer: University Health Alliance Commercial	$433.44

PLATE LCKING COUNTOUR DUAL 3.5

Facility

$1,535.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$767.50
Max. Negotiated Rate	$1,488.95
Rate for Payer: AlohaCare Medicaid	$767.50
Rate for Payer: AlohaCare Medicare	$1,166.60
Rate for Payer: Cash Price	$921.00
Rate for Payer: Devoted Health Medicare	$1,289.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,166.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,074.50
Rate for Payer: Health Management Network Commercial	$1,304.75
Rate for Payer: Humana Medicare	$1,166.60
Rate for Payer: Kaiser Permanente Commercial	$1,381.50
Rate for Payer: Kaiser Permanente Medicaid	$782.85
Rate for Payer: Kaiser Permanente Medicare	$1,166.60
Rate for Payer: MDX Hawaii PPO	$1,488.95
Rate for Payer: Ohana Health Plan Medicaid	$1,166.60
Rate for Payer: Ohana Health Plan Medicare	$1,166.60
Rate for Payer: UnitedHealthcare Medicare	$1,166.60
Rate for Payer: University Health Alliance Commercial	$859.60

PLATE LCKING COUNTOUR DUAL 3.5

Facility

$1,535.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$859.60
Max. Negotiated Rate	$1,488.95
Rate for Payer: Cash Price	$921.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,074.50
Rate for Payer: Health Management Network Commercial	$1,304.75
Rate for Payer: Kaiser Permanente Commercial	$1,381.50
Rate for Payer: MDX Hawaii PPO	$1,488.95
Rate for Payer: University Health Alliance Commercial	$859.60

PLATE LCKING DUAL COMPRESS 3.5

Facility

$1,488.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$833.28
Max. Negotiated Rate	$1,443.36
Rate for Payer: Cash Price	$892.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,041.60
Rate for Payer: Health Management Network Commercial	$1,264.80
Rate for Payer: Kaiser Permanente Commercial	$1,339.20
Rate for Payer: MDX Hawaii PPO	$1,443.36
Rate for Payer: University Health Alliance Commercial	$833.28

PLATE LCKING DUAL COMPRESS 3.5

Facility

$1,488.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$744.00
Max. Negotiated Rate	$1,443.36
Rate for Payer: AlohaCare Medicaid	$744.00
Rate for Payer: AlohaCare Medicare	$1,130.88
Rate for Payer: Cash Price	$892.80
Rate for Payer: Devoted Health Medicare	$1,249.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,130.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,041.60
Rate for Payer: Health Management Network Commercial	$1,264.80
Rate for Payer: Humana Medicare	$1,130.88
Rate for Payer: Kaiser Permanente Commercial	$1,339.20
Rate for Payer: Kaiser Permanente Medicaid	$758.88
Rate for Payer: Kaiser Permanente Medicare	$1,130.88
Rate for Payer: MDX Hawaii PPO	$1,443.36
Rate for Payer: Ohana Health Plan Medicaid	$1,130.88
Rate for Payer: Ohana Health Plan Medicare	$1,130.88
Rate for Payer: UnitedHealthcare Medicare	$1,130.88
Rate for Payer: University Health Alliance Commercial	$833.28

PLATE LCK LAT HK AR-8943TH-03

Facility

$2,205.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,102.50
Max. Negotiated Rate	$2,138.85
Rate for Payer: AlohaCare Medicaid	$1,102.50
Rate for Payer: AlohaCare Medicare	$1,675.80
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Devoted Health Medicare	$1,852.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,675.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,543.50
Rate for Payer: Health Management Network Commercial	$1,874.25
Rate for Payer: Humana Medicare	$1,675.80
Rate for Payer: Kaiser Permanente Commercial	$1,984.50
Rate for Payer: Kaiser Permanente Medicaid	$1,124.55
Rate for Payer: Kaiser Permanente Medicare	$1,675.80
Rate for Payer: MDX Hawaii PPO	$2,138.85
Rate for Payer: Ohana Health Plan Medicaid	$1,675.80
Rate for Payer: Ohana Health Plan Medicare	$1,675.80
Rate for Payer: UnitedHealthcare Medicare	$1,675.80
Rate for Payer: University Health Alliance Commercial	$1,234.80

PLATE LCK LAT HK AR-8943TH-03

Facility

$2,205.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,234.80
Max. Negotiated Rate	$2,138.85
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,543.50
Rate for Payer: Health Management Network Commercial	$1,874.25
Rate for Payer: Kaiser Permanente Commercial	$1,984.50
Rate for Payer: MDX Hawaii PPO	$2,138.85
Rate for Payer: University Health Alliance Commercial	$1,234.80

PLATE LCKNG 2.3MM 3D 57-15392

Facility

$2,476.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,238.00
Max. Negotiated Rate	$2,401.72
Rate for Payer: AlohaCare Medicaid	$1,238.00
Rate for Payer: AlohaCare Medicare	$1,881.76
Rate for Payer: Cash Price	$1,485.60
Rate for Payer: Devoted Health Medicare	$2,079.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,881.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,733.20
Rate for Payer: Health Management Network Commercial	$2,104.60
Rate for Payer: Humana Medicare	$1,881.76
Rate for Payer: Kaiser Permanente Commercial	$2,228.40
Rate for Payer: Kaiser Permanente Medicaid	$1,262.76
Rate for Payer: Kaiser Permanente Medicare	$1,881.76
Rate for Payer: MDX Hawaii PPO	$2,401.72
Rate for Payer: Ohana Health Plan Medicaid	$1,881.76
Rate for Payer: Ohana Health Plan Medicare	$1,881.76
Rate for Payer: UnitedHealthcare Medicare	$1,881.76
Rate for Payer: University Health Alliance Commercial	$1,386.56

PLATE LCKNG 2.3MM 3D 57-15392

Facility

$2,476.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,386.56
Max. Negotiated Rate	$2,401.72
Rate for Payer: Cash Price	$1,485.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,733.20
Rate for Payer: Health Management Network Commercial	$2,104.60
Rate for Payer: Kaiser Permanente Commercial	$2,228.40
Rate for Payer: MDX Hawaii PPO	$2,401.72
Rate for Payer: University Health Alliance Commercial	$1,386.56

PLATE LCK RT 3 HOLE 627233

Facility

$5,084.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,847.04
Max. Negotiated Rate	$4,931.48
Rate for Payer: Cash Price	$3,050.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,558.80
Rate for Payer: Health Management Network Commercial	$4,321.40
Rate for Payer: Kaiser Permanente Commercial	$4,575.60
Rate for Payer: MDX Hawaii PPO	$4,931.48
Rate for Payer: University Health Alliance Commercial	$2,847.04

PLATE LCK RT 3 HOLE 627233

Facility

$5,084.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,542.00
Max. Negotiated Rate	$4,931.48
Rate for Payer: AlohaCare Medicaid	$2,542.00
Rate for Payer: AlohaCare Medicare	$3,863.84
Rate for Payer: Cash Price	$3,050.40
Rate for Payer: Devoted Health Medicare	$4,270.56
Rate for Payer: Hawaii Medical Service Association Medicare	$3,863.84
Rate for Payer: Hawaii Western Management Group Commercial	$3,558.80
Rate for Payer: Health Management Network Commercial	$4,321.40
Rate for Payer: Humana Medicare	$3,863.84
Rate for Payer: Kaiser Permanente Commercial	$4,575.60
Rate for Payer: Kaiser Permanente Medicaid	$2,592.84
Rate for Payer: Kaiser Permanente Medicare	$3,863.84
Rate for Payer: MDX Hawaii PPO	$4,931.48
Rate for Payer: Ohana Health Plan Medicaid	$3,863.84
Rate for Payer: Ohana Health Plan Medicare	$3,863.84
Rate for Payer: UnitedHealthcare Medicare	$3,863.84
Rate for Payer: University Health Alliance Commercial	$2,847.04

PLATE LCK ST 10H AR-8943C-10

Facility

$1,874.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,049.44
Max. Negotiated Rate	$1,817.78
Rate for Payer: Cash Price	$1,124.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,311.80
Rate for Payer: Health Management Network Commercial	$1,592.90
Rate for Payer: Kaiser Permanente Commercial	$1,686.60
Rate for Payer: MDX Hawaii PPO	$1,817.78
Rate for Payer: University Health Alliance Commercial	$1,049.44

PLATE LCK ST 10H AR-8943C-10

Facility

$1,874.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$937.00
Max. Negotiated Rate	$1,817.78
Rate for Payer: AlohaCare Medicaid	$937.00
Rate for Payer: AlohaCare Medicare	$1,424.24
Rate for Payer: Cash Price	$1,124.40
Rate for Payer: Devoted Health Medicare	$1,574.16
Rate for Payer: Hawaii Medical Service Association Medicare	$1,424.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,311.80
Rate for Payer: Health Management Network Commercial	$1,592.90
Rate for Payer: Humana Medicare	$1,424.24
Rate for Payer: Kaiser Permanente Commercial	$1,686.60
Rate for Payer: Kaiser Permanente Medicaid	$955.74
Rate for Payer: Kaiser Permanente Medicare	$1,424.24
Rate for Payer: MDX Hawaii PPO	$1,817.78
Rate for Payer: Ohana Health Plan Medicaid	$1,424.24
Rate for Payer: Ohana Health Plan Medicare	$1,424.24
Rate for Payer: UnitedHealthcare Medicare	$1,424.24
Rate for Payer: University Health Alliance Commercial	$1,049.44

PLATE LCK STR 7H AR-8943C-06

Facility

$1,746.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$873.00
Max. Negotiated Rate	$1,693.62
Rate for Payer: AlohaCare Medicaid	$873.00
Rate for Payer: AlohaCare Medicare	$1,326.96
Rate for Payer: Cash Price	$1,047.60
Rate for Payer: Devoted Health Medicare	$1,466.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,326.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,222.20
Rate for Payer: Health Management Network Commercial	$1,484.10
Rate for Payer: Humana Medicare	$1,326.96
Rate for Payer: Kaiser Permanente Commercial	$1,571.40
Rate for Payer: Kaiser Permanente Medicaid	$890.46
Rate for Payer: Kaiser Permanente Medicare	$1,326.96
Rate for Payer: MDX Hawaii PPO	$1,693.62
Rate for Payer: Ohana Health Plan Medicaid	$1,326.96
Rate for Payer: Ohana Health Plan Medicare	$1,326.96
Rate for Payer: UnitedHealthcare Medicare	$1,326.96
Rate for Payer: University Health Alliance Commercial	$977.76

PLATE LCK STR 7H AR-8943C-06

Facility

$1,746.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$977.76
Max. Negotiated Rate	$1,693.62
Rate for Payer: Cash Price	$1,047.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,222.20
Rate for Payer: Health Management Network Commercial	$1,484.10
Rate for Payer: Kaiser Permanente Commercial	$1,571.40
Rate for Payer: MDX Hawaii PPO	$1,693.62
Rate for Payer: University Health Alliance Commercial	$977.76

Know your out-of-pocket cost for care.

All Charges