Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE LCK STR 8H AR-8943C-08

Facility

$1,650.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,600.50
Rate for Payer: AlohaCare Medicaid	$825.00
Rate for Payer: AlohaCare Medicare	$1,254.00
Rate for Payer: Cash Price	$990.00
Rate for Payer: Devoted Health Medicare	$1,386.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,254.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,155.00
Rate for Payer: Health Management Network Commercial	$1,402.50
Rate for Payer: Humana Medicare	$1,254.00
Rate for Payer: Kaiser Permanente Commercial	$1,485.00
Rate for Payer: Kaiser Permanente Medicaid	$841.50
Rate for Payer: Kaiser Permanente Medicare	$1,254.00
Rate for Payer: MDX Hawaii PPO	$1,600.50
Rate for Payer: Ohana Health Plan Medicaid	$1,254.00
Rate for Payer: Ohana Health Plan Medicare	$1,254.00
Rate for Payer: UnitedHealthcare Medicare	$1,254.00
Rate for Payer: University Health Alliance Commercial	$924.00

PLATE LCK STR 8H AR-8943C-08

Facility

$1,650.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$924.00
Max. Negotiated Rate	$1,600.50
Rate for Payer: Cash Price	$990.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,155.00
Rate for Payer: Health Management Network Commercial	$1,402.50
Rate for Payer: Kaiser Permanente Commercial	$1,485.00
Rate for Payer: MDX Hawaii PPO	$1,600.50
Rate for Payer: University Health Alliance Commercial	$924.00

PLATE LCK THIRD 4H AR-8943T-04

Facility

$886.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$496.16
Max. Negotiated Rate	$859.42
Rate for Payer: Cash Price	$531.60
Rate for Payer: Hawaii Western Management Group Commercial	$620.20
Rate for Payer: Health Management Network Commercial	$753.10
Rate for Payer: Kaiser Permanente Commercial	$797.40
Rate for Payer: MDX Hawaii PPO	$859.42
Rate for Payer: University Health Alliance Commercial	$496.16

PLATE LCK THIRD 4H AR-8943T-04

Facility

$886.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$443.00
Max. Negotiated Rate	$859.42
Rate for Payer: AlohaCare Medicaid	$443.00
Rate for Payer: AlohaCare Medicare	$673.36
Rate for Payer: Cash Price	$531.60
Rate for Payer: Devoted Health Medicare	$744.24
Rate for Payer: Hawaii Medical Service Association Medicare	$673.36
Rate for Payer: Hawaii Western Management Group Commercial	$620.20
Rate for Payer: Health Management Network Commercial	$753.10
Rate for Payer: Humana Medicare	$673.36
Rate for Payer: Kaiser Permanente Commercial	$797.40
Rate for Payer: Kaiser Permanente Medicaid	$451.86
Rate for Payer: Kaiser Permanente Medicare	$673.36
Rate for Payer: MDX Hawaii PPO	$859.42
Rate for Payer: Ohana Health Plan Medicaid	$673.36
Rate for Payer: Ohana Health Plan Medicare	$673.36
Rate for Payer: UnitedHealthcare Medicare	$673.36
Rate for Payer: University Health Alliance Commercial	$496.16

PLATE LCK TIBIAL LF 5H 627705

Facility

$4,456.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,495.36
Max. Negotiated Rate	$4,322.32
Rate for Payer: Cash Price	$2,673.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,119.20
Rate for Payer: Health Management Network Commercial	$3,787.60
Rate for Payer: Kaiser Permanente Commercial	$4,010.40
Rate for Payer: MDX Hawaii PPO	$4,322.32
Rate for Payer: University Health Alliance Commercial	$2,495.36

PLATE LCK TIBIAL LF 5H 627705

Facility

$4,456.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,228.00
Max. Negotiated Rate	$4,322.32
Rate for Payer: AlohaCare Medicaid	$2,228.00
Rate for Payer: AlohaCare Medicare	$3,386.56
Rate for Payer: Cash Price	$2,673.60
Rate for Payer: Devoted Health Medicare	$3,743.04
Rate for Payer: Hawaii Medical Service Association Medicare	$3,386.56
Rate for Payer: Hawaii Western Management Group Commercial	$3,119.20
Rate for Payer: Health Management Network Commercial	$3,787.60
Rate for Payer: Humana Medicare	$3,386.56
Rate for Payer: Kaiser Permanente Commercial	$4,010.40
Rate for Payer: Kaiser Permanente Medicaid	$2,272.56
Rate for Payer: Kaiser Permanente Medicare	$3,386.56
Rate for Payer: MDX Hawaii PPO	$4,322.32
Rate for Payer: Ohana Health Plan Medicaid	$3,386.56
Rate for Payer: Ohana Health Plan Medicare	$3,386.56
Rate for Payer: UnitedHealthcare Medicare	$3,386.56
Rate for Payer: University Health Alliance Commercial	$2,495.36

PLATE LCK TIBIAL RT 2H 627332

Facility

$4,894.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,740.64
Max. Negotiated Rate	$4,747.18
Rate for Payer: Cash Price	$2,936.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,425.80
Rate for Payer: Health Management Network Commercial	$4,159.90
Rate for Payer: Kaiser Permanente Commercial	$4,404.60
Rate for Payer: MDX Hawaii PPO	$4,747.18
Rate for Payer: University Health Alliance Commercial	$2,740.64

PLATE LCK TIBIAL RT 2H 627332

Facility

$4,894.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,447.00
Max. Negotiated Rate	$4,747.18
Rate for Payer: AlohaCare Medicaid	$2,447.00
Rate for Payer: AlohaCare Medicare	$3,719.44
Rate for Payer: Cash Price	$2,936.40
Rate for Payer: Devoted Health Medicare	$4,110.96
Rate for Payer: Hawaii Medical Service Association Medicare	$3,719.44
Rate for Payer: Hawaii Western Management Group Commercial	$3,425.80
Rate for Payer: Health Management Network Commercial	$4,159.90
Rate for Payer: Humana Medicare	$3,719.44
Rate for Payer: Kaiser Permanente Commercial	$4,404.60
Rate for Payer: Kaiser Permanente Medicaid	$2,495.94
Rate for Payer: Kaiser Permanente Medicare	$3,719.44
Rate for Payer: MDX Hawaii PPO	$4,747.18
Rate for Payer: Ohana Health Plan Medicaid	$3,719.44
Rate for Payer: Ohana Health Plan Medicare	$3,719.44
Rate for Payer: UnitedHealthcare Medicare	$3,719.44
Rate for Payer: University Health Alliance Commercial	$2,740.64

PLATE LCK TIB LT DIST 627412

Facility

$3,890.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,178.40
Max. Negotiated Rate	$3,773.30
Rate for Payer: Cash Price	$2,334.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,723.00
Rate for Payer: Health Management Network Commercial	$3,306.50
Rate for Payer: Kaiser Permanente Commercial	$3,501.00
Rate for Payer: MDX Hawaii PPO	$3,773.30
Rate for Payer: University Health Alliance Commercial	$2,178.40

PLATE LCK TIB LT DIST 627412

Facility

$3,890.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,945.00
Max. Negotiated Rate	$3,773.30
Rate for Payer: AlohaCare Medicaid	$1,945.00
Rate for Payer: AlohaCare Medicare	$2,956.40
Rate for Payer: Cash Price	$2,334.00
Rate for Payer: Devoted Health Medicare	$3,267.60
Rate for Payer: Hawaii Medical Service Association Medicare	$2,956.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,723.00
Rate for Payer: Health Management Network Commercial	$3,306.50
Rate for Payer: Humana Medicare	$2,956.40
Rate for Payer: Kaiser Permanente Commercial	$3,501.00
Rate for Payer: Kaiser Permanente Medicaid	$1,983.90
Rate for Payer: Kaiser Permanente Medicare	$2,956.40
Rate for Payer: MDX Hawaii PPO	$3,773.30
Rate for Payer: Ohana Health Plan Medicaid	$2,956.40
Rate for Payer: Ohana Health Plan Medicare	$2,956.40
Rate for Payer: UnitedHealthcare Medicare	$2,956.40
Rate for Payer: University Health Alliance Commercial	$2,178.40

PLATE LCK TUBU 10H AR-8943T-10

Facility

$1,029.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$576.24
Max. Negotiated Rate	$998.13
Rate for Payer: Cash Price	$617.40
Rate for Payer: Hawaii Western Management Group Commercial	$720.30
Rate for Payer: Health Management Network Commercial	$874.65
Rate for Payer: Kaiser Permanente Commercial	$926.10
Rate for Payer: MDX Hawaii PPO	$998.13
Rate for Payer: University Health Alliance Commercial	$576.24

PLATE LCK TUBU 10H AR-8943T-10

Facility

$1,029.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$514.50
Max. Negotiated Rate	$998.13
Rate for Payer: AlohaCare Medicaid	$514.50
Rate for Payer: AlohaCare Medicare	$782.04
Rate for Payer: Cash Price	$617.40
Rate for Payer: Devoted Health Medicare	$864.36
Rate for Payer: Hawaii Medical Service Association Medicare	$782.04
Rate for Payer: Hawaii Western Management Group Commercial	$720.30
Rate for Payer: Health Management Network Commercial	$874.65
Rate for Payer: Humana Medicare	$782.04
Rate for Payer: Kaiser Permanente Commercial	$926.10
Rate for Payer: Kaiser Permanente Medicaid	$524.79
Rate for Payer: Kaiser Permanente Medicare	$782.04
Rate for Payer: MDX Hawaii PPO	$998.13
Rate for Payer: Ohana Health Plan Medicaid	$782.04
Rate for Payer: Ohana Health Plan Medicare	$782.04
Rate for Payer: UnitedHealthcare Medicare	$782.04
Rate for Payer: University Health Alliance Commercial	$576.24

PLATE LCK TUBUL 5H AR-8943T-05

Facility

$925.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$518.00
Max. Negotiated Rate	$897.25
Rate for Payer: Cash Price	$555.00
Rate for Payer: Hawaii Western Management Group Commercial	$647.50
Rate for Payer: Health Management Network Commercial	$786.25
Rate for Payer: Kaiser Permanente Commercial	$832.50
Rate for Payer: MDX Hawaii PPO	$897.25
Rate for Payer: University Health Alliance Commercial	$518.00

PLATE LCK TUBUL 5H AR-8943T-05

Facility

$925.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$462.50
Max. Negotiated Rate	$897.25
Rate for Payer: AlohaCare Medicaid	$462.50
Rate for Payer: AlohaCare Medicare	$703.00
Rate for Payer: Cash Price	$555.00
Rate for Payer: Devoted Health Medicare	$777.00
Rate for Payer: Hawaii Medical Service Association Medicare	$703.00
Rate for Payer: Hawaii Western Management Group Commercial	$647.50
Rate for Payer: Health Management Network Commercial	$786.25
Rate for Payer: Humana Medicare	$703.00
Rate for Payer: Kaiser Permanente Commercial	$832.50
Rate for Payer: Kaiser Permanente Medicaid	$471.75
Rate for Payer: Kaiser Permanente Medicare	$703.00
Rate for Payer: MDX Hawaii PPO	$897.25
Rate for Payer: Ohana Health Plan Medicaid	$703.00
Rate for Payer: Ohana Health Plan Medicare	$703.00
Rate for Payer: UnitedHealthcare Medicare	$703.00
Rate for Payer: University Health Alliance Commercial	$518.00

PLATE LCP 10H 3.5X159 #239.940

Facility

$4,952.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,773.12
Max. Negotiated Rate	$4,803.44
Rate for Payer: Cash Price	$2,971.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,466.40
Rate for Payer: Health Management Network Commercial	$4,209.20
Rate for Payer: Kaiser Permanente Commercial	$4,456.80
Rate for Payer: MDX Hawaii PPO	$4,803.44
Rate for Payer: University Health Alliance Commercial	$2,773.12

PLATE LCP 10H 3.5X159 #239.940

Facility

$4,952.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,476.00
Max. Negotiated Rate	$4,803.44
Rate for Payer: AlohaCare Medicaid	$2,476.00
Rate for Payer: AlohaCare Medicare	$3,763.52
Rate for Payer: Cash Price	$2,971.20
Rate for Payer: Devoted Health Medicare	$4,159.68
Rate for Payer: Hawaii Medical Service Association Medicare	$3,763.52
Rate for Payer: Hawaii Western Management Group Commercial	$3,466.40
Rate for Payer: Health Management Network Commercial	$4,209.20
Rate for Payer: Humana Medicare	$3,763.52
Rate for Payer: Kaiser Permanente Commercial	$4,456.80
Rate for Payer: Kaiser Permanente Medicaid	$2,525.52
Rate for Payer: Kaiser Permanente Medicare	$3,763.52
Rate for Payer: MDX Hawaii PPO	$4,803.44
Rate for Payer: Ohana Health Plan Medicaid	$3,763.52
Rate for Payer: Ohana Health Plan Medicare	$3,763.52
Rate for Payer: UnitedHealthcare Medicare	$3,763.52
Rate for Payer: University Health Alliance Commercial	$2,773.12

PLATE LCP 10H 3.5X159 #239.941

Facility

$4,628.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,591.68
Max. Negotiated Rate	$4,489.16
Rate for Payer: Cash Price	$2,776.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,239.60
Rate for Payer: Health Management Network Commercial	$3,933.80
Rate for Payer: Kaiser Permanente Commercial	$4,165.20
Rate for Payer: MDX Hawaii PPO	$4,489.16
Rate for Payer: University Health Alliance Commercial	$2,591.68

PLATE LCP 10H 3.5X159 #239.941

Facility

$4,628.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,314.00
Max. Negotiated Rate	$4,489.16
Rate for Payer: AlohaCare Medicaid	$2,314.00
Rate for Payer: AlohaCare Medicare	$3,517.28
Rate for Payer: Cash Price	$2,776.80
Rate for Payer: Devoted Health Medicare	$3,887.52
Rate for Payer: Hawaii Medical Service Association Medicare	$3,517.28
Rate for Payer: Hawaii Western Management Group Commercial	$3,239.60
Rate for Payer: Health Management Network Commercial	$3,933.80
Rate for Payer: Humana Medicare	$3,517.28
Rate for Payer: Kaiser Permanente Commercial	$4,165.20
Rate for Payer: Kaiser Permanente Medicaid	$2,360.28
Rate for Payer: Kaiser Permanente Medicare	$3,517.28
Rate for Payer: MDX Hawaii PPO	$4,489.16
Rate for Payer: Ohana Health Plan Medicaid	$3,517.28
Rate for Payer: Ohana Health Plan Medicare	$3,517.28
Rate for Payer: UnitedHealthcare Medicare	$3,517.28
Rate for Payer: University Health Alliance Commercial	$2,591.68

PLATE LCP 12H 3.5X185 #239.942

Facility

$3,462.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,731.00
Max. Negotiated Rate	$3,358.14
Rate for Payer: AlohaCare Medicaid	$1,731.00
Rate for Payer: AlohaCare Medicare	$2,631.12
Rate for Payer: Cash Price	$2,077.20
Rate for Payer: Devoted Health Medicare	$2,908.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,631.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,423.40
Rate for Payer: Health Management Network Commercial	$2,942.70
Rate for Payer: Humana Medicare	$2,631.12
Rate for Payer: Kaiser Permanente Commercial	$3,115.80
Rate for Payer: Kaiser Permanente Medicaid	$1,765.62
Rate for Payer: Kaiser Permanente Medicare	$2,631.12
Rate for Payer: MDX Hawaii PPO	$3,358.14
Rate for Payer: Ohana Health Plan Medicaid	$2,631.12
Rate for Payer: Ohana Health Plan Medicare	$2,631.12
Rate for Payer: UnitedHealthcare Medicare	$2,631.12
Rate for Payer: University Health Alliance Commercial	$1,938.72

PLATE LCP 12H 3.5X185 #239.942

Facility

$3,462.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,938.72
Max. Negotiated Rate	$3,358.14
Rate for Payer: Cash Price	$2,077.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,423.40
Rate for Payer: Health Management Network Commercial	$2,942.70
Rate for Payer: Kaiser Permanente Commercial	$3,115.80
Rate for Payer: MDX Hawaii PPO	$3,358.14
Rate for Payer: University Health Alliance Commercial	$1,938.72

PLATE LCP 12H 3.5X185 #239.943

Facility

$3,462.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,731.00
Max. Negotiated Rate	$3,358.14
Rate for Payer: AlohaCare Medicaid	$1,731.00
Rate for Payer: AlohaCare Medicare	$2,631.12
Rate for Payer: Cash Price	$2,077.20
Rate for Payer: Devoted Health Medicare	$2,908.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,631.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,423.40
Rate for Payer: Health Management Network Commercial	$2,942.70
Rate for Payer: Humana Medicare	$2,631.12
Rate for Payer: Kaiser Permanente Commercial	$3,115.80
Rate for Payer: Kaiser Permanente Medicaid	$1,765.62
Rate for Payer: Kaiser Permanente Medicare	$2,631.12
Rate for Payer: MDX Hawaii PPO	$3,358.14
Rate for Payer: Ohana Health Plan Medicaid	$2,631.12
Rate for Payer: Ohana Health Plan Medicare	$2,631.12
Rate for Payer: UnitedHealthcare Medicare	$2,631.12
Rate for Payer: University Health Alliance Commercial	$1,938.72

PLATE LCP 12H 3.5X185 #239.943

Facility

$3,462.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,938.72
Max. Negotiated Rate	$3,358.14
Rate for Payer: Cash Price	$2,077.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,423.40
Rate for Payer: Health Management Network Commercial	$2,942.70
Rate for Payer: Kaiser Permanente Commercial	$3,115.80
Rate for Payer: MDX Hawaii PPO	$3,358.14
Rate for Payer: University Health Alliance Commercial	$1,938.72

PLATE LCP 14H 3.5X211 #239.944

Facility

$4,738.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,653.28
Max. Negotiated Rate	$4,595.86
Rate for Payer: Cash Price	$2,842.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,316.60
Rate for Payer: Health Management Network Commercial	$4,027.30
Rate for Payer: Kaiser Permanente Commercial	$4,264.20
Rate for Payer: MDX Hawaii PPO	$4,595.86
Rate for Payer: University Health Alliance Commercial	$2,653.28

PLATE LCP 14H 3.5X211 #239.944

Facility

$4,738.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,369.00
Max. Negotiated Rate	$4,595.86
Rate for Payer: AlohaCare Medicaid	$2,369.00
Rate for Payer: AlohaCare Medicare	$3,600.88
Rate for Payer: Cash Price	$2,842.80
Rate for Payer: Devoted Health Medicare	$3,979.92
Rate for Payer: Hawaii Medical Service Association Medicare	$3,600.88
Rate for Payer: Hawaii Western Management Group Commercial	$3,316.60
Rate for Payer: Health Management Network Commercial	$4,027.30
Rate for Payer: Humana Medicare	$3,600.88
Rate for Payer: Kaiser Permanente Commercial	$4,264.20
Rate for Payer: Kaiser Permanente Medicaid	$2,416.38
Rate for Payer: Kaiser Permanente Medicare	$3,600.88
Rate for Payer: MDX Hawaii PPO	$4,595.86
Rate for Payer: Ohana Health Plan Medicaid	$3,600.88
Rate for Payer: Ohana Health Plan Medicare	$3,600.88
Rate for Payer: UnitedHealthcare Medicare	$3,600.88
Rate for Payer: University Health Alliance Commercial	$2,653.28

PLATE LCP 14H 3.5X211 #239.945

Facility

$4,738.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,653.28
Max. Negotiated Rate	$4,595.86
Rate for Payer: Cash Price	$2,842.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,316.60
Rate for Payer: Health Management Network Commercial	$4,027.30
Rate for Payer: Kaiser Permanente Commercial	$4,264.20
Rate for Payer: MDX Hawaii PPO	$4,595.86
Rate for Payer: University Health Alliance Commercial	$2,653.28

Know your out-of-pocket cost for care.

All Charges