Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE LEFT 3H 74MM 2358-108-03

Facility

$2,820.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.20
Max. Negotiated Rate	$2,735.40
Rate for Payer: Cash Price	$1,692.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,974.00
Rate for Payer: Health Management Network Commercial	$2,397.00
Rate for Payer: Kaiser Permanente Commercial	$2,538.00
Rate for Payer: MDX Hawaii PPO	$2,735.40
Rate for Payer: University Health Alliance Commercial	$1,579.20

PLATE LEFT STD 4HOLE DVRAL

Facility

$2,660.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,489.60
Max. Negotiated Rate	$2,580.20
Rate for Payer: Cash Price	$1,596.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,862.00
Rate for Payer: Health Management Network Commercial	$2,261.00
Rate for Payer: Kaiser Permanente Commercial	$2,394.00
Rate for Payer: MDX Hawaii PPO	$2,580.20
Rate for Payer: University Health Alliance Commercial	$1,489.60

PLATE LEFT STD 4HOLE DVRAL

Facility

$2,660.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,330.00
Max. Negotiated Rate	$2,580.20
Rate for Payer: AlohaCare Medicaid	$1,330.00
Rate for Payer: AlohaCare Medicare	$2,021.60
Rate for Payer: Cash Price	$1,596.00
Rate for Payer: Devoted Health Medicare	$2,234.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,021.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,862.00
Rate for Payer: Health Management Network Commercial	$2,261.00
Rate for Payer: Humana Medicare	$2,021.60
Rate for Payer: Kaiser Permanente Commercial	$2,394.00
Rate for Payer: Kaiser Permanente Medicaid	$1,356.60
Rate for Payer: Kaiser Permanente Medicare	$2,021.60
Rate for Payer: MDX Hawaii PPO	$2,580.20
Rate for Payer: Ohana Health Plan Medicaid	$2,021.60
Rate for Payer: Ohana Health Plan Medicare	$2,021.60
Rate for Payer: UnitedHealthcare Medicare	$2,021.60
Rate for Payer: University Health Alliance Commercial	$1,489.60

PLATE LF 10H 120MM AR-2653CL

Facility

$2,678.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,339.00
Max. Negotiated Rate	$2,597.66
Rate for Payer: AlohaCare Medicaid	$1,339.00
Rate for Payer: AlohaCare Medicare	$2,035.28
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Devoted Health Medicare	$2,249.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,035.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,874.60
Rate for Payer: Health Management Network Commercial	$2,276.30
Rate for Payer: Humana Medicare	$2,035.28
Rate for Payer: Kaiser Permanente Commercial	$2,410.20
Rate for Payer: Kaiser Permanente Medicaid	$1,365.78
Rate for Payer: Kaiser Permanente Medicare	$2,035.28
Rate for Payer: MDX Hawaii PPO	$2,597.66
Rate for Payer: Ohana Health Plan Medicaid	$2,035.28
Rate for Payer: Ohana Health Plan Medicare	$2,035.28
Rate for Payer: UnitedHealthcare Medicare	$2,035.28
Rate for Payer: University Health Alliance Commercial	$1,499.68

PLATE LF 10H 120MM AR-2653CL

Facility

$2,678.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,499.68
Max. Negotiated Rate	$2,597.66
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,874.60
Rate for Payer: Health Management Network Commercial	$2,276.30
Rate for Payer: Kaiser Permanente Commercial	$2,410.20
Rate for Payer: MDX Hawaii PPO	$2,597.66
Rate for Payer: University Health Alliance Commercial	$1,499.68

PLATE LF 3.5/4.0X58MM 336-3540

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 LF 3.5/4.0X58MM 336-3540

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 LF 4X6 0.5MM 04.503.334

Facility

$1,941.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$970.50
Max. Negotiated Rate	$1,882.77
Rate for Payer: AlohaCare Medicaid	$970.50
Rate for Payer: AlohaCare Medicare	$1,475.16
Rate for Payer: Cash Price	$1,164.60
Rate for Payer: Devoted Health Medicare	$1,630.44
Rate for Payer: Hawaii Medical Service Association Medicare	$1,475.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,358.70
Rate for Payer: Health Management Network Commercial	$1,649.85
Rate for Payer: Humana Medicare	$1,475.16
Rate for Payer: Kaiser Permanente Commercial	$1,746.90
Rate for Payer: Kaiser Permanente Medicaid	$989.91
Rate for Payer: Kaiser Permanente Medicare	$1,475.16
Rate for Payer: MDX Hawaii PPO	$1,882.77
Rate for Payer: Ohana Health Plan Medicaid	$1,475.16
Rate for Payer: Ohana Health Plan Medicare	$1,475.16
Rate for Payer: UnitedHealthcare Medicare	$1,475.16
Rate for Payer: University Health Alliance Commercial	$1,086.96

PLATE LF 4X6 0.5MM 04.503.334

Facility

$1,941.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,086.96
Max. Negotiated Rate	$1,882.77
Rate for Payer: Cash Price	$1,164.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,358.70
Rate for Payer: Health Management Network Commercial	$1,649.85
Rate for Payer: Kaiser Permanente Commercial	$1,746.90
Rate for Payer: MDX Hawaii PPO	$1,882.77
Rate for Payer: University Health Alliance Commercial	$1,086.96

PLATE LF 4X6 0.7MM 04.503.364

Facility

$2,079.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$2,016.63
Rate for Payer: AlohaCare Medicaid	$1,039.50
Rate for Payer: AlohaCare Medicare	$1,580.04
Rate for Payer: Cash Price	$1,247.40
Rate for Payer: Devoted Health Medicare	$1,746.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1,580.04
Rate for Payer: Hawaii Western Management Group Commercial	$1,455.30
Rate for Payer: Health Management Network Commercial	$1,767.15
Rate for Payer: Humana Medicare	$1,580.04
Rate for Payer: Kaiser Permanente Commercial	$1,871.10
Rate for Payer: Kaiser Permanente Medicaid	$1,060.29
Rate for Payer: Kaiser Permanente Medicare	$1,580.04
Rate for Payer: MDX Hawaii PPO	$2,016.63
Rate for Payer: Ohana Health Plan Medicaid	$1,580.04
Rate for Payer: Ohana Health Plan Medicare	$1,580.04
Rate for Payer: UnitedHealthcare Medicare	$1,580.04
Rate for Payer: University Health Alliance Commercial	$1,164.24

PLATE LF 4X6 0.7MM 04.503.364

Facility

$2,079.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,164.24
Max. Negotiated Rate	$2,016.63
Rate for Payer: Cash Price	$1,247.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,455.30
Rate for Payer: Health Management Network Commercial	$1,767.15
Rate for Payer: Kaiser Permanente Commercial	$1,871.10
Rate for Payer: MDX Hawaii PPO	$2,016.63
Rate for Payer: University Health Alliance Commercial	$1,164.24

PLATE LF MED 8H 93M AR-2651CL

Facility

$2,678.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,499.68
Max. Negotiated Rate	$2,597.66
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,874.60
Rate for Payer: Health Management Network Commercial	$2,276.30
Rate for Payer: Kaiser Permanente Commercial	$2,410.20
Rate for Payer: MDX Hawaii PPO	$2,597.66
Rate for Payer: University Health Alliance Commercial	$1,499.68

PLATE LF MED 8H 93M AR-2651CL

Facility

$2,678.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,339.00
Max. Negotiated Rate	$2,597.66
Rate for Payer: AlohaCare Medicaid	$1,339.00
Rate for Payer: AlohaCare Medicare	$2,035.28
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Devoted Health Medicare	$2,249.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,035.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,874.60
Rate for Payer: Health Management Network Commercial	$2,276.30
Rate for Payer: Humana Medicare	$2,035.28
Rate for Payer: Kaiser Permanente Commercial	$2,410.20
Rate for Payer: Kaiser Permanente Medicaid	$1,365.78
Rate for Payer: Kaiser Permanente Medicare	$2,035.28
Rate for Payer: MDX Hawaii PPO	$2,597.66
Rate for Payer: Ohana Health Plan Medicaid	$2,035.28
Rate for Payer: Ohana Health Plan Medicare	$2,035.28
Rate for Payer: UnitedHealthcare Medicare	$2,035.28
Rate for Payer: University Health Alliance Commercial	$1,499.68

PLATE LF MI 3.5X65MM 336-3541

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 LF MI 3.5X65MM 336-3541

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 LKG ST 12H AR-8943C-12

Facility

$2,189.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,225.84
Max. Negotiated Rate	$2,123.33
Rate for Payer: Cash Price	$1,313.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,532.30
Rate for Payer: Health Management Network Commercial	$1,860.65
Rate for Payer: Kaiser Permanente Commercial	$1,970.10
Rate for Payer: MDX Hawaii PPO	$2,123.33
Rate for Payer: University Health Alliance Commercial	$1,225.84

PLATE LKG ST 12H AR-8943C-12

Facility

$2,189.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,094.50
Max. Negotiated Rate	$2,123.33
Rate for Payer: AlohaCare Medicaid	$1,094.50
Rate for Payer: AlohaCare Medicare	$1,663.64
Rate for Payer: Cash Price	$1,313.40
Rate for Payer: Devoted Health Medicare	$1,838.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,663.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,532.30
Rate for Payer: Health Management Network Commercial	$1,860.65
Rate for Payer: Humana Medicare	$1,663.64
Rate for Payer: Kaiser Permanente Commercial	$1,970.10
Rate for Payer: Kaiser Permanente Medicaid	$1,116.39
Rate for Payer: Kaiser Permanente Medicare	$1,663.64
Rate for Payer: MDX Hawaii PPO	$2,123.33
Rate for Payer: Ohana Health Plan Medicaid	$1,663.64
Rate for Payer: Ohana Health Plan Medicare	$1,663.64
Rate for Payer: UnitedHealthcare Medicare	$1,663.64
Rate for Payer: University Health Alliance Commercial	$1,225.84

PLATE L OBLIQUE 04.503.365

Facility

$2,079.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,164.24
Max. Negotiated Rate	$2,016.63
Rate for Payer: Cash Price	$1,247.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,455.30
Rate for Payer: Health Management Network Commercial	$1,767.15
Rate for Payer: Kaiser Permanente Commercial	$1,871.10
Rate for Payer: MDX Hawaii PPO	$2,016.63
Rate for Payer: University Health Alliance Commercial	$1,164.24

PLATE L OBLIQUE 04.503.365

Facility

$2,079.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$2,016.63
Rate for Payer: AlohaCare Medicaid	$1,039.50
Rate for Payer: AlohaCare Medicare	$1,580.04
Rate for Payer: Cash Price	$1,247.40
Rate for Payer: Devoted Health Medicare	$1,746.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1,580.04
Rate for Payer: Hawaii Western Management Group Commercial	$1,455.30
Rate for Payer: Health Management Network Commercial	$1,767.15
Rate for Payer: Humana Medicare	$1,580.04
Rate for Payer: Kaiser Permanente Commercial	$1,871.10
Rate for Payer: Kaiser Permanente Medicaid	$1,060.29
Rate for Payer: Kaiser Permanente Medicare	$1,580.04
Rate for Payer: MDX Hawaii PPO	$2,016.63
Rate for Payer: Ohana Health Plan Medicaid	$1,580.04
Rate for Payer: Ohana Health Plan Medicare	$1,580.04
Rate for Payer: UnitedHealthcare Medicare	$1,580.04
Rate for Payer: University Health Alliance Commercial	$1,164.24

PLATE LOCKING 2.3MM 57-15370

Facility

$1,900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,064.00
Max. Negotiated Rate	$1,843.00
Rate for Payer: Cash Price	$1,140.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,330.00
Rate for Payer: Health Management Network Commercial	$1,615.00
Rate for Payer: Kaiser Permanente Commercial	$1,710.00
Rate for Payer: MDX Hawaii PPO	$1,843.00
Rate for Payer: University Health Alliance Commercial	$1,064.00

PLATE LOCKING 2.3MM 57-15370

Facility

$1,900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$950.00
Max. Negotiated Rate	$1,843.00
Rate for Payer: AlohaCare Medicaid	$950.00
Rate for Payer: AlohaCare Medicare	$1,444.00
Rate for Payer: Cash Price	$1,140.00
Rate for Payer: Devoted Health Medicare	$1,596.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,444.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,330.00
Rate for Payer: Health Management Network Commercial	$1,615.00
Rate for Payer: Humana Medicare	$1,444.00
Rate for Payer: Kaiser Permanente Commercial	$1,710.00
Rate for Payer: Kaiser Permanente Medicaid	$969.00
Rate for Payer: Kaiser Permanente Medicare	$1,444.00
Rate for Payer: MDX Hawaii PPO	$1,843.00
Rate for Payer: Ohana Health Plan Medicaid	$1,444.00
Rate for Payer: Ohana Health Plan Medicare	$1,444.00
Rate for Payer: UnitedHealthcare Medicare	$1,444.00
Rate for Payer: University Health Alliance Commercial	$1,064.00

PLATE LOCKING STR 12H PS12

Facility

$2,920.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,635.20
Max. Negotiated Rate	$2,832.40
Rate for Payer: Cash Price	$1,752.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,044.00
Rate for Payer: Health Management Network Commercial	$2,482.00
Rate for Payer: Kaiser Permanente Commercial	$2,628.00
Rate for Payer: MDX Hawaii PPO	$2,832.40
Rate for Payer: University Health Alliance Commercial	$1,635.20

PLATE LOCKING STR 12H PS12

Facility

$2,920.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,460.00
Max. Negotiated Rate	$2,832.40
Rate for Payer: AlohaCare Medicaid	$1,460.00
Rate for Payer: AlohaCare Medicare	$2,219.20
Rate for Payer: Cash Price	$1,752.00
Rate for Payer: Devoted Health Medicare	$2,452.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,219.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,044.00
Rate for Payer: Health Management Network Commercial	$2,482.00
Rate for Payer: Humana Medicare	$2,219.20
Rate for Payer: Kaiser Permanente Commercial	$2,628.00
Rate for Payer: Kaiser Permanente Medicaid	$1,489.20
Rate for Payer: Kaiser Permanente Medicare	$2,219.20
Rate for Payer: MDX Hawaii PPO	$2,832.40
Rate for Payer: Ohana Health Plan Medicaid	$2,219.20
Rate for Payer: Ohana Health Plan Medicare	$2,219.20
Rate for Payer: UnitedHealthcare Medicare	$2,219.20
Rate for Payer: University Health Alliance Commercial	$1,635.20

PLATE LOK COMPRES ST 6H 629546

Facility

$1,514.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$757.00
Max. Negotiated Rate	$1,468.58
Rate for Payer: AlohaCare Medicaid	$757.00
Rate for Payer: AlohaCare Medicare	$1,150.64
Rate for Payer: Cash Price	$908.40
Rate for Payer: Devoted Health Medicare	$1,271.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,150.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,059.80
Rate for Payer: Health Management Network Commercial	$1,286.90
Rate for Payer: Humana Medicare	$1,150.64
Rate for Payer: Kaiser Permanente Commercial	$1,362.60
Rate for Payer: Kaiser Permanente Medicaid	$772.14
Rate for Payer: Kaiser Permanente Medicare	$1,150.64
Rate for Payer: MDX Hawaii PPO	$1,468.58
Rate for Payer: Ohana Health Plan Medicaid	$1,150.64
Rate for Payer: Ohana Health Plan Medicare	$1,150.64
Rate for Payer: UnitedHealthcare Medicare	$1,150.64
Rate for Payer: University Health Alliance Commercial	$847.84

PLATE LOK COMPRES ST 6H 629546

Facility

$1,514.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$847.84
Max. Negotiated Rate	$1,468.58
Rate for Payer: Cash Price	$908.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,059.80
Rate for Payer: Health Management Network Commercial	$1,286.90
Rate for Payer: Kaiser Permanente Commercial	$1,362.60
Rate for Payer: MDX Hawaii PPO	$1,468.58
Rate for Payer: University Health Alliance Commercial	$847.84

Know your out-of-pocket cost for care.

All Charges