Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE MESH 65MM CALC 336-3531

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 MINI 1.0MM RT 04.503.780

Facility

$2,382.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.92
Max. Negotiated Rate	$2,310.54
Rate for Payer: Cash Price	$1,429.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,667.40
Rate for Payer: Health Management Network Commercial	$2,024.70
Rate for Payer: Kaiser Permanente Commercial	$2,143.80
Rate for Payer: MDX Hawaii PPO	$2,310.54
Rate for Payer: University Health Alliance Commercial	$1,333.92

PLATE MINI 1.0MM RT 04.503.780

Facility

$2,382.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,191.00
Max. Negotiated Rate	$2,310.54
Rate for Payer: AlohaCare Medicaid	$1,191.00
Rate for Payer: AlohaCare Medicare	$1,810.32
Rate for Payer: Cash Price	$1,429.20
Rate for Payer: Devoted Health Medicare	$2,000.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,810.32
Rate for Payer: Hawaii Western Management Group Commercial	$1,667.40
Rate for Payer: Health Management Network Commercial	$2,024.70
Rate for Payer: Humana Medicare	$1,810.32
Rate for Payer: Kaiser Permanente Commercial	$2,143.80
Rate for Payer: Kaiser Permanente Medicaid	$1,214.82
Rate for Payer: Kaiser Permanente Medicare	$1,810.32
Rate for Payer: MDX Hawaii PPO	$2,310.54
Rate for Payer: Ohana Health Plan Medicaid	$1,810.32
Rate for Payer: Ohana Health Plan Medicare	$1,810.32
Rate for Payer: UnitedHealthcare Medicare	$1,810.32
Rate for Payer: University Health Alliance Commercial	$1,333.92

PLATE MINI 2X2 HOLE 04.503.750

Facility

$2,276.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,138.00
Max. Negotiated Rate	$2,207.72
Rate for Payer: AlohaCare Medicaid	$1,138.00
Rate for Payer: AlohaCare Medicare	$1,729.76
Rate for Payer: Cash Price	$1,365.60
Rate for Payer: Devoted Health Medicare	$1,911.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,729.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,593.20
Rate for Payer: Health Management Network Commercial	$1,934.60
Rate for Payer: Humana Medicare	$1,729.76
Rate for Payer: Kaiser Permanente Commercial	$2,048.40
Rate for Payer: Kaiser Permanente Medicaid	$1,160.76
Rate for Payer: Kaiser Permanente Medicare	$1,729.76
Rate for Payer: MDX Hawaii PPO	$2,207.72
Rate for Payer: Ohana Health Plan Medicaid	$1,729.76
Rate for Payer: Ohana Health Plan Medicare	$1,729.76
Rate for Payer: UnitedHealthcare Medicare	$1,729.76
Rate for Payer: University Health Alliance Commercial	$1,274.56

PLATE MINI 2X2 HOLE 04.503.750

Facility

$2,276.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,274.56
Max. Negotiated Rate	$2,207.72
Rate for Payer: Cash Price	$1,365.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,593.20
Rate for Payer: Health Management Network Commercial	$1,934.60
Rate for Payer: Kaiser Permanente Commercial	$2,048.40
Rate for Payer: MDX Hawaii PPO	$2,207.72
Rate for Payer: University Health Alliance Commercial	$1,274.56

PLATE MINI 2X2 HOLE 04.503.781

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,473.50
Rate for Payer: AlohaCare Medicaid	$1,275.00
Rate for Payer: AlohaCare Medicare	$1,938.00
Rate for Payer: Cash Price	$1,530.00
Rate for Payer: Devoted Health Medicare	$2,142.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,938.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,785.00
Rate for Payer: Health Management Network Commercial	$2,167.50
Rate for Payer: Humana Medicare	$1,938.00
Rate for Payer: Kaiser Permanente Commercial	$2,295.00
Rate for Payer: Kaiser Permanente Medicaid	$1,300.50
Rate for Payer: Kaiser Permanente Medicare	$1,938.00
Rate for Payer: MDX Hawaii PPO	$2,473.50
Rate for Payer: Ohana Health Plan Medicaid	$1,938.00
Rate for Payer: Ohana Health Plan Medicare	$1,938.00
Rate for Payer: UnitedHealthcare Medicare	$1,938.00
Rate for Payer: University Health Alliance Commercial	$1,428.00

PLATE MINI 2X2 HOLE 04.503.781

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,428.00
Max. Negotiated Rate	$2,473.50
Rate for Payer: Cash Price	$1,530.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,785.00
Rate for Payer: Health Management Network Commercial	$2,167.50
Rate for Payer: Kaiser Permanente Commercial	$2,295.00
Rate for Payer: MDX Hawaii PPO	$2,473.50
Rate for Payer: University Health Alliance Commercial	$1,428.00

PLATE MINI FRAG 2.0 4H 629604

Facility

$1,564.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$875.84
Max. Negotiated Rate	$1,517.08
Rate for Payer: Cash Price	$938.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,094.80
Rate for Payer: Health Management Network Commercial	$1,329.40
Rate for Payer: Kaiser Permanente Commercial	$1,407.60
Rate for Payer: MDX Hawaii PPO	$1,517.08
Rate for Payer: University Health Alliance Commercial	$875.84

PLATE MINI FRAG 2.0 4H 629604

Facility

$1,564.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$782.00
Max. Negotiated Rate	$1,517.08
Rate for Payer: AlohaCare Medicaid	$782.00
Rate for Payer: AlohaCare Medicare	$1,188.64
Rate for Payer: Cash Price	$938.40
Rate for Payer: Devoted Health Medicare	$1,313.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,188.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,094.80
Rate for Payer: Health Management Network Commercial	$1,329.40
Rate for Payer: Humana Medicare	$1,188.64
Rate for Payer: Kaiser Permanente Commercial	$1,407.60
Rate for Payer: Kaiser Permanente Medicaid	$797.64
Rate for Payer: Kaiser Permanente Medicare	$1,188.64
Rate for Payer: MDX Hawaii PPO	$1,517.08
Rate for Payer: Ohana Health Plan Medicaid	$1,188.64
Rate for Payer: Ohana Health Plan Medicare	$1,188.64
Rate for Payer: UnitedHealthcare Medicare	$1,188.64
Rate for Payer: University Health Alliance Commercial	$875.84

PLATE MINI LF DVR 131822040

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.28
Max. Negotiated Rate	$2,825.61
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE MINI LF DVR 131822040

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.50
Max. Negotiated Rate	$2,825.61
Rate for Payer: AlohaCare Medicaid	$1,456.50
Rate for Payer: AlohaCare Medicare	$2,213.88
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Devoted Health Medicare	$2,446.92
Rate for Payer: Hawaii Medical Service Association Medicare	$2,213.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Humana Medicare	$2,213.88
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: Kaiser Permanente Medicaid	$1,485.63
Rate for Payer: Kaiser Permanente Medicare	$2,213.88
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: Ohana Health Plan Medicaid	$2,213.88
Rate for Payer: Ohana Health Plan Medicare	$2,213.88
Rate for Payer: UnitedHealthcare Medicare	$2,213.88
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE M LCK T REG 7H 57-15360

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 M LCK T REG 7H 57-15360

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 NARR LCK 2.0

Facility

$1,907.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$953.50
Max. Negotiated Rate	$1,849.79
Rate for Payer: AlohaCare Medicaid	$953.50
Rate for Payer: AlohaCare Medicare	$1,449.32
Rate for Payer: Cash Price	$1,144.20
Rate for Payer: Devoted Health Medicare	$1,601.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,449.32
Rate for Payer: Hawaii Western Management Group Commercial	$1,334.90
Rate for Payer: Health Management Network Commercial	$1,620.95
Rate for Payer: Humana Medicare	$1,449.32
Rate for Payer: Kaiser Permanente Commercial	$1,716.30
Rate for Payer: Kaiser Permanente Medicaid	$972.57
Rate for Payer: Kaiser Permanente Medicare	$1,449.32
Rate for Payer: MDX Hawaii PPO	$1,849.79
Rate for Payer: Ohana Health Plan Medicaid	$1,449.32
Rate for Payer: Ohana Health Plan Medicare	$1,449.32
Rate for Payer: UnitedHealthcare Medicare	$1,449.32
Rate for Payer: University Health Alliance Commercial	$1,067.92

PLATE NARR LCK 2.0

Facility

$1,907.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,067.92
Max. Negotiated Rate	$1,849.79
Rate for Payer: Cash Price	$1,144.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,334.90
Rate for Payer: Health Management Network Commercial	$1,620.95
Rate for Payer: Kaiser Permanente Commercial	$1,716.30
Rate for Payer: MDX Hawaii PPO	$1,849.79
Rate for Payer: University Health Alliance Commercial	$1,067.92

PLATE NARROW LEFT DVRAN-L

Facility

$2,460.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,377.60
Max. Negotiated Rate	$2,386.20
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,722.00
Rate for Payer: Health Management Network Commercial	$2,091.00
Rate for Payer: Kaiser Permanente Commercial	$2,214.00
Rate for Payer: MDX Hawaii PPO	$2,386.20
Rate for Payer: University Health Alliance Commercial	$1,377.60

PLATE NARROW LEFT DVRAN-L

Facility

$2,460.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,230.00
Max. Negotiated Rate	$2,386.20
Rate for Payer: AlohaCare Medicaid	$1,230.00
Rate for Payer: AlohaCare Medicare	$1,869.60
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Devoted Health Medicare	$2,066.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,869.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,722.00
Rate for Payer: Health Management Network Commercial	$2,091.00
Rate for Payer: Humana Medicare	$1,869.60
Rate for Payer: Kaiser Permanente Commercial	$2,214.00
Rate for Payer: Kaiser Permanente Medicaid	$1,254.60
Rate for Payer: Kaiser Permanente Medicare	$1,869.60
Rate for Payer: MDX Hawaii PPO	$2,386.20
Rate for Payer: Ohana Health Plan Medicaid	$1,869.60
Rate for Payer: Ohana Health Plan Medicare	$1,869.60
Rate for Payer: UnitedHealthcare Medicare	$1,869.60
Rate for Payer: University Health Alliance Commercial	$1,377.60

PLATE NCB RT 12H 02.03264.012

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,250.00
Max. Negotiated Rate	$6,305.00
Rate for Payer: AlohaCare Medicaid	$3,250.00
Rate for Payer: AlohaCare Medicare	$4,940.00
Rate for Payer: Cash Price	$3,900.00
Rate for Payer: Devoted Health Medicare	$5,460.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,940.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,550.00
Rate for Payer: Health Management Network Commercial	$5,525.00
Rate for Payer: Humana Medicare	$4,940.00
Rate for Payer: Kaiser Permanente Commercial	$5,850.00
Rate for Payer: Kaiser Permanente Medicaid	$3,315.00
Rate for Payer: Kaiser Permanente Medicare	$4,940.00
Rate for Payer: MDX Hawaii PPO	$6,305.00
Rate for Payer: Ohana Health Plan Medicaid	$4,940.00
Rate for Payer: Ohana Health Plan Medicare	$4,940.00
Rate for Payer: UnitedHealthcare Medicare	$4,940.00
Rate for Payer: University Health Alliance Commercial	$3,640.00

PLATE NCB RT 12H 02.03264.012

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,640.00
Max. Negotiated Rate	$6,305.00
Rate for Payer: Cash Price	$3,900.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,550.00
Rate for Payer: Health Management Network Commercial	$5,525.00
Rate for Payer: Kaiser Permanente Commercial	$5,850.00
Rate for Payer: MDX Hawaii PPO	$6,305.00
Rate for Payer: University Health Alliance Commercial	$3,640.00

PLATE NON COMP FEM LF 627610

Facility

$4,707.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,635.92
Max. Negotiated Rate	$4,565.79
Rate for Payer: Cash Price	$2,824.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,294.90
Rate for Payer: Health Management Network Commercial	$4,000.95
Rate for Payer: Kaiser Permanente Commercial	$4,236.30
Rate for Payer: MDX Hawaii PPO	$4,565.79
Rate for Payer: University Health Alliance Commercial	$2,635.92

PLATE NON COMP FEM LF 627610

Facility

$4,707.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,353.50
Max. Negotiated Rate	$4,565.79
Rate for Payer: AlohaCare Medicaid	$2,353.50
Rate for Payer: AlohaCare Medicare	$3,577.32
Rate for Payer: Cash Price	$2,824.20
Rate for Payer: Devoted Health Medicare	$3,953.88
Rate for Payer: Hawaii Medical Service Association Medicare	$3,577.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,294.90
Rate for Payer: Health Management Network Commercial	$4,000.95
Rate for Payer: Humana Medicare	$3,577.32
Rate for Payer: Kaiser Permanente Commercial	$4,236.30
Rate for Payer: Kaiser Permanente Medicaid	$2,400.57
Rate for Payer: Kaiser Permanente Medicare	$3,577.32
Rate for Payer: MDX Hawaii PPO	$4,565.79
Rate for Payer: Ohana Health Plan Medicaid	$3,577.32
Rate for Payer: Ohana Health Plan Medicare	$3,577.32
Rate for Payer: UnitedHealthcare Medicare	$3,577.32
Rate for Payer: University Health Alliance Commercial	$2,635.92

PLATE OLECRANON 12HOLE 629352S

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 OLECRANON 12HOLE 629352S

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 OLECRANON 3H 65MM 629343

Facility

$2,193.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,096.50
Max. Negotiated Rate	$2,127.21
Rate for Payer: AlohaCare Medicaid	$1,096.50
Rate for Payer: AlohaCare Medicare	$1,666.68
Rate for Payer: Cash Price	$1,315.80
Rate for Payer: Devoted Health Medicare	$1,842.12
Rate for Payer: Hawaii Medical Service Association Medicare	$1,666.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,535.10
Rate for Payer: Health Management Network Commercial	$1,864.05
Rate for Payer: Humana Medicare	$1,666.68
Rate for Payer: Kaiser Permanente Commercial	$1,973.70
Rate for Payer: Kaiser Permanente Medicaid	$1,118.43
Rate for Payer: Kaiser Permanente Medicare	$1,666.68
Rate for Payer: MDX Hawaii PPO	$2,127.21
Rate for Payer: Ohana Health Plan Medicaid	$1,666.68
Rate for Payer: Ohana Health Plan Medicare	$1,666.68
Rate for Payer: UnitedHealthcare Medicare	$1,666.68
Rate for Payer: University Health Alliance Commercial	$1,228.08

PLATE OLECRANON 3H 65MM 629343

Facility

$2,193.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,228.08
Max. Negotiated Rate	$2,127.21
Rate for Payer: Cash Price	$1,315.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,535.10
Rate for Payer: Health Management Network Commercial	$1,864.05
Rate for Payer: Kaiser Permanente Commercial	$1,973.70
Rate for Payer: MDX Hawaii PPO	$2,127.21
Rate for Payer: University Health Alliance Commercial	$1,228.08

Know your out-of-pocket cost for care.

All Charges