Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE OLECRANON LF 629344

Facility

$2,418.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,209.00
Max. Negotiated Rate	$2,345.46
Rate for Payer: AlohaCare Medicaid	$1,209.00
Rate for Payer: AlohaCare Medicare	$1,837.68
Rate for Payer: Cash Price	$1,450.80
Rate for Payer: Devoted Health Medicare	$2,031.12
Rate for Payer: Hawaii Medical Service Association Medicare	$1,837.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,692.60
Rate for Payer: Health Management Network Commercial	$2,055.30
Rate for Payer: Humana Medicare	$1,837.68
Rate for Payer: Kaiser Permanente Commercial	$2,176.20
Rate for Payer: Kaiser Permanente Medicaid	$1,233.18
Rate for Payer: Kaiser Permanente Medicare	$1,837.68
Rate for Payer: MDX Hawaii PPO	$2,345.46
Rate for Payer: Ohana Health Plan Medicaid	$1,837.68
Rate for Payer: Ohana Health Plan Medicare	$1,837.68
Rate for Payer: UnitedHealthcare Medicare	$1,837.68
Rate for Payer: University Health Alliance Commercial	$1,354.08

PLATE OLECRANON LF 629344

Facility

$2,418.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,354.08
Max. Negotiated Rate	$2,345.46
Rate for Payer: Cash Price	$1,450.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,692.60
Rate for Payer: Health Management Network Commercial	$2,055.30
Rate for Payer: Kaiser Permanente Commercial	$2,176.20
Rate for Payer: MDX Hawaii PPO	$2,345.46
Rate for Payer: University Health Alliance Commercial	$1,354.08

PLATE ONE THIRD 7H 71MM 626676

Facility

$1,234.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$617.00
Max. Negotiated Rate	$1,196.98
Rate for Payer: AlohaCare Medicaid	$617.00
Rate for Payer: AlohaCare Medicare	$937.84
Rate for Payer: Cash Price	$740.40
Rate for Payer: Devoted Health Medicare	$1,036.56
Rate for Payer: Hawaii Medical Service Association Medicare	$937.84
Rate for Payer: Hawaii Western Management Group Commercial	$863.80
Rate for Payer: Health Management Network Commercial	$1,048.90
Rate for Payer: Humana Medicare	$937.84
Rate for Payer: Kaiser Permanente Commercial	$1,110.60
Rate for Payer: Kaiser Permanente Medicaid	$629.34
Rate for Payer: Kaiser Permanente Medicare	$937.84
Rate for Payer: MDX Hawaii PPO	$1,196.98
Rate for Payer: Ohana Health Plan Medicaid	$937.84
Rate for Payer: Ohana Health Plan Medicare	$937.84
Rate for Payer: UnitedHealthcare Medicare	$937.84
Rate for Payer: University Health Alliance Commercial	$691.04

PLATE ONE THIRD 7H 71MM 626676

Facility

$1,234.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$691.04
Max. Negotiated Rate	$1,196.98
Rate for Payer: Cash Price	$740.40
Rate for Payer: Hawaii Western Management Group Commercial	$863.80
Rate for Payer: Health Management Network Commercial	$1,048.90
Rate for Payer: Kaiser Permanente Commercial	$1,110.60
Rate for Payer: MDX Hawaii PPO	$1,196.98
Rate for Payer: University Health Alliance Commercial	$691.04

PLATE PRIMARY 6 HOLE 336-3554

Facility

$3,605.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,018.80
Max. Negotiated Rate	$3,496.85
Rate for Payer: Cash Price	$2,163.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,523.50
Rate for Payer: Health Management Network Commercial	$3,064.25
Rate for Payer: Kaiser Permanente Commercial	$3,244.50
Rate for Payer: MDX Hawaii PPO	$3,496.85
Rate for Payer: University Health Alliance Commercial	$2,018.80

PLATE PRIMARY 6 HOLE 336-3554

Facility

$3,605.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,802.50
Max. Negotiated Rate	$3,496.85
Rate for Payer: AlohaCare Medicaid	$1,802.50
Rate for Payer: AlohaCare Medicare	$2,739.80
Rate for Payer: Cash Price	$2,163.00
Rate for Payer: Devoted Health Medicare	$3,028.20
Rate for Payer: Hawaii Medical Service Association Medicare	$2,739.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,523.50
Rate for Payer: Health Management Network Commercial	$3,064.25
Rate for Payer: Humana Medicare	$2,739.80
Rate for Payer: Kaiser Permanente Commercial	$3,244.50
Rate for Payer: Kaiser Permanente Medicaid	$1,838.55
Rate for Payer: Kaiser Permanente Medicare	$2,739.80
Rate for Payer: MDX Hawaii PPO	$3,496.85
Rate for Payer: Ohana Health Plan Medicaid	$2,739.80
Rate for Payer: Ohana Health Plan Medicare	$2,739.80
Rate for Payer: UnitedHealthcare Medicare	$2,739.80
Rate for Payer: University Health Alliance Commercial	$2,018.80

PLATE PRIMRY 2.7MM LT 336-2754

Facility

$3,605.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,802.50
Max. Negotiated Rate	$3,496.85
Rate for Payer: AlohaCare Medicaid	$1,802.50
Rate for Payer: AlohaCare Medicare	$2,739.80
Rate for Payer: Cash Price	$2,163.00
Rate for Payer: Devoted Health Medicare	$3,028.20
Rate for Payer: Hawaii Medical Service Association Medicare	$2,739.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,523.50
Rate for Payer: Health Management Network Commercial	$3,064.25
Rate for Payer: Humana Medicare	$2,739.80
Rate for Payer: Kaiser Permanente Commercial	$3,244.50
Rate for Payer: Kaiser Permanente Medicaid	$1,838.55
Rate for Payer: Kaiser Permanente Medicare	$2,739.80
Rate for Payer: MDX Hawaii PPO	$3,496.85
Rate for Payer: Ohana Health Plan Medicaid	$2,739.80
Rate for Payer: Ohana Health Plan Medicare	$2,739.80
Rate for Payer: UnitedHealthcare Medicare	$2,739.80
Rate for Payer: University Health Alliance Commercial	$2,018.80

PLATE PRIMRY 2.7MM LT 336-2754

Facility

$3,605.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,018.80
Max. Negotiated Rate	$3,496.85
Rate for Payer: Cash Price	$2,163.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,523.50
Rate for Payer: Health Management Network Commercial	$3,064.25
Rate for Payer: Kaiser Permanente Commercial	$3,244.50
Rate for Payer: MDX Hawaii PPO	$3,496.85
Rate for Payer: University Health Alliance Commercial	$2,018.80

PLATE PRMARY 2.7MM RT 336-2759

Facility

$3,605.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,018.80
Max. Negotiated Rate	$3,496.85
Rate for Payer: Cash Price	$2,163.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,523.50
Rate for Payer: Health Management Network Commercial	$3,064.25
Rate for Payer: Kaiser Permanente Commercial	$3,244.50
Rate for Payer: MDX Hawaii PPO	$3,496.85
Rate for Payer: University Health Alliance Commercial	$2,018.80

PLATE PRMARY 2.7MM RT 336-2759

Facility

$3,605.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,802.50
Max. Negotiated Rate	$3,496.85
Rate for Payer: AlohaCare Medicaid	$1,802.50
Rate for Payer: AlohaCare Medicare	$2,739.80
Rate for Payer: Cash Price	$2,163.00
Rate for Payer: Devoted Health Medicare	$3,028.20
Rate for Payer: Hawaii Medical Service Association Medicare	$2,739.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,523.50
Rate for Payer: Health Management Network Commercial	$3,064.25
Rate for Payer: Humana Medicare	$2,739.80
Rate for Payer: Kaiser Permanente Commercial	$3,244.50
Rate for Payer: Kaiser Permanente Medicaid	$1,838.55
Rate for Payer: Kaiser Permanente Medicare	$2,739.80
Rate for Payer: MDX Hawaii PPO	$3,496.85
Rate for Payer: Ohana Health Plan Medicaid	$2,739.80
Rate for Payer: Ohana Health Plan Medicare	$2,739.80
Rate for Payer: UnitedHealthcare Medicare	$2,739.80
Rate for Payer: University Health Alliance Commercial	$2,018.80

PLATE PROX HUMERUS 6H 627236

Facility

$5,532.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,097.92
Max. Negotiated Rate	$5,366.04
Rate for Payer: Cash Price	$3,319.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,872.40
Rate for Payer: Health Management Network Commercial	$4,702.20
Rate for Payer: Kaiser Permanente Commercial	$4,978.80
Rate for Payer: MDX Hawaii PPO	$5,366.04
Rate for Payer: University Health Alliance Commercial	$3,097.92

PLATE PROX HUMERUS 6H 627236

Facility

$5,532.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,766.00
Max. Negotiated Rate	$5,366.04
Rate for Payer: AlohaCare Medicaid	$2,766.00
Rate for Payer: AlohaCare Medicare	$4,204.32
Rate for Payer: Cash Price	$3,319.20
Rate for Payer: Devoted Health Medicare	$4,646.88
Rate for Payer: Hawaii Medical Service Association Medicare	$4,204.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,872.40
Rate for Payer: Health Management Network Commercial	$4,702.20
Rate for Payer: Humana Medicare	$4,204.32
Rate for Payer: Kaiser Permanente Commercial	$4,978.80
Rate for Payer: Kaiser Permanente Medicaid	$2,821.32
Rate for Payer: Kaiser Permanente Medicare	$4,204.32
Rate for Payer: MDX Hawaii PPO	$5,366.04
Rate for Payer: Ohana Health Plan Medicaid	$4,204.32
Rate for Payer: Ohana Health Plan Medicare	$4,204.32
Rate for Payer: UnitedHealthcare Medicare	$4,204.32
Rate for Payer: University Health Alliance Commercial	$3,097.92

PLATE PROX HUM LAT, 12HOLE

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

PLATE PROX HUM LAT, 12HOLE

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$3,800.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$4,200.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$3,800.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$3,800.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$3,800.00
Rate for Payer: Ohana Health Plan Medicare	$3,800.00
Rate for Payer: UnitedHealthcare Medicare	$3,800.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

PLATE PROXIMAL HURMERUS 627204

Facility

$3,774.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$3,660.78
Rate for Payer: AlohaCare Medicaid	$1,887.00
Rate for Payer: AlohaCare Medicare	$2,868.24
Rate for Payer: Cash Price	$2,264.40
Rate for Payer: Devoted Health Medicare	$3,170.16
Rate for Payer: Hawaii Medical Service Association Medicare	$2,868.24
Rate for Payer: Hawaii Western Management Group Commercial	$2,641.80
Rate for Payer: Health Management Network Commercial	$3,207.90
Rate for Payer: Humana Medicare	$2,868.24
Rate for Payer: Kaiser Permanente Commercial	$3,396.60
Rate for Payer: Kaiser Permanente Medicaid	$1,924.74
Rate for Payer: Kaiser Permanente Medicare	$2,868.24
Rate for Payer: MDX Hawaii PPO	$3,660.78
Rate for Payer: Ohana Health Plan Medicaid	$2,868.24
Rate for Payer: Ohana Health Plan Medicare	$2,868.24
Rate for Payer: UnitedHealthcare Medicare	$2,868.24
Rate for Payer: University Health Alliance Commercial	$2,113.44

PLATE PROXIMAL HURMERUS 627204

Facility

$3,774.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,113.44
Max. Negotiated Rate	$3,660.78
Rate for Payer: Cash Price	$2,264.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,641.80
Rate for Payer: Health Management Network Commercial	$3,207.90
Rate for Payer: Kaiser Permanente Commercial	$3,396.60
Rate for Payer: MDX Hawaii PPO	$3,660.78
Rate for Payer: University Health Alliance Commercial	$2,113.44

PLATE PROXIMAL LATERAL 627242S

Facility

$6,127.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,063.50
Max. Negotiated Rate	$5,943.19
Rate for Payer: AlohaCare Medicaid	$3,063.50
Rate for Payer: AlohaCare Medicare	$4,656.52
Rate for Payer: Cash Price	$3,676.20
Rate for Payer: Devoted Health Medicare	$5,146.68
Rate for Payer: Hawaii Medical Service Association Medicare	$4,656.52
Rate for Payer: Hawaii Western Management Group Commercial	$4,288.90
Rate for Payer: Health Management Network Commercial	$5,207.95
Rate for Payer: Humana Medicare	$4,656.52
Rate for Payer: Kaiser Permanente Commercial	$5,514.30
Rate for Payer: Kaiser Permanente Medicaid	$3,124.77
Rate for Payer: Kaiser Permanente Medicare	$4,656.52
Rate for Payer: MDX Hawaii PPO	$5,943.19
Rate for Payer: Ohana Health Plan Medicaid	$4,656.52
Rate for Payer: Ohana Health Plan Medicare	$4,656.52
Rate for Payer: UnitedHealthcare Medicare	$4,656.52
Rate for Payer: University Health Alliance Commercial	$3,431.12

PLATE PROXIMAL LATERAL 627242S

Facility

$6,127.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,431.12
Max. Negotiated Rate	$5,943.19
Rate for Payer: Cash Price	$3,676.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,288.90
Rate for Payer: Health Management Network Commercial	$5,207.95
Rate for Payer: Kaiser Permanente Commercial	$5,514.30
Rate for Payer: MDX Hawaii PPO	$5,943.19
Rate for Payer: University Health Alliance Commercial	$3,431.12

PLATE PROXIMAL LATERAL HUMERUS

Facility

$3,774.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,113.44
Max. Negotiated Rate	$3,660.78
Rate for Payer: Cash Price	$2,264.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,641.80
Rate for Payer: Health Management Network Commercial	$3,207.90
Rate for Payer: Kaiser Permanente Commercial	$3,396.60
Rate for Payer: MDX Hawaii PPO	$3,660.78
Rate for Payer: University Health Alliance Commercial	$2,113.44

PLATE PROXIMAL LATERAL HUMERUS

Facility

$3,774.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,887.00
Max. Negotiated Rate	$3,660.78
Rate for Payer: AlohaCare Medicaid	$1,887.00
Rate for Payer: AlohaCare Medicare	$2,868.24
Rate for Payer: Cash Price	$2,264.40
Rate for Payer: Devoted Health Medicare	$3,170.16
Rate for Payer: Hawaii Medical Service Association Medicare	$2,868.24
Rate for Payer: Hawaii Western Management Group Commercial	$2,641.80
Rate for Payer: Health Management Network Commercial	$3,207.90
Rate for Payer: Humana Medicare	$2,868.24
Rate for Payer: Kaiser Permanente Commercial	$3,396.60
Rate for Payer: Kaiser Permanente Medicaid	$1,924.74
Rate for Payer: Kaiser Permanente Medicare	$2,868.24
Rate for Payer: MDX Hawaii PPO	$3,660.78
Rate for Payer: Ohana Health Plan Medicaid	$2,868.24
Rate for Payer: Ohana Health Plan Medicare	$2,868.24
Rate for Payer: UnitedHealthcare Medicare	$2,868.24
Rate for Payer: University Health Alliance Commercial	$2,113.44

PLATE PROX LATERAL RT 627234

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 PROX LATERAL RT 627234

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 PROX LATERAL TIB 627302

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,817.50
Max. Negotiated Rate	$3,525.95
Rate for Payer: AlohaCare Medicaid	$1,817.50
Rate for Payer: AlohaCare Medicare	$2,762.60
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Devoted Health Medicare	$3,053.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,762.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: Humana Medicare	$2,762.60
Rate for Payer: Kaiser Permanente Commercial	$3,271.50
Rate for Payer: Kaiser Permanente Medicaid	$1,853.85
Rate for Payer: Kaiser Permanente Medicare	$2,762.60
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: Ohana Health Plan Medicaid	$2,762.60
Rate for Payer: Ohana Health Plan Medicare	$2,762.60
Rate for Payer: UnitedHealthcare Medicare	$2,762.60
Rate for Payer: University Health Alliance Commercial	$2,035.60

PLATE PROX LATERAL TIB 627302

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.60
Max. Negotiated Rate	$3,525.95
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: Kaiser Permanente Commercial	$3,271.50
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: University Health Alliance Commercial	$2,035.60

PLATE PROX RADIUS LG 131218401

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

Know your out-of-pocket cost for care.

All Charges