Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE PROX RADIUS LG 131218401

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 PRX LT 4H 90MM 110030301

Facility

$4,832.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,705.92
Max. Negotiated Rate	$4,687.04
Rate for Payer: Cash Price	$2,899.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,382.40
Rate for Payer: Health Management Network Commercial	$4,107.20
Rate for Payer: Kaiser Permanente Commercial	$4,348.80
Rate for Payer: MDX Hawaii PPO	$4,687.04
Rate for Payer: University Health Alliance Commercial	$2,705.92

PLATE PRX LT 4H 90MM 110030301

Facility

$4,832.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,416.00
Max. Negotiated Rate	$4,687.04
Rate for Payer: AlohaCare Medicaid	$2,416.00
Rate for Payer: AlohaCare Medicare	$3,672.32
Rate for Payer: Cash Price	$2,899.20
Rate for Payer: Devoted Health Medicare	$4,058.88
Rate for Payer: Hawaii Medical Service Association Medicare	$3,672.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,382.40
Rate for Payer: Health Management Network Commercial	$4,107.20
Rate for Payer: Humana Medicare	$3,672.32
Rate for Payer: Kaiser Permanente Commercial	$4,348.80
Rate for Payer: Kaiser Permanente Medicaid	$2,464.32
Rate for Payer: Kaiser Permanente Medicare	$3,672.32
Rate for Payer: MDX Hawaii PPO	$4,687.04
Rate for Payer: Ohana Health Plan Medicaid	$3,672.32
Rate for Payer: Ohana Health Plan Medicare	$3,672.32
Rate for Payer: UnitedHealthcare Medicare	$3,672.32
Rate for Payer: University Health Alliance Commercial	$2,705.92

PLATE RADIAL COLUMN 3H RCP3

Facility

$2,385.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.60
Max. Negotiated Rate	$2,313.45
Rate for Payer: Cash Price	$1,431.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,669.50
Rate for Payer: Health Management Network Commercial	$2,027.25
Rate for Payer: Kaiser Permanente Commercial	$2,146.50
Rate for Payer: MDX Hawaii PPO	$2,313.45
Rate for Payer: University Health Alliance Commercial	$1,335.60

PLATE RADIAL COLUMN 3H RCP3

Facility

$2,385.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,192.50
Max. Negotiated Rate	$2,313.45
Rate for Payer: AlohaCare Medicaid	$1,192.50
Rate for Payer: AlohaCare Medicare	$1,812.60
Rate for Payer: Cash Price	$1,431.00
Rate for Payer: Devoted Health Medicare	$2,003.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,812.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,669.50
Rate for Payer: Health Management Network Commercial	$2,027.25
Rate for Payer: Humana Medicare	$1,812.60
Rate for Payer: Kaiser Permanente Commercial	$2,146.50
Rate for Payer: Kaiser Permanente Medicaid	$1,216.35
Rate for Payer: Kaiser Permanente Medicare	$1,812.60
Rate for Payer: MDX Hawaii PPO	$2,313.45
Rate for Payer: Ohana Health Plan Medicaid	$1,812.60
Rate for Payer: Ohana Health Plan Medicare	$1,812.60
Rate for Payer: UnitedHealthcare Medicare	$1,812.60
Rate for Payer: University Health Alliance Commercial	$1,335.60

PLATE RADIAL COLUMN 5H RCP5

Facility

$2,385.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.60
Max. Negotiated Rate	$2,313.45
Rate for Payer: Cash Price	$1,431.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,669.50
Rate for Payer: Health Management Network Commercial	$2,027.25
Rate for Payer: Kaiser Permanente Commercial	$2,146.50
Rate for Payer: MDX Hawaii PPO	$2,313.45
Rate for Payer: University Health Alliance Commercial	$1,335.60

PLATE RADIAL COLUMN 5H RCP5

Facility

$2,385.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,192.50
Max. Negotiated Rate	$2,313.45
Rate for Payer: AlohaCare Medicaid	$1,192.50
Rate for Payer: AlohaCare Medicare	$1,812.60
Rate for Payer: Cash Price	$1,431.00
Rate for Payer: Devoted Health Medicare	$2,003.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,812.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,669.50
Rate for Payer: Health Management Network Commercial	$2,027.25
Rate for Payer: Humana Medicare	$1,812.60
Rate for Payer: Kaiser Permanente Commercial	$2,146.50
Rate for Payer: Kaiser Permanente Medicaid	$1,216.35
Rate for Payer: Kaiser Permanente Medicare	$1,812.60
Rate for Payer: MDX Hawaii PPO	$2,313.45
Rate for Payer: Ohana Health Plan Medicaid	$1,812.60
Rate for Payer: Ohana Health Plan Medicare	$1,812.60
Rate for Payer: UnitedHealthcare Medicare	$1,812.60
Rate for Payer: University Health Alliance Commercial	$1,335.60

PLATE RADIAL COLUMN 7H RCP7

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$1,940.00
Rate for Payer: AlohaCare Medicaid	$1,000.00
Rate for Payer: AlohaCare Medicare	$1,520.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Devoted Health Medicare	$1,680.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.00
Rate for Payer: Health Management Network Commercial	$1,700.00
Rate for Payer: Humana Medicare	$1,520.00
Rate for Payer: Kaiser Permanente Commercial	$1,800.00
Rate for Payer: Kaiser Permanente Medicaid	$1,020.00
Rate for Payer: Kaiser Permanente Medicare	$1,520.00
Rate for Payer: MDX Hawaii PPO	$1,940.00
Rate for Payer: Ohana Health Plan Medicaid	$1,520.00
Rate for Payer: Ohana Health Plan Medicare	$1,520.00
Rate for Payer: UnitedHealthcare Medicare	$1,520.00
Rate for Payer: University Health Alliance Commercial	$1,120.00

PLATE RADIAL COLUMN 7H RCP7

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,120.00
Max. Negotiated Rate	$1,940.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.00
Rate for Payer: Health Management Network Commercial	$1,700.00
Rate for Payer: Kaiser Permanente Commercial	$1,800.00
Rate for Payer: MDX Hawaii PPO	$1,940.00
Rate for Payer: University Health Alliance Commercial	$1,120.00

PLATE RAD PEG LT 10PEG RPGL-10

Facility

$3,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,848.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

PLATE RAD PEG LT 10PEG RPGL-10

Facility

$3,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: AlohaCare Medicaid	$1,650.00
Rate for Payer: AlohaCare Medicare	$2,508.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Devoted Health Medicare	$2,772.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,508.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Humana Medicare	$2,508.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: Kaiser Permanente Medicaid	$1,683.00
Rate for Payer: Kaiser Permanente Medicare	$2,508.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: Ohana Health Plan Medicaid	$2,508.00
Rate for Payer: Ohana Health Plan Medicare	$2,508.00
Rate for Payer: UnitedHealthcare Medicare	$2,508.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

PLATE RAD PEG LT 7PEG RPGL-7

Facility

$2,480.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,388.80
Max. Negotiated Rate	$2,405.60
Rate for Payer: Cash Price	$1,488.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,736.00
Rate for Payer: Health Management Network Commercial	$2,108.00
Rate for Payer: Kaiser Permanente Commercial	$2,232.00
Rate for Payer: MDX Hawaii PPO	$2,405.60
Rate for Payer: University Health Alliance Commercial	$1,388.80

PLATE RAD PEG LT 7PEG RPGL-7

Facility

$2,480.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,240.00
Max. Negotiated Rate	$2,405.60
Rate for Payer: AlohaCare Medicaid	$1,240.00
Rate for Payer: AlohaCare Medicare	$1,884.80
Rate for Payer: Cash Price	$1,488.00
Rate for Payer: Devoted Health Medicare	$2,083.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,884.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,736.00
Rate for Payer: Health Management Network Commercial	$2,108.00
Rate for Payer: Humana Medicare	$1,884.80
Rate for Payer: Kaiser Permanente Commercial	$2,232.00
Rate for Payer: Kaiser Permanente Medicaid	$1,264.80
Rate for Payer: Kaiser Permanente Medicare	$1,884.80
Rate for Payer: MDX Hawaii PPO	$2,405.60
Rate for Payer: Ohana Health Plan Medicaid	$1,884.80
Rate for Payer: Ohana Health Plan Medicare	$1,884.80
Rate for Payer: UnitedHealthcare Medicare	$1,884.80
Rate for Payer: University Health Alliance Commercial	$1,388.80

PLATE RAD PEG RT 10PEG RPGR-10

Facility

$3,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,848.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

PLATE RAD PEG RT 10PEG RPGR-10

Facility

$3,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: AlohaCare Medicaid	$1,650.00
Rate for Payer: AlohaCare Medicare	$2,508.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Devoted Health Medicare	$2,772.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,508.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Humana Medicare	$2,508.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: Kaiser Permanente Medicaid	$1,683.00
Rate for Payer: Kaiser Permanente Medicare	$2,508.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: Ohana Health Plan Medicaid	$2,508.00
Rate for Payer: Ohana Health Plan Medicare	$2,508.00
Rate for Payer: UnitedHealthcare Medicare	$2,508.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

PLATE RAD PEG RT 7PEG RPGR-7

Facility

$2,910.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,629.60
Max. Negotiated Rate	$2,822.70
Rate for Payer: Cash Price	$1,746.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,037.00
Rate for Payer: Health Management Network Commercial	$2,473.50
Rate for Payer: Kaiser Permanente Commercial	$2,619.00
Rate for Payer: MDX Hawaii PPO	$2,822.70
Rate for Payer: University Health Alliance Commercial	$1,629.60

PLATE RAD PEG RT 7PEG RPGR-7

Facility

$2,910.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,455.00
Max. Negotiated Rate	$2,822.70
Rate for Payer: AlohaCare Medicaid	$1,455.00
Rate for Payer: AlohaCare Medicare	$2,211.60
Rate for Payer: Cash Price	$1,746.00
Rate for Payer: Devoted Health Medicare	$2,444.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,211.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,037.00
Rate for Payer: Health Management Network Commercial	$2,473.50
Rate for Payer: Humana Medicare	$2,211.60
Rate for Payer: Kaiser Permanente Commercial	$2,619.00
Rate for Payer: Kaiser Permanente Medicaid	$1,484.10
Rate for Payer: Kaiser Permanente Medicare	$2,211.60
Rate for Payer: MDX Hawaii PPO	$2,822.70
Rate for Payer: Ohana Health Plan Medicaid	$2,211.60
Rate for Payer: Ohana Health Plan Medicare	$2,211.60
Rate for Payer: UnitedHealthcare Medicare	$2,211.60
Rate for Payer: University Health Alliance Commercial	$1,629.60

PLATE RIGHT DVR SHORT DVRAS-R

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 RIGHT DVR SHORT DVRAS-R

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 RIGHT WIDE 4HOLE DVRAWR

Facility

$2,540.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,270.00
Max. Negotiated Rate	$2,463.80
Rate for Payer: AlohaCare Medicaid	$1,270.00
Rate for Payer: AlohaCare Medicare	$1,930.40
Rate for Payer: Cash Price	$1,524.00
Rate for Payer: Devoted Health Medicare	$2,133.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,930.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,778.00
Rate for Payer: Health Management Network Commercial	$2,159.00
Rate for Payer: Humana Medicare	$1,930.40
Rate for Payer: Kaiser Permanente Commercial	$2,286.00
Rate for Payer: Kaiser Permanente Medicaid	$1,295.40
Rate for Payer: Kaiser Permanente Medicare	$1,930.40
Rate for Payer: MDX Hawaii PPO	$2,463.80
Rate for Payer: Ohana Health Plan Medicaid	$1,930.40
Rate for Payer: Ohana Health Plan Medicare	$1,930.40
Rate for Payer: UnitedHealthcare Medicare	$1,930.40
Rate for Payer: University Health Alliance Commercial	$1,422.40

PLATE RIGHT WIDE 4HOLE DVRAWR

Facility

$2,540.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,422.40
Max. Negotiated Rate	$2,463.80
Rate for Payer: MDX Hawaii PPO	$2,463.80
Rate for Payer: Cash Price	$1,524.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,778.00
Rate for Payer: Health Management Network Commercial	$2,159.00
Rate for Payer: Kaiser Permanente Commercial	$2,286.00
Rate for Payer: University Health Alliance Commercial	$1,422.40

PLATE ROTATION W 5H 57-10185

Facility

$2,388.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,337.28
Max. Negotiated Rate	$2,316.36
Rate for Payer: Cash Price	$1,432.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,671.60
Rate for Payer: Health Management Network Commercial	$2,029.80
Rate for Payer: Kaiser Permanente Commercial	$2,149.20
Rate for Payer: MDX Hawaii PPO	$2,316.36
Rate for Payer: University Health Alliance Commercial	$1,337.28

PLATE ROTATION W 5H 57-10185

Facility

$2,388.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,194.00
Max. Negotiated Rate	$2,316.36
Rate for Payer: AlohaCare Medicaid	$1,194.00
Rate for Payer: AlohaCare Medicare	$1,814.88
Rate for Payer: Cash Price	$1,432.80
Rate for Payer: Devoted Health Medicare	$2,005.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,814.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,671.60
Rate for Payer: Health Management Network Commercial	$2,029.80
Rate for Payer: Humana Medicare	$1,814.88
Rate for Payer: Kaiser Permanente Commercial	$2,149.20
Rate for Payer: Kaiser Permanente Medicaid	$1,217.88
Rate for Payer: Kaiser Permanente Medicare	$1,814.88
Rate for Payer: MDX Hawaii PPO	$2,316.36
Rate for Payer: Ohana Health Plan Medicaid	$1,814.88
Rate for Payer: Ohana Health Plan Medicare	$1,814.88
Rate for Payer: UnitedHealthcare Medicare	$1,814.88
Rate for Payer: University Health Alliance Commercial	$1,337.28

PLATE RT 178MM 10H

Facility

$3,817.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,137.52
Max. Negotiated Rate	$3,702.49
Rate for Payer: Cash Price	$2,290.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,671.90
Rate for Payer: Health Management Network Commercial	$3,244.45
Rate for Payer: Kaiser Permanente Commercial	$3,435.30
Rate for Payer: MDX Hawaii PPO	$3,702.49
Rate for Payer: University Health Alliance Commercial	$2,137.52

PLATE RT 178MM 10H

Facility

$3,817.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,908.50
Max. Negotiated Rate	$3,702.49
Rate for Payer: AlohaCare Medicaid	$1,908.50
Rate for Payer: AlohaCare Medicare	$2,900.92
Rate for Payer: Cash Price	$2,290.20
Rate for Payer: Devoted Health Medicare	$3,206.28
Rate for Payer: Hawaii Medical Service Association Medicare	$2,900.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,671.90
Rate for Payer: Health Management Network Commercial	$3,244.45
Rate for Payer: Humana Medicare	$2,900.92
Rate for Payer: Kaiser Permanente Commercial	$3,435.30
Rate for Payer: Kaiser Permanente Medicaid	$1,946.67
Rate for Payer: Kaiser Permanente Medicare	$2,900.92
Rate for Payer: MDX Hawaii PPO	$3,702.49
Rate for Payer: Ohana Health Plan Medicaid	$2,900.92
Rate for Payer: Ohana Health Plan Medicare	$2,900.92
Rate for Payer: UnitedHealthcare Medicare	$2,900.92
Rate for Payer: University Health Alliance Commercial	$2,137.52

Know your out-of-pocket cost for care.

All Charges