Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE RT 3.5/4X58MM 336-3545

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 RT 3.5/4X58MM 336-3545

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 RT 4H 3.5X109 02.112.510

Facility

$3,221.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,803.76
Max. Negotiated Rate	$3,124.37
Rate for Payer: Cash Price	$1,932.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,254.70
Rate for Payer: Health Management Network Commercial	$2,737.85
Rate for Payer: Kaiser Permanente Commercial	$2,898.90
Rate for Payer: MDX Hawaii PPO	$3,124.37
Rate for Payer: University Health Alliance Commercial	$1,803.76

PLATE RT 4H 3.5X109 02.112.510

Facility

$3,221.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,610.50
Max. Negotiated Rate	$3,124.37
Rate for Payer: AlohaCare Medicaid	$1,610.50
Rate for Payer: AlohaCare Medicare	$2,447.96
Rate for Payer: Cash Price	$1,932.60
Rate for Payer: Devoted Health Medicare	$2,705.64
Rate for Payer: Hawaii Medical Service Association Medicare	$2,447.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,254.70
Rate for Payer: Health Management Network Commercial	$2,737.85
Rate for Payer: Humana Medicare	$2,447.96
Rate for Payer: Kaiser Permanente Commercial	$2,898.90
Rate for Payer: Kaiser Permanente Medicaid	$1,642.71
Rate for Payer: Kaiser Permanente Medicare	$2,447.96
Rate for Payer: MDX Hawaii PPO	$3,124.37
Rate for Payer: Ohana Health Plan Medicaid	$2,447.96
Rate for Payer: Ohana Health Plan Medicare	$2,447.96
Rate for Payer: UnitedHealthcare Medicare	$2,447.96
Rate for Payer: University Health Alliance Commercial	$1,803.76

PLATE RT MI 3.5X65MM 336-3546

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 RT MI 3.5X65MM 336-3546

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 RT XS CRV 8H AR-2654CR

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 RT XS CRV 8H AR-2654CR

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 RT X-SMALL CURVE 8 HOLE

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 RT X-SMALL CURVE 8 HOLE

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 SEMI-TUB 4H/71MM 222.04

Facility

$380.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$190.00
Max. Negotiated Rate	$368.60
Rate for Payer: AlohaCare Medicaid	$190.00
Rate for Payer: AlohaCare Medicare	$288.80
Rate for Payer: Cash Price	$228.00
Rate for Payer: Devoted Health Medicare	$319.20
Rate for Payer: Hawaii Medical Service Association Medicare	$288.80
Rate for Payer: Hawaii Western Management Group Commercial	$266.00
Rate for Payer: Health Management Network Commercial	$323.00
Rate for Payer: Humana Medicare	$288.80
Rate for Payer: Kaiser Permanente Commercial	$342.00
Rate for Payer: Kaiser Permanente Medicaid	$193.80
Rate for Payer: Kaiser Permanente Medicare	$288.80
Rate for Payer: MDX Hawaii PPO	$368.60
Rate for Payer: Ohana Health Plan Medicaid	$288.80
Rate for Payer: Ohana Health Plan Medicare	$288.80
Rate for Payer: UnitedHealthcare Medicare	$288.80
Rate for Payer: University Health Alliance Commercial	$212.80

PLATE SEMI-TUB 4H/71MM 222.04

Facility

$380.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$212.80
Max. Negotiated Rate	$368.60
Rate for Payer: Cash Price	$228.00
Rate for Payer: Hawaii Western Management Group Commercial	$266.00
Rate for Payer: Health Management Network Commercial	$323.00
Rate for Payer: Kaiser Permanente Commercial	$342.00
Rate for Payer: MDX Hawaii PPO	$368.60
Rate for Payer: University Health Alliance Commercial	$212.80

PLATE SEMI-TUBULAR 5H SMTP-5

Facility

$1,260.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$705.60
Max. Negotiated Rate	$1,222.20
Rate for Payer: Cash Price	$756.00
Rate for Payer: Hawaii Western Management Group Commercial	$882.00
Rate for Payer: Health Management Network Commercial	$1,071.00
Rate for Payer: Kaiser Permanente Commercial	$1,134.00
Rate for Payer: MDX Hawaii PPO	$1,222.20
Rate for Payer: University Health Alliance Commercial	$705.60

PLATE SEMI-TUBULAR 5H SMTP-5

Facility

$1,260.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$630.00
Max. Negotiated Rate	$1,222.20
Rate for Payer: AlohaCare Medicaid	$630.00
Rate for Payer: AlohaCare Medicare	$957.60
Rate for Payer: Cash Price	$756.00
Rate for Payer: Devoted Health Medicare	$1,058.40
Rate for Payer: Hawaii Medical Service Association Medicare	$957.60
Rate for Payer: Hawaii Western Management Group Commercial	$882.00
Rate for Payer: Health Management Network Commercial	$1,071.00
Rate for Payer: Humana Medicare	$957.60
Rate for Payer: Kaiser Permanente Commercial	$1,134.00
Rate for Payer: Kaiser Permanente Medicaid	$642.60
Rate for Payer: Kaiser Permanente Medicare	$957.60
Rate for Payer: MDX Hawaii PPO	$1,222.20
Rate for Payer: Ohana Health Plan Medicaid	$957.60
Rate for Payer: Ohana Health Plan Medicare	$957.60
Rate for Payer: UnitedHealthcare Medicare	$957.60
Rate for Payer: University Health Alliance Commercial	$705.60

PLATE SEMI-TUBULAR 8H SMTP-8

Facility

$1,418.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$709.00
Max. Negotiated Rate	$1,375.46
Rate for Payer: AlohaCare Medicaid	$709.00
Rate for Payer: AlohaCare Medicare	$1,077.68
Rate for Payer: Cash Price	$850.80
Rate for Payer: Devoted Health Medicare	$1,191.12
Rate for Payer: Hawaii Medical Service Association Medicare	$1,077.68
Rate for Payer: Hawaii Western Management Group Commercial	$992.60
Rate for Payer: Health Management Network Commercial	$1,205.30
Rate for Payer: Humana Medicare	$1,077.68
Rate for Payer: Kaiser Permanente Commercial	$1,276.20
Rate for Payer: Kaiser Permanente Medicaid	$723.18
Rate for Payer: Kaiser Permanente Medicare	$1,077.68
Rate for Payer: MDX Hawaii PPO	$1,375.46
Rate for Payer: Ohana Health Plan Medicaid	$1,077.68
Rate for Payer: Ohana Health Plan Medicare	$1,077.68
Rate for Payer: UnitedHealthcare Medicare	$1,077.68
Rate for Payer: University Health Alliance Commercial	$794.08

PLATE SEMI-TUBULAR 8H SMTP-8

Facility

$1,418.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$794.08
Max. Negotiated Rate	$1,375.46
Rate for Payer: Cash Price	$850.80
Rate for Payer: Hawaii Western Management Group Commercial	$992.60
Rate for Payer: Health Management Network Commercial	$1,205.30
Rate for Payer: Kaiser Permanente Commercial	$1,276.20
Rate for Payer: MDX Hawaii PPO	$1,375.46
Rate for Payer: University Health Alliance Commercial	$794.08

PLATE SIDEWINDER LT 6H SWOL-6M

Facility

$2,895.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,447.50
Max. Negotiated Rate	$2,808.15
Rate for Payer: AlohaCare Medicaid	$1,447.50
Rate for Payer: AlohaCare Medicare	$2,200.20
Rate for Payer: Cash Price	$1,737.00
Rate for Payer: Devoted Health Medicare	$2,431.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,200.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,026.50
Rate for Payer: Health Management Network Commercial	$2,460.75
Rate for Payer: Humana Medicare	$2,200.20
Rate for Payer: Kaiser Permanente Commercial	$2,605.50
Rate for Payer: Kaiser Permanente Medicaid	$1,476.45
Rate for Payer: Kaiser Permanente Medicare	$2,200.20
Rate for Payer: MDX Hawaii PPO	$2,808.15
Rate for Payer: Ohana Health Plan Medicaid	$2,200.20
Rate for Payer: Ohana Health Plan Medicare	$2,200.20
Rate for Payer: UnitedHealthcare Medicare	$2,200.20
Rate for Payer: University Health Alliance Commercial	$1,621.20

PLATE SIDEWINDER LT 6H SWOL-6M

Facility

$2,895.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,621.20
Max. Negotiated Rate	$2,808.15
Rate for Payer: Cash Price	$1,737.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,026.50
Rate for Payer: Health Management Network Commercial	$2,460.75
Rate for Payer: Kaiser Permanente Commercial	$2,605.50
Rate for Payer: MDX Hawaii PPO	$2,808.15
Rate for Payer: University Health Alliance Commercial	$1,621.20

PLATE SIDEWINDER LT 6H SWOL-6N

Facility

$2,895.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,447.50
Max. Negotiated Rate	$2,808.15
Rate for Payer: AlohaCare Medicaid	$1,447.50
Rate for Payer: AlohaCare Medicare	$2,200.20
Rate for Payer: Cash Price	$1,737.00
Rate for Payer: Devoted Health Medicare	$2,431.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,200.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,026.50
Rate for Payer: Health Management Network Commercial	$2,460.75
Rate for Payer: Humana Medicare	$2,200.20
Rate for Payer: Kaiser Permanente Commercial	$2,605.50
Rate for Payer: Kaiser Permanente Medicaid	$1,476.45
Rate for Payer: Kaiser Permanente Medicare	$2,200.20
Rate for Payer: MDX Hawaii PPO	$2,808.15
Rate for Payer: Ohana Health Plan Medicaid	$2,200.20
Rate for Payer: Ohana Health Plan Medicare	$2,200.20
Rate for Payer: UnitedHealthcare Medicare	$2,200.20
Rate for Payer: University Health Alliance Commercial	$1,621.20

PLATE SIDEWINDER LT 6H SWOL-6N

Facility

$2,895.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,621.20
Max. Negotiated Rate	$2,808.15
Rate for Payer: Cash Price	$1,737.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,026.50
Rate for Payer: Health Management Network Commercial	$2,460.75
Rate for Payer: Kaiser Permanente Commercial	$2,605.50
Rate for Payer: MDX Hawaii PPO	$2,808.15
Rate for Payer: University Health Alliance Commercial	$1,621.20

PLATE SIDEWINDER LT 6H SWOL-6W

Facility

$2,895.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,621.20
Max. Negotiated Rate	$2,808.15
Rate for Payer: Cash Price	$1,737.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,026.50
Rate for Payer: Health Management Network Commercial	$2,460.75
Rate for Payer: Kaiser Permanente Commercial	$2,605.50
Rate for Payer: MDX Hawaii PPO	$2,808.15
Rate for Payer: University Health Alliance Commercial	$1,621.20

PLATE SIDEWINDER LT 6H SWOL-6W

Facility

$2,895.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,447.50
Max. Negotiated Rate	$2,808.15
Rate for Payer: AlohaCare Medicaid	$1,447.50
Rate for Payer: AlohaCare Medicare	$2,200.20
Rate for Payer: Cash Price	$1,737.00
Rate for Payer: Devoted Health Medicare	$2,431.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,200.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,026.50
Rate for Payer: Health Management Network Commercial	$2,460.75
Rate for Payer: Humana Medicare	$2,200.20
Rate for Payer: Kaiser Permanente Commercial	$2,605.50
Rate for Payer: Kaiser Permanente Medicaid	$1,476.45
Rate for Payer: Kaiser Permanente Medicare	$2,200.20
Rate for Payer: MDX Hawaii PPO	$2,808.15
Rate for Payer: Ohana Health Plan Medicaid	$2,200.20
Rate for Payer: Ohana Health Plan Medicare	$2,200.20
Rate for Payer: UnitedHealthcare Medicare	$2,200.20
Rate for Payer: University Health Alliance Commercial	$1,621.20

PLATE SIDEWINDER LT 7H SWOL-7M

Facility

$2,200.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$2,134.00
Rate for Payer: AlohaCare Medicaid	$1,100.00
Rate for Payer: AlohaCare Medicare	$1,672.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Devoted Health Medicare	$1,848.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,672.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,540.00
Rate for Payer: Health Management Network Commercial	$1,870.00
Rate for Payer: Humana Medicare	$1,672.00
Rate for Payer: Kaiser Permanente Commercial	$1,980.00
Rate for Payer: Kaiser Permanente Medicaid	$1,122.00
Rate for Payer: Kaiser Permanente Medicare	$1,672.00
Rate for Payer: MDX Hawaii PPO	$2,134.00
Rate for Payer: Ohana Health Plan Medicaid	$1,672.00
Rate for Payer: Ohana Health Plan Medicare	$1,672.00
Rate for Payer: UnitedHealthcare Medicare	$1,672.00
Rate for Payer: University Health Alliance Commercial	$1,232.00

PLATE SIDEWINDER LT 7H SWOL-7M

Facility

$2,200.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,232.00
Max. Negotiated Rate	$2,134.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,540.00
Rate for Payer: Health Management Network Commercial	$1,870.00
Rate for Payer: Kaiser Permanente Commercial	$1,980.00
Rate for Payer: MDX Hawaii PPO	$2,134.00
Rate for Payer: University Health Alliance Commercial	$1,232.00

PLATE SIDEWINDER LT 7H SWOL-7W

Facility

$2,200.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,232.00
Max. Negotiated Rate	$2,134.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,540.00
Rate for Payer: Health Management Network Commercial	$1,870.00
Rate for Payer: Kaiser Permanente Commercial	$1,980.00
Rate for Payer: MDX Hawaii PPO	$2,134.00
Rate for Payer: University Health Alliance Commercial	$1,232.00

Know your out-of-pocket cost for care.

All Charges