Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE SIDEWINDER LT 7H SWOL-7W

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 RT 6H SWOR-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 RT 6H SWOR-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 RT 6H SWOR-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 RT 6H SWOR-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 RT 6H SWOR-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 RT 6H SWOR-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: Kaiser Permanente Medicare	$2,200.20
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: 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 RT 7H SWOR-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 RT 7H SWOR-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 RT 7H SWOR-7N

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 RT 7H SWOR-7N

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 RT 7H SWOR-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

PLATE SIDEWINDER RT 7H SWOR-7W

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 SMALL FRAGMENT 131217003

Facility

$1,671.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$835.50
Max. Negotiated Rate	$1,620.87
Rate for Payer: AlohaCare Medicaid	$835.50
Rate for Payer: AlohaCare Medicare	$1,269.96
Rate for Payer: Cash Price	$1,002.60
Rate for Payer: Devoted Health Medicare	$1,403.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,269.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,169.70
Rate for Payer: Health Management Network Commercial	$1,420.35
Rate for Payer: Humana Medicare	$1,269.96
Rate for Payer: Kaiser Permanente Commercial	$1,503.90
Rate for Payer: Kaiser Permanente Medicaid	$852.21
Rate for Payer: Kaiser Permanente Medicare	$1,269.96
Rate for Payer: MDX Hawaii PPO	$1,620.87
Rate for Payer: Ohana Health Plan Medicaid	$1,269.96
Rate for Payer: Ohana Health Plan Medicare	$1,269.96
Rate for Payer: UnitedHealthcare Medicare	$1,269.96
Rate for Payer: University Health Alliance Commercial	$935.76

PLATE SMALL FRAGMENT 131217003

Facility

$1,671.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$935.76
Max. Negotiated Rate	$1,620.87
Rate for Payer: Cash Price	$1,002.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,169.70
Rate for Payer: Health Management Network Commercial	$1,420.35
Rate for Payer: Kaiser Permanente Commercial	$1,503.90
Rate for Payer: MDX Hawaii PPO	$1,620.87
Rate for Payer: University Health Alliance Commercial	$935.76

PLATE SPOON 5HOLE/100MM 240.05

Facility

$914.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$511.84
Max. Negotiated Rate	$886.58
Rate for Payer: Cash Price	$548.40
Rate for Payer: Hawaii Western Management Group Commercial	$639.80
Rate for Payer: Health Management Network Commercial	$776.90
Rate for Payer: Kaiser Permanente Commercial	$822.60
Rate for Payer: MDX Hawaii PPO	$886.58
Rate for Payer: University Health Alliance Commercial	$511.84

PLATE SPOON 5HOLE/100MM 240.05

Facility

$914.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$457.00
Max. Negotiated Rate	$886.58
Rate for Payer: AlohaCare Medicaid	$457.00
Rate for Payer: AlohaCare Medicare	$694.64
Rate for Payer: Cash Price	$548.40
Rate for Payer: Devoted Health Medicare	$767.76
Rate for Payer: Hawaii Medical Service Association Medicare	$694.64
Rate for Payer: Hawaii Western Management Group Commercial	$639.80
Rate for Payer: Health Management Network Commercial	$776.90
Rate for Payer: Humana Medicare	$694.64
Rate for Payer: Kaiser Permanente Commercial	$822.60
Rate for Payer: Kaiser Permanente Medicaid	$466.14
Rate for Payer: Kaiser Permanente Medicare	$694.64
Rate for Payer: MDX Hawaii PPO	$886.58
Rate for Payer: Ohana Health Plan Medicaid	$694.64
Rate for Payer: Ohana Health Plan Medicare	$694.64
Rate for Payer: UnitedHealthcare Medicare	$694.64
Rate for Payer: University Health Alliance Commercial	$511.84

PLATE SPOON 6HOLE/120MM 240.06

Facility

$914.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$457.00
Max. Negotiated Rate	$886.58
Rate for Payer: AlohaCare Medicaid	$457.00
Rate for Payer: AlohaCare Medicare	$694.64
Rate for Payer: Cash Price	$548.40
Rate for Payer: Devoted Health Medicare	$767.76
Rate for Payer: Hawaii Medical Service Association Medicare	$694.64
Rate for Payer: Hawaii Western Management Group Commercial	$639.80
Rate for Payer: Health Management Network Commercial	$776.90
Rate for Payer: Humana Medicare	$694.64
Rate for Payer: Kaiser Permanente Commercial	$822.60
Rate for Payer: Kaiser Permanente Medicaid	$466.14
Rate for Payer: Kaiser Permanente Medicare	$694.64
Rate for Payer: MDX Hawaii PPO	$886.58
Rate for Payer: Ohana Health Plan Medicaid	$694.64
Rate for Payer: Ohana Health Plan Medicare	$694.64
Rate for Payer: UnitedHealthcare Medicare	$694.64
Rate for Payer: University Health Alliance Commercial	$511.84

PLATE SPOON 6HOLE/120MM 240.06

Facility

$914.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$511.84
Max. Negotiated Rate	$886.58
Rate for Payer: Cash Price	$548.40
Rate for Payer: Hawaii Western Management Group Commercial	$639.80
Rate for Payer: Health Management Network Commercial	$776.90
Rate for Payer: Kaiser Permanente Commercial	$822.60
Rate for Payer: MDX Hawaii PPO	$886.58
Rate for Payer: University Health Alliance Commercial	$511.84

PLATE STANDARD RIGHT DVRA-R

Facility

$2,235.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,251.60
Max. Negotiated Rate	$2,167.95
Rate for Payer: Cash Price	$1,341.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,564.50
Rate for Payer: Health Management Network Commercial	$1,899.75
Rate for Payer: Kaiser Permanente Commercial	$2,011.50
Rate for Payer: MDX Hawaii PPO	$2,167.95
Rate for Payer: University Health Alliance Commercial	$1,251.60

PLATE STANDARD RIGHT DVRA-R

Facility

$2,235.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,117.50
Max. Negotiated Rate	$2,167.95
Rate for Payer: AlohaCare Medicaid	$1,117.50
Rate for Payer: AlohaCare Medicare	$1,698.60
Rate for Payer: Cash Price	$1,341.00
Rate for Payer: Devoted Health Medicare	$1,877.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,698.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,564.50
Rate for Payer: Health Management Network Commercial	$1,899.75
Rate for Payer: Humana Medicare	$1,698.60
Rate for Payer: Kaiser Permanente Commercial	$2,011.50
Rate for Payer: Kaiser Permanente Medicaid	$1,139.85
Rate for Payer: Kaiser Permanente Medicare	$1,698.60
Rate for Payer: MDX Hawaii PPO	$2,167.95
Rate for Payer: Ohana Health Plan Medicaid	$1,698.60
Rate for Payer: Ohana Health Plan Medicare	$1,698.60
Rate for Payer: UnitedHealthcare Medicare	$1,698.60
Rate for Payer: University Health Alliance Commercial	$1,251.60

PLATE STD LFT 3H AR-8916VSL-03

Facility

$2,272.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,272.32
Max. Negotiated Rate	$2,203.84
Rate for Payer: Cash Price	$1,363.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,590.40
Rate for Payer: Health Management Network Commercial	$1,931.20
Rate for Payer: Kaiser Permanente Commercial	$2,044.80
Rate for Payer: MDX Hawaii PPO	$2,203.84
Rate for Payer: University Health Alliance Commercial	$1,272.32

PLATE STD LFT 3H AR-8916VSL-03

Facility

$2,272.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,136.00
Max. Negotiated Rate	$2,203.84
Rate for Payer: AlohaCare Medicaid	$1,136.00
Rate for Payer: AlohaCare Medicare	$1,726.72
Rate for Payer: Cash Price	$1,363.20
Rate for Payer: Devoted Health Medicare	$1,908.48
Rate for Payer: Hawaii Medical Service Association Medicare	$1,726.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,590.40
Rate for Payer: Health Management Network Commercial	$1,931.20
Rate for Payer: Humana Medicare	$1,726.72
Rate for Payer: Kaiser Permanente Commercial	$2,044.80
Rate for Payer: Kaiser Permanente Medicaid	$1,158.72
Rate for Payer: Kaiser Permanente Medicare	$1,726.72
Rate for Payer: MDX Hawaii PPO	$2,203.84
Rate for Payer: Ohana Health Plan Medicaid	$1,726.72
Rate for Payer: Ohana Health Plan Medicare	$1,726.72
Rate for Payer: UnitedHealthcare Medicare	$1,726.72
Rate for Payer: University Health Alliance Commercial	$1,272.32

PLATE STD RT ANKLE 28.14.102

Facility

$3,800.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,128.00
Max. Negotiated Rate	$3,686.00
Rate for Payer: Cash Price	$2,280.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,660.00
Rate for Payer: Health Management Network Commercial	$3,230.00
Rate for Payer: Kaiser Permanente Commercial	$3,420.00
Rate for Payer: MDX Hawaii PPO	$3,686.00
Rate for Payer: University Health Alliance Commercial	$2,128.00

PLATE STD RT ANKLE 28.14.102

Facility

$3,800.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,900.00
Max. Negotiated Rate	$3,686.00
Rate for Payer: AlohaCare Medicaid	$1,900.00
Rate for Payer: AlohaCare Medicare	$2,888.00
Rate for Payer: Cash Price	$2,280.00
Rate for Payer: Devoted Health Medicare	$3,192.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,888.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,660.00
Rate for Payer: Health Management Network Commercial	$3,230.00
Rate for Payer: Humana Medicare	$2,888.00
Rate for Payer: Kaiser Permanente Commercial	$3,420.00
Rate for Payer: Kaiser Permanente Medicaid	$1,938.00
Rate for Payer: Kaiser Permanente Medicare	$2,888.00
Rate for Payer: MDX Hawaii PPO	$3,686.00
Rate for Payer: Ohana Health Plan Medicaid	$2,888.00
Rate for Payer: Ohana Health Plan Medicare	$2,888.00
Rate for Payer: UnitedHealthcare Medicare	$2,888.00
Rate for Payer: University Health Alliance Commercial	$2,128.00

Know your out-of-pocket cost for care.

All Charges