Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE STR 103MM 8H 629548

Facility

$2,900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,450.00
Max. Negotiated Rate	$2,813.00
Rate for Payer: AlohaCare Medicaid	$1,450.00
Rate for Payer: AlohaCare Medicare	$2,204.00
Rate for Payer: Cash Price	$1,740.00
Rate for Payer: Devoted Health Medicare	$2,436.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,204.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,030.00
Rate for Payer: Health Management Network Commercial	$2,465.00
Rate for Payer: Humana Medicare	$2,204.00
Rate for Payer: Kaiser Permanente Commercial	$2,610.00
Rate for Payer: Kaiser Permanente Medicaid	$1,479.00
Rate for Payer: Kaiser Permanente Medicare	$2,204.00
Rate for Payer: MDX Hawaii PPO	$2,813.00
Rate for Payer: Ohana Health Plan Medicaid	$2,204.00
Rate for Payer: Ohana Health Plan Medicare	$2,204.00
Rate for Payer: UnitedHealthcare Medicare	$2,204.00
Rate for Payer: University Health Alliance Commercial	$1,624.00

PLATE STR 103MM 8H 629548

Facility

$2,900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,624.00
Max. Negotiated Rate	$2,813.00
Rate for Payer: Cash Price	$1,740.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,030.00
Rate for Payer: Health Management Network Commercial	$2,465.00
Rate for Payer: Kaiser Permanente Commercial	$2,610.00
Rate for Payer: MDX Hawaii PPO	$2,813.00
Rate for Payer: University Health Alliance Commercial	$1,624.00

PLATE STRAIGHT 2.3X16 57-15316

Facility

$2,476.00

Service Code	HCPCS C1776
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 STRAIGHT 2.3X16 57-15316

Facility

$2,476.00

Service Code	HCPCS C1776
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 STR NARR 114MM 9H 629509

Facility

$2,225.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,246.00
Max. Negotiated Rate	$2,158.25
Rate for Payer: Cash Price	$1,335.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,557.50
Rate for Payer: Health Management Network Commercial	$1,891.25
Rate for Payer: Kaiser Permanente Commercial	$2,002.50
Rate for Payer: MDX Hawaii PPO	$2,158.25
Rate for Payer: University Health Alliance Commercial	$1,246.00

PLATE STR NARR 114MM 9H 629509

Facility

$2,225.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,112.50
Max. Negotiated Rate	$2,158.25
Rate for Payer: AlohaCare Medicaid	$1,112.50
Rate for Payer: AlohaCare Medicare	$1,691.00
Rate for Payer: Cash Price	$1,335.00
Rate for Payer: Devoted Health Medicare	$1,869.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,691.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,557.50
Rate for Payer: Health Management Network Commercial	$1,891.25
Rate for Payer: Humana Medicare	$1,691.00
Rate for Payer: Kaiser Permanente Commercial	$2,002.50
Rate for Payer: Kaiser Permanente Medicaid	$1,134.75
Rate for Payer: Kaiser Permanente Medicare	$1,691.00
Rate for Payer: MDX Hawaii PPO	$2,158.25
Rate for Payer: Ohana Health Plan Medicaid	$1,691.00
Rate for Payer: Ohana Health Plan Medicare	$1,691.00
Rate for Payer: UnitedHealthcare Medicare	$1,691.00
Rate for Payer: University Health Alliance Commercial	$1,246.00

PLATE STR NARR 90MM 7H 629527

Facility

$1,514.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$757.00
Max. Negotiated Rate	$1,468.58
Rate for Payer: AlohaCare Medicaid	$757.00
Rate for Payer: AlohaCare Medicare	$1,150.64
Rate for Payer: Cash Price	$908.40
Rate for Payer: Devoted Health Medicare	$1,271.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,150.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,059.80
Rate for Payer: Health Management Network Commercial	$1,286.90
Rate for Payer: Humana Medicare	$1,150.64
Rate for Payer: Kaiser Permanente Commercial	$1,362.60
Rate for Payer: Kaiser Permanente Medicaid	$772.14
Rate for Payer: Kaiser Permanente Medicare	$1,150.64
Rate for Payer: MDX Hawaii PPO	$1,468.58
Rate for Payer: Ohana Health Plan Medicaid	$1,150.64
Rate for Payer: Ohana Health Plan Medicare	$1,150.64
Rate for Payer: UnitedHealthcare Medicare	$1,150.64
Rate for Payer: University Health Alliance Commercial	$847.84

PLATE STR NARR 90MM 7H 629527

Facility

$1,514.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$847.84
Max. Negotiated Rate	$1,468.58
Rate for Payer: Cash Price	$908.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,059.80
Rate for Payer: Health Management Network Commercial	$1,286.90
Rate for Payer: Kaiser Permanente Commercial	$1,362.60
Rate for Payer: MDX Hawaii PPO	$1,468.58
Rate for Payer: University Health Alliance Commercial	$847.84

PLATE STR NARROW 54MM 4H

Facility

$1,331.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$665.50
Max. Negotiated Rate	$1,291.07
Rate for Payer: AlohaCare Medicaid	$665.50
Rate for Payer: AlohaCare Medicare	$1,011.56
Rate for Payer: Cash Price	$798.60
Rate for Payer: Devoted Health Medicare	$1,118.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1,011.56
Rate for Payer: Hawaii Western Management Group Commercial	$931.70
Rate for Payer: Health Management Network Commercial	$1,131.35
Rate for Payer: Humana Medicare	$1,011.56
Rate for Payer: Kaiser Permanente Commercial	$1,197.90
Rate for Payer: Kaiser Permanente Medicaid	$678.81
Rate for Payer: Kaiser Permanente Medicare	$1,011.56
Rate for Payer: MDX Hawaii PPO	$1,291.07
Rate for Payer: Ohana Health Plan Medicaid	$1,011.56
Rate for Payer: Ohana Health Plan Medicare	$1,011.56
Rate for Payer: UnitedHealthcare Medicare	$1,011.56
Rate for Payer: University Health Alliance Commercial	$745.36

PLATE STR NARROW 54MM 4H

Facility

$1,331.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$745.36
Max. Negotiated Rate	$1,291.07
Rate for Payer: Cash Price	$798.60
Rate for Payer: Hawaii Western Management Group Commercial	$931.70
Rate for Payer: Health Management Network Commercial	$1,131.35
Rate for Payer: Kaiser Permanente Commercial	$1,197.90
Rate for Payer: MDX Hawaii PPO	$1,291.07
Rate for Payer: University Health Alliance Commercial	$745.36

PLATE STR NARROW 66MM 5H

Facility

$1,514.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$847.84
Max. Negotiated Rate	$1,468.58
Rate for Payer: Cash Price	$908.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,059.80
Rate for Payer: Health Management Network Commercial	$1,286.90
Rate for Payer: Kaiser Permanente Commercial	$1,362.60
Rate for Payer: MDX Hawaii PPO	$1,468.58
Rate for Payer: University Health Alliance Commercial	$847.84

PLATE STR NARROW 66MM 5H

Facility

$1,514.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$757.00
Max. Negotiated Rate	$1,468.58
Rate for Payer: AlohaCare Medicaid	$757.00
Rate for Payer: AlohaCare Medicare	$1,150.64
Rate for Payer: Cash Price	$908.40
Rate for Payer: Devoted Health Medicare	$1,271.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,150.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,059.80
Rate for Payer: Health Management Network Commercial	$1,286.90
Rate for Payer: Humana Medicare	$1,150.64
Rate for Payer: Kaiser Permanente Commercial	$1,362.60
Rate for Payer: Kaiser Permanente Medicaid	$772.14
Rate for Payer: Kaiser Permanente Medicare	$1,150.64
Rate for Payer: MDX Hawaii PPO	$1,468.58
Rate for Payer: Ohana Health Plan Medicaid	$1,150.64
Rate for Payer: Ohana Health Plan Medicare	$1,150.64
Rate for Payer: UnitedHealthcare Medicare	$1,150.64
Rate for Payer: University Health Alliance Commercial	$847.84

PLATE SUPERIOR MIDSHAFT

Facility

$2,985.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,492.50
Max. Negotiated Rate	$2,895.45
Rate for Payer: AlohaCare Medicaid	$1,492.50
Rate for Payer: AlohaCare Medicare	$2,268.60
Rate for Payer: Cash Price	$1,791.00
Rate for Payer: Devoted Health Medicare	$2,507.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,268.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,089.50
Rate for Payer: Health Management Network Commercial	$2,537.25
Rate for Payer: Humana Medicare	$2,268.60
Rate for Payer: Kaiser Permanente Commercial	$2,686.50
Rate for Payer: Kaiser Permanente Medicaid	$1,522.35
Rate for Payer: Kaiser Permanente Medicare	$2,268.60
Rate for Payer: MDX Hawaii PPO	$2,895.45
Rate for Payer: Ohana Health Plan Medicaid	$2,268.60
Rate for Payer: Ohana Health Plan Medicare	$2,268.60
Rate for Payer: UnitedHealthcare Medicare	$2,268.60
Rate for Payer: University Health Alliance Commercial	$1,671.60

PLATE SUPERIOR MIDSHAFT

Facility

$2,985.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,671.60
Max. Negotiated Rate	$2,895.45
Rate for Payer: Cash Price	$1,791.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,089.50
Rate for Payer: Health Management Network Commercial	$2,537.25
Rate for Payer: Kaiser Permanente Commercial	$2,686.50
Rate for Payer: MDX Hawaii PPO	$2,895.45
Rate for Payer: University Health Alliance Commercial	$1,671.60

PLATE-T 3.5MM/3-HOLE 241.13

Facility

$401.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$224.56
Max. Negotiated Rate	$388.97
Rate for Payer: Cash Price	$240.60
Rate for Payer: Hawaii Western Management Group Commercial	$280.70
Rate for Payer: Health Management Network Commercial	$340.85
Rate for Payer: Kaiser Permanente Commercial	$360.90
Rate for Payer: MDX Hawaii PPO	$388.97
Rate for Payer: University Health Alliance Commercial	$224.56

PLATE-T 3.5MM/3-HOLE 241.13

Facility

$401.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$200.50
Max. Negotiated Rate	$388.97
Rate for Payer: AlohaCare Medicaid	$200.50
Rate for Payer: AlohaCare Medicare	$304.76
Rate for Payer: Cash Price	$240.60
Rate for Payer: Devoted Health Medicare	$336.84
Rate for Payer: Hawaii Medical Service Association Medicare	$304.76
Rate for Payer: Hawaii Western Management Group Commercial	$280.70
Rate for Payer: Health Management Network Commercial	$340.85
Rate for Payer: Humana Medicare	$304.76
Rate for Payer: Kaiser Permanente Commercial	$360.90
Rate for Payer: Kaiser Permanente Medicaid	$204.51
Rate for Payer: Kaiser Permanente Medicare	$304.76
Rate for Payer: MDX Hawaii PPO	$388.97
Rate for Payer: Ohana Health Plan Medicaid	$304.76
Rate for Payer: Ohana Health Plan Medicare	$304.76
Rate for Payer: UnitedHealthcare Medicare	$304.76
Rate for Payer: University Health Alliance Commercial	$224.56

PLATE-T 3.5MM/3-HOLE 241.23

Facility

$525.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$294.00
Max. Negotiated Rate	$509.25
Rate for Payer: Cash Price	$315.00
Rate for Payer: Hawaii Western Management Group Commercial	$367.50
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: MDX Hawaii PPO	$509.25
Rate for Payer: University Health Alliance Commercial	$294.00

PLATE-T 3.5MM/3-HOLE 241.23

Facility

$525.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$509.25
Rate for Payer: AlohaCare Medicaid	$262.50
Rate for Payer: AlohaCare Medicare	$399.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Devoted Health Medicare	$441.00
Rate for Payer: Hawaii Medical Service Association Medicare	$399.00
Rate for Payer: Hawaii Western Management Group Commercial	$367.50
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Humana Medicare	$399.00
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: Kaiser Permanente Medicaid	$267.75
Rate for Payer: Kaiser Permanente Medicare	$399.00
Rate for Payer: MDX Hawaii PPO	$509.25
Rate for Payer: Ohana Health Plan Medicaid	$399.00
Rate for Payer: Ohana Health Plan Medicare	$399.00
Rate for Payer: UnitedHealthcare Medicare	$399.00
Rate for Payer: University Health Alliance Commercial	$294.00

PLATE-T 3.5MM/4-HOLE 241.14

Facility

$413.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$206.50
Max. Negotiated Rate	$400.61
Rate for Payer: AlohaCare Medicaid	$206.50
Rate for Payer: AlohaCare Medicare	$313.88
Rate for Payer: Cash Price	$247.80
Rate for Payer: Devoted Health Medicare	$346.92
Rate for Payer: Hawaii Medical Service Association Medicare	$313.88
Rate for Payer: Hawaii Western Management Group Commercial	$289.10
Rate for Payer: Health Management Network Commercial	$351.05
Rate for Payer: Humana Medicare	$313.88
Rate for Payer: Kaiser Permanente Commercial	$371.70
Rate for Payer: Kaiser Permanente Medicaid	$210.63
Rate for Payer: Kaiser Permanente Medicare	$313.88
Rate for Payer: MDX Hawaii PPO	$400.61
Rate for Payer: Ohana Health Plan Medicaid	$313.88
Rate for Payer: Ohana Health Plan Medicare	$313.88
Rate for Payer: UnitedHealthcare Medicare	$313.88
Rate for Payer: University Health Alliance Commercial	$231.28

PLATE-T 3.5MM/4-HOLE 241.14

Facility

$413.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$231.28
Max. Negotiated Rate	$400.61
Rate for Payer: Cash Price	$247.80
Rate for Payer: Hawaii Western Management Group Commercial	$289.10
Rate for Payer: Health Management Network Commercial	$351.05
Rate for Payer: Kaiser Permanente Commercial	$371.70
Rate for Payer: MDX Hawaii PPO	$400.61
Rate for Payer: University Health Alliance Commercial	$231.28

PLATE-T 3.5MM/5-HOLE 241.25

Facility

$761.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$380.50
Max. Negotiated Rate	$738.17
Rate for Payer: AlohaCare Medicaid	$380.50
Rate for Payer: AlohaCare Medicare	$578.36
Rate for Payer: Cash Price	$456.60
Rate for Payer: Devoted Health Medicare	$639.24
Rate for Payer: Hawaii Medical Service Association Medicare	$578.36
Rate for Payer: Hawaii Western Management Group Commercial	$532.70
Rate for Payer: Health Management Network Commercial	$646.85
Rate for Payer: Humana Medicare	$578.36
Rate for Payer: Kaiser Permanente Commercial	$684.90
Rate for Payer: Kaiser Permanente Medicaid	$388.11
Rate for Payer: Kaiser Permanente Medicare	$578.36
Rate for Payer: MDX Hawaii PPO	$738.17
Rate for Payer: Ohana Health Plan Medicaid	$578.36
Rate for Payer: Ohana Health Plan Medicare	$578.36
Rate for Payer: UnitedHealthcare Medicare	$578.36
Rate for Payer: University Health Alliance Commercial	$426.16

PLATE-T 3.5MM/5-HOLE 241.25

Facility

$761.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$426.16
Max. Negotiated Rate	$738.17
Rate for Payer: Cash Price	$456.60
Rate for Payer: Hawaii Western Management Group Commercial	$532.70
Rate for Payer: Health Management Network Commercial	$646.85
Rate for Payer: Kaiser Permanente Commercial	$684.90
Rate for Payer: MDX Hawaii PPO	$738.17
Rate for Payer: University Health Alliance Commercial	$426.16

PLATE-T 3.5MM/5-HOLE RT 241.15

Facility

$461.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$230.50
Max. Negotiated Rate	$447.17
Rate for Payer: AlohaCare Medicaid	$230.50
Rate for Payer: AlohaCare Medicare	$350.36
Rate for Payer: Cash Price	$276.60
Rate for Payer: Devoted Health Medicare	$387.24
Rate for Payer: Hawaii Medical Service Association Medicare	$350.36
Rate for Payer: Hawaii Western Management Group Commercial	$322.70
Rate for Payer: Health Management Network Commercial	$391.85
Rate for Payer: Humana Medicare	$350.36
Rate for Payer: Kaiser Permanente Commercial	$414.90
Rate for Payer: Kaiser Permanente Medicaid	$235.11
Rate for Payer: Kaiser Permanente Medicare	$350.36
Rate for Payer: MDX Hawaii PPO	$447.17
Rate for Payer: Ohana Health Plan Medicaid	$350.36
Rate for Payer: Ohana Health Plan Medicare	$350.36
Rate for Payer: UnitedHealthcare Medicare	$350.36
Rate for Payer: University Health Alliance Commercial	$258.16

PLATE-T 3.5MM/5-HOLE RT 241.15

Facility

$461.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$258.16
Max. Negotiated Rate	$447.17
Rate for Payer: Cash Price	$276.60
Rate for Payer: Hawaii Western Management Group Commercial	$322.70
Rate for Payer: Health Management Network Commercial	$391.85
Rate for Payer: Kaiser Permanente Commercial	$414.90
Rate for Payer: MDX Hawaii PPO	$447.17
Rate for Payer: University Health Alliance Commercial	$258.16

PLATE-T 4H 84MM 240.14

Facility

$1,176.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$658.56
Max. Negotiated Rate	$1,140.72
Rate for Payer: Cash Price	$705.60
Rate for Payer: Hawaii Western Management Group Commercial	$823.20
Rate for Payer: Health Management Network Commercial	$999.60
Rate for Payer: Kaiser Permanente Commercial	$1,058.40
Rate for Payer: MDX Hawaii PPO	$1,140.72
Rate for Payer: University Health Alliance Commercial	$658.56

Know your out-of-pocket cost for care.

All Charges