Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE TI MATRIX 04.503.396

Facility

$2,892.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,446.00
Max. Negotiated Rate	$2,805.24
Rate for Payer: AlohaCare Medicaid	$1,446.00
Rate for Payer: AlohaCare Medicare	$2,197.92
Rate for Payer: Cash Price	$1,735.20
Rate for Payer: Devoted Health Medicare	$2,429.28
Rate for Payer: Hawaii Medical Service Association Medicare	$2,197.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,024.40
Rate for Payer: Health Management Network Commercial	$2,458.20
Rate for Payer: Humana Medicare	$2,197.92
Rate for Payer: Kaiser Permanente Commercial	$2,602.80
Rate for Payer: Kaiser Permanente Medicaid	$1,474.92
Rate for Payer: Kaiser Permanente Medicare	$2,197.92
Rate for Payer: MDX Hawaii PPO	$2,805.24
Rate for Payer: Ohana Health Plan Medicaid	$2,197.92
Rate for Payer: Ohana Health Plan Medicare	$2,197.92
Rate for Payer: UnitedHealthcare Medicare	$2,197.92
Rate for Payer: University Health Alliance Commercial	$1,619.52

PLATE TI MATRIX 04.503.396

Facility

$2,892.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,619.52
Max. Negotiated Rate	$2,805.24
Rate for Payer: Cash Price	$1,735.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,024.40
Rate for Payer: Health Management Network Commercial	$2,458.20
Rate for Payer: Kaiser Permanente Commercial	$2,602.80
Rate for Payer: MDX Hawaii PPO	$2,805.24
Rate for Payer: University Health Alliance Commercial	$1,619.52

PLATE TIT MANDI 12H 04.503.729

Facility

$2,770.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,551.20
Max. Negotiated Rate	$2,686.90
Rate for Payer: Cash Price	$1,662.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,939.00
Rate for Payer: Health Management Network Commercial	$2,354.50
Rate for Payer: Kaiser Permanente Commercial	$2,493.00
Rate for Payer: MDX Hawaii PPO	$2,686.90
Rate for Payer: University Health Alliance Commercial	$1,551.20

PLATE TIT MANDI 12H 04.503.729

Facility

$2,770.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,385.00
Max. Negotiated Rate	$2,686.90
Rate for Payer: AlohaCare Medicaid	$1,385.00
Rate for Payer: AlohaCare Medicare	$2,105.20
Rate for Payer: Cash Price	$1,662.00
Rate for Payer: Devoted Health Medicare	$2,326.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,105.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,939.00
Rate for Payer: Health Management Network Commercial	$2,354.50
Rate for Payer: Humana Medicare	$2,105.20
Rate for Payer: Kaiser Permanente Commercial	$2,493.00
Rate for Payer: Kaiser Permanente Medicaid	$1,412.70
Rate for Payer: Kaiser Permanente Medicare	$2,105.20
Rate for Payer: MDX Hawaii PPO	$2,686.90
Rate for Payer: Ohana Health Plan Medicaid	$2,105.20
Rate for Payer: Ohana Health Plan Medicare	$2,105.20
Rate for Payer: UnitedHealthcare Medicare	$2,105.20
Rate for Payer: University Health Alliance Commercial	$1,551.20

PLATE TIT MANDI 6H 04.503.728

Facility

$2,770.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,551.20
Max. Negotiated Rate	$2,686.90
Rate for Payer: Cash Price	$1,662.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,939.00
Rate for Payer: Health Management Network Commercial	$2,354.50
Rate for Payer: Kaiser Permanente Commercial	$2,493.00
Rate for Payer: MDX Hawaii PPO	$2,686.90
Rate for Payer: University Health Alliance Commercial	$1,551.20

PLATE TIT MANDI 6H 04.503.728

Facility

$2,770.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,385.00
Max. Negotiated Rate	$2,686.90
Rate for Payer: AlohaCare Medicaid	$1,385.00
Rate for Payer: AlohaCare Medicare	$2,105.20
Rate for Payer: Cash Price	$1,662.00
Rate for Payer: Devoted Health Medicare	$2,326.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,105.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,939.00
Rate for Payer: Health Management Network Commercial	$2,354.50
Rate for Payer: Humana Medicare	$2,105.20
Rate for Payer: Kaiser Permanente Commercial	$2,493.00
Rate for Payer: Kaiser Permanente Medicaid	$1,412.70
Rate for Payer: Kaiser Permanente Medicare	$2,105.20
Rate for Payer: MDX Hawaii PPO	$2,686.90
Rate for Payer: Ohana Health Plan Medicaid	$2,105.20
Rate for Payer: Ohana Health Plan Medicare	$2,105.20
Rate for Payer: UnitedHealthcare Medicare	$2,105.20
Rate for Payer: University Health Alliance Commercial	$1,551.20

PLATE T NARR LCK 2.0

Facility

$2,083.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,166.48
Max. Negotiated Rate	$2,020.51
Rate for Payer: Cash Price	$1,249.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,458.10
Rate for Payer: Health Management Network Commercial	$1,770.55
Rate for Payer: Kaiser Permanente Commercial	$1,874.70
Rate for Payer: MDX Hawaii PPO	$2,020.51
Rate for Payer: University Health Alliance Commercial	$1,166.48

PLATE T NARR LCK 2.0

Facility

$2,083.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.50
Max. Negotiated Rate	$2,020.51
Rate for Payer: AlohaCare Medicaid	$1,041.50
Rate for Payer: AlohaCare Medicare	$1,583.08
Rate for Payer: Cash Price	$1,249.80
Rate for Payer: Devoted Health Medicare	$1,749.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,583.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,458.10
Rate for Payer: Health Management Network Commercial	$1,770.55
Rate for Payer: Humana Medicare	$1,583.08
Rate for Payer: Kaiser Permanente Commercial	$1,874.70
Rate for Payer: Kaiser Permanente Medicaid	$1,062.33
Rate for Payer: Kaiser Permanente Medicare	$1,583.08
Rate for Payer: MDX Hawaii PPO	$2,020.51
Rate for Payer: Ohana Health Plan Medicaid	$1,583.08
Rate for Payer: Ohana Health Plan Medicare	$1,583.08
Rate for Payer: UnitedHealthcare Medicare	$1,583.08
Rate for Payer: University Health Alliance Commercial	$1,166.48

PLATE TUB 1/3 6H/73MM 241.36

Facility

$435.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$243.60
Max. Negotiated Rate	$421.95
Rate for Payer: Cash Price	$261.00
Rate for Payer: Hawaii Western Management Group Commercial	$304.50
Rate for Payer: Health Management Network Commercial	$369.75
Rate for Payer: Kaiser Permanente Commercial	$391.50
Rate for Payer: MDX Hawaii PPO	$421.95
Rate for Payer: University Health Alliance Commercial	$243.60

PLATE TUB 1/3 6H/73MM 241.36

Facility

$435.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$217.50
Max. Negotiated Rate	$421.95
Rate for Payer: AlohaCare Medicaid	$217.50
Rate for Payer: AlohaCare Medicare	$330.60
Rate for Payer: Cash Price	$261.00
Rate for Payer: Devoted Health Medicare	$365.40
Rate for Payer: Hawaii Medical Service Association Medicare	$330.60
Rate for Payer: Hawaii Western Management Group Commercial	$304.50
Rate for Payer: Health Management Network Commercial	$369.75
Rate for Payer: Humana Medicare	$330.60
Rate for Payer: Kaiser Permanente Commercial	$391.50
Rate for Payer: Kaiser Permanente Medicaid	$221.85
Rate for Payer: Kaiser Permanente Medicare	$330.60
Rate for Payer: MDX Hawaii PPO	$421.95
Rate for Payer: Ohana Health Plan Medicaid	$330.60
Rate for Payer: Ohana Health Plan Medicare	$330.60
Rate for Payer: UnitedHealthcare Medicare	$330.60
Rate for Payer: University Health Alliance Commercial	$243.60

PLATE TUBULAR 626674

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 TUBULAR 626674

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 TUBULAR 95MM 8 HOLES

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 TUBULAR 95MM 8 HOLES

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 ULNAR PEG 5H UPG-5

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 ULNAR PEG 5H UPG-5

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 ULNAR PEG 7H UPG-7

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 ULNAR PEG 7H UPG-7

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 VA-LCP 2.7X69 02.117.401

Facility

$2,749.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,539.44
Max. Negotiated Rate	$2,666.53
Rate for Payer: Cash Price	$1,649.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.30
Rate for Payer: Health Management Network Commercial	$2,336.65
Rate for Payer: Kaiser Permanente Commercial	$2,474.10
Rate for Payer: MDX Hawaii PPO	$2,666.53
Rate for Payer: University Health Alliance Commercial	$1,539.44

PLATE VA-LCP 2.7X69 02.117.401

Facility

$2,749.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,374.50
Max. Negotiated Rate	$2,666.53
Rate for Payer: AlohaCare Medicaid	$1,374.50
Rate for Payer: AlohaCare Medicare	$2,089.24
Rate for Payer: Cash Price	$1,649.40
Rate for Payer: Devoted Health Medicare	$2,309.16
Rate for Payer: Hawaii Medical Service Association Medicare	$2,089.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.30
Rate for Payer: Health Management Network Commercial	$2,336.65
Rate for Payer: Humana Medicare	$2,089.24
Rate for Payer: Kaiser Permanente Commercial	$2,474.10
Rate for Payer: Kaiser Permanente Medicaid	$1,401.99
Rate for Payer: Kaiser Permanente Medicare	$2,089.24
Rate for Payer: MDX Hawaii PPO	$2,666.53
Rate for Payer: Ohana Health Plan Medicaid	$2,089.24
Rate for Payer: Ohana Health Plan Medicare	$2,089.24
Rate for Payer: UnitedHealthcare Medicare	$2,089.24
Rate for Payer: University Health Alliance Commercial	$1,539.44

PLATE VA-LCP RT SM 02.127.220

Facility

$3,704.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,852.00
Max. Negotiated Rate	$3,592.88
Rate for Payer: AlohaCare Medicaid	$1,852.00
Rate for Payer: AlohaCare Medicare	$2,815.04
Rate for Payer: Cash Price	$2,222.40
Rate for Payer: Devoted Health Medicare	$3,111.36
Rate for Payer: Hawaii Medical Service Association Medicare	$2,815.04
Rate for Payer: Hawaii Western Management Group Commercial	$2,592.80
Rate for Payer: Health Management Network Commercial	$3,148.40
Rate for Payer: Humana Medicare	$2,815.04
Rate for Payer: Kaiser Permanente Commercial	$3,333.60
Rate for Payer: Kaiser Permanente Medicaid	$1,889.04
Rate for Payer: Kaiser Permanente Medicare	$2,815.04
Rate for Payer: MDX Hawaii PPO	$3,592.88
Rate for Payer: Ohana Health Plan Medicaid	$2,815.04
Rate for Payer: Ohana Health Plan Medicare	$2,815.04
Rate for Payer: UnitedHealthcare Medicare	$2,815.04
Rate for Payer: University Health Alliance Commercial	$2,074.24

PLATE VA-LCP RT SM 02.127.220

Facility

$3,704.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,074.24
Max. Negotiated Rate	$3,592.88
Rate for Payer: Cash Price	$2,222.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,592.80
Rate for Payer: Health Management Network Commercial	$3,148.40
Rate for Payer: Kaiser Permanente Commercial	$3,333.60
Rate for Payer: MDX Hawaii PPO	$3,592.88
Rate for Payer: University Health Alliance Commercial	$2,074.24

PLATE VOLAR DISTAL RAD RT 3H

Facility

$2,650.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,325.00
Max. Negotiated Rate	$2,570.50
Rate for Payer: AlohaCare Medicaid	$1,325.00
Rate for Payer: AlohaCare Medicare	$2,014.00
Rate for Payer: Cash Price	$1,590.00
Rate for Payer: Devoted Health Medicare	$2,226.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,014.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,855.00
Rate for Payer: Health Management Network Commercial	$2,252.50
Rate for Payer: Humana Medicare	$2,014.00
Rate for Payer: Kaiser Permanente Commercial	$2,385.00
Rate for Payer: Kaiser Permanente Medicaid	$1,351.50
Rate for Payer: Kaiser Permanente Medicare	$2,014.00
Rate for Payer: MDX Hawaii PPO	$2,570.50
Rate for Payer: Ohana Health Plan Medicaid	$2,014.00
Rate for Payer: Ohana Health Plan Medicare	$2,014.00
Rate for Payer: UnitedHealthcare Medicare	$2,014.00
Rate for Payer: University Health Alliance Commercial	$1,484.00

PLATE VOLAR DISTAL RAD RT 3H

Facility

$2,650.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,484.00
Max. Negotiated Rate	$2,570.50
Rate for Payer: Cash Price	$1,590.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,855.00
Rate for Payer: Health Management Network Commercial	$2,252.50
Rate for Payer: Kaiser Permanente Commercial	$2,385.00
Rate for Payer: MDX Hawaii PPO	$2,570.50
Rate for Payer: University Health Alliance Commercial	$1,484.00

PLATE VOLAR EXT LEFT DVRAX-L

Facility

$2,391.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,338.96
Max. Negotiated Rate	$2,319.27
Rate for Payer: Cash Price	$1,434.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,673.70
Rate for Payer: Health Management Network Commercial	$2,032.35
Rate for Payer: Kaiser Permanente Commercial	$2,151.90
Rate for Payer: MDX Hawaii PPO	$2,319.27
Rate for Payer: University Health Alliance Commercial	$1,338.96

Know your out-of-pocket cost for care.

All Charges