Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE WIRE FORM 5H WFP5

Facility

$1,680.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$940.80
Max. Negotiated Rate	$1,629.60
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,176.00
Rate for Payer: Health Management Network Commercial	$1,428.00
Rate for Payer: Kaiser Permanente Commercial	$1,512.00
Rate for Payer: MDX Hawaii PPO	$1,629.60
Rate for Payer: University Health Alliance Commercial	$940.80

PLATE WIRE FORM 5H WFP5

Facility

$1,680.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,629.60
Rate for Payer: AlohaCare Medicaid	$840.00
Rate for Payer: AlohaCare Medicare	$1,276.80
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Devoted Health Medicare	$1,411.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,276.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,176.00
Rate for Payer: Health Management Network Commercial	$1,428.00
Rate for Payer: Humana Medicare	$1,276.80
Rate for Payer: Kaiser Permanente Commercial	$1,512.00
Rate for Payer: Kaiser Permanente Medicaid	$856.80
Rate for Payer: Kaiser Permanente Medicare	$1,276.80
Rate for Payer: MDX Hawaii PPO	$1,629.60
Rate for Payer: Ohana Health Plan Medicaid	$1,276.80
Rate for Payer: Ohana Health Plan Medicare	$1,276.80
Rate for Payer: UnitedHealthcare Medicare	$1,276.80
Rate for Payer: University Health Alliance Commercial	$940.80

PLATE WRIST FUSION RFP-SHB

Facility

$2,070.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,159.20
Max. Negotiated Rate	$2,007.90
Rate for Payer: Cash Price	$1,242.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,449.00
Rate for Payer: Health Management Network Commercial	$1,759.50
Rate for Payer: Kaiser Permanente Commercial	$1,863.00
Rate for Payer: MDX Hawaii PPO	$2,007.90
Rate for Payer: University Health Alliance Commercial	$1,159.20

PLATE WRIST FUSION RFP-SHB

Facility

$2,070.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.00
Max. Negotiated Rate	$2,007.90
Rate for Payer: AlohaCare Medicaid	$1,035.00
Rate for Payer: AlohaCare Medicare	$1,573.20
Rate for Payer: Cash Price	$1,242.00
Rate for Payer: Devoted Health Medicare	$1,738.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,573.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,449.00
Rate for Payer: Health Management Network Commercial	$1,759.50
Rate for Payer: Humana Medicare	$1,573.20
Rate for Payer: Kaiser Permanente Commercial	$1,863.00
Rate for Payer: Kaiser Permanente Medicaid	$1,055.70
Rate for Payer: Kaiser Permanente Medicare	$1,573.20
Rate for Payer: MDX Hawaii PPO	$2,007.90
Rate for Payer: Ohana Health Plan Medicaid	$1,573.20
Rate for Payer: Ohana Health Plan Medicare	$1,573.20
Rate for Payer: UnitedHealthcare Medicare	$1,573.20
Rate for Payer: University Health Alliance Commercial	$1,159.20

PLATE WRIST FUSION STR RFP-STR

Facility

$2,070.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,159.20
Max. Negotiated Rate	$2,007.90
Rate for Payer: Cash Price	$1,242.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,449.00
Rate for Payer: Health Management Network Commercial	$1,759.50
Rate for Payer: Kaiser Permanente Commercial	$1,863.00
Rate for Payer: MDX Hawaii PPO	$2,007.90
Rate for Payer: University Health Alliance Commercial	$1,159.20

PLATE WRIST FUSION STR RFP-STR

Facility

$2,070.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.00
Max. Negotiated Rate	$2,007.90
Rate for Payer: AlohaCare Medicaid	$1,035.00
Rate for Payer: AlohaCare Medicare	$1,573.20
Rate for Payer: Cash Price	$1,242.00
Rate for Payer: Devoted Health Medicare	$1,738.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,573.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,449.00
Rate for Payer: Health Management Network Commercial	$1,759.50
Rate for Payer: Humana Medicare	$1,573.20
Rate for Payer: Kaiser Permanente Commercial	$1,863.00
Rate for Payer: Kaiser Permanente Medicaid	$1,055.70
Rate for Payer: Kaiser Permanente Medicare	$1,573.20
Rate for Payer: MDX Hawaii PPO	$2,007.90
Rate for Payer: Ohana Health Plan Medicaid	$1,573.20
Rate for Payer: Ohana Health Plan Medicare	$1,573.20
Rate for Payer: UnitedHealthcare Medicare	$1,573.20
Rate for Payer: University Health Alliance Commercial	$1,159.20

PLATE WRIST SPANNING TI

Facility

$5,984.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,351.04
Max. Negotiated Rate	$5,804.48
Rate for Payer: Cash Price	$3,590.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,188.80
Rate for Payer: Health Management Network Commercial	$5,086.40
Rate for Payer: Kaiser Permanente Commercial	$5,385.60
Rate for Payer: MDX Hawaii PPO	$5,804.48
Rate for Payer: University Health Alliance Commercial	$3,351.04

PLATE WRIST SPANNING TI

Facility

$5,984.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,992.00
Max. Negotiated Rate	$5,804.48
Rate for Payer: AlohaCare Medicaid	$2,992.00
Rate for Payer: AlohaCare Medicare	$4,547.84
Rate for Payer: Cash Price	$3,590.40
Rate for Payer: Devoted Health Medicare	$5,026.56
Rate for Payer: Hawaii Medical Service Association Medicare	$4,547.84
Rate for Payer: Hawaii Western Management Group Commercial	$4,188.80
Rate for Payer: Health Management Network Commercial	$5,086.40
Rate for Payer: Humana Medicare	$4,547.84
Rate for Payer: Kaiser Permanente Commercial	$5,385.60
Rate for Payer: Kaiser Permanente Medicaid	$3,051.84
Rate for Payer: Kaiser Permanente Medicare	$4,547.84
Rate for Payer: MDX Hawaii PPO	$5,804.48
Rate for Payer: Ohana Health Plan Medicaid	$4,547.84
Rate for Payer: Ohana Health Plan Medicare	$4,547.84
Rate for Payer: UnitedHealthcare Medicare	$4,547.84
Rate for Payer: University Health Alliance Commercial	$3,351.04

PLATE Y 629770

Facility

$2,739.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.84
Max. Negotiated Rate	$2,656.83
Rate for Payer: Cash Price	$1,643.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,917.30
Rate for Payer: Health Management Network Commercial	$2,328.15
Rate for Payer: Kaiser Permanente Commercial	$2,465.10
Rate for Payer: MDX Hawaii PPO	$2,656.83
Rate for Payer: University Health Alliance Commercial	$1,533.84

PLATE Y 629770

Facility

$2,739.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,369.50
Max. Negotiated Rate	$2,656.83
Rate for Payer: AlohaCare Medicaid	$1,369.50
Rate for Payer: AlohaCare Medicare	$2,081.64
Rate for Payer: Cash Price	$1,643.40
Rate for Payer: Devoted Health Medicare	$2,300.76
Rate for Payer: Hawaii Medical Service Association Medicare	$2,081.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,917.30
Rate for Payer: Health Management Network Commercial	$2,328.15
Rate for Payer: Humana Medicare	$2,081.64
Rate for Payer: Kaiser Permanente Commercial	$2,465.10
Rate for Payer: Kaiser Permanente Medicaid	$1,396.89
Rate for Payer: Kaiser Permanente Medicare	$2,081.64
Rate for Payer: MDX Hawaii PPO	$2,656.83
Rate for Payer: Ohana Health Plan Medicaid	$2,081.64
Rate for Payer: Ohana Health Plan Medicare	$2,081.64
Rate for Payer: UnitedHealthcare Medicare	$2,081.64
Rate for Payer: University Health Alliance Commercial	$1,533.84

PLATE Y NARROW 7H 57-10170

Facility

$1,562.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$781.00
Max. Negotiated Rate	$1,515.14
Rate for Payer: AlohaCare Medicaid	$781.00
Rate for Payer: AlohaCare Medicare	$1,187.12
Rate for Payer: Cash Price	$937.20
Rate for Payer: Devoted Health Medicare	$1,312.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,187.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.40
Rate for Payer: Health Management Network Commercial	$1,327.70
Rate for Payer: Humana Medicare	$1,187.12
Rate for Payer: Kaiser Permanente Commercial	$1,405.80
Rate for Payer: Kaiser Permanente Medicaid	$796.62
Rate for Payer: Kaiser Permanente Medicare	$1,187.12
Rate for Payer: MDX Hawaii PPO	$1,515.14
Rate for Payer: Ohana Health Plan Medicaid	$1,187.12
Rate for Payer: Ohana Health Plan Medicare	$1,187.12
Rate for Payer: UnitedHealthcare Medicare	$1,187.12
Rate for Payer: University Health Alliance Commercial	$874.72

PLATE Y NARROW 7H 57-10170

Facility

$1,562.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$874.72
Max. Negotiated Rate	$1,515.14
Rate for Payer: Cash Price	$937.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.40
Rate for Payer: Health Management Network Commercial	$1,327.70
Rate for Payer: Kaiser Permanente Commercial	$1,405.80
Rate for Payer: MDX Hawaii PPO	$1,515.14
Rate for Payer: University Health Alliance Commercial	$874.72

PLATFORM GELPOINT 11CM C2A11

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$2,182.50
Rate for Payer: AlohaCare Medicaid	$1,125.00
Rate for Payer: AlohaCare Medicare	$1,710.00
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Devoted Health Medicare	$1,890.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,710.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,137.50
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Humana Medicare	$1,710.00
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: Kaiser Permanente Medicaid	$1,147.50
Rate for Payer: Kaiser Permanente Medicare	$1,710.00
Rate for Payer: MDX Hawaii PPO	$2,182.50
Rate for Payer: Ohana Health Plan Medicaid	$1,710.00
Rate for Payer: Ohana Health Plan Medicare	$1,710.00
Rate for Payer: UnitedHealthcare Medicare	$1,710.00
Rate for Payer: University Health Alliance Commercial	$1,640.03

PLATFORM GELPOINT 11CM C2A11

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,912.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: MDX Hawaii PPO	$2,182.50

PLATFORM GELPOINT 12CM C2A12

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$2,182.50
Rate for Payer: AlohaCare Medicaid	$1,125.00
Rate for Payer: AlohaCare Medicare	$1,710.00
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Devoted Health Medicare	$1,890.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,710.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,137.50
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Humana Medicare	$1,710.00
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: Kaiser Permanente Medicaid	$1,147.50
Rate for Payer: Kaiser Permanente Medicare	$1,710.00
Rate for Payer: MDX Hawaii PPO	$2,182.50
Rate for Payer: Ohana Health Plan Medicaid	$1,710.00
Rate for Payer: Ohana Health Plan Medicare	$1,710.00
Rate for Payer: UnitedHealthcare Medicare	$1,710.00
Rate for Payer: University Health Alliance Commercial	$1,640.03

PLATFORM GELPOINT 12CM C2A12

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,912.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: MDX Hawaii PPO	$2,182.50

PLATFORM GELPOINT 7CM C2A15

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$2,182.50
Rate for Payer: AlohaCare Medicaid	$1,125.00
Rate for Payer: AlohaCare Medicare	$1,710.00
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Devoted Health Medicare	$1,890.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,710.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,137.50
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Humana Medicare	$1,710.00
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: Kaiser Permanente Medicaid	$1,147.50
Rate for Payer: Kaiser Permanente Medicare	$1,710.00
Rate for Payer: MDX Hawaii PPO	$2,182.50
Rate for Payer: Ohana Health Plan Medicaid	$1,710.00
Rate for Payer: Ohana Health Plan Medicare	$1,710.00
Rate for Payer: UnitedHealthcare Medicare	$1,710.00
Rate for Payer: University Health Alliance Commercial	$1,640.03

PLATFORM GELPOINT 7CM C2A15

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,912.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: MDX Hawaii PPO	$2,182.50

PLAT LCDCP 9H 4.5X160MM 224.59

Facility

$896.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$448.00
Max. Negotiated Rate	$869.12
Rate for Payer: AlohaCare Medicaid	$448.00
Rate for Payer: AlohaCare Medicare	$680.96
Rate for Payer: Cash Price	$537.60
Rate for Payer: Devoted Health Medicare	$752.64
Rate for Payer: Hawaii Medical Service Association Medicare	$680.96
Rate for Payer: Hawaii Western Management Group Commercial	$627.20
Rate for Payer: Health Management Network Commercial	$761.60
Rate for Payer: Humana Medicare	$680.96
Rate for Payer: Kaiser Permanente Commercial	$806.40
Rate for Payer: Kaiser Permanente Medicaid	$456.96
Rate for Payer: Kaiser Permanente Medicare	$680.96
Rate for Payer: MDX Hawaii PPO	$869.12
Rate for Payer: Ohana Health Plan Medicaid	$680.96
Rate for Payer: Ohana Health Plan Medicare	$680.96
Rate for Payer: UnitedHealthcare Medicare	$680.96
Rate for Payer: University Health Alliance Commercial	$501.76

PLAT LCDCP 9H 4.5X160MM 224.59

Facility

$896.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$501.76
Max. Negotiated Rate	$869.12
Rate for Payer: Cash Price	$537.60
Rate for Payer: Hawaii Western Management Group Commercial	$627.20
Rate for Payer: Health Management Network Commercial	$761.60
Rate for Payer: Kaiser Permanente Commercial	$806.40
Rate for Payer: MDX Hawaii PPO	$869.12
Rate for Payer: University Health Alliance Commercial	$501.76

PLAT LCP 10H 3.5X137MM 223.601

Facility

$1,497.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$838.32
Max. Negotiated Rate	$1,452.09
Rate for Payer: Cash Price	$898.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,047.90
Rate for Payer: Health Management Network Commercial	$1,272.45
Rate for Payer: Kaiser Permanente Commercial	$1,347.30
Rate for Payer: MDX Hawaii PPO	$1,452.09
Rate for Payer: University Health Alliance Commercial	$838.32

PLAT LCP 10H 3.5X137MM 223.601

Facility

$1,497.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$748.50
Max. Negotiated Rate	$1,452.09
Rate for Payer: AlohaCare Medicaid	$748.50
Rate for Payer: AlohaCare Medicare	$1,137.72
Rate for Payer: Cash Price	$898.20
Rate for Payer: Devoted Health Medicare	$1,257.48
Rate for Payer: Hawaii Medical Service Association Medicare	$1,137.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,047.90
Rate for Payer: Health Management Network Commercial	$1,272.45
Rate for Payer: Humana Medicare	$1,137.72
Rate for Payer: Kaiser Permanente Commercial	$1,347.30
Rate for Payer: Kaiser Permanente Medicaid	$763.47
Rate for Payer: Kaiser Permanente Medicare	$1,137.72
Rate for Payer: MDX Hawaii PPO	$1,452.09
Rate for Payer: Ohana Health Plan Medicaid	$1,137.72
Rate for Payer: Ohana Health Plan Medicare	$1,137.72
Rate for Payer: UnitedHealthcare Medicare	$1,137.72
Rate for Payer: University Health Alliance Commercial	$838.32

PLAT LCP 10H 4.5X188MM 224.601

Facility

$2,409.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,349.04
Max. Negotiated Rate	$2,336.73
Rate for Payer: Cash Price	$1,445.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,686.30
Rate for Payer: Health Management Network Commercial	$2,047.65
Rate for Payer: Kaiser Permanente Commercial	$2,168.10
Rate for Payer: MDX Hawaii PPO	$2,336.73
Rate for Payer: University Health Alliance Commercial	$1,349.04

PLAT LCP 10H 4.5X188MM 224.601

Facility

$2,409.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.50
Max. Negotiated Rate	$2,336.73
Rate for Payer: AlohaCare Medicaid	$1,204.50
Rate for Payer: AlohaCare Medicare	$1,830.84
Rate for Payer: Cash Price	$1,445.40
Rate for Payer: Devoted Health Medicare	$2,023.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,830.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,686.30
Rate for Payer: Health Management Network Commercial	$2,047.65
Rate for Payer: Humana Medicare	$1,830.84
Rate for Payer: Kaiser Permanente Commercial	$2,168.10
Rate for Payer: Kaiser Permanente Medicaid	$1,228.59
Rate for Payer: Kaiser Permanente Medicare	$1,830.84
Rate for Payer: MDX Hawaii PPO	$2,336.73
Rate for Payer: Ohana Health Plan Medicaid	$1,830.84
Rate for Payer: Ohana Health Plan Medicare	$1,830.84
Rate for Payer: UnitedHealthcare Medicare	$1,830.84
Rate for Payer: University Health Alliance Commercial	$1,349.04

PLAT LCP 10H 4.5X188MM 226.601

Facility

$2,790.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,562.40
Max. Negotiated Rate	$2,706.30
Rate for Payer: Cash Price	$1,674.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,953.00
Rate for Payer: Health Management Network Commercial	$2,371.50
Rate for Payer: Kaiser Permanente Commercial	$2,511.00
Rate for Payer: MDX Hawaii PPO	$2,706.30
Rate for Payer: University Health Alliance Commercial	$1,562.40

Know your out-of-pocket cost for care.

All Charges