Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE 2.0 LCP 3H/7H 247.615

Facility

$1,566.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$876.96
Max. Negotiated Rate	$1,519.02
Rate for Payer: Cash Price	$939.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,096.20
Rate for Payer: Health Management Network Commercial	$1,331.10
Rate for Payer: Kaiser Permanente Commercial	$1,409.40
Rate for Payer: MDX Hawaii PPO	$1,519.02
Rate for Payer: University Health Alliance Commercial	$876.96

PLATE 2.0 LCP 4H/31 247.344

Facility

$1,051.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$525.50
Max. Negotiated Rate	$1,019.47
Rate for Payer: AlohaCare Medicaid	$525.50
Rate for Payer: AlohaCare Medicare	$798.76
Rate for Payer: Cash Price	$630.60
Rate for Payer: Devoted Health Medicare	$882.84
Rate for Payer: Hawaii Medical Service Association Medicare	$798.76
Rate for Payer: Hawaii Western Management Group Commercial	$735.70
Rate for Payer: Health Management Network Commercial	$893.35
Rate for Payer: Humana Medicare	$798.76
Rate for Payer: Kaiser Permanente Commercial	$945.90
Rate for Payer: Kaiser Permanente Medicaid	$536.01
Rate for Payer: Kaiser Permanente Medicare	$798.76
Rate for Payer: MDX Hawaii PPO	$1,019.47
Rate for Payer: Ohana Health Plan Medicaid	$798.76
Rate for Payer: Ohana Health Plan Medicare	$798.76
Rate for Payer: UnitedHealthcare Medicare	$798.76
Rate for Payer: University Health Alliance Commercial	$588.56

PLATE 2.0 LCP 4H/31 247.344

Facility

$1,051.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$588.56
Max. Negotiated Rate	$1,019.47
Rate for Payer: Cash Price	$630.60
Rate for Payer: Hawaii Western Management Group Commercial	$735.70
Rate for Payer: Health Management Network Commercial	$893.35
Rate for Payer: Kaiser Permanente Commercial	$945.90
Rate for Payer: MDX Hawaii PPO	$1,019.47
Rate for Payer: University Health Alliance Commercial	$588.56

PLATE 2.0 LCP 6H/45 247.346

Facility

$1,126.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$630.56
Max. Negotiated Rate	$1,092.22
Rate for Payer: Cash Price	$675.60
Rate for Payer: Hawaii Western Management Group Commercial	$788.20
Rate for Payer: Health Management Network Commercial	$957.10
Rate for Payer: Kaiser Permanente Commercial	$1,013.40
Rate for Payer: MDX Hawaii PPO	$1,092.22
Rate for Payer: University Health Alliance Commercial	$630.56

PLATE 2.0 LCP 6H/45 247.346

Facility

$1,126.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$563.00
Max. Negotiated Rate	$1,092.22
Rate for Payer: AlohaCare Medicaid	$563.00
Rate for Payer: AlohaCare Medicare	$855.76
Rate for Payer: Cash Price	$675.60
Rate for Payer: Devoted Health Medicare	$945.84
Rate for Payer: Hawaii Medical Service Association Medicare	$855.76
Rate for Payer: Hawaii Western Management Group Commercial	$788.20
Rate for Payer: Health Management Network Commercial	$957.10
Rate for Payer: Humana Medicare	$855.76
Rate for Payer: Kaiser Permanente Commercial	$1,013.40
Rate for Payer: Kaiser Permanente Medicaid	$574.26
Rate for Payer: Kaiser Permanente Medicare	$855.76
Rate for Payer: MDX Hawaii PPO	$1,092.22
Rate for Payer: Ohana Health Plan Medicaid	$855.76
Rate for Payer: Ohana Health Plan Medicare	$855.76
Rate for Payer: UnitedHealthcare Medicare	$855.76
Rate for Payer: University Health Alliance Commercial	$630.56

PLATE 2.0 LCP 7H/52 247.347

Facility

$1,033.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$516.50
Max. Negotiated Rate	$1,002.01
Rate for Payer: AlohaCare Medicaid	$516.50
Rate for Payer: AlohaCare Medicare	$785.08
Rate for Payer: Cash Price	$619.80
Rate for Payer: Devoted Health Medicare	$867.72
Rate for Payer: Hawaii Medical Service Association Medicare	$785.08
Rate for Payer: Hawaii Western Management Group Commercial	$723.10
Rate for Payer: Health Management Network Commercial	$878.05
Rate for Payer: Humana Medicare	$785.08
Rate for Payer: Kaiser Permanente Commercial	$929.70
Rate for Payer: Kaiser Permanente Medicaid	$526.83
Rate for Payer: Kaiser Permanente Medicare	$785.08
Rate for Payer: MDX Hawaii PPO	$1,002.01
Rate for Payer: Ohana Health Plan Medicaid	$785.08
Rate for Payer: Ohana Health Plan Medicare	$785.08
Rate for Payer: UnitedHealthcare Medicare	$785.08
Rate for Payer: University Health Alliance Commercial	$578.48

PLATE 2.0 LCP 7H/52 247.347

Facility

$1,033.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$578.48
Max. Negotiated Rate	$1,002.01
Rate for Payer: Cash Price	$619.80
Rate for Payer: Hawaii Western Management Group Commercial	$723.10
Rate for Payer: Health Management Network Commercial	$878.05
Rate for Payer: Kaiser Permanente Commercial	$929.70
Rate for Payer: MDX Hawaii PPO	$1,002.01
Rate for Payer: University Health Alliance Commercial	$578.48

PLATE 2.0 LCP 8H/59 247.348

Facility

$1,033.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$578.48
Max. Negotiated Rate	$1,002.01
Rate for Payer: Cash Price	$619.80
Rate for Payer: Hawaii Western Management Group Commercial	$723.10
Rate for Payer: Health Management Network Commercial	$878.05
Rate for Payer: Kaiser Permanente Commercial	$929.70
Rate for Payer: MDX Hawaii PPO	$1,002.01
Rate for Payer: University Health Alliance Commercial	$578.48

PLATE 2.0 LCP 8H/59 247.348

Facility

$1,033.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$516.50
Max. Negotiated Rate	$1,002.01
Rate for Payer: AlohaCare Medicaid	$516.50
Rate for Payer: AlohaCare Medicare	$785.08
Rate for Payer: Cash Price	$619.80
Rate for Payer: Devoted Health Medicare	$867.72
Rate for Payer: Hawaii Medical Service Association Medicare	$785.08
Rate for Payer: Hawaii Western Management Group Commercial	$723.10
Rate for Payer: Health Management Network Commercial	$878.05
Rate for Payer: Humana Medicare	$785.08
Rate for Payer: Kaiser Permanente Commercial	$929.70
Rate for Payer: Kaiser Permanente Medicaid	$526.83
Rate for Payer: Kaiser Permanente Medicare	$785.08
Rate for Payer: MDX Hawaii PPO	$1,002.01
Rate for Payer: Ohana Health Plan Medicaid	$785.08
Rate for Payer: Ohana Health Plan Medicare	$785.08
Rate for Payer: UnitedHealthcare Medicare	$785.08
Rate for Payer: University Health Alliance Commercial	$578.48

PLATE 2.0 STRAIGHT MCS-6

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$831.50
Max. Negotiated Rate	$1,613.11
Rate for Payer: AlohaCare Medicaid	$831.50
Rate for Payer: AlohaCare Medicare	$1,263.88
Rate for Payer: Cash Price	$997.80
Rate for Payer: Devoted Health Medicare	$1,396.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,263.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Humana Medicare	$1,263.88
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: Kaiser Permanente Medicaid	$848.13
Rate for Payer: Kaiser Permanente Medicare	$1,263.88
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: Ohana Health Plan Medicaid	$1,263.88
Rate for Payer: Ohana Health Plan Medicare	$1,263.88
Rate for Payer: UnitedHealthcare Medicare	$1,263.88
Rate for Payer: University Health Alliance Commercial	$931.28

PLATE 2.0 STRAIGHT MCS-6

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$931.28
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

PLATE 2.3 L COMP 6H 57-13408

Facility

$1,272.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$712.32
Max. Negotiated Rate	$1,233.84
Rate for Payer: Cash Price	$763.20
Rate for Payer: Hawaii Western Management Group Commercial	$890.40
Rate for Payer: Health Management Network Commercial	$1,081.20
Rate for Payer: Kaiser Permanente Commercial	$1,144.80
Rate for Payer: MDX Hawaii PPO	$1,233.84
Rate for Payer: University Health Alliance Commercial	$712.32

PLATE 2.3 L COMP 6H 57-13408

Facility

$1,272.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$636.00
Max. Negotiated Rate	$1,233.84
Rate for Payer: AlohaCare Medicaid	$636.00
Rate for Payer: AlohaCare Medicare	$966.72
Rate for Payer: Cash Price	$763.20
Rate for Payer: Devoted Health Medicare	$1,068.48
Rate for Payer: Hawaii Medical Service Association Medicare	$966.72
Rate for Payer: Hawaii Western Management Group Commercial	$890.40
Rate for Payer: Health Management Network Commercial	$1,081.20
Rate for Payer: Humana Medicare	$966.72
Rate for Payer: Kaiser Permanente Commercial	$1,144.80
Rate for Payer: Kaiser Permanente Medicaid	$648.72
Rate for Payer: Kaiser Permanente Medicare	$966.72
Rate for Payer: MDX Hawaii PPO	$1,233.84
Rate for Payer: Ohana Health Plan Medicaid	$966.72
Rate for Payer: Ohana Health Plan Medicare	$966.72
Rate for Payer: UnitedHealthcare Medicare	$966.72
Rate for Payer: University Health Alliance Commercial	$712.32

PLATE 2.3 M LCK 13H 57-15379

Facility

$2,476.00

Service Code	HCPCS C1713
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 2.3 M LCK 13H 57-15379

Facility

$2,476.00

Service Code	HCPCS C1713
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 2.3MM 16H STR 57-10116

Facility

$1,677.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$838.50
Max. Negotiated Rate	$1,626.69
Rate for Payer: AlohaCare Medicaid	$838.50
Rate for Payer: AlohaCare Medicare	$1,274.52
Rate for Payer: Cash Price	$1,006.20
Rate for Payer: Devoted Health Medicare	$1,408.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,274.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,173.90
Rate for Payer: Health Management Network Commercial	$1,425.45
Rate for Payer: Humana Medicare	$1,274.52
Rate for Payer: Kaiser Permanente Commercial	$1,509.30
Rate for Payer: Kaiser Permanente Medicaid	$855.27
Rate for Payer: Kaiser Permanente Medicare	$1,274.52
Rate for Payer: MDX Hawaii PPO	$1,626.69
Rate for Payer: Ohana Health Plan Medicaid	$1,274.52
Rate for Payer: Ohana Health Plan Medicare	$1,274.52
Rate for Payer: UnitedHealthcare Medicare	$1,274.52
Rate for Payer: University Health Alliance Commercial	$939.12

PLATE 2.3MM 16H STR 57-10116

Facility

$1,677.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$939.12
Max. Negotiated Rate	$1,626.69
Rate for Payer: Cash Price	$1,006.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,173.90
Rate for Payer: Health Management Network Commercial	$1,425.45
Rate for Payer: Kaiser Permanente Commercial	$1,509.30
Rate for Payer: MDX Hawaii PPO	$1,626.69
Rate for Payer: University Health Alliance Commercial	$939.12

PLATE 2.3MM STR 4HOLE 57-10101

Facility

$1,277.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$715.12
Max. Negotiated Rate	$1,238.69
Rate for Payer: Cash Price	$766.20
Rate for Payer: Hawaii Western Management Group Commercial	$893.90
Rate for Payer: Health Management Network Commercial	$1,085.45
Rate for Payer: Kaiser Permanente Commercial	$1,149.30
Rate for Payer: MDX Hawaii PPO	$1,238.69
Rate for Payer: University Health Alliance Commercial	$715.12

PLATE 2.3MM STR 4HOLE 57-10101

Facility

$1,277.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$638.50
Max. Negotiated Rate	$1,238.69
Rate for Payer: AlohaCare Medicaid	$638.50
Rate for Payer: AlohaCare Medicare	$970.52
Rate for Payer: Cash Price	$766.20
Rate for Payer: Devoted Health Medicare	$1,072.68
Rate for Payer: Hawaii Medical Service Association Medicare	$970.52
Rate for Payer: Hawaii Western Management Group Commercial	$893.90
Rate for Payer: Health Management Network Commercial	$1,085.45
Rate for Payer: Humana Medicare	$970.52
Rate for Payer: Kaiser Permanente Commercial	$1,149.30
Rate for Payer: Kaiser Permanente Medicaid	$651.27
Rate for Payer: Kaiser Permanente Medicare	$970.52
Rate for Payer: MDX Hawaii PPO	$1,238.69
Rate for Payer: Ohana Health Plan Medicaid	$970.52
Rate for Payer: Ohana Health Plan Medicare	$970.52
Rate for Payer: UnitedHealthcare Medicare	$970.52
Rate for Payer: University Health Alliance Commercial	$715.12

PLATE 2.3 STANDARD LF 57-10121

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

PLATE 2.3 STANDARD LF 57-10121

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 2.3X1.5MM 5HOLE 57-15324

Facility

$2,335.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,167.50
Max. Negotiated Rate	$2,264.95
Rate for Payer: AlohaCare Medicaid	$1,167.50
Rate for Payer: AlohaCare Medicare	$1,774.60
Rate for Payer: Cash Price	$1,401.00
Rate for Payer: Devoted Health Medicare	$1,961.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,774.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,634.50
Rate for Payer: Health Management Network Commercial	$1,984.75
Rate for Payer: Humana Medicare	$1,774.60
Rate for Payer: Kaiser Permanente Commercial	$2,101.50
Rate for Payer: Kaiser Permanente Medicaid	$1,190.85
Rate for Payer: Kaiser Permanente Medicare	$1,774.60
Rate for Payer: MDX Hawaii PPO	$2,264.95
Rate for Payer: Ohana Health Plan Medicaid	$1,774.60
Rate for Payer: Ohana Health Plan Medicare	$1,774.60
Rate for Payer: UnitedHealthcare Medicare	$1,774.60
Rate for Payer: University Health Alliance Commercial	$1,307.60

PLATE 2.3X1.5MM 5HOLE 57-15324

Facility

$2,335.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,307.60
Max. Negotiated Rate	$2,264.95
Rate for Payer: Cash Price	$1,401.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,634.50
Rate for Payer: Health Management Network Commercial	$1,984.75
Rate for Payer: Kaiser Permanente Commercial	$2,101.50
Rate for Payer: MDX Hawaii PPO	$2,264.95
Rate for Payer: University Health Alliance Commercial	$1,307.60

PLATE 2.4 CONDYLAR 249.679

Facility

$2,064.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.84
Max. Negotiated Rate	$2,002.08
Rate for Payer: Cash Price	$1,238.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,444.80
Rate for Payer: Health Management Network Commercial	$1,754.40
Rate for Payer: Kaiser Permanente Commercial	$1,857.60
Rate for Payer: MDX Hawaii PPO	$2,002.08
Rate for Payer: University Health Alliance Commercial	$1,155.84

PLATE 2.4 CONDYLAR 249.679

Facility

$2,064.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,032.00
Max. Negotiated Rate	$2,002.08
Rate for Payer: AlohaCare Medicaid	$1,032.00
Rate for Payer: AlohaCare Medicare	$1,568.64
Rate for Payer: Cash Price	$1,238.40
Rate for Payer: Devoted Health Medicare	$1,733.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,568.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,444.80
Rate for Payer: Health Management Network Commercial	$1,754.40
Rate for Payer: Humana Medicare	$1,568.64
Rate for Payer: Kaiser Permanente Commercial	$1,857.60
Rate for Payer: Kaiser Permanente Medicaid	$1,052.64
Rate for Payer: Kaiser Permanente Medicare	$1,568.64
Rate for Payer: MDX Hawaii PPO	$2,002.08
Rate for Payer: Ohana Health Plan Medicaid	$1,568.64
Rate for Payer: Ohana Health Plan Medicare	$1,568.64
Rate for Payer: UnitedHealthcare Medicare	$1,568.64
Rate for Payer: University Health Alliance Commercial	$1,155.84

Know your out-of-pocket cost for care.

All Charges