Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE 2.7 LCP 7H 67MM 249.683

Facility

$1,693.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$948.08
Max. Negotiated Rate	$1,642.21
Rate for Payer: Cash Price	$1,015.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,185.10
Rate for Payer: Health Management Network Commercial	$1,439.05
Rate for Payer: Kaiser Permanente Commercial	$1,523.70
Rate for Payer: MDX Hawaii PPO	$1,642.21
Rate for Payer: University Health Alliance Commercial	$948.08

PLATE 2.7 LCP 7H 67MM 249.683

Facility

$1,693.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$846.50
Max. Negotiated Rate	$1,642.21
Rate for Payer: AlohaCare Medicaid	$846.50
Rate for Payer: AlohaCare Medicare	$1,286.68
Rate for Payer: Cash Price	$1,015.80
Rate for Payer: Devoted Health Medicare	$1,422.12
Rate for Payer: Hawaii Medical Service Association Medicare	$1,286.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,185.10
Rate for Payer: Health Management Network Commercial	$1,439.05
Rate for Payer: Humana Medicare	$1,286.68
Rate for Payer: Kaiser Permanente Commercial	$1,523.70
Rate for Payer: Kaiser Permanente Medicaid	$863.43
Rate for Payer: Kaiser Permanente Medicare	$1,286.68
Rate for Payer: MDX Hawaii PPO	$1,642.21
Rate for Payer: Ohana Health Plan Medicaid	$1,286.68
Rate for Payer: Ohana Health Plan Medicare	$1,286.68
Rate for Payer: UnitedHealthcare Medicare	$1,286.68
Rate for Payer: University Health Alliance Commercial	$948.08

PLATE 2.7 LCP 8H 76MM 247.372

Facility

$1,693.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$846.50
Max. Negotiated Rate	$1,642.21
Rate for Payer: AlohaCare Medicaid	$846.50
Rate for Payer: AlohaCare Medicare	$1,286.68
Rate for Payer: Cash Price	$1,015.80
Rate for Payer: Devoted Health Medicare	$1,422.12
Rate for Payer: Hawaii Medical Service Association Medicare	$1,286.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,185.10
Rate for Payer: Health Management Network Commercial	$1,439.05
Rate for Payer: Humana Medicare	$1,286.68
Rate for Payer: Kaiser Permanente Commercial	$1,523.70
Rate for Payer: Kaiser Permanente Medicaid	$863.43
Rate for Payer: Kaiser Permanente Medicare	$1,286.68
Rate for Payer: MDX Hawaii PPO	$1,642.21
Rate for Payer: Ohana Health Plan Medicaid	$1,286.68
Rate for Payer: Ohana Health Plan Medicare	$1,286.68
Rate for Payer: UnitedHealthcare Medicare	$1,286.68
Rate for Payer: University Health Alliance Commercial	$948.08

PLATE 2.7 LCP 8H 76MM 247.372

Facility

$1,693.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$948.08
Max. Negotiated Rate	$1,642.21
Rate for Payer: Cash Price	$1,015.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,185.10
Rate for Payer: Health Management Network Commercial	$1,439.05
Rate for Payer: Kaiser Permanente Commercial	$1,523.70
Rate for Payer: MDX Hawaii PPO	$1,642.21
Rate for Payer: University Health Alliance Commercial	$948.08

PLATE 2.7M LCP 6H 58MM 249.682

Facility

$1,693.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$948.08
Max. Negotiated Rate	$1,642.21
Rate for Payer: Cash Price	$1,015.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,185.10
Rate for Payer: Health Management Network Commercial	$1,439.05
Rate for Payer: Kaiser Permanente Commercial	$1,523.70
Rate for Payer: MDX Hawaii PPO	$1,642.21
Rate for Payer: University Health Alliance Commercial	$948.08

PLATE 2.7M LCP 6H 58MM 249.682

Facility

$1,693.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$846.50
Max. Negotiated Rate	$1,642.21
Rate for Payer: AlohaCare Medicaid	$846.50
Rate for Payer: AlohaCare Medicare	$1,286.68
Rate for Payer: Cash Price	$1,015.80
Rate for Payer: Devoted Health Medicare	$1,422.12
Rate for Payer: Hawaii Medical Service Association Medicare	$1,286.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,185.10
Rate for Payer: Health Management Network Commercial	$1,439.05
Rate for Payer: Humana Medicare	$1,286.68
Rate for Payer: Kaiser Permanente Commercial	$1,523.70
Rate for Payer: Kaiser Permanente Medicaid	$863.43
Rate for Payer: Kaiser Permanente Medicare	$1,286.68
Rate for Payer: MDX Hawaii PPO	$1,642.21
Rate for Payer: Ohana Health Plan Medicaid	$1,286.68
Rate for Payer: Ohana Health Plan Medicare	$1,286.68
Rate for Payer: UnitedHealthcare Medicare	$1,286.68
Rate for Payer: University Health Alliance Commercial	$948.08

PLATE 2.7MM 0MM STEP 336-2720

Facility

$2,667.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,493.52
Max. Negotiated Rate	$2,586.99
Rate for Payer: Cash Price	$1,600.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,866.90
Rate for Payer: Health Management Network Commercial	$2,266.95
Rate for Payer: Kaiser Permanente Commercial	$2,400.30
Rate for Payer: MDX Hawaii PPO	$2,586.99
Rate for Payer: University Health Alliance Commercial	$1,493.52

PLATE 2.7MM 0MM STEP 336-2720

Facility

$2,667.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.50
Max. Negotiated Rate	$2,586.99
Rate for Payer: AlohaCare Medicaid	$1,333.50
Rate for Payer: AlohaCare Medicare	$2,026.92
Rate for Payer: Cash Price	$1,600.20
Rate for Payer: Devoted Health Medicare	$2,240.28
Rate for Payer: Hawaii Medical Service Association Medicare	$2,026.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,866.90
Rate for Payer: Health Management Network Commercial	$2,266.95
Rate for Payer: Humana Medicare	$2,026.92
Rate for Payer: Kaiser Permanente Commercial	$2,400.30
Rate for Payer: Kaiser Permanente Medicaid	$1,360.17
Rate for Payer: Kaiser Permanente Medicare	$2,026.92
Rate for Payer: MDX Hawaii PPO	$2,586.99
Rate for Payer: Ohana Health Plan Medicaid	$2,026.92
Rate for Payer: Ohana Health Plan Medicare	$2,026.92
Rate for Payer: UnitedHealthcare Medicare	$2,026.92
Rate for Payer: University Health Alliance Commercial	$1,493.52

PLATE 2.7MM 10H 336-2710

Facility

$2,597.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,298.50
Max. Negotiated Rate	$2,519.09
Rate for Payer: AlohaCare Medicaid	$1,298.50
Rate for Payer: AlohaCare Medicare	$1,973.72
Rate for Payer: Cash Price	$1,558.20
Rate for Payer: Devoted Health Medicare	$2,181.48
Rate for Payer: Hawaii Medical Service Association Medicare	$1,973.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,817.90
Rate for Payer: Health Management Network Commercial	$2,207.45
Rate for Payer: Humana Medicare	$1,973.72
Rate for Payer: Kaiser Permanente Commercial	$2,337.30
Rate for Payer: Kaiser Permanente Medicaid	$1,324.47
Rate for Payer: Kaiser Permanente Medicare	$1,973.72
Rate for Payer: MDX Hawaii PPO	$2,519.09
Rate for Payer: Ohana Health Plan Medicaid	$1,973.72
Rate for Payer: Ohana Health Plan Medicare	$1,973.72
Rate for Payer: UnitedHealthcare Medicare	$1,973.72
Rate for Payer: University Health Alliance Commercial	$1,454.32

PLATE 2.7MM 10H 336-2710

Facility

$2,597.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,454.32
Max. Negotiated Rate	$2,519.09
Rate for Payer: Cash Price	$1,558.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,817.90
Rate for Payer: Health Management Network Commercial	$2,207.45
Rate for Payer: Kaiser Permanente Commercial	$2,337.30
Rate for Payer: MDX Hawaii PPO	$2,519.09
Rate for Payer: University Health Alliance Commercial	$1,454.32

PLATE 2.7MM 1ST LEFT 336-2752

Facility

$3,031.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,697.36
Max. Negotiated Rate	$2,940.07
Rate for Payer: Cash Price	$1,818.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,121.70
Rate for Payer: Health Management Network Commercial	$2,576.35
Rate for Payer: Kaiser Permanente Commercial	$2,727.90
Rate for Payer: MDX Hawaii PPO	$2,940.07
Rate for Payer: University Health Alliance Commercial	$1,697.36

PLATE 2.7MM 1ST LEFT 336-2752

Facility

$3,031.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,515.50
Max. Negotiated Rate	$2,940.07
Rate for Payer: AlohaCare Medicaid	$1,515.50
Rate for Payer: AlohaCare Medicare	$2,303.56
Rate for Payer: Cash Price	$1,818.60
Rate for Payer: Devoted Health Medicare	$2,546.04
Rate for Payer: Hawaii Medical Service Association Medicare	$2,303.56
Rate for Payer: Hawaii Western Management Group Commercial	$2,121.70
Rate for Payer: Health Management Network Commercial	$2,576.35
Rate for Payer: Humana Medicare	$2,303.56
Rate for Payer: Kaiser Permanente Commercial	$2,727.90
Rate for Payer: Kaiser Permanente Medicaid	$1,545.81
Rate for Payer: Kaiser Permanente Medicare	$2,303.56
Rate for Payer: MDX Hawaii PPO	$2,940.07
Rate for Payer: Ohana Health Plan Medicaid	$2,303.56
Rate for Payer: Ohana Health Plan Medicare	$2,303.56
Rate for Payer: UnitedHealthcare Medicare	$2,303.56
Rate for Payer: University Health Alliance Commercial	$1,697.36

PLATE 2.7MM 1ST PRIM 336-2757

Facility

$3,031.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,515.50
Max. Negotiated Rate	$2,940.07
Rate for Payer: AlohaCare Medicaid	$1,515.50
Rate for Payer: AlohaCare Medicare	$2,303.56
Rate for Payer: Cash Price	$1,818.60
Rate for Payer: Devoted Health Medicare	$2,546.04
Rate for Payer: Hawaii Medical Service Association Medicare	$2,303.56
Rate for Payer: Hawaii Western Management Group Commercial	$2,121.70
Rate for Payer: Health Management Network Commercial	$2,576.35
Rate for Payer: Humana Medicare	$2,303.56
Rate for Payer: Kaiser Permanente Commercial	$2,727.90
Rate for Payer: Kaiser Permanente Medicaid	$1,545.81
Rate for Payer: Kaiser Permanente Medicare	$2,303.56
Rate for Payer: MDX Hawaii PPO	$2,940.07
Rate for Payer: Ohana Health Plan Medicaid	$2,303.56
Rate for Payer: Ohana Health Plan Medicare	$2,303.56
Rate for Payer: UnitedHealthcare Medicare	$2,303.56
Rate for Payer: University Health Alliance Commercial	$1,697.36

PLATE 2.7MM 1ST PRIM 336-2757

Facility

$3,031.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,697.36
Max. Negotiated Rate	$2,940.07
Rate for Payer: Cash Price	$1,818.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,121.70
Rate for Payer: Health Management Network Commercial	$2,576.35
Rate for Payer: Kaiser Permanente Commercial	$2,727.90
Rate for Payer: MDX Hawaii PPO	$2,940.07
Rate for Payer: University Health Alliance Commercial	$1,697.36

PLATE 2.7MM 2H/3H SFT 249.685

Facility

$2,525.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,262.50
Max. Negotiated Rate	$2,449.25
Rate for Payer: AlohaCare Medicaid	$1,262.50
Rate for Payer: AlohaCare Medicare	$1,919.00
Rate for Payer: Cash Price	$1,515.00
Rate for Payer: Devoted Health Medicare	$2,121.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,919.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,767.50
Rate for Payer: Health Management Network Commercial	$2,146.25
Rate for Payer: Humana Medicare	$1,919.00
Rate for Payer: Kaiser Permanente Commercial	$2,272.50
Rate for Payer: Kaiser Permanente Medicaid	$1,287.75
Rate for Payer: Kaiser Permanente Medicare	$1,919.00
Rate for Payer: MDX Hawaii PPO	$2,449.25
Rate for Payer: Ohana Health Plan Medicaid	$1,919.00
Rate for Payer: Ohana Health Plan Medicare	$1,919.00
Rate for Payer: UnitedHealthcare Medicare	$1,919.00
Rate for Payer: University Health Alliance Commercial	$1,414.00

PLATE 2.7MM 2H/3H SFT 249.685

Facility

$2,525.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,414.00
Max. Negotiated Rate	$2,449.25
Rate for Payer: Cash Price	$1,515.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,767.50
Rate for Payer: Health Management Network Commercial	$2,146.25
Rate for Payer: Kaiser Permanente Commercial	$2,272.50
Rate for Payer: MDX Hawaii PPO	$2,449.25
Rate for Payer: University Health Alliance Commercial	$1,414.00

PLATE 2.7MM 6-HOLE/48MM 245.20

Facility

$1,043.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$584.08
Max. Negotiated Rate	$1,011.71
Rate for Payer: Cash Price	$625.80
Rate for Payer: Hawaii Western Management Group Commercial	$730.10
Rate for Payer: Health Management Network Commercial	$886.55
Rate for Payer: Kaiser Permanente Commercial	$938.70
Rate for Payer: MDX Hawaii PPO	$1,011.71
Rate for Payer: University Health Alliance Commercial	$584.08

PLATE 2.7MM 6-HOLE/48MM 245.20

Facility

$1,043.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$521.50
Max. Negotiated Rate	$1,011.71
Rate for Payer: AlohaCare Medicaid	$521.50
Rate for Payer: AlohaCare Medicare	$792.68
Rate for Payer: Cash Price	$625.80
Rate for Payer: Devoted Health Medicare	$876.12
Rate for Payer: Hawaii Medical Service Association Medicare	$792.68
Rate for Payer: Hawaii Western Management Group Commercial	$730.10
Rate for Payer: Health Management Network Commercial	$886.55
Rate for Payer: Humana Medicare	$792.68
Rate for Payer: Kaiser Permanente Commercial	$938.70
Rate for Payer: Kaiser Permanente Medicaid	$531.93
Rate for Payer: Kaiser Permanente Medicare	$792.68
Rate for Payer: MDX Hawaii PPO	$1,011.71
Rate for Payer: Ohana Health Plan Medicaid	$792.68
Rate for Payer: Ohana Health Plan Medicare	$792.68
Rate for Payer: UnitedHealthcare Medicare	$792.68
Rate for Payer: University Health Alliance Commercial	$584.08

PLATE 2.7MM CND 7H SFT 249.684

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
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	$1,575.00
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	$1,260.00

PLATE 2.7MM CND 7H SFT 249.684

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,260.00
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,575.00
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
Rate for Payer: University Health Alliance Commercial	$1,260.00

PLATE 2.7MM LEFT SMALL 58MM

Facility

$2,351.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,316.56
Max. Negotiated Rate	$2,280.47
Rate for Payer: Cash Price	$1,410.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,645.70
Rate for Payer: Health Management Network Commercial	$1,998.35
Rate for Payer: Kaiser Permanente Commercial	$2,115.90
Rate for Payer: MDX Hawaii PPO	$2,280.47
Rate for Payer: University Health Alliance Commercial	$1,316.56

PLATE 2.7MM LEFT SMALL 58MM

Facility

$2,351.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,175.50
Max. Negotiated Rate	$2,280.47
Rate for Payer: AlohaCare Medicaid	$1,175.50
Rate for Payer: AlohaCare Medicare	$1,786.76
Rate for Payer: Cash Price	$1,410.60
Rate for Payer: Devoted Health Medicare	$1,974.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,786.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,645.70
Rate for Payer: Health Management Network Commercial	$1,998.35
Rate for Payer: Humana Medicare	$1,786.76
Rate for Payer: Kaiser Permanente Commercial	$2,115.90
Rate for Payer: Kaiser Permanente Medicaid	$1,199.01
Rate for Payer: Kaiser Permanente Medicare	$1,786.76
Rate for Payer: MDX Hawaii PPO	$2,280.47
Rate for Payer: Ohana Health Plan Medicaid	$1,786.76
Rate for Payer: Ohana Health Plan Medicare	$1,786.76
Rate for Payer: UnitedHealthcare Medicare	$1,786.76
Rate for Payer: University Health Alliance Commercial	$1,316.56

PLATE 2.7MM LT 2H 249.689

Facility

$1,606.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$803.00
Max. Negotiated Rate	$1,557.82
Rate for Payer: AlohaCare Medicaid	$803.00
Rate for Payer: AlohaCare Medicare	$1,220.56
Rate for Payer: Cash Price	$963.60
Rate for Payer: Devoted Health Medicare	$1,349.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1,220.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,124.20
Rate for Payer: Health Management Network Commercial	$1,365.10
Rate for Payer: Humana Medicare	$1,220.56
Rate for Payer: Kaiser Permanente Commercial	$1,445.40
Rate for Payer: Kaiser Permanente Medicaid	$819.06
Rate for Payer: Kaiser Permanente Medicare	$1,220.56
Rate for Payer: MDX Hawaii PPO	$1,557.82
Rate for Payer: Ohana Health Plan Medicaid	$1,220.56
Rate for Payer: Ohana Health Plan Medicare	$1,220.56
Rate for Payer: UnitedHealthcare Medicare	$1,220.56
Rate for Payer: University Health Alliance Commercial	$899.36

PLATE 2.7MM LT 2H 249.689

Facility

$1,606.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$899.36
Max. Negotiated Rate	$1,557.82
Rate for Payer: Cash Price	$963.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,124.20
Rate for Payer: Health Management Network Commercial	$1,365.10
Rate for Payer: Kaiser Permanente Commercial	$1,445.40
Rate for Payer: MDX Hawaii PPO	$1,557.82
Rate for Payer: University Health Alliance Commercial	$899.36

PLATE 2.7MM OBL LT 2H 249.687

Facility

$1,606.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$899.36
Max. Negotiated Rate	$1,557.82
Rate for Payer: Cash Price	$963.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,124.20
Rate for Payer: Health Management Network Commercial	$1,365.10
Rate for Payer: Kaiser Permanente Commercial	$1,445.40
Rate for Payer: MDX Hawaii PPO	$1,557.82
Rate for Payer: University Health Alliance Commercial	$899.36

Know your out-of-pocket cost for care.

All Charges