Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE 3.5 7-HOLE/90MM 223.57

Facility

$1,422.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$796.32
Max. Negotiated Rate	$1,379.34
Rate for Payer: Cash Price	$853.20
Rate for Payer: Hawaii Western Management Group Commercial	$995.40
Rate for Payer: Health Management Network Commercial	$1,208.70
Rate for Payer: Kaiser Permanente Commercial	$1,279.80
Rate for Payer: MDX Hawaii PPO	$1,379.34
Rate for Payer: University Health Alliance Commercial	$796.32

PLATE 3.5 7-HOLE/90MM 223.57

Facility

$1,422.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$711.00
Max. Negotiated Rate	$1,379.34
Rate for Payer: AlohaCare Medicaid	$711.00
Rate for Payer: AlohaCare Medicare	$1,080.72
Rate for Payer: Cash Price	$853.20
Rate for Payer: Devoted Health Medicare	$1,194.48
Rate for Payer: Hawaii Medical Service Association Medicare	$1,080.72
Rate for Payer: Hawaii Western Management Group Commercial	$995.40
Rate for Payer: Health Management Network Commercial	$1,208.70
Rate for Payer: Humana Medicare	$1,080.72
Rate for Payer: Kaiser Permanente Commercial	$1,279.80
Rate for Payer: Kaiser Permanente Medicaid	$725.22
Rate for Payer: Kaiser Permanente Medicare	$1,080.72
Rate for Payer: MDX Hawaii PPO	$1,379.34
Rate for Payer: Ohana Health Plan Medicaid	$1,080.72
Rate for Payer: Ohana Health Plan Medicare	$1,080.72
Rate for Payer: UnitedHealthcare Medicare	$1,080.72
Rate for Payer: University Health Alliance Commercial	$796.32

PLATE 3.5 LCP 2H 02.120.702S

Facility

$2,414.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.84
Max. Negotiated Rate	$2,341.58
Rate for Payer: Cash Price	$1,448.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,689.80
Rate for Payer: Health Management Network Commercial	$2,051.90
Rate for Payer: Kaiser Permanente Commercial	$2,172.60
Rate for Payer: MDX Hawaii PPO	$2,341.58
Rate for Payer: University Health Alliance Commercial	$1,351.84

PLATE 3.5 LCP 2H 02.120.702S

Facility

$2,414.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,207.00
Max. Negotiated Rate	$2,341.58
Rate for Payer: AlohaCare Medicaid	$1,207.00
Rate for Payer: AlohaCare Medicare	$1,834.64
Rate for Payer: Cash Price	$1,448.40
Rate for Payer: Devoted Health Medicare	$2,027.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,834.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,689.80
Rate for Payer: Health Management Network Commercial	$2,051.90
Rate for Payer: Humana Medicare	$1,834.64
Rate for Payer: Kaiser Permanente Commercial	$2,172.60
Rate for Payer: Kaiser Permanente Medicaid	$1,231.14
Rate for Payer: Kaiser Permanente Medicare	$1,834.64
Rate for Payer: MDX Hawaii PPO	$2,341.58
Rate for Payer: Ohana Health Plan Medicaid	$1,834.64
Rate for Payer: Ohana Health Plan Medicare	$1,834.64
Rate for Payer: UnitedHealthcare Medicare	$1,834.64
Rate for Payer: University Health Alliance Commercial	$1,351.84

PLATE 3.5 LF 4 HOLE 02.110.107

Facility

$3,709.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,854.50
Max. Negotiated Rate	$3,597.73
Rate for Payer: AlohaCare Medicaid	$1,854.50
Rate for Payer: AlohaCare Medicare	$2,818.84
Rate for Payer: Cash Price	$2,225.40
Rate for Payer: Devoted Health Medicare	$3,115.56
Rate for Payer: Hawaii Medical Service Association Medicare	$2,818.84
Rate for Payer: Hawaii Western Management Group Commercial	$2,596.30
Rate for Payer: Health Management Network Commercial	$3,152.65
Rate for Payer: Humana Medicare	$2,818.84
Rate for Payer: Kaiser Permanente Commercial	$3,338.10
Rate for Payer: Kaiser Permanente Medicaid	$1,891.59
Rate for Payer: Kaiser Permanente Medicare	$2,818.84
Rate for Payer: MDX Hawaii PPO	$3,597.73
Rate for Payer: Ohana Health Plan Medicaid	$2,818.84
Rate for Payer: Ohana Health Plan Medicare	$2,818.84
Rate for Payer: UnitedHealthcare Medicare	$2,818.84
Rate for Payer: University Health Alliance Commercial	$2,077.04

PLATE 3.5 LF 4 HOLE 02.110.107

Facility

$3,709.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,077.04
Max. Negotiated Rate	$3,597.73
Rate for Payer: Cash Price	$2,225.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,596.30
Rate for Payer: Health Management Network Commercial	$3,152.65
Rate for Payer: Kaiser Permanente Commercial	$3,338.10
Rate for Payer: MDX Hawaii PPO	$3,597.73
Rate for Payer: University Health Alliance Commercial	$2,077.04

PLATE 3.5MM 10HL/194MM 239.913

Facility

$3,066.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,716.96
Max. Negotiated Rate	$2,974.02
Rate for Payer: Cash Price	$1,839.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,146.20
Rate for Payer: Health Management Network Commercial	$2,606.10
Rate for Payer: Kaiser Permanente Commercial	$2,759.40
Rate for Payer: MDX Hawaii PPO	$2,974.02
Rate for Payer: University Health Alliance Commercial	$1,716.96

PLATE 3.5MM 10HL/194MM 239.913

Facility

$3,066.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.00
Max. Negotiated Rate	$2,974.02
Rate for Payer: AlohaCare Medicaid	$1,533.00
Rate for Payer: AlohaCare Medicare	$2,330.16
Rate for Payer: Cash Price	$1,839.60
Rate for Payer: Devoted Health Medicare	$2,575.44
Rate for Payer: Hawaii Medical Service Association Medicare	$2,330.16
Rate for Payer: Hawaii Western Management Group Commercial	$2,146.20
Rate for Payer: Health Management Network Commercial	$2,606.10
Rate for Payer: Humana Medicare	$2,330.16
Rate for Payer: Kaiser Permanente Commercial	$2,759.40
Rate for Payer: Kaiser Permanente Medicaid	$1,563.66
Rate for Payer: Kaiser Permanente Medicare	$2,330.16
Rate for Payer: MDX Hawaii PPO	$2,974.02
Rate for Payer: Ohana Health Plan Medicaid	$2,330.16
Rate for Payer: Ohana Health Plan Medicare	$2,330.16
Rate for Payer: UnitedHealthcare Medicare	$2,330.16
Rate for Payer: University Health Alliance Commercial	$1,716.96

PLATE 3.5MM 10HL/195MM 239.912

Facility

$3,066.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.00
Max. Negotiated Rate	$2,974.02
Rate for Payer: AlohaCare Medicaid	$1,533.00
Rate for Payer: AlohaCare Medicare	$2,330.16
Rate for Payer: Cash Price	$1,839.60
Rate for Payer: Devoted Health Medicare	$2,575.44
Rate for Payer: Hawaii Medical Service Association Medicare	$2,330.16
Rate for Payer: Hawaii Western Management Group Commercial	$2,146.20
Rate for Payer: Health Management Network Commercial	$2,606.10
Rate for Payer: Humana Medicare	$2,330.16
Rate for Payer: Kaiser Permanente Commercial	$2,759.40
Rate for Payer: Kaiser Permanente Medicaid	$1,563.66
Rate for Payer: Kaiser Permanente Medicare	$2,330.16
Rate for Payer: MDX Hawaii PPO	$2,974.02
Rate for Payer: Ohana Health Plan Medicaid	$2,330.16
Rate for Payer: Ohana Health Plan Medicare	$2,330.16
Rate for Payer: UnitedHealthcare Medicare	$2,330.16
Rate for Payer: University Health Alliance Commercial	$1,716.96

PLATE 3.5MM 10HL/195MM 239.912

Facility

$3,066.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,716.96
Max. Negotiated Rate	$2,974.02
Rate for Payer: Cash Price	$1,839.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,146.20
Rate for Payer: Health Management Network Commercial	$2,606.10
Rate for Payer: Kaiser Permanente Commercial	$2,759.40
Rate for Payer: MDX Hawaii PPO	$2,974.02
Rate for Payer: University Health Alliance Commercial	$1,716.96

PLATE 3.5MM 10HOL/118MM 245.00

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 3.5MM 10HOL/118MM 245.00

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 3.5MM 10HOL/121MM 248.10

Facility

$701.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$350.50
Max. Negotiated Rate	$679.97
Rate for Payer: AlohaCare Medicaid	$350.50
Rate for Payer: AlohaCare Medicare	$532.76
Rate for Payer: Cash Price	$420.60
Rate for Payer: Devoted Health Medicare	$588.84
Rate for Payer: Hawaii Medical Service Association Medicare	$532.76
Rate for Payer: Hawaii Western Management Group Commercial	$490.70
Rate for Payer: Health Management Network Commercial	$595.85
Rate for Payer: Humana Medicare	$532.76
Rate for Payer: Kaiser Permanente Commercial	$630.90
Rate for Payer: Kaiser Permanente Medicaid	$357.51
Rate for Payer: Kaiser Permanente Medicare	$532.76
Rate for Payer: MDX Hawaii PPO	$679.97
Rate for Payer: Ohana Health Plan Medicaid	$532.76
Rate for Payer: Ohana Health Plan Medicare	$532.76
Rate for Payer: UnitedHealthcare Medicare	$532.76
Rate for Payer: University Health Alliance Commercial	$392.56

PLATE 3.5MM 10HOL/121MM 248.10

Facility

$701.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$392.56
Max. Negotiated Rate	$679.97
Rate for Payer: Cash Price	$420.60
Rate for Payer: Hawaii Western Management Group Commercial	$490.70
Rate for Payer: Health Management Network Commercial	$595.85
Rate for Payer: Kaiser Permanente Commercial	$630.90
Rate for Payer: MDX Hawaii PPO	$679.97
Rate for Payer: University Health Alliance Commercial	$392.56

PLATE 3.5MM 12HL/220MM 239.916

Facility

$3,066.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.00
Max. Negotiated Rate	$2,974.02
Rate for Payer: AlohaCare Medicaid	$1,533.00
Rate for Payer: AlohaCare Medicare	$2,330.16
Rate for Payer: Cash Price	$1,839.60
Rate for Payer: Devoted Health Medicare	$2,575.44
Rate for Payer: Hawaii Medical Service Association Medicare	$2,330.16
Rate for Payer: Hawaii Western Management Group Commercial	$2,146.20
Rate for Payer: Health Management Network Commercial	$2,606.10
Rate for Payer: Humana Medicare	$2,330.16
Rate for Payer: Kaiser Permanente Commercial	$2,759.40
Rate for Payer: Kaiser Permanente Medicaid	$1,563.66
Rate for Payer: Kaiser Permanente Medicare	$2,330.16
Rate for Payer: MDX Hawaii PPO	$2,974.02
Rate for Payer: Ohana Health Plan Medicaid	$2,330.16
Rate for Payer: Ohana Health Plan Medicare	$2,330.16
Rate for Payer: UnitedHealthcare Medicare	$2,330.16
Rate for Payer: University Health Alliance Commercial	$1,716.96

PLATE 3.5MM 12HL/220MM 239.916

Facility

$3,066.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,716.96
Max. Negotiated Rate	$2,974.02
Rate for Payer: Cash Price	$1,839.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,146.20
Rate for Payer: Health Management Network Commercial	$2,606.10
Rate for Payer: Kaiser Permanente Commercial	$2,759.40
Rate for Payer: MDX Hawaii PPO	$2,974.02
Rate for Payer: University Health Alliance Commercial	$1,716.96

PLATE 3.5MM 12HL/220MM 239.917

Facility

$3,066.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,716.96
Max. Negotiated Rate	$2,974.02
Rate for Payer: Cash Price	$1,839.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,146.20
Rate for Payer: Health Management Network Commercial	$2,606.10
Rate for Payer: Kaiser Permanente Commercial	$2,759.40
Rate for Payer: MDX Hawaii PPO	$2,974.02
Rate for Payer: University Health Alliance Commercial	$1,716.96

PLATE 3.5MM 12HL/220MM 239.917

Facility

$3,066.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.00
Max. Negotiated Rate	$2,974.02
Rate for Payer: AlohaCare Medicaid	$1,533.00
Rate for Payer: AlohaCare Medicare	$2,330.16
Rate for Payer: Cash Price	$1,839.60
Rate for Payer: Devoted Health Medicare	$2,575.44
Rate for Payer: Hawaii Medical Service Association Medicare	$2,330.16
Rate for Payer: Hawaii Western Management Group Commercial	$2,146.20
Rate for Payer: Health Management Network Commercial	$2,606.10
Rate for Payer: Humana Medicare	$2,330.16
Rate for Payer: Kaiser Permanente Commercial	$2,759.40
Rate for Payer: Kaiser Permanente Medicaid	$1,563.66
Rate for Payer: Kaiser Permanente Medicare	$2,330.16
Rate for Payer: MDX Hawaii PPO	$2,974.02
Rate for Payer: Ohana Health Plan Medicaid	$2,330.16
Rate for Payer: Ohana Health Plan Medicare	$2,330.16
Rate for Payer: UnitedHealthcare Medicare	$2,330.16
Rate for Payer: University Health Alliance Commercial	$1,716.96

PLATE 3.5MM 5-HOLE/58MM 245.15

Facility

$931.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$521.36
Max. Negotiated Rate	$903.07
Rate for Payer: Cash Price	$558.60
Rate for Payer: Hawaii Western Management Group Commercial	$651.70
Rate for Payer: Health Management Network Commercial	$791.35
Rate for Payer: Kaiser Permanente Commercial	$837.90
Rate for Payer: MDX Hawaii PPO	$903.07
Rate for Payer: University Health Alliance Commercial	$521.36

PLATE 3.5MM 5-HOLE/58MM 245.15

Facility

$931.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$465.50
Max. Negotiated Rate	$903.07
Rate for Payer: AlohaCare Medicaid	$465.50
Rate for Payer: AlohaCare Medicare	$707.56
Rate for Payer: Cash Price	$558.60
Rate for Payer: Devoted Health Medicare	$782.04
Rate for Payer: Hawaii Medical Service Association Medicare	$707.56
Rate for Payer: Hawaii Western Management Group Commercial	$651.70
Rate for Payer: Health Management Network Commercial	$791.35
Rate for Payer: Humana Medicare	$707.56
Rate for Payer: Kaiser Permanente Commercial	$837.90
Rate for Payer: Kaiser Permanente Medicaid	$474.81
Rate for Payer: Kaiser Permanente Medicare	$707.56
Rate for Payer: MDX Hawaii PPO	$903.07
Rate for Payer: Ohana Health Plan Medicaid	$707.56
Rate for Payer: Ohana Health Plan Medicare	$707.56
Rate for Payer: UnitedHealthcare Medicare	$707.56
Rate for Payer: University Health Alliance Commercial	$521.36

PLATE 3.5MM 6HOL/142MM 239.905

Facility

$3,066.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,716.96
Max. Negotiated Rate	$2,974.02
Rate for Payer: Cash Price	$1,839.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,146.20
Rate for Payer: Health Management Network Commercial	$2,606.10
Rate for Payer: Kaiser Permanente Commercial	$2,759.40
Rate for Payer: MDX Hawaii PPO	$2,974.02
Rate for Payer: University Health Alliance Commercial	$1,716.96

PLATE 3.5MM 6HOL/142MM 239.905

Facility

$3,066.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.00
Max. Negotiated Rate	$2,974.02
Rate for Payer: AlohaCare Medicaid	$1,533.00
Rate for Payer: AlohaCare Medicare	$2,330.16
Rate for Payer: Cash Price	$1,839.60
Rate for Payer: Devoted Health Medicare	$2,575.44
Rate for Payer: Hawaii Medical Service Association Medicare	$2,330.16
Rate for Payer: Hawaii Western Management Group Commercial	$2,146.20
Rate for Payer: Health Management Network Commercial	$2,606.10
Rate for Payer: Humana Medicare	$2,330.16
Rate for Payer: Kaiser Permanente Commercial	$2,759.40
Rate for Payer: Kaiser Permanente Medicaid	$1,563.66
Rate for Payer: Kaiser Permanente Medicare	$2,330.16
Rate for Payer: MDX Hawaii PPO	$2,974.02
Rate for Payer: Ohana Health Plan Medicaid	$2,330.16
Rate for Payer: Ohana Health Plan Medicare	$2,330.16
Rate for Payer: UnitedHealthcare Medicare	$2,330.16
Rate for Payer: University Health Alliance Commercial	$1,716.96

PLATE 3.5MM 6-HOLE/70MM 245.16

Facility

$1,075.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$602.00
Max. Negotiated Rate	$1,042.75
Rate for Payer: Cash Price	$645.00
Rate for Payer: Hawaii Western Management Group Commercial	$752.50
Rate for Payer: Health Management Network Commercial	$913.75
Rate for Payer: Kaiser Permanente Commercial	$967.50
Rate for Payer: MDX Hawaii PPO	$1,042.75
Rate for Payer: University Health Alliance Commercial	$602.00

PLATE 3.5MM 6-HOLE/70MM 245.16

Facility

$1,075.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$537.50
Max. Negotiated Rate	$1,042.75
Rate for Payer: AlohaCare Medicaid	$537.50
Rate for Payer: AlohaCare Medicare	$817.00
Rate for Payer: Cash Price	$645.00
Rate for Payer: Devoted Health Medicare	$903.00
Rate for Payer: Hawaii Medical Service Association Medicare	$817.00
Rate for Payer: Hawaii Western Management Group Commercial	$752.50
Rate for Payer: Health Management Network Commercial	$913.75
Rate for Payer: Humana Medicare	$817.00
Rate for Payer: Kaiser Permanente Commercial	$967.50
Rate for Payer: Kaiser Permanente Medicaid	$548.25
Rate for Payer: Kaiser Permanente Medicare	$817.00
Rate for Payer: MDX Hawaii PPO	$1,042.75
Rate for Payer: Ohana Health Plan Medicaid	$817.00
Rate for Payer: Ohana Health Plan Medicare	$817.00
Rate for Payer: UnitedHealthcare Medicare	$817.00
Rate for Payer: University Health Alliance Commercial	$602.00

PLATE 3.5MM 7-HOLE/82MM 245.17

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

Know your out-of-pocket cost for care.

All Charges