Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE CROSSLCK M RT 131812060

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.28
Max. Negotiated Rate	$2,825.61
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE CRSLCK NARR RT 131811050

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.28
Max. Negotiated Rate	$2,825.61
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE CRSLCK NARR RT 131811050

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.50
Max. Negotiated Rate	$2,825.61
Rate for Payer: AlohaCare Medicaid	$1,456.50
Rate for Payer: AlohaCare Medicare	$2,213.88
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Devoted Health Medicare	$2,446.92
Rate for Payer: Hawaii Medical Service Association Medicare	$2,213.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Humana Medicare	$2,213.88
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: Kaiser Permanente Medicaid	$1,485.63
Rate for Payer: Kaiser Permanente Medicare	$2,213.88
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: Ohana Health Plan Medicaid	$2,213.88
Rate for Payer: Ohana Health Plan Medicare	$2,213.88
Rate for Payer: UnitedHealthcare Medicare	$2,213.88
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE DCP 11H 218MM #240.91

Facility

$2,580.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,444.80
Max. Negotiated Rate	$2,502.60
Rate for Payer: Cash Price	$1,548.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,806.00
Rate for Payer: Health Management Network Commercial	$2,193.00
Rate for Payer: Kaiser Permanente Commercial	$2,322.00
Rate for Payer: MDX Hawaii PPO	$2,502.60
Rate for Payer: University Health Alliance Commercial	$1,444.80

PLATE DCP 11H 218MM #240.91

Facility

$2,580.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,290.00
Max. Negotiated Rate	$2,502.60
Rate for Payer: AlohaCare Medicaid	$1,290.00
Rate for Payer: AlohaCare Medicare	$1,960.80
Rate for Payer: Cash Price	$1,548.00
Rate for Payer: Devoted Health Medicare	$2,167.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,960.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,806.00
Rate for Payer: Health Management Network Commercial	$2,193.00
Rate for Payer: Humana Medicare	$1,960.80
Rate for Payer: Kaiser Permanente Commercial	$2,322.00
Rate for Payer: Kaiser Permanente Medicaid	$1,315.80
Rate for Payer: Kaiser Permanente Medicare	$1,960.80
Rate for Payer: MDX Hawaii PPO	$2,502.60
Rate for Payer: Ohana Health Plan Medicaid	$1,960.80
Rate for Payer: Ohana Health Plan Medicare	$1,960.80
Rate for Payer: UnitedHealthcare Medicare	$1,960.80
Rate for Payer: University Health Alliance Commercial	$1,444.80

PLATE DCP 2X2 HOLE 04.503.710

Facility

$2,481.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,240.50
Max. Negotiated Rate	$2,406.57
Rate for Payer: AlohaCare Medicaid	$1,240.50
Rate for Payer: AlohaCare Medicare	$1,885.56
Rate for Payer: Cash Price	$1,488.60
Rate for Payer: Devoted Health Medicare	$2,084.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1,885.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,736.70
Rate for Payer: Health Management Network Commercial	$2,108.85
Rate for Payer: Humana Medicare	$1,885.56
Rate for Payer: Kaiser Permanente Commercial	$2,232.90
Rate for Payer: Kaiser Permanente Medicaid	$1,265.31
Rate for Payer: Kaiser Permanente Medicare	$1,885.56
Rate for Payer: MDX Hawaii PPO	$2,406.57
Rate for Payer: Ohana Health Plan Medicaid	$1,885.56
Rate for Payer: Ohana Health Plan Medicare	$1,885.56
Rate for Payer: UnitedHealthcare Medicare	$1,885.56
Rate for Payer: University Health Alliance Commercial	$1,389.36

PLATE DCP 2X2 HOLE 04.503.710

Facility

$2,481.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,389.36
Max. Negotiated Rate	$2,406.57
Rate for Payer: Cash Price	$1,488.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,736.70
Rate for Payer: Health Management Network Commercial	$2,108.85
Rate for Payer: Kaiser Permanente Commercial	$2,232.90
Rate for Payer: MDX Hawaii PPO	$2,406.57
Rate for Payer: University Health Alliance Commercial	$1,389.36

PLATE DHS 130D/2H/46MM 281.021

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 DHS 130D/2H/46MM 281.021

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

PLATE DHS 130D 2H 46MM 281.502

Facility

$2,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,360.80
Max. Negotiated Rate	$2,357.10
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,701.00
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: Kaiser Permanente Commercial	$2,187.00
Rate for Payer: MDX Hawaii PPO	$2,357.10
Rate for Payer: University Health Alliance Commercial	$1,360.80

PLATE DHS 130D 2H 46MM 281.502

Facility

$2,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,215.00
Max. Negotiated Rate	$2,357.10
Rate for Payer: AlohaCare Medicaid	$1,215.00
Rate for Payer: AlohaCare Medicare	$1,846.80
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Devoted Health Medicare	$2,041.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,846.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,701.00
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: Humana Medicare	$1,846.80
Rate for Payer: Kaiser Permanente Commercial	$2,187.00
Rate for Payer: Kaiser Permanente Medicaid	$1,239.30
Rate for Payer: Kaiser Permanente Medicare	$1,846.80
Rate for Payer: MDX Hawaii PPO	$2,357.10
Rate for Payer: Ohana Health Plan Medicaid	$1,846.80
Rate for Payer: Ohana Health Plan Medicare	$1,846.80
Rate for Payer: UnitedHealthcare Medicare	$1,846.80
Rate for Payer: University Health Alliance Commercial	$1,360.80

PLATE DHS 135D 2H/46MM 281.102

Facility

$2,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,360.80
Max. Negotiated Rate	$2,357.10
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,701.00
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: Kaiser Permanente Commercial	$2,187.00
Rate for Payer: MDX Hawaii PPO	$2,357.10
Rate for Payer: University Health Alliance Commercial	$1,360.80

PLATE DHS 135D 2H/46MM 281.102

Facility

$2,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,215.00
Max. Negotiated Rate	$2,357.10
Rate for Payer: AlohaCare Medicaid	$1,215.00
Rate for Payer: AlohaCare Medicare	$1,846.80
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Devoted Health Medicare	$2,041.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,846.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,701.00
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: Humana Medicare	$1,846.80
Rate for Payer: Kaiser Permanente Commercial	$2,187.00
Rate for Payer: Kaiser Permanente Medicaid	$1,239.30
Rate for Payer: Kaiser Permanente Medicare	$1,846.80
Rate for Payer: MDX Hawaii PPO	$2,357.10
Rate for Payer: Ohana Health Plan Medicaid	$1,846.80
Rate for Payer: Ohana Health Plan Medicare	$1,846.80
Rate for Payer: UnitedHealthcare Medicare	$1,846.80
Rate for Payer: University Health Alliance Commercial	$1,360.80

PLATE DHS 135D 2H 46MM 281.520

Facility

$2,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,215.00
Max. Negotiated Rate	$2,357.10
Rate for Payer: AlohaCare Medicaid	$1,215.00
Rate for Payer: AlohaCare Medicare	$1,846.80
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Devoted Health Medicare	$2,041.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,846.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,701.00
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: Humana Medicare	$1,846.80
Rate for Payer: Kaiser Permanente Commercial	$2,187.00
Rate for Payer: Kaiser Permanente Medicaid	$1,239.30
Rate for Payer: Kaiser Permanente Medicare	$1,846.80
Rate for Payer: MDX Hawaii PPO	$2,357.10
Rate for Payer: Ohana Health Plan Medicaid	$1,846.80
Rate for Payer: Ohana Health Plan Medicare	$1,846.80
Rate for Payer: UnitedHealthcare Medicare	$1,846.80
Rate for Payer: University Health Alliance Commercial	$1,360.80

PLATE DHS 135D 2H 46MM 281.520

Facility

$2,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,360.80
Max. Negotiated Rate	$2,357.10
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,701.00
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: Kaiser Permanente Commercial	$2,187.00
Rate for Payer: MDX Hawaii PPO	$2,357.10
Rate for Payer: University Health Alliance Commercial	$1,360.80

PLATE DHS 135D 4H 78MM 281.140

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

PLATE DHS 135D 4H 78MM 281.140

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 DHS 135D/4H/78MM 281.540

Facility

$2,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,360.80
Max. Negotiated Rate	$2,357.10
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,701.00
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: Kaiser Permanente Commercial	$2,187.00
Rate for Payer: MDX Hawaii PPO	$2,357.10
Rate for Payer: University Health Alliance Commercial	$1,360.80

PLATE DHS 135D/4H/78MM 281.540

Facility

$2,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,215.00
Max. Negotiated Rate	$2,357.10
Rate for Payer: AlohaCare Medicaid	$1,215.00
Rate for Payer: AlohaCare Medicare	$1,846.80
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Devoted Health Medicare	$2,041.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,846.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,701.00
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: Humana Medicare	$1,846.80
Rate for Payer: Kaiser Permanente Commercial	$2,187.00
Rate for Payer: Kaiser Permanente Medicaid	$1,239.30
Rate for Payer: Kaiser Permanente Medicare	$1,846.80
Rate for Payer: MDX Hawaii PPO	$2,357.10
Rate for Payer: Ohana Health Plan Medicaid	$1,846.80
Rate for Payer: Ohana Health Plan Medicare	$1,846.80
Rate for Payer: UnitedHealthcare Medicare	$1,846.80
Rate for Payer: University Health Alliance Commercial	$1,360.80

PLATE DHS 135D/5H/94MM 281.150

Facility

$2,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,360.80
Max. Negotiated Rate	$2,357.10
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,701.00
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: Kaiser Permanente Commercial	$2,187.00
Rate for Payer: MDX Hawaii PPO	$2,357.10
Rate for Payer: University Health Alliance Commercial	$1,360.80

PLATE DHS 135D/5H/94MM 281.150

Facility

$2,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,215.00
Max. Negotiated Rate	$2,357.10
Rate for Payer: AlohaCare Medicaid	$1,215.00
Rate for Payer: AlohaCare Medicare	$1,846.80
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Devoted Health Medicare	$2,041.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,846.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,701.00
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: Humana Medicare	$1,846.80
Rate for Payer: Kaiser Permanente Commercial	$2,187.00
Rate for Payer: Kaiser Permanente Medicaid	$1,239.30
Rate for Payer: Kaiser Permanente Medicare	$1,846.80
Rate for Payer: MDX Hawaii PPO	$2,357.10
Rate for Payer: Ohana Health Plan Medicaid	$1,846.80
Rate for Payer: Ohana Health Plan Medicare	$1,846.80
Rate for Payer: UnitedHealthcare Medicare	$1,846.80
Rate for Payer: University Health Alliance Commercial	$1,360.80

PLATE DHS 140D/4H/78MM 281.240

Facility

$2,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,215.00
Max. Negotiated Rate	$2,357.10
Rate for Payer: AlohaCare Medicaid	$1,215.00
Rate for Payer: AlohaCare Medicare	$1,846.80
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Devoted Health Medicare	$2,041.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,846.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,701.00
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: Humana Medicare	$1,846.80
Rate for Payer: Kaiser Permanente Commercial	$2,187.00
Rate for Payer: Kaiser Permanente Medicaid	$1,239.30
Rate for Payer: Kaiser Permanente Medicare	$1,846.80
Rate for Payer: MDX Hawaii PPO	$2,357.10
Rate for Payer: Ohana Health Plan Medicaid	$1,846.80
Rate for Payer: Ohana Health Plan Medicare	$1,846.80
Rate for Payer: UnitedHealthcare Medicare	$1,846.80
Rate for Payer: University Health Alliance Commercial	$1,360.80

PLATE DHS 140D/4H/78MM 281.240

Facility

$2,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,360.80
Max. Negotiated Rate	$2,357.10
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,701.00
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: Kaiser Permanente Commercial	$2,187.00
Rate for Payer: MDX Hawaii PPO	$2,357.10
Rate for Payer: University Health Alliance Commercial	$1,360.80

PLATE DHS 140D/5H/94MM 281.250

Facility

$2,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,215.00
Max. Negotiated Rate	$2,357.10
Rate for Payer: AlohaCare Medicaid	$1,215.00
Rate for Payer: AlohaCare Medicare	$1,846.80
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Devoted Health Medicare	$2,041.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,846.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,701.00
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: Humana Medicare	$1,846.80
Rate for Payer: Kaiser Permanente Commercial	$2,187.00
Rate for Payer: Kaiser Permanente Medicaid	$1,239.30
Rate for Payer: Kaiser Permanente Medicare	$1,846.80
Rate for Payer: MDX Hawaii PPO	$2,357.10
Rate for Payer: Ohana Health Plan Medicaid	$1,846.80
Rate for Payer: Ohana Health Plan Medicare	$1,846.80
Rate for Payer: UnitedHealthcare Medicare	$1,846.80
Rate for Payer: University Health Alliance Commercial	$1,360.80

PLATE DHS 140D/5H/94MM 281.250

Facility

$2,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,360.80
Max. Negotiated Rate	$2,357.10
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,701.00
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: Kaiser Permanente Commercial	$2,187.00
Rate for Payer: MDX Hawaii PPO	$2,357.10
Rate for Payer: University Health Alliance Commercial	$1,360.80

Know your out-of-pocket cost for care.

All Charges