Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE LCP 3.5/14H/R 02.127.360

Facility

$4,964.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,779.84
Max. Negotiated Rate	$4,815.08
Rate for Payer: Cash Price	$2,978.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,474.80
Rate for Payer: Health Management Network Commercial	$4,219.40
Rate for Payer: Kaiser Permanente Commercial	$4,467.60
Rate for Payer: MDX Hawaii PPO	$4,815.08
Rate for Payer: University Health Alliance Commercial	$2,779.84

PLATE LCP 3.5/14H/R 02.127.360

Facility

$4,964.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,482.00
Max. Negotiated Rate	$4,815.08
Rate for Payer: AlohaCare Medicaid	$2,482.00
Rate for Payer: AlohaCare Medicare	$3,772.64
Rate for Payer: Cash Price	$2,978.40
Rate for Payer: Devoted Health Medicare	$4,169.76
Rate for Payer: Hawaii Medical Service Association Medicare	$3,772.64
Rate for Payer: Hawaii Western Management Group Commercial	$3,474.80
Rate for Payer: Health Management Network Commercial	$4,219.40
Rate for Payer: Humana Medicare	$3,772.64
Rate for Payer: Kaiser Permanente Commercial	$4,467.60
Rate for Payer: Kaiser Permanente Medicaid	$2,531.64
Rate for Payer: Kaiser Permanente Medicare	$3,772.64
Rate for Payer: MDX Hawaii PPO	$4,815.08
Rate for Payer: Ohana Health Plan Medicaid	$3,772.64
Rate for Payer: Ohana Health Plan Medicare	$3,772.64
Rate for Payer: UnitedHealthcare Medicare	$3,772.64
Rate for Payer: University Health Alliance Commercial	$2,779.84

PLATE LCP 3.5/3H/LT 02.112.007

Facility

$2,888.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,617.28
Max. Negotiated Rate	$2,801.36
Rate for Payer: Cash Price	$1,732.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,021.60
Rate for Payer: Health Management Network Commercial	$2,454.80
Rate for Payer: Kaiser Permanente Commercial	$2,599.20
Rate for Payer: MDX Hawaii PPO	$2,801.36
Rate for Payer: University Health Alliance Commercial	$1,617.28

PLATE LCP 3.5/3H/LT 02.112.007

Facility

$2,888.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,444.00
Max. Negotiated Rate	$2,801.36
Rate for Payer: AlohaCare Medicaid	$1,444.00
Rate for Payer: AlohaCare Medicare	$2,194.88
Rate for Payer: Cash Price	$1,732.80
Rate for Payer: Devoted Health Medicare	$2,425.92
Rate for Payer: Hawaii Medical Service Association Medicare	$2,194.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,021.60
Rate for Payer: Health Management Network Commercial	$2,454.80
Rate for Payer: Humana Medicare	$2,194.88
Rate for Payer: Kaiser Permanente Commercial	$2,599.20
Rate for Payer: Kaiser Permanente Medicaid	$1,472.88
Rate for Payer: Kaiser Permanente Medicare	$2,194.88
Rate for Payer: MDX Hawaii PPO	$2,801.36
Rate for Payer: Ohana Health Plan Medicaid	$2,194.88
Rate for Payer: Ohana Health Plan Medicare	$2,194.88
Rate for Payer: UnitedHealthcare Medicare	$2,194.88
Rate for Payer: University Health Alliance Commercial	$1,617.28

PLATE LCP 3.5/3H/RT 02.112.006

Facility

$2,888.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,444.00
Max. Negotiated Rate	$2,801.36
Rate for Payer: AlohaCare Medicaid	$1,444.00
Rate for Payer: AlohaCare Medicare	$2,194.88
Rate for Payer: Cash Price	$1,732.80
Rate for Payer: Devoted Health Medicare	$2,425.92
Rate for Payer: Hawaii Medical Service Association Medicare	$2,194.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,021.60
Rate for Payer: Health Management Network Commercial	$2,454.80
Rate for Payer: Humana Medicare	$2,194.88
Rate for Payer: Kaiser Permanente Commercial	$2,599.20
Rate for Payer: Kaiser Permanente Medicaid	$1,472.88
Rate for Payer: Kaiser Permanente Medicare	$2,194.88
Rate for Payer: MDX Hawaii PPO	$2,801.36
Rate for Payer: Ohana Health Plan Medicaid	$2,194.88
Rate for Payer: Ohana Health Plan Medicare	$2,194.88
Rate for Payer: UnitedHealthcare Medicare	$2,194.88
Rate for Payer: University Health Alliance Commercial	$1,617.28

PLATE LCP 3.5/3H/RT 02.112.006

Facility

$2,888.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,617.28
Max. Negotiated Rate	$2,801.36
Rate for Payer: Cash Price	$1,732.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,021.60
Rate for Payer: Health Management Network Commercial	$2,454.80
Rate for Payer: Kaiser Permanente Commercial	$2,599.20
Rate for Payer: MDX Hawaii PPO	$2,801.36
Rate for Payer: University Health Alliance Commercial	$1,617.28

PLATE LCP 3.5/4H/L 02.127.311

Facility

$3,664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,051.84
Max. Negotiated Rate	$3,554.08
Rate for Payer: Cash Price	$2,198.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,564.80
Rate for Payer: Health Management Network Commercial	$3,114.40
Rate for Payer: Kaiser Permanente Commercial	$3,297.60
Rate for Payer: MDX Hawaii PPO	$3,554.08
Rate for Payer: University Health Alliance Commercial	$2,051.84

PLATE LCP 3.5/4H/L 02.127.311

Facility

$3,664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,832.00
Max. Negotiated Rate	$3,554.08
Rate for Payer: AlohaCare Medicaid	$1,832.00
Rate for Payer: AlohaCare Medicare	$2,784.64
Rate for Payer: Cash Price	$2,198.40
Rate for Payer: Devoted Health Medicare	$3,077.76
Rate for Payer: Hawaii Medical Service Association Medicare	$2,784.64
Rate for Payer: Hawaii Western Management Group Commercial	$2,564.80
Rate for Payer: Health Management Network Commercial	$3,114.40
Rate for Payer: Humana Medicare	$2,784.64
Rate for Payer: Kaiser Permanente Commercial	$3,297.60
Rate for Payer: Kaiser Permanente Medicaid	$1,868.64
Rate for Payer: Kaiser Permanente Medicare	$2,784.64
Rate for Payer: MDX Hawaii PPO	$3,554.08
Rate for Payer: Ohana Health Plan Medicaid	$2,784.64
Rate for Payer: Ohana Health Plan Medicare	$2,784.64
Rate for Payer: UnitedHealthcare Medicare	$2,784.64
Rate for Payer: University Health Alliance Commercial	$2,051.84

PLATE LCP 3.5/4H/LT 02.112.011

Facility

$2,930.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,640.80
Max. Negotiated Rate	$2,842.10
Rate for Payer: Cash Price	$1,758.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,051.00
Rate for Payer: Health Management Network Commercial	$2,490.50
Rate for Payer: Kaiser Permanente Commercial	$2,637.00
Rate for Payer: MDX Hawaii PPO	$2,842.10
Rate for Payer: University Health Alliance Commercial	$1,640.80

PLATE LCP 3.5/4H/LT 02.112.011

Facility

$2,930.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,465.00
Max. Negotiated Rate	$2,842.10
Rate for Payer: AlohaCare Medicaid	$1,465.00
Rate for Payer: AlohaCare Medicare	$2,226.80
Rate for Payer: Cash Price	$1,758.00
Rate for Payer: Devoted Health Medicare	$2,461.20
Rate for Payer: Hawaii Medical Service Association Medicare	$2,226.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,051.00
Rate for Payer: Health Management Network Commercial	$2,490.50
Rate for Payer: Humana Medicare	$2,226.80
Rate for Payer: Kaiser Permanente Commercial	$2,637.00
Rate for Payer: Kaiser Permanente Medicaid	$1,494.30
Rate for Payer: Kaiser Permanente Medicare	$2,226.80
Rate for Payer: MDX Hawaii PPO	$2,842.10
Rate for Payer: Ohana Health Plan Medicaid	$2,226.80
Rate for Payer: Ohana Health Plan Medicare	$2,226.80
Rate for Payer: UnitedHealthcare Medicare	$2,226.80
Rate for Payer: University Health Alliance Commercial	$1,640.80

PLATE LCP 3.5/4H/LT 02.127.211

Facility

$3,664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,051.84
Max. Negotiated Rate	$3,554.08
Rate for Payer: Cash Price	$2,198.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,564.80
Rate for Payer: Health Management Network Commercial	$3,114.40
Rate for Payer: Kaiser Permanente Commercial	$3,297.60
Rate for Payer: MDX Hawaii PPO	$3,554.08
Rate for Payer: University Health Alliance Commercial	$2,051.84

PLATE LCP 3.5/4H/LT 02.127.211

Facility

$3,664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,832.00
Max. Negotiated Rate	$3,554.08
Rate for Payer: AlohaCare Medicaid	$1,832.00
Rate for Payer: AlohaCare Medicare	$2,784.64
Rate for Payer: Cash Price	$2,198.40
Rate for Payer: Devoted Health Medicare	$3,077.76
Rate for Payer: Hawaii Medical Service Association Medicare	$2,784.64
Rate for Payer: Hawaii Western Management Group Commercial	$2,564.80
Rate for Payer: Health Management Network Commercial	$3,114.40
Rate for Payer: Humana Medicare	$2,784.64
Rate for Payer: Kaiser Permanente Commercial	$3,297.60
Rate for Payer: Kaiser Permanente Medicaid	$1,868.64
Rate for Payer: Kaiser Permanente Medicare	$2,784.64
Rate for Payer: MDX Hawaii PPO	$3,554.08
Rate for Payer: Ohana Health Plan Medicaid	$2,784.64
Rate for Payer: Ohana Health Plan Medicare	$2,784.64
Rate for Payer: UnitedHealthcare Medicare	$2,784.64
Rate for Payer: University Health Alliance Commercial	$2,051.84

PLATE LCP 3.5/4H/R 02.127.310

Facility

$3,664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,051.84
Max. Negotiated Rate	$3,554.08
Rate for Payer: Cash Price	$2,198.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,564.80
Rate for Payer: Health Management Network Commercial	$3,114.40
Rate for Payer: Kaiser Permanente Commercial	$3,297.60
Rate for Payer: MDX Hawaii PPO	$3,554.08
Rate for Payer: University Health Alliance Commercial	$2,051.84

PLATE LCP 3.5/4H/R 02.127.310

Facility

$3,664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,832.00
Max. Negotiated Rate	$3,554.08
Rate for Payer: AlohaCare Medicaid	$1,832.00
Rate for Payer: AlohaCare Medicare	$2,784.64
Rate for Payer: Cash Price	$2,198.40
Rate for Payer: Devoted Health Medicare	$3,077.76
Rate for Payer: Hawaii Medical Service Association Medicare	$2,784.64
Rate for Payer: Hawaii Western Management Group Commercial	$2,564.80
Rate for Payer: Health Management Network Commercial	$3,114.40
Rate for Payer: Humana Medicare	$2,784.64
Rate for Payer: Kaiser Permanente Commercial	$3,297.60
Rate for Payer: Kaiser Permanente Medicaid	$1,868.64
Rate for Payer: Kaiser Permanente Medicare	$2,784.64
Rate for Payer: MDX Hawaii PPO	$3,554.08
Rate for Payer: Ohana Health Plan Medicaid	$2,784.64
Rate for Payer: Ohana Health Plan Medicare	$2,784.64
Rate for Payer: UnitedHealthcare Medicare	$2,784.64
Rate for Payer: University Health Alliance Commercial	$2,051.84

PLATE LCP 3.5/4H/RT 02.112.010

Facility

$2,930.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,640.80
Max. Negotiated Rate	$2,842.10
Rate for Payer: Cash Price	$1,758.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,051.00
Rate for Payer: Health Management Network Commercial	$2,490.50
Rate for Payer: Kaiser Permanente Commercial	$2,637.00
Rate for Payer: MDX Hawaii PPO	$2,842.10
Rate for Payer: University Health Alliance Commercial	$1,640.80

PLATE LCP 3.5/4H/RT 02.112.010

Facility

$2,930.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,465.00
Max. Negotiated Rate	$2,842.10
Rate for Payer: AlohaCare Medicaid	$1,465.00
Rate for Payer: AlohaCare Medicare	$2,226.80
Rate for Payer: Cash Price	$1,758.00
Rate for Payer: Devoted Health Medicare	$2,461.20
Rate for Payer: Hawaii Medical Service Association Medicare	$2,226.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,051.00
Rate for Payer: Health Management Network Commercial	$2,490.50
Rate for Payer: Humana Medicare	$2,226.80
Rate for Payer: Kaiser Permanente Commercial	$2,637.00
Rate for Payer: Kaiser Permanente Medicaid	$1,494.30
Rate for Payer: Kaiser Permanente Medicare	$2,226.80
Rate for Payer: MDX Hawaii PPO	$2,842.10
Rate for Payer: Ohana Health Plan Medicaid	$2,226.80
Rate for Payer: Ohana Health Plan Medicare	$2,226.80
Rate for Payer: UnitedHealthcare Medicare	$2,226.80
Rate for Payer: University Health Alliance Commercial	$1,640.80

PLATE LCP 3.5/5H/LT 02.112.013

Facility

$2,978.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,489.00
Max. Negotiated Rate	$2,888.66
Rate for Payer: AlohaCare Medicaid	$1,489.00
Rate for Payer: AlohaCare Medicare	$2,263.28
Rate for Payer: Cash Price	$1,786.80
Rate for Payer: Devoted Health Medicare	$2,501.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,263.28
Rate for Payer: Hawaii Western Management Group Commercial	$2,084.60
Rate for Payer: Health Management Network Commercial	$2,531.30
Rate for Payer: Humana Medicare	$2,263.28
Rate for Payer: Kaiser Permanente Commercial	$2,680.20
Rate for Payer: Kaiser Permanente Medicaid	$1,518.78
Rate for Payer: Kaiser Permanente Medicare	$2,263.28
Rate for Payer: MDX Hawaii PPO	$2,888.66
Rate for Payer: Ohana Health Plan Medicaid	$2,263.28
Rate for Payer: Ohana Health Plan Medicare	$2,263.28
Rate for Payer: UnitedHealthcare Medicare	$2,263.28
Rate for Payer: University Health Alliance Commercial	$1,667.68

PLATE LCP 3.5/5H/LT 02.112.013

Facility

$2,978.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,667.68
Max. Negotiated Rate	$2,888.66
Rate for Payer: Cash Price	$1,786.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,084.60
Rate for Payer: Health Management Network Commercial	$2,531.30
Rate for Payer: Kaiser Permanente Commercial	$2,680.20
Rate for Payer: MDX Hawaii PPO	$2,888.66
Rate for Payer: University Health Alliance Commercial	$1,667.68

PLATE LCP 3.5/5H/RT 02.112.012

Facility

$2,978.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,667.68
Max. Negotiated Rate	$2,888.66
Rate for Payer: Cash Price	$1,786.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,084.60
Rate for Payer: Health Management Network Commercial	$2,531.30
Rate for Payer: Kaiser Permanente Commercial	$2,680.20
Rate for Payer: MDX Hawaii PPO	$2,888.66
Rate for Payer: University Health Alliance Commercial	$1,667.68

PLATE LCP 3.5/5H/RT 02.112.012

Facility

$2,978.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,489.00
Max. Negotiated Rate	$2,888.66
Rate for Payer: AlohaCare Medicaid	$1,489.00
Rate for Payer: AlohaCare Medicare	$2,263.28
Rate for Payer: Cash Price	$1,786.80
Rate for Payer: Devoted Health Medicare	$2,501.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,263.28
Rate for Payer: Hawaii Western Management Group Commercial	$2,084.60
Rate for Payer: Health Management Network Commercial	$2,531.30
Rate for Payer: Humana Medicare	$2,263.28
Rate for Payer: Kaiser Permanente Commercial	$2,680.20
Rate for Payer: Kaiser Permanente Medicaid	$1,518.78
Rate for Payer: Kaiser Permanente Medicare	$2,263.28
Rate for Payer: MDX Hawaii PPO	$2,888.66
Rate for Payer: Ohana Health Plan Medicaid	$2,263.28
Rate for Payer: Ohana Health Plan Medicare	$2,263.28
Rate for Payer: UnitedHealthcare Medicare	$2,263.28
Rate for Payer: University Health Alliance Commercial	$1,667.68

PLATE LCP 3.5/6H/L 02.127.321

Facility

$3,714.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,857.00
Max. Negotiated Rate	$3,602.58
Rate for Payer: AlohaCare Medicaid	$1,857.00
Rate for Payer: AlohaCare Medicare	$2,822.64
Rate for Payer: Cash Price	$2,228.40
Rate for Payer: Devoted Health Medicare	$3,119.76
Rate for Payer: Hawaii Medical Service Association Medicare	$2,822.64
Rate for Payer: Hawaii Western Management Group Commercial	$2,599.80
Rate for Payer: Health Management Network Commercial	$3,156.90
Rate for Payer: Humana Medicare	$2,822.64
Rate for Payer: Kaiser Permanente Commercial	$3,342.60
Rate for Payer: Kaiser Permanente Medicaid	$1,894.14
Rate for Payer: Kaiser Permanente Medicare	$2,822.64
Rate for Payer: MDX Hawaii PPO	$3,602.58
Rate for Payer: Ohana Health Plan Medicaid	$2,822.64
Rate for Payer: Ohana Health Plan Medicare	$2,822.64
Rate for Payer: UnitedHealthcare Medicare	$2,822.64
Rate for Payer: University Health Alliance Commercial	$2,079.84

PLATE LCP 3.5/6H/L 02.127.321

Facility

$3,714.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,079.84
Max. Negotiated Rate	$3,602.58
Rate for Payer: Cash Price	$2,228.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,599.80
Rate for Payer: Health Management Network Commercial	$3,156.90
Rate for Payer: Kaiser Permanente Commercial	$3,342.60
Rate for Payer: MDX Hawaii PPO	$3,602.58
Rate for Payer: University Health Alliance Commercial	$2,079.84

PLATE LCP 3.5/6H/LT 02.112.009

Facility

$3,010.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$2,919.70
Rate for Payer: AlohaCare Medicaid	$1,505.00
Rate for Payer: AlohaCare Medicare	$2,287.60
Rate for Payer: Cash Price	$1,806.00
Rate for Payer: Devoted Health Medicare	$2,528.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,287.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,107.00
Rate for Payer: Health Management Network Commercial	$2,558.50
Rate for Payer: Humana Medicare	$2,287.60
Rate for Payer: Kaiser Permanente Commercial	$2,709.00
Rate for Payer: Kaiser Permanente Medicaid	$1,535.10
Rate for Payer: Kaiser Permanente Medicare	$2,287.60
Rate for Payer: MDX Hawaii PPO	$2,919.70
Rate for Payer: Ohana Health Plan Medicaid	$2,287.60
Rate for Payer: Ohana Health Plan Medicare	$2,287.60
Rate for Payer: UnitedHealthcare Medicare	$2,287.60
Rate for Payer: University Health Alliance Commercial	$1,685.60

PLATE LCP 3.5/6H/LT 02.112.009

Facility

$3,010.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,685.60
Max. Negotiated Rate	$2,919.70
Rate for Payer: Cash Price	$1,806.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,107.00
Rate for Payer: Health Management Network Commercial	$2,558.50
Rate for Payer: Kaiser Permanente Commercial	$2,709.00
Rate for Payer: MDX Hawaii PPO	$2,919.70
Rate for Payer: University Health Alliance Commercial	$1,685.60

PLATE LCP 3.5/6H/LT 02.112.027

Facility

$2,412.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,206.00
Max. Negotiated Rate	$2,339.64
Rate for Payer: AlohaCare Medicaid	$1,206.00
Rate for Payer: AlohaCare Medicare	$1,833.12
Rate for Payer: Cash Price	$1,447.20
Rate for Payer: Devoted Health Medicare	$2,026.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,833.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,688.40
Rate for Payer: Health Management Network Commercial	$2,050.20
Rate for Payer: Humana Medicare	$1,833.12
Rate for Payer: Kaiser Permanente Commercial	$2,170.80
Rate for Payer: Kaiser Permanente Medicaid	$1,230.12
Rate for Payer: Kaiser Permanente Medicare	$1,833.12
Rate for Payer: MDX Hawaii PPO	$2,339.64
Rate for Payer: Ohana Health Plan Medicaid	$1,833.12
Rate for Payer: Ohana Health Plan Medicare	$1,833.12
Rate for Payer: UnitedHealthcare Medicare	$1,833.12
Rate for Payer: University Health Alliance Commercial	$1,350.72

Know your out-of-pocket cost for care.

All Charges