Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE LCP 3.5/6H/LT 02.112.027

Facility

$2,412.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.72
Max. Negotiated Rate	$2,339.64
Rate for Payer: Cash Price	$1,447.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,688.40
Rate for Payer: Health Management Network Commercial	$2,050.20
Rate for Payer: Kaiser Permanente Commercial	$2,170.80
Rate for Payer: MDX Hawaii PPO	$2,339.64
Rate for Payer: University Health Alliance Commercial	$1,350.72

PLATE LCP 3.5/6H/LT 02.112.081

Facility

$2,164.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,082.00
Max. Negotiated Rate	$2,099.08
Rate for Payer: AlohaCare Medicaid	$1,082.00
Rate for Payer: AlohaCare Medicare	$1,644.64
Rate for Payer: Cash Price	$1,298.40
Rate for Payer: Devoted Health Medicare	$1,817.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,644.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,514.80
Rate for Payer: Health Management Network Commercial	$1,839.40
Rate for Payer: Humana Medicare	$1,644.64
Rate for Payer: Kaiser Permanente Commercial	$1,947.60
Rate for Payer: Kaiser Permanente Medicaid	$1,103.64
Rate for Payer: Kaiser Permanente Medicare	$1,644.64
Rate for Payer: MDX Hawaii PPO	$2,099.08
Rate for Payer: Ohana Health Plan Medicaid	$1,644.64
Rate for Payer: Ohana Health Plan Medicare	$1,644.64
Rate for Payer: UnitedHealthcare Medicare	$1,644.64
Rate for Payer: University Health Alliance Commercial	$1,211.84

PLATE LCP 3.5/6H/LT 02.112.081

Facility

$2,164.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,211.84
Max. Negotiated Rate	$2,099.08
Rate for Payer: Cash Price	$1,298.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,514.80
Rate for Payer: Health Management Network Commercial	$1,839.40
Rate for Payer: Kaiser Permanente Commercial	$1,947.60
Rate for Payer: MDX Hawaii PPO	$2,099.08
Rate for Payer: University Health Alliance Commercial	$1,211.84

PLATE LCP 3.5/6H/LT 02.127.221

Facility

$3,704.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,852.00
Max. Negotiated Rate	$3,592.88
Rate for Payer: AlohaCare Medicaid	$1,852.00
Rate for Payer: AlohaCare Medicare	$2,815.04
Rate for Payer: Cash Price	$2,222.40
Rate for Payer: Devoted Health Medicare	$3,111.36
Rate for Payer: Hawaii Medical Service Association Medicare	$2,815.04
Rate for Payer: Hawaii Western Management Group Commercial	$2,592.80
Rate for Payer: Health Management Network Commercial	$3,148.40
Rate for Payer: Humana Medicare	$2,815.04
Rate for Payer: Kaiser Permanente Commercial	$3,333.60
Rate for Payer: Kaiser Permanente Medicaid	$1,889.04
Rate for Payer: Kaiser Permanente Medicare	$2,815.04
Rate for Payer: MDX Hawaii PPO	$3,592.88
Rate for Payer: Ohana Health Plan Medicaid	$2,815.04
Rate for Payer: Ohana Health Plan Medicare	$2,815.04
Rate for Payer: UnitedHealthcare Medicare	$2,815.04
Rate for Payer: University Health Alliance Commercial	$2,074.24

PLATE LCP 3.5/6H/LT 02.127.221

Facility

$3,704.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,074.24
Max. Negotiated Rate	$3,592.88
Rate for Payer: Cash Price	$2,222.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,592.80
Rate for Payer: Health Management Network Commercial	$3,148.40
Rate for Payer: Kaiser Permanente Commercial	$3,333.60
Rate for Payer: MDX Hawaii PPO	$3,592.88
Rate for Payer: University Health Alliance Commercial	$2,074.24

PLATE LCP 3.5/6H/R 02.127.320

Facility

$4,684.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,342.00
Max. Negotiated Rate	$4,543.48
Rate for Payer: AlohaCare Medicaid	$2,342.00
Rate for Payer: AlohaCare Medicare	$3,559.84
Rate for Payer: Cash Price	$2,810.40
Rate for Payer: Devoted Health Medicare	$3,934.56
Rate for Payer: Hawaii Medical Service Association Medicare	$3,559.84
Rate for Payer: Hawaii Western Management Group Commercial	$3,278.80
Rate for Payer: Health Management Network Commercial	$3,981.40
Rate for Payer: Humana Medicare	$3,559.84
Rate for Payer: Kaiser Permanente Commercial	$4,215.60
Rate for Payer: Kaiser Permanente Medicaid	$2,388.84
Rate for Payer: Kaiser Permanente Medicare	$3,559.84
Rate for Payer: MDX Hawaii PPO	$4,543.48
Rate for Payer: Ohana Health Plan Medicaid	$3,559.84
Rate for Payer: Ohana Health Plan Medicare	$3,559.84
Rate for Payer: UnitedHealthcare Medicare	$3,559.84
Rate for Payer: University Health Alliance Commercial	$2,623.04

PLATE LCP 3.5/6H/R 02.127.320

Facility

$4,684.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,623.04
Max. Negotiated Rate	$4,543.48
Rate for Payer: Cash Price	$2,810.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,278.80
Rate for Payer: Health Management Network Commercial	$3,981.40
Rate for Payer: Kaiser Permanente Commercial	$4,215.60
Rate for Payer: MDX Hawaii PPO	$4,543.48
Rate for Payer: University Health Alliance Commercial	$2,623.04

PLATE LCP 3.5/6H/RT 02.112.026

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/RT 02.112.026

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/RT 02.112.080

Facility

$2,486.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,243.00
Max. Negotiated Rate	$2,411.42
Rate for Payer: AlohaCare Medicaid	$1,243.00
Rate for Payer: AlohaCare Medicare	$1,889.36
Rate for Payer: Cash Price	$1,491.60
Rate for Payer: Devoted Health Medicare	$2,088.24
Rate for Payer: Hawaii Medical Service Association Medicare	$1,889.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,740.20
Rate for Payer: Health Management Network Commercial	$2,113.10
Rate for Payer: Humana Medicare	$1,889.36
Rate for Payer: Kaiser Permanente Commercial	$2,237.40
Rate for Payer: Kaiser Permanente Medicaid	$1,267.86
Rate for Payer: Kaiser Permanente Medicare	$1,889.36
Rate for Payer: MDX Hawaii PPO	$2,411.42
Rate for Payer: Ohana Health Plan Medicaid	$1,889.36
Rate for Payer: Ohana Health Plan Medicare	$1,889.36
Rate for Payer: UnitedHealthcare Medicare	$1,889.36
Rate for Payer: University Health Alliance Commercial	$1,392.16

PLATE LCP 3.5/6H/RT 02.112.080

Facility

$2,486.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,392.16
Max. Negotiated Rate	$2,411.42
Rate for Payer: Cash Price	$1,491.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,740.20
Rate for Payer: Health Management Network Commercial	$2,113.10
Rate for Payer: Kaiser Permanente Commercial	$2,237.40
Rate for Payer: MDX Hawaii PPO	$2,411.42
Rate for Payer: University Health Alliance Commercial	$1,392.16

PLATE LCP 3.5/7H/LT 02.112.019

Facility

$3,084.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,727.04
Max. Negotiated Rate	$2,991.48
Rate for Payer: Cash Price	$1,850.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,158.80
Rate for Payer: Health Management Network Commercial	$2,621.40
Rate for Payer: Kaiser Permanente Commercial	$2,775.60
Rate for Payer: MDX Hawaii PPO	$2,991.48
Rate for Payer: University Health Alliance Commercial	$1,727.04

PLATE LCP 3.5/7H/LT 02.112.019

Facility

$3,084.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,542.00
Max. Negotiated Rate	$2,991.48
Rate for Payer: AlohaCare Medicaid	$1,542.00
Rate for Payer: AlohaCare Medicare	$2,343.84
Rate for Payer: Cash Price	$1,850.40
Rate for Payer: Devoted Health Medicare	$2,590.56
Rate for Payer: Hawaii Medical Service Association Medicare	$2,343.84
Rate for Payer: Hawaii Western Management Group Commercial	$2,158.80
Rate for Payer: Health Management Network Commercial	$2,621.40
Rate for Payer: Humana Medicare	$2,343.84
Rate for Payer: Kaiser Permanente Commercial	$2,775.60
Rate for Payer: Kaiser Permanente Medicaid	$1,572.84
Rate for Payer: Kaiser Permanente Medicare	$2,343.84
Rate for Payer: MDX Hawaii PPO	$2,991.48
Rate for Payer: Ohana Health Plan Medicaid	$2,343.84
Rate for Payer: Ohana Health Plan Medicare	$2,343.84
Rate for Payer: UnitedHealthcare Medicare	$2,343.84
Rate for Payer: University Health Alliance Commercial	$1,727.04

PLATE LCP 3.5/7H/LT 02.112.029

Facility

$2,219.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,242.64
Max. Negotiated Rate	$2,152.43
Rate for Payer: Cash Price	$1,331.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,553.30
Rate for Payer: Health Management Network Commercial	$1,886.15
Rate for Payer: Kaiser Permanente Commercial	$1,997.10
Rate for Payer: MDX Hawaii PPO	$2,152.43
Rate for Payer: University Health Alliance Commercial	$1,242.64

PLATE LCP 3.5/7H/LT 02.112.029

Facility

$2,219.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,109.50
Max. Negotiated Rate	$2,152.43
Rate for Payer: AlohaCare Medicaid	$1,109.50
Rate for Payer: AlohaCare Medicare	$1,686.44
Rate for Payer: Cash Price	$1,331.40
Rate for Payer: Devoted Health Medicare	$1,863.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,686.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,553.30
Rate for Payer: Health Management Network Commercial	$1,886.15
Rate for Payer: Humana Medicare	$1,686.44
Rate for Payer: Kaiser Permanente Commercial	$1,997.10
Rate for Payer: Kaiser Permanente Medicaid	$1,131.69
Rate for Payer: Kaiser Permanente Medicare	$1,686.44
Rate for Payer: MDX Hawaii PPO	$2,152.43
Rate for Payer: Ohana Health Plan Medicaid	$1,686.44
Rate for Payer: Ohana Health Plan Medicare	$1,686.44
Rate for Payer: UnitedHealthcare Medicare	$1,686.44
Rate for Payer: University Health Alliance Commercial	$1,242.64

PLATE LCP 3.5/7H/LT 02.112.083

Facility

$2,219.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,242.64
Max. Negotiated Rate	$2,152.43
Rate for Payer: Cash Price	$1,331.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,553.30
Rate for Payer: Health Management Network Commercial	$1,886.15
Rate for Payer: Kaiser Permanente Commercial	$1,997.10
Rate for Payer: MDX Hawaii PPO	$2,152.43
Rate for Payer: University Health Alliance Commercial	$1,242.64

PLATE LCP 3.5/7H/LT 02.112.083

Facility

$2,219.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,109.50
Max. Negotiated Rate	$2,152.43
Rate for Payer: AlohaCare Medicaid	$1,109.50
Rate for Payer: AlohaCare Medicare	$1,686.44
Rate for Payer: Cash Price	$1,331.40
Rate for Payer: Devoted Health Medicare	$1,863.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,686.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,553.30
Rate for Payer: Health Management Network Commercial	$1,886.15
Rate for Payer: Humana Medicare	$1,686.44
Rate for Payer: Kaiser Permanente Commercial	$1,997.10
Rate for Payer: Kaiser Permanente Medicaid	$1,131.69
Rate for Payer: Kaiser Permanente Medicare	$1,686.44
Rate for Payer: MDX Hawaii PPO	$2,152.43
Rate for Payer: Ohana Health Plan Medicaid	$1,686.44
Rate for Payer: Ohana Health Plan Medicare	$1,686.44
Rate for Payer: UnitedHealthcare Medicare	$1,686.44
Rate for Payer: University Health Alliance Commercial	$1,242.64

PLATE LCP 3.5/7H/RT 02.112.028

Facility

$2,573.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,286.50
Max. Negotiated Rate	$2,495.81
Rate for Payer: AlohaCare Medicaid	$1,286.50
Rate for Payer: AlohaCare Medicare	$1,955.48
Rate for Payer: Cash Price	$1,543.80
Rate for Payer: Devoted Health Medicare	$2,161.32
Rate for Payer: Hawaii Medical Service Association Medicare	$1,955.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,801.10
Rate for Payer: Health Management Network Commercial	$2,187.05
Rate for Payer: Humana Medicare	$1,955.48
Rate for Payer: Kaiser Permanente Commercial	$2,315.70
Rate for Payer: Kaiser Permanente Medicaid	$1,312.23
Rate for Payer: Kaiser Permanente Medicare	$1,955.48
Rate for Payer: MDX Hawaii PPO	$2,495.81
Rate for Payer: Ohana Health Plan Medicaid	$1,955.48
Rate for Payer: Ohana Health Plan Medicare	$1,955.48
Rate for Payer: UnitedHealthcare Medicare	$1,955.48
Rate for Payer: University Health Alliance Commercial	$1,440.88

PLATE LCP 3.5/7H/RT 02.112.028

Facility

$2,573.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,440.88
Max. Negotiated Rate	$2,495.81
Rate for Payer: Cash Price	$1,543.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,801.10
Rate for Payer: Health Management Network Commercial	$2,187.05
Rate for Payer: Kaiser Permanente Commercial	$2,315.70
Rate for Payer: MDX Hawaii PPO	$2,495.81
Rate for Payer: University Health Alliance Commercial	$1,440.88

PLATE LCP 3.5/7H/RT 02.112.082

Facility

$2,219.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,242.64
Max. Negotiated Rate	$2,152.43
Rate for Payer: Cash Price	$1,331.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,553.30
Rate for Payer: Health Management Network Commercial	$1,886.15
Rate for Payer: Kaiser Permanente Commercial	$1,997.10
Rate for Payer: MDX Hawaii PPO	$2,152.43
Rate for Payer: University Health Alliance Commercial	$1,242.64

PLATE LCP 3.5/7H/RT 02.112.082

Facility

$2,219.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,109.50
Max. Negotiated Rate	$2,152.43
Rate for Payer: AlohaCare Medicaid	$1,109.50
Rate for Payer: AlohaCare Medicare	$1,686.44
Rate for Payer: Cash Price	$1,331.40
Rate for Payer: Devoted Health Medicare	$1,863.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,686.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,553.30
Rate for Payer: Health Management Network Commercial	$1,886.15
Rate for Payer: Humana Medicare	$1,686.44
Rate for Payer: Kaiser Permanente Commercial	$1,997.10
Rate for Payer: Kaiser Permanente Medicaid	$1,131.69
Rate for Payer: Kaiser Permanente Medicare	$1,686.44
Rate for Payer: MDX Hawaii PPO	$2,152.43
Rate for Payer: Ohana Health Plan Medicaid	$1,686.44
Rate for Payer: Ohana Health Plan Medicare	$1,686.44
Rate for Payer: UnitedHealthcare Medicare	$1,686.44
Rate for Payer: University Health Alliance Commercial	$1,242.64

PLATE LCP 3.5/8H/L 02.127.331

Facility

$4,215.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,107.50
Max. Negotiated Rate	$4,088.55
Rate for Payer: AlohaCare Medicaid	$2,107.50
Rate for Payer: AlohaCare Medicare	$3,203.40
Rate for Payer: Cash Price	$2,529.00
Rate for Payer: Devoted Health Medicare	$3,540.60
Rate for Payer: Hawaii Medical Service Association Medicare	$3,203.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,950.50
Rate for Payer: Health Management Network Commercial	$3,582.75
Rate for Payer: Humana Medicare	$3,203.40
Rate for Payer: Kaiser Permanente Commercial	$3,793.50
Rate for Payer: Kaiser Permanente Medicaid	$2,149.65
Rate for Payer: Kaiser Permanente Medicare	$3,203.40
Rate for Payer: MDX Hawaii PPO	$4,088.55
Rate for Payer: Ohana Health Plan Medicaid	$3,203.40
Rate for Payer: Ohana Health Plan Medicare	$3,203.40
Rate for Payer: UnitedHealthcare Medicare	$3,203.40
Rate for Payer: University Health Alliance Commercial	$2,360.40

PLATE LCP 3.5/8H/L 02.127.331

Facility

$4,215.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,360.40
Max. Negotiated Rate	$4,088.55
Rate for Payer: MDX Hawaii PPO	$4,088.55
Rate for Payer: Cash Price	$2,529.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,950.50
Rate for Payer: Health Management Network Commercial	$3,582.75
Rate for Payer: Kaiser Permanente Commercial	$3,793.50
Rate for Payer: University Health Alliance Commercial	$2,360.40

PLATE LCP 3.5/8H/LT 02.112.021

Facility

$3,160.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,769.60
Max. Negotiated Rate	$3,065.20
Rate for Payer: Cash Price	$1,896.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,212.00
Rate for Payer: Health Management Network Commercial	$2,686.00
Rate for Payer: Kaiser Permanente Commercial	$2,844.00
Rate for Payer: MDX Hawaii PPO	$3,065.20
Rate for Payer: University Health Alliance Commercial	$1,769.60

PLATE LCP 3.5/8H/LT 02.112.021

Facility

$3,160.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,580.00
Max. Negotiated Rate	$3,065.20
Rate for Payer: AlohaCare Medicaid	$1,580.00
Rate for Payer: AlohaCare Medicare	$2,401.60
Rate for Payer: Cash Price	$1,896.00
Rate for Payer: Devoted Health Medicare	$2,654.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,401.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,212.00
Rate for Payer: Health Management Network Commercial	$2,686.00
Rate for Payer: Humana Medicare	$2,401.60
Rate for Payer: Kaiser Permanente Commercial	$2,844.00
Rate for Payer: Kaiser Permanente Medicaid	$1,611.60
Rate for Payer: Kaiser Permanente Medicare	$2,401.60
Rate for Payer: MDX Hawaii PPO	$3,065.20
Rate for Payer: Ohana Health Plan Medicaid	$2,401.60
Rate for Payer: Ohana Health Plan Medicare	$2,401.60
Rate for Payer: UnitedHealthcare Medicare	$2,401.60
Rate for Payer: University Health Alliance Commercial	$1,769.60

Know your out-of-pocket cost for care.

All Charges