Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE LCP 3H 4.5X62MM 224.531

Facility

$1,694.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$948.64
Max. Negotiated Rate	$1,643.18
Rate for Payer: Cash Price	$1,016.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,185.80
Rate for Payer: Health Management Network Commercial	$1,439.90
Rate for Payer: Kaiser Permanente Commercial	$1,524.60
Rate for Payer: MDX Hawaii PPO	$1,643.18
Rate for Payer: University Health Alliance Commercial	$948.64

PLATE LCP 4.5X266MM 02.124.413

Facility

$4,419.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,474.64
Max. Negotiated Rate	$4,286.43
Rate for Payer: Cash Price	$2,651.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,093.30
Rate for Payer: Health Management Network Commercial	$3,756.15
Rate for Payer: Kaiser Permanente Commercial	$3,977.10
Rate for Payer: MDX Hawaii PPO	$4,286.43
Rate for Payer: University Health Alliance Commercial	$2,474.64

PLATE LCP 4.5X266MM 02.124.413

Facility

$4,419.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,209.50
Max. Negotiated Rate	$4,286.43
Rate for Payer: AlohaCare Medicaid	$2,209.50
Rate for Payer: AlohaCare Medicare	$3,358.44
Rate for Payer: Cash Price	$2,651.40
Rate for Payer: Devoted Health Medicare	$3,711.96
Rate for Payer: Hawaii Medical Service Association Medicare	$3,358.44
Rate for Payer: Hawaii Western Management Group Commercial	$3,093.30
Rate for Payer: Health Management Network Commercial	$3,756.15
Rate for Payer: Humana Medicare	$3,358.44
Rate for Payer: Kaiser Permanente Commercial	$3,977.10
Rate for Payer: Kaiser Permanente Medicaid	$2,253.69
Rate for Payer: Kaiser Permanente Medicare	$3,358.44
Rate for Payer: MDX Hawaii PPO	$4,286.43
Rate for Payer: Ohana Health Plan Medicaid	$3,358.44
Rate for Payer: Ohana Health Plan Medicare	$3,358.44
Rate for Payer: UnitedHealthcare Medicare	$3,358.44
Rate for Payer: University Health Alliance Commercial	$2,474.64

PLATE LCP 4.5X3.5 12H 224.757

Facility

$2,923.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,636.88
Max. Negotiated Rate	$2,835.31
Rate for Payer: Cash Price	$1,753.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,046.10
Rate for Payer: Health Management Network Commercial	$2,484.55
Rate for Payer: Kaiser Permanente Commercial	$2,630.70
Rate for Payer: MDX Hawaii PPO	$2,835.31
Rate for Payer: University Health Alliance Commercial	$1,636.88

PLATE LCP 4.5X3.5 12H 224.757

Facility

$2,923.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,461.50
Max. Negotiated Rate	$2,835.31
Rate for Payer: AlohaCare Medicaid	$1,461.50
Rate for Payer: AlohaCare Medicare	$2,221.48
Rate for Payer: Cash Price	$1,753.80
Rate for Payer: Devoted Health Medicare	$2,455.32
Rate for Payer: Hawaii Medical Service Association Medicare	$2,221.48
Rate for Payer: Hawaii Western Management Group Commercial	$2,046.10
Rate for Payer: Health Management Network Commercial	$2,484.55
Rate for Payer: Humana Medicare	$2,221.48
Rate for Payer: Kaiser Permanente Commercial	$2,630.70
Rate for Payer: Kaiser Permanente Medicaid	$1,490.73
Rate for Payer: Kaiser Permanente Medicare	$2,221.48
Rate for Payer: MDX Hawaii PPO	$2,835.31
Rate for Payer: Ohana Health Plan Medicaid	$2,221.48
Rate for Payer: Ohana Health Plan Medicare	$2,221.48
Rate for Payer: UnitedHealthcare Medicare	$2,221.48
Rate for Payer: University Health Alliance Commercial	$1,636.88

PLATE LCP 4H 109MM 04.112.510

Facility

$3,542.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,771.00
Max. Negotiated Rate	$3,435.74
Rate for Payer: AlohaCare Medicaid	$1,771.00
Rate for Payer: AlohaCare Medicare	$2,691.92
Rate for Payer: Cash Price	$2,125.20
Rate for Payer: Devoted Health Medicare	$2,975.28
Rate for Payer: Hawaii Medical Service Association Medicare	$2,691.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,479.40
Rate for Payer: Health Management Network Commercial	$3,010.70
Rate for Payer: Humana Medicare	$2,691.92
Rate for Payer: Kaiser Permanente Commercial	$3,187.80
Rate for Payer: Kaiser Permanente Medicaid	$1,806.42
Rate for Payer: Kaiser Permanente Medicare	$2,691.92
Rate for Payer: MDX Hawaii PPO	$3,435.74
Rate for Payer: Ohana Health Plan Medicaid	$2,691.92
Rate for Payer: Ohana Health Plan Medicare	$2,691.92
Rate for Payer: UnitedHealthcare Medicare	$2,691.92
Rate for Payer: University Health Alliance Commercial	$1,983.52

PLATE LCP 4H 109MM 04.112.510

Facility

$3,542.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,983.52
Max. Negotiated Rate	$3,435.74
Rate for Payer: Cash Price	$2,125.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,479.40
Rate for Payer: Health Management Network Commercial	$3,010.70
Rate for Payer: Kaiser Permanente Commercial	$3,187.80
Rate for Payer: MDX Hawaii PPO	$3,435.74
Rate for Payer: University Health Alliance Commercial	$1,983.52

PLATE LCP 4H 3.5X81MM #239.934

Facility

$4,472.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,504.32
Max. Negotiated Rate	$4,337.84
Rate for Payer: Cash Price	$2,683.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,130.40
Rate for Payer: Health Management Network Commercial	$3,801.20
Rate for Payer: Kaiser Permanente Commercial	$4,024.80
Rate for Payer: MDX Hawaii PPO	$4,337.84
Rate for Payer: University Health Alliance Commercial	$2,504.32

PLATE LCP 4H 3.5X81MM #239.934

Facility

$4,472.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,236.00
Max. Negotiated Rate	$4,337.84
Rate for Payer: AlohaCare Medicaid	$2,236.00
Rate for Payer: AlohaCare Medicare	$3,398.72
Rate for Payer: Cash Price	$2,683.20
Rate for Payer: Devoted Health Medicare	$3,756.48
Rate for Payer: Hawaii Medical Service Association Medicare	$3,398.72
Rate for Payer: Hawaii Western Management Group Commercial	$3,130.40
Rate for Payer: Health Management Network Commercial	$3,801.20
Rate for Payer: Humana Medicare	$3,398.72
Rate for Payer: Kaiser Permanente Commercial	$4,024.80
Rate for Payer: Kaiser Permanente Medicaid	$2,280.72
Rate for Payer: Kaiser Permanente Medicare	$3,398.72
Rate for Payer: MDX Hawaii PPO	$4,337.84
Rate for Payer: Ohana Health Plan Medicaid	$3,398.72
Rate for Payer: Ohana Health Plan Medicare	$3,398.72
Rate for Payer: UnitedHealthcare Medicare	$3,398.72
Rate for Payer: University Health Alliance Commercial	$2,504.32

PLATE LCP 4H 3.5X81MM #239.935

Facility

$3,302.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,651.00
Max. Negotiated Rate	$3,202.94
Rate for Payer: AlohaCare Medicaid	$1,651.00
Rate for Payer: AlohaCare Medicare	$2,509.52
Rate for Payer: Cash Price	$1,981.20
Rate for Payer: Devoted Health Medicare	$2,773.68
Rate for Payer: Hawaii Medical Service Association Medicare	$2,509.52
Rate for Payer: Hawaii Western Management Group Commercial	$2,311.40
Rate for Payer: Health Management Network Commercial	$2,806.70
Rate for Payer: Humana Medicare	$2,509.52
Rate for Payer: Kaiser Permanente Commercial	$2,971.80
Rate for Payer: Kaiser Permanente Medicaid	$1,684.02
Rate for Payer: Kaiser Permanente Medicare	$2,509.52
Rate for Payer: MDX Hawaii PPO	$3,202.94
Rate for Payer: Ohana Health Plan Medicaid	$2,509.52
Rate for Payer: Ohana Health Plan Medicare	$2,509.52
Rate for Payer: UnitedHealthcare Medicare	$2,509.52
Rate for Payer: University Health Alliance Commercial	$1,849.12

PLATE LCP 4H 3.5X81MM #239.935

Facility

$3,302.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,849.12
Max. Negotiated Rate	$3,202.94
Rate for Payer: Cash Price	$1,981.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,311.40
Rate for Payer: Health Management Network Commercial	$2,806.70
Rate for Payer: Kaiser Permanente Commercial	$2,971.80
Rate for Payer: MDX Hawaii PPO	$3,202.94
Rate for Payer: University Health Alliance Commercial	$1,849.12

PLATE LCP 4H 4.5X82MM 240.036

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 4H 4.5X82MM 240.036

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 4H 4.5X82MM 240.037

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 4H 4.5X82MM 240.037

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 5H 1/3T 57MM 241.351

Facility

$743.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$371.50
Max. Negotiated Rate	$720.71
Rate for Payer: AlohaCare Medicaid	$371.50
Rate for Payer: AlohaCare Medicare	$564.68
Rate for Payer: Cash Price	$445.80
Rate for Payer: Devoted Health Medicare	$624.12
Rate for Payer: Hawaii Medical Service Association Medicare	$564.68
Rate for Payer: Hawaii Western Management Group Commercial	$520.10
Rate for Payer: Health Management Network Commercial	$631.55
Rate for Payer: Humana Medicare	$564.68
Rate for Payer: Kaiser Permanente Commercial	$668.70
Rate for Payer: Kaiser Permanente Medicaid	$378.93
Rate for Payer: Kaiser Permanente Medicare	$564.68
Rate for Payer: MDX Hawaii PPO	$720.71
Rate for Payer: Ohana Health Plan Medicaid	$564.68
Rate for Payer: Ohana Health Plan Medicare	$564.68
Rate for Payer: UnitedHealthcare Medicare	$564.68
Rate for Payer: University Health Alliance Commercial	$416.08

PLATE LCP 5H 1/3T 57MM 241.351

Facility

$743.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$416.08
Max. Negotiated Rate	$720.71
Rate for Payer: Cash Price	$445.80
Rate for Payer: Hawaii Western Management Group Commercial	$520.10
Rate for Payer: Health Management Network Commercial	$631.55
Rate for Payer: Kaiser Permanente Commercial	$668.70
Rate for Payer: MDX Hawaii PPO	$720.71
Rate for Payer: University Health Alliance Commercial	$416.08

PLATE LCP 5H 3.5X114MM 241.903

Facility

$3,516.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,758.00
Max. Negotiated Rate	$3,410.52
Rate for Payer: AlohaCare Medicaid	$1,758.00
Rate for Payer: AlohaCare Medicare	$2,672.16
Rate for Payer: Cash Price	$2,109.60
Rate for Payer: Devoted Health Medicare	$2,953.44
Rate for Payer: Hawaii Medical Service Association Medicare	$2,672.16
Rate for Payer: Hawaii Western Management Group Commercial	$2,461.20
Rate for Payer: Health Management Network Commercial	$2,988.60
Rate for Payer: Humana Medicare	$2,672.16
Rate for Payer: Kaiser Permanente Commercial	$3,164.40
Rate for Payer: Kaiser Permanente Medicaid	$1,793.16
Rate for Payer: Kaiser Permanente Medicare	$2,672.16
Rate for Payer: MDX Hawaii PPO	$3,410.52
Rate for Payer: Ohana Health Plan Medicaid	$2,672.16
Rate for Payer: Ohana Health Plan Medicare	$2,672.16
Rate for Payer: UnitedHealthcare Medicare	$2,672.16
Rate for Payer: University Health Alliance Commercial	$1,968.96

PLATE LCP 5H 3.5X114MM 241.903

Facility

$3,516.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,968.96
Max. Negotiated Rate	$3,410.52
Rate for Payer: Cash Price	$2,109.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,461.20
Rate for Payer: Health Management Network Commercial	$2,988.60
Rate for Payer: Kaiser Permanente Commercial	$3,164.40
Rate for Payer: MDX Hawaii PPO	$3,410.52
Rate for Payer: University Health Alliance Commercial	$1,968.96

PLATE LCP 5H 3.5X70MM 245.051

Facility

$2,196.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,229.76
Max. Negotiated Rate	$2,130.12
Rate for Payer: Cash Price	$1,317.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,537.20
Rate for Payer: Health Management Network Commercial	$1,866.60
Rate for Payer: Kaiser Permanente Commercial	$1,976.40
Rate for Payer: MDX Hawaii PPO	$2,130.12
Rate for Payer: University Health Alliance Commercial	$1,229.76

PLATE LCP 5H 3.5X70MM 245.051

Facility

$2,196.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,098.00
Max. Negotiated Rate	$2,130.12
Rate for Payer: AlohaCare Medicaid	$1,098.00
Rate for Payer: AlohaCare Medicare	$1,668.96
Rate for Payer: Cash Price	$1,317.60
Rate for Payer: Devoted Health Medicare	$1,844.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,668.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,537.20
Rate for Payer: Health Management Network Commercial	$1,866.60
Rate for Payer: Humana Medicare	$1,668.96
Rate for Payer: Kaiser Permanente Commercial	$1,976.40
Rate for Payer: Kaiser Permanente Medicaid	$1,119.96
Rate for Payer: Kaiser Permanente Medicare	$1,668.96
Rate for Payer: MDX Hawaii PPO	$2,130.12
Rate for Payer: Ohana Health Plan Medicaid	$1,668.96
Rate for Payer: Ohana Health Plan Medicare	$1,668.96
Rate for Payer: UnitedHealthcare Medicare	$1,668.96
Rate for Payer: University Health Alliance Commercial	$1,229.76

PLATE LCP 5H 3.5X72MM 223.551

Facility

$1,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$846.72
Max. Negotiated Rate	$1,466.64
Rate for Payer: Cash Price	$907.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,058.40
Rate for Payer: Health Management Network Commercial	$1,285.20
Rate for Payer: Kaiser Permanente Commercial	$1,360.80
Rate for Payer: MDX Hawaii PPO	$1,466.64
Rate for Payer: University Health Alliance Commercial	$846.72

PLATE LCP 5H 3.5X72MM 223.551

Facility

$1,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$756.00
Max. Negotiated Rate	$1,466.64
Rate for Payer: AlohaCare Medicaid	$756.00
Rate for Payer: AlohaCare Medicare	$1,149.12
Rate for Payer: Cash Price	$907.20
Rate for Payer: Devoted Health Medicare	$1,270.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,149.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,058.40
Rate for Payer: Health Management Network Commercial	$1,285.20
Rate for Payer: Humana Medicare	$1,149.12
Rate for Payer: Kaiser Permanente Commercial	$1,360.80
Rate for Payer: Kaiser Permanente Medicaid	$771.12
Rate for Payer: Kaiser Permanente Medicare	$1,149.12
Rate for Payer: MDX Hawaii PPO	$1,466.64
Rate for Payer: Ohana Health Plan Medicaid	$1,149.12
Rate for Payer: Ohana Health Plan Medicare	$1,149.12
Rate for Payer: UnitedHealthcare Medicare	$1,149.12
Rate for Payer: University Health Alliance Commercial	$846.72

PLATE LCP 5H 4.5X98MM 224.551

Facility

$1,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$817.50
Max. Negotiated Rate	$1,585.95
Rate for Payer: AlohaCare Medicaid	$817.50
Rate for Payer: AlohaCare Medicare	$1,242.60
Rate for Payer: Cash Price	$981.00
Rate for Payer: Devoted Health Medicare	$1,373.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,242.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,144.50
Rate for Payer: Health Management Network Commercial	$1,389.75
Rate for Payer: Humana Medicare	$1,242.60
Rate for Payer: Kaiser Permanente Commercial	$1,471.50
Rate for Payer: Kaiser Permanente Medicaid	$833.85
Rate for Payer: Kaiser Permanente Medicare	$1,242.60
Rate for Payer: MDX Hawaii PPO	$1,585.95
Rate for Payer: Ohana Health Plan Medicaid	$1,242.60
Rate for Payer: Ohana Health Plan Medicare	$1,242.60
Rate for Payer: UnitedHealthcare Medicare	$1,242.60
Rate for Payer: University Health Alliance Commercial	$915.60

PLATE LCP 5H 4.5X98MM 224.551

Facility

$1,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$915.60
Max. Negotiated Rate	$1,585.95
Rate for Payer: Cash Price	$981.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,144.50
Rate for Payer: Health Management Network Commercial	$1,389.75
Rate for Payer: Kaiser Permanente Commercial	$1,471.50
Rate for Payer: MDX Hawaii PPO	$1,585.95
Rate for Payer: University Health Alliance Commercial	$915.60

Know your out-of-pocket cost for care.

All Charges