Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE LCP 6H 1/3T 69MM 241.361

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 6H 1/3T 69MM 241.361

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 6H 145MM 02.111.681S

Facility

$4,333.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,426.48
Max. Negotiated Rate	$4,203.01
Rate for Payer: Cash Price	$2,599.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,033.10
Rate for Payer: Health Management Network Commercial	$3,683.05
Rate for Payer: Kaiser Permanente Commercial	$3,899.70
Rate for Payer: MDX Hawaii PPO	$4,203.01
Rate for Payer: University Health Alliance Commercial	$2,426.48

PLATE LCP 6H 145MM 02.111.681S

Facility

$4,333.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,166.50
Max. Negotiated Rate	$4,203.01
Rate for Payer: AlohaCare Medicaid	$2,166.50
Rate for Payer: AlohaCare Medicare	$3,293.08
Rate for Payer: Cash Price	$2,599.80
Rate for Payer: Devoted Health Medicare	$3,639.72
Rate for Payer: Hawaii Medical Service Association Medicare	$3,293.08
Rate for Payer: Hawaii Western Management Group Commercial	$3,033.10
Rate for Payer: Health Management Network Commercial	$3,683.05
Rate for Payer: Humana Medicare	$3,293.08
Rate for Payer: Kaiser Permanente Commercial	$3,899.70
Rate for Payer: Kaiser Permanente Medicaid	$2,209.83
Rate for Payer: Kaiser Permanente Medicare	$3,293.08
Rate for Payer: MDX Hawaii PPO	$4,203.01
Rate for Payer: Ohana Health Plan Medicaid	$3,293.08
Rate for Payer: Ohana Health Plan Medicare	$3,293.08
Rate for Payer: UnitedHealthcare Medicare	$3,293.08
Rate for Payer: University Health Alliance Commercial	$2,426.48

PLATE LCP 6H 3.5X107MM 239.936

Facility

$3,342.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,671.00
Max. Negotiated Rate	$3,241.74
Rate for Payer: AlohaCare Medicaid	$1,671.00
Rate for Payer: AlohaCare Medicare	$2,539.92
Rate for Payer: Cash Price	$2,005.20
Rate for Payer: Devoted Health Medicare	$2,807.28
Rate for Payer: Hawaii Medical Service Association Medicare	$2,539.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,339.40
Rate for Payer: Health Management Network Commercial	$2,840.70
Rate for Payer: Humana Medicare	$2,539.92
Rate for Payer: Kaiser Permanente Commercial	$3,007.80
Rate for Payer: Kaiser Permanente Medicaid	$1,704.42
Rate for Payer: Kaiser Permanente Medicare	$2,539.92
Rate for Payer: MDX Hawaii PPO	$3,241.74
Rate for Payer: Ohana Health Plan Medicaid	$2,539.92
Rate for Payer: Ohana Health Plan Medicare	$2,539.92
Rate for Payer: UnitedHealthcare Medicare	$2,539.92
Rate for Payer: University Health Alliance Commercial	$1,871.52

PLATE LCP 6H 3.5X107MM 239.936

Facility

$3,342.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,871.52
Max. Negotiated Rate	$3,241.74
Rate for Payer: Cash Price	$2,005.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,339.40
Rate for Payer: Health Management Network Commercial	$2,840.70
Rate for Payer: Kaiser Permanente Commercial	$3,007.80
Rate for Payer: MDX Hawaii PPO	$3,241.74
Rate for Payer: University Health Alliance Commercial	$1,871.52

PLATE LCP 6H 3.5X107MM 239.937

Facility

$3,342.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,671.00
Max. Negotiated Rate	$3,241.74
Rate for Payer: AlohaCare Medicaid	$1,671.00
Rate for Payer: AlohaCare Medicare	$2,539.92
Rate for Payer: Cash Price	$2,005.20
Rate for Payer: Devoted Health Medicare	$2,807.28
Rate for Payer: Hawaii Medical Service Association Medicare	$2,539.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,339.40
Rate for Payer: Health Management Network Commercial	$2,840.70
Rate for Payer: Humana Medicare	$2,539.92
Rate for Payer: Kaiser Permanente Commercial	$3,007.80
Rate for Payer: Kaiser Permanente Medicaid	$1,704.42
Rate for Payer: Kaiser Permanente Medicare	$2,539.92
Rate for Payer: MDX Hawaii PPO	$3,241.74
Rate for Payer: Ohana Health Plan Medicaid	$2,539.92
Rate for Payer: Ohana Health Plan Medicare	$2,539.92
Rate for Payer: UnitedHealthcare Medicare	$2,539.92
Rate for Payer: University Health Alliance Commercial	$1,871.52

PLATE LCP 6H 3.5X107MM 239.937

Facility

$3,342.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,871.52
Max. Negotiated Rate	$3,241.74
Rate for Payer: Cash Price	$2,005.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,339.40
Rate for Payer: Health Management Network Commercial	$2,840.70
Rate for Payer: Kaiser Permanente Commercial	$3,007.80
Rate for Payer: MDX Hawaii PPO	$3,241.74
Rate for Payer: University Health Alliance Commercial	$1,871.52

PLATE LCP 6H 3.5X84MM 245.061

Facility

$1,751.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$980.56
Max. Negotiated Rate	$1,698.47
Rate for Payer: Cash Price	$1,050.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,225.70
Rate for Payer: Health Management Network Commercial	$1,488.35
Rate for Payer: Kaiser Permanente Commercial	$1,575.90
Rate for Payer: MDX Hawaii PPO	$1,698.47
Rate for Payer: University Health Alliance Commercial	$980.56

PLATE LCP 6H 3.5X84MM 245.061

Facility

$1,751.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$875.50
Max. Negotiated Rate	$1,698.47
Rate for Payer: AlohaCare Medicaid	$875.50
Rate for Payer: AlohaCare Medicare	$1,330.76
Rate for Payer: Cash Price	$1,050.60
Rate for Payer: Devoted Health Medicare	$1,470.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,330.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,225.70
Rate for Payer: Health Management Network Commercial	$1,488.35
Rate for Payer: Humana Medicare	$1,330.76
Rate for Payer: Kaiser Permanente Commercial	$1,575.90
Rate for Payer: Kaiser Permanente Medicaid	$893.01
Rate for Payer: Kaiser Permanente Medicare	$1,330.76
Rate for Payer: MDX Hawaii PPO	$1,698.47
Rate for Payer: Ohana Health Plan Medicaid	$1,330.76
Rate for Payer: Ohana Health Plan Medicare	$1,330.76
Rate for Payer: UnitedHealthcare Medicare	$1,330.76
Rate for Payer: University Health Alliance Commercial	$980.56

PLATE LCP 6H 3.5X85MM 223.561

Facility

$1,280.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$716.80
Max. Negotiated Rate	$1,241.60
Rate for Payer: Cash Price	$768.00
Rate for Payer: Hawaii Western Management Group Commercial	$896.00
Rate for Payer: Health Management Network Commercial	$1,088.00
Rate for Payer: Kaiser Permanente Commercial	$1,152.00
Rate for Payer: MDX Hawaii PPO	$1,241.60
Rate for Payer: University Health Alliance Commercial	$716.80

PLATE LCP 6H 3.5X85MM 223.561

Facility

$1,280.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$640.00
Max. Negotiated Rate	$1,241.60
Rate for Payer: AlohaCare Medicaid	$640.00
Rate for Payer: AlohaCare Medicare	$972.80
Rate for Payer: Cash Price	$768.00
Rate for Payer: Devoted Health Medicare	$1,075.20
Rate for Payer: Hawaii Medical Service Association Medicare	$972.80
Rate for Payer: Hawaii Western Management Group Commercial	$896.00
Rate for Payer: Health Management Network Commercial	$1,088.00
Rate for Payer: Humana Medicare	$972.80
Rate for Payer: Kaiser Permanente Commercial	$1,152.00
Rate for Payer: Kaiser Permanente Medicaid	$652.80
Rate for Payer: Kaiser Permanente Medicare	$972.80
Rate for Payer: MDX Hawaii PPO	$1,241.60
Rate for Payer: Ohana Health Plan Medicaid	$972.80
Rate for Payer: Ohana Health Plan Medicare	$972.80
Rate for Payer: UnitedHealthcare Medicare	$972.80
Rate for Payer: University Health Alliance Commercial	$716.80

PLATE LCP 6H 4.5X116MM 224.561

Facility

$1,731.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$969.36
Max. Negotiated Rate	$1,679.07
Rate for Payer: Cash Price	$1,038.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,211.70
Rate for Payer: Health Management Network Commercial	$1,471.35
Rate for Payer: Kaiser Permanente Commercial	$1,557.90
Rate for Payer: MDX Hawaii PPO	$1,679.07
Rate for Payer: University Health Alliance Commercial	$969.36

PLATE LCP 6H 4.5X116MM 224.561

Facility

$1,731.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$865.50
Max. Negotiated Rate	$1,679.07
Rate for Payer: AlohaCare Medicaid	$865.50
Rate for Payer: AlohaCare Medicare	$1,315.56
Rate for Payer: Cash Price	$1,038.60
Rate for Payer: Devoted Health Medicare	$1,454.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1,315.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,211.70
Rate for Payer: Health Management Network Commercial	$1,471.35
Rate for Payer: Humana Medicare	$1,315.56
Rate for Payer: Kaiser Permanente Commercial	$1,557.90
Rate for Payer: Kaiser Permanente Medicaid	$882.81
Rate for Payer: Kaiser Permanente Medicare	$1,315.56
Rate for Payer: MDX Hawaii PPO	$1,679.07
Rate for Payer: Ohana Health Plan Medicaid	$1,315.56
Rate for Payer: Ohana Health Plan Medicare	$1,315.56
Rate for Payer: UnitedHealthcare Medicare	$1,315.56
Rate for Payer: University Health Alliance Commercial	$969.36

PLATE LCP 6H 4.5X116MM 226.561

Facility

$1,848.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$924.00
Max. Negotiated Rate	$1,792.56
Rate for Payer: AlohaCare Medicaid	$924.00
Rate for Payer: AlohaCare Medicare	$1,404.48
Rate for Payer: Cash Price	$1,108.80
Rate for Payer: Devoted Health Medicare	$1,552.32
Rate for Payer: Hawaii Medical Service Association Medicare	$1,404.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,293.60
Rate for Payer: Health Management Network Commercial	$1,570.80
Rate for Payer: Humana Medicare	$1,404.48
Rate for Payer: Kaiser Permanente Commercial	$1,663.20
Rate for Payer: Kaiser Permanente Medicaid	$942.48
Rate for Payer: Kaiser Permanente Medicare	$1,404.48
Rate for Payer: MDX Hawaii PPO	$1,792.56
Rate for Payer: Ohana Health Plan Medicaid	$1,404.48
Rate for Payer: Ohana Health Plan Medicare	$1,404.48
Rate for Payer: UnitedHealthcare Medicare	$1,404.48
Rate for Payer: University Health Alliance Commercial	$1,034.88

PLATE LCP 6H 4.5X116MM 226.561

Facility

$1,848.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,034.88
Max. Negotiated Rate	$1,792.56
Rate for Payer: Cash Price	$1,108.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,293.60
Rate for Payer: Health Management Network Commercial	$1,570.80
Rate for Payer: Kaiser Permanente Commercial	$1,663.20
Rate for Payer: MDX Hawaii PPO	$1,792.56
Rate for Payer: University Health Alliance Commercial	$1,034.88

PLATE LCP 6H 4.5X118MM 240.038

Facility

$3,751.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.56
Max. Negotiated Rate	$3,638.47
Rate for Payer: Cash Price	$2,250.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,625.70
Rate for Payer: Health Management Network Commercial	$3,188.35
Rate for Payer: Kaiser Permanente Commercial	$3,375.90
Rate for Payer: MDX Hawaii PPO	$3,638.47
Rate for Payer: University Health Alliance Commercial	$2,100.56

PLATE LCP 6H 4.5X118MM 240.038

Facility

$3,751.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.50
Max. Negotiated Rate	$3,638.47
Rate for Payer: AlohaCare Medicaid	$1,875.50
Rate for Payer: AlohaCare Medicare	$2,850.76
Rate for Payer: Cash Price	$2,250.60
Rate for Payer: Devoted Health Medicare	$3,150.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2,850.76
Rate for Payer: Hawaii Western Management Group Commercial	$2,625.70
Rate for Payer: Health Management Network Commercial	$3,188.35
Rate for Payer: Humana Medicare	$2,850.76
Rate for Payer: Kaiser Permanente Commercial	$3,375.90
Rate for Payer: Kaiser Permanente Medicaid	$1,913.01
Rate for Payer: Kaiser Permanente Medicare	$2,850.76
Rate for Payer: MDX Hawaii PPO	$3,638.47
Rate for Payer: Ohana Health Plan Medicaid	$2,850.76
Rate for Payer: Ohana Health Plan Medicare	$2,850.76
Rate for Payer: UnitedHealthcare Medicare	$2,850.76
Rate for Payer: University Health Alliance Commercial	$2,100.56

PLATE LCP 6H 4.5X118MM 240.039

Facility

$3,751.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.56
Max. Negotiated Rate	$3,638.47
Rate for Payer: Cash Price	$2,250.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,625.70
Rate for Payer: Health Management Network Commercial	$3,188.35
Rate for Payer: Kaiser Permanente Commercial	$3,375.90
Rate for Payer: MDX Hawaii PPO	$3,638.47
Rate for Payer: University Health Alliance Commercial	$2,100.56

PLATE LCP 6H 4.5X118MM 240.039

Facility

$3,751.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.50
Max. Negotiated Rate	$3,638.47
Rate for Payer: AlohaCare Medicaid	$1,875.50
Rate for Payer: AlohaCare Medicare	$2,850.76
Rate for Payer: Cash Price	$2,250.60
Rate for Payer: Devoted Health Medicare	$3,150.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2,850.76
Rate for Payer: Hawaii Western Management Group Commercial	$2,625.70
Rate for Payer: Health Management Network Commercial	$3,188.35
Rate for Payer: Humana Medicare	$2,850.76
Rate for Payer: Kaiser Permanente Commercial	$3,375.90
Rate for Payer: Kaiser Permanente Medicaid	$1,913.01
Rate for Payer: Kaiser Permanente Medicare	$2,850.76
Rate for Payer: MDX Hawaii PPO	$3,638.47
Rate for Payer: Ohana Health Plan Medicaid	$2,850.76
Rate for Payer: Ohana Health Plan Medicare	$2,850.76
Rate for Payer: UnitedHealthcare Medicare	$2,850.76
Rate for Payer: University Health Alliance Commercial	$2,100.56

PLATE LCP 7H 1/3T 81MM 241.371

Facility

$756.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$378.00
Max. Negotiated Rate	$733.32
Rate for Payer: AlohaCare Medicaid	$378.00
Rate for Payer: AlohaCare Medicare	$574.56
Rate for Payer: Cash Price	$453.60
Rate for Payer: Devoted Health Medicare	$635.04
Rate for Payer: Hawaii Medical Service Association Medicare	$574.56
Rate for Payer: Hawaii Western Management Group Commercial	$529.20
Rate for Payer: Health Management Network Commercial	$642.60
Rate for Payer: Humana Medicare	$574.56
Rate for Payer: Kaiser Permanente Commercial	$680.40
Rate for Payer: Kaiser Permanente Medicaid	$385.56
Rate for Payer: Kaiser Permanente Medicare	$574.56
Rate for Payer: MDX Hawaii PPO	$733.32
Rate for Payer: Ohana Health Plan Medicaid	$574.56
Rate for Payer: Ohana Health Plan Medicare	$574.56
Rate for Payer: UnitedHealthcare Medicare	$574.56
Rate for Payer: University Health Alliance Commercial	$423.36

PLATE LCP 7H 1/3T 81MM 241.371

Facility

$756.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$423.36
Max. Negotiated Rate	$733.32
Rate for Payer: Cash Price	$453.60
Rate for Payer: Hawaii Western Management Group Commercial	$529.20
Rate for Payer: Health Management Network Commercial	$642.60
Rate for Payer: Kaiser Permanente Commercial	$680.40
Rate for Payer: MDX Hawaii PPO	$733.32
Rate for Payer: University Health Alliance Commercial	$423.36

PLATE LCP 7H 3.5X98MM 223.571

Facility

$1,328.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$664.00
Max. Negotiated Rate	$1,288.16
Rate for Payer: AlohaCare Medicaid	$664.00
Rate for Payer: AlohaCare Medicare	$1,009.28
Rate for Payer: Cash Price	$796.80
Rate for Payer: Devoted Health Medicare	$1,115.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,009.28
Rate for Payer: Hawaii Western Management Group Commercial	$929.60
Rate for Payer: Health Management Network Commercial	$1,128.80
Rate for Payer: Humana Medicare	$1,009.28
Rate for Payer: Kaiser Permanente Commercial	$1,195.20
Rate for Payer: Kaiser Permanente Medicaid	$677.28
Rate for Payer: Kaiser Permanente Medicare	$1,009.28
Rate for Payer: MDX Hawaii PPO	$1,288.16
Rate for Payer: Ohana Health Plan Medicaid	$1,009.28
Rate for Payer: Ohana Health Plan Medicare	$1,009.28
Rate for Payer: UnitedHealthcare Medicare	$1,009.28
Rate for Payer: University Health Alliance Commercial	$743.68

PLATE LCP 7H 3.5X98MM 223.571

Facility

$1,328.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$743.68
Max. Negotiated Rate	$1,288.16
Rate for Payer: Cash Price	$796.80
Rate for Payer: Hawaii Western Management Group Commercial	$929.60
Rate for Payer: Health Management Network Commercial	$1,128.80
Rate for Payer: Kaiser Permanente Commercial	$1,195.20
Rate for Payer: MDX Hawaii PPO	$1,288.16
Rate for Payer: University Health Alliance Commercial	$743.68

PLATE LCP 7H 3.5X98MM 245.071

Facility

$1,836.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,028.16
Max. Negotiated Rate	$1,780.92
Rate for Payer: Cash Price	$1,101.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,285.20
Rate for Payer: Health Management Network Commercial	$1,560.60
Rate for Payer: Kaiser Permanente Commercial	$1,652.40
Rate for Payer: MDX Hawaii PPO	$1,780.92
Rate for Payer: University Health Alliance Commercial	$1,028.16

Know your out-of-pocket cost for care.

All Charges