Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE LCP 7H 3.5X98MM 245.071

Facility

$1,836.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$918.00
Max. Negotiated Rate	$1,780.92
Rate for Payer: AlohaCare Medicaid	$918.00
Rate for Payer: AlohaCare Medicare	$1,395.36
Rate for Payer: Cash Price	$1,101.60
Rate for Payer: Devoted Health Medicare	$1,542.24
Rate for Payer: Hawaii Medical Service Association Medicare	$1,395.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,285.20
Rate for Payer: Health Management Network Commercial	$1,560.60
Rate for Payer: Humana Medicare	$1,395.36
Rate for Payer: Kaiser Permanente Commercial	$1,652.40
Rate for Payer: Kaiser Permanente Medicaid	$936.36
Rate for Payer: Kaiser Permanente Medicare	$1,395.36
Rate for Payer: MDX Hawaii PPO	$1,780.92
Rate for Payer: Ohana Health Plan Medicaid	$1,395.36
Rate for Payer: Ohana Health Plan Medicare	$1,395.36
Rate for Payer: UnitedHealthcare Medicare	$1,395.36
Rate for Payer: University Health Alliance Commercial	$1,028.16

PLATE LCP 7H 4.5X134MM 224.571

Facility

$2,004.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,122.24
Max. Negotiated Rate	$1,943.88
Rate for Payer: Cash Price	$1,202.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,402.80
Rate for Payer: Health Management Network Commercial	$1,703.40
Rate for Payer: Kaiser Permanente Commercial	$1,803.60
Rate for Payer: MDX Hawaii PPO	$1,943.88
Rate for Payer: University Health Alliance Commercial	$1,122.24

PLATE LCP 7H 4.5X134MM 224.571

Facility

$2,004.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,002.00
Max. Negotiated Rate	$1,943.88
Rate for Payer: AlohaCare Medicaid	$1,002.00
Rate for Payer: AlohaCare Medicare	$1,523.04
Rate for Payer: Cash Price	$1,202.40
Rate for Payer: Devoted Health Medicare	$1,683.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1,523.04
Rate for Payer: Hawaii Western Management Group Commercial	$1,402.80
Rate for Payer: Health Management Network Commercial	$1,703.40
Rate for Payer: Humana Medicare	$1,523.04
Rate for Payer: Kaiser Permanente Commercial	$1,803.60
Rate for Payer: Kaiser Permanente Medicaid	$1,022.04
Rate for Payer: Kaiser Permanente Medicare	$1,523.04
Rate for Payer: MDX Hawaii PPO	$1,943.88
Rate for Payer: Ohana Health Plan Medicaid	$1,523.04
Rate for Payer: Ohana Health Plan Medicare	$1,523.04
Rate for Payer: UnitedHealthcare Medicare	$1,523.04
Rate for Payer: University Health Alliance Commercial	$1,122.24

PLATE LCP 7H 4.5X134MM 226.571

Facility

$1,962.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,098.72
Max. Negotiated Rate	$1,903.14
Rate for Payer: Cash Price	$1,177.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,373.40
Rate for Payer: Health Management Network Commercial	$1,667.70
Rate for Payer: Kaiser Permanente Commercial	$1,765.80
Rate for Payer: MDX Hawaii PPO	$1,903.14
Rate for Payer: University Health Alliance Commercial	$1,098.72

PLATE LCP 7H 4.5X134MM 226.571

Facility

$1,962.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$981.00
Max. Negotiated Rate	$1,903.14
Rate for Payer: AlohaCare Medicaid	$981.00
Rate for Payer: AlohaCare Medicare	$1,491.12
Rate for Payer: Cash Price	$1,177.20
Rate for Payer: Devoted Health Medicare	$1,648.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,491.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,373.40
Rate for Payer: Health Management Network Commercial	$1,667.70
Rate for Payer: Humana Medicare	$1,491.12
Rate for Payer: Kaiser Permanente Commercial	$1,765.80
Rate for Payer: Kaiser Permanente Medicaid	$1,000.62
Rate for Payer: Kaiser Permanente Medicare	$1,491.12
Rate for Payer: MDX Hawaii PPO	$1,903.14
Rate for Payer: Ohana Health Plan Medicaid	$1,491.12
Rate for Payer: Ohana Health Plan Medicare	$1,491.12
Rate for Payer: UnitedHealthcare Medicare	$1,491.12
Rate for Payer: University Health Alliance Commercial	$1,098.72

PLATE LCP 8H 1/3T 93MM 241.381

Facility

$800.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$400.00
Max. Negotiated Rate	$776.00
Rate for Payer: AlohaCare Medicaid	$400.00
Rate for Payer: AlohaCare Medicare	$608.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Devoted Health Medicare	$672.00
Rate for Payer: Hawaii Medical Service Association Medicare	$608.00
Rate for Payer: Hawaii Western Management Group Commercial	$560.00
Rate for Payer: Health Management Network Commercial	$680.00
Rate for Payer: Humana Medicare	$608.00
Rate for Payer: Kaiser Permanente Commercial	$720.00
Rate for Payer: Kaiser Permanente Medicaid	$408.00
Rate for Payer: Kaiser Permanente Medicare	$608.00
Rate for Payer: MDX Hawaii PPO	$776.00
Rate for Payer: Ohana Health Plan Medicaid	$608.00
Rate for Payer: Ohana Health Plan Medicare	$608.00
Rate for Payer: UnitedHealthcare Medicare	$608.00
Rate for Payer: University Health Alliance Commercial	$448.00

PLATE LCP 8H 1/3T 93MM 241.381

Facility

$800.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$448.00
Max. Negotiated Rate	$776.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Hawaii Western Management Group Commercial	$560.00
Rate for Payer: Health Management Network Commercial	$680.00
Rate for Payer: Kaiser Permanente Commercial	$720.00
Rate for Payer: MDX Hawaii PPO	$776.00
Rate for Payer: University Health Alliance Commercial	$448.00

PLATE LCP 8H 3.5X111MM 223.581

Facility

$1,396.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$698.00
Max. Negotiated Rate	$1,354.12
Rate for Payer: AlohaCare Medicaid	$698.00
Rate for Payer: AlohaCare Medicare	$1,060.96
Rate for Payer: Cash Price	$837.60
Rate for Payer: Devoted Health Medicare	$1,172.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,060.96
Rate for Payer: Hawaii Western Management Group Commercial	$977.20
Rate for Payer: Health Management Network Commercial	$1,186.60
Rate for Payer: Humana Medicare	$1,060.96
Rate for Payer: Kaiser Permanente Commercial	$1,256.40
Rate for Payer: Kaiser Permanente Medicaid	$711.96
Rate for Payer: Kaiser Permanente Medicare	$1,060.96
Rate for Payer: MDX Hawaii PPO	$1,354.12
Rate for Payer: Ohana Health Plan Medicaid	$1,060.96
Rate for Payer: Ohana Health Plan Medicare	$1,060.96
Rate for Payer: UnitedHealthcare Medicare	$1,060.96
Rate for Payer: University Health Alliance Commercial	$781.76

PLATE LCP 8H 3.5X111MM 223.581

Facility

$1,396.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$781.76
Max. Negotiated Rate	$1,354.12
Rate for Payer: Cash Price	$837.60
Rate for Payer: Hawaii Western Management Group Commercial	$977.20
Rate for Payer: Health Management Network Commercial	$1,186.60
Rate for Payer: Kaiser Permanente Commercial	$1,256.40
Rate for Payer: MDX Hawaii PPO	$1,354.12
Rate for Payer: University Health Alliance Commercial	$781.76

PLATE LCP 8H 3.5X133MM 239.938

Facility

$4,578.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,563.68
Max. Negotiated Rate	$4,440.66
Rate for Payer: Cash Price	$2,746.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,204.60
Rate for Payer: Health Management Network Commercial	$3,891.30
Rate for Payer: Kaiser Permanente Commercial	$4,120.20
Rate for Payer: MDX Hawaii PPO	$4,440.66
Rate for Payer: University Health Alliance Commercial	$2,563.68

PLATE LCP 8H 3.5X133MM 239.938

Facility

$4,578.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,289.00
Max. Negotiated Rate	$4,440.66
Rate for Payer: AlohaCare Medicaid	$2,289.00
Rate for Payer: AlohaCare Medicare	$3,479.28
Rate for Payer: Cash Price	$2,746.80
Rate for Payer: Devoted Health Medicare	$3,845.52
Rate for Payer: Hawaii Medical Service Association Medicare	$3,479.28
Rate for Payer: Hawaii Western Management Group Commercial	$3,204.60
Rate for Payer: Health Management Network Commercial	$3,891.30
Rate for Payer: Humana Medicare	$3,479.28
Rate for Payer: Kaiser Permanente Commercial	$4,120.20
Rate for Payer: Kaiser Permanente Medicaid	$2,334.78
Rate for Payer: Kaiser Permanente Medicare	$3,479.28
Rate for Payer: MDX Hawaii PPO	$4,440.66
Rate for Payer: Ohana Health Plan Medicaid	$3,479.28
Rate for Payer: Ohana Health Plan Medicare	$3,479.28
Rate for Payer: UnitedHealthcare Medicare	$3,479.28
Rate for Payer: University Health Alliance Commercial	$2,563.68

PLATE LCP 8H 3.5X133MM 239.939

Facility

$4,989.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,793.84
Max. Negotiated Rate	$4,839.33
Rate for Payer: Cash Price	$2,993.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,492.30
Rate for Payer: Health Management Network Commercial	$4,240.65
Rate for Payer: Kaiser Permanente Commercial	$4,490.10
Rate for Payer: MDX Hawaii PPO	$4,839.33
Rate for Payer: University Health Alliance Commercial	$2,793.84

PLATE LCP 8H 3.5X133MM 239.939

Facility

$4,989.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,494.50
Max. Negotiated Rate	$4,839.33
Rate for Payer: AlohaCare Medicaid	$2,494.50
Rate for Payer: AlohaCare Medicare	$3,791.64
Rate for Payer: Cash Price	$2,993.40
Rate for Payer: Devoted Health Medicare	$4,190.76
Rate for Payer: Hawaii Medical Service Association Medicare	$3,791.64
Rate for Payer: Hawaii Western Management Group Commercial	$3,492.30
Rate for Payer: Health Management Network Commercial	$4,240.65
Rate for Payer: Humana Medicare	$3,791.64
Rate for Payer: Kaiser Permanente Commercial	$4,490.10
Rate for Payer: Kaiser Permanente Medicaid	$2,544.39
Rate for Payer: Kaiser Permanente Medicare	$3,791.64
Rate for Payer: MDX Hawaii PPO	$4,839.33
Rate for Payer: Ohana Health Plan Medicaid	$3,791.64
Rate for Payer: Ohana Health Plan Medicare	$3,791.64
Rate for Payer: UnitedHealthcare Medicare	$3,791.64
Rate for Payer: University Health Alliance Commercial	$2,793.84

PLATE LCP 8H 4.5X152MM 224.581

Facility

$1,685.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$943.60
Max. Negotiated Rate	$1,634.45
Rate for Payer: Cash Price	$1,011.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,179.50
Rate for Payer: Health Management Network Commercial	$1,432.25
Rate for Payer: Kaiser Permanente Commercial	$1,516.50
Rate for Payer: MDX Hawaii PPO	$1,634.45
Rate for Payer: University Health Alliance Commercial	$943.60

PLATE LCP 8H 4.5X152MM 224.581

Facility

$1,685.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$842.50
Max. Negotiated Rate	$1,634.45
Rate for Payer: AlohaCare Medicaid	$842.50
Rate for Payer: AlohaCare Medicare	$1,280.60
Rate for Payer: Cash Price	$1,011.00
Rate for Payer: Devoted Health Medicare	$1,415.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,280.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,179.50
Rate for Payer: Health Management Network Commercial	$1,432.25
Rate for Payer: Humana Medicare	$1,280.60
Rate for Payer: Kaiser Permanente Commercial	$1,516.50
Rate for Payer: Kaiser Permanente Medicaid	$859.35
Rate for Payer: Kaiser Permanente Medicare	$1,280.60
Rate for Payer: MDX Hawaii PPO	$1,634.45
Rate for Payer: Ohana Health Plan Medicaid	$1,280.60
Rate for Payer: Ohana Health Plan Medicare	$1,280.60
Rate for Payer: UnitedHealthcare Medicare	$1,280.60
Rate for Payer: University Health Alliance Commercial	$943.60

PLATE LCP 8H 4.5X152MM 226.581

Facility

$1,904.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$952.00
Max. Negotiated Rate	$1,846.88
Rate for Payer: AlohaCare Medicaid	$952.00
Rate for Payer: AlohaCare Medicare	$1,447.04
Rate for Payer: Cash Price	$1,142.40
Rate for Payer: Devoted Health Medicare	$1,599.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1,447.04
Rate for Payer: Hawaii Western Management Group Commercial	$1,332.80
Rate for Payer: Health Management Network Commercial	$1,618.40
Rate for Payer: Humana Medicare	$1,447.04
Rate for Payer: Kaiser Permanente Commercial	$1,713.60
Rate for Payer: Kaiser Permanente Medicaid	$971.04
Rate for Payer: Kaiser Permanente Medicare	$1,447.04
Rate for Payer: MDX Hawaii PPO	$1,846.88
Rate for Payer: Ohana Health Plan Medicaid	$1,447.04
Rate for Payer: Ohana Health Plan Medicare	$1,447.04
Rate for Payer: UnitedHealthcare Medicare	$1,447.04
Rate for Payer: University Health Alliance Commercial	$1,066.24

PLATE LCP 8H 4.5X152MM 226.581

Facility

$1,904.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,066.24
Max. Negotiated Rate	$1,846.88
Rate for Payer: Cash Price	$1,142.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,332.80
Rate for Payer: Health Management Network Commercial	$1,618.40
Rate for Payer: Kaiser Permanente Commercial	$1,713.60
Rate for Payer: MDX Hawaii PPO	$1,846.88
Rate for Payer: University Health Alliance Commercial	$1,066.24

PLATE LCP 9H 3.5X124MM 223.591

Facility

$1,454.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$727.00
Max. Negotiated Rate	$1,410.38
Rate for Payer: AlohaCare Medicaid	$727.00
Rate for Payer: AlohaCare Medicare	$1,105.04
Rate for Payer: Cash Price	$872.40
Rate for Payer: Devoted Health Medicare	$1,221.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1,105.04
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.80
Rate for Payer: Health Management Network Commercial	$1,235.90
Rate for Payer: Humana Medicare	$1,105.04
Rate for Payer: Kaiser Permanente Commercial	$1,308.60
Rate for Payer: Kaiser Permanente Medicaid	$741.54
Rate for Payer: Kaiser Permanente Medicare	$1,105.04
Rate for Payer: MDX Hawaii PPO	$1,410.38
Rate for Payer: Ohana Health Plan Medicaid	$1,105.04
Rate for Payer: Ohana Health Plan Medicare	$1,105.04
Rate for Payer: UnitedHealthcare Medicare	$1,105.04
Rate for Payer: University Health Alliance Commercial	$814.24

PLATE LCP 9H 3.5X124MM 223.591

Facility

$1,454.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$814.24
Max. Negotiated Rate	$1,410.38
Rate for Payer: Cash Price	$872.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.80
Rate for Payer: Health Management Network Commercial	$1,235.90
Rate for Payer: Kaiser Permanente Commercial	$1,308.60
Rate for Payer: MDX Hawaii PPO	$1,410.38
Rate for Payer: University Health Alliance Commercial	$814.24

PLATE LCP 9H 4.5X170MM 224.591

Facility

$1,762.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$986.72
Max. Negotiated Rate	$1,709.14
Rate for Payer: Cash Price	$1,057.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,233.40
Rate for Payer: Health Management Network Commercial	$1,497.70
Rate for Payer: Kaiser Permanente Commercial	$1,585.80
Rate for Payer: MDX Hawaii PPO	$1,709.14
Rate for Payer: University Health Alliance Commercial	$986.72

PLATE LCP 9H 4.5X170MM 224.591

Facility

$1,762.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$881.00
Max. Negotiated Rate	$1,709.14
Rate for Payer: AlohaCare Medicaid	$881.00
Rate for Payer: AlohaCare Medicare	$1,339.12
Rate for Payer: Cash Price	$1,057.20
Rate for Payer: Devoted Health Medicare	$1,480.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,339.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,233.40
Rate for Payer: Health Management Network Commercial	$1,497.70
Rate for Payer: Humana Medicare	$1,339.12
Rate for Payer: Kaiser Permanente Commercial	$1,585.80
Rate for Payer: Kaiser Permanente Medicaid	$898.62
Rate for Payer: Kaiser Permanente Medicare	$1,339.12
Rate for Payer: MDX Hawaii PPO	$1,709.14
Rate for Payer: Ohana Health Plan Medicaid	$1,339.12
Rate for Payer: Ohana Health Plan Medicare	$1,339.12
Rate for Payer: UnitedHealthcare Medicare	$1,339.12
Rate for Payer: University Health Alliance Commercial	$986.72

PLATE LCP FIB-L 11H 01.118.413

Facility

$3,140.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,570.00
Max. Negotiated Rate	$3,045.80
Rate for Payer: AlohaCare Medicaid	$1,570.00
Rate for Payer: AlohaCare Medicare	$2,386.40
Rate for Payer: Cash Price	$1,884.00
Rate for Payer: Devoted Health Medicare	$2,637.60
Rate for Payer: Hawaii Medical Service Association Medicare	$2,386.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,198.00
Rate for Payer: Health Management Network Commercial	$2,669.00
Rate for Payer: Humana Medicare	$2,386.40
Rate for Payer: Kaiser Permanente Commercial	$2,826.00
Rate for Payer: Kaiser Permanente Medicaid	$1,601.40
Rate for Payer: Kaiser Permanente Medicare	$2,386.40
Rate for Payer: MDX Hawaii PPO	$3,045.80
Rate for Payer: Ohana Health Plan Medicaid	$2,386.40
Rate for Payer: Ohana Health Plan Medicare	$2,386.40
Rate for Payer: UnitedHealthcare Medicare	$2,386.40
Rate for Payer: University Health Alliance Commercial	$1,758.40

PLATE LCP FIB-L 11H 01.118.413

Facility

$3,140.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,758.40
Max. Negotiated Rate	$3,045.80
Rate for Payer: Cash Price	$1,884.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,198.00
Rate for Payer: Health Management Network Commercial	$2,669.00
Rate for Payer: Kaiser Permanente Commercial	$2,826.00
Rate for Payer: MDX Hawaii PPO	$3,045.80
Rate for Payer: University Health Alliance Commercial	$1,758.40

PLATE LCP FIB-L 13H 02.118.415

Facility

$3,378.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,891.68
Max. Negotiated Rate	$3,276.66
Rate for Payer: Cash Price	$2,026.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,364.60
Rate for Payer: Health Management Network Commercial	$2,871.30
Rate for Payer: Kaiser Permanente Commercial	$3,040.20
Rate for Payer: MDX Hawaii PPO	$3,276.66
Rate for Payer: University Health Alliance Commercial	$1,891.68

PLATE LCP FIB-L 13H 02.118.415

Facility

$3,378.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,689.00
Max. Negotiated Rate	$3,276.66
Rate for Payer: AlohaCare Medicaid	$1,689.00
Rate for Payer: AlohaCare Medicare	$2,567.28
Rate for Payer: Cash Price	$2,026.80
Rate for Payer: Devoted Health Medicare	$2,837.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,567.28
Rate for Payer: Hawaii Western Management Group Commercial	$2,364.60
Rate for Payer: Health Management Network Commercial	$2,871.30
Rate for Payer: Humana Medicare	$2,567.28
Rate for Payer: Kaiser Permanente Commercial	$3,040.20
Rate for Payer: Kaiser Permanente Medicaid	$1,722.78
Rate for Payer: Kaiser Permanente Medicare	$2,567.28
Rate for Payer: MDX Hawaii PPO	$3,276.66
Rate for Payer: Ohana Health Plan Medicaid	$2,567.28
Rate for Payer: Ohana Health Plan Medicare	$2,567.28
Rate for Payer: UnitedHealthcare Medicare	$2,567.28
Rate for Payer: University Health Alliance Commercial	$1,891.68

Know your out-of-pocket cost for care.

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