Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLAT LCP 10H 4.5X188MM 226.601

Facility

$2,790.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,395.00
Max. Negotiated Rate	$2,706.30
Rate for Payer: AlohaCare Medicaid	$1,395.00
Rate for Payer: AlohaCare Medicare	$2,120.40
Rate for Payer: Cash Price	$1,674.00
Rate for Payer: Devoted Health Medicare	$2,343.60
Rate for Payer: Hawaii Medical Service Association Medicare	$2,120.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,953.00
Rate for Payer: Health Management Network Commercial	$2,371.50
Rate for Payer: Humana Medicare	$2,120.40
Rate for Payer: Kaiser Permanente Commercial	$2,511.00
Rate for Payer: Kaiser Permanente Medicaid	$1,422.90
Rate for Payer: Kaiser Permanente Medicare	$2,120.40
Rate for Payer: MDX Hawaii PPO	$2,706.30
Rate for Payer: Ohana Health Plan Medicaid	$2,120.40
Rate for Payer: Ohana Health Plan Medicare	$2,120.40
Rate for Payer: UnitedHealthcare Medicare	$2,120.40
Rate for Payer: University Health Alliance Commercial	$1,562.40

PLAT LCP 11H 4.5X206MM 224.611

Facility

$2,595.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,453.20
Max. Negotiated Rate	$2,517.15
Rate for Payer: Cash Price	$1,557.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,816.50
Rate for Payer: Health Management Network Commercial	$2,205.75
Rate for Payer: Kaiser Permanente Commercial	$2,335.50
Rate for Payer: MDX Hawaii PPO	$2,517.15
Rate for Payer: University Health Alliance Commercial	$1,453.20

PLAT LCP 11H 4.5X206MM 224.611

Facility

$2,595.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,297.50
Max. Negotiated Rate	$2,517.15
Rate for Payer: AlohaCare Medicaid	$1,297.50
Rate for Payer: AlohaCare Medicare	$1,972.20
Rate for Payer: Cash Price	$1,557.00
Rate for Payer: Devoted Health Medicare	$2,179.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,972.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,816.50
Rate for Payer: Health Management Network Commercial	$2,205.75
Rate for Payer: Humana Medicare	$1,972.20
Rate for Payer: Kaiser Permanente Commercial	$2,335.50
Rate for Payer: Kaiser Permanente Medicaid	$1,323.45
Rate for Payer: Kaiser Permanente Medicare	$1,972.20
Rate for Payer: MDX Hawaii PPO	$2,517.15
Rate for Payer: Ohana Health Plan Medicaid	$1,972.20
Rate for Payer: Ohana Health Plan Medicare	$1,972.20
Rate for Payer: UnitedHealthcare Medicare	$1,972.20
Rate for Payer: University Health Alliance Commercial	$1,453.20

PLAT LCP 11H 4.5X206MM 226.611

Facility

$2,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,485.00
Max. Negotiated Rate	$2,880.90
Rate for Payer: AlohaCare Medicaid	$1,485.00
Rate for Payer: AlohaCare Medicare	$2,257.20
Rate for Payer: Cash Price	$1,782.00
Rate for Payer: Devoted Health Medicare	$2,494.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,257.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,079.00
Rate for Payer: Health Management Network Commercial	$2,524.50
Rate for Payer: Humana Medicare	$2,257.20
Rate for Payer: Kaiser Permanente Commercial	$2,673.00
Rate for Payer: Kaiser Permanente Medicaid	$1,514.70
Rate for Payer: Kaiser Permanente Medicare	$2,257.20
Rate for Payer: MDX Hawaii PPO	$2,880.90
Rate for Payer: Ohana Health Plan Medicaid	$2,257.20
Rate for Payer: Ohana Health Plan Medicare	$2,257.20
Rate for Payer: UnitedHealthcare Medicare	$2,257.20
Rate for Payer: University Health Alliance Commercial	$1,663.20

PLAT LCP 11H 4.5X206MM 226.611

Facility

$2,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,663.20
Max. Negotiated Rate	$2,880.90
Rate for Payer: Cash Price	$1,782.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,079.00
Rate for Payer: Health Management Network Commercial	$2,524.50
Rate for Payer: Kaiser Permanente Commercial	$2,673.00
Rate for Payer: MDX Hawaii PPO	$2,880.90
Rate for Payer: University Health Alliance Commercial	$1,663.20

PLAT LCP 12H 3.5X163MM 223.621

Facility

$1,652.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$925.12
Max. Negotiated Rate	$1,602.44
Rate for Payer: Cash Price	$991.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,156.40
Rate for Payer: Health Management Network Commercial	$1,404.20
Rate for Payer: Kaiser Permanente Commercial	$1,486.80
Rate for Payer: MDX Hawaii PPO	$1,602.44
Rate for Payer: University Health Alliance Commercial	$925.12

PLAT LCP 12H 3.5X163MM 223.621

Facility

$1,652.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$826.00
Max. Negotiated Rate	$1,602.44
Rate for Payer: AlohaCare Medicaid	$826.00
Rate for Payer: AlohaCare Medicare	$1,255.52
Rate for Payer: Cash Price	$991.20
Rate for Payer: Devoted Health Medicare	$1,387.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,255.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,156.40
Rate for Payer: Health Management Network Commercial	$1,404.20
Rate for Payer: Humana Medicare	$1,255.52
Rate for Payer: Kaiser Permanente Commercial	$1,486.80
Rate for Payer: Kaiser Permanente Medicaid	$842.52
Rate for Payer: Kaiser Permanente Medicare	$1,255.52
Rate for Payer: MDX Hawaii PPO	$1,602.44
Rate for Payer: Ohana Health Plan Medicaid	$1,255.52
Rate for Payer: Ohana Health Plan Medicare	$1,255.52
Rate for Payer: UnitedHealthcare Medicare	$1,255.52
Rate for Payer: University Health Alliance Commercial	$925.12

PLAT LCP 12H 3.5X168MM 245.121

Facility

$2,037.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,140.72
Max. Negotiated Rate	$1,975.89
Rate for Payer: Cash Price	$1,222.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,425.90
Rate for Payer: Health Management Network Commercial	$1,731.45
Rate for Payer: Kaiser Permanente Commercial	$1,833.30
Rate for Payer: MDX Hawaii PPO	$1,975.89
Rate for Payer: University Health Alliance Commercial	$1,140.72

PLAT LCP 12H 3.5X168MM 245.121

Facility

$2,037.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,018.50
Max. Negotiated Rate	$1,975.89
Rate for Payer: AlohaCare Medicaid	$1,018.50
Rate for Payer: AlohaCare Medicare	$1,548.12
Rate for Payer: Cash Price	$1,222.20
Rate for Payer: Devoted Health Medicare	$1,711.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,548.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,425.90
Rate for Payer: Health Management Network Commercial	$1,731.45
Rate for Payer: Humana Medicare	$1,548.12
Rate for Payer: Kaiser Permanente Commercial	$1,833.30
Rate for Payer: Kaiser Permanente Medicaid	$1,038.87
Rate for Payer: Kaiser Permanente Medicare	$1,548.12
Rate for Payer: MDX Hawaii PPO	$1,975.89
Rate for Payer: Ohana Health Plan Medicaid	$1,548.12
Rate for Payer: Ohana Health Plan Medicare	$1,548.12
Rate for Payer: UnitedHealthcare Medicare	$1,548.12
Rate for Payer: University Health Alliance Commercial	$1,140.72

PLAT LCP 12H 3.5X220MM 238.709

Facility

$3,724.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,862.00
Max. Negotiated Rate	$3,612.28
Rate for Payer: AlohaCare Medicaid	$1,862.00
Rate for Payer: AlohaCare Medicare	$2,830.24
Rate for Payer: Cash Price	$2,234.40
Rate for Payer: Devoted Health Medicare	$3,128.16
Rate for Payer: Hawaii Medical Service Association Medicare	$2,830.24
Rate for Payer: Hawaii Western Management Group Commercial	$2,606.80
Rate for Payer: Health Management Network Commercial	$3,165.40
Rate for Payer: Humana Medicare	$2,830.24
Rate for Payer: Kaiser Permanente Commercial	$3,351.60
Rate for Payer: Kaiser Permanente Medicaid	$1,899.24
Rate for Payer: Kaiser Permanente Medicare	$2,830.24
Rate for Payer: MDX Hawaii PPO	$3,612.28
Rate for Payer: Ohana Health Plan Medicaid	$2,830.24
Rate for Payer: Ohana Health Plan Medicare	$2,830.24
Rate for Payer: UnitedHealthcare Medicare	$2,830.24
Rate for Payer: University Health Alliance Commercial	$2,085.44

PLAT LCP 12H 3.5X220MM 238.709

Facility

$3,724.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,085.44
Max. Negotiated Rate	$3,612.28
Rate for Payer: Cash Price	$2,234.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,606.80
Rate for Payer: Health Management Network Commercial	$3,165.40
Rate for Payer: Kaiser Permanente Commercial	$3,351.60
Rate for Payer: MDX Hawaii PPO	$3,612.28
Rate for Payer: University Health Alliance Commercial	$2,085.44

PLAT LCP 12H 4.5X224MM 224.621

Facility

$2,217.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,241.52
Max. Negotiated Rate	$2,150.49
Rate for Payer: Cash Price	$1,330.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,551.90
Rate for Payer: Health Management Network Commercial	$1,884.45
Rate for Payer: Kaiser Permanente Commercial	$1,995.30
Rate for Payer: MDX Hawaii PPO	$2,150.49
Rate for Payer: University Health Alliance Commercial	$1,241.52

PLAT LCP 12H 4.5X224MM 224.621

Facility

$2,217.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,108.50
Max. Negotiated Rate	$2,150.49
Rate for Payer: AlohaCare Medicaid	$1,108.50
Rate for Payer: AlohaCare Medicare	$1,684.92
Rate for Payer: Cash Price	$1,330.20
Rate for Payer: Devoted Health Medicare	$1,862.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,684.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,551.90
Rate for Payer: Health Management Network Commercial	$1,884.45
Rate for Payer: Humana Medicare	$1,684.92
Rate for Payer: Kaiser Permanente Commercial	$1,995.30
Rate for Payer: Kaiser Permanente Medicaid	$1,130.67
Rate for Payer: Kaiser Permanente Medicare	$1,684.92
Rate for Payer: MDX Hawaii PPO	$2,150.49
Rate for Payer: Ohana Health Plan Medicaid	$1,684.92
Rate for Payer: Ohana Health Plan Medicare	$1,684.92
Rate for Payer: UnitedHealthcare Medicare	$1,684.92
Rate for Payer: University Health Alliance Commercial	$1,241.52

PLAT LCP 12H 4.5X224MM 226.621

Facility

$2,102.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,051.00
Max. Negotiated Rate	$2,038.94
Rate for Payer: AlohaCare Medicaid	$1,051.00
Rate for Payer: AlohaCare Medicare	$1,597.52
Rate for Payer: Cash Price	$1,261.20
Rate for Payer: Devoted Health Medicare	$1,765.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,597.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,471.40
Rate for Payer: Health Management Network Commercial	$1,786.70
Rate for Payer: Humana Medicare	$1,597.52
Rate for Payer: Kaiser Permanente Commercial	$1,891.80
Rate for Payer: Kaiser Permanente Medicaid	$1,072.02
Rate for Payer: Kaiser Permanente Medicare	$1,597.52
Rate for Payer: MDX Hawaii PPO	$2,038.94
Rate for Payer: Ohana Health Plan Medicaid	$1,597.52
Rate for Payer: Ohana Health Plan Medicare	$1,597.52
Rate for Payer: UnitedHealthcare Medicare	$1,597.52
Rate for Payer: University Health Alliance Commercial	$1,177.12

PLAT LCP 12H 4.5X224MM 226.621

Facility

$2,102.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,177.12
Max. Negotiated Rate	$2,038.94
Rate for Payer: Cash Price	$1,261.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,471.40
Rate for Payer: Health Management Network Commercial	$1,786.70
Rate for Payer: Kaiser Permanente Commercial	$1,891.80
Rate for Payer: MDX Hawaii PPO	$2,038.94
Rate for Payer: University Health Alliance Commercial	$1,177.12

PLAT LCP 13H 4.5X242MM 224.631

Facility

$2,739.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,533.84
Max. Negotiated Rate	$2,656.83
Rate for Payer: Cash Price	$1,643.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,917.30
Rate for Payer: Health Management Network Commercial	$2,328.15
Rate for Payer: Kaiser Permanente Commercial	$2,465.10
Rate for Payer: MDX Hawaii PPO	$2,656.83
Rate for Payer: University Health Alliance Commercial	$1,533.84

PLAT LCP 13H 4.5X242MM 224.631

Facility

$2,739.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,369.50
Max. Negotiated Rate	$2,656.83
Rate for Payer: AlohaCare Medicaid	$1,369.50
Rate for Payer: AlohaCare Medicare	$2,081.64
Rate for Payer: Cash Price	$1,643.40
Rate for Payer: Devoted Health Medicare	$2,300.76
Rate for Payer: Hawaii Medical Service Association Medicare	$2,081.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,917.30
Rate for Payer: Health Management Network Commercial	$2,328.15
Rate for Payer: Humana Medicare	$2,081.64
Rate for Payer: Kaiser Permanente Commercial	$2,465.10
Rate for Payer: Kaiser Permanente Medicaid	$1,396.89
Rate for Payer: Kaiser Permanente Medicare	$2,081.64
Rate for Payer: MDX Hawaii PPO	$2,656.83
Rate for Payer: Ohana Health Plan Medicaid	$2,081.64
Rate for Payer: Ohana Health Plan Medicare	$2,081.64
Rate for Payer: UnitedHealthcare Medicare	$2,081.64
Rate for Payer: University Health Alliance Commercial	$1,533.84

PLAT LCP 14H 3.5X189MM 223.641

Facility

$2,124.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,189.44
Max. Negotiated Rate	$2,060.28
Rate for Payer: Cash Price	$1,274.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,486.80
Rate for Payer: Health Management Network Commercial	$1,805.40
Rate for Payer: Kaiser Permanente Commercial	$1,911.60
Rate for Payer: MDX Hawaii PPO	$2,060.28
Rate for Payer: University Health Alliance Commercial	$1,189.44

PLAT LCP 14H 3.5X189MM 223.641

Facility

$2,124.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,062.00
Max. Negotiated Rate	$2,060.28
Rate for Payer: AlohaCare Medicaid	$1,062.00
Rate for Payer: AlohaCare Medicare	$1,614.24
Rate for Payer: Cash Price	$1,274.40
Rate for Payer: Devoted Health Medicare	$1,784.16
Rate for Payer: Hawaii Medical Service Association Medicare	$1,614.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,486.80
Rate for Payer: Health Management Network Commercial	$1,805.40
Rate for Payer: Humana Medicare	$1,614.24
Rate for Payer: Kaiser Permanente Commercial	$1,911.60
Rate for Payer: Kaiser Permanente Medicaid	$1,083.24
Rate for Payer: Kaiser Permanente Medicare	$1,614.24
Rate for Payer: MDX Hawaii PPO	$2,060.28
Rate for Payer: Ohana Health Plan Medicaid	$1,614.24
Rate for Payer: Ohana Health Plan Medicare	$1,614.24
Rate for Payer: UnitedHealthcare Medicare	$1,614.24
Rate for Payer: University Health Alliance Commercial	$1,189.44

PLAT LCP 14H 4.5X260MM 224.641

Facility

$2,086.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,043.00
Max. Negotiated Rate	$2,023.42
Rate for Payer: AlohaCare Medicaid	$1,043.00
Rate for Payer: AlohaCare Medicare	$1,585.36
Rate for Payer: Cash Price	$1,251.60
Rate for Payer: Devoted Health Medicare	$1,752.24
Rate for Payer: Hawaii Medical Service Association Medicare	$1,585.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,460.20
Rate for Payer: Health Management Network Commercial	$1,773.10
Rate for Payer: Humana Medicare	$1,585.36
Rate for Payer: Kaiser Permanente Commercial	$1,877.40
Rate for Payer: Kaiser Permanente Medicaid	$1,063.86
Rate for Payer: Kaiser Permanente Medicare	$1,585.36
Rate for Payer: MDX Hawaii PPO	$2,023.42
Rate for Payer: Ohana Health Plan Medicaid	$1,585.36
Rate for Payer: Ohana Health Plan Medicare	$1,585.36
Rate for Payer: UnitedHealthcare Medicare	$1,585.36
Rate for Payer: University Health Alliance Commercial	$1,168.16

PLAT LCP 14H 4.5X260MM 224.641

Facility

$2,086.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,168.16
Max. Negotiated Rate	$2,023.42
Rate for Payer: Cash Price	$1,251.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,460.20
Rate for Payer: Health Management Network Commercial	$1,773.10
Rate for Payer: Kaiser Permanente Commercial	$1,877.40
Rate for Payer: MDX Hawaii PPO	$2,023.42
Rate for Payer: University Health Alliance Commercial	$1,168.16

PLAT LCP 14H 4.5X260MM 226.641

Facility

$2,786.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,393.00
Max. Negotiated Rate	$2,702.42
Rate for Payer: AlohaCare Medicaid	$1,393.00
Rate for Payer: AlohaCare Medicare	$2,117.36
Rate for Payer: Cash Price	$1,671.60
Rate for Payer: Devoted Health Medicare	$2,340.24
Rate for Payer: Hawaii Medical Service Association Medicare	$2,117.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,950.20
Rate for Payer: Health Management Network Commercial	$2,368.10
Rate for Payer: Humana Medicare	$2,117.36
Rate for Payer: Kaiser Permanente Commercial	$2,507.40
Rate for Payer: Kaiser Permanente Medicaid	$1,420.86
Rate for Payer: Kaiser Permanente Medicare	$2,117.36
Rate for Payer: MDX Hawaii PPO	$2,702.42
Rate for Payer: Ohana Health Plan Medicaid	$2,117.36
Rate for Payer: Ohana Health Plan Medicare	$2,117.36
Rate for Payer: UnitedHealthcare Medicare	$2,117.36
Rate for Payer: University Health Alliance Commercial	$1,560.16

PLAT LCP 14H 4.5X260MM 226.641

Facility

$2,786.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,560.16
Max. Negotiated Rate	$2,702.42
Rate for Payer: Cash Price	$1,671.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,950.20
Rate for Payer: Health Management Network Commercial	$2,368.10
Rate for Payer: Kaiser Permanente Commercial	$2,507.40
Rate for Payer: MDX Hawaii PPO	$2,702.42
Rate for Payer: University Health Alliance Commercial	$1,560.16

PLAT LCP 16H 4.5X296MM 224.661

Facility

$2,438.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,219.00
Max. Negotiated Rate	$2,364.86
Rate for Payer: AlohaCare Medicaid	$1,219.00
Rate for Payer: AlohaCare Medicare	$1,852.88
Rate for Payer: Cash Price	$1,462.80
Rate for Payer: Devoted Health Medicare	$2,047.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,852.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,706.60
Rate for Payer: Health Management Network Commercial	$2,072.30
Rate for Payer: Humana Medicare	$1,852.88
Rate for Payer: Kaiser Permanente Commercial	$2,194.20
Rate for Payer: Kaiser Permanente Medicaid	$1,243.38
Rate for Payer: Kaiser Permanente Medicare	$1,852.88
Rate for Payer: MDX Hawaii PPO	$2,364.86
Rate for Payer: Ohana Health Plan Medicaid	$1,852.88
Rate for Payer: Ohana Health Plan Medicare	$1,852.88
Rate for Payer: UnitedHealthcare Medicare	$1,852.88
Rate for Payer: University Health Alliance Commercial	$1,365.28

PLAT LCP 16H 4.5X296MM 224.661

Facility

$2,438.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,365.28
Max. Negotiated Rate	$2,364.86
Rate for Payer: Cash Price	$1,462.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,706.60
Rate for Payer: Health Management Network Commercial	$2,072.30
Rate for Payer: Kaiser Permanente Commercial	$2,194.20
Rate for Payer: MDX Hawaii PPO	$2,364.86
Rate for Payer: University Health Alliance Commercial	$1,365.28

Know your out-of-pocket cost for care.

All Charges