Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLAT LCP 16H 4.5X296MM 226.661

Facility

$2,842.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.00
Max. Negotiated Rate	$2,756.74
Rate for Payer: AlohaCare Medicaid	$1,421.00
Rate for Payer: AlohaCare Medicare	$2,159.92
Rate for Payer: Cash Price	$1,705.20
Rate for Payer: Devoted Health Medicare	$2,387.28
Rate for Payer: Hawaii Medical Service Association Medicare	$2,159.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,989.40
Rate for Payer: Health Management Network Commercial	$2,415.70
Rate for Payer: Humana Medicare	$2,159.92
Rate for Payer: Kaiser Permanente Commercial	$2,557.80
Rate for Payer: Kaiser Permanente Medicaid	$1,449.42
Rate for Payer: Kaiser Permanente Medicare	$2,159.92
Rate for Payer: MDX Hawaii PPO	$2,756.74
Rate for Payer: Ohana Health Plan Medicaid	$2,159.92
Rate for Payer: Ohana Health Plan Medicare	$2,159.92
Rate for Payer: UnitedHealthcare Medicare	$2,159.92
Rate for Payer: University Health Alliance Commercial	$1,591.52

PLAT LCP 16H 4.5X296MM 226.661

Facility

$2,842.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,591.52
Max. Negotiated Rate	$2,756.74
Rate for Payer: Cash Price	$1,705.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,989.40
Rate for Payer: Health Management Network Commercial	$2,415.70
Rate for Payer: Kaiser Permanente Commercial	$2,557.80
Rate for Payer: MDX Hawaii PPO	$2,756.74
Rate for Payer: University Health Alliance Commercial	$1,591.52

PLAT LCP 18H 4.5X332MM 224.681

Facility

$2,960.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,657.60
Max. Negotiated Rate	$2,871.20
Rate for Payer: Cash Price	$1,776.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,072.00
Rate for Payer: Health Management Network Commercial	$2,516.00
Rate for Payer: Kaiser Permanente Commercial	$2,664.00
Rate for Payer: MDX Hawaii PPO	$2,871.20
Rate for Payer: University Health Alliance Commercial	$1,657.60

PLAT LCP 18H 4.5X332MM 224.681

Facility

$2,960.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,480.00
Max. Negotiated Rate	$2,871.20
Rate for Payer: AlohaCare Medicaid	$1,480.00
Rate for Payer: AlohaCare Medicare	$2,249.60
Rate for Payer: Cash Price	$1,776.00
Rate for Payer: Devoted Health Medicare	$2,486.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,249.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,072.00
Rate for Payer: Health Management Network Commercial	$2,516.00
Rate for Payer: Humana Medicare	$2,249.60
Rate for Payer: Kaiser Permanente Commercial	$2,664.00
Rate for Payer: Kaiser Permanente Medicaid	$1,509.60
Rate for Payer: Kaiser Permanente Medicare	$2,249.60
Rate for Payer: MDX Hawaii PPO	$2,871.20
Rate for Payer: Ohana Health Plan Medicaid	$2,249.60
Rate for Payer: Ohana Health Plan Medicare	$2,249.60
Rate for Payer: UnitedHealthcare Medicare	$2,249.60
Rate for Payer: University Health Alliance Commercial	$1,657.60

PLAT LCP 18H 4.5X332MM 226.681

Facility

$3,460.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,730.00
Max. Negotiated Rate	$3,356.20
Rate for Payer: AlohaCare Medicaid	$1,730.00
Rate for Payer: AlohaCare Medicare	$2,629.60
Rate for Payer: Cash Price	$2,076.00
Rate for Payer: Devoted Health Medicare	$2,906.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,629.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,422.00
Rate for Payer: Health Management Network Commercial	$2,941.00
Rate for Payer: Humana Medicare	$2,629.60
Rate for Payer: Kaiser Permanente Commercial	$3,114.00
Rate for Payer: Kaiser Permanente Medicaid	$1,764.60
Rate for Payer: Kaiser Permanente Medicare	$2,629.60
Rate for Payer: MDX Hawaii PPO	$3,356.20
Rate for Payer: Ohana Health Plan Medicaid	$2,629.60
Rate for Payer: Ohana Health Plan Medicare	$2,629.60
Rate for Payer: UnitedHealthcare Medicare	$2,629.60
Rate for Payer: University Health Alliance Commercial	$1,937.60

PLAT LCP 18H 4.5X332MM 226.681

Facility

$3,460.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,937.60
Max. Negotiated Rate	$3,356.20
Rate for Payer: Cash Price	$2,076.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,422.00
Rate for Payer: Health Management Network Commercial	$2,941.00
Rate for Payer: Kaiser Permanente Commercial	$3,114.00
Rate for Payer: MDX Hawaii PPO	$3,356.20
Rate for Payer: University Health Alliance Commercial	$1,937.60

PLAT LCP 20H 4.5X368MM 224.701

Facility

$3,764.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,107.84
Max. Negotiated Rate	$3,651.08
Rate for Payer: Cash Price	$2,258.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,634.80
Rate for Payer: Health Management Network Commercial	$3,199.40
Rate for Payer: Kaiser Permanente Commercial	$3,387.60
Rate for Payer: MDX Hawaii PPO	$3,651.08
Rate for Payer: University Health Alliance Commercial	$2,107.84

PLAT LCP 20H 4.5X368MM 224.701

Facility

$3,764.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,882.00
Max. Negotiated Rate	$3,651.08
Rate for Payer: AlohaCare Medicaid	$1,882.00
Rate for Payer: AlohaCare Medicare	$2,860.64
Rate for Payer: Cash Price	$2,258.40
Rate for Payer: Devoted Health Medicare	$3,161.76
Rate for Payer: Hawaii Medical Service Association Medicare	$2,860.64
Rate for Payer: Hawaii Western Management Group Commercial	$2,634.80
Rate for Payer: Health Management Network Commercial	$3,199.40
Rate for Payer: Humana Medicare	$2,860.64
Rate for Payer: Kaiser Permanente Commercial	$3,387.60
Rate for Payer: Kaiser Permanente Medicaid	$1,919.64
Rate for Payer: Kaiser Permanente Medicare	$2,860.64
Rate for Payer: MDX Hawaii PPO	$3,651.08
Rate for Payer: Ohana Health Plan Medicaid	$2,860.64
Rate for Payer: Ohana Health Plan Medicare	$2,860.64
Rate for Payer: UnitedHealthcare Medicare	$2,860.64
Rate for Payer: University Health Alliance Commercial	$2,107.84

PLAT LCP 20H 4.5X368MM 226.701

Facility

$3,820.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,910.00
Max. Negotiated Rate	$3,705.40
Rate for Payer: AlohaCare Medicaid	$1,910.00
Rate for Payer: AlohaCare Medicare	$2,903.20
Rate for Payer: Cash Price	$2,292.00
Rate for Payer: Devoted Health Medicare	$3,208.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,903.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,674.00
Rate for Payer: Health Management Network Commercial	$3,247.00
Rate for Payer: Humana Medicare	$2,903.20
Rate for Payer: Kaiser Permanente Commercial	$3,438.00
Rate for Payer: Kaiser Permanente Medicaid	$1,948.20
Rate for Payer: Kaiser Permanente Medicare	$2,903.20
Rate for Payer: MDX Hawaii PPO	$3,705.40
Rate for Payer: Ohana Health Plan Medicaid	$2,903.20
Rate for Payer: Ohana Health Plan Medicare	$2,903.20
Rate for Payer: UnitedHealthcare Medicare	$2,903.20
Rate for Payer: University Health Alliance Commercial	$2,139.20

PLAT LCP 20H 4.5X368MM 226.701

Facility

$3,820.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,139.20
Max. Negotiated Rate	$3,705.40
Rate for Payer: Cash Price	$2,292.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,674.00
Rate for Payer: Health Management Network Commercial	$3,247.00
Rate for Payer: Kaiser Permanente Commercial	$3,438.00
Rate for Payer: MDX Hawaii PPO	$3,705.40
Rate for Payer: University Health Alliance Commercial	$2,139.20

PLAT LCP 22H 4.5X404MM 224.721

Facility

$4,108.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,300.48
Max. Negotiated Rate	$3,984.76
Rate for Payer: Cash Price	$2,464.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,875.60
Rate for Payer: Health Management Network Commercial	$3,491.80
Rate for Payer: Kaiser Permanente Commercial	$3,697.20
Rate for Payer: MDX Hawaii PPO	$3,984.76
Rate for Payer: University Health Alliance Commercial	$2,300.48

PLAT LCP 22H 4.5X404MM 224.721

Facility

$4,108.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,054.00
Max. Negotiated Rate	$3,984.76
Rate for Payer: AlohaCare Medicaid	$2,054.00
Rate for Payer: AlohaCare Medicare	$3,122.08
Rate for Payer: Cash Price	$2,464.80
Rate for Payer: Devoted Health Medicare	$3,450.72
Rate for Payer: Hawaii Medical Service Association Medicare	$3,122.08
Rate for Payer: Hawaii Western Management Group Commercial	$2,875.60
Rate for Payer: Health Management Network Commercial	$3,491.80
Rate for Payer: Humana Medicare	$3,122.08
Rate for Payer: Kaiser Permanente Commercial	$3,697.20
Rate for Payer: Kaiser Permanente Medicaid	$2,095.08
Rate for Payer: Kaiser Permanente Medicare	$3,122.08
Rate for Payer: MDX Hawaii PPO	$3,984.76
Rate for Payer: Ohana Health Plan Medicaid	$3,122.08
Rate for Payer: Ohana Health Plan Medicare	$3,122.08
Rate for Payer: UnitedHealthcare Medicare	$3,122.08
Rate for Payer: University Health Alliance Commercial	$2,300.48

PLAT LCP 22H 4.5X404MM 226.721

Facility

$4,186.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,093.00
Max. Negotiated Rate	$4,060.42
Rate for Payer: AlohaCare Medicaid	$2,093.00
Rate for Payer: AlohaCare Medicare	$3,181.36
Rate for Payer: Cash Price	$2,511.60
Rate for Payer: Devoted Health Medicare	$3,516.24
Rate for Payer: Hawaii Medical Service Association Medicare	$3,181.36
Rate for Payer: Hawaii Western Management Group Commercial	$2,930.20
Rate for Payer: Health Management Network Commercial	$3,558.10
Rate for Payer: Humana Medicare	$3,181.36
Rate for Payer: Kaiser Permanente Commercial	$3,767.40
Rate for Payer: Kaiser Permanente Medicaid	$2,134.86
Rate for Payer: Kaiser Permanente Medicare	$3,181.36
Rate for Payer: MDX Hawaii PPO	$4,060.42
Rate for Payer: Ohana Health Plan Medicaid	$3,181.36
Rate for Payer: Ohana Health Plan Medicare	$3,181.36
Rate for Payer: UnitedHealthcare Medicare	$3,181.36
Rate for Payer: University Health Alliance Commercial	$2,344.16

PLAT LCP 22H 4.5X404MM 226.721

Facility

$4,186.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,344.16
Max. Negotiated Rate	$4,060.42
Rate for Payer: Cash Price	$2,511.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,930.20
Rate for Payer: Health Management Network Commercial	$3,558.10
Rate for Payer: Kaiser Permanente Commercial	$3,767.40
Rate for Payer: MDX Hawaii PPO	$4,060.42
Rate for Payer: University Health Alliance Commercial	$2,344.16

PLAT LCP 4H 3.5X116MM 238.701

Facility

$3,570.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,785.00
Max. Negotiated Rate	$3,462.90
Rate for Payer: AlohaCare Medicaid	$1,785.00
Rate for Payer: AlohaCare Medicare	$2,713.20
Rate for Payer: Cash Price	$2,142.00
Rate for Payer: Devoted Health Medicare	$2,998.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,713.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,499.00
Rate for Payer: Health Management Network Commercial	$3,034.50
Rate for Payer: Humana Medicare	$2,713.20
Rate for Payer: Kaiser Permanente Commercial	$3,213.00
Rate for Payer: Kaiser Permanente Medicaid	$1,820.70
Rate for Payer: Kaiser Permanente Medicare	$2,713.20
Rate for Payer: MDX Hawaii PPO	$3,462.90
Rate for Payer: Ohana Health Plan Medicaid	$2,713.20
Rate for Payer: Ohana Health Plan Medicare	$2,713.20
Rate for Payer: UnitedHealthcare Medicare	$2,713.20
Rate for Payer: University Health Alliance Commercial	$1,999.20

PLAT LCP 4H 3.5X116MM 238.701

Facility

$3,570.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,999.20
Max. Negotiated Rate	$3,462.90
Rate for Payer: Cash Price	$2,142.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,499.00
Rate for Payer: Health Management Network Commercial	$3,034.50
Rate for Payer: Kaiser Permanente Commercial	$3,213.00
Rate for Payer: MDX Hawaii PPO	$3,462.90
Rate for Payer: University Health Alliance Commercial	$1,999.20

PLAT LCP 6H 3.5X142MM 238.702

Facility

$3,610.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,805.00
Max. Negotiated Rate	$3,501.70
Rate for Payer: AlohaCare Medicaid	$1,805.00
Rate for Payer: AlohaCare Medicare	$2,743.60
Rate for Payer: Cash Price	$2,166.00
Rate for Payer: Devoted Health Medicare	$3,032.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,743.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,527.00
Rate for Payer: Health Management Network Commercial	$3,068.50
Rate for Payer: Humana Medicare	$2,743.60
Rate for Payer: Kaiser Permanente Commercial	$3,249.00
Rate for Payer: Kaiser Permanente Medicaid	$1,841.10
Rate for Payer: Kaiser Permanente Medicare	$2,743.60
Rate for Payer: MDX Hawaii PPO	$3,501.70
Rate for Payer: Ohana Health Plan Medicaid	$2,743.60
Rate for Payer: Ohana Health Plan Medicare	$2,743.60
Rate for Payer: UnitedHealthcare Medicare	$2,743.60
Rate for Payer: University Health Alliance Commercial	$2,021.60

PLAT LCP 6H 3.5X142MM 238.702

Facility

$3,610.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,021.60
Max. Negotiated Rate	$3,501.70
Rate for Payer: Cash Price	$2,166.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,527.00
Rate for Payer: Health Management Network Commercial	$3,068.50
Rate for Payer: Kaiser Permanente Commercial	$3,249.00
Rate for Payer: MDX Hawaii PPO	$3,501.70
Rate for Payer: University Health Alliance Commercial	$2,021.60

PLAT LCP 6H 3.5X142MM 238.703

Facility

$3,610.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,021.60
Max. Negotiated Rate	$3,501.70
Rate for Payer: Cash Price	$2,166.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,527.00
Rate for Payer: Health Management Network Commercial	$3,068.50
Rate for Payer: Kaiser Permanente Commercial	$3,249.00
Rate for Payer: MDX Hawaii PPO	$3,501.70
Rate for Payer: University Health Alliance Commercial	$2,021.60

PLAT LCP 6H 3.5X142MM 238.703

Facility

$3,610.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,805.00
Max. Negotiated Rate	$3,501.70
Rate for Payer: AlohaCare Medicaid	$1,805.00
Rate for Payer: AlohaCare Medicare	$2,743.60
Rate for Payer: Cash Price	$2,166.00
Rate for Payer: Devoted Health Medicare	$3,032.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,743.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,527.00
Rate for Payer: Health Management Network Commercial	$3,068.50
Rate for Payer: Humana Medicare	$2,743.60
Rate for Payer: Kaiser Permanente Commercial	$3,249.00
Rate for Payer: Kaiser Permanente Medicaid	$1,841.10
Rate for Payer: Kaiser Permanente Medicare	$2,743.60
Rate for Payer: MDX Hawaii PPO	$3,501.70
Rate for Payer: Ohana Health Plan Medicaid	$2,743.60
Rate for Payer: Ohana Health Plan Medicare	$2,743.60
Rate for Payer: UnitedHealthcare Medicare	$2,743.60
Rate for Payer: University Health Alliance Commercial	$2,021.60

PLAT LCP 8H 3.5X168MM 238.704

Facility

$3,646.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,041.76
Max. Negotiated Rate	$3,536.62
Rate for Payer: Cash Price	$2,187.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,552.20
Rate for Payer: Health Management Network Commercial	$3,099.10
Rate for Payer: Kaiser Permanente Commercial	$3,281.40
Rate for Payer: MDX Hawaii PPO	$3,536.62
Rate for Payer: University Health Alliance Commercial	$2,041.76

PLAT LCP 8H 3.5X168MM 238.704

Facility

$3,646.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,823.00
Max. Negotiated Rate	$3,536.62
Rate for Payer: AlohaCare Medicaid	$1,823.00
Rate for Payer: AlohaCare Medicare	$2,770.96
Rate for Payer: Cash Price	$2,187.60
Rate for Payer: Devoted Health Medicare	$3,062.64
Rate for Payer: Hawaii Medical Service Association Medicare	$2,770.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,552.20
Rate for Payer: Health Management Network Commercial	$3,099.10
Rate for Payer: Humana Medicare	$2,770.96
Rate for Payer: Kaiser Permanente Commercial	$3,281.40
Rate for Payer: Kaiser Permanente Medicaid	$1,859.46
Rate for Payer: Kaiser Permanente Medicare	$2,770.96
Rate for Payer: MDX Hawaii PPO	$3,536.62
Rate for Payer: Ohana Health Plan Medicaid	$2,770.96
Rate for Payer: Ohana Health Plan Medicare	$2,770.96
Rate for Payer: UnitedHealthcare Medicare	$2,770.96
Rate for Payer: University Health Alliance Commercial	$2,041.76

PLAT LCP-T 3H 3.5X50MM 241.131

Facility

$1,292.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$646.00
Max. Negotiated Rate	$1,253.24
Rate for Payer: AlohaCare Medicaid	$646.00
Rate for Payer: AlohaCare Medicare	$981.92
Rate for Payer: Cash Price	$775.20
Rate for Payer: Devoted Health Medicare	$1,085.28
Rate for Payer: Hawaii Medical Service Association Medicare	$981.92
Rate for Payer: Hawaii Western Management Group Commercial	$904.40
Rate for Payer: Health Management Network Commercial	$1,098.20
Rate for Payer: Humana Medicare	$981.92
Rate for Payer: Kaiser Permanente Commercial	$1,162.80
Rate for Payer: Kaiser Permanente Medicaid	$658.92
Rate for Payer: Kaiser Permanente Medicare	$981.92
Rate for Payer: MDX Hawaii PPO	$1,253.24
Rate for Payer: Ohana Health Plan Medicaid	$981.92
Rate for Payer: Ohana Health Plan Medicare	$981.92
Rate for Payer: UnitedHealthcare Medicare	$981.92
Rate for Payer: University Health Alliance Commercial	$723.52

PLAT LCP-T 3H 3.5X50MM 241.131

Facility

$1,292.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$723.52
Max. Negotiated Rate	$1,253.24
Rate for Payer: Cash Price	$775.20
Rate for Payer: Hawaii Western Management Group Commercial	$904.40
Rate for Payer: Health Management Network Commercial	$1,098.20
Rate for Payer: Kaiser Permanente Commercial	$1,162.80
Rate for Payer: MDX Hawaii PPO	$1,253.24
Rate for Payer: University Health Alliance Commercial	$723.52

PLAT LCP-T 3H 3.5X52MM 241.931

Facility

$1,596.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$893.76
Max. Negotiated Rate	$1,548.12
Rate for Payer: Cash Price	$957.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,117.20
Rate for Payer: Health Management Network Commercial	$1,356.60
Rate for Payer: Kaiser Permanente Commercial	$1,436.40
Rate for Payer: MDX Hawaii PPO	$1,548.12
Rate for Payer: University Health Alliance Commercial	$893.76

Know your out-of-pocket cost for care.

All Charges