Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLAT LCP-T 3H 3.5X52MM 241.931

Facility

$1,596.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$798.00
Max. Negotiated Rate	$1,548.12
Rate for Payer: AlohaCare Medicaid	$798.00
Rate for Payer: AlohaCare Medicare	$1,212.96
Rate for Payer: Cash Price	$957.60
Rate for Payer: Devoted Health Medicare	$1,340.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,212.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,117.20
Rate for Payer: Health Management Network Commercial	$1,356.60
Rate for Payer: Humana Medicare	$1,212.96
Rate for Payer: Kaiser Permanente Commercial	$1,436.40
Rate for Payer: Kaiser Permanente Medicaid	$813.96
Rate for Payer: Kaiser Permanente Medicare	$1,212.96
Rate for Payer: MDX Hawaii PPO	$1,548.12
Rate for Payer: Ohana Health Plan Medicaid	$1,212.96
Rate for Payer: Ohana Health Plan Medicare	$1,212.96
Rate for Payer: UnitedHealthcare Medicare	$1,212.96
Rate for Payer: University Health Alliance Commercial	$893.76

PLAT LCP-T 4H 3.5X52MM 241.031

Facility

$1,593.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$892.08
Max. Negotiated Rate	$1,545.21
Rate for Payer: Cash Price	$955.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,115.10
Rate for Payer: Health Management Network Commercial	$1,354.05
Rate for Payer: Kaiser Permanente Commercial	$1,433.70
Rate for Payer: MDX Hawaii PPO	$1,545.21
Rate for Payer: University Health Alliance Commercial	$892.08

PLAT LCP-T 4H 3.5X52MM 241.031

Facility

$1,593.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$796.50
Max. Negotiated Rate	$1,545.21
Rate for Payer: AlohaCare Medicaid	$796.50
Rate for Payer: AlohaCare Medicare	$1,210.68
Rate for Payer: Cash Price	$955.80
Rate for Payer: Devoted Health Medicare	$1,338.12
Rate for Payer: Hawaii Medical Service Association Medicare	$1,210.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,115.10
Rate for Payer: Health Management Network Commercial	$1,354.05
Rate for Payer: Humana Medicare	$1,210.68
Rate for Payer: Kaiser Permanente Commercial	$1,433.70
Rate for Payer: Kaiser Permanente Medicaid	$812.43
Rate for Payer: Kaiser Permanente Medicare	$1,210.68
Rate for Payer: MDX Hawaii PPO	$1,545.21
Rate for Payer: Ohana Health Plan Medicaid	$1,210.68
Rate for Payer: Ohana Health Plan Medicare	$1,210.68
Rate for Payer: UnitedHealthcare Medicare	$1,210.68
Rate for Payer: University Health Alliance Commercial	$892.08

PLAT LCP-T 4H 3.5X56MM 241.141

Facility

$1,335.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$747.60
Max. Negotiated Rate	$1,294.95
Rate for Payer: Cash Price	$801.00
Rate for Payer: Hawaii Western Management Group Commercial	$934.50
Rate for Payer: Health Management Network Commercial	$1,134.75
Rate for Payer: Kaiser Permanente Commercial	$1,201.50
Rate for Payer: MDX Hawaii PPO	$1,294.95
Rate for Payer: University Health Alliance Commercial	$747.60

PLAT LCP-T 4H 3.5X56MM 241.141

Facility

$1,335.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$667.50
Max. Negotiated Rate	$1,294.95
Rate for Payer: AlohaCare Medicaid	$667.50
Rate for Payer: AlohaCare Medicare	$1,014.60
Rate for Payer: Cash Price	$801.00
Rate for Payer: Devoted Health Medicare	$1,121.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,014.60
Rate for Payer: Hawaii Western Management Group Commercial	$934.50
Rate for Payer: Health Management Network Commercial	$1,134.75
Rate for Payer: Humana Medicare	$1,014.60
Rate for Payer: Kaiser Permanente Commercial	$1,201.50
Rate for Payer: Kaiser Permanente Medicaid	$680.85
Rate for Payer: Kaiser Permanente Medicare	$1,014.60
Rate for Payer: MDX Hawaii PPO	$1,294.95
Rate for Payer: Ohana Health Plan Medicaid	$1,014.60
Rate for Payer: Ohana Health Plan Medicare	$1,014.60
Rate for Payer: UnitedHealthcare Medicare	$1,014.60
Rate for Payer: University Health Alliance Commercial	$747.60

PLAT LCP-T 4H 3.5X63MM 241.041

Facility

$1,666.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$833.00
Max. Negotiated Rate	$1,616.02
Rate for Payer: AlohaCare Medicaid	$833.00
Rate for Payer: AlohaCare Medicare	$1,266.16
Rate for Payer: Cash Price	$999.60
Rate for Payer: Devoted Health Medicare	$1,399.44
Rate for Payer: Hawaii Medical Service Association Medicare	$1,266.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,166.20
Rate for Payer: Health Management Network Commercial	$1,416.10
Rate for Payer: Humana Medicare	$1,266.16
Rate for Payer: Kaiser Permanente Commercial	$1,499.40
Rate for Payer: Kaiser Permanente Medicaid	$849.66
Rate for Payer: Kaiser Permanente Medicare	$1,266.16
Rate for Payer: MDX Hawaii PPO	$1,616.02
Rate for Payer: Ohana Health Plan Medicaid	$1,266.16
Rate for Payer: Ohana Health Plan Medicare	$1,266.16
Rate for Payer: UnitedHealthcare Medicare	$1,266.16
Rate for Payer: University Health Alliance Commercial	$932.96

PLAT LCP-T 4H 3.5X63MM 241.041

Facility

$1,666.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$932.96
Max. Negotiated Rate	$1,616.02
Rate for Payer: Cash Price	$999.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,166.20
Rate for Payer: Health Management Network Commercial	$1,416.10
Rate for Payer: Kaiser Permanente Commercial	$1,499.40
Rate for Payer: MDX Hawaii PPO	$1,616.02
Rate for Payer: University Health Alliance Commercial	$932.96

PLAT LCP-T 4H 3.5X63MM 241.941

Facility

$1,673.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$936.88
Max. Negotiated Rate	$1,622.81
Rate for Payer: MDX Hawaii PPO	$1,622.81
Rate for Payer: Cash Price	$1,003.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,171.10
Rate for Payer: Health Management Network Commercial	$1,422.05
Rate for Payer: Kaiser Permanente Commercial	$1,505.70
Rate for Payer: University Health Alliance Commercial	$936.88

PLAT LCP-T 4H 3.5X63MM 241.941

Facility

$1,673.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$836.50
Max. Negotiated Rate	$1,622.81
Rate for Payer: AlohaCare Medicaid	$836.50
Rate for Payer: AlohaCare Medicare	$1,271.48
Rate for Payer: Cash Price	$1,003.80
Rate for Payer: Devoted Health Medicare	$1,405.32
Rate for Payer: Hawaii Medical Service Association Medicare	$1,271.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,171.10
Rate for Payer: Health Management Network Commercial	$1,422.05
Rate for Payer: Humana Medicare	$1,271.48
Rate for Payer: Kaiser Permanente Commercial	$1,505.70
Rate for Payer: Kaiser Permanente Medicaid	$853.23
Rate for Payer: Kaiser Permanente Medicare	$1,271.48
Rate for Payer: MDX Hawaii PPO	$1,622.81
Rate for Payer: Ohana Health Plan Medicaid	$1,271.48
Rate for Payer: Ohana Health Plan Medicare	$1,271.48
Rate for Payer: UnitedHealthcare Medicare	$1,271.48
Rate for Payer: University Health Alliance Commercial	$936.88

PLAT LCP-T 4H 4.5X83MM 240.141

Facility

$2,679.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.24
Max. Negotiated Rate	$2,598.63
Rate for Payer: Cash Price	$1,607.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,875.30
Rate for Payer: Health Management Network Commercial	$2,277.15
Rate for Payer: Kaiser Permanente Commercial	$2,411.10
Rate for Payer: MDX Hawaii PPO	$2,598.63
Rate for Payer: University Health Alliance Commercial	$1,500.24

PLAT LCP-T 4H 4.5X83MM 240.141

Facility

$2,679.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,339.50
Max. Negotiated Rate	$2,598.63
Rate for Payer: AlohaCare Medicaid	$1,339.50
Rate for Payer: AlohaCare Medicare	$2,036.04
Rate for Payer: Cash Price	$1,607.40
Rate for Payer: Devoted Health Medicare	$2,250.36
Rate for Payer: Hawaii Medical Service Association Medicare	$2,036.04
Rate for Payer: Hawaii Western Management Group Commercial	$1,875.30
Rate for Payer: Health Management Network Commercial	$2,277.15
Rate for Payer: Humana Medicare	$2,036.04
Rate for Payer: Kaiser Permanente Commercial	$2,411.10
Rate for Payer: Kaiser Permanente Medicaid	$1,366.29
Rate for Payer: Kaiser Permanente Medicare	$2,036.04
Rate for Payer: MDX Hawaii PPO	$2,598.63
Rate for Payer: Ohana Health Plan Medicaid	$2,036.04
Rate for Payer: Ohana Health Plan Medicare	$2,036.04
Rate for Payer: UnitedHealthcare Medicare	$2,036.04
Rate for Payer: University Health Alliance Commercial	$1,500.24

PLAT LCP-T 5H 3.5X67MM 241.151

Facility

$1,569.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$784.50
Max. Negotiated Rate	$1,521.93
Rate for Payer: AlohaCare Medicaid	$784.50
Rate for Payer: AlohaCare Medicare	$1,192.44
Rate for Payer: Cash Price	$941.40
Rate for Payer: Devoted Health Medicare	$1,317.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,192.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,098.30
Rate for Payer: Health Management Network Commercial	$1,333.65
Rate for Payer: Humana Medicare	$1,192.44
Rate for Payer: Kaiser Permanente Commercial	$1,412.10
Rate for Payer: Kaiser Permanente Medicaid	$800.19
Rate for Payer: Kaiser Permanente Medicare	$1,192.44
Rate for Payer: MDX Hawaii PPO	$1,521.93
Rate for Payer: Ohana Health Plan Medicaid	$1,192.44
Rate for Payer: Ohana Health Plan Medicare	$1,192.44
Rate for Payer: UnitedHealthcare Medicare	$1,192.44
Rate for Payer: University Health Alliance Commercial	$878.64

PLAT LCP-T 5H 3.5X67MM 241.151

Facility

$1,569.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$878.64
Max. Negotiated Rate	$1,521.93
Rate for Payer: Cash Price	$941.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,098.30
Rate for Payer: Health Management Network Commercial	$1,333.65
Rate for Payer: Kaiser Permanente Commercial	$1,412.10
Rate for Payer: MDX Hawaii PPO	$1,521.93
Rate for Payer: University Health Alliance Commercial	$878.64

PLAT LCP-T 5H 3.5X74MM 214.051

Facility

$1,740.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$974.40
Max. Negotiated Rate	$1,687.80
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,218.00
Rate for Payer: Health Management Network Commercial	$1,479.00
Rate for Payer: Kaiser Permanente Commercial	$1,566.00
Rate for Payer: MDX Hawaii PPO	$1,687.80
Rate for Payer: University Health Alliance Commercial	$974.40

PLAT LCP-T 5H 3.5X74MM 214.051

Facility

$1,740.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$870.00
Max. Negotiated Rate	$1,687.80
Rate for Payer: AlohaCare Medicaid	$870.00
Rate for Payer: AlohaCare Medicare	$1,322.40
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: Devoted Health Medicare	$1,461.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,322.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,218.00
Rate for Payer: Health Management Network Commercial	$1,479.00
Rate for Payer: Humana Medicare	$1,322.40
Rate for Payer: Kaiser Permanente Commercial	$1,566.00
Rate for Payer: Kaiser Permanente Medicaid	$887.40
Rate for Payer: Kaiser Permanente Medicare	$1,322.40
Rate for Payer: MDX Hawaii PPO	$1,687.80
Rate for Payer: Ohana Health Plan Medicaid	$1,322.40
Rate for Payer: Ohana Health Plan Medicare	$1,322.40
Rate for Payer: UnitedHealthcare Medicare	$1,322.40
Rate for Payer: University Health Alliance Commercial	$974.40

PLAT LCP-T 5H 3.5X74MM 241.951

Facility

$1,747.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$873.50
Max. Negotiated Rate	$1,694.59
Rate for Payer: AlohaCare Medicaid	$873.50
Rate for Payer: AlohaCare Medicare	$1,327.72
Rate for Payer: Cash Price	$1,048.20
Rate for Payer: Devoted Health Medicare	$1,467.48
Rate for Payer: Hawaii Medical Service Association Medicare	$1,327.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,222.90
Rate for Payer: Health Management Network Commercial	$1,484.95
Rate for Payer: Humana Medicare	$1,327.72
Rate for Payer: Kaiser Permanente Commercial	$1,572.30
Rate for Payer: Kaiser Permanente Medicaid	$890.97
Rate for Payer: Kaiser Permanente Medicare	$1,327.72
Rate for Payer: MDX Hawaii PPO	$1,694.59
Rate for Payer: Ohana Health Plan Medicaid	$1,327.72
Rate for Payer: Ohana Health Plan Medicare	$1,327.72
Rate for Payer: UnitedHealthcare Medicare	$1,327.72
Rate for Payer: University Health Alliance Commercial	$978.32

PLAT LCP-T 5H 3.5X74MM 241.951

Facility

$1,747.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$978.32
Max. Negotiated Rate	$1,694.59
Rate for Payer: Cash Price	$1,048.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,222.90
Rate for Payer: Health Management Network Commercial	$1,484.95
Rate for Payer: Kaiser Permanente Commercial	$1,572.30
Rate for Payer: MDX Hawaii PPO	$1,694.59
Rate for Payer: University Health Alliance Commercial	$978.32

PLAT LCP-T 6H 3.5X78MM 241.161

Facility

$1,710.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$957.60
Max. Negotiated Rate	$1,658.70
Rate for Payer: Cash Price	$1,026.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,197.00
Rate for Payer: Health Management Network Commercial	$1,453.50
Rate for Payer: Kaiser Permanente Commercial	$1,539.00
Rate for Payer: MDX Hawaii PPO	$1,658.70
Rate for Payer: University Health Alliance Commercial	$957.60

PLAT LCP-T 6H 3.5X78MM 241.161

Facility

$1,710.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$1,658.70
Rate for Payer: AlohaCare Medicaid	$855.00
Rate for Payer: AlohaCare Medicare	$1,299.60
Rate for Payer: Cash Price	$1,026.00
Rate for Payer: Devoted Health Medicare	$1,436.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,299.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,197.00
Rate for Payer: Health Management Network Commercial	$1,453.50
Rate for Payer: Humana Medicare	$1,299.60
Rate for Payer: Kaiser Permanente Commercial	$1,539.00
Rate for Payer: Kaiser Permanente Medicaid	$872.10
Rate for Payer: Kaiser Permanente Medicare	$1,299.60
Rate for Payer: MDX Hawaii PPO	$1,658.70
Rate for Payer: Ohana Health Plan Medicaid	$1,299.60
Rate for Payer: Ohana Health Plan Medicare	$1,299.60
Rate for Payer: UnitedHealthcare Medicare	$1,299.60
Rate for Payer: University Health Alliance Commercial	$957.60

PLAT LCP-T 7H 3.5X87MM 241.171

Facility

$2,022.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,132.32
Max. Negotiated Rate	$1,961.34
Rate for Payer: Cash Price	$1,213.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,415.40
Rate for Payer: Health Management Network Commercial	$1,718.70
Rate for Payer: Kaiser Permanente Commercial	$1,819.80
Rate for Payer: MDX Hawaii PPO	$1,961.34
Rate for Payer: University Health Alliance Commercial	$1,132.32

PLAT LCP-T 7H 3.5X87MM 241.171

Facility

$2,022.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,011.00
Max. Negotiated Rate	$1,961.34
Rate for Payer: AlohaCare Medicaid	$1,011.00
Rate for Payer: AlohaCare Medicare	$1,536.72
Rate for Payer: Cash Price	$1,213.20
Rate for Payer: Devoted Health Medicare	$1,698.48
Rate for Payer: Hawaii Medical Service Association Medicare	$1,536.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,415.40
Rate for Payer: Health Management Network Commercial	$1,718.70
Rate for Payer: Humana Medicare	$1,536.72
Rate for Payer: Kaiser Permanente Commercial	$1,819.80
Rate for Payer: Kaiser Permanente Medicaid	$1,031.22
Rate for Payer: Kaiser Permanente Medicare	$1,536.72
Rate for Payer: MDX Hawaii PPO	$1,961.34
Rate for Payer: Ohana Health Plan Medicaid	$1,536.72
Rate for Payer: Ohana Health Plan Medicare	$1,536.72
Rate for Payer: UnitedHealthcare Medicare	$1,536.72
Rate for Payer: University Health Alliance Commercial	$1,132.32

PLAT LCP-T 7H 3.5X96MM 241.071

Facility

$1,620.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$810.00
Max. Negotiated Rate	$1,571.40
Rate for Payer: AlohaCare Medicaid	$810.00
Rate for Payer: AlohaCare Medicare	$1,231.20
Rate for Payer: Cash Price	$972.00
Rate for Payer: Devoted Health Medicare	$1,360.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,231.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,134.00
Rate for Payer: Health Management Network Commercial	$1,377.00
Rate for Payer: Humana Medicare	$1,231.20
Rate for Payer: Kaiser Permanente Commercial	$1,458.00
Rate for Payer: Kaiser Permanente Medicaid	$826.20
Rate for Payer: Kaiser Permanente Medicare	$1,231.20
Rate for Payer: MDX Hawaii PPO	$1,571.40
Rate for Payer: Ohana Health Plan Medicaid	$1,231.20
Rate for Payer: Ohana Health Plan Medicare	$1,231.20
Rate for Payer: UnitedHealthcare Medicare	$1,231.20
Rate for Payer: University Health Alliance Commercial	$907.20

PLAT LCP-T 7H 3.5X96MM 241.071

Facility

$1,620.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$907.20
Max. Negotiated Rate	$1,571.40
Rate for Payer: Cash Price	$972.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,134.00
Rate for Payer: Health Management Network Commercial	$1,377.00
Rate for Payer: Kaiser Permanente Commercial	$1,458.00
Rate for Payer: MDX Hawaii PPO	$1,571.40
Rate for Payer: University Health Alliance Commercial	$907.20

PLAT LCP-T 7H 3.5X96MM 241.971

Facility

$1,623.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$811.50
Max. Negotiated Rate	$1,574.31
Rate for Payer: AlohaCare Medicaid	$811.50
Rate for Payer: AlohaCare Medicare	$1,233.48
Rate for Payer: Cash Price	$973.80
Rate for Payer: Devoted Health Medicare	$1,363.32
Rate for Payer: Hawaii Medical Service Association Medicare	$1,233.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,136.10
Rate for Payer: Health Management Network Commercial	$1,379.55
Rate for Payer: Humana Medicare	$1,233.48
Rate for Payer: Kaiser Permanente Commercial	$1,460.70
Rate for Payer: Kaiser Permanente Medicaid	$827.73
Rate for Payer: Kaiser Permanente Medicare	$1,233.48
Rate for Payer: MDX Hawaii PPO	$1,574.31
Rate for Payer: Ohana Health Plan Medicaid	$1,233.48
Rate for Payer: Ohana Health Plan Medicare	$1,233.48
Rate for Payer: UnitedHealthcare Medicare	$1,233.48
Rate for Payer: University Health Alliance Commercial	$908.88

PLAT LCP-T 7H 3.5X96MM 241.971

Facility

$1,623.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$908.88
Max. Negotiated Rate	$1,574.31
Rate for Payer: Cash Price	$973.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,136.10
Rate for Payer: Health Management Network Commercial	$1,379.55
Rate for Payer: Kaiser Permanente Commercial	$1,460.70
Rate for Payer: MDX Hawaii PPO	$1,574.31
Rate for Payer: University Health Alliance Commercial	$908.88

Know your out-of-pocket cost for care.

All Charges