Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLEURAL EFFUSION WITH CC

Facility

$27,565.43

Service Code	MSDRG 187
Min. Negotiated Rate	$27,565.43
Max. Negotiated Rate	$27,565.43
Rate for Payer: Hawaii Medical Service Association Commercial	$27,565.43

PLEURAL EFFUSION WITH MCC

Facility

$28,205.38

Service Code	MSDRG 186
Min. Negotiated Rate	$28,205.38
Max. Negotiated Rate	$28,205.38
Rate for Payer: Hawaii Medical Service Association Commercial	$28,205.38

PLEURAL EFFUSION WITHOUT CC/MCC

Facility

$22,516.90

Service Code	MSDRG 188
Min. Negotiated Rate	$22,516.90
Max. Negotiated Rate	$22,516.90
Rate for Payer: Hawaii Medical Service Association Commercial	$22,516.90

PLEURIX CATHETER ABDOMEN DRAIN

Facility

$2,028.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,723.80
Max. Negotiated Rate	$1,967.16
Rate for Payer: Cash Price	$1,216.80
Rate for Payer: Health Management Network Commercial	$1,723.80
Rate for Payer: Kaiser Permanente Commercial	$1,825.20
Rate for Payer: MDX Hawaii PPO	$1,967.16

PLEURIX CATHETER ABDOMEN DRAIN

Facility

$2,028.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,014.00
Max. Negotiated Rate	$1,967.16
Rate for Payer: AlohaCare Medicaid	$1,014.00
Rate for Payer: AlohaCare Medicare	$1,541.28
Rate for Payer: Cash Price	$1,216.80
Rate for Payer: Devoted Health Medicare	$1,703.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,541.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,926.60
Rate for Payer: Health Management Network Commercial	$1,723.80
Rate for Payer: Humana Medicare	$1,541.28
Rate for Payer: Kaiser Permanente Commercial	$1,825.20
Rate for Payer: Kaiser Permanente Medicaid	$1,034.28
Rate for Payer: Kaiser Permanente Medicare	$1,541.28
Rate for Payer: MDX Hawaii PPO	$1,967.16
Rate for Payer: Ohana Health Plan Medicaid	$1,541.28
Rate for Payer: Ohana Health Plan Medicare	$1,541.28
Rate for Payer: UnitedHealthcare Medicare	$1,541.28
Rate for Payer: University Health Alliance Commercial	$1,478.21

PLT CLASS 135D 4H 100MM 124131

Facility

$2,688.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,505.28
Max. Negotiated Rate	$2,607.36
Rate for Payer: Cash Price	$1,612.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,881.60
Rate for Payer: Health Management Network Commercial	$2,284.80
Rate for Payer: Kaiser Permanente Commercial	$2,419.20
Rate for Payer: MDX Hawaii PPO	$2,607.36
Rate for Payer: University Health Alliance Commercial	$1,505.28

PLT CLASS 135D 4H 100MM 124131

Facility

$2,688.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,607.36
Rate for Payer: AlohaCare Medicaid	$1,344.00
Rate for Payer: AlohaCare Medicare	$2,042.88
Rate for Payer: Cash Price	$1,612.80
Rate for Payer: Devoted Health Medicare	$2,257.92
Rate for Payer: Hawaii Medical Service Association Medicare	$2,042.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,881.60
Rate for Payer: Health Management Network Commercial	$2,284.80
Rate for Payer: Humana Medicare	$2,042.88
Rate for Payer: Kaiser Permanente Commercial	$2,419.20
Rate for Payer: Kaiser Permanente Medicaid	$1,370.88
Rate for Payer: Kaiser Permanente Medicare	$2,042.88
Rate for Payer: MDX Hawaii PPO	$2,607.36
Rate for Payer: Ohana Health Plan Medicaid	$2,042.88
Rate for Payer: Ohana Health Plan Medicare	$2,042.88
Rate for Payer: UnitedHealthcare Medicare	$2,042.88
Rate for Payer: University Health Alliance Commercial	$1,505.28

PLT CLASS 135D 8H 180MM 124146

Facility

$2,223.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,244.88
Max. Negotiated Rate	$2,156.31
Rate for Payer: Cash Price	$1,333.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,556.10
Rate for Payer: Health Management Network Commercial	$1,889.55
Rate for Payer: Kaiser Permanente Commercial	$2,000.70
Rate for Payer: MDX Hawaii PPO	$2,156.31
Rate for Payer: University Health Alliance Commercial	$1,244.88

PLT CLASS 135D 8H 180MM 124146

Facility

$2,223.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,111.50
Max. Negotiated Rate	$2,156.31
Rate for Payer: AlohaCare Medicaid	$1,111.50
Rate for Payer: AlohaCare Medicare	$1,689.48
Rate for Payer: Cash Price	$1,333.80
Rate for Payer: Devoted Health Medicare	$1,867.32
Rate for Payer: Hawaii Medical Service Association Medicare	$1,689.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,556.10
Rate for Payer: Health Management Network Commercial	$1,889.55
Rate for Payer: Humana Medicare	$1,689.48
Rate for Payer: Kaiser Permanente Commercial	$2,000.70
Rate for Payer: Kaiser Permanente Medicaid	$1,133.73
Rate for Payer: Kaiser Permanente Medicare	$1,689.48
Rate for Payer: MDX Hawaii PPO	$2,156.31
Rate for Payer: Ohana Health Plan Medicaid	$1,689.48
Rate for Payer: Ohana Health Plan Medicare	$1,689.48
Rate for Payer: UnitedHealthcare Medicare	$1,689.48
Rate for Payer: University Health Alliance Commercial	$1,244.88

PLT CLASS 140D 4H 100MM 124132

Facility

$2,688.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,607.36
Rate for Payer: AlohaCare Medicaid	$1,344.00
Rate for Payer: AlohaCare Medicare	$2,042.88
Rate for Payer: Cash Price	$1,612.80
Rate for Payer: Devoted Health Medicare	$2,257.92
Rate for Payer: Hawaii Medical Service Association Medicare	$2,042.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,881.60
Rate for Payer: Health Management Network Commercial	$2,284.80
Rate for Payer: Humana Medicare	$2,042.88
Rate for Payer: Kaiser Permanente Commercial	$2,419.20
Rate for Payer: Kaiser Permanente Medicaid	$1,370.88
Rate for Payer: Kaiser Permanente Medicare	$2,042.88
Rate for Payer: MDX Hawaii PPO	$2,607.36
Rate for Payer: Ohana Health Plan Medicaid	$2,042.88
Rate for Payer: Ohana Health Plan Medicare	$2,042.88
Rate for Payer: UnitedHealthcare Medicare	$2,042.88
Rate for Payer: University Health Alliance Commercial	$1,505.28

PLT CLASS 140D 4H 100MM 124132

Facility

$2,688.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,505.28
Max. Negotiated Rate	$2,607.36
Rate for Payer: Cash Price	$1,612.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,881.60
Rate for Payer: Health Management Network Commercial	$2,284.80
Rate for Payer: Kaiser Permanente Commercial	$2,419.20
Rate for Payer: MDX Hawaii PPO	$2,607.36
Rate for Payer: University Health Alliance Commercial	$1,505.28

PLT CLASS 140D 6H 140MM 124142

Facility

$1,617.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$808.50
Max. Negotiated Rate	$1,568.49
Rate for Payer: AlohaCare Medicaid	$808.50
Rate for Payer: AlohaCare Medicare	$1,228.92
Rate for Payer: Cash Price	$970.20
Rate for Payer: Devoted Health Medicare	$1,358.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,228.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,131.90
Rate for Payer: Health Management Network Commercial	$1,374.45
Rate for Payer: Humana Medicare	$1,228.92
Rate for Payer: Kaiser Permanente Commercial	$1,455.30
Rate for Payer: Kaiser Permanente Medicaid	$824.67
Rate for Payer: Kaiser Permanente Medicare	$1,228.92
Rate for Payer: MDX Hawaii PPO	$1,568.49
Rate for Payer: Ohana Health Plan Medicaid	$1,228.92
Rate for Payer: Ohana Health Plan Medicare	$1,228.92
Rate for Payer: UnitedHealthcare Medicare	$1,228.92
Rate for Payer: University Health Alliance Commercial	$905.52

PLT CLASS 140D 6H 140MM 124142

Facility

$1,617.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$905.52
Max. Negotiated Rate	$1,568.49
Rate for Payer: Cash Price	$970.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,131.90
Rate for Payer: Health Management Network Commercial	$1,374.45
Rate for Payer: Kaiser Permanente Commercial	$1,455.30
Rate for Payer: MDX Hawaii PPO	$1,568.49
Rate for Payer: University Health Alliance Commercial	$905.52

PLT CLASS 145D 4H 100MM 124133

Facility

$2,337.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,168.50
Max. Negotiated Rate	$2,266.89
Rate for Payer: AlohaCare Medicaid	$1,168.50
Rate for Payer: AlohaCare Medicare	$1,776.12
Rate for Payer: Cash Price	$1,402.20
Rate for Payer: Devoted Health Medicare	$1,963.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,776.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,635.90
Rate for Payer: Health Management Network Commercial	$1,986.45
Rate for Payer: Humana Medicare	$1,776.12
Rate for Payer: Kaiser Permanente Commercial	$2,103.30
Rate for Payer: Kaiser Permanente Medicaid	$1,191.87
Rate for Payer: Kaiser Permanente Medicare	$1,776.12
Rate for Payer: MDX Hawaii PPO	$2,266.89
Rate for Payer: Ohana Health Plan Medicaid	$1,776.12
Rate for Payer: Ohana Health Plan Medicare	$1,776.12
Rate for Payer: UnitedHealthcare Medicare	$1,776.12
Rate for Payer: University Health Alliance Commercial	$1,308.72

PLT CLASS 145D 4H 100MM 124133

Facility

$2,337.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,308.72
Max. Negotiated Rate	$2,266.89
Rate for Payer: Cash Price	$1,402.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,635.90
Rate for Payer: Health Management Network Commercial	$1,986.45
Rate for Payer: Kaiser Permanente Commercial	$2,103.30
Rate for Payer: MDX Hawaii PPO	$2,266.89
Rate for Payer: University Health Alliance Commercial	$1,308.72

PLT CLASS 145D 6H 140MM 124143

Facility

$2,568.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,284.00
Max. Negotiated Rate	$2,490.96
Rate for Payer: AlohaCare Medicaid	$1,284.00
Rate for Payer: AlohaCare Medicare	$1,951.68
Rate for Payer: Cash Price	$1,540.80
Rate for Payer: Devoted Health Medicare	$2,157.12
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,797.60
Rate for Payer: Health Management Network Commercial	$2,182.80
Rate for Payer: Humana Medicare	$1,951.68
Rate for Payer: Kaiser Permanente Commercial	$2,311.20
Rate for Payer: Kaiser Permanente Medicaid	$1,309.68
Rate for Payer: Kaiser Permanente Medicare	$1,951.68
Rate for Payer: MDX Hawaii PPO	$2,490.96
Rate for Payer: Ohana Health Plan Medicaid	$1,951.68
Rate for Payer: Ohana Health Plan Medicare	$1,951.68
Rate for Payer: UnitedHealthcare Medicare	$1,951.68
Rate for Payer: University Health Alliance Commercial	$1,438.08

PLT CLASS 145D 6H 140MM 124143

Facility

$2,568.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,438.08
Max. Negotiated Rate	$2,490.96
Rate for Payer: Cash Price	$1,540.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,797.60
Rate for Payer: Health Management Network Commercial	$2,182.80
Rate for Payer: Kaiser Permanente Commercial	$2,311.20
Rate for Payer: MDX Hawaii PPO	$2,490.96
Rate for Payer: University Health Alliance Commercial	$1,438.08

PLT CLASS 150D 4H 100MM 124134

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

PLT CLASS 150D 4H 100MM 124134

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

PLT COMP 10H 3.5X121MM 4935-10

Facility

$600.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$336.00
Max. Negotiated Rate	$582.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Hawaii Western Management Group Commercial	$420.00
Rate for Payer: Health Management Network Commercial	$510.00
Rate for Payer: Kaiser Permanente Commercial	$540.00
Rate for Payer: MDX Hawaii PPO	$582.00
Rate for Payer: University Health Alliance Commercial	$336.00

PLT COMP 10H 3.5X121MM 4935-10

Facility

$600.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$582.00
Rate for Payer: AlohaCare Medicaid	$300.00
Rate for Payer: AlohaCare Medicare	$456.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Devoted Health Medicare	$504.00
Rate for Payer: Hawaii Medical Service Association Medicare	$456.00
Rate for Payer: Hawaii Western Management Group Commercial	$420.00
Rate for Payer: Health Management Network Commercial	$510.00
Rate for Payer: Humana Medicare	$456.00
Rate for Payer: Kaiser Permanente Commercial	$540.00
Rate for Payer: Kaiser Permanente Medicaid	$306.00
Rate for Payer: Kaiser Permanente Medicare	$456.00
Rate for Payer: MDX Hawaii PPO	$582.00
Rate for Payer: Ohana Health Plan Medicaid	$456.00
Rate for Payer: Ohana Health Plan Medicare	$456.00
Rate for Payer: UnitedHealthcare Medicare	$456.00
Rate for Payer: University Health Alliance Commercial	$336.00

PLT COMP 12H 3.5X145MM 4935-12

Facility

$926.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$463.00
Max. Negotiated Rate	$898.22
Rate for Payer: AlohaCare Medicaid	$463.00
Rate for Payer: AlohaCare Medicare	$703.76
Rate for Payer: Cash Price	$555.60
Rate for Payer: Devoted Health Medicare	$777.84
Rate for Payer: Hawaii Medical Service Association Medicare	$703.76
Rate for Payer: Hawaii Western Management Group Commercial	$648.20
Rate for Payer: Health Management Network Commercial	$787.10
Rate for Payer: Humana Medicare	$703.76
Rate for Payer: Kaiser Permanente Commercial	$833.40
Rate for Payer: Kaiser Permanente Medicaid	$472.26
Rate for Payer: Kaiser Permanente Medicare	$703.76
Rate for Payer: MDX Hawaii PPO	$898.22
Rate for Payer: Ohana Health Plan Medicaid	$703.76
Rate for Payer: Ohana Health Plan Medicare	$703.76
Rate for Payer: UnitedHealthcare Medicare	$703.76
Rate for Payer: University Health Alliance Commercial	$518.56

PLT COMP 12H 3.5X145MM 4935-12

Facility

$926.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$518.56
Max. Negotiated Rate	$898.22
Rate for Payer: Cash Price	$555.60
Rate for Payer: Hawaii Western Management Group Commercial	$648.20
Rate for Payer: Health Management Network Commercial	$787.10
Rate for Payer: Kaiser Permanente Commercial	$833.40
Rate for Payer: MDX Hawaii PPO	$898.22
Rate for Payer: University Health Alliance Commercial	$518.56

PLT COMP 14H 3.5X169MM 4935-14

Facility

$1,544.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$772.00
Max. Negotiated Rate	$1,497.68
Rate for Payer: AlohaCare Medicaid	$772.00
Rate for Payer: AlohaCare Medicare	$1,173.44
Rate for Payer: Cash Price	$926.40
Rate for Payer: Devoted Health Medicare	$1,296.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,173.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,080.80
Rate for Payer: Health Management Network Commercial	$1,312.40
Rate for Payer: Humana Medicare	$1,173.44
Rate for Payer: Kaiser Permanente Commercial	$1,389.60
Rate for Payer: Kaiser Permanente Medicaid	$787.44
Rate for Payer: Kaiser Permanente Medicare	$1,173.44
Rate for Payer: MDX Hawaii PPO	$1,497.68
Rate for Payer: Ohana Health Plan Medicaid	$1,173.44
Rate for Payer: Ohana Health Plan Medicare	$1,173.44
Rate for Payer: UnitedHealthcare Medicare	$1,173.44
Rate for Payer: University Health Alliance Commercial	$864.64

PLT COMP 14H 3.5X169MM 4935-14

Facility

$1,544.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$864.64
Max. Negotiated Rate	$1,497.68
Rate for Payer: Cash Price	$926.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,080.80
Rate for Payer: Health Management Network Commercial	$1,312.40
Rate for Payer: Kaiser Permanente Commercial	$1,389.60
Rate for Payer: MDX Hawaii PPO	$1,497.68
Rate for Payer: University Health Alliance Commercial	$864.64

Know your out-of-pocket cost for care.

All Charges