Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

COUNTERSINK 2.7MM QR 320-2727

Facility

$840.00

Hospital Revenue Code	272
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$814.80
Rate for Payer: AlohaCare Medicaid	$420.00
Rate for Payer: AlohaCare Medicare	$638.40
Rate for Payer: Cash Price	$504.00
Rate for Payer: Devoted Health Medicare	$705.60
Rate for Payer: Hawaii Medical Service Association Medicare	$638.40
Rate for Payer: Hawaii Western Management Group Commercial	$798.00
Rate for Payer: Health Management Network Commercial	$714.00
Rate for Payer: Humana Medicare	$638.40
Rate for Payer: Kaiser Permanente Commercial	$756.00
Rate for Payer: Kaiser Permanente Medicaid	$428.40
Rate for Payer: Kaiser Permanente Medicare	$638.40
Rate for Payer: MDX Hawaii PPO	$814.80
Rate for Payer: Ohana Health Plan Medicaid	$638.40
Rate for Payer: Ohana Health Plan Medicare	$638.40
Rate for Payer: UnitedHealthcare Medicare	$638.40
Rate for Payer: University Health Alliance Commercial	$612.28

COUNTERSINK 3.0MM HSINK-3.0

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$611.10
Rate for Payer: AlohaCare Medicaid	$315.00
Rate for Payer: AlohaCare Medicare	$478.80
Rate for Payer: Cash Price	$378.00
Rate for Payer: Devoted Health Medicare	$529.20
Rate for Payer: Hawaii Medical Service Association Medicare	$478.80
Rate for Payer: Hawaii Western Management Group Commercial	$598.50
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Humana Medicare	$478.80
Rate for Payer: Kaiser Permanente Commercial	$567.00
Rate for Payer: Kaiser Permanente Medicaid	$321.30
Rate for Payer: Kaiser Permanente Medicare	$478.80
Rate for Payer: MDX Hawaii PPO	$611.10
Rate for Payer: Ohana Health Plan Medicaid	$478.80
Rate for Payer: Ohana Health Plan Medicare	$478.80
Rate for Payer: UnitedHealthcare Medicare	$478.80
Rate for Payer: University Health Alliance Commercial	$459.21

COUNTERSINK 3.0MM HSINK-3.0

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Kaiser Permanente Commercial	$567.00
Rate for Payer: MDX Hawaii PPO	$611.10

COUNTERSINK 3.5MM HSINK-3.5

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$611.10
Rate for Payer: AlohaCare Medicaid	$315.00
Rate for Payer: AlohaCare Medicare	$478.80
Rate for Payer: Cash Price	$378.00
Rate for Payer: Devoted Health Medicare	$529.20
Rate for Payer: Hawaii Medical Service Association Medicare	$478.80
Rate for Payer: Hawaii Western Management Group Commercial	$598.50
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Humana Medicare	$478.80
Rate for Payer: Kaiser Permanente Commercial	$567.00
Rate for Payer: Kaiser Permanente Medicaid	$321.30
Rate for Payer: Kaiser Permanente Medicare	$478.80
Rate for Payer: MDX Hawaii PPO	$611.10
Rate for Payer: Ohana Health Plan Medicaid	$478.80
Rate for Payer: Ohana Health Plan Medicare	$478.80
Rate for Payer: UnitedHealthcare Medicare	$478.80
Rate for Payer: University Health Alliance Commercial	$459.21

COUNTERSINK 3.5MM HSINK-3.5

Facility

$630.00

Hospital Revenue Code	272
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Kaiser Permanente Commercial	$567.00
Rate for Payer: MDX Hawaii PPO	$611.10

COUNTERSINK 4.5/5.5MM

Facility

$1,846.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$1,569.10
Max. Negotiated Rate	$1,790.62
Rate for Payer: Cash Price	$1,107.60
Rate for Payer: Health Management Network Commercial	$1,569.10
Rate for Payer: Kaiser Permanente Commercial	$1,661.40
Rate for Payer: MDX Hawaii PPO	$1,790.62

COUNTERSINK 4.5/5.5MM

Facility

$1,846.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$923.00
Max. Negotiated Rate	$1,790.62
Rate for Payer: AlohaCare Medicaid	$923.00
Rate for Payer: AlohaCare Medicare	$1,402.96
Rate for Payer: Cash Price	$1,107.60
Rate for Payer: Devoted Health Medicare	$1,550.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,402.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.70
Rate for Payer: Health Management Network Commercial	$1,569.10
Rate for Payer: Humana Medicare	$1,402.96
Rate for Payer: Kaiser Permanente Commercial	$1,661.40
Rate for Payer: Kaiser Permanente Medicaid	$941.46
Rate for Payer: Kaiser Permanente Medicare	$1,402.96
Rate for Payer: MDX Hawaii PPO	$1,790.62
Rate for Payer: Ohana Health Plan Medicaid	$1,402.96
Rate for Payer: Ohana Health Plan Medicare	$1,402.96
Rate for Payer: UnitedHealthcare Medicare	$1,402.96
Rate for Payer: University Health Alliance Commercial	$1,345.55

COUNTER SINK 45-80040

Facility

$535.00

Hospital Revenue Code	272
Min. Negotiated Rate	$454.75
Max. Negotiated Rate	$518.95
Rate for Payer: Cash Price	$321.00
Rate for Payer: Health Management Network Commercial	$454.75
Rate for Payer: Kaiser Permanente Commercial	$481.50
Rate for Payer: MDX Hawaii PPO	$518.95

COUNTER SINK 45-80040

Facility

$535.00

Hospital Revenue Code	272
Min. Negotiated Rate	$267.50
Max. Negotiated Rate	$518.95
Rate for Payer: AlohaCare Medicaid	$267.50
Rate for Payer: AlohaCare Medicare	$406.60
Rate for Payer: Cash Price	$321.00
Rate for Payer: Devoted Health Medicare	$449.40
Rate for Payer: Hawaii Medical Service Association Medicare	$406.60
Rate for Payer: Hawaii Western Management Group Commercial	$508.25
Rate for Payer: Health Management Network Commercial	$454.75
Rate for Payer: Humana Medicare	$406.60
Rate for Payer: Kaiser Permanente Commercial	$481.50
Rate for Payer: Kaiser Permanente Medicaid	$272.85
Rate for Payer: Kaiser Permanente Medicare	$406.60
Rate for Payer: MDX Hawaii PPO	$518.95
Rate for Payer: Ohana Health Plan Medicaid	$406.60
Rate for Payer: Ohana Health Plan Medicare	$406.60
Rate for Payer: UnitedHealthcare Medicare	$406.60
Rate for Payer: University Health Alliance Commercial	$389.96

COUNTERSNK CANN 3/4MM 316-0201

Facility

$1,054.00

Hospital Revenue Code	272
Min. Negotiated Rate	$895.90
Max. Negotiated Rate	$1,022.38
Rate for Payer: Cash Price	$632.40
Rate for Payer: Health Management Network Commercial	$895.90
Rate for Payer: Kaiser Permanente Commercial	$948.60
Rate for Payer: MDX Hawaii PPO	$1,022.38

COUNTERSNK CANN 3/4MM 316-0201

Facility

$1,054.00

Hospital Revenue Code	272
Min. Negotiated Rate	$527.00
Max. Negotiated Rate	$1,022.38
Rate for Payer: AlohaCare Medicaid	$527.00
Rate for Payer: AlohaCare Medicare	$801.04
Rate for Payer: Cash Price	$632.40
Rate for Payer: Devoted Health Medicare	$885.36
Rate for Payer: Hawaii Medical Service Association Medicare	$801.04
Rate for Payer: Hawaii Western Management Group Commercial	$1,001.30
Rate for Payer: Health Management Network Commercial	$895.90
Rate for Payer: Humana Medicare	$801.04
Rate for Payer: Kaiser Permanente Commercial	$948.60
Rate for Payer: Kaiser Permanente Medicaid	$537.54
Rate for Payer: Kaiser Permanente Medicare	$801.04
Rate for Payer: MDX Hawaii PPO	$1,022.38
Rate for Payer: Ohana Health Plan Medicaid	$801.04
Rate for Payer: Ohana Health Plan Medicare	$801.04
Rate for Payer: UnitedHealthcare Medicare	$801.04
Rate for Payer: University Health Alliance Commercial	$768.26

COUPLING BAR TO BAR 4922-1-010

Facility

$2,156.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,078.00
Max. Negotiated Rate	$2,091.32
Rate for Payer: AlohaCare Medicaid	$1,078.00
Rate for Payer: AlohaCare Medicare	$1,638.56
Rate for Payer: Cash Price	$1,293.60
Rate for Payer: Devoted Health Medicare	$1,811.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1,638.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,509.20
Rate for Payer: Health Management Network Commercial	$1,832.60
Rate for Payer: Humana Medicare	$1,638.56
Rate for Payer: Kaiser Permanente Commercial	$1,940.40
Rate for Payer: Kaiser Permanente Medicaid	$1,099.56
Rate for Payer: Kaiser Permanente Medicare	$1,638.56
Rate for Payer: MDX Hawaii PPO	$2,091.32
Rate for Payer: Ohana Health Plan Medicaid	$1,638.56
Rate for Payer: Ohana Health Plan Medicare	$1,638.56
Rate for Payer: UnitedHealthcare Medicare	$1,638.56
Rate for Payer: University Health Alliance Commercial	$1,207.36

COUPLING BAR TO BAR 4922-1-010

Facility

$2,156.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,207.36
Max. Negotiated Rate	$2,091.32
Rate for Payer: Cash Price	$1,293.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,509.20
Rate for Payer: Health Management Network Commercial	$1,832.60
Rate for Payer: Kaiser Permanente Commercial	$1,940.40
Rate for Payer: MDX Hawaii PPO	$2,091.32
Rate for Payer: University Health Alliance Commercial	$1,207.36

COUPLING PIN TO ROD 4922-1-020

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

COUPLING PIN TO ROD 4922-1-020

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

COVER ALEXIS LAP MEDIUM C8502

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$437.50
Max. Negotiated Rate	$848.75
Rate for Payer: AlohaCare Medicaid	$437.50
Rate for Payer: AlohaCare Medicare	$665.00
Rate for Payer: Cash Price	$525.00
Rate for Payer: Devoted Health Medicare	$735.00
Rate for Payer: Hawaii Medical Service Association Medicare	$665.00
Rate for Payer: Hawaii Western Management Group Commercial	$831.25
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Humana Medicare	$665.00
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: Kaiser Permanente Medicare	$665.00
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: Ohana Health Plan Medicaid	$665.00
Rate for Payer: Ohana Health Plan Medicare	$665.00
Rate for Payer: UnitedHealthcare Medicare	$665.00
Rate for Payer: University Health Alliance Commercial	$637.79

COVER ALEXIS LAP MEDIUM C8502

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$743.75
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: MDX Hawaii PPO	$848.75

COVER ALEXIS LAP SMALL C8501

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$743.75
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: MDX Hawaii PPO	$848.75

COVER ALEXIS LAP SMALL C8501

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$437.50
Max. Negotiated Rate	$848.75
Rate for Payer: AlohaCare Medicaid	$437.50
Rate for Payer: AlohaCare Medicare	$665.00
Rate for Payer: Cash Price	$525.00
Rate for Payer: Devoted Health Medicare	$735.00
Rate for Payer: Hawaii Medical Service Association Medicare	$665.00
Rate for Payer: Hawaii Western Management Group Commercial	$831.25
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Humana Medicare	$665.00
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: Kaiser Permanente Medicare	$665.00
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: Ohana Health Plan Medicaid	$665.00
Rate for Payer: Ohana Health Plan Medicare	$665.00
Rate for Payer: UnitedHealthcare Medicare	$665.00
Rate for Payer: University Health Alliance Commercial	$637.79

COVER TIP ACCESSORY 400180

Facility

$126.00

Hospital Revenue Code	272
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: MDX Hawaii PPO	$122.22

COVER TIP ACCESSORY 400180

Facility

$126.00

Hospital Revenue Code	272
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$122.22
Rate for Payer: AlohaCare Medicaid	$63.00
Rate for Payer: AlohaCare Medicare	$95.76
Rate for Payer: Cash Price	$75.60
Rate for Payer: Devoted Health Medicare	$105.84
Rate for Payer: Hawaii Medical Service Association Medicare	$95.76
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Humana Medicare	$95.76
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicare	$95.76
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: Ohana Health Plan Medicaid	$95.76
Rate for Payer: Ohana Health Plan Medicare	$95.76
Rate for Payer: UnitedHealthcare Medicare	$95.76
Rate for Payer: University Health Alliance Commercial	$91.84

CRANIAL ACCESS KIT 82-6614

Facility

$1,665.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,415.25
Max. Negotiated Rate	$1,615.05
Rate for Payer: Cash Price	$999.00
Rate for Payer: Health Management Network Commercial	$1,415.25
Rate for Payer: Kaiser Permanente Commercial	$1,498.50
Rate for Payer: MDX Hawaii PPO	$1,615.05

CRANIAL ACCESS KIT 82-6614

Facility

$1,665.00

Hospital Revenue Code	272
Min. Negotiated Rate	$832.50
Max. Negotiated Rate	$1,615.05
Rate for Payer: AlohaCare Medicaid	$832.50
Rate for Payer: AlohaCare Medicare	$1,265.40
Rate for Payer: Cash Price	$999.00
Rate for Payer: Devoted Health Medicare	$1,398.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,265.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,581.75
Rate for Payer: Health Management Network Commercial	$1,415.25
Rate for Payer: Humana Medicare	$1,265.40
Rate for Payer: Kaiser Permanente Commercial	$1,498.50
Rate for Payer: Kaiser Permanente Medicaid	$849.15
Rate for Payer: Kaiser Permanente Medicare	$1,265.40
Rate for Payer: MDX Hawaii PPO	$1,615.05
Rate for Payer: Ohana Health Plan Medicaid	$1,265.40
Rate for Payer: Ohana Health Plan Medicare	$1,265.40
Rate for Payer: UnitedHealthcare Medicare	$1,265.40
Rate for Payer: University Health Alliance Commercial	$1,213.62

CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC

Facility

$24,507.87

Service Code	MSDRG 073
Min. Negotiated Rate	$24,507.87
Max. Negotiated Rate	$24,507.87
Rate for Payer: Hawaii Medical Service Association Commercial	$24,507.87

CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC

Facility

$22,327.28

Service Code	MSDRG 074
Min. Negotiated Rate	$22,327.28
Max. Negotiated Rate	$22,327.28
Rate for Payer: Hawaii Medical Service Association Commercial	$22,327.28

Know your out-of-pocket cost for care.

All Charges