Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

DRILL BIT 2.0MM 13551

Facility

$489.00

Hospital Revenue Code	272
Min. Negotiated Rate	$415.65
Max. Negotiated Rate	$474.33
Rate for Payer: Cash Price	$293.40
Rate for Payer: Health Management Network Commercial	$415.65
Rate for Payer: Kaiser Permanente Commercial	$440.10
Rate for Payer: MDX Hawaii PPO	$474.33

DRILL BIT 2.0MM 13551A

Facility

$342.00

Hospital Revenue Code	272
Min. Negotiated Rate	$290.70
Max. Negotiated Rate	$331.74
Rate for Payer: Cash Price	$205.20
Rate for Payer: Health Management Network Commercial	$290.70
Rate for Payer: Kaiser Permanente Commercial	$307.80
Rate for Payer: MDX Hawaii PPO	$331.74

DRILL BIT 2.0MM 13551A

Facility

$342.00

Hospital Revenue Code	272
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$331.74
Rate for Payer: AlohaCare Medicaid	$171.00
Rate for Payer: AlohaCare Medicare	$259.92
Rate for Payer: Cash Price	$205.20
Rate for Payer: Devoted Health Medicare	$287.28
Rate for Payer: Hawaii Medical Service Association Medicare	$259.92
Rate for Payer: Hawaii Western Management Group Commercial	$324.90
Rate for Payer: Health Management Network Commercial	$290.70
Rate for Payer: Humana Medicare	$259.92
Rate for Payer: Kaiser Permanente Commercial	$307.80
Rate for Payer: Kaiser Permanente Medicaid	$174.42
Rate for Payer: Kaiser Permanente Medicare	$259.92
Rate for Payer: MDX Hawaii PPO	$331.74
Rate for Payer: Ohana Health Plan Medicaid	$259.92
Rate for Payer: Ohana Health Plan Medicare	$259.92
Rate for Payer: UnitedHealthcare Medicare	$259.92
Rate for Payer: University Health Alliance Commercial	$249.28

DRILL BIT 2.0MM/2.4MM 310.972

Facility

$506.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$430.10
Max. Negotiated Rate	$490.82
Rate for Payer: Cash Price	$303.60
Rate for Payer: Health Management Network Commercial	$430.10
Rate for Payer: Kaiser Permanente Commercial	$455.40
Rate for Payer: MDX Hawaii PPO	$490.82

DRILL BIT 2.0MM/2.4MM 310.972

Facility

$506.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$253.00
Max. Negotiated Rate	$490.82
Rate for Payer: AlohaCare Medicaid	$253.00
Rate for Payer: AlohaCare Medicare	$384.56
Rate for Payer: Cash Price	$303.60
Rate for Payer: Devoted Health Medicare	$425.04
Rate for Payer: Hawaii Medical Service Association Medicare	$384.56
Rate for Payer: Hawaii Western Management Group Commercial	$480.70
Rate for Payer: Health Management Network Commercial	$430.10
Rate for Payer: Humana Medicare	$384.56
Rate for Payer: Kaiser Permanente Commercial	$455.40
Rate for Payer: Kaiser Permanente Medicaid	$258.06
Rate for Payer: Kaiser Permanente Medicare	$384.56
Rate for Payer: MDX Hawaii PPO	$490.82
Rate for Payer: Ohana Health Plan Medicaid	$384.56
Rate for Payer: Ohana Health Plan Medicare	$384.56
Rate for Payer: UnitedHealthcare Medicare	$384.56
Rate for Payer: University Health Alliance Commercial	$368.82

DRILL BIT 2.0MM CAL AR-8943-16

Facility

$399.00

Hospital Revenue Code	272
Min. Negotiated Rate	$339.15
Max. Negotiated Rate	$387.03
Rate for Payer: Cash Price	$239.40
Rate for Payer: Health Management Network Commercial	$339.15
Rate for Payer: Kaiser Permanente Commercial	$359.10
Rate for Payer: MDX Hawaii PPO	$387.03

DRILL BIT 2.0MM CAL AR-8943-16

Facility

$399.00

Hospital Revenue Code	272
Min. Negotiated Rate	$199.50
Max. Negotiated Rate	$387.03
Rate for Payer: AlohaCare Medicaid	$199.50
Rate for Payer: AlohaCare Medicare	$303.24
Rate for Payer: Cash Price	$239.40
Rate for Payer: Devoted Health Medicare	$335.16
Rate for Payer: Hawaii Medical Service Association Medicare	$303.24
Rate for Payer: Hawaii Western Management Group Commercial	$379.05
Rate for Payer: Health Management Network Commercial	$339.15
Rate for Payer: Humana Medicare	$303.24
Rate for Payer: Kaiser Permanente Commercial	$359.10
Rate for Payer: Kaiser Permanente Medicaid	$203.49
Rate for Payer: Kaiser Permanente Medicare	$303.24
Rate for Payer: MDX Hawaii PPO	$387.03
Rate for Payer: Ohana Health Plan Medicaid	$303.24
Rate for Payer: Ohana Health Plan Medicare	$303.24
Rate for Payer: UnitedHealthcare Medicare	$303.24
Rate for Payer: University Health Alliance Commercial	$290.83

DRILL BIT 2.0MM DIAMOND

Facility

$494.00

Hospital Revenue Code	272
Min. Negotiated Rate	$247.00
Max. Negotiated Rate	$479.18
Rate for Payer: AlohaCare Medicaid	$247.00
Rate for Payer: AlohaCare Medicare	$375.44
Rate for Payer: Cash Price	$296.40
Rate for Payer: Devoted Health Medicare	$414.96
Rate for Payer: Hawaii Medical Service Association Medicare	$375.44
Rate for Payer: Hawaii Western Management Group Commercial	$469.30
Rate for Payer: Health Management Network Commercial	$419.90
Rate for Payer: Humana Medicare	$375.44
Rate for Payer: Kaiser Permanente Commercial	$444.60
Rate for Payer: Kaiser Permanente Medicaid	$251.94
Rate for Payer: Kaiser Permanente Medicare	$375.44
Rate for Payer: MDX Hawaii PPO	$479.18
Rate for Payer: Ohana Health Plan Medicaid	$375.44
Rate for Payer: Ohana Health Plan Medicare	$375.44
Rate for Payer: UnitedHealthcare Medicare	$375.44
Rate for Payer: University Health Alliance Commercial	$360.08

DRILL BIT 2.0MM DIAMOND

Facility

$494.00

Hospital Revenue Code	272
Min. Negotiated Rate	$419.90
Max. Negotiated Rate	$479.18
Rate for Payer: Cash Price	$296.40
Rate for Payer: Health Management Network Commercial	$419.90
Rate for Payer: Kaiser Permanente Commercial	$444.60
Rate for Payer: MDX Hawaii PPO	$479.18

DRILL BIT 2.0MM FDB20

Facility

$713.00

Hospital Revenue Code	272
Min. Negotiated Rate	$356.50
Max. Negotiated Rate	$691.61
Rate for Payer: AlohaCare Medicaid	$356.50
Rate for Payer: AlohaCare Medicare	$541.88
Rate for Payer: Cash Price	$427.80
Rate for Payer: Devoted Health Medicare	$598.92
Rate for Payer: Hawaii Medical Service Association Medicare	$541.88
Rate for Payer: Hawaii Western Management Group Commercial	$677.35
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: Humana Medicare	$541.88
Rate for Payer: Kaiser Permanente Commercial	$641.70
Rate for Payer: Kaiser Permanente Medicaid	$363.63
Rate for Payer: Kaiser Permanente Medicare	$541.88
Rate for Payer: MDX Hawaii PPO	$691.61
Rate for Payer: Ohana Health Plan Medicaid	$541.88
Rate for Payer: Ohana Health Plan Medicare	$541.88
Rate for Payer: UnitedHealthcare Medicare	$541.88
Rate for Payer: University Health Alliance Commercial	$519.71

DRILL BIT 2.0MM FDB20

Facility

$713.00

Hospital Revenue Code	272
Min. Negotiated Rate	$606.05
Max. Negotiated Rate	$691.61
Rate for Payer: Cash Price	$427.80
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: Kaiser Permanente Commercial	$641.70
Rate for Payer: MDX Hawaii PPO	$691.61

DRILL BIT 2.0X150MM QC 310.221

Facility

$1,509.00

Hospital Revenue Code	272
Min. Negotiated Rate	$754.50
Max. Negotiated Rate	$1,463.73
Rate for Payer: AlohaCare Medicaid	$754.50
Rate for Payer: AlohaCare Medicare	$1,146.84
Rate for Payer: Cash Price	$905.40
Rate for Payer: Devoted Health Medicare	$1,267.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,146.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,433.55
Rate for Payer: Health Management Network Commercial	$1,282.65
Rate for Payer: Humana Medicare	$1,146.84
Rate for Payer: Kaiser Permanente Commercial	$1,358.10
Rate for Payer: Kaiser Permanente Medicaid	$769.59
Rate for Payer: Kaiser Permanente Medicare	$1,146.84
Rate for Payer: MDX Hawaii PPO	$1,463.73
Rate for Payer: Ohana Health Plan Medicaid	$1,146.84
Rate for Payer: Ohana Health Plan Medicare	$1,146.84
Rate for Payer: UnitedHealthcare Medicare	$1,146.84
Rate for Payer: University Health Alliance Commercial	$1,099.91

DRILL BIT 2.0X150MM QC 310.221

Facility

$1,509.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,282.65
Max. Negotiated Rate	$1,463.73
Rate for Payer: Cash Price	$905.40
Rate for Payer: Health Management Network Commercial	$1,282.65
Rate for Payer: Kaiser Permanente Commercial	$1,358.10
Rate for Payer: MDX Hawaii PPO	$1,463.73

DRILL BIT 2.2MM NS 231200200

Facility

$439.00

Hospital Revenue Code	272
Min. Negotiated Rate	$373.15
Max. Negotiated Rate	$425.83
Rate for Payer: Cash Price	$263.40
Rate for Payer: Health Management Network Commercial	$373.15
Rate for Payer: Kaiser Permanente Commercial	$395.10
Rate for Payer: MDX Hawaii PPO	$425.83

DRILL BIT 2.2MM NS 231200200

Facility

$439.00

Hospital Revenue Code	272
Min. Negotiated Rate	$219.50
Max. Negotiated Rate	$425.83
Rate for Payer: AlohaCare Medicaid	$219.50
Rate for Payer: AlohaCare Medicare	$333.64
Rate for Payer: Cash Price	$263.40
Rate for Payer: Devoted Health Medicare	$368.76
Rate for Payer: Hawaii Medical Service Association Medicare	$333.64
Rate for Payer: Hawaii Western Management Group Commercial	$417.05
Rate for Payer: Health Management Network Commercial	$373.15
Rate for Payer: Humana Medicare	$333.64
Rate for Payer: Kaiser Permanente Commercial	$395.10
Rate for Payer: Kaiser Permanente Medicaid	$223.89
Rate for Payer: Kaiser Permanente Medicare	$333.64
Rate for Payer: MDX Hawaii PPO	$425.83
Rate for Payer: Ohana Health Plan Medicaid	$333.64
Rate for Payer: Ohana Health Plan Medicare	$333.64
Rate for Payer: UnitedHealthcare Medicare	$333.64
Rate for Payer: University Health Alliance Commercial	$319.99

DRILL BIT 240X4.8MM 11002A

Facility

$342.00

Hospital Revenue Code	272
Min. Negotiated Rate	$290.70
Max. Negotiated Rate	$331.74
Rate for Payer: Cash Price	$205.20
Rate for Payer: Health Management Network Commercial	$290.70
Rate for Payer: Kaiser Permanente Commercial	$307.80
Rate for Payer: MDX Hawaii PPO	$331.74

DRILL BIT 240X4.8MM 11002A

Facility

$342.00

Hospital Revenue Code	272
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$331.74
Rate for Payer: AlohaCare Medicaid	$171.00
Rate for Payer: AlohaCare Medicare	$259.92
Rate for Payer: Cash Price	$205.20
Rate for Payer: Devoted Health Medicare	$287.28
Rate for Payer: Hawaii Medical Service Association Medicare	$259.92
Rate for Payer: Hawaii Western Management Group Commercial	$324.90
Rate for Payer: Health Management Network Commercial	$290.70
Rate for Payer: Humana Medicare	$259.92
Rate for Payer: Kaiser Permanente Commercial	$307.80
Rate for Payer: Kaiser Permanente Medicaid	$174.42
Rate for Payer: Kaiser Permanente Medicare	$259.92
Rate for Payer: MDX Hawaii PPO	$331.74
Rate for Payer: Ohana Health Plan Medicaid	$259.92
Rate for Payer: Ohana Health Plan Medicare	$259.92
Rate for Payer: UnitedHealthcare Medicare	$259.92
Rate for Payer: University Health Alliance Commercial	$249.28

DRILL BIT 240X4.8MM 1-1100201

Facility

$527.00

Hospital Revenue Code	272
Min. Negotiated Rate	$447.95
Max. Negotiated Rate	$511.19
Rate for Payer: Cash Price	$316.20
Rate for Payer: Health Management Network Commercial	$447.95
Rate for Payer: Kaiser Permanente Commercial	$474.30
Rate for Payer: MDX Hawaii PPO	$511.19

DRILL BIT 240X4.8MM 1-1100201

Facility

$527.00

Hospital Revenue Code	272
Min. Negotiated Rate	$263.50
Max. Negotiated Rate	$511.19
Rate for Payer: AlohaCare Medicaid	$263.50
Rate for Payer: AlohaCare Medicare	$400.52
Rate for Payer: Cash Price	$316.20
Rate for Payer: Devoted Health Medicare	$442.68
Rate for Payer: Hawaii Medical Service Association Medicare	$400.52
Rate for Payer: Hawaii Western Management Group Commercial	$500.65
Rate for Payer: Health Management Network Commercial	$447.95
Rate for Payer: Humana Medicare	$400.52
Rate for Payer: Kaiser Permanente Commercial	$474.30
Rate for Payer: Kaiser Permanente Medicaid	$268.77
Rate for Payer: Kaiser Permanente Medicare	$400.52
Rate for Payer: MDX Hawaii PPO	$511.19
Rate for Payer: Ohana Health Plan Medicaid	$400.52
Rate for Payer: Ohana Health Plan Medicare	$400.52
Rate for Payer: UnitedHealthcare Medicare	$400.52
Rate for Payer: University Health Alliance Commercial	$384.13

DRILL BIT 2.5 03.133.103

Facility

$756.00

Hospital Revenue Code	272
Min. Negotiated Rate	$642.60
Max. Negotiated Rate	$733.32
Rate for Payer: Cash Price	$453.60
Rate for Payer: Health Management Network Commercial	$642.60
Rate for Payer: Kaiser Permanente Commercial	$680.40
Rate for Payer: MDX Hawaii PPO	$733.32

DRILL BIT 2.5 03.133.103

Facility

$756.00

Hospital Revenue Code	272
Min. Negotiated Rate	$378.00
Max. Negotiated Rate	$733.32
Rate for Payer: AlohaCare Medicaid	$378.00
Rate for Payer: AlohaCare Medicare	$574.56
Rate for Payer: Cash Price	$453.60
Rate for Payer: Devoted Health Medicare	$635.04
Rate for Payer: Hawaii Medical Service Association Medicare	$574.56
Rate for Payer: Hawaii Western Management Group Commercial	$718.20
Rate for Payer: Health Management Network Commercial	$642.60
Rate for Payer: Humana Medicare	$574.56
Rate for Payer: Kaiser Permanente Commercial	$680.40
Rate for Payer: Kaiser Permanente Medicaid	$385.56
Rate for Payer: Kaiser Permanente Medicare	$574.56
Rate for Payer: MDX Hawaii PPO	$733.32
Rate for Payer: Ohana Health Plan Medicaid	$574.56
Rate for Payer: Ohana Health Plan Medicare	$574.56
Rate for Payer: UnitedHealthcare Medicare	$574.56
Rate for Payer: University Health Alliance Commercial	$551.05

DRILL BIT 2.5/95MM JC 310.24

Facility

$348.00

Hospital Revenue Code	272
Min. Negotiated Rate	$295.80
Max. Negotiated Rate	$337.56
Rate for Payer: Cash Price	$208.80
Rate for Payer: Health Management Network Commercial	$295.80
Rate for Payer: Kaiser Permanente Commercial	$313.20
Rate for Payer: MDX Hawaii PPO	$337.56

DRILL BIT 2.5/95MM JC 310.24

Facility

$348.00

Hospital Revenue Code	272
Min. Negotiated Rate	$174.00
Max. Negotiated Rate	$337.56
Rate for Payer: AlohaCare Medicaid	$174.00
Rate for Payer: AlohaCare Medicare	$264.48
Rate for Payer: Cash Price	$208.80
Rate for Payer: Devoted Health Medicare	$292.32
Rate for Payer: Hawaii Medical Service Association Medicare	$264.48
Rate for Payer: Hawaii Western Management Group Commercial	$330.60
Rate for Payer: Health Management Network Commercial	$295.80
Rate for Payer: Humana Medicare	$264.48
Rate for Payer: Kaiser Permanente Commercial	$313.20
Rate for Payer: Kaiser Permanente Medicaid	$177.48
Rate for Payer: Kaiser Permanente Medicare	$264.48
Rate for Payer: MDX Hawaii PPO	$337.56
Rate for Payer: Ohana Health Plan Medicaid	$264.48
Rate for Payer: Ohana Health Plan Medicare	$264.48
Rate for Payer: UnitedHealthcare Medicare	$264.48
Rate for Payer: University Health Alliance Commercial	$253.66

DRILL BIT 2.5 CALI AR-8943-42

Facility

$357.00

Hospital Revenue Code	272
Min. Negotiated Rate	$303.45
Max. Negotiated Rate	$346.29
Rate for Payer: Cash Price	$214.20
Rate for Payer: Health Management Network Commercial	$303.45
Rate for Payer: Kaiser Permanente Commercial	$321.30
Rate for Payer: MDX Hawaii PPO	$346.29

DRILL BIT 2.5 CALI AR-8943-42

Facility

$357.00

Hospital Revenue Code	272
Min. Negotiated Rate	$178.50
Max. Negotiated Rate	$346.29
Rate for Payer: AlohaCare Medicaid	$178.50
Rate for Payer: AlohaCare Medicare	$271.32
Rate for Payer: Cash Price	$214.20
Rate for Payer: Devoted Health Medicare	$299.88
Rate for Payer: Hawaii Medical Service Association Medicare	$271.32
Rate for Payer: Hawaii Western Management Group Commercial	$339.15
Rate for Payer: Health Management Network Commercial	$303.45
Rate for Payer: Humana Medicare	$271.32
Rate for Payer: Kaiser Permanente Commercial	$321.30
Rate for Payer: Kaiser Permanente Medicaid	$182.07
Rate for Payer: Kaiser Permanente Medicare	$271.32
Rate for Payer: MDX Hawaii PPO	$346.29
Rate for Payer: Ohana Health Plan Medicaid	$271.32
Rate for Payer: Ohana Health Plan Medicare	$271.32
Rate for Payer: UnitedHealthcare Medicare	$271.32
Rate for Payer: University Health Alliance Commercial	$260.22

Know your out-of-pocket cost for care.

All Charges