Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

DRILL BIT 2X110MM 4806-110-20

Facility

$638.00

Hospital Revenue Code	272
Min. Negotiated Rate	$542.30
Max. Negotiated Rate	$618.86
Rate for Payer: Cash Price	$382.80
Rate for Payer: Health Management Network Commercial	$542.30
Rate for Payer: Kaiser Permanente Commercial	$574.20
Rate for Payer: MDX Hawaii PPO	$618.86

DRILL BIT 2X110MM 4806-110-20

Facility

$638.00

Hospital Revenue Code	272
Min. Negotiated Rate	$319.00
Max. Negotiated Rate	$618.86
Rate for Payer: AlohaCare Medicaid	$319.00
Rate for Payer: AlohaCare Medicare	$484.88
Rate for Payer: Cash Price	$382.80
Rate for Payer: Devoted Health Medicare	$535.92
Rate for Payer: Hawaii Medical Service Association Medicare	$484.88
Rate for Payer: Hawaii Western Management Group Commercial	$606.10
Rate for Payer: Health Management Network Commercial	$542.30
Rate for Payer: Humana Medicare	$484.88
Rate for Payer: Kaiser Permanente Commercial	$574.20
Rate for Payer: Kaiser Permanente Medicaid	$325.38
Rate for Payer: Kaiser Permanente Medicare	$484.88
Rate for Payer: MDX Hawaii PPO	$618.86
Rate for Payer: Ohana Health Plan Medicaid	$484.88
Rate for Payer: Ohana Health Plan Medicare	$484.88
Rate for Payer: UnitedHealthcare Medicare	$484.88
Rate for Payer: University Health Alliance Commercial	$465.04

DRILL BIT 3.0MM AR-8943-36

Facility

$453.00

Hospital Revenue Code	272
Min. Negotiated Rate	$385.05
Max. Negotiated Rate	$439.41
Rate for Payer: Cash Price	$271.80
Rate for Payer: Health Management Network Commercial	$385.05
Rate for Payer: Kaiser Permanente Commercial	$407.70
Rate for Payer: MDX Hawaii PPO	$439.41

DRILL BIT 3.0MM AR-8943-36

Facility

$453.00

Hospital Revenue Code	272
Min. Negotiated Rate	$226.50
Max. Negotiated Rate	$439.41
Rate for Payer: AlohaCare Medicaid	$226.50
Rate for Payer: AlohaCare Medicare	$344.28
Rate for Payer: Cash Price	$271.80
Rate for Payer: Devoted Health Medicare	$380.52
Rate for Payer: Hawaii Medical Service Association Medicare	$344.28
Rate for Payer: Hawaii Western Management Group Commercial	$430.35
Rate for Payer: Health Management Network Commercial	$385.05
Rate for Payer: Humana Medicare	$344.28
Rate for Payer: Kaiser Permanente Commercial	$407.70
Rate for Payer: Kaiser Permanente Medicaid	$231.03
Rate for Payer: Kaiser Permanente Medicare	$344.28
Rate for Payer: MDX Hawaii PPO	$439.41
Rate for Payer: Ohana Health Plan Medicaid	$344.28
Rate for Payer: Ohana Health Plan Medicare	$344.28
Rate for Payer: UnitedHealthcare Medicare	$344.28
Rate for Payer: University Health Alliance Commercial	$330.19

DRILL BIT 3.0MM CANN 310.804

Facility

$1,724.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$1,465.40
Max. Negotiated Rate	$1,672.28
Rate for Payer: Cash Price	$1,034.40
Rate for Payer: Health Management Network Commercial	$1,465.40
Rate for Payer: Kaiser Permanente Commercial	$1,551.60
Rate for Payer: MDX Hawaii PPO	$1,672.28

DRILL BIT 3.0MM CANN 310.804

Facility

$1,724.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$862.00
Max. Negotiated Rate	$1,672.28
Rate for Payer: AlohaCare Medicaid	$862.00
Rate for Payer: AlohaCare Medicare	$1,310.24
Rate for Payer: Cash Price	$1,034.40
Rate for Payer: Devoted Health Medicare	$1,448.16
Rate for Payer: Hawaii Medical Service Association Medicare	$1,310.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,637.80
Rate for Payer: Health Management Network Commercial	$1,465.40
Rate for Payer: Humana Medicare	$1,310.24
Rate for Payer: Kaiser Permanente Commercial	$1,551.60
Rate for Payer: Kaiser Permanente Medicaid	$879.24
Rate for Payer: Kaiser Permanente Medicare	$1,310.24
Rate for Payer: MDX Hawaii PPO	$1,672.28
Rate for Payer: Ohana Health Plan Medicaid	$1,310.24
Rate for Payer: Ohana Health Plan Medicare	$1,310.24
Rate for Payer: UnitedHealthcare Medicare	$1,310.24
Rate for Payer: University Health Alliance Commercial	$1,256.62

DRILL BIT 3.0MM CANNULATED

Facility

$1,749.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,486.65
Max. Negotiated Rate	$1,696.53
Rate for Payer: Cash Price	$1,049.40
Rate for Payer: Health Management Network Commercial	$1,486.65
Rate for Payer: Kaiser Permanente Commercial	$1,574.10
Rate for Payer: MDX Hawaii PPO	$1,696.53

DRILL BIT 3.0MM CANNULATED

Facility

$1,749.00

Hospital Revenue Code	272
Min. Negotiated Rate	$874.50
Max. Negotiated Rate	$1,696.53
Rate for Payer: AlohaCare Medicaid	$874.50
Rate for Payer: AlohaCare Medicare	$1,329.24
Rate for Payer: Cash Price	$1,049.40
Rate for Payer: Devoted Health Medicare	$1,469.16
Rate for Payer: Hawaii Medical Service Association Medicare	$1,329.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,661.55
Rate for Payer: Health Management Network Commercial	$1,486.65
Rate for Payer: Humana Medicare	$1,329.24
Rate for Payer: Kaiser Permanente Commercial	$1,574.10
Rate for Payer: Kaiser Permanente Medicaid	$891.99
Rate for Payer: Kaiser Permanente Medicare	$1,329.24
Rate for Payer: MDX Hawaii PPO	$1,696.53
Rate for Payer: Ohana Health Plan Medicaid	$1,329.24
Rate for Payer: Ohana Health Plan Medicare	$1,329.24
Rate for Payer: UnitedHealthcare Medicare	$1,329.24
Rate for Payer: University Health Alliance Commercial	$1,274.85

DRILL BIT 3.0MM 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 3.0MM 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 3.0MM PRECISION

Facility

$1,580.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,343.00
Max. Negotiated Rate	$1,532.60
Rate for Payer: Cash Price	$948.00
Rate for Payer: Health Management Network Commercial	$1,343.00
Rate for Payer: Kaiser Permanente Commercial	$1,422.00
Rate for Payer: MDX Hawaii PPO	$1,532.60

DRILL BIT 3.0MM PRECISION

Facility

$1,580.00

Hospital Revenue Code	272
Min. Negotiated Rate	$790.00
Max. Negotiated Rate	$1,532.60
Rate for Payer: AlohaCare Medicaid	$790.00
Rate for Payer: AlohaCare Medicare	$1,200.80
Rate for Payer: Cash Price	$948.00
Rate for Payer: Devoted Health Medicare	$1,327.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,200.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,501.00
Rate for Payer: Health Management Network Commercial	$1,343.00
Rate for Payer: Humana Medicare	$1,200.80
Rate for Payer: Kaiser Permanente Commercial	$1,422.00
Rate for Payer: Kaiser Permanente Medicaid	$805.80
Rate for Payer: Kaiser Permanente Medicare	$1,200.80
Rate for Payer: MDX Hawaii PPO	$1,532.60
Rate for Payer: Ohana Health Plan Medicaid	$1,200.80
Rate for Payer: Ohana Health Plan Medicare	$1,200.80
Rate for Payer: UnitedHealthcare Medicare	$1,200.80
Rate for Payer: University Health Alliance Commercial	$1,151.66

DRILL BIT 3.0MM QR 320-2030

Facility

$538.00

Hospital Revenue Code	272
Min. Negotiated Rate	$269.00
Max. Negotiated Rate	$521.86
Rate for Payer: AlohaCare Medicaid	$269.00
Rate for Payer: AlohaCare Medicare	$408.88
Rate for Payer: Cash Price	$322.80
Rate for Payer: Devoted Health Medicare	$451.92
Rate for Payer: Hawaii Medical Service Association Medicare	$408.88
Rate for Payer: Hawaii Western Management Group Commercial	$511.10
Rate for Payer: Health Management Network Commercial	$457.30
Rate for Payer: Humana Medicare	$408.88
Rate for Payer: Kaiser Permanente Commercial	$484.20
Rate for Payer: Kaiser Permanente Medicaid	$274.38
Rate for Payer: Kaiser Permanente Medicare	$408.88
Rate for Payer: MDX Hawaii PPO	$521.86
Rate for Payer: Ohana Health Plan Medicaid	$408.88
Rate for Payer: Ohana Health Plan Medicare	$408.88
Rate for Payer: UnitedHealthcare Medicare	$408.88
Rate for Payer: University Health Alliance Commercial	$392.15

DRILL BIT 3.0MM QR 320-2030

Facility

$538.00

Hospital Revenue Code	272
Min. Negotiated Rate	$457.30
Max. Negotiated Rate	$521.86
Rate for Payer: Cash Price	$322.80
Rate for Payer: Health Management Network Commercial	$457.30
Rate for Payer: Kaiser Permanente Commercial	$484.20
Rate for Payer: MDX Hawaii PPO	$521.86

DRILL BIT 3.1MM 5901-1126

Facility

$294.00

Hospital Revenue Code	272
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$176.40
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Kaiser Permanente Commercial	$264.60
Rate for Payer: MDX Hawaii PPO	$285.18

DRILL BIT 3.1MM 5901-1126

Facility

$294.00

Hospital Revenue Code	272
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$147.00
Rate for Payer: AlohaCare Medicare	$223.44
Rate for Payer: Cash Price	$176.40
Rate for Payer: Devoted Health Medicare	$246.96
Rate for Payer: Hawaii Medical Service Association Medicare	$223.44
Rate for Payer: Hawaii Western Management Group Commercial	$279.30
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$223.44
Rate for Payer: Kaiser Permanente Commercial	$264.60
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$223.44
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$223.44
Rate for Payer: Ohana Health Plan Medicare	$223.44
Rate for Payer: UnitedHealthcare Medicare	$223.44
Rate for Payer: University Health Alliance Commercial	$214.30

DRILL BIT 3.2/200MM 1-1101101

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 3.2/200MM 1-1101101

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 32-467619

Facility

$536.00

Hospital Revenue Code	272
Min. Negotiated Rate	$268.00
Max. Negotiated Rate	$519.92
Rate for Payer: AlohaCare Medicaid	$268.00
Rate for Payer: AlohaCare Medicare	$407.36
Rate for Payer: Cash Price	$321.60
Rate for Payer: Devoted Health Medicare	$450.24
Rate for Payer: Hawaii Medical Service Association Medicare	$407.36
Rate for Payer: Hawaii Western Management Group Commercial	$509.20
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: Humana Medicare	$407.36
Rate for Payer: Kaiser Permanente Commercial	$482.40
Rate for Payer: Kaiser Permanente Medicaid	$273.36
Rate for Payer: Kaiser Permanente Medicare	$407.36
Rate for Payer: MDX Hawaii PPO	$519.92
Rate for Payer: Ohana Health Plan Medicaid	$407.36
Rate for Payer: Ohana Health Plan Medicare	$407.36
Rate for Payer: UnitedHealthcare Medicare	$407.36
Rate for Payer: University Health Alliance Commercial	$390.69

DRILL BIT 32-467619

Facility

$536.00

Hospital Revenue Code	272
Min. Negotiated Rate	$455.60
Max. Negotiated Rate	$519.92
Rate for Payer: Cash Price	$321.60
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: Kaiser Permanente Commercial	$482.40
Rate for Payer: MDX Hawaii PPO	$519.92

DRILL BIT 3.2 CAN 01-1010-009

Facility

$1,932.00

Hospital Revenue Code	272
Min. Negotiated Rate	$966.00
Max. Negotiated Rate	$1,874.04
Rate for Payer: AlohaCare Medicaid	$966.00
Rate for Payer: AlohaCare Medicare	$1,468.32
Rate for Payer: Cash Price	$1,159.20
Rate for Payer: Devoted Health Medicare	$1,622.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,468.32
Rate for Payer: Hawaii Western Management Group Commercial	$1,835.40
Rate for Payer: Health Management Network Commercial	$1,642.20
Rate for Payer: Humana Medicare	$1,468.32
Rate for Payer: Kaiser Permanente Commercial	$1,738.80
Rate for Payer: Kaiser Permanente Medicaid	$985.32
Rate for Payer: Kaiser Permanente Medicare	$1,468.32
Rate for Payer: MDX Hawaii PPO	$1,874.04
Rate for Payer: Ohana Health Plan Medicaid	$1,468.32
Rate for Payer: Ohana Health Plan Medicare	$1,468.32
Rate for Payer: UnitedHealthcare Medicare	$1,468.32
Rate for Payer: University Health Alliance Commercial	$1,408.23

DRILL BIT 3.2 CAN 01-1010-009

Facility

$1,932.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,642.20
Max. Negotiated Rate	$1,874.04
Rate for Payer: Cash Price	$1,159.20
Rate for Payer: Health Management Network Commercial	$1,642.20
Rate for Payer: Kaiser Permanente Commercial	$1,738.80
Rate for Payer: MDX Hawaii PPO	$1,874.04

DRILL BIT 3.2MM 110017537

Facility

$896.00

Hospital Revenue Code	272
Min. Negotiated Rate	$448.00
Max. Negotiated Rate	$869.12
Rate for Payer: AlohaCare Medicaid	$448.00
Rate for Payer: AlohaCare Medicare	$680.96
Rate for Payer: Cash Price	$537.60
Rate for Payer: Devoted Health Medicare	$752.64
Rate for Payer: Hawaii Medical Service Association Medicare	$680.96
Rate for Payer: Hawaii Western Management Group Commercial	$851.20
Rate for Payer: Health Management Network Commercial	$761.60
Rate for Payer: Humana Medicare	$680.96
Rate for Payer: Kaiser Permanente Commercial	$806.40
Rate for Payer: Kaiser Permanente Medicaid	$456.96
Rate for Payer: Kaiser Permanente Medicare	$680.96
Rate for Payer: MDX Hawaii PPO	$869.12
Rate for Payer: Ohana Health Plan Medicaid	$680.96
Rate for Payer: Ohana Health Plan Medicare	$680.96
Rate for Payer: UnitedHealthcare Medicare	$680.96
Rate for Payer: University Health Alliance Commercial	$653.09

DRILL BIT 3.2MM 110017537

Facility

$896.00

Hospital Revenue Code	272
Min. Negotiated Rate	$761.60
Max. Negotiated Rate	$869.12
Rate for Payer: Cash Price	$537.60
Rate for Payer: Health Management Network Commercial	$761.60
Rate for Payer: Kaiser Permanente Commercial	$806.40
Rate for Payer: MDX Hawaii PPO	$869.12

DRILL BIT 3.2MM 2129-57-012

Facility

$394.00

Hospital Revenue Code	272
Min. Negotiated Rate	$334.90
Max. Negotiated Rate	$382.18
Rate for Payer: Cash Price	$236.40
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Kaiser Permanente Commercial	$354.60
Rate for Payer: MDX Hawaii PPO	$382.18

Know your out-of-pocket cost for care.

All Charges