Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

DRILL BIT QC 2.0X100MM 310.19

Facility

$361.00

Hospital Revenue Code	272
Min. Negotiated Rate	$180.50
Max. Negotiated Rate	$350.17
Rate for Payer: AlohaCare Medicaid	$180.50
Rate for Payer: AlohaCare Medicare	$274.36
Rate for Payer: Cash Price	$216.60
Rate for Payer: Devoted Health Medicare	$303.24
Rate for Payer: Hawaii Medical Service Association Medicare	$274.36
Rate for Payer: Hawaii Western Management Group Commercial	$342.95
Rate for Payer: Health Management Network Commercial	$306.85
Rate for Payer: Humana Medicare	$274.36
Rate for Payer: Kaiser Permanente Commercial	$324.90
Rate for Payer: Kaiser Permanente Medicaid	$184.11
Rate for Payer: Kaiser Permanente Medicare	$274.36
Rate for Payer: MDX Hawaii PPO	$350.17
Rate for Payer: Ohana Health Plan Medicaid	$274.36
Rate for Payer: Ohana Health Plan Medicare	$274.36
Rate for Payer: UnitedHealthcare Medicare	$274.36
Rate for Payer: University Health Alliance Commercial	$263.13

DRILL BIT QC 2.0X125MM 310.21

Facility

$392.00

Hospital Revenue Code	272
Min. Negotiated Rate	$333.20
Max. Negotiated Rate	$380.24
Rate for Payer: Cash Price	$235.20
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: MDX Hawaii PPO	$380.24

DRILL BIT QC 2.0X125MM 310.21

Facility

$392.00

Hospital Revenue Code	272
Min. Negotiated Rate	$196.00
Max. Negotiated Rate	$380.24
Rate for Payer: AlohaCare Medicaid	$196.00
Rate for Payer: AlohaCare Medicare	$297.92
Rate for Payer: Cash Price	$235.20
Rate for Payer: Devoted Health Medicare	$329.28
Rate for Payer: Hawaii Medical Service Association Medicare	$297.92
Rate for Payer: Hawaii Western Management Group Commercial	$372.40
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Humana Medicare	$297.92
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: Kaiser Permanente Medicaid	$199.92
Rate for Payer: Kaiser Permanente Medicare	$297.92
Rate for Payer: MDX Hawaii PPO	$380.24
Rate for Payer: Ohana Health Plan Medicaid	$297.92
Rate for Payer: Ohana Health Plan Medicare	$297.92
Rate for Payer: UnitedHealthcare Medicare	$297.92
Rate for Payer: University Health Alliance Commercial	$285.73

DRILL BIT QC 2.0X140MM 323.062

Facility

$700.00

Hospital Revenue Code	272
Min. Negotiated Rate	$595.00
Max. Negotiated Rate	$679.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Health Management Network Commercial	$595.00
Rate for Payer: Kaiser Permanente Commercial	$630.00
Rate for Payer: MDX Hawaii PPO	$679.00

DRILL BIT QC 2.0X140MM 323.062

Facility

$700.00

Hospital Revenue Code	272
Min. Negotiated Rate	$350.00
Max. Negotiated Rate	$679.00
Rate for Payer: AlohaCare Medicaid	$350.00
Rate for Payer: AlohaCare Medicare	$532.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Devoted Health Medicare	$588.00
Rate for Payer: Hawaii Medical Service Association Medicare	$532.00
Rate for Payer: Hawaii Western Management Group Commercial	$665.00
Rate for Payer: Health Management Network Commercial	$595.00
Rate for Payer: Humana Medicare	$532.00
Rate for Payer: Kaiser Permanente Commercial	$630.00
Rate for Payer: Kaiser Permanente Medicaid	$357.00
Rate for Payer: Kaiser Permanente Medicare	$532.00
Rate for Payer: MDX Hawaii PPO	$679.00
Rate for Payer: Ohana Health Plan Medicaid	$532.00
Rate for Payer: Ohana Health Plan Medicare	$532.00
Rate for Payer: UnitedHealthcare Medicare	$532.00
Rate for Payer: University Health Alliance Commercial	$510.23

DRILL BIT QC 2.4/100MM 310.530

Facility

$914.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$457.00
Max. Negotiated Rate	$886.58
Rate for Payer: AlohaCare Medicaid	$457.00
Rate for Payer: AlohaCare Medicare	$694.64
Rate for Payer: Cash Price	$548.40
Rate for Payer: Devoted Health Medicare	$767.76
Rate for Payer: Hawaii Medical Service Association Medicare	$694.64
Rate for Payer: Hawaii Western Management Group Commercial	$868.30
Rate for Payer: Health Management Network Commercial	$776.90
Rate for Payer: Humana Medicare	$694.64
Rate for Payer: Kaiser Permanente Commercial	$822.60
Rate for Payer: Kaiser Permanente Medicaid	$466.14
Rate for Payer: Kaiser Permanente Medicare	$694.64
Rate for Payer: MDX Hawaii PPO	$886.58
Rate for Payer: Ohana Health Plan Medicaid	$694.64
Rate for Payer: Ohana Health Plan Medicare	$694.64
Rate for Payer: UnitedHealthcare Medicare	$694.64
Rate for Payer: University Health Alliance Commercial	$666.21

DRILL BIT QC 2.4/100MM 310.530

Facility

$914.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$776.90
Max. Negotiated Rate	$886.58
Rate for Payer: Cash Price	$548.40
Rate for Payer: Health Management Network Commercial	$776.90
Rate for Payer: Kaiser Permanente Commercial	$822.60
Rate for Payer: MDX Hawaii PPO	$886.58

DRILL BIT QC 2.7X125MM 315.28

Facility

$520.00

Hospital Revenue Code	272
Min. Negotiated Rate	$260.00
Max. Negotiated Rate	$504.40
Rate for Payer: AlohaCare Medicaid	$260.00
Rate for Payer: AlohaCare Medicare	$395.20
Rate for Payer: Cash Price	$312.00
Rate for Payer: Devoted Health Medicare	$436.80
Rate for Payer: Hawaii Medical Service Association Medicare	$395.20
Rate for Payer: Hawaii Western Management Group Commercial	$494.00
Rate for Payer: Health Management Network Commercial	$442.00
Rate for Payer: Humana Medicare	$395.20
Rate for Payer: Kaiser Permanente Commercial	$468.00
Rate for Payer: Kaiser Permanente Medicaid	$265.20
Rate for Payer: Kaiser Permanente Medicare	$395.20
Rate for Payer: MDX Hawaii PPO	$504.40
Rate for Payer: Ohana Health Plan Medicaid	$395.20
Rate for Payer: Ohana Health Plan Medicare	$395.20
Rate for Payer: UnitedHealthcare Medicare	$395.20
Rate for Payer: University Health Alliance Commercial	$379.03

DRILL BIT QC 2.7X125MM 315.28

Facility

$520.00

Hospital Revenue Code	272
Min. Negotiated Rate	$442.00
Max. Negotiated Rate	$504.40
Rate for Payer: Cash Price	$312.00
Rate for Payer: Health Management Network Commercial	$442.00
Rate for Payer: Kaiser Permanente Commercial	$468.00
Rate for Payer: MDX Hawaii PPO	$504.40

DRILL BIT QC 2.7X160MM 310.67

Facility

$1,545.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,313.25
Max. Negotiated Rate	$1,498.65
Rate for Payer: Cash Price	$927.00
Rate for Payer: Health Management Network Commercial	$1,313.25
Rate for Payer: Kaiser Permanente Commercial	$1,390.50
Rate for Payer: MDX Hawaii PPO	$1,498.65

DRILL BIT QC 2.7X160MM 310.67

Facility

$1,545.00

Hospital Revenue Code	272
Min. Negotiated Rate	$772.50
Max. Negotiated Rate	$1,498.65
Rate for Payer: AlohaCare Medicaid	$772.50
Rate for Payer: AlohaCare Medicare	$1,174.20
Rate for Payer: Cash Price	$927.00
Rate for Payer: Devoted Health Medicare	$1,297.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,174.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,467.75
Rate for Payer: Health Management Network Commercial	$1,313.25
Rate for Payer: Humana Medicare	$1,174.20
Rate for Payer: Kaiser Permanente Commercial	$1,390.50
Rate for Payer: Kaiser Permanente Medicaid	$787.95
Rate for Payer: Kaiser Permanente Medicare	$1,174.20
Rate for Payer: MDX Hawaii PPO	$1,498.65
Rate for Payer: Ohana Health Plan Medicaid	$1,174.20
Rate for Payer: Ohana Health Plan Medicare	$1,174.20
Rate for Payer: UnitedHealthcare Medicare	$1,174.20
Rate for Payer: University Health Alliance Commercial	$1,126.15

DRILL BIT QC 2.8X165MM 310.288

Facility

$406.00

Hospital Revenue Code	272
Min. Negotiated Rate	$203.00
Max. Negotiated Rate	$393.82
Rate for Payer: AlohaCare Medicaid	$203.00
Rate for Payer: AlohaCare Medicare	$308.56
Rate for Payer: Cash Price	$243.60
Rate for Payer: Devoted Health Medicare	$341.04
Rate for Payer: Hawaii Medical Service Association Medicare	$308.56
Rate for Payer: Hawaii Western Management Group Commercial	$385.70
Rate for Payer: Health Management Network Commercial	$345.10
Rate for Payer: Humana Medicare	$308.56
Rate for Payer: Kaiser Permanente Commercial	$365.40
Rate for Payer: Kaiser Permanente Medicaid	$207.06
Rate for Payer: Kaiser Permanente Medicare	$308.56
Rate for Payer: MDX Hawaii PPO	$393.82
Rate for Payer: Ohana Health Plan Medicaid	$308.56
Rate for Payer: Ohana Health Plan Medicare	$308.56
Rate for Payer: UnitedHealthcare Medicare	$308.56
Rate for Payer: University Health Alliance Commercial	$295.93

DRILL BIT QC 2.8X165MM 310.288

Facility

$406.00

Hospital Revenue Code	272
Min. Negotiated Rate	$345.10
Max. Negotiated Rate	$393.82
Rate for Payer: Cash Price	$243.60
Rate for Payer: Health Management Network Commercial	$345.10
Rate for Payer: Kaiser Permanente Commercial	$365.40
Rate for Payer: MDX Hawaii PPO	$393.82

DRILL BIT QC 2.8X200MM 324.214

Facility

$815.00

Hospital Revenue Code	272
Min. Negotiated Rate	$407.50
Max. Negotiated Rate	$790.55
Rate for Payer: AlohaCare Medicaid	$407.50
Rate for Payer: AlohaCare Medicare	$619.40
Rate for Payer: Cash Price	$489.00
Rate for Payer: Devoted Health Medicare	$684.60
Rate for Payer: Hawaii Medical Service Association Medicare	$619.40
Rate for Payer: Hawaii Western Management Group Commercial	$774.25
Rate for Payer: Health Management Network Commercial	$692.75
Rate for Payer: Humana Medicare	$619.40
Rate for Payer: Kaiser Permanente Commercial	$733.50
Rate for Payer: Kaiser Permanente Medicaid	$415.65
Rate for Payer: Kaiser Permanente Medicare	$619.40
Rate for Payer: MDX Hawaii PPO	$790.55
Rate for Payer: Ohana Health Plan Medicaid	$619.40
Rate for Payer: Ohana Health Plan Medicare	$619.40
Rate for Payer: UnitedHealthcare Medicare	$619.40
Rate for Payer: University Health Alliance Commercial	$594.05

DRILL BIT QC 2.8X200MM 324.214

Facility

$815.00

Hospital Revenue Code	272
Min. Negotiated Rate	$692.75
Max. Negotiated Rate	$790.55
Rate for Payer: Cash Price	$489.00
Rate for Payer: Health Management Network Commercial	$692.75
Rate for Payer: Kaiser Permanente Commercial	$733.50
Rate for Payer: MDX Hawaii PPO	$790.55

DRILL BIT QC 2.9X150MM 310.229

Facility

$514.00

Hospital Revenue Code	272
Min. Negotiated Rate	$436.90
Max. Negotiated Rate	$498.58
Rate for Payer: Cash Price	$308.40
Rate for Payer: Health Management Network Commercial	$436.90
Rate for Payer: Kaiser Permanente Commercial	$462.60
Rate for Payer: MDX Hawaii PPO	$498.58

DRILL BIT QC 2.9X150MM 310.229

Facility

$514.00

Hospital Revenue Code	272
Min. Negotiated Rate	$257.00
Max. Negotiated Rate	$498.58
Rate for Payer: AlohaCare Medicaid	$257.00
Rate for Payer: AlohaCare Medicare	$390.64
Rate for Payer: Cash Price	$308.40
Rate for Payer: Devoted Health Medicare	$431.76
Rate for Payer: Hawaii Medical Service Association Medicare	$390.64
Rate for Payer: Hawaii Western Management Group Commercial	$488.30
Rate for Payer: Health Management Network Commercial	$436.90
Rate for Payer: Humana Medicare	$390.64
Rate for Payer: Kaiser Permanente Commercial	$462.60
Rate for Payer: Kaiser Permanente Medicaid	$262.14
Rate for Payer: Kaiser Permanente Medicare	$390.64
Rate for Payer: MDX Hawaii PPO	$498.58
Rate for Payer: Ohana Health Plan Medicaid	$390.64
Rate for Payer: Ohana Health Plan Medicare	$390.64
Rate for Payer: UnitedHealthcare Medicare	$390.64
Rate for Payer: University Health Alliance Commercial	$374.65

DRILL BIT QC 3.2X145MM 310.31

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 QC 3.2X145MM 310.31

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 QC 3.5X110MM 310.35

Facility

$373.00

Hospital Revenue Code	272
Min. Negotiated Rate	$186.50
Max. Negotiated Rate	$361.81
Rate for Payer: AlohaCare Medicaid	$186.50
Rate for Payer: AlohaCare Medicare	$283.48
Rate for Payer: Cash Price	$223.80
Rate for Payer: Devoted Health Medicare	$313.32
Rate for Payer: Hawaii Medical Service Association Medicare	$283.48
Rate for Payer: Hawaii Western Management Group Commercial	$354.35
Rate for Payer: Health Management Network Commercial	$317.05
Rate for Payer: Humana Medicare	$283.48
Rate for Payer: Kaiser Permanente Commercial	$335.70
Rate for Payer: Kaiser Permanente Medicaid	$190.23
Rate for Payer: Kaiser Permanente Medicare	$283.48
Rate for Payer: MDX Hawaii PPO	$361.81
Rate for Payer: Ohana Health Plan Medicaid	$283.48
Rate for Payer: Ohana Health Plan Medicare	$283.48
Rate for Payer: UnitedHealthcare Medicare	$283.48
Rate for Payer: University Health Alliance Commercial	$271.88

DRILL BIT QC 3.5X110MM 310.35

Facility

$373.00

Hospital Revenue Code	272
Min. Negotiated Rate	$317.05
Max. Negotiated Rate	$361.81
Rate for Payer: Cash Price	$223.80
Rate for Payer: Health Management Network Commercial	$317.05
Rate for Payer: Kaiser Permanente Commercial	$335.70
Rate for Payer: MDX Hawaii PPO	$361.81

DRILL BIT QC 3.5X195MM #310.37

Facility

$385.00

Hospital Revenue Code	272
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$373.45
Rate for Payer: AlohaCare Medicaid	$192.50
Rate for Payer: AlohaCare Medicare	$292.60
Rate for Payer: Cash Price	$231.00
Rate for Payer: Devoted Health Medicare	$323.40
Rate for Payer: Hawaii Medical Service Association Medicare	$292.60
Rate for Payer: Hawaii Western Management Group Commercial	$365.75
Rate for Payer: Health Management Network Commercial	$327.25
Rate for Payer: Humana Medicare	$292.60
Rate for Payer: Kaiser Permanente Commercial	$346.50
Rate for Payer: Kaiser Permanente Medicaid	$196.35
Rate for Payer: Kaiser Permanente Medicare	$292.60
Rate for Payer: MDX Hawaii PPO	$373.45
Rate for Payer: Ohana Health Plan Medicaid	$292.60
Rate for Payer: Ohana Health Plan Medicare	$292.60
Rate for Payer: UnitedHealthcare Medicare	$292.60
Rate for Payer: University Health Alliance Commercial	$280.63

DRILL BIT QC 3.5X195MM #310.37

Facility

$385.00

Hospital Revenue Code	272
Min. Negotiated Rate	$327.25
Max. Negotiated Rate	$373.45
Rate for Payer: Cash Price	$231.00
Rate for Payer: Health Management Network Commercial	$327.25
Rate for Payer: Kaiser Permanente Commercial	$346.50
Rate for Payer: MDX Hawaii PPO	$373.45

DRILL BIT QC 3.8MMX270MM

Facility

$1,194.00

Hospital Revenue Code	272
Min. Negotiated Rate	$597.00
Max. Negotiated Rate	$1,158.18
Rate for Payer: AlohaCare Medicaid	$597.00
Rate for Payer: AlohaCare Medicare	$907.44
Rate for Payer: Cash Price	$716.40
Rate for Payer: Devoted Health Medicare	$1,002.96
Rate for Payer: Hawaii Medical Service Association Medicare	$907.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,134.30
Rate for Payer: Health Management Network Commercial	$1,014.90
Rate for Payer: Humana Medicare	$907.44
Rate for Payer: Kaiser Permanente Commercial	$1,074.60
Rate for Payer: Kaiser Permanente Medicaid	$608.94
Rate for Payer: Kaiser Permanente Medicare	$907.44
Rate for Payer: MDX Hawaii PPO	$1,158.18
Rate for Payer: Ohana Health Plan Medicaid	$907.44
Rate for Payer: Ohana Health Plan Medicare	$907.44
Rate for Payer: UnitedHealthcare Medicare	$907.44
Rate for Payer: University Health Alliance Commercial	$870.31

DRILL BIT QC 3.8MMX270MM

Facility

$1,194.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,014.90
Max. Negotiated Rate	$1,158.18
Rate for Payer: Cash Price	$716.40
Rate for Payer: Health Management Network Commercial	$1,014.90
Rate for Payer: Kaiser Permanente Commercial	$1,074.60
Rate for Payer: MDX Hawaii PPO	$1,158.18

Know your out-of-pocket cost for care.

All Charges