Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

DRILL LG BB-TAK AR-8970-09

Facility

$506.00

Service Code	HCPCS C1713
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 LG BB-TAK AR-8970-09

Facility

$506.00

Service Code	HCPCS C1713
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 LONG 3.0MM QR 320-2130

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 LONG 3.0MM QR 320-2130

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 NON-CAN DRILL-2.3/120

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

DRILL NON-CAN DRILL-2.3/120

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

DRILL NON-CANN 4MM #AR-1204D

Facility

$431.00

Hospital Revenue Code	272
Min. Negotiated Rate	$366.35
Max. Negotiated Rate	$418.07
Rate for Payer: Cash Price	$258.60
Rate for Payer: Health Management Network Commercial	$366.35
Rate for Payer: Kaiser Permanente Commercial	$387.90
Rate for Payer: MDX Hawaii PPO	$418.07

DRILL NON-CANN 4MM #AR-1204D

Facility

$431.00

Hospital Revenue Code	272
Min. Negotiated Rate	$215.50
Max. Negotiated Rate	$418.07
Rate for Payer: AlohaCare Medicaid	$215.50
Rate for Payer: AlohaCare Medicare	$327.56
Rate for Payer: Cash Price	$258.60
Rate for Payer: Devoted Health Medicare	$362.04
Rate for Payer: Hawaii Medical Service Association Medicare	$327.56
Rate for Payer: Hawaii Western Management Group Commercial	$409.45
Rate for Payer: Health Management Network Commercial	$366.35
Rate for Payer: Humana Medicare	$327.56
Rate for Payer: Kaiser Permanente Commercial	$387.90
Rate for Payer: Kaiser Permanente Medicaid	$219.81
Rate for Payer: Kaiser Permanente Medicare	$327.56
Rate for Payer: MDX Hawaii PPO	$418.07
Rate for Payer: Ohana Health Plan Medicaid	$327.56
Rate for Payer: Ohana Health Plan Medicare	$327.56
Rate for Payer: UnitedHealthcare Medicare	$327.56
Rate for Payer: University Health Alliance Commercial	$314.16

DRILL OVER 2.4 703696

Facility

$924.00

Hospital Revenue Code	272
Min. Negotiated Rate	$785.40
Max. Negotiated Rate	$896.28
Rate for Payer: Cash Price	$554.40
Rate for Payer: Health Management Network Commercial	$785.40
Rate for Payer: Kaiser Permanente Commercial	$831.60
Rate for Payer: MDX Hawaii PPO	$896.28

DRILL OVER 2.4 703696

Facility

$924.00

Hospital Revenue Code	272
Min. Negotiated Rate	$462.00
Max. Negotiated Rate	$896.28
Rate for Payer: AlohaCare Medicaid	$462.00
Rate for Payer: AlohaCare Medicare	$702.24
Rate for Payer: Cash Price	$554.40
Rate for Payer: Devoted Health Medicare	$776.16
Rate for Payer: Hawaii Medical Service Association Medicare	$702.24
Rate for Payer: Hawaii Western Management Group Commercial	$877.80
Rate for Payer: Health Management Network Commercial	$785.40
Rate for Payer: Humana Medicare	$702.24
Rate for Payer: Kaiser Permanente Commercial	$831.60
Rate for Payer: Kaiser Permanente Medicaid	$471.24
Rate for Payer: Kaiser Permanente Medicare	$702.24
Rate for Payer: MDX Hawaii PPO	$896.28
Rate for Payer: Ohana Health Plan Medicaid	$702.24
Rate for Payer: Ohana Health Plan Medicare	$702.24
Rate for Payer: UnitedHealthcare Medicare	$702.24
Rate for Payer: University Health Alliance Commercial	$673.50

DRILL OVER 2.7 703695

Facility

$648.00

Hospital Revenue Code	272
Min. Negotiated Rate	$324.00
Max. Negotiated Rate	$628.56
Rate for Payer: AlohaCare Medicaid	$324.00
Rate for Payer: AlohaCare Medicare	$492.48
Rate for Payer: Cash Price	$388.80
Rate for Payer: Devoted Health Medicare	$544.32
Rate for Payer: Hawaii Medical Service Association Medicare	$492.48
Rate for Payer: Hawaii Western Management Group Commercial	$615.60
Rate for Payer: Health Management Network Commercial	$550.80
Rate for Payer: Humana Medicare	$492.48
Rate for Payer: Kaiser Permanente Commercial	$583.20
Rate for Payer: Kaiser Permanente Medicaid	$330.48
Rate for Payer: Kaiser Permanente Medicare	$492.48
Rate for Payer: MDX Hawaii PPO	$628.56
Rate for Payer: Ohana Health Plan Medicaid	$492.48
Rate for Payer: Ohana Health Plan Medicare	$492.48
Rate for Payer: UnitedHealthcare Medicare	$492.48
Rate for Payer: University Health Alliance Commercial	$472.33

DRILL OVER 2.7 703695

Facility

$648.00

Hospital Revenue Code	272
Min. Negotiated Rate	$550.80
Max. Negotiated Rate	$628.56
Rate for Payer: Cash Price	$388.80
Rate for Payer: Health Management Network Commercial	$550.80
Rate for Payer: Kaiser Permanente Commercial	$583.20
Rate for Payer: MDX Hawaii PPO	$628.56

DRILL OVER 2.7MM QR 320-2027

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 OVER 2.7MM QR 320-2027

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 OVER 3.5MM QR 320-2035

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 OVER 3.5MM QR 320-2035

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 OVER 4.0MM QR 320-2040

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 OVER 4.0MM QR 320-2040

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 PIN 3.7MM AR-2272

Facility

$814.00

Hospital Revenue Code	278
Min. Negotiated Rate	$407.00
Max. Negotiated Rate	$789.58
Rate for Payer: AlohaCare Medicaid	$407.00
Rate for Payer: AlohaCare Medicare	$618.64
Rate for Payer: Cash Price	$488.40
Rate for Payer: Devoted Health Medicare	$683.76
Rate for Payer: Hawaii Medical Service Association Medicare	$618.64
Rate for Payer: Hawaii Western Management Group Commercial	$569.80
Rate for Payer: Health Management Network Commercial	$691.90
Rate for Payer: Humana Medicare	$618.64
Rate for Payer: Kaiser Permanente Commercial	$732.60
Rate for Payer: Kaiser Permanente Medicaid	$415.14
Rate for Payer: Kaiser Permanente Medicare	$618.64
Rate for Payer: MDX Hawaii PPO	$789.58
Rate for Payer: Ohana Health Plan Medicaid	$618.64
Rate for Payer: Ohana Health Plan Medicare	$618.64
Rate for Payer: UnitedHealthcare Medicare	$618.64
Rate for Payer: University Health Alliance Commercial	$455.84

DRILL PIN 3.7MM AR-2272

Facility

$814.00

Hospital Revenue Code	278
Min. Negotiated Rate	$455.84
Max. Negotiated Rate	$789.58
Rate for Payer: Cash Price	$488.40
Rate for Payer: Hawaii Western Management Group Commercial	$569.80
Rate for Payer: Health Management Network Commercial	$691.90
Rate for Payer: Kaiser Permanente Commercial	$732.60
Rate for Payer: MDX Hawaii PPO	$789.58
Rate for Payer: University Health Alliance Commercial	$455.84

DRILL PIN 75MM 00-5901-020-00

Facility

$1,190.00

Hospital Revenue Code	278
Min. Negotiated Rate	$666.40
Max. Negotiated Rate	$1,154.30
Rate for Payer: Cash Price	$714.00
Rate for Payer: Hawaii Western Management Group Commercial	$833.00
Rate for Payer: Health Management Network Commercial	$1,011.50
Rate for Payer: Kaiser Permanente Commercial	$1,071.00
Rate for Payer: MDX Hawaii PPO	$1,154.30
Rate for Payer: University Health Alliance Commercial	$666.40

DRILL PIN 75MM 00-5901-020-00

Facility

$1,190.00

Hospital Revenue Code	278
Min. Negotiated Rate	$595.00
Max. Negotiated Rate	$1,154.30
Rate for Payer: AlohaCare Medicaid	$595.00
Rate for Payer: AlohaCare Medicare	$904.40
Rate for Payer: Cash Price	$714.00
Rate for Payer: Devoted Health Medicare	$999.60
Rate for Payer: Hawaii Medical Service Association Medicare	$904.40
Rate for Payer: Hawaii Western Management Group Commercial	$833.00
Rate for Payer: Health Management Network Commercial	$1,011.50
Rate for Payer: Humana Medicare	$904.40
Rate for Payer: Kaiser Permanente Commercial	$1,071.00
Rate for Payer: Kaiser Permanente Medicaid	$606.90
Rate for Payer: Kaiser Permanente Medicare	$904.40
Rate for Payer: MDX Hawaii PPO	$1,154.30
Rate for Payer: Ohana Health Plan Medicaid	$904.40
Rate for Payer: Ohana Health Plan Medicare	$904.40
Rate for Payer: UnitedHealthcare Medicare	$904.40
Rate for Payer: University Health Alliance Commercial	$666.40

DRILL PIN EYELET 4MM AR-1595TC

Facility

$469.00

Hospital Revenue Code	272
Min. Negotiated Rate	$398.65
Max. Negotiated Rate	$454.93
Rate for Payer: Cash Price	$281.40
Rate for Payer: Health Management Network Commercial	$398.65
Rate for Payer: Kaiser Permanente Commercial	$422.10
Rate for Payer: MDX Hawaii PPO	$454.93

DRILL PIN EYELET 4MM AR-1595TC

Facility

$469.00

Hospital Revenue Code	272
Min. Negotiated Rate	$234.50
Max. Negotiated Rate	$454.93
Rate for Payer: AlohaCare Medicaid	$234.50
Rate for Payer: AlohaCare Medicare	$356.44
Rate for Payer: Cash Price	$281.40
Rate for Payer: Devoted Health Medicare	$393.96
Rate for Payer: Hawaii Medical Service Association Medicare	$356.44
Rate for Payer: Hawaii Western Management Group Commercial	$445.55
Rate for Payer: Health Management Network Commercial	$398.65
Rate for Payer: Humana Medicare	$356.44
Rate for Payer: Kaiser Permanente Commercial	$422.10
Rate for Payer: Kaiser Permanente Medicaid	$239.19
Rate for Payer: Kaiser Permanente Medicare	$356.44
Rate for Payer: MDX Hawaii PPO	$454.93
Rate for Payer: Ohana Health Plan Medicaid	$356.44
Rate for Payer: Ohana Health Plan Medicare	$356.44
Rate for Payer: UnitedHealthcare Medicare	$356.44
Rate for Payer: University Health Alliance Commercial	$341.85

DRILL PIN TRIM 2X100 AR-4152DS

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: AlohaCare Medicaid	$750.00
Rate for Payer: AlohaCare Medicare	$1,140.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Devoted Health Medicare	$1,260.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,140.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,050.00
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: Humana Medicare	$1,140.00
Rate for Payer: Kaiser Permanente Commercial	$1,350.00
Rate for Payer: Kaiser Permanente Medicaid	$765.00
Rate for Payer: Kaiser Permanente Medicare	$1,140.00
Rate for Payer: MDX Hawaii PPO	$1,455.00
Rate for Payer: Ohana Health Plan Medicaid	$1,140.00
Rate for Payer: Ohana Health Plan Medicare	$1,140.00
Rate for Payer: UnitedHealthcare Medicare	$1,140.00
Rate for Payer: University Health Alliance Commercial	$840.00

Know your out-of-pocket cost for care.

All Charges