Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

DRILL PIN TRIM 2X100 AR-4152DS

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,455.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,050.00
Rate for Payer: Health Management Network Commercial	$1,275.00
Rate for Payer: Kaiser Permanente Commercial	$1,350.00
Rate for Payer: MDX Hawaii PPO	$1,455.00
Rate for Payer: University Health Alliance Commercial	$840.00

DRILL QC 00-4806-100-20

Facility

$258.00

Hospital Revenue Code	272
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$250.26
Rate for Payer: AlohaCare Medicaid	$129.00
Rate for Payer: AlohaCare Medicare	$196.08
Rate for Payer: Cash Price	$154.80
Rate for Payer: Devoted Health Medicare	$216.72
Rate for Payer: Hawaii Medical Service Association Medicare	$196.08
Rate for Payer: Hawaii Western Management Group Commercial	$245.10
Rate for Payer: Health Management Network Commercial	$219.30
Rate for Payer: Humana Medicare	$196.08
Rate for Payer: Kaiser Permanente Commercial	$232.20
Rate for Payer: Kaiser Permanente Medicaid	$131.58
Rate for Payer: Kaiser Permanente Medicare	$196.08
Rate for Payer: MDX Hawaii PPO	$250.26
Rate for Payer: Ohana Health Plan Medicaid	$196.08
Rate for Payer: Ohana Health Plan Medicare	$196.08
Rate for Payer: UnitedHealthcare Medicare	$196.08
Rate for Payer: University Health Alliance Commercial	$188.06

DRILL QC 00-4806-100-20

Facility

$258.00

Hospital Revenue Code	272
Min. Negotiated Rate	$219.30
Max. Negotiated Rate	$250.26
Rate for Payer: Cash Price	$154.80
Rate for Payer: Health Management Network Commercial	$219.30
Rate for Payer: Kaiser Permanente Commercial	$232.20
Rate for Payer: MDX Hawaii PPO	$250.26

DRILL QC 12MM CANN #03.010.036

Facility

$1,892.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,608.20
Max. Negotiated Rate	$1,835.24
Rate for Payer: Cash Price	$1,135.20
Rate for Payer: Health Management Network Commercial	$1,608.20
Rate for Payer: Kaiser Permanente Commercial	$1,702.80
Rate for Payer: MDX Hawaii PPO	$1,835.24

DRILL QC 12MM CANN #03.010.036

Facility

$1,892.00

Hospital Revenue Code	272
Min. Negotiated Rate	$946.00
Max. Negotiated Rate	$1,835.24
Rate for Payer: AlohaCare Medicaid	$946.00
Rate for Payer: AlohaCare Medicare	$1,437.92
Rate for Payer: Cash Price	$1,135.20
Rate for Payer: Devoted Health Medicare	$1,589.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,437.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,797.40
Rate for Payer: Health Management Network Commercial	$1,608.20
Rate for Payer: Humana Medicare	$1,437.92
Rate for Payer: Kaiser Permanente Commercial	$1,702.80
Rate for Payer: Kaiser Permanente Medicaid	$964.92
Rate for Payer: Kaiser Permanente Medicare	$1,437.92
Rate for Payer: MDX Hawaii PPO	$1,835.24
Rate for Payer: Ohana Health Plan Medicaid	$1,437.92
Rate for Payer: Ohana Health Plan Medicare	$1,437.92
Rate for Payer: UnitedHealthcare Medicare	$1,437.92
Rate for Payer: University Health Alliance Commercial	$1,379.08

DRILL QC 2.7X100MM

Facility

$525.00

Hospital Revenue Code	272
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$509.25
Rate for Payer: AlohaCare Medicaid	$262.50
Rate for Payer: AlohaCare Medicare	$399.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Devoted Health Medicare	$441.00
Rate for Payer: Hawaii Medical Service Association Medicare	$399.00
Rate for Payer: Hawaii Western Management Group Commercial	$498.75
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Humana Medicare	$399.00
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: Kaiser Permanente Medicaid	$267.75
Rate for Payer: Kaiser Permanente Medicare	$399.00
Rate for Payer: MDX Hawaii PPO	$509.25
Rate for Payer: Ohana Health Plan Medicaid	$399.00
Rate for Payer: Ohana Health Plan Medicare	$399.00
Rate for Payer: UnitedHealthcare Medicare	$399.00
Rate for Payer: University Health Alliance Commercial	$382.67

DRILL QC 2.7X100MM

Facility

$525.00

Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$509.25
Rate for Payer: Cash Price	$315.00
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: MDX Hawaii PPO	$509.25

DRILL QC 3.2MM #03.010.103

Facility

$761.00

Hospital Revenue Code	272
Min. Negotiated Rate	$380.50
Max. Negotiated Rate	$738.17
Rate for Payer: AlohaCare Medicaid	$380.50
Rate for Payer: AlohaCare Medicare	$578.36
Rate for Payer: Cash Price	$456.60
Rate for Payer: Devoted Health Medicare	$639.24
Rate for Payer: Hawaii Medical Service Association Medicare	$578.36
Rate for Payer: Hawaii Western Management Group Commercial	$722.95
Rate for Payer: Health Management Network Commercial	$646.85
Rate for Payer: Humana Medicare	$578.36
Rate for Payer: Kaiser Permanente Commercial	$684.90
Rate for Payer: Kaiser Permanente Medicaid	$388.11
Rate for Payer: Kaiser Permanente Medicare	$578.36
Rate for Payer: MDX Hawaii PPO	$738.17
Rate for Payer: Ohana Health Plan Medicaid	$578.36
Rate for Payer: Ohana Health Plan Medicare	$578.36
Rate for Payer: UnitedHealthcare Medicare	$578.36
Rate for Payer: University Health Alliance Commercial	$554.69

DRILL QC 3.2MM #03.010.103

Facility

$761.00

Hospital Revenue Code	272
Min. Negotiated Rate	$646.85
Max. Negotiated Rate	$738.17
Rate for Payer: Cash Price	$456.60
Rate for Payer: Health Management Network Commercial	$646.85
Rate for Payer: Kaiser Permanente Commercial	$684.90
Rate for Payer: MDX Hawaii PPO	$738.17

DRILL SHORT 3.1 705031

Facility

$1,372.00

Hospital Revenue Code	272
Min. Negotiated Rate	$686.00
Max. Negotiated Rate	$1,330.84
Rate for Payer: AlohaCare Medicaid	$686.00
Rate for Payer: AlohaCare Medicare	$1,042.72
Rate for Payer: Cash Price	$823.20
Rate for Payer: Devoted Health Medicare	$1,152.48
Rate for Payer: Hawaii Medical Service Association Medicare	$1,042.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,303.40
Rate for Payer: Health Management Network Commercial	$1,166.20
Rate for Payer: Humana Medicare	$1,042.72
Rate for Payer: Kaiser Permanente Commercial	$1,234.80
Rate for Payer: Kaiser Permanente Medicaid	$699.72
Rate for Payer: Kaiser Permanente Medicare	$1,042.72
Rate for Payer: MDX Hawaii PPO	$1,330.84
Rate for Payer: Ohana Health Plan Medicaid	$1,042.72
Rate for Payer: Ohana Health Plan Medicare	$1,042.72
Rate for Payer: UnitedHealthcare Medicare	$1,042.72
Rate for Payer: University Health Alliance Commercial	$1,000.05

DRILL SHORT 3.1 705031

Facility

$1,372.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,166.20
Max. Negotiated Rate	$1,330.84
Rate for Payer: Cash Price	$823.20
Rate for Payer: Health Management Network Commercial	$1,166.20
Rate for Payer: Kaiser Permanente Commercial	$1,234.80
Rate for Payer: MDX Hawaii PPO	$1,330.84

DRILL SHORT QR 2.5MM 320-2025

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 SHORT QR 2.5MM 320-2025

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 SLEEVE 14/8X130MM

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 SLEEVE 14/8X130MM

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 SLEEVE 1.7MM 2.4MM HOLE

Facility

$236.00

Hospital Revenue Code	272
Min. Negotiated Rate	$118.00
Max. Negotiated Rate	$228.92
Rate for Payer: AlohaCare Medicaid	$118.00
Rate for Payer: AlohaCare Medicare	$179.36
Rate for Payer: Cash Price	$141.60
Rate for Payer: Devoted Health Medicare	$198.24
Rate for Payer: Hawaii Medical Service Association Medicare	$179.36
Rate for Payer: Hawaii Western Management Group Commercial	$224.20
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Humana Medicare	$179.36
Rate for Payer: Kaiser Permanente Commercial	$212.40
Rate for Payer: Kaiser Permanente Medicaid	$120.36
Rate for Payer: Kaiser Permanente Medicare	$179.36
Rate for Payer: MDX Hawaii PPO	$228.92
Rate for Payer: Ohana Health Plan Medicaid	$179.36
Rate for Payer: Ohana Health Plan Medicare	$179.36
Rate for Payer: UnitedHealthcare Medicare	$179.36
Rate for Payer: University Health Alliance Commercial	$172.02

DRILL SLEEVE 1.7MM 2.4MM HOLE

Facility

$236.00

Hospital Revenue Code	272
Min. Negotiated Rate	$200.60
Max. Negotiated Rate	$228.92
Rate for Payer: Cash Price	$141.60
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Kaiser Permanente Commercial	$212.40
Rate for Payer: MDX Hawaii PPO	$228.92

DRILL SLEEVE 3.5X2.5MM 312.30

Facility

$314.00

Hospital Revenue Code	272
Min. Negotiated Rate	$266.90
Max. Negotiated Rate	$304.58
Rate for Payer: Cash Price	$188.40
Rate for Payer: Health Management Network Commercial	$266.90
Rate for Payer: Kaiser Permanente Commercial	$282.60
Rate for Payer: MDX Hawaii PPO	$304.58

DRILL SLEEVE 3.5X2.5MM 312.30

Facility

$314.00

Hospital Revenue Code	272
Min. Negotiated Rate	$157.00
Max. Negotiated Rate	$304.58
Rate for Payer: AlohaCare Medicaid	$157.00
Rate for Payer: AlohaCare Medicare	$238.64
Rate for Payer: Cash Price	$188.40
Rate for Payer: Devoted Health Medicare	$263.76
Rate for Payer: Hawaii Medical Service Association Medicare	$238.64
Rate for Payer: Hawaii Western Management Group Commercial	$298.30
Rate for Payer: Health Management Network Commercial	$266.90
Rate for Payer: Humana Medicare	$238.64
Rate for Payer: Kaiser Permanente Commercial	$282.60
Rate for Payer: Kaiser Permanente Medicaid	$160.14
Rate for Payer: Kaiser Permanente Medicare	$238.64
Rate for Payer: MDX Hawaii PPO	$304.58
Rate for Payer: Ohana Health Plan Medicaid	$238.64
Rate for Payer: Ohana Health Plan Medicare	$238.64
Rate for Payer: UnitedHealthcare Medicare	$238.64
Rate for Payer: University Health Alliance Commercial	$228.87

DRILL SLEEVE 8/3.2X200MM

Facility

$984.00

Hospital Revenue Code	272
Min. Negotiated Rate	$492.00
Max. Negotiated Rate	$954.48
Rate for Payer: AlohaCare Medicaid	$492.00
Rate for Payer: AlohaCare Medicare	$747.84
Rate for Payer: Cash Price	$590.40
Rate for Payer: Devoted Health Medicare	$826.56
Rate for Payer: Hawaii Medical Service Association Medicare	$747.84
Rate for Payer: Hawaii Western Management Group Commercial	$934.80
Rate for Payer: Health Management Network Commercial	$836.40
Rate for Payer: Humana Medicare	$747.84
Rate for Payer: Kaiser Permanente Commercial	$885.60
Rate for Payer: Kaiser Permanente Medicaid	$501.84
Rate for Payer: Kaiser Permanente Medicare	$747.84
Rate for Payer: MDX Hawaii PPO	$954.48
Rate for Payer: Ohana Health Plan Medicaid	$747.84
Rate for Payer: Ohana Health Plan Medicare	$747.84
Rate for Payer: UnitedHealthcare Medicare	$747.84
Rate for Payer: University Health Alliance Commercial	$717.24

DRILL SLEEVE 8/3.2X200MM

Facility

$984.00

Hospital Revenue Code	272
Min. Negotiated Rate	$836.40
Max. Negotiated Rate	$954.48
Rate for Payer: Cash Price	$590.40
Rate for Payer: Health Management Network Commercial	$836.40
Rate for Payer: Kaiser Permanente Commercial	$885.60
Rate for Payer: MDX Hawaii PPO	$954.48

DRILL SPEEDGUIDE 2.6 30 703894

Facility

$1,110.00

Hospital Revenue Code	272
Min. Negotiated Rate	$555.00
Max. Negotiated Rate	$1,076.70
Rate for Payer: AlohaCare Medicaid	$555.00
Rate for Payer: AlohaCare Medicare	$843.60
Rate for Payer: Cash Price	$666.00
Rate for Payer: Devoted Health Medicare	$932.40
Rate for Payer: Hawaii Medical Service Association Medicare	$843.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,054.50
Rate for Payer: Health Management Network Commercial	$943.50
Rate for Payer: Humana Medicare	$843.60
Rate for Payer: Kaiser Permanente Commercial	$999.00
Rate for Payer: Kaiser Permanente Medicaid	$566.10
Rate for Payer: Kaiser Permanente Medicare	$843.60
Rate for Payer: MDX Hawaii PPO	$1,076.70
Rate for Payer: Ohana Health Plan Medicaid	$843.60
Rate for Payer: Ohana Health Plan Medicare	$843.60
Rate for Payer: UnitedHealthcare Medicare	$843.60
Rate for Payer: University Health Alliance Commercial	$809.08

DRILL SPEEDGUIDE 2.6 30 703894

Facility

$1,110.00

Hospital Revenue Code	272
Min. Negotiated Rate	$943.50
Max. Negotiated Rate	$1,076.70
Rate for Payer: Cash Price	$666.00
Rate for Payer: Health Management Network Commercial	$943.50
Rate for Payer: Kaiser Permanente Commercial	$999.00
Rate for Payer: MDX Hawaii PPO	$1,076.70

DRILL STEP 2.4MM #AR-1250LT

Facility

$320.00

Hospital Revenue Code	272
Min. Negotiated Rate	$160.00
Max. Negotiated Rate	$310.40
Rate for Payer: AlohaCare Medicaid	$160.00
Rate for Payer: AlohaCare Medicare	$243.20
Rate for Payer: Cash Price	$192.00
Rate for Payer: Devoted Health Medicare	$268.80
Rate for Payer: Hawaii Medical Service Association Medicare	$243.20
Rate for Payer: Hawaii Western Management Group Commercial	$304.00
Rate for Payer: Health Management Network Commercial	$272.00
Rate for Payer: Humana Medicare	$243.20
Rate for Payer: Kaiser Permanente Commercial	$288.00
Rate for Payer: Kaiser Permanente Medicaid	$163.20
Rate for Payer: Kaiser Permanente Medicare	$243.20
Rate for Payer: MDX Hawaii PPO	$310.40
Rate for Payer: Ohana Health Plan Medicaid	$243.20
Rate for Payer: Ohana Health Plan Medicare	$243.20
Rate for Payer: UnitedHealthcare Medicare	$243.20
Rate for Payer: University Health Alliance Commercial	$233.25

DRILL STEP 2.4MM #AR-1250LT

Facility

$320.00

Hospital Revenue Code	272
Min. Negotiated Rate	$272.00
Max. Negotiated Rate	$310.40
Rate for Payer: Cash Price	$192.00
Rate for Payer: Health Management Network Commercial	$272.00
Rate for Payer: Kaiser Permanente Commercial	$288.00
Rate for Payer: MDX Hawaii PPO	$310.40

Know your out-of-pocket cost for care.

All Charges