Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

K-WIRE 1.8X310MM 0152-0218S

Facility

$689.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$585.65
Max. Negotiated Rate	$668.33
Rate for Payer: Cash Price	$413.40
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Kaiser Permanente Commercial	$620.10
Rate for Payer: MDX Hawaii PPO	$668.33

K-WIRE 2.0 230MM WIRE-2.0/230

Facility

$150.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$145.50
Rate for Payer: AlohaCare Medicaid	$75.00
Rate for Payer: AlohaCare Medicare	$114.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Devoted Health Medicare	$126.00
Rate for Payer: Hawaii Medical Service Association Medicare	$114.00
Rate for Payer: Hawaii Western Management Group Commercial	$142.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Humana Medicare	$114.00
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicare	$114.00
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: Ohana Health Plan Medicaid	$114.00
Rate for Payer: Ohana Health Plan Medicare	$114.00
Rate for Payer: UnitedHealthcare Medicare	$114.00
Rate for Payer: University Health Alliance Commercial	$109.33

K-WIRE 2.0 230MM WIRE-2.0/230

Facility

$150.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: MDX Hawaii PPO	$145.50

KWIRE 2.0 703583

Facility

$446.00

Hospital Revenue Code	272
Min. Negotiated Rate	$379.10
Max. Negotiated Rate	$432.62
Rate for Payer: Cash Price	$267.60
Rate for Payer: Health Management Network Commercial	$379.10
Rate for Payer: Kaiser Permanente Commercial	$401.40
Rate for Payer: MDX Hawaii PPO	$432.62

KWIRE 2.0 703583

Facility

$446.00

Hospital Revenue Code	272
Min. Negotiated Rate	$223.00
Max. Negotiated Rate	$432.62
Rate for Payer: AlohaCare Medicaid	$223.00
Rate for Payer: AlohaCare Medicare	$338.96
Rate for Payer: Cash Price	$267.60
Rate for Payer: Devoted Health Medicare	$374.64
Rate for Payer: Hawaii Medical Service Association Medicare	$338.96
Rate for Payer: Hawaii Western Management Group Commercial	$423.70
Rate for Payer: Health Management Network Commercial	$379.10
Rate for Payer: Humana Medicare	$338.96
Rate for Payer: Kaiser Permanente Commercial	$401.40
Rate for Payer: Kaiser Permanente Medicaid	$227.46
Rate for Payer: Kaiser Permanente Medicare	$338.96
Rate for Payer: MDX Hawaii PPO	$432.62
Rate for Payer: Ohana Health Plan Medicaid	$338.96
Rate for Payer: Ohana Health Plan Medicare	$338.96
Rate for Payer: UnitedHealthcare Medicare	$338.96
Rate for Payer: University Health Alliance Commercial	$325.09

K-WIRE 2.0 DRILL TIP 705002

Facility

$240.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$232.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Kaiser Permanente Commercial	$216.00
Rate for Payer: MDX Hawaii PPO	$232.80

K-WIRE 2.0 DRILL TIP 705002

Facility

$240.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$232.80
Rate for Payer: AlohaCare Medicaid	$120.00
Rate for Payer: AlohaCare Medicare	$182.40
Rate for Payer: Cash Price	$144.00
Rate for Payer: Devoted Health Medicare	$201.60
Rate for Payer: Hawaii Medical Service Association Medicare	$182.40
Rate for Payer: Hawaii Western Management Group Commercial	$228.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Humana Medicare	$182.40
Rate for Payer: Kaiser Permanente Commercial	$216.00
Rate for Payer: Kaiser Permanente Medicaid	$122.40
Rate for Payer: Kaiser Permanente Medicare	$182.40
Rate for Payer: MDX Hawaii PPO	$232.80
Rate for Payer: Ohana Health Plan Medicaid	$182.40
Rate for Payer: Ohana Health Plan Medicare	$182.40
Rate for Payer: UnitedHealthcare Medicare	$182.40
Rate for Payer: University Health Alliance Commercial	$174.94

K-WIRE 2.0X150MM 292.20

Facility

$73.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$36.50
Max. Negotiated Rate	$70.81
Rate for Payer: AlohaCare Medicaid	$36.50
Rate for Payer: AlohaCare Medicare	$55.48
Rate for Payer: Cash Price	$43.80
Rate for Payer: Devoted Health Medicare	$61.32
Rate for Payer: Hawaii Medical Service Association Medicare	$55.48
Rate for Payer: Hawaii Western Management Group Commercial	$69.35
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Humana Medicare	$55.48
Rate for Payer: Kaiser Permanente Commercial	$65.70
Rate for Payer: Kaiser Permanente Medicaid	$37.23
Rate for Payer: Kaiser Permanente Medicare	$55.48
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: Ohana Health Plan Medicaid	$55.48
Rate for Payer: Ohana Health Plan Medicare	$55.48
Rate for Payer: UnitedHealthcare Medicare	$55.48
Rate for Payer: University Health Alliance Commercial	$53.21

K-WIRE 2.0X150MM 292.20

Facility

$73.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$62.05
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$43.80
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Kaiser Permanente Commercial	$65.70
Rate for Payer: MDX Hawaii PPO	$70.81

K-WIRE 2.0X150MM 4901-20-15

Facility

$91.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$88.27
Rate for Payer: AlohaCare Medicaid	$45.50
Rate for Payer: AlohaCare Medicare	$69.16
Rate for Payer: Cash Price	$54.60
Rate for Payer: Devoted Health Medicare	$76.44
Rate for Payer: Hawaii Medical Service Association Medicare	$69.16
Rate for Payer: Hawaii Western Management Group Commercial	$63.70
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Humana Medicare	$69.16
Rate for Payer: Kaiser Permanente Commercial	$81.90
Rate for Payer: Kaiser Permanente Medicaid	$46.41
Rate for Payer: Kaiser Permanente Medicare	$69.16
Rate for Payer: MDX Hawaii PPO	$88.27
Rate for Payer: Ohana Health Plan Medicaid	$69.16
Rate for Payer: Ohana Health Plan Medicare	$69.16
Rate for Payer: UnitedHealthcare Medicare	$69.16
Rate for Payer: University Health Alliance Commercial	$50.96

K-WIRE 2.0X150MM 4901-20-15

Facility

$91.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$50.96
Max. Negotiated Rate	$88.27
Rate for Payer: Cash Price	$54.60
Rate for Payer: Hawaii Western Management Group Commercial	$63.70
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Kaiser Permanente Commercial	$81.90
Rate for Payer: MDX Hawaii PPO	$88.27
Rate for Payer: University Health Alliance Commercial	$50.96

K-WIRE 2.0X150MM P99-192-2015

Facility

$150.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: MDX Hawaii PPO	$145.50

K-WIRE 2.0X150MM P99-192-2015

Facility

$150.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$145.50
Rate for Payer: AlohaCare Medicaid	$75.00
Rate for Payer: AlohaCare Medicare	$114.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Devoted Health Medicare	$126.00
Rate for Payer: Hawaii Medical Service Association Medicare	$114.00
Rate for Payer: Hawaii Western Management Group Commercial	$142.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Humana Medicare	$114.00
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicare	$114.00
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: Ohana Health Plan Medicaid	$114.00
Rate for Payer: Ohana Health Plan Medicare	$114.00
Rate for Payer: UnitedHealthcare Medicare	$114.00
Rate for Payer: University Health Alliance Commercial	$109.33

K-WIRE 2.0X285MM 292.21

Facility

$76.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$38.00
Max. Negotiated Rate	$73.72
Rate for Payer: AlohaCare Medicaid	$38.00
Rate for Payer: AlohaCare Medicare	$57.76
Rate for Payer: Cash Price	$45.60
Rate for Payer: Devoted Health Medicare	$63.84
Rate for Payer: Hawaii Medical Service Association Medicare	$57.76
Rate for Payer: Hawaii Western Management Group Commercial	$72.20
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Humana Medicare	$57.76
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: Kaiser Permanente Medicaid	$38.76
Rate for Payer: Kaiser Permanente Medicare	$57.76
Rate for Payer: MDX Hawaii PPO	$73.72
Rate for Payer: Ohana Health Plan Medicaid	$57.76
Rate for Payer: Ohana Health Plan Medicare	$57.76
Rate for Payer: UnitedHealthcare Medicare	$57.76
Rate for Payer: University Health Alliance Commercial	$55.40

K-WIRE 2.0X285MM 292.21

Facility

$76.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$64.60
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$45.60
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: MDX Hawaii PPO	$73.72

K-WIRE 2.3X230MM P99-192-2323

Facility

$158.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$134.30
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$94.80
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: MDX Hawaii PPO	$153.26

K-WIRE 2.3X230MM P99-192-2323

Facility

$158.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$153.26
Rate for Payer: AlohaCare Medicaid	$79.00
Rate for Payer: AlohaCare Medicare	$120.08
Rate for Payer: Cash Price	$94.80
Rate for Payer: Devoted Health Medicare	$132.72
Rate for Payer: Hawaii Medical Service Association Medicare	$120.08
Rate for Payer: Hawaii Western Management Group Commercial	$150.10
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Humana Medicare	$120.08
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: Kaiser Permanente Medicaid	$80.58
Rate for Payer: Kaiser Permanente Medicare	$120.08
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: Ohana Health Plan Medicaid	$120.08
Rate for Payer: Ohana Health Plan Medicare	$120.08
Rate for Payer: UnitedHealthcare Medicare	$120.08
Rate for Payer: University Health Alliance Commercial	$115.17

K-WIRE 2X150MM 11.146

Facility

$135.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$130.95
Rate for Payer: AlohaCare Medicaid	$67.50
Rate for Payer: AlohaCare Medicare	$102.60
Rate for Payer: Cash Price	$81.00
Rate for Payer: Devoted Health Medicare	$113.40
Rate for Payer: Hawaii Medical Service Association Medicare	$102.60
Rate for Payer: Hawaii Western Management Group Commercial	$128.25
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: Humana Medicare	$102.60
Rate for Payer: Kaiser Permanente Commercial	$121.50
Rate for Payer: Kaiser Permanente Medicaid	$68.85
Rate for Payer: Kaiser Permanente Medicare	$102.60
Rate for Payer: MDX Hawaii PPO	$130.95
Rate for Payer: Ohana Health Plan Medicaid	$102.60
Rate for Payer: Ohana Health Plan Medicare	$102.60
Rate for Payer: UnitedHealthcare Medicare	$102.60
Rate for Payer: University Health Alliance Commercial	$98.40

K-WIRE 2X150MM 11.146

Facility

$135.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$81.00
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: Kaiser Permanente Commercial	$121.50
Rate for Payer: MDX Hawaii PPO	$130.95

K-WIRE 2X150MM 6052-02-150

Facility

$360.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$349.20
Rate for Payer: AlohaCare Medicaid	$180.00
Rate for Payer: AlohaCare Medicare	$273.60
Rate for Payer: Cash Price	$216.00
Rate for Payer: Devoted Health Medicare	$302.40
Rate for Payer: Hawaii Medical Service Association Medicare	$273.60
Rate for Payer: Hawaii Western Management Group Commercial	$252.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Humana Medicare	$273.60
Rate for Payer: Kaiser Permanente Commercial	$324.00
Rate for Payer: Kaiser Permanente Medicaid	$183.60
Rate for Payer: Kaiser Permanente Medicare	$273.60
Rate for Payer: MDX Hawaii PPO	$349.20
Rate for Payer: Ohana Health Plan Medicaid	$273.60
Rate for Payer: Ohana Health Plan Medicare	$273.60
Rate for Payer: UnitedHealthcare Medicare	$273.60
Rate for Payer: University Health Alliance Commercial	$201.60

K-WIRE 2X150MM 6052-02-150

Facility

$360.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$201.60
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Hawaii Western Management Group Commercial	$252.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Kaiser Permanente Commercial	$324.00
Rate for Payer: MDX Hawaii PPO	$349.20
Rate for Payer: University Health Alliance Commercial	$201.60

K-WIRE 3.2X450MM 1210-6450S

Facility

$516.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$258.00
Max. Negotiated Rate	$500.52
Rate for Payer: AlohaCare Medicaid	$258.00
Rate for Payer: AlohaCare Medicare	$392.16
Rate for Payer: Cash Price	$309.60
Rate for Payer: Devoted Health Medicare	$433.44
Rate for Payer: Hawaii Medical Service Association Medicare	$392.16
Rate for Payer: Hawaii Western Management Group Commercial	$490.20
Rate for Payer: Health Management Network Commercial	$438.60
Rate for Payer: Humana Medicare	$392.16
Rate for Payer: Kaiser Permanente Commercial	$464.40
Rate for Payer: Kaiser Permanente Medicaid	$263.16
Rate for Payer: Kaiser Permanente Medicare	$392.16
Rate for Payer: MDX Hawaii PPO	$500.52
Rate for Payer: Ohana Health Plan Medicaid	$392.16
Rate for Payer: Ohana Health Plan Medicare	$392.16
Rate for Payer: UnitedHealthcare Medicare	$392.16
Rate for Payer: University Health Alliance Commercial	$376.11

K-WIRE 3.2X450MM 1210-6450S

Facility

$516.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$438.60
Max. Negotiated Rate	$500.52
Rate for Payer: Cash Price	$309.60
Rate for Payer: Health Management Network Commercial	$438.60
Rate for Payer: Kaiser Permanente Commercial	$464.40
Rate for Payer: MDX Hawaii PPO	$500.52

K-WIRE .35X6 DBL TRO 164206035

Facility

$875.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$743.75
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: MDX Hawaii PPO	$848.75

K-WIRE .35X6 DBL TRO 164206035

Facility

$875.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$437.50
Max. Negotiated Rate	$848.75
Rate for Payer: AlohaCare Medicaid	$437.50
Rate for Payer: AlohaCare Medicare	$665.00
Rate for Payer: Cash Price	$525.00
Rate for Payer: Devoted Health Medicare	$735.00
Rate for Payer: Hawaii Medical Service Association Medicare	$665.00
Rate for Payer: Hawaii Western Management Group Commercial	$831.25
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Humana Medicare	$665.00
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: Kaiser Permanente Medicare	$665.00
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: Ohana Health Plan Medicaid	$665.00
Rate for Payer: Ohana Health Plan Medicare	$665.00
Rate for Payer: UnitedHealthcare Medicare	$665.00
Rate for Payer: University Health Alliance Commercial	$637.79

Know your out-of-pocket cost for care.

All Charges