Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PIN APEX S/D HALF 5018-5-120

Facility

$631.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$353.36
Max. Negotiated Rate	$612.07
Rate for Payer: Cash Price	$378.60
Rate for Payer: Hawaii Western Management Group Commercial	$441.70
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: Kaiser Permanente Commercial	$567.90
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: University Health Alliance Commercial	$353.36

PIN APEX SELF-DRILL 5018-5-200

Facility

$631.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$353.36
Max. Negotiated Rate	$612.07
Rate for Payer: Cash Price	$378.60
Rate for Payer: Hawaii Western Management Group Commercial	$441.70
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: Kaiser Permanente Commercial	$567.90
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: University Health Alliance Commercial	$353.36

PIN APEX SELF-DRILL 5018-5-200

Facility

$631.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$315.50
Max. Negotiated Rate	$612.07
Rate for Payer: AlohaCare Medicaid	$315.50
Rate for Payer: AlohaCare Medicare	$479.56
Rate for Payer: Cash Price	$378.60
Rate for Payer: Devoted Health Medicare	$530.04
Rate for Payer: Hawaii Medical Service Association Medicare	$479.56
Rate for Payer: Hawaii Western Management Group Commercial	$441.70
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: Humana Medicare	$479.56
Rate for Payer: Kaiser Permanente Commercial	$567.90
Rate for Payer: Kaiser Permanente Medicaid	$321.81
Rate for Payer: Kaiser Permanente Medicare	$479.56
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: Ohana Health Plan Medicaid	$479.56
Rate for Payer: Ohana Health Plan Medicare	$479.56
Rate for Payer: UnitedHealthcare Medicare	$479.56
Rate for Payer: University Health Alliance Commercial	$353.36

PIN AXIS 2.5X40 IJS-EAP-25400

Facility

$1,127.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$563.50
Max. Negotiated Rate	$1,093.19
Rate for Payer: AlohaCare Medicaid	$563.50
Rate for Payer: AlohaCare Medicare	$856.52
Rate for Payer: Cash Price	$676.20
Rate for Payer: Devoted Health Medicare	$946.68
Rate for Payer: Hawaii Medical Service Association Medicare	$856.52
Rate for Payer: Hawaii Western Management Group Commercial	$788.90
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: Humana Medicare	$856.52
Rate for Payer: Kaiser Permanente Commercial	$1,014.30
Rate for Payer: Kaiser Permanente Medicaid	$574.77
Rate for Payer: Kaiser Permanente Medicare	$856.52
Rate for Payer: MDX Hawaii PPO	$1,093.19
Rate for Payer: Ohana Health Plan Medicaid	$856.52
Rate for Payer: Ohana Health Plan Medicare	$856.52
Rate for Payer: UnitedHealthcare Medicare	$856.52
Rate for Payer: University Health Alliance Commercial	$631.12

PIN AXIS 2.5X40 IJS-EAP-25400

Facility

$1,127.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$631.12
Max. Negotiated Rate	$1,093.19
Rate for Payer: Cash Price	$676.20
Rate for Payer: Hawaii Western Management Group Commercial	$788.90
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: Kaiser Permanente Commercial	$1,014.30
Rate for Payer: MDX Hawaii PPO	$1,093.19
Rate for Payer: University Health Alliance Commercial	$631.12

PIN CLAMP 10 HOLES 4921-2-060

Facility

$2,456.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,228.00
Max. Negotiated Rate	$2,382.32
Rate for Payer: AlohaCare Medicaid	$1,228.00
Rate for Payer: AlohaCare Medicare	$1,866.56
Rate for Payer: Cash Price	$1,473.60
Rate for Payer: Devoted Health Medicare	$2,063.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1,866.56
Rate for Payer: Hawaii Western Management Group Commercial	$2,333.20
Rate for Payer: Health Management Network Commercial	$2,087.60
Rate for Payer: Humana Medicare	$1,866.56
Rate for Payer: Kaiser Permanente Commercial	$2,210.40
Rate for Payer: Kaiser Permanente Medicaid	$1,252.56
Rate for Payer: Kaiser Permanente Medicare	$1,866.56
Rate for Payer: MDX Hawaii PPO	$2,382.32
Rate for Payer: Ohana Health Plan Medicaid	$1,866.56
Rate for Payer: Ohana Health Plan Medicare	$1,866.56
Rate for Payer: UnitedHealthcare Medicare	$1,866.56
Rate for Payer: University Health Alliance Commercial	$1,790.18

PIN CLAMP 10 HOLES 4921-2-060

Facility

$2,456.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,087.60
Max. Negotiated Rate	$2,382.32
Rate for Payer: Cash Price	$1,473.60
Rate for Payer: Health Management Network Commercial	$2,087.60
Rate for Payer: Kaiser Permanente Commercial	$2,210.40
Rate for Payer: MDX Hawaii PPO	$2,382.32

PIN CLAMP 4922-2-240

Facility

$2,452.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,373.12
Max. Negotiated Rate	$2,378.44
Rate for Payer: Cash Price	$1,471.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,716.40
Rate for Payer: Health Management Network Commercial	$2,084.20
Rate for Payer: Kaiser Permanente Commercial	$2,206.80
Rate for Payer: MDX Hawaii PPO	$2,378.44
Rate for Payer: University Health Alliance Commercial	$1,373.12

PIN CLAMP 4922-2-240

Facility

$2,452.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,226.00
Max. Negotiated Rate	$2,378.44
Rate for Payer: AlohaCare Medicaid	$1,226.00
Rate for Payer: AlohaCare Medicare	$1,863.52
Rate for Payer: Cash Price	$1,471.20
Rate for Payer: Devoted Health Medicare	$2,059.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,863.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,716.40
Rate for Payer: Health Management Network Commercial	$2,084.20
Rate for Payer: Humana Medicare	$1,863.52
Rate for Payer: Kaiser Permanente Commercial	$2,206.80
Rate for Payer: Kaiser Permanente Medicaid	$1,250.52
Rate for Payer: Kaiser Permanente Medicare	$1,863.52
Rate for Payer: MDX Hawaii PPO	$2,378.44
Rate for Payer: Ohana Health Plan Medicaid	$1,863.52
Rate for Payer: Ohana Health Plan Medicare	$1,863.52
Rate for Payer: UnitedHealthcare Medicare	$1,863.52
Rate for Payer: University Health Alliance Commercial	$1,373.12

PIN DRILL 1.5X100MM AR-4151DS

Facility

$1,225.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$686.00
Max. Negotiated Rate	$1,188.25
Rate for Payer: Cash Price	$735.00
Rate for Payer: Hawaii Western Management Group Commercial	$857.50
Rate for Payer: Health Management Network Commercial	$1,041.25
Rate for Payer: Kaiser Permanente Commercial	$1,102.50
Rate for Payer: MDX Hawaii PPO	$1,188.25
Rate for Payer: University Health Alliance Commercial	$686.00

PIN DRILL 1.5X100MM AR-4151DS

Facility

$1,225.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$612.50
Max. Negotiated Rate	$1,188.25
Rate for Payer: AlohaCare Medicaid	$612.50
Rate for Payer: AlohaCare Medicare	$931.00
Rate for Payer: Cash Price	$735.00
Rate for Payer: Devoted Health Medicare	$1,029.00
Rate for Payer: Hawaii Medical Service Association Medicare	$931.00
Rate for Payer: Hawaii Western Management Group Commercial	$857.50
Rate for Payer: Health Management Network Commercial	$1,041.25
Rate for Payer: Humana Medicare	$931.00
Rate for Payer: Kaiser Permanente Commercial	$1,102.50
Rate for Payer: Kaiser Permanente Medicaid	$624.75
Rate for Payer: Kaiser Permanente Medicare	$931.00
Rate for Payer: MDX Hawaii PPO	$1,188.25
Rate for Payer: Ohana Health Plan Medicaid	$931.00
Rate for Payer: Ohana Health Plan Medicare	$931.00
Rate for Payer: UnitedHealthcare Medicare	$931.00
Rate for Payer: University Health Alliance Commercial	$686.00

PIN GAMMA4 PRECISIN 1420-0065S

Facility

$887.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$496.72
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$532.20
Rate for Payer: Hawaii Western Management Group Commercial	$620.90
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: MDX Hawaii PPO	$860.39
Rate for Payer: University Health Alliance Commercial	$496.72

PIN GAMMA4 PRECISIN 1420-0065S

Facility

$887.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$443.50
Max. Negotiated Rate	$860.39
Rate for Payer: AlohaCare Medicaid	$443.50
Rate for Payer: AlohaCare Medicare	$674.12
Rate for Payer: Cash Price	$532.20
Rate for Payer: Devoted Health Medicare	$745.08
Rate for Payer: Hawaii Medical Service Association Medicare	$674.12
Rate for Payer: Hawaii Western Management Group Commercial	$620.90
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Humana Medicare	$674.12
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: Kaiser Permanente Medicaid	$452.37
Rate for Payer: Kaiser Permanente Medicare	$674.12
Rate for Payer: MDX Hawaii PPO	$860.39
Rate for Payer: Ohana Health Plan Medicaid	$674.12
Rate for Payer: Ohana Health Plan Medicare	$674.12
Rate for Payer: UnitedHealthcare Medicare	$674.12
Rate for Payer: University Health Alliance Commercial	$496.72

PIN GLENOID 7000-35-230

Facility

$5,047.00

Service Code	HCPCS C1769
Hospital Revenue Code	278
Min. Negotiated Rate	$2,826.32
Max. Negotiated Rate	$4,895.59
Rate for Payer: Cash Price	$3,028.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,532.90
Rate for Payer: Health Management Network Commercial	$4,289.95
Rate for Payer: Kaiser Permanente Commercial	$4,542.30
Rate for Payer: MDX Hawaii PPO	$4,895.59
Rate for Payer: University Health Alliance Commercial	$2,826.32

PIN GLENOID 7000-35-230

Facility

$5,047.00

Service Code	HCPCS C1769
Hospital Revenue Code	278
Min. Negotiated Rate	$2,523.50
Max. Negotiated Rate	$4,895.59
Rate for Payer: AlohaCare Medicaid	$2,523.50
Rate for Payer: AlohaCare Medicare	$3,835.72
Rate for Payer: Cash Price	$3,028.20
Rate for Payer: Devoted Health Medicare	$4,239.48
Rate for Payer: Hawaii Medical Service Association Medicare	$3,835.72
Rate for Payer: Hawaii Western Management Group Commercial	$3,532.90
Rate for Payer: Health Management Network Commercial	$4,289.95
Rate for Payer: Humana Medicare	$3,835.72
Rate for Payer: Kaiser Permanente Commercial	$4,542.30
Rate for Payer: Kaiser Permanente Medicaid	$2,573.97
Rate for Payer: Kaiser Permanente Medicare	$3,835.72
Rate for Payer: MDX Hawaii PPO	$4,895.59
Rate for Payer: Ohana Health Plan Medicaid	$3,835.72
Rate for Payer: Ohana Health Plan Medicare	$3,835.72
Rate for Payer: UnitedHealthcare Medicare	$3,835.72
Rate for Payer: University Health Alliance Commercial	$2,826.32

PIN HALF TL 4MMX180MM 54-11230

Facility

$489.00

Hospital Revenue Code	272
Min. Negotiated Rate	$415.65
Max. Negotiated Rate	$474.33
Rate for Payer: Cash Price	$293.40
Rate for Payer: Health Management Network Commercial	$415.65
Rate for Payer: Kaiser Permanente Commercial	$440.10
Rate for Payer: MDX Hawaii PPO	$474.33

PIN HALF TL 4MMX180MM 54-11230

Facility

$489.00

Hospital Revenue Code	272
Min. Negotiated Rate	$244.50
Max. Negotiated Rate	$474.33
Rate for Payer: AlohaCare Medicaid	$244.50
Rate for Payer: AlohaCare Medicare	$371.64
Rate for Payer: Cash Price	$293.40
Rate for Payer: Devoted Health Medicare	$410.76
Rate for Payer: Hawaii Medical Service Association Medicare	$371.64
Rate for Payer: Hawaii Western Management Group Commercial	$464.55
Rate for Payer: Health Management Network Commercial	$415.65
Rate for Payer: Humana Medicare	$371.64
Rate for Payer: Kaiser Permanente Commercial	$440.10
Rate for Payer: Kaiser Permanente Medicaid	$249.39
Rate for Payer: Kaiser Permanente Medicare	$371.64
Rate for Payer: MDX Hawaii PPO	$474.33
Rate for Payer: Ohana Health Plan Medicaid	$371.64
Rate for Payer: Ohana Health Plan Medicare	$371.64
Rate for Payer: UnitedHealthcare Medicare	$371.64
Rate for Payer: University Health Alliance Commercial	$356.43

PIN HALF TL 5MMX180MM 54-11240

Facility

$490.00

Hospital Revenue Code	272
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$475.30
Rate for Payer: AlohaCare Medicaid	$245.00
Rate for Payer: AlohaCare Medicare	$372.40
Rate for Payer: Cash Price	$294.00
Rate for Payer: Devoted Health Medicare	$411.60
Rate for Payer: Hawaii Medical Service Association Medicare	$372.40
Rate for Payer: Hawaii Western Management Group Commercial	$465.50
Rate for Payer: Health Management Network Commercial	$416.50
Rate for Payer: Humana Medicare	$372.40
Rate for Payer: Kaiser Permanente Commercial	$441.00
Rate for Payer: Kaiser Permanente Medicaid	$249.90
Rate for Payer: Kaiser Permanente Medicare	$372.40
Rate for Payer: MDX Hawaii PPO	$475.30
Rate for Payer: Ohana Health Plan Medicaid	$372.40
Rate for Payer: Ohana Health Plan Medicare	$372.40
Rate for Payer: UnitedHealthcare Medicare	$372.40
Rate for Payer: University Health Alliance Commercial	$357.16

PIN HALF TL 5MMX180MM 54-11240

Facility

$490.00

Hospital Revenue Code	272
Min. Negotiated Rate	$416.50
Max. Negotiated Rate	$475.30
Rate for Payer: Cash Price	$294.00
Rate for Payer: Health Management Network Commercial	$416.50
Rate for Payer: Kaiser Permanente Commercial	$441.00
Rate for Payer: MDX Hawaii PPO	$475.30

PIN HALF TL 6MMX180MM 54-11250

Facility

$489.00

Hospital Revenue Code	272
Min. Negotiated Rate	$244.50
Max. Negotiated Rate	$474.33
Rate for Payer: AlohaCare Medicaid	$244.50
Rate for Payer: AlohaCare Medicare	$371.64
Rate for Payer: Cash Price	$293.40
Rate for Payer: Devoted Health Medicare	$410.76
Rate for Payer: Hawaii Medical Service Association Medicare	$371.64
Rate for Payer: Hawaii Western Management Group Commercial	$464.55
Rate for Payer: Health Management Network Commercial	$415.65
Rate for Payer: Humana Medicare	$371.64
Rate for Payer: Kaiser Permanente Commercial	$440.10
Rate for Payer: Kaiser Permanente Medicaid	$249.39
Rate for Payer: Kaiser Permanente Medicare	$371.64
Rate for Payer: MDX Hawaii PPO	$474.33
Rate for Payer: Ohana Health Plan Medicaid	$371.64
Rate for Payer: Ohana Health Plan Medicare	$371.64
Rate for Payer: UnitedHealthcare Medicare	$371.64
Rate for Payer: University Health Alliance Commercial	$356.43

PIN HALF TL 6MMX180MM 54-11250

Facility

$489.00

Hospital Revenue Code	272
Min. Negotiated Rate	$415.65
Max. Negotiated Rate	$474.33
Rate for Payer: Cash Price	$293.40
Rate for Payer: Health Management Network Commercial	$415.65
Rate for Payer: Kaiser Permanente Commercial	$440.10
Rate for Payer: MDX Hawaii PPO	$474.33

PINNING SYSTEM 2544-00-111

Facility

$875.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
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	$612.50
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	$490.00

PINNING SYSTEM 2544-00-111

Facility

$875.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$490.00
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Hawaii Western Management Group Commercial	$612.50
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
Rate for Payer: University Health Alliance Commercial	$490.00

PIN PRECISION 1420-0060S

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

PIN PRECISION 1420-0060S

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

Know your out-of-pocket cost for care.

All Charges