Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

SCREW 4.5MM CANNULATED 32MM

Facility

$1,317.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$658.50
Max. Negotiated Rate	$1,277.49
Rate for Payer: AlohaCare Medicaid	$658.50
Rate for Payer: AlohaCare Medicare	$1,000.92
Rate for Payer: Cash Price	$790.20
Rate for Payer: Devoted Health Medicare	$1,106.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,000.92
Rate for Payer: Hawaii Western Management Group Commercial	$921.90
Rate for Payer: Health Management Network Commercial	$1,119.45
Rate for Payer: Humana Medicare	$1,000.92
Rate for Payer: Kaiser Permanente Commercial	$1,185.30
Rate for Payer: Kaiser Permanente Medicaid	$671.67
Rate for Payer: Kaiser Permanente Medicare	$1,000.92
Rate for Payer: MDX Hawaii PPO	$1,277.49
Rate for Payer: Ohana Health Plan Medicaid	$1,000.92
Rate for Payer: Ohana Health Plan Medicare	$1,000.92
Rate for Payer: UnitedHealthcare Medicare	$1,000.92
Rate for Payer: University Health Alliance Commercial	$737.52

SCREW 4.5MM CORTEX 85MM

Facility

$216.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$108.00
Max. Negotiated Rate	$209.52
Rate for Payer: AlohaCare Medicaid	$108.00
Rate for Payer: AlohaCare Medicare	$164.16
Rate for Payer: Cash Price	$129.60
Rate for Payer: Devoted Health Medicare	$181.44
Rate for Payer: Hawaii Medical Service Association Medicare	$164.16
Rate for Payer: Hawaii Western Management Group Commercial	$151.20
Rate for Payer: Health Management Network Commercial	$183.60
Rate for Payer: Humana Medicare	$164.16
Rate for Payer: Kaiser Permanente Commercial	$194.40
Rate for Payer: Kaiser Permanente Medicaid	$110.16
Rate for Payer: Kaiser Permanente Medicare	$164.16
Rate for Payer: MDX Hawaii PPO	$209.52
Rate for Payer: Ohana Health Plan Medicaid	$164.16
Rate for Payer: Ohana Health Plan Medicare	$164.16
Rate for Payer: UnitedHealthcare Medicare	$164.16
Rate for Payer: University Health Alliance Commercial	$120.96

SCREW 4.5MM CORTEX 85MM

Facility

$216.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$120.96
Max. Negotiated Rate	$209.52
Rate for Payer: Cash Price	$129.60
Rate for Payer: Hawaii Western Management Group Commercial	$151.20
Rate for Payer: Health Management Network Commercial	$183.60
Rate for Payer: Kaiser Permanente Commercial	$194.40
Rate for Payer: MDX Hawaii PPO	$209.52
Rate for Payer: University Health Alliance Commercial	$120.96

SCREW 5.0 LCK SELF TAP 661134

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$403.00
Max. Negotiated Rate	$781.82
Rate for Payer: AlohaCare Medicaid	$403.00
Rate for Payer: AlohaCare Medicare	$612.56
Rate for Payer: Cash Price	$483.60
Rate for Payer: Devoted Health Medicare	$677.04
Rate for Payer: Hawaii Medical Service Association Medicare	$612.56
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Humana Medicare	$612.56
Rate for Payer: Kaiser Permanente Commercial	$725.40
Rate for Payer: Kaiser Permanente Medicaid	$411.06
Rate for Payer: Kaiser Permanente Medicare	$612.56
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: Ohana Health Plan Medicaid	$612.56
Rate for Payer: Ohana Health Plan Medicare	$612.56
Rate for Payer: UnitedHealthcare Medicare	$612.56
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0 LCK SELF TAP 661134

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$451.36
Max. Negotiated Rate	$781.82
Rate for Payer: Cash Price	$483.60
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Kaiser Permanente Commercial	$725.40
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0 LCK SP 30MM 661130

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$403.00
Max. Negotiated Rate	$781.82
Rate for Payer: AlohaCare Medicaid	$403.00
Rate for Payer: AlohaCare Medicare	$612.56
Rate for Payer: Cash Price	$483.60
Rate for Payer: Devoted Health Medicare	$677.04
Rate for Payer: Hawaii Medical Service Association Medicare	$612.56
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Humana Medicare	$612.56
Rate for Payer: Kaiser Permanente Commercial	$725.40
Rate for Payer: Kaiser Permanente Medicaid	$411.06
Rate for Payer: Kaiser Permanente Medicare	$612.56
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: Ohana Health Plan Medicaid	$612.56
Rate for Payer: Ohana Health Plan Medicare	$612.56
Rate for Payer: UnitedHealthcare Medicare	$612.56
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0 LCK SP 30MM 661130

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$451.36
Max. Negotiated Rate	$781.82
Rate for Payer: Cash Price	$483.60
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Kaiser Permanente Commercial	$725.40
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0 LCK S/T 24MM 661124

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$451.36
Max. Negotiated Rate	$781.82
Rate for Payer: Cash Price	$483.60
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Kaiser Permanente Commercial	$725.40
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0 LCK S/T 24MM 661124

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$403.00
Max. Negotiated Rate	$781.82
Rate for Payer: AlohaCare Medicaid	$403.00
Rate for Payer: AlohaCare Medicare	$612.56
Rate for Payer: Cash Price	$483.60
Rate for Payer: Devoted Health Medicare	$677.04
Rate for Payer: Hawaii Medical Service Association Medicare	$612.56
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Humana Medicare	$612.56
Rate for Payer: Kaiser Permanente Commercial	$725.40
Rate for Payer: Kaiser Permanente Medicaid	$411.06
Rate for Payer: Kaiser Permanente Medicare	$612.56
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: Ohana Health Plan Medicaid	$612.56
Rate for Payer: Ohana Health Plan Medicare	$612.56
Rate for Payer: UnitedHealthcare Medicare	$612.56
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0 LCK S/T 46MM

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$403.00
Max. Negotiated Rate	$781.82
Rate for Payer: AlohaCare Medicaid	$403.00
Rate for Payer: AlohaCare Medicare	$612.56
Rate for Payer: Cash Price	$483.60
Rate for Payer: Devoted Health Medicare	$677.04
Rate for Payer: Hawaii Medical Service Association Medicare	$612.56
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Humana Medicare	$612.56
Rate for Payer: Kaiser Permanente Commercial	$725.40
Rate for Payer: Kaiser Permanente Medicaid	$411.06
Rate for Payer: Kaiser Permanente Medicare	$612.56
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: Ohana Health Plan Medicaid	$612.56
Rate for Payer: Ohana Health Plan Medicare	$612.56
Rate for Payer: UnitedHealthcare Medicare	$612.56
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0 LCK S/T 46MM

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$451.36
Max. Negotiated Rate	$781.82
Rate for Payer: Cash Price	$483.60
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Kaiser Permanente Commercial	$725.40
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0MM LCKNG #71645060

Facility

$4,780.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,390.00
Max. Negotiated Rate	$4,636.60
Rate for Payer: AlohaCare Medicaid	$2,390.00
Rate for Payer: AlohaCare Medicare	$3,632.80
Rate for Payer: Cash Price	$2,868.00
Rate for Payer: Devoted Health Medicare	$4,015.20
Rate for Payer: Hawaii Medical Service Association Medicare	$3,632.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,346.00
Rate for Payer: Health Management Network Commercial	$4,063.00
Rate for Payer: Humana Medicare	$3,632.80
Rate for Payer: Kaiser Permanente Commercial	$4,302.00
Rate for Payer: Kaiser Permanente Medicaid	$2,437.80
Rate for Payer: Kaiser Permanente Medicare	$3,632.80
Rate for Payer: MDX Hawaii PPO	$4,636.60
Rate for Payer: Ohana Health Plan Medicaid	$3,632.80
Rate for Payer: Ohana Health Plan Medicare	$3,632.80
Rate for Payer: UnitedHealthcare Medicare	$3,632.80
Rate for Payer: University Health Alliance Commercial	$2,676.80

SCREW 5.0MM LCKNG #71645060

Facility

$4,780.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,676.80
Max. Negotiated Rate	$4,636.60
Rate for Payer: Cash Price	$2,868.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,346.00
Rate for Payer: Health Management Network Commercial	$4,063.00
Rate for Payer: Kaiser Permanente Commercial	$4,302.00
Rate for Payer: MDX Hawaii PPO	$4,636.60
Rate for Payer: University Health Alliance Commercial	$2,676.80

SCREW 5.0MM LOCK SELF TAP 26MM

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$451.36
Max. Negotiated Rate	$781.82
Rate for Payer: Cash Price	$483.60
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Kaiser Permanente Commercial	$725.40
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0MM LOCK SELF TAP 26MM

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$403.00
Max. Negotiated Rate	$781.82
Rate for Payer: AlohaCare Medicaid	$403.00
Rate for Payer: AlohaCare Medicare	$612.56
Rate for Payer: Cash Price	$483.60
Rate for Payer: Devoted Health Medicare	$677.04
Rate for Payer: Hawaii Medical Service Association Medicare	$612.56
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Humana Medicare	$612.56
Rate for Payer: Kaiser Permanente Commercial	$725.40
Rate for Payer: Kaiser Permanente Medicaid	$411.06
Rate for Payer: Kaiser Permanente Medicare	$612.56
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: Ohana Health Plan Medicaid	$612.56
Rate for Payer: Ohana Health Plan Medicare	$612.56
Rate for Payer: UnitedHealthcare Medicare	$612.56
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0MM LOCK SELFTAP 32MM

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$403.00
Max. Negotiated Rate	$781.82
Rate for Payer: AlohaCare Medicaid	$403.00
Rate for Payer: AlohaCare Medicare	$612.56
Rate for Payer: Cash Price	$483.60
Rate for Payer: Devoted Health Medicare	$677.04
Rate for Payer: Hawaii Medical Service Association Medicare	$612.56
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Humana Medicare	$612.56
Rate for Payer: Kaiser Permanente Commercial	$725.40
Rate for Payer: Kaiser Permanente Medicaid	$411.06
Rate for Payer: Kaiser Permanente Medicare	$612.56
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: Ohana Health Plan Medicaid	$612.56
Rate for Payer: Ohana Health Plan Medicare	$612.56
Rate for Payer: UnitedHealthcare Medicare	$612.56
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0MM LOCK SELFTAP 32MM

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$451.36
Max. Negotiated Rate	$781.82
Rate for Payer: Cash Price	$483.60
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Kaiser Permanente Commercial	$725.40
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0MM LOCK SELF TAP 50MM

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$451.36
Max. Negotiated Rate	$781.82
Rate for Payer: Cash Price	$483.60
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Kaiser Permanente Commercial	$725.40
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0MM LOCK SELF TAP 50MM

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$403.00
Max. Negotiated Rate	$781.82
Rate for Payer: AlohaCare Medicaid	$403.00
Rate for Payer: AlohaCare Medicare	$612.56
Rate for Payer: Cash Price	$483.60
Rate for Payer: Devoted Health Medicare	$677.04
Rate for Payer: Hawaii Medical Service Association Medicare	$612.56
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Humana Medicare	$612.56
Rate for Payer: Kaiser Permanente Commercial	$725.40
Rate for Payer: Kaiser Permanente Medicaid	$411.06
Rate for Payer: Kaiser Permanente Medicare	$612.56
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: Ohana Health Plan Medicaid	$612.56
Rate for Payer: Ohana Health Plan Medicare	$612.56
Rate for Payer: UnitedHealthcare Medicare	$612.56
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0MM LOCK SELF TAP 55MM

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$403.00
Max. Negotiated Rate	$781.82
Rate for Payer: AlohaCare Medicaid	$403.00
Rate for Payer: AlohaCare Medicare	$612.56
Rate for Payer: Cash Price	$483.60
Rate for Payer: Devoted Health Medicare	$677.04
Rate for Payer: Hawaii Medical Service Association Medicare	$612.56
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Humana Medicare	$612.56
Rate for Payer: Kaiser Permanente Commercial	$725.40
Rate for Payer: Kaiser Permanente Medicaid	$411.06
Rate for Payer: Kaiser Permanente Medicare	$612.56
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: Ohana Health Plan Medicaid	$612.56
Rate for Payer: Ohana Health Plan Medicare	$612.56
Rate for Payer: UnitedHealthcare Medicare	$612.56
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5.0MM LOCK SELF TAP 55MM

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$451.36
Max. Negotiated Rate	$781.82
Rate for Payer: Cash Price	$483.60
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Kaiser Permanente Commercial	$725.40
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: University Health Alliance Commercial	$451.36

SCREW 5MM X 12MM

Facility

$1,317.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$658.50
Max. Negotiated Rate	$1,277.49
Rate for Payer: AlohaCare Medicaid	$658.50
Rate for Payer: AlohaCare Medicare	$1,000.92
Rate for Payer: Cash Price	$790.20
Rate for Payer: Devoted Health Medicare	$1,106.28
Rate for Payer: Hawaii Medical Service Association Medicare	$1,000.92
Rate for Payer: Hawaii Western Management Group Commercial	$921.90
Rate for Payer: Health Management Network Commercial	$1,119.45
Rate for Payer: Humana Medicare	$1,000.92
Rate for Payer: Kaiser Permanente Commercial	$1,185.30
Rate for Payer: Kaiser Permanente Medicaid	$671.67
Rate for Payer: Kaiser Permanente Medicare	$1,000.92
Rate for Payer: MDX Hawaii PPO	$1,277.49
Rate for Payer: Ohana Health Plan Medicaid	$1,000.92
Rate for Payer: Ohana Health Plan Medicare	$1,000.92
Rate for Payer: UnitedHealthcare Medicare	$1,000.92
Rate for Payer: University Health Alliance Commercial	$737.52

SCREW 5MM X 12MM

Facility

$1,317.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$737.52
Max. Negotiated Rate	$1,277.49
Rate for Payer: Cash Price	$790.20
Rate for Payer: Hawaii Western Management Group Commercial	$921.90
Rate for Payer: Health Management Network Commercial	$1,119.45
Rate for Payer: Kaiser Permanente Commercial	$1,185.30
Rate for Payer: MDX Hawaii PPO	$1,277.49
Rate for Payer: University Health Alliance Commercial	$737.52

SCREW 5MM X 14MM

Facility

$1,196.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$598.00
Max. Negotiated Rate	$1,160.12
Rate for Payer: AlohaCare Medicaid	$598.00
Rate for Payer: AlohaCare Medicare	$908.96
Rate for Payer: Cash Price	$717.60
Rate for Payer: Devoted Health Medicare	$1,004.64
Rate for Payer: Hawaii Medical Service Association Medicare	$908.96
Rate for Payer: Hawaii Western Management Group Commercial	$837.20
Rate for Payer: Health Management Network Commercial	$1,016.60
Rate for Payer: Humana Medicare	$908.96
Rate for Payer: Kaiser Permanente Commercial	$1,076.40
Rate for Payer: Kaiser Permanente Medicaid	$609.96
Rate for Payer: Kaiser Permanente Medicare	$908.96
Rate for Payer: MDX Hawaii PPO	$1,160.12
Rate for Payer: Ohana Health Plan Medicaid	$908.96
Rate for Payer: Ohana Health Plan Medicare	$908.96
Rate for Payer: UnitedHealthcare Medicare	$908.96
Rate for Payer: University Health Alliance Commercial	$669.76

SCREW 5MM X 14MM

Facility

$1,196.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$669.76
Max. Negotiated Rate	$1,160.12
Rate for Payer: Cash Price	$717.60
Rate for Payer: Hawaii Western Management Group Commercial	$837.20
Rate for Payer: Health Management Network Commercial	$1,016.60
Rate for Payer: Kaiser Permanente Commercial	$1,076.40
Rate for Payer: MDX Hawaii PPO	$1,160.12
Rate for Payer: University Health Alliance Commercial	$669.76

Know your out-of-pocket cost for care.

All Charges