Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

SCREW 6.5X16MM 2030-6516-1

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 6.5X16MM 2030-6516-1

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 BNE STND 2.7X65MM 657165

Facility

$417.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$233.52
Max. Negotiated Rate	$404.49
Rate for Payer: Cash Price	$250.20
Rate for Payer: Hawaii Western Management Group Commercial	$291.90
Rate for Payer: Health Management Network Commercial	$354.45
Rate for Payer: Kaiser Permanente Commercial	$375.30
Rate for Payer: MDX Hawaii PPO	$404.49
Rate for Payer: University Health Alliance Commercial	$233.52

SCREW BNE STND 2.7X65MM 657165

Facility

$417.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$208.50
Max. Negotiated Rate	$404.49
Rate for Payer: AlohaCare Medicaid	$208.50
Rate for Payer: AlohaCare Medicare	$316.92
Rate for Payer: Cash Price	$250.20
Rate for Payer: Devoted Health Medicare	$350.28
Rate for Payer: Hawaii Medical Service Association Medicare	$316.92
Rate for Payer: Hawaii Western Management Group Commercial	$291.90
Rate for Payer: Health Management Network Commercial	$354.45
Rate for Payer: Humana Medicare	$316.92
Rate for Payer: Kaiser Permanente Commercial	$375.30
Rate for Payer: Kaiser Permanente Medicaid	$212.67
Rate for Payer: Kaiser Permanente Medicare	$316.92
Rate for Payer: MDX Hawaii PPO	$404.49
Rate for Payer: Ohana Health Plan Medicaid	$316.92
Rate for Payer: Ohana Health Plan Medicare	$316.92
Rate for Payer: UnitedHealthcare Medicare	$316.92
Rate for Payer: University Health Alliance Commercial	$233.52

SCREW CANN 4.0X50 AR-8840CL-50

Facility

$664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$332.00
Max. Negotiated Rate	$644.08
Rate for Payer: AlohaCare Medicaid	$332.00
Rate for Payer: AlohaCare Medicare	$504.64
Rate for Payer: Cash Price	$398.40
Rate for Payer: Devoted Health Medicare	$557.76
Rate for Payer: Hawaii Medical Service Association Medicare	$504.64
Rate for Payer: Hawaii Western Management Group Commercial	$464.80
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: Humana Medicare	$504.64
Rate for Payer: Kaiser Permanente Commercial	$597.60
Rate for Payer: Kaiser Permanente Medicaid	$338.64
Rate for Payer: Kaiser Permanente Medicare	$504.64
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: Ohana Health Plan Medicaid	$504.64
Rate for Payer: Ohana Health Plan Medicare	$504.64
Rate for Payer: UnitedHealthcare Medicare	$504.64
Rate for Payer: University Health Alliance Commercial	$371.84

SCREW CANN 4.0X50 AR-8840CL-50

Facility

$664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$371.84
Max. Negotiated Rate	$644.08
Rate for Payer: Cash Price	$398.40
Rate for Payer: Hawaii Western Management Group Commercial	$464.80
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: Kaiser Permanente Commercial	$597.60
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: University Health Alliance Commercial	$371.84

SCREW CANN 6.5X75MM 208.410

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 CANN 6.5X75MM 208.410

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 CANNULATED 4MM 34MM

Facility

$664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$371.84
Max. Negotiated Rate	$644.08
Rate for Payer: Cash Price	$398.40
Rate for Payer: Hawaii Western Management Group Commercial	$464.80
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: Kaiser Permanente Commercial	$597.60
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: University Health Alliance Commercial	$371.84

SCREW CANNULATED 4MM 34MM

Facility

$664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$332.00
Max. Negotiated Rate	$644.08
Rate for Payer: AlohaCare Medicaid	$332.00
Rate for Payer: AlohaCare Medicare	$504.64
Rate for Payer: Cash Price	$398.40
Rate for Payer: Devoted Health Medicare	$557.76
Rate for Payer: Hawaii Medical Service Association Medicare	$504.64
Rate for Payer: Hawaii Western Management Group Commercial	$464.80
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: Humana Medicare	$504.64
Rate for Payer: Kaiser Permanente Commercial	$597.60
Rate for Payer: Kaiser Permanente Medicaid	$338.64
Rate for Payer: Kaiser Permanente Medicare	$504.64
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: Ohana Health Plan Medicaid	$504.64
Rate for Payer: Ohana Health Plan Medicare	$504.64
Rate for Payer: UnitedHealthcare Medicare	$504.64
Rate for Payer: University Health Alliance Commercial	$371.84

SCREW CANNULATED 4MM 42MM

Facility

$664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$332.00
Max. Negotiated Rate	$644.08
Rate for Payer: AlohaCare Medicaid	$332.00
Rate for Payer: AlohaCare Medicare	$504.64
Rate for Payer: Cash Price	$398.40
Rate for Payer: Devoted Health Medicare	$557.76
Rate for Payer: Hawaii Medical Service Association Medicare	$504.64
Rate for Payer: Hawaii Western Management Group Commercial	$464.80
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: Humana Medicare	$504.64
Rate for Payer: Kaiser Permanente Commercial	$597.60
Rate for Payer: Kaiser Permanente Medicaid	$338.64
Rate for Payer: Kaiser Permanente Medicare	$504.64
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: Ohana Health Plan Medicaid	$504.64
Rate for Payer: Ohana Health Plan Medicare	$504.64
Rate for Payer: UnitedHealthcare Medicare	$504.64
Rate for Payer: University Health Alliance Commercial	$371.84

SCREW CANNULATED 4MM 42MM

Facility

$664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$371.84
Max. Negotiated Rate	$644.08
Rate for Payer: Cash Price	$398.40
Rate for Payer: Hawaii Western Management Group Commercial	$464.80
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: Kaiser Permanente Commercial	$597.60
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: University Health Alliance Commercial	$371.84

SCREW CANNULATED 4MM 44MM

Facility

$664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$371.84
Max. Negotiated Rate	$644.08
Rate for Payer: Cash Price	$398.40
Rate for Payer: Hawaii Western Management Group Commercial	$464.80
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: Kaiser Permanente Commercial	$597.60
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: University Health Alliance Commercial	$371.84

SCREW CANNULATED 4MM 44MM

Facility

$664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$332.00
Max. Negotiated Rate	$644.08
Rate for Payer: AlohaCare Medicaid	$332.00
Rate for Payer: AlohaCare Medicare	$504.64
Rate for Payer: Cash Price	$398.40
Rate for Payer: Devoted Health Medicare	$557.76
Rate for Payer: Hawaii Medical Service Association Medicare	$504.64
Rate for Payer: Hawaii Western Management Group Commercial	$464.80
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: Humana Medicare	$504.64
Rate for Payer: Kaiser Permanente Commercial	$597.60
Rate for Payer: Kaiser Permanente Medicaid	$338.64
Rate for Payer: Kaiser Permanente Medicare	$504.64
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: Ohana Health Plan Medicaid	$504.64
Rate for Payer: Ohana Health Plan Medicare	$504.64
Rate for Payer: UnitedHealthcare Medicare	$504.64
Rate for Payer: University Health Alliance Commercial	$371.84

SCREW CANNULATED 4MM 46MM

Facility

$664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$332.00
Max. Negotiated Rate	$644.08
Rate for Payer: AlohaCare Medicaid	$332.00
Rate for Payer: AlohaCare Medicare	$504.64
Rate for Payer: Cash Price	$398.40
Rate for Payer: Devoted Health Medicare	$557.76
Rate for Payer: Hawaii Medical Service Association Medicare	$504.64
Rate for Payer: Hawaii Western Management Group Commercial	$464.80
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: Humana Medicare	$504.64
Rate for Payer: Kaiser Permanente Commercial	$597.60
Rate for Payer: Kaiser Permanente Medicaid	$338.64
Rate for Payer: Kaiser Permanente Medicare	$504.64
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: Ohana Health Plan Medicaid	$504.64
Rate for Payer: Ohana Health Plan Medicare	$504.64
Rate for Payer: UnitedHealthcare Medicare	$504.64
Rate for Payer: University Health Alliance Commercial	$371.84

SCREW CANNULATED 4MM 46MM

Facility

$664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$371.84
Max. Negotiated Rate	$644.08
Rate for Payer: Cash Price	$398.40
Rate for Payer: Hawaii Western Management Group Commercial	$464.80
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: Kaiser Permanente Commercial	$597.60
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: University Health Alliance Commercial	$371.84

SCREW CANNULATED 4MM 48MM

Facility

$664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$332.00
Max. Negotiated Rate	$644.08
Rate for Payer: AlohaCare Medicaid	$332.00
Rate for Payer: AlohaCare Medicare	$504.64
Rate for Payer: Cash Price	$398.40
Rate for Payer: Devoted Health Medicare	$557.76
Rate for Payer: Hawaii Medical Service Association Medicare	$504.64
Rate for Payer: Hawaii Western Management Group Commercial	$464.80
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: Humana Medicare	$504.64
Rate for Payer: Kaiser Permanente Commercial	$597.60
Rate for Payer: Kaiser Permanente Medicaid	$338.64
Rate for Payer: Kaiser Permanente Medicare	$504.64
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: Ohana Health Plan Medicaid	$504.64
Rate for Payer: Ohana Health Plan Medicare	$504.64
Rate for Payer: UnitedHealthcare Medicare	$504.64
Rate for Payer: University Health Alliance Commercial	$371.84

SCREW CANNULATED 4MM 48MM

Facility

$664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$371.84
Max. Negotiated Rate	$644.08
Rate for Payer: Cash Price	$398.40
Rate for Payer: Hawaii Western Management Group Commercial	$464.80
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: Kaiser Permanente Commercial	$597.60
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: University Health Alliance Commercial	$371.84

SCREW CENTRAL 6.5 X 40

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 CENTRAL 6.5 X 40

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 CORT 4.5 60MM 661760

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 CORT 4.5 60MM 661760

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 DRILL 2.7MM #405889

Facility

$581.00

Hospital Revenue Code	272
Min. Negotiated Rate	$493.85
Max. Negotiated Rate	$563.57
Rate for Payer: Cash Price	$348.60
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: Kaiser Permanente Commercial	$522.90
Rate for Payer: MDX Hawaii PPO	$563.57

SCREW DRILL 2.7MM #405889

Facility

$581.00

Hospital Revenue Code	272
Min. Negotiated Rate	$290.50
Max. Negotiated Rate	$563.57
Rate for Payer: AlohaCare Medicaid	$290.50
Rate for Payer: AlohaCare Medicare	$441.56
Rate for Payer: Cash Price	$348.60
Rate for Payer: Devoted Health Medicare	$488.04
Rate for Payer: Hawaii Medical Service Association Medicare	$441.56
Rate for Payer: Hawaii Western Management Group Commercial	$551.95
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: Humana Medicare	$441.56
Rate for Payer: Kaiser Permanente Commercial	$522.90
Rate for Payer: Kaiser Permanente Medicaid	$296.31
Rate for Payer: Kaiser Permanente Medicare	$441.56
Rate for Payer: MDX Hawaii PPO	$563.57
Rate for Payer: Ohana Health Plan Medicaid	$441.56
Rate for Payer: Ohana Health Plan Medicare	$441.56
Rate for Payer: UnitedHealthcare Medicare	$441.56
Rate for Payer: University Health Alliance Commercial	$423.49

SCREWDRIVER 2.0/2.4MM 316-0102

Facility

$722.00

Hospital Revenue Code	272
Min. Negotiated Rate	$613.70
Max. Negotiated Rate	$700.34
Rate for Payer: Cash Price	$433.20
Rate for Payer: Health Management Network Commercial	$613.70
Rate for Payer: Kaiser Permanente Commercial	$649.80
Rate for Payer: MDX Hawaii PPO	$700.34

Know your out-of-pocket cost for care.

All Charges