Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

SCREW LOCK 2.7X36MM 02.211.036

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 LOCK 2.7X36MM 02.211.036

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 LOCKING 2.7MM 10MM

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 LOCKING 2.7MM 10MM

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 LOCKING 3.5 X10MM

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

SCREW LOCKING 3.5 X10MM

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 LO-PRO PT THD TI 4.5X50

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 LO-PRO PT THD TI 4.5X50

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 LP 2.7X14 131227214

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 LP 2.7X14 131227214

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 LP 2.7X16 131227216

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 LP 2.7X16 131227216

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 MATRX 2X12 04.503.412.01

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 MATRX 2X12 04.503.412.01

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 NL 3.5X28MM 657428

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 NL 3.5X28MM 657428

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 NLCK 2.7X26MM 131227226

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 NLCK 2.7X26MM 131227226

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 NON-LCK 16MM 663816

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 NON-LCK 16MM 663816

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 NON-LCK 24MM 656424

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 NON-LCK 24MM 656424

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 NON-LCK 2.7X10 131227210

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 NON-LCK 2.7X10 131227210

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 NON-LCK 2.7X24MM 657124

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

Know your out-of-pocket cost for care.

All Charges