Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

SCREW NON-LCK 2.7X24MM 657124

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 NON-LCK 3.5 657430

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 3.5 657430

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 PART THREAD 46MM 604646

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 PART THREAD 46MM 604646

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 PERIPHERAL 5.0 DWJ338

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 PERIPHERAL 5.0 DWJ338

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 SURGICAL BONE 311.63

Facility

$1,661.00

Hospital Revenue Code	272
Min. Negotiated Rate	$830.50
Max. Negotiated Rate	$1,611.17
Rate for Payer: AlohaCare Medicaid	$830.50
Rate for Payer: AlohaCare Medicare	$1,262.36
Rate for Payer: Cash Price	$996.60
Rate for Payer: Devoted Health Medicare	$1,395.24
Rate for Payer: Hawaii Medical Service Association Medicare	$1,262.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,577.95
Rate for Payer: Health Management Network Commercial	$1,411.85
Rate for Payer: Humana Medicare	$1,262.36
Rate for Payer: Kaiser Permanente Commercial	$1,494.90
Rate for Payer: Kaiser Permanente Medicaid	$847.11
Rate for Payer: Kaiser Permanente Medicare	$1,262.36
Rate for Payer: MDX Hawaii PPO	$1,611.17
Rate for Payer: Ohana Health Plan Medicaid	$1,262.36
Rate for Payer: Ohana Health Plan Medicare	$1,262.36
Rate for Payer: UnitedHealthcare Medicare	$1,262.36
Rate for Payer: University Health Alliance Commercial	$1,210.70

SCREW SURGICAL BONE 311.63

Facility

$1,661.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,411.85
Max. Negotiated Rate	$1,611.17
Rate for Payer: Cash Price	$996.60
Rate for Payer: Health Management Network Commercial	$1,411.85
Rate for Payer: Kaiser Permanente Commercial	$1,494.90
Rate for Payer: MDX Hawaii PPO	$1,611.17

SCRFIT MX HIP SYST #6052-0625S

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,236.80
Max. Negotiated Rate	$5,606.60
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Kaiser Permanente Commercial	$5,202.00
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: University Health Alliance Commercial	$3,236.80

SCRFIT MX HIP SYST #6052-0625S

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$5,606.60
Rate for Payer: AlohaCare Medicaid	$2,890.00
Rate for Payer: AlohaCare Medicare	$4,392.80
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Devoted Health Medicare	$4,855.20
Rate for Payer: Hawaii Medical Service Association Medicare	$4,392.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Humana Medicare	$4,392.80
Rate for Payer: Kaiser Permanente Commercial	$5,202.00
Rate for Payer: Kaiser Permanente Medicaid	$2,947.80
Rate for Payer: Kaiser Permanente Medicare	$4,392.80
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: Ohana Health Plan Medicaid	$4,392.80
Rate for Payer: Ohana Health Plan Medicare	$4,392.80
Rate for Payer: UnitedHealthcare Medicare	$4,392.80
Rate for Payer: University Health Alliance Commercial	$3,236.80

SCRW METAP 2.7X28MM 02.118.528

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

SCRW METAP 2.7X28MM 02.118.528

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

SEALANT XT HYDRO OPAQUE 726

Facility

$103.00

Hospital Revenue Code	272
Min. Negotiated Rate	$87.55
Max. Negotiated Rate	$99.91
Rate for Payer: Cash Price	$61.80
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Kaiser Permanente Commercial	$92.70
Rate for Payer: MDX Hawaii PPO	$99.91

SEALANT XT HYDRO OPAQUE 726

Facility

$103.00

Hospital Revenue Code	272
Min. Negotiated Rate	$51.50
Max. Negotiated Rate	$99.91
Rate for Payer: AlohaCare Medicaid	$51.50
Rate for Payer: AlohaCare Medicare	$78.28
Rate for Payer: Cash Price	$61.80
Rate for Payer: Devoted Health Medicare	$86.52
Rate for Payer: Hawaii Medical Service Association Medicare	$78.28
Rate for Payer: Hawaii Western Management Group Commercial	$97.85
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Humana Medicare	$78.28
Rate for Payer: Kaiser Permanente Commercial	$92.70
Rate for Payer: Kaiser Permanente Medicaid	$52.53
Rate for Payer: Kaiser Permanente Medicare	$78.28
Rate for Payer: MDX Hawaii PPO	$99.91
Rate for Payer: Ohana Health Plan Medicaid	$78.28
Rate for Payer: Ohana Health Plan Medicare	$78.28
Rate for Payer: UnitedHealthcare Medicare	$78.28
Rate for Payer: University Health Alliance Commercial	$75.08

SEAL DRIVE SHAFT RIA 351.718S

Facility

$136.00

Hospital Revenue Code	272
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$131.92
Rate for Payer: AlohaCare Medicaid	$68.00
Rate for Payer: AlohaCare Medicare	$103.36
Rate for Payer: Cash Price	$81.60
Rate for Payer: Devoted Health Medicare	$114.24
Rate for Payer: Hawaii Medical Service Association Medicare	$103.36
Rate for Payer: Hawaii Western Management Group Commercial	$129.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Humana Medicare	$103.36
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: Kaiser Permanente Medicaid	$69.36
Rate for Payer: Kaiser Permanente Medicare	$103.36
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: Ohana Health Plan Medicaid	$103.36
Rate for Payer: Ohana Health Plan Medicare	$103.36
Rate for Payer: UnitedHealthcare Medicare	$103.36
Rate for Payer: University Health Alliance Commercial	$99.13

SEAL DRIVE SHAFT RIA 351.718S

Facility

$136.00

Hospital Revenue Code	272
Min. Negotiated Rate	$115.60
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$81.60
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: MDX Hawaii PPO	$131.92

SEALER/DIVIDER MARYLAN LXMJ37S

Facility

$1,634.00

Hospital Revenue Code	272
Min. Negotiated Rate	$817.00
Max. Negotiated Rate	$1,584.98
Rate for Payer: AlohaCare Medicaid	$817.00
Rate for Payer: AlohaCare Medicare	$1,241.84
Rate for Payer: Cash Price	$980.40
Rate for Payer: Devoted Health Medicare	$1,372.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,241.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,552.30
Rate for Payer: Health Management Network Commercial	$1,388.90
Rate for Payer: Humana Medicare	$1,241.84
Rate for Payer: Kaiser Permanente Commercial	$1,470.60
Rate for Payer: Kaiser Permanente Medicaid	$833.34
Rate for Payer: Kaiser Permanente Medicare	$1,241.84
Rate for Payer: MDX Hawaii PPO	$1,584.98
Rate for Payer: Ohana Health Plan Medicaid	$1,241.84
Rate for Payer: Ohana Health Plan Medicare	$1,241.84
Rate for Payer: UnitedHealthcare Medicare	$1,241.84
Rate for Payer: University Health Alliance Commercial	$1,191.02

SEALER/DIVIDER MARYLAN LXMJ37S

Facility

$1,634.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,388.90
Max. Negotiated Rate	$1,584.98
Rate for Payer: Cash Price	$980.40
Rate for Payer: Health Management Network Commercial	$1,388.90
Rate for Payer: Kaiser Permanente Commercial	$1,470.60
Rate for Payer: MDX Hawaii PPO	$1,584.98

SEAL SUCTION VALVE

Facility

$78.00

Hospital Revenue Code	272
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$75.66
Rate for Payer: AlohaCare Medicaid	$39.00
Rate for Payer: AlohaCare Medicare	$59.28
Rate for Payer: Cash Price	$46.80
Rate for Payer: Devoted Health Medicare	$65.52
Rate for Payer: Hawaii Medical Service Association Medicare	$59.28
Rate for Payer: Hawaii Western Management Group Commercial	$74.10
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Humana Medicare	$59.28
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: Kaiser Permanente Medicare	$59.28
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: Ohana Health Plan Medicaid	$59.28
Rate for Payer: Ohana Health Plan Medicare	$59.28
Rate for Payer: UnitedHealthcare Medicare	$59.28
Rate for Payer: University Health Alliance Commercial	$56.85

SEAL SUCTION VALVE

Facility

$78.00

Hospital Revenue Code	272
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: MDX Hawaii PPO	$75.66

SEAL UNIVERSAL 5-12MM 470500

Facility

$114.00

Hospital Revenue Code	272
Min. Negotiated Rate	$57.00
Max. Negotiated Rate	$110.58
Rate for Payer: AlohaCare Medicaid	$57.00
Rate for Payer: AlohaCare Medicare	$86.64
Rate for Payer: Cash Price	$68.40
Rate for Payer: Devoted Health Medicare	$95.76
Rate for Payer: Hawaii Medical Service Association Medicare	$86.64
Rate for Payer: Hawaii Western Management Group Commercial	$108.30
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Humana Medicare	$86.64
Rate for Payer: Kaiser Permanente Commercial	$102.60
Rate for Payer: Kaiser Permanente Medicaid	$58.14
Rate for Payer: Kaiser Permanente Medicare	$86.64
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: Ohana Health Plan Medicaid	$86.64
Rate for Payer: Ohana Health Plan Medicare	$86.64
Rate for Payer: UnitedHealthcare Medicare	$86.64
Rate for Payer: University Health Alliance Commercial	$83.09

SEAL UNIVERSAL 5-12MM 470500

Facility

$114.00

Hospital Revenue Code	272
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$68.40
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Kaiser Permanente Commercial	$102.60
Rate for Payer: MDX Hawaii PPO	$110.58

SEAL Y ADJUSTABLE BIOPSY PORT

Facility

$125.00

Service Code	HCPCS A4649
Hospital Revenue Code	272
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$75.00
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: MDX Hawaii PPO	$121.25

SEAL Y ADJUSTABLE BIOPSY PORT

Facility

$125.00

Service Code	HCPCS A4649
Hospital Revenue Code	272
Min. Negotiated Rate	$62.50
Max. Negotiated Rate	$121.25
Rate for Payer: AlohaCare Medicaid	$62.50
Rate for Payer: AlohaCare Medicare	$95.00
Rate for Payer: Cash Price	$75.00
Rate for Payer: Devoted Health Medicare	$105.00
Rate for Payer: Hawaii Medical Service Association Medicare	$95.00
Rate for Payer: Hawaii Western Management Group Commercial	$118.75
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Humana Medicare	$95.00
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: Kaiser Permanente Medicare	$95.00
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: Ohana Health Plan Medicaid	$95.00
Rate for Payer: Ohana Health Plan Medicare	$95.00
Rate for Payer: UnitedHealthcare Medicare	$95.00
Rate for Payer: University Health Alliance Commercial	$91.11

Know your out-of-pocket cost for care.

All Charges