Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

EMBLEM MRI S-ICD

Facility

$38,000.00

Service Code	HCPCS C1722
Hospital Revenue Code	275
Min. Negotiated Rate	$21,280.00
Max. Negotiated Rate	$36,860.00
Rate for Payer: Cash Price	$22,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$26,600.00
Rate for Payer: Health Management Network Commercial	$32,300.00
Rate for Payer: Kaiser Permanente Commercial	$34,200.00
Rate for Payer: MDX Hawaii PPO	$36,860.00
Rate for Payer: University Health Alliance Commercial	$21,280.00

EMBLEM S-ICD DELIVERY

Facility

$2,000.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,700.00
Max. Negotiated Rate	$1,940.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Health Management Network Commercial	$1,700.00
Rate for Payer: Kaiser Permanente Commercial	$1,800.00
Rate for Payer: MDX Hawaii PPO	$1,940.00

EMBLEM S-ICD DELIVERY

Facility

$2,000.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$1,940.00
Rate for Payer: AlohaCare Medicaid	$1,000.00
Rate for Payer: AlohaCare Medicare	$1,520.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Devoted Health Medicare	$1,680.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,900.00
Rate for Payer: Health Management Network Commercial	$1,700.00
Rate for Payer: Humana Medicare	$1,520.00
Rate for Payer: Kaiser Permanente Commercial	$1,800.00
Rate for Payer: Kaiser Permanente Medicaid	$1,020.00
Rate for Payer: Kaiser Permanente Medicare	$1,520.00
Rate for Payer: MDX Hawaii PPO	$1,940.00
Rate for Payer: Ohana Health Plan Medicaid	$1,520.00
Rate for Payer: Ohana Health Plan Medicare	$1,520.00
Rate for Payer: UnitedHealthcare Medicare	$1,520.00
Rate for Payer: University Health Alliance Commercial	$1,457.80

EMBLEM S-ICD ELECTRODE

Facility

$9,000.00

Service Code	HCPCS C1896
Hospital Revenue Code	278
Min. Negotiated Rate	$4,500.00
Max. Negotiated Rate	$8,730.00
Rate for Payer: AlohaCare Medicaid	$4,500.00
Rate for Payer: AlohaCare Medicare	$6,840.00
Rate for Payer: Cash Price	$5,400.00
Rate for Payer: Devoted Health Medicare	$7,560.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,840.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,300.00
Rate for Payer: Health Management Network Commercial	$7,650.00
Rate for Payer: Humana Medicare	$6,840.00
Rate for Payer: Kaiser Permanente Commercial	$8,100.00
Rate for Payer: Kaiser Permanente Medicaid	$4,590.00
Rate for Payer: Kaiser Permanente Medicare	$6,840.00
Rate for Payer: MDX Hawaii PPO	$8,730.00
Rate for Payer: Ohana Health Plan Medicaid	$6,840.00
Rate for Payer: Ohana Health Plan Medicare	$6,840.00
Rate for Payer: UnitedHealthcare Medicare	$6,840.00
Rate for Payer: University Health Alliance Commercial	$5,040.00

EMBLEM S-ICD ELECTRODE

Facility

$9,000.00

Service Code	HCPCS C1896
Hospital Revenue Code	278
Min. Negotiated Rate	$5,040.00
Max. Negotiated Rate	$8,730.00
Rate for Payer: Cash Price	$5,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,300.00
Rate for Payer: Health Management Network Commercial	$7,650.00
Rate for Payer: Kaiser Permanente Commercial	$8,100.00
Rate for Payer: MDX Hawaii PPO	$8,730.00
Rate for Payer: University Health Alliance Commercial	$5,040.00

EMBOLECTOMY CATH 2F E1801-26

Facility

$746.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$634.10
Max. Negotiated Rate	$723.62
Rate for Payer: Cash Price	$447.60
Rate for Payer: Health Management Network Commercial	$634.10
Rate for Payer: Kaiser Permanente Commercial	$671.40
Rate for Payer: MDX Hawaii PPO	$723.62

EMBOLECTOMY CATH 2F E1801-26

Facility

$746.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$373.00
Max. Negotiated Rate	$723.62
Rate for Payer: AlohaCare Medicaid	$373.00
Rate for Payer: AlohaCare Medicare	$566.96
Rate for Payer: Cash Price	$447.60
Rate for Payer: Devoted Health Medicare	$626.64
Rate for Payer: Hawaii Medical Service Association Medicare	$566.96
Rate for Payer: Hawaii Western Management Group Commercial	$708.70
Rate for Payer: Health Management Network Commercial	$634.10
Rate for Payer: Humana Medicare	$566.96
Rate for Payer: Kaiser Permanente Commercial	$671.40
Rate for Payer: Kaiser Permanente Medicaid	$380.46
Rate for Payer: Kaiser Permanente Medicare	$566.96
Rate for Payer: MDX Hawaii PPO	$723.62
Rate for Payer: Ohana Health Plan Medicaid	$566.96
Rate for Payer: Ohana Health Plan Medicare	$566.96
Rate for Payer: UnitedHealthcare Medicare	$566.96
Rate for Payer: University Health Alliance Commercial	$543.76

EMBOLECTOMY CATH 5FR E1801-58

Facility

$521.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$260.50
Max. Negotiated Rate	$505.37
Rate for Payer: AlohaCare Medicaid	$260.50
Rate for Payer: AlohaCare Medicare	$395.96
Rate for Payer: Cash Price	$312.60
Rate for Payer: Devoted Health Medicare	$437.64
Rate for Payer: Hawaii Medical Service Association Medicare	$395.96
Rate for Payer: Hawaii Western Management Group Commercial	$494.95
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Humana Medicare	$395.96
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: Kaiser Permanente Medicaid	$265.71
Rate for Payer: Kaiser Permanente Medicare	$395.96
Rate for Payer: MDX Hawaii PPO	$505.37
Rate for Payer: Ohana Health Plan Medicaid	$395.96
Rate for Payer: Ohana Health Plan Medicare	$395.96
Rate for Payer: UnitedHealthcare Medicare	$395.96
Rate for Payer: University Health Alliance Commercial	$379.76

EMBOLECTOMY CATH 5FR E1801-58

Facility

$521.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$442.85
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$312.60
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: MDX Hawaii PPO	$505.37

EMBOLECTOMY CATH 6F E1801-68

Facility

$521.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$442.85
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$312.60
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: MDX Hawaii PPO	$505.37

EMBOLECTOMY CATH 6F E1801-68

Facility

$521.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$260.50
Max. Negotiated Rate	$505.37
Rate for Payer: AlohaCare Medicaid	$260.50
Rate for Payer: AlohaCare Medicare	$395.96
Rate for Payer: Cash Price	$312.60
Rate for Payer: Devoted Health Medicare	$437.64
Rate for Payer: Hawaii Medical Service Association Medicare	$395.96
Rate for Payer: Hawaii Western Management Group Commercial	$494.95
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Humana Medicare	$395.96
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: Kaiser Permanente Medicaid	$265.71
Rate for Payer: Kaiser Permanente Medicare	$395.96
Rate for Payer: MDX Hawaii PPO	$505.37
Rate for Payer: Ohana Health Plan Medicaid	$395.96
Rate for Payer: Ohana Health Plan Medicare	$395.96
Rate for Payer: UnitedHealthcare Medicare	$395.96
Rate for Payer: University Health Alliance Commercial	$379.76

EMPAGLIFLOZIN 10 MG TABLET [126630]

Facility

$63.00

Service Code	NDC 00597015237
Hospital Revenue Code	250
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$61.11
Rate for Payer: Cash Price	$37.80
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: MDX Hawaii PPO	$61.11

EMPAGLIFLOZIN 10 MG TABLET [126630]

Facility

$63.00

Service Code	NDC 00597015237
Hospital Revenue Code	637
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$61.11
Rate for Payer: AlohaCare Medicaid	$31.50
Rate for Payer: AlohaCare Medicare	$47.88
Rate for Payer: Cash Price	$37.80
Rate for Payer: Devoted Health Medicare	$52.92
Rate for Payer: Hawaii Medical Service Association Medicare	$47.88
Rate for Payer: Hawaii Western Management Group Commercial	$59.85
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Humana Medicare	$47.88
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: Kaiser Permanente Medicaid	$32.13
Rate for Payer: Kaiser Permanente Medicare	$47.88
Rate for Payer: MDX Hawaii PPO	$61.11
Rate for Payer: Ohana Health Plan Medicaid	$47.88
Rate for Payer: Ohana Health Plan Medicare	$47.88
Rate for Payer: UnitedHealthcare Medicare	$47.88
Rate for Payer: University Health Alliance Commercial	$45.92

EMPAGLIFLOZIN 25 MG TABLET [126632]

Facility

$63.00

Service Code	NDC 00597015337
Hospital Revenue Code	250
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$61.11
Rate for Payer: Cash Price	$37.80
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: MDX Hawaii PPO	$61.11

EMPAGLIFLOZIN 25 MG TABLET [126632]

Facility

$63.00

Service Code	NDC 00597015337
Hospital Revenue Code	637
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$61.11
Rate for Payer: AlohaCare Medicaid	$31.50
Rate for Payer: AlohaCare Medicare	$47.88
Rate for Payer: Cash Price	$37.80
Rate for Payer: Devoted Health Medicare	$52.92
Rate for Payer: Hawaii Medical Service Association Medicare	$47.88
Rate for Payer: Hawaii Western Management Group Commercial	$59.85
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Humana Medicare	$47.88
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: Kaiser Permanente Medicaid	$32.13
Rate for Payer: Kaiser Permanente Medicare	$47.88
Rate for Payer: MDX Hawaii PPO	$61.11
Rate for Payer: Ohana Health Plan Medicaid	$47.88
Rate for Payer: Ohana Health Plan Medicare	$47.88
Rate for Payer: UnitedHealthcare Medicare	$47.88
Rate for Payer: University Health Alliance Commercial	$45.92

EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [39255]

Facility

$141.00

Service Code	NDC 00378193093
Hospital Revenue Code	637
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$136.77
Rate for Payer: AlohaCare Medicaid	$70.50
Rate for Payer: AlohaCare Medicare	$107.16
Rate for Payer: Cash Price	$84.60
Rate for Payer: Devoted Health Medicare	$118.44
Rate for Payer: Hawaii Medical Service Association Medicare	$107.16
Rate for Payer: Hawaii Western Management Group Commercial	$133.95
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Humana Medicare	$107.16
Rate for Payer: Kaiser Permanente Commercial	$126.90
Rate for Payer: Kaiser Permanente Medicaid	$71.91
Rate for Payer: Kaiser Permanente Medicare	$107.16
Rate for Payer: MDX Hawaii PPO	$136.77
Rate for Payer: Ohana Health Plan Medicaid	$107.16
Rate for Payer: Ohana Health Plan Medicare	$107.16
Rate for Payer: UnitedHealthcare Medicare	$107.16
Rate for Payer: University Health Alliance Commercial	$102.77

EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [39255]

Facility

$141.00

Service Code	NDC 42385095330
Hospital Revenue Code	637
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$136.77
Rate for Payer: AlohaCare Medicaid	$70.50
Rate for Payer: AlohaCare Medicare	$107.16
Rate for Payer: Cash Price	$84.60
Rate for Payer: Devoted Health Medicare	$118.44
Rate for Payer: Hawaii Medical Service Association Medicare	$107.16
Rate for Payer: Hawaii Western Management Group Commercial	$133.95
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Humana Medicare	$107.16
Rate for Payer: Kaiser Permanente Commercial	$126.90
Rate for Payer: Kaiser Permanente Medicaid	$71.91
Rate for Payer: Kaiser Permanente Medicare	$107.16
Rate for Payer: MDX Hawaii PPO	$136.77
Rate for Payer: Ohana Health Plan Medicaid	$107.16
Rate for Payer: Ohana Health Plan Medicare	$107.16
Rate for Payer: UnitedHealthcare Medicare	$107.16
Rate for Payer: University Health Alliance Commercial	$102.77

EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [39255]

Facility

$141.00

Service Code	NDC 42385095330
Hospital Revenue Code	250
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$84.60
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Kaiser Permanente Commercial	$126.90
Rate for Payer: MDX Hawaii PPO	$136.77

EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET [39255]

Facility

$141.00

Service Code	NDC 00378193093
Hospital Revenue Code	250
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$84.60
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Kaiser Permanente Commercial	$126.90
Rate for Payer: MDX Hawaii PPO	$136.77

ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]

Facility

$20.00

Service Code	NDC 00143978701
Hospital Revenue Code	250
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: MDX Hawaii PPO	$19.40

ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]

Facility

$40.00

Service Code	NDC 00143978601
Hospital Revenue Code	250
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: MDX Hawaii PPO	$38.80

ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]

Facility

$40.00

Service Code	NDC 00143978610
Hospital Revenue Code	250
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: MDX Hawaii PPO	$38.80

ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION [9929]

Facility

$20.00

Service Code	NDC 00143978710
Hospital Revenue Code	250
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: MDX Hawaii PPO	$19.40

ENALAPRIL MALEATE 10 MG TABLET [9924]

Facility

$7.00

Service Code	NDC 43547054710
Hospital Revenue Code	637
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$6.79
Rate for Payer: AlohaCare Medicaid	$3.50
Rate for Payer: AlohaCare Medicare	$5.32
Rate for Payer: Cash Price	$4.20
Rate for Payer: Devoted Health Medicare	$5.88
Rate for Payer: Hawaii Medical Service Association Medicare	$5.32
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Humana Medicare	$5.32
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: Kaiser Permanente Medicare	$5.32
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: Ohana Health Plan Medicaid	$5.32
Rate for Payer: Ohana Health Plan Medicare	$5.32
Rate for Payer: UnitedHealthcare Medicare	$5.32
Rate for Payer: University Health Alliance Commercial	$5.10

ENALAPRIL MALEATE 10 MG TABLET [9924]

Facility

$7.00

Service Code	NDC 43547054710
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$6.79

Know your out-of-pocket cost for care.

All Charges