Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

ENALAPRIL MALEATE 5 MG TABLET [9927]

Facility

$7.00

Service Code	NDC 51672403801
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 5 MG TABLET [9927]

Facility

$7.00

Service Code	NDC 43547054610
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

ENALAPRIL MALEATE 5 MG TABLET [9927]

Facility

$7.00

Service Code	NDC 43547054610
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 5 MG TABLET [9927]

Facility

$7.00

Service Code	NDC 51672403801
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

END CAP 0MM TI 04.013.000S

Facility

$894.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$447.00
Max. Negotiated Rate	$867.18
Rate for Payer: AlohaCare Medicaid	$447.00
Rate for Payer: AlohaCare Medicare	$679.44
Rate for Payer: Cash Price	$536.40
Rate for Payer: Devoted Health Medicare	$750.96
Rate for Payer: Hawaii Medical Service Association Medicare	$679.44
Rate for Payer: Hawaii Western Management Group Commercial	$625.80
Rate for Payer: Health Management Network Commercial	$759.90
Rate for Payer: Humana Medicare	$679.44
Rate for Payer: Kaiser Permanente Commercial	$804.60
Rate for Payer: Kaiser Permanente Medicaid	$455.94
Rate for Payer: Kaiser Permanente Medicare	$679.44
Rate for Payer: MDX Hawaii PPO	$867.18
Rate for Payer: Ohana Health Plan Medicaid	$679.44
Rate for Payer: Ohana Health Plan Medicare	$679.44
Rate for Payer: UnitedHealthcare Medicare	$679.44
Rate for Payer: University Health Alliance Commercial	$500.64

END CAP 0MM TI 04.013.000S

Facility

$894.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$500.64
Max. Negotiated Rate	$867.18
Rate for Payer: Cash Price	$536.40
Rate for Payer: Hawaii Western Management Group Commercial	$625.80
Rate for Payer: Health Management Network Commercial	$759.90
Rate for Payer: Kaiser Permanente Commercial	$804.60
Rate for Payer: MDX Hawaii PPO	$867.18
Rate for Payer: University Health Alliance Commercial	$500.64

END CAP 12X5MM 04.004.009S

Facility

$1,130.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$632.80
Max. Negotiated Rate	$1,096.10
Rate for Payer: Cash Price	$678.00
Rate for Payer: Hawaii Western Management Group Commercial	$791.00
Rate for Payer: Health Management Network Commercial	$960.50
Rate for Payer: Kaiser Permanente Commercial	$1,017.00
Rate for Payer: MDX Hawaii PPO	$1,096.10
Rate for Payer: University Health Alliance Commercial	$632.80

END CAP 12X5MM 04.004.009S

Facility

$1,130.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$565.00
Max. Negotiated Rate	$1,096.10
Rate for Payer: AlohaCare Medicaid	$565.00
Rate for Payer: AlohaCare Medicare	$858.80
Rate for Payer: Cash Price	$678.00
Rate for Payer: Devoted Health Medicare	$949.20
Rate for Payer: Hawaii Medical Service Association Medicare	$858.80
Rate for Payer: Hawaii Western Management Group Commercial	$791.00
Rate for Payer: Health Management Network Commercial	$960.50
Rate for Payer: Humana Medicare	$858.80
Rate for Payer: Kaiser Permanente Commercial	$1,017.00
Rate for Payer: Kaiser Permanente Medicaid	$576.30
Rate for Payer: Kaiser Permanente Medicare	$858.80
Rate for Payer: MDX Hawaii PPO	$1,096.10
Rate for Payer: Ohana Health Plan Medicaid	$858.80
Rate for Payer: Ohana Health Plan Medicare	$858.80
Rate for Payer: UnitedHealthcare Medicare	$858.80
Rate for Payer: University Health Alliance Commercial	$632.80

END CAP TI 0MM T40 04.003.000S

Facility

$925.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$462.50
Max. Negotiated Rate	$897.25
Rate for Payer: AlohaCare Medicaid	$462.50
Rate for Payer: AlohaCare Medicare	$703.00
Rate for Payer: Cash Price	$555.00
Rate for Payer: Devoted Health Medicare	$777.00
Rate for Payer: Hawaii Medical Service Association Medicare	$703.00
Rate for Payer: Hawaii Western Management Group Commercial	$647.50
Rate for Payer: Health Management Network Commercial	$786.25
Rate for Payer: Humana Medicare	$703.00
Rate for Payer: Kaiser Permanente Commercial	$832.50
Rate for Payer: Kaiser Permanente Medicaid	$471.75
Rate for Payer: Kaiser Permanente Medicare	$703.00
Rate for Payer: MDX Hawaii PPO	$897.25
Rate for Payer: Ohana Health Plan Medicaid	$703.00
Rate for Payer: Ohana Health Plan Medicare	$703.00
Rate for Payer: UnitedHealthcare Medicare	$703.00
Rate for Payer: University Health Alliance Commercial	$518.00

END CAP TI 0MM T40 04.003.000S

Facility

$925.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$518.00
Max. Negotiated Rate	$897.25
Rate for Payer: Cash Price	$555.00
Rate for Payer: Hawaii Western Management Group Commercial	$647.50
Rate for Payer: Health Management Network Commercial	$786.25
Rate for Payer: Kaiser Permanente Commercial	$832.50
Rate for Payer: MDX Hawaii PPO	$897.25
Rate for Payer: University Health Alliance Commercial	$518.00

ENDOCRINE DISORDERS WITH CC

Facility

$19,388.24

Service Code	MSDRG 644
Min. Negotiated Rate	$19,388.24
Max. Negotiated Rate	$19,388.24
Rate for Payer: Hawaii Medical Service Association Commercial	$19,388.24

ENDOCRINE DISORDERS WITH MCC

Facility

$19,388.24

Service Code	MSDRG 643
Min. Negotiated Rate	$19,388.24
Max. Negotiated Rate	$19,388.24
Rate for Payer: Hawaii Medical Service Association Commercial	$19,388.24

ENDOCRINE DISORDERS WITHOUT CC/MCC

Facility

$16,781.02

Service Code	MSDRG 645
Min. Negotiated Rate	$16,781.02
Max. Negotiated Rate	$16,781.02
Rate for Payer: Hawaii Medical Service Association Commercial	$16,781.02

ENDO GIA 30 LOADING UNIT

Facility

$676.00

Hospital Revenue Code	272
Min. Negotiated Rate	$338.00
Max. Negotiated Rate	$655.72
Rate for Payer: AlohaCare Medicaid	$338.00
Rate for Payer: AlohaCare Medicare	$513.76
Rate for Payer: Cash Price	$405.60
Rate for Payer: Devoted Health Medicare	$567.84
Rate for Payer: Hawaii Medical Service Association Medicare	$513.76
Rate for Payer: Hawaii Western Management Group Commercial	$642.20
Rate for Payer: Health Management Network Commercial	$574.60
Rate for Payer: Humana Medicare	$513.76
Rate for Payer: Kaiser Permanente Commercial	$608.40
Rate for Payer: Kaiser Permanente Medicaid	$344.76
Rate for Payer: Kaiser Permanente Medicare	$513.76
Rate for Payer: MDX Hawaii PPO	$655.72
Rate for Payer: Ohana Health Plan Medicaid	$513.76
Rate for Payer: Ohana Health Plan Medicare	$513.76
Rate for Payer: UnitedHealthcare Medicare	$513.76
Rate for Payer: University Health Alliance Commercial	$492.74

ENDO GIA 30 LOADING UNIT

Facility

$676.00

Hospital Revenue Code	272
Min. Negotiated Rate	$574.60
Max. Negotiated Rate	$655.72
Rate for Payer: Cash Price	$405.60
Rate for Payer: Health Management Network Commercial	$574.60
Rate for Payer: Kaiser Permanente Commercial	$608.40
Rate for Payer: MDX Hawaii PPO	$655.72

ENDO GIA 45M CURVD SIG45CTAVM

Facility

$726.00

Hospital Revenue Code	272
Min. Negotiated Rate	$617.10
Max. Negotiated Rate	$704.22
Rate for Payer: Cash Price	$435.60
Rate for Payer: Health Management Network Commercial	$617.10
Rate for Payer: Kaiser Permanente Commercial	$653.40
Rate for Payer: MDX Hawaii PPO	$704.22

ENDO GIA 45M CURVD SIG45CTAVM

Facility

$726.00

Hospital Revenue Code	272
Min. Negotiated Rate	$363.00
Max. Negotiated Rate	$704.22
Rate for Payer: AlohaCare Medicaid	$363.00
Rate for Payer: AlohaCare Medicare	$551.76
Rate for Payer: Cash Price	$435.60
Rate for Payer: Devoted Health Medicare	$609.84
Rate for Payer: Hawaii Medical Service Association Medicare	$551.76
Rate for Payer: Hawaii Western Management Group Commercial	$689.70
Rate for Payer: Health Management Network Commercial	$617.10
Rate for Payer: Humana Medicare	$551.76
Rate for Payer: Kaiser Permanente Commercial	$653.40
Rate for Payer: Kaiser Permanente Medicaid	$370.26
Rate for Payer: Kaiser Permanente Medicare	$551.76
Rate for Payer: MDX Hawaii PPO	$704.22
Rate for Payer: Ohana Health Plan Medicaid	$551.76
Rate for Payer: Ohana Health Plan Medicare	$551.76
Rate for Payer: UnitedHealthcare Medicare	$551.76
Rate for Payer: University Health Alliance Commercial	$529.18

ENDO GIA ROTICULATOR 45-2.0

Facility

$776.00

Hospital Revenue Code	272
Min. Negotiated Rate	$659.60
Max. Negotiated Rate	$752.72
Rate for Payer: Cash Price	$465.60
Rate for Payer: Health Management Network Commercial	$659.60
Rate for Payer: Kaiser Permanente Commercial	$698.40
Rate for Payer: MDX Hawaii PPO	$752.72

ENDO GIA ROTICULATOR 45-2.0

Facility

$776.00

Hospital Revenue Code	272
Min. Negotiated Rate	$388.00
Max. Negotiated Rate	$752.72
Rate for Payer: AlohaCare Medicaid	$388.00
Rate for Payer: AlohaCare Medicare	$589.76
Rate for Payer: Cash Price	$465.60
Rate for Payer: Devoted Health Medicare	$651.84
Rate for Payer: Hawaii Medical Service Association Medicare	$589.76
Rate for Payer: Hawaii Western Management Group Commercial	$737.20
Rate for Payer: Health Management Network Commercial	$659.60
Rate for Payer: Humana Medicare	$589.76
Rate for Payer: Kaiser Permanente Commercial	$698.40
Rate for Payer: Kaiser Permanente Medicaid	$395.76
Rate for Payer: Kaiser Permanente Medicare	$589.76
Rate for Payer: MDX Hawaii PPO	$752.72
Rate for Payer: Ohana Health Plan Medicaid	$589.76
Rate for Payer: Ohana Health Plan Medicare	$589.76
Rate for Payer: UnitedHealthcare Medicare	$589.76
Rate for Payer: University Health Alliance Commercial	$565.63

ENDOPATH BLUNT DISSECTOR

Facility

$257.00

Hospital Revenue Code	272
Min. Negotiated Rate	$128.50
Max. Negotiated Rate	$249.29
Rate for Payer: AlohaCare Medicaid	$128.50
Rate for Payer: AlohaCare Medicare	$195.32
Rate for Payer: Cash Price	$154.20
Rate for Payer: Devoted Health Medicare	$215.88
Rate for Payer: Hawaii Medical Service Association Medicare	$195.32
Rate for Payer: Hawaii Western Management Group Commercial	$244.15
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Humana Medicare	$195.32
Rate for Payer: Kaiser Permanente Commercial	$231.30
Rate for Payer: Kaiser Permanente Medicaid	$131.07
Rate for Payer: Kaiser Permanente Medicare	$195.32
Rate for Payer: MDX Hawaii PPO	$249.29
Rate for Payer: Ohana Health Plan Medicaid	$195.32
Rate for Payer: Ohana Health Plan Medicare	$195.32
Rate for Payer: UnitedHealthcare Medicare	$195.32
Rate for Payer: University Health Alliance Commercial	$187.33

ENDOPATH BLUNT DISSECTOR

Facility

$257.00

Hospital Revenue Code	272
Min. Negotiated Rate	$218.45
Max. Negotiated Rate	$249.29
Rate for Payer: Cash Price	$154.20
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Kaiser Permanente Commercial	$231.30
Rate for Payer: MDX Hawaii PPO	$249.29

ENDOPROSTHESIS 7FR VBJR081502A

Facility

$8,980.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$5,028.80
Max. Negotiated Rate	$8,710.60
Rate for Payer: Cash Price	$5,388.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,286.00
Rate for Payer: Health Management Network Commercial	$7,633.00
Rate for Payer: Kaiser Permanente Commercial	$8,082.00
Rate for Payer: MDX Hawaii PPO	$8,710.60
Rate for Payer: University Health Alliance Commercial	$5,028.80

ENDOPROSTHESIS 7FR VBJR081502A

Facility

$8,980.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,490.00
Max. Negotiated Rate	$8,710.60
Rate for Payer: AlohaCare Medicaid	$4,490.00
Rate for Payer: AlohaCare Medicare	$6,824.80
Rate for Payer: Cash Price	$5,388.00
Rate for Payer: Devoted Health Medicare	$7,543.20
Rate for Payer: Hawaii Medical Service Association Medicare	$6,824.80
Rate for Payer: Hawaii Western Management Group Commercial	$6,286.00
Rate for Payer: Health Management Network Commercial	$7,633.00
Rate for Payer: Humana Medicare	$6,824.80
Rate for Payer: Kaiser Permanente Commercial	$8,082.00
Rate for Payer: Kaiser Permanente Medicaid	$4,579.80
Rate for Payer: Kaiser Permanente Medicare	$6,824.80
Rate for Payer: MDX Hawaii PPO	$8,710.60
Rate for Payer: Ohana Health Plan Medicaid	$6,824.80
Rate for Payer: Ohana Health Plan Medicare	$6,824.80
Rate for Payer: UnitedHealthcare Medicare	$6,824.80
Rate for Payer: University Health Alliance Commercial	$5,028.80

ENDOPROSTHESIS VBHR091002A

Facility

$7,138.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,569.00
Max. Negotiated Rate	$6,923.86
Rate for Payer: AlohaCare Medicaid	$3,569.00
Rate for Payer: AlohaCare Medicare	$5,424.88
Rate for Payer: Cash Price	$4,282.80
Rate for Payer: Devoted Health Medicare	$5,995.92
Rate for Payer: Hawaii Medical Service Association Medicare	$5,424.88
Rate for Payer: Hawaii Western Management Group Commercial	$4,996.60
Rate for Payer: Health Management Network Commercial	$6,067.30
Rate for Payer: Humana Medicare	$5,424.88
Rate for Payer: Kaiser Permanente Commercial	$6,424.20
Rate for Payer: Kaiser Permanente Medicaid	$3,640.38
Rate for Payer: Kaiser Permanente Medicare	$5,424.88
Rate for Payer: MDX Hawaii PPO	$6,923.86
Rate for Payer: Ohana Health Plan Medicaid	$5,424.88
Rate for Payer: Ohana Health Plan Medicare	$5,424.88
Rate for Payer: UnitedHealthcare Medicare	$5,424.88
Rate for Payer: University Health Alliance Commercial	$3,997.28

ENDOPROSTHESIS VBHR091002A

Facility

$7,138.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,997.28
Max. Negotiated Rate	$6,923.86
Rate for Payer: Cash Price	$4,282.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,996.60
Rate for Payer: Health Management Network Commercial	$6,067.30
Rate for Payer: Kaiser Permanente Commercial	$6,424.20
Rate for Payer: MDX Hawaii PPO	$6,923.86
Rate for Payer: University Health Alliance Commercial	$3,997.28

Know your out-of-pocket cost for care.

All Charges