Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC

Facility

$103,008.89

Service Code	MSDRG 277
Min. Negotiated Rate	$103,008.89
Max. Negotiated Rate	$103,008.89
Rate for Payer: Hawaii Medical Service Association Commercial	$103,008.89

CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC

Facility

$23,085.75

Service Code	MSDRG 258
Min. Negotiated Rate	$23,085.75
Max. Negotiated Rate	$23,085.75
Rate for Payer: Hawaii Medical Service Association Commercial	$23,085.75

CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC

Facility

$23,085.75

Service Code	MSDRG 259
Min. Negotiated Rate	$23,085.75
Max. Negotiated Rate	$23,085.75
Rate for Payer: Hawaii Medical Service Association Commercial	$23,085.75

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC

Facility

$31,168.13

Service Code	MSDRG 261
Min. Negotiated Rate	$31,168.13
Max. Negotiated Rate	$31,168.13
Rate for Payer: Hawaii Medical Service Association Commercial	$31,168.13

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC

Facility

$31,168.13

Service Code	MSDRG 260
Min. Negotiated Rate	$31,168.13
Max. Negotiated Rate	$31,168.13
Rate for Payer: Hawaii Medical Service Association Commercial	$31,168.13

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC

Facility

$31,168.13

Service Code	MSDRG 262
Min. Negotiated Rate	$31,168.13
Max. Negotiated Rate	$31,168.13
Rate for Payer: Hawaii Medical Service Association Commercial	$31,168.13

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC

Facility

$193,360.92

Service Code	MSDRG 217
Min. Negotiated Rate	$193,360.92
Max. Negotiated Rate	$193,360.92
Rate for Payer: Hawaii Medical Service Association Commercial	$193,360.92

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$193,360.92

Service Code	MSDRG 216
Min. Negotiated Rate	$193,360.92
Max. Negotiated Rate	$193,360.92
Rate for Payer: Hawaii Medical Service Association Commercial	$193,360.92

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$193,360.92

Service Code	MSDRG 218
Min. Negotiated Rate	$193,360.92
Max. Negotiated Rate	$193,360.92
Rate for Payer: Hawaii Medical Service Association Commercial	$193,360.92

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC

Facility

$125,762.81

Service Code	MSDRG 220
Min. Negotiated Rate	$125,762.81
Max. Negotiated Rate	$125,762.81
Rate for Payer: Hawaii Medical Service Association Commercial	$125,762.81

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$125,762.81

Service Code	MSDRG 219
Min. Negotiated Rate	$125,762.81
Max. Negotiated Rate	$125,762.81
Rate for Payer: Hawaii Medical Service Association Commercial	$125,762.81

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$125,762.81

Service Code	MSDRG 221
Min. Negotiated Rate	$125,762.81
Max. Negotiated Rate	$125,762.81
Rate for Payer: Hawaii Medical Service Association Commercial	$125,762.81

CARFILZOMIB 10 MG INTRAVENOUS SOLUTION [162615]

Facility

$1,062.00

Service Code	HCPCS J9047
Hospital Revenue Code	250
Min. Negotiated Rate	$902.70
Max. Negotiated Rate	$1,030.14
Rate for Payer: Cash Price	$637.20
Rate for Payer: Health Management Network Commercial	$902.70
Rate for Payer: Kaiser Permanente Commercial	$955.80
Rate for Payer: MDX Hawaii PPO	$1,030.14

CARFILZOMIB 10 MG INTRAVENOUS SOLUTION [162615]

Facility

$1,062.00

Service Code	HCPCS J9047
Hospital Revenue Code	636
Min. Negotiated Rate	$55.09
Max. Negotiated Rate	$1,030.14
Rate for Payer: AlohaCare Medicaid	$531.00
Rate for Payer: AlohaCare Medicare	$807.12
Rate for Payer: Cash Price	$637.20
Rate for Payer: Cash Price	$637.20
Rate for Payer: Devoted Health Medicare	$892.08
Rate for Payer: Hawaii Medical Service Association ABD	$55.09
Rate for Payer: Hawaii Medical Service Association Commercial	$70.30
Rate for Payer: Hawaii Medical Service Association Medicare	$807.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$55.09
Rate for Payer: Hawaii Western Management Group Commercial	$1,008.90
Rate for Payer: Health Management Network Commercial	$902.70
Rate for Payer: Humana Medicare	$807.12
Rate for Payer: Kaiser Permanente Commercial	$955.80
Rate for Payer: Kaiser Permanente Medicaid	$541.62
Rate for Payer: Kaiser Permanente Medicare	$807.12
Rate for Payer: MDX Hawaii PPO	$1,030.14
Rate for Payer: Ohana Health Plan Medicaid	$807.12
Rate for Payer: Ohana Health Plan Medicare	$807.12
Rate for Payer: UnitedHealthcare Medicaid	$637.20
Rate for Payer: UnitedHealthcare Medicare	$807.12
Rate for Payer: University Health Alliance Commercial	$774.09

CARFILZOMIB 30 MG INTRAVENOUS SOLUTION [132744]

Facility

$2,623.00

Service Code	HCPCS J9047
Hospital Revenue Code	250
Min. Negotiated Rate	$2,229.55
Max. Negotiated Rate	$2,544.31
Rate for Payer: Cash Price	$1,573.80
Rate for Payer: Health Management Network Commercial	$2,229.55
Rate for Payer: Kaiser Permanente Commercial	$2,360.70
Rate for Payer: MDX Hawaii PPO	$2,544.31

CARFILZOMIB 30 MG INTRAVENOUS SOLUTION [132744]

Facility

$2,623.00

Service Code	HCPCS J9047
Hospital Revenue Code	636
Min. Negotiated Rate	$55.09
Max. Negotiated Rate	$2,544.31
Rate for Payer: AlohaCare Medicaid	$1,311.50
Rate for Payer: AlohaCare Medicare	$1,993.48
Rate for Payer: Cash Price	$1,573.80
Rate for Payer: Cash Price	$1,573.80
Rate for Payer: Devoted Health Medicare	$2,203.32
Rate for Payer: Hawaii Medical Service Association ABD	$55.09
Rate for Payer: Hawaii Medical Service Association Commercial	$70.30
Rate for Payer: Hawaii Medical Service Association Medicare	$1,993.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$55.09
Rate for Payer: Hawaii Western Management Group Commercial	$2,491.85
Rate for Payer: Health Management Network Commercial	$2,229.55
Rate for Payer: Humana Medicare	$1,993.48
Rate for Payer: Kaiser Permanente Commercial	$2,360.70
Rate for Payer: Kaiser Permanente Medicaid	$1,337.73
Rate for Payer: Kaiser Permanente Medicare	$1,993.48
Rate for Payer: MDX Hawaii PPO	$2,544.31
Rate for Payer: Ohana Health Plan Medicaid	$1,993.48
Rate for Payer: Ohana Health Plan Medicare	$1,993.48
Rate for Payer: UnitedHealthcare Medicaid	$1,573.80
Rate for Payer: UnitedHealthcare Medicare	$1,993.48
Rate for Payer: University Health Alliance Commercial	$1,911.90

CARFILZOMIB 60 MG/30ML IV (WET SOLR VIAL) [430117047]

Facility

$4,745.00

Service Code	HCPCS J9047
Hospital Revenue Code	250
Min. Negotiated Rate	$4,033.25
Max. Negotiated Rate	$4,602.65
Rate for Payer: Cash Price	$2,847.00
Rate for Payer: Health Management Network Commercial	$4,033.25
Rate for Payer: Kaiser Permanente Commercial	$4,270.50
Rate for Payer: MDX Hawaii PPO	$4,602.65

CARFILZOMIB 60 MG/30ML IV (WET SOLR VIAL) [430117047]

Facility

$4,745.00

Service Code	HCPCS J9047
Hospital Revenue Code	636
Min. Negotiated Rate	$55.09
Max. Negotiated Rate	$4,602.65
Rate for Payer: AlohaCare Medicaid	$2,372.50
Rate for Payer: AlohaCare Medicare	$3,606.20
Rate for Payer: Cash Price	$2,847.00
Rate for Payer: Cash Price	$2,847.00
Rate for Payer: Devoted Health Medicare	$3,985.80
Rate for Payer: Hawaii Medical Service Association ABD	$55.09
Rate for Payer: Hawaii Medical Service Association Commercial	$70.30
Rate for Payer: Hawaii Medical Service Association Medicare	$3,606.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$55.09
Rate for Payer: Hawaii Western Management Group Commercial	$4,507.75
Rate for Payer: Health Management Network Commercial	$4,033.25
Rate for Payer: Humana Medicare	$3,606.20
Rate for Payer: Kaiser Permanente Commercial	$4,270.50
Rate for Payer: Kaiser Permanente Medicaid	$2,419.95
Rate for Payer: Kaiser Permanente Medicare	$3,606.20
Rate for Payer: MDX Hawaii PPO	$4,602.65
Rate for Payer: Ohana Health Plan Medicaid	$3,606.20
Rate for Payer: Ohana Health Plan Medicare	$3,606.20
Rate for Payer: UnitedHealthcare Medicaid	$2,847.00
Rate for Payer: UnitedHealthcare Medicare	$3,606.20
Rate for Payer: University Health Alliance Commercial	$3,458.63

CARFILZOMIB 60 MG INTRAVENOUS SOLUTION [117047]

Facility

$2,071.00

Service Code	HCPCS J9047
Hospital Revenue Code	636
Min. Negotiated Rate	$55.09
Max. Negotiated Rate	$2,008.87
Rate for Payer: AlohaCare Medicaid	$1,035.50
Rate for Payer: AlohaCare Medicaid	$2,372.50
Rate for Payer: AlohaCare Medicare	$3,606.20
Rate for Payer: AlohaCare Medicare	$1,573.96
Rate for Payer: Cash Price	$2,847.00
Rate for Payer: Cash Price	$1,242.60
Rate for Payer: Cash Price	$2,847.00
Rate for Payer: Cash Price	$1,242.60
Rate for Payer: Devoted Health Medicare	$1,739.64
Rate for Payer: Devoted Health Medicare	$3,985.80
Rate for Payer: Hawaii Medical Service Association ABD	$55.09
Rate for Payer: Hawaii Medical Service Association ABD	$55.09
Rate for Payer: Hawaii Medical Service Association Commercial	$70.30
Rate for Payer: Hawaii Medical Service Association Commercial	$70.30
Rate for Payer: Hawaii Medical Service Association Medicare	$3,606.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,573.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$55.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$55.09
Rate for Payer: Hawaii Western Management Group Commercial	$1,967.45
Rate for Payer: Hawaii Western Management Group Commercial	$4,507.75
Rate for Payer: Health Management Network Commercial	$4,033.25
Rate for Payer: Health Management Network Commercial	$1,760.35
Rate for Payer: Humana Medicare	$1,573.96
Rate for Payer: Humana Medicare	$3,606.20
Rate for Payer: Kaiser Permanente Commercial	$1,863.90
Rate for Payer: Kaiser Permanente Commercial	$4,270.50
Rate for Payer: Kaiser Permanente Medicaid	$2,419.95
Rate for Payer: Kaiser Permanente Medicaid	$1,056.21
Rate for Payer: Kaiser Permanente Medicare	$1,573.96
Rate for Payer: Kaiser Permanente Medicare	$3,606.20
Rate for Payer: MDX Hawaii PPO	$2,008.87
Rate for Payer: MDX Hawaii PPO	$4,602.65
Rate for Payer: Ohana Health Plan Medicaid	$3,606.20
Rate for Payer: Ohana Health Plan Medicaid	$1,573.96
Rate for Payer: Ohana Health Plan Medicare	$1,573.96
Rate for Payer: Ohana Health Plan Medicare	$3,606.20
Rate for Payer: UnitedHealthcare Medicaid	$2,847.00
Rate for Payer: UnitedHealthcare Medicaid	$1,242.60
Rate for Payer: UnitedHealthcare Medicare	$1,573.96
Rate for Payer: UnitedHealthcare Medicare	$3,606.20
Rate for Payer: University Health Alliance Commercial	$1,509.55
Rate for Payer: University Health Alliance Commercial	$3,458.63

CARFILZOMIB 60 MG INTRAVENOUS SOLUTION [117047]

Facility

$2,071.00

Service Code	HCPCS J9047
Hospital Revenue Code	250
Min. Negotiated Rate	$1,760.35
Max. Negotiated Rate	$2,008.87
Rate for Payer: Cash Price	$1,242.60
Rate for Payer: Cash Price	$2,847.00
Rate for Payer: Health Management Network Commercial	$1,760.35
Rate for Payer: Health Management Network Commercial	$4,033.25
Rate for Payer: Kaiser Permanente Commercial	$1,863.90
Rate for Payer: Kaiser Permanente Commercial	$4,270.50
Rate for Payer: MDX Hawaii PPO	$4,602.65
Rate for Payer: MDX Hawaii PPO	$2,008.87

CARIPRAZINE 1.5 MG CAPSULE [131293]

Facility

$122.00

Service Code	NDC 61874011530
Hospital Revenue Code	250
Min. Negotiated Rate	$103.70
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$73.20
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: MDX Hawaii PPO	$118.34

CARIPRAZINE 1.5 MG CAPSULE [131293]

Facility

$122.00

Service Code	NDC 61874011530
Hospital Revenue Code	637
Min. Negotiated Rate	$61.00
Max. Negotiated Rate	$118.34
Rate for Payer: AlohaCare Medicaid	$61.00
Rate for Payer: AlohaCare Medicare	$92.72
Rate for Payer: Cash Price	$73.20
Rate for Payer: Devoted Health Medicare	$102.48
Rate for Payer: Hawaii Medical Service Association Medicare	$92.72
Rate for Payer: Hawaii Western Management Group Commercial	$115.90
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Humana Medicare	$92.72
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Medicaid	$62.22
Rate for Payer: Kaiser Permanente Medicare	$92.72
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: Ohana Health Plan Medicaid	$92.72
Rate for Payer: Ohana Health Plan Medicare	$92.72
Rate for Payer: UnitedHealthcare Medicare	$92.72
Rate for Payer: University Health Alliance Commercial	$88.93

CARIPRAZINE 1.5 MG CAPSULE [131293]

Facility

$122.00

Service Code	NDC 61874011520
Hospital Revenue Code	637
Min. Negotiated Rate	$61.00
Max. Negotiated Rate	$118.34
Rate for Payer: AlohaCare Medicaid	$61.00
Rate for Payer: AlohaCare Medicare	$92.72
Rate for Payer: Cash Price	$73.20
Rate for Payer: Devoted Health Medicare	$102.48
Rate for Payer: Hawaii Medical Service Association Medicare	$92.72
Rate for Payer: Hawaii Western Management Group Commercial	$115.90
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Humana Medicare	$92.72
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Medicaid	$62.22
Rate for Payer: Kaiser Permanente Medicare	$92.72
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: Ohana Health Plan Medicaid	$92.72
Rate for Payer: Ohana Health Plan Medicare	$92.72
Rate for Payer: UnitedHealthcare Medicare	$92.72
Rate for Payer: University Health Alliance Commercial	$88.93

CARIPRAZINE 1.5 MG CAPSULE [131293]

Facility

$122.00

Service Code	NDC 61874011520
Hospital Revenue Code	250
Min. Negotiated Rate	$103.70
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$73.20
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: MDX Hawaii PPO	$118.34

CARIPRAZINE 3 MG CAPSULE [131294]

Facility

$122.00

Service Code	NDC 61874013011
Hospital Revenue Code	637
Min. Negotiated Rate	$61.00
Max. Negotiated Rate	$118.34
Rate for Payer: AlohaCare Medicaid	$61.00
Rate for Payer: AlohaCare Medicare	$92.72
Rate for Payer: Cash Price	$73.20
Rate for Payer: Devoted Health Medicare	$102.48
Rate for Payer: Hawaii Medical Service Association Medicare	$92.72
Rate for Payer: Hawaii Western Management Group Commercial	$115.90
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Humana Medicare	$92.72
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Medicaid	$62.22
Rate for Payer: Kaiser Permanente Medicare	$92.72
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: Ohana Health Plan Medicaid	$92.72
Rate for Payer: Ohana Health Plan Medicare	$92.72
Rate for Payer: UnitedHealthcare Medicare	$92.72
Rate for Payer: University Health Alliance Commercial	$88.93

Know your out-of-pocket cost for care.

All Charges