Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

NEONATE WITH OTHER SIGNIFICANT PROBLEMS

Facility

IP

$25,459.28

Service Code	MSDRG 794
Min. Negotiated Rate	$4,125.22
Max. Negotiated Rate	$25,459.28
Rate for Payer: AlohaCare Medicare	$16,787.26
Rate for Payer: Devoted Health Medicare	$18,465.99
Rate for Payer: Hawaii Medical Service Association Commercial	$4,125.22
Rate for Payer: Hawaii Medical Service Association Medicare	$16,787.26
Rate for Payer: Humana Medicare	$16,787.26
Rate for Payer: Kaiser Permanente Commercial	$25,459.28
Rate for Payer: Kaiser Permanente Medicare	$16,787.26
Rate for Payer: Ohana Health Plan Medicare	$16,787.26
Rate for Payer: UnitedHealthcare Medicare	$16,787.26

NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [122267]

Facility

IP

$38.00

Service Code	NDC 00641614910
Hospital Revenue Code	250
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: MDX Hawaii PPO	$36.86

NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [122267]

Facility

IP

$7.00

Service Code	NDC 00641626501
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: MDX Hawaii PPO	$6.79

NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [122267]

Facility

IP

$10.00

Service Code	NDC 00641626510
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.00
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: MDX Hawaii PPO	$9.70

NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [122267]

Facility

IP

$78.00

Service Code	NDC 51754122003
Hospital Revenue Code	250
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: MDX Hawaii PPO	$75.66

NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [122267]

Facility

IP

$38.00

Service Code	NDC 00641614901
Hospital Revenue Code	250
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: MDX Hawaii PPO	$36.86

NEPHRITIS & NEPHROSIS

Facility

IP

$6,304.91

Service Code	APR-DRG 4623
Min. Negotiated Rate	$6,304.91
Max. Negotiated Rate	$6,304.91
Rate for Payer: AlohaCare Medicaid	$6,304.91
Rate for Payer: Hawaii Medical Service Association ABD	$6,304.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,304.91
Rate for Payer: Kaiser Permanente Medicaid	$6,304.91
Rate for Payer: Ohana Health Plan Medicaid	$6,304.91
Rate for Payer: UnitedHealthcare Medicaid	$6,304.91

NEPHRITIS & NEPHROSIS

Facility

IP

$18,117.65

Service Code	APR-DRG 4624
Min. Negotiated Rate	$18,117.65
Max. Negotiated Rate	$18,117.65
Rate for Payer: AlohaCare Medicaid	$18,117.65
Rate for Payer: Hawaii Medical Service Association ABD	$18,117.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,117.65
Rate for Payer: Kaiser Permanente Medicaid	$18,117.65
Rate for Payer: Ohana Health Plan Medicaid	$18,117.65
Rate for Payer: UnitedHealthcare Medicaid	$18,117.65

NEPHRITIS & NEPHROSIS

Facility

IP

$2,406.25

Service Code	APR-DRG 4621
Min. Negotiated Rate	$2,406.25
Max. Negotiated Rate	$2,406.25
Rate for Payer: AlohaCare Medicaid	$2,406.25
Rate for Payer: Hawaii Medical Service Association ABD	$2,406.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,406.25
Rate for Payer: Kaiser Permanente Medicaid	$2,406.25
Rate for Payer: Ohana Health Plan Medicaid	$2,406.25
Rate for Payer: UnitedHealthcare Medicaid	$2,406.25

NEPHRITIS & NEPHROSIS

Facility

IP

$3,297.91

Service Code	APR-DRG 4622
Min. Negotiated Rate	$3,297.91
Max. Negotiated Rate	$3,297.91
Rate for Payer: AlohaCare Medicaid	$3,297.91
Rate for Payer: Hawaii Medical Service Association ABD	$3,297.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,297.91
Rate for Payer: Kaiser Permanente Medicaid	$3,297.91
Rate for Payer: Ohana Health Plan Medicaid	$3,297.91
Rate for Payer: UnitedHealthcare Medicaid	$3,297.91

NERVEANA FACIAL

Facility

IP

$563.00

Hospital Revenue Code	272
Min. Negotiated Rate	$478.55
Max. Negotiated Rate	$546.11
Rate for Payer: Cash Price	$337.80
Rate for Payer: Health Management Network Commercial	$478.55
Rate for Payer: MDX Hawaii PPO	$546.11

NERVEANA FACIAL

Facility

OP

$563.00

Hospital Revenue Code	272
Min. Negotiated Rate	$287.13
Max. Negotiated Rate	$546.11
Rate for Payer: Cash Price	$337.80
Rate for Payer: Hawaii Western Management Group Commercial	$534.85
Rate for Payer: Health Management Network Commercial	$478.55
Rate for Payer: Kaiser Permanente Commercial	$354.69
Rate for Payer: Kaiser Permanente Medicaid	$287.13
Rate for Payer: MDX Hawaii PPO	$546.11
Rate for Payer: University Health Alliance Commercial	$410.37

NERVE CONNECTOR 1.5X15 AGX115

Facility

OP

$3,850.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$1,963.50
Max. Negotiated Rate	$3,734.50
Rate for Payer: Cash Price	$2,310.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,695.00
Rate for Payer: Health Management Network Commercial	$3,272.50
Rate for Payer: Kaiser Permanente Commercial	$2,425.50
Rate for Payer: Kaiser Permanente Medicaid	$1,963.50
Rate for Payer: MDX Hawaii PPO	$3,734.50
Rate for Payer: University Health Alliance Commercial	$2,156.00

NERVE CONNECTOR 1.5X15 AGX115

Facility

IP

$3,850.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,156.00
Max. Negotiated Rate	$3,734.50
Rate for Payer: Cash Price	$2,310.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,695.00
Rate for Payer: Health Management Network Commercial	$3,272.50
Rate for Payer: MDX Hawaii PPO	$3,734.50
Rate for Payer: University Health Alliance Commercial	$2,156.00

NERVE CONNECTOR 2X20 AG0220

Facility

OP

$4,406.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,247.06
Max. Negotiated Rate	$4,273.82
Rate for Payer: Cash Price	$2,643.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,084.20
Rate for Payer: Health Management Network Commercial	$3,745.10
Rate for Payer: Kaiser Permanente Commercial	$2,775.78
Rate for Payer: Kaiser Permanente Medicaid	$2,247.06
Rate for Payer: MDX Hawaii PPO	$4,273.82
Rate for Payer: University Health Alliance Commercial	$2,467.36

NERVE CONNECTOR 2X20 AG0220

Facility

IP

$4,406.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,467.36
Max. Negotiated Rate	$4,273.82
Rate for Payer: Cash Price	$2,643.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,084.20
Rate for Payer: Health Management Network Commercial	$3,745.10
Rate for Payer: MDX Hawaii PPO	$4,273.82
Rate for Payer: University Health Alliance Commercial	$2,467.36

NERVE CONNECTOR 3X15 AGX315

Facility

IP

$3,850.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,156.00
Max. Negotiated Rate	$3,734.50
Rate for Payer: Cash Price	$2,310.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,695.00
Rate for Payer: Health Management Network Commercial	$3,272.50
Rate for Payer: MDX Hawaii PPO	$3,734.50
Rate for Payer: University Health Alliance Commercial	$2,156.00

NERVE CONNECTOR 3X15 AGX315

Facility

OP

$3,850.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$1,963.50
Max. Negotiated Rate	$3,734.50
Rate for Payer: Cash Price	$2,310.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,695.00
Rate for Payer: Health Management Network Commercial	$3,272.50
Rate for Payer: Kaiser Permanente Commercial	$2,425.50
Rate for Payer: Kaiser Permanente Medicaid	$1,963.50
Rate for Payer: MDX Hawaii PPO	$3,734.50
Rate for Payer: University Health Alliance Commercial	$2,156.00

NERVE CONNECTOR 4X15 AGX415

Facility

IP

$3,996.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,237.76
Max. Negotiated Rate	$3,876.12
Rate for Payer: Cash Price	$2,397.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,797.20
Rate for Payer: Health Management Network Commercial	$3,396.60
Rate for Payer: MDX Hawaii PPO	$3,876.12
Rate for Payer: University Health Alliance Commercial	$2,237.76

NERVE CONNECTOR 4X15 AGX415

Facility

OP

$3,996.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,037.96
Max. Negotiated Rate	$3,876.12
Rate for Payer: Cash Price	$2,397.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,797.20
Rate for Payer: Health Management Network Commercial	$3,396.60
Rate for Payer: Kaiser Permanente Commercial	$2,517.48
Rate for Payer: Kaiser Permanente Medicaid	$2,037.96
Rate for Payer: MDX Hawaii PPO	$3,876.12
Rate for Payer: University Health Alliance Commercial	$2,237.76

NERVE CONNECTOR 5X40 AG0540

Facility

OP

$5,344.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.44
Max. Negotiated Rate	$5,183.68
Rate for Payer: Cash Price	$3,206.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,740.80
Rate for Payer: Health Management Network Commercial	$4,542.40
Rate for Payer: Kaiser Permanente Commercial	$3,366.72
Rate for Payer: Kaiser Permanente Medicaid	$2,725.44
Rate for Payer: MDX Hawaii PPO	$5,183.68
Rate for Payer: University Health Alliance Commercial	$2,992.64

NERVE CONNECTOR 5X40 AG0540

Facility

IP

$5,344.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,992.64
Max. Negotiated Rate	$5,183.68
Rate for Payer: Cash Price	$3,206.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,740.80
Rate for Payer: Health Management Network Commercial	$4,542.40
Rate for Payer: MDX Hawaii PPO	$5,183.68
Rate for Payer: University Health Alliance Commercial	$2,992.64

NERVE CONNECTOR 6X15 AGX615

Facility

IP

$3,996.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,237.76
Max. Negotiated Rate	$3,876.12
Rate for Payer: Cash Price	$2,397.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,797.20
Rate for Payer: Health Management Network Commercial	$3,396.60
Rate for Payer: MDX Hawaii PPO	$3,876.12
Rate for Payer: University Health Alliance Commercial	$2,237.76

NERVE CONNECTOR 6X15 AGX615

Facility

OP

$3,996.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,037.96
Max. Negotiated Rate	$3,876.12
Rate for Payer: Cash Price	$2,397.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,797.20
Rate for Payer: Health Management Network Commercial	$3,396.60
Rate for Payer: Kaiser Permanente Commercial	$2,517.48
Rate for Payer: Kaiser Permanente Medicaid	$2,037.96
Rate for Payer: MDX Hawaii PPO	$3,876.12
Rate for Payer: University Health Alliance Commercial	$2,237.76

NERVE GRAFT 3MM DIAM 311270

Facility

OP

$16,378.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$8,352.78
Max. Negotiated Rate	$15,886.66
Rate for Payer: Cash Price	$9,826.80
Rate for Payer: Hawaii Western Management Group Commercial	$11,464.60
Rate for Payer: Health Management Network Commercial	$13,921.30
Rate for Payer: Kaiser Permanente Commercial	$10,318.14
Rate for Payer: Kaiser Permanente Medicaid	$8,352.78
Rate for Payer: MDX Hawaii PPO	$15,886.66
Rate for Payer: University Health Alliance Commercial	$9,171.68

<<
<
622
623
624
625
626
627
628
629
630
631
>
>>