Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

NALOXONE 1 MG/ML INJECTION SYRINGE [134075]

Facility

OP

$99.00

Service Code	HCPCS J2312
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$96.03
Rate for Payer: AlohaCare Medicaid	$49.50
Rate for Payer: AlohaCare Medicare	$75.24
Rate for Payer: Cash Price	$59.40
Rate for Payer: Cash Price	$59.40
Rate for Payer: Devoted Health Medicare	$83.16
Rate for Payer: Hawaii Medical Service Association ABD	$0.07
Rate for Payer: Hawaii Medical Service Association Medicare	$75.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.07
Rate for Payer: Hawaii Western Management Group Commercial	$94.05
Rate for Payer: Health Management Network Commercial	$84.15
Rate for Payer: Humana Medicare	$75.24
Rate for Payer: Kaiser Permanente Commercial	$89.10
Rate for Payer: Kaiser Permanente Medicaid	$50.49
Rate for Payer: Kaiser Permanente Medicare	$75.24
Rate for Payer: MDX Hawaii PPO	$96.03
Rate for Payer: Ohana Health Plan Medicaid	$75.24
Rate for Payer: Ohana Health Plan Medicare	$75.24
Rate for Payer: UnitedHealthcare Medicaid	$59.40
Rate for Payer: UnitedHealthcare Medicare	$75.24
Rate for Payer: University Health Alliance Commercial	$72.16

NALOXONE 4 MG/ACTUATION NASAL SPRAY [131429]

Facility

IP

$120.00

Service Code	NDC 45802057884
Hospital Revenue Code	250
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Kaiser Permanente Commercial	$108.00
Rate for Payer: MDX Hawaii PPO	$116.40

NALOXONE 4 MG/ACTUATION NASAL SPRAY [131429]

Facility

IP

$68.00

Service Code	NDC 69547062702
Hospital Revenue Code	250
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$40.80
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Kaiser Permanente Commercial	$61.20
Rate for Payer: MDX Hawaii PPO	$65.96

NALTREXONE 50 MG TABLET [10685]

Facility

IP

$20.00

Service Code	NDC 00406117003
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

NALTREXONE 50 MG TABLET [10685]

Facility

IP

$8.00

Service Code	NDC 00904703604
Hospital Revenue Code	250
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: MDX Hawaii PPO	$7.76

NALTREXONE 50 MG TABLET [10685]

Facility

IP

$15.00

Service Code	NDC 47335032683
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

NALTREXONE 50 MG TABLET [10685]

Facility

OP

$20.00

Service Code	NDC 00406117003
Hospital Revenue Code	637
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$19.40
Rate for Payer: AlohaCare Medicaid	$10.00
Rate for Payer: AlohaCare Medicare	$15.20
Rate for Payer: Cash Price	$12.00
Rate for Payer: Devoted Health Medicare	$16.80
Rate for Payer: Hawaii Medical Service Association Medicare	$15.20
Rate for Payer: Hawaii Western Management Group Commercial	$19.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Humana Medicare	$15.20
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: Kaiser Permanente Medicaid	$10.20
Rate for Payer: Kaiser Permanente Medicare	$15.20
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: Ohana Health Plan Medicaid	$15.20
Rate for Payer: Ohana Health Plan Medicare	$15.20
Rate for Payer: UnitedHealthcare Medicare	$15.20
Rate for Payer: University Health Alliance Commercial	$14.58

NALTREXONE 50 MG TABLET [10685]

Facility

OP

$8.00

Service Code	NDC 00904703604
Hospital Revenue Code	637
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.76
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$6.08
Rate for Payer: Cash Price	$4.80
Rate for Payer: Devoted Health Medicare	$6.72
Rate for Payer: Hawaii Medical Service Association Medicare	$6.08
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Humana Medicare	$6.08
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicare	$6.08
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: Ohana Health Plan Medicaid	$6.08
Rate for Payer: Ohana Health Plan Medicare	$6.08
Rate for Payer: UnitedHealthcare Medicare	$6.08
Rate for Payer: University Health Alliance Commercial	$5.83

NALTREXONE 50 MG TABLET [10685]

Facility

OP

$15.00

Service Code	NDC 47335032683
Hospital Revenue Code	637
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$11.40
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$12.60
Rate for Payer: Hawaii Medical Service Association Medicare	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$11.40
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$11.40
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$11.40
Rate for Payer: Ohana Health Plan Medicare	$11.40
Rate for Payer: UnitedHealthcare Medicare	$11.40
Rate for Payer: University Health Alliance Commercial	$10.93

NALTREXONE 50 MG TABLET [10685]

Facility

IP

$16.00

Service Code	NDC 68084029111
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

NALTREXONE 50 MG TABLET [10685]

Facility

OP

$16.00

Service Code	NDC 68084029111
Hospital Revenue Code	637
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$15.52
Rate for Payer: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$12.16
Rate for Payer: Cash Price	$9.60
Rate for Payer: Devoted Health Medicare	$13.44
Rate for Payer: Hawaii Medical Service Association Medicare	$12.16
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Humana Medicare	$12.16
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicare	$12.16
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: Ohana Health Plan Medicaid	$12.16
Rate for Payer: Ohana Health Plan Medicare	$12.16
Rate for Payer: UnitedHealthcare Medicare	$12.16
Rate for Payer: University Health Alliance Commercial	$11.66

NAPROXEN 250 MG TABLET [5391]

Facility

OP

$3.00

Service Code	NDC 50268059415
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

NAPROXEN 250 MG TABLET [5391]

Facility

OP

$3.00

Service Code	NDC 70010013701
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

NAPROXEN 250 MG TABLET [5391]

Facility

IP

$3.00

Service Code	NDC 50268059415
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

NAPROXEN 250 MG TABLET [5391]

Facility

IP

$3.00

Service Code	NDC 70010013701
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

NAPROXEN 375 MG TABLET [5392]

Facility

IP

$4.00

Service Code	NDC 68462018901
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

NAPROXEN 375 MG TABLET [5392]

Facility

IP

$4.00

Service Code	NDC 50268059515
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

NAPROXEN 375 MG TABLET [5392]

Facility

OP

$4.00

Service Code	NDC 50268059515
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$3.04
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3.04
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$3.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$3.04
Rate for Payer: Ohana Health Plan Medicare	$3.04
Rate for Payer: UnitedHealthcare Medicare	$3.04
Rate for Payer: University Health Alliance Commercial	$2.92

NAPROXEN 375 MG TABLET [5392]

Facility

OP

$4.00

Service Code	NDC 68462018901
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$3.04
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3.04
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$3.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$3.04
Rate for Payer: Ohana Health Plan Medicare	$3.04
Rate for Payer: UnitedHealthcare Medicare	$3.04
Rate for Payer: University Health Alliance Commercial	$2.92

NASAL PACKING W/STRING 440411

Facility

IP

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: MDX Hawaii PPO	$201.76

NASAL PACKING W/STRING 440411

Facility

OP

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$104.00
Max. Negotiated Rate	$201.76
Rate for Payer: AlohaCare Medicaid	$104.00
Rate for Payer: AlohaCare Medicare	$158.08
Rate for Payer: Cash Price	$124.80
Rate for Payer: Devoted Health Medicare	$174.72
Rate for Payer: Hawaii Medical Service Association Medicare	$158.08
Rate for Payer: Hawaii Western Management Group Commercial	$197.60
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Humana Medicare	$158.08
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: Kaiser Permanente Medicaid	$106.08
Rate for Payer: Kaiser Permanente Medicare	$158.08
Rate for Payer: MDX Hawaii PPO	$201.76
Rate for Payer: Ohana Health Plan Medicaid	$158.08
Rate for Payer: Ohana Health Plan Medicare	$158.08
Rate for Payer: UnitedHealthcare Medicare	$158.08
Rate for Payer: University Health Alliance Commercial	$151.61

NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION [40120]

Facility

IP

$15,983.00

Service Code	HCPCS J2323
Hospital Revenue Code	250
Min. Negotiated Rate	$13,585.55
Max. Negotiated Rate	$15,503.51
Rate for Payer: Cash Price	$9,589.80
Rate for Payer: Health Management Network Commercial	$13,585.55
Rate for Payer: Kaiser Permanente Commercial	$14,384.70
Rate for Payer: MDX Hawaii PPO	$15,503.51

NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION [40120]

Facility

OP

$15,983.00

Service Code	HCPCS J2323
Hospital Revenue Code	636
Min. Negotiated Rate	$24.13
Max. Negotiated Rate	$15,503.51
Rate for Payer: AlohaCare Medicaid	$7,991.50
Rate for Payer: AlohaCare Medicare	$12,147.08
Rate for Payer: Cash Price	$9,589.80
Rate for Payer: Cash Price	$9,589.80
Rate for Payer: Devoted Health Medicare	$13,425.72
Rate for Payer: Hawaii Medical Service Association ABD	$24.13
Rate for Payer: Hawaii Medical Service Association Commercial	$30.40
Rate for Payer: Hawaii Medical Service Association Medicare	$12,147.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.13
Rate for Payer: Hawaii Western Management Group Commercial	$15,183.85
Rate for Payer: Health Management Network Commercial	$13,585.55
Rate for Payer: Humana Medicare	$12,147.08
Rate for Payer: Kaiser Permanente Commercial	$14,384.70
Rate for Payer: Kaiser Permanente Medicaid	$8,151.33
Rate for Payer: Kaiser Permanente Medicare	$12,147.08
Rate for Payer: MDX Hawaii PPO	$15,503.51
Rate for Payer: Ohana Health Plan Medicaid	$12,147.08
Rate for Payer: Ohana Health Plan Medicare	$12,147.08
Rate for Payer: UnitedHealthcare Medicaid	$9,589.80
Rate for Payer: UnitedHealthcare Medicare	$12,147.08
Rate for Payer: University Health Alliance Commercial	$11,650.01

NATRELLE BREAST IMPLAN SCX-800

Facility

IP

$2,190.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,226.40
Max. Negotiated Rate	$2,124.30
Rate for Payer: Cash Price	$1,314.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,533.00
Rate for Payer: Health Management Network Commercial	$1,861.50
Rate for Payer: Kaiser Permanente Commercial	$1,971.00
Rate for Payer: MDX Hawaii PPO	$2,124.30
Rate for Payer: University Health Alliance Commercial	$1,226.40

NATRELLE BREAST IMPLAN SCX-800

Facility

OP

$2,190.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,095.00
Max. Negotiated Rate	$2,124.30
Rate for Payer: AlohaCare Medicaid	$1,095.00
Rate for Payer: AlohaCare Medicare	$1,664.40
Rate for Payer: Cash Price	$1,314.00
Rate for Payer: Devoted Health Medicare	$1,839.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,664.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,533.00
Rate for Payer: Health Management Network Commercial	$1,861.50
Rate for Payer: Humana Medicare	$1,664.40
Rate for Payer: Kaiser Permanente Commercial	$1,971.00
Rate for Payer: Kaiser Permanente Medicaid	$1,116.90
Rate for Payer: Kaiser Permanente Medicare	$1,664.40
Rate for Payer: MDX Hawaii PPO	$2,124.30
Rate for Payer: Ohana Health Plan Medicaid	$1,664.40
Rate for Payer: Ohana Health Plan Medicare	$1,664.40
Rate for Payer: UnitedHealthcare Medicare	$1,664.40
Rate for Payer: University Health Alliance Commercial	$1,226.40

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