Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [122267]

Facility

$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: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$6.79

NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION [122267]

Facility

$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: Kaiser Permanente Commercial	$9.00
Rate for Payer: MDX Hawaii PPO	$9.70

NERVEANA FACIAL

Facility

$563.00

Hospital Revenue Code	272
Min. Negotiated Rate	$281.50
Max. Negotiated Rate	$546.11
Rate for Payer: AlohaCare Medicaid	$281.50
Rate for Payer: AlohaCare Medicare	$427.88
Rate for Payer: Cash Price	$337.80
Rate for Payer: Devoted Health Medicare	$472.92
Rate for Payer: Hawaii Medical Service Association Medicare	$427.88
Rate for Payer: Hawaii Western Management Group Commercial	$534.85
Rate for Payer: Health Management Network Commercial	$478.55
Rate for Payer: Humana Medicare	$427.88
Rate for Payer: Kaiser Permanente Commercial	$506.70
Rate for Payer: Kaiser Permanente Medicaid	$287.13
Rate for Payer: Kaiser Permanente Medicare	$427.88
Rate for Payer: MDX Hawaii PPO	$546.11
Rate for Payer: Ohana Health Plan Medicaid	$427.88
Rate for Payer: Ohana Health Plan Medicare	$427.88
Rate for Payer: UnitedHealthcare Medicare	$427.88
Rate for Payer: University Health Alliance Commercial	$410.37

NERVEANA FACIAL

Facility

$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: Kaiser Permanente Commercial	$506.70
Rate for Payer: MDX Hawaii PPO	$546.11

NERVE CONNECTOR 1.5X15 AGX115

Facility

$3,850.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$1,925.00
Max. Negotiated Rate	$3,734.50
Rate for Payer: AlohaCare Medicaid	$1,925.00
Rate for Payer: AlohaCare Medicare	$2,926.00
Rate for Payer: Cash Price	$2,310.00
Rate for Payer: Devoted Health Medicare	$3,234.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,926.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,695.00
Rate for Payer: Health Management Network Commercial	$3,272.50
Rate for Payer: Humana Medicare	$2,926.00
Rate for Payer: Kaiser Permanente Commercial	$3,465.00
Rate for Payer: Kaiser Permanente Medicaid	$1,963.50
Rate for Payer: Kaiser Permanente Medicare	$2,926.00
Rate for Payer: MDX Hawaii PPO	$3,734.50
Rate for Payer: Ohana Health Plan Medicaid	$2,926.00
Rate for Payer: Ohana Health Plan Medicare	$2,926.00
Rate for Payer: UnitedHealthcare Medicare	$2,926.00
Rate for Payer: University Health Alliance Commercial	$2,156.00

NERVE CONNECTOR 1.5X15 AGX115

Facility

$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: Kaiser Permanente Commercial	$3,465.00
Rate for Payer: MDX Hawaii PPO	$3,734.50
Rate for Payer: University Health Alliance Commercial	$2,156.00

NERVE CONNECTOR 2X20 AG0220

Facility

$4,406.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,203.00
Max. Negotiated Rate	$4,273.82
Rate for Payer: AlohaCare Medicaid	$2,203.00
Rate for Payer: AlohaCare Medicare	$3,348.56
Rate for Payer: Cash Price	$2,643.60
Rate for Payer: Devoted Health Medicare	$3,701.04
Rate for Payer: Hawaii Medical Service Association Medicare	$3,348.56
Rate for Payer: Hawaii Western Management Group Commercial	$3,084.20
Rate for Payer: Health Management Network Commercial	$3,745.10
Rate for Payer: Humana Medicare	$3,348.56
Rate for Payer: Kaiser Permanente Commercial	$3,965.40
Rate for Payer: Kaiser Permanente Medicaid	$2,247.06
Rate for Payer: Kaiser Permanente Medicare	$3,348.56
Rate for Payer: MDX Hawaii PPO	$4,273.82
Rate for Payer: Ohana Health Plan Medicaid	$3,348.56
Rate for Payer: Ohana Health Plan Medicare	$3,348.56
Rate for Payer: UnitedHealthcare Medicare	$3,348.56
Rate for Payer: University Health Alliance Commercial	$2,467.36

NERVE CONNECTOR 2X20 AG0220

Facility

$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: Kaiser Permanente Commercial	$3,965.40
Rate for Payer: MDX Hawaii PPO	$4,273.82
Rate for Payer: University Health Alliance Commercial	$2,467.36

NERVE CONNECTOR 3X15 AGX315

Facility

$3,850.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$1,925.00
Max. Negotiated Rate	$3,734.50
Rate for Payer: AlohaCare Medicaid	$1,925.00
Rate for Payer: AlohaCare Medicare	$2,926.00
Rate for Payer: Cash Price	$2,310.00
Rate for Payer: Devoted Health Medicare	$3,234.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,926.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,695.00
Rate for Payer: Health Management Network Commercial	$3,272.50
Rate for Payer: Humana Medicare	$2,926.00
Rate for Payer: Kaiser Permanente Commercial	$3,465.00
Rate for Payer: Kaiser Permanente Medicaid	$1,963.50
Rate for Payer: Kaiser Permanente Medicare	$2,926.00
Rate for Payer: MDX Hawaii PPO	$3,734.50
Rate for Payer: Ohana Health Plan Medicaid	$2,926.00
Rate for Payer: Ohana Health Plan Medicare	$2,926.00
Rate for Payer: UnitedHealthcare Medicare	$2,926.00
Rate for Payer: University Health Alliance Commercial	$2,156.00

NERVE CONNECTOR 3X15 AGX315

Facility

$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: Kaiser Permanente Commercial	$3,465.00
Rate for Payer: MDX Hawaii PPO	$3,734.50
Rate for Payer: University Health Alliance Commercial	$2,156.00

NERVE CONNECTOR 4X15 AGX415

Facility

$3,996.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$1,998.00
Max. Negotiated Rate	$3,876.12
Rate for Payer: AlohaCare Medicaid	$1,998.00
Rate for Payer: AlohaCare Medicare	$3,036.96
Rate for Payer: Cash Price	$2,397.60
Rate for Payer: Devoted Health Medicare	$3,356.64
Rate for Payer: Hawaii Medical Service Association Medicare	$3,036.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,797.20
Rate for Payer: Health Management Network Commercial	$3,396.60
Rate for Payer: Humana Medicare	$3,036.96
Rate for Payer: Kaiser Permanente Commercial	$3,596.40
Rate for Payer: Kaiser Permanente Medicaid	$2,037.96
Rate for Payer: Kaiser Permanente Medicare	$3,036.96
Rate for Payer: MDX Hawaii PPO	$3,876.12
Rate for Payer: Ohana Health Plan Medicaid	$3,036.96
Rate for Payer: Ohana Health Plan Medicare	$3,036.96
Rate for Payer: UnitedHealthcare Medicare	$3,036.96
Rate for Payer: University Health Alliance Commercial	$2,237.76

NERVE CONNECTOR 4X15 AGX415

Facility

$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: Kaiser Permanente Commercial	$3,596.40
Rate for Payer: MDX Hawaii PPO	$3,876.12
Rate for Payer: University Health Alliance Commercial	$2,237.76

NERVE CONNECTOR 5X40 AG0540

Facility

$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: Kaiser Permanente Commercial	$4,809.60
Rate for Payer: MDX Hawaii PPO	$5,183.68
Rate for Payer: University Health Alliance Commercial	$2,992.64

NERVE CONNECTOR 5X40 AG0540

Facility

$5,344.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,672.00
Max. Negotiated Rate	$5,183.68
Rate for Payer: AlohaCare Medicaid	$2,672.00
Rate for Payer: AlohaCare Medicare	$4,061.44
Rate for Payer: Cash Price	$3,206.40
Rate for Payer: Devoted Health Medicare	$4,488.96
Rate for Payer: Hawaii Medical Service Association Medicare	$4,061.44
Rate for Payer: Hawaii Western Management Group Commercial	$3,740.80
Rate for Payer: Health Management Network Commercial	$4,542.40
Rate for Payer: Humana Medicare	$4,061.44
Rate for Payer: Kaiser Permanente Commercial	$4,809.60
Rate for Payer: Kaiser Permanente Medicaid	$2,725.44
Rate for Payer: Kaiser Permanente Medicare	$4,061.44
Rate for Payer: MDX Hawaii PPO	$5,183.68
Rate for Payer: Ohana Health Plan Medicaid	$4,061.44
Rate for Payer: Ohana Health Plan Medicare	$4,061.44
Rate for Payer: UnitedHealthcare Medicare	$4,061.44
Rate for Payer: University Health Alliance Commercial	$2,992.64

NERVE CONNECTOR 6X15 AGX615

Facility

$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: Kaiser Permanente Commercial	$3,596.40
Rate for Payer: MDX Hawaii PPO	$3,876.12
Rate for Payer: University Health Alliance Commercial	$2,237.76

NERVE CONNECTOR 6X15 AGX615

Facility

$3,996.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$1,998.00
Max. Negotiated Rate	$3,876.12
Rate for Payer: AlohaCare Medicaid	$1,998.00
Rate for Payer: AlohaCare Medicare	$3,036.96
Rate for Payer: Cash Price	$2,397.60
Rate for Payer: Devoted Health Medicare	$3,356.64
Rate for Payer: Hawaii Medical Service Association Medicare	$3,036.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,797.20
Rate for Payer: Health Management Network Commercial	$3,396.60
Rate for Payer: Humana Medicare	$3,036.96
Rate for Payer: Kaiser Permanente Commercial	$3,596.40
Rate for Payer: Kaiser Permanente Medicaid	$2,037.96
Rate for Payer: Kaiser Permanente Medicare	$3,036.96
Rate for Payer: MDX Hawaii PPO	$3,876.12
Rate for Payer: Ohana Health Plan Medicaid	$3,036.96
Rate for Payer: Ohana Health Plan Medicare	$3,036.96
Rate for Payer: UnitedHealthcare Medicare	$3,036.96
Rate for Payer: University Health Alliance Commercial	$2,237.76

NERVE GRAFT 3MM DIAM 311270

Facility

$16,378.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$8,189.00
Max. Negotiated Rate	$15,886.66
Rate for Payer: AlohaCare Medicaid	$8,189.00
Rate for Payer: AlohaCare Medicare	$12,447.28
Rate for Payer: Cash Price	$9,826.80
Rate for Payer: Devoted Health Medicare	$13,757.52
Rate for Payer: Hawaii Medical Service Association Medicare	$12,447.28
Rate for Payer: Hawaii Western Management Group Commercial	$11,464.60
Rate for Payer: Health Management Network Commercial	$13,921.30
Rate for Payer: Humana Medicare	$12,447.28
Rate for Payer: Kaiser Permanente Commercial	$14,740.20
Rate for Payer: Kaiser Permanente Medicaid	$8,352.78
Rate for Payer: Kaiser Permanente Medicare	$12,447.28
Rate for Payer: MDX Hawaii PPO	$15,886.66
Rate for Payer: Ohana Health Plan Medicaid	$12,447.28
Rate for Payer: Ohana Health Plan Medicare	$12,447.28
Rate for Payer: UnitedHealthcare Medicare	$12,447.28
Rate for Payer: University Health Alliance Commercial	$9,171.68

NERVE GRAFT 3MM DIAM 311270

Facility

$16,378.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$9,171.68
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	$14,740.20
Rate for Payer: MDX Hawaii PPO	$15,886.66
Rate for Payer: University Health Alliance Commercial	$9,171.68

NERVE PROTECTOR 2X15MM AGX215

Facility

$3,996.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$1,998.00
Max. Negotiated Rate	$3,876.12
Rate for Payer: AlohaCare Medicaid	$1,998.00
Rate for Payer: AlohaCare Medicare	$3,036.96
Rate for Payer: Cash Price	$2,397.60
Rate for Payer: Devoted Health Medicare	$3,356.64
Rate for Payer: Hawaii Medical Service Association Medicare	$3,036.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,797.20
Rate for Payer: Health Management Network Commercial	$3,396.60
Rate for Payer: Humana Medicare	$3,036.96
Rate for Payer: Kaiser Permanente Commercial	$3,596.40
Rate for Payer: Kaiser Permanente Medicaid	$2,037.96
Rate for Payer: Kaiser Permanente Medicare	$3,036.96
Rate for Payer: MDX Hawaii PPO	$3,876.12
Rate for Payer: Ohana Health Plan Medicaid	$3,036.96
Rate for Payer: Ohana Health Plan Medicare	$3,036.96
Rate for Payer: UnitedHealthcare Medicare	$3,036.96
Rate for Payer: University Health Alliance Commercial	$2,237.76

NERVE PROTECTOR 2X15MM AGX215

Facility

$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: Kaiser Permanente Commercial	$3,596.40
Rate for Payer: MDX Hawaii PPO	$3,876.12
Rate for Payer: University Health Alliance Commercial	$2,237.76

NERVE PROTECTOR 7X40MM AG0740

Facility

$5,670.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,835.00
Max. Negotiated Rate	$5,499.90
Rate for Payer: AlohaCare Medicaid	$2,835.00
Rate for Payer: AlohaCare Medicare	$4,309.20
Rate for Payer: Cash Price	$3,402.00
Rate for Payer: Devoted Health Medicare	$4,762.80
Rate for Payer: Hawaii Medical Service Association Medicare	$4,309.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,969.00
Rate for Payer: Health Management Network Commercial	$4,819.50
Rate for Payer: Humana Medicare	$4,309.20
Rate for Payer: Kaiser Permanente Commercial	$5,103.00
Rate for Payer: Kaiser Permanente Medicaid	$2,891.70
Rate for Payer: Kaiser Permanente Medicare	$4,309.20
Rate for Payer: MDX Hawaii PPO	$5,499.90
Rate for Payer: Ohana Health Plan Medicaid	$4,309.20
Rate for Payer: Ohana Health Plan Medicare	$4,309.20
Rate for Payer: UnitedHealthcare Medicare	$4,309.20
Rate for Payer: University Health Alliance Commercial	$3,175.20

NERVE PROTECTOR 7X40MM AG0740

Facility

$5,670.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$3,175.20
Max. Negotiated Rate	$5,499.90
Rate for Payer: Cash Price	$3,402.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,969.00
Rate for Payer: Health Management Network Commercial	$4,819.50
Rate for Payer: Kaiser Permanente Commercial	$5,103.00
Rate for Payer: MDX Hawaii PPO	$5,499.90
Rate for Payer: University Health Alliance Commercial	$3,175.20

NERVE PROTECTOR AG0340

Facility

$5,344.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,672.00
Max. Negotiated Rate	$5,183.68
Rate for Payer: AlohaCare Medicaid	$2,672.00
Rate for Payer: AlohaCare Medicare	$4,061.44
Rate for Payer: Cash Price	$3,206.40
Rate for Payer: Devoted Health Medicare	$4,488.96
Rate for Payer: Hawaii Medical Service Association Medicare	$4,061.44
Rate for Payer: Hawaii Western Management Group Commercial	$3,740.80
Rate for Payer: Health Management Network Commercial	$4,542.40
Rate for Payer: Humana Medicare	$4,061.44
Rate for Payer: Kaiser Permanente Commercial	$4,809.60
Rate for Payer: Kaiser Permanente Medicaid	$2,725.44
Rate for Payer: Kaiser Permanente Medicare	$4,061.44
Rate for Payer: MDX Hawaii PPO	$5,183.68
Rate for Payer: Ohana Health Plan Medicaid	$4,061.44
Rate for Payer: Ohana Health Plan Medicare	$4,061.44
Rate for Payer: UnitedHealthcare Medicare	$4,061.44
Rate for Payer: University Health Alliance Commercial	$2,992.64

NERVE PROTECTOR AG0340

Facility

$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: Kaiser Permanente Commercial	$4,809.60
Rate for Payer: MDX Hawaii PPO	$5,183.68
Rate for Payer: University Health Alliance Commercial	$2,992.64

NERVOUS SYSTEM NEOPLASMS WITH MCC

Facility

$23,915.32

Service Code	MSDRG 054
Min. Negotiated Rate	$23,915.32
Max. Negotiated Rate	$23,915.32
Rate for Payer: Hawaii Medical Service Association Commercial	$23,915.32

Know your out-of-pocket cost for care.

All Charges