Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

NEX TIB PL SZ:6 00-5980-047-02

Facility

$4,224.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,112.00
Max. Negotiated Rate	$4,097.28
Rate for Payer: AlohaCare Medicaid	$2,112.00
Rate for Payer: AlohaCare Medicare	$3,210.24
Rate for Payer: Cash Price	$2,534.40
Rate for Payer: Devoted Health Medicare	$3,548.16
Rate for Payer: Hawaii Medical Service Association Medicare	$3,210.24
Rate for Payer: Hawaii Western Management Group Commercial	$2,956.80
Rate for Payer: Health Management Network Commercial	$3,590.40
Rate for Payer: Humana Medicare	$3,210.24
Rate for Payer: Kaiser Permanente Commercial	$3,801.60
Rate for Payer: Kaiser Permanente Medicaid	$2,154.24
Rate for Payer: Kaiser Permanente Medicare	$3,210.24
Rate for Payer: MDX Hawaii PPO	$4,097.28
Rate for Payer: Ohana Health Plan Medicaid	$3,210.24
Rate for Payer: Ohana Health Plan Medicare	$3,210.24
Rate for Payer: UnitedHealthcare Medicare	$3,210.24
Rate for Payer: University Health Alliance Commercial	$2,365.44

NEX TIB PL SZ:6 00-5980-047-02

Facility

$4,224.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,365.44
Max. Negotiated Rate	$4,097.28
Rate for Payer: Cash Price	$2,534.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,956.80
Rate for Payer: Health Management Network Commercial	$3,590.40
Rate for Payer: Kaiser Permanente Commercial	$3,801.60
Rate for Payer: MDX Hawaii PPO	$4,097.28
Rate for Payer: University Health Alliance Commercial	$2,365.44

NEX TIB PL SZ:8 00-5980-057-02

Facility

$4,224.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,112.00
Max. Negotiated Rate	$4,097.28
Rate for Payer: AlohaCare Medicaid	$2,112.00
Rate for Payer: AlohaCare Medicare	$3,210.24
Rate for Payer: Cash Price	$2,534.40
Rate for Payer: Devoted Health Medicare	$3,548.16
Rate for Payer: Hawaii Medical Service Association Medicare	$3,210.24
Rate for Payer: Hawaii Western Management Group Commercial	$2,956.80
Rate for Payer: Health Management Network Commercial	$3,590.40
Rate for Payer: Humana Medicare	$3,210.24
Rate for Payer: Kaiser Permanente Commercial	$3,801.60
Rate for Payer: Kaiser Permanente Medicaid	$2,154.24
Rate for Payer: Kaiser Permanente Medicare	$3,210.24
Rate for Payer: MDX Hawaii PPO	$4,097.28
Rate for Payer: Ohana Health Plan Medicaid	$3,210.24
Rate for Payer: Ohana Health Plan Medicare	$3,210.24
Rate for Payer: UnitedHealthcare Medicare	$3,210.24
Rate for Payer: University Health Alliance Commercial	$2,365.44

NEX TIB PL SZ:8 00-5980-057-02

Facility

$4,224.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,365.44
Max. Negotiated Rate	$4,097.28
Rate for Payer: Cash Price	$2,534.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,956.80
Rate for Payer: Health Management Network Commercial	$3,590.40
Rate for Payer: Kaiser Permanente Commercial	$3,801.60
Rate for Payer: MDX Hawaii PPO	$4,097.28
Rate for Payer: University Health Alliance Commercial	$2,365.44

NICARDIPINE 20 MG CAPSULE [10712]

Facility

$39.00

Service Code	NDC 42806050109
Hospital Revenue Code	637
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$37.83
Rate for Payer: AlohaCare Medicaid	$19.50
Rate for Payer: AlohaCare Medicare	$29.64
Rate for Payer: Cash Price	$23.40
Rate for Payer: Devoted Health Medicare	$32.76
Rate for Payer: Hawaii Medical Service Association Medicare	$29.64
Rate for Payer: Hawaii Western Management Group Commercial	$37.05
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Humana Medicare	$29.64
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: Kaiser Permanente Medicare	$29.64
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: Ohana Health Plan Medicaid	$29.64
Rate for Payer: Ohana Health Plan Medicare	$29.64
Rate for Payer: UnitedHealthcare Medicare	$29.64
Rate for Payer: University Health Alliance Commercial	$28.43

NICARDIPINE 20 MG CAPSULE [10712]

Facility

$39.00

Service Code	NDC 42806050109
Hospital Revenue Code	250
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: MDX Hawaii PPO	$37.83

NICARDIPINE 20 MG CAPSULE [10712]

Facility

$39.00

Service Code	NDC 68462012090
Hospital Revenue Code	637
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$37.83
Rate for Payer: AlohaCare Medicaid	$19.50
Rate for Payer: AlohaCare Medicare	$29.64
Rate for Payer: Cash Price	$23.40
Rate for Payer: Devoted Health Medicare	$32.76
Rate for Payer: Hawaii Medical Service Association Medicare	$29.64
Rate for Payer: Hawaii Western Management Group Commercial	$37.05
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Humana Medicare	$29.64
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: Kaiser Permanente Medicare	$29.64
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: Ohana Health Plan Medicaid	$29.64
Rate for Payer: Ohana Health Plan Medicare	$29.64
Rate for Payer: UnitedHealthcare Medicare	$29.64
Rate for Payer: University Health Alliance Commercial	$28.43

NICARDIPINE 20 MG CAPSULE [10712]

Facility

$39.00

Service Code	NDC 68462012090
Hospital Revenue Code	250
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: MDX Hawaii PPO	$37.83

NICARDIPINE 25 MG/10 ML INTRAVENOUS SOLUTION [12370]

Facility

$108.00

Service Code	HCPCS J2404
Hospital Revenue Code	250
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cash Price	$54.00
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Kaiser Permanente Commercial	$97.20
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: MDX Hawaii PPO	$104.76

NICARDIPINE 40 MG/200 ML(0.2 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN [94576]

Facility

$336.00

Service Code	HCPCS J2404
Hospital Revenue Code	250
Min. Negotiated Rate	$285.60
Max. Negotiated Rate	$325.92
Rate for Payer: Cash Price	$201.60
Rate for Payer: Health Management Network Commercial	$285.60
Rate for Payer: Kaiser Permanente Commercial	$302.40
Rate for Payer: MDX Hawaii PPO	$325.92

NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH [27862]

Facility

$8.00

Service Code	NDC 68001043390
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

NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH [27862]

Facility

$8.00

Service Code	NDC 68001043390
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

NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH [27862]

Facility

$8.00

Service Code	NDC 60505706200
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

NICOTINE 14 MG/24 HR DAILY TRANSDERMAL PATCH [27862]

Facility

$8.00

Service Code	NDC 60505706200
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

NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]

Facility

$9.00

Service Code	NDC 60505706300
Hospital Revenue Code	637
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$8.73
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$6.84
Rate for Payer: Cash Price	$5.40
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Hawaii Medical Service Association Medicare	$6.84
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Humana Medicare	$6.84
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicare	$6.84
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$6.84
Rate for Payer: Ohana Health Plan Medicare	$6.84
Rate for Payer: UnitedHealthcare Medicare	$6.84
Rate for Payer: University Health Alliance Commercial	$6.56

NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]

Facility

$8.00

Service Code	NDC 68001043490
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

NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]

Facility

$9.00

Service Code	NDC 60505706300
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73

NICOTINE 21 MG/24 HR DAILY TRANSDERMAL PATCH [27863]

Facility

$8.00

Service Code	NDC 68001043490
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

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]

Facility

$7.00

Service Code	NDC 60505706100
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

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]

Facility

$8.00

Service Code	NDC 68001043290
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

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]

Facility

$8.00

Service Code	NDC 68001043290
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

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH [27860]

Facility

$7.00

Service Code	NDC 60505706100
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

NICOTINE (POLACRILEX) 4 MG BUCCAL MINI LOZENGE [119764]

Facility

$3.00

Service Code	NDC 46122071660
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

NIFEDIPINE 10 MG CAPSULE [5558]

Facility

$4.00

Service Code	NDC 69315021101
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

NIFEDIPINE 10 MG CAPSULE [5558]

Facility

$5.00

Service Code	NDC 00904722961
Hospital Revenue Code	637
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$3.80
Rate for Payer: Cash Price	$3.00
Rate for Payer: Devoted Health Medicare	$4.20
Rate for Payer: Hawaii Medical Service Association Medicare	$3.80
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$3.80
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$3.80
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$3.80
Rate for Payer: Ohana Health Plan Medicare	$3.80
Rate for Payer: UnitedHealthcare Medicare	$3.80
Rate for Payer: University Health Alliance Commercial	$3.64

Know your out-of-pocket cost for care.

All Charges