Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) IN 0.9 % NACL IV [134543]

Facility

$215.00

Service Code	NDC 44567064101
Hospital Revenue Code	250
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$129.00
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: MDX Hawaii PPO	$208.55

NORETHINDRONE 1 MG-ETHINYL ESTRADIOL 35 MCG TABLET [10742]

Facility

$4.00

Service Code	NDC 00555901079
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

NORETHINDRONE 1 MG-ETHINYL ESTRADIOL 35 MCG TABLET [10742]

Facility

$4.00

Service Code	NDC 00555901079
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

NORETHINDRONE 1 MG-ETHINYL ESTRADIOL 35 MCG TABLET [10742]

Facility

$4.00

Service Code	NDC 00555901058
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

NORETHINDRONE 1 MG-ETHINYL ESTRADIOL 35 MCG TABLET [10742]

Facility

$4.00

Service Code	NDC 00555901058
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

NORFLURANE-PENTAFLUOROPROPANE TOPICAL SPRAY [39802]

Facility

$123.00

Service Code	NDC 00802000000
Hospital Revenue Code	250
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$119.31
Rate for Payer: Cash Price	$73.80
Rate for Payer: Health Management Network Commercial	$104.55
Rate for Payer: Kaiser Permanente Commercial	$110.70
Rate for Payer: MDX Hawaii PPO	$119.31

NORFLURANE-PENTAFLUOROPROPANE TOPICAL SPRAY [39802]

Facility

$118.00

Service Code	NDC 00803000000
Hospital Revenue Code	637
Min. Negotiated Rate	$59.00
Max. Negotiated Rate	$114.46
Rate for Payer: AlohaCare Medicaid	$59.00
Rate for Payer: AlohaCare Medicare	$89.68
Rate for Payer: Cash Price	$70.80
Rate for Payer: Devoted Health Medicare	$99.12
Rate for Payer: Hawaii Medical Service Association Medicare	$89.68
Rate for Payer: Hawaii Western Management Group Commercial	$112.10
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Humana Medicare	$89.68
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: Kaiser Permanente Medicaid	$60.18
Rate for Payer: Kaiser Permanente Medicare	$89.68
Rate for Payer: MDX Hawaii PPO	$114.46
Rate for Payer: Ohana Health Plan Medicaid	$89.68
Rate for Payer: Ohana Health Plan Medicare	$89.68
Rate for Payer: UnitedHealthcare Medicare	$89.68
Rate for Payer: University Health Alliance Commercial	$86.01

NORFLURANE-PENTAFLUOROPROPANE TOPICAL SPRAY [39802]

Facility

$118.00

Service Code	NDC 00803000000
Hospital Revenue Code	250
Min. Negotiated Rate	$100.30
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$70.80
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: MDX Hawaii PPO	$114.46

NORFLURANE-PENTAFLUOROPROPANE TOPICAL SPRAY [39802]

Facility

$123.00

Service Code	NDC 00802000000
Hospital Revenue Code	637
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$119.31
Rate for Payer: AlohaCare Medicaid	$61.50
Rate for Payer: AlohaCare Medicare	$93.48
Rate for Payer: Cash Price	$73.80
Rate for Payer: Devoted Health Medicare	$103.32
Rate for Payer: Hawaii Medical Service Association Medicare	$93.48
Rate for Payer: Hawaii Western Management Group Commercial	$116.85
Rate for Payer: Health Management Network Commercial	$104.55
Rate for Payer: Humana Medicare	$93.48
Rate for Payer: Kaiser Permanente Commercial	$110.70
Rate for Payer: Kaiser Permanente Medicaid	$62.73
Rate for Payer: Kaiser Permanente Medicare	$93.48
Rate for Payer: MDX Hawaii PPO	$119.31
Rate for Payer: Ohana Health Plan Medicaid	$93.48
Rate for Payer: Ohana Health Plan Medicare	$93.48
Rate for Payer: UnitedHealthcare Medicare	$93.48
Rate for Payer: University Health Alliance Commercial	$89.65

NORIAN DRILLABLE 5CC

Facility

$4,282.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,141.00
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$3,254.32
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$3,596.88
Rate for Payer: Hawaii Medical Service Association Medicare	$3,254.32
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$3,254.32
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$3,254.32
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$3,254.32
Rate for Payer: Ohana Health Plan Medicare	$3,254.32
Rate for Payer: UnitedHealthcare Medicare	$3,254.32
Rate for Payer: University Health Alliance Commercial	$2,397.92

NORIAN DRILLABLE 5CC

Facility

$4,282.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

NORIAN DRILLABLE INJECT 10CC

Facility

$6,330.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,165.00
Max. Negotiated Rate	$6,140.10
Rate for Payer: AlohaCare Medicaid	$3,165.00
Rate for Payer: AlohaCare Medicare	$4,810.80
Rate for Payer: Cash Price	$3,798.00
Rate for Payer: Devoted Health Medicare	$5,317.20
Rate for Payer: Hawaii Medical Service Association Medicare	$4,810.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,431.00
Rate for Payer: Health Management Network Commercial	$5,380.50
Rate for Payer: Humana Medicare	$4,810.80
Rate for Payer: Kaiser Permanente Commercial	$5,697.00
Rate for Payer: Kaiser Permanente Medicaid	$3,228.30
Rate for Payer: Kaiser Permanente Medicare	$4,810.80
Rate for Payer: MDX Hawaii PPO	$6,140.10
Rate for Payer: Ohana Health Plan Medicaid	$4,810.80
Rate for Payer: Ohana Health Plan Medicare	$4,810.80
Rate for Payer: UnitedHealthcare Medicare	$4,810.80
Rate for Payer: University Health Alliance Commercial	$3,544.80

NORIAN DRILLABLE INJECT 10CC

Facility

$6,330.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,544.80
Max. Negotiated Rate	$6,140.10
Rate for Payer: Cash Price	$3,798.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,431.00
Rate for Payer: Health Management Network Commercial	$5,380.50
Rate for Payer: Kaiser Permanente Commercial	$5,697.00
Rate for Payer: MDX Hawaii PPO	$6,140.10
Rate for Payer: University Health Alliance Commercial	$3,544.80

NORMAL NEWBORN

Facility

$2,678.33

Service Code	MSDRG 795
Min. Negotiated Rate	$2,678.33
Max. Negotiated Rate	$2,678.33
Rate for Payer: Hawaii Medical Service Association Commercial	$2,678.33

NORTRIPTYLINE 10 MG CAPSULE [5674]

Facility

$2.00

Service Code	NDC 60687028101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

NORTRIPTYLINE 10 MG CAPSULE [5674]

Facility

$3.00

Service Code	NDC 75907006901
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

NORTRIPTYLINE 10 MG CAPSULE [5674]

Facility

$3.00

Service Code	NDC 75907006901
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

NORTRIPTYLINE 10 MG CAPSULE [5674]

Facility

$2.00

Service Code	NDC 60687028101
Hospital Revenue Code	637
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$1.52
Rate for Payer: Cash Price	$1.20
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.52
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$1.52
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$1.52
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$1.52
Rate for Payer: Ohana Health Plan Medicare	$1.52
Rate for Payer: UnitedHealthcare Medicare	$1.52
Rate for Payer: University Health Alliance Commercial	$1.46

NORTRIPTYLINE 25 MG CAPSULE [5675]

Facility

$3.00

Service Code	NDC 50268060415
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

NORTRIPTYLINE 25 MG CAPSULE [5675]

Facility

$3.00

Service Code	NDC 50268060415
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

NORTRIPTYLINE 25 MG CAPSULE [5675]

Facility

$6.00

Service Code	NDC 75907007001
Hospital Revenue Code	637
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$4.56
Rate for Payer: Cash Price	$3.60
Rate for Payer: Devoted Health Medicare	$5.04
Rate for Payer: Hawaii Medical Service Association Medicare	$4.56
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$4.56
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$4.56
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$4.56
Rate for Payer: Ohana Health Plan Medicare	$4.56
Rate for Payer: UnitedHealthcare Medicare	$4.56
Rate for Payer: University Health Alliance Commercial	$4.37

NORTRIPTYLINE 25 MG CAPSULE [5675]

Facility

$6.00

Service Code	NDC 75907007001
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

NOVASURE DEVICE NS2013KITUS

Facility

$2,276.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,934.60
Max. Negotiated Rate	$2,207.72
Rate for Payer: Cash Price	$1,365.60
Rate for Payer: Health Management Network Commercial	$1,934.60
Rate for Payer: Kaiser Permanente Commercial	$2,048.40
Rate for Payer: MDX Hawaii PPO	$2,207.72

NOVASURE DEVICE NS2013KITUS

Facility

$2,276.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,138.00
Max. Negotiated Rate	$2,207.72
Rate for Payer: AlohaCare Medicaid	$1,138.00
Rate for Payer: AlohaCare Medicare	$1,729.76
Rate for Payer: Cash Price	$1,365.60
Rate for Payer: Devoted Health Medicare	$1,911.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,729.76
Rate for Payer: Hawaii Western Management Group Commercial	$2,162.20
Rate for Payer: Health Management Network Commercial	$1,934.60
Rate for Payer: Humana Medicare	$1,729.76
Rate for Payer: Kaiser Permanente Commercial	$2,048.40
Rate for Payer: Kaiser Permanente Medicaid	$1,160.76
Rate for Payer: Kaiser Permanente Medicare	$1,729.76
Rate for Payer: MDX Hawaii PPO	$2,207.72
Rate for Payer: Ohana Health Plan Medicaid	$1,729.76
Rate for Payer: Ohana Health Plan Medicare	$1,729.76
Rate for Payer: UnitedHealthcare Medicare	$1,729.76
Rate for Payer: University Health Alliance Commercial	$1,658.98

NOVASURE KIT NS2007

Facility

$7,320.00

Hospital Revenue Code	272
Min. Negotiated Rate	$6,222.00
Max. Negotiated Rate	$7,100.40
Rate for Payer: Cash Price	$4,392.00
Rate for Payer: Health Management Network Commercial	$6,222.00
Rate for Payer: Kaiser Permanente Commercial	$6,588.00
Rate for Payer: MDX Hawaii PPO	$7,100.40

Know your out-of-pocket cost for care.

All Charges