Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

TISSUE TRACE ALLOGRAFT 400145

Facility

OP

$996.00

Service Code	HCPCS C1762
Hospital Revenue Code	278
Min. Negotiated Rate	$507.96
Max. Negotiated Rate	$966.12
Rate for Payer: Cash Price	$597.60
Rate for Payer: Hawaii Western Management Group Commercial	$697.20
Rate for Payer: Health Management Network Commercial	$846.60
Rate for Payer: Kaiser Permanente Commercial	$627.48
Rate for Payer: Kaiser Permanente Medicaid	$507.96
Rate for Payer: MDX Hawaii PPO	$966.12
Rate for Payer: University Health Alliance Commercial	$557.76

TISSUE TRACE ALLOGRAFT 400145

Facility

IP

$996.00

Service Code	HCPCS C1762
Hospital Revenue Code	278
Min. Negotiated Rate	$557.76
Max. Negotiated Rate	$966.12
Rate for Payer: Cash Price	$597.60
Rate for Payer: Hawaii Western Management Group Commercial	$697.20
Rate for Payer: Health Management Network Commercial	$846.60
Rate for Payer: MDX Hawaii PPO	$966.12
Rate for Payer: University Health Alliance Commercial	$557.76

TITAN END CAP T25 STARDR 0MM

Facility

OP

$910.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$464.10
Max. Negotiated Rate	$882.70
Rate for Payer: Cash Price	$546.00
Rate for Payer: Hawaii Western Management Group Commercial	$637.00
Rate for Payer: Health Management Network Commercial	$773.50
Rate for Payer: Kaiser Permanente Commercial	$573.30
Rate for Payer: Kaiser Permanente Medicaid	$464.10
Rate for Payer: MDX Hawaii PPO	$882.70
Rate for Payer: University Health Alliance Commercial	$509.60

TITAN END CAP T25 STARDR 0MM

Facility

IP

$910.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$509.60
Max. Negotiated Rate	$882.70
Rate for Payer: Cash Price	$546.00
Rate for Payer: Hawaii Western Management Group Commercial	$637.00
Rate for Payer: Health Management Network Commercial	$773.50
Rate for Payer: MDX Hawaii PPO	$882.70
Rate for Payer: University Health Alliance Commercial	$509.60

TIXAGEV AND CILGAV

Professional

Both

$2.00

Service Code	HCPCS Q0220
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.70
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70

TIZANIDINE 4 MG TABLET [14793]

Facility

OP

$6.00

Service Code	NDC 68084064501
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$3.78
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: University Health Alliance Commercial	$4.37

TIZANIDINE 4 MG TABLET [14793]

Facility

IP

$6.00

Service Code	NDC 68084064501
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: MDX Hawaii PPO	$5.82

TIZANIDINE 4 MG TABLET [14793]

Facility

OP

$6.00

Service Code	NDC 68084064511
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$3.78
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: University Health Alliance Commercial	$4.37

TIZANIDINE 4 MG TABLET [14793]

Facility

OP

$3.00

Service Code	NDC 68084064565
Hospital Revenue Code	637
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$1.89
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: University Health Alliance Commercial	$2.19

TIZANIDINE 4 MG TABLET [14793]

Facility

IP

$6.00

Service Code	NDC 68084064511
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: MDX Hawaii PPO	$5.82

TIZANIDINE 4 MG TABLET [14793]

Facility

IP

$3.00

Service Code	NDC 68084064565
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: MDX Hawaii PPO	$2.91

TL 1-HOLE POST 54-11600

Facility

IP

$489.00

Hospital Revenue Code	272
Min. Negotiated Rate	$415.65
Max. Negotiated Rate	$474.33
Rate for Payer: Cash Price	$293.40
Rate for Payer: Health Management Network Commercial	$415.65
Rate for Payer: MDX Hawaii PPO	$474.33

TL 1-HOLE POST 54-11600

Facility

OP

$489.00

Hospital Revenue Code	272
Min. Negotiated Rate	$249.39
Max. Negotiated Rate	$474.33
Rate for Payer: Cash Price	$293.40
Rate for Payer: Hawaii Western Management Group Commercial	$464.55
Rate for Payer: Health Management Network Commercial	$415.65
Rate for Payer: Kaiser Permanente Commercial	$308.07
Rate for Payer: Kaiser Permanente Medicaid	$249.39
Rate for Payer: MDX Hawaii PPO	$474.33
Rate for Payer: University Health Alliance Commercial	$356.43

TNSN BND NR2X2H/MAL 04.503.701

Facility

IP

$1,962.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,098.72
Max. Negotiated Rate	$1,903.14
Rate for Payer: Cash Price	$1,177.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,373.40
Rate for Payer: Health Management Network Commercial	$1,667.70
Rate for Payer: MDX Hawaii PPO	$1,903.14
Rate for Payer: University Health Alliance Commercial	$1,098.72

TNSN BND NR2X2H/MAL 04.503.701

Facility

OP

$1,962.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.62
Max. Negotiated Rate	$1,903.14
Rate for Payer: Cash Price	$1,177.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,373.40
Rate for Payer: Health Management Network Commercial	$1,667.70
Rate for Payer: Kaiser Permanente Commercial	$1,236.06
Rate for Payer: Kaiser Permanente Medicaid	$1,000.62
Rate for Payer: MDX Hawaii PPO	$1,903.14
Rate for Payer: University Health Alliance Commercial	$1,098.72

TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION [11567]

Facility

OP

$305.00

Service Code	NDC 24208029505
Hospital Revenue Code	637
Min. Negotiated Rate	$155.55
Max. Negotiated Rate	$295.85
Rate for Payer: Cash Price	$183.00
Rate for Payer: Hawaii Western Management Group Commercial	$289.75
Rate for Payer: Health Management Network Commercial	$259.25
Rate for Payer: Kaiser Permanente Commercial	$192.15
Rate for Payer: Kaiser Permanente Medicaid	$155.55
Rate for Payer: MDX Hawaii PPO	$295.85
Rate for Payer: University Health Alliance Commercial	$222.31

TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION [11567]

Facility

IP

$229.00

Service Code	NDC 00574403105
Hospital Revenue Code	250
Min. Negotiated Rate	$194.65
Max. Negotiated Rate	$222.13
Rate for Payer: Cash Price	$137.40
Rate for Payer: Health Management Network Commercial	$194.65
Rate for Payer: MDX Hawaii PPO	$222.13

TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION [11567]

Facility

IP

$305.00

Service Code	NDC 24208029505
Hospital Revenue Code	250
Min. Negotiated Rate	$259.25
Max. Negotiated Rate	$295.85
Rate for Payer: Cash Price	$183.00
Rate for Payer: Health Management Network Commercial	$259.25
Rate for Payer: MDX Hawaii PPO	$295.85

TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION [11567]

Facility

OP

$229.00

Service Code	NDC 00574403105
Hospital Revenue Code	637
Min. Negotiated Rate	$116.79
Max. Negotiated Rate	$222.13
Rate for Payer: Cash Price	$137.40
Rate for Payer: Hawaii Western Management Group Commercial	$217.55
Rate for Payer: Health Management Network Commercial	$194.65
Rate for Payer: Kaiser Permanente Commercial	$144.27
Rate for Payer: Kaiser Permanente Medicaid	$116.79
Rate for Payer: MDX Hawaii PPO	$222.13
Rate for Payer: University Health Alliance Commercial	$166.92

TOBRAMYCIN 0.3 % EYE DROPS [124422]

Facility

OP

$50.00

Service Code	NDC 24208029005
Hospital Revenue Code	637
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$30.00
Rate for Payer: Hawaii Western Management Group Commercial	$47.50
Rate for Payer: Health Management Network Commercial	$42.50
Rate for Payer: Kaiser Permanente Commercial	$31.50
Rate for Payer: Kaiser Permanente Medicaid	$25.50
Rate for Payer: MDX Hawaii PPO	$48.50
Rate for Payer: University Health Alliance Commercial	$36.45

TOBRAMYCIN 0.3 % EYE DROPS [124422]

Facility

IP

$50.00

Service Code	NDC 24208029005
Hospital Revenue Code	250
Min. Negotiated Rate	$42.50
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$30.00
Rate for Payer: Health Management Network Commercial	$42.50
Rate for Payer: MDX Hawaii PPO	$48.50

TOBRAMYCIN 0.3 % EYE OINTMENT [125508]

Facility

IP

$588.00

Service Code	NDC 00078081301
Hospital Revenue Code	250
Min. Negotiated Rate	$499.80
Max. Negotiated Rate	$570.36
Rate for Payer: Cash Price	$352.80
Rate for Payer: Health Management Network Commercial	$499.80
Rate for Payer: MDX Hawaii PPO	$570.36

TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION [11565]

Facility

IP

$200.00

Service Code	HCPCS J3260
Hospital Revenue Code	250
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: MDX Hawaii PPO	$194.00

TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION [11565]

Facility

OP

$200.00

Service Code	HCPCS J3260
Hospital Revenue Code	636
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Hawaii Medical Service Association ABD	$2.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.46
Rate for Payer: Hawaii Western Management Group Commercial	$190.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: UnitedHealthcare Medicaid	$120.00
Rate for Payer: University Health Alliance Commercial	$145.78

TOBRAMYCIN 40 MG/ML INJECTION SOLUTION [39918]

Facility

OP

$15.00

Service Code	HCPCS J3260
Hospital Revenue Code	636
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cash Price	$18.60
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cash Price	$18.60
Rate for Payer: Cash Price	$23.40
Rate for Payer: Hawaii Medical Service Association ABD	$2.46
Rate for Payer: Hawaii Medical Service Association ABD	$2.46
Rate for Payer: Hawaii Medical Service Association ABD	$2.46
Rate for Payer: Hawaii Medical Service Association ABD	$2.46
Rate for Payer: Hawaii Medical Service Association ABD	$2.46
Rate for Payer: Hawaii Medical Service Association ABD	$2.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.46
Rate for Payer: Hawaii Western Management Group Commercial	$88.35
Rate for Payer: Hawaii Western Management Group Commercial	$19.00
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Hawaii Western Management Group Commercial	$87.40
Rate for Payer: Hawaii Western Management Group Commercial	$29.45
Rate for Payer: Hawaii Western Management Group Commercial	$37.05
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Kaiser Permanente Commercial	$24.57
Rate for Payer: Kaiser Permanente Commercial	$58.59
Rate for Payer: Kaiser Permanente Commercial	$57.96
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: Kaiser Permanente Commercial	$19.53
Rate for Payer: Kaiser Permanente Medicaid	$10.20
Rate for Payer: Kaiser Permanente Medicaid	$15.81
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicaid	$46.92
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: MDX Hawaii PPO	$30.07
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: MDX Hawaii PPO	$89.24
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: UnitedHealthcare Medicaid	$55.80
Rate for Payer: UnitedHealthcare Medicaid	$9.00
Rate for Payer: UnitedHealthcare Medicaid	$12.00
Rate for Payer: UnitedHealthcare Medicaid	$23.40
Rate for Payer: UnitedHealthcare Medicaid	$18.60
Rate for Payer: UnitedHealthcare Medicaid	$55.20
Rate for Payer: University Health Alliance Commercial	$10.93
Rate for Payer: University Health Alliance Commercial	$28.43
Rate for Payer: University Health Alliance Commercial	$67.06
Rate for Payer: University Health Alliance Commercial	$67.79
Rate for Payer: University Health Alliance Commercial	$22.60
Rate for Payer: University Health Alliance Commercial	$14.58