Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE [15636]

Facility

IP

$1.00

Service Code	NDC 43463000000
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: MDX Hawaii PPO	$0.97

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE [15636]

Facility

OP

$2.00

Service Code	NDC 86815000000
Hospital Revenue Code	637
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.26
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: University Health Alliance Commercial	$1.46

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE [15636]

Facility

IP

$2.00

Service Code	NDC 86811000000
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: MDX Hawaii PPO	$1.94

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE [15636]

Facility

IP

$1.00

Service Code	NDC 13100000000
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: MDX Hawaii PPO	$0.97

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE [15636]

Facility

OP

$1.00

Service Code	NDC 13100000000
Hospital Revenue Code	637
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.63
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: University Health Alliance Commercial	$0.73

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE [15636]

Facility

OP

$1.00

Service Code	NDC 43463000000
Hospital Revenue Code	637
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.63
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: University Health Alliance Commercial	$0.73

CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) CAPSULE [15636]

Facility

IP

$2.00

Service Code	NDC 86815000000
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: MDX Hawaii PPO	$1.94

CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET [76950]

Facility

IP

$1.00

Service Code	NDC 03300000000
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: MDX Hawaii PPO	$0.97

CHOLECALCIFEROL (VITAMIN D3) 25 MCG (1,000 UNIT) TABLET [76950]

Facility

OP

$1.00

Service Code	NDC 03300000000
Hospital Revenue Code	637
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.63
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: University Health Alliance Commercial	$0.73

CHOLECYSTECTOMY

Facility

IP

$9,686.97

Service Code	APR-DRG 2633
Min. Negotiated Rate	$9,686.97
Max. Negotiated Rate	$9,686.97
Rate for Payer: AlohaCare Medicaid	$9,686.97
Rate for Payer: Hawaii Medical Service Association ABD	$9,686.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,686.97
Rate for Payer: Kaiser Permanente Medicaid	$9,686.97
Rate for Payer: Ohana Health Plan Medicaid	$9,686.97
Rate for Payer: UnitedHealthcare Medicaid	$9,686.97

CHOLECYSTECTOMY

Facility

IP

$17,154.89

Service Code	APR-DRG 2634
Min. Negotiated Rate	$17,154.89
Max. Negotiated Rate	$17,154.89
Rate for Payer: AlohaCare Medicaid	$17,154.89
Rate for Payer: Hawaii Medical Service Association ABD	$17,154.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,154.89
Rate for Payer: Kaiser Permanente Medicaid	$17,154.89
Rate for Payer: Ohana Health Plan Medicaid	$17,154.89
Rate for Payer: UnitedHealthcare Medicaid	$17,154.89

CHOLECYSTECTOMY

Facility

IP

$7,488.14

Service Code	APR-DRG 2632
Min. Negotiated Rate	$7,488.14
Max. Negotiated Rate	$7,488.14
Rate for Payer: AlohaCare Medicaid	$7,488.14
Rate for Payer: Hawaii Medical Service Association ABD	$7,488.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,488.14
Rate for Payer: Kaiser Permanente Medicaid	$7,488.14
Rate for Payer: Ohana Health Plan Medicaid	$7,488.14
Rate for Payer: UnitedHealthcare Medicaid	$7,488.14

CHOLECYSTECTOMY

Facility

IP

$5,910.93

Service Code	APR-DRG 2631
Min. Negotiated Rate	$5,910.93
Max. Negotiated Rate	$5,910.93
Rate for Payer: AlohaCare Medicaid	$5,910.93
Rate for Payer: Hawaii Medical Service Association ABD	$5,910.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,910.93
Rate for Payer: Kaiser Permanente Medicaid	$5,910.93
Rate for Payer: Ohana Health Plan Medicaid	$5,910.93
Rate for Payer: UnitedHealthcare Medicaid	$5,910.93

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC

Facility

IP

$39,480.78

Service Code	MSDRG 415
Min. Negotiated Rate	$23,507.18
Max. Negotiated Rate	$39,480.78
Rate for Payer: AlohaCare Medicare	$23,507.18
Rate for Payer: Devoted Health Medicare	$25,857.90
Rate for Payer: Hawaii Medical Service Association Commercial	$39,480.78
Rate for Payer: Hawaii Medical Service Association Medicare	$23,507.18
Rate for Payer: Humana Medicare	$23,507.18
Rate for Payer: Kaiser Permanente Commercial	$35,650.57
Rate for Payer: Kaiser Permanente Medicare	$23,507.18
Rate for Payer: Ohana Health Plan Medicare	$23,507.18
Rate for Payer: UnitedHealthcare Medicare	$23,507.18

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC

Facility

IP

$61,454.85

Service Code	MSDRG 414
Min. Negotiated Rate	$40,521.92
Max. Negotiated Rate	$61,454.85
Rate for Payer: AlohaCare Medicare	$40,521.92
Rate for Payer: Devoted Health Medicare	$44,574.11
Rate for Payer: Hawaii Medical Service Association Commercial	$42,416.97
Rate for Payer: Hawaii Medical Service Association Medicare	$40,521.92
Rate for Payer: Humana Medicare	$40,521.92
Rate for Payer: Kaiser Permanente Commercial	$61,454.85
Rate for Payer: Kaiser Permanente Medicare	$40,521.92
Rate for Payer: Ohana Health Plan Medicare	$40,521.92
Rate for Payer: UnitedHealthcare Medicare	$40,521.92

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC

Facility

IP

$27,420.58

Service Code	MSDRG 416
Min. Negotiated Rate	$15,506.54
Max. Negotiated Rate	$27,420.58
Rate for Payer: AlohaCare Medicare	$15,506.54
Rate for Payer: Devoted Health Medicare	$17,057.19
Rate for Payer: Hawaii Medical Service Association Commercial	$27,420.58
Rate for Payer: Hawaii Medical Service Association Medicare	$15,506.54
Rate for Payer: Humana Medicare	$15,506.54
Rate for Payer: Kaiser Permanente Commercial	$23,516.92
Rate for Payer: Kaiser Permanente Medicare	$15,506.54
Rate for Payer: Ohana Health Plan Medicare	$15,506.54
Rate for Payer: UnitedHealthcare Medicare	$15,506.54

CHOLECYSTECTOMY WITH C.D.E. WITH CC

Facility

IP

$42,878.02

Service Code	MSDRG 412
Min. Negotiated Rate	$23,914.38
Max. Negotiated Rate	$42,878.02
Rate for Payer: AlohaCare Medicare	$23,914.38
Rate for Payer: Devoted Health Medicare	$26,305.82
Rate for Payer: Hawaii Medical Service Association Commercial	$42,878.02
Rate for Payer: Hawaii Medical Service Association Medicare	$23,914.38
Rate for Payer: Humana Medicare	$23,914.38
Rate for Payer: Kaiser Permanente Commercial	$36,268.12
Rate for Payer: Kaiser Permanente Medicare	$23,914.38
Rate for Payer: Ohana Health Plan Medicare	$23,914.38
Rate for Payer: UnitedHealthcare Medicare	$23,914.38

CHOLECYSTECTOMY WITH C.D.E. WITH MCC

Facility

IP

$56,981.93

Service Code	MSDRG 411
Min. Negotiated Rate	$37,572.57
Max. Negotiated Rate	$56,981.93
Rate for Payer: AlohaCare Medicare	$37,572.57
Rate for Payer: Devoted Health Medicare	$41,329.83
Rate for Payer: Hawaii Medical Service Association Commercial	$51,274.06
Rate for Payer: Hawaii Medical Service Association Medicare	$37,572.57
Rate for Payer: Humana Medicare	$37,572.57
Rate for Payer: Kaiser Permanente Commercial	$56,981.93
Rate for Payer: Kaiser Permanente Medicare	$37,572.57
Rate for Payer: Ohana Health Plan Medicare	$37,572.57
Rate for Payer: UnitedHealthcare Medicare	$37,572.57

CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC

Facility

IP

$34,506.25

Service Code	MSDRG 413
Min. Negotiated Rate	$18,886.96
Max. Negotiated Rate	$34,506.25
Rate for Payer: AlohaCare Medicare	$18,886.96
Rate for Payer: Devoted Health Medicare	$20,775.66
Rate for Payer: Hawaii Medical Service Association Commercial	$34,506.25
Rate for Payer: Hawaii Medical Service Association Medicare	$18,886.96
Rate for Payer: Humana Medicare	$18,886.96
Rate for Payer: Kaiser Permanente Commercial	$28,643.62
Rate for Payer: Kaiser Permanente Medicare	$18,886.96
Rate for Payer: Ohana Health Plan Medicare	$18,886.96
Rate for Payer: UnitedHealthcare Medicare	$18,886.96

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

OP

$12.00

Service Code	NDC 67877029860
Hospital Revenue Code	637
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.20
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$7.56
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: University Health Alliance Commercial	$8.75

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

IP

$12.00

Service Code	NDC 42806026695
Hospital Revenue Code	250
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: MDX Hawaii PPO	$11.64

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

IP

$12.00

Service Code	NDC 42806026698
Hospital Revenue Code	250
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: MDX Hawaii PPO	$11.64

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

OP

$12.00

Service Code	NDC 42806026698
Hospital Revenue Code	637
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.20
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$7.56
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: University Health Alliance Commercial	$8.75

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

IP

$12.00

Service Code	NDC 67877029860
Hospital Revenue Code	250
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: MDX Hawaii PPO	$11.64

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

OP

$12.00

Service Code	NDC 42806026695
Hospital Revenue Code	637
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.20
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$7.56
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: University Health Alliance Commercial	$8.75

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