Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]

Facility

IP

$673.00

Service Code	NDC 43598032675
Hospital Revenue Code	250
Min. Negotiated Rate	$572.05
Max. Negotiated Rate	$652.81
Rate for Payer: Cash Price	$403.80
Rate for Payer: Health Management Network Commercial	$572.05
Rate for Payer: MDX Hawaii PPO	$652.81

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]

Facility

IP

$385.00

Service Code	NDC 72485062513
Hospital Revenue Code	250
Min. Negotiated Rate	$327.25
Max. Negotiated Rate	$373.45
Rate for Payer: Cash Price	$231.00
Rate for Payer: Health Management Network Commercial	$327.25
Rate for Payer: MDX Hawaii PPO	$373.45

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]

Facility

IP

$701.00

Service Code	NDC 00781618667
Hospital Revenue Code	250
Min. Negotiated Rate	$595.85
Max. Negotiated Rate	$679.97
Rate for Payer: Cash Price	$420.60
Rate for Payer: Health Management Network Commercial	$595.85
Rate for Payer: MDX Hawaii PPO	$679.97

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]

Facility

OP

$673.00

Service Code	NDC 43598032675
Hospital Revenue Code	637
Min. Negotiated Rate	$343.23
Max. Negotiated Rate	$652.81
Rate for Payer: Cash Price	$403.80
Rate for Payer: Hawaii Western Management Group Commercial	$639.35
Rate for Payer: Health Management Network Commercial	$572.05
Rate for Payer: Kaiser Permanente Commercial	$423.99
Rate for Payer: Kaiser Permanente Medicaid	$343.23
Rate for Payer: MDX Hawaii PPO	$652.81
Rate for Payer: University Health Alliance Commercial	$490.55

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]

Facility

OP

$385.00

Service Code	NDC 72485062513
Hospital Revenue Code	637
Min. Negotiated Rate	$196.35
Max. Negotiated Rate	$373.45
Rate for Payer: Cash Price	$231.00
Rate for Payer: Hawaii Western Management Group Commercial	$365.75
Rate for Payer: Health Management Network Commercial	$327.25
Rate for Payer: Kaiser Permanente Commercial	$242.55
Rate for Payer: Kaiser Permanente Medicaid	$196.35
Rate for Payer: MDX Hawaii PPO	$373.45
Rate for Payer: University Health Alliance Commercial	$280.63

CIPROFLOXACIN 0.3 % EYE DROPS [9610]

Facility

IP

$142.00

Service Code	NDC 61314065605
Hospital Revenue Code	250
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$85.20
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: MDX Hawaii PPO	$137.74

CIPROFLOXACIN 0.3 % EYE DROPS [9610]

Facility

OP

$142.00

Service Code	NDC 61314065605
Hospital Revenue Code	637
Min. Negotiated Rate	$72.42
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$85.20
Rate for Payer: Hawaii Western Management Group Commercial	$134.90
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$89.46
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: University Health Alliance Commercial	$103.50

CIPROFLOXACIN 250 MG TABLET [25118]

Facility

IP

$17.00

Service Code	NDC 65862007601
Hospital Revenue Code	250
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: MDX Hawaii PPO	$16.49

CIPROFLOXACIN 250 MG TABLET [25118]

Facility

OP

$17.00

Service Code	NDC 00143992701
Hospital Revenue Code	637
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$10.71
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: University Health Alliance Commercial	$12.39

CIPROFLOXACIN 250 MG TABLET [25118]

Facility

OP

$16.00

Service Code	NDC 55111012601
Hospital Revenue Code	637
Min. Negotiated Rate	$8.16
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$10.08
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: University Health Alliance Commercial	$11.66

CIPROFLOXACIN 250 MG TABLET [25118]

Facility

OP

$17.00

Service Code	NDC 65862007601
Hospital Revenue Code	637
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$10.71
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: University Health Alliance Commercial	$12.39

CIPROFLOXACIN 250 MG TABLET [25118]

Facility

IP

$17.00

Service Code	NDC 00143992701
Hospital Revenue Code	250
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: MDX Hawaii PPO	$16.49

CIPROFLOXACIN 250 MG TABLET [25118]

Facility

IP

$16.00

Service Code	NDC 55111012601
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: MDX Hawaii PPO	$15.52

CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108132]

Facility

OP

$30.00

Service Code	HCPCS J0744
Hospital Revenue Code	636
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Hawaii Medical Service Association ABD	$2.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.32
Rate for Payer: Hawaii Western Management Group Commercial	$28.50
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$15.30
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: UnitedHealthcare Medicaid	$18.00
Rate for Payer: University Health Alliance Commercial	$21.87

CIPROFLOXACIN 400 MG/200 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [108132]

Facility

IP

$30.00

Service Code	HCPCS J0744
Hospital Revenue Code	250
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: MDX Hawaii PPO	$29.10

CIPROFLOXACIN 500 MG TABLET [25119]

Facility

OP

$2.00

Service Code	NDC 00904724361
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

CIPROFLOXACIN 500 MG TABLET [25119]

Facility

OP

$2.00

Service Code	NDC 00904708361
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

CIPROFLOXACIN 500 MG TABLET [25119]

Facility

IP

$2.00

Service Code	NDC 00904708361
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

CIPROFLOXACIN 500 MG TABLET [25119]

Facility

IP

$2.00

Service Code	NDC 00904724361
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

CIPROFLOXACIN TABLETS (CIPRO) 500 MG (TAKE HOME) [4080346]

Facility

OP

$15.00

Service Code	NDC 00004080134
Hospital Revenue Code	253
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: University Health Alliance Commercial	$10.93

CIPROFLOXACIN TABLETS (CIPRO) 500 MG (TAKE HOME) [4080346]

Facility

IP

$15.00

Service Code	NDC 00004080134
Hospital Revenue Code	253
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: MDX Hawaii PPO	$14.55

CIRCL STR PASSER AR-7821

Facility

OP

$1,127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$574.77
Max. Negotiated Rate	$1,093.19
Rate for Payer: Cash Price	$676.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,070.65
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: Kaiser Permanente Commercial	$710.01
Rate for Payer: Kaiser Permanente Medicaid	$574.77
Rate for Payer: MDX Hawaii PPO	$1,093.19
Rate for Payer: University Health Alliance Commercial	$821.47

CIRCL STR PASSER AR-7821

Facility

IP

$1,127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$957.95
Max. Negotiated Rate	$1,093.19
Rate for Payer: Cash Price	$676.20
Rate for Payer: Health Management Network Commercial	$957.95
Rate for Payer: MDX Hawaii PPO	$1,093.19

CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC

Facility

IP

$38,170.80

Service Code	MSDRG 286
Min. Negotiated Rate	$25,168.96
Max. Negotiated Rate	$38,170.80
Rate for Payer: AlohaCare Medicare	$25,168.96
Rate for Payer: Devoted Health Medicare	$27,685.86
Rate for Payer: Hawaii Medical Service Association Commercial	$34,943.04
Rate for Payer: Hawaii Medical Service Association Medicare	$25,168.96
Rate for Payer: Humana Medicare	$25,168.96
Rate for Payer: Kaiser Permanente Commercial	$38,170.80
Rate for Payer: Kaiser Permanente Medicare	$25,168.96
Rate for Payer: Ohana Health Plan Medicare	$25,168.96
Rate for Payer: UnitedHealthcare Medicare	$25,168.96

CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC

Facility

IP

$30,769.29

Service Code	MSDRG 287
Min. Negotiated Rate	$12,171.59
Max. Negotiated Rate	$30,769.29
Rate for Payer: AlohaCare Medicare	$12,171.59
Rate for Payer: Devoted Health Medicare	$13,388.75
Rate for Payer: Hawaii Medical Service Association Commercial	$30,769.29
Rate for Payer: Hawaii Medical Service Association Medicare	$12,171.59
Rate for Payer: Humana Medicare	$12,171.59
Rate for Payer: Kaiser Permanente Commercial	$18,459.22
Rate for Payer: Kaiser Permanente Medicare	$12,171.59
Rate for Payer: Ohana Health Plan Medicare	$12,171.59
Rate for Payer: UnitedHealthcare Medicare	$12,171.59

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