Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]

Facility

OP

$14.00

Service Code	NDC 68084041501
Hospital Revenue Code	637
Min. Negotiated Rate	$7.14
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$8.40
Rate for Payer: Hawaii Western Management Group Commercial	$13.30
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Kaiser Permanente Commercial	$8.82
Rate for Payer: Kaiser Permanente Medicaid	$7.14
Rate for Payer: MDX Hawaii PPO	$13.58
Rate for Payer: University Health Alliance Commercial	$10.20

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]

Facility

IP

$14.00

Service Code	NDC 68084041501
Hospital Revenue Code	250
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$8.40
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: MDX Hawaii PPO	$13.58

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]

Facility

OP

$11.00

Service Code	NDC 68084041502
Hospital Revenue Code	637
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Hawaii Western Management Group Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Kaiser Permanente Commercial	$6.93
Rate for Payer: Kaiser Permanente Medicaid	$5.61
Rate for Payer: MDX Hawaii PPO	$10.67
Rate for Payer: University Health Alliance Commercial	$8.02

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]

Facility

OP

$11.00

Service Code	NDC 68084041593
Hospital Revenue Code	637
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Hawaii Western Management Group Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Kaiser Permanente Commercial	$6.93
Rate for Payer: Kaiser Permanente Medicaid	$5.61
Rate for Payer: MDX Hawaii PPO	$10.67
Rate for Payer: University Health Alliance Commercial	$8.02

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]

Facility

IP

$11.00

Service Code	NDC 68084041502
Hospital Revenue Code	250
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: MDX Hawaii PPO	$10.67

DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]

Facility

IP

$11.00

Service Code	NDC 68084041593
Hospital Revenue Code	250
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: MDX Hawaii PPO	$10.67

DIVERTICULITIS & DIVERTICULOSIS

Facility

IP

$2,820.45

Service Code	APR-DRG 2441
Min. Negotiated Rate	$2,820.45
Max. Negotiated Rate	$2,820.45
Rate for Payer: AlohaCare Medicaid	$2,820.45
Rate for Payer: Hawaii Medical Service Association ABD	$2,820.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,820.45
Rate for Payer: Kaiser Permanente Medicaid	$2,820.45
Rate for Payer: Ohana Health Plan Medicaid	$2,820.45
Rate for Payer: UnitedHealthcare Medicaid	$2,820.45

DIVERTICULITIS & DIVERTICULOSIS

Facility

IP

$3,596.66

Service Code	APR-DRG 2442
Min. Negotiated Rate	$3,596.66
Max. Negotiated Rate	$3,596.66
Rate for Payer: AlohaCare Medicaid	$3,596.66
Rate for Payer: Hawaii Medical Service Association ABD	$3,596.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,596.66
Rate for Payer: Kaiser Permanente Medicaid	$3,596.66
Rate for Payer: Ohana Health Plan Medicaid	$3,596.66
Rate for Payer: UnitedHealthcare Medicaid	$3,596.66

DIVERTICULITIS & DIVERTICULOSIS

Facility

IP

$5,441.29

Service Code	APR-DRG 2443
Min. Negotiated Rate	$5,441.29
Max. Negotiated Rate	$5,441.29
Rate for Payer: AlohaCare Medicaid	$5,441.29
Rate for Payer: Hawaii Medical Service Association ABD	$5,441.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,441.29
Rate for Payer: Kaiser Permanente Medicaid	$5,441.29
Rate for Payer: Ohana Health Plan Medicaid	$5,441.29
Rate for Payer: UnitedHealthcare Medicaid	$5,441.29

DIVERTICULITIS & DIVERTICULOSIS

Facility

IP

$9,953.09

Service Code	APR-DRG 2444
Min. Negotiated Rate	$9,953.09
Max. Negotiated Rate	$9,953.09
Rate for Payer: AlohaCare Medicaid	$9,953.09
Rate for Payer: Hawaii Medical Service Association ABD	$9,953.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,953.09
Rate for Payer: Kaiser Permanente Medicaid	$9,953.09
Rate for Payer: Ohana Health Plan Medicaid	$9,953.09
Rate for Payer: UnitedHealthcare Medicaid	$9,953.09

D-M DRAINGAGE CATH 12FR

Facility

OP

$368.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$187.68
Max. Negotiated Rate	$356.96
Rate for Payer: Cash Price	$220.80
Rate for Payer: Hawaii Western Management Group Commercial	$349.60
Rate for Payer: Health Management Network Commercial	$312.80
Rate for Payer: Kaiser Permanente Commercial	$231.84
Rate for Payer: Kaiser Permanente Medicaid	$187.68
Rate for Payer: MDX Hawaii PPO	$356.96
Rate for Payer: University Health Alliance Commercial	$268.24

D-M DRAINGAGE CATH 12FR

Facility

IP

$368.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$312.80
Max. Negotiated Rate	$356.96
Rate for Payer: Cash Price	$220.80
Rate for Payer: Health Management Network Commercial	$312.80
Rate for Payer: MDX Hawaii PPO	$356.96

DMUELLER DRAINAGE CATH 10.2F

Facility

OP

$357.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$182.07
Max. Negotiated Rate	$346.29
Rate for Payer: Cash Price	$214.20
Rate for Payer: Hawaii Western Management Group Commercial	$339.15
Rate for Payer: Health Management Network Commercial	$303.45
Rate for Payer: Kaiser Permanente Commercial	$224.91
Rate for Payer: Kaiser Permanente Medicaid	$182.07
Rate for Payer: MDX Hawaii PPO	$346.29
Rate for Payer: University Health Alliance Commercial	$260.22

DMUELLER DRAINAGE CATH 10.2F

Facility

IP

$357.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$303.45
Max. Negotiated Rate	$346.29
Rate for Payer: Cash Price	$214.20
Rate for Payer: Health Management Network Commercial	$303.45
Rate for Payer: MDX Hawaii PPO	$346.29

DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION [9892]

Facility

IP

$33.00

Service Code	HCPCS J1250
Hospital Revenue Code	250
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cash Price	$13.20
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: MDX Hawaii PPO	$32.01
Rate for Payer: MDX Hawaii PPO	$31.04
Rate for Payer: MDX Hawaii PPO	$21.34

DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION [9892]

Facility

OP

$32.00

Service Code	HCPCS J1250
Hospital Revenue Code	636
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$13.20
Rate for Payer: Cash Price	$13.20
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.20
Rate for Payer: Hawaii Medical Service Association ABD	$7.98
Rate for Payer: Hawaii Medical Service Association ABD	$7.98
Rate for Payer: Hawaii Medical Service Association ABD	$7.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.98
Rate for Payer: Hawaii Western Management Group Commercial	$20.90
Rate for Payer: Hawaii Western Management Group Commercial	$30.40
Rate for Payer: Hawaii Western Management Group Commercial	$31.35
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Kaiser Permanente Commercial	$20.79
Rate for Payer: Kaiser Permanente Commercial	$20.16
Rate for Payer: Kaiser Permanente Commercial	$13.86
Rate for Payer: Kaiser Permanente Medicaid	$11.22
Rate for Payer: Kaiser Permanente Medicaid	$16.32
Rate for Payer: Kaiser Permanente Medicaid	$16.83
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: MDX Hawaii PPO	$31.04
Rate for Payer: MDX Hawaii PPO	$32.01
Rate for Payer: UnitedHealthcare Medicaid	$19.20
Rate for Payer: UnitedHealthcare Medicaid	$19.80
Rate for Payer: UnitedHealthcare Medicaid	$13.20
Rate for Payer: University Health Alliance Commercial	$16.04
Rate for Payer: University Health Alliance Commercial	$23.32
Rate for Payer: University Health Alliance Commercial	$24.05

DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS [18314]

Facility

IP

$97.00

Service Code	HCPCS J1250
Hospital Revenue Code	250
Min. Negotiated Rate	$82.45
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$58.20
Rate for Payer: Cash Price	$58.80
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: MDX Hawaii PPO	$94.09
Rate for Payer: MDX Hawaii PPO	$95.06

DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION [116947]

Facility

IP

$4,382.00

Service Code	HCPCS J9171
Hospital Revenue Code	250
Min. Negotiated Rate	$3,724.70
Max. Negotiated Rate	$4,250.54
Rate for Payer: Cash Price	$2,629.20
Rate for Payer: Cash Price	$626.40
Rate for Payer: Cash Price	$1,459.20
Rate for Payer: Health Management Network Commercial	$887.40
Rate for Payer: Health Management Network Commercial	$2,067.20
Rate for Payer: Health Management Network Commercial	$3,724.70
Rate for Payer: MDX Hawaii PPO	$1,012.68
Rate for Payer: MDX Hawaii PPO	$4,250.54
Rate for Payer: MDX Hawaii PPO	$2,359.04

DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION [116947]

Facility

OP

$2,432.00

Service Code	HCPCS J9171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$2,359.04
Rate for Payer: Cash Price	$1,459.20
Rate for Payer: Cash Price	$626.40
Rate for Payer: Cash Price	$626.40
Rate for Payer: Cash Price	$2,629.20
Rate for Payer: Cash Price	$2,629.20
Rate for Payer: Cash Price	$1,459.20
Rate for Payer: Hawaii Medical Service Association ABD	$0.38
Rate for Payer: Hawaii Medical Service Association ABD	$0.38
Rate for Payer: Hawaii Medical Service Association ABD	$0.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.38
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.40
Rate for Payer: Hawaii Western Management Group Commercial	$991.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,162.90
Rate for Payer: Health Management Network Commercial	$887.40
Rate for Payer: Health Management Network Commercial	$3,724.70
Rate for Payer: Health Management Network Commercial	$2,067.20
Rate for Payer: Kaiser Permanente Commercial	$657.72
Rate for Payer: Kaiser Permanente Commercial	$1,532.16
Rate for Payer: Kaiser Permanente Commercial	$2,760.66
Rate for Payer: Kaiser Permanente Medicaid	$2,234.82
Rate for Payer: Kaiser Permanente Medicaid	$1,240.32
Rate for Payer: Kaiser Permanente Medicaid	$532.44
Rate for Payer: MDX Hawaii PPO	$1,012.68
Rate for Payer: MDX Hawaii PPO	$4,250.54
Rate for Payer: MDX Hawaii PPO	$2,359.04
Rate for Payer: UnitedHealthcare Medicaid	$626.40
Rate for Payer: UnitedHealthcare Medicaid	$1,459.20
Rate for Payer: UnitedHealthcare Medicaid	$2,629.20
Rate for Payer: University Health Alliance Commercial	$1,772.68
Rate for Payer: University Health Alliance Commercial	$760.97
Rate for Payer: University Health Alliance Commercial	$3,194.04

DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION [106443]

Facility

OP

$197.00

Service Code	HCPCS J9171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$191.09
Rate for Payer: Cash Price	$118.20
Rate for Payer: Cash Price	$220.80
Rate for Payer: Cash Price	$220.80
Rate for Payer: Cash Price	$118.20
Rate for Payer: Hawaii Medical Service Association ABD	$0.38
Rate for Payer: Hawaii Medical Service Association ABD	$0.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.38
Rate for Payer: Hawaii Western Management Group Commercial	$187.15
Rate for Payer: Hawaii Western Management Group Commercial	$349.60
Rate for Payer: Health Management Network Commercial	$312.80
Rate for Payer: Health Management Network Commercial	$167.45
Rate for Payer: Kaiser Permanente Commercial	$124.11
Rate for Payer: Kaiser Permanente Commercial	$231.84
Rate for Payer: Kaiser Permanente Medicaid	$187.68
Rate for Payer: Kaiser Permanente Medicaid	$100.47
Rate for Payer: MDX Hawaii PPO	$191.09
Rate for Payer: MDX Hawaii PPO	$356.96
Rate for Payer: UnitedHealthcare Medicaid	$118.20
Rate for Payer: UnitedHealthcare Medicaid	$220.80
Rate for Payer: University Health Alliance Commercial	$143.59
Rate for Payer: University Health Alliance Commercial	$268.24

DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION [106443]

Facility

IP

$197.00

Service Code	HCPCS J9171
Hospital Revenue Code	250
Min. Negotiated Rate	$167.45
Max. Negotiated Rate	$191.09
Rate for Payer: Cash Price	$118.20
Rate for Payer: Cash Price	$220.80
Rate for Payer: Health Management Network Commercial	$312.80
Rate for Payer: Health Management Network Commercial	$167.45
Rate for Payer: MDX Hawaii PPO	$356.96
Rate for Payer: MDX Hawaii PPO	$191.09

DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION [108122]

Facility

OP

$670.00

Service Code	HCPCS J9171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$649.90
Rate for Payer: Cash Price	$402.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$469.80
Rate for Payer: Cash Price	$469.80
Rate for Payer: Cash Price	$402.00
Rate for Payer: Hawaii Medical Service Association ABD	$0.38
Rate for Payer: Hawaii Medical Service Association ABD	$0.38
Rate for Payer: Hawaii Medical Service Association ABD	$0.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.38
Rate for Payer: Hawaii Western Management Group Commercial	$636.50
Rate for Payer: Hawaii Western Management Group Commercial	$242.25
Rate for Payer: Hawaii Western Management Group Commercial	$743.85
Rate for Payer: Health Management Network Commercial	$569.50
Rate for Payer: Health Management Network Commercial	$216.75
Rate for Payer: Health Management Network Commercial	$665.55
Rate for Payer: Kaiser Permanente Commercial	$160.65
Rate for Payer: Kaiser Permanente Commercial	$422.10
Rate for Payer: Kaiser Permanente Commercial	$493.29
Rate for Payer: Kaiser Permanente Medicaid	$130.05
Rate for Payer: Kaiser Permanente Medicaid	$341.70
Rate for Payer: Kaiser Permanente Medicaid	$399.33
Rate for Payer: MDX Hawaii PPO	$759.51
Rate for Payer: MDX Hawaii PPO	$247.35
Rate for Payer: MDX Hawaii PPO	$649.90
Rate for Payer: UnitedHealthcare Medicaid	$153.00
Rate for Payer: UnitedHealthcare Medicaid	$469.80
Rate for Payer: UnitedHealthcare Medicaid	$402.00
Rate for Payer: University Health Alliance Commercial	$570.73
Rate for Payer: University Health Alliance Commercial	$185.87
Rate for Payer: University Health Alliance Commercial	$488.36

DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION [108122]

Facility

IP

$783.00

Service Code	HCPCS J9171
Hospital Revenue Code	250
Min. Negotiated Rate	$665.55
Max. Negotiated Rate	$759.51
Rate for Payer: Cash Price	$469.80
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$402.00
Rate for Payer: Health Management Network Commercial	$216.75
Rate for Payer: Health Management Network Commercial	$569.50
Rate for Payer: Health Management Network Commercial	$665.55
Rate for Payer: MDX Hawaii PPO	$247.35
Rate for Payer: MDX Hawaii PPO	$759.51
Rate for Payer: MDX Hawaii PPO	$649.90

DOCUSATE SODIUM 100 MG CAPSULE [2087]

Facility

OP

$1.00

Service Code	NDC 00904718361
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

DOCUSATE SODIUM 100 MG CAPSULE [2087]

Facility

IP

$1.00

Service Code	NDC 60687012901
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

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