Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

ENSEAL X1 CURVED NSLX137C

Facility

IP

$2,613.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,221.05
Max. Negotiated Rate	$2,534.61
Rate for Payer: Cash Price	$1,567.80
Rate for Payer: Health Management Network Commercial	$2,221.05
Rate for Payer: MDX Hawaii PPO	$2,534.61

ENSEAL X1 CURVED NSLX137C

Facility

OP

$2,613.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,332.63
Max. Negotiated Rate	$2,534.61
Rate for Payer: Cash Price	$1,567.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,482.35
Rate for Payer: Health Management Network Commercial	$2,221.05
Rate for Payer: Kaiser Permanente Commercial	$1,646.19
Rate for Payer: Kaiser Permanente Medicaid	$1,332.63
Rate for Payer: MDX Hawaii PPO	$2,534.61
Rate for Payer: University Health Alliance Commercial	$1,904.62

EPHEDRINE (PF) 50 MG/5 ML (10 MG/ML) IN 0.9% SOD. CHLORIDE IV SYRINGE [132373]

Facility

IP

$9.00

Service Code	NDC 71266904505
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: MDX Hawaii PPO	$8.73

EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [132566]

Facility

IP

$47.00

Service Code	NDC 43598072525
Hospital Revenue Code	250
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$28.20
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: MDX Hawaii PPO	$45.59

EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [132566]

Facility

IP

$47.00

Service Code	NDC 43598072511
Hospital Revenue Code	250
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$28.20
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: MDX Hawaii PPO	$45.59

EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [132566]

Facility

IP

$119.00

Service Code	NDC 00781326995
Hospital Revenue Code	250
Min. Negotiated Rate	$101.15
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$71.40
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: MDX Hawaii PPO	$115.43

EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [132566]

Facility

IP

$47.00

Service Code	NDC 51754420001
Hospital Revenue Code	250
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$28.20
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: MDX Hawaii PPO	$45.59

EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [132566]

Facility

IP

$47.00

Service Code	NDC 51754420004
Hospital Revenue Code	250
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$28.20
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: MDX Hawaii PPO	$45.59

EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [132566]

Facility

IP

$114.00

Service Code	NDC 70121163707
Hospital Revenue Code	250
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$68.40
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: MDX Hawaii PPO	$110.58

EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [132566]

Facility

IP

$119.00

Service Code	NDC 00781326971
Hospital Revenue Code	250
Min. Negotiated Rate	$101.15
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$71.40
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: MDX Hawaii PPO	$115.43

EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [132566]

Facility

IP

$29.00

Service Code	NDC 00641623825
Hospital Revenue Code	250
Min. Negotiated Rate	$24.65
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$17.40
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: MDX Hawaii PPO	$28.13

EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE [162620]

Facility

IP

$43.00

Service Code	HCPCS J0168
Hospital Revenue Code	250
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Cash Price	$34.80
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: MDX Hawaii PPO	$56.26
Rate for Payer: MDX Hawaii PPO	$41.71

EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE [162620]

Facility

OP

$58.00

Service Code	HCPCS J0168
Hospital Revenue Code	636
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$34.80
Rate for Payer: Cash Price	$25.80
Rate for Payer: Cash Price	$34.80
Rate for Payer: Cash Price	$25.80
Rate for Payer: Hawaii Medical Service Association ABD	$2.18
Rate for Payer: Hawaii Medical Service Association ABD	$2.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.18
Rate for Payer: Hawaii Western Management Group Commercial	$40.85
Rate for Payer: Hawaii Western Management Group Commercial	$55.10
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Kaiser Permanente Commercial	$27.09
Rate for Payer: Kaiser Permanente Commercial	$36.54
Rate for Payer: Kaiser Permanente Medicaid	$29.58
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: MDX Hawaii PPO	$56.26
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: UnitedHealthcare Medicaid	$25.80
Rate for Payer: UnitedHealthcare Medicaid	$34.80
Rate for Payer: University Health Alliance Commercial	$31.34
Rate for Payer: University Health Alliance Commercial	$42.28

EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR [124987]

Facility

OP

$371.00

Service Code	HCPCS J0165
Hospital Revenue Code	636
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$359.87
Rate for Payer: Cash Price	$222.60
Rate for Payer: Cash Price	$169.20
Rate for Payer: Cash Price	$222.60
Rate for Payer: Cash Price	$169.20
Rate for Payer: Hawaii Medical Service Association ABD	$0.58
Rate for Payer: Hawaii Medical Service Association ABD	$0.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.58
Rate for Payer: Hawaii Western Management Group Commercial	$267.90
Rate for Payer: Hawaii Western Management Group Commercial	$352.45
Rate for Payer: Health Management Network Commercial	$315.35
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: Kaiser Permanente Commercial	$233.73
Rate for Payer: Kaiser Permanente Commercial	$177.66
Rate for Payer: Kaiser Permanente Medicaid	$143.82
Rate for Payer: Kaiser Permanente Medicaid	$189.21
Rate for Payer: MDX Hawaii PPO	$359.87
Rate for Payer: MDX Hawaii PPO	$273.54
Rate for Payer: UnitedHealthcare Medicaid	$169.20
Rate for Payer: UnitedHealthcare Medicaid	$222.60
Rate for Payer: University Health Alliance Commercial	$270.42
Rate for Payer: University Health Alliance Commercial	$205.55

EPINEPHRINE 0.3 MG/0.3 ML INJECTION, AUTO-INJECTOR [124987]

Facility

IP

$371.00

Service Code	HCPCS J0165
Hospital Revenue Code	250
Min. Negotiated Rate	$315.35
Max. Negotiated Rate	$359.87
Rate for Payer: Cash Price	$222.60
Rate for Payer: Cash Price	$169.20
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: Health Management Network Commercial	$315.35
Rate for Payer: MDX Hawaii PPO	$273.54
Rate for Payer: MDX Hawaii PPO	$359.87

EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION [146012]

Facility

IP

$30.00

Service Code	HCPCS J0169
Hospital Revenue Code	250
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: MDX Hawaii PPO	$8.73

EPINEPHRINE 1 MG/ML (1 ML) INJECTION SOLUTION [146012]

Facility

OP

$9.00

Service Code	HCPCS J0169
Hospital Revenue Code	636
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$5.40
Rate for Payer: Hawaii Medical Service Association ABD	$1.32
Rate for Payer: Hawaii Medical Service Association ABD	$1.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.32
Rate for Payer: Hawaii Western Management Group Commercial	$28.50
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Kaiser Permanente Commercial	$5.67
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$15.30
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: UnitedHealthcare Medicaid	$5.40
Rate for Payer: UnitedHealthcare Medicaid	$18.00
Rate for Payer: University Health Alliance Commercial	$6.56
Rate for Payer: University Health Alliance Commercial	$21.87

EPINEPHRINE 1 MG/ML INJECTION SOLUTION [121505]

Facility

IP

$412.00

Service Code	HCPCS J0165
Hospital Revenue Code	250
Min. Negotiated Rate	$350.20
Max. Negotiated Rate	$399.64
Rate for Payer: Cash Price	$247.20
Rate for Payer: Health Management Network Commercial	$350.20
Rate for Payer: MDX Hawaii PPO	$399.64

EPINEPHRINE 1 MG/ML INJECTION SOLUTION [121505]

Facility

OP

$412.00

Service Code	HCPCS J0165
Hospital Revenue Code	636
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$399.64
Rate for Payer: Cash Price	$247.20
Rate for Payer: Cash Price	$247.20
Rate for Payer: Hawaii Medical Service Association ABD	$0.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.58
Rate for Payer: Hawaii Western Management Group Commercial	$391.40
Rate for Payer: Health Management Network Commercial	$350.20
Rate for Payer: Kaiser Permanente Commercial	$259.56
Rate for Payer: Kaiser Permanente Medicaid	$210.12
Rate for Payer: MDX Hawaii PPO	$399.64
Rate for Payer: UnitedHealthcare Medicaid	$247.20
Rate for Payer: University Health Alliance Commercial	$300.31

EPINEPHRINE (EPIPEN) 0.3 MG (0.3 ML) (TAKE HOME) [4080358]

Facility

OP

$15.00

Service Code	HCPCS J0165
Hospital Revenue Code	253
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Hawaii Medical Service Association ABD	$0.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.58
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: UnitedHealthcare Medicaid	$0.44
Rate for Payer: University Health Alliance Commercial	$10.93

EPINEPHRINE (EPIPEN) 0.3 MG (0.3 ML) (TAKE HOME) [4080358]

Facility

IP

$15.00

Service Code	HCPCS J0165
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

EPINEPHRINE (EPIPEN JR) 0.15 MG (0.3 ML) (TAKE HOME) [4080359]

Facility

IP

$15.00

Service Code	HCPCS J0165
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

EPINEPHRINE (EPIPEN JR) 0.15 MG (0.3 ML) (TAKE HOME) [4080359]

Facility

OP

$15.00

Service Code	HCPCS J0165
Hospital Revenue Code	253
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Hawaii Medical Service Association ABD	$0.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.58
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: UnitedHealthcare Medicaid	$0.44
Rate for Payer: University Health Alliance Commercial	$10.93

EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION [146332]

Facility

IP

$44.00

Service Code	HCPCS J0166
Hospital Revenue Code	250
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$26.40
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: MDX Hawaii PPO	$42.68

EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJECTION SOLUTION [146332]

Facility

OP

$44.00

Service Code	HCPCS J0166
Hospital Revenue Code	636
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$26.40
Rate for Payer: Hawaii Medical Service Association ABD	$2.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$41.80
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Kaiser Permanente Commercial	$27.72
Rate for Payer: Kaiser Permanente Medicaid	$22.44
Rate for Payer: MDX Hawaii PPO	$42.68
Rate for Payer: UnitedHealthcare Medicaid	$26.40
Rate for Payer: University Health Alliance Commercial	$32.07

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