Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

FAT EMULSION 20 % INTRAVENOUS [10014]

Facility

IP

$212.00

Service Code	NDC 65219053301
Hospital Revenue Code	250
Min. Negotiated Rate	$180.20
Max. Negotiated Rate	$205.64
Rate for Payer: Cash Price	$127.20
Rate for Payer: Health Management Network Commercial	$180.20
Rate for Payer: MDX Hawaii PPO	$205.64

FAT EMULSION 20 % INTRAVENOUS [10014]

Facility

IP

$132.00

Service Code	NDC 00338051958
Hospital Revenue Code	250
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$128.04
Rate for Payer: Cash Price	$79.20
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: MDX Hawaii PPO	$128.04

FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS [166807]

Facility

IP

$126.00

Service Code	NDC 63323082004
Hospital Revenue Code	258
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: MDX Hawaii PPO	$122.22

FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS [166807]

Facility

OP

$126.00

Service Code	NDC 63323082004
Hospital Revenue Code	258
Min. Negotiated Rate	$64.26
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$79.38
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: University Health Alliance Commercial	$91.84

FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS [166807]

Facility

IP

$126.00

Service Code	NDC 63323082074
Hospital Revenue Code	258
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: MDX Hawaii PPO	$122.22

FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS [166807]

Facility

OP

$126.00

Service Code	NDC 63323082074
Hospital Revenue Code	258
Min. Negotiated Rate	$64.26
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$79.38
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: University Health Alliance Commercial	$91.84

FEBUXOSTAT 40 MG TABLET [97133]

Facility

IP

$34.00

Service Code	NDC 64764091830
Hospital Revenue Code	250
Min. Negotiated Rate	$28.90
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$20.40
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: MDX Hawaii PPO	$32.98

FEBUXOSTAT 40 MG TABLET [97133]

Facility

OP

$30.00

Service Code	NDC 33342027407
Hospital Revenue Code	637
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
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: University Health Alliance Commercial	$21.87

FEBUXOSTAT 40 MG TABLET [97133]

Facility

OP

$31.00

Service Code	NDC 62332019030
Hospital Revenue Code	637
Min. Negotiated Rate	$15.81
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Hawaii Western Management Group Commercial	$29.45
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Kaiser Permanente Commercial	$19.53
Rate for Payer: Kaiser Permanente Medicaid	$15.81
Rate for Payer: MDX Hawaii PPO	$30.07
Rate for Payer: University Health Alliance Commercial	$22.60

FEBUXOSTAT 40 MG TABLET [97133]

Facility

IP

$31.00

Service Code	NDC 62332019030
Hospital Revenue Code	250
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: MDX Hawaii PPO	$30.07

FEBUXOSTAT 40 MG TABLET [97133]

Facility

OP

$34.00

Service Code	NDC 64764091830
Hospital Revenue Code	637
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$20.40
Rate for Payer: Hawaii Western Management Group Commercial	$32.30
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Kaiser Permanente Commercial	$21.42
Rate for Payer: Kaiser Permanente Medicaid	$17.34
Rate for Payer: MDX Hawaii PPO	$32.98
Rate for Payer: University Health Alliance Commercial	$24.78

FEBUXOSTAT 40 MG TABLET [97133]

Facility

IP

$30.00

Service Code	NDC 33342027407
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

FEBUXOSTAT 80 MG TABLET [97134]

Facility

OP

$31.00

Service Code	NDC 62332019130
Hospital Revenue Code	637
Min. Negotiated Rate	$15.81
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Hawaii Western Management Group Commercial	$29.45
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Kaiser Permanente Commercial	$19.53
Rate for Payer: Kaiser Permanente Medicaid	$15.81
Rate for Payer: MDX Hawaii PPO	$30.07
Rate for Payer: University Health Alliance Commercial	$22.60

FEBUXOSTAT 80 MG TABLET [97134]

Facility

IP

$31.00

Service Code	NDC 62332019130
Hospital Revenue Code	250
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: MDX Hawaii PPO	$30.07

FEEDING TUBE 18FR 0200-18

Facility

IP

$529.00

Hospital Revenue Code	272
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: MDX Hawaii PPO	$513.13

FEEDING TUBE 18FR 0200-18

Facility

OP

$529.00

Hospital Revenue Code	272
Min. Negotiated Rate	$269.79
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Hawaii Western Management Group Commercial	$502.55
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Kaiser Permanente Commercial	$333.27
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: University Health Alliance Commercial	$385.59

FEEDING TUBE 20FR 0200-20

Facility

OP

$536.00

Hospital Revenue Code	272
Min. Negotiated Rate	$273.36
Max. Negotiated Rate	$519.92
Rate for Payer: Cash Price	$321.60
Rate for Payer: Hawaii Western Management Group Commercial	$509.20
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: Kaiser Permanente Commercial	$337.68
Rate for Payer: Kaiser Permanente Medicaid	$273.36
Rate for Payer: MDX Hawaii PPO	$519.92
Rate for Payer: University Health Alliance Commercial	$390.69

FEEDING TUBE 20FR 0200-20

Facility

IP

$536.00

Hospital Revenue Code	272
Min. Negotiated Rate	$455.60
Max. Negotiated Rate	$519.92
Rate for Payer: Cash Price	$321.60
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: MDX Hawaii PPO	$519.92

FEMALE REPRODUCTIVE SYSTEM INFECTIONS

Facility

IP

$9,216.67

Service Code	APR-DRG 5314
Min. Negotiated Rate	$9,216.67
Max. Negotiated Rate	$9,216.67
Rate for Payer: AlohaCare Medicaid	$9,216.67
Rate for Payer: Hawaii Medical Service Association ABD	$9,216.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,216.67
Rate for Payer: Kaiser Permanente Medicaid	$9,216.67
Rate for Payer: Ohana Health Plan Medicaid	$9,216.67
Rate for Payer: UnitedHealthcare Medicaid	$9,216.67

FEMALE REPRODUCTIVE SYSTEM INFECTIONS

Facility

IP

$5,534.57

Service Code	APR-DRG 5313
Min. Negotiated Rate	$5,534.57
Max. Negotiated Rate	$5,534.57
Rate for Payer: AlohaCare Medicaid	$5,534.57
Rate for Payer: Hawaii Medical Service Association ABD	$5,534.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,534.57
Rate for Payer: Kaiser Permanente Medicaid	$5,534.57
Rate for Payer: Ohana Health Plan Medicaid	$5,534.57
Rate for Payer: UnitedHealthcare Medicaid	$5,534.57

FEMALE REPRODUCTIVE SYSTEM INFECTIONS

Facility

IP

$2,594.11

Service Code	APR-DRG 5311
Min. Negotiated Rate	$2,594.11
Max. Negotiated Rate	$2,594.11
Rate for Payer: AlohaCare Medicaid	$2,594.11
Rate for Payer: Hawaii Medical Service Association ABD	$2,594.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,594.11
Rate for Payer: Kaiser Permanente Medicaid	$2,594.11
Rate for Payer: Ohana Health Plan Medicaid	$2,594.11
Rate for Payer: UnitedHealthcare Medicaid	$2,594.11

FEMALE REPRODUCTIVE SYSTEM INFECTIONS

Facility

IP

$3,331.18

Service Code	APR-DRG 5312
Min. Negotiated Rate	$3,331.18
Max. Negotiated Rate	$3,331.18
Rate for Payer: AlohaCare Medicaid	$3,331.18
Rate for Payer: Hawaii Medical Service Association ABD	$3,331.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,331.18
Rate for Payer: Kaiser Permanente Medicaid	$3,331.18
Rate for Payer: Ohana Health Plan Medicaid	$3,331.18
Rate for Payer: UnitedHealthcare Medicaid	$3,331.18

FEMALE REPRODUCTIVE SYSTEM MALIGNANCY

Facility

IP

$3,746.03

Service Code	APR-DRG 5302
Min. Negotiated Rate	$3,746.03
Max. Negotiated Rate	$3,746.03
Rate for Payer: AlohaCare Medicaid	$3,746.03
Rate for Payer: Hawaii Medical Service Association ABD	$3,746.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,746.03
Rate for Payer: Kaiser Permanente Medicaid	$3,746.03
Rate for Payer: Ohana Health Plan Medicaid	$3,746.03
Rate for Payer: UnitedHealthcare Medicaid	$3,746.03

FEMALE REPRODUCTIVE SYSTEM MALIGNANCY

Facility

IP

$2,983.51

Service Code	APR-DRG 5301
Min. Negotiated Rate	$2,983.51
Max. Negotiated Rate	$2,983.51
Rate for Payer: AlohaCare Medicaid	$2,983.51
Rate for Payer: Hawaii Medical Service Association ABD	$2,983.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,983.51
Rate for Payer: Kaiser Permanente Medicaid	$2,983.51
Rate for Payer: Ohana Health Plan Medicaid	$2,983.51
Rate for Payer: UnitedHealthcare Medicaid	$2,983.51

FEMALE REPRODUCTIVE SYSTEM MALIGNANCY

Facility

IP

$5,401.51

Service Code	APR-DRG 5303
Min. Negotiated Rate	$5,401.51
Max. Negotiated Rate	$5,401.51
Rate for Payer: AlohaCare Medicaid	$5,401.51
Rate for Payer: Hawaii Medical Service Association ABD	$5,401.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,401.51
Rate for Payer: Kaiser Permanente Medicaid	$5,401.51
Rate for Payer: Ohana Health Plan Medicaid	$5,401.51
Rate for Payer: UnitedHealthcare Medicaid	$5,401.51

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