Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

FENTANYL 2500 MCG/250 ML (10 MCG/ML) IN D5W INFUSION (SIMPLE) [4080505]

Facility

IP

$118.00

Service Code	HCPCS J3010
Hospital Revenue Code	250
Min. Negotiated Rate	$100.30
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$70.80
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: MDX Hawaii PPO	$114.46

FENTANYL 2500 MCG/250 ML (10 MCG/ML) IN D5W INFUSION (SIMPLE) [4080505]

Facility

OP

$118.00

Service Code	HCPCS J3010
Hospital Revenue Code	636
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$70.80
Rate for Payer: Cash Price	$70.80
Rate for Payer: Hawaii Medical Service Association ABD	$0.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.96
Rate for Payer: Hawaii Western Management Group Commercial	$112.10
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Kaiser Permanente Commercial	$74.34
Rate for Payer: Kaiser Permanente Medicaid	$60.18
Rate for Payer: MDX Hawaii PPO	$114.46
Rate for Payer: UnitedHealthcare Medicaid	$70.80
Rate for Payer: University Health Alliance Commercial	$86.01

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

OP

$37.00

Service Code	NDC 00378912198
Hospital Revenue Code	637
Min. Negotiated Rate	$18.87
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Hawaii Western Management Group Commercial	$35.15
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$23.31
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: University Health Alliance Commercial	$26.97

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

OP

$37.00

Service Code	NDC 00406912576
Hospital Revenue Code	637
Min. Negotiated Rate	$18.87
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Hawaii Western Management Group Commercial	$35.15
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$23.31
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: University Health Alliance Commercial	$26.97

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

OP

$37.00

Service Code	NDC 00378912116
Hospital Revenue Code	637
Min. Negotiated Rate	$18.87
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Hawaii Western Management Group Commercial	$35.15
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$23.31
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: University Health Alliance Commercial	$26.97

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

IP

$37.00

Service Code	NDC 00378912116
Hospital Revenue Code	250
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: MDX Hawaii PPO	$35.89

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

IP

$37.00

Service Code	NDC 00378912198
Hospital Revenue Code	250
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: MDX Hawaii PPO	$35.89

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

IP

$37.00

Service Code	NDC 00406912576
Hospital Revenue Code	250
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: MDX Hawaii PPO	$35.89

FENTANYL 500 MCG/50 ML IN NS PCA (SIMPLE) [4080043]

Facility

IP

$60.00

Service Code	NDC 00004080014
Hospital Revenue Code	250
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: MDX Hawaii PPO	$58.20

FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]

Facility

OP

$66.00

Service Code	NDC 00378912298
Hospital Revenue Code	637
Min. Negotiated Rate	$33.66
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$39.60
Rate for Payer: Hawaii Western Management Group Commercial	$62.70
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Kaiser Permanente Commercial	$41.58
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: University Health Alliance Commercial	$48.11

FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]

Facility

IP

$66.00

Service Code	NDC 00378912298
Hospital Revenue Code	250
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$39.60
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: MDX Hawaii PPO	$64.02

FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]

Facility

OP

$66.00

Service Code	NDC 00406915076
Hospital Revenue Code	637
Min. Negotiated Rate	$33.66
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$39.60
Rate for Payer: Hawaii Western Management Group Commercial	$62.70
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Kaiser Permanente Commercial	$41.58
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: University Health Alliance Commercial	$48.11

FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]

Facility

IP

$66.00

Service Code	NDC 00406915076
Hospital Revenue Code	250
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$39.60
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: MDX Hawaii PPO	$64.02

FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]

Facility

OP

$101.00

Service Code	NDC 00406917576
Hospital Revenue Code	637
Min. Negotiated Rate	$51.51
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$60.60
Rate for Payer: Hawaii Western Management Group Commercial	$95.95
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Kaiser Permanente Commercial	$63.63
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: University Health Alliance Commercial	$73.62

FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]

Facility

IP

$101.00

Service Code	NDC 00378912316
Hospital Revenue Code	250
Min. Negotiated Rate	$85.85
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$60.60
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: MDX Hawaii PPO	$97.97

FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]

Facility

IP

$101.00

Service Code	NDC 00378912398
Hospital Revenue Code	250
Min. Negotiated Rate	$85.85
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$60.60
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: MDX Hawaii PPO	$97.97

FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]

Facility

IP

$101.00

Service Code	NDC 00406917576
Hospital Revenue Code	250
Min. Negotiated Rate	$85.85
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$60.60
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: MDX Hawaii PPO	$97.97

FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]

Facility

OP

$101.00

Service Code	NDC 00378912316
Hospital Revenue Code	637
Min. Negotiated Rate	$51.51
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$60.60
Rate for Payer: Hawaii Western Management Group Commercial	$95.95
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Kaiser Permanente Commercial	$63.63
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: University Health Alliance Commercial	$73.62

FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]

Facility

OP

$101.00

Service Code	NDC 00378912398
Hospital Revenue Code	637
Min. Negotiated Rate	$51.51
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$60.60
Rate for Payer: Hawaii Western Management Group Commercial	$95.95
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Kaiser Permanente Commercial	$63.63
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: University Health Alliance Commercial	$73.62

FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN (WRAPPED) [4080003037]

Facility

OP

$12.00

Service Code	HCPCS J3010
Hospital Revenue Code	636
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Hawaii Medical Service Association ABD	$0.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.96
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: UnitedHealthcare Medicaid	$7.20
Rate for Payer: University Health Alliance Commercial	$8.75

FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN (WRAPPED) [4080003037]

Facility

IP

$12.00

Service Code	HCPCS J3010
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

FENTANYL (PF) 10 MCG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [134120]

Facility

IP

$1,651.00

Service Code	HCPCS J3010
Hospital Revenue Code	250
Min. Negotiated Rate	$1,403.35
Max. Negotiated Rate	$1,601.47
Rate for Payer: Cash Price	$990.60
Rate for Payer: Cash Price	$60.60
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Health Management Network Commercial	$1,403.35
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: MDX Hawaii PPO	$1,601.47

FENTANYL (PF) 10 MCG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [134120]

Facility

OP

$1,651.00

Service Code	HCPCS J3010
Hospital Revenue Code	636
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$1,601.47
Rate for Payer: Cash Price	$990.60
Rate for Payer: Cash Price	$60.60
Rate for Payer: Cash Price	$990.60
Rate for Payer: Cash Price	$60.60
Rate for Payer: Hawaii Medical Service Association ABD	$0.96
Rate for Payer: Hawaii Medical Service Association ABD	$0.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.96
Rate for Payer: Hawaii Western Management Group Commercial	$95.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,568.45
Rate for Payer: Health Management Network Commercial	$1,403.35
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Kaiser Permanente Commercial	$1,040.13
Rate for Payer: Kaiser Permanente Commercial	$63.63
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: Kaiser Permanente Medicaid	$842.01
Rate for Payer: MDX Hawaii PPO	$1,601.47
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: UnitedHealthcare Medicaid	$60.60
Rate for Payer: UnitedHealthcare Medicaid	$990.60
Rate for Payer: University Health Alliance Commercial	$1,203.41
Rate for Payer: University Health Alliance Commercial	$73.62

FENTANYL (PF) 2 MCG/ML-BUPIVACAINE 0.125 %-NACL INJECTION SOLUTION [134136]

Facility

IP

$83.00

Service Code	NDC 70092110436
Hospital Revenue Code	250
Min. Negotiated Rate	$70.55
Max. Negotiated Rate	$80.51
Rate for Payer: Cash Price	$49.80
Rate for Payer: Health Management Network Commercial	$70.55
Rate for Payer: MDX Hawaii PPO	$80.51

FENTANYL (PF) 2 MCG/ML-BUPIVACAINE 0.125 %-NACL INJECTION SOLUTION - BOLUS FROM BAG [4080509]

Facility

IP

$83.00

Service Code	NDC 70092110436
Hospital Revenue Code	250
Min. Negotiated Rate	$70.55
Max. Negotiated Rate	$80.51
Rate for Payer: Cash Price	$49.80
Rate for Payer: Health Management Network Commercial	$70.55
Rate for Payer: MDX Hawaii PPO	$80.51

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