Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

ASCORBIC ACID (VITAMIN C) 250 MG TABLET [663]

Facility

OP

$1.00

Service Code	NDC 00100000000
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

ASCORBIC ACID (VITAMIN C) 250 MG TABLET [663]

Facility

IP

$1.00

Service Code	NDC 86015000000
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

ASCORBIC ACID (VITAMIN C) 250 MG TABLET [663]

Facility

IP

$1.00

Service Code	NDC 00100000000
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

ASCORBIC ACID (VITAMIN C) 250 MG TABLET [663]

Facility

OP

$1.00

Service Code	NDC 86011000000
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

ASCORBIC ACID (VITAMIN C) 250 MG TABLET [663]

Facility

IP

$1.00

Service Code	NDC 86011000000
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

ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]

Facility

OP

$1.00

Service Code	NDC 52361000000
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

ASCORBIC ACID (VITAMIN C) 500 MG TABLET [664]

Facility

IP

$1.00

Service Code	NDC 52361000000
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

ASH SPLIT CATH 16FRX40CM

Facility

IP

$1,292.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$1,098.20
Max. Negotiated Rate	$1,253.24
Rate for Payer: Cash Price	$775.20
Rate for Payer: Health Management Network Commercial	$1,098.20
Rate for Payer: MDX Hawaii PPO	$1,253.24

ASH SPLIT CATH 16FRX40CM

Facility

OP

$1,292.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$658.92
Max. Negotiated Rate	$1,253.24
Rate for Payer: Cash Price	$775.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,227.40
Rate for Payer: Health Management Network Commercial	$1,098.20
Rate for Payer: Kaiser Permanente Commercial	$813.96
Rate for Payer: Kaiser Permanente Medicaid	$658.92
Rate for Payer: MDX Hawaii PPO	$1,253.24
Rate for Payer: University Health Alliance Commercial	$941.74

ASPIRATE BONE MARRW MC-RAN-11C

Facility

IP

$2,500.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,125.00
Max. Negotiated Rate	$2,425.00
Rate for Payer: Cash Price	$1,500.00
Rate for Payer: Health Management Network Commercial	$2,125.00
Rate for Payer: MDX Hawaii PPO	$2,425.00

ASPIRATE BONE MARRW MC-RAN-11C

Facility

OP

$2,500.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,425.00
Rate for Payer: Cash Price	$1,500.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,375.00
Rate for Payer: Health Management Network Commercial	$2,125.00
Rate for Payer: Kaiser Permanente Commercial	$1,575.00
Rate for Payer: Kaiser Permanente Medicaid	$1,275.00
Rate for Payer: MDX Hawaii PPO	$2,425.00
Rate for Payer: University Health Alliance Commercial	$1,822.25

ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER

Facility

OP

$5,509.00

Service Code	CPT 51102
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$2,469.46
Rate for Payer: AlohaCare Medicare	$2,469.46
Rate for Payer: Devoted Health Medicare	$2,716.41
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,469.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Humana Medicare	$2,469.46
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,469.46
Rate for Payer: Ohana Health Plan Medicaid	$2,716.41
Rate for Payer: Ohana Health Plan Medicare	$2,469.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,469.46

ASPIRATION TUBING PAL-1200

Facility

OP

$95.00

Hospital Revenue Code	272
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$57.00
Rate for Payer: Hawaii Western Management Group Commercial	$90.25
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Kaiser Permanente Commercial	$59.85
Rate for Payer: Kaiser Permanente Medicaid	$48.45
Rate for Payer: MDX Hawaii PPO	$92.15
Rate for Payer: University Health Alliance Commercial	$69.25

ASPIRATION TUBING PAL-1200

Facility

IP

$95.00

Hospital Revenue Code	272
Min. Negotiated Rate	$80.75
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$57.00
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: MDX Hawaii PPO	$92.15

ASPIRIN 300 MG RECTAL SUPPOSITORY [693]

Facility

OP

$6.00

Service Code	NDC 00574703412
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$3.78
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: University Health Alliance Commercial	$4.37

ASPIRIN 300 MG RECTAL SUPPOSITORY [693]

Facility

IP

$6.00

Service Code	NDC 00574703412
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: MDX Hawaii PPO	$5.82

ASPIRIN 325 MG TABLET [681]

Facility

OP

$1.00

Service Code	NDC 00536105429
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

ASPIRIN 325 MG TABLET [681]

Facility

IP

$1.00

Service Code	NDC 00280200010
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

ASPIRIN 325 MG TABLET [681]

Facility

OP

$1.00

Service Code	NDC 00280200010
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

ASPIRIN 325 MG TABLET [681]

Facility

IP

$1.00

Service Code	NDC 00536105429
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

ASPIRIN 325 MG TABLET,DELAYED RELEASE [685]

Facility

IP

$1.00

Service Code	NDC 00536123201
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

ASPIRIN 325 MG TABLET,DELAYED RELEASE [685]

Facility

IP

$1.00

Service Code	NDC 69618001501
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

ASPIRIN 325 MG TABLET,DELAYED RELEASE [685]

Facility

OP

$1.00

Service Code	NDC 69618001501
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

ASPIRIN 325 MG TABLET,DELAYED RELEASE [685]

Facility

OP

$1.00

Service Code	NDC 00536123201
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

ASPIRIN 81 MG CHEWABLE TABLET [680]

Facility

IP

$1.00

Service Code	NDC 00904404073
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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