Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

ASPIRIN 81 MG CHEWABLE TABLET [680]

Facility

OP

$1.00

Service Code	NDC 00904679430
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

ASPIRIN 81 MG CHEWABLE TABLET [680]

Facility

IP

$1.00

Service Code	NDC 00904679430
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 81 MG CHEWABLE TABLET [680]

Facility

IP

$1.00

Service Code	NDC 00904750930
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 81 MG CHEWABLE TABLET [680]

Facility

OP

$1.00

Service Code	NDC 00904404073
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 TABLET,DELAYED RELEASE [688]

Facility

OP

$1.00

Service Code	NDC 00536123441
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 TABLET,DELAYED RELEASE [688]

Facility

OP

$1.00

Service Code	NDC 71399101402
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 TABLET,DELAYED RELEASE [688]

Facility

OP

$1.00

Service Code	NDC 71399862702
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 TABLET,DELAYED RELEASE [688]

Facility

IP

$1.00

Service Code	NDC 71399101402
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 81 MG TABLET,DELAYED RELEASE [688]

Facility

IP

$1.00

Service Code	NDC 71399862702
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 81 MG TABLET,DELAYED RELEASE [688]

Facility

IP

$1.00

Service Code	NDC 00536123441
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

ASTHMA

Facility

IP

$2,112.73

Service Code	APR-DRG 1411
Min. Negotiated Rate	$2,112.73
Max. Negotiated Rate	$2,112.73
Rate for Payer: AlohaCare Medicaid	$2,112.73
Rate for Payer: Hawaii Medical Service Association ABD	$2,112.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,112.73
Rate for Payer: Kaiser Permanente Medicaid	$2,112.73
Rate for Payer: Ohana Health Plan Medicaid	$2,112.73
Rate for Payer: UnitedHealthcare Medicaid	$2,112.73

ASTHMA

Facility

IP

$7,073.94

Service Code	APR-DRG 1414
Min. Negotiated Rate	$7,073.94
Max. Negotiated Rate	$7,073.94
Rate for Payer: AlohaCare Medicaid	$7,073.94
Rate for Payer: Hawaii Medical Service Association ABD	$7,073.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,073.94
Rate for Payer: Kaiser Permanente Medicaid	$7,073.94
Rate for Payer: Ohana Health Plan Medicaid	$7,073.94
Rate for Payer: UnitedHealthcare Medicaid	$7,073.94

ASTHMA

Facility

IP

$4,156.31

Service Code	APR-DRG 1413
Min. Negotiated Rate	$4,156.31
Max. Negotiated Rate	$4,156.31
Rate for Payer: AlohaCare Medicaid	$4,156.31
Rate for Payer: Hawaii Medical Service Association ABD	$4,156.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,156.31
Rate for Payer: Kaiser Permanente Medicaid	$4,156.31
Rate for Payer: Ohana Health Plan Medicaid	$4,156.31
Rate for Payer: UnitedHealthcare Medicaid	$4,156.31

ASTHMA

Facility

IP

$2,973.73

Service Code	APR-DRG 1412
Min. Negotiated Rate	$2,973.73
Max. Negotiated Rate	$2,973.73
Rate for Payer: AlohaCare Medicaid	$2,973.73
Rate for Payer: Hawaii Medical Service Association ABD	$2,973.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,973.73
Rate for Payer: Kaiser Permanente Medicaid	$2,973.73
Rate for Payer: Ohana Health Plan Medicaid	$2,973.73
Rate for Payer: UnitedHealthcare Medicaid	$2,973.73

ASYMMETRIC 35X10 5551-G-350-E

Facility

OP

$2,341.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,193.91
Max. Negotiated Rate	$2,270.77
Rate for Payer: Cash Price	$1,404.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,638.70
Rate for Payer: Health Management Network Commercial	$1,989.85
Rate for Payer: Kaiser Permanente Commercial	$1,474.83
Rate for Payer: Kaiser Permanente Medicaid	$1,193.91
Rate for Payer: MDX Hawaii PPO	$2,270.77
Rate for Payer: University Health Alliance Commercial	$1,310.96

ASYMMETRIC 35X10 5551-G-350-E

Facility

IP

$2,341.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,310.96
Max. Negotiated Rate	$2,270.77
Rate for Payer: Cash Price	$1,404.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,638.70
Rate for Payer: Health Management Network Commercial	$1,989.85
Rate for Payer: MDX Hawaii PPO	$2,270.77
Rate for Payer: University Health Alliance Commercial	$1,310.96

ATENOLOL 25 MG TABLET [717]

Facility

IP

$1.00

Service Code	NDC 00904718761
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

ATENOLOL 25 MG TABLET [717]

Facility

IP

$3.00

Service Code	NDC 51079075920
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: MDX Hawaii PPO	$2.91

ATENOLOL 25 MG TABLET [717]

Facility

OP

$3.00

Service Code	NDC 51079075920
Hospital Revenue Code	637
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$1.89
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: University Health Alliance Commercial	$2.19

ATENOLOL 25 MG TABLET [717]

Facility

OP

$1.00

Service Code	NDC 00904718761
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

ATENOLOL 50 MG TABLET [718]

Facility

IP

$4.00

Service Code	NDC 51079068401
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: MDX Hawaii PPO	$3.88

ATENOLOL 50 MG TABLET [718]

Facility

OP

$4.00

Service Code	NDC 51079068420
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.92

ATENOLOL 50 MG TABLET [718]

Facility

OP

$4.00

Service Code	NDC 51079068401
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.92

ATENOLOL 50 MG TABLET [718]

Facility

IP

$4.00

Service Code	NDC 51079068420
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: MDX Hawaii PPO	$3.88

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