Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

BACITRACIN 500 UNIT/GRAM TOPICAL PACKET [201691]

Facility

IP

$1.00

Service Code	NDC 68001047745
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

BACITRACIN 500 UNIT/GRAM TOPICAL PACKET [201691]

Facility

OP

$1.00

Service Code	NDC 45802006070
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

BACITRACIN 500 UNIT/GRAM TOPICAL PACKET [201691]

Facility

OP

$1.00

Service Code	NDC 68001047745
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

BACITRACIN 500 UNIT/GRAM TOPICAL PACKET [201691]

Facility

OP

$1.00

Service Code	NDC 68001047748
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

BACITRACIN 500 UNIT/GRAM TOPICAL PACKET [201691]

Facility

IP

$1.00

Service Code	NDC 45802006070
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

BACITRACIN-POLYMYXIN B 500 UNIT-10,000 UNIT/GRAM EYE OINTMENT [856]

Facility

IP

$76.00

Service Code	NDC 24208055555
Hospital Revenue Code	250
Min. Negotiated Rate	$64.60
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$45.60
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: MDX Hawaii PPO	$73.72

BACITRACIN-POLYMYXIN B 500 UNIT-10,000 UNIT/GRAM EYE OINTMENT [856]

Facility

OP

$76.00

Service Code	NDC 24208055555
Hospital Revenue Code	637
Min. Negotiated Rate	$38.76
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$45.60
Rate for Payer: Hawaii Western Management Group Commercial	$72.20
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Kaiser Permanente Commercial	$47.88
Rate for Payer: Kaiser Permanente Medicaid	$38.76
Rate for Payer: MDX Hawaii PPO	$73.72
Rate for Payer: University Health Alliance Commercial	$55.40

BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT [13818]

Facility

IP

$17.00

Service Code	NDC 51672207501
Hospital Revenue Code	250
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: MDX Hawaii PPO	$16.49

BACITRACIN ZINC 500 UNIT/GRAM TOPICAL OINTMENT [13818]

Facility

OP

$17.00

Service Code	NDC 51672207501
Hospital Revenue Code	637
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$10.71
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: University Health Alliance Commercial	$12.39

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC

Facility

IP

$47,464.30

Service Code	MSDRG 519
Min. Negotiated Rate	$22,750.79
Max. Negotiated Rate	$47,464.30
Rate for Payer: AlohaCare Medicare	$22,750.79
Rate for Payer: Devoted Health Medicare	$25,025.87
Rate for Payer: Hawaii Medical Service Association Commercial	$47,464.30
Rate for Payer: Hawaii Medical Service Association Medicare	$22,750.79
Rate for Payer: Humana Medicare	$22,750.79
Rate for Payer: Kaiser Permanente Commercial	$34,503.45
Rate for Payer: Kaiser Permanente Medicare	$22,750.79
Rate for Payer: Ohana Health Plan Medicare	$22,750.79
Rate for Payer: UnitedHealthcare Medicare	$22,750.79

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR

Facility

IP

$64,468.43

Service Code	MSDRG 518
Min. Negotiated Rate	$42,509.00
Max. Negotiated Rate	$64,468.43
Rate for Payer: AlohaCare Medicare	$42,509.00
Rate for Payer: Devoted Health Medicare	$46,759.90
Rate for Payer: Hawaii Medical Service Association Commercial	$47,464.30
Rate for Payer: Hawaii Medical Service Association Medicare	$42,509.00
Rate for Payer: Humana Medicare	$42,509.00
Rate for Payer: Kaiser Permanente Commercial	$64,468.43
Rate for Payer: Kaiser Permanente Medicare	$42,509.00
Rate for Payer: Ohana Health Plan Medicare	$42,509.00
Rate for Payer: UnitedHealthcare Medicare	$42,509.00

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC

Facility

IP

$30,623.69

Service Code	MSDRG 520
Min. Negotiated Rate	$16,992.01
Max. Negotiated Rate	$30,623.69
Rate for Payer: AlohaCare Medicare	$16,992.01
Rate for Payer: Devoted Health Medicare	$18,691.21
Rate for Payer: Hawaii Medical Service Association Commercial	$30,623.69
Rate for Payer: Hawaii Medical Service Association Medicare	$16,992.01
Rate for Payer: Humana Medicare	$16,992.01
Rate for Payer: Kaiser Permanente Commercial	$25,769.78
Rate for Payer: Kaiser Permanente Medicare	$16,992.01
Rate for Payer: Ohana Health Plan Medicare	$16,992.01
Rate for Payer: UnitedHealthcare Medicare	$16,992.01

BACLOFEN 10 MG TABLET [860]

Facility

OP

$3.00

Service Code	NDC 50268010615
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

BACLOFEN 10 MG TABLET [860]

Facility

OP

$2.00

Service Code	NDC 00904647561
Hospital Revenue Code	637
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.26
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: University Health Alliance Commercial	$1.46

BACLOFEN 10 MG TABLET [860]

Facility

IP

$2.00

Service Code	NDC 00904647561
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: MDX Hawaii PPO	$1.94

BACLOFEN 10 MG TABLET [860]

Facility

IP

$3.00

Service Code	NDC 50268010615
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

BACLOFEN 20 MG TABLET [861]

Facility

IP

$4.00

Service Code	NDC 60687082611
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

BACLOFEN 20 MG TABLET [861]

Facility

OP

$18.00

Service Code	NDC 70710128601
Hospital Revenue Code	637
Min. Negotiated Rate	$9.18
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$10.80
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$11.34
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: University Health Alliance Commercial	$13.12

BACLOFEN 20 MG TABLET [861]

Facility

OP

$4.00

Service Code	NDC 60687082611
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

BACLOFEN 20 MG TABLET [861]

Facility

IP

$18.00

Service Code	NDC 70710128601
Hospital Revenue Code	250
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: MDX Hawaii PPO	$17.46

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC

Facility

IP

$52,535.89

Service Code	MSDRG 095
Min. Negotiated Rate	$29,336.47
Max. Negotiated Rate	$52,535.89
Rate for Payer: AlohaCare Medicare	$29,336.47
Rate for Payer: Devoted Health Medicare	$32,270.12
Rate for Payer: Hawaii Medical Service Association Commercial	$52,535.89
Rate for Payer: Hawaii Medical Service Association Medicare	$29,336.47
Rate for Payer: Humana Medicare	$29,336.47
Rate for Payer: Kaiser Permanente Commercial	$44,491.20
Rate for Payer: Kaiser Permanente Medicare	$29,336.47
Rate for Payer: Ohana Health Plan Medicare	$29,336.47
Rate for Payer: UnitedHealthcare Medicare	$29,336.47

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC

Facility

IP

$60,709.65

Service Code	MSDRG 094
Min. Negotiated Rate	$40,030.56
Max. Negotiated Rate	$60,709.65
Rate for Payer: AlohaCare Medicare	$40,030.56
Rate for Payer: Devoted Health Medicare	$44,033.62
Rate for Payer: Hawaii Medical Service Association Commercial	$52,535.89
Rate for Payer: Hawaii Medical Service Association Medicare	$40,030.56
Rate for Payer: Humana Medicare	$40,030.56
Rate for Payer: Kaiser Permanente Commercial	$60,709.65
Rate for Payer: Kaiser Permanente Medicare	$40,030.56
Rate for Payer: Ohana Health Plan Medicare	$40,030.56
Rate for Payer: UnitedHealthcare Medicare	$40,030.56

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

IP

$52,535.89

Service Code	MSDRG 096
Min. Negotiated Rate	$29,336.47
Max. Negotiated Rate	$52,535.89
Rate for Payer: AlohaCare Medicare	$29,336.47
Rate for Payer: Devoted Health Medicare	$32,270.12
Rate for Payer: Hawaii Medical Service Association Commercial	$52,535.89
Rate for Payer: Hawaii Medical Service Association Medicare	$29,336.47
Rate for Payer: Humana Medicare	$29,336.47
Rate for Payer: Kaiser Permanente Commercial	$44,491.20
Rate for Payer: Kaiser Permanente Medicare	$29,336.47
Rate for Payer: Ohana Health Plan Medicare	$29,336.47
Rate for Payer: UnitedHealthcare Medicare	$29,336.47

BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

IP

$5,697.64

Service Code	APR-DRG 0491
Min. Negotiated Rate	$5,697.64
Max. Negotiated Rate	$5,697.64
Rate for Payer: AlohaCare Medicaid	$5,697.64
Rate for Payer: Hawaii Medical Service Association ABD	$5,697.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,697.64
Rate for Payer: Kaiser Permanente Medicaid	$5,697.64
Rate for Payer: Ohana Health Plan Medicaid	$5,697.64
Rate for Payer: UnitedHealthcare Medicaid	$5,697.64

BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

IP

$10,514.71

Service Code	APR-DRG 0493
Min. Negotiated Rate	$10,514.71
Max. Negotiated Rate	$10,514.71
Rate for Payer: AlohaCare Medicaid	$10,514.71
Rate for Payer: Hawaii Medical Service Association ABD	$10,514.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,514.71
Rate for Payer: Kaiser Permanente Medicaid	$10,514.71
Rate for Payer: Ohana Health Plan Medicaid	$10,514.71
Rate for Payer: UnitedHealthcare Medicaid	$10,514.71

<<
<
41
42
43
44
45
46
47
48
49
50
>
>>