Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [122366]

Facility

OP

$33.00

Service Code	NDC 59011042020
Hospital Revenue Code	637
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$19.80
Rate for Payer: Hawaii Western Management Group Commercial	$31.35
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Kaiser Permanente Commercial	$20.79
Rate for Payer: Kaiser Permanente Medicaid	$16.83
Rate for Payer: MDX Hawaii PPO	$32.01
Rate for Payer: University Health Alliance Commercial	$24.05

OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [122368]

Facility

OP

$56.00

Service Code	NDC 59011044020
Hospital Revenue Code	637
Min. Negotiated Rate	$28.56
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$33.60
Rate for Payer: Hawaii Western Management Group Commercial	$53.20
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Kaiser Permanente Commercial	$35.28
Rate for Payer: Kaiser Permanente Medicaid	$28.56
Rate for Payer: MDX Hawaii PPO	$54.32
Rate for Payer: University Health Alliance Commercial	$40.82

OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [122368]

Facility

IP

$56.00

Service Code	NDC 59011044020
Hospital Revenue Code	250
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$33.60
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: MDX Hawaii PPO	$54.32

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

OP

$1.00

Service Code	NDC 00904676130
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

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

OP

$24.00

Service Code	NDC 46122016510
Hospital Revenue Code	637
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$14.40
Rate for Payer: Hawaii Western Management Group Commercial	$22.80
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Kaiser Permanente Commercial	$15.12
Rate for Payer: Kaiser Permanente Medicaid	$12.24
Rate for Payer: MDX Hawaii PPO	$23.28
Rate for Payer: University Health Alliance Commercial	$17.49

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

IP

$10.00

Service Code	NDC 00904742730
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.00
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: MDX Hawaii PPO	$9.70

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

IP

$24.00

Service Code	NDC 46122016510
Hospital Revenue Code	250
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: MDX Hawaii PPO	$23.28

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

IP

$1.00

Service Code	NDC 00904676130
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

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

OP

$23.00

Service Code	NDC 81127000000
Hospital Revenue Code	637
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$13.80
Rate for Payer: Hawaii Western Management Group Commercial	$21.85
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Kaiser Permanente Commercial	$14.49
Rate for Payer: Kaiser Permanente Medicaid	$11.73
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: University Health Alliance Commercial	$16.76

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

IP

$23.00

Service Code	NDC 81127000000
Hospital Revenue Code	250
Min. Negotiated Rate	$19.55
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$13.80
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: MDX Hawaii PPO	$22.31

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

OP

$10.00

Service Code	NDC 00904742730
Hospital Revenue Code	637
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.00
Rate for Payer: Hawaii Western Management Group Commercial	$9.50
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$5.10
Rate for Payer: MDX Hawaii PPO	$9.70
Rate for Payer: University Health Alliance Commercial	$7.29

OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]

Facility

IP

$7.00

Service Code	NDC 63323001207
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: MDX Hawaii PPO	$6.79

OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]

Facility

IP

$15.00

Service Code	NDC 63323001203
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: MDX Hawaii PPO	$14.55

OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]

Facility

IP

$43.00

Service Code	NDC 63323001210
Hospital Revenue Code	250
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: MDX Hawaii PPO	$41.71

OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]

Facility

IP

$59.00

Service Code	NDC 42023011602
Hospital Revenue Code	250
Min. Negotiated Rate	$50.15
Max. Negotiated Rate	$57.23
Rate for Payer: Cash Price	$35.40
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: MDX Hawaii PPO	$57.23

OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]

Facility

IP

$15.00

Service Code	NDC 63323001211
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$26.40
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: MDX Hawaii PPO	$42.68

OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [136947]

Facility

IP

$81.00

Service Code	NDC 70092106807
Hospital Revenue Code	250
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$48.60
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: MDX Hawaii PPO	$78.57

OXYTOCIN 30 UNIT/500 ML IN NS BOLUS [4080179]

Facility

IP

$81.00

Service Code	NDC 70092106807
Hospital Revenue Code	250
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$48.60
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: MDX Hawaii PPO	$78.57

OXYTOCIN 30 UNITS IN 500 ML NS (SIMPLE) [4080272]

Facility

IP

$58.00

Service Code	NDC 00004080196
Hospital Revenue Code	250
Min. Negotiated Rate	$49.30
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$34.80
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: MDX Hawaii PPO	$56.26

PACEL BIPOLAR PACING CATH 5FR

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

PACEL BIPOLAR PACING CATH 5FR

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

PACEMAKER ASSURITY MRI PM2272

Facility

IP

$10,000.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$5,600.00
Max. Negotiated Rate	$9,700.00
Rate for Payer: Cash Price	$6,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,000.00
Rate for Payer: Health Management Network Commercial	$8,500.00
Rate for Payer: MDX Hawaii PPO	$9,700.00
Rate for Payer: University Health Alliance Commercial	$5,600.00

PACEMAKER ASSURITY MRI PM2272

Facility

OP

$10,000.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$5,100.00
Max. Negotiated Rate	$9,700.00
Rate for Payer: Cash Price	$6,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,000.00
Rate for Payer: Health Management Network Commercial	$8,500.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: Kaiser Permanente Medicaid	$5,100.00
Rate for Payer: MDX Hawaii PPO	$9,700.00
Rate for Payer: University Health Alliance Commercial	$5,600.00

PACEMAKER DUAL ASSURITY PM2240

Facility

OP

$9,200.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$4,692.00
Max. Negotiated Rate	$8,924.00
Rate for Payer: Cash Price	$5,520.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,440.00
Rate for Payer: Health Management Network Commercial	$7,820.00
Rate for Payer: Kaiser Permanente Commercial	$5,796.00
Rate for Payer: Kaiser Permanente Medicaid	$4,692.00
Rate for Payer: MDX Hawaii PPO	$8,924.00
Rate for Payer: University Health Alliance Commercial	$5,152.00

PACEMAKER DUAL ASSURITY PM2240

Facility

IP

$9,200.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$5,152.00
Max. Negotiated Rate	$8,924.00
Rate for Payer: Cash Price	$5,520.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,440.00
Rate for Payer: Health Management Network Commercial	$7,820.00
Rate for Payer: MDX Hawaii PPO	$8,924.00
Rate for Payer: University Health Alliance Commercial	$5,152.00

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