Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

ACETAZOLAMIDE 250 MG TABLET [113]

Facility

IP

$15.00

Service Code	NDC 60687061911
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

ACETAZOLAMIDE 250 MG TABLET [113]

Facility

OP

$15.00

Service Code	NDC 50268005415
Hospital Revenue Code	637
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: University Health Alliance Commercial	$10.93

ACETAZOLAMIDE 250 MG TABLET [113]

Facility

IP

$15.00

Service Code	NDC 50268005415
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

ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION [114]

Facility

IP

$106.00

Service Code	HCPCS J1120
Hospital Revenue Code	250
Min. Negotiated Rate	$90.10
Max. Negotiated Rate	$102.82
Rate for Payer: Cash Price	$63.60
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: MDX Hawaii PPO	$102.82

ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION [114]

Facility

OP

$106.00

Service Code	HCPCS J1120
Hospital Revenue Code	636
Min. Negotiated Rate	$17.23
Max. Negotiated Rate	$102.82
Rate for Payer: Cash Price	$63.60
Rate for Payer: Cash Price	$63.60
Rate for Payer: Hawaii Medical Service Association ABD	$17.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.23
Rate for Payer: Hawaii Western Management Group Commercial	$100.70
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Kaiser Permanente Commercial	$66.78
Rate for Payer: Kaiser Permanente Medicaid	$54.06
Rate for Payer: MDX Hawaii PPO	$102.82
Rate for Payer: UnitedHealthcare Medicaid	$63.60
Rate for Payer: University Health Alliance Commercial	$77.26

ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE [8962]

Facility

IP

$21.00

Service Code	NDC 50268004212
Hospital Revenue Code	250
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: MDX Hawaii PPO	$20.37

ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE [8962]

Facility

IP

$16.00

Service Code	NDC 42571024301
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: MDX Hawaii PPO	$15.52

ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE [8962]

Facility

OP

$16.00

Service Code	NDC 42571024301
Hospital Revenue Code	637
Min. Negotiated Rate	$8.16
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$10.08
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: University Health Alliance Commercial	$11.66

ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE [8962]

Facility

IP

$21.00

Service Code	NDC 50268004211
Hospital Revenue Code	250
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: MDX Hawaii PPO	$20.37

ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE [8962]

Facility

OP

$21.00

Service Code	NDC 50268004212
Hospital Revenue Code	637
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Hawaii Western Management Group Commercial	$19.95
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$13.23
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: University Health Alliance Commercial	$15.31

ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE [8962]

Facility

OP

$21.00

Service Code	NDC 50268004211
Hospital Revenue Code	637
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Hawaii Western Management Group Commercial	$19.95
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$13.23
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: University Health Alliance Commercial	$15.31

ACETIC ACID 0.25 % IRRIGATION SOLUTION [8963]

Facility

IP

$21.00

Service Code	NDC 00990614309
Hospital Revenue Code	250
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: MDX Hawaii PPO	$20.37

ACETIC ACID 2 % EAR SOLUTION [17801]

Facility

OP

$168.00

Service Code	NDC 52817081615
Hospital Revenue Code	637
Min. Negotiated Rate	$85.68
Max. Negotiated Rate	$162.96
Rate for Payer: Cash Price	$100.80
Rate for Payer: Hawaii Western Management Group Commercial	$159.60
Rate for Payer: Health Management Network Commercial	$142.80
Rate for Payer: Kaiser Permanente Commercial	$105.84
Rate for Payer: Kaiser Permanente Medicaid	$85.68
Rate for Payer: MDX Hawaii PPO	$162.96
Rate for Payer: University Health Alliance Commercial	$122.46

ACETIC ACID 2 % EAR SOLUTION [17801]

Facility

IP

$168.00

Service Code	NDC 52817081615
Hospital Revenue Code	250
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$162.96
Rate for Payer: Cash Price	$100.80
Rate for Payer: Health Management Network Commercial	$142.80
Rate for Payer: MDX Hawaii PPO	$162.96

ACETIC ACID 5% 1 GAL [4080288]

Facility

IP

$1.00

Service Code	NDC 00004080071
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Cash Price	$17.40
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: MDX Hawaii PPO	$28.13

ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) INTRAOCULAR KIT [132335]

Facility

IP

$236.00

Service Code	NDC 24208053920
Hospital Revenue Code	250
Min. Negotiated Rate	$200.60
Max. Negotiated Rate	$228.92
Rate for Payer: Cash Price	$141.60
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: MDX Hawaii PPO	$228.92

ACETYLCHOLINE CHLORIDE 1 % (10 MG/ML) INTRAOCULAR KIT [132335]

Facility

OP

$236.00

Service Code	NDC 24208053920
Hospital Revenue Code	637
Min. Negotiated Rate	$120.36
Max. Negotiated Rate	$228.92
Rate for Payer: Cash Price	$141.60
Rate for Payer: Hawaii Western Management Group Commercial	$224.20
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Kaiser Permanente Commercial	$148.68
Rate for Payer: Kaiser Permanente Medicaid	$120.36
Rate for Payer: MDX Hawaii PPO	$228.92
Rate for Payer: University Health Alliance Commercial	$172.02

ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION [38303]

Facility

OP

$77.00

Service Code	HCPCS J0132
Hospital Revenue Code	636
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$90.60
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$46.20
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$90.60
Rate for Payer: Hawaii Medical Service Association ABD	$0.37
Rate for Payer: Hawaii Medical Service Association ABD	$0.37
Rate for Payer: Hawaii Medical Service Association ABD	$0.37
Rate for Payer: Hawaii Medical Service Association ABD	$0.37
Rate for Payer: Hawaii Medical Service Association ABD	$0.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.37
Rate for Payer: Hawaii Western Management Group Commercial	$199.50
Rate for Payer: Hawaii Western Management Group Commercial	$143.45
Rate for Payer: Hawaii Western Management Group Commercial	$216.60
Rate for Payer: Hawaii Western Management Group Commercial	$73.15
Rate for Payer: Hawaii Western Management Group Commercial	$212.80
Rate for Payer: Health Management Network Commercial	$190.40
Rate for Payer: Health Management Network Commercial	$128.35
Rate for Payer: Health Management Network Commercial	$178.50
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$141.12
Rate for Payer: Kaiser Permanente Commercial	$48.51
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Commercial	$95.13
Rate for Payer: Kaiser Permanente Commercial	$143.64
Rate for Payer: Kaiser Permanente Medicaid	$114.24
Rate for Payer: Kaiser Permanente Medicaid	$77.01
Rate for Payer: Kaiser Permanente Medicaid	$39.27
Rate for Payer: Kaiser Permanente Medicaid	$116.28
Rate for Payer: Kaiser Permanente Medicaid	$107.10
Rate for Payer: MDX Hawaii PPO	$217.28
Rate for Payer: MDX Hawaii PPO	$203.70
Rate for Payer: MDX Hawaii PPO	$221.16
Rate for Payer: MDX Hawaii PPO	$146.47
Rate for Payer: MDX Hawaii PPO	$74.69
Rate for Payer: UnitedHealthcare Medicaid	$90.60
Rate for Payer: UnitedHealthcare Medicaid	$136.80
Rate for Payer: UnitedHealthcare Medicaid	$46.20
Rate for Payer: UnitedHealthcare Medicaid	$126.00
Rate for Payer: UnitedHealthcare Medicaid	$134.40
Rate for Payer: University Health Alliance Commercial	$166.19
Rate for Payer: University Health Alliance Commercial	$163.27
Rate for Payer: University Health Alliance Commercial	$153.07
Rate for Payer: University Health Alliance Commercial	$110.06
Rate for Payer: University Health Alliance Commercial	$56.13

ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION [38303]

Facility

IP

$228.00

Service Code	HCPCS J0132
Hospital Revenue Code	250
Min. Negotiated Rate	$193.80
Max. Negotiated Rate	$221.16
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$46.20
Rate for Payer: Cash Price	$90.60
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$134.40
Rate for Payer: Health Management Network Commercial	$128.35
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: Health Management Network Commercial	$190.40
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Health Management Network Commercial	$178.50
Rate for Payer: MDX Hawaii PPO	$74.69
Rate for Payer: MDX Hawaii PPO	$146.47
Rate for Payer: MDX Hawaii PPO	$203.70
Rate for Payer: MDX Hawaii PPO	$217.28
Rate for Payer: MDX Hawaii PPO	$221.16

ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION [123]

Facility

IP

$80.00

Service Code	HCPCS J7608
Hospital Revenue Code	250
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$43.80
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: MDX Hawaii PPO	$77.60

ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION [123]

Facility

OP

$73.00

Service Code	HCPCS J7608
Hospital Revenue Code	637
Min. Negotiated Rate	$6.67
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$43.80
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$43.80
Rate for Payer: Hawaii Medical Service Association ABD	$8.89
Rate for Payer: Hawaii Medical Service Association ABD	$8.89
Rate for Payer: Hawaii Medical Service Association ABD	$8.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.89
Rate for Payer: Hawaii Western Management Group Commercial	$79.80
Rate for Payer: Hawaii Western Management Group Commercial	$69.35
Rate for Payer: Hawaii Western Management Group Commercial	$76.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Kaiser Permanente Commercial	$50.40
Rate for Payer: Kaiser Permanente Commercial	$45.99
Rate for Payer: Kaiser Permanente Commercial	$52.92
Rate for Payer: Kaiser Permanente Medicaid	$42.84
Rate for Payer: Kaiser Permanente Medicaid	$37.23
Rate for Payer: Kaiser Permanente Medicaid	$40.80
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: MDX Hawaii PPO	$77.60
Rate for Payer: UnitedHealthcare Medicaid	$6.67
Rate for Payer: UnitedHealthcare Medicaid	$6.67
Rate for Payer: UnitedHealthcare Medicaid	$6.67
Rate for Payer: University Health Alliance Commercial	$58.31
Rate for Payer: University Health Alliance Commercial	$61.23
Rate for Payer: University Health Alliance Commercial	$53.21

ACHILLES TENDON BIOCLN 453042

Facility

IP

$6,070.00

Service Code	HCPCS C1716
Hospital Revenue Code	278
Min. Negotiated Rate	$3,399.20
Max. Negotiated Rate	$5,887.90
Rate for Payer: Cash Price	$3,642.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,249.00
Rate for Payer: Health Management Network Commercial	$5,159.50
Rate for Payer: MDX Hawaii PPO	$5,887.90
Rate for Payer: University Health Alliance Commercial	$3,399.20

ACHILLES TENDON BIOCLN 453042

Facility

OP

$6,070.00

Service Code	HCPCS C1716
Hospital Revenue Code	278
Min. Negotiated Rate	$593.84
Max. Negotiated Rate	$5,887.90
Rate for Payer: AlohaCare Medicaid	$593.84
Rate for Payer: AlohaCare Medicare	$593.84
Rate for Payer: Cash Price	$3,642.00
Rate for Payer: Cash Price	$3,642.00
Rate for Payer: Devoted Health Medicare	$653.22
Rate for Payer: Hawaii Medical Service Association Commercial	$742.30
Rate for Payer: Hawaii Medical Service Association Medicare	$593.84
Rate for Payer: Hawaii Western Management Group Commercial	$4,249.00
Rate for Payer: Health Management Network Commercial	$5,159.50
Rate for Payer: Humana Medicare	$593.84
Rate for Payer: Kaiser Permanente Commercial	$3,824.10
Rate for Payer: Kaiser Permanente Medicaid	$3,095.70
Rate for Payer: Kaiser Permanente Medicare	$593.84
Rate for Payer: MDX Hawaii PPO	$5,887.90
Rate for Payer: Ohana Health Plan Medicaid	$653.22
Rate for Payer: Ohana Health Plan Medicare	$593.84
Rate for Payer: UnitedHealthcare Medicaid	$651.25
Rate for Payer: UnitedHealthcare Medicare	$593.84
Rate for Payer: University Health Alliance Commercial	$3,399.20

ACL THIGHTROPE II AR-1588RT-2J

Facility

IP

$1,709.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$957.04
Max. Negotiated Rate	$1,657.73
Rate for Payer: Cash Price	$1,025.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,196.30
Rate for Payer: Health Management Network Commercial	$1,452.65
Rate for Payer: MDX Hawaii PPO	$1,657.73
Rate for Payer: University Health Alliance Commercial	$957.04

ACL THIGHTROPE II AR-1588RT-2J

Facility

OP

$1,709.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$871.59
Max. Negotiated Rate	$1,657.73
Rate for Payer: Cash Price	$1,025.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,196.30
Rate for Payer: Health Management Network Commercial	$1,452.65
Rate for Payer: Kaiser Permanente Commercial	$1,076.67
Rate for Payer: Kaiser Permanente Medicaid	$871.59
Rate for Payer: MDX Hawaii PPO	$1,657.73
Rate for Payer: University Health Alliance Commercial	$957.04

<<
<
5
6
7
8
9
10
11
12
13
14
>
>>