Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

QUETIAPINE 300 MG TABLET [29267]

Facility

OP

$41.00

Service Code	NDC 60687037111
Hospital Revenue Code	637
Min. Negotiated Rate	$20.91
Max. Negotiated Rate	$39.77
Rate for Payer: Cash Price	$24.60
Rate for Payer: Hawaii Western Management Group Commercial	$38.95
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: Kaiser Permanente Commercial	$25.83
Rate for Payer: Kaiser Permanente Medicaid	$20.91
Rate for Payer: MDX Hawaii PPO	$39.77
Rate for Payer: University Health Alliance Commercial	$29.88

QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR [96233]

Facility

IP

$40.00

Service Code	NDC 16729010912
Hospital Revenue Code	250
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: MDX Hawaii PPO	$38.80

QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR [96233]

Facility

IP

$40.00

Service Code	NDC 68001059906
Hospital Revenue Code	250
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: MDX Hawaii PPO	$38.80

QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR [96233]

Facility

OP

$40.00

Service Code	NDC 16729010912
Hospital Revenue Code	637
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Hawaii Western Management Group Commercial	$38.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Medicaid	$20.40
Rate for Payer: MDX Hawaii PPO	$38.80
Rate for Payer: University Health Alliance Commercial	$29.16

QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR [96233]

Facility

OP

$40.00

Service Code	NDC 68001059906
Hospital Revenue Code	637
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Hawaii Western Management Group Commercial	$38.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Medicaid	$20.40
Rate for Payer: MDX Hawaii PPO	$38.80
Rate for Payer: University Health Alliance Commercial	$29.16

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR [82089]

Facility

OP

$44.00

Service Code	NDC 68001051306
Hospital Revenue Code	637
Min. Negotiated Rate	$22.44
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$26.40
Rate for Payer: Hawaii Western Management Group Commercial	$41.80
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Kaiser Permanente Commercial	$27.72
Rate for Payer: Kaiser Permanente Medicaid	$22.44
Rate for Payer: MDX Hawaii PPO	$42.68
Rate for Payer: University Health Alliance Commercial	$32.07

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR [82089]

Facility

OP

$5.00

Service Code	NDC 00904680361
Hospital Revenue Code	637
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$3.15
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: University Health Alliance Commercial	$3.64

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR [82089]

Facility

IP

$44.00

Service Code	NDC 68001051306
Hospital Revenue Code	250
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$26.40
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: MDX Hawaii PPO	$42.68

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR [82089]

Facility

IP

$44.00

Service Code	NDC 68001060006
Hospital Revenue Code	250
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$26.40
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: MDX Hawaii PPO	$42.68

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR [82089]

Facility

IP

$5.00

Service Code	NDC 00904680361
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: MDX Hawaii PPO	$4.85

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR [82089]

Facility

OP

$44.00

Service Code	NDC 68001060006
Hospital Revenue Code	637
Min. Negotiated Rate	$22.44
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$26.40
Rate for Payer: Hawaii Western Management Group Commercial	$41.80
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Kaiser Permanente Commercial	$27.72
Rate for Payer: Kaiser Permanente Medicaid	$22.44
Rate for Payer: MDX Hawaii PPO	$42.68
Rate for Payer: University Health Alliance Commercial	$32.07

QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [95676]

Facility

OP

$27.00

Service Code	NDC 29300030816
Hospital Revenue Code	637
Min. Negotiated Rate	$13.77
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$16.20
Rate for Payer: Hawaii Western Management Group Commercial	$25.65
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Kaiser Permanente Commercial	$17.01
Rate for Payer: Kaiser Permanente Medicaid	$13.77
Rate for Payer: MDX Hawaii PPO	$26.19
Rate for Payer: University Health Alliance Commercial	$19.68

QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [95676]

Facility

IP

$4.00

Service Code	NDC 00904680161
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

QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [95676]

Facility

IP

$27.00

Service Code	NDC 29300030816
Hospital Revenue Code	250
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: MDX Hawaii PPO	$26.19

QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [95676]

Facility

IP

$27.00

Service Code	NDC 68001051106
Hospital Revenue Code	250
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: MDX Hawaii PPO	$26.19

QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [95676]

Facility

OP

$4.00

Service Code	NDC 00904680161
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

QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [95676]

Facility

OP

$27.00

Service Code	NDC 68001051106
Hospital Revenue Code	637
Min. Negotiated Rate	$13.77
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$16.20
Rate for Payer: Hawaii Western Management Group Commercial	$25.65
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Kaiser Permanente Commercial	$17.01
Rate for Payer: Kaiser Permanente Medicaid	$13.77
Rate for Payer: MDX Hawaii PPO	$26.19
Rate for Payer: University Health Alliance Commercial	$19.68

QUICKANCHOR PLUS #3/0 212843

Facility

OP

$2,133.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.83
Max. Negotiated Rate	$2,069.01
Rate for Payer: Cash Price	$1,279.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,493.10
Rate for Payer: Health Management Network Commercial	$1,813.05
Rate for Payer: Kaiser Permanente Commercial	$1,343.79
Rate for Payer: Kaiser Permanente Medicaid	$1,087.83
Rate for Payer: MDX Hawaii PPO	$2,069.01
Rate for Payer: University Health Alliance Commercial	$1,194.48

QUICKANCHOR PLUS #3/0 212843

Facility

IP

$2,133.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,194.48
Max. Negotiated Rate	$2,069.01
Rate for Payer: Cash Price	$1,279.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,493.10
Rate for Payer: Health Management Network Commercial	$1,813.05
Rate for Payer: MDX Hawaii PPO	$2,069.01
Rate for Payer: University Health Alliance Commercial	$1,194.48

QUILL 0, CT-2 12" VLP-4135

Facility

IP

$22.00

Hospital Revenue Code	272
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$13.20
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: MDX Hawaii PPO	$21.34

QUILL 0, CT-2 12" VLP-4135

Facility

OP

$22.00

Hospital Revenue Code	272
Min. Negotiated Rate	$11.22
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$13.20
Rate for Payer: Hawaii Western Management Group Commercial	$20.90
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Kaiser Permanente Commercial	$13.86
Rate for Payer: Kaiser Permanente Medicaid	$11.22
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: University Health Alliance Commercial	$16.04

QUILL 0, CT-2 9" VLP-4147

Facility

IP

$124.00

Hospital Revenue Code	272
Min. Negotiated Rate	$105.40
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$74.40
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: MDX Hawaii PPO	$120.28

QUILL 0, CT-2 9" VLP-4147

Facility

OP

$124.00

Hospital Revenue Code	272
Min. Negotiated Rate	$63.24
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$74.40
Rate for Payer: Hawaii Western Management Group Commercial	$117.80
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Kaiser Permanente Commercial	$78.12
Rate for Payer: Kaiser Permanente Medicaid	$63.24
Rate for Payer: MDX Hawaii PPO	$120.28
Rate for Payer: University Health Alliance Commercial	$90.38

QUINTON TUNNELER 8888415679

Facility

IP

$621.00

Hospital Revenue Code	272
Min. Negotiated Rate	$527.85
Max. Negotiated Rate	$602.37
Rate for Payer: Cash Price	$372.60
Rate for Payer: Health Management Network Commercial	$527.85
Rate for Payer: MDX Hawaii PPO	$602.37

QUINTON TUNNELER 8888415679

Facility

OP

$621.00

Hospital Revenue Code	272
Min. Negotiated Rate	$316.71
Max. Negotiated Rate	$602.37
Rate for Payer: Cash Price	$372.60
Rate for Payer: Hawaii Western Management Group Commercial	$589.95
Rate for Payer: Health Management Network Commercial	$527.85
Rate for Payer: Kaiser Permanente Commercial	$391.23
Rate for Payer: Kaiser Permanente Medicaid	$316.71
Rate for Payer: MDX Hawaii PPO	$602.37
Rate for Payer: University Health Alliance Commercial	$452.65

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