Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

CARVEDILOL 25 MG TABLET [15748]

Facility

IP

$8.00

Service Code	NDC 68001015200
Hospital Revenue Code	250
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: MDX Hawaii PPO	$7.76

CARVEDILOL 25 MG TABLET [15748]

Facility

OP

$1.00

Service Code	NDC 00904730861
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

CARVEDILOL 25 MG TABLET [15748]

Facility

OP

$8.00

Service Code	NDC 68001015200
Hospital Revenue Code	637
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$5.04
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: University Health Alliance Commercial	$5.83

CARVEDILOL 3.125 MG TABLET [18551]

Facility

IP

$8.00

Service Code	NDC 68001015300
Hospital Revenue Code	250
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: MDX Hawaii PPO	$7.76

CARVEDILOL 3.125 MG TABLET [18551]

Facility

OP

$8.00

Service Code	NDC 00904630061
Hospital Revenue Code	637
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$5.04
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: University Health Alliance Commercial	$5.83

CARVEDILOL 3.125 MG TABLET [18551]

Facility

OP

$1.00

Service Code	NDC 00904730561
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

CARVEDILOL 3.125 MG TABLET [18551]

Facility

OP

$8.00

Service Code	NDC 68001015300
Hospital Revenue Code	637
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$5.04
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: University Health Alliance Commercial	$5.83

CARVEDILOL 3.125 MG TABLET [18551]

Facility

IP

$8.00

Service Code	NDC 00904630061
Hospital Revenue Code	250
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: MDX Hawaii PPO	$7.76

CARVEDILOL 3.125 MG TABLET [18551]

Facility

IP

$1.00

Service Code	NDC 00904730561
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

CARVEDILOL 6.25 MG TABLET [15747]

Facility

IP

$7.00

Service Code	NDC 68084085401
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

CARVEDILOL 6.25 MG TABLET [15747]

Facility

OP

$7.00

Service Code	NDC 68084085411
Hospital Revenue Code	637
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$4.41
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: University Health Alliance Commercial	$5.10

CARVEDILOL 6.25 MG TABLET [15747]

Facility

OP

$7.00

Service Code	NDC 68084085401
Hospital Revenue Code	637
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$4.41
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: University Health Alliance Commercial	$5.10

CARVEDILOL 6.25 MG TABLET [15747]

Facility

IP

$7.00

Service Code	NDC 68084085411
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

CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]

Facility

OP

$31.00

Service Code	NDC 57664066483
Hospital Revenue Code	637
Min. Negotiated Rate	$15.81
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Hawaii Western Management Group Commercial	$29.45
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Kaiser Permanente Commercial	$19.53
Rate for Payer: Kaiser Permanente Medicaid	$15.81
Rate for Payer: MDX Hawaii PPO	$30.07
Rate for Payer: University Health Alliance Commercial	$22.60

CARVEDILOL PHOSPHATE ER 20 MG CAPSULE,EXT.RELEASE24HR MULTIPHASE [77665]

Facility

IP

$31.00

Service Code	NDC 57664066483
Hospital Revenue Code	250
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: MDX Hawaii PPO	$30.07

CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION [29567]

Facility

IP

$449.00

Service Code	HCPCS J0637
Hospital Revenue Code	250
Min. Negotiated Rate	$381.65
Max. Negotiated Rate	$435.53
Rate for Payer: Cash Price	$269.40
Rate for Payer: Cash Price	$364.20
Rate for Payer: Health Management Network Commercial	$515.95
Rate for Payer: Health Management Network Commercial	$381.65
Rate for Payer: MDX Hawaii PPO	$435.53
Rate for Payer: MDX Hawaii PPO	$588.79

CASPOFUNGIN 50 MG INTRAVENOUS SOLUTION [29567]

Facility

OP

$449.00

Service Code	HCPCS J0637
Hospital Revenue Code	636
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$435.53
Rate for Payer: Cash Price	$269.40
Rate for Payer: Cash Price	$269.40
Rate for Payer: Cash Price	$364.20
Rate for Payer: Cash Price	$364.20
Rate for Payer: Hawaii Medical Service Association ABD	$2.27
Rate for Payer: Hawaii Medical Service Association ABD	$2.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.27
Rate for Payer: Hawaii Western Management Group Commercial	$576.65
Rate for Payer: Hawaii Western Management Group Commercial	$426.55
Rate for Payer: Health Management Network Commercial	$381.65
Rate for Payer: Health Management Network Commercial	$515.95
Rate for Payer: Kaiser Permanente Commercial	$382.41
Rate for Payer: Kaiser Permanente Commercial	$282.87
Rate for Payer: Kaiser Permanente Medicaid	$228.99
Rate for Payer: Kaiser Permanente Medicaid	$309.57
Rate for Payer: MDX Hawaii PPO	$435.53
Rate for Payer: MDX Hawaii PPO	$588.79
Rate for Payer: UnitedHealthcare Medicaid	$364.20
Rate for Payer: UnitedHealthcare Medicaid	$269.40
Rate for Payer: University Health Alliance Commercial	$327.28
Rate for Payer: University Health Alliance Commercial	$442.44

CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION [29568]

Facility

IP

$190.00

Service Code	HCPCS J0637
Hospital Revenue Code	250
Min. Negotiated Rate	$161.50
Max. Negotiated Rate	$184.30
Rate for Payer: Cash Price	$114.00
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: MDX Hawaii PPO	$184.30

CASPOFUNGIN 70 MG INTRAVENOUS SOLUTION [29568]

Facility

OP

$190.00

Service Code	HCPCS J0637
Hospital Revenue Code	636
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$184.30
Rate for Payer: Cash Price	$114.00
Rate for Payer: Cash Price	$114.00
Rate for Payer: Hawaii Medical Service Association ABD	$2.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.27
Rate for Payer: Hawaii Western Management Group Commercial	$180.50
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$96.90
Rate for Payer: MDX Hawaii PPO	$184.30
Rate for Payer: UnitedHealthcare Medicaid	$114.00
Rate for Payer: University Health Alliance Commercial	$138.49

CASPOFUNGIN ACETATE 50 MG/10ML IV (WET SOLR VIAL) [43029567]

Facility

IP

$607.00

Service Code	HCPCS J0637
Hospital Revenue Code	250
Min. Negotiated Rate	$515.95
Max. Negotiated Rate	$588.79
Rate for Payer: Cash Price	$364.20
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Health Management Network Commercial	$1,547.00
Rate for Payer: Health Management Network Commercial	$515.95
Rate for Payer: MDX Hawaii PPO	$588.79
Rate for Payer: MDX Hawaii PPO	$1,765.40

CASPOFUNGIN ACETATE 50 MG/10ML IV (WET SOLR VIAL) [43029567]

Facility

OP

$1,820.00

Service Code	HCPCS J0637
Hospital Revenue Code	636
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$1,765.40
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Cash Price	$1,092.00
Rate for Payer: Cash Price	$364.20
Rate for Payer: Cash Price	$364.20
Rate for Payer: Hawaii Medical Service Association ABD	$2.27
Rate for Payer: Hawaii Medical Service Association ABD	$2.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.27
Rate for Payer: Hawaii Western Management Group Commercial	$1,729.00
Rate for Payer: Hawaii Western Management Group Commercial	$576.65
Rate for Payer: Health Management Network Commercial	$1,547.00
Rate for Payer: Health Management Network Commercial	$515.95
Rate for Payer: Kaiser Permanente Commercial	$1,146.60
Rate for Payer: Kaiser Permanente Commercial	$382.41
Rate for Payer: Kaiser Permanente Medicaid	$309.57
Rate for Payer: Kaiser Permanente Medicaid	$928.20
Rate for Payer: MDX Hawaii PPO	$588.79
Rate for Payer: MDX Hawaii PPO	$1,765.40
Rate for Payer: UnitedHealthcare Medicaid	$1,092.00
Rate for Payer: UnitedHealthcare Medicaid	$364.20
Rate for Payer: University Health Alliance Commercial	$1,326.60
Rate for Payer: University Health Alliance Commercial	$442.44

CASPOFUNGIN ACETATE 70 MG/10ML IV (WET SOLR VIAL) [43029568]

Facility

IP

$136.00

Service Code	HCPCS J0637
Hospital Revenue Code	250
Min. Negotiated Rate	$115.60
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cash Price	$114.00
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: MDX Hawaii PPO	$184.30

CASPOFUNGIN ACETATE 70 MG/10ML IV (WET SOLR VIAL) [43029568]

Facility

OP

$136.00

Service Code	HCPCS J0637
Hospital Revenue Code	636
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cash Price	$114.00
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cash Price	$114.00
Rate for Payer: Hawaii Medical Service Association ABD	$2.27
Rate for Payer: Hawaii Medical Service Association ABD	$2.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.27
Rate for Payer: Hawaii Western Management Group Commercial	$180.50
Rate for Payer: Hawaii Western Management Group Commercial	$129.20
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Commercial	$85.68
Rate for Payer: Kaiser Permanente Medicaid	$69.36
Rate for Payer: Kaiser Permanente Medicaid	$96.90
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: MDX Hawaii PPO	$184.30
Rate for Payer: UnitedHealthcare Medicaid	$114.00
Rate for Payer: UnitedHealthcare Medicaid	$81.60
Rate for Payer: University Health Alliance Commercial	$99.13
Rate for Payer: University Health Alliance Commercial	$138.49

CASSETTE IRRIG 5400-050-001

Facility

OP

$245.00

Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$237.65
Rate for Payer: Cash Price	$147.00
Rate for Payer: Hawaii Western Management Group Commercial	$232.75
Rate for Payer: Health Management Network Commercial	$208.25
Rate for Payer: Kaiser Permanente Commercial	$154.35
Rate for Payer: Kaiser Permanente Medicaid	$124.95
Rate for Payer: MDX Hawaii PPO	$237.65
Rate for Payer: University Health Alliance Commercial	$178.58

CASSETTE IRRIG 5400-050-001

Facility

IP

$245.00

Hospital Revenue Code	272
Min. Negotiated Rate	$208.25
Max. Negotiated Rate	$237.65
Rate for Payer: Cash Price	$147.00
Rate for Payer: Health Management Network Commercial	$208.25
Rate for Payer: MDX Hawaii PPO	$237.65

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