Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]

Facility

OP

$11.00

Service Code	NDC 57237031005
Hospital Revenue Code	637
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Hawaii Western Management Group Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Kaiser Permanente Commercial	$6.93
Rate for Payer: Kaiser Permanente Medicaid	$5.61
Rate for Payer: MDX Hawaii PPO	$10.67
Rate for Payer: University Health Alliance Commercial	$8.02

SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]

Facility

OP

$9.00

Service Code	NDC 48433021940
Hospital Revenue Code	637
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$5.67
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: University Health Alliance Commercial	$6.56

SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]

Facility

IP

$11.00

Service Code	NDC 57237031054
Hospital Revenue Code	250
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: MDX Hawaii PPO	$10.67

SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]

Facility

IP

$11.00

Service Code	NDC 57237031005
Hospital Revenue Code	250
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: MDX Hawaii PPO	$10.67

SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]

Facility

OP

$11.00

Service Code	NDC 57237031054
Hospital Revenue Code	637
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Hawaii Western Management Group Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Kaiser Permanente Commercial	$6.93
Rate for Payer: Kaiser Permanente Medicaid	$5.61
Rate for Payer: MDX Hawaii PPO	$10.67
Rate for Payer: University Health Alliance Commercial	$8.02

SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]

Facility

IP

$11.00

Service Code	NDC 50268073111
Hospital Revenue Code	250
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: MDX Hawaii PPO	$10.67

SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]

Facility

IP

$9.00

Service Code	NDC 48433021940
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: MDX Hawaii PPO	$8.73

SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]

Facility

OP

$11.00

Service Code	NDC 50268073111
Hospital Revenue Code	637
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Hawaii Western Management Group Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Kaiser Permanente Commercial	$6.93
Rate for Payer: Kaiser Permanente Medicaid	$5.61
Rate for Payer: MDX Hawaii PPO	$10.67
Rate for Payer: University Health Alliance Commercial	$8.02

SENSIA DUAL CHMBR GNRTR SEDR01

Facility

IP

$11,520.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$6,451.20
Max. Negotiated Rate	$11,174.40
Rate for Payer: Cash Price	$6,912.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,064.00
Rate for Payer: Health Management Network Commercial	$9,792.00
Rate for Payer: MDX Hawaii PPO	$11,174.40
Rate for Payer: University Health Alliance Commercial	$6,451.20

SENSIA DUAL CHMBR GNRTR SEDR01

Facility

OP

$11,520.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$5,875.20
Max. Negotiated Rate	$11,174.40
Rate for Payer: Cash Price	$6,912.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,064.00
Rate for Payer: Health Management Network Commercial	$9,792.00
Rate for Payer: Kaiser Permanente Commercial	$7,257.60
Rate for Payer: Kaiser Permanente Medicaid	$5,875.20
Rate for Payer: MDX Hawaii PPO	$11,174.40
Rate for Payer: University Health Alliance Commercial	$6,451.20

SENSIA DUAL CHMBR GNRTR SESR01

Facility

OP

$9,720.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$4,957.20
Max. Negotiated Rate	$9,428.40
Rate for Payer: Cash Price	$5,832.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.00
Rate for Payer: Health Management Network Commercial	$8,262.00
Rate for Payer: Kaiser Permanente Commercial	$6,123.60
Rate for Payer: Kaiser Permanente Medicaid	$4,957.20
Rate for Payer: MDX Hawaii PPO	$9,428.40
Rate for Payer: University Health Alliance Commercial	$5,443.20

SENSIA DUAL CHMBR GNRTR SESR01

Facility

IP

$9,720.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$5,443.20
Max. Negotiated Rate	$9,428.40
Rate for Payer: Cash Price	$5,832.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.00
Rate for Payer: Health Management Network Commercial	$8,262.00
Rate for Payer: MDX Hawaii PPO	$9,428.40
Rate for Payer: University Health Alliance Commercial	$5,443.20

SENSOR ANGLE TIP

Facility

OP

$203.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$103.53
Max. Negotiated Rate	$196.91
Rate for Payer: Cash Price	$121.80
Rate for Payer: Hawaii Western Management Group Commercial	$192.85
Rate for Payer: Health Management Network Commercial	$172.55
Rate for Payer: Kaiser Permanente Commercial	$127.89
Rate for Payer: Kaiser Permanente Medicaid	$103.53
Rate for Payer: MDX Hawaii PPO	$196.91
Rate for Payer: University Health Alliance Commercial	$147.97

SENSOR ANGLE TIP

Facility

IP

$203.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$172.55
Max. Negotiated Rate	$196.91
Rate for Payer: Cash Price	$121.80
Rate for Payer: Health Management Network Commercial	$172.55
Rate for Payer: MDX Hawaii PPO	$196.91

SENSOR PAD BED 10X30

Facility

OP

$121.00

Service Code	HCPCS A9280
Hospital Revenue Code	271
Min. Negotiated Rate	$61.71
Max. Negotiated Rate	$117.37
Rate for Payer: Cash Price	$72.60
Rate for Payer: Hawaii Western Management Group Commercial	$114.95
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Kaiser Permanente Commercial	$76.23
Rate for Payer: Kaiser Permanente Medicaid	$61.71
Rate for Payer: MDX Hawaii PPO	$117.37
Rate for Payer: University Health Alliance Commercial	$88.20

SENSOR PAD BED 10X30

Facility

IP

$121.00

Service Code	HCPCS A9280
Hospital Revenue Code	271
Min. Negotiated Rate	$102.85
Max. Negotiated Rate	$117.37
Rate for Payer: Cash Price	$72.60
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: MDX Hawaii PPO	$117.37

SEPRA FILM ADH BARRIER 4301-02

Facility

OP

$1,018.00

Service Code	HCPCS C1765
Hospital Revenue Code	278
Min. Negotiated Rate	$519.18
Max. Negotiated Rate	$987.46
Rate for Payer: Cash Price	$610.80
Rate for Payer: Hawaii Western Management Group Commercial	$712.60
Rate for Payer: Health Management Network Commercial	$865.30
Rate for Payer: Kaiser Permanente Commercial	$641.34
Rate for Payer: Kaiser Permanente Medicaid	$519.18
Rate for Payer: MDX Hawaii PPO	$987.46
Rate for Payer: University Health Alliance Commercial	$570.08

SEPRA FILM ADH BARRIER 4301-02

Facility

IP

$1,018.00

Service Code	HCPCS C1765
Hospital Revenue Code	278
Min. Negotiated Rate	$570.08
Max. Negotiated Rate	$987.46
Rate for Payer: Cash Price	$610.80
Rate for Payer: Hawaii Western Management Group Commercial	$712.60
Rate for Payer: Health Management Network Commercial	$865.30
Rate for Payer: MDX Hawaii PPO	$987.46
Rate for Payer: University Health Alliance Commercial	$570.08

SEPTIC ARTHRITIS WITH CC

Facility

IP

$25,042.51

Service Code	MSDRG 549
Min. Negotiated Rate	$13,730.99
Max. Negotiated Rate	$25,042.51
Rate for Payer: AlohaCare Medicare	$13,730.99
Rate for Payer: Devoted Health Medicare	$15,104.09
Rate for Payer: Hawaii Medical Service Association Commercial	$25,042.51
Rate for Payer: Hawaii Medical Service Association Medicare	$13,730.99
Rate for Payer: Humana Medicare	$13,730.99
Rate for Payer: Kaiser Permanente Commercial	$20,824.20
Rate for Payer: Kaiser Permanente Medicare	$13,730.99
Rate for Payer: Ohana Health Plan Medicare	$13,730.99
Rate for Payer: UnitedHealthcare Medicare	$13,730.99

SEPTIC ARTHRITIS WITH MCC

Facility

IP

$33,308.03

Service Code	MSDRG 548
Min. Negotiated Rate	$21,962.55
Max. Negotiated Rate	$33,308.03
Rate for Payer: AlohaCare Medicare	$21,962.55
Rate for Payer: Devoted Health Medicare	$24,158.81
Rate for Payer: Hawaii Medical Service Association Commercial	$25,042.51
Rate for Payer: Hawaii Medical Service Association Medicare	$21,962.55
Rate for Payer: Humana Medicare	$21,962.55
Rate for Payer: Kaiser Permanente Commercial	$33,308.03
Rate for Payer: Kaiser Permanente Medicare	$21,962.55
Rate for Payer: Ohana Health Plan Medicare	$21,962.55
Rate for Payer: UnitedHealthcare Medicare	$21,962.55

SEPTIC ARTHRITIS WITHOUT CC/MCC

Facility

IP

$25,042.51

Service Code	MSDRG 550
Min. Negotiated Rate	$9,942.24
Max. Negotiated Rate	$25,042.51
Rate for Payer: AlohaCare Medicare	$9,942.24
Rate for Payer: Devoted Health Medicare	$10,936.46
Rate for Payer: Hawaii Medical Service Association Commercial	$25,042.51
Rate for Payer: Hawaii Medical Service Association Medicare	$9,942.24
Rate for Payer: Humana Medicare	$9,942.24
Rate for Payer: Kaiser Permanente Commercial	$15,078.23
Rate for Payer: Kaiser Permanente Medicare	$9,942.24
Rate for Payer: Ohana Health Plan Medicare	$9,942.24
Rate for Payer: UnitedHealthcare Medicare	$9,942.24

SEPTICEMIA & DISSEMINATED INFECTIONS

Facility

IP

$3,070.27

Service Code	APR-DRG 7201
Min. Negotiated Rate	$3,070.27
Max. Negotiated Rate	$3,070.27
Rate for Payer: AlohaCare Medicaid	$3,070.27
Rate for Payer: Hawaii Medical Service Association ABD	$3,070.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,070.27
Rate for Payer: Kaiser Permanente Medicaid	$3,070.27
Rate for Payer: Ohana Health Plan Medicaid	$3,070.27
Rate for Payer: UnitedHealthcare Medicaid	$3,070.27

SEPTICEMIA & DISSEMINATED INFECTIONS

Facility

IP

$5,764.17

Service Code	APR-DRG 7203
Min. Negotiated Rate	$5,764.17
Max. Negotiated Rate	$5,764.17
Rate for Payer: AlohaCare Medicaid	$5,764.17
Rate for Payer: Hawaii Medical Service Association ABD	$5,764.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,764.17
Rate for Payer: Kaiser Permanente Medicaid	$5,764.17
Rate for Payer: Ohana Health Plan Medicaid	$5,764.17
Rate for Payer: UnitedHealthcare Medicaid	$5,764.17

SEPTICEMIA & DISSEMINATED INFECTIONS

Facility

IP

$3,940.41

Service Code	APR-DRG 7202
Min. Negotiated Rate	$3,940.41
Max. Negotiated Rate	$3,940.41
Rate for Payer: AlohaCare Medicaid	$3,940.41
Rate for Payer: Hawaii Medical Service Association ABD	$3,940.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,940.41
Rate for Payer: Kaiser Permanente Medicaid	$3,940.41
Rate for Payer: Ohana Health Plan Medicaid	$3,940.41
Rate for Payer: UnitedHealthcare Medicaid	$3,940.41

SEPTICEMIA & DISSEMINATED INFECTIONS

Facility

IP

$9,653.05

Service Code	APR-DRG 7204
Min. Negotiated Rate	$9,653.05
Max. Negotiated Rate	$9,653.05
Rate for Payer: AlohaCare Medicaid	$9,653.05
Rate for Payer: Hawaii Medical Service Association ABD	$9,653.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,653.05
Rate for Payer: Kaiser Permanente Medicaid	$9,653.05
Rate for Payer: Ohana Health Plan Medicaid	$9,653.05
Rate for Payer: UnitedHealthcare Medicaid	$9,653.05

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