Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

SODIUM CHLORIDE 0.45 % IV BOLUS [400292]

Facility

IP

$18.00

Service Code	NDC 00264580400
Hospital Revenue Code	258
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: MDX Hawaii PPO	$17.46

SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL [7030]

Facility

IP

$5.00

Service Code	NDC 00904386575
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

SODIUM CHLORIDE 0.9 %, BACTERIOSTATIC INJECTION SOLUTION [7028]

Facility

IP

$8.00

Service Code	NDC 63323092410
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

SODIUM CHLORIDE 0.9 %, BACTERIOSTATIC INJECTION SOLUTION [7028]

Facility

IP

$10.00

Service Code	NDC 00409196602
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

SODIUM CHLORIDE 0.9 %, BACTERIOSTATIC INJECTION SOLUTION [7028]

Facility

IP

$10.00

Service Code	NDC 00409196607
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

SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]

Facility

IP

$4.00

Service Code	NDC 00409488810
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

SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]

Facility

IP

$5.00

Service Code	NDC 63323018601
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

SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]

Facility

IP

$9.00

Service Code	NDC 63323018603
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

SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]

Facility

IP

$1.00

Service Code	NDC 63323018610
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	$3.00
Rate for Payer: Cash Price	$13.20
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: MDX Hawaii PPO	$4.85

SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]

Facility

IP

$9.00

Service Code	NDC 63323018620
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

SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]

Facility

IP

$4.00

Service Code	NDC 00409488802
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

SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]

Facility

IP

$11.00

Service Code	NDC 00409488803
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

SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]

Facility

IP

$11.00

Service Code	NDC 00409488820
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

SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]

Facility

IP

$12.00

Service Code	HCPCS J7030
Hospital Revenue Code	258
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$0.60
Rate for Payer: Cash Price	$6.60
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$8.40
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$1.20
Rate for Payer: Cash Price	$1.80
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: MDX Hawaii PPO	$13.58
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: MDX Hawaii PPO	$10.67

SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]

Facility

OP

$2.00

Service Code	HCPCS J7030
Hospital Revenue Code	258
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$2.28
Rate for Payer: Cash Price	$1.20
Rate for Payer: Cash Price	$1.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$1.80
Rate for Payer: Cash Price	$1.80
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$8.40
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$6.60
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$0.60
Rate for Payer: Cash Price	$6.60
Rate for Payer: Cash Price	$0.60
Rate for Payer: Cash Price	$8.40
Rate for Payer: Hawaii Medical Service Association ABD	$2.28
Rate for Payer: Hawaii Medical Service Association ABD	$2.28
Rate for Payer: Hawaii Medical Service Association ABD	$2.28
Rate for Payer: Hawaii Medical Service Association ABD	$2.28
Rate for Payer: Hawaii Medical Service Association ABD	$2.28
Rate for Payer: Hawaii Medical Service Association ABD	$2.28
Rate for Payer: Hawaii Medical Service Association ABD	$2.28
Rate for Payer: Hawaii Medical Service Association ABD	$2.28
Rate for Payer: Hawaii Medical Service Association ABD	$2.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$13.30
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Hawaii Western Management Group Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$0.63
Rate for Payer: Kaiser Permanente Commercial	$7.56
Rate for Payer: Kaiser Permanente Commercial	$8.82
Rate for Payer: Kaiser Permanente Commercial	$6.93
Rate for Payer: Kaiser Permanente Commercial	$11.34
Rate for Payer: Kaiser Permanente Commercial	$8.19
Rate for Payer: Kaiser Permanente Commercial	$3.78
Rate for Payer: Kaiser Permanente Commercial	$1.26
Rate for Payer: Kaiser Permanente Commercial	$1.89
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicaid	$7.14
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicaid	$5.61
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: MDX Hawaii PPO	$10.67
Rate for Payer: MDX Hawaii PPO	$13.58
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: UnitedHealthcare Medicaid	$1.71
Rate for Payer: UnitedHealthcare Medicaid	$1.71
Rate for Payer: UnitedHealthcare Medicaid	$1.71
Rate for Payer: UnitedHealthcare Medicaid	$1.71
Rate for Payer: UnitedHealthcare Medicaid	$1.71
Rate for Payer: UnitedHealthcare Medicaid	$1.71
Rate for Payer: UnitedHealthcare Medicaid	$1.71
Rate for Payer: UnitedHealthcare Medicaid	$1.71
Rate for Payer: UnitedHealthcare Medicaid	$1.71
Rate for Payer: University Health Alliance Commercial	$1.46
Rate for Payer: University Health Alliance Commercial	$4.37
Rate for Payer: University Health Alliance Commercial	$13.12
Rate for Payer: University Health Alliance Commercial	$8.02
Rate for Payer: University Health Alliance Commercial	$0.73
Rate for Payer: University Health Alliance Commercial	$8.75
Rate for Payer: University Health Alliance Commercial	$2.19
Rate for Payer: University Health Alliance Commercial	$9.48
Rate for Payer: University Health Alliance Commercial	$10.20

SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION [11403]

Facility

IP

$16.00

Service Code	NDC 00264220110
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

SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION [11403]

Facility

IP

$18.00

Service Code	NDC 00264220100
Hospital Revenue Code	250
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: MDX Hawaii PPO	$17.46

SODIUM CHLORIDE 0.9 % IV BOLUS [400291]

Facility

OP

$14.00

Service Code	HCPCS J7050
Hospital Revenue Code	258
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$8.40
Rate for Payer: Cash Price	$6.60
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$6.60
Rate for Payer: Cash Price	$8.40
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$10.80
Rate for Payer: Hawaii Medical Service Association ABD	$0.71
Rate for Payer: Hawaii Medical Service Association ABD	$0.71
Rate for Payer: Hawaii Medical Service Association ABD	$0.71
Rate for Payer: Hawaii Medical Service Association ABD	$0.71
Rate for Payer: Hawaii Medical Service Association ABD	$0.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.71
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Hawaii Western Management Group Commercial	$13.30
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$10.45
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$6.93
Rate for Payer: Kaiser Permanente Commercial	$8.19
Rate for Payer: Kaiser Permanente Commercial	$8.82
Rate for Payer: Kaiser Permanente Commercial	$7.56
Rate for Payer: Kaiser Permanente Commercial	$11.34
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: Kaiser Permanente Medicaid	$7.14
Rate for Payer: Kaiser Permanente Medicaid	$5.61
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: MDX Hawaii PPO	$10.67
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: MDX Hawaii PPO	$13.58
Rate for Payer: UnitedHealthcare Medicaid	$0.53
Rate for Payer: UnitedHealthcare Medicaid	$0.53
Rate for Payer: UnitedHealthcare Medicaid	$0.53
Rate for Payer: UnitedHealthcare Medicaid	$0.53
Rate for Payer: UnitedHealthcare Medicaid	$0.53
Rate for Payer: University Health Alliance Commercial	$13.12
Rate for Payer: University Health Alliance Commercial	$8.75
Rate for Payer: University Health Alliance Commercial	$9.48
Rate for Payer: University Health Alliance Commercial	$10.20
Rate for Payer: University Health Alliance Commercial	$8.02

SODIUM CHLORIDE 0.9 % IV BOLUS [400291]

Facility

IP

$18.00

Service Code	HCPCS J7050
Hospital Revenue Code	258
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$6.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$8.40
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: MDX Hawaii PPO	$13.58
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: MDX Hawaii PPO	$10.67

SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET [7328]

Facility

IP

$1.00

Service Code	NDC 22001000000
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

SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET [7328]

Facility

OP

$2.00

Service Code	NDC 77333084410
Hospital Revenue Code	637
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.26
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: University Health Alliance Commercial	$1.46

SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET [7328]

Facility

OP

$2.00

Service Code	NDC 77333084425
Hospital Revenue Code	637
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.26
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: University Health Alliance Commercial	$1.46

SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET [7328]

Facility

OP

$1.00

Service Code	NDC 22001000000
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

SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET [7328]

Facility

IP

$2.00

Service Code	NDC 77333084425
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: MDX Hawaii PPO	$1.94

SODIUM CHLORIDE 1,000 MG SOLUBLE TABLET [7328]

Facility

IP

$2.00

Service Code	NDC 77333084410
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: MDX Hawaii PPO	$1.94

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