Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION [7536]

Facility

IP

$84.00

Service Code	NDC 00781341195
Hospital Revenue Code	250
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: MDX Hawaii PPO	$81.48

SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION [7536]

Facility

IP

$84.00

Service Code	NDC 70710137702
Hospital Revenue Code	250
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: MDX Hawaii PPO	$81.48

SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]

Facility

IP

$33.00

Service Code	NDC 60687073842
Hospital Revenue Code	250
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$19.80
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: MDX Hawaii PPO	$32.01

SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]

Facility

IP

$26.00

Service Code	NDC 50268074511
Hospital Revenue Code	250
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$15.60
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: MDX Hawaii PPO	$25.22

SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]

Facility

IP

$22.00

Service Code	NDC 68094004159
Hospital Revenue Code	250
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

SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]

Facility

IP

$33.00

Service Code	NDC 68094004362
Hospital Revenue Code	250
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$19.80
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: MDX Hawaii PPO	$32.01

SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]

Facility

OP

$26.00

Service Code	NDC 50268074511
Hospital Revenue Code	637
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$15.60
Rate for Payer: Hawaii Western Management Group Commercial	$24.70
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Kaiser Permanente Commercial	$16.38
Rate for Payer: Kaiser Permanente Medicaid	$13.26
Rate for Payer: MDX Hawaii PPO	$25.22
Rate for Payer: University Health Alliance Commercial	$18.95

SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]

Facility

OP

$481.00

Service Code	NDC 58914017014
Hospital Revenue Code	637
Min. Negotiated Rate	$245.31
Max. Negotiated Rate	$466.57
Rate for Payer: Cash Price	$288.60
Rate for Payer: Hawaii Western Management Group Commercial	$456.95
Rate for Payer: Health Management Network Commercial	$408.85
Rate for Payer: Kaiser Permanente Commercial	$303.03
Rate for Payer: Kaiser Permanente Medicaid	$245.31
Rate for Payer: MDX Hawaii PPO	$466.57
Rate for Payer: University Health Alliance Commercial	$350.60

SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]

Facility

OP

$33.00

Service Code	NDC 60687073808
Hospital Revenue Code	637
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$19.80
Rate for Payer: Hawaii Western Management Group Commercial	$31.35
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Kaiser Permanente Commercial	$20.79
Rate for Payer: Kaiser Permanente Medicaid	$16.83
Rate for Payer: MDX Hawaii PPO	$32.01
Rate for Payer: University Health Alliance Commercial	$24.05

SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]

Facility

OP

$33.00

Service Code	NDC 60687073842
Hospital Revenue Code	637
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$19.80
Rate for Payer: Hawaii Western Management Group Commercial	$31.35
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Kaiser Permanente Commercial	$20.79
Rate for Payer: Kaiser Permanente Medicaid	$16.83
Rate for Payer: MDX Hawaii PPO	$32.01
Rate for Payer: University Health Alliance Commercial	$24.05

SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]

Facility

OP

$22.00

Service Code	NDC 68094004159
Hospital Revenue Code	637
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

SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]

Facility

OP

$33.00

Service Code	NDC 68094004362
Hospital Revenue Code	637
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$19.80
Rate for Payer: Hawaii Western Management Group Commercial	$31.35
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Kaiser Permanente Commercial	$20.79
Rate for Payer: Kaiser Permanente Medicaid	$16.83
Rate for Payer: MDX Hawaii PPO	$32.01
Rate for Payer: University Health Alliance Commercial	$24.05

SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]

Facility

IP

$481.00

Service Code	NDC 58914017014
Hospital Revenue Code	250
Min. Negotiated Rate	$408.85
Max. Negotiated Rate	$466.57
Rate for Payer: Cash Price	$288.60
Rate for Payer: Health Management Network Commercial	$408.85
Rate for Payer: MDX Hawaii PPO	$466.57

SUCRALFATE 100 MG/ML ORAL SUSPENSION [11441]

Facility

IP

$33.00

Service Code	NDC 60687073808
Hospital Revenue Code	250
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$19.80
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: MDX Hawaii PPO	$32.01

SUCRALFATE 1 GRAM TABLET [11442]

Facility

OP

$2.00

Service Code	NDC 60687069501
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

SUCRALFATE 1 GRAM TABLET [11442]

Facility

OP

$2.00

Service Code	NDC 60687069511
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

SUCRALFATE 1 GRAM TABLET [11442]

Facility

IP

$2.00

Service Code	NDC 51079075320
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

SUCRALFATE 1 GRAM TABLET [11442]

Facility

IP

$2.00

Service Code	NDC 60687069501
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

SUCRALFATE 1 GRAM TABLET [11442]

Facility

IP

$2.00

Service Code	NDC 60687069511
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

SUCRALFATE 1 GRAM TABLET [11442]

Facility

OP

$2.00

Service Code	NDC 51079075320
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

SUCTION IRRIGIGATOR WITH TIP

Facility

IP

$233.00

Hospital Revenue Code	272
Min. Negotiated Rate	$198.05
Max. Negotiated Rate	$226.01
Rate for Payer: Cash Price	$139.80
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: MDX Hawaii PPO	$226.01

SUCTION IRRIGIGATOR WITH TIP

Facility

OP

$233.00

Hospital Revenue Code	272
Min. Negotiated Rate	$118.83
Max. Negotiated Rate	$226.01
Rate for Payer: Cash Price	$139.80
Rate for Payer: Hawaii Western Management Group Commercial	$221.35
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: Kaiser Permanente Commercial	$146.79
Rate for Payer: Kaiser Permanente Medicaid	$118.83
Rate for Payer: MDX Hawaii PPO	$226.01
Rate for Payer: University Health Alliance Commercial	$169.83

SUCTN CANISTER SAFETOUCH

Facility

OP

$91.00

Hospital Revenue Code	272
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$88.27
Rate for Payer: Cash Price	$54.60
Rate for Payer: Hawaii Western Management Group Commercial	$86.45
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Kaiser Permanente Commercial	$57.33
Rate for Payer: Kaiser Permanente Medicaid	$46.41
Rate for Payer: MDX Hawaii PPO	$88.27
Rate for Payer: University Health Alliance Commercial	$66.33

SUCTN CANISTER SAFETOUCH

Facility

IP

$91.00

Hospital Revenue Code	272
Min. Negotiated Rate	$77.35
Max. Negotiated Rate	$88.27
Rate for Payer: Cash Price	$54.60
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: MDX Hawaii PPO	$88.27

SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION [131263]

Facility

IP

$246.00

Service Code	NDC 00006542302
Hospital Revenue Code	250
Min. Negotiated Rate	$209.10
Max. Negotiated Rate	$238.62
Rate for Payer: Cash Price	$147.60
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: MDX Hawaii PPO	$238.62

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