Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC

Facility

IP

$33,704.24

Service Code	MSDRG 413
Min. Negotiated Rate	$33,704.24
Max. Negotiated Rate	$33,704.24
Rate for Payer: Hawaii Medical Service Association Commercial	$33,704.24

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

IP

$12.00

Service Code	NDC 42806026698
Hospital Revenue Code	250
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: MDX Hawaii PPO	$11.64

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

IP

$12.00

Service Code	NDC 42806026695
Hospital Revenue Code	250
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: MDX Hawaii PPO	$11.64

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

OP

$12.00

Service Code	NDC 42806026698
Hospital Revenue Code	637
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$11.64
Rate for Payer: AlohaCare Medicaid	$6.00
Rate for Payer: AlohaCare Medicare	$9.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Devoted Health Medicare	$10.08
Rate for Payer: Hawaii Medical Service Association Medicare	$9.12
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Humana Medicare	$9.12
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicare	$9.12
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: Ohana Health Plan Medicaid	$9.12
Rate for Payer: Ohana Health Plan Medicare	$9.12
Rate for Payer: UnitedHealthcare Medicare	$9.12
Rate for Payer: University Health Alliance Commercial	$8.75

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

OP

$12.00

Service Code	NDC 42806026695
Hospital Revenue Code	637
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$11.64
Rate for Payer: AlohaCare Medicaid	$6.00
Rate for Payer: AlohaCare Medicare	$9.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Devoted Health Medicare	$10.08
Rate for Payer: Hawaii Medical Service Association Medicare	$9.12
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Humana Medicare	$9.12
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicare	$9.12
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: Ohana Health Plan Medicaid	$9.12
Rate for Payer: Ohana Health Plan Medicare	$9.12
Rate for Payer: UnitedHealthcare Medicare	$9.12
Rate for Payer: University Health Alliance Commercial	$8.75

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

IP

$12.00

Service Code	NDC 67877029860
Hospital Revenue Code	250
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: MDX Hawaii PPO	$11.64

CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET [9588]

Facility

OP

$12.00

Service Code	NDC 67877029860
Hospital Revenue Code	637
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$11.64
Rate for Payer: AlohaCare Medicaid	$6.00
Rate for Payer: AlohaCare Medicare	$9.12
Rate for Payer: Cash Price	$7.20
Rate for Payer: Devoted Health Medicare	$10.08
Rate for Payer: Hawaii Medical Service Association Medicare	$9.12
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Humana Medicare	$9.12
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicare	$9.12
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: Ohana Health Plan Medicaid	$9.12
Rate for Payer: Ohana Health Plan Medicare	$9.12
Rate for Payer: UnitedHealthcare Medicare	$9.12
Rate for Payer: University Health Alliance Commercial	$8.75

CHO PLATE 20MM 00-1012-220

Facility

IP

$2,643.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,480.08
Max. Negotiated Rate	$2,563.71
Rate for Payer: Cash Price	$1,585.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,850.10
Rate for Payer: Health Management Network Commercial	$2,246.55
Rate for Payer: Kaiser Permanente Commercial	$2,378.70
Rate for Payer: MDX Hawaii PPO	$2,563.71
Rate for Payer: University Health Alliance Commercial	$1,480.08

CHO PLATE 20MM 00-1012-220

Facility

OP

$2,643.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,321.50
Max. Negotiated Rate	$2,563.71
Rate for Payer: AlohaCare Medicaid	$1,321.50
Rate for Payer: AlohaCare Medicare	$2,008.68
Rate for Payer: Cash Price	$1,585.80
Rate for Payer: Devoted Health Medicare	$2,220.12
Rate for Payer: Hawaii Medical Service Association Medicare	$2,008.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,850.10
Rate for Payer: Health Management Network Commercial	$2,246.55
Rate for Payer: Humana Medicare	$2,008.68
Rate for Payer: Kaiser Permanente Commercial	$2,378.70
Rate for Payer: Kaiser Permanente Medicaid	$1,347.93
Rate for Payer: Kaiser Permanente Medicare	$2,008.68
Rate for Payer: MDX Hawaii PPO	$2,563.71
Rate for Payer: Ohana Health Plan Medicaid	$2,008.68
Rate for Payer: Ohana Health Plan Medicare	$2,008.68
Rate for Payer: UnitedHealthcare Medicare	$2,008.68
Rate for Payer: University Health Alliance Commercial	$1,480.08

CHO PLATE 24MM 00-1012-224

Facility

IP

$2,643.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,480.08
Max. Negotiated Rate	$2,563.71
Rate for Payer: Cash Price	$1,585.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,850.10
Rate for Payer: Health Management Network Commercial	$2,246.55
Rate for Payer: Kaiser Permanente Commercial	$2,378.70
Rate for Payer: MDX Hawaii PPO	$2,563.71
Rate for Payer: University Health Alliance Commercial	$1,480.08

CHO PLATE 24MM 00-1012-224

Facility

OP

$2,643.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,321.50
Max. Negotiated Rate	$2,563.71
Rate for Payer: AlohaCare Medicaid	$1,321.50
Rate for Payer: AlohaCare Medicare	$2,008.68
Rate for Payer: Cash Price	$1,585.80
Rate for Payer: Devoted Health Medicare	$2,220.12
Rate for Payer: Hawaii Medical Service Association Medicare	$2,008.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,850.10
Rate for Payer: Health Management Network Commercial	$2,246.55
Rate for Payer: Humana Medicare	$2,008.68
Rate for Payer: Kaiser Permanente Commercial	$2,378.70
Rate for Payer: Kaiser Permanente Medicaid	$1,347.93
Rate for Payer: Kaiser Permanente Medicare	$2,008.68
Rate for Payer: MDX Hawaii PPO	$2,563.71
Rate for Payer: Ohana Health Plan Medicaid	$2,008.68
Rate for Payer: Ohana Health Plan Medicare	$2,008.68
Rate for Payer: UnitedHealthcare Medicare	$2,008.68
Rate for Payer: University Health Alliance Commercial	$1,480.08

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC

Facility

IP

$18,487.56

Service Code	MSDRG 191
Min. Negotiated Rate	$18,487.56
Max. Negotiated Rate	$18,487.56
Rate for Payer: Hawaii Medical Service Association Commercial	$18,487.56

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC

Facility

IP

$18,487.56

Service Code	MSDRG 190
Min. Negotiated Rate	$18,487.56
Max. Negotiated Rate	$18,487.56
Rate for Payer: Hawaii Medical Service Association Commercial	$18,487.56

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC

Facility

IP

$18,487.56

Service Code	MSDRG 192
Min. Negotiated Rate	$18,487.56
Max. Negotiated Rate	$18,487.56
Rate for Payer: Hawaii Medical Service Association Commercial	$18,487.56

CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION [17378]

Facility

IP

$1,332.00

Service Code	HCPCS J0740
Hospital Revenue Code	250
Min. Negotiated Rate	$1,132.20
Max. Negotiated Rate	$1,292.04
Rate for Payer: Cash Price	$799.20
Rate for Payer: Health Management Network Commercial	$1,132.20
Rate for Payer: Kaiser Permanente Commercial	$1,198.80
Rate for Payer: MDX Hawaii PPO	$1,292.04

CIDOFOVIR 75 MG/ML INTRAVENOUS SOLUTION [17378]

Facility

OP

$1,332.00

Service Code	HCPCS J0740
Hospital Revenue Code	636
Min. Negotiated Rate	$529.38
Max. Negotiated Rate	$1,292.04
Rate for Payer: AlohaCare Medicaid	$666.00
Rate for Payer: AlohaCare Medicare	$1,012.32
Rate for Payer: Cash Price	$799.20
Rate for Payer: Cash Price	$799.20
Rate for Payer: Devoted Health Medicare	$1,118.88
Rate for Payer: Hawaii Medical Service Association ABD	$529.38
Rate for Payer: Hawaii Medical Service Association Commercial	$700.99
Rate for Payer: Hawaii Medical Service Association Medicare	$1,012.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$529.38
Rate for Payer: Hawaii Western Management Group Commercial	$1,265.40
Rate for Payer: Health Management Network Commercial	$1,132.20
Rate for Payer: Humana Medicare	$1,012.32
Rate for Payer: Kaiser Permanente Commercial	$1,198.80
Rate for Payer: Kaiser Permanente Medicaid	$679.32
Rate for Payer: Kaiser Permanente Medicare	$1,012.32
Rate for Payer: MDX Hawaii PPO	$1,292.04
Rate for Payer: Ohana Health Plan Medicaid	$1,012.32
Rate for Payer: Ohana Health Plan Medicare	$1,012.32
Rate for Payer: UnitedHealthcare Medicaid	$799.20
Rate for Payer: UnitedHealthcare Medicare	$1,012.32
Rate for Payer: University Health Alliance Commercial	$970.89

CILOSTAZOL 50 MG TABLET [24473]

Facility

IP

$7.00

Service Code	NDC 00093206506
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: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$6.79

CILOSTAZOL 50 MG TABLET [24473]

Facility

IP

$8.00

Service Code	NDC 50268017615
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: Kaiser Permanente Commercial	$7.20
Rate for Payer: MDX Hawaii PPO	$7.76

CILOSTAZOL 50 MG TABLET [24473]

Facility

OP

$7.00

Service Code	NDC 00093206506
Hospital Revenue Code	637
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$6.79
Rate for Payer: AlohaCare Medicaid	$3.50
Rate for Payer: AlohaCare Medicare	$5.32
Rate for Payer: Cash Price	$4.20
Rate for Payer: Devoted Health Medicare	$5.88
Rate for Payer: Hawaii Medical Service Association Medicare	$5.32
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Humana Medicare	$5.32
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: Kaiser Permanente Medicare	$5.32
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: Ohana Health Plan Medicaid	$5.32
Rate for Payer: Ohana Health Plan Medicare	$5.32
Rate for Payer: UnitedHealthcare Medicare	$5.32
Rate for Payer: University Health Alliance Commercial	$5.10

CILOSTAZOL 50 MG TABLET [24473]

Facility

OP

$8.00

Service Code	NDC 50268017615
Hospital Revenue Code	637
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.76
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$6.08
Rate for Payer: Cash Price	$4.80
Rate for Payer: Devoted Health Medicare	$6.72
Rate for Payer: Hawaii Medical Service Association Medicare	$6.08
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Humana Medicare	$6.08
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicare	$6.08
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: Ohana Health Plan Medicaid	$6.08
Rate for Payer: Ohana Health Plan Medicare	$6.08
Rate for Payer: UnitedHealthcare Medicare	$6.08
Rate for Payer: University Health Alliance Commercial	$5.83

CINACALCET 30 MG TABLET [38100]

Facility

OP

$77.00

Service Code	NDC 69097041002
Hospital Revenue Code	637
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$74.69
Rate for Payer: AlohaCare Medicaid	$38.50
Rate for Payer: AlohaCare Medicare	$58.52
Rate for Payer: Cash Price	$46.20
Rate for Payer: Devoted Health Medicare	$64.68
Rate for Payer: Hawaii Medical Service Association Medicare	$58.52
Rate for Payer: Hawaii Western Management Group Commercial	$73.15
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Humana Medicare	$58.52
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: Kaiser Permanente Medicaid	$39.27
Rate for Payer: Kaiser Permanente Medicare	$58.52
Rate for Payer: MDX Hawaii PPO	$74.69
Rate for Payer: Ohana Health Plan Medicaid	$58.52
Rate for Payer: Ohana Health Plan Medicare	$58.52
Rate for Payer: UnitedHealthcare Medicare	$58.52
Rate for Payer: University Health Alliance Commercial	$56.13

CINACALCET 30 MG TABLET [38100]

Facility

IP

$77.00

Service Code	NDC 69097041002
Hospital Revenue Code	250
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: MDX Hawaii PPO	$74.69

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]

Facility

IP

$701.00

Service Code	NDC 00781618667
Hospital Revenue Code	250
Min. Negotiated Rate	$595.85
Max. Negotiated Rate	$679.97
Rate for Payer: Cash Price	$420.60
Rate for Payer: Health Management Network Commercial	$595.85
Rate for Payer: Kaiser Permanente Commercial	$630.90
Rate for Payer: MDX Hawaii PPO	$679.97

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]

Facility

OP

$385.00

Service Code	NDC 72485062513
Hospital Revenue Code	637
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$373.45
Rate for Payer: AlohaCare Medicaid	$192.50
Rate for Payer: AlohaCare Medicare	$292.60
Rate for Payer: Cash Price	$231.00
Rate for Payer: Devoted Health Medicare	$323.40
Rate for Payer: Hawaii Medical Service Association Medicare	$292.60
Rate for Payer: Hawaii Western Management Group Commercial	$365.75
Rate for Payer: Health Management Network Commercial	$327.25
Rate for Payer: Humana Medicare	$292.60
Rate for Payer: Kaiser Permanente Commercial	$346.50
Rate for Payer: Kaiser Permanente Medicaid	$196.35
Rate for Payer: Kaiser Permanente Medicare	$292.60
Rate for Payer: MDX Hawaii PPO	$373.45
Rate for Payer: Ohana Health Plan Medicaid	$292.60
Rate for Payer: Ohana Health Plan Medicare	$292.60
Rate for Payer: UnitedHealthcare Medicare	$292.60
Rate for Payer: University Health Alliance Commercial	$280.63

CIPROFLOXACIN 0.3 %-DEXAMETHASONE 0.1 % EAR DROPS,SUSPENSION [36576]

Facility

IP

$385.00

Service Code	NDC 72485062513
Hospital Revenue Code	250
Min. Negotiated Rate	$327.25
Max. Negotiated Rate	$373.45
Rate for Payer: Cash Price	$231.00
Rate for Payer: Health Management Network Commercial	$327.25
Rate for Payer: Kaiser Permanente Commercial	$346.50
Rate for Payer: MDX Hawaii PPO	$373.45

<<
<
124
125
126
127
128
129
130
131
132
133
>
>>