Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]

Facility

OP

$51.00

Service Code	NDC 50742054905
Hospital Revenue Code	637
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$49.47
Rate for Payer: AlohaCare Medicaid	$25.50
Rate for Payer: AlohaCare Medicare	$38.76
Rate for Payer: Cash Price	$30.60
Rate for Payer: Devoted Health Medicare	$42.84
Rate for Payer: Hawaii Medical Service Association Medicare	$38.76
Rate for Payer: Hawaii Western Management Group Commercial	$48.45
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Humana Medicare	$38.76
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: Kaiser Permanente Medicaid	$26.01
Rate for Payer: Kaiser Permanente Medicare	$38.76
Rate for Payer: MDX Hawaii PPO	$49.47
Rate for Payer: Ohana Health Plan Medicaid	$38.76
Rate for Payer: Ohana Health Plan Medicare	$38.76
Rate for Payer: UnitedHealthcare Medicare	$38.76
Rate for Payer: University Health Alliance Commercial	$37.17

FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]

Facility

IP

$51.00

Service Code	NDC 00378911916
Hospital Revenue Code	250
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$49.47
Rate for Payer: Cash Price	$30.60
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: MDX Hawaii PPO	$49.47

FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]

Facility

IP

$51.00

Service Code	NDC 50742054905
Hospital Revenue Code	250
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$49.47
Rate for Payer: Cash Price	$30.60
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: MDX Hawaii PPO	$49.47

FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]

Facility

OP

$51.00

Service Code	NDC 00406911276
Hospital Revenue Code	637
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$49.47
Rate for Payer: AlohaCare Medicaid	$25.50
Rate for Payer: AlohaCare Medicare	$38.76
Rate for Payer: Cash Price	$30.60
Rate for Payer: Devoted Health Medicare	$42.84
Rate for Payer: Hawaii Medical Service Association Medicare	$38.76
Rate for Payer: Hawaii Western Management Group Commercial	$48.45
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Humana Medicare	$38.76
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: Kaiser Permanente Medicaid	$26.01
Rate for Payer: Kaiser Permanente Medicare	$38.76
Rate for Payer: MDX Hawaii PPO	$49.47
Rate for Payer: Ohana Health Plan Medicaid	$38.76
Rate for Payer: Ohana Health Plan Medicare	$38.76
Rate for Payer: UnitedHealthcare Medicare	$38.76
Rate for Payer: University Health Alliance Commercial	$37.17

FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]

Facility

IP

$51.00

Service Code	NDC 00406911276
Hospital Revenue Code	250
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$49.47
Rate for Payer: Cash Price	$30.60
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: MDX Hawaii PPO	$49.47

FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]

Facility

IP

$51.00

Service Code	NDC 00378911998
Hospital Revenue Code	250
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$49.47
Rate for Payer: Cash Price	$30.60
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: MDX Hawaii PPO	$49.47

FENTANYL 12 MCG/HR TRANSDERMAL PATCH [41382]

Facility

OP

$51.00

Service Code	NDC 00378911916
Hospital Revenue Code	637
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$49.47
Rate for Payer: AlohaCare Medicaid	$25.50
Rate for Payer: AlohaCare Medicare	$38.76
Rate for Payer: Cash Price	$30.60
Rate for Payer: Devoted Health Medicare	$42.84
Rate for Payer: Hawaii Medical Service Association Medicare	$38.76
Rate for Payer: Hawaii Western Management Group Commercial	$48.45
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Humana Medicare	$38.76
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: Kaiser Permanente Medicaid	$26.01
Rate for Payer: Kaiser Permanente Medicare	$38.76
Rate for Payer: MDX Hawaii PPO	$49.47
Rate for Payer: Ohana Health Plan Medicaid	$38.76
Rate for Payer: Ohana Health Plan Medicare	$38.76
Rate for Payer: UnitedHealthcare Medicare	$38.76
Rate for Payer: University Health Alliance Commercial	$37.17

FENTANYL 2500 MCG/250 ML (10 MCG/ML) IN D5W INFUSION (SIMPLE) [4080505]

Facility

OP

$118.00

Service Code	HCPCS J3010
Hospital Revenue Code	636
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$114.46
Rate for Payer: AlohaCare Medicaid	$59.00
Rate for Payer: AlohaCare Medicare	$89.68
Rate for Payer: Cash Price	$70.80
Rate for Payer: Cash Price	$70.80
Rate for Payer: Devoted Health Medicare	$99.12
Rate for Payer: Hawaii Medical Service Association ABD	$0.96
Rate for Payer: Hawaii Medical Service Association Medicare	$89.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.96
Rate for Payer: Hawaii Western Management Group Commercial	$112.10
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Humana Medicare	$89.68
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: Kaiser Permanente Medicaid	$60.18
Rate for Payer: Kaiser Permanente Medicare	$89.68
Rate for Payer: MDX Hawaii PPO	$114.46
Rate for Payer: Ohana Health Plan Medicaid	$89.68
Rate for Payer: Ohana Health Plan Medicare	$89.68
Rate for Payer: UnitedHealthcare Medicaid	$70.80
Rate for Payer: UnitedHealthcare Medicare	$89.68
Rate for Payer: University Health Alliance Commercial	$86.01

FENTANYL 2500 MCG/250 ML (10 MCG/ML) IN D5W INFUSION (SIMPLE) [4080505]

Facility

IP

$118.00

Service Code	HCPCS J3010
Hospital Revenue Code	250
Min. Negotiated Rate	$100.30
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$70.80
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: MDX Hawaii PPO	$114.46

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

OP

$37.00

Service Code	NDC 00406912576
Hospital Revenue Code	637
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$35.89
Rate for Payer: AlohaCare Medicaid	$18.50
Rate for Payer: AlohaCare Medicare	$28.12
Rate for Payer: Cash Price	$22.20
Rate for Payer: Devoted Health Medicare	$31.08
Rate for Payer: Hawaii Medical Service Association Medicare	$28.12
Rate for Payer: Hawaii Western Management Group Commercial	$35.15
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Humana Medicare	$28.12
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: Kaiser Permanente Medicare	$28.12
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: Ohana Health Plan Medicaid	$28.12
Rate for Payer: Ohana Health Plan Medicare	$28.12
Rate for Payer: UnitedHealthcare Medicare	$28.12
Rate for Payer: University Health Alliance Commercial	$26.97

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

OP

$37.00

Service Code	NDC 00378912198
Hospital Revenue Code	637
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$35.89
Rate for Payer: AlohaCare Medicaid	$18.50
Rate for Payer: AlohaCare Medicare	$28.12
Rate for Payer: Cash Price	$22.20
Rate for Payer: Devoted Health Medicare	$31.08
Rate for Payer: Hawaii Medical Service Association Medicare	$28.12
Rate for Payer: Hawaii Western Management Group Commercial	$35.15
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Humana Medicare	$28.12
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: Kaiser Permanente Medicare	$28.12
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: Ohana Health Plan Medicaid	$28.12
Rate for Payer: Ohana Health Plan Medicare	$28.12
Rate for Payer: UnitedHealthcare Medicare	$28.12
Rate for Payer: University Health Alliance Commercial	$26.97

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

OP

$37.00

Service Code	NDC 00378912116
Hospital Revenue Code	637
Min. Negotiated Rate	$18.50
Max. Negotiated Rate	$35.89
Rate for Payer: AlohaCare Medicaid	$18.50
Rate for Payer: AlohaCare Medicare	$28.12
Rate for Payer: Cash Price	$22.20
Rate for Payer: Devoted Health Medicare	$31.08
Rate for Payer: Hawaii Medical Service Association Medicare	$28.12
Rate for Payer: Hawaii Western Management Group Commercial	$35.15
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Humana Medicare	$28.12
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: Kaiser Permanente Medicare	$28.12
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: Ohana Health Plan Medicaid	$28.12
Rate for Payer: Ohana Health Plan Medicare	$28.12
Rate for Payer: UnitedHealthcare Medicare	$28.12
Rate for Payer: University Health Alliance Commercial	$26.97

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

IP

$37.00

Service Code	NDC 00406912576
Hospital Revenue Code	250
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: MDX Hawaii PPO	$35.89

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

IP

$37.00

Service Code	NDC 00378912198
Hospital Revenue Code	250
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: MDX Hawaii PPO	$35.89

FENTANYL 25 MCG/HR TRANSDERMAL PATCH [27905]

Facility

IP

$37.00

Service Code	NDC 00378912116
Hospital Revenue Code	250
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: MDX Hawaii PPO	$35.89

FENTANYL 500 MCG/50 ML IN NS PCA (SIMPLE) [4080043]

Facility

IP

$60.00

Service Code	NDC 00004080014
Hospital Revenue Code	250
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: MDX Hawaii PPO	$58.20

FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]

Facility

IP

$66.00

Service Code	NDC 00406915076
Hospital Revenue Code	250
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$39.60
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: MDX Hawaii PPO	$64.02

FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]

Facility

OP

$66.00

Service Code	NDC 00378912298
Hospital Revenue Code	637
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$64.02
Rate for Payer: AlohaCare Medicaid	$33.00
Rate for Payer: AlohaCare Medicare	$50.16
Rate for Payer: Cash Price	$39.60
Rate for Payer: Devoted Health Medicare	$55.44
Rate for Payer: Hawaii Medical Service Association Medicare	$50.16
Rate for Payer: Hawaii Western Management Group Commercial	$62.70
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Humana Medicare	$50.16
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: Kaiser Permanente Medicare	$50.16
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: Ohana Health Plan Medicaid	$50.16
Rate for Payer: Ohana Health Plan Medicare	$50.16
Rate for Payer: UnitedHealthcare Medicare	$50.16
Rate for Payer: University Health Alliance Commercial	$48.11

FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]

Facility

IP

$66.00

Service Code	NDC 00378912298
Hospital Revenue Code	250
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$39.60
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: MDX Hawaii PPO	$64.02

FENTANYL 50 MCG/HR TRANSDERMAL PATCH [27906]

Facility

OP

$66.00

Service Code	NDC 00406915076
Hospital Revenue Code	637
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$64.02
Rate for Payer: AlohaCare Medicaid	$33.00
Rate for Payer: AlohaCare Medicare	$50.16
Rate for Payer: Cash Price	$39.60
Rate for Payer: Devoted Health Medicare	$55.44
Rate for Payer: Hawaii Medical Service Association Medicare	$50.16
Rate for Payer: Hawaii Western Management Group Commercial	$62.70
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Humana Medicare	$50.16
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: Kaiser Permanente Medicare	$50.16
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: Ohana Health Plan Medicaid	$50.16
Rate for Payer: Ohana Health Plan Medicare	$50.16
Rate for Payer: UnitedHealthcare Medicare	$50.16
Rate for Payer: University Health Alliance Commercial	$48.11

FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]

Facility

OP

$101.00

Service Code	NDC 00406917576
Hospital Revenue Code	637
Min. Negotiated Rate	$50.50
Max. Negotiated Rate	$97.97
Rate for Payer: AlohaCare Medicaid	$50.50
Rate for Payer: AlohaCare Medicare	$76.76
Rate for Payer: Cash Price	$60.60
Rate for Payer: Devoted Health Medicare	$84.84
Rate for Payer: Hawaii Medical Service Association Medicare	$76.76
Rate for Payer: Hawaii Western Management Group Commercial	$95.95
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Humana Medicare	$76.76
Rate for Payer: Kaiser Permanente Commercial	$90.90
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: Kaiser Permanente Medicare	$76.76
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: Ohana Health Plan Medicaid	$76.76
Rate for Payer: Ohana Health Plan Medicare	$76.76
Rate for Payer: UnitedHealthcare Medicare	$76.76
Rate for Payer: University Health Alliance Commercial	$73.62

FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]

Facility

OP

$101.00

Service Code	NDC 00378912398
Hospital Revenue Code	637
Min. Negotiated Rate	$50.50
Max. Negotiated Rate	$97.97
Rate for Payer: AlohaCare Medicaid	$50.50
Rate for Payer: AlohaCare Medicare	$76.76
Rate for Payer: Cash Price	$60.60
Rate for Payer: Devoted Health Medicare	$84.84
Rate for Payer: Hawaii Medical Service Association Medicare	$76.76
Rate for Payer: Hawaii Western Management Group Commercial	$95.95
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Humana Medicare	$76.76
Rate for Payer: Kaiser Permanente Commercial	$90.90
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: Kaiser Permanente Medicare	$76.76
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: Ohana Health Plan Medicaid	$76.76
Rate for Payer: Ohana Health Plan Medicare	$76.76
Rate for Payer: UnitedHealthcare Medicare	$76.76
Rate for Payer: University Health Alliance Commercial	$73.62

FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]

Facility

IP

$101.00

Service Code	NDC 00378912398
Hospital Revenue Code	250
Min. Negotiated Rate	$85.85
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$60.60
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Kaiser Permanente Commercial	$90.90
Rate for Payer: MDX Hawaii PPO	$97.97

FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]

Facility

OP

$101.00

Service Code	NDC 00378912316
Hospital Revenue Code	637
Min. Negotiated Rate	$50.50
Max. Negotiated Rate	$97.97
Rate for Payer: AlohaCare Medicaid	$50.50
Rate for Payer: AlohaCare Medicare	$76.76
Rate for Payer: Cash Price	$60.60
Rate for Payer: Devoted Health Medicare	$84.84
Rate for Payer: Hawaii Medical Service Association Medicare	$76.76
Rate for Payer: Hawaii Western Management Group Commercial	$95.95
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Humana Medicare	$76.76
Rate for Payer: Kaiser Permanente Commercial	$90.90
Rate for Payer: Kaiser Permanente Medicaid	$51.51
Rate for Payer: Kaiser Permanente Medicare	$76.76
Rate for Payer: MDX Hawaii PPO	$97.97
Rate for Payer: Ohana Health Plan Medicaid	$76.76
Rate for Payer: Ohana Health Plan Medicare	$76.76
Rate for Payer: UnitedHealthcare Medicare	$76.76
Rate for Payer: University Health Alliance Commercial	$73.62

FENTANYL 75 MCG/HR TRANSDERMAL PATCH [27907]

Facility

IP

$101.00

Service Code	NDC 00378912316
Hospital Revenue Code	250
Min. Negotiated Rate	$85.85
Max. Negotiated Rate	$97.97
Rate for Payer: Cash Price	$60.60
Rate for Payer: Health Management Network Commercial	$85.85
Rate for Payer: Kaiser Permanente Commercial	$90.90
Rate for Payer: MDX Hawaii PPO	$97.97

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