Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

ASPIRIN 81 MG TABLET,DELAYED RELEASE [688]

Facility

OP

$1.00

Service Code	NDC 00536123441
Hospital Revenue Code	637
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.76
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.76
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.76
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.76
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.76
Rate for Payer: Ohana Health Plan Medicare	$0.76
Rate for Payer: UnitedHealthcare Medicare	$0.76
Rate for Payer: University Health Alliance Commercial	$0.73

ASPIRIN 81 MG TABLET,DELAYED RELEASE [688]

Facility

IP

$1.00

Service Code	NDC 71399862702
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: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

ASPIRIN 81 MG TABLET,DELAYED RELEASE [688]

Facility

IP

$1.00

Service Code	NDC 71399101402
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: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

ASPIRIN 81 MG TABLET,DELAYED RELEASE [688]

Facility

OP

$1.00

Service Code	NDC 71399101402
Hospital Revenue Code	637
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.76
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.76
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.76
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.76
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.76
Rate for Payer: Ohana Health Plan Medicare	$0.76
Rate for Payer: UnitedHealthcare Medicare	$0.76
Rate for Payer: University Health Alliance Commercial	$0.73

ASPIRIN 81 MG TABLET,DELAYED RELEASE [688]

Facility

IP

$1.00

Service Code	NDC 00536123441
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: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

ASPIRIN 81 MG TABLET,DELAYED RELEASE [688]

Facility

OP

$1.00

Service Code	NDC 71399862702
Hospital Revenue Code	637
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.76
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.76
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.76
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.76
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.76
Rate for Payer: Ohana Health Plan Medicare	$0.76
Rate for Payer: UnitedHealthcare Medicare	$0.76
Rate for Payer: University Health Alliance Commercial	$0.73

ASYMMETRIC 35X10 5551-G-350-E

Facility

OP

$2,341.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,170.50
Max. Negotiated Rate	$2,270.77
Rate for Payer: AlohaCare Medicaid	$1,170.50
Rate for Payer: AlohaCare Medicare	$1,779.16
Rate for Payer: Cash Price	$1,404.60
Rate for Payer: Devoted Health Medicare	$1,966.44
Rate for Payer: Hawaii Medical Service Association Medicare	$1,779.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,638.70
Rate for Payer: Health Management Network Commercial	$1,989.85
Rate for Payer: Humana Medicare	$1,779.16
Rate for Payer: Kaiser Permanente Commercial	$2,106.90
Rate for Payer: Kaiser Permanente Medicaid	$1,193.91
Rate for Payer: Kaiser Permanente Medicare	$1,779.16
Rate for Payer: MDX Hawaii PPO	$2,270.77
Rate for Payer: Ohana Health Plan Medicaid	$1,779.16
Rate for Payer: Ohana Health Plan Medicare	$1,779.16
Rate for Payer: UnitedHealthcare Medicare	$1,779.16
Rate for Payer: University Health Alliance Commercial	$1,310.96

ASYMMETRIC 35X10 5551-G-350-E

Facility

IP

$2,341.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,310.96
Max. Negotiated Rate	$2,270.77
Rate for Payer: Cash Price	$1,404.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,638.70
Rate for Payer: Health Management Network Commercial	$1,989.85
Rate for Payer: Kaiser Permanente Commercial	$2,106.90
Rate for Payer: MDX Hawaii PPO	$2,270.77
Rate for Payer: University Health Alliance Commercial	$1,310.96

ATENOLOL 25 MG TABLET [717]

Facility

IP

$3.00

Service Code	NDC 51079075920
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

ATENOLOL 25 MG TABLET [717]

Facility

OP

$3.00

Service Code	NDC 51079075920
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

ATENOLOL 25 MG TABLET [717]

Facility

IP

$1.00

Service Code	NDC 00904718761
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: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

ATENOLOL 25 MG TABLET [717]

Facility

OP

$1.00

Service Code	NDC 00904718761
Hospital Revenue Code	637
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.76
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.76
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.76
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.76
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.76
Rate for Payer: Ohana Health Plan Medicare	$0.76
Rate for Payer: UnitedHealthcare Medicare	$0.76
Rate for Payer: University Health Alliance Commercial	$0.73

ATENOLOL 50 MG TABLET [718]

Facility

OP

$4.00

Service Code	NDC 51079068401
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$3.04
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3.04
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$3.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$3.04
Rate for Payer: Ohana Health Plan Medicare	$3.04
Rate for Payer: UnitedHealthcare Medicare	$3.04
Rate for Payer: University Health Alliance Commercial	$2.92

ATENOLOL 50 MG TABLET [718]

Facility

OP

$4.00

Service Code	NDC 51079068420
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$3.04
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3.04
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$3.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$3.04
Rate for Payer: Ohana Health Plan Medicare	$3.04
Rate for Payer: UnitedHealthcare Medicare	$3.04
Rate for Payer: University Health Alliance Commercial	$2.92

ATENOLOL 50 MG TABLET [718]

Facility

IP

$4.00

Service Code	NDC 51079068420
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: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

ATENOLOL 50 MG TABLET [718]

Facility

IP

$4.00

Service Code	NDC 51079068401
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: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION [132613]

Facility

OP

$20,861.00

Service Code	HCPCS J9022
Hospital Revenue Code	636
Min. Negotiated Rate	$91.02
Max. Negotiated Rate	$20,235.17
Rate for Payer: AlohaCare Medicaid	$10,430.50
Rate for Payer: AlohaCare Medicare	$15,854.36
Rate for Payer: Cash Price	$12,516.60
Rate for Payer: Cash Price	$12,516.60
Rate for Payer: Devoted Health Medicare	$17,523.24
Rate for Payer: Hawaii Medical Service Association ABD	$91.02
Rate for Payer: Hawaii Medical Service Association Commercial	$117.50
Rate for Payer: Hawaii Medical Service Association Medicare	$15,854.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$91.02
Rate for Payer: Hawaii Western Management Group Commercial	$19,817.95
Rate for Payer: Health Management Network Commercial	$17,731.85
Rate for Payer: Humana Medicare	$15,854.36
Rate for Payer: Kaiser Permanente Commercial	$18,774.90
Rate for Payer: Kaiser Permanente Medicaid	$10,639.11
Rate for Payer: Kaiser Permanente Medicare	$15,854.36
Rate for Payer: MDX Hawaii PPO	$20,235.17
Rate for Payer: Ohana Health Plan Medicaid	$15,854.36
Rate for Payer: Ohana Health Plan Medicare	$15,854.36
Rate for Payer: UnitedHealthcare Medicaid	$12,516.60
Rate for Payer: UnitedHealthcare Medicare	$15,854.36
Rate for Payer: University Health Alliance Commercial	$15,205.58

ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) INTRAVENOUS SOLUTION [132613]

Facility

IP

$20,861.00

Service Code	HCPCS J9022
Hospital Revenue Code	250
Min. Negotiated Rate	$17,731.85
Max. Negotiated Rate	$20,235.17
Rate for Payer: Cash Price	$12,516.60
Rate for Payer: Health Management Network Commercial	$17,731.85
Rate for Payer: Kaiser Permanente Commercial	$18,774.90
Rate for Payer: MDX Hawaii PPO	$20,235.17

ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) INTRAVENOUS SOLUTION [166705]

Facility

OP

$13,630.00

Service Code	HCPCS J9022
Hospital Revenue Code	636
Min. Negotiated Rate	$91.02
Max. Negotiated Rate	$13,221.10
Rate for Payer: AlohaCare Medicaid	$6,815.00
Rate for Payer: AlohaCare Medicare	$10,358.80
Rate for Payer: Cash Price	$8,178.00
Rate for Payer: Cash Price	$8,178.00
Rate for Payer: Devoted Health Medicare	$11,449.20
Rate for Payer: Hawaii Medical Service Association ABD	$91.02
Rate for Payer: Hawaii Medical Service Association Commercial	$117.50
Rate for Payer: Hawaii Medical Service Association Medicare	$10,358.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$91.02
Rate for Payer: Hawaii Western Management Group Commercial	$12,948.50
Rate for Payer: Health Management Network Commercial	$11,585.50
Rate for Payer: Humana Medicare	$10,358.80
Rate for Payer: Kaiser Permanente Commercial	$12,267.00
Rate for Payer: Kaiser Permanente Medicaid	$6,951.30
Rate for Payer: Kaiser Permanente Medicare	$10,358.80
Rate for Payer: MDX Hawaii PPO	$13,221.10
Rate for Payer: Ohana Health Plan Medicaid	$10,358.80
Rate for Payer: Ohana Health Plan Medicare	$10,358.80
Rate for Payer: UnitedHealthcare Medicaid	$8,178.00
Rate for Payer: UnitedHealthcare Medicare	$10,358.80
Rate for Payer: University Health Alliance Commercial	$9,934.91

ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) INTRAVENOUS SOLUTION [166705]

Facility

IP

$13,630.00

Service Code	HCPCS J9022
Hospital Revenue Code	250
Min. Negotiated Rate	$11,585.50
Max. Negotiated Rate	$13,221.10
Rate for Payer: Cash Price	$8,178.00
Rate for Payer: Health Management Network Commercial	$11,585.50
Rate for Payer: Kaiser Permanente Commercial	$12,267.00
Rate for Payer: MDX Hawaii PPO	$13,221.10

ATHEROSCLEROSIS WITH MCC

Facility

IP

$14,197.50

Service Code	MSDRG 302
Min. Negotiated Rate	$14,197.50
Max. Negotiated Rate	$14,197.50
Rate for Payer: Hawaii Medical Service Association Commercial	$14,197.50

ATHEROSCLEROSIS WITHOUT MCC

Facility

IP

$14,078.99

Service Code	MSDRG 303
Min. Negotiated Rate	$14,078.99
Max. Negotiated Rate	$14,078.99
Rate for Payer: Hawaii Medical Service Association Commercial	$14,078.99

ATLAS GOLD NC 8F 18X40X120

Facility

OP

$1,488.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$744.00
Max. Negotiated Rate	$1,443.36
Rate for Payer: AlohaCare Medicaid	$744.00
Rate for Payer: AlohaCare Medicare	$1,130.88
Rate for Payer: Cash Price	$892.80
Rate for Payer: Devoted Health Medicare	$1,249.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,130.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,413.60
Rate for Payer: Health Management Network Commercial	$1,264.80
Rate for Payer: Humana Medicare	$1,130.88
Rate for Payer: Kaiser Permanente Commercial	$1,339.20
Rate for Payer: Kaiser Permanente Medicaid	$758.88
Rate for Payer: Kaiser Permanente Medicare	$1,130.88
Rate for Payer: MDX Hawaii PPO	$1,443.36
Rate for Payer: Ohana Health Plan Medicaid	$1,130.88
Rate for Payer: Ohana Health Plan Medicare	$1,130.88
Rate for Payer: UnitedHealthcare Medicare	$1,130.88
Rate for Payer: University Health Alliance Commercial	$1,084.60

ATLAS GOLD NC 8F 18X40X120

Facility

IP

$1,488.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$1,264.80
Max. Negotiated Rate	$1,443.36
Rate for Payer: Cash Price	$892.80
Rate for Payer: Health Management Network Commercial	$1,264.80
Rate for Payer: Kaiser Permanente Commercial	$1,339.20
Rate for Payer: MDX Hawaii PPO	$1,443.36

ATORVASTATIN 10 MG TABLET [19176]

Facility

OP

$3.00

Service Code	NDC 68084009701
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$2.19

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