Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

SODIUM CHLORIDE 7 % FOR NEBULIZATION [82134]

Facility

OP

$3.00

Service Code	NDC 02160000000
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

SODIUM CHLORIDE 7 % FOR NEBULIZATION [82134]

Facility

IP

$3.00

Service Code	NDC 00730000000
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

SODIUM CHLORIDE 7 % FOR NEBULIZATION [82134]

Facility

IP

$3.00

Service Code	NDC 14123000000
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

SODIUM CHLORIDE 7 % FOR NEBULIZATION [82134]

Facility

IP

$3.00

Service Code	NDC 02160000000
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

SODIUM CHLORIDE 7 % FOR NEBULIZATION [82134]

Facility

OP

$3.00

Service Code	NDC 14123000000
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

SODIUM CHLORIDE 7 % FOR NEBULIZATION [82134]

Facility

OP

$3.00

Service Code	NDC 00730000000
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

SODIUM CHLORIDE-ALOE VERA NASAL GEL [15371]

Facility

IP

$12.00

Service Code	NDC 52547000000
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

SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION [11394]

Facility

OP

$19.00

Service Code	NDC 19000000000
Hospital Revenue Code	637
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$18.43
Rate for Payer: AlohaCare Medicaid	$9.50
Rate for Payer: AlohaCare Medicare	$14.44
Rate for Payer: Cash Price	$11.40
Rate for Payer: Devoted Health Medicare	$15.96
Rate for Payer: Hawaii Medical Service Association Medicare	$14.44
Rate for Payer: Hawaii Western Management Group Commercial	$18.05
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Humana Medicare	$14.44
Rate for Payer: Kaiser Permanente Commercial	$17.10
Rate for Payer: Kaiser Permanente Medicaid	$9.69
Rate for Payer: Kaiser Permanente Medicare	$14.44
Rate for Payer: MDX Hawaii PPO	$18.43
Rate for Payer: Ohana Health Plan Medicaid	$14.44
Rate for Payer: Ohana Health Plan Medicare	$14.44
Rate for Payer: UnitedHealthcare Medicare	$14.44
Rate for Payer: University Health Alliance Commercial	$13.85

SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION [11394]

Facility

IP

$19.00

Service Code	NDC 19030000000
Hospital Revenue Code	250
Min. Negotiated Rate	$16.15
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$11.40
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Kaiser Permanente Commercial	$17.10
Rate for Payer: MDX Hawaii PPO	$18.43

SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION [11394]

Facility

IP

$19.00

Service Code	NDC 19000000000
Hospital Revenue Code	250
Min. Negotiated Rate	$16.15
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$11.40
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Kaiser Permanente Commercial	$17.10
Rate for Payer: MDX Hawaii PPO	$18.43

SODIUM CITRATE-CITRIC ACID 500 MG-334 MG/5 ML ORAL SOLUTION [11394]

Facility

OP

$19.00

Service Code	NDC 19030000000
Hospital Revenue Code	637
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$18.43
Rate for Payer: AlohaCare Medicaid	$9.50
Rate for Payer: AlohaCare Medicare	$14.44
Rate for Payer: Cash Price	$11.40
Rate for Payer: Devoted Health Medicare	$15.96
Rate for Payer: Hawaii Medical Service Association Medicare	$14.44
Rate for Payer: Hawaii Western Management Group Commercial	$18.05
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Humana Medicare	$14.44
Rate for Payer: Kaiser Permanente Commercial	$17.10
Rate for Payer: Kaiser Permanente Medicaid	$9.69
Rate for Payer: Kaiser Permanente Medicare	$14.44
Rate for Payer: MDX Hawaii PPO	$18.43
Rate for Payer: Ohana Health Plan Medicaid	$14.44
Rate for Payer: Ohana Health Plan Medicare	$14.44
Rate for Payer: UnitedHealthcare Medicare	$14.44
Rate for Payer: University Health Alliance Commercial	$13.85

SODIUM HYPOCHLORITE 0.125 % SOLUTION [76724]

Facility

IP

$65.00

Service Code	NDC 06412000000
Hospital Revenue Code	250
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$39.00
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Kaiser Permanente Commercial	$58.50
Rate for Payer: MDX Hawaii PPO	$63.05

SODIUM HYPOCHLORITE 0.125 % SOLUTION [76724]

Facility

OP

$65.00

Service Code	NDC 06412000000
Hospital Revenue Code	637
Min. Negotiated Rate	$32.50
Max. Negotiated Rate	$63.05
Rate for Payer: AlohaCare Medicaid	$32.50
Rate for Payer: AlohaCare Medicare	$49.40
Rate for Payer: Cash Price	$39.00
Rate for Payer: Devoted Health Medicare	$54.60
Rate for Payer: Hawaii Medical Service Association Medicare	$49.40
Rate for Payer: Hawaii Western Management Group Commercial	$61.75
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Humana Medicare	$49.40
Rate for Payer: Kaiser Permanente Commercial	$58.50
Rate for Payer: Kaiser Permanente Medicaid	$33.15
Rate for Payer: Kaiser Permanente Medicare	$49.40
Rate for Payer: MDX Hawaii PPO	$63.05
Rate for Payer: Ohana Health Plan Medicaid	$49.40
Rate for Payer: Ohana Health Plan Medicare	$49.40
Rate for Payer: UnitedHealthcare Medicare	$49.40
Rate for Payer: University Health Alliance Commercial	$47.38

SODIUM HYPOCHLORITE 0.25 % SOLUTION [15950]

Facility

IP

$49.00

Service Code	NDC 00436093616
Hospital Revenue Code	250
Min. Negotiated Rate	$41.65
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$29.40
Rate for Payer: Health Management Network Commercial	$41.65
Rate for Payer: Kaiser Permanente Commercial	$44.10
Rate for Payer: MDX Hawaii PPO	$47.53

SODIUM HYPOCHLORITE 0.25 % SOLUTION [15950]

Facility

OP

$49.00

Service Code	NDC 00436093616
Hospital Revenue Code	637
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$47.53
Rate for Payer: AlohaCare Medicaid	$24.50
Rate for Payer: AlohaCare Medicare	$37.24
Rate for Payer: Cash Price	$29.40
Rate for Payer: Devoted Health Medicare	$41.16
Rate for Payer: Hawaii Medical Service Association Medicare	$37.24
Rate for Payer: Hawaii Western Management Group Commercial	$46.55
Rate for Payer: Health Management Network Commercial	$41.65
Rate for Payer: Humana Medicare	$37.24
Rate for Payer: Kaiser Permanente Commercial	$44.10
Rate for Payer: Kaiser Permanente Medicaid	$24.99
Rate for Payer: Kaiser Permanente Medicare	$37.24
Rate for Payer: MDX Hawaii PPO	$47.53
Rate for Payer: Ohana Health Plan Medicaid	$37.24
Rate for Payer: Ohana Health Plan Medicare	$37.24
Rate for Payer: UnitedHealthcare Medicare	$37.24
Rate for Payer: University Health Alliance Commercial	$35.72

SODIUM IODIDE-131 (I-131) 3.7 MBQ (100 MICROCI) CAPSULE [209258]

Facility

OP

$59.00

Service Code	HCPCS A9517
Hospital Revenue Code	343
Min. Negotiated Rate	$29.50
Max. Negotiated Rate	$117.25
Rate for Payer: AlohaCare Medicaid	$29.50
Rate for Payer: AlohaCare Medicare	$44.84
Rate for Payer: Cash Price	$35.40
Rate for Payer: Cash Price	$35.40
Rate for Payer: Devoted Health Medicare	$49.56
Rate for Payer: Hawaii Medical Service Association Commercial	$30.09
Rate for Payer: Hawaii Medical Service Association Medicare	$44.84
Rate for Payer: Hawaii Western Management Group Commercial	$56.05
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: Humana Medicare	$44.84
Rate for Payer: Kaiser Permanente Commercial	$53.10
Rate for Payer: Kaiser Permanente Medicaid	$30.09
Rate for Payer: Kaiser Permanente Medicare	$44.84
Rate for Payer: MDX Hawaii PPO	$57.23
Rate for Payer: Ohana Health Plan Medicaid	$44.84
Rate for Payer: Ohana Health Plan Medicare	$44.84
Rate for Payer: UnitedHealthcare Medicaid	$117.25
Rate for Payer: UnitedHealthcare Medicare	$44.84
Rate for Payer: University Health Alliance Commercial	$43.01

SODIUM IODIDE-131 (I-131) 3.7 MBQ (100 MICROCI) CAPSULE [209258]

Facility

IP

$59.00

Service Code	HCPCS A9517
Hospital Revenue Code	343
Min. Negotiated Rate	$50.15
Max. Negotiated Rate	$57.23
Rate for Payer: Cash Price	$35.40
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: Kaiser Permanente Commercial	$53.10
Rate for Payer: MDX Hawaii PPO	$57.23

SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION [18908]

Facility

IP

$60.00

Service Code	NDC 72485010501
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

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION [137040]

Facility

IP

$169.00

Service Code	NDC 00409739172
Hospital Revenue Code	250
Min. Negotiated Rate	$143.65
Max. Negotiated Rate	$163.93
Rate for Payer: Cash Price	$101.40
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: Kaiser Permanente Commercial	$152.10
Rate for Payer: MDX Hawaii PPO	$163.93

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION [137040]

Facility

IP

$169.00

Service Code	NDC 00409739182
Hospital Revenue Code	250
Min. Negotiated Rate	$143.65
Max. Negotiated Rate	$163.93
Rate for Payer: Cash Price	$101.40
Rate for Payer: Health Management Network Commercial	$143.65
Rate for Payer: Kaiser Permanente Commercial	$152.10
Rate for Payer: MDX Hawaii PPO	$163.93

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION [137040]

Facility

IP

$82.00

Service Code	NDC 63323088406
Hospital Revenue Code	250
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$49.20
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: MDX Hawaii PPO	$79.54

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION [137040]

Facility

IP

$174.00

Service Code	NDC 63323088116
Hospital Revenue Code	250
Min. Negotiated Rate	$147.90
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$104.40
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: MDX Hawaii PPO	$168.78

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION [137040]

Facility

IP

$82.00

Service Code	NDC 63323088401
Hospital Revenue Code	250
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$49.20
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: MDX Hawaii PPO	$79.54

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION [137040]

Facility

IP

$116.00

Service Code	NDC 63323088101
Hospital Revenue Code	250
Min. Negotiated Rate	$98.60
Max. Negotiated Rate	$112.52
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cash Price	$8.40
Rate for Payer: Cash Price	$104.40
Rate for Payer: Cash Price	$34.80
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Health Management Network Commercial	$98.60
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: Kaiser Permanente Commercial	$52.20
Rate for Payer: Kaiser Permanente Commercial	$104.40
Rate for Payer: MDX Hawaii PPO	$56.26
Rate for Payer: MDX Hawaii PPO	$13.58
Rate for Payer: MDX Hawaii PPO	$112.52
Rate for Payer: MDX Hawaii PPO	$168.78

SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA [2805]

Facility

IP

$7.00

Service Code	NDC 00132020140
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

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