Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [95676]

Facility

OP

$27.00

Service Code	NDC 29300030816
Hospital Revenue Code	637
Min. Negotiated Rate	$8.37
Max. Negotiated Rate	$26.19
Rate for Payer: AlohaCare Medicaid	$13.50
Rate for Payer: AlohaCare Medicare	$8.37
Rate for Payer: Cash Price	$16.20
Rate for Payer: Devoted Health Medicare	$9.18
Rate for Payer: Hawaii Medical Service Association Medicare	$8.37
Rate for Payer: Hawaii Western Management Group Commercial	$25.65
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Humana Medicare	$8.37
Rate for Payer: Kaiser Permanente Commercial	$24.30
Rate for Payer: Kaiser Permanente Medicaid	$13.77
Rate for Payer: Kaiser Permanente Medicare	$8.37
Rate for Payer: MDX Hawaii PPO	$26.19
Rate for Payer: Ohana Health Plan Medicaid	$8.37
Rate for Payer: Ohana Health Plan Medicare	$8.37
Rate for Payer: UnitedHealthcare Medicare	$8.37
Rate for Payer: University Health Alliance Commercial	$19.68

QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [95676]

Facility

OP

$4.00

Service Code	NDC 00904680161
Hospital Revenue Code	637
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$1.24
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$1.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$1.24
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$1.24
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$1.24
Rate for Payer: Ohana Health Plan Medicare	$1.24
Rate for Payer: UnitedHealthcare Medicare	$1.24
Rate for Payer: University Health Alliance Commercial	$2.92

QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [95676]

Facility

IP

$4.00

Service Code	NDC 00904680161
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

QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [95676]

Facility

IP

$27.00

Service Code	NDC 29300030816
Hospital Revenue Code	250
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Kaiser Permanente Commercial	$24.30
Rate for Payer: MDX Hawaii PPO	$26.19

QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [95676]

Facility

IP

$27.00

Service Code	NDC 68001051106
Hospital Revenue Code	250
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Kaiser Permanente Commercial	$24.30
Rate for Payer: MDX Hawaii PPO	$26.19

QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR [95676]

Facility

OP

$27.00

Service Code	NDC 68001051106
Hospital Revenue Code	637
Min. Negotiated Rate	$8.37
Max. Negotiated Rate	$26.19
Rate for Payer: AlohaCare Medicaid	$13.50
Rate for Payer: AlohaCare Medicare	$8.37
Rate for Payer: Cash Price	$16.20
Rate for Payer: Devoted Health Medicare	$9.18
Rate for Payer: Hawaii Medical Service Association Medicare	$8.37
Rate for Payer: Hawaii Western Management Group Commercial	$25.65
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Humana Medicare	$8.37
Rate for Payer: Kaiser Permanente Commercial	$24.30
Rate for Payer: Kaiser Permanente Medicaid	$13.77
Rate for Payer: Kaiser Permanente Medicare	$8.37
Rate for Payer: MDX Hawaii PPO	$26.19
Rate for Payer: Ohana Health Plan Medicaid	$8.37
Rate for Payer: Ohana Health Plan Medicare	$8.37
Rate for Payer: UnitedHealthcare Medicare	$8.37
Rate for Payer: University Health Alliance Commercial	$19.68

QUICKANCHOR PLUS #3/0 212843

Facility

IP

$2,133.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,194.48
Max. Negotiated Rate	$2,069.01
Rate for Payer: Cash Price	$1,279.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,493.10
Rate for Payer: Health Management Network Commercial	$1,813.05
Rate for Payer: Kaiser Permanente Commercial	$1,919.70
Rate for Payer: MDX Hawaii PPO	$2,069.01
Rate for Payer: University Health Alliance Commercial	$1,194.48

QUICKANCHOR PLUS #3/0 212843

Facility

OP

$2,133.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$661.23
Max. Negotiated Rate	$2,069.01
Rate for Payer: AlohaCare Medicaid	$1,066.50
Rate for Payer: AlohaCare Medicare	$661.23
Rate for Payer: Cash Price	$1,279.80
Rate for Payer: Devoted Health Medicare	$725.22
Rate for Payer: Hawaii Medical Service Association Medicare	$661.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,493.10
Rate for Payer: Health Management Network Commercial	$1,813.05
Rate for Payer: Humana Medicare	$661.23
Rate for Payer: Kaiser Permanente Commercial	$1,919.70
Rate for Payer: Kaiser Permanente Medicaid	$1,087.83
Rate for Payer: Kaiser Permanente Medicare	$661.23
Rate for Payer: MDX Hawaii PPO	$2,069.01
Rate for Payer: Ohana Health Plan Medicaid	$661.23
Rate for Payer: Ohana Health Plan Medicare	$661.23
Rate for Payer: UnitedHealthcare Medicare	$661.23
Rate for Payer: University Health Alliance Commercial	$1,194.48

QUILL 0, CT-2 12" VLP-4135

Facility

OP

$22.00

Hospital Revenue Code	272
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$21.34
Rate for Payer: AlohaCare Medicaid	$11.00
Rate for Payer: AlohaCare Medicare	$6.82
Rate for Payer: Cash Price	$13.20
Rate for Payer: Devoted Health Medicare	$7.48
Rate for Payer: Hawaii Medical Service Association Medicare	$6.82
Rate for Payer: Hawaii Western Management Group Commercial	$20.90
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Humana Medicare	$6.82
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: Kaiser Permanente Medicaid	$11.22
Rate for Payer: Kaiser Permanente Medicare	$6.82
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: Ohana Health Plan Medicaid	$6.82
Rate for Payer: Ohana Health Plan Medicare	$6.82
Rate for Payer: UnitedHealthcare Medicare	$6.82
Rate for Payer: University Health Alliance Commercial	$16.04

QUILL 0, CT-2 12" VLP-4135

Facility

IP

$22.00

Hospital Revenue Code	272
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: Kaiser Permanente Commercial	$19.80
Rate for Payer: MDX Hawaii PPO	$21.34

QUILL 0, CT-2 9" VLP-4147

Facility

IP

$124.00

Hospital Revenue Code	272
Min. Negotiated Rate	$105.40
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$74.40
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Kaiser Permanente Commercial	$111.60
Rate for Payer: MDX Hawaii PPO	$120.28

QUILL 0, CT-2 9" VLP-4147

Facility

OP

$124.00

Hospital Revenue Code	272
Min. Negotiated Rate	$38.44
Max. Negotiated Rate	$120.28
Rate for Payer: AlohaCare Medicaid	$62.00
Rate for Payer: AlohaCare Medicare	$38.44
Rate for Payer: Cash Price	$74.40
Rate for Payer: Devoted Health Medicare	$42.16
Rate for Payer: Hawaii Medical Service Association Medicare	$38.44
Rate for Payer: Hawaii Western Management Group Commercial	$117.80
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Humana Medicare	$38.44
Rate for Payer: Kaiser Permanente Commercial	$111.60
Rate for Payer: Kaiser Permanente Medicaid	$63.24
Rate for Payer: Kaiser Permanente Medicare	$38.44
Rate for Payer: MDX Hawaii PPO	$120.28
Rate for Payer: Ohana Health Plan Medicaid	$38.44
Rate for Payer: Ohana Health Plan Medicare	$38.44
Rate for Payer: UnitedHealthcare Medicare	$38.44
Rate for Payer: University Health Alliance Commercial	$90.38

QUINTON TUNNELER 8888415679

Facility

OP

$621.00

Hospital Revenue Code	272
Min. Negotiated Rate	$192.51
Max. Negotiated Rate	$602.37
Rate for Payer: AlohaCare Medicaid	$310.50
Rate for Payer: AlohaCare Medicare	$192.51
Rate for Payer: Cash Price	$372.60
Rate for Payer: Devoted Health Medicare	$211.14
Rate for Payer: Hawaii Medical Service Association Medicare	$192.51
Rate for Payer: Hawaii Western Management Group Commercial	$589.95
Rate for Payer: Health Management Network Commercial	$527.85
Rate for Payer: Humana Medicare	$192.51
Rate for Payer: Kaiser Permanente Commercial	$558.90
Rate for Payer: Kaiser Permanente Medicaid	$316.71
Rate for Payer: Kaiser Permanente Medicare	$192.51
Rate for Payer: MDX Hawaii PPO	$602.37
Rate for Payer: Ohana Health Plan Medicaid	$192.51
Rate for Payer: Ohana Health Plan Medicare	$192.51
Rate for Payer: UnitedHealthcare Medicare	$192.51
Rate for Payer: University Health Alliance Commercial	$452.65

QUINTON TUNNELER 8888415679

Facility

IP

$621.00

Hospital Revenue Code	272
Min. Negotiated Rate	$527.85
Max. Negotiated Rate	$602.37
Rate for Payer: Cash Price	$372.60
Rate for Payer: Health Management Network Commercial	$527.85
Rate for Payer: Kaiser Permanente Commercial	$558.90
Rate for Payer: MDX Hawaii PPO	$602.37

RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [113082]

Facility

IP

$9.00

Service Code	NDC 00487590199
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73

RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION [113082]

Facility

IP

$9.00

Service Code	NDC 00487278401
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73

RADIAL RELOAD MEDIUM THICK

Facility

IP

$1,302.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,106.70
Max. Negotiated Rate	$1,262.94
Rate for Payer: Cash Price	$781.20
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: MDX Hawaii PPO	$1,262.94

RADIAL RELOAD MEDIUM THICK

Facility

OP

$1,302.00

Hospital Revenue Code	272
Min. Negotiated Rate	$403.62
Max. Negotiated Rate	$1,262.94
Rate for Payer: AlohaCare Medicaid	$651.00
Rate for Payer: AlohaCare Medicare	$403.62
Rate for Payer: Cash Price	$781.20
Rate for Payer: Devoted Health Medicare	$442.68
Rate for Payer: Hawaii Medical Service Association Medicare	$403.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,236.90
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Humana Medicare	$403.62
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: Kaiser Permanente Medicaid	$664.02
Rate for Payer: Kaiser Permanente Medicare	$403.62
Rate for Payer: MDX Hawaii PPO	$1,262.94
Rate for Payer: Ohana Health Plan Medicaid	$403.62
Rate for Payer: Ohana Health Plan Medicare	$403.62
Rate for Payer: UnitedHealthcare Medicare	$403.62
Rate for Payer: University Health Alliance Commercial	$949.03

RADIOGRAPHIC CHARMS 10MM

Facility

IP

$122.00

Hospital Revenue Code	272
Min. Negotiated Rate	$103.70
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$73.20
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: MDX Hawaii PPO	$118.34

RADIOGRAPHIC CHARMS 10MM

Facility

OP

$122.00

Hospital Revenue Code	272
Min. Negotiated Rate	$37.82
Max. Negotiated Rate	$118.34
Rate for Payer: AlohaCare Medicaid	$61.00
Rate for Payer: AlohaCare Medicare	$37.82
Rate for Payer: Cash Price	$73.20
Rate for Payer: Devoted Health Medicare	$41.48
Rate for Payer: Hawaii Medical Service Association Medicare	$37.82
Rate for Payer: Hawaii Western Management Group Commercial	$115.90
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Humana Medicare	$37.82
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Medicaid	$62.22
Rate for Payer: Kaiser Permanente Medicare	$37.82
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: Ohana Health Plan Medicaid	$37.82
Rate for Payer: Ohana Health Plan Medicare	$37.82
Rate for Payer: UnitedHealthcare Medicare	$37.82
Rate for Payer: University Health Alliance Commercial	$88.93

RADIOTHERAPY

Facility

IP

$17,373.57

Service Code	MSDRG 849
Min. Negotiated Rate	$17,373.57
Max. Negotiated Rate	$17,373.57
Rate for Payer: Hawaii Medical Service Association Commercial	$17,373.57

RALOXIFENE 60 MG TABLET [22143]

Facility

IP

$22.00

Service Code	NDC 43598050530
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: Kaiser Permanente Commercial	$19.80
Rate for Payer: MDX Hawaii PPO	$21.34

RALOXIFENE 60 MG TABLET [22143]

Facility

OP

$22.00

Service Code	NDC 43598050530
Hospital Revenue Code	637
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$21.34
Rate for Payer: AlohaCare Medicaid	$11.00
Rate for Payer: AlohaCare Medicare	$6.82
Rate for Payer: Cash Price	$13.20
Rate for Payer: Devoted Health Medicare	$7.48
Rate for Payer: Hawaii Medical Service Association Medicare	$6.82
Rate for Payer: Hawaii Western Management Group Commercial	$20.90
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Humana Medicare	$6.82
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: Kaiser Permanente Medicaid	$11.22
Rate for Payer: Kaiser Permanente Medicare	$6.82
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: Ohana Health Plan Medicaid	$6.82
Rate for Payer: Ohana Health Plan Medicare	$6.82
Rate for Payer: UnitedHealthcare Medicare	$6.82
Rate for Payer: University Health Alliance Commercial	$16.04

RALOXIFENE 60 MG TABLET [22143]

Facility

OP

$22.00

Service Code	NDC 65862070930
Hospital Revenue Code	637
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$21.34
Rate for Payer: AlohaCare Medicaid	$11.00
Rate for Payer: AlohaCare Medicare	$6.82
Rate for Payer: Cash Price	$13.20
Rate for Payer: Devoted Health Medicare	$7.48
Rate for Payer: Hawaii Medical Service Association Medicare	$6.82
Rate for Payer: Hawaii Western Management Group Commercial	$20.90
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Humana Medicare	$6.82
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: Kaiser Permanente Medicaid	$11.22
Rate for Payer: Kaiser Permanente Medicare	$6.82
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: Ohana Health Plan Medicaid	$6.82
Rate for Payer: Ohana Health Plan Medicare	$6.82
Rate for Payer: UnitedHealthcare Medicare	$6.82
Rate for Payer: University Health Alliance Commercial	$16.04

RALOXIFENE 60 MG TABLET [22143]

Facility

IP

$22.00

Service Code	NDC 65862070930
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: Kaiser Permanente Commercial	$19.80
Rate for Payer: MDX Hawaii PPO	$21.34

<<
<
724
725
726
727
728
729
730
731
732
733
>
>>