Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Ethyl Glucuronide and Ethyl Sulfate Urine w/ Confirmation FSI

Facility

IP

$375.00

Service Code	HCPCS 80321
Hospital Charge Code	8117908
Hospital Revenue Code	300
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$363.75
Rate for Payer: Cash Price	$243.75
Rate for Payer: Health Management Network Commercial	$318.75
Rate for Payer: Kaiser Permanente Commercial	$337.50
Rate for Payer: MDX Hawaii PPO	$363.75

Ethyl Glucuronide and Ethyl Sulfate Urine w/ Confirmation FSI

Facility

OP

$375.00

Service Code	HCPCS 80321
Hospital Charge Code	8117908
Hospital Revenue Code	300
Min. Negotiated Rate	$14.93
Max. Negotiated Rate	$363.75
Rate for Payer: AlohaCare Medicaid	$187.50
Rate for Payer: AlohaCare Medicare	$187.50
Rate for Payer: Cash Price	$243.75
Rate for Payer: Cash Price	$243.75
Rate for Payer: Devoted Health Medicare	$206.25
Rate for Payer: Hawaii Medical Service Association ABD	$14.93
Rate for Payer: Hawaii Medical Service Association Medicare	$187.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.68
Rate for Payer: Hawaii Western Management Group Commercial	$356.25
Rate for Payer: Health Management Network Commercial	$318.75
Rate for Payer: Humana Medicare	$187.50
Rate for Payer: Kaiser Permanente Commercial	$337.50
Rate for Payer: Kaiser Permanente Medicaid	$191.25
Rate for Payer: Kaiser Permanente Medicare	$187.50
Rate for Payer: MDX Hawaii PPO	$363.75
Rate for Payer: Ohana Health Plan Medicaid	$187.50
Rate for Payer: Ohana Health Plan Medicare	$187.50
Rate for Payer: UnitedHealthcare Medicare	$187.50
Rate for Payer: University Health Alliance Commercial	$273.34

etomidate 20 mg/10 ml vial [HHSC]

Facility

OP

$41.82

Service Code	NDC 65219044510
Hospital Charge Code	2500317
Hospital Revenue Code	250
Min. Negotiated Rate	$20.91
Max. Negotiated Rate	$40.57
Rate for Payer: AlohaCare Medicaid	$20.91
Rate for Payer: AlohaCare Medicare	$20.91
Rate for Payer: Cash Price	$27.18
Rate for Payer: Devoted Health Medicare	$23.00
Rate for Payer: Hawaii Medical Service Association Medicare	$20.91
Rate for Payer: Hawaii Western Management Group Commercial	$39.73
Rate for Payer: Health Management Network Commercial	$35.55
Rate for Payer: Humana Medicare	$20.91
Rate for Payer: Kaiser Permanente Commercial	$37.64
Rate for Payer: Kaiser Permanente Medicaid	$21.33
Rate for Payer: Kaiser Permanente Medicare	$20.91
Rate for Payer: MDX Hawaii PPO	$40.57
Rate for Payer: Ohana Health Plan Medicaid	$20.91
Rate for Payer: Ohana Health Plan Medicare	$20.91
Rate for Payer: UnitedHealthcare Medicaid	$25.09
Rate for Payer: UnitedHealthcare Medicare	$20.91
Rate for Payer: University Health Alliance Commercial	$30.48

etomidate 20 mg/10 ml vial [HHSC]

Facility

IP

$41.82

Service Code	NDC 65219044510
Hospital Charge Code	2500317
Hospital Revenue Code	250
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$40.57
Rate for Payer: Cash Price	$27.18
Rate for Payer: Health Management Network Commercial	$35.55
Rate for Payer: Kaiser Permanente Commercial	$37.64
Rate for Payer: MDX Hawaii PPO	$40.57

etomidate 20 mg/10 ml vial [HHSC]

Facility

IP

$18.68

Service Code	NDC 00143931010
Hospital Charge Code	2500317
Hospital Revenue Code	250
Min. Negotiated Rate	$15.88
Max. Negotiated Rate	$18.12
Rate for Payer: Cash Price	$12.14
Rate for Payer: Health Management Network Commercial	$15.88
Rate for Payer: Kaiser Permanente Commercial	$16.81
Rate for Payer: MDX Hawaii PPO	$18.12

etomidate 20 mg/10 ml vial [HHSC]

Facility

OP

$18.68

Service Code	NDC 00143931010
Hospital Charge Code	2500317
Hospital Revenue Code	250
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$18.12
Rate for Payer: AlohaCare Medicaid	$9.34
Rate for Payer: AlohaCare Medicare	$9.34
Rate for Payer: Cash Price	$12.14
Rate for Payer: Devoted Health Medicare	$10.27
Rate for Payer: Hawaii Medical Service Association Medicare	$9.34
Rate for Payer: Hawaii Western Management Group Commercial	$17.75
Rate for Payer: Health Management Network Commercial	$15.88
Rate for Payer: Humana Medicare	$9.34
Rate for Payer: Kaiser Permanente Commercial	$16.81
Rate for Payer: Kaiser Permanente Medicaid	$9.53
Rate for Payer: Kaiser Permanente Medicare	$9.34
Rate for Payer: MDX Hawaii PPO	$18.12
Rate for Payer: Ohana Health Plan Medicaid	$9.34
Rate for Payer: Ohana Health Plan Medicare	$9.34
Rate for Payer: UnitedHealthcare Medicaid	$11.21
Rate for Payer: UnitedHealthcare Medicare	$9.34
Rate for Payer: University Health Alliance Commercial	$13.62

etomidate 20 mg/10 ml vial [HHSC]

Facility

IP

$56.43

Service Code	NDC 55150022110
Hospital Charge Code	2500317
Hospital Revenue Code	250
Min. Negotiated Rate	$47.97
Max. Negotiated Rate	$54.74
Rate for Payer: Cash Price	$36.68
Rate for Payer: Health Management Network Commercial	$47.97
Rate for Payer: Kaiser Permanente Commercial	$50.79
Rate for Payer: MDX Hawaii PPO	$54.74

etomidate 20 mg/10 ml vial [HHSC]

Facility

OP

$46.03

Service Code	NDC 00143950610
Hospital Charge Code	2500317
Hospital Revenue Code	250
Min. Negotiated Rate	$23.02
Max. Negotiated Rate	$44.65
Rate for Payer: AlohaCare Medicaid	$23.02
Rate for Payer: AlohaCare Medicare	$23.02
Rate for Payer: Cash Price	$29.92
Rate for Payer: Devoted Health Medicare	$25.32
Rate for Payer: Hawaii Medical Service Association Medicare	$23.02
Rate for Payer: Hawaii Western Management Group Commercial	$43.73
Rate for Payer: Health Management Network Commercial	$39.13
Rate for Payer: Humana Medicare	$23.02
Rate for Payer: Kaiser Permanente Commercial	$41.43
Rate for Payer: Kaiser Permanente Medicaid	$23.48
Rate for Payer: Kaiser Permanente Medicare	$23.02
Rate for Payer: MDX Hawaii PPO	$44.65
Rate for Payer: Ohana Health Plan Medicaid	$23.02
Rate for Payer: Ohana Health Plan Medicare	$23.02
Rate for Payer: UnitedHealthcare Medicaid	$27.62
Rate for Payer: UnitedHealthcare Medicare	$23.02
Rate for Payer: University Health Alliance Commercial	$33.55

etomidate 20 mg/10 ml vial [HHSC]

Facility

IP

$46.03

Service Code	NDC 00143950610
Hospital Charge Code	2500317
Hospital Revenue Code	250
Min. Negotiated Rate	$39.13
Max. Negotiated Rate	$44.65
Rate for Payer: Cash Price	$29.92
Rate for Payer: Health Management Network Commercial	$39.13
Rate for Payer: Kaiser Permanente Commercial	$41.43
Rate for Payer: MDX Hawaii PPO	$44.65

etomidate 20 mg/10 ml vial [HHSC]

Facility

OP

$56.43

Service Code	NDC 55150022110
Hospital Charge Code	2500317
Hospital Revenue Code	250
Min. Negotiated Rate	$28.21
Max. Negotiated Rate	$54.74
Rate for Payer: AlohaCare Medicaid	$28.21
Rate for Payer: AlohaCare Medicare	$28.21
Rate for Payer: Cash Price	$36.68
Rate for Payer: Devoted Health Medicare	$31.04
Rate for Payer: Hawaii Medical Service Association Medicare	$28.21
Rate for Payer: Hawaii Western Management Group Commercial	$53.61
Rate for Payer: Health Management Network Commercial	$47.97
Rate for Payer: Humana Medicare	$28.21
Rate for Payer: Kaiser Permanente Commercial	$50.79
Rate for Payer: Kaiser Permanente Medicaid	$28.78
Rate for Payer: Kaiser Permanente Medicare	$28.21
Rate for Payer: MDX Hawaii PPO	$54.74
Rate for Payer: Ohana Health Plan Medicaid	$28.21
Rate for Payer: Ohana Health Plan Medicare	$28.21
Rate for Payer: UnitedHealthcare Medicaid	$33.86
Rate for Payer: UnitedHealthcare Medicare	$28.21
Rate for Payer: University Health Alliance Commercial	$41.13

Eval of Oral and Pharyngeal Swallowing Fx Chg

Facility

OP

$521.00

Service Code	HCPCS 92610 GO,CO
Hospital Charge Code	8171799
Hospital Revenue Code	444
Min. Negotiated Rate	$88.36
Max. Negotiated Rate	$505.37
Rate for Payer: AlohaCare Medicaid	$260.50
Rate for Payer: AlohaCare Medicare	$260.50
Rate for Payer: Cash Price	$338.65
Rate for Payer: Cash Price	$338.65
Rate for Payer: Devoted Health Medicare	$286.55
Rate for Payer: Hawaii Medical Service Association Medicare	$260.50
Rate for Payer: Hawaii Western Management Group Commercial	$494.95
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Humana Medicare	$260.50
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: Kaiser Permanente Medicaid	$265.71
Rate for Payer: Kaiser Permanente Medicare	$260.50
Rate for Payer: MDX Hawaii PPO	$505.37
Rate for Payer: Ohana Health Plan Medicaid	$260.50
Rate for Payer: Ohana Health Plan Medicare	$260.50
Rate for Payer: UnitedHealthcare Medicaid	$88.36
Rate for Payer: UnitedHealthcare Medicare	$260.50
Rate for Payer: University Health Alliance Commercial	$379.76

Eval of Oral and Pharyngeal Swallowing Fx Chg

Facility

IP

$521.00

Service Code	HCPCS 92610 GO,CO
Hospital Charge Code	8171799
Hospital Revenue Code	444
Min. Negotiated Rate	$442.85
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$338.65
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: MDX Hawaii PPO	$505.37

Eval of Oral and Pharyngeal Swallowing Fx Chg

Facility

OP

$521.00

Service Code	HCPCS 92610 GO,CO
Hospital Charge Code	8359326
Hospital Revenue Code	444
Min. Negotiated Rate	$88.36
Max. Negotiated Rate	$505.37
Rate for Payer: AlohaCare Medicaid	$260.50
Rate for Payer: AlohaCare Medicare	$260.50
Rate for Payer: Cash Price	$338.65
Rate for Payer: Cash Price	$338.65
Rate for Payer: Devoted Health Medicare	$286.55
Rate for Payer: Hawaii Medical Service Association Medicare	$260.50
Rate for Payer: Hawaii Western Management Group Commercial	$494.95
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Humana Medicare	$260.50
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: Kaiser Permanente Medicaid	$265.71
Rate for Payer: Kaiser Permanente Medicare	$260.50
Rate for Payer: MDX Hawaii PPO	$505.37
Rate for Payer: Ohana Health Plan Medicaid	$260.50
Rate for Payer: Ohana Health Plan Medicare	$260.50
Rate for Payer: UnitedHealthcare Medicaid	$88.36
Rate for Payer: UnitedHealthcare Medicare	$260.50
Rate for Payer: University Health Alliance Commercial	$379.76

Eval of Oral and Pharyngeal Swallowing Fx Chg

Facility

IP

$521.00

Service Code	HCPCS 92610 GO,CO
Hospital Charge Code	8359326
Hospital Revenue Code	444
Min. Negotiated Rate	$442.85
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$338.65
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: MDX Hawaii PPO	$505.37

EVIVA BREAST BX NEEDLE, PETITE 9GX10CM

Facility

OP

$1,078.00

Hospital Charge Code	12925600
Hospital Revenue Code	272
Min. Negotiated Rate	$539.00
Max. Negotiated Rate	$1,045.66
Rate for Payer: AlohaCare Medicaid	$539.00
Rate for Payer: AlohaCare Medicare	$539.00
Rate for Payer: Cash Price	$700.70
Rate for Payer: Devoted Health Medicare	$592.90
Rate for Payer: Hawaii Medical Service Association Medicare	$539.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,024.10
Rate for Payer: Health Management Network Commercial	$916.30
Rate for Payer: Humana Medicare	$539.00
Rate for Payer: Kaiser Permanente Commercial	$970.20
Rate for Payer: Kaiser Permanente Medicaid	$549.78
Rate for Payer: Kaiser Permanente Medicare	$539.00
Rate for Payer: MDX Hawaii PPO	$1,045.66
Rate for Payer: Ohana Health Plan Medicaid	$539.00
Rate for Payer: Ohana Health Plan Medicare	$539.00
Rate for Payer: UnitedHealthcare Medicare	$539.00
Rate for Payer: University Health Alliance Commercial	$785.75

EVIVA BREAST BX NEEDLE, PETITE 9GX10CM

Facility

IP

$1,078.00

Hospital Charge Code	12925600
Hospital Revenue Code	272
Min. Negotiated Rate	$916.30
Max. Negotiated Rate	$1,045.66
Rate for Payer: Cash Price	$700.70
Rate for Payer: Health Management Network Commercial	$916.30
Rate for Payer: Kaiser Permanente Commercial	$970.20
Rate for Payer: MDX Hawaii PPO	$1,045.66

EVIVA BREAST BX NEEDLE, STANDARD 9GX13CM

Facility

OP

$1,078.00

Hospital Charge Code	12925598
Hospital Revenue Code	272
Min. Negotiated Rate	$539.00
Max. Negotiated Rate	$1,045.66
Rate for Payer: AlohaCare Medicaid	$539.00
Rate for Payer: AlohaCare Medicare	$539.00
Rate for Payer: Cash Price	$700.70
Rate for Payer: Devoted Health Medicare	$592.90
Rate for Payer: Hawaii Medical Service Association Medicare	$539.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,024.10
Rate for Payer: Health Management Network Commercial	$916.30
Rate for Payer: Humana Medicare	$539.00
Rate for Payer: Kaiser Permanente Commercial	$970.20
Rate for Payer: Kaiser Permanente Medicaid	$549.78
Rate for Payer: Kaiser Permanente Medicare	$539.00
Rate for Payer: MDX Hawaii PPO	$1,045.66
Rate for Payer: Ohana Health Plan Medicaid	$539.00
Rate for Payer: Ohana Health Plan Medicare	$539.00
Rate for Payer: UnitedHealthcare Medicare	$539.00
Rate for Payer: University Health Alliance Commercial	$785.75

EVIVA BREAST BX NEEDLE, STANDARD 9GX13CM

Facility

IP

$1,078.00

Hospital Charge Code	12925598
Hospital Revenue Code	272
Min. Negotiated Rate	$916.30
Max. Negotiated Rate	$1,045.66
Rate for Payer: Cash Price	$700.70
Rate for Payer: Health Management Network Commercial	$916.30
Rate for Payer: Kaiser Permanente Commercial	$970.20
Rate for Payer: MDX Hawaii PPO	$1,045.66

EXCHANGE OF INTRAOCULAR LENS

Facility

OP

$7,085.00

Service Code	CPT 66986
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,085.00
Rate for Payer: AlohaCare Medicaid	$1,799.51
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$7,085.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: University Health Alliance Commercial	$6,743.44

EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 0.5 CM OR LESS

Facility

OP

$4,035.20

Service Code	CPT 11400
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: Hawaii Medical Service Association Commercial	$904.34
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: University Health Alliance Commercial	$4,035.20

EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER OVER 4.0 CM

Facility

OP

$5,655.00

Service Code	CPT 11406
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$901.48
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: University Health Alliance Commercial	$5,160.40

EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 1.1 TO 2.0 CM

Facility

OP

$2,837.00

Service Code	CPT 11642
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: Hawaii Medical Service Association Commercial	$904.34
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18

EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 1.1 TO 2.0 CM

Facility

OP

$2,837.00

Service Code	CPT 11622
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: Hawaii Medical Service Association Commercial	$904.34
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18

EXCISION, MALIGNANT LESION INCLUDING MARGINS, TRUNK, ARMS, OR LEGS; EXCISED DIAMETER OVER 4.0 CM

Facility

OP

$5,655.00

Service Code	CPT 11606
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$901.48
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: University Health Alliance Commercial	$5,160.40

EXCISION OF LESION, CONJUNCTIVA; UP TO 1 CM

Facility

OP

$5,655.00

Service Code	CPT 68110
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,655.00
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: University Health Alliance Commercial	$5,160.40

<<
<
232
233
234
235
236
237
238
239
240
241
>
>>