Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC

Facility

IP

$21,952.06

Service Code	MSDRG 067
Min. Negotiated Rate	$21,952.06
Max. Negotiated Rate	$21,952.06
Rate for Payer: Hawaii Medical Service Association Commercial	$21,952.06

PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC

Facility

IP

$21,952.06

Service Code	MSDRG 068
Min. Negotiated Rate	$21,952.06
Max. Negotiated Rate	$21,952.06
Rate for Payer: Hawaii Medical Service Association Commercial	$21,952.06

prednisoLONE 15 mg/5 mL 5mL U/D [HHSC]

Facility

OP

$8.68

Service Code	HCPCS J7510
Hospital Charge Code	2500693
Hospital Revenue Code	636
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$8.42
Rate for Payer: AlohaCare Medicaid	$4.34
Rate for Payer: AlohaCare Medicare	$4.34
Rate for Payer: Cash Price	$5.64
Rate for Payer: Cash Price	$5.64
Rate for Payer: Devoted Health Medicare	$4.77
Rate for Payer: Hawaii Medical Service Association ABD	$0.27
Rate for Payer: Hawaii Medical Service Association Medicare	$4.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.27
Rate for Payer: Hawaii Western Management Group Commercial	$8.25
Rate for Payer: Health Management Network Commercial	$7.38
Rate for Payer: Humana Medicare	$4.34
Rate for Payer: Kaiser Permanente Commercial	$7.81
Rate for Payer: Kaiser Permanente Medicaid	$4.43
Rate for Payer: Kaiser Permanente Medicare	$4.34
Rate for Payer: MDX Hawaii PPO	$8.42
Rate for Payer: Ohana Health Plan Medicaid	$4.34
Rate for Payer: Ohana Health Plan Medicare	$4.34
Rate for Payer: UnitedHealthcare Medicaid	$5.21
Rate for Payer: UnitedHealthcare Medicare	$4.34
Rate for Payer: University Health Alliance Commercial	$6.33

prednisoLONE 15 mg/5 mL 5mL U/D [HHSC]

Facility

IP

$8.68

Service Code	HCPCS J7510
Hospital Charge Code	2500693
Hospital Revenue Code	250
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$8.42
Rate for Payer: Cash Price	$5.64
Rate for Payer: Health Management Network Commercial	$7.38
Rate for Payer: Kaiser Permanente Commercial	$7.81
Rate for Payer: MDX Hawaii PPO	$8.42

prednisoLONE acetate 1% ophth drop [HHSC]

Facility

OP

$479.96

Service Code	NDC 00065063827
Hospital Charge Code	2500691
Hospital Revenue Code	250
Min. Negotiated Rate	$239.98
Max. Negotiated Rate	$465.56
Rate for Payer: AlohaCare Medicaid	$239.98
Rate for Payer: AlohaCare Medicare	$239.98
Rate for Payer: Cash Price	$311.97
Rate for Payer: Devoted Health Medicare	$263.98
Rate for Payer: Hawaii Medical Service Association Medicare	$239.98
Rate for Payer: Hawaii Western Management Group Commercial	$455.96
Rate for Payer: Health Management Network Commercial	$407.97
Rate for Payer: Humana Medicare	$239.98
Rate for Payer: Kaiser Permanente Commercial	$431.96
Rate for Payer: Kaiser Permanente Medicaid	$244.78
Rate for Payer: Kaiser Permanente Medicare	$239.98
Rate for Payer: MDX Hawaii PPO	$465.56
Rate for Payer: Ohana Health Plan Medicaid	$239.98
Rate for Payer: Ohana Health Plan Medicare	$239.98
Rate for Payer: UnitedHealthcare Medicaid	$287.98
Rate for Payer: UnitedHealthcare Medicare	$239.98
Rate for Payer: University Health Alliance Commercial	$349.84

prednisoLONE acetate 1% ophth drop [HHSC]

Facility

IP

$479.96

Service Code	NDC 00065063827
Hospital Charge Code	2500691
Hospital Revenue Code	250
Min. Negotiated Rate	$407.97
Max. Negotiated Rate	$465.56
Rate for Payer: Cash Price	$311.97
Rate for Payer: Health Management Network Commercial	$407.97
Rate for Payer: Kaiser Permanente Commercial	$431.96
Rate for Payer: MDX Hawaii PPO	$465.56

prednisoLONE acetate 1% ophth drop [HHSC]

Facility

OP

$284.17

Service Code	NDC 60758011905
Hospital Charge Code	2500691
Hospital Revenue Code	250
Min. Negotiated Rate	$142.09
Max. Negotiated Rate	$275.64
Rate for Payer: AlohaCare Medicaid	$142.09
Rate for Payer: AlohaCare Medicare	$142.09
Rate for Payer: Cash Price	$184.71
Rate for Payer: Devoted Health Medicare	$156.29
Rate for Payer: Hawaii Medical Service Association Medicare	$142.09
Rate for Payer: Hawaii Western Management Group Commercial	$269.96
Rate for Payer: Health Management Network Commercial	$241.54
Rate for Payer: Humana Medicare	$142.09
Rate for Payer: Kaiser Permanente Commercial	$255.75
Rate for Payer: Kaiser Permanente Medicaid	$144.93
Rate for Payer: Kaiser Permanente Medicare	$142.09
Rate for Payer: MDX Hawaii PPO	$275.64
Rate for Payer: Ohana Health Plan Medicaid	$142.09
Rate for Payer: Ohana Health Plan Medicare	$142.09
Rate for Payer: UnitedHealthcare Medicaid	$170.50
Rate for Payer: UnitedHealthcare Medicare	$142.09
Rate for Payer: University Health Alliance Commercial	$207.13

prednisoLONE acetate 1% ophth drop [HHSC]

Facility

IP

$284.17

Service Code	NDC 60758011905
Hospital Charge Code	2500691
Hospital Revenue Code	250
Min. Negotiated Rate	$241.54
Max. Negotiated Rate	$275.64
Rate for Payer: Cash Price	$184.71
Rate for Payer: Health Management Network Commercial	$241.54
Rate for Payer: Kaiser Permanente Commercial	$255.75
Rate for Payer: MDX Hawaii PPO	$275.64

prednisoLONE acetate 1% ophth drop [HHSC]

Facility

OP

$74.58

Service Code	NDC 58016655705
Hospital Charge Code	2500691
Hospital Revenue Code	250
Min. Negotiated Rate	$37.29
Max. Negotiated Rate	$72.34
Rate for Payer: AlohaCare Medicaid	$37.29
Rate for Payer: AlohaCare Medicare	$37.29
Rate for Payer: Cash Price	$48.48
Rate for Payer: Devoted Health Medicare	$41.02
Rate for Payer: Hawaii Medical Service Association Medicare	$37.29
Rate for Payer: Hawaii Western Management Group Commercial	$70.85
Rate for Payer: Health Management Network Commercial	$63.39
Rate for Payer: Humana Medicare	$37.29
Rate for Payer: Kaiser Permanente Commercial	$67.12
Rate for Payer: Kaiser Permanente Medicaid	$38.04
Rate for Payer: Kaiser Permanente Medicare	$37.29
Rate for Payer: MDX Hawaii PPO	$72.34
Rate for Payer: Ohana Health Plan Medicaid	$37.29
Rate for Payer: Ohana Health Plan Medicare	$37.29
Rate for Payer: UnitedHealthcare Medicaid	$44.75
Rate for Payer: UnitedHealthcare Medicare	$37.29
Rate for Payer: University Health Alliance Commercial	$54.36

prednisoLONE acetate 1% ophth drop [HHSC]

Facility

IP

$74.58

Service Code	NDC 58016655705
Hospital Charge Code	2500691
Hospital Revenue Code	250
Min. Negotiated Rate	$63.39
Max. Negotiated Rate	$72.34
Rate for Payer: Cash Price	$48.48
Rate for Payer: Health Management Network Commercial	$63.39
Rate for Payer: Kaiser Permanente Commercial	$67.12
Rate for Payer: MDX Hawaii PPO	$72.34

prednisoLONE acetate 1% ophth drop [HHSC]

Facility

IP

$292.94

Service Code	NDC 61314063705
Hospital Charge Code	2500691
Hospital Revenue Code	250
Min. Negotiated Rate	$249.00
Max. Negotiated Rate	$284.15
Rate for Payer: Cash Price	$190.41
Rate for Payer: Health Management Network Commercial	$249.00
Rate for Payer: Kaiser Permanente Commercial	$263.65
Rate for Payer: MDX Hawaii PPO	$284.15

prednisoLONE acetate 1% ophth drop [HHSC]

Facility

OP

$292.94

Service Code	NDC 61314063705
Hospital Charge Code	2500691
Hospital Revenue Code	250
Min. Negotiated Rate	$146.47
Max. Negotiated Rate	$284.15
Rate for Payer: AlohaCare Medicaid	$146.47
Rate for Payer: AlohaCare Medicare	$146.47
Rate for Payer: Cash Price	$190.41
Rate for Payer: Devoted Health Medicare	$161.12
Rate for Payer: Hawaii Medical Service Association Medicare	$146.47
Rate for Payer: Hawaii Western Management Group Commercial	$278.29
Rate for Payer: Health Management Network Commercial	$249.00
Rate for Payer: Humana Medicare	$146.47
Rate for Payer: Kaiser Permanente Commercial	$263.65
Rate for Payer: Kaiser Permanente Medicaid	$149.40
Rate for Payer: Kaiser Permanente Medicare	$146.47
Rate for Payer: MDX Hawaii PPO	$284.15
Rate for Payer: Ohana Health Plan Medicaid	$146.47
Rate for Payer: Ohana Health Plan Medicare	$146.47
Rate for Payer: UnitedHealthcare Medicaid	$175.76
Rate for Payer: UnitedHealthcare Medicare	$146.47
Rate for Payer: University Health Alliance Commercial	$213.52

predniSONE 10 mg tablet [HHSC]

Facility

IP

$3.00

Service Code	HCPCS J7512
Hospital Charge Code	2500694
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
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

predniSONE 10 mg tablet [HHSC]

Facility

OP

$3.00

Service Code	HCPCS J7512
Hospital Charge Code	2500694
Hospital Revenue Code	637
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

predniSONE 20 mg tablet [HHSC]

Facility

IP

$8.35

Service Code	HCPCS J7512
Hospital Charge Code	2500695
Hospital Revenue Code	250
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$8.10
Rate for Payer: Cash Price	$5.43
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$7.10
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Commercial	$7.51
Rate for Payer: MDX Hawaii PPO	$8.10
Rate for Payer: MDX Hawaii PPO	$2.91

predniSONE 20 mg tablet [HHSC]

Facility

OP

$3.00

Service Code	HCPCS J7512
Hospital Charge Code	2500695
Hospital Revenue Code	637
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicaid	$4.17
Rate for Payer: AlohaCare Medicare	$4.17
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$5.43
Rate for Payer: Cash Price	$1.95
Rate for Payer: Cash Price	$1.95
Rate for Payer: Cash Price	$5.43
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Devoted Health Medicare	$4.59
Rate for Payer: Hawaii Medical Service Association ABD	$0.01
Rate for Payer: Hawaii Medical Service Association ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Medicare	$4.17
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Hawaii Western Management Group Commercial	$7.93
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Health Management Network Commercial	$7.10
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Humana Medicare	$4.17
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Commercial	$7.51
Rate for Payer: Kaiser Permanente Medicaid	$4.26
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$4.17
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: MDX Hawaii PPO	$8.10
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicaid	$4.17
Rate for Payer: Ohana Health Plan Medicare	$4.17
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicare	$4.17
Rate for Payer: University Health Alliance Commercial	$2.19
Rate for Payer: University Health Alliance Commercial	$6.09

pregabalin 100 mg capsule [HHSC]

Facility

IP

$8.99

Service Code	NDC 60687050601
Hospital Charge Code	2501065
Hospital Revenue Code	250
Min. Negotiated Rate	$7.64
Max. Negotiated Rate	$8.72
Rate for Payer: Cash Price	$5.84
Rate for Payer: Health Management Network Commercial	$7.64
Rate for Payer: Kaiser Permanente Commercial	$8.09
Rate for Payer: MDX Hawaii PPO	$8.72

pregabalin 100 mg capsule [HHSC]

Facility

OP

$8.99

Service Code	NDC 60687050601
Hospital Charge Code	2501065
Hospital Revenue Code	250
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$8.72
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$4.50
Rate for Payer: Cash Price	$5.84
Rate for Payer: Devoted Health Medicare	$4.94
Rate for Payer: Hawaii Medical Service Association Medicare	$4.50
Rate for Payer: Hawaii Western Management Group Commercial	$8.54
Rate for Payer: Health Management Network Commercial	$7.64
Rate for Payer: Humana Medicare	$4.50
Rate for Payer: Kaiser Permanente Commercial	$8.09
Rate for Payer: Kaiser Permanente Medicaid	$4.58
Rate for Payer: Kaiser Permanente Medicare	$4.50
Rate for Payer: MDX Hawaii PPO	$8.72
Rate for Payer: Ohana Health Plan Medicaid	$4.50
Rate for Payer: Ohana Health Plan Medicare	$4.50
Rate for Payer: UnitedHealthcare Medicaid	$5.39
Rate for Payer: UnitedHealthcare Medicare	$4.50
Rate for Payer: University Health Alliance Commercial	$6.55

pregabalin 25 mg capsule [HHSC]

Facility

OP

$8.99

Service Code	NDC 60687047301
Hospital Charge Code	2501064
Hospital Revenue Code	250
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$8.72
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$4.50
Rate for Payer: Cash Price	$5.84
Rate for Payer: Devoted Health Medicare	$4.94
Rate for Payer: Hawaii Medical Service Association Medicare	$4.50
Rate for Payer: Hawaii Western Management Group Commercial	$8.54
Rate for Payer: Health Management Network Commercial	$7.64
Rate for Payer: Humana Medicare	$4.50
Rate for Payer: Kaiser Permanente Commercial	$8.09
Rate for Payer: Kaiser Permanente Medicaid	$4.58
Rate for Payer: Kaiser Permanente Medicare	$4.50
Rate for Payer: MDX Hawaii PPO	$8.72
Rate for Payer: Ohana Health Plan Medicaid	$4.50
Rate for Payer: Ohana Health Plan Medicare	$4.50
Rate for Payer: UnitedHealthcare Medicaid	$5.39
Rate for Payer: UnitedHealthcare Medicare	$4.50
Rate for Payer: University Health Alliance Commercial	$6.55

pregabalin 25 mg capsule [HHSC]

Facility

IP

$8.99

Service Code	NDC 60687047301
Hospital Charge Code	2501064
Hospital Revenue Code	250
Min. Negotiated Rate	$7.64
Max. Negotiated Rate	$8.72
Rate for Payer: Cash Price	$5.84
Rate for Payer: Health Management Network Commercial	$7.64
Rate for Payer: Kaiser Permanente Commercial	$8.09
Rate for Payer: MDX Hawaii PPO	$8.72

Pregnancy Toxoplasma IgG and IgM with Reflex FSI

Facility

OP

$165.00

Service Code	HCPCS 86777
Hospital Charge Code	9754668
Hospital Revenue Code	302
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$160.05
Rate for Payer: AlohaCare Medicaid	$82.50
Rate for Payer: AlohaCare Medicare	$82.50
Rate for Payer: Cash Price	$107.25
Rate for Payer: Cash Price	$107.25
Rate for Payer: Devoted Health Medicare	$90.75
Rate for Payer: Hawaii Medical Service Association ABD	$19.89
Rate for Payer: Hawaii Medical Service Association Commercial	$17.99
Rate for Payer: Hawaii Medical Service Association Medicare	$82.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.88
Rate for Payer: Hawaii Western Management Group Commercial	$14.39
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: Humana Medicare	$82.50
Rate for Payer: Kaiser Permanente Commercial	$148.50
Rate for Payer: Kaiser Permanente Medicaid	$84.15
Rate for Payer: Kaiser Permanente Medicare	$82.50
Rate for Payer: MDX Hawaii PPO	$160.05
Rate for Payer: Ohana Health Plan Medicaid	$82.50
Rate for Payer: Ohana Health Plan Medicare	$82.50
Rate for Payer: UnitedHealthcare Medicaid	$19.89
Rate for Payer: UnitedHealthcare Medicare	$82.50
Rate for Payer: University Health Alliance Commercial	$37.20

Pregnancy Toxoplasma IgG and IgM with Reflex FSI

Facility

IP

$165.00

Service Code	HCPCS 86777
Hospital Charge Code	9754668
Hospital Revenue Code	302
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$160.05
Rate for Payer: Cash Price	$107.25
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: Kaiser Permanente Commercial	$148.50
Rate for Payer: MDX Hawaii PPO	$160.05

Pregnenolone FSI

Facility

OP

$154.00

Service Code	HCPCS 84140
Hospital Charge Code	10075144
Hospital Revenue Code	301
Min. Negotiated Rate	$20.67
Max. Negotiated Rate	$149.38
Rate for Payer: AlohaCare Medicaid	$77.00
Rate for Payer: AlohaCare Medicare	$77.00
Rate for Payer: Cash Price	$100.10
Rate for Payer: Cash Price	$100.10
Rate for Payer: Devoted Health Medicare	$84.70
Rate for Payer: Hawaii Medical Service Association ABD	$28.58
Rate for Payer: Hawaii Medical Service Association Commercial	$25.84
Rate for Payer: Hawaii Medical Service Association Medicare	$77.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.01
Rate for Payer: Hawaii Western Management Group Commercial	$20.67
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Humana Medicare	$77.00
Rate for Payer: Kaiser Permanente Commercial	$138.60
Rate for Payer: Kaiser Permanente Medicaid	$78.54
Rate for Payer: Kaiser Permanente Medicare	$77.00
Rate for Payer: MDX Hawaii PPO	$149.38
Rate for Payer: Ohana Health Plan Medicaid	$77.00
Rate for Payer: Ohana Health Plan Medicare	$77.00
Rate for Payer: UnitedHealthcare Medicaid	$28.58
Rate for Payer: UnitedHealthcare Medicare	$77.00
Rate for Payer: University Health Alliance Commercial	$53.45

Pregnenolone FSI

Facility

IP

$154.00

Service Code	HCPCS 84140
Hospital Charge Code	10075144
Hospital Revenue Code	301
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$149.38
Rate for Payer: Cash Price	$100.10
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Kaiser Permanente Commercial	$138.60
Rate for Payer: MDX Hawaii PPO	$149.38

PREMATURITY WITH MAJOR PROBLEMS

Facility

IP

$66,238.61

Service Code	MSDRG 791
Min. Negotiated Rate	$66,238.61
Max. Negotiated Rate	$66,238.61
Rate for Payer: Hawaii Medical Service Association Commercial	$66,238.61

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