Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC

Facility

IP

$34,415.30

Service Code	MSDRG 066
Min. Negotiated Rate	$34,415.30
Max. Negotiated Rate	$34,415.30
Rate for Payer: Hawaii Medical Service Association Commercial	$34,415.30

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC

Facility

IP

$245,292.00

Service Code	MSDRG 021
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$245,292.00
Rate for Payer: Hawaii Medical Service Association Commercial	$245,292.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC

Facility

IP

$245,292.00

Service Code	MSDRG 020
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$245,292.00
Rate for Payer: Hawaii Medical Service Association Commercial	$245,292.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC

Facility

IP

$245,292.00

Service Code	MSDRG 022
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$245,292.00
Rate for Payer: Hawaii Medical Service Association Commercial	$245,292.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRAOCULAR PROCEDURES WITH CC/MCC

Facility

IP

$18,511.26

Service Code	MSDRG 116
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$18,511.26
Rate for Payer: Hawaii Medical Service Association Commercial	$18,511.26
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRAOCULAR PROCEDURES WITHOUT CC/MCC

Facility

IP

$18,345.35

Service Code	MSDRG 117
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$18,345.35
Rate for Payer: Hawaii Medical Service Association Commercial	$18,345.35
Rate for Payer: University Health Alliance Commercial	$10,400.00

IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHAL NEBU

Facility

IP

$12.19

Service Code	NDC 00487020101
Hospital Revenue Code	250
Min. Negotiated Rate	$10.36
Max. Negotiated Rate	$11.82
Rate for Payer: Cash Price	$7.92
Rate for Payer: Health Management Network Commercial	$10.36
Rate for Payer: Kaiser Permanente Commercial	$10.97
Rate for Payer: MDX Hawaii PPO	$11.82

IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHAL NEBU

Facility

IP

$4.31

Service Code	NDC 60687040579
Hospital Revenue Code	250
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$4.18
Rate for Payer: Cash Price	$2.80
Rate for Payer: Health Management Network Commercial	$3.66
Rate for Payer: Kaiser Permanente Commercial	$3.88
Rate for Payer: MDX Hawaii PPO	$4.18

IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHAL NEBU

Facility

OP

$4.31

Service Code	NDC 60687040579
Hospital Revenue Code	250
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$4.27
Rate for Payer: AlohaCare Medicaid	$2.15
Rate for Payer: AlohaCare Medicare	$3.88
Rate for Payer: Cash Price	$2.80
Rate for Payer: Devoted Health Medicare	$4.27
Rate for Payer: Hawaii Medical Service Association Medicare	$3.88
Rate for Payer: Hawaii Western Management Group Commercial	$4.09
Rate for Payer: Health Management Network Commercial	$3.66
Rate for Payer: Humana Medicare	$3.88
Rate for Payer: Kaiser Permanente Commercial	$3.88
Rate for Payer: Kaiser Permanente Medicaid	$2.20
Rate for Payer: Kaiser Permanente Medicare	$3.88
Rate for Payer: MDX Hawaii PPO	$4.18
Rate for Payer: Ohana Health Plan Medicaid	$3.88
Rate for Payer: Ohana Health Plan Medicare	$3.88
Rate for Payer: UnitedHealthcare Medicaid	$2.59
Rate for Payer: UnitedHealthcare Medicare	$3.88
Rate for Payer: University Health Alliance Commercial	$3.14

IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHAL NEBU

Facility

OP

$4.31

Service Code	NDC 60687040583
Hospital Revenue Code	250
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$4.27
Rate for Payer: AlohaCare Medicaid	$2.15
Rate for Payer: AlohaCare Medicare	$3.88
Rate for Payer: Cash Price	$2.80
Rate for Payer: Devoted Health Medicare	$4.27
Rate for Payer: Hawaii Medical Service Association Medicare	$3.88
Rate for Payer: Hawaii Western Management Group Commercial	$4.09
Rate for Payer: Health Management Network Commercial	$3.66
Rate for Payer: Humana Medicare	$3.88
Rate for Payer: Kaiser Permanente Commercial	$3.88
Rate for Payer: Kaiser Permanente Medicaid	$2.20
Rate for Payer: Kaiser Permanente Medicare	$3.88
Rate for Payer: MDX Hawaii PPO	$4.18
Rate for Payer: Ohana Health Plan Medicaid	$3.88
Rate for Payer: Ohana Health Plan Medicare	$3.88
Rate for Payer: UnitedHealthcare Medicaid	$2.59
Rate for Payer: UnitedHealthcare Medicare	$3.88
Rate for Payer: University Health Alliance Commercial	$3.14

IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHAL NEBU

Facility

IP

$4.31

Service Code	NDC 60687040583
Hospital Revenue Code	250
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$4.18
Rate for Payer: Cash Price	$2.80
Rate for Payer: Health Management Network Commercial	$3.66
Rate for Payer: Kaiser Permanente Commercial	$3.88
Rate for Payer: MDX Hawaii PPO	$4.18

IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHAL NEBU

Facility

OP

$12.19

Service Code	NDC 00487020101
Hospital Revenue Code	250
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$12.07
Rate for Payer: AlohaCare Medicaid	$6.09
Rate for Payer: AlohaCare Medicare	$10.97
Rate for Payer: Cash Price	$7.92
Rate for Payer: Devoted Health Medicare	$12.07
Rate for Payer: Hawaii Medical Service Association Medicare	$10.97
Rate for Payer: Hawaii Western Management Group Commercial	$11.58
Rate for Payer: Health Management Network Commercial	$10.36
Rate for Payer: Humana Medicare	$10.97
Rate for Payer: Kaiser Permanente Commercial	$10.97
Rate for Payer: Kaiser Permanente Medicaid	$6.22
Rate for Payer: Kaiser Permanente Medicare	$10.97
Rate for Payer: MDX Hawaii PPO	$11.82
Rate for Payer: Ohana Health Plan Medicaid	$10.97
Rate for Payer: Ohana Health Plan Medicare	$10.97
Rate for Payer: UnitedHealthcare Medicaid	$7.31
Rate for Payer: UnitedHealthcare Medicare	$10.97
Rate for Payer: University Health Alliance Commercial	$8.89

IPRATROPIUM BROMIDE 0.02 % INHAL SOLN

Facility

IP

$1.99

Service Code	NDC 00487980101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.93
Rate for Payer: Cash Price	$1.29
Rate for Payer: Health Management Network Commercial	$1.69
Rate for Payer: Kaiser Permanente Commercial	$1.79
Rate for Payer: MDX Hawaii PPO	$1.93

IPRATROPIUM BROMIDE 0.02 % INHAL SOLN

Facility

OP

$1.99

Service Code	NDC 00487980101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.97
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$1.79
Rate for Payer: Cash Price	$1.29
Rate for Payer: Devoted Health Medicare	$1.97
Rate for Payer: Hawaii Medical Service Association Medicare	$1.79
Rate for Payer: Hawaii Western Management Group Commercial	$1.89
Rate for Payer: Health Management Network Commercial	$1.69
Rate for Payer: Humana Medicare	$1.79
Rate for Payer: Kaiser Permanente Commercial	$1.79
Rate for Payer: Kaiser Permanente Medicaid	$1.01
Rate for Payer: Kaiser Permanente Medicare	$1.79
Rate for Payer: MDX Hawaii PPO	$1.93
Rate for Payer: Ohana Health Plan Medicaid	$1.79
Rate for Payer: Ohana Health Plan Medicare	$1.79
Rate for Payer: UnitedHealthcare Medicaid	$1.19
Rate for Payer: UnitedHealthcare Medicare	$1.79
Rate for Payer: University Health Alliance Commercial	$1.45

IRON SUCROSE 100 MG/5 ML IRON IV SOLN

Facility

OP

$324.07

Service Code	HCPCS J1756
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$320.83
Rate for Payer: AlohaCare Medicaid	$162.03
Rate for Payer: AlohaCare Medicare	$291.66
Rate for Payer: Cash Price	$210.65
Rate for Payer: Cash Price	$210.65
Rate for Payer: Devoted Health Medicare	$320.83
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Medicare	$291.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Western Management Group Commercial	$307.87
Rate for Payer: Health Management Network Commercial	$275.46
Rate for Payer: Humana Medicare	$291.66
Rate for Payer: Kaiser Permanente Commercial	$291.66
Rate for Payer: Kaiser Permanente Medicaid	$165.28
Rate for Payer: Kaiser Permanente Medicare	$291.66
Rate for Payer: MDX Hawaii PPO	$314.35
Rate for Payer: Ohana Health Plan Medicaid	$291.66
Rate for Payer: Ohana Health Plan Medicare	$291.66
Rate for Payer: UnitedHealthcare Medicaid	$194.44
Rate for Payer: UnitedHealthcare Medicare	$291.66
Rate for Payer: University Health Alliance Commercial	$236.21

IRON SUCROSE 100 MG/5 ML IRON IV SOLN

Facility

IP

$324.07

Service Code	HCPCS J1756
Hospital Revenue Code	250
Min. Negotiated Rate	$275.46
Max. Negotiated Rate	$314.35
Rate for Payer: Cash Price	$210.65
Rate for Payer: Health Management Network Commercial	$275.46
Rate for Payer: Kaiser Permanente Commercial	$291.66
Rate for Payer: MDX Hawaii PPO	$314.35

IRRIGATION SODIUM CHLORIDE 500CC [2701102]

Facility

OP

$9.44

Hospital Charge Code	2701102.0
Hospital Revenue Code	272
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$9.35
Rate for Payer: AlohaCare Medicaid	$4.72
Rate for Payer: AlohaCare Medicare	$8.50
Rate for Payer: Cash Price	$6.14
Rate for Payer: Devoted Health Medicare	$9.35
Rate for Payer: Hawaii Medical Service Association Medicare	$8.50
Rate for Payer: Hawaii Western Management Group Commercial	$8.97
Rate for Payer: Health Management Network Commercial	$8.02
Rate for Payer: Humana Medicare	$8.50
Rate for Payer: Kaiser Permanente Commercial	$8.50
Rate for Payer: Kaiser Permanente Medicaid	$4.81
Rate for Payer: Kaiser Permanente Medicare	$8.50
Rate for Payer: MDX Hawaii PPO	$9.16
Rate for Payer: Ohana Health Plan Medicaid	$8.50
Rate for Payer: Ohana Health Plan Medicare	$8.50
Rate for Payer: UnitedHealthcare Medicare	$8.50
Rate for Payer: University Health Alliance Commercial	$6.88

IRRIGATION SODIUM CHLORIDE 500CC [2701102]

Facility

IP

$9.44

Hospital Charge Code	2701102.0
Hospital Revenue Code	272
Min. Negotiated Rate	$8.02
Max. Negotiated Rate	$9.16
Rate for Payer: Cash Price	$6.14
Rate for Payer: Health Management Network Commercial	$8.02
Rate for Payer: Kaiser Permanente Commercial	$8.50
Rate for Payer: MDX Hawaii PPO	$9.16

ISAVUCONAZONIUM SULFATE 186 MG PO CAP

Facility

OP

$480.30

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$240.15
Max. Negotiated Rate	$475.50
Rate for Payer: AlohaCare Medicaid	$240.15
Rate for Payer: AlohaCare Medicare	$432.27
Rate for Payer: Cash Price	$312.20
Rate for Payer: Devoted Health Medicare	$475.50
Rate for Payer: Hawaii Medical Service Association Medicare	$432.27
Rate for Payer: Hawaii Western Management Group Commercial	$456.29
Rate for Payer: Health Management Network Commercial	$408.25
Rate for Payer: Humana Medicare	$432.27
Rate for Payer: Kaiser Permanente Commercial	$432.27
Rate for Payer: Kaiser Permanente Medicaid	$244.95
Rate for Payer: Kaiser Permanente Medicare	$432.27
Rate for Payer: MDX Hawaii PPO	$465.89
Rate for Payer: Ohana Health Plan Medicaid	$432.27
Rate for Payer: Ohana Health Plan Medicare	$432.27
Rate for Payer: UnitedHealthcare Medicare	$432.27
Rate for Payer: University Health Alliance Commercial	$350.09

ISAVUCONAZONIUM SULFATE 186 MG PO CAP

Facility

IP

$480.30

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$408.25
Max. Negotiated Rate	$465.89
Rate for Payer: Cash Price	$312.20
Rate for Payer: Health Management Network Commercial	$408.25
Rate for Payer: Kaiser Permanente Commercial	$432.27
Rate for Payer: MDX Hawaii PPO	$465.89

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC

Facility

IP

$50,817.09

Service Code	MSDRG 062
Min. Negotiated Rate	$50,817.09
Max. Negotiated Rate	$50,817.09
Rate for Payer: Hawaii Medical Service Association Commercial	$50,817.09

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC

Facility

IP

$50,817.09

Service Code	MSDRG 061
Min. Negotiated Rate	$50,817.09
Max. Negotiated Rate	$50,817.09
Rate for Payer: Hawaii Medical Service Association Commercial	$50,817.09

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC

Facility

IP

$50,817.09

Service Code	MSDRG 063
Min. Negotiated Rate	$50,817.09
Max. Negotiated Rate	$50,817.09
Rate for Payer: Hawaii Medical Service Association Commercial	$50,817.09

ISOLATION

Facility

IP

$4,000.00

Hospital Charge Code	H0000014
Hospital Revenue Code	164
Min. Negotiated Rate	$3,400.00
Max. Negotiated Rate	$10,998.90
Rate for Payer: AlohaCare Medicaid	$4,140.84
Rate for Payer: AlohaCare Medicare	$9,999.00
Rate for Payer: Cash Price	$2,600.00
Rate for Payer: Cash Price	$2,600.00
Rate for Payer: Devoted Health Medicare	$10,998.90
Rate for Payer: Hawaii Medical Service Association ABD	$4,140.84
Rate for Payer: Hawaii Medical Service Association Medicare	$9,999.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,140.84
Rate for Payer: Hawaii Western Management Group Commercial	$7,250.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Humana Medicare	$9,999.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: Kaiser Permanente Medicaid	$4,140.84
Rate for Payer: Kaiser Permanente Medicare	$9,999.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: Ohana Health Plan Medicaid	$4,140.84
Rate for Payer: Ohana Health Plan Medicare	$9,999.00
Rate for Payer: UnitedHealthcare Medicaid	$4,140.84
Rate for Payer: UnitedHealthcare Medicare	$9,999.00
Rate for Payer: University Health Alliance Commercial	$5,923.00

ISOSORBIDE DINITRATE 10 MG PO TABLET

Facility

IP

$6.90

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.87
Max. Negotiated Rate	$6.69
Rate for Payer: Cash Price	$4.49
Rate for Payer: Health Management Network Commercial	$5.87
Rate for Payer: Kaiser Permanente Commercial	$6.21
Rate for Payer: MDX Hawaii PPO	$6.69

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