Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

ALBUMIN, HUMAN 5 % IV SOLP (250 ML)

Facility

OP

$410.64

Service Code	HCPCS P9045
Hospital Revenue Code	636
Min. Negotiated Rate	$53.08
Max. Negotiated Rate	$406.53
Rate for Payer: AlohaCare Medicaid	$205.32
Rate for Payer: AlohaCare Medicare	$369.58
Rate for Payer: Cash Price	$266.92
Rate for Payer: Cash Price	$266.92
Rate for Payer: Devoted Health Medicare	$406.53
Rate for Payer: Hawaii Medical Service Association ABD	$53.08
Rate for Payer: Hawaii Medical Service Association Commercial	$66.35
Rate for Payer: Hawaii Medical Service Association Medicare	$369.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$53.08
Rate for Payer: Hawaii Western Management Group Commercial	$390.11
Rate for Payer: Health Management Network Commercial	$349.04
Rate for Payer: Humana Medicare	$369.58
Rate for Payer: Kaiser Permanente Commercial	$369.58
Rate for Payer: Kaiser Permanente Medicaid	$209.43
Rate for Payer: Kaiser Permanente Medicare	$369.58
Rate for Payer: MDX Hawaii PPO	$398.32
Rate for Payer: Ohana Health Plan Medicaid	$369.58
Rate for Payer: Ohana Health Plan Medicare	$369.58
Rate for Payer: UnitedHealthcare Medicaid	$246.38
Rate for Payer: UnitedHealthcare Medicare	$369.58
Rate for Payer: University Health Alliance Commercial	$299.32

ALBUMIN, HUMAN 5 % IV SOLP (250 ML)

Facility

IP

$410.64

Service Code	HCPCS P9045
Hospital Revenue Code	250
Min. Negotiated Rate	$349.04
Max. Negotiated Rate	$398.32
Rate for Payer: Cash Price	$266.92
Rate for Payer: Health Management Network Commercial	$349.04
Rate for Payer: Kaiser Permanente Commercial	$369.58
Rate for Payer: MDX Hawaii PPO	$398.32

ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHAL NEBU

Facility

IP

$1.91

Service Code	NDC 60687039579
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$1.85
Rate for Payer: Cash Price	$1.24
Rate for Payer: Health Management Network Commercial	$1.62
Rate for Payer: Kaiser Permanente Commercial	$1.72
Rate for Payer: MDX Hawaii PPO	$1.85

ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHAL NEBU

Facility

IP

$4.43

Service Code	NDC 04879050101
Hospital Revenue Code	250
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$4.30
Rate for Payer: Cash Price	$2.88
Rate for Payer: Health Management Network Commercial	$3.77
Rate for Payer: Kaiser Permanente Commercial	$3.99
Rate for Payer: MDX Hawaii PPO	$4.30

ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHAL NEBU

Facility

IP

$1.91

Service Code	NDC 60687039583
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$1.85
Rate for Payer: Cash Price	$1.24
Rate for Payer: Health Management Network Commercial	$1.62
Rate for Payer: Kaiser Permanente Commercial	$1.72
Rate for Payer: MDX Hawaii PPO	$1.85

ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHAL NEBU

Facility

OP

$4.43

Service Code	NDC 04879050101
Hospital Revenue Code	250
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$4.39
Rate for Payer: AlohaCare Medicaid	$2.21
Rate for Payer: AlohaCare Medicare	$3.99
Rate for Payer: Cash Price	$2.88
Rate for Payer: Devoted Health Medicare	$4.39
Rate for Payer: Hawaii Medical Service Association Medicare	$3.99
Rate for Payer: Hawaii Western Management Group Commercial	$4.21
Rate for Payer: Health Management Network Commercial	$3.77
Rate for Payer: Humana Medicare	$3.99
Rate for Payer: Kaiser Permanente Commercial	$3.99
Rate for Payer: Kaiser Permanente Medicaid	$2.26
Rate for Payer: Kaiser Permanente Medicare	$3.99
Rate for Payer: MDX Hawaii PPO	$4.30
Rate for Payer: Ohana Health Plan Medicaid	$3.99
Rate for Payer: Ohana Health Plan Medicare	$3.99
Rate for Payer: UnitedHealthcare Medicaid	$2.66
Rate for Payer: UnitedHealthcare Medicare	$3.99
Rate for Payer: University Health Alliance Commercial	$3.23

ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHAL NEBU

Facility

IP

$4.43

Service Code	NDC 00487950101
Hospital Revenue Code	250
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$4.30
Rate for Payer: Cash Price	$2.88
Rate for Payer: Health Management Network Commercial	$3.77
Rate for Payer: Kaiser Permanente Commercial	$3.99
Rate for Payer: MDX Hawaii PPO	$4.30

ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHAL NEBU

Facility

IP

$7.72

Service Code	NDC 76204020001
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$7.49
Rate for Payer: Cash Price	$5.02
Rate for Payer: Health Management Network Commercial	$6.56
Rate for Payer: Kaiser Permanente Commercial	$6.95
Rate for Payer: MDX Hawaii PPO	$7.49

ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHAL NEBU

Facility

OP

$7.72

Service Code	NDC 76204020001
Hospital Revenue Code	250
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$7.64
Rate for Payer: AlohaCare Medicaid	$3.86
Rate for Payer: AlohaCare Medicare	$6.95
Rate for Payer: Cash Price	$5.02
Rate for Payer: Devoted Health Medicare	$7.64
Rate for Payer: Hawaii Medical Service Association Medicare	$6.95
Rate for Payer: Hawaii Western Management Group Commercial	$7.33
Rate for Payer: Health Management Network Commercial	$6.56
Rate for Payer: Humana Medicare	$6.95
Rate for Payer: Kaiser Permanente Commercial	$6.95
Rate for Payer: Kaiser Permanente Medicaid	$3.94
Rate for Payer: Kaiser Permanente Medicare	$6.95
Rate for Payer: MDX Hawaii PPO	$7.49
Rate for Payer: Ohana Health Plan Medicaid	$6.95
Rate for Payer: Ohana Health Plan Medicare	$6.95
Rate for Payer: UnitedHealthcare Medicaid	$4.63
Rate for Payer: UnitedHealthcare Medicare	$6.95
Rate for Payer: University Health Alliance Commercial	$5.63

ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHAL NEBU

Facility

OP

$1.91

Service Code	NDC 60687039583
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$1.89
Rate for Payer: AlohaCare Medicaid	$0.96
Rate for Payer: AlohaCare Medicare	$1.72
Rate for Payer: Cash Price	$1.24
Rate for Payer: Devoted Health Medicare	$1.89
Rate for Payer: Hawaii Medical Service Association Medicare	$1.72
Rate for Payer: Hawaii Western Management Group Commercial	$1.81
Rate for Payer: Health Management Network Commercial	$1.62
Rate for Payer: Humana Medicare	$1.72
Rate for Payer: Kaiser Permanente Commercial	$1.72
Rate for Payer: Kaiser Permanente Medicaid	$0.97
Rate for Payer: Kaiser Permanente Medicare	$1.72
Rate for Payer: MDX Hawaii PPO	$1.85
Rate for Payer: Ohana Health Plan Medicaid	$1.72
Rate for Payer: Ohana Health Plan Medicare	$1.72
Rate for Payer: UnitedHealthcare Medicaid	$1.15
Rate for Payer: UnitedHealthcare Medicare	$1.72
Rate for Payer: University Health Alliance Commercial	$1.39

ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHAL NEBU

Facility

OP

$1.91

Service Code	NDC 60687039579
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$1.89
Rate for Payer: AlohaCare Medicaid	$0.96
Rate for Payer: AlohaCare Medicare	$1.72
Rate for Payer: Cash Price	$1.24
Rate for Payer: Devoted Health Medicare	$1.89
Rate for Payer: Hawaii Medical Service Association Medicare	$1.72
Rate for Payer: Hawaii Western Management Group Commercial	$1.81
Rate for Payer: Health Management Network Commercial	$1.62
Rate for Payer: Humana Medicare	$1.72
Rate for Payer: Kaiser Permanente Commercial	$1.72
Rate for Payer: Kaiser Permanente Medicaid	$0.97
Rate for Payer: Kaiser Permanente Medicare	$1.72
Rate for Payer: MDX Hawaii PPO	$1.85
Rate for Payer: Ohana Health Plan Medicaid	$1.72
Rate for Payer: Ohana Health Plan Medicare	$1.72
Rate for Payer: UnitedHealthcare Medicaid	$1.15
Rate for Payer: UnitedHealthcare Medicare	$1.72
Rate for Payer: University Health Alliance Commercial	$1.39

ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHAL NEBU

Facility

OP

$4.43

Service Code	NDC 00487950101
Hospital Revenue Code	250
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$4.39
Rate for Payer: AlohaCare Medicaid	$2.21
Rate for Payer: AlohaCare Medicare	$3.99
Rate for Payer: Cash Price	$2.88
Rate for Payer: Devoted Health Medicare	$4.39
Rate for Payer: Hawaii Medical Service Association Medicare	$3.99
Rate for Payer: Hawaii Western Management Group Commercial	$4.21
Rate for Payer: Health Management Network Commercial	$3.77
Rate for Payer: Humana Medicare	$3.99
Rate for Payer: Kaiser Permanente Commercial	$3.99
Rate for Payer: Kaiser Permanente Medicaid	$2.26
Rate for Payer: Kaiser Permanente Medicare	$3.99
Rate for Payer: MDX Hawaii PPO	$4.30
Rate for Payer: Ohana Health Plan Medicaid	$3.99
Rate for Payer: Ohana Health Plan Medicare	$3.99
Rate for Payer: UnitedHealthcare Medicaid	$2.66
Rate for Payer: UnitedHealthcare Medicare	$3.99
Rate for Payer: University Health Alliance Commercial	$3.23

ALBUTEROL SULFATE 90 MCG/ACTUATION INHAL HFAA

Facility

OP

$227.11

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$113.56
Max. Negotiated Rate	$224.84
Rate for Payer: AlohaCare Medicaid	$113.56
Rate for Payer: AlohaCare Medicare	$204.40
Rate for Payer: Cash Price	$147.62
Rate for Payer: Devoted Health Medicare	$224.84
Rate for Payer: Hawaii Medical Service Association Medicare	$204.40
Rate for Payer: Hawaii Western Management Group Commercial	$215.75
Rate for Payer: Health Management Network Commercial	$193.04
Rate for Payer: Humana Medicare	$204.40
Rate for Payer: Kaiser Permanente Commercial	$204.40
Rate for Payer: Kaiser Permanente Medicaid	$115.83
Rate for Payer: Kaiser Permanente Medicare	$204.40
Rate for Payer: MDX Hawaii PPO	$220.30
Rate for Payer: Ohana Health Plan Medicaid	$204.40
Rate for Payer: Ohana Health Plan Medicare	$204.40
Rate for Payer: UnitedHealthcare Medicare	$204.40
Rate for Payer: University Health Alliance Commercial	$165.54

ALBUTEROL SULFATE 90 MCG/ACTUATION INHAL HFAA

Facility

IP

$227.11

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$193.04
Max. Negotiated Rate	$220.30
Rate for Payer: Cash Price	$147.62
Rate for Payer: Health Management Network Commercial	$193.04
Rate for Payer: Kaiser Permanente Commercial	$204.40
Rate for Payer: MDX Hawaii PPO	$220.30

ALBUTEROL SULFATE 90 MCG/ACTUATION INHAL HFAA (200 DOSE)

Facility

OP

$125.42

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$62.71
Max. Negotiated Rate	$124.17
Rate for Payer: AlohaCare Medicaid	$62.71
Rate for Payer: AlohaCare Medicare	$112.88
Rate for Payer: Cash Price	$81.52
Rate for Payer: Devoted Health Medicare	$124.17
Rate for Payer: Hawaii Medical Service Association Medicare	$112.88
Rate for Payer: Hawaii Western Management Group Commercial	$119.15
Rate for Payer: Health Management Network Commercial	$106.61
Rate for Payer: Humana Medicare	$112.88
Rate for Payer: Kaiser Permanente Commercial	$112.88
Rate for Payer: Kaiser Permanente Medicaid	$63.96
Rate for Payer: Kaiser Permanente Medicare	$112.88
Rate for Payer: MDX Hawaii PPO	$121.66
Rate for Payer: Ohana Health Plan Medicaid	$112.88
Rate for Payer: Ohana Health Plan Medicare	$112.88
Rate for Payer: UnitedHealthcare Medicare	$112.88
Rate for Payer: University Health Alliance Commercial	$91.42

ALBUTEROL SULFATE 90 MCG/ACTUATION INHAL HFAA (200 DOSE)

Facility

IP

$125.42

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$106.61
Max. Negotiated Rate	$121.66
Rate for Payer: Cash Price	$81.52
Rate for Payer: Health Management Network Commercial	$106.61
Rate for Payer: Kaiser Permanente Commercial	$112.88
Rate for Payer: MDX Hawaii PPO	$121.66

ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA

Facility

IP

$8,461.61

Service Code	MSDRG 894
Min. Negotiated Rate	$8,461.61
Max. Negotiated Rate	$8,461.61
Rate for Payer: Hawaii Medical Service Association Commercial	$8,461.61

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC

Facility

IP

$22,588.01

Service Code	MSDRG 896
Min. Negotiated Rate	$22,588.01
Max. Negotiated Rate	$22,588.01
Rate for Payer: Hawaii Medical Service Association Commercial	$22,588.01

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC

Facility

IP

$14,410.82

Service Code	MSDRG 897
Min. Negotiated Rate	$14,410.82
Max. Negotiated Rate	$14,410.82
Rate for Payer: Hawaii Medical Service Association Commercial	$14,410.82

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY

Facility

IP

$22,588.01

Service Code	MSDRG 895
Min. Negotiated Rate	$22,588.01
Max. Negotiated Rate	$22,588.01
Rate for Payer: Hawaii Medical Service Association Commercial	$22,588.01

ALENDRONATE 70 MG PO TABLET

Facility

IP

$102.80

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$87.38
Max. Negotiated Rate	$99.72
Rate for Payer: Cash Price	$66.82
Rate for Payer: Health Management Network Commercial	$87.38
Rate for Payer: Kaiser Permanente Commercial	$92.52
Rate for Payer: MDX Hawaii PPO	$99.72

ALENDRONATE 70 MG PO TABLET

Facility

OP

$102.80

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$51.40
Max. Negotiated Rate	$101.77
Rate for Payer: AlohaCare Medicaid	$51.40
Rate for Payer: AlohaCare Medicare	$92.52
Rate for Payer: Cash Price	$66.82
Rate for Payer: Devoted Health Medicare	$101.77
Rate for Payer: Hawaii Medical Service Association Medicare	$92.52
Rate for Payer: Hawaii Western Management Group Commercial	$97.66
Rate for Payer: Health Management Network Commercial	$87.38
Rate for Payer: Humana Medicare	$92.52
Rate for Payer: Kaiser Permanente Commercial	$92.52
Rate for Payer: Kaiser Permanente Medicaid	$52.43
Rate for Payer: Kaiser Permanente Medicare	$92.52
Rate for Payer: MDX Hawaii PPO	$99.72
Rate for Payer: Ohana Health Plan Medicaid	$92.52
Rate for Payer: Ohana Health Plan Medicare	$92.52
Rate for Payer: UnitedHealthcare Medicare	$92.52
Rate for Payer: University Health Alliance Commercial	$74.93

ALLERGIC REACTIONS WITH MCC

Facility

IP

$13,130.91

Service Code	MSDRG 915
Min. Negotiated Rate	$13,130.91
Max. Negotiated Rate	$13,130.91
Rate for Payer: Hawaii Medical Service Association Commercial	$13,130.91

ALLERGIC REACTIONS WITHOUT MCC

Facility

IP

$13,130.91

Service Code	MSDRG 916
Min. Negotiated Rate	$13,130.91
Max. Negotiated Rate	$13,130.91
Rate for Payer: Hawaii Medical Service Association Commercial	$13,130.91

ALLOGENEIC BONE MARROW TRANSPLANT

Facility

IP

$228,961.32

Service Code	MSDRG 014
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$228,961.32
Rate for Payer: Hawaii Medical Service Association Commercial	$228,961.32
Rate for Payer: University Health Alliance Commercial	$10,400.00

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