Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

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: MDX Hawaii PPO	$1.85

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: 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	$2.26
Max. Negotiated Rate	$4.30
Rate for Payer: Cash Price	$2.88
Rate for Payer: Hawaii Western Management Group Commercial	$4.21
Rate for Payer: Health Management Network Commercial	$3.77
Rate for Payer: Kaiser Permanente Commercial	$2.79
Rate for Payer: Kaiser Permanente Medicaid	$2.26
Rate for Payer: MDX Hawaii PPO	$4.30
Rate for Payer: UnitedHealthcare Medicaid	$2.66
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: MDX Hawaii PPO	$4.30

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	$0.97
Max. Negotiated Rate	$1.85
Rate for Payer: Cash Price	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$1.81
Rate for Payer: Health Management Network Commercial	$1.62
Rate for Payer: Kaiser Permanente Commercial	$1.20
Rate for Payer: Kaiser Permanente Medicaid	$0.97
Rate for Payer: MDX Hawaii PPO	$1.85
Rate for Payer: UnitedHealthcare Medicaid	$1.15
Rate for Payer: University Health Alliance Commercial	$1.39

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

Facility

IP

$4.43

Service Code	NDC 00487950125
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: MDX Hawaii PPO	$4.30

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: MDX Hawaii PPO	$4.30

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	$0.97
Max. Negotiated Rate	$1.85
Rate for Payer: Cash Price	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$1.81
Rate for Payer: Health Management Network Commercial	$1.62
Rate for Payer: Kaiser Permanente Commercial	$1.20
Rate for Payer: Kaiser Permanente Medicaid	$0.97
Rate for Payer: MDX Hawaii PPO	$1.85
Rate for Payer: UnitedHealthcare Medicaid	$1.15
Rate for Payer: University Health Alliance Commercial	$1.39

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	$3.94
Max. Negotiated Rate	$7.49
Rate for Payer: Cash Price	$5.02
Rate for Payer: Hawaii Western Management Group Commercial	$7.33
Rate for Payer: Health Management Network Commercial	$6.56
Rate for Payer: Kaiser Permanente Commercial	$4.86
Rate for Payer: Kaiser Permanente Medicaid	$3.94
Rate for Payer: MDX Hawaii PPO	$7.49
Rate for Payer: UnitedHealthcare Medicaid	$4.63
Rate for Payer: University Health Alliance Commercial	$5.63

ALBUTEROL SULFATE 90 MCG/ACTUATION INHAL HFAA

Facility

OP

$227.11

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$115.83
Max. Negotiated Rate	$220.30
Rate for Payer: Cash Price	$147.62
Rate for Payer: Hawaii Western Management Group Commercial	$215.75
Rate for Payer: Health Management Network Commercial	$193.04
Rate for Payer: Kaiser Permanente Commercial	$143.08
Rate for Payer: Kaiser Permanente Medicaid	$115.83
Rate for Payer: MDX Hawaii PPO	$220.30
Rate for Payer: UnitedHealthcare Medicaid	$136.27
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: MDX Hawaii PPO	$220.30

ALBUTEROL SULFATE 90 MCG/ACTUATION INHAL HFAA (60 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: MDX Hawaii PPO	$121.66

ALBUTEROL SULFATE 90 MCG/ACTUATION INHAL HFAA (60 DOSE)

Facility

OP

$125.42

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$63.96
Max. Negotiated Rate	$121.66
Rate for Payer: Cash Price	$81.52
Rate for Payer: Hawaii Western Management Group Commercial	$119.15
Rate for Payer: Health Management Network Commercial	$106.61
Rate for Payer: Kaiser Permanente Commercial	$79.01
Rate for Payer: Kaiser Permanente Medicaid	$63.96
Rate for Payer: MDX Hawaii PPO	$121.66
Rate for Payer: UnitedHealthcare Medicaid	$75.25
Rate for Payer: University Health Alliance Commercial	$91.42

ALCOHOL ABUSE & DEPENDENCE

Facility

IP

$2,404.22

Service Code	APR-DRG 7751
Min. Negotiated Rate	$2,404.22
Max. Negotiated Rate	$2,404.22
Rate for Payer: AlohaCare Medicaid	$2,404.22
Rate for Payer: Hawaii Medical Service Association ABD	$2,404.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,404.22
Rate for Payer: Kaiser Permanente Medicaid	$2,404.22
Rate for Payer: Ohana Health Plan Medicaid	$2,404.22
Rate for Payer: UnitedHealthcare Medicaid	$2,404.22

ALCOHOL ABUSE & DEPENDENCE

Facility

IP

$3,302.78

Service Code	APR-DRG 7752
Min. Negotiated Rate	$3,302.78
Max. Negotiated Rate	$3,302.78
Rate for Payer: AlohaCare Medicaid	$3,302.78
Rate for Payer: Hawaii Medical Service Association ABD	$3,302.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,302.78
Rate for Payer: Kaiser Permanente Medicaid	$3,302.78
Rate for Payer: Ohana Health Plan Medicaid	$3,302.78
Rate for Payer: UnitedHealthcare Medicaid	$3,302.78

ALCOHOL ABUSE & DEPENDENCE

Facility

IP

$12,515.41

Service Code	APR-DRG 7754
Min. Negotiated Rate	$12,515.41
Max. Negotiated Rate	$12,515.41
Rate for Payer: AlohaCare Medicaid	$12,515.41
Rate for Payer: Hawaii Medical Service Association ABD	$12,515.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,515.41
Rate for Payer: Kaiser Permanente Medicaid	$12,515.41
Rate for Payer: Ohana Health Plan Medicaid	$12,515.41
Rate for Payer: UnitedHealthcare Medicaid	$12,515.41

ALCOHOL ABUSE & DEPENDENCE

Facility

IP

$5,327.65

Service Code	APR-DRG 7753
Min. Negotiated Rate	$5,327.65
Max. Negotiated Rate	$5,327.65
Rate for Payer: AlohaCare Medicaid	$5,327.65
Rate for Payer: Hawaii Medical Service Association ABD	$5,327.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,327.65
Rate for Payer: Kaiser Permanente Medicaid	$5,327.65
Rate for Payer: Ohana Health Plan Medicaid	$5,327.65
Rate for Payer: UnitedHealthcare Medicaid	$5,327.65

ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA

Facility

IP

$10,641.52

Service Code	MSDRG 894
Min. Negotiated Rate	$8,113.93
Max. Negotiated Rate	$10,641.52
Rate for Payer: AlohaCare Medicare	$8,113.93
Rate for Payer: Devoted Health Medicare	$8,925.32
Rate for Payer: Hawaii Medical Service Association Commercial	$8,606.20
Rate for Payer: Hawaii Medical Service Association Medicare	$8,113.93
Rate for Payer: Humana Medicare	$8,113.93
Rate for Payer: Kaiser Permanente Commercial	$10,641.52
Rate for Payer: Kaiser Permanente Medicare	$8,113.93
Rate for Payer: Ohana Health Plan Medicare	$8,113.93
Rate for Payer: UnitedHealthcare Medicare	$8,113.93

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC

Facility

IP

$30,102.97

Service Code	MSDRG 896
Min. Negotiated Rate	$22,952.89
Max. Negotiated Rate	$30,102.97
Rate for Payer: AlohaCare Medicare	$22,952.89
Rate for Payer: Devoted Health Medicare	$25,248.18
Rate for Payer: Hawaii Medical Service Association Commercial	$22,973.97
Rate for Payer: Hawaii Medical Service Association Medicare	$22,952.89
Rate for Payer: Humana Medicare	$22,952.89
Rate for Payer: Kaiser Permanente Commercial	$30,102.97
Rate for Payer: Kaiser Permanente Medicare	$22,952.89
Rate for Payer: Ohana Health Plan Medicare	$22,952.89
Rate for Payer: UnitedHealthcare Medicare	$22,952.89

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC

Facility

IP

$15,228.30

Service Code	MSDRG 897
Min. Negotiated Rate	$11,611.26
Max. Negotiated Rate	$15,228.30
Rate for Payer: AlohaCare Medicare	$11,611.26
Rate for Payer: Devoted Health Medicare	$12,772.39
Rate for Payer: Hawaii Medical Service Association Commercial	$14,657.06
Rate for Payer: Hawaii Medical Service Association Medicare	$11,611.26
Rate for Payer: Humana Medicare	$11,611.26
Rate for Payer: Kaiser Permanente Commercial	$15,228.30
Rate for Payer: Kaiser Permanente Medicare	$11,611.26
Rate for Payer: Ohana Health Plan Medicare	$11,611.26
Rate for Payer: UnitedHealthcare Medicare	$11,611.26

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY

Facility

IP

$24,419.10

Service Code	MSDRG 895
Min. Negotiated Rate	$18,619.05
Max. Negotiated Rate	$24,419.10
Rate for Payer: AlohaCare Medicare	$18,619.05
Rate for Payer: Devoted Health Medicare	$20,480.96
Rate for Payer: Hawaii Medical Service Association Commercial	$22,973.97
Rate for Payer: Hawaii Medical Service Association Medicare	$18,619.05
Rate for Payer: Humana Medicare	$18,619.05
Rate for Payer: Kaiser Permanente Commercial	$24,419.10
Rate for Payer: Kaiser Permanente Medicare	$18,619.05
Rate for Payer: Ohana Health Plan Medicare	$18,619.05
Rate for Payer: UnitedHealthcare Medicare	$18,619.05

ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY

Facility

IP

$2,946.87

Service Code	APR-DRG 7721
Min. Negotiated Rate	$2,946.87
Max. Negotiated Rate	$2,946.87
Rate for Payer: AlohaCare Medicaid	$2,946.87
Rate for Payer: Hawaii Medical Service Association ABD	$2,946.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,946.87
Rate for Payer: Kaiser Permanente Medicaid	$2,946.87
Rate for Payer: Ohana Health Plan Medicaid	$2,946.87
Rate for Payer: UnitedHealthcare Medicaid	$2,946.87

ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY

Facility

IP

$3,854.95

Service Code	APR-DRG 7722
Min. Negotiated Rate	$3,854.95
Max. Negotiated Rate	$3,854.95
Rate for Payer: AlohaCare Medicaid	$3,854.95
Rate for Payer: Hawaii Medical Service Association ABD	$3,854.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,854.95
Rate for Payer: Kaiser Permanente Medicaid	$3,854.95
Rate for Payer: Ohana Health Plan Medicaid	$3,854.95
Rate for Payer: UnitedHealthcare Medicaid	$3,854.95

ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY

Facility

IP

$5,063.28

Service Code	APR-DRG 7723
Min. Negotiated Rate	$5,063.28
Max. Negotiated Rate	$5,063.28
Rate for Payer: AlohaCare Medicaid	$5,063.28
Rate for Payer: Hawaii Medical Service Association ABD	$5,063.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,063.28
Rate for Payer: Kaiser Permanente Medicaid	$5,063.28
Rate for Payer: Ohana Health Plan Medicaid	$5,063.28
Rate for Payer: UnitedHealthcare Medicaid	$5,063.28

ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY

Facility

IP

$13,840.18

Service Code	APR-DRG 7724
Min. Negotiated Rate	$13,840.18
Max. Negotiated Rate	$13,840.18
Rate for Payer: AlohaCare Medicaid	$13,840.18
Rate for Payer: Hawaii Medical Service Association ABD	$13,840.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,840.18
Rate for Payer: Kaiser Permanente Medicaid	$13,840.18
Rate for Payer: Ohana Health Plan Medicaid	$13,840.18
Rate for Payer: UnitedHealthcare Medicaid	$13,840.18

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