Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

Hemorrhoid THDSlideone kit 800070 [3601175]

Facility

IP

$2,978.00

Hospital Charge Code	3601175
Hospital Revenue Code	272
Min. Negotiated Rate	$2,531.30
Max. Negotiated Rate	$2,888.66
Rate for Payer: Cash Price	$1,935.70
Rate for Payer: Health Management Network Commercial	$2,531.30
Rate for Payer: MDX Hawaii PPO	$2,888.66

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN

Facility

IP

$21.37

Service Code	HCPCS J1644
Hospital Revenue Code	250
Min. Negotiated Rate	$18.16
Max. Negotiated Rate	$20.73
Rate for Payer: Cash Price	$13.89
Rate for Payer: Cash Price	$6.46
Rate for Payer: Health Management Network Commercial	$18.16
Rate for Payer: Health Management Network Commercial	$8.45
Rate for Payer: MDX Hawaii PPO	$20.73
Rate for Payer: MDX Hawaii PPO	$9.64

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN

Facility

OP

$21.37

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$20.73
Rate for Payer: Cash Price	$13.89
Rate for Payer: Cash Price	$13.89
Rate for Payer: Cash Price	$6.46
Rate for Payer: Cash Price	$6.46
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Western Management Group Commercial	$20.30
Rate for Payer: Hawaii Western Management Group Commercial	$9.44
Rate for Payer: Health Management Network Commercial	$8.45
Rate for Payer: Health Management Network Commercial	$18.16
Rate for Payer: Kaiser Permanente Commercial	$6.26
Rate for Payer: Kaiser Permanente Commercial	$13.46
Rate for Payer: Kaiser Permanente Medicaid	$10.90
Rate for Payer: Kaiser Permanente Medicaid	$5.07
Rate for Payer: MDX Hawaii PPO	$9.64
Rate for Payer: MDX Hawaii PPO	$20.73
Rate for Payer: UnitedHealthcare Medicaid	$12.82
Rate for Payer: UnitedHealthcare Medicaid	$5.96
Rate for Payer: University Health Alliance Commercial	$7.25
Rate for Payer: University Health Alliance Commercial	$15.58

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN (FOR NON IV USE)

Facility

OP

$9.94

Service Code	NDC 71288040201
Hospital Revenue Code	250
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$9.64
Rate for Payer: Cash Price	$6.46
Rate for Payer: Hawaii Western Management Group Commercial	$9.44
Rate for Payer: Health Management Network Commercial	$8.45
Rate for Payer: Kaiser Permanente Commercial	$6.26
Rate for Payer: Kaiser Permanente Medicaid	$5.07
Rate for Payer: MDX Hawaii PPO	$9.64
Rate for Payer: UnitedHealthcare Medicaid	$5.96
Rate for Payer: University Health Alliance Commercial	$7.25

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN (FOR NON IV USE)

Facility

OP

$21.37

Service Code	NDC 63323054013
Hospital Revenue Code	250
Min. Negotiated Rate	$10.90
Max. Negotiated Rate	$20.73
Rate for Payer: Cash Price	$13.89
Rate for Payer: Hawaii Western Management Group Commercial	$20.30
Rate for Payer: Health Management Network Commercial	$18.16
Rate for Payer: Kaiser Permanente Commercial	$13.46
Rate for Payer: Kaiser Permanente Medicaid	$10.90
Rate for Payer: MDX Hawaii PPO	$20.73
Rate for Payer: UnitedHealthcare Medicaid	$12.82
Rate for Payer: University Health Alliance Commercial	$15.58

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN (FOR NON IV USE)

Facility

OP

$21.37

Service Code	NDC 63323054003
Hospital Revenue Code	250
Min. Negotiated Rate	$10.90
Max. Negotiated Rate	$20.73
Rate for Payer: Cash Price	$13.89
Rate for Payer: Hawaii Western Management Group Commercial	$20.30
Rate for Payer: Health Management Network Commercial	$18.16
Rate for Payer: Kaiser Permanente Commercial	$13.46
Rate for Payer: Kaiser Permanente Medicaid	$10.90
Rate for Payer: MDX Hawaii PPO	$20.73
Rate for Payer: UnitedHealthcare Medicaid	$12.82
Rate for Payer: University Health Alliance Commercial	$15.58

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN (FOR NON IV USE)

Facility

IP

$21.37

Service Code	NDC 63323054003
Hospital Revenue Code	250
Min. Negotiated Rate	$18.16
Max. Negotiated Rate	$20.73
Rate for Payer: Cash Price	$13.89
Rate for Payer: Health Management Network Commercial	$18.16
Rate for Payer: MDX Hawaii PPO	$20.73

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN (FOR NON IV USE)

Facility

IP

$9.94

Service Code	NDC 71288040201
Hospital Revenue Code	250
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$9.64
Rate for Payer: Cash Price	$6.46
Rate for Payer: Health Management Network Commercial	$8.45
Rate for Payer: MDX Hawaii PPO	$9.64

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN (FOR NON IV USE)

Facility

IP

$9.94

Service Code	NDC 71288040202
Hospital Revenue Code	250
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$9.64
Rate for Payer: Cash Price	$6.46
Rate for Payer: Health Management Network Commercial	$8.45
Rate for Payer: MDX Hawaii PPO	$9.64

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN (FOR NON IV USE)

Facility

IP

$21.37

Service Code	NDC 63323054013
Hospital Revenue Code	250
Min. Negotiated Rate	$18.16
Max. Negotiated Rate	$20.73
Rate for Payer: Cash Price	$13.89
Rate for Payer: Health Management Network Commercial	$18.16
Rate for Payer: MDX Hawaii PPO	$20.73

HEPARIN (PORCINE) 1000 UNIT/ML INJ SOLN (FOR NON IV USE)

Facility

OP

$9.94

Service Code	NDC 71288040202
Hospital Revenue Code	250
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$9.64
Rate for Payer: Cash Price	$6.46
Rate for Payer: Hawaii Western Management Group Commercial	$9.44
Rate for Payer: Health Management Network Commercial	$8.45
Rate for Payer: Kaiser Permanente Commercial	$6.26
Rate for Payer: Kaiser Permanente Medicaid	$5.07
Rate for Payer: MDX Hawaii PPO	$9.64
Rate for Payer: UnitedHealthcare Medicaid	$5.96
Rate for Payer: University Health Alliance Commercial	$7.25

HEPARIN (PORCINE) 5000 UNIT/ML INJ SOLN

Facility

IP

$8.28

Service Code	HCPCS J1644
Hospital Revenue Code	250
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$8.03
Rate for Payer: Cash Price	$5.38
Rate for Payer: Cash Price	$6.82
Rate for Payer: Cash Price	$7.25
Rate for Payer: Health Management Network Commercial	$7.04
Rate for Payer: Health Management Network Commercial	$9.49
Rate for Payer: Health Management Network Commercial	$8.92
Rate for Payer: MDX Hawaii PPO	$10.18
Rate for Payer: MDX Hawaii PPO	$10.83
Rate for Payer: MDX Hawaii PPO	$8.03

HEPARIN (PORCINE) 5000 UNIT/ML INJ SOLN

Facility

OP

$10.49

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$10.18
Rate for Payer: Cash Price	$6.82
Rate for Payer: Cash Price	$7.25
Rate for Payer: Cash Price	$5.38
Rate for Payer: Cash Price	$6.82
Rate for Payer: Cash Price	$5.38
Rate for Payer: Cash Price	$7.25
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Western Management Group Commercial	$10.60
Rate for Payer: Hawaii Western Management Group Commercial	$9.97
Rate for Payer: Hawaii Western Management Group Commercial	$7.87
Rate for Payer: Health Management Network Commercial	$7.04
Rate for Payer: Health Management Network Commercial	$8.92
Rate for Payer: Health Management Network Commercial	$9.49
Rate for Payer: Kaiser Permanente Commercial	$5.22
Rate for Payer: Kaiser Permanente Commercial	$7.03
Rate for Payer: Kaiser Permanente Commercial	$6.61
Rate for Payer: Kaiser Permanente Medicaid	$5.35
Rate for Payer: Kaiser Permanente Medicaid	$4.22
Rate for Payer: Kaiser Permanente Medicaid	$5.69
Rate for Payer: MDX Hawaii PPO	$8.03
Rate for Payer: MDX Hawaii PPO	$10.83
Rate for Payer: MDX Hawaii PPO	$10.18
Rate for Payer: UnitedHealthcare Medicaid	$6.29
Rate for Payer: UnitedHealthcare Medicaid	$6.70
Rate for Payer: UnitedHealthcare Medicaid	$4.97
Rate for Payer: University Health Alliance Commercial	$8.13
Rate for Payer: University Health Alliance Commercial	$7.65
Rate for Payer: University Health Alliance Commercial	$6.04

HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/500 ML (50 UNIT/ML) IV SOLP

Facility

OP

$86.31

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$83.72
Rate for Payer: Cash Price	$56.10
Rate for Payer: Cash Price	$43.99
Rate for Payer: Cash Price	$43.99
Rate for Payer: Cash Price	$56.10
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Western Management Group Commercial	$64.30
Rate for Payer: Hawaii Western Management Group Commercial	$81.99
Rate for Payer: Health Management Network Commercial	$73.36
Rate for Payer: Health Management Network Commercial	$57.53
Rate for Payer: Kaiser Permanente Commercial	$54.38
Rate for Payer: Kaiser Permanente Commercial	$42.64
Rate for Payer: Kaiser Permanente Medicaid	$34.52
Rate for Payer: Kaiser Permanente Medicaid	$44.02
Rate for Payer: MDX Hawaii PPO	$83.72
Rate for Payer: MDX Hawaii PPO	$65.65
Rate for Payer: UnitedHealthcare Medicaid	$40.61
Rate for Payer: UnitedHealthcare Medicaid	$51.79
Rate for Payer: University Health Alliance Commercial	$49.33
Rate for Payer: University Health Alliance Commercial	$62.91

HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/500 ML (50 UNIT/ML) IV SOLP

Facility

IP

$67.68

Service Code	HCPCS J1644
Hospital Revenue Code	250
Min. Negotiated Rate	$57.53
Max. Negotiated Rate	$65.65
Rate for Payer: Cash Price	$43.99
Rate for Payer: Cash Price	$56.10
Rate for Payer: Health Management Network Commercial	$57.53
Rate for Payer: Health Management Network Commercial	$73.36
Rate for Payer: MDX Hawaii PPO	$65.65
Rate for Payer: MDX Hawaii PPO	$83.72

HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS

Facility

IP

$3,205.67

Service Code	APR-DRG 2792
Min. Negotiated Rate	$3,205.67
Max. Negotiated Rate	$3,205.67
Rate for Payer: AlohaCare Medicaid	$3,205.67
Rate for Payer: Hawaii Medical Service Association ABD	$3,205.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,205.67
Rate for Payer: Kaiser Permanente Medicaid	$3,205.67
Rate for Payer: Ohana Health Plan Medicaid	$3,205.67
Rate for Payer: UnitedHealthcare Medicaid	$3,205.67

HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS

Facility

IP

$9,881.27

Service Code	APR-DRG 2794
Min. Negotiated Rate	$9,881.27
Max. Negotiated Rate	$9,881.27
Rate for Payer: AlohaCare Medicaid	$9,881.27
Rate for Payer: Hawaii Medical Service Association ABD	$9,881.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,881.27
Rate for Payer: Kaiser Permanente Medicaid	$9,881.27
Rate for Payer: Ohana Health Plan Medicaid	$9,881.27
Rate for Payer: UnitedHealthcare Medicaid	$9,881.27

HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS

Facility

IP

$4,743.55

Service Code	APR-DRG 2793
Min. Negotiated Rate	$4,743.55
Max. Negotiated Rate	$4,743.55
Rate for Payer: AlohaCare Medicaid	$4,743.55
Rate for Payer: Hawaii Medical Service Association ABD	$4,743.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,743.55
Rate for Payer: Kaiser Permanente Medicaid	$4,743.55
Rate for Payer: Ohana Health Plan Medicaid	$4,743.55
Rate for Payer: UnitedHealthcare Medicaid	$4,743.55

HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS

Facility

IP

$2,479.71

Service Code	APR-DRG 2791
Min. Negotiated Rate	$2,479.71
Max. Negotiated Rate	$2,479.71
Rate for Payer: AlohaCare Medicaid	$2,479.71
Rate for Payer: Hawaii Medical Service Association ABD	$2,479.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,479.71
Rate for Payer: Kaiser Permanente Medicaid	$2,479.71
Rate for Payer: Ohana Health Plan Medicaid	$2,479.71
Rate for Payer: UnitedHealthcare Medicaid	$2,479.71

HEPATIC FUNCTION PANEL

Professional

Both

$16.00

Service Code	HCPCS 80076
Min. Negotiated Rate	$8.17
Max. Negotiated Rate	$17.40
Rate for Payer: Cash Price	$10.40
Rate for Payer: AlohaCare Medicaid	$11.29
Rate for Payer: AlohaCare Medicare	$8.17
Rate for Payer: Cash Price	$10.40
Rate for Payer: Devoted Health Medicare	$8.99
Rate for Payer: Hawaii Medical Service Association Medicare	$8.17
Rate for Payer: Hawaii Western Management Group Commercial	$17.40
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$9.80
Rate for Payer: Kaiser Permanente Medicaid	$9.80
Rate for Payer: Kaiser Permanente Medicare	$9.80
Rate for Payer: Ohana Health Plan Medicaid	$11.29
Rate for Payer: Ohana Health Plan Medicare	$8.17
Rate for Payer: UnitedHealthcare Medicaid	$11.29
Rate for Payer: UnitedHealthcare Medicare	$8.17

HEPATITIS A VIRUS VACCINE (PF) 1440 ELISA UNIT/ML IM SYR

Facility

IP

$394.75

Service Code	HCPCS 90632
Hospital Revenue Code	250
Min. Negotiated Rate	$335.54
Max. Negotiated Rate	$382.91
Rate for Payer: Cash Price	$256.59
Rate for Payer: Health Management Network Commercial	$335.54
Rate for Payer: MDX Hawaii PPO	$382.91

HEPATITIS A VIRUS VACCINE (PF) 1440 ELISA UNIT/ML IM SYR

Facility

OP

$394.75

Service Code	HCPCS 90632
Hospital Revenue Code	250
Min. Negotiated Rate	$71.61
Max. Negotiated Rate	$382.91
Rate for Payer: Cash Price	$256.59
Rate for Payer: Cash Price	$256.59
Rate for Payer: Hawaii Medical Service Association ABD	$71.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$71.61
Rate for Payer: Hawaii Western Management Group Commercial	$375.01
Rate for Payer: Health Management Network Commercial	$335.54
Rate for Payer: Kaiser Permanente Commercial	$248.69
Rate for Payer: Kaiser Permanente Medicaid	$201.32
Rate for Payer: MDX Hawaii PPO	$382.91
Rate for Payer: UnitedHealthcare Medicaid	$236.85
Rate for Payer: University Health Alliance Commercial	$287.73

HEPATITIS B IMMUNE GLOBULIN 110 UNIT/0.5 ML IM SYR

Facility

OP

$405.29

Service Code	HCPCS 90371
Hospital Revenue Code	250
Min. Negotiated Rate	$140.21
Max. Negotiated Rate	$393.13
Rate for Payer: AlohaCare Medicaid	$140.21
Rate for Payer: AlohaCare Medicare	$140.21
Rate for Payer: Cash Price	$263.44
Rate for Payer: Cash Price	$263.44
Rate for Payer: Devoted Health Medicare	$154.23
Rate for Payer: Hawaii Medical Service Association Commercial	$175.26
Rate for Payer: Hawaii Medical Service Association Medicare	$140.21
Rate for Payer: Hawaii Western Management Group Commercial	$385.03
Rate for Payer: Health Management Network Commercial	$344.50
Rate for Payer: Humana Medicare	$140.21
Rate for Payer: Kaiser Permanente Commercial	$255.33
Rate for Payer: Kaiser Permanente Medicaid	$206.70
Rate for Payer: Kaiser Permanente Medicare	$140.21
Rate for Payer: MDX Hawaii PPO	$393.13
Rate for Payer: Ohana Health Plan Medicaid	$154.23
Rate for Payer: Ohana Health Plan Medicare	$140.21
Rate for Payer: UnitedHealthcare Medicaid	$243.17
Rate for Payer: UnitedHealthcare Medicare	$140.21
Rate for Payer: University Health Alliance Commercial	$295.42

HEPATITIS B IMMUNE GLOBULIN 110 UNIT/0.5 ML IM SYR

Facility

IP

$405.29

Service Code	HCPCS 90371
Hospital Revenue Code	250
Min. Negotiated Rate	$344.50
Max. Negotiated Rate	$393.13
Rate for Payer: Cash Price	$263.44
Rate for Payer: Health Management Network Commercial	$344.50
Rate for Payer: MDX Hawaii PPO	$393.13

HEPATITIS B IMMUNE GLOBULIN GREATER THAN 1,560 UNIT/5 ML IM SOLN

Facility

IP

$1,880.81

Service Code	HCPCS 90371
Hospital Revenue Code	250
Min. Negotiated Rate	$1,598.69
Max. Negotiated Rate	$1,824.39
Rate for Payer: Cash Price	$1,222.53
Rate for Payer: Health Management Network Commercial	$1,598.69
Rate for Payer: MDX Hawaii PPO	$1,824.39

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