Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

SODIUM HYPOCHLORITE 0.5 % MISC SOLN

Facility

OP

$94.38

Service Code	NDC 39328006250
Hospital Revenue Code	250
Min. Negotiated Rate	$48.13
Max. Negotiated Rate	$91.55
Rate for Payer: Cash Price	$61.35
Rate for Payer: Hawaii Western Management Group Commercial	$89.66
Rate for Payer: Health Management Network Commercial	$80.22
Rate for Payer: Kaiser Permanente Commercial	$59.46
Rate for Payer: Kaiser Permanente Medicaid	$48.13
Rate for Payer: MDX Hawaii PPO	$91.55
Rate for Payer: UnitedHealthcare Medicaid	$56.63
Rate for Payer: University Health Alliance Commercial	$68.79

SODIUM HYPOCHLORITE 0.5 % MISC SOLN

Facility

OP

$88.50

Service Code	NDC 00436094616
Hospital Revenue Code	250
Min. Negotiated Rate	$45.13
Max. Negotiated Rate	$85.84
Rate for Payer: Cash Price	$57.52
Rate for Payer: Hawaii Western Management Group Commercial	$84.08
Rate for Payer: Health Management Network Commercial	$75.22
Rate for Payer: Kaiser Permanente Commercial	$55.76
Rate for Payer: Kaiser Permanente Medicaid	$45.13
Rate for Payer: MDX Hawaii PPO	$85.84
Rate for Payer: UnitedHealthcare Medicaid	$53.10
Rate for Payer: University Health Alliance Commercial	$64.51

SODIUM HYPOCHLORITE 0.5 % MISC SOLN

Facility

IP

$88.50

Service Code	NDC 00436094616
Hospital Revenue Code	250
Min. Negotiated Rate	$75.22
Max. Negotiated Rate	$85.84
Rate for Payer: Cash Price	$57.52
Rate for Payer: Health Management Network Commercial	$75.22
Rate for Payer: MDX Hawaii PPO	$85.84

SODIUM NITROPRUSSIDE 25 MG/ML IV SOLN

Facility

IP

$121.50

Service Code	NDC 70069026101
Hospital Revenue Code	250
Min. Negotiated Rate	$103.28
Max. Negotiated Rate	$117.86
Rate for Payer: Cash Price	$78.98
Rate for Payer: Health Management Network Commercial	$103.28
Rate for Payer: MDX Hawaii PPO	$117.86

SODIUM NITROPRUSSIDE 25 MG/ML IV SOLN

Facility

OP

$117.36

Service Code	NDC 72485010501
Hospital Revenue Code	250
Min. Negotiated Rate	$59.85
Max. Negotiated Rate	$113.84
Rate for Payer: Cash Price	$76.28
Rate for Payer: Hawaii Western Management Group Commercial	$111.49
Rate for Payer: Health Management Network Commercial	$99.76
Rate for Payer: Kaiser Permanente Commercial	$73.94
Rate for Payer: Kaiser Permanente Medicaid	$59.85
Rate for Payer: MDX Hawaii PPO	$113.84
Rate for Payer: UnitedHealthcare Medicaid	$70.42
Rate for Payer: University Health Alliance Commercial	$85.54

SODIUM NITROPRUSSIDE 25 MG/ML IV SOLN

Facility

IP

$117.36

Service Code	NDC 72485010501
Hospital Revenue Code	250
Min. Negotiated Rate	$99.76
Max. Negotiated Rate	$113.84
Rate for Payer: Cash Price	$76.28
Rate for Payer: Health Management Network Commercial	$99.76
Rate for Payer: MDX Hawaii PPO	$113.84

SODIUM NITROPRUSSIDE 25 MG/ML IV SOLN

Facility

OP

$911.88

Service Code	NDC 71839012001
Hospital Revenue Code	250
Min. Negotiated Rate	$465.06
Max. Negotiated Rate	$884.52
Rate for Payer: Cash Price	$592.72
Rate for Payer: Hawaii Western Management Group Commercial	$866.29
Rate for Payer: Health Management Network Commercial	$775.10
Rate for Payer: Kaiser Permanente Commercial	$574.48
Rate for Payer: Kaiser Permanente Medicaid	$465.06
Rate for Payer: MDX Hawaii PPO	$884.52
Rate for Payer: UnitedHealthcare Medicaid	$547.13
Rate for Payer: University Health Alliance Commercial	$664.67

SODIUM NITROPRUSSIDE 25 MG/ML IV SOLN

Facility

IP

$911.88

Service Code	NDC 71839012001
Hospital Revenue Code	250
Min. Negotiated Rate	$775.10
Max. Negotiated Rate	$884.52
Rate for Payer: Cash Price	$592.72
Rate for Payer: Health Management Network Commercial	$775.10
Rate for Payer: MDX Hawaii PPO	$884.52

SODIUM NITROPRUSSIDE 25 MG/ML IV SOLN

Facility

OP

$121.50

Service Code	NDC 70069026101
Hospital Revenue Code	250
Min. Negotiated Rate	$61.97
Max. Negotiated Rate	$117.86
Rate for Payer: Cash Price	$78.98
Rate for Payer: Hawaii Western Management Group Commercial	$115.42
Rate for Payer: Health Management Network Commercial	$103.28
Rate for Payer: Kaiser Permanente Commercial	$76.55
Rate for Payer: Kaiser Permanente Medicaid	$61.97
Rate for Payer: MDX Hawaii PPO	$117.86
Rate for Payer: UnitedHealthcare Medicaid	$72.90
Rate for Payer: University Health Alliance Commercial	$88.56

SODIUM PHOSPHATE 3 MMOLE/ML IV SOLN

Facility

IP

$98.36

Service Code	NDC 63323088406
Hospital Revenue Code	250
Min. Negotiated Rate	$83.61
Max. Negotiated Rate	$95.41
Rate for Payer: Cash Price	$63.93
Rate for Payer: Health Management Network Commercial	$83.61
Rate for Payer: MDX Hawaii PPO	$95.41

SODIUM PHOSPHATE 3 MMOLE/ML IV SOLN

Facility

OP

$98.36

Service Code	NDC 63323088406
Hospital Revenue Code	250
Min. Negotiated Rate	$50.16
Max. Negotiated Rate	$95.41
Rate for Payer: Cash Price	$63.93
Rate for Payer: Hawaii Western Management Group Commercial	$93.44
Rate for Payer: Health Management Network Commercial	$83.61
Rate for Payer: Kaiser Permanente Commercial	$61.97
Rate for Payer: Kaiser Permanente Medicaid	$50.16
Rate for Payer: MDX Hawaii PPO	$95.41
Rate for Payer: UnitedHealthcare Medicaid	$59.02
Rate for Payer: University Health Alliance Commercial	$71.69

SODIUM PHOSPHATE 3 MMOLE/ML IV SOLN

Facility

IP

$98.36

Service Code	NDC 63323088401
Hospital Revenue Code	250
Min. Negotiated Rate	$83.61
Max. Negotiated Rate	$95.41
Rate for Payer: Cash Price	$63.93
Rate for Payer: Health Management Network Commercial	$83.61
Rate for Payer: MDX Hawaii PPO	$95.41

SODIUM PHOSPHATE 3 MMOLE/ML IV SOLN

Facility

OP

$98.36

Service Code	NDC 63323088401
Hospital Revenue Code	250
Min. Negotiated Rate	$50.16
Max. Negotiated Rate	$95.41
Rate for Payer: Cash Price	$63.93
Rate for Payer: Hawaii Western Management Group Commercial	$93.44
Rate for Payer: Health Management Network Commercial	$83.61
Rate for Payer: Kaiser Permanente Commercial	$61.97
Rate for Payer: Kaiser Permanente Medicaid	$50.16
Rate for Payer: MDX Hawaii PPO	$95.41
Rate for Payer: UnitedHealthcare Medicaid	$59.02
Rate for Payer: University Health Alliance Commercial	$71.69

SODIUM PHOSPHATES 19-7 GRAM/118 ML PR ENEMA

Facility

OP

$11.02

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$10.69
Rate for Payer: Cash Price	$7.16
Rate for Payer: Hawaii Western Management Group Commercial	$10.47
Rate for Payer: Health Management Network Commercial	$9.37
Rate for Payer: Kaiser Permanente Commercial	$6.94
Rate for Payer: Kaiser Permanente Medicaid	$5.62
Rate for Payer: MDX Hawaii PPO	$10.69
Rate for Payer: UnitedHealthcare Medicaid	$6.61
Rate for Payer: University Health Alliance Commercial	$8.03

SODIUM PHOSPHATES 19-7 GRAM/118 ML PR ENEMA

Facility

IP

$11.02

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.37
Max. Negotiated Rate	$10.69
Rate for Payer: Cash Price	$7.16
Rate for Payer: Health Management Network Commercial	$9.37
Rate for Payer: MDX Hawaii PPO	$10.69

SODIUM PHOSPHATES 9.5-3.5 GRAM/59 ML PR ENEMA

Facility

OP

$13.12

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$12.73
Rate for Payer: Cash Price	$8.53
Rate for Payer: Hawaii Western Management Group Commercial	$12.46
Rate for Payer: Health Management Network Commercial	$11.15
Rate for Payer: Kaiser Permanente Commercial	$8.27
Rate for Payer: Kaiser Permanente Medicaid	$6.69
Rate for Payer: MDX Hawaii PPO	$12.73
Rate for Payer: UnitedHealthcare Medicaid	$7.87
Rate for Payer: University Health Alliance Commercial	$9.56

SODIUM PHOSPHATES 9.5-3.5 GRAM/59 ML PR ENEMA

Facility

IP

$13.12

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.15
Max. Negotiated Rate	$12.73
Rate for Payer: Cash Price	$8.53
Rate for Payer: Health Management Network Commercial	$11.15
Rate for Payer: MDX Hawaii PPO	$12.73

SODIUM POLYSTYRENE SULFONATE (SPS) 15 G/60 ML RECTAL SUSP (RECTAL USE ONLY)

Facility

IP

$146.43

Service Code	NDC 46287000660
Hospital Revenue Code	250
Min. Negotiated Rate	$124.47
Max. Negotiated Rate	$142.04
Rate for Payer: Cash Price	$95.18
Rate for Payer: Health Management Network Commercial	$124.47
Rate for Payer: MDX Hawaii PPO	$142.04

SODIUM POLYSTYRENE SULFONATE (SPS) 15 G/60 ML RECTAL SUSP (RECTAL USE ONLY)

Facility

OP

$784.99

Service Code	NDC 46287000601
Hospital Revenue Code	250
Min. Negotiated Rate	$400.34
Max. Negotiated Rate	$761.44
Rate for Payer: Cash Price	$510.24
Rate for Payer: Hawaii Western Management Group Commercial	$745.74
Rate for Payer: Health Management Network Commercial	$667.24
Rate for Payer: Kaiser Permanente Commercial	$494.54
Rate for Payer: Kaiser Permanente Medicaid	$400.34
Rate for Payer: MDX Hawaii PPO	$761.44
Rate for Payer: UnitedHealthcare Medicaid	$470.99
Rate for Payer: University Health Alliance Commercial	$572.18

SODIUM POLYSTYRENE SULFONATE (SPS) 15 G/60 ML RECTAL SUSP (RECTAL USE ONLY)

Facility

IP

$784.99

Service Code	NDC 46287000601
Hospital Revenue Code	250
Min. Negotiated Rate	$667.24
Max. Negotiated Rate	$761.44
Rate for Payer: Cash Price	$510.24
Rate for Payer: Health Management Network Commercial	$667.24
Rate for Payer: MDX Hawaii PPO	$761.44

SODIUM POLYSTYRENE SULFONATE (SPS) 15 G/60 ML RECTAL SUSP (RECTAL USE ONLY)

Facility

OP

$146.43

Service Code	NDC 46287000660
Hospital Revenue Code	250
Min. Negotiated Rate	$74.68
Max. Negotiated Rate	$142.04
Rate for Payer: Cash Price	$95.18
Rate for Payer: Hawaii Western Management Group Commercial	$139.11
Rate for Payer: Health Management Network Commercial	$124.47
Rate for Payer: Kaiser Permanente Commercial	$92.25
Rate for Payer: Kaiser Permanente Medicaid	$74.68
Rate for Payer: MDX Hawaii PPO	$142.04
Rate for Payer: UnitedHealthcare Medicaid	$87.86
Rate for Payer: University Health Alliance Commercial	$106.73

SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML PO SUSP

Facility

IP

$784.99

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$667.24
Max. Negotiated Rate	$761.44
Rate for Payer: Cash Price	$510.24
Rate for Payer: Cash Price	$95.18
Rate for Payer: Health Management Network Commercial	$124.47
Rate for Payer: Health Management Network Commercial	$667.24
Rate for Payer: MDX Hawaii PPO	$761.44
Rate for Payer: MDX Hawaii PPO	$142.04

SODIUM POLYSTYRENE SULF-SORBTL 15-20 GRAM/60 ML PO SUSP

Facility

OP

$146.43

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$74.68
Max. Negotiated Rate	$142.04
Rate for Payer: Cash Price	$95.18
Rate for Payer: Cash Price	$510.24
Rate for Payer: Hawaii Western Management Group Commercial	$139.11
Rate for Payer: Hawaii Western Management Group Commercial	$745.74
Rate for Payer: Health Management Network Commercial	$124.47
Rate for Payer: Health Management Network Commercial	$667.24
Rate for Payer: Kaiser Permanente Commercial	$92.25
Rate for Payer: Kaiser Permanente Commercial	$494.54
Rate for Payer: Kaiser Permanente Medicaid	$74.68
Rate for Payer: Kaiser Permanente Medicaid	$400.34
Rate for Payer: MDX Hawaii PPO	$142.04
Rate for Payer: MDX Hawaii PPO	$761.44
Rate for Payer: UnitedHealthcare Medicaid	$470.99
Rate for Payer: UnitedHealthcare Medicaid	$87.86
Rate for Payer: University Health Alliance Commercial	$106.73
Rate for Payer: University Health Alliance Commercial	$572.18

SODIUM SERUM PLASMA OR WHOLE BLOOD

Professional

Both

$10.00

Service Code	HCPCS 84295
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$8.50
Rate for Payer: AlohaCare Medicaid	$6.65
Rate for Payer: AlohaCare Medicare	$4.81
Rate for Payer: Cash Price	$6.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Devoted Health Medicare	$5.29
Rate for Payer: Hawaii Medical Service Association Medicare	$4.81
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$5.77
Rate for Payer: Kaiser Permanente Medicaid	$5.77
Rate for Payer: Kaiser Permanente Medicare	$5.77
Rate for Payer: Ohana Health Plan Medicaid	$6.65
Rate for Payer: Ohana Health Plan Medicare	$4.81
Rate for Payer: UnitedHealthcare Medicaid	$6.65
Rate for Payer: UnitedHealthcare Medicare	$4.81

SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) IV SOLN

Facility

IP

$489.12

Service Code	HCPCS J0209
Hospital Revenue Code	250
Min. Negotiated Rate	$415.75
Max. Negotiated Rate	$474.45
Rate for Payer: Cash Price	$317.93
Rate for Payer: Health Management Network Commercial	$415.75
Rate for Payer: MDX Hawaii PPO	$474.45

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