Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

potassium chlor ER 10 mEq tablet [HHSC]

Facility

IP

$3.14

Service Code	NDC 00245531611
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$3.05
Rate for Payer: Cash Price	$2.04
Rate for Payer: Health Management Network Commercial	$2.67
Rate for Payer: Kaiser Permanente Commercial	$2.83
Rate for Payer: MDX Hawaii PPO	$3.05

potassium chlor ER 10 mEq tablet [HHSC]

Facility

OP

$3.14

Service Code	NDC 00245531611
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$3.05
Rate for Payer: AlohaCare Medicaid	$1.57
Rate for Payer: AlohaCare Medicare	$1.57
Rate for Payer: Cash Price	$2.04
Rate for Payer: Devoted Health Medicare	$1.73
Rate for Payer: Hawaii Medical Service Association Medicare	$1.57
Rate for Payer: Hawaii Western Management Group Commercial	$2.98
Rate for Payer: Health Management Network Commercial	$2.67
Rate for Payer: Humana Medicare	$1.57
Rate for Payer: Kaiser Permanente Commercial	$2.83
Rate for Payer: Kaiser Permanente Medicaid	$1.60
Rate for Payer: Kaiser Permanente Medicare	$1.57
Rate for Payer: MDX Hawaii PPO	$3.05
Rate for Payer: Ohana Health Plan Medicaid	$1.57
Rate for Payer: Ohana Health Plan Medicare	$1.57
Rate for Payer: UnitedHealthcare Medicaid	$1.88
Rate for Payer: UnitedHealthcare Medicare	$1.57
Rate for Payer: University Health Alliance Commercial	$2.29

potassium chlor ER 10 mEq tablet [HHSC]

Facility

IP

$3.14

Service Code	NDC 65862098701
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$3.05
Rate for Payer: Cash Price	$2.04
Rate for Payer: Health Management Network Commercial	$2.67
Rate for Payer: Kaiser Permanente Commercial	$2.83
Rate for Payer: MDX Hawaii PPO	$3.05

potassium chlor ER 10 mEq tablet [HHSC]

Facility

IP

$3.43

Service Code	NDC 00245531701
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$3.33
Rate for Payer: Cash Price	$2.23
Rate for Payer: Health Management Network Commercial	$2.92
Rate for Payer: Kaiser Permanente Commercial	$3.09
Rate for Payer: MDX Hawaii PPO	$3.33

potassium chlor ER 10 mEq tablet [HHSC]

Facility

OP

$3.43

Service Code	NDC 00245531701
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$3.33
Rate for Payer: AlohaCare Medicaid	$1.72
Rate for Payer: AlohaCare Medicare	$1.72
Rate for Payer: Cash Price	$2.23
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	$3.26
Rate for Payer: Health Management Network Commercial	$2.92
Rate for Payer: Humana Medicare	$1.72
Rate for Payer: Kaiser Permanente Commercial	$3.09
Rate for Payer: Kaiser Permanente Medicaid	$1.75
Rate for Payer: Kaiser Permanente Medicare	$1.72
Rate for Payer: MDX Hawaii PPO	$3.33
Rate for Payer: Ohana Health Plan Medicaid	$1.72
Rate for Payer: Ohana Health Plan Medicare	$1.72
Rate for Payer: UnitedHealthcare Medicaid	$2.06
Rate for Payer: UnitedHealthcare Medicare	$1.72
Rate for Payer: University Health Alliance Commercial	$2.50

potassium chlor ER 10 mEq tablet [HHSC]

Facility

IP

$3.40

Service Code	NDC 60687046601
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$3.30
Rate for Payer: Cash Price	$2.21
Rate for Payer: Health Management Network Commercial	$2.89
Rate for Payer: Kaiser Permanente Commercial	$3.06
Rate for Payer: MDX Hawaii PPO	$3.30

potassium chlor ER 10 mEq tablet [HHSC]

Facility

OP

$3.00

Service Code	NDC 60687081009
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

potassium chlor ER 10 mEq tablet [HHSC]

Facility

IP

$3.00

Service Code	NDC 60687081009
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

potassium chlor ER 10 mEq tablet [HHSC]

Facility

OP

$3.14

Service Code	NDC 65862098701
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$3.05
Rate for Payer: AlohaCare Medicaid	$1.57
Rate for Payer: AlohaCare Medicare	$1.57
Rate for Payer: Cash Price	$2.04
Rate for Payer: Devoted Health Medicare	$1.73
Rate for Payer: Hawaii Medical Service Association Medicare	$1.57
Rate for Payer: Hawaii Western Management Group Commercial	$2.98
Rate for Payer: Health Management Network Commercial	$2.67
Rate for Payer: Humana Medicare	$1.57
Rate for Payer: Kaiser Permanente Commercial	$2.83
Rate for Payer: Kaiser Permanente Medicaid	$1.60
Rate for Payer: Kaiser Permanente Medicare	$1.57
Rate for Payer: MDX Hawaii PPO	$3.05
Rate for Payer: Ohana Health Plan Medicaid	$1.57
Rate for Payer: Ohana Health Plan Medicare	$1.57
Rate for Payer: UnitedHealthcare Medicaid	$1.88
Rate for Payer: UnitedHealthcare Medicare	$1.57
Rate for Payer: University Health Alliance Commercial	$2.29

potassium chlor ER 10 mEq tablet [HHSC]

Facility

IP

$3.62

Service Code	NDC 66758016013
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$3.51
Rate for Payer: Cash Price	$2.35
Rate for Payer: Health Management Network Commercial	$3.08
Rate for Payer: Kaiser Permanente Commercial	$3.26
Rate for Payer: MDX Hawaii PPO	$3.51

potassium chlor ER 10 mEq tablet [HHSC]

Facility

OP

$3.62

Service Code	NDC 66758016013
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$3.51
Rate for Payer: AlohaCare Medicaid	$1.81
Rate for Payer: AlohaCare Medicare	$1.81
Rate for Payer: Cash Price	$2.35
Rate for Payer: Devoted Health Medicare	$1.99
Rate for Payer: Hawaii Medical Service Association Medicare	$1.81
Rate for Payer: Hawaii Western Management Group Commercial	$3.44
Rate for Payer: Health Management Network Commercial	$3.08
Rate for Payer: Humana Medicare	$1.81
Rate for Payer: Kaiser Permanente Commercial	$3.26
Rate for Payer: Kaiser Permanente Medicaid	$1.85
Rate for Payer: Kaiser Permanente Medicare	$1.81
Rate for Payer: MDX Hawaii PPO	$3.51
Rate for Payer: Ohana Health Plan Medicaid	$1.81
Rate for Payer: Ohana Health Plan Medicare	$1.81
Rate for Payer: UnitedHealthcare Medicaid	$2.17
Rate for Payer: UnitedHealthcare Medicare	$1.81
Rate for Payer: University Health Alliance Commercial	$2.64

potassium chlor ER 10 mEq tablet [HHSC]

Facility

IP

$3.14

Service Code	NDC 68001051800
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$3.05
Rate for Payer: Cash Price	$2.04
Rate for Payer: Health Management Network Commercial	$2.67
Rate for Payer: Kaiser Permanente Commercial	$2.83
Rate for Payer: MDX Hawaii PPO	$3.05

potassium chlor ER 10 mEq tablet [HHSC]

Facility

OP

$3.40

Service Code	NDC 60687046601
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$3.30
Rate for Payer: AlohaCare Medicaid	$1.70
Rate for Payer: AlohaCare Medicare	$1.70
Rate for Payer: Cash Price	$2.21
Rate for Payer: Devoted Health Medicare	$1.87
Rate for Payer: Hawaii Medical Service Association Medicare	$1.70
Rate for Payer: Hawaii Western Management Group Commercial	$3.23
Rate for Payer: Health Management Network Commercial	$2.89
Rate for Payer: Humana Medicare	$1.70
Rate for Payer: Kaiser Permanente Commercial	$3.06
Rate for Payer: Kaiser Permanente Medicaid	$1.73
Rate for Payer: Kaiser Permanente Medicare	$1.70
Rate for Payer: MDX Hawaii PPO	$3.30
Rate for Payer: Ohana Health Plan Medicaid	$1.70
Rate for Payer: Ohana Health Plan Medicare	$1.70
Rate for Payer: UnitedHealthcare Medicaid	$2.04
Rate for Payer: UnitedHealthcare Medicare	$1.70
Rate for Payer: University Health Alliance Commercial	$2.48

potassium chlor ER 10 mEq tablet [HHSC]

Facility

OP

$3.14

Service Code	NDC 68001051800
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$3.05
Rate for Payer: AlohaCare Medicaid	$1.57
Rate for Payer: AlohaCare Medicare	$1.57
Rate for Payer: Cash Price	$2.04
Rate for Payer: Devoted Health Medicare	$1.73
Rate for Payer: Hawaii Medical Service Association Medicare	$1.57
Rate for Payer: Hawaii Western Management Group Commercial	$2.98
Rate for Payer: Health Management Network Commercial	$2.67
Rate for Payer: Humana Medicare	$1.57
Rate for Payer: Kaiser Permanente Commercial	$2.83
Rate for Payer: Kaiser Permanente Medicaid	$1.60
Rate for Payer: Kaiser Permanente Medicare	$1.57
Rate for Payer: MDX Hawaii PPO	$3.05
Rate for Payer: Ohana Health Plan Medicaid	$1.57
Rate for Payer: Ohana Health Plan Medicare	$1.57
Rate for Payer: UnitedHealthcare Medicaid	$1.88
Rate for Payer: UnitedHealthcare Medicare	$1.57
Rate for Payer: University Health Alliance Commercial	$2.29

Potassium FSI

Facility

IP

$225.00

Service Code	HCPCS 84132
Hospital Charge Code	8118016
Hospital Revenue Code	301
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

Potassium FSI

Facility

OP

$225.00

Service Code	HCPCS 84132
Hospital Charge Code	8118016
Hospital Revenue Code	301
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$112.50
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Devoted Health Medicare	$123.75
Rate for Payer: Hawaii Medical Service Association ABD	$6.35
Rate for Payer: Hawaii Medical Service Association Commercial	$5.95
Rate for Payer: Hawaii Medical Service Association Medicare	$112.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.67
Rate for Payer: Hawaii Western Management Group Commercial	$4.76
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$112.50
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$112.50
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$112.50
Rate for Payer: Ohana Health Plan Medicare	$112.50
Rate for Payer: UnitedHealthcare Medicaid	$6.35
Rate for Payer: UnitedHealthcare Medicare	$112.50
Rate for Payer: University Health Alliance Commercial	$11.88

Potassium iSTAT

Facility

OP

$220.00

Service Code	HCPCS 84132 QW
Hospital Charge Code	8293267
Hospital Revenue Code	301
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$213.40
Rate for Payer: AlohaCare Medicaid	$110.00
Rate for Payer: AlohaCare Medicare	$110.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Devoted Health Medicare	$121.00
Rate for Payer: Hawaii Medical Service Association ABD	$6.35
Rate for Payer: Hawaii Medical Service Association Commercial	$5.95
Rate for Payer: Hawaii Medical Service Association Medicare	$110.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.67
Rate for Payer: Hawaii Western Management Group Commercial	$4.76
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Humana Medicare	$110.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: Kaiser Permanente Medicaid	$112.20
Rate for Payer: Kaiser Permanente Medicare	$110.00
Rate for Payer: MDX Hawaii PPO	$213.40
Rate for Payer: Ohana Health Plan Medicaid	$110.00
Rate for Payer: Ohana Health Plan Medicare	$110.00
Rate for Payer: UnitedHealthcare Medicaid	$6.35
Rate for Payer: UnitedHealthcare Medicare	$110.00
Rate for Payer: University Health Alliance Commercial	$11.88

Potassium iSTAT

Facility

IP

$220.00

Service Code	HCPCS 84132 QW
Hospital Charge Code	8293267
Hospital Revenue Code	301
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$143.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: MDX Hawaii PPO	$213.40

Potassium Urine Random FSI

Facility

OP

$53.00

Service Code	HCPCS 84133
Hospital Charge Code	8228910
Hospital Revenue Code	301
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$51.41
Rate for Payer: AlohaCare Medicaid	$26.50
Rate for Payer: AlohaCare Medicare	$26.50
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Devoted Health Medicare	$29.15
Rate for Payer: Hawaii Medical Service Association ABD	$5.94
Rate for Payer: Hawaii Medical Service Association Commercial	$5.91
Rate for Payer: Hawaii Medical Service Association Medicare	$26.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.24
Rate for Payer: Hawaii Western Management Group Commercial	$4.73
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Humana Medicare	$26.50
Rate for Payer: Kaiser Permanente Commercial	$47.70
Rate for Payer: Kaiser Permanente Medicaid	$27.03
Rate for Payer: Kaiser Permanente Medicare	$26.50
Rate for Payer: MDX Hawaii PPO	$51.41
Rate for Payer: Ohana Health Plan Medicaid	$26.50
Rate for Payer: Ohana Health Plan Medicare	$26.50
Rate for Payer: UnitedHealthcare Medicaid	$5.94
Rate for Payer: UnitedHealthcare Medicare	$26.50
Rate for Payer: University Health Alliance Commercial	$11.12

Potassium Urine Random FSI

Facility

IP

$53.00

Service Code	HCPCS 84133
Hospital Charge Code	8228910
Hospital Revenue Code	301
Min. Negotiated Rate	$45.05
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$34.45
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Kaiser Permanente Commercial	$47.70
Rate for Payer: MDX Hawaii PPO	$51.41

Potassium Urine Timed FSI

Facility

OP

$53.00

Service Code	HCPCS 84133
Hospital Charge Code	8228911
Hospital Revenue Code	301
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$51.41
Rate for Payer: AlohaCare Medicaid	$26.50
Rate for Payer: AlohaCare Medicare	$26.50
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Devoted Health Medicare	$29.15
Rate for Payer: Hawaii Medical Service Association ABD	$5.94
Rate for Payer: Hawaii Medical Service Association Commercial	$5.91
Rate for Payer: Hawaii Medical Service Association Medicare	$26.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.24
Rate for Payer: Hawaii Western Management Group Commercial	$4.73
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Humana Medicare	$26.50
Rate for Payer: Kaiser Permanente Commercial	$47.70
Rate for Payer: Kaiser Permanente Medicaid	$27.03
Rate for Payer: Kaiser Permanente Medicare	$26.50
Rate for Payer: MDX Hawaii PPO	$51.41
Rate for Payer: Ohana Health Plan Medicaid	$26.50
Rate for Payer: Ohana Health Plan Medicare	$26.50
Rate for Payer: UnitedHealthcare Medicaid	$5.94
Rate for Payer: UnitedHealthcare Medicare	$26.50
Rate for Payer: University Health Alliance Commercial	$11.12

Potassium Urine Timed FSI

Facility

IP

$53.00

Service Code	HCPCS 84133
Hospital Charge Code	8228911
Hospital Revenue Code	301
Min. Negotiated Rate	$45.05
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$34.45
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Kaiser Permanente Commercial	$47.70
Rate for Payer: MDX Hawaii PPO	$51.41

Potassium (Venous) POCT

Facility

IP

$225.00

Service Code	HCPCS 84132
Hospital Charge Code	9364729
Hospital Revenue Code	301
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

Potassium (Venous) POCT

Facility

OP

$225.00

Service Code	HCPCS 84132
Hospital Charge Code	9364729
Hospital Revenue Code	301
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$112.50
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Devoted Health Medicare	$123.75
Rate for Payer: Hawaii Medical Service Association ABD	$6.35
Rate for Payer: Hawaii Medical Service Association Commercial	$5.95
Rate for Payer: Hawaii Medical Service Association Medicare	$112.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.67
Rate for Payer: Hawaii Western Management Group Commercial	$4.76
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$112.50
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$112.50
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$112.50
Rate for Payer: Ohana Health Plan Medicare	$112.50
Rate for Payer: UnitedHealthcare Medicaid	$6.35
Rate for Payer: UnitedHealthcare Medicare	$112.50
Rate for Payer: University Health Alliance Commercial	$11.88

PP acetaminoph 120 mg supp #4 [HHSC]

Facility

OP

$12.95

Service Code	HCPCS A9150
Hospital Charge Code	2530909
Hospital Revenue Code	253
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$12.56
Rate for Payer: AlohaCare Medicaid	$6.47
Rate for Payer: AlohaCare Medicare	$6.47
Rate for Payer: Cash Price	$8.42
Rate for Payer: Devoted Health Medicare	$7.12
Rate for Payer: Hawaii Medical Service Association Medicare	$6.47
Rate for Payer: Hawaii Western Management Group Commercial	$12.30
Rate for Payer: Health Management Network Commercial	$11.01
Rate for Payer: Humana Medicare	$6.47
Rate for Payer: Kaiser Permanente Commercial	$11.65
Rate for Payer: Kaiser Permanente Medicaid	$6.60
Rate for Payer: Kaiser Permanente Medicare	$6.47
Rate for Payer: MDX Hawaii PPO	$12.56
Rate for Payer: Ohana Health Plan Medicaid	$6.47
Rate for Payer: Ohana Health Plan Medicare	$6.47
Rate for Payer: UnitedHealthcare Medicare	$6.47
Rate for Payer: University Health Alliance Commercial	$7.25

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