Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

BISACODYL 5 MG TABLET,DELAYED RELEASE [1079]

Facility

OP

$1.00

Service Code	NDC 00904640761
Hospital Revenue Code	637
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.63
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: University Health Alliance Commercial	$0.73

BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION [1090]

Facility

IP

$14.00

Service Code	NDC 00536128636
Hospital Revenue Code	250
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$8.40
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: MDX Hawaii PPO	$13.58

BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION [1090]

Facility

OP

$14.00

Service Code	NDC 00536128636
Hospital Revenue Code	637
Min. Negotiated Rate	$7.14
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$8.40
Rate for Payer: Hawaii Western Management Group Commercial	$13.30
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Kaiser Permanente Commercial	$8.82
Rate for Payer: Kaiser Permanente Medicaid	$7.14
Rate for Payer: MDX Hawaii PPO	$13.58
Rate for Payer: University Health Alliance Commercial	$10.20

BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET [9284]

Facility

OP

$1.00

Service Code	NDC 00904720546
Hospital Revenue Code	637
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.63
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: University Health Alliance Commercial	$0.73

BISMUTH SUBSALICYLATE 262 MG CHEWABLE TABLET [9284]

Facility

IP

$1.00

Service Code	NDC 00904720546
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: MDX Hawaii PPO	$0.97

BISOPROLOL FUMARATE 5 MG TABLET [18288]

Facility

IP

$6.00

Service Code	NDC 60687067911
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: MDX Hawaii PPO	$5.82

BISOPROLOL FUMARATE 5 MG TABLET [18288]

Facility

OP

$6.00

Service Code	NDC 60687067911
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$3.78
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: University Health Alliance Commercial	$4.37

BISOPROLOL FUMARATE 5 MG TABLET [18288]

Facility

OP

$6.00

Service Code	NDC 60687067921
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$3.78
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: University Health Alliance Commercial	$4.37

BISOPROLOL FUMARATE 5 MG TABLET [18288]

Facility

OP

$5.00

Service Code	NDC 29300012613
Hospital Revenue Code	637
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$3.15
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: University Health Alliance Commercial	$3.64

BISOPROLOL FUMARATE 5 MG TABLET [18288]

Facility

IP

$5.00

Service Code	NDC 29300012613
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: MDX Hawaii PPO	$4.85

BISOPROLOL FUMARATE 5 MG TABLET [18288]

Facility

IP

$6.00

Service Code	NDC 60687067921
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: MDX Hawaii PPO	$5.82

BIVALIRUDIN 250 MG/5ML IV (WET SOLR VIAL) [430160216]

Facility

OP

$1,638.00

Service Code	HCPCS J0583
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$1,588.86
Rate for Payer: Cash Price	$982.80
Rate for Payer: Cash Price	$982.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Western Management Group Commercial	$1,556.10
Rate for Payer: Hawaii Western Management Group Commercial	$159.60
Rate for Payer: Health Management Network Commercial	$142.80
Rate for Payer: Health Management Network Commercial	$1,392.30
Rate for Payer: Kaiser Permanente Commercial	$105.84
Rate for Payer: Kaiser Permanente Commercial	$1,031.94
Rate for Payer: Kaiser Permanente Medicaid	$835.38
Rate for Payer: Kaiser Permanente Medicaid	$85.68
Rate for Payer: MDX Hawaii PPO	$162.96
Rate for Payer: MDX Hawaii PPO	$1,588.86
Rate for Payer: UnitedHealthcare Medicaid	$982.80
Rate for Payer: UnitedHealthcare Medicaid	$100.80
Rate for Payer: University Health Alliance Commercial	$122.46
Rate for Payer: University Health Alliance Commercial	$1,193.94

BIVALIRUDIN 250 MG/5ML IV (WET SOLR VIAL) [430160216]

Facility

IP

$168.00

Service Code	HCPCS J0583
Hospital Revenue Code	250
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$162.96
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$982.80
Rate for Payer: Health Management Network Commercial	$1,392.30
Rate for Payer: Health Management Network Commercial	$142.80
Rate for Payer: MDX Hawaii PPO	$1,588.86
Rate for Payer: MDX Hawaii PPO	$162.96

BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION [160216]

Facility

IP

$1,638.00

Service Code	HCPCS J0583
Hospital Revenue Code	250
Min. Negotiated Rate	$1,392.30
Max. Negotiated Rate	$1,588.86
Rate for Payer: Cash Price	$982.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Health Management Network Commercial	$1,392.30
Rate for Payer: Health Management Network Commercial	$142.80
Rate for Payer: MDX Hawaii PPO	$1,588.86
Rate for Payer: MDX Hawaii PPO	$162.96

BIVALIRUDIN 250 MG INTRAVENOUS POWDER FOR SOLUTION [160216]

Facility

OP

$168.00

Service Code	HCPCS J0583
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$162.96
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$982.80
Rate for Payer: Cash Price	$982.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Western Management Group Commercial	$1,556.10
Rate for Payer: Hawaii Western Management Group Commercial	$159.60
Rate for Payer: Health Management Network Commercial	$142.80
Rate for Payer: Health Management Network Commercial	$1,392.30
Rate for Payer: Kaiser Permanente Commercial	$105.84
Rate for Payer: Kaiser Permanente Commercial	$1,031.94
Rate for Payer: Kaiser Permanente Medicaid	$835.38
Rate for Payer: Kaiser Permanente Medicaid	$85.68
Rate for Payer: MDX Hawaii PPO	$1,588.86
Rate for Payer: MDX Hawaii PPO	$162.96
Rate for Payer: UnitedHealthcare Medicaid	$100.80
Rate for Payer: UnitedHealthcare Medicaid	$982.80
Rate for Payer: University Health Alliance Commercial	$122.46
Rate for Payer: University Health Alliance Commercial	$1,193.94

BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT (INCLUDING RETENTION TIME)

Facility

OP

$2,837.00

Service Code	CPT 51720
Hospital Revenue Code	360
Min. Negotiated Rate	$68.68
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$823.75
Rate for Payer: AlohaCare Medicare	$823.75
Rate for Payer: Devoted Health Medicare	$906.12
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$823.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Humana Medicare	$823.75
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$823.75
Rate for Payer: Ohana Health Plan Medicaid	$906.12
Rate for Payer: Ohana Health Plan Medicare	$823.75
Rate for Payer: UnitedHealthcare Medicaid	$68.68
Rate for Payer: UnitedHealthcare Medicare	$823.75

BLADDER IRRIGATION, SIMPLE, LAVAGE AND/OR INSTILLATION

Facility

OP

$2,837.00

Service Code	CPT 51700
Hospital Revenue Code	360
Min. Negotiated Rate	$30.96
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$295.16
Rate for Payer: AlohaCare Medicare	$295.16
Rate for Payer: Devoted Health Medicare	$324.68
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$295.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Humana Medicare	$295.16
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$295.16
Rate for Payer: Ohana Health Plan Medicaid	$324.68
Rate for Payer: Ohana Health Plan Medicare	$295.16
Rate for Payer: UnitedHealthcare Medicaid	$30.96
Rate for Payer: UnitedHealthcare Medicare	$295.16

BLADE 100MM HELICL 04.038.400S

Facility

IP

$2,664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,491.84
Max. Negotiated Rate	$2,584.08
Rate for Payer: Cash Price	$1,598.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,864.80
Rate for Payer: Health Management Network Commercial	$2,264.40
Rate for Payer: MDX Hawaii PPO	$2,584.08
Rate for Payer: University Health Alliance Commercial	$1,491.84

BLADE 100MM HELICL 04.038.400S

Facility

OP

$2,664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,358.64
Max. Negotiated Rate	$2,584.08
Rate for Payer: Cash Price	$1,598.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,864.80
Rate for Payer: Health Management Network Commercial	$2,264.40
Rate for Payer: Kaiser Permanente Commercial	$1,678.32
Rate for Payer: Kaiser Permanente Medicaid	$1,358.64
Rate for Payer: MDX Hawaii PPO	$2,584.08
Rate for Payer: University Health Alliance Commercial	$1,491.84

BLADE 105MM HELICL 04.038.405S

Facility

OP

$2,664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,358.64
Max. Negotiated Rate	$2,584.08
Rate for Payer: Cash Price	$1,598.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,864.80
Rate for Payer: Health Management Network Commercial	$2,264.40
Rate for Payer: Kaiser Permanente Commercial	$1,678.32
Rate for Payer: Kaiser Permanente Medicaid	$1,358.64
Rate for Payer: MDX Hawaii PPO	$2,584.08
Rate for Payer: University Health Alliance Commercial	$1,491.84

BLADE 105MM HELICL 04.038.405S

Facility

IP

$2,664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,491.84
Max. Negotiated Rate	$2,584.08
Rate for Payer: Cash Price	$1,598.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,864.80
Rate for Payer: Health Management Network Commercial	$2,264.40
Rate for Payer: MDX Hawaii PPO	$2,584.08
Rate for Payer: University Health Alliance Commercial	$1,491.84

BLADE 110MM HELICL 04.038.410S

Facility

IP

$2,664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,491.84
Max. Negotiated Rate	$2,584.08
Rate for Payer: Cash Price	$1,598.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,864.80
Rate for Payer: Health Management Network Commercial	$2,264.40
Rate for Payer: MDX Hawaii PPO	$2,584.08
Rate for Payer: University Health Alliance Commercial	$1,491.84

BLADE 110MM HELICL 04.038.410S

Facility

OP

$2,664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,358.64
Max. Negotiated Rate	$2,584.08
Rate for Payer: Cash Price	$1,598.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,864.80
Rate for Payer: Health Management Network Commercial	$2,264.40
Rate for Payer: Kaiser Permanente Commercial	$1,678.32
Rate for Payer: Kaiser Permanente Medicaid	$1,358.64
Rate for Payer: MDX Hawaii PPO	$2,584.08
Rate for Payer: University Health Alliance Commercial	$1,491.84

BLADE 11.0M TI HELICAL 85MM

Facility

IP

$2,182.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,221.92
Max. Negotiated Rate	$2,116.54
Rate for Payer: Cash Price	$1,309.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,527.40
Rate for Payer: Health Management Network Commercial	$1,854.70
Rate for Payer: MDX Hawaii PPO	$2,116.54
Rate for Payer: University Health Alliance Commercial	$1,221.92

BLADE 11.0M TI HELICAL 85MM

Facility

OP

$2,182.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,112.82
Max. Negotiated Rate	$2,116.54
Rate for Payer: Cash Price	$1,309.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,527.40
Rate for Payer: Health Management Network Commercial	$1,854.70
Rate for Payer: Kaiser Permanente Commercial	$1,374.66
Rate for Payer: Kaiser Permanente Medicaid	$1,112.82
Rate for Payer: MDX Hawaii PPO	$2,116.54
Rate for Payer: University Health Alliance Commercial	$1,221.92

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