Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

BRITE TIP INTRODUCER 9X11

Facility

OP

$554.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$282.54
Max. Negotiated Rate	$537.38
Rate for Payer: Cash Price	$332.40
Rate for Payer: Hawaii Western Management Group Commercial	$526.30
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: Kaiser Permanente Commercial	$349.02
Rate for Payer: Kaiser Permanente Medicaid	$282.54
Rate for Payer: MDX Hawaii PPO	$537.38
Rate for Payer: University Health Alliance Commercial	$403.81

BRITE TIP INTRODUCER 9X11

Facility

IP

$554.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$470.90
Max. Negotiated Rate	$537.38
Rate for Payer: Cash Price	$332.40
Rate for Payer: Health Management Network Commercial	$470.90
Rate for Payer: MDX Hawaii PPO	$537.38

BRITE TIP INTRODUCER 9X23

Facility

OP

$150.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Hawaii Western Management Group Commercial	$142.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: University Health Alliance Commercial	$109.33

BRITE TIP INTRODUCER 9X23

Facility

IP

$150.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: MDX Hawaii PPO	$145.50

BRIVARACETAM 50 MG/5 ML INTRAVENOUS SOLUTION [131987]

Facility

IP

$152.00

Service Code	NDC 50474097063
Hospital Revenue Code	250
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: MDX Hawaii PPO	$147.44

BRIVARACETAM 50 MG/5 ML INTRAVENOUS SOLUTION [131987]

Facility

IP

$152.00

Service Code	NDC 50474097075
Hospital Revenue Code	250
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: MDX Hawaii PPO	$147.44

BRIVARACETAM 50 MG TABLET [131983]

Facility

OP

$74.00

Service Code	NDC 50474057066
Hospital Revenue Code	637
Min. Negotiated Rate	$37.74
Max. Negotiated Rate	$71.78
Rate for Payer: Cash Price	$44.40
Rate for Payer: Hawaii Western Management Group Commercial	$70.30
Rate for Payer: Health Management Network Commercial	$62.90
Rate for Payer: Kaiser Permanente Commercial	$46.62
Rate for Payer: Kaiser Permanente Medicaid	$37.74
Rate for Payer: MDX Hawaii PPO	$71.78
Rate for Payer: University Health Alliance Commercial	$53.94

BRIVARACETAM 50 MG TABLET [131983]

Facility

IP

$74.00

Service Code	NDC 50474057066
Hospital Revenue Code	250
Min. Negotiated Rate	$62.90
Max. Negotiated Rate	$71.78
Rate for Payer: Cash Price	$44.40
Rate for Payer: Health Management Network Commercial	$62.90
Rate for Payer: MDX Hawaii PPO	$71.78

BROMOCRIPTINE 2.5 MG TABLET [9297]

Facility

IP

$15.00

Service Code	NDC 00574010603
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: MDX Hawaii PPO	$14.55

BROMOCRIPTINE 2.5 MG TABLET [9297]

Facility

OP

$15.00

Service Code	NDC 70954097810
Hospital Revenue Code	637
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: University Health Alliance Commercial	$10.93

BROMOCRIPTINE 2.5 MG TABLET [9297]

Facility

OP

$19.00

Service Code	NDC 00781532531
Hospital Revenue Code	637
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$11.40
Rate for Payer: Hawaii Western Management Group Commercial	$18.05
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Kaiser Permanente Commercial	$11.97
Rate for Payer: Kaiser Permanente Medicaid	$9.69
Rate for Payer: MDX Hawaii PPO	$18.43
Rate for Payer: University Health Alliance Commercial	$13.85

BROMOCRIPTINE 2.5 MG TABLET [9297]

Facility

IP

$19.00

Service Code	NDC 00781532531
Hospital Revenue Code	250
Min. Negotiated Rate	$16.15
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$11.40
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: MDX Hawaii PPO	$18.43

BROMOCRIPTINE 2.5 MG TABLET [9297]

Facility

IP

$15.00

Service Code	NDC 70954097810
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: MDX Hawaii PPO	$14.55

BROMOCRIPTINE 2.5 MG TABLET [9297]

Facility

OP

$15.00

Service Code	NDC 00574010603
Hospital Revenue Code	637
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: University Health Alliance Commercial	$10.93

BRONCHIOLITIS & RSV PNEUMONIA

Facility

IP

$2,593.45

Service Code	APR-DRG 1382
Min. Negotiated Rate	$2,593.45
Max. Negotiated Rate	$2,593.45
Rate for Payer: AlohaCare Medicaid	$2,593.45
Rate for Payer: Hawaii Medical Service Association ABD	$2,593.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,593.45
Rate for Payer: Kaiser Permanente Medicaid	$2,593.45
Rate for Payer: Ohana Health Plan Medicaid	$2,593.45
Rate for Payer: UnitedHealthcare Medicaid	$2,593.45

BRONCHIOLITIS & RSV PNEUMONIA

Facility

IP

$4,444.62

Service Code	APR-DRG 1383
Min. Negotiated Rate	$4,444.62
Max. Negotiated Rate	$4,444.62
Rate for Payer: AlohaCare Medicaid	$4,444.62
Rate for Payer: Hawaii Medical Service Association ABD	$4,444.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,444.62
Rate for Payer: Kaiser Permanente Medicaid	$4,444.62
Rate for Payer: Ohana Health Plan Medicaid	$4,444.62
Rate for Payer: UnitedHealthcare Medicaid	$4,444.62

BRONCHIOLITIS & RSV PNEUMONIA

Facility

IP

$9,276.68

Service Code	APR-DRG 1384
Min. Negotiated Rate	$9,276.68
Max. Negotiated Rate	$9,276.68
Rate for Payer: AlohaCare Medicaid	$9,276.68
Rate for Payer: Hawaii Medical Service Association ABD	$9,276.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,276.68
Rate for Payer: Kaiser Permanente Medicaid	$9,276.68
Rate for Payer: Ohana Health Plan Medicaid	$9,276.68
Rate for Payer: UnitedHealthcare Medicaid	$9,276.68

BRONCHIOLITIS & RSV PNEUMONIA

Facility

IP

$1,846.60

Service Code	APR-DRG 1381
Min. Negotiated Rate	$1,846.60
Max. Negotiated Rate	$1,846.60
Rate for Payer: AlohaCare Medicaid	$1,846.60
Rate for Payer: Hawaii Medical Service Association ABD	$1,846.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,846.60
Rate for Payer: Kaiser Permanente Medicaid	$1,846.60
Rate for Payer: Ohana Health Plan Medicaid	$1,846.60
Rate for Payer: UnitedHealthcare Medicaid	$1,846.60

BRONCHITIS AND ASTHMA WITH CC/MCC

Facility

IP

$18,223.77

Service Code	MSDRG 202
Min. Negotiated Rate	$11,046.69
Max. Negotiated Rate	$18,223.77
Rate for Payer: AlohaCare Medicare	$11,046.69
Rate for Payer: Devoted Health Medicare	$12,151.36
Rate for Payer: Hawaii Medical Service Association Commercial	$18,223.77
Rate for Payer: Hawaii Medical Service Association Medicare	$11,046.69
Rate for Payer: Humana Medicare	$11,046.69
Rate for Payer: Kaiser Permanente Commercial	$16,753.20
Rate for Payer: Kaiser Permanente Medicare	$11,046.69
Rate for Payer: Ohana Health Plan Medicare	$11,046.69
Rate for Payer: UnitedHealthcare Medicare	$11,046.69

BRONCHITIS AND ASTHMA WITHOUT CC/MCC

Facility

IP

$13,855.89

Service Code	MSDRG 203
Min. Negotiated Rate	$7,620.76
Max. Negotiated Rate	$13,855.89
Rate for Payer: AlohaCare Medicare	$7,620.76
Rate for Payer: Devoted Health Medicare	$8,382.84
Rate for Payer: Hawaii Medical Service Association Commercial	$13,855.89
Rate for Payer: Hawaii Medical Service Association Medicare	$7,620.76
Rate for Payer: Humana Medicare	$7,620.76
Rate for Payer: Kaiser Permanente Commercial	$11,557.50
Rate for Payer: Kaiser Permanente Medicare	$7,620.76
Rate for Payer: Ohana Health Plan Medicare	$7,620.76
Rate for Payer: UnitedHealthcare Medicare	$7,620.76

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL ALVEOLAR LAVAGE

Facility

OP

$5,509.00

Service Code	CPT 31624
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$2,102.67
Rate for Payer: AlohaCare Medicare	$2,102.67
Rate for Payer: Devoted Health Medicare	$2,312.94
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,102.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Humana Medicare	$2,102.67
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,102.67
Rate for Payer: Ohana Health Plan Medicaid	$2,312.94
Rate for Payer: Ohana Health Plan Medicare	$2,102.67
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,102.67
Rate for Payer: University Health Alliance Commercial	$5,160.40

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL OR ENDOBRONCHIAL BIOPSY(S), SINGLE OR MULTIPLE SITES

Facility

OP

$5,509.00

Service Code	CPT 31625
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$2,102.67
Rate for Payer: AlohaCare Medicare	$2,102.67
Rate for Payer: Devoted Health Medicare	$2,312.94
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,102.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Humana Medicare	$2,102.67
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,102.67
Rate for Payer: Ohana Health Plan Medicaid	$2,312.94
Rate for Payer: Ohana Health Plan Medicare	$2,102.67
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,102.67
Rate for Payer: University Health Alliance Commercial	$5,160.40

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRUSHING OR PROTECTED BRUSHINGS

Facility

OP

$5,509.00

Service Code	CPT 31623
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$2,102.67
Rate for Payer: AlohaCare Medicare	$2,102.67
Rate for Payer: Devoted Health Medicare	$2,312.94
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,102.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Humana Medicare	$2,102.67
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,102.67
Rate for Payer: Ohana Health Plan Medicaid	$2,312.94
Rate for Payer: Ohana Health Plan Medicare	$2,102.67
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,102.67
Rate for Payer: University Health Alliance Commercial	$5,160.40

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH THERAPEUTIC ASPIRATION OF TRACHEOBRONCHIAL TREE, INITIAL

Facility

OP

$5,509.00

Service Code	CPT 31645
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,509.00
Rate for Payer: AlohaCare Medicaid	$2,102.67
Rate for Payer: AlohaCare Medicare	$2,102.67
Rate for Payer: Devoted Health Medicare	$2,312.94
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,509.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,102.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,028.67
Rate for Payer: Humana Medicare	$2,102.67
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,102.67
Rate for Payer: Ohana Health Plan Medicaid	$2,312.94
Rate for Payer: Ohana Health Plan Medicare	$2,102.67
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,102.67
Rate for Payer: University Health Alliance Commercial	$4,035.20

BRUSH CYSTOLOGY ENDO

Facility

OP

$93.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$47.43
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$55.80
Rate for Payer: Hawaii Western Management Group Commercial	$88.35
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Kaiser Permanente Commercial	$58.59
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: University Health Alliance Commercial	$67.79

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