Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]

Facility

IP

$7.00

Service Code	NDC 31722006701
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: MDX Hawaii PPO	$6.79

BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]

Facility

OP

$7.00

Service Code	NDC 00591354105
Hospital Revenue Code	637
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$4.41
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: University Health Alliance Commercial	$5.10

BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]

Facility

OP

$7.00

Service Code	NDC 31722006701
Hospital Revenue Code	637
Min. Negotiated Rate	$3.57
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$4.41
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: University Health Alliance Commercial	$5.10

BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]

Facility

IP

$3.00

Service Code	NDC 68084070895
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: MDX Hawaii PPO	$2.91

BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]

Facility

IP

$3.00

Service Code	NDC 68084070825
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: MDX Hawaii PPO	$2.91

BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]

Facility

IP

$7.00

Service Code	NDC 00591354105
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: MDX Hawaii PPO	$6.79

BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]

Facility

OP

$3.00

Service Code	NDC 68084070825
Hospital Revenue Code	637
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$1.89
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: University Health Alliance Commercial	$2.19

BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE [18386]

Facility

OP

$3.00

Service Code	NDC 68084070895
Hospital Revenue Code	637
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$1.89
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: University Health Alliance Commercial	$2.19

BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE [36775]

Facility

OP

$6.00

Service Code	NDC 00904708404
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

BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE [36775]

Facility

OP

$24.00

Service Code	NDC 50268014013
Hospital Revenue Code	637
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$14.40
Rate for Payer: Hawaii Western Management Group Commercial	$22.80
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Kaiser Permanente Commercial	$15.12
Rate for Payer: Kaiser Permanente Medicaid	$12.24
Rate for Payer: MDX Hawaii PPO	$23.28
Rate for Payer: University Health Alliance Commercial	$17.49

BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE [36775]

Facility

IP

$8.00

Service Code	NDC 60687078211
Hospital Revenue Code	250
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: MDX Hawaii PPO	$7.76

BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE [36775]

Facility

IP

$24.00

Service Code	NDC 50268014013
Hospital Revenue Code	250
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: MDX Hawaii PPO	$23.28

BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE [36775]

Facility

IP

$6.00

Service Code	NDC 00904708404
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

BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE [36775]

Facility

OP

$8.00

Service Code	NDC 60687078211
Hospital Revenue Code	637
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$5.04
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: University Health Alliance Commercial	$5.83

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE [36776]

Facility

IP

$11.00

Service Code	NDC 60687079321
Hospital Revenue Code	250
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: MDX Hawaii PPO	$10.67

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE [36776]

Facility

OP

$17.00

Service Code	NDC 68084025221
Hospital Revenue Code	637
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$10.71
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: University Health Alliance Commercial	$12.39

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE [36776]

Facility

OP

$11.00

Service Code	NDC 60687079321
Hospital Revenue Code	637
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Hawaii Western Management Group Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Kaiser Permanente Commercial	$6.93
Rate for Payer: Kaiser Permanente Medicaid	$5.61
Rate for Payer: MDX Hawaii PPO	$10.67
Rate for Payer: University Health Alliance Commercial	$8.02

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE [36776]

Facility

IP

$17.00

Service Code	NDC 68084025221
Hospital Revenue Code	250
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: MDX Hawaii PPO	$16.49

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE [36776]

Facility

OP

$11.00

Service Code	NDC 60687079311
Hospital Revenue Code	637
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Hawaii Western Management Group Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Kaiser Permanente Commercial	$6.93
Rate for Payer: Kaiser Permanente Medicaid	$5.61
Rate for Payer: MDX Hawaii PPO	$10.67
Rate for Payer: University Health Alliance Commercial	$8.02

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE [36776]

Facility

IP

$11.00

Service Code	NDC 60687079311
Hospital Revenue Code	250
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: MDX Hawaii PPO	$10.67

BUR 2.0X54 ROUND 1608-006-087

Facility

IP

$375.00

Hospital Revenue Code	272
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$363.75
Rate for Payer: Cash Price	$225.00
Rate for Payer: Health Management Network Commercial	$318.75
Rate for Payer: MDX Hawaii PPO	$363.75

BUR 2.0X54 ROUND 1608-006-087

Facility

OP

$375.00

Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$363.75
Rate for Payer: Cash Price	$225.00
Rate for Payer: Hawaii Western Management Group Commercial	$356.25
Rate for Payer: Health Management Network Commercial	$318.75
Rate for Payer: Kaiser Permanente Commercial	$236.25
Rate for Payer: Kaiser Permanente Medicaid	$191.25
Rate for Payer: MDX Hawaii PPO	$363.75
Rate for Payer: University Health Alliance Commercial	$273.34

BUR 3.0MM ROUND 1608-006-091

Facility

IP

$356.00

Hospital Revenue Code	272
Min. Negotiated Rate	$302.60
Max. Negotiated Rate	$345.32
Rate for Payer: Cash Price	$213.60
Rate for Payer: Health Management Network Commercial	$302.60
Rate for Payer: MDX Hawaii PPO	$345.32

BUR 3.0MM ROUND 1608-006-091

Facility

OP

$356.00

Hospital Revenue Code	272
Min. Negotiated Rate	$181.56
Max. Negotiated Rate	$345.32
Rate for Payer: Cash Price	$213.60
Rate for Payer: Hawaii Western Management Group Commercial	$338.20
Rate for Payer: Health Management Network Commercial	$302.60
Rate for Payer: Kaiser Permanente Commercial	$224.28
Rate for Payer: Kaiser Permanente Medicaid	$181.56
Rate for Payer: MDX Hawaii PPO	$345.32
Rate for Payer: University Health Alliance Commercial	$259.49

BUR DIAMOND 4MM 15 DEG

Facility

IP

$998.00

Hospital Revenue Code	272
Min. Negotiated Rate	$848.30
Max. Negotiated Rate	$968.06
Rate for Payer: Cash Price	$598.80
Rate for Payer: Health Management Network Commercial	$848.30
Rate for Payer: MDX Hawaii PPO	$968.06

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