Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

budesonide 0.5 mg/2 mL neb susp [HHSC]

Facility

IP

$64.97

Service Code	HCPCS J7626
Hospital Charge Code	2500117
Hospital Revenue Code	250
Min. Negotiated Rate	$55.22
Max. Negotiated Rate	$63.02
Rate for Payer: Cash Price	$42.23
Rate for Payer: Cash Price	$42.13
Rate for Payer: Cash Price	$41.90
Rate for Payer: Health Management Network Commercial	$54.79
Rate for Payer: Health Management Network Commercial	$55.22
Rate for Payer: Health Management Network Commercial	$55.10
Rate for Payer: Kaiser Permanente Commercial	$58.34
Rate for Payer: Kaiser Permanente Commercial	$58.47
Rate for Payer: Kaiser Permanente Commercial	$58.01
Rate for Payer: MDX Hawaii PPO	$62.88
Rate for Payer: MDX Hawaii PPO	$62.53
Rate for Payer: MDX Hawaii PPO	$63.02

BUGBEE ELECTRODE 5 FR 58CM L DISPOSABLE STERILE

Facility

OP

$340.00

Hospital Charge Code	9816284
Hospital Revenue Code	272
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$329.80
Rate for Payer: AlohaCare Medicaid	$170.00
Rate for Payer: AlohaCare Medicare	$170.00
Rate for Payer: Cash Price	$221.00
Rate for Payer: Devoted Health Medicare	$187.00
Rate for Payer: Hawaii Medical Service Association Medicare	$170.00
Rate for Payer: Hawaii Western Management Group Commercial	$323.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Humana Medicare	$170.00
Rate for Payer: Kaiser Permanente Commercial	$306.00
Rate for Payer: Kaiser Permanente Medicaid	$173.40
Rate for Payer: Kaiser Permanente Medicare	$170.00
Rate for Payer: MDX Hawaii PPO	$329.80
Rate for Payer: Ohana Health Plan Medicaid	$170.00
Rate for Payer: Ohana Health Plan Medicare	$170.00
Rate for Payer: UnitedHealthcare Medicare	$170.00
Rate for Payer: University Health Alliance Commercial	$247.83

BUGBEE ELECTRODE 5 FR 58CM L DISPOSABLE STERILE

Facility

IP

$340.00

Hospital Charge Code	9816284
Hospital Revenue Code	272
Min. Negotiated Rate	$289.00
Max. Negotiated Rate	$329.80
Rate for Payer: Cash Price	$221.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Kaiser Permanente Commercial	$306.00
Rate for Payer: MDX Hawaii PPO	$329.80

bumetanide 1 mg/4 mL vial [HHSC]

Facility

IP

$13.28

Service Code	NDC 00641628410
Hospital Charge Code	2501040
Hospital Revenue Code	250
Min. Negotiated Rate	$11.29
Max. Negotiated Rate	$12.88
Rate for Payer: Cash Price	$8.63
Rate for Payer: Health Management Network Commercial	$11.29
Rate for Payer: Kaiser Permanente Commercial	$11.95
Rate for Payer: MDX Hawaii PPO	$12.88

bumetanide 1 mg/4 mL vial [HHSC]

Facility

IP

$17.35

Service Code	NDC 72205010107
Hospital Charge Code	2501040
Hospital Revenue Code	250
Min. Negotiated Rate	$14.75
Max. Negotiated Rate	$16.83
Rate for Payer: Cash Price	$11.28
Rate for Payer: Health Management Network Commercial	$14.75
Rate for Payer: Kaiser Permanente Commercial	$15.62
Rate for Payer: MDX Hawaii PPO	$16.83

bumetanide 1 mg/4 mL vial [HHSC]

Facility

IP

$14.08

Service Code	NDC 00409141204
Hospital Charge Code	2501040
Hospital Revenue Code	250
Min. Negotiated Rate	$11.97
Max. Negotiated Rate	$13.66
Rate for Payer: Cash Price	$9.15
Rate for Payer: Health Management Network Commercial	$11.97
Rate for Payer: Kaiser Permanente Commercial	$12.67
Rate for Payer: MDX Hawaii PPO	$13.66

bumetanide 1 mg/4 mL vial [HHSC]

Facility

OP

$13.28

Service Code	NDC 00641628410
Hospital Charge Code	2501040
Hospital Revenue Code	250
Min. Negotiated Rate	$6.64
Max. Negotiated Rate	$12.88
Rate for Payer: AlohaCare Medicaid	$6.64
Rate for Payer: AlohaCare Medicare	$6.64
Rate for Payer: Cash Price	$8.63
Rate for Payer: Devoted Health Medicare	$7.30
Rate for Payer: Hawaii Medical Service Association Medicare	$6.64
Rate for Payer: Hawaii Western Management Group Commercial	$12.62
Rate for Payer: Health Management Network Commercial	$11.29
Rate for Payer: Humana Medicare	$6.64
Rate for Payer: Kaiser Permanente Commercial	$11.95
Rate for Payer: Kaiser Permanente Medicaid	$6.77
Rate for Payer: Kaiser Permanente Medicare	$6.64
Rate for Payer: MDX Hawaii PPO	$12.88
Rate for Payer: Ohana Health Plan Medicaid	$6.64
Rate for Payer: Ohana Health Plan Medicare	$6.64
Rate for Payer: UnitedHealthcare Medicaid	$7.97
Rate for Payer: UnitedHealthcare Medicare	$6.64
Rate for Payer: University Health Alliance Commercial	$9.68

bumetanide 1 mg/4 mL vial [HHSC]

Facility

IP

$14.08

Service Code	NDC 70860040504
Hospital Charge Code	2501040
Hospital Revenue Code	250
Min. Negotiated Rate	$11.97
Max. Negotiated Rate	$13.66
Rate for Payer: Cash Price	$9.15
Rate for Payer: Health Management Network Commercial	$11.97
Rate for Payer: Kaiser Permanente Commercial	$12.67
Rate for Payer: MDX Hawaii PPO	$13.66

bumetanide 1 mg/4 mL vial [HHSC]

Facility

OP

$17.35

Service Code	NDC 72205010107
Hospital Charge Code	2501040
Hospital Revenue Code	250
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$16.83
Rate for Payer: AlohaCare Medicaid	$8.68
Rate for Payer: AlohaCare Medicare	$8.68
Rate for Payer: Cash Price	$11.28
Rate for Payer: Devoted Health Medicare	$9.54
Rate for Payer: Hawaii Medical Service Association Medicare	$8.68
Rate for Payer: Hawaii Western Management Group Commercial	$16.48
Rate for Payer: Health Management Network Commercial	$14.75
Rate for Payer: Humana Medicare	$8.68
Rate for Payer: Kaiser Permanente Commercial	$15.62
Rate for Payer: Kaiser Permanente Medicaid	$8.85
Rate for Payer: Kaiser Permanente Medicare	$8.68
Rate for Payer: MDX Hawaii PPO	$16.83
Rate for Payer: Ohana Health Plan Medicaid	$8.68
Rate for Payer: Ohana Health Plan Medicare	$8.68
Rate for Payer: UnitedHealthcare Medicaid	$10.41
Rate for Payer: UnitedHealthcare Medicare	$8.68
Rate for Payer: University Health Alliance Commercial	$12.65

bumetanide 1 mg/4 mL vial [HHSC]

Facility

OP

$14.08

Service Code	NDC 00409141204
Hospital Charge Code	2501040
Hospital Revenue Code	250
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$13.66
Rate for Payer: AlohaCare Medicaid	$7.04
Rate for Payer: AlohaCare Medicare	$7.04
Rate for Payer: Cash Price	$9.15
Rate for Payer: Devoted Health Medicare	$7.74
Rate for Payer: Hawaii Medical Service Association Medicare	$7.04
Rate for Payer: Hawaii Western Management Group Commercial	$13.38
Rate for Payer: Health Management Network Commercial	$11.97
Rate for Payer: Humana Medicare	$7.04
Rate for Payer: Kaiser Permanente Commercial	$12.67
Rate for Payer: Kaiser Permanente Medicaid	$7.18
Rate for Payer: Kaiser Permanente Medicare	$7.04
Rate for Payer: MDX Hawaii PPO	$13.66
Rate for Payer: Ohana Health Plan Medicaid	$7.04
Rate for Payer: Ohana Health Plan Medicare	$7.04
Rate for Payer: UnitedHealthcare Medicaid	$8.45
Rate for Payer: UnitedHealthcare Medicare	$7.04
Rate for Payer: University Health Alliance Commercial	$10.26

bumetanide 1 mg/4 mL vial [HHSC]

Facility

IP

$20.15

Service Code	NDC 00641600810
Hospital Charge Code	2501040
Hospital Revenue Code	250
Min. Negotiated Rate	$17.13
Max. Negotiated Rate	$19.55
Rate for Payer: Cash Price	$13.10
Rate for Payer: Health Management Network Commercial	$17.13
Rate for Payer: Kaiser Permanente Commercial	$18.14
Rate for Payer: MDX Hawaii PPO	$19.55

bumetanide 1 mg/4 mL vial [HHSC]

Facility

OP

$20.15

Service Code	NDC 00641600810
Hospital Charge Code	2501040
Hospital Revenue Code	250
Min. Negotiated Rate	$10.07
Max. Negotiated Rate	$19.55
Rate for Payer: AlohaCare Medicaid	$10.07
Rate for Payer: AlohaCare Medicare	$10.07
Rate for Payer: Cash Price	$13.10
Rate for Payer: Devoted Health Medicare	$11.08
Rate for Payer: Hawaii Medical Service Association Medicare	$10.07
Rate for Payer: Hawaii Western Management Group Commercial	$19.14
Rate for Payer: Health Management Network Commercial	$17.13
Rate for Payer: Humana Medicare	$10.07
Rate for Payer: Kaiser Permanente Commercial	$18.14
Rate for Payer: Kaiser Permanente Medicaid	$10.28
Rate for Payer: Kaiser Permanente Medicare	$10.07
Rate for Payer: MDX Hawaii PPO	$19.55
Rate for Payer: Ohana Health Plan Medicaid	$10.07
Rate for Payer: Ohana Health Plan Medicare	$10.07
Rate for Payer: UnitedHealthcare Medicaid	$12.09
Rate for Payer: UnitedHealthcare Medicare	$10.07
Rate for Payer: University Health Alliance Commercial	$14.69

bumetanide 1 mg/4 mL vial [HHSC]

Facility

OP

$14.08

Service Code	NDC 70860040504
Hospital Charge Code	2501040
Hospital Revenue Code	250
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$13.66
Rate for Payer: AlohaCare Medicaid	$7.04
Rate for Payer: AlohaCare Medicare	$7.04
Rate for Payer: Cash Price	$9.15
Rate for Payer: Devoted Health Medicare	$7.74
Rate for Payer: Hawaii Medical Service Association Medicare	$7.04
Rate for Payer: Hawaii Western Management Group Commercial	$13.38
Rate for Payer: Health Management Network Commercial	$11.97
Rate for Payer: Humana Medicare	$7.04
Rate for Payer: Kaiser Permanente Commercial	$12.67
Rate for Payer: Kaiser Permanente Medicaid	$7.18
Rate for Payer: Kaiser Permanente Medicare	$7.04
Rate for Payer: MDX Hawaii PPO	$13.66
Rate for Payer: Ohana Health Plan Medicaid	$7.04
Rate for Payer: Ohana Health Plan Medicare	$7.04
Rate for Payer: UnitedHealthcare Medicaid	$8.45
Rate for Payer: UnitedHealthcare Medicare	$7.04
Rate for Payer: University Health Alliance Commercial	$10.26

BUN (Arterial) POCT

Facility

OP

$61.00

Service Code	HCPCS 84520
Hospital Charge Code	9364704
Hospital Revenue Code	301
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$59.17
Rate for Payer: AlohaCare Medicaid	$30.50
Rate for Payer: AlohaCare Medicare	$30.50
Rate for Payer: Cash Price	$39.65
Rate for Payer: Cash Price	$39.65
Rate for Payer: Devoted Health Medicare	$33.55
Rate for Payer: Hawaii Medical Service Association ABD	$5.45
Rate for Payer: Hawaii Medical Service Association Commercial	$4.94
Rate for Payer: Hawaii Medical Service Association Medicare	$30.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.72
Rate for Payer: Hawaii Western Management Group Commercial	$3.95
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Humana Medicare	$30.50
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: Kaiser Permanente Medicaid	$31.11
Rate for Payer: Kaiser Permanente Medicare	$30.50
Rate for Payer: MDX Hawaii PPO	$59.17
Rate for Payer: Ohana Health Plan Medicaid	$30.50
Rate for Payer: Ohana Health Plan Medicare	$30.50
Rate for Payer: UnitedHealthcare Medicaid	$5.45
Rate for Payer: UnitedHealthcare Medicare	$30.50
Rate for Payer: University Health Alliance Commercial	$10.19

BUN (Arterial) POCT

Facility

IP

$61.00

Service Code	HCPCS 84520
Hospital Charge Code	9364704
Hospital Revenue Code	301
Min. Negotiated Rate	$51.85
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$39.65
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: MDX Hawaii PPO	$59.17

BUN FSI

Facility

OP

$61.00

Service Code	HCPCS 84520
Hospital Charge Code	8117867
Hospital Revenue Code	301
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$59.17
Rate for Payer: AlohaCare Medicaid	$30.50
Rate for Payer: AlohaCare Medicare	$30.50
Rate for Payer: Cash Price	$39.65
Rate for Payer: Cash Price	$39.65
Rate for Payer: Devoted Health Medicare	$33.55
Rate for Payer: Hawaii Medical Service Association ABD	$5.45
Rate for Payer: Hawaii Medical Service Association Commercial	$4.94
Rate for Payer: Hawaii Medical Service Association Medicare	$30.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.72
Rate for Payer: Hawaii Western Management Group Commercial	$3.95
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Humana Medicare	$30.50
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: Kaiser Permanente Medicaid	$31.11
Rate for Payer: Kaiser Permanente Medicare	$30.50
Rate for Payer: MDX Hawaii PPO	$59.17
Rate for Payer: Ohana Health Plan Medicaid	$30.50
Rate for Payer: Ohana Health Plan Medicare	$30.50
Rate for Payer: UnitedHealthcare Medicaid	$5.45
Rate for Payer: UnitedHealthcare Medicare	$30.50
Rate for Payer: University Health Alliance Commercial	$10.19

BUN FSI

Facility

IP

$61.00

Service Code	HCPCS 84520
Hospital Charge Code	8117867
Hospital Revenue Code	301
Min. Negotiated Rate	$51.85
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$39.65
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: MDX Hawaii PPO	$59.17

BUN iSTAT

Facility

IP

$56.00

Service Code	HCPCS 84520 QW
Hospital Charge Code	1019789
Hospital Revenue Code	301
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$36.40
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Kaiser Permanente Commercial	$50.40
Rate for Payer: MDX Hawaii PPO	$54.32

BUN iSTAT

Facility

OP

$56.00

Service Code	HCPCS 84520 QW
Hospital Charge Code	1019789
Hospital Revenue Code	301
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$54.32
Rate for Payer: AlohaCare Medicaid	$28.00
Rate for Payer: AlohaCare Medicare	$28.00
Rate for Payer: Cash Price	$36.40
Rate for Payer: Cash Price	$36.40
Rate for Payer: Devoted Health Medicare	$30.80
Rate for Payer: Hawaii Medical Service Association ABD	$5.45
Rate for Payer: Hawaii Medical Service Association Commercial	$4.94
Rate for Payer: Hawaii Medical Service Association Medicare	$28.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.72
Rate for Payer: Hawaii Western Management Group Commercial	$3.95
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Humana Medicare	$28.00
Rate for Payer: Kaiser Permanente Commercial	$50.40
Rate for Payer: Kaiser Permanente Medicaid	$28.56
Rate for Payer: Kaiser Permanente Medicare	$28.00
Rate for Payer: MDX Hawaii PPO	$54.32
Rate for Payer: Ohana Health Plan Medicaid	$28.00
Rate for Payer: Ohana Health Plan Medicare	$28.00
Rate for Payer: UnitedHealthcare Medicaid	$5.45
Rate for Payer: UnitedHealthcare Medicare	$28.00
Rate for Payer: University Health Alliance Commercial	$10.19

BUN (Venous) POCT

Facility

OP

$61.00

Service Code	HCPCS 84520
Hospital Charge Code	9364733
Hospital Revenue Code	301
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$59.17
Rate for Payer: AlohaCare Medicaid	$30.50
Rate for Payer: AlohaCare Medicare	$30.50
Rate for Payer: Cash Price	$39.65
Rate for Payer: Cash Price	$39.65
Rate for Payer: Devoted Health Medicare	$33.55
Rate for Payer: Hawaii Medical Service Association ABD	$5.45
Rate for Payer: Hawaii Medical Service Association Commercial	$4.94
Rate for Payer: Hawaii Medical Service Association Medicare	$30.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.72
Rate for Payer: Hawaii Western Management Group Commercial	$3.95
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Humana Medicare	$30.50
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: Kaiser Permanente Medicaid	$31.11
Rate for Payer: Kaiser Permanente Medicare	$30.50
Rate for Payer: MDX Hawaii PPO	$59.17
Rate for Payer: Ohana Health Plan Medicaid	$30.50
Rate for Payer: Ohana Health Plan Medicare	$30.50
Rate for Payer: UnitedHealthcare Medicaid	$5.45
Rate for Payer: UnitedHealthcare Medicare	$30.50
Rate for Payer: University Health Alliance Commercial	$10.19

BUN (Venous) POCT

Facility

IP

$61.00

Service Code	HCPCS 84520
Hospital Charge Code	9364733
Hospital Revenue Code	301
Min. Negotiated Rate	$51.85
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$39.65
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: MDX Hawaii PPO	$59.17

Bupiv 0.75%/Lido 2%-Epi Cmpd [HHSC]

Facility

OP

$59.65

Service Code	NDC 99999999912
Hospital Charge Code	2500988
Hospital Revenue Code	250
Min. Negotiated Rate	$29.82
Max. Negotiated Rate	$57.86
Rate for Payer: AlohaCare Medicaid	$29.82
Rate for Payer: AlohaCare Medicare	$29.82
Rate for Payer: Cash Price	$38.77
Rate for Payer: Devoted Health Medicare	$32.81
Rate for Payer: Hawaii Medical Service Association Medicare	$29.82
Rate for Payer: Hawaii Western Management Group Commercial	$56.67
Rate for Payer: Health Management Network Commercial	$50.70
Rate for Payer: Humana Medicare	$29.82
Rate for Payer: Kaiser Permanente Commercial	$53.69
Rate for Payer: Kaiser Permanente Medicaid	$30.42
Rate for Payer: Kaiser Permanente Medicare	$29.82
Rate for Payer: MDX Hawaii PPO	$57.86
Rate for Payer: Ohana Health Plan Medicaid	$29.82
Rate for Payer: Ohana Health Plan Medicare	$29.82
Rate for Payer: UnitedHealthcare Medicaid	$35.79
Rate for Payer: UnitedHealthcare Medicare	$29.82
Rate for Payer: University Health Alliance Commercial	$43.48

Bupiv 0.75%/Lido 2%-Epi Cmpd [HHSC]

Facility

IP

$59.65

Service Code	NDC 99999999912
Hospital Charge Code	2500988
Hospital Revenue Code	250
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$57.86
Rate for Payer: Cash Price	$38.77
Rate for Payer: Health Management Network Commercial	$50.70
Rate for Payer: Kaiser Permanente Commercial	$53.69
Rate for Payer: MDX Hawaii PPO	$57.86

bupivac-0.25% EPI 1:200,000 (PF) vial 30ml [HHSC]

Facility

OP

$54.68

Service Code	NDC 63323046837
Hospital Charge Code	2500125
Hospital Revenue Code	250
Min. Negotiated Rate	$27.34
Max. Negotiated Rate	$53.04
Rate for Payer: AlohaCare Medicaid	$27.34
Rate for Payer: AlohaCare Medicare	$27.34
Rate for Payer: Cash Price	$35.54
Rate for Payer: Devoted Health Medicare	$30.07
Rate for Payer: Hawaii Medical Service Association Medicare	$27.34
Rate for Payer: Hawaii Western Management Group Commercial	$51.95
Rate for Payer: Health Management Network Commercial	$46.48
Rate for Payer: Humana Medicare	$27.34
Rate for Payer: Kaiser Permanente Commercial	$49.21
Rate for Payer: Kaiser Permanente Medicaid	$27.89
Rate for Payer: Kaiser Permanente Medicare	$27.34
Rate for Payer: MDX Hawaii PPO	$53.04
Rate for Payer: Ohana Health Plan Medicaid	$27.34
Rate for Payer: Ohana Health Plan Medicare	$27.34
Rate for Payer: UnitedHealthcare Medicaid	$32.81
Rate for Payer: UnitedHealthcare Medicare	$27.34
Rate for Payer: University Health Alliance Commercial	$39.86

bupivac-0.25% EPI 1:200,000 (PF) vial 30ml [HHSC]

Facility

IP

$76.34

Service Code	NDC 00409154110
Hospital Charge Code	2500125
Hospital Revenue Code	250
Min. Negotiated Rate	$64.89
Max. Negotiated Rate	$74.05
Rate for Payer: Cash Price	$49.62
Rate for Payer: Health Management Network Commercial	$64.89
Rate for Payer: Kaiser Permanente Commercial	$68.71
Rate for Payer: MDX Hawaii PPO	$74.05

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