Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

carBAMazepine 200 mg tablet [HHSC]

Facility

IP

$8.89

Service Code	NDC 75834022101
Hospital Charge Code	2500142
Hospital Revenue Code	250
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$8.62
Rate for Payer: Cash Price	$5.78
Rate for Payer: Health Management Network Commercial	$7.56
Rate for Payer: Kaiser Permanente Commercial	$8.00
Rate for Payer: MDX Hawaii PPO	$8.62

carBAMazepine 200 mg tablet [HHSC]

Facility

OP

$9.14

Service Code	NDC 68084044401
Hospital Charge Code	2500142
Hospital Revenue Code	250
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$8.87
Rate for Payer: AlohaCare Medicaid	$4.57
Rate for Payer: AlohaCare Medicare	$4.57
Rate for Payer: Cash Price	$5.94
Rate for Payer: Devoted Health Medicare	$5.03
Rate for Payer: Hawaii Medical Service Association Medicare	$4.57
Rate for Payer: Hawaii Western Management Group Commercial	$8.68
Rate for Payer: Health Management Network Commercial	$7.77
Rate for Payer: Humana Medicare	$4.57
Rate for Payer: Kaiser Permanente Commercial	$8.23
Rate for Payer: Kaiser Permanente Medicaid	$4.66
Rate for Payer: Kaiser Permanente Medicare	$4.57
Rate for Payer: MDX Hawaii PPO	$8.87
Rate for Payer: Ohana Health Plan Medicaid	$4.57
Rate for Payer: Ohana Health Plan Medicare	$4.57
Rate for Payer: UnitedHealthcare Medicaid	$5.48
Rate for Payer: UnitedHealthcare Medicare	$4.57
Rate for Payer: University Health Alliance Commercial	$6.66

carBAMazepine 200 mg tablet [HHSC]

Facility

OP

$8.89

Service Code	NDC 75834022101
Hospital Charge Code	2500142
Hospital Revenue Code	250
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$8.62
Rate for Payer: AlohaCare Medicaid	$4.45
Rate for Payer: AlohaCare Medicare	$4.45
Rate for Payer: Cash Price	$5.78
Rate for Payer: Devoted Health Medicare	$4.89
Rate for Payer: Hawaii Medical Service Association Medicare	$4.45
Rate for Payer: Hawaii Western Management Group Commercial	$8.45
Rate for Payer: Health Management Network Commercial	$7.56
Rate for Payer: Humana Medicare	$4.45
Rate for Payer: Kaiser Permanente Commercial	$8.00
Rate for Payer: Kaiser Permanente Medicaid	$4.53
Rate for Payer: Kaiser Permanente Medicare	$4.45
Rate for Payer: MDX Hawaii PPO	$8.62
Rate for Payer: Ohana Health Plan Medicaid	$4.45
Rate for Payer: Ohana Health Plan Medicare	$4.45
Rate for Payer: UnitedHealthcare Medicaid	$5.33
Rate for Payer: UnitedHealthcare Medicare	$4.45
Rate for Payer: University Health Alliance Commercial	$6.48

carBAMazepine 200 mg tablet [HHSC]

Facility

IP

$9.14

Service Code	NDC 68084044401
Hospital Charge Code	2500142
Hospital Revenue Code	250
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$8.87
Rate for Payer: Cash Price	$5.94
Rate for Payer: Health Management Network Commercial	$7.77
Rate for Payer: Kaiser Permanente Commercial	$8.23
Rate for Payer: MDX Hawaii PPO	$8.87

carBAMazepine 200 mg tablet [HHSC]

Facility

IP

$8.89

Service Code	NDC 51672400501
Hospital Charge Code	2500142
Hospital Revenue Code	250
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$8.62
Rate for Payer: Cash Price	$5.78
Rate for Payer: Health Management Network Commercial	$7.56
Rate for Payer: Kaiser Permanente Commercial	$8.00
Rate for Payer: MDX Hawaii PPO	$8.62

carBAMazepine 200 mg tablet [HHSC]

Facility

IP

$8.89

Service Code	NDC 60505018300
Hospital Charge Code	2500142
Hospital Revenue Code	250
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$8.62
Rate for Payer: Cash Price	$5.78
Rate for Payer: Health Management Network Commercial	$7.56
Rate for Payer: Kaiser Permanente Commercial	$8.00
Rate for Payer: MDX Hawaii PPO	$8.62

carBAMazepine 200 mg tablet [HHSC]

Facility

OP

$8.89

Service Code	NDC 60505018300
Hospital Charge Code	2500142
Hospital Revenue Code	250
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$8.62
Rate for Payer: AlohaCare Medicaid	$4.45
Rate for Payer: AlohaCare Medicare	$4.45
Rate for Payer: Cash Price	$5.78
Rate for Payer: Devoted Health Medicare	$4.89
Rate for Payer: Hawaii Medical Service Association Medicare	$4.45
Rate for Payer: Hawaii Western Management Group Commercial	$8.45
Rate for Payer: Health Management Network Commercial	$7.56
Rate for Payer: Humana Medicare	$4.45
Rate for Payer: Kaiser Permanente Commercial	$8.00
Rate for Payer: Kaiser Permanente Medicaid	$4.53
Rate for Payer: Kaiser Permanente Medicare	$4.45
Rate for Payer: MDX Hawaii PPO	$8.62
Rate for Payer: Ohana Health Plan Medicaid	$4.45
Rate for Payer: Ohana Health Plan Medicare	$4.45
Rate for Payer: UnitedHealthcare Medicaid	$5.33
Rate for Payer: UnitedHealthcare Medicare	$4.45
Rate for Payer: University Health Alliance Commercial	$6.48

carBAMazepine 200 mg tablet [HHSC]

Facility

OP

$8.89

Service Code	NDC 51672400501
Hospital Charge Code	2500142
Hospital Revenue Code	250
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$8.62
Rate for Payer: AlohaCare Medicaid	$4.45
Rate for Payer: AlohaCare Medicare	$4.45
Rate for Payer: Cash Price	$5.78
Rate for Payer: Devoted Health Medicare	$4.89
Rate for Payer: Hawaii Medical Service Association Medicare	$4.45
Rate for Payer: Hawaii Western Management Group Commercial	$8.45
Rate for Payer: Health Management Network Commercial	$7.56
Rate for Payer: Humana Medicare	$4.45
Rate for Payer: Kaiser Permanente Commercial	$8.00
Rate for Payer: Kaiser Permanente Medicaid	$4.53
Rate for Payer: Kaiser Permanente Medicare	$4.45
Rate for Payer: MDX Hawaii PPO	$8.62
Rate for Payer: Ohana Health Plan Medicaid	$4.45
Rate for Payer: Ohana Health Plan Medicare	$4.45
Rate for Payer: UnitedHealthcare Medicaid	$5.33
Rate for Payer: UnitedHealthcare Medicare	$4.45
Rate for Payer: University Health Alliance Commercial	$6.48

Carbamazepine/Tegretol FSI

Facility

OP

$166.00

Service Code	HCPCS 82436
Hospital Charge Code	8117873
Hospital Revenue Code	301
Min. Negotiated Rate	$5.75
Max. Negotiated Rate	$161.02
Rate for Payer: AlohaCare Medicaid	$83.00
Rate for Payer: AlohaCare Medicare	$83.00
Rate for Payer: Cash Price	$107.90
Rate for Payer: Cash Price	$107.90
Rate for Payer: Devoted Health Medicare	$91.30
Rate for Payer: Hawaii Medical Service Association ABD	$6.95
Rate for Payer: Hawaii Medical Service Association Commercial	$7.19
Rate for Payer: Hawaii Medical Service Association Medicare	$83.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.30
Rate for Payer: Hawaii Western Management Group Commercial	$5.75
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Humana Medicare	$83.00
Rate for Payer: Kaiser Permanente Commercial	$149.40
Rate for Payer: Kaiser Permanente Medicaid	$84.66
Rate for Payer: Kaiser Permanente Medicare	$83.00
Rate for Payer: MDX Hawaii PPO	$161.02
Rate for Payer: Ohana Health Plan Medicaid	$83.00
Rate for Payer: Ohana Health Plan Medicare	$83.00
Rate for Payer: UnitedHealthcare Medicaid	$6.95
Rate for Payer: UnitedHealthcare Medicare	$83.00
Rate for Payer: University Health Alliance Commercial	$12.99

Carbamazepine/Tegretol FSI

Facility

IP

$166.00

Service Code	HCPCS 82436
Hospital Charge Code	8117873
Hospital Revenue Code	301
Min. Negotiated Rate	$141.10
Max. Negotiated Rate	$161.02
Rate for Payer: Cash Price	$107.90
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Kaiser Permanente Commercial	$149.40
Rate for Payer: MDX Hawaii PPO	$161.02

carbamide peroxide 6.5% drops [HHSC]

Facility

IP

$3.00

Service Code	NDC 46122055705
Hospital Charge Code	2500143
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

carbamide peroxide 6.5% drops [HHSC]

Facility

OP

$3.00

Service Code	NDC 46122055705
Hospital Charge Code	2500143
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

carbamide peroxide 6.5% drops [HHSC]

Facility

IP

$3.72

Service Code	NDC 42037010479
Hospital Charge Code	2500143
Hospital Revenue Code	250
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$3.61
Rate for Payer: Cash Price	$2.42
Rate for Payer: Health Management Network Commercial	$3.16
Rate for Payer: Kaiser Permanente Commercial	$3.35
Rate for Payer: MDX Hawaii PPO	$3.61

carbamide peroxide 6.5% drops [HHSC]

Facility

OP

$3.72

Service Code	NDC 42037010479
Hospital Charge Code	2500143
Hospital Revenue Code	250
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$3.61
Rate for Payer: AlohaCare Medicaid	$1.86
Rate for Payer: AlohaCare Medicare	$1.86
Rate for Payer: Cash Price	$2.42
Rate for Payer: Devoted Health Medicare	$2.05
Rate for Payer: Hawaii Medical Service Association Medicare	$1.86
Rate for Payer: Hawaii Western Management Group Commercial	$3.53
Rate for Payer: Health Management Network Commercial	$3.16
Rate for Payer: Humana Medicare	$1.86
Rate for Payer: Kaiser Permanente Commercial	$3.35
Rate for Payer: Kaiser Permanente Medicaid	$1.90
Rate for Payer: Kaiser Permanente Medicare	$1.86
Rate for Payer: MDX Hawaii PPO	$3.61
Rate for Payer: Ohana Health Plan Medicaid	$1.86
Rate for Payer: Ohana Health Plan Medicare	$1.86
Rate for Payer: UnitedHealthcare Medicaid	$2.23
Rate for Payer: UnitedHealthcare Medicare	$1.86
Rate for Payer: University Health Alliance Commercial	$2.71

carbamide peroxide 6.5% drops [HHSC]

Facility

IP

$3.00

Service Code	NDC 42037010478
Hospital Charge Code	2500143
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

carbamide peroxide 6.5% drops [HHSC]

Facility

OP

$3.00

Service Code	NDC 00904662735
Hospital Charge Code	2500143
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

carbamide peroxide 6.5% drops [HHSC]

Facility

IP

$3.00

Service Code	NDC 00904662735
Hospital Charge Code	2500143
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

carbamide peroxide 6.5% drops [HHSC]

Facility

OP

$3.00

Service Code	NDC 42037010478
Hospital Charge Code	2500143
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

carbidopa-levodopa 10/100 mg tablet [HHSC]

Facility

IP

$4.29

Service Code	HCPCS J8499
Hospital Charge Code	2500144
Hospital Revenue Code	250
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$4.16
Rate for Payer: Cash Price	$2.79
Rate for Payer: Cash Price	$2.56
Rate for Payer: Health Management Network Commercial	$3.35
Rate for Payer: Health Management Network Commercial	$3.65
Rate for Payer: Kaiser Permanente Commercial	$3.55
Rate for Payer: Kaiser Permanente Commercial	$3.86
Rate for Payer: MDX Hawaii PPO	$4.16
Rate for Payer: MDX Hawaii PPO	$3.82

carbidopa-levodopa 10/100 mg tablet [HHSC]

Facility

OP

$4.29

Service Code	HCPCS J8499
Hospital Charge Code	2500144
Hospital Revenue Code	636
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$4.16
Rate for Payer: AlohaCare Medicaid	$2.15
Rate for Payer: AlohaCare Medicaid	$1.97
Rate for Payer: AlohaCare Medicare	$2.15
Rate for Payer: AlohaCare Medicare	$1.97
Rate for Payer: Cash Price	$2.56
Rate for Payer: Cash Price	$2.79
Rate for Payer: Devoted Health Medicare	$2.17
Rate for Payer: Devoted Health Medicare	$2.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1.97
Rate for Payer: Hawaii Medical Service Association Medicare	$2.15
Rate for Payer: Hawaii Western Management Group Commercial	$4.08
Rate for Payer: Hawaii Western Management Group Commercial	$3.74
Rate for Payer: Health Management Network Commercial	$3.65
Rate for Payer: Health Management Network Commercial	$3.35
Rate for Payer: Humana Medicare	$1.97
Rate for Payer: Humana Medicare	$2.15
Rate for Payer: Kaiser Permanente Commercial	$3.55
Rate for Payer: Kaiser Permanente Commercial	$3.86
Rate for Payer: Kaiser Permanente Medicaid	$2.01
Rate for Payer: Kaiser Permanente Medicaid	$2.19
Rate for Payer: Kaiser Permanente Medicare	$2.15
Rate for Payer: Kaiser Permanente Medicare	$1.97
Rate for Payer: MDX Hawaii PPO	$4.16
Rate for Payer: MDX Hawaii PPO	$3.82
Rate for Payer: Ohana Health Plan Medicaid	$2.15
Rate for Payer: Ohana Health Plan Medicaid	$1.97
Rate for Payer: Ohana Health Plan Medicare	$1.97
Rate for Payer: Ohana Health Plan Medicare	$2.15
Rate for Payer: UnitedHealthcare Medicaid	$2.57
Rate for Payer: UnitedHealthcare Medicaid	$2.36
Rate for Payer: UnitedHealthcare Medicare	$1.97
Rate for Payer: UnitedHealthcare Medicare	$2.15
Rate for Payer: University Health Alliance Commercial	$2.87
Rate for Payer: University Health Alliance Commercial	$3.13

carbidopa-levodopa 25/100 mg tablet [HHSC]

Facility

IP

$4.56

Service Code	HCPCS J8499
Hospital Charge Code	2500145
Hospital Revenue Code	250
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$4.42
Rate for Payer: Cash Price	$2.96
Rate for Payer: Health Management Network Commercial	$3.88
Rate for Payer: Kaiser Permanente Commercial	$4.10
Rate for Payer: MDX Hawaii PPO	$4.42

carbidopa-levodopa 25/100 mg tablet [HHSC]

Facility

OP

$4.56

Service Code	HCPCS J8499
Hospital Charge Code	2500145
Hospital Revenue Code	636
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$4.42
Rate for Payer: AlohaCare Medicaid	$2.28
Rate for Payer: AlohaCare Medicare	$2.28
Rate for Payer: Cash Price	$2.96
Rate for Payer: Devoted Health Medicare	$2.51
Rate for Payer: Hawaii Medical Service Association Medicare	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$4.33
Rate for Payer: Health Management Network Commercial	$3.88
Rate for Payer: Humana Medicare	$2.28
Rate for Payer: Kaiser Permanente Commercial	$4.10
Rate for Payer: Kaiser Permanente Medicaid	$2.33
Rate for Payer: Kaiser Permanente Medicare	$2.28
Rate for Payer: MDX Hawaii PPO	$4.42
Rate for Payer: Ohana Health Plan Medicaid	$2.28
Rate for Payer: Ohana Health Plan Medicare	$2.28
Rate for Payer: UnitedHealthcare Medicaid	$2.74
Rate for Payer: UnitedHealthcare Medicare	$2.28
Rate for Payer: University Health Alliance Commercial	$3.32

carboprost 250 mcg/1ml ampule [HHSC]

Facility

IP

$1,042.03

Service Code	NDC 71839013710
Hospital Charge Code	2500146
Hospital Revenue Code	250
Min. Negotiated Rate	$885.73
Max. Negotiated Rate	$1,010.77
Rate for Payer: Cash Price	$677.32
Rate for Payer: Health Management Network Commercial	$885.73
Rate for Payer: Kaiser Permanente Commercial	$937.83
Rate for Payer: MDX Hawaii PPO	$1,010.77

carboprost 250 mcg/1ml ampule [HHSC]

Facility

OP

$1,042.03

Service Code	NDC 43598069858
Hospital Charge Code	2500146
Hospital Revenue Code	250
Min. Negotiated Rate	$521.01
Max. Negotiated Rate	$1,010.77
Rate for Payer: AlohaCare Medicaid	$521.01
Rate for Payer: AlohaCare Medicare	$521.01
Rate for Payer: Cash Price	$677.32
Rate for Payer: Devoted Health Medicare	$573.12
Rate for Payer: Hawaii Medical Service Association Medicare	$521.01
Rate for Payer: Hawaii Western Management Group Commercial	$989.93
Rate for Payer: Health Management Network Commercial	$885.73
Rate for Payer: Humana Medicare	$521.01
Rate for Payer: Kaiser Permanente Commercial	$937.83
Rate for Payer: Kaiser Permanente Medicaid	$531.44
Rate for Payer: Kaiser Permanente Medicare	$521.01
Rate for Payer: MDX Hawaii PPO	$1,010.77
Rate for Payer: Ohana Health Plan Medicaid	$521.01
Rate for Payer: Ohana Health Plan Medicare	$521.01
Rate for Payer: UnitedHealthcare Medicaid	$625.22
Rate for Payer: UnitedHealthcare Medicare	$521.01
Rate for Payer: University Health Alliance Commercial	$759.54

carboprost 250 mcg/1ml ampule [HHSC]

Facility

IP

$1,130.92

Service Code	NDC 00009085608
Hospital Charge Code	2500146
Hospital Revenue Code	250
Min. Negotiated Rate	$961.28
Max. Negotiated Rate	$1,096.99
Rate for Payer: Cash Price	$735.10
Rate for Payer: Health Management Network Commercial	$961.28
Rate for Payer: Kaiser Permanente Commercial	$1,017.83
Rate for Payer: MDX Hawaii PPO	$1,096.99

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