Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

tranexamic acid 1000 mg/10 ml vial [HHSC]

Facility

OP

$41.82

Service Code	NDC 81284061110
Hospital Charge Code	2500831
Hospital Revenue Code	250
Min. Negotiated Rate	$20.91
Max. Negotiated Rate	$40.57
Rate for Payer: AlohaCare Medicaid	$20.91
Rate for Payer: AlohaCare Medicare	$20.91
Rate for Payer: Cash Price	$27.18
Rate for Payer: Devoted Health Medicare	$23.00
Rate for Payer: Hawaii Medical Service Association Medicare	$20.91
Rate for Payer: Hawaii Western Management Group Commercial	$39.73
Rate for Payer: Health Management Network Commercial	$35.55
Rate for Payer: Humana Medicare	$20.91
Rate for Payer: Kaiser Permanente Commercial	$37.64
Rate for Payer: Kaiser Permanente Medicaid	$21.33
Rate for Payer: Kaiser Permanente Medicare	$20.91
Rate for Payer: MDX Hawaii PPO	$40.57
Rate for Payer: Ohana Health Plan Medicaid	$20.91
Rate for Payer: Ohana Health Plan Medicare	$20.91
Rate for Payer: UnitedHealthcare Medicaid	$25.09
Rate for Payer: UnitedHealthcare Medicare	$20.91
Rate for Payer: University Health Alliance Commercial	$30.48

tranexamic acid 1000 mg/10 ml vial [HHSC]

Facility

OP

$122.57

Service Code	NDC 00517096010
Hospital Charge Code	2500831
Hospital Revenue Code	250
Min. Negotiated Rate	$61.28
Max. Negotiated Rate	$118.89
Rate for Payer: AlohaCare Medicaid	$61.28
Rate for Payer: AlohaCare Medicare	$61.28
Rate for Payer: Cash Price	$79.67
Rate for Payer: Devoted Health Medicare	$67.41
Rate for Payer: Hawaii Medical Service Association Medicare	$61.28
Rate for Payer: Hawaii Western Management Group Commercial	$116.44
Rate for Payer: Health Management Network Commercial	$104.18
Rate for Payer: Humana Medicare	$61.28
Rate for Payer: Kaiser Permanente Commercial	$110.31
Rate for Payer: Kaiser Permanente Medicaid	$62.51
Rate for Payer: Kaiser Permanente Medicare	$61.28
Rate for Payer: MDX Hawaii PPO	$118.89
Rate for Payer: Ohana Health Plan Medicaid	$61.28
Rate for Payer: Ohana Health Plan Medicare	$61.28
Rate for Payer: UnitedHealthcare Medicaid	$73.54
Rate for Payer: UnitedHealthcare Medicare	$61.28
Rate for Payer: University Health Alliance Commercial	$89.34

tranexamic acid 1000 mg/10 ml vial [HHSC]

Facility

IP

$172.14

Service Code	NDC 39822100001
Hospital Charge Code	2500831
Hospital Revenue Code	250
Min. Negotiated Rate	$146.32
Max. Negotiated Rate	$166.98
Rate for Payer: Cash Price	$111.89
Rate for Payer: Health Management Network Commercial	$146.32
Rate for Payer: Kaiser Permanente Commercial	$154.93
Rate for Payer: MDX Hawaii PPO	$166.98

tranexamic acid 1000 mg/10 ml vial [HHSC]

Facility

IP

$122.45

Service Code	NDC 61990061102
Hospital Charge Code	2500831
Hospital Revenue Code	250
Min. Negotiated Rate	$104.08
Max. Negotiated Rate	$118.78
Rate for Payer: Cash Price	$79.59
Rate for Payer: Health Management Network Commercial	$104.08
Rate for Payer: Kaiser Permanente Commercial	$110.20
Rate for Payer: MDX Hawaii PPO	$118.78

tranexamic acid 1000 mg/10 ml vial [HHSC]

Facility

OP

$122.45

Service Code	NDC 61990061102
Hospital Charge Code	2500831
Hospital Revenue Code	250
Min. Negotiated Rate	$61.23
Max. Negotiated Rate	$118.78
Rate for Payer: AlohaCare Medicaid	$61.23
Rate for Payer: AlohaCare Medicare	$61.23
Rate for Payer: Cash Price	$79.59
Rate for Payer: Devoted Health Medicare	$67.35
Rate for Payer: Hawaii Medical Service Association Medicare	$61.23
Rate for Payer: Hawaii Western Management Group Commercial	$116.33
Rate for Payer: Health Management Network Commercial	$104.08
Rate for Payer: Humana Medicare	$61.23
Rate for Payer: Kaiser Permanente Commercial	$110.20
Rate for Payer: Kaiser Permanente Medicaid	$62.45
Rate for Payer: Kaiser Permanente Medicare	$61.23
Rate for Payer: MDX Hawaii PPO	$118.78
Rate for Payer: Ohana Health Plan Medicaid	$61.23
Rate for Payer: Ohana Health Plan Medicare	$61.23
Rate for Payer: UnitedHealthcare Medicaid	$73.47
Rate for Payer: UnitedHealthcare Medicare	$61.23
Rate for Payer: University Health Alliance Commercial	$89.25

tranexamic acid 1000 mg/10 ml vial [HHSC]

Facility

IP

$52.05

Service Code	NDC 70860040010
Hospital Charge Code	2500831
Hospital Revenue Code	250
Min. Negotiated Rate	$44.24
Max. Negotiated Rate	$50.49
Rate for Payer: Cash Price	$33.83
Rate for Payer: Health Management Network Commercial	$44.24
Rate for Payer: Kaiser Permanente Commercial	$46.84
Rate for Payer: MDX Hawaii PPO	$50.49

tranexamic acid 1000 mg/10 ml vial [HHSC]

Facility

IP

$25.35

Service Code	NDC 81284061210
Hospital Charge Code	2500831
Hospital Revenue Code	250
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$24.59
Rate for Payer: Cash Price	$16.48
Rate for Payer: Health Management Network Commercial	$21.55
Rate for Payer: Kaiser Permanente Commercial	$22.82
Rate for Payer: MDX Hawaii PPO	$24.59

tranexamic acid 1000 mg/10 ml vial [HHSC]

Facility

OP

$25.35

Service Code	NDC 81284061210
Hospital Charge Code	2500831
Hospital Revenue Code	250
Min. Negotiated Rate	$12.68
Max. Negotiated Rate	$24.59
Rate for Payer: AlohaCare Medicaid	$12.68
Rate for Payer: AlohaCare Medicare	$12.68
Rate for Payer: Cash Price	$16.48
Rate for Payer: Devoted Health Medicare	$13.94
Rate for Payer: Hawaii Medical Service Association Medicare	$12.68
Rate for Payer: Hawaii Western Management Group Commercial	$24.08
Rate for Payer: Health Management Network Commercial	$21.55
Rate for Payer: Humana Medicare	$12.68
Rate for Payer: Kaiser Permanente Commercial	$22.82
Rate for Payer: Kaiser Permanente Medicaid	$12.93
Rate for Payer: Kaiser Permanente Medicare	$12.68
Rate for Payer: MDX Hawaii PPO	$24.59
Rate for Payer: Ohana Health Plan Medicaid	$12.68
Rate for Payer: Ohana Health Plan Medicare	$12.68
Rate for Payer: UnitedHealthcare Medicaid	$15.21
Rate for Payer: UnitedHealthcare Medicare	$12.68
Rate for Payer: University Health Alliance Commercial	$18.48

tranexamic acid 1000 mg/10 ml vial [HHSC]

Facility

OP

$172.14

Service Code	NDC 39822100001
Hospital Charge Code	2500831
Hospital Revenue Code	250
Min. Negotiated Rate	$86.07
Max. Negotiated Rate	$166.98
Rate for Payer: AlohaCare Medicaid	$86.07
Rate for Payer: AlohaCare Medicare	$86.07
Rate for Payer: Cash Price	$111.89
Rate for Payer: Devoted Health Medicare	$94.68
Rate for Payer: Hawaii Medical Service Association Medicare	$86.07
Rate for Payer: Hawaii Western Management Group Commercial	$163.53
Rate for Payer: Health Management Network Commercial	$146.32
Rate for Payer: Humana Medicare	$86.07
Rate for Payer: Kaiser Permanente Commercial	$154.93
Rate for Payer: Kaiser Permanente Medicaid	$87.79
Rate for Payer: Kaiser Permanente Medicare	$86.07
Rate for Payer: MDX Hawaii PPO	$166.98
Rate for Payer: Ohana Health Plan Medicaid	$86.07
Rate for Payer: Ohana Health Plan Medicare	$86.07
Rate for Payer: UnitedHealthcare Medicaid	$103.28
Rate for Payer: UnitedHealthcare Medicare	$86.07
Rate for Payer: University Health Alliance Commercial	$125.47

tranexamic acid 1000 mg/10 ml vial [HHSC]

Facility

OP

$172.14

Service Code	NDC 39822100107
Hospital Charge Code	2500831
Hospital Revenue Code	250
Min. Negotiated Rate	$86.07
Max. Negotiated Rate	$166.98
Rate for Payer: AlohaCare Medicaid	$86.07
Rate for Payer: AlohaCare Medicare	$86.07
Rate for Payer: Cash Price	$111.89
Rate for Payer: Devoted Health Medicare	$94.68
Rate for Payer: Hawaii Medical Service Association Medicare	$86.07
Rate for Payer: Hawaii Western Management Group Commercial	$163.53
Rate for Payer: Health Management Network Commercial	$146.32
Rate for Payer: Humana Medicare	$86.07
Rate for Payer: Kaiser Permanente Commercial	$154.93
Rate for Payer: Kaiser Permanente Medicaid	$87.79
Rate for Payer: Kaiser Permanente Medicare	$86.07
Rate for Payer: MDX Hawaii PPO	$166.98
Rate for Payer: Ohana Health Plan Medicaid	$86.07
Rate for Payer: Ohana Health Plan Medicare	$86.07
Rate for Payer: UnitedHealthcare Medicaid	$103.28
Rate for Payer: UnitedHealthcare Medicare	$86.07
Rate for Payer: University Health Alliance Commercial	$125.47

tranexamic acid 1000 mg/10 ml vial [HHSC]

Facility

IP

$172.14

Service Code	NDC 39822100107
Hospital Charge Code	2500831
Hospital Revenue Code	250
Min. Negotiated Rate	$146.32
Max. Negotiated Rate	$166.98
Rate for Payer: Cash Price	$111.89
Rate for Payer: Health Management Network Commercial	$146.32
Rate for Payer: Kaiser Permanente Commercial	$154.93
Rate for Payer: MDX Hawaii PPO	$166.98

tranexamic acid 1000 mg/10 ml vial [HHSC]

Facility

IP

$44.74

Service Code	NDC 55150018810
Hospital Charge Code	2500831
Hospital Revenue Code	250
Min. Negotiated Rate	$38.03
Max. Negotiated Rate	$43.40
Rate for Payer: Cash Price	$29.08
Rate for Payer: Health Management Network Commercial	$38.03
Rate for Payer: Kaiser Permanente Commercial	$40.27
Rate for Payer: MDX Hawaii PPO	$43.40

tranexamic acid 1000 mg/10 ml vial [HHSC]

Facility

IP

$122.57

Service Code	NDC 00517096010
Hospital Charge Code	2500831
Hospital Revenue Code	250
Min. Negotiated Rate	$104.18
Max. Negotiated Rate	$118.89
Rate for Payer: Cash Price	$79.67
Rate for Payer: Health Management Network Commercial	$104.18
Rate for Payer: Kaiser Permanente Commercial	$110.31
Rate for Payer: MDX Hawaii PPO	$118.89

tranexamic acid 1000 mg/10 ml vial [HHSC]

Facility

OP

$44.74

Service Code	NDC 55150018810
Hospital Charge Code	2500831
Hospital Revenue Code	250
Min. Negotiated Rate	$22.37
Max. Negotiated Rate	$43.40
Rate for Payer: AlohaCare Medicaid	$22.37
Rate for Payer: AlohaCare Medicare	$22.37
Rate for Payer: Cash Price	$29.08
Rate for Payer: Devoted Health Medicare	$24.61
Rate for Payer: Hawaii Medical Service Association Medicare	$22.37
Rate for Payer: Hawaii Western Management Group Commercial	$42.50
Rate for Payer: Health Management Network Commercial	$38.03
Rate for Payer: Humana Medicare	$22.37
Rate for Payer: Kaiser Permanente Commercial	$40.27
Rate for Payer: Kaiser Permanente Medicaid	$22.82
Rate for Payer: Kaiser Permanente Medicare	$22.37
Rate for Payer: MDX Hawaii PPO	$43.40
Rate for Payer: Ohana Health Plan Medicaid	$22.37
Rate for Payer: Ohana Health Plan Medicare	$22.37
Rate for Payer: UnitedHealthcare Medicaid	$26.84
Rate for Payer: UnitedHealthcare Medicare	$22.37
Rate for Payer: University Health Alliance Commercial	$32.61

Transcutaneous Bilirubin POC

Facility

IP

$16.00

Service Code	HCPCS 88720 QW
Hospital Charge Code	8126193
Hospital Revenue Code	300
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$10.40
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

Transcutaneous Bilirubin POC

Professional

Both

$10.00

Service Code	HCPCS 88720 QW
Hospital Charge Code	8126193
Hospital Revenue Code	300
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Health Management Network Commercial	$8.50

Transcutaneous Bilirubin POC

Facility

OP

$16.00

Service Code	HCPCS 88720 QW
Hospital Charge Code	8126193
Hospital Revenue Code	300
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$15.52
Rate for Payer: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$8.00
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cash Price	$10.40
Rate for Payer: Devoted Health Medicare	$8.80
Rate for Payer: Hawaii Medical Service Association Medicare	$8.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.19
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Humana Medicare	$8.00
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicare	$8.00
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: Ohana Health Plan Medicaid	$8.00
Rate for Payer: Ohana Health Plan Medicare	$8.00
Rate for Payer: UnitedHealthcare Medicaid	$3.77
Rate for Payer: UnitedHealthcare Medicare	$8.00
Rate for Payer: University Health Alliance Commercial	$8.96

Transcutaneous Bilirubin POCT

Facility

IP

$13.00

Service Code	HCPCS 88720
Hospital Charge Code	9687349
Hospital Revenue Code	300
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$8.45
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

Transcutaneous Bilirubin POCT

Facility

OP

$13.00

Service Code	HCPCS 88720
Hospital Charge Code	9687349
Hospital Revenue Code	300
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$12.61
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$6.50
Rate for Payer: Cash Price	$8.45
Rate for Payer: Cash Price	$8.45
Rate for Payer: Devoted Health Medicare	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$6.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.19
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Humana Medicare	$6.50
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$6.50
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: Ohana Health Plan Medicaid	$6.50
Rate for Payer: Ohana Health Plan Medicare	$6.50
Rate for Payer: UnitedHealthcare Medicaid	$3.77
Rate for Payer: UnitedHealthcare Medicare	$6.50
Rate for Payer: University Health Alliance Commercial	$7.28

Transferrin REF

Facility

OP

$147.00

Service Code	HCPCS 84466
Hospital Charge Code	8160010
Hospital Revenue Code	301
Min. Negotiated Rate	$12.76
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$73.50
Rate for Payer: Cash Price	$95.55
Rate for Payer: Cash Price	$95.55
Rate for Payer: Devoted Health Medicare	$80.85
Rate for Payer: Hawaii Medical Service Association ABD	$17.65
Rate for Payer: Hawaii Medical Service Association Commercial	$15.95
Rate for Payer: Hawaii Medical Service Association Medicare	$73.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.53
Rate for Payer: Hawaii Western Management Group Commercial	$12.76
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$73.50
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$73.50
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$73.50
Rate for Payer: Ohana Health Plan Medicare	$73.50
Rate for Payer: UnitedHealthcare Medicaid	$17.65
Rate for Payer: UnitedHealthcare Medicare	$73.50
Rate for Payer: University Health Alliance Commercial	$33.00

Transferrin REF

Facility

IP

$147.00

Service Code	HCPCS 84466
Hospital Charge Code	8160010
Hospital Revenue Code	301
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$95.55
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59

Transfuse Cryoprecipitate Product

Facility

IP

$2,059.00

Service Code	HCPCS 36430
Hospital Charge Code	7894717
Hospital Revenue Code	391
Min. Negotiated Rate	$1,750.15
Max. Negotiated Rate	$1,997.23
Rate for Payer: Cash Price	$1,338.35
Rate for Payer: Health Management Network Commercial	$1,750.15
Rate for Payer: Kaiser Permanente Commercial	$1,853.10
Rate for Payer: MDX Hawaii PPO	$1,997.23

Transfuse Cryoprecipitate Product

Facility

OP

$2,059.00

Service Code	HCPCS 36430
Hospital Charge Code	7894717
Hospital Revenue Code	391
Min. Negotiated Rate	$33.38
Max. Negotiated Rate	$1,997.23
Rate for Payer: AlohaCare Medicaid	$1,029.50
Rate for Payer: AlohaCare Medicare	$1,029.50
Rate for Payer: Cash Price	$1,338.35
Rate for Payer: Cash Price	$1,338.35
Rate for Payer: Devoted Health Medicare	$1,132.45
Rate for Payer: Hawaii Medical Service Association Commercial	$563.41
Rate for Payer: Hawaii Medical Service Association Medicare	$1,029.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,956.05
Rate for Payer: Health Management Network Commercial	$1,750.15
Rate for Payer: Humana Medicare	$1,029.50
Rate for Payer: Kaiser Permanente Commercial	$1,853.10
Rate for Payer: Kaiser Permanente Medicaid	$1,050.09
Rate for Payer: Kaiser Permanente Medicare	$1,029.50
Rate for Payer: MDX Hawaii PPO	$1,997.23
Rate for Payer: Ohana Health Plan Medicaid	$1,029.50
Rate for Payer: Ohana Health Plan Medicare	$1,029.50
Rate for Payer: UnitedHealthcare Medicaid	$33.38
Rate for Payer: UnitedHealthcare Medicare	$1,029.50
Rate for Payer: University Health Alliance Commercial	$1,153.04

Transfuse Fresh Frozen Plasma

Facility

IP

$2,059.00

Service Code	HCPCS 36430
Hospital Charge Code	7894718
Hospital Revenue Code	391
Min. Negotiated Rate	$1,750.15
Max. Negotiated Rate	$1,997.23
Rate for Payer: Cash Price	$1,338.35
Rate for Payer: Health Management Network Commercial	$1,750.15
Rate for Payer: Kaiser Permanente Commercial	$1,853.10
Rate for Payer: MDX Hawaii PPO	$1,997.23

Transfuse Fresh Frozen Plasma

Facility

OP

$2,059.00

Service Code	HCPCS 36430
Hospital Charge Code	7894718
Hospital Revenue Code	391
Min. Negotiated Rate	$33.38
Max. Negotiated Rate	$1,997.23
Rate for Payer: AlohaCare Medicaid	$1,029.50
Rate for Payer: AlohaCare Medicare	$1,029.50
Rate for Payer: Cash Price	$1,338.35
Rate for Payer: Cash Price	$1,338.35
Rate for Payer: Devoted Health Medicare	$1,132.45
Rate for Payer: Hawaii Medical Service Association Commercial	$563.41
Rate for Payer: Hawaii Medical Service Association Medicare	$1,029.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,956.05
Rate for Payer: Health Management Network Commercial	$1,750.15
Rate for Payer: Humana Medicare	$1,029.50
Rate for Payer: Kaiser Permanente Commercial	$1,853.10
Rate for Payer: Kaiser Permanente Medicaid	$1,050.09
Rate for Payer: Kaiser Permanente Medicare	$1,029.50
Rate for Payer: MDX Hawaii PPO	$1,997.23
Rate for Payer: Ohana Health Plan Medicaid	$1,029.50
Rate for Payer: Ohana Health Plan Medicare	$1,029.50
Rate for Payer: UnitedHealthcare Medicaid	$33.38
Rate for Payer: UnitedHealthcare Medicare	$1,029.50
Rate for Payer: University Health Alliance Commercial	$1,153.04

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