Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM [8113]

Facility

OP

$21.00

Service Code	NDC 67877025115
Hospital Revenue Code	637
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Hawaii Western Management Group Commercial	$19.95
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$13.23
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: University Health Alliance Commercial	$15.31

TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM [8113]

Facility

IP

$20.00

Service Code	NDC 51672128201
Hospital Revenue Code	250
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: MDX Hawaii PPO	$19.40

TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]

Facility

OP

$20.00

Service Code	NDC 45802005535
Hospital Revenue Code	637
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$12.00
Rate for Payer: Hawaii Western Management Group Commercial	$19.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: Kaiser Permanente Medicaid	$10.20
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: University Health Alliance Commercial	$14.58

TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]

Facility

OP

$21.00

Service Code	NDC 51672128401
Hospital Revenue Code	637
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Hawaii Western Management Group Commercial	$19.95
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$13.23
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: University Health Alliance Commercial	$15.31

TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]

Facility

IP

$49.00

Service Code	NDC 00168000680
Hospital Revenue Code	250
Min. Negotiated Rate	$41.65
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$29.40
Rate for Payer: Health Management Network Commercial	$41.65
Rate for Payer: MDX Hawaii PPO	$47.53

TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]

Facility

IP

$20.00

Service Code	NDC 45802005535
Hospital Revenue Code	250
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: MDX Hawaii PPO	$19.40

TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]

Facility

IP

$47.00

Service Code	NDC 51672128408
Hospital Revenue Code	250
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$28.20
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: MDX Hawaii PPO	$45.59

TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]

Facility

OP

$47.00

Service Code	NDC 51672128408
Hospital Revenue Code	637
Min. Negotiated Rate	$23.97
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$28.20
Rate for Payer: Hawaii Western Management Group Commercial	$44.65
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Kaiser Permanente Commercial	$29.61
Rate for Payer: Kaiser Permanente Medicaid	$23.97
Rate for Payer: MDX Hawaii PPO	$45.59
Rate for Payer: University Health Alliance Commercial	$34.26

TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]

Facility

IP

$21.00

Service Code	NDC 51672128401
Hospital Revenue Code	250
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: MDX Hawaii PPO	$20.37

TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]

Facility

OP

$49.00

Service Code	NDC 00168000680
Hospital Revenue Code	637
Min. Negotiated Rate	$24.99
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$29.40
Rate for Payer: Hawaii Western Management Group Commercial	$46.55
Rate for Payer: Health Management Network Commercial	$41.65
Rate for Payer: Kaiser Permanente Commercial	$30.87
Rate for Payer: Kaiser Permanente Medicaid	$24.99
Rate for Payer: MDX Hawaii PPO	$47.53
Rate for Payer: University Health Alliance Commercial	$35.72

TRIAMCINOLONE ACETONIDE 10 MG/ML SUSPENSION FOR INJECTION [11584]

Facility

IP

$48.00

Service Code	HCPCS J3301
Hospital Revenue Code	250
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$30.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: MDX Hawaii PPO	$49.47

TRIAMCINOLONE ACETONIDE 10 MG/ML SUSPENSION FOR INJECTION [11584]

Facility

OP

$51.00

Service Code	HCPCS J3301
Hospital Revenue Code	636
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$49.47
Rate for Payer: Cash Price	$30.60
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$30.60
Rate for Payer: Hawaii Medical Service Association ABD	$0.86
Rate for Payer: Hawaii Medical Service Association ABD	$0.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.86
Rate for Payer: Hawaii Western Management Group Commercial	$45.60
Rate for Payer: Hawaii Western Management Group Commercial	$48.45
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Kaiser Permanente Commercial	$32.13
Rate for Payer: Kaiser Permanente Commercial	$30.24
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: Kaiser Permanente Medicaid	$26.01
Rate for Payer: MDX Hawaii PPO	$49.47
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: UnitedHealthcare Medicaid	$28.80
Rate for Payer: UnitedHealthcare Medicaid	$30.60
Rate for Payer: University Health Alliance Commercial	$34.99
Rate for Payer: University Health Alliance Commercial	$37.17

TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [8120]

Facility

IP

$31.00

Service Code	HCPCS J3301
Hospital Revenue Code	250
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Cash Price	$94.20
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: MDX Hawaii PPO	$30.07
Rate for Payer: MDX Hawaii PPO	$152.29
Rate for Payer: MDX Hawaii PPO	$145.50

TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION [8120]

Facility

OP

$157.00

Service Code	HCPCS J3301
Hospital Revenue Code	636
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$152.29
Rate for Payer: Cash Price	$94.20
Rate for Payer: Cash Price	$18.60
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$18.60
Rate for Payer: Cash Price	$94.20
Rate for Payer: Hawaii Medical Service Association ABD	$0.86
Rate for Payer: Hawaii Medical Service Association ABD	$0.86
Rate for Payer: Hawaii Medical Service Association ABD	$0.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.86
Rate for Payer: Hawaii Western Management Group Commercial	$142.50
Rate for Payer: Hawaii Western Management Group Commercial	$149.15
Rate for Payer: Hawaii Western Management Group Commercial	$29.45
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: Kaiser Permanente Commercial	$19.53
Rate for Payer: Kaiser Permanente Commercial	$98.91
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicaid	$80.07
Rate for Payer: Kaiser Permanente Medicaid	$15.81
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: MDX Hawaii PPO	$152.29
Rate for Payer: MDX Hawaii PPO	$30.07
Rate for Payer: UnitedHealthcare Medicaid	$94.20
Rate for Payer: UnitedHealthcare Medicaid	$18.60
Rate for Payer: UnitedHealthcare Medicaid	$90.00
Rate for Payer: University Health Alliance Commercial	$109.33
Rate for Payer: University Health Alliance Commercial	$114.44
Rate for Payer: University Health Alliance Commercial	$22.60

TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE [12729]

Facility

IP

$2.00

Service Code	NDC 72578009001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: MDX Hawaii PPO	$1.94

TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE [12729]

Facility

OP

$2.00

Service Code	NDC 72578009001
Hospital Revenue Code	637
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.26
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: University Health Alliance Commercial	$1.46

TRI ASYMX3 PATELLA 5551-G-299

Facility

OP

$2,341.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,193.91
Max. Negotiated Rate	$2,270.77
Rate for Payer: Cash Price	$1,404.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,638.70
Rate for Payer: Health Management Network Commercial	$1,989.85
Rate for Payer: Kaiser Permanente Commercial	$1,474.83
Rate for Payer: Kaiser Permanente Medicaid	$1,193.91
Rate for Payer: MDX Hawaii PPO	$2,270.77
Rate for Payer: University Health Alliance Commercial	$1,310.96

TRI ASYMX3 PATELLA 5551-G-299

Facility

IP

$2,341.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,310.96
Max. Negotiated Rate	$2,270.77
Rate for Payer: Cash Price	$1,404.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,638.70
Rate for Payer: Health Management Network Commercial	$1,989.85
Rate for Payer: MDX Hawaii PPO	$2,270.77
Rate for Payer: University Health Alliance Commercial	$1,310.96

TRI ASYMX3 PATELLA 5551-G-350

Facility

OP

$2,341.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,193.91
Max. Negotiated Rate	$2,270.77
Rate for Payer: Cash Price	$1,404.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,638.70
Rate for Payer: Health Management Network Commercial	$1,989.85
Rate for Payer: Kaiser Permanente Commercial	$1,474.83
Rate for Payer: Kaiser Permanente Medicaid	$1,193.91
Rate for Payer: MDX Hawaii PPO	$2,270.77
Rate for Payer: University Health Alliance Commercial	$1,310.96

TRI ASYMX3 PATELLA 5551-G-350

Facility

IP

$2,341.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,310.96
Max. Negotiated Rate	$2,270.77
Rate for Payer: Cash Price	$1,404.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,638.70
Rate for Payer: Health Management Network Commercial	$1,989.85
Rate for Payer: MDX Hawaii PPO	$2,270.77
Rate for Payer: University Health Alliance Commercial	$1,310.96

TRI ASYMX3 PATELLA #5551-G-381

Facility

IP

$2,341.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,310.96
Max. Negotiated Rate	$2,270.77
Rate for Payer: Cash Price	$1,404.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,638.70
Rate for Payer: Health Management Network Commercial	$1,989.85
Rate for Payer: MDX Hawaii PPO	$2,270.77
Rate for Payer: University Health Alliance Commercial	$1,310.96

TRI ASYMX3 PATELLA #5551-G-381

Facility

OP

$2,341.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,193.91
Max. Negotiated Rate	$2,270.77
Rate for Payer: Cash Price	$1,404.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,638.70
Rate for Payer: Health Management Network Commercial	$1,989.85
Rate for Payer: Kaiser Permanente Commercial	$1,474.83
Rate for Payer: Kaiser Permanente Medicaid	$1,193.91
Rate for Payer: MDX Hawaii PPO	$2,270.77
Rate for Payer: University Health Alliance Commercial	$1,310.96

TRI ASYMX3 PATELLA #5551-G-401

Facility

OP

$2,341.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,193.91
Max. Negotiated Rate	$2,270.77
Rate for Payer: Cash Price	$1,404.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,638.70
Rate for Payer: Health Management Network Commercial	$1,989.85
Rate for Payer: Kaiser Permanente Commercial	$1,474.83
Rate for Payer: Kaiser Permanente Medicaid	$1,193.91
Rate for Payer: MDX Hawaii PPO	$2,270.77
Rate for Payer: University Health Alliance Commercial	$1,310.96

TRI ASYMX3 PATELLA #5551-G-401

Facility

IP

$2,341.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,310.96
Max. Negotiated Rate	$2,270.77
Rate for Payer: Cash Price	$1,404.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,638.70
Rate for Payer: Health Management Network Commercial	$1,989.85
Rate for Payer: MDX Hawaii PPO	$2,270.77
Rate for Payer: University Health Alliance Commercial	$1,310.96

TRIATHLN PE FEMUR #5515-F-502

Facility

OP

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,183.82
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$2,697.66
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92