Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]

Facility

IP

$7.00

Service Code	NDC 60687076811
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

GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]

Facility

IP

$7.00

Service Code	NDC 60687076821
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

GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]

Facility

IP

$5.00

Service Code	NDC 60687048021
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: MDX Hawaii PPO	$4.85

GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]

Facility

OP

$5.00

Service Code	NDC 60687048021
Hospital Revenue Code	637
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$3.15
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: University Health Alliance Commercial	$3.64

GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]

Facility

OP

$7.00

Service Code	NDC 60687076811
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

GLIPIZIDE ER 2.5 MG TABLET, EXTENDED RELEASE 24 HR [37648]

Facility

OP

$7.00

Service Code	NDC 60687076821
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

GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]

Facility

IP

$2.00

Service Code	NDC 64980028001
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

GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]

Facility

IP

$3.00

Service Code	NDC 68084011101
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

GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]

Facility

OP

$2.00

Service Code	NDC 64980028001
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

GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR [37649]

Facility

OP

$3.00

Service Code	NDC 68084011101
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

GLOSSECTOMY; LESS THAN ONE-HALF TONGUE

Facility

OP

$11,157.19

Service Code	CPT 41120
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$11,157.19
Rate for Payer: AlohaCare Medicaid	$6,993.36
Rate for Payer: AlohaCare Medicare	$6,993.36
Rate for Payer: Devoted Health Medicare	$7,692.70
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$8,270.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,993.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$6,993.36
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,993.36
Rate for Payer: Ohana Health Plan Medicaid	$7,692.70
Rate for Payer: Ohana Health Plan Medicare	$6,993.36
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,993.36
Rate for Payer: University Health Alliance Commercial	$11,157.19

GLUCAGON 1 MG SOLUTION FOR INJECTION [24869]

Facility

IP

$504.00

Service Code	HCPCS J1610
Hospital Revenue Code	250
Min. Negotiated Rate	$428.40
Max. Negotiated Rate	$488.88
Rate for Payer: Cash Price	$302.40
Rate for Payer: Health Management Network Commercial	$428.40
Rate for Payer: MDX Hawaii PPO	$488.88

GLUCAGON 1 MG SOLUTION FOR INJECTION [24869]

Facility

OP

$504.00

Service Code	HCPCS J1610
Hospital Revenue Code	636
Min. Negotiated Rate	$146.33
Max. Negotiated Rate	$488.88
Rate for Payer: AlohaCare Medicaid	$146.33
Rate for Payer: AlohaCare Medicare	$146.33
Rate for Payer: Cash Price	$302.40
Rate for Payer: Cash Price	$302.40
Rate for Payer: Devoted Health Medicare	$160.96
Rate for Payer: Hawaii Medical Service Association ABD	$195.79
Rate for Payer: Hawaii Medical Service Association Commercial	$182.91
Rate for Payer: Hawaii Medical Service Association Medicare	$146.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$195.79
Rate for Payer: Hawaii Western Management Group Commercial	$478.80
Rate for Payer: Health Management Network Commercial	$428.40
Rate for Payer: Humana Medicare	$146.33
Rate for Payer: Kaiser Permanente Commercial	$317.52
Rate for Payer: Kaiser Permanente Medicaid	$257.04
Rate for Payer: Kaiser Permanente Medicare	$146.33
Rate for Payer: MDX Hawaii PPO	$488.88
Rate for Payer: Ohana Health Plan Medicaid	$160.96
Rate for Payer: Ohana Health Plan Medicare	$146.33
Rate for Payer: UnitedHealthcare Medicaid	$302.40
Rate for Payer: UnitedHealthcare Medicare	$146.33
Rate for Payer: University Health Alliance Commercial	$367.37

GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION [129601]

Facility

OP

$455.00

Service Code	HCPCS J1611
Hospital Revenue Code	636
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$441.35
Rate for Payer: AlohaCare Medicaid	$135.00
Rate for Payer: AlohaCare Medicare	$135.00
Rate for Payer: Cash Price	$273.00
Rate for Payer: Cash Price	$273.00
Rate for Payer: Devoted Health Medicare	$148.50
Rate for Payer: Hawaii Medical Service Association ABD	$144.88
Rate for Payer: Hawaii Medical Service Association Commercial	$168.75
Rate for Payer: Hawaii Medical Service Association Medicare	$135.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$144.88
Rate for Payer: Hawaii Western Management Group Commercial	$432.25
Rate for Payer: Health Management Network Commercial	$386.75
Rate for Payer: Humana Medicare	$135.00
Rate for Payer: Kaiser Permanente Commercial	$286.65
Rate for Payer: Kaiser Permanente Medicaid	$232.05
Rate for Payer: Kaiser Permanente Medicare	$135.00
Rate for Payer: MDX Hawaii PPO	$441.35
Rate for Payer: Ohana Health Plan Medicaid	$148.50
Rate for Payer: Ohana Health Plan Medicare	$135.00
Rate for Payer: UnitedHealthcare Medicaid	$273.00
Rate for Payer: UnitedHealthcare Medicare	$135.00
Rate for Payer: University Health Alliance Commercial	$331.65

GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION [129601]

Facility

IP

$455.00

Service Code	HCPCS J1611
Hospital Revenue Code	250
Min. Negotiated Rate	$386.75
Max. Negotiated Rate	$441.35
Rate for Payer: Cash Price	$273.00
Rate for Payer: Health Management Network Commercial	$386.75
Rate for Payer: MDX Hawaii PPO	$441.35

GLUCAGON HCL 1 MG SOLUTION FOR INJECTION [170521]

Facility

OP

$504.00

Service Code	HCPCS J1611
Hospital Revenue Code	636
Min. Negotiated Rate	$135.00
Max. Negotiated Rate	$488.88
Rate for Payer: AlohaCare Medicaid	$135.00
Rate for Payer: AlohaCare Medicare	$135.00
Rate for Payer: Cash Price	$302.40
Rate for Payer: Cash Price	$302.40
Rate for Payer: Devoted Health Medicare	$148.50
Rate for Payer: Hawaii Medical Service Association ABD	$144.88
Rate for Payer: Hawaii Medical Service Association Commercial	$168.75
Rate for Payer: Hawaii Medical Service Association Medicare	$135.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$144.88
Rate for Payer: Hawaii Western Management Group Commercial	$478.80
Rate for Payer: Health Management Network Commercial	$428.40
Rate for Payer: Humana Medicare	$135.00
Rate for Payer: Kaiser Permanente Commercial	$317.52
Rate for Payer: Kaiser Permanente Medicaid	$257.04
Rate for Payer: Kaiser Permanente Medicare	$135.00
Rate for Payer: MDX Hawaii PPO	$488.88
Rate for Payer: Ohana Health Plan Medicaid	$148.50
Rate for Payer: Ohana Health Plan Medicare	$135.00
Rate for Payer: UnitedHealthcare Medicaid	$302.40
Rate for Payer: UnitedHealthcare Medicare	$135.00
Rate for Payer: University Health Alliance Commercial	$367.37

GLUCAGON HCL 1 MG SOLUTION FOR INJECTION [170521]

Facility

IP

$504.00

Service Code	HCPCS J1611
Hospital Revenue Code	250
Min. Negotiated Rate	$428.40
Max. Negotiated Rate	$488.88
Rate for Payer: Cash Price	$302.40
Rate for Payer: Health Management Network Commercial	$428.40
Rate for Payer: MDX Hawaii PPO	$488.88

GLYBURIDE 2.5 MG TABLET [10126]

Facility

OP

$2.00

Service Code	NDC 72241003905
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

GLYBURIDE 2.5 MG TABLET [10126]

Facility

IP

$2.00

Service Code	NDC 72241003905
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

GLYBURIDE 5 MG TABLET [3489]

Facility

OP

$3.00

Service Code	NDC 00093936401
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

GLYBURIDE 5 MG TABLET [3489]

Facility

IP

$3.00

Service Code	NDC 72241004005
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

GLYBURIDE 5 MG TABLET [3489]

Facility

IP

$3.00

Service Code	NDC 00093936401
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

GLYBURIDE 5 MG TABLET [3489]

Facility

OP

$3.00

Service Code	NDC 72241004005
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

GLYCERIN (ADULT) RECTAL SUPPOSITORY [41003]

Facility

IP

$1.00

Service Code	NDC 46122022171
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: MDX Hawaii PPO	$0.97

GLYCERIN (ADULT) RECTAL SUPPOSITORY [41003]

Facility

OP

$1.00

Service Code	NDC 42511000000
Hospital Revenue Code	637
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.63
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: University Health Alliance Commercial	$0.73

<<
<
268
269
270
271
272
273
274
275
276
277
>
>>