Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

HYALURONATE SODIUM, STABILIZED 60 MG/3 ML INTRA-ARTICULAR SYRINGE [150807]

Facility

IP

$2,007.00

Service Code	HCPCS J7318
Hospital Revenue Code	250
Min. Negotiated Rate	$1,705.95
Max. Negotiated Rate	$1,946.79
Rate for Payer: Cash Price	$1,204.20
Rate for Payer: Health Management Network Commercial	$1,705.95
Rate for Payer: MDX Hawaii PPO	$1,946.79

HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION [76338]

Facility

OP

$134.00

Service Code	HCPCS J3473
Hospital Revenue Code	636
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$129.98
Rate for Payer: Cash Price	$80.40
Rate for Payer: Cash Price	$80.40
Rate for Payer: Hawaii Medical Service Association ABD	$0.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.36
Rate for Payer: Hawaii Western Management Group Commercial	$127.30
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Kaiser Permanente Commercial	$84.42
Rate for Payer: Kaiser Permanente Medicaid	$68.34
Rate for Payer: MDX Hawaii PPO	$129.98
Rate for Payer: UnitedHealthcare Medicaid	$80.40
Rate for Payer: University Health Alliance Commercial	$97.67

HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION [76338]

Facility

IP

$134.00

Service Code	HCPCS J3473
Hospital Revenue Code	250
Min. Negotiated Rate	$113.90
Max. Negotiated Rate	$129.98
Rate for Payer: Cash Price	$80.40
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: MDX Hawaii PPO	$129.98

HYDRALAZINE 10 MG TABLET [3698]

Facility

OP

$2.00

Service Code	NDC 60687081101
Hospital Revenue Code	637
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.94
Rate for Payer: Kaiser Permanente Medicaid	$1.02
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: MDX Hawaii PPO	$1.94
Rate for Payer: University Health Alliance Commercial	$1.46

HYDRALAZINE 10 MG TABLET [3698]

Facility

IP

$2.00

Service Code	NDC 50111039801
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

HYDRALAZINE 10 MG TABLET [3698]

Facility

OP

$2.00

Service Code	NDC 50111039801
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

HYDRALAZINE 10 MG TABLET [3698]

Facility

IP

$2.00

Service Code	NDC 60687081111
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

HYDRALAZINE 10 MG TABLET [3698]

Facility

OP

$2.00

Service Code	NDC 60687081111
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

HYDRALAZINE 10 MG TABLET [3698]

Facility

IP

$2.00

Service Code	NDC 60687081101
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

HYDRALAZINE 20 MG/ML INJECTION SOLUTION [3697]

Facility

OP

$52.00

Service Code	HCPCS J0360
Hospital Revenue Code	636
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$50.44
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Hawaii Medical Service Association ABD	$5.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.19
Rate for Payer: Hawaii Western Management Group Commercial	$49.40
Rate for Payer: Health Management Network Commercial	$44.20
Rate for Payer: Kaiser Permanente Commercial	$32.76
Rate for Payer: Kaiser Permanente Medicaid	$26.52
Rate for Payer: MDX Hawaii PPO	$50.44
Rate for Payer: UnitedHealthcare Medicaid	$31.20
Rate for Payer: University Health Alliance Commercial	$37.90

HYDRALAZINE 20 MG/ML INJECTION SOLUTION [3697]

Facility

IP

$52.00

Service Code	HCPCS J0360
Hospital Revenue Code	250
Min. Negotiated Rate	$44.20
Max. Negotiated Rate	$50.44
Rate for Payer: Cash Price	$31.20
Rate for Payer: Health Management Network Commercial	$44.20
Rate for Payer: MDX Hawaii PPO	$50.44

HYDRALAZINE 25 MG TABLET [3700]

Facility

IP

$1.00

Service Code	NDC 60687082201
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

HYDRALAZINE 25 MG TABLET [3700]

Facility

OP

$1.00

Service Code	NDC 60687082211
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

HYDRALAZINE 25 MG TABLET [3700]

Facility

OP

$1.00

Service Code	NDC 60687082201
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

HYDRALAZINE 25 MG TABLET [3700]

Facility

IP

$1.00

Service Code	NDC 60687082211
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

HYDRALAZINE 50 MG TABLET [3701]

Facility

OP

$2.00

Service Code	NDC 60687083311
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

HYDRALAZINE 50 MG TABLET [3701]

Facility

OP

$2.00

Service Code	NDC 60687083301
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

HYDRALAZINE 50 MG TABLET [3701]

Facility

IP

$2.00

Service Code	NDC 60687083311
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

HYDRALAZINE 50 MG TABLET [3701]

Facility

IP

$2.00

Service Code	NDC 60687083301
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

HYDROCHLOROTHIAZIDE 12.5 MG TABLET [76988]

Facility

IP

$1.00

Service Code	NDC 69315015501
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

HYDROCHLOROTHIAZIDE 12.5 MG TABLET [76988]

Facility

OP

$1.00

Service Code	NDC 69315015501
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

HYDROCHLOROTHIAZIDE 12.5 MG TABLET [76988]

Facility

IP

$1.00

Service Code	NDC 51407033001
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

HYDROCHLOROTHIAZIDE 12.5 MG TABLET [76988]

Facility

OP

$1.00

Service Code	NDC 51407033001
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

HYDROCHLOROTHIAZIDE 25 MG TABLET [3720]

Facility

OP

$1.00

Service Code	NDC 60687059301
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

HYDROCHLOROTHIAZIDE 25 MG TABLET [3720]

Facility

IP

$1.00

Service Code	NDC 60687059301
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

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