Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

HYDROCORTISONE 2.5 % TOPICAL CREAM [3727]

Facility

IP

$32.00

Service Code	NDC 51672300302
Hospital Revenue Code	250
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$19.20
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: MDX Hawaii PPO	$31.04

HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [172266]

Facility

IP

$292.00

Service Code	NDC 62559043130
Hospital Revenue Code	250
Min. Negotiated Rate	$248.20
Max. Negotiated Rate	$283.24
Rate for Payer: Cash Price	$175.20
Rate for Payer: Health Management Network Commercial	$248.20
Rate for Payer: MDX Hawaii PPO	$283.24

HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [172266]

Facility

OP

$292.00

Service Code	NDC 62559043130
Hospital Revenue Code	637
Min. Negotiated Rate	$148.92
Max. Negotiated Rate	$283.24
Rate for Payer: Cash Price	$175.20
Rate for Payer: Hawaii Western Management Group Commercial	$277.40
Rate for Payer: Health Management Network Commercial	$248.20
Rate for Payer: Kaiser Permanente Commercial	$183.96
Rate for Payer: Kaiser Permanente Medicaid	$148.92
Rate for Payer: MDX Hawaii PPO	$283.24
Rate for Payer: University Health Alliance Commercial	$212.84

HYDROCORTISONE 2.5 % TOPICAL OINTMENT [3732]

Facility

IP

$37.00

Service Code	NDC 00168014630
Hospital Revenue Code	250
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: MDX Hawaii PPO	$35.89

HYDROCORTISONE 2.5 % TOPICAL OINTMENT [3732]

Facility

OP

$37.00

Service Code	NDC 00168014630
Hospital Revenue Code	637
Min. Negotiated Rate	$18.87
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Hawaii Western Management Group Commercial	$35.15
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$23.31
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: University Health Alliance Commercial	$26.97

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]

Facility

OP

$57.00

Service Code	NDC 00713050306
Hospital Revenue Code	637
Min. Negotiated Rate	$29.07
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$34.20
Rate for Payer: Hawaii Western Management Group Commercial	$54.15
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Kaiser Permanente Commercial	$35.91
Rate for Payer: Kaiser Permanente Medicaid	$29.07
Rate for Payer: MDX Hawaii PPO	$55.29
Rate for Payer: University Health Alliance Commercial	$41.55

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]

Facility

OP

$57.00

Service Code	NDC 00713050312
Hospital Revenue Code	637
Min. Negotiated Rate	$29.07
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$34.20
Rate for Payer: Hawaii Western Management Group Commercial	$54.15
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Kaiser Permanente Commercial	$35.91
Rate for Payer: Kaiser Permanente Medicaid	$29.07
Rate for Payer: MDX Hawaii PPO	$55.29
Rate for Payer: University Health Alliance Commercial	$41.55

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]

Facility

OP

$37.00

Service Code	NDC 50268041111
Hospital Revenue Code	637
Min. Negotiated Rate	$18.87
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Hawaii Western Management Group Commercial	$35.15
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$23.31
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: University Health Alliance Commercial	$26.97

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]

Facility

IP

$57.00

Service Code	NDC 00713050306
Hospital Revenue Code	250
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$34.20
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: MDX Hawaii PPO	$55.29

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]

Facility

IP

$57.00

Service Code	NDC 00713050312
Hospital Revenue Code	250
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$34.20
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: MDX Hawaii PPO	$55.29

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]

Facility

IP

$37.00

Service Code	NDC 50268041111
Hospital Revenue Code	250
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: MDX Hawaii PPO	$35.89

HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]

Facility

OP

$565.00

Service Code	NDC 51672300701
Hospital Revenue Code	637
Min. Negotiated Rate	$288.15
Max. Negotiated Rate	$548.05
Rate for Payer: Cash Price	$339.00
Rate for Payer: Hawaii Western Management Group Commercial	$536.75
Rate for Payer: Health Management Network Commercial	$480.25
Rate for Payer: Kaiser Permanente Commercial	$355.95
Rate for Payer: Kaiser Permanente Medicaid	$288.15
Rate for Payer: MDX Hawaii PPO	$548.05
Rate for Payer: University Health Alliance Commercial	$411.83

HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]

Facility

IP

$565.00

Service Code	NDC 51672300701
Hospital Revenue Code	250
Min. Negotiated Rate	$480.25
Max. Negotiated Rate	$548.05
Rate for Payer: Cash Price	$339.00
Rate for Payer: Health Management Network Commercial	$480.25
Rate for Payer: MDX Hawaii PPO	$548.05

HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION [204602]

Facility

IP

$73.00

Service Code	HCPCS J1720
Hospital Revenue Code	250
Min. Negotiated Rate	$62.05
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$43.80
Rate for Payer: Cash Price	$42.60
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: MDX Hawaii PPO	$68.87

HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION [204602]

Facility

OP

$71.00

Service Code	HCPCS J1720
Hospital Revenue Code	636
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$42.60
Rate for Payer: Cash Price	$42.60
Rate for Payer: Cash Price	$43.80
Rate for Payer: Cash Price	$43.80
Rate for Payer: Hawaii Medical Service Association ABD	$21.20
Rate for Payer: Hawaii Medical Service Association ABD	$21.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.20
Rate for Payer: Hawaii Western Management Group Commercial	$67.45
Rate for Payer: Hawaii Western Management Group Commercial	$69.35
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$45.99
Rate for Payer: Kaiser Permanente Commercial	$44.73
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicaid	$37.23
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: UnitedHealthcare Medicaid	$42.60
Rate for Payer: UnitedHealthcare Medicaid	$43.80
Rate for Payer: University Health Alliance Commercial	$53.21
Rate for Payer: University Health Alliance Commercial	$51.75

HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION [204601]

Facility

OP

$43.00

Service Code	HCPCS J1720
Hospital Revenue Code	636
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Cash Price	$64.20
Rate for Payer: Cash Price	$64.20
Rate for Payer: Cash Price	$25.80
Rate for Payer: Hawaii Medical Service Association ABD	$21.20
Rate for Payer: Hawaii Medical Service Association ABD	$21.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.20
Rate for Payer: Hawaii Western Management Group Commercial	$101.65
Rate for Payer: Hawaii Western Management Group Commercial	$40.85
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: Kaiser Permanente Commercial	$27.09
Rate for Payer: Kaiser Permanente Commercial	$67.41
Rate for Payer: Kaiser Permanente Medicaid	$54.57
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: MDX Hawaii PPO	$103.79
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: UnitedHealthcare Medicaid	$25.80
Rate for Payer: UnitedHealthcare Medicaid	$64.20
Rate for Payer: University Health Alliance Commercial	$31.34
Rate for Payer: University Health Alliance Commercial	$77.99

HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION [204601]

Facility

IP

$107.00

Service Code	HCPCS J1720
Hospital Revenue Code	250
Min. Negotiated Rate	$90.95
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$64.20
Rate for Payer: Cash Price	$25.80
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: MDX Hawaii PPO	$103.79
Rate for Payer: MDX Hawaii PPO	$41.71

HYDROMORPHONE 2 MG/ML INJECTION SYRINGE [201344]

Facility

IP

$15.00

Service Code	HCPCS J1171
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: MDX Hawaii PPO	$14.55

HYDROMORPHONE 2 MG/ML INJECTION SYRINGE [201344]

Facility

OP

$15.00

Service Code	HCPCS J1171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$9.00
Rate for Payer: Hawaii Medical Service Association ABD	$0.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.09
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$9.45
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: UnitedHealthcare Medicaid	$9.00
Rate for Payer: University Health Alliance Commercial	$10.93

HYDROMORPHONE 2 MG TABLET [3760]

Facility

IP

$3.00

Service Code	NDC 00406324301
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

HYDROMORPHONE 2 MG TABLET [3760]

Facility

OP

$3.00

Service Code	NDC 00406324301
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

HYDROMORPHONE 4 MG TABLET [3761]

Facility

IP

$4.00

Service Code	NDC 00406324401
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: MDX Hawaii PPO	$3.88

HYDROMORPHONE 4 MG TABLET [3761]

Facility

OP

$3.00

Service Code	NDC 60687059011
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

HYDROMORPHONE 4 MG TABLET [3761]

Facility

OP

$3.00

Service Code	NDC 60687059001
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

HYDROMORPHONE 4 MG TABLET [3761]

Facility

OP

$1.00

Service Code	NDC 42858030225
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

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