Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION [3771]

Facility

IP

$390.00

Service Code	NDC 54838050280
Hospital Revenue Code	250
Min. Negotiated Rate	$331.50
Max. Negotiated Rate	$378.30
Rate for Payer: Cash Price	$234.00
Rate for Payer: Health Management Network Commercial	$331.50
Rate for Payer: MDX Hawaii PPO	$378.30

HYDROXYZINE HCL 10 MG TABLET [3772]

Facility

IP

$1.00

Service Code	NDC 60687066401
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

HYDROXYZINE HCL 10 MG TABLET [3772]

Facility

OP

$1.00

Service Code	NDC 60687066411
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

HYDROXYZINE HCL 10 MG TABLET [3772]

Facility

IP

$1.00

Service Code	NDC 60687066411
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

HYDROXYZINE HCL 10 MG TABLET [3772]

Facility

OP

$1.00

Service Code	NDC 60687066401
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

HYDROXYZINE HCL 25 MG TABLET [3774]

Facility

IP

$4.00

Service Code	NDC 00093506101
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

HYDROXYZINE HCL 25 MG TABLET [3774]

Facility

OP

$4.00

Service Code	NDC 00093506101
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.92

HYDROXYZINE HCL 25 MG TABLET [3774]

Facility

IP

$2.00

Service Code	NDC 60687067511
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

HYDROXYZINE HCL 25 MG TABLET [3774]

Facility

OP

$2.00

Service Code	NDC 60687067501
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

HYDROXYZINE HCL 25 MG TABLET [3774]

Facility

IP

$2.00

Service Code	NDC 60687067501
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

HYDROXYZINE HCL 25 MG TABLET [3774]

Facility

OP

$2.00

Service Code	NDC 60687067511
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

HYDROXYZINE HCL 50 MG/ML INTRAMUSCULAR SOLUTION [3770]

Facility

IP

$102.00

Service Code	HCPCS J3410
Hospital Revenue Code	250
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$98.94
Rate for Payer: Cash Price	$61.20
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: MDX Hawaii PPO	$98.94

HYDROXYZINE HCL 50 MG/ML INTRAMUSCULAR SOLUTION [3770]

Facility

OP

$102.00

Service Code	HCPCS J3410
Hospital Revenue Code	636
Min. Negotiated Rate	$16.93
Max. Negotiated Rate	$98.94
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cash Price	$61.20
Rate for Payer: Hawaii Medical Service Association ABD	$16.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.93
Rate for Payer: Hawaii Western Management Group Commercial	$96.90
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: Kaiser Permanente Commercial	$64.26
Rate for Payer: Kaiser Permanente Medicaid	$52.02
Rate for Payer: MDX Hawaii PPO	$98.94
Rate for Payer: UnitedHealthcare Medicaid	$61.20
Rate for Payer: University Health Alliance Commercial	$74.35

HYDROXYZINE HCL TABLETS (ATARAX) 25 MG (TAKE HOME) [4080366]

Facility

OP

$15.00

Service Code	NDC 00004080154
Hospital Revenue Code	253
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
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: University Health Alliance Commercial	$10.93

HYDROXYZINE HCL TABLETS (ATARAX) 25 MG (TAKE HOME) [4080366]

Facility

IP

$15.00

Service Code	NDC 00004080154
Hospital Revenue Code	253
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

HYOSCYAMINE SULFATE 0.125 MG TABLET [3783]

Facility

OP

$3.00

Service Code	NDC 42192034001
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

HYOSCYAMINE SULFATE 0.125 MG TABLET [3783]

Facility

IP

$3.00

Service Code	NDC 42192034001
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

HYPERTENSION

Facility

IP

$3,153.76

Service Code	APR-DRG 1992
Min. Negotiated Rate	$3,153.76
Max. Negotiated Rate	$3,153.76
Rate for Payer: AlohaCare Medicaid	$3,153.76
Rate for Payer: Hawaii Medical Service Association ABD	$3,153.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,153.76
Rate for Payer: Kaiser Permanente Medicaid	$3,153.76
Rate for Payer: Ohana Health Plan Medicaid	$3,153.76
Rate for Payer: UnitedHealthcare Medicaid	$3,153.76

HYPERTENSION

Facility

IP

$7,099.38

Service Code	APR-DRG 1994
Min. Negotiated Rate	$7,099.38
Max. Negotiated Rate	$7,099.38
Rate for Payer: AlohaCare Medicaid	$7,099.38
Rate for Payer: Hawaii Medical Service Association ABD	$7,099.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,099.38
Rate for Payer: Kaiser Permanente Medicaid	$7,099.38
Rate for Payer: Ohana Health Plan Medicaid	$7,099.38
Rate for Payer: UnitedHealthcare Medicaid	$7,099.38

HYPERTENSION

Facility

IP

$4,342.86

Service Code	APR-DRG 1993
Min. Negotiated Rate	$4,342.86
Max. Negotiated Rate	$4,342.86
Rate for Payer: AlohaCare Medicaid	$4,342.86
Rate for Payer: Hawaii Medical Service Association ABD	$4,342.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,342.86
Rate for Payer: Kaiser Permanente Medicaid	$4,342.86
Rate for Payer: Ohana Health Plan Medicaid	$4,342.86
Rate for Payer: UnitedHealthcare Medicaid	$4,342.86

HYPERTENSION

Facility

IP

$2,604.54

Service Code	APR-DRG 1991
Min. Negotiated Rate	$2,604.54
Max. Negotiated Rate	$2,604.54
Rate for Payer: AlohaCare Medicaid	$2,604.54
Rate for Payer: Hawaii Medical Service Association ABD	$2,604.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,604.54
Rate for Payer: Kaiser Permanente Medicaid	$2,604.54
Rate for Payer: Ohana Health Plan Medicaid	$2,604.54
Rate for Payer: UnitedHealthcare Medicaid	$2,604.54

HYPERTENSION WITH MCC

Facility

IP

$20,527.50

Service Code	MSDRG 304
Min. Negotiated Rate	$13,535.36
Max. Negotiated Rate	$20,527.50
Rate for Payer: AlohaCare Medicare	$13,535.36
Rate for Payer: Devoted Health Medicare	$14,888.90
Rate for Payer: Hawaii Medical Service Association Commercial	$14,025.75
Rate for Payer: Hawaii Medical Service Association Medicare	$13,535.36
Rate for Payer: Humana Medicare	$13,535.36
Rate for Payer: Kaiser Permanente Commercial	$20,527.50
Rate for Payer: Kaiser Permanente Medicare	$13,535.36
Rate for Payer: Ohana Health Plan Medicare	$13,535.36
Rate for Payer: UnitedHealthcare Medicare	$13,535.36

HYPERTENSION WITHOUT MCC

Facility

IP

$14,025.75

Service Code	MSDRG 305
Min. Negotiated Rate	$8,588.69
Max. Negotiated Rate	$14,025.75
Rate for Payer: AlohaCare Medicare	$8,588.69
Rate for Payer: Devoted Health Medicare	$9,447.56
Rate for Payer: Hawaii Medical Service Association Commercial	$14,025.75
Rate for Payer: Hawaii Medical Service Association Medicare	$8,588.69
Rate for Payer: Humana Medicare	$8,588.69
Rate for Payer: Kaiser Permanente Commercial	$13,025.48
Rate for Payer: Kaiser Permanente Medicare	$8,588.69
Rate for Payer: Ohana Health Plan Medicare	$8,588.69
Rate for Payer: UnitedHealthcare Medicare	$8,588.69

HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS

Facility

IP

$2,027.28

Service Code	APR-DRG 4221
Min. Negotiated Rate	$2,027.28
Max. Negotiated Rate	$2,027.28
Rate for Payer: AlohaCare Medicaid	$2,027.28
Rate for Payer: Hawaii Medical Service Association ABD	$2,027.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,027.28
Rate for Payer: Kaiser Permanente Medicaid	$2,027.28
Rate for Payer: Ohana Health Plan Medicaid	$2,027.28
Rate for Payer: UnitedHealthcare Medicaid	$2,027.28

HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS

Facility

IP

$2,700.43

Service Code	APR-DRG 4222
Min. Negotiated Rate	$2,700.43
Max. Negotiated Rate	$2,700.43
Rate for Payer: AlohaCare Medicaid	$2,700.43
Rate for Payer: Hawaii Medical Service Association ABD	$2,700.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,700.43
Rate for Payer: Kaiser Permanente Medicaid	$2,700.43
Rate for Payer: Ohana Health Plan Medicaid	$2,700.43
Rate for Payer: UnitedHealthcare Medicaid	$2,700.43

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