Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

IP

$2.00

Service Code	NDC 60687073609
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

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

IP

$2.00

Service Code	NDC 68084081309
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

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE [26225]

Facility

OP

$2.00

Service Code	NDC 68084081309
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

PANTOPRAZOLE 80 MG/250 ML IN NS (SIMPLE) [4080132]

Facility

IP

$28.00

Service Code	NDC 00004080030
Hospital Revenue Code	250
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$16.80
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: MDX Hawaii PPO	$27.16

PANTOPRAZOLE SODIUM 40 MG/10ML IV (WET SOLR VIAL) [43026226]

Facility

IP

$15.00

Service Code	NDC 00143928410
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

PANTOPRAZOLE SODIUM 40 MG/10ML IV (WET SOLR VIAL) [43026226]

Facility

IP

$13.00

Service Code	NDC 55150020210
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$4.20
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: MDX Hawaii PPO	$6.79

PANTOPRAZOLE TABLETS (PROTONIX) 40 MG (TAKE HOME) [4080386]

Facility

IP

$15.00

Service Code	NDC 00004080174
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

PANTOPRAZOLE TABLETS (PROTONIX) 40 MG (TAKE HOME) [4080386]

Facility

OP

$15.00

Service Code	NDC 00004080174
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

PAPAVERINE 30 MG/ML INJECTION SOLUTION [6030]

Facility

IP

$113.00

Service Code	NDC 14789012105
Hospital Revenue Code	250
Min. Negotiated Rate	$96.05
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$67.80
Rate for Payer: Health Management Network Commercial	$96.05
Rate for Payer: MDX Hawaii PPO	$109.61

PAPAVERINE 30 MG/ML INJECTION SOLUTION [6030]

Facility

IP

$125.00

Service Code	NDC 00517400225
Hospital Revenue Code	250
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$75.00
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: MDX Hawaii PPO	$121.25

PAPAVERINE 30 MG/ML INJECTION SOLUTION [6030]

Facility

IP

$113.00

Service Code	NDC 14789012107
Hospital Revenue Code	250
Min. Negotiated Rate	$96.05
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$67.80
Rate for Payer: Health Management Network Commercial	$96.05
Rate for Payer: MDX Hawaii PPO	$109.61

PAPAVERINE 30 MG/ML INJECTION SOLUTION [6030]

Facility

IP

$98.00

Service Code	NDC 54288014201
Hospital Revenue Code	250
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$95.06
Rate for Payer: Cash Price	$58.80
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: MDX Hawaii PPO	$95.06

PAPAVERINE 30 MG/ML INJECTION SOLUTION [6030]

Facility

IP

$98.00

Service Code	NDC 54288014210
Hospital Revenue Code	250
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$95.06
Rate for Payer: Cash Price	$58.80
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: MDX Hawaii PPO	$95.06

PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S);

Facility

OP

$24,500.00

Service Code	CPT 60500
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$24,500.00
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	$1,900.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,395.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,993.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,695.11
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	$24,500.00

PARICALCITOL 1 MCG CAPSULE [41497]

Facility

IP

$24.00

Service Code	NDC 49483068703
Hospital Revenue Code	250
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: MDX Hawaii PPO	$23.28

PARICALCITOL 1 MCG CAPSULE [41497]

Facility

OP

$24.00

Service Code	NDC 49483068703
Hospital Revenue Code	637
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$14.40
Rate for Payer: Hawaii Western Management Group Commercial	$22.80
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Kaiser Permanente Commercial	$15.12
Rate for Payer: Kaiser Permanente Medicaid	$12.24
Rate for Payer: MDX Hawaii PPO	$23.28
Rate for Payer: University Health Alliance Commercial	$17.49

PARIETEX PLUG

Facility

IP

$398.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$222.88
Max. Negotiated Rate	$386.06
Rate for Payer: Cash Price	$238.80
Rate for Payer: Hawaii Western Management Group Commercial	$278.60
Rate for Payer: Health Management Network Commercial	$338.30
Rate for Payer: MDX Hawaii PPO	$386.06
Rate for Payer: University Health Alliance Commercial	$222.88

PARIETEX PLUG

Facility

OP

$398.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$202.98
Max. Negotiated Rate	$386.06
Rate for Payer: Cash Price	$238.80
Rate for Payer: Hawaii Western Management Group Commercial	$278.60
Rate for Payer: Health Management Network Commercial	$338.30
Rate for Payer: Kaiser Permanente Commercial	$250.74
Rate for Payer: Kaiser Permanente Medicaid	$202.98
Rate for Payer: MDX Hawaii PPO	$386.06
Rate for Payer: University Health Alliance Commercial	$222.88

PAROXETINE 10 MG TABLET [16632]

Facility

OP

$10.00

Service Code	NDC 68382009706
Hospital Revenue Code	637
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.00
Rate for Payer: Hawaii Western Management Group Commercial	$9.50
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$5.10
Rate for Payer: MDX Hawaii PPO	$9.70
Rate for Payer: University Health Alliance Commercial	$7.29

PAROXETINE 10 MG TABLET [16632]

Facility

IP

$10.00

Service Code	NDC 68382009706
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.00
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: MDX Hawaii PPO	$9.70

PAROXETINE 20 MG TABLET [10855]

Facility

IP

$10.00

Service Code	NDC 68382009806
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.00
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: MDX Hawaii PPO	$9.70

PAROXETINE 20 MG TABLET [10855]

Facility

OP

$10.00

Service Code	NDC 68382009806
Hospital Revenue Code	637
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.00
Rate for Payer: Hawaii Western Management Group Commercial	$9.50
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$5.10
Rate for Payer: MDX Hawaii PPO	$9.70
Rate for Payer: University Health Alliance Commercial	$7.29

PAROXETINE 20 MG TABLET [10855]

Facility

OP

$10.00

Service Code	NDC 68084004501
Hospital Revenue Code	637
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.00
Rate for Payer: Hawaii Western Management Group Commercial	$9.50
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$5.10
Rate for Payer: MDX Hawaii PPO	$9.70
Rate for Payer: University Health Alliance Commercial	$7.29

PAROXETINE 20 MG TABLET [10855]

Facility

IP

$10.00

Service Code	NDC 68084004501
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.00
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: MDX Hawaii PPO	$9.70

PARTIAL HYMENECTOMY OR REVISION OF HYMENAL RING

Facility

OP

$8,270.00

Service Code	CPT 56700
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$8,270.00
Rate for Payer: AlohaCare Medicaid	$3,824.16
Rate for Payer: AlohaCare Medicare	$3,824.16
Rate for Payer: Devoted Health Medicare	$4,206.58
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	$3,824.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,427.62
Rate for Payer: Humana Medicare	$3,824.16
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,824.16
Rate for Payer: Ohana Health Plan Medicaid	$4,206.58
Rate for Payer: Ohana Health Plan Medicare	$3,824.16
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,824.16
Rate for Payer: University Health Alliance Commercial	$4,035.20

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