Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET [168911]

Facility

IP

$40.00

Service Code	NDC 00378698188
Hospital Revenue Code	250
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: MDX Hawaii PPO	$38.80

LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET [168911]

Facility

IP

$40.00

Service Code	NDC 65862089510
Hospital Revenue Code	250
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: MDX Hawaii PPO	$38.80

LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET [168911]

Facility

OP

$40.00

Service Code	NDC 65862089510
Hospital Revenue Code	637
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$38.80
Rate for Payer: AlohaCare Medicaid	$20.00
Rate for Payer: AlohaCare Medicare	$12.40
Rate for Payer: Cash Price	$24.00
Rate for Payer: Devoted Health Medicare	$13.60
Rate for Payer: Hawaii Medical Service Association Medicare	$12.40
Rate for Payer: Hawaii Western Management Group Commercial	$38.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Humana Medicare	$12.40
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: Kaiser Permanente Medicaid	$20.40
Rate for Payer: Kaiser Permanente Medicare	$12.40
Rate for Payer: MDX Hawaii PPO	$38.80
Rate for Payer: Ohana Health Plan Medicaid	$12.40
Rate for Payer: Ohana Health Plan Medicare	$12.40
Rate for Payer: UnitedHealthcare Medicare	$12.40
Rate for Payer: University Health Alliance Commercial	$29.16

LANSOPRAZOLE 15 MG DELAYED RELEASE,DISINTEGRATING TABLET [168911]

Facility

OP

$40.00

Service Code	NDC 00378698188
Hospital Revenue Code	637
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$38.80
Rate for Payer: AlohaCare Medicaid	$20.00
Rate for Payer: AlohaCare Medicare	$12.40
Rate for Payer: Cash Price	$24.00
Rate for Payer: Devoted Health Medicare	$13.60
Rate for Payer: Hawaii Medical Service Association Medicare	$12.40
Rate for Payer: Hawaii Western Management Group Commercial	$38.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Humana Medicare	$12.40
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: Kaiser Permanente Medicaid	$20.40
Rate for Payer: Kaiser Permanente Medicare	$12.40
Rate for Payer: MDX Hawaii PPO	$38.80
Rate for Payer: Ohana Health Plan Medicaid	$12.40
Rate for Payer: Ohana Health Plan Medicare	$12.40
Rate for Payer: UnitedHealthcare Medicare	$12.40
Rate for Payer: University Health Alliance Commercial	$29.16

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET [168912]

Facility

IP

$40.00

Service Code	NDC 00378698288
Hospital Revenue Code	250
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: MDX Hawaii PPO	$38.80

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET [168912]

Facility

IP

$40.00

Service Code	NDC 65862089678
Hospital Revenue Code	250
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: MDX Hawaii PPO	$38.80

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET [168912]

Facility

IP

$40.00

Service Code	NDC 65862089610
Hospital Revenue Code	250
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$24.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: MDX Hawaii PPO	$38.80

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET [168912]

Facility

OP

$40.00

Service Code	NDC 65862089610
Hospital Revenue Code	637
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$38.80
Rate for Payer: AlohaCare Medicaid	$20.00
Rate for Payer: AlohaCare Medicare	$12.40
Rate for Payer: Cash Price	$24.00
Rate for Payer: Devoted Health Medicare	$13.60
Rate for Payer: Hawaii Medical Service Association Medicare	$12.40
Rate for Payer: Hawaii Western Management Group Commercial	$38.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Humana Medicare	$12.40
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: Kaiser Permanente Medicaid	$20.40
Rate for Payer: Kaiser Permanente Medicare	$12.40
Rate for Payer: MDX Hawaii PPO	$38.80
Rate for Payer: Ohana Health Plan Medicaid	$12.40
Rate for Payer: Ohana Health Plan Medicare	$12.40
Rate for Payer: UnitedHealthcare Medicare	$12.40
Rate for Payer: University Health Alliance Commercial	$29.16

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET [168912]

Facility

OP

$40.00

Service Code	NDC 00378698288
Hospital Revenue Code	637
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$38.80
Rate for Payer: AlohaCare Medicaid	$20.00
Rate for Payer: AlohaCare Medicare	$12.40
Rate for Payer: Cash Price	$24.00
Rate for Payer: Devoted Health Medicare	$13.60
Rate for Payer: Hawaii Medical Service Association Medicare	$12.40
Rate for Payer: Hawaii Western Management Group Commercial	$38.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Humana Medicare	$12.40
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: Kaiser Permanente Medicaid	$20.40
Rate for Payer: Kaiser Permanente Medicare	$12.40
Rate for Payer: MDX Hawaii PPO	$38.80
Rate for Payer: Ohana Health Plan Medicaid	$12.40
Rate for Payer: Ohana Health Plan Medicare	$12.40
Rate for Payer: UnitedHealthcare Medicare	$12.40
Rate for Payer: University Health Alliance Commercial	$29.16

LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET [168912]

Facility

OP

$40.00

Service Code	NDC 65862089678
Hospital Revenue Code	637
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$38.80
Rate for Payer: AlohaCare Medicaid	$20.00
Rate for Payer: AlohaCare Medicare	$12.40
Rate for Payer: Cash Price	$24.00
Rate for Payer: Devoted Health Medicare	$13.60
Rate for Payer: Hawaii Medical Service Association Medicare	$12.40
Rate for Payer: Hawaii Western Management Group Commercial	$38.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Humana Medicare	$12.40
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: Kaiser Permanente Medicaid	$20.40
Rate for Payer: Kaiser Permanente Medicare	$12.40
Rate for Payer: MDX Hawaii PPO	$38.80
Rate for Payer: Ohana Health Plan Medicaid	$12.40
Rate for Payer: Ohana Health Plan Medicare	$12.40
Rate for Payer: UnitedHealthcare Medicare	$12.40
Rate for Payer: University Health Alliance Commercial	$29.16

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC

Facility

IP

$26,996.58

Service Code	MSDRG 418
Min. Negotiated Rate	$26,996.58
Max. Negotiated Rate	$26,996.58
Rate for Payer: Hawaii Medical Service Association Commercial	$26,996.58

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC

Facility

IP

$29,603.80

Service Code	MSDRG 417
Min. Negotiated Rate	$29,603.80
Max. Negotiated Rate	$29,603.80
Rate for Payer: Hawaii Medical Service Association Commercial	$29,603.80

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC

Facility

IP

$17,468.37

Service Code	MSDRG 419
Min. Negotiated Rate	$17,468.37
Max. Negotiated Rate	$17,468.37
Rate for Payer: Hawaii Medical Service Association Commercial	$17,468.37

LATANOPROST 0.005 % EYE DROPS [18621]

Facility

OP

$238.00

Service Code	NDC 70069042101
Hospital Revenue Code	637
Min. Negotiated Rate	$73.78
Max. Negotiated Rate	$230.86
Rate for Payer: AlohaCare Medicaid	$119.00
Rate for Payer: AlohaCare Medicare	$73.78
Rate for Payer: Cash Price	$142.80
Rate for Payer: Devoted Health Medicare	$80.92
Rate for Payer: Hawaii Medical Service Association Medicare	$73.78
Rate for Payer: Hawaii Western Management Group Commercial	$226.10
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Humana Medicare	$73.78
Rate for Payer: Kaiser Permanente Commercial	$214.20
Rate for Payer: Kaiser Permanente Medicaid	$121.38
Rate for Payer: Kaiser Permanente Medicare	$73.78
Rate for Payer: MDX Hawaii PPO	$230.86
Rate for Payer: Ohana Health Plan Medicaid	$73.78
Rate for Payer: Ohana Health Plan Medicare	$73.78
Rate for Payer: UnitedHealthcare Medicare	$73.78
Rate for Payer: University Health Alliance Commercial	$173.48

LATANOPROST 0.005 % EYE DROPS [18621]

Facility

IP

$238.00

Service Code	NDC 70069042101
Hospital Revenue Code	250
Min. Negotiated Rate	$202.30
Max. Negotiated Rate	$230.86
Rate for Payer: Cash Price	$142.80
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Kaiser Permanente Commercial	$214.20
Rate for Payer: MDX Hawaii PPO	$230.86

LATANOPROST 0.005 % EYE DROPS [18621]

Facility

IP

$32.00

Service Code	NDC 70069042103
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: Kaiser Permanente Commercial	$28.80
Rate for Payer: MDX Hawaii PPO	$31.04

LATANOPROST 0.005 % EYE DROPS [18621]

Facility

OP

$32.00

Service Code	NDC 70069042103
Hospital Revenue Code	637
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$31.04
Rate for Payer: AlohaCare Medicaid	$16.00
Rate for Payer: AlohaCare Medicare	$9.92
Rate for Payer: Cash Price	$19.20
Rate for Payer: Devoted Health Medicare	$10.88
Rate for Payer: Hawaii Medical Service Association Medicare	$9.92
Rate for Payer: Hawaii Western Management Group Commercial	$30.40
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Humana Medicare	$9.92
Rate for Payer: Kaiser Permanente Commercial	$28.80
Rate for Payer: Kaiser Permanente Medicaid	$16.32
Rate for Payer: Kaiser Permanente Medicare	$9.92
Rate for Payer: MDX Hawaii PPO	$31.04
Rate for Payer: Ohana Health Plan Medicaid	$9.92
Rate for Payer: Ohana Health Plan Medicare	$9.92
Rate for Payer: UnitedHealthcare Medicare	$9.92
Rate for Payer: University Health Alliance Commercial	$23.32

LAUNCHER BACK UP LEFT 4.5

Facility

IP

$225.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

LAUNCHER BACK UP LEFT 4.5

Facility

OP

$225.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$69.75
Rate for Payer: Cash Price	$135.00
Rate for Payer: Devoted Health Medicare	$76.50
Rate for Payer: Hawaii Medical Service Association Medicare	$69.75
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$69.75
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$69.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$69.75
Rate for Payer: Ohana Health Plan Medicare	$69.75
Rate for Payer: UnitedHealthcare Medicare	$69.75
Rate for Payer: University Health Alliance Commercial	$164.00

LAUNCHER CORONARY 7FR EBU 3.5

Facility

IP

$225.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

LAUNCHER CORONARY 7FR EBU 3.5

Facility

OP

$225.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$69.75
Rate for Payer: Cash Price	$135.00
Rate for Payer: Devoted Health Medicare	$76.50
Rate for Payer: Hawaii Medical Service Association Medicare	$69.75
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$69.75
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$69.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$69.75
Rate for Payer: Ohana Health Plan Medicare	$69.75
Rate for Payer: UnitedHealthcare Medicare	$69.75
Rate for Payer: University Health Alliance Commercial	$164.00

LAUNCHER GUIDE JR5 6FR

Facility

OP

$225.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$69.75
Rate for Payer: Cash Price	$135.00
Rate for Payer: Devoted Health Medicare	$76.50
Rate for Payer: Hawaii Medical Service Association Medicare	$69.75
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$69.75
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$69.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$69.75
Rate for Payer: Ohana Health Plan Medicare	$69.75
Rate for Payer: UnitedHealthcare Medicare	$69.75
Rate for Payer: University Health Alliance Commercial	$164.00

LAUNCHER GUIDE JR5 6FR

Facility

IP

$225.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

LAUNCHER JR 6F

Facility

OP

$225.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$69.75
Rate for Payer: Cash Price	$135.00
Rate for Payer: Devoted Health Medicare	$76.50
Rate for Payer: Hawaii Medical Service Association Medicare	$69.75
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$69.75
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$69.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$69.75
Rate for Payer: Ohana Health Plan Medicare	$69.75
Rate for Payer: UnitedHealthcare Medicare	$69.75
Rate for Payer: University Health Alliance Commercial	$164.00

LAUNCHER JR 6F

Facility

IP

$225.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

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