Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

paliperidone 156 mg/mL ER [KMC]

Facility

$7,277.83

Service Code	HCPCS J2426
Hospital Revenue Code	636
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$7,059.50
Rate for Payer: AlohaCare Medicaid	$3,638.91
Rate for Payer: AlohaCare Medicare	$3,056.69
Rate for Payer: Cash Price	$4,730.59
Rate for Payer: Cash Price	$4,730.59
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6,695.60
Rate for Payer: Devoted Health Medicare	$3,056.69
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$15.08
Rate for Payer: Hawaii Medical Service Association Commercial	$18.85
Rate for Payer: Hawaii Medical Service Association Medicare	$3,056.69
Rate for Payer: Hawaii Western Management Group Commercial	$6,913.94
Rate for Payer: Health Management Network Commercial	$6,186.16
Rate for Payer: Humana Medicare	$3,056.69
Rate for Payer: Kaiser Permanente Commercial	$6,550.05
Rate for Payer: Kaiser Permanente Medicaid	$3,711.69
Rate for Payer: Kaiser Permanente Medicare	$3,056.69
Rate for Payer: MDX Hawaii PPO	$7,059.50
Rate for Payer: Ohana Health Plan Medicaid	$3,056.69
Rate for Payer: Ohana Health Plan Medicare	$3,056.69
Rate for Payer: UnitedHealthcare Medicaid	$4,366.70
Rate for Payer: UnitedHealthcare Medicare	$3,056.69
Rate for Payer: University Health Alliance Commercial	$5,304.81

paliperidone 234 mg/1.5 mL ER [KMC]

Facility

$17,131.92

Service Code	HCPCS J2426
Hospital Revenue Code	636
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$16,617.96
Rate for Payer: AlohaCare Medicaid	$8,565.96
Rate for Payer: AlohaCare Medicare	$7,195.41
Rate for Payer: Cash Price	$11,135.75
Rate for Payer: Cash Price	$11,135.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$15,761.37
Rate for Payer: Devoted Health Medicare	$7,195.41
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$15.08
Rate for Payer: Hawaii Medical Service Association Commercial	$18.85
Rate for Payer: Hawaii Medical Service Association Medicare	$7,195.41
Rate for Payer: Hawaii Western Management Group Commercial	$16,275.32
Rate for Payer: Health Management Network Commercial	$14,562.13
Rate for Payer: Humana Medicare	$7,195.41
Rate for Payer: Kaiser Permanente Commercial	$15,418.73
Rate for Payer: Kaiser Permanente Medicaid	$8,737.28
Rate for Payer: Kaiser Permanente Medicare	$7,195.41
Rate for Payer: MDX Hawaii PPO	$16,617.96
Rate for Payer: Ohana Health Plan Medicaid	$7,195.41
Rate for Payer: Ohana Health Plan Medicare	$7,195.41
Rate for Payer: UnitedHealthcare Medicaid	$10,279.15
Rate for Payer: UnitedHealthcare Medicare	$7,195.41
Rate for Payer: University Health Alliance Commercial	$12,487.46

paliperidone 234 mg/1.5 mL ER [KMC]

Facility

$17,131.92

Service Code	HCPCS J2426
Hospital Revenue Code	636
Min. Negotiated Rate	$14,562.13
Max. Negotiated Rate	$16,617.96
Rate for Payer: Cash Price	$11,135.75
Rate for Payer: Health Management Network Commercial	$14,562.13
Rate for Payer: Kaiser Permanente Commercial	$15,418.73
Rate for Payer: MDX Hawaii PPO	$16,617.96

paliperidone 3 mg ER Tab [KMC]

Facility

$52.97

Service Code	NDC 31722031830
Hospital Revenue Code	250
Min. Negotiated Rate	$22.25
Max. Negotiated Rate	$51.38
Rate for Payer: AlohaCare Medicaid	$26.48
Rate for Payer: AlohaCare Medicare	$22.25
Rate for Payer: Cash Price	$34.43
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$48.73
Rate for Payer: Devoted Health Medicare	$22.25
Rate for Payer: Hawaii Medical Service Association Medicare	$22.25
Rate for Payer: Hawaii Western Management Group Commercial	$50.32
Rate for Payer: Health Management Network Commercial	$45.02
Rate for Payer: Humana Medicare	$22.25
Rate for Payer: Kaiser Permanente Commercial	$47.67
Rate for Payer: Kaiser Permanente Medicaid	$27.01
Rate for Payer: Kaiser Permanente Medicare	$22.25
Rate for Payer: MDX Hawaii PPO	$51.38
Rate for Payer: Ohana Health Plan Medicaid	$22.25
Rate for Payer: Ohana Health Plan Medicare	$22.25
Rate for Payer: UnitedHealthcare Medicaid	$31.78
Rate for Payer: UnitedHealthcare Medicare	$22.25
Rate for Payer: University Health Alliance Commercial	$38.61

paliperidone 3 mg ER Tab [KMC]

Facility

$52.97

Service Code	NDC 31722031830
Hospital Revenue Code	250
Min. Negotiated Rate	$45.02
Max. Negotiated Rate	$51.38
Rate for Payer: Cash Price	$34.43
Rate for Payer: Health Management Network Commercial	$45.02
Rate for Payer: Kaiser Permanente Commercial	$47.67
Rate for Payer: MDX Hawaii PPO	$51.38

paliperidone 410 mg/1.315 mL ER [KMC]

Facility

$15,359.79

Service Code	HCPCS J2426
Hospital Revenue Code	636
Min. Negotiated Rate	$13,055.82
Max. Negotiated Rate	$14,899.00
Rate for Payer: Cash Price	$9,983.86
Rate for Payer: Health Management Network Commercial	$13,055.82
Rate for Payer: Kaiser Permanente Commercial	$13,823.81
Rate for Payer: MDX Hawaii PPO	$14,899.00

paliperidone 410 mg/1.315 mL ER [KMC]

Facility

$15,359.79

Service Code	HCPCS J2426
Hospital Revenue Code	636
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$14,899.00
Rate for Payer: AlohaCare Medicaid	$7,679.90
Rate for Payer: AlohaCare Medicare	$6,451.11
Rate for Payer: Cash Price	$9,983.86
Rate for Payer: Cash Price	$9,983.86
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$14,131.01
Rate for Payer: Devoted Health Medicare	$6,451.11
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$15.08
Rate for Payer: Hawaii Medical Service Association Commercial	$18.85
Rate for Payer: Hawaii Medical Service Association Medicare	$6,451.11
Rate for Payer: Hawaii Western Management Group Commercial	$14,591.80
Rate for Payer: Health Management Network Commercial	$13,055.82
Rate for Payer: Humana Medicare	$6,451.11
Rate for Payer: Kaiser Permanente Commercial	$13,823.81
Rate for Payer: Kaiser Permanente Medicaid	$7,833.49
Rate for Payer: Kaiser Permanente Medicare	$6,451.11
Rate for Payer: MDX Hawaii PPO	$14,899.00
Rate for Payer: Ohana Health Plan Medicaid	$6,451.11
Rate for Payer: Ohana Health Plan Medicare	$6,451.11
Rate for Payer: UnitedHealthcare Medicaid	$9,215.87
Rate for Payer: UnitedHealthcare Medicare	$6,451.11
Rate for Payer: University Health Alliance Commercial	$11,195.75

paliperidone 6 mg ER Tab [KMC]

Facility

$122.15

Service Code	NDC 16714086801
Hospital Revenue Code	250
Min. Negotiated Rate	$103.83
Max. Negotiated Rate	$118.49
Rate for Payer: Cash Price	$79.40
Rate for Payer: Health Management Network Commercial	$103.83
Rate for Payer: Kaiser Permanente Commercial	$109.94
Rate for Payer: MDX Hawaii PPO	$118.49

paliperidone 6 mg ER Tab [KMC]

Facility

$122.15

Service Code	NDC 16714086801
Hospital Revenue Code	250
Min. Negotiated Rate	$51.30
Max. Negotiated Rate	$118.49
Rate for Payer: AlohaCare Medicaid	$61.08
Rate for Payer: AlohaCare Medicare	$51.30
Rate for Payer: Cash Price	$79.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$112.38
Rate for Payer: Devoted Health Medicare	$51.30
Rate for Payer: Hawaii Medical Service Association Medicare	$51.30
Rate for Payer: Hawaii Western Management Group Commercial	$116.04
Rate for Payer: Health Management Network Commercial	$103.83
Rate for Payer: Humana Medicare	$51.30
Rate for Payer: Kaiser Permanente Commercial	$109.94
Rate for Payer: Kaiser Permanente Medicaid	$62.30
Rate for Payer: Kaiser Permanente Medicare	$51.30
Rate for Payer: MDX Hawaii PPO	$118.49
Rate for Payer: Ohana Health Plan Medicaid	$51.30
Rate for Payer: Ohana Health Plan Medicare	$51.30
Rate for Payer: UnitedHealthcare Medicaid	$73.29
Rate for Payer: UnitedHealthcare Medicare	$51.30
Rate for Payer: University Health Alliance Commercial	$89.04

paliperidone 9 mg ER tab [KMC]

Facility

$183.17

Service Code	NDC 10147095403
Hospital Revenue Code	250
Min. Negotiated Rate	$76.93
Max. Negotiated Rate	$177.67
Rate for Payer: AlohaCare Medicaid	$91.58
Rate for Payer: AlohaCare Medicare	$76.93
Rate for Payer: Cash Price	$119.06
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$168.52
Rate for Payer: Devoted Health Medicare	$76.93
Rate for Payer: Hawaii Medical Service Association Medicare	$76.93
Rate for Payer: Hawaii Western Management Group Commercial	$174.01
Rate for Payer: Health Management Network Commercial	$155.69
Rate for Payer: Humana Medicare	$76.93
Rate for Payer: Kaiser Permanente Commercial	$164.85
Rate for Payer: Kaiser Permanente Medicaid	$93.42
Rate for Payer: Kaiser Permanente Medicare	$76.93
Rate for Payer: MDX Hawaii PPO	$177.67
Rate for Payer: Ohana Health Plan Medicaid	$76.93
Rate for Payer: Ohana Health Plan Medicare	$76.93
Rate for Payer: UnitedHealthcare Medicaid	$109.90
Rate for Payer: UnitedHealthcare Medicare	$76.93
Rate for Payer: University Health Alliance Commercial	$133.51

paliperidone 9 mg ER tab [KMC]

Facility

$183.17

Service Code	NDC 10147095403
Hospital Revenue Code	250
Min. Negotiated Rate	$155.69
Max. Negotiated Rate	$177.67
Rate for Payer: Cash Price	$119.06
Rate for Payer: Health Management Network Commercial	$155.69
Rate for Payer: Kaiser Permanente Commercial	$164.85
Rate for Payer: MDX Hawaii PPO	$177.67

PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC

Facility

$51,646.66

Service Code	MSDRG 406
Min. Negotiated Rate	$51,646.66
Max. Negotiated Rate	$51,646.66
Rate for Payer: Hawaii Medical Service Association Commercial	$51,646.66

PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC

Facility

$93,433.28

Service Code	MSDRG 405
Min. Negotiated Rate	$93,433.28
Max. Negotiated Rate	$93,433.28
Rate for Payer: Hawaii Medical Service Association Commercial	$93,433.28

PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC

Facility

$37,022.52

Service Code	MSDRG 407
Min. Negotiated Rate	$37,022.52
Max. Negotiated Rate	$37,022.52
Rate for Payer: Hawaii Medical Service Association Commercial	$37,022.52

PANCREAS TRANSPLANT

Facility

$10,400.00

Service Code	MSDRG 010
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$10,400.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

pancrelipase 12k - 38k - 60k units DR cap [KMC]

Facility

$17.03

Service Code	NDC 00032121201
Hospital Revenue Code	250
Min. Negotiated Rate	$14.48
Max. Negotiated Rate	$16.52
Rate for Payer: Cash Price	$11.07
Rate for Payer: Health Management Network Commercial	$14.48
Rate for Payer: Kaiser Permanente Commercial	$15.33
Rate for Payer: MDX Hawaii PPO	$16.52

pancrelipase 12k - 38k - 60k units DR cap [KMC]

Facility

$17.03

Service Code	NDC 00032121201
Hospital Revenue Code	250
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$16.52
Rate for Payer: AlohaCare Medicaid	$8.52
Rate for Payer: AlohaCare Medicare	$7.15
Rate for Payer: Cash Price	$11.07
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$15.67
Rate for Payer: Devoted Health Medicare	$7.15
Rate for Payer: Hawaii Medical Service Association Medicare	$7.15
Rate for Payer: Hawaii Western Management Group Commercial	$16.18
Rate for Payer: Health Management Network Commercial	$14.48
Rate for Payer: Humana Medicare	$7.15
Rate for Payer: Kaiser Permanente Commercial	$15.33
Rate for Payer: Kaiser Permanente Medicaid	$8.69
Rate for Payer: Kaiser Permanente Medicare	$7.15
Rate for Payer: MDX Hawaii PPO	$16.52
Rate for Payer: Ohana Health Plan Medicaid	$7.15
Rate for Payer: Ohana Health Plan Medicare	$7.15
Rate for Payer: UnitedHealthcare Medicaid	$10.22
Rate for Payer: UnitedHealthcare Medicare	$7.15
Rate for Payer: University Health Alliance Commercial	$12.41

pancrelipase 24k - 76k - 120k units DR Cap [KMC]

Facility

$40.82

Service Code	NDC 00032263601
Hospital Revenue Code	250
Min. Negotiated Rate	$34.70
Max. Negotiated Rate	$39.60
Rate for Payer: Cash Price	$26.53
Rate for Payer: Health Management Network Commercial	$34.70
Rate for Payer: Kaiser Permanente Commercial	$36.74
Rate for Payer: MDX Hawaii PPO	$39.60

pancrelipase 24k - 76k - 120k units DR Cap [KMC]

Facility

$40.82

Service Code	NDC 00032263601
Hospital Revenue Code	250
Min. Negotiated Rate	$17.14
Max. Negotiated Rate	$39.60
Rate for Payer: AlohaCare Medicaid	$20.41
Rate for Payer: AlohaCare Medicare	$17.14
Rate for Payer: Cash Price	$26.53
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$37.55
Rate for Payer: Devoted Health Medicare	$17.14
Rate for Payer: Hawaii Medical Service Association Medicare	$17.14
Rate for Payer: Hawaii Western Management Group Commercial	$38.78
Rate for Payer: Health Management Network Commercial	$34.70
Rate for Payer: Humana Medicare	$17.14
Rate for Payer: Kaiser Permanente Commercial	$36.74
Rate for Payer: Kaiser Permanente Medicaid	$20.82
Rate for Payer: Kaiser Permanente Medicare	$17.14
Rate for Payer: MDX Hawaii PPO	$39.60
Rate for Payer: Ohana Health Plan Medicaid	$17.14
Rate for Payer: Ohana Health Plan Medicare	$17.14
Rate for Payer: UnitedHealthcare Medicaid	$24.49
Rate for Payer: UnitedHealthcare Medicare	$17.14
Rate for Payer: University Health Alliance Commercial	$29.75

pancrelipase 36,000 -114,000 -180,000 units DR cap [KMC]

Facility

$39.41

Service Code	NDC 00032301613
Hospital Revenue Code	250
Min. Negotiated Rate	$16.55
Max. Negotiated Rate	$38.23
Rate for Payer: AlohaCare Medicaid	$19.70
Rate for Payer: AlohaCare Medicare	$16.55
Rate for Payer: Cash Price	$25.62
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$36.26
Rate for Payer: Devoted Health Medicare	$16.55
Rate for Payer: Hawaii Medical Service Association Medicare	$16.55
Rate for Payer: Hawaii Western Management Group Commercial	$37.44
Rate for Payer: Health Management Network Commercial	$33.50
Rate for Payer: Humana Medicare	$16.55
Rate for Payer: Kaiser Permanente Commercial	$35.47
Rate for Payer: Kaiser Permanente Medicaid	$20.10
Rate for Payer: Kaiser Permanente Medicare	$16.55
Rate for Payer: MDX Hawaii PPO	$38.23
Rate for Payer: Ohana Health Plan Medicaid	$16.55
Rate for Payer: Ohana Health Plan Medicare	$16.55
Rate for Payer: UnitedHealthcare Medicaid	$23.65
Rate for Payer: UnitedHealthcare Medicare	$16.55
Rate for Payer: University Health Alliance Commercial	$28.73

pancrelipase 36,000 -114,000 -180,000 units DR cap [KMC]

Facility

$39.41

Service Code	NDC 00032301613
Hospital Revenue Code	250
Min. Negotiated Rate	$33.50
Max. Negotiated Rate	$38.23
Rate for Payer: Cash Price	$25.62
Rate for Payer: Health Management Network Commercial	$33.50
Rate for Payer: Kaiser Permanente Commercial	$35.47
Rate for Payer: MDX Hawaii PPO	$38.23

pancrelipase 5,000 -17,000 - 24,000 units DR cap [KMC]

Facility

$9.26

Service Code	NDC 73562011501
Hospital Revenue Code	250
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$8.98
Rate for Payer: AlohaCare Medicaid	$4.63
Rate for Payer: AlohaCare Medicare	$3.89
Rate for Payer: Cash Price	$6.02
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$8.52
Rate for Payer: Devoted Health Medicare	$3.89
Rate for Payer: Hawaii Medical Service Association Medicare	$3.89
Rate for Payer: Hawaii Western Management Group Commercial	$8.80
Rate for Payer: Health Management Network Commercial	$7.87
Rate for Payer: Humana Medicare	$3.89
Rate for Payer: Kaiser Permanente Commercial	$8.33
Rate for Payer: Kaiser Permanente Medicaid	$4.72
Rate for Payer: Kaiser Permanente Medicare	$3.89
Rate for Payer: MDX Hawaii PPO	$8.98
Rate for Payer: Ohana Health Plan Medicaid	$3.89
Rate for Payer: Ohana Health Plan Medicare	$3.89
Rate for Payer: UnitedHealthcare Medicaid	$5.56
Rate for Payer: UnitedHealthcare Medicare	$3.89
Rate for Payer: University Health Alliance Commercial	$6.75

pancrelipase 5,000 -17,000 - 24,000 units DR cap [KMC]

Facility

$9.26

Service Code	NDC 73562011501
Hospital Revenue Code	250
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$8.98
Rate for Payer: Cash Price	$6.02
Rate for Payer: Health Management Network Commercial	$7.87
Rate for Payer: Kaiser Permanente Commercial	$8.33
Rate for Payer: MDX Hawaii PPO	$8.98

pancrelipase 6,000 -19,000 -30,000 units DR cap [KMC]

Facility

$6.17

Service Code	NDC 00032120601
Hospital Revenue Code	250
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$5.98
Rate for Payer: Cash Price	$4.01
Rate for Payer: Health Management Network Commercial	$5.24
Rate for Payer: Kaiser Permanente Commercial	$5.55
Rate for Payer: MDX Hawaii PPO	$5.98

pancrelipase 6,000 -19,000 -30,000 units DR cap [KMC]

Facility

$6.17

Service Code	NDC 00032120601
Hospital Revenue Code	250
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$5.98
Rate for Payer: AlohaCare Medicaid	$3.08
Rate for Payer: AlohaCare Medicare	$2.59
Rate for Payer: Cash Price	$4.01
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.68
Rate for Payer: Devoted Health Medicare	$2.59
Rate for Payer: Hawaii Medical Service Association Medicare	$2.59
Rate for Payer: Hawaii Western Management Group Commercial	$5.86
Rate for Payer: Health Management Network Commercial	$5.24
Rate for Payer: Humana Medicare	$2.59
Rate for Payer: Kaiser Permanente Commercial	$5.55
Rate for Payer: Kaiser Permanente Medicaid	$3.15
Rate for Payer: Kaiser Permanente Medicare	$2.59
Rate for Payer: MDX Hawaii PPO	$5.98
Rate for Payer: Ohana Health Plan Medicaid	$2.59
Rate for Payer: Ohana Health Plan Medicare	$2.59
Rate for Payer: UnitedHealthcare Medicaid	$3.70
Rate for Payer: UnitedHealthcare Medicare	$2.59
Rate for Payer: University Health Alliance Commercial	$4.50

Know your out-of-pocket cost for care.

All Charges