Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

phytonadione 5 mg Tab [KMC]

Facility

$267.95

Service Code	NDC 69097099902
Hospital Revenue Code	250
Min. Negotiated Rate	$227.76
Max. Negotiated Rate	$259.91
Rate for Payer: Cash Price	$174.17
Rate for Payer: Health Management Network Commercial	$227.76
Rate for Payer: Kaiser Permanente Commercial	$241.16
Rate for Payer: MDX Hawaii PPO	$259.91

phytonadione 5 mg Tab [KMC]

Facility

$267.95

Service Code	NDC 69097099902
Hospital Revenue Code	250
Min. Negotiated Rate	$112.54
Max. Negotiated Rate	$259.91
Rate for Payer: AlohaCare Medicaid	$133.97
Rate for Payer: AlohaCare Medicare	$112.54
Rate for Payer: Cash Price	$174.17
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$246.51
Rate for Payer: Devoted Health Medicare	$112.54
Rate for Payer: Hawaii Medical Service Association Medicare	$112.54
Rate for Payer: Hawaii Western Management Group Commercial	$254.55
Rate for Payer: Health Management Network Commercial	$227.76
Rate for Payer: Humana Medicare	$112.54
Rate for Payer: Kaiser Permanente Commercial	$241.16
Rate for Payer: Kaiser Permanente Medicaid	$136.65
Rate for Payer: Kaiser Permanente Medicare	$112.54
Rate for Payer: MDX Hawaii PPO	$259.91
Rate for Payer: Ohana Health Plan Medicaid	$112.54
Rate for Payer: Ohana Health Plan Medicare	$112.54
Rate for Payer: UnitedHealthcare Medicaid	$160.77
Rate for Payer: UnitedHealthcare Medicare	$112.54
Rate for Payer: University Health Alliance Commercial	$195.31

pilocarpine 5 mg Tab [KMC]

Facility

$7.26

Service Code	NDC 00527131301
Hospital Revenue Code	250
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$7.04
Rate for Payer: AlohaCare Medicaid	$3.63
Rate for Payer: AlohaCare Medicare	$3.05
Rate for Payer: Cash Price	$4.72
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6.68
Rate for Payer: Devoted Health Medicare	$3.05
Rate for Payer: Hawaii Medical Service Association Medicare	$3.05
Rate for Payer: Hawaii Western Management Group Commercial	$6.90
Rate for Payer: Health Management Network Commercial	$6.17
Rate for Payer: Humana Medicare	$3.05
Rate for Payer: Kaiser Permanente Commercial	$6.53
Rate for Payer: Kaiser Permanente Medicaid	$3.70
Rate for Payer: Kaiser Permanente Medicare	$3.05
Rate for Payer: MDX Hawaii PPO	$7.04
Rate for Payer: Ohana Health Plan Medicaid	$3.05
Rate for Payer: Ohana Health Plan Medicare	$3.05
Rate for Payer: UnitedHealthcare Medicaid	$4.36
Rate for Payer: UnitedHealthcare Medicare	$3.05
Rate for Payer: University Health Alliance Commercial	$5.29

pilocarpine 5 mg Tab [KMC]

Facility

$7.26

Service Code	NDC 00527131301
Hospital Revenue Code	250
Min. Negotiated Rate	$6.17
Max. Negotiated Rate	$7.04
Rate for Payer: Cash Price	$4.72
Rate for Payer: Health Management Network Commercial	$6.17
Rate for Payer: Kaiser Permanente Commercial	$6.53
Rate for Payer: MDX Hawaii PPO	$7.04

pioglitazone 15 mg Tab [KMC]

Facility

$28.04

Service Code	NDC 16714064502
Hospital Revenue Code	250
Min. Negotiated Rate	$23.83
Max. Negotiated Rate	$27.20
Rate for Payer: Cash Price	$18.23
Rate for Payer: Health Management Network Commercial	$23.83
Rate for Payer: Kaiser Permanente Commercial	$25.24
Rate for Payer: MDX Hawaii PPO	$27.20

pioglitazone 15 mg Tab [KMC]

Facility

$28.04

Service Code	NDC 16714064502
Hospital Revenue Code	250
Min. Negotiated Rate	$11.78
Max. Negotiated Rate	$27.20
Rate for Payer: AlohaCare Medicaid	$14.02
Rate for Payer: AlohaCare Medicare	$11.78
Rate for Payer: Cash Price	$18.23
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$25.80
Rate for Payer: Devoted Health Medicare	$11.78
Rate for Payer: Hawaii Medical Service Association Medicare	$11.78
Rate for Payer: Hawaii Western Management Group Commercial	$26.64
Rate for Payer: Health Management Network Commercial	$23.83
Rate for Payer: Humana Medicare	$11.78
Rate for Payer: Kaiser Permanente Commercial	$25.24
Rate for Payer: Kaiser Permanente Medicaid	$14.30
Rate for Payer: Kaiser Permanente Medicare	$11.78
Rate for Payer: MDX Hawaii PPO	$27.20
Rate for Payer: Ohana Health Plan Medicaid	$11.78
Rate for Payer: Ohana Health Plan Medicare	$11.78
Rate for Payer: UnitedHealthcare Medicaid	$16.82
Rate for Payer: UnitedHealthcare Medicare	$11.78
Rate for Payer: University Health Alliance Commercial	$20.44

piperacillin-tazobactam 2 g-0.25 g IV Inj [KMC]

Facility

$49.23

Service Code	HCPCS J2543
Hospital Revenue Code	636
Min. Negotiated Rate	$41.85
Max. Negotiated Rate	$47.75
Rate for Payer: Cash Price	$32.00
Rate for Payer: Health Management Network Commercial	$41.85
Rate for Payer: Kaiser Permanente Commercial	$44.31
Rate for Payer: MDX Hawaii PPO	$47.75

piperacillin-tazobactam 2 g-0.25 g IV Inj [KMC]

Facility

$49.23

Service Code	HCPCS J2543
Hospital Revenue Code	636
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$47.75
Rate for Payer: AlohaCare Medicaid	$24.61
Rate for Payer: AlohaCare Medicare	$20.68
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$45.29
Rate for Payer: Devoted Health Medicare	$20.68
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$1.11
Rate for Payer: Hawaii Medical Service Association Medicare	$20.68
Rate for Payer: Hawaii Western Management Group Commercial	$46.77
Rate for Payer: Health Management Network Commercial	$41.85
Rate for Payer: Humana Medicare	$20.68
Rate for Payer: Kaiser Permanente Commercial	$44.31
Rate for Payer: Kaiser Permanente Medicaid	$25.11
Rate for Payer: Kaiser Permanente Medicare	$20.68
Rate for Payer: MDX Hawaii PPO	$47.75
Rate for Payer: Ohana Health Plan Medicaid	$20.68
Rate for Payer: Ohana Health Plan Medicare	$20.68
Rate for Payer: UnitedHealthcare Medicaid	$29.54
Rate for Payer: UnitedHealthcare Medicare	$20.68
Rate for Payer: University Health Alliance Commercial	$35.88

piperacillin-tazobactam 3 g-0.375 g IV Inj [KMC]

Facility

$24.72

Service Code	HCPCS J2543
Hospital Revenue Code	636
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$23.98
Rate for Payer: AlohaCare Medicaid	$12.36
Rate for Payer: AlohaCare Medicare	$10.38
Rate for Payer: Cash Price	$16.07
Rate for Payer: Cash Price	$16.07
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$22.74
Rate for Payer: Devoted Health Medicare	$10.38
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$1.11
Rate for Payer: Hawaii Medical Service Association Medicare	$10.38
Rate for Payer: Hawaii Western Management Group Commercial	$23.48
Rate for Payer: Health Management Network Commercial	$21.01
Rate for Payer: Humana Medicare	$10.38
Rate for Payer: Kaiser Permanente Commercial	$22.25
Rate for Payer: Kaiser Permanente Medicaid	$12.61
Rate for Payer: Kaiser Permanente Medicare	$10.38
Rate for Payer: MDX Hawaii PPO	$23.98
Rate for Payer: Ohana Health Plan Medicaid	$10.38
Rate for Payer: Ohana Health Plan Medicare	$10.38
Rate for Payer: UnitedHealthcare Medicaid	$14.83
Rate for Payer: UnitedHealthcare Medicare	$10.38
Rate for Payer: University Health Alliance Commercial	$18.02

piperacillin-tazobactam 3 g-0.375 g IV Inj [KMC]

Facility

$24.72

Service Code	HCPCS J2543
Hospital Revenue Code	636
Min. Negotiated Rate	$21.01
Max. Negotiated Rate	$23.98
Rate for Payer: Cash Price	$16.07
Rate for Payer: Health Management Network Commercial	$21.01
Rate for Payer: Kaiser Permanente Commercial	$22.25
Rate for Payer: MDX Hawaii PPO	$23.98

piperacillin-tazobactam 4 g-0.5 g IV Inj [KMC]

Facility

$86.80

Service Code	HCPCS J2543
Hospital Revenue Code	636
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$84.20
Rate for Payer: AlohaCare Medicaid	$43.40
Rate for Payer: AlohaCare Medicare	$36.46
Rate for Payer: Cash Price	$56.42
Rate for Payer: Cash Price	$56.42
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$79.86
Rate for Payer: Devoted Health Medicare	$36.46
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$1.11
Rate for Payer: Hawaii Medical Service Association Medicare	$36.46
Rate for Payer: Hawaii Western Management Group Commercial	$82.46
Rate for Payer: Health Management Network Commercial	$73.78
Rate for Payer: Humana Medicare	$36.46
Rate for Payer: Kaiser Permanente Commercial	$78.12
Rate for Payer: Kaiser Permanente Medicaid	$44.27
Rate for Payer: Kaiser Permanente Medicare	$36.46
Rate for Payer: MDX Hawaii PPO	$84.20
Rate for Payer: Ohana Health Plan Medicaid	$36.46
Rate for Payer: Ohana Health Plan Medicare	$36.46
Rate for Payer: UnitedHealthcare Medicaid	$52.08
Rate for Payer: UnitedHealthcare Medicare	$36.46
Rate for Payer: University Health Alliance Commercial	$63.27

piperacillin-tazobactam 4 g-0.5 g IV Inj [KMC]

Facility

$86.80

Service Code	HCPCS J2543
Hospital Revenue Code	636
Min. Negotiated Rate	$73.78
Max. Negotiated Rate	$84.20
Rate for Payer: Cash Price	$56.42
Rate for Payer: Health Management Network Commercial	$73.78
Rate for Payer: Kaiser Permanente Commercial	$78.12
Rate for Payer: MDX Hawaii PPO	$84.20

PLAN OF CARE TO ADDRESS PAIN DOCUMENTED

Professional

Both

$0.01

Service Code	HCPCS 0521F
Hospital Revenue Code	521
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$290.48
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$273.13

Platelet Count

Facility

$69.00

Service Code	HCPCS 85032
Hospital Charge Code	422850320
Hospital Revenue Code	305
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$44.85
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: MDX Hawaii PPO	$66.93

Platelet Count

Facility

$69.00

Service Code	HCPCS 85032
Hospital Charge Code	422850320
Hospital Revenue Code	305
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$66.93
Rate for Payer: AlohaCare Medicaid	$34.50
Rate for Payer: AlohaCare Medicare	$28.98
Rate for Payer: Cash Price	$44.85
Rate for Payer: Cash Price	$44.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$63.48
Rate for Payer: Devoted Health Medicare	$28.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$6.01
Rate for Payer: Hawaii Medical Service Association Commercial	$5.39
Rate for Payer: Hawaii Medical Service Association Medicare	$28.98
Rate for Payer: Hawaii Western Management Group Commercial	$4.31
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Humana Medicare	$28.98
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: Kaiser Permanente Medicaid	$35.19
Rate for Payer: Kaiser Permanente Medicare	$28.98
Rate for Payer: MDX Hawaii PPO	$66.93
Rate for Payer: Ohana Health Plan Medicaid	$28.98
Rate for Payer: Ohana Health Plan Medicare	$28.98
Rate for Payer: UnitedHealthcare Medicaid	$6.01
Rate for Payer: UnitedHealthcare Medicare	$28.98
Rate for Payer: University Health Alliance Commercial	$11.12

Platelet (ESTM)

Facility

$67.00

Service Code	HCPCS 85049
Hospital Charge Code	422850490
Hospital Revenue Code	305
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$64.99
Rate for Payer: AlohaCare Medicaid	$33.50
Rate for Payer: AlohaCare Medicare	$28.14
Rate for Payer: Cash Price	$43.55
Rate for Payer: Cash Price	$43.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$61.64
Rate for Payer: Devoted Health Medicare	$28.14
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$6.25
Rate for Payer: Hawaii Medical Service Association Commercial	$5.60
Rate for Payer: Hawaii Medical Service Association Medicare	$28.14
Rate for Payer: Hawaii Western Management Group Commercial	$4.48
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: Humana Medicare	$28.14
Rate for Payer: Kaiser Permanente Commercial	$60.30
Rate for Payer: Kaiser Permanente Medicaid	$34.17
Rate for Payer: Kaiser Permanente Medicare	$28.14
Rate for Payer: MDX Hawaii PPO	$64.99
Rate for Payer: Ohana Health Plan Medicaid	$28.14
Rate for Payer: Ohana Health Plan Medicare	$28.14
Rate for Payer: UnitedHealthcare Medicaid	$6.25
Rate for Payer: UnitedHealthcare Medicare	$28.14
Rate for Payer: University Health Alliance Commercial	$11.56

Platelet (ESTM)

Facility

$67.00

Service Code	HCPCS 85049
Hospital Charge Code	422850490
Hospital Revenue Code	305
Min. Negotiated Rate	$56.95
Max. Negotiated Rate	$64.99
Rate for Payer: Cash Price	$43.55
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: Kaiser Permanente Commercial	$60.30
Rate for Payer: MDX Hawaii PPO	$64.99

Plethysmography KHKU

Facility

$433.00

Service Code	HCPCS 94726
Hospital Charge Code	429947260
Hospital Revenue Code	460
Min. Negotiated Rate	$368.05
Max. Negotiated Rate	$420.01
Rate for Payer: Cash Price	$281.45
Rate for Payer: Health Management Network Commercial	$368.05
Rate for Payer: Kaiser Permanente Commercial	$389.70
Rate for Payer: MDX Hawaii PPO	$420.01

Plethysmography KHKU

Facility

$433.00

Service Code	HCPCS 94726
Hospital Charge Code	429947260
Hospital Revenue Code	460
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$551.04
Rate for Payer: AlohaCare Medicaid	$216.50
Rate for Payer: AlohaCare Medicare	$181.86
Rate for Payer: Cash Price	$281.45
Rate for Payer: Cash Price	$281.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$398.36
Rate for Payer: Devoted Health Medicare	$181.86
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$28.57
Rate for Payer: Hawaii Medical Service Association Commercial	$551.04
Rate for Payer: Hawaii Medical Service Association Medicare	$181.86
Rate for Payer: Hawaii Western Management Group Commercial	$411.35
Rate for Payer: Health Management Network Commercial	$368.05
Rate for Payer: Humana Medicare	$181.86
Rate for Payer: Kaiser Permanente Commercial	$389.70
Rate for Payer: Kaiser Permanente Medicaid	$220.83
Rate for Payer: Kaiser Permanente Medicare	$181.86
Rate for Payer: MDX Hawaii PPO	$420.01
Rate for Payer: Ohana Health Plan Medicaid	$181.86
Rate for Payer: Ohana Health Plan Medicare	$181.86
Rate for Payer: UnitedHealthcare Medicaid	$28.57
Rate for Payer: UnitedHealthcare Medicare	$181.86
Rate for Payer: University Health Alliance Commercial	$315.61

PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST

Professional

Both

$412.00

Service Code	HCPCS 94726
Hospital Revenue Code	410
Min. Negotiated Rate	$60.23
Max. Negotiated Rate	$350.20
Rate for Payer: AlohaCare Medicaid	$62.38
Rate for Payer: AlohaCare Medicare	$70.83
Rate for Payer: Cash Price	$267.80
Rate for Payer: Cash Price	$267.80
Rate for Payer: Devoted Health Medicare	$70.83
Rate for Payer: Hawaii Medical Service Association Medicare	$70.83
Rate for Payer: Hawaii Western Management Group Commercial	$60.23
Rate for Payer: Health Management Network Commercial	$350.20
Rate for Payer: Kaiser Permanente Commercial	$85.00
Rate for Payer: Kaiser Permanente Medicaid	$85.00
Rate for Payer: Kaiser Permanente Medicare	$85.00
Rate for Payer: Ohana Health Plan Medicaid	$62.38
Rate for Payer: Ohana Health Plan Medicare	$70.83
Rate for Payer: UnitedHealthcare Medicaid	$62.38
Rate for Payer: UnitedHealthcare Medicare	$70.83

PLEURAL EFFUSION WITH CC

Facility

$27,565.43

Service Code	MSDRG 187
Min. Negotiated Rate	$27,565.43
Max. Negotiated Rate	$27,565.43
Rate for Payer: Hawaii Medical Service Association Commercial	$27,565.43

PLEURAL EFFUSION WITH MCC

Facility

$28,205.38

Service Code	MSDRG 186
Min. Negotiated Rate	$28,205.38
Max. Negotiated Rate	$28,205.38
Rate for Payer: Hawaii Medical Service Association Commercial	$28,205.38

PLEURAL EFFUSION WITHOUT CC/MCC

Facility

$22,516.90

Service Code	MSDRG 188
Min. Negotiated Rate	$22,516.90
Max. Negotiated Rate	$22,516.90
Rate for Payer: Hawaii Medical Service Association Commercial	$22,516.90

pneumococcal 20-valent conjugate vaccine 0.5 mL susp [KMC]

Facility

$2,582.50

Service Code	NDC 00005200002
Hospital Revenue Code	250
Min. Negotiated Rate	$1,084.65
Max. Negotiated Rate	$2,505.03
Rate for Payer: AlohaCare Medicaid	$1,291.25
Rate for Payer: AlohaCare Medicare	$1,084.65
Rate for Payer: Cash Price	$1,678.62
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2,375.90
Rate for Payer: Devoted Health Medicare	$1,084.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1,084.65
Rate for Payer: Hawaii Western Management Group Commercial	$2,453.38
Rate for Payer: Health Management Network Commercial	$2,195.12
Rate for Payer: Humana Medicare	$1,084.65
Rate for Payer: Kaiser Permanente Commercial	$2,324.25
Rate for Payer: Kaiser Permanente Medicaid	$1,317.08
Rate for Payer: Kaiser Permanente Medicare	$1,084.65
Rate for Payer: MDX Hawaii PPO	$2,505.03
Rate for Payer: Ohana Health Plan Medicaid	$1,084.65
Rate for Payer: Ohana Health Plan Medicare	$1,084.65
Rate for Payer: UnitedHealthcare Medicaid	$1,549.50
Rate for Payer: UnitedHealthcare Medicare	$1,084.65
Rate for Payer: University Health Alliance Commercial	$1,882.38

pneumococcal 20-valent conjugate vaccine 0.5 mL susp [KMC]

Facility

$2,582.50

Service Code	NDC 00005200002
Hospital Revenue Code	250
Min. Negotiated Rate	$2,195.12
Max. Negotiated Rate	$2,505.03
Rate for Payer: Cash Price	$1,678.62
Rate for Payer: Health Management Network Commercial	$2,195.12
Rate for Payer: Kaiser Permanente Commercial	$2,324.25
Rate for Payer: MDX Hawaii PPO	$2,505.03

Know your out-of-pocket cost for care.

All Charges