Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

prasugrel 10 mg Tab [KMC]

Facility

$66.02

Service Code	NDC 60505464303
Hospital Revenue Code	250
Min. Negotiated Rate	$27.73
Max. Negotiated Rate	$64.04
Rate for Payer: AlohaCare Medicaid	$33.01
Rate for Payer: AlohaCare Medicare	$27.73
Rate for Payer: Cash Price	$42.91
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$60.74
Rate for Payer: Devoted Health Medicare	$27.73
Rate for Payer: Hawaii Medical Service Association Medicare	$27.73
Rate for Payer: Hawaii Western Management Group Commercial	$62.72
Rate for Payer: Health Management Network Commercial	$56.12
Rate for Payer: Humana Medicare	$27.73
Rate for Payer: Kaiser Permanente Commercial	$59.42
Rate for Payer: Kaiser Permanente Medicaid	$33.67
Rate for Payer: Kaiser Permanente Medicare	$27.73
Rate for Payer: MDX Hawaii PPO	$64.04
Rate for Payer: Ohana Health Plan Medicaid	$27.73
Rate for Payer: Ohana Health Plan Medicare	$27.73
Rate for Payer: UnitedHealthcare Medicaid	$39.61
Rate for Payer: UnitedHealthcare Medicare	$27.73
Rate for Payer: University Health Alliance Commercial	$48.12

prasugrel 10 mg Tab [KMC]

Facility

$66.02

Service Code	NDC 60505464303
Hospital Revenue Code	250
Min. Negotiated Rate	$56.12
Max. Negotiated Rate	$64.04
Rate for Payer: Cash Price	$42.91
Rate for Payer: Health Management Network Commercial	$56.12
Rate for Payer: Kaiser Permanente Commercial	$59.42
Rate for Payer: MDX Hawaii PPO	$64.04

pravastatin 10 mg Tab [KMC]

Facility

$12.86

Service Code	NDC 16714055801
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$12.47
Rate for Payer: AlohaCare Medicaid	$6.43
Rate for Payer: AlohaCare Medicare	$5.40
Rate for Payer: Cash Price	$8.36
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$11.83
Rate for Payer: Devoted Health Medicare	$5.40
Rate for Payer: Hawaii Medical Service Association Medicare	$5.40
Rate for Payer: Hawaii Western Management Group Commercial	$12.22
Rate for Payer: Health Management Network Commercial	$10.93
Rate for Payer: Humana Medicare	$5.40
Rate for Payer: Kaiser Permanente Commercial	$11.57
Rate for Payer: Kaiser Permanente Medicaid	$6.56
Rate for Payer: Kaiser Permanente Medicare	$5.40
Rate for Payer: MDX Hawaii PPO	$12.47
Rate for Payer: Ohana Health Plan Medicaid	$5.40
Rate for Payer: Ohana Health Plan Medicare	$5.40
Rate for Payer: UnitedHealthcare Medicaid	$7.72
Rate for Payer: UnitedHealthcare Medicare	$5.40
Rate for Payer: University Health Alliance Commercial	$9.37

pravastatin 10 mg Tab [KMC]

Facility

$12.86

Service Code	NDC 16714055801
Hospital Revenue Code	250
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$12.47
Rate for Payer: Cash Price	$8.36
Rate for Payer: Health Management Network Commercial	$10.93
Rate for Payer: Kaiser Permanente Commercial	$11.57
Rate for Payer: MDX Hawaii PPO	$12.47

pravastatin 40 mg Tab [KMC]

Facility

$19.18

Service Code	NDC 16714056001
Hospital Revenue Code	250
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$18.60
Rate for Payer: Cash Price	$12.47
Rate for Payer: Health Management Network Commercial	$16.30
Rate for Payer: Kaiser Permanente Commercial	$17.26
Rate for Payer: MDX Hawaii PPO	$18.60

pravastatin 40 mg Tab [KMC]

Facility

$19.18

Service Code	NDC 16714056001
Hospital Revenue Code	250
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$18.60
Rate for Payer: AlohaCare Medicaid	$9.59
Rate for Payer: AlohaCare Medicare	$8.06
Rate for Payer: Cash Price	$12.47
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$17.65
Rate for Payer: Devoted Health Medicare	$8.06
Rate for Payer: Hawaii Medical Service Association Medicare	$8.06
Rate for Payer: Hawaii Western Management Group Commercial	$18.22
Rate for Payer: Health Management Network Commercial	$16.30
Rate for Payer: Humana Medicare	$8.06
Rate for Payer: Kaiser Permanente Commercial	$17.26
Rate for Payer: Kaiser Permanente Medicaid	$9.78
Rate for Payer: Kaiser Permanente Medicare	$8.06
Rate for Payer: MDX Hawaii PPO	$18.60
Rate for Payer: Ohana Health Plan Medicaid	$8.06
Rate for Payer: Ohana Health Plan Medicare	$8.06
Rate for Payer: UnitedHealthcare Medicaid	$11.51
Rate for Payer: UnitedHealthcare Medicare	$8.06
Rate for Payer: University Health Alliance Commercial	$13.98

prazosin 1 mg Cap [KMC]

Facility

$3.58

Service Code	NDC 70954001950
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$3.47
Rate for Payer: AlohaCare Medicaid	$1.79
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$2.33
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3.29
Rate for Payer: Devoted Health Medicare	$1.50
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$3.40
Rate for Payer: Health Management Network Commercial	$3.04
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$3.22
Rate for Payer: Kaiser Permanente Medicaid	$1.83
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$3.47
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$2.15
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.61

prazosin 1 mg Cap [KMC]

Facility

$3.58

Service Code	NDC 70954001950
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$3.47
Rate for Payer: Cash Price	$2.33
Rate for Payer: Health Management Network Commercial	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.22
Rate for Payer: MDX Hawaii PPO	$3.47

prazosin 5 mg Cap [KMC]

Facility

$3.54

Service Code	NDC 59762535001
Hospital Revenue Code	250
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$3.43
Rate for Payer: Cash Price	$2.30
Rate for Payer: Health Management Network Commercial	$3.01
Rate for Payer: Kaiser Permanente Commercial	$3.19
Rate for Payer: MDX Hawaii PPO	$3.43

prazosin 5 mg Cap [KMC]

Facility

$3.54

Service Code	NDC 59762535001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$3.43
Rate for Payer: AlohaCare Medicaid	$1.77
Rate for Payer: AlohaCare Medicare	$1.49
Rate for Payer: Cash Price	$2.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3.26
Rate for Payer: Devoted Health Medicare	$1.49
Rate for Payer: Hawaii Medical Service Association Medicare	$1.49
Rate for Payer: Hawaii Western Management Group Commercial	$3.36
Rate for Payer: Health Management Network Commercial	$3.01
Rate for Payer: Humana Medicare	$1.49
Rate for Payer: Kaiser Permanente Commercial	$3.19
Rate for Payer: Kaiser Permanente Medicaid	$1.81
Rate for Payer: Kaiser Permanente Medicare	$1.49
Rate for Payer: MDX Hawaii PPO	$3.43
Rate for Payer: Ohana Health Plan Medicaid	$1.49
Rate for Payer: Ohana Health Plan Medicare	$1.49
Rate for Payer: UnitedHealthcare Medicaid	$2.12
Rate for Payer: UnitedHealthcare Medicare	$1.49
Rate for Payer: University Health Alliance Commercial	$2.58

PRDONTAL SCALING&ROOT PLANING 1-3 TEETH-QUAD

Professional

Both

$3.00

Service Code	HCPCS D4342
Hospital Revenue Code	361
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$58.26
Rate for Payer: AlohaCare Medicaid	$58.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Ohana Health Plan Medicaid	$58.26
Rate for Payer: UnitedHealthcare Medicaid	$58.26

Prealbumin DLS

Facility

$265.00

Service Code	HCPCS 84134
Hospital Charge Code	422841345
Hospital Revenue Code	301
Min. Negotiated Rate	$14.59
Max. Negotiated Rate	$257.05
Rate for Payer: AlohaCare Medicaid	$132.50
Rate for Payer: AlohaCare Medicare	$111.30
Rate for Payer: Cash Price	$172.25
Rate for Payer: Cash Price	$172.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$243.80
Rate for Payer: Devoted Health Medicare	$111.30
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$20.16
Rate for Payer: Hawaii Medical Service Association Commercial	$18.24
Rate for Payer: Hawaii Medical Service Association Medicare	$111.30
Rate for Payer: Hawaii Western Management Group Commercial	$14.59
Rate for Payer: Health Management Network Commercial	$225.25
Rate for Payer: Humana Medicare	$111.30
Rate for Payer: Kaiser Permanente Commercial	$238.50
Rate for Payer: Kaiser Permanente Medicaid	$135.15
Rate for Payer: Kaiser Permanente Medicare	$111.30
Rate for Payer: MDX Hawaii PPO	$257.05
Rate for Payer: Ohana Health Plan Medicaid	$111.30
Rate for Payer: Ohana Health Plan Medicare	$111.30
Rate for Payer: UnitedHealthcare Medicaid	$20.16
Rate for Payer: UnitedHealthcare Medicare	$111.30
Rate for Payer: University Health Alliance Commercial	$37.70

Prealbumin DLS

Facility

$265.00

Service Code	HCPCS 84134
Hospital Charge Code	422841345
Hospital Revenue Code	301
Min. Negotiated Rate	$225.25
Max. Negotiated Rate	$257.05
Rate for Payer: Cash Price	$172.25
Rate for Payer: Health Management Network Commercial	$225.25
Rate for Payer: Kaiser Permanente Commercial	$238.50
Rate for Payer: MDX Hawaii PPO	$257.05

Prealbumin Level

Facility

$265.00

Service Code	HCPCS 84134
Hospital Charge Code	422841345
Hospital Revenue Code	301
Min. Negotiated Rate	$14.59
Max. Negotiated Rate	$257.05
Rate for Payer: AlohaCare Medicaid	$132.50
Rate for Payer: AlohaCare Medicare	$111.30
Rate for Payer: Cash Price	$172.25
Rate for Payer: Cash Price	$172.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$243.80
Rate for Payer: Devoted Health Medicare	$111.30
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$20.16
Rate for Payer: Hawaii Medical Service Association Commercial	$18.24
Rate for Payer: Hawaii Medical Service Association Medicare	$111.30
Rate for Payer: Hawaii Western Management Group Commercial	$14.59
Rate for Payer: Health Management Network Commercial	$225.25
Rate for Payer: Humana Medicare	$111.30
Rate for Payer: Kaiser Permanente Commercial	$238.50
Rate for Payer: Kaiser Permanente Medicaid	$135.15
Rate for Payer: Kaiser Permanente Medicare	$111.30
Rate for Payer: MDX Hawaii PPO	$257.05
Rate for Payer: Ohana Health Plan Medicaid	$111.30
Rate for Payer: Ohana Health Plan Medicare	$111.30
Rate for Payer: UnitedHealthcare Medicaid	$20.16
Rate for Payer: UnitedHealthcare Medicare	$111.30
Rate for Payer: University Health Alliance Commercial	$37.70

Prealbumin Level

Facility

$265.00

Service Code	HCPCS 84134
Hospital Charge Code	422841345
Hospital Revenue Code	301
Min. Negotiated Rate	$225.25
Max. Negotiated Rate	$257.05
Rate for Payer: Cash Price	$172.25
Rate for Payer: Health Management Network Commercial	$225.25
Rate for Payer: Kaiser Permanente Commercial	$238.50
Rate for Payer: MDX Hawaii PPO	$257.05

PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC

Facility

$20,407.42

Service Code	MSDRG 067
Min. Negotiated Rate	$20,407.42
Max. Negotiated Rate	$20,407.42
Rate for Payer: Hawaii Medical Service Association Commercial	$20,407.42

PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC

Facility

$20,407.42

Service Code	MSDRG 068
Min. Negotiated Rate	$20,407.42
Max. Negotiated Rate	$20,407.42
Rate for Payer: Hawaii Medical Service Association Commercial	$20,407.42

prednisoLONE 1% ophthalmic susp [KMC]

Facility

$42.24

Service Code	NDC 60758011905
Hospital Revenue Code	250
Min. Negotiated Rate	$35.90
Max. Negotiated Rate	$40.97
Rate for Payer: Cash Price	$27.46
Rate for Payer: Health Management Network Commercial	$35.90
Rate for Payer: Kaiser Permanente Commercial	$38.02
Rate for Payer: MDX Hawaii PPO	$40.97

prednisoLONE 1% ophthalmic susp [KMC]

Facility

$42.24

Service Code	NDC 60758011905
Hospital Revenue Code	250
Min. Negotiated Rate	$17.74
Max. Negotiated Rate	$40.97
Rate for Payer: AlohaCare Medicaid	$21.12
Rate for Payer: AlohaCare Medicare	$17.74
Rate for Payer: Cash Price	$27.46
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$38.86
Rate for Payer: Devoted Health Medicare	$17.74
Rate for Payer: Hawaii Medical Service Association Medicare	$17.74
Rate for Payer: Hawaii Western Management Group Commercial	$40.13
Rate for Payer: Health Management Network Commercial	$35.90
Rate for Payer: Humana Medicare	$17.74
Rate for Payer: Kaiser Permanente Commercial	$38.02
Rate for Payer: Kaiser Permanente Medicaid	$21.54
Rate for Payer: Kaiser Permanente Medicare	$17.74
Rate for Payer: MDX Hawaii PPO	$40.97
Rate for Payer: Ohana Health Plan Medicaid	$17.74
Rate for Payer: Ohana Health Plan Medicare	$17.74
Rate for Payer: UnitedHealthcare Medicaid	$25.34
Rate for Payer: UnitedHealthcare Medicare	$17.74
Rate for Payer: University Health Alliance Commercial	$30.79

prednisoLONE sodium phosphate 15 mg/5 mL Oral Liq [KMC]

Facility

$1.25

Service Code	HCPCS J7510
Hospital Revenue Code	636
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$1.21
Rate for Payer: AlohaCare Medicaid	$0.63
Rate for Payer: AlohaCare Medicare	$0.53
Rate for Payer: Cash Price	$0.81
Rate for Payer: Cash Price	$0.81
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1.15
Rate for Payer: Devoted Health Medicare	$0.53
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.27
Rate for Payer: Hawaii Medical Service Association Medicare	$0.53
Rate for Payer: Hawaii Western Management Group Commercial	$1.19
Rate for Payer: Health Management Network Commercial	$1.06
Rate for Payer: Humana Medicare	$0.53
Rate for Payer: Kaiser Permanente Commercial	$1.12
Rate for Payer: Kaiser Permanente Medicaid	$0.64
Rate for Payer: Kaiser Permanente Medicare	$0.53
Rate for Payer: MDX Hawaii PPO	$1.21
Rate for Payer: Ohana Health Plan Medicaid	$0.53
Rate for Payer: Ohana Health Plan Medicare	$0.53
Rate for Payer: UnitedHealthcare Medicaid	$0.75
Rate for Payer: UnitedHealthcare Medicare	$0.53
Rate for Payer: University Health Alliance Commercial	$0.91

prednisoLONE sodium phosphate 15 mg/5 mL Oral Liq [KMC]

Facility

$1.25

Service Code	HCPCS J7510
Hospital Revenue Code	636
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$1.21
Rate for Payer: Cash Price	$0.81
Rate for Payer: Health Management Network Commercial	$1.06
Rate for Payer: Kaiser Permanente Commercial	$1.12
Rate for Payer: MDX Hawaii PPO	$1.21

predniSONE 10 mg Tab [KMC]

Facility

$3.00

Service Code	HCPCS J7512
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

predniSONE 10 mg Tab [KMC]

Facility

$3.00

Service Code	HCPCS J7512
Hospital Revenue Code	636
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

predniSONE 1 mg Tab [KMC]

Facility

$3.00

Service Code	HCPCS J7512
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

predniSONE 1 mg Tab [KMC]

Facility

$3.00

Service Code	HCPCS J7512
Hospital Revenue Code	636
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

Know your out-of-pocket cost for care.

All Charges