Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

propafenone 150 mg Tab [KMC]

Facility

$6.54

Service Code	NDC 00603544821
Hospital Revenue Code	250
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$6.34
Rate for Payer: Cash Price	$4.25
Rate for Payer: Health Management Network Commercial	$5.56
Rate for Payer: Kaiser Permanente Commercial	$5.89
Rate for Payer: MDX Hawaii PPO	$6.34

propafenone 325 mg ER Cap [KMC]

Facility

$40.00

Service Code	NDC 00832074160
Hospital Revenue Code	250
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$26.00
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

propafenone 325 mg ER Cap [KMC]

Facility

$40.00

Service Code	NDC 00832074160
Hospital Revenue Code	250
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$38.80
Rate for Payer: AlohaCare Medicaid	$20.00
Rate for Payer: AlohaCare Medicare	$16.80
Rate for Payer: Cash Price	$26.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$36.80
Rate for Payer: Devoted Health Medicare	$16.80
Rate for Payer: Hawaii Medical Service Association Medicare	$16.80
Rate for Payer: Hawaii Western Management Group Commercial	$38.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Humana Medicare	$16.80
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: Kaiser Permanente Medicaid	$20.40
Rate for Payer: Kaiser Permanente Medicare	$16.80
Rate for Payer: MDX Hawaii PPO	$38.80
Rate for Payer: Ohana Health Plan Medicaid	$16.80
Rate for Payer: Ohana Health Plan Medicare	$16.80
Rate for Payer: UnitedHealthcare Medicaid	$24.00
Rate for Payer: UnitedHealthcare Medicare	$16.80
Rate for Payer: University Health Alliance Commercial	$29.16

proparacaine Ophth 0.5% Sol [KMC]

Facility

$11.23

Service Code	NDC 24208073006
Hospital Revenue Code	250
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$10.89
Rate for Payer: AlohaCare Medicaid	$5.62
Rate for Payer: AlohaCare Medicare	$4.72
Rate for Payer: Cash Price	$7.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$10.33
Rate for Payer: Devoted Health Medicare	$4.72
Rate for Payer: Hawaii Medical Service Association Medicare	$4.72
Rate for Payer: Hawaii Western Management Group Commercial	$10.67
Rate for Payer: Health Management Network Commercial	$9.55
Rate for Payer: Humana Medicare	$4.72
Rate for Payer: Kaiser Permanente Commercial	$10.11
Rate for Payer: Kaiser Permanente Medicaid	$5.73
Rate for Payer: Kaiser Permanente Medicare	$4.72
Rate for Payer: MDX Hawaii PPO	$10.89
Rate for Payer: Ohana Health Plan Medicaid	$4.72
Rate for Payer: Ohana Health Plan Medicare	$4.72
Rate for Payer: UnitedHealthcare Medicaid	$6.74
Rate for Payer: UnitedHealthcare Medicare	$4.72
Rate for Payer: University Health Alliance Commercial	$8.19

proparacaine Ophth 0.5% Sol [KMC]

Facility

$11.23

Service Code	NDC 24208073006
Hospital Revenue Code	250
Min. Negotiated Rate	$9.55
Max. Negotiated Rate	$10.89
Rate for Payer: Cash Price	$7.30
Rate for Payer: Health Management Network Commercial	$9.55
Rate for Payer: Kaiser Permanente Commercial	$10.11
Rate for Payer: MDX Hawaii PPO	$10.89

PROPHYLAXIS - ADULT

Professional

Both

$0.01

Service Code	HCPCS D1110
Hospital Revenue Code	361
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$43.20
Rate for Payer: AlohaCare Medicaid	$43.20
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Ohana Health Plan Medicaid	$43.20
Rate for Payer: UnitedHealthcare Medicaid	$43.20

PROPHYLAXIS - CHILD

Professional

Both

$0.01

Service Code	HCPCS D1120
Hospital Revenue Code	361
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$29.28
Rate for Payer: AlohaCare Medicaid	$29.28
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Ohana Health Plan Medicaid	$29.28
Rate for Payer: UnitedHealthcare Medicaid	$29.28

propofol 10 mg/mL inj (20 mL or 100 mL vials) [KMC]

Facility

$1.04

Service Code	HCPCS J2704
Hospital Revenue Code	636
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$1.01
Rate for Payer: Cash Price	$0.68
Rate for Payer: Health Management Network Commercial	$0.88
Rate for Payer: Kaiser Permanente Commercial	$0.94
Rate for Payer: MDX Hawaii PPO	$1.01

propofol 10 mg/mL inj (20 mL or 100 mL vials) [KMC]

Facility

$1.04

Service Code	HCPCS J2704
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.01
Rate for Payer: AlohaCare Medicaid	$0.52
Rate for Payer: AlohaCare Medicare	$0.44
Rate for Payer: Cash Price	$0.68
Rate for Payer: Cash Price	$0.68
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.96
Rate for Payer: Devoted Health Medicare	$0.44
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.09
Rate for Payer: Hawaii Medical Service Association Medicare	$0.44
Rate for Payer: Hawaii Western Management Group Commercial	$0.99
Rate for Payer: Health Management Network Commercial	$0.88
Rate for Payer: Humana Medicare	$0.44
Rate for Payer: Kaiser Permanente Commercial	$0.94
Rate for Payer: Kaiser Permanente Medicaid	$0.53
Rate for Payer: Kaiser Permanente Medicare	$0.44
Rate for Payer: MDX Hawaii PPO	$1.01
Rate for Payer: Ohana Health Plan Medicaid	$0.44
Rate for Payer: Ohana Health Plan Medicare	$0.44
Rate for Payer: UnitedHealthcare Medicaid	$0.62
Rate for Payer: UnitedHealthcare Medicare	$0.44
Rate for Payer: University Health Alliance Commercial	$0.76

propranolol 10 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00603548221
Hospital Revenue Code	250
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

propranolol 10 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00603548221
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
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: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
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

propranolol 120 mg ER Cap [KMC]

Facility

$11.93

Service Code	NDC 00527411837
Hospital Revenue Code	250
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$11.57
Rate for Payer: Cash Price	$7.75
Rate for Payer: Health Management Network Commercial	$10.14
Rate for Payer: Kaiser Permanente Commercial	$10.74
Rate for Payer: MDX Hawaii PPO	$11.57

propranolol 120 mg ER Cap [KMC]

Facility

$11.93

Service Code	NDC 00527411837
Hospital Revenue Code	250
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$11.57
Rate for Payer: AlohaCare Medicaid	$5.96
Rate for Payer: AlohaCare Medicare	$5.01
Rate for Payer: Cash Price	$7.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$10.98
Rate for Payer: Devoted Health Medicare	$5.01
Rate for Payer: Hawaii Medical Service Association Medicare	$5.01
Rate for Payer: Hawaii Western Management Group Commercial	$11.33
Rate for Payer: Health Management Network Commercial	$10.14
Rate for Payer: Humana Medicare	$5.01
Rate for Payer: Kaiser Permanente Commercial	$10.74
Rate for Payer: Kaiser Permanente Medicaid	$6.08
Rate for Payer: Kaiser Permanente Medicare	$5.01
Rate for Payer: MDX Hawaii PPO	$11.57
Rate for Payer: Ohana Health Plan Medicaid	$5.01
Rate for Payer: Ohana Health Plan Medicare	$5.01
Rate for Payer: UnitedHealthcare Medicaid	$7.16
Rate for Payer: UnitedHealthcare Medicare	$5.01
Rate for Payer: University Health Alliance Commercial	$8.70

propranolol 20 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 69238207801
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
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: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
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

propranolol 20 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 69238207801
Hospital Revenue Code	250
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

propranolol 60 mg ER Cap [KMC]

Facility

$8.23

Service Code	NDC 00527411637
Hospital Revenue Code	250
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$7.98
Rate for Payer: AlohaCare Medicaid	$4.12
Rate for Payer: AlohaCare Medicare	$3.46
Rate for Payer: Cash Price	$5.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7.57
Rate for Payer: Devoted Health Medicare	$3.46
Rate for Payer: Hawaii Medical Service Association Medicare	$3.46
Rate for Payer: Hawaii Western Management Group Commercial	$7.82
Rate for Payer: Health Management Network Commercial	$7.00
Rate for Payer: Humana Medicare	$3.46
Rate for Payer: Kaiser Permanente Commercial	$7.41
Rate for Payer: Kaiser Permanente Medicaid	$4.20
Rate for Payer: Kaiser Permanente Medicare	$3.46
Rate for Payer: MDX Hawaii PPO	$7.98
Rate for Payer: Ohana Health Plan Medicaid	$3.46
Rate for Payer: Ohana Health Plan Medicare	$3.46
Rate for Payer: UnitedHealthcare Medicaid	$4.94
Rate for Payer: UnitedHealthcare Medicare	$3.46
Rate for Payer: University Health Alliance Commercial	$6.00

propranolol 60 mg ER Cap [KMC]

Facility

$8.23

Service Code	NDC 00527411637
Hospital Revenue Code	250
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$7.98
Rate for Payer: Cash Price	$5.35
Rate for Payer: Health Management Network Commercial	$7.00
Rate for Payer: Kaiser Permanente Commercial	$7.41
Rate for Payer: MDX Hawaii PPO	$7.98

propranolol 80 mg ER capsule [KMC]

Facility

$9.63

Service Code	NDC 00527411737
Hospital Revenue Code	250
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$9.34
Rate for Payer: AlohaCare Medicaid	$4.82
Rate for Payer: AlohaCare Medicare	$4.04
Rate for Payer: Cash Price	$6.26
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$8.86
Rate for Payer: Devoted Health Medicare	$4.04
Rate for Payer: Hawaii Medical Service Association Medicare	$4.04
Rate for Payer: Hawaii Western Management Group Commercial	$9.15
Rate for Payer: Health Management Network Commercial	$8.19
Rate for Payer: Humana Medicare	$4.04
Rate for Payer: Kaiser Permanente Commercial	$8.67
Rate for Payer: Kaiser Permanente Medicaid	$4.91
Rate for Payer: Kaiser Permanente Medicare	$4.04
Rate for Payer: MDX Hawaii PPO	$9.34
Rate for Payer: Ohana Health Plan Medicaid	$4.04
Rate for Payer: Ohana Health Plan Medicare	$4.04
Rate for Payer: UnitedHealthcare Medicaid	$5.78
Rate for Payer: UnitedHealthcare Medicare	$4.04
Rate for Payer: University Health Alliance Commercial	$7.02

propranolol 80 mg ER capsule [KMC]

Facility

$9.63

Service Code	NDC 00527411737
Hospital Revenue Code	250
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$9.34
Rate for Payer: Cash Price	$6.26
Rate for Payer: Health Management Network Commercial	$8.19
Rate for Payer: Kaiser Permanente Commercial	$8.67
Rate for Payer: MDX Hawaii PPO	$9.34

PROSTATECTOMY WITH CC

Facility

$22,564.30

Service Code	MSDRG 666
Min. Negotiated Rate	$22,564.30
Max. Negotiated Rate	$22,564.30
Rate for Payer: Hawaii Medical Service Association Commercial	$22,564.30

PROSTATECTOMY WITH MCC

Facility

$22,564.30

Service Code	MSDRG 665
Min. Negotiated Rate	$22,564.30
Max. Negotiated Rate	$22,564.30
Rate for Payer: Hawaii Medical Service Association Commercial	$22,564.30

PROSTATECTOMY WITHOUT CC/MCC

Facility

$15,927.74

Service Code	MSDRG 667
Min. Negotiated Rate	$15,927.74
Max. Negotiated Rate	$15,927.74
Rate for Payer: Hawaii Medical Service Association Commercial	$15,927.74

Prosthetic Charge

Facility

$179.00

Service Code	HCPCS 97761 GO
Hospital Charge Code	426977610
Hospital Revenue Code	431
Min. Negotiated Rate	$152.15
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$116.35
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63

Prosthetic Charge

Facility

$179.00

Service Code	HCPCS 97761 GO
Hospital Charge Code	426977610
Hospital Revenue Code	431
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$173.63
Rate for Payer: AlohaCare Medicaid	$89.50
Rate for Payer: AlohaCare Medicare	$75.18
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$164.68
Rate for Payer: Devoted Health Medicare	$75.18
Rate for Payer: Hawaii Medical Service Association Medicare	$75.18
Rate for Payer: Hawaii Western Management Group Commercial	$170.05
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Humana Medicare	$75.18
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: Kaiser Permanente Medicaid	$91.29
Rate for Payer: Kaiser Permanente Medicare	$75.18
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: Ohana Health Plan Medicaid	$75.18
Rate for Payer: Ohana Health Plan Medicare	$75.18
Rate for Payer: UnitedHealthcare Medicaid	$17.70
Rate for Payer: UnitedHealthcare Medicare	$75.18
Rate for Payer: University Health Alliance Commercial	$130.47

PROSTHETICS TRAINING INITIAL ENCTR EA 15 MINS

Professional

Both

$171.00

Service Code	HCPCS 97761
Hospital Revenue Code	420
Min. Negotiated Rate	$35.65
Max. Negotiated Rate	$145.35
Rate for Payer: AlohaCare Medicaid	$45.13
Rate for Payer: AlohaCare Medicare	$43.48
Rate for Payer: Cash Price	$111.15
Rate for Payer: Cash Price	$111.15
Rate for Payer: Devoted Health Medicare	$43.48
Rate for Payer: Hawaii Medical Service Association Medicare	$43.48
Rate for Payer: Hawaii Western Management Group Commercial	$35.65
Rate for Payer: Health Management Network Commercial	$145.35
Rate for Payer: Kaiser Permanente Commercial	$52.18
Rate for Payer: Kaiser Permanente Medicaid	$52.18
Rate for Payer: Kaiser Permanente Medicare	$52.18
Rate for Payer: Ohana Health Plan Medicaid	$45.13
Rate for Payer: Ohana Health Plan Medicare	$43.48
Rate for Payer: UnitedHealthcare Medicaid	$45.13
Rate for Payer: UnitedHealthcare Medicare	$43.48

Know your out-of-pocket cost for care.

All Charges