Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

PT RE-EVALUATION Physical

Facility

$396.00

Service Code	HCPCS 97002 GP
Hospital Charge Code	426970020
Hospital Revenue Code	424
Min. Negotiated Rate	$166.32
Max. Negotiated Rate	$384.12
Rate for Payer: AlohaCare Medicaid	$198.00
Rate for Payer: AlohaCare Medicare	$166.32
Rate for Payer: Cash Price	$257.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$364.32
Rate for Payer: Devoted Health Medicare	$166.32
Rate for Payer: Hawaii Medical Service Association Medicare	$166.32
Rate for Payer: Hawaii Western Management Group Commercial	$376.20
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: Humana Medicare	$166.32
Rate for Payer: Kaiser Permanente Commercial	$356.40
Rate for Payer: Kaiser Permanente Medicaid	$201.96
Rate for Payer: Kaiser Permanente Medicare	$166.32
Rate for Payer: MDX Hawaii PPO	$384.12
Rate for Payer: Ohana Health Plan Medicaid	$166.32
Rate for Payer: Ohana Health Plan Medicare	$166.32
Rate for Payer: UnitedHealthcare Medicare	$166.32
Rate for Payer: University Health Alliance Commercial	$288.64

PT ReEval Units

Facility

$248.00

Service Code	HCPCS 97164 GP
Hospital Charge Code	432971640
Hospital Revenue Code	424
Min. Negotiated Rate	$74.59
Max. Negotiated Rate	$240.56
Rate for Payer: AlohaCare Medicaid	$124.00
Rate for Payer: AlohaCare Medicare	$104.16
Rate for Payer: Cash Price	$161.20
Rate for Payer: Cash Price	$161.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$228.16
Rate for Payer: Devoted Health Medicare	$104.16
Rate for Payer: Hawaii Medical Service Association Medicare	$104.16
Rate for Payer: Hawaii Western Management Group Commercial	$235.60
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Humana Medicare	$104.16
Rate for Payer: Kaiser Permanente Commercial	$223.20
Rate for Payer: Kaiser Permanente Medicaid	$126.48
Rate for Payer: Kaiser Permanente Medicare	$104.16
Rate for Payer: MDX Hawaii PPO	$240.56
Rate for Payer: Ohana Health Plan Medicaid	$104.16
Rate for Payer: Ohana Health Plan Medicare	$104.16
Rate for Payer: UnitedHealthcare Medicaid	$74.59
Rate for Payer: UnitedHealthcare Medicare	$104.16
Rate for Payer: University Health Alliance Commercial	$180.77

PT ReEval Units

Facility

$248.00

Service Code	HCPCS 97164 GP
Hospital Charge Code	432971640
Hospital Revenue Code	424
Min. Negotiated Rate	$210.80
Max. Negotiated Rate	$240.56
Rate for Payer: Cash Price	$161.20
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Kaiser Permanente Commercial	$223.20
Rate for Payer: MDX Hawaii PPO	$240.56

PT ROM Measurements and Report Charges

Facility

$179.00

Service Code	HCPCS 95851 GP
Hospital Charge Code	432958510
Hospital Revenue Code	420
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

PT ROM Measurements and Report Charges

Facility

$179.00

Service Code	HCPCS 95851 GP
Hospital Charge Code	432958510
Hospital Revenue Code	420
Min. Negotiated Rate	$7.89
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	$7.89
Rate for Payer: UnitedHealthcare Medicare	$75.18
Rate for Payer: University Health Alliance Commercial	$130.47

PT SCRND TOBACCO USE RCVD TOBACCO CESSATION TALK

Professional

Both

$0.01

Service Code	HCPCS 4004F
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

PT Sensory Integration Charges

Facility

$179.00

Service Code	HCPCS 97533 GP
Hospital Charge Code	432975330
Hospital Revenue Code	420
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

PT Sensory Integration Charges

Facility

$179.00

Service Code	HCPCS 97533 GP
Hospital Charge Code	432975330
Hospital Revenue Code	420
Min. Negotiated Rate	$17.81
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	$17.81
Rate for Payer: UnitedHealthcare Medicare	$75.18
Rate for Payer: University Health Alliance Commercial	$130.47

PTT

Facility

$89.00

Service Code	HCPCS 85730
Hospital Charge Code	422857300
Hospital Revenue Code	305
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$57.85
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$86.33

PTT

Facility

$89.00

Service Code	HCPCS 85730
Hospital Charge Code	422857300
Hospital Revenue Code	305
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$86.33
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$37.38
Rate for Payer: Cash Price	$57.85
Rate for Payer: Cash Price	$57.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$81.88
Rate for Payer: Devoted Health Medicare	$37.38
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$8.30
Rate for Payer: Hawaii Medical Service Association Commercial	$7.51
Rate for Payer: Hawaii Medical Service Association Medicare	$37.38
Rate for Payer: Hawaii Western Management Group Commercial	$6.01
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Humana Medicare	$37.38
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicare	$37.38
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$37.38
Rate for Payer: Ohana Health Plan Medicare	$37.38
Rate for Payer: UnitedHealthcare Medicaid	$8.30
Rate for Payer: UnitedHealthcare Medicare	$37.38
Rate for Payer: University Health Alliance Commercial	$15.50

PT Unlisted Therapeutic Procedures Charges

Facility

$179.00

Service Code	HCPCS 97139 GP
Hospital Charge Code	432971390
Hospital Revenue Code	420
Min. Negotiated Rate	$12.02
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	$12.02
Rate for Payer: UnitedHealthcare Medicare	$75.18
Rate for Payer: University Health Alliance Commercial	$130.47

PT Unlisted Therapeutic Procedures Charges

Facility

$179.00

Service Code	HCPCS 97139 GP
Hospital Charge Code	432971390
Hospital Revenue Code	420
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

PT Work Hardening Charge

Facility

$296.00

Service Code	HCPCS 97545 GP
Hospital Charge Code	426975450
Hospital Revenue Code	420
Min. Negotiated Rate	$251.60
Max. Negotiated Rate	$287.12
Rate for Payer: Cash Price	$192.40
Rate for Payer: Health Management Network Commercial	$251.60
Rate for Payer: Kaiser Permanente Commercial	$266.40
Rate for Payer: MDX Hawaii PPO	$287.12

PT Work Hardening Charge

Facility

$296.00

Service Code	HCPCS 97545 GP
Hospital Charge Code	426975450
Hospital Revenue Code	420
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$287.12
Rate for Payer: AlohaCare Medicaid	$148.00
Rate for Payer: AlohaCare Medicare	$124.32
Rate for Payer: Cash Price	$192.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$272.32
Rate for Payer: Devoted Health Medicare	$124.32
Rate for Payer: Hawaii Medical Service Association Medicare	$124.32
Rate for Payer: Hawaii Western Management Group Commercial	$281.20
Rate for Payer: Health Management Network Commercial	$251.60
Rate for Payer: Humana Medicare	$124.32
Rate for Payer: Kaiser Permanente Commercial	$266.40
Rate for Payer: Kaiser Permanente Medicaid	$150.96
Rate for Payer: Kaiser Permanente Medicare	$124.32
Rate for Payer: MDX Hawaii PPO	$287.12
Rate for Payer: Ohana Health Plan Medicaid	$124.32
Rate for Payer: Ohana Health Plan Medicare	$124.32
Rate for Payer: UnitedHealthcare Medicare	$124.32
Rate for Payer: University Health Alliance Commercial	$215.75

PULMONARY EDEMA AND RESPIRATORY FAILURE

Facility

$45,602.65

Service Code	MSDRG 189
Min. Negotiated Rate	$45,602.65
Max. Negotiated Rate	$45,602.65
Rate for Payer: Hawaii Medical Service Association Commercial	$45,602.65

PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE

Facility

$30,954.81

Service Code	MSDRG 175
Min. Negotiated Rate	$30,954.81
Max. Negotiated Rate	$30,954.81
Rate for Payer: Hawaii Medical Service Association Commercial	$30,954.81

PULMONARY EMBOLISM WITHOUT MCC

Facility

$30,954.81

Service Code	MSDRG 176
Min. Negotiated Rate	$30,954.81
Max. Negotiated Rate	$30,954.81
Rate for Payer: Hawaii Medical Service Association Commercial	$30,954.81

Pulmonary Rehab with continuous monitoring

Facility

$192.00

Service Code	HCPCS 94626
Hospital Charge Code	429946260
Hospital Revenue Code	948
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$186.24
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: MDX Hawaii PPO	$186.24

Pulmonary Rehab with continuous monitoring

Facility

$192.00

Service Code	HCPCS 94626
Hospital Charge Code	429946260
Hospital Revenue Code	948
Min. Negotiated Rate	$27.22
Max. Negotiated Rate	$186.24
Rate for Payer: AlohaCare Medicaid	$96.00
Rate for Payer: AlohaCare Medicare	$80.64
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cash Price	$124.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$176.64
Rate for Payer: Devoted Health Medicare	$80.64
Rate for Payer: Hawaii Medical Service Association Commercial	$87.11
Rate for Payer: Hawaii Medical Service Association Medicare	$80.64
Rate for Payer: Hawaii Western Management Group Commercial	$182.40
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Humana Medicare	$80.64
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: Kaiser Permanente Medicaid	$97.92
Rate for Payer: Kaiser Permanente Medicare	$80.64
Rate for Payer: MDX Hawaii PPO	$186.24
Rate for Payer: Ohana Health Plan Medicaid	$80.64
Rate for Payer: Ohana Health Plan Medicare	$80.64
Rate for Payer: UnitedHealthcare Medicaid	$27.22
Rate for Payer: UnitedHealthcare Medicare	$80.64
Rate for Payer: University Health Alliance Commercial	$139.95

Pulmonary Rehab without continuous monitoring

Facility

$204.00

Service Code	HCPCS 94625
Hospital Charge Code	429946250
Hospital Revenue Code	948
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$197.88
Rate for Payer: Cash Price	$132.60
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Kaiser Permanente Commercial	$183.60
Rate for Payer: MDX Hawaii PPO	$197.88

Pulmonary Rehab without continuous monitoring

Facility

$204.00

Service Code	HCPCS 94625
Hospital Charge Code	429946250
Hospital Revenue Code	948
Min. Negotiated Rate	$18.47
Max. Negotiated Rate	$197.88
Rate for Payer: AlohaCare Medicaid	$102.00
Rate for Payer: AlohaCare Medicare	$85.68
Rate for Payer: Cash Price	$132.60
Rate for Payer: Cash Price	$132.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$187.68
Rate for Payer: Devoted Health Medicare	$85.68
Rate for Payer: Hawaii Medical Service Association Commercial	$87.11
Rate for Payer: Hawaii Medical Service Association Medicare	$85.68
Rate for Payer: Hawaii Western Management Group Commercial	$193.80
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Humana Medicare	$85.68
Rate for Payer: Kaiser Permanente Commercial	$183.60
Rate for Payer: Kaiser Permanente Medicaid	$104.04
Rate for Payer: Kaiser Permanente Medicare	$85.68
Rate for Payer: MDX Hawaii PPO	$197.88
Rate for Payer: Ohana Health Plan Medicaid	$85.68
Rate for Payer: Ohana Health Plan Medicare	$85.68
Rate for Payer: UnitedHealthcare Medicaid	$18.47
Rate for Payer: UnitedHealthcare Medicare	$85.68
Rate for Payer: University Health Alliance Commercial	$148.70

PULMONARY STRESS TESTING

Professional

Both

$373.00

Service Code	HCPCS 94618
Hospital Revenue Code	410
Min. Negotiated Rate	$36.04
Max. Negotiated Rate	$317.05
Rate for Payer: AlohaCare Medicaid	$36.04
Rate for Payer: AlohaCare Medicare	$39.44
Rate for Payer: Cash Price	$242.45
Rate for Payer: Cash Price	$242.45
Rate for Payer: Devoted Health Medicare	$39.44
Rate for Payer: Hawaii Medical Service Association Medicare	$39.44
Rate for Payer: Hawaii Western Management Group Commercial	$36.94
Rate for Payer: Health Management Network Commercial	$317.05
Rate for Payer: Kaiser Permanente Commercial	$47.33
Rate for Payer: Kaiser Permanente Medicaid	$47.33
Rate for Payer: Kaiser Permanente Medicare	$47.33
Rate for Payer: Ohana Health Plan Medicaid	$36.04
Rate for Payer: Ohana Health Plan Medicare	$39.44
Rate for Payer: UnitedHealthcare Medicaid	$36.04
Rate for Payer: UnitedHealthcare Medicare	$39.44

PULMONARY STRESS TESTING, SIMPLE

Professional

Both

$388.00

Service Code	HCPCS 94620
Hospital Revenue Code	410
Min. Negotiated Rate	$115.78
Max. Negotiated Rate	$329.80
Rate for Payer: Cash Price	$252.20
Rate for Payer: Cash Price	$252.20
Rate for Payer: Hawaii Western Management Group Commercial	$115.78
Rate for Payer: Health Management Network Commercial	$329.80

Pulmonary Stress Test KHKU

Facility

$373.00

Service Code	HCPCS 94618
Hospital Charge Code	429946180
Hospital Revenue Code	460
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$361.81
Rate for Payer: AlohaCare Medicaid	$186.50
Rate for Payer: AlohaCare Medicare	$156.66
Rate for Payer: Cash Price	$242.45
Rate for Payer: Cash Price	$242.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$343.16
Rate for Payer: Devoted Health Medicare	$156.66
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.81
Rate for Payer: Hawaii Medical Service Association Commercial	$196.47
Rate for Payer: Hawaii Medical Service Association Medicare	$156.66
Rate for Payer: Hawaii Western Management Group Commercial	$354.35
Rate for Payer: Health Management Network Commercial	$317.05
Rate for Payer: Humana Medicare	$156.66
Rate for Payer: Kaiser Permanente Commercial	$335.70
Rate for Payer: Kaiser Permanente Medicaid	$190.23
Rate for Payer: Kaiser Permanente Medicare	$156.66
Rate for Payer: MDX Hawaii PPO	$361.81
Rate for Payer: Ohana Health Plan Medicaid	$156.66
Rate for Payer: Ohana Health Plan Medicare	$156.66
Rate for Payer: UnitedHealthcare Medicaid	$36.04
Rate for Payer: UnitedHealthcare Medicare	$156.66
Rate for Payer: University Health Alliance Commercial	$271.88

Pulmonary Stress Test KHKU

Facility

$373.00

Service Code	HCPCS 94618
Hospital Charge Code	429946180
Hospital Revenue Code	460
Min. Negotiated Rate	$317.05
Max. Negotiated Rate	$361.81
Rate for Payer: Cash Price	$242.45
Rate for Payer: Health Management Network Commercial	$317.05
Rate for Payer: Kaiser Permanente Commercial	$335.70
Rate for Payer: MDX Hawaii PPO	$361.81

Know your out-of-pocket cost for care.

All Charges