CPT 97162
The standard charge for PT Evaluation - Moderate Complexity is $361.00. However, the price you pay depends on the rate negotiated by your insurance plan and what portion your insurance plan requires you to contribute towards that amount. Enter your info below to start your estimate.
To calculate an estimate of your cost, you will need two things:
LOCATION
56-117 Pualalea Street, Kahuku, HI, 96731CONTACT
(808) 293-9221 Visit WebsiteIn compliance with the Centers for Medicare and Medicaid Services (CMS) Final 2020 Price Transparency Rules, effective January 1, 2021, all hospitals in the United States annually must provide a machine-readable file containing negotiated charges (rates) for ALL items and services. Additionally, the rule requires that for 300 shoppable items and services only, hospitals must provide a consumer-friendly display of gross charge and negotiated charges (rates) or estimation tool. Accordingly, below you will find links to the consumer estimation tool and the machine-readable file.
The fees and/or costs provided via this tool are only estimates, and your final bill may be higher or lower than the estimate for various reasons including but not limited to differences in the number of conditions among patients having the same or similar primary procedures, differences in physician ordering practices, unforeseen complications, etc. Moreover, this is not a guarantee of your benefit plan coverage or payment, and the actual payer and patient portion reflected in your final bill may also be higher or lower.
In some instances, where no recent historical claims and/or payment information is available for the payer plan and the item or service you have selected, the estimate may be for the base rate only or not available. Consequently, the estimate may exclude estimates for additional charges and payer payments for services billed in conjunction with the item or service you selected.
Also, this estimate DOES NOT include other services billed for separately by other providers including but not limited to physician or practitioner fees such as pathologist, radiologist, anesthesiologist, physician surgeon or assistant surgeon, etc.
If you have questions about your individual situation or were unable to find an estimate for your upcoming service, please contact us at (808)293-9221
Choose a plan to view the insurance rate estimate.
Total estimated charges
$361.00Insurance Discount
-$180.50Price Negotiated by Insurer
$180.50Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
CBC w/ Diff & Platelet Count DLS
$92.00Comprehensive Metabolic Profile DLS
$79.50EPOC Basic
$76.00ER ACCUCHECK Charge
$18.50Magnesium Level
$62.00Phosphorus Level
$34.50promethazine 25 mg Tab [KMC]
$1.50Therapeutic Activities Charges
$89.50Therapeutic Exercise Charges
$89.50This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Kahuku Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Kahuku Medical Center directly.
Total estimated charges
$361.00Insurance Discount
-$209.38Price Negotiated by Insurer
$151.62Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
CBC w/ Diff & Platelet Count DLS
$77.28Comprehensive Metabolic Profile DLS
$66.78EPOC Basic
$63.84ER ACCUCHECK Charge
$15.54Magnesium Level
$52.08Phosphorus Level
$28.98promethazine 25 mg Tab [KMC]
$1.97Therapeutic Activities Charges
$75.18Therapeutic Exercise Charges
$75.18This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Kahuku Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Kahuku Medical Center directly.
Total estimated charges
$361.00Insurance Discount
-$126.35Price Negotiated by Insurer
$234.65Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
CBC w/ Diff & Platelet Count DLS
$119.60Comprehensive Metabolic Profile DLS
$103.35EPOC Basic
$98.80ER ACCUCHECK Charge
$24.05Magnesium Level
$80.60Phosphorus Level
$44.85promethazine 25 mg Tab [KMC]
$1.95Therapeutic Activities Charges
$116.35Therapeutic Exercise Charges
$116.35This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Kahuku Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Kahuku Medical Center directly.
Total estimated charges
$361.00Insurance Discount
-$28.88Price Negotiated by Insurer
$332.12Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
CBC w/ Diff & Platelet Count DLS
$169.28Comprehensive Metabolic Profile DLS
$146.28EPOC Basic
$139.84ER ACCUCHECK Charge
$34.04Magnesium Level
$114.08Phosphorus Level
$63.48promethazine 25 mg Tab [KMC]
$4.31Therapeutic Activities Charges
$164.68Therapeutic Exercise Charges
$164.68This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Kahuku Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Kahuku Medical Center directly.
Total estimated charges
$361.00Insurance Discount
-$209.38Price Negotiated by Insurer
$151.62Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
CBC w/ Diff & Platelet Count DLS
$77.28Comprehensive Metabolic Profile DLS
$66.78EPOC Basic
$63.84ER ACCUCHECK Charge
$15.54Magnesium Level
$52.08Phosphorus Level
$28.98promethazine 25 mg Tab [KMC]
$1.97Therapeutic Activities Charges
$75.18Therapeutic Exercise Charges
$75.18This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Kahuku Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Kahuku Medical Center directly.
Total estimated charges
$361.00Insurance Discount
-$209.38Price Negotiated by Insurer
$151.62Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
CBC w/ Diff & Platelet Count DLS
$77.28Comprehensive Metabolic Profile DLS
$66.78EPOC Basic
$63.84ER ACCUCHECK Charge
$15.54Magnesium Level
$52.08Phosphorus Level
$28.98promethazine 25 mg Tab [KMC]
$1.97Therapeutic Activities Charges
$75.18Therapeutic Exercise Charges
$75.18This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Kahuku Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Kahuku Medical Center directly.
Total estimated charges
$361.00Insurance Discount
-$18.05Price Negotiated by Insurer
$342.95Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
CBC w/ Diff & Platelet Count DLS
$7.77Comprehensive Metabolic Profile DLS
$10.56EPOC Basic
$8.46ER ACCUCHECK Charge
$3.28Magnesium Level
$6.70Phosphorus Level
$4.74promethazine 25 mg Tab [KMC]
$4.46Therapeutic Activities Charges
$170.05Therapeutic Exercise Charges
$170.05This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Kahuku Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Kahuku Medical Center directly.
Total estimated charges
$361.00Insurance Discount
-$54.15Price Negotiated by Insurer
$306.85Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
CBC w/ Diff & Platelet Count DLS
$156.40Comprehensive Metabolic Profile DLS
$135.15EPOC Basic
$129.20ER ACCUCHECK Charge
$31.45Magnesium Level
$105.40Phosphorus Level
$58.65promethazine 25 mg Tab [KMC]
$2.55Therapeutic Activities Charges
$152.15Therapeutic Exercise Charges
$152.15This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Kahuku Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Kahuku Medical Center directly.
Total estimated charges
$361.00Insurance Discount
-$209.38Price Negotiated by Insurer
$151.62Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
CBC w/ Diff & Platelet Count DLS
$77.28Comprehensive Metabolic Profile DLS
$66.78EPOC Basic
$63.84ER ACCUCHECK Charge
$15.54Magnesium Level
$52.08Phosphorus Level
$28.98promethazine 25 mg Tab [KMC]
$1.26Therapeutic Activities Charges
$75.18Therapeutic Exercise Charges
$75.18This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Kahuku Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Kahuku Medical Center directly.
Total estimated charges
$361.00Insurance Discount
-$36.10Price Negotiated by Insurer
$324.90Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
CBC w/ Diff & Platelet Count DLS
$165.60Comprehensive Metabolic Profile DLS
$143.10EPOC Basic
$136.80ER ACCUCHECK Charge
$33.30Magnesium Level
$111.60Phosphorus Level
$62.10promethazine 25 mg Tab [KMC]
$4.22Therapeutic Activities Charges
$161.10Therapeutic Exercise Charges
$161.10This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Kahuku Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Kahuku Medical Center directly.
Total estimated charges
$361.00Insurance Discount
-$176.89Price Negotiated by Insurer
$184.11Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
CBC w/ Diff & Platelet Count DLS
$93.84Comprehensive Metabolic Profile DLS
$81.09EPOC Basic
$77.52ER ACCUCHECK Charge
$18.87Magnesium Level
$63.24Phosphorus Level
$35.19promethazine 25 mg Tab [KMC]
$2.39Therapeutic Activities Charges
$91.29Therapeutic Exercise Charges
$91.29This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Kahuku Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Kahuku Medical Center directly.
Total estimated charges
$361.00Insurance Discount
-$209.38Price Negotiated by Insurer
$151.62Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
CBC w/ Diff & Platelet Count DLS
$77.28Comprehensive Metabolic Profile DLS
$66.78EPOC Basic
$63.84ER ACCUCHECK Charge
$15.54Magnesium Level
$52.08Phosphorus Level
$28.98promethazine 25 mg Tab [KMC]
$1.97Therapeutic Activities Charges
$75.18Therapeutic Exercise Charges
$75.18This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Kahuku Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Kahuku Medical Center directly.
Total estimated charges
$361.00Insurance Discount
-$10.83Price Negotiated by Insurer
$350.17Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
CBC w/ Diff & Platelet Count DLS
$178.48Comprehensive Metabolic Profile DLS
$154.23EPOC Basic
$147.44ER ACCUCHECK Charge
$35.89Magnesium Level
$120.28Phosphorus Level
$66.93promethazine 25 mg Tab [KMC]
$2.91Therapeutic Activities Charges
$173.63Therapeutic Exercise Charges
$173.63This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Kahuku Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Kahuku Medical Center directly.
Total estimated charges
$361.00Insurance Discount
-$209.38Price Negotiated by Insurer
$151.62Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
CBC w/ Diff & Platelet Count DLS
$77.28Comprehensive Metabolic Profile DLS
$66.78EPOC Basic
$63.84ER ACCUCHECK Charge
$15.54Magnesium Level
$52.08Phosphorus Level
$28.98promethazine 25 mg Tab [KMC]
$1.26Therapeutic Activities Charges
$75.18Therapeutic Exercise Charges
$75.18This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Kahuku Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Kahuku Medical Center directly.
Total estimated charges
$361.00Insurance Discount
-$209.38Price Negotiated by Insurer
$151.62Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
CBC w/ Diff & Platelet Count DLS
$77.28Comprehensive Metabolic Profile DLS
$66.78EPOC Basic
$63.84ER ACCUCHECK Charge
$15.54Magnesium Level
$52.08Phosphorus Level
$28.98promethazine 25 mg Tab [KMC]
$1.97Therapeutic Activities Charges
$75.18Therapeutic Exercise Charges
$75.18This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Kahuku Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Kahuku Medical Center directly.
Total estimated charges
$361.00Insurance Discount
-$254.30Price Negotiated by Insurer
$106.70Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
CBC w/ Diff & Platelet Count DLS
$10.74Comprehensive Metabolic Profile DLS
$14.61EPOC Basic
$11.70ER ACCUCHECK Charge
$5.42Magnesium Level
$9.26Phosphorus Level
$6.56Therapeutic Activities Charges
$18.32Therapeutic Exercise Charges
$17.65This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Kahuku Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Kahuku Medical Center directly.
Total estimated charges
$361.00Insurance Discount
-$209.38Price Negotiated by Insurer
$151.62Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
CBC w/ Diff & Platelet Count DLS
$77.28Comprehensive Metabolic Profile DLS
$66.78EPOC Basic
$63.84ER ACCUCHECK Charge
$15.54Magnesium Level
$52.08Phosphorus Level
$28.98promethazine 25 mg Tab [KMC]
$1.97Therapeutic Activities Charges
$75.18Therapeutic Exercise Charges
$75.18This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Kahuku Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Kahuku Medical Center directly.
Total estimated charges
$361.00Insurance Discount
-$97.87Price Negotiated by Insurer
$263.13Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
CBC w/ Diff & Platelet Count DLS
$20.09Comprehensive Metabolic Profile DLS
$27.32EPOC Basic
$21.89ER ACCUCHECK Charge
$4.68Magnesium Level
$17.32Phosphorus Level
$12.27promethazine 25 mg Tab [KMC]
$3.42Therapeutic Activities Charges
$130.47Therapeutic Exercise Charges
$130.47This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Kahuku Medical Center so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Kahuku Medical Center directly.