Kohala Hospital

All Charges

Charge

Type

Setting

Price

PANTOPRAZOLE 40 MG IV RECON.SOLN.

Facility

$19.32

Service Code	HCPCS J2470
Hospital Revenue Code	250
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$18.74
Rate for Payer: Cash Price	$12.56
Rate for Payer: Health Management Network Commercial	$16.42
Rate for Payer: Kaiser Permanente Commercial	$17.39
Rate for Payer: MDX Hawaii PPO	$18.74

PANTOPRAZOLE 40 MG IV RECON.SOLN.

Facility

$19.32

Service Code	HCPCS J2470
Hospital Revenue Code	636
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$19.13
Rate for Payer: AlohaCare Medicaid	$9.66
Rate for Payer: AlohaCare Medicare	$17.39
Rate for Payer: Cash Price	$12.56
Rate for Payer: Devoted Health Medicare	$19.13
Rate for Payer: Hawaii Medical Service Association Medicare	$17.39
Rate for Payer: Hawaii Western Management Group Commercial	$18.35
Rate for Payer: Health Management Network Commercial	$16.42
Rate for Payer: Humana Medicare	$17.39
Rate for Payer: Kaiser Permanente Commercial	$17.39
Rate for Payer: Kaiser Permanente Medicaid	$9.85
Rate for Payer: Kaiser Permanente Medicare	$17.39
Rate for Payer: MDX Hawaii PPO	$18.74
Rate for Payer: Ohana Health Plan Medicaid	$17.39
Rate for Payer: Ohana Health Plan Medicare	$17.39
Rate for Payer: UnitedHealthcare Medicaid	$11.59
Rate for Payer: UnitedHealthcare Medicare	$17.39
Rate for Payer: University Health Alliance Commercial	$14.08

PANTOPRAZOLE 40 MG PO GRPS

Facility

$76.61

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$65.12
Max. Negotiated Rate	$74.31
Rate for Payer: Cash Price	$49.80
Rate for Payer: Health Management Network Commercial	$65.12
Rate for Payer: Kaiser Permanente Commercial	$68.95
Rate for Payer: MDX Hawaii PPO	$74.31

PANTOPRAZOLE 40 MG PO GRPS

Facility

$76.61

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$38.30
Max. Negotiated Rate	$75.84
Rate for Payer: AlohaCare Medicaid	$38.30
Rate for Payer: AlohaCare Medicare	$68.95
Rate for Payer: Cash Price	$49.80
Rate for Payer: Devoted Health Medicare	$75.84
Rate for Payer: Hawaii Medical Service Association Medicare	$68.95
Rate for Payer: Hawaii Western Management Group Commercial	$72.78
Rate for Payer: Health Management Network Commercial	$65.12
Rate for Payer: Humana Medicare	$68.95
Rate for Payer: Kaiser Permanente Commercial	$68.95
Rate for Payer: Kaiser Permanente Medicaid	$39.07
Rate for Payer: Kaiser Permanente Medicare	$68.95
Rate for Payer: MDX Hawaii PPO	$74.31
Rate for Payer: Ohana Health Plan Medicaid	$68.95
Rate for Payer: Ohana Health Plan Medicare	$68.95
Rate for Payer: UnitedHealthcare Medicare	$68.95
Rate for Payer: University Health Alliance Commercial	$55.84

PANTOPRAZOLE 40 MG PO TAB DR EC

Facility

$2.50

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$2.42
Rate for Payer: Cash Price	$1.62
Rate for Payer: Cash Price	$14.45
Rate for Payer: Health Management Network Commercial	$2.12
Rate for Payer: Health Management Network Commercial	$18.90
Rate for Payer: Kaiser Permanente Commercial	$2.25
Rate for Payer: Kaiser Permanente Commercial	$20.01
Rate for Payer: MDX Hawaii PPO	$21.56
Rate for Payer: MDX Hawaii PPO	$2.42

PANTOPRAZOLE 40 MG PO TAB DR EC

Facility

$22.23

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$11.12
Max. Negotiated Rate	$22.01
Rate for Payer: AlohaCare Medicaid	$11.12
Rate for Payer: AlohaCare Medicaid	$1.25
Rate for Payer: AlohaCare Medicare	$20.01
Rate for Payer: AlohaCare Medicare	$2.25
Rate for Payer: Cash Price	$1.62
Rate for Payer: Cash Price	$14.45
Rate for Payer: Devoted Health Medicare	$22.01
Rate for Payer: Devoted Health Medicare	$2.48
Rate for Payer: Hawaii Medical Service Association Medicare	$2.25
Rate for Payer: Hawaii Medical Service Association Medicare	$20.01
Rate for Payer: Hawaii Western Management Group Commercial	$2.38
Rate for Payer: Hawaii Western Management Group Commercial	$21.12
Rate for Payer: Health Management Network Commercial	$18.90
Rate for Payer: Health Management Network Commercial	$2.12
Rate for Payer: Humana Medicare	$2.25
Rate for Payer: Humana Medicare	$20.01
Rate for Payer: Kaiser Permanente Commercial	$20.01
Rate for Payer: Kaiser Permanente Commercial	$2.25
Rate for Payer: Kaiser Permanente Medicaid	$1.27
Rate for Payer: Kaiser Permanente Medicaid	$11.34
Rate for Payer: Kaiser Permanente Medicare	$2.25
Rate for Payer: Kaiser Permanente Medicare	$20.01
Rate for Payer: MDX Hawaii PPO	$2.42
Rate for Payer: MDX Hawaii PPO	$21.56
Rate for Payer: Ohana Health Plan Medicaid	$20.01
Rate for Payer: Ohana Health Plan Medicaid	$2.25
Rate for Payer: Ohana Health Plan Medicare	$20.01
Rate for Payer: Ohana Health Plan Medicare	$2.25
Rate for Payer: UnitedHealthcare Medicare	$20.01
Rate for Payer: UnitedHealthcare Medicare	$2.25
Rate for Payer: University Health Alliance Commercial	$1.82
Rate for Payer: University Health Alliance Commercial	$16.20

PAROXETINE HCL 20 MG PO TABLET

Facility

$15.09

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$14.94
Rate for Payer: AlohaCare Medicaid	$7.54
Rate for Payer: AlohaCare Medicare	$13.58
Rate for Payer: Cash Price	$9.81
Rate for Payer: Devoted Health Medicare	$14.94
Rate for Payer: Hawaii Medical Service Association Medicare	$13.58
Rate for Payer: Hawaii Western Management Group Commercial	$14.34
Rate for Payer: Health Management Network Commercial	$12.83
Rate for Payer: Humana Medicare	$13.58
Rate for Payer: Kaiser Permanente Commercial	$13.58
Rate for Payer: Kaiser Permanente Medicaid	$7.70
Rate for Payer: Kaiser Permanente Medicare	$13.58
Rate for Payer: MDX Hawaii PPO	$14.64
Rate for Payer: Ohana Health Plan Medicaid	$13.58
Rate for Payer: Ohana Health Plan Medicare	$13.58
Rate for Payer: UnitedHealthcare Medicare	$13.58
Rate for Payer: University Health Alliance Commercial	$11.00

PAROXETINE HCL 20 MG PO TABLET

Facility

$15.09

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$12.83
Max. Negotiated Rate	$14.64
Rate for Payer: Cash Price	$9.81
Rate for Payer: Health Management Network Commercial	$12.83
Rate for Payer: Kaiser Permanente Commercial	$13.58
Rate for Payer: MDX Hawaii PPO	$14.64

PAROXETINE HCL 20 MG PO TABLET (0.5 TAB) = 10 MG

Facility

$15.09

Service Code	NDC RPKWH000705
Hospital Revenue Code	637
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$14.94
Rate for Payer: AlohaCare Medicaid	$7.54
Rate for Payer: AlohaCare Medicare	$13.58
Rate for Payer: Cash Price	$9.81
Rate for Payer: Devoted Health Medicare	$14.94
Rate for Payer: Hawaii Medical Service Association Medicare	$13.58
Rate for Payer: Hawaii Western Management Group Commercial	$14.34
Rate for Payer: Health Management Network Commercial	$12.83
Rate for Payer: Humana Medicare	$13.58
Rate for Payer: Kaiser Permanente Commercial	$13.58
Rate for Payer: Kaiser Permanente Medicaid	$7.70
Rate for Payer: Kaiser Permanente Medicare	$13.58
Rate for Payer: MDX Hawaii PPO	$14.64
Rate for Payer: Ohana Health Plan Medicaid	$13.58
Rate for Payer: Ohana Health Plan Medicare	$13.58
Rate for Payer: UnitedHealthcare Medicare	$13.58
Rate for Payer: University Health Alliance Commercial	$11.00

PAROXETINE HCL 20 MG PO TABLET (0.5 TAB) = 10 MG

Facility

$15.09

Service Code	NDC RPKWH000705
Hospital Revenue Code	250
Min. Negotiated Rate	$12.83
Max. Negotiated Rate	$14.64
Rate for Payer: Cash Price	$9.81
Rate for Payer: Health Management Network Commercial	$12.83
Rate for Payer: Kaiser Permanente Commercial	$13.58
Rate for Payer: MDX Hawaii PPO	$14.64

PAROXETINE HCL 30 MG PO TABLET

Facility

$15.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$15.07
Rate for Payer: Cash Price	$10.10
Rate for Payer: Health Management Network Commercial	$13.21
Rate for Payer: Kaiser Permanente Commercial	$13.99
Rate for Payer: MDX Hawaii PPO	$15.07

PAROXETINE HCL 30 MG PO TABLET

Facility

$15.54

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$15.38
Rate for Payer: AlohaCare Medicaid	$7.77
Rate for Payer: AlohaCare Medicare	$13.99
Rate for Payer: Cash Price	$10.10
Rate for Payer: Devoted Health Medicare	$15.38
Rate for Payer: Hawaii Medical Service Association Medicare	$13.99
Rate for Payer: Hawaii Western Management Group Commercial	$14.76
Rate for Payer: Health Management Network Commercial	$13.21
Rate for Payer: Humana Medicare	$13.99
Rate for Payer: Kaiser Permanente Commercial	$13.99
Rate for Payer: Kaiser Permanente Medicaid	$7.93
Rate for Payer: Kaiser Permanente Medicare	$13.99
Rate for Payer: MDX Hawaii PPO	$15.07
Rate for Payer: Ohana Health Plan Medicaid	$13.99
Rate for Payer: Ohana Health Plan Medicare	$13.99
Rate for Payer: UnitedHealthcare Medicare	$13.99
Rate for Payer: University Health Alliance Commercial	$11.33

PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC

Facility

$32,874.67

Service Code	MSDRG 543
Min. Negotiated Rate	$32,874.67
Max. Negotiated Rate	$32,874.67
Rate for Payer: Hawaii Medical Service Association Commercial	$32,874.67

PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC

Facility

$32,874.67

Service Code	MSDRG 542
Min. Negotiated Rate	$32,874.67
Max. Negotiated Rate	$32,874.67
Rate for Payer: Hawaii Medical Service Association Commercial	$32,874.67

PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC

Facility

$32,874.67

Service Code	MSDRG 544
Min. Negotiated Rate	$32,874.67
Max. Negotiated Rate	$32,874.67
Rate for Payer: Hawaii Medical Service Association Commercial	$32,874.67

PEDI CALCIUM CHLORIDE 100 MG/ML IV SYRINGE (FOR CARDIAC ARREST)

Facility

$60.38

Service Code	HCPCS J0618
Hospital Revenue Code	636
Min. Negotiated Rate	$30.19
Max. Negotiated Rate	$59.78
Rate for Payer: AlohaCare Medicaid	$30.19
Rate for Payer: AlohaCare Medicare	$54.34
Rate for Payer: Cash Price	$39.25
Rate for Payer: Devoted Health Medicare	$59.78
Rate for Payer: Hawaii Medical Service Association Medicare	$54.34
Rate for Payer: Hawaii Western Management Group Commercial	$57.36
Rate for Payer: Health Management Network Commercial	$51.32
Rate for Payer: Humana Medicare	$54.34
Rate for Payer: Kaiser Permanente Commercial	$54.34
Rate for Payer: Kaiser Permanente Medicaid	$30.79
Rate for Payer: Kaiser Permanente Medicare	$54.34
Rate for Payer: MDX Hawaii PPO	$58.57
Rate for Payer: Ohana Health Plan Medicaid	$54.34
Rate for Payer: Ohana Health Plan Medicare	$54.34
Rate for Payer: UnitedHealthcare Medicaid	$36.23
Rate for Payer: UnitedHealthcare Medicare	$54.34
Rate for Payer: University Health Alliance Commercial	$44.01

PEDI CALCIUM CHLORIDE 100 MG/ML IV SYRINGE (FOR CARDIAC ARREST)

Facility

$60.38

Service Code	HCPCS J0618
Hospital Revenue Code	250
Min. Negotiated Rate	$51.32
Max. Negotiated Rate	$58.57
Rate for Payer: Cash Price	$39.25
Rate for Payer: Health Management Network Commercial	$51.32
Rate for Payer: Kaiser Permanente Commercial	$54.34
Rate for Payer: MDX Hawaii PPO	$58.57

PEDI CEFEPIME SYRINGE (WHR)

Facility

$141.58

Service Code	HCPCS J0692
Hospital Revenue Code	636
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$140.16
Rate for Payer: AlohaCare Medicaid	$70.79
Rate for Payer: AlohaCare Medicare	$127.42
Rate for Payer: Cash Price	$92.03
Rate for Payer: Cash Price	$92.03
Rate for Payer: Devoted Health Medicare	$140.16
Rate for Payer: Hawaii Medical Service Association ABD	$6.19
Rate for Payer: Hawaii Medical Service Association Medicare	$127.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.19
Rate for Payer: Hawaii Western Management Group Commercial	$134.50
Rate for Payer: Health Management Network Commercial	$120.34
Rate for Payer: Humana Medicare	$127.42
Rate for Payer: Kaiser Permanente Commercial	$127.42
Rate for Payer: Kaiser Permanente Medicaid	$72.21
Rate for Payer: Kaiser Permanente Medicare	$127.42
Rate for Payer: MDX Hawaii PPO	$137.33
Rate for Payer: Ohana Health Plan Medicaid	$127.42
Rate for Payer: Ohana Health Plan Medicare	$127.42
Rate for Payer: UnitedHealthcare Medicaid	$84.95
Rate for Payer: UnitedHealthcare Medicare	$127.42
Rate for Payer: University Health Alliance Commercial	$103.20

PEDI CEFEPIME SYRINGE (WHR)

Facility

$141.58

Service Code	HCPCS J0692
Hospital Revenue Code	250
Min. Negotiated Rate	$120.34
Max. Negotiated Rate	$137.33
Rate for Payer: Cash Price	$92.03
Rate for Payer: Health Management Network Commercial	$120.34
Rate for Payer: Kaiser Permanente Commercial	$127.42
Rate for Payer: MDX Hawaii PPO	$137.33

PEDI FOSPHENYTOIN MAINTENANCE DOSE ORDERABLE

Facility

$26.50

Service Code	NDC 00641613601
Hospital Revenue Code	250
Min. Negotiated Rate	$22.52
Max. Negotiated Rate	$25.70
Rate for Payer: Cash Price	$17.23
Rate for Payer: Health Management Network Commercial	$22.52
Rate for Payer: Kaiser Permanente Commercial	$23.85
Rate for Payer: MDX Hawaii PPO	$25.70

PEDI FOSPHENYTOIN MAINTENANCE DOSE ORDERABLE

Facility

$26.50

Service Code	NDC 00641613601
Hospital Revenue Code	636
Min. Negotiated Rate	$13.25
Max. Negotiated Rate	$26.23
Rate for Payer: AlohaCare Medicaid	$13.25
Rate for Payer: AlohaCare Medicare	$23.85
Rate for Payer: Cash Price	$17.23
Rate for Payer: Devoted Health Medicare	$26.23
Rate for Payer: Hawaii Medical Service Association Medicare	$23.85
Rate for Payer: Hawaii Western Management Group Commercial	$25.18
Rate for Payer: Health Management Network Commercial	$22.52
Rate for Payer: Humana Medicare	$23.85
Rate for Payer: Kaiser Permanente Commercial	$23.85
Rate for Payer: Kaiser Permanente Medicaid	$13.52
Rate for Payer: Kaiser Permanente Medicare	$23.85
Rate for Payer: MDX Hawaii PPO	$25.70
Rate for Payer: Ohana Health Plan Medicaid	$23.85
Rate for Payer: Ohana Health Plan Medicare	$23.85
Rate for Payer: UnitedHealthcare Medicaid	$15.90
Rate for Payer: UnitedHealthcare Medicare	$23.85
Rate for Payer: University Health Alliance Commercial	$19.32

PEDI FOSPHENYTOIN MAINTENANCE DOSE ORDERABLE

Facility

$26.50

Service Code	NDC 00641613625
Hospital Revenue Code	250
Min. Negotiated Rate	$22.52
Max. Negotiated Rate	$25.70
Rate for Payer: Cash Price	$17.23
Rate for Payer: Health Management Network Commercial	$22.52
Rate for Payer: Kaiser Permanente Commercial	$23.85
Rate for Payer: MDX Hawaii PPO	$25.70

PEDI FOSPHENYTOIN MAINTENANCE DOSE ORDERABLE

Facility

$26.50

Service Code	NDC 00641613625
Hospital Revenue Code	636
Min. Negotiated Rate	$13.25
Max. Negotiated Rate	$26.23
Rate for Payer: AlohaCare Medicaid	$13.25
Rate for Payer: AlohaCare Medicare	$23.85
Rate for Payer: Cash Price	$17.23
Rate for Payer: Devoted Health Medicare	$26.23
Rate for Payer: Hawaii Medical Service Association Medicare	$23.85
Rate for Payer: Hawaii Western Management Group Commercial	$25.18
Rate for Payer: Health Management Network Commercial	$22.52
Rate for Payer: Humana Medicare	$23.85
Rate for Payer: Kaiser Permanente Commercial	$23.85
Rate for Payer: Kaiser Permanente Medicaid	$13.52
Rate for Payer: Kaiser Permanente Medicare	$23.85
Rate for Payer: MDX Hawaii PPO	$25.70
Rate for Payer: Ohana Health Plan Medicaid	$23.85
Rate for Payer: Ohana Health Plan Medicare	$23.85
Rate for Payer: UnitedHealthcare Medicaid	$15.90
Rate for Payer: UnitedHealthcare Medicare	$23.85
Rate for Payer: University Health Alliance Commercial	$19.32

PEDI METHYLPREDNISOLONE 10 MG/ML INJ

Facility

$40.89

Service Code	NDC 00009003930
Hospital Revenue Code	250
Min. Negotiated Rate	$34.76
Max. Negotiated Rate	$39.66
Rate for Payer: Cash Price	$26.58
Rate for Payer: Health Management Network Commercial	$34.76
Rate for Payer: Kaiser Permanente Commercial	$36.80
Rate for Payer: MDX Hawaii PPO	$39.66

PEDI METHYLPREDNISOLONE 10 MG/ML INJ

Facility

$40.89

Service Code	NDC 00009003928
Hospital Revenue Code	250
Min. Negotiated Rate	$34.76
Max. Negotiated Rate	$39.66
Rate for Payer: Cash Price	$26.58
Rate for Payer: Health Management Network Commercial	$34.76
Rate for Payer: Kaiser Permanente Commercial	$36.80
Rate for Payer: MDX Hawaii PPO	$39.66

Know your out-of-pocket cost for care.

All Charges