Kohala Hospital

All Charges

Charge

Type

Setting

Price

PSYLLIUM HUSK 3.4 GRAM PO PWPK

Facility

$1.83

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$1.81
Rate for Payer: AlohaCare Medicaid	$0.92
Rate for Payer: AlohaCare Medicare	$1.65
Rate for Payer: Cash Price	$1.19
Rate for Payer: Devoted Health Medicare	$1.81
Rate for Payer: Hawaii Medical Service Association Medicare	$1.65
Rate for Payer: Hawaii Western Management Group Commercial	$1.74
Rate for Payer: Health Management Network Commercial	$1.56
Rate for Payer: Humana Medicare	$1.65
Rate for Payer: Kaiser Permanente Commercial	$1.65
Rate for Payer: Kaiser Permanente Medicaid	$0.93
Rate for Payer: Kaiser Permanente Medicare	$1.65
Rate for Payer: MDX Hawaii PPO	$1.78
Rate for Payer: Ohana Health Plan Medicaid	$1.65
Rate for Payer: Ohana Health Plan Medicare	$1.65
Rate for Payer: UnitedHealthcare Medicare	$1.65
Rate for Payer: University Health Alliance Commercial	$1.33

PSYLLIUM HUSK 3.4 GRAM PO PWPK

Facility

$1.83

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.78
Rate for Payer: Cash Price	$1.19
Rate for Payer: Health Management Network Commercial	$1.56
Rate for Payer: Kaiser Permanente Commercial	$1.65
Rate for Payer: MDX Hawaii PPO	$1.78

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

PYRANTEL PAMOATE 50 MG/ML PO SUSP

Facility

$45.44

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$38.62
Max. Negotiated Rate	$44.08
Rate for Payer: Cash Price	$29.54
Rate for Payer: Health Management Network Commercial	$38.62
Rate for Payer: Kaiser Permanente Commercial	$40.90
Rate for Payer: MDX Hawaii PPO	$44.08

PYRANTEL PAMOATE 50 MG/ML PO SUSP

Facility

$45.44

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$22.72
Max. Negotiated Rate	$44.99
Rate for Payer: AlohaCare Medicaid	$22.72
Rate for Payer: AlohaCare Medicare	$40.90
Rate for Payer: Cash Price	$29.54
Rate for Payer: Devoted Health Medicare	$44.99
Rate for Payer: Hawaii Medical Service Association Medicare	$40.90
Rate for Payer: Hawaii Western Management Group Commercial	$43.17
Rate for Payer: Health Management Network Commercial	$38.62
Rate for Payer: Humana Medicare	$40.90
Rate for Payer: Kaiser Permanente Commercial	$40.90
Rate for Payer: Kaiser Permanente Medicaid	$23.17
Rate for Payer: Kaiser Permanente Medicare	$40.90
Rate for Payer: MDX Hawaii PPO	$44.08
Rate for Payer: Ohana Health Plan Medicaid	$40.90
Rate for Payer: Ohana Health Plan Medicare	$40.90
Rate for Payer: UnitedHealthcare Medicare	$40.90
Rate for Payer: University Health Alliance Commercial	$33.12

PYRAZINAMIDE 500 MG PO TABLET

Facility

$43.29

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$36.80
Max. Negotiated Rate	$41.99
Rate for Payer: Cash Price	$28.14
Rate for Payer: Health Management Network Commercial	$36.80
Rate for Payer: Kaiser Permanente Commercial	$38.96
Rate for Payer: MDX Hawaii PPO	$41.99

PYRAZINAMIDE 500 MG PO TABLET

Facility

$43.29

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$21.64
Max. Negotiated Rate	$42.86
Rate for Payer: AlohaCare Medicaid	$21.64
Rate for Payer: AlohaCare Medicare	$38.96
Rate for Payer: Cash Price	$28.14
Rate for Payer: Devoted Health Medicare	$42.86
Rate for Payer: Hawaii Medical Service Association Medicare	$38.96
Rate for Payer: Hawaii Western Management Group Commercial	$41.13
Rate for Payer: Health Management Network Commercial	$36.80
Rate for Payer: Humana Medicare	$38.96
Rate for Payer: Kaiser Permanente Commercial	$38.96
Rate for Payer: Kaiser Permanente Medicaid	$22.08
Rate for Payer: Kaiser Permanente Medicare	$38.96
Rate for Payer: MDX Hawaii PPO	$41.99
Rate for Payer: Ohana Health Plan Medicaid	$38.96
Rate for Payer: Ohana Health Plan Medicare	$38.96
Rate for Payer: UnitedHealthcare Medicare	$38.96
Rate for Payer: University Health Alliance Commercial	$31.55

PYRIDOSTIGMINE BROMIDE 60 MG PO TABLET

Facility

$9.17

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$8.89
Rate for Payer: Cash Price	$5.96
Rate for Payer: Health Management Network Commercial	$7.79
Rate for Payer: Kaiser Permanente Commercial	$8.25
Rate for Payer: MDX Hawaii PPO	$8.89

PYRIDOSTIGMINE BROMIDE 60 MG PO TABLET

Facility

$9.17

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$9.08
Rate for Payer: AlohaCare Medicaid	$4.58
Rate for Payer: AlohaCare Medicare	$8.25
Rate for Payer: Cash Price	$5.96
Rate for Payer: Devoted Health Medicare	$9.08
Rate for Payer: Hawaii Medical Service Association Medicare	$8.25
Rate for Payer: Hawaii Western Management Group Commercial	$8.71
Rate for Payer: Health Management Network Commercial	$7.79
Rate for Payer: Humana Medicare	$8.25
Rate for Payer: Kaiser Permanente Commercial	$8.25
Rate for Payer: Kaiser Permanente Medicaid	$4.68
Rate for Payer: Kaiser Permanente Medicare	$8.25
Rate for Payer: MDX Hawaii PPO	$8.89
Rate for Payer: Ohana Health Plan Medicaid	$8.25
Rate for Payer: Ohana Health Plan Medicare	$8.25
Rate for Payer: UnitedHealthcare Medicare	$8.25
Rate for Payer: University Health Alliance Commercial	$6.68

PYRIDOXINE (VITAMIN B6) 100 MG/ML INJ SOLN

Facility

$107.97

Service Code	HCPCS J3415
Hospital Revenue Code	636
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$106.89
Rate for Payer: AlohaCare Medicaid	$53.98
Rate for Payer: AlohaCare Medicare	$97.17
Rate for Payer: Cash Price	$70.18
Rate for Payer: Cash Price	$70.18
Rate for Payer: Devoted Health Medicare	$106.89
Rate for Payer: Hawaii Medical Service Association ABD	$12.80
Rate for Payer: Hawaii Medical Service Association Medicare	$97.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.80
Rate for Payer: Hawaii Western Management Group Commercial	$102.57
Rate for Payer: Health Management Network Commercial	$91.77
Rate for Payer: Humana Medicare	$97.17
Rate for Payer: Kaiser Permanente Commercial	$97.17
Rate for Payer: Kaiser Permanente Medicaid	$55.06
Rate for Payer: Kaiser Permanente Medicare	$97.17
Rate for Payer: MDX Hawaii PPO	$104.73
Rate for Payer: Ohana Health Plan Medicaid	$97.17
Rate for Payer: Ohana Health Plan Medicare	$97.17
Rate for Payer: UnitedHealthcare Medicaid	$64.78
Rate for Payer: UnitedHealthcare Medicare	$97.17
Rate for Payer: University Health Alliance Commercial	$78.70

PYRIDOXINE (VITAMIN B6) 100 MG/ML INJ SOLN

Facility

$107.97

Service Code	HCPCS J3415
Hospital Revenue Code	250
Min. Negotiated Rate	$91.77
Max. Negotiated Rate	$104.73
Rate for Payer: Cash Price	$70.18
Rate for Payer: Health Management Network Commercial	$91.77
Rate for Payer: Kaiser Permanente Commercial	$97.17
Rate for Payer: MDX Hawaii PPO	$104.73

PYRIDOXINE (VITAMIN B6) 100 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: MDX Hawaii PPO	$1.16

PYRIDOXINE (VITAMIN B6) 100 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.19
Rate for Payer: AlohaCare Medicaid	$0.60
Rate for Payer: AlohaCare Medicare	$1.08
Rate for Payer: Cash Price	$0.78
Rate for Payer: Devoted Health Medicare	$1.19
Rate for Payer: Hawaii Medical Service Association Medicare	$1.08
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Humana Medicare	$1.08
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicare	$1.08
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: Ohana Health Plan Medicaid	$1.08
Rate for Payer: Ohana Health Plan Medicare	$1.08
Rate for Payer: UnitedHealthcare Medicare	$1.08
Rate for Payer: University Health Alliance Commercial	$0.87

QUETIAPINE 100 MG PO TABLET

Facility

$40.93

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$34.79
Max. Negotiated Rate	$39.70
Rate for Payer: Cash Price	$26.60
Rate for Payer: Cash Price	$27.81
Rate for Payer: Health Management Network Commercial	$34.79
Rate for Payer: Health Management Network Commercial	$36.36
Rate for Payer: Kaiser Permanente Commercial	$36.84
Rate for Payer: Kaiser Permanente Commercial	$38.50
Rate for Payer: MDX Hawaii PPO	$41.50
Rate for Payer: MDX Hawaii PPO	$39.70

QUETIAPINE 100 MG PO TABLET

Facility

$42.78

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$21.39
Max. Negotiated Rate	$42.35
Rate for Payer: AlohaCare Medicaid	$21.39
Rate for Payer: AlohaCare Medicaid	$20.46
Rate for Payer: AlohaCare Medicare	$36.84
Rate for Payer: AlohaCare Medicare	$38.50
Rate for Payer: Cash Price	$26.60
Rate for Payer: Cash Price	$27.81
Rate for Payer: Devoted Health Medicare	$42.35
Rate for Payer: Devoted Health Medicare	$40.52
Rate for Payer: Hawaii Medical Service Association Medicare	$36.84
Rate for Payer: Hawaii Medical Service Association Medicare	$38.50
Rate for Payer: Hawaii Western Management Group Commercial	$38.88
Rate for Payer: Hawaii Western Management Group Commercial	$40.64
Rate for Payer: Health Management Network Commercial	$36.36
Rate for Payer: Health Management Network Commercial	$34.79
Rate for Payer: Humana Medicare	$38.50
Rate for Payer: Humana Medicare	$36.84
Rate for Payer: Kaiser Permanente Commercial	$36.84
Rate for Payer: Kaiser Permanente Commercial	$38.50
Rate for Payer: Kaiser Permanente Medicaid	$21.82
Rate for Payer: Kaiser Permanente Medicaid	$20.87
Rate for Payer: Kaiser Permanente Medicare	$36.84
Rate for Payer: Kaiser Permanente Medicare	$38.50
Rate for Payer: MDX Hawaii PPO	$39.70
Rate for Payer: MDX Hawaii PPO	$41.50
Rate for Payer: Ohana Health Plan Medicaid	$36.84
Rate for Payer: Ohana Health Plan Medicaid	$38.50
Rate for Payer: Ohana Health Plan Medicare	$36.84
Rate for Payer: Ohana Health Plan Medicare	$38.50
Rate for Payer: UnitedHealthcare Medicare	$38.50
Rate for Payer: UnitedHealthcare Medicare	$36.84
Rate for Payer: University Health Alliance Commercial	$31.18
Rate for Payer: University Health Alliance Commercial	$29.83

QUETIAPINE 200 MG PO TABLET

Facility

$5.25

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$5.09
Rate for Payer: Cash Price	$3.41
Rate for Payer: Health Management Network Commercial	$4.46
Rate for Payer: Kaiser Permanente Commercial	$4.72
Rate for Payer: MDX Hawaii PPO	$5.09

QUETIAPINE 200 MG PO TABLET

Facility

$5.25

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$5.20
Rate for Payer: AlohaCare Medicaid	$2.62
Rate for Payer: AlohaCare Medicare	$4.72
Rate for Payer: Cash Price	$3.41
Rate for Payer: Devoted Health Medicare	$5.20
Rate for Payer: Hawaii Medical Service Association Medicare	$4.72
Rate for Payer: Hawaii Western Management Group Commercial	$4.99
Rate for Payer: Health Management Network Commercial	$4.46
Rate for Payer: Humana Medicare	$4.72
Rate for Payer: Kaiser Permanente Commercial	$4.72
Rate for Payer: Kaiser Permanente Medicaid	$2.68
Rate for Payer: Kaiser Permanente Medicare	$4.72
Rate for Payer: MDX Hawaii PPO	$5.09
Rate for Payer: Ohana Health Plan Medicaid	$4.72
Rate for Payer: Ohana Health Plan Medicare	$4.72
Rate for Payer: UnitedHealthcare Medicare	$4.72
Rate for Payer: University Health Alliance Commercial	$3.83

QUETIAPINE 200 MG PO TAB SR 24H

Facility

$88.08

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$44.04
Max. Negotiated Rate	$87.20
Rate for Payer: AlohaCare Medicaid	$44.04
Rate for Payer: AlohaCare Medicare	$79.27
Rate for Payer: Cash Price	$57.25
Rate for Payer: Devoted Health Medicare	$87.20
Rate for Payer: Hawaii Medical Service Association Medicare	$79.27
Rate for Payer: Hawaii Western Management Group Commercial	$83.68
Rate for Payer: Health Management Network Commercial	$74.87
Rate for Payer: Humana Medicare	$79.27
Rate for Payer: Kaiser Permanente Commercial	$79.27
Rate for Payer: Kaiser Permanente Medicaid	$44.92
Rate for Payer: Kaiser Permanente Medicare	$79.27
Rate for Payer: MDX Hawaii PPO	$85.44
Rate for Payer: Ohana Health Plan Medicaid	$79.27
Rate for Payer: Ohana Health Plan Medicare	$79.27
Rate for Payer: UnitedHealthcare Medicare	$79.27
Rate for Payer: University Health Alliance Commercial	$64.20

QUETIAPINE 200 MG PO TAB SR 24H

Facility

$88.08

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$74.87
Max. Negotiated Rate	$85.44
Rate for Payer: Cash Price	$57.25
Rate for Payer: Health Management Network Commercial	$74.87
Rate for Payer: Kaiser Permanente Commercial	$79.27
Rate for Payer: MDX Hawaii PPO	$85.44

QUETIAPINE 25 MG PO TABLET

Facility

$20.85

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$10.43
Max. Negotiated Rate	$20.64
Rate for Payer: AlohaCare Medicaid	$10.43
Rate for Payer: AlohaCare Medicare	$18.77
Rate for Payer: Cash Price	$13.55
Rate for Payer: Devoted Health Medicare	$20.64
Rate for Payer: Hawaii Medical Service Association Medicare	$18.77
Rate for Payer: Hawaii Western Management Group Commercial	$19.81
Rate for Payer: Health Management Network Commercial	$17.72
Rate for Payer: Humana Medicare	$18.77
Rate for Payer: Kaiser Permanente Commercial	$18.77
Rate for Payer: Kaiser Permanente Medicaid	$10.63
Rate for Payer: Kaiser Permanente Medicare	$18.77
Rate for Payer: MDX Hawaii PPO	$20.22
Rate for Payer: Ohana Health Plan Medicaid	$18.77
Rate for Payer: Ohana Health Plan Medicare	$18.77
Rate for Payer: UnitedHealthcare Medicare	$18.77
Rate for Payer: University Health Alliance Commercial	$15.20

QUETIAPINE 25 MG PO TABLET

Facility

$20.85

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$20.22
Rate for Payer: Cash Price	$13.55
Rate for Payer: Health Management Network Commercial	$17.72
Rate for Payer: Kaiser Permanente Commercial	$18.77
Rate for Payer: MDX Hawaii PPO	$20.22

QUETIAPINE 50 MG PO TABLET

Facility

$39.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$33.61
Max. Negotiated Rate	$38.35
Rate for Payer: Cash Price	$25.70
Rate for Payer: Health Management Network Commercial	$33.61
Rate for Payer: Kaiser Permanente Commercial	$35.59
Rate for Payer: MDX Hawaii PPO	$38.35

QUETIAPINE 50 MG PO TABLET

Facility

$39.54

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$19.77
Max. Negotiated Rate	$39.14
Rate for Payer: AlohaCare Medicaid	$19.77
Rate for Payer: AlohaCare Medicare	$35.59
Rate for Payer: Cash Price	$25.70
Rate for Payer: Devoted Health Medicare	$39.14
Rate for Payer: Hawaii Medical Service Association Medicare	$35.59
Rate for Payer: Hawaii Western Management Group Commercial	$37.56
Rate for Payer: Health Management Network Commercial	$33.61
Rate for Payer: Humana Medicare	$35.59
Rate for Payer: Kaiser Permanente Commercial	$35.59
Rate for Payer: Kaiser Permanente Medicaid	$20.17
Rate for Payer: Kaiser Permanente Medicare	$35.59
Rate for Payer: MDX Hawaii PPO	$38.35
Rate for Payer: Ohana Health Plan Medicaid	$35.59
Rate for Payer: Ohana Health Plan Medicare	$35.59
Rate for Payer: UnitedHealthcare Medicare	$35.59
Rate for Payer: University Health Alliance Commercial	$28.82

Know your out-of-pocket cost for care.

All Charges