Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

felodipine 10 mg ER Tab [KMC]

Facility

$11.36

Service Code	NDC 68462023501
Hospital Revenue Code	250
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$11.02
Rate for Payer: Cash Price	$7.38
Rate for Payer: Health Management Network Commercial	$9.66
Rate for Payer: Kaiser Permanente Commercial	$10.22
Rate for Payer: MDX Hawaii PPO	$11.02

felodipine 10 mg ER Tab [KMC]

Facility

$11.36

Service Code	NDC 68462023501
Hospital Revenue Code	250
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$11.02
Rate for Payer: AlohaCare Medicaid	$5.68
Rate for Payer: AlohaCare Medicare	$4.77
Rate for Payer: Cash Price	$7.38
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$10.45
Rate for Payer: Devoted Health Medicare	$4.77
Rate for Payer: Hawaii Medical Service Association Medicare	$4.77
Rate for Payer: Hawaii Western Management Group Commercial	$10.79
Rate for Payer: Health Management Network Commercial	$9.66
Rate for Payer: Humana Medicare	$4.77
Rate for Payer: Kaiser Permanente Commercial	$10.22
Rate for Payer: Kaiser Permanente Medicaid	$5.79
Rate for Payer: Kaiser Permanente Medicare	$4.77
Rate for Payer: MDX Hawaii PPO	$11.02
Rate for Payer: Ohana Health Plan Medicaid	$4.77
Rate for Payer: Ohana Health Plan Medicare	$4.77
Rate for Payer: UnitedHealthcare Medicaid	$6.82
Rate for Payer: UnitedHealthcare Medicare	$4.77
Rate for Payer: University Health Alliance Commercial	$8.28

felodipine 5 mg ER Tab [KMC]

Facility

$6.04

Service Code	NDC 00603358221
Hospital Revenue Code	250
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$5.86
Rate for Payer: AlohaCare Medicaid	$3.02
Rate for Payer: AlohaCare Medicare	$2.54
Rate for Payer: Cash Price	$3.93
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.56
Rate for Payer: Devoted Health Medicare	$2.54
Rate for Payer: Hawaii Medical Service Association Medicare	$2.54
Rate for Payer: Hawaii Western Management Group Commercial	$5.74
Rate for Payer: Health Management Network Commercial	$5.13
Rate for Payer: Humana Medicare	$2.54
Rate for Payer: Kaiser Permanente Commercial	$5.44
Rate for Payer: Kaiser Permanente Medicaid	$3.08
Rate for Payer: Kaiser Permanente Medicare	$2.54
Rate for Payer: MDX Hawaii PPO	$5.86
Rate for Payer: Ohana Health Plan Medicaid	$2.54
Rate for Payer: Ohana Health Plan Medicare	$2.54
Rate for Payer: UnitedHealthcare Medicaid	$3.62
Rate for Payer: UnitedHealthcare Medicare	$2.54
Rate for Payer: University Health Alliance Commercial	$4.40

felodipine 5 mg ER Tab [KMC]

Facility

$6.04

Service Code	NDC 00603358221
Hospital Revenue Code	250
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$5.86
Rate for Payer: Cash Price	$3.93
Rate for Payer: Health Management Network Commercial	$5.13
Rate for Payer: Kaiser Permanente Commercial	$5.44
Rate for Payer: MDX Hawaii PPO	$5.86

FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

$18,203.14

Service Code	MSDRG 748
Min. Negotiated Rate	$18,203.14
Max. Negotiated Rate	$18,203.14
Rate for Payer: Hawaii Medical Service Association Commercial	$18,203.14

FEMUR 2 VWS

Facility

$369.00

Service Code	HCPCS 73552
Hospital Charge Code	424735520
Hospital Revenue Code	320
Min. Negotiated Rate	$313.65
Max. Negotiated Rate	$357.93
Rate for Payer: Cash Price	$239.85
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: MDX Hawaii PPO	$357.93

FEMUR 2 VWS

Facility

$369.00

Service Code	HCPCS 73552
Hospital Charge Code	424735520
Hospital Revenue Code	320
Min. Negotiated Rate	$15.87
Max. Negotiated Rate	$357.93
Rate for Payer: AlohaCare Medicaid	$184.50
Rate for Payer: AlohaCare Medicare	$154.98
Rate for Payer: Cash Price	$239.85
Rate for Payer: Cash Price	$239.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$339.48
Rate for Payer: Devoted Health Medicare	$154.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$15.87
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$154.98
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Humana Medicare	$154.98
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: Kaiser Permanente Medicaid	$188.19
Rate for Payer: Kaiser Permanente Medicare	$154.98
Rate for Payer: MDX Hawaii PPO	$357.93
Rate for Payer: Ohana Health Plan Medicaid	$154.98
Rate for Payer: Ohana Health Plan Medicare	$154.98
Rate for Payer: UnitedHealthcare Medicaid	$23.78
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$67.43

FEMUR 2VWS

Facility

$369.00

Service Code	HCPCS 73552
Hospital Charge Code	42473551
Hospital Revenue Code	320
Min. Negotiated Rate	$313.65
Max. Negotiated Rate	$357.93
Rate for Payer: Cash Price	$239.85
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: MDX Hawaii PPO	$357.93

FEMUR 2VWS

Facility

$369.00

Service Code	HCPCS 73552
Hospital Charge Code	42473551
Hospital Revenue Code	320
Min. Negotiated Rate	$15.87
Max. Negotiated Rate	$357.93
Rate for Payer: AlohaCare Medicaid	$184.50
Rate for Payer: AlohaCare Medicare	$154.98
Rate for Payer: Cash Price	$239.85
Rate for Payer: Cash Price	$239.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$339.48
Rate for Payer: Devoted Health Medicare	$154.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$15.87
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$154.98
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Humana Medicare	$154.98
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: Kaiser Permanente Medicaid	$188.19
Rate for Payer: Kaiser Permanente Medicare	$154.98
Rate for Payer: MDX Hawaii PPO	$357.93
Rate for Payer: Ohana Health Plan Medicaid	$154.98
Rate for Payer: Ohana Health Plan Medicare	$154.98
Rate for Payer: UnitedHealthcare Medicaid	$23.78
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$67.43

fenofibrate 145 mg Tab [KMC]

Facility

$22.91

Service Code	NDC 00378306677
Hospital Revenue Code	250
Min. Negotiated Rate	$19.47
Max. Negotiated Rate	$22.22
Rate for Payer: Cash Price	$14.89
Rate for Payer: Health Management Network Commercial	$19.47
Rate for Payer: Kaiser Permanente Commercial	$20.62
Rate for Payer: MDX Hawaii PPO	$22.22

fenofibrate 145 mg Tab [KMC]

Facility

$22.91

Service Code	NDC 00378306677
Hospital Revenue Code	250
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$22.22
Rate for Payer: AlohaCare Medicaid	$11.46
Rate for Payer: AlohaCare Medicare	$9.62
Rate for Payer: Cash Price	$14.89
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$21.08
Rate for Payer: Devoted Health Medicare	$9.62
Rate for Payer: Hawaii Medical Service Association Medicare	$9.62
Rate for Payer: Hawaii Western Management Group Commercial	$21.76
Rate for Payer: Health Management Network Commercial	$19.47
Rate for Payer: Humana Medicare	$9.62
Rate for Payer: Kaiser Permanente Commercial	$20.62
Rate for Payer: Kaiser Permanente Medicaid	$11.68
Rate for Payer: Kaiser Permanente Medicare	$9.62
Rate for Payer: MDX Hawaii PPO	$22.22
Rate for Payer: Ohana Health Plan Medicaid	$9.62
Rate for Payer: Ohana Health Plan Medicare	$9.62
Rate for Payer: UnitedHealthcare Medicaid	$13.75
Rate for Payer: UnitedHealthcare Medicare	$9.62
Rate for Payer: University Health Alliance Commercial	$16.70

fenofibrate 160 mg Tab [KMC]

Facility

$9.51

Service Code	NDC 00115552210
Hospital Revenue Code	250
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$9.22
Rate for Payer: AlohaCare Medicaid	$4.75
Rate for Payer: AlohaCare Medicare	$3.99
Rate for Payer: Cash Price	$6.18
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$8.75
Rate for Payer: Devoted Health Medicare	$3.99
Rate for Payer: Hawaii Medical Service Association Medicare	$3.99
Rate for Payer: Hawaii Western Management Group Commercial	$9.03
Rate for Payer: Health Management Network Commercial	$8.08
Rate for Payer: Humana Medicare	$3.99
Rate for Payer: Kaiser Permanente Commercial	$8.56
Rate for Payer: Kaiser Permanente Medicaid	$4.85
Rate for Payer: Kaiser Permanente Medicare	$3.99
Rate for Payer: MDX Hawaii PPO	$9.22
Rate for Payer: Ohana Health Plan Medicaid	$3.99
Rate for Payer: Ohana Health Plan Medicare	$3.99
Rate for Payer: UnitedHealthcare Medicaid	$5.71
Rate for Payer: UnitedHealthcare Medicare	$3.99
Rate for Payer: University Health Alliance Commercial	$6.93

fenofibrate 160 mg Tab [KMC]

Facility

$9.51

Service Code	NDC 00115552210
Hospital Revenue Code	250
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$9.22
Rate for Payer: Cash Price	$6.18
Rate for Payer: Health Management Network Commercial	$8.08
Rate for Payer: Kaiser Permanente Commercial	$8.56
Rate for Payer: MDX Hawaii PPO	$9.22

fenofibrate 54 mg Tab [KMC]

Facility

$3.17

Service Code	NDC 59651057590
Hospital Revenue Code	250
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$3.07
Rate for Payer: Cash Price	$2.06
Rate for Payer: Health Management Network Commercial	$2.69
Rate for Payer: Kaiser Permanente Commercial	$2.85
Rate for Payer: MDX Hawaii PPO	$3.07

fenofibrate 54 mg Tab [KMC]

Facility

$3.17

Service Code	NDC 59651057590
Hospital Revenue Code	250
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$3.07
Rate for Payer: AlohaCare Medicaid	$1.58
Rate for Payer: AlohaCare Medicare	$1.33
Rate for Payer: Cash Price	$2.06
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.92
Rate for Payer: Devoted Health Medicare	$1.33
Rate for Payer: Hawaii Medical Service Association Medicare	$1.33
Rate for Payer: Hawaii Western Management Group Commercial	$3.01
Rate for Payer: Health Management Network Commercial	$2.69
Rate for Payer: Humana Medicare	$1.33
Rate for Payer: Kaiser Permanente Commercial	$2.85
Rate for Payer: Kaiser Permanente Medicaid	$1.62
Rate for Payer: Kaiser Permanente Medicare	$1.33
Rate for Payer: MDX Hawaii PPO	$3.07
Rate for Payer: Ohana Health Plan Medicaid	$1.33
Rate for Payer: Ohana Health Plan Medicare	$1.33
Rate for Payer: UnitedHealthcare Medicaid	$1.90
Rate for Payer: UnitedHealthcare Medicare	$1.33
Rate for Payer: University Health Alliance Commercial	$2.31

fentaNYL 100 mcg/hr ER film [KMC]

Facility

$213.66

Service Code	NDC 00591321472
Hospital Revenue Code	250
Min. Negotiated Rate	$89.74
Max. Negotiated Rate	$207.25
Rate for Payer: AlohaCare Medicaid	$106.83
Rate for Payer: AlohaCare Medicare	$89.74
Rate for Payer: Cash Price	$138.88
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$196.57
Rate for Payer: Devoted Health Medicare	$89.74
Rate for Payer: Hawaii Medical Service Association Medicare	$89.74
Rate for Payer: Hawaii Western Management Group Commercial	$202.98
Rate for Payer: Health Management Network Commercial	$181.61
Rate for Payer: Humana Medicare	$89.74
Rate for Payer: Kaiser Permanente Commercial	$192.29
Rate for Payer: Kaiser Permanente Medicaid	$108.97
Rate for Payer: Kaiser Permanente Medicare	$89.74
Rate for Payer: MDX Hawaii PPO	$207.25
Rate for Payer: Ohana Health Plan Medicaid	$89.74
Rate for Payer: Ohana Health Plan Medicare	$89.74
Rate for Payer: UnitedHealthcare Medicaid	$128.20
Rate for Payer: UnitedHealthcare Medicare	$89.74
Rate for Payer: University Health Alliance Commercial	$155.74

fentaNYL 100 mcg/hr ER film [KMC]

Facility

$213.66

Service Code	NDC 00591321472
Hospital Revenue Code	250
Min. Negotiated Rate	$181.61
Max. Negotiated Rate	$207.25
Rate for Payer: Cash Price	$138.88
Rate for Payer: Health Management Network Commercial	$181.61
Rate for Payer: Kaiser Permanente Commercial	$192.29
Rate for Payer: MDX Hawaii PPO	$207.25

fentaNYL 12 mcg/hr ER film [KMC]

Facility

$81.21

Service Code	NDC 00378911998
Hospital Revenue Code	250
Min. Negotiated Rate	$34.11
Max. Negotiated Rate	$78.77
Rate for Payer: AlohaCare Medicaid	$40.60
Rate for Payer: AlohaCare Medicare	$34.11
Rate for Payer: Cash Price	$52.79
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$74.71
Rate for Payer: Devoted Health Medicare	$34.11
Rate for Payer: Hawaii Medical Service Association Medicare	$34.11
Rate for Payer: Hawaii Western Management Group Commercial	$77.15
Rate for Payer: Health Management Network Commercial	$69.03
Rate for Payer: Humana Medicare	$34.11
Rate for Payer: Kaiser Permanente Commercial	$73.09
Rate for Payer: Kaiser Permanente Medicaid	$41.42
Rate for Payer: Kaiser Permanente Medicare	$34.11
Rate for Payer: MDX Hawaii PPO	$78.77
Rate for Payer: Ohana Health Plan Medicaid	$34.11
Rate for Payer: Ohana Health Plan Medicare	$34.11
Rate for Payer: UnitedHealthcare Medicaid	$48.73
Rate for Payer: UnitedHealthcare Medicare	$34.11
Rate for Payer: University Health Alliance Commercial	$59.19

fentaNYL 12 mcg/hr ER film [KMC]

Facility

$81.21

Service Code	NDC 00378911998
Hospital Revenue Code	250
Min. Negotiated Rate	$69.03
Max. Negotiated Rate	$78.77
Rate for Payer: Cash Price	$52.79
Rate for Payer: Health Management Network Commercial	$69.03
Rate for Payer: Kaiser Permanente Commercial	$73.09
Rate for Payer: MDX Hawaii PPO	$78.77

fentaNYL 25 mcg/hr ER film [KMC]

Facility

$57.68

Service Code	NDC 00378912198
Hospital Revenue Code	250
Min. Negotiated Rate	$24.23
Max. Negotiated Rate	$55.95
Rate for Payer: AlohaCare Medicaid	$28.84
Rate for Payer: AlohaCare Medicare	$24.23
Rate for Payer: Cash Price	$37.49
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$53.07
Rate for Payer: Devoted Health Medicare	$24.23
Rate for Payer: Hawaii Medical Service Association Medicare	$24.23
Rate for Payer: Hawaii Western Management Group Commercial	$54.80
Rate for Payer: Health Management Network Commercial	$49.03
Rate for Payer: Humana Medicare	$24.23
Rate for Payer: Kaiser Permanente Commercial	$51.91
Rate for Payer: Kaiser Permanente Medicaid	$29.42
Rate for Payer: Kaiser Permanente Medicare	$24.23
Rate for Payer: MDX Hawaii PPO	$55.95
Rate for Payer: Ohana Health Plan Medicaid	$24.23
Rate for Payer: Ohana Health Plan Medicare	$24.23
Rate for Payer: UnitedHealthcare Medicaid	$34.61
Rate for Payer: UnitedHealthcare Medicare	$24.23
Rate for Payer: University Health Alliance Commercial	$42.04

fentaNYL 25 mcg/hr ER film [KMC]

Facility

$57.68

Service Code	NDC 00378912198
Hospital Revenue Code	250
Min. Negotiated Rate	$49.03
Max. Negotiated Rate	$55.95
Rate for Payer: Cash Price	$37.49
Rate for Payer: Health Management Network Commercial	$49.03
Rate for Payer: Kaiser Permanente Commercial	$51.91
Rate for Payer: MDX Hawaii PPO	$55.95

fentaNYL 50 mcg/hr ER film [KMC]

Facility

$105.44

Service Code	NDC 00406905076
Hospital Revenue Code	250
Min. Negotiated Rate	$44.28
Max. Negotiated Rate	$102.28
Rate for Payer: AlohaCare Medicaid	$52.72
Rate for Payer: AlohaCare Medicare	$44.28
Rate for Payer: Cash Price	$68.54
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$97.00
Rate for Payer: Devoted Health Medicare	$44.28
Rate for Payer: Hawaii Medical Service Association Medicare	$44.28
Rate for Payer: Hawaii Western Management Group Commercial	$100.17
Rate for Payer: Health Management Network Commercial	$89.62
Rate for Payer: Humana Medicare	$44.28
Rate for Payer: Kaiser Permanente Commercial	$94.90
Rate for Payer: Kaiser Permanente Medicaid	$53.77
Rate for Payer: Kaiser Permanente Medicare	$44.28
Rate for Payer: MDX Hawaii PPO	$102.28
Rate for Payer: Ohana Health Plan Medicaid	$44.28
Rate for Payer: Ohana Health Plan Medicare	$44.28
Rate for Payer: UnitedHealthcare Medicaid	$63.26
Rate for Payer: UnitedHealthcare Medicare	$44.28
Rate for Payer: University Health Alliance Commercial	$76.86

fentaNYL 50 mcg/hr ER film [KMC]

Facility

$105.44

Service Code	NDC 00406905076
Hospital Revenue Code	250
Min. Negotiated Rate	$89.62
Max. Negotiated Rate	$102.28
Rate for Payer: Cash Price	$68.54
Rate for Payer: Health Management Network Commercial	$89.62
Rate for Payer: Kaiser Permanente Commercial	$94.90
Rate for Payer: MDX Hawaii PPO	$102.28

fentaNYL 75 mcg/hr ER film [KMC]

Facility

$237.22

Service Code	NDC 47781042747
Hospital Revenue Code	250
Min. Negotiated Rate	$99.63
Max. Negotiated Rate	$230.10
Rate for Payer: AlohaCare Medicaid	$118.61
Rate for Payer: AlohaCare Medicare	$99.63
Rate for Payer: Cash Price	$154.19
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$218.24
Rate for Payer: Devoted Health Medicare	$99.63
Rate for Payer: Hawaii Medical Service Association Medicare	$99.63
Rate for Payer: Hawaii Western Management Group Commercial	$225.36
Rate for Payer: Health Management Network Commercial	$201.64
Rate for Payer: Humana Medicare	$99.63
Rate for Payer: Kaiser Permanente Commercial	$213.50
Rate for Payer: Kaiser Permanente Medicaid	$120.98
Rate for Payer: Kaiser Permanente Medicare	$99.63
Rate for Payer: MDX Hawaii PPO	$230.10
Rate for Payer: Ohana Health Plan Medicaid	$99.63
Rate for Payer: Ohana Health Plan Medicare	$99.63
Rate for Payer: UnitedHealthcare Medicaid	$142.33
Rate for Payer: UnitedHealthcare Medicare	$99.63
Rate for Payer: University Health Alliance Commercial	$172.91

fentaNYL 75 mcg/hr ER film [KMC]

Facility

$237.22

Service Code	NDC 47781042747
Hospital Revenue Code	250
Min. Negotiated Rate	$201.64
Max. Negotiated Rate	$230.10
Rate for Payer: Cash Price	$154.19
Rate for Payer: Health Management Network Commercial	$201.64
Rate for Payer: Kaiser Permanente Commercial	$213.50
Rate for Payer: MDX Hawaii PPO	$230.10

Know your out-of-pocket cost for care.

All Charges