Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

FOLEY CATH 30CC 24FR

Facility

$51.00

Hospital Charge Code	8114
Hospital Revenue Code	274
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$49.47
Rate for Payer: AlohaCare Medicaid	$25.50
Rate for Payer: AlohaCare Medicare	$21.42
Rate for Payer: Cash Price	$33.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$46.92
Rate for Payer: Devoted Health Medicare	$21.42
Rate for Payer: Hawaii Medical Service Association Medicare	$21.42
Rate for Payer: Hawaii Western Management Group Commercial	$35.70
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Humana Medicare	$21.42
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: Kaiser Permanente Medicaid	$26.01
Rate for Payer: Kaiser Permanente Medicare	$21.42
Rate for Payer: MDX Hawaii PPO	$49.47
Rate for Payer: Ohana Health Plan Medicaid	$21.42
Rate for Payer: Ohana Health Plan Medicare	$21.42
Rate for Payer: UnitedHealthcare Medicare	$21.42
Rate for Payer: University Health Alliance Commercial	$28.56

FOLEY CATH 3CC 10FR

Facility

$294.00

Hospital Charge Code	8116
Hospital Revenue Code	274
Min. Negotiated Rate	$164.64
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$191.10
Rate for Payer: Hawaii Western Management Group Commercial	$205.80
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Kaiser Permanente Commercial	$264.60
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: University Health Alliance Commercial	$164.64

FOLEY CATH 3CC 10FR

Facility

$294.00

Hospital Charge Code	8116
Hospital Revenue Code	274
Min. Negotiated Rate	$123.48
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$147.00
Rate for Payer: AlohaCare Medicare	$123.48
Rate for Payer: Cash Price	$191.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$270.48
Rate for Payer: Devoted Health Medicare	$123.48
Rate for Payer: Hawaii Medical Service Association Medicare	$123.48
Rate for Payer: Hawaii Western Management Group Commercial	$205.80
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$123.48
Rate for Payer: Kaiser Permanente Commercial	$264.60
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$123.48
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$123.48
Rate for Payer: Ohana Health Plan Medicare	$123.48
Rate for Payer: UnitedHealthcare Medicare	$123.48
Rate for Payer: University Health Alliance Commercial	$164.64

FOLEY CATH 3CC 10 R PEDS

Facility

$280.00

Hospital Charge Code	8115
Hospital Revenue Code	274
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$271.60
Rate for Payer: AlohaCare Medicaid	$140.00
Rate for Payer: AlohaCare Medicare	$117.60
Rate for Payer: Cash Price	$182.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$257.60
Rate for Payer: Devoted Health Medicare	$117.60
Rate for Payer: Hawaii Medical Service Association Medicare	$117.60
Rate for Payer: Hawaii Western Management Group Commercial	$196.00
Rate for Payer: Health Management Network Commercial	$238.00
Rate for Payer: Humana Medicare	$117.60
Rate for Payer: Kaiser Permanente Commercial	$252.00
Rate for Payer: Kaiser Permanente Medicaid	$142.80
Rate for Payer: Kaiser Permanente Medicare	$117.60
Rate for Payer: MDX Hawaii PPO	$271.60
Rate for Payer: Ohana Health Plan Medicaid	$117.60
Rate for Payer: Ohana Health Plan Medicare	$117.60
Rate for Payer: UnitedHealthcare Medicare	$117.60
Rate for Payer: University Health Alliance Commercial	$156.80

FOLEY CATH 3CC 10 R PEDS

Facility

$280.00

Hospital Charge Code	8115
Hospital Revenue Code	274
Min. Negotiated Rate	$156.80
Max. Negotiated Rate	$271.60
Rate for Payer: Cash Price	$182.00
Rate for Payer: Hawaii Western Management Group Commercial	$196.00
Rate for Payer: Health Management Network Commercial	$238.00
Rate for Payer: Kaiser Permanente Commercial	$252.00
Rate for Payer: MDX Hawaii PPO	$271.60
Rate for Payer: University Health Alliance Commercial	$156.80

FOLEY CATH 3CC 8FR

Facility

$93.00

Hospital Charge Code	8117
Hospital Revenue Code	274
Min. Negotiated Rate	$39.06
Max. Negotiated Rate	$90.21
Rate for Payer: AlohaCare Medicaid	$46.50
Rate for Payer: AlohaCare Medicare	$39.06
Rate for Payer: Cash Price	$60.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$85.56
Rate for Payer: Devoted Health Medicare	$39.06
Rate for Payer: Hawaii Medical Service Association Medicare	$39.06
Rate for Payer: Hawaii Western Management Group Commercial	$65.10
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Humana Medicare	$39.06
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: Kaiser Permanente Medicare	$39.06
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: Ohana Health Plan Medicaid	$39.06
Rate for Payer: Ohana Health Plan Medicare	$39.06
Rate for Payer: UnitedHealthcare Medicare	$39.06
Rate for Payer: University Health Alliance Commercial	$52.08

FOLEY CATH 3CC 8FR

Facility

$93.00

Hospital Charge Code	8117
Hospital Revenue Code	274
Min. Negotiated Rate	$52.08
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$60.45
Rate for Payer: Hawaii Western Management Group Commercial	$65.10
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: University Health Alliance Commercial	$52.08

FOLEY CATH 3 WAY 30CC 20FR

Facility

$7.00

Hospital Charge Code	8110
Hospital Revenue Code	274
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.55
Rate for Payer: Hawaii Western Management Group Commercial	$4.90
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: University Health Alliance Commercial	$3.92

FOLEY CATH 3 WAY 30CC 20FR

Facility

$7.00

Hospital Charge Code	8110
Hospital Revenue Code	274
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$6.79
Rate for Payer: AlohaCare Medicaid	$3.50
Rate for Payer: AlohaCare Medicare	$2.94
Rate for Payer: Cash Price	$4.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6.44
Rate for Payer: Devoted Health Medicare	$2.94
Rate for Payer: Hawaii Medical Service Association Medicare	$2.94
Rate for Payer: Hawaii Western Management Group Commercial	$4.90
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Humana Medicare	$2.94
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: Kaiser Permanente Medicare	$2.94
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: Ohana Health Plan Medicaid	$2.94
Rate for Payer: Ohana Health Plan Medicare	$2.94
Rate for Payer: UnitedHealthcare Medicare	$2.94
Rate for Payer: University Health Alliance Commercial	$3.92

FOLEY CATH 5CC 14FR CONDUE TIP

Facility

$325.00

Hospital Charge Code	8119
Hospital Revenue Code	274
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$315.25
Rate for Payer: AlohaCare Medicaid	$162.50
Rate for Payer: AlohaCare Medicare	$136.50
Rate for Payer: Cash Price	$211.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$299.00
Rate for Payer: Devoted Health Medicare	$136.50
Rate for Payer: Hawaii Medical Service Association Medicare	$136.50
Rate for Payer: Hawaii Western Management Group Commercial	$227.50
Rate for Payer: Health Management Network Commercial	$276.25
Rate for Payer: Humana Medicare	$136.50
Rate for Payer: Kaiser Permanente Commercial	$292.50
Rate for Payer: Kaiser Permanente Medicaid	$165.75
Rate for Payer: Kaiser Permanente Medicare	$136.50
Rate for Payer: MDX Hawaii PPO	$315.25
Rate for Payer: Ohana Health Plan Medicaid	$136.50
Rate for Payer: Ohana Health Plan Medicare	$136.50
Rate for Payer: UnitedHealthcare Medicare	$136.50
Rate for Payer: University Health Alliance Commercial	$182.00

FOLEY CATH 5CC 14FR CONDUE TIP

Facility

$325.00

Hospital Charge Code	8119
Hospital Revenue Code	274
Min. Negotiated Rate	$182.00
Max. Negotiated Rate	$315.25
Rate for Payer: Cash Price	$211.25
Rate for Payer: Hawaii Western Management Group Commercial	$227.50
Rate for Payer: Health Management Network Commercial	$276.25
Rate for Payer: Kaiser Permanente Commercial	$292.50
Rate for Payer: MDX Hawaii PPO	$315.25
Rate for Payer: University Health Alliance Commercial	$182.00

FOLEY CATH 5CC 16FR ANTI INFECTIVE

Facility

$107.00

Hospital Charge Code	8120
Hospital Revenue Code	274
Min. Negotiated Rate	$44.94
Max. Negotiated Rate	$103.79
Rate for Payer: AlohaCare Medicaid	$53.50
Rate for Payer: AlohaCare Medicare	$44.94
Rate for Payer: Cash Price	$69.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$98.44
Rate for Payer: Devoted Health Medicare	$44.94
Rate for Payer: Hawaii Medical Service Association Medicare	$44.94
Rate for Payer: Hawaii Western Management Group Commercial	$74.90
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: Humana Medicare	$44.94
Rate for Payer: Kaiser Permanente Commercial	$96.30
Rate for Payer: Kaiser Permanente Medicaid	$54.57
Rate for Payer: Kaiser Permanente Medicare	$44.94
Rate for Payer: MDX Hawaii PPO	$103.79
Rate for Payer: Ohana Health Plan Medicaid	$44.94
Rate for Payer: Ohana Health Plan Medicare	$44.94
Rate for Payer: UnitedHealthcare Medicare	$44.94
Rate for Payer: University Health Alliance Commercial	$59.92

FOLEY CATH 5CC 16FR ANTI INFECTIVE

Facility

$107.00

Hospital Charge Code	8120
Hospital Revenue Code	274
Min. Negotiated Rate	$59.92
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$69.55
Rate for Payer: Hawaii Western Management Group Commercial	$74.90
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: Kaiser Permanente Commercial	$96.30
Rate for Payer: MDX Hawaii PPO	$103.79
Rate for Payer: University Health Alliance Commercial	$59.92

FOLEY CATH 5CC 16FR CONDUE TIP

Facility

$40.00

Hospital Charge Code	8121
Hospital Revenue Code	274
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$38.80
Rate for Payer: AlohaCare Medicaid	$20.00
Rate for Payer: AlohaCare Medicare	$16.80
Rate for Payer: Cash Price	$26.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$36.80
Rate for Payer: Devoted Health Medicare	$16.80
Rate for Payer: Hawaii Medical Service Association Medicare	$16.80
Rate for Payer: Hawaii Western Management Group Commercial	$28.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Humana Medicare	$16.80
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: Kaiser Permanente Medicaid	$20.40
Rate for Payer: Kaiser Permanente Medicare	$16.80
Rate for Payer: MDX Hawaii PPO	$38.80
Rate for Payer: Ohana Health Plan Medicaid	$16.80
Rate for Payer: Ohana Health Plan Medicare	$16.80
Rate for Payer: UnitedHealthcare Medicare	$16.80
Rate for Payer: University Health Alliance Commercial	$22.40

FOLEY CATH 5CC 16FR CONDUE TIP

Facility

$40.00

Hospital Charge Code	8121
Hospital Revenue Code	274
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$26.00
Rate for Payer: Hawaii Western Management Group Commercial	$28.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: MDX Hawaii PPO	$38.80
Rate for Payer: University Health Alliance Commercial	$22.40

FOLEY CATH 5CC 18FR

Facility

$93.00

Hospital Charge Code	8122
Hospital Revenue Code	274
Min. Negotiated Rate	$39.06
Max. Negotiated Rate	$90.21
Rate for Payer: AlohaCare Medicaid	$46.50
Rate for Payer: AlohaCare Medicare	$39.06
Rate for Payer: Cash Price	$60.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$85.56
Rate for Payer: Devoted Health Medicare	$39.06
Rate for Payer: Hawaii Medical Service Association Medicare	$39.06
Rate for Payer: Hawaii Western Management Group Commercial	$65.10
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Humana Medicare	$39.06
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: Kaiser Permanente Medicare	$39.06
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: Ohana Health Plan Medicaid	$39.06
Rate for Payer: Ohana Health Plan Medicare	$39.06
Rate for Payer: UnitedHealthcare Medicare	$39.06
Rate for Payer: University Health Alliance Commercial	$52.08

FOLEY CATH 5CC 18FR

Facility

$93.00

Hospital Charge Code	8122
Hospital Revenue Code	274
Min. Negotiated Rate	$52.08
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$60.45
Rate for Payer: Hawaii Western Management Group Commercial	$65.10
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: University Health Alliance Commercial	$52.08

FOLEY CATH 5CC 20FR

Facility

$4.00

Hospital Charge Code	8123
Hospital Revenue Code	274
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.60
Rate for Payer: Hawaii Western Management Group Commercial	$2.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.24

FOLEY CATH 5CC 20FR

Facility

$4.00

Hospital Charge Code	8123
Hospital Revenue Code	274
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$1.68
Rate for Payer: Cash Price	$2.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3.68
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.68
Rate for Payer: Hawaii Western Management Group Commercial	$2.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$1.68
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$1.68
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$1.68
Rate for Payer: Ohana Health Plan Medicare	$1.68
Rate for Payer: UnitedHealthcare Medicare	$1.68
Rate for Payer: University Health Alliance Commercial	$2.24

FOLEY CATH INSERT COMPLICATED. CHARGE

Facility

$1,080.00

Service Code	HCPCS 51703
Hospital Charge Code	440517030
Hospital Revenue Code	450
Min. Negotiated Rate	$918.00
Max. Negotiated Rate	$1,047.60
Rate for Payer: Cash Price	$702.00
Rate for Payer: Health Management Network Commercial	$918.00
Rate for Payer: Kaiser Permanente Commercial	$972.00
Rate for Payer: MDX Hawaii PPO	$1,047.60

FOLEY CATH INSERT COMPLICATED. CHARGE

Facility

$1,080.00

Service Code	HCPCS 51703
Hospital Charge Code	440517030
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$540.00
Rate for Payer: AlohaCare Medicare	$453.60
Rate for Payer: Cash Price	$702.00
Rate for Payer: Cash Price	$702.00
Rate for Payer: Cash Price	$702.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$993.60
Rate for Payer: Devoted Health Medicare	$453.60
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$453.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,026.00
Rate for Payer: Health Management Network Commercial	$918.00
Rate for Payer: Humana Medicare	$453.60
Rate for Payer: Kaiser Permanente Commercial	$972.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$453.60
Rate for Payer: MDX Hawaii PPO	$1,047.60
Rate for Payer: Ohana Health Plan Medicaid	$453.60
Rate for Payer: Ohana Health Plan Medicare	$453.60
Rate for Payer: UnitedHealthcare Medicare	$453.60
Rate for Payer: University Health Alliance Commercial	$787.21

FOLEY TRAY

Facility

$7.00

Hospital Charge Code	8124
Hospital Revenue Code	274
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.55
Rate for Payer: Hawaii Western Management Group Commercial	$4.90
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: University Health Alliance Commercial	$3.92

FOLEY TRAY

Facility

$7.00

Hospital Charge Code	8124
Hospital Revenue Code	274
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$6.79
Rate for Payer: AlohaCare Medicaid	$3.50
Rate for Payer: AlohaCare Medicare	$2.94
Rate for Payer: Cash Price	$4.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6.44
Rate for Payer: Devoted Health Medicare	$2.94
Rate for Payer: Hawaii Medical Service Association Medicare	$2.94
Rate for Payer: Hawaii Western Management Group Commercial	$4.90
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Humana Medicare	$2.94
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: Kaiser Permanente Medicare	$2.94
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: Ohana Health Plan Medicaid	$2.94
Rate for Payer: Ohana Health Plan Medicare	$2.94
Rate for Payer: UnitedHealthcare Medicare	$2.94
Rate for Payer: University Health Alliance Commercial	$3.92

folic acid 1 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 60687068101
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

folic acid 1 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 60687068101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

Know your out-of-pocket cost for care.

All Charges