Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

acetylcysteine 20% Neb Soln [KMC]

Facility

$15.83

Service Code	HCPCS J7608
Hospital Revenue Code	636
Min. Negotiated Rate	$13.46
Max. Negotiated Rate	$15.36
Rate for Payer: Cash Price	$10.29
Rate for Payer: Health Management Network Commercial	$13.46
Rate for Payer: Kaiser Permanente Commercial	$14.25
Rate for Payer: MDX Hawaii PPO	$15.36

acetylcysteine 6000mg / 30mL (20%) IV Soln [KMC]

Facility

$33.15

Service Code	HCPCS J0132
Hospital Revenue Code	636
Min. Negotiated Rate	$28.18
Max. Negotiated Rate	$32.16
Rate for Payer: Cash Price	$21.55
Rate for Payer: Health Management Network Commercial	$28.18
Rate for Payer: Kaiser Permanente Commercial	$29.84
Rate for Payer: MDX Hawaii PPO	$32.16

acetylcysteine 6000mg / 30mL (20%) IV Soln [KMC]

Facility

$33.15

Service Code	HCPCS J0132
Hospital Revenue Code	636
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$32.16
Rate for Payer: AlohaCare Medicaid	$16.57
Rate for Payer: AlohaCare Medicare	$13.92
Rate for Payer: Cash Price	$21.55
Rate for Payer: Cash Price	$21.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$30.50
Rate for Payer: Devoted Health Medicare	$13.92
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.37
Rate for Payer: Hawaii Medical Service Association Medicare	$13.92
Rate for Payer: Hawaii Western Management Group Commercial	$31.49
Rate for Payer: Health Management Network Commercial	$28.18
Rate for Payer: Humana Medicare	$13.92
Rate for Payer: Kaiser Permanente Commercial	$29.84
Rate for Payer: Kaiser Permanente Medicaid	$16.91
Rate for Payer: Kaiser Permanente Medicare	$13.92
Rate for Payer: MDX Hawaii PPO	$32.16
Rate for Payer: Ohana Health Plan Medicaid	$13.92
Rate for Payer: Ohana Health Plan Medicare	$13.92
Rate for Payer: UnitedHealthcare Medicaid	$19.89
Rate for Payer: UnitedHealthcare Medicare	$13.92
Rate for Payer: University Health Alliance Commercial	$24.16

Acid Fast Smear and Culture DLS

Facility

$285.00

Service Code	HCPCS 87206
Hospital Charge Code	422872065
Hospital Revenue Code	306
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$276.45
Rate for Payer: Cash Price	$185.25
Rate for Payer: Health Management Network Commercial	$242.25
Rate for Payer: Kaiser Permanente Commercial	$256.50
Rate for Payer: MDX Hawaii PPO	$276.45

Acid Fast Smear and Culture DLS

Facility

$285.00

Service Code	HCPCS 87206
Hospital Charge Code	422872065
Hospital Revenue Code	306
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$276.45
Rate for Payer: AlohaCare Medicaid	$142.50
Rate for Payer: AlohaCare Medicare	$119.70
Rate for Payer: Cash Price	$185.25
Rate for Payer: Cash Price	$185.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$262.20
Rate for Payer: Devoted Health Medicare	$119.70
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.42
Rate for Payer: Hawaii Medical Service Association Commercial	$6.74
Rate for Payer: Hawaii Medical Service Association Medicare	$119.70
Rate for Payer: Hawaii Western Management Group Commercial	$5.39
Rate for Payer: Health Management Network Commercial	$242.25
Rate for Payer: Humana Medicare	$119.70
Rate for Payer: Kaiser Permanente Commercial	$256.50
Rate for Payer: Kaiser Permanente Medicaid	$145.35
Rate for Payer: Kaiser Permanente Medicare	$119.70
Rate for Payer: MDX Hawaii PPO	$276.45
Rate for Payer: Ohana Health Plan Medicaid	$119.70
Rate for Payer: Ohana Health Plan Medicare	$119.70
Rate for Payer: UnitedHealthcare Medicaid	$7.42
Rate for Payer: UnitedHealthcare Medicare	$119.70
Rate for Payer: University Health Alliance Commercial	$13.88

acitretin 10 mg Cap [KMC]

Facility

$124.81

Service Code	NDC 00115175008
Hospital Revenue Code	250
Min. Negotiated Rate	$52.42
Max. Negotiated Rate	$121.07
Rate for Payer: AlohaCare Medicaid	$62.41
Rate for Payer: AlohaCare Medicare	$52.42
Rate for Payer: Cash Price	$81.13
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$114.83
Rate for Payer: Devoted Health Medicare	$52.42
Rate for Payer: Hawaii Medical Service Association Medicare	$52.42
Rate for Payer: Hawaii Western Management Group Commercial	$118.57
Rate for Payer: Health Management Network Commercial	$106.09
Rate for Payer: Humana Medicare	$52.42
Rate for Payer: Kaiser Permanente Commercial	$112.33
Rate for Payer: Kaiser Permanente Medicaid	$63.65
Rate for Payer: Kaiser Permanente Medicare	$52.42
Rate for Payer: MDX Hawaii PPO	$121.07
Rate for Payer: Ohana Health Plan Medicaid	$52.42
Rate for Payer: Ohana Health Plan Medicare	$52.42
Rate for Payer: UnitedHealthcare Medicaid	$74.89
Rate for Payer: UnitedHealthcare Medicare	$52.42
Rate for Payer: University Health Alliance Commercial	$90.97

acitretin 10 mg Cap [KMC]

Facility

$124.81

Service Code	NDC 00115175008
Hospital Revenue Code	250
Min. Negotiated Rate	$106.09
Max. Negotiated Rate	$121.07
Rate for Payer: Cash Price	$81.13
Rate for Payer: Health Management Network Commercial	$106.09
Rate for Payer: Kaiser Permanente Commercial	$112.33
Rate for Payer: MDX Hawaii PPO	$121.07

A-C JOINTS BILATERAL

Facility

$381.00

Service Code	HCPCS 73050
Hospital Charge Code	424730500
Hospital Revenue Code	320
Min. Negotiated Rate	$323.85
Max. Negotiated Rate	$369.57
Rate for Payer: Cash Price	$247.65
Rate for Payer: Health Management Network Commercial	$323.85
Rate for Payer: Kaiser Permanente Commercial	$342.90
Rate for Payer: MDX Hawaii PPO	$369.57

A-C JOINTS BILATERAL

Facility

$381.00

Service Code	HCPCS 73050
Hospital Charge Code	424730500
Hospital Revenue Code	320
Min. Negotiated Rate	$21.96
Max. Negotiated Rate	$369.57
Rate for Payer: AlohaCare Medicaid	$190.50
Rate for Payer: AlohaCare Medicare	$160.02
Rate for Payer: Cash Price	$247.65
Rate for Payer: Cash Price	$247.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$350.52
Rate for Payer: Devoted Health Medicare	$160.02
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$21.96
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$160.02
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$323.85
Rate for Payer: Humana Medicare	$160.02
Rate for Payer: Kaiser Permanente Commercial	$342.90
Rate for Payer: Kaiser Permanente Medicaid	$194.31
Rate for Payer: Kaiser Permanente Medicare	$160.02
Rate for Payer: MDX Hawaii PPO	$369.57
Rate for Payer: Ohana Health Plan Medicaid	$160.02
Rate for Payer: Ohana Health Plan Medicare	$160.02
Rate for Payer: UnitedHealthcare Medicaid	$21.96
Rate for Payer: UnitedHealthcare Medicare	$160.02
Rate for Payer: University Health Alliance Commercial	$73.74

aclidinium 400 mcg/inh powder inhaler [KMC]

Facility

$745.09

Service Code	NDC 00310080039
Hospital Revenue Code	250
Min. Negotiated Rate	$312.94
Max. Negotiated Rate	$722.74
Rate for Payer: AlohaCare Medicaid	$372.55
Rate for Payer: AlohaCare Medicare	$312.94
Rate for Payer: Cash Price	$484.31
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$685.48
Rate for Payer: Devoted Health Medicare	$312.94
Rate for Payer: Hawaii Medical Service Association Medicare	$312.94
Rate for Payer: Hawaii Western Management Group Commercial	$707.84
Rate for Payer: Health Management Network Commercial	$633.33
Rate for Payer: Humana Medicare	$312.94
Rate for Payer: Kaiser Permanente Commercial	$670.58
Rate for Payer: Kaiser Permanente Medicaid	$380.00
Rate for Payer: Kaiser Permanente Medicare	$312.94
Rate for Payer: MDX Hawaii PPO	$722.74
Rate for Payer: Ohana Health Plan Medicaid	$312.94
Rate for Payer: Ohana Health Plan Medicare	$312.94
Rate for Payer: UnitedHealthcare Medicaid	$447.05
Rate for Payer: UnitedHealthcare Medicare	$312.94
Rate for Payer: University Health Alliance Commercial	$543.10

aclidinium 400 mcg/inh powder inhaler [KMC]

Facility

$745.09

Service Code	NDC 00310080039
Hospital Revenue Code	250
Min. Negotiated Rate	$633.33
Max. Negotiated Rate	$722.74
Rate for Payer: Cash Price	$484.31
Rate for Payer: Health Management Network Commercial	$633.33
Rate for Payer: Kaiser Permanente Commercial	$670.58
Rate for Payer: MDX Hawaii PPO	$722.74

ACNE SURGERY

Professional

Both

$261.00

Service Code	HCPCS 10040
Hospital Revenue Code	361
Min. Negotiated Rate	$35.88
Max. Negotiated Rate	$221.85
Rate for Payer: AlohaCare Medicaid	$52.81
Rate for Payer: AlohaCare Medicare	$42.67
Rate for Payer: Cash Price	$169.65
Rate for Payer: Cash Price	$169.65
Rate for Payer: Devoted Health Medicare	$42.67
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$52.81
Rate for Payer: Hawaii Medical Service Association Medicare	$42.67
Rate for Payer: Hawaii Western Management Group Commercial	$35.88
Rate for Payer: Health Management Network Commercial	$221.85
Rate for Payer: Kaiser Permanente Commercial	$51.20
Rate for Payer: Kaiser Permanente Medicaid	$51.20
Rate for Payer: Kaiser Permanente Medicare	$51.20
Rate for Payer: Ohana Health Plan Medicaid	$52.81
Rate for Payer: Ohana Health Plan Medicare	$42.67
Rate for Payer: UnitedHealthcare Medicaid	$52.81
Rate for Payer: UnitedHealthcare Medicare	$42.67

ACTH, Plasma DLS

Facility

$704.00

Service Code	HCPCS 82024
Hospital Charge Code	422820245
Hospital Revenue Code	301
Min. Negotiated Rate	$598.40
Max. Negotiated Rate	$682.88
Rate for Payer: Cash Price	$457.60
Rate for Payer: Health Management Network Commercial	$598.40
Rate for Payer: Kaiser Permanente Commercial	$633.60
Rate for Payer: MDX Hawaii PPO	$682.88

ACTH, Plasma DLS

Facility

$704.00

Service Code	HCPCS 82024
Hospital Charge Code	422820245
Hospital Revenue Code	301
Min. Negotiated Rate	$38.62
Max. Negotiated Rate	$682.88
Rate for Payer: AlohaCare Medicaid	$352.00
Rate for Payer: AlohaCare Medicare	$295.68
Rate for Payer: Cash Price	$457.60
Rate for Payer: Cash Price	$457.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$647.68
Rate for Payer: Devoted Health Medicare	$295.68
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$53.38
Rate for Payer: Hawaii Medical Service Association Commercial	$48.27
Rate for Payer: Hawaii Medical Service Association Medicare	$295.68
Rate for Payer: Hawaii Western Management Group Commercial	$38.62
Rate for Payer: Health Management Network Commercial	$598.40
Rate for Payer: Humana Medicare	$295.68
Rate for Payer: Kaiser Permanente Commercial	$633.60
Rate for Payer: Kaiser Permanente Medicaid	$359.04
Rate for Payer: Kaiser Permanente Medicare	$295.68
Rate for Payer: MDX Hawaii PPO	$682.88
Rate for Payer: Ohana Health Plan Medicaid	$295.68
Rate for Payer: Ohana Health Plan Medicare	$295.68
Rate for Payer: UnitedHealthcare Medicaid	$53.38
Rate for Payer: UnitedHealthcare Medicare	$295.68
Rate for Payer: University Health Alliance Commercial	$99.84

Actin (Smooth Muscle), AB, IgG DLS

Facility

$154.00

Service Code	HCPCS 83516
Hospital Charge Code	422835165
Hospital Revenue Code	301
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$149.38
Rate for Payer: AlohaCare Medicaid	$77.00
Rate for Payer: AlohaCare Medicare	$64.68
Rate for Payer: Cash Price	$100.10
Rate for Payer: Cash Price	$100.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$141.68
Rate for Payer: Devoted Health Medicare	$64.68
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$15.95
Rate for Payer: Hawaii Medical Service Association Commercial	$14.41
Rate for Payer: Hawaii Medical Service Association Medicare	$64.68
Rate for Payer: Hawaii Western Management Group Commercial	$11.53
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Humana Medicare	$64.68
Rate for Payer: Kaiser Permanente Commercial	$138.60
Rate for Payer: Kaiser Permanente Medicaid	$78.54
Rate for Payer: Kaiser Permanente Medicare	$64.68
Rate for Payer: MDX Hawaii PPO	$149.38
Rate for Payer: Ohana Health Plan Medicaid	$64.68
Rate for Payer: Ohana Health Plan Medicare	$64.68
Rate for Payer: UnitedHealthcare Medicaid	$15.95
Rate for Payer: UnitedHealthcare Medicare	$64.68
Rate for Payer: University Health Alliance Commercial	$29.82

Actin (Smooth Muscle), AB, IgG DLS

Facility

$154.00

Service Code	HCPCS 83516
Hospital Charge Code	422835165
Hospital Revenue Code	301
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$149.38
Rate for Payer: Cash Price	$100.10
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Kaiser Permanente Commercial	$138.60
Rate for Payer: MDX Hawaii PPO	$149.38

ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION

Facility

$11,661.38

Service Code	MSDRG 880
Min. Negotiated Rate	$11,661.38
Max. Negotiated Rate	$11,661.38
Rate for Payer: Hawaii Medical Service Association Commercial	$11,661.38

ACUTE AND SUBACUTE ENDOCARDITIS WITH CC

Facility

$47,996.55

Service Code	MSDRG 289
Min. Negotiated Rate	$47,996.55
Max. Negotiated Rate	$47,996.55
Rate for Payer: Hawaii Medical Service Association Commercial	$47,996.55

ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC

Facility

$47,996.55

Service Code	MSDRG 288
Min. Negotiated Rate	$47,996.55
Max. Negotiated Rate	$47,996.55
Rate for Payer: Hawaii Medical Service Association Commercial	$47,996.55

ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC

Facility

$47,996.55

Service Code	MSDRG 290
Min. Negotiated Rate	$47,996.55
Max. Negotiated Rate	$47,996.55
Rate for Payer: Hawaii Medical Service Association Commercial	$47,996.55

Acute Hepatitis Panel DLS

Facility

$549.00

Service Code	HCPCS 80074
Hospital Charge Code	422800745
Hospital Revenue Code	301
Min. Negotiated Rate	$47.63
Max. Negotiated Rate	$532.53
Rate for Payer: AlohaCare Medicaid	$274.50
Rate for Payer: AlohaCare Medicare	$230.58
Rate for Payer: Cash Price	$356.85
Rate for Payer: Cash Price	$356.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$505.08
Rate for Payer: Devoted Health Medicare	$230.58
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$65.82
Rate for Payer: Hawaii Medical Service Association Commercial	$59.54
Rate for Payer: Hawaii Medical Service Association Medicare	$230.58
Rate for Payer: Hawaii Western Management Group Commercial	$47.63
Rate for Payer: Health Management Network Commercial	$466.65
Rate for Payer: Humana Medicare	$230.58
Rate for Payer: Kaiser Permanente Commercial	$494.10
Rate for Payer: Kaiser Permanente Medicaid	$279.99
Rate for Payer: Kaiser Permanente Medicare	$230.58
Rate for Payer: MDX Hawaii PPO	$532.53
Rate for Payer: Ohana Health Plan Medicaid	$230.58
Rate for Payer: Ohana Health Plan Medicare	$230.58
Rate for Payer: UnitedHealthcare Medicaid	$65.82
Rate for Payer: UnitedHealthcare Medicare	$230.58
Rate for Payer: University Health Alliance Commercial	$123.10

Acute Hepatitis Panel DLS

Facility

$549.00

Service Code	HCPCS 80074
Hospital Charge Code	422800745
Hospital Revenue Code	301
Min. Negotiated Rate	$466.65
Max. Negotiated Rate	$532.53
Rate for Payer: Cash Price	$356.85
Rate for Payer: Health Management Network Commercial	$466.65
Rate for Payer: Kaiser Permanente Commercial	$494.10
Rate for Payer: MDX Hawaii PPO	$532.53

ACUTE LEUKEMIA WITH CC

Facility

$139,699.59

Service Code	MSDRG 835
Min. Negotiated Rate	$139,699.59
Max. Negotiated Rate	$139,699.59
Rate for Payer: Hawaii Medical Service Association Commercial	$139,699.59

ACUTE LEUKEMIA WITH MCC

Facility

$139,699.59

Service Code	MSDRG 834
Min. Negotiated Rate	$139,699.59
Max. Negotiated Rate	$139,699.59
Rate for Payer: Hawaii Medical Service Association Commercial	$139,699.59

ACUTE LEUKEMIA WITH OTHER PROCEDURES

Facility

$139,699.59

Service Code	MSDRG 850
Min. Negotiated Rate	$139,699.59
Max. Negotiated Rate	$139,699.59
Rate for Payer: Hawaii Medical Service Association Commercial	$139,699.59

Know your out-of-pocket cost for care.

All Charges