Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

guaiFENesin 600 mg ER tab [KMC]

Facility

$3.00

Service Code	NDC 00536116361
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

guaiFENesin 600 mg ER tab [KMC]

Facility

$3.00

Service Code	NDC 00536116361
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

halobetasol 0.05% Ointment [KMC]

Facility

$17.31

Service Code	NDC 00713063986
Hospital Revenue Code	250
Min. Negotiated Rate	$14.71
Max. Negotiated Rate	$16.79
Rate for Payer: Cash Price	$11.25
Rate for Payer: Health Management Network Commercial	$14.71
Rate for Payer: Kaiser Permanente Commercial	$15.58
Rate for Payer: MDX Hawaii PPO	$16.79

halobetasol 0.05% Ointment [KMC]

Facility

$17.31

Service Code	NDC 00713063986
Hospital Revenue Code	250
Min. Negotiated Rate	$7.27
Max. Negotiated Rate	$16.79
Rate for Payer: AlohaCare Medicaid	$8.65
Rate for Payer: AlohaCare Medicare	$7.27
Rate for Payer: Cash Price	$11.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$15.93
Rate for Payer: Devoted Health Medicare	$7.27
Rate for Payer: Hawaii Medical Service Association Medicare	$7.27
Rate for Payer: Hawaii Western Management Group Commercial	$16.44
Rate for Payer: Health Management Network Commercial	$14.71
Rate for Payer: Humana Medicare	$7.27
Rate for Payer: Kaiser Permanente Commercial	$15.58
Rate for Payer: Kaiser Permanente Medicaid	$8.83
Rate for Payer: Kaiser Permanente Medicare	$7.27
Rate for Payer: MDX Hawaii PPO	$16.79
Rate for Payer: Ohana Health Plan Medicaid	$7.27
Rate for Payer: Ohana Health Plan Medicare	$7.27
Rate for Payer: UnitedHealthcare Medicaid	$10.39
Rate for Payer: UnitedHealthcare Medicare	$7.27
Rate for Payer: University Health Alliance Commercial	$12.62

haloperidol 0.5 mg Tab [KMC]

Facility

$3.58

Service Code	NDC 00832151011
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$3.47
Rate for Payer: AlohaCare Medicaid	$1.79
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$2.33
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3.29
Rate for Payer: Devoted Health Medicare	$1.50
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$3.40
Rate for Payer: Health Management Network Commercial	$3.04
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$3.22
Rate for Payer: Kaiser Permanente Medicaid	$1.83
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$3.47
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$2.15
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.61

haloperidol 0.5 mg Tab [KMC]

Facility

$3.58

Service Code	NDC 00832151011
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$3.47
Rate for Payer: Cash Price	$2.33
Rate for Payer: Health Management Network Commercial	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.22
Rate for Payer: MDX Hawaii PPO	$3.47

haloperidol 1 mg / 0.5 mL Oral Concentrate [KMC]

Facility

$10.66

Service Code	NDC 54838050115
Hospital Revenue Code	250
Min. Negotiated Rate	$9.06
Max. Negotiated Rate	$10.34
Rate for Payer: Cash Price	$6.93
Rate for Payer: Health Management Network Commercial	$9.06
Rate for Payer: Kaiser Permanente Commercial	$9.59
Rate for Payer: MDX Hawaii PPO	$10.34

haloperidol 1 mg / 0.5 mL Oral Concentrate [KMC]

Facility

$10.66

Service Code	NDC 54838050115
Hospital Revenue Code	250
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$10.34
Rate for Payer: AlohaCare Medicaid	$5.33
Rate for Payer: AlohaCare Medicare	$4.48
Rate for Payer: Cash Price	$6.93
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$9.81
Rate for Payer: Devoted Health Medicare	$4.48
Rate for Payer: Hawaii Medical Service Association Medicare	$4.48
Rate for Payer: Hawaii Western Management Group Commercial	$10.13
Rate for Payer: Health Management Network Commercial	$9.06
Rate for Payer: Humana Medicare	$4.48
Rate for Payer: Kaiser Permanente Commercial	$9.59
Rate for Payer: Kaiser Permanente Medicaid	$5.44
Rate for Payer: Kaiser Permanente Medicare	$4.48
Rate for Payer: MDX Hawaii PPO	$10.34
Rate for Payer: Ohana Health Plan Medicaid	$4.48
Rate for Payer: Ohana Health Plan Medicare	$4.48
Rate for Payer: UnitedHealthcare Medicaid	$6.40
Rate for Payer: UnitedHealthcare Medicare	$4.48
Rate for Payer: University Health Alliance Commercial	$7.77

haloperidol 1 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 70756000211
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

haloperidol 1 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 70756000211
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

haloperidol 5 mg/mL Inj Sol [KMC]

Facility

$5.76

Service Code	HCPCS J1630
Hospital Revenue Code	636
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$5.59
Rate for Payer: Cash Price	$3.74
Rate for Payer: Health Management Network Commercial	$4.90
Rate for Payer: Kaiser Permanente Commercial	$5.18
Rate for Payer: MDX Hawaii PPO	$5.59

haloperidol 5 mg/mL Inj Sol [KMC]

Facility

$5.76

Service Code	HCPCS J1630
Hospital Revenue Code	636
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$5.59
Rate for Payer: AlohaCare Medicaid	$2.88
Rate for Payer: AlohaCare Medicare	$2.42
Rate for Payer: Cash Price	$3.74
Rate for Payer: Cash Price	$3.74
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.30
Rate for Payer: Devoted Health Medicare	$2.42
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2.42
Rate for Payer: Hawaii Western Management Group Commercial	$5.47
Rate for Payer: Health Management Network Commercial	$4.90
Rate for Payer: Humana Medicare	$2.42
Rate for Payer: Kaiser Permanente Commercial	$5.18
Rate for Payer: Kaiser Permanente Medicaid	$2.94
Rate for Payer: Kaiser Permanente Medicare	$2.42
Rate for Payer: MDX Hawaii PPO	$5.59
Rate for Payer: Ohana Health Plan Medicaid	$2.42
Rate for Payer: Ohana Health Plan Medicare	$2.42
Rate for Payer: UnitedHealthcare Medicaid	$3.46
Rate for Payer: UnitedHealthcare Medicare	$2.42
Rate for Payer: University Health Alliance Commercial	$4.20

haloperidol 5 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 70756000411
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

haloperidol 5 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 70756000411
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

HAND MIN 3 VWS

Facility

$369.00

Service Code	HCPCS 73130
Hospital Charge Code	424731300
Hospital Revenue Code	320
Min. Negotiated Rate	$19.08
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	$19.08
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	$19.08
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$62.59

HAND MIN 3 VWS

Facility

$369.00

Service Code	HCPCS 73130
Hospital Charge Code	424731300
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

HAND MUSCLE TEST, MANUAL

Professional

Both

$171.00

Service Code	HCPCS 95832
Hospital Revenue Code	420
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$145.35
Rate for Payer: Cash Price	$111.15
Rate for Payer: Cash Price	$111.15
Rate for Payer: Hawaii Western Management Group Commercial	$21.15
Rate for Payer: Health Management Network Commercial	$145.35

HAND MUSC TESTING MANUAL Occupational

Facility

$179.00

Service Code	HCPCS 95832 GO
Hospital Charge Code	432958320
Hospital Revenue Code	430
Min. Negotiated Rate	$75.18
Max. Negotiated Rate	$173.63
Rate for Payer: AlohaCare Medicaid	$89.50
Rate for Payer: AlohaCare Medicare	$75.18
Rate for Payer: Cash Price	$116.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$164.68
Rate for Payer: Devoted Health Medicare	$75.18
Rate for Payer: Hawaii Medical Service Association Medicare	$75.18
Rate for Payer: Hawaii Western Management Group Commercial	$170.05
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Humana Medicare	$75.18
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: Kaiser Permanente Medicaid	$91.29
Rate for Payer: Kaiser Permanente Medicare	$75.18
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: Ohana Health Plan Medicaid	$75.18
Rate for Payer: Ohana Health Plan Medicare	$75.18
Rate for Payer: UnitedHealthcare Medicare	$75.18
Rate for Payer: University Health Alliance Commercial	$130.47

HAND MUSC TESTING MANUAL Occupational

Facility

$179.00

Service Code	HCPCS 95832 GO
Hospital Charge Code	432958320
Hospital Revenue Code	430
Min. Negotiated Rate	$152.15
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$116.35
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63

HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC

Facility

$26,641.05

Service Code	MSDRG 513
Min. Negotiated Rate	$26,641.05
Max. Negotiated Rate	$26,641.05
Rate for Payer: Hawaii Medical Service Association Commercial	$26,641.05

HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$18,416.45

Service Code	MSDRG 514
Min. Negotiated Rate	$18,416.45
Max. Negotiated Rate	$18,416.45
Rate for Payer: Hawaii Medical Service Association Commercial	$18,416.45

HAND PROCEDURES FOR INJURIES

Facility

$22,161.37

Service Code	MSDRG 906
Min. Negotiated Rate	$22,161.37
Max. Negotiated Rate	$22,161.37
Rate for Payer: Hawaii Medical Service Association Commercial	$22,161.37

Haptoglobin DLS

Facility

$171.00

Service Code	HCPCS 83010
Hospital Charge Code	422830105
Hospital Revenue Code	301
Min. Negotiated Rate	$12.58
Max. Negotiated Rate	$165.87
Rate for Payer: AlohaCare Medicaid	$85.50
Rate for Payer: AlohaCare Medicare	$71.82
Rate for Payer: Cash Price	$111.15
Rate for Payer: Cash Price	$111.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$157.32
Rate for Payer: Devoted Health Medicare	$71.82
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$17.38
Rate for Payer: Hawaii Medical Service Association Commercial	$15.72
Rate for Payer: Hawaii Medical Service Association Medicare	$71.82
Rate for Payer: Hawaii Western Management Group Commercial	$12.58
Rate for Payer: Health Management Network Commercial	$145.35
Rate for Payer: Humana Medicare	$71.82
Rate for Payer: Kaiser Permanente Commercial	$153.90
Rate for Payer: Kaiser Permanente Medicaid	$87.21
Rate for Payer: Kaiser Permanente Medicare	$71.82
Rate for Payer: MDX Hawaii PPO	$165.87
Rate for Payer: Ohana Health Plan Medicaid	$71.82
Rate for Payer: Ohana Health Plan Medicare	$71.82
Rate for Payer: UnitedHealthcare Medicaid	$17.38
Rate for Payer: UnitedHealthcare Medicare	$71.82
Rate for Payer: University Health Alliance Commercial	$32.52

Haptoglobin DLS

Facility

$171.00

Service Code	HCPCS 83010
Hospital Charge Code	422830105
Hospital Revenue Code	301
Min. Negotiated Rate	$145.35
Max. Negotiated Rate	$165.87
Rate for Payer: Cash Price	$111.15
Rate for Payer: Health Management Network Commercial	$145.35
Rate for Payer: Kaiser Permanente Commercial	$153.90
Rate for Payer: MDX Hawaii PPO	$165.87

HARTMANN FORCEPS STRAIGHT 3.5"

Facility

$2.00

Hospital Charge Code	8551
Hospital Revenue Code	270
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.30
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

Know your out-of-pocket cost for care.

All Charges