Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

HC NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM

Professional

Both

$799.00

Service Code	HCPCS 97606
Hospital Charge Code	761976060
Min. Negotiated Rate	$23.32
Max. Negotiated Rate	$679.15
Rate for Payer: AlohaCare Medicaid	$27.04
Rate for Payer: AlohaCare Medicare	$23.32
Rate for Payer: Cash Price	$519.35
Rate for Payer: Cash Price	$519.35
Rate for Payer: Devoted Health Medicare	$23.32
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$27.04
Rate for Payer: Hawaii Medical Service Association Medicare	$23.32
Rate for Payer: Hawaii Western Management Group Commercial	$35.63
Rate for Payer: Health Management Network Commercial	$679.15
Rate for Payer: Kaiser Permanente Commercial	$27.98
Rate for Payer: Kaiser Permanente Medicaid	$27.98
Rate for Payer: Kaiser Permanente Medicare	$27.98
Rate for Payer: Ohana Health Plan Medicaid	$27.04
Rate for Payer: Ohana Health Plan Medicare	$23.32
Rate for Payer: UnitedHealthcare Medicaid	$27.04
Rate for Payer: UnitedHealthcare Medicare	$23.32
Rate for Payer: University Health Alliance Commercial	$33.42

HC OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP

Professional

Both

$218.00

Service Code	HCPCS 99211
Hospital Charge Code	761992110
Min. Negotiated Rate	$7.72
Max. Negotiated Rate	$185.30
Rate for Payer: AlohaCare Medicaid	$8.86
Rate for Payer: AlohaCare Medicare	$7.72
Rate for Payer: Cash Price	$141.70
Rate for Payer: Cash Price	$141.70
Rate for Payer: Devoted Health Medicare	$7.72
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$8.86
Rate for Payer: Hawaii Medical Service Association Medicare	$7.72
Rate for Payer: Hawaii Western Management Group Commercial	$17.23
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Kaiser Permanente Commercial	$9.26
Rate for Payer: Kaiser Permanente Medicaid	$9.26
Rate for Payer: Kaiser Permanente Medicare	$9.26
Rate for Payer: Ohana Health Plan Medicaid	$8.86
Rate for Payer: Ohana Health Plan Medicare	$7.72
Rate for Payer: UnitedHealthcare Medicaid	$8.86
Rate for Payer: UnitedHealthcare Medicare	$7.72

HC PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4

Professional

Both

$597.00

Service Code	HCPCS 10057
Hospital Charge Code	761100570
Min. Negotiated Rate	$507.45
Max. Negotiated Rate	$507.45
Rate for Payer: Cash Price	$388.05
Rate for Payer: Health Management Network Commercial	$507.45

HC STRAPPING UNNA BOOT

Professional

Both

$474.00

Service Code	HCPCS 29580
Hospital Charge Code	761295800
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$402.90
Rate for Payer: AlohaCare Medicaid	$25.73
Rate for Payer: AlohaCare Medicare	$22.81
Rate for Payer: Cash Price	$308.10
Rate for Payer: Cash Price	$308.10
Rate for Payer: Devoted Health Medicare	$22.81
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$25.73
Rate for Payer: Hawaii Medical Service Association Commercial	$51.81
Rate for Payer: Hawaii Medical Service Association Medicare	$22.81
Rate for Payer: Hawaii Western Management Group Commercial	$47.58
Rate for Payer: Health Management Network Commercial	$402.90
Rate for Payer: Kaiser Permanente Commercial	$27.37
Rate for Payer: Kaiser Permanente Medicaid	$27.37
Rate for Payer: Kaiser Permanente Medicare	$27.37
Rate for Payer: Ohana Health Plan Medicaid	$25.73
Rate for Payer: Ohana Health Plan Medicare	$22.81
Rate for Payer: UnitedHealthcare Medicaid	$25.73
Rate for Payer: UnitedHealthcare Medicare	$22.81
Rate for Payer: University Health Alliance Commercial	$34.82

HC TRIM BENIGN HYPERKERATOTIC SKIN LESION,2-4

Professional

Both

$597.00

Service Code	HCPCS 11056
Hospital Charge Code	761110560
Min. Negotiated Rate	$19.42
Max. Negotiated Rate	$507.45
Rate for Payer: AlohaCare Medicaid	$21.60
Rate for Payer: AlohaCare Medicare	$19.42
Rate for Payer: Cash Price	$388.05
Rate for Payer: Cash Price	$388.05
Rate for Payer: Devoted Health Medicare	$19.42
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$21.60
Rate for Payer: Hawaii Medical Service Association Commercial	$42.02
Rate for Payer: Hawaii Medical Service Association Medicare	$19.42
Rate for Payer: Hawaii Western Management Group Commercial	$28.86
Rate for Payer: Health Management Network Commercial	$507.45
Rate for Payer: Kaiser Permanente Commercial	$23.30
Rate for Payer: Kaiser Permanente Medicaid	$23.30
Rate for Payer: Kaiser Permanente Medicare	$23.30
Rate for Payer: Ohana Health Plan Medicaid	$21.60
Rate for Payer: Ohana Health Plan Medicare	$19.42
Rate for Payer: UnitedHealthcare Medicaid	$21.60
Rate for Payer: UnitedHealthcare Medicare	$19.42
Rate for Payer: University Health Alliance Commercial	$23.71

HC TRIM HYPERKERATOTIC SKIN LESION, ONE

Professional

Both

$597.00

Service Code	HCPCS 11055
Hospital Charge Code	761110550
Min. Negotiated Rate	$13.46
Max. Negotiated Rate	$507.45
Rate for Payer: AlohaCare Medicaid	$15.27
Rate for Payer: AlohaCare Medicare	$13.46
Rate for Payer: Cash Price	$388.05
Rate for Payer: Cash Price	$388.05
Rate for Payer: Devoted Health Medicare	$13.46
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$15.27
Rate for Payer: Hawaii Medical Service Association Commercial	$29.76
Rate for Payer: Hawaii Medical Service Association Medicare	$13.46
Rate for Payer: Hawaii Western Management Group Commercial	$21.32
Rate for Payer: Health Management Network Commercial	$507.45
Rate for Payer: Kaiser Permanente Commercial	$16.15
Rate for Payer: Kaiser Permanente Medicaid	$16.15
Rate for Payer: Kaiser Permanente Medicare	$16.15
Rate for Payer: Ohana Health Plan Medicaid	$15.27
Rate for Payer: Ohana Health Plan Medicare	$13.46
Rate for Payer: UnitedHealthcare Medicaid	$15.27
Rate for Payer: UnitedHealthcare Medicare	$13.46
Rate for Payer: University Health Alliance Commercial	$16.47

HCTZ-triamterene 25-37.5 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 60505265601
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

HCTZ-triamterene 25-37.5 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 60505265601
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

HEADACHES WITH MCC

Facility

$15,667.02

Service Code	MSDRG 102
Min. Negotiated Rate	$15,667.02
Max. Negotiated Rate	$15,667.02
Rate for Payer: Hawaii Medical Service Association Commercial	$15,667.02

HEADACHES WITHOUT MCC

Facility

$15,667.02

Service Code	MSDRG 103
Min. Negotiated Rate	$15,667.02
Max. Negotiated Rate	$15,667.02
Rate for Payer: Hawaii Medical Service Association Commercial	$15,667.02

HEARTBEAT RESTING TAB EGG ELECTRODES

Facility

$20.00

Hospital Charge Code	8566
Hospital Revenue Code	270
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$13.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: MDX Hawaii PPO	$19.40

HEARTBEAT RESTING TAB EGG ELECTRODES

Facility

$20.00

Hospital Charge Code	8566
Hospital Revenue Code	270
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$19.40
Rate for Payer: AlohaCare Medicaid	$10.00
Rate for Payer: AlohaCare Medicare	$8.40
Rate for Payer: Cash Price	$13.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$18.40
Rate for Payer: Devoted Health Medicare	$8.40
Rate for Payer: Hawaii Medical Service Association Medicare	$8.40
Rate for Payer: Hawaii Western Management Group Commercial	$19.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Humana Medicare	$8.40
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: Kaiser Permanente Medicaid	$10.20
Rate for Payer: Kaiser Permanente Medicare	$8.40
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: Ohana Health Plan Medicaid	$8.40
Rate for Payer: Ohana Health Plan Medicare	$8.40
Rate for Payer: UnitedHealthcare Medicare	$8.40
Rate for Payer: University Health Alliance Commercial	$14.58

HEART FAILURE AND SHOCK WITH CC

Facility

$28,513.51

Service Code	MSDRG 292
Min. Negotiated Rate	$28,513.51
Max. Negotiated Rate	$28,513.51
Rate for Payer: Hawaii Medical Service Association Commercial	$28,513.51

HEART FAILURE AND SHOCK WITH MCC

Facility

$28,513.51

Service Code	MSDRG 291
Min. Negotiated Rate	$28,513.51
Max. Negotiated Rate	$28,513.51
Rate for Payer: Hawaii Medical Service Association Commercial	$28,513.51

HEART FAILURE AND SHOCK WITHOUT CC/MCC

Facility

$28,513.51

Service Code	MSDRG 293
Min. Negotiated Rate	$28,513.51
Max. Negotiated Rate	$28,513.51
Rate for Payer: Hawaii Medical Service Association Commercial	$28,513.51

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC

Facility

$270,036.89

Service Code	MSDRG 001
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$270,036.89
Rate for Payer: Hawaii Medical Service Association Commercial	$270,036.89
Rate for Payer: University Health Alliance Commercial	$10,400.00

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC

Facility

$270,036.89

Service Code	MSDRG 002
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$270,036.89
Rate for Payer: Hawaii Medical Service Association Commercial	$270,036.89
Rate for Payer: University Health Alliance Commercial	$10,400.00

Helicobacter Pylori Panel DLS

Facility

$41.00

Service Code	HCPCS 87081
Hospital Charge Code	422870815
Hospital Revenue Code	306
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$39.77
Rate for Payer: AlohaCare Medicaid	$20.50
Rate for Payer: AlohaCare Medicare	$17.22
Rate for Payer: Cash Price	$26.65
Rate for Payer: Cash Price	$26.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$37.72
Rate for Payer: Devoted Health Medicare	$17.22
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$9.16
Rate for Payer: Hawaii Medical Service Association Commercial	$8.29
Rate for Payer: Hawaii Medical Service Association Medicare	$17.22
Rate for Payer: Hawaii Western Management Group Commercial	$6.63
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: Humana Medicare	$17.22
Rate for Payer: Kaiser Permanente Commercial	$36.90
Rate for Payer: Kaiser Permanente Medicaid	$20.91
Rate for Payer: Kaiser Permanente Medicare	$17.22
Rate for Payer: MDX Hawaii PPO	$39.77
Rate for Payer: Ohana Health Plan Medicaid	$17.22
Rate for Payer: Ohana Health Plan Medicare	$17.22
Rate for Payer: UnitedHealthcare Medicaid	$9.16
Rate for Payer: UnitedHealthcare Medicare	$17.22
Rate for Payer: University Health Alliance Commercial	$17.13

Helicobacter Pylori Panel DLS

Facility

$41.00

Service Code	HCPCS 87081
Hospital Charge Code	422870815
Hospital Revenue Code	306
Min. Negotiated Rate	$34.85
Max. Negotiated Rate	$39.77
Rate for Payer: Cash Price	$26.65
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: Kaiser Permanente Commercial	$36.90
Rate for Payer: MDX Hawaii PPO	$39.77

HEMOCCULT ED Charge

Facility

$61.00

Service Code	HCPCS 82270
Hospital Charge Code	317822700
Hospital Revenue Code	301
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$59.17
Rate for Payer: AlohaCare Medicaid	$30.50
Rate for Payer: AlohaCare Medicare	$25.62
Rate for Payer: Cash Price	$39.65
Rate for Payer: Cash Price	$39.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$56.12
Rate for Payer: Devoted Health Medicare	$25.62
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$4.49
Rate for Payer: Hawaii Medical Service Association Commercial	$5.47
Rate for Payer: Hawaii Medical Service Association Medicare	$25.62
Rate for Payer: Hawaii Western Management Group Commercial	$4.38
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Humana Medicare	$25.62
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: Kaiser Permanente Medicaid	$31.11
Rate for Payer: Kaiser Permanente Medicare	$25.62
Rate for Payer: MDX Hawaii PPO	$59.17
Rate for Payer: Ohana Health Plan Medicaid	$25.62
Rate for Payer: Ohana Health Plan Medicare	$25.62
Rate for Payer: UnitedHealthcare Medicaid	$4.49
Rate for Payer: UnitedHealthcare Medicare	$25.62
Rate for Payer: University Health Alliance Commercial	$8.40

HEMOCCULT ED Charge

Facility

$61.00

Service Code	HCPCS 82270
Hospital Charge Code	317822700
Hospital Revenue Code	301
Min. Negotiated Rate	$51.85
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$39.65
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: MDX Hawaii PPO	$59.17

Hemoglobin

Facility

$57.00

Service Code	HCPCS 85018
Hospital Charge Code	422850180
Hospital Revenue Code	305
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$55.29
Rate for Payer: AlohaCare Medicaid	$28.50
Rate for Payer: AlohaCare Medicare	$23.94
Rate for Payer: Cash Price	$37.05
Rate for Payer: Cash Price	$37.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$52.44
Rate for Payer: Devoted Health Medicare	$23.94
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$3.27
Rate for Payer: Hawaii Medical Service Association Commercial	$2.96
Rate for Payer: Hawaii Medical Service Association Medicare	$23.94
Rate for Payer: Hawaii Western Management Group Commercial	$2.37
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Humana Medicare	$23.94
Rate for Payer: Kaiser Permanente Commercial	$51.30
Rate for Payer: Kaiser Permanente Medicaid	$29.07
Rate for Payer: Kaiser Permanente Medicare	$23.94
Rate for Payer: MDX Hawaii PPO	$55.29
Rate for Payer: Ohana Health Plan Medicaid	$23.94
Rate for Payer: Ohana Health Plan Medicare	$23.94
Rate for Payer: UnitedHealthcare Medicaid	$3.27
Rate for Payer: UnitedHealthcare Medicare	$23.94
Rate for Payer: University Health Alliance Commercial	$6.12

Hemoglobin

Facility

$57.00

Service Code	HCPCS 85018
Hospital Charge Code	422850180
Hospital Revenue Code	305
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$37.05
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Kaiser Permanente Commercial	$51.30
Rate for Payer: MDX Hawaii PPO	$55.29

Hemoglobin A1c 1

Facility

$155.00

Service Code	HCPCS 83036
Hospital Charge Code	422830360
Hospital Revenue Code	301
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$100.75
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: MDX Hawaii PPO	$150.35

Hemoglobin A1c 1

Facility

$155.00

Service Code	HCPCS 83036
Hospital Charge Code	422830360
Hospital Revenue Code	301
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$150.35
Rate for Payer: AlohaCare Medicaid	$77.50
Rate for Payer: AlohaCare Medicare	$65.10
Rate for Payer: Cash Price	$100.75
Rate for Payer: Cash Price	$100.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$142.60
Rate for Payer: Devoted Health Medicare	$65.10
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$13.42
Rate for Payer: Hawaii Medical Service Association Commercial	$12.14
Rate for Payer: Hawaii Medical Service Association Medicare	$65.10
Rate for Payer: Hawaii Western Management Group Commercial	$9.71
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Humana Medicare	$65.10
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: Kaiser Permanente Medicare	$65.10
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: Ohana Health Plan Medicaid	$65.10
Rate for Payer: Ohana Health Plan Medicare	$65.10
Rate for Payer: UnitedHealthcare Medicaid	$13.42
Rate for Payer: UnitedHealthcare Medicare	$65.10
Rate for Payer: University Health Alliance Commercial	$25.09

Know your out-of-pocket cost for care.

All Charges