Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC

Facility

$34,960.45

Service Code	MSDRG 482
Min. Negotiated Rate	$34,960.45
Max. Negotiated Rate	$34,960.45
Rate for Payer: Hawaii Medical Service Association Commercial	$34,960.45

HIP BILAT MIN 2 VWS EA HIP

Facility

$581.00

Service Code	HCPCS 73521
Hospital Charge Code	424735210
Hospital Revenue Code	320
Min. Negotiated Rate	$493.85
Max. Negotiated Rate	$563.57
Rate for Payer: Cash Price	$377.65
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: Kaiser Permanente Commercial	$522.90
Rate for Payer: MDX Hawaii PPO	$563.57

HIP BILAT MIN 2 VWS EA HIP

Facility

$581.00

Service Code	HCPCS 73521
Hospital Charge Code	424735210
Hospital Revenue Code	320
Min. Negotiated Rate	$19.61
Max. Negotiated Rate	$563.57
Rate for Payer: AlohaCare Medicaid	$290.50
Rate for Payer: AlohaCare Medicare	$244.02
Rate for Payer: Cash Price	$377.65
Rate for Payer: Cash Price	$377.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$534.52
Rate for Payer: Devoted Health Medicare	$244.02
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$19.61
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$244.02
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: Humana Medicare	$244.02
Rate for Payer: Kaiser Permanente Commercial	$522.90
Rate for Payer: Kaiser Permanente Medicaid	$296.31
Rate for Payer: Kaiser Permanente Medicare	$244.02
Rate for Payer: MDX Hawaii PPO	$563.57
Rate for Payer: Ohana Health Plan Medicaid	$244.02
Rate for Payer: Ohana Health Plan Medicare	$244.02
Rate for Payer: UnitedHealthcare Medicaid	$27.57
Rate for Payer: UnitedHealthcare Medicare	$244.02
Rate for Payer: University Health Alliance Commercial	$82.40

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC

Facility

$50,580.07

Service Code	MSDRG 521
Min. Negotiated Rate	$50,580.07
Max. Negotiated Rate	$50,580.07
Rate for Payer: Hawaii Medical Service Association Commercial	$50,580.07

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC

Facility

$36,880.31

Service Code	MSDRG 522
Min. Negotiated Rate	$36,880.31
Max. Negotiated Rate	$36,880.31
Rate for Payer: Hawaii Medical Service Association Commercial	$36,880.31

HIP UNILAT 1 VW

Facility

$369.00

Service Code	HCPCS 73501
Hospital Charge Code	424735000
Hospital Revenue Code	320
Min. Negotiated Rate	$14.12
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	$14.12
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	$21.95
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$61.27

HIP UNILAT 1 VW

Facility

$369.00

Service Code	HCPCS 73501
Hospital Charge Code	424735010
Hospital Revenue Code	320
Min. Negotiated Rate	$14.12
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	$14.12
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	$21.95
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$61.27

HIP UNILAT 1 VW

Facility

$369.00

Hospital Charge Code	424735000
Hospital Revenue Code	320
Min. Negotiated Rate	$154.98
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: Deseret Mutual Benefit Administrators Commercial	$339.48
Rate for Payer: Devoted Health Medicare	$154.98
Rate for Payer: Hawaii Medical Service Association Medicare	$154.98
Rate for Payer: Hawaii Western Management Group Commercial	$350.55
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 Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$268.96

HIP UNILAT 1 VW

Facility

$369.00

Service Code	HCPCS 73501
Hospital Charge Code	424735000
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

HIP UNILAT 1 VW

Facility

$369.00

Hospital Charge Code	424735000
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

HIP UNILAT 1 VW

Facility

$369.00

Service Code	HCPCS 73501
Hospital Charge Code	424735010
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

HIP UNILAT COMPLETE MIN 2 VWS

Facility

$381.00

Service Code	HCPCS 73502
Hospital Charge Code	424735029
Hospital Revenue Code	320
Min. Negotiated Rate	$20.87
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	$20.87
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	$31.93
Rate for Payer: UnitedHealthcare Medicare	$160.02
Rate for Payer: University Health Alliance Commercial	$86.21

HIP UNILAT COMPLETE MIN 2 VWS

Facility

$381.00

Service Code	HCPCS 73502
Hospital Charge Code	424735029
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

HIP UNILAT COMPLETE MIN 2 VWS

Facility

$381.00

Service Code	HCPCS 73502
Hospital Charge Code	424735020
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

HIP UNILAT COMPLETE MIN 2 VWS

Facility

$381.00

Service Code	HCPCS 73502
Hospital Charge Code	424735020
Hospital Revenue Code	320
Min. Negotiated Rate	$20.87
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	$20.87
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	$31.93
Rate for Payer: UnitedHealthcare Medicare	$160.02
Rate for Payer: University Health Alliance Commercial	$86.21

HI Regional Respiratory Allergy Panel DLS

Facility

$670.00

Service Code	HCPCS 86003
Hospital Charge Code	422860035
Hospital Revenue Code	302
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$649.90
Rate for Payer: AlohaCare Medicaid	$335.00
Rate for Payer: AlohaCare Medicare	$281.40
Rate for Payer: Cash Price	$435.50
Rate for Payer: Cash Price	$435.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$616.40
Rate for Payer: Devoted Health Medicare	$281.40
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.22
Rate for Payer: Hawaii Medical Service Association Commercial	$6.53
Rate for Payer: Hawaii Medical Service Association Medicare	$281.40
Rate for Payer: Hawaii Western Management Group Commercial	$5.22
Rate for Payer: Health Management Network Commercial	$569.50
Rate for Payer: Humana Medicare	$281.40
Rate for Payer: Kaiser Permanente Commercial	$603.00
Rate for Payer: Kaiser Permanente Medicaid	$341.70
Rate for Payer: Kaiser Permanente Medicare	$281.40
Rate for Payer: MDX Hawaii PPO	$649.90
Rate for Payer: Ohana Health Plan Medicaid	$281.40
Rate for Payer: Ohana Health Plan Medicare	$281.40
Rate for Payer: UnitedHealthcare Medicaid	$7.22
Rate for Payer: UnitedHealthcare Medicare	$281.40
Rate for Payer: University Health Alliance Commercial	$13.51

HI Regional Respiratory Allergy Panel DLS

Facility

$670.00

Service Code	HCPCS 86003
Hospital Charge Code	422860035
Hospital Revenue Code	302
Min. Negotiated Rate	$569.50
Max. Negotiated Rate	$649.90
Rate for Payer: Cash Price	$435.50
Rate for Payer: Health Management Network Commercial	$569.50
Rate for Payer: Kaiser Permanente Commercial	$603.00
Rate for Payer: MDX Hawaii PPO	$649.90

Histone Antibody DLS

Facility

$256.00

Service Code	HCPCS 83516
Hospital Charge Code	422835165
Hospital Revenue Code	301
Min. Negotiated Rate	$217.60
Max. Negotiated Rate	$248.32
Rate for Payer: Cash Price	$166.40
Rate for Payer: Health Management Network Commercial	$217.60
Rate for Payer: Kaiser Permanente Commercial	$230.40
Rate for Payer: MDX Hawaii PPO	$248.32

Histone Antibody DLS

Facility

$256.00

Service Code	HCPCS 83516
Hospital Charge Code	422835165
Hospital Revenue Code	301
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$248.32
Rate for Payer: AlohaCare Medicaid	$128.00
Rate for Payer: AlohaCare Medicare	$107.52
Rate for Payer: Cash Price	$166.40
Rate for Payer: Cash Price	$166.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$235.52
Rate for Payer: Devoted Health Medicare	$107.52
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	$107.52
Rate for Payer: Hawaii Western Management Group Commercial	$11.53
Rate for Payer: Health Management Network Commercial	$217.60
Rate for Payer: Humana Medicare	$107.52
Rate for Payer: Kaiser Permanente Commercial	$230.40
Rate for Payer: Kaiser Permanente Medicaid	$130.56
Rate for Payer: Kaiser Permanente Medicare	$107.52
Rate for Payer: MDX Hawaii PPO	$248.32
Rate for Payer: Ohana Health Plan Medicaid	$107.52
Rate for Payer: Ohana Health Plan Medicare	$107.52
Rate for Payer: UnitedHealthcare Medicaid	$15.95
Rate for Payer: UnitedHealthcare Medicare	$107.52
Rate for Payer: University Health Alliance Commercial	$29.82

HIV 1/2 Ab DLS

Facility

$80.00

Service Code	HCPCS 86703
Hospital Charge Code	422867035
Hospital Revenue Code	301
Min. Negotiated Rate	$13.71
Max. Negotiated Rate	$77.60
Rate for Payer: AlohaCare Medicaid	$40.00
Rate for Payer: AlohaCare Medicare	$33.60
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$73.60
Rate for Payer: Devoted Health Medicare	$33.60
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.96
Rate for Payer: Hawaii Medical Service Association Commercial	$17.14
Rate for Payer: Hawaii Medical Service Association Medicare	$33.60
Rate for Payer: Hawaii Western Management Group Commercial	$13.71
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Humana Medicare	$33.60
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: Kaiser Permanente Medicaid	$40.80
Rate for Payer: Kaiser Permanente Medicare	$33.60
Rate for Payer: MDX Hawaii PPO	$77.60
Rate for Payer: Ohana Health Plan Medicaid	$33.60
Rate for Payer: Ohana Health Plan Medicare	$33.60
Rate for Payer: UnitedHealthcare Medicaid	$18.96
Rate for Payer: UnitedHealthcare Medicare	$33.60
Rate for Payer: University Health Alliance Commercial	$35.46

HIV 1/2 Ab DLS

Facility

$80.00

Service Code	HCPCS 86703
Hospital Charge Code	422867035
Hospital Revenue Code	301
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$52.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: MDX Hawaii PPO	$77.60

HIV-1/2 Ag/Ab Screen with Reflex DLS

Facility

$47.00

Service Code	HCPCS 87389
Hospital Charge Code	30087389
Hospital Revenue Code	300
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$30.55
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Kaiser Permanente Commercial	$42.30
Rate for Payer: MDX Hawaii PPO	$45.59

HIV-1/2 Ag/Ab Screen with Reflex DLS

Facility

$47.00

Service Code	HCPCS 87389
Hospital Charge Code	30087389
Hospital Revenue Code	300
Min. Negotiated Rate	$19.74
Max. Negotiated Rate	$63.12
Rate for Payer: AlohaCare Medicaid	$23.50
Rate for Payer: AlohaCare Medicare	$19.74
Rate for Payer: Cash Price	$30.55
Rate for Payer: Cash Price	$30.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$43.24
Rate for Payer: Devoted Health Medicare	$19.74
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$34.12
Rate for Payer: Hawaii Medical Service Association Commercial	$30.10
Rate for Payer: Hawaii Medical Service Association Medicare	$19.74
Rate for Payer: Hawaii Western Management Group Commercial	$24.08
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Humana Medicare	$19.74
Rate for Payer: Kaiser Permanente Commercial	$42.30
Rate for Payer: Kaiser Permanente Medicaid	$23.97
Rate for Payer: Kaiser Permanente Medicare	$19.74
Rate for Payer: MDX Hawaii PPO	$45.59
Rate for Payer: Ohana Health Plan Medicaid	$19.74
Rate for Payer: Ohana Health Plan Medicare	$19.74
Rate for Payer: UnitedHealthcare Medicaid	$34.12
Rate for Payer: UnitedHealthcare Medicare	$19.74
Rate for Payer: University Health Alliance Commercial	$63.12

HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC

Facility

$99,074.36

Service Code	MSDRG 969
Min. Negotiated Rate	$99,074.36
Max. Negotiated Rate	$99,074.36
Rate for Payer: Hawaii Medical Service Association Commercial	$99,074.36

HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC

Facility

$99,074.36

Service Code	MSDRG 970
Min. Negotiated Rate	$99,074.36
Max. Negotiated Rate	$99,074.36
Rate for Payer: Hawaii Medical Service Association Commercial	$99,074.36

Know your out-of-pocket cost for care.

All Charges