Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

ADJUSTIBLE COLLAR WITH EXTENSION ADULT

Facility

$3.00

Hospital Charge Code	8011
Hospital Revenue Code	270
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

ADJUSTIBLE COLLAR WITH EXTENSION ADULT

Facility

$3.00

Hospital Charge Code	8011
Hospital Revenue Code	270
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 Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

ADJUSTIBLE COLLAR WITH EXTENSION INFANT/PEDS

Facility

$228.00

Hospital Charge Code	8012
Hospital Revenue Code	270
Min. Negotiated Rate	$95.76
Max. Negotiated Rate	$221.16
Rate for Payer: AlohaCare Medicaid	$114.00
Rate for Payer: AlohaCare Medicare	$95.76
Rate for Payer: Cash Price	$148.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$209.76
Rate for Payer: Devoted Health Medicare	$95.76
Rate for Payer: Hawaii Medical Service Association Medicare	$95.76
Rate for Payer: Hawaii Western Management Group Commercial	$216.60
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: Humana Medicare	$95.76
Rate for Payer: Kaiser Permanente Commercial	$205.20
Rate for Payer: Kaiser Permanente Medicaid	$116.28
Rate for Payer: Kaiser Permanente Medicare	$95.76
Rate for Payer: MDX Hawaii PPO	$221.16
Rate for Payer: Ohana Health Plan Medicaid	$95.76
Rate for Payer: Ohana Health Plan Medicare	$95.76
Rate for Payer: UnitedHealthcare Medicare	$95.76
Rate for Payer: University Health Alliance Commercial	$166.19

ADJUSTIBLE COLLAR WITH EXTENSION INFANT/PEDS

Facility

$228.00

Hospital Charge Code	8012
Hospital Revenue Code	270
Min. Negotiated Rate	$193.80
Max. Negotiated Rate	$221.16
Rate for Payer: Cash Price	$148.20
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: Kaiser Permanente Commercial	$205.20
Rate for Payer: MDX Hawaii PPO	$221.16

ADMIN HEPATITIS B VACCINE

Professional

Both

$57.00

Service Code	HCPCS G0010
Hospital Revenue Code	771
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$48.45
Rate for Payer: Cash Price	$37.05
Rate for Payer: Cash Price	$37.05
Rate for Payer: Hawaii Western Management Group Commercial	$18.00
Rate for Payer: Health Management Network Commercial	$48.45

ADMIN INFLUENZA VIRUS VAC

Professional

Both

$57.00

Service Code	HCPCS G0008
Hospital Revenue Code	771
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$48.45
Rate for Payer: Cash Price	$37.05
Rate for Payer: Cash Price	$37.05
Rate for Payer: Hawaii Western Management Group Commercial	$18.00
Rate for Payer: Health Management Network Commercial	$48.45

ADMIN PNEUMOCOCCAL VACCINE

Professional

Both

$57.00

Service Code	HCPCS G0009
Hospital Revenue Code	771
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$48.45
Rate for Payer: Cash Price	$37.05
Rate for Payer: Cash Price	$37.05
Rate for Payer: Hawaii Western Management Group Commercial	$18.00
Rate for Payer: Health Management Network Commercial	$48.45

ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC

Facility

$57,050.71

Service Code	MSDRG 614
Min. Negotiated Rate	$57,050.71
Max. Negotiated Rate	$57,050.71
Rate for Payer: Hawaii Medical Service Association Commercial	$57,050.71

ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC

Facility

$57,050.71

Service Code	MSDRG 615
Min. Negotiated Rate	$57,050.71
Max. Negotiated Rate	$57,050.71
Rate for Payer: Hawaii Medical Service Association Commercial	$57,050.71

ADSON TISSUE FORCEPS 1X2T 4-3/4"

Facility

$2.00

Hospital Charge Code	8552
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

ADSON TISSUE FORCEPS 1X2T 4-3/4"

Facility

$2.00

Hospital Charge Code	8552
Hospital Revenue Code	270
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$0.84
Rate for Payer: Cash Price	$1.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1.84
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.84
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$0.84
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$0.84
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$0.84
Rate for Payer: Ohana Health Plan Medicare	$0.84
Rate for Payer: UnitedHealthcare Medicare	$0.84
Rate for Payer: University Health Alliance Commercial	$1.46

ADULT ELONGATED MASK

Facility

$37.00

Hospital Charge Code	8428
Hospital Revenue Code	270
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$24.05
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: MDX Hawaii PPO	$35.89

ADULT ELONGATED MASK

Facility

$37.00

Hospital Charge Code	8428
Hospital Revenue Code	270
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$35.89
Rate for Payer: AlohaCare Medicaid	$18.50
Rate for Payer: AlohaCare Medicare	$15.54
Rate for Payer: Cash Price	$24.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$34.04
Rate for Payer: Devoted Health Medicare	$15.54
Rate for Payer: Hawaii Medical Service Association Medicare	$15.54
Rate for Payer: Hawaii Western Management Group Commercial	$35.15
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Humana Medicare	$15.54
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: Kaiser Permanente Medicare	$15.54
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: Ohana Health Plan Medicaid	$15.54
Rate for Payer: Ohana Health Plan Medicare	$15.54
Rate for Payer: UnitedHealthcare Medicare	$15.54
Rate for Payer: University Health Alliance Commercial	$26.97

ADV CARE PLN/ NO ALT DCSN MKR DOCD OR REFUSAL

Professional

Both

$0.01

Service Code	HCPCS 1124F
Hospital Revenue Code	521
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$290.48
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$273.13
Rate for Payer: UnitedHealthcare Medicare	$152.00

ADV CARE PLN TLKD & ALT DCSN MAKER DOCD

Professional

Both

$0.01

Service Code	HCPCS 1123F
Hospital Revenue Code	521
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$290.48
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$273.13

ADVNC CARE PLANNING TLK DOCD IN MED RCRD

Professional

Both

$0.01

Service Code	HCPCS 1158F
Hospital Revenue Code	521
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$290.48
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$273.13

ADVNC CARE PLAN OR EQV LGL DOC IN MED RCRD

Professional

Both

$0.01

Service Code	HCPCS 1157F
Hospital Revenue Code	521
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$290.48
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$273.13

Aerochamber/Spacer

Facility

$97.00

Hospital Charge Code	10005
Hospital Revenue Code	270
Min. Negotiated Rate	$40.74
Max. Negotiated Rate	$94.09
Rate for Payer: AlohaCare Medicaid	$48.50
Rate for Payer: AlohaCare Medicare	$40.74
Rate for Payer: Cash Price	$63.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$89.24
Rate for Payer: Devoted Health Medicare	$40.74
Rate for Payer: Hawaii Medical Service Association Medicare	$40.74
Rate for Payer: Hawaii Western Management Group Commercial	$92.15
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Humana Medicare	$40.74
Rate for Payer: Kaiser Permanente Commercial	$87.30
Rate for Payer: Kaiser Permanente Medicaid	$49.47
Rate for Payer: Kaiser Permanente Medicare	$40.74
Rate for Payer: MDX Hawaii PPO	$94.09
Rate for Payer: Ohana Health Plan Medicaid	$40.74
Rate for Payer: Ohana Health Plan Medicare	$40.74
Rate for Payer: UnitedHealthcare Medicare	$40.74
Rate for Payer: University Health Alliance Commercial	$70.70

Aerochamber/Spacer

Facility

$97.00

Hospital Charge Code	10005
Hospital Revenue Code	270
Min. Negotiated Rate	$82.45
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$63.05
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Kaiser Permanente Commercial	$87.30
Rate for Payer: MDX Hawaii PPO	$94.09

AEROSOL MASK

Facility

$4.00

Hospital Charge Code	8014
Hospital Revenue Code	270
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.60
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

AEROSOL MASK

Facility

$4.00

Hospital Charge Code	8014
Hospital Revenue Code	270
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	$3.80
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	$2.92

AFB Blood/Bone Marrow DLS

Facility

$1,948.00

Service Code	HCPCS 87153
Hospital Charge Code	422871535
Hospital Revenue Code	306
Min. Negotiated Rate	$115.36
Max. Negotiated Rate	$1,889.56
Rate for Payer: AlohaCare Medicaid	$974.00
Rate for Payer: AlohaCare Medicare	$818.16
Rate for Payer: Cash Price	$1,266.20
Rate for Payer: Cash Price	$1,266.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,792.16
Rate for Payer: Devoted Health Medicare	$818.16
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$165.22
Rate for Payer: Hawaii Medical Service Association Commercial	$144.20
Rate for Payer: Hawaii Medical Service Association Medicare	$818.16
Rate for Payer: Hawaii Western Management Group Commercial	$115.36
Rate for Payer: Health Management Network Commercial	$1,655.80
Rate for Payer: Humana Medicare	$818.16
Rate for Payer: Kaiser Permanente Commercial	$1,753.20
Rate for Payer: Kaiser Permanente Medicaid	$993.48
Rate for Payer: Kaiser Permanente Medicare	$818.16
Rate for Payer: MDX Hawaii PPO	$1,889.56
Rate for Payer: Ohana Health Plan Medicaid	$818.16
Rate for Payer: Ohana Health Plan Medicare	$818.16
Rate for Payer: UnitedHealthcare Medicaid	$165.22
Rate for Payer: UnitedHealthcare Medicare	$818.16
Rate for Payer: University Health Alliance Commercial	$300.31

AFB Blood/Bone Marrow DLS

Facility

$1,948.00

Service Code	HCPCS 87153
Hospital Charge Code	422871535
Hospital Revenue Code	306
Min. Negotiated Rate	$1,655.80
Max. Negotiated Rate	$1,889.56
Rate for Payer: Cash Price	$1,266.20
Rate for Payer: Health Management Network Commercial	$1,655.80
Rate for Payer: Kaiser Permanente Commercial	$1,753.20
Rate for Payer: MDX Hawaii PPO	$1,889.56

AFP Non-Maternal, Serum DLS

Facility

$122.00

Service Code	HCPCS 82105
Hospital Charge Code	422821055
Hospital Revenue Code	301
Min. Negotiated Rate	$103.70
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$79.30
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: MDX Hawaii PPO	$118.34

AFP Non-Maternal, Serum DLS

Facility

$122.00

Service Code	HCPCS 82105
Hospital Charge Code	422821055
Hospital Revenue Code	301
Min. Negotiated Rate	$16.77
Max. Negotiated Rate	$118.34
Rate for Payer: AlohaCare Medicaid	$61.00
Rate for Payer: AlohaCare Medicare	$51.24
Rate for Payer: Cash Price	$79.30
Rate for Payer: Cash Price	$79.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$112.24
Rate for Payer: Devoted Health Medicare	$51.24
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$23.18
Rate for Payer: Hawaii Medical Service Association Commercial	$20.96
Rate for Payer: Hawaii Medical Service Association Medicare	$51.24
Rate for Payer: Hawaii Western Management Group Commercial	$16.77
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Humana Medicare	$51.24
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Medicaid	$62.22
Rate for Payer: Kaiser Permanente Medicare	$51.24
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: Ohana Health Plan Medicaid	$51.24
Rate for Payer: Ohana Health Plan Medicare	$51.24
Rate for Payer: UnitedHealthcare Medicaid	$23.18
Rate for Payer: UnitedHealthcare Medicare	$51.24
Rate for Payer: University Health Alliance Commercial	$43.36

Know your out-of-pocket cost for care.

All Charges