Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

hydrocortisone 1% cream [KMC]

Facility

$0.49

Service Code	NDC 00472034356
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.48
Rate for Payer: AlohaCare Medicaid	$0.25
Rate for Payer: AlohaCare Medicare	$0.21
Rate for Payer: Cash Price	$0.32
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.45
Rate for Payer: Devoted Health Medicare	$0.21
Rate for Payer: Hawaii Medical Service Association Medicare	$0.21
Rate for Payer: Hawaii Western Management Group Commercial	$0.47
Rate for Payer: Health Management Network Commercial	$0.42
Rate for Payer: Humana Medicare	$0.21
Rate for Payer: Kaiser Permanente Commercial	$0.44
Rate for Payer: Kaiser Permanente Medicaid	$0.25
Rate for Payer: Kaiser Permanente Medicare	$0.21
Rate for Payer: MDX Hawaii PPO	$0.48
Rate for Payer: Ohana Health Plan Medicaid	$0.21
Rate for Payer: Ohana Health Plan Medicare	$0.21
Rate for Payer: UnitedHealthcare Medicaid	$0.29
Rate for Payer: UnitedHealthcare Medicare	$0.21
Rate for Payer: University Health Alliance Commercial	$0.36

hydrocortisone 1% cream [KMC]

Facility

$0.49

Service Code	NDC 00472034356
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.48
Rate for Payer: Cash Price	$0.32
Rate for Payer: Health Management Network Commercial	$0.42
Rate for Payer: Kaiser Permanente Commercial	$0.44
Rate for Payer: MDX Hawaii PPO	$0.48

hydrocortisone 25 mg Supp [KMC]

Facility

$72.60

Service Code	NDC 50268041101
Hospital Revenue Code	250
Min. Negotiated Rate	$30.49
Max. Negotiated Rate	$70.42
Rate for Payer: AlohaCare Medicaid	$36.30
Rate for Payer: AlohaCare Medicare	$30.49
Rate for Payer: Cash Price	$47.19
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$66.79
Rate for Payer: Devoted Health Medicare	$30.49
Rate for Payer: Hawaii Medical Service Association Medicare	$30.49
Rate for Payer: Hawaii Western Management Group Commercial	$68.97
Rate for Payer: Health Management Network Commercial	$61.71
Rate for Payer: Humana Medicare	$30.49
Rate for Payer: Kaiser Permanente Commercial	$65.34
Rate for Payer: Kaiser Permanente Medicaid	$37.03
Rate for Payer: Kaiser Permanente Medicare	$30.49
Rate for Payer: MDX Hawaii PPO	$70.42
Rate for Payer: Ohana Health Plan Medicaid	$30.49
Rate for Payer: Ohana Health Plan Medicare	$30.49
Rate for Payer: UnitedHealthcare Medicaid	$43.56
Rate for Payer: UnitedHealthcare Medicare	$30.49
Rate for Payer: University Health Alliance Commercial	$52.92

hydrocortisone 25 mg Supp [KMC]

Facility

$72.60

Service Code	NDC 50268041101
Hospital Revenue Code	250
Min. Negotiated Rate	$61.71
Max. Negotiated Rate	$70.42
Rate for Payer: Cash Price	$47.19
Rate for Payer: Health Management Network Commercial	$61.71
Rate for Payer: Kaiser Permanente Commercial	$65.34
Rate for Payer: MDX Hawaii PPO	$70.42

hydrocortisone 2.5% rectal cream [KMC]

Facility

$11.64

Service Code	NDC 64980032430
Hospital Revenue Code	250
Min. Negotiated Rate	$9.89
Max. Negotiated Rate	$11.29
Rate for Payer: Cash Price	$7.57
Rate for Payer: Health Management Network Commercial	$9.89
Rate for Payer: Kaiser Permanente Commercial	$10.48
Rate for Payer: MDX Hawaii PPO	$11.29

hydrocortisone 2.5% rectal cream [KMC]

Facility

$11.64

Service Code	NDC 64980032430
Hospital Revenue Code	250
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$11.29
Rate for Payer: AlohaCare Medicaid	$5.82
Rate for Payer: AlohaCare Medicare	$4.89
Rate for Payer: Cash Price	$7.57
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$10.71
Rate for Payer: Devoted Health Medicare	$4.89
Rate for Payer: Hawaii Medical Service Association Medicare	$4.89
Rate for Payer: Hawaii Western Management Group Commercial	$11.06
Rate for Payer: Health Management Network Commercial	$9.89
Rate for Payer: Humana Medicare	$4.89
Rate for Payer: Kaiser Permanente Commercial	$10.48
Rate for Payer: Kaiser Permanente Medicaid	$5.94
Rate for Payer: Kaiser Permanente Medicare	$4.89
Rate for Payer: MDX Hawaii PPO	$11.29
Rate for Payer: Ohana Health Plan Medicaid	$4.89
Rate for Payer: Ohana Health Plan Medicare	$4.89
Rate for Payer: UnitedHealthcare Medicaid	$6.98
Rate for Payer: UnitedHealthcare Medicare	$4.89
Rate for Payer: University Health Alliance Commercial	$8.48

hydrocortisone 2.5% topical cream [KMC]

Facility

$1.47

Service Code	NDC 00316019330
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$1.43
Rate for Payer: AlohaCare Medicaid	$0.74
Rate for Payer: AlohaCare Medicare	$0.62
Rate for Payer: Cash Price	$0.96
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1.35
Rate for Payer: Devoted Health Medicare	$0.62
Rate for Payer: Hawaii Medical Service Association Medicare	$0.62
Rate for Payer: Hawaii Western Management Group Commercial	$1.40
Rate for Payer: Health Management Network Commercial	$1.25
Rate for Payer: Humana Medicare	$0.62
Rate for Payer: Kaiser Permanente Commercial	$1.32
Rate for Payer: Kaiser Permanente Medicaid	$0.75
Rate for Payer: Kaiser Permanente Medicare	$0.62
Rate for Payer: MDX Hawaii PPO	$1.43
Rate for Payer: Ohana Health Plan Medicaid	$0.62
Rate for Payer: Ohana Health Plan Medicare	$0.62
Rate for Payer: UnitedHealthcare Medicaid	$0.88
Rate for Payer: UnitedHealthcare Medicare	$0.62
Rate for Payer: University Health Alliance Commercial	$1.07

hydrocortisone 2.5% topical cream [KMC]

Facility

$1.47

Service Code	NDC 00316019330
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.43
Rate for Payer: Cash Price	$0.96
Rate for Payer: Health Management Network Commercial	$1.25
Rate for Payer: Kaiser Permanente Commercial	$1.32
Rate for Payer: MDX Hawaii PPO	$1.43

hydrocortisone/neomycin/polymyxin B Otic Susp [KMC]

Facility

$12.32

Service Code	NDC 24208063562
Hospital Revenue Code	250
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$11.95
Rate for Payer: AlohaCare Medicaid	$6.16
Rate for Payer: AlohaCare Medicare	$5.17
Rate for Payer: Cash Price	$8.01
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$11.33
Rate for Payer: Devoted Health Medicare	$5.17
Rate for Payer: Hawaii Medical Service Association Medicare	$5.17
Rate for Payer: Hawaii Western Management Group Commercial	$11.70
Rate for Payer: Health Management Network Commercial	$10.47
Rate for Payer: Humana Medicare	$5.17
Rate for Payer: Kaiser Permanente Commercial	$11.09
Rate for Payer: Kaiser Permanente Medicaid	$6.28
Rate for Payer: Kaiser Permanente Medicare	$5.17
Rate for Payer: MDX Hawaii PPO	$11.95
Rate for Payer: Ohana Health Plan Medicaid	$5.17
Rate for Payer: Ohana Health Plan Medicare	$5.17
Rate for Payer: UnitedHealthcare Medicaid	$7.39
Rate for Payer: UnitedHealthcare Medicare	$5.17
Rate for Payer: University Health Alliance Commercial	$8.98

hydrocortisone/neomycin/polymyxin B Otic Susp [KMC]

Facility

$12.32

Service Code	NDC 24208063562
Hospital Revenue Code	250
Min. Negotiated Rate	$10.47
Max. Negotiated Rate	$11.95
Rate for Payer: Cash Price	$8.01
Rate for Payer: Health Management Network Commercial	$10.47
Rate for Payer: Kaiser Permanente Commercial	$11.09
Rate for Payer: MDX Hawaii PPO	$11.95

hydrogen peroxide 3% topical Soln [KMC]

Facility

$0.03

Service Code	NDC 49348003134
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Management Network Commercial	$0.03
Rate for Payer: Kaiser Permanente Commercial	$0.03
Rate for Payer: MDX Hawaii PPO	$0.03

hydrogen peroxide 3% topical Soln [KMC]

Facility

$0.03

Service Code	NDC 49348003134
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: AlohaCare Medicaid	$0.02
Rate for Payer: AlohaCare Medicare	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.03
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Hawaii Medical Service Association Medicare	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$0.03
Rate for Payer: Health Management Network Commercial	$0.03
Rate for Payer: Humana Medicare	$0.01
Rate for Payer: Kaiser Permanente Commercial	$0.03
Rate for Payer: Kaiser Permanente Medicaid	$0.02
Rate for Payer: Kaiser Permanente Medicare	$0.01
Rate for Payer: MDX Hawaii PPO	$0.03
Rate for Payer: Ohana Health Plan Medicaid	$0.01
Rate for Payer: Ohana Health Plan Medicare	$0.01
Rate for Payer: UnitedHealthcare Medicaid	$0.02
Rate for Payer: UnitedHealthcare Medicare	$0.01
Rate for Payer: University Health Alliance Commercial	$0.02

HYDROmorphone 1 mg/mL Inj Sol [KMC]

Facility

$12.48

Service Code	HCPCS J1170
Hospital Revenue Code	636
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$12.11
Rate for Payer: AlohaCare Medicaid	$6.24
Rate for Payer: AlohaCare Medicare	$5.24
Rate for Payer: Cash Price	$8.11
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$11.48
Rate for Payer: Devoted Health Medicare	$5.24
Rate for Payer: Hawaii Medical Service Association Medicare	$5.24
Rate for Payer: Hawaii Western Management Group Commercial	$11.86
Rate for Payer: Health Management Network Commercial	$10.61
Rate for Payer: Humana Medicare	$5.24
Rate for Payer: Kaiser Permanente Commercial	$11.23
Rate for Payer: Kaiser Permanente Medicaid	$6.36
Rate for Payer: Kaiser Permanente Medicare	$5.24
Rate for Payer: MDX Hawaii PPO	$12.11
Rate for Payer: Ohana Health Plan Medicaid	$5.24
Rate for Payer: Ohana Health Plan Medicare	$5.24
Rate for Payer: UnitedHealthcare Medicaid	$7.49
Rate for Payer: UnitedHealthcare Medicare	$5.24
Rate for Payer: University Health Alliance Commercial	$9.10

HYDROmorphone 1 mg/mL Inj Sol [KMC]

Facility

$12.48

Service Code	HCPCS J1170
Hospital Revenue Code	636
Min. Negotiated Rate	$10.61
Max. Negotiated Rate	$12.11
Rate for Payer: Cash Price	$8.11
Rate for Payer: Health Management Network Commercial	$10.61
Rate for Payer: Kaiser Permanente Commercial	$11.23
Rate for Payer: MDX Hawaii PPO	$12.11

HYDROmorphone 2 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00406324301
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

HYDROmorphone 2 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00406324301
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

HYDROmorphone 4 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00406324401
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

HYDROmorphone 4 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00406324401
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

HYDROmorphone 8 mg Tab [KMC]

Facility

$5.54

Service Code	NDC 00406324901
Hospital Revenue Code	250
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$5.37
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$4.71
Rate for Payer: Kaiser Permanente Commercial	$4.99
Rate for Payer: MDX Hawaii PPO	$5.37

HYDROmorphone 8 mg Tab [KMC]

Facility

$5.54

Service Code	NDC 00406324901
Hospital Revenue Code	250
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$5.37
Rate for Payer: AlohaCare Medicaid	$2.77
Rate for Payer: AlohaCare Medicare	$2.33
Rate for Payer: Cash Price	$3.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.10
Rate for Payer: Devoted Health Medicare	$2.33
Rate for Payer: Hawaii Medical Service Association Medicare	$2.33
Rate for Payer: Hawaii Western Management Group Commercial	$5.26
Rate for Payer: Health Management Network Commercial	$4.71
Rate for Payer: Humana Medicare	$2.33
Rate for Payer: Kaiser Permanente Commercial	$4.99
Rate for Payer: Kaiser Permanente Medicaid	$2.83
Rate for Payer: Kaiser Permanente Medicare	$2.33
Rate for Payer: MDX Hawaii PPO	$5.37
Rate for Payer: Ohana Health Plan Medicaid	$2.33
Rate for Payer: Ohana Health Plan Medicare	$2.33
Rate for Payer: UnitedHealthcare Medicaid	$3.32
Rate for Payer: UnitedHealthcare Medicare	$2.33
Rate for Payer: University Health Alliance Commercial	$4.04

hydroxocobalamin 1000 mcg/mL Inj Sol [KMC]

Facility

$5.10

Service Code	NDC 00591288830
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.95
Rate for Payer: AlohaCare Medicaid	$2.55
Rate for Payer: AlohaCare Medicare	$2.14
Rate for Payer: Cash Price	$3.32
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.69
Rate for Payer: Devoted Health Medicare	$2.14
Rate for Payer: Hawaii Medical Service Association Medicare	$2.14
Rate for Payer: Hawaii Western Management Group Commercial	$4.84
Rate for Payer: Health Management Network Commercial	$4.33
Rate for Payer: Humana Medicare	$2.14
Rate for Payer: Kaiser Permanente Commercial	$4.59
Rate for Payer: Kaiser Permanente Medicaid	$2.60
Rate for Payer: Kaiser Permanente Medicare	$2.14
Rate for Payer: MDX Hawaii PPO	$4.95
Rate for Payer: Ohana Health Plan Medicaid	$2.14
Rate for Payer: Ohana Health Plan Medicare	$2.14
Rate for Payer: UnitedHealthcare Medicaid	$3.06
Rate for Payer: UnitedHealthcare Medicare	$2.14
Rate for Payer: University Health Alliance Commercial	$3.72

hydroxocobalamin 1000 mcg/mL Inj Sol [KMC]

Facility

$5.10

Service Code	NDC 00591288830
Hospital Revenue Code	250
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$4.95
Rate for Payer: Cash Price	$3.32
Rate for Payer: Health Management Network Commercial	$4.33
Rate for Payer: Kaiser Permanente Commercial	$4.59
Rate for Payer: MDX Hawaii PPO	$4.95

hydroxocobalamin 5 g REC [KMC]

Facility

$3,117.40

Service Code	NDC 11704037001
Hospital Revenue Code	250
Min. Negotiated Rate	$2,649.79
Max. Negotiated Rate	$3,023.88
Rate for Payer: Cash Price	$2,026.31
Rate for Payer: Health Management Network Commercial	$2,649.79
Rate for Payer: Kaiser Permanente Commercial	$2,805.66
Rate for Payer: MDX Hawaii PPO	$3,023.88

hydroxocobalamin 5 g REC [KMC]

Facility

$3,117.40

Service Code	NDC 11704037001
Hospital Revenue Code	250
Min. Negotiated Rate	$1,309.31
Max. Negotiated Rate	$3,023.88
Rate for Payer: AlohaCare Medicaid	$1,558.70
Rate for Payer: AlohaCare Medicare	$1,309.31
Rate for Payer: Cash Price	$2,026.31
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2,868.01
Rate for Payer: Devoted Health Medicare	$1,309.31
Rate for Payer: Hawaii Medical Service Association Medicare	$1,309.31
Rate for Payer: Hawaii Western Management Group Commercial	$2,961.53
Rate for Payer: Health Management Network Commercial	$2,649.79
Rate for Payer: Humana Medicare	$1,309.31
Rate for Payer: Kaiser Permanente Commercial	$2,805.66
Rate for Payer: Kaiser Permanente Medicaid	$1,589.87
Rate for Payer: Kaiser Permanente Medicare	$1,309.31
Rate for Payer: MDX Hawaii PPO	$3,023.88
Rate for Payer: Ohana Health Plan Medicaid	$1,309.31
Rate for Payer: Ohana Health Plan Medicare	$1,309.31
Rate for Payer: UnitedHealthcare Medicaid	$1,870.44
Rate for Payer: UnitedHealthcare Medicare	$1,309.31
Rate for Payer: University Health Alliance Commercial	$2,272.27

hydroxychloroquine 200 mg Tab [KMC]

Facility

$16.74

Service Code	NDC 16714011001
Hospital Revenue Code	250
Min. Negotiated Rate	$7.03
Max. Negotiated Rate	$16.24
Rate for Payer: AlohaCare Medicaid	$8.37
Rate for Payer: AlohaCare Medicare	$7.03
Rate for Payer: Cash Price	$10.88
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$15.40
Rate for Payer: Devoted Health Medicare	$7.03
Rate for Payer: Hawaii Medical Service Association Medicare	$7.03
Rate for Payer: Hawaii Western Management Group Commercial	$15.90
Rate for Payer: Health Management Network Commercial	$14.23
Rate for Payer: Humana Medicare	$7.03
Rate for Payer: Kaiser Permanente Commercial	$15.07
Rate for Payer: Kaiser Permanente Medicaid	$8.54
Rate for Payer: Kaiser Permanente Medicare	$7.03
Rate for Payer: MDX Hawaii PPO	$16.24
Rate for Payer: Ohana Health Plan Medicaid	$7.03
Rate for Payer: Ohana Health Plan Medicare	$7.03
Rate for Payer: UnitedHealthcare Medicaid	$10.04
Rate for Payer: UnitedHealthcare Medicare	$7.03
Rate for Payer: University Health Alliance Commercial	$12.20

Know your out-of-pocket cost for care.

All Charges