Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$13,178.31

Service Code	MSDRG 727
Min. Negotiated Rate	$13,178.31
Max. Negotiated Rate	$13,178.31
Rate for Payer: Hawaii Medical Service Association Commercial	$13,178.31

INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC

Facility

$13,178.31

Service Code	MSDRG 728
Min. Negotiated Rate	$13,178.31
Max. Negotiated Rate	$13,178.31
Rate for Payer: Hawaii Medical Service Association Commercial	$13,178.31

INFLAMMATORY BOWEL DISEASE WITH CC

Facility

$19,435.64

Service Code	MSDRG 386
Min. Negotiated Rate	$19,435.64
Max. Negotiated Rate	$19,435.64
Rate for Payer: Hawaii Medical Service Association Commercial	$19,435.64

INFLAMMATORY BOWEL DISEASE WITH MCC

Facility

$19,435.64

Service Code	MSDRG 385
Min. Negotiated Rate	$19,435.64
Max. Negotiated Rate	$19,435.64
Rate for Payer: Hawaii Medical Service Association Commercial	$19,435.64

INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC

Facility

$19,435.64

Service Code	MSDRG 387
Min. Negotiated Rate	$19,435.64
Max. Negotiated Rate	$19,435.64
Rate for Payer: Hawaii Medical Service Association Commercial	$19,435.64

inFLIXimab 100 mg vial [KMC]

Facility

$2,280.00

Service Code	HCPCS J1745
Hospital Revenue Code	636
Min. Negotiated Rate	$1,938.00
Max. Negotiated Rate	$2,211.60
Rate for Payer: Cash Price	$1,482.00
Rate for Payer: Health Management Network Commercial	$1,938.00
Rate for Payer: Kaiser Permanente Commercial	$2,052.00
Rate for Payer: MDX Hawaii PPO	$2,211.60

inFLIXimab 100 mg vial [KMC]

Facility

$2,280.00

Service Code	HCPCS J1745
Hospital Revenue Code	636
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$2,211.60
Rate for Payer: AlohaCare Medicaid	$1,140.00
Rate for Payer: AlohaCare Medicare	$957.60
Rate for Payer: Cash Price	$1,482.00
Rate for Payer: Cash Price	$1,482.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2,097.60
Rate for Payer: Devoted Health Medicare	$957.60
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$109.98
Rate for Payer: Hawaii Medical Service Association Commercial	$38.80
Rate for Payer: Hawaii Medical Service Association Medicare	$957.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,166.00
Rate for Payer: Health Management Network Commercial	$1,938.00
Rate for Payer: Humana Medicare	$957.60
Rate for Payer: Kaiser Permanente Commercial	$2,052.00
Rate for Payer: Kaiser Permanente Medicaid	$1,162.80
Rate for Payer: Kaiser Permanente Medicare	$957.60
Rate for Payer: MDX Hawaii PPO	$2,211.60
Rate for Payer: Ohana Health Plan Medicaid	$957.60
Rate for Payer: Ohana Health Plan Medicare	$957.60
Rate for Payer: UnitedHealthcare Medicaid	$1,368.00
Rate for Payer: UnitedHealthcare Medicare	$957.60
Rate for Payer: University Health Alliance Commercial	$1,661.89

inFLIXimab (INFLECTRA) 100 mg REC vial [KMC]

Facility

$4,542.14

Service Code	HCPCS Q5103
Hospital Revenue Code	637
Min. Negotiated Rate	$3,860.82
Max. Negotiated Rate	$4,405.88
Rate for Payer: Cash Price	$2,952.39
Rate for Payer: Health Management Network Commercial	$3,860.82
Rate for Payer: Kaiser Permanente Commercial	$4,087.93
Rate for Payer: MDX Hawaii PPO	$4,405.88

inFLIXimab (INFLECTRA) 100 mg REC vial [KMC]

Facility

$4,542.14

Service Code	HCPCS Q5103
Hospital Revenue Code	637
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$4,405.88
Rate for Payer: AlohaCare Medicaid	$2,271.07
Rate for Payer: AlohaCare Medicare	$1,907.70
Rate for Payer: Cash Price	$2,952.39
Rate for Payer: Cash Price	$2,952.39
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4,178.77
Rate for Payer: Devoted Health Medicare	$1,907.70
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$19.68
Rate for Payer: Hawaii Medical Service Association Commercial	$32.55
Rate for Payer: Hawaii Medical Service Association Medicare	$1,907.70
Rate for Payer: Hawaii Western Management Group Commercial	$4,315.03
Rate for Payer: Health Management Network Commercial	$3,860.82
Rate for Payer: Humana Medicare	$1,907.70
Rate for Payer: Kaiser Permanente Commercial	$4,087.93
Rate for Payer: Kaiser Permanente Medicaid	$2,316.49
Rate for Payer: Kaiser Permanente Medicare	$1,907.70
Rate for Payer: MDX Hawaii PPO	$4,405.88
Rate for Payer: Ohana Health Plan Medicaid	$1,907.70
Rate for Payer: Ohana Health Plan Medicare	$1,907.70
Rate for Payer: UnitedHealthcare Medicaid	$14.76
Rate for Payer: UnitedHealthcare Medicare	$1,907.70
Rate for Payer: University Health Alliance Commercial	$3,310.77

Influenza A and B Antigen DLS

Facility

$59.00

Service Code	HCPCS 86710
Hospital Charge Code	422867105
Hospital Revenue Code	306
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$57.23
Rate for Payer: AlohaCare Medicaid	$29.50
Rate for Payer: AlohaCare Medicare	$24.78
Rate for Payer: Cash Price	$38.35
Rate for Payer: Cash Price	$38.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$54.28
Rate for Payer: Devoted Health Medicare	$24.78
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.36
Rate for Payer: Hawaii Medical Service Association Commercial	$16.94
Rate for Payer: Hawaii Medical Service Association Medicare	$24.78
Rate for Payer: Hawaii Western Management Group Commercial	$13.55
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: Humana Medicare	$24.78
Rate for Payer: Kaiser Permanente Commercial	$53.10
Rate for Payer: Kaiser Permanente Medicaid	$30.09
Rate for Payer: Kaiser Permanente Medicare	$24.78
Rate for Payer: MDX Hawaii PPO	$57.23
Rate for Payer: Ohana Health Plan Medicaid	$24.78
Rate for Payer: Ohana Health Plan Medicare	$24.78
Rate for Payer: UnitedHealthcare Medicaid	$11.36
Rate for Payer: UnitedHealthcare Medicare	$24.78
Rate for Payer: University Health Alliance Commercial	$35.04

Influenza A and B Antigen DLS

Facility

$59.00

Service Code	HCPCS 86710
Hospital Charge Code	422867105
Hospital Revenue Code	306
Min. Negotiated Rate	$50.15
Max. Negotiated Rate	$57.23
Rate for Payer: Cash Price	$38.35
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: Kaiser Permanente Commercial	$53.10
Rate for Payer: MDX Hawaii PPO	$57.23

Influenza A&B 7

Facility

$384.00

Service Code	HCPCS 87502
Hospital Charge Code	422875025
Hospital Revenue Code	300
Min. Negotiated Rate	$95.80
Max. Negotiated Rate	$372.48
Rate for Payer: AlohaCare Medicaid	$192.00
Rate for Payer: AlohaCare Medicare	$161.28
Rate for Payer: Cash Price	$249.60
Rate for Payer: Cash Price	$249.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$353.28
Rate for Payer: Devoted Health Medicare	$161.28
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$119.75
Rate for Payer: Hawaii Medical Service Association Commercial	$119.75
Rate for Payer: Hawaii Medical Service Association Medicare	$161.28
Rate for Payer: Hawaii Western Management Group Commercial	$95.80
Rate for Payer: Health Management Network Commercial	$326.40
Rate for Payer: Humana Medicare	$161.28
Rate for Payer: Kaiser Permanente Commercial	$345.60
Rate for Payer: Kaiser Permanente Medicaid	$195.84
Rate for Payer: Kaiser Permanente Medicare	$161.28
Rate for Payer: MDX Hawaii PPO	$372.48
Rate for Payer: Ohana Health Plan Medicaid	$161.28
Rate for Payer: Ohana Health Plan Medicare	$161.28
Rate for Payer: UnitedHealthcare Medicaid	$119.75
Rate for Payer: UnitedHealthcare Medicare	$161.28
Rate for Payer: University Health Alliance Commercial	$221.54

Influenza A&B 7

Facility

$384.00

Service Code	HCPCS 87502
Hospital Charge Code	422875025
Hospital Revenue Code	300
Min. Negotiated Rate	$326.40
Max. Negotiated Rate	$372.48
Rate for Payer: Cash Price	$249.60
Rate for Payer: Health Management Network Commercial	$326.40
Rate for Payer: Kaiser Permanente Commercial	$345.60
Rate for Payer: MDX Hawaii PPO	$372.48

.Influenza A/B Antigen,Reflex RT-PCR DLS

Facility

$59.00

Service Code	HCPCS 86710
Hospital Charge Code	422867105
Hospital Revenue Code	306
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$57.23
Rate for Payer: AlohaCare Medicaid	$29.50
Rate for Payer: AlohaCare Medicare	$24.78
Rate for Payer: Cash Price	$38.35
Rate for Payer: Cash Price	$38.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$54.28
Rate for Payer: Devoted Health Medicare	$24.78
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.36
Rate for Payer: Hawaii Medical Service Association Commercial	$16.94
Rate for Payer: Hawaii Medical Service Association Medicare	$24.78
Rate for Payer: Hawaii Western Management Group Commercial	$13.55
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: Humana Medicare	$24.78
Rate for Payer: Kaiser Permanente Commercial	$53.10
Rate for Payer: Kaiser Permanente Medicaid	$30.09
Rate for Payer: Kaiser Permanente Medicare	$24.78
Rate for Payer: MDX Hawaii PPO	$57.23
Rate for Payer: Ohana Health Plan Medicaid	$24.78
Rate for Payer: Ohana Health Plan Medicare	$24.78
Rate for Payer: UnitedHealthcare Medicaid	$11.36
Rate for Payer: UnitedHealthcare Medicare	$24.78
Rate for Payer: University Health Alliance Commercial	$35.04

.Influenza A/B Antigen,Reflex RT-PCR DLS

Facility

$59.00

Service Code	HCPCS 86710
Hospital Charge Code	422867105
Hospital Revenue Code	306
Min. Negotiated Rate	$50.15
Max. Negotiated Rate	$57.23
Rate for Payer: Cash Price	$38.35
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: Kaiser Permanente Commercial	$53.10
Rate for Payer: MDX Hawaii PPO	$57.23

Influenza A & B POCT

Facility

$59.00

Service Code	HCPCS 86710
Hospital Charge Code	435867100
Hospital Revenue Code	306
Min. Negotiated Rate	$50.15
Max. Negotiated Rate	$57.23
Rate for Payer: Cash Price	$38.35
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: Kaiser Permanente Commercial	$53.10
Rate for Payer: MDX Hawaii PPO	$57.23

Influenza A & B POCT

Facility

$59.00

Service Code	HCPCS 86710
Hospital Charge Code	435867100
Hospital Revenue Code	306
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$57.23
Rate for Payer: AlohaCare Medicaid	$29.50
Rate for Payer: AlohaCare Medicare	$24.78
Rate for Payer: Cash Price	$38.35
Rate for Payer: Cash Price	$38.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$54.28
Rate for Payer: Devoted Health Medicare	$24.78
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.36
Rate for Payer: Hawaii Medical Service Association Commercial	$16.94
Rate for Payer: Hawaii Medical Service Association Medicare	$24.78
Rate for Payer: Hawaii Western Management Group Commercial	$13.55
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: Humana Medicare	$24.78
Rate for Payer: Kaiser Permanente Commercial	$53.10
Rate for Payer: Kaiser Permanente Medicaid	$30.09
Rate for Payer: Kaiser Permanente Medicare	$24.78
Rate for Payer: MDX Hawaii PPO	$57.23
Rate for Payer: Ohana Health Plan Medicaid	$24.78
Rate for Payer: Ohana Health Plan Medicare	$24.78
Rate for Payer: UnitedHealthcare Medicaid	$11.36
Rate for Payer: UnitedHealthcare Medicare	$24.78
Rate for Payer: University Health Alliance Commercial	$35.04

INFLUENZA IMMUNIZATION ORDERED OR ADMINISTERED

Professional

Both

$0.01

Service Code	HCPCS 4037F
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

Influenza type A and B, RT-PCR DLS

Facility

$384.00

Service Code	HCPCS 87502
Hospital Charge Code	422875025
Hospital Revenue Code	300
Min. Negotiated Rate	$326.40
Max. Negotiated Rate	$372.48
Rate for Payer: Cash Price	$249.60
Rate for Payer: Health Management Network Commercial	$326.40
Rate for Payer: Kaiser Permanente Commercial	$345.60
Rate for Payer: MDX Hawaii PPO	$372.48

Influenza type A and B, RT-PCR DLS

Facility

$384.00

Service Code	HCPCS 87502
Hospital Charge Code	422875025
Hospital Revenue Code	300
Min. Negotiated Rate	$95.80
Max. Negotiated Rate	$372.48
Rate for Payer: AlohaCare Medicaid	$192.00
Rate for Payer: AlohaCare Medicare	$161.28
Rate for Payer: Cash Price	$249.60
Rate for Payer: Cash Price	$249.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$353.28
Rate for Payer: Devoted Health Medicare	$161.28
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$119.75
Rate for Payer: Hawaii Medical Service Association Commercial	$119.75
Rate for Payer: Hawaii Medical Service Association Medicare	$161.28
Rate for Payer: Hawaii Western Management Group Commercial	$95.80
Rate for Payer: Health Management Network Commercial	$326.40
Rate for Payer: Humana Medicare	$161.28
Rate for Payer: Kaiser Permanente Commercial	$345.60
Rate for Payer: Kaiser Permanente Medicaid	$195.84
Rate for Payer: Kaiser Permanente Medicare	$161.28
Rate for Payer: MDX Hawaii PPO	$372.48
Rate for Payer: Ohana Health Plan Medicaid	$161.28
Rate for Payer: Ohana Health Plan Medicare	$161.28
Rate for Payer: UnitedHealthcare Medicaid	$119.75
Rate for Payer: UnitedHealthcare Medicare	$161.28
Rate for Payer: University Health Alliance Commercial	$221.54

influenza vaccine, quad >65yo HIGH DOSE (Fluad) [KMC]

Facility

$513.68

Service Code	NDC 70461012003
Hospital Revenue Code	250
Min. Negotiated Rate	$436.63
Max. Negotiated Rate	$498.27
Rate for Payer: Cash Price	$333.89
Rate for Payer: Health Management Network Commercial	$436.63
Rate for Payer: Kaiser Permanente Commercial	$462.31
Rate for Payer: MDX Hawaii PPO	$498.27

influenza vaccine, quad >65yo HIGH DOSE (Fluad) [KMC]

Facility

$513.68

Service Code	NDC 70461012003
Hospital Revenue Code	250
Min. Negotiated Rate	$215.75
Max. Negotiated Rate	$498.27
Rate for Payer: AlohaCare Medicaid	$256.84
Rate for Payer: AlohaCare Medicare	$215.75
Rate for Payer: Cash Price	$333.89
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$472.59
Rate for Payer: Devoted Health Medicare	$215.75
Rate for Payer: Hawaii Medical Service Association Medicare	$215.75
Rate for Payer: Hawaii Western Management Group Commercial	$488.00
Rate for Payer: Health Management Network Commercial	$436.63
Rate for Payer: Humana Medicare	$215.75
Rate for Payer: Kaiser Permanente Commercial	$462.31
Rate for Payer: Kaiser Permanente Medicaid	$261.98
Rate for Payer: Kaiser Permanente Medicare	$215.75
Rate for Payer: MDX Hawaii PPO	$498.27
Rate for Payer: Ohana Health Plan Medicaid	$215.75
Rate for Payer: Ohana Health Plan Medicare	$215.75
Rate for Payer: UnitedHealthcare Medicaid	$308.21
Rate for Payer: UnitedHealthcare Medicare	$215.75
Rate for Payer: University Health Alliance Commercial	$374.42

influenza vaccine, quadrivalent >6mo ADULT/CHILD [KMC]

Facility

$198.42

Service Code	HCPCS 90686
Hospital Revenue Code	637
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$192.47
Rate for Payer: AlohaCare Medicaid	$99.21
Rate for Payer: AlohaCare Medicare	$83.34
Rate for Payer: Cash Price	$128.97
Rate for Payer: Cash Price	$128.97
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$182.55
Rate for Payer: Devoted Health Medicare	$83.34
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$22.35
Rate for Payer: Hawaii Medical Service Association Medicare	$83.34
Rate for Payer: Hawaii Western Management Group Commercial	$188.50
Rate for Payer: Health Management Network Commercial	$168.66
Rate for Payer: Humana Medicare	$83.34
Rate for Payer: Kaiser Permanente Commercial	$178.58
Rate for Payer: Kaiser Permanente Medicaid	$101.19
Rate for Payer: Kaiser Permanente Medicare	$83.34
Rate for Payer: MDX Hawaii PPO	$192.47
Rate for Payer: Ohana Health Plan Medicaid	$83.34
Rate for Payer: Ohana Health Plan Medicare	$83.34
Rate for Payer: UnitedHealthcare Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicare	$83.34
Rate for Payer: University Health Alliance Commercial	$144.63

influenza vaccine, quadrivalent >6mo ADULT/CHILD [KMC]

Facility

$198.42

Service Code	HCPCS 90686
Hospital Revenue Code	637
Min. Negotiated Rate	$168.66
Max. Negotiated Rate	$192.47
Rate for Payer: Cash Price	$128.97
Rate for Payer: Health Management Network Commercial	$168.66
Rate for Payer: Kaiser Permanente Commercial	$178.58
Rate for Payer: MDX Hawaii PPO	$192.47

influenza vaccine, trivalent Susp >6mo ADULT/CHILD [KMC]

Facility

$189.49

Service Code	HCPCS 90656
Hospital Revenue Code	637
Min. Negotiated Rate	$161.07
Max. Negotiated Rate	$183.81
Rate for Payer: Cash Price	$123.17
Rate for Payer: Health Management Network Commercial	$161.07
Rate for Payer: Kaiser Permanente Commercial	$170.54
Rate for Payer: MDX Hawaii PPO	$183.81

Know your out-of-pocket cost for care.

All Charges