Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$189.49

Service Code	HCPCS 90656
Hospital Revenue Code	637
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$183.81
Rate for Payer: AlohaCare Medicaid	$94.75
Rate for Payer: AlohaCare Medicare	$79.59
Rate for Payer: Cash Price	$123.17
Rate for Payer: Cash Price	$123.17
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$174.33
Rate for Payer: Devoted Health Medicare	$79.59
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$22.35
Rate for Payer: Hawaii Medical Service Association Medicare	$79.59
Rate for Payer: Hawaii Western Management Group Commercial	$180.02
Rate for Payer: Health Management Network Commercial	$161.07
Rate for Payer: Humana Medicare	$79.59
Rate for Payer: Kaiser Permanente Commercial	$170.54
Rate for Payer: Kaiser Permanente Medicaid	$96.64
Rate for Payer: Kaiser Permanente Medicare	$79.59
Rate for Payer: MDX Hawaii PPO	$183.81
Rate for Payer: Ohana Health Plan Medicaid	$79.59
Rate for Payer: Ohana Health Plan Medicare	$79.59
Rate for Payer: UnitedHealthcare Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicare	$79.59
Rate for Payer: University Health Alliance Commercial	$138.12

Infrared Charge

Facility

$32.00

Service Code	HCPCS 97026 GO
Hospital Charge Code	426970260
Hospital Revenue Code	430
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$20.80
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Kaiser Permanente Commercial	$28.80
Rate for Payer: MDX Hawaii PPO	$31.04

Infrared Charge

Facility

$32.00

Service Code	HCPCS 97026 GO
Hospital Charge Code	426970260
Hospital Revenue Code	430
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$31.04
Rate for Payer: AlohaCare Medicaid	$16.00
Rate for Payer: AlohaCare Medicare	$13.44
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$29.44
Rate for Payer: Devoted Health Medicare	$13.44
Rate for Payer: Hawaii Medical Service Association Medicare	$13.44
Rate for Payer: Hawaii Western Management Group Commercial	$30.40
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Humana Medicare	$13.44
Rate for Payer: Kaiser Permanente Commercial	$28.80
Rate for Payer: Kaiser Permanente Medicaid	$16.32
Rate for Payer: Kaiser Permanente Medicare	$13.44
Rate for Payer: MDX Hawaii PPO	$31.04
Rate for Payer: Ohana Health Plan Medicaid	$13.44
Rate for Payer: Ohana Health Plan Medicare	$13.44
Rate for Payer: UnitedHealthcare Medicaid	$4.50
Rate for Payer: UnitedHealthcare Medicare	$13.44
Rate for Payer: University Health Alliance Commercial	$23.32

Infrared-Light Therapy Charge

Facility

$32.00

Service Code	HCPCS 97026 GP
Hospital Charge Code	432970260
Hospital Revenue Code	420
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$31.04
Rate for Payer: AlohaCare Medicaid	$16.00
Rate for Payer: AlohaCare Medicare	$13.44
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$29.44
Rate for Payer: Devoted Health Medicare	$13.44
Rate for Payer: Hawaii Medical Service Association Medicare	$13.44
Rate for Payer: Hawaii Western Management Group Commercial	$30.40
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Humana Medicare	$13.44
Rate for Payer: Kaiser Permanente Commercial	$28.80
Rate for Payer: Kaiser Permanente Medicaid	$16.32
Rate for Payer: Kaiser Permanente Medicare	$13.44
Rate for Payer: MDX Hawaii PPO	$31.04
Rate for Payer: Ohana Health Plan Medicaid	$13.44
Rate for Payer: Ohana Health Plan Medicare	$13.44
Rate for Payer: UnitedHealthcare Medicaid	$4.50
Rate for Payer: UnitedHealthcare Medicare	$13.44
Rate for Payer: University Health Alliance Commercial	$23.32

Infrared-Light Therapy Charge

Facility

$32.00

Service Code	HCPCS 97026 GP
Hospital Charge Code	432970260
Hospital Revenue Code	420
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$20.80
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Kaiser Permanente Commercial	$28.80
Rate for Payer: MDX Hawaii PPO	$31.04

INFRARED Occupational

Facility

$32.00

Service Code	HCPCS 97026 GO
Hospital Charge Code	426970260
Hospital Revenue Code	430
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$20.80
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Kaiser Permanente Commercial	$28.80
Rate for Payer: MDX Hawaii PPO	$31.04

INFRARED Occupational

Facility

$32.00

Service Code	HCPCS 97026 GO
Hospital Charge Code	426970260
Hospital Revenue Code	430
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$31.04
Rate for Payer: AlohaCare Medicaid	$16.00
Rate for Payer: AlohaCare Medicare	$13.44
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$29.44
Rate for Payer: Devoted Health Medicare	$13.44
Rate for Payer: Hawaii Medical Service Association Medicare	$13.44
Rate for Payer: Hawaii Western Management Group Commercial	$30.40
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Humana Medicare	$13.44
Rate for Payer: Kaiser Permanente Commercial	$28.80
Rate for Payer: Kaiser Permanente Medicaid	$16.32
Rate for Payer: Kaiser Permanente Medicare	$13.44
Rate for Payer: MDX Hawaii PPO	$31.04
Rate for Payer: Ohana Health Plan Medicaid	$13.44
Rate for Payer: Ohana Health Plan Medicare	$13.44
Rate for Payer: UnitedHealthcare Medicaid	$4.50
Rate for Payer: UnitedHealthcare Medicare	$13.44
Rate for Payer: University Health Alliance Commercial	$23.32

INFRARED Physical

Facility

$32.00

Service Code	HCPCS 97026 GP
Hospital Charge Code	432970260
Hospital Revenue Code	420
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$31.04
Rate for Payer: AlohaCare Medicaid	$16.00
Rate for Payer: AlohaCare Medicare	$13.44
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$29.44
Rate for Payer: Devoted Health Medicare	$13.44
Rate for Payer: Hawaii Medical Service Association Medicare	$13.44
Rate for Payer: Hawaii Western Management Group Commercial	$30.40
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Humana Medicare	$13.44
Rate for Payer: Kaiser Permanente Commercial	$28.80
Rate for Payer: Kaiser Permanente Medicaid	$16.32
Rate for Payer: Kaiser Permanente Medicare	$13.44
Rate for Payer: MDX Hawaii PPO	$31.04
Rate for Payer: Ohana Health Plan Medicaid	$13.44
Rate for Payer: Ohana Health Plan Medicare	$13.44
Rate for Payer: UnitedHealthcare Medicaid	$4.50
Rate for Payer: UnitedHealthcare Medicare	$13.44
Rate for Payer: University Health Alliance Commercial	$23.32

INFRARED Physical

Facility

$32.00

Service Code	HCPCS 97026 GP
Hospital Charge Code	432970260
Hospital Revenue Code	420
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$20.80
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Kaiser Permanente Commercial	$28.80
Rate for Payer: MDX Hawaii PPO	$31.04

INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC

Facility

$29,888.22

Service Code	MSDRG 351
Min. Negotiated Rate	$29,888.22
Max. Negotiated Rate	$29,888.22
Rate for Payer: Hawaii Medical Service Association Commercial	$29,888.22

INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC

Facility

$37,117.33

Service Code	MSDRG 350
Min. Negotiated Rate	$37,117.33
Max. Negotiated Rate	$37,117.33
Rate for Payer: Hawaii Medical Service Association Commercial	$37,117.33

INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC

Facility

$15,453.70

Service Code	MSDRG 352
Min. Negotiated Rate	$15,453.70
Max. Negotiated Rate	$15,453.70
Rate for Payer: Hawaii Medical Service Association Commercial	$15,453.70

Inhibin B DLS

Facility

$508.00

Service Code	HCPCS 82397
Hospital Charge Code	422823975
Hospital Revenue Code	300
Min. Negotiated Rate	$11.84
Max. Negotiated Rate	$492.76
Rate for Payer: AlohaCare Medicaid	$254.00
Rate for Payer: AlohaCare Medicare	$213.36
Rate for Payer: Cash Price	$330.20
Rate for Payer: Cash Price	$330.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$467.36
Rate for Payer: Devoted Health Medicare	$213.36
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.84
Rate for Payer: Hawaii Medical Service Association Commercial	$17.65
Rate for Payer: Hawaii Medical Service Association Medicare	$213.36
Rate for Payer: Hawaii Western Management Group Commercial	$14.12
Rate for Payer: Health Management Network Commercial	$431.80
Rate for Payer: Humana Medicare	$213.36
Rate for Payer: Kaiser Permanente Commercial	$457.20
Rate for Payer: Kaiser Permanente Medicaid	$259.08
Rate for Payer: Kaiser Permanente Medicare	$213.36
Rate for Payer: MDX Hawaii PPO	$492.76
Rate for Payer: Ohana Health Plan Medicaid	$213.36
Rate for Payer: Ohana Health Plan Medicare	$213.36
Rate for Payer: UnitedHealthcare Medicaid	$11.84
Rate for Payer: UnitedHealthcare Medicare	$213.36
Rate for Payer: University Health Alliance Commercial	$36.52

Inhibin B DLS

Facility

$508.00

Service Code	HCPCS 82397
Hospital Charge Code	422823975
Hospital Revenue Code	300
Min. Negotiated Rate	$431.80
Max. Negotiated Rate	$492.76
Rate for Payer: Cash Price	$330.20
Rate for Payer: Health Management Network Commercial	$431.80
Rate for Payer: Kaiser Permanente Commercial	$457.20
Rate for Payer: MDX Hawaii PPO	$492.76

INHIBIN B DLS

Facility

$508.00

Service Code	HCPCS 82397
Hospital Charge Code	422823975
Hospital Revenue Code	300
Min. Negotiated Rate	$431.80
Max. Negotiated Rate	$492.76
Rate for Payer: Cash Price	$330.20
Rate for Payer: Health Management Network Commercial	$431.80
Rate for Payer: Kaiser Permanente Commercial	$457.20
Rate for Payer: MDX Hawaii PPO	$492.76

INHIBIN B DLS

Facility

$508.00

Service Code	HCPCS 82397
Hospital Charge Code	422823975
Hospital Revenue Code	300
Min. Negotiated Rate	$11.84
Max. Negotiated Rate	$492.76
Rate for Payer: AlohaCare Medicaid	$254.00
Rate for Payer: AlohaCare Medicare	$213.36
Rate for Payer: Cash Price	$330.20
Rate for Payer: Cash Price	$330.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$467.36
Rate for Payer: Devoted Health Medicare	$213.36
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.84
Rate for Payer: Hawaii Medical Service Association Commercial	$17.65
Rate for Payer: Hawaii Medical Service Association Medicare	$213.36
Rate for Payer: Hawaii Western Management Group Commercial	$14.12
Rate for Payer: Health Management Network Commercial	$431.80
Rate for Payer: Humana Medicare	$213.36
Rate for Payer: Kaiser Permanente Commercial	$457.20
Rate for Payer: Kaiser Permanente Medicaid	$259.08
Rate for Payer: Kaiser Permanente Medicare	$213.36
Rate for Payer: MDX Hawaii PPO	$492.76
Rate for Payer: Ohana Health Plan Medicaid	$213.36
Rate for Payer: Ohana Health Plan Medicare	$213.36
Rate for Payer: UnitedHealthcare Medicaid	$11.84
Rate for Payer: UnitedHealthcare Medicare	$213.36
Rate for Payer: University Health Alliance Commercial	$36.52

Initial Hospital Care Level 1 - 99221

Professional

Both

$305.00

Service Code	HCPCS 99221
Hospital Charge Code	435992210
Hospital Revenue Code	987
Min. Negotiated Rate	$68.50
Max. Negotiated Rate	$259.25
Rate for Payer: AlohaCare Medicaid	$82.48
Rate for Payer: AlohaCare Medicare	$73.69
Rate for Payer: Cash Price	$198.25
Rate for Payer: Cash Price	$198.25
Rate for Payer: Devoted Health Medicare	$73.69
Rate for Payer: Hawaii Medical Service Association Medicare	$73.69
Rate for Payer: Hawaii Western Management Group Commercial	$68.50
Rate for Payer: Health Management Network Commercial	$259.25
Rate for Payer: Kaiser Permanente Commercial	$88.43
Rate for Payer: Kaiser Permanente Medicaid	$88.43
Rate for Payer: Kaiser Permanente Medicare	$88.43
Rate for Payer: Ohana Health Plan Medicaid	$82.48
Rate for Payer: Ohana Health Plan Medicare	$73.69
Rate for Payer: UnitedHealthcare Medicaid	$82.48
Rate for Payer: UnitedHealthcare Medicare	$73.69

Initial Hospital Care Level 2 - 99222

Professional

Both

$416.00

Service Code	HCPCS 99222
Hospital Charge Code	435992220
Hospital Revenue Code	987
Min. Negotiated Rate	$113.39
Max. Negotiated Rate	$353.60
Rate for Payer: AlohaCare Medicaid	$131.00
Rate for Payer: AlohaCare Medicare	$116.73
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cash Price	$270.40
Rate for Payer: Devoted Health Medicare	$116.73
Rate for Payer: Hawaii Medical Service Association Medicare	$116.73
Rate for Payer: Hawaii Western Management Group Commercial	$113.39
Rate for Payer: Health Management Network Commercial	$353.60
Rate for Payer: Kaiser Permanente Commercial	$140.08
Rate for Payer: Kaiser Permanente Medicaid	$140.08
Rate for Payer: Kaiser Permanente Medicare	$140.08
Rate for Payer: Ohana Health Plan Medicaid	$131.00
Rate for Payer: Ohana Health Plan Medicare	$116.73
Rate for Payer: UnitedHealthcare Medicaid	$131.00
Rate for Payer: UnitedHealthcare Medicare	$116.73

Initial Hospital Care Level 3 - 99223

Professional

Both

$612.00

Service Code	HCPCS 99223
Hospital Charge Code	435992230
Hospital Revenue Code	987
Min. Negotiated Rate	$149.55
Max. Negotiated Rate	$520.20
Rate for Payer: AlohaCare Medicaid	$174.14
Rate for Payer: AlohaCare Medicare	$156.50
Rate for Payer: Cash Price	$397.80
Rate for Payer: Cash Price	$397.80
Rate for Payer: Devoted Health Medicare	$156.50
Rate for Payer: Hawaii Medical Service Association Medicare	$156.50
Rate for Payer: Hawaii Western Management Group Commercial	$149.55
Rate for Payer: Health Management Network Commercial	$520.20
Rate for Payer: Kaiser Permanente Commercial	$187.80
Rate for Payer: Kaiser Permanente Medicaid	$187.80
Rate for Payer: Kaiser Permanente Medicare	$187.80
Rate for Payer: Ohana Health Plan Medicaid	$174.14
Rate for Payer: Ohana Health Plan Medicare	$156.50
Rate for Payer: UnitedHealthcare Medicaid	$174.14
Rate for Payer: UnitedHealthcare Medicare	$156.50

Initial Inpatient Consult Level 1 - 99251

Professional

Both

$191.00

Service Code	HCPCS 99251
Hospital Charge Code	435992510
Hospital Revenue Code	988
Min. Negotiated Rate	$49.51
Max. Negotiated Rate	$162.35
Rate for Payer: Cash Price	$124.15
Rate for Payer: Cash Price	$124.15
Rate for Payer: Hawaii Western Management Group Commercial	$49.51
Rate for Payer: Health Management Network Commercial	$162.35

Initial Inpatient Consult Level 2 - 99252

Professional

Both

$290.00

Service Code	HCPCS 99252
Hospital Charge Code	435992520
Hospital Revenue Code	988
Min. Negotiated Rate	$77.22
Max. Negotiated Rate	$246.50
Rate for Payer: Cash Price	$188.50
Rate for Payer: Cash Price	$188.50
Rate for Payer: Hawaii Western Management Group Commercial	$77.22
Rate for Payer: Health Management Network Commercial	$246.50

Initial Inpatient Consult Level 3 - 99253

Professional

Both

$441.00

Service Code	HCPCS 99253
Hospital Charge Code	435992530
Hospital Revenue Code	988
Min. Negotiated Rate	$102.55
Max. Negotiated Rate	$374.85
Rate for Payer: Cash Price	$286.65
Rate for Payer: Cash Price	$286.65
Rate for Payer: Hawaii Western Management Group Commercial	$102.55
Rate for Payer: Health Management Network Commercial	$374.85

Initial Inpatient Consult Level 4 - 99254

Professional

Both

$635.00

Service Code	HCPCS 99254
Hospital Charge Code	435992540
Hospital Revenue Code	988
Min. Negotiated Rate	$141.07
Max. Negotiated Rate	$539.75
Rate for Payer: Cash Price	$412.75
Rate for Payer: Cash Price	$412.75
Rate for Payer: Hawaii Western Management Group Commercial	$141.07
Rate for Payer: Health Management Network Commercial	$539.75

Initial Inpatient Consult Level 5 - 99255

Professional

Both

$767.00

Service Code	HCPCS 99255
Hospital Charge Code	435992550
Hospital Revenue Code	988
Min. Negotiated Rate	$190.80
Max. Negotiated Rate	$651.95
Rate for Payer: Cash Price	$498.55
Rate for Payer: Cash Price	$498.55
Rate for Payer: Hawaii Western Management Group Commercial	$190.80
Rate for Payer: Health Management Network Commercial	$651.95

Initial Observatiom Care Level 3 99220

Professional

Both

$558.00

Service Code	HCPCS 99220
Hospital Charge Code	435992200
Hospital Revenue Code	987
Min. Negotiated Rate	$150.26
Max. Negotiated Rate	$474.30
Rate for Payer: Cash Price	$362.70
Rate for Payer: Cash Price	$362.70
Rate for Payer: Hawaii Western Management Group Commercial	$150.26
Rate for Payer: Health Management Network Commercial	$474.30

Know your out-of-pocket cost for care.

All Charges