Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$16,567.70

Service Code	MSDRG 560
Min. Negotiated Rate	$16,567.70
Max. Negotiated Rate	$16,567.70
Rate for Payer: Hawaii Medical Service Association Commercial	$16,567.70

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$16,567.70

Service Code	MSDRG 559
Min. Negotiated Rate	$16,567.70
Max. Negotiated Rate	$16,567.70
Rate for Payer: Hawaii Medical Service Association Commercial	$16,567.70

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$16,567.70

Service Code	MSDRG 561
Min. Negotiated Rate	$16,567.70
Max. Negotiated Rate	$16,567.70
Rate for Payer: Hawaii Medical Service Association Commercial	$16,567.70

AFTERCARE WITH CC/MCC

Facility

$17,610.59

Service Code	MSDRG 949
Min. Negotiated Rate	$17,610.59
Max. Negotiated Rate	$17,610.59
Rate for Payer: Hawaii Medical Service Association Commercial	$17,610.59

AFTERCARE WITHOUT CC/MCC

Facility

$5,214.44

Service Code	MSDRG 950
Min. Negotiated Rate	$5,214.44
Max. Negotiated Rate	$5,214.44
Rate for Payer: Hawaii Medical Service Association Commercial	$5,214.44

AICD GENERATOR PROCEDURES

Facility

$77,315.92

Service Code	MSDRG 245
Min. Negotiated Rate	$77,315.92
Max. Negotiated Rate	$77,315.92
Rate for Payer: Hawaii Medical Service Association Commercial	$77,315.92

AICD LEAD PROCEDURES

Facility

$77,315.92

Service Code	MSDRG 265
Min. Negotiated Rate	$77,315.92
Max. Negotiated Rate	$77,315.92
Rate for Payer: Hawaii Medical Service Association Commercial	$77,315.92

AIR CUSHION MASK INFANT

Facility

$9.00

Hospital Charge Code	8439
Hospital Revenue Code	270
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$8.73
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$3.78
Rate for Payer: Cash Price	$5.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$8.28
Rate for Payer: Devoted Health Medicare	$3.78
Rate for Payer: Hawaii Medical Service Association Medicare	$3.78
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Humana Medicare	$3.78
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicare	$3.78
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$3.78
Rate for Payer: Ohana Health Plan Medicare	$3.78
Rate for Payer: UnitedHealthcare Medicare	$3.78
Rate for Payer: University Health Alliance Commercial	$6.56

AIR CUSHION MASK INFANT

Facility

$9.00

Hospital Charge Code	8439
Hospital Revenue Code	270
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73

AIR CUSHION MASK NEONATE

Facility

$9.00

Hospital Charge Code	8440
Hospital Revenue Code	270
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$8.73
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$3.78
Rate for Payer: Cash Price	$5.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$8.28
Rate for Payer: Devoted Health Medicare	$3.78
Rate for Payer: Hawaii Medical Service Association Medicare	$3.78
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Humana Medicare	$3.78
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicare	$3.78
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$3.78
Rate for Payer: Ohana Health Plan Medicare	$3.78
Rate for Payer: UnitedHealthcare Medicare	$3.78
Rate for Payer: University Health Alliance Commercial	$6.56

AIR CUSHION MASK NEONATE

Facility

$9.00

Hospital Charge Code	8440
Hospital Revenue Code	270
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73

AIR ENTRAPMENT MASK

Facility

$4.00

Hospital Charge Code	8016
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

AIR ENTRAPMENT MASK

Facility

$4.00

Hospital Charge Code	8016
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

Alanine Amintransderase DLS

Facility

$314.00

Service Code	HCPCS 86812
Hospital Charge Code	422868125
Hospital Revenue Code	302
Min. Negotiated Rate	$25.81
Max. Negotiated Rate	$304.58
Rate for Payer: AlohaCare Medicaid	$157.00
Rate for Payer: AlohaCare Medicare	$131.88
Rate for Payer: Cash Price	$204.10
Rate for Payer: Cash Price	$204.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$288.88
Rate for Payer: Devoted Health Medicare	$131.88
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$35.66
Rate for Payer: Hawaii Medical Service Association Commercial	$32.26
Rate for Payer: Hawaii Medical Service Association Medicare	$131.88
Rate for Payer: Hawaii Western Management Group Commercial	$25.81
Rate for Payer: Health Management Network Commercial	$266.90
Rate for Payer: Humana Medicare	$131.88
Rate for Payer: Kaiser Permanente Commercial	$282.60
Rate for Payer: Kaiser Permanente Medicaid	$160.14
Rate for Payer: Kaiser Permanente Medicare	$131.88
Rate for Payer: MDX Hawaii PPO	$304.58
Rate for Payer: Ohana Health Plan Medicaid	$131.88
Rate for Payer: Ohana Health Plan Medicare	$131.88
Rate for Payer: UnitedHealthcare Medicaid	$35.66
Rate for Payer: UnitedHealthcare Medicare	$131.88
Rate for Payer: University Health Alliance Commercial	$66.71

Alanine Amintransderase DLS

Facility

$314.00

Service Code	HCPCS 86812
Hospital Charge Code	422868125
Hospital Revenue Code	302
Min. Negotiated Rate	$266.90
Max. Negotiated Rate	$304.58
Rate for Payer: Cash Price	$204.10
Rate for Payer: Health Management Network Commercial	$266.90
Rate for Payer: Kaiser Permanente Commercial	$282.60
Rate for Payer: MDX Hawaii PPO	$304.58

Albumin Creatinine Ratio (ACR) DLS

Facility

$25.00

Service Code	HCPCS 82042
Hospital Charge Code	422820425
Hospital Revenue Code	301
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: MDX Hawaii PPO	$24.25

Albumin Creatinine Ratio (ACR) DLS

Facility

$25.00

Service Code	HCPCS 82042
Hospital Charge Code	422820425
Hospital Revenue Code	301
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$24.25
Rate for Payer: AlohaCare Medicaid	$12.50
Rate for Payer: AlohaCare Medicare	$10.50
Rate for Payer: Cash Price	$16.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$23.00
Rate for Payer: Devoted Health Medicare	$10.50
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$9.72
Rate for Payer: Hawaii Medical Service Association Medicare	$10.50
Rate for Payer: Hawaii Western Management Group Commercial	$7.78
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Humana Medicare	$10.50
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: Kaiser Permanente Medicaid	$12.75
Rate for Payer: Kaiser Permanente Medicare	$10.50
Rate for Payer: MDX Hawaii PPO	$24.25
Rate for Payer: Ohana Health Plan Medicaid	$10.50
Rate for Payer: Ohana Health Plan Medicare	$10.50
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$10.50
Rate for Payer: University Health Alliance Commercial	$13.38

albumin human 25% Soln [KMC]

Facility

$4.64

Service Code	HCPCS P9047
Hospital Revenue Code	637
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$4.50
Rate for Payer: Cash Price	$3.02
Rate for Payer: Health Management Network Commercial	$3.94
Rate for Payer: Kaiser Permanente Commercial	$4.18
Rate for Payer: MDX Hawaii PPO	$4.50

albumin human 25% Soln [KMC]

Facility

$4.64

Service Code	HCPCS P9047
Hospital Revenue Code	637
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$66.35
Rate for Payer: AlohaCare Medicaid	$2.32
Rate for Payer: AlohaCare Medicare	$1.95
Rate for Payer: Cash Price	$3.02
Rate for Payer: Cash Price	$3.02
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.27
Rate for Payer: Devoted Health Medicare	$1.95
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$53.08
Rate for Payer: Hawaii Medical Service Association Commercial	$66.35
Rate for Payer: Hawaii Medical Service Association Medicare	$1.95
Rate for Payer: Hawaii Western Management Group Commercial	$4.41
Rate for Payer: Health Management Network Commercial	$3.94
Rate for Payer: Humana Medicare	$1.95
Rate for Payer: Kaiser Permanente Commercial	$4.18
Rate for Payer: Kaiser Permanente Medicaid	$2.37
Rate for Payer: Kaiser Permanente Medicare	$1.95
Rate for Payer: MDX Hawaii PPO	$4.50
Rate for Payer: Ohana Health Plan Medicaid	$1.95
Rate for Payer: Ohana Health Plan Medicare	$1.95
Rate for Payer: UnitedHealthcare Medicaid	$39.81
Rate for Payer: UnitedHealthcare Medicare	$1.95
Rate for Payer: University Health Alliance Commercial	$3.38

albumin human 5% Soln [KMC]

Facility

$0.93

Service Code	HCPCS P9045
Hospital Revenue Code	637
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.90
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.79
Rate for Payer: Kaiser Permanente Commercial	$0.84
Rate for Payer: MDX Hawaii PPO	$0.90

albumin human 5% Soln [KMC]

Facility

$0.93

Service Code	HCPCS P9045
Hospital Revenue Code	637
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$66.35
Rate for Payer: AlohaCare Medicaid	$0.47
Rate for Payer: AlohaCare Medicare	$0.39
Rate for Payer: Cash Price	$0.60
Rate for Payer: Cash Price	$0.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.86
Rate for Payer: Devoted Health Medicare	$0.39
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$53.08
Rate for Payer: Hawaii Medical Service Association Commercial	$66.35
Rate for Payer: Hawaii Medical Service Association Medicare	$0.39
Rate for Payer: Hawaii Western Management Group Commercial	$0.88
Rate for Payer: Health Management Network Commercial	$0.79
Rate for Payer: Humana Medicare	$0.39
Rate for Payer: Kaiser Permanente Commercial	$0.84
Rate for Payer: Kaiser Permanente Medicaid	$0.47
Rate for Payer: Kaiser Permanente Medicare	$0.39
Rate for Payer: MDX Hawaii PPO	$0.90
Rate for Payer: Ohana Health Plan Medicaid	$0.39
Rate for Payer: Ohana Health Plan Medicare	$0.39
Rate for Payer: UnitedHealthcare Medicaid	$39.81
Rate for Payer: UnitedHealthcare Medicare	$0.39
Rate for Payer: University Health Alliance Commercial	$0.68

Albumin Level

Facility

$69.00

Service Code	HCPCS 82040
Hospital Charge Code	422820400
Hospital Revenue Code	301
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$44.85
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: MDX Hawaii PPO	$66.93

Albumin Level

Facility

$69.00

Service Code	HCPCS 82040
Hospital Charge Code	422820400
Hospital Revenue Code	301
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$66.93
Rate for Payer: AlohaCare Medicaid	$34.50
Rate for Payer: AlohaCare Medicare	$28.98
Rate for Payer: Cash Price	$44.85
Rate for Payer: Cash Price	$44.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$63.48
Rate for Payer: Devoted Health Medicare	$28.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$6.85
Rate for Payer: Hawaii Medical Service Association Commercial	$6.19
Rate for Payer: Hawaii Medical Service Association Medicare	$28.98
Rate for Payer: Hawaii Western Management Group Commercial	$4.95
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Humana Medicare	$28.98
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: Kaiser Permanente Medicaid	$35.19
Rate for Payer: Kaiser Permanente Medicare	$28.98
Rate for Payer: MDX Hawaii PPO	$66.93
Rate for Payer: Ohana Health Plan Medicaid	$28.98
Rate for Payer: Ohana Health Plan Medicare	$28.98
Rate for Payer: UnitedHealthcare Medicaid	$6.85
Rate for Payer: UnitedHealthcare Medicare	$28.98
Rate for Payer: University Health Alliance Commercial	$12.80

albuterol 2.5mg/3 mL (0.083%) Neb Soln [KMC]

Facility

$1.77

Service Code	HCPCS J7613
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.72
Rate for Payer: Cash Price	$1.15
Rate for Payer: Health Management Network Commercial	$1.50
Rate for Payer: Kaiser Permanente Commercial	$1.59
Rate for Payer: MDX Hawaii PPO	$1.72

albuterol 2.5mg/3 mL (0.083%) Neb Soln [KMC]

Facility

$1.77

Service Code	HCPCS J7613
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.72
Rate for Payer: AlohaCare Medicaid	$0.89
Rate for Payer: AlohaCare Medicare	$0.74
Rate for Payer: Cash Price	$1.15
Rate for Payer: Cash Price	$1.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1.63
Rate for Payer: Devoted Health Medicare	$0.74
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.08
Rate for Payer: Hawaii Medical Service Association Medicare	$0.74
Rate for Payer: Hawaii Western Management Group Commercial	$1.68
Rate for Payer: Health Management Network Commercial	$1.50
Rate for Payer: Humana Medicare	$0.74
Rate for Payer: Kaiser Permanente Commercial	$1.59
Rate for Payer: Kaiser Permanente Medicaid	$0.90
Rate for Payer: Kaiser Permanente Medicare	$0.74
Rate for Payer: MDX Hawaii PPO	$1.72
Rate for Payer: Ohana Health Plan Medicaid	$0.74
Rate for Payer: Ohana Health Plan Medicare	$0.74
Rate for Payer: UnitedHealthcare Medicaid	$1.06
Rate for Payer: UnitedHealthcare Medicare	$0.74
Rate for Payer: University Health Alliance Commercial	$1.29

Know your out-of-pocket cost for care.

All Charges