Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

INTERMED LAC FACE >30CM ED Charge

Facility

$1,017.00

Service Code	HCPCS 12057
Hospital Charge Code	440120570
Hospital Revenue Code	450
Min. Negotiated Rate	$864.45
Max. Negotiated Rate	$986.49
Rate for Payer: Cash Price	$661.05
Rate for Payer: Health Management Network Commercial	$864.45
Rate for Payer: Kaiser Permanente Commercial	$915.30
Rate for Payer: MDX Hawaii PPO	$986.49

INTERMED LAC FACE >30CM ED Charge

Facility

$1,017.00

Service Code	HCPCS 12057
Hospital Charge Code	440120570
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$508.50
Rate for Payer: AlohaCare Medicare	$427.14
Rate for Payer: Cash Price	$661.05
Rate for Payer: Cash Price	$661.05
Rate for Payer: Cash Price	$661.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$935.64
Rate for Payer: Devoted Health Medicare	$427.14
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$427.14
Rate for Payer: Hawaii Western Management Group Commercial	$966.15
Rate for Payer: Health Management Network Commercial	$864.45
Rate for Payer: Humana Medicare	$427.14
Rate for Payer: Kaiser Permanente Commercial	$915.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$427.14
Rate for Payer: MDX Hawaii PPO	$986.49
Rate for Payer: Ohana Health Plan Medicaid	$427.14
Rate for Payer: Ohana Health Plan Medicare	$427.14
Rate for Payer: UnitedHealthcare Medicare	$427.14
Rate for Payer: University Health Alliance Commercial	$741.29

INTERMED LAC FACE 5.1-7.5 ED Charge

Facility

$1,017.00

Service Code	HCPCS 12053
Hospital Charge Code	440120530
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$508.50
Rate for Payer: AlohaCare Medicare	$427.14
Rate for Payer: Cash Price	$661.05
Rate for Payer: Cash Price	$661.05
Rate for Payer: Cash Price	$661.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$935.64
Rate for Payer: Devoted Health Medicare	$427.14
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$427.14
Rate for Payer: Hawaii Western Management Group Commercial	$966.15
Rate for Payer: Health Management Network Commercial	$864.45
Rate for Payer: Humana Medicare	$427.14
Rate for Payer: Kaiser Permanente Commercial	$915.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$427.14
Rate for Payer: MDX Hawaii PPO	$986.49
Rate for Payer: Ohana Health Plan Medicaid	$427.14
Rate for Payer: Ohana Health Plan Medicare	$427.14
Rate for Payer: UnitedHealthcare Medicare	$427.14
Rate for Payer: University Health Alliance Commercial	$741.29

INTERMED LAC FACE 5.1-7.5 ED Charge

Facility

$1,017.00

Service Code	HCPCS 12053
Hospital Charge Code	440120530
Hospital Revenue Code	450
Min. Negotiated Rate	$864.45
Max. Negotiated Rate	$986.49
Rate for Payer: Cash Price	$661.05
Rate for Payer: Health Management Network Commercial	$864.45
Rate for Payer: Kaiser Permanente Commercial	$915.30
Rate for Payer: MDX Hawaii PPO	$986.49

INTERMED LAC FACE 7.6-12 ED Charge

Facility

$1,017.00

Service Code	HCPCS 12054
Hospital Charge Code	440120540
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$508.50
Rate for Payer: AlohaCare Medicare	$427.14
Rate for Payer: Cash Price	$661.05
Rate for Payer: Cash Price	$661.05
Rate for Payer: Cash Price	$661.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$935.64
Rate for Payer: Devoted Health Medicare	$427.14
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$427.14
Rate for Payer: Hawaii Western Management Group Commercial	$966.15
Rate for Payer: Health Management Network Commercial	$864.45
Rate for Payer: Humana Medicare	$427.14
Rate for Payer: Kaiser Permanente Commercial	$915.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$427.14
Rate for Payer: MDX Hawaii PPO	$986.49
Rate for Payer: Ohana Health Plan Medicaid	$427.14
Rate for Payer: Ohana Health Plan Medicare	$427.14
Rate for Payer: UnitedHealthcare Medicare	$427.14
Rate for Payer: University Health Alliance Commercial	$741.29

INTERMED LAC FACE 7.6-12 ED Charge

Facility

$1,017.00

Service Code	HCPCS 12054
Hospital Charge Code	440120540
Hospital Revenue Code	450
Min. Negotiated Rate	$864.45
Max. Negotiated Rate	$986.49
Rate for Payer: Cash Price	$661.05
Rate for Payer: Health Management Network Commercial	$864.45
Rate for Payer: Kaiser Permanente Commercial	$915.30
Rate for Payer: MDX Hawaii PPO	$986.49

INTERMED LAC FACE/NECK 12 ED Charge

Facility

$1,017.00

Service Code	HCPCS 12055
Hospital Charge Code	440120550
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$508.50
Rate for Payer: AlohaCare Medicare	$427.14
Rate for Payer: Cash Price	$661.05
Rate for Payer: Cash Price	$661.05
Rate for Payer: Cash Price	$661.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$935.64
Rate for Payer: Devoted Health Medicare	$427.14
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$427.14
Rate for Payer: Hawaii Western Management Group Commercial	$966.15
Rate for Payer: Health Management Network Commercial	$864.45
Rate for Payer: Humana Medicare	$427.14
Rate for Payer: Kaiser Permanente Commercial	$915.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$427.14
Rate for Payer: MDX Hawaii PPO	$986.49
Rate for Payer: Ohana Health Plan Medicaid	$427.14
Rate for Payer: Ohana Health Plan Medicare	$427.14
Rate for Payer: UnitedHealthcare Medicare	$427.14
Rate for Payer: University Health Alliance Commercial	$741.29

INTERMED LAC FACE/NECK 12 ED Charge

Facility

$1,017.00

Service Code	HCPCS 12055
Hospital Charge Code	440120550
Hospital Revenue Code	450
Min. Negotiated Rate	$864.45
Max. Negotiated Rate	$986.49
Rate for Payer: Cash Price	$661.05
Rate for Payer: Health Management Network Commercial	$864.45
Rate for Payer: Kaiser Permanente Commercial	$915.30
Rate for Payer: MDX Hawaii PPO	$986.49

INTERMED LAC NECK>30CM ED Charge

Facility

$2,091.00

Service Code	HCPCS 12047
Hospital Charge Code	440120470
Hospital Revenue Code	450
Min. Negotiated Rate	$1,777.35
Max. Negotiated Rate	$2,028.27
Rate for Payer: Cash Price	$1,359.15
Rate for Payer: Health Management Network Commercial	$1,777.35
Rate for Payer: Kaiser Permanente Commercial	$1,881.90
Rate for Payer: MDX Hawaii PPO	$2,028.27

INTERMED LAC NECK>30CM ED Charge

Facility

$2,091.00

Service Code	HCPCS 12047
Hospital Charge Code	440120470
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$2,028.27
Rate for Payer: AlohaCare Medicaid	$1,045.50
Rate for Payer: AlohaCare Medicare	$878.22
Rate for Payer: Cash Price	$1,359.15
Rate for Payer: Cash Price	$1,359.15
Rate for Payer: Cash Price	$1,359.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,923.72
Rate for Payer: Devoted Health Medicare	$878.22
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$878.22
Rate for Payer: Hawaii Western Management Group Commercial	$1,986.45
Rate for Payer: Health Management Network Commercial	$1,777.35
Rate for Payer: Humana Medicare	$878.22
Rate for Payer: Kaiser Permanente Commercial	$1,881.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$878.22
Rate for Payer: MDX Hawaii PPO	$2,028.27
Rate for Payer: Ohana Health Plan Medicaid	$878.22
Rate for Payer: Ohana Health Plan Medicare	$878.22
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$878.22
Rate for Payer: University Health Alliance Commercial	$1,524.13

INTERMED LAC SCP/NK 20.1 ED Charge

Facility

$2,091.00

Service Code	HCPCS 12036
Hospital Charge Code	440120360
Hospital Revenue Code	450
Min. Negotiated Rate	$1,777.35
Max. Negotiated Rate	$2,028.27
Rate for Payer: Cash Price	$1,359.15
Rate for Payer: Health Management Network Commercial	$1,777.35
Rate for Payer: Kaiser Permanente Commercial	$1,881.90
Rate for Payer: MDX Hawaii PPO	$2,028.27

INTERMED LAC SCP/NK 20.1 ED Charge

Facility

$2,091.00

Service Code	HCPCS 12036
Hospital Charge Code	440120360
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$2,028.27
Rate for Payer: AlohaCare Medicaid	$1,045.50
Rate for Payer: AlohaCare Medicare	$878.22
Rate for Payer: Cash Price	$1,359.15
Rate for Payer: Cash Price	$1,359.15
Rate for Payer: Cash Price	$1,359.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,923.72
Rate for Payer: Devoted Health Medicare	$878.22
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$878.22
Rate for Payer: Hawaii Western Management Group Commercial	$1,986.45
Rate for Payer: Health Management Network Commercial	$1,777.35
Rate for Payer: Humana Medicare	$878.22
Rate for Payer: Kaiser Permanente Commercial	$1,881.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$878.22
Rate for Payer: MDX Hawaii PPO	$2,028.27
Rate for Payer: Ohana Health Plan Medicaid	$878.22
Rate for Payer: Ohana Health Plan Medicare	$878.22
Rate for Payer: UnitedHealthcare Medicare	$878.22
Rate for Payer: University Health Alliance Commercial	$1,524.13

INTERMED LAC SCP/NK >30CM ED Charge

Facility

$2,091.00

Service Code	HCPCS 12037
Hospital Charge Code	440120370
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$2,028.27
Rate for Payer: AlohaCare Medicaid	$1,045.50
Rate for Payer: AlohaCare Medicare	$878.22
Rate for Payer: Cash Price	$1,359.15
Rate for Payer: Cash Price	$1,359.15
Rate for Payer: Cash Price	$1,359.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,923.72
Rate for Payer: Devoted Health Medicare	$878.22
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$878.22
Rate for Payer: Hawaii Western Management Group Commercial	$1,986.45
Rate for Payer: Health Management Network Commercial	$1,777.35
Rate for Payer: Humana Medicare	$878.22
Rate for Payer: Kaiser Permanente Commercial	$1,881.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$878.22
Rate for Payer: MDX Hawaii PPO	$2,028.27
Rate for Payer: Ohana Health Plan Medicaid	$878.22
Rate for Payer: Ohana Health Plan Medicare	$878.22
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$878.22
Rate for Payer: University Health Alliance Commercial	$1,524.13

INTERMED LAC SCP/NK >30CM ED Charge

Facility

$2,091.00

Service Code	HCPCS 12037
Hospital Charge Code	440120370
Hospital Revenue Code	450
Min. Negotiated Rate	$1,777.35
Max. Negotiated Rate	$2,028.27
Rate for Payer: Cash Price	$1,359.15
Rate for Payer: Health Management Network Commercial	$1,777.35
Rate for Payer: Kaiser Permanente Commercial	$1,881.90
Rate for Payer: MDX Hawaii PPO	$2,028.27

INTERMED LAYER CLOSURE, <2.5CM CHARGE

Facility

$1,017.00

Service Code	HCPCS 12031
Hospital Charge Code	440120310
Hospital Revenue Code	450
Min. Negotiated Rate	$864.45
Max. Negotiated Rate	$986.49
Rate for Payer: Cash Price	$661.05
Rate for Payer: Health Management Network Commercial	$864.45
Rate for Payer: Kaiser Permanente Commercial	$915.30
Rate for Payer: MDX Hawaii PPO	$986.49

INTERMED LAYER CLOSURE, <2.5CM CHARGE

Facility

$1,017.00

Service Code	HCPCS 12031
Hospital Charge Code	440120310
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$508.50
Rate for Payer: AlohaCare Medicare	$427.14
Rate for Payer: Cash Price	$661.05
Rate for Payer: Cash Price	$661.05
Rate for Payer: Cash Price	$661.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$935.64
Rate for Payer: Devoted Health Medicare	$427.14
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$427.14
Rate for Payer: Hawaii Western Management Group Commercial	$966.15
Rate for Payer: Health Management Network Commercial	$864.45
Rate for Payer: Humana Medicare	$427.14
Rate for Payer: Kaiser Permanente Commercial	$915.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$427.14
Rate for Payer: MDX Hawaii PPO	$986.49
Rate for Payer: Ohana Health Plan Medicaid	$427.14
Rate for Payer: Ohana Health Plan Medicare	$427.14
Rate for Payer: UnitedHealthcare Medicare	$427.14
Rate for Payer: University Health Alliance Commercial	$741.29

INTERSTITIAL LUNG DISEASE WITH CC

Facility

$34,391.60

Service Code	MSDRG 197
Min. Negotiated Rate	$34,391.60
Max. Negotiated Rate	$34,391.60
Rate for Payer: Hawaii Medical Service Association Commercial	$34,391.60

INTERSTITIAL LUNG DISEASE WITH MCC

Facility

$34,391.60

Service Code	MSDRG 196
Min. Negotiated Rate	$34,391.60
Max. Negotiated Rate	$34,391.60
Rate for Payer: Hawaii Medical Service Association Commercial	$34,391.60

INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC

Facility

$34,391.60

Service Code	MSDRG 198
Min. Negotiated Rate	$34,391.60
Max. Negotiated Rate	$34,391.60
Rate for Payer: Hawaii Medical Service Association Commercial	$34,391.60

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS

Facility

$34,415.30

Service Code	MSDRG 065
Min. Negotiated Rate	$34,415.30
Max. Negotiated Rate	$34,415.30
Rate for Payer: Hawaii Medical Service Association Commercial	$34,415.30

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC

Facility

$34,415.30

Service Code	MSDRG 064
Min. Negotiated Rate	$34,415.30
Max. Negotiated Rate	$34,415.30
Rate for Payer: Hawaii Medical Service Association Commercial	$34,415.30

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC

Facility

$34,415.30

Service Code	MSDRG 066
Min. Negotiated Rate	$34,415.30
Max. Negotiated Rate	$34,415.30
Rate for Payer: Hawaii Medical Service Association Commercial	$34,415.30

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC

Facility

$245,292.00

Service Code	MSDRG 021
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$245,292.00
Rate for Payer: Hawaii Medical Service Association Commercial	$245,292.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC

Facility

$245,292.00

Service Code	MSDRG 020
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$245,292.00
Rate for Payer: Hawaii Medical Service Association Commercial	$245,292.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC

Facility

$245,292.00

Service Code	MSDRG 022
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$245,292.00
Rate for Payer: Hawaii Medical Service Association Commercial	$245,292.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

Know your out-of-pocket cost for care.

All Charges