Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

INTRANSAL MUCOSAL ATOMIZATION DEVICE W/OUT SYRINGE

Facility

$4.00

Hospital Charge Code	8149
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

INTRANSAL MUCOSAL ATOMIZATION DEVICE W/OUT SYRINGE

Facility

$4.00

Hospital Charge Code	8149
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

INTRAOCULAR PROCEDURES WITH CC/MCC

Facility

$18,511.26

Service Code	MSDRG 116
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$18,511.26
Rate for Payer: Hawaii Medical Service Association Commercial	$18,511.26
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRAOCULAR PROCEDURES WITHOUT CC/MCC

Facility

$18,345.35

Service Code	MSDRG 117
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$18,345.35
Rate for Payer: Hawaii Medical Service Association Commercial	$18,345.35
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRAOSSEOUS INFUSION Charge

Facility

$275.00

Service Code	HCPCS 36680
Hospital Charge Code	440366800
Hospital Revenue Code	450
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$137.50
Rate for Payer: AlohaCare Medicare	$115.50
Rate for Payer: Cash Price	$178.75
Rate for Payer: Cash Price	$178.75
Rate for Payer: Cash Price	$178.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$253.00
Rate for Payer: Devoted Health Medicare	$115.50
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	$115.50
Rate for Payer: Hawaii Western Management Group Commercial	$261.25
Rate for Payer: Health Management Network Commercial	$233.75
Rate for Payer: Humana Medicare	$115.50
Rate for Payer: Kaiser Permanente Commercial	$247.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$115.50
Rate for Payer: MDX Hawaii PPO	$266.75
Rate for Payer: Ohana Health Plan Medicaid	$115.50
Rate for Payer: Ohana Health Plan Medicare	$115.50
Rate for Payer: UnitedHealthcare Medicare	$115.50
Rate for Payer: University Health Alliance Commercial	$200.45

INTRAOSSEOUS INFUSION Charge

Facility

$275.00

Service Code	HCPCS 36680
Hospital Charge Code	440366800
Hospital Revenue Code	450
Min. Negotiated Rate	$233.75
Max. Negotiated Rate	$266.75
Rate for Payer: Cash Price	$178.75
Rate for Payer: Health Management Network Commercial	$233.75
Rate for Payer: Kaiser Permanente Commercial	$247.50
Rate for Payer: MDX Hawaii PPO	$266.75

INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE

Professional

Both

$803.00

Service Code	HCPCS 31500
Hospital Revenue Code	361
Min. Negotiated Rate	$119.08
Max. Negotiated Rate	$682.55
Rate for Payer: AlohaCare Medicaid	$136.20
Rate for Payer: AlohaCare Medicare	$128.79
Rate for Payer: Cash Price	$521.95
Rate for Payer: Cash Price	$521.95
Rate for Payer: Devoted Health Medicare	$128.79
Rate for Payer: Hawaii Medical Service Association Medicare	$128.79
Rate for Payer: Hawaii Western Management Group Commercial	$119.08
Rate for Payer: Health Management Network Commercial	$682.55
Rate for Payer: Kaiser Permanente Commercial	$154.55
Rate for Payer: Kaiser Permanente Medicaid	$154.55
Rate for Payer: Kaiser Permanente Medicare	$154.55
Rate for Payer: Ohana Health Plan Medicaid	$136.20
Rate for Payer: Ohana Health Plan Medicare	$128.79
Rate for Payer: UnitedHealthcare Medicaid	$136.20
Rate for Payer: UnitedHealthcare Medicare	$128.79

INTUBATION Respiratory Therapy Charges

Facility

$843.00

Service Code	HCPCS 31500
Hospital Charge Code	361315000
Hospital Revenue Code	361
Min. Negotiated Rate	$93.64
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$421.50
Rate for Payer: AlohaCare Medicare	$354.06
Rate for Payer: Cash Price	$547.95
Rate for Payer: Cash Price	$547.95
Rate for Payer: Cash Price	$547.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$775.56
Rate for Payer: Devoted Health Medicare	$354.06
Rate for Payer: Hawaii Medical Service Association Commercial	$349.75
Rate for Payer: Hawaii Medical Service Association Medicare	$354.06
Rate for Payer: Health Management Network Commercial	$716.55
Rate for Payer: Humana Medicare	$354.06
Rate for Payer: Kaiser Permanente Commercial	$758.70
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$354.06
Rate for Payer: MDX Hawaii PPO	$817.71
Rate for Payer: Ohana Health Plan Medicaid	$354.06
Rate for Payer: Ohana Health Plan Medicare	$354.06
Rate for Payer: UnitedHealthcare Medicaid	$93.64
Rate for Payer: UnitedHealthcare Medicare	$354.06
Rate for Payer: University Health Alliance Commercial	$4,035.20

INTUBATION Respiratory Therapy Charges

Facility

$843.00

Service Code	HCPCS 31500
Hospital Charge Code	361315000
Hospital Revenue Code	361
Min. Negotiated Rate	$716.55
Max. Negotiated Rate	$817.71
Rate for Payer: Cash Price	$547.95
Rate for Payer: Health Management Network Commercial	$716.55
Rate for Payer: Kaiser Permanente Commercial	$758.70
Rate for Payer: MDX Hawaii PPO	$817.71

INTUBATION STYLET 2.5MM-4.5MM

Facility

$79.00

Hospital Charge Code	8464
Hospital Revenue Code	270
Min. Negotiated Rate	$67.15
Max. Negotiated Rate	$76.63
Rate for Payer: Cash Price	$51.35
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Kaiser Permanente Commercial	$71.10
Rate for Payer: MDX Hawaii PPO	$76.63

INTUBATION STYLET 2.5MM-4.5MM

Facility

$79.00

Hospital Charge Code	8464
Hospital Revenue Code	270
Min. Negotiated Rate	$33.18
Max. Negotiated Rate	$76.63
Rate for Payer: AlohaCare Medicaid	$39.50
Rate for Payer: AlohaCare Medicare	$33.18
Rate for Payer: Cash Price	$51.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$72.68
Rate for Payer: Devoted Health Medicare	$33.18
Rate for Payer: Hawaii Medical Service Association Medicare	$33.18
Rate for Payer: Hawaii Western Management Group Commercial	$75.05
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Humana Medicare	$33.18
Rate for Payer: Kaiser Permanente Commercial	$71.10
Rate for Payer: Kaiser Permanente Medicaid	$40.29
Rate for Payer: Kaiser Permanente Medicare	$33.18
Rate for Payer: MDX Hawaii PPO	$76.63
Rate for Payer: Ohana Health Plan Medicaid	$33.18
Rate for Payer: Ohana Health Plan Medicare	$33.18
Rate for Payer: UnitedHealthcare Medicare	$33.18
Rate for Payer: University Health Alliance Commercial	$57.58

INTUBATION STYLET 5.0MM-7.0MM

Facility

$66.00

Hospital Charge Code	8465
Hospital Revenue Code	270
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$64.02
Rate for Payer: AlohaCare Medicaid	$33.00
Rate for Payer: AlohaCare Medicare	$27.72
Rate for Payer: Cash Price	$42.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$60.72
Rate for Payer: Devoted Health Medicare	$27.72
Rate for Payer: Hawaii Medical Service Association Medicare	$27.72
Rate for Payer: Hawaii Western Management Group Commercial	$62.70
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Humana Medicare	$27.72
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: Kaiser Permanente Medicare	$27.72
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: Ohana Health Plan Medicaid	$27.72
Rate for Payer: Ohana Health Plan Medicare	$27.72
Rate for Payer: UnitedHealthcare Medicare	$27.72
Rate for Payer: University Health Alliance Commercial	$48.11

INTUBATION STYLET 5.0MM-7.0MM

Facility

$66.00

Hospital Charge Code	8465
Hospital Revenue Code	270
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$42.90
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: MDX Hawaii PPO	$64.02

INTUBATION STYLET 7.5MM-10.0MM

Facility

$66.00

Hospital Charge Code	8466
Hospital Revenue Code	270
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$64.02
Rate for Payer: AlohaCare Medicaid	$33.00
Rate for Payer: AlohaCare Medicare	$27.72
Rate for Payer: Cash Price	$42.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$60.72
Rate for Payer: Devoted Health Medicare	$27.72
Rate for Payer: Hawaii Medical Service Association Medicare	$27.72
Rate for Payer: Hawaii Western Management Group Commercial	$62.70
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Humana Medicare	$27.72
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: Kaiser Permanente Medicare	$27.72
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: Ohana Health Plan Medicaid	$27.72
Rate for Payer: Ohana Health Plan Medicare	$27.72
Rate for Payer: UnitedHealthcare Medicare	$27.72
Rate for Payer: University Health Alliance Commercial	$48.11

INTUBATION STYLET 7.5MM-10.0MM

Facility

$66.00

Hospital Charge Code	8466
Hospital Revenue Code	270
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$42.90
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: MDX Hawaii PPO	$64.02

Iodine, Serum/Plasma DLS

Facility

$103.00

Service Code	HCPCS 82542
Hospital Charge Code	422825425
Hospital Revenue Code	300
Min. Negotiated Rate	$24.09
Max. Negotiated Rate	$99.91
Rate for Payer: AlohaCare Medicaid	$51.50
Rate for Payer: AlohaCare Medicare	$43.26
Rate for Payer: Cash Price	$66.95
Rate for Payer: Cash Price	$66.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$94.76
Rate for Payer: Devoted Health Medicare	$43.26
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$24.96
Rate for Payer: Hawaii Medical Service Association Commercial	$30.11
Rate for Payer: Hawaii Medical Service Association Medicare	$43.26
Rate for Payer: Hawaii Western Management Group Commercial	$24.09
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Humana Medicare	$43.26
Rate for Payer: Kaiser Permanente Commercial	$92.70
Rate for Payer: Kaiser Permanente Medicaid	$52.53
Rate for Payer: Kaiser Permanente Medicare	$43.26
Rate for Payer: MDX Hawaii PPO	$99.91
Rate for Payer: Ohana Health Plan Medicaid	$43.26
Rate for Payer: Ohana Health Plan Medicare	$43.26
Rate for Payer: UnitedHealthcare Medicaid	$24.96
Rate for Payer: UnitedHealthcare Medicare	$43.26
Rate for Payer: University Health Alliance Commercial	$46.68

Iodine, Serum/Plasma DLS

Facility

$103.00

Service Code	HCPCS 82542
Hospital Charge Code	422825425
Hospital Revenue Code	300
Min. Negotiated Rate	$87.55
Max. Negotiated Rate	$99.91
Rate for Payer: Cash Price	$66.95
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Kaiser Permanente Commercial	$92.70
Rate for Payer: MDX Hawaii PPO	$99.91

iohexol 240 mg/mL Soln [KMC]

Facility

$12.87

Service Code	HCPCS Q9966
Hospital Revenue Code	637
Min. Negotiated Rate	$10.94
Max. Negotiated Rate	$12.48
Rate for Payer: Cash Price	$8.37
Rate for Payer: Health Management Network Commercial	$10.94
Rate for Payer: Kaiser Permanente Commercial	$11.58
Rate for Payer: MDX Hawaii PPO	$12.48

iohexol 240 mg/mL Soln [KMC]

Facility

$12.87

Service Code	HCPCS Q9966
Hospital Revenue Code	637
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$12.48
Rate for Payer: AlohaCare Medicaid	$6.43
Rate for Payer: AlohaCare Medicare	$5.41
Rate for Payer: Cash Price	$8.37
Rate for Payer: Cash Price	$8.37
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$11.84
Rate for Payer: Devoted Health Medicare	$5.41
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.45
Rate for Payer: Hawaii Medical Service Association Medicare	$5.41
Rate for Payer: Hawaii Western Management Group Commercial	$12.23
Rate for Payer: Health Management Network Commercial	$10.94
Rate for Payer: Humana Medicare	$5.41
Rate for Payer: Kaiser Permanente Commercial	$11.58
Rate for Payer: Kaiser Permanente Medicaid	$6.56
Rate for Payer: Kaiser Permanente Medicare	$5.41
Rate for Payer: MDX Hawaii PPO	$12.48
Rate for Payer: Ohana Health Plan Medicaid	$5.41
Rate for Payer: Ohana Health Plan Medicare	$5.41
Rate for Payer: UnitedHealthcare Medicaid	$1.14
Rate for Payer: UnitedHealthcare Medicare	$5.41
Rate for Payer: University Health Alliance Commercial	$9.38

iohexol 300 mg/mL Soln [KMC]

Facility

$4.32

Service Code	HCPCS Q9967
Hospital Revenue Code	637
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$4.19
Rate for Payer: AlohaCare Medicaid	$2.16
Rate for Payer: AlohaCare Medicare	$1.81
Rate for Payer: Cash Price	$2.81
Rate for Payer: Cash Price	$2.81
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3.97
Rate for Payer: Devoted Health Medicare	$1.81
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.15
Rate for Payer: Hawaii Medical Service Association Medicare	$1.81
Rate for Payer: Hawaii Western Management Group Commercial	$4.10
Rate for Payer: Health Management Network Commercial	$3.67
Rate for Payer: Humana Medicare	$1.81
Rate for Payer: Kaiser Permanente Commercial	$3.89
Rate for Payer: Kaiser Permanente Medicaid	$2.20
Rate for Payer: Kaiser Permanente Medicare	$1.81
Rate for Payer: MDX Hawaii PPO	$4.19
Rate for Payer: Ohana Health Plan Medicaid	$1.81
Rate for Payer: Ohana Health Plan Medicare	$1.81
Rate for Payer: UnitedHealthcare Medicaid	$0.30
Rate for Payer: UnitedHealthcare Medicare	$1.81
Rate for Payer: University Health Alliance Commercial	$3.15

iohexol 300 mg/mL Soln [KMC]

Facility

$4.32

Service Code	HCPCS Q9967
Hospital Revenue Code	637
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$4.19
Rate for Payer: Cash Price	$2.81
Rate for Payer: Health Management Network Commercial	$3.67
Rate for Payer: Kaiser Permanente Commercial	$3.89
Rate for Payer: MDX Hawaii PPO	$4.19

iohexol 350 mg/mL Soln [KMC]

Facility

$4.83

Service Code	HCPCS Q9967
Hospital Revenue Code	637
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$4.69
Rate for Payer: AlohaCare Medicaid	$2.42
Rate for Payer: AlohaCare Medicare	$2.03
Rate for Payer: Cash Price	$3.14
Rate for Payer: Cash Price	$3.14
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.44
Rate for Payer: Devoted Health Medicare	$2.03
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.15
Rate for Payer: Hawaii Medical Service Association Medicare	$2.03
Rate for Payer: Hawaii Western Management Group Commercial	$4.59
Rate for Payer: Health Management Network Commercial	$4.11
Rate for Payer: Humana Medicare	$2.03
Rate for Payer: Kaiser Permanente Commercial	$4.35
Rate for Payer: Kaiser Permanente Medicaid	$2.46
Rate for Payer: Kaiser Permanente Medicare	$2.03
Rate for Payer: MDX Hawaii PPO	$4.69
Rate for Payer: Ohana Health Plan Medicaid	$2.03
Rate for Payer: Ohana Health Plan Medicare	$2.03
Rate for Payer: UnitedHealthcare Medicaid	$0.30
Rate for Payer: UnitedHealthcare Medicare	$2.03
Rate for Payer: University Health Alliance Commercial	$3.52

iohexol 350 mg/mL Soln [KMC]

Facility

$4.83

Service Code	HCPCS Q9967
Hospital Revenue Code	637
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$4.69
Rate for Payer: Cash Price	$3.14
Rate for Payer: Health Management Network Commercial	$4.11
Rate for Payer: Kaiser Permanente Commercial	$4.35
Rate for Payer: MDX Hawaii PPO	$4.69

Ionized Calcium Level

Facility

$46.00

Service Code	HCPCS 82330
Hospital Charge Code	422823305
Hospital Revenue Code	300
Min. Negotiated Rate	$39.10
Max. Negotiated Rate	$44.62
Rate for Payer: Cash Price	$29.90
Rate for Payer: Health Management Network Commercial	$39.10
Rate for Payer: Kaiser Permanente Commercial	$41.40
Rate for Payer: MDX Hawaii PPO	$44.62

Ionized Calcium Level

Facility

$46.00

Service Code	HCPCS 82330
Hospital Charge Code	422823305
Hospital Revenue Code	300
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$44.62
Rate for Payer: AlohaCare Medicaid	$23.00
Rate for Payer: AlohaCare Medicare	$19.32
Rate for Payer: Cash Price	$29.90
Rate for Payer: Cash Price	$29.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$42.32
Rate for Payer: Devoted Health Medicare	$19.32
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.88
Rate for Payer: Hawaii Medical Service Association Commercial	$17.10
Rate for Payer: Hawaii Medical Service Association Medicare	$19.32
Rate for Payer: Hawaii Western Management Group Commercial	$13.68
Rate for Payer: Health Management Network Commercial	$39.10
Rate for Payer: Humana Medicare	$19.32
Rate for Payer: Kaiser Permanente Commercial	$41.40
Rate for Payer: Kaiser Permanente Medicaid	$23.46
Rate for Payer: Kaiser Permanente Medicare	$19.32
Rate for Payer: MDX Hawaii PPO	$44.62
Rate for Payer: Ohana Health Plan Medicaid	$19.32
Rate for Payer: Ohana Health Plan Medicare	$19.32
Rate for Payer: UnitedHealthcare Medicaid	$18.88
Rate for Payer: UnitedHealthcare Medicare	$19.32
Rate for Payer: University Health Alliance Commercial	$35.32

Know your out-of-pocket cost for care.

All Charges