Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC

Facility

$50,817.09

Service Code	MSDRG 061
Min. Negotiated Rate	$50,817.09
Max. Negotiated Rate	$50,817.09
Rate for Payer: Hawaii Medical Service Association Commercial	$50,817.09

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC

Facility

$50,817.09

Service Code	MSDRG 063
Min. Negotiated Rate	$50,817.09
Max. Negotiated Rate	$50,817.09
Rate for Payer: Hawaii Medical Service Association Commercial	$50,817.09

Islet Cell Ab Screen Reflex to Titer DLS

Facility

$102.00

Service Code	HCPCS 86341
Hospital Charge Code	422863415
Hospital Revenue Code	300
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$98.94
Rate for Payer: Cash Price	$66.30
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: Kaiser Permanente Commercial	$91.80
Rate for Payer: MDX Hawaii PPO	$98.94

Islet Cell Ab Screen Reflex to Titer DLS

Facility

$102.00

Service Code	HCPCS 86341
Hospital Charge Code	422863415
Hospital Revenue Code	300
Min. Negotiated Rate	$23.57
Max. Negotiated Rate	$98.94
Rate for Payer: AlohaCare Medicaid	$51.00
Rate for Payer: AlohaCare Medicare	$42.84
Rate for Payer: Cash Price	$66.30
Rate for Payer: Cash Price	$66.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$93.84
Rate for Payer: Devoted Health Medicare	$42.84
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$25.15
Rate for Payer: Hawaii Medical Service Association Commercial	$29.46
Rate for Payer: Hawaii Medical Service Association Medicare	$42.84
Rate for Payer: Hawaii Western Management Group Commercial	$23.57
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: Humana Medicare	$42.84
Rate for Payer: Kaiser Permanente Commercial	$91.80
Rate for Payer: Kaiser Permanente Medicaid	$52.02
Rate for Payer: Kaiser Permanente Medicare	$42.84
Rate for Payer: MDX Hawaii PPO	$98.94
Rate for Payer: Ohana Health Plan Medicaid	$42.84
Rate for Payer: Ohana Health Plan Medicare	$42.84
Rate for Payer: UnitedHealthcare Medicaid	$25.15
Rate for Payer: UnitedHealthcare Medicare	$42.84
Rate for Payer: University Health Alliance Commercial	$47.05

isoniazid 300 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00555007102
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

isoniazid 300 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00555007102
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

isopropyl alcohol Top 70% Liq [KMC]

Facility

$0.02

Service Code	NDC 49348003038
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: AlohaCare Medicaid	$0.01
Rate for Payer: AlohaCare Medicare	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.02
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Hawaii Medical Service Association Medicare	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$0.02
Rate for Payer: Health Management Network Commercial	$0.02
Rate for Payer: Humana Medicare	$0.01
Rate for Payer: Kaiser Permanente Commercial	$0.02
Rate for Payer: Kaiser Permanente Medicaid	$0.01
Rate for Payer: Kaiser Permanente Medicare	$0.01
Rate for Payer: MDX Hawaii PPO	$0.02
Rate for Payer: Ohana Health Plan Medicaid	$0.01
Rate for Payer: Ohana Health Plan Medicare	$0.01
Rate for Payer: UnitedHealthcare Medicaid	$0.01
Rate for Payer: UnitedHealthcare Medicare	$0.01
Rate for Payer: University Health Alliance Commercial	$0.01

isopropyl alcohol Top 70% Liq [KMC]

Facility

$0.02

Service Code	NDC 49348003038
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.02
Rate for Payer: Kaiser Permanente Commercial	$0.02
Rate for Payer: MDX Hawaii PPO	$0.02

isosorbide dinitrate 20 mg Tab [KMC]

Facility

$4.77

Service Code	NDC 00781169501
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$4.63
Rate for Payer: AlohaCare Medicaid	$2.38
Rate for Payer: AlohaCare Medicare	$2.00
Rate for Payer: Cash Price	$3.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.39
Rate for Payer: Devoted Health Medicare	$2.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2.00
Rate for Payer: Hawaii Western Management Group Commercial	$4.53
Rate for Payer: Health Management Network Commercial	$4.05
Rate for Payer: Humana Medicare	$2.00
Rate for Payer: Kaiser Permanente Commercial	$4.29
Rate for Payer: Kaiser Permanente Medicaid	$2.43
Rate for Payer: Kaiser Permanente Medicare	$2.00
Rate for Payer: MDX Hawaii PPO	$4.63
Rate for Payer: Ohana Health Plan Medicaid	$2.00
Rate for Payer: Ohana Health Plan Medicare	$2.00
Rate for Payer: UnitedHealthcare Medicaid	$2.86
Rate for Payer: UnitedHealthcare Medicare	$2.00
Rate for Payer: University Health Alliance Commercial	$3.48

isosorbide dinitrate 20 mg Tab [KMC]

Facility

$4.77

Service Code	NDC 00781169501
Hospital Revenue Code	250
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.63
Rate for Payer: Cash Price	$3.10
Rate for Payer: Health Management Network Commercial	$4.05
Rate for Payer: Kaiser Permanente Commercial	$4.29
Rate for Payer: MDX Hawaii PPO	$4.63

isosorbide mononitrate 30 mg ER [KMC]

Facility

$13.41

Service Code	NDC 59651053901
Hospital Revenue Code	250
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$13.01
Rate for Payer: Cash Price	$8.72
Rate for Payer: Health Management Network Commercial	$11.40
Rate for Payer: Kaiser Permanente Commercial	$12.07
Rate for Payer: MDX Hawaii PPO	$13.01

isosorbide mononitrate 30 mg ER [KMC]

Facility

$13.41

Service Code	NDC 59651053901
Hospital Revenue Code	250
Min. Negotiated Rate	$5.63
Max. Negotiated Rate	$13.01
Rate for Payer: AlohaCare Medicaid	$6.71
Rate for Payer: AlohaCare Medicare	$5.63
Rate for Payer: Cash Price	$8.72
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$12.34
Rate for Payer: Devoted Health Medicare	$5.63
Rate for Payer: Hawaii Medical Service Association Medicare	$5.63
Rate for Payer: Hawaii Western Management Group Commercial	$12.74
Rate for Payer: Health Management Network Commercial	$11.40
Rate for Payer: Humana Medicare	$5.63
Rate for Payer: Kaiser Permanente Commercial	$12.07
Rate for Payer: Kaiser Permanente Medicaid	$6.84
Rate for Payer: Kaiser Permanente Medicare	$5.63
Rate for Payer: MDX Hawaii PPO	$13.01
Rate for Payer: Ohana Health Plan Medicaid	$5.63
Rate for Payer: Ohana Health Plan Medicare	$5.63
Rate for Payer: UnitedHealthcare Medicaid	$8.05
Rate for Payer: UnitedHealthcare Medicare	$5.63
Rate for Payer: University Health Alliance Commercial	$9.77

isosorbide mononitrate 60 mg ER [KMC]

Facility

$17.10

Service Code	NDC 13668010501
Hospital Revenue Code	250
Min. Negotiated Rate	$14.54
Max. Negotiated Rate	$16.59
Rate for Payer: Cash Price	$11.12
Rate for Payer: Health Management Network Commercial	$14.54
Rate for Payer: Kaiser Permanente Commercial	$15.39
Rate for Payer: MDX Hawaii PPO	$16.59

isosorbide mononitrate 60 mg ER [KMC]

Facility

$17.10

Service Code	NDC 13668010501
Hospital Revenue Code	250
Min. Negotiated Rate	$7.18
Max. Negotiated Rate	$16.59
Rate for Payer: AlohaCare Medicaid	$8.55
Rate for Payer: AlohaCare Medicare	$7.18
Rate for Payer: Cash Price	$11.12
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$15.73
Rate for Payer: Devoted Health Medicare	$7.18
Rate for Payer: Hawaii Medical Service Association Medicare	$7.18
Rate for Payer: Hawaii Western Management Group Commercial	$16.25
Rate for Payer: Health Management Network Commercial	$14.54
Rate for Payer: Humana Medicare	$7.18
Rate for Payer: Kaiser Permanente Commercial	$15.39
Rate for Payer: Kaiser Permanente Medicaid	$8.72
Rate for Payer: Kaiser Permanente Medicare	$7.18
Rate for Payer: MDX Hawaii PPO	$16.59
Rate for Payer: Ohana Health Plan Medicaid	$7.18
Rate for Payer: Ohana Health Plan Medicare	$7.18
Rate for Payer: UnitedHealthcare Medicaid	$10.26
Rate for Payer: UnitedHealthcare Medicare	$7.18
Rate for Payer: University Health Alliance Commercial	$12.46

IV INFUS HYDRATE EA ADDL HR

Facility

$144.00

Service Code	HCPCS 96361
Hospital Charge Code	317963610
Hospital Revenue Code	260
Min. Negotiated Rate	$10.81
Max. Negotiated Rate	$139.68
Rate for Payer: AlohaCare Medicaid	$72.00
Rate for Payer: AlohaCare Medicare	$60.48
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$132.48
Rate for Payer: Devoted Health Medicare	$60.48
Rate for Payer: Hawaii Medical Service Association Commercial	$69.15
Rate for Payer: Hawaii Medical Service Association Medicare	$60.48
Rate for Payer: Hawaii Western Management Group Commercial	$136.80
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Humana Medicare	$60.48
Rate for Payer: Kaiser Permanente Commercial	$129.60
Rate for Payer: Kaiser Permanente Medicaid	$73.44
Rate for Payer: Kaiser Permanente Medicare	$60.48
Rate for Payer: MDX Hawaii PPO	$139.68
Rate for Payer: Ohana Health Plan Medicaid	$60.48
Rate for Payer: Ohana Health Plan Medicare	$60.48
Rate for Payer: UnitedHealthcare Medicaid	$10.81
Rate for Payer: UnitedHealthcare Medicare	$60.48
Rate for Payer: University Health Alliance Commercial	$104.96

IV INFUS HYDRATE EA ADDL HR

Facility

$144.00

Service Code	HCPCS 96361
Hospital Charge Code	317963610
Hospital Revenue Code	260
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$139.68
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Kaiser Permanente Commercial	$129.60
Rate for Payer: MDX Hawaii PPO	$139.68

IV PRIMARY

Facility

$116.00

Hospital Charge Code	8152
Hospital Revenue Code	270
Min. Negotiated Rate	$98.60
Max. Negotiated Rate	$112.52
Rate for Payer: Cash Price	$75.40
Rate for Payer: Health Management Network Commercial	$98.60
Rate for Payer: Kaiser Permanente Commercial	$104.40
Rate for Payer: MDX Hawaii PPO	$112.52

IV PRIMARY

Facility

$116.00

Hospital Charge Code	8152
Hospital Revenue Code	270
Min. Negotiated Rate	$48.72
Max. Negotiated Rate	$112.52
Rate for Payer: AlohaCare Medicaid	$58.00
Rate for Payer: AlohaCare Medicare	$48.72
Rate for Payer: Cash Price	$75.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$106.72
Rate for Payer: Devoted Health Medicare	$48.72
Rate for Payer: Hawaii Medical Service Association Medicare	$48.72
Rate for Payer: Hawaii Western Management Group Commercial	$110.20
Rate for Payer: Health Management Network Commercial	$98.60
Rate for Payer: Humana Medicare	$48.72
Rate for Payer: Kaiser Permanente Commercial	$104.40
Rate for Payer: Kaiser Permanente Medicaid	$59.16
Rate for Payer: Kaiser Permanente Medicare	$48.72
Rate for Payer: MDX Hawaii PPO	$112.52
Rate for Payer: Ohana Health Plan Medicaid	$48.72
Rate for Payer: Ohana Health Plan Medicare	$48.72
Rate for Payer: UnitedHealthcare Medicare	$48.72
Rate for Payer: University Health Alliance Commercial	$84.55

IV SECONDARY

Facility

$97.00

Hospital Charge Code	8153
Hospital Revenue Code	270
Min. Negotiated Rate	$82.45
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$63.05
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Kaiser Permanente Commercial	$87.30
Rate for Payer: MDX Hawaii PPO	$94.09

IV SECONDARY

Facility

$97.00

Hospital Charge Code	8153
Hospital Revenue Code	270
Min. Negotiated Rate	$40.74
Max. Negotiated Rate	$94.09
Rate for Payer: AlohaCare Medicaid	$48.50
Rate for Payer: AlohaCare Medicare	$40.74
Rate for Payer: Cash Price	$63.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$89.24
Rate for Payer: Devoted Health Medicare	$40.74
Rate for Payer: Hawaii Medical Service Association Medicare	$40.74
Rate for Payer: Hawaii Western Management Group Commercial	$92.15
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Humana Medicare	$40.74
Rate for Payer: Kaiser Permanente Commercial	$87.30
Rate for Payer: Kaiser Permanente Medicaid	$49.47
Rate for Payer: Kaiser Permanente Medicare	$40.74
Rate for Payer: MDX Hawaii PPO	$94.09
Rate for Payer: Ohana Health Plan Medicaid	$40.74
Rate for Payer: Ohana Health Plan Medicare	$40.74
Rate for Payer: UnitedHealthcare Medicare	$40.74
Rate for Payer: University Health Alliance Commercial	$70.70

IV START KIT

Facility

$51.00

Hospital Charge Code	8154
Hospital Revenue Code	270
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$49.47
Rate for Payer: Cash Price	$33.15
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: MDX Hawaii PPO	$49.47

IV START KIT

Facility

$51.00

Hospital Charge Code	8154
Hospital Revenue Code	270
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$49.47
Rate for Payer: AlohaCare Medicaid	$25.50
Rate for Payer: AlohaCare Medicare	$21.42
Rate for Payer: Cash Price	$33.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$46.92
Rate for Payer: Devoted Health Medicare	$21.42
Rate for Payer: Hawaii Medical Service Association Medicare	$21.42
Rate for Payer: Hawaii Western Management Group Commercial	$48.45
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Humana Medicare	$21.42
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: Kaiser Permanente Medicaid	$26.01
Rate for Payer: Kaiser Permanente Medicare	$21.42
Rate for Payer: MDX Hawaii PPO	$49.47
Rate for Payer: Ohana Health Plan Medicaid	$21.42
Rate for Payer: Ohana Health Plan Medicare	$21.42
Rate for Payer: UnitedHealthcare Medicare	$21.42
Rate for Payer: University Health Alliance Commercial	$37.17

IV START KIT MACROBORE

Facility

$53.00

Hospital Charge Code	8155
Hospital Revenue Code	270
Min. Negotiated Rate	$45.05
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$34.45
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Kaiser Permanente Commercial	$47.70
Rate for Payer: MDX Hawaii PPO	$51.41

IV START KIT MACROBORE

Facility

$53.00

Hospital Charge Code	8155
Hospital Revenue Code	270
Min. Negotiated Rate	$22.26
Max. Negotiated Rate	$51.41
Rate for Payer: AlohaCare Medicaid	$26.50
Rate for Payer: AlohaCare Medicare	$22.26
Rate for Payer: Cash Price	$34.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$48.76
Rate for Payer: Devoted Health Medicare	$22.26
Rate for Payer: Hawaii Medical Service Association Medicare	$22.26
Rate for Payer: Hawaii Western Management Group Commercial	$50.35
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Humana Medicare	$22.26
Rate for Payer: Kaiser Permanente Commercial	$47.70
Rate for Payer: Kaiser Permanente Medicaid	$27.03
Rate for Payer: Kaiser Permanente Medicare	$22.26
Rate for Payer: MDX Hawaii PPO	$51.41
Rate for Payer: Ohana Health Plan Medicaid	$22.26
Rate for Payer: Ohana Health Plan Medicare	$22.26
Rate for Payer: UnitedHealthcare Medicare	$22.26
Rate for Payer: University Health Alliance Commercial	$38.63

Jak2, V617F Mutation, Qual W/R DLS

Facility

$716.00

Service Code	HCPCS 81270
Hospital Charge Code	422812705
Hospital Revenue Code	300
Min. Negotiated Rate	$608.60
Max. Negotiated Rate	$694.52
Rate for Payer: Cash Price	$465.40
Rate for Payer: Health Management Network Commercial	$608.60
Rate for Payer: Kaiser Permanente Commercial	$644.40
Rate for Payer: MDX Hawaii PPO	$694.52

Know your out-of-pocket cost for care.

All Charges