Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

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	$49.73
Max. Negotiated Rate	$694.52
Rate for Payer: AlohaCare Medicaid	$358.00
Rate for Payer: AlohaCare Medicare	$300.72
Rate for Payer: Cash Price	$465.40
Rate for Payer: Cash Price	$465.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$658.72
Rate for Payer: Devoted Health Medicare	$300.72
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$122.70
Rate for Payer: Hawaii Medical Service Association Commercial	$114.58
Rate for Payer: Hawaii Medical Service Association Medicare	$300.72
Rate for Payer: Hawaii Western Management Group Commercial	$91.66
Rate for Payer: Health Management Network Commercial	$608.60
Rate for Payer: Humana Medicare	$300.72
Rate for Payer: Kaiser Permanente Commercial	$644.40
Rate for Payer: Kaiser Permanente Medicaid	$365.16
Rate for Payer: Kaiser Permanente Medicare	$300.72
Rate for Payer: MDX Hawaii PPO	$694.52
Rate for Payer: Ohana Health Plan Medicaid	$300.72
Rate for Payer: Ohana Health Plan Medicare	$300.72
Rate for Payer: UnitedHealthcare Medicaid	$49.73
Rate for Payer: UnitedHealthcare Medicare	$300.72
Rate for Payer: University Health Alliance Commercial	$230.79

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	$49.73
Max. Negotiated Rate	$694.52
Rate for Payer: AlohaCare Medicaid	$358.00
Rate for Payer: AlohaCare Medicare	$300.72
Rate for Payer: Cash Price	$465.40
Rate for Payer: Cash Price	$465.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$658.72
Rate for Payer: Devoted Health Medicare	$300.72
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$122.70
Rate for Payer: Hawaii Medical Service Association Commercial	$114.58
Rate for Payer: Hawaii Medical Service Association Medicare	$300.72
Rate for Payer: Hawaii Western Management Group Commercial	$91.66
Rate for Payer: Health Management Network Commercial	$608.60
Rate for Payer: Humana Medicare	$300.72
Rate for Payer: Kaiser Permanente Commercial	$644.40
Rate for Payer: Kaiser Permanente Medicaid	$365.16
Rate for Payer: Kaiser Permanente Medicare	$300.72
Rate for Payer: MDX Hawaii PPO	$694.52
Rate for Payer: Ohana Health Plan Medicaid	$300.72
Rate for Payer: Ohana Health Plan Medicare	$300.72
Rate for Payer: UnitedHealthcare Medicaid	$49.73
Rate for Payer: UnitedHealthcare Medicare	$300.72
Rate for Payer: University Health Alliance Commercial	$230.79

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

JOINT SURVEY SGL 2 PLUS JNTS

Facility

$369.00

Service Code	HCPCS 77077
Hospital Charge Code	424770770
Hospital Revenue Code	320
Min. Negotiated Rate	$313.65
Max. Negotiated Rate	$357.93
Rate for Payer: Cash Price	$239.85
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: MDX Hawaii PPO	$357.93

JOINT SURVEY SGL 2 PLUS JNTS

Facility

$369.00

Service Code	HCPCS 77077
Hospital Charge Code	424770770
Hospital Revenue Code	320
Min. Negotiated Rate	$29.89
Max. Negotiated Rate	$357.93
Rate for Payer: AlohaCare Medicaid	$184.50
Rate for Payer: AlohaCare Medicare	$154.98
Rate for Payer: Cash Price	$239.85
Rate for Payer: Cash Price	$239.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$339.48
Rate for Payer: Devoted Health Medicare	$154.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$29.89
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$154.98
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Humana Medicare	$154.98
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: Kaiser Permanente Medicaid	$188.19
Rate for Payer: Kaiser Permanente Medicare	$154.98
Rate for Payer: MDX Hawaii PPO	$357.93
Rate for Payer: Ohana Health Plan Medicaid	$154.98
Rate for Payer: Ohana Health Plan Medicare	$154.98
Rate for Payer: UnitedHealthcare Medicaid	$29.89
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$97.64

Juven 1 packet [KMC]

Facility

$12.16

Service Code	NDC 59781022550
Hospital Revenue Code	250
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$11.80
Rate for Payer: Cash Price	$7.90
Rate for Payer: Health Management Network Commercial	$10.34
Rate for Payer: Kaiser Permanente Commercial	$10.94
Rate for Payer: MDX Hawaii PPO	$11.80

Juven 1 packet [KMC]

Facility

$12.16

Service Code	NDC 59781022550
Hospital Revenue Code	250
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$11.80
Rate for Payer: AlohaCare Medicaid	$6.08
Rate for Payer: AlohaCare Medicare	$5.11
Rate for Payer: Cash Price	$7.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$11.19
Rate for Payer: Devoted Health Medicare	$5.11
Rate for Payer: Hawaii Medical Service Association Medicare	$5.11
Rate for Payer: Hawaii Western Management Group Commercial	$11.55
Rate for Payer: Health Management Network Commercial	$10.34
Rate for Payer: Humana Medicare	$5.11
Rate for Payer: Kaiser Permanente Commercial	$10.94
Rate for Payer: Kaiser Permanente Medicaid	$6.20
Rate for Payer: Kaiser Permanente Medicare	$5.11
Rate for Payer: MDX Hawaii PPO	$11.80
Rate for Payer: Ohana Health Plan Medicaid	$5.11
Rate for Payer: Ohana Health Plan Medicare	$5.11
Rate for Payer: UnitedHealthcare Medicaid	$7.30
Rate for Payer: UnitedHealthcare Medicare	$5.11
Rate for Payer: University Health Alliance Commercial	$8.86

Kappa and Lambda Light Chains Free DLS

Facility

$205.00

Service Code	HCPCS 83883
Hospital Charge Code	422838835
Hospital Revenue Code	300
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$198.85
Rate for Payer: AlohaCare Medicaid	$102.50
Rate for Payer: AlohaCare Medicare	$86.10
Rate for Payer: Cash Price	$133.25
Rate for Payer: Cash Price	$133.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$188.60
Rate for Payer: Devoted Health Medicare	$86.10
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.79
Rate for Payer: Hawaii Medical Service Association Commercial	$17.00
Rate for Payer: Hawaii Medical Service Association Medicare	$86.10
Rate for Payer: Hawaii Western Management Group Commercial	$13.60
Rate for Payer: Health Management Network Commercial	$174.25
Rate for Payer: Humana Medicare	$86.10
Rate for Payer: Kaiser Permanente Commercial	$184.50
Rate for Payer: Kaiser Permanente Medicaid	$104.55
Rate for Payer: Kaiser Permanente Medicare	$86.10
Rate for Payer: MDX Hawaii PPO	$198.85
Rate for Payer: Ohana Health Plan Medicaid	$86.10
Rate for Payer: Ohana Health Plan Medicare	$86.10
Rate for Payer: UnitedHealthcare Medicaid	$18.79
Rate for Payer: UnitedHealthcare Medicare	$86.10
Rate for Payer: University Health Alliance Commercial	$35.15

Kappa and Lambda Light Chains Free DLS

Facility

$205.00

Service Code	HCPCS 83883
Hospital Charge Code	422838835
Hospital Revenue Code	300
Min. Negotiated Rate	$174.25
Max. Negotiated Rate	$198.85
Rate for Payer: Cash Price	$133.25
Rate for Payer: Health Management Network Commercial	$174.25
Rate for Payer: Kaiser Permanente Commercial	$184.50
Rate for Payer: MDX Hawaii PPO	$198.85

KATZ EXTRACTOR

Facility

$6.00

Hospital Charge Code	8156
Hospital Revenue Code	270
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$2.52
Rate for Payer: Cash Price	$3.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.52
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.52
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$2.52
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$2.52
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$2.52
Rate for Payer: Ohana Health Plan Medicare	$2.52
Rate for Payer: UnitedHealthcare Medicare	$2.52
Rate for Payer: University Health Alliance Commercial	$4.37

KATZ EXTRACTOR

Facility

$6.00

Hospital Charge Code	8156
Hospital Revenue Code	270
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.90
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

KELLY FORCEPS CURVED 5.5"

Facility

$13.00

Hospital Charge Code	8569
Hospital Revenue Code	270
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$12.61
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$5.46
Rate for Payer: Cash Price	$8.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$11.96
Rate for Payer: Devoted Health Medicare	$5.46
Rate for Payer: Hawaii Medical Service Association Medicare	$5.46
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Humana Medicare	$5.46
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$5.46
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: Ohana Health Plan Medicaid	$5.46
Rate for Payer: Ohana Health Plan Medicare	$5.46
Rate for Payer: UnitedHealthcare Medicare	$5.46
Rate for Payer: University Health Alliance Commercial	$9.48

KELLY FORCEPS CURVED 5.5"

Facility

$13.00

Hospital Charge Code	8569
Hospital Revenue Code	270
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$8.45
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

KELLY FORCEPS STRAIGHT 5.5"

Facility

$204.00

Hospital Charge Code	8570
Hospital Revenue Code	270
Min. Negotiated Rate	$85.68
Max. Negotiated Rate	$197.88
Rate for Payer: AlohaCare Medicaid	$102.00
Rate for Payer: AlohaCare Medicare	$85.68
Rate for Payer: Cash Price	$132.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$187.68
Rate for Payer: Devoted Health Medicare	$85.68
Rate for Payer: Hawaii Medical Service Association Medicare	$85.68
Rate for Payer: Hawaii Western Management Group Commercial	$193.80
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Humana Medicare	$85.68
Rate for Payer: Kaiser Permanente Commercial	$183.60
Rate for Payer: Kaiser Permanente Medicaid	$104.04
Rate for Payer: Kaiser Permanente Medicare	$85.68
Rate for Payer: MDX Hawaii PPO	$197.88
Rate for Payer: Ohana Health Plan Medicaid	$85.68
Rate for Payer: Ohana Health Plan Medicare	$85.68
Rate for Payer: UnitedHealthcare Medicare	$85.68
Rate for Payer: University Health Alliance Commercial	$148.70

KELLY FORCEPS STRAIGHT 5.5"

Facility

$204.00

Hospital Charge Code	8570
Hospital Revenue Code	270
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$197.88
Rate for Payer: Cash Price	$132.60
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Kaiser Permanente Commercial	$183.60
Rate for Payer: MDX Hawaii PPO	$197.88

ketamine 500 mg / 5 mL Soln [KMC]

Facility

$7.98

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$6.78
Max. Negotiated Rate	$7.74
Rate for Payer: Cash Price	$5.19
Rate for Payer: Health Management Network Commercial	$6.78
Rate for Payer: Kaiser Permanente Commercial	$7.18
Rate for Payer: MDX Hawaii PPO	$7.74

ketamine 500 mg / 5 mL Soln [KMC]

Facility

$7.98

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$7.74
Rate for Payer: AlohaCare Medicaid	$3.99
Rate for Payer: AlohaCare Medicare	$3.35
Rate for Payer: Cash Price	$5.19
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7.34
Rate for Payer: Devoted Health Medicare	$3.35
Rate for Payer: Hawaii Medical Service Association Medicare	$3.35
Rate for Payer: Hawaii Western Management Group Commercial	$7.58
Rate for Payer: Health Management Network Commercial	$6.78
Rate for Payer: Humana Medicare	$3.35
Rate for Payer: Kaiser Permanente Commercial	$7.18
Rate for Payer: Kaiser Permanente Medicaid	$4.07
Rate for Payer: Kaiser Permanente Medicare	$3.35
Rate for Payer: MDX Hawaii PPO	$7.74
Rate for Payer: Ohana Health Plan Medicaid	$3.35
Rate for Payer: Ohana Health Plan Medicare	$3.35
Rate for Payer: UnitedHealthcare Medicaid	$4.79
Rate for Payer: UnitedHealthcare Medicare	$3.35
Rate for Payer: University Health Alliance Commercial	$5.82

ketoconazole 200 mg Tab [KMC]

Facility

$15.16

Service Code	NDC 64380082706
Hospital Revenue Code	250
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$14.71
Rate for Payer: AlohaCare Medicaid	$7.58
Rate for Payer: AlohaCare Medicare	$6.37
Rate for Payer: Cash Price	$9.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$13.95
Rate for Payer: Devoted Health Medicare	$6.37
Rate for Payer: Hawaii Medical Service Association Medicare	$6.37
Rate for Payer: Hawaii Western Management Group Commercial	$14.40
Rate for Payer: Health Management Network Commercial	$12.89
Rate for Payer: Humana Medicare	$6.37
Rate for Payer: Kaiser Permanente Commercial	$13.64
Rate for Payer: Kaiser Permanente Medicaid	$7.73
Rate for Payer: Kaiser Permanente Medicare	$6.37
Rate for Payer: MDX Hawaii PPO	$14.71
Rate for Payer: Ohana Health Plan Medicaid	$6.37
Rate for Payer: Ohana Health Plan Medicare	$6.37
Rate for Payer: UnitedHealthcare Medicaid	$9.10
Rate for Payer: UnitedHealthcare Medicare	$6.37
Rate for Payer: University Health Alliance Commercial	$11.05

ketoconazole 200 mg Tab [KMC]

Facility

$15.16

Service Code	NDC 64380082706
Hospital Revenue Code	250
Min. Negotiated Rate	$12.89
Max. Negotiated Rate	$14.71
Rate for Payer: Cash Price	$9.85
Rate for Payer: Health Management Network Commercial	$12.89
Rate for Payer: Kaiser Permanente Commercial	$13.64
Rate for Payer: MDX Hawaii PPO	$14.71

ketoconazole 2% Cream [KMC]

Facility

$13.50

Service Code	NDC 16714095502
Hospital Revenue Code	250
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$13.10
Rate for Payer: Cash Price	$8.78
Rate for Payer: Health Management Network Commercial	$11.47
Rate for Payer: Kaiser Permanente Commercial	$12.15
Rate for Payer: MDX Hawaii PPO	$13.10

ketoconazole 2% Cream [KMC]

Facility

$13.50

Service Code	NDC 16714095502
Hospital Revenue Code	250
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$13.10
Rate for Payer: AlohaCare Medicaid	$6.75
Rate for Payer: AlohaCare Medicare	$5.67
Rate for Payer: Cash Price	$8.78
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$12.42
Rate for Payer: Devoted Health Medicare	$5.67
Rate for Payer: Hawaii Medical Service Association Medicare	$5.67
Rate for Payer: Hawaii Western Management Group Commercial	$12.82
Rate for Payer: Health Management Network Commercial	$11.47
Rate for Payer: Humana Medicare	$5.67
Rate for Payer: Kaiser Permanente Commercial	$12.15
Rate for Payer: Kaiser Permanente Medicaid	$6.88
Rate for Payer: Kaiser Permanente Medicare	$5.67
Rate for Payer: MDX Hawaii PPO	$13.10
Rate for Payer: Ohana Health Plan Medicaid	$5.67
Rate for Payer: Ohana Health Plan Medicare	$5.67
Rate for Payer: UnitedHealthcare Medicaid	$8.10
Rate for Payer: UnitedHealthcare Medicare	$5.67
Rate for Payer: University Health Alliance Commercial	$9.84

ketoconazole 2% Shampoo [KMC]

Facility

$0.80

Service Code	NDC 63646001004
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.78
Rate for Payer: Cash Price	$0.52
Rate for Payer: Health Management Network Commercial	$0.68
Rate for Payer: Kaiser Permanente Commercial	$0.72
Rate for Payer: MDX Hawaii PPO	$0.78

ketoconazole 2% Shampoo [KMC]

Facility

$0.80

Service Code	NDC 63646001004
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.78
Rate for Payer: AlohaCare Medicaid	$0.40
Rate for Payer: AlohaCare Medicare	$0.34
Rate for Payer: Cash Price	$0.52
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.74
Rate for Payer: Devoted Health Medicare	$0.34
Rate for Payer: Hawaii Medical Service Association Medicare	$0.34
Rate for Payer: Hawaii Western Management Group Commercial	$0.76
Rate for Payer: Health Management Network Commercial	$0.68
Rate for Payer: Humana Medicare	$0.34
Rate for Payer: Kaiser Permanente Commercial	$0.72
Rate for Payer: Kaiser Permanente Medicaid	$0.41
Rate for Payer: Kaiser Permanente Medicare	$0.34
Rate for Payer: MDX Hawaii PPO	$0.78
Rate for Payer: Ohana Health Plan Medicaid	$0.34
Rate for Payer: Ohana Health Plan Medicare	$0.34
Rate for Payer: UnitedHealthcare Medicaid	$0.48
Rate for Payer: UnitedHealthcare Medicare	$0.34
Rate for Payer: University Health Alliance Commercial	$0.58

ketorolac 30 mg/mL Inj Sol [KMC]

Facility

$8.40

Service Code	HCPCS J1885
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$8.15
Rate for Payer: AlohaCare Medicaid	$4.20
Rate for Payer: AlohaCare Medicare	$3.53
Rate for Payer: Cash Price	$5.46
Rate for Payer: Cash Price	$5.46
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7.73
Rate for Payer: Devoted Health Medicare	$3.53
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.35
Rate for Payer: Hawaii Medical Service Association Commercial	$0.49
Rate for Payer: Hawaii Medical Service Association Medicare	$3.53
Rate for Payer: Hawaii Western Management Group Commercial	$7.98
Rate for Payer: Health Management Network Commercial	$7.14
Rate for Payer: Humana Medicare	$3.53
Rate for Payer: Kaiser Permanente Commercial	$7.56
Rate for Payer: Kaiser Permanente Medicaid	$4.28
Rate for Payer: Kaiser Permanente Medicare	$3.53
Rate for Payer: MDX Hawaii PPO	$8.15
Rate for Payer: Ohana Health Plan Medicaid	$3.53
Rate for Payer: Ohana Health Plan Medicare	$3.53
Rate for Payer: UnitedHealthcare Medicaid	$5.04
Rate for Payer: UnitedHealthcare Medicare	$3.53
Rate for Payer: University Health Alliance Commercial	$6.12

ketorolac 30 mg/mL Inj Sol [KMC]

Facility

$8.40

Service Code	HCPCS J1885
Hospital Revenue Code	636
Min. Negotiated Rate	$7.14
Max. Negotiated Rate	$8.15
Rate for Payer: Cash Price	$5.46
Rate for Payer: Health Management Network Commercial	$7.14
Rate for Payer: Kaiser Permanente Commercial	$7.56
Rate for Payer: MDX Hawaii PPO	$8.15

Know your out-of-pocket cost for care.

All Charges