Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

KETOROLAC TROMETHAMINE INJ

Professional

Both

$6.00

Service Code	HCPCS J1885
Hospital Revenue Code	636
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$13.19
Rate for Payer: AlohaCare Medicare	$0.34
Rate for Payer: Cash Price	$3.90
Rate for Payer: Cash Price	$3.90
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	$13.19
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$0.41
Rate for Payer: Kaiser Permanente Medicaid	$0.41
Rate for Payer: Kaiser Permanente Medicare	$0.41
Rate for Payer: Ohana Health Plan Medicare	$0.34
Rate for Payer: UnitedHealthcare Medicare	$0.34

ketotifen ophthalmic 0.025% Soln [KMC]

Facility

$9.75

Service Code	NDC 17478071710
Hospital Revenue Code	250
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$9.46
Rate for Payer: AlohaCare Medicaid	$4.88
Rate for Payer: AlohaCare Medicare	$4.09
Rate for Payer: Cash Price	$6.34
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$8.97
Rate for Payer: Devoted Health Medicare	$4.09
Rate for Payer: Hawaii Medical Service Association Medicare	$4.09
Rate for Payer: Hawaii Western Management Group Commercial	$9.26
Rate for Payer: Health Management Network Commercial	$8.29
Rate for Payer: Humana Medicare	$4.09
Rate for Payer: Kaiser Permanente Commercial	$8.78
Rate for Payer: Kaiser Permanente Medicaid	$4.97
Rate for Payer: Kaiser Permanente Medicare	$4.09
Rate for Payer: MDX Hawaii PPO	$9.46
Rate for Payer: Ohana Health Plan Medicaid	$4.09
Rate for Payer: Ohana Health Plan Medicare	$4.09
Rate for Payer: UnitedHealthcare Medicaid	$5.85
Rate for Payer: UnitedHealthcare Medicare	$4.09
Rate for Payer: University Health Alliance Commercial	$7.11

ketotifen ophthalmic 0.025% Soln [KMC]

Facility

$9.75

Service Code	NDC 17478071710
Hospital Revenue Code	250
Min. Negotiated Rate	$8.29
Max. Negotiated Rate	$9.46
Rate for Payer: Cash Price	$6.34
Rate for Payer: Health Management Network Commercial	$8.29
Rate for Payer: Kaiser Permanente Commercial	$8.78
Rate for Payer: MDX Hawaii PPO	$9.46

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC

Facility

$43,279.85

Service Code	MSDRG 657
Min. Negotiated Rate	$43,279.85
Max. Negotiated Rate	$43,279.85
Rate for Payer: Hawaii Medical Service Association Commercial	$43,279.85

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC

Facility

$43,279.85

Service Code	MSDRG 656
Min. Negotiated Rate	$43,279.85
Max. Negotiated Rate	$43,279.85
Rate for Payer: Hawaii Medical Service Association Commercial	$43,279.85

KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC

Facility

$43,279.85

Service Code	MSDRG 658
Min. Negotiated Rate	$43,279.85
Max. Negotiated Rate	$43,279.85
Rate for Payer: Hawaii Medical Service Association Commercial	$43,279.85

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC

Facility

$46,052.99

Service Code	MSDRG 660
Min. Negotiated Rate	$46,052.99
Max. Negotiated Rate	$46,052.99
Rate for Payer: Hawaii Medical Service Association Commercial	$46,052.99

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC

Facility

$47,759.53

Service Code	MSDRG 659
Min. Negotiated Rate	$47,759.53
Max. Negotiated Rate	$47,759.53
Rate for Payer: Hawaii Medical Service Association Commercial	$47,759.53

KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC

Facility

$31,144.43

Service Code	MSDRG 661
Min. Negotiated Rate	$31,144.43
Max. Negotiated Rate	$31,144.43
Rate for Payer: Hawaii Medical Service Association Commercial	$31,144.43

KIDNEY AND URINARY TRACT INFECTIONS WITH MCC

Facility

$17,539.48

Service Code	MSDRG 689
Min. Negotiated Rate	$17,539.48
Max. Negotiated Rate	$17,539.48
Rate for Payer: Hawaii Medical Service Association Commercial	$17,539.48

KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC

Facility

$14,979.66

Service Code	MSDRG 690
Min. Negotiated Rate	$14,979.66
Max. Negotiated Rate	$14,979.66
Rate for Payer: Hawaii Medical Service Association Commercial	$14,979.66

KIDNEY AND URINARY TRACT NEOPLASMS WITH CC

Facility

$30,931.11

Service Code	MSDRG 687
Min. Negotiated Rate	$30,931.11
Max. Negotiated Rate	$30,931.11
Rate for Payer: Hawaii Medical Service Association Commercial	$30,931.11

KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC

Facility

$30,931.11

Service Code	MSDRG 686
Min. Negotiated Rate	$30,931.11
Max. Negotiated Rate	$30,931.11
Rate for Payer: Hawaii Medical Service Association Commercial	$30,931.11

KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC

Facility

$30,931.11

Service Code	MSDRG 688
Min. Negotiated Rate	$30,931.11
Max. Negotiated Rate	$30,931.11
Rate for Payer: Hawaii Medical Service Association Commercial	$30,931.11

KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC

Facility

$20,525.93

Service Code	MSDRG 695
Min. Negotiated Rate	$20,525.93
Max. Negotiated Rate	$20,525.93
Rate for Payer: Hawaii Medical Service Association Commercial	$20,525.93

KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC

Facility

$20,525.93

Service Code	MSDRG 696
Min. Negotiated Rate	$20,525.93
Max. Negotiated Rate	$20,525.93
Rate for Payer: Hawaii Medical Service Association Commercial	$20,525.93

Kidney Stone Analysis DLS

Facility

$170.00

Service Code	HCPCS 82365
Hospital Charge Code	422823655
Hospital Revenue Code	301
Min. Negotiated Rate	$144.50
Max. Negotiated Rate	$164.90
Rate for Payer: Cash Price	$110.50
Rate for Payer: Health Management Network Commercial	$144.50
Rate for Payer: Kaiser Permanente Commercial	$153.00
Rate for Payer: MDX Hawaii PPO	$164.90

Kidney Stone Analysis DLS

Facility

$170.00

Service Code	HCPCS 82365
Hospital Charge Code	422823655
Hospital Revenue Code	301
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$164.90
Rate for Payer: AlohaCare Medicaid	$85.00
Rate for Payer: AlohaCare Medicare	$71.40
Rate for Payer: Cash Price	$110.50
Rate for Payer: Cash Price	$110.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$156.40
Rate for Payer: Devoted Health Medicare	$71.40
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.44
Rate for Payer: Hawaii Medical Service Association Commercial	$16.12
Rate for Payer: Hawaii Medical Service Association Medicare	$71.40
Rate for Payer: Hawaii Western Management Group Commercial	$12.90
Rate for Payer: Health Management Network Commercial	$144.50
Rate for Payer: Humana Medicare	$71.40
Rate for Payer: Kaiser Permanente Commercial	$153.00
Rate for Payer: Kaiser Permanente Medicaid	$86.70
Rate for Payer: Kaiser Permanente Medicare	$71.40
Rate for Payer: MDX Hawaii PPO	$164.90
Rate for Payer: Ohana Health Plan Medicaid	$71.40
Rate for Payer: Ohana Health Plan Medicare	$71.40
Rate for Payer: UnitedHealthcare Medicaid	$11.44
Rate for Payer: UnitedHealthcare Medicare	$71.40
Rate for Payer: University Health Alliance Commercial	$21.40

KIDNEY TRANSPLANT

Facility

$154,726.66

Service Code	MSDRG 652
Min. Negotiated Rate	$154,726.66
Max. Negotiated Rate	$154,726.66
Rate for Payer: Hawaii Medical Service Association Commercial	$154,726.66

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC

Facility

$154,726.66

Service Code	MSDRG 650
Min. Negotiated Rate	$154,726.66
Max. Negotiated Rate	$154,726.66
Rate for Payer: Hawaii Medical Service Association Commercial	$154,726.66

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC

Facility

$154,726.66

Service Code	MSDRG 651
Min. Negotiated Rate	$154,726.66
Max. Negotiated Rate	$154,726.66
Rate for Payer: Hawaii Medical Service Association Commercial	$154,726.66

KLEENSPEC LG

Facility

$10.00

Hospital Charge Code	8157
Hospital Revenue Code	270
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.50
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: MDX Hawaii PPO	$9.70

KLEENSPEC LG

Facility

$10.00

Hospital Charge Code	8157
Hospital Revenue Code	270
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$9.70
Rate for Payer: AlohaCare Medicaid	$5.00
Rate for Payer: AlohaCare Medicare	$4.20
Rate for Payer: Cash Price	$6.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$9.20
Rate for Payer: Devoted Health Medicare	$4.20
Rate for Payer: Hawaii Medical Service Association Medicare	$4.20
Rate for Payer: Hawaii Western Management Group Commercial	$9.50
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Humana Medicare	$4.20
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: Kaiser Permanente Medicaid	$5.10
Rate for Payer: Kaiser Permanente Medicare	$4.20
Rate for Payer: MDX Hawaii PPO	$9.70
Rate for Payer: Ohana Health Plan Medicaid	$4.20
Rate for Payer: Ohana Health Plan Medicare	$4.20
Rate for Payer: UnitedHealthcare Medicare	$4.20
Rate for Payer: University Health Alliance Commercial	$7.29

KLEENSPEC MED

Facility

$501.00

Hospital Charge Code	8158
Hospital Revenue Code	270
Min. Negotiated Rate	$210.42
Max. Negotiated Rate	$485.97
Rate for Payer: AlohaCare Medicaid	$250.50
Rate for Payer: AlohaCare Medicare	$210.42
Rate for Payer: Cash Price	$325.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$460.92
Rate for Payer: Devoted Health Medicare	$210.42
Rate for Payer: Hawaii Medical Service Association Medicare	$210.42
Rate for Payer: Hawaii Western Management Group Commercial	$475.95
Rate for Payer: Health Management Network Commercial	$425.85
Rate for Payer: Humana Medicare	$210.42
Rate for Payer: Kaiser Permanente Commercial	$450.90
Rate for Payer: Kaiser Permanente Medicaid	$255.51
Rate for Payer: Kaiser Permanente Medicare	$210.42
Rate for Payer: MDX Hawaii PPO	$485.97
Rate for Payer: Ohana Health Plan Medicaid	$210.42
Rate for Payer: Ohana Health Plan Medicare	$210.42
Rate for Payer: UnitedHealthcare Medicare	$210.42
Rate for Payer: University Health Alliance Commercial	$365.18

KLEENSPEC MED

Facility

$501.00

Hospital Charge Code	8158
Hospital Revenue Code	270
Min. Negotiated Rate	$425.85
Max. Negotiated Rate	$485.97
Rate for Payer: Cash Price	$325.65
Rate for Payer: Health Management Network Commercial	$425.85
Rate for Payer: Kaiser Permanente Commercial	$450.90
Rate for Payer: MDX Hawaii PPO	$485.97

Know your out-of-pocket cost for care.

All Charges