Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

KLEENSPEC SM

Facility

$7.00

Hospital Charge Code	8159
Hospital Revenue Code	270
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$6.79
Rate for Payer: AlohaCare Medicaid	$3.50
Rate for Payer: AlohaCare Medicare	$2.94
Rate for Payer: Cash Price	$4.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6.44
Rate for Payer: Devoted Health Medicare	$2.94
Rate for Payer: Hawaii Medical Service Association Medicare	$2.94
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Humana Medicare	$2.94
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: Kaiser Permanente Medicare	$2.94
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: Ohana Health Plan Medicaid	$2.94
Rate for Payer: Ohana Health Plan Medicare	$2.94
Rate for Payer: UnitedHealthcare Medicare	$2.94
Rate for Payer: University Health Alliance Commercial	$5.10

KLEENSPEC SM

Facility

$7.00

Hospital Charge Code	8159
Hospital Revenue Code	270
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.55
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$6.79

KLING 2"

Facility

$6.00

Hospital Charge Code	8160
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

KLING 2"

Facility

$6.00

Hospital Charge Code	8160
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

KLING 3"

Facility

$4.00

Hospital Charge Code	8161
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

KLING 3"

Facility

$4.00

Hospital Charge Code	8161
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

KLING 4"

Facility

$5.00

Hospital Charge Code	8162
Hospital Revenue Code	270
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$2.10
Rate for Payer: Cash Price	$3.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.60
Rate for Payer: Devoted Health Medicare	$2.10
Rate for Payer: Hawaii Medical Service Association Medicare	$2.10
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$2.10
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$2.10
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$2.10
Rate for Payer: Ohana Health Plan Medicare	$2.10
Rate for Payer: UnitedHealthcare Medicare	$2.10
Rate for Payer: University Health Alliance Commercial	$3.64

KLING 4"

Facility

$5.00

Hospital Charge Code	8162
Hospital Revenue Code	270
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.25
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

KLING 6"

Facility

$3.00

Hospital Charge Code	8163
Hospital Revenue Code	270
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

KLING 6"

Facility

$3.00

Hospital Charge Code	8163
Hospital Revenue Code	270
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 Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

KNEE 1 2 VWS

Facility

$369.00

Service Code	HCPCS 73560
Hospital Charge Code	424735600
Hospital Revenue Code	320
Min. Negotiated Rate	$17.04
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	$17.04
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$154.98
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
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	$17.04
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$58.59

KNEE 1 2 VWS

Facility

$369.00

Service Code	HCPCS 73560
Hospital Charge Code	424735600
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

KNEE BOTH STANDING AP

Facility

$321.00

Service Code	HCPCS 73565
Hospital Charge Code	424735650
Hospital Revenue Code	320
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$311.37
Rate for Payer: AlohaCare Medicaid	$160.50
Rate for Payer: AlohaCare Medicare	$134.82
Rate for Payer: Cash Price	$208.65
Rate for Payer: Cash Price	$208.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$295.32
Rate for Payer: Devoted Health Medicare	$134.82
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$16.41
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$134.82
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$272.85
Rate for Payer: Humana Medicare	$134.82
Rate for Payer: Kaiser Permanente Commercial	$288.90
Rate for Payer: Kaiser Permanente Medicaid	$163.71
Rate for Payer: Kaiser Permanente Medicare	$134.82
Rate for Payer: MDX Hawaii PPO	$311.37
Rate for Payer: Ohana Health Plan Medicaid	$134.82
Rate for Payer: Ohana Health Plan Medicare	$134.82
Rate for Payer: UnitedHealthcare Medicaid	$16.41
Rate for Payer: UnitedHealthcare Medicare	$134.82
Rate for Payer: University Health Alliance Commercial	$60.18

KNEE BOTH STANDING AP

Facility

$321.00

Service Code	HCPCS 73565
Hospital Charge Code	424735650
Hospital Revenue Code	320
Min. Negotiated Rate	$272.85
Max. Negotiated Rate	$311.37
Rate for Payer: Cash Price	$208.65
Rate for Payer: Health Management Network Commercial	$272.85
Rate for Payer: Kaiser Permanente Commercial	$288.90
Rate for Payer: MDX Hawaii PPO	$311.37

KNEE COMP MIN 4 VWS

Facility

$420.00

Service Code	HCPCS 73564
Hospital Charge Code	424735640
Hospital Revenue Code	320
Min. Negotiated Rate	$357.00
Max. Negotiated Rate	$407.40
Rate for Payer: Cash Price	$273.00
Rate for Payer: Health Management Network Commercial	$357.00
Rate for Payer: Kaiser Permanente Commercial	$378.00
Rate for Payer: MDX Hawaii PPO	$407.40

KNEE COMP MIN 4 VWS

Facility

$420.00

Service Code	HCPCS 73564
Hospital Charge Code	424735640
Hospital Revenue Code	320
Min. Negotiated Rate	$22.13
Max. Negotiated Rate	$407.40
Rate for Payer: AlohaCare Medicaid	$210.00
Rate for Payer: AlohaCare Medicare	$176.40
Rate for Payer: Cash Price	$273.00
Rate for Payer: Cash Price	$273.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$386.40
Rate for Payer: Devoted Health Medicare	$176.40
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$22.13
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$176.40
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$357.00
Rate for Payer: Humana Medicare	$176.40
Rate for Payer: Kaiser Permanente Commercial	$378.00
Rate for Payer: Kaiser Permanente Medicaid	$214.20
Rate for Payer: Kaiser Permanente Medicare	$176.40
Rate for Payer: MDX Hawaii PPO	$407.40
Rate for Payer: Ohana Health Plan Medicaid	$176.40
Rate for Payer: Ohana Health Plan Medicare	$176.40
Rate for Payer: UnitedHealthcare Medicaid	$22.13
Rate for Payer: UnitedHealthcare Medicare	$176.40
Rate for Payer: University Health Alliance Commercial	$77.64

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC

Facility

$24,934.50

Service Code	MSDRG 488
Min. Negotiated Rate	$24,934.50
Max. Negotiated Rate	$24,934.50
Rate for Payer: Hawaii Medical Service Association Commercial	$24,934.50

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$24,934.50

Service Code	MSDRG 489
Min. Negotiated Rate	$24,934.50
Max. Negotiated Rate	$24,934.50
Rate for Payer: Hawaii Medical Service Association Commercial	$24,934.50

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC

Facility

$44,156.83

Service Code	MSDRG 486
Min. Negotiated Rate	$44,156.83
Max. Negotiated Rate	$44,156.83
Rate for Payer: Hawaii Medical Service Association Commercial	$44,156.83

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC

Facility

$44,156.83

Service Code	MSDRG 485
Min. Negotiated Rate	$44,156.83
Max. Negotiated Rate	$44,156.83
Rate for Payer: Hawaii Medical Service Association Commercial	$44,156.83

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$31,547.36

Service Code	MSDRG 487
Min. Negotiated Rate	$31,547.36
Max. Negotiated Rate	$31,547.36
Rate for Payer: Hawaii Medical Service Association Commercial	$31,547.36

KNEE SPLINT 14"

Facility

$57.00

Hospital Charge Code	8165
Hospital Revenue Code	270
Min. Negotiated Rate	$23.94
Max. Negotiated Rate	$55.29
Rate for Payer: AlohaCare Medicaid	$28.50
Rate for Payer: AlohaCare Medicare	$23.94
Rate for Payer: Cash Price	$37.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$52.44
Rate for Payer: Devoted Health Medicare	$23.94
Rate for Payer: Hawaii Medical Service Association Medicare	$23.94
Rate for Payer: Hawaii Western Management Group Commercial	$54.15
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Humana Medicare	$23.94
Rate for Payer: Kaiser Permanente Commercial	$51.30
Rate for Payer: Kaiser Permanente Medicaid	$29.07
Rate for Payer: Kaiser Permanente Medicare	$23.94
Rate for Payer: MDX Hawaii PPO	$55.29
Rate for Payer: Ohana Health Plan Medicaid	$23.94
Rate for Payer: Ohana Health Plan Medicare	$23.94
Rate for Payer: UnitedHealthcare Medicare	$23.94
Rate for Payer: University Health Alliance Commercial	$41.55

KNEE SPLINT 14"

Facility

$57.00

Hospital Charge Code	8165
Hospital Revenue Code	270
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$37.05
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Kaiser Permanente Commercial	$51.30
Rate for Payer: MDX Hawaii PPO	$55.29

KNEE SPLINT 16"

Facility

$4.00

Hospital Charge Code	8164
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

KNEE SPLINT 16"

Facility

$4.00

Hospital Charge Code	8164
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

Know your out-of-pocket cost for care.

All Charges