Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

albuterol 4 mg Tab [KMC]

Facility

$23.50

Service Code	NDC 70710106201
Hospital Revenue Code	250
Min. Negotiated Rate	$19.98
Max. Negotiated Rate	$22.80
Rate for Payer: Cash Price	$15.28
Rate for Payer: Health Management Network Commercial	$19.98
Rate for Payer: Kaiser Permanente Commercial	$21.15
Rate for Payer: MDX Hawaii PPO	$22.80

albuterol 4 mg Tab [KMC]

Facility

$23.50

Service Code	NDC 70710106201
Hospital Revenue Code	250
Min. Negotiated Rate	$9.87
Max. Negotiated Rate	$22.80
Rate for Payer: AlohaCare Medicaid	$11.75
Rate for Payer: AlohaCare Medicare	$9.87
Rate for Payer: Cash Price	$15.28
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$21.62
Rate for Payer: Devoted Health Medicare	$9.87
Rate for Payer: Hawaii Medical Service Association Medicare	$9.87
Rate for Payer: Hawaii Western Management Group Commercial	$22.32
Rate for Payer: Health Management Network Commercial	$19.98
Rate for Payer: Humana Medicare	$9.87
Rate for Payer: Kaiser Permanente Commercial	$21.15
Rate for Payer: Kaiser Permanente Medicaid	$11.98
Rate for Payer: Kaiser Permanente Medicare	$9.87
Rate for Payer: MDX Hawaii PPO	$22.80
Rate for Payer: Ohana Health Plan Medicaid	$9.87
Rate for Payer: Ohana Health Plan Medicare	$9.87
Rate for Payer: UnitedHealthcare Medicaid	$14.10
Rate for Payer: UnitedHealthcare Medicare	$9.87
Rate for Payer: University Health Alliance Commercial	$17.13

albuterol-ipratropium 100-20 mcg/puff Inhaler [KMC]

Facility

$287.11

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$244.04
Max. Negotiated Rate	$278.50
Rate for Payer: Cash Price	$186.62
Rate for Payer: Health Management Network Commercial	$244.04
Rate for Payer: Kaiser Permanente Commercial	$258.40
Rate for Payer: MDX Hawaii PPO	$278.50

albuterol-ipratropium 100-20 mcg/puff Inhaler [KMC]

Facility

$287.11

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$120.59
Max. Negotiated Rate	$278.50
Rate for Payer: AlohaCare Medicaid	$143.56
Rate for Payer: AlohaCare Medicare	$120.59
Rate for Payer: Cash Price	$186.62
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$264.14
Rate for Payer: Devoted Health Medicare	$120.59
Rate for Payer: Hawaii Medical Service Association Medicare	$120.59
Rate for Payer: Hawaii Western Management Group Commercial	$272.75
Rate for Payer: Health Management Network Commercial	$244.04
Rate for Payer: Humana Medicare	$120.59
Rate for Payer: Kaiser Permanente Commercial	$258.40
Rate for Payer: Kaiser Permanente Medicaid	$146.43
Rate for Payer: Kaiser Permanente Medicare	$120.59
Rate for Payer: MDX Hawaii PPO	$278.50
Rate for Payer: Ohana Health Plan Medicaid	$120.59
Rate for Payer: Ohana Health Plan Medicare	$120.59
Rate for Payer: UnitedHealthcare Medicare	$120.59
Rate for Payer: University Health Alliance Commercial	$209.27

albuterol-ipratropium 2.5-0.5mg/3mL Neb Soln [KMC]

Facility

$2.92

Service Code	HCPCS J7620
Hospital Revenue Code	636
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$2.83
Rate for Payer: AlohaCare Medicaid	$1.46
Rate for Payer: AlohaCare Medicare	$1.23
Rate for Payer: Cash Price	$1.90
Rate for Payer: Cash Price	$1.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.69
Rate for Payer: Devoted Health Medicare	$1.23
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1.23
Rate for Payer: Hawaii Western Management Group Commercial	$2.77
Rate for Payer: Health Management Network Commercial	$2.48
Rate for Payer: Humana Medicare	$1.23
Rate for Payer: Kaiser Permanente Commercial	$2.63
Rate for Payer: Kaiser Permanente Medicaid	$1.49
Rate for Payer: Kaiser Permanente Medicare	$1.23
Rate for Payer: MDX Hawaii PPO	$2.83
Rate for Payer: Ohana Health Plan Medicaid	$1.23
Rate for Payer: Ohana Health Plan Medicare	$1.23
Rate for Payer: UnitedHealthcare Medicaid	$1.75
Rate for Payer: UnitedHealthcare Medicare	$1.23
Rate for Payer: University Health Alliance Commercial	$2.13

albuterol-ipratropium 2.5-0.5mg/3mL Neb Soln [KMC]

Facility

$2.92

Service Code	HCPCS J7620
Hospital Revenue Code	636
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$2.83
Rate for Payer: Cash Price	$1.90
Rate for Payer: Health Management Network Commercial	$2.48
Rate for Payer: Kaiser Permanente Commercial	$2.63
Rate for Payer: MDX Hawaii PPO	$2.83

albuterol (Ventolin) 90 mcg/puff Inhaler [KMC]

Facility

$13.88

Service Code	NDC 66993001968
Hospital Revenue Code	250
Min. Negotiated Rate	$11.80
Max. Negotiated Rate	$13.46
Rate for Payer: Cash Price	$9.02
Rate for Payer: Health Management Network Commercial	$11.80
Rate for Payer: Kaiser Permanente Commercial	$12.49
Rate for Payer: MDX Hawaii PPO	$13.46

albuterol (Ventolin) 90 mcg/puff Inhaler [KMC]

Facility

$13.88

Service Code	NDC 66993001968
Hospital Revenue Code	250
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$13.46
Rate for Payer: AlohaCare Medicaid	$6.94
Rate for Payer: AlohaCare Medicare	$5.83
Rate for Payer: Cash Price	$9.02
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$12.77
Rate for Payer: Devoted Health Medicare	$5.83
Rate for Payer: Hawaii Medical Service Association Medicare	$5.83
Rate for Payer: Hawaii Western Management Group Commercial	$13.19
Rate for Payer: Health Management Network Commercial	$11.80
Rate for Payer: Humana Medicare	$5.83
Rate for Payer: Kaiser Permanente Commercial	$12.49
Rate for Payer: Kaiser Permanente Medicaid	$7.08
Rate for Payer: Kaiser Permanente Medicare	$5.83
Rate for Payer: MDX Hawaii PPO	$13.46
Rate for Payer: Ohana Health Plan Medicaid	$5.83
Rate for Payer: Ohana Health Plan Medicare	$5.83
Rate for Payer: UnitedHealthcare Medicaid	$8.33
Rate for Payer: UnitedHealthcare Medicare	$5.83
Rate for Payer: University Health Alliance Commercial	$10.12

ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA

Facility

$8,461.61

Service Code	MSDRG 894
Min. Negotiated Rate	$8,461.61
Max. Negotiated Rate	$8,461.61
Rate for Payer: Hawaii Medical Service Association Commercial	$8,461.61

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC

Facility

$22,588.01

Service Code	MSDRG 896
Min. Negotiated Rate	$22,588.01
Max. Negotiated Rate	$22,588.01
Rate for Payer: Hawaii Medical Service Association Commercial	$22,588.01

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC

Facility

$14,410.82

Service Code	MSDRG 897
Min. Negotiated Rate	$14,410.82
Max. Negotiated Rate	$14,410.82
Rate for Payer: Hawaii Medical Service Association Commercial	$14,410.82

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY

Facility

$22,588.01

Service Code	MSDRG 895
Min. Negotiated Rate	$22,588.01
Max. Negotiated Rate	$22,588.01
Rate for Payer: Hawaii Medical Service Association Commercial	$22,588.01

Aldosterone DLS

Facility

$370.00

Service Code	HCPCS 82088
Hospital Charge Code	422820885
Hospital Revenue Code	301
Min. Negotiated Rate	$40.75
Max. Negotiated Rate	$358.90
Rate for Payer: AlohaCare Medicaid	$185.00
Rate for Payer: AlohaCare Medicare	$155.40
Rate for Payer: Cash Price	$240.50
Rate for Payer: Cash Price	$240.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$340.40
Rate for Payer: Devoted Health Medicare	$155.40
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$56.32
Rate for Payer: Hawaii Medical Service Association Commercial	$50.94
Rate for Payer: Hawaii Medical Service Association Medicare	$155.40
Rate for Payer: Hawaii Western Management Group Commercial	$40.75
Rate for Payer: Health Management Network Commercial	$314.50
Rate for Payer: Humana Medicare	$155.40
Rate for Payer: Kaiser Permanente Commercial	$333.00
Rate for Payer: Kaiser Permanente Medicaid	$188.70
Rate for Payer: Kaiser Permanente Medicare	$155.40
Rate for Payer: MDX Hawaii PPO	$358.90
Rate for Payer: Ohana Health Plan Medicaid	$155.40
Rate for Payer: Ohana Health Plan Medicare	$155.40
Rate for Payer: UnitedHealthcare Medicaid	$56.32
Rate for Payer: UnitedHealthcare Medicare	$155.40
Rate for Payer: University Health Alliance Commercial	$105.34

Aldosterone DLS

Facility

$370.00

Service Code	HCPCS 82088
Hospital Charge Code	422820885
Hospital Revenue Code	301
Min. Negotiated Rate	$314.50
Max. Negotiated Rate	$358.90
Rate for Payer: Cash Price	$240.50
Rate for Payer: Health Management Network Commercial	$314.50
Rate for Payer: Kaiser Permanente Commercial	$333.00
Rate for Payer: MDX Hawaii PPO	$358.90

alendronate 10 mg Tab [KMC]

Facility

$11.71

Service Code	NDC 16714063101
Hospital Revenue Code	250
Min. Negotiated Rate	$9.95
Max. Negotiated Rate	$11.36
Rate for Payer: Cash Price	$7.61
Rate for Payer: Health Management Network Commercial	$9.95
Rate for Payer: Kaiser Permanente Commercial	$10.54
Rate for Payer: MDX Hawaii PPO	$11.36

alendronate 10 mg Tab [KMC]

Facility

$11.71

Service Code	NDC 16714063101
Hospital Revenue Code	250
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$11.36
Rate for Payer: AlohaCare Medicaid	$5.86
Rate for Payer: AlohaCare Medicare	$4.92
Rate for Payer: Cash Price	$7.61
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$10.77
Rate for Payer: Devoted Health Medicare	$4.92
Rate for Payer: Hawaii Medical Service Association Medicare	$4.92
Rate for Payer: Hawaii Western Management Group Commercial	$11.12
Rate for Payer: Health Management Network Commercial	$9.95
Rate for Payer: Humana Medicare	$4.92
Rate for Payer: Kaiser Permanente Commercial	$10.54
Rate for Payer: Kaiser Permanente Medicaid	$5.97
Rate for Payer: Kaiser Permanente Medicare	$4.92
Rate for Payer: MDX Hawaii PPO	$11.36
Rate for Payer: Ohana Health Plan Medicaid	$4.92
Rate for Payer: Ohana Health Plan Medicare	$4.92
Rate for Payer: UnitedHealthcare Medicaid	$7.03
Rate for Payer: UnitedHealthcare Medicare	$4.92
Rate for Payer: University Health Alliance Commercial	$8.54

alendronate 70 mg Tab [KMC]

Facility

$81.94

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$34.41
Max. Negotiated Rate	$79.48
Rate for Payer: AlohaCare Medicaid	$40.97
Rate for Payer: AlohaCare Medicare	$34.41
Rate for Payer: Cash Price	$53.26
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$75.38
Rate for Payer: Devoted Health Medicare	$34.41
Rate for Payer: Hawaii Medical Service Association Medicare	$34.41
Rate for Payer: Hawaii Western Management Group Commercial	$77.84
Rate for Payer: Health Management Network Commercial	$69.65
Rate for Payer: Humana Medicare	$34.41
Rate for Payer: Kaiser Permanente Commercial	$73.75
Rate for Payer: Kaiser Permanente Medicaid	$41.79
Rate for Payer: Kaiser Permanente Medicare	$34.41
Rate for Payer: MDX Hawaii PPO	$79.48
Rate for Payer: Ohana Health Plan Medicaid	$34.41
Rate for Payer: Ohana Health Plan Medicare	$34.41
Rate for Payer: UnitedHealthcare Medicare	$34.41
Rate for Payer: University Health Alliance Commercial	$59.73

alendronate 70 mg Tab [KMC]

Facility

$81.94

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$69.65
Max. Negotiated Rate	$79.48
Rate for Payer: Cash Price	$53.26
Rate for Payer: Health Management Network Commercial	$69.65
Rate for Payer: Kaiser Permanente Commercial	$73.75
Rate for Payer: MDX Hawaii PPO	$79.48

alfuzosin 10 mg ER tab [KMC]

Facility

$16.85

Service Code	NDC 29300015501
Hospital Revenue Code	250
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$16.34
Rate for Payer: Cash Price	$10.95
Rate for Payer: Health Management Network Commercial	$14.32
Rate for Payer: Kaiser Permanente Commercial	$15.16
Rate for Payer: MDX Hawaii PPO	$16.34

alfuzosin 10 mg ER tab [KMC]

Facility

$16.85

Service Code	NDC 29300015501
Hospital Revenue Code	250
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$16.34
Rate for Payer: AlohaCare Medicaid	$8.43
Rate for Payer: AlohaCare Medicare	$7.08
Rate for Payer: Cash Price	$10.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$15.50
Rate for Payer: Devoted Health Medicare	$7.08
Rate for Payer: Hawaii Medical Service Association Medicare	$7.08
Rate for Payer: Hawaii Western Management Group Commercial	$16.01
Rate for Payer: Health Management Network Commercial	$14.32
Rate for Payer: Humana Medicare	$7.08
Rate for Payer: Kaiser Permanente Commercial	$15.16
Rate for Payer: Kaiser Permanente Medicaid	$8.59
Rate for Payer: Kaiser Permanente Medicare	$7.08
Rate for Payer: MDX Hawaii PPO	$16.34
Rate for Payer: Ohana Health Plan Medicaid	$7.08
Rate for Payer: Ohana Health Plan Medicare	$7.08
Rate for Payer: UnitedHealthcare Medicaid	$10.11
Rate for Payer: UnitedHealthcare Medicare	$7.08
Rate for Payer: University Health Alliance Commercial	$12.28

Alkaline Phosphatase

Facility

$72.00

Service Code	HCPCS 84075
Hospital Charge Code	422840750
Hospital Revenue Code	301
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: MDX Hawaii PPO	$69.84

Alkaline Phosphatase

Facility

$72.00

Service Code	HCPCS 84075
Hospital Charge Code	422840750
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$69.84
Rate for Payer: AlohaCare Medicaid	$36.00
Rate for Payer: AlohaCare Medicare	$30.24
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$66.24
Rate for Payer: Devoted Health Medicare	$30.24
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$30.24
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Humana Medicare	$30.24
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$30.24
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$30.24
Rate for Payer: Ohana Health Plan Medicare	$30.24
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$30.24
Rate for Payer: University Health Alliance Commercial	$13.38

Alkaline Phosphatase Isoenzymes DLS

Facility

$24.00

Service Code	HCPCS 84075
Hospital Charge Code	422840755
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$23.28
Rate for Payer: AlohaCare Medicaid	$12.00
Rate for Payer: AlohaCare Medicare	$10.08
Rate for Payer: Cash Price	$15.60
Rate for Payer: Cash Price	$15.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$22.08
Rate for Payer: Devoted Health Medicare	$10.08
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$10.08
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Humana Medicare	$10.08
Rate for Payer: Kaiser Permanente Commercial	$21.60
Rate for Payer: Kaiser Permanente Medicaid	$12.24
Rate for Payer: Kaiser Permanente Medicare	$10.08
Rate for Payer: MDX Hawaii PPO	$23.28
Rate for Payer: Ohana Health Plan Medicaid	$10.08
Rate for Payer: Ohana Health Plan Medicare	$10.08
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$10.08
Rate for Payer: University Health Alliance Commercial	$13.38

Alkaline Phosphatase Isoenzymes DLS

Facility

$24.00

Service Code	HCPCS 84075
Hospital Charge Code	422840755
Hospital Revenue Code	301
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$15.60
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Kaiser Permanente Commercial	$21.60
Rate for Payer: MDX Hawaii PPO	$23.28

Allergen 1 DLS

Facility

$56.00

Service Code	HCPCS 86003
Hospital Charge Code	422860035
Hospital Revenue Code	302
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$36.40
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Kaiser Permanente Commercial	$50.40
Rate for Payer: MDX Hawaii PPO	$54.32

Know your out-of-pocket cost for care.

All Charges