Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

lamoTRIgine 25 mg Tab [KMC]

Facility

$16.64

Service Code	NDC 65862022701
Hospital Revenue Code	250
Min. Negotiated Rate	$14.14
Max. Negotiated Rate	$16.14
Rate for Payer: Cash Price	$10.82
Rate for Payer: Health Management Network Commercial	$14.14
Rate for Payer: Kaiser Permanente Commercial	$14.98
Rate for Payer: MDX Hawaii PPO	$16.14

LANG COMP CURRENT STATUS

Professional

Both

$0.01

Service Code	HCPCS G9159
Hospital Revenue Code	440
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

LANG COMP D/C STATUS

Professional

Both

$0.01

Service Code	HCPCS G9161
Hospital Revenue Code	440
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

LANG COMP D/C STATUS Speech

Facility

$1.00

Service Code	HCPCS G9161 GN
Hospital Charge Code	432G91610
Hospital Revenue Code	440
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.65
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

LANG COMP D/C STATUS Speech

Facility

$1.00

Service Code	HCPCS G9161 GN
Hospital Charge Code	432G91610
Hospital Revenue Code	440
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.42
Rate for Payer: Cash Price	$0.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.92
Rate for Payer: Devoted Health Medicare	$0.42
Rate for Payer: Hawaii Medical Service Association Medicare	$0.42
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.42
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.42
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.42
Rate for Payer: Ohana Health Plan Medicare	$0.42
Rate for Payer: UnitedHealthcare Medicare	$0.42
Rate for Payer: University Health Alliance Commercial	$0.73

LANG COMP GOAL STATUS

Professional

Both

$0.01

Service Code	HCPCS G9160
Hospital Revenue Code	440
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

LANG COMP GOAL STATUS Speech

Facility

$1.00

Service Code	HCPCS G9160 GN
Hospital Charge Code	432G91600
Hospital Revenue Code	440
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.65
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

LANG COMP GOAL STATUS Speech

Facility

$1.00

Service Code	HCPCS G9160 GN
Hospital Charge Code	432G91600
Hospital Revenue Code	440
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.42
Rate for Payer: Cash Price	$0.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.92
Rate for Payer: Devoted Health Medicare	$0.42
Rate for Payer: Hawaii Medical Service Association Medicare	$0.42
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.42
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.42
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.42
Rate for Payer: Ohana Health Plan Medicare	$0.42
Rate for Payer: UnitedHealthcare Medicare	$0.42
Rate for Payer: University Health Alliance Commercial	$0.73

LANG EXPRESS CURRENT STATUS

Professional

Both

$0.01

Service Code	HCPCS G9162
Hospital Revenue Code	440
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

LANG EXPRESS CURR STATUS Speech

Facility

$1.00

Service Code	HCPCS G9162 GN
Hospital Charge Code	432G91620
Hospital Revenue Code	440
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.42
Rate for Payer: Cash Price	$0.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.92
Rate for Payer: Devoted Health Medicare	$0.42
Rate for Payer: Hawaii Medical Service Association Medicare	$0.42
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.42
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.42
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.42
Rate for Payer: Ohana Health Plan Medicare	$0.42
Rate for Payer: UnitedHealthcare Medicare	$0.42
Rate for Payer: University Health Alliance Commercial	$0.73

LANG EXPRESS CURR STATUS Speech

Facility

$1.00

Service Code	HCPCS G9162 GN
Hospital Charge Code	432G91620
Hospital Revenue Code	440
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.65
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

LANG EXPRESS D/C STATUS

Professional

Both

$0.01

Service Code	HCPCS G9164
Hospital Revenue Code	440
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

LANG EXPRESS D/C STATUS Speech

Facility

$1.00

Service Code	HCPCS G9164 GN
Hospital Charge Code	432G91640
Hospital Revenue Code	440
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.42
Rate for Payer: Cash Price	$0.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.92
Rate for Payer: Devoted Health Medicare	$0.42
Rate for Payer: Hawaii Medical Service Association Medicare	$0.42
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.42
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.42
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.42
Rate for Payer: Ohana Health Plan Medicare	$0.42
Rate for Payer: UnitedHealthcare Medicare	$0.42
Rate for Payer: University Health Alliance Commercial	$0.73

LANG EXPRESS D/C STATUS Speech

Facility

$1.00

Service Code	HCPCS G9164 GN
Hospital Charge Code	432G91640
Hospital Revenue Code	440
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.65
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

LANG EXPRESS GOAL STATUS

Professional

Both

$0.01

Service Code	HCPCS G9163
Hospital Revenue Code	440
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

LANG EXPRESS GOAL STATUS Speech

Facility

$1.00

Service Code	HCPCS G9163 GN
Hospital Charge Code	432G91630
Hospital Revenue Code	440
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.65
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

LANG EXPRESS GOAL STATUS Speech

Facility

$1.00

Service Code	HCPCS G9163 GN
Hospital Charge Code	432G91630
Hospital Revenue Code	440
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.42
Rate for Payer: Cash Price	$0.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.92
Rate for Payer: Devoted Health Medicare	$0.42
Rate for Payer: Hawaii Medical Service Association Medicare	$0.42
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.42
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.42
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.42
Rate for Payer: Ohana Health Plan Medicare	$0.42
Rate for Payer: UnitedHealthcare Medicare	$0.42
Rate for Payer: University Health Alliance Commercial	$0.73

lansoprazole 30 mg DIS Tab [KMC]

Facility

$63.09

Service Code	NDC 16714018602
Hospital Revenue Code	250
Min. Negotiated Rate	$26.50
Max. Negotiated Rate	$61.20
Rate for Payer: AlohaCare Medicaid	$31.55
Rate for Payer: AlohaCare Medicare	$26.50
Rate for Payer: Cash Price	$41.01
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$58.04
Rate for Payer: Devoted Health Medicare	$26.50
Rate for Payer: Hawaii Medical Service Association Medicare	$26.50
Rate for Payer: Hawaii Western Management Group Commercial	$59.94
Rate for Payer: Health Management Network Commercial	$53.63
Rate for Payer: Humana Medicare	$26.50
Rate for Payer: Kaiser Permanente Commercial	$56.78
Rate for Payer: Kaiser Permanente Medicaid	$32.18
Rate for Payer: Kaiser Permanente Medicare	$26.50
Rate for Payer: MDX Hawaii PPO	$61.20
Rate for Payer: Ohana Health Plan Medicaid	$26.50
Rate for Payer: Ohana Health Plan Medicare	$26.50
Rate for Payer: UnitedHealthcare Medicaid	$37.85
Rate for Payer: UnitedHealthcare Medicare	$26.50
Rate for Payer: University Health Alliance Commercial	$45.99

lansoprazole 30 mg DIS Tab [KMC]

Facility

$63.09

Service Code	NDC 16714018602
Hospital Revenue Code	250
Min. Negotiated Rate	$53.63
Max. Negotiated Rate	$61.20
Rate for Payer: Cash Price	$41.01
Rate for Payer: Health Management Network Commercial	$53.63
Rate for Payer: Kaiser Permanente Commercial	$56.78
Rate for Payer: MDX Hawaii PPO	$61.20

lansoprazole 30 mg DR cap [KMC]

Facility

$23.38

Service Code	NDC 67877027590
Hospital Revenue Code	250
Min. Negotiated Rate	$19.87
Max. Negotiated Rate	$22.68
Rate for Payer: Cash Price	$15.20
Rate for Payer: Health Management Network Commercial	$19.87
Rate for Payer: Kaiser Permanente Commercial	$21.04
Rate for Payer: MDX Hawaii PPO	$22.68

lansoprazole 30 mg DR cap [KMC]

Facility

$23.38

Service Code	NDC 67877027590
Hospital Revenue Code	250
Min. Negotiated Rate	$9.82
Max. Negotiated Rate	$22.68
Rate for Payer: AlohaCare Medicaid	$11.69
Rate for Payer: AlohaCare Medicare	$9.82
Rate for Payer: Cash Price	$15.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$21.51
Rate for Payer: Devoted Health Medicare	$9.82
Rate for Payer: Hawaii Medical Service Association Medicare	$9.82
Rate for Payer: Hawaii Western Management Group Commercial	$22.21
Rate for Payer: Health Management Network Commercial	$19.87
Rate for Payer: Humana Medicare	$9.82
Rate for Payer: Kaiser Permanente Commercial	$21.04
Rate for Payer: Kaiser Permanente Medicaid	$11.92
Rate for Payer: Kaiser Permanente Medicare	$9.82
Rate for Payer: MDX Hawaii PPO	$22.68
Rate for Payer: Ohana Health Plan Medicaid	$9.82
Rate for Payer: Ohana Health Plan Medicare	$9.82
Rate for Payer: UnitedHealthcare Medicaid	$14.03
Rate for Payer: UnitedHealthcare Medicare	$9.82
Rate for Payer: University Health Alliance Commercial	$17.04

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC

Facility

$26,996.58

Service Code	MSDRG 418
Min. Negotiated Rate	$26,996.58
Max. Negotiated Rate	$26,996.58
Rate for Payer: Hawaii Medical Service Association Commercial	$26,996.58

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC

Facility

$29,603.80

Service Code	MSDRG 417
Min. Negotiated Rate	$29,603.80
Max. Negotiated Rate	$29,603.80
Rate for Payer: Hawaii Medical Service Association Commercial	$29,603.80

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$17,468.37

Service Code	MSDRG 419
Min. Negotiated Rate	$17,468.37
Max. Negotiated Rate	$17,468.37
Rate for Payer: Hawaii Medical Service Association Commercial	$17,468.37

LARYNGOSCOPY DIRECT DIAGNOSTIC EXCEPT NEWBORN

Facility

$6,211.00

Service Code	HCPCS 31525
Hospital Charge Code	440315250
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$6,024.67
Rate for Payer: AlohaCare Medicaid	$3,105.50
Rate for Payer: AlohaCare Medicare	$2,608.62
Rate for Payer: Cash Price	$4,037.15
Rate for Payer: Cash Price	$4,037.15
Rate for Payer: Cash Price	$4,037.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5,714.12
Rate for Payer: Devoted Health Medicare	$2,608.62
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,608.62
Rate for Payer: Hawaii Western Management Group Commercial	$5,900.45
Rate for Payer: Health Management Network Commercial	$5,279.35
Rate for Payer: Humana Medicare	$2,608.62
Rate for Payer: Kaiser Permanente Commercial	$5,589.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,608.62
Rate for Payer: MDX Hawaii PPO	$6,024.67
Rate for Payer: Ohana Health Plan Medicaid	$2,608.62
Rate for Payer: Ohana Health Plan Medicare	$2,608.62
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,608.62
Rate for Payer: University Health Alliance Commercial	$4,035.20

Know your out-of-pocket cost for care.

All Charges