Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

LARYNGOSCOPY DIRECT DIAGNOSTIC EXCEPT NEWBORN

Facility

$6,211.00

Service Code	HCPCS 31525
Hospital Charge Code	440315250
Hospital Revenue Code	450
Min. Negotiated Rate	$5,279.35
Max. Negotiated Rate	$6,024.67
Rate for Payer: Cash Price	$4,037.15
Rate for Payer: Health Management Network Commercial	$5,279.35
Rate for Payer: Kaiser Permanente Commercial	$5,589.90
Rate for Payer: MDX Hawaii PPO	$6,024.67

LARYNGOSCOPY DIRECT W/WO TRACH Charge

Facility

$6,211.00

Service Code	HCPCS 31515
Hospital Charge Code	440315150
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 Medicare	$2,608.62
Rate for Payer: University Health Alliance Commercial	$4,035.20

LARYNGOSCOPY DIRECT W/WO TRACH Charge

Facility

$6,211.00

Service Code	HCPCS 31515
Hospital Charge Code	440315150
Hospital Revenue Code	450
Min. Negotiated Rate	$5,279.35
Max. Negotiated Rate	$6,024.67
Rate for Payer: Cash Price	$4,037.15
Rate for Payer: Health Management Network Commercial	$5,279.35
Rate for Payer: Kaiser Permanente Commercial	$5,589.90
Rate for Payer: MDX Hawaii PPO	$6,024.67

LARYNGOSCOPY INDIRECT DIAGNOSTIC CHARGE

Facility

$769.00

Service Code	HCPCS 31505
Hospital Charge Code	440315050
Hospital Revenue Code	450
Min. Negotiated Rate	$653.65
Max. Negotiated Rate	$745.93
Rate for Payer: Cash Price	$499.85
Rate for Payer: Health Management Network Commercial	$653.65
Rate for Payer: Kaiser Permanente Commercial	$692.10
Rate for Payer: MDX Hawaii PPO	$745.93

LARYNGOSCOPY INDIRECT DIAGNOSTIC CHARGE

Facility

$769.00

Service Code	HCPCS 31505
Hospital Charge Code	440315050
Hospital Revenue Code	450
Min. Negotiated Rate	$322.98
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$384.50
Rate for Payer: AlohaCare Medicare	$322.98
Rate for Payer: Cash Price	$499.85
Rate for Payer: Cash Price	$499.85
Rate for Payer: Cash Price	$499.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$707.48
Rate for Payer: Devoted Health Medicare	$322.98
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	$322.98
Rate for Payer: Hawaii Western Management Group Commercial	$730.55
Rate for Payer: Health Management Network Commercial	$653.65
Rate for Payer: Humana Medicare	$322.98
Rate for Payer: Kaiser Permanente Commercial	$692.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$322.98
Rate for Payer: MDX Hawaii PPO	$745.93
Rate for Payer: Ohana Health Plan Medicaid	$322.98
Rate for Payer: Ohana Health Plan Medicare	$322.98
Rate for Payer: UnitedHealthcare Medicare	$322.98
Rate for Payer: University Health Alliance Commercial	$560.52

LARYNGOSCOPY W/R FB ED Charge

Facility

$769.00

Service Code	HCPCS 31511
Hospital Charge Code	440315110
Hospital Revenue Code	450
Min. Negotiated Rate	$653.65
Max. Negotiated Rate	$745.93
Rate for Payer: Cash Price	$499.85
Rate for Payer: Health Management Network Commercial	$653.65
Rate for Payer: Kaiser Permanente Commercial	$692.10
Rate for Payer: MDX Hawaii PPO	$745.93

LARYNGOSCOPY W/R FB ED Charge

Facility

$769.00

Service Code	HCPCS 31511
Hospital Charge Code	440315110
Hospital Revenue Code	450
Min. Negotiated Rate	$322.98
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$384.50
Rate for Payer: AlohaCare Medicare	$322.98
Rate for Payer: Cash Price	$499.85
Rate for Payer: Cash Price	$499.85
Rate for Payer: Cash Price	$499.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$707.48
Rate for Payer: Devoted Health Medicare	$322.98
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	$322.98
Rate for Payer: Hawaii Western Management Group Commercial	$730.55
Rate for Payer: Health Management Network Commercial	$653.65
Rate for Payer: Humana Medicare	$322.98
Rate for Payer: Kaiser Permanente Commercial	$692.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$322.98
Rate for Payer: MDX Hawaii PPO	$745.93
Rate for Payer: Ohana Health Plan Medicaid	$322.98
Rate for Payer: Ohana Health Plan Medicare	$322.98
Rate for Payer: UnitedHealthcare Medicare	$322.98
Rate for Payer: University Health Alliance Commercial	$560.52

latanoprostene bunod ophthalmic 0.024% Soln [KMC]

Facility

$436.32

Service Code	NDC 24208050402
Hospital Revenue Code	250
Min. Negotiated Rate	$370.87
Max. Negotiated Rate	$423.23
Rate for Payer: Cash Price	$283.61
Rate for Payer: Health Management Network Commercial	$370.87
Rate for Payer: Kaiser Permanente Commercial	$392.69
Rate for Payer: MDX Hawaii PPO	$423.23

latanoprostene bunod ophthalmic 0.024% Soln [KMC]

Facility

$436.32

Service Code	NDC 24208050402
Hospital Revenue Code	250
Min. Negotiated Rate	$183.25
Max. Negotiated Rate	$423.23
Rate for Payer: AlohaCare Medicaid	$218.16
Rate for Payer: AlohaCare Medicare	$183.25
Rate for Payer: Cash Price	$283.61
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$401.41
Rate for Payer: Devoted Health Medicare	$183.25
Rate for Payer: Hawaii Medical Service Association Medicare	$183.25
Rate for Payer: Hawaii Western Management Group Commercial	$414.50
Rate for Payer: Health Management Network Commercial	$370.87
Rate for Payer: Humana Medicare	$183.25
Rate for Payer: Kaiser Permanente Commercial	$392.69
Rate for Payer: Kaiser Permanente Medicaid	$222.52
Rate for Payer: Kaiser Permanente Medicare	$183.25
Rate for Payer: MDX Hawaii PPO	$423.23
Rate for Payer: Ohana Health Plan Medicaid	$183.25
Rate for Payer: Ohana Health Plan Medicare	$183.25
Rate for Payer: UnitedHealthcare Medicaid	$261.79
Rate for Payer: UnitedHealthcare Medicare	$183.25
Rate for Payer: University Health Alliance Commercial	$318.03

latanoprost-netarsudil 0.005-0.02% eye drops [KMC]

Facility

$678.91

Service Code	NDC 70727052925
Hospital Revenue Code	250
Min. Negotiated Rate	$577.07
Max. Negotiated Rate	$658.54
Rate for Payer: Cash Price	$441.29
Rate for Payer: Health Management Network Commercial	$577.07
Rate for Payer: Kaiser Permanente Commercial	$611.02
Rate for Payer: MDX Hawaii PPO	$658.54

latanoprost-netarsudil 0.005-0.02% eye drops [KMC]

Facility

$678.91

Service Code	NDC 70727052925
Hospital Revenue Code	250
Min. Negotiated Rate	$285.14
Max. Negotiated Rate	$658.54
Rate for Payer: AlohaCare Medicaid	$339.45
Rate for Payer: AlohaCare Medicare	$285.14
Rate for Payer: Cash Price	$441.29
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$624.60
Rate for Payer: Devoted Health Medicare	$285.14
Rate for Payer: Hawaii Medical Service Association Medicare	$285.14
Rate for Payer: Hawaii Western Management Group Commercial	$644.96
Rate for Payer: Health Management Network Commercial	$577.07
Rate for Payer: Humana Medicare	$285.14
Rate for Payer: Kaiser Permanente Commercial	$611.02
Rate for Payer: Kaiser Permanente Medicaid	$346.24
Rate for Payer: Kaiser Permanente Medicare	$285.14
Rate for Payer: MDX Hawaii PPO	$658.54
Rate for Payer: Ohana Health Plan Medicaid	$285.14
Rate for Payer: Ohana Health Plan Medicare	$285.14
Rate for Payer: UnitedHealthcare Medicaid	$407.35
Rate for Payer: UnitedHealthcare Medicare	$285.14
Rate for Payer: University Health Alliance Commercial	$494.86

latanoprost Ophth 0.005% Sol [KMC]

Facility

$152.00

Service Code	NDC 70069042101
Hospital Revenue Code	250
Min. Negotiated Rate	$63.84
Max. Negotiated Rate	$147.44
Rate for Payer: AlohaCare Medicaid	$76.00
Rate for Payer: AlohaCare Medicare	$63.84
Rate for Payer: Cash Price	$98.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$139.84
Rate for Payer: Devoted Health Medicare	$63.84
Rate for Payer: Hawaii Medical Service Association Medicare	$63.84
Rate for Payer: Hawaii Western Management Group Commercial	$144.40
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Humana Medicare	$63.84
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: Kaiser Permanente Medicaid	$77.52
Rate for Payer: Kaiser Permanente Medicare	$63.84
Rate for Payer: MDX Hawaii PPO	$147.44
Rate for Payer: Ohana Health Plan Medicaid	$63.84
Rate for Payer: Ohana Health Plan Medicare	$63.84
Rate for Payer: UnitedHealthcare Medicaid	$91.20
Rate for Payer: UnitedHealthcare Medicare	$63.84
Rate for Payer: University Health Alliance Commercial	$110.79

latanoprost Ophth 0.005% Sol [KMC]

Facility

$152.00

Service Code	NDC 70069042101
Hospital Revenue Code	250
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$98.80
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: MDX Hawaii PPO	$147.44

LATEX PENROSE TUBING 3/8"X18"

Facility

$7.00

Hospital Charge Code	8170
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

LATEX PENROSE TUBING 3/8"X18"

Facility

$7.00

Hospital Charge Code	8170
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

LDH, Total DLS

Facility

$82.00

Service Code	HCPCS 83615
Hospital Charge Code	422836155
Hospital Revenue Code	301
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$79.54
Rate for Payer: AlohaCare Medicaid	$41.00
Rate for Payer: AlohaCare Medicare	$34.44
Rate for Payer: Cash Price	$53.30
Rate for Payer: Cash Price	$53.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$75.44
Rate for Payer: Devoted Health Medicare	$34.44
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$8.35
Rate for Payer: Hawaii Medical Service Association Commercial	$7.55
Rate for Payer: Hawaii Medical Service Association Medicare	$34.44
Rate for Payer: Hawaii Western Management Group Commercial	$6.04
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Humana Medicare	$34.44
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: Kaiser Permanente Medicaid	$41.82
Rate for Payer: Kaiser Permanente Medicare	$34.44
Rate for Payer: MDX Hawaii PPO	$79.54
Rate for Payer: Ohana Health Plan Medicaid	$34.44
Rate for Payer: Ohana Health Plan Medicare	$34.44
Rate for Payer: UnitedHealthcare Medicaid	$8.35
Rate for Payer: UnitedHealthcare Medicare	$34.44
Rate for Payer: University Health Alliance Commercial	$15.61

LDH, Total DLS

Facility

$82.00

Service Code	HCPCS 83615
Hospital Charge Code	422836155
Hospital Revenue Code	301
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$53.30
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: MDX Hawaii PPO	$79.54

LDL-Cholesterol, Direct DLS

Facility

$38.00

Service Code	HCPCS 83721
Hospital Charge Code	422837215
Hospital Revenue Code	301
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$24.70
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Kaiser Permanente Commercial	$34.20
Rate for Payer: MDX Hawaii PPO	$36.86

LDL-Cholesterol, Direct DLS

Facility

$38.00

Service Code	HCPCS 83721
Hospital Charge Code	422837215
Hospital Revenue Code	301
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$36.86
Rate for Payer: AlohaCare Medicaid	$19.00
Rate for Payer: AlohaCare Medicare	$15.96
Rate for Payer: Cash Price	$24.70
Rate for Payer: Cash Price	$24.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$34.96
Rate for Payer: Devoted Health Medicare	$15.96
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$13.18
Rate for Payer: Hawaii Medical Service Association Commercial	$13.12
Rate for Payer: Hawaii Medical Service Association Medicare	$15.96
Rate for Payer: Hawaii Western Management Group Commercial	$10.50
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Humana Medicare	$15.96
Rate for Payer: Kaiser Permanente Commercial	$34.20
Rate for Payer: Kaiser Permanente Medicaid	$19.38
Rate for Payer: Kaiser Permanente Medicare	$15.96
Rate for Payer: MDX Hawaii PPO	$36.86
Rate for Payer: Ohana Health Plan Medicaid	$15.96
Rate for Payer: Ohana Health Plan Medicare	$15.96
Rate for Payer: UnitedHealthcare Medicaid	$13.18
Rate for Payer: UnitedHealthcare Medicare	$15.96
Rate for Payer: University Health Alliance Commercial	$24.66

Lead, Blood: DLS

Facility

$134.00

Service Code	HCPCS 83655
Hospital Charge Code	422836555
Hospital Revenue Code	301
Min. Negotiated Rate	$113.90
Max. Negotiated Rate	$129.98
Rate for Payer: Cash Price	$87.10
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: MDX Hawaii PPO	$129.98

Lead, Blood: DLS

Facility

$134.00

Service Code	HCPCS 83655
Hospital Charge Code	422836555
Hospital Revenue Code	301
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$129.98
Rate for Payer: AlohaCare Medicaid	$67.00
Rate for Payer: AlohaCare Medicare	$56.28
Rate for Payer: Cash Price	$87.10
Rate for Payer: Cash Price	$87.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$123.28
Rate for Payer: Devoted Health Medicare	$56.28
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$16.72
Rate for Payer: Hawaii Medical Service Association Commercial	$15.14
Rate for Payer: Hawaii Medical Service Association Medicare	$56.28
Rate for Payer: Hawaii Western Management Group Commercial	$12.11
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Humana Medicare	$56.28
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: Kaiser Permanente Medicaid	$68.34
Rate for Payer: Kaiser Permanente Medicare	$56.28
Rate for Payer: MDX Hawaii PPO	$129.98
Rate for Payer: Ohana Health Plan Medicaid	$56.28
Rate for Payer: Ohana Health Plan Medicare	$56.28
Rate for Payer: UnitedHealthcare Medicaid	$16.72
Rate for Payer: UnitedHealthcare Medicare	$56.28
Rate for Payer: University Health Alliance Commercial	$31.28

leflunomide 10 mg Tab [KMC]

Facility

$12.80

Service Code	NDC 70748012906
Hospital Revenue Code	250
Min. Negotiated Rate	$5.38
Max. Negotiated Rate	$12.42
Rate for Payer: AlohaCare Medicaid	$6.40
Rate for Payer: AlohaCare Medicare	$5.38
Rate for Payer: Cash Price	$8.32
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$11.78
Rate for Payer: Devoted Health Medicare	$5.38
Rate for Payer: Hawaii Medical Service Association Medicare	$5.38
Rate for Payer: Hawaii Western Management Group Commercial	$12.16
Rate for Payer: Health Management Network Commercial	$10.88
Rate for Payer: Humana Medicare	$5.38
Rate for Payer: Kaiser Permanente Commercial	$11.52
Rate for Payer: Kaiser Permanente Medicaid	$6.53
Rate for Payer: Kaiser Permanente Medicare	$5.38
Rate for Payer: MDX Hawaii PPO	$12.42
Rate for Payer: Ohana Health Plan Medicaid	$5.38
Rate for Payer: Ohana Health Plan Medicare	$5.38
Rate for Payer: UnitedHealthcare Medicaid	$7.68
Rate for Payer: UnitedHealthcare Medicare	$5.38
Rate for Payer: University Health Alliance Commercial	$9.33

leflunomide 10 mg Tab [KMC]

Facility

$12.80

Service Code	NDC 70748012906
Hospital Revenue Code	250
Min. Negotiated Rate	$10.88
Max. Negotiated Rate	$12.42
Rate for Payer: Cash Price	$8.32
Rate for Payer: Health Management Network Commercial	$10.88
Rate for Payer: Kaiser Permanente Commercial	$11.52
Rate for Payer: MDX Hawaii PPO	$12.42

Leptospira Antibody, IgM DLS

Facility

$138.00

Service Code	HCPCS 86720
Hospital Charge Code	422867205
Hospital Revenue Code	301
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$133.86
Rate for Payer: AlohaCare Medicaid	$69.00
Rate for Payer: AlohaCare Medicare	$57.96
Rate for Payer: Cash Price	$89.70
Rate for Payer: Cash Price	$89.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$126.96
Rate for Payer: Devoted Health Medicare	$57.96
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.23
Rate for Payer: Hawaii Medical Service Association Commercial	$20.25
Rate for Payer: Hawaii Medical Service Association Medicare	$57.96
Rate for Payer: Hawaii Western Management Group Commercial	$16.20
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Humana Medicare	$57.96
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: Kaiser Permanente Medicaid	$70.38
Rate for Payer: Kaiser Permanente Medicare	$57.96
Rate for Payer: MDX Hawaii PPO	$133.86
Rate for Payer: Ohana Health Plan Medicaid	$57.96
Rate for Payer: Ohana Health Plan Medicare	$57.96
Rate for Payer: UnitedHealthcare Medicaid	$18.23
Rate for Payer: UnitedHealthcare Medicare	$57.96
Rate for Payer: University Health Alliance Commercial	$34.10

Leptospira Antibody, IgM DLS

Facility

$138.00

Service Code	HCPCS 86720
Hospital Charge Code	422867205
Hospital Revenue Code	301
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$89.70
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: MDX Hawaii PPO	$133.86

Know your out-of-pocket cost for care.

All Charges