Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

MD REPAIR MOUTH>2.5cm Charge

Facility

$2,784.00

Service Code	HCPCS 40831
Hospital Charge Code	440408310
Hospital Revenue Code	450
Min. Negotiated Rate	$2,366.40
Max. Negotiated Rate	$2,700.48
Rate for Payer: Cash Price	$1,809.60
Rate for Payer: Health Management Network Commercial	$2,366.40
Rate for Payer: Kaiser Permanente Commercial	$2,505.60
Rate for Payer: MDX Hawaii PPO	$2,700.48

MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ

Professional

Both

$0.01

Service Code	HCPCS 90710 SL
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$230.98
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$230.98
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Ohana Health Plan Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicaid	$4.00

MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ

Professional

Both

$330.00

Service Code	HCPCS 90710
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$280.50
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: Cash Price	$214.50
Rate for Payer: Cash Price	$214.50
Rate for Payer: Hawaii Western Management Group Commercial	$230.98
Rate for Payer: Health Management Network Commercial	$280.50
Rate for Payer: Ohana Health Plan Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicaid	$4.00

MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ

Professional

Both

$345.00

Service Code	HCPCS 90707
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$293.25
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: Cash Price	$224.25
Rate for Payer: Cash Price	$224.25
Rate for Payer: Hawaii Western Management Group Commercial	$80.64
Rate for Payer: Health Management Network Commercial	$293.25
Rate for Payer: Ohana Health Plan Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicaid	$4.00

MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ

Professional

Both

$0.01

Service Code	HCPCS 90707 SL
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$80.64
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$80.64
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Ohana Health Plan Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicaid	$4.00

meclizine 12.5 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 70710116101
Hospital Revenue Code	250
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 Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

meclizine 12.5 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 70710116101
Hospital Revenue Code	250
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

MEDIAL CLSD TX W/MANIPULATION Charge

Facility

$6,394.00

Service Code	HCPCS 27762
Hospital Charge Code	440277620
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$6,202.18
Rate for Payer: AlohaCare Medicaid	$3,197.00
Rate for Payer: AlohaCare Medicare	$2,685.48
Rate for Payer: Cash Price	$4,156.10
Rate for Payer: Cash Price	$4,156.10
Rate for Payer: Cash Price	$4,156.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5,882.48
Rate for Payer: Devoted Health Medicare	$2,685.48
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	$2,685.48
Rate for Payer: Hawaii Western Management Group Commercial	$6,074.30
Rate for Payer: Health Management Network Commercial	$5,434.90
Rate for Payer: Humana Medicare	$2,685.48
Rate for Payer: Kaiser Permanente Commercial	$5,754.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,685.48
Rate for Payer: MDX Hawaii PPO	$6,202.18
Rate for Payer: Ohana Health Plan Medicaid	$2,685.48
Rate for Payer: Ohana Health Plan Medicare	$2,685.48
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,685.48
Rate for Payer: University Health Alliance Commercial	$4,660.59

MEDIAL CLSD TX W/MANIPULATION Charge

Facility

$6,394.00

Service Code	HCPCS 27762
Hospital Charge Code	440277620
Hospital Revenue Code	450
Min. Negotiated Rate	$5,434.90
Max. Negotiated Rate	$6,202.18
Rate for Payer: Cash Price	$4,156.10
Rate for Payer: Health Management Network Commercial	$5,434.90
Rate for Payer: Kaiser Permanente Commercial	$5,754.60
Rate for Payer: MDX Hawaii PPO	$6,202.18

MEDICAL BACK PROBLEMS WITH MCC

Facility

$14,647.84

Service Code	MSDRG 551
Min. Negotiated Rate	$14,647.84
Max. Negotiated Rate	$14,647.84
Rate for Payer: Hawaii Medical Service Association Commercial	$14,647.84

MEDICAL BACK PROBLEMS WITHOUT MCC

Facility

$14,647.84

Service Code	MSDRG 552
Min. Negotiated Rate	$14,647.84
Max. Negotiated Rate	$14,647.84
Rate for Payer: Hawaii Medical Service Association Commercial	$14,647.84

MEDICATION LIST DOCUMENTED IN MEDICAL RECORD

Professional

Both

$0.01

Service Code	HCPCS 1159F
Hospital Revenue Code	521
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$290.48
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$273.13

MEDIHONEY 4X5

Facility

$18.00

Hospital Charge Code	8421
Hospital Revenue Code	270
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$11.70
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: MDX Hawaii PPO	$17.46

MEDIHONEY 4X5

Facility

$18.00

Hospital Charge Code	8421
Hospital Revenue Code	270
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$17.46
Rate for Payer: AlohaCare Medicaid	$9.00
Rate for Payer: AlohaCare Medicare	$7.56
Rate for Payer: Cash Price	$11.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$16.56
Rate for Payer: Devoted Health Medicare	$7.56
Rate for Payer: Hawaii Medical Service Association Medicare	$7.56
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Humana Medicare	$7.56
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: Kaiser Permanente Medicare	$7.56
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: Ohana Health Plan Medicaid	$7.56
Rate for Payer: Ohana Health Plan Medicare	$7.56
Rate for Payer: UnitedHealthcare Medicare	$7.56
Rate for Payer: University Health Alliance Commercial	$13.12

MEDIHONEY [KMC]

Facility

$3.00

Service Code	NDC 09958033601
Hospital Revenue Code	250
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

MEDIHONEY [KMC]

Facility

$3.00

Service Code	NDC 09958033601
Hospital Revenue Code	250
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 Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

medroxyPROGESTERone 10 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00555077902
Hospital Revenue Code	250
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

medroxyPROGESTERone 10 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00555077902
Hospital Revenue Code	250
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 Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

medroxyPROGESTERone 150 mg/mL Susp [KMC]

Facility

$216.00

Service Code	HCPCS J1050
Hospital Revenue Code	636
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$209.52
Rate for Payer: AlohaCare Medicaid	$108.00
Rate for Payer: AlohaCare Medicare	$90.72
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$198.72
Rate for Payer: Devoted Health Medicare	$90.72
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.57
Rate for Payer: Hawaii Medical Service Association Medicare	$90.72
Rate for Payer: Hawaii Western Management Group Commercial	$205.20
Rate for Payer: Health Management Network Commercial	$183.60
Rate for Payer: Humana Medicare	$90.72
Rate for Payer: Kaiser Permanente Commercial	$194.40
Rate for Payer: Kaiser Permanente Medicaid	$110.16
Rate for Payer: Kaiser Permanente Medicare	$90.72
Rate for Payer: MDX Hawaii PPO	$209.52
Rate for Payer: Ohana Health Plan Medicaid	$90.72
Rate for Payer: Ohana Health Plan Medicare	$90.72
Rate for Payer: UnitedHealthcare Medicaid	$129.60
Rate for Payer: UnitedHealthcare Medicare	$90.72
Rate for Payer: University Health Alliance Commercial	$157.44

medroxyPROGESTERone 150 mg/mL Susp [KMC]

Facility

$216.00

Service Code	HCPCS J1050
Hospital Revenue Code	636
Min. Negotiated Rate	$183.60
Max. Negotiated Rate	$209.52
Rate for Payer: Cash Price	$140.40
Rate for Payer: Health Management Network Commercial	$183.60
Rate for Payer: Kaiser Permanente Commercial	$194.40
Rate for Payer: MDX Hawaii PPO	$209.52

megestrol 200 mg/5 mL Susp [KMC]

Facility

$2.40

Service Code	NDC 70954089610
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$2.33
Rate for Payer: AlohaCare Medicaid	$1.20
Rate for Payer: AlohaCare Medicare	$1.01
Rate for Payer: Cash Price	$1.56
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.21
Rate for Payer: Devoted Health Medicare	$1.01
Rate for Payer: Hawaii Medical Service Association Medicare	$1.01
Rate for Payer: Hawaii Western Management Group Commercial	$2.28
Rate for Payer: Health Management Network Commercial	$2.04
Rate for Payer: Humana Medicare	$1.01
Rate for Payer: Kaiser Permanente Commercial	$2.16
Rate for Payer: Kaiser Permanente Medicaid	$1.22
Rate for Payer: Kaiser Permanente Medicare	$1.01
Rate for Payer: MDX Hawaii PPO	$2.33
Rate for Payer: Ohana Health Plan Medicaid	$1.01
Rate for Payer: Ohana Health Plan Medicare	$1.01
Rate for Payer: UnitedHealthcare Medicaid	$1.44
Rate for Payer: UnitedHealthcare Medicare	$1.01
Rate for Payer: University Health Alliance Commercial	$1.75

megestrol 200 mg/5 mL Susp [KMC]

Facility

$2.40

Service Code	NDC 70954089610
Hospital Revenue Code	250
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$2.33
Rate for Payer: Cash Price	$1.56
Rate for Payer: Health Management Network Commercial	$2.04
Rate for Payer: Kaiser Permanente Commercial	$2.16
Rate for Payer: MDX Hawaii PPO	$2.33

megestrol 40 mg Tab [KMC]

Facility

$6.83

Service Code	NDC 00555060702
Hospital Revenue Code	250
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$6.63
Rate for Payer: AlohaCare Medicaid	$3.42
Rate for Payer: AlohaCare Medicare	$2.87
Rate for Payer: Cash Price	$4.44
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6.28
Rate for Payer: Devoted Health Medicare	$2.87
Rate for Payer: Hawaii Medical Service Association Medicare	$2.87
Rate for Payer: Hawaii Western Management Group Commercial	$6.49
Rate for Payer: Health Management Network Commercial	$5.81
Rate for Payer: Humana Medicare	$2.87
Rate for Payer: Kaiser Permanente Commercial	$6.15
Rate for Payer: Kaiser Permanente Medicaid	$3.48
Rate for Payer: Kaiser Permanente Medicare	$2.87
Rate for Payer: MDX Hawaii PPO	$6.63
Rate for Payer: Ohana Health Plan Medicaid	$2.87
Rate for Payer: Ohana Health Plan Medicare	$2.87
Rate for Payer: UnitedHealthcare Medicaid	$4.10
Rate for Payer: UnitedHealthcare Medicare	$2.87
Rate for Payer: University Health Alliance Commercial	$4.98

megestrol 40 mg Tab [KMC]

Facility

$6.83

Service Code	NDC 00555060702
Hospital Revenue Code	250
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$6.63
Rate for Payer: Cash Price	$4.44
Rate for Payer: Health Management Network Commercial	$5.81
Rate for Payer: Kaiser Permanente Commercial	$6.15
Rate for Payer: MDX Hawaii PPO	$6.63

melatonin 3 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 50268052415
Hospital Revenue Code	250
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

Know your out-of-pocket cost for care.

All Charges