Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM

Professional

Both

$0.01

Service Code	HCPCS 90620 SL
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$193.50
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$193.50
Rate for Payer: Health Management Network Commercial	$0.01

meningococcal B vaccine (Bexsero, MCV-B) 0.5 mL susp [KMC]

Facility

$1,438.87

Service Code	NDC 58160097606
Hospital Revenue Code	250
Min. Negotiated Rate	$604.33
Max. Negotiated Rate	$1,395.70
Rate for Payer: AlohaCare Medicaid	$719.43
Rate for Payer: AlohaCare Medicare	$604.33
Rate for Payer: Cash Price	$935.27
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,323.76
Rate for Payer: Devoted Health Medicare	$604.33
Rate for Payer: Hawaii Medical Service Association Medicare	$604.33
Rate for Payer: Hawaii Western Management Group Commercial	$1,366.93
Rate for Payer: Health Management Network Commercial	$1,223.04
Rate for Payer: Humana Medicare	$604.33
Rate for Payer: Kaiser Permanente Commercial	$1,294.98
Rate for Payer: Kaiser Permanente Medicaid	$733.82
Rate for Payer: Kaiser Permanente Medicare	$604.33
Rate for Payer: MDX Hawaii PPO	$1,395.70
Rate for Payer: Ohana Health Plan Medicaid	$604.33
Rate for Payer: Ohana Health Plan Medicare	$604.33
Rate for Payer: UnitedHealthcare Medicaid	$863.32
Rate for Payer: UnitedHealthcare Medicare	$604.33
Rate for Payer: University Health Alliance Commercial	$1,048.79

meningococcal B vaccine (Bexsero, MCV-B) 0.5 mL susp [KMC]

Facility

$1,438.87

Service Code	NDC 58160097606
Hospital Revenue Code	250
Min. Negotiated Rate	$1,223.04
Max. Negotiated Rate	$1,395.70
Rate for Payer: Cash Price	$935.27
Rate for Payer: Health Management Network Commercial	$1,223.04
Rate for Payer: Kaiser Permanente Commercial	$1,294.98
Rate for Payer: MDX Hawaii PPO	$1,395.70

meningococcal vaccine (Menveo, MCV) 0.5 mL inj [KMC]

Facility

$550.14

Service Code	NDC 58160095509
Hospital Revenue Code	250
Min. Negotiated Rate	$231.06
Max. Negotiated Rate	$533.64
Rate for Payer: AlohaCare Medicaid	$275.07
Rate for Payer: AlohaCare Medicare	$231.06
Rate for Payer: Cash Price	$357.59
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$506.13
Rate for Payer: Devoted Health Medicare	$231.06
Rate for Payer: Hawaii Medical Service Association Medicare	$231.06
Rate for Payer: Hawaii Western Management Group Commercial	$522.63
Rate for Payer: Health Management Network Commercial	$467.62
Rate for Payer: Humana Medicare	$231.06
Rate for Payer: Kaiser Permanente Commercial	$495.13
Rate for Payer: Kaiser Permanente Medicaid	$280.57
Rate for Payer: Kaiser Permanente Medicare	$231.06
Rate for Payer: MDX Hawaii PPO	$533.64
Rate for Payer: Ohana Health Plan Medicaid	$231.06
Rate for Payer: Ohana Health Plan Medicare	$231.06
Rate for Payer: UnitedHealthcare Medicaid	$330.08
Rate for Payer: UnitedHealthcare Medicare	$231.06
Rate for Payer: University Health Alliance Commercial	$401.00

meningococcal vaccine (Menveo, MCV) 0.5 mL inj [KMC]

Facility

$550.14

Service Code	NDC 58160095509
Hospital Revenue Code	250
Min. Negotiated Rate	$467.62
Max. Negotiated Rate	$533.64
Rate for Payer: Cash Price	$357.59
Rate for Payer: Health Management Network Commercial	$467.62
Rate for Payer: Kaiser Permanente Commercial	$495.13
Rate for Payer: MDX Hawaii PPO	$533.64

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC

Facility

$11,993.21

Service Code	MSDRG 760
Min. Negotiated Rate	$11,993.21
Max. Negotiated Rate	$11,993.21
Rate for Payer: Hawaii Medical Service Association Commercial	$11,993.21

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$11,993.21

Service Code	MSDRG 761
Min. Negotiated Rate	$11,993.21
Max. Negotiated Rate	$11,993.21
Rate for Payer: Hawaii Medical Service Association Commercial	$11,993.21

menthol, methyl salicylate (Muscle Rub) 10-15% Cream

Facility

$0.17

Service Code	NDC 45802017453
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.16
Rate for Payer: Cash Price	$0.11
Rate for Payer: Health Management Network Commercial	$0.14
Rate for Payer: Kaiser Permanente Commercial	$0.15
Rate for Payer: MDX Hawaii PPO	$0.16

menthol, methyl salicylate (Muscle Rub) 10-15% Cream

Facility

$0.17

Service Code	NDC 45802017453
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.16
Rate for Payer: AlohaCare Medicaid	$0.09
Rate for Payer: AlohaCare Medicare	$0.07
Rate for Payer: Cash Price	$0.11
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.16
Rate for Payer: Devoted Health Medicare	$0.07
Rate for Payer: Hawaii Medical Service Association Medicare	$0.07
Rate for Payer: Hawaii Western Management Group Commercial	$0.16
Rate for Payer: Health Management Network Commercial	$0.14
Rate for Payer: Humana Medicare	$0.07
Rate for Payer: Kaiser Permanente Commercial	$0.15
Rate for Payer: Kaiser Permanente Medicaid	$0.09
Rate for Payer: Kaiser Permanente Medicare	$0.07
Rate for Payer: MDX Hawaii PPO	$0.16
Rate for Payer: Ohana Health Plan Medicaid	$0.07
Rate for Payer: Ohana Health Plan Medicare	$0.07
Rate for Payer: UnitedHealthcare Medicaid	$0.10
Rate for Payer: UnitedHealthcare Medicare	$0.07
Rate for Payer: University Health Alliance Commercial	$0.12

menthol, zinc oxide 0.4%-20.6% (Calmoseptine) oint [KMC]

Facility

$0.31

Service Code	NDC 00799000104
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.30
Rate for Payer: AlohaCare Medicaid	$0.16
Rate for Payer: AlohaCare Medicare	$0.13
Rate for Payer: Cash Price	$0.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.29
Rate for Payer: Devoted Health Medicare	$0.13
Rate for Payer: Hawaii Medical Service Association Medicare	$0.13
Rate for Payer: Hawaii Western Management Group Commercial	$0.29
Rate for Payer: Health Management Network Commercial	$0.26
Rate for Payer: Humana Medicare	$0.13
Rate for Payer: Kaiser Permanente Commercial	$0.28
Rate for Payer: Kaiser Permanente Medicaid	$0.16
Rate for Payer: Kaiser Permanente Medicare	$0.13
Rate for Payer: MDX Hawaii PPO	$0.30
Rate for Payer: Ohana Health Plan Medicaid	$0.13
Rate for Payer: Ohana Health Plan Medicare	$0.13
Rate for Payer: UnitedHealthcare Medicaid	$0.19
Rate for Payer: UnitedHealthcare Medicare	$0.13
Rate for Payer: University Health Alliance Commercial	$0.23

menthol, zinc oxide 0.4%-20.6% (Calmoseptine) oint [KMC]

Facility

$0.31

Service Code	NDC 00799000104
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.30
Rate for Payer: Cash Price	$0.20
Rate for Payer: Health Management Network Commercial	$0.26
Rate for Payer: Kaiser Permanente Commercial	$0.28
Rate for Payer: MDX Hawaii PPO	$0.30

meperidine 50 mg/mL Inj Sol [KMC]

Facility

$10.21

Service Code	HCPCS J2175
Hospital Revenue Code	636
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$15.69
Rate for Payer: AlohaCare Medicaid	$5.11
Rate for Payer: AlohaCare Medicare	$4.29
Rate for Payer: Cash Price	$6.64
Rate for Payer: Cash Price	$6.64
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$9.39
Rate for Payer: Devoted Health Medicare	$4.29
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$15.69
Rate for Payer: Hawaii Medical Service Association Medicare	$4.29
Rate for Payer: Hawaii Western Management Group Commercial	$9.70
Rate for Payer: Health Management Network Commercial	$8.68
Rate for Payer: Humana Medicare	$4.29
Rate for Payer: Kaiser Permanente Commercial	$9.19
Rate for Payer: Kaiser Permanente Medicaid	$5.21
Rate for Payer: Kaiser Permanente Medicare	$4.29
Rate for Payer: MDX Hawaii PPO	$9.90
Rate for Payer: Ohana Health Plan Medicaid	$4.29
Rate for Payer: Ohana Health Plan Medicare	$4.29
Rate for Payer: UnitedHealthcare Medicaid	$6.13
Rate for Payer: UnitedHealthcare Medicare	$4.29
Rate for Payer: University Health Alliance Commercial	$7.44

meperidine 50 mg/mL Inj Sol [KMC]

Facility

$10.21

Service Code	HCPCS J2175
Hospital Revenue Code	636
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$9.90
Rate for Payer: Cash Price	$6.64
Rate for Payer: Health Management Network Commercial	$8.68
Rate for Payer: Kaiser Permanente Commercial	$9.19
Rate for Payer: MDX Hawaii PPO	$9.90

MEPILEX BORDER HEEL 8.7" X 9.1"

Facility

$2.00

Hospital Charge Code	8568
Hospital Revenue Code	270
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.30
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

MEPILEX BORDER HEEL 8.7" X 9.1"

Facility

$2.00

Hospital Charge Code	8568
Hospital Revenue Code	270
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$0.84
Rate for Payer: Cash Price	$1.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1.84
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.84
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$0.84
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$0.84
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$0.84
Rate for Payer: Ohana Health Plan Medicare	$0.84
Rate for Payer: UnitedHealthcare Medicare	$0.84
Rate for Payer: University Health Alliance Commercial	$1.46

MEPILEX BORDER SACRUM 6.3" X 7.9"

Facility

$2.00

Hospital Charge Code	8567
Hospital Revenue Code	270
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.30
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

MEPILEX BORDER SACRUM 6.3" X 7.9"

Facility

$2.00

Hospital Charge Code	8567
Hospital Revenue Code	270
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$0.84
Rate for Payer: Cash Price	$1.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1.84
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.84
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$0.84
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$0.84
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$0.84
Rate for Payer: Ohana Health Plan Medicare	$0.84
Rate for Payer: UnitedHealthcare Medicare	$0.84
Rate for Payer: University Health Alliance Commercial	$1.46

MERCURY DLS

Facility

$129.00

Service Code	HCPCS 83825
Hospital Charge Code	422838255
Hospital Revenue Code	300
Min. Negotiated Rate	$16.26
Max. Negotiated Rate	$125.13
Rate for Payer: AlohaCare Medicaid	$64.50
Rate for Payer: AlohaCare Medicare	$54.18
Rate for Payer: Cash Price	$83.85
Rate for Payer: Cash Price	$83.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$118.68
Rate for Payer: Devoted Health Medicare	$54.18
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$22.47
Rate for Payer: Hawaii Medical Service Association Commercial	$20.32
Rate for Payer: Hawaii Medical Service Association Medicare	$54.18
Rate for Payer: Hawaii Western Management Group Commercial	$16.26
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Humana Medicare	$54.18
Rate for Payer: Kaiser Permanente Commercial	$116.10
Rate for Payer: Kaiser Permanente Medicaid	$65.79
Rate for Payer: Kaiser Permanente Medicare	$54.18
Rate for Payer: MDX Hawaii PPO	$125.13
Rate for Payer: Ohana Health Plan Medicaid	$54.18
Rate for Payer: Ohana Health Plan Medicare	$54.18
Rate for Payer: UnitedHealthcare Medicaid	$22.47
Rate for Payer: UnitedHealthcare Medicare	$54.18
Rate for Payer: University Health Alliance Commercial	$42.03

MERCURY DLS

Facility

$129.00

Service Code	HCPCS 83825
Hospital Charge Code	422838255
Hospital Revenue Code	300
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$125.13
Rate for Payer: Cash Price	$83.85
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Kaiser Permanente Commercial	$116.10
Rate for Payer: MDX Hawaii PPO	$125.13

meropenem 1 g IV Inj [KMC]

Facility

$96.00

Service Code	HCPCS J2185
Hospital Revenue Code	636
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$62.40
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12

meropenem 1 g IV Inj [KMC]

Facility

$96.00

Service Code	HCPCS J2185
Hospital Revenue Code	636
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$93.12
Rate for Payer: AlohaCare Medicaid	$48.00
Rate for Payer: AlohaCare Medicare	$40.32
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$88.32
Rate for Payer: Devoted Health Medicare	$40.32
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.44
Rate for Payer: Hawaii Medical Service Association Medicare	$40.32
Rate for Payer: Hawaii Western Management Group Commercial	$91.20
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Humana Medicare	$40.32
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: Kaiser Permanente Medicare	$40.32
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: Ohana Health Plan Medicaid	$40.32
Rate for Payer: Ohana Health Plan Medicare	$40.32
Rate for Payer: UnitedHealthcare Medicaid	$57.60
Rate for Payer: UnitedHealthcare Medicare	$40.32
Rate for Payer: University Health Alliance Commercial	$69.97

meropenem 500 mg REC [KMC]

Facility

$48.00

Service Code	HCPCS J2185
Hospital Revenue Code	636
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$31.20
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: MDX Hawaii PPO	$46.56

meropenem 500 mg REC [KMC]

Facility

$48.00

Service Code	HCPCS J2185
Hospital Revenue Code	636
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$46.56
Rate for Payer: AlohaCare Medicaid	$24.00
Rate for Payer: AlohaCare Medicare	$20.16
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$44.16
Rate for Payer: Devoted Health Medicare	$20.16
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.44
Rate for Payer: Hawaii Medical Service Association Medicare	$20.16
Rate for Payer: Hawaii Western Management Group Commercial	$45.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Humana Medicare	$20.16
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: Kaiser Permanente Medicare	$20.16
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: Ohana Health Plan Medicaid	$20.16
Rate for Payer: Ohana Health Plan Medicare	$20.16
Rate for Payer: UnitedHealthcare Medicaid	$28.80
Rate for Payer: UnitedHealthcare Medicare	$20.16
Rate for Payer: University Health Alliance Commercial	$34.99

mesalamine 1.2 gm DR Tab [KMC]

Facility

$40.44

Service Code	NDC 68382071119
Hospital Revenue Code	250
Min. Negotiated Rate	$34.37
Max. Negotiated Rate	$39.23
Rate for Payer: Cash Price	$26.29
Rate for Payer: Health Management Network Commercial	$34.37
Rate for Payer: Kaiser Permanente Commercial	$36.40
Rate for Payer: MDX Hawaii PPO	$39.23

mesalamine 1.2 gm DR Tab [KMC]

Facility

$40.44

Service Code	NDC 68382071119
Hospital Revenue Code	250
Min. Negotiated Rate	$16.98
Max. Negotiated Rate	$39.23
Rate for Payer: AlohaCare Medicaid	$20.22
Rate for Payer: AlohaCare Medicare	$16.98
Rate for Payer: Cash Price	$26.29
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$37.20
Rate for Payer: Devoted Health Medicare	$16.98
Rate for Payer: Hawaii Medical Service Association Medicare	$16.98
Rate for Payer: Hawaii Western Management Group Commercial	$38.42
Rate for Payer: Health Management Network Commercial	$34.37
Rate for Payer: Humana Medicare	$16.98
Rate for Payer: Kaiser Permanente Commercial	$36.40
Rate for Payer: Kaiser Permanente Medicaid	$20.62
Rate for Payer: Kaiser Permanente Medicare	$16.98
Rate for Payer: MDX Hawaii PPO	$39.23
Rate for Payer: Ohana Health Plan Medicaid	$16.98
Rate for Payer: Ohana Health Plan Medicare	$16.98
Rate for Payer: UnitedHealthcare Medicaid	$24.26
Rate for Payer: UnitedHealthcare Medicare	$16.98
Rate for Payer: University Health Alliance Commercial	$29.48

Know your out-of-pocket cost for care.

All Charges