Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

MOTOR SPEECH GOAL STATUS Speech

Facility

$1.00

Service Code	HCPCS G9186 GN
Hospital Charge Code	432G91860
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

MOUTH PROCEDURES WITH CC/MCC

Facility

$59,776.44

Service Code	MSDRG 137
Min. Negotiated Rate	$59,776.44
Max. Negotiated Rate	$59,776.44
Rate for Payer: Hawaii Medical Service Association Commercial	$59,776.44

MOUTH PROCEDURES WITHOUT CC/MCC

Facility

$31,760.68

Service Code	MSDRG 138
Min. Negotiated Rate	$31,760.68
Max. Negotiated Rate	$31,760.68
Rate for Payer: Hawaii Medical Service Association Commercial	$31,760.68

moxifloxacin 400 mg/250 mL Sol [KMC]

Facility

$0.88

Service Code	HCPCS J2280
Hospital Revenue Code	636
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$8.71
Rate for Payer: AlohaCare Medicaid	$0.44
Rate for Payer: AlohaCare Medicare	$0.37
Rate for Payer: Cash Price	$0.57
Rate for Payer: Cash Price	$0.57
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.81
Rate for Payer: Devoted Health Medicare	$0.37
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$8.71
Rate for Payer: Hawaii Medical Service Association Medicare	$0.37
Rate for Payer: Hawaii Western Management Group Commercial	$0.84
Rate for Payer: Health Management Network Commercial	$0.75
Rate for Payer: Humana Medicare	$0.37
Rate for Payer: Kaiser Permanente Commercial	$0.79
Rate for Payer: Kaiser Permanente Medicaid	$0.45
Rate for Payer: Kaiser Permanente Medicare	$0.37
Rate for Payer: MDX Hawaii PPO	$0.85
Rate for Payer: Ohana Health Plan Medicaid	$0.37
Rate for Payer: Ohana Health Plan Medicare	$0.37
Rate for Payer: UnitedHealthcare Medicaid	$0.53
Rate for Payer: UnitedHealthcare Medicare	$0.37
Rate for Payer: University Health Alliance Commercial	$0.64

moxifloxacin 400 mg/250 mL Sol [KMC]

Facility

$0.88

Service Code	HCPCS J2280
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.85
Rate for Payer: Cash Price	$0.57
Rate for Payer: Health Management Network Commercial	$0.75
Rate for Payer: Kaiser Permanente Commercial	$0.79
Rate for Payer: MDX Hawaii PPO	$0.85

moxifloxacin 400 mg Tab [KMC]

Facility

$108.78

Service Code	NDC 55111011230
Hospital Revenue Code	250
Min. Negotiated Rate	$92.46
Max. Negotiated Rate	$105.52
Rate for Payer: Cash Price	$70.71
Rate for Payer: Health Management Network Commercial	$92.46
Rate for Payer: Kaiser Permanente Commercial	$97.90
Rate for Payer: MDX Hawaii PPO	$105.52

moxifloxacin 400 mg Tab [KMC]

Facility

$108.78

Service Code	NDC 55111011230
Hospital Revenue Code	250
Min. Negotiated Rate	$45.69
Max. Negotiated Rate	$105.52
Rate for Payer: AlohaCare Medicaid	$54.39
Rate for Payer: AlohaCare Medicare	$45.69
Rate for Payer: Cash Price	$70.71
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$100.08
Rate for Payer: Devoted Health Medicare	$45.69
Rate for Payer: Hawaii Medical Service Association Medicare	$45.69
Rate for Payer: Hawaii Western Management Group Commercial	$103.34
Rate for Payer: Health Management Network Commercial	$92.46
Rate for Payer: Humana Medicare	$45.69
Rate for Payer: Kaiser Permanente Commercial	$97.90
Rate for Payer: Kaiser Permanente Medicaid	$55.48
Rate for Payer: Kaiser Permanente Medicare	$45.69
Rate for Payer: MDX Hawaii PPO	$105.52
Rate for Payer: Ohana Health Plan Medicaid	$45.69
Rate for Payer: Ohana Health Plan Medicare	$45.69
Rate for Payer: UnitedHealthcare Medicaid	$65.27
Rate for Payer: UnitedHealthcare Medicare	$45.69
Rate for Payer: University Health Alliance Commercial	$79.29

moxifloxacin ophthalmic 0.5% Sol [KMC]

Facility

$278.59

Service Code	NDC 00065401303
Hospital Revenue Code	250
Min. Negotiated Rate	$236.80
Max. Negotiated Rate	$270.23
Rate for Payer: Cash Price	$181.08
Rate for Payer: Health Management Network Commercial	$236.80
Rate for Payer: Kaiser Permanente Commercial	$250.73
Rate for Payer: MDX Hawaii PPO	$270.23

moxifloxacin ophthalmic 0.5% Sol [KMC]

Facility

$278.59

Service Code	NDC 00065401303
Hospital Revenue Code	250
Min. Negotiated Rate	$117.01
Max. Negotiated Rate	$270.23
Rate for Payer: AlohaCare Medicaid	$139.29
Rate for Payer: AlohaCare Medicare	$117.01
Rate for Payer: Cash Price	$181.08
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$256.30
Rate for Payer: Devoted Health Medicare	$117.01
Rate for Payer: Hawaii Medical Service Association Medicare	$117.01
Rate for Payer: Hawaii Western Management Group Commercial	$264.66
Rate for Payer: Health Management Network Commercial	$236.80
Rate for Payer: Humana Medicare	$117.01
Rate for Payer: Kaiser Permanente Commercial	$250.73
Rate for Payer: Kaiser Permanente Medicaid	$142.08
Rate for Payer: Kaiser Permanente Medicare	$117.01
Rate for Payer: MDX Hawaii PPO	$270.23
Rate for Payer: Ohana Health Plan Medicaid	$117.01
Rate for Payer: Ohana Health Plan Medicare	$117.01
Rate for Payer: UnitedHealthcare Medicaid	$167.15
Rate for Payer: UnitedHealthcare Medicare	$117.01
Rate for Payer: University Health Alliance Commercial	$203.06

MRSA Culture Screen DLS

Facility

$122.00

Service Code	HCPCS 87081
Hospital Charge Code	422870815
Hospital Revenue Code	306
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$118.34
Rate for Payer: AlohaCare Medicaid	$61.00
Rate for Payer: AlohaCare Medicare	$51.24
Rate for Payer: Cash Price	$79.30
Rate for Payer: Cash Price	$79.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$112.24
Rate for Payer: Devoted Health Medicare	$51.24
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$9.16
Rate for Payer: Hawaii Medical Service Association Commercial	$8.29
Rate for Payer: Hawaii Medical Service Association Medicare	$51.24
Rate for Payer: Hawaii Western Management Group Commercial	$6.63
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Humana Medicare	$51.24
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Medicaid	$62.22
Rate for Payer: Kaiser Permanente Medicare	$51.24
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: Ohana Health Plan Medicaid	$51.24
Rate for Payer: Ohana Health Plan Medicare	$51.24
Rate for Payer: UnitedHealthcare Medicaid	$9.16
Rate for Payer: UnitedHealthcare Medicare	$51.24
Rate for Payer: University Health Alliance Commercial	$17.13

MRSA Culture Screen DLS

Facility

$122.00

Service Code	HCPCS 87081
Hospital Charge Code	422870815
Hospital Revenue Code	306
Min. Negotiated Rate	$103.70
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$79.30
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: MDX Hawaii PPO	$118.34

.MRSA, Rapid Test DLS

Facility

$100.00

Service Code	HCPCS 86403
Hospital Charge Code	422864035
Hospital Revenue Code	306
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$97.00
Rate for Payer: AlohaCare Medicaid	$50.00
Rate for Payer: AlohaCare Medicare	$42.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$92.00
Rate for Payer: Devoted Health Medicare	$42.00
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$14.08
Rate for Payer: Hawaii Medical Service Association Commercial	$14.43
Rate for Payer: Hawaii Medical Service Association Medicare	$42.00
Rate for Payer: Hawaii Western Management Group Commercial	$11.54
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: Humana Medicare	$42.00
Rate for Payer: Kaiser Permanente Commercial	$90.00
Rate for Payer: Kaiser Permanente Medicaid	$51.00
Rate for Payer: Kaiser Permanente Medicare	$42.00
Rate for Payer: MDX Hawaii PPO	$97.00
Rate for Payer: Ohana Health Plan Medicaid	$42.00
Rate for Payer: Ohana Health Plan Medicare	$42.00
Rate for Payer: UnitedHealthcare Medicaid	$14.08
Rate for Payer: UnitedHealthcare Medicare	$42.00
Rate for Payer: University Health Alliance Commercial	$26.34

.MRSA, Rapid Test DLS

Facility

$100.00

Service Code	HCPCS 86403
Hospital Charge Code	422864035
Hospital Revenue Code	306
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: Kaiser Permanente Commercial	$90.00
Rate for Payer: MDX Hawaii PPO	$97.00

MTHFR Mutation DLS

Facility

$994.00

Service Code	HCPCS 81291
Hospital Charge Code	422812915
Hospital Revenue Code	309
Min. Negotiated Rate	$844.90
Max. Negotiated Rate	$964.18
Rate for Payer: Cash Price	$646.10
Rate for Payer: Health Management Network Commercial	$844.90
Rate for Payer: Kaiser Permanente Commercial	$894.60
Rate for Payer: MDX Hawaii PPO	$964.18

MTHFR Mutation DLS

Facility

$994.00

Service Code	HCPCS 81291
Hospital Charge Code	422812915
Hospital Revenue Code	309
Min. Negotiated Rate	$55.75
Max. Negotiated Rate	$964.18
Rate for Payer: AlohaCare Medicaid	$497.00
Rate for Payer: AlohaCare Medicare	$417.48
Rate for Payer: Cash Price	$646.10
Rate for Payer: Cash Price	$646.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$914.48
Rate for Payer: Devoted Health Medicare	$417.48
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$58.43
Rate for Payer: Hawaii Medical Service Association Commercial	$81.67
Rate for Payer: Hawaii Medical Service Association Medicare	$417.48
Rate for Payer: Hawaii Western Management Group Commercial	$65.34
Rate for Payer: Health Management Network Commercial	$844.90
Rate for Payer: Humana Medicare	$417.48
Rate for Payer: Kaiser Permanente Commercial	$894.60
Rate for Payer: Kaiser Permanente Medicaid	$506.94
Rate for Payer: Kaiser Permanente Medicare	$417.48
Rate for Payer: MDX Hawaii PPO	$964.18
Rate for Payer: Ohana Health Plan Medicaid	$417.48
Rate for Payer: Ohana Health Plan Medicare	$417.48
Rate for Payer: UnitedHealthcare Medicaid	$55.75
Rate for Payer: UnitedHealthcare Medicare	$417.48
Rate for Payer: University Health Alliance Commercial	$110.17

.M. tuberculosis complex DNA Probe DLS

Facility

$394.00

Service Code	HCPCS 87555
Hospital Charge Code	422875555
Hospital Revenue Code	301
Min. Negotiated Rate	$26.88
Max. Negotiated Rate	$382.18
Rate for Payer: AlohaCare Medicaid	$197.00
Rate for Payer: AlohaCare Medicare	$165.48
Rate for Payer: Cash Price	$256.10
Rate for Payer: Cash Price	$256.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$362.48
Rate for Payer: Devoted Health Medicare	$165.48
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$27.71
Rate for Payer: Hawaii Medical Service Association Commercial	$33.60
Rate for Payer: Hawaii Medical Service Association Medicare	$165.48
Rate for Payer: Hawaii Western Management Group Commercial	$26.88
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Humana Medicare	$165.48
Rate for Payer: Kaiser Permanente Commercial	$354.60
Rate for Payer: Kaiser Permanente Medicaid	$200.94
Rate for Payer: Kaiser Permanente Medicare	$165.48
Rate for Payer: MDX Hawaii PPO	$382.18
Rate for Payer: Ohana Health Plan Medicaid	$165.48
Rate for Payer: Ohana Health Plan Medicare	$165.48
Rate for Payer: UnitedHealthcare Medicaid	$27.71
Rate for Payer: UnitedHealthcare Medicare	$165.48
Rate for Payer: University Health Alliance Commercial	$51.84

.M. tuberculosis complex DNA Probe DLS

Facility

$394.00

Service Code	HCPCS 87555
Hospital Charge Code	422875555
Hospital Revenue Code	301
Min. Negotiated Rate	$334.90
Max. Negotiated Rate	$382.18
Rate for Payer: Cash Price	$256.10
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Kaiser Permanente Commercial	$354.60
Rate for Payer: MDX Hawaii PPO	$382.18

MULTI LUMEN CENTRAL VENOUS CATH KIT 7FR 20CM

Facility

$5.00

Hospital Charge Code	8185
Hospital Revenue Code	270
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.25
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

MULTI LUMEN CENTRAL VENOUS CATH KIT 7FR 20CM

Facility

$5.00

Hospital Charge Code	8185
Hospital Revenue Code	270
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$2.10
Rate for Payer: Cash Price	$3.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.60
Rate for Payer: Devoted Health Medicare	$2.10
Rate for Payer: Hawaii Medical Service Association Medicare	$2.10
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$2.10
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$2.10
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$2.10
Rate for Payer: Ohana Health Plan Medicare	$2.10
Rate for Payer: UnitedHealthcare Medicare	$2.10
Rate for Payer: University Health Alliance Commercial	$3.64

MULTI LUMEN CVC KIT 7FR. 16CM

Facility

$51.00

Hospital Charge Code	8186
Hospital Revenue Code	270
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$49.47
Rate for Payer: AlohaCare Medicaid	$25.50
Rate for Payer: AlohaCare Medicare	$21.42
Rate for Payer: Cash Price	$33.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$46.92
Rate for Payer: Devoted Health Medicare	$21.42
Rate for Payer: Hawaii Medical Service Association Medicare	$21.42
Rate for Payer: Hawaii Western Management Group Commercial	$48.45
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Humana Medicare	$21.42
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: Kaiser Permanente Medicaid	$26.01
Rate for Payer: Kaiser Permanente Medicare	$21.42
Rate for Payer: MDX Hawaii PPO	$49.47
Rate for Payer: Ohana Health Plan Medicaid	$21.42
Rate for Payer: Ohana Health Plan Medicare	$21.42
Rate for Payer: UnitedHealthcare Medicare	$21.42
Rate for Payer: University Health Alliance Commercial	$37.17

MULTI LUMEN CVC KIT 7FR. 16CM

Facility

$51.00

Hospital Charge Code	8186
Hospital Revenue Code	270
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$49.47
Rate for Payer: Cash Price	$33.15
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: MDX Hawaii PPO	$49.47

MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC

Facility

$115,594.65

Service Code	MSDRG 427
Min. Negotiated Rate	$115,594.65
Max. Negotiated Rate	$115,594.65
Rate for Payer: Hawaii Medical Service Association Commercial	$115,594.65

MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$115,594.65

Service Code	MSDRG 426
Min. Negotiated Rate	$115,594.65
Max. Negotiated Rate	$115,594.65
Rate for Payer: Hawaii Medical Service Association Commercial	$115,594.65

MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC

Facility

$115,594.65

Service Code	MSDRG 428
Min. Negotiated Rate	$115,594.65
Max. Negotiated Rate	$115,594.65
Rate for Payer: Hawaii Medical Service Association Commercial	$115,594.65

MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$84,260.61

Service Code	MSDRG 447
Min. Negotiated Rate	$84,260.61
Max. Negotiated Rate	$84,260.61
Rate for Payer: Hawaii Medical Service Association Commercial	$84,260.61

Know your out-of-pocket cost for care.

All Charges