Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC

Facility

$79,283.19

Service Code	MSDRG 448
Min. Negotiated Rate	$79,283.19
Max. Negotiated Rate	$79,283.19
Rate for Payer: Hawaii Medical Service Association Commercial	$79,283.19

MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC

Facility

$20,170.40

Service Code	MSDRG 059
Min. Negotiated Rate	$20,170.40
Max. Negotiated Rate	$20,170.40
Rate for Payer: Hawaii Medical Service Association Commercial	$20,170.40

MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC

Facility

$20,170.40

Service Code	MSDRG 058
Min. Negotiated Rate	$20,170.40
Max. Negotiated Rate	$20,170.40
Rate for Payer: Hawaii Medical Service Association Commercial	$20,170.40

MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC

Facility

$20,170.40

Service Code	MSDRG 060
Min. Negotiated Rate	$20,170.40
Max. Negotiated Rate	$20,170.40
Rate for Payer: Hawaii Medical Service Association Commercial	$20,170.40

Multiple Vitamins IV Sol 10 mL [KMC]

Facility

$105.84

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$44.45
Max. Negotiated Rate	$102.66
Rate for Payer: AlohaCare Medicaid	$52.92
Rate for Payer: AlohaCare Medicare	$44.45
Rate for Payer: Cash Price	$68.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$97.37
Rate for Payer: Devoted Health Medicare	$44.45
Rate for Payer: Hawaii Medical Service Association Medicare	$44.45
Rate for Payer: Hawaii Western Management Group Commercial	$100.55
Rate for Payer: Health Management Network Commercial	$89.96
Rate for Payer: Humana Medicare	$44.45
Rate for Payer: Kaiser Permanente Commercial	$95.26
Rate for Payer: Kaiser Permanente Medicaid	$53.98
Rate for Payer: Kaiser Permanente Medicare	$44.45
Rate for Payer: MDX Hawaii PPO	$102.66
Rate for Payer: Ohana Health Plan Medicaid	$44.45
Rate for Payer: Ohana Health Plan Medicare	$44.45
Rate for Payer: UnitedHealthcare Medicaid	$63.50
Rate for Payer: UnitedHealthcare Medicare	$44.45
Rate for Payer: University Health Alliance Commercial	$77.15

Multiple Vitamins IV Sol 10 mL [KMC]

Facility

$105.84

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$89.96
Max. Negotiated Rate	$102.66
Rate for Payer: Cash Price	$68.80
Rate for Payer: Health Management Network Commercial	$89.96
Rate for Payer: Kaiser Permanente Commercial	$95.26
Rate for Payer: MDX Hawaii PPO	$102.66

.Multispot HIV-1/HIV-2 Antibodies DLS

Facility

$80.00

Service Code	HCPCS 86703
Hospital Charge Code	422867035
Hospital Revenue Code	301
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$52.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: MDX Hawaii PPO	$77.60

.Multispot HIV-1/HIV-2 Antibodies DLS

Facility

$80.00

Service Code	HCPCS 86703
Hospital Charge Code	422867035
Hospital Revenue Code	301
Min. Negotiated Rate	$13.71
Max. Negotiated Rate	$77.60
Rate for Payer: AlohaCare Medicaid	$40.00
Rate for Payer: AlohaCare Medicare	$33.60
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$73.60
Rate for Payer: Devoted Health Medicare	$33.60
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.96
Rate for Payer: Hawaii Medical Service Association Commercial	$17.14
Rate for Payer: Hawaii Medical Service Association Medicare	$33.60
Rate for Payer: Hawaii Western Management Group Commercial	$13.71
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Humana Medicare	$33.60
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: Kaiser Permanente Medicaid	$40.80
Rate for Payer: Kaiser Permanente Medicare	$33.60
Rate for Payer: MDX Hawaii PPO	$77.60
Rate for Payer: Ohana Health Plan Medicaid	$33.60
Rate for Payer: Ohana Health Plan Medicare	$33.60
Rate for Payer: UnitedHealthcare Medicaid	$18.96
Rate for Payer: UnitedHealthcare Medicare	$33.60
Rate for Payer: University Health Alliance Commercial	$35.46

Multivitamins with minerals tablet [KMC]

Facility

$3.00

Service Code	NDC 00904549280
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

Multivitamins with minerals tablet [KMC]

Facility

$3.00

Service Code	NDC 00904549280
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

multivitamin (Tab-A-Vite) NO IRON Tab [KMC]

Facility

$3.00

Service Code	NDC 00904053060
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

multivitamin (Tab-A-Vite) NO IRON Tab [KMC]

Facility

$3.00

Service Code	NDC 00904053060
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

Mumps Ab, IgG DLS

Facility

$238.00

Service Code	HCPCS 86735
Hospital Charge Code	422867355
Hospital Revenue Code	301
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$230.86
Rate for Payer: AlohaCare Medicaid	$119.00
Rate for Payer: AlohaCare Medicare	$99.96
Rate for Payer: Cash Price	$154.70
Rate for Payer: Cash Price	$154.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$218.96
Rate for Payer: Devoted Health Medicare	$99.96
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.03
Rate for Payer: Hawaii Medical Service Association Commercial	$16.31
Rate for Payer: Hawaii Medical Service Association Medicare	$99.96
Rate for Payer: Hawaii Western Management Group Commercial	$13.05
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Humana Medicare	$99.96
Rate for Payer: Kaiser Permanente Commercial	$214.20
Rate for Payer: Kaiser Permanente Medicaid	$121.38
Rate for Payer: Kaiser Permanente Medicare	$99.96
Rate for Payer: MDX Hawaii PPO	$230.86
Rate for Payer: Ohana Health Plan Medicaid	$99.96
Rate for Payer: Ohana Health Plan Medicare	$99.96
Rate for Payer: UnitedHealthcare Medicaid	$18.03
Rate for Payer: UnitedHealthcare Medicare	$99.96
Rate for Payer: University Health Alliance Commercial	$33.73

Mumps Ab, IgG DLS

Facility

$238.00

Service Code	HCPCS 86735
Hospital Charge Code	422867355
Hospital Revenue Code	301
Min. Negotiated Rate	$202.30
Max. Negotiated Rate	$230.86
Rate for Payer: Cash Price	$154.70
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Kaiser Permanente Commercial	$214.20
Rate for Payer: MDX Hawaii PPO	$230.86

Mumps Ab, IgM DLS

Facility

$238.00

Service Code	HCPCS 86735
Hospital Charge Code	422867355
Hospital Revenue Code	301
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$230.86
Rate for Payer: AlohaCare Medicaid	$119.00
Rate for Payer: AlohaCare Medicare	$99.96
Rate for Payer: Cash Price	$154.70
Rate for Payer: Cash Price	$154.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$218.96
Rate for Payer: Devoted Health Medicare	$99.96
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.03
Rate for Payer: Hawaii Medical Service Association Commercial	$16.31
Rate for Payer: Hawaii Medical Service Association Medicare	$99.96
Rate for Payer: Hawaii Western Management Group Commercial	$13.05
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Humana Medicare	$99.96
Rate for Payer: Kaiser Permanente Commercial	$214.20
Rate for Payer: Kaiser Permanente Medicaid	$121.38
Rate for Payer: Kaiser Permanente Medicare	$99.96
Rate for Payer: MDX Hawaii PPO	$230.86
Rate for Payer: Ohana Health Plan Medicaid	$99.96
Rate for Payer: Ohana Health Plan Medicare	$99.96
Rate for Payer: UnitedHealthcare Medicaid	$18.03
Rate for Payer: UnitedHealthcare Medicare	$99.96
Rate for Payer: University Health Alliance Commercial	$33.73

Mumps Ab, IgM DLS

Facility

$238.00

Service Code	HCPCS 86735
Hospital Charge Code	422867355
Hospital Revenue Code	301
Min. Negotiated Rate	$202.30
Max. Negotiated Rate	$230.86
Rate for Payer: Cash Price	$154.70
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Kaiser Permanente Commercial	$214.20
Rate for Payer: MDX Hawaii PPO	$230.86

Mumps RNA, Qual Real Time PCR DLS

Facility

$144.00

Service Code	HCPCS 87798
Hospital Charge Code	422877985
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$139.68
Rate for Payer: AlohaCare Medicaid	$72.00
Rate for Payer: AlohaCare Medicare	$60.48
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$132.48
Rate for Payer: Devoted Health Medicare	$60.48
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$60.48
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Humana Medicare	$60.48
Rate for Payer: Kaiser Permanente Commercial	$129.60
Rate for Payer: Kaiser Permanente Medicaid	$73.44
Rate for Payer: Kaiser Permanente Medicare	$60.48
Rate for Payer: MDX Hawaii PPO	$139.68
Rate for Payer: Ohana Health Plan Medicaid	$60.48
Rate for Payer: Ohana Health Plan Medicare	$60.48
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$60.48
Rate for Payer: University Health Alliance Commercial	$90.72

Mumps RNA, Qual Real Time PCR DLS

Facility

$144.00

Service Code	HCPCS 87798
Hospital Charge Code	422877985
Hospital Revenue Code	306
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$139.68
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Kaiser Permanente Commercial	$129.60
Rate for Payer: MDX Hawaii PPO	$139.68

mupirocin 2% Ointment [KMC]

Facility

$4.55

Service Code	NDC 51672131200
Hospital Revenue Code	250
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$4.41
Rate for Payer: AlohaCare Medicaid	$2.27
Rate for Payer: AlohaCare Medicare	$1.91
Rate for Payer: Cash Price	$2.96
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.19
Rate for Payer: Devoted Health Medicare	$1.91
Rate for Payer: Hawaii Medical Service Association Medicare	$1.91
Rate for Payer: Hawaii Western Management Group Commercial	$4.32
Rate for Payer: Health Management Network Commercial	$3.87
Rate for Payer: Humana Medicare	$1.91
Rate for Payer: Kaiser Permanente Commercial	$4.09
Rate for Payer: Kaiser Permanente Medicaid	$2.32
Rate for Payer: Kaiser Permanente Medicare	$1.91
Rate for Payer: MDX Hawaii PPO	$4.41
Rate for Payer: Ohana Health Plan Medicaid	$1.91
Rate for Payer: Ohana Health Plan Medicare	$1.91
Rate for Payer: UnitedHealthcare Medicaid	$2.73
Rate for Payer: UnitedHealthcare Medicare	$1.91
Rate for Payer: University Health Alliance Commercial	$3.32

mupirocin 2% Ointment [KMC]

Facility

$4.55

Service Code	NDC 51672131200
Hospital Revenue Code	250
Min. Negotiated Rate	$3.87
Max. Negotiated Rate	$4.41
Rate for Payer: Cash Price	$2.96
Rate for Payer: Health Management Network Commercial	$3.87
Rate for Payer: Kaiser Permanente Commercial	$4.09
Rate for Payer: MDX Hawaii PPO	$4.41

MUSCLE TESTING EXTRMTY Physical

Facility

$173.00

Service Code	HCPCS 95831 GP
Hospital Charge Code	432958310
Hospital Revenue Code	420
Min. Negotiated Rate	$72.66
Max. Negotiated Rate	$167.81
Rate for Payer: AlohaCare Medicaid	$86.50
Rate for Payer: AlohaCare Medicare	$72.66
Rate for Payer: Cash Price	$112.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$159.16
Rate for Payer: Devoted Health Medicare	$72.66
Rate for Payer: Hawaii Medical Service Association Medicare	$72.66
Rate for Payer: Hawaii Western Management Group Commercial	$164.35
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Humana Medicare	$72.66
Rate for Payer: Kaiser Permanente Commercial	$155.70
Rate for Payer: Kaiser Permanente Medicaid	$88.23
Rate for Payer: Kaiser Permanente Medicare	$72.66
Rate for Payer: MDX Hawaii PPO	$167.81
Rate for Payer: Ohana Health Plan Medicaid	$72.66
Rate for Payer: Ohana Health Plan Medicare	$72.66
Rate for Payer: UnitedHealthcare Medicare	$72.66
Rate for Payer: University Health Alliance Commercial	$126.10

MUSCLE TESTING EXTRMTY Physical

Facility

$173.00

Service Code	HCPCS 95831 GP
Hospital Charge Code	432958310
Hospital Revenue Code	420
Min. Negotiated Rate	$147.05
Max. Negotiated Rate	$167.81
Rate for Payer: Cash Price	$112.45
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Kaiser Permanente Commercial	$155.70
Rate for Payer: MDX Hawaii PPO	$167.81

MUSCLE TESTING TTL BODY Physical

Facility

$300.00

Service Code	HCPCS 95833 GP
Hospital Charge Code	426958330
Hospital Revenue Code	420
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$291.00
Rate for Payer: AlohaCare Medicaid	$150.00
Rate for Payer: AlohaCare Medicare	$126.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$276.00
Rate for Payer: Devoted Health Medicare	$126.00
Rate for Payer: Hawaii Medical Service Association Medicare	$126.00
Rate for Payer: Hawaii Western Management Group Commercial	$285.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Humana Medicare	$126.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: Kaiser Permanente Medicaid	$153.00
Rate for Payer: Kaiser Permanente Medicare	$126.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: Ohana Health Plan Medicaid	$126.00
Rate for Payer: Ohana Health Plan Medicare	$126.00
Rate for Payer: UnitedHealthcare Medicare	$126.00
Rate for Payer: University Health Alliance Commercial	$218.67

MUSCLE TESTING TTL BODY Physical

Facility

$300.00

Service Code	HCPCS 95833 GP
Hospital Charge Code	426958330
Hospital Revenue Code	420
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: MDX Hawaii PPO	$291.00

mycophenolate mofetil 200 mg/mL Susp [KMC]

Facility

$36.24

Service Code	HCPCS J7517
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$35.15
Rate for Payer: AlohaCare Medicaid	$18.12
Rate for Payer: AlohaCare Medicare	$15.22
Rate for Payer: Cash Price	$23.56
Rate for Payer: Cash Price	$23.56
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$33.34
Rate for Payer: Devoted Health Medicare	$15.22
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.16
Rate for Payer: Hawaii Medical Service Association Medicare	$15.22
Rate for Payer: Hawaii Western Management Group Commercial	$34.43
Rate for Payer: Health Management Network Commercial	$30.80
Rate for Payer: Humana Medicare	$15.22
Rate for Payer: Kaiser Permanente Commercial	$32.62
Rate for Payer: Kaiser Permanente Medicaid	$18.48
Rate for Payer: Kaiser Permanente Medicare	$15.22
Rate for Payer: MDX Hawaii PPO	$35.15
Rate for Payer: Ohana Health Plan Medicaid	$15.22
Rate for Payer: Ohana Health Plan Medicare	$15.22
Rate for Payer: UnitedHealthcare Medicaid	$21.74
Rate for Payer: UnitedHealthcare Medicare	$15.22
Rate for Payer: University Health Alliance Commercial	$26.42

Know your out-of-pocket cost for care.

All Charges