Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

mycophenolate mofetil 200 mg/mL Susp [KMC]

Facility

$36.24

Service Code	HCPCS J7517
Hospital Revenue Code	636
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$35.15
Rate for Payer: Cash Price	$23.56
Rate for Payer: Health Management Network Commercial	$30.80
Rate for Payer: Kaiser Permanente Commercial	$32.62
Rate for Payer: MDX Hawaii PPO	$35.15

mycophenolate mofetil 250 mg Cap [KMC]

Facility

$15.85

Service Code	HCPCS J7517
Hospital Revenue Code	636
Min. Negotiated Rate	$13.47
Max. Negotiated Rate	$15.37
Rate for Payer: Cash Price	$10.30
Rate for Payer: Health Management Network Commercial	$13.47
Rate for Payer: Kaiser Permanente Commercial	$14.27
Rate for Payer: MDX Hawaii PPO	$15.37

mycophenolate mofetil 250 mg Cap [KMC]

Facility

$15.85

Service Code	HCPCS J7517
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$15.37
Rate for Payer: AlohaCare Medicaid	$7.92
Rate for Payer: AlohaCare Medicare	$6.66
Rate for Payer: Cash Price	$10.30
Rate for Payer: Cash Price	$10.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$14.58
Rate for Payer: Devoted Health Medicare	$6.66
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.16
Rate for Payer: Hawaii Medical Service Association Medicare	$6.66
Rate for Payer: Hawaii Western Management Group Commercial	$15.06
Rate for Payer: Health Management Network Commercial	$13.47
Rate for Payer: Humana Medicare	$6.66
Rate for Payer: Kaiser Permanente Commercial	$14.27
Rate for Payer: Kaiser Permanente Medicaid	$8.08
Rate for Payer: Kaiser Permanente Medicare	$6.66
Rate for Payer: MDX Hawaii PPO	$15.37
Rate for Payer: Ohana Health Plan Medicaid	$6.66
Rate for Payer: Ohana Health Plan Medicare	$6.66
Rate for Payer: UnitedHealthcare Medicaid	$9.51
Rate for Payer: UnitedHealthcare Medicare	$6.66
Rate for Payer: University Health Alliance Commercial	$11.55

mycophenolate mofetil 500 mg Tab [KMC]

Facility

$31.74

Service Code	HCPCS J7517
Hospital Revenue Code	636
Min. Negotiated Rate	$26.98
Max. Negotiated Rate	$30.79
Rate for Payer: Cash Price	$20.63
Rate for Payer: Health Management Network Commercial	$26.98
Rate for Payer: Kaiser Permanente Commercial	$28.57
Rate for Payer: MDX Hawaii PPO	$30.79

mycophenolate mofetil 500 mg Tab [KMC]

Facility

$31.74

Service Code	HCPCS J7517
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$30.79
Rate for Payer: AlohaCare Medicaid	$15.87
Rate for Payer: AlohaCare Medicare	$13.33
Rate for Payer: Cash Price	$20.63
Rate for Payer: Cash Price	$20.63
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$29.20
Rate for Payer: Devoted Health Medicare	$13.33
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.16
Rate for Payer: Hawaii Medical Service Association Medicare	$13.33
Rate for Payer: Hawaii Western Management Group Commercial	$30.15
Rate for Payer: Health Management Network Commercial	$26.98
Rate for Payer: Humana Medicare	$13.33
Rate for Payer: Kaiser Permanente Commercial	$28.57
Rate for Payer: Kaiser Permanente Medicaid	$16.19
Rate for Payer: Kaiser Permanente Medicare	$13.33
Rate for Payer: MDX Hawaii PPO	$30.79
Rate for Payer: Ohana Health Plan Medicaid	$13.33
Rate for Payer: Ohana Health Plan Medicare	$13.33
Rate for Payer: UnitedHealthcare Medicaid	$19.04
Rate for Payer: UnitedHealthcare Medicare	$13.33
Rate for Payer: University Health Alliance Commercial	$23.14

mycophenolic acid 360 mg DR tab [KMC]

Facility

$36.54

Service Code	HCPCS J7518
Hospital Revenue Code	636
Min. Negotiated Rate	$31.06
Max. Negotiated Rate	$35.44
Rate for Payer: Cash Price	$23.75
Rate for Payer: Health Management Network Commercial	$31.06
Rate for Payer: Kaiser Permanente Commercial	$32.89
Rate for Payer: MDX Hawaii PPO	$35.44

mycophenolic acid 360 mg DR tab [KMC]

Facility

$36.54

Service Code	HCPCS J7518
Hospital Revenue Code	636
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$35.44
Rate for Payer: AlohaCare Medicaid	$18.27
Rate for Payer: AlohaCare Medicare	$15.35
Rate for Payer: Cash Price	$23.75
Rate for Payer: Cash Price	$23.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$33.62
Rate for Payer: Devoted Health Medicare	$15.35
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.37
Rate for Payer: Hawaii Medical Service Association Medicare	$15.35
Rate for Payer: Hawaii Western Management Group Commercial	$34.71
Rate for Payer: Health Management Network Commercial	$31.06
Rate for Payer: Humana Medicare	$15.35
Rate for Payer: Kaiser Permanente Commercial	$32.89
Rate for Payer: Kaiser Permanente Medicaid	$18.64
Rate for Payer: Kaiser Permanente Medicare	$15.35
Rate for Payer: MDX Hawaii PPO	$35.44
Rate for Payer: Ohana Health Plan Medicaid	$15.35
Rate for Payer: Ohana Health Plan Medicare	$15.35
Rate for Payer: UnitedHealthcare Medicaid	$21.92
Rate for Payer: UnitedHealthcare Medicare	$15.35
Rate for Payer: University Health Alliance Commercial	$26.63

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC

Facility

$73,452.50

Service Code	MSDRG 827
Min. Negotiated Rate	$73,452.50
Max. Negotiated Rate	$73,452.50
Rate for Payer: Hawaii Medical Service Association Commercial	$73,452.50

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC

Facility

$73,452.50

Service Code	MSDRG 826
Min. Negotiated Rate	$73,452.50
Max. Negotiated Rate	$73,452.50
Rate for Payer: Hawaii Medical Service Association Commercial	$73,452.50

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$37,069.93

Service Code	MSDRG 828
Min. Negotiated Rate	$37,069.93
Max. Negotiated Rate	$37,069.93
Rate for Payer: Hawaii Medical Service Association Commercial	$37,069.93

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC

Facility

$46,811.45

Service Code	MSDRG 829
Min. Negotiated Rate	$46,811.45
Max. Negotiated Rate	$46,811.45
Rate for Payer: Hawaii Medical Service Association Commercial	$46,811.45

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC

Facility

$46,811.45

Service Code	MSDRG 830
Min. Negotiated Rate	$46,811.45
Max. Negotiated Rate	$46,811.45
Rate for Payer: Hawaii Medical Service Association Commercial	$46,811.45

nabumetone 500 mg Tab [KMC]

Facility

$4.95

Service Code	NDC 50228046501
Hospital Revenue Code	250
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$4.80
Rate for Payer: AlohaCare Medicaid	$2.48
Rate for Payer: AlohaCare Medicare	$2.08
Rate for Payer: Cash Price	$3.22
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.55
Rate for Payer: Devoted Health Medicare	$2.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2.08
Rate for Payer: Hawaii Western Management Group Commercial	$4.70
Rate for Payer: Health Management Network Commercial	$4.21
Rate for Payer: Humana Medicare	$2.08
Rate for Payer: Kaiser Permanente Commercial	$4.46
Rate for Payer: Kaiser Permanente Medicaid	$2.52
Rate for Payer: Kaiser Permanente Medicare	$2.08
Rate for Payer: MDX Hawaii PPO	$4.80
Rate for Payer: Ohana Health Plan Medicaid	$2.08
Rate for Payer: Ohana Health Plan Medicare	$2.08
Rate for Payer: UnitedHealthcare Medicaid	$2.97
Rate for Payer: UnitedHealthcare Medicare	$2.08
Rate for Payer: University Health Alliance Commercial	$3.61

nabumetone 500 mg Tab [KMC]

Facility

$4.95

Service Code	NDC 50228046501
Hospital Revenue Code	250
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$4.80
Rate for Payer: Cash Price	$3.22
Rate for Payer: Health Management Network Commercial	$4.21
Rate for Payer: Kaiser Permanente Commercial	$4.46
Rate for Payer: MDX Hawaii PPO	$4.80

nadolol 20 mg Tab [KMC]

Facility

$13.56

Service Code	NDC 76385013301
Hospital Revenue Code	250
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$13.15
Rate for Payer: Cash Price	$8.81
Rate for Payer: Health Management Network Commercial	$11.53
Rate for Payer: Kaiser Permanente Commercial	$12.20
Rate for Payer: MDX Hawaii PPO	$13.15

nadolol 20 mg Tab [KMC]

Facility

$13.56

Service Code	NDC 76385013301
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$13.15
Rate for Payer: AlohaCare Medicaid	$6.78
Rate for Payer: AlohaCare Medicare	$5.70
Rate for Payer: Cash Price	$8.81
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$12.48
Rate for Payer: Devoted Health Medicare	$5.70
Rate for Payer: Hawaii Medical Service Association Medicare	$5.70
Rate for Payer: Hawaii Western Management Group Commercial	$12.88
Rate for Payer: Health Management Network Commercial	$11.53
Rate for Payer: Humana Medicare	$5.70
Rate for Payer: Kaiser Permanente Commercial	$12.20
Rate for Payer: Kaiser Permanente Medicaid	$6.92
Rate for Payer: Kaiser Permanente Medicare	$5.70
Rate for Payer: MDX Hawaii PPO	$13.15
Rate for Payer: Ohana Health Plan Medicaid	$5.70
Rate for Payer: Ohana Health Plan Medicare	$5.70
Rate for Payer: UnitedHealthcare Medicaid	$8.14
Rate for Payer: UnitedHealthcare Medicare	$5.70
Rate for Payer: University Health Alliance Commercial	$9.88

nafcillin 2 gm vial [KMC]

Facility

$113.10

Service Code	NDC 55150012316
Hospital Revenue Code	250
Min. Negotiated Rate	$47.50
Max. Negotiated Rate	$109.71
Rate for Payer: AlohaCare Medicaid	$56.55
Rate for Payer: AlohaCare Medicare	$47.50
Rate for Payer: Cash Price	$73.52
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$104.05
Rate for Payer: Devoted Health Medicare	$47.50
Rate for Payer: Hawaii Medical Service Association Medicare	$47.50
Rate for Payer: Hawaii Western Management Group Commercial	$107.44
Rate for Payer: Health Management Network Commercial	$96.14
Rate for Payer: Humana Medicare	$47.50
Rate for Payer: Kaiser Permanente Commercial	$101.79
Rate for Payer: Kaiser Permanente Medicaid	$57.68
Rate for Payer: Kaiser Permanente Medicare	$47.50
Rate for Payer: MDX Hawaii PPO	$109.71
Rate for Payer: Ohana Health Plan Medicaid	$47.50
Rate for Payer: Ohana Health Plan Medicare	$47.50
Rate for Payer: UnitedHealthcare Medicaid	$67.86
Rate for Payer: UnitedHealthcare Medicare	$47.50
Rate for Payer: University Health Alliance Commercial	$82.44

nafcillin 2 gm vial [KMC]

Facility

$113.10

Service Code	NDC 55150012316
Hospital Revenue Code	250
Min. Negotiated Rate	$96.14
Max. Negotiated Rate	$109.71
Rate for Payer: Cash Price	$73.52
Rate for Payer: Health Management Network Commercial	$96.14
Rate for Payer: Kaiser Permanente Commercial	$101.79
Rate for Payer: MDX Hawaii PPO	$109.71

NAIL SLITTER ENGLISH ANVIL 5"

Facility

$2.00

Hospital Charge Code	8560
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

NAIL SLITTER ENGLISH ANVIL 5"

Facility

$2.00

Hospital Charge Code	8560
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

naloxone 2 mg/2 mL Inj Sol [KMC]

Facility

$75.60

Service Code	HCPCS J2310
Hospital Revenue Code	636
Min. Negotiated Rate	$9.21
Max. Negotiated Rate	$73.33
Rate for Payer: AlohaCare Medicaid	$37.80
Rate for Payer: AlohaCare Medicare	$31.75
Rate for Payer: Cash Price	$49.14
Rate for Payer: Cash Price	$49.14
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$69.55
Rate for Payer: Devoted Health Medicare	$31.75
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$9.21
Rate for Payer: Hawaii Medical Service Association Medicare	$31.75
Rate for Payer: Hawaii Western Management Group Commercial	$71.82
Rate for Payer: Health Management Network Commercial	$64.26
Rate for Payer: Humana Medicare	$31.75
Rate for Payer: Kaiser Permanente Commercial	$68.04
Rate for Payer: Kaiser Permanente Medicaid	$38.56
Rate for Payer: Kaiser Permanente Medicare	$31.75
Rate for Payer: MDX Hawaii PPO	$73.33
Rate for Payer: Ohana Health Plan Medicaid	$31.75
Rate for Payer: Ohana Health Plan Medicare	$31.75
Rate for Payer: UnitedHealthcare Medicaid	$45.36
Rate for Payer: UnitedHealthcare Medicare	$31.75
Rate for Payer: University Health Alliance Commercial	$55.10

naloxone 2 mg/2 mL Inj Sol [KMC]

Facility

$75.60

Service Code	HCPCS J2310
Hospital Revenue Code	636
Min. Negotiated Rate	$64.26
Max. Negotiated Rate	$73.33
Rate for Payer: Cash Price	$49.14
Rate for Payer: Health Management Network Commercial	$64.26
Rate for Payer: Kaiser Permanente Commercial	$68.04
Rate for Payer: MDX Hawaii PPO	$73.33

naloxone 4 mg/0.1 mL nasal spray [KMC]

Facility

$281.26

Service Code	NDC 00781717612
Hospital Revenue Code	250
Min. Negotiated Rate	$118.13
Max. Negotiated Rate	$272.82
Rate for Payer: AlohaCare Medicaid	$140.63
Rate for Payer: AlohaCare Medicare	$118.13
Rate for Payer: Cash Price	$182.82
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$258.76
Rate for Payer: Devoted Health Medicare	$118.13
Rate for Payer: Hawaii Medical Service Association Medicare	$118.13
Rate for Payer: Hawaii Western Management Group Commercial	$267.20
Rate for Payer: Health Management Network Commercial	$239.07
Rate for Payer: Humana Medicare	$118.13
Rate for Payer: Kaiser Permanente Commercial	$253.13
Rate for Payer: Kaiser Permanente Medicaid	$143.44
Rate for Payer: Kaiser Permanente Medicare	$118.13
Rate for Payer: MDX Hawaii PPO	$272.82
Rate for Payer: Ohana Health Plan Medicaid	$118.13
Rate for Payer: Ohana Health Plan Medicare	$118.13
Rate for Payer: UnitedHealthcare Medicaid	$168.76
Rate for Payer: UnitedHealthcare Medicare	$118.13
Rate for Payer: University Health Alliance Commercial	$205.01

naloxone 4 mg/0.1 mL nasal spray [KMC]

Facility

$281.26

Service Code	NDC 00781717612
Hospital Revenue Code	250
Min. Negotiated Rate	$239.07
Max. Negotiated Rate	$272.82
Rate for Payer: Cash Price	$182.82
Rate for Payer: Health Management Network Commercial	$239.07
Rate for Payer: Kaiser Permanente Commercial	$253.13
Rate for Payer: MDX Hawaii PPO	$272.82

naltrexone 50 mg Tab [KMC]

Facility

$10.94

Service Code	NDC 68094085362
Hospital Revenue Code	250
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$10.61
Rate for Payer: Cash Price	$7.11
Rate for Payer: Health Management Network Commercial	$9.30
Rate for Payer: Kaiser Permanente Commercial	$9.85
Rate for Payer: MDX Hawaii PPO	$10.61

Know your out-of-pocket cost for care.

All Charges