Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

naltrexone 50 mg Tab [KMC]

Facility

$10.94

Service Code	NDC 68094085362
Hospital Revenue Code	250
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$10.61
Rate for Payer: AlohaCare Medicaid	$5.47
Rate for Payer: AlohaCare Medicare	$4.59
Rate for Payer: Cash Price	$7.11
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$10.06
Rate for Payer: Devoted Health Medicare	$4.59
Rate for Payer: Hawaii Medical Service Association Medicare	$4.59
Rate for Payer: Hawaii Western Management Group Commercial	$10.39
Rate for Payer: Health Management Network Commercial	$9.30
Rate for Payer: Humana Medicare	$4.59
Rate for Payer: Kaiser Permanente Commercial	$9.85
Rate for Payer: Kaiser Permanente Medicaid	$5.58
Rate for Payer: Kaiser Permanente Medicare	$4.59
Rate for Payer: MDX Hawaii PPO	$10.61
Rate for Payer: Ohana Health Plan Medicaid	$4.59
Rate for Payer: Ohana Health Plan Medicare	$4.59
Rate for Payer: UnitedHealthcare Medicaid	$6.56
Rate for Payer: UnitedHealthcare Medicare	$4.59
Rate for Payer: University Health Alliance Commercial	$7.97

naphazoline ophthalmic 0.1% Sol [KMC]

Facility

$1.90

Service Code	NDC 17478021612
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.84
Rate for Payer: AlohaCare Medicaid	$0.95
Rate for Payer: AlohaCare Medicare	$0.80
Rate for Payer: Cash Price	$1.23
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1.75
Rate for Payer: Devoted Health Medicare	$0.80
Rate for Payer: Hawaii Medical Service Association Medicare	$0.80
Rate for Payer: Hawaii Western Management Group Commercial	$1.80
Rate for Payer: Health Management Network Commercial	$1.61
Rate for Payer: Humana Medicare	$0.80
Rate for Payer: Kaiser Permanente Commercial	$1.71
Rate for Payer: Kaiser Permanente Medicaid	$0.97
Rate for Payer: Kaiser Permanente Medicare	$0.80
Rate for Payer: MDX Hawaii PPO	$1.84
Rate for Payer: Ohana Health Plan Medicaid	$0.80
Rate for Payer: Ohana Health Plan Medicare	$0.80
Rate for Payer: UnitedHealthcare Medicaid	$1.14
Rate for Payer: UnitedHealthcare Medicare	$0.80
Rate for Payer: University Health Alliance Commercial	$1.38

naphazoline ophthalmic 0.1% Sol [KMC]

Facility

$1.90

Service Code	NDC 17478021612
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$1.84
Rate for Payer: Cash Price	$1.23
Rate for Payer: Health Management Network Commercial	$1.61
Rate for Payer: Kaiser Permanente Commercial	$1.71
Rate for Payer: MDX Hawaii PPO	$1.84

naproxen 250 mg Tab [KMC]

Facility

$3.10

Service Code	NDC 68462018801
Hospital Revenue Code	250
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$3.01
Rate for Payer: Cash Price	$2.02
Rate for Payer: Health Management Network Commercial	$2.63
Rate for Payer: Kaiser Permanente Commercial	$2.79
Rate for Payer: MDX Hawaii PPO	$3.01

naproxen 250 mg Tab [KMC]

Facility

$3.10

Service Code	NDC 68462018801
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$3.01
Rate for Payer: AlohaCare Medicaid	$1.55
Rate for Payer: AlohaCare Medicare	$1.30
Rate for Payer: Cash Price	$2.02
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.85
Rate for Payer: Devoted Health Medicare	$1.30
Rate for Payer: Hawaii Medical Service Association Medicare	$1.30
Rate for Payer: Hawaii Western Management Group Commercial	$2.94
Rate for Payer: Health Management Network Commercial	$2.63
Rate for Payer: Humana Medicare	$1.30
Rate for Payer: Kaiser Permanente Commercial	$2.79
Rate for Payer: Kaiser Permanente Medicaid	$1.58
Rate for Payer: Kaiser Permanente Medicare	$1.30
Rate for Payer: MDX Hawaii PPO	$3.01
Rate for Payer: Ohana Health Plan Medicaid	$1.30
Rate for Payer: Ohana Health Plan Medicare	$1.30
Rate for Payer: UnitedHealthcare Medicaid	$1.86
Rate for Payer: UnitedHealthcare Medicare	$1.30
Rate for Payer: University Health Alliance Commercial	$2.26

NASAL BONES COMP MIN 3 VWS

Facility

$369.00

Service Code	HCPCS 70160
Hospital Charge Code	424701600
Hospital Revenue Code	320
Min. Negotiated Rate	$313.65
Max. Negotiated Rate	$357.93
Rate for Payer: Cash Price	$239.85
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: MDX Hawaii PPO	$357.93

NASAL BONES COMP MIN 3 VWS

Facility

$369.00

Service Code	HCPCS 70160
Hospital Charge Code	424701600
Hospital Revenue Code	320
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$357.93
Rate for Payer: AlohaCare Medicaid	$184.50
Rate for Payer: AlohaCare Medicare	$154.98
Rate for Payer: Cash Price	$239.85
Rate for Payer: Cash Price	$239.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$339.48
Rate for Payer: Devoted Health Medicare	$154.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$17.04
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$154.98
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Humana Medicare	$154.98
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: Kaiser Permanente Medicaid	$188.19
Rate for Payer: Kaiser Permanente Medicare	$154.98
Rate for Payer: MDX Hawaii PPO	$357.93
Rate for Payer: Ohana Health Plan Medicaid	$154.98
Rate for Payer: Ohana Health Plan Medicare	$154.98
Rate for Payer: UnitedHealthcare Medicaid	$17.04
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$63.38

NASAL CANNULA ADULT

Facility

$31.00

Hospital Charge Code	8187
Hospital Revenue Code	272
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$20.15
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: MDX Hawaii PPO	$30.07

NASAL CANNULA ADULT

Facility

$31.00

Hospital Charge Code	8187
Hospital Revenue Code	272
Min. Negotiated Rate	$13.02
Max. Negotiated Rate	$30.07
Rate for Payer: AlohaCare Medicaid	$15.50
Rate for Payer: AlohaCare Medicare	$13.02
Rate for Payer: Cash Price	$20.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$28.52
Rate for Payer: Devoted Health Medicare	$13.02
Rate for Payer: Hawaii Medical Service Association Medicare	$13.02
Rate for Payer: Hawaii Western Management Group Commercial	$29.45
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Humana Medicare	$13.02
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: Kaiser Permanente Medicaid	$15.81
Rate for Payer: Kaiser Permanente Medicare	$13.02
Rate for Payer: MDX Hawaii PPO	$30.07
Rate for Payer: Ohana Health Plan Medicaid	$13.02
Rate for Payer: Ohana Health Plan Medicare	$13.02
Rate for Payer: UnitedHealthcare Medicare	$13.02
Rate for Payer: University Health Alliance Commercial	$22.60

NASAL CANNULA PEDS

Facility

$3.00

Hospital Charge Code	8188
Hospital Revenue Code	272
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

NASAL CANNULA PEDS

Facility

$3.00

Hospital Charge Code	8188
Hospital Revenue Code	272
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 Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

NASAL SPECULUM

Facility

$125.00

Hospital Charge Code	8544
Hospital Revenue Code	270
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: MDX Hawaii PPO	$121.25

NASAL SPECULUM

Facility

$125.00

Hospital Charge Code	8544
Hospital Revenue Code	270
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$121.25
Rate for Payer: AlohaCare Medicaid	$62.50
Rate for Payer: AlohaCare Medicare	$52.50
Rate for Payer: Cash Price	$81.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$115.00
Rate for Payer: Devoted Health Medicare	$52.50
Rate for Payer: Hawaii Medical Service Association Medicare	$52.50
Rate for Payer: Hawaii Western Management Group Commercial	$118.75
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Humana Medicare	$52.50
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: Kaiser Permanente Medicare	$52.50
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: Ohana Health Plan Medicaid	$52.50
Rate for Payer: Ohana Health Plan Medicare	$52.50
Rate for Payer: UnitedHealthcare Medicare	$52.50
Rate for Payer: University Health Alliance Commercial	$91.11

NASO OR ORO-GASTRIC TUBE PLACEMENT REQUIRING PHYSI

Facility

$773.00

Service Code	HCPCS 43752
Hospital Charge Code	440437520
Hospital Revenue Code	450
Min. Negotiated Rate	$657.05
Max. Negotiated Rate	$749.81
Rate for Payer: Cash Price	$502.45
Rate for Payer: Health Management Network Commercial	$657.05
Rate for Payer: Kaiser Permanente Commercial	$695.70
Rate for Payer: MDX Hawaii PPO	$749.81

NASO OR ORO-GASTRIC TUBE PLACEMENT REQUIRING PHYSI

Facility

$773.00

Service Code	HCPCS 43752
Hospital Charge Code	440437520
Hospital Revenue Code	450
Min. Negotiated Rate	$324.66
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$386.50
Rate for Payer: AlohaCare Medicare	$324.66
Rate for Payer: Cash Price	$502.45
Rate for Payer: Cash Price	$502.45
Rate for Payer: Cash Price	$502.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$711.16
Rate for Payer: Devoted Health Medicare	$324.66
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	$324.66
Rate for Payer: Hawaii Western Management Group Commercial	$734.35
Rate for Payer: Health Management Network Commercial	$657.05
Rate for Payer: Humana Medicare	$324.66
Rate for Payer: Kaiser Permanente Commercial	$695.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$324.66
Rate for Payer: MDX Hawaii PPO	$749.81
Rate for Payer: Ohana Health Plan Medicaid	$324.66
Rate for Payer: Ohana Health Plan Medicare	$324.66
Rate for Payer: UnitedHealthcare Medicare	$324.66
Rate for Payer: University Health Alliance Commercial	$563.44

nebivolol 2.5 mg Tab [KMC]

Facility

$18.95

Service Code	NDC 43547052403
Hospital Revenue Code	250
Min. Negotiated Rate	$7.96
Max. Negotiated Rate	$18.38
Rate for Payer: AlohaCare Medicaid	$9.47
Rate for Payer: AlohaCare Medicare	$7.96
Rate for Payer: Cash Price	$12.32
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$17.43
Rate for Payer: Devoted Health Medicare	$7.96
Rate for Payer: Hawaii Medical Service Association Medicare	$7.96
Rate for Payer: Hawaii Western Management Group Commercial	$18.00
Rate for Payer: Health Management Network Commercial	$16.11
Rate for Payer: Humana Medicare	$7.96
Rate for Payer: Kaiser Permanente Commercial	$17.05
Rate for Payer: Kaiser Permanente Medicaid	$9.66
Rate for Payer: Kaiser Permanente Medicare	$7.96
Rate for Payer: MDX Hawaii PPO	$18.38
Rate for Payer: Ohana Health Plan Medicaid	$7.96
Rate for Payer: Ohana Health Plan Medicare	$7.96
Rate for Payer: UnitedHealthcare Medicaid	$11.37
Rate for Payer: UnitedHealthcare Medicare	$7.96
Rate for Payer: University Health Alliance Commercial	$13.81

nebivolol 2.5 mg Tab [KMC]

Facility

$18.95

Service Code	NDC 43547052403
Hospital Revenue Code	250
Min. Negotiated Rate	$16.11
Max. Negotiated Rate	$18.38
Rate for Payer: Cash Price	$12.32
Rate for Payer: Health Management Network Commercial	$16.11
Rate for Payer: Kaiser Permanente Commercial	$17.05
Rate for Payer: MDX Hawaii PPO	$18.38

NECK SOFT TISSUE

Facility

$369.00

Service Code	HCPCS 70360
Hospital Charge Code	424703600
Hospital Revenue Code	320
Min. Negotiated Rate	$20.82
Max. Negotiated Rate	$357.93
Rate for Payer: AlohaCare Medicaid	$184.50
Rate for Payer: AlohaCare Medicare	$154.98
Rate for Payer: Cash Price	$239.85
Rate for Payer: Cash Price	$239.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$339.48
Rate for Payer: Devoted Health Medicare	$154.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$20.82
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$154.98
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Humana Medicare	$154.98
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: Kaiser Permanente Medicaid	$188.19
Rate for Payer: Kaiser Permanente Medicare	$154.98
Rate for Payer: MDX Hawaii PPO	$357.93
Rate for Payer: Ohana Health Plan Medicaid	$154.98
Rate for Payer: Ohana Health Plan Medicare	$154.98
Rate for Payer: UnitedHealthcare Medicaid	$20.82
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$53.78

NECK SOFT TISSUE

Facility

$369.00

Service Code	HCPCS 70360
Hospital Charge Code	424703600
Hospital Revenue Code	320
Min. Negotiated Rate	$313.65
Max. Negotiated Rate	$357.93
Rate for Payer: Cash Price	$239.85
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: MDX Hawaii PPO	$357.93

NEEDLE 18G

Facility

$6.00

Hospital Charge Code	8189
Hospital Revenue Code	272
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$2.52
Rate for Payer: Cash Price	$3.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.52
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.52
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$2.52
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$2.52
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$2.52
Rate for Payer: Ohana Health Plan Medicare	$2.52
Rate for Payer: UnitedHealthcare Medicare	$2.52
Rate for Payer: University Health Alliance Commercial	$4.37

NEEDLE 18G

Facility

$6.00

Hospital Charge Code	8189
Hospital Revenue Code	272
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.90
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

NEEDLE 18G SAFETY

Facility

$403.00

Hospital Charge Code	8190
Hospital Revenue Code	272
Min. Negotiated Rate	$169.26
Max. Negotiated Rate	$390.91
Rate for Payer: AlohaCare Medicaid	$201.50
Rate for Payer: AlohaCare Medicare	$169.26
Rate for Payer: Cash Price	$261.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$370.76
Rate for Payer: Devoted Health Medicare	$169.26
Rate for Payer: Hawaii Medical Service Association Medicare	$169.26
Rate for Payer: Hawaii Western Management Group Commercial	$382.85
Rate for Payer: Health Management Network Commercial	$342.55
Rate for Payer: Humana Medicare	$169.26
Rate for Payer: Kaiser Permanente Commercial	$362.70
Rate for Payer: Kaiser Permanente Medicaid	$205.53
Rate for Payer: Kaiser Permanente Medicare	$169.26
Rate for Payer: MDX Hawaii PPO	$390.91
Rate for Payer: Ohana Health Plan Medicaid	$169.26
Rate for Payer: Ohana Health Plan Medicare	$169.26
Rate for Payer: UnitedHealthcare Medicare	$169.26
Rate for Payer: University Health Alliance Commercial	$293.75

NEEDLE 18G SAFETY

Facility

$403.00

Hospital Charge Code	8190
Hospital Revenue Code	272
Min. Negotiated Rate	$342.55
Max. Negotiated Rate	$390.91
Rate for Payer: Cash Price	$261.95
Rate for Payer: Health Management Network Commercial	$342.55
Rate for Payer: Kaiser Permanente Commercial	$362.70
Rate for Payer: MDX Hawaii PPO	$390.91

NEEDLE 20G

Facility

$2.00

Hospital Charge Code	8191
Hospital Revenue Code	272
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

NEEDLE 20G

Facility

$2.00

Hospital Charge Code	8191
Hospital Revenue Code	272
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

Know your out-of-pocket cost for care.

All Charges