Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

NEEDLE BLUNT FILL W/FILTER 18G 1-1/2

Facility

$2.00

Hospital Charge Code	8204
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

NEEDLE BONE MARROW 15G

Facility

$2.00

Hospital Charge Code	8205
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 BONE MARROW 15G

Facility

$2.00

Hospital Charge Code	8205
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

NEEDLE BONE MARROW 18G

Facility

$2.00

Hospital Charge Code	8206
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 BONE MARROW 18G

Facility

$2.00

Hospital Charge Code	8206
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

NEEDLE HUBER 20G 1"

Facility

$97.00

Hospital Charge Code	8207
Hospital Revenue Code	272
Min. Negotiated Rate	$40.74
Max. Negotiated Rate	$94.09
Rate for Payer: AlohaCare Medicaid	$48.50
Rate for Payer: AlohaCare Medicare	$40.74
Rate for Payer: Cash Price	$63.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$89.24
Rate for Payer: Devoted Health Medicare	$40.74
Rate for Payer: Hawaii Medical Service Association Medicare	$40.74
Rate for Payer: Hawaii Western Management Group Commercial	$92.15
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Humana Medicare	$40.74
Rate for Payer: Kaiser Permanente Commercial	$87.30
Rate for Payer: Kaiser Permanente Medicaid	$49.47
Rate for Payer: Kaiser Permanente Medicare	$40.74
Rate for Payer: MDX Hawaii PPO	$94.09
Rate for Payer: Ohana Health Plan Medicaid	$40.74
Rate for Payer: Ohana Health Plan Medicare	$40.74
Rate for Payer: UnitedHealthcare Medicare	$40.74
Rate for Payer: University Health Alliance Commercial	$70.70

NEEDLE HUBER 20G 1"

Facility

$97.00

Hospital Charge Code	8207
Hospital Revenue Code	272
Min. Negotiated Rate	$82.45
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$63.05
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Kaiser Permanente Commercial	$87.30
Rate for Payer: MDX Hawaii PPO	$94.09

NEEDLE JELCO 16G 1.16

Facility

$125.00

Hospital Charge Code	8208
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

NEEDLE JELCO 16G 1.16

Facility

$125.00

Hospital Charge Code	8208
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

NEEDLE JELCO 18G 1.16

Facility

$125.00

Hospital Charge Code	8209
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

NEEDLE JELCO 18G 1.16

Facility

$125.00

Hospital Charge Code	8209
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

NEEDLE JELCO 18G 1.88

Facility

$3.00

Hospital Charge Code	8210
Hospital Revenue Code	270
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

NEEDLE JELCO 18G 1.88

Facility

$3.00

Hospital Charge Code	8210
Hospital Revenue Code	270
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

NEEDLE JELCO 20G 1.16

Facility

$3.00

Hospital Charge Code	8211
Hospital Revenue Code	270
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

NEEDLE JELCO 20G 1.16

Facility

$3.00

Hospital Charge Code	8211
Hospital Revenue Code	270
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

NEEDLE JELCO 20G 1.88

Facility

$3.00

Hospital Charge Code	8528
Hospital Revenue Code	270
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

NEEDLE JELCO 20G 1.88

Facility

$3.00

Hospital Charge Code	8528
Hospital Revenue Code	270
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

NEEDLE JELCO 22G 1

Facility

$44.00

Hospital Charge Code	8212
Hospital Revenue Code	270
Min. Negotiated Rate	$18.48
Max. Negotiated Rate	$42.68
Rate for Payer: AlohaCare Medicaid	$22.00
Rate for Payer: AlohaCare Medicare	$18.48
Rate for Payer: Cash Price	$28.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$40.48
Rate for Payer: Devoted Health Medicare	$18.48
Rate for Payer: Hawaii Medical Service Association Medicare	$18.48
Rate for Payer: Hawaii Western Management Group Commercial	$41.80
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Humana Medicare	$18.48
Rate for Payer: Kaiser Permanente Commercial	$39.60
Rate for Payer: Kaiser Permanente Medicaid	$22.44
Rate for Payer: Kaiser Permanente Medicare	$18.48
Rate for Payer: MDX Hawaii PPO	$42.68
Rate for Payer: Ohana Health Plan Medicaid	$18.48
Rate for Payer: Ohana Health Plan Medicare	$18.48
Rate for Payer: UnitedHealthcare Medicare	$18.48
Rate for Payer: University Health Alliance Commercial	$32.07

NEEDLE JELCO 22G 1

Facility

$44.00

Hospital Charge Code	8212
Hospital Revenue Code	270
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$28.60
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Kaiser Permanente Commercial	$39.60
Rate for Payer: MDX Hawaii PPO	$42.68

NEEDLE JELCO 24G .75

Facility

$4.00

Hospital Charge Code	8213
Hospital Revenue Code	270
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$1.68
Rate for Payer: Cash Price	$2.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3.68
Rate for Payer: Devoted Health Medicare	$1.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1.68
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$1.68
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$1.68
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$1.68
Rate for Payer: Ohana Health Plan Medicare	$1.68
Rate for Payer: UnitedHealthcare Medicare	$1.68
Rate for Payer: University Health Alliance Commercial	$2.92

NEEDLE JELCO 24G .75

Facility

$4.00

Hospital Charge Code	8213
Hospital Revenue Code	270
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.60
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

NEEDLE NEONATAL 25G 1M

Facility

$3.00

Hospital Charge Code	8214
Hospital Revenue Code	270
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

NEEDLE NEONATAL 25G 1M

Facility

$3.00

Hospital Charge Code	8214
Hospital Revenue Code	270
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

NEEDLE PLACEMENT IN VEIN CHARGE

Facility

$611.00

Service Code	HCPCS 36000
Hospital Charge Code	440360000
Hospital Revenue Code	450
Min. Negotiated Rate	$519.35
Max. Negotiated Rate	$592.67
Rate for Payer: Cash Price	$397.15
Rate for Payer: Health Management Network Commercial	$519.35
Rate for Payer: Kaiser Permanente Commercial	$549.90
Rate for Payer: MDX Hawaii PPO	$592.67

NEEDLE PLACEMENT IN VEIN CHARGE

Facility

$611.00

Service Code	HCPCS 36000
Hospital Charge Code	440360000
Hospital Revenue Code	450
Min. Negotiated Rate	$256.62
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$305.50
Rate for Payer: AlohaCare Medicare	$256.62
Rate for Payer: Cash Price	$397.15
Rate for Payer: Cash Price	$397.15
Rate for Payer: Cash Price	$397.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$562.12
Rate for Payer: Devoted Health Medicare	$256.62
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	$256.62
Rate for Payer: Hawaii Western Management Group Commercial	$580.45
Rate for Payer: Health Management Network Commercial	$519.35
Rate for Payer: Humana Medicare	$256.62
Rate for Payer: Kaiser Permanente Commercial	$549.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$256.62
Rate for Payer: MDX Hawaii PPO	$592.67
Rate for Payer: Ohana Health Plan Medicaid	$256.62
Rate for Payer: Ohana Health Plan Medicare	$256.62
Rate for Payer: UnitedHealthcare Medicare	$256.62
Rate for Payer: University Health Alliance Commercial	$445.36

Know your out-of-pocket cost for care.

All Charges