Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

NEEDLE SET 15G 15MM

Facility

$8.00

Hospital Charge Code	8215
Hospital Revenue Code	270
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$7.76
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$3.36
Rate for Payer: Cash Price	$5.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7.36
Rate for Payer: Devoted Health Medicare	$3.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3.36
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Humana Medicare	$3.36
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicare	$3.36
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: Ohana Health Plan Medicaid	$3.36
Rate for Payer: Ohana Health Plan Medicare	$3.36
Rate for Payer: UnitedHealthcare Medicare	$3.36
Rate for Payer: University Health Alliance Commercial	$5.83

NEEDLE SET 15G 15MM

Facility

$8.00

Hospital Charge Code	8215
Hospital Revenue Code	270
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$5.20
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: MDX Hawaii PPO	$7.76

NEEDLE SET 15G 25MM

Facility

$3.00

Hospital Charge Code	8216
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 SET 15G 25MM

Facility

$3.00

Hospital Charge Code	8216
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 SET 15G 45MM

Facility

$15.00

Hospital Charge Code	8217
Hospital Revenue Code	270
Min. Negotiated Rate	$6.30
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$6.30
Rate for Payer: Cash Price	$9.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$13.80
Rate for Payer: Devoted Health Medicare	$6.30
Rate for Payer: Hawaii Medical Service Association Medicare	$6.30
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$6.30
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$6.30
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$6.30
Rate for Payer: Ohana Health Plan Medicare	$6.30
Rate for Payer: UnitedHealthcare Medicare	$6.30
Rate for Payer: University Health Alliance Commercial	$10.93

NEEDLE SET 15G 45MM

Facility

$15.00

Hospital Charge Code	8217
Hospital Revenue Code	270
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.75
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

NEEDLE SPINAL 20G 6"

Facility

$553.00

Hospital Charge Code	8218
Hospital Revenue Code	272
Min. Negotiated Rate	$232.26
Max. Negotiated Rate	$536.41
Rate for Payer: AlohaCare Medicaid	$276.50
Rate for Payer: AlohaCare Medicare	$232.26
Rate for Payer: Cash Price	$359.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$508.76
Rate for Payer: Devoted Health Medicare	$232.26
Rate for Payer: Hawaii Medical Service Association Medicare	$232.26
Rate for Payer: Hawaii Western Management Group Commercial	$525.35
Rate for Payer: Health Management Network Commercial	$470.05
Rate for Payer: Humana Medicare	$232.26
Rate for Payer: Kaiser Permanente Commercial	$497.70
Rate for Payer: Kaiser Permanente Medicaid	$282.03
Rate for Payer: Kaiser Permanente Medicare	$232.26
Rate for Payer: MDX Hawaii PPO	$536.41
Rate for Payer: Ohana Health Plan Medicaid	$232.26
Rate for Payer: Ohana Health Plan Medicare	$232.26
Rate for Payer: UnitedHealthcare Medicare	$232.26
Rate for Payer: University Health Alliance Commercial	$403.08

NEEDLE SPINAL 20G 6"

Facility

$553.00

Hospital Charge Code	8218
Hospital Revenue Code	272
Min. Negotiated Rate	$470.05
Max. Negotiated Rate	$536.41
Rate for Payer: Cash Price	$359.45
Rate for Payer: Health Management Network Commercial	$470.05
Rate for Payer: Kaiser Permanente Commercial	$497.70
Rate for Payer: MDX Hawaii PPO	$536.41

NEEDLE SPINAL 22G 5"

Facility

$553.00

Hospital Charge Code	8219
Hospital Revenue Code	272
Min. Negotiated Rate	$470.05
Max. Negotiated Rate	$536.41
Rate for Payer: Cash Price	$359.45
Rate for Payer: Health Management Network Commercial	$470.05
Rate for Payer: Kaiser Permanente Commercial	$497.70
Rate for Payer: MDX Hawaii PPO	$536.41

NEEDLE SPINAL 22G 5"

Facility

$553.00

Hospital Charge Code	8219
Hospital Revenue Code	272
Min. Negotiated Rate	$232.26
Max. Negotiated Rate	$536.41
Rate for Payer: AlohaCare Medicaid	$276.50
Rate for Payer: AlohaCare Medicare	$232.26
Rate for Payer: Cash Price	$359.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$508.76
Rate for Payer: Devoted Health Medicare	$232.26
Rate for Payer: Hawaii Medical Service Association Medicare	$232.26
Rate for Payer: Hawaii Western Management Group Commercial	$525.35
Rate for Payer: Health Management Network Commercial	$470.05
Rate for Payer: Humana Medicare	$232.26
Rate for Payer: Kaiser Permanente Commercial	$497.70
Rate for Payer: Kaiser Permanente Medicaid	$282.03
Rate for Payer: Kaiser Permanente Medicare	$232.26
Rate for Payer: MDX Hawaii PPO	$536.41
Rate for Payer: Ohana Health Plan Medicaid	$232.26
Rate for Payer: Ohana Health Plan Medicare	$232.26
Rate for Payer: UnitedHealthcare Medicare	$232.26
Rate for Payer: University Health Alliance Commercial	$403.08

NEGATIVE MICROALBUMINURIA TEST RESULT DOC&REV

Professional

Both

$0.01

Service Code	HCPCS 3061F
Hospital Revenue Code	521
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$290.48
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$273.13

NEG DEP SYMP CAT USING STAND DEP ASSESS TOOL

Professional

Both

$0.01

Service Code	HCPCS 3351F
Hospital Revenue Code	521
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$290.48
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$273.13
Rate for Payer: UnitedHealthcare Medicare	$152.00

NEG PRES WOUND >50 SQ CM

Professional

Both

$980.00

Service Code	HCPCS G0457
Hospital Revenue Code	521
Min. Negotiated Rate	$47.77
Max. Negotiated Rate	$833.00
Rate for Payer: Cash Price	$637.00
Rate for Payer: Cash Price	$637.00
Rate for Payer: Cash Price	$637.00
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Western Management Group Commercial	$47.77
Rate for Payer: Health Management Network Commercial	$833.00
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$273.13

Neg Pres Wound >50 Sq Cm Occupational

Facility

$1,029.00

Service Code	HCPCS G0457 GO
Hospital Charge Code	426G04570
Hospital Revenue Code	430
Min. Negotiated Rate	$874.65
Max. Negotiated Rate	$998.13
Rate for Payer: Cash Price	$668.85
Rate for Payer: Health Management Network Commercial	$874.65
Rate for Payer: Kaiser Permanente Commercial	$926.10
Rate for Payer: MDX Hawaii PPO	$998.13

Neg Pres Wound >50 Sq Cm Occupational

Facility

$1,029.00

Service Code	HCPCS G0457 GO
Hospital Charge Code	426G04570
Hospital Revenue Code	430
Min. Negotiated Rate	$432.18
Max. Negotiated Rate	$998.13
Rate for Payer: AlohaCare Medicaid	$514.50
Rate for Payer: AlohaCare Medicare	$432.18
Rate for Payer: Cash Price	$668.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$946.68
Rate for Payer: Devoted Health Medicare	$432.18
Rate for Payer: Hawaii Medical Service Association Medicare	$432.18
Rate for Payer: Hawaii Western Management Group Commercial	$977.55
Rate for Payer: Health Management Network Commercial	$874.65
Rate for Payer: Humana Medicare	$432.18
Rate for Payer: Kaiser Permanente Commercial	$926.10
Rate for Payer: Kaiser Permanente Medicaid	$524.79
Rate for Payer: Kaiser Permanente Medicare	$432.18
Rate for Payer: MDX Hawaii PPO	$998.13
Rate for Payer: Ohana Health Plan Medicaid	$432.18
Rate for Payer: Ohana Health Plan Medicare	$432.18
Rate for Payer: UnitedHealthcare Medicare	$432.18
Rate for Payer: University Health Alliance Commercial	$750.04

Neg Pres Wound >50 Sq Cm Physical

Facility

$1,405.00

Service Code	HCPCS G0457 GP
Hospital Charge Code	432G04570
Hospital Revenue Code	420
Min. Negotiated Rate	$1,194.25
Max. Negotiated Rate	$1,362.85
Rate for Payer: Cash Price	$913.25
Rate for Payer: Health Management Network Commercial	$1,194.25
Rate for Payer: Kaiser Permanente Commercial	$1,264.50
Rate for Payer: MDX Hawaii PPO	$1,362.85

Neg Pres Wound >50 Sq Cm Physical

Facility

$1,405.00

Service Code	HCPCS G0457 GP
Hospital Charge Code	432G04570
Hospital Revenue Code	420
Min. Negotiated Rate	$590.10
Max. Negotiated Rate	$1,362.85
Rate for Payer: AlohaCare Medicaid	$702.50
Rate for Payer: AlohaCare Medicare	$590.10
Rate for Payer: Cash Price	$913.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,292.60
Rate for Payer: Devoted Health Medicare	$590.10
Rate for Payer: Hawaii Medical Service Association Medicare	$590.10
Rate for Payer: Hawaii Western Management Group Commercial	$1,334.75
Rate for Payer: Health Management Network Commercial	$1,194.25
Rate for Payer: Humana Medicare	$590.10
Rate for Payer: Kaiser Permanente Commercial	$1,264.50
Rate for Payer: Kaiser Permanente Medicaid	$716.55
Rate for Payer: Kaiser Permanente Medicare	$590.10
Rate for Payer: MDX Hawaii PPO	$1,362.85
Rate for Payer: Ohana Health Plan Medicaid	$590.10
Rate for Payer: Ohana Health Plan Medicare	$590.10
Rate for Payer: UnitedHealthcare Medicare	$590.10
Rate for Payer: University Health Alliance Commercial	$1,024.10

NEG PRE WOUND <=50 SQ CM

Professional

Both

$980.00

Service Code	HCPCS G0456
Hospital Revenue Code	521
Min. Negotiated Rate	$45.18
Max. Negotiated Rate	$833.00
Rate for Payer: Cash Price	$637.00
Rate for Payer: Cash Price	$637.00
Rate for Payer: Cash Price	$637.00
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Hawaii Western Management Group Commercial	$45.18
Rate for Payer: Health Management Network Commercial	$833.00
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$273.13

Neg Pre Wound <50 Sq Cm Occupational

Facility

$1,405.00

Service Code	HCPCS G0456 GO
Hospital Charge Code	426G04560
Hospital Revenue Code	430
Min. Negotiated Rate	$590.10
Max. Negotiated Rate	$1,362.85
Rate for Payer: AlohaCare Medicaid	$702.50
Rate for Payer: AlohaCare Medicare	$590.10
Rate for Payer: Cash Price	$913.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,292.60
Rate for Payer: Devoted Health Medicare	$590.10
Rate for Payer: Hawaii Medical Service Association Medicare	$590.10
Rate for Payer: Hawaii Western Management Group Commercial	$1,334.75
Rate for Payer: Health Management Network Commercial	$1,194.25
Rate for Payer: Humana Medicare	$590.10
Rate for Payer: Kaiser Permanente Commercial	$1,264.50
Rate for Payer: Kaiser Permanente Medicaid	$716.55
Rate for Payer: Kaiser Permanente Medicare	$590.10
Rate for Payer: MDX Hawaii PPO	$1,362.85
Rate for Payer: Ohana Health Plan Medicaid	$590.10
Rate for Payer: Ohana Health Plan Medicare	$590.10
Rate for Payer: UnitedHealthcare Medicare	$590.10
Rate for Payer: University Health Alliance Commercial	$1,024.10

Neg Pre Wound <50 Sq Cm Occupational

Facility

$1,405.00

Service Code	HCPCS G0456 GO
Hospital Charge Code	426G04560
Hospital Revenue Code	430
Min. Negotiated Rate	$1,194.25
Max. Negotiated Rate	$1,362.85
Rate for Payer: Cash Price	$913.25
Rate for Payer: Health Management Network Commercial	$1,194.25
Rate for Payer: Kaiser Permanente Commercial	$1,264.50
Rate for Payer: MDX Hawaii PPO	$1,362.85

Neg Pre Wound <50 Sq Cm Physical

Facility

$1,029.00

Service Code	HCPCS G0456 GP
Hospital Charge Code	432G04560
Hospital Revenue Code	420
Min. Negotiated Rate	$874.65
Max. Negotiated Rate	$998.13
Rate for Payer: Cash Price	$668.85
Rate for Payer: Health Management Network Commercial	$874.65
Rate for Payer: Kaiser Permanente Commercial	$926.10
Rate for Payer: MDX Hawaii PPO	$998.13

Neg Pre Wound <50 Sq Cm Physical

Facility

$1,029.00

Service Code	HCPCS G0456 GP
Hospital Charge Code	432G04560
Hospital Revenue Code	420
Min. Negotiated Rate	$432.18
Max. Negotiated Rate	$998.13
Rate for Payer: AlohaCare Medicaid	$514.50
Rate for Payer: AlohaCare Medicare	$432.18
Rate for Payer: Cash Price	$668.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$946.68
Rate for Payer: Devoted Health Medicare	$432.18
Rate for Payer: Hawaii Medical Service Association Medicare	$432.18
Rate for Payer: Hawaii Western Management Group Commercial	$977.55
Rate for Payer: Health Management Network Commercial	$874.65
Rate for Payer: Humana Medicare	$432.18
Rate for Payer: Kaiser Permanente Commercial	$926.10
Rate for Payer: Kaiser Permanente Medicaid	$524.79
Rate for Payer: Kaiser Permanente Medicare	$432.18
Rate for Payer: MDX Hawaii PPO	$998.13
Rate for Payer: Ohana Health Plan Medicaid	$432.18
Rate for Payer: Ohana Health Plan Medicare	$432.18
Rate for Payer: UnitedHealthcare Medicare	$432.18
Rate for Payer: University Health Alliance Commercial	$750.04

neomycin 500 mg Tab [KMC]

Facility

$5.46

Service Code	NDC 00093117701
Hospital Revenue Code	250
Min. Negotiated Rate	$4.64
Max. Negotiated Rate	$5.30
Rate for Payer: Cash Price	$3.55
Rate for Payer: Health Management Network Commercial	$4.64
Rate for Payer: Kaiser Permanente Commercial	$4.91
Rate for Payer: MDX Hawaii PPO	$5.30

neomycin 500 mg Tab [KMC]

Facility

$5.46

Service Code	NDC 00093117701
Hospital Revenue Code	250
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$5.30
Rate for Payer: AlohaCare Medicaid	$2.73
Rate for Payer: AlohaCare Medicare	$2.29
Rate for Payer: Cash Price	$3.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.02
Rate for Payer: Devoted Health Medicare	$2.29
Rate for Payer: Hawaii Medical Service Association Medicare	$2.29
Rate for Payer: Hawaii Western Management Group Commercial	$5.19
Rate for Payer: Health Management Network Commercial	$4.64
Rate for Payer: Humana Medicare	$2.29
Rate for Payer: Kaiser Permanente Commercial	$4.91
Rate for Payer: Kaiser Permanente Medicaid	$2.78
Rate for Payer: Kaiser Permanente Medicare	$2.29
Rate for Payer: MDX Hawaii PPO	$5.30
Rate for Payer: Ohana Health Plan Medicaid	$2.29
Rate for Payer: Ohana Health Plan Medicare	$2.29
Rate for Payer: UnitedHealthcare Medicaid	$3.28
Rate for Payer: UnitedHealthcare Medicare	$2.29
Rate for Payer: University Health Alliance Commercial	$3.98

Neonatal Bilirubin 1

Facility

$69.00

Service Code	HCPCS 82247
Hospital Charge Code	422822470
Hospital Revenue Code	301
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$44.85
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: MDX Hawaii PPO	$66.93

Know your out-of-pocket cost for care.

All Charges