Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

Neonatal Bilirubin 1

Facility

$69.00

Service Code	HCPCS 82247
Hospital Charge Code	422822470
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$66.93
Rate for Payer: AlohaCare Medicaid	$34.50
Rate for Payer: AlohaCare Medicare	$28.98
Rate for Payer: Cash Price	$44.85
Rate for Payer: Cash Price	$44.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$63.48
Rate for Payer: Devoted Health Medicare	$28.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$28.98
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Humana Medicare	$28.98
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: Kaiser Permanente Medicaid	$35.19
Rate for Payer: Kaiser Permanente Medicare	$28.98
Rate for Payer: MDX Hawaii PPO	$66.93
Rate for Payer: Ohana Health Plan Medicaid	$28.98
Rate for Payer: Ohana Health Plan Medicare	$28.98
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$28.98
Rate for Payer: University Health Alliance Commercial	$12.99

NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY

Facility

$64,422.04

Service Code	MSDRG 789
Min. Negotiated Rate	$64,422.04
Max. Negotiated Rate	$64,422.04
Rate for Payer: Hawaii Medical Service Association Commercial	$64,422.04

NEONATE WITH OTHER SIGNIFICANT PROBLEMS

Facility

$4,029.34

Service Code	MSDRG 794
Min. Negotiated Rate	$4,029.34
Max. Negotiated Rate	$4,029.34
Rate for Payer: Hawaii Medical Service Association Commercial	$4,029.34

Nephron FA tab [KMC]

Facility

$3.00

Service Code	NDC 59528445601
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

Nephron FA tab [KMC]

Facility

$3.00

Service Code	NDC 59528445601
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

NERVOUS SYSTEM NEOPLASMS WITH MCC

Facility

$23,915.32

Service Code	MSDRG 054
Min. Negotiated Rate	$23,915.32
Max. Negotiated Rate	$23,915.32
Rate for Payer: Hawaii Medical Service Association Commercial	$23,915.32

NERVOUS SYSTEM NEOPLASMS WITHOUT MCC

Facility

$23,678.30

Service Code	MSDRG 055
Min. Negotiated Rate	$23,678.30
Max. Negotiated Rate	$23,678.30
Rate for Payer: Hawaii Medical Service Association Commercial	$23,678.30

netarsudil ophthalmic 0.02% Soln [KMC]

Facility

$522.37

Service Code	NDC 70727049725
Hospital Revenue Code	250
Min. Negotiated Rate	$444.01
Max. Negotiated Rate	$506.70
Rate for Payer: Cash Price	$339.54
Rate for Payer: Health Management Network Commercial	$444.01
Rate for Payer: Kaiser Permanente Commercial	$470.13
Rate for Payer: MDX Hawaii PPO	$506.70

netarsudil ophthalmic 0.02% Soln [KMC]

Facility

$522.37

Service Code	NDC 70727049725
Hospital Revenue Code	250
Min. Negotiated Rate	$219.40
Max. Negotiated Rate	$506.70
Rate for Payer: AlohaCare Medicaid	$261.19
Rate for Payer: AlohaCare Medicare	$219.40
Rate for Payer: Cash Price	$339.54
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$480.58
Rate for Payer: Devoted Health Medicare	$219.40
Rate for Payer: Hawaii Medical Service Association Medicare	$219.40
Rate for Payer: Hawaii Western Management Group Commercial	$496.25
Rate for Payer: Health Management Network Commercial	$444.01
Rate for Payer: Humana Medicare	$219.40
Rate for Payer: Kaiser Permanente Commercial	$470.13
Rate for Payer: Kaiser Permanente Medicaid	$266.41
Rate for Payer: Kaiser Permanente Medicare	$219.40
Rate for Payer: MDX Hawaii PPO	$506.70
Rate for Payer: Ohana Health Plan Medicaid	$219.40
Rate for Payer: Ohana Health Plan Medicare	$219.40
Rate for Payer: UnitedHealthcare Medicaid	$313.42
Rate for Payer: UnitedHealthcare Medicare	$219.40
Rate for Payer: University Health Alliance Commercial	$380.76

NEUROLOGICAL EYE DISORDERS

Facility

$16,638.80

Service Code	MSDRG 123
Min. Negotiated Rate	$16,638.80
Max. Negotiated Rate	$16,638.80
Rate for Payer: Hawaii Medical Service Association Commercial	$16,638.80

Neuromuscular Reeducation Charges

Facility

$179.00

Service Code	HCPCS 97112 GO
Hospital Charge Code	426971120
Hospital Revenue Code	430
Min. Negotiated Rate	$152.15
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$116.35
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63

Neuromuscular Reeducation Charges

Facility

$179.00

Service Code	HCPCS 97112 GP
Hospital Charge Code	432971120
Hospital Revenue Code	420
Min. Negotiated Rate	$152.15
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$116.35
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63

Neuromuscular Reeducation Charges

Facility

$179.00

Service Code	HCPCS 97112 GO
Hospital Charge Code	426971120
Hospital Revenue Code	430
Min. Negotiated Rate	$18.58
Max. Negotiated Rate	$173.63
Rate for Payer: AlohaCare Medicaid	$89.50
Rate for Payer: AlohaCare Medicare	$75.18
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$164.68
Rate for Payer: Devoted Health Medicare	$75.18
Rate for Payer: Hawaii Medical Service Association Medicare	$75.18
Rate for Payer: Hawaii Western Management Group Commercial	$170.05
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Humana Medicare	$75.18
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: Kaiser Permanente Medicaid	$91.29
Rate for Payer: Kaiser Permanente Medicare	$75.18
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: Ohana Health Plan Medicaid	$75.18
Rate for Payer: Ohana Health Plan Medicare	$75.18
Rate for Payer: UnitedHealthcare Medicaid	$18.58
Rate for Payer: UnitedHealthcare Medicare	$75.18
Rate for Payer: University Health Alliance Commercial	$130.47

Neuromuscular Reeducation Charges

Facility

$179.00

Service Code	HCPCS 97112 GP
Hospital Charge Code	432971120
Hospital Revenue Code	420
Min. Negotiated Rate	$18.58
Max. Negotiated Rate	$173.63
Rate for Payer: AlohaCare Medicaid	$89.50
Rate for Payer: AlohaCare Medicare	$75.18
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$164.68
Rate for Payer: Devoted Health Medicare	$75.18
Rate for Payer: Hawaii Medical Service Association Medicare	$75.18
Rate for Payer: Hawaii Western Management Group Commercial	$170.05
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Humana Medicare	$75.18
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: Kaiser Permanente Medicaid	$91.29
Rate for Payer: Kaiser Permanente Medicare	$75.18
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: Ohana Health Plan Medicaid	$75.18
Rate for Payer: Ohana Health Plan Medicare	$75.18
Rate for Payer: UnitedHealthcare Medicaid	$18.58
Rate for Payer: UnitedHealthcare Medicare	$75.18
Rate for Payer: University Health Alliance Commercial	$130.47

NEURO RE-EDUC EA 15 MIN Occupational

Facility

$179.00

Service Code	HCPCS 97112 GO
Hospital Charge Code	426971120
Hospital Revenue Code	430
Min. Negotiated Rate	$18.58
Max. Negotiated Rate	$173.63
Rate for Payer: AlohaCare Medicaid	$89.50
Rate for Payer: AlohaCare Medicare	$75.18
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$164.68
Rate for Payer: Devoted Health Medicare	$75.18
Rate for Payer: Hawaii Medical Service Association Medicare	$75.18
Rate for Payer: Hawaii Western Management Group Commercial	$170.05
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Humana Medicare	$75.18
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: Kaiser Permanente Medicaid	$91.29
Rate for Payer: Kaiser Permanente Medicare	$75.18
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: Ohana Health Plan Medicaid	$75.18
Rate for Payer: Ohana Health Plan Medicare	$75.18
Rate for Payer: UnitedHealthcare Medicaid	$18.58
Rate for Payer: UnitedHealthcare Medicare	$75.18
Rate for Payer: University Health Alliance Commercial	$130.47

NEURO RE-EDUC EA 15 MIN Occupational

Facility

$179.00

Service Code	HCPCS 97112 GO
Hospital Charge Code	426971120
Hospital Revenue Code	430
Min. Negotiated Rate	$152.15
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$116.35
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63

NEURO RE-EDUC EA 15 MIN Physical

Facility

$179.00

Service Code	HCPCS 97112 GP
Hospital Charge Code	432971120
Hospital Revenue Code	420
Min. Negotiated Rate	$18.58
Max. Negotiated Rate	$173.63
Rate for Payer: AlohaCare Medicaid	$89.50
Rate for Payer: AlohaCare Medicare	$75.18
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$164.68
Rate for Payer: Devoted Health Medicare	$75.18
Rate for Payer: Hawaii Medical Service Association Medicare	$75.18
Rate for Payer: Hawaii Western Management Group Commercial	$170.05
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Humana Medicare	$75.18
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: Kaiser Permanente Medicaid	$91.29
Rate for Payer: Kaiser Permanente Medicare	$75.18
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: Ohana Health Plan Medicaid	$75.18
Rate for Payer: Ohana Health Plan Medicare	$75.18
Rate for Payer: UnitedHealthcare Medicaid	$18.58
Rate for Payer: UnitedHealthcare Medicare	$75.18
Rate for Payer: University Health Alliance Commercial	$130.47

NEURO RE-EDUC EA 15 MIN Physical

Facility

$179.00

Service Code	HCPCS 97112 GP
Hospital Charge Code	432971120
Hospital Revenue Code	420
Min. Negotiated Rate	$152.15
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$116.35
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63

NEUROSES EXCEPT DEPRESSIVE

Facility

$9,528.20

Service Code	MSDRG 882
Min. Negotiated Rate	$9,528.20
Max. Negotiated Rate	$9,528.20
Rate for Payer: Hawaii Medical Service Association Commercial	$9,528.20

NEWS TRACHEAL HOOK 6"

Facility

$16.00

Hospital Charge Code	8546
Hospital Revenue Code	270
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$10.40
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

NEWS TRACHEAL HOOK 6"

Facility

$16.00

Hospital Charge Code	8546
Hospital Revenue Code	270
Min. Negotiated Rate	$6.72
Max. Negotiated Rate	$15.52
Rate for Payer: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$6.72
Rate for Payer: Cash Price	$10.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$14.72
Rate for Payer: Devoted Health Medicare	$6.72
Rate for Payer: Hawaii Medical Service Association Medicare	$6.72
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Humana Medicare	$6.72
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicare	$6.72
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: Ohana Health Plan Medicaid	$6.72
Rate for Payer: Ohana Health Plan Medicare	$6.72
Rate for Payer: UnitedHealthcare Medicare	$6.72
Rate for Payer: University Health Alliance Commercial	$11.66

NF DISCH DAY MGMT GT 30 MIN

Professional

Both

$322.00

Service Code	HCPCS 99316
Hospital Charge Code	400993160
Hospital Revenue Code	987
Min. Negotiated Rate	$73.13
Max. Negotiated Rate	$273.70
Rate for Payer: AlohaCare Medicaid	$133.44
Rate for Payer: AlohaCare Medicare	$119.07
Rate for Payer: Cash Price	$209.30
Rate for Payer: Cash Price	$209.30
Rate for Payer: Devoted Health Medicare	$119.07
Rate for Payer: Hawaii Medical Service Association Medicare	$119.07
Rate for Payer: Hawaii Western Management Group Commercial	$73.13
Rate for Payer: Health Management Network Commercial	$273.70
Rate for Payer: Kaiser Permanente Commercial	$142.88
Rate for Payer: Kaiser Permanente Medicaid	$142.88
Rate for Payer: Kaiser Permanente Medicare	$142.88
Rate for Payer: Ohana Health Plan Medicaid	$133.44
Rate for Payer: Ohana Health Plan Medicare	$119.07
Rate for Payer: UnitedHealthcare Medicaid	$133.44
Rate for Payer: UnitedHealthcare Medicare	$119.07

niacin 100 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00536407601
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

niacin 100 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00536407601
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

niacin 500 mg ER Tab [KMC]

Facility

$3.00

Service Code	NDC 00245006311
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

Know your out-of-pocket cost for care.

All Charges