Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

niacin 500 mg ER Tab [KMC]

Facility

$3.00

Service Code	NDC 00245006311
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

niacinamide 500 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00904420260
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

niacinamide 500 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00904420260
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

niCARdipine 20 mg Cap [KMC]

Facility

$61.98

Service Code	NDC 68462012090
Hospital Revenue Code	250
Min. Negotiated Rate	$52.68
Max. Negotiated Rate	$60.12
Rate for Payer: Cash Price	$40.29
Rate for Payer: Health Management Network Commercial	$52.68
Rate for Payer: Kaiser Permanente Commercial	$55.78
Rate for Payer: MDX Hawaii PPO	$60.12

niCARdipine 20 mg Cap [KMC]

Facility

$61.98

Service Code	NDC 68462012090
Hospital Revenue Code	250
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$60.12
Rate for Payer: AlohaCare Medicaid	$30.99
Rate for Payer: AlohaCare Medicare	$26.03
Rate for Payer: Cash Price	$40.29
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$57.02
Rate for Payer: Devoted Health Medicare	$26.03
Rate for Payer: Hawaii Medical Service Association Medicare	$26.03
Rate for Payer: Hawaii Western Management Group Commercial	$58.88
Rate for Payer: Health Management Network Commercial	$52.68
Rate for Payer: Humana Medicare	$26.03
Rate for Payer: Kaiser Permanente Commercial	$55.78
Rate for Payer: Kaiser Permanente Medicaid	$31.61
Rate for Payer: Kaiser Permanente Medicare	$26.03
Rate for Payer: MDX Hawaii PPO	$60.12
Rate for Payer: Ohana Health Plan Medicaid	$26.03
Rate for Payer: Ohana Health Plan Medicare	$26.03
Rate for Payer: UnitedHealthcare Medicaid	$37.19
Rate for Payer: UnitedHealthcare Medicare	$26.03
Rate for Payer: University Health Alliance Commercial	$45.18

niCARdipine 25 mg/ 10 mL IV Sol [KMC]

Facility

$12.25

Service Code	NDC 00143968910
Hospital Revenue Code	250
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$11.88
Rate for Payer: AlohaCare Medicaid	$6.12
Rate for Payer: AlohaCare Medicare	$5.14
Rate for Payer: Cash Price	$7.96
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$11.27
Rate for Payer: Devoted Health Medicare	$5.14
Rate for Payer: Hawaii Medical Service Association Medicare	$5.14
Rate for Payer: Hawaii Western Management Group Commercial	$11.64
Rate for Payer: Health Management Network Commercial	$10.41
Rate for Payer: Humana Medicare	$5.14
Rate for Payer: Kaiser Permanente Commercial	$11.03
Rate for Payer: Kaiser Permanente Medicaid	$6.25
Rate for Payer: Kaiser Permanente Medicare	$5.14
Rate for Payer: MDX Hawaii PPO	$11.88
Rate for Payer: Ohana Health Plan Medicaid	$5.14
Rate for Payer: Ohana Health Plan Medicare	$5.14
Rate for Payer: UnitedHealthcare Medicaid	$7.35
Rate for Payer: UnitedHealthcare Medicare	$5.14
Rate for Payer: University Health Alliance Commercial	$8.93

niCARdipine 25 mg/ 10 mL IV Sol [KMC]

Facility

$12.25

Service Code	NDC 00143968910
Hospital Revenue Code	250
Min. Negotiated Rate	$10.41
Max. Negotiated Rate	$11.88
Rate for Payer: Cash Price	$7.96
Rate for Payer: Health Management Network Commercial	$10.41
Rate for Payer: Kaiser Permanente Commercial	$11.03
Rate for Payer: MDX Hawaii PPO	$11.88

nicotine 14 mg/24 hr Transderm ER Film [KMC]

Facility

$8.57

Service Code	NDC 00536110788
Hospital Revenue Code	250
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$8.31
Rate for Payer: Cash Price	$5.57
Rate for Payer: Health Management Network Commercial	$7.28
Rate for Payer: Kaiser Permanente Commercial	$7.71
Rate for Payer: MDX Hawaii PPO	$8.31

nicotine 14 mg/24 hr Transderm ER Film [KMC]

Facility

$8.57

Service Code	NDC 00536110788
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.31
Rate for Payer: AlohaCare Medicaid	$4.29
Rate for Payer: AlohaCare Medicare	$3.60
Rate for Payer: Cash Price	$5.57
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7.88
Rate for Payer: Devoted Health Medicare	$3.60
Rate for Payer: Hawaii Medical Service Association Medicare	$3.60
Rate for Payer: Hawaii Western Management Group Commercial	$8.14
Rate for Payer: Health Management Network Commercial	$7.28
Rate for Payer: Humana Medicare	$3.60
Rate for Payer: Kaiser Permanente Commercial	$7.71
Rate for Payer: Kaiser Permanente Medicaid	$4.37
Rate for Payer: Kaiser Permanente Medicare	$3.60
Rate for Payer: MDX Hawaii PPO	$8.31
Rate for Payer: Ohana Health Plan Medicaid	$3.60
Rate for Payer: Ohana Health Plan Medicare	$3.60
Rate for Payer: UnitedHealthcare Medicaid	$5.14
Rate for Payer: UnitedHealthcare Medicare	$3.60
Rate for Payer: University Health Alliance Commercial	$6.25

nicotine 21 mg/24 hr Transderm ER Film [KMC]

Facility

$8.57

Service Code	NDC 00536110888
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.31
Rate for Payer: AlohaCare Medicaid	$4.29
Rate for Payer: AlohaCare Medicare	$3.60
Rate for Payer: Cash Price	$5.57
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7.88
Rate for Payer: Devoted Health Medicare	$3.60
Rate for Payer: Hawaii Medical Service Association Medicare	$3.60
Rate for Payer: Hawaii Western Management Group Commercial	$8.14
Rate for Payer: Health Management Network Commercial	$7.28
Rate for Payer: Humana Medicare	$3.60
Rate for Payer: Kaiser Permanente Commercial	$7.71
Rate for Payer: Kaiser Permanente Medicaid	$4.37
Rate for Payer: Kaiser Permanente Medicare	$3.60
Rate for Payer: MDX Hawaii PPO	$8.31
Rate for Payer: Ohana Health Plan Medicaid	$3.60
Rate for Payer: Ohana Health Plan Medicare	$3.60
Rate for Payer: UnitedHealthcare Medicaid	$5.14
Rate for Payer: UnitedHealthcare Medicare	$3.60
Rate for Payer: University Health Alliance Commercial	$6.25

nicotine 21 mg/24 hr Transderm ER Film [KMC]

Facility

$8.57

Service Code	NDC 00536110888
Hospital Revenue Code	250
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$8.31
Rate for Payer: Cash Price	$5.57
Rate for Payer: Health Management Network Commercial	$7.28
Rate for Payer: Kaiser Permanente Commercial	$7.71
Rate for Payer: MDX Hawaii PPO	$8.31

nicotine 2 mg Oral transmucosal Gum [KMC]

Facility

$3.00

Service Code	NDC 00536136223
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

nicotine 2 mg Oral transmucosal Gum [KMC]

Facility

$3.00

Service Code	NDC 00536136223
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

Nicotine 4 mg lozenge [KMC]

Facility

$3.00

Service Code	NDC 62011017101
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

Nicotine 4 mg lozenge [KMC]

Facility

$3.00

Service Code	NDC 62011017101
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

nicotine 4 mg Oral transmucosal Gum [KMC]

Facility

$3.00

Service Code	NDC 49348057208
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

nicotine 4 mg Oral transmucosal Gum [KMC]

Facility

$3.00

Service Code	NDC 49348057208
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

nicotine 7 mg/24 hr Transderm ER Film [KMC]

Facility

$8.57

Service Code	NDC 00536589488
Hospital Revenue Code	250
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$8.31
Rate for Payer: Cash Price	$5.57
Rate for Payer: Health Management Network Commercial	$7.28
Rate for Payer: Kaiser Permanente Commercial	$7.71
Rate for Payer: MDX Hawaii PPO	$8.31

nicotine 7 mg/24 hr Transderm ER Film [KMC]

Facility

$8.57

Service Code	NDC 00536589488
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.31
Rate for Payer: AlohaCare Medicaid	$4.29
Rate for Payer: AlohaCare Medicare	$3.60
Rate for Payer: Cash Price	$5.57
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7.88
Rate for Payer: Devoted Health Medicare	$3.60
Rate for Payer: Hawaii Medical Service Association Medicare	$3.60
Rate for Payer: Hawaii Western Management Group Commercial	$8.14
Rate for Payer: Health Management Network Commercial	$7.28
Rate for Payer: Humana Medicare	$3.60
Rate for Payer: Kaiser Permanente Commercial	$7.71
Rate for Payer: Kaiser Permanente Medicaid	$4.37
Rate for Payer: Kaiser Permanente Medicare	$3.60
Rate for Payer: MDX Hawaii PPO	$8.31
Rate for Payer: Ohana Health Plan Medicaid	$3.60
Rate for Payer: Ohana Health Plan Medicare	$3.60
Rate for Payer: UnitedHealthcare Medicaid	$5.14
Rate for Payer: UnitedHealthcare Medicare	$3.60
Rate for Payer: University Health Alliance Commercial	$6.25

NIFEdipine 10 mg Cap [KMC]

Facility

$5.15

Service Code	NDC 43386044024
Hospital Revenue Code	250
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$5.00
Rate for Payer: Cash Price	$3.35
Rate for Payer: Health Management Network Commercial	$4.38
Rate for Payer: Kaiser Permanente Commercial	$4.63
Rate for Payer: MDX Hawaii PPO	$5.00

NIFEdipine 10 mg Cap [KMC]

Facility

$5.15

Service Code	NDC 43386044024
Hospital Revenue Code	250
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$5.00
Rate for Payer: AlohaCare Medicaid	$2.58
Rate for Payer: AlohaCare Medicare	$2.16
Rate for Payer: Cash Price	$3.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.74
Rate for Payer: Devoted Health Medicare	$2.16
Rate for Payer: Hawaii Medical Service Association Medicare	$2.16
Rate for Payer: Hawaii Western Management Group Commercial	$4.89
Rate for Payer: Health Management Network Commercial	$4.38
Rate for Payer: Humana Medicare	$2.16
Rate for Payer: Kaiser Permanente Commercial	$4.63
Rate for Payer: Kaiser Permanente Medicaid	$2.63
Rate for Payer: Kaiser Permanente Medicare	$2.16
Rate for Payer: MDX Hawaii PPO	$5.00
Rate for Payer: Ohana Health Plan Medicaid	$2.16
Rate for Payer: Ohana Health Plan Medicare	$2.16
Rate for Payer: UnitedHealthcare Medicaid	$3.09
Rate for Payer: UnitedHealthcare Medicare	$2.16
Rate for Payer: University Health Alliance Commercial	$3.75

NIFEdipine 30 mg ER tablet [KMC]

Facility

$5.30

Service Code	NDC 50742026001
Hospital Revenue Code	250
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$5.14
Rate for Payer: AlohaCare Medicaid	$2.65
Rate for Payer: AlohaCare Medicare	$2.23
Rate for Payer: Cash Price	$3.44
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.88
Rate for Payer: Devoted Health Medicare	$2.23
Rate for Payer: Hawaii Medical Service Association Medicare	$2.23
Rate for Payer: Hawaii Western Management Group Commercial	$5.04
Rate for Payer: Health Management Network Commercial	$4.50
Rate for Payer: Humana Medicare	$2.23
Rate for Payer: Kaiser Permanente Commercial	$4.77
Rate for Payer: Kaiser Permanente Medicaid	$2.70
Rate for Payer: Kaiser Permanente Medicare	$2.23
Rate for Payer: MDX Hawaii PPO	$5.14
Rate for Payer: Ohana Health Plan Medicaid	$2.23
Rate for Payer: Ohana Health Plan Medicare	$2.23
Rate for Payer: UnitedHealthcare Medicaid	$3.18
Rate for Payer: UnitedHealthcare Medicare	$2.23
Rate for Payer: University Health Alliance Commercial	$3.86

NIFEdipine 30 mg ER tablet [KMC]

Facility

$5.30

Service Code	NDC 50742026001
Hospital Revenue Code	250
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$5.14
Rate for Payer: Cash Price	$3.44
Rate for Payer: Health Management Network Commercial	$4.50
Rate for Payer: Kaiser Permanente Commercial	$4.77
Rate for Payer: MDX Hawaii PPO	$5.14

NIFEdipine 90 mg ER Tab [KMC]

Facility

$12.13

Service Code	NDC 50742062201
Hospital Revenue Code	250
Min. Negotiated Rate	$5.09
Max. Negotiated Rate	$11.77
Rate for Payer: AlohaCare Medicaid	$6.07
Rate for Payer: AlohaCare Medicare	$5.09
Rate for Payer: Cash Price	$7.88
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$11.16
Rate for Payer: Devoted Health Medicare	$5.09
Rate for Payer: Hawaii Medical Service Association Medicare	$5.09
Rate for Payer: Hawaii Western Management Group Commercial	$11.52
Rate for Payer: Health Management Network Commercial	$10.31
Rate for Payer: Humana Medicare	$5.09
Rate for Payer: Kaiser Permanente Commercial	$10.92
Rate for Payer: Kaiser Permanente Medicaid	$6.19
Rate for Payer: Kaiser Permanente Medicare	$5.09
Rate for Payer: MDX Hawaii PPO	$11.77
Rate for Payer: Ohana Health Plan Medicaid	$5.09
Rate for Payer: Ohana Health Plan Medicare	$5.09
Rate for Payer: UnitedHealthcare Medicaid	$7.28
Rate for Payer: UnitedHealthcare Medicare	$5.09
Rate for Payer: University Health Alliance Commercial	$8.84

NIFEdipine 90 mg ER Tab [KMC]

Facility

$12.13

Service Code	NDC 50742062201
Hospital Revenue Code	250
Min. Negotiated Rate	$10.31
Max. Negotiated Rate	$11.77
Rate for Payer: Cash Price	$7.88
Rate for Payer: Health Management Network Commercial	$10.31
Rate for Payer: Kaiser Permanente Commercial	$10.92
Rate for Payer: MDX Hawaii PPO	$11.77

Know your out-of-pocket cost for care.

All Charges