Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

Nitrofurantoin 100 mg cap [KMC]

Facility

$17.73

Service Code	NDC 72603019601
Hospital Revenue Code	250
Min. Negotiated Rate	$15.07
Max. Negotiated Rate	$17.20
Rate for Payer: Cash Price	$11.52
Rate for Payer: Health Management Network Commercial	$15.07
Rate for Payer: Kaiser Permanente Commercial	$15.96
Rate for Payer: MDX Hawaii PPO	$17.20

Nitrofurantoin 100 mg cap [KMC]

Facility

$17.73

Service Code	NDC 72603019601
Hospital Revenue Code	250
Min. Negotiated Rate	$7.45
Max. Negotiated Rate	$17.20
Rate for Payer: AlohaCare Medicaid	$8.87
Rate for Payer: AlohaCare Medicare	$7.45
Rate for Payer: Cash Price	$11.52
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$16.31
Rate for Payer: Devoted Health Medicare	$7.45
Rate for Payer: Hawaii Medical Service Association Medicare	$7.45
Rate for Payer: Hawaii Western Management Group Commercial	$16.84
Rate for Payer: Health Management Network Commercial	$15.07
Rate for Payer: Humana Medicare	$7.45
Rate for Payer: Kaiser Permanente Commercial	$15.96
Rate for Payer: Kaiser Permanente Medicaid	$9.04
Rate for Payer: Kaiser Permanente Medicare	$7.45
Rate for Payer: MDX Hawaii PPO	$17.20
Rate for Payer: Ohana Health Plan Medicaid	$7.45
Rate for Payer: Ohana Health Plan Medicare	$7.45
Rate for Payer: UnitedHealthcare Medicaid	$10.64
Rate for Payer: UnitedHealthcare Medicare	$7.45
Rate for Payer: University Health Alliance Commercial	$12.92

nitroglycerin 0.4 mg/hr ER patch [KMC]

Facility

$8.69

Service Code	NDC 00378911293
Hospital Revenue Code	250
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$8.43
Rate for Payer: Cash Price	$5.65
Rate for Payer: Health Management Network Commercial	$7.39
Rate for Payer: Kaiser Permanente Commercial	$7.82
Rate for Payer: MDX Hawaii PPO	$8.43

nitroglycerin 0.4 mg/hr ER patch [KMC]

Facility

$8.69

Service Code	NDC 00378911293
Hospital Revenue Code	250
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$8.43
Rate for Payer: AlohaCare Medicaid	$4.34
Rate for Payer: AlohaCare Medicare	$3.65
Rate for Payer: Cash Price	$5.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7.99
Rate for Payer: Devoted Health Medicare	$3.65
Rate for Payer: Hawaii Medical Service Association Medicare	$3.65
Rate for Payer: Hawaii Western Management Group Commercial	$8.26
Rate for Payer: Health Management Network Commercial	$7.39
Rate for Payer: Humana Medicare	$3.65
Rate for Payer: Kaiser Permanente Commercial	$7.82
Rate for Payer: Kaiser Permanente Medicaid	$4.43
Rate for Payer: Kaiser Permanente Medicare	$3.65
Rate for Payer: MDX Hawaii PPO	$8.43
Rate for Payer: Ohana Health Plan Medicaid	$3.65
Rate for Payer: Ohana Health Plan Medicare	$3.65
Rate for Payer: UnitedHealthcare Medicaid	$5.21
Rate for Payer: UnitedHealthcare Medicare	$3.65
Rate for Payer: University Health Alliance Commercial	$6.33

nitroglycerin 0.4 mg sublingual Tab [KMC]

Facility

$6.58

Service Code	NDC 00071041813
Hospital Revenue Code	250
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$6.38
Rate for Payer: AlohaCare Medicaid	$3.29
Rate for Payer: AlohaCare Medicare	$2.76
Rate for Payer: Cash Price	$4.28
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6.05
Rate for Payer: Devoted Health Medicare	$2.76
Rate for Payer: Hawaii Medical Service Association Medicare	$2.76
Rate for Payer: Hawaii Western Management Group Commercial	$6.25
Rate for Payer: Health Management Network Commercial	$5.59
Rate for Payer: Humana Medicare	$2.76
Rate for Payer: Kaiser Permanente Commercial	$5.92
Rate for Payer: Kaiser Permanente Medicaid	$3.36
Rate for Payer: Kaiser Permanente Medicare	$2.76
Rate for Payer: MDX Hawaii PPO	$6.38
Rate for Payer: Ohana Health Plan Medicaid	$2.76
Rate for Payer: Ohana Health Plan Medicare	$2.76
Rate for Payer: UnitedHealthcare Medicaid	$3.95
Rate for Payer: UnitedHealthcare Medicare	$2.76
Rate for Payer: University Health Alliance Commercial	$4.80

nitroglycerin 0.4 mg sublingual Tab [KMC]

Facility

$6.58

Service Code	NDC 00071041813
Hospital Revenue Code	250
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$6.38
Rate for Payer: Cash Price	$4.28
Rate for Payer: Health Management Network Commercial	$5.59
Rate for Payer: Kaiser Permanente Commercial	$5.92
Rate for Payer: MDX Hawaii PPO	$6.38

nitroglycerin 2% Top Ointment [KMC]

Facility

$11.02

Service Code	NDC 00281032608
Hospital Revenue Code	250
Min. Negotiated Rate	$4.63
Max. Negotiated Rate	$10.69
Rate for Payer: AlohaCare Medicaid	$5.51
Rate for Payer: AlohaCare Medicare	$4.63
Rate for Payer: Cash Price	$7.16
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$10.14
Rate for Payer: Devoted Health Medicare	$4.63
Rate for Payer: Hawaii Medical Service Association Medicare	$4.63
Rate for Payer: Hawaii Western Management Group Commercial	$10.47
Rate for Payer: Health Management Network Commercial	$9.37
Rate for Payer: Humana Medicare	$4.63
Rate for Payer: Kaiser Permanente Commercial	$9.92
Rate for Payer: Kaiser Permanente Medicaid	$5.62
Rate for Payer: Kaiser Permanente Medicare	$4.63
Rate for Payer: MDX Hawaii PPO	$10.69
Rate for Payer: Ohana Health Plan Medicaid	$4.63
Rate for Payer: Ohana Health Plan Medicare	$4.63
Rate for Payer: UnitedHealthcare Medicaid	$6.61
Rate for Payer: UnitedHealthcare Medicare	$4.63
Rate for Payer: University Health Alliance Commercial	$8.03

nitroglycerin 2% Top Ointment [KMC]

Facility

$11.02

Service Code	NDC 00281032608
Hospital Revenue Code	250
Min. Negotiated Rate	$9.37
Max. Negotiated Rate	$10.69
Rate for Payer: Cash Price	$7.16
Rate for Payer: Health Management Network Commercial	$9.37
Rate for Payer: Kaiser Permanente Commercial	$9.92
Rate for Payer: MDX Hawaii PPO	$10.69

nitroglycerin 50 mg / 250 mL D5W IV Soln [KMC]

Facility

$0.43

Service Code	NDC 00338104902
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.42
Rate for Payer: Cash Price	$0.28
Rate for Payer: Health Management Network Commercial	$0.37
Rate for Payer: Kaiser Permanente Commercial	$0.39
Rate for Payer: MDX Hawaii PPO	$0.42

nitroglycerin 50 mg / 250 mL D5W IV Soln [KMC]

Facility

$0.43

Service Code	NDC 00338104902
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.42
Rate for Payer: AlohaCare Medicaid	$0.22
Rate for Payer: AlohaCare Medicare	$0.18
Rate for Payer: Cash Price	$0.28
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.40
Rate for Payer: Devoted Health Medicare	$0.18
Rate for Payer: Hawaii Medical Service Association Medicare	$0.18
Rate for Payer: Hawaii Western Management Group Commercial	$0.41
Rate for Payer: Health Management Network Commercial	$0.37
Rate for Payer: Humana Medicare	$0.18
Rate for Payer: Kaiser Permanente Commercial	$0.39
Rate for Payer: Kaiser Permanente Medicaid	$0.22
Rate for Payer: Kaiser Permanente Medicare	$0.18
Rate for Payer: MDX Hawaii PPO	$0.42
Rate for Payer: Ohana Health Plan Medicaid	$0.18
Rate for Payer: Ohana Health Plan Medicare	$0.18
Rate for Payer: UnitedHealthcare Medicaid	$0.26
Rate for Payer: UnitedHealthcare Medicare	$0.18
Rate for Payer: University Health Alliance Commercial	$0.31

nitroprusside 25 mg/mL IV Sol [KMC]

Facility

$117.98

Service Code	NDC 72485010501
Hospital Revenue Code	250
Min. Negotiated Rate	$49.55
Max. Negotiated Rate	$114.44
Rate for Payer: AlohaCare Medicaid	$58.99
Rate for Payer: AlohaCare Medicare	$49.55
Rate for Payer: Cash Price	$76.69
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$108.54
Rate for Payer: Devoted Health Medicare	$49.55
Rate for Payer: Hawaii Medical Service Association Medicare	$49.55
Rate for Payer: Hawaii Western Management Group Commercial	$112.08
Rate for Payer: Health Management Network Commercial	$100.28
Rate for Payer: Humana Medicare	$49.55
Rate for Payer: Kaiser Permanente Commercial	$106.18
Rate for Payer: Kaiser Permanente Medicaid	$60.17
Rate for Payer: Kaiser Permanente Medicare	$49.55
Rate for Payer: MDX Hawaii PPO	$114.44
Rate for Payer: Ohana Health Plan Medicaid	$49.55
Rate for Payer: Ohana Health Plan Medicare	$49.55
Rate for Payer: UnitedHealthcare Medicaid	$70.79
Rate for Payer: UnitedHealthcare Medicare	$49.55
Rate for Payer: University Health Alliance Commercial	$86.00

nitroprusside 25 mg/mL IV Sol [KMC]

Facility

$117.98

Service Code	NDC 72485010501
Hospital Revenue Code	250
Min. Negotiated Rate	$100.28
Max. Negotiated Rate	$114.44
Rate for Payer: Cash Price	$76.69
Rate for Payer: Health Management Network Commercial	$100.28
Rate for Payer: Kaiser Permanente Commercial	$106.18
Rate for Payer: MDX Hawaii PPO	$114.44

NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION

Professional

Both

$221.00

Service Code	HCPCS 0232T
Hospital Revenue Code	361
Min. Negotiated Rate	$76.45
Max. Negotiated Rate	$187.85
Rate for Payer: Cash Price	$143.65
Rate for Payer: Cash Price	$143.65
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$76.45
Rate for Payer: Hawaii Western Management Group Commercial	$151.32
Rate for Payer: Health Management Network Commercial	$187.85

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC

Facility

$37,543.97

Service Code	MSDRG 098
Min. Negotiated Rate	$37,543.97
Max. Negotiated Rate	$37,543.97
Rate for Payer: Hawaii Medical Service Association Commercial	$37,543.97

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC

Facility

$37,543.97

Service Code	MSDRG 097
Min. Negotiated Rate	$37,543.97
Max. Negotiated Rate	$37,543.97
Rate for Payer: Hawaii Medical Service Association Commercial	$37,543.97

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$37,543.97

Service Code	MSDRG 099
Min. Negotiated Rate	$37,543.97
Max. Negotiated Rate	$37,543.97
Rate for Payer: Hawaii Medical Service Association Commercial	$37,543.97

NON CONDUCTIVE SUCTION TUBE

Facility

$5.00

Hospital Charge Code	8221
Hospital Revenue Code	270
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$2.10
Rate for Payer: Cash Price	$3.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.60
Rate for Payer: Devoted Health Medicare	$2.10
Rate for Payer: Hawaii Medical Service Association Medicare	$2.10
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$2.10
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$2.10
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$2.10
Rate for Payer: Ohana Health Plan Medicare	$2.10
Rate for Payer: UnitedHealthcare Medicare	$2.10
Rate for Payer: University Health Alliance Commercial	$3.64

NON CONDUCTIVE SUCTION TUBE

Facility

$5.00

Hospital Charge Code	8221
Hospital Revenue Code	270
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.25
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$38,018.01

Service Code	MSDRG 988
Min. Negotiated Rate	$38,018.01
Max. Negotiated Rate	$38,018.01
Rate for Payer: Hawaii Medical Service Association Commercial	$38,018.01

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$38,018.01

Service Code	MSDRG 987
Min. Negotiated Rate	$38,018.01
Max. Negotiated Rate	$38,018.01
Rate for Payer: Hawaii Medical Service Association Commercial	$38,018.01

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$38,018.01

Service Code	MSDRG 989
Min. Negotiated Rate	$38,018.01
Max. Negotiated Rate	$38,018.01
Rate for Payer: Hawaii Medical Service Association Commercial	$38,018.01

NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER

Professional

Both

$737.00

Service Code	HCPCS 94761
Hospital Revenue Code	410
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$626.45
Rate for Payer: AlohaCare Medicaid	$4.39
Rate for Payer: AlohaCare Medicare	$4.75
Rate for Payer: Cash Price	$479.05
Rate for Payer: Cash Price	$479.05
Rate for Payer: Devoted Health Medicare	$4.75
Rate for Payer: Hawaii Medical Service Association Medicare	$4.75
Rate for Payer: Hawaii Western Management Group Commercial	$28.79
Rate for Payer: Health Management Network Commercial	$626.45
Rate for Payer: Kaiser Permanente Commercial	$5.70
Rate for Payer: Kaiser Permanente Medicaid	$5.70
Rate for Payer: Kaiser Permanente Medicare	$5.70
Rate for Payer: Ohana Health Plan Medicaid	$4.39
Rate for Payer: Ohana Health Plan Medicare	$4.75
Rate for Payer: UnitedHealthcare Medicaid	$4.39
Rate for Payer: UnitedHealthcare Medicare	$4.75

NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER

Professional

Both

$176.00

Service Code	HCPCS 94760
Hospital Revenue Code	410
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$149.60
Rate for Payer: AlohaCare Medicaid	$2.86
Rate for Payer: AlohaCare Medicare	$4.37
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cash Price	$114.40
Rate for Payer: Devoted Health Medicare	$4.37
Rate for Payer: Hawaii Medical Service Association Medicare	$4.37
Rate for Payer: Hawaii Western Management Group Commercial	$11.26
Rate for Payer: Health Management Network Commercial	$149.60
Rate for Payer: Kaiser Permanente Commercial	$5.24
Rate for Payer: Kaiser Permanente Medicaid	$5.24
Rate for Payer: Kaiser Permanente Medicare	$5.24
Rate for Payer: Ohana Health Plan Medicaid	$2.86
Rate for Payer: Ohana Health Plan Medicare	$4.37
Rate for Payer: UnitedHealthcare Medicaid	$2.86
Rate for Payer: UnitedHealthcare Medicare	$4.37

NON-MALIGNANT BREAST DISORDERS WITH CC/MCC

Facility

$15,998.85

Service Code	MSDRG 600
Min. Negotiated Rate	$15,998.85
Max. Negotiated Rate	$15,998.85
Rate for Payer: Hawaii Medical Service Association Commercial	$15,998.85

NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$15,998.85

Service Code	MSDRG 601
Min. Negotiated Rate	$15,998.85
Max. Negotiated Rate	$15,998.85
Rate for Payer: Hawaii Medical Service Association Commercial	$15,998.85

Know your out-of-pocket cost for care.

All Charges