Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

ORTHOTIC FIT/TRAIN 15 MIN Occupational

Facility

$179.00

Service Code	HCPCS 97760 GO
Hospital Charge Code	426977600
Hospital Revenue Code	430
Min. Negotiated Rate	$17.21
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	$17.21
Rate for Payer: UnitedHealthcare Medicare	$75.18
Rate for Payer: University Health Alliance Commercial	$130.47

ORTHOTIC FIT/TRAIN 15 MIN Occupational

Facility

$179.00

Service Code	HCPCS 97760 GO
Hospital Charge Code	426977600
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

ORTHOTIC FIT/TRAIN 15 MIN Physical

Facility

$179.00

Service Code	HCPCS 97760 GP
Hospital Charge Code	432977600
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

ORTHOTIC FIT/TRAIN 15 MIN Physical

Facility

$179.00

Service Code	HCPCS 97760 GP
Hospital Charge Code	432977600
Hospital Revenue Code	420
Min. Negotiated Rate	$17.21
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	$17.21
Rate for Payer: UnitedHealthcare Medicare	$75.18
Rate for Payer: University Health Alliance Commercial	$130.47

Orthotic Mgmt and Training Charges

Facility

$179.00

Service Code	HCPCS 97760 GO
Hospital Charge Code	426977600
Hospital Revenue Code	430
Min. Negotiated Rate	$17.21
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	$17.21
Rate for Payer: UnitedHealthcare Medicare	$75.18
Rate for Payer: University Health Alliance Commercial	$130.47

Orthotic Mgmt and Training Charges

Facility

$179.00

Service Code	HCPCS 97760 GP
Hospital Charge Code	432977600
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

Orthotic Mgmt and Training Charges

Facility

$179.00

Service Code	HCPCS 97760 GP
Hospital Charge Code	432977600
Hospital Revenue Code	420
Min. Negotiated Rate	$17.21
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	$17.21
Rate for Payer: UnitedHealthcare Medicare	$75.18
Rate for Payer: University Health Alliance Commercial	$130.47

Orthotic Mgmt and Training Charges

Facility

$179.00

Service Code	HCPCS 97760 GO
Hospital Charge Code	426977600
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

ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS

Professional

Both

$171.00

Service Code	HCPCS 97760
Hospital Revenue Code	420
Min. Negotiated Rate	$29.47
Max. Negotiated Rate	$145.35
Rate for Payer: AlohaCare Medicaid	$52.02
Rate for Payer: AlohaCare Medicare	$49.93
Rate for Payer: Cash Price	$111.15
Rate for Payer: Cash Price	$111.15
Rate for Payer: Devoted Health Medicare	$49.93
Rate for Payer: Hawaii Medical Service Association Medicare	$49.93
Rate for Payer: Hawaii Western Management Group Commercial	$29.47
Rate for Payer: Health Management Network Commercial	$145.35
Rate for Payer: Kaiser Permanente Commercial	$59.92
Rate for Payer: Kaiser Permanente Medicaid	$59.92
Rate for Payer: Kaiser Permanente Medicare	$59.92
Rate for Payer: Ohana Health Plan Medicaid	$52.02
Rate for Payer: Ohana Health Plan Medicare	$49.93
Rate for Payer: UnitedHealthcare Medicaid	$52.02
Rate for Payer: UnitedHealthcare Medicare	$49.93

oseltamivir 30 mg Cap [KMC]

Facility

$56.72

Service Code	NDC 31722063031
Hospital Revenue Code	250
Min. Negotiated Rate	$48.21
Max. Negotiated Rate	$55.02
Rate for Payer: Cash Price	$36.87
Rate for Payer: Health Management Network Commercial	$48.21
Rate for Payer: Kaiser Permanente Commercial	$51.05
Rate for Payer: MDX Hawaii PPO	$55.02

oseltamivir 30 mg Cap [KMC]

Facility

$56.72

Service Code	NDC 31722063031
Hospital Revenue Code	250
Min. Negotiated Rate	$23.82
Max. Negotiated Rate	$55.02
Rate for Payer: AlohaCare Medicaid	$28.36
Rate for Payer: AlohaCare Medicare	$23.82
Rate for Payer: Cash Price	$36.87
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$52.18
Rate for Payer: Devoted Health Medicare	$23.82
Rate for Payer: Hawaii Medical Service Association Medicare	$23.82
Rate for Payer: Hawaii Western Management Group Commercial	$53.88
Rate for Payer: Health Management Network Commercial	$48.21
Rate for Payer: Humana Medicare	$23.82
Rate for Payer: Kaiser Permanente Commercial	$51.05
Rate for Payer: Kaiser Permanente Medicaid	$28.93
Rate for Payer: Kaiser Permanente Medicare	$23.82
Rate for Payer: MDX Hawaii PPO	$55.02
Rate for Payer: Ohana Health Plan Medicaid	$23.82
Rate for Payer: Ohana Health Plan Medicare	$23.82
Rate for Payer: UnitedHealthcare Medicaid	$34.03
Rate for Payer: UnitedHealthcare Medicare	$23.82
Rate for Payer: University Health Alliance Commercial	$41.34

oseltamivir 6 mg/mL REC powder (60 mL) [KMC]

Facility

$10.92

Service Code	NDC 68180067801
Hospital Revenue Code	250
Min. Negotiated Rate	$9.28
Max. Negotiated Rate	$10.59
Rate for Payer: Cash Price	$7.10
Rate for Payer: Health Management Network Commercial	$9.28
Rate for Payer: Kaiser Permanente Commercial	$9.83
Rate for Payer: MDX Hawaii PPO	$10.59

oseltamivir 6 mg/mL REC powder (60 mL) [KMC]

Facility

$10.92

Service Code	NDC 68180067801
Hospital Revenue Code	250
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$10.59
Rate for Payer: AlohaCare Medicaid	$5.46
Rate for Payer: AlohaCare Medicare	$4.59
Rate for Payer: Cash Price	$7.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$10.05
Rate for Payer: Devoted Health Medicare	$4.59
Rate for Payer: Hawaii Medical Service Association Medicare	$4.59
Rate for Payer: Hawaii Western Management Group Commercial	$10.37
Rate for Payer: Health Management Network Commercial	$9.28
Rate for Payer: Humana Medicare	$4.59
Rate for Payer: Kaiser Permanente Commercial	$9.83
Rate for Payer: Kaiser Permanente Medicaid	$5.57
Rate for Payer: Kaiser Permanente Medicare	$4.59
Rate for Payer: MDX Hawaii PPO	$10.59
Rate for Payer: Ohana Health Plan Medicaid	$4.59
Rate for Payer: Ohana Health Plan Medicare	$4.59
Rate for Payer: UnitedHealthcare Medicaid	$6.55
Rate for Payer: UnitedHealthcare Medicare	$4.59
Rate for Payer: University Health Alliance Commercial	$7.96

oseltamivir 75 mg Cap [KMC]

Facility

$61.77

Service Code	NDC 16714081901
Hospital Revenue Code	250
Min. Negotiated Rate	$25.94
Max. Negotiated Rate	$59.92
Rate for Payer: AlohaCare Medicaid	$30.89
Rate for Payer: AlohaCare Medicare	$25.94
Rate for Payer: Cash Price	$40.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$56.83
Rate for Payer: Devoted Health Medicare	$25.94
Rate for Payer: Hawaii Medical Service Association Medicare	$25.94
Rate for Payer: Hawaii Western Management Group Commercial	$58.68
Rate for Payer: Health Management Network Commercial	$52.50
Rate for Payer: Humana Medicare	$25.94
Rate for Payer: Kaiser Permanente Commercial	$55.59
Rate for Payer: Kaiser Permanente Medicaid	$31.50
Rate for Payer: Kaiser Permanente Medicare	$25.94
Rate for Payer: MDX Hawaii PPO	$59.92
Rate for Payer: Ohana Health Plan Medicaid	$25.94
Rate for Payer: Ohana Health Plan Medicare	$25.94
Rate for Payer: UnitedHealthcare Medicaid	$37.06
Rate for Payer: UnitedHealthcare Medicare	$25.94
Rate for Payer: University Health Alliance Commercial	$45.02

oseltamivir 75 mg Cap [KMC]

Facility

$61.77

Service Code	NDC 16714081901
Hospital Revenue Code	250
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$59.92
Rate for Payer: Cash Price	$40.15
Rate for Payer: Health Management Network Commercial	$52.50
Rate for Payer: Kaiser Permanente Commercial	$55.59
Rate for Payer: MDX Hawaii PPO	$59.92

Osmolality DLS

Facility

$89.00

Service Code	HCPCS 83930
Hospital Charge Code	422839305
Hospital Revenue Code	301
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$57.85
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$86.33

Osmolality DLS

Facility

$89.00

Service Code	HCPCS 83930
Hospital Charge Code	422839305
Hospital Revenue Code	301
Min. Negotiated Rate	$6.61
Max. Negotiated Rate	$86.33
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$37.38
Rate for Payer: Cash Price	$57.85
Rate for Payer: Cash Price	$57.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$81.88
Rate for Payer: Devoted Health Medicare	$37.38
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$9.13
Rate for Payer: Hawaii Medical Service Association Commercial	$8.26
Rate for Payer: Hawaii Medical Service Association Medicare	$37.38
Rate for Payer: Hawaii Western Management Group Commercial	$6.61
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Humana Medicare	$37.38
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicare	$37.38
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$37.38
Rate for Payer: Ohana Health Plan Medicare	$37.38
Rate for Payer: UnitedHealthcare Medicaid	$9.13
Rate for Payer: UnitedHealthcare Medicare	$37.38
Rate for Payer: University Health Alliance Commercial	$17.09

Osmolality, Urine DLS

Facility

$89.00

Service Code	HCPCS 83935
Hospital Charge Code	422839355
Hospital Revenue Code	301
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$57.85
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$86.33

Osmolality, Urine DLS

Facility

$89.00

Service Code	HCPCS 83935
Hospital Charge Code	422839355
Hospital Revenue Code	301
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$86.33
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$37.38
Rate for Payer: Cash Price	$57.85
Rate for Payer: Cash Price	$57.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$81.88
Rate for Payer: Devoted Health Medicare	$37.38
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$9.42
Rate for Payer: Hawaii Medical Service Association Commercial	$8.53
Rate for Payer: Hawaii Medical Service Association Medicare	$37.38
Rate for Payer: Hawaii Western Management Group Commercial	$6.82
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Humana Medicare	$37.38
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicare	$37.38
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$37.38
Rate for Payer: Ohana Health Plan Medicare	$37.38
Rate for Payer: UnitedHealthcare Medicaid	$9.42
Rate for Payer: UnitedHealthcare Medicare	$37.38
Rate for Payer: University Health Alliance Commercial	$17.61

OSSEOUS SURVEY INFANT

Facility

$675.00

Service Code	HCPCS 77076
Hospital Charge Code	424770760
Hospital Revenue Code	320
Min. Negotiated Rate	$29.98
Max. Negotiated Rate	$654.75
Rate for Payer: AlohaCare Medicaid	$337.50
Rate for Payer: AlohaCare Medicare	$283.50
Rate for Payer: Cash Price	$438.75
Rate for Payer: Cash Price	$438.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$621.00
Rate for Payer: Devoted Health Medicare	$283.50
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$29.98
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$283.50
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$573.75
Rate for Payer: Humana Medicare	$283.50
Rate for Payer: Kaiser Permanente Commercial	$607.50
Rate for Payer: Kaiser Permanente Medicaid	$344.25
Rate for Payer: Kaiser Permanente Medicare	$283.50
Rate for Payer: MDX Hawaii PPO	$654.75
Rate for Payer: Ohana Health Plan Medicaid	$283.50
Rate for Payer: Ohana Health Plan Medicare	$283.50
Rate for Payer: UnitedHealthcare Medicaid	$29.98
Rate for Payer: UnitedHealthcare Medicare	$283.50
Rate for Payer: University Health Alliance Commercial	$155.46

OSSEOUS SURVEY INFANT

Facility

$675.00

Service Code	HCPCS 77076
Hospital Charge Code	424770760
Hospital Revenue Code	320
Min. Negotiated Rate	$573.75
Max. Negotiated Rate	$654.75
Rate for Payer: Cash Price	$438.75
Rate for Payer: Health Management Network Commercial	$573.75
Rate for Payer: Kaiser Permanente Commercial	$607.50
Rate for Payer: MDX Hawaii PPO	$654.75

OSTEOMYELITIS WITH CC

Facility

$39,013.49

Service Code	MSDRG 540
Min. Negotiated Rate	$39,013.49
Max. Negotiated Rate	$39,013.49
Rate for Payer: Hawaii Medical Service Association Commercial	$39,013.49

OSTEOMYELITIS WITH MCC

Facility

$39,013.49

Service Code	MSDRG 539
Min. Negotiated Rate	$39,013.49
Max. Negotiated Rate	$39,013.49
Rate for Payer: Hawaii Medical Service Association Commercial	$39,013.49

OSTEOMYELITIS WITHOUT CC/MCC

Facility

$39,013.49

Service Code	MSDRG 541
Min. Negotiated Rate	$39,013.49
Max. Negotiated Rate	$39,013.49
Rate for Payer: Hawaii Medical Service Association Commercial	$39,013.49

OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS

Professional

Both

$164.00

Service Code	HCPCS 98925
Hospital Revenue Code	530
Min. Negotiated Rate	$17.23
Max. Negotiated Rate	$139.40
Rate for Payer: AlohaCare Medicaid	$23.14
Rate for Payer: AlohaCare Medicare	$19.79
Rate for Payer: Cash Price	$106.60
Rate for Payer: Cash Price	$106.60
Rate for Payer: Devoted Health Medicare	$19.79
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$23.14
Rate for Payer: Hawaii Medical Service Association Medicare	$19.79
Rate for Payer: Hawaii Western Management Group Commercial	$17.23
Rate for Payer: Health Management Network Commercial	$139.40
Rate for Payer: Kaiser Permanente Commercial	$23.75
Rate for Payer: Kaiser Permanente Medicaid	$23.75
Rate for Payer: Kaiser Permanente Medicare	$23.75
Rate for Payer: Ohana Health Plan Medicaid	$23.14
Rate for Payer: Ohana Health Plan Medicare	$19.79
Rate for Payer: UnitedHealthcare Medicaid	$23.14
Rate for Payer: UnitedHealthcare Medicare	$19.79
Rate for Payer: University Health Alliance Commercial	$24.53

Know your out-of-pocket cost for care.

All Charges