Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

OT Cognitive Function Medicare Charge

Facility

$161.00

Service Code	HCPCS G0515 GO
Hospital Charge Code	426G05150
Hospital Revenue Code	434
Min. Negotiated Rate	$136.85
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$104.65
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Kaiser Permanente Commercial	$144.90
Rate for Payer: MDX Hawaii PPO	$156.17

OT Cognitive Function Medicare Charge

Facility

$161.00

Service Code	HCPCS G0515 GO
Hospital Charge Code	426G05150
Hospital Revenue Code	434
Min. Negotiated Rate	$67.62
Max. Negotiated Rate	$156.17
Rate for Payer: AlohaCare Medicaid	$80.50
Rate for Payer: AlohaCare Medicare	$67.62
Rate for Payer: Cash Price	$104.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$148.12
Rate for Payer: Devoted Health Medicare	$67.62
Rate for Payer: Hawaii Medical Service Association Medicare	$67.62
Rate for Payer: Hawaii Western Management Group Commercial	$152.95
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Humana Medicare	$67.62
Rate for Payer: Kaiser Permanente Commercial	$144.90
Rate for Payer: Kaiser Permanente Medicaid	$82.11
Rate for Payer: Kaiser Permanente Medicare	$67.62
Rate for Payer: MDX Hawaii PPO	$156.17
Rate for Payer: Ohana Health Plan Medicaid	$67.62
Rate for Payer: Ohana Health Plan Medicare	$67.62
Rate for Payer: UnitedHealthcare Medicare	$67.62
Rate for Payer: University Health Alliance Commercial	$117.35

OT EVALUATION Occupational

Facility

$396.00

Service Code	HCPCS 97003 GO
Hospital Charge Code	432970030
Hospital Revenue Code	434
Min. Negotiated Rate	$166.32
Max. Negotiated Rate	$384.12
Rate for Payer: AlohaCare Medicaid	$198.00
Rate for Payer: AlohaCare Medicare	$166.32
Rate for Payer: Cash Price	$257.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$364.32
Rate for Payer: Devoted Health Medicare	$166.32
Rate for Payer: Hawaii Medical Service Association Medicare	$166.32
Rate for Payer: Hawaii Western Management Group Commercial	$376.20
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: Humana Medicare	$166.32
Rate for Payer: Kaiser Permanente Commercial	$356.40
Rate for Payer: Kaiser Permanente Medicaid	$201.96
Rate for Payer: Kaiser Permanente Medicare	$166.32
Rate for Payer: MDX Hawaii PPO	$384.12
Rate for Payer: Ohana Health Plan Medicaid	$166.32
Rate for Payer: Ohana Health Plan Medicare	$166.32
Rate for Payer: UnitedHealthcare Medicare	$166.32
Rate for Payer: University Health Alliance Commercial	$288.64

OT EVALUATION Occupational

Facility

$396.00

Service Code	HCPCS 97003 GO
Hospital Charge Code	432970030
Hospital Revenue Code	434
Min. Negotiated Rate	$336.60
Max. Negotiated Rate	$384.12
Rate for Payer: Cash Price	$257.40
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: Kaiser Permanente Commercial	$356.40
Rate for Payer: MDX Hawaii PPO	$384.12

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC

Facility

$10,618.50

Service Code	MSDRG 818
Min. Negotiated Rate	$10,618.50
Max. Negotiated Rate	$10,618.50
Rate for Payer: Hawaii Medical Service Association Commercial	$10,618.50

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC

Facility

$10,618.50

Service Code	MSDRG 817
Min. Negotiated Rate	$10,618.50
Max. Negotiated Rate	$10,618.50
Rate for Payer: Hawaii Medical Service Association Commercial	$10,618.50

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$10,334.07

Service Code	MSDRG 819
Min. Negotiated Rate	$10,334.07
Max. Negotiated Rate	$10,334.07
Rate for Payer: Hawaii Medical Service Association Commercial	$10,334.07

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC

Facility

$9,314.89

Service Code	MSDRG 832
Min. Negotiated Rate	$9,314.89
Max. Negotiated Rate	$9,314.89
Rate for Payer: Hawaii Medical Service Association Commercial	$9,314.89

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC

Facility

$9,314.89

Service Code	MSDRG 831
Min. Negotiated Rate	$9,314.89
Max. Negotiated Rate	$9,314.89
Rate for Payer: Hawaii Medical Service Association Commercial	$9,314.89

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$9,172.67

Service Code	MSDRG 833
Min. Negotiated Rate	$9,172.67
Max. Negotiated Rate	$9,172.67
Rate for Payer: Hawaii Medical Service Association Commercial	$9,172.67

OTHER CARDIOTHORACIC PROCEDURES WITH MCC

Facility

$112,679.31

Service Code	MSDRG 228
Min. Negotiated Rate	$112,679.31
Max. Negotiated Rate	$112,679.31
Rate for Payer: Hawaii Medical Service Association Commercial	$112,679.31

OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC

Facility

$112,679.31

Service Code	MSDRG 229
Min. Negotiated Rate	$112,679.31
Max. Negotiated Rate	$112,679.31
Rate for Payer: Hawaii Medical Service Association Commercial	$112,679.31

OTHER CEREBROVASCULAR DISORDERS WITH CC

Facility

$26,238.11

Service Code	MSDRG 071
Min. Negotiated Rate	$26,238.11
Max. Negotiated Rate	$26,238.11
Rate for Payer: Hawaii Medical Service Association Commercial	$26,238.11

OTHER CEREBROVASCULAR DISORDERS WITH MCC

Facility

$27,968.36

Service Code	MSDRG 070
Min. Negotiated Rate	$27,968.36
Max. Negotiated Rate	$27,968.36
Rate for Payer: Hawaii Medical Service Association Commercial	$27,968.36

OTHER CEREBROVASCULAR DISORDERS WITHOUT CC/MCC

Facility

$16,235.87

Service Code	MSDRG 072
Min. Negotiated Rate	$16,235.87
Max. Negotiated Rate	$16,235.87
Rate for Payer: Hawaii Medical Service Association Commercial	$16,235.87

OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC

Facility

$26,641.05

Service Code	MSDRG 315
Min. Negotiated Rate	$26,641.05
Max. Negotiated Rate	$26,641.05
Rate for Payer: Hawaii Medical Service Association Commercial	$26,641.05

OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC

Facility

$39,724.55

Service Code	MSDRG 314
Min. Negotiated Rate	$39,724.55
Max. Negotiated Rate	$39,724.55
Rate for Payer: Hawaii Medical Service Association Commercial	$39,724.55

OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$16,994.33

Service Code	MSDRG 316
Min. Negotiated Rate	$16,994.33
Max. Negotiated Rate	$16,994.33
Rate for Payer: Hawaii Medical Service Association Commercial	$16,994.33

OTHER CIRCULATORY SYSTEM O.R. PROCEDURES

Facility

$161,742.45

Service Code	MSDRG 264
Min. Negotiated Rate	$161,742.45
Max. Negotiated Rate	$161,742.45
Rate for Payer: Hawaii Medical Service Association Commercial	$161,742.45

OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC

Facility

$18,321.65

Service Code	MSDRG 394
Min. Negotiated Rate	$18,321.65
Max. Negotiated Rate	$18,321.65
Rate for Payer: Hawaii Medical Service Association Commercial	$18,321.65

OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC

Facility

$25,266.33

Service Code	MSDRG 393
Min. Negotiated Rate	$25,266.33
Max. Negotiated Rate	$25,266.33
Rate for Payer: Hawaii Medical Service Association Commercial	$25,266.33

OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$16,686.21

Service Code	MSDRG 395
Min. Negotiated Rate	$16,686.21
Max. Negotiated Rate	$16,686.21
Rate for Payer: Hawaii Medical Service Association Commercial	$16,686.21

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC

Facility

$58,022.50

Service Code	MSDRG 357
Min. Negotiated Rate	$58,022.50
Max. Negotiated Rate	$58,022.50
Rate for Payer: Hawaii Medical Service Association Commercial	$58,022.50

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC

Facility

$63,023.62

Service Code	MSDRG 356
Min. Negotiated Rate	$63,023.62
Max. Negotiated Rate	$63,023.62
Rate for Payer: Hawaii Medical Service Association Commercial	$63,023.62

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$32,448.04

Service Code	MSDRG 358
Min. Negotiated Rate	$32,448.04
Max. Negotiated Rate	$32,448.04
Rate for Payer: Hawaii Medical Service Association Commercial	$32,448.04

Know your out-of-pocket cost for care.

All Charges