Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC

Facility

$61,435.58

Service Code	MSDRG 516
Min. Negotiated Rate	$61,435.58
Max. Negotiated Rate	$61,435.58
Rate for Payer: Hawaii Medical Service Association Commercial	$61,435.58

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC

Facility

$61,435.58

Service Code	MSDRG 515
Min. Negotiated Rate	$61,435.58
Max. Negotiated Rate	$61,435.58
Rate for Payer: Hawaii Medical Service Association Commercial	$61,435.58

OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC

Facility

$34,083.48

Service Code	MSDRG 517
Min. Negotiated Rate	$34,083.48
Max. Negotiated Rate	$34,083.48
Rate for Payer: Hawaii Medical Service Association Commercial	$34,083.48

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC

Facility

$41,620.71

Service Code	MSDRG 844
Min. Negotiated Rate	$41,620.71
Max. Negotiated Rate	$41,620.71
Rate for Payer: Hawaii Medical Service Association Commercial	$41,620.71

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC

Facility

$46,052.99

Service Code	MSDRG 843
Min. Negotiated Rate	$46,052.99
Max. Negotiated Rate	$46,052.99
Rate for Payer: Hawaii Medical Service Association Commercial	$46,052.99

OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC

Facility

$41,620.71

Service Code	MSDRG 845
Min. Negotiated Rate	$41,620.71
Max. Negotiated Rate	$41,620.71
Rate for Payer: Hawaii Medical Service Association Commercial	$41,620.71

OTHER O.R. PROCEDURES FOR INJURIES WITH CC

Facility

$44,370.14

Service Code	MSDRG 908
Min. Negotiated Rate	$44,370.14
Max. Negotiated Rate	$44,370.14
Rate for Payer: Hawaii Medical Service Association Commercial	$44,370.14

OTHER O.R. PROCEDURES FOR INJURIES WITH MCC

Facility

$47,475.11

Service Code	MSDRG 907
Min. Negotiated Rate	$47,475.11
Max. Negotiated Rate	$47,475.11
Rate for Payer: Hawaii Medical Service Association Commercial	$47,475.11

OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC

Facility

$22,990.94

Service Code	MSDRG 909
Min. Negotiated Rate	$22,990.94
Max. Negotiated Rate	$22,990.94
Rate for Payer: Hawaii Medical Service Association Commercial	$22,990.94

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$152,759.39

Service Code	MSDRG 958
Min. Negotiated Rate	$152,759.39
Max. Negotiated Rate	$152,759.39
Rate for Payer: Hawaii Medical Service Association Commercial	$152,759.39

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$152,759.39

Service Code	MSDRG 957
Min. Negotiated Rate	$152,759.39
Max. Negotiated Rate	$152,759.39
Rate for Payer: Hawaii Medical Service Association Commercial	$152,759.39

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$152,759.39

Service Code	MSDRG 959
Min. Negotiated Rate	$152,759.39
Max. Negotiated Rate	$152,759.39
Rate for Payer: Hawaii Medical Service Association Commercial	$152,759.39

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC

Facility

$42,260.67

Service Code	MSDRG 803
Min. Negotiated Rate	$42,260.67
Max. Negotiated Rate	$42,260.67
Rate for Payer: Hawaii Medical Service Association Commercial	$42,260.67

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC

Facility

$42,260.67

Service Code	MSDRG 802
Min. Negotiated Rate	$42,260.67
Max. Negotiated Rate	$42,260.67
Rate for Payer: Hawaii Medical Service Association Commercial	$42,260.67

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC

Facility

$42,260.67

Service Code	MSDRG 804
Min. Negotiated Rate	$42,260.67
Max. Negotiated Rate	$42,260.67
Rate for Payer: Hawaii Medical Service Association Commercial	$42,260.67

OTHER PT/OT CURRENT STATUS

Professional

Both

$0.01

Service Code	HCPCS G8990
Hospital Revenue Code	420
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

OTHER PT/OT CURR STATUS Occupational

Facility

$2.00

Service Code	HCPCS G8990 GO
Hospital Charge Code	426G89990
Hospital Revenue Code	430
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.30
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

OTHER PT/OT CURR STATUS Occupational

Facility

$2.00

Service Code	HCPCS G8990 GO
Hospital Charge Code	426G89990
Hospital Revenue Code	430
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$0.84
Rate for Payer: Cash Price	$1.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1.84
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.84
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$0.84
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$0.84
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$0.84
Rate for Payer: Ohana Health Plan Medicare	$0.84
Rate for Payer: UnitedHealthcare Medicare	$0.84
Rate for Payer: University Health Alliance Commercial	$1.46

OTHER PT/OT CURR STATUS Physical

Facility

$1.00

Service Code	HCPCS G8990 GP
Hospital Charge Code	432G89900
Hospital Revenue Code	420
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.65
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

OTHER PT/OT CURR STATUS Physical

Facility

$1.00

Service Code	HCPCS G8990 GP
Hospital Charge Code	432G89900
Hospital Revenue Code	420
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.42
Rate for Payer: Cash Price	$0.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.92
Rate for Payer: Devoted Health Medicare	$0.42
Rate for Payer: Hawaii Medical Service Association Medicare	$0.42
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.42
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.42
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.42
Rate for Payer: Ohana Health Plan Medicare	$0.42
Rate for Payer: UnitedHealthcare Medicare	$0.42
Rate for Payer: University Health Alliance Commercial	$0.73

OTHER PT/OT D/C STATUS

Professional

Both

$0.01

Service Code	HCPCS G8992
Hospital Revenue Code	420
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

OTHER PT/OT D/C STATUS Occupational

Facility

$2.00

Service Code	HCPCS G8992 GO
Hospital Charge Code	426G89920
Hospital Revenue Code	430
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.30
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

OTHER PT/OT D/C STATUS Occupational

Facility

$2.00

Service Code	HCPCS G8992 GO
Hospital Charge Code	426G89920
Hospital Revenue Code	430
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$0.84
Rate for Payer: Cash Price	$1.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1.84
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.84
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$0.84
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$0.84
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$0.84
Rate for Payer: Ohana Health Plan Medicare	$0.84
Rate for Payer: UnitedHealthcare Medicare	$0.84
Rate for Payer: University Health Alliance Commercial	$1.46

OTHER PT/OT D/C STATUS Physical

Facility

$1.00

Service Code	HCPCS G8992 GP
Hospital Charge Code	432G89920
Hospital Revenue Code	420
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.42
Rate for Payer: Cash Price	$0.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.92
Rate for Payer: Devoted Health Medicare	$0.42
Rate for Payer: Hawaii Medical Service Association Medicare	$0.42
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.42
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.42
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.42
Rate for Payer: Ohana Health Plan Medicare	$0.42
Rate for Payer: UnitedHealthcare Medicare	$0.42
Rate for Payer: University Health Alliance Commercial	$0.73

OTHER PT/OT D/C STATUS Physical

Facility

$1.00

Service Code	HCPCS G8992 GP
Hospital Charge Code	432G89920
Hospital Revenue Code	420
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.65
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

Know your out-of-pocket cost for care.

All Charges