Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

anastrozole 1 mg Tab[KMC]

Facility

$53.38

Service Code	NDC 51991062090
Hospital Revenue Code	250
Min. Negotiated Rate	$22.42
Max. Negotiated Rate	$51.78
Rate for Payer: AlohaCare Medicaid	$26.69
Rate for Payer: AlohaCare Medicare	$22.42
Rate for Payer: Cash Price	$34.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$49.11
Rate for Payer: Devoted Health Medicare	$22.42
Rate for Payer: Hawaii Medical Service Association Medicare	$22.42
Rate for Payer: Hawaii Western Management Group Commercial	$50.71
Rate for Payer: Health Management Network Commercial	$45.37
Rate for Payer: Humana Medicare	$22.42
Rate for Payer: Kaiser Permanente Commercial	$48.04
Rate for Payer: Kaiser Permanente Medicaid	$27.22
Rate for Payer: Kaiser Permanente Medicare	$22.42
Rate for Payer: MDX Hawaii PPO	$51.78
Rate for Payer: Ohana Health Plan Medicaid	$22.42
Rate for Payer: Ohana Health Plan Medicare	$22.42
Rate for Payer: UnitedHealthcare Medicaid	$32.03
Rate for Payer: UnitedHealthcare Medicare	$22.42
Rate for Payer: University Health Alliance Commercial	$38.91

ANGINA PECTORIS

Facility

$12,704.27

Service Code	MSDRG 311
Min. Negotiated Rate	$12,704.27
Max. Negotiated Rate	$12,704.27
Rate for Payer: Hawaii Medical Service Association Commercial	$12,704.27

anidulafungin 100 mg REC [KMC]

Facility

$864.00

Service Code	HCPCS J0348
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$838.08
Rate for Payer: AlohaCare Medicaid	$432.00
Rate for Payer: AlohaCare Medicare	$362.88
Rate for Payer: Cash Price	$561.60
Rate for Payer: Cash Price	$561.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$794.88
Rate for Payer: Devoted Health Medicare	$362.88
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.48
Rate for Payer: Hawaii Medical Service Association Medicare	$362.88
Rate for Payer: Hawaii Western Management Group Commercial	$820.80
Rate for Payer: Health Management Network Commercial	$734.40
Rate for Payer: Humana Medicare	$362.88
Rate for Payer: Kaiser Permanente Commercial	$777.60
Rate for Payer: Kaiser Permanente Medicaid	$440.64
Rate for Payer: Kaiser Permanente Medicare	$362.88
Rate for Payer: MDX Hawaii PPO	$838.08
Rate for Payer: Ohana Health Plan Medicaid	$362.88
Rate for Payer: Ohana Health Plan Medicare	$362.88
Rate for Payer: UnitedHealthcare Medicaid	$518.40
Rate for Payer: UnitedHealthcare Medicare	$362.88
Rate for Payer: University Health Alliance Commercial	$629.77

anidulafungin 100 mg REC [KMC]

Facility

$864.00

Service Code	HCPCS J0348
Hospital Revenue Code	636
Min. Negotiated Rate	$734.40
Max. Negotiated Rate	$838.08
Rate for Payer: Cash Price	$561.60
Rate for Payer: Health Management Network Commercial	$734.40
Rate for Payer: Kaiser Permanente Commercial	$777.60
Rate for Payer: MDX Hawaii PPO	$838.08

ANKLE 2 VWS

Facility

$369.00

Service Code	HCPCS 73600
Hospital Charge Code	424736000
Hospital Revenue Code	320
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$357.93
Rate for Payer: AlohaCare Medicaid	$184.50
Rate for Payer: AlohaCare Medicare	$154.98
Rate for Payer: Cash Price	$239.85
Rate for Payer: Cash Price	$239.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$339.48
Rate for Payer: Devoted Health Medicare	$154.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$16.41
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$154.98
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Humana Medicare	$154.98
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: Kaiser Permanente Medicaid	$188.19
Rate for Payer: Kaiser Permanente Medicare	$154.98
Rate for Payer: MDX Hawaii PPO	$357.93
Rate for Payer: Ohana Health Plan Medicaid	$154.98
Rate for Payer: Ohana Health Plan Medicare	$154.98
Rate for Payer: UnitedHealthcare Medicaid	$16.41
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$55.46

ANKLE 2 VWS

Facility

$369.00

Service Code	HCPCS 73600
Hospital Charge Code	424736000
Hospital Revenue Code	320
Min. Negotiated Rate	$313.65
Max. Negotiated Rate	$357.93
Rate for Payer: Cash Price	$239.85
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: MDX Hawaii PPO	$357.93

ANKLE COMP MIN 3 VWS

Facility

$369.00

Service Code	HCPCS 73610
Hospital Charge Code	424736100
Hospital Revenue Code	320
Min. Negotiated Rate	$313.65
Max. Negotiated Rate	$357.93
Rate for Payer: Cash Price	$239.85
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: MDX Hawaii PPO	$357.93

ANKLE COMP MIN 3 VWS

Facility

$369.00

Service Code	HCPCS 73610
Hospital Charge Code	424736100
Hospital Revenue Code	320
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$357.93
Rate for Payer: AlohaCare Medicaid	$184.50
Rate for Payer: AlohaCare Medicare	$154.98
Rate for Payer: Cash Price	$239.85
Rate for Payer: Cash Price	$239.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$339.48
Rate for Payer: Devoted Health Medicare	$154.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$17.34
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$154.98
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Humana Medicare	$154.98
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: Kaiser Permanente Medicaid	$188.19
Rate for Payer: Kaiser Permanente Medicare	$154.98
Rate for Payer: MDX Hawaii PPO	$357.93
Rate for Payer: Ohana Health Plan Medicaid	$154.98
Rate for Payer: Ohana Health Plan Medicare	$154.98
Rate for Payer: UnitedHealthcare Medicaid	$17.34
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$62.59

Antacid 200-200-20 mg/5 mL oral suspension [KMC]

Facility

$0.04

Service Code	NDC 00536131783
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Cash Price	$0.03
Rate for Payer: Health Management Network Commercial	$0.03
Rate for Payer: Kaiser Permanente Commercial	$0.04
Rate for Payer: MDX Hawaii PPO	$0.04

Antacid 200-200-20 mg/5 mL oral suspension [KMC]

Facility

$0.04

Service Code	NDC 00536131783
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: AlohaCare Medicaid	$0.02
Rate for Payer: AlohaCare Medicare	$0.02
Rate for Payer: Cash Price	$0.03
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.04
Rate for Payer: Devoted Health Medicare	$0.02
Rate for Payer: Hawaii Medical Service Association Medicare	$0.02
Rate for Payer: Hawaii Western Management Group Commercial	$0.04
Rate for Payer: Health Management Network Commercial	$0.03
Rate for Payer: Humana Medicare	$0.02
Rate for Payer: Kaiser Permanente Commercial	$0.04
Rate for Payer: Kaiser Permanente Medicaid	$0.02
Rate for Payer: Kaiser Permanente Medicare	$0.02
Rate for Payer: MDX Hawaii PPO	$0.04
Rate for Payer: Ohana Health Plan Medicaid	$0.02
Rate for Payer: Ohana Health Plan Medicare	$0.02
Rate for Payer: UnitedHealthcare Medicaid	$0.02
Rate for Payer: UnitedHealthcare Medicare	$0.02
Rate for Payer: University Health Alliance Commercial	$0.03

ANTIBODY INFLUENZA VIRUS

Professional

Both

$56.00

Service Code	HCPCS 86710
Hospital Revenue Code	300
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$47.60
Rate for Payer: AlohaCare Medicaid	$11.36
Rate for Payer: AlohaCare Medicare	$13.55
Rate for Payer: Cash Price	$36.40
Rate for Payer: Cash Price	$36.40
Rate for Payer: Devoted Health Medicare	$13.55
Rate for Payer: Hawaii Medical Service Association Medicare	$13.55
Rate for Payer: Hawaii Western Management Group Commercial	$18.75
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Kaiser Permanente Commercial	$16.26
Rate for Payer: Kaiser Permanente Medicaid	$16.26
Rate for Payer: Kaiser Permanente Medicare	$16.26
Rate for Payer: Ohana Health Plan Medicaid	$11.36
Rate for Payer: Ohana Health Plan Medicare	$13.55
Rate for Payer: UnitedHealthcare Medicaid	$11.36
Rate for Payer: UnitedHealthcare Medicare	$13.55

Antibody Screen DLS

Facility

$96.00

Service Code	HCPCS 86850
Hospital Charge Code	422868505
Hospital Revenue Code	302
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$62.40
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12

Antibody Screen DLS

Facility

$96.00

Service Code	HCPCS 86850
Hospital Charge Code	422868505
Hospital Revenue Code	302
Min. Negotiated Rate	$9.77
Max. Negotiated Rate	$93.12
Rate for Payer: AlohaCare Medicaid	$48.00
Rate for Payer: AlohaCare Medicare	$40.32
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$88.32
Rate for Payer: Devoted Health Medicare	$40.32
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$19.65
Rate for Payer: Hawaii Medical Service Association Commercial	$12.21
Rate for Payer: Hawaii Medical Service Association Medicare	$40.32
Rate for Payer: Hawaii Western Management Group Commercial	$9.77
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Humana Medicare	$40.32
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: Kaiser Permanente Medicare	$40.32
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: Ohana Health Plan Medicaid	$40.32
Rate for Payer: Ohana Health Plan Medicare	$40.32
Rate for Payer: UnitedHealthcare Medicaid	$19.65
Rate for Payer: UnitedHealthcare Medicare	$40.32
Rate for Payer: University Health Alliance Commercial	$50.88

Anti-DNA (Double Stranded) DLS

Facility

$108.00

Service Code	HCPCS 86225
Hospital Charge Code	422862255
Hospital Revenue Code	301
Min. Negotiated Rate	$13.74
Max. Negotiated Rate	$104.76
Rate for Payer: AlohaCare Medicaid	$54.00
Rate for Payer: AlohaCare Medicare	$45.36
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cash Price	$70.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$99.36
Rate for Payer: Devoted Health Medicare	$45.36
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.99
Rate for Payer: Hawaii Medical Service Association Commercial	$17.18
Rate for Payer: Hawaii Medical Service Association Medicare	$45.36
Rate for Payer: Hawaii Western Management Group Commercial	$13.74
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Humana Medicare	$45.36
Rate for Payer: Kaiser Permanente Commercial	$97.20
Rate for Payer: Kaiser Permanente Medicaid	$55.08
Rate for Payer: Kaiser Permanente Medicare	$45.36
Rate for Payer: MDX Hawaii PPO	$104.76
Rate for Payer: Ohana Health Plan Medicaid	$45.36
Rate for Payer: Ohana Health Plan Medicare	$45.36
Rate for Payer: UnitedHealthcare Medicaid	$18.99
Rate for Payer: UnitedHealthcare Medicare	$45.36
Rate for Payer: University Health Alliance Commercial	$35.52

Anti-DNA (Double Stranded) DLS

Facility

$108.00

Service Code	HCPCS 86225
Hospital Charge Code	422862255
Hospital Revenue Code	301
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$70.20
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Kaiser Permanente Commercial	$97.20
Rate for Payer: MDX Hawaii PPO	$104.76

ANTI EMBOLISUM STOCKINGS THIGH LG

Facility

$70.00

Hospital Charge Code	8414
Hospital Revenue Code	270
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$45.50
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: MDX Hawaii PPO	$67.90

ANTI EMBOLISUM STOCKINGS THIGH LG

Facility

$70.00

Hospital Charge Code	8414
Hospital Revenue Code	270
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$67.90
Rate for Payer: AlohaCare Medicaid	$35.00
Rate for Payer: AlohaCare Medicare	$29.40
Rate for Payer: Cash Price	$45.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$64.40
Rate for Payer: Devoted Health Medicare	$29.40
Rate for Payer: Hawaii Medical Service Association Medicare	$29.40
Rate for Payer: Hawaii Western Management Group Commercial	$66.50
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Humana Medicare	$29.40
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: Kaiser Permanente Medicaid	$35.70
Rate for Payer: Kaiser Permanente Medicare	$29.40
Rate for Payer: MDX Hawaii PPO	$67.90
Rate for Payer: Ohana Health Plan Medicaid	$29.40
Rate for Payer: Ohana Health Plan Medicare	$29.40
Rate for Payer: UnitedHealthcare Medicare	$29.40
Rate for Payer: University Health Alliance Commercial	$51.02

ANTI EMBOLISUM STOCKINGS THIGH MED

Facility

$20.00

Hospital Charge Code	8415
Hospital Revenue Code	270
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$13.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: MDX Hawaii PPO	$19.40

ANTI EMBOLISUM STOCKINGS THIGH MED

Facility

$20.00

Hospital Charge Code	8415
Hospital Revenue Code	270
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$19.40
Rate for Payer: AlohaCare Medicaid	$10.00
Rate for Payer: AlohaCare Medicare	$8.40
Rate for Payer: Cash Price	$13.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$18.40
Rate for Payer: Devoted Health Medicare	$8.40
Rate for Payer: Hawaii Medical Service Association Medicare	$8.40
Rate for Payer: Hawaii Western Management Group Commercial	$19.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Humana Medicare	$8.40
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: Kaiser Permanente Medicaid	$10.20
Rate for Payer: Kaiser Permanente Medicare	$8.40
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: Ohana Health Plan Medicaid	$8.40
Rate for Payer: Ohana Health Plan Medicare	$8.40
Rate for Payer: UnitedHealthcare Medicare	$8.40
Rate for Payer: University Health Alliance Commercial	$14.58

ANTI EMBOLISUM STOCKINGS THIGH SM

Facility

$13.00

Hospital Charge Code	8416
Hospital Revenue Code	270
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$12.61
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$5.46
Rate for Payer: Cash Price	$8.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$11.96
Rate for Payer: Devoted Health Medicare	$5.46
Rate for Payer: Hawaii Medical Service Association Medicare	$5.46
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Humana Medicare	$5.46
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$5.46
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: Ohana Health Plan Medicaid	$5.46
Rate for Payer: Ohana Health Plan Medicare	$5.46
Rate for Payer: UnitedHealthcare Medicare	$5.46
Rate for Payer: University Health Alliance Commercial	$9.48

ANTI EMBOLISUM STOCKINGS THIGH SM

Facility

$13.00

Hospital Charge Code	8416
Hospital Revenue Code	270
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$8.45
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

ANTI EMOBISM STOCKING LG

Facility

$17.00

Hospital Charge Code	8023
Hospital Revenue Code	270
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$11.05
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: MDX Hawaii PPO	$16.49

ANTI EMOBISM STOCKING LG

Facility

$17.00

Hospital Charge Code	8023
Hospital Revenue Code	270
Min. Negotiated Rate	$7.14
Max. Negotiated Rate	$16.49
Rate for Payer: AlohaCare Medicaid	$8.50
Rate for Payer: AlohaCare Medicare	$7.14
Rate for Payer: Cash Price	$11.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$15.64
Rate for Payer: Devoted Health Medicare	$7.14
Rate for Payer: Hawaii Medical Service Association Medicare	$7.14
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Humana Medicare	$7.14
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: Kaiser Permanente Medicare	$7.14
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: Ohana Health Plan Medicaid	$7.14
Rate for Payer: Ohana Health Plan Medicare	$7.14
Rate for Payer: UnitedHealthcare Medicare	$7.14
Rate for Payer: University Health Alliance Commercial	$12.39

ANTI EMOBISM STOCKING MED

Facility

$25.00

Hospital Charge Code	8021
Hospital Revenue Code	270
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$24.25
Rate for Payer: AlohaCare Medicaid	$12.50
Rate for Payer: AlohaCare Medicare	$10.50
Rate for Payer: Cash Price	$16.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$23.00
Rate for Payer: Devoted Health Medicare	$10.50
Rate for Payer: Hawaii Medical Service Association Medicare	$10.50
Rate for Payer: Hawaii Western Management Group Commercial	$23.75
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Humana Medicare	$10.50
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: Kaiser Permanente Medicaid	$12.75
Rate for Payer: Kaiser Permanente Medicare	$10.50
Rate for Payer: MDX Hawaii PPO	$24.25
Rate for Payer: Ohana Health Plan Medicaid	$10.50
Rate for Payer: Ohana Health Plan Medicare	$10.50
Rate for Payer: UnitedHealthcare Medicare	$10.50
Rate for Payer: University Health Alliance Commercial	$18.22

ANTI EMOBISM STOCKING MED

Facility

$25.00

Hospital Charge Code	8021
Hospital Revenue Code	270
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: MDX Hawaii PPO	$24.25

Know your out-of-pocket cost for care.

All Charges