Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC

Facility

$37,899.50

Service Code	MSDRG 856
Min. Negotiated Rate	$37,899.50
Max. Negotiated Rate	$37,899.50
Rate for Payer: Hawaii Medical Service Association Commercial	$37,899.50

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$37,899.50

Service Code	MSDRG 858
Min. Negotiated Rate	$37,899.50
Max. Negotiated Rate	$37,899.50
Rate for Payer: Hawaii Medical Service Association Commercial	$37,899.50

POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES

Facility

$25,124.12

Service Code	MSDRG 769
Min. Negotiated Rate	$25,124.12
Max. Negotiated Rate	$25,124.12
Rate for Payer: Hawaii Medical Service Association Commercial	$25,124.12

POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES

Facility

$9,599.31

Service Code	MSDRG 776
Min. Negotiated Rate	$9,599.31
Max. Negotiated Rate	$9,599.31
Rate for Payer: Hawaii Medical Service Association Commercial	$9,599.31

POSTPARTUM CARE VISIT

Professional

Both

$0.01

Service Code	HCPCS 0503F
Hospital Revenue Code	521
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$290.48
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$273.13

Potassium Chl 10 mEq / 100 mL bag [KMC]

Facility

$0.19

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.18
Rate for Payer: AlohaCare Medicaid	$0.10
Rate for Payer: AlohaCare Medicare	$0.08
Rate for Payer: Cash Price	$0.12
Rate for Payer: Cash Price	$0.12
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.17
Rate for Payer: Devoted Health Medicare	$0.08
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Medicare	$0.08
Rate for Payer: Hawaii Western Management Group Commercial	$0.18
Rate for Payer: Health Management Network Commercial	$0.16
Rate for Payer: Humana Medicare	$0.08
Rate for Payer: Kaiser Permanente Commercial	$0.17
Rate for Payer: Kaiser Permanente Medicaid	$0.10
Rate for Payer: Kaiser Permanente Medicare	$0.08
Rate for Payer: MDX Hawaii PPO	$0.18
Rate for Payer: Ohana Health Plan Medicaid	$0.08
Rate for Payer: Ohana Health Plan Medicare	$0.08
Rate for Payer: UnitedHealthcare Medicaid	$0.11
Rate for Payer: UnitedHealthcare Medicare	$0.08
Rate for Payer: University Health Alliance Commercial	$0.14

Potassium Chl 10 mEq / 100 mL bag [KMC]

Facility

$0.19

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.12
Rate for Payer: Health Management Network Commercial	$0.16
Rate for Payer: Kaiser Permanente Commercial	$0.17
Rate for Payer: MDX Hawaii PPO	$0.18

Potassium Chl 10 mEq - D5% - 1/2 NS - 1000 mL bag [KMC]

Facility

$0.05

Service Code	NDC 00338066904
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.05
Rate for Payer: Cash Price	$0.03
Rate for Payer: Health Management Network Commercial	$0.04
Rate for Payer: Kaiser Permanente Commercial	$0.05
Rate for Payer: MDX Hawaii PPO	$0.05

Potassium Chl 10 mEq - D5% - 1/2 NS - 1000 mL bag [KMC]

Facility

$0.05

Service Code	NDC 00338066904
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
Rate for Payer: AlohaCare Medicaid	$0.03
Rate for Payer: AlohaCare Medicare	$0.02
Rate for Payer: Cash Price	$0.03
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.05
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	$0.05
Rate for Payer: Health Management Network Commercial	$0.04
Rate for Payer: Humana Medicare	$0.02
Rate for Payer: Kaiser Permanente Commercial	$0.05
Rate for Payer: Kaiser Permanente Medicaid	$0.03
Rate for Payer: Kaiser Permanente Medicare	$0.02
Rate for Payer: MDX Hawaii PPO	$0.05
Rate for Payer: Ohana Health Plan Medicaid	$0.02
Rate for Payer: Ohana Health Plan Medicare	$0.02
Rate for Payer: UnitedHealthcare Medicaid	$0.03
Rate for Payer: UnitedHealthcare Medicare	$0.02
Rate for Payer: University Health Alliance Commercial	$0.04

Potassium Chl 20 mEq - D5% - 1/2 NS - 1000 mL bag [KMC]

Facility

$0.02

Service Code	HCPCS S5013
Hospital Revenue Code	637
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.02
Rate for Payer: Kaiser Permanente Commercial	$0.02
Rate for Payer: MDX Hawaii PPO	$0.02

Potassium Chl 20 mEq - D5% - 1/2 NS - 1000 mL bag [KMC]

Facility

$0.02

Service Code	HCPCS S5013
Hospital Revenue Code	637
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: AlohaCare Medicaid	$0.01
Rate for Payer: AlohaCare Medicare	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.02
Rate for Payer: Devoted Health Medicare	$0.01
Rate for Payer: Hawaii Medical Service Association Medicare	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$0.02
Rate for Payer: Health Management Network Commercial	$0.02
Rate for Payer: Humana Medicare	$0.01
Rate for Payer: Kaiser Permanente Commercial	$0.02
Rate for Payer: Kaiser Permanente Medicaid	$0.01
Rate for Payer: Kaiser Permanente Medicare	$0.01
Rate for Payer: MDX Hawaii PPO	$0.02
Rate for Payer: Ohana Health Plan Medicaid	$0.01
Rate for Payer: Ohana Health Plan Medicare	$0.01
Rate for Payer: UnitedHealthcare Medicare	$0.01
Rate for Payer: University Health Alliance Commercial	$0.01

Potassium Chl 20 mEq - D5% - NS - 1000mL bag [KMC]

Facility

$0.05

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.05
Rate for Payer: Cash Price	$0.03
Rate for Payer: Health Management Network Commercial	$0.04
Rate for Payer: Kaiser Permanente Commercial	$0.05
Rate for Payer: MDX Hawaii PPO	$0.05

Potassium Chl 20 mEq - D5% - NS - 1000mL bag [KMC]

Facility

$0.05

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.17
Rate for Payer: AlohaCare Medicaid	$0.03
Rate for Payer: AlohaCare Medicare	$0.02
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cash Price	$0.03
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.05
Rate for Payer: Devoted Health Medicare	$0.02
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Medicare	$0.02
Rate for Payer: Hawaii Western Management Group Commercial	$0.05
Rate for Payer: Health Management Network Commercial	$0.04
Rate for Payer: Humana Medicare	$0.02
Rate for Payer: Kaiser Permanente Commercial	$0.05
Rate for Payer: Kaiser Permanente Medicaid	$0.03
Rate for Payer: Kaiser Permanente Medicare	$0.02
Rate for Payer: MDX Hawaii PPO	$0.05
Rate for Payer: Ohana Health Plan Medicaid	$0.02
Rate for Payer: Ohana Health Plan Medicare	$0.02
Rate for Payer: UnitedHealthcare Medicaid	$0.03
Rate for Payer: UnitedHealthcare Medicare	$0.02
Rate for Payer: University Health Alliance Commercial	$0.04

Potassium Chl 20 mEq - NS - 1000 mL bag [KMC]

Facility

$0.05

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.05
Rate for Payer: Cash Price	$0.03
Rate for Payer: Health Management Network Commercial	$0.04
Rate for Payer: Kaiser Permanente Commercial	$0.05
Rate for Payer: MDX Hawaii PPO	$0.05

Potassium Chl 20 mEq - NS - 1000 mL bag [KMC]

Facility

$0.05

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.17
Rate for Payer: AlohaCare Medicaid	$0.03
Rate for Payer: AlohaCare Medicare	$0.02
Rate for Payer: Cash Price	$0.03
Rate for Payer: Cash Price	$0.03
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.05
Rate for Payer: Devoted Health Medicare	$0.02
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Medicare	$0.02
Rate for Payer: Hawaii Western Management Group Commercial	$0.05
Rate for Payer: Health Management Network Commercial	$0.04
Rate for Payer: Humana Medicare	$0.02
Rate for Payer: Kaiser Permanente Commercial	$0.05
Rate for Payer: Kaiser Permanente Medicaid	$0.03
Rate for Payer: Kaiser Permanente Medicare	$0.02
Rate for Payer: MDX Hawaii PPO	$0.05
Rate for Payer: Ohana Health Plan Medicaid	$0.02
Rate for Payer: Ohana Health Plan Medicare	$0.02
Rate for Payer: UnitedHealthcare Medicaid	$0.03
Rate for Payer: UnitedHealthcare Medicare	$0.02
Rate for Payer: University Health Alliance Commercial	$0.04

potassium chloride 10 mEq ER Tab [KMC]

Facility

$3.00

Service Code	NDC 00378456177
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

potassium chloride 10 mEq ER Tab [KMC]

Facility

$3.00

Service Code	NDC 00378456177
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

potassium chloride 20 mEq ER Tab [KMC]

Facility

$3.00

Service Code	NDC 70010013501
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

potassium chloride 20 mEq ER Tab [KMC]

Facility

$3.00

Service Code	NDC 70010013501
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

potassium chloride 20 mEq Oral Pwdr [KMC]

Facility

$40.81

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$17.14
Max. Negotiated Rate	$39.59
Rate for Payer: AlohaCare Medicaid	$20.41
Rate for Payer: AlohaCare Medicare	$17.14
Rate for Payer: Cash Price	$26.53
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$37.55
Rate for Payer: Devoted Health Medicare	$17.14
Rate for Payer: Hawaii Medical Service Association Medicare	$17.14
Rate for Payer: Hawaii Western Management Group Commercial	$38.77
Rate for Payer: Health Management Network Commercial	$34.69
Rate for Payer: Humana Medicare	$17.14
Rate for Payer: Kaiser Permanente Commercial	$36.73
Rate for Payer: Kaiser Permanente Medicaid	$20.81
Rate for Payer: Kaiser Permanente Medicare	$17.14
Rate for Payer: MDX Hawaii PPO	$39.59
Rate for Payer: Ohana Health Plan Medicaid	$17.14
Rate for Payer: Ohana Health Plan Medicare	$17.14
Rate for Payer: UnitedHealthcare Medicare	$17.14
Rate for Payer: University Health Alliance Commercial	$29.75

potassium chloride 20 mEq Oral Pwdr [KMC]

Facility

$40.81

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$34.69
Max. Negotiated Rate	$39.59
Rate for Payer: Cash Price	$26.53
Rate for Payer: Health Management Network Commercial	$34.69
Rate for Payer: Kaiser Permanente Commercial	$36.73
Rate for Payer: MDX Hawaii PPO	$39.59

potassium citrate 1080 mg ER Tab [KMC]

Facility

$9.82

Service Code	NDC 68382053701
Hospital Revenue Code	250
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$9.53
Rate for Payer: AlohaCare Medicaid	$4.91
Rate for Payer: AlohaCare Medicare	$4.12
Rate for Payer: Cash Price	$6.38
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$9.03
Rate for Payer: Devoted Health Medicare	$4.12
Rate for Payer: Hawaii Medical Service Association Medicare	$4.12
Rate for Payer: Hawaii Western Management Group Commercial	$9.33
Rate for Payer: Health Management Network Commercial	$8.35
Rate for Payer: Humana Medicare	$4.12
Rate for Payer: Kaiser Permanente Commercial	$8.84
Rate for Payer: Kaiser Permanente Medicaid	$5.01
Rate for Payer: Kaiser Permanente Medicare	$4.12
Rate for Payer: MDX Hawaii PPO	$9.53
Rate for Payer: Ohana Health Plan Medicaid	$4.12
Rate for Payer: Ohana Health Plan Medicare	$4.12
Rate for Payer: UnitedHealthcare Medicaid	$5.89
Rate for Payer: UnitedHealthcare Medicare	$4.12
Rate for Payer: University Health Alliance Commercial	$7.16

potassium citrate 1080 mg ER Tab [KMC]

Facility

$9.82

Service Code	NDC 68382053701
Hospital Revenue Code	250
Min. Negotiated Rate	$8.35
Max. Negotiated Rate	$9.53
Rate for Payer: Cash Price	$6.38
Rate for Payer: Health Management Network Commercial	$8.35
Rate for Payer: Kaiser Permanente Commercial	$8.84
Rate for Payer: MDX Hawaii PPO	$9.53

potassium citrate 15 mEq ER Tab [KMC]

Facility

$10.65

Service Code	NDC 31722013201
Hospital Revenue Code	250
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$10.33
Rate for Payer: AlohaCare Medicaid	$5.33
Rate for Payer: AlohaCare Medicare	$4.47
Rate for Payer: Cash Price	$6.92
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$9.80
Rate for Payer: Devoted Health Medicare	$4.47
Rate for Payer: Hawaii Medical Service Association Medicare	$4.47
Rate for Payer: Hawaii Western Management Group Commercial	$10.12
Rate for Payer: Health Management Network Commercial	$9.05
Rate for Payer: Humana Medicare	$4.47
Rate for Payer: Kaiser Permanente Commercial	$9.59
Rate for Payer: Kaiser Permanente Medicaid	$5.43
Rate for Payer: Kaiser Permanente Medicare	$4.47
Rate for Payer: MDX Hawaii PPO	$10.33
Rate for Payer: Ohana Health Plan Medicaid	$4.47
Rate for Payer: Ohana Health Plan Medicare	$4.47
Rate for Payer: UnitedHealthcare Medicaid	$6.39
Rate for Payer: UnitedHealthcare Medicare	$4.47
Rate for Payer: University Health Alliance Commercial	$7.76

potassium citrate 15 mEq ER Tab [KMC]

Facility

$10.65

Service Code	NDC 31722013201
Hospital Revenue Code	250
Min. Negotiated Rate	$9.05
Max. Negotiated Rate	$10.33
Rate for Payer: Cash Price	$6.92
Rate for Payer: Health Management Network Commercial	$9.05
Rate for Payer: Kaiser Permanente Commercial	$9.59
Rate for Payer: MDX Hawaii PPO	$10.33

Know your out-of-pocket cost for care.

All Charges