Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

RA (Rheumatoid Factor) DLS

Facility

$52.00

Service Code	HCPCS 86431
Hospital Charge Code	422864315
Hospital Revenue Code	301
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$50.44
Rate for Payer: AlohaCare Medicaid	$26.00
Rate for Payer: AlohaCare Medicare	$21.84
Rate for Payer: Cash Price	$33.80
Rate for Payer: Cash Price	$33.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$47.84
Rate for Payer: Devoted Health Medicare	$21.84
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.85
Rate for Payer: Hawaii Medical Service Association Commercial	$7.09
Rate for Payer: Hawaii Medical Service Association Medicare	$21.84
Rate for Payer: Hawaii Western Management Group Commercial	$5.67
Rate for Payer: Health Management Network Commercial	$44.20
Rate for Payer: Humana Medicare	$21.84
Rate for Payer: Kaiser Permanente Commercial	$46.80
Rate for Payer: Kaiser Permanente Medicaid	$26.52
Rate for Payer: Kaiser Permanente Medicare	$21.84
Rate for Payer: MDX Hawaii PPO	$50.44
Rate for Payer: Ohana Health Plan Medicaid	$21.84
Rate for Payer: Ohana Health Plan Medicare	$21.84
Rate for Payer: UnitedHealthcare Medicaid	$7.85
Rate for Payer: UnitedHealthcare Medicare	$21.84
Rate for Payer: University Health Alliance Commercial	$14.67

RBC CPD AS1 450 LR

Facility

$756.00

Service Code	HCPCS P9016
Hospital Charge Code	422P90160
Hospital Revenue Code	381
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$733.32
Rate for Payer: AlohaCare Medicaid	$378.00
Rate for Payer: AlohaCare Medicare	$317.52
Rate for Payer: Cash Price	$491.40
Rate for Payer: Cash Price	$491.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$695.52
Rate for Payer: Devoted Health Medicare	$317.52
Rate for Payer: Hawaii Medical Service Association Commercial	$267.26
Rate for Payer: Hawaii Medical Service Association Medicare	$317.52
Rate for Payer: Hawaii Western Management Group Commercial	$718.20
Rate for Payer: Health Management Network Commercial	$642.60
Rate for Payer: Humana Medicare	$317.52
Rate for Payer: Kaiser Permanente Commercial	$680.40
Rate for Payer: Kaiser Permanente Medicaid	$385.56
Rate for Payer: Kaiser Permanente Medicare	$317.52
Rate for Payer: MDX Hawaii PPO	$733.32
Rate for Payer: Ohana Health Plan Medicaid	$317.52
Rate for Payer: Ohana Health Plan Medicare	$317.52
Rate for Payer: UnitedHealthcare Medicaid	$136.50
Rate for Payer: UnitedHealthcare Medicare	$317.52
Rate for Payer: University Health Alliance Commercial	$551.05

RBC CPD AS1 450 LR

Facility

$756.00

Service Code	HCPCS P9016
Hospital Charge Code	422P90160
Hospital Revenue Code	381
Min. Negotiated Rate	$642.60
Max. Negotiated Rate	$733.32
Rate for Payer: Cash Price	$491.40
Rate for Payer: Health Management Network Commercial	$642.60
Rate for Payer: Kaiser Permanente Commercial	$680.40
Rate for Payer: MDX Hawaii PPO	$733.32

RBC CPD AS1 500 LR

Facility

$777.00

Service Code	HCPCS P9201
Hospital Charge Code	422P90160
Hospital Revenue Code	381
Min. Negotiated Rate	$660.45
Max. Negotiated Rate	$753.69
Rate for Payer: Cash Price	$505.05
Rate for Payer: Health Management Network Commercial	$660.45
Rate for Payer: Kaiser Permanente Commercial	$699.30
Rate for Payer: MDX Hawaii PPO	$753.69

RBC CPD AS1 500 LR

Facility

$777.00

Service Code	HCPCS P9201
Hospital Charge Code	422P90160
Hospital Revenue Code	381
Min. Negotiated Rate	$326.34
Max. Negotiated Rate	$753.69
Rate for Payer: AlohaCare Medicaid	$388.50
Rate for Payer: AlohaCare Medicare	$326.34
Rate for Payer: Cash Price	$505.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$714.84
Rate for Payer: Devoted Health Medicare	$326.34
Rate for Payer: Hawaii Medical Service Association Medicare	$326.34
Rate for Payer: Hawaii Western Management Group Commercial	$738.15
Rate for Payer: Health Management Network Commercial	$660.45
Rate for Payer: Humana Medicare	$326.34
Rate for Payer: Kaiser Permanente Commercial	$699.30
Rate for Payer: Kaiser Permanente Medicaid	$396.27
Rate for Payer: Kaiser Permanente Medicare	$326.34
Rate for Payer: MDX Hawaii PPO	$753.69
Rate for Payer: Ohana Health Plan Medicaid	$326.34
Rate for Payer: Ohana Health Plan Medicare	$326.34
Rate for Payer: UnitedHealthcare Medicare	$326.34
Rate for Payer: University Health Alliance Commercial	$566.36

RBC CPD AS5 450

Facility

$774.00

Service Code	HCPCS P9201
Hospital Charge Code	422P90210
Hospital Revenue Code	381
Min. Negotiated Rate	$657.90
Max. Negotiated Rate	$750.78
Rate for Payer: Cash Price	$503.10
Rate for Payer: Health Management Network Commercial	$657.90
Rate for Payer: Kaiser Permanente Commercial	$696.60
Rate for Payer: MDX Hawaii PPO	$750.78

RBC CPD AS5 450

Facility

$774.00

Service Code	HCPCS P9201
Hospital Charge Code	422P90210
Hospital Revenue Code	381
Min. Negotiated Rate	$325.08
Max. Negotiated Rate	$750.78
Rate for Payer: AlohaCare Medicaid	$387.00
Rate for Payer: AlohaCare Medicare	$325.08
Rate for Payer: Cash Price	$503.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$712.08
Rate for Payer: Devoted Health Medicare	$325.08
Rate for Payer: Hawaii Medical Service Association Medicare	$325.08
Rate for Payer: Hawaii Western Management Group Commercial	$735.30
Rate for Payer: Health Management Network Commercial	$657.90
Rate for Payer: Humana Medicare	$325.08
Rate for Payer: Kaiser Permanente Commercial	$696.60
Rate for Payer: Kaiser Permanente Medicaid	$394.74
Rate for Payer: Kaiser Permanente Medicare	$325.08
Rate for Payer: MDX Hawaii PPO	$750.78
Rate for Payer: Ohana Health Plan Medicaid	$325.08
Rate for Payer: Ohana Health Plan Medicare	$325.08
Rate for Payer: UnitedHealthcare Medicare	$325.08
Rate for Payer: University Health Alliance Commercial	$564.17

RBC CPD AS5 450 LR

Facility

$510.00

Service Code	HCPCS P9201
Hospital Charge Code	422P90210
Hospital Revenue Code	381
Min. Negotiated Rate	$433.50
Max. Negotiated Rate	$494.70
Rate for Payer: Cash Price	$331.50
Rate for Payer: Health Management Network Commercial	$433.50
Rate for Payer: Kaiser Permanente Commercial	$459.00
Rate for Payer: MDX Hawaii PPO	$494.70

RBC CPD AS5 450 LR

Facility

$510.00

Service Code	HCPCS P9201
Hospital Charge Code	422P90210
Hospital Revenue Code	381
Min. Negotiated Rate	$214.20
Max. Negotiated Rate	$494.70
Rate for Payer: AlohaCare Medicaid	$255.00
Rate for Payer: AlohaCare Medicare	$214.20
Rate for Payer: Cash Price	$331.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$469.20
Rate for Payer: Devoted Health Medicare	$214.20
Rate for Payer: Hawaii Medical Service Association Medicare	$214.20
Rate for Payer: Hawaii Western Management Group Commercial	$484.50
Rate for Payer: Health Management Network Commercial	$433.50
Rate for Payer: Humana Medicare	$214.20
Rate for Payer: Kaiser Permanente Commercial	$459.00
Rate for Payer: Kaiser Permanente Medicaid	$260.10
Rate for Payer: Kaiser Permanente Medicare	$214.20
Rate for Payer: MDX Hawaii PPO	$494.70
Rate for Payer: Ohana Health Plan Medicaid	$214.20
Rate for Payer: Ohana Health Plan Medicare	$214.20
Rate for Payer: UnitedHealthcare Medicare	$214.20
Rate for Payer: University Health Alliance Commercial	$371.74

RECONSTRUCTION OF NAIL BED WITH GRAFT CHARGE

Facility

$7,000.00

Service Code	HCPCS 11762
Hospital Charge Code	440117620
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: AlohaCare Medicaid	$3,500.00
Rate for Payer: AlohaCare Medicare	$2,940.00
Rate for Payer: Cash Price	$4,550.00
Rate for Payer: Cash Price	$4,550.00
Rate for Payer: Cash Price	$4,550.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6,440.00
Rate for Payer: Devoted Health Medicare	$2,940.00
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,940.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,650.00
Rate for Payer: Health Management Network Commercial	$5,950.00
Rate for Payer: Humana Medicare	$2,940.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,940.00
Rate for Payer: MDX Hawaii PPO	$6,790.00
Rate for Payer: Ohana Health Plan Medicaid	$2,940.00
Rate for Payer: Ohana Health Plan Medicare	$2,940.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,940.00
Rate for Payer: University Health Alliance Commercial	$5,102.30

RECONSTRUCTION OF NAIL BED WITH GRAFT CHARGE

Facility

$7,000.00

Service Code	HCPCS 11762
Hospital Charge Code	440117620
Hospital Revenue Code	450
Min. Negotiated Rate	$5,950.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: Cash Price	$4,550.00
Rate for Payer: Health Management Network Commercial	$5,950.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: MDX Hawaii PPO	$6,790.00

RECTAL RESECTION WITH CC

Facility

$71,224.51

Service Code	MSDRG 333
Min. Negotiated Rate	$71,224.51
Max. Negotiated Rate	$71,224.51
Rate for Payer: Hawaii Medical Service Association Commercial	$71,224.51

RECTAL RESECTION WITH MCC

Facility

$71,224.51

Service Code	MSDRG 332
Min. Negotiated Rate	$71,224.51
Max. Negotiated Rate	$71,224.51
Rate for Payer: Hawaii Medical Service Association Commercial	$71,224.51

RECTAL RESECTION WITHOUT CC/MCC

Facility

$34,083.48

Service Code	MSDRG 334
Min. Negotiated Rate	$34,083.48
Max. Negotiated Rate	$34,083.48
Rate for Payer: Hawaii Medical Service Association Commercial	$34,083.48

RED BLOOD CELL DISORDERS WITH MCC

Facility

$31,049.62

Service Code	MSDRG 811
Min. Negotiated Rate	$31,049.62
Max. Negotiated Rate	$31,049.62
Rate for Payer: Hawaii Medical Service Association Commercial	$31,049.62

RED BLOOD CELL DISORDERS WITHOUT MCC

Facility

$16,638.80

Service Code	MSDRG 812
Min. Negotiated Rate	$16,638.80
Max. Negotiated Rate	$16,638.80
Rate for Payer: Hawaii Medical Service Association Commercial	$16,638.80

REF Antibody ID

Facility

$1,063.00

Service Code	HCPCS 86870
Hospital Charge Code	422868700
Hospital Revenue Code	302
Min. Negotiated Rate	$903.55
Max. Negotiated Rate	$1,031.11
Rate for Payer: Cash Price	$690.95
Rate for Payer: Health Management Network Commercial	$903.55
Rate for Payer: Kaiser Permanente Commercial	$956.70
Rate for Payer: MDX Hawaii PPO	$1,031.11

REF Antibody ID

Facility

$1,063.00

Service Code	HCPCS 86870
Hospital Charge Code	422868700
Hospital Revenue Code	302
Min. Negotiated Rate	$55.70
Max. Negotiated Rate	$1,031.11
Rate for Payer: AlohaCare Medicaid	$531.50
Rate for Payer: AlohaCare Medicare	$446.46
Rate for Payer: Cash Price	$690.95
Rate for Payer: Cash Price	$690.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$977.96
Rate for Payer: Devoted Health Medicare	$446.46
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$55.70
Rate for Payer: Hawaii Medical Service Association Commercial	$529.31
Rate for Payer: Hawaii Medical Service Association Medicare	$446.46
Rate for Payer: Hawaii Western Management Group Commercial	$423.45
Rate for Payer: Health Management Network Commercial	$903.55
Rate for Payer: Humana Medicare	$446.46
Rate for Payer: Kaiser Permanente Commercial	$956.70
Rate for Payer: Kaiser Permanente Medicaid	$542.13
Rate for Payer: Kaiser Permanente Medicare	$446.46
Rate for Payer: MDX Hawaii PPO	$1,031.11
Rate for Payer: Ohana Health Plan Medicaid	$446.46
Rate for Payer: Ohana Health Plan Medicare	$446.46
Rate for Payer: UnitedHealthcare Medicaid	$55.70
Rate for Payer: UnitedHealthcare Medicare	$446.46
Rate for Payer: University Health Alliance Commercial	$774.82

REGULAR BAD PAN

Facility

$17.00

Hospital Charge Code	8251
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

REGULAR BAD PAN

Facility

$17.00

Hospital Charge Code	8251
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

REHABILITATION WITH CC/MCC

Facility

$9,765.22

Service Code	MSDRG 945
Min. Negotiated Rate	$9,765.22
Max. Negotiated Rate	$9,765.22
Rate for Payer: Hawaii Medical Service Association Commercial	$9,765.22

REHABILITATION WITHOUT CC/MCC

Facility

$9,765.22

Service Code	MSDRG 946
Min. Negotiated Rate	$9,765.22
Max. Negotiated Rate	$9,765.22
Rate for Payer: Hawaii Medical Service Association Commercial	$9,765.22

relugolix 120 mg Tab [KMC]

Facility

$370.08

Service Code	NDC 72974012001
Hospital Revenue Code	250
Min. Negotiated Rate	$155.43
Max. Negotiated Rate	$358.98
Rate for Payer: AlohaCare Medicaid	$185.04
Rate for Payer: AlohaCare Medicare	$155.43
Rate for Payer: Cash Price	$240.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$340.47
Rate for Payer: Devoted Health Medicare	$155.43
Rate for Payer: Hawaii Medical Service Association Medicare	$155.43
Rate for Payer: Hawaii Western Management Group Commercial	$351.58
Rate for Payer: Health Management Network Commercial	$314.57
Rate for Payer: Humana Medicare	$155.43
Rate for Payer: Kaiser Permanente Commercial	$333.07
Rate for Payer: Kaiser Permanente Medicaid	$188.74
Rate for Payer: Kaiser Permanente Medicare	$155.43
Rate for Payer: MDX Hawaii PPO	$358.98
Rate for Payer: Ohana Health Plan Medicaid	$155.43
Rate for Payer: Ohana Health Plan Medicare	$155.43
Rate for Payer: UnitedHealthcare Medicaid	$222.05
Rate for Payer: UnitedHealthcare Medicare	$155.43
Rate for Payer: University Health Alliance Commercial	$269.75

relugolix 120 mg Tab [KMC]

Facility

$370.08

Service Code	NDC 72974012001
Hospital Revenue Code	250
Min. Negotiated Rate	$314.57
Max. Negotiated Rate	$358.98
Rate for Payer: Cash Price	$240.55
Rate for Payer: Health Management Network Commercial	$314.57
Rate for Payer: Kaiser Permanente Commercial	$333.07
Rate for Payer: MDX Hawaii PPO	$358.98

REMOVAL FOREIGN BODY; EYE CHARGE

Facility

$397.00

Service Code	HCPCS 65205
Hospital Charge Code	440652050
Hospital Revenue Code	450
Min. Negotiated Rate	$166.74
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$198.50
Rate for Payer: AlohaCare Medicare	$166.74
Rate for Payer: Cash Price	$258.05
Rate for Payer: Cash Price	$258.05
Rate for Payer: Cash Price	$258.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$365.24
Rate for Payer: Devoted Health Medicare	$166.74
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$166.74
Rate for Payer: Hawaii Western Management Group Commercial	$377.15
Rate for Payer: Health Management Network Commercial	$337.45
Rate for Payer: Humana Medicare	$166.74
Rate for Payer: Kaiser Permanente Commercial	$357.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$166.74
Rate for Payer: MDX Hawaii PPO	$385.09
Rate for Payer: Ohana Health Plan Medicaid	$166.74
Rate for Payer: Ohana Health Plan Medicare	$166.74
Rate for Payer: UnitedHealthcare Medicare	$166.74
Rate for Payer: University Health Alliance Commercial	$289.37

Know your out-of-pocket cost for care.

All Charges