Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC

Facility

$33,277.61

Service Code	MSDRG 179
Min. Negotiated Rate	$33,277.61
Max. Negotiated Rate	$33,277.61
Rate for Payer: Hawaii Medical Service Association Commercial	$33,277.61

RESPIRATORY NEOPLASMS WITH CC

Facility

$35,932.23

Service Code	MSDRG 181
Min. Negotiated Rate	$35,932.23
Max. Negotiated Rate	$35,932.23
Rate for Payer: Hawaii Medical Service Association Commercial	$35,932.23

RESPIRATORY NEOPLASMS WITH MCC

Facility

$35,932.23

Service Code	MSDRG 180
Min. Negotiated Rate	$35,932.23
Max. Negotiated Rate	$35,932.23
Rate for Payer: Hawaii Medical Service Association Commercial	$35,932.23

RESPIRATORY NEOPLASMS WITHOUT CC/MCC

Facility

$35,932.23

Service Code	MSDRG 182
Min. Negotiated Rate	$35,932.23
Max. Negotiated Rate	$35,932.23
Rate for Payer: Hawaii Medical Service Association Commercial	$35,932.23

Respiratory Panel by FilmArray DLS

Facility

$1,890.00

Service Code	HCPCS 87633
Hospital Charge Code	422876335
Hospital Revenue Code	300
Min. Negotiated Rate	$343.75
Max. Negotiated Rate	$1,833.30
Rate for Payer: AlohaCare Medicaid	$945.00
Rate for Payer: AlohaCare Medicare	$793.80
Rate for Payer: Cash Price	$1,228.50
Rate for Payer: Cash Price	$1,228.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,738.80
Rate for Payer: Devoted Health Medicare	$793.80
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$567.18
Rate for Payer: Hawaii Medical Service Association Commercial	$520.98
Rate for Payer: Hawaii Medical Service Association Medicare	$793.80
Rate for Payer: Hawaii Western Management Group Commercial	$416.78
Rate for Payer: Health Management Network Commercial	$1,606.50
Rate for Payer: Humana Medicare	$793.80
Rate for Payer: Kaiser Permanente Commercial	$1,701.00
Rate for Payer: Kaiser Permanente Medicaid	$963.90
Rate for Payer: Kaiser Permanente Medicare	$793.80
Rate for Payer: MDX Hawaii PPO	$1,833.30
Rate for Payer: Ohana Health Plan Medicaid	$793.80
Rate for Payer: Ohana Health Plan Medicare	$793.80
Rate for Payer: UnitedHealthcare Medicaid	$343.75
Rate for Payer: UnitedHealthcare Medicare	$793.80
Rate for Payer: University Health Alliance Commercial	$1,059.88

Respiratory Panel by FilmArray DLS

Facility

$1,890.00

Service Code	HCPCS 87633
Hospital Charge Code	422876335
Hospital Revenue Code	300
Min. Negotiated Rate	$1,606.50
Max. Negotiated Rate	$1,833.30
Rate for Payer: Cash Price	$1,228.50
Rate for Payer: Health Management Network Commercial	$1,606.50
Rate for Payer: Kaiser Permanente Commercial	$1,701.00
Rate for Payer: MDX Hawaii PPO	$1,833.30

RESPIRATORY SIGNS AND SYMPTOMS

Facility

$13,486.44

Service Code	MSDRG 204
Min. Negotiated Rate	$13,486.44
Max. Negotiated Rate	$13,486.44
Rate for Payer: Hawaii Medical Service Association Commercial	$13,486.44

Respiratory Syncytial Virus 5

Facility

$144.00

Service Code	HCPCS 87798
Hospital Charge Code	422877985
Hospital Revenue Code	300
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$139.68
Rate for Payer: AlohaCare Medicaid	$72.00
Rate for Payer: AlohaCare Medicare	$60.48
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$132.48
Rate for Payer: Devoted Health Medicare	$60.48
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$60.48
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Humana Medicare	$60.48
Rate for Payer: Kaiser Permanente Commercial	$129.60
Rate for Payer: Kaiser Permanente Medicaid	$73.44
Rate for Payer: Kaiser Permanente Medicare	$60.48
Rate for Payer: MDX Hawaii PPO	$139.68
Rate for Payer: Ohana Health Plan Medicaid	$60.48
Rate for Payer: Ohana Health Plan Medicare	$60.48
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$60.48
Rate for Payer: University Health Alliance Commercial	$90.72

Respiratory Syncytial Virus 5

Facility

$144.00

Service Code	HCPCS 87798
Hospital Charge Code	422877985
Hospital Revenue Code	300
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$139.68
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Kaiser Permanente Commercial	$129.60
Rate for Payer: MDX Hawaii PPO	$139.68

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS

Facility

$70,205.32

Service Code	MSDRG 208
Min. Negotiated Rate	$70,205.32
Max. Negotiated Rate	$70,205.32
Rate for Payer: Hawaii Medical Service Association Commercial	$70,205.32

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS

Facility

$185,231.13

Service Code	MSDRG 207
Min. Negotiated Rate	$185,231.13
Max. Negotiated Rate	$185,231.13
Rate for Payer: Hawaii Medical Service Association Commercial	$185,231.13

RESPIRATORY TRMT Respiratory Therapy Charges

Facility

$67.00

Service Code	HCPCS 94645
Hospital Charge Code	429946450
Hospital Revenue Code	410
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$64.99
Rate for Payer: AlohaCare Medicaid	$33.50
Rate for Payer: AlohaCare Medicare	$28.14
Rate for Payer: Cash Price	$43.55
Rate for Payer: Cash Price	$43.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$61.64
Rate for Payer: Devoted Health Medicare	$28.14
Rate for Payer: Hawaii Medical Service Association Medicare	$28.14
Rate for Payer: Hawaii Western Management Group Commercial	$63.65
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: Humana Medicare	$28.14
Rate for Payer: Kaiser Permanente Commercial	$60.30
Rate for Payer: Kaiser Permanente Medicaid	$34.17
Rate for Payer: Kaiser Permanente Medicare	$28.14
Rate for Payer: MDX Hawaii PPO	$64.99
Rate for Payer: Ohana Health Plan Medicaid	$28.14
Rate for Payer: Ohana Health Plan Medicare	$28.14
Rate for Payer: UnitedHealthcare Medicaid	$10.46
Rate for Payer: UnitedHealthcare Medicare	$28.14
Rate for Payer: University Health Alliance Commercial	$48.84

RESPIRATORY TRMT Respiratory Therapy Charges

Facility

$67.00

Service Code	HCPCS 94645
Hospital Charge Code	429946450
Hospital Revenue Code	410
Min. Negotiated Rate	$56.95
Max. Negotiated Rate	$64.99
Rate for Payer: Cash Price	$43.55
Rate for Payer: Health Management Network Commercial	$56.95
Rate for Payer: Kaiser Permanente Commercial	$60.30
Rate for Payer: MDX Hawaii PPO	$64.99

RESPIRATORY TRMT SUBQ Respiratory Therapy Charges

Facility

$302.00

Service Code	HCPCS 94640
Hospital Charge Code	440946400
Hospital Revenue Code	410
Min. Negotiated Rate	$256.70
Max. Negotiated Rate	$292.94
Rate for Payer: Cash Price	$196.30
Rate for Payer: Health Management Network Commercial	$256.70
Rate for Payer: Kaiser Permanente Commercial	$271.80
Rate for Payer: MDX Hawaii PPO	$292.94

RESPIRATORY TRMT SUBQ Respiratory Therapy Charges

Facility

$302.00

Service Code	HCPCS 94640
Hospital Charge Code	440946400
Hospital Revenue Code	410
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$323.36
Rate for Payer: AlohaCare Medicaid	$151.00
Rate for Payer: AlohaCare Medicare	$126.84
Rate for Payer: Cash Price	$196.30
Rate for Payer: Cash Price	$196.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$277.84
Rate for Payer: Devoted Health Medicare	$126.84
Rate for Payer: Hawaii Medical Service Association Commercial	$323.36
Rate for Payer: Hawaii Medical Service Association Medicare	$126.84
Rate for Payer: Hawaii Western Management Group Commercial	$286.90
Rate for Payer: Health Management Network Commercial	$256.70
Rate for Payer: Humana Medicare	$126.84
Rate for Payer: Kaiser Permanente Commercial	$271.80
Rate for Payer: Kaiser Permanente Medicaid	$154.02
Rate for Payer: Kaiser Permanente Medicare	$126.84
Rate for Payer: MDX Hawaii PPO	$292.94
Rate for Payer: Ohana Health Plan Medicaid	$126.84
Rate for Payer: Ohana Health Plan Medicare	$126.84
Rate for Payer: UnitedHealthcare Medicaid	$13.32
Rate for Payer: UnitedHealthcare Medicare	$126.84
Rate for Payer: University Health Alliance Commercial	$220.13

Reticulocyte Count

Facility

$73.00

Service Code	HCPCS 85045
Hospital Charge Code	422850450
Hospital Revenue Code	305
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$70.81
Rate for Payer: AlohaCare Medicaid	$36.50
Rate for Payer: AlohaCare Medicare	$30.66
Rate for Payer: Cash Price	$47.45
Rate for Payer: Cash Price	$47.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$67.16
Rate for Payer: Devoted Health Medicare	$30.66
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$5.59
Rate for Payer: Hawaii Medical Service Association Commercial	$4.99
Rate for Payer: Hawaii Medical Service Association Medicare	$30.66
Rate for Payer: Hawaii Western Management Group Commercial	$3.99
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Humana Medicare	$30.66
Rate for Payer: Kaiser Permanente Commercial	$65.70
Rate for Payer: Kaiser Permanente Medicaid	$37.23
Rate for Payer: Kaiser Permanente Medicare	$30.66
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: Ohana Health Plan Medicaid	$30.66
Rate for Payer: Ohana Health Plan Medicare	$30.66
Rate for Payer: UnitedHealthcare Medicaid	$5.59
Rate for Payer: UnitedHealthcare Medicare	$30.66
Rate for Payer: University Health Alliance Commercial	$10.34

Reticulocyte Count

Facility

$73.00

Service Code	HCPCS 85045
Hospital Charge Code	422850450
Hospital Revenue Code	305
Min. Negotiated Rate	$62.05
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$47.45
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Kaiser Permanente Commercial	$65.70
Rate for Payer: MDX Hawaii PPO	$70.81

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC

Facility

$15,975.15

Service Code	MSDRG 815
Min. Negotiated Rate	$15,975.15
Max. Negotiated Rate	$15,975.15
Rate for Payer: Hawaii Medical Service Association Commercial	$15,975.15

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC

Facility

$15,975.15

Service Code	MSDRG 814
Min. Negotiated Rate	$15,975.15
Max. Negotiated Rate	$15,975.15
Rate for Payer: Hawaii Medical Service Association Commercial	$15,975.15

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC

Facility

$11,685.09

Service Code	MSDRG 816
Min. Negotiated Rate	$11,685.09
Max. Negotiated Rate	$11,685.09
Rate for Payer: Hawaii Medical Service Association Commercial	$11,685.09

revefenacin 175 mcg/3 mL Neb Soln [KMC]

Facility

$60.32

Service Code	HCPCS J7677
Hospital Revenue Code	636
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$58.51
Rate for Payer: AlohaCare Medicaid	$30.16
Rate for Payer: AlohaCare Medicare	$25.33
Rate for Payer: Cash Price	$39.21
Rate for Payer: Cash Price	$39.21
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$55.49
Rate for Payer: Devoted Health Medicare	$25.33
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.19
Rate for Payer: Hawaii Medical Service Association Medicare	$25.33
Rate for Payer: Hawaii Western Management Group Commercial	$57.30
Rate for Payer: Health Management Network Commercial	$51.27
Rate for Payer: Humana Medicare	$25.33
Rate for Payer: Kaiser Permanente Commercial	$54.29
Rate for Payer: Kaiser Permanente Medicaid	$30.76
Rate for Payer: Kaiser Permanente Medicare	$25.33
Rate for Payer: MDX Hawaii PPO	$58.51
Rate for Payer: Ohana Health Plan Medicaid	$25.33
Rate for Payer: Ohana Health Plan Medicare	$25.33
Rate for Payer: UnitedHealthcare Medicaid	$36.19
Rate for Payer: UnitedHealthcare Medicare	$25.33
Rate for Payer: University Health Alliance Commercial	$43.97

revefenacin 175 mcg/3 mL Neb Soln [KMC]

Facility

$60.32

Service Code	HCPCS J7677
Hospital Revenue Code	636
Min. Negotiated Rate	$51.27
Max. Negotiated Rate	$58.51
Rate for Payer: Cash Price	$39.21
Rate for Payer: Health Management Network Commercial	$51.27
Rate for Payer: Kaiser Permanente Commercial	$54.29
Rate for Payer: MDX Hawaii PPO	$58.51

REVISION OF HIP OR KNEE REPLACEMENT WITH CC

Facility

$56,576.67

Service Code	MSDRG 467
Min. Negotiated Rate	$56,576.67
Max. Negotiated Rate	$56,576.67
Rate for Payer: Hawaii Medical Service Association Commercial	$56,576.67

REVISION OF HIP OR KNEE REPLACEMENT WITH MCC

Facility

$56,576.67

Service Code	MSDRG 466
Min. Negotiated Rate	$56,576.67
Max. Negotiated Rate	$56,576.67
Rate for Payer: Hawaii Medical Service Association Commercial	$56,576.67

REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC

Facility

$56,576.67

Service Code	MSDRG 468
Min. Negotiated Rate	$56,576.67
Max. Negotiated Rate	$56,576.67
Rate for Payer: Hawaii Medical Service Association Commercial	$56,576.67

Know your out-of-pocket cost for care.

All Charges