Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

Rhogam immune globulin 300 mcg Soln [KMC]

Facility

$508.80

Service Code	HCPCS J2790
Hospital Revenue Code	636
Min. Negotiated Rate	$82.42
Max. Negotiated Rate	$493.54
Rate for Payer: AlohaCare Medicaid	$254.40
Rate for Payer: AlohaCare Medicare	$213.70
Rate for Payer: Cash Price	$330.72
Rate for Payer: Cash Price	$330.72
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$468.10
Rate for Payer: Devoted Health Medicare	$213.70
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$82.42
Rate for Payer: Hawaii Medical Service Association Medicare	$213.70
Rate for Payer: Hawaii Western Management Group Commercial	$483.36
Rate for Payer: Health Management Network Commercial	$432.48
Rate for Payer: Humana Medicare	$213.70
Rate for Payer: Kaiser Permanente Commercial	$457.92
Rate for Payer: Kaiser Permanente Medicaid	$259.49
Rate for Payer: Kaiser Permanente Medicare	$213.70
Rate for Payer: MDX Hawaii PPO	$493.54
Rate for Payer: Ohana Health Plan Medicaid	$213.70
Rate for Payer: Ohana Health Plan Medicare	$213.70
Rate for Payer: UnitedHealthcare Medicaid	$305.28
Rate for Payer: UnitedHealthcare Medicare	$213.70
Rate for Payer: University Health Alliance Commercial	$370.86

Rhogam immune globulin 300 mcg Soln [KMC]

Facility

$508.80

Service Code	HCPCS J2790
Hospital Revenue Code	636
Min. Negotiated Rate	$432.48
Max. Negotiated Rate	$493.54
Rate for Payer: Cash Price	$330.72
Rate for Payer: Health Management Network Commercial	$432.48
Rate for Payer: Kaiser Permanente Commercial	$457.92
Rate for Payer: MDX Hawaii PPO	$493.54

RHYTHM ECG 1-3 LEADS TRACING ONLY WITHOUT INTERPRE

Facility

$206.00

Service Code	HCPCS 93041
Hospital Charge Code	317930410
Hospital Revenue Code	730
Min. Negotiated Rate	$175.10
Max. Negotiated Rate	$199.82
Rate for Payer: Cash Price	$133.90
Rate for Payer: Health Management Network Commercial	$175.10
Rate for Payer: Kaiser Permanente Commercial	$185.40
Rate for Payer: MDX Hawaii PPO	$199.82

RHYTHM ECG 1-3 LEADS TRACING ONLY WITHOUT INTERPRE

Facility

$206.00

Service Code	HCPCS 93041
Hospital Charge Code	317930410
Hospital Revenue Code	730
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$199.82
Rate for Payer: AlohaCare Medicaid	$103.00
Rate for Payer: AlohaCare Medicare	$86.52
Rate for Payer: Cash Price	$133.90
Rate for Payer: Cash Price	$133.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$189.52
Rate for Payer: Devoted Health Medicare	$86.52
Rate for Payer: Hawaii Medical Service Association Commercial	$87.11
Rate for Payer: Hawaii Medical Service Association Medicare	$86.52
Rate for Payer: Hawaii Western Management Group Commercial	$195.70
Rate for Payer: Health Management Network Commercial	$175.10
Rate for Payer: Humana Medicare	$86.52
Rate for Payer: Kaiser Permanente Commercial	$185.40
Rate for Payer: Kaiser Permanente Medicaid	$105.06
Rate for Payer: Kaiser Permanente Medicare	$86.52
Rate for Payer: MDX Hawaii PPO	$199.82
Rate for Payer: Ohana Health Plan Medicaid	$86.52
Rate for Payer: Ohana Health Plan Medicare	$86.52
Rate for Payer: UnitedHealthcare Medicaid	$4.93
Rate for Payer: UnitedHealthcare Medicare	$86.52
Rate for Payer: University Health Alliance Commercial	$150.15

RIBS BILAT 3 VWS

Facility

$581.00

Service Code	HCPCS 71110
Hospital Charge Code	424711100
Hospital Revenue Code	320
Min. Negotiated Rate	$25.96
Max. Negotiated Rate	$563.57
Rate for Payer: AlohaCare Medicaid	$290.50
Rate for Payer: AlohaCare Medicare	$244.02
Rate for Payer: Cash Price	$377.65
Rate for Payer: Cash Price	$377.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$534.52
Rate for Payer: Devoted Health Medicare	$244.02
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$25.96
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$244.02
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: Humana Medicare	$244.02
Rate for Payer: Kaiser Permanente Commercial	$522.90
Rate for Payer: Kaiser Permanente Medicaid	$296.31
Rate for Payer: Kaiser Permanente Medicare	$244.02
Rate for Payer: MDX Hawaii PPO	$563.57
Rate for Payer: Ohana Health Plan Medicaid	$244.02
Rate for Payer: Ohana Health Plan Medicare	$244.02
Rate for Payer: UnitedHealthcare Medicaid	$25.96
Rate for Payer: UnitedHealthcare Medicare	$244.02
Rate for Payer: University Health Alliance Commercial	$85.69

RIBS BILAT 3 VWS

Facility

$581.00

Service Code	HCPCS 71110
Hospital Charge Code	424711100
Hospital Revenue Code	320
Min. Negotiated Rate	$493.85
Max. Negotiated Rate	$563.57
Rate for Payer: Cash Price	$377.65
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: Kaiser Permanente Commercial	$522.90
Rate for Payer: MDX Hawaii PPO	$563.57

RIBS UNILAT 2 VWS

Facility

$433.00

Service Code	HCPCS 71100
Hospital Charge Code	424711000
Hospital Revenue Code	320
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$420.01
Rate for Payer: AlohaCare Medicaid	$216.50
Rate for Payer: AlohaCare Medicare	$181.86
Rate for Payer: Cash Price	$281.45
Rate for Payer: Cash Price	$281.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$398.36
Rate for Payer: Devoted Health Medicare	$181.86
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.84
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$181.86
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$368.05
Rate for Payer: Humana Medicare	$181.86
Rate for Payer: Kaiser Permanente Commercial	$389.70
Rate for Payer: Kaiser Permanente Medicaid	$220.83
Rate for Payer: Kaiser Permanente Medicare	$181.86
Rate for Payer: MDX Hawaii PPO	$420.01
Rate for Payer: Ohana Health Plan Medicaid	$181.86
Rate for Payer: Ohana Health Plan Medicare	$181.86
Rate for Payer: UnitedHealthcare Medicaid	$18.84
Rate for Payer: UnitedHealthcare Medicare	$181.86
Rate for Payer: University Health Alliance Commercial	$66.43

RIBS UNILAT 2 VWS

Facility

$433.00

Service Code	HCPCS 71100
Hospital Charge Code	424711000
Hospital Revenue Code	320
Min. Negotiated Rate	$368.05
Max. Negotiated Rate	$420.01
Rate for Payer: Cash Price	$281.45
Rate for Payer: Health Management Network Commercial	$368.05
Rate for Payer: Kaiser Permanente Commercial	$389.70
Rate for Payer: MDX Hawaii PPO	$420.01

RIBS W PA CHEST MIN 3 VWS

Facility

$581.00

Service Code	HCPCS 71101
Hospital Charge Code	424711010
Hospital Revenue Code	320
Min. Negotiated Rate	$21.96
Max. Negotiated Rate	$563.57
Rate for Payer: AlohaCare Medicaid	$290.50
Rate for Payer: AlohaCare Medicare	$244.02
Rate for Payer: Cash Price	$377.65
Rate for Payer: Cash Price	$377.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$534.52
Rate for Payer: Devoted Health Medicare	$244.02
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$21.96
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$244.02
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: Humana Medicare	$244.02
Rate for Payer: Kaiser Permanente Commercial	$522.90
Rate for Payer: Kaiser Permanente Medicaid	$296.31
Rate for Payer: Kaiser Permanente Medicare	$244.02
Rate for Payer: MDX Hawaii PPO	$563.57
Rate for Payer: Ohana Health Plan Medicaid	$244.02
Rate for Payer: Ohana Health Plan Medicare	$244.02
Rate for Payer: UnitedHealthcare Medicaid	$21.96
Rate for Payer: UnitedHealthcare Medicare	$244.02
Rate for Payer: University Health Alliance Commercial	$80.36

RIBS W PA CHEST MIN 3 VWS

Facility

$581.00

Service Code	HCPCS 71101
Hospital Charge Code	424711010
Hospital Revenue Code	320
Min. Negotiated Rate	$493.85
Max. Negotiated Rate	$563.57
Rate for Payer: Cash Price	$377.65
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: Kaiser Permanente Commercial	$522.90
Rate for Payer: MDX Hawaii PPO	$563.57

RIBS W PA CHEST MIN 4 VWS

Facility

$581.00

Service Code	HCPCS 71111
Hospital Charge Code	424711110
Hospital Revenue Code	320
Min. Negotiated Rate	$29.64
Max. Negotiated Rate	$563.57
Rate for Payer: AlohaCare Medicaid	$290.50
Rate for Payer: AlohaCare Medicare	$244.02
Rate for Payer: Cash Price	$377.65
Rate for Payer: Cash Price	$377.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$534.52
Rate for Payer: Devoted Health Medicare	$244.02
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$29.64
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$244.02
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: Humana Medicare	$244.02
Rate for Payer: Kaiser Permanente Commercial	$522.90
Rate for Payer: Kaiser Permanente Medicaid	$296.31
Rate for Payer: Kaiser Permanente Medicare	$244.02
Rate for Payer: MDX Hawaii PPO	$563.57
Rate for Payer: Ohana Health Plan Medicaid	$244.02
Rate for Payer: Ohana Health Plan Medicare	$244.02
Rate for Payer: UnitedHealthcare Medicaid	$29.64
Rate for Payer: UnitedHealthcare Medicare	$244.02
Rate for Payer: University Health Alliance Commercial	$105.84

RIBS W PA CHEST MIN 4 VWS

Facility

$581.00

Service Code	HCPCS 71111
Hospital Charge Code	424711110
Hospital Revenue Code	320
Min. Negotiated Rate	$493.85
Max. Negotiated Rate	$563.57
Rate for Payer: Cash Price	$377.65
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: Kaiser Permanente Commercial	$522.90
Rate for Payer: MDX Hawaii PPO	$563.57

RICOLA (menthol) throat lozenges [KMC]

Facility

$3.00

Service Code	NDC 03660207344
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

RICOLA (menthol) throat lozenges [KMC]

Facility

$3.00

Service Code	NDC 03660207344
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

rifabutin 150 mg Cap [KMC]

Facility

$69.98

Service Code	NDC 59762135001
Hospital Revenue Code	250
Min. Negotiated Rate	$59.48
Max. Negotiated Rate	$67.88
Rate for Payer: Cash Price	$45.49
Rate for Payer: Health Management Network Commercial	$59.48
Rate for Payer: Kaiser Permanente Commercial	$62.98
Rate for Payer: MDX Hawaii PPO	$67.88

rifabutin 150 mg Cap [KMC]

Facility

$69.98

Service Code	NDC 59762135001
Hospital Revenue Code	250
Min. Negotiated Rate	$29.39
Max. Negotiated Rate	$67.88
Rate for Payer: AlohaCare Medicaid	$34.99
Rate for Payer: AlohaCare Medicare	$29.39
Rate for Payer: Cash Price	$45.49
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$64.38
Rate for Payer: Devoted Health Medicare	$29.39
Rate for Payer: Hawaii Medical Service Association Medicare	$29.39
Rate for Payer: Hawaii Western Management Group Commercial	$66.48
Rate for Payer: Health Management Network Commercial	$59.48
Rate for Payer: Humana Medicare	$29.39
Rate for Payer: Kaiser Permanente Commercial	$62.98
Rate for Payer: Kaiser Permanente Medicaid	$35.69
Rate for Payer: Kaiser Permanente Medicare	$29.39
Rate for Payer: MDX Hawaii PPO	$67.88
Rate for Payer: Ohana Health Plan Medicaid	$29.39
Rate for Payer: Ohana Health Plan Medicare	$29.39
Rate for Payer: UnitedHealthcare Medicaid	$41.99
Rate for Payer: UnitedHealthcare Medicare	$29.39
Rate for Payer: University Health Alliance Commercial	$51.01

rifAMPin 150 mg Cap [KMC]

Facility

$12.97

Service Code	NDC 68180065806
Hospital Revenue Code	250
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$12.58
Rate for Payer: AlohaCare Medicaid	$6.49
Rate for Payer: AlohaCare Medicare	$5.45
Rate for Payer: Cash Price	$8.43
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$11.93
Rate for Payer: Devoted Health Medicare	$5.45
Rate for Payer: Hawaii Medical Service Association Medicare	$5.45
Rate for Payer: Hawaii Western Management Group Commercial	$12.32
Rate for Payer: Health Management Network Commercial	$11.02
Rate for Payer: Humana Medicare	$5.45
Rate for Payer: Kaiser Permanente Commercial	$11.67
Rate for Payer: Kaiser Permanente Medicaid	$6.61
Rate for Payer: Kaiser Permanente Medicare	$5.45
Rate for Payer: MDX Hawaii PPO	$12.58
Rate for Payer: Ohana Health Plan Medicaid	$5.45
Rate for Payer: Ohana Health Plan Medicare	$5.45
Rate for Payer: UnitedHealthcare Medicaid	$7.78
Rate for Payer: UnitedHealthcare Medicare	$5.45
Rate for Payer: University Health Alliance Commercial	$9.45

rifAMPin 150 mg Cap [KMC]

Facility

$12.97

Service Code	NDC 68180065806
Hospital Revenue Code	250
Min. Negotiated Rate	$11.02
Max. Negotiated Rate	$12.58
Rate for Payer: Cash Price	$8.43
Rate for Payer: Health Management Network Commercial	$11.02
Rate for Payer: Kaiser Permanente Commercial	$11.67
Rate for Payer: MDX Hawaii PPO	$12.58

rifAMPin 300 mg Cap [KMC]

Facility

$18.37

Service Code	NDC 68180065906
Hospital Revenue Code	250
Min. Negotiated Rate	$15.61
Max. Negotiated Rate	$17.82
Rate for Payer: Cash Price	$11.94
Rate for Payer: Health Management Network Commercial	$15.61
Rate for Payer: Kaiser Permanente Commercial	$16.53
Rate for Payer: MDX Hawaii PPO	$17.82

rifAMPin 300 mg Cap [KMC]

Facility

$18.37

Service Code	NDC 68180065906
Hospital Revenue Code	250
Min. Negotiated Rate	$7.72
Max. Negotiated Rate	$17.82
Rate for Payer: AlohaCare Medicaid	$9.19
Rate for Payer: AlohaCare Medicare	$7.72
Rate for Payer: Cash Price	$11.94
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$16.90
Rate for Payer: Devoted Health Medicare	$7.72
Rate for Payer: Hawaii Medical Service Association Medicare	$7.72
Rate for Payer: Hawaii Western Management Group Commercial	$17.45
Rate for Payer: Health Management Network Commercial	$15.61
Rate for Payer: Humana Medicare	$7.72
Rate for Payer: Kaiser Permanente Commercial	$16.53
Rate for Payer: Kaiser Permanente Medicaid	$9.37
Rate for Payer: Kaiser Permanente Medicare	$7.72
Rate for Payer: MDX Hawaii PPO	$17.82
Rate for Payer: Ohana Health Plan Medicaid	$7.72
Rate for Payer: Ohana Health Plan Medicare	$7.72
Rate for Payer: UnitedHealthcare Medicaid	$11.02
Rate for Payer: UnitedHealthcare Medicare	$7.72
Rate for Payer: University Health Alliance Commercial	$13.39

rifaximin 550 mg Tab [KMC]

Facility

$105.72

Service Code	NDC 65649030302
Hospital Revenue Code	250
Min. Negotiated Rate	$44.40
Max. Negotiated Rate	$102.55
Rate for Payer: AlohaCare Medicaid	$52.86
Rate for Payer: AlohaCare Medicare	$44.40
Rate for Payer: Cash Price	$68.72
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$97.26
Rate for Payer: Devoted Health Medicare	$44.40
Rate for Payer: Hawaii Medical Service Association Medicare	$44.40
Rate for Payer: Hawaii Western Management Group Commercial	$100.43
Rate for Payer: Health Management Network Commercial	$89.86
Rate for Payer: Humana Medicare	$44.40
Rate for Payer: Kaiser Permanente Commercial	$95.15
Rate for Payer: Kaiser Permanente Medicaid	$53.92
Rate for Payer: Kaiser Permanente Medicare	$44.40
Rate for Payer: MDX Hawaii PPO	$102.55
Rate for Payer: Ohana Health Plan Medicaid	$44.40
Rate for Payer: Ohana Health Plan Medicare	$44.40
Rate for Payer: UnitedHealthcare Medicaid	$63.43
Rate for Payer: UnitedHealthcare Medicare	$44.40
Rate for Payer: University Health Alliance Commercial	$77.06

rifaximin 550 mg Tab [KMC]

Facility

$105.72

Service Code	NDC 65649030302
Hospital Revenue Code	250
Min. Negotiated Rate	$89.86
Max. Negotiated Rate	$102.55
Rate for Payer: Cash Price	$68.72
Rate for Payer: Health Management Network Commercial	$89.86
Rate for Payer: Kaiser Permanente Commercial	$95.15
Rate for Payer: MDX Hawaii PPO	$102.55

rilpivirine 25 mg Tab [KMC]

Facility

$162.20

Service Code	NDC 59676027801
Hospital Revenue Code	250
Min. Negotiated Rate	$137.87
Max. Negotiated Rate	$157.33
Rate for Payer: Cash Price	$105.43
Rate for Payer: Health Management Network Commercial	$137.87
Rate for Payer: Kaiser Permanente Commercial	$145.98
Rate for Payer: MDX Hawaii PPO	$157.33

rilpivirine 25 mg Tab [KMC]

Facility

$162.20

Service Code	NDC 59676027801
Hospital Revenue Code	250
Min. Negotiated Rate	$68.12
Max. Negotiated Rate	$157.33
Rate for Payer: AlohaCare Medicaid	$81.10
Rate for Payer: AlohaCare Medicare	$68.12
Rate for Payer: Cash Price	$105.43
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$149.22
Rate for Payer: Devoted Health Medicare	$68.12
Rate for Payer: Hawaii Medical Service Association Medicare	$68.12
Rate for Payer: Hawaii Western Management Group Commercial	$154.09
Rate for Payer: Health Management Network Commercial	$137.87
Rate for Payer: Humana Medicare	$68.12
Rate for Payer: Kaiser Permanente Commercial	$145.98
Rate for Payer: Kaiser Permanente Medicaid	$82.72
Rate for Payer: Kaiser Permanente Medicare	$68.12
Rate for Payer: MDX Hawaii PPO	$157.33
Rate for Payer: Ohana Health Plan Medicaid	$68.12
Rate for Payer: Ohana Health Plan Medicare	$68.12
Rate for Payer: UnitedHealthcare Medicaid	$97.32
Rate for Payer: UnitedHealthcare Medicare	$68.12
Rate for Payer: University Health Alliance Commercial	$118.23

rimegepant 75 mg DIS tablet [KMC]

Facility

$510.00

Service Code	NDC 72618300002
Hospital Revenue Code	250
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

Know your out-of-pocket cost for care.

All Charges