Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

rosuvastatin 10 mg Tab [KMC]

Facility

$5.49

Service Code	NDC 50268070915
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$5.33
Rate for Payer: AlohaCare Medicaid	$2.75
Rate for Payer: AlohaCare Medicare	$2.31
Rate for Payer: Cash Price	$3.57
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.05
Rate for Payer: Devoted Health Medicare	$2.31
Rate for Payer: Hawaii Medical Service Association Medicare	$2.31
Rate for Payer: Hawaii Western Management Group Commercial	$5.22
Rate for Payer: Health Management Network Commercial	$4.67
Rate for Payer: Humana Medicare	$2.31
Rate for Payer: Kaiser Permanente Commercial	$4.94
Rate for Payer: Kaiser Permanente Medicaid	$2.80
Rate for Payer: Kaiser Permanente Medicare	$2.31
Rate for Payer: MDX Hawaii PPO	$5.33
Rate for Payer: Ohana Health Plan Medicaid	$2.31
Rate for Payer: Ohana Health Plan Medicare	$2.31
Rate for Payer: UnitedHealthcare Medicaid	$3.29
Rate for Payer: UnitedHealthcare Medicare	$2.31
Rate for Payer: University Health Alliance Commercial	$4.00

rosuvastatin 10 mg Tab [KMC]

Facility

$5.49

Service Code	NDC 50268070915
Hospital Revenue Code	250
Min. Negotiated Rate	$4.67
Max. Negotiated Rate	$5.33
Rate for Payer: Cash Price	$3.57
Rate for Payer: Health Management Network Commercial	$4.67
Rate for Payer: Kaiser Permanente Commercial	$4.94
Rate for Payer: MDX Hawaii PPO	$5.33

rosuvastatin 40 mg Tab [KMC]

Facility

$35.78

Service Code	NDC 70377000913
Hospital Revenue Code	250
Min. Negotiated Rate	$30.41
Max. Negotiated Rate	$34.71
Rate for Payer: Cash Price	$23.26
Rate for Payer: Health Management Network Commercial	$30.41
Rate for Payer: Kaiser Permanente Commercial	$32.20
Rate for Payer: MDX Hawaii PPO	$34.71

rosuvastatin 40 mg Tab [KMC]

Facility

$35.78

Service Code	NDC 70377000913
Hospital Revenue Code	250
Min. Negotiated Rate	$15.03
Max. Negotiated Rate	$34.71
Rate for Payer: AlohaCare Medicaid	$17.89
Rate for Payer: AlohaCare Medicare	$15.03
Rate for Payer: Cash Price	$23.26
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$32.92
Rate for Payer: Devoted Health Medicare	$15.03
Rate for Payer: Hawaii Medical Service Association Medicare	$15.03
Rate for Payer: Hawaii Western Management Group Commercial	$33.99
Rate for Payer: Health Management Network Commercial	$30.41
Rate for Payer: Humana Medicare	$15.03
Rate for Payer: Kaiser Permanente Commercial	$32.20
Rate for Payer: Kaiser Permanente Medicaid	$18.25
Rate for Payer: Kaiser Permanente Medicare	$15.03
Rate for Payer: MDX Hawaii PPO	$34.71
Rate for Payer: Ohana Health Plan Medicaid	$15.03
Rate for Payer: Ohana Health Plan Medicare	$15.03
Rate for Payer: UnitedHealthcare Medicaid	$21.47
Rate for Payer: UnitedHealthcare Medicare	$15.03
Rate for Payer: University Health Alliance Commercial	$26.08

rotigotine 6 mg/24 hr ER patch [KMC]

Facility

$121.86

Service Code	NDC 50474080503
Hospital Revenue Code	250
Min. Negotiated Rate	$103.58
Max. Negotiated Rate	$118.20
Rate for Payer: Cash Price	$79.21
Rate for Payer: Health Management Network Commercial	$103.58
Rate for Payer: Kaiser Permanente Commercial	$109.67
Rate for Payer: MDX Hawaii PPO	$118.20

rotigotine 6 mg/24 hr ER patch [KMC]

Facility

$121.86

Service Code	NDC 50474080503
Hospital Revenue Code	250
Min. Negotiated Rate	$51.18
Max. Negotiated Rate	$118.20
Rate for Payer: AlohaCare Medicaid	$60.93
Rate for Payer: AlohaCare Medicare	$51.18
Rate for Payer: Cash Price	$79.21
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$112.11
Rate for Payer: Devoted Health Medicare	$51.18
Rate for Payer: Hawaii Medical Service Association Medicare	$51.18
Rate for Payer: Hawaii Western Management Group Commercial	$115.77
Rate for Payer: Health Management Network Commercial	$103.58
Rate for Payer: Humana Medicare	$51.18
Rate for Payer: Kaiser Permanente Commercial	$109.67
Rate for Payer: Kaiser Permanente Medicaid	$62.15
Rate for Payer: Kaiser Permanente Medicare	$51.18
Rate for Payer: MDX Hawaii PPO	$118.20
Rate for Payer: Ohana Health Plan Medicaid	$51.18
Rate for Payer: Ohana Health Plan Medicare	$51.18
Rate for Payer: UnitedHealthcare Medicaid	$73.12
Rate for Payer: UnitedHealthcare Medicare	$51.18
Rate for Payer: University Health Alliance Commercial	$88.82

RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM

Professional

Both

$727.00

Service Code	HCPCS 12046
Hospital Revenue Code	361
Min. Negotiated Rate	$222.30
Max. Negotiated Rate	$617.95
Rate for Payer: AlohaCare Medicaid	$323.16
Rate for Payer: AlohaCare Medicare	$316.18
Rate for Payer: Cash Price	$472.55
Rate for Payer: Cash Price	$472.55
Rate for Payer: Devoted Health Medicare	$316.18
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$323.16
Rate for Payer: Hawaii Medical Service Association Commercial	$482.16
Rate for Payer: Hawaii Medical Service Association Medicare	$316.18
Rate for Payer: Hawaii Western Management Group Commercial	$222.30
Rate for Payer: Health Management Network Commercial	$617.95
Rate for Payer: Kaiser Permanente Commercial	$379.42
Rate for Payer: Kaiser Permanente Medicaid	$379.42
Rate for Payer: Kaiser Permanente Medicare	$379.42
Rate for Payer: Ohana Health Plan Medicaid	$323.16
Rate for Payer: Ohana Health Plan Medicare	$316.18
Rate for Payer: UnitedHealthcare Medicaid	$323.16
Rate for Payer: UnitedHealthcare Medicare	$316.18
Rate for Payer: University Health Alliance Commercial	$351.47

RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE

Facility

$8,008.00

Service Code	HCPCS 49520
Hospital Charge Code	440495200
Hospital Revenue Code	450
Min. Negotiated Rate	$6,806.80
Max. Negotiated Rate	$7,767.76
Rate for Payer: Cash Price	$5,205.20
Rate for Payer: Health Management Network Commercial	$6,806.80
Rate for Payer: Kaiser Permanente Commercial	$7,207.20
Rate for Payer: MDX Hawaii PPO	$7,767.76

RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE

Facility

$8,008.00

Service Code	HCPCS 49520
Hospital Charge Code	440495200
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$16,700.00
Rate for Payer: AlohaCare Medicaid	$4,004.00
Rate for Payer: AlohaCare Medicare	$3,363.36
Rate for Payer: Cash Price	$5,205.20
Rate for Payer: Cash Price	$5,205.20
Rate for Payer: Cash Price	$5,205.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7,367.36
Rate for Payer: Devoted Health Medicare	$3,363.36
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	$3,363.36
Rate for Payer: Hawaii Western Management Group Commercial	$7,607.60
Rate for Payer: Health Management Network Commercial	$6,806.80
Rate for Payer: Humana Medicare	$3,363.36
Rate for Payer: Kaiser Permanente Commercial	$7,207.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,363.36
Rate for Payer: MDX Hawaii PPO	$7,767.76
Rate for Payer: Ohana Health Plan Medicaid	$3,363.36
Rate for Payer: Ohana Health Plan Medicare	$3,363.36
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,363.36
Rate for Payer: University Health Alliance Commercial	$16,700.00

RPR, Reflex to Titer DLS

Facility

$88.00

Service Code	HCPCS 86592
Hospital Charge Code	422865925
Hospital Revenue Code	301
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$57.20
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Kaiser Permanente Commercial	$79.20
Rate for Payer: MDX Hawaii PPO	$85.36

RPR, Reflex to Titer DLS

Facility

$88.00

Service Code	HCPCS 86592
Hospital Charge Code	422865925
Hospital Revenue Code	301
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$85.36
Rate for Payer: AlohaCare Medicaid	$44.00
Rate for Payer: AlohaCare Medicare	$36.96
Rate for Payer: Cash Price	$57.20
Rate for Payer: Cash Price	$57.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$80.96
Rate for Payer: Devoted Health Medicare	$36.96
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$5.90
Rate for Payer: Hawaii Medical Service Association Commercial	$5.34
Rate for Payer: Hawaii Medical Service Association Medicare	$36.96
Rate for Payer: Hawaii Western Management Group Commercial	$4.27
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Humana Medicare	$36.96
Rate for Payer: Kaiser Permanente Commercial	$79.20
Rate for Payer: Kaiser Permanente Medicaid	$44.88
Rate for Payer: Kaiser Permanente Medicare	$36.96
Rate for Payer: MDX Hawaii PPO	$85.36
Rate for Payer: Ohana Health Plan Medicaid	$36.96
Rate for Payer: Ohana Health Plan Medicare	$36.96
Rate for Payer: UnitedHealthcare Medicaid	$5.90
Rate for Payer: UnitedHealthcare Medicare	$36.96
Rate for Payer: University Health Alliance Commercial	$11.03

RSV

Facility

$52.00

Service Code	HCPCS 87634
Hospital Charge Code	422876340
Hospital Revenue Code	300
Min. Negotiated Rate	$44.20
Max. Negotiated Rate	$50.44
Rate for Payer: Cash Price	$33.80
Rate for Payer: Health Management Network Commercial	$44.20
Rate for Payer: Kaiser Permanente Commercial	$46.80
Rate for Payer: MDX Hawaii PPO	$50.44

RSV

Facility

$52.00

Service Code	HCPCS 87634
Hospital Charge Code	422876340
Hospital Revenue Code	300
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$160.32
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	$58.84
Rate for Payer: Hawaii Medical Service Association Commercial	$87.75
Rate for Payer: Hawaii Medical Service Association Medicare	$21.84
Rate for Payer: Hawaii Western Management Group Commercial	$70.20
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	$52.00
Rate for Payer: UnitedHealthcare Medicare	$21.84
Rate for Payer: University Health Alliance Commercial	$160.32

RSV Antigen DLS

Facility

$230.00

Service Code	HCPCS 87420
Hospital Charge Code	422874205
Hospital Revenue Code	306
Min. Negotiated Rate	$195.50
Max. Negotiated Rate	$223.10
Rate for Payer: Cash Price	$149.50
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: MDX Hawaii PPO	$223.10

RSV Antigen DLS

Facility

$230.00

Service Code	HCPCS 87420
Hospital Charge Code	422874205
Hospital Revenue Code	306
Min. Negotiated Rate	$13.91
Max. Negotiated Rate	$223.10
Rate for Payer: AlohaCare Medicaid	$115.00
Rate for Payer: AlohaCare Medicare	$96.60
Rate for Payer: Cash Price	$149.50
Rate for Payer: Cash Price	$149.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$211.60
Rate for Payer: Devoted Health Medicare	$96.60
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$17.39
Rate for Payer: Hawaii Medical Service Association Medicare	$96.60
Rate for Payer: Hawaii Western Management Group Commercial	$13.91
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Humana Medicare	$96.60
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: Kaiser Permanente Medicaid	$117.30
Rate for Payer: Kaiser Permanente Medicare	$96.60
Rate for Payer: MDX Hawaii PPO	$223.10
Rate for Payer: Ohana Health Plan Medicaid	$96.60
Rate for Payer: Ohana Health Plan Medicare	$96.60
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$96.60
Rate for Payer: University Health Alliance Commercial	$31.01

RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE

Professional

Both

$600.00

Service Code	HCPCS 90380
Hospital Revenue Code	636
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$510.00
Rate for Payer: Cash Price	$390.00
Rate for Payer: Health Management Network Commercial	$510.00

RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE

Professional

Both

$600.00

Service Code	HCPCS 90381
Hospital Revenue Code	636
Min. Negotiated Rate	$510.00
Max. Negotiated Rate	$510.00
Rate for Payer: Cash Price	$390.00
Rate for Payer: Health Management Network Commercial	$510.00

RSV POCT

Facility

$52.00

Service Code	HCPCS 87634
Hospital Charge Code	435876340
Hospital Revenue Code	300
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$160.32
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	$58.84
Rate for Payer: Hawaii Medical Service Association Commercial	$87.75
Rate for Payer: Hawaii Medical Service Association Medicare	$21.84
Rate for Payer: Hawaii Western Management Group Commercial	$70.20
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	$52.00
Rate for Payer: UnitedHealthcare Medicare	$21.84
Rate for Payer: University Health Alliance Commercial	$160.32

RSV POCT

Facility

$52.00

Service Code	HCPCS 87634
Hospital Charge Code	435876340
Hospital Revenue Code	300
Min. Negotiated Rate	$44.20
Max. Negotiated Rate	$50.44
Rate for Payer: Cash Price	$33.80
Rate for Payer: Health Management Network Commercial	$44.20
Rate for Payer: Kaiser Permanente Commercial	$46.80
Rate for Payer: MDX Hawaii PPO	$50.44

RSV RNA, Real-time PCR DLS

Facility

$240.00

Service Code	HCPCS 87798
Hospital Charge Code	422877985
Hospital Revenue Code	306
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$232.80
Rate for Payer: Cash Price	$156.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Kaiser Permanente Commercial	$216.00
Rate for Payer: MDX Hawaii PPO	$232.80

RSV RNA, Real-time PCR DLS

Facility

$240.00

Service Code	HCPCS 87798
Hospital Charge Code	422877985
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$232.80
Rate for Payer: AlohaCare Medicaid	$120.00
Rate for Payer: AlohaCare Medicare	$100.80
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$220.80
Rate for Payer: Devoted Health Medicare	$100.80
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	$100.80
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Humana Medicare	$100.80
Rate for Payer: Kaiser Permanente Commercial	$216.00
Rate for Payer: Kaiser Permanente Medicaid	$122.40
Rate for Payer: Kaiser Permanente Medicare	$100.80
Rate for Payer: MDX Hawaii PPO	$232.80
Rate for Payer: Ohana Health Plan Medicaid	$100.80
Rate for Payer: Ohana Health Plan Medicare	$100.80
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$100.80
Rate for Payer: University Health Alliance Commercial	$90.72

Rubella Antibody, IgG DLS

Facility

$192.00

Service Code	HCPCS 86762
Hospital Charge Code	422867625
Hospital Revenue Code	301
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$186.24
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: MDX Hawaii PPO	$186.24

Rubella Antibody, IgG DLS

Facility

$192.00

Service Code	HCPCS 86762
Hospital Charge Code	422867625
Hospital Revenue Code	301
Min. Negotiated Rate	$14.39
Max. Negotiated Rate	$186.24
Rate for Payer: AlohaCare Medicaid	$96.00
Rate for Payer: AlohaCare Medicare	$80.64
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cash Price	$124.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$176.64
Rate for Payer: Devoted Health Medicare	$80.64
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$19.89
Rate for Payer: Hawaii Medical Service Association Commercial	$17.99
Rate for Payer: Hawaii Medical Service Association Medicare	$80.64
Rate for Payer: Hawaii Western Management Group Commercial	$14.39
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Humana Medicare	$80.64
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: Kaiser Permanente Medicaid	$97.92
Rate for Payer: Kaiser Permanente Medicare	$80.64
Rate for Payer: MDX Hawaii PPO	$186.24
Rate for Payer: Ohana Health Plan Medicaid	$80.64
Rate for Payer: Ohana Health Plan Medicare	$80.64
Rate for Payer: UnitedHealthcare Medicaid	$19.89
Rate for Payer: UnitedHealthcare Medicare	$80.64
Rate for Payer: University Health Alliance Commercial	$37.20

Rubeola (Measles) Ab, IgG DLS

Facility

$351.00

Service Code	HCPCS 86765
Hospital Charge Code	422867655
Hospital Revenue Code	301
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$340.47
Rate for Payer: AlohaCare Medicaid	$175.50
Rate for Payer: AlohaCare Medicare	$147.42
Rate for Payer: Cash Price	$228.15
Rate for Payer: Cash Price	$228.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$322.92
Rate for Payer: Devoted Health Medicare	$147.42
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$17.81
Rate for Payer: Hawaii Medical Service Association Commercial	$16.10
Rate for Payer: Hawaii Medical Service Association Medicare	$147.42
Rate for Payer: Hawaii Western Management Group Commercial	$12.88
Rate for Payer: Health Management Network Commercial	$298.35
Rate for Payer: Humana Medicare	$147.42
Rate for Payer: Kaiser Permanente Commercial	$315.90
Rate for Payer: Kaiser Permanente Medicaid	$179.01
Rate for Payer: Kaiser Permanente Medicare	$147.42
Rate for Payer: MDX Hawaii PPO	$340.47
Rate for Payer: Ohana Health Plan Medicaid	$147.42
Rate for Payer: Ohana Health Plan Medicare	$147.42
Rate for Payer: UnitedHealthcare Medicaid	$17.81
Rate for Payer: UnitedHealthcare Medicare	$147.42
Rate for Payer: University Health Alliance Commercial	$33.30

Rubeola (Measles) Ab, IgG DLS

Facility

$351.00

Service Code	HCPCS 86765
Hospital Charge Code	422867655
Hospital Revenue Code	301
Min. Negotiated Rate	$298.35
Max. Negotiated Rate	$340.47
Rate for Payer: Cash Price	$228.15
Rate for Payer: Health Management Network Commercial	$298.35
Rate for Payer: Kaiser Permanente Commercial	$315.90
Rate for Payer: MDX Hawaii PPO	$340.47

Know your out-of-pocket cost for care.

All Charges