Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$14,150.09

Service Code	MSDRG 578
Min. Negotiated Rate	$14,150.09
Max. Negotiated Rate	$14,150.09
Rate for Payer: Hawaii Medical Service Association Commercial	$14,150.09

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$57,738.07

Service Code	MSDRG 574
Min. Negotiated Rate	$57,738.07
Max. Negotiated Rate	$57,738.07
Rate for Payer: Hawaii Medical Service Association Commercial	$57,738.07

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$60,890.44

Service Code	MSDRG 573
Min. Negotiated Rate	$60,890.44
Max. Negotiated Rate	$60,890.44
Rate for Payer: Hawaii Medical Service Association Commercial	$60,890.44

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$34,984.15

Service Code	MSDRG 575
Min. Negotiated Rate	$34,984.15
Max. Negotiated Rate	$34,984.15
Rate for Payer: Hawaii Medical Service Association Commercial	$34,984.15

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

$46,076.69

Service Code	MSDRG 623
Min. Negotiated Rate	$46,076.69
Max. Negotiated Rate	$46,076.69
Rate for Payer: Hawaii Medical Service Association Commercial	$46,076.69

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

$46,076.69

Service Code	MSDRG 622
Min. Negotiated Rate	$46,076.69
Max. Negotiated Rate	$46,076.69
Rate for Payer: Hawaii Medical Service Association Commercial	$46,076.69

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

$46,076.69

Service Code	MSDRG 624
Min. Negotiated Rate	$46,076.69
Max. Negotiated Rate	$46,076.69
Rate for Payer: Hawaii Medical Service Association Commercial	$46,076.69

SKIN GRAFTS FOR INJURIES WITH CC/MCC

Facility

$65,061.99

Service Code	MSDRG 904
Min. Negotiated Rate	$65,061.99
Max. Negotiated Rate	$65,061.99
Rate for Payer: Hawaii Medical Service Association Commercial	$65,061.99

SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC

Facility

$65,061.99

Service Code	MSDRG 905
Min. Negotiated Rate	$65,061.99
Max. Negotiated Rate	$65,061.99
Rate for Payer: Hawaii Medical Service Association Commercial	$65,061.99

SKIN STAPLER

Facility

$6.00

Hospital Charge Code	8273
Hospital Revenue Code	270
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.90
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

SKIN STAPLER

Facility

$6.00

Hospital Charge Code	8273
Hospital Revenue Code	270
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$2.52
Rate for Payer: Cash Price	$3.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.52
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.52
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$2.52
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$2.52
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$2.52
Rate for Payer: Ohana Health Plan Medicare	$2.52
Rate for Payer: UnitedHealthcare Medicare	$2.52
Rate for Payer: University Health Alliance Commercial	$4.37

SKIN STAPLER REMOVER

Facility

$3.00

Hospital Charge Code	8274
Hospital Revenue Code	270
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

SKIN STAPLER REMOVER

Facility

$3.00

Hospital Charge Code	8274
Hospital Revenue Code	270
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 Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

SKIN TEST TUBERCULOSIS INTRADERMAL

Professional

Both

$29.00

Service Code	HCPCS 86580
Hospital Revenue Code	300
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$24.65
Rate for Payer: AlohaCare Medicaid	$7.00
Rate for Payer: AlohaCare Medicare	$12.35
Rate for Payer: Cash Price	$18.85
Rate for Payer: Cash Price	$18.85
Rate for Payer: Devoted Health Medicare	$12.35
Rate for Payer: Hawaii Medical Service Association Medicare	$12.35
Rate for Payer: Hawaii Western Management Group Commercial	$11.35
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Kaiser Permanente Commercial	$14.82
Rate for Payer: Kaiser Permanente Medicaid	$14.82
Rate for Payer: Kaiser Permanente Medicare	$14.82
Rate for Payer: Ohana Health Plan Medicaid	$7.00
Rate for Payer: Ohana Health Plan Medicare	$12.35
Rate for Payer: UnitedHealthcare Medicaid	$7.00
Rate for Payer: UnitedHealthcare Medicare	$12.35

SKIN ULCERS WITH CC

Facility

$23,038.34

Service Code	MSDRG 593
Min. Negotiated Rate	$23,038.34
Max. Negotiated Rate	$23,038.34
Rate for Payer: Hawaii Medical Service Association Commercial	$23,038.34

SKIN ULCERS WITH MCC

Facility

$23,038.34

Service Code	MSDRG 592
Min. Negotiated Rate	$23,038.34
Max. Negotiated Rate	$23,038.34
Rate for Payer: Hawaii Medical Service Association Commercial	$23,038.34

SKIN ULCERS WITHOUT CC/MCC

Facility

$23,038.34

Service Code	MSDRG 594
Min. Negotiated Rate	$23,038.34
Max. Negotiated Rate	$23,038.34
Rate for Payer: Hawaii Medical Service Association Commercial	$23,038.34

SKULL COMP MIN 4 VW WO W STER

Facility

$581.00

Service Code	HCPCS 70260
Hospital Charge Code	424702600
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

SKULL COMP MIN 4 VW WO W STER

Facility

$581.00

Service Code	HCPCS 70260
Hospital Charge Code	424702600
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	$100.57

SKULL LESS THN 4 VWS WO W STER

Facility

$409.00

Service Code	HCPCS 70250
Hospital Charge Code	424702500
Hospital Revenue Code	320
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$396.73
Rate for Payer: AlohaCare Medicaid	$204.50
Rate for Payer: AlohaCare Medicare	$171.78
Rate for Payer: Cash Price	$265.85
Rate for Payer: Cash Price	$265.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$376.28
Rate for Payer: Devoted Health Medicare	$171.78
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$20.40
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$171.78
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$347.65
Rate for Payer: Humana Medicare	$171.78
Rate for Payer: Kaiser Permanente Commercial	$368.10
Rate for Payer: Kaiser Permanente Medicaid	$208.59
Rate for Payer: Kaiser Permanente Medicare	$171.78
Rate for Payer: MDX Hawaii PPO	$396.73
Rate for Payer: Ohana Health Plan Medicaid	$171.78
Rate for Payer: Ohana Health Plan Medicare	$171.78
Rate for Payer: UnitedHealthcare Medicaid	$20.40
Rate for Payer: UnitedHealthcare Medicare	$171.78
Rate for Payer: University Health Alliance Commercial	$72.65

SKULL LESS THN 4 VWS WO W STER

Facility

$409.00

Service Code	HCPCS 70250
Hospital Charge Code	424702500
Hospital Revenue Code	320
Min. Negotiated Rate	$347.65
Max. Negotiated Rate	$396.73
Rate for Payer: Cash Price	$265.85
Rate for Payer: Health Management Network Commercial	$347.65
Rate for Payer: Kaiser Permanente Commercial	$368.10
Rate for Payer: MDX Hawaii PPO	$396.73

SLP Cognitive Function Medicare Charge

Facility

$161.00

Service Code	HCPCS G0515 GN
Hospital Charge Code	431G05150
Hospital Revenue Code	442
Min. Negotiated Rate	$136.85
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$104.65
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Kaiser Permanente Commercial	$144.90
Rate for Payer: MDX Hawaii PPO	$156.17

SLP Cognitive Function Medicare Charge

Facility

$161.00

Service Code	HCPCS G0515 GN
Hospital Charge Code	431G05150
Hospital Revenue Code	442
Min. Negotiated Rate	$67.62
Max. Negotiated Rate	$156.17
Rate for Payer: AlohaCare Medicaid	$80.50
Rate for Payer: AlohaCare Medicare	$67.62
Rate for Payer: Cash Price	$104.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$148.12
Rate for Payer: Devoted Health Medicare	$67.62
Rate for Payer: Hawaii Medical Service Association Medicare	$67.62
Rate for Payer: Hawaii Western Management Group Commercial	$152.95
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Humana Medicare	$67.62
Rate for Payer: Kaiser Permanente Commercial	$144.90
Rate for Payer: Kaiser Permanente Medicaid	$82.11
Rate for Payer: Kaiser Permanente Medicare	$67.62
Rate for Payer: MDX Hawaii PPO	$156.17
Rate for Payer: Ohana Health Plan Medicaid	$67.62
Rate for Payer: Ohana Health Plan Medicare	$67.62
Rate for Payer: UnitedHealthcare Medicare	$67.62
Rate for Payer: University Health Alliance Commercial	$117.35

SMART SURELINE PLUS NEO-ADULT

Facility

$293.00

Hospital Charge Code	8426
Hospital Revenue Code	270
Min. Negotiated Rate	$249.05
Max. Negotiated Rate	$284.21
Rate for Payer: Cash Price	$190.45
Rate for Payer: Health Management Network Commercial	$249.05
Rate for Payer: Kaiser Permanente Commercial	$263.70
Rate for Payer: MDX Hawaii PPO	$284.21

SMART SURELINE PLUS NEO-ADULT

Facility

$293.00

Hospital Charge Code	8426
Hospital Revenue Code	270
Min. Negotiated Rate	$123.06
Max. Negotiated Rate	$284.21
Rate for Payer: AlohaCare Medicaid	$146.50
Rate for Payer: AlohaCare Medicare	$123.06
Rate for Payer: Cash Price	$190.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$269.56
Rate for Payer: Devoted Health Medicare	$123.06
Rate for Payer: Hawaii Medical Service Association Medicare	$123.06
Rate for Payer: Hawaii Western Management Group Commercial	$278.35
Rate for Payer: Health Management Network Commercial	$249.05
Rate for Payer: Humana Medicare	$123.06
Rate for Payer: Kaiser Permanente Commercial	$263.70
Rate for Payer: Kaiser Permanente Medicaid	$149.43
Rate for Payer: Kaiser Permanente Medicare	$123.06
Rate for Payer: MDX Hawaii PPO	$284.21
Rate for Payer: Ohana Health Plan Medicaid	$123.06
Rate for Payer: Ohana Health Plan Medicare	$123.06
Rate for Payer: UnitedHealthcare Medicare	$123.06
Rate for Payer: University Health Alliance Commercial	$213.57

Know your out-of-pocket cost for care.

All Charges