Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

SPEECH LANG GOAL STATUS

Professional

Both

$0.01

Service Code	HCPCS G9175
Hospital Revenue Code	440
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

SPEECH LANG GOAL STATUS Speech

Facility

$1.00

Service Code	HCPCS G9175 GN
Hospital Charge Code	432G91750
Hospital Revenue Code	440
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.42
Rate for Payer: Cash Price	$0.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.92
Rate for Payer: Devoted Health Medicare	$0.42
Rate for Payer: Hawaii Medical Service Association Medicare	$0.42
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.42
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.42
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.42
Rate for Payer: Ohana Health Plan Medicare	$0.42
Rate for Payer: UnitedHealthcare Medicare	$0.42
Rate for Payer: University Health Alliance Commercial	$0.73

SPEECH LANG GOAL STATUS Speech

Facility

$1.00

Service Code	HCPCS G9175 GN
Hospital Charge Code	432G91750
Hospital Revenue Code	440
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.65
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

SPEECH SCREENING Speech

Facility

$175.00

Service Code	HCPCS 92700 GN
Hospital Charge Code	431927000
Hospital Revenue Code	444
Min. Negotiated Rate	$18.37
Max. Negotiated Rate	$169.75
Rate for Payer: AlohaCare Medicaid	$87.50
Rate for Payer: AlohaCare Medicare	$73.50
Rate for Payer: Cash Price	$113.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$161.00
Rate for Payer: Devoted Health Medicare	$73.50
Rate for Payer: Hawaii Medical Service Association Medicare	$73.50
Rate for Payer: Hawaii Western Management Group Commercial	$166.25
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: Humana Medicare	$73.50
Rate for Payer: Kaiser Permanente Commercial	$157.50
Rate for Payer: Kaiser Permanente Medicaid	$89.25
Rate for Payer: Kaiser Permanente Medicare	$73.50
Rate for Payer: MDX Hawaii PPO	$169.75
Rate for Payer: Ohana Health Plan Medicaid	$73.50
Rate for Payer: Ohana Health Plan Medicare	$73.50
Rate for Payer: UnitedHealthcare Medicaid	$18.37
Rate for Payer: UnitedHealthcare Medicare	$73.50
Rate for Payer: University Health Alliance Commercial	$127.56

SPEECH SCREENING Speech

Facility

$175.00

Service Code	HCPCS 92700 GN
Hospital Charge Code	431927000
Hospital Revenue Code	444
Min. Negotiated Rate	$148.75
Max. Negotiated Rate	$169.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: Kaiser Permanente Commercial	$157.50
Rate for Payer: MDX Hawaii PPO	$169.75

SPEECH TRMT INDIVIDUAL Speech

Facility

$336.00

Service Code	HCPCS 92507 GN
Hospital Charge Code	431925070
Hospital Revenue Code	441
Min. Negotiated Rate	$21.05
Max. Negotiated Rate	$325.92
Rate for Payer: AlohaCare Medicaid	$168.00
Rate for Payer: AlohaCare Medicare	$141.12
Rate for Payer: Cash Price	$218.40
Rate for Payer: Cash Price	$218.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$309.12
Rate for Payer: Devoted Health Medicare	$141.12
Rate for Payer: Hawaii Medical Service Association Medicare	$141.12
Rate for Payer: Hawaii Western Management Group Commercial	$319.20
Rate for Payer: Health Management Network Commercial	$285.60
Rate for Payer: Humana Medicare	$141.12
Rate for Payer: Kaiser Permanente Commercial	$302.40
Rate for Payer: Kaiser Permanente Medicaid	$171.36
Rate for Payer: Kaiser Permanente Medicare	$141.12
Rate for Payer: MDX Hawaii PPO	$325.92
Rate for Payer: Ohana Health Plan Medicaid	$141.12
Rate for Payer: Ohana Health Plan Medicare	$141.12
Rate for Payer: UnitedHealthcare Medicaid	$21.05
Rate for Payer: UnitedHealthcare Medicare	$141.12
Rate for Payer: University Health Alliance Commercial	$244.91

SPEECH TRMT INDIVIDUAL Speech

Facility

$336.00

Service Code	HCPCS 92507 GN
Hospital Charge Code	431925070
Hospital Revenue Code	441
Min. Negotiated Rate	$285.60
Max. Negotiated Rate	$325.92
Rate for Payer: Cash Price	$218.40
Rate for Payer: Health Management Network Commercial	$285.60
Rate for Payer: Kaiser Permanente Commercial	$302.40
Rate for Payer: MDX Hawaii PPO	$325.92

SPENCER STITCH SCISSORS 3.5"

Facility

$3.00

Hospital Charge Code	8548
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

SPENCER STITCH SCISSORS 3.5"

Facility

$3.00

Hospital Charge Code	8548
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

SPINAL DISORDERS AND INJURIES WITH CC/MCC

Facility

$34,581.22

Service Code	MSDRG 052
Min. Negotiated Rate	$34,581.22
Max. Negotiated Rate	$34,581.22
Rate for Payer: Hawaii Medical Service Association Commercial	$34,581.22

SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC

Facility

$34,581.22

Service Code	MSDRG 053
Min. Negotiated Rate	$34,581.22
Max. Negotiated Rate	$34,581.22
Rate for Payer: Hawaii Medical Service Association Commercial	$34,581.22

Spinal Fluid Cell Count, w/Diff DLS

Facility

$38.00

Service Code	HCPCS 89051
Hospital Charge Code	422890515
Hospital Revenue Code	309
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$36.86
Rate for Payer: AlohaCare Medicaid	$19.00
Rate for Payer: AlohaCare Medicare	$15.96
Rate for Payer: Cash Price	$24.70
Rate for Payer: Cash Price	$24.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$34.96
Rate for Payer: Devoted Health Medicare	$15.96
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.61
Rate for Payer: Hawaii Medical Service Association Commercial	$7.00
Rate for Payer: Hawaii Medical Service Association Medicare	$15.96
Rate for Payer: Hawaii Western Management Group Commercial	$5.60
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Humana Medicare	$15.96
Rate for Payer: Kaiser Permanente Commercial	$34.20
Rate for Payer: Kaiser Permanente Medicaid	$19.38
Rate for Payer: Kaiser Permanente Medicare	$15.96
Rate for Payer: MDX Hawaii PPO	$36.86
Rate for Payer: Ohana Health Plan Medicaid	$15.96
Rate for Payer: Ohana Health Plan Medicare	$15.96
Rate for Payer: UnitedHealthcare Medicaid	$7.61
Rate for Payer: UnitedHealthcare Medicare	$15.96
Rate for Payer: University Health Alliance Commercial	$14.24

Spinal Fluid Cell Count, w/Diff DLS

Facility

$38.00

Service Code	HCPCS 89051
Hospital Charge Code	422890515
Hospital Revenue Code	309
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$24.70
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Kaiser Permanente Commercial	$34.20
Rate for Payer: MDX Hawaii PPO	$36.86

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC

Facility

$137,281.98

Service Code	MSDRG 457
Min. Negotiated Rate	$137,281.98
Max. Negotiated Rate	$137,281.98
Rate for Payer: Hawaii Medical Service Association Commercial	$137,281.98

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC

Facility

$137,281.98

Service Code	MSDRG 456
Min. Negotiated Rate	$137,281.98
Max. Negotiated Rate	$137,281.98
Rate for Payer: Hawaii Medical Service Association Commercial	$137,281.98

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC

Facility

$137,281.98

Service Code	MSDRG 458
Min. Negotiated Rate	$137,281.98
Max. Negotiated Rate	$137,281.98
Rate for Payer: Hawaii Medical Service Association Commercial	$137,281.98

SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS

Facility

$71,177.11

Service Code	MSDRG 029
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$71,177.11
Rate for Payer: Hawaii Medical Service Association Commercial	$71,177.11
Rate for Payer: University Health Alliance Commercial	$10,400.00

SPINAL PROCEDURES WITH MCC

Facility

$86,038.26

Service Code	MSDRG 028
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$86,038.26
Rate for Payer: Hawaii Medical Service Association Commercial	$86,038.26
Rate for Payer: University Health Alliance Commercial	$10,400.00

SPINAL PROCEDURES WITHOUT CC/MCC

Facility

$47,190.68

Service Code	MSDRG 030
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$47,190.68
Rate for Payer: Hawaii Medical Service Association Commercial	$47,190.68
Rate for Payer: University Health Alliance Commercial	$10,400.00

SPINAL TAP, DIAGNOSTIC

Facility

$1,809.00

Service Code	HCPCS 62270
Hospital Charge Code	440622700
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$904.50
Rate for Payer: AlohaCare Medicare	$759.78
Rate for Payer: Cash Price	$1,175.85
Rate for Payer: Cash Price	$1,175.85
Rate for Payer: Cash Price	$1,175.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,664.28
Rate for Payer: Devoted Health Medicare	$759.78
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	$759.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,718.55
Rate for Payer: Health Management Network Commercial	$1,537.65
Rate for Payer: Humana Medicare	$759.78
Rate for Payer: Kaiser Permanente Commercial	$1,628.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$759.78
Rate for Payer: MDX Hawaii PPO	$1,754.73
Rate for Payer: Ohana Health Plan Medicaid	$759.78
Rate for Payer: Ohana Health Plan Medicare	$759.78
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$759.78
Rate for Payer: University Health Alliance Commercial	$4,035.20

SPINAL TAP, DIAGNOSTIC

Facility

$1,809.00

Service Code	HCPCS 62270
Hospital Charge Code	440622700
Hospital Revenue Code	450
Min. Negotiated Rate	$1,537.65
Max. Negotiated Rate	$1,754.73
Rate for Payer: Cash Price	$1,175.85
Rate for Payer: Health Management Network Commercial	$1,537.65
Rate for Payer: Kaiser Permanente Commercial	$1,628.10
Rate for Payer: MDX Hawaii PPO	$1,754.73

SPINE CERVCL 2-3 VWS

Facility

$369.00

Service Code	HCPCS 72040
Hospital Charge Code	424720400
Hospital Revenue Code	320
Min. Negotiated Rate	$19.78
Max. Negotiated Rate	$357.93
Rate for Payer: AlohaCare Medicaid	$184.50
Rate for Payer: AlohaCare Medicare	$154.98
Rate for Payer: Cash Price	$239.85
Rate for Payer: Cash Price	$239.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$339.48
Rate for Payer: Devoted Health Medicare	$154.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$19.78
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$154.98
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Humana Medicare	$154.98
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: Kaiser Permanente Medicaid	$188.19
Rate for Payer: Kaiser Permanente Medicare	$154.98
Rate for Payer: MDX Hawaii PPO	$357.93
Rate for Payer: Ohana Health Plan Medicaid	$154.98
Rate for Payer: Ohana Health Plan Medicare	$154.98
Rate for Payer: UnitedHealthcare Medicaid	$19.78
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$73.65

SPINE CERVCL 2-3 VWS

Facility

$369.00

Service Code	HCPCS 72040
Hospital Charge Code	424720400
Hospital Revenue Code	320
Min. Negotiated Rate	$313.65
Max. Negotiated Rate	$357.93
Rate for Payer: Cash Price	$239.85
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: MDX Hawaii PPO	$357.93

SPINE CERVCL 4-5 VWS

Facility

$581.00

Service Code	HCPCS 72050
Hospital Charge Code	424720500
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	$105.14

SPINE CERVCL 4-5 VWS

Facility

$581.00

Service Code	HCPCS 72050
Hospital Charge Code	424720500
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

Know your out-of-pocket cost for care.

All Charges