Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

Aspirate Culture with Gram Stain DLS

Facility

$129.00

Service Code	HCPCS 87070
Hospital Charge Code	422870705
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$125.13
Rate for Payer: AlohaCare Medicaid	$64.50
Rate for Payer: AlohaCare Medicare	$54.18
Rate for Payer: Cash Price	$83.85
Rate for Payer: Cash Price	$83.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$118.68
Rate for Payer: Devoted Health Medicare	$54.18
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.90
Rate for Payer: Hawaii Medical Service Association Commercial	$10.78
Rate for Payer: Hawaii Medical Service Association Medicare	$54.18
Rate for Payer: Hawaii Western Management Group Commercial	$8.62
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Humana Medicare	$54.18
Rate for Payer: Kaiser Permanente Commercial	$116.10
Rate for Payer: Kaiser Permanente Medicaid	$65.79
Rate for Payer: Kaiser Permanente Medicare	$54.18
Rate for Payer: MDX Hawaii PPO	$125.13
Rate for Payer: Ohana Health Plan Medicaid	$54.18
Rate for Payer: Ohana Health Plan Medicare	$54.18
Rate for Payer: UnitedHealthcare Medicaid	$11.90
Rate for Payer: UnitedHealthcare Medicare	$54.18
Rate for Payer: University Health Alliance Commercial	$22.26

Aspirate Culture with Gram Stain DLS

Facility

$129.00

Service Code	HCPCS 87070
Hospital Charge Code	422870705
Hospital Revenue Code	306
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$125.13
Rate for Payer: Cash Price	$83.85
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Kaiser Permanente Commercial	$116.10
Rate for Payer: MDX Hawaii PPO	$125.13

ASPIRATION CHARGE

Facility

$816.00

Service Code	HCPCS 10160
Hospital Charge Code	440101600
Hospital Revenue Code	450
Min. Negotiated Rate	$693.60
Max. Negotiated Rate	$791.52
Rate for Payer: Cash Price	$530.40
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: Kaiser Permanente Commercial	$734.40
Rate for Payer: MDX Hawaii PPO	$791.52

ASPIRATION CHARGE

Facility

$816.00

Service Code	HCPCS 10160
Hospital Charge Code	440101600
Hospital Revenue Code	450
Min. Negotiated Rate	$342.72
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$408.00
Rate for Payer: AlohaCare Medicare	$342.72
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$750.72
Rate for Payer: Devoted Health Medicare	$342.72
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	$342.72
Rate for Payer: Hawaii Western Management Group Commercial	$775.20
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: Humana Medicare	$342.72
Rate for Payer: Kaiser Permanente Commercial	$734.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$342.72
Rate for Payer: MDX Hawaii PPO	$791.52
Rate for Payer: Ohana Health Plan Medicaid	$342.72
Rate for Payer: Ohana Health Plan Medicare	$342.72
Rate for Payer: UnitedHealthcare Medicare	$342.72
Rate for Payer: University Health Alliance Commercial	$4,035.20

ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ

Professional

Both

$245.00

Service Code	HCPCS 20612
Hospital Revenue Code	361
Min. Negotiated Rate	$36.99
Max. Negotiated Rate	$208.25
Rate for Payer: AlohaCare Medicaid	$41.62
Rate for Payer: AlohaCare Medicare	$36.99
Rate for Payer: Cash Price	$159.25
Rate for Payer: Cash Price	$159.25
Rate for Payer: Devoted Health Medicare	$36.99
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$41.62
Rate for Payer: Hawaii Medical Service Association Commercial	$64.53
Rate for Payer: Hawaii Medical Service Association Medicare	$36.99
Rate for Payer: Hawaii Western Management Group Commercial	$55.12
Rate for Payer: Health Management Network Commercial	$208.25
Rate for Payer: Kaiser Permanente Commercial	$44.39
Rate for Payer: Kaiser Permanente Medicaid	$44.39
Rate for Payer: Kaiser Permanente Medicare	$44.39
Rate for Payer: Ohana Health Plan Medicaid	$41.62
Rate for Payer: Ohana Health Plan Medicare	$36.99
Rate for Payer: UnitedHealthcare Medicaid	$41.62
Rate for Payer: UnitedHealthcare Medicare	$36.99

ASPIRATION, INTERMED JOINT CHARGE

Facility

$1,035.00

Service Code	HCPCS 20605
Hospital Charge Code	440206050
Hospital Revenue Code	450
Min. Negotiated Rate	$879.75
Max. Negotiated Rate	$1,003.95
Rate for Payer: Cash Price	$672.75
Rate for Payer: Health Management Network Commercial	$879.75
Rate for Payer: Kaiser Permanente Commercial	$931.50
Rate for Payer: MDX Hawaii PPO	$1,003.95

ASPIRATION, INTERMED JOINT CHARGE

Facility

$1,035.00

Service Code	HCPCS 20605
Hospital Charge Code	440206050
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$517.50
Rate for Payer: AlohaCare Medicare	$434.70
Rate for Payer: Cash Price	$672.75
Rate for Payer: Cash Price	$672.75
Rate for Payer: Cash Price	$672.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$952.20
Rate for Payer: Devoted Health Medicare	$434.70
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	$434.70
Rate for Payer: Hawaii Western Management Group Commercial	$983.25
Rate for Payer: Health Management Network Commercial	$879.75
Rate for Payer: Humana Medicare	$434.70
Rate for Payer: Kaiser Permanente Commercial	$931.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$434.70
Rate for Payer: MDX Hawaii PPO	$1,003.95
Rate for Payer: Ohana Health Plan Medicaid	$434.70
Rate for Payer: Ohana Health Plan Medicare	$434.70
Rate for Payer: UnitedHealthcare Medicare	$434.70
Rate for Payer: University Health Alliance Commercial	$4,035.20

aspirin 300 mg Supp [KMC]

Facility

$5.83

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.66
Rate for Payer: AlohaCare Medicaid	$2.92
Rate for Payer: AlohaCare Medicare	$2.45
Rate for Payer: Cash Price	$3.79
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.36
Rate for Payer: Devoted Health Medicare	$2.45
Rate for Payer: Hawaii Medical Service Association Medicare	$2.45
Rate for Payer: Hawaii Western Management Group Commercial	$5.54
Rate for Payer: Health Management Network Commercial	$4.96
Rate for Payer: Humana Medicare	$2.45
Rate for Payer: Kaiser Permanente Commercial	$5.25
Rate for Payer: Kaiser Permanente Medicaid	$2.97
Rate for Payer: Kaiser Permanente Medicare	$2.45
Rate for Payer: MDX Hawaii PPO	$5.66
Rate for Payer: Ohana Health Plan Medicaid	$2.45
Rate for Payer: Ohana Health Plan Medicare	$2.45
Rate for Payer: UnitedHealthcare Medicare	$2.45
Rate for Payer: University Health Alliance Commercial	$4.25

aspirin 300 mg Supp [KMC]

Facility

$5.83

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$5.66
Rate for Payer: Cash Price	$3.79
Rate for Payer: Health Management Network Commercial	$4.96
Rate for Payer: Kaiser Permanente Commercial	$5.25
Rate for Payer: MDX Hawaii PPO	$5.66

aspirin 325 mg Oral EC Tab [KMC]

Facility

$3.00

Service Code	NDC 00536123201
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

aspirin 325 mg Oral EC Tab [KMC]

Facility

$3.00

Service Code	NDC 00536123201
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

aspirin 81 mg Chew Tab [KMC]

Facility

$3.00

Service Code	NDC 00904679430
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

aspirin 81 mg Chew Tab [KMC]

Facility

$3.00

Service Code	NDC 00904679430
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

aspirin 81 mg Oral EC Tab [KMC]

Facility

$3.00

Service Code	NDC 63739021202
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

aspirin 81 mg Oral EC Tab [KMC]

Facility

$3.00

Service Code	NDC 63739021202
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

aspirin-dipyridamole 25-200 mg ER cap [KMC]

Facility

$33.42

Service Code	NDC 62559085060
Hospital Revenue Code	250
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$32.42
Rate for Payer: AlohaCare Medicaid	$16.71
Rate for Payer: AlohaCare Medicare	$14.04
Rate for Payer: Cash Price	$21.72
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$30.75
Rate for Payer: Devoted Health Medicare	$14.04
Rate for Payer: Hawaii Medical Service Association Medicare	$14.04
Rate for Payer: Hawaii Western Management Group Commercial	$31.75
Rate for Payer: Health Management Network Commercial	$28.41
Rate for Payer: Humana Medicare	$14.04
Rate for Payer: Kaiser Permanente Commercial	$30.08
Rate for Payer: Kaiser Permanente Medicaid	$17.04
Rate for Payer: Kaiser Permanente Medicare	$14.04
Rate for Payer: MDX Hawaii PPO	$32.42
Rate for Payer: Ohana Health Plan Medicaid	$14.04
Rate for Payer: Ohana Health Plan Medicare	$14.04
Rate for Payer: UnitedHealthcare Medicaid	$20.05
Rate for Payer: UnitedHealthcare Medicare	$14.04
Rate for Payer: University Health Alliance Commercial	$24.36

aspirin-dipyridamole 25-200 mg ER cap [KMC]

Facility

$33.42

Service Code	NDC 62559085060
Hospital Revenue Code	250
Min. Negotiated Rate	$28.41
Max. Negotiated Rate	$32.42
Rate for Payer: Cash Price	$21.72
Rate for Payer: Health Management Network Commercial	$28.41
Rate for Payer: Kaiser Permanente Commercial	$30.08
Rate for Payer: MDX Hawaii PPO	$32.42

AST

Facility

$72.00

Service Code	HCPCS 84450
Hospital Charge Code	422844500
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$69.84
Rate for Payer: AlohaCare Medicaid	$36.00
Rate for Payer: AlohaCare Medicare	$30.24
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$66.24
Rate for Payer: Devoted Health Medicare	$30.24
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.14
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$30.24
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Humana Medicare	$30.24
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$30.24
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$30.24
Rate for Payer: Ohana Health Plan Medicare	$30.24
Rate for Payer: UnitedHealthcare Medicaid	$7.14
Rate for Payer: UnitedHealthcare Medicare	$30.24
Rate for Payer: University Health Alliance Commercial	$13.36

AST

Facility

$72.00

Service Code	HCPCS 84450
Hospital Charge Code	422844500
Hospital Revenue Code	301
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: MDX Hawaii PPO	$69.84

atazanavir 300 mg Cap [KMC]

Facility

$200.37

Service Code	NDC 42385092230
Hospital Revenue Code	250
Min. Negotiated Rate	$170.31
Max. Negotiated Rate	$194.36
Rate for Payer: Cash Price	$130.24
Rate for Payer: Health Management Network Commercial	$170.31
Rate for Payer: Kaiser Permanente Commercial	$180.33
Rate for Payer: MDX Hawaii PPO	$194.36

atazanavir 300 mg Cap [KMC]

Facility

$200.37

Service Code	NDC 42385092230
Hospital Revenue Code	250
Min. Negotiated Rate	$84.16
Max. Negotiated Rate	$194.36
Rate for Payer: AlohaCare Medicaid	$100.19
Rate for Payer: AlohaCare Medicare	$84.16
Rate for Payer: Cash Price	$130.24
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$184.34
Rate for Payer: Devoted Health Medicare	$84.16
Rate for Payer: Hawaii Medical Service Association Medicare	$84.16
Rate for Payer: Hawaii Western Management Group Commercial	$190.35
Rate for Payer: Health Management Network Commercial	$170.31
Rate for Payer: Humana Medicare	$84.16
Rate for Payer: Kaiser Permanente Commercial	$180.33
Rate for Payer: Kaiser Permanente Medicaid	$102.19
Rate for Payer: Kaiser Permanente Medicare	$84.16
Rate for Payer: MDX Hawaii PPO	$194.36
Rate for Payer: Ohana Health Plan Medicaid	$84.16
Rate for Payer: Ohana Health Plan Medicare	$84.16
Rate for Payer: UnitedHealthcare Medicaid	$120.22
Rate for Payer: UnitedHealthcare Medicare	$84.16
Rate for Payer: University Health Alliance Commercial	$146.05

atenolol 25 mg Tab [KMC]

Facility

$3.27

Service Code	NDC 29300041001
Hospital Revenue Code	250
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$3.17
Rate for Payer: Cash Price	$2.13
Rate for Payer: Health Management Network Commercial	$2.78
Rate for Payer: Kaiser Permanente Commercial	$2.94
Rate for Payer: MDX Hawaii PPO	$3.17

atenolol 25 mg Tab [KMC]

Facility

$3.27

Service Code	NDC 29300041001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$3.17
Rate for Payer: AlohaCare Medicaid	$1.64
Rate for Payer: AlohaCare Medicare	$1.37
Rate for Payer: Cash Price	$2.13
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3.01
Rate for Payer: Devoted Health Medicare	$1.37
Rate for Payer: Hawaii Medical Service Association Medicare	$1.37
Rate for Payer: Hawaii Western Management Group Commercial	$3.11
Rate for Payer: Health Management Network Commercial	$2.78
Rate for Payer: Humana Medicare	$1.37
Rate for Payer: Kaiser Permanente Commercial	$2.94
Rate for Payer: Kaiser Permanente Medicaid	$1.67
Rate for Payer: Kaiser Permanente Medicare	$1.37
Rate for Payer: MDX Hawaii PPO	$3.17
Rate for Payer: Ohana Health Plan Medicaid	$1.37
Rate for Payer: Ohana Health Plan Medicare	$1.37
Rate for Payer: UnitedHealthcare Medicaid	$1.96
Rate for Payer: UnitedHealthcare Medicare	$1.37
Rate for Payer: University Health Alliance Commercial	$2.38

ATHEROSCLEROSIS WITH MCC

Facility

$14,197.50

Service Code	MSDRG 302
Min. Negotiated Rate	$14,197.50
Max. Negotiated Rate	$14,197.50
Rate for Payer: Hawaii Medical Service Association Commercial	$14,197.50

ATHEROSCLEROSIS WITHOUT MCC

Facility

$14,078.99

Service Code	MSDRG 303
Min. Negotiated Rate	$14,078.99
Max. Negotiated Rate	$14,078.99
Rate for Payer: Hawaii Medical Service Association Commercial	$14,078.99

Know your out-of-pocket cost for care.

All Charges