Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

SUTURE VICRYL 5-0 P-1

Facility

$434.00

Hospital Charge Code	8325
Hospital Revenue Code	270
Min. Negotiated Rate	$182.28
Max. Negotiated Rate	$420.98
Rate for Payer: AlohaCare Medicaid	$217.00
Rate for Payer: AlohaCare Medicare	$182.28
Rate for Payer: Cash Price	$282.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$399.28
Rate for Payer: Devoted Health Medicare	$182.28
Rate for Payer: Hawaii Medical Service Association Medicare	$182.28
Rate for Payer: Hawaii Western Management Group Commercial	$412.30
Rate for Payer: Health Management Network Commercial	$368.90
Rate for Payer: Humana Medicare	$182.28
Rate for Payer: Kaiser Permanente Commercial	$390.60
Rate for Payer: Kaiser Permanente Medicaid	$221.34
Rate for Payer: Kaiser Permanente Medicare	$182.28
Rate for Payer: MDX Hawaii PPO	$420.98
Rate for Payer: Ohana Health Plan Medicaid	$182.28
Rate for Payer: Ohana Health Plan Medicare	$182.28
Rate for Payer: UnitedHealthcare Medicare	$182.28
Rate for Payer: University Health Alliance Commercial	$316.34

SUTURE VICRYL 6-0 PS-3

Facility

$56.00

Hospital Charge Code	8326
Hospital Revenue Code	270
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$36.40
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Kaiser Permanente Commercial	$50.40
Rate for Payer: MDX Hawaii PPO	$54.32

SUTURE VICRYL 6-0 PS-3

Facility

$56.00

Hospital Charge Code	8326
Hospital Revenue Code	270
Min. Negotiated Rate	$23.52
Max. Negotiated Rate	$54.32
Rate for Payer: AlohaCare Medicaid	$28.00
Rate for Payer: AlohaCare Medicare	$23.52
Rate for Payer: Cash Price	$36.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$51.52
Rate for Payer: Devoted Health Medicare	$23.52
Rate for Payer: Hawaii Medical Service Association Medicare	$23.52
Rate for Payer: Hawaii Western Management Group Commercial	$53.20
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Humana Medicare	$23.52
Rate for Payer: Kaiser Permanente Commercial	$50.40
Rate for Payer: Kaiser Permanente Medicaid	$28.56
Rate for Payer: Kaiser Permanente Medicare	$23.52
Rate for Payer: MDX Hawaii PPO	$54.32
Rate for Payer: Ohana Health Plan Medicaid	$23.52
Rate for Payer: Ohana Health Plan Medicare	$23.52
Rate for Payer: UnitedHealthcare Medicare	$23.52
Rate for Payer: University Health Alliance Commercial	$40.82

SWALLOW CURRENT STATUS

Professional

Both

$0.01

Service Code	HCPCS G8996
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

SWALLOW CURRENT STATUS Speech

Facility

$1.00

Service Code	HCPCS G8996 GN
Hospital Charge Code	432G89960
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

SWALLOW CURRENT STATUS Speech

Facility

$1.00

Service Code	HCPCS G8996 GN
Hospital Charge Code	432G89960
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

SWALLOW D/C STATUS

Professional

Both

$0.01

Service Code	HCPCS G8998
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

SWALLOW D/C STATUS Speech

Facility

$1.00

Service Code	HCPCS G8998 GN
Hospital Charge Code	432G89980
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

SWALLOW D/C STATUS Speech

Facility

$1.00

Service Code	HCPCS G8998 GN
Hospital Charge Code	432G89980
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

SWALLOW EVAL FLUORO Speech

Facility

$863.00

Service Code	HCPCS 92611 GN
Hospital Charge Code	431926110
Hospital Revenue Code	444
Min. Negotiated Rate	$88.36
Max. Negotiated Rate	$837.11
Rate for Payer: AlohaCare Medicaid	$431.50
Rate for Payer: AlohaCare Medicare	$362.46
Rate for Payer: Cash Price	$560.95
Rate for Payer: Cash Price	$560.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$793.96
Rate for Payer: Devoted Health Medicare	$362.46
Rate for Payer: Hawaii Medical Service Association Medicare	$362.46
Rate for Payer: Hawaii Western Management Group Commercial	$819.85
Rate for Payer: Health Management Network Commercial	$733.55
Rate for Payer: Humana Medicare	$362.46
Rate for Payer: Kaiser Permanente Commercial	$776.70
Rate for Payer: Kaiser Permanente Medicaid	$440.13
Rate for Payer: Kaiser Permanente Medicare	$362.46
Rate for Payer: MDX Hawaii PPO	$837.11
Rate for Payer: Ohana Health Plan Medicaid	$362.46
Rate for Payer: Ohana Health Plan Medicare	$362.46
Rate for Payer: UnitedHealthcare Medicaid	$88.36
Rate for Payer: UnitedHealthcare Medicare	$362.46
Rate for Payer: University Health Alliance Commercial	$629.04

SWALLOW EVAL FLUORO Speech

Facility

$863.00

Service Code	HCPCS 92611 GN
Hospital Charge Code	431926110
Hospital Revenue Code	444
Min. Negotiated Rate	$733.55
Max. Negotiated Rate	$837.11
Rate for Payer: Cash Price	$560.95
Rate for Payer: Health Management Network Commercial	$733.55
Rate for Payer: Kaiser Permanente Commercial	$776.70
Rate for Payer: MDX Hawaii PPO	$837.11

SWALLOW GOAL STATUS

Professional

Both

$0.01

Service Code	HCPCS G8997
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

SWALLOW GOAL STATUS Speech

Facility

$1.00

Service Code	HCPCS G8997 GN
Hospital Charge Code	432G89970
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

SWALLOW GOAL STATUS Speech

Facility

$1.00

Service Code	HCPCS G8997 GN
Hospital Charge Code	432G89970
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

SWALLOWING EVALUATION Speech

Facility

$515.00

Service Code	HCPCS 92610 GN
Hospital Charge Code	431926100
Hospital Revenue Code	444
Min. Negotiated Rate	$88.36
Max. Negotiated Rate	$499.55
Rate for Payer: AlohaCare Medicaid	$257.50
Rate for Payer: AlohaCare Medicare	$216.30
Rate for Payer: Cash Price	$334.75
Rate for Payer: Cash Price	$334.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$473.80
Rate for Payer: Devoted Health Medicare	$216.30
Rate for Payer: Hawaii Medical Service Association Medicare	$216.30
Rate for Payer: Hawaii Western Management Group Commercial	$489.25
Rate for Payer: Health Management Network Commercial	$437.75
Rate for Payer: Humana Medicare	$216.30
Rate for Payer: Kaiser Permanente Commercial	$463.50
Rate for Payer: Kaiser Permanente Medicaid	$262.65
Rate for Payer: Kaiser Permanente Medicare	$216.30
Rate for Payer: MDX Hawaii PPO	$499.55
Rate for Payer: Ohana Health Plan Medicaid	$216.30
Rate for Payer: Ohana Health Plan Medicare	$216.30
Rate for Payer: UnitedHealthcare Medicaid	$88.36
Rate for Payer: UnitedHealthcare Medicare	$216.30
Rate for Payer: University Health Alliance Commercial	$375.38

SWALLOWING EVALUATION Speech

Facility

$515.00

Service Code	HCPCS 92610 GN
Hospital Charge Code	431926100
Hospital Revenue Code	444
Min. Negotiated Rate	$437.75
Max. Negotiated Rate	$499.55
Rate for Payer: Cash Price	$334.75
Rate for Payer: Health Management Network Commercial	$437.75
Rate for Payer: Kaiser Permanente Commercial	$463.50
Rate for Payer: MDX Hawaii PPO	$499.55

SWALLOWING TRMT FOR FEED Speech

Facility

$397.00

Service Code	HCPCS 92526 GN
Hospital Charge Code	431925260
Hospital Revenue Code	441
Min. Negotiated Rate	$337.45
Max. Negotiated Rate	$385.09
Rate for Payer: Cash Price	$258.05
Rate for Payer: Health Management Network Commercial	$337.45
Rate for Payer: Kaiser Permanente Commercial	$357.30
Rate for Payer: MDX Hawaii PPO	$385.09

SWALLOWING TRMT FOR FEED Speech

Facility

$397.00

Service Code	HCPCS 92526 GN
Hospital Charge Code	431925260
Hospital Revenue Code	441
Min. Negotiated Rate	$22.46
Max. Negotiated Rate	$385.09
Rate for Payer: AlohaCare Medicaid	$198.50
Rate for Payer: AlohaCare Medicare	$166.74
Rate for Payer: Cash Price	$258.05
Rate for Payer: Cash Price	$258.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$365.24
Rate for Payer: Devoted Health Medicare	$166.74
Rate for Payer: Hawaii Medical Service Association Medicare	$166.74
Rate for Payer: Hawaii Western Management Group Commercial	$377.15
Rate for Payer: Health Management Network Commercial	$337.45
Rate for Payer: Humana Medicare	$166.74
Rate for Payer: Kaiser Permanente Commercial	$357.30
Rate for Payer: Kaiser Permanente Medicaid	$202.47
Rate for Payer: Kaiser Permanente Medicare	$166.74
Rate for Payer: MDX Hawaii PPO	$385.09
Rate for Payer: Ohana Health Plan Medicaid	$166.74
Rate for Payer: Ohana Health Plan Medicare	$166.74
Rate for Payer: UnitedHealthcare Medicaid	$22.46
Rate for Payer: UnitedHealthcare Medicare	$166.74
Rate for Payer: University Health Alliance Commercial	$289.37

SYNCOPE AND COLLAPSE

Facility

$14,007.88

Service Code	MSDRG 312
Min. Negotiated Rate	$14,007.88
Max. Negotiated Rate	$14,007.88
Rate for Payer: Hawaii Medical Service Association Commercial	$14,007.88

SYNTHETIC UNDER CAST PADDING 4"

Facility

$3.00

Hospital Charge Code	8331
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

SYNTHETIC UNDER CAST PADDING 4"

Facility

$3.00

Hospital Charge Code	8331
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

SYRINGE 10CC

Facility

$2.00

Hospital Charge Code	8332
Hospital Revenue Code	270
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$0.84
Rate for Payer: Cash Price	$1.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1.84
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.84
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$0.84
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$0.84
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$0.84
Rate for Payer: Ohana Health Plan Medicare	$0.84
Rate for Payer: UnitedHealthcare Medicare	$0.84
Rate for Payer: University Health Alliance Commercial	$1.46

SYRINGE 10CC

Facility

$2.00

Hospital Charge Code	8332
Hospital Revenue Code	270
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.30
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

SYRINGE 20 CC

Facility

$39.00

Hospital Charge Code	8333
Hospital Revenue Code	270
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$37.83
Rate for Payer: AlohaCare Medicaid	$19.50
Rate for Payer: AlohaCare Medicare	$16.38
Rate for Payer: Cash Price	$25.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$35.88
Rate for Payer: Devoted Health Medicare	$16.38
Rate for Payer: Hawaii Medical Service Association Medicare	$16.38
Rate for Payer: Hawaii Western Management Group Commercial	$37.05
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Humana Medicare	$16.38
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: Kaiser Permanente Medicare	$16.38
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: Ohana Health Plan Medicaid	$16.38
Rate for Payer: Ohana Health Plan Medicare	$16.38
Rate for Payer: UnitedHealthcare Medicare	$16.38
Rate for Payer: University Health Alliance Commercial	$28.43

SYRINGE 20 CC

Facility

$39.00

Hospital Charge Code	8333
Hospital Revenue Code	270
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$25.35
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: MDX Hawaii PPO	$37.83

Know your out-of-pocket cost for care.

All Charges