Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

telmisartan 40 mg Tab [KMC]

Facility

$17.72

Service Code	NDC 00597004037
Hospital Revenue Code	250
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$17.19
Rate for Payer: AlohaCare Medicaid	$8.86
Rate for Payer: AlohaCare Medicare	$7.44
Rate for Payer: Cash Price	$11.52
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$16.30
Rate for Payer: Devoted Health Medicare	$7.44
Rate for Payer: Hawaii Medical Service Association Medicare	$7.44
Rate for Payer: Hawaii Western Management Group Commercial	$16.83
Rate for Payer: Health Management Network Commercial	$15.06
Rate for Payer: Humana Medicare	$7.44
Rate for Payer: Kaiser Permanente Commercial	$15.95
Rate for Payer: Kaiser Permanente Medicaid	$9.04
Rate for Payer: Kaiser Permanente Medicare	$7.44
Rate for Payer: MDX Hawaii PPO	$17.19
Rate for Payer: Ohana Health Plan Medicaid	$7.44
Rate for Payer: Ohana Health Plan Medicare	$7.44
Rate for Payer: UnitedHealthcare Medicaid	$10.63
Rate for Payer: UnitedHealthcare Medicare	$7.44
Rate for Payer: University Health Alliance Commercial	$12.92

telmisartan 40 mg Tab [KMC]

Facility

$17.72

Service Code	NDC 00597004037
Hospital Revenue Code	250
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$17.19
Rate for Payer: Cash Price	$11.52
Rate for Payer: Health Management Network Commercial	$15.06
Rate for Payer: Kaiser Permanente Commercial	$15.95
Rate for Payer: MDX Hawaii PPO	$17.19

telmisartan 80 mg Tab [KMC]

Facility

$17.72

Service Code	NDC 00597004137
Hospital Revenue Code	250
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$17.19
Rate for Payer: AlohaCare Medicaid	$8.86
Rate for Payer: AlohaCare Medicare	$7.44
Rate for Payer: Cash Price	$11.52
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$16.30
Rate for Payer: Devoted Health Medicare	$7.44
Rate for Payer: Hawaii Medical Service Association Medicare	$7.44
Rate for Payer: Hawaii Western Management Group Commercial	$16.83
Rate for Payer: Health Management Network Commercial	$15.06
Rate for Payer: Humana Medicare	$7.44
Rate for Payer: Kaiser Permanente Commercial	$15.95
Rate for Payer: Kaiser Permanente Medicaid	$9.04
Rate for Payer: Kaiser Permanente Medicare	$7.44
Rate for Payer: MDX Hawaii PPO	$17.19
Rate for Payer: Ohana Health Plan Medicaid	$7.44
Rate for Payer: Ohana Health Plan Medicare	$7.44
Rate for Payer: UnitedHealthcare Medicaid	$10.63
Rate for Payer: UnitedHealthcare Medicare	$7.44
Rate for Payer: University Health Alliance Commercial	$12.92

telmisartan 80 mg Tab [KMC]

Facility

$17.72

Service Code	NDC 00597004137
Hospital Revenue Code	250
Min. Negotiated Rate	$15.06
Max. Negotiated Rate	$17.19
Rate for Payer: Cash Price	$11.52
Rate for Payer: Health Management Network Commercial	$15.06
Rate for Payer: Kaiser Permanente Commercial	$15.95
Rate for Payer: MDX Hawaii PPO	$17.19

temazepam 15 mg Cap [KMC]

Facility

$3.00

Service Code	NDC 00781220101
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

temazepam 15 mg Cap [KMC]

Facility

$3.00

Service Code	NDC 00781220101
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

temazepam 30 mg Cap [KMC]

Facility

$3.60

Service Code	NDC 00406996201
Hospital Revenue Code	250
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$3.49
Rate for Payer: Cash Price	$2.34
Rate for Payer: Health Management Network Commercial	$3.06
Rate for Payer: Kaiser Permanente Commercial	$3.24
Rate for Payer: MDX Hawaii PPO	$3.49

temazepam 30 mg Cap [KMC]

Facility

$3.60

Service Code	NDC 00406996201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$3.49
Rate for Payer: AlohaCare Medicaid	$1.80
Rate for Payer: AlohaCare Medicare	$1.51
Rate for Payer: Cash Price	$2.34
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3.31
Rate for Payer: Devoted Health Medicare	$1.51
Rate for Payer: Hawaii Medical Service Association Medicare	$1.51
Rate for Payer: Hawaii Western Management Group Commercial	$3.42
Rate for Payer: Health Management Network Commercial	$3.06
Rate for Payer: Humana Medicare	$1.51
Rate for Payer: Kaiser Permanente Commercial	$3.24
Rate for Payer: Kaiser Permanente Medicaid	$1.84
Rate for Payer: Kaiser Permanente Medicare	$1.51
Rate for Payer: MDX Hawaii PPO	$3.49
Rate for Payer: Ohana Health Plan Medicaid	$1.51
Rate for Payer: Ohana Health Plan Medicare	$1.51
Rate for Payer: UnitedHealthcare Medicaid	$2.16
Rate for Payer: UnitedHealthcare Medicare	$1.51
Rate for Payer: University Health Alliance Commercial	$2.62

TENDONITIS, MYOSITIS AND BURSITIS WITH MCC

Facility

$19,767.47

Service Code	MSDRG 557
Min. Negotiated Rate	$19,767.47
Max. Negotiated Rate	$19,767.47
Rate for Payer: Hawaii Medical Service Association Commercial	$19,767.47

TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC

Facility

$19,767.47

Service Code	MSDRG 558
Min. Negotiated Rate	$19,767.47
Max. Negotiated Rate	$19,767.47
Rate for Payer: Hawaii Medical Service Association Commercial	$19,767.47

tenecteplase 50 mg IV Inj [KMC]

Facility

$16,777.18

Service Code	HCPCS J3101
Hospital Revenue Code	636
Min. Negotiated Rate	$171.94
Max. Negotiated Rate	$16,273.86
Rate for Payer: AlohaCare Medicaid	$8,388.59
Rate for Payer: AlohaCare Medicare	$7,046.42
Rate for Payer: Cash Price	$10,905.17
Rate for Payer: Cash Price	$10,905.17
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$15,435.01
Rate for Payer: Devoted Health Medicare	$7,046.42
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$171.94
Rate for Payer: Hawaii Medical Service Association Commercial	$246.80
Rate for Payer: Hawaii Medical Service Association Medicare	$7,046.42
Rate for Payer: Hawaii Western Management Group Commercial	$15,938.32
Rate for Payer: Health Management Network Commercial	$14,260.60
Rate for Payer: Humana Medicare	$7,046.42
Rate for Payer: Kaiser Permanente Commercial	$15,099.46
Rate for Payer: Kaiser Permanente Medicaid	$8,556.36
Rate for Payer: Kaiser Permanente Medicare	$7,046.42
Rate for Payer: MDX Hawaii PPO	$16,273.86
Rate for Payer: Ohana Health Plan Medicaid	$7,046.42
Rate for Payer: Ohana Health Plan Medicare	$7,046.42
Rate for Payer: UnitedHealthcare Medicaid	$10,066.31
Rate for Payer: UnitedHealthcare Medicare	$7,046.42
Rate for Payer: University Health Alliance Commercial	$12,228.89

tenecteplase 50 mg IV Inj [KMC]

Facility

$16,777.18

Service Code	HCPCS J3101
Hospital Revenue Code	636
Min. Negotiated Rate	$14,260.60
Max. Negotiated Rate	$16,273.86
Rate for Payer: Cash Price	$10,905.17
Rate for Payer: Health Management Network Commercial	$14,260.60
Rate for Payer: Kaiser Permanente Commercial	$15,099.46
Rate for Payer: MDX Hawaii PPO	$16,273.86

tenofovir 300 mg Tab [KMC]

Facility

$162.13

Service Code	NDC 64380071404
Hospital Revenue Code	250
Min. Negotiated Rate	$68.09
Max. Negotiated Rate	$157.27
Rate for Payer: AlohaCare Medicaid	$81.06
Rate for Payer: AlohaCare Medicare	$68.09
Rate for Payer: Cash Price	$105.38
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$149.16
Rate for Payer: Devoted Health Medicare	$68.09
Rate for Payer: Hawaii Medical Service Association Medicare	$68.09
Rate for Payer: Hawaii Western Management Group Commercial	$154.02
Rate for Payer: Health Management Network Commercial	$137.81
Rate for Payer: Humana Medicare	$68.09
Rate for Payer: Kaiser Permanente Commercial	$145.92
Rate for Payer: Kaiser Permanente Medicaid	$82.69
Rate for Payer: Kaiser Permanente Medicare	$68.09
Rate for Payer: MDX Hawaii PPO	$157.27
Rate for Payer: Ohana Health Plan Medicaid	$68.09
Rate for Payer: Ohana Health Plan Medicare	$68.09
Rate for Payer: UnitedHealthcare Medicaid	$97.28
Rate for Payer: UnitedHealthcare Medicare	$68.09
Rate for Payer: University Health Alliance Commercial	$118.18

tenofovir 300 mg Tab [KMC]

Facility

$162.13

Service Code	NDC 64380071404
Hospital Revenue Code	250
Min. Negotiated Rate	$137.81
Max. Negotiated Rate	$157.27
Rate for Payer: Cash Price	$105.38
Rate for Payer: Health Management Network Commercial	$137.81
Rate for Payer: Kaiser Permanente Commercial	$145.92
Rate for Payer: MDX Hawaii PPO	$157.27

terazosin 1 mg Cap [KMC]

Facility

$6.42

Service Code	NDC 00781205101
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$6.23
Rate for Payer: AlohaCare Medicaid	$3.21
Rate for Payer: AlohaCare Medicare	$2.70
Rate for Payer: Cash Price	$4.17
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.91
Rate for Payer: Devoted Health Medicare	$2.70
Rate for Payer: Hawaii Medical Service Association Medicare	$2.70
Rate for Payer: Hawaii Western Management Group Commercial	$6.10
Rate for Payer: Health Management Network Commercial	$5.46
Rate for Payer: Humana Medicare	$2.70
Rate for Payer: Kaiser Permanente Commercial	$5.78
Rate for Payer: Kaiser Permanente Medicaid	$3.27
Rate for Payer: Kaiser Permanente Medicare	$2.70
Rate for Payer: MDX Hawaii PPO	$6.23
Rate for Payer: Ohana Health Plan Medicaid	$2.70
Rate for Payer: Ohana Health Plan Medicare	$2.70
Rate for Payer: UnitedHealthcare Medicaid	$3.85
Rate for Payer: UnitedHealthcare Medicare	$2.70
Rate for Payer: University Health Alliance Commercial	$4.68

terazosin 1 mg Cap [KMC]

Facility

$6.42

Service Code	NDC 00781205101
Hospital Revenue Code	250
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$6.23
Rate for Payer: Cash Price	$4.17
Rate for Payer: Health Management Network Commercial	$5.46
Rate for Payer: Kaiser Permanente Commercial	$5.78
Rate for Payer: MDX Hawaii PPO	$6.23

terazosin 2 mg Cap [KMC]

Facility

$6.42

Service Code	NDC 51079093720
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$6.23
Rate for Payer: AlohaCare Medicaid	$3.21
Rate for Payer: AlohaCare Medicare	$2.70
Rate for Payer: Cash Price	$4.17
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.91
Rate for Payer: Devoted Health Medicare	$2.70
Rate for Payer: Hawaii Medical Service Association Medicare	$2.70
Rate for Payer: Hawaii Western Management Group Commercial	$6.10
Rate for Payer: Health Management Network Commercial	$5.46
Rate for Payer: Humana Medicare	$2.70
Rate for Payer: Kaiser Permanente Commercial	$5.78
Rate for Payer: Kaiser Permanente Medicaid	$3.27
Rate for Payer: Kaiser Permanente Medicare	$2.70
Rate for Payer: MDX Hawaii PPO	$6.23
Rate for Payer: Ohana Health Plan Medicaid	$2.70
Rate for Payer: Ohana Health Plan Medicare	$2.70
Rate for Payer: UnitedHealthcare Medicaid	$3.85
Rate for Payer: UnitedHealthcare Medicare	$2.70
Rate for Payer: University Health Alliance Commercial	$4.68

terazosin 2 mg Cap [KMC]

Facility

$6.42

Service Code	NDC 51079093720
Hospital Revenue Code	250
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$6.23
Rate for Payer: Cash Price	$4.17
Rate for Payer: Health Management Network Commercial	$5.46
Rate for Payer: Kaiser Permanente Commercial	$5.78
Rate for Payer: MDX Hawaii PPO	$6.23

terazosin 5 mg Cap [KMC]

Facility

$6.42

Service Code	NDC 59746038506
Hospital Revenue Code	250
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$6.23
Rate for Payer: Cash Price	$4.17
Rate for Payer: Health Management Network Commercial	$5.46
Rate for Payer: Kaiser Permanente Commercial	$5.78
Rate for Payer: MDX Hawaii PPO	$6.23

terazosin 5 mg Cap [KMC]

Facility

$6.42

Service Code	NDC 59746038506
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$6.23
Rate for Payer: AlohaCare Medicaid	$3.21
Rate for Payer: AlohaCare Medicare	$2.70
Rate for Payer: Cash Price	$4.17
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.91
Rate for Payer: Devoted Health Medicare	$2.70
Rate for Payer: Hawaii Medical Service Association Medicare	$2.70
Rate for Payer: Hawaii Western Management Group Commercial	$6.10
Rate for Payer: Health Management Network Commercial	$5.46
Rate for Payer: Humana Medicare	$2.70
Rate for Payer: Kaiser Permanente Commercial	$5.78
Rate for Payer: Kaiser Permanente Medicaid	$3.27
Rate for Payer: Kaiser Permanente Medicare	$2.70
Rate for Payer: MDX Hawaii PPO	$6.23
Rate for Payer: Ohana Health Plan Medicaid	$2.70
Rate for Payer: Ohana Health Plan Medicare	$2.70
Rate for Payer: UnitedHealthcare Medicaid	$3.85
Rate for Payer: UnitedHealthcare Medicare	$2.70
Rate for Payer: University Health Alliance Commercial	$4.68

terbinafine 1% Cream [KMC]

Facility

$2.15

Service Code	NDC 51672208001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$2.09
Rate for Payer: AlohaCare Medicaid	$1.07
Rate for Payer: AlohaCare Medicare	$0.90
Rate for Payer: Cash Price	$1.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1.98
Rate for Payer: Devoted Health Medicare	$0.90
Rate for Payer: Hawaii Medical Service Association Medicare	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$2.04
Rate for Payer: Health Management Network Commercial	$1.83
Rate for Payer: Humana Medicare	$0.90
Rate for Payer: Kaiser Permanente Commercial	$1.94
Rate for Payer: Kaiser Permanente Medicaid	$1.10
Rate for Payer: Kaiser Permanente Medicare	$0.90
Rate for Payer: MDX Hawaii PPO	$2.09
Rate for Payer: Ohana Health Plan Medicaid	$0.90
Rate for Payer: Ohana Health Plan Medicare	$0.90
Rate for Payer: UnitedHealthcare Medicaid	$1.29
Rate for Payer: UnitedHealthcare Medicare	$0.90
Rate for Payer: University Health Alliance Commercial	$1.57

terbinafine 1% Cream [KMC]

Facility

$2.15

Service Code	NDC 51672208001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$2.09
Rate for Payer: Cash Price	$1.40
Rate for Payer: Health Management Network Commercial	$1.83
Rate for Payer: Kaiser Permanente Commercial	$1.94
Rate for Payer: MDX Hawaii PPO	$2.09

terbinafine 250 mg Tab[KMC]

Facility

$53.51

Service Code	NDC 16714079502
Hospital Revenue Code	250
Min. Negotiated Rate	$45.48
Max. Negotiated Rate	$51.90
Rate for Payer: Cash Price	$34.78
Rate for Payer: Health Management Network Commercial	$45.48
Rate for Payer: Kaiser Permanente Commercial	$48.16
Rate for Payer: MDX Hawaii PPO	$51.90

terbinafine 250 mg Tab[KMC]

Facility

$53.51

Service Code	NDC 16714079502
Hospital Revenue Code	250
Min. Negotiated Rate	$22.47
Max. Negotiated Rate	$51.90
Rate for Payer: AlohaCare Medicaid	$26.75
Rate for Payer: AlohaCare Medicare	$22.47
Rate for Payer: Cash Price	$34.78
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$49.23
Rate for Payer: Devoted Health Medicare	$22.47
Rate for Payer: Hawaii Medical Service Association Medicare	$22.47
Rate for Payer: Hawaii Western Management Group Commercial	$50.83
Rate for Payer: Health Management Network Commercial	$45.48
Rate for Payer: Humana Medicare	$22.47
Rate for Payer: Kaiser Permanente Commercial	$48.16
Rate for Payer: Kaiser Permanente Medicaid	$27.29
Rate for Payer: Kaiser Permanente Medicare	$22.47
Rate for Payer: MDX Hawaii PPO	$51.90
Rate for Payer: Ohana Health Plan Medicaid	$22.47
Rate for Payer: Ohana Health Plan Medicare	$22.47
Rate for Payer: UnitedHealthcare Medicaid	$32.11
Rate for Payer: UnitedHealthcare Medicare	$22.47
Rate for Payer: University Health Alliance Commercial	$39.00

terbutaline 1 mg/mL Sol [KMC]

Facility

$86.35

Service Code	HCPCS J3105
Hospital Revenue Code	636
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$83.76
Rate for Payer: AlohaCare Medicaid	$43.17
Rate for Payer: AlohaCare Medicare	$36.27
Rate for Payer: Cash Price	$56.13
Rate for Payer: Cash Price	$56.13
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$79.44
Rate for Payer: Devoted Health Medicare	$36.27
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$2.74
Rate for Payer: Hawaii Medical Service Association Medicare	$36.27
Rate for Payer: Hawaii Western Management Group Commercial	$82.03
Rate for Payer: Health Management Network Commercial	$73.40
Rate for Payer: Humana Medicare	$36.27
Rate for Payer: Kaiser Permanente Commercial	$77.72
Rate for Payer: Kaiser Permanente Medicaid	$44.04
Rate for Payer: Kaiser Permanente Medicare	$36.27
Rate for Payer: MDX Hawaii PPO	$83.76
Rate for Payer: Ohana Health Plan Medicaid	$36.27
Rate for Payer: Ohana Health Plan Medicare	$36.27
Rate for Payer: UnitedHealthcare Medicaid	$51.81
Rate for Payer: UnitedHealthcare Medicare	$36.27
Rate for Payer: University Health Alliance Commercial	$62.94

Know your out-of-pocket cost for care.

All Charges