Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

thyroid desiccated 65 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 64727330001
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

thyroid desiccated 65 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 64727330001
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

thyroid desiccated 90 mg Tab [KMC]

Facility

$7.28

Service Code	NDC 42192033101
Hospital Revenue Code	250
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$7.06
Rate for Payer: AlohaCare Medicaid	$3.64
Rate for Payer: AlohaCare Medicare	$3.06
Rate for Payer: Cash Price	$4.73
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6.70
Rate for Payer: Devoted Health Medicare	$3.06
Rate for Payer: Hawaii Medical Service Association Medicare	$3.06
Rate for Payer: Hawaii Western Management Group Commercial	$6.92
Rate for Payer: Health Management Network Commercial	$6.19
Rate for Payer: Humana Medicare	$3.06
Rate for Payer: Kaiser Permanente Commercial	$6.55
Rate for Payer: Kaiser Permanente Medicaid	$3.71
Rate for Payer: Kaiser Permanente Medicare	$3.06
Rate for Payer: MDX Hawaii PPO	$7.06
Rate for Payer: Ohana Health Plan Medicaid	$3.06
Rate for Payer: Ohana Health Plan Medicare	$3.06
Rate for Payer: UnitedHealthcare Medicaid	$4.37
Rate for Payer: UnitedHealthcare Medicare	$3.06
Rate for Payer: University Health Alliance Commercial	$5.31

thyroid desiccated 90 mg Tab [KMC]

Facility

$7.28

Service Code	NDC 42192033101
Hospital Revenue Code	250
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$7.06
Rate for Payer: Cash Price	$4.73
Rate for Payer: Health Management Network Commercial	$6.19
Rate for Payer: Kaiser Permanente Commercial	$6.55
Rate for Payer: MDX Hawaii PPO	$7.06

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC

Facility

$21,047.38

Service Code	MSDRG 626
Min. Negotiated Rate	$21,047.38
Max. Negotiated Rate	$21,047.38
Rate for Payer: Hawaii Medical Service Association Commercial	$21,047.38

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC

Facility

$21,047.38

Service Code	MSDRG 625
Min. Negotiated Rate	$21,047.38
Max. Negotiated Rate	$21,047.38
Rate for Payer: Hawaii Medical Service Association Commercial	$21,047.38

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC

Facility

$21,047.38

Service Code	MSDRG 627
Min. Negotiated Rate	$21,047.38
Max. Negotiated Rate	$21,047.38
Rate for Payer: Hawaii Medical Service Association Commercial	$21,047.38

Thyroid Stimulating Hormone

Facility

$150.00

Service Code	HCPCS 84443
Hospital Charge Code	422844430
Hospital Revenue Code	301
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$145.50
Rate for Payer: AlohaCare Medicaid	$75.00
Rate for Payer: AlohaCare Medicare	$63.00
Rate for Payer: Cash Price	$97.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$138.00
Rate for Payer: Devoted Health Medicare	$63.00
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$23.21
Rate for Payer: Hawaii Medical Service Association Commercial	$21.00
Rate for Payer: Hawaii Medical Service Association Medicare	$63.00
Rate for Payer: Hawaii Western Management Group Commercial	$16.80
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Humana Medicare	$63.00
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicare	$63.00
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: Ohana Health Plan Medicaid	$63.00
Rate for Payer: Ohana Health Plan Medicare	$63.00
Rate for Payer: UnitedHealthcare Medicaid	$23.21
Rate for Payer: UnitedHealthcare Medicare	$63.00
Rate for Payer: University Health Alliance Commercial	$43.42

Thyroid Stimulating Hormone

Facility

$150.00

Service Code	HCPCS 84443
Hospital Charge Code	422844430
Hospital Revenue Code	301
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: MDX Hawaii PPO	$145.50

Thyroxine Binding Globulin DLS

Facility

$185.00

Service Code	HCPCS 84442
Hospital Charge Code	422844425
Hospital Revenue Code	301
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$179.45
Rate for Payer: AlohaCare Medicaid	$92.50
Rate for Payer: AlohaCare Medicare	$77.70
Rate for Payer: Cash Price	$120.25
Rate for Payer: Cash Price	$120.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$170.20
Rate for Payer: Devoted Health Medicare	$77.70
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$20.44
Rate for Payer: Hawaii Medical Service Association Commercial	$18.48
Rate for Payer: Hawaii Medical Service Association Medicare	$77.70
Rate for Payer: Hawaii Western Management Group Commercial	$14.78
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: Humana Medicare	$77.70
Rate for Payer: Kaiser Permanente Commercial	$166.50
Rate for Payer: Kaiser Permanente Medicaid	$94.35
Rate for Payer: Kaiser Permanente Medicare	$77.70
Rate for Payer: MDX Hawaii PPO	$179.45
Rate for Payer: Ohana Health Plan Medicaid	$77.70
Rate for Payer: Ohana Health Plan Medicare	$77.70
Rate for Payer: UnitedHealthcare Medicaid	$20.44
Rate for Payer: UnitedHealthcare Medicare	$77.70
Rate for Payer: University Health Alliance Commercial	$38.22

Thyroxine Binding Globulin DLS

Facility

$185.00

Service Code	HCPCS 84442
Hospital Charge Code	422844425
Hospital Revenue Code	301
Min. Negotiated Rate	$157.25
Max. Negotiated Rate	$179.45
Rate for Payer: Cash Price	$120.25
Rate for Payer: Health Management Network Commercial	$157.25
Rate for Payer: Kaiser Permanente Commercial	$166.50
Rate for Payer: MDX Hawaii PPO	$179.45

TIBIA FIBULA 2 VWS

Facility

$321.00

Service Code	HCPCS 73590
Hospital Charge Code	424735900
Hospital Revenue Code	320
Min. Negotiated Rate	$272.85
Max. Negotiated Rate	$311.37
Rate for Payer: Cash Price	$208.65
Rate for Payer: Cash Price	$239.85
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Health Management Network Commercial	$272.85
Rate for Payer: Kaiser Permanente Commercial	$288.90
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: MDX Hawaii PPO	$311.37
Rate for Payer: MDX Hawaii PPO	$357.93

TIBIA FIBULA 2 VWS

Facility

$369.00

Service Code	HCPCS 73590
Hospital Charge Code	424735900
Hospital Revenue Code	320
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$357.93
Rate for Payer: AlohaCare Medicaid	$184.50
Rate for Payer: AlohaCare Medicaid	$160.50
Rate for Payer: AlohaCare Medicare	$154.98
Rate for Payer: AlohaCare Medicare	$134.82
Rate for Payer: Cash Price	$239.85
Rate for Payer: Cash Price	$208.65
Rate for Payer: Cash Price	$208.65
Rate for Payer: Cash Price	$239.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$339.48
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$295.32
Rate for Payer: Devoted Health Medicare	$134.82
Rate for Payer: Devoted Health Medicare	$154.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.46
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.46
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$134.82
Rate for Payer: Hawaii Medical Service Association Medicare	$154.98
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$272.85
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Humana Medicare	$154.98
Rate for Payer: Humana Medicare	$134.82
Rate for Payer: Kaiser Permanente Commercial	$288.90
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: Kaiser Permanente Medicaid	$188.19
Rate for Payer: Kaiser Permanente Medicaid	$163.71
Rate for Payer: Kaiser Permanente Medicare	$154.98
Rate for Payer: Kaiser Permanente Medicare	$134.82
Rate for Payer: MDX Hawaii PPO	$357.93
Rate for Payer: MDX Hawaii PPO	$311.37
Rate for Payer: Ohana Health Plan Medicaid	$154.98
Rate for Payer: Ohana Health Plan Medicaid	$134.82
Rate for Payer: Ohana Health Plan Medicare	$134.82
Rate for Payer: Ohana Health Plan Medicare	$154.98
Rate for Payer: UnitedHealthcare Medicaid	$18.46
Rate for Payer: UnitedHealthcare Medicaid	$18.46
Rate for Payer: UnitedHealthcare Medicare	$134.82
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$56.98
Rate for Payer: University Health Alliance Commercial	$56.98

ticagrelor 60 mg Tab [KMC]

Facility

$29.93

Service Code	NDC 00186077660
Hospital Revenue Code	250
Min. Negotiated Rate	$25.44
Max. Negotiated Rate	$29.03
Rate for Payer: Cash Price	$19.45
Rate for Payer: Health Management Network Commercial	$25.44
Rate for Payer: Kaiser Permanente Commercial	$26.94
Rate for Payer: MDX Hawaii PPO	$29.03

ticagrelor 60 mg Tab [KMC]

Facility

$29.93

Service Code	NDC 00186077660
Hospital Revenue Code	250
Min. Negotiated Rate	$12.57
Max. Negotiated Rate	$29.03
Rate for Payer: AlohaCare Medicaid	$14.96
Rate for Payer: AlohaCare Medicare	$12.57
Rate for Payer: Cash Price	$19.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$27.54
Rate for Payer: Devoted Health Medicare	$12.57
Rate for Payer: Hawaii Medical Service Association Medicare	$12.57
Rate for Payer: Hawaii Western Management Group Commercial	$28.43
Rate for Payer: Health Management Network Commercial	$25.44
Rate for Payer: Humana Medicare	$12.57
Rate for Payer: Kaiser Permanente Commercial	$26.94
Rate for Payer: Kaiser Permanente Medicaid	$15.26
Rate for Payer: Kaiser Permanente Medicare	$12.57
Rate for Payer: MDX Hawaii PPO	$29.03
Rate for Payer: Ohana Health Plan Medicaid	$12.57
Rate for Payer: Ohana Health Plan Medicare	$12.57
Rate for Payer: UnitedHealthcare Medicaid	$17.96
Rate for Payer: UnitedHealthcare Medicare	$12.57
Rate for Payer: University Health Alliance Commercial	$21.82

ticagrelor 90 mg Tab [KMC]

Facility

$34.02

Service Code	NDC 00186077739
Hospital Revenue Code	250
Min. Negotiated Rate	$28.92
Max. Negotiated Rate	$33.00
Rate for Payer: Cash Price	$22.11
Rate for Payer: Health Management Network Commercial	$28.92
Rate for Payer: Kaiser Permanente Commercial	$30.62
Rate for Payer: MDX Hawaii PPO	$33.00

ticagrelor 90 mg Tab [KMC]

Facility

$34.02

Service Code	NDC 00186077739
Hospital Revenue Code	250
Min. Negotiated Rate	$14.29
Max. Negotiated Rate	$33.00
Rate for Payer: AlohaCare Medicaid	$17.01
Rate for Payer: AlohaCare Medicare	$14.29
Rate for Payer: Cash Price	$22.11
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$31.30
Rate for Payer: Devoted Health Medicare	$14.29
Rate for Payer: Hawaii Medical Service Association Medicare	$14.29
Rate for Payer: Hawaii Western Management Group Commercial	$32.32
Rate for Payer: Health Management Network Commercial	$28.92
Rate for Payer: Humana Medicare	$14.29
Rate for Payer: Kaiser Permanente Commercial	$30.62
Rate for Payer: Kaiser Permanente Medicaid	$17.35
Rate for Payer: Kaiser Permanente Medicare	$14.29
Rate for Payer: MDX Hawaii PPO	$33.00
Rate for Payer: Ohana Health Plan Medicaid	$14.29
Rate for Payer: Ohana Health Plan Medicare	$14.29
Rate for Payer: UnitedHealthcare Medicaid	$20.41
Rate for Payer: UnitedHealthcare Medicare	$14.29
Rate for Payer: University Health Alliance Commercial	$24.80

tigecycline 50 mg REC vial [KMC]

Facility

$676.08

Service Code	HCPCS J3243
Hospital Revenue Code	636
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$655.80
Rate for Payer: AlohaCare Medicaid	$338.04
Rate for Payer: AlohaCare Medicare	$283.95
Rate for Payer: Cash Price	$439.45
Rate for Payer: Cash Price	$439.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$621.99
Rate for Payer: Devoted Health Medicare	$283.95
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$3.18
Rate for Payer: Hawaii Medical Service Association Medicare	$283.95
Rate for Payer: Hawaii Western Management Group Commercial	$642.28
Rate for Payer: Health Management Network Commercial	$574.67
Rate for Payer: Humana Medicare	$283.95
Rate for Payer: Kaiser Permanente Commercial	$608.47
Rate for Payer: Kaiser Permanente Medicaid	$344.80
Rate for Payer: Kaiser Permanente Medicare	$283.95
Rate for Payer: MDX Hawaii PPO	$655.80
Rate for Payer: Ohana Health Plan Medicaid	$283.95
Rate for Payer: Ohana Health Plan Medicare	$283.95
Rate for Payer: UnitedHealthcare Medicaid	$405.65
Rate for Payer: UnitedHealthcare Medicare	$283.95
Rate for Payer: University Health Alliance Commercial	$492.79

tigecycline 50 mg REC vial [KMC]

Facility

$676.08

Service Code	HCPCS J3243
Hospital Revenue Code	636
Min. Negotiated Rate	$574.67
Max. Negotiated Rate	$655.80
Rate for Payer: Cash Price	$439.45
Rate for Payer: Health Management Network Commercial	$574.67
Rate for Payer: Kaiser Permanente Commercial	$608.47
Rate for Payer: MDX Hawaii PPO	$655.80

timolol ophthalmic 0.25% Sol [KMC]

Facility

$12.00

Service Code	NDC 61314022605
Hospital Revenue Code	250
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$11.64
Rate for Payer: AlohaCare Medicaid	$6.00
Rate for Payer: AlohaCare Medicare	$5.04
Rate for Payer: Cash Price	$7.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$11.04
Rate for Payer: Devoted Health Medicare	$5.04
Rate for Payer: Hawaii Medical Service Association Medicare	$5.04
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Humana Medicare	$5.04
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicare	$5.04
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: Ohana Health Plan Medicaid	$5.04
Rate for Payer: Ohana Health Plan Medicare	$5.04
Rate for Payer: UnitedHealthcare Medicaid	$7.20
Rate for Payer: UnitedHealthcare Medicare	$5.04
Rate for Payer: University Health Alliance Commercial	$8.75

timolol ophthalmic 0.25% Sol [KMC]

Facility

$12.00

Service Code	NDC 61314022605
Hospital Revenue Code	250
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: MDX Hawaii PPO	$11.64

timolol ophthalmic 0.5% Sol [KMC]

Facility

$3.85

Service Code	NDC 60758080110
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$3.73
Rate for Payer: AlohaCare Medicaid	$1.93
Rate for Payer: AlohaCare Medicare	$1.62
Rate for Payer: Cash Price	$2.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3.54
Rate for Payer: Devoted Health Medicare	$1.62
Rate for Payer: Hawaii Medical Service Association Medicare	$1.62
Rate for Payer: Hawaii Western Management Group Commercial	$3.66
Rate for Payer: Health Management Network Commercial	$3.27
Rate for Payer: Humana Medicare	$1.62
Rate for Payer: Kaiser Permanente Commercial	$3.46
Rate for Payer: Kaiser Permanente Medicaid	$1.96
Rate for Payer: Kaiser Permanente Medicare	$1.62
Rate for Payer: MDX Hawaii PPO	$3.73
Rate for Payer: Ohana Health Plan Medicaid	$1.62
Rate for Payer: Ohana Health Plan Medicare	$1.62
Rate for Payer: UnitedHealthcare Medicaid	$2.31
Rate for Payer: UnitedHealthcare Medicare	$1.62
Rate for Payer: University Health Alliance Commercial	$2.81

timolol ophthalmic 0.5% Sol [KMC]

Facility

$3.85

Service Code	NDC 60758080110
Hospital Revenue Code	250
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$3.73
Rate for Payer: Cash Price	$2.50
Rate for Payer: Health Management Network Commercial	$3.27
Rate for Payer: Kaiser Permanente Commercial	$3.46
Rate for Payer: MDX Hawaii PPO	$3.73

tiotropium 1.25 mcg inhaler [KMC]

Facility

$596.54

Service Code	NDC 00597016061
Hospital Revenue Code	250
Min. Negotiated Rate	$250.55
Max. Negotiated Rate	$578.64
Rate for Payer: AlohaCare Medicaid	$298.27
Rate for Payer: AlohaCare Medicare	$250.55
Rate for Payer: Cash Price	$387.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$548.82
Rate for Payer: Devoted Health Medicare	$250.55
Rate for Payer: Hawaii Medical Service Association Medicare	$250.55
Rate for Payer: Hawaii Western Management Group Commercial	$566.71
Rate for Payer: Health Management Network Commercial	$507.06
Rate for Payer: Humana Medicare	$250.55
Rate for Payer: Kaiser Permanente Commercial	$536.89
Rate for Payer: Kaiser Permanente Medicaid	$304.24
Rate for Payer: Kaiser Permanente Medicare	$250.55
Rate for Payer: MDX Hawaii PPO	$578.64
Rate for Payer: Ohana Health Plan Medicaid	$250.55
Rate for Payer: Ohana Health Plan Medicare	$250.55
Rate for Payer: UnitedHealthcare Medicaid	$357.92
Rate for Payer: UnitedHealthcare Medicare	$250.55
Rate for Payer: University Health Alliance Commercial	$434.82

tiotropium 1.25 mcg inhaler [KMC]

Facility

$596.54

Service Code	NDC 00597016061
Hospital Revenue Code	250
Min. Negotiated Rate	$507.06
Max. Negotiated Rate	$578.64
Rate for Payer: Cash Price	$387.75
Rate for Payer: Health Management Network Commercial	$507.06
Rate for Payer: Kaiser Permanente Commercial	$536.89
Rate for Payer: MDX Hawaii PPO	$578.64

Know your out-of-pocket cost for care.

All Charges