Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

TRACHEAL TUBE 8.5

Facility

$7.00

Hospital Charge Code	8361
Hospital Revenue Code	272
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$6.79
Rate for Payer: AlohaCare Medicaid	$3.50
Rate for Payer: AlohaCare Medicare	$2.94
Rate for Payer: Cash Price	$4.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6.44
Rate for Payer: Devoted Health Medicare	$2.94
Rate for Payer: Hawaii Medical Service Association Medicare	$2.94
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Humana Medicare	$2.94
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: Kaiser Permanente Medicare	$2.94
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: Ohana Health Plan Medicaid	$2.94
Rate for Payer: Ohana Health Plan Medicare	$2.94
Rate for Payer: UnitedHealthcare Medicare	$2.94
Rate for Payer: University Health Alliance Commercial	$5.10

TRACHEOSTOMY EMERGENCY PROCEDURE CRICOTHYROID MEMB

Facility

$2,784.00

Service Code	HCPCS 31605
Hospital Charge Code	440316050
Hospital Revenue Code	450
Min. Negotiated Rate	$2,366.40
Max. Negotiated Rate	$2,700.48
Rate for Payer: Cash Price	$1,809.60
Rate for Payer: Health Management Network Commercial	$2,366.40
Rate for Payer: Kaiser Permanente Commercial	$2,505.60
Rate for Payer: MDX Hawaii PPO	$2,700.48

TRACHEOSTOMY EMERGENCY PROCEDURE CRICOTHYROID MEMB

Facility

$2,784.00

Service Code	HCPCS 31605
Hospital Charge Code	440316050
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$2,700.48
Rate for Payer: AlohaCare Medicaid	$1,392.00
Rate for Payer: AlohaCare Medicare	$1,169.28
Rate for Payer: Cash Price	$1,809.60
Rate for Payer: Cash Price	$1,809.60
Rate for Payer: Cash Price	$1,809.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2,561.28
Rate for Payer: Devoted Health Medicare	$1,169.28
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	$1,169.28
Rate for Payer: Hawaii Western Management Group Commercial	$2,644.80
Rate for Payer: Health Management Network Commercial	$2,366.40
Rate for Payer: Humana Medicare	$1,169.28
Rate for Payer: Kaiser Permanente Commercial	$2,505.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,169.28
Rate for Payer: MDX Hawaii PPO	$2,700.48
Rate for Payer: Ohana Health Plan Medicaid	$1,169.28
Rate for Payer: Ohana Health Plan Medicare	$1,169.28
Rate for Payer: UnitedHealthcare Medicare	$1,169.28
Rate for Payer: University Health Alliance Commercial	$2,029.26

TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL CHA

Facility

$2,784.00

Service Code	HCPCS 31603
Hospital Charge Code	440316030
Hospital Revenue Code	450
Min. Negotiated Rate	$2,366.40
Max. Negotiated Rate	$2,700.48
Rate for Payer: Cash Price	$1,809.60
Rate for Payer: Health Management Network Commercial	$2,366.40
Rate for Payer: Kaiser Permanente Commercial	$2,505.60
Rate for Payer: MDX Hawaii PPO	$2,700.48

TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL CHA

Facility

$2,784.00

Service Code	HCPCS 31603
Hospital Charge Code	440316030
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$1,392.00
Rate for Payer: AlohaCare Medicare	$1,169.28
Rate for Payer: Cash Price	$1,809.60
Rate for Payer: Cash Price	$1,809.60
Rate for Payer: Cash Price	$1,809.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2,561.28
Rate for Payer: Devoted Health Medicare	$1,169.28
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	$1,169.28
Rate for Payer: Hawaii Western Management Group Commercial	$2,644.80
Rate for Payer: Health Management Network Commercial	$2,366.40
Rate for Payer: Humana Medicare	$1,169.28
Rate for Payer: Kaiser Permanente Commercial	$2,505.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,169.28
Rate for Payer: MDX Hawaii PPO	$2,700.48
Rate for Payer: Ohana Health Plan Medicaid	$1,169.28
Rate for Payer: Ohana Health Plan Medicare	$1,169.28
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,169.28
Rate for Payer: University Health Alliance Commercial	$4,035.20

TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC

Facility

$83,122.91

Service Code	MSDRG 012
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$83,122.91
Rate for Payer: Hawaii Medical Service Association Commercial	$83,122.91
Rate for Payer: University Health Alliance Commercial	$10,400.00

TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC

Facility

$83,122.91

Service Code	MSDRG 011
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$83,122.91
Rate for Payer: Hawaii Medical Service Association Commercial	$83,122.91
Rate for Payer: University Health Alliance Commercial	$10,400.00

TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC

Facility

$83,122.91

Service Code	MSDRG 013
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$83,122.91
Rate for Payer: Hawaii Medical Service Association Commercial	$83,122.91
Rate for Payer: University Health Alliance Commercial	$10,400.00

TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES

Facility

$404,593.14

Service Code	MSDRG 004
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$404,593.14
Rate for Payer: Hawaii Medical Service Association Commercial	$404,593.14
Rate for Payer: University Health Alliance Commercial	$10,400.00

TRACTION MECHANICAL Occupational

Facility

$130.00

Service Code	HCPCS 97012 GO
Hospital Charge Code	432970120
Hospital Revenue Code	430
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$126.10
Rate for Payer: AlohaCare Medicaid	$65.00
Rate for Payer: AlohaCare Medicare	$54.60
Rate for Payer: Cash Price	$84.50
Rate for Payer: Cash Price	$84.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$119.60
Rate for Payer: Devoted Health Medicare	$54.60
Rate for Payer: Hawaii Medical Service Association Medicare	$54.60
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Humana Medicare	$54.60
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: Kaiser Permanente Medicaid	$66.30
Rate for Payer: Kaiser Permanente Medicare	$54.60
Rate for Payer: MDX Hawaii PPO	$126.10
Rate for Payer: Ohana Health Plan Medicaid	$54.60
Rate for Payer: Ohana Health Plan Medicare	$54.60
Rate for Payer: UnitedHealthcare Medicaid	$13.69
Rate for Payer: UnitedHealthcare Medicare	$54.60
Rate for Payer: University Health Alliance Commercial	$94.76

TRACTION MECHANICAL Occupational

Facility

$130.00

Service Code	HCPCS 97012 GO
Hospital Charge Code	432970120
Hospital Revenue Code	430
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$84.50
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: MDX Hawaii PPO	$126.10

TRACTION MECHANICAL Physical

Facility

$130.00

Service Code	HCPCS 97012 GP
Hospital Charge Code	426970120
Hospital Revenue Code	420
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$126.10
Rate for Payer: AlohaCare Medicaid	$65.00
Rate for Payer: AlohaCare Medicare	$54.60
Rate for Payer: Cash Price	$84.50
Rate for Payer: Cash Price	$84.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$119.60
Rate for Payer: Devoted Health Medicare	$54.60
Rate for Payer: Hawaii Medical Service Association Medicare	$54.60
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Humana Medicare	$54.60
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: Kaiser Permanente Medicaid	$66.30
Rate for Payer: Kaiser Permanente Medicare	$54.60
Rate for Payer: MDX Hawaii PPO	$126.10
Rate for Payer: Ohana Health Plan Medicaid	$54.60
Rate for Payer: Ohana Health Plan Medicare	$54.60
Rate for Payer: UnitedHealthcare Medicaid	$13.69
Rate for Payer: UnitedHealthcare Medicare	$54.60
Rate for Payer: University Health Alliance Commercial	$94.76

TRACTION MECHANICAL Physical

Facility

$130.00

Service Code	HCPCS 97012 GP
Hospital Charge Code	426970120
Hospital Revenue Code	420
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$84.50
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: MDX Hawaii PPO	$126.10

traMADol 50 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 60687079501
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

traMADol 50 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 60687079501
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

trametinib 2 mg Tab [KMC]

Facility

$1,811.39

Service Code	NDC 00078066815
Hospital Revenue Code	250
Min. Negotiated Rate	$760.78
Max. Negotiated Rate	$1,757.05
Rate for Payer: AlohaCare Medicaid	$905.70
Rate for Payer: AlohaCare Medicare	$760.78
Rate for Payer: Cash Price	$1,177.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,666.48
Rate for Payer: Devoted Health Medicare	$760.78
Rate for Payer: Hawaii Medical Service Association Medicare	$760.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,720.82
Rate for Payer: Health Management Network Commercial	$1,539.68
Rate for Payer: Humana Medicare	$760.78
Rate for Payer: Kaiser Permanente Commercial	$1,630.25
Rate for Payer: Kaiser Permanente Medicaid	$923.81
Rate for Payer: Kaiser Permanente Medicare	$760.78
Rate for Payer: MDX Hawaii PPO	$1,757.05
Rate for Payer: Ohana Health Plan Medicaid	$760.78
Rate for Payer: Ohana Health Plan Medicare	$760.78
Rate for Payer: UnitedHealthcare Medicaid	$1,086.83
Rate for Payer: UnitedHealthcare Medicare	$760.78
Rate for Payer: University Health Alliance Commercial	$1,320.32

trametinib 2 mg Tab [KMC]

Facility

$1,811.39

Service Code	NDC 00078066815
Hospital Revenue Code	250
Min. Negotiated Rate	$1,539.68
Max. Negotiated Rate	$1,757.05
Rate for Payer: Cash Price	$1,177.40
Rate for Payer: Health Management Network Commercial	$1,539.68
Rate for Payer: Kaiser Permanente Commercial	$1,630.25
Rate for Payer: MDX Hawaii PPO	$1,757.05

tranexamic acid 1000 mg / 10 mL Soln [KMC]

Facility

$14.74

Service Code	NDC 39822100107
Hospital Revenue Code	250
Min. Negotiated Rate	$6.19
Max. Negotiated Rate	$14.30
Rate for Payer: AlohaCare Medicaid	$7.37
Rate for Payer: AlohaCare Medicare	$6.19
Rate for Payer: Cash Price	$9.58
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$13.56
Rate for Payer: Devoted Health Medicare	$6.19
Rate for Payer: Hawaii Medical Service Association Medicare	$6.19
Rate for Payer: Hawaii Western Management Group Commercial	$14.00
Rate for Payer: Health Management Network Commercial	$12.53
Rate for Payer: Humana Medicare	$6.19
Rate for Payer: Kaiser Permanente Commercial	$13.27
Rate for Payer: Kaiser Permanente Medicaid	$7.52
Rate for Payer: Kaiser Permanente Medicare	$6.19
Rate for Payer: MDX Hawaii PPO	$14.30
Rate for Payer: Ohana Health Plan Medicaid	$6.19
Rate for Payer: Ohana Health Plan Medicare	$6.19
Rate for Payer: UnitedHealthcare Medicaid	$8.84
Rate for Payer: UnitedHealthcare Medicare	$6.19
Rate for Payer: University Health Alliance Commercial	$10.74

tranexamic acid 1000 mg / 10 mL Soln [KMC]

Facility

$14.74

Service Code	NDC 39822100107
Hospital Revenue Code	250
Min. Negotiated Rate	$12.53
Max. Negotiated Rate	$14.30
Rate for Payer: Cash Price	$9.58
Rate for Payer: Health Management Network Commercial	$12.53
Rate for Payer: Kaiser Permanente Commercial	$13.27
Rate for Payer: MDX Hawaii PPO	$14.30

tranexamic acid 650 mg Tab [KMC]

Facility

$20.86

Service Code	NDC 69918030130
Hospital Revenue Code	250
Min. Negotiated Rate	$17.73
Max. Negotiated Rate	$20.23
Rate for Payer: Cash Price	$13.56
Rate for Payer: Health Management Network Commercial	$17.73
Rate for Payer: Kaiser Permanente Commercial	$18.77
Rate for Payer: MDX Hawaii PPO	$20.23

tranexamic acid 650 mg Tab [KMC]

Facility

$20.86

Service Code	NDC 69918030130
Hospital Revenue Code	250
Min. Negotiated Rate	$8.76
Max. Negotiated Rate	$20.23
Rate for Payer: AlohaCare Medicaid	$10.43
Rate for Payer: AlohaCare Medicare	$8.76
Rate for Payer: Cash Price	$13.56
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$19.19
Rate for Payer: Devoted Health Medicare	$8.76
Rate for Payer: Hawaii Medical Service Association Medicare	$8.76
Rate for Payer: Hawaii Western Management Group Commercial	$19.82
Rate for Payer: Health Management Network Commercial	$17.73
Rate for Payer: Humana Medicare	$8.76
Rate for Payer: Kaiser Permanente Commercial	$18.77
Rate for Payer: Kaiser Permanente Medicaid	$10.64
Rate for Payer: Kaiser Permanente Medicare	$8.76
Rate for Payer: MDX Hawaii PPO	$20.23
Rate for Payer: Ohana Health Plan Medicaid	$8.76
Rate for Payer: Ohana Health Plan Medicare	$8.76
Rate for Payer: UnitedHealthcare Medicaid	$12.52
Rate for Payer: UnitedHealthcare Medicare	$8.76
Rate for Payer: University Health Alliance Commercial	$15.20

Transferrin DLS

Facility

$130.00

Service Code	HCPCS 84466
Hospital Charge Code	422844665
Hospital Revenue Code	301
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$84.50
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: MDX Hawaii PPO	$126.10

Transferrin DLS

Facility

$130.00

Service Code	HCPCS 84466
Hospital Charge Code	422844665
Hospital Revenue Code	301
Min. Negotiated Rate	$12.76
Max. Negotiated Rate	$126.10
Rate for Payer: AlohaCare Medicaid	$65.00
Rate for Payer: AlohaCare Medicare	$54.60
Rate for Payer: Cash Price	$84.50
Rate for Payer: Cash Price	$84.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$119.60
Rate for Payer: Devoted Health Medicare	$54.60
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$17.65
Rate for Payer: Hawaii Medical Service Association Commercial	$15.95
Rate for Payer: Hawaii Medical Service Association Medicare	$54.60
Rate for Payer: Hawaii Western Management Group Commercial	$12.76
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Humana Medicare	$54.60
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: Kaiser Permanente Medicaid	$66.30
Rate for Payer: Kaiser Permanente Medicare	$54.60
Rate for Payer: MDX Hawaii PPO	$126.10
Rate for Payer: Ohana Health Plan Medicaid	$54.60
Rate for Payer: Ohana Health Plan Medicare	$54.60
Rate for Payer: UnitedHealthcare Medicaid	$17.65
Rate for Payer: UnitedHealthcare Medicare	$54.60
Rate for Payer: University Health Alliance Commercial	$33.00

TRANSFUSION, BLD/BLD CMPNTS CHARGE

Facility

$1,457.00

Service Code	HCPCS 36430
Hospital Charge Code	440364300
Hospital Revenue Code	450
Min. Negotiated Rate	$1,238.45
Max. Negotiated Rate	$1,413.29
Rate for Payer: Cash Price	$947.05
Rate for Payer: Health Management Network Commercial	$1,238.45
Rate for Payer: Kaiser Permanente Commercial	$1,311.30
Rate for Payer: MDX Hawaii PPO	$1,413.29

TRANSFUSION, BLD/BLD CMPNTS CHARGE

Facility

$1,457.00

Service Code	HCPCS 36430
Hospital Charge Code	440364300
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$728.50
Rate for Payer: AlohaCare Medicare	$611.94
Rate for Payer: Cash Price	$947.05
Rate for Payer: Cash Price	$947.05
Rate for Payer: Cash Price	$947.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,340.44
Rate for Payer: Devoted Health Medicare	$611.94
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	$611.94
Rate for Payer: Hawaii Western Management Group Commercial	$1,384.15
Rate for Payer: Health Management Network Commercial	$1,238.45
Rate for Payer: Humana Medicare	$611.94
Rate for Payer: Kaiser Permanente Commercial	$1,311.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$611.94
Rate for Payer: MDX Hawaii PPO	$1,413.29
Rate for Payer: Ohana Health Plan Medicaid	$611.94
Rate for Payer: Ohana Health Plan Medicare	$611.94
Rate for Payer: UnitedHealthcare Medicare	$611.94
Rate for Payer: University Health Alliance Commercial	$1,062.01

Know your out-of-pocket cost for care.

All Charges