Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC

Facility

$17,468.37

Service Code	MSDRG 069
Min. Negotiated Rate	$17,468.37
Max. Negotiated Rate	$17,468.37
Rate for Payer: Hawaii Medical Service Association Commercial	$17,468.37

TRANSPORE TAPE 1"

Facility

$41.00

Hospital Charge Code	8364
Hospital Revenue Code	270
Min. Negotiated Rate	$34.85
Max. Negotiated Rate	$39.77
Rate for Payer: Cash Price	$26.65
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: Kaiser Permanente Commercial	$36.90
Rate for Payer: MDX Hawaii PPO	$39.77

TRANSPORE TAPE 1"

Facility

$41.00

Hospital Charge Code	8364
Hospital Revenue Code	270
Min. Negotiated Rate	$17.22
Max. Negotiated Rate	$39.77
Rate for Payer: AlohaCare Medicaid	$20.50
Rate for Payer: AlohaCare Medicare	$17.22
Rate for Payer: Cash Price	$26.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$37.72
Rate for Payer: Devoted Health Medicare	$17.22
Rate for Payer: Hawaii Medical Service Association Medicare	$17.22
Rate for Payer: Hawaii Western Management Group Commercial	$38.95
Rate for Payer: Health Management Network Commercial	$34.85
Rate for Payer: Humana Medicare	$17.22
Rate for Payer: Kaiser Permanente Commercial	$36.90
Rate for Payer: Kaiser Permanente Medicaid	$20.91
Rate for Payer: Kaiser Permanente Medicare	$17.22
Rate for Payer: MDX Hawaii PPO	$39.77
Rate for Payer: Ohana Health Plan Medicaid	$17.22
Rate for Payer: Ohana Health Plan Medicare	$17.22
Rate for Payer: UnitedHealthcare Medicare	$17.22
Rate for Payer: University Health Alliance Commercial	$29.88

TRANSURETHRAL PROCEDURES WITH CC

Facility

$21,165.89

Service Code	MSDRG 669
Min. Negotiated Rate	$21,165.89
Max. Negotiated Rate	$21,165.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21,165.89

TRANSURETHRAL PROCEDURES WITH MCC

Facility

$21,165.89

Service Code	MSDRG 668
Min. Negotiated Rate	$21,165.89
Max. Negotiated Rate	$21,165.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21,165.89

TRANSURETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$18,771.98

Service Code	MSDRG 670
Min. Negotiated Rate	$18,771.98
Max. Negotiated Rate	$18,771.98
Rate for Payer: Hawaii Medical Service Association Commercial	$18,771.98

TRANSURETHRAL PROSTATECTOMY WITH CC/MCC

Facility

$17,681.69

Service Code	MSDRG 713
Min. Negotiated Rate	$17,681.69
Max. Negotiated Rate	$17,681.69
Rate for Payer: Hawaii Medical Service Association Commercial	$17,681.69

TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC

Facility

$14,007.88

Service Code	MSDRG 714
Min. Negotiated Rate	$14,007.88
Max. Negotiated Rate	$14,007.88
Rate for Payer: Hawaii Medical Service Association Commercial	$14,007.88

TRAUMATIC INJURY WITH MCC

Facility

$14,861.15

Service Code	MSDRG 913
Min. Negotiated Rate	$14,861.15
Max. Negotiated Rate	$14,861.15
Rate for Payer: Hawaii Medical Service Association Commercial	$14,861.15

TRAUMATIC INJURY WITHOUT MCC

Facility

$14,861.15

Service Code	MSDRG 914
Min. Negotiated Rate	$14,861.15
Max. Negotiated Rate	$14,861.15
Rate for Payer: Hawaii Medical Service Association Commercial	$14,861.15

TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC

Facility

$16,709.91

Service Code	MSDRG 086
Min. Negotiated Rate	$16,709.91
Max. Negotiated Rate	$16,709.91
Rate for Payer: Hawaii Medical Service Association Commercial	$16,709.91

TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC

Facility

$37,757.29

Service Code	MSDRG 083
Min. Negotiated Rate	$37,757.29
Max. Negotiated Rate	$37,757.29
Rate for Payer: Hawaii Medical Service Association Commercial	$37,757.29

TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC

Facility

$58,235.81

Service Code	MSDRG 085
Min. Negotiated Rate	$58,235.81
Max. Negotiated Rate	$58,235.81
Rate for Payer: Hawaii Medical Service Association Commercial	$58,235.81

TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC

Facility

$37,757.29

Service Code	MSDRG 082
Min. Negotiated Rate	$37,757.29
Max. Negotiated Rate	$37,757.29
Rate for Payer: Hawaii Medical Service Association Commercial	$37,757.29

TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC

Facility

$15,216.68

Service Code	MSDRG 087
Min. Negotiated Rate	$15,216.68
Max. Negotiated Rate	$15,216.68
Rate for Payer: Hawaii Medical Service Association Commercial	$15,216.68

TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC

Facility

$37,757.29

Service Code	MSDRG 084
Min. Negotiated Rate	$37,757.29
Max. Negotiated Rate	$37,757.29
Rate for Payer: Hawaii Medical Service Association Commercial	$37,757.29

TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC

Facility

$17,918.71

Service Code	MSDRG 604
Min. Negotiated Rate	$17,918.71
Max. Negotiated Rate	$17,918.71
Rate for Payer: Hawaii Medical Service Association Commercial	$17,918.71

TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC

Facility

$14,718.94

Service Code	MSDRG 605
Min. Negotiated Rate	$14,718.94
Max. Negotiated Rate	$14,718.94
Rate for Payer: Hawaii Medical Service Association Commercial	$14,718.94

travoprost ophthalmic 0.004% Soln [KMC]

Facility

$335.38

Service Code	NDC 60505059304
Hospital Revenue Code	250
Min. Negotiated Rate	$140.86
Max. Negotiated Rate	$325.32
Rate for Payer: AlohaCare Medicaid	$167.69
Rate for Payer: AlohaCare Medicare	$140.86
Rate for Payer: Cash Price	$218.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$308.55
Rate for Payer: Devoted Health Medicare	$140.86
Rate for Payer: Hawaii Medical Service Association Medicare	$140.86
Rate for Payer: Hawaii Western Management Group Commercial	$318.61
Rate for Payer: Health Management Network Commercial	$285.07
Rate for Payer: Humana Medicare	$140.86
Rate for Payer: Kaiser Permanente Commercial	$301.84
Rate for Payer: Kaiser Permanente Medicaid	$171.04
Rate for Payer: Kaiser Permanente Medicare	$140.86
Rate for Payer: MDX Hawaii PPO	$325.32
Rate for Payer: Ohana Health Plan Medicaid	$140.86
Rate for Payer: Ohana Health Plan Medicare	$140.86
Rate for Payer: UnitedHealthcare Medicaid	$201.23
Rate for Payer: UnitedHealthcare Medicare	$140.86
Rate for Payer: University Health Alliance Commercial	$244.46

travoprost ophthalmic 0.004% Soln [KMC]

Facility

$335.38

Service Code	NDC 60505059304
Hospital Revenue Code	250
Min. Negotiated Rate	$285.07
Max. Negotiated Rate	$325.32
Rate for Payer: Cash Price	$218.00
Rate for Payer: Health Management Network Commercial	$285.07
Rate for Payer: Kaiser Permanente Commercial	$301.84
Rate for Payer: MDX Hawaii PPO	$325.32

traZODone 150 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 42291082990
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

traZODone 150 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 42291082990
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

traZODone 50 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 60687044301
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

traZODone 50 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 60687044301
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

TREAT ELBOW DISLOC, PEDIATRIC CHARGE

Facility

$887.00

Service Code	HCPCS 24640
Hospital Charge Code	440246400
Hospital Revenue Code	450
Min. Negotiated Rate	$372.54
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$443.50
Rate for Payer: AlohaCare Medicare	$372.54
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Cash Price	$576.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$816.04
Rate for Payer: Devoted Health Medicare	$372.54
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	$372.54
Rate for Payer: Hawaii Western Management Group Commercial	$842.65
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Humana Medicare	$372.54
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$372.54
Rate for Payer: MDX Hawaii PPO	$860.39
Rate for Payer: Ohana Health Plan Medicaid	$372.54
Rate for Payer: Ohana Health Plan Medicare	$372.54
Rate for Payer: UnitedHealthcare Medicare	$372.54
Rate for Payer: University Health Alliance Commercial	$646.53

Know your out-of-pocket cost for care.

All Charges