Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

TREAT ELBOW DISLOC, PEDIATRIC CHARGE

Facility

$887.00

Service Code	HCPCS 24640
Hospital Charge Code	440246400
Hospital Revenue Code	450
Min. Negotiated Rate	$753.95
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$576.55
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: MDX Hawaii PPO	$860.39

TREAT HUMERUS FRACTURE CHARGE

Facility

$887.00

Service Code	HCPCS 24565
Hospital Charge Code	440245650
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

TREAT HUMERUS FRACTURE CHARGE

Facility

$887.00

Service Code	HCPCS 24565
Hospital Charge Code	440245650
Hospital Revenue Code	450
Min. Negotiated Rate	$753.95
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$576.55
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: MDX Hawaii PPO	$860.39

TREATMENT OF FINGER FRACTURE CHARGE

Facility

$887.00

Service Code	HCPCS 26755
Hospital Charge Code	440267550
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

TREATMENT OF FINGER FRACTURE CHARGE

Facility

$887.00

Service Code	HCPCS 26755
Hospital Charge Code	440267550
Hospital Revenue Code	450
Min. Negotiated Rate	$753.95
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$576.55
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: MDX Hawaii PPO	$860.39

Treatment of Swallowing Dysfunction

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

Treatment of Swallowing Dysfunction

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

TREATMENT OF TIBIA FRACTURE

Facility

$6,394.00

Service Code	HCPCS 27752
Hospital Charge Code	440277520
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$6,202.18
Rate for Payer: AlohaCare Medicaid	$3,197.00
Rate for Payer: AlohaCare Medicare	$2,685.48
Rate for Payer: Cash Price	$4,156.10
Rate for Payer: Cash Price	$4,156.10
Rate for Payer: Cash Price	$4,156.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5,882.48
Rate for Payer: Devoted Health Medicare	$2,685.48
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	$2,685.48
Rate for Payer: Hawaii Western Management Group Commercial	$6,074.30
Rate for Payer: Health Management Network Commercial	$5,434.90
Rate for Payer: Humana Medicare	$2,685.48
Rate for Payer: Kaiser Permanente Commercial	$5,754.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,685.48
Rate for Payer: MDX Hawaii PPO	$6,202.18
Rate for Payer: Ohana Health Plan Medicaid	$2,685.48
Rate for Payer: Ohana Health Plan Medicare	$2,685.48
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,685.48
Rate for Payer: University Health Alliance Commercial	$4,035.20

TREATMENT OF TIBIA FRACTURE

Facility

$6,394.00

Service Code	HCPCS 27752
Hospital Charge Code	440277520
Hospital Revenue Code	450
Min. Negotiated Rate	$5,434.90
Max. Negotiated Rate	$6,202.18
Rate for Payer: Cash Price	$4,156.10
Rate for Payer: Health Management Network Commercial	$5,434.90
Rate for Payer: Kaiser Permanente Commercial	$5,754.60
Rate for Payer: MDX Hawaii PPO	$6,202.18

TREATMENT OF WRIST DISLOCATION CHARGE

Facility

$887.00

Service Code	HCPCS 25650
Hospital Charge Code	440256500
Hospital Revenue Code	450
Min. Negotiated Rate	$753.95
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$576.55
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: MDX Hawaii PPO	$860.39

TREATMENT OF WRIST DISLOCATION CHARGE

Facility

$887.00

Service Code	HCPCS 25650
Hospital Charge Code	440256500
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

TREAT THIGH FRACTURE ED Charge

Facility

$887.00

Service Code	HCPCS 27238
Hospital Charge Code	440272380
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

TREAT THIGH FRACTURE ED Charge

Facility

$887.00

Service Code	HCPCS 27238
Hospital Charge Code	440272380
Hospital Revenue Code	450
Min. Negotiated Rate	$753.95
Max. Negotiated Rate	$860.39
Rate for Payer: Cash Price	$576.55
Rate for Payer: Health Management Network Commercial	$753.95
Rate for Payer: Kaiser Permanente Commercial	$798.30
Rate for Payer: MDX Hawaii PPO	$860.39

Triad Paste [KMC]

Facility

$3.00

Service Code	NDC 99999999951
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

Triad Paste [KMC]

Facility

$3.00

Service Code	NDC 99999999951
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

triamcinolone 0.025% Cream [KMC]

Facility

$1.19

Service Code	NDC 00168000315
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.15
Rate for Payer: Cash Price	$0.77
Rate for Payer: Health Management Network Commercial	$1.01
Rate for Payer: Kaiser Permanente Commercial	$1.07
Rate for Payer: MDX Hawaii PPO	$1.15

triamcinolone 0.025% Cream [KMC]

Facility

$1.19

Service Code	NDC 00168000315
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.15
Rate for Payer: AlohaCare Medicaid	$0.60
Rate for Payer: AlohaCare Medicare	$0.50
Rate for Payer: Cash Price	$0.77
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1.09
Rate for Payer: Devoted Health Medicare	$0.50
Rate for Payer: Hawaii Medical Service Association Medicare	$0.50
Rate for Payer: Hawaii Western Management Group Commercial	$1.13
Rate for Payer: Health Management Network Commercial	$1.01
Rate for Payer: Humana Medicare	$0.50
Rate for Payer: Kaiser Permanente Commercial	$1.07
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicare	$0.50
Rate for Payer: MDX Hawaii PPO	$1.15
Rate for Payer: Ohana Health Plan Medicaid	$0.50
Rate for Payer: Ohana Health Plan Medicare	$0.50
Rate for Payer: UnitedHealthcare Medicaid	$0.71
Rate for Payer: UnitedHealthcare Medicare	$0.50
Rate for Payer: University Health Alliance Commercial	$0.87

triamcinolone 0.1% Cream [KMC]

Facility

$0.58

Service Code	NDC 16714098603
Hospital Revenue Code	250
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.56
Rate for Payer: Cash Price	$0.38
Rate for Payer: Health Management Network Commercial	$0.49
Rate for Payer: Kaiser Permanente Commercial	$0.52
Rate for Payer: MDX Hawaii PPO	$0.56

triamcinolone 0.1% Cream [KMC]

Facility

$0.58

Service Code	NDC 16714098603
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.56
Rate for Payer: AlohaCare Medicaid	$0.29
Rate for Payer: AlohaCare Medicare	$0.24
Rate for Payer: Cash Price	$0.38
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.53
Rate for Payer: Devoted Health Medicare	$0.24
Rate for Payer: Hawaii Medical Service Association Medicare	$0.24
Rate for Payer: Hawaii Western Management Group Commercial	$0.55
Rate for Payer: Health Management Network Commercial	$0.49
Rate for Payer: Humana Medicare	$0.24
Rate for Payer: Kaiser Permanente Commercial	$0.52
Rate for Payer: Kaiser Permanente Medicaid	$0.30
Rate for Payer: Kaiser Permanente Medicare	$0.24
Rate for Payer: MDX Hawaii PPO	$0.56
Rate for Payer: Ohana Health Plan Medicaid	$0.24
Rate for Payer: Ohana Health Plan Medicare	$0.24
Rate for Payer: UnitedHealthcare Medicaid	$0.35
Rate for Payer: UnitedHealthcare Medicare	$0.24
Rate for Payer: University Health Alliance Commercial	$0.42

triamcinolone 0.1% dental paste [KMC]

Facility

$64.47

Service Code	NDC 51672126705
Hospital Revenue Code	250
Min. Negotiated Rate	$27.08
Max. Negotiated Rate	$62.54
Rate for Payer: AlohaCare Medicaid	$32.23
Rate for Payer: AlohaCare Medicare	$27.08
Rate for Payer: Cash Price	$41.91
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$59.31
Rate for Payer: Devoted Health Medicare	$27.08
Rate for Payer: Hawaii Medical Service Association Medicare	$27.08
Rate for Payer: Hawaii Western Management Group Commercial	$61.25
Rate for Payer: Health Management Network Commercial	$54.80
Rate for Payer: Humana Medicare	$27.08
Rate for Payer: Kaiser Permanente Commercial	$58.02
Rate for Payer: Kaiser Permanente Medicaid	$32.88
Rate for Payer: Kaiser Permanente Medicare	$27.08
Rate for Payer: MDX Hawaii PPO	$62.54
Rate for Payer: Ohana Health Plan Medicaid	$27.08
Rate for Payer: Ohana Health Plan Medicare	$27.08
Rate for Payer: UnitedHealthcare Medicaid	$38.68
Rate for Payer: UnitedHealthcare Medicare	$27.08
Rate for Payer: University Health Alliance Commercial	$46.99

triamcinolone 0.1% dental paste [KMC]

Facility

$64.47

Service Code	NDC 51672126705
Hospital Revenue Code	250
Min. Negotiated Rate	$54.80
Max. Negotiated Rate	$62.54
Rate for Payer: Cash Price	$41.91
Rate for Payer: Health Management Network Commercial	$54.80
Rate for Payer: Kaiser Permanente Commercial	$58.02
Rate for Payer: MDX Hawaii PPO	$62.54

triamcinolone 0.1% Ointment [KMC]

Facility

$1.50

Service Code	NDC 45802005535
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.46
Rate for Payer: AlohaCare Medicaid	$0.75
Rate for Payer: AlohaCare Medicare	$0.63
Rate for Payer: Cash Price	$0.98
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1.38
Rate for Payer: Devoted Health Medicare	$0.63
Rate for Payer: Hawaii Medical Service Association Medicare	$0.63
Rate for Payer: Hawaii Western Management Group Commercial	$1.43
Rate for Payer: Health Management Network Commercial	$1.27
Rate for Payer: Humana Medicare	$0.63
Rate for Payer: Kaiser Permanente Commercial	$1.35
Rate for Payer: Kaiser Permanente Medicaid	$0.77
Rate for Payer: Kaiser Permanente Medicare	$0.63
Rate for Payer: MDX Hawaii PPO	$1.46
Rate for Payer: Ohana Health Plan Medicaid	$0.63
Rate for Payer: Ohana Health Plan Medicare	$0.63
Rate for Payer: UnitedHealthcare Medicaid	$0.90
Rate for Payer: UnitedHealthcare Medicare	$0.63
Rate for Payer: University Health Alliance Commercial	$1.09

triamcinolone 0.1% Ointment [KMC]

Facility

$1.50

Service Code	NDC 45802005535
Hospital Revenue Code	250
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$1.46
Rate for Payer: Cash Price	$0.98
Rate for Payer: Health Management Network Commercial	$1.27
Rate for Payer: Kaiser Permanente Commercial	$1.35
Rate for Payer: MDX Hawaii PPO	$1.46

triamcinolone 0.5% Cream [KMC]

Facility

$2.96

Service Code	NDC 00168000215
Hospital Revenue Code	250
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$2.87
Rate for Payer: Cash Price	$1.92
Rate for Payer: Health Management Network Commercial	$2.52
Rate for Payer: Kaiser Permanente Commercial	$2.66
Rate for Payer: MDX Hawaii PPO	$2.87

triamcinolone 0.5% Cream [KMC]

Facility

$2.96

Service Code	NDC 00168000215
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$2.87
Rate for Payer: AlohaCare Medicaid	$1.48
Rate for Payer: AlohaCare Medicare	$1.24
Rate for Payer: Cash Price	$1.92
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.72
Rate for Payer: Devoted Health Medicare	$1.24
Rate for Payer: Hawaii Medical Service Association Medicare	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$2.81
Rate for Payer: Health Management Network Commercial	$2.52
Rate for Payer: Humana Medicare	$1.24
Rate for Payer: Kaiser Permanente Commercial	$2.66
Rate for Payer: Kaiser Permanente Medicaid	$1.51
Rate for Payer: Kaiser Permanente Medicare	$1.24
Rate for Payer: MDX Hawaii PPO	$2.87
Rate for Payer: Ohana Health Plan Medicaid	$1.24
Rate for Payer: Ohana Health Plan Medicare	$1.24
Rate for Payer: UnitedHealthcare Medicaid	$1.78
Rate for Payer: UnitedHealthcare Medicare	$1.24
Rate for Payer: University Health Alliance Commercial	$2.16

Know your out-of-pocket cost for care.

All Charges