Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

US UE Venous Duplex Left

Facility

$689.00

Service Code	HCPCS 93971
Hospital Charge Code	424939710
Hospital Revenue Code	402
Min. Negotiated Rate	$585.65
Max. Negotiated Rate	$668.33
Rate for Payer: Cash Price	$447.85
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Kaiser Permanente Commercial	$620.10
Rate for Payer: MDX Hawaii PPO	$668.33

US UE Venous Duplex Left

Facility

$689.00

Service Code	HCPCS 93971
Hospital Charge Code	424939710
Hospital Revenue Code	402
Min. Negotiated Rate	$93.10
Max. Negotiated Rate	$668.33
Rate for Payer: AlohaCare Medicaid	$344.50
Rate for Payer: AlohaCare Medicare	$289.38
Rate for Payer: Cash Price	$447.85
Rate for Payer: Cash Price	$447.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$633.88
Rate for Payer: Devoted Health Medicare	$289.38
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$93.10
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$289.38
Rate for Payer: Hawaii Western Management Group Commercial	$654.55
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Humana Medicare	$289.38
Rate for Payer: Kaiser Permanente Commercial	$620.10
Rate for Payer: Kaiser Permanente Medicaid	$351.39
Rate for Payer: Kaiser Permanente Medicare	$289.38
Rate for Payer: MDX Hawaii PPO	$668.33
Rate for Payer: Ohana Health Plan Medicaid	$289.38
Rate for Payer: Ohana Health Plan Medicare	$289.38
Rate for Payer: UnitedHealthcare Medicaid	$93.10
Rate for Payer: UnitedHealthcare Medicare	$289.38
Rate for Payer: University Health Alliance Commercial	$502.21

US UE Venous Duplex Right

Facility

$689.00

Service Code	HCPCS 93971
Hospital Charge Code	424939710
Hospital Revenue Code	402
Min. Negotiated Rate	$585.65
Max. Negotiated Rate	$668.33
Rate for Payer: Cash Price	$447.85
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Kaiser Permanente Commercial	$620.10
Rate for Payer: MDX Hawaii PPO	$668.33

US UE Venous Duplex Right

Facility

$689.00

Service Code	HCPCS 93971
Hospital Charge Code	424939710
Hospital Revenue Code	402
Min. Negotiated Rate	$93.10
Max. Negotiated Rate	$668.33
Rate for Payer: AlohaCare Medicaid	$344.50
Rate for Payer: AlohaCare Medicare	$289.38
Rate for Payer: Cash Price	$447.85
Rate for Payer: Cash Price	$447.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$633.88
Rate for Payer: Devoted Health Medicare	$289.38
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$93.10
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$289.38
Rate for Payer: Hawaii Western Management Group Commercial	$654.55
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Humana Medicare	$289.38
Rate for Payer: Kaiser Permanente Commercial	$620.10
Rate for Payer: Kaiser Permanente Medicaid	$351.39
Rate for Payer: Kaiser Permanente Medicare	$289.38
Rate for Payer: MDX Hawaii PPO	$668.33
Rate for Payer: Ohana Health Plan Medicaid	$289.38
Rate for Payer: Ohana Health Plan Medicare	$289.38
Rate for Payer: UnitedHealthcare Medicaid	$93.10
Rate for Payer: UnitedHealthcare Medicare	$289.38
Rate for Payer: University Health Alliance Commercial	$502.21

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC

Facility

$22,279.88

Service Code	MSDRG 742
Min. Negotiated Rate	$22,279.88
Max. Negotiated Rate	$22,279.88
Rate for Payer: Hawaii Medical Service Association Commercial	$22,279.88

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC

Facility

$20,028.19

Service Code	MSDRG 743
Min. Negotiated Rate	$20,028.19
Max. Negotiated Rate	$20,028.19
Rate for Payer: Hawaii Medical Service Association Commercial	$20,028.19

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC

Facility

$36,074.44

Service Code	MSDRG 740
Min. Negotiated Rate	$36,074.44
Max. Negotiated Rate	$36,074.44
Rate for Payer: Hawaii Medical Service Association Commercial	$36,074.44

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC

Facility

$37,496.56

Service Code	MSDRG 739
Min. Negotiated Rate	$37,496.56
Max. Negotiated Rate	$37,496.56
Rate for Payer: Hawaii Medical Service Association Commercial	$37,496.56

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$25,835.18

Service Code	MSDRG 741
Min. Negotiated Rate	$25,835.18
Max. Negotiated Rate	$25,835.18
Rate for Payer: Hawaii Medical Service Association Commercial	$25,835.18

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC

Facility

$45,626.35

Service Code	MSDRG 737
Min. Negotiated Rate	$45,626.35
Max. Negotiated Rate	$45,626.35
Rate for Payer: Hawaii Medical Service Association Commercial	$45,626.35

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC

Facility

$45,626.35

Service Code	MSDRG 736
Min. Negotiated Rate	$45,626.35
Max. Negotiated Rate	$45,626.35
Rate for Payer: Hawaii Medical Service Association Commercial	$45,626.35

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$45,626.35

Service Code	MSDRG 738
Min. Negotiated Rate	$45,626.35
Max. Negotiated Rate	$45,626.35
Rate for Payer: Hawaii Medical Service Association Commercial	$45,626.35

UTIL CATH 14FR

Facility

$3.00

Hospital Charge Code	8383
Hospital Revenue Code	270
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

UTIL CATH 14FR

Facility

$3.00

Hospital Charge Code	8383
Hospital Revenue Code	270
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 Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

VACUTAINER MULTISAMPLE ADAPTER

Facility

$2.00

Hospital Charge Code	8385
Hospital Revenue Code	270
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$0.84
Rate for Payer: Cash Price	$1.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1.84
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.84
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$0.84
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$0.84
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$0.84
Rate for Payer: Ohana Health Plan Medicare	$0.84
Rate for Payer: UnitedHealthcare Medicare	$0.84
Rate for Payer: University Health Alliance Commercial	$1.46

VACUTAINER MULTISAMPLE ADAPTER

Facility

$2.00

Hospital Charge Code	8385
Hospital Revenue Code	270
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.30
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

VAG DELIVERY W/WO EPISIOTOMY Charge

Facility

$7,021.00

Service Code	HCPCS 59409
Hospital Charge Code	440594090
Hospital Revenue Code	450
Min. Negotiated Rate	$5,967.85
Max. Negotiated Rate	$6,810.37
Rate for Payer: Cash Price	$4,563.65
Rate for Payer: Health Management Network Commercial	$5,967.85
Rate for Payer: Kaiser Permanente Commercial	$6,318.90
Rate for Payer: MDX Hawaii PPO	$6,810.37

VAG DELIVERY W/WO EPISIOTOMY Charge

Facility

$7,021.00

Service Code	HCPCS 59409
Hospital Charge Code	440594090
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$6,810.37
Rate for Payer: AlohaCare Medicaid	$3,510.50
Rate for Payer: AlohaCare Medicare	$2,948.82
Rate for Payer: Cash Price	$4,563.65
Rate for Payer: Cash Price	$4,563.65
Rate for Payer: Cash Price	$4,563.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6,459.32
Rate for Payer: Devoted Health Medicare	$2,948.82
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	$2,948.82
Rate for Payer: Hawaii Western Management Group Commercial	$6,669.95
Rate for Payer: Health Management Network Commercial	$5,967.85
Rate for Payer: Humana Medicare	$2,948.82
Rate for Payer: Kaiser Permanente Commercial	$6,318.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,948.82
Rate for Payer: MDX Hawaii PPO	$6,810.37
Rate for Payer: Ohana Health Plan Medicaid	$2,948.82
Rate for Payer: Ohana Health Plan Medicare	$2,948.82
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,948.82
Rate for Payer: University Health Alliance Commercial	$5,117.61

VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC

Facility

$26,451.43

Service Code	MSDRG 746
Min. Negotiated Rate	$26,451.43
Max. Negotiated Rate	$26,451.43
Rate for Payer: Hawaii Medical Service Association Commercial	$26,451.43

VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC

Facility

$26,451.43

Service Code	MSDRG 747
Min. Negotiated Rate	$26,451.43
Max. Negotiated Rate	$26,451.43
Rate for Payer: Hawaii Medical Service Association Commercial	$26,451.43

VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C

Facility

$12,490.95

Service Code	MSDRG 768
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$12,490.95
Rate for Payer: Hawaii Medical Service Association Commercial	$12,490.95
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC

Facility

$10,120.75

Service Code	MSDRG 806
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$10,120.75
Rate for Payer: Hawaii Medical Service Association Commercial	$10,120.75
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC

Facility

$10,120.75

Service Code	MSDRG 805
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$10,120.75
Rate for Payer: Hawaii Medical Service Association Commercial	$10,120.75
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC

Facility

$9,125.27

Service Code	MSDRG 807
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$9,125.27
Rate for Payer: Hawaii Medical Service Association Commercial	$9,125.27
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: University Health Alliance Commercial	$7,760.00

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC

Facility

$14,695.24

Service Code	MSDRG 797
Min. Negotiated Rate	$7,300.00
Max. Negotiated Rate	$14,695.24
Rate for Payer: Hawaii Medical Service Association Commercial	$14,695.24
Rate for Payer: Hawaii Western Management Group Commercial	$7,300.00
Rate for Payer: University Health Alliance Commercial	$7,760.00

Know your out-of-pocket cost for care.

All Charges