Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

bacitracin/neomycin/polymyxin B topical 400 units-3.5 mg-5000 units/g Oint [KMC]

Facility

$1.02

Service Code	NDC 00472017956
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.99
Rate for Payer: Cash Price	$0.66
Rate for Payer: Health Management Network Commercial	$0.87
Rate for Payer: Kaiser Permanente Commercial	$0.92
Rate for Payer: MDX Hawaii PPO	$0.99

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC

Facility

$46,361.11

Service Code	MSDRG 519
Min. Negotiated Rate	$46,361.11
Max. Negotiated Rate	$46,361.11
Rate for Payer: Hawaii Medical Service Association Commercial	$46,361.11

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR

Facility

$46,361.11

Service Code	MSDRG 518
Min. Negotiated Rate	$46,361.11
Max. Negotiated Rate	$46,361.11
Rate for Payer: Hawaii Medical Service Association Commercial	$46,361.11

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC

Facility

$29,911.92

Service Code	MSDRG 520
Min. Negotiated Rate	$29,911.92
Max. Negotiated Rate	$29,911.92
Rate for Payer: Hawaii Medical Service Association Commercial	$29,911.92

baclofen 10 mg Tab [KMC]

Facility

$9.88

Service Code	NDC 59651039401
Hospital Revenue Code	250
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$9.58
Rate for Payer: AlohaCare Medicaid	$4.94
Rate for Payer: AlohaCare Medicare	$4.15
Rate for Payer: Cash Price	$6.42
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$9.09
Rate for Payer: Devoted Health Medicare	$4.15
Rate for Payer: Hawaii Medical Service Association Medicare	$4.15
Rate for Payer: Hawaii Western Management Group Commercial	$9.39
Rate for Payer: Health Management Network Commercial	$8.40
Rate for Payer: Humana Medicare	$4.15
Rate for Payer: Kaiser Permanente Commercial	$8.89
Rate for Payer: Kaiser Permanente Medicaid	$5.04
Rate for Payer: Kaiser Permanente Medicare	$4.15
Rate for Payer: MDX Hawaii PPO	$9.58
Rate for Payer: Ohana Health Plan Medicaid	$4.15
Rate for Payer: Ohana Health Plan Medicare	$4.15
Rate for Payer: UnitedHealthcare Medicaid	$5.93
Rate for Payer: UnitedHealthcare Medicare	$4.15
Rate for Payer: University Health Alliance Commercial	$7.20

baclofen 10 mg Tab [KMC]

Facility

$9.88

Service Code	NDC 59651039401
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$9.58
Rate for Payer: Cash Price	$6.42
Rate for Payer: Health Management Network Commercial	$8.40
Rate for Payer: Kaiser Permanente Commercial	$8.89
Rate for Payer: MDX Hawaii PPO	$9.58

baclofen 20 mg Tab [KMC]

Facility

$4.39

Service Code	NDC 16714007204
Hospital Revenue Code	250
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$4.26
Rate for Payer: AlohaCare Medicaid	$2.19
Rate for Payer: AlohaCare Medicare	$1.84
Rate for Payer: Cash Price	$2.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.04
Rate for Payer: Devoted Health Medicare	$1.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1.84
Rate for Payer: Hawaii Western Management Group Commercial	$4.17
Rate for Payer: Health Management Network Commercial	$3.73
Rate for Payer: Humana Medicare	$1.84
Rate for Payer: Kaiser Permanente Commercial	$3.95
Rate for Payer: Kaiser Permanente Medicaid	$2.24
Rate for Payer: Kaiser Permanente Medicare	$1.84
Rate for Payer: MDX Hawaii PPO	$4.26
Rate for Payer: Ohana Health Plan Medicaid	$1.84
Rate for Payer: Ohana Health Plan Medicare	$1.84
Rate for Payer: UnitedHealthcare Medicaid	$2.63
Rate for Payer: UnitedHealthcare Medicare	$1.84
Rate for Payer: University Health Alliance Commercial	$3.20

baclofen 20 mg Tab [KMC]

Facility

$4.39

Service Code	NDC 16714007204
Hospital Revenue Code	250
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$4.26
Rate for Payer: Cash Price	$2.85
Rate for Payer: Health Management Network Commercial	$3.73
Rate for Payer: Kaiser Permanente Commercial	$3.95
Rate for Payer: MDX Hawaii PPO	$4.26

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC

Facility

$51,314.83

Service Code	MSDRG 095
Min. Negotiated Rate	$51,314.83
Max. Negotiated Rate	$51,314.83
Rate for Payer: Hawaii Medical Service Association Commercial	$51,314.83

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC

Facility

$51,314.83

Service Code	MSDRG 094
Min. Negotiated Rate	$51,314.83
Max. Negotiated Rate	$51,314.83
Rate for Payer: Hawaii Medical Service Association Commercial	$51,314.83

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$51,314.83

Service Code	MSDRG 096
Min. Negotiated Rate	$51,314.83
Max. Negotiated Rate	$51,314.83
Rate for Payer: Hawaii Medical Service Association Commercial	$51,314.83

balsam-castor oil (Venelex) top ointment [KMC]

Facility

$3.97

Service Code	NDC 58980078011
Hospital Revenue Code	250
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$3.85
Rate for Payer: Cash Price	$2.58
Rate for Payer: Health Management Network Commercial	$3.37
Rate for Payer: Kaiser Permanente Commercial	$3.57
Rate for Payer: MDX Hawaii PPO	$3.85

balsam-castor oil (Venelex) top ointment [KMC]

Facility

$3.97

Service Code	NDC 58980078011
Hospital Revenue Code	250
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$3.85
Rate for Payer: AlohaCare Medicaid	$1.99
Rate for Payer: AlohaCare Medicare	$1.67
Rate for Payer: Cash Price	$2.58
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3.65
Rate for Payer: Devoted Health Medicare	$1.67
Rate for Payer: Hawaii Medical Service Association Medicare	$1.67
Rate for Payer: Hawaii Western Management Group Commercial	$3.77
Rate for Payer: Health Management Network Commercial	$3.37
Rate for Payer: Humana Medicare	$1.67
Rate for Payer: Kaiser Permanente Commercial	$3.57
Rate for Payer: Kaiser Permanente Medicaid	$2.02
Rate for Payer: Kaiser Permanente Medicare	$1.67
Rate for Payer: MDX Hawaii PPO	$3.85
Rate for Payer: Ohana Health Plan Medicaid	$1.67
Rate for Payer: Ohana Health Plan Medicare	$1.67
Rate for Payer: UnitedHealthcare Medicaid	$2.38
Rate for Payer: UnitedHealthcare Medicare	$1.67
Rate for Payer: University Health Alliance Commercial	$2.89

barium sulfate 2.1% oral Susp 450 mL [KMC]

Facility

$0.06

Service Code	NDC 32909071503
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.06
Rate for Payer: Cash Price	$0.04
Rate for Payer: Health Management Network Commercial	$0.05
Rate for Payer: Kaiser Permanente Commercial	$0.05
Rate for Payer: MDX Hawaii PPO	$0.06

barium sulfate 2.1% oral Susp 450 mL [KMC]

Facility

$0.06

Service Code	NDC 32909071503
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: AlohaCare Medicaid	$0.03
Rate for Payer: AlohaCare Medicare	$0.03
Rate for Payer: Cash Price	$0.04
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.06
Rate for Payer: Devoted Health Medicare	$0.03
Rate for Payer: Hawaii Medical Service Association Medicare	$0.03
Rate for Payer: Hawaii Western Management Group Commercial	$0.06
Rate for Payer: Health Management Network Commercial	$0.05
Rate for Payer: Humana Medicare	$0.03
Rate for Payer: Kaiser Permanente Commercial	$0.05
Rate for Payer: Kaiser Permanente Medicaid	$0.03
Rate for Payer: Kaiser Permanente Medicare	$0.03
Rate for Payer: MDX Hawaii PPO	$0.06
Rate for Payer: Ohana Health Plan Medicaid	$0.03
Rate for Payer: Ohana Health Plan Medicare	$0.03
Rate for Payer: UnitedHealthcare Medicaid	$0.04
Rate for Payer: UnitedHealthcare Medicare	$0.03
Rate for Payer: University Health Alliance Commercial	$0.04

Basic Metabolic Panel 10

Facility

$152.00

Service Code	HCPCS 80048
Hospital Charge Code	422800480
Hospital Revenue Code	301
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$98.80
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: MDX Hawaii PPO	$147.44

Basic Metabolic Panel 10

Facility

$152.00

Service Code	HCPCS 80048
Hospital Charge Code	422800480
Hospital Revenue Code	301
Min. Negotiated Rate	$8.46
Max. Negotiated Rate	$147.44
Rate for Payer: AlohaCare Medicaid	$76.00
Rate for Payer: AlohaCare Medicare	$63.84
Rate for Payer: Cash Price	$98.80
Rate for Payer: Cash Price	$98.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$139.84
Rate for Payer: Devoted Health Medicare	$63.84
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.70
Rate for Payer: Hawaii Medical Service Association Commercial	$10.57
Rate for Payer: Hawaii Medical Service Association Medicare	$63.84
Rate for Payer: Hawaii Western Management Group Commercial	$8.46
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Humana Medicare	$63.84
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: Kaiser Permanente Medicaid	$77.52
Rate for Payer: Kaiser Permanente Medicare	$63.84
Rate for Payer: MDX Hawaii PPO	$147.44
Rate for Payer: Ohana Health Plan Medicaid	$63.84
Rate for Payer: Ohana Health Plan Medicare	$63.84
Rate for Payer: UnitedHealthcare Medicaid	$11.70
Rate for Payer: UnitedHealthcare Medicare	$63.84
Rate for Payer: University Health Alliance Commercial	$21.89

Basic Metabolic Profile DLS

Facility

$152.00

Service Code	HCPCS 80048
Hospital Charge Code	422800485
Hospital Revenue Code	301
Min. Negotiated Rate	$8.46
Max. Negotiated Rate	$147.44
Rate for Payer: AlohaCare Medicaid	$76.00
Rate for Payer: AlohaCare Medicare	$63.84
Rate for Payer: Cash Price	$98.80
Rate for Payer: Cash Price	$98.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$139.84
Rate for Payer: Devoted Health Medicare	$63.84
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.70
Rate for Payer: Hawaii Medical Service Association Commercial	$10.57
Rate for Payer: Hawaii Medical Service Association Medicare	$63.84
Rate for Payer: Hawaii Western Management Group Commercial	$8.46
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Humana Medicare	$63.84
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: Kaiser Permanente Medicaid	$77.52
Rate for Payer: Kaiser Permanente Medicare	$63.84
Rate for Payer: MDX Hawaii PPO	$147.44
Rate for Payer: Ohana Health Plan Medicaid	$63.84
Rate for Payer: Ohana Health Plan Medicare	$63.84
Rate for Payer: UnitedHealthcare Medicaid	$11.70
Rate for Payer: UnitedHealthcare Medicare	$63.84
Rate for Payer: University Health Alliance Commercial	$21.89

Basic Metabolic Profile DLS

Facility

$152.00

Service Code	HCPCS 80048
Hospital Charge Code	422800485
Hospital Revenue Code	301
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$98.80
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: MDX Hawaii PPO	$147.44

BD Pen Needles 31G 5mm [KMC]

Facility

$194.52

Service Code	NDC 08290320119
Hospital Revenue Code	250
Min. Negotiated Rate	$165.34
Max. Negotiated Rate	$188.68
Rate for Payer: Cash Price	$126.44
Rate for Payer: Health Management Network Commercial	$165.34
Rate for Payer: Kaiser Permanente Commercial	$175.07
Rate for Payer: MDX Hawaii PPO	$188.68

BD Pen Needles 31G 5mm [KMC]

Facility

$194.52

Service Code	NDC 08290320119
Hospital Revenue Code	250
Min. Negotiated Rate	$81.70
Max. Negotiated Rate	$188.68
Rate for Payer: AlohaCare Medicaid	$97.26
Rate for Payer: AlohaCare Medicare	$81.70
Rate for Payer: Cash Price	$126.44
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$178.96
Rate for Payer: Devoted Health Medicare	$81.70
Rate for Payer: Hawaii Medical Service Association Medicare	$81.70
Rate for Payer: Hawaii Western Management Group Commercial	$184.79
Rate for Payer: Health Management Network Commercial	$165.34
Rate for Payer: Humana Medicare	$81.70
Rate for Payer: Kaiser Permanente Commercial	$175.07
Rate for Payer: Kaiser Permanente Medicaid	$99.21
Rate for Payer: Kaiser Permanente Medicare	$81.70
Rate for Payer: MDX Hawaii PPO	$188.68
Rate for Payer: Ohana Health Plan Medicaid	$81.70
Rate for Payer: Ohana Health Plan Medicare	$81.70
Rate for Payer: UnitedHealthcare Medicaid	$116.71
Rate for Payer: UnitedHealthcare Medicare	$81.70
Rate for Payer: University Health Alliance Commercial	$141.79

becaplermin topical 0.01% Gel [KMC]

Facility

$394.66

Service Code	NDC 50484081015
Hospital Revenue Code	250
Min. Negotiated Rate	$335.46
Max. Negotiated Rate	$382.82
Rate for Payer: Cash Price	$256.53
Rate for Payer: Health Management Network Commercial	$335.46
Rate for Payer: Kaiser Permanente Commercial	$355.19
Rate for Payer: MDX Hawaii PPO	$382.82

becaplermin topical 0.01% Gel [KMC]

Facility

$394.66

Service Code	NDC 50484081015
Hospital Revenue Code	250
Min. Negotiated Rate	$165.76
Max. Negotiated Rate	$382.82
Rate for Payer: AlohaCare Medicaid	$197.33
Rate for Payer: AlohaCare Medicare	$165.76
Rate for Payer: Cash Price	$256.53
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$363.09
Rate for Payer: Devoted Health Medicare	$165.76
Rate for Payer: Hawaii Medical Service Association Medicare	$165.76
Rate for Payer: Hawaii Western Management Group Commercial	$374.93
Rate for Payer: Health Management Network Commercial	$335.46
Rate for Payer: Humana Medicare	$165.76
Rate for Payer: Kaiser Permanente Commercial	$355.19
Rate for Payer: Kaiser Permanente Medicaid	$201.28
Rate for Payer: Kaiser Permanente Medicare	$165.76
Rate for Payer: MDX Hawaii PPO	$382.82
Rate for Payer: Ohana Health Plan Medicaid	$165.76
Rate for Payer: Ohana Health Plan Medicare	$165.76
Rate for Payer: UnitedHealthcare Medicaid	$236.80
Rate for Payer: UnitedHealthcare Medicare	$165.76
Rate for Payer: University Health Alliance Commercial	$287.67

BEHAVIORAL AND DEVELOPMENTAL DISORDERS

Facility

$14,126.39

Service Code	MSDRG 886
Min. Negotiated Rate	$14,126.39
Max. Negotiated Rate	$14,126.39
Rate for Payer: Hawaii Medical Service Association Commercial	$14,126.39

BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE

Professional

Both

$317.00

Service Code	HCPCS 92524
Hospital Revenue Code	440
Min. Negotiated Rate	$102.20
Max. Negotiated Rate	$269.45
Rate for Payer: AlohaCare Medicaid	$114.94
Rate for Payer: AlohaCare Medicare	$115.22
Rate for Payer: Cash Price	$206.05
Rate for Payer: Cash Price	$206.05
Rate for Payer: Devoted Health Medicare	$115.22
Rate for Payer: Hawaii Medical Service Association Medicare	$115.22
Rate for Payer: Hawaii Western Management Group Commercial	$102.20
Rate for Payer: Health Management Network Commercial	$269.45
Rate for Payer: Kaiser Permanente Commercial	$138.26
Rate for Payer: Kaiser Permanente Medicaid	$138.26
Rate for Payer: Kaiser Permanente Medicare	$138.26
Rate for Payer: Ohana Health Plan Medicaid	$114.94
Rate for Payer: Ohana Health Plan Medicare	$115.22
Rate for Payer: UnitedHealthcare Medicaid	$114.94
Rate for Payer: UnitedHealthcare Medicare	$115.22

Know your out-of-pocket cost for care.

All Charges