Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$14,695.24

Service Code	MSDRG 796
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

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

Facility

$14,695.24

Service Code	MSDRG 798
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

Vaginitis Panel, DNA Direct Probe DLS

Facility

$73.00

Service Code	HCPCS 87480
Hospital Charge Code	422874809
Hospital Revenue Code	306
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$70.81
Rate for Payer: AlohaCare Medicaid	$36.50
Rate for Payer: AlohaCare Medicare	$30.66
Rate for Payer: Cash Price	$47.45
Rate for Payer: Cash Price	$47.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$67.16
Rate for Payer: Devoted Health Medicare	$30.66
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$27.71
Rate for Payer: Hawaii Medical Service Association Commercial	$25.06
Rate for Payer: Hawaii Medical Service Association Medicare	$30.66
Rate for Payer: Hawaii Western Management Group Commercial	$20.05
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Humana Medicare	$30.66
Rate for Payer: Kaiser Permanente Commercial	$65.70
Rate for Payer: Kaiser Permanente Medicaid	$37.23
Rate for Payer: Kaiser Permanente Medicare	$30.66
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: Ohana Health Plan Medicaid	$30.66
Rate for Payer: Ohana Health Plan Medicare	$30.66
Rate for Payer: UnitedHealthcare Medicaid	$27.71
Rate for Payer: UnitedHealthcare Medicare	$30.66
Rate for Payer: University Health Alliance Commercial	$51.84

Vaginitis Panel, DNA Direct Probe DLS

Facility

$73.00

Service Code	HCPCS 87480
Hospital Charge Code	422874809
Hospital Revenue Code	306
Min. Negotiated Rate	$62.05
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$47.45
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Kaiser Permanente Commercial	$65.70
Rate for Payer: MDX Hawaii PPO	$70.81

valACYclovir 1 g Tab [KMC]

Facility

$50.57

Service Code	NDC 31722070530
Hospital Revenue Code	250
Min. Negotiated Rate	$42.98
Max. Negotiated Rate	$49.05
Rate for Payer: Cash Price	$32.87
Rate for Payer: Health Management Network Commercial	$42.98
Rate for Payer: Kaiser Permanente Commercial	$45.51
Rate for Payer: MDX Hawaii PPO	$49.05

valACYclovir 1 g Tab [KMC]

Facility

$50.57

Service Code	NDC 31722070530
Hospital Revenue Code	250
Min. Negotiated Rate	$21.24
Max. Negotiated Rate	$49.05
Rate for Payer: AlohaCare Medicaid	$25.29
Rate for Payer: AlohaCare Medicare	$21.24
Rate for Payer: Cash Price	$32.87
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$46.52
Rate for Payer: Devoted Health Medicare	$21.24
Rate for Payer: Hawaii Medical Service Association Medicare	$21.24
Rate for Payer: Hawaii Western Management Group Commercial	$48.04
Rate for Payer: Health Management Network Commercial	$42.98
Rate for Payer: Humana Medicare	$21.24
Rate for Payer: Kaiser Permanente Commercial	$45.51
Rate for Payer: Kaiser Permanente Medicaid	$25.79
Rate for Payer: Kaiser Permanente Medicare	$21.24
Rate for Payer: MDX Hawaii PPO	$49.05
Rate for Payer: Ohana Health Plan Medicaid	$21.24
Rate for Payer: Ohana Health Plan Medicare	$21.24
Rate for Payer: UnitedHealthcare Medicaid	$30.34
Rate for Payer: UnitedHealthcare Medicare	$21.24
Rate for Payer: University Health Alliance Commercial	$36.86

valACYclovir 500 mg Tab [KMC]

Facility

$28.90

Service Code	NDC 31722070430
Hospital Revenue Code	250
Min. Negotiated Rate	$12.14
Max. Negotiated Rate	$28.03
Rate for Payer: AlohaCare Medicaid	$14.45
Rate for Payer: AlohaCare Medicare	$12.14
Rate for Payer: Cash Price	$18.78
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$26.59
Rate for Payer: Devoted Health Medicare	$12.14
Rate for Payer: Hawaii Medical Service Association Medicare	$12.14
Rate for Payer: Hawaii Western Management Group Commercial	$27.45
Rate for Payer: Health Management Network Commercial	$24.57
Rate for Payer: Humana Medicare	$12.14
Rate for Payer: Kaiser Permanente Commercial	$26.01
Rate for Payer: Kaiser Permanente Medicaid	$14.74
Rate for Payer: Kaiser Permanente Medicare	$12.14
Rate for Payer: MDX Hawaii PPO	$28.03
Rate for Payer: Ohana Health Plan Medicaid	$12.14
Rate for Payer: Ohana Health Plan Medicare	$12.14
Rate for Payer: UnitedHealthcare Medicaid	$17.34
Rate for Payer: UnitedHealthcare Medicare	$12.14
Rate for Payer: University Health Alliance Commercial	$21.07

valACYclovir 500 mg Tab [KMC]

Facility

$28.90

Service Code	NDC 31722070430
Hospital Revenue Code	250
Min. Negotiated Rate	$24.57
Max. Negotiated Rate	$28.03
Rate for Payer: Cash Price	$18.78
Rate for Payer: Health Management Network Commercial	$24.57
Rate for Payer: Kaiser Permanente Commercial	$26.01
Rate for Payer: MDX Hawaii PPO	$28.03

valGANciclovir 450 mg Tab [KMC]

Facility

$424.33

Service Code	NDC 42291097360
Hospital Revenue Code	250
Min. Negotiated Rate	$360.68
Max. Negotiated Rate	$411.60
Rate for Payer: Cash Price	$275.81
Rate for Payer: Health Management Network Commercial	$360.68
Rate for Payer: Kaiser Permanente Commercial	$381.90
Rate for Payer: MDX Hawaii PPO	$411.60

valGANciclovir 450 mg Tab [KMC]

Facility

$424.33

Service Code	NDC 42291097360
Hospital Revenue Code	250
Min. Negotiated Rate	$178.22
Max. Negotiated Rate	$411.60
Rate for Payer: AlohaCare Medicaid	$212.16
Rate for Payer: AlohaCare Medicare	$178.22
Rate for Payer: Cash Price	$275.81
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$390.38
Rate for Payer: Devoted Health Medicare	$178.22
Rate for Payer: Hawaii Medical Service Association Medicare	$178.22
Rate for Payer: Hawaii Western Management Group Commercial	$403.11
Rate for Payer: Health Management Network Commercial	$360.68
Rate for Payer: Humana Medicare	$178.22
Rate for Payer: Kaiser Permanente Commercial	$381.90
Rate for Payer: Kaiser Permanente Medicaid	$216.41
Rate for Payer: Kaiser Permanente Medicare	$178.22
Rate for Payer: MDX Hawaii PPO	$411.60
Rate for Payer: Ohana Health Plan Medicaid	$178.22
Rate for Payer: Ohana Health Plan Medicare	$178.22
Rate for Payer: UnitedHealthcare Medicaid	$254.60
Rate for Payer: UnitedHealthcare Medicare	$178.22
Rate for Payer: University Health Alliance Commercial	$309.29

valGANciclovir 50 mg/mL REC Oral Susp [KMC]

Facility

$40.01

Service Code	NDC 27241015919
Hospital Revenue Code	250
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$38.81
Rate for Payer: AlohaCare Medicaid	$20.00
Rate for Payer: AlohaCare Medicare	$16.80
Rate for Payer: Cash Price	$26.01
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$36.81
Rate for Payer: Devoted Health Medicare	$16.80
Rate for Payer: Hawaii Medical Service Association Medicare	$16.80
Rate for Payer: Hawaii Western Management Group Commercial	$38.01
Rate for Payer: Health Management Network Commercial	$34.01
Rate for Payer: Humana Medicare	$16.80
Rate for Payer: Kaiser Permanente Commercial	$36.01
Rate for Payer: Kaiser Permanente Medicaid	$20.41
Rate for Payer: Kaiser Permanente Medicare	$16.80
Rate for Payer: MDX Hawaii PPO	$38.81
Rate for Payer: Ohana Health Plan Medicaid	$16.80
Rate for Payer: Ohana Health Plan Medicare	$16.80
Rate for Payer: UnitedHealthcare Medicaid	$24.01
Rate for Payer: UnitedHealthcare Medicare	$16.80
Rate for Payer: University Health Alliance Commercial	$29.16

valGANciclovir 50 mg/mL REC Oral Susp [KMC]

Facility

$40.01

Service Code	NDC 27241015919
Hospital Revenue Code	250
Min. Negotiated Rate	$34.01
Max. Negotiated Rate	$38.81
Rate for Payer: Cash Price	$26.01
Rate for Payer: Health Management Network Commercial	$34.01
Rate for Payer: Kaiser Permanente Commercial	$36.01
Rate for Payer: MDX Hawaii PPO	$38.81

valproate sodium 500 mg/5 mL IV Soln [KMC]

Facility

$16.60

Service Code	NDC 00143978510
Hospital Revenue Code	250
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$16.10
Rate for Payer: AlohaCare Medicaid	$8.30
Rate for Payer: AlohaCare Medicare	$6.97
Rate for Payer: Cash Price	$10.79
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$15.27
Rate for Payer: Devoted Health Medicare	$6.97
Rate for Payer: Hawaii Medical Service Association Medicare	$6.97
Rate for Payer: Hawaii Western Management Group Commercial	$15.77
Rate for Payer: Health Management Network Commercial	$14.11
Rate for Payer: Humana Medicare	$6.97
Rate for Payer: Kaiser Permanente Commercial	$14.94
Rate for Payer: Kaiser Permanente Medicaid	$8.47
Rate for Payer: Kaiser Permanente Medicare	$6.97
Rate for Payer: MDX Hawaii PPO	$16.10
Rate for Payer: Ohana Health Plan Medicaid	$6.97
Rate for Payer: Ohana Health Plan Medicare	$6.97
Rate for Payer: UnitedHealthcare Medicaid	$9.96
Rate for Payer: UnitedHealthcare Medicare	$6.97
Rate for Payer: University Health Alliance Commercial	$12.10

valproate sodium 500 mg/5 mL IV Soln [KMC]

Facility

$16.60

Service Code	NDC 00143978510
Hospital Revenue Code	250
Min. Negotiated Rate	$14.11
Max. Negotiated Rate	$16.10
Rate for Payer: Cash Price	$10.79
Rate for Payer: Health Management Network Commercial	$14.11
Rate for Payer: Kaiser Permanente Commercial	$14.94
Rate for Payer: MDX Hawaii PPO	$16.10

valproic acid 250 mg/5 mL oral syrup [KMC]

Facility

$0.62

Service Code	NDC 60432062116
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.60
Rate for Payer: AlohaCare Medicaid	$0.31
Rate for Payer: AlohaCare Medicare	$0.26
Rate for Payer: Cash Price	$0.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.57
Rate for Payer: Devoted Health Medicare	$0.26
Rate for Payer: Hawaii Medical Service Association Medicare	$0.26
Rate for Payer: Hawaii Western Management Group Commercial	$0.59
Rate for Payer: Health Management Network Commercial	$0.53
Rate for Payer: Humana Medicare	$0.26
Rate for Payer: Kaiser Permanente Commercial	$0.56
Rate for Payer: Kaiser Permanente Medicaid	$0.32
Rate for Payer: Kaiser Permanente Medicare	$0.26
Rate for Payer: MDX Hawaii PPO	$0.60
Rate for Payer: Ohana Health Plan Medicaid	$0.26
Rate for Payer: Ohana Health Plan Medicare	$0.26
Rate for Payer: UnitedHealthcare Medicaid	$0.37
Rate for Payer: UnitedHealthcare Medicare	$0.26
Rate for Payer: University Health Alliance Commercial	$0.45

valproic acid 250 mg/5 mL oral syrup [KMC]

Facility

$0.62

Service Code	NDC 60432062116
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.60
Rate for Payer: Cash Price	$0.40
Rate for Payer: Health Management Network Commercial	$0.53
Rate for Payer: Kaiser Permanente Commercial	$0.56
Rate for Payer: MDX Hawaii PPO	$0.60

valproic acid 250 mg Cap [KMC]

Facility

$3.18

Service Code	NDC 00591401201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$3.08
Rate for Payer: AlohaCare Medicaid	$1.59
Rate for Payer: AlohaCare Medicare	$1.34
Rate for Payer: Cash Price	$2.07
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.93
Rate for Payer: Devoted Health Medicare	$1.34
Rate for Payer: Hawaii Medical Service Association Medicare	$1.34
Rate for Payer: Hawaii Western Management Group Commercial	$3.02
Rate for Payer: Health Management Network Commercial	$2.70
Rate for Payer: Humana Medicare	$1.34
Rate for Payer: Kaiser Permanente Commercial	$2.86
Rate for Payer: Kaiser Permanente Medicaid	$1.62
Rate for Payer: Kaiser Permanente Medicare	$1.34
Rate for Payer: MDX Hawaii PPO	$3.08
Rate for Payer: Ohana Health Plan Medicaid	$1.34
Rate for Payer: Ohana Health Plan Medicare	$1.34
Rate for Payer: UnitedHealthcare Medicaid	$1.91
Rate for Payer: UnitedHealthcare Medicare	$1.34
Rate for Payer: University Health Alliance Commercial	$2.32

valproic acid 250 mg Cap [KMC]

Facility

$3.18

Service Code	NDC 00591401201
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$3.08
Rate for Payer: Cash Price	$2.07
Rate for Payer: Health Management Network Commercial	$2.70
Rate for Payer: Kaiser Permanente Commercial	$2.86
Rate for Payer: MDX Hawaii PPO	$3.08

Valproic Acid DLS

Facility

$200.00

Service Code	HCPCS 80164
Hospital Charge Code	422801645
Hospital Revenue Code	301
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$130.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: MDX Hawaii PPO	$194.00

Valproic Acid DLS

Facility

$200.00

Service Code	HCPCS 80164
Hospital Charge Code	422801645
Hospital Revenue Code	301
Min. Negotiated Rate	$13.54
Max. Negotiated Rate	$194.00
Rate for Payer: AlohaCare Medicaid	$100.00
Rate for Payer: AlohaCare Medicare	$84.00
Rate for Payer: Cash Price	$130.00
Rate for Payer: Cash Price	$130.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$184.00
Rate for Payer: Devoted Health Medicare	$84.00
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.72
Rate for Payer: Hawaii Medical Service Association Commercial	$16.93
Rate for Payer: Hawaii Medical Service Association Medicare	$84.00
Rate for Payer: Hawaii Western Management Group Commercial	$13.54
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Humana Medicare	$84.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: Kaiser Permanente Medicare	$84.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: Ohana Health Plan Medicaid	$84.00
Rate for Payer: Ohana Health Plan Medicare	$84.00
Rate for Payer: UnitedHealthcare Medicaid	$18.72
Rate for Payer: UnitedHealthcare Medicare	$84.00
Rate for Payer: University Health Alliance Commercial	$35.02

valsartan 160 mg Tab [KMC]

Facility

$20.85

Service Code	NDC 31722015390
Hospital Revenue Code	250
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$20.22
Rate for Payer: Cash Price	$13.55
Rate for Payer: Health Management Network Commercial	$17.72
Rate for Payer: Kaiser Permanente Commercial	$18.77
Rate for Payer: MDX Hawaii PPO	$20.22

valsartan 160 mg Tab [KMC]

Facility

$20.85

Service Code	NDC 31722015390
Hospital Revenue Code	250
Min. Negotiated Rate	$8.76
Max. Negotiated Rate	$20.22
Rate for Payer: AlohaCare Medicaid	$10.43
Rate for Payer: AlohaCare Medicare	$8.76
Rate for Payer: Cash Price	$13.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$19.18
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	$19.81
Rate for Payer: Health Management Network Commercial	$17.72
Rate for Payer: Humana Medicare	$8.76
Rate for Payer: Kaiser Permanente Commercial	$18.77
Rate for Payer: Kaiser Permanente Medicaid	$10.63
Rate for Payer: Kaiser Permanente Medicare	$8.76
Rate for Payer: MDX Hawaii PPO	$20.22
Rate for Payer: Ohana Health Plan Medicaid	$8.76
Rate for Payer: Ohana Health Plan Medicare	$8.76
Rate for Payer: UnitedHealthcare Medicaid	$12.51
Rate for Payer: UnitedHealthcare Medicare	$8.76
Rate for Payer: University Health Alliance Commercial	$15.20

vancomycin 1.25 gm/250 mL premixed bag [KMC]

Facility

$0.36

Service Code	HCPCS J3370
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$8.20
Rate for Payer: AlohaCare Medicaid	$0.18
Rate for Payer: AlohaCare Medicare	$0.15
Rate for Payer: Cash Price	$0.23
Rate for Payer: Cash Price	$0.23
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.33
Rate for Payer: Devoted Health Medicare	$0.15
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$8.20
Rate for Payer: Hawaii Medical Service Association Medicare	$0.15
Rate for Payer: Hawaii Western Management Group Commercial	$0.34
Rate for Payer: Health Management Network Commercial	$0.31
Rate for Payer: Humana Medicare	$0.15
Rate for Payer: Kaiser Permanente Commercial	$0.32
Rate for Payer: Kaiser Permanente Medicaid	$0.18
Rate for Payer: Kaiser Permanente Medicare	$0.15
Rate for Payer: MDX Hawaii PPO	$0.35
Rate for Payer: Ohana Health Plan Medicaid	$0.15
Rate for Payer: Ohana Health Plan Medicare	$0.15
Rate for Payer: UnitedHealthcare Medicaid	$0.22
Rate for Payer: UnitedHealthcare Medicare	$0.15
Rate for Payer: University Health Alliance Commercial	$0.26

vancomycin 1.25 gm/250 mL premixed bag [KMC]

Facility

$0.36

Service Code	HCPCS J3370
Hospital Revenue Code	636
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.35
Rate for Payer: Cash Price	$0.23
Rate for Payer: Health Management Network Commercial	$0.31
Rate for Payer: Kaiser Permanente Commercial	$0.32
Rate for Payer: MDX Hawaii PPO	$0.35

vancomycin 125 mg Cap [KMC]

Facility

$12.24

Service Code	NDC 23155085878
Hospital Revenue Code	250
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$11.87
Rate for Payer: AlohaCare Medicaid	$6.12
Rate for Payer: AlohaCare Medicare	$5.14
Rate for Payer: Cash Price	$7.96
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$11.26
Rate for Payer: Devoted Health Medicare	$5.14
Rate for Payer: Hawaii Medical Service Association Medicare	$5.14
Rate for Payer: Hawaii Western Management Group Commercial	$11.63
Rate for Payer: Health Management Network Commercial	$10.40
Rate for Payer: Humana Medicare	$5.14
Rate for Payer: Kaiser Permanente Commercial	$11.02
Rate for Payer: Kaiser Permanente Medicaid	$6.24
Rate for Payer: Kaiser Permanente Medicare	$5.14
Rate for Payer: MDX Hawaii PPO	$11.87
Rate for Payer: Ohana Health Plan Medicaid	$5.14
Rate for Payer: Ohana Health Plan Medicare	$5.14
Rate for Payer: UnitedHealthcare Medicaid	$7.34
Rate for Payer: UnitedHealthcare Medicare	$5.14
Rate for Payer: University Health Alliance Commercial	$8.92

Know your out-of-pocket cost for care.

All Charges