Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

VOICE CURRENT STATUS Speech

Facility

$1.00

Service Code	HCPCS G9171 GN
Hospital Charge Code	432G91710
Hospital Revenue Code	440
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.65
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

VOICE CURRENT STATUS Speech

Facility

$1.00

Service Code	HCPCS G9171 GN
Hospital Charge Code	432G91710
Hospital Revenue Code	440
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.42
Rate for Payer: Cash Price	$0.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.92
Rate for Payer: Devoted Health Medicare	$0.42
Rate for Payer: Hawaii Medical Service Association Medicare	$0.42
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.42
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.42
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.42
Rate for Payer: Ohana Health Plan Medicare	$0.42
Rate for Payer: UnitedHealthcare Medicare	$0.42
Rate for Payer: University Health Alliance Commercial	$0.73

VOICE D/C STATUS

Professional

Both

$0.01

Service Code	HCPCS G9173
Hospital Revenue Code	440
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

VOICE D/C STATUS Speech

Facility

$1.00

Service Code	HCPCS G9173 GN
Hospital Charge Code	432G91730
Hospital Revenue Code	440
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.42
Rate for Payer: Cash Price	$0.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.92
Rate for Payer: Devoted Health Medicare	$0.42
Rate for Payer: Hawaii Medical Service Association Medicare	$0.42
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.42
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.42
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.42
Rate for Payer: Ohana Health Plan Medicare	$0.42
Rate for Payer: UnitedHealthcare Medicare	$0.42
Rate for Payer: University Health Alliance Commercial	$0.73

VOICE D/C STATUS Speech

Facility

$1.00

Service Code	HCPCS G9173 GN
Hospital Charge Code	432G91730
Hospital Revenue Code	440
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.65
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

VOICE GOAL STATUS

Professional

Both

$0.01

Service Code	HCPCS G9172
Hospital Revenue Code	440
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

VOICE GOAL STATUS Speech

Facility

$1.00

Service Code	HCPCS G9172 GN
Hospital Charge Code	432G91720
Hospital Revenue Code	440
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.65
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

VOICE GOAL STATUS Speech

Facility

$1.00

Service Code	HCPCS G9172 GN
Hospital Charge Code	432G91720
Hospital Revenue Code	440
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.42
Rate for Payer: Cash Price	$0.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.92
Rate for Payer: Devoted Health Medicare	$0.42
Rate for Payer: Hawaii Medical Service Association Medicare	$0.42
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.42
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.42
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.42
Rate for Payer: Ohana Health Plan Medicare	$0.42
Rate for Payer: UnitedHealthcare Medicare	$0.42
Rate for Payer: University Health Alliance Commercial	$0.73

voriconazole 200 mg Tab [KMC]

Facility

$294.52

Service Code	NDC 16714019901
Hospital Revenue Code	250
Min. Negotiated Rate	$123.70
Max. Negotiated Rate	$285.68
Rate for Payer: AlohaCare Medicaid	$147.26
Rate for Payer: AlohaCare Medicare	$123.70
Rate for Payer: Cash Price	$191.44
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$270.96
Rate for Payer: Devoted Health Medicare	$123.70
Rate for Payer: Hawaii Medical Service Association Medicare	$123.70
Rate for Payer: Hawaii Western Management Group Commercial	$279.79
Rate for Payer: Health Management Network Commercial	$250.34
Rate for Payer: Humana Medicare	$123.70
Rate for Payer: Kaiser Permanente Commercial	$265.07
Rate for Payer: Kaiser Permanente Medicaid	$150.21
Rate for Payer: Kaiser Permanente Medicare	$123.70
Rate for Payer: MDX Hawaii PPO	$285.68
Rate for Payer: Ohana Health Plan Medicaid	$123.70
Rate for Payer: Ohana Health Plan Medicare	$123.70
Rate for Payer: UnitedHealthcare Medicaid	$176.71
Rate for Payer: UnitedHealthcare Medicare	$123.70
Rate for Payer: University Health Alliance Commercial	$214.68

voriconazole 200 mg Tab [KMC]

Facility

$294.52

Service Code	NDC 16714019901
Hospital Revenue Code	250
Min. Negotiated Rate	$250.34
Max. Negotiated Rate	$285.68
Rate for Payer: Cash Price	$191.44
Rate for Payer: Health Management Network Commercial	$250.34
Rate for Payer: Kaiser Permanente Commercial	$265.07
Rate for Payer: MDX Hawaii PPO	$285.68

vortioxetine 20 mg Tab [KMC]

Facility

$61.39

Service Code	NDC 64764075030
Hospital Revenue Code	250
Min. Negotiated Rate	$25.78
Max. Negotiated Rate	$59.55
Rate for Payer: AlohaCare Medicaid	$30.70
Rate for Payer: AlohaCare Medicare	$25.78
Rate for Payer: Cash Price	$39.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$56.48
Rate for Payer: Devoted Health Medicare	$25.78
Rate for Payer: Hawaii Medical Service Association Medicare	$25.78
Rate for Payer: Hawaii Western Management Group Commercial	$58.32
Rate for Payer: Health Management Network Commercial	$52.18
Rate for Payer: Humana Medicare	$25.78
Rate for Payer: Kaiser Permanente Commercial	$55.25
Rate for Payer: Kaiser Permanente Medicaid	$31.31
Rate for Payer: Kaiser Permanente Medicare	$25.78
Rate for Payer: MDX Hawaii PPO	$59.55
Rate for Payer: Ohana Health Plan Medicaid	$25.78
Rate for Payer: Ohana Health Plan Medicare	$25.78
Rate for Payer: UnitedHealthcare Medicaid	$36.83
Rate for Payer: UnitedHealthcare Medicare	$25.78
Rate for Payer: University Health Alliance Commercial	$44.75

vortioxetine 20 mg Tab [KMC]

Facility

$61.39

Service Code	NDC 64764075030
Hospital Revenue Code	250
Min. Negotiated Rate	$52.18
Max. Negotiated Rate	$59.55
Rate for Payer: Cash Price	$39.90
Rate for Payer: Health Management Network Commercial	$52.18
Rate for Payer: Kaiser Permanente Commercial	$55.25
Rate for Payer: MDX Hawaii PPO	$59.55

warfarin 1 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00093171201
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

warfarin 1 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00093171201
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

warfarin 2.5 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00093171401
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

warfarin 2.5 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00093171401
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

warfarin 2 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00832121201
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

warfarin 2 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00832121201
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

warfarin 3 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 57237012201
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

warfarin 3 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 57237012201
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

warfarin 4 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00093171601
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

warfarin 4 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 00093171601
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

warfarin 5 mg Tab

Facility

$3.00

Service Code	NDC 00832121601
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

warfarin 5 mg Tab

Facility

$3.00

Service Code	NDC 00832121601
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

warfarin 7.5 mg Tab [KMC]

Facility

$3.92

Service Code	NDC 00093172301
Hospital Revenue Code	250
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$3.80
Rate for Payer: Cash Price	$2.55
Rate for Payer: Health Management Network Commercial	$3.33
Rate for Payer: Kaiser Permanente Commercial	$3.53
Rate for Payer: MDX Hawaii PPO	$3.80

Know your out-of-pocket cost for care.

All Charges