Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

WHFO PFGAUNT W/DRSL HD Occupational

Facility

$349.00

Service Code	HCPCS L3931
Hospital Charge Code	432L39310
Hospital Revenue Code	274
Min. Negotiated Rate	$146.58
Max. Negotiated Rate	$338.53
Rate for Payer: AlohaCare Medicaid	$174.50
Rate for Payer: AlohaCare Medicare	$146.58
Rate for Payer: Cash Price	$226.85
Rate for Payer: Cash Price	$226.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$321.08
Rate for Payer: Devoted Health Medicare	$146.58
Rate for Payer: Hawaii Medical Service Association Medicare	$146.58
Rate for Payer: Hawaii Western Management Group Commercial	$244.30
Rate for Payer: Health Management Network Commercial	$296.65
Rate for Payer: Humana Medicare	$146.58
Rate for Payer: Kaiser Permanente Commercial	$314.10
Rate for Payer: Kaiser Permanente Medicaid	$177.99
Rate for Payer: Kaiser Permanente Medicare	$146.58
Rate for Payer: MDX Hawaii PPO	$338.53
Rate for Payer: Ohana Health Plan Medicaid	$146.58
Rate for Payer: Ohana Health Plan Medicare	$146.58
Rate for Payer: UnitedHealthcare Medicaid	$195.96
Rate for Payer: UnitedHealthcare Medicare	$146.58
Rate for Payer: University Health Alliance Commercial	$195.44

WHFO PF T-SPICA REST Occupational

Facility

$340.00

Service Code	HCPCS L3807
Hospital Charge Code	432L38070
Hospital Revenue Code	274
Min. Negotiated Rate	$107.29
Max. Negotiated Rate	$329.80
Rate for Payer: AlohaCare Medicaid	$170.00
Rate for Payer: AlohaCare Medicare	$142.80
Rate for Payer: Cash Price	$221.00
Rate for Payer: Cash Price	$221.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$312.80
Rate for Payer: Devoted Health Medicare	$142.80
Rate for Payer: Hawaii Medical Service Association Medicare	$142.80
Rate for Payer: Hawaii Western Management Group Commercial	$238.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Humana Medicare	$142.80
Rate for Payer: Kaiser Permanente Commercial	$306.00
Rate for Payer: Kaiser Permanente Medicaid	$173.40
Rate for Payer: Kaiser Permanente Medicare	$142.80
Rate for Payer: MDX Hawaii PPO	$329.80
Rate for Payer: Ohana Health Plan Medicaid	$142.80
Rate for Payer: Ohana Health Plan Medicare	$142.80
Rate for Payer: UnitedHealthcare Medicaid	$107.29
Rate for Payer: UnitedHealthcare Medicare	$142.80
Rate for Payer: University Health Alliance Commercial	$190.40

WHFO PF T-SPICA REST Occupational

Facility

$340.00

Service Code	HCPCS L3807
Hospital Charge Code	432L38070
Hospital Revenue Code	274
Min. Negotiated Rate	$190.40
Max. Negotiated Rate	$329.80
Rate for Payer: Cash Price	$221.00
Rate for Payer: Hawaii Western Management Group Commercial	$238.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Kaiser Permanente Commercial	$306.00
Rate for Payer: MDX Hawaii PPO	$329.80
Rate for Payer: University Health Alliance Commercial	$190.40

Whirlpool Extremity Charge

Facility

$130.00

Service Code	HCPCS 97022 GO
Hospital Charge Code	426970220
Hospital Revenue Code	430
Min. Negotiated Rate	$11.89
Max. Negotiated Rate	$126.10
Rate for Payer: AlohaCare Medicaid	$65.00
Rate for Payer: AlohaCare Medicare	$54.60
Rate for Payer: Cash Price	$84.50
Rate for Payer: Cash Price	$84.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$119.60
Rate for Payer: Devoted Health Medicare	$54.60
Rate for Payer: Hawaii Medical Service Association Medicare	$54.60
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Humana Medicare	$54.60
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: Kaiser Permanente Medicaid	$66.30
Rate for Payer: Kaiser Permanente Medicare	$54.60
Rate for Payer: MDX Hawaii PPO	$126.10
Rate for Payer: Ohana Health Plan Medicaid	$54.60
Rate for Payer: Ohana Health Plan Medicare	$54.60
Rate for Payer: UnitedHealthcare Medicaid	$11.89
Rate for Payer: UnitedHealthcare Medicare	$54.60
Rate for Payer: University Health Alliance Commercial	$94.76

Whirlpool Extremity Charge

Facility

$130.00

Service Code	HCPCS 97022 GO
Hospital Charge Code	426970220
Hospital Revenue Code	430
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$84.50
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: MDX Hawaii PPO	$126.10

Whirlpool Full Body Charge

Facility

$130.00

Service Code	HCPCS 97022 GP
Hospital Charge Code	432970220
Hospital Revenue Code	420
Min. Negotiated Rate	$11.89
Max. Negotiated Rate	$126.10
Rate for Payer: AlohaCare Medicaid	$65.00
Rate for Payer: AlohaCare Medicare	$54.60
Rate for Payer: Cash Price	$84.50
Rate for Payer: Cash Price	$84.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$119.60
Rate for Payer: Devoted Health Medicare	$54.60
Rate for Payer: Hawaii Medical Service Association Medicare	$54.60
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Humana Medicare	$54.60
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: Kaiser Permanente Medicaid	$66.30
Rate for Payer: Kaiser Permanente Medicare	$54.60
Rate for Payer: MDX Hawaii PPO	$126.10
Rate for Payer: Ohana Health Plan Medicaid	$54.60
Rate for Payer: Ohana Health Plan Medicare	$54.60
Rate for Payer: UnitedHealthcare Medicaid	$11.89
Rate for Payer: UnitedHealthcare Medicare	$54.60
Rate for Payer: University Health Alliance Commercial	$94.76

Whirlpool Full Body Charge

Facility

$130.00

Service Code	HCPCS 97022 GP
Hospital Charge Code	432970220
Hospital Revenue Code	420
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$84.50
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: MDX Hawaii PPO	$126.10

WHIRLPOOL Occupational

Facility

$130.00

Service Code	HCPCS 97022 GO
Hospital Charge Code	426970220
Hospital Revenue Code	430
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$84.50
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: MDX Hawaii PPO	$126.10

WHIRLPOOL Occupational

Facility

$130.00

Service Code	HCPCS 97022 GO
Hospital Charge Code	426970220
Hospital Revenue Code	430
Min. Negotiated Rate	$11.89
Max. Negotiated Rate	$126.10
Rate for Payer: AlohaCare Medicaid	$65.00
Rate for Payer: AlohaCare Medicare	$54.60
Rate for Payer: Cash Price	$84.50
Rate for Payer: Cash Price	$84.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$119.60
Rate for Payer: Devoted Health Medicare	$54.60
Rate for Payer: Hawaii Medical Service Association Medicare	$54.60
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Humana Medicare	$54.60
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: Kaiser Permanente Medicaid	$66.30
Rate for Payer: Kaiser Permanente Medicare	$54.60
Rate for Payer: MDX Hawaii PPO	$126.10
Rate for Payer: Ohana Health Plan Medicaid	$54.60
Rate for Payer: Ohana Health Plan Medicare	$54.60
Rate for Payer: UnitedHealthcare Medicaid	$11.89
Rate for Payer: UnitedHealthcare Medicare	$54.60
Rate for Payer: University Health Alliance Commercial	$94.76

WHIRLPOOL Physical

Facility

$130.00

Service Code	HCPCS 97022 GP
Hospital Charge Code	432970220
Hospital Revenue Code	420
Min. Negotiated Rate	$11.89
Max. Negotiated Rate	$126.10
Rate for Payer: AlohaCare Medicaid	$65.00
Rate for Payer: AlohaCare Medicare	$54.60
Rate for Payer: Cash Price	$84.50
Rate for Payer: Cash Price	$84.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$119.60
Rate for Payer: Devoted Health Medicare	$54.60
Rate for Payer: Hawaii Medical Service Association Medicare	$54.60
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Humana Medicare	$54.60
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: Kaiser Permanente Medicaid	$66.30
Rate for Payer: Kaiser Permanente Medicare	$54.60
Rate for Payer: MDX Hawaii PPO	$126.10
Rate for Payer: Ohana Health Plan Medicaid	$54.60
Rate for Payer: Ohana Health Plan Medicare	$54.60
Rate for Payer: UnitedHealthcare Medicaid	$11.89
Rate for Payer: UnitedHealthcare Medicare	$54.60
Rate for Payer: University Health Alliance Commercial	$94.76

WHIRLPOOL Physical

Facility

$130.00

Service Code	HCPCS 97022 GP
Hospital Charge Code	432970220
Hospital Revenue Code	420
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$126.10
Rate for Payer: Cash Price	$84.50
Rate for Payer: Health Management Network Commercial	$110.50
Rate for Payer: Kaiser Permanente Commercial	$117.00
Rate for Payer: MDX Hawaii PPO	$126.10

WHO CF CCKUP ULN/RAD REST Occupational

Facility

$810.00

Service Code	HCPCS L3906
Hospital Charge Code	432L39060
Hospital Revenue Code	274
Min. Negotiated Rate	$255.64
Max. Negotiated Rate	$785.70
Rate for Payer: AlohaCare Medicaid	$405.00
Rate for Payer: AlohaCare Medicare	$340.20
Rate for Payer: Cash Price	$526.50
Rate for Payer: Cash Price	$526.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$745.20
Rate for Payer: Devoted Health Medicare	$340.20
Rate for Payer: Hawaii Medical Service Association Medicare	$340.20
Rate for Payer: Hawaii Western Management Group Commercial	$567.00
Rate for Payer: Health Management Network Commercial	$688.50
Rate for Payer: Humana Medicare	$340.20
Rate for Payer: Kaiser Permanente Commercial	$729.00
Rate for Payer: Kaiser Permanente Medicaid	$413.10
Rate for Payer: Kaiser Permanente Medicare	$340.20
Rate for Payer: MDX Hawaii PPO	$785.70
Rate for Payer: Ohana Health Plan Medicaid	$340.20
Rate for Payer: Ohana Health Plan Medicare	$340.20
Rate for Payer: UnitedHealthcare Medicaid	$255.64
Rate for Payer: UnitedHealthcare Medicare	$340.20
Rate for Payer: University Health Alliance Commercial	$453.60

WHO CF CCKUP ULN/RAD REST Occupational

Facility

$810.00

Service Code	HCPCS L3906
Hospital Charge Code	432L39060
Hospital Revenue Code	274
Min. Negotiated Rate	$453.60
Max. Negotiated Rate	$785.70
Rate for Payer: Cash Price	$526.50
Rate for Payer: Hawaii Western Management Group Commercial	$567.00
Rate for Payer: Health Management Network Commercial	$688.50
Rate for Payer: Kaiser Permanente Commercial	$729.00
Rate for Payer: MDX Hawaii PPO	$785.70
Rate for Payer: University Health Alliance Commercial	$453.60

WO PF COCK-UP Occupational

Facility

$207.00

Service Code	HCPCS L3908
Hospital Charge Code	432L39080
Hospital Revenue Code	274
Min. Negotiated Rate	$49.46
Max. Negotiated Rate	$200.79
Rate for Payer: AlohaCare Medicaid	$103.50
Rate for Payer: AlohaCare Medicare	$86.94
Rate for Payer: Cash Price	$134.55
Rate for Payer: Cash Price	$134.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$190.44
Rate for Payer: Devoted Health Medicare	$86.94
Rate for Payer: Hawaii Medical Service Association Medicare	$86.94
Rate for Payer: Hawaii Western Management Group Commercial	$144.90
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: Humana Medicare	$86.94
Rate for Payer: Kaiser Permanente Commercial	$186.30
Rate for Payer: Kaiser Permanente Medicaid	$105.57
Rate for Payer: Kaiser Permanente Medicare	$86.94
Rate for Payer: MDX Hawaii PPO	$200.79
Rate for Payer: Ohana Health Plan Medicaid	$86.94
Rate for Payer: Ohana Health Plan Medicare	$86.94
Rate for Payer: UnitedHealthcare Medicaid	$49.46
Rate for Payer: UnitedHealthcare Medicare	$86.94
Rate for Payer: University Health Alliance Commercial	$115.92

WO PF COCK-UP Occupational

Facility

$207.00

Service Code	HCPCS L3908
Hospital Charge Code	432L39080
Hospital Revenue Code	274
Min. Negotiated Rate	$115.92
Max. Negotiated Rate	$200.79
Rate for Payer: Cash Price	$134.55
Rate for Payer: Hawaii Western Management Group Commercial	$144.90
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: Kaiser Permanente Commercial	$186.30
Rate for Payer: MDX Hawaii PPO	$200.79
Rate for Payer: University Health Alliance Commercial	$115.92

WO PF (EG NEO/LYCRA)Occupational

Facility

$115.00

Service Code	HCPCS L3909
Hospital Charge Code	432L39090
Hospital Revenue Code	274
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$111.55
Rate for Payer: Cash Price	$74.75
Rate for Payer: Hawaii Western Management Group Commercial	$80.50
Rate for Payer: Health Management Network Commercial	$97.75
Rate for Payer: Kaiser Permanente Commercial	$103.50
Rate for Payer: MDX Hawaii PPO	$111.55
Rate for Payer: University Health Alliance Commercial	$64.40

WO PF (EG NEO/LYCRA)Occupational

Facility

$115.00

Service Code	HCPCS L3909
Hospital Charge Code	432L39090
Hospital Revenue Code	274
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$111.55
Rate for Payer: AlohaCare Medicaid	$57.50
Rate for Payer: AlohaCare Medicare	$48.30
Rate for Payer: Cash Price	$74.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$105.80
Rate for Payer: Devoted Health Medicare	$48.30
Rate for Payer: Hawaii Medical Service Association Medicare	$48.30
Rate for Payer: Hawaii Western Management Group Commercial	$80.50
Rate for Payer: Health Management Network Commercial	$97.75
Rate for Payer: Humana Medicare	$48.30
Rate for Payer: Kaiser Permanente Commercial	$103.50
Rate for Payer: Kaiser Permanente Medicaid	$58.65
Rate for Payer: Kaiser Permanente Medicare	$48.30
Rate for Payer: MDX Hawaii PPO	$111.55
Rate for Payer: Ohana Health Plan Medicaid	$48.30
Rate for Payer: Ohana Health Plan Medicare	$48.30
Rate for Payer: UnitedHealthcare Medicare	$48.30
Rate for Payer: University Health Alliance Commercial	$64.40

Work Hardening Additional Hours Charge

Facility

$179.00

Service Code	HCPCS 97546 GP
Hospital Charge Code	426975460
Hospital Revenue Code	420
Min. Negotiated Rate	$75.18
Max. Negotiated Rate	$173.63
Rate for Payer: AlohaCare Medicaid	$89.50
Rate for Payer: AlohaCare Medicare	$75.18
Rate for Payer: Cash Price	$116.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$164.68
Rate for Payer: Devoted Health Medicare	$75.18
Rate for Payer: Hawaii Medical Service Association Medicare	$75.18
Rate for Payer: Hawaii Western Management Group Commercial	$170.05
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Humana Medicare	$75.18
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: Kaiser Permanente Medicaid	$91.29
Rate for Payer: Kaiser Permanente Medicare	$75.18
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: Ohana Health Plan Medicaid	$75.18
Rate for Payer: Ohana Health Plan Medicare	$75.18
Rate for Payer: UnitedHealthcare Medicare	$75.18
Rate for Payer: University Health Alliance Commercial	$130.47

Work Hardening Additional Hours Charge

Facility

$179.00

Service Code	HCPCS 97546 GP
Hospital Charge Code	426975460
Hospital Revenue Code	420
Min. Negotiated Rate	$152.15
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$116.35
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63

WORK HARDENING/CONDITIONING 1ST 2 HR

Professional

Both

$268.00

Service Code	HCPCS 97545
Hospital Revenue Code	420
Min. Negotiated Rate	$64.63
Max. Negotiated Rate	$227.80
Rate for Payer: Cash Price	$174.20
Rate for Payer: Cash Price	$174.20
Rate for Payer: Hawaii Western Management Group Commercial	$64.63
Rate for Payer: Health Management Network Commercial	$227.80

WORK HARDENING/CONDITIONING EACH HOUR

Professional

Both

$162.00

Service Code	HCPCS 97546
Hospital Revenue Code	420
Min. Negotiated Rate	$25.85
Max. Negotiated Rate	$137.70
Rate for Payer: Cash Price	$105.30
Rate for Payer: Cash Price	$105.30
Rate for Payer: Hawaii Western Management Group Commercial	$25.85
Rate for Payer: Health Management Network Commercial	$137.70

Wound Culture with Gram stain DLS

Facility

$129.00

Service Code	HCPCS 87070
Hospital Charge Code	422870705
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$125.13
Rate for Payer: AlohaCare Medicaid	$64.50
Rate for Payer: AlohaCare Medicare	$54.18
Rate for Payer: Cash Price	$83.85
Rate for Payer: Cash Price	$83.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$118.68
Rate for Payer: Devoted Health Medicare	$54.18
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.90
Rate for Payer: Hawaii Medical Service Association Commercial	$10.78
Rate for Payer: Hawaii Medical Service Association Medicare	$54.18
Rate for Payer: Hawaii Western Management Group Commercial	$8.62
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Humana Medicare	$54.18
Rate for Payer: Kaiser Permanente Commercial	$116.10
Rate for Payer: Kaiser Permanente Medicaid	$65.79
Rate for Payer: Kaiser Permanente Medicare	$54.18
Rate for Payer: MDX Hawaii PPO	$125.13
Rate for Payer: Ohana Health Plan Medicaid	$54.18
Rate for Payer: Ohana Health Plan Medicare	$54.18
Rate for Payer: UnitedHealthcare Medicaid	$11.90
Rate for Payer: UnitedHealthcare Medicare	$54.18
Rate for Payer: University Health Alliance Commercial	$22.26

Wound Culture with Gram stain DLS

Facility

$129.00

Service Code	HCPCS 87070
Hospital Charge Code	422870705
Hospital Revenue Code	306
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$125.13
Rate for Payer: Cash Price	$83.85
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Kaiser Permanente Commercial	$116.10
Rate for Payer: MDX Hawaii PPO	$125.13

WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$101,136.43

Service Code	MSDRG 464
Min. Negotiated Rate	$101,136.43
Max. Negotiated Rate	$101,136.43
Rate for Payer: Hawaii Medical Service Association Commercial	$101,136.43

WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$101,136.43

Service Code	MSDRG 463
Min. Negotiated Rate	$101,136.43
Max. Negotiated Rate	$101,136.43
Rate for Payer: Hawaii Medical Service Association Commercial	$101,136.43

Know your out-of-pocket cost for care.

All Charges