Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

belzutifan 40 mg Tab

Facility

$1,581.94

Service Code	NDC 00006533101
Hospital Revenue Code	250
Min. Negotiated Rate	$1,344.65
Max. Negotiated Rate	$1,534.48
Rate for Payer: Cash Price	$1,028.26
Rate for Payer: Health Management Network Commercial	$1,344.65
Rate for Payer: Kaiser Permanente Commercial	$1,423.75
Rate for Payer: MDX Hawaii PPO	$1,534.48

belzutifan 40 mg Tab

Facility

$1,581.94

Service Code	NDC 00006533101
Hospital Revenue Code	250
Min. Negotiated Rate	$664.41
Max. Negotiated Rate	$1,534.48
Rate for Payer: AlohaCare Medicaid	$790.97
Rate for Payer: AlohaCare Medicare	$664.41
Rate for Payer: Cash Price	$1,028.26
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,455.38
Rate for Payer: Devoted Health Medicare	$664.41
Rate for Payer: Hawaii Medical Service Association Medicare	$664.41
Rate for Payer: Hawaii Western Management Group Commercial	$1,502.84
Rate for Payer: Health Management Network Commercial	$1,344.65
Rate for Payer: Humana Medicare	$664.41
Rate for Payer: Kaiser Permanente Commercial	$1,423.75
Rate for Payer: Kaiser Permanente Medicaid	$806.79
Rate for Payer: Kaiser Permanente Medicare	$664.41
Rate for Payer: MDX Hawaii PPO	$1,534.48
Rate for Payer: Ohana Health Plan Medicaid	$664.41
Rate for Payer: Ohana Health Plan Medicare	$664.41
Rate for Payer: UnitedHealthcare Medicaid	$949.16
Rate for Payer: UnitedHealthcare Medicare	$664.41
Rate for Payer: University Health Alliance Commercial	$1,153.08

bempedoic acid 180 mg Tab [KMC]

Facility

$61.51

Service Code	NDC 72426011803
Hospital Revenue Code	250
Min. Negotiated Rate	$25.83
Max. Negotiated Rate	$59.66
Rate for Payer: AlohaCare Medicaid	$30.75
Rate for Payer: AlohaCare Medicare	$25.83
Rate for Payer: Cash Price	$39.98
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$56.59
Rate for Payer: Devoted Health Medicare	$25.83
Rate for Payer: Hawaii Medical Service Association Medicare	$25.83
Rate for Payer: Hawaii Western Management Group Commercial	$58.43
Rate for Payer: Health Management Network Commercial	$52.28
Rate for Payer: Humana Medicare	$25.83
Rate for Payer: Kaiser Permanente Commercial	$55.36
Rate for Payer: Kaiser Permanente Medicaid	$31.37
Rate for Payer: Kaiser Permanente Medicare	$25.83
Rate for Payer: MDX Hawaii PPO	$59.66
Rate for Payer: Ohana Health Plan Medicaid	$25.83
Rate for Payer: Ohana Health Plan Medicare	$25.83
Rate for Payer: UnitedHealthcare Medicaid	$36.91
Rate for Payer: UnitedHealthcare Medicare	$25.83
Rate for Payer: University Health Alliance Commercial	$44.83

bempedoic acid 180 mg Tab [KMC]

Facility

$61.51

Service Code	NDC 72426011803
Hospital Revenue Code	250
Min. Negotiated Rate	$52.28
Max. Negotiated Rate	$59.66
Rate for Payer: Cash Price	$39.98
Rate for Payer: Health Management Network Commercial	$52.28
Rate for Payer: Kaiser Permanente Commercial	$55.36
Rate for Payer: MDX Hawaii PPO	$59.66

Benefiber powder [KMC]

Facility

$3.00

Service Code	NDC 88679001338
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

Benefiber powder [KMC]

Facility

$3.00

Service Code	NDC 88679001338
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

BENIGN PROSTATIC HYPERTROPHY WITH MCC

Facility

$25,005.61

Service Code	MSDRG 725
Min. Negotiated Rate	$25,005.61
Max. Negotiated Rate	$25,005.61
Rate for Payer: Hawaii Medical Service Association Commercial	$25,005.61

BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC

Facility

$25,005.61

Service Code	MSDRG 726
Min. Negotiated Rate	$25,005.61
Max. Negotiated Rate	$25,005.61
Rate for Payer: Hawaii Medical Service Association Commercial	$25,005.61

benzathine penicillin-procaine penicillin 600,000 units-600,000 units/2 mL Sus [KMC]

Facility

$204.13

Service Code	HCPCS J0558
Hospital Revenue Code	636
Min. Negotiated Rate	$17.37
Max. Negotiated Rate	$198.01
Rate for Payer: AlohaCare Medicaid	$102.06
Rate for Payer: AlohaCare Medicare	$85.73
Rate for Payer: Cash Price	$132.68
Rate for Payer: Cash Price	$132.68
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$187.80
Rate for Payer: Devoted Health Medicare	$85.73
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$17.37
Rate for Payer: Hawaii Medical Service Association Commercial	$24.40
Rate for Payer: Hawaii Medical Service Association Medicare	$85.73
Rate for Payer: Hawaii Western Management Group Commercial	$193.92
Rate for Payer: Health Management Network Commercial	$173.51
Rate for Payer: Humana Medicare	$85.73
Rate for Payer: Kaiser Permanente Commercial	$183.72
Rate for Payer: Kaiser Permanente Medicaid	$104.11
Rate for Payer: Kaiser Permanente Medicare	$85.73
Rate for Payer: MDX Hawaii PPO	$198.01
Rate for Payer: Ohana Health Plan Medicaid	$85.73
Rate for Payer: Ohana Health Plan Medicare	$85.73
Rate for Payer: UnitedHealthcare Medicaid	$122.48
Rate for Payer: UnitedHealthcare Medicare	$85.73
Rate for Payer: University Health Alliance Commercial	$148.79

benzathine penicillin-procaine penicillin 600,000 units-600,000 units/2 mL Sus [KMC]

Facility

$204.13

Service Code	HCPCS J0558
Hospital Revenue Code	636
Min. Negotiated Rate	$173.51
Max. Negotiated Rate	$198.01
Rate for Payer: Cash Price	$132.68
Rate for Payer: Health Management Network Commercial	$173.51
Rate for Payer: Kaiser Permanente Commercial	$183.72
Rate for Payer: MDX Hawaii PPO	$198.01

benzocaine (Hurricaine) 20% spray [KMC]

Facility

$2.27

Service Code	NDC 00283067902
Hospital Revenue Code	250
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$2.20
Rate for Payer: Cash Price	$1.48
Rate for Payer: Health Management Network Commercial	$1.93
Rate for Payer: Kaiser Permanente Commercial	$2.04
Rate for Payer: MDX Hawaii PPO	$2.20

benzocaine (Hurricaine) 20% spray [KMC]

Facility

$2.27

Service Code	NDC 00283067902
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$2.20
Rate for Payer: AlohaCare Medicaid	$1.14
Rate for Payer: AlohaCare Medicare	$0.95
Rate for Payer: Cash Price	$1.48
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.09
Rate for Payer: Devoted Health Medicare	$0.95
Rate for Payer: Hawaii Medical Service Association Medicare	$0.95
Rate for Payer: Hawaii Western Management Group Commercial	$2.16
Rate for Payer: Health Management Network Commercial	$1.93
Rate for Payer: Humana Medicare	$0.95
Rate for Payer: Kaiser Permanente Commercial	$2.04
Rate for Payer: Kaiser Permanente Medicaid	$1.16
Rate for Payer: Kaiser Permanente Medicare	$0.95
Rate for Payer: MDX Hawaii PPO	$2.20
Rate for Payer: Ohana Health Plan Medicaid	$0.95
Rate for Payer: Ohana Health Plan Medicare	$0.95
Rate for Payer: UnitedHealthcare Medicaid	$1.36
Rate for Payer: UnitedHealthcare Medicare	$0.95
Rate for Payer: University Health Alliance Commercial	$1.65

benzocaine (Orajel) 20% Oral Liquid [KMC]

Facility

$1.85

Service Code	NDC 10310032945
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.79
Rate for Payer: AlohaCare Medicaid	$0.93
Rate for Payer: AlohaCare Medicare	$0.78
Rate for Payer: Cash Price	$1.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1.70
Rate for Payer: Devoted Health Medicare	$0.78
Rate for Payer: Hawaii Medical Service Association Medicare	$0.78
Rate for Payer: Hawaii Western Management Group Commercial	$1.76
Rate for Payer: Health Management Network Commercial	$1.57
Rate for Payer: Humana Medicare	$0.78
Rate for Payer: Kaiser Permanente Commercial	$1.67
Rate for Payer: Kaiser Permanente Medicaid	$0.94
Rate for Payer: Kaiser Permanente Medicare	$0.78
Rate for Payer: MDX Hawaii PPO	$1.79
Rate for Payer: Ohana Health Plan Medicaid	$0.78
Rate for Payer: Ohana Health Plan Medicare	$0.78
Rate for Payer: UnitedHealthcare Medicaid	$1.11
Rate for Payer: UnitedHealthcare Medicare	$0.78
Rate for Payer: University Health Alliance Commercial	$1.35

benzocaine (Orajel) 20% Oral Liquid [KMC]

Facility

$1.85

Service Code	NDC 10310032945
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.79
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.57
Rate for Payer: Kaiser Permanente Commercial	$1.67
Rate for Payer: MDX Hawaii PPO	$1.79

benzonatate 100 mg Cap [KMC]

Facility

$9.08

Service Code	NDC 42806071405
Hospital Revenue Code	250
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$8.81
Rate for Payer: AlohaCare Medicaid	$4.54
Rate for Payer: AlohaCare Medicare	$3.81
Rate for Payer: Cash Price	$5.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$8.35
Rate for Payer: Devoted Health Medicare	$3.81
Rate for Payer: Hawaii Medical Service Association Medicare	$3.81
Rate for Payer: Hawaii Western Management Group Commercial	$8.63
Rate for Payer: Health Management Network Commercial	$7.72
Rate for Payer: Humana Medicare	$3.81
Rate for Payer: Kaiser Permanente Commercial	$8.17
Rate for Payer: Kaiser Permanente Medicaid	$4.63
Rate for Payer: Kaiser Permanente Medicare	$3.81
Rate for Payer: MDX Hawaii PPO	$8.81
Rate for Payer: Ohana Health Plan Medicaid	$3.81
Rate for Payer: Ohana Health Plan Medicare	$3.81
Rate for Payer: UnitedHealthcare Medicaid	$5.45
Rate for Payer: UnitedHealthcare Medicare	$3.81
Rate for Payer: University Health Alliance Commercial	$6.62

benzonatate 100 mg Cap [KMC]

Facility

$9.08

Service Code	NDC 42806071405
Hospital Revenue Code	250
Min. Negotiated Rate	$7.72
Max. Negotiated Rate	$8.81
Rate for Payer: Cash Price	$5.90
Rate for Payer: Health Management Network Commercial	$7.72
Rate for Payer: Kaiser Permanente Commercial	$8.17
Rate for Payer: MDX Hawaii PPO	$8.81

benztropine 0.5 mg Tab [KMC]

Facility

$3.00

Service Code	HCPCS A9270
Hospital Revenue Code	637
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

benztropine 0.5 mg Tab [KMC]

Facility

$3.00

Service Code	HCPCS A9270
Hospital Revenue Code	637
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

benztropine 2 mg / 2 mL Inj Sol [KMC]

Facility

$150.00

Service Code	HCPCS J0515
Hospital Revenue Code	636
Min. Negotiated Rate	$17.27
Max. Negotiated Rate	$145.50
Rate for Payer: AlohaCare Medicaid	$75.00
Rate for Payer: AlohaCare Medicare	$63.00
Rate for Payer: Cash Price	$97.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$138.00
Rate for Payer: Devoted Health Medicare	$63.00
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$17.27
Rate for Payer: Hawaii Medical Service Association Medicare	$63.00
Rate for Payer: Hawaii Western Management Group Commercial	$142.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Humana Medicare	$63.00
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicare	$63.00
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: Ohana Health Plan Medicaid	$63.00
Rate for Payer: Ohana Health Plan Medicare	$63.00
Rate for Payer: UnitedHealthcare Medicaid	$90.00
Rate for Payer: UnitedHealthcare Medicare	$63.00
Rate for Payer: University Health Alliance Commercial	$109.33

benztropine 2 mg / 2 mL Inj Sol [KMC]

Facility

$150.00

Service Code	HCPCS J0515
Hospital Revenue Code	636
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$97.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: MDX Hawaii PPO	$145.50

benztropine 2 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 69315013801
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

benztropine 2 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 69315013801
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

betamethasone 6 mg/mL Susp [KMC]

Facility

$39.92

Service Code	HCPCS J0702
Hospital Revenue Code	636
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$38.72
Rate for Payer: AlohaCare Medicaid	$19.96
Rate for Payer: AlohaCare Medicare	$16.77
Rate for Payer: Cash Price	$25.95
Rate for Payer: Cash Price	$25.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$36.73
Rate for Payer: Devoted Health Medicare	$16.77
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$6.89
Rate for Payer: Hawaii Medical Service Association Medicare	$16.77
Rate for Payer: Hawaii Western Management Group Commercial	$37.92
Rate for Payer: Health Management Network Commercial	$33.93
Rate for Payer: Humana Medicare	$16.77
Rate for Payer: Kaiser Permanente Commercial	$35.93
Rate for Payer: Kaiser Permanente Medicaid	$20.36
Rate for Payer: Kaiser Permanente Medicare	$16.77
Rate for Payer: MDX Hawaii PPO	$38.72
Rate for Payer: Ohana Health Plan Medicaid	$16.77
Rate for Payer: Ohana Health Plan Medicare	$16.77
Rate for Payer: UnitedHealthcare Medicaid	$23.95
Rate for Payer: UnitedHealthcare Medicare	$16.77
Rate for Payer: University Health Alliance Commercial	$29.10

betamethasone 6 mg/mL Susp [KMC]

Facility

$39.92

Service Code	HCPCS J0702
Hospital Revenue Code	636
Min. Negotiated Rate	$33.93
Max. Negotiated Rate	$38.72
Rate for Payer: Cash Price	$25.95
Rate for Payer: Health Management Network Commercial	$33.93
Rate for Payer: Kaiser Permanente Commercial	$35.93
Rate for Payer: MDX Hawaii PPO	$38.72

betamethasone AUGMENTED 0.05% Cream

Facility

$1.23

Service Code	NDC 45802037635
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.19
Rate for Payer: Cash Price	$0.80
Rate for Payer: Health Management Network Commercial	$1.05
Rate for Payer: Kaiser Permanente Commercial	$1.11
Rate for Payer: MDX Hawaii PPO	$1.19

Know your out-of-pocket cost for care.

All Charges