Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

XR Insert PICC Line less than 5 Year

Facility

$4,339.00

Service Code	HCPCS 36568
Hospital Charge Code	440365680
Hospital Revenue Code	450
Min. Negotiated Rate	$3,688.15
Max. Negotiated Rate	$4,208.83
Rate for Payer: Cash Price	$2,820.35
Rate for Payer: Health Management Network Commercial	$3,688.15
Rate for Payer: Kaiser Permanente Commercial	$3,905.10
Rate for Payer: MDX Hawaii PPO	$4,208.83

XR Upper Extremity Infant Left

Facility

$581.00

Service Code	HCPCS 73092
Hospital Charge Code	424730920
Hospital Revenue Code	320
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$563.57
Rate for Payer: AlohaCare Medicaid	$290.50
Rate for Payer: AlohaCare Medicare	$244.02
Rate for Payer: Cash Price	$377.65
Rate for Payer: Cash Price	$377.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$534.52
Rate for Payer: Devoted Health Medicare	$244.02
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$16.41
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$244.02
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: Humana Medicare	$244.02
Rate for Payer: Kaiser Permanente Commercial	$522.90
Rate for Payer: Kaiser Permanente Medicaid	$296.31
Rate for Payer: Kaiser Permanente Medicare	$244.02
Rate for Payer: MDX Hawaii PPO	$563.57
Rate for Payer: Ohana Health Plan Medicaid	$244.02
Rate for Payer: Ohana Health Plan Medicare	$244.02
Rate for Payer: UnitedHealthcare Medicaid	$16.41
Rate for Payer: UnitedHealthcare Medicare	$244.02
Rate for Payer: University Health Alliance Commercial	$56.28

XR Upper Extremity Infant Left

Facility

$581.00

Service Code	HCPCS 73092
Hospital Charge Code	424730920
Hospital Revenue Code	320
Min. Negotiated Rate	$493.85
Max. Negotiated Rate	$563.57
Rate for Payer: Cash Price	$377.65
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: Kaiser Permanente Commercial	$522.90
Rate for Payer: MDX Hawaii PPO	$563.57

XR Upper Extremity Infant Right

Facility

$581.00

Service Code	HCPCS 73092
Hospital Charge Code	424730920
Hospital Revenue Code	320
Min. Negotiated Rate	$493.85
Max. Negotiated Rate	$563.57
Rate for Payer: Cash Price	$377.65
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: Kaiser Permanente Commercial	$522.90
Rate for Payer: MDX Hawaii PPO	$563.57

XR Upper Extremity Infant Right

Facility

$581.00

Service Code	HCPCS 73092
Hospital Charge Code	424730920
Hospital Revenue Code	320
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$563.57
Rate for Payer: AlohaCare Medicaid	$290.50
Rate for Payer: AlohaCare Medicare	$244.02
Rate for Payer: Cash Price	$377.65
Rate for Payer: Cash Price	$377.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$534.52
Rate for Payer: Devoted Health Medicare	$244.02
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$16.41
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$244.02
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: Humana Medicare	$244.02
Rate for Payer: Kaiser Permanente Commercial	$522.90
Rate for Payer: Kaiser Permanente Medicaid	$296.31
Rate for Payer: Kaiser Permanente Medicare	$244.02
Rate for Payer: MDX Hawaii PPO	$563.57
Rate for Payer: Ohana Health Plan Medicaid	$244.02
Rate for Payer: Ohana Health Plan Medicare	$244.02
Rate for Payer: UnitedHealthcare Medicaid	$16.41
Rate for Payer: UnitedHealthcare Medicare	$244.02
Rate for Payer: University Health Alliance Commercial	$56.28

XTRNL ECG REC<48 HRS RECORDING SCAN A/R R&I

Professional

Both

$240.00

Service Code	HCPCS 93224
Hospital Revenue Code	730
Min. Negotiated Rate	$77.83
Max. Negotiated Rate	$204.00
Rate for Payer: AlohaCare Medicaid	$80.09
Rate for Payer: AlohaCare Medicare	$77.83
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Devoted Health Medicare	$77.83
Rate for Payer: Hawaii Medical Service Association Medicare	$77.83
Rate for Payer: Hawaii Western Management Group Commercial	$183.11
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Kaiser Permanente Commercial	$93.40
Rate for Payer: Kaiser Permanente Medicaid	$93.40
Rate for Payer: Kaiser Permanente Medicare	$93.40
Rate for Payer: Ohana Health Plan Medicaid	$80.09
Rate for Payer: Ohana Health Plan Medicare	$77.83
Rate for Payer: UnitedHealthcare Medicaid	$80.09
Rate for Payer: UnitedHealthcare Medicare	$77.83

YANKAUER

Facility

$6.00

Hospital Charge Code	8393
Hospital Revenue Code	270
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.90
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

YANKAUER

Facility

$6.00

Hospital Charge Code	8393
Hospital Revenue Code	270
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$2.52
Rate for Payer: Cash Price	$3.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.52
Rate for Payer: Devoted Health Medicare	$2.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2.52
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$2.52
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$2.52
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$2.52
Rate for Payer: Ohana Health Plan Medicare	$2.52
Rate for Payer: UnitedHealthcare Medicare	$2.52
Rate for Payer: University Health Alliance Commercial	$4.37

Yersinia Stool Culture DLS

Facility

$25.00

Service Code	HCPCS 87046
Hospital Charge Code	422870465
Hospital Revenue Code	306
Min. Negotiated Rate	$7.91
Max. Negotiated Rate	$24.38
Rate for Payer: AlohaCare Medicaid	$12.50
Rate for Payer: AlohaCare Medicare	$10.50
Rate for Payer: Cash Price	$16.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$23.00
Rate for Payer: Devoted Health Medicare	$10.50
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.91
Rate for Payer: Hawaii Medical Service Association Commercial	$11.80
Rate for Payer: Hawaii Medical Service Association Medicare	$10.50
Rate for Payer: Hawaii Western Management Group Commercial	$9.44
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Humana Medicare	$10.50
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: Kaiser Permanente Medicaid	$12.75
Rate for Payer: Kaiser Permanente Medicare	$10.50
Rate for Payer: MDX Hawaii PPO	$24.25
Rate for Payer: Ohana Health Plan Medicaid	$10.50
Rate for Payer: Ohana Health Plan Medicare	$10.50
Rate for Payer: UnitedHealthcare Medicaid	$7.91
Rate for Payer: UnitedHealthcare Medicare	$10.50
Rate for Payer: University Health Alliance Commercial	$24.38

Yersinia Stool Culture DLS

Facility

$25.00

Service Code	HCPCS 87046
Hospital Charge Code	422870465
Hospital Revenue Code	306
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: MDX Hawaii PPO	$24.25

zafirlukast 20 mg Tab [KMC]

Facility

$8.65

Service Code	NDC 55111062660
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$8.39
Rate for Payer: Cash Price	$5.62
Rate for Payer: Health Management Network Commercial	$7.35
Rate for Payer: Kaiser Permanente Commercial	$7.79
Rate for Payer: MDX Hawaii PPO	$8.39

zafirlukast 20 mg Tab [KMC]

Facility

$8.65

Service Code	NDC 55111062660
Hospital Revenue Code	250
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$8.39
Rate for Payer: AlohaCare Medicaid	$4.33
Rate for Payer: AlohaCare Medicare	$3.63
Rate for Payer: Cash Price	$5.62
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7.96
Rate for Payer: Devoted Health Medicare	$3.63
Rate for Payer: Hawaii Medical Service Association Medicare	$3.63
Rate for Payer: Hawaii Western Management Group Commercial	$8.22
Rate for Payer: Health Management Network Commercial	$7.35
Rate for Payer: Humana Medicare	$3.63
Rate for Payer: Kaiser Permanente Commercial	$7.79
Rate for Payer: Kaiser Permanente Medicaid	$4.41
Rate for Payer: Kaiser Permanente Medicare	$3.63
Rate for Payer: MDX Hawaii PPO	$8.39
Rate for Payer: Ohana Health Plan Medicaid	$3.63
Rate for Payer: Ohana Health Plan Medicare	$3.63
Rate for Payer: UnitedHealthcare Medicaid	$5.19
Rate for Payer: UnitedHealthcare Medicare	$3.63
Rate for Payer: University Health Alliance Commercial	$6.30

Zinc DLS

Facility

$207.00

Service Code	HCPCS 84630
Hospital Charge Code	422846305
Hospital Revenue Code	301
Min. Negotiated Rate	$175.95
Max. Negotiated Rate	$200.79
Rate for Payer: Cash Price	$134.55
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

Zinc DLS

Facility

$207.00

Service Code	HCPCS 84630
Hospital Charge Code	422846305
Hospital Revenue Code	301
Min. Negotiated Rate	$11.39
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 ABD/Non-ABD	$15.74
Rate for Payer: Hawaii Medical Service Association Commercial	$14.24
Rate for Payer: Hawaii Medical Service Association Medicare	$86.94
Rate for Payer: Hawaii Western Management Group Commercial	$11.39
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	$15.74
Rate for Payer: UnitedHealthcare Medicare	$86.94
Rate for Payer: University Health Alliance Commercial	$29.43

zinc oxide 20% Ointment [KMC]

Facility

$0.64

Service Code	NDC 75834017002
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.62
Rate for Payer: Cash Price	$0.42
Rate for Payer: Health Management Network Commercial	$0.54
Rate for Payer: Kaiser Permanente Commercial	$0.58
Rate for Payer: MDX Hawaii PPO	$0.62

zinc oxide 20% Ointment [KMC]

Facility

$0.64

Service Code	NDC 75834017002
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.62
Rate for Payer: AlohaCare Medicaid	$0.32
Rate for Payer: AlohaCare Medicare	$0.27
Rate for Payer: Cash Price	$0.42
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.59
Rate for Payer: Devoted Health Medicare	$0.27
Rate for Payer: Hawaii Medical Service Association Medicare	$0.27
Rate for Payer: Hawaii Western Management Group Commercial	$0.61
Rate for Payer: Health Management Network Commercial	$0.54
Rate for Payer: Humana Medicare	$0.27
Rate for Payer: Kaiser Permanente Commercial	$0.58
Rate for Payer: Kaiser Permanente Medicaid	$0.33
Rate for Payer: Kaiser Permanente Medicare	$0.27
Rate for Payer: MDX Hawaii PPO	$0.62
Rate for Payer: Ohana Health Plan Medicaid	$0.27
Rate for Payer: Ohana Health Plan Medicare	$0.27
Rate for Payer: UnitedHealthcare Medicaid	$0.38
Rate for Payer: UnitedHealthcare Medicare	$0.27
Rate for Payer: University Health Alliance Commercial	$0.47

zinc oxide (Desitin) 13% Ointment [KMC]

Facility

$3.00

Service Code	NDC 58232071903
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

zinc oxide (Desitin) 13% Ointment [KMC]

Facility

$3.00

Service Code	NDC 58232071903
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

zinc sulfate 220 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 80681013500
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

zinc sulfate 220 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 80681013500
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

ziprasidone 20 mg REC vial [KMC]

Facility

$157.39

Service Code	HCPCS J3486
Hospital Revenue Code	636
Min. Negotiated Rate	$133.78
Max. Negotiated Rate	$152.67
Rate for Payer: Cash Price	$102.30
Rate for Payer: Health Management Network Commercial	$133.78
Rate for Payer: Kaiser Permanente Commercial	$141.65
Rate for Payer: MDX Hawaii PPO	$152.67

ziprasidone 20 mg REC vial [KMC]

Facility

$157.39

Service Code	HCPCS J3486
Hospital Revenue Code	636
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$152.67
Rate for Payer: AlohaCare Medicaid	$78.69
Rate for Payer: AlohaCare Medicare	$66.10
Rate for Payer: Cash Price	$102.30
Rate for Payer: Cash Price	$102.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$144.80
Rate for Payer: Devoted Health Medicare	$66.10
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$3.14
Rate for Payer: Hawaii Medical Service Association Medicare	$66.10
Rate for Payer: Hawaii Western Management Group Commercial	$149.52
Rate for Payer: Health Management Network Commercial	$133.78
Rate for Payer: Humana Medicare	$66.10
Rate for Payer: Kaiser Permanente Commercial	$141.65
Rate for Payer: Kaiser Permanente Medicaid	$80.27
Rate for Payer: Kaiser Permanente Medicare	$66.10
Rate for Payer: MDX Hawaii PPO	$152.67
Rate for Payer: Ohana Health Plan Medicaid	$66.10
Rate for Payer: Ohana Health Plan Medicare	$66.10
Rate for Payer: UnitedHealthcare Medicaid	$94.43
Rate for Payer: UnitedHealthcare Medicare	$66.10
Rate for Payer: University Health Alliance Commercial	$114.72

ziprasidone 40 mg Cap [KMC]

Facility

$51.59

Service Code	NDC 00049397060
Hospital Revenue Code	250
Min. Negotiated Rate	$43.85
Max. Negotiated Rate	$50.04
Rate for Payer: Cash Price	$33.53
Rate for Payer: Health Management Network Commercial	$43.85
Rate for Payer: Kaiser Permanente Commercial	$46.43
Rate for Payer: MDX Hawaii PPO	$50.04

ziprasidone 40 mg Cap [KMC]

Facility

$51.59

Service Code	NDC 00049397060
Hospital Revenue Code	250
Min. Negotiated Rate	$21.67
Max. Negotiated Rate	$50.04
Rate for Payer: AlohaCare Medicaid	$25.80
Rate for Payer: AlohaCare Medicare	$21.67
Rate for Payer: Cash Price	$33.53
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$47.46
Rate for Payer: Devoted Health Medicare	$21.67
Rate for Payer: Hawaii Medical Service Association Medicare	$21.67
Rate for Payer: Hawaii Western Management Group Commercial	$49.01
Rate for Payer: Health Management Network Commercial	$43.85
Rate for Payer: Humana Medicare	$21.67
Rate for Payer: Kaiser Permanente Commercial	$46.43
Rate for Payer: Kaiser Permanente Medicaid	$26.31
Rate for Payer: Kaiser Permanente Medicare	$21.67
Rate for Payer: MDX Hawaii PPO	$50.04
Rate for Payer: Ohana Health Plan Medicaid	$21.67
Rate for Payer: Ohana Health Plan Medicare	$21.67
Rate for Payer: UnitedHealthcare Medicaid	$30.95
Rate for Payer: UnitedHealthcare Medicare	$21.67
Rate for Payer: University Health Alliance Commercial	$37.60

ziprasidone 60 mg Cap [KMC]

Facility

$43.05

Service Code	NDC 16714083701
Hospital Revenue Code	250
Min. Negotiated Rate	$36.59
Max. Negotiated Rate	$41.76
Rate for Payer: Cash Price	$27.98
Rate for Payer: Health Management Network Commercial	$36.59
Rate for Payer: Kaiser Permanente Commercial	$38.74
Rate for Payer: MDX Hawaii PPO	$41.76

Know your out-of-pocket cost for care.

All Charges