Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

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

betamethasone-clotrimazole 0.05-1% Top Cream [KMC]

Facility

$6.35

Service Code	NDC 16714049602
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$6.16
Rate for Payer: Cash Price	$4.13
Rate for Payer: Health Management Network Commercial	$5.40
Rate for Payer: Kaiser Permanente Commercial	$5.71
Rate for Payer: MDX Hawaii PPO	$6.16

betamethasone-clotrimazole 0.05-1% Top Cream [KMC]

Facility

$6.35

Service Code	NDC 16714049602
Hospital Revenue Code	250
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$6.16
Rate for Payer: AlohaCare Medicaid	$3.17
Rate for Payer: AlohaCare Medicare	$2.67
Rate for Payer: Cash Price	$4.13
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.84
Rate for Payer: Devoted Health Medicare	$2.67
Rate for Payer: Hawaii Medical Service Association Medicare	$2.67
Rate for Payer: Hawaii Western Management Group Commercial	$6.03
Rate for Payer: Health Management Network Commercial	$5.40
Rate for Payer: Humana Medicare	$2.67
Rate for Payer: Kaiser Permanente Commercial	$5.71
Rate for Payer: Kaiser Permanente Medicaid	$3.24
Rate for Payer: Kaiser Permanente Medicare	$2.67
Rate for Payer: MDX Hawaii PPO	$6.16
Rate for Payer: Ohana Health Plan Medicaid	$2.67
Rate for Payer: Ohana Health Plan Medicare	$2.67
Rate for Payer: UnitedHealthcare Medicaid	$3.81
Rate for Payer: UnitedHealthcare Medicare	$2.67
Rate for Payer: University Health Alliance Commercial	$4.63

betamethasone dipropionate 0.05% Cream [KMC]

Facility

$9.39

Service Code	NDC 00168005546
Hospital Revenue Code	250
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$9.11
Rate for Payer: AlohaCare Medicaid	$4.70
Rate for Payer: AlohaCare Medicare	$3.94
Rate for Payer: Cash Price	$6.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$8.64
Rate for Payer: Devoted Health Medicare	$3.94
Rate for Payer: Hawaii Medical Service Association Medicare	$3.94
Rate for Payer: Hawaii Western Management Group Commercial	$8.92
Rate for Payer: Health Management Network Commercial	$7.98
Rate for Payer: Humana Medicare	$3.94
Rate for Payer: Kaiser Permanente Commercial	$8.45
Rate for Payer: Kaiser Permanente Medicaid	$4.79
Rate for Payer: Kaiser Permanente Medicare	$3.94
Rate for Payer: MDX Hawaii PPO	$9.11
Rate for Payer: Ohana Health Plan Medicaid	$3.94
Rate for Payer: Ohana Health Plan Medicare	$3.94
Rate for Payer: UnitedHealthcare Medicaid	$5.63
Rate for Payer: UnitedHealthcare Medicare	$3.94
Rate for Payer: University Health Alliance Commercial	$6.84

betamethasone dipropionate 0.05% Cream [KMC]

Facility

$9.39

Service Code	NDC 00168005546
Hospital Revenue Code	250
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$9.11
Rate for Payer: Cash Price	$6.10
Rate for Payer: Health Management Network Commercial	$7.98
Rate for Payer: Kaiser Permanente Commercial	$8.45
Rate for Payer: MDX Hawaii PPO	$9.11

betamethasone dipropionate 0.05% Lotion

Facility

$3.20

Service Code	NDC 00168005760
Hospital Revenue Code	250
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$3.10
Rate for Payer: Cash Price	$2.08
Rate for Payer: Health Management Network Commercial	$2.72
Rate for Payer: Kaiser Permanente Commercial	$2.88
Rate for Payer: MDX Hawaii PPO	$3.10

betamethasone dipropionate 0.05% Lotion

Facility

$3.20

Service Code	NDC 00168005760
Hospital Revenue Code	250
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$3.10
Rate for Payer: AlohaCare Medicaid	$1.60
Rate for Payer: AlohaCare Medicare	$1.34
Rate for Payer: Cash Price	$2.08
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.94
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	$3.04
Rate for Payer: Health Management Network Commercial	$2.72
Rate for Payer: Humana Medicare	$1.34
Rate for Payer: Kaiser Permanente Commercial	$2.88
Rate for Payer: Kaiser Permanente Medicaid	$1.63
Rate for Payer: Kaiser Permanente Medicare	$1.34
Rate for Payer: MDX Hawaii PPO	$3.10
Rate for Payer: Ohana Health Plan Medicaid	$1.34
Rate for Payer: Ohana Health Plan Medicare	$1.34
Rate for Payer: UnitedHealthcare Medicaid	$1.92
Rate for Payer: UnitedHealthcare Medicare	$1.34
Rate for Payer: University Health Alliance Commercial	$2.33

betamethasone valerate 0.1% Cream [KMC]

Facility

$5.97

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$5.07
Max. Negotiated Rate	$5.79
Rate for Payer: Cash Price	$3.88
Rate for Payer: Health Management Network Commercial	$5.07
Rate for Payer: Kaiser Permanente Commercial	$5.37
Rate for Payer: MDX Hawaii PPO	$5.79

betamethasone valerate 0.1% Cream [KMC]

Facility

$5.97

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$5.79
Rate for Payer: AlohaCare Medicaid	$2.98
Rate for Payer: AlohaCare Medicare	$2.51
Rate for Payer: Cash Price	$3.88
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.49
Rate for Payer: Devoted Health Medicare	$2.51
Rate for Payer: Hawaii Medical Service Association Medicare	$2.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.67
Rate for Payer: Health Management Network Commercial	$5.07
Rate for Payer: Humana Medicare	$2.51
Rate for Payer: Kaiser Permanente Commercial	$5.37
Rate for Payer: Kaiser Permanente Medicaid	$3.04
Rate for Payer: Kaiser Permanente Medicare	$2.51
Rate for Payer: MDX Hawaii PPO	$5.79
Rate for Payer: Ohana Health Plan Medicaid	$2.51
Rate for Payer: Ohana Health Plan Medicare	$2.51
Rate for Payer: UnitedHealthcare Medicare	$2.51
Rate for Payer: University Health Alliance Commercial	$4.35

betamethasone valerate 0.1% Lotion [KMC]

Facility

$4.82

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$4.68
Rate for Payer: Cash Price	$3.13
Rate for Payer: Health Management Network Commercial	$4.10
Rate for Payer: Kaiser Permanente Commercial	$4.34
Rate for Payer: MDX Hawaii PPO	$4.68

betamethasone valerate 0.1% Lotion [KMC]

Facility

$4.82

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$4.68
Rate for Payer: AlohaCare Medicaid	$2.41
Rate for Payer: AlohaCare Medicare	$2.02
Rate for Payer: Cash Price	$3.13
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.43
Rate for Payer: Devoted Health Medicare	$2.02
Rate for Payer: Hawaii Medical Service Association Medicare	$2.02
Rate for Payer: Hawaii Western Management Group Commercial	$4.58
Rate for Payer: Health Management Network Commercial	$4.10
Rate for Payer: Humana Medicare	$2.02
Rate for Payer: Kaiser Permanente Commercial	$4.34
Rate for Payer: Kaiser Permanente Medicaid	$2.46
Rate for Payer: Kaiser Permanente Medicare	$2.02
Rate for Payer: MDX Hawaii PPO	$4.68
Rate for Payer: Ohana Health Plan Medicaid	$2.02
Rate for Payer: Ohana Health Plan Medicare	$2.02
Rate for Payer: UnitedHealthcare Medicare	$2.02
Rate for Payer: University Health Alliance Commercial	$3.51

bethanechol 10 mg Tab [KMC]

Facility

$6.42

Service Code	NDC 53746057201
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$6.23
Rate for Payer: AlohaCare Medicaid	$3.21
Rate for Payer: AlohaCare Medicare	$2.70
Rate for Payer: Cash Price	$4.17
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.91
Rate for Payer: Devoted Health Medicare	$2.70
Rate for Payer: Hawaii Medical Service Association Medicare	$2.70
Rate for Payer: Hawaii Western Management Group Commercial	$6.10
Rate for Payer: Health Management Network Commercial	$5.46
Rate for Payer: Humana Medicare	$2.70
Rate for Payer: Kaiser Permanente Commercial	$5.78
Rate for Payer: Kaiser Permanente Medicaid	$3.27
Rate for Payer: Kaiser Permanente Medicare	$2.70
Rate for Payer: MDX Hawaii PPO	$6.23
Rate for Payer: Ohana Health Plan Medicaid	$2.70
Rate for Payer: Ohana Health Plan Medicare	$2.70
Rate for Payer: UnitedHealthcare Medicaid	$3.85
Rate for Payer: UnitedHealthcare Medicare	$2.70
Rate for Payer: University Health Alliance Commercial	$4.68

bethanechol 10 mg Tab [KMC]

Facility

$6.42

Service Code	NDC 53746057201
Hospital Revenue Code	250
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$6.23
Rate for Payer: Cash Price	$4.17
Rate for Payer: Health Management Network Commercial	$5.46
Rate for Payer: Kaiser Permanente Commercial	$5.78
Rate for Payer: MDX Hawaii PPO	$6.23

bethanechol 25 mg Tab [KMC]

Facility

$8.56

Service Code	NDC 53746057301
Hospital Revenue Code	250
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$8.30
Rate for Payer: Cash Price	$5.56
Rate for Payer: Health Management Network Commercial	$7.28
Rate for Payer: Kaiser Permanente Commercial	$7.70
Rate for Payer: MDX Hawaii PPO	$8.30

bethanechol 25 mg Tab [KMC]

Facility

$8.56

Service Code	NDC 53746057301
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.30
Rate for Payer: AlohaCare Medicaid	$4.28
Rate for Payer: AlohaCare Medicare	$3.60
Rate for Payer: Cash Price	$5.56
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7.88
Rate for Payer: Devoted Health Medicare	$3.60
Rate for Payer: Hawaii Medical Service Association Medicare	$3.60
Rate for Payer: Hawaii Western Management Group Commercial	$8.13
Rate for Payer: Health Management Network Commercial	$7.28
Rate for Payer: Humana Medicare	$3.60
Rate for Payer: Kaiser Permanente Commercial	$7.70
Rate for Payer: Kaiser Permanente Medicaid	$4.37
Rate for Payer: Kaiser Permanente Medicare	$3.60
Rate for Payer: MDX Hawaii PPO	$8.30
Rate for Payer: Ohana Health Plan Medicaid	$3.60
Rate for Payer: Ohana Health Plan Medicare	$3.60
Rate for Payer: UnitedHealthcare Medicaid	$5.14
Rate for Payer: UnitedHealthcare Medicare	$3.60
Rate for Payer: University Health Alliance Commercial	$6.24

bicalutamide 50 mg Tab [KMC]

Facility

$73.41

Service Code	NDC 16729002310
Hospital Revenue Code	250
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$71.21
Rate for Payer: Cash Price	$47.72
Rate for Payer: Health Management Network Commercial	$62.40
Rate for Payer: Kaiser Permanente Commercial	$66.07
Rate for Payer: MDX Hawaii PPO	$71.21

bicalutamide 50 mg Tab [KMC]

Facility

$73.41

Service Code	NDC 16729002310
Hospital Revenue Code	250
Min. Negotiated Rate	$30.83
Max. Negotiated Rate	$71.21
Rate for Payer: AlohaCare Medicaid	$36.70
Rate for Payer: AlohaCare Medicare	$30.83
Rate for Payer: Cash Price	$47.72
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$67.54
Rate for Payer: Devoted Health Medicare	$30.83
Rate for Payer: Hawaii Medical Service Association Medicare	$30.83
Rate for Payer: Hawaii Western Management Group Commercial	$69.74
Rate for Payer: Health Management Network Commercial	$62.40
Rate for Payer: Humana Medicare	$30.83
Rate for Payer: Kaiser Permanente Commercial	$66.07
Rate for Payer: Kaiser Permanente Medicaid	$37.44
Rate for Payer: Kaiser Permanente Medicare	$30.83
Rate for Payer: MDX Hawaii PPO	$71.21
Rate for Payer: Ohana Health Plan Medicaid	$30.83
Rate for Payer: Ohana Health Plan Medicare	$30.83
Rate for Payer: UnitedHealthcare Medicaid	$44.05
Rate for Payer: UnitedHealthcare Medicare	$30.83
Rate for Payer: University Health Alliance Commercial	$53.51

bictegravir-emtricitabine-tenofovir 30-120-15 mg Tab [KMC]

Facility

$636.99

Service Code	NDC 61958250501
Hospital Revenue Code	250
Min. Negotiated Rate	$267.54
Max. Negotiated Rate	$617.88
Rate for Payer: AlohaCare Medicaid	$318.50
Rate for Payer: AlohaCare Medicare	$267.54
Rate for Payer: Cash Price	$414.04
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$586.03
Rate for Payer: Devoted Health Medicare	$267.54
Rate for Payer: Hawaii Medical Service Association Medicare	$267.54
Rate for Payer: Hawaii Western Management Group Commercial	$605.14
Rate for Payer: Health Management Network Commercial	$541.44
Rate for Payer: Humana Medicare	$267.54
Rate for Payer: Kaiser Permanente Commercial	$573.29
Rate for Payer: Kaiser Permanente Medicaid	$324.86
Rate for Payer: Kaiser Permanente Medicare	$267.54
Rate for Payer: MDX Hawaii PPO	$617.88
Rate for Payer: Ohana Health Plan Medicaid	$267.54
Rate for Payer: Ohana Health Plan Medicare	$267.54
Rate for Payer: UnitedHealthcare Medicaid	$382.19
Rate for Payer: UnitedHealthcare Medicare	$267.54
Rate for Payer: University Health Alliance Commercial	$464.30

bictegravir-emtricitabine-tenofovir 30-120-15 mg Tab [KMC]

Facility

$636.99

Service Code	NDC 61958250501
Hospital Revenue Code	250
Min. Negotiated Rate	$541.44
Max. Negotiated Rate	$617.88
Rate for Payer: Cash Price	$414.04
Rate for Payer: Health Management Network Commercial	$541.44
Rate for Payer: Kaiser Permanente Commercial	$573.29
Rate for Payer: MDX Hawaii PPO	$617.88

bictegravir/emtricitabine/tenofovir 50-200-25 mg Tab [KMC]

Facility

$674.58

Service Code	NDC 61958250103
Hospital Revenue Code	250
Min. Negotiated Rate	$573.39
Max. Negotiated Rate	$654.34
Rate for Payer: Cash Price	$438.48
Rate for Payer: Health Management Network Commercial	$573.39
Rate for Payer: Kaiser Permanente Commercial	$607.12
Rate for Payer: MDX Hawaii PPO	$654.34

bictegravir/emtricitabine/tenofovir 50-200-25 mg Tab [KMC]

Facility

$674.58

Service Code	NDC 61958250103
Hospital Revenue Code	250
Min. Negotiated Rate	$283.32
Max. Negotiated Rate	$654.34
Rate for Payer: AlohaCare Medicaid	$337.29
Rate for Payer: AlohaCare Medicare	$283.32
Rate for Payer: Cash Price	$438.48
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$620.61
Rate for Payer: Devoted Health Medicare	$283.32
Rate for Payer: Hawaii Medical Service Association Medicare	$283.32
Rate for Payer: Hawaii Western Management Group Commercial	$640.85
Rate for Payer: Health Management Network Commercial	$573.39
Rate for Payer: Humana Medicare	$283.32
Rate for Payer: Kaiser Permanente Commercial	$607.12
Rate for Payer: Kaiser Permanente Medicaid	$344.04
Rate for Payer: Kaiser Permanente Medicare	$283.32
Rate for Payer: MDX Hawaii PPO	$654.34
Rate for Payer: Ohana Health Plan Medicaid	$283.32
Rate for Payer: Ohana Health Plan Medicare	$283.32
Rate for Payer: UnitedHealthcare Medicaid	$404.75
Rate for Payer: UnitedHealthcare Medicare	$283.32
Rate for Payer: University Health Alliance Commercial	$491.70

BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC

Facility

$66,318.20

Service Code	MSDRG 461
Min. Negotiated Rate	$66,318.20
Max. Negotiated Rate	$66,318.20
Rate for Payer: Hawaii Medical Service Association Commercial	$66,318.20

BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC

Facility

$66,318.20

Service Code	MSDRG 462
Min. Negotiated Rate	$66,318.20
Max. Negotiated Rate	$66,318.20
Rate for Payer: Hawaii Medical Service Association Commercial	$66,318.20

Bile Acid Fractionated & Total DLS (NON-pregnancy)

Facility

$278.00

Service Code	HCPCS 82542
Hospital Charge Code	422825425
Hospital Revenue Code	300
Min. Negotiated Rate	$24.09
Max. Negotiated Rate	$269.66
Rate for Payer: AlohaCare Medicaid	$139.00
Rate for Payer: AlohaCare Medicare	$116.76
Rate for Payer: Cash Price	$180.70
Rate for Payer: Cash Price	$180.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$255.76
Rate for Payer: Devoted Health Medicare	$116.76
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$24.96
Rate for Payer: Hawaii Medical Service Association Commercial	$30.11
Rate for Payer: Hawaii Medical Service Association Medicare	$116.76
Rate for Payer: Hawaii Western Management Group Commercial	$24.09
Rate for Payer: Health Management Network Commercial	$236.30
Rate for Payer: Humana Medicare	$116.76
Rate for Payer: Kaiser Permanente Commercial	$250.20
Rate for Payer: Kaiser Permanente Medicaid	$141.78
Rate for Payer: Kaiser Permanente Medicare	$116.76
Rate for Payer: MDX Hawaii PPO	$269.66
Rate for Payer: Ohana Health Plan Medicaid	$116.76
Rate for Payer: Ohana Health Plan Medicare	$116.76
Rate for Payer: UnitedHealthcare Medicaid	$24.96
Rate for Payer: UnitedHealthcare Medicare	$116.76
Rate for Payer: University Health Alliance Commercial	$46.68

Bile Acid Fractionated & Total DLS (NON-pregnancy)

Facility

$278.00

Service Code	HCPCS 82542
Hospital Charge Code	422825425
Hospital Revenue Code	300
Min. Negotiated Rate	$236.30
Max. Negotiated Rate	$269.66
Rate for Payer: Cash Price	$180.70
Rate for Payer: Health Management Network Commercial	$236.30
Rate for Payer: Kaiser Permanente Commercial	$250.20
Rate for Payer: MDX Hawaii PPO	$269.66

Know your out-of-pocket cost for care.

All Charges