Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

Bile Acid Fractionated & Total DLS (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 (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

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC

Facility

$46,242.60

Service Code	MSDRG 409
Min. Negotiated Rate	$46,242.60
Max. Negotiated Rate	$46,242.60
Rate for Payer: Hawaii Medical Service Association Commercial	$46,242.60

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC

Facility

$46,242.60

Service Code	MSDRG 408
Min. Negotiated Rate	$46,242.60
Max. Negotiated Rate	$46,242.60
Rate for Payer: Hawaii Medical Service Association Commercial	$46,242.60

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$45,247.12

Service Code	MSDRG 410
Min. Negotiated Rate	$45,247.12
Max. Negotiated Rate	$45,247.12
Rate for Payer: Hawaii Medical Service Association Commercial	$45,247.12

Bilirubin Direct

Facility

$69.00

Service Code	HCPCS 82248
Hospital Charge Code	422822480
Hospital Revenue Code	301
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$44.85
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: MDX Hawaii PPO	$66.93

Bilirubin Direct

Facility

$69.00

Service Code	HCPCS 82248
Hospital Charge Code	422822480
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$66.93
Rate for Payer: AlohaCare Medicaid	$34.50
Rate for Payer: AlohaCare Medicare	$28.98
Rate for Payer: Cash Price	$44.85
Rate for Payer: Cash Price	$44.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$63.48
Rate for Payer: Devoted Health Medicare	$28.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$28.98
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Humana Medicare	$28.98
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: Kaiser Permanente Medicaid	$35.19
Rate for Payer: Kaiser Permanente Medicare	$28.98
Rate for Payer: MDX Hawaii PPO	$66.93
Rate for Payer: Ohana Health Plan Medicaid	$28.98
Rate for Payer: Ohana Health Plan Medicare	$28.98
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$28.98
Rate for Payer: University Health Alliance Commercial	$12.99

Bilirubin Direct DLS

Facility

$69.00

Service Code	HCPCS 82248
Hospital Charge Code	422822485
Hospital Revenue Code	301
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$44.85
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: MDX Hawaii PPO	$66.93

Bilirubin Direct DLS

Facility

$69.00

Service Code	HCPCS 82248
Hospital Charge Code	422822485
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$66.93
Rate for Payer: AlohaCare Medicaid	$34.50
Rate for Payer: AlohaCare Medicare	$28.98
Rate for Payer: Cash Price	$44.85
Rate for Payer: Cash Price	$44.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$63.48
Rate for Payer: Devoted Health Medicare	$28.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$28.98
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Humana Medicare	$28.98
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: Kaiser Permanente Medicaid	$35.19
Rate for Payer: Kaiser Permanente Medicare	$28.98
Rate for Payer: MDX Hawaii PPO	$66.93
Rate for Payer: Ohana Health Plan Medicaid	$28.98
Rate for Payer: Ohana Health Plan Medicare	$28.98
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$28.98
Rate for Payer: University Health Alliance Commercial	$12.99

Bilirubin Total

Facility

$69.00

Service Code	HCPCS 82247
Hospital Charge Code	422822470
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$66.93
Rate for Payer: AlohaCare Medicaid	$34.50
Rate for Payer: AlohaCare Medicare	$28.98
Rate for Payer: Cash Price	$44.85
Rate for Payer: Cash Price	$44.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$63.48
Rate for Payer: Devoted Health Medicare	$28.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$28.98
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Humana Medicare	$28.98
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: Kaiser Permanente Medicaid	$35.19
Rate for Payer: Kaiser Permanente Medicare	$28.98
Rate for Payer: MDX Hawaii PPO	$66.93
Rate for Payer: Ohana Health Plan Medicaid	$28.98
Rate for Payer: Ohana Health Plan Medicare	$28.98
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$28.98
Rate for Payer: University Health Alliance Commercial	$12.99

Bilirubin Total

Facility

$69.00

Service Code	HCPCS 82247
Hospital Charge Code	422822470
Hospital Revenue Code	301
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$44.85
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: MDX Hawaii PPO	$66.93

Bilirubin Total DLS

Facility

$69.00

Service Code	HCPCS 82247
Hospital Charge Code	422822470
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$66.93
Rate for Payer: AlohaCare Medicaid	$34.50
Rate for Payer: AlohaCare Medicare	$28.98
Rate for Payer: Cash Price	$44.85
Rate for Payer: Cash Price	$44.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$63.48
Rate for Payer: Devoted Health Medicare	$28.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$28.98
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Humana Medicare	$28.98
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: Kaiser Permanente Medicaid	$35.19
Rate for Payer: Kaiser Permanente Medicare	$28.98
Rate for Payer: MDX Hawaii PPO	$66.93
Rate for Payer: Ohana Health Plan Medicaid	$28.98
Rate for Payer: Ohana Health Plan Medicare	$28.98
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$28.98
Rate for Payer: University Health Alliance Commercial	$12.99

Bilirubin Total DLS

Facility

$69.00

Service Code	HCPCS 82247
Hospital Charge Code	422822470
Hospital Revenue Code	301
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$44.85
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: MDX Hawaii PPO	$66.93

BILIRUBIN TOTAL TRANSCUTANEOUS

Professional

Both

$16.00

Service Code	HCPCS 88720
Hospital Revenue Code	300
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$13.60
Rate for Payer: AlohaCare Medicare	$5.02
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cash Price	$10.40
Rate for Payer: Devoted Health Medicare	$5.02
Rate for Payer: Hawaii Medical Service Association Medicare	$5.02
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$6.02
Rate for Payer: Kaiser Permanente Medicaid	$6.02
Rate for Payer: Kaiser Permanente Medicare	$6.02
Rate for Payer: Ohana Health Plan Medicare	$5.02
Rate for Payer: UnitedHealthcare Medicare	$5.02

Bill Aldolase

Facility

$52.00

Service Code	HCPCS 82085
Hospital Charge Code	422820855
Hospital Revenue Code	300
Min. Negotiated Rate	$44.20
Max. Negotiated Rate	$50.44
Rate for Payer: Cash Price	$33.80
Rate for Payer: Health Management Network Commercial	$44.20
Rate for Payer: Kaiser Permanente Commercial	$46.80
Rate for Payer: MDX Hawaii PPO	$50.44

Bill Aldolase

Facility

$52.00

Service Code	HCPCS 82085
Hospital Charge Code	422820855
Hospital Revenue Code	300
Min. Negotiated Rate	$9.71
Max. Negotiated Rate	$50.44
Rate for Payer: AlohaCare Medicaid	$26.00
Rate for Payer: AlohaCare Medicare	$21.84
Rate for Payer: Cash Price	$33.80
Rate for Payer: Cash Price	$33.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$47.84
Rate for Payer: Devoted Health Medicare	$21.84
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$13.42
Rate for Payer: Hawaii Medical Service Association Commercial	$12.14
Rate for Payer: Hawaii Medical Service Association Medicare	$21.84
Rate for Payer: Hawaii Western Management Group Commercial	$9.71
Rate for Payer: Health Management Network Commercial	$44.20
Rate for Payer: Humana Medicare	$21.84
Rate for Payer: Kaiser Permanente Commercial	$46.80
Rate for Payer: Kaiser Permanente Medicaid	$26.52
Rate for Payer: Kaiser Permanente Medicare	$21.84
Rate for Payer: MDX Hawaii PPO	$50.44
Rate for Payer: Ohana Health Plan Medicaid	$21.84
Rate for Payer: Ohana Health Plan Medicare	$21.84
Rate for Payer: UnitedHealthcare Medicaid	$13.42
Rate for Payer: UnitedHealthcare Medicare	$21.84
Rate for Payer: University Health Alliance Commercial	$25.09

Bill Antigen Screen

Facility

$65.00

Service Code	HCPCS 86904
Hospital Charge Code	422869040
Hospital Revenue Code	302
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$63.05
Rate for Payer: AlohaCare Medicaid	$32.50
Rate for Payer: AlohaCare Medicare	$27.30
Rate for Payer: Cash Price	$42.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$59.80
Rate for Payer: Devoted Health Medicare	$27.30
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$4.02
Rate for Payer: Hawaii Medical Service Association Commercial	$20.43
Rate for Payer: Hawaii Medical Service Association Medicare	$27.30
Rate for Payer: Hawaii Western Management Group Commercial	$16.34
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Humana Medicare	$27.30
Rate for Payer: Kaiser Permanente Commercial	$58.50
Rate for Payer: Kaiser Permanente Medicaid	$33.15
Rate for Payer: Kaiser Permanente Medicare	$27.30
Rate for Payer: MDX Hawaii PPO	$63.05
Rate for Payer: Ohana Health Plan Medicaid	$27.30
Rate for Payer: Ohana Health Plan Medicare	$27.30
Rate for Payer: UnitedHealthcare Medicaid	$4.02
Rate for Payer: UnitedHealthcare Medicare	$27.30
Rate for Payer: University Health Alliance Commercial	$12.39

Bill Antigen Screen

Facility

$65.00

Service Code	HCPCS 86904
Hospital Charge Code	422869040
Hospital Revenue Code	302
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$42.25
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Kaiser Permanente Commercial	$58.50
Rate for Payer: MDX Hawaii PPO	$63.05

Bill Antigen Type RBCs

Facility

$1,063.00

Service Code	HCPCS 86905
Hospital Charge Code	422869050
Hospital Revenue Code	302
Min. Negotiated Rate	$903.55
Max. Negotiated Rate	$1,031.11
Rate for Payer: Cash Price	$690.95
Rate for Payer: Health Management Network Commercial	$903.55
Rate for Payer: Kaiser Permanente Commercial	$956.70
Rate for Payer: MDX Hawaii PPO	$1,031.11

Bill Antigen Type RBCs

Facility

$1,063.00

Service Code	HCPCS 86905
Hospital Charge Code	422869050
Hospital Revenue Code	302
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$1,031.11
Rate for Payer: AlohaCare Medicaid	$531.50
Rate for Payer: AlohaCare Medicare	$446.46
Rate for Payer: Cash Price	$690.95
Rate for Payer: Cash Price	$690.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$977.96
Rate for Payer: Devoted Health Medicare	$446.46
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$5.28
Rate for Payer: Hawaii Medical Service Association Commercial	$4.79
Rate for Payer: Hawaii Medical Service Association Medicare	$446.46
Rate for Payer: Hawaii Western Management Group Commercial	$3.83
Rate for Payer: Health Management Network Commercial	$903.55
Rate for Payer: Humana Medicare	$446.46
Rate for Payer: Kaiser Permanente Commercial	$956.70
Rate for Payer: Kaiser Permanente Medicaid	$542.13
Rate for Payer: Kaiser Permanente Medicare	$446.46
Rate for Payer: MDX Hawaii PPO	$1,031.11
Rate for Payer: Ohana Health Plan Medicaid	$446.46
Rate for Payer: Ohana Health Plan Medicare	$446.46
Rate for Payer: UnitedHealthcare Medicaid	$5.28
Rate for Payer: UnitedHealthcare Medicare	$446.46
Rate for Payer: University Health Alliance Commercial	$9.88

Bill Anti-Reticulin IgA

Facility

$144.00

Service Code	HCPCS 86255
Hospital Charge Code	422862555
Hospital Revenue Code	300
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$139.68
Rate for Payer: AlohaCare Medicaid	$72.00
Rate for Payer: AlohaCare Medicare	$60.48
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$132.48
Rate for Payer: Devoted Health Medicare	$60.48
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$16.66
Rate for Payer: Hawaii Medical Service Association Commercial	$15.06
Rate for Payer: Hawaii Medical Service Association Medicare	$60.48
Rate for Payer: Hawaii Western Management Group Commercial	$12.05
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Humana Medicare	$60.48
Rate for Payer: Kaiser Permanente Commercial	$129.60
Rate for Payer: Kaiser Permanente Medicaid	$73.44
Rate for Payer: Kaiser Permanente Medicare	$60.48
Rate for Payer: MDX Hawaii PPO	$139.68
Rate for Payer: Ohana Health Plan Medicaid	$60.48
Rate for Payer: Ohana Health Plan Medicare	$60.48
Rate for Payer: UnitedHealthcare Medicaid	$16.66
Rate for Payer: UnitedHealthcare Medicare	$60.48
Rate for Payer: University Health Alliance Commercial	$31.15

Bill Anti-Reticulin IgA

Facility

$144.00

Service Code	HCPCS 86255
Hospital Charge Code	422862555
Hospital Revenue Code	300
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$139.68
Rate for Payer: Cash Price	$93.60
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Kaiser Permanente Commercial	$129.60
Rate for Payer: MDX Hawaii PPO	$139.68

Bill Arsenic

Facility

$161.00

Service Code	HCPCS 82175
Hospital Charge Code	422821755
Hospital Revenue Code	300
Min. Negotiated Rate	$136.85
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$104.65
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Kaiser Permanente Commercial	$144.90
Rate for Payer: MDX Hawaii PPO	$156.17

Bill Arsenic

Facility

$161.00

Service Code	HCPCS 82175
Hospital Charge Code	422821755
Hospital Revenue Code	300
Min. Negotiated Rate	$18.97
Max. Negotiated Rate	$156.17
Rate for Payer: AlohaCare Medicaid	$80.50
Rate for Payer: AlohaCare Medicare	$67.62
Rate for Payer: Cash Price	$104.65
Rate for Payer: Cash Price	$104.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$148.12
Rate for Payer: Devoted Health Medicare	$67.62
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$26.22
Rate for Payer: Hawaii Medical Service Association Commercial	$23.71
Rate for Payer: Hawaii Medical Service Association Medicare	$67.62
Rate for Payer: Hawaii Western Management Group Commercial	$18.97
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Humana Medicare	$67.62
Rate for Payer: Kaiser Permanente Commercial	$144.90
Rate for Payer: Kaiser Permanente Medicaid	$82.11
Rate for Payer: Kaiser Permanente Medicare	$67.62
Rate for Payer: MDX Hawaii PPO	$156.17
Rate for Payer: Ohana Health Plan Medicaid	$67.62
Rate for Payer: Ohana Health Plan Medicare	$67.62
Rate for Payer: UnitedHealthcare Medicaid	$26.22
Rate for Payer: UnitedHealthcare Medicare	$67.62
Rate for Payer: University Health Alliance Commercial	$49.04

Bill Endomysial Ab IgA Reflex Titer

Facility

$192.00

Service Code	HCPCS 86255
Hospital Charge Code	422862556
Hospital Revenue Code	300
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$186.24
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: MDX Hawaii PPO	$186.24

Know your out-of-pocket cost for care.

All Charges