Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

BLOOD/SOLUTION SET

Facility

$5.00

Hospital Charge Code	8038
Hospital Revenue Code	272
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.25
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

BLOOD/SOLUTION SET

Facility

$5.00

Hospital Charge Code	8038
Hospital Revenue Code	272
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$2.10
Rate for Payer: Cash Price	$3.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.60
Rate for Payer: Devoted Health Medicare	$2.10
Rate for Payer: Hawaii Medical Service Association Medicare	$2.10
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$2.10
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$2.10
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$2.10
Rate for Payer: Ohana Health Plan Medicare	$2.10
Rate for Payer: UnitedHealthcare Medicare	$2.10
Rate for Payer: University Health Alliance Commercial	$3.64

BLOOD TRANSFER DEVICE FEMALE LUER ADAPTER

Facility

$3.00

Hospital Charge Code	8037
Hospital Revenue Code	270
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

BLOOD TRANSFER DEVICE FEMALE LUER ADAPTER

Facility

$3.00

Hospital Charge Code	8037
Hospital Revenue Code	270
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

BNP DLS

Facility

$189.00

Service Code	HCPCS 83880
Hospital Charge Code	422838805
Hospital Revenue Code	301
Min. Negotiated Rate	$28.46
Max. Negotiated Rate	$183.33
Rate for Payer: AlohaCare Medicaid	$94.50
Rate for Payer: AlohaCare Medicare	$79.38
Rate for Payer: Cash Price	$122.85
Rate for Payer: Cash Price	$122.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$173.88
Rate for Payer: Devoted Health Medicare	$79.38
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$28.46
Rate for Payer: Hawaii Medical Service Association Commercial	$49.08
Rate for Payer: Hawaii Medical Service Association Medicare	$79.38
Rate for Payer: Hawaii Western Management Group Commercial	$39.26
Rate for Payer: Health Management Network Commercial	$160.65
Rate for Payer: Humana Medicare	$79.38
Rate for Payer: Kaiser Permanente Commercial	$170.10
Rate for Payer: Kaiser Permanente Medicaid	$96.39
Rate for Payer: Kaiser Permanente Medicare	$79.38
Rate for Payer: MDX Hawaii PPO	$183.33
Rate for Payer: Ohana Health Plan Medicaid	$79.38
Rate for Payer: Ohana Health Plan Medicare	$79.38
Rate for Payer: UnitedHealthcare Medicaid	$28.46
Rate for Payer: UnitedHealthcare Medicare	$79.38
Rate for Payer: University Health Alliance Commercial	$87.75

BNP DLS

Facility

$189.00

Service Code	HCPCS 83880
Hospital Charge Code	422838805
Hospital Revenue Code	301
Min. Negotiated Rate	$160.65
Max. Negotiated Rate	$183.33
Rate for Payer: Cash Price	$122.85
Rate for Payer: Health Management Network Commercial	$160.65
Rate for Payer: Kaiser Permanente Commercial	$170.10
Rate for Payer: MDX Hawaii PPO	$183.33

Body Fluid Cell Count, w/Diff DLS

Facility

$93.00

Service Code	HCPCS 89051
Hospital Charge Code	422890515
Hospital Revenue Code	309
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$60.45
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: MDX Hawaii PPO	$90.21

Body Fluid Cell Count, w/Diff DLS

Facility

$93.00

Service Code	HCPCS 89051
Hospital Charge Code	422890515
Hospital Revenue Code	309
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$90.21
Rate for Payer: AlohaCare Medicaid	$46.50
Rate for Payer: AlohaCare Medicare	$39.06
Rate for Payer: Cash Price	$60.45
Rate for Payer: Cash Price	$60.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$85.56
Rate for Payer: Devoted Health Medicare	$39.06
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.61
Rate for Payer: Hawaii Medical Service Association Commercial	$7.00
Rate for Payer: Hawaii Medical Service Association Medicare	$39.06
Rate for Payer: Hawaii Western Management Group Commercial	$5.60
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Humana Medicare	$39.06
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: Kaiser Permanente Medicare	$39.06
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: Ohana Health Plan Medicaid	$39.06
Rate for Payer: Ohana Health Plan Medicare	$39.06
Rate for Payer: UnitedHealthcare Medicaid	$7.61
Rate for Payer: UnitedHealthcare Medicare	$39.06
Rate for Payer: University Health Alliance Commercial	$14.24

Body Fluid Crystal Exam DLS

Facility

$39.00

Service Code	HCPCS 89060
Hospital Charge Code	422890605
Hospital Revenue Code	309
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$25.35
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: MDX Hawaii PPO	$37.83

Body Fluid Crystal Exam DLS

Facility

$39.00

Service Code	HCPCS 89060
Hospital Charge Code	422890605
Hospital Revenue Code	309
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$37.83
Rate for Payer: AlohaCare Medicaid	$19.50
Rate for Payer: AlohaCare Medicare	$16.38
Rate for Payer: Cash Price	$25.35
Rate for Payer: Cash Price	$25.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$35.88
Rate for Payer: Devoted Health Medicare	$16.38
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$9.88
Rate for Payer: Hawaii Medical Service Association Commercial	$9.16
Rate for Payer: Hawaii Medical Service Association Medicare	$16.38
Rate for Payer: Hawaii Western Management Group Commercial	$7.33
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Humana Medicare	$16.38
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: Kaiser Permanente Medicare	$16.38
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: Ohana Health Plan Medicaid	$16.38
Rate for Payer: Ohana Health Plan Medicare	$16.38
Rate for Payer: UnitedHealthcare Medicaid	$9.88
Rate for Payer: UnitedHealthcare Medicare	$16.38
Rate for Payer: University Health Alliance Commercial	$18.48

Body Fluid Culture and 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

Body Fluid Culture and 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

BODY MASS INDEX DOCUMENTED

Professional

Both

$0.01

Service Code	HCPCS 3008F
Hospital Revenue Code	521
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$290.48
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$273.13

BODY MUSCLE TEST, MANUAL, NO HANDS

Professional

Both

$285.00

Service Code	HCPCS 95833
Hospital Revenue Code	420
Min. Negotiated Rate	$33.25
Max. Negotiated Rate	$242.25
Rate for Payer: Cash Price	$185.25
Rate for Payer: Cash Price	$185.25
Rate for Payer: Hawaii Western Management Group Commercial	$33.25
Rate for Payer: Health Management Network Commercial	$242.25

BODY POS CURRENT STATUS

Professional

Both

$0.01

Service Code	HCPCS G8981
Hospital Revenue Code	420
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

BODY POS D/C STATUS

Professional

Both

$0.01

Service Code	HCPCS G8983
Hospital Revenue Code	420
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

BODY POS GOAL STATUS

Professional

Both

$0.01

Service Code	HCPCS G8982
Hospital Revenue Code	420
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

BONE AGE STUDIES

Facility

$369.00

Service Code	HCPCS 77072
Hospital Charge Code	424770720
Hospital Revenue Code	320
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$357.93
Rate for Payer: AlohaCare Medicaid	$184.50
Rate for Payer: AlohaCare Medicare	$154.98
Rate for Payer: Cash Price	$239.85
Rate for Payer: Cash Price	$239.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$339.48
Rate for Payer: Devoted Health Medicare	$154.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$10.46
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$154.98
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Humana Medicare	$154.98
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: Kaiser Permanente Medicaid	$188.19
Rate for Payer: Kaiser Permanente Medicare	$154.98
Rate for Payer: MDX Hawaii PPO	$357.93
Rate for Payer: Ohana Health Plan Medicaid	$154.98
Rate for Payer: Ohana Health Plan Medicare	$154.98
Rate for Payer: UnitedHealthcare Medicaid	$10.46
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$47.17

BONE AGE STUDIES

Facility

$369.00

Service Code	HCPCS 77072
Hospital Charge Code	424770720
Hospital Revenue Code	320
Min. Negotiated Rate	$313.65
Max. Negotiated Rate	$357.93
Rate for Payer: Cash Price	$239.85
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: MDX Hawaii PPO	$357.93

BONE DISEASES AND ARTHROPATHIES WITH MCC

Facility

$12,490.95

Service Code	MSDRG 553
Min. Negotiated Rate	$12,490.95
Max. Negotiated Rate	$12,490.95
Rate for Payer: Hawaii Medical Service Association Commercial	$12,490.95

BONE DISEASES AND ARTHROPATHIES WITHOUT MCC

Facility

$12,396.15

Service Code	MSDRG 554
Min. Negotiated Rate	$12,396.15
Max. Negotiated Rate	$12,396.15
Rate for Payer: Hawaii Medical Service Association Commercial	$12,396.15

BONE LENGTH STUDIES

Facility

$580.00

Service Code	HCPCS 77073
Hospital Charge Code	424770730
Hospital Revenue Code	320
Min. Negotiated Rate	$22.30
Max. Negotiated Rate	$562.60
Rate for Payer: AlohaCare Medicaid	$290.00
Rate for Payer: AlohaCare Medicare	$243.60
Rate for Payer: Cash Price	$377.00
Rate for Payer: Cash Price	$377.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$533.60
Rate for Payer: Devoted Health Medicare	$243.60
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$22.30
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$243.60
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$493.00
Rate for Payer: Humana Medicare	$243.60
Rate for Payer: Kaiser Permanente Commercial	$522.00
Rate for Payer: Kaiser Permanente Medicaid	$295.80
Rate for Payer: Kaiser Permanente Medicare	$243.60
Rate for Payer: MDX Hawaii PPO	$562.60
Rate for Payer: Ohana Health Plan Medicaid	$243.60
Rate for Payer: Ohana Health Plan Medicare	$243.60
Rate for Payer: UnitedHealthcare Medicaid	$22.30
Rate for Payer: UnitedHealthcare Medicare	$243.60
Rate for Payer: University Health Alliance Commercial	$82.49

BONE LENGTH STUDIES

Facility

$580.00

Service Code	HCPCS 77073
Hospital Charge Code	424770730
Hospital Revenue Code	320
Min. Negotiated Rate	$493.00
Max. Negotiated Rate	$562.60
Rate for Payer: Cash Price	$377.00
Rate for Payer: Health Management Network Commercial	$493.00
Rate for Payer: Kaiser Permanente Commercial	$522.00
Rate for Payer: MDX Hawaii PPO	$562.60

Bone length studies (orthoroentgenogram, scanogram)

Facility

$65.00

Service Code	HCPCS 77073
Hospital Charge Code	424770739
Hospital Revenue Code	972
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$42.25
Rate for Payer: Cash Price	$39.65
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Kaiser Permanente Commercial	$58.50
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: MDX Hawaii PPO	$59.17
Rate for Payer: MDX Hawaii PPO	$63.05

Bone length studies (orthoroentgenogram, scanogram)

Facility

$61.00

Service Code	HCPCS 77073
Hospital Charge Code	424770739
Hospital Revenue Code	972
Min. Negotiated Rate	$22.30
Max. Negotiated Rate	$154.38
Rate for Payer: AlohaCare Medicaid	$30.50
Rate for Payer: AlohaCare Medicaid	$32.50
Rate for Payer: AlohaCare Medicare	$27.30
Rate for Payer: AlohaCare Medicare	$25.62
Rate for Payer: Cash Price	$39.65
Rate for Payer: Cash Price	$39.65
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: Deseret Mutual Benefit Administrators Commercial	$56.12
Rate for Payer: Devoted Health Medicare	$25.62
Rate for Payer: Devoted Health Medicare	$27.30
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$22.30
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$22.30
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$25.62
Rate for Payer: Hawaii Medical Service Association Medicare	$27.30
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Humana Medicare	$25.62
Rate for Payer: Humana Medicare	$27.30
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: Kaiser Permanente Commercial	$58.50
Rate for Payer: Kaiser Permanente Medicaid	$31.11
Rate for Payer: Kaiser Permanente Medicaid	$33.15
Rate for Payer: Kaiser Permanente Medicare	$27.30
Rate for Payer: Kaiser Permanente Medicare	$25.62
Rate for Payer: MDX Hawaii PPO	$59.17
Rate for Payer: MDX Hawaii PPO	$63.05
Rate for Payer: Ohana Health Plan Medicaid	$25.62
Rate for Payer: Ohana Health Plan Medicaid	$27.30
Rate for Payer: Ohana Health Plan Medicare	$25.62
Rate for Payer: Ohana Health Plan Medicare	$27.30
Rate for Payer: UnitedHealthcare Medicaid	$22.30
Rate for Payer: UnitedHealthcare Medicaid	$22.30
Rate for Payer: UnitedHealthcare Medicare	$27.30
Rate for Payer: UnitedHealthcare Medicare	$25.62
Rate for Payer: University Health Alliance Commercial	$82.49
Rate for Payer: University Health Alliance Commercial	$82.49

Know your out-of-pocket cost for care.

All Charges