Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

BOOT CAST LG

Facility

$6.00

Hospital Charge Code	8401
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

BOOT CAST LG

Facility

$6.00

Hospital Charge Code	8401
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

BOOT CAST MED

Facility

$80.00

Hospital Charge Code	8402
Hospital Revenue Code	270
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$52.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: MDX Hawaii PPO	$77.60

BOOT CAST MED

Facility

$80.00

Hospital Charge Code	8402
Hospital Revenue Code	270
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$77.60
Rate for Payer: AlohaCare Medicaid	$40.00
Rate for Payer: AlohaCare Medicare	$33.60
Rate for Payer: Cash Price	$52.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$73.60
Rate for Payer: Devoted Health Medicare	$33.60
Rate for Payer: Hawaii Medical Service Association Medicare	$33.60
Rate for Payer: Hawaii Western Management Group Commercial	$76.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Humana Medicare	$33.60
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: Kaiser Permanente Medicaid	$40.80
Rate for Payer: Kaiser Permanente Medicare	$33.60
Rate for Payer: MDX Hawaii PPO	$77.60
Rate for Payer: Ohana Health Plan Medicaid	$33.60
Rate for Payer: Ohana Health Plan Medicare	$33.60
Rate for Payer: UnitedHealthcare Medicare	$33.60
Rate for Payer: University Health Alliance Commercial	$58.31

BOOT CAST SM

Facility

$228.00

Hospital Charge Code	8403
Hospital Revenue Code	270
Min. Negotiated Rate	$95.76
Max. Negotiated Rate	$221.16
Rate for Payer: AlohaCare Medicaid	$114.00
Rate for Payer: AlohaCare Medicare	$95.76
Rate for Payer: Cash Price	$148.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$209.76
Rate for Payer: Devoted Health Medicare	$95.76
Rate for Payer: Hawaii Medical Service Association Medicare	$95.76
Rate for Payer: Hawaii Western Management Group Commercial	$216.60
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: Humana Medicare	$95.76
Rate for Payer: Kaiser Permanente Commercial	$205.20
Rate for Payer: Kaiser Permanente Medicaid	$116.28
Rate for Payer: Kaiser Permanente Medicare	$95.76
Rate for Payer: MDX Hawaii PPO	$221.16
Rate for Payer: Ohana Health Plan Medicaid	$95.76
Rate for Payer: Ohana Health Plan Medicare	$95.76
Rate for Payer: UnitedHealthcare Medicare	$95.76
Rate for Payer: University Health Alliance Commercial	$166.19

BOOT CAST SM

Facility

$228.00

Hospital Charge Code	8403
Hospital Revenue Code	270
Min. Negotiated Rate	$193.80
Max. Negotiated Rate	$221.16
Rate for Payer: Cash Price	$148.20
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: Kaiser Permanente Commercial	$205.20
Rate for Payer: MDX Hawaii PPO	$221.16

Bordetella DNA Qual Real-Time PCR DLS

Facility

$247.00

Service Code	HCPCS 87081
Hospital Charge Code	422870815
Hospital Revenue Code	306
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$239.59
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$103.74
Rate for Payer: Cash Price	$160.55
Rate for Payer: Cash Price	$160.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$227.24
Rate for Payer: Devoted Health Medicare	$103.74
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$9.16
Rate for Payer: Hawaii Medical Service Association Commercial	$8.29
Rate for Payer: Hawaii Medical Service Association Medicare	$103.74
Rate for Payer: Hawaii Western Management Group Commercial	$6.63
Rate for Payer: Health Management Network Commercial	$209.95
Rate for Payer: Humana Medicare	$103.74
Rate for Payer: Kaiser Permanente Commercial	$222.30
Rate for Payer: Kaiser Permanente Medicaid	$125.97
Rate for Payer: Kaiser Permanente Medicare	$103.74
Rate for Payer: MDX Hawaii PPO	$239.59
Rate for Payer: Ohana Health Plan Medicaid	$103.74
Rate for Payer: Ohana Health Plan Medicare	$103.74
Rate for Payer: UnitedHealthcare Medicaid	$9.16
Rate for Payer: UnitedHealthcare Medicare	$103.74
Rate for Payer: University Health Alliance Commercial	$17.13

Bordetella DNA Qual Real-Time PCR DLS

Facility

$247.00

Service Code	HCPCS 87081
Hospital Charge Code	422870815
Hospital Revenue Code	306
Min. Negotiated Rate	$209.95
Max. Negotiated Rate	$239.59
Rate for Payer: Cash Price	$160.55
Rate for Payer: Health Management Network Commercial	$209.95
Rate for Payer: Kaiser Permanente Commercial	$222.30
Rate for Payer: MDX Hawaii PPO	$239.59

BOUGIE ADULT 15FR

Facility

$3.00

Hospital Charge Code	8042
Hospital Revenue Code	272
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

BOUGIE ADULT 15FR

Facility

$3.00

Hospital Charge Code	8042
Hospital Revenue Code	272
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

BOVIE CAUTER HIGH TEMP. FINE TIP

Facility

$5.00

Hospital Charge Code	8043
Hospital Revenue Code	270
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

BOVIE CAUTER HIGH TEMP. FINE TIP

Facility

$5.00

Hospital Charge Code	8043
Hospital Revenue Code	270
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

Brain Natriuretic Peptide

Facility

$301.00

Service Code	HCPCS 83880
Hospital Charge Code	422838800
Hospital Revenue Code	301
Min. Negotiated Rate	$28.46
Max. Negotiated Rate	$291.97
Rate for Payer: AlohaCare Medicaid	$150.50
Rate for Payer: AlohaCare Medicare	$126.42
Rate for Payer: Cash Price	$195.65
Rate for Payer: Cash Price	$195.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$276.92
Rate for Payer: Devoted Health Medicare	$126.42
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	$126.42
Rate for Payer: Hawaii Western Management Group Commercial	$39.26
Rate for Payer: Health Management Network Commercial	$255.85
Rate for Payer: Humana Medicare	$126.42
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: Kaiser Permanente Medicaid	$153.51
Rate for Payer: Kaiser Permanente Medicare	$126.42
Rate for Payer: MDX Hawaii PPO	$291.97
Rate for Payer: Ohana Health Plan Medicaid	$126.42
Rate for Payer: Ohana Health Plan Medicare	$126.42
Rate for Payer: UnitedHealthcare Medicaid	$28.46
Rate for Payer: UnitedHealthcare Medicare	$126.42
Rate for Payer: University Health Alliance Commercial	$87.75

Brain Natriuretic Peptide

Facility

$301.00

Service Code	HCPCS 83880
Hospital Charge Code	422838800
Hospital Revenue Code	301
Min. Negotiated Rate	$255.85
Max. Negotiated Rate	$291.97
Rate for Payer: Cash Price	$195.65
Rate for Payer: Health Management Network Commercial	$255.85
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: MDX Hawaii PPO	$291.97

BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC

Facility

$25,171.52

Service Code	MSDRG 584
Min. Negotiated Rate	$25,171.52
Max. Negotiated Rate	$25,171.52
Rate for Payer: Hawaii Medical Service Association Commercial	$25,171.52

BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC

Facility

$24,365.66

Service Code	MSDRG 585
Min. Negotiated Rate	$24,365.66
Max. Negotiated Rate	$24,365.66
Rate for Payer: Hawaii Medical Service Association Commercial	$24,365.66

brexpiprazole 1 mg Tab [KMC]

Facility

$199.43

Service Code	NDC 59148003713
Hospital Revenue Code	250
Min. Negotiated Rate	$169.52
Max. Negotiated Rate	$193.45
Rate for Payer: Cash Price	$129.63
Rate for Payer: Health Management Network Commercial	$169.52
Rate for Payer: Kaiser Permanente Commercial	$179.49
Rate for Payer: MDX Hawaii PPO	$193.45

brexpiprazole 1 mg Tab [KMC]

Facility

$199.43

Service Code	NDC 59148003713
Hospital Revenue Code	250
Min. Negotiated Rate	$83.76
Max. Negotiated Rate	$193.45
Rate for Payer: AlohaCare Medicaid	$99.72
Rate for Payer: AlohaCare Medicare	$83.76
Rate for Payer: Cash Price	$129.63
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$183.48
Rate for Payer: Devoted Health Medicare	$83.76
Rate for Payer: Hawaii Medical Service Association Medicare	$83.76
Rate for Payer: Hawaii Western Management Group Commercial	$189.46
Rate for Payer: Health Management Network Commercial	$169.52
Rate for Payer: Humana Medicare	$83.76
Rate for Payer: Kaiser Permanente Commercial	$179.49
Rate for Payer: Kaiser Permanente Medicaid	$101.71
Rate for Payer: Kaiser Permanente Medicare	$83.76
Rate for Payer: MDX Hawaii PPO	$193.45
Rate for Payer: Ohana Health Plan Medicaid	$83.76
Rate for Payer: Ohana Health Plan Medicare	$83.76
Rate for Payer: UnitedHealthcare Medicaid	$119.66
Rate for Payer: UnitedHealthcare Medicare	$83.76
Rate for Payer: University Health Alliance Commercial	$145.36

brimonidine Ophth 0.15% Sol [KMC]

Facility

$153.34

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$148.74
Rate for Payer: AlohaCare Medicaid	$76.67
Rate for Payer: AlohaCare Medicare	$64.40
Rate for Payer: Cash Price	$99.67
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$141.07
Rate for Payer: Devoted Health Medicare	$64.40
Rate for Payer: Hawaii Medical Service Association Medicare	$64.40
Rate for Payer: Hawaii Western Management Group Commercial	$145.67
Rate for Payer: Health Management Network Commercial	$130.34
Rate for Payer: Humana Medicare	$64.40
Rate for Payer: Kaiser Permanente Commercial	$138.01
Rate for Payer: Kaiser Permanente Medicaid	$78.20
Rate for Payer: Kaiser Permanente Medicare	$64.40
Rate for Payer: MDX Hawaii PPO	$148.74
Rate for Payer: Ohana Health Plan Medicaid	$64.40
Rate for Payer: Ohana Health Plan Medicare	$64.40
Rate for Payer: UnitedHealthcare Medicare	$64.40
Rate for Payer: University Health Alliance Commercial	$111.77

brimonidine Ophth 0.15% Sol [KMC]

Facility

$153.34

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$130.34
Max. Negotiated Rate	$148.74
Rate for Payer: Cash Price	$99.67
Rate for Payer: Health Management Network Commercial	$130.34
Rate for Payer: Kaiser Permanente Commercial	$138.01
Rate for Payer: MDX Hawaii PPO	$148.74

brimonidine ophthalmic 0.1% Sol [KMC]

Facility

$177.78

Service Code	NDC 00023932105
Hospital Revenue Code	250
Min. Negotiated Rate	$151.11
Max. Negotiated Rate	$172.45
Rate for Payer: Cash Price	$115.56
Rate for Payer: Health Management Network Commercial	$151.11
Rate for Payer: Kaiser Permanente Commercial	$160.00
Rate for Payer: MDX Hawaii PPO	$172.45

brimonidine ophthalmic 0.1% Sol [KMC]

Facility

$177.78

Service Code	NDC 00023932105
Hospital Revenue Code	250
Min. Negotiated Rate	$74.67
Max. Negotiated Rate	$172.45
Rate for Payer: AlohaCare Medicaid	$88.89
Rate for Payer: AlohaCare Medicare	$74.67
Rate for Payer: Cash Price	$115.56
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$163.56
Rate for Payer: Devoted Health Medicare	$74.67
Rate for Payer: Hawaii Medical Service Association Medicare	$74.67
Rate for Payer: Hawaii Western Management Group Commercial	$168.89
Rate for Payer: Health Management Network Commercial	$151.11
Rate for Payer: Humana Medicare	$74.67
Rate for Payer: Kaiser Permanente Commercial	$160.00
Rate for Payer: Kaiser Permanente Medicaid	$90.67
Rate for Payer: Kaiser Permanente Medicare	$74.67
Rate for Payer: MDX Hawaii PPO	$172.45
Rate for Payer: Ohana Health Plan Medicaid	$74.67
Rate for Payer: Ohana Health Plan Medicare	$74.67
Rate for Payer: UnitedHealthcare Medicaid	$106.67
Rate for Payer: UnitedHealthcare Medicare	$74.67
Rate for Payer: University Health Alliance Commercial	$129.58

brimonidine ophthalmic 0.2% Soln [KMC]

Facility

$14.58

Service Code	NDC 24208041115
Hospital Revenue Code	250
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$14.14
Rate for Payer: AlohaCare Medicaid	$7.29
Rate for Payer: AlohaCare Medicare	$6.12
Rate for Payer: Cash Price	$9.48
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$13.41
Rate for Payer: Devoted Health Medicare	$6.12
Rate for Payer: Hawaii Medical Service Association Medicare	$6.12
Rate for Payer: Hawaii Western Management Group Commercial	$13.85
Rate for Payer: Health Management Network Commercial	$12.39
Rate for Payer: Humana Medicare	$6.12
Rate for Payer: Kaiser Permanente Commercial	$13.12
Rate for Payer: Kaiser Permanente Medicaid	$7.44
Rate for Payer: Kaiser Permanente Medicare	$6.12
Rate for Payer: MDX Hawaii PPO	$14.14
Rate for Payer: Ohana Health Plan Medicaid	$6.12
Rate for Payer: Ohana Health Plan Medicare	$6.12
Rate for Payer: UnitedHealthcare Medicaid	$8.75
Rate for Payer: UnitedHealthcare Medicare	$6.12
Rate for Payer: University Health Alliance Commercial	$10.63

brimonidine ophthalmic 0.2% Soln [KMC]

Facility

$14.58

Service Code	NDC 24208041115
Hospital Revenue Code	250
Min. Negotiated Rate	$12.39
Max. Negotiated Rate	$14.14
Rate for Payer: Cash Price	$9.48
Rate for Payer: Health Management Network Commercial	$12.39
Rate for Payer: Kaiser Permanente Commercial	$13.12
Rate for Payer: MDX Hawaii PPO	$14.14

brimonidine-timolol ophthalmic 0.2%-0.5% Sol [KMC]

Facility

$177.30

Service Code	NDC 82182045505
Hospital Revenue Code	250
Min. Negotiated Rate	$74.47
Max. Negotiated Rate	$171.98
Rate for Payer: AlohaCare Medicaid	$88.65
Rate for Payer: AlohaCare Medicare	$74.47
Rate for Payer: Cash Price	$115.24
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$163.12
Rate for Payer: Devoted Health Medicare	$74.47
Rate for Payer: Hawaii Medical Service Association Medicare	$74.47
Rate for Payer: Hawaii Western Management Group Commercial	$168.44
Rate for Payer: Health Management Network Commercial	$150.71
Rate for Payer: Humana Medicare	$74.47
Rate for Payer: Kaiser Permanente Commercial	$159.57
Rate for Payer: Kaiser Permanente Medicaid	$90.42
Rate for Payer: Kaiser Permanente Medicare	$74.47
Rate for Payer: MDX Hawaii PPO	$171.98
Rate for Payer: Ohana Health Plan Medicaid	$74.47
Rate for Payer: Ohana Health Plan Medicare	$74.47
Rate for Payer: UnitedHealthcare Medicaid	$106.38
Rate for Payer: UnitedHealthcare Medicare	$74.47
Rate for Payer: University Health Alliance Commercial	$129.23

Know your out-of-pocket cost for care.

All Charges