Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

carbidopa/entacapone/levodopa 25 mg-200 mg-100 mg Tab [KMC]

Facility

$15.00

Service Code	NDC 00378830201
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.75
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

carbidopa-levodopa 10 mg-100 mg Tab [KMC]

Facility

$3.09

Service Code	NDC 00093970101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$3.00
Rate for Payer: AlohaCare Medicaid	$1.54
Rate for Payer: AlohaCare Medicare	$1.30
Rate for Payer: Cash Price	$2.01
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.84
Rate for Payer: Devoted Health Medicare	$1.30
Rate for Payer: Hawaii Medical Service Association Medicare	$1.30
Rate for Payer: Hawaii Western Management Group Commercial	$2.94
Rate for Payer: Health Management Network Commercial	$2.63
Rate for Payer: Humana Medicare	$1.30
Rate for Payer: Kaiser Permanente Commercial	$2.78
Rate for Payer: Kaiser Permanente Medicaid	$1.58
Rate for Payer: Kaiser Permanente Medicare	$1.30
Rate for Payer: MDX Hawaii PPO	$3.00
Rate for Payer: Ohana Health Plan Medicaid	$1.30
Rate for Payer: Ohana Health Plan Medicare	$1.30
Rate for Payer: UnitedHealthcare Medicaid	$1.85
Rate for Payer: UnitedHealthcare Medicare	$1.30
Rate for Payer: University Health Alliance Commercial	$2.25

carbidopa-levodopa 10 mg-100 mg Tab [KMC]

Facility

$3.09

Service Code	NDC 00093970101
Hospital Revenue Code	250
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$3.00
Rate for Payer: Cash Price	$2.01
Rate for Payer: Health Management Network Commercial	$2.63
Rate for Payer: Kaiser Permanente Commercial	$2.78
Rate for Payer: MDX Hawaii PPO	$3.00

carbidopa-levodopa 25-250 mg Tab [KMC]

Facility

$4.45

Service Code	NDC 50228045901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$4.32
Rate for Payer: AlohaCare Medicaid	$2.23
Rate for Payer: AlohaCare Medicare	$1.87
Rate for Payer: Cash Price	$2.89
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.09
Rate for Payer: Devoted Health Medicare	$1.87
Rate for Payer: Hawaii Medical Service Association Medicare	$1.87
Rate for Payer: Hawaii Western Management Group Commercial	$4.23
Rate for Payer: Health Management Network Commercial	$3.78
Rate for Payer: Humana Medicare	$1.87
Rate for Payer: Kaiser Permanente Commercial	$4.00
Rate for Payer: Kaiser Permanente Medicaid	$2.27
Rate for Payer: Kaiser Permanente Medicare	$1.87
Rate for Payer: MDX Hawaii PPO	$4.32
Rate for Payer: Ohana Health Plan Medicaid	$1.87
Rate for Payer: Ohana Health Plan Medicare	$1.87
Rate for Payer: UnitedHealthcare Medicaid	$2.67
Rate for Payer: UnitedHealthcare Medicare	$1.87
Rate for Payer: University Health Alliance Commercial	$3.24

carbidopa-levodopa 25-250 mg Tab [KMC]

Facility

$4.45

Service Code	NDC 50228045901
Hospital Revenue Code	250
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$4.32
Rate for Payer: Cash Price	$2.89
Rate for Payer: Health Management Network Commercial	$3.78
Rate for Payer: Kaiser Permanente Commercial	$4.00
Rate for Payer: MDX Hawaii PPO	$4.32

carbidopa-levodopa 25 mg-100 mg Tab [KMC]

Facility

$3.00

Service Code	HCPCS A9270
Hospital Revenue Code	637
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

carbidopa-levodopa 25 mg-100 mg Tab [KMC]

Facility

$3.00

Service Code	HCPCS A9270
Hospital Revenue Code	637
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

carbidopa-levodopa 50-200 mg ER tab [KMC]

Facility

$7.22

Service Code	NDC 50228046101
Hospital Revenue Code	250
Min. Negotiated Rate	$6.14
Max. Negotiated Rate	$7.00
Rate for Payer: Cash Price	$4.69
Rate for Payer: Health Management Network Commercial	$6.14
Rate for Payer: Kaiser Permanente Commercial	$6.50
Rate for Payer: MDX Hawaii PPO	$7.00

carbidopa-levodopa 50-200 mg ER tab [KMC]

Facility

$7.22

Service Code	NDC 50228046101
Hospital Revenue Code	250
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$7.00
Rate for Payer: AlohaCare Medicaid	$3.61
Rate for Payer: AlohaCare Medicare	$3.03
Rate for Payer: Cash Price	$4.69
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6.64
Rate for Payer: Devoted Health Medicare	$3.03
Rate for Payer: Hawaii Medical Service Association Medicare	$3.03
Rate for Payer: Hawaii Western Management Group Commercial	$6.86
Rate for Payer: Health Management Network Commercial	$6.14
Rate for Payer: Humana Medicare	$3.03
Rate for Payer: Kaiser Permanente Commercial	$6.50
Rate for Payer: Kaiser Permanente Medicaid	$3.68
Rate for Payer: Kaiser Permanente Medicare	$3.03
Rate for Payer: MDX Hawaii PPO	$7.00
Rate for Payer: Ohana Health Plan Medicaid	$3.03
Rate for Payer: Ohana Health Plan Medicare	$3.03
Rate for Payer: UnitedHealthcare Medicaid	$4.33
Rate for Payer: UnitedHealthcare Medicare	$3.03
Rate for Payer: University Health Alliance Commercial	$5.26

Carbon Dioxide Level

Facility

$69.00

Service Code	HCPCS 82374
Hospital Charge Code	422823740
Hospital Revenue Code	301
Min. Negotiated Rate	$4.88
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	$6.76
Rate for Payer: Hawaii Medical Service Association Commercial	$6.10
Rate for Payer: Hawaii Medical Service Association Medicare	$28.98
Rate for Payer: Hawaii Western Management Group Commercial	$4.88
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	$6.76
Rate for Payer: UnitedHealthcare Medicare	$28.98
Rate for Payer: University Health Alliance Commercial	$12.64

Carbon Dioxide Level

Facility

$69.00

Service Code	HCPCS 82374
Hospital Charge Code	422823740
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

CARDIAC ARREST, UNEXPLAINED WITH CC

Facility

$44,678.27

Service Code	MSDRG 297
Min. Negotiated Rate	$44,678.27
Max. Negotiated Rate	$44,678.27
Rate for Payer: Hawaii Medical Service Association Commercial	$44,678.27

CARDIAC ARREST, UNEXPLAINED WITH MCC

Facility

$44,678.27

Service Code	MSDRG 296
Min. Negotiated Rate	$44,678.27
Max. Negotiated Rate	$44,678.27
Rate for Payer: Hawaii Medical Service Association Commercial	$44,678.27

CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC

Facility

$44,678.27

Service Code	MSDRG 298
Min. Negotiated Rate	$44,678.27
Max. Negotiated Rate	$44,678.27
Rate for Payer: Hawaii Medical Service Association Commercial	$44,678.27

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC

Facility

$19,814.87

Service Code	MSDRG 309
Min. Negotiated Rate	$19,814.87
Max. Negotiated Rate	$19,814.87
Rate for Payer: Hawaii Medical Service Association Commercial	$19,814.87

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC

Facility

$21,118.48

Service Code	MSDRG 308
Min. Negotiated Rate	$21,118.48
Max. Negotiated Rate	$21,118.48
Rate for Payer: Hawaii Medical Service Association Commercial	$21,118.48

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC

Facility

$15,192.98

Service Code	MSDRG 310
Min. Negotiated Rate	$15,192.98
Max. Negotiated Rate	$15,192.98
Rate for Payer: Hawaii Medical Service Association Commercial	$15,192.98

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC

Facility

$13,960.48

Service Code	MSDRG 306
Min. Negotiated Rate	$13,960.48
Max. Negotiated Rate	$13,960.48
Rate for Payer: Hawaii Medical Service Association Commercial	$13,960.48

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC

Facility

$12,893.89

Service Code	MSDRG 307
Min. Negotiated Rate	$12,893.89
Max. Negotiated Rate	$12,893.89
Rate for Payer: Hawaii Medical Service Association Commercial	$12,893.89

CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC

Facility

$160,035.90

Service Code	MSDRG 275
Min. Negotiated Rate	$160,035.90
Max. Negotiated Rate	$160,035.90
Rate for Payer: Hawaii Medical Service Association Commercial	$160,035.90

CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR

Facility

$103,008.89

Service Code	MSDRG 276
Min. Negotiated Rate	$103,008.89
Max. Negotiated Rate	$103,008.89
Rate for Payer: Hawaii Medical Service Association Commercial	$103,008.89

CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC

Facility

$103,008.89

Service Code	MSDRG 277
Min. Negotiated Rate	$103,008.89
Max. Negotiated Rate	$103,008.89
Rate for Payer: Hawaii Medical Service Association Commercial	$103,008.89

CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC

Facility

$23,085.75

Service Code	MSDRG 258
Min. Negotiated Rate	$23,085.75
Max. Negotiated Rate	$23,085.75
Rate for Payer: Hawaii Medical Service Association Commercial	$23,085.75

CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC

Facility

$23,085.75

Service Code	MSDRG 259
Min. Negotiated Rate	$23,085.75
Max. Negotiated Rate	$23,085.75
Rate for Payer: Hawaii Medical Service Association Commercial	$23,085.75

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC

Facility

$31,168.13

Service Code	MSDRG 261
Min. Negotiated Rate	$31,168.13
Max. Negotiated Rate	$31,168.13
Rate for Payer: Hawaii Medical Service Association Commercial	$31,168.13

Know your out-of-pocket cost for care.

All Charges