Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

CENTRAL VEN CATH UNDER 5 Charge

Facility

$4,339.00

Service Code	HCPCS 36555
Hospital Charge Code	440365550
Hospital Revenue Code	450
Min. Negotiated Rate	$3,688.15
Max. Negotiated Rate	$4,208.83
Rate for Payer: Cash Price	$2,820.35
Rate for Payer: Health Management Network Commercial	$3,688.15
Rate for Payer: Kaiser Permanente Commercial	$3,905.10
Rate for Payer: MDX Hawaii PPO	$4,208.83

CEPACOL (benzocaine-menthol) throat lozenges [KMC]

Facility

$3.00

Service Code	NDC 00904625549
Hospital Revenue Code	250
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 Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

CEPACOL (benzocaine-menthol) throat lozenges [KMC]

Facility

$3.00

Service Code	NDC 00904625549
Hospital Revenue Code	250
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

cephalexin 250 mg Cap [KMC]

Facility

$3.00

Service Code	NDC 00093314501
Hospital Revenue Code	250
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

cephalexin 250 mg Cap [KMC]

Facility

$3.00

Service Code	NDC 00093314501
Hospital Revenue Code	250
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 Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

cephalexin 500 mg Cap [KMC]

Facility

$5.41

Service Code	NDC 60687016301
Hospital Revenue Code	250
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$5.25
Rate for Payer: AlohaCare Medicaid	$2.71
Rate for Payer: AlohaCare Medicare	$2.27
Rate for Payer: Cash Price	$3.52
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.98
Rate for Payer: Devoted Health Medicare	$2.27
Rate for Payer: Hawaii Medical Service Association Medicare	$2.27
Rate for Payer: Hawaii Western Management Group Commercial	$5.14
Rate for Payer: Health Management Network Commercial	$4.60
Rate for Payer: Humana Medicare	$2.27
Rate for Payer: Kaiser Permanente Commercial	$4.87
Rate for Payer: Kaiser Permanente Medicaid	$2.76
Rate for Payer: Kaiser Permanente Medicare	$2.27
Rate for Payer: MDX Hawaii PPO	$5.25
Rate for Payer: Ohana Health Plan Medicaid	$2.27
Rate for Payer: Ohana Health Plan Medicare	$2.27
Rate for Payer: UnitedHealthcare Medicaid	$3.25
Rate for Payer: UnitedHealthcare Medicare	$2.27
Rate for Payer: University Health Alliance Commercial	$3.94

cephalexin 500 mg Cap [KMC]

Facility

$5.41

Service Code	NDC 60687016301
Hospital Revenue Code	250
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$5.25
Rate for Payer: Cash Price	$3.52
Rate for Payer: Health Management Network Commercial	$4.60
Rate for Payer: Kaiser Permanente Commercial	$4.87
Rate for Payer: MDX Hawaii PPO	$5.25

CeraVe topical emollient lotion [KMC]

Facility

$0.12

Service Code	NDC 00187137112
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.12
Rate for Payer: Cash Price	$0.08
Rate for Payer: Health Management Network Commercial	$0.10
Rate for Payer: Kaiser Permanente Commercial	$0.11
Rate for Payer: MDX Hawaii PPO	$0.12

CeraVe topical emollient lotion [KMC]

Facility

$0.12

Service Code	NDC 00187137112
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.12
Rate for Payer: AlohaCare Medicaid	$0.06
Rate for Payer: AlohaCare Medicare	$0.05
Rate for Payer: Cash Price	$0.08
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.11
Rate for Payer: Devoted Health Medicare	$0.05
Rate for Payer: Hawaii Medical Service Association Medicare	$0.05
Rate for Payer: Hawaii Western Management Group Commercial	$0.11
Rate for Payer: Health Management Network Commercial	$0.10
Rate for Payer: Humana Medicare	$0.05
Rate for Payer: Kaiser Permanente Commercial	$0.11
Rate for Payer: Kaiser Permanente Medicaid	$0.06
Rate for Payer: Kaiser Permanente Medicare	$0.05
Rate for Payer: MDX Hawaii PPO	$0.12
Rate for Payer: Ohana Health Plan Medicaid	$0.05
Rate for Payer: Ohana Health Plan Medicare	$0.05
Rate for Payer: UnitedHealthcare Medicaid	$0.07
Rate for Payer: UnitedHealthcare Medicare	$0.05
Rate for Payer: University Health Alliance Commercial	$0.09

Ceruloplasmin DLS

Facility

$63.00

Service Code	HCPCS 82390
Hospital Charge Code	422823905
Hospital Revenue Code	301
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$61.11
Rate for Payer: AlohaCare Medicaid	$31.50
Rate for Payer: AlohaCare Medicare	$26.46
Rate for Payer: Cash Price	$40.95
Rate for Payer: Cash Price	$40.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$57.96
Rate for Payer: Devoted Health Medicare	$26.46
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$14.84
Rate for Payer: Hawaii Medical Service Association Commercial	$13.43
Rate for Payer: Hawaii Medical Service Association Medicare	$26.46
Rate for Payer: Hawaii Western Management Group Commercial	$10.74
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Humana Medicare	$26.46
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: Kaiser Permanente Medicaid	$32.13
Rate for Payer: Kaiser Permanente Medicare	$26.46
Rate for Payer: MDX Hawaii PPO	$61.11
Rate for Payer: Ohana Health Plan Medicaid	$26.46
Rate for Payer: Ohana Health Plan Medicare	$26.46
Rate for Payer: UnitedHealthcare Medicaid	$14.84
Rate for Payer: UnitedHealthcare Medicare	$26.46
Rate for Payer: University Health Alliance Commercial	$27.77

Ceruloplasmin DLS

Facility

$63.00

Service Code	HCPCS 82390
Hospital Charge Code	422823905
Hospital Revenue Code	301
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$61.11
Rate for Payer: Cash Price	$40.95
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: MDX Hawaii PPO	$61.11

CERVICAL CANCER SCREENING RESULTS DOCD & RVWD

Professional

Both

$0.01

Service Code	HCPCS 3015F
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	$273.13
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
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	$152.00
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$273.13

CERVICAL SPINAL FUSION WITH CC

Facility

$50,129.73

Service Code	MSDRG 472
Min. Negotiated Rate	$50,129.73
Max. Negotiated Rate	$50,129.73
Rate for Payer: Hawaii Medical Service Association Commercial	$50,129.73

CERVICAL SPINAL FUSION WITH MCC

Facility

$61,909.62

Service Code	MSDRG 471
Min. Negotiated Rate	$61,909.62
Max. Negotiated Rate	$61,909.62
Rate for Payer: Hawaii Medical Service Association Commercial	$61,909.62

CERVICAL SPINAL FUSION WITHOUT CC/MCC

Facility

$46,005.58

Service Code	MSDRG 473
Min. Negotiated Rate	$46,005.58
Max. Negotiated Rate	$46,005.58
Rate for Payer: Hawaii Medical Service Association Commercial	$46,005.58

CESAREAN SECTION WITHOUT STERILIZATION WITH CC

Facility

$19,103.81

Service Code	MSDRG 787
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$19,103.81
Rate for Payer: Hawaii Medical Service Association Commercial	$19,103.81
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION WITHOUT STERILIZATION WITH MCC

Facility

$19,103.81

Service Code	MSDRG 786
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$19,103.81
Rate for Payer: Hawaii Medical Service Association Commercial	$19,103.81
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC

Facility

$16,923.23

Service Code	MSDRG 788
Min. Negotiated Rate	$16,923.23
Max. Negotiated Rate	$16,923.23
Rate for Payer: Hawaii Medical Service Association Commercial	$16,923.23

CESAREAN SECTION WITH STERILIZATION WITH CC

Facility

$19,103.81

Service Code	MSDRG 784
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$19,103.81
Rate for Payer: Hawaii Medical Service Association Commercial	$19,103.81
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION WITH STERILIZATION WITH MCC

Facility

$19,103.81

Service Code	MSDRG 783
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$19,103.81
Rate for Payer: Hawaii Medical Service Association Commercial	$19,103.81
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC

Facility

$16,923.23

Service Code	MSDRG 785
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$16,923.23
Rate for Payer: Hawaii Medical Service Association Commercial	$16,923.23
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: University Health Alliance Commercial	$9,950.00

Cetaphil emollients, Top Lotion [KMC]

Facility

$0.11

Service Code	NDC 00299391808
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: AlohaCare Medicaid	$0.06
Rate for Payer: AlohaCare Medicare	$0.05
Rate for Payer: Cash Price	$0.07
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.10
Rate for Payer: Devoted Health Medicare	$0.05
Rate for Payer: Hawaii Medical Service Association Medicare	$0.05
Rate for Payer: Hawaii Western Management Group Commercial	$0.10
Rate for Payer: Health Management Network Commercial	$0.09
Rate for Payer: Humana Medicare	$0.05
Rate for Payer: Kaiser Permanente Commercial	$0.10
Rate for Payer: Kaiser Permanente Medicaid	$0.06
Rate for Payer: Kaiser Permanente Medicare	$0.05
Rate for Payer: MDX Hawaii PPO	$0.11
Rate for Payer: Ohana Health Plan Medicaid	$0.05
Rate for Payer: Ohana Health Plan Medicare	$0.05
Rate for Payer: UnitedHealthcare Medicaid	$0.07
Rate for Payer: UnitedHealthcare Medicare	$0.05
Rate for Payer: University Health Alliance Commercial	$0.08

Cetaphil emollients, Top Lotion [KMC]

Facility

$0.11

Service Code	NDC 00299391808
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.11
Rate for Payer: Cash Price	$0.07
Rate for Payer: Health Management Network Commercial	$0.09
Rate for Payer: Kaiser Permanente Commercial	$0.10
Rate for Payer: MDX Hawaii PPO	$0.11

cetirizine 10 mg Tab [KMC]

Facility

$9.87

Service Code	NDC 16714079902
Hospital Revenue Code	250
Min. Negotiated Rate	$8.39
Max. Negotiated Rate	$9.57
Rate for Payer: Cash Price	$6.42
Rate for Payer: Health Management Network Commercial	$8.39
Rate for Payer: Kaiser Permanente Commercial	$8.88
Rate for Payer: MDX Hawaii PPO	$9.57

cetirizine 10 mg Tab [KMC]

Facility

$9.87

Service Code	NDC 16714079902
Hospital Revenue Code	250
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$9.57
Rate for Payer: AlohaCare Medicaid	$4.93
Rate for Payer: AlohaCare Medicare	$4.15
Rate for Payer: Cash Price	$6.42
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$9.08
Rate for Payer: Devoted Health Medicare	$4.15
Rate for Payer: Hawaii Medical Service Association Medicare	$4.15
Rate for Payer: Hawaii Western Management Group Commercial	$9.38
Rate for Payer: Health Management Network Commercial	$8.39
Rate for Payer: Humana Medicare	$4.15
Rate for Payer: Kaiser Permanente Commercial	$8.88
Rate for Payer: Kaiser Permanente Medicaid	$5.03
Rate for Payer: Kaiser Permanente Medicare	$4.15
Rate for Payer: MDX Hawaii PPO	$9.57
Rate for Payer: Ohana Health Plan Medicaid	$4.15
Rate for Payer: Ohana Health Plan Medicare	$4.15
Rate for Payer: UnitedHealthcare Medicaid	$5.92
Rate for Payer: UnitedHealthcare Medicare	$4.15
Rate for Payer: University Health Alliance Commercial	$7.19

Know your out-of-pocket cost for care.

All Charges