Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

cholecalciferol 5,000 units Tab [KMC]

Facility

$3.00

Service Code	NDC 00904598660
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

cholecalciferol 5,000 units Tab [KMC]

Facility

$3.00

Service Code	NDC 00904598660
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

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC

Facility

$38,563.15

Service Code	MSDRG 415
Min. Negotiated Rate	$38,563.15
Max. Negotiated Rate	$38,563.15
Rate for Payer: Hawaii Medical Service Association Commercial	$38,563.15

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC

Facility

$41,431.10

Service Code	MSDRG 414
Min. Negotiated Rate	$41,431.10
Max. Negotiated Rate	$41,431.10
Rate for Payer: Hawaii Medical Service Association Commercial	$41,431.10

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$26,783.26

Service Code	MSDRG 416
Min. Negotiated Rate	$26,783.26
Max. Negotiated Rate	$26,783.26
Rate for Payer: Hawaii Medical Service Association Commercial	$26,783.26

CHOLECYSTECTOMY WITH C.D.E. WITH CC

Facility

$41,881.43

Service Code	MSDRG 412
Min. Negotiated Rate	$41,881.43
Max. Negotiated Rate	$41,881.43
Rate for Payer: Hawaii Medical Service Association Commercial	$41,881.43

CHOLECYSTECTOMY WITH C.D.E. WITH MCC

Facility

$50,082.33

Service Code	MSDRG 411
Min. Negotiated Rate	$50,082.33
Max. Negotiated Rate	$50,082.33
Rate for Payer: Hawaii Medical Service Association Commercial	$50,082.33

CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC

Facility

$33,704.24

Service Code	MSDRG 413
Min. Negotiated Rate	$33,704.24
Max. Negotiated Rate	$33,704.24
Rate for Payer: Hawaii Medical Service Association Commercial	$33,704.24

Cholesterol HDL

Facility

$159.00

Service Code	HCPCS 83718
Hospital Charge Code	422837180
Hospital Revenue Code	301
Min. Negotiated Rate	$135.15
Max. Negotiated Rate	$154.23
Rate for Payer: Cash Price	$103.35
Rate for Payer: Health Management Network Commercial	$135.15
Rate for Payer: Kaiser Permanente Commercial	$143.10
Rate for Payer: MDX Hawaii PPO	$154.23

Cholesterol HDL

Facility

$159.00

Service Code	HCPCS 83718
Hospital Charge Code	422837180
Hospital Revenue Code	301
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$154.23
Rate for Payer: AlohaCare Medicaid	$79.50
Rate for Payer: AlohaCare Medicare	$66.78
Rate for Payer: Cash Price	$103.35
Rate for Payer: Cash Price	$103.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$146.28
Rate for Payer: Devoted Health Medicare	$66.78
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.31
Rate for Payer: Hawaii Medical Service Association Commercial	$10.24
Rate for Payer: Hawaii Medical Service Association Medicare	$66.78
Rate for Payer: Hawaii Western Management Group Commercial	$8.19
Rate for Payer: Health Management Network Commercial	$135.15
Rate for Payer: Humana Medicare	$66.78
Rate for Payer: Kaiser Permanente Commercial	$143.10
Rate for Payer: Kaiser Permanente Medicaid	$81.09
Rate for Payer: Kaiser Permanente Medicare	$66.78
Rate for Payer: MDX Hawaii PPO	$154.23
Rate for Payer: Ohana Health Plan Medicaid	$66.78
Rate for Payer: Ohana Health Plan Medicare	$66.78
Rate for Payer: UnitedHealthcare Medicaid	$11.31
Rate for Payer: UnitedHealthcare Medicare	$66.78
Rate for Payer: University Health Alliance Commercial	$21.16

Cholesterol HDL DLS

Facility

$51.00

Service Code	HCPCS 83718
Hospital Charge Code	422837185
Hospital Revenue Code	301
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$49.47
Rate for Payer: Cash Price	$33.15
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: MDX Hawaii PPO	$49.47

Cholesterol HDL DLS

Facility

$51.00

Service Code	HCPCS 83718
Hospital Charge Code	422837185
Hospital Revenue Code	301
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$49.47
Rate for Payer: AlohaCare Medicaid	$25.50
Rate for Payer: AlohaCare Medicare	$21.42
Rate for Payer: Cash Price	$33.15
Rate for Payer: Cash Price	$33.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$46.92
Rate for Payer: Devoted Health Medicare	$21.42
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.31
Rate for Payer: Hawaii Medical Service Association Commercial	$10.24
Rate for Payer: Hawaii Medical Service Association Medicare	$21.42
Rate for Payer: Hawaii Western Management Group Commercial	$8.19
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Humana Medicare	$21.42
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: Kaiser Permanente Medicaid	$26.01
Rate for Payer: Kaiser Permanente Medicare	$21.42
Rate for Payer: MDX Hawaii PPO	$49.47
Rate for Payer: Ohana Health Plan Medicaid	$21.42
Rate for Payer: Ohana Health Plan Medicare	$21.42
Rate for Payer: UnitedHealthcare Medicaid	$11.31
Rate for Payer: UnitedHealthcare Medicare	$21.42
Rate for Payer: University Health Alliance Commercial	$21.16

Cholesterol Total

Facility

$69.00

Service Code	HCPCS 82465
Hospital Charge Code	422824650
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

Cholesterol Total

Facility

$69.00

Service Code	HCPCS 82465
Hospital Charge Code	422824650
Hospital Revenue Code	301
Min. Negotiated Rate	$4.35
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	$6.02
Rate for Payer: Hawaii Medical Service Association Commercial	$5.44
Rate for Payer: Hawaii Medical Service Association Medicare	$28.98
Rate for Payer: Hawaii Western Management Group Commercial	$4.35
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	$6.02
Rate for Payer: UnitedHealthcare Medicare	$28.98
Rate for Payer: University Health Alliance Commercial	$11.25

Cholesterol Total DLS

Facility

$23.00

Service Code	HCPCS 82465
Hospital Charge Code	422824655
Hospital Revenue Code	301
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$22.31
Rate for Payer: AlohaCare Medicaid	$11.50
Rate for Payer: AlohaCare Medicare	$9.66
Rate for Payer: Cash Price	$14.95
Rate for Payer: Cash Price	$14.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$21.16
Rate for Payer: Devoted Health Medicare	$9.66
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$6.02
Rate for Payer: Hawaii Medical Service Association Commercial	$5.44
Rate for Payer: Hawaii Medical Service Association Medicare	$9.66
Rate for Payer: Hawaii Western Management Group Commercial	$4.35
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Humana Medicare	$9.66
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: Kaiser Permanente Medicaid	$11.73
Rate for Payer: Kaiser Permanente Medicare	$9.66
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: Ohana Health Plan Medicaid	$9.66
Rate for Payer: Ohana Health Plan Medicare	$9.66
Rate for Payer: UnitedHealthcare Medicaid	$6.02
Rate for Payer: UnitedHealthcare Medicare	$9.66
Rate for Payer: University Health Alliance Commercial	$11.25

Cholesterol Total DLS

Facility

$23.00

Service Code	HCPCS 82465
Hospital Charge Code	422824655
Hospital Revenue Code	301
Min. Negotiated Rate	$19.55
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$14.95
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: MDX Hawaii PPO	$22.31

cholestyramine 4 gm packet [KMC]

Facility

$20.43

Service Code	NDC 00245003642
Hospital Revenue Code	250
Min. Negotiated Rate	$17.37
Max. Negotiated Rate	$19.82
Rate for Payer: Cash Price	$13.28
Rate for Payer: Health Management Network Commercial	$17.37
Rate for Payer: Kaiser Permanente Commercial	$18.39
Rate for Payer: MDX Hawaii PPO	$19.82

cholestyramine 4 gm packet [KMC]

Facility

$20.43

Service Code	NDC 00245003642
Hospital Revenue Code	250
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$19.82
Rate for Payer: AlohaCare Medicaid	$10.21
Rate for Payer: AlohaCare Medicare	$8.58
Rate for Payer: Cash Price	$13.28
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$18.80
Rate for Payer: Devoted Health Medicare	$8.58
Rate for Payer: Hawaii Medical Service Association Medicare	$8.58
Rate for Payer: Hawaii Western Management Group Commercial	$19.41
Rate for Payer: Health Management Network Commercial	$17.37
Rate for Payer: Humana Medicare	$8.58
Rate for Payer: Kaiser Permanente Commercial	$18.39
Rate for Payer: Kaiser Permanente Medicaid	$10.42
Rate for Payer: Kaiser Permanente Medicare	$8.58
Rate for Payer: MDX Hawaii PPO	$19.82
Rate for Payer: Ohana Health Plan Medicaid	$8.58
Rate for Payer: Ohana Health Plan Medicare	$8.58
Rate for Payer: UnitedHealthcare Medicaid	$12.26
Rate for Payer: UnitedHealthcare Medicare	$8.58
Rate for Payer: University Health Alliance Commercial	$14.89

CHROMOSOME ANALYSIS 15-20 DLS

Facility

$983.00

Service Code	HCPCS 88262
Hospital Charge Code	422882625
Hospital Revenue Code	300
Min. Negotiated Rate	$835.55
Max. Negotiated Rate	$953.51
Rate for Payer: Cash Price	$638.95
Rate for Payer: Health Management Network Commercial	$835.55
Rate for Payer: Kaiser Permanente Commercial	$884.70
Rate for Payer: MDX Hawaii PPO	$953.51

CHROMOSOME ANALYSIS 15-20 DLS

Facility

$983.00

Service Code	HCPCS 88262
Hospital Charge Code	422882625
Hospital Revenue Code	300
Min. Negotiated Rate	$124.02
Max. Negotiated Rate	$953.51
Rate for Payer: AlohaCare Medicaid	$491.50
Rate for Payer: AlohaCare Medicare	$412.86
Rate for Payer: Cash Price	$638.95
Rate for Payer: Cash Price	$638.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$904.36
Rate for Payer: Devoted Health Medicare	$412.86
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$124.02
Rate for Payer: Hawaii Medical Service Association Commercial	$156.86
Rate for Payer: Hawaii Medical Service Association Medicare	$412.86
Rate for Payer: Hawaii Western Management Group Commercial	$125.49
Rate for Payer: Health Management Network Commercial	$835.55
Rate for Payer: Humana Medicare	$412.86
Rate for Payer: Kaiser Permanente Commercial	$884.70
Rate for Payer: Kaiser Permanente Medicaid	$501.33
Rate for Payer: Kaiser Permanente Medicare	$412.86
Rate for Payer: MDX Hawaii PPO	$953.51
Rate for Payer: Ohana Health Plan Medicaid	$412.86
Rate for Payer: Ohana Health Plan Medicare	$412.86
Rate for Payer: UnitedHealthcare Medicaid	$124.02
Rate for Payer: UnitedHealthcare Medicare	$412.86
Rate for Payer: University Health Alliance Commercial	$322.16

CHRONIC CARE MGMT SVCS STAFF 1ST 20 MIN CAL MO

Professional

Both

$117.00

Service Code	HCPCS 99490
Hospital Revenue Code	521
Min. Negotiated Rate	$43.87
Max. Negotiated Rate	$290.48
Rate for Payer: AlohaCare Medicaid	$50.66
Rate for Payer: AlohaCare Medicare	$43.87
Rate for Payer: Cash Price	$76.05
Rate for Payer: Cash Price	$76.05
Rate for Payer: Cash Price	$76.05
Rate for Payer: Devoted Health Medicare	$43.87
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	$99.45
Rate for Payer: Kaiser Permanente Commercial	$52.64
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: Ohana Health Plan Medicaid	$50.66
Rate for Payer: Ohana Health Plan Medicare	$43.87
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$273.13
Rate for Payer: UnitedHealthcare Medicare	$152.00

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC

Facility

$18,487.56

Service Code	MSDRG 191
Min. Negotiated Rate	$18,487.56
Max. Negotiated Rate	$18,487.56
Rate for Payer: Hawaii Medical Service Association Commercial	$18,487.56

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC

Facility

$18,487.56

Service Code	MSDRG 190
Min. Negotiated Rate	$18,487.56
Max. Negotiated Rate	$18,487.56
Rate for Payer: Hawaii Medical Service Association Commercial	$18,487.56

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC

Facility

$18,487.56

Service Code	MSDRG 192
Min. Negotiated Rate	$18,487.56
Max. Negotiated Rate	$18,487.56
Rate for Payer: Hawaii Medical Service Association Commercial	$18,487.56

cilostazol 100 mg Tab [KMC]

Facility

$7.30

Service Code	NDC 00093206406
Hospital Revenue Code	250
Min. Negotiated Rate	$6.21
Max. Negotiated Rate	$7.08
Rate for Payer: Cash Price	$4.74
Rate for Payer: Health Management Network Commercial	$6.21
Rate for Payer: Kaiser Permanente Commercial	$6.57
Rate for Payer: MDX Hawaii PPO	$7.08

Know your out-of-pocket cost for care.

All Charges