Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE

Professional

Both

$464.00

Service Code	HCPCS 57456
Hospital Revenue Code	361
Min. Negotiated Rate	$87.01
Max. Negotiated Rate	$394.40
Rate for Payer: AlohaCare Medicaid	$100.65
Rate for Payer: AlohaCare Medicare	$87.01
Rate for Payer: Cash Price	$301.60
Rate for Payer: Cash Price	$301.60
Rate for Payer: Devoted Health Medicare	$87.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$100.65
Rate for Payer: Hawaii Medical Service Association Commercial	$156.99
Rate for Payer: Hawaii Medical Service Association Medicare	$87.01
Rate for Payer: Hawaii Western Management Group Commercial	$129.74
Rate for Payer: Health Management Network Commercial	$394.40
Rate for Payer: Kaiser Permanente Commercial	$104.41
Rate for Payer: Kaiser Permanente Medicaid	$104.41
Rate for Payer: Kaiser Permanente Medicare	$104.41
Rate for Payer: Ohana Health Plan Medicaid	$100.65
Rate for Payer: Ohana Health Plan Medicare	$87.01
Rate for Payer: UnitedHealthcare Medicaid	$100.65
Rate for Payer: UnitedHealthcare Medicare	$87.01
Rate for Payer: University Health Alliance Commercial	$123.75

COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA

Professional

Both

$389.00

Service Code	HCPCS 57452
Hospital Revenue Code	361
Min. Negotiated Rate	$73.58
Max. Negotiated Rate	$330.65
Rate for Payer: AlohaCare Medicaid	$92.28
Rate for Payer: AlohaCare Medicare	$82.28
Rate for Payer: Cash Price	$252.85
Rate for Payer: Cash Price	$252.85
Rate for Payer: Devoted Health Medicare	$82.28
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$92.28
Rate for Payer: Hawaii Medical Service Association Commercial	$142.23
Rate for Payer: Hawaii Medical Service Association Medicare	$82.28
Rate for Payer: Hawaii Western Management Group Commercial	$73.58
Rate for Payer: Health Management Network Commercial	$330.65
Rate for Payer: Kaiser Permanente Commercial	$98.74
Rate for Payer: Kaiser Permanente Medicaid	$98.74
Rate for Payer: Kaiser Permanente Medicare	$98.74
Rate for Payer: Ohana Health Plan Medicaid	$92.28
Rate for Payer: Ohana Health Plan Medicare	$82.28
Rate for Payer: UnitedHealthcare Medicaid	$92.28
Rate for Payer: UnitedHealthcare Medicare	$82.28
Rate for Payer: University Health Alliance Commercial	$114.35

COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX

Professional

Both

$494.00

Service Code	HCPCS 57455
Hospital Revenue Code	361
Min. Negotiated Rate	$94.17
Max. Negotiated Rate	$419.90
Rate for Payer: AlohaCare Medicaid	$107.97
Rate for Payer: AlohaCare Medicare	$94.17
Rate for Payer: Cash Price	$321.10
Rate for Payer: Cash Price	$321.10
Rate for Payer: Devoted Health Medicare	$94.17
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$107.97
Rate for Payer: Hawaii Medical Service Association Commercial	$168.95
Rate for Payer: Hawaii Medical Service Association Medicare	$94.17
Rate for Payer: Hawaii Western Management Group Commercial	$137.02
Rate for Payer: Health Management Network Commercial	$419.90
Rate for Payer: Kaiser Permanente Commercial	$113.00
Rate for Payer: Kaiser Permanente Medicaid	$113.00
Rate for Payer: Kaiser Permanente Medicare	$113.00
Rate for Payer: Ohana Health Plan Medicaid	$107.97
Rate for Payer: Ohana Health Plan Medicare	$94.17
Rate for Payer: UnitedHealthcare Medicaid	$107.97
Rate for Payer: UnitedHealthcare Medicare	$94.17
Rate for Payer: University Health Alliance Commercial	$133.96

COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT

Professional

Both

$409.00

Service Code	HCPCS 57420
Hospital Revenue Code	361
Min. Negotiated Rate	$79.55
Max. Negotiated Rate	$347.65
Rate for Payer: AlohaCare Medicaid	$89.86
Rate for Payer: AlohaCare Medicare	$79.55
Rate for Payer: Cash Price	$265.85
Rate for Payer: Cash Price	$265.85
Rate for Payer: Devoted Health Medicare	$79.55
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$89.86
Rate for Payer: Hawaii Medical Service Association Commercial	$138.93
Rate for Payer: Hawaii Medical Service Association Medicare	$79.55
Rate for Payer: Hawaii Western Management Group Commercial	$114.66
Rate for Payer: Health Management Network Commercial	$347.65
Rate for Payer: Kaiser Permanente Commercial	$95.46
Rate for Payer: Kaiser Permanente Medicaid	$95.46
Rate for Payer: Kaiser Permanente Medicare	$95.46
Rate for Payer: Ohana Health Plan Medicaid	$89.86
Rate for Payer: Ohana Health Plan Medicare	$79.55
Rate for Payer: UnitedHealthcare Medicaid	$89.86
Rate for Payer: UnitedHealthcare Medicare	$79.55
Rate for Payer: University Health Alliance Commercial	$117.63

COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX

Professional

Both

$540.00

Service Code	HCPCS 57421
Hospital Revenue Code	361
Min. Negotiated Rate	$106.52
Max. Negotiated Rate	$459.00
Rate for Payer: AlohaCare Medicaid	$121.25
Rate for Payer: AlohaCare Medicare	$106.52
Rate for Payer: Cash Price	$351.00
Rate for Payer: Cash Price	$351.00
Rate for Payer: Devoted Health Medicare	$106.52
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$121.25
Rate for Payer: Hawaii Medical Service Association Commercial	$188.72
Rate for Payer: Hawaii Medical Service Association Medicare	$106.52
Rate for Payer: Hawaii Western Management Group Commercial	$158.34
Rate for Payer: Health Management Network Commercial	$459.00
Rate for Payer: Kaiser Permanente Commercial	$127.82
Rate for Payer: Kaiser Permanente Medicaid	$127.82
Rate for Payer: Kaiser Permanente Medicare	$127.82
Rate for Payer: Ohana Health Plan Medicaid	$121.25
Rate for Payer: Ohana Health Plan Medicare	$106.52
Rate for Payer: UnitedHealthcare Medicaid	$121.25
Rate for Payer: UnitedHealthcare Medicare	$106.52
Rate for Payer: University Health Alliance Commercial	$159.78

COLPOSCOPY VULVA

Professional

Both

$385.00

Service Code	HCPCS 56820
Hospital Revenue Code	361
Min. Negotiated Rate	$74.11
Max. Negotiated Rate	$327.25
Rate for Payer: AlohaCare Medicaid	$84.25
Rate for Payer: AlohaCare Medicare	$74.11
Rate for Payer: Cash Price	$250.25
Rate for Payer: Cash Price	$250.25
Rate for Payer: Devoted Health Medicare	$74.11
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$84.25
Rate for Payer: Hawaii Medical Service Association Commercial	$131.31
Rate for Payer: Hawaii Medical Service Association Medicare	$74.11
Rate for Payer: Hawaii Western Management Group Commercial	$116.74
Rate for Payer: Health Management Network Commercial	$327.25
Rate for Payer: Kaiser Permanente Commercial	$88.93
Rate for Payer: Kaiser Permanente Medicaid	$88.93
Rate for Payer: Kaiser Permanente Medicare	$88.93
Rate for Payer: Ohana Health Plan Medicaid	$84.25
Rate for Payer: Ohana Health Plan Medicare	$74.11
Rate for Payer: UnitedHealthcare Medicaid	$84.25
Rate for Payer: UnitedHealthcare Medicare	$74.11
Rate for Payer: University Health Alliance Commercial	$111.18

COLPOSCOPY VULVA W/BIOPSY

Professional

Both

$510.00

Service Code	HCPCS 56821
Hospital Revenue Code	361
Min. Negotiated Rate	$98.84
Max. Negotiated Rate	$433.50
Rate for Payer: AlohaCare Medicaid	$113.02
Rate for Payer: AlohaCare Medicare	$98.84
Rate for Payer: Cash Price	$331.50
Rate for Payer: Cash Price	$331.50
Rate for Payer: Devoted Health Medicare	$98.84
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$113.02
Rate for Payer: Hawaii Medical Service Association Commercial	$176.36
Rate for Payer: Hawaii Medical Service Association Medicare	$98.84
Rate for Payer: Hawaii Western Management Group Commercial	$151.06
Rate for Payer: Health Management Network Commercial	$433.50
Rate for Payer: Kaiser Permanente Commercial	$118.61
Rate for Payer: Kaiser Permanente Medicaid	$118.61
Rate for Payer: Kaiser Permanente Medicare	$118.61
Rate for Payer: Ohana Health Plan Medicaid	$113.02
Rate for Payer: Ohana Health Plan Medicare	$98.84
Rate for Payer: UnitedHealthcare Medicaid	$113.02
Rate for Payer: UnitedHealthcare Medicare	$98.84
Rate for Payer: University Health Alliance Commercial	$149.31

COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC

Facility

$115,594.65

Service Code	MSDRG 429
Min. Negotiated Rate	$115,594.65
Max. Negotiated Rate	$115,594.65
Rate for Payer: Hawaii Medical Service Association Commercial	$115,594.65

COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC

Facility

$115,594.65

Service Code	MSDRG 430
Min. Negotiated Rate	$115,594.65
Max. Negotiated Rate	$115,594.65
Rate for Payer: Hawaii Medical Service Association Commercial	$115,594.65

Community/Work Reintegration Charges

Facility

$179.00

Service Code	HCPCS 97537 GO
Hospital Charge Code	426975370
Hospital Revenue Code	430
Min. Negotiated Rate	$18.95
Max. Negotiated Rate	$173.63
Rate for Payer: AlohaCare Medicaid	$89.50
Rate for Payer: AlohaCare Medicare	$75.18
Rate for Payer: Cash Price	$116.35
Rate for Payer: Cash Price	$116.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$164.68
Rate for Payer: Devoted Health Medicare	$75.18
Rate for Payer: Hawaii Medical Service Association Medicare	$75.18
Rate for Payer: Hawaii Western Management Group Commercial	$170.05
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Humana Medicare	$75.18
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: Kaiser Permanente Medicaid	$91.29
Rate for Payer: Kaiser Permanente Medicare	$75.18
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: Ohana Health Plan Medicaid	$75.18
Rate for Payer: Ohana Health Plan Medicare	$75.18
Rate for Payer: UnitedHealthcare Medicaid	$18.95
Rate for Payer: UnitedHealthcare Medicare	$75.18
Rate for Payer: University Health Alliance Commercial	$130.47

Community/Work Reintegration Charges

Facility

$179.00

Service Code	HCPCS 97537 GO
Hospital Charge Code	426975370
Hospital Revenue Code	430
Min. Negotiated Rate	$152.15
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$116.35
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63

COMMUNITY/WORK REINTEGRATION TRAING EA 15 MIN

Professional

Both

$162.00

Service Code	HCPCS 97537
Hospital Revenue Code	420
Min. Negotiated Rate	$21.27
Max. Negotiated Rate	$137.70
Rate for Payer: AlohaCare Medicare	$34.07
Rate for Payer: Cash Price	$105.30
Rate for Payer: Cash Price	$105.30
Rate for Payer: Devoted Health Medicare	$34.07
Rate for Payer: Hawaii Medical Service Association Medicare	$34.07
Rate for Payer: Hawaii Western Management Group Commercial	$21.27
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: Kaiser Permanente Commercial	$40.88
Rate for Payer: Kaiser Permanente Medicaid	$40.88
Rate for Payer: Kaiser Permanente Medicare	$40.88
Rate for Payer: Ohana Health Plan Medicare	$34.07
Rate for Payer: UnitedHealthcare Medicare	$34.07

COMP LAC EYE/NOSE/EAR/LIP ED Charge

Facility

$2,091.00

Service Code	HCPCS 13152
Hospital Charge Code	440131520
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$6,743.44
Rate for Payer: AlohaCare Medicaid	$1,045.50
Rate for Payer: AlohaCare Medicare	$878.22
Rate for Payer: Cash Price	$1,359.15
Rate for Payer: Cash Price	$1,359.15
Rate for Payer: Cash Price	$1,359.15
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,923.72
Rate for Payer: Devoted Health Medicare	$878.22
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$878.22
Rate for Payer: Hawaii Western Management Group Commercial	$1,986.45
Rate for Payer: Health Management Network Commercial	$1,777.35
Rate for Payer: Humana Medicare	$878.22
Rate for Payer: Kaiser Permanente Commercial	$1,881.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$878.22
Rate for Payer: MDX Hawaii PPO	$2,028.27
Rate for Payer: Ohana Health Plan Medicaid	$878.22
Rate for Payer: Ohana Health Plan Medicare	$878.22
Rate for Payer: UnitedHealthcare Medicare	$878.22
Rate for Payer: University Health Alliance Commercial	$6,743.44

COMP LAC EYE/NOSE/EAR/LIP ED Charge

Facility

$2,091.00

Service Code	HCPCS 13152
Hospital Charge Code	440131520
Hospital Revenue Code	450
Min. Negotiated Rate	$1,777.35
Max. Negotiated Rate	$2,028.27
Rate for Payer: Cash Price	$1,359.15
Rate for Payer: Health Management Network Commercial	$1,777.35
Rate for Payer: Kaiser Permanente Commercial	$1,881.90
Rate for Payer: MDX Hawaii PPO	$2,028.27

COMPLEX AORTIC ARCH PROCEDURES

Facility

$193,360.92

Service Code	MSDRG 209
Min. Negotiated Rate	$193,360.92
Max. Negotiated Rate	$193,360.92
Rate for Payer: Hawaii Medical Service Association Commercial	$193,360.92

COMPLICATED PEPTIC ULCER WITH CC

Facility

$23,796.81

Service Code	MSDRG 381
Min. Negotiated Rate	$23,796.81
Max. Negotiated Rate	$23,796.81
Rate for Payer: Hawaii Medical Service Association Commercial	$23,796.81

COMPLICATED PEPTIC ULCER WITH MCC

Facility

$23,796.81

Service Code	MSDRG 380
Min. Negotiated Rate	$23,796.81
Max. Negotiated Rate	$23,796.81
Rate for Payer: Hawaii Medical Service Association Commercial	$23,796.81

COMPLICATED PEPTIC ULCER WITHOUT CC/MCC

Facility

$23,796.81

Service Code	MSDRG 382
Min. Negotiated Rate	$23,796.81
Max. Negotiated Rate	$23,796.81
Rate for Payer: Hawaii Medical Service Association Commercial	$23,796.81

COMPLICATIONS OF TREATMENT WITH CC

Facility

$27,826.15

Service Code	MSDRG 920
Min. Negotiated Rate	$27,826.15
Max. Negotiated Rate	$27,826.15
Rate for Payer: Hawaii Medical Service Association Commercial	$27,826.15

COMPLICATIONS OF TREATMENT WITH MCC

Facility

$27,826.15

Service Code	MSDRG 919
Min. Negotiated Rate	$27,826.15
Max. Negotiated Rate	$27,826.15
Rate for Payer: Hawaii Medical Service Association Commercial	$27,826.15

COMPLICATIONS OF TREATMENT WITHOUT CC/MCC

Facility

$15,761.83

Service Code	MSDRG 921
Min. Negotiated Rate	$15,761.83
Max. Negotiated Rate	$15,761.83
Rate for Payer: Hawaii Medical Service Association Commercial	$15,761.83

Comprehensive Metabolic Panel 15

Facility

$159.00

Service Code	HCPCS 80053
Hospital Charge Code	422800530
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

Comprehensive Metabolic Panel 15

Facility

$159.00

Service Code	HCPCS 80053
Hospital Charge Code	422800530
Hospital Revenue Code	301
Min. Negotiated Rate	$10.56
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	$14.61
Rate for Payer: Hawaii Medical Service Association Commercial	$13.20
Rate for Payer: Hawaii Medical Service Association Medicare	$66.78
Rate for Payer: Hawaii Western Management Group Commercial	$10.56
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	$14.61
Rate for Payer: UnitedHealthcare Medicare	$66.78
Rate for Payer: University Health Alliance Commercial	$27.32

Comprehensive Metabolic Profile DLS

Facility

$159.00

Service Code	HCPCS 80053
Hospital Charge Code	422800535
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

Comprehensive Metabolic Profile DLS

Facility

$159.00

Service Code	HCPCS 80053
Hospital Charge Code	422800535
Hospital Revenue Code	301
Min. Negotiated Rate	$10.56
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	$14.61
Rate for Payer: Hawaii Medical Service Association Commercial	$13.20
Rate for Payer: Hawaii Medical Service Association Medicare	$66.78
Rate for Payer: Hawaii Western Management Group Commercial	$10.56
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	$14.61
Rate for Payer: UnitedHealthcare Medicare	$66.78
Rate for Payer: University Health Alliance Commercial	$27.32

Know your out-of-pocket cost for care.

All Charges