Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

CONCUSSION WITHOUT CC/MCC

Facility

$16,781.02

Service Code	MSDRG 090
Min. Negotiated Rate	$16,781.02
Max. Negotiated Rate	$16,781.02
Rate for Payer: Hawaii Medical Service Association Commercial	$16,781.02

CONNECTIVE TISSUE DISORDERS WITH CC

Facility

$34,652.32

Service Code	MSDRG 546
Min. Negotiated Rate	$34,652.32
Max. Negotiated Rate	$34,652.32
Rate for Payer: Hawaii Medical Service Association Commercial	$34,652.32

CONNECTIVE TISSUE DISORDERS WITH MCC

Facility

$40,032.68

Service Code	MSDRG 545
Min. Negotiated Rate	$40,032.68
Max. Negotiated Rate	$40,032.68
Rate for Payer: Hawaii Medical Service Association Commercial	$40,032.68

CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC

Facility

$29,295.67

Service Code	MSDRG 547
Min. Negotiated Rate	$29,295.67
Max. Negotiated Rate	$29,295.67
Rate for Payer: Hawaii Medical Service Association Commercial	$29,295.67

CONTINUOUS INHALATION TREATMENT EA ADDL HR

Professional

Both

$63.00

Service Code	HCPCS 94645
Hospital Revenue Code	410
Min. Negotiated Rate	$18.55
Max. Negotiated Rate	$53.55
Rate for Payer: AlohaCare Medicaid	$18.55
Rate for Payer: AlohaCare Medicare	$18.80
Rate for Payer: Cash Price	$40.95
Rate for Payer: Cash Price	$40.95
Rate for Payer: Devoted Health Medicare	$18.80
Rate for Payer: Hawaii Medical Service Association Medicare	$18.80
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Kaiser Permanente Commercial	$22.56
Rate for Payer: Kaiser Permanente Medicaid	$22.56
Rate for Payer: Kaiser Permanente Medicare	$22.56
Rate for Payer: Ohana Health Plan Medicaid	$18.55
Rate for Payer: Ohana Health Plan Medicare	$18.80
Rate for Payer: UnitedHealthcare Medicaid	$18.55
Rate for Payer: UnitedHealthcare Medicare	$18.80

CONTROL HEMORRHAGE, ANTERIOR CHARGE

Facility

$432.00

Service Code	HCPCS 30903
Hospital Charge Code	440309030
Hospital Revenue Code	450
Min. Negotiated Rate	$181.44
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$216.00
Rate for Payer: AlohaCare Medicare	$181.44
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cash Price	$280.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$397.44
Rate for Payer: Devoted Health Medicare	$181.44
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	$181.44
Rate for Payer: Hawaii Western Management Group Commercial	$410.40
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Humana Medicare	$181.44
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$181.44
Rate for Payer: MDX Hawaii PPO	$419.04
Rate for Payer: Ohana Health Plan Medicaid	$181.44
Rate for Payer: Ohana Health Plan Medicare	$181.44
Rate for Payer: UnitedHealthcare Medicare	$181.44
Rate for Payer: University Health Alliance Commercial	$314.88

CONTROL HEMORRHAGE, ANTERIOR CHARGE

Facility

$432.00

Service Code	HCPCS 30903
Hospital Charge Code	440309030
Hospital Revenue Code	450
Min. Negotiated Rate	$367.20
Max. Negotiated Rate	$419.04
Rate for Payer: Cash Price	$280.80
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: MDX Hawaii PPO	$419.04

CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE

Professional

Both

$308.00

Service Code	HCPCS 30901
Hospital Revenue Code	361
Min. Negotiated Rate	$48.15
Max. Negotiated Rate	$261.80
Rate for Payer: AlohaCare Medicaid	$55.46
Rate for Payer: AlohaCare Medicare	$48.15
Rate for Payer: Cash Price	$200.20
Rate for Payer: Cash Price	$200.20
Rate for Payer: Devoted Health Medicare	$48.15
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$55.46
Rate for Payer: Hawaii Medical Service Association Commercial	$86.88
Rate for Payer: Hawaii Medical Service Association Medicare	$48.15
Rate for Payer: Hawaii Western Management Group Commercial	$71.50
Rate for Payer: Health Management Network Commercial	$261.80
Rate for Payer: Kaiser Permanente Commercial	$57.78
Rate for Payer: Kaiser Permanente Medicaid	$57.78
Rate for Payer: Kaiser Permanente Medicare	$57.78
Rate for Payer: Ohana Health Plan Medicaid	$55.46
Rate for Payer: Ohana Health Plan Medicare	$48.15
Rate for Payer: UnitedHealthcare Medicaid	$55.46
Rate for Payer: UnitedHealthcare Medicare	$48.15
Rate for Payer: University Health Alliance Commercial	$68.69

Copper DLS

Facility

$92.00

Service Code	HCPCS 82525
Hospital Charge Code	422825255
Hospital Revenue Code	301
Min. Negotiated Rate	$12.41
Max. Negotiated Rate	$89.24
Rate for Payer: AlohaCare Medicaid	$46.00
Rate for Payer: AlohaCare Medicare	$38.64
Rate for Payer: Cash Price	$59.80
Rate for Payer: Cash Price	$59.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$84.64
Rate for Payer: Devoted Health Medicare	$38.64
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$17.15
Rate for Payer: Hawaii Medical Service Association Commercial	$15.51
Rate for Payer: Hawaii Medical Service Association Medicare	$38.64
Rate for Payer: Hawaii Western Management Group Commercial	$12.41
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Humana Medicare	$38.64
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: Kaiser Permanente Medicaid	$46.92
Rate for Payer: Kaiser Permanente Medicare	$38.64
Rate for Payer: MDX Hawaii PPO	$89.24
Rate for Payer: Ohana Health Plan Medicaid	$38.64
Rate for Payer: Ohana Health Plan Medicare	$38.64
Rate for Payer: UnitedHealthcare Medicaid	$17.15
Rate for Payer: UnitedHealthcare Medicare	$38.64
Rate for Payer: University Health Alliance Commercial	$32.08

Copper DLS

Facility

$92.00

Service Code	HCPCS 82525
Hospital Charge Code	422825255
Hospital Revenue Code	301
Min. Negotiated Rate	$78.20
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$59.80
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: MDX Hawaii PPO	$89.24

CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC

Facility

$127,327.14

Service Code	MSDRG 233
Min. Negotiated Rate	$127,327.14
Max. Negotiated Rate	$127,327.14
Rate for Payer: Hawaii Medical Service Association Commercial	$127,327.14

CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC

Facility

$111,754.93

Service Code	MSDRG 234
Min. Negotiated Rate	$111,754.93
Max. Negotiated Rate	$111,754.93
Rate for Payer: Hawaii Medical Service Association Commercial	$111,754.93

CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$97,201.90

Service Code	MSDRG 235
Min. Negotiated Rate	$97,201.90
Max. Negotiated Rate	$97,201.90
Rate for Payer: Hawaii Medical Service Association Commercial	$97,201.90

CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$90,375.73

Service Code	MSDRG 236
Min. Negotiated Rate	$90,375.73
Max. Negotiated Rate	$90,375.73
Rate for Payer: Hawaii Medical Service Association Commercial	$90,375.73

CORONARY BYPASS WITH PTCA WITH MCC

Facility

$140,505.46

Service Code	MSDRG 231
Min. Negotiated Rate	$140,505.46
Max. Negotiated Rate	$140,505.46
Rate for Payer: Hawaii Medical Service Association Commercial	$140,505.46

CORONARY BYPASS WITH PTCA WITHOUT MCC

Facility

$140,505.46

Service Code	MSDRG 232
Min. Negotiated Rate	$140,505.46
Max. Negotiated Rate	$140,505.46
Rate for Payer: Hawaii Medical Service Association Commercial	$140,505.46

CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC

Facility

$40,483.02

Service Code	MSDRG 323
Min. Negotiated Rate	$40,483.02
Max. Negotiated Rate	$40,483.02
Rate for Payer: Hawaii Medical Service Association Commercial	$40,483.02

CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$40,483.02

Service Code	MSDRG 324
Min. Negotiated Rate	$40,483.02
Max. Negotiated Rate	$40,483.02
Rate for Payer: Hawaii Medical Service Association Commercial	$40,483.02

CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE

Facility

$38,112.82

Service Code	MSDRG 325
Min. Negotiated Rate	$38,112.82
Max. Negotiated Rate	$38,112.82
Rate for Payer: Hawaii Medical Service Association Commercial	$38,112.82

Coronavirus SARS Ag (QuickVue)

Facility

$292.00

Service Code	HCPCS 87635
Hospital Charge Code	422876350
Hospital Revenue Code	300
Min. Negotiated Rate	$248.20
Max. Negotiated Rate	$283.24
Rate for Payer: Cash Price	$189.80
Rate for Payer: Health Management Network Commercial	$248.20
Rate for Payer: Kaiser Permanente Commercial	$262.80
Rate for Payer: MDX Hawaii PPO	$283.24

Coronavirus SARS Ag (QuickVue)

Facility

$292.00

Service Code	HCPCS 87635
Hospital Charge Code	422876350
Hospital Revenue Code	300
Min. Negotiated Rate	$51.31
Max. Negotiated Rate	$283.24
Rate for Payer: AlohaCare Medicaid	$146.00
Rate for Payer: AlohaCare Medicare	$122.64
Rate for Payer: Cash Price	$189.80
Rate for Payer: Cash Price	$189.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$268.64
Rate for Payer: Devoted Health Medicare	$122.64
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$51.31
Rate for Payer: Hawaii Medical Service Association Commercial	$64.14
Rate for Payer: Hawaii Medical Service Association Medicare	$122.64
Rate for Payer: Hawaii Western Management Group Commercial	$51.31
Rate for Payer: Health Management Network Commercial	$248.20
Rate for Payer: Humana Medicare	$122.64
Rate for Payer: Kaiser Permanente Commercial	$262.80
Rate for Payer: Kaiser Permanente Medicaid	$148.92
Rate for Payer: Kaiser Permanente Medicare	$122.64
Rate for Payer: MDX Hawaii PPO	$283.24
Rate for Payer: Ohana Health Plan Medicaid	$122.64
Rate for Payer: Ohana Health Plan Medicare	$122.64
Rate for Payer: UnitedHealthcare Medicaid	$51.31
Rate for Payer: UnitedHealthcare Medicare	$122.64
Rate for Payer: University Health Alliance Commercial	$94.96

Cortisol, A.M. DLS

Facility

$168.00

Service Code	HCPCS 82533
Hospital Charge Code	422825335
Hospital Revenue Code	301
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$162.96
Rate for Payer: Cash Price	$109.20
Rate for Payer: Health Management Network Commercial	$142.80
Rate for Payer: Kaiser Permanente Commercial	$151.20
Rate for Payer: MDX Hawaii PPO	$162.96

Cortisol, A.M. DLS

Facility

$168.00

Service Code	HCPCS 82533
Hospital Charge Code	422825335
Hospital Revenue Code	301
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$162.96
Rate for Payer: AlohaCare Medicaid	$84.00
Rate for Payer: AlohaCare Medicare	$70.56
Rate for Payer: Cash Price	$109.20
Rate for Payer: Cash Price	$109.20
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$154.56
Rate for Payer: Devoted Health Medicare	$70.56
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$22.53
Rate for Payer: Hawaii Medical Service Association Commercial	$20.38
Rate for Payer: Hawaii Medical Service Association Medicare	$70.56
Rate for Payer: Hawaii Western Management Group Commercial	$16.30
Rate for Payer: Health Management Network Commercial	$142.80
Rate for Payer: Humana Medicare	$70.56
Rate for Payer: Kaiser Permanente Commercial	$151.20
Rate for Payer: Kaiser Permanente Medicaid	$85.68
Rate for Payer: Kaiser Permanente Medicare	$70.56
Rate for Payer: MDX Hawaii PPO	$162.96
Rate for Payer: Ohana Health Plan Medicaid	$70.56
Rate for Payer: Ohana Health Plan Medicare	$70.56
Rate for Payer: UnitedHealthcare Medicaid	$22.53
Rate for Payer: UnitedHealthcare Medicare	$70.56
Rate for Payer: University Health Alliance Commercial	$42.14

Cortisol, P.M. DLS

Facility

$275.00

Service Code	HCPCS 82533
Hospital Charge Code	422825335
Hospital Revenue Code	301
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$266.75
Rate for Payer: AlohaCare Medicaid	$137.50
Rate for Payer: AlohaCare Medicare	$115.50
Rate for Payer: Cash Price	$178.75
Rate for Payer: Cash Price	$178.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$253.00
Rate for Payer: Devoted Health Medicare	$115.50
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$22.53
Rate for Payer: Hawaii Medical Service Association Commercial	$20.38
Rate for Payer: Hawaii Medical Service Association Medicare	$115.50
Rate for Payer: Hawaii Western Management Group Commercial	$16.30
Rate for Payer: Health Management Network Commercial	$233.75
Rate for Payer: Humana Medicare	$115.50
Rate for Payer: Kaiser Permanente Commercial	$247.50
Rate for Payer: Kaiser Permanente Medicaid	$140.25
Rate for Payer: Kaiser Permanente Medicare	$115.50
Rate for Payer: MDX Hawaii PPO	$266.75
Rate for Payer: Ohana Health Plan Medicaid	$115.50
Rate for Payer: Ohana Health Plan Medicare	$115.50
Rate for Payer: UnitedHealthcare Medicaid	$22.53
Rate for Payer: UnitedHealthcare Medicare	$115.50
Rate for Payer: University Health Alliance Commercial	$42.14

Cortisol, P.M. DLS

Facility

$275.00

Service Code	HCPCS 82533
Hospital Charge Code	422825335
Hospital Revenue Code	301
Min. Negotiated Rate	$233.75
Max. Negotiated Rate	$266.75
Rate for Payer: Cash Price	$178.75
Rate for Payer: Health Management Network Commercial	$233.75
Rate for Payer: Kaiser Permanente Commercial	$247.50
Rate for Payer: MDX Hawaii PPO	$266.75

Know your out-of-pocket cost for care.

All Charges