Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

CPAP initiation and management

Facility

$449.00

Service Code	HCPCS 94660
Hospital Charge Code	429946600
Hospital Revenue Code	410
Min. Negotiated Rate	$39.67
Max. Negotiated Rate	$435.53
Rate for Payer: AlohaCare Medicaid	$224.50
Rate for Payer: AlohaCare Medicare	$188.58
Rate for Payer: Cash Price	$291.85
Rate for Payer: Cash Price	$291.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$413.08
Rate for Payer: Devoted Health Medicare	$188.58
Rate for Payer: Hawaii Medical Service Association Commercial	$323.36
Rate for Payer: Hawaii Medical Service Association Medicare	$188.58
Rate for Payer: Hawaii Western Management Group Commercial	$426.55
Rate for Payer: Health Management Network Commercial	$381.65
Rate for Payer: Humana Medicare	$188.58
Rate for Payer: Kaiser Permanente Commercial	$404.10
Rate for Payer: Kaiser Permanente Medicaid	$228.99
Rate for Payer: Kaiser Permanente Medicare	$188.58
Rate for Payer: MDX Hawaii PPO	$435.53
Rate for Payer: Ohana Health Plan Medicaid	$188.58
Rate for Payer: Ohana Health Plan Medicare	$188.58
Rate for Payer: UnitedHealthcare Medicaid	$39.67
Rate for Payer: UnitedHealthcare Medicare	$188.58
Rate for Payer: University Health Alliance Commercial	$327.28

CPAP initiation and management

Facility

$449.00

Service Code	HCPCS 94660
Hospital Charge Code	429946600
Hospital Revenue Code	410
Min. Negotiated Rate	$381.65
Max. Negotiated Rate	$435.53
Rate for Payer: Cash Price	$291.85
Rate for Payer: Health Management Network Commercial	$381.65
Rate for Payer: Kaiser Permanente Commercial	$404.10
Rate for Payer: MDX Hawaii PPO	$435.53

CPAP VENTILATION CPAP INITIATION&MGMT

Professional

Both

$428.00

Service Code	HCPCS 94660
Hospital Revenue Code	410
Min. Negotiated Rate	$32.33
Max. Negotiated Rate	$363.80
Rate for Payer: AlohaCare Medicaid	$37.13
Rate for Payer: AlohaCare Medicare	$32.33
Rate for Payer: Cash Price	$278.20
Rate for Payer: Cash Price	$278.20
Rate for Payer: Devoted Health Medicare	$32.33
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$37.13
Rate for Payer: Hawaii Medical Service Association Medicare	$32.33
Rate for Payer: Hawaii Western Management Group Commercial	$54.19
Rate for Payer: Health Management Network Commercial	$363.80
Rate for Payer: Kaiser Permanente Commercial	$38.80
Rate for Payer: Kaiser Permanente Medicaid	$38.80
Rate for Payer: Kaiser Permanente Medicare	$38.80
Rate for Payer: Ohana Health Plan Medicaid	$37.13
Rate for Payer: Ohana Health Plan Medicare	$32.33
Rate for Payer: UnitedHealthcare Medicaid	$37.13
Rate for Payer: UnitedHealthcare Medicare	$32.33
Rate for Payer: University Health Alliance Commercial	$41.64

C-Peptide DLS

Facility

$122.00

Service Code	HCPCS 84681
Hospital Charge Code	422846815
Hospital Revenue Code	301
Min. Negotiated Rate	$103.70
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$79.30
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: MDX Hawaii PPO	$118.34

C-Peptide DLS

Facility

$122.00

Service Code	HCPCS 84681
Hospital Charge Code	422846815
Hospital Revenue Code	301
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$118.34
Rate for Payer: AlohaCare Medicaid	$61.00
Rate for Payer: AlohaCare Medicare	$51.24
Rate for Payer: Cash Price	$79.30
Rate for Payer: Cash Price	$79.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$112.24
Rate for Payer: Devoted Health Medicare	$51.24
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$28.75
Rate for Payer: Hawaii Medical Service Association Commercial	$26.01
Rate for Payer: Hawaii Medical Service Association Medicare	$51.24
Rate for Payer: Hawaii Western Management Group Commercial	$20.81
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Humana Medicare	$51.24
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Medicaid	$62.22
Rate for Payer: Kaiser Permanente Medicare	$51.24
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: Ohana Health Plan Medicaid	$51.24
Rate for Payer: Ohana Health Plan Medicare	$51.24
Rate for Payer: UnitedHealthcare Medicaid	$28.75
Rate for Payer: UnitedHealthcare Medicare	$51.24
Rate for Payer: University Health Alliance Commercial	$53.78

CPR/CARDIAC ARREST ED

Facility

$843.00

Service Code	HCPCS 92950
Hospital Charge Code	317929500
Hospital Revenue Code	410
Min. Negotiated Rate	$716.55
Max. Negotiated Rate	$817.71
Rate for Payer: Cash Price	$547.95
Rate for Payer: Health Management Network Commercial	$716.55
Rate for Payer: Kaiser Permanente Commercial	$758.70
Rate for Payer: MDX Hawaii PPO	$817.71

CPR/CARDIAC ARREST ED

Facility

$843.00

Service Code	HCPCS 92950
Hospital Charge Code	317929500
Hospital Revenue Code	410
Min. Negotiated Rate	$168.25
Max. Negotiated Rate	$817.71
Rate for Payer: AlohaCare Medicaid	$421.50
Rate for Payer: AlohaCare Medicare	$354.06
Rate for Payer: Cash Price	$547.95
Rate for Payer: Cash Price	$547.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$775.56
Rate for Payer: Devoted Health Medicare	$354.06
Rate for Payer: Hawaii Medical Service Association Commercial	$318.85
Rate for Payer: Hawaii Medical Service Association Medicare	$354.06
Rate for Payer: Hawaii Western Management Group Commercial	$800.85
Rate for Payer: Health Management Network Commercial	$716.55
Rate for Payer: Humana Medicare	$354.06
Rate for Payer: Kaiser Permanente Commercial	$758.70
Rate for Payer: Kaiser Permanente Medicaid	$429.93
Rate for Payer: Kaiser Permanente Medicare	$354.06
Rate for Payer: MDX Hawaii PPO	$817.71
Rate for Payer: Ohana Health Plan Medicaid	$354.06
Rate for Payer: Ohana Health Plan Medicare	$354.06
Rate for Payer: UnitedHealthcare Medicaid	$168.25
Rate for Payer: UnitedHealthcare Medicare	$354.06
Rate for Payer: University Health Alliance Commercial	$614.46

cranberry 250 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 87651042067
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

cranberry 250 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 87651042067
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

CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC

Facility

$24,507.87

Service Code	MSDRG 073
Min. Negotiated Rate	$24,507.87
Max. Negotiated Rate	$24,507.87
Rate for Payer: Hawaii Medical Service Association Commercial	$24,507.87

CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC

Facility

$22,327.28

Service Code	MSDRG 074
Min. Negotiated Rate	$22,327.28
Max. Negotiated Rate	$22,327.28
Rate for Payer: Hawaii Medical Service Association Commercial	$22,327.28

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC

Facility

$89,095.82

Service Code	MSDRG 026
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$89,095.82
Rate for Payer: Hawaii Medical Service Association Commercial	$89,095.82
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC

Facility

$89,095.82

Service Code	MSDRG 025
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$89,095.82
Rate for Payer: Hawaii Medical Service Association Commercial	$89,095.82
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$76,652.27

Service Code	MSDRG 027
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$76,652.27
Rate for Payer: Hawaii Medical Service Association Commercial	$76,652.27
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$224,860.87

Service Code	MSDRG 955
Min. Negotiated Rate	$224,860.87
Max. Negotiated Rate	$224,860.87
Rate for Payer: Hawaii Medical Service Association Commercial	$224,860.87

CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR

Facility

$104,857.65

Service Code	MSDRG 023
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$104,857.65
Rate for Payer: Hawaii Medical Service Association Commercial	$104,857.65
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC

Facility

$99,927.63

Service Code	MSDRG 024
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$99,927.63
Rate for Payer: Hawaii Medical Service Association Commercial	$99,927.63
Rate for Payer: University Health Alliance Commercial	$10,400.00

C-Reactive Protein

Facility

$122.00

Service Code	HCPCS 86140
Hospital Charge Code	422861405
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$118.34
Rate for Payer: AlohaCare Medicaid	$61.00
Rate for Payer: AlohaCare Medicare	$51.24
Rate for Payer: Cash Price	$79.30
Rate for Payer: Cash Price	$79.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$112.24
Rate for Payer: Devoted Health Medicare	$51.24
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$51.24
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Humana Medicare	$51.24
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Medicaid	$62.22
Rate for Payer: Kaiser Permanente Medicare	$51.24
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: Ohana Health Plan Medicaid	$51.24
Rate for Payer: Ohana Health Plan Medicare	$51.24
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$51.24
Rate for Payer: University Health Alliance Commercial	$13.38

C-Reactive Protein

Facility

$122.00

Service Code	HCPCS 86140
Hospital Charge Code	422861405
Hospital Revenue Code	301
Min. Negotiated Rate	$103.70
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$79.30
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: MDX Hawaii PPO	$118.34

C-Reactive Protein (CRP) DLS

Facility

$122.00

Service Code	HCPCS 86140
Hospital Charge Code	422861405
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$118.34
Rate for Payer: AlohaCare Medicaid	$61.00
Rate for Payer: AlohaCare Medicare	$51.24
Rate for Payer: Cash Price	$79.30
Rate for Payer: Cash Price	$79.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$112.24
Rate for Payer: Devoted Health Medicare	$51.24
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$51.24
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Humana Medicare	$51.24
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Medicaid	$62.22
Rate for Payer: Kaiser Permanente Medicare	$51.24
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: Ohana Health Plan Medicaid	$51.24
Rate for Payer: Ohana Health Plan Medicare	$51.24
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$51.24
Rate for Payer: University Health Alliance Commercial	$13.38

C-Reactive Protein (CRP) DLS

Facility

$122.00

Service Code	HCPCS 86140
Hospital Charge Code	422861405
Hospital Revenue Code	301
Min. Negotiated Rate	$103.70
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$79.30
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: MDX Hawaii PPO	$118.34

Creatine Kinase

Facility

$103.00

Service Code	HCPCS 82550
Hospital Charge Code	422825500
Hospital Revenue Code	301
Min. Negotiated Rate	$87.55
Max. Negotiated Rate	$99.91
Rate for Payer: Cash Price	$66.95
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Kaiser Permanente Commercial	$92.70
Rate for Payer: MDX Hawaii PPO	$99.91

Creatine Kinase

Facility

$103.00

Service Code	HCPCS 82550
Hospital Charge Code	422825500
Hospital Revenue Code	301
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$99.91
Rate for Payer: AlohaCare Medicaid	$51.50
Rate for Payer: AlohaCare Medicare	$43.26
Rate for Payer: Cash Price	$66.95
Rate for Payer: Cash Price	$66.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$94.76
Rate for Payer: Devoted Health Medicare	$43.26
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$9.01
Rate for Payer: Hawaii Medical Service Association Commercial	$8.14
Rate for Payer: Hawaii Medical Service Association Medicare	$43.26
Rate for Payer: Hawaii Western Management Group Commercial	$6.51
Rate for Payer: Health Management Network Commercial	$87.55
Rate for Payer: Humana Medicare	$43.26
Rate for Payer: Kaiser Permanente Commercial	$92.70
Rate for Payer: Kaiser Permanente Medicaid	$52.53
Rate for Payer: Kaiser Permanente Medicare	$43.26
Rate for Payer: MDX Hawaii PPO	$99.91
Rate for Payer: Ohana Health Plan Medicaid	$43.26
Rate for Payer: Ohana Health Plan Medicare	$43.26
Rate for Payer: UnitedHealthcare Medicaid	$9.01
Rate for Payer: UnitedHealthcare Medicare	$43.26
Rate for Payer: University Health Alliance Commercial	$16.84

Creatine Kinase-MB

Facility

$241.00

Service Code	HCPCS 82553
Hospital Charge Code	422825530
Hospital Revenue Code	301
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$233.77
Rate for Payer: AlohaCare Medicaid	$120.50
Rate for Payer: AlohaCare Medicare	$101.22
Rate for Payer: Cash Price	$156.65
Rate for Payer: Cash Price	$156.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$221.72
Rate for Payer: Devoted Health Medicare	$101.22
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$15.95
Rate for Payer: Hawaii Medical Service Association Commercial	$14.44
Rate for Payer: Hawaii Medical Service Association Medicare	$101.22
Rate for Payer: Hawaii Western Management Group Commercial	$11.55
Rate for Payer: Health Management Network Commercial	$204.85
Rate for Payer: Humana Medicare	$101.22
Rate for Payer: Kaiser Permanente Commercial	$216.90
Rate for Payer: Kaiser Permanente Medicaid	$122.91
Rate for Payer: Kaiser Permanente Medicare	$101.22
Rate for Payer: MDX Hawaii PPO	$233.77
Rate for Payer: Ohana Health Plan Medicaid	$101.22
Rate for Payer: Ohana Health Plan Medicare	$101.22
Rate for Payer: UnitedHealthcare Medicaid	$15.95
Rate for Payer: UnitedHealthcare Medicare	$101.22
Rate for Payer: University Health Alliance Commercial	$29.84

Creatine Kinase-MB

Facility

$241.00

Service Code	HCPCS 82553
Hospital Charge Code	422825530
Hospital Revenue Code	301
Min. Negotiated Rate	$204.85
Max. Negotiated Rate	$233.77
Rate for Payer: Cash Price	$156.65
Rate for Payer: Health Management Network Commercial	$204.85
Rate for Payer: Kaiser Permanente Commercial	$216.90
Rate for Payer: MDX Hawaii PPO	$233.77

Know your out-of-pocket cost for care.

All Charges