Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

96373 INJ INTRA-ARTERIAL Charge

Facility

$407.00

Service Code	HCPCS 96373
Hospital Charge Code	317963730
Hospital Revenue Code	260
Min. Negotiated Rate	$345.95
Max. Negotiated Rate	$394.79
Rate for Payer: Cash Price	$264.55
Rate for Payer: Health Management Network Commercial	$345.95
Rate for Payer: Kaiser Permanente Commercial	$366.30
Rate for Payer: MDX Hawaii PPO	$394.79

96374 INJ IV PUSH INITIAL DRUG Charge

Facility

$407.00

Service Code	HCPCS 96374
Hospital Charge Code	317963740
Hospital Revenue Code	260
Min. Negotiated Rate	$36.88
Max. Negotiated Rate	$394.79
Rate for Payer: AlohaCare Medicaid	$203.50
Rate for Payer: AlohaCare Medicare	$170.94
Rate for Payer: Cash Price	$264.55
Rate for Payer: Cash Price	$264.55
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$374.44
Rate for Payer: Devoted Health Medicare	$170.94
Rate for Payer: Hawaii Medical Service Association Commercial	$314.10
Rate for Payer: Hawaii Medical Service Association Medicare	$170.94
Rate for Payer: Hawaii Western Management Group Commercial	$386.65
Rate for Payer: Health Management Network Commercial	$345.95
Rate for Payer: Humana Medicare	$170.94
Rate for Payer: Kaiser Permanente Commercial	$366.30
Rate for Payer: Kaiser Permanente Medicaid	$207.57
Rate for Payer: Kaiser Permanente Medicare	$170.94
Rate for Payer: MDX Hawaii PPO	$394.79
Rate for Payer: Ohana Health Plan Medicaid	$170.94
Rate for Payer: Ohana Health Plan Medicare	$170.94
Rate for Payer: UnitedHealthcare Medicaid	$36.88
Rate for Payer: UnitedHealthcare Medicare	$170.94
Rate for Payer: University Health Alliance Commercial	$296.66

96374 INJ IV PUSH INITIAL DRUG Charge

Facility

$407.00

Service Code	HCPCS 96374
Hospital Charge Code	317963740
Hospital Revenue Code	260
Min. Negotiated Rate	$345.95
Max. Negotiated Rate	$394.79
Rate for Payer: Cash Price	$264.55
Rate for Payer: Health Management Network Commercial	$345.95
Rate for Payer: Kaiser Permanente Commercial	$366.30
Rate for Payer: MDX Hawaii PPO	$394.79

96375 IV PUSH EA ADDL SEQ DRUG Charge

Facility

$285.00

Service Code	HCPCS 96375
Hospital Charge Code	317963750
Hospital Revenue Code	260
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$276.45
Rate for Payer: Cash Price	$185.25
Rate for Payer: Health Management Network Commercial	$242.25
Rate for Payer: Kaiser Permanente Commercial	$256.50
Rate for Payer: MDX Hawaii PPO	$276.45

96375 IV PUSH EA ADDL SEQ DRUG Charge

Facility

$285.00

Service Code	HCPCS 96375
Hospital Charge Code	317963750
Hospital Revenue Code	260
Min. Negotiated Rate	$15.80
Max. Negotiated Rate	$276.45
Rate for Payer: AlohaCare Medicaid	$142.50
Rate for Payer: AlohaCare Medicare	$119.70
Rate for Payer: Cash Price	$185.25
Rate for Payer: Cash Price	$185.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$262.20
Rate for Payer: Devoted Health Medicare	$119.70
Rate for Payer: Hawaii Medical Service Association Commercial	$69.15
Rate for Payer: Hawaii Medical Service Association Medicare	$119.70
Rate for Payer: Hawaii Western Management Group Commercial	$270.75
Rate for Payer: Health Management Network Commercial	$242.25
Rate for Payer: Humana Medicare	$119.70
Rate for Payer: Kaiser Permanente Commercial	$256.50
Rate for Payer: Kaiser Permanente Medicaid	$145.35
Rate for Payer: Kaiser Permanente Medicare	$119.70
Rate for Payer: MDX Hawaii PPO	$276.45
Rate for Payer: Ohana Health Plan Medicaid	$119.70
Rate for Payer: Ohana Health Plan Medicare	$119.70
Rate for Payer: UnitedHealthcare Medicaid	$15.80
Rate for Payer: UnitedHealthcare Medicare	$119.70
Rate for Payer: University Health Alliance Commercial	$207.74

96376 IV PUSH EA ADDL SAME DRUG Charge

Facility

$285.00

Service Code	HCPCS 96376
Hospital Charge Code	317963760
Hospital Revenue Code	260
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$276.45
Rate for Payer: Cash Price	$185.25
Rate for Payer: Health Management Network Commercial	$242.25
Rate for Payer: Kaiser Permanente Commercial	$256.50
Rate for Payer: MDX Hawaii PPO	$276.45

96376 IV PUSH EA ADDL SAME DRUG Charge

Facility

$285.00

Service Code	HCPCS 96376
Hospital Charge Code	317963760
Hospital Revenue Code	260
Min. Negotiated Rate	$119.70
Max. Negotiated Rate	$276.45
Rate for Payer: AlohaCare Medicaid	$142.50
Rate for Payer: AlohaCare Medicare	$119.70
Rate for Payer: Cash Price	$185.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$262.20
Rate for Payer: Devoted Health Medicare	$119.70
Rate for Payer: Hawaii Medical Service Association Medicare	$119.70
Rate for Payer: Hawaii Western Management Group Commercial	$270.75
Rate for Payer: Health Management Network Commercial	$242.25
Rate for Payer: Humana Medicare	$119.70
Rate for Payer: Kaiser Permanente Commercial	$256.50
Rate for Payer: Kaiser Permanente Medicaid	$145.35
Rate for Payer: Kaiser Permanente Medicare	$119.70
Rate for Payer: MDX Hawaii PPO	$276.45
Rate for Payer: Ohana Health Plan Medicaid	$119.70
Rate for Payer: Ohana Health Plan Medicare	$119.70
Rate for Payer: UnitedHealthcare Medicare	$119.70
Rate for Payer: University Health Alliance Commercial	$207.74

99235. IP/OBS Admit/Disch. Same Day-MODERATE

Professional

Both

$509.00

Service Code	HCPCS 99235
Hospital Charge Code	435992350
Hospital Revenue Code	987
Min. Negotiated Rate	$117.50
Max. Negotiated Rate	$432.65
Rate for Payer: AlohaCare Medicaid	$160.14
Rate for Payer: AlohaCare Medicare	$143.06
Rate for Payer: Cash Price	$330.85
Rate for Payer: Cash Price	$330.85
Rate for Payer: Devoted Health Medicare	$143.06
Rate for Payer: Hawaii Medical Service Association Medicare	$143.06
Rate for Payer: Hawaii Western Management Group Commercial	$117.50
Rate for Payer: Health Management Network Commercial	$432.65
Rate for Payer: Kaiser Permanente Commercial	$171.67
Rate for Payer: Kaiser Permanente Medicaid	$171.67
Rate for Payer: Kaiser Permanente Medicare	$171.67
Rate for Payer: Ohana Health Plan Medicaid	$160.14
Rate for Payer: Ohana Health Plan Medicare	$143.06
Rate for Payer: UnitedHealthcare Medicaid	$160.14
Rate for Payer: UnitedHealthcare Medicare	$143.06

9VHPV VACC 2/3 DOSE SCHED IM USE

Professional

Both

$0.01

Service Code	HCPCS 90651 SL
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$234.35
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$234.35
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Ohana Health Plan Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicaid	$4.00

9VHPV VACC 2/3 DOSE SCHED IM USE

Professional

Both

$366.00

Service Code	HCPCS 90651
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$311.10
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: Cash Price	$237.90
Rate for Payer: Cash Price	$237.90
Rate for Payer: Hawaii Western Management Group Commercial	$234.35
Rate for Payer: Health Management Network Commercial	$311.10
Rate for Payer: Ohana Health Plan Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicaid	$4.00

abacavir 300 mg Tab [KMC]

Facility

$40.18

Service Code	NDC 00378410591
Hospital Revenue Code	250
Min. Negotiated Rate	$16.88
Max. Negotiated Rate	$38.97
Rate for Payer: AlohaCare Medicaid	$20.09
Rate for Payer: AlohaCare Medicare	$16.88
Rate for Payer: Cash Price	$26.12
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$36.97
Rate for Payer: Devoted Health Medicare	$16.88
Rate for Payer: Hawaii Medical Service Association Medicare	$16.88
Rate for Payer: Hawaii Western Management Group Commercial	$38.17
Rate for Payer: Health Management Network Commercial	$34.15
Rate for Payer: Humana Medicare	$16.88
Rate for Payer: Kaiser Permanente Commercial	$36.16
Rate for Payer: Kaiser Permanente Medicaid	$20.49
Rate for Payer: Kaiser Permanente Medicare	$16.88
Rate for Payer: MDX Hawaii PPO	$38.97
Rate for Payer: Ohana Health Plan Medicaid	$16.88
Rate for Payer: Ohana Health Plan Medicare	$16.88
Rate for Payer: UnitedHealthcare Medicaid	$24.11
Rate for Payer: UnitedHealthcare Medicare	$16.88
Rate for Payer: University Health Alliance Commercial	$29.29

abacavir 300 mg Tab [KMC]

Facility

$40.18

Service Code	NDC 00378410591
Hospital Revenue Code	250
Min. Negotiated Rate	$34.15
Max. Negotiated Rate	$38.97
Rate for Payer: Cash Price	$26.12
Rate for Payer: Health Management Network Commercial	$34.15
Rate for Payer: Kaiser Permanente Commercial	$36.16
Rate for Payer: MDX Hawaii PPO	$38.97

Abacavir-Lamivudine 600-300 mg tab [KMC]

Facility

$186.01

Service Code	NDC 69097036202
Hospital Revenue Code	250
Min. Negotiated Rate	$158.11
Max. Negotiated Rate	$180.43
Rate for Payer: Cash Price	$120.91
Rate for Payer: Health Management Network Commercial	$158.11
Rate for Payer: Kaiser Permanente Commercial	$167.41
Rate for Payer: MDX Hawaii PPO	$180.43

Abacavir-Lamivudine 600-300 mg tab [KMC]

Facility

$186.01

Service Code	NDC 69097036202
Hospital Revenue Code	250
Min. Negotiated Rate	$78.12
Max. Negotiated Rate	$180.43
Rate for Payer: AlohaCare Medicaid	$93.00
Rate for Payer: AlohaCare Medicare	$78.12
Rate for Payer: Cash Price	$120.91
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$171.13
Rate for Payer: Devoted Health Medicare	$78.12
Rate for Payer: Hawaii Medical Service Association Medicare	$78.12
Rate for Payer: Hawaii Western Management Group Commercial	$176.71
Rate for Payer: Health Management Network Commercial	$158.11
Rate for Payer: Humana Medicare	$78.12
Rate for Payer: Kaiser Permanente Commercial	$167.41
Rate for Payer: Kaiser Permanente Medicaid	$94.87
Rate for Payer: Kaiser Permanente Medicare	$78.12
Rate for Payer: MDX Hawaii PPO	$180.43
Rate for Payer: Ohana Health Plan Medicaid	$78.12
Rate for Payer: Ohana Health Plan Medicare	$78.12
Rate for Payer: UnitedHealthcare Medicaid	$111.61
Rate for Payer: UnitedHealthcare Medicare	$78.12
Rate for Payer: University Health Alliance Commercial	$135.58

abatacept 125 mg/mL Soln

Facility

$6,447.48

Service Code	HCPCS J0129
Hospital Revenue Code	636
Min. Negotiated Rate	$5,480.36
Max. Negotiated Rate	$6,254.06
Rate for Payer: Cash Price	$4,190.86
Rate for Payer: Health Management Network Commercial	$5,480.36
Rate for Payer: Kaiser Permanente Commercial	$5,802.73
Rate for Payer: MDX Hawaii PPO	$6,254.06

abatacept 125 mg/mL Soln

Facility

$6,447.48

Service Code	HCPCS J0129
Hospital Revenue Code	636
Min. Negotiated Rate	$44.49
Max. Negotiated Rate	$6,254.06
Rate for Payer: AlohaCare Medicaid	$3,223.74
Rate for Payer: AlohaCare Medicare	$2,707.94
Rate for Payer: Cash Price	$4,190.86
Rate for Payer: Cash Price	$4,190.86
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5,931.68
Rate for Payer: Devoted Health Medicare	$2,707.94
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$44.49
Rate for Payer: Hawaii Medical Service Association Commercial	$55.90
Rate for Payer: Hawaii Medical Service Association Medicare	$2,707.94
Rate for Payer: Hawaii Western Management Group Commercial	$6,125.11
Rate for Payer: Health Management Network Commercial	$5,480.36
Rate for Payer: Humana Medicare	$2,707.94
Rate for Payer: Kaiser Permanente Commercial	$5,802.73
Rate for Payer: Kaiser Permanente Medicaid	$3,288.21
Rate for Payer: Kaiser Permanente Medicare	$2,707.94
Rate for Payer: MDX Hawaii PPO	$6,254.06
Rate for Payer: Ohana Health Plan Medicaid	$2,707.94
Rate for Payer: Ohana Health Plan Medicare	$2,707.94
Rate for Payer: UnitedHealthcare Medicaid	$3,868.49
Rate for Payer: UnitedHealthcare Medicare	$2,707.94
Rate for Payer: University Health Alliance Commercial	$4,699.57

ABCESS DRAINAGE Charge

Facility

$816.00

Service Code	HCPCS 41800
Hospital Charge Code	440418000
Hospital Revenue Code	450
Min. Negotiated Rate	$693.60
Max. Negotiated Rate	$791.52
Rate for Payer: Cash Price	$530.40
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: Kaiser Permanente Commercial	$734.40
Rate for Payer: MDX Hawaii PPO	$791.52

ABCESS DRAINAGE Charge

Facility

$816.00

Service Code	HCPCS 41800
Hospital Charge Code	440418000
Hospital Revenue Code	450
Min. Negotiated Rate	$342.72
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$408.00
Rate for Payer: AlohaCare Medicare	$342.72
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$750.72
Rate for Payer: Devoted Health Medicare	$342.72
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	$342.72
Rate for Payer: Hawaii Western Management Group Commercial	$775.20
Rate for Payer: Health Management Network Commercial	$693.60
Rate for Payer: Humana Medicare	$342.72
Rate for Payer: Kaiser Permanente Commercial	$734.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$342.72
Rate for Payer: MDX Hawaii PPO	$791.52
Rate for Payer: Ohana Health Plan Medicaid	$342.72
Rate for Payer: Ohana Health Plan Medicare	$342.72
Rate for Payer: UnitedHealthcare Medicare	$342.72
Rate for Payer: University Health Alliance Commercial	$594.78

ABD AP OBLQ CONE VWS

Facility

$369.00

Service Code	HCPCS 74018
Hospital Charge Code	424740180
Hospital Revenue Code	320
Min. Negotiated Rate	$18.74
Max. Negotiated Rate	$357.93
Rate for Payer: AlohaCare Medicaid	$184.50
Rate for Payer: AlohaCare Medicare	$154.98
Rate for Payer: Cash Price	$239.85
Rate for Payer: Cash Price	$239.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$339.48
Rate for Payer: Devoted Health Medicare	$154.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.74
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$154.98
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Humana Medicare	$154.98
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: Kaiser Permanente Medicaid	$188.19
Rate for Payer: Kaiser Permanente Medicare	$154.98
Rate for Payer: MDX Hawaii PPO	$357.93
Rate for Payer: Ohana Health Plan Medicaid	$154.98
Rate for Payer: Ohana Health Plan Medicare	$154.98
Rate for Payer: UnitedHealthcare Medicaid	$20.11
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$56.31

ABD AP OBLQ CONE VWS

Facility

$369.00

Service Code	HCPCS 74018
Hospital Charge Code	424740180
Hospital Revenue Code	320
Min. Negotiated Rate	$313.65
Max. Negotiated Rate	$357.93
Rate for Payer: Cash Price	$239.85
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: MDX Hawaii PPO	$357.93

ABD COMP INC DECUB ERECT

Facility

$369.00

Service Code	HCPCS 74019
Hospital Charge Code	424740190
Hospital Revenue Code	320
Min. Negotiated Rate	$18.84
Max. Negotiated Rate	$357.93
Rate for Payer: AlohaCare Medicaid	$184.50
Rate for Payer: AlohaCare Medicare	$154.98
Rate for Payer: Cash Price	$239.85
Rate for Payer: Cash Price	$239.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$339.48
Rate for Payer: Devoted Health Medicare	$154.98
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.84
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$154.98
Rate for Payer: Hawaii Western Management Group Commercial	$123.50
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Humana Medicare	$154.98
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: Kaiser Permanente Medicaid	$188.19
Rate for Payer: Kaiser Permanente Medicare	$154.98
Rate for Payer: MDX Hawaii PPO	$357.93
Rate for Payer: Ohana Health Plan Medicaid	$154.98
Rate for Payer: Ohana Health Plan Medicare	$154.98
Rate for Payer: UnitedHealthcare Medicaid	$24.32
Rate for Payer: UnitedHealthcare Medicare	$154.98
Rate for Payer: University Health Alliance Commercial	$68.82

ABD COMP INC DECUB ERECT

Facility

$369.00

Service Code	HCPCS 74019
Hospital Charge Code	424740190
Hospital Revenue Code	320
Min. Negotiated Rate	$313.65
Max. Negotiated Rate	$357.93
Rate for Payer: Cash Price	$239.85
Rate for Payer: Health Management Network Commercial	$313.65
Rate for Payer: Kaiser Permanente Commercial	$332.10
Rate for Payer: MDX Hawaii PPO	$357.93

ABDMONIAL XRAY 1 View

Facility

$321.00

Service Code	HCPCS 74018
Hospital Charge Code	424740180
Hospital Revenue Code	320
Min. Negotiated Rate	$18.74
Max. Negotiated Rate	$311.37
Rate for Payer: AlohaCare Medicaid	$160.50
Rate for Payer: AlohaCare Medicare	$134.82
Rate for Payer: Cash Price	$208.65
Rate for Payer: Cash Price	$208.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$295.32
Rate for Payer: Devoted Health Medicare	$134.82
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.74
Rate for Payer: Hawaii Medical Service Association Commercial	$128.51
Rate for Payer: Hawaii Medical Service Association Medicare	$134.82
Rate for Payer: Hawaii Western Management Group Commercial	$102.81
Rate for Payer: Health Management Network Commercial	$272.85
Rate for Payer: Humana Medicare	$134.82
Rate for Payer: Kaiser Permanente Commercial	$288.90
Rate for Payer: Kaiser Permanente Medicaid	$163.71
Rate for Payer: Kaiser Permanente Medicare	$134.82
Rate for Payer: MDX Hawaii PPO	$311.37
Rate for Payer: Ohana Health Plan Medicaid	$134.82
Rate for Payer: Ohana Health Plan Medicare	$134.82
Rate for Payer: UnitedHealthcare Medicaid	$20.11
Rate for Payer: UnitedHealthcare Medicare	$134.82
Rate for Payer: University Health Alliance Commercial	$56.31

ABDMONIAL XRAY 1 View

Facility

$321.00

Service Code	HCPCS 74018
Hospital Charge Code	424740180
Hospital Revenue Code	320
Min. Negotiated Rate	$272.85
Max. Negotiated Rate	$311.37
Rate for Payer: Cash Price	$208.65
Rate for Payer: Health Management Network Commercial	$272.85
Rate for Payer: Kaiser Permanente Commercial	$288.90
Rate for Payer: MDX Hawaii PPO	$311.37

ABDOM ACUTE SERIES PA CHEST

Facility

$581.00

Service Code	HCPCS 74022
Hospital Charge Code	424740220
Hospital Revenue Code	320
Min. Negotiated Rate	$493.85
Max. Negotiated Rate	$563.57
Rate for Payer: Cash Price	$377.65
Rate for Payer: Health Management Network Commercial	$493.85
Rate for Payer: Kaiser Permanente Commercial	$522.90
Rate for Payer: MDX Hawaii PPO	$563.57

Know your out-of-pocket cost for care.

All Charges