Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

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

ABDOMINAL AORTA LIMITED

Facility

$689.00

Service Code	HCPCS 93979
Hospital Charge Code	424939790
Hospital Revenue Code	921
Min. Negotiated Rate	$585.65
Max. Negotiated Rate	$668.33
Rate for Payer: Cash Price	$447.85
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Kaiser Permanente Commercial	$620.10
Rate for Payer: MDX Hawaii PPO	$668.33

ABDOMINAL AORTA LIMITED

Facility

$689.00

Service Code	HCPCS 93979
Hospital Charge Code	424939790
Hospital Revenue Code	921
Min. Negotiated Rate	$86.67
Max. Negotiated Rate	$668.33
Rate for Payer: AlohaCare Medicaid	$344.50
Rate for Payer: AlohaCare Medicare	$289.38
Rate for Payer: Cash Price	$447.85
Rate for Payer: Cash Price	$447.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$633.88
Rate for Payer: Devoted Health Medicare	$289.38
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$86.67
Rate for Payer: Hawaii Medical Service Association Commercial	$154.38
Rate for Payer: Hawaii Medical Service Association Medicare	$289.38
Rate for Payer: Hawaii Western Management Group Commercial	$654.55
Rate for Payer: Health Management Network Commercial	$585.65
Rate for Payer: Humana Medicare	$289.38
Rate for Payer: Kaiser Permanente Commercial	$620.10
Rate for Payer: Kaiser Permanente Medicaid	$351.39
Rate for Payer: Kaiser Permanente Medicare	$289.38
Rate for Payer: MDX Hawaii PPO	$668.33
Rate for Payer: Ohana Health Plan Medicaid	$289.38
Rate for Payer: Ohana Health Plan Medicare	$289.38
Rate for Payer: UnitedHealthcare Medicaid	$86.67
Rate for Payer: UnitedHealthcare Medicare	$289.38
Rate for Payer: University Health Alliance Commercial	$502.21

ABD PAD

Facility

$2.00

Hospital Charge Code	8002
Hospital Revenue Code	270
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.30
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

ABD PAD

Facility

$2.00

Hospital Charge Code	8002
Hospital Revenue Code	270
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$0.84
Rate for Payer: Cash Price	$1.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1.84
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.84
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$0.84
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$0.84
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$0.84
Rate for Payer: Ohana Health Plan Medicare	$0.84
Rate for Payer: UnitedHealthcare Medicare	$0.84
Rate for Payer: University Health Alliance Commercial	$1.46

ABD SGL AP VW

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 SGL AP VW

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

ABILIFY INJ 9.75MG [KMC]

Facility

$102.79

Service Code	HCPCS J0400
Hospital Revenue Code	636
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$99.71
Rate for Payer: AlohaCare Medicaid	$51.40
Rate for Payer: AlohaCare Medicare	$43.17
Rate for Payer: Cash Price	$66.81
Rate for Payer: Cash Price	$66.81
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$94.57
Rate for Payer: Devoted Health Medicare	$43.17
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.76
Rate for Payer: Hawaii Medical Service Association Medicare	$43.17
Rate for Payer: Hawaii Western Management Group Commercial	$97.65
Rate for Payer: Health Management Network Commercial	$87.37
Rate for Payer: Humana Medicare	$43.17
Rate for Payer: Kaiser Permanente Commercial	$92.51
Rate for Payer: Kaiser Permanente Medicaid	$52.42
Rate for Payer: Kaiser Permanente Medicare	$43.17
Rate for Payer: MDX Hawaii PPO	$99.71
Rate for Payer: Ohana Health Plan Medicaid	$43.17
Rate for Payer: Ohana Health Plan Medicare	$43.17
Rate for Payer: UnitedHealthcare Medicaid	$61.67
Rate for Payer: UnitedHealthcare Medicare	$43.17
Rate for Payer: University Health Alliance Commercial	$74.92

ABILIFY INJ 9.75MG [KMC]

Facility

$102.79

Service Code	HCPCS J0400
Hospital Revenue Code	636
Min. Negotiated Rate	$87.37
Max. Negotiated Rate	$99.71
Rate for Payer: Cash Price	$66.81
Rate for Payer: Health Management Network Commercial	$87.37
Rate for Payer: Kaiser Permanente Commercial	$92.51
Rate for Payer: MDX Hawaii PPO	$99.71

ABO Rh. Interp

Facility

$410.00

Service Code	HCPCS 86900
Hospital Charge Code	422869000
Hospital Revenue Code	302
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$397.70
Rate for Payer: AlohaCare Medicaid	$205.00
Rate for Payer: AlohaCare Medicare	$172.20
Rate for Payer: Cash Price	$266.50
Rate for Payer: Cash Price	$266.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$377.20
Rate for Payer: Devoted Health Medicare	$172.20
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$4.12
Rate for Payer: Hawaii Medical Service Association Commercial	$3.74
Rate for Payer: Hawaii Medical Service Association Medicare	$172.20
Rate for Payer: Hawaii Western Management Group Commercial	$2.99
Rate for Payer: Health Management Network Commercial	$348.50
Rate for Payer: Humana Medicare	$172.20
Rate for Payer: Kaiser Permanente Commercial	$369.00
Rate for Payer: Kaiser Permanente Medicaid	$209.10
Rate for Payer: Kaiser Permanente Medicare	$172.20
Rate for Payer: MDX Hawaii PPO	$397.70
Rate for Payer: Ohana Health Plan Medicaid	$172.20
Rate for Payer: Ohana Health Plan Medicare	$172.20
Rate for Payer: UnitedHealthcare Medicaid	$4.12
Rate for Payer: UnitedHealthcare Medicare	$172.20
Rate for Payer: University Health Alliance Commercial	$7.71

ABO Rh. Interp

Facility

$410.00

Service Code	HCPCS 86900
Hospital Charge Code	422869000
Hospital Revenue Code	302
Min. Negotiated Rate	$348.50
Max. Negotiated Rate	$397.70
Rate for Payer: Cash Price	$266.50
Rate for Payer: Health Management Network Commercial	$348.50
Rate for Payer: Kaiser Permanente Commercial	$369.00
Rate for Payer: MDX Hawaii PPO	$397.70

ABO Rh. Retype

Facility

$37.00

Service Code	HCPCS 86901
Hospital Charge Code	422869010
Hospital Revenue Code	302
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$24.05
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: MDX Hawaii PPO	$35.89

ABO Rh. Retype

Facility

$37.00

Service Code	HCPCS 86901
Hospital Charge Code	422869010
Hospital Revenue Code	302
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$35.89
Rate for Payer: AlohaCare Medicaid	$18.50
Rate for Payer: AlohaCare Medicare	$15.54
Rate for Payer: Cash Price	$24.05
Rate for Payer: Cash Price	$24.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$34.04
Rate for Payer: Devoted Health Medicare	$15.54
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$8.22
Rate for Payer: Hawaii Medical Service Association Commercial	$3.74
Rate for Payer: Hawaii Medical Service Association Medicare	$15.54
Rate for Payer: Hawaii Western Management Group Commercial	$2.99
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Humana Medicare	$15.54
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: Kaiser Permanente Medicare	$15.54
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: Ohana Health Plan Medicaid	$15.54
Rate for Payer: Ohana Health Plan Medicare	$15.54
Rate for Payer: UnitedHealthcare Medicaid	$8.22
Rate for Payer: UnitedHealthcare Medicare	$15.54
Rate for Payer: University Health Alliance Commercial	$7.71

ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$10,760.71

Service Code	MSDRG 770
Min. Negotiated Rate	$10,760.71
Max. Negotiated Rate	$10,760.71
Rate for Payer: Hawaii Medical Service Association Commercial	$10,760.71

ABORTION WITHOUT D&C

Facility

$7,347.62

Service Code	MSDRG 779
Min. Negotiated Rate	$7,347.62
Max. Negotiated Rate	$7,347.62
Rate for Payer: Hawaii Medical Service Association Commercial	$7,347.62

Abscess Culture with Gram stain DLS

Facility

$129.00

Service Code	HCPCS 87070
Hospital Charge Code	422870705
Hospital Revenue Code	306
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$125.13
Rate for Payer: Cash Price	$83.85
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Kaiser Permanente Commercial	$116.10
Rate for Payer: MDX Hawaii PPO	$125.13

Abscess Culture with Gram stain DLS

Facility

$129.00

Service Code	HCPCS 87070
Hospital Charge Code	422870705
Hospital Revenue Code	306
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$125.13
Rate for Payer: AlohaCare Medicaid	$64.50
Rate for Payer: AlohaCare Medicare	$54.18
Rate for Payer: Cash Price	$83.85
Rate for Payer: Cash Price	$83.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$118.68
Rate for Payer: Devoted Health Medicare	$54.18
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.90
Rate for Payer: Hawaii Medical Service Association Commercial	$10.78
Rate for Payer: Hawaii Medical Service Association Medicare	$54.18
Rate for Payer: Hawaii Western Management Group Commercial	$8.62
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Humana Medicare	$54.18
Rate for Payer: Kaiser Permanente Commercial	$116.10
Rate for Payer: Kaiser Permanente Medicaid	$65.79
Rate for Payer: Kaiser Permanente Medicare	$54.18
Rate for Payer: MDX Hawaii PPO	$125.13
Rate for Payer: Ohana Health Plan Medicaid	$54.18
Rate for Payer: Ohana Health Plan Medicare	$54.18
Rate for Payer: UnitedHealthcare Medicaid	$11.90
Rate for Payer: UnitedHealthcare Medicare	$54.18
Rate for Payer: University Health Alliance Commercial	$22.26

ABSC Gel 1

Facility

$182.00

Service Code	HCPCS 86850
Hospital Charge Code	422868500
Hospital Revenue Code	390
Min. Negotiated Rate	$154.70
Max. Negotiated Rate	$176.54
Rate for Payer: Cash Price	$118.30
Rate for Payer: Health Management Network Commercial	$154.70
Rate for Payer: Kaiser Permanente Commercial	$163.80
Rate for Payer: MDX Hawaii PPO	$176.54

ABSC Gel 1

Facility

$182.00

Service Code	HCPCS 86850
Hospital Charge Code	422868500
Hospital Revenue Code	390
Min. Negotiated Rate	$9.77
Max. Negotiated Rate	$176.54
Rate for Payer: AlohaCare Medicaid	$91.00
Rate for Payer: AlohaCare Medicare	$76.44
Rate for Payer: Cash Price	$118.30
Rate for Payer: Cash Price	$118.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$167.44
Rate for Payer: Devoted Health Medicare	$76.44
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$19.65
Rate for Payer: Hawaii Medical Service Association Commercial	$12.21
Rate for Payer: Hawaii Medical Service Association Medicare	$76.44
Rate for Payer: Hawaii Western Management Group Commercial	$9.77
Rate for Payer: Health Management Network Commercial	$154.70
Rate for Payer: Humana Medicare	$76.44
Rate for Payer: Kaiser Permanente Commercial	$163.80
Rate for Payer: Kaiser Permanente Medicaid	$92.82
Rate for Payer: Kaiser Permanente Medicare	$76.44
Rate for Payer: MDX Hawaii PPO	$176.54
Rate for Payer: Ohana Health Plan Medicaid	$76.44
Rate for Payer: Ohana Health Plan Medicare	$76.44
Rate for Payer: UnitedHealthcare Medicaid	$19.65
Rate for Payer: UnitedHealthcare Medicare	$76.44
Rate for Payer: University Health Alliance Commercial	$50.88

Acapella

Facility

$3.00

Hospital Charge Code	10000
Hospital Revenue Code	290
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

Acapella

Facility

$3.00

Hospital Charge Code	10000
Hospital Revenue Code	290
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 Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

acarbose 100 mg Tab [KMC]

Facility

$4.69

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$4.55
Rate for Payer: Cash Price	$3.05
Rate for Payer: Health Management Network Commercial	$3.99
Rate for Payer: Kaiser Permanente Commercial	$4.22
Rate for Payer: MDX Hawaii PPO	$4.55

acarbose 100 mg Tab [KMC]

Facility

$4.69

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$4.55
Rate for Payer: AlohaCare Medicaid	$2.35
Rate for Payer: AlohaCare Medicare	$1.97
Rate for Payer: Cash Price	$3.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.31
Rate for Payer: Devoted Health Medicare	$1.97
Rate for Payer: Hawaii Medical Service Association Medicare	$1.97
Rate for Payer: Hawaii Western Management Group Commercial	$4.46
Rate for Payer: Health Management Network Commercial	$3.99
Rate for Payer: Humana Medicare	$1.97
Rate for Payer: Kaiser Permanente Commercial	$4.22
Rate for Payer: Kaiser Permanente Medicaid	$2.39
Rate for Payer: Kaiser Permanente Medicare	$1.97
Rate for Payer: MDX Hawaii PPO	$4.55
Rate for Payer: Ohana Health Plan Medicaid	$1.97
Rate for Payer: Ohana Health Plan Medicare	$1.97
Rate for Payer: UnitedHealthcare Medicare	$1.97
Rate for Payer: University Health Alliance Commercial	$3.42

acarbose 25 mg Tab [KMC]

Facility

$3.64

Service Code	NDC 00378282077
Hospital Revenue Code	250
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$3.53
Rate for Payer: Cash Price	$2.37
Rate for Payer: Health Management Network Commercial	$3.09
Rate for Payer: Kaiser Permanente Commercial	$3.28
Rate for Payer: MDX Hawaii PPO	$3.53

acarbose 25 mg Tab [KMC]

Facility

$3.64

Service Code	NDC 00378282077
Hospital Revenue Code	250
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$3.53
Rate for Payer: AlohaCare Medicaid	$1.82
Rate for Payer: AlohaCare Medicare	$1.53
Rate for Payer: Cash Price	$2.37
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3.35
Rate for Payer: Devoted Health Medicare	$1.53
Rate for Payer: Hawaii Medical Service Association Medicare	$1.53
Rate for Payer: Hawaii Western Management Group Commercial	$3.46
Rate for Payer: Health Management Network Commercial	$3.09
Rate for Payer: Humana Medicare	$1.53
Rate for Payer: Kaiser Permanente Commercial	$3.28
Rate for Payer: Kaiser Permanente Medicaid	$1.86
Rate for Payer: Kaiser Permanente Medicare	$1.53
Rate for Payer: MDX Hawaii PPO	$3.53
Rate for Payer: Ohana Health Plan Medicaid	$1.53
Rate for Payer: Ohana Health Plan Medicare	$1.53
Rate for Payer: UnitedHealthcare Medicaid	$2.18
Rate for Payer: UnitedHealthcare Medicare	$1.53
Rate for Payer: University Health Alliance Commercial	$2.65

Know your out-of-pocket cost for care.

All Charges