Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

ELONGATED MASK PEDS

Facility

$338.00

Hospital Charge Code	8094
Hospital Revenue Code	270
Min. Negotiated Rate	$287.30
Max. Negotiated Rate	$327.86
Rate for Payer: Cash Price	$219.70
Rate for Payer: Health Management Network Commercial	$287.30
Rate for Payer: Kaiser Permanente Commercial	$304.20
Rate for Payer: MDX Hawaii PPO	$327.86

eltrombopag 50 mg Tab [KMC]

Facility

$2,039.28

Service Code	NDC 31722084330
Hospital Revenue Code	250
Min. Negotiated Rate	$1,733.39
Max. Negotiated Rate	$1,978.10
Rate for Payer: Cash Price	$1,325.53
Rate for Payer: Health Management Network Commercial	$1,733.39
Rate for Payer: Kaiser Permanente Commercial	$1,835.35
Rate for Payer: MDX Hawaii PPO	$1,978.10

eltrombopag 50 mg Tab [KMC]

Facility

$2,039.28

Service Code	NDC 31722084330
Hospital Revenue Code	250
Min. Negotiated Rate	$856.50
Max. Negotiated Rate	$1,978.10
Rate for Payer: AlohaCare Medicaid	$1,019.64
Rate for Payer: AlohaCare Medicare	$856.50
Rate for Payer: Cash Price	$1,325.53
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,876.14
Rate for Payer: Devoted Health Medicare	$856.50
Rate for Payer: Hawaii Medical Service Association Medicare	$856.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,937.32
Rate for Payer: Health Management Network Commercial	$1,733.39
Rate for Payer: Humana Medicare	$856.50
Rate for Payer: Kaiser Permanente Commercial	$1,835.35
Rate for Payer: Kaiser Permanente Medicaid	$1,040.03
Rate for Payer: Kaiser Permanente Medicare	$856.50
Rate for Payer: MDX Hawaii PPO	$1,978.10
Rate for Payer: Ohana Health Plan Medicaid	$856.50
Rate for Payer: Ohana Health Plan Medicare	$856.50
Rate for Payer: UnitedHealthcare Medicaid	$1,223.57
Rate for Payer: UnitedHealthcare Medicare	$856.50
Rate for Payer: University Health Alliance Commercial	$1,486.43

EMERGENCY CRICOTHYROTOMY CATHETER SET UNIVERSAL

Facility

$5.00

Hospital Charge Code	8437
Hospital Revenue Code	270
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.25
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

EMERGENCY CRICOTHYROTOMY CATHETER SET UNIVERSAL

Facility

$5.00

Hospital Charge Code	8437
Hospital Revenue Code	270
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$2.10
Rate for Payer: Cash Price	$3.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.60
Rate for Payer: Devoted Health Medicare	$2.10
Rate for Payer: Hawaii Medical Service Association Medicare	$2.10
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$2.10
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$2.10
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$2.10
Rate for Payer: Ohana Health Plan Medicare	$2.10
Rate for Payer: UnitedHealthcare Medicare	$2.10
Rate for Payer: University Health Alliance Commercial	$3.64

empagliflozin 10 mg Tab [KMC]

Facility

$94.93

Service Code	NDC 00597015237
Hospital Revenue Code	250
Min. Negotiated Rate	$80.69
Max. Negotiated Rate	$92.08
Rate for Payer: Cash Price	$61.70
Rate for Payer: Health Management Network Commercial	$80.69
Rate for Payer: Kaiser Permanente Commercial	$85.44
Rate for Payer: MDX Hawaii PPO	$92.08

empagliflozin 10 mg Tab [KMC]

Facility

$94.93

Service Code	NDC 00597015237
Hospital Revenue Code	250
Min. Negotiated Rate	$39.87
Max. Negotiated Rate	$92.08
Rate for Payer: AlohaCare Medicaid	$47.47
Rate for Payer: AlohaCare Medicare	$39.87
Rate for Payer: Cash Price	$61.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$87.34
Rate for Payer: Devoted Health Medicare	$39.87
Rate for Payer: Hawaii Medical Service Association Medicare	$39.87
Rate for Payer: Hawaii Western Management Group Commercial	$90.18
Rate for Payer: Health Management Network Commercial	$80.69
Rate for Payer: Humana Medicare	$39.87
Rate for Payer: Kaiser Permanente Commercial	$85.44
Rate for Payer: Kaiser Permanente Medicaid	$48.41
Rate for Payer: Kaiser Permanente Medicare	$39.87
Rate for Payer: MDX Hawaii PPO	$92.08
Rate for Payer: Ohana Health Plan Medicaid	$39.87
Rate for Payer: Ohana Health Plan Medicare	$39.87
Rate for Payer: UnitedHealthcare Medicaid	$56.96
Rate for Payer: UnitedHealthcare Medicare	$39.87
Rate for Payer: University Health Alliance Commercial	$69.19

empagliflozin 25 mg Tab [KMC]

Facility

$94.93

Service Code	NDC 00597015390
Hospital Revenue Code	250
Min. Negotiated Rate	$39.87
Max. Negotiated Rate	$92.08
Rate for Payer: AlohaCare Medicaid	$47.47
Rate for Payer: AlohaCare Medicare	$39.87
Rate for Payer: Cash Price	$61.70
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$87.34
Rate for Payer: Devoted Health Medicare	$39.87
Rate for Payer: Hawaii Medical Service Association Medicare	$39.87
Rate for Payer: Hawaii Western Management Group Commercial	$90.18
Rate for Payer: Health Management Network Commercial	$80.69
Rate for Payer: Humana Medicare	$39.87
Rate for Payer: Kaiser Permanente Commercial	$85.44
Rate for Payer: Kaiser Permanente Medicaid	$48.41
Rate for Payer: Kaiser Permanente Medicare	$39.87
Rate for Payer: MDX Hawaii PPO	$92.08
Rate for Payer: Ohana Health Plan Medicaid	$39.87
Rate for Payer: Ohana Health Plan Medicare	$39.87
Rate for Payer: UnitedHealthcare Medicaid	$56.96
Rate for Payer: UnitedHealthcare Medicare	$39.87
Rate for Payer: University Health Alliance Commercial	$69.19

empagliflozin 25 mg Tab [KMC]

Facility

$94.93

Service Code	NDC 00597015390
Hospital Revenue Code	250
Min. Negotiated Rate	$80.69
Max. Negotiated Rate	$92.08
Rate for Payer: Cash Price	$61.70
Rate for Payer: Health Management Network Commercial	$80.69
Rate for Payer: Kaiser Permanente Commercial	$85.44
Rate for Payer: MDX Hawaii PPO	$92.08

emtricitabine-rilpivirine-tenofovir 200-25-25 mg Tab

Facility

$613.92

Service Code	NDC 61958210101
Hospital Revenue Code	250
Min. Negotiated Rate	$257.85
Max. Negotiated Rate	$595.50
Rate for Payer: AlohaCare Medicaid	$306.96
Rate for Payer: AlohaCare Medicare	$257.85
Rate for Payer: Cash Price	$399.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$564.81
Rate for Payer: Devoted Health Medicare	$257.85
Rate for Payer: Hawaii Medical Service Association Medicare	$257.85
Rate for Payer: Hawaii Western Management Group Commercial	$583.22
Rate for Payer: Health Management Network Commercial	$521.83
Rate for Payer: Humana Medicare	$257.85
Rate for Payer: Kaiser Permanente Commercial	$552.53
Rate for Payer: Kaiser Permanente Medicaid	$313.10
Rate for Payer: Kaiser Permanente Medicare	$257.85
Rate for Payer: MDX Hawaii PPO	$595.50
Rate for Payer: Ohana Health Plan Medicaid	$257.85
Rate for Payer: Ohana Health Plan Medicare	$257.85
Rate for Payer: UnitedHealthcare Medicaid	$368.35
Rate for Payer: UnitedHealthcare Medicare	$257.85
Rate for Payer: University Health Alliance Commercial	$447.49

emtricitabine-rilpivirine-tenofovir 200-25-25 mg Tab

Facility

$613.92

Service Code	NDC 61958210101
Hospital Revenue Code	250
Min. Negotiated Rate	$521.83
Max. Negotiated Rate	$595.50
Rate for Payer: Cash Price	$399.05
Rate for Payer: Health Management Network Commercial	$521.83
Rate for Payer: Kaiser Permanente Commercial	$552.53
Rate for Payer: MDX Hawaii PPO	$595.50

emtricitabine-tenofovir 200-300 mg Tab [KMC]

Facility

$280.03

Service Code	NDC 42385095330
Hospital Revenue Code	250
Min. Negotiated Rate	$238.03
Max. Negotiated Rate	$271.63
Rate for Payer: Cash Price	$182.02
Rate for Payer: Health Management Network Commercial	$238.03
Rate for Payer: Kaiser Permanente Commercial	$252.03
Rate for Payer: MDX Hawaii PPO	$271.63

emtricitabine-tenofovir 200-300 mg Tab [KMC]

Facility

$280.03

Service Code	NDC 42385095330
Hospital Revenue Code	250
Min. Negotiated Rate	$117.61
Max. Negotiated Rate	$271.63
Rate for Payer: AlohaCare Medicaid	$140.01
Rate for Payer: AlohaCare Medicare	$117.61
Rate for Payer: Cash Price	$182.02
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$257.63
Rate for Payer: Devoted Health Medicare	$117.61
Rate for Payer: Hawaii Medical Service Association Medicare	$117.61
Rate for Payer: Hawaii Western Management Group Commercial	$266.03
Rate for Payer: Health Management Network Commercial	$238.03
Rate for Payer: Humana Medicare	$117.61
Rate for Payer: Kaiser Permanente Commercial	$252.03
Rate for Payer: Kaiser Permanente Medicaid	$142.82
Rate for Payer: Kaiser Permanente Medicare	$117.61
Rate for Payer: MDX Hawaii PPO	$271.63
Rate for Payer: Ohana Health Plan Medicaid	$117.61
Rate for Payer: Ohana Health Plan Medicare	$117.61
Rate for Payer: UnitedHealthcare Medicaid	$168.02
Rate for Payer: UnitedHealthcare Medicare	$117.61
Rate for Payer: University Health Alliance Commercial	$204.11

emtricitabine-tenofovir 200 mg-25 mg Tab [KMC]

Facility

$213.30

Service Code	NDC 61958200201
Hospital Revenue Code	250
Min. Negotiated Rate	$89.59
Max. Negotiated Rate	$206.90
Rate for Payer: AlohaCare Medicaid	$106.65
Rate for Payer: AlohaCare Medicare	$89.59
Rate for Payer: Cash Price	$138.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$196.24
Rate for Payer: Devoted Health Medicare	$89.59
Rate for Payer: Hawaii Medical Service Association Medicare	$89.59
Rate for Payer: Hawaii Western Management Group Commercial	$202.63
Rate for Payer: Health Management Network Commercial	$181.31
Rate for Payer: Humana Medicare	$89.59
Rate for Payer: Kaiser Permanente Commercial	$191.97
Rate for Payer: Kaiser Permanente Medicaid	$108.78
Rate for Payer: Kaiser Permanente Medicare	$89.59
Rate for Payer: MDX Hawaii PPO	$206.90
Rate for Payer: Ohana Health Plan Medicaid	$89.59
Rate for Payer: Ohana Health Plan Medicare	$89.59
Rate for Payer: UnitedHealthcare Medicaid	$127.98
Rate for Payer: UnitedHealthcare Medicare	$89.59
Rate for Payer: University Health Alliance Commercial	$155.47

emtricitabine-tenofovir 200 mg-25 mg Tab [KMC]

Facility

$213.30

Service Code	NDC 61958200201
Hospital Revenue Code	250
Min. Negotiated Rate	$181.31
Max. Negotiated Rate	$206.90
Rate for Payer: Cash Price	$138.65
Rate for Payer: Health Management Network Commercial	$181.31
Rate for Payer: Kaiser Permanente Commercial	$191.97
Rate for Payer: MDX Hawaii PPO	$206.90

enalapril 2.5 mg Tab [KMC]

Facility

$4.71

Service Code	NDC 16714044201
Hospital Revenue Code	250
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.57
Rate for Payer: Cash Price	$3.06
Rate for Payer: Health Management Network Commercial	$4.00
Rate for Payer: Kaiser Permanente Commercial	$4.24
Rate for Payer: MDX Hawaii PPO	$4.57

enalapril 2.5 mg Tab [KMC]

Facility

$4.71

Service Code	NDC 16714044201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$4.57
Rate for Payer: AlohaCare Medicaid	$2.35
Rate for Payer: AlohaCare Medicare	$1.98
Rate for Payer: Cash Price	$3.06
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$4.33
Rate for Payer: Devoted Health Medicare	$1.98
Rate for Payer: Hawaii Medical Service Association Medicare	$1.98
Rate for Payer: Hawaii Western Management Group Commercial	$4.47
Rate for Payer: Health Management Network Commercial	$4.00
Rate for Payer: Humana Medicare	$1.98
Rate for Payer: Kaiser Permanente Commercial	$4.24
Rate for Payer: Kaiser Permanente Medicaid	$2.40
Rate for Payer: Kaiser Permanente Medicare	$1.98
Rate for Payer: MDX Hawaii PPO	$4.57
Rate for Payer: Ohana Health Plan Medicaid	$1.98
Rate for Payer: Ohana Health Plan Medicare	$1.98
Rate for Payer: UnitedHealthcare Medicaid	$2.83
Rate for Payer: UnitedHealthcare Medicare	$1.98
Rate for Payer: University Health Alliance Commercial	$3.43

enalaprilat 1.25 mg/mL Sol [KMC]

Facility

$25.48

Service Code	NDC 00143978710
Hospital Revenue Code	250
Min. Negotiated Rate	$10.70
Max. Negotiated Rate	$24.72
Rate for Payer: AlohaCare Medicaid	$12.74
Rate for Payer: AlohaCare Medicare	$10.70
Rate for Payer: Cash Price	$16.56
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$23.44
Rate for Payer: Devoted Health Medicare	$10.70
Rate for Payer: Hawaii Medical Service Association Medicare	$10.70
Rate for Payer: Hawaii Western Management Group Commercial	$24.21
Rate for Payer: Health Management Network Commercial	$21.66
Rate for Payer: Humana Medicare	$10.70
Rate for Payer: Kaiser Permanente Commercial	$22.93
Rate for Payer: Kaiser Permanente Medicaid	$12.99
Rate for Payer: Kaiser Permanente Medicare	$10.70
Rate for Payer: MDX Hawaii PPO	$24.72
Rate for Payer: Ohana Health Plan Medicaid	$10.70
Rate for Payer: Ohana Health Plan Medicare	$10.70
Rate for Payer: UnitedHealthcare Medicaid	$15.29
Rate for Payer: UnitedHealthcare Medicare	$10.70
Rate for Payer: University Health Alliance Commercial	$18.57

enalaprilat 1.25 mg/mL Sol [KMC]

Facility

$25.48

Service Code	NDC 00143978710
Hospital Revenue Code	250
Min. Negotiated Rate	$21.66
Max. Negotiated Rate	$24.72
Rate for Payer: Cash Price	$16.56
Rate for Payer: Health Management Network Commercial	$21.66
Rate for Payer: Kaiser Permanente Commercial	$22.93
Rate for Payer: MDX Hawaii PPO	$24.72

ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C

Professional

Both

$483.00

Service Code	HCPCS 57505
Hospital Revenue Code	361
Min. Negotiated Rate	$79.82
Max. Negotiated Rate	$410.55
Rate for Payer: AlohaCare Medicaid	$117.16
Rate for Payer: AlohaCare Medicare	$103.95
Rate for Payer: Cash Price	$313.95
Rate for Payer: Cash Price	$313.95
Rate for Payer: Devoted Health Medicare	$103.95
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$117.16
Rate for Payer: Hawaii Medical Service Association Medicare	$103.95
Rate for Payer: Hawaii Western Management Group Commercial	$79.82
Rate for Payer: Health Management Network Commercial	$410.55
Rate for Payer: Kaiser Permanente Commercial	$124.74
Rate for Payer: Kaiser Permanente Medicaid	$124.74
Rate for Payer: Kaiser Permanente Medicare	$124.74
Rate for Payer: Ohana Health Plan Medicaid	$117.16
Rate for Payer: Ohana Health Plan Medicare	$103.95
Rate for Payer: UnitedHealthcare Medicaid	$117.16
Rate for Payer: UnitedHealthcare Medicare	$103.95
Rate for Payer: University Health Alliance Commercial	$153.20

ENDOCRINE DISORDERS WITH CC

Facility

$19,388.24

Service Code	MSDRG 644
Min. Negotiated Rate	$19,388.24
Max. Negotiated Rate	$19,388.24
Rate for Payer: Hawaii Medical Service Association Commercial	$19,388.24

ENDOCRINE DISORDERS WITH MCC

Facility

$19,388.24

Service Code	MSDRG 643
Min. Negotiated Rate	$19,388.24
Max. Negotiated Rate	$19,388.24
Rate for Payer: Hawaii Medical Service Association Commercial	$19,388.24

ENDOCRINE DISORDERS WITHOUT CC/MCC

Facility

$16,781.02

Service Code	MSDRG 645
Min. Negotiated Rate	$16,781.02
Max. Negotiated Rate	$16,781.02
Rate for Payer: Hawaii Medical Service Association Commercial	$16,781.02

ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX

Professional

Both

$316.00

Service Code	HCPCS 58100
Hospital Revenue Code	361
Min. Negotiated Rate	$53.35
Max. Negotiated Rate	$268.60
Rate for Payer: AlohaCare Medicaid	$62.37
Rate for Payer: AlohaCare Medicare	$53.35
Rate for Payer: Cash Price	$205.40
Rate for Payer: Cash Price	$205.40
Rate for Payer: Devoted Health Medicare	$53.35
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$62.37
Rate for Payer: Hawaii Medical Service Association Commercial	$121.63
Rate for Payer: Hawaii Medical Service Association Medicare	$53.35
Rate for Payer: Hawaii Western Management Group Commercial	$118.30
Rate for Payer: Health Management Network Commercial	$268.60
Rate for Payer: Kaiser Permanente Commercial	$64.02
Rate for Payer: Kaiser Permanente Medicaid	$64.02
Rate for Payer: Kaiser Permanente Medicare	$64.02
Rate for Payer: Ohana Health Plan Medicaid	$62.37
Rate for Payer: Ohana Health Plan Medicare	$53.35
Rate for Payer: UnitedHealthcare Medicaid	$62.37
Rate for Payer: UnitedHealthcare Medicare	$53.35
Rate for Payer: University Health Alliance Commercial	$76.97

ENDOSCOPY Charge

Facility

$503.00

Service Code	HCPCS 46600
Hospital Charge Code	440466000
Hospital Revenue Code	450
Min. Negotiated Rate	$427.55
Max. Negotiated Rate	$487.91
Rate for Payer: Cash Price	$326.95
Rate for Payer: Health Management Network Commercial	$427.55
Rate for Payer: Kaiser Permanente Commercial	$452.70
Rate for Payer: MDX Hawaii PPO	$487.91

Know your out-of-pocket cost for care.

All Charges