Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

ENDOSCOPY Charge

Facility

$503.00

Service Code	HCPCS 46600
Hospital Charge Code	440466000
Hospital Revenue Code	450
Min. Negotiated Rate	$211.26
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$251.50
Rate for Payer: AlohaCare Medicare	$211.26
Rate for Payer: Cash Price	$326.95
Rate for Payer: Cash Price	$326.95
Rate for Payer: Cash Price	$326.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$462.76
Rate for Payer: Devoted Health Medicare	$211.26
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	$211.26
Rate for Payer: Hawaii Western Management Group Commercial	$477.85
Rate for Payer: Health Management Network Commercial	$427.55
Rate for Payer: Humana Medicare	$211.26
Rate for Payer: Kaiser Permanente Commercial	$452.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$211.26
Rate for Payer: MDX Hawaii PPO	$487.91
Rate for Payer: Ohana Health Plan Medicaid	$211.26
Rate for Payer: Ohana Health Plan Medicare	$211.26
Rate for Payer: UnitedHealthcare Medicare	$211.26
Rate for Payer: University Health Alliance Commercial	$366.64

ENDO TRACH INTUBATION ED

Facility

$843.00

Service Code	HCPCS 31500
Hospital Charge Code	429315000
Hospital Revenue Code	361
Min. Negotiated Rate	$93.64
Max. Negotiated Rate	$4,035.20
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: 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	$349.75
Rate for Payer: Hawaii Medical Service Association Medicare	$354.06
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	$2,837.00
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	$93.64
Rate for Payer: UnitedHealthcare Medicare	$354.06
Rate for Payer: University Health Alliance Commercial	$4,035.20

ENDO TRACH INTUBATION ED

Facility

$843.00

Service Code	HCPCS 31500
Hospital Charge Code	429315000
Hospital Revenue Code	361
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

ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES

Facility

$96,040.50

Service Code	MSDRG 213
Min. Negotiated Rate	$96,040.50
Max. Negotiated Rate	$96,040.50
Rate for Payer: Hawaii Medical Service Association Commercial	$96,040.50

ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC

Facility

$92,366.69

Service Code	MSDRG 266
Min. Negotiated Rate	$92,366.69
Max. Negotiated Rate	$92,366.69
Rate for Payer: Hawaii Medical Service Association Commercial	$92,366.69

ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC

Facility

$80,444.59

Service Code	MSDRG 267
Min. Negotiated Rate	$80,444.59
Max. Negotiated Rate	$80,444.59
Rate for Payer: Hawaii Medical Service Association Commercial	$80,444.59

ENEMA SET

Facility

$24.00

Hospital Charge Code	8097
Hospital Revenue Code	270
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$23.28
Rate for Payer: AlohaCare Medicaid	$12.00
Rate for Payer: AlohaCare Medicare	$10.08
Rate for Payer: Cash Price	$15.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$22.08
Rate for Payer: Devoted Health Medicare	$10.08
Rate for Payer: Hawaii Medical Service Association Medicare	$10.08
Rate for Payer: Hawaii Western Management Group Commercial	$22.80
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Humana Medicare	$10.08
Rate for Payer: Kaiser Permanente Commercial	$21.60
Rate for Payer: Kaiser Permanente Medicaid	$12.24
Rate for Payer: Kaiser Permanente Medicare	$10.08
Rate for Payer: MDX Hawaii PPO	$23.28
Rate for Payer: Ohana Health Plan Medicaid	$10.08
Rate for Payer: Ohana Health Plan Medicare	$10.08
Rate for Payer: UnitedHealthcare Medicare	$10.08
Rate for Payer: University Health Alliance Commercial	$17.49

ENEMA SET

Facility

$24.00

Hospital Charge Code	8097
Hospital Revenue Code	270
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$15.60
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Kaiser Permanente Commercial	$21.60
Rate for Payer: MDX Hawaii PPO	$23.28

ENK OXYGEN FLOW MODULATOR SET

Facility

$3.00

Hospital Charge Code	8451
Hospital Revenue Code	270
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

ENK OXYGEN FLOW MODULATOR SET

Facility

$3.00

Hospital Charge Code	8451
Hospital Revenue Code	270
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

enoxaparin 100 mg/mL SubQ Sol [KMC]

Facility

$93.60

Service Code	HCPCS J1650
Hospital Revenue Code	636
Min. Negotiated Rate	$79.56
Max. Negotiated Rate	$90.79
Rate for Payer: Cash Price	$60.84
Rate for Payer: Health Management Network Commercial	$79.56
Rate for Payer: Kaiser Permanente Commercial	$84.24
Rate for Payer: MDX Hawaii PPO	$90.79

enoxaparin 100 mg/mL SubQ Sol [KMC]

Facility

$93.60

Service Code	HCPCS J1650
Hospital Revenue Code	636
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$90.79
Rate for Payer: AlohaCare Medicaid	$46.80
Rate for Payer: AlohaCare Medicare	$39.31
Rate for Payer: Cash Price	$60.84
Rate for Payer: Cash Price	$60.84
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$86.11
Rate for Payer: Devoted Health Medicare	$39.31
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$1.24
Rate for Payer: Hawaii Medical Service Association Medicare	$39.31
Rate for Payer: Hawaii Western Management Group Commercial	$88.92
Rate for Payer: Health Management Network Commercial	$79.56
Rate for Payer: Humana Medicare	$39.31
Rate for Payer: Kaiser Permanente Commercial	$84.24
Rate for Payer: Kaiser Permanente Medicaid	$47.74
Rate for Payer: Kaiser Permanente Medicare	$39.31
Rate for Payer: MDX Hawaii PPO	$90.79
Rate for Payer: Ohana Health Plan Medicaid	$39.31
Rate for Payer: Ohana Health Plan Medicare	$39.31
Rate for Payer: UnitedHealthcare Medicaid	$56.16
Rate for Payer: UnitedHealthcare Medicare	$39.31
Rate for Payer: University Health Alliance Commercial	$68.23

enoxaparin 120 mg/0.8 mL Sol UD

Facility

$396.00

Service Code	HCPCS J1650
Hospital Revenue Code	636
Min. Negotiated Rate	$336.60
Max. Negotiated Rate	$384.12
Rate for Payer: Cash Price	$257.40
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: Kaiser Permanente Commercial	$356.40
Rate for Payer: MDX Hawaii PPO	$384.12

enoxaparin 120 mg/0.8 mL Sol UD

Facility

$396.00

Service Code	HCPCS J1650
Hospital Revenue Code	636
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$384.12
Rate for Payer: AlohaCare Medicaid	$198.00
Rate for Payer: AlohaCare Medicare	$166.32
Rate for Payer: Cash Price	$257.40
Rate for Payer: Cash Price	$257.40
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$364.32
Rate for Payer: Devoted Health Medicare	$166.32
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$1.24
Rate for Payer: Hawaii Medical Service Association Medicare	$166.32
Rate for Payer: Hawaii Western Management Group Commercial	$376.20
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: Humana Medicare	$166.32
Rate for Payer: Kaiser Permanente Commercial	$356.40
Rate for Payer: Kaiser Permanente Medicaid	$201.96
Rate for Payer: Kaiser Permanente Medicare	$166.32
Rate for Payer: MDX Hawaii PPO	$384.12
Rate for Payer: Ohana Health Plan Medicaid	$166.32
Rate for Payer: Ohana Health Plan Medicare	$166.32
Rate for Payer: UnitedHealthcare Medicaid	$237.60
Rate for Payer: UnitedHealthcare Medicare	$166.32
Rate for Payer: University Health Alliance Commercial	$288.64

enoxaparin 150 mg/mL Soln [KMC]

Facility

$143.09

Service Code	HCPCS J1650
Hospital Revenue Code	636
Min. Negotiated Rate	$121.63
Max. Negotiated Rate	$138.80
Rate for Payer: Cash Price	$93.01
Rate for Payer: Health Management Network Commercial	$121.63
Rate for Payer: Kaiser Permanente Commercial	$128.78
Rate for Payer: MDX Hawaii PPO	$138.80

enoxaparin 150 mg/mL Soln [KMC]

Facility

$143.09

Service Code	HCPCS J1650
Hospital Revenue Code	636
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$138.80
Rate for Payer: AlohaCare Medicaid	$71.55
Rate for Payer: AlohaCare Medicare	$60.10
Rate for Payer: Cash Price	$93.01
Rate for Payer: Cash Price	$93.01
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$131.64
Rate for Payer: Devoted Health Medicare	$60.10
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$1.24
Rate for Payer: Hawaii Medical Service Association Medicare	$60.10
Rate for Payer: Hawaii Western Management Group Commercial	$135.94
Rate for Payer: Health Management Network Commercial	$121.63
Rate for Payer: Humana Medicare	$60.10
Rate for Payer: Kaiser Permanente Commercial	$128.78
Rate for Payer: Kaiser Permanente Medicaid	$72.98
Rate for Payer: Kaiser Permanente Medicare	$60.10
Rate for Payer: MDX Hawaii PPO	$138.80
Rate for Payer: Ohana Health Plan Medicaid	$60.10
Rate for Payer: Ohana Health Plan Medicare	$60.10
Rate for Payer: UnitedHealthcare Medicaid	$85.85
Rate for Payer: UnitedHealthcare Medicare	$60.10
Rate for Payer: University Health Alliance Commercial	$104.30

enoxaparin 30 mg/0.3 mL SC Sol [KMC]

Facility

$48.16

Service Code	HCPCS J1650
Hospital Revenue Code	636
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$46.72
Rate for Payer: AlohaCare Medicaid	$24.08
Rate for Payer: AlohaCare Medicare	$20.23
Rate for Payer: Cash Price	$31.30
Rate for Payer: Cash Price	$31.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$44.31
Rate for Payer: Devoted Health Medicare	$20.23
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$1.24
Rate for Payer: Hawaii Medical Service Association Medicare	$20.23
Rate for Payer: Hawaii Western Management Group Commercial	$45.75
Rate for Payer: Health Management Network Commercial	$40.94
Rate for Payer: Humana Medicare	$20.23
Rate for Payer: Kaiser Permanente Commercial	$43.34
Rate for Payer: Kaiser Permanente Medicaid	$24.56
Rate for Payer: Kaiser Permanente Medicare	$20.23
Rate for Payer: MDX Hawaii PPO	$46.72
Rate for Payer: Ohana Health Plan Medicaid	$20.23
Rate for Payer: Ohana Health Plan Medicare	$20.23
Rate for Payer: UnitedHealthcare Medicaid	$28.90
Rate for Payer: UnitedHealthcare Medicare	$20.23
Rate for Payer: University Health Alliance Commercial	$35.10

enoxaparin 30 mg/0.3 mL SC Sol [KMC]

Facility

$48.16

Service Code	HCPCS J1650
Hospital Revenue Code	636
Min. Negotiated Rate	$40.94
Max. Negotiated Rate	$46.72
Rate for Payer: Cash Price	$31.30
Rate for Payer: Health Management Network Commercial	$40.94
Rate for Payer: Kaiser Permanente Commercial	$43.34
Rate for Payer: MDX Hawaii PPO	$46.72

enoxaparin 40 mg/0.4 mL SC Sol [KMC]

Facility

$95.28

Service Code	HCPCS J1650
Hospital Revenue Code	636
Min. Negotiated Rate	$80.99
Max. Negotiated Rate	$92.42
Rate for Payer: Cash Price	$61.93
Rate for Payer: Health Management Network Commercial	$80.99
Rate for Payer: Kaiser Permanente Commercial	$85.75
Rate for Payer: MDX Hawaii PPO	$92.42

enoxaparin 40 mg/0.4 mL SC Sol [KMC]

Facility

$95.28

Service Code	HCPCS J1650
Hospital Revenue Code	636
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$92.42
Rate for Payer: AlohaCare Medicaid	$47.64
Rate for Payer: AlohaCare Medicare	$40.02
Rate for Payer: Cash Price	$61.93
Rate for Payer: Cash Price	$61.93
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$87.66
Rate for Payer: Devoted Health Medicare	$40.02
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$1.24
Rate for Payer: Hawaii Medical Service Association Medicare	$40.02
Rate for Payer: Hawaii Western Management Group Commercial	$90.52
Rate for Payer: Health Management Network Commercial	$80.99
Rate for Payer: Humana Medicare	$40.02
Rate for Payer: Kaiser Permanente Commercial	$85.75
Rate for Payer: Kaiser Permanente Medicaid	$48.59
Rate for Payer: Kaiser Permanente Medicare	$40.02
Rate for Payer: MDX Hawaii PPO	$92.42
Rate for Payer: Ohana Health Plan Medicaid	$40.02
Rate for Payer: Ohana Health Plan Medicare	$40.02
Rate for Payer: UnitedHealthcare Medicaid	$57.17
Rate for Payer: UnitedHealthcare Medicare	$40.02
Rate for Payer: University Health Alliance Commercial	$69.45

enoxaparin 60 mg/0.6 mL Soln [KMC]

Facility

$94.67

Service Code	HCPCS J1650
Hospital Revenue Code	636
Min. Negotiated Rate	$80.47
Max. Negotiated Rate	$91.83
Rate for Payer: Cash Price	$61.54
Rate for Payer: Health Management Network Commercial	$80.47
Rate for Payer: Kaiser Permanente Commercial	$85.20
Rate for Payer: MDX Hawaii PPO	$91.83

enoxaparin 60 mg/0.6 mL Soln [KMC]

Facility

$94.67

Service Code	HCPCS J1650
Hospital Revenue Code	636
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$91.83
Rate for Payer: AlohaCare Medicaid	$47.34
Rate for Payer: AlohaCare Medicare	$39.76
Rate for Payer: Cash Price	$61.54
Rate for Payer: Cash Price	$61.54
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$87.10
Rate for Payer: Devoted Health Medicare	$39.76
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$1.24
Rate for Payer: Hawaii Medical Service Association Medicare	$39.76
Rate for Payer: Hawaii Western Management Group Commercial	$89.94
Rate for Payer: Health Management Network Commercial	$80.47
Rate for Payer: Humana Medicare	$39.76
Rate for Payer: Kaiser Permanente Commercial	$85.20
Rate for Payer: Kaiser Permanente Medicaid	$48.28
Rate for Payer: Kaiser Permanente Medicare	$39.76
Rate for Payer: MDX Hawaii PPO	$91.83
Rate for Payer: Ohana Health Plan Medicaid	$39.76
Rate for Payer: Ohana Health Plan Medicare	$39.76
Rate for Payer: UnitedHealthcare Medicaid	$56.80
Rate for Payer: UnitedHealthcare Medicare	$39.76
Rate for Payer: University Health Alliance Commercial	$69.00

enoxaparin 80 mg/0.8 mL Soln [KMC]

Facility

$95.40

Service Code	HCPCS J1650
Hospital Revenue Code	636
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$92.54
Rate for Payer: AlohaCare Medicaid	$47.70
Rate for Payer: AlohaCare Medicare	$40.07
Rate for Payer: Cash Price	$62.01
Rate for Payer: Cash Price	$62.01
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$87.77
Rate for Payer: Devoted Health Medicare	$40.07
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$1.24
Rate for Payer: Hawaii Medical Service Association Medicare	$40.07
Rate for Payer: Hawaii Western Management Group Commercial	$90.63
Rate for Payer: Health Management Network Commercial	$81.09
Rate for Payer: Humana Medicare	$40.07
Rate for Payer: Kaiser Permanente Commercial	$85.86
Rate for Payer: Kaiser Permanente Medicaid	$48.65
Rate for Payer: Kaiser Permanente Medicare	$40.07
Rate for Payer: MDX Hawaii PPO	$92.54
Rate for Payer: Ohana Health Plan Medicaid	$40.07
Rate for Payer: Ohana Health Plan Medicare	$40.07
Rate for Payer: UnitedHealthcare Medicaid	$57.24
Rate for Payer: UnitedHealthcare Medicare	$40.07
Rate for Payer: University Health Alliance Commercial	$69.54

enoxaparin 80 mg/0.8 mL Soln [KMC]

Facility

$95.40

Service Code	HCPCS J1650
Hospital Revenue Code	636
Min. Negotiated Rate	$81.09
Max. Negotiated Rate	$92.54
Rate for Payer: Cash Price	$62.01
Rate for Payer: Health Management Network Commercial	$81.09
Rate for Payer: Kaiser Permanente Commercial	$85.86
Rate for Payer: MDX Hawaii PPO	$92.54

entacapone 200 mg Tab

Facility

$18.16

Service Code	NDC 27241004910
Hospital Revenue Code	250
Min. Negotiated Rate	$15.44
Max. Negotiated Rate	$17.62
Rate for Payer: Cash Price	$11.80
Rate for Payer: Health Management Network Commercial	$15.44
Rate for Payer: Kaiser Permanente Commercial	$16.34
Rate for Payer: MDX Hawaii PPO	$17.62

Know your out-of-pocket cost for care.

All Charges