Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

entacapone 200 mg Tab

Facility

$18.16

Service Code	NDC 27241004910
Hospital Revenue Code	250
Min. Negotiated Rate	$7.63
Max. Negotiated Rate	$17.62
Rate for Payer: AlohaCare Medicaid	$9.08
Rate for Payer: AlohaCare Medicare	$7.63
Rate for Payer: Cash Price	$11.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$16.71
Rate for Payer: Devoted Health Medicare	$7.63
Rate for Payer: Hawaii Medical Service Association Medicare	$7.63
Rate for Payer: Hawaii Western Management Group Commercial	$17.25
Rate for Payer: Health Management Network Commercial	$15.44
Rate for Payer: Humana Medicare	$7.63
Rate for Payer: Kaiser Permanente Commercial	$16.34
Rate for Payer: Kaiser Permanente Medicaid	$9.26
Rate for Payer: Kaiser Permanente Medicare	$7.63
Rate for Payer: MDX Hawaii PPO	$17.62
Rate for Payer: Ohana Health Plan Medicaid	$7.63
Rate for Payer: Ohana Health Plan Medicare	$7.63
Rate for Payer: UnitedHealthcare Medicaid	$10.90
Rate for Payer: UnitedHealthcare Medicare	$7.63
Rate for Payer: University Health Alliance Commercial	$13.24

entecavir 0.5 mg Tab [KMC]

Facility

$177.74

Service Code	NDC 42806065830
Hospital Revenue Code	250
Min. Negotiated Rate	$151.08
Max. Negotiated Rate	$172.41
Rate for Payer: Cash Price	$115.53
Rate for Payer: Health Management Network Commercial	$151.08
Rate for Payer: Kaiser Permanente Commercial	$159.97
Rate for Payer: MDX Hawaii PPO	$172.41

entecavir 0.5 mg Tab [KMC]

Facility

$177.74

Service Code	NDC 42806065830
Hospital Revenue Code	250
Min. Negotiated Rate	$74.65
Max. Negotiated Rate	$172.41
Rate for Payer: AlohaCare Medicaid	$88.87
Rate for Payer: AlohaCare Medicare	$74.65
Rate for Payer: Cash Price	$115.53
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$163.52
Rate for Payer: Devoted Health Medicare	$74.65
Rate for Payer: Hawaii Medical Service Association Medicare	$74.65
Rate for Payer: Hawaii Western Management Group Commercial	$168.85
Rate for Payer: Health Management Network Commercial	$151.08
Rate for Payer: Humana Medicare	$74.65
Rate for Payer: Kaiser Permanente Commercial	$159.97
Rate for Payer: Kaiser Permanente Medicaid	$90.65
Rate for Payer: Kaiser Permanente Medicare	$74.65
Rate for Payer: MDX Hawaii PPO	$172.41
Rate for Payer: Ohana Health Plan Medicaid	$74.65
Rate for Payer: Ohana Health Plan Medicare	$74.65
Rate for Payer: UnitedHealthcare Medicaid	$106.64
Rate for Payer: UnitedHealthcare Medicare	$74.65
Rate for Payer: University Health Alliance Commercial	$129.55

enzalutamide 40 mg Cap [KMC]

Facility

$248.33

Service Code	NDC 00469012599
Hospital Revenue Code	250
Min. Negotiated Rate	$104.30
Max. Negotiated Rate	$240.88
Rate for Payer: AlohaCare Medicaid	$124.17
Rate for Payer: AlohaCare Medicare	$104.30
Rate for Payer: Cash Price	$161.41
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$228.46
Rate for Payer: Devoted Health Medicare	$104.30
Rate for Payer: Hawaii Medical Service Association Medicare	$104.30
Rate for Payer: Hawaii Western Management Group Commercial	$235.91
Rate for Payer: Health Management Network Commercial	$211.08
Rate for Payer: Humana Medicare	$104.30
Rate for Payer: Kaiser Permanente Commercial	$223.50
Rate for Payer: Kaiser Permanente Medicaid	$126.65
Rate for Payer: Kaiser Permanente Medicare	$104.30
Rate for Payer: MDX Hawaii PPO	$240.88
Rate for Payer: Ohana Health Plan Medicaid	$104.30
Rate for Payer: Ohana Health Plan Medicare	$104.30
Rate for Payer: UnitedHealthcare Medicaid	$149.00
Rate for Payer: UnitedHealthcare Medicare	$104.30
Rate for Payer: University Health Alliance Commercial	$181.01

enzalutamide 40 mg Cap [KMC]

Facility

$248.33

Service Code	NDC 00469012599
Hospital Revenue Code	250
Min. Negotiated Rate	$211.08
Max. Negotiated Rate	$240.88
Rate for Payer: Cash Price	$161.41
Rate for Payer: Health Management Network Commercial	$211.08
Rate for Payer: Kaiser Permanente Commercial	$223.50
Rate for Payer: MDX Hawaii PPO	$240.88

EPID INJECTION SINGLE LS ED Charge

Facility

$3,421.00

Service Code	HCPCS 62311
Hospital Charge Code	440623110
Hospital Revenue Code	450
Min. Negotiated Rate	$2,907.85
Max. Negotiated Rate	$3,318.37
Rate for Payer: Cash Price	$2,223.65
Rate for Payer: Health Management Network Commercial	$2,907.85
Rate for Payer: Kaiser Permanente Commercial	$3,078.90
Rate for Payer: MDX Hawaii PPO	$3,318.37

EPID INJECTION SINGLE LS ED Charge

Facility

$3,421.00

Service Code	HCPCS 62311
Hospital Charge Code	440623110
Hospital Revenue Code	450
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$3,318.37
Rate for Payer: AlohaCare Medicaid	$1,710.50
Rate for Payer: AlohaCare Medicare	$1,436.82
Rate for Payer: Cash Price	$2,223.65
Rate for Payer: Cash Price	$2,223.65
Rate for Payer: Cash Price	$2,223.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3,147.32
Rate for Payer: Devoted Health Medicare	$1,436.82
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	$1,436.82
Rate for Payer: Hawaii Western Management Group Commercial	$3,249.95
Rate for Payer: Health Management Network Commercial	$2,907.85
Rate for Payer: Humana Medicare	$1,436.82
Rate for Payer: Kaiser Permanente Commercial	$3,078.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,436.82
Rate for Payer: MDX Hawaii PPO	$3,318.37
Rate for Payer: Ohana Health Plan Medicaid	$1,436.82
Rate for Payer: Ohana Health Plan Medicare	$1,436.82
Rate for Payer: UnitedHealthcare Medicare	$1,436.82
Rate for Payer: University Health Alliance Commercial	$2,493.57

EPINEPHrine 1 mg / 10 mL IV syringe [KMC]

Facility

$2.56

Service Code	HCPCS J0171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$2.48
Rate for Payer: AlohaCare Medicaid	$1.28
Rate for Payer: AlohaCare Medicare	$1.08
Rate for Payer: Cash Price	$1.66
Rate for Payer: Cash Price	$1.66
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.36
Rate for Payer: Devoted Health Medicare	$1.08
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.73
Rate for Payer: Hawaii Medical Service Association Medicare	$1.08
Rate for Payer: Hawaii Western Management Group Commercial	$2.43
Rate for Payer: Health Management Network Commercial	$2.18
Rate for Payer: Humana Medicare	$1.08
Rate for Payer: Kaiser Permanente Commercial	$2.30
Rate for Payer: Kaiser Permanente Medicaid	$1.31
Rate for Payer: Kaiser Permanente Medicare	$1.08
Rate for Payer: MDX Hawaii PPO	$2.48
Rate for Payer: Ohana Health Plan Medicaid	$1.08
Rate for Payer: Ohana Health Plan Medicare	$1.08
Rate for Payer: UnitedHealthcare Medicaid	$1.54
Rate for Payer: UnitedHealthcare Medicare	$1.08
Rate for Payer: University Health Alliance Commercial	$1.87

EPINEPHrine 1 mg / 10 mL IV syringe [KMC]

Facility

$2.56

Service Code	HCPCS J0171
Hospital Revenue Code	636
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$2.48
Rate for Payer: Cash Price	$1.66
Rate for Payer: Health Management Network Commercial	$2.18
Rate for Payer: Kaiser Permanente Commercial	$2.30
Rate for Payer: MDX Hawaii PPO	$2.48

EPINEPHrine 1 mg/mL IM/SQ Inj Sol [KMC]

Facility

$43.20

Service Code	HCPCS J0171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$41.90
Rate for Payer: AlohaCare Medicaid	$21.60
Rate for Payer: AlohaCare Medicare	$18.14
Rate for Payer: Cash Price	$28.08
Rate for Payer: Cash Price	$28.08
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$39.74
Rate for Payer: Devoted Health Medicare	$18.14
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.73
Rate for Payer: Hawaii Medical Service Association Medicare	$18.14
Rate for Payer: Hawaii Western Management Group Commercial	$41.04
Rate for Payer: Health Management Network Commercial	$36.72
Rate for Payer: Humana Medicare	$18.14
Rate for Payer: Kaiser Permanente Commercial	$38.88
Rate for Payer: Kaiser Permanente Medicaid	$22.03
Rate for Payer: Kaiser Permanente Medicare	$18.14
Rate for Payer: MDX Hawaii PPO	$41.90
Rate for Payer: Ohana Health Plan Medicaid	$18.14
Rate for Payer: Ohana Health Plan Medicare	$18.14
Rate for Payer: UnitedHealthcare Medicaid	$25.92
Rate for Payer: UnitedHealthcare Medicare	$18.14
Rate for Payer: University Health Alliance Commercial	$31.49

EPINEPHrine 1 mg/mL IM/SQ Inj Sol [KMC]

Facility

$43.20

Service Code	HCPCS J0171
Hospital Revenue Code	636
Min. Negotiated Rate	$36.72
Max. Negotiated Rate	$41.90
Rate for Payer: Cash Price	$28.08
Rate for Payer: Health Management Network Commercial	$36.72
Rate for Payer: Kaiser Permanente Commercial	$38.88
Rate for Payer: MDX Hawaii PPO	$41.90

EPINEPHrine-lidocaine 1:100,000-1% Inj Sol 20 mL [KMC]

Facility

$0.52

Service Code	HCPCS J2001
Hospital Revenue Code	636
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.50
Rate for Payer: Cash Price	$0.34
Rate for Payer: Health Management Network Commercial	$0.44
Rate for Payer: Kaiser Permanente Commercial	$0.47
Rate for Payer: MDX Hawaii PPO	$0.50

EPINEPHrine-lidocaine 1:100,000-1% Inj Sol 20 mL [KMC]

Facility

$0.52

Service Code	HCPCS J2001
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.50
Rate for Payer: AlohaCare Medicaid	$0.26
Rate for Payer: AlohaCare Medicare	$0.22
Rate for Payer: Cash Price	$0.34
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.48
Rate for Payer: Devoted Health Medicare	$0.22
Rate for Payer: Hawaii Medical Service Association Medicare	$0.22
Rate for Payer: Hawaii Western Management Group Commercial	$0.49
Rate for Payer: Health Management Network Commercial	$0.44
Rate for Payer: Humana Medicare	$0.22
Rate for Payer: Kaiser Permanente Commercial	$0.47
Rate for Payer: Kaiser Permanente Medicaid	$0.27
Rate for Payer: Kaiser Permanente Medicare	$0.22
Rate for Payer: MDX Hawaii PPO	$0.50
Rate for Payer: Ohana Health Plan Medicaid	$0.22
Rate for Payer: Ohana Health Plan Medicare	$0.22
Rate for Payer: UnitedHealthcare Medicaid	$0.31
Rate for Payer: UnitedHealthcare Medicare	$0.22
Rate for Payer: University Health Alliance Commercial	$0.38

EPINEPHrine-lidocaine 1:100000-1% Sol [KMC]

Facility

$0.90

Service Code	NDC 63323048227
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.87
Rate for Payer: Cash Price	$0.59
Rate for Payer: Health Management Network Commercial	$0.77
Rate for Payer: Kaiser Permanente Commercial	$0.81
Rate for Payer: MDX Hawaii PPO	$0.87

EPINEPHrine-lidocaine 1:100000-1% Sol [KMC]

Facility

$0.90

Service Code	NDC 63323048227
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.87
Rate for Payer: AlohaCare Medicaid	$0.45
Rate for Payer: AlohaCare Medicare	$0.38
Rate for Payer: Cash Price	$0.59
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.83
Rate for Payer: Devoted Health Medicare	$0.38
Rate for Payer: Hawaii Medical Service Association Medicare	$0.38
Rate for Payer: Hawaii Western Management Group Commercial	$0.86
Rate for Payer: Health Management Network Commercial	$0.77
Rate for Payer: Humana Medicare	$0.38
Rate for Payer: Kaiser Permanente Commercial	$0.81
Rate for Payer: Kaiser Permanente Medicaid	$0.46
Rate for Payer: Kaiser Permanente Medicare	$0.38
Rate for Payer: MDX Hawaii PPO	$0.87
Rate for Payer: Ohana Health Plan Medicaid	$0.38
Rate for Payer: Ohana Health Plan Medicare	$0.38
Rate for Payer: UnitedHealthcare Medicaid	$0.54
Rate for Payer: UnitedHealthcare Medicare	$0.38
Rate for Payer: University Health Alliance Commercial	$0.66

EpiPen 0.3 mg Kit [KMC]

Facility

$988.02

Service Code	HCPCS J0171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$958.38
Rate for Payer: AlohaCare Medicaid	$494.01
Rate for Payer: AlohaCare Medicare	$414.97
Rate for Payer: Cash Price	$642.21
Rate for Payer: Cash Price	$642.21
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$908.98
Rate for Payer: Devoted Health Medicare	$414.97
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$0.73
Rate for Payer: Hawaii Medical Service Association Medicare	$414.97
Rate for Payer: Hawaii Western Management Group Commercial	$938.62
Rate for Payer: Health Management Network Commercial	$839.82
Rate for Payer: Humana Medicare	$414.97
Rate for Payer: Kaiser Permanente Commercial	$889.22
Rate for Payer: Kaiser Permanente Medicaid	$503.89
Rate for Payer: Kaiser Permanente Medicare	$414.97
Rate for Payer: MDX Hawaii PPO	$958.38
Rate for Payer: Ohana Health Plan Medicaid	$414.97
Rate for Payer: Ohana Health Plan Medicare	$414.97
Rate for Payer: UnitedHealthcare Medicaid	$592.81
Rate for Payer: UnitedHealthcare Medicare	$414.97
Rate for Payer: University Health Alliance Commercial	$720.17

EpiPen 0.3 mg Kit [KMC]

Facility

$988.02

Service Code	HCPCS J0171
Hospital Revenue Code	636
Min. Negotiated Rate	$839.82
Max. Negotiated Rate	$958.38
Rate for Payer: Cash Price	$642.21
Rate for Payer: Health Management Network Commercial	$839.82
Rate for Payer: Kaiser Permanente Commercial	$889.22
Rate for Payer: MDX Hawaii PPO	$958.38

EPISTAXIS WITH MCC

Facility

$10,405.18

Service Code	MSDRG 150
Min. Negotiated Rate	$10,405.18
Max. Negotiated Rate	$10,405.18
Rate for Payer: Hawaii Medical Service Association Commercial	$10,405.18

EPISTAXIS WITHOUT MCC

Facility

$10,405.18

Service Code	MSDRG 151
Min. Negotiated Rate	$10,405.18
Max. Negotiated Rate	$10,405.18
Rate for Payer: Hawaii Medical Service Association Commercial	$10,405.18

eplerenone 50 mg Tab [KMC]

Facility

$17.36

Service Code	NDC 16729029410
Hospital Revenue Code	250
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$16.84
Rate for Payer: Cash Price	$11.28
Rate for Payer: Health Management Network Commercial	$14.76
Rate for Payer: Kaiser Permanente Commercial	$15.62
Rate for Payer: MDX Hawaii PPO	$16.84

eplerenone 50 mg Tab [KMC]

Facility

$17.36

Service Code	NDC 16729029410
Hospital Revenue Code	250
Min. Negotiated Rate	$7.29
Max. Negotiated Rate	$16.84
Rate for Payer: AlohaCare Medicaid	$8.68
Rate for Payer: AlohaCare Medicare	$7.29
Rate for Payer: Cash Price	$11.28
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$15.97
Rate for Payer: Devoted Health Medicare	$7.29
Rate for Payer: Hawaii Medical Service Association Medicare	$7.29
Rate for Payer: Hawaii Western Management Group Commercial	$16.49
Rate for Payer: Health Management Network Commercial	$14.76
Rate for Payer: Humana Medicare	$7.29
Rate for Payer: Kaiser Permanente Commercial	$15.62
Rate for Payer: Kaiser Permanente Medicaid	$8.85
Rate for Payer: Kaiser Permanente Medicare	$7.29
Rate for Payer: MDX Hawaii PPO	$16.84
Rate for Payer: Ohana Health Plan Medicaid	$7.29
Rate for Payer: Ohana Health Plan Medicare	$7.29
Rate for Payer: UnitedHealthcare Medicaid	$10.42
Rate for Payer: UnitedHealthcare Medicare	$7.29
Rate for Payer: University Health Alliance Commercial	$12.65

EPOC Basic

Facility

$152.00

Service Code	HCPCS 80048
Hospital Charge Code	422800480
Hospital Revenue Code	301
Min. Negotiated Rate	$8.46
Max. Negotiated Rate	$147.44
Rate for Payer: AlohaCare Medicaid	$76.00
Rate for Payer: AlohaCare Medicare	$63.84
Rate for Payer: Cash Price	$98.80
Rate for Payer: Cash Price	$98.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$139.84
Rate for Payer: Devoted Health Medicare	$63.84
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.70
Rate for Payer: Hawaii Medical Service Association Commercial	$10.57
Rate for Payer: Hawaii Medical Service Association Medicare	$63.84
Rate for Payer: Hawaii Western Management Group Commercial	$8.46
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Humana Medicare	$63.84
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: Kaiser Permanente Medicaid	$77.52
Rate for Payer: Kaiser Permanente Medicare	$63.84
Rate for Payer: MDX Hawaii PPO	$147.44
Rate for Payer: Ohana Health Plan Medicaid	$63.84
Rate for Payer: Ohana Health Plan Medicare	$63.84
Rate for Payer: UnitedHealthcare Medicaid	$11.70
Rate for Payer: UnitedHealthcare Medicare	$63.84
Rate for Payer: University Health Alliance Commercial	$21.89

EPOC Basic

Facility

$152.00

Service Code	HCPCS 80048
Hospital Charge Code	422800480
Hospital Revenue Code	301
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$98.80
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: MDX Hawaii PPO	$147.44

epoetin 20,000 units/mL Soln [KMC]

Facility

$1,058.88

Service Code	HCPCS Q5106
Hospital Revenue Code	637
Min. Negotiated Rate	$900.05
Max. Negotiated Rate	$1,027.11
Rate for Payer: Cash Price	$688.27
Rate for Payer: Health Management Network Commercial	$900.05
Rate for Payer: Kaiser Permanente Commercial	$952.99
Rate for Payer: MDX Hawaii PPO	$1,027.11

epoetin 20,000 units/mL Soln [KMC]

Facility

$1,058.88

Service Code	HCPCS Q5106
Hospital Revenue Code	637
Min. Negotiated Rate	$5.68
Max. Negotiated Rate	$1,027.11
Rate for Payer: AlohaCare Medicaid	$529.44
Rate for Payer: AlohaCare Medicare	$444.73
Rate for Payer: Cash Price	$688.27
Rate for Payer: Cash Price	$688.27
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$974.17
Rate for Payer: Devoted Health Medicare	$444.73
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.57
Rate for Payer: Hawaii Medical Service Association Commercial	$9.85
Rate for Payer: Hawaii Medical Service Association Medicare	$444.73
Rate for Payer: Hawaii Western Management Group Commercial	$1,005.94
Rate for Payer: Health Management Network Commercial	$900.05
Rate for Payer: Humana Medicare	$444.73
Rate for Payer: Kaiser Permanente Commercial	$952.99
Rate for Payer: Kaiser Permanente Medicaid	$540.03
Rate for Payer: Kaiser Permanente Medicare	$444.73
Rate for Payer: MDX Hawaii PPO	$1,027.11
Rate for Payer: Ohana Health Plan Medicaid	$444.73
Rate for Payer: Ohana Health Plan Medicare	$444.73
Rate for Payer: UnitedHealthcare Medicaid	$5.68
Rate for Payer: UnitedHealthcare Medicare	$444.73
Rate for Payer: University Health Alliance Commercial	$771.82

Know your out-of-pocket cost for care.

All Charges