Kau Hospital

All Charges

Charge

Type

Setting

Price

ACUITY CORONARY WIDE 9F

Facility

$1,733.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$1,473.05
Max. Negotiated Rate	$1,681.01
Rate for Payer: Cash Price	$1,039.80
Rate for Payer: Health Management Network Commercial	$1,473.05
Rate for Payer: Kaiser Permanente Commercial	$1,559.70
Rate for Payer: MDX Hawaii PPO	$1,681.01

ACUITY WHISPER VIEW .014X190

Facility

$525.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$162.75
Max. Negotiated Rate	$509.25
Rate for Payer: AlohaCare Medicaid	$262.50
Rate for Payer: AlohaCare Medicare	$162.75
Rate for Payer: Cash Price	$315.00
Rate for Payer: Devoted Health Medicare	$178.50
Rate for Payer: Hawaii Medical Service Association Medicare	$162.75
Rate for Payer: Hawaii Western Management Group Commercial	$498.75
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Humana Medicare	$162.75
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: Kaiser Permanente Medicaid	$267.75
Rate for Payer: Kaiser Permanente Medicare	$162.75
Rate for Payer: MDX Hawaii PPO	$509.25
Rate for Payer: Ohana Health Plan Medicaid	$162.75
Rate for Payer: Ohana Health Plan Medicare	$162.75
Rate for Payer: UnitedHealthcare Medicare	$162.75
Rate for Payer: University Health Alliance Commercial	$382.67

ACUITY WHISPER VIEW .014X190

Facility

$525.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$509.25
Rate for Payer: Cash Price	$315.00
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: MDX Hawaii PPO	$509.25

ACUSEAL #ECH460045A

Facility

$3,108.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,740.48
Max. Negotiated Rate	$3,014.76
Rate for Payer: Cash Price	$1,864.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,175.60
Rate for Payer: Health Management Network Commercial	$2,641.80
Rate for Payer: Kaiser Permanente Commercial	$2,797.20
Rate for Payer: MDX Hawaii PPO	$3,014.76
Rate for Payer: University Health Alliance Commercial	$1,740.48

ACUSEAL #ECH460045A

Facility

$3,108.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$963.48
Max. Negotiated Rate	$3,014.76
Rate for Payer: AlohaCare Medicaid	$1,554.00
Rate for Payer: AlohaCare Medicare	$963.48
Rate for Payer: Cash Price	$1,864.80
Rate for Payer: Devoted Health Medicare	$1,056.72
Rate for Payer: Hawaii Medical Service Association Medicare	$963.48
Rate for Payer: Hawaii Western Management Group Commercial	$2,175.60
Rate for Payer: Health Management Network Commercial	$2,641.80
Rate for Payer: Humana Medicare	$963.48
Rate for Payer: Kaiser Permanente Commercial	$2,797.20
Rate for Payer: Kaiser Permanente Medicaid	$1,585.08
Rate for Payer: Kaiser Permanente Medicare	$963.48
Rate for Payer: MDX Hawaii PPO	$3,014.76
Rate for Payer: Ohana Health Plan Medicaid	$963.48
Rate for Payer: Ohana Health Plan Medicare	$963.48
Rate for Payer: UnitedHealthcare Medicare	$963.48
Rate for Payer: University Health Alliance Commercial	$1,740.48

ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION

Facility

$11,661.38

Service Code	MSDRG 880
Min. Negotiated Rate	$11,661.38
Max. Negotiated Rate	$11,661.38
Rate for Payer: Hawaii Medical Service Association Commercial	$11,661.38

ACUTE AND SUBACUTE ENDOCARDITIS WITH CC

Facility

$47,996.55

Service Code	MSDRG 289
Min. Negotiated Rate	$47,996.55
Max. Negotiated Rate	$47,996.55
Rate for Payer: Hawaii Medical Service Association Commercial	$47,996.55

ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC

Facility

$47,996.55

Service Code	MSDRG 288
Min. Negotiated Rate	$47,996.55
Max. Negotiated Rate	$47,996.55
Rate for Payer: Hawaii Medical Service Association Commercial	$47,996.55

ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC

Facility

$47,996.55

Service Code	MSDRG 290
Min. Negotiated Rate	$47,996.55
Max. Negotiated Rate	$47,996.55
Rate for Payer: Hawaii Medical Service Association Commercial	$47,996.55

ACUTE LEUKEMIA WITH CC

Facility

$139,699.59

Service Code	MSDRG 835
Min. Negotiated Rate	$139,699.59
Max. Negotiated Rate	$139,699.59
Rate for Payer: Hawaii Medical Service Association Commercial	$139,699.59

ACUTE LEUKEMIA WITH MCC

Facility

$139,699.59

Service Code	MSDRG 834
Min. Negotiated Rate	$139,699.59
Max. Negotiated Rate	$139,699.59
Rate for Payer: Hawaii Medical Service Association Commercial	$139,699.59

ACUTE LEUKEMIA WITH OTHER PROCEDURES

Facility

$139,699.59

Service Code	MSDRG 850
Min. Negotiated Rate	$139,699.59
Max. Negotiated Rate	$139,699.59
Rate for Payer: Hawaii Medical Service Association Commercial	$139,699.59

ACUTE LEUKEMIA WITHOUT CC/MCC

Facility

$139,699.59

Service Code	MSDRG 836
Min. Negotiated Rate	$139,699.59
Max. Negotiated Rate	$139,699.59
Rate for Payer: Hawaii Medical Service Association Commercial	$139,699.59

ACUTE MAJOR EYE INFECTIONS WITH CC/MCC

Facility

$9,125.27

Service Code	MSDRG 121
Min. Negotiated Rate	$9,125.27
Max. Negotiated Rate	$9,125.27
Rate for Payer: Hawaii Medical Service Association Commercial	$9,125.27

ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC

Facility

$9,125.27

Service Code	MSDRG 122
Min. Negotiated Rate	$9,125.27
Max. Negotiated Rate	$9,125.27
Rate for Payer: Hawaii Medical Service Association Commercial	$9,125.27

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC

Facility

$28,940.14

Service Code	MSDRG 281
Min. Negotiated Rate	$28,940.14
Max. Negotiated Rate	$28,940.14
Rate for Payer: Hawaii Medical Service Association Commercial	$28,940.14

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC

Facility

$33,467.22

Service Code	MSDRG 280
Min. Negotiated Rate	$33,467.22
Max. Negotiated Rate	$33,467.22
Rate for Payer: Hawaii Medical Service Association Commercial	$33,467.22

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC

Facility

$25,337.44

Service Code	MSDRG 282
Min. Negotiated Rate	$25,337.44
Max. Negotiated Rate	$25,337.44
Rate for Payer: Hawaii Medical Service Association Commercial	$25,337.44

ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC

Facility

$55,913.02

Service Code	MSDRG 284
Min. Negotiated Rate	$55,913.02
Max. Negotiated Rate	$55,913.02
Rate for Payer: Hawaii Medical Service Association Commercial	$55,913.02

ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC

Facility

$55,913.02

Service Code	MSDRG 283
Min. Negotiated Rate	$55,913.02
Max. Negotiated Rate	$55,913.02
Rate for Payer: Hawaii Medical Service Association Commercial	$55,913.02

ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC

Facility

$55,913.02

Service Code	MSDRG 285
Min. Negotiated Rate	$55,913.02
Max. Negotiated Rate	$55,913.02
Rate for Payer: Hawaii Medical Service Association Commercial	$55,913.02

ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION [8970]

Facility

$659.00

Service Code	NDC 70954018810
Hospital Revenue Code	250
Min. Negotiated Rate	$560.15
Max. Negotiated Rate	$639.23
Rate for Payer: Cash Price	$395.40
Rate for Payer: Health Management Network Commercial	$560.15
Rate for Payer: Kaiser Permanente Commercial	$593.10
Rate for Payer: MDX Hawaii PPO	$639.23

ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION [8970]

Facility

$659.00

Service Code	NDC 31722068147
Hospital Revenue Code	250
Min. Negotiated Rate	$560.15
Max. Negotiated Rate	$639.23
Rate for Payer: Cash Price	$395.40
Rate for Payer: Health Management Network Commercial	$560.15
Rate for Payer: Kaiser Permanente Commercial	$593.10
Rate for Payer: MDX Hawaii PPO	$639.23

ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION [8970]

Facility

$659.00

Service Code	NDC 31722068147
Hospital Revenue Code	637
Min. Negotiated Rate	$204.29
Max. Negotiated Rate	$639.23
Rate for Payer: AlohaCare Medicaid	$329.50
Rate for Payer: AlohaCare Medicare	$204.29
Rate for Payer: Cash Price	$395.40
Rate for Payer: Devoted Health Medicare	$224.06
Rate for Payer: Hawaii Medical Service Association Medicare	$204.29
Rate for Payer: Hawaii Western Management Group Commercial	$626.05
Rate for Payer: Health Management Network Commercial	$560.15
Rate for Payer: Humana Medicare	$204.29
Rate for Payer: Kaiser Permanente Commercial	$593.10
Rate for Payer: Kaiser Permanente Medicaid	$336.09
Rate for Payer: Kaiser Permanente Medicare	$204.29
Rate for Payer: MDX Hawaii PPO	$639.23
Rate for Payer: Ohana Health Plan Medicaid	$204.29
Rate for Payer: Ohana Health Plan Medicare	$204.29
Rate for Payer: UnitedHealthcare Medicare	$204.29
Rate for Payer: University Health Alliance Commercial	$480.35

ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION [8970]

Facility

$659.00

Service Code	NDC 70954018810
Hospital Revenue Code	637
Min. Negotiated Rate	$204.29
Max. Negotiated Rate	$639.23
Rate for Payer: AlohaCare Medicaid	$329.50
Rate for Payer: AlohaCare Medicare	$204.29
Rate for Payer: Cash Price	$395.40
Rate for Payer: Devoted Health Medicare	$224.06
Rate for Payer: Hawaii Medical Service Association Medicare	$204.29
Rate for Payer: Hawaii Western Management Group Commercial	$626.05
Rate for Payer: Health Management Network Commercial	$560.15
Rate for Payer: Humana Medicare	$204.29
Rate for Payer: Kaiser Permanente Commercial	$593.10
Rate for Payer: Kaiser Permanente Medicaid	$336.09
Rate for Payer: Kaiser Permanente Medicare	$204.29
Rate for Payer: MDX Hawaii PPO	$639.23
Rate for Payer: Ohana Health Plan Medicaid	$204.29
Rate for Payer: Ohana Health Plan Medicare	$204.29
Rate for Payer: UnitedHealthcare Medicare	$204.29
Rate for Payer: University Health Alliance Commercial	$480.35

Know your out-of-pocket cost for care.

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