Kau Hospital

All Charges

Charge

Type

Setting

Price

CEPHALEXIN SUSPENSION (KEFLEX) 250 MG/5 ML (100 ML) (TAKE HOME) [4080343]

Facility

$15.00

Service Code	NDC 00004080131
Hospital Revenue Code	253
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$4.65
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$5.10
Rate for Payer: Hawaii Medical Service Association Medicare	$4.65
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$4.65
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$4.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$4.65
Rate for Payer: Ohana Health Plan Medicare	$4.65
Rate for Payer: UnitedHealthcare Medicare	$4.65
Rate for Payer: University Health Alliance Commercial	$10.93

CEPHALEXIN SUSPENSION (KEFLEX) 250 MG/5 ML (100 ML) (TAKE HOME) [4080343]

Facility

$15.00

Service Code	NDC 00004080131
Hospital Revenue Code	253
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

CERAMENT G 10ML A0535-05

Facility

$14,874.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$4,610.94
Max. Negotiated Rate	$14,427.78
Rate for Payer: AlohaCare Medicaid	$7,437.00
Rate for Payer: AlohaCare Medicare	$4,610.94
Rate for Payer: Cash Price	$8,924.40
Rate for Payer: Devoted Health Medicare	$5,057.16
Rate for Payer: Hawaii Medical Service Association Medicare	$4,610.94
Rate for Payer: Hawaii Western Management Group Commercial	$10,411.80
Rate for Payer: Health Management Network Commercial	$12,642.90
Rate for Payer: Humana Medicare	$4,610.94
Rate for Payer: Kaiser Permanente Commercial	$13,386.60
Rate for Payer: Kaiser Permanente Medicaid	$7,585.74
Rate for Payer: Kaiser Permanente Medicare	$4,610.94
Rate for Payer: MDX Hawaii PPO	$14,427.78
Rate for Payer: Ohana Health Plan Medicaid	$4,610.94
Rate for Payer: Ohana Health Plan Medicare	$4,610.94
Rate for Payer: UnitedHealthcare Medicare	$4,610.94
Rate for Payer: University Health Alliance Commercial	$8,329.44

CERAMENT G 10ML A0535-05

Facility

$14,874.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$8,329.44
Max. Negotiated Rate	$14,427.78
Rate for Payer: Cash Price	$8,924.40
Rate for Payer: Hawaii Western Management Group Commercial	$10,411.80
Rate for Payer: Health Management Network Commercial	$12,642.90
Rate for Payer: Kaiser Permanente Commercial	$13,386.60
Rate for Payer: MDX Hawaii PPO	$14,427.78
Rate for Payer: University Health Alliance Commercial	$8,329.44

CERAMIC FEMORAL HEAD 18-36-3

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$829.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: AlohaCare Medicaid	$1,338.00
Rate for Payer: AlohaCare Medicare	$829.56
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Devoted Health Medicare	$909.84
Rate for Payer: Hawaii Medical Service Association Medicare	$829.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Humana Medicare	$829.56
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: Kaiser Permanente Medicare	$829.56
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: Ohana Health Plan Medicaid	$829.56
Rate for Payer: Ohana Health Plan Medicare	$829.56
Rate for Payer: UnitedHealthcare Medicare	$829.56
Rate for Payer: University Health Alliance Commercial	$1,498.56

CERAMIC FEMORAL HEAD 18-36-3

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

CERAMIC HEAD 36/0 6570-0-136

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$837.93
Max. Negotiated Rate	$2,621.91
Rate for Payer: AlohaCare Medicaid	$1,351.50
Rate for Payer: AlohaCare Medicare	$837.93
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Devoted Health Medicare	$919.02
Rate for Payer: Hawaii Medical Service Association Medicare	$837.93
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Humana Medicare	$837.93
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: Kaiser Permanente Medicaid	$1,378.53
Rate for Payer: Kaiser Permanente Medicare	$837.93
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: Ohana Health Plan Medicaid	$837.93
Rate for Payer: Ohana Health Plan Medicare	$837.93
Rate for Payer: UnitedHealthcare Medicare	$837.93
Rate for Payer: University Health Alliance Commercial	$1,513.68

CERAMIC HEAD 36/0 6570-0-136

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.68
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

CERAMIC HEAD 36MM 6570-0-436

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

CERAMIC HEAD 36MM 6570-0-436

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$829.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: AlohaCare Medicaid	$1,338.00
Rate for Payer: AlohaCare Medicare	$829.56
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Devoted Health Medicare	$909.84
Rate for Payer: Hawaii Medical Service Association Medicare	$829.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Humana Medicare	$829.56
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: Kaiser Permanente Medicare	$829.56
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: Ohana Health Plan Medicaid	$829.56
Rate for Payer: Ohana Health Plan Medicare	$829.56
Rate for Payer: UnitedHealthcare Medicare	$829.56
Rate for Payer: University Health Alliance Commercial	$1,498.56

CERC CBL 1.8X635MM 2232-04-18

Facility

$1,764.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$987.84
Max. Negotiated Rate	$1,711.08
Rate for Payer: Cash Price	$1,058.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.80
Rate for Payer: Health Management Network Commercial	$1,499.40
Rate for Payer: Kaiser Permanente Commercial	$1,587.60
Rate for Payer: MDX Hawaii PPO	$1,711.08
Rate for Payer: University Health Alliance Commercial	$987.84

CERC CBL 1.8X635MM 2232-04-18

Facility

$1,764.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$546.84
Max. Negotiated Rate	$1,711.08
Rate for Payer: AlohaCare Medicaid	$882.00
Rate for Payer: AlohaCare Medicare	$546.84
Rate for Payer: Cash Price	$1,058.40
Rate for Payer: Devoted Health Medicare	$599.76
Rate for Payer: Hawaii Medical Service Association Medicare	$546.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.80
Rate for Payer: Health Management Network Commercial	$1,499.40
Rate for Payer: Humana Medicare	$546.84
Rate for Payer: Kaiser Permanente Commercial	$1,587.60
Rate for Payer: Kaiser Permanente Medicaid	$899.64
Rate for Payer: Kaiser Permanente Medicare	$546.84
Rate for Payer: MDX Hawaii PPO	$1,711.08
Rate for Payer: Ohana Health Plan Medicaid	$546.84
Rate for Payer: Ohana Health Plan Medicare	$546.84
Rate for Payer: UnitedHealthcare Medicare	$546.84
Rate for Payer: University Health Alliance Commercial	$987.84

CERC CBL W/CRMP 22" 2232-01-18

Facility

$1,764.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$546.84
Max. Negotiated Rate	$1,711.08
Rate for Payer: AlohaCare Medicaid	$882.00
Rate for Payer: AlohaCare Medicare	$546.84
Rate for Payer: Cash Price	$1,058.40
Rate for Payer: Devoted Health Medicare	$599.76
Rate for Payer: Hawaii Medical Service Association Medicare	$546.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.80
Rate for Payer: Health Management Network Commercial	$1,499.40
Rate for Payer: Humana Medicare	$546.84
Rate for Payer: Kaiser Permanente Commercial	$1,587.60
Rate for Payer: Kaiser Permanente Medicaid	$899.64
Rate for Payer: Kaiser Permanente Medicare	$546.84
Rate for Payer: MDX Hawaii PPO	$1,711.08
Rate for Payer: Ohana Health Plan Medicaid	$546.84
Rate for Payer: Ohana Health Plan Medicare	$546.84
Rate for Payer: UnitedHealthcare Medicare	$546.84
Rate for Payer: University Health Alliance Commercial	$987.84

CERC CBL W/CRMP 22" 2232-01-18

Facility

$1,764.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$987.84
Max. Negotiated Rate	$1,711.08
Rate for Payer: Cash Price	$1,058.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,234.80
Rate for Payer: Health Management Network Commercial	$1,499.40
Rate for Payer: Kaiser Permanente Commercial	$1,587.60
Rate for Payer: MDX Hawaii PPO	$1,711.08
Rate for Payer: University Health Alliance Commercial	$987.84

CERC CBL W/CRMP 36" 2232-01-28

Facility

$2,730.00

Hospital Revenue Code	278
Min. Negotiated Rate	$846.30
Max. Negotiated Rate	$2,648.10
Rate for Payer: AlohaCare Medicaid	$1,365.00
Rate for Payer: AlohaCare Medicare	$846.30
Rate for Payer: Cash Price	$1,638.00
Rate for Payer: Devoted Health Medicare	$928.20
Rate for Payer: Hawaii Medical Service Association Medicare	$846.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,911.00
Rate for Payer: Health Management Network Commercial	$2,320.50
Rate for Payer: Humana Medicare	$846.30
Rate for Payer: Kaiser Permanente Commercial	$2,457.00
Rate for Payer: Kaiser Permanente Medicaid	$1,392.30
Rate for Payer: Kaiser Permanente Medicare	$846.30
Rate for Payer: MDX Hawaii PPO	$2,648.10
Rate for Payer: Ohana Health Plan Medicaid	$846.30
Rate for Payer: Ohana Health Plan Medicare	$846.30
Rate for Payer: UnitedHealthcare Medicare	$846.30
Rate for Payer: University Health Alliance Commercial	$1,528.80

CERC CBL W/CRMP 36" 2232-01-28

Facility

$2,730.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,528.80
Max. Negotiated Rate	$2,648.10
Rate for Payer: Cash Price	$1,638.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,911.00
Rate for Payer: Health Management Network Commercial	$2,320.50
Rate for Payer: Kaiser Permanente Commercial	$2,457.00
Rate for Payer: MDX Hawaii PPO	$2,648.10
Rate for Payer: University Health Alliance Commercial	$1,528.80

CERCLAGE PC 0.5X175 291.230.98

Facility

$121.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$102.85
Max. Negotiated Rate	$117.37
Rate for Payer: Cash Price	$72.60
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Kaiser Permanente Commercial	$108.90
Rate for Payer: MDX Hawaii PPO	$117.37

CERCLAGE PC 0.5X175 291.230.98

Facility

$121.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$37.51
Max. Negotiated Rate	$117.37
Rate for Payer: AlohaCare Medicaid	$60.50
Rate for Payer: AlohaCare Medicare	$37.51
Rate for Payer: Cash Price	$72.60
Rate for Payer: Devoted Health Medicare	$41.14
Rate for Payer: Hawaii Medical Service Association Medicare	$37.51
Rate for Payer: Hawaii Western Management Group Commercial	$114.95
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Humana Medicare	$37.51
Rate for Payer: Kaiser Permanente Commercial	$108.90
Rate for Payer: Kaiser Permanente Medicaid	$61.71
Rate for Payer: Kaiser Permanente Medicare	$37.51
Rate for Payer: MDX Hawaii PPO	$117.37
Rate for Payer: Ohana Health Plan Medicaid	$37.51
Rate for Payer: Ohana Health Plan Medicare	$37.51
Rate for Payer: UnitedHealthcare Medicare	$37.51
Rate for Payer: University Health Alliance Commercial	$88.20

CERCLAGE TENSIONER AR-7820

Facility

$1,011.00

Hospital Revenue Code	272
Min. Negotiated Rate	$859.35
Max. Negotiated Rate	$980.67
Rate for Payer: Cash Price	$606.60
Rate for Payer: Health Management Network Commercial	$859.35
Rate for Payer: Kaiser Permanente Commercial	$909.90
Rate for Payer: MDX Hawaii PPO	$980.67

CERCLAGE TENSIONER AR-7820

Facility

$1,011.00

Hospital Revenue Code	272
Min. Negotiated Rate	$313.41
Max. Negotiated Rate	$980.67
Rate for Payer: AlohaCare Medicaid	$505.50
Rate for Payer: AlohaCare Medicare	$313.41
Rate for Payer: Cash Price	$606.60
Rate for Payer: Devoted Health Medicare	$343.74
Rate for Payer: Hawaii Medical Service Association Medicare	$313.41
Rate for Payer: Hawaii Western Management Group Commercial	$960.45
Rate for Payer: Health Management Network Commercial	$859.35
Rate for Payer: Humana Medicare	$313.41
Rate for Payer: Kaiser Permanente Commercial	$909.90
Rate for Payer: Kaiser Permanente Medicaid	$515.61
Rate for Payer: Kaiser Permanente Medicare	$313.41
Rate for Payer: MDX Hawaii PPO	$980.67
Rate for Payer: Ohana Health Plan Medicaid	$313.41
Rate for Payer: Ohana Health Plan Medicare	$313.41
Rate for Payer: UnitedHealthcare Medicare	$313.41
Rate for Payer: University Health Alliance Commercial	$736.92

CERMENT BONE VOID A0210-08

Facility

$5,390.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,018.40
Max. Negotiated Rate	$5,228.30
Rate for Payer: Cash Price	$3,234.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,773.00
Rate for Payer: Health Management Network Commercial	$4,581.50
Rate for Payer: Kaiser Permanente Commercial	$4,851.00
Rate for Payer: MDX Hawaii PPO	$5,228.30
Rate for Payer: University Health Alliance Commercial	$3,018.40

CERMENT BONE VOID A0210-08

Facility

$5,390.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,670.90
Max. Negotiated Rate	$5,228.30
Rate for Payer: AlohaCare Medicaid	$2,695.00
Rate for Payer: AlohaCare Medicare	$1,670.90
Rate for Payer: Cash Price	$3,234.00
Rate for Payer: Devoted Health Medicare	$1,832.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,670.90
Rate for Payer: Hawaii Western Management Group Commercial	$3,773.00
Rate for Payer: Health Management Network Commercial	$4,581.50
Rate for Payer: Humana Medicare	$1,670.90
Rate for Payer: Kaiser Permanente Commercial	$4,851.00
Rate for Payer: Kaiser Permanente Medicaid	$2,748.90
Rate for Payer: Kaiser Permanente Medicare	$1,670.90
Rate for Payer: MDX Hawaii PPO	$5,228.30
Rate for Payer: Ohana Health Plan Medicaid	$1,670.90
Rate for Payer: Ohana Health Plan Medicare	$1,670.90
Rate for Payer: UnitedHealthcare Medicare	$1,670.90
Rate for Payer: University Health Alliance Commercial	$3,018.40

CERVICAL RIPENING BALLOON 18FR

Facility

$288.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$279.36
Rate for Payer: Cash Price	$172.80
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: Kaiser Permanente Commercial	$259.20
Rate for Payer: MDX Hawaii PPO	$279.36

CERVICAL RIPENING BALLOON 18FR

Facility

$288.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$89.28
Max. Negotiated Rate	$279.36
Rate for Payer: AlohaCare Medicaid	$144.00
Rate for Payer: AlohaCare Medicare	$89.28
Rate for Payer: Cash Price	$172.80
Rate for Payer: Devoted Health Medicare	$97.92
Rate for Payer: Hawaii Medical Service Association Medicare	$89.28
Rate for Payer: Hawaii Western Management Group Commercial	$273.60
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: Humana Medicare	$89.28
Rate for Payer: Kaiser Permanente Commercial	$259.20
Rate for Payer: Kaiser Permanente Medicaid	$146.88
Rate for Payer: Kaiser Permanente Medicare	$89.28
Rate for Payer: MDX Hawaii PPO	$279.36
Rate for Payer: Ohana Health Plan Medicaid	$89.28
Rate for Payer: Ohana Health Plan Medicare	$89.28
Rate for Payer: UnitedHealthcare Medicare	$89.28
Rate for Payer: University Health Alliance Commercial	$209.92

CERVICAL SPINAL FUSION WITH CC

Facility

$50,129.73

Service Code	MSDRG 472
Min. Negotiated Rate	$50,129.73
Max. Negotiated Rate	$50,129.73
Rate for Payer: Hawaii Medical Service Association Commercial	$50,129.73

Know your out-of-pocket cost for care.

All Charges