Kau Hospital

All Charges

Charge

Type

Setting

Price

DRSG SM VAC PEEL

Facility

$377.00

Hospital Revenue Code	272
Min. Negotiated Rate	$320.45
Max. Negotiated Rate	$365.69
Rate for Payer: Cash Price	$226.20
Rate for Payer: Health Management Network Commercial	$320.45
Rate for Payer: Kaiser Permanente Commercial	$339.30
Rate for Payer: MDX Hawaii PPO	$365.69

DRSG SM VAC PEEL

Facility

$377.00

Hospital Revenue Code	272
Min. Negotiated Rate	$116.87
Max. Negotiated Rate	$365.69
Rate for Payer: AlohaCare Medicaid	$188.50
Rate for Payer: AlohaCare Medicare	$116.87
Rate for Payer: Cash Price	$226.20
Rate for Payer: Devoted Health Medicare	$128.18
Rate for Payer: Hawaii Medical Service Association Medicare	$116.87
Rate for Payer: Hawaii Western Management Group Commercial	$358.15
Rate for Payer: Health Management Network Commercial	$320.45
Rate for Payer: Humana Medicare	$116.87
Rate for Payer: Kaiser Permanente Commercial	$339.30
Rate for Payer: Kaiser Permanente Medicaid	$192.27
Rate for Payer: Kaiser Permanente Medicare	$116.87
Rate for Payer: MDX Hawaii PPO	$365.69
Rate for Payer: Ohana Health Plan Medicaid	$116.87
Rate for Payer: Ohana Health Plan Medicare	$116.87
Rate for Payer: UnitedHealthcare Medicare	$116.87
Rate for Payer: University Health Alliance Commercial	$274.80

DRSG SURGICEL 3X2

Facility

$255.00

Hospital Revenue Code	272
Min. Negotiated Rate	$216.75
Max. Negotiated Rate	$247.35
Rate for Payer: Cash Price	$153.00
Rate for Payer: Health Management Network Commercial	$216.75
Rate for Payer: Kaiser Permanente Commercial	$229.50
Rate for Payer: MDX Hawaii PPO	$247.35

DRSG SURGICEL 3X2

Facility

$255.00

Hospital Revenue Code	272
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$247.35
Rate for Payer: AlohaCare Medicaid	$127.50
Rate for Payer: AlohaCare Medicare	$79.05
Rate for Payer: Cash Price	$153.00
Rate for Payer: Devoted Health Medicare	$86.70
Rate for Payer: Hawaii Medical Service Association Medicare	$79.05
Rate for Payer: Hawaii Western Management Group Commercial	$242.25
Rate for Payer: Health Management Network Commercial	$216.75
Rate for Payer: Humana Medicare	$79.05
Rate for Payer: Kaiser Permanente Commercial	$229.50
Rate for Payer: Kaiser Permanente Medicaid	$130.05
Rate for Payer: Kaiser Permanente Medicare	$79.05
Rate for Payer: MDX Hawaii PPO	$247.35
Rate for Payer: Ohana Health Plan Medicaid	$79.05
Rate for Payer: Ohana Health Plan Medicare	$79.05
Rate for Payer: UnitedHealthcare Medicare	$79.05
Rate for Payer: University Health Alliance Commercial	$185.87

DRSG SURGICEL 4X8

Facility

$432.00

Hospital Revenue Code	272
Min. Negotiated Rate	$367.20
Max. Negotiated Rate	$419.04
Rate for Payer: Cash Price	$259.20
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: MDX Hawaii PPO	$419.04

DRSG SURGICEL 4X8

Facility

$432.00

Hospital Revenue Code	272
Min. Negotiated Rate	$133.92
Max. Negotiated Rate	$419.04
Rate for Payer: AlohaCare Medicaid	$216.00
Rate for Payer: AlohaCare Medicare	$133.92
Rate for Payer: Cash Price	$259.20
Rate for Payer: Devoted Health Medicare	$146.88
Rate for Payer: Hawaii Medical Service Association Medicare	$133.92
Rate for Payer: Hawaii Western Management Group Commercial	$410.40
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Humana Medicare	$133.92
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: Kaiser Permanente Medicaid	$220.32
Rate for Payer: Kaiser Permanente Medicare	$133.92
Rate for Payer: MDX Hawaii PPO	$419.04
Rate for Payer: Ohana Health Plan Medicaid	$133.92
Rate for Payer: Ohana Health Plan Medicare	$133.92
Rate for Payer: UnitedHealthcare Medicare	$133.92
Rate for Payer: University Health Alliance Commercial	$314.88

DRSG SURGICEL .5X2

Facility

$165.00

Hospital Revenue Code	272
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$160.05
Rate for Payer: Cash Price	$99.00
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: Kaiser Permanente Commercial	$148.50
Rate for Payer: MDX Hawaii PPO	$160.05

DRSG SURGICEL .5X2

Facility

$165.00

Hospital Revenue Code	272
Min. Negotiated Rate	$51.15
Max. Negotiated Rate	$160.05
Rate for Payer: AlohaCare Medicaid	$82.50
Rate for Payer: AlohaCare Medicare	$51.15
Rate for Payer: Cash Price	$99.00
Rate for Payer: Devoted Health Medicare	$56.10
Rate for Payer: Hawaii Medical Service Association Medicare	$51.15
Rate for Payer: Hawaii Western Management Group Commercial	$156.75
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: Humana Medicare	$51.15
Rate for Payer: Kaiser Permanente Commercial	$148.50
Rate for Payer: Kaiser Permanente Medicaid	$84.15
Rate for Payer: Kaiser Permanente Medicare	$51.15
Rate for Payer: MDX Hawaii PPO	$160.05
Rate for Payer: Ohana Health Plan Medicaid	$51.15
Rate for Payer: Ohana Health Plan Medicare	$51.15
Rate for Payer: UnitedHealthcare Medicare	$51.15
Rate for Payer: University Health Alliance Commercial	$120.27

DRSG WOUND VAC LG

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: MDX Hawaii PPO	$201.76

DRSG WOUND VAC LG

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$64.48
Max. Negotiated Rate	$201.76
Rate for Payer: AlohaCare Medicaid	$104.00
Rate for Payer: AlohaCare Medicare	$64.48
Rate for Payer: Cash Price	$124.80
Rate for Payer: Devoted Health Medicare	$70.72
Rate for Payer: Hawaii Medical Service Association Medicare	$64.48
Rate for Payer: Hawaii Western Management Group Commercial	$197.60
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Humana Medicare	$64.48
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: Kaiser Permanente Medicaid	$106.08
Rate for Payer: Kaiser Permanente Medicare	$64.48
Rate for Payer: MDX Hawaii PPO	$201.76
Rate for Payer: Ohana Health Plan Medicaid	$64.48
Rate for Payer: Ohana Health Plan Medicare	$64.48
Rate for Payer: UnitedHealthcare Medicare	$64.48
Rate for Payer: University Health Alliance Commercial	$151.61

DRSG WOUND VAC MED

Facility

$211.00

Hospital Revenue Code	272
Min. Negotiated Rate	$179.35
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$126.60
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: MDX Hawaii PPO	$204.67

DRSG WOUND VAC MED

Facility

$211.00

Hospital Revenue Code	272
Min. Negotiated Rate	$65.41
Max. Negotiated Rate	$204.67
Rate for Payer: AlohaCare Medicaid	$105.50
Rate for Payer: AlohaCare Medicare	$65.41
Rate for Payer: Cash Price	$126.60
Rate for Payer: Devoted Health Medicare	$71.74
Rate for Payer: Hawaii Medical Service Association Medicare	$65.41
Rate for Payer: Hawaii Western Management Group Commercial	$200.45
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Humana Medicare	$65.41
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: Kaiser Permanente Medicaid	$107.61
Rate for Payer: Kaiser Permanente Medicare	$65.41
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: Ohana Health Plan Medicaid	$65.41
Rate for Payer: Ohana Health Plan Medicare	$65.41
Rate for Payer: UnitedHealthcare Medicare	$65.41
Rate for Payer: University Health Alliance Commercial	$153.80

DRSG WOUND VAC SM

Facility

$171.00

Hospital Revenue Code	272
Min. Negotiated Rate	$145.35
Max. Negotiated Rate	$165.87
Rate for Payer: Cash Price	$102.60
Rate for Payer: Health Management Network Commercial	$145.35
Rate for Payer: Kaiser Permanente Commercial	$153.90
Rate for Payer: MDX Hawaii PPO	$165.87

DRSG WOUND VAC SM

Facility

$171.00

Hospital Revenue Code	272
Min. Negotiated Rate	$53.01
Max. Negotiated Rate	$165.87
Rate for Payer: AlohaCare Medicaid	$85.50
Rate for Payer: AlohaCare Medicare	$53.01
Rate for Payer: Cash Price	$102.60
Rate for Payer: Devoted Health Medicare	$58.14
Rate for Payer: Hawaii Medical Service Association Medicare	$53.01
Rate for Payer: Hawaii Western Management Group Commercial	$162.45
Rate for Payer: Health Management Network Commercial	$145.35
Rate for Payer: Humana Medicare	$53.01
Rate for Payer: Kaiser Permanente Commercial	$153.90
Rate for Payer: Kaiser Permanente Medicaid	$87.21
Rate for Payer: Kaiser Permanente Medicare	$53.01
Rate for Payer: MDX Hawaii PPO	$165.87
Rate for Payer: Ohana Health Plan Medicaid	$53.01
Rate for Payer: Ohana Health Plan Medicare	$53.01
Rate for Payer: UnitedHealthcare Medicare	$53.01
Rate for Payer: University Health Alliance Commercial	$124.64

DUALKNIFE J UPPER LGTH KD-655L

Facility

$2,909.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,472.65
Max. Negotiated Rate	$2,821.73
Rate for Payer: Cash Price	$1,745.40
Rate for Payer: Health Management Network Commercial	$2,472.65
Rate for Payer: Kaiser Permanente Commercial	$2,618.10
Rate for Payer: MDX Hawaii PPO	$2,821.73

DUALKNIFE J UPPER LGTH KD-655L

Facility

$2,909.00

Hospital Revenue Code	272
Min. Negotiated Rate	$901.79
Max. Negotiated Rate	$2,821.73
Rate for Payer: AlohaCare Medicaid	$1,454.50
Rate for Payer: AlohaCare Medicare	$901.79
Rate for Payer: Cash Price	$1,745.40
Rate for Payer: Devoted Health Medicare	$989.06
Rate for Payer: Hawaii Medical Service Association Medicare	$901.79
Rate for Payer: Hawaii Western Management Group Commercial	$2,763.55
Rate for Payer: Health Management Network Commercial	$2,472.65
Rate for Payer: Humana Medicare	$901.79
Rate for Payer: Kaiser Permanente Commercial	$2,618.10
Rate for Payer: Kaiser Permanente Medicaid	$1,483.59
Rate for Payer: Kaiser Permanente Medicare	$901.79
Rate for Payer: MDX Hawaii PPO	$2,821.73
Rate for Payer: Ohana Health Plan Medicaid	$901.79
Rate for Payer: Ohana Health Plan Medicare	$901.79
Rate for Payer: UnitedHealthcare Medicare	$901.79
Rate for Payer: University Health Alliance Commercial	$2,120.37

DUAL PORT COAXIAL INTRO KIT

Facility

$1,365.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$1,160.25
Max. Negotiated Rate	$1,324.05
Rate for Payer: Cash Price	$819.00
Rate for Payer: Health Management Network Commercial	$1,160.25
Rate for Payer: Kaiser Permanente Commercial	$1,228.50
Rate for Payer: MDX Hawaii PPO	$1,324.05

DUAL PORT COAXIAL INTRO KIT

Facility

$1,365.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$423.15
Max. Negotiated Rate	$1,324.05
Rate for Payer: AlohaCare Medicaid	$682.50
Rate for Payer: AlohaCare Medicare	$423.15
Rate for Payer: Cash Price	$819.00
Rate for Payer: Devoted Health Medicare	$464.10
Rate for Payer: Hawaii Medical Service Association Medicare	$423.15
Rate for Payer: Hawaii Western Management Group Commercial	$1,296.75
Rate for Payer: Health Management Network Commercial	$1,160.25
Rate for Payer: Humana Medicare	$423.15
Rate for Payer: Kaiser Permanente Commercial	$1,228.50
Rate for Payer: Kaiser Permanente Medicaid	$696.15
Rate for Payer: Kaiser Permanente Medicare	$423.15
Rate for Payer: MDX Hawaii PPO	$1,324.05
Rate for Payer: Ohana Health Plan Medicaid	$423.15
Rate for Payer: Ohana Health Plan Medicare	$423.15
Rate for Payer: UnitedHealthcare Medicare	$423.15
Rate for Payer: University Health Alliance Commercial	$994.95

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE [39275]

Facility

$21.00

Service Code	NDC 27241009706
Hospital Revenue Code	637
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$20.37
Rate for Payer: AlohaCare Medicaid	$10.50
Rate for Payer: AlohaCare Medicare	$6.51
Rate for Payer: Cash Price	$12.60
Rate for Payer: Devoted Health Medicare	$7.14
Rate for Payer: Hawaii Medical Service Association Medicare	$6.51
Rate for Payer: Hawaii Western Management Group Commercial	$19.95
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Humana Medicare	$6.51
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: Kaiser Permanente Medicare	$6.51
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: Ohana Health Plan Medicaid	$6.51
Rate for Payer: Ohana Health Plan Medicare	$6.51
Rate for Payer: UnitedHealthcare Medicare	$6.51
Rate for Payer: University Health Alliance Commercial	$15.31

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE [39275]

Facility

$7.00

Service Code	NDC 00904704304
Hospital Revenue Code	637
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$6.79
Rate for Payer: AlohaCare Medicaid	$3.50
Rate for Payer: AlohaCare Medicare	$2.17
Rate for Payer: Cash Price	$4.20
Rate for Payer: Devoted Health Medicare	$2.38
Rate for Payer: Hawaii Medical Service Association Medicare	$2.17
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Humana Medicare	$2.17
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: Kaiser Permanente Medicare	$2.17
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: Ohana Health Plan Medicaid	$2.17
Rate for Payer: Ohana Health Plan Medicare	$2.17
Rate for Payer: UnitedHealthcare Medicare	$2.17
Rate for Payer: University Health Alliance Commercial	$5.10

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE [39275]

Facility

$25.00

Service Code	NDC 60687072311
Hospital Revenue Code	250
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$15.00
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: MDX Hawaii PPO	$24.25

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE [39275]

Facility

$25.00

Service Code	NDC 60687072311
Hospital Revenue Code	637
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$24.25
Rate for Payer: AlohaCare Medicaid	$12.50
Rate for Payer: AlohaCare Medicare	$7.75
Rate for Payer: Cash Price	$15.00
Rate for Payer: Devoted Health Medicare	$8.50
Rate for Payer: Hawaii Medical Service Association Medicare	$7.75
Rate for Payer: Hawaii Western Management Group Commercial	$23.75
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Humana Medicare	$7.75
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: Kaiser Permanente Medicaid	$12.75
Rate for Payer: Kaiser Permanente Medicare	$7.75
Rate for Payer: MDX Hawaii PPO	$24.25
Rate for Payer: Ohana Health Plan Medicaid	$7.75
Rate for Payer: Ohana Health Plan Medicare	$7.75
Rate for Payer: UnitedHealthcare Medicare	$7.75
Rate for Payer: University Health Alliance Commercial	$18.22

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE [39275]

Facility

$25.00

Service Code	NDC 68084067521
Hospital Revenue Code	637
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$24.25
Rate for Payer: AlohaCare Medicaid	$12.50
Rate for Payer: AlohaCare Medicare	$7.75
Rate for Payer: Cash Price	$15.00
Rate for Payer: Devoted Health Medicare	$8.50
Rate for Payer: Hawaii Medical Service Association Medicare	$7.75
Rate for Payer: Hawaii Western Management Group Commercial	$23.75
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Humana Medicare	$7.75
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: Kaiser Permanente Medicaid	$12.75
Rate for Payer: Kaiser Permanente Medicare	$7.75
Rate for Payer: MDX Hawaii PPO	$24.25
Rate for Payer: Ohana Health Plan Medicaid	$7.75
Rate for Payer: Ohana Health Plan Medicare	$7.75
Rate for Payer: UnitedHealthcare Medicare	$7.75
Rate for Payer: University Health Alliance Commercial	$18.22

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE [39275]

Facility

$21.00

Service Code	NDC 27241009706
Hospital Revenue Code	250
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: MDX Hawaii PPO	$20.37

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE [39275]

Facility

$7.00

Service Code	NDC 00904704304
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$6.79

Know your out-of-pocket cost for care.

All Charges