Kau Hospital

All Charges

Charge

Type

Setting

Price

FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS [166807]

Facility

$126.00

Service Code	NDC 63323082074
Hospital Revenue Code	258
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: MDX Hawaii PPO	$122.22

FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS [166807]

Facility

$126.00

Service Code	NDC 63323082074
Hospital Revenue Code	258
Min. Negotiated Rate	$39.06
Max. Negotiated Rate	$122.22
Rate for Payer: AlohaCare Medicaid	$63.00
Rate for Payer: AlohaCare Medicare	$39.06
Rate for Payer: Cash Price	$75.60
Rate for Payer: Devoted Health Medicare	$42.84
Rate for Payer: Hawaii Medical Service Association Medicare	$39.06
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Humana Medicare	$39.06
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicare	$39.06
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: Ohana Health Plan Medicaid	$39.06
Rate for Payer: Ohana Health Plan Medicare	$39.06
Rate for Payer: UnitedHealthcare Medicare	$39.06
Rate for Payer: University Health Alliance Commercial	$91.84

FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS [166807]

Facility

$126.00

Service Code	NDC 63323082004
Hospital Revenue Code	258
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: MDX Hawaii PPO	$122.22

FEBUXOSTAT 40 MG TABLET [97133]

Facility

$31.00

Service Code	NDC 62332019030
Hospital Revenue Code	250
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: MDX Hawaii PPO	$30.07

FEBUXOSTAT 40 MG TABLET [97133]

Facility

$31.00

Service Code	NDC 62332019030
Hospital Revenue Code	637
Min. Negotiated Rate	$9.61
Max. Negotiated Rate	$30.07
Rate for Payer: AlohaCare Medicaid	$15.50
Rate for Payer: AlohaCare Medicare	$9.61
Rate for Payer: Cash Price	$18.60
Rate for Payer: Devoted Health Medicare	$10.54
Rate for Payer: Hawaii Medical Service Association Medicare	$9.61
Rate for Payer: Hawaii Western Management Group Commercial	$29.45
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Humana Medicare	$9.61
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: Kaiser Permanente Medicaid	$15.81
Rate for Payer: Kaiser Permanente Medicare	$9.61
Rate for Payer: MDX Hawaii PPO	$30.07
Rate for Payer: Ohana Health Plan Medicaid	$9.61
Rate for Payer: Ohana Health Plan Medicare	$9.61
Rate for Payer: UnitedHealthcare Medicare	$9.61
Rate for Payer: University Health Alliance Commercial	$22.60

FEBUXOSTAT 40 MG TABLET [97133]

Facility

$30.00

Service Code	NDC 33342027407
Hospital Revenue Code	637
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$29.10
Rate for Payer: AlohaCare Medicaid	$15.00
Rate for Payer: AlohaCare Medicare	$9.30
Rate for Payer: Cash Price	$18.00
Rate for Payer: Devoted Health Medicare	$10.20
Rate for Payer: Hawaii Medical Service Association Medicare	$9.30
Rate for Payer: Hawaii Western Management Group Commercial	$28.50
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Humana Medicare	$9.30
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: Kaiser Permanente Medicaid	$15.30
Rate for Payer: Kaiser Permanente Medicare	$9.30
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: Ohana Health Plan Medicaid	$9.30
Rate for Payer: Ohana Health Plan Medicare	$9.30
Rate for Payer: UnitedHealthcare Medicare	$9.30
Rate for Payer: University Health Alliance Commercial	$21.87

FEBUXOSTAT 40 MG TABLET [97133]

Facility

$30.00

Service Code	NDC 33342027407
Hospital Revenue Code	250
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: MDX Hawaii PPO	$29.10

FEBUXOSTAT 40 MG TABLET [97133]

Facility

$34.00

Service Code	NDC 64764091830
Hospital Revenue Code	637
Min. Negotiated Rate	$10.54
Max. Negotiated Rate	$32.98
Rate for Payer: AlohaCare Medicaid	$17.00
Rate for Payer: AlohaCare Medicare	$10.54
Rate for Payer: Cash Price	$20.40
Rate for Payer: Devoted Health Medicare	$11.56
Rate for Payer: Hawaii Medical Service Association Medicare	$10.54
Rate for Payer: Hawaii Western Management Group Commercial	$32.30
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Humana Medicare	$10.54
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: Kaiser Permanente Medicaid	$17.34
Rate for Payer: Kaiser Permanente Medicare	$10.54
Rate for Payer: MDX Hawaii PPO	$32.98
Rate for Payer: Ohana Health Plan Medicaid	$10.54
Rate for Payer: Ohana Health Plan Medicare	$10.54
Rate for Payer: UnitedHealthcare Medicare	$10.54
Rate for Payer: University Health Alliance Commercial	$24.78

FEBUXOSTAT 40 MG TABLET [97133]

Facility

$34.00

Service Code	NDC 64764091830
Hospital Revenue Code	250
Min. Negotiated Rate	$28.90
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$20.40
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$32.98

FEBUXOSTAT 80 MG TABLET [97134]

Facility

$31.00

Service Code	NDC 62332019130
Hospital Revenue Code	637
Min. Negotiated Rate	$9.61
Max. Negotiated Rate	$30.07
Rate for Payer: AlohaCare Medicaid	$15.50
Rate for Payer: AlohaCare Medicare	$9.61
Rate for Payer: Cash Price	$18.60
Rate for Payer: Devoted Health Medicare	$10.54
Rate for Payer: Hawaii Medical Service Association Medicare	$9.61
Rate for Payer: Hawaii Western Management Group Commercial	$29.45
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Humana Medicare	$9.61
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: Kaiser Permanente Medicaid	$15.81
Rate for Payer: Kaiser Permanente Medicare	$9.61
Rate for Payer: MDX Hawaii PPO	$30.07
Rate for Payer: Ohana Health Plan Medicaid	$9.61
Rate for Payer: Ohana Health Plan Medicare	$9.61
Rate for Payer: UnitedHealthcare Medicare	$9.61
Rate for Payer: University Health Alliance Commercial	$22.60

FEBUXOSTAT 80 MG TABLET [97134]

Facility

$31.00

Service Code	NDC 62332019130
Hospital Revenue Code	250
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: MDX Hawaii PPO	$30.07

FEEDING TUBE 18FR 0200-18

Facility

$529.00

Hospital Revenue Code	272
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: MDX Hawaii PPO	$513.13

FEEDING TUBE 18FR 0200-18

Facility

$529.00

Hospital Revenue Code	272
Min. Negotiated Rate	$163.99
Max. Negotiated Rate	$513.13
Rate for Payer: AlohaCare Medicaid	$264.50
Rate for Payer: AlohaCare Medicare	$163.99
Rate for Payer: Cash Price	$317.40
Rate for Payer: Devoted Health Medicare	$179.86
Rate for Payer: Hawaii Medical Service Association Medicare	$163.99
Rate for Payer: Hawaii Western Management Group Commercial	$502.55
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Humana Medicare	$163.99
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: Kaiser Permanente Medicare	$163.99
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: Ohana Health Plan Medicaid	$163.99
Rate for Payer: Ohana Health Plan Medicare	$163.99
Rate for Payer: UnitedHealthcare Medicare	$163.99
Rate for Payer: University Health Alliance Commercial	$385.59

FEEDING TUBE 20FR 0200-20

Facility

$536.00

Hospital Revenue Code	272
Min. Negotiated Rate	$455.60
Max. Negotiated Rate	$519.92
Rate for Payer: Cash Price	$321.60
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: Kaiser Permanente Commercial	$482.40
Rate for Payer: MDX Hawaii PPO	$519.92

FEEDING TUBE 20FR 0200-20

Facility

$536.00

Hospital Revenue Code	272
Min. Negotiated Rate	$166.16
Max. Negotiated Rate	$519.92
Rate for Payer: AlohaCare Medicaid	$268.00
Rate for Payer: AlohaCare Medicare	$166.16
Rate for Payer: Cash Price	$321.60
Rate for Payer: Devoted Health Medicare	$182.24
Rate for Payer: Hawaii Medical Service Association Medicare	$166.16
Rate for Payer: Hawaii Western Management Group Commercial	$509.20
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: Humana Medicare	$166.16
Rate for Payer: Kaiser Permanente Commercial	$482.40
Rate for Payer: Kaiser Permanente Medicaid	$273.36
Rate for Payer: Kaiser Permanente Medicare	$166.16
Rate for Payer: MDX Hawaii PPO	$519.92
Rate for Payer: Ohana Health Plan Medicaid	$166.16
Rate for Payer: Ohana Health Plan Medicare	$166.16
Rate for Payer: UnitedHealthcare Medicare	$166.16
Rate for Payer: University Health Alliance Commercial	$390.69

FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

$18,203.14

Service Code	MSDRG 748
Min. Negotiated Rate	$18,203.14
Max. Negotiated Rate	$18,203.14
Rate for Payer: Hawaii Medical Service Association Commercial	$18,203.14

FEM CNL PRESS MED 206-566-000

Facility

$138.00

Hospital Revenue Code	272
Min. Negotiated Rate	$42.78
Max. Negotiated Rate	$133.86
Rate for Payer: AlohaCare Medicaid	$69.00
Rate for Payer: AlohaCare Medicare	$42.78
Rate for Payer: Cash Price	$82.80
Rate for Payer: Devoted Health Medicare	$46.92
Rate for Payer: Hawaii Medical Service Association Medicare	$42.78
Rate for Payer: Hawaii Western Management Group Commercial	$131.10
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Humana Medicare	$42.78
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: Kaiser Permanente Medicaid	$70.38
Rate for Payer: Kaiser Permanente Medicare	$42.78
Rate for Payer: MDX Hawaii PPO	$133.86
Rate for Payer: Ohana Health Plan Medicaid	$42.78
Rate for Payer: Ohana Health Plan Medicare	$42.78
Rate for Payer: UnitedHealthcare Medicare	$42.78
Rate for Payer: University Health Alliance Commercial	$100.59

FEM CNL PRESS MED 206-566-000

Facility

$138.00

Hospital Revenue Code	272
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$82.80
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: MDX Hawaii PPO	$133.86

FEM HEAD 36/+0 00-8775-036-02

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$806.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: AlohaCare Medicaid	$1,300.00
Rate for Payer: AlohaCare Medicare	$806.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Devoted Health Medicare	$884.00
Rate for Payer: Hawaii Medical Service Association Medicare	$806.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Humana Medicare	$806.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: Kaiser Permanente Medicaid	$1,326.00
Rate for Payer: Kaiser Permanente Medicare	$806.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: Ohana Health Plan Medicaid	$806.00
Rate for Payer: Ohana Health Plan Medicare	$806.00
Rate for Payer: UnitedHealthcare Medicare	$806.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

FEM HEAD 36/+0 00-8775-036-02

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

FEM HEAD 40/+0 00-8775-040-02

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

FEM HEAD 40/+0 00-8775-040-02

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$806.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: AlohaCare Medicaid	$1,300.00
Rate for Payer: AlohaCare Medicare	$806.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Devoted Health Medicare	$884.00
Rate for Payer: Hawaii Medical Service Association Medicare	$806.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Humana Medicare	$806.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: Kaiser Permanente Medicaid	$1,326.00
Rate for Payer: Kaiser Permanente Medicare	$806.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: Ohana Health Plan Medicaid	$806.00
Rate for Payer: Ohana Health Plan Medicare	$806.00
Rate for Payer: UnitedHealthcare Medicare	$806.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

FEM HED 36/-3.5 00-8775-036-01

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

FEM HED 36/-3.5 00-8775-036-01

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$806.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: AlohaCare Medicaid	$1,300.00
Rate for Payer: AlohaCare Medicare	$806.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Devoted Health Medicare	$884.00
Rate for Payer: Hawaii Medical Service Association Medicare	$806.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Humana Medicare	$806.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: Kaiser Permanente Medicaid	$1,326.00
Rate for Payer: Kaiser Permanente Medicare	$806.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: Ohana Health Plan Medicaid	$806.00
Rate for Payer: Ohana Health Plan Medicare	$806.00
Rate for Payer: UnitedHealthcare Medicare	$806.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

FEM KNE SZ:D/RT 00-5956-014-02

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$1,550.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$1,700.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$1,550.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$1,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$1,550.00
Rate for Payer: Ohana Health Plan Medicare	$1,550.00
Rate for Payer: UnitedHealthcare Medicare	$1,550.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

Know your out-of-pocket cost for care.

All Charges