Kau Hospital

All Charges

Charge

Type

Setting

Price

FIBERSTITCH STRAIGHT AR-4580S

Facility

$1,559.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$873.04
Max. Negotiated Rate	$1,512.23
Rate for Payer: Cash Price	$935.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,091.30
Rate for Payer: Health Management Network Commercial	$1,325.15
Rate for Payer: Kaiser Permanente Commercial	$1,403.10
Rate for Payer: MDX Hawaii PPO	$1,512.23
Rate for Payer: University Health Alliance Commercial	$873.04

FIBERSTITCH STRAIGHT AR-4580S

Facility

$1,559.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$483.29
Max. Negotiated Rate	$1,512.23
Rate for Payer: AlohaCare Medicaid	$779.50
Rate for Payer: AlohaCare Medicare	$483.29
Rate for Payer: Cash Price	$935.40
Rate for Payer: Devoted Health Medicare	$530.06
Rate for Payer: Hawaii Medical Service Association Medicare	$483.29
Rate for Payer: Hawaii Western Management Group Commercial	$1,091.30
Rate for Payer: Health Management Network Commercial	$1,325.15
Rate for Payer: Humana Medicare	$483.29
Rate for Payer: Kaiser Permanente Commercial	$1,403.10
Rate for Payer: Kaiser Permanente Medicaid	$795.09
Rate for Payer: Kaiser Permanente Medicare	$483.29
Rate for Payer: MDX Hawaii PPO	$1,512.23
Rate for Payer: Ohana Health Plan Medicaid	$483.29
Rate for Payer: Ohana Health Plan Medicare	$483.29
Rate for Payer: UnitedHealthcare Medicare	$483.29
Rate for Payer: University Health Alliance Commercial	$873.04

FIBERTAG TIGHTROPE II ABS

Facility

$2,025.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$627.75
Max. Negotiated Rate	$1,964.25
Rate for Payer: AlohaCare Medicaid	$1,012.50
Rate for Payer: AlohaCare Medicare	$627.75
Rate for Payer: Cash Price	$1,215.00
Rate for Payer: Devoted Health Medicare	$688.50
Rate for Payer: Hawaii Medical Service Association Medicare	$627.75
Rate for Payer: Hawaii Western Management Group Commercial	$1,417.50
Rate for Payer: Health Management Network Commercial	$1,721.25
Rate for Payer: Humana Medicare	$627.75
Rate for Payer: Kaiser Permanente Commercial	$1,822.50
Rate for Payer: Kaiser Permanente Medicaid	$1,032.75
Rate for Payer: Kaiser Permanente Medicare	$627.75
Rate for Payer: MDX Hawaii PPO	$1,964.25
Rate for Payer: Ohana Health Plan Medicaid	$627.75
Rate for Payer: Ohana Health Plan Medicare	$627.75
Rate for Payer: UnitedHealthcare Medicare	$627.75
Rate for Payer: University Health Alliance Commercial	$1,134.00

FIBERTAG TIGHTROPE II ABS

Facility

$2,025.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,134.00
Max. Negotiated Rate	$1,964.25
Rate for Payer: Cash Price	$1,215.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,417.50
Rate for Payer: Health Management Network Commercial	$1,721.25
Rate for Payer: Kaiser Permanente Commercial	$1,822.50
Rate for Payer: MDX Hawaii PPO	$1,964.25
Rate for Payer: University Health Alliance Commercial	$1,134.00

FIBERTAG TR II AR-1588RTT2-IB

Facility

$2,285.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$708.35
Max. Negotiated Rate	$2,216.45
Rate for Payer: AlohaCare Medicaid	$1,142.50
Rate for Payer: AlohaCare Medicare	$708.35
Rate for Payer: Cash Price	$1,371.00
Rate for Payer: Devoted Health Medicare	$776.90
Rate for Payer: Hawaii Medical Service Association Medicare	$708.35
Rate for Payer: Hawaii Western Management Group Commercial	$1,599.50
Rate for Payer: Health Management Network Commercial	$1,942.25
Rate for Payer: Humana Medicare	$708.35
Rate for Payer: Kaiser Permanente Commercial	$2,056.50
Rate for Payer: Kaiser Permanente Medicaid	$1,165.35
Rate for Payer: Kaiser Permanente Medicare	$708.35
Rate for Payer: MDX Hawaii PPO	$2,216.45
Rate for Payer: Ohana Health Plan Medicaid	$708.35
Rate for Payer: Ohana Health Plan Medicare	$708.35
Rate for Payer: UnitedHealthcare Medicare	$708.35
Rate for Payer: University Health Alliance Commercial	$1,279.60

FIBERTAG TR II AR-1588RTT2-IB

Facility

$2,285.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,279.60
Max. Negotiated Rate	$2,216.45
Rate for Payer: Cash Price	$1,371.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,599.50
Rate for Payer: Health Management Network Commercial	$1,942.25
Rate for Payer: Kaiser Permanente Commercial	$2,056.50
Rate for Payer: MDX Hawaii PPO	$2,216.45
Rate for Payer: University Health Alliance Commercial	$1,279.60

FIBERTAK 1.3MM SUTAPE AR-3602

Facility

$1,587.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$491.97
Max. Negotiated Rate	$1,539.39
Rate for Payer: AlohaCare Medicaid	$793.50
Rate for Payer: AlohaCare Medicare	$491.97
Rate for Payer: Cash Price	$952.20
Rate for Payer: Devoted Health Medicare	$539.58
Rate for Payer: Hawaii Medical Service Association Medicare	$491.97
Rate for Payer: Hawaii Western Management Group Commercial	$1,110.90
Rate for Payer: Health Management Network Commercial	$1,348.95
Rate for Payer: Humana Medicare	$491.97
Rate for Payer: Kaiser Permanente Commercial	$1,428.30
Rate for Payer: Kaiser Permanente Medicaid	$809.37
Rate for Payer: Kaiser Permanente Medicare	$491.97
Rate for Payer: MDX Hawaii PPO	$1,539.39
Rate for Payer: Ohana Health Plan Medicaid	$491.97
Rate for Payer: Ohana Health Plan Medicare	$491.97
Rate for Payer: UnitedHealthcare Medicare	$491.97
Rate for Payer: University Health Alliance Commercial	$888.72

FIBERTAK 1.3MM SUTAPE AR-3602

Facility

$1,587.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$888.72
Max. Negotiated Rate	$1,539.39
Rate for Payer: Cash Price	$952.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,110.90
Rate for Payer: Health Management Network Commercial	$1,348.95
Rate for Payer: Kaiser Permanente Commercial	$1,428.30
Rate for Payer: MDX Hawaii PPO	$1,539.39
Rate for Payer: University Health Alliance Commercial	$888.72

FIBERTAK 1.3 SUTAPE AR-3602-2

Facility

$1,295.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$401.45
Max. Negotiated Rate	$1,256.15
Rate for Payer: AlohaCare Medicaid	$647.50
Rate for Payer: AlohaCare Medicare	$401.45
Rate for Payer: Cash Price	$777.00
Rate for Payer: Devoted Health Medicare	$440.30
Rate for Payer: Hawaii Medical Service Association Medicare	$401.45
Rate for Payer: Hawaii Western Management Group Commercial	$906.50
Rate for Payer: Health Management Network Commercial	$1,100.75
Rate for Payer: Humana Medicare	$401.45
Rate for Payer: Kaiser Permanente Commercial	$1,165.50
Rate for Payer: Kaiser Permanente Medicaid	$660.45
Rate for Payer: Kaiser Permanente Medicare	$401.45
Rate for Payer: MDX Hawaii PPO	$1,256.15
Rate for Payer: Ohana Health Plan Medicaid	$401.45
Rate for Payer: Ohana Health Plan Medicare	$401.45
Rate for Payer: UnitedHealthcare Medicare	$401.45
Rate for Payer: University Health Alliance Commercial	$725.20

FIBERTAK 1.3 SUTAPE AR-3602-2

Facility

$1,295.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$725.20
Max. Negotiated Rate	$1,256.15
Rate for Payer: Cash Price	$777.00
Rate for Payer: Hawaii Western Management Group Commercial	$906.50
Rate for Payer: Health Management Network Commercial	$1,100.75
Rate for Payer: Kaiser Permanente Commercial	$1,165.50
Rate for Payer: MDX Hawaii PPO	$1,256.15
Rate for Payer: University Health Alliance Commercial	$725.20

FIBERTAK BICEPS SYS AR-3670

Facility

$1,969.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$610.39
Max. Negotiated Rate	$1,909.93
Rate for Payer: AlohaCare Medicaid	$984.50
Rate for Payer: AlohaCare Medicare	$610.39
Rate for Payer: Cash Price	$1,181.40
Rate for Payer: Devoted Health Medicare	$669.46
Rate for Payer: Hawaii Medical Service Association Medicare	$610.39
Rate for Payer: Hawaii Western Management Group Commercial	$1,378.30
Rate for Payer: Health Management Network Commercial	$1,673.65
Rate for Payer: Humana Medicare	$610.39
Rate for Payer: Kaiser Permanente Commercial	$1,772.10
Rate for Payer: Kaiser Permanente Medicaid	$1,004.19
Rate for Payer: Kaiser Permanente Medicare	$610.39
Rate for Payer: MDX Hawaii PPO	$1,909.93
Rate for Payer: Ohana Health Plan Medicaid	$610.39
Rate for Payer: Ohana Health Plan Medicare	$610.39
Rate for Payer: UnitedHealthcare Medicare	$610.39
Rate for Payer: University Health Alliance Commercial	$1,102.64

FIBERTAK BICEPS SYS AR-3670

Facility

$1,969.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,102.64
Max. Negotiated Rate	$1,909.93
Rate for Payer: Cash Price	$1,181.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,378.30
Rate for Payer: Health Management Network Commercial	$1,673.65
Rate for Payer: Kaiser Permanente Commercial	$1,772.10
Rate for Payer: MDX Hawaii PPO	$1,909.93
Rate for Payer: University Health Alliance Commercial	$1,102.64

FIBERTAK SUT ANC KIT AR-3600DC

Facility

$731.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$621.35
Max. Negotiated Rate	$709.07
Rate for Payer: Cash Price	$438.60
Rate for Payer: Health Management Network Commercial	$621.35
Rate for Payer: Kaiser Permanente Commercial	$657.90
Rate for Payer: MDX Hawaii PPO	$709.07

FIBERTAK SUT ANC KIT AR-3600DC

Facility

$731.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$226.61
Max. Negotiated Rate	$709.07
Rate for Payer: AlohaCare Medicaid	$365.50
Rate for Payer: AlohaCare Medicare	$226.61
Rate for Payer: Cash Price	$438.60
Rate for Payer: Devoted Health Medicare	$248.54
Rate for Payer: Hawaii Medical Service Association Medicare	$226.61
Rate for Payer: Hawaii Western Management Group Commercial	$694.45
Rate for Payer: Health Management Network Commercial	$621.35
Rate for Payer: Humana Medicare	$226.61
Rate for Payer: Kaiser Permanente Commercial	$657.90
Rate for Payer: Kaiser Permanente Medicaid	$372.81
Rate for Payer: Kaiser Permanente Medicare	$226.61
Rate for Payer: MDX Hawaii PPO	$709.07
Rate for Payer: Ohana Health Plan Medicaid	$226.61
Rate for Payer: Ohana Health Plan Medicare	$226.61
Rate for Payer: UnitedHealthcare Medicare	$226.61
Rate for Payer: University Health Alliance Commercial	$532.83

FIBERTAK SUTURE AR-3600-2

Facility

$1,701.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$952.56
Max. Negotiated Rate	$1,649.97
Rate for Payer: Cash Price	$1,020.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,190.70
Rate for Payer: Health Management Network Commercial	$1,445.85
Rate for Payer: Kaiser Permanente Commercial	$1,530.90
Rate for Payer: MDX Hawaii PPO	$1,649.97
Rate for Payer: University Health Alliance Commercial	$952.56

FIBERTAK SUTURE AR-3600-2

Facility

$1,701.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$527.31
Max. Negotiated Rate	$1,649.97
Rate for Payer: AlohaCare Medicaid	$850.50
Rate for Payer: AlohaCare Medicare	$527.31
Rate for Payer: Cash Price	$1,020.60
Rate for Payer: Devoted Health Medicare	$578.34
Rate for Payer: Hawaii Medical Service Association Medicare	$527.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,190.70
Rate for Payer: Health Management Network Commercial	$1,445.85
Rate for Payer: Humana Medicare	$527.31
Rate for Payer: Kaiser Permanente Commercial	$1,530.90
Rate for Payer: Kaiser Permanente Medicaid	$867.51
Rate for Payer: Kaiser Permanente Medicare	$527.31
Rate for Payer: MDX Hawaii PPO	$1,649.97
Rate for Payer: Ohana Health Plan Medicaid	$527.31
Rate for Payer: Ohana Health Plan Medicare	$527.31
Rate for Payer: UnitedHealthcare Medicare	$527.31
Rate for Payer: University Health Alliance Commercial	$952.56

FIBER TAPE CERCLAGE AR-7268

Facility

$1,746.00

Hospital Revenue Code	278
Min. Negotiated Rate	$541.26
Max. Negotiated Rate	$1,693.62
Rate for Payer: AlohaCare Medicaid	$873.00
Rate for Payer: AlohaCare Medicare	$541.26
Rate for Payer: Cash Price	$1,047.60
Rate for Payer: Devoted Health Medicare	$593.64
Rate for Payer: Hawaii Medical Service Association Medicare	$541.26
Rate for Payer: Hawaii Western Management Group Commercial	$1,222.20
Rate for Payer: Health Management Network Commercial	$1,484.10
Rate for Payer: Humana Medicare	$541.26
Rate for Payer: Kaiser Permanente Commercial	$1,571.40
Rate for Payer: Kaiser Permanente Medicaid	$890.46
Rate for Payer: Kaiser Permanente Medicare	$541.26
Rate for Payer: MDX Hawaii PPO	$1,693.62
Rate for Payer: Ohana Health Plan Medicaid	$541.26
Rate for Payer: Ohana Health Plan Medicare	$541.26
Rate for Payer: UnitedHealthcare Medicare	$541.26
Rate for Payer: University Health Alliance Commercial	$977.76

FIBER TAPE CERCLAGE AR-7268

Facility

$1,746.00

Hospital Revenue Code	278
Min. Negotiated Rate	$977.76
Max. Negotiated Rate	$1,693.62
Rate for Payer: Cash Price	$1,047.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,222.20
Rate for Payer: Health Management Network Commercial	$1,484.10
Rate for Payer: Kaiser Permanente Commercial	$1,571.40
Rate for Payer: MDX Hawaii PPO	$1,693.62
Rate for Payer: University Health Alliance Commercial	$977.76

FIBER WIRE 5 / 7 METRIC 38"

Facility

$167.00

Hospital Revenue Code	272
Min. Negotiated Rate	$51.77
Max. Negotiated Rate	$161.99
Rate for Payer: AlohaCare Medicaid	$83.50
Rate for Payer: AlohaCare Medicare	$51.77
Rate for Payer: Cash Price	$100.20
Rate for Payer: Devoted Health Medicare	$56.78
Rate for Payer: Hawaii Medical Service Association Medicare	$51.77
Rate for Payer: Hawaii Western Management Group Commercial	$158.65
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: Humana Medicare	$51.77
Rate for Payer: Kaiser Permanente Commercial	$150.30
Rate for Payer: Kaiser Permanente Medicaid	$85.17
Rate for Payer: Kaiser Permanente Medicare	$51.77
Rate for Payer: MDX Hawaii PPO	$161.99
Rate for Payer: Ohana Health Plan Medicaid	$51.77
Rate for Payer: Ohana Health Plan Medicare	$51.77
Rate for Payer: UnitedHealthcare Medicare	$51.77
Rate for Payer: University Health Alliance Commercial	$121.73

FIBER WIRE 5 / 7 METRIC 38"

Facility

$167.00

Hospital Revenue Code	272
Min. Negotiated Rate	$141.95
Max. Negotiated Rate	$161.99
Rate for Payer: Cash Price	$100.20
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: Kaiser Permanente Commercial	$150.30
Rate for Payer: MDX Hawaii PPO	$161.99

FIBRIN SEALANT 4.8X4.8

Facility

$1,547.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,314.95
Max. Negotiated Rate	$1,500.59
Rate for Payer: Cash Price	$928.20
Rate for Payer: Health Management Network Commercial	$1,314.95
Rate for Payer: Kaiser Permanente Commercial	$1,392.30
Rate for Payer: MDX Hawaii PPO	$1,500.59

FIBRIN SEALANT 4.8X4.8

Facility

$1,547.00

Hospital Revenue Code	272
Min. Negotiated Rate	$479.57
Max. Negotiated Rate	$1,500.59
Rate for Payer: AlohaCare Medicaid	$773.50
Rate for Payer: AlohaCare Medicare	$479.57
Rate for Payer: Cash Price	$928.20
Rate for Payer: Devoted Health Medicare	$525.98
Rate for Payer: Hawaii Medical Service Association Medicare	$479.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,469.65
Rate for Payer: Health Management Network Commercial	$1,314.95
Rate for Payer: Humana Medicare	$479.57
Rate for Payer: Kaiser Permanente Commercial	$1,392.30
Rate for Payer: Kaiser Permanente Medicaid	$788.97
Rate for Payer: Kaiser Permanente Medicare	$479.57
Rate for Payer: MDX Hawaii PPO	$1,500.59
Rate for Payer: Ohana Health Plan Medicaid	$479.57
Rate for Payer: Ohana Health Plan Medicare	$479.57
Rate for Payer: UnitedHealthcare Medicare	$479.57
Rate for Payer: University Health Alliance Commercial	$1,127.61

FIBRIN SEALANT 9.5X4.8

Facility

$1,507.00

Hospital Revenue Code	272
Min. Negotiated Rate	$467.17
Max. Negotiated Rate	$1,461.79
Rate for Payer: AlohaCare Medicaid	$753.50
Rate for Payer: AlohaCare Medicare	$467.17
Rate for Payer: Cash Price	$904.20
Rate for Payer: Devoted Health Medicare	$512.38
Rate for Payer: Hawaii Medical Service Association Medicare	$467.17
Rate for Payer: Hawaii Western Management Group Commercial	$1,431.65
Rate for Payer: Health Management Network Commercial	$1,280.95
Rate for Payer: Humana Medicare	$467.17
Rate for Payer: Kaiser Permanente Commercial	$1,356.30
Rate for Payer: Kaiser Permanente Medicaid	$768.57
Rate for Payer: Kaiser Permanente Medicare	$467.17
Rate for Payer: MDX Hawaii PPO	$1,461.79
Rate for Payer: Ohana Health Plan Medicaid	$467.17
Rate for Payer: Ohana Health Plan Medicare	$467.17
Rate for Payer: UnitedHealthcare Medicare	$467.17
Rate for Payer: University Health Alliance Commercial	$1,098.45

FIBRIN SEALANT 9.5X4.8

Facility

$1,507.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,280.95
Max. Negotiated Rate	$1,461.79
Rate for Payer: Cash Price	$904.20
Rate for Payer: Health Management Network Commercial	$1,280.95
Rate for Payer: Kaiser Permanente Commercial	$1,356.30
Rate for Payer: MDX Hawaii PPO	$1,461.79

FIDAXOMICIN 200 MG TABLET [110360]

Facility

$469.00

Service Code	NDC 52015008001
Hospital Revenue Code	250
Min. Negotiated Rate	$398.65
Max. Negotiated Rate	$454.93
Rate for Payer: Cash Price	$281.40
Rate for Payer: Health Management Network Commercial	$398.65
Rate for Payer: Kaiser Permanente Commercial	$422.10
Rate for Payer: MDX Hawaii PPO	$454.93

Know your out-of-pocket cost for care.

All Charges