Kau Hospital

All Charges

Charge

Type

Setting

Price

FIDAXOMICIN 200 MG TABLET [110360]

Facility

$469.00

Service Code	NDC 52015008001
Hospital Revenue Code	637
Min. Negotiated Rate	$145.39
Max. Negotiated Rate	$454.93
Rate for Payer: AlohaCare Medicaid	$234.50
Rate for Payer: AlohaCare Medicare	$145.39
Rate for Payer: Cash Price	$281.40
Rate for Payer: Devoted Health Medicare	$159.46
Rate for Payer: Hawaii Medical Service Association Medicare	$145.39
Rate for Payer: Hawaii Western Management Group Commercial	$445.55
Rate for Payer: Health Management Network Commercial	$398.65
Rate for Payer: Humana Medicare	$145.39
Rate for Payer: Kaiser Permanente Commercial	$422.10
Rate for Payer: Kaiser Permanente Medicaid	$239.19
Rate for Payer: Kaiser Permanente Medicare	$145.39
Rate for Payer: MDX Hawaii PPO	$454.93
Rate for Payer: Ohana Health Plan Medicaid	$145.39
Rate for Payer: Ohana Health Plan Medicare	$145.39
Rate for Payer: UnitedHealthcare Medicare	$145.39
Rate for Payer: University Health Alliance Commercial	$341.85

FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE [129453]

Facility

$494.00

Service Code	HCPCS Q5101
Hospital Revenue Code	250
Min. Negotiated Rate	$419.90
Max. Negotiated Rate	$479.18
Rate for Payer: Cash Price	$296.40
Rate for Payer: Health Management Network Commercial	$419.90
Rate for Payer: Kaiser Permanente Commercial	$444.60
Rate for Payer: MDX Hawaii PPO	$479.18

FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE [129453]

Facility

$494.00

Service Code	HCPCS Q5101
Hospital Revenue Code	636
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$479.18
Rate for Payer: AlohaCare Medicaid	$247.00
Rate for Payer: AlohaCare Medicare	$153.14
Rate for Payer: Cash Price	$296.40
Rate for Payer: Cash Price	$296.40
Rate for Payer: Devoted Health Medicare	$167.96
Rate for Payer: Hawaii Medical Service Association ABD	$0.37
Rate for Payer: Hawaii Medical Service Association Commercial	$0.44
Rate for Payer: Hawaii Medical Service Association Medicare	$153.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.37
Rate for Payer: Hawaii Western Management Group Commercial	$469.30
Rate for Payer: Health Management Network Commercial	$419.90
Rate for Payer: Humana Medicare	$153.14
Rate for Payer: Kaiser Permanente Commercial	$444.60
Rate for Payer: Kaiser Permanente Medicaid	$251.94
Rate for Payer: Kaiser Permanente Medicare	$153.14
Rate for Payer: MDX Hawaii PPO	$479.18
Rate for Payer: Ohana Health Plan Medicaid	$153.14
Rate for Payer: Ohana Health Plan Medicare	$153.14
Rate for Payer: UnitedHealthcare Medicaid	$296.40
Rate for Payer: UnitedHealthcare Medicare	$153.14
Rate for Payer: University Health Alliance Commercial	$360.08

FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE [129454]

Facility

$791.00

Service Code	HCPCS Q5101
Hospital Revenue Code	250
Min. Negotiated Rate	$672.35
Max. Negotiated Rate	$767.27
Rate for Payer: Cash Price	$474.60
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: MDX Hawaii PPO	$767.27

FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE [129454]

Facility

$791.00

Service Code	HCPCS Q5101
Hospital Revenue Code	636
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$767.27
Rate for Payer: AlohaCare Medicaid	$395.50
Rate for Payer: AlohaCare Medicare	$245.21
Rate for Payer: Cash Price	$474.60
Rate for Payer: Cash Price	$474.60
Rate for Payer: Devoted Health Medicare	$268.94
Rate for Payer: Hawaii Medical Service Association ABD	$0.37
Rate for Payer: Hawaii Medical Service Association Commercial	$0.44
Rate for Payer: Hawaii Medical Service Association Medicare	$245.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.37
Rate for Payer: Hawaii Western Management Group Commercial	$751.45
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Humana Medicare	$245.21
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: Kaiser Permanente Medicaid	$403.41
Rate for Payer: Kaiser Permanente Medicare	$245.21
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: Ohana Health Plan Medicaid	$245.21
Rate for Payer: Ohana Health Plan Medicare	$245.21
Rate for Payer: UnitedHealthcare Medicaid	$474.60
Rate for Payer: UnitedHealthcare Medicare	$245.21
Rate for Payer: University Health Alliance Commercial	$576.56

FILTER LEUKOCYT PALL

Facility

$96.00

Hospital Revenue Code	272
Min. Negotiated Rate	$29.76
Max. Negotiated Rate	$93.12
Rate for Payer: AlohaCare Medicaid	$48.00
Rate for Payer: AlohaCare Medicare	$29.76
Rate for Payer: Cash Price	$57.60
Rate for Payer: Devoted Health Medicare	$32.64
Rate for Payer: Hawaii Medical Service Association Medicare	$29.76
Rate for Payer: Hawaii Western Management Group Commercial	$91.20
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Humana Medicare	$29.76
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: Kaiser Permanente Medicare	$29.76
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: Ohana Health Plan Medicaid	$29.76
Rate for Payer: Ohana Health Plan Medicare	$29.76
Rate for Payer: UnitedHealthcare Medicare	$29.76
Rate for Payer: University Health Alliance Commercial	$69.97

FILTER LEUKOCYT PALL

Facility

$96.00

Hospital Revenue Code	272
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$57.60
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12

FILTER PLATELTS PALL

Facility

$157.00

Hospital Revenue Code	272
Min. Negotiated Rate	$133.45
Max. Negotiated Rate	$152.29
Rate for Payer: Cash Price	$94.20
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: Kaiser Permanente Commercial	$141.30
Rate for Payer: MDX Hawaii PPO	$152.29

FILTER PLATELTS PALL

Facility

$157.00

Hospital Revenue Code	272
Min. Negotiated Rate	$48.67
Max. Negotiated Rate	$152.29
Rate for Payer: AlohaCare Medicaid	$78.50
Rate for Payer: AlohaCare Medicare	$48.67
Rate for Payer: Cash Price	$94.20
Rate for Payer: Devoted Health Medicare	$53.38
Rate for Payer: Hawaii Medical Service Association Medicare	$48.67
Rate for Payer: Hawaii Western Management Group Commercial	$149.15
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: Humana Medicare	$48.67
Rate for Payer: Kaiser Permanente Commercial	$141.30
Rate for Payer: Kaiser Permanente Medicaid	$80.07
Rate for Payer: Kaiser Permanente Medicare	$48.67
Rate for Payer: MDX Hawaii PPO	$152.29
Rate for Payer: Ohana Health Plan Medicaid	$48.67
Rate for Payer: Ohana Health Plan Medicare	$48.67
Rate for Payer: UnitedHealthcare Medicare	$48.67
Rate for Payer: University Health Alliance Commercial	$114.44

FINASTERIDE 5 MG TABLET [10037]

Facility

$11.00

Service Code	NDC 50268031415
Hospital Revenue Code	637
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$10.67
Rate for Payer: AlohaCare Medicaid	$5.50
Rate for Payer: AlohaCare Medicare	$3.41
Rate for Payer: Cash Price	$6.60
Rate for Payer: Devoted Health Medicare	$3.74
Rate for Payer: Hawaii Medical Service Association Medicare	$3.41
Rate for Payer: Hawaii Western Management Group Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Humana Medicare	$3.41
Rate for Payer: Kaiser Permanente Commercial	$9.90
Rate for Payer: Kaiser Permanente Medicaid	$5.61
Rate for Payer: Kaiser Permanente Medicare	$3.41
Rate for Payer: MDX Hawaii PPO	$10.67
Rate for Payer: Ohana Health Plan Medicaid	$3.41
Rate for Payer: Ohana Health Plan Medicare	$3.41
Rate for Payer: UnitedHealthcare Medicare	$3.41
Rate for Payer: University Health Alliance Commercial	$8.02

FINASTERIDE 5 MG TABLET [10037]

Facility

$4.00

Service Code	NDC 60687042865
Hospital Revenue Code	637
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$1.24
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$1.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$1.24
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$1.24
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$1.24
Rate for Payer: Ohana Health Plan Medicare	$1.24
Rate for Payer: UnitedHealthcare Medicare	$1.24
Rate for Payer: University Health Alliance Commercial	$2.92

FINASTERIDE 5 MG TABLET [10037]

Facility

$4.00

Service Code	NDC 60687042811
Hospital Revenue Code	637
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$1.24
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$1.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$1.24
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$1.24
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$1.24
Rate for Payer: Ohana Health Plan Medicare	$1.24
Rate for Payer: UnitedHealthcare Medicare	$1.24
Rate for Payer: University Health Alliance Commercial	$2.92

FINASTERIDE 5 MG TABLET [10037]

Facility

$4.00

Service Code	NDC 60687042801
Hospital Revenue Code	637
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$1.24
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$1.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$1.24
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$1.24
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$1.24
Rate for Payer: Ohana Health Plan Medicare	$1.24
Rate for Payer: UnitedHealthcare Medicare	$1.24
Rate for Payer: University Health Alliance Commercial	$2.92

FINASTERIDE 5 MG TABLET [10037]

Facility

$4.00

Service Code	NDC 60687042811
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

FINASTERIDE 5 MG TABLET [10037]

Facility

$4.00

Service Code	NDC 60687042801
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

FINASTERIDE 5 MG TABLET [10037]

Facility

$11.00

Service Code	NDC 50268031415
Hospital Revenue Code	250
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Kaiser Permanente Commercial	$9.90
Rate for Payer: MDX Hawaii PPO	$10.67

FINASTERIDE 5 MG TABLET [10037]

Facility

$4.00

Service Code	NDC 60687042865
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

FINELINE LEAD AV 45CM 4469

Facility

$1,815.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$1,016.40
Max. Negotiated Rate	$1,760.55
Rate for Payer: Cash Price	$1,089.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,270.50
Rate for Payer: Health Management Network Commercial	$1,542.75
Rate for Payer: Kaiser Permanente Commercial	$1,633.50
Rate for Payer: MDX Hawaii PPO	$1,760.55
Rate for Payer: University Health Alliance Commercial	$1,016.40

FINELINE LEAD AV 45CM 4469

Facility

$1,815.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$562.65
Max. Negotiated Rate	$1,760.55
Rate for Payer: AlohaCare Medicaid	$907.50
Rate for Payer: AlohaCare Medicare	$562.65
Rate for Payer: Cash Price	$1,089.00
Rate for Payer: Devoted Health Medicare	$617.10
Rate for Payer: Hawaii Medical Service Association Medicare	$562.65
Rate for Payer: Hawaii Western Management Group Commercial	$1,270.50
Rate for Payer: Health Management Network Commercial	$1,542.75
Rate for Payer: Humana Medicare	$562.65
Rate for Payer: Kaiser Permanente Commercial	$1,633.50
Rate for Payer: Kaiser Permanente Medicaid	$925.65
Rate for Payer: Kaiser Permanente Medicare	$562.65
Rate for Payer: MDX Hawaii PPO	$1,760.55
Rate for Payer: Ohana Health Plan Medicaid	$562.65
Rate for Payer: Ohana Health Plan Medicare	$562.65
Rate for Payer: UnitedHealthcare Medicare	$562.65
Rate for Payer: University Health Alliance Commercial	$1,016.40

FINELINE LEAD AV 52CM 4470

Facility

$1,815.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$562.65
Max. Negotiated Rate	$1,760.55
Rate for Payer: AlohaCare Medicaid	$907.50
Rate for Payer: AlohaCare Medicare	$562.65
Rate for Payer: Cash Price	$1,089.00
Rate for Payer: Devoted Health Medicare	$617.10
Rate for Payer: Hawaii Medical Service Association Medicare	$562.65
Rate for Payer: Hawaii Western Management Group Commercial	$1,270.50
Rate for Payer: Health Management Network Commercial	$1,542.75
Rate for Payer: Humana Medicare	$562.65
Rate for Payer: Kaiser Permanente Commercial	$1,633.50
Rate for Payer: Kaiser Permanente Medicaid	$925.65
Rate for Payer: Kaiser Permanente Medicare	$562.65
Rate for Payer: MDX Hawaii PPO	$1,760.55
Rate for Payer: Ohana Health Plan Medicaid	$562.65
Rate for Payer: Ohana Health Plan Medicare	$562.65
Rate for Payer: UnitedHealthcare Medicare	$562.65
Rate for Payer: University Health Alliance Commercial	$1,016.40

FINELINE LEAD AV 52CM 4470

Facility

$1,815.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$1,016.40
Max. Negotiated Rate	$1,760.55
Rate for Payer: Cash Price	$1,089.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,270.50
Rate for Payer: Health Management Network Commercial	$1,542.75
Rate for Payer: Kaiser Permanente Commercial	$1,633.50
Rate for Payer: MDX Hawaii PPO	$1,760.55
Rate for Payer: University Health Alliance Commercial	$1,016.40

FINELINE LEAD STEROX 4457

Facility

$2,400.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$744.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: AlohaCare Medicaid	$1,200.00
Rate for Payer: AlohaCare Medicare	$744.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Devoted Health Medicare	$816.00
Rate for Payer: Hawaii Medical Service Association Medicare	$744.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Humana Medicare	$744.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: Kaiser Permanente Medicaid	$1,224.00
Rate for Payer: Kaiser Permanente Medicare	$744.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: Ohana Health Plan Medicaid	$744.00
Rate for Payer: Ohana Health Plan Medicare	$744.00
Rate for Payer: UnitedHealthcare Medicare	$744.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

FINELINE LEAD STEROX 4457

Facility

$2,400.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

FIXATION DEVICE 5MM 174006

Facility

$2,260.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,921.00
Max. Negotiated Rate	$2,192.20
Rate for Payer: Cash Price	$1,356.00
Rate for Payer: Health Management Network Commercial	$1,921.00
Rate for Payer: Kaiser Permanente Commercial	$2,034.00
Rate for Payer: MDX Hawaii PPO	$2,192.20

FIXATION DEVICE 5MM 174006

Facility

$2,260.00

Hospital Revenue Code	272
Min. Negotiated Rate	$700.60
Max. Negotiated Rate	$2,192.20
Rate for Payer: AlohaCare Medicaid	$1,130.00
Rate for Payer: AlohaCare Medicare	$700.60
Rate for Payer: Cash Price	$1,356.00
Rate for Payer: Devoted Health Medicare	$768.40
Rate for Payer: Hawaii Medical Service Association Medicare	$700.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,147.00
Rate for Payer: Health Management Network Commercial	$1,921.00
Rate for Payer: Humana Medicare	$700.60
Rate for Payer: Kaiser Permanente Commercial	$2,034.00
Rate for Payer: Kaiser Permanente Medicaid	$1,152.60
Rate for Payer: Kaiser Permanente Medicare	$700.60
Rate for Payer: MDX Hawaii PPO	$2,192.20
Rate for Payer: Ohana Health Plan Medicaid	$700.60
Rate for Payer: Ohana Health Plan Medicare	$700.60
Rate for Payer: UnitedHealthcare Medicare	$700.60
Rate for Payer: University Health Alliance Commercial	$1,647.31

Know your out-of-pocket cost for care.

All Charges