Kau Hospital

All Charges

Charge

Type

Setting

Price

GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION [3425]

Facility

$223.00

Service Code	HCPCS J1580
Hospital Revenue Code	636
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$216.31
Rate for Payer: AlohaCare Medicaid	$111.50
Rate for Payer: AlohaCare Medicaid	$13.00
Rate for Payer: AlohaCare Medicare	$8.06
Rate for Payer: AlohaCare Medicare	$69.13
Rate for Payer: Cash Price	$15.60
Rate for Payer: Cash Price	$133.80
Rate for Payer: Cash Price	$133.80
Rate for Payer: Cash Price	$15.60
Rate for Payer: Devoted Health Medicare	$75.82
Rate for Payer: Devoted Health Medicare	$8.84
Rate for Payer: Hawaii Medical Service Association ABD	$2.62
Rate for Payer: Hawaii Medical Service Association ABD	$2.62
Rate for Payer: Hawaii Medical Service Association Medicare	$8.06
Rate for Payer: Hawaii Medical Service Association Medicare	$69.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.62
Rate for Payer: Hawaii Western Management Group Commercial	$211.85
Rate for Payer: Hawaii Western Management Group Commercial	$24.70
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: Humana Medicare	$69.13
Rate for Payer: Humana Medicare	$8.06
Rate for Payer: Kaiser Permanente Commercial	$200.70
Rate for Payer: Kaiser Permanente Commercial	$23.40
Rate for Payer: Kaiser Permanente Medicaid	$13.26
Rate for Payer: Kaiser Permanente Medicaid	$113.73
Rate for Payer: Kaiser Permanente Medicare	$69.13
Rate for Payer: Kaiser Permanente Medicare	$8.06
Rate for Payer: MDX Hawaii PPO	$216.31
Rate for Payer: MDX Hawaii PPO	$25.22
Rate for Payer: Ohana Health Plan Medicaid	$8.06
Rate for Payer: Ohana Health Plan Medicaid	$69.13
Rate for Payer: Ohana Health Plan Medicare	$69.13
Rate for Payer: Ohana Health Plan Medicare	$8.06
Rate for Payer: UnitedHealthcare Medicaid	$15.60
Rate for Payer: UnitedHealthcare Medicaid	$133.80
Rate for Payer: UnitedHealthcare Medicare	$69.13
Rate for Payer: UnitedHealthcare Medicare	$8.06
Rate for Payer: University Health Alliance Commercial	$162.54
Rate for Payer: University Health Alliance Commercial	$18.95

GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION [3425]

Facility

$223.00

Service Code	HCPCS J1580
Hospital Revenue Code	250
Min. Negotiated Rate	$189.55
Max. Negotiated Rate	$216.31
Rate for Payer: Cash Price	$133.80
Rate for Payer: Cash Price	$15.60
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Kaiser Permanente Commercial	$200.70
Rate for Payer: Kaiser Permanente Commercial	$23.40
Rate for Payer: MDX Hawaii PPO	$25.22
Rate for Payer: MDX Hawaii PPO	$216.31

GIA 60-3.8 LOADING GIA6038L

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

GIA 60-3.8 LOADING GIA6038L

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

GIA 6-3.8 STAPLER GIA6038S

Facility

$358.00

Hospital Revenue Code	272
Min. Negotiated Rate	$110.98
Max. Negotiated Rate	$347.26
Rate for Payer: AlohaCare Medicaid	$179.00
Rate for Payer: AlohaCare Medicare	$110.98
Rate for Payer: Cash Price	$214.80
Rate for Payer: Devoted Health Medicare	$121.72
Rate for Payer: Hawaii Medical Service Association Medicare	$110.98
Rate for Payer: Hawaii Western Management Group Commercial	$340.10
Rate for Payer: Health Management Network Commercial	$304.30
Rate for Payer: Humana Medicare	$110.98
Rate for Payer: Kaiser Permanente Commercial	$322.20
Rate for Payer: Kaiser Permanente Medicaid	$182.58
Rate for Payer: Kaiser Permanente Medicare	$110.98
Rate for Payer: MDX Hawaii PPO	$347.26
Rate for Payer: Ohana Health Plan Medicaid	$110.98
Rate for Payer: Ohana Health Plan Medicare	$110.98
Rate for Payer: UnitedHealthcare Medicare	$110.98
Rate for Payer: University Health Alliance Commercial	$260.95

GIA 6-3.8 STAPLER GIA6038S

Facility

$358.00

Hospital Revenue Code	272
Min. Negotiated Rate	$304.30
Max. Negotiated Rate	$347.26
Rate for Payer: Cash Price	$214.80
Rate for Payer: Health Management Network Commercial	$304.30
Rate for Payer: Kaiser Permanente Commercial	$322.20
Rate for Payer: MDX Hawaii PPO	$347.26

GIA 80-3.8 STAPLER GIA8038S

Facility

$433.00

Hospital Revenue Code	272
Min. Negotiated Rate	$368.05
Max. Negotiated Rate	$420.01
Rate for Payer: Cash Price	$259.80
Rate for Payer: Health Management Network Commercial	$368.05
Rate for Payer: Kaiser Permanente Commercial	$389.70
Rate for Payer: MDX Hawaii PPO	$420.01

GIA 80-3.8 STAPLER GIA8038S

Facility

$433.00

Hospital Revenue Code	272
Min. Negotiated Rate	$134.23
Max. Negotiated Rate	$420.01
Rate for Payer: AlohaCare Medicaid	$216.50
Rate for Payer: AlohaCare Medicare	$134.23
Rate for Payer: Cash Price	$259.80
Rate for Payer: Devoted Health Medicare	$147.22
Rate for Payer: Hawaii Medical Service Association Medicare	$134.23
Rate for Payer: Hawaii Western Management Group Commercial	$411.35
Rate for Payer: Health Management Network Commercial	$368.05
Rate for Payer: Humana Medicare	$134.23
Rate for Payer: Kaiser Permanente Commercial	$389.70
Rate for Payer: Kaiser Permanente Medicaid	$220.83
Rate for Payer: Kaiser Permanente Medicare	$134.23
Rate for Payer: MDX Hawaii PPO	$420.01
Rate for Payer: Ohana Health Plan Medicaid	$134.23
Rate for Payer: Ohana Health Plan Medicare	$134.23
Rate for Payer: UnitedHealthcare Medicare	$134.23
Rate for Payer: University Health Alliance Commercial	$315.61

GIA 80-3.8 SULU GIA8038L

Facility

$241.00

Hospital Revenue Code	272
Min. Negotiated Rate	$74.71
Max. Negotiated Rate	$233.77
Rate for Payer: AlohaCare Medicaid	$120.50
Rate for Payer: AlohaCare Medicare	$74.71
Rate for Payer: Cash Price	$144.60
Rate for Payer: Devoted Health Medicare	$81.94
Rate for Payer: Hawaii Medical Service Association Medicare	$74.71
Rate for Payer: Hawaii Western Management Group Commercial	$228.95
Rate for Payer: Health Management Network Commercial	$204.85
Rate for Payer: Humana Medicare	$74.71
Rate for Payer: Kaiser Permanente Commercial	$216.90
Rate for Payer: Kaiser Permanente Medicaid	$122.91
Rate for Payer: Kaiser Permanente Medicare	$74.71
Rate for Payer: MDX Hawaii PPO	$233.77
Rate for Payer: Ohana Health Plan Medicaid	$74.71
Rate for Payer: Ohana Health Plan Medicare	$74.71
Rate for Payer: UnitedHealthcare Medicare	$74.71
Rate for Payer: University Health Alliance Commercial	$175.66

GIA 80-3.8 SULU GIA8038L

Facility

$241.00

Hospital Revenue Code	272
Min. Negotiated Rate	$204.85
Max. Negotiated Rate	$233.77
Rate for Payer: Cash Price	$144.60
Rate for Payer: Health Management Network Commercial	$204.85
Rate for Payer: Kaiser Permanente Commercial	$216.90
Rate for Payer: MDX Hawaii PPO	$233.77

GIA 80-4.8 RELOAD GIA 8048L

Facility

$281.00

Hospital Revenue Code	272
Min. Negotiated Rate	$238.85
Max. Negotiated Rate	$272.57
Rate for Payer: Cash Price	$168.60
Rate for Payer: Health Management Network Commercial	$238.85
Rate for Payer: Kaiser Permanente Commercial	$252.90
Rate for Payer: MDX Hawaii PPO	$272.57

GIA 80-4.8 RELOAD GIA 8048L

Facility

$281.00

Hospital Revenue Code	272
Min. Negotiated Rate	$87.11
Max. Negotiated Rate	$272.57
Rate for Payer: AlohaCare Medicaid	$140.50
Rate for Payer: AlohaCare Medicare	$87.11
Rate for Payer: Cash Price	$168.60
Rate for Payer: Devoted Health Medicare	$95.54
Rate for Payer: Hawaii Medical Service Association Medicare	$87.11
Rate for Payer: Hawaii Western Management Group Commercial	$266.95
Rate for Payer: Health Management Network Commercial	$238.85
Rate for Payer: Humana Medicare	$87.11
Rate for Payer: Kaiser Permanente Commercial	$252.90
Rate for Payer: Kaiser Permanente Medicaid	$143.31
Rate for Payer: Kaiser Permanente Medicare	$87.11
Rate for Payer: MDX Hawaii PPO	$272.57
Rate for Payer: Ohana Health Plan Medicaid	$87.11
Rate for Payer: Ohana Health Plan Medicare	$87.11
Rate for Payer: UnitedHealthcare Medicare	$87.11
Rate for Payer: University Health Alliance Commercial	$204.82

GIA 80-4.8 STAPLER GIA8048S

Facility

$495.00

Hospital Revenue Code	272
Min. Negotiated Rate	$153.45
Max. Negotiated Rate	$480.15
Rate for Payer: AlohaCare Medicaid	$247.50
Rate for Payer: AlohaCare Medicare	$153.45
Rate for Payer: Cash Price	$297.00
Rate for Payer: Devoted Health Medicare	$168.30
Rate for Payer: Hawaii Medical Service Association Medicare	$153.45
Rate for Payer: Hawaii Western Management Group Commercial	$470.25
Rate for Payer: Health Management Network Commercial	$420.75
Rate for Payer: Humana Medicare	$153.45
Rate for Payer: Kaiser Permanente Commercial	$445.50
Rate for Payer: Kaiser Permanente Medicaid	$252.45
Rate for Payer: Kaiser Permanente Medicare	$153.45
Rate for Payer: MDX Hawaii PPO	$480.15
Rate for Payer: Ohana Health Plan Medicaid	$153.45
Rate for Payer: Ohana Health Plan Medicare	$153.45
Rate for Payer: UnitedHealthcare Medicare	$153.45
Rate for Payer: University Health Alliance Commercial	$360.81

GIA 80-4.8 STAPLER GIA8048S

Facility

$495.00

Hospital Revenue Code	272
Min. Negotiated Rate	$420.75
Max. Negotiated Rate	$480.15
Rate for Payer: Cash Price	$297.00
Rate for Payer: Health Management Network Commercial	$420.75
Rate for Payer: Kaiser Permanente Commercial	$445.50
Rate for Payer: MDX Hawaii PPO	$480.15

GIA ENDO 30VAS/MED SIG30AVM

Facility

$559.00

Hospital Revenue Code	272
Min. Negotiated Rate	$475.15
Max. Negotiated Rate	$542.23
Rate for Payer: Cash Price	$335.40
Rate for Payer: Health Management Network Commercial	$475.15
Rate for Payer: Kaiser Permanente Commercial	$503.10
Rate for Payer: MDX Hawaii PPO	$542.23

GIA ENDO 30VAS/MED SIG30AVM

Facility

$559.00

Hospital Revenue Code	272
Min. Negotiated Rate	$173.29
Max. Negotiated Rate	$542.23
Rate for Payer: AlohaCare Medicaid	$279.50
Rate for Payer: AlohaCare Medicare	$173.29
Rate for Payer: Cash Price	$335.40
Rate for Payer: Devoted Health Medicare	$190.06
Rate for Payer: Hawaii Medical Service Association Medicare	$173.29
Rate for Payer: Hawaii Western Management Group Commercial	$531.05
Rate for Payer: Health Management Network Commercial	$475.15
Rate for Payer: Humana Medicare	$173.29
Rate for Payer: Kaiser Permanente Commercial	$503.10
Rate for Payer: Kaiser Permanente Medicaid	$285.09
Rate for Payer: Kaiser Permanente Medicare	$173.29
Rate for Payer: MDX Hawaii PPO	$542.23
Rate for Payer: Ohana Health Plan Medicaid	$173.29
Rate for Payer: Ohana Health Plan Medicare	$173.29
Rate for Payer: UnitedHealthcare Medicare	$173.29
Rate for Payer: University Health Alliance Commercial	$407.46

GIA ENDO 45MEDIUM EGIA45AVMGIA

Facility

$555.00

Hospital Revenue Code	272
Min. Negotiated Rate	$172.05
Max. Negotiated Rate	$538.35
Rate for Payer: AlohaCare Medicaid	$277.50
Rate for Payer: AlohaCare Medicare	$172.05
Rate for Payer: Cash Price	$333.00
Rate for Payer: Devoted Health Medicare	$188.70
Rate for Payer: Hawaii Medical Service Association Medicare	$172.05
Rate for Payer: Hawaii Western Management Group Commercial	$527.25
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Humana Medicare	$172.05
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: Kaiser Permanente Medicaid	$283.05
Rate for Payer: Kaiser Permanente Medicare	$172.05
Rate for Payer: MDX Hawaii PPO	$538.35
Rate for Payer: Ohana Health Plan Medicaid	$172.05
Rate for Payer: Ohana Health Plan Medicare	$172.05
Rate for Payer: UnitedHealthcare Medicare	$172.05
Rate for Payer: University Health Alliance Commercial	$404.54

GIA ENDO 45MEDIUM EGIA45AVMGIA

Facility

$555.00

Hospital Revenue Code	272
Min. Negotiated Rate	$471.75
Max. Negotiated Rate	$538.35
Rate for Payer: Cash Price	$333.00
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: MDX Hawaii PPO	$538.35

GIA ENDO 45MED/THK EGIA45AMT

Facility

$555.00

Hospital Revenue Code	272
Min. Negotiated Rate	$172.05
Max. Negotiated Rate	$538.35
Rate for Payer: AlohaCare Medicaid	$277.50
Rate for Payer: AlohaCare Medicare	$172.05
Rate for Payer: Cash Price	$333.00
Rate for Payer: Devoted Health Medicare	$188.70
Rate for Payer: Hawaii Medical Service Association Medicare	$172.05
Rate for Payer: Hawaii Western Management Group Commercial	$527.25
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Humana Medicare	$172.05
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: Kaiser Permanente Medicaid	$283.05
Rate for Payer: Kaiser Permanente Medicare	$172.05
Rate for Payer: MDX Hawaii PPO	$538.35
Rate for Payer: Ohana Health Plan Medicaid	$172.05
Rate for Payer: Ohana Health Plan Medicare	$172.05
Rate for Payer: UnitedHealthcare Medicare	$172.05
Rate for Payer: University Health Alliance Commercial	$404.54

GIA ENDO 45MED/THK EGIA45AMT

Facility

$555.00

Hospital Revenue Code	272
Min. Negotiated Rate	$471.75
Max. Negotiated Rate	$538.35
Rate for Payer: Cash Price	$333.00
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: MDX Hawaii PPO	$538.35

GIA ENDO 60MEDIUM EGIA60AVM

Facility

$705.00

Hospital Revenue Code	272
Min. Negotiated Rate	$218.55
Max. Negotiated Rate	$683.85
Rate for Payer: AlohaCare Medicaid	$352.50
Rate for Payer: AlohaCare Medicare	$218.55
Rate for Payer: Cash Price	$423.00
Rate for Payer: Devoted Health Medicare	$239.70
Rate for Payer: Hawaii Medical Service Association Medicare	$218.55
Rate for Payer: Hawaii Western Management Group Commercial	$669.75
Rate for Payer: Health Management Network Commercial	$599.25
Rate for Payer: Humana Medicare	$218.55
Rate for Payer: Kaiser Permanente Commercial	$634.50
Rate for Payer: Kaiser Permanente Medicaid	$359.55
Rate for Payer: Kaiser Permanente Medicare	$218.55
Rate for Payer: MDX Hawaii PPO	$683.85
Rate for Payer: Ohana Health Plan Medicaid	$218.55
Rate for Payer: Ohana Health Plan Medicare	$218.55
Rate for Payer: UnitedHealthcare Medicare	$218.55
Rate for Payer: University Health Alliance Commercial	$513.87

GIA ENDO 60MEDIUM EGIA60AVM

Facility

$705.00

Hospital Revenue Code	272
Min. Negotiated Rate	$599.25
Max. Negotiated Rate	$683.85
Rate for Payer: Cash Price	$423.00
Rate for Payer: Health Management Network Commercial	$599.25
Rate for Payer: Kaiser Permanente Commercial	$634.50
Rate for Payer: MDX Hawaii PPO	$683.85

GI ANCHOR SET 98701

Facility

$455.00

Hospital Revenue Code	278
Min. Negotiated Rate	$254.80
Max. Negotiated Rate	$441.35
Rate for Payer: Cash Price	$273.00
Rate for Payer: Hawaii Western Management Group Commercial	$318.50
Rate for Payer: Health Management Network Commercial	$386.75
Rate for Payer: Kaiser Permanente Commercial	$409.50
Rate for Payer: MDX Hawaii PPO	$441.35
Rate for Payer: University Health Alliance Commercial	$254.80

GI ANCHOR SET 98701

Facility

$455.00

Hospital Revenue Code	278
Min. Negotiated Rate	$141.05
Max. Negotiated Rate	$441.35
Rate for Payer: AlohaCare Medicaid	$227.50
Rate for Payer: AlohaCare Medicare	$141.05
Rate for Payer: Cash Price	$273.00
Rate for Payer: Devoted Health Medicare	$154.70
Rate for Payer: Hawaii Medical Service Association Medicare	$141.05
Rate for Payer: Hawaii Western Management Group Commercial	$318.50
Rate for Payer: Health Management Network Commercial	$386.75
Rate for Payer: Humana Medicare	$141.05
Rate for Payer: Kaiser Permanente Commercial	$409.50
Rate for Payer: Kaiser Permanente Medicaid	$232.05
Rate for Payer: Kaiser Permanente Medicare	$141.05
Rate for Payer: MDX Hawaii PPO	$441.35
Rate for Payer: Ohana Health Plan Medicaid	$141.05
Rate for Payer: Ohana Health Plan Medicare	$141.05
Rate for Payer: UnitedHealthcare Medicare	$141.05
Rate for Payer: University Health Alliance Commercial	$254.80

GIA ULTRA UNIV STPLR EGIAUSTND

Facility

$292.00

Hospital Revenue Code	272
Min. Negotiated Rate	$90.52
Max. Negotiated Rate	$283.24
Rate for Payer: AlohaCare Medicaid	$146.00
Rate for Payer: AlohaCare Medicare	$90.52
Rate for Payer: Cash Price	$175.20
Rate for Payer: Devoted Health Medicare	$99.28
Rate for Payer: Hawaii Medical Service Association Medicare	$90.52
Rate for Payer: Hawaii Western Management Group Commercial	$277.40
Rate for Payer: Health Management Network Commercial	$248.20
Rate for Payer: Humana Medicare	$90.52
Rate for Payer: Kaiser Permanente Commercial	$262.80
Rate for Payer: Kaiser Permanente Medicaid	$148.92
Rate for Payer: Kaiser Permanente Medicare	$90.52
Rate for Payer: MDX Hawaii PPO	$283.24
Rate for Payer: Ohana Health Plan Medicaid	$90.52
Rate for Payer: Ohana Health Plan Medicare	$90.52
Rate for Payer: UnitedHealthcare Medicare	$90.52
Rate for Payer: University Health Alliance Commercial	$212.84

Know your out-of-pocket cost for care.

All Charges