Kau Hospital

All Charges

Charge

Type

Setting

Price

HEART FAILURE AND SHOCK WITH CC

Facility

$28,513.51

Service Code	MSDRG 292
Min. Negotiated Rate	$28,513.51
Max. Negotiated Rate	$28,513.51
Rate for Payer: Hawaii Medical Service Association Commercial	$28,513.51

HEART FAILURE AND SHOCK WITH MCC

Facility

$28,513.51

Service Code	MSDRG 291
Min. Negotiated Rate	$28,513.51
Max. Negotiated Rate	$28,513.51
Rate for Payer: Hawaii Medical Service Association Commercial	$28,513.51

HEART FAILURE AND SHOCK WITHOUT CC/MCC

Facility

$28,513.51

Service Code	MSDRG 293
Min. Negotiated Rate	$28,513.51
Max. Negotiated Rate	$28,513.51
Rate for Payer: Hawaii Medical Service Association Commercial	$28,513.51

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC

Facility

$270,036.89

Service Code	MSDRG 001
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$270,036.89
Rate for Payer: Hawaii Medical Service Association Commercial	$270,036.89
Rate for Payer: University Health Alliance Commercial	$10,400.00

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC

Facility

$270,036.89

Service Code	MSDRG 002
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$270,036.89
Rate for Payer: Hawaii Medical Service Association Commercial	$270,036.89
Rate for Payer: University Health Alliance Commercial	$10,400.00

HEMAGARD KNITTED 12X6 #HGK1206

Facility

$1,844.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$571.64
Max. Negotiated Rate	$1,788.68
Rate for Payer: AlohaCare Medicaid	$922.00
Rate for Payer: AlohaCare Medicare	$571.64
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Devoted Health Medicare	$626.96
Rate for Payer: Hawaii Medical Service Association Medicare	$571.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,290.80
Rate for Payer: Health Management Network Commercial	$1,567.40
Rate for Payer: Humana Medicare	$571.64
Rate for Payer: Kaiser Permanente Commercial	$1,659.60
Rate for Payer: Kaiser Permanente Medicaid	$940.44
Rate for Payer: Kaiser Permanente Medicare	$571.64
Rate for Payer: MDX Hawaii PPO	$1,788.68
Rate for Payer: Ohana Health Plan Medicaid	$571.64
Rate for Payer: Ohana Health Plan Medicare	$571.64
Rate for Payer: UnitedHealthcare Medicare	$571.64
Rate for Payer: University Health Alliance Commercial	$1,032.64

HEMAGARD KNITTED 12X6 #HGK1206

Facility

$1,844.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,032.64
Max. Negotiated Rate	$1,788.68
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,290.80
Rate for Payer: Health Management Network Commercial	$1,567.40
Rate for Payer: Kaiser Permanente Commercial	$1,659.60
Rate for Payer: MDX Hawaii PPO	$1,788.68
Rate for Payer: University Health Alliance Commercial	$1,032.64

HEMOCLIP RESOLUTION M00522611

Facility

$591.00

Hospital Revenue Code	272
Min. Negotiated Rate	$502.35
Max. Negotiated Rate	$573.27
Rate for Payer: Cash Price	$354.60
Rate for Payer: Health Management Network Commercial	$502.35
Rate for Payer: Kaiser Permanente Commercial	$531.90
Rate for Payer: MDX Hawaii PPO	$573.27

HEMOCLIP RESOLUTION M00522611

Facility

$591.00

Hospital Revenue Code	272
Min. Negotiated Rate	$183.21
Max. Negotiated Rate	$573.27
Rate for Payer: AlohaCare Medicaid	$295.50
Rate for Payer: AlohaCare Medicare	$183.21
Rate for Payer: Cash Price	$354.60
Rate for Payer: Devoted Health Medicare	$200.94
Rate for Payer: Hawaii Medical Service Association Medicare	$183.21
Rate for Payer: Hawaii Western Management Group Commercial	$561.45
Rate for Payer: Health Management Network Commercial	$502.35
Rate for Payer: Humana Medicare	$183.21
Rate for Payer: Kaiser Permanente Commercial	$531.90
Rate for Payer: Kaiser Permanente Medicaid	$301.41
Rate for Payer: Kaiser Permanente Medicare	$183.21
Rate for Payer: MDX Hawaii PPO	$573.27
Rate for Payer: Ohana Health Plan Medicaid	$183.21
Rate for Payer: Ohana Health Plan Medicare	$183.21
Rate for Payer: UnitedHealthcare Medicare	$183.21
Rate for Payer: University Health Alliance Commercial	$430.78

HEMOST ABSORBALBLE 3X4

Facility

$552.00

Hospital Revenue Code	272
Min. Negotiated Rate	$171.12
Max. Negotiated Rate	$535.44
Rate for Payer: AlohaCare Medicaid	$276.00
Rate for Payer: AlohaCare Medicare	$171.12
Rate for Payer: Cash Price	$331.20
Rate for Payer: Devoted Health Medicare	$187.68
Rate for Payer: Hawaii Medical Service Association Medicare	$171.12
Rate for Payer: Hawaii Western Management Group Commercial	$524.40
Rate for Payer: Health Management Network Commercial	$469.20
Rate for Payer: Humana Medicare	$171.12
Rate for Payer: Kaiser Permanente Commercial	$496.80
Rate for Payer: Kaiser Permanente Medicaid	$281.52
Rate for Payer: Kaiser Permanente Medicare	$171.12
Rate for Payer: MDX Hawaii PPO	$535.44
Rate for Payer: Ohana Health Plan Medicaid	$171.12
Rate for Payer: Ohana Health Plan Medicare	$171.12
Rate for Payer: UnitedHealthcare Medicare	$171.12
Rate for Payer: University Health Alliance Commercial	$402.35

HEMOST ABSORBALBLE 3X4

Facility

$552.00

Hospital Revenue Code	272
Min. Negotiated Rate	$469.20
Max. Negotiated Rate	$535.44
Rate for Payer: Cash Price	$331.20
Rate for Payer: Health Management Network Commercial	$469.20
Rate for Payer: Kaiser Permanente Commercial	$496.80
Rate for Payer: MDX Hawaii PPO	$535.44

HEMOSTAT DSTAT DRY TOPIC 3001

Facility

$190.00

Hospital Revenue Code	272
Min. Negotiated Rate	$161.50
Max. Negotiated Rate	$184.30
Rate for Payer: Cash Price	$114.00
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: Kaiser Permanente Commercial	$171.00
Rate for Payer: MDX Hawaii PPO	$184.30

HEMOSTAT DSTAT DRY TOPIC 3001

Facility

$190.00

Hospital Revenue Code	272
Min. Negotiated Rate	$58.90
Max. Negotiated Rate	$184.30
Rate for Payer: AlohaCare Medicaid	$95.00
Rate for Payer: AlohaCare Medicare	$58.90
Rate for Payer: Cash Price	$114.00
Rate for Payer: Devoted Health Medicare	$64.60
Rate for Payer: Hawaii Medical Service Association Medicare	$58.90
Rate for Payer: Hawaii Western Management Group Commercial	$180.50
Rate for Payer: Health Management Network Commercial	$161.50
Rate for Payer: Humana Medicare	$58.90
Rate for Payer: Kaiser Permanente Commercial	$171.00
Rate for Payer: Kaiser Permanente Medicaid	$96.90
Rate for Payer: Kaiser Permanente Medicare	$58.90
Rate for Payer: MDX Hawaii PPO	$184.30
Rate for Payer: Ohana Health Plan Medicaid	$58.90
Rate for Payer: Ohana Health Plan Medicare	$58.90
Rate for Payer: UnitedHealthcare Medicare	$58.90
Rate for Payer: University Health Alliance Commercial	$138.49

HEMOST FLEXITIP APPLICATOR

Facility

$149.00

Hospital Revenue Code	272
Min. Negotiated Rate	$126.65
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$89.40
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Kaiser Permanente Commercial	$134.10
Rate for Payer: MDX Hawaii PPO	$144.53

HEMOST FLEXITIP APPLICATOR

Facility

$149.00

Hospital Revenue Code	272
Min. Negotiated Rate	$46.19
Max. Negotiated Rate	$144.53
Rate for Payer: AlohaCare Medicaid	$74.50
Rate for Payer: AlohaCare Medicare	$46.19
Rate for Payer: Cash Price	$89.40
Rate for Payer: Devoted Health Medicare	$50.66
Rate for Payer: Hawaii Medical Service Association Medicare	$46.19
Rate for Payer: Hawaii Western Management Group Commercial	$141.55
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Humana Medicare	$46.19
Rate for Payer: Kaiser Permanente Commercial	$134.10
Rate for Payer: Kaiser Permanente Medicaid	$75.99
Rate for Payer: Kaiser Permanente Medicare	$46.19
Rate for Payer: MDX Hawaii PPO	$144.53
Rate for Payer: Ohana Health Plan Medicaid	$46.19
Rate for Payer: Ohana Health Plan Medicare	$46.19
Rate for Payer: UnitedHealthcare Medicare	$46.19
Rate for Payer: University Health Alliance Commercial	$108.61

HEMOST PARTICLES 3G

Facility

$812.00

Hospital Revenue Code	272
Min. Negotiated Rate	$690.20
Max. Negotiated Rate	$787.64
Rate for Payer: Cash Price	$487.20
Rate for Payer: Health Management Network Commercial	$690.20
Rate for Payer: Kaiser Permanente Commercial	$730.80
Rate for Payer: MDX Hawaii PPO	$787.64

HEMOST PARTICLES 3G

Facility

$812.00

Hospital Revenue Code	272
Min. Negotiated Rate	$251.72
Max. Negotiated Rate	$787.64
Rate for Payer: AlohaCare Medicaid	$406.00
Rate for Payer: AlohaCare Medicare	$251.72
Rate for Payer: Cash Price	$487.20
Rate for Payer: Devoted Health Medicare	$276.08
Rate for Payer: Hawaii Medical Service Association Medicare	$251.72
Rate for Payer: Hawaii Western Management Group Commercial	$771.40
Rate for Payer: Health Management Network Commercial	$690.20
Rate for Payer: Humana Medicare	$251.72
Rate for Payer: Kaiser Permanente Commercial	$730.80
Rate for Payer: Kaiser Permanente Medicaid	$414.12
Rate for Payer: Kaiser Permanente Medicare	$251.72
Rate for Payer: MDX Hawaii PPO	$787.64
Rate for Payer: Ohana Health Plan Medicaid	$251.72
Rate for Payer: Ohana Health Plan Medicare	$251.72
Rate for Payer: UnitedHealthcare Medicare	$251.72
Rate for Payer: University Health Alliance Commercial	$591.87

HEMOST SPRAY 10

Facility

$5,000.00

Service Code	HCPCS C1052
Hospital Revenue Code	272
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	$4,750.00
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	$3,644.50

HEMOST SPRAY 10

Facility

$5,000.00

Service Code	HCPCS C1052
Hospital Revenue Code	272
Min. Negotiated Rate	$4,250.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00

HEMOST SPRAY 7

Facility

$5,000.00

Service Code	HCPCS C1052
Hospital Revenue Code	272
Min. Negotiated Rate	$4,250.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00

HEMOST SPRAY 7

Facility

$5,000.00

Service Code	HCPCS C1052
Hospital Revenue Code	272
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	$4,750.00
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	$3,644.50

HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION [10177]

Facility

$32.00

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$31.04
Rate for Payer: AlohaCare Medicaid	$16.00
Rate for Payer: AlohaCare Medicare	$9.92
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cash Price	$19.20
Rate for Payer: Devoted Health Medicare	$10.88
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Medicare	$9.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Western Management Group Commercial	$30.40
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Humana Medicare	$9.92
Rate for Payer: Kaiser Permanente Commercial	$28.80
Rate for Payer: Kaiser Permanente Medicaid	$16.32
Rate for Payer: Kaiser Permanente Medicare	$9.92
Rate for Payer: MDX Hawaii PPO	$31.04
Rate for Payer: Ohana Health Plan Medicaid	$9.92
Rate for Payer: Ohana Health Plan Medicare	$9.92
Rate for Payer: UnitedHealthcare Medicaid	$19.20
Rate for Payer: UnitedHealthcare Medicare	$9.92
Rate for Payer: University Health Alliance Commercial	$23.32

HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION [10177]

Facility

$32.00

Service Code	HCPCS J1644
Hospital Revenue Code	250
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$19.20
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Kaiser Permanente Commercial	$28.80
Rate for Payer: MDX Hawaii PPO	$31.04

HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]

Facility

$15.00

Service Code	HCPCS J1644
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$18.60
Rate for Payer: Cash Price	$10.20
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: MDX Hawaii PPO	$30.07
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: MDX Hawaii PPO	$16.49

HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [10176]

Facility

$17.00

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$16.49
Rate for Payer: AlohaCare Medicaid	$8.50
Rate for Payer: AlohaCare Medicaid	$15.50
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$9.61
Rate for Payer: AlohaCare Medicare	$4.65
Rate for Payer: AlohaCare Medicare	$5.27
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$18.60
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$18.60
Rate for Payer: Cash Price	$10.20
Rate for Payer: Cash Price	$10.20
Rate for Payer: Devoted Health Medicare	$10.54
Rate for Payer: Devoted Health Medicare	$5.78
Rate for Payer: Devoted Health Medicare	$5.10
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Medicare	$5.27
Rate for Payer: Hawaii Medical Service Association Medicare	$9.61
Rate for Payer: Hawaii Medical Service Association Medicare	$4.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Western Management Group Commercial	$29.45
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Humana Medicare	$5.27
Rate for Payer: Humana Medicare	$4.65
Rate for Payer: Humana Medicare	$9.61
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: Kaiser Permanente Medicaid	$15.81
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$5.27
Rate for Payer: Kaiser Permanente Medicare	$4.65
Rate for Payer: Kaiser Permanente Medicare	$9.61
Rate for Payer: MDX Hawaii PPO	$30.07
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: Ohana Health Plan Medicaid	$5.27
Rate for Payer: Ohana Health Plan Medicaid	$9.61
Rate for Payer: Ohana Health Plan Medicaid	$4.65
Rate for Payer: Ohana Health Plan Medicare	$9.61
Rate for Payer: Ohana Health Plan Medicare	$4.65
Rate for Payer: Ohana Health Plan Medicare	$5.27
Rate for Payer: UnitedHealthcare Medicaid	$9.00
Rate for Payer: UnitedHealthcare Medicaid	$10.20
Rate for Payer: UnitedHealthcare Medicaid	$18.60
Rate for Payer: UnitedHealthcare Medicare	$4.65
Rate for Payer: UnitedHealthcare Medicare	$9.61
Rate for Payer: UnitedHealthcare Medicare	$5.27
Rate for Payer: University Health Alliance Commercial	$22.60
Rate for Payer: University Health Alliance Commercial	$12.39
Rate for Payer: University Health Alliance Commercial	$10.93

Know your out-of-pocket cost for care.

All Charges