Kau Hospital

All Charges

Charge

Type

Setting

Price

HEPARIN (PORCINE) 25,000 UNIT/500 ML (50 UNIT/ML) IN DEXTROSE 5 % IV [166269]

Facility

$51.00

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$49.47
Rate for Payer: AlohaCare Medicaid	$25.50
Rate for Payer: AlohaCare Medicare	$15.81
Rate for Payer: Cash Price	$30.60
Rate for Payer: Cash Price	$30.60
Rate for Payer: Devoted Health Medicare	$17.34
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Medicare	$15.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Western Management Group Commercial	$48.45
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Humana Medicare	$15.81
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: Kaiser Permanente Medicaid	$26.01
Rate for Payer: Kaiser Permanente Medicare	$15.81
Rate for Payer: MDX Hawaii PPO	$49.47
Rate for Payer: Ohana Health Plan Medicaid	$15.81
Rate for Payer: Ohana Health Plan Medicare	$15.81
Rate for Payer: UnitedHealthcare Medicaid	$30.60
Rate for Payer: UnitedHealthcare Medicare	$15.81
Rate for Payer: University Health Alliance Commercial	$37.17

HEPARIN (PORCINE) 25,000 UNIT/500 ML (50 UNIT/ML) IN DEXTROSE 5 % IV [166269]

Facility

$51.00

Service Code	HCPCS J1644
Hospital Revenue Code	250
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$49.47
Rate for Payer: Cash Price	$30.60
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: MDX Hawaii PPO	$49.47

HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]

Facility

$18.00

Service Code	HCPCS J1644
Hospital Revenue Code	250
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: MDX Hawaii PPO	$17.46

HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [10181]

Facility

$18.00

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$17.46
Rate for Payer: AlohaCare Medicaid	$9.00
Rate for Payer: AlohaCare Medicare	$5.58
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$10.80
Rate for Payer: Devoted Health Medicare	$6.12
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Medicare	$5.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Humana Medicare	$5.58
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: Kaiser Permanente Medicare	$5.58
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: Ohana Health Plan Medicaid	$5.58
Rate for Payer: Ohana Health Plan Medicare	$5.58
Rate for Payer: UnitedHealthcare Medicaid	$10.80
Rate for Payer: UnitedHealthcare Medicare	$5.58
Rate for Payer: University Health Alliance Commercial	$13.12

HEPARIN (PORCINE) (PF) 1,000 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE IV [166266]

Facility

$27.00

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$26.19
Rate for Payer: AlohaCare Medicaid	$13.50
Rate for Payer: AlohaCare Medicare	$8.37
Rate for Payer: Cash Price	$16.20
Rate for Payer: Cash Price	$16.20
Rate for Payer: Devoted Health Medicare	$9.18
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Medicare	$8.37
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Western Management Group Commercial	$25.65
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Humana Medicare	$8.37
Rate for Payer: Kaiser Permanente Commercial	$24.30
Rate for Payer: Kaiser Permanente Medicaid	$13.77
Rate for Payer: Kaiser Permanente Medicare	$8.37
Rate for Payer: MDX Hawaii PPO	$26.19
Rate for Payer: Ohana Health Plan Medicaid	$8.37
Rate for Payer: Ohana Health Plan Medicare	$8.37
Rate for Payer: UnitedHealthcare Medicaid	$16.20
Rate for Payer: UnitedHealthcare Medicare	$8.37
Rate for Payer: University Health Alliance Commercial	$19.68

HEPARIN (PORCINE) (PF) 1,000 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE IV [166266]

Facility

$27.00

Service Code	HCPCS J1644
Hospital Revenue Code	250
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$26.19
Rate for Payer: Cash Price	$16.20
Rate for Payer: Health Management Network Commercial	$22.95
Rate for Payer: Kaiser Permanente Commercial	$24.30
Rate for Payer: MDX Hawaii PPO	$26.19

HEPARIN, PORCINE (PF) 1,000 UNIT/ML INJECTION SOLUTION [197315]

Facility

$50.00

Service Code	HCPCS J1644
Hospital Revenue Code	250
Min. Negotiated Rate	$42.50
Max. Negotiated Rate	$48.50
Rate for Payer: Cash Price	$30.00
Rate for Payer: Health Management Network Commercial	$42.50
Rate for Payer: Kaiser Permanente Commercial	$45.00
Rate for Payer: MDX Hawaii PPO	$48.50

HEPARIN, PORCINE (PF) 1,000 UNIT/ML INJECTION SOLUTION [197315]

Facility

$50.00

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$48.50
Rate for Payer: AlohaCare Medicaid	$25.00
Rate for Payer: AlohaCare Medicare	$15.50
Rate for Payer: Cash Price	$30.00
Rate for Payer: Cash Price	$30.00
Rate for Payer: Devoted Health Medicare	$17.00
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Medicare	$15.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Western Management Group Commercial	$47.50
Rate for Payer: Health Management Network Commercial	$42.50
Rate for Payer: Humana Medicare	$15.50
Rate for Payer: Kaiser Permanente Commercial	$45.00
Rate for Payer: Kaiser Permanente Medicaid	$25.50
Rate for Payer: Kaiser Permanente Medicare	$15.50
Rate for Payer: MDX Hawaii PPO	$48.50
Rate for Payer: Ohana Health Plan Medicaid	$15.50
Rate for Payer: Ohana Health Plan Medicare	$15.50
Rate for Payer: UnitedHealthcare Medicaid	$30.00
Rate for Payer: UnitedHealthcare Medicare	$15.50
Rate for Payer: University Health Alliance Commercial	$36.45

HEPARIN (PORCINE) (PF) 2,000 UNIT/1,000 ML IN 0.9 % SODIUM CHLORIDE IV [166267]

Facility

$28.00

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$27.16
Rate for Payer: AlohaCare Medicaid	$14.00
Rate for Payer: AlohaCare Medicaid	$17.50
Rate for Payer: AlohaCare Medicare	$10.85
Rate for Payer: AlohaCare Medicare	$8.68
Rate for Payer: Cash Price	$21.00
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$21.00
Rate for Payer: Devoted Health Medicare	$9.52
Rate for Payer: Devoted Health Medicare	$11.90
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	$10.85
Rate for Payer: Hawaii Medical Service Association Medicare	$8.68
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	$26.60
Rate for Payer: Hawaii Western Management Group Commercial	$33.25
Rate for Payer: Health Management Network Commercial	$29.75
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Humana Medicare	$8.68
Rate for Payer: Humana Medicare	$10.85
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Commercial	$31.50
Rate for Payer: Kaiser Permanente Medicaid	$17.85
Rate for Payer: Kaiser Permanente Medicaid	$14.28
Rate for Payer: Kaiser Permanente Medicare	$8.68
Rate for Payer: Kaiser Permanente Medicare	$10.85
Rate for Payer: MDX Hawaii PPO	$27.16
Rate for Payer: MDX Hawaii PPO	$33.95
Rate for Payer: Ohana Health Plan Medicaid	$10.85
Rate for Payer: Ohana Health Plan Medicaid	$8.68
Rate for Payer: Ohana Health Plan Medicare	$8.68
Rate for Payer: Ohana Health Plan Medicare	$10.85
Rate for Payer: UnitedHealthcare Medicaid	$21.00
Rate for Payer: UnitedHealthcare Medicaid	$16.80
Rate for Payer: UnitedHealthcare Medicare	$8.68
Rate for Payer: UnitedHealthcare Medicare	$10.85
Rate for Payer: University Health Alliance Commercial	$20.41
Rate for Payer: University Health Alliance Commercial	$25.51

HEPARIN (PORCINE) (PF) 2,000 UNIT/1,000 ML IN 0.9 % SODIUM CHLORIDE IV [166267]

Facility

$28.00

Service Code	HCPCS J1644
Hospital Revenue Code	250
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$21.00
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Health Management Network Commercial	$29.75
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Commercial	$31.50
Rate for Payer: MDX Hawaii PPO	$33.95
Rate for Payer: MDX Hawaii PPO	$27.16

HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [203251]

Facility

$155.00

Service Code	HCPCS 90632
Hospital Revenue Code	636
Min. Negotiated Rate	$48.05
Max. Negotiated Rate	$150.35
Rate for Payer: AlohaCare Medicaid	$77.50
Rate for Payer: AlohaCare Medicare	$48.05
Rate for Payer: Cash Price	$93.00
Rate for Payer: Cash Price	$93.00
Rate for Payer: Devoted Health Medicare	$52.70
Rate for Payer: Hawaii Medical Service Association ABD	$71.61
Rate for Payer: Hawaii Medical Service Association Medicare	$48.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$71.61
Rate for Payer: Hawaii Western Management Group Commercial	$147.25
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Humana Medicare	$48.05
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: Kaiser Permanente Medicare	$48.05
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: Ohana Health Plan Medicaid	$48.05
Rate for Payer: Ohana Health Plan Medicare	$48.05
Rate for Payer: UnitedHealthcare Medicaid	$93.00
Rate for Payer: UnitedHealthcare Medicare	$48.05
Rate for Payer: University Health Alliance Commercial	$112.98

HEPATITIS A VACCINE (PF) 1,440 ELISA UNIT/ML INTRAMUSCULAR SYRINGE [203251]

Facility

$155.00

Service Code	HCPCS 90632
Hospital Revenue Code	250
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$93.00
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: MDX Hawaii PPO	$150.35

HEPATITIS B IMMUNE GLOBULIN 110 UNIT/0.5 ML INTRAMUSCULAR SYRINGE [180688]

Facility

$160.00

Service Code	HCPCS 90371
Hospital Revenue Code	250
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Kaiser Permanente Commercial	$144.00
Rate for Payer: MDX Hawaii PPO	$155.20

HEPATITIS B IMMUNE GLOBULIN 110 UNIT/0.5 ML INTRAMUSCULAR SYRINGE [180688]

Facility

$160.00

Service Code	HCPCS 90371
Hospital Revenue Code	636
Min. Negotiated Rate	$49.60
Max. Negotiated Rate	$175.26
Rate for Payer: AlohaCare Medicaid	$80.00
Rate for Payer: AlohaCare Medicare	$49.60
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Devoted Health Medicare	$54.40
Rate for Payer: Hawaii Medical Service Association Commercial	$175.26
Rate for Payer: Hawaii Medical Service Association Medicare	$49.60
Rate for Payer: Hawaii Western Management Group Commercial	$152.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Humana Medicare	$49.60
Rate for Payer: Kaiser Permanente Commercial	$144.00
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: Kaiser Permanente Medicare	$49.60
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: Ohana Health Plan Medicaid	$49.60
Rate for Payer: Ohana Health Plan Medicare	$49.60
Rate for Payer: UnitedHealthcare Medicaid	$96.00
Rate for Payer: UnitedHealthcare Medicare	$49.60
Rate for Payer: University Health Alliance Commercial	$116.62

HEPATITIS B IMMUNE GLOBULIN > 1,560 UNIT/5 ML INTRAMUSCULAR SOLUTION [91047]

Facility

$1,423.00

Service Code	HCPCS 90371
Hospital Revenue Code	250
Min. Negotiated Rate	$1,209.55
Max. Negotiated Rate	$1,380.31
Rate for Payer: Cash Price	$853.80
Rate for Payer: Health Management Network Commercial	$1,209.55
Rate for Payer: Kaiser Permanente Commercial	$1,280.70
Rate for Payer: MDX Hawaii PPO	$1,380.31

HEPATITIS B VIRUS VACCINE RECMB(PF) 5 MCG/0.5 ML INTRAMUSCULAR SYRINGE [187816]

Facility

$70.00

Service Code	NDC 00006409301
Hospital Revenue Code	250
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$42.00
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: MDX Hawaii PPO	$67.90

HEPATITIS B VIRUS VACCINE RECMB(PF) 5 MCG/0.5 ML INTRAMUSCULAR SYRINGE [187816]

Facility

$70.00

Service Code	NDC 00006409302
Hospital Revenue Code	250
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$42.00
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: MDX Hawaii PPO	$67.90

HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [203219]

Facility

$88.00

Service Code	HCPCS 90744
Hospital Revenue Code	636
Min. Negotiated Rate	$27.28
Max. Negotiated Rate	$85.36
Rate for Payer: AlohaCare Medicaid	$44.00
Rate for Payer: AlohaCare Medicare	$27.28
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cash Price	$52.80
Rate for Payer: Devoted Health Medicare	$29.92
Rate for Payer: Hawaii Medical Service Association ABD	$30.77
Rate for Payer: Hawaii Medical Service Association Medicare	$27.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.77
Rate for Payer: Hawaii Western Management Group Commercial	$83.60
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Humana Medicare	$27.28
Rate for Payer: Kaiser Permanente Commercial	$79.20
Rate for Payer: Kaiser Permanente Medicaid	$44.88
Rate for Payer: Kaiser Permanente Medicare	$27.28
Rate for Payer: MDX Hawaii PPO	$85.36
Rate for Payer: Ohana Health Plan Medicaid	$27.28
Rate for Payer: Ohana Health Plan Medicare	$27.28
Rate for Payer: UnitedHealthcare Medicaid	$52.80
Rate for Payer: UnitedHealthcare Medicare	$27.28
Rate for Payer: University Health Alliance Commercial	$64.14

HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [203219]

Facility

$88.00

Service Code	HCPCS 90744
Hospital Revenue Code	250
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$52.80
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Kaiser Permanente Commercial	$79.20
Rate for Payer: MDX Hawaii PPO	$85.36

HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [203192]

Facility

$174.00

Service Code	HCPCS 90747
Hospital Revenue Code	250
Min. Negotiated Rate	$147.90
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$104.40
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: MDX Hawaii PPO	$168.78

HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [203192]

Facility

$174.00

Service Code	HCPCS 90747
Hospital Revenue Code	636
Min. Negotiated Rate	$53.94
Max. Negotiated Rate	$168.78
Rate for Payer: AlohaCare Medicaid	$87.00
Rate for Payer: AlohaCare Medicare	$53.94
Rate for Payer: Cash Price	$104.40
Rate for Payer: Cash Price	$104.40
Rate for Payer: Devoted Health Medicare	$59.16
Rate for Payer: Hawaii Medical Service Association ABD	$140.75
Rate for Payer: Hawaii Medical Service Association Medicare	$53.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$140.75
Rate for Payer: Hawaii Western Management Group Commercial	$165.30
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Humana Medicare	$53.94
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: Kaiser Permanente Medicaid	$88.74
Rate for Payer: Kaiser Permanente Medicare	$53.94
Rate for Payer: MDX Hawaii PPO	$168.78
Rate for Payer: Ohana Health Plan Medicaid	$53.94
Rate for Payer: Ohana Health Plan Medicare	$53.94
Rate for Payer: UnitedHealthcare Medicaid	$104.40
Rate for Payer: UnitedHealthcare Medicare	$53.94
Rate for Payer: University Health Alliance Commercial	$126.83

HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [203192]

Facility

$174.00

Service Code	HCPCS 90740
Hospital Revenue Code	250
Min. Negotiated Rate	$147.90
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$104.40
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: MDX Hawaii PPO	$168.78

HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [203192]

Facility

$174.00

Service Code	HCPCS 90740
Hospital Revenue Code	636
Min. Negotiated Rate	$53.94
Max. Negotiated Rate	$168.78
Rate for Payer: AlohaCare Medicaid	$87.00
Rate for Payer: AlohaCare Medicare	$53.94
Rate for Payer: Cash Price	$104.40
Rate for Payer: Cash Price	$104.40
Rate for Payer: Devoted Health Medicare	$59.16
Rate for Payer: Hawaii Medical Service Association ABD	$158.15
Rate for Payer: Hawaii Medical Service Association Medicare	$53.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$158.15
Rate for Payer: Hawaii Western Management Group Commercial	$165.30
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Humana Medicare	$53.94
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: Kaiser Permanente Medicaid	$88.74
Rate for Payer: Kaiser Permanente Medicare	$53.94
Rate for Payer: MDX Hawaii PPO	$168.78
Rate for Payer: Ohana Health Plan Medicaid	$53.94
Rate for Payer: Ohana Health Plan Medicare	$53.94
Rate for Payer: UnitedHealthcare Medicaid	$104.40
Rate for Payer: UnitedHealthcare Medicare	$53.94
Rate for Payer: University Health Alliance Commercial	$126.83

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC

Facility

$65,464.92

Service Code	MSDRG 421
Min. Negotiated Rate	$65,464.92
Max. Negotiated Rate	$65,464.92
Rate for Payer: Hawaii Medical Service Association Commercial	$65,464.92

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC

Facility

$65,464.92

Service Code	MSDRG 420
Min. Negotiated Rate	$65,464.92
Max. Negotiated Rate	$65,464.92
Rate for Payer: Hawaii Medical Service Association Commercial	$65,464.92

Know your out-of-pocket cost for care.

All Charges