Kau Hospital

All Charges

Charge

Type

Setting

Price

INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION [134057]

Facility

$1,636.00

Service Code	HCPCS Q5103
Hospital Revenue Code	636
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$1,586.92
Rate for Payer: AlohaCare Medicaid	$818.00
Rate for Payer: AlohaCare Medicare	$507.16
Rate for Payer: Cash Price	$981.60
Rate for Payer: Cash Price	$981.60
Rate for Payer: Devoted Health Medicare	$556.24
Rate for Payer: Hawaii Medical Service Association ABD	$19.68
Rate for Payer: Hawaii Medical Service Association Commercial	$32.55
Rate for Payer: Hawaii Medical Service Association Medicare	$507.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,554.20
Rate for Payer: Health Management Network Commercial	$1,390.60
Rate for Payer: Humana Medicare	$507.16
Rate for Payer: Kaiser Permanente Commercial	$1,472.40
Rate for Payer: Kaiser Permanente Medicaid	$834.36
Rate for Payer: Kaiser Permanente Medicare	$507.16
Rate for Payer: MDX Hawaii PPO	$1,586.92
Rate for Payer: Ohana Health Plan Medicaid	$507.16
Rate for Payer: Ohana Health Plan Medicare	$507.16
Rate for Payer: UnitedHealthcare Medicaid	$981.60
Rate for Payer: UnitedHealthcare Medicare	$507.16
Rate for Payer: University Health Alliance Commercial	$1,192.48

INGENIO DR IS-1 GENERATOR

Facility

$12,310.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$3,816.10
Max. Negotiated Rate	$11,940.70
Rate for Payer: AlohaCare Medicaid	$6,155.00
Rate for Payer: AlohaCare Medicare	$3,816.10
Rate for Payer: Cash Price	$7,386.00
Rate for Payer: Devoted Health Medicare	$4,185.40
Rate for Payer: Hawaii Medical Service Association Medicare	$3,816.10
Rate for Payer: Hawaii Western Management Group Commercial	$8,617.00
Rate for Payer: Health Management Network Commercial	$10,463.50
Rate for Payer: Humana Medicare	$3,816.10
Rate for Payer: Kaiser Permanente Commercial	$11,079.00
Rate for Payer: Kaiser Permanente Medicaid	$6,278.10
Rate for Payer: Kaiser Permanente Medicare	$3,816.10
Rate for Payer: MDX Hawaii PPO	$11,940.70
Rate for Payer: Ohana Health Plan Medicaid	$3,816.10
Rate for Payer: Ohana Health Plan Medicare	$3,816.10
Rate for Payer: UnitedHealthcare Medicare	$3,816.10
Rate for Payer: University Health Alliance Commercial	$6,893.60

INGENIO DR IS-1 GENERATOR

Facility

$12,310.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$6,893.60
Max. Negotiated Rate	$11,940.70
Rate for Payer: Cash Price	$7,386.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,617.00
Rate for Payer: Health Management Network Commercial	$10,463.50
Rate for Payer: Kaiser Permanente Commercial	$11,079.00
Rate for Payer: MDX Hawaii PPO	$11,940.70
Rate for Payer: University Health Alliance Commercial	$6,893.60

INGEVITY LEAD 45CM

Facility

$1,302.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$403.62
Max. Negotiated Rate	$1,262.94
Rate for Payer: AlohaCare Medicaid	$651.00
Rate for Payer: AlohaCare Medicare	$403.62
Rate for Payer: Cash Price	$781.20
Rate for Payer: Devoted Health Medicare	$442.68
Rate for Payer: Hawaii Medical Service Association Medicare	$403.62
Rate for Payer: Hawaii Western Management Group Commercial	$911.40
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Humana Medicare	$403.62
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: Kaiser Permanente Medicaid	$664.02
Rate for Payer: Kaiser Permanente Medicare	$403.62
Rate for Payer: MDX Hawaii PPO	$1,262.94
Rate for Payer: Ohana Health Plan Medicaid	$403.62
Rate for Payer: Ohana Health Plan Medicare	$403.62
Rate for Payer: UnitedHealthcare Medicare	$403.62
Rate for Payer: University Health Alliance Commercial	$729.12

INGEVITY LEAD 45CM

Facility

$1,302.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$729.12
Max. Negotiated Rate	$1,262.94
Rate for Payer: Cash Price	$781.20
Rate for Payer: Hawaii Western Management Group Commercial	$911.40
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: MDX Hawaii PPO	$1,262.94
Rate for Payer: University Health Alliance Commercial	$729.12

INGEVITY LEAD 59CM

Facility

$1,302.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$403.62
Max. Negotiated Rate	$1,262.94
Rate for Payer: AlohaCare Medicaid	$651.00
Rate for Payer: AlohaCare Medicare	$403.62
Rate for Payer: Cash Price	$781.20
Rate for Payer: Devoted Health Medicare	$442.68
Rate for Payer: Hawaii Medical Service Association Medicare	$403.62
Rate for Payer: Hawaii Western Management Group Commercial	$911.40
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Humana Medicare	$403.62
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: Kaiser Permanente Medicaid	$664.02
Rate for Payer: Kaiser Permanente Medicare	$403.62
Rate for Payer: MDX Hawaii PPO	$1,262.94
Rate for Payer: Ohana Health Plan Medicaid	$403.62
Rate for Payer: Ohana Health Plan Medicare	$403.62
Rate for Payer: UnitedHealthcare Medicare	$403.62
Rate for Payer: University Health Alliance Commercial	$729.12

INGEVITY LEAD 59CM

Facility

$1,302.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$729.12
Max. Negotiated Rate	$1,262.94
Rate for Payer: Cash Price	$781.20
Rate for Payer: Hawaii Western Management Group Commercial	$911.40
Rate for Payer: Health Management Network Commercial	$1,106.70
Rate for Payer: Kaiser Permanente Commercial	$1,171.80
Rate for Payer: MDX Hawaii PPO	$1,262.94
Rate for Payer: University Health Alliance Commercial	$729.12

INGEVITY MRI 59CM 7742

Facility

$1,875.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,818.75
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,312.50
Rate for Payer: Health Management Network Commercial	$1,593.75
Rate for Payer: Kaiser Permanente Commercial	$1,687.50
Rate for Payer: MDX Hawaii PPO	$1,818.75
Rate for Payer: University Health Alliance Commercial	$1,050.00

INGEVITY MRI 59CM 7742

Facility

$1,875.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$581.25
Max. Negotiated Rate	$1,818.75
Rate for Payer: AlohaCare Medicaid	$937.50
Rate for Payer: AlohaCare Medicare	$581.25
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Devoted Health Medicare	$637.50
Rate for Payer: Hawaii Medical Service Association Medicare	$581.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,312.50
Rate for Payer: Health Management Network Commercial	$1,593.75
Rate for Payer: Humana Medicare	$581.25
Rate for Payer: Kaiser Permanente Commercial	$1,687.50
Rate for Payer: Kaiser Permanente Medicaid	$956.25
Rate for Payer: Kaiser Permanente Medicare	$581.25
Rate for Payer: MDX Hawaii PPO	$1,818.75
Rate for Payer: Ohana Health Plan Medicaid	$581.25
Rate for Payer: Ohana Health Plan Medicare	$581.25
Rate for Payer: UnitedHealthcare Medicare	$581.25
Rate for Payer: University Health Alliance Commercial	$1,050.00

INGEVITY MRI FIX 52CM 7741

Facility

$1,875.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$581.25
Max. Negotiated Rate	$1,818.75
Rate for Payer: AlohaCare Medicaid	$937.50
Rate for Payer: AlohaCare Medicare	$581.25
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Devoted Health Medicare	$637.50
Rate for Payer: Hawaii Medical Service Association Medicare	$581.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,312.50
Rate for Payer: Health Management Network Commercial	$1,593.75
Rate for Payer: Humana Medicare	$581.25
Rate for Payer: Kaiser Permanente Commercial	$1,687.50
Rate for Payer: Kaiser Permanente Medicaid	$956.25
Rate for Payer: Kaiser Permanente Medicare	$581.25
Rate for Payer: MDX Hawaii PPO	$1,818.75
Rate for Payer: Ohana Health Plan Medicaid	$581.25
Rate for Payer: Ohana Health Plan Medicare	$581.25
Rate for Payer: UnitedHealthcare Medicare	$581.25
Rate for Payer: University Health Alliance Commercial	$1,050.00

INGEVITY MRI FIX 52CM 7741

Facility

$1,875.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,818.75
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,312.50
Rate for Payer: Health Management Network Commercial	$1,593.75
Rate for Payer: Kaiser Permanente Commercial	$1,687.50
Rate for Payer: MDX Hawaii PPO	$1,818.75
Rate for Payer: University Health Alliance Commercial	$1,050.00

INGEVITY + PACING LEAD 52CM

Facility

$1,414.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$791.84
Max. Negotiated Rate	$1,371.58
Rate for Payer: Cash Price	$848.40
Rate for Payer: Hawaii Western Management Group Commercial	$989.80
Rate for Payer: Health Management Network Commercial	$1,201.90
Rate for Payer: Kaiser Permanente Commercial	$1,272.60
Rate for Payer: MDX Hawaii PPO	$1,371.58
Rate for Payer: University Health Alliance Commercial	$791.84

INGEVITY + PACING LEAD 52CM

Facility

$1,414.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$438.34
Max. Negotiated Rate	$1,371.58
Rate for Payer: AlohaCare Medicaid	$707.00
Rate for Payer: AlohaCare Medicare	$438.34
Rate for Payer: Cash Price	$848.40
Rate for Payer: Devoted Health Medicare	$480.76
Rate for Payer: Hawaii Medical Service Association Medicare	$438.34
Rate for Payer: Hawaii Western Management Group Commercial	$989.80
Rate for Payer: Health Management Network Commercial	$1,201.90
Rate for Payer: Humana Medicare	$438.34
Rate for Payer: Kaiser Permanente Commercial	$1,272.60
Rate for Payer: Kaiser Permanente Medicaid	$721.14
Rate for Payer: Kaiser Permanente Medicare	$438.34
Rate for Payer: MDX Hawaii PPO	$1,371.58
Rate for Payer: Ohana Health Plan Medicaid	$438.34
Rate for Payer: Ohana Health Plan Medicare	$438.34
Rate for Payer: UnitedHealthcare Medicare	$438.34
Rate for Payer: University Health Alliance Commercial	$791.84

INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC

Facility

$29,888.22

Service Code	MSDRG 351
Min. Negotiated Rate	$29,888.22
Max. Negotiated Rate	$29,888.22
Rate for Payer: Hawaii Medical Service Association Commercial	$29,888.22

INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC

Facility

$37,117.33

Service Code	MSDRG 350
Min. Negotiated Rate	$37,117.33
Max. Negotiated Rate	$37,117.33
Rate for Payer: Hawaii Medical Service Association Commercial	$37,117.33

INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC

Facility

$15,453.70

Service Code	MSDRG 352
Min. Negotiated Rate	$15,453.70
Max. Negotiated Rate	$15,453.70
Rate for Payer: Hawaii Medical Service Association Commercial	$15,453.70

INLINE TL CANN ASSM 51-10430

Facility

$1,244.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,057.40
Max. Negotiated Rate	$1,206.68
Rate for Payer: Cash Price	$746.40
Rate for Payer: Health Management Network Commercial	$1,057.40
Rate for Payer: Kaiser Permanente Commercial	$1,119.60
Rate for Payer: MDX Hawaii PPO	$1,206.68

INLINE TL CANN ASSM 51-10430

Facility

$1,244.00

Hospital Revenue Code	272
Min. Negotiated Rate	$385.64
Max. Negotiated Rate	$1,206.68
Rate for Payer: AlohaCare Medicaid	$622.00
Rate for Payer: AlohaCare Medicare	$385.64
Rate for Payer: Cash Price	$746.40
Rate for Payer: Devoted Health Medicare	$422.96
Rate for Payer: Hawaii Medical Service Association Medicare	$385.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,181.80
Rate for Payer: Health Management Network Commercial	$1,057.40
Rate for Payer: Humana Medicare	$385.64
Rate for Payer: Kaiser Permanente Commercial	$1,119.60
Rate for Payer: Kaiser Permanente Medicaid	$634.44
Rate for Payer: Kaiser Permanente Medicare	$385.64
Rate for Payer: MDX Hawaii PPO	$1,206.68
Rate for Payer: Ohana Health Plan Medicaid	$385.64
Rate for Payer: Ohana Health Plan Medicare	$385.64
Rate for Payer: UnitedHealthcare Medicare	$385.64
Rate for Payer: University Health Alliance Commercial	$906.75

INNER VISION 50FR TIP 1465-50

Facility

$450.00

Hospital Revenue Code	272
Min. Negotiated Rate	$139.50
Max. Negotiated Rate	$436.50
Rate for Payer: AlohaCare Medicaid	$225.00
Rate for Payer: AlohaCare Medicare	$139.50
Rate for Payer: Cash Price	$270.00
Rate for Payer: Devoted Health Medicare	$153.00
Rate for Payer: Hawaii Medical Service Association Medicare	$139.50
Rate for Payer: Hawaii Western Management Group Commercial	$427.50
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: Humana Medicare	$139.50
Rate for Payer: Kaiser Permanente Commercial	$405.00
Rate for Payer: Kaiser Permanente Medicaid	$229.50
Rate for Payer: Kaiser Permanente Medicare	$139.50
Rate for Payer: MDX Hawaii PPO	$436.50
Rate for Payer: Ohana Health Plan Medicaid	$139.50
Rate for Payer: Ohana Health Plan Medicare	$139.50
Rate for Payer: UnitedHealthcare Medicare	$139.50
Rate for Payer: University Health Alliance Commercial	$328.00

INNER VISION 50FR TIP 1465-50

Facility

$450.00

Hospital Revenue Code	272
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$270.00
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: Kaiser Permanente Commercial	$405.00
Rate for Payer: MDX Hawaii PPO	$436.50

INSERT ACETABULAR 7236-2-848

Facility

$3,211.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$995.41
Max. Negotiated Rate	$3,114.67
Rate for Payer: AlohaCare Medicaid	$1,605.50
Rate for Payer: AlohaCare Medicare	$995.41
Rate for Payer: Cash Price	$1,926.60
Rate for Payer: Devoted Health Medicare	$1,091.74
Rate for Payer: Hawaii Medical Service Association Medicare	$995.41
Rate for Payer: Hawaii Western Management Group Commercial	$2,247.70
Rate for Payer: Health Management Network Commercial	$2,729.35
Rate for Payer: Humana Medicare	$995.41
Rate for Payer: Kaiser Permanente Commercial	$2,889.90
Rate for Payer: Kaiser Permanente Medicaid	$1,637.61
Rate for Payer: Kaiser Permanente Medicare	$995.41
Rate for Payer: MDX Hawaii PPO	$3,114.67
Rate for Payer: Ohana Health Plan Medicaid	$995.41
Rate for Payer: Ohana Health Plan Medicare	$995.41
Rate for Payer: UnitedHealthcare Medicare	$995.41
Rate for Payer: University Health Alliance Commercial	$1,798.16

INSERT ACETABULAR 7236-2-848

Facility

$3,211.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,798.16
Max. Negotiated Rate	$3,114.67
Rate for Payer: Cash Price	$1,926.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,247.70
Rate for Payer: Health Management Network Commercial	$2,729.35
Rate for Payer: Kaiser Permanente Commercial	$2,889.90
Rate for Payer: MDX Hawaii PPO	$3,114.67
Rate for Payer: University Health Alliance Commercial	$1,798.16

INSERT ADM MDM X3 1236-2-852

Facility

$3,244.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,816.64
Max. Negotiated Rate	$3,146.68
Rate for Payer: Cash Price	$1,946.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,270.80
Rate for Payer: Health Management Network Commercial	$2,757.40
Rate for Payer: Kaiser Permanente Commercial	$2,919.60
Rate for Payer: MDX Hawaii PPO	$3,146.68
Rate for Payer: University Health Alliance Commercial	$1,816.64

INSERT ADM MDM X3 1236-2-852

Facility

$3,244.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.64
Max. Negotiated Rate	$3,146.68
Rate for Payer: AlohaCare Medicaid	$1,622.00
Rate for Payer: AlohaCare Medicare	$1,005.64
Rate for Payer: Cash Price	$1,946.40
Rate for Payer: Devoted Health Medicare	$1,102.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,005.64
Rate for Payer: Hawaii Western Management Group Commercial	$2,270.80
Rate for Payer: Health Management Network Commercial	$2,757.40
Rate for Payer: Humana Medicare	$1,005.64
Rate for Payer: Kaiser Permanente Commercial	$2,919.60
Rate for Payer: Kaiser Permanente Medicaid	$1,654.44
Rate for Payer: Kaiser Permanente Medicare	$1,005.64
Rate for Payer: MDX Hawaii PPO	$3,146.68
Rate for Payer: Ohana Health Plan Medicaid	$1,005.64
Rate for Payer: Ohana Health Plan Medicare	$1,005.64
Rate for Payer: UnitedHealthcare Medicare	$1,005.64
Rate for Payer: University Health Alliance Commercial	$1,816.64

INSERT ADM/MDM X3 1236-2-854

Facility

$3,244.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.64
Max. Negotiated Rate	$3,146.68
Rate for Payer: AlohaCare Medicaid	$1,622.00
Rate for Payer: AlohaCare Medicare	$1,005.64
Rate for Payer: Cash Price	$1,946.40
Rate for Payer: Devoted Health Medicare	$1,102.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,005.64
Rate for Payer: Hawaii Western Management Group Commercial	$2,270.80
Rate for Payer: Health Management Network Commercial	$2,757.40
Rate for Payer: Humana Medicare	$1,005.64
Rate for Payer: Kaiser Permanente Commercial	$2,919.60
Rate for Payer: Kaiser Permanente Medicaid	$1,654.44
Rate for Payer: Kaiser Permanente Medicare	$1,005.64
Rate for Payer: MDX Hawaii PPO	$3,146.68
Rate for Payer: Ohana Health Plan Medicaid	$1,005.64
Rate for Payer: Ohana Health Plan Medicare	$1,005.64
Rate for Payer: UnitedHealthcare Medicare	$1,005.64
Rate for Payer: University Health Alliance Commercial	$1,816.64

Know your out-of-pocket cost for care.

All Charges