Kau Hospital

All Charges

Charge

Type

Setting

Price

MALIGNANT BREAST DISORDERS WITH CC

Facility

$51,978.49

Service Code	MSDRG 598
Min. Negotiated Rate	$51,978.49
Max. Negotiated Rate	$51,978.49
Rate for Payer: Hawaii Medical Service Association Commercial	$51,978.49

MALIGNANT BREAST DISORDERS WITH MCC

Facility

$51,978.49

Service Code	MSDRG 597
Min. Negotiated Rate	$51,978.49
Max. Negotiated Rate	$51,978.49
Rate for Payer: Hawaii Medical Service Association Commercial	$51,978.49

MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$1,753.95

Service Code	MSDRG 599
Min. Negotiated Rate	$1,753.95
Max. Negotiated Rate	$1,753.95
Rate for Payer: Hawaii Medical Service Association Commercial	$1,753.95

MANDIBLE PLATE 3X3 04.503.716

Facility

$2,530.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,416.80
Max. Negotiated Rate	$2,454.10
Rate for Payer: Cash Price	$1,518.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,771.00
Rate for Payer: Health Management Network Commercial	$2,150.50
Rate for Payer: Kaiser Permanente Commercial	$2,277.00
Rate for Payer: MDX Hawaii PPO	$2,454.10
Rate for Payer: University Health Alliance Commercial	$1,416.80

MANDIBLE PLATE 3X3 04.503.716

Facility

$2,530.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$784.30
Max. Negotiated Rate	$2,454.10
Rate for Payer: AlohaCare Medicaid	$1,265.00
Rate for Payer: AlohaCare Medicare	$784.30
Rate for Payer: Cash Price	$1,518.00
Rate for Payer: Devoted Health Medicare	$860.20
Rate for Payer: Hawaii Medical Service Association Medicare	$784.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,771.00
Rate for Payer: Health Management Network Commercial	$2,150.50
Rate for Payer: Humana Medicare	$784.30
Rate for Payer: Kaiser Permanente Commercial	$2,277.00
Rate for Payer: Kaiser Permanente Medicaid	$1,290.30
Rate for Payer: Kaiser Permanente Medicare	$784.30
Rate for Payer: MDX Hawaii PPO	$2,454.10
Rate for Payer: Ohana Health Plan Medicaid	$784.30
Rate for Payer: Ohana Health Plan Medicare	$784.30
Rate for Payer: UnitedHealthcare Medicare	$784.30
Rate for Payer: University Health Alliance Commercial	$1,416.80

MANDIBLE RAMUS 4.0 04.305.100

Facility

$2,668.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,494.08
Max. Negotiated Rate	$2,587.96
Rate for Payer: Cash Price	$1,600.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,867.60
Rate for Payer: Health Management Network Commercial	$2,267.80
Rate for Payer: Kaiser Permanente Commercial	$2,401.20
Rate for Payer: MDX Hawaii PPO	$2,587.96
Rate for Payer: University Health Alliance Commercial	$1,494.08

MANDIBLE RAMUS 4.0 04.305.100

Facility

$2,668.00

Hospital Revenue Code	278
Min. Negotiated Rate	$827.08
Max. Negotiated Rate	$2,587.96
Rate for Payer: AlohaCare Medicaid	$1,334.00
Rate for Payer: AlohaCare Medicare	$827.08
Rate for Payer: Cash Price	$1,600.80
Rate for Payer: Devoted Health Medicare	$907.12
Rate for Payer: Hawaii Medical Service Association Medicare	$827.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,867.60
Rate for Payer: Health Management Network Commercial	$2,267.80
Rate for Payer: Humana Medicare	$827.08
Rate for Payer: Kaiser Permanente Commercial	$2,401.20
Rate for Payer: Kaiser Permanente Medicaid	$1,360.68
Rate for Payer: Kaiser Permanente Medicare	$827.08
Rate for Payer: MDX Hawaii PPO	$2,587.96
Rate for Payer: Ohana Health Plan Medicaid	$827.08
Rate for Payer: Ohana Health Plan Medicare	$827.08
Rate for Payer: UnitedHealthcare Medicare	$827.08
Rate for Payer: University Health Alliance Commercial	$1,494.08

MANNITOL 20 % INTRAVENOUS SOLUTION [4749]

Facility

$98.00

Service Code	NDC 00990771512
Hospital Revenue Code	250
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$95.06
Rate for Payer: Cash Price	$58.80
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: MDX Hawaii PPO	$95.06

MANNITOL 20 % INTRAVENOUS SOLUTION [4749]

Facility

$81.00

Service Code	NDC 00990771503
Hospital Revenue Code	250
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$48.60
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: Kaiser Permanente Commercial	$72.90
Rate for Payer: MDX Hawaii PPO	$78.57

MANNITOL 20 % INTRAVENOUS SOLUTION [4749]

Facility

$81.00

Service Code	NDC 00990771513
Hospital Revenue Code	250
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$48.60
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: Kaiser Permanente Commercial	$72.90
Rate for Payer: MDX Hawaii PPO	$78.57

MANNITOL 25 % INTRAVENOUS SOLUTION [4750]

Facility

$26.00

Service Code	HCPCS J2150
Hospital Revenue Code	636
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$25.22
Rate for Payer: AlohaCare Medicaid	$13.00
Rate for Payer: AlohaCare Medicare	$8.06
Rate for Payer: Cash Price	$15.60
Rate for Payer: Cash Price	$15.60
Rate for Payer: Devoted Health Medicare	$8.84
Rate for Payer: Hawaii Medical Service Association ABD	$2.24
Rate for Payer: Hawaii Medical Service Association Medicare	$8.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.24
Rate for Payer: Hawaii Western Management Group Commercial	$24.70
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Humana Medicare	$8.06
Rate for Payer: Kaiser Permanente Commercial	$23.40
Rate for Payer: Kaiser Permanente Medicaid	$13.26
Rate for Payer: Kaiser Permanente Medicare	$8.06
Rate for Payer: MDX Hawaii PPO	$25.22
Rate for Payer: Ohana Health Plan Medicaid	$8.06
Rate for Payer: Ohana Health Plan Medicare	$8.06
Rate for Payer: UnitedHealthcare Medicaid	$15.60
Rate for Payer: UnitedHealthcare Medicare	$8.06
Rate for Payer: University Health Alliance Commercial	$18.95

MANNITOL 25 % INTRAVENOUS SOLUTION [4750]

Facility

$26.00

Service Code	HCPCS J2150
Hospital Revenue Code	250
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$15.60
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Kaiser Permanente Commercial	$23.40
Rate for Payer: MDX Hawaii PPO	$25.22

MARGETUXIMAB-CMKB 25 MG/ML INTRAVENOUS SOLUTION [177326]

Facility

$12,417.00

Service Code	HCPCS J9353
Hospital Revenue Code	636
Min. Negotiated Rate	$50.45
Max. Negotiated Rate	$12,044.49
Rate for Payer: AlohaCare Medicaid	$6,208.50
Rate for Payer: AlohaCare Medicaid	$2,406.50
Rate for Payer: AlohaCare Medicare	$1,492.03
Rate for Payer: AlohaCare Medicare	$3,849.27
Rate for Payer: Cash Price	$7,450.20
Rate for Payer: Cash Price	$7,450.20
Rate for Payer: Cash Price	$2,887.80
Rate for Payer: Cash Price	$2,887.80
Rate for Payer: Devoted Health Medicare	$4,221.78
Rate for Payer: Devoted Health Medicare	$1,636.42
Rate for Payer: Hawaii Medical Service Association ABD	$50.45
Rate for Payer: Hawaii Medical Service Association ABD	$50.45
Rate for Payer: Hawaii Medical Service Association Commercial	$66.59
Rate for Payer: Hawaii Medical Service Association Commercial	$66.59
Rate for Payer: Hawaii Medical Service Association Medicare	$3,849.27
Rate for Payer: Hawaii Medical Service Association Medicare	$1,492.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.45
Rate for Payer: Hawaii Western Management Group Commercial	$11,796.15
Rate for Payer: Hawaii Western Management Group Commercial	$4,572.35
Rate for Payer: Health Management Network Commercial	$10,554.45
Rate for Payer: Health Management Network Commercial	$4,091.05
Rate for Payer: Humana Medicare	$3,849.27
Rate for Payer: Humana Medicare	$1,492.03
Rate for Payer: Kaiser Permanente Commercial	$11,175.30
Rate for Payer: Kaiser Permanente Commercial	$4,331.70
Rate for Payer: Kaiser Permanente Medicaid	$6,332.67
Rate for Payer: Kaiser Permanente Medicaid	$2,454.63
Rate for Payer: Kaiser Permanente Medicare	$3,849.27
Rate for Payer: Kaiser Permanente Medicare	$1,492.03
Rate for Payer: MDX Hawaii PPO	$12,044.49
Rate for Payer: MDX Hawaii PPO	$4,668.61
Rate for Payer: Ohana Health Plan Medicaid	$1,492.03
Rate for Payer: Ohana Health Plan Medicaid	$3,849.27
Rate for Payer: Ohana Health Plan Medicare	$3,849.27
Rate for Payer: Ohana Health Plan Medicare	$1,492.03
Rate for Payer: UnitedHealthcare Medicaid	$7,450.20
Rate for Payer: UnitedHealthcare Medicaid	$2,887.80
Rate for Payer: UnitedHealthcare Medicare	$1,492.03
Rate for Payer: UnitedHealthcare Medicare	$3,849.27
Rate for Payer: University Health Alliance Commercial	$9,050.75
Rate for Payer: University Health Alliance Commercial	$3,508.20

MARGETUXIMAB-CMKB 25 MG/ML INTRAVENOUS SOLUTION [177326]

Facility

$12,417.00

Service Code	HCPCS J9353
Hospital Revenue Code	250
Min. Negotiated Rate	$10,554.45
Max. Negotiated Rate	$12,044.49
Rate for Payer: Cash Price	$7,450.20
Rate for Payer: Cash Price	$2,887.80
Rate for Payer: Health Management Network Commercial	$4,091.05
Rate for Payer: Health Management Network Commercial	$10,554.45
Rate for Payer: Kaiser Permanente Commercial	$11,175.30
Rate for Payer: Kaiser Permanente Commercial	$4,331.70
Rate for Payer: MDX Hawaii PPO	$12,044.49
Rate for Payer: MDX Hawaii PPO	$4,668.61

MARKERS MARGIN PAINT MMS6/MMC6

Facility

$421.00

Hospital Revenue Code	272
Min. Negotiated Rate	$357.85
Max. Negotiated Rate	$408.37
Rate for Payer: Cash Price	$252.60
Rate for Payer: Health Management Network Commercial	$357.85
Rate for Payer: Kaiser Permanente Commercial	$378.90
Rate for Payer: MDX Hawaii PPO	$408.37

MARKERS MARGIN PAINT MMS6/MMC6

Facility

$421.00

Hospital Revenue Code	272
Min. Negotiated Rate	$130.51
Max. Negotiated Rate	$408.37
Rate for Payer: AlohaCare Medicaid	$210.50
Rate for Payer: AlohaCare Medicare	$130.51
Rate for Payer: Cash Price	$252.60
Rate for Payer: Devoted Health Medicare	$143.14
Rate for Payer: Hawaii Medical Service Association Medicare	$130.51
Rate for Payer: Hawaii Western Management Group Commercial	$399.95
Rate for Payer: Health Management Network Commercial	$357.85
Rate for Payer: Humana Medicare	$130.51
Rate for Payer: Kaiser Permanente Commercial	$378.90
Rate for Payer: Kaiser Permanente Medicaid	$214.71
Rate for Payer: Kaiser Permanente Medicare	$130.51
Rate for Payer: MDX Hawaii PPO	$408.37
Rate for Payer: Ohana Health Plan Medicaid	$130.51
Rate for Payer: Ohana Health Plan Medicare	$130.51
Rate for Payer: UnitedHealthcare Medicare	$130.51
Rate for Payer: University Health Alliance Commercial	$306.87

MARYLAND XP INLINESEAL DIVIDER

Facility

$1,782.00

Hospital Revenue Code	272
Min. Negotiated Rate	$552.42
Max. Negotiated Rate	$1,728.54
Rate for Payer: AlohaCare Medicaid	$891.00
Rate for Payer: AlohaCare Medicare	$552.42
Rate for Payer: Cash Price	$1,069.20
Rate for Payer: Devoted Health Medicare	$605.88
Rate for Payer: Hawaii Medical Service Association Medicare	$552.42
Rate for Payer: Hawaii Western Management Group Commercial	$1,692.90
Rate for Payer: Health Management Network Commercial	$1,514.70
Rate for Payer: Humana Medicare	$552.42
Rate for Payer: Kaiser Permanente Commercial	$1,603.80
Rate for Payer: Kaiser Permanente Medicaid	$908.82
Rate for Payer: Kaiser Permanente Medicare	$552.42
Rate for Payer: MDX Hawaii PPO	$1,728.54
Rate for Payer: Ohana Health Plan Medicaid	$552.42
Rate for Payer: Ohana Health Plan Medicare	$552.42
Rate for Payer: UnitedHealthcare Medicare	$552.42
Rate for Payer: University Health Alliance Commercial	$1,298.90

MARYLAND XP INLINESEAL DIVIDER

Facility

$1,782.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,514.70
Max. Negotiated Rate	$1,728.54
Rate for Payer: Cash Price	$1,069.20
Rate for Payer: Health Management Network Commercial	$1,514.70
Rate for Payer: Kaiser Permanente Commercial	$1,603.80
Rate for Payer: MDX Hawaii PPO	$1,728.54

MASK COMPRESSION

Facility

$132.00

Hospital Revenue Code	272
Min. Negotiated Rate	$40.92
Max. Negotiated Rate	$128.04
Rate for Payer: AlohaCare Medicaid	$66.00
Rate for Payer: AlohaCare Medicare	$40.92
Rate for Payer: Cash Price	$79.20
Rate for Payer: Devoted Health Medicare	$44.88
Rate for Payer: Hawaii Medical Service Association Medicare	$40.92
Rate for Payer: Hawaii Western Management Group Commercial	$125.40
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: Humana Medicare	$40.92
Rate for Payer: Kaiser Permanente Commercial	$118.80
Rate for Payer: Kaiser Permanente Medicaid	$67.32
Rate for Payer: Kaiser Permanente Medicare	$40.92
Rate for Payer: MDX Hawaii PPO	$128.04
Rate for Payer: Ohana Health Plan Medicaid	$40.92
Rate for Payer: Ohana Health Plan Medicare	$40.92
Rate for Payer: UnitedHealthcare Medicare	$40.92
Rate for Payer: University Health Alliance Commercial	$96.21

MASK COMPRESSION

Facility

$132.00

Hospital Revenue Code	272
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$128.04
Rate for Payer: Cash Price	$79.20
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: Kaiser Permanente Commercial	$118.80
Rate for Payer: MDX Hawaii PPO	$128.04

MASTECTOMY FOR MALIGNANCY WITH CC/MCC

Facility

$25,029.31

Service Code	MSDRG 582
Min. Negotiated Rate	$25,029.31
Max. Negotiated Rate	$25,029.31
Rate for Payer: Hawaii Medical Service Association Commercial	$25,029.31

MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC

Facility

$22,848.73

Service Code	MSDRG 583
Min. Negotiated Rate	$22,848.73
Max. Negotiated Rate	$22,848.73
Rate for Payer: Hawaii Medical Service Association Commercial	$22,848.73

MATCHSTICK 3.0MM 5220-107-530

Facility

$434.00

Hospital Revenue Code	272
Min. Negotiated Rate	$368.90
Max. Negotiated Rate	$420.98
Rate for Payer: Cash Price	$260.40
Rate for Payer: Health Management Network Commercial	$368.90
Rate for Payer: Kaiser Permanente Commercial	$390.60
Rate for Payer: MDX Hawaii PPO	$420.98

MATCHSTICK 3.0MM 5220-107-530

Facility

$434.00

Hospital Revenue Code	272
Min. Negotiated Rate	$134.54
Max. Negotiated Rate	$420.98
Rate for Payer: AlohaCare Medicaid	$217.00
Rate for Payer: AlohaCare Medicare	$134.54
Rate for Payer: Cash Price	$260.40
Rate for Payer: Devoted Health Medicare	$147.56
Rate for Payer: Hawaii Medical Service Association Medicare	$134.54
Rate for Payer: Hawaii Western Management Group Commercial	$412.30
Rate for Payer: Health Management Network Commercial	$368.90
Rate for Payer: Humana Medicare	$134.54
Rate for Payer: Kaiser Permanente Commercial	$390.60
Rate for Payer: Kaiser Permanente Medicaid	$221.34
Rate for Payer: Kaiser Permanente Medicare	$134.54
Rate for Payer: MDX Hawaii PPO	$420.98
Rate for Payer: Ohana Health Plan Medicaid	$134.54
Rate for Payer: Ohana Health Plan Medicare	$134.54
Rate for Payer: UnitedHealthcare Medicare	$134.54
Rate for Payer: University Health Alliance Commercial	$316.34

MATRIXMAND 1.5 DB 03.503.408

Facility

$1,131.00

Hospital Revenue Code	272
Min. Negotiated Rate	$350.61
Max. Negotiated Rate	$1,097.07
Rate for Payer: AlohaCare Medicaid	$565.50
Rate for Payer: AlohaCare Medicare	$350.61
Rate for Payer: Cash Price	$678.60
Rate for Payer: Devoted Health Medicare	$384.54
Rate for Payer: Hawaii Medical Service Association Medicare	$350.61
Rate for Payer: Hawaii Western Management Group Commercial	$1,074.45
Rate for Payer: Health Management Network Commercial	$961.35
Rate for Payer: Humana Medicare	$350.61
Rate for Payer: Kaiser Permanente Commercial	$1,017.90
Rate for Payer: Kaiser Permanente Medicaid	$576.81
Rate for Payer: Kaiser Permanente Medicare	$350.61
Rate for Payer: MDX Hawaii PPO	$1,097.07
Rate for Payer: Ohana Health Plan Medicaid	$350.61
Rate for Payer: Ohana Health Plan Medicare	$350.61
Rate for Payer: UnitedHealthcare Medicare	$350.61
Rate for Payer: University Health Alliance Commercial	$824.39

Know your out-of-pocket cost for care.

All Charges