Kau Hospital

All Charges

Charge

Type

Setting

Price

NATRELLE STY SALINE 68HP-700

Facility

$1,050.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$325.50
Max. Negotiated Rate	$1,018.50
Rate for Payer: AlohaCare Medicaid	$525.00
Rate for Payer: AlohaCare Medicare	$325.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Devoted Health Medicare	$357.00
Rate for Payer: Hawaii Medical Service Association Medicare	$325.50
Rate for Payer: Hawaii Western Management Group Commercial	$735.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Humana Medicare	$325.50
Rate for Payer: Kaiser Permanente Commercial	$945.00
Rate for Payer: Kaiser Permanente Medicaid	$535.50
Rate for Payer: Kaiser Permanente Medicare	$325.50
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: Ohana Health Plan Medicaid	$325.50
Rate for Payer: Ohana Health Plan Medicare	$325.50
Rate for Payer: UnitedHealthcare Medicare	$325.50
Rate for Payer: University Health Alliance Commercial	$588.00

NATRELLE STY SALINE 68HP-800

Facility

$1,050.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$325.50
Max. Negotiated Rate	$1,018.50
Rate for Payer: AlohaCare Medicaid	$525.00
Rate for Payer: AlohaCare Medicare	$325.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Devoted Health Medicare	$357.00
Rate for Payer: Hawaii Medical Service Association Medicare	$325.50
Rate for Payer: Hawaii Western Management Group Commercial	$735.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Humana Medicare	$325.50
Rate for Payer: Kaiser Permanente Commercial	$945.00
Rate for Payer: Kaiser Permanente Medicaid	$535.50
Rate for Payer: Kaiser Permanente Medicare	$325.50
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: Ohana Health Plan Medicaid	$325.50
Rate for Payer: Ohana Health Plan Medicare	$325.50
Rate for Payer: UnitedHealthcare Medicare	$325.50
Rate for Payer: University Health Alliance Commercial	$588.00

NATRELLE STY SALINE 68HP-800

Facility

$1,050.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$588.00
Max. Negotiated Rate	$1,018.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Hawaii Western Management Group Commercial	$735.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Kaiser Permanente Commercial	$945.00
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: University Health Alliance Commercial	$588.00

NATURELLE STY SALINE 684HP-500

Facility

$1,050.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$325.50
Max. Negotiated Rate	$1,018.50
Rate for Payer: AlohaCare Medicaid	$525.00
Rate for Payer: AlohaCare Medicare	$325.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Devoted Health Medicare	$357.00
Rate for Payer: Hawaii Medical Service Association Medicare	$325.50
Rate for Payer: Hawaii Western Management Group Commercial	$735.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Humana Medicare	$325.50
Rate for Payer: Kaiser Permanente Commercial	$945.00
Rate for Payer: Kaiser Permanente Medicaid	$535.50
Rate for Payer: Kaiser Permanente Medicare	$325.50
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: Ohana Health Plan Medicaid	$325.50
Rate for Payer: Ohana Health Plan Medicare	$325.50
Rate for Payer: UnitedHealthcare Medicare	$325.50
Rate for Payer: University Health Alliance Commercial	$588.00

NATURELLE STY SALINE 684HP-500

Facility

$1,050.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$588.00
Max. Negotiated Rate	$1,018.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Hawaii Western Management Group Commercial	$735.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Kaiser Permanente Commercial	$945.00
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: University Health Alliance Commercial	$588.00

NEBIVOLOL 5 MG TABLET [89284]

Facility

$13.00

Service Code	NDC 60687064121
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

NEBIVOLOL 5 MG TABLET [89284]

Facility

$13.00

Service Code	NDC 60687064111
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

NEBIVOLOL 5 MG TABLET [89284]

Facility

$13.00

Service Code	NDC 60687064111
Hospital Revenue Code	637
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$12.61
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$4.03
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$4.42
Rate for Payer: Hawaii Medical Service Association Medicare	$4.03
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Humana Medicare	$4.03
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$4.03
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: Ohana Health Plan Medicaid	$4.03
Rate for Payer: Ohana Health Plan Medicare	$4.03
Rate for Payer: UnitedHealthcare Medicare	$4.03
Rate for Payer: University Health Alliance Commercial	$9.48

NEBIVOLOL 5 MG TABLET [89284]

Facility

$13.00

Service Code	NDC 60687064121
Hospital Revenue Code	637
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$12.61
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$4.03
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$4.42
Rate for Payer: Hawaii Medical Service Association Medicare	$4.03
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Humana Medicare	$4.03
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$4.03
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: Ohana Health Plan Medicaid	$4.03
Rate for Payer: Ohana Health Plan Medicare	$4.03
Rate for Payer: UnitedHealthcare Medicare	$4.03
Rate for Payer: University Health Alliance Commercial	$9.48

NEEDLE 10X3.25 DECOMPRESSION

Facility

$108.00

Hospital Revenue Code	272
Min. Negotiated Rate	$33.48
Max. Negotiated Rate	$104.76
Rate for Payer: AlohaCare Medicaid	$54.00
Rate for Payer: AlohaCare Medicare	$33.48
Rate for Payer: Cash Price	$64.80
Rate for Payer: Devoted Health Medicare	$36.72
Rate for Payer: Hawaii Medical Service Association Medicare	$33.48
Rate for Payer: Hawaii Western Management Group Commercial	$102.60
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Humana Medicare	$33.48
Rate for Payer: Kaiser Permanente Commercial	$97.20
Rate for Payer: Kaiser Permanente Medicaid	$55.08
Rate for Payer: Kaiser Permanente Medicare	$33.48
Rate for Payer: MDX Hawaii PPO	$104.76
Rate for Payer: Ohana Health Plan Medicaid	$33.48
Rate for Payer: Ohana Health Plan Medicare	$33.48
Rate for Payer: UnitedHealthcare Medicare	$33.48
Rate for Payer: University Health Alliance Commercial	$78.72

NEEDLE 10X3.25 DECOMPRESSION

Facility

$108.00

Hospital Revenue Code	272
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$64.80
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Kaiser Permanente Commercial	$97.20
Rate for Payer: MDX Hawaii PPO	$104.76

NEEDLE 14G BIOPSY SOFT TISSUE

Facility

$96.00

Hospital Revenue Code	272
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$57.60
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12

NEEDLE 14G BIOPSY SOFT TISSUE

Facility

$96.00

Hospital Revenue Code	272
Min. Negotiated Rate	$29.76
Max. Negotiated Rate	$93.12
Rate for Payer: AlohaCare Medicaid	$48.00
Rate for Payer: AlohaCare Medicare	$29.76
Rate for Payer: Cash Price	$57.60
Rate for Payer: Devoted Health Medicare	$32.64
Rate for Payer: Hawaii Medical Service Association Medicare	$29.76
Rate for Payer: Hawaii Western Management Group Commercial	$91.20
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Humana Medicare	$29.76
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: Kaiser Permanente Medicare	$29.76
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: Ohana Health Plan Medicaid	$29.76
Rate for Payer: Ohana Health Plan Medicare	$29.76
Rate for Payer: UnitedHealthcare Medicare	$29.76
Rate for Payer: University Health Alliance Commercial	$69.97

NEEDLE 14GX4.5 BIOPSY

Facility

$96.00

Hospital Revenue Code	272
Min. Negotiated Rate	$29.76
Max. Negotiated Rate	$93.12
Rate for Payer: AlohaCare Medicaid	$48.00
Rate for Payer: AlohaCare Medicare	$29.76
Rate for Payer: Cash Price	$57.60
Rate for Payer: Devoted Health Medicare	$32.64
Rate for Payer: Hawaii Medical Service Association Medicare	$29.76
Rate for Payer: Hawaii Western Management Group Commercial	$91.20
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Humana Medicare	$29.76
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: Kaiser Permanente Medicare	$29.76
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: Ohana Health Plan Medicaid	$29.76
Rate for Payer: Ohana Health Plan Medicare	$29.76
Rate for Payer: UnitedHealthcare Medicare	$29.76
Rate for Payer: University Health Alliance Commercial	$69.97

NEEDLE 14GX4.5 BIOPSY

Facility

$96.00

Hospital Revenue Code	272
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$57.60
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12

NEEDLE 150MM INSUFFLATION

Facility

$89.00

Hospital Revenue Code	272
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$53.40
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$86.33

NEEDLE 150MM INSUFFLATION

Facility

$89.00

Hospital Revenue Code	272
Min. Negotiated Rate	$27.59
Max. Negotiated Rate	$86.33
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$27.59
Rate for Payer: Cash Price	$53.40
Rate for Payer: Devoted Health Medicare	$30.26
Rate for Payer: Hawaii Medical Service Association Medicare	$27.59
Rate for Payer: Hawaii Western Management Group Commercial	$84.55
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Humana Medicare	$27.59
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicare	$27.59
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$27.59
Rate for Payer: Ohana Health Plan Medicare	$27.59
Rate for Payer: UnitedHealthcare Medicare	$27.59
Rate for Payer: University Health Alliance Commercial	$64.87

NEEDLE 15GX70MM BONE MARROW

Facility

$90.00

Hospital Revenue Code	272
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$54.00
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: MDX Hawaii PPO	$87.30

NEEDLE 15GX70MM BONE MARROW

Facility

$90.00

Hospital Revenue Code	272
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$87.30
Rate for Payer: AlohaCare Medicaid	$45.00
Rate for Payer: AlohaCare Medicare	$27.90
Rate for Payer: Cash Price	$54.00
Rate for Payer: Devoted Health Medicare	$30.60
Rate for Payer: Hawaii Medical Service Association Medicare	$27.90
Rate for Payer: Hawaii Western Management Group Commercial	$85.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Humana Medicare	$27.90
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: Kaiser Permanente Medicare	$27.90
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: Ohana Health Plan Medicaid	$27.90
Rate for Payer: Ohana Health Plan Medicare	$27.90
Rate for Payer: UnitedHealthcare Medicare	$27.90
Rate for Payer: University Health Alliance Commercial	$65.60

NEEDLE 15X13 8CM TRUGUIDE

Facility

$94.00

Hospital Revenue Code	272
Min. Negotiated Rate	$79.90
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$56.40
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Kaiser Permanente Commercial	$84.60
Rate for Payer: MDX Hawaii PPO	$91.18

NEEDLE 15X13 8CM TRUGUIDE

Facility

$94.00

Hospital Revenue Code	272
Min. Negotiated Rate	$29.14
Max. Negotiated Rate	$91.18
Rate for Payer: AlohaCare Medicaid	$47.00
Rate for Payer: AlohaCare Medicare	$29.14
Rate for Payer: Cash Price	$56.40
Rate for Payer: Devoted Health Medicare	$31.96
Rate for Payer: Hawaii Medical Service Association Medicare	$29.14
Rate for Payer: Hawaii Western Management Group Commercial	$89.30
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Humana Medicare	$29.14
Rate for Payer: Kaiser Permanente Commercial	$84.60
Rate for Payer: Kaiser Permanente Medicaid	$47.94
Rate for Payer: Kaiser Permanente Medicare	$29.14
Rate for Payer: MDX Hawaii PPO	$91.18
Rate for Payer: Ohana Health Plan Medicaid	$29.14
Rate for Payer: Ohana Health Plan Medicare	$29.14
Rate for Payer: UnitedHealthcare Medicare	$29.14
Rate for Payer: University Health Alliance Commercial	$68.52

NEEDLE 18X16 MONOPTY CORE

Facility

$141.00

Hospital Revenue Code	272
Min. Negotiated Rate	$43.71
Max. Negotiated Rate	$136.77
Rate for Payer: AlohaCare Medicaid	$70.50
Rate for Payer: AlohaCare Medicare	$43.71
Rate for Payer: Cash Price	$84.60
Rate for Payer: Devoted Health Medicare	$47.94
Rate for Payer: Hawaii Medical Service Association Medicare	$43.71
Rate for Payer: Hawaii Western Management Group Commercial	$133.95
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Humana Medicare	$43.71
Rate for Payer: Kaiser Permanente Commercial	$126.90
Rate for Payer: Kaiser Permanente Medicaid	$71.91
Rate for Payer: Kaiser Permanente Medicare	$43.71
Rate for Payer: MDX Hawaii PPO	$136.77
Rate for Payer: Ohana Health Plan Medicaid	$43.71
Rate for Payer: Ohana Health Plan Medicare	$43.71
Rate for Payer: UnitedHealthcare Medicare	$43.71
Rate for Payer: University Health Alliance Commercial	$102.77

NEEDLE 18X16 MONOPTY CORE

Facility

$141.00

Hospital Revenue Code	272
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$84.60
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Kaiser Permanente Commercial	$126.90
Rate for Payer: MDX Hawaii PPO	$136.77

NEEDLE 20G TRANSBRONCH ASP

Facility

$328.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$101.68
Max. Negotiated Rate	$318.16
Rate for Payer: AlohaCare Medicaid	$164.00
Rate for Payer: AlohaCare Medicare	$101.68
Rate for Payer: Cash Price	$196.80
Rate for Payer: Devoted Health Medicare	$111.52
Rate for Payer: Hawaii Medical Service Association Medicare	$101.68
Rate for Payer: Hawaii Western Management Group Commercial	$311.60
Rate for Payer: Health Management Network Commercial	$278.80
Rate for Payer: Humana Medicare	$101.68
Rate for Payer: Kaiser Permanente Commercial	$295.20
Rate for Payer: Kaiser Permanente Medicaid	$167.28
Rate for Payer: Kaiser Permanente Medicare	$101.68
Rate for Payer: MDX Hawaii PPO	$318.16
Rate for Payer: Ohana Health Plan Medicaid	$101.68
Rate for Payer: Ohana Health Plan Medicare	$101.68
Rate for Payer: UnitedHealthcare Medicare	$101.68
Rate for Payer: University Health Alliance Commercial	$239.08

NEEDLE 20G TRANSBRONCH ASP

Facility

$328.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$278.80
Max. Negotiated Rate	$318.16
Rate for Payer: Cash Price	$196.80
Rate for Payer: Health Management Network Commercial	$278.80
Rate for Payer: Kaiser Permanente Commercial	$295.20
Rate for Payer: MDX Hawaii PPO	$318.16

Know your out-of-pocket cost for care.

All Charges