Kau Hospital

All Charges

Charge

Type

Setting

Price

OPTISEAL VALVED INTROD 9X13

Facility

$910.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$282.10
Max. Negotiated Rate	$882.70
Rate for Payer: AlohaCare Medicaid	$455.00
Rate for Payer: AlohaCare Medicare	$282.10
Rate for Payer: Cash Price	$546.00
Rate for Payer: Devoted Health Medicare	$309.40
Rate for Payer: Hawaii Medical Service Association Medicare	$282.10
Rate for Payer: Hawaii Western Management Group Commercial	$864.50
Rate for Payer: Health Management Network Commercial	$773.50
Rate for Payer: Humana Medicare	$282.10
Rate for Payer: Kaiser Permanente Commercial	$819.00
Rate for Payer: Kaiser Permanente Medicaid	$464.10
Rate for Payer: Kaiser Permanente Medicare	$282.10
Rate for Payer: MDX Hawaii PPO	$882.70
Rate for Payer: Ohana Health Plan Medicaid	$282.10
Rate for Payer: Ohana Health Plan Medicare	$282.10
Rate for Payer: UnitedHealthcare Medicare	$282.10
Rate for Payer: University Health Alliance Commercial	$663.30

OPTISEAL VALVED INTROD 9X13

Facility

$910.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$773.50
Max. Negotiated Rate	$882.70
Rate for Payer: Cash Price	$546.00
Rate for Payer: Health Management Network Commercial	$773.50
Rate for Payer: Kaiser Permanente Commercial	$819.00
Rate for Payer: MDX Hawaii PPO	$882.70

OPTITORQUE TIGER 6F 4X100

Facility

$225.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$69.75
Rate for Payer: Cash Price	$135.00
Rate for Payer: Devoted Health Medicare	$76.50
Rate for Payer: Hawaii Medical Service Association Medicare	$69.75
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$69.75
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$69.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$69.75
Rate for Payer: Ohana Health Plan Medicare	$69.75
Rate for Payer: UnitedHealthcare Medicare	$69.75
Rate for Payer: University Health Alliance Commercial	$164.00

OPTITORQUE TIGER 6F 4X100

Facility

$225.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

ORBITAL PROCEDURES WITH CC/MCC

Facility

$19,103.81

Service Code	MSDRG 113
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$19,103.81
Rate for Payer: Hawaii Medical Service Association Commercial	$19,103.81
Rate for Payer: University Health Alliance Commercial	$10,400.00

ORBITAL PROCEDURES WITHOUT CC/MCC

Facility

$19,103.81

Service Code	MSDRG 114
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$19,103.81
Rate for Payer: Hawaii Medical Service Association Commercial	$19,103.81
Rate for Payer: University Health Alliance Commercial	$10,400.00

ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY

Facility

$25,669.27

Service Code	MSDRG 884
Min. Negotiated Rate	$25,669.27
Max. Negotiated Rate	$25,669.27
Rate for Payer: Hawaii Medical Service Association Commercial	$25,669.27

O.R. PROCEDURES FOR OBESITY WITH CC

Facility

$51,717.76

Service Code	MSDRG 620
Min. Negotiated Rate	$51,717.76
Max. Negotiated Rate	$51,717.76
Rate for Payer: Hawaii Medical Service Association Commercial	$51,717.76

O.R. PROCEDURES FOR OBESITY WITH MCC

Facility

$51,717.76

Service Code	MSDRG 619
Min. Negotiated Rate	$51,717.76
Max. Negotiated Rate	$51,717.76
Rate for Payer: Hawaii Medical Service Association Commercial	$51,717.76

O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC

Facility

$51,504.45

Service Code	MSDRG 621
Min. Negotiated Rate	$51,504.45
Max. Negotiated Rate	$51,504.45
Rate for Payer: Hawaii Medical Service Association Commercial	$51,504.45

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC

Facility

$38,586.86

Service Code	MSDRG 940
Min. Negotiated Rate	$38,586.86
Max. Negotiated Rate	$38,586.86
Rate for Payer: Hawaii Medical Service Association Commercial	$38,586.86

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC

Facility

$38,586.86

Service Code	MSDRG 939
Min. Negotiated Rate	$38,586.86
Max. Negotiated Rate	$38,586.86
Rate for Payer: Hawaii Medical Service Association Commercial	$38,586.86

O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC

Facility

$38,586.86

Service Code	MSDRG 941
Min. Negotiated Rate	$38,586.86
Max. Negotiated Rate	$38,586.86
Rate for Payer: Hawaii Medical Service Association Commercial	$38,586.86

O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS

Facility

$85,990.86

Service Code	MSDRG 876
Min. Negotiated Rate	$85,990.86
Max. Negotiated Rate	$85,990.86
Rate for Payer: Hawaii Medical Service Association Commercial	$85,990.86

ORTHALIGN PLUS 403001

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,912.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: MDX Hawaii PPO	$2,182.50

ORTHALIGN PLUS 403001

Facility

$2,250.00

Hospital Revenue Code	272
Min. Negotiated Rate	$697.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: AlohaCare Medicaid	$1,125.00
Rate for Payer: AlohaCare Medicare	$697.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Devoted Health Medicare	$765.00
Rate for Payer: Hawaii Medical Service Association Medicare	$697.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,137.50
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Humana Medicare	$697.50
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: Kaiser Permanente Medicaid	$1,147.50
Rate for Payer: Kaiser Permanente Medicare	$697.50
Rate for Payer: MDX Hawaii PPO	$2,182.50
Rate for Payer: Ohana Health Plan Medicaid	$697.50
Rate for Payer: Ohana Health Plan Medicare	$697.50
Rate for Payer: UnitedHealthcare Medicare	$697.50
Rate for Payer: University Health Alliance Commercial	$1,640.03

OSELTAMIVIR 30 MG CAPSULE [88704]

Facility

$36.00

Service Code	NDC 68180067511
Hospital Revenue Code	637
Min. Negotiated Rate	$11.16
Max. Negotiated Rate	$34.92
Rate for Payer: AlohaCare Medicaid	$18.00
Rate for Payer: AlohaCare Medicare	$11.16
Rate for Payer: Cash Price	$21.60
Rate for Payer: Devoted Health Medicare	$12.24
Rate for Payer: Hawaii Medical Service Association Medicare	$11.16
Rate for Payer: Hawaii Western Management Group Commercial	$34.20
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Humana Medicare	$11.16
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: Kaiser Permanente Medicare	$11.16
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: Ohana Health Plan Medicaid	$11.16
Rate for Payer: Ohana Health Plan Medicare	$11.16
Rate for Payer: UnitedHealthcare Medicare	$11.16
Rate for Payer: University Health Alliance Commercial	$26.24

OSELTAMIVIR 30 MG CAPSULE [88704]

Facility

$36.00

Service Code	NDC 68180067511
Hospital Revenue Code	250
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$21.60
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: MDX Hawaii PPO	$34.92

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [110998]

Facility

$247.00

Service Code	NDC 70710116506
Hospital Revenue Code	250
Min. Negotiated Rate	$209.95
Max. Negotiated Rate	$239.59
Rate for Payer: Cash Price	$148.20
Rate for Payer: Health Management Network Commercial	$209.95
Rate for Payer: Kaiser Permanente Commercial	$222.30
Rate for Payer: MDX Hawaii PPO	$239.59

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [110998]

Facility

$247.00

Service Code	NDC 70710116506
Hospital Revenue Code	637
Min. Negotiated Rate	$76.57
Max. Negotiated Rate	$239.59
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$76.57
Rate for Payer: Cash Price	$148.20
Rate for Payer: Devoted Health Medicare	$83.98
Rate for Payer: Hawaii Medical Service Association Medicare	$76.57
Rate for Payer: Hawaii Western Management Group Commercial	$234.65
Rate for Payer: Health Management Network Commercial	$209.95
Rate for Payer: Humana Medicare	$76.57
Rate for Payer: Kaiser Permanente Commercial	$222.30
Rate for Payer: Kaiser Permanente Medicaid	$125.97
Rate for Payer: Kaiser Permanente Medicare	$76.57
Rate for Payer: MDX Hawaii PPO	$239.59
Rate for Payer: Ohana Health Plan Medicaid	$76.57
Rate for Payer: Ohana Health Plan Medicare	$76.57
Rate for Payer: UnitedHealthcare Medicare	$76.57
Rate for Payer: University Health Alliance Commercial	$180.04

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [110998]

Facility

$247.00

Service Code	NDC 27241013909
Hospital Revenue Code	250
Min. Negotiated Rate	$209.95
Max. Negotiated Rate	$239.59
Rate for Payer: Cash Price	$148.20
Rate for Payer: Health Management Network Commercial	$209.95
Rate for Payer: Kaiser Permanente Commercial	$222.30
Rate for Payer: MDX Hawaii PPO	$239.59

OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [110998]

Facility

$247.00

Service Code	NDC 27241013909
Hospital Revenue Code	637
Min. Negotiated Rate	$76.57
Max. Negotiated Rate	$239.59
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$76.57
Rate for Payer: Cash Price	$148.20
Rate for Payer: Devoted Health Medicare	$83.98
Rate for Payer: Hawaii Medical Service Association Medicare	$76.57
Rate for Payer: Hawaii Western Management Group Commercial	$234.65
Rate for Payer: Health Management Network Commercial	$209.95
Rate for Payer: Humana Medicare	$76.57
Rate for Payer: Kaiser Permanente Commercial	$222.30
Rate for Payer: Kaiser Permanente Medicaid	$125.97
Rate for Payer: Kaiser Permanente Medicare	$76.57
Rate for Payer: MDX Hawaii PPO	$239.59
Rate for Payer: Ohana Health Plan Medicaid	$76.57
Rate for Payer: Ohana Health Plan Medicare	$76.57
Rate for Payer: UnitedHealthcare Medicare	$76.57
Rate for Payer: University Health Alliance Commercial	$180.04

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$39.00

Service Code	NDC 68180067711
Hospital Revenue Code	250
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$37.83
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: MDX Hawaii PPO	$37.83

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$39.00

Service Code	NDC 64380079901
Hospital Revenue Code	637
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$37.83
Rate for Payer: AlohaCare Medicaid	$19.50
Rate for Payer: AlohaCare Medicare	$12.09
Rate for Payer: Cash Price	$23.40
Rate for Payer: Devoted Health Medicare	$13.26
Rate for Payer: Hawaii Medical Service Association Medicare	$12.09
Rate for Payer: Hawaii Western Management Group Commercial	$37.05
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Humana Medicare	$12.09
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: Kaiser Permanente Medicare	$12.09
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: Ohana Health Plan Medicaid	$12.09
Rate for Payer: Ohana Health Plan Medicare	$12.09
Rate for Payer: UnitedHealthcare Medicare	$12.09
Rate for Payer: University Health Alliance Commercial	$28.43

OSELTAMIVIR 75 MG CAPSULE [26546]

Facility

$39.00

Service Code	NDC 68180067711
Hospital Revenue Code	637
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$37.83
Rate for Payer: AlohaCare Medicaid	$19.50
Rate for Payer: AlohaCare Medicare	$12.09
Rate for Payer: Cash Price	$23.40
Rate for Payer: Devoted Health Medicare	$13.26
Rate for Payer: Hawaii Medical Service Association Medicare	$12.09
Rate for Payer: Hawaii Western Management Group Commercial	$37.05
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Humana Medicare	$12.09
Rate for Payer: Kaiser Permanente Commercial	$35.10
Rate for Payer: Kaiser Permanente Medicaid	$19.89
Rate for Payer: Kaiser Permanente Medicare	$12.09
Rate for Payer: MDX Hawaii PPO	$37.83
Rate for Payer: Ohana Health Plan Medicaid	$12.09
Rate for Payer: Ohana Health Plan Medicare	$12.09
Rate for Payer: UnitedHealthcare Medicare	$12.09
Rate for Payer: University Health Alliance Commercial	$28.43

Know your out-of-pocket cost for care.

All Charges