Kau Hospital

All Charges

Charge

Type

Setting

Price

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC

Facility

$60,511.21

Service Code	MSDRG 167
Min. Negotiated Rate	$60,511.21
Max. Negotiated Rate	$60,511.21
Rate for Payer: Hawaii Medical Service Association Commercial	$60,511.21

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC

Facility

$63,497.66

Service Code	MSDRG 166
Min. Negotiated Rate	$63,497.66
Max. Negotiated Rate	$63,497.66
Rate for Payer: Hawaii Medical Service Association Commercial	$63,497.66

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$43,232.45

Service Code	MSDRG 168
Min. Negotiated Rate	$43,232.45
Max. Negotiated Rate	$43,232.45
Rate for Payer: Hawaii Medical Service Association Commercial	$43,232.45

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC

Facility

$29,295.67

Service Code	MSDRG 580
Min. Negotiated Rate	$29,295.67
Max. Negotiated Rate	$29,295.67
Rate for Payer: Hawaii Medical Service Association Commercial	$29,295.67

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC

Facility

$46,811.45

Service Code	MSDRG 579
Min. Negotiated Rate	$46,811.45
Max. Negotiated Rate	$46,811.45
Rate for Payer: Hawaii Medical Service Association Commercial	$46,811.45

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC

Facility

$24,057.53

Service Code	MSDRG 581
Min. Negotiated Rate	$24,057.53
Max. Negotiated Rate	$24,057.53
Rate for Payer: Hawaii Medical Service Association Commercial	$24,057.53

OTHER VASCULAR PROCEDURES WITH CC

Facility

$67,550.70

Service Code	MSDRG 253
Min. Negotiated Rate	$67,550.70
Max. Negotiated Rate	$67,550.70
Rate for Payer: Hawaii Medical Service Association Commercial	$67,550.70

OTHER VASCULAR PROCEDURES WITH MCC

Facility

$71,911.87

Service Code	MSDRG 252
Min. Negotiated Rate	$71,911.87
Max. Negotiated Rate	$71,911.87
Rate for Payer: Hawaii Medical Service Association Commercial	$71,911.87

OTHER VASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$48,826.12

Service Code	MSDRG 254
Min. Negotiated Rate	$48,826.12
Max. Negotiated Rate	$48,826.12
Rate for Payer: Hawaii Medical Service Association Commercial	$48,826.12

OTITIS MEDIA AND URI WITH MCC

Facility

$12,182.83

Service Code	MSDRG 152
Min. Negotiated Rate	$12,182.83
Max. Negotiated Rate	$12,182.83
Rate for Payer: Hawaii Medical Service Association Commercial	$12,182.83

OTITIS MEDIA AND URI WITHOUT MCC

Facility

$10,547.39

Service Code	MSDRG 153
Min. Negotiated Rate	$10,547.39
Max. Negotiated Rate	$10,547.39
Rate for Payer: Hawaii Medical Service Association Commercial	$10,547.39

OUTBOARD TL ASSM 51-10440

Facility

$1,742.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,480.70
Max. Negotiated Rate	$1,689.74
Rate for Payer: Cash Price	$1,045.20
Rate for Payer: Health Management Network Commercial	$1,480.70
Rate for Payer: Kaiser Permanente Commercial	$1,567.80
Rate for Payer: MDX Hawaii PPO	$1,689.74

OUTBOARD TL ASSM 51-10440

Facility

$1,742.00

Hospital Revenue Code	272
Min. Negotiated Rate	$540.02
Max. Negotiated Rate	$1,689.74
Rate for Payer: AlohaCare Medicaid	$871.00
Rate for Payer: AlohaCare Medicare	$540.02
Rate for Payer: Cash Price	$1,045.20
Rate for Payer: Devoted Health Medicare	$592.28
Rate for Payer: Hawaii Medical Service Association Medicare	$540.02
Rate for Payer: Hawaii Western Management Group Commercial	$1,654.90
Rate for Payer: Health Management Network Commercial	$1,480.70
Rate for Payer: Humana Medicare	$540.02
Rate for Payer: Kaiser Permanente Commercial	$1,567.80
Rate for Payer: Kaiser Permanente Medicaid	$888.42
Rate for Payer: Kaiser Permanente Medicare	$540.02
Rate for Payer: MDX Hawaii PPO	$1,689.74
Rate for Payer: Ohana Health Plan Medicaid	$540.02
Rate for Payer: Ohana Health Plan Medicare	$540.02
Rate for Payer: UnitedHealthcare Medicare	$540.02
Rate for Payer: University Health Alliance Commercial	$1,269.74

OVERDRILL 2.0 705137

Facility

$826.00

Hospital Revenue Code	272
Min. Negotiated Rate	$256.06
Max. Negotiated Rate	$801.22
Rate for Payer: AlohaCare Medicaid	$413.00
Rate for Payer: AlohaCare Medicare	$256.06
Rate for Payer: Cash Price	$495.60
Rate for Payer: Devoted Health Medicare	$280.84
Rate for Payer: Hawaii Medical Service Association Medicare	$256.06
Rate for Payer: Hawaii Western Management Group Commercial	$784.70
Rate for Payer: Health Management Network Commercial	$702.10
Rate for Payer: Humana Medicare	$256.06
Rate for Payer: Kaiser Permanente Commercial	$743.40
Rate for Payer: Kaiser Permanente Medicaid	$421.26
Rate for Payer: Kaiser Permanente Medicare	$256.06
Rate for Payer: MDX Hawaii PPO	$801.22
Rate for Payer: Ohana Health Plan Medicaid	$256.06
Rate for Payer: Ohana Health Plan Medicare	$256.06
Rate for Payer: UnitedHealthcare Medicare	$256.06
Rate for Payer: University Health Alliance Commercial	$602.07

OVERDRILL 2.0 705137

Facility

$826.00

Hospital Revenue Code	272
Min. Negotiated Rate	$702.10
Max. Negotiated Rate	$801.22
Rate for Payer: Cash Price	$495.60
Rate for Payer: Health Management Network Commercial	$702.10
Rate for Payer: Kaiser Permanente Commercial	$743.40
Rate for Payer: MDX Hawaii PPO	$801.22

OVERTUBE ENDOSCOPIC ACCESS

Facility

$798.00

Hospital Revenue Code	272
Min. Negotiated Rate	$678.30
Max. Negotiated Rate	$774.06
Rate for Payer: Cash Price	$478.80
Rate for Payer: Health Management Network Commercial	$678.30
Rate for Payer: Kaiser Permanente Commercial	$718.20
Rate for Payer: MDX Hawaii PPO	$774.06

OVERTUBE ENDOSCOPIC ACCESS

Facility

$798.00

Hospital Revenue Code	272
Min. Negotiated Rate	$247.38
Max. Negotiated Rate	$774.06
Rate for Payer: AlohaCare Medicaid	$399.00
Rate for Payer: AlohaCare Medicare	$247.38
Rate for Payer: Cash Price	$478.80
Rate for Payer: Devoted Health Medicare	$271.32
Rate for Payer: Hawaii Medical Service Association Medicare	$247.38
Rate for Payer: Hawaii Western Management Group Commercial	$758.10
Rate for Payer: Health Management Network Commercial	$678.30
Rate for Payer: Humana Medicare	$247.38
Rate for Payer: Kaiser Permanente Commercial	$718.20
Rate for Payer: Kaiser Permanente Medicaid	$406.98
Rate for Payer: Kaiser Permanente Medicare	$247.38
Rate for Payer: MDX Hawaii PPO	$774.06
Rate for Payer: Ohana Health Plan Medicaid	$247.38
Rate for Payer: Ohana Health Plan Medicare	$247.38
Rate for Payer: UnitedHealthcare Medicare	$247.38
Rate for Payer: University Health Alliance Commercial	$581.66

OVOMATION 56X52MM 8HM2-5652-A

Facility

$8,670.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,855.20
Max. Negotiated Rate	$8,409.90
Rate for Payer: Cash Price	$5,202.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,069.00
Rate for Payer: Health Management Network Commercial	$7,369.50
Rate for Payer: Kaiser Permanente Commercial	$7,803.00
Rate for Payer: MDX Hawaii PPO	$8,409.90
Rate for Payer: University Health Alliance Commercial	$4,855.20

OVOMATION 56X52MM 8HM2-5652-A

Facility

$8,670.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,687.70
Max. Negotiated Rate	$8,409.90
Rate for Payer: AlohaCare Medicaid	$4,335.00
Rate for Payer: AlohaCare Medicare	$2,687.70
Rate for Payer: Cash Price	$5,202.00
Rate for Payer: Devoted Health Medicare	$2,947.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,687.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,069.00
Rate for Payer: Health Management Network Commercial	$7,369.50
Rate for Payer: Humana Medicare	$2,687.70
Rate for Payer: Kaiser Permanente Commercial	$7,803.00
Rate for Payer: Kaiser Permanente Medicaid	$4,421.70
Rate for Payer: Kaiser Permanente Medicare	$2,687.70
Rate for Payer: MDX Hawaii PPO	$8,409.90
Rate for Payer: Ohana Health Plan Medicaid	$2,687.70
Rate for Payer: Ohana Health Plan Medicare	$2,687.70
Rate for Payer: UnitedHealthcare Medicare	$2,687.70
Rate for Payer: University Health Alliance Commercial	$4,855.20

OVOMOTION SHOULDER SYS 54X50MM

Facility

$8,670.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,855.20
Max. Negotiated Rate	$8,409.90
Rate for Payer: Cash Price	$5,202.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,069.00
Rate for Payer: Health Management Network Commercial	$7,369.50
Rate for Payer: Kaiser Permanente Commercial	$7,803.00
Rate for Payer: MDX Hawaii PPO	$8,409.90
Rate for Payer: University Health Alliance Commercial	$4,855.20

OVOMOTION SHOULDER SYS 54X50MM

Facility

$8,670.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,687.70
Max. Negotiated Rate	$8,409.90
Rate for Payer: AlohaCare Medicaid	$4,335.00
Rate for Payer: AlohaCare Medicare	$2,687.70
Rate for Payer: Cash Price	$5,202.00
Rate for Payer: Devoted Health Medicare	$2,947.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,687.70
Rate for Payer: Hawaii Western Management Group Commercial	$6,069.00
Rate for Payer: Health Management Network Commercial	$7,369.50
Rate for Payer: Humana Medicare	$2,687.70
Rate for Payer: Kaiser Permanente Commercial	$7,803.00
Rate for Payer: Kaiser Permanente Medicaid	$4,421.70
Rate for Payer: Kaiser Permanente Medicare	$2,687.70
Rate for Payer: MDX Hawaii PPO	$8,409.90
Rate for Payer: Ohana Health Plan Medicaid	$2,687.70
Rate for Payer: Ohana Health Plan Medicare	$2,687.70
Rate for Payer: UnitedHealthcare Medicare	$2,687.70
Rate for Payer: University Health Alliance Commercial	$4,855.20

OXACILLIN 10 GRAM SOLUTION FOR INJECTION [171652]

Facility

$211.00

Service Code	HCPCS J2700
Hospital Revenue Code	636
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$204.67
Rate for Payer: AlohaCare Medicaid	$105.50
Rate for Payer: AlohaCare Medicaid	$109.00
Rate for Payer: AlohaCare Medicare	$67.58
Rate for Payer: AlohaCare Medicare	$65.41
Rate for Payer: Cash Price	$130.80
Rate for Payer: Cash Price	$126.60
Rate for Payer: Cash Price	$126.60
Rate for Payer: Cash Price	$130.80
Rate for Payer: Devoted Health Medicare	$71.74
Rate for Payer: Devoted Health Medicare	$74.12
Rate for Payer: Hawaii Medical Service Association ABD	$0.82
Rate for Payer: Hawaii Medical Service Association ABD	$0.82
Rate for Payer: Hawaii Medical Service Association Medicare	$67.58
Rate for Payer: Hawaii Medical Service Association Medicare	$65.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.82
Rate for Payer: Hawaii Western Management Group Commercial	$200.45
Rate for Payer: Hawaii Western Management Group Commercial	$207.10
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Humana Medicare	$65.41
Rate for Payer: Humana Medicare	$67.58
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: Kaiser Permanente Commercial	$196.20
Rate for Payer: Kaiser Permanente Medicaid	$111.18
Rate for Payer: Kaiser Permanente Medicaid	$107.61
Rate for Payer: Kaiser Permanente Medicare	$65.41
Rate for Payer: Kaiser Permanente Medicare	$67.58
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: MDX Hawaii PPO	$211.46
Rate for Payer: Ohana Health Plan Medicaid	$67.58
Rate for Payer: Ohana Health Plan Medicaid	$65.41
Rate for Payer: Ohana Health Plan Medicare	$65.41
Rate for Payer: Ohana Health Plan Medicare	$67.58
Rate for Payer: UnitedHealthcare Medicaid	$130.80
Rate for Payer: UnitedHealthcare Medicaid	$126.60
Rate for Payer: UnitedHealthcare Medicare	$65.41
Rate for Payer: UnitedHealthcare Medicare	$67.58
Rate for Payer: University Health Alliance Commercial	$153.80
Rate for Payer: University Health Alliance Commercial	$158.90

OXACILLIN 10 GRAM SOLUTION FOR INJECTION [171652]

Facility

$211.00

Service Code	HCPCS J2700
Hospital Revenue Code	250
Min. Negotiated Rate	$179.35
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$126.60
Rate for Payer: Cash Price	$130.80
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: Kaiser Permanente Commercial	$196.20
Rate for Payer: MDX Hawaii PPO	$211.46
Rate for Payer: MDX Hawaii PPO	$204.67

OXACILLIN 1 GRAM SOLUTION FOR INJECTION [5924]

Facility

$30.00

Service Code	HCPCS J2700
Hospital Revenue Code	636
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$29.10
Rate for Payer: AlohaCare Medicaid	$15.00
Rate for Payer: AlohaCare Medicaid	$18.50
Rate for Payer: AlohaCare Medicare	$11.47
Rate for Payer: AlohaCare Medicare	$9.30
Rate for Payer: Cash Price	$22.20
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$22.20
Rate for Payer: Devoted Health Medicare	$10.20
Rate for Payer: Devoted Health Medicare	$12.58
Rate for Payer: Hawaii Medical Service Association ABD	$0.82
Rate for Payer: Hawaii Medical Service Association ABD	$0.82
Rate for Payer: Hawaii Medical Service Association Medicare	$11.47
Rate for Payer: Hawaii Medical Service Association Medicare	$9.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.82
Rate for Payer: Hawaii Western Management Group Commercial	$28.50
Rate for Payer: Hawaii Western Management Group Commercial	$35.15
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Humana Medicare	$9.30
Rate for Payer: Humana Medicare	$11.47
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: Kaiser Permanente Medicaid	$15.30
Rate for Payer: Kaiser Permanente Medicare	$9.30
Rate for Payer: Kaiser Permanente Medicare	$11.47
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: Ohana Health Plan Medicaid	$11.47
Rate for Payer: Ohana Health Plan Medicaid	$9.30
Rate for Payer: Ohana Health Plan Medicare	$9.30
Rate for Payer: Ohana Health Plan Medicare	$11.47
Rate for Payer: UnitedHealthcare Medicaid	$22.20
Rate for Payer: UnitedHealthcare Medicaid	$18.00
Rate for Payer: UnitedHealthcare Medicare	$9.30
Rate for Payer: UnitedHealthcare Medicare	$11.47
Rate for Payer: University Health Alliance Commercial	$21.87
Rate for Payer: University Health Alliance Commercial	$26.97

OXACILLIN 1 GRAM SOLUTION FOR INJECTION [5924]

Facility

$30.00

Service Code	HCPCS J2700
Hospital Revenue Code	250
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$22.20
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: MDX Hawaii PPO	$29.10

Know your out-of-pocket cost for care.

All Charges