Kau Hospital

All Charges

Charge

Type

Setting

Price

PATELLA X3 S31X9MM 5550-G-319

Facility

$3,628.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,031.68
Max. Negotiated Rate	$3,519.16
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,539.60
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: Kaiser Permanente Commercial	$3,265.20
Rate for Payer: MDX Hawaii PPO	$3,519.16
Rate for Payer: University Health Alliance Commercial	$2,031.68

PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC

Facility

$32,874.67

Service Code	MSDRG 543
Min. Negotiated Rate	$32,874.67
Max. Negotiated Rate	$32,874.67
Rate for Payer: Hawaii Medical Service Association Commercial	$32,874.67

PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC

Facility

$32,874.67

Service Code	MSDRG 542
Min. Negotiated Rate	$32,874.67
Max. Negotiated Rate	$32,874.67
Rate for Payer: Hawaii Medical Service Association Commercial	$32,874.67

PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC

Facility

$32,874.67

Service Code	MSDRG 544
Min. Negotiated Rate	$32,874.67
Max. Negotiated Rate	$32,874.67
Rate for Payer: Hawaii Medical Service Association Commercial	$32,874.67

PEC REPAIR LG EYELETS AR-2269

Facility

$3,465.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,940.40
Max. Negotiated Rate	$3,361.05
Rate for Payer: Cash Price	$2,079.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,425.50
Rate for Payer: Health Management Network Commercial	$2,945.25
Rate for Payer: Kaiser Permanente Commercial	$3,118.50
Rate for Payer: MDX Hawaii PPO	$3,361.05
Rate for Payer: University Health Alliance Commercial	$1,940.40

PEC REPAIR LG EYELETS AR-2269

Facility

$3,465.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,074.15
Max. Negotiated Rate	$3,361.05
Rate for Payer: AlohaCare Medicaid	$1,732.50
Rate for Payer: AlohaCare Medicare	$1,074.15
Rate for Payer: Cash Price	$2,079.00
Rate for Payer: Devoted Health Medicare	$1,178.10
Rate for Payer: Hawaii Medical Service Association Medicare	$1,074.15
Rate for Payer: Hawaii Western Management Group Commercial	$2,425.50
Rate for Payer: Health Management Network Commercial	$2,945.25
Rate for Payer: Humana Medicare	$1,074.15
Rate for Payer: Kaiser Permanente Commercial	$3,118.50
Rate for Payer: Kaiser Permanente Medicaid	$1,767.15
Rate for Payer: Kaiser Permanente Medicare	$1,074.15
Rate for Payer: MDX Hawaii PPO	$3,361.05
Rate for Payer: Ohana Health Plan Medicaid	$1,074.15
Rate for Payer: Ohana Health Plan Medicare	$1,074.15
Rate for Payer: UnitedHealthcare Medicare	$1,074.15
Rate for Payer: University Health Alliance Commercial	$1,940.40

PEG3350 100 GRAM-SOD SULF 7.5 GRAM-NACL-KCL-ASCORBATE-C ORAL PWDR PACK [77400]

Facility

$182.00

Service Code	NDC 68682020175
Hospital Revenue Code	637
Min. Negotiated Rate	$56.42
Max. Negotiated Rate	$176.54
Rate for Payer: AlohaCare Medicaid	$91.00
Rate for Payer: AlohaCare Medicare	$56.42
Rate for Payer: Cash Price	$109.20
Rate for Payer: Devoted Health Medicare	$61.88
Rate for Payer: Hawaii Medical Service Association Medicare	$56.42
Rate for Payer: Hawaii Western Management Group Commercial	$172.90
Rate for Payer: Health Management Network Commercial	$154.70
Rate for Payer: Humana Medicare	$56.42
Rate for Payer: Kaiser Permanente Commercial	$163.80
Rate for Payer: Kaiser Permanente Medicaid	$92.82
Rate for Payer: Kaiser Permanente Medicare	$56.42
Rate for Payer: MDX Hawaii PPO	$176.54
Rate for Payer: Ohana Health Plan Medicaid	$56.42
Rate for Payer: Ohana Health Plan Medicare	$56.42
Rate for Payer: UnitedHealthcare Medicare	$56.42
Rate for Payer: University Health Alliance Commercial	$132.66

PEG3350 100 GRAM-SOD SULF 7.5 GRAM-NACL-KCL-ASCORBATE-C ORAL PWDR PACK [77400]

Facility

$182.00

Service Code	NDC 68682020175
Hospital Revenue Code	250
Min. Negotiated Rate	$154.70
Max. Negotiated Rate	$176.54
Rate for Payer: Cash Price	$109.20
Rate for Payer: Health Management Network Commercial	$154.70
Rate for Payer: Kaiser Permanente Commercial	$163.80
Rate for Payer: MDX Hawaii PPO	$176.54

PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [10839]

Facility

$80.00

Service Code	NDC 52268010001
Hospital Revenue Code	250
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: MDX Hawaii PPO	$77.60

PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [10839]

Facility

$70.00

Service Code	NDC 10572010001
Hospital Revenue Code	637
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$67.90
Rate for Payer: AlohaCare Medicaid	$35.00
Rate for Payer: AlohaCare Medicare	$21.70
Rate for Payer: Cash Price	$42.00
Rate for Payer: Devoted Health Medicare	$23.80
Rate for Payer: Hawaii Medical Service Association Medicare	$21.70
Rate for Payer: Hawaii Western Management Group Commercial	$66.50
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Humana Medicare	$21.70
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: Kaiser Permanente Medicaid	$35.70
Rate for Payer: Kaiser Permanente Medicare	$21.70
Rate for Payer: MDX Hawaii PPO	$67.90
Rate for Payer: Ohana Health Plan Medicaid	$21.70
Rate for Payer: Ohana Health Plan Medicare	$21.70
Rate for Payer: UnitedHealthcare Medicare	$21.70
Rate for Payer: University Health Alliance Commercial	$51.02

PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [10839]

Facility

$70.00

Service Code	NDC 10572010001
Hospital Revenue Code	250
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$42.00
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: MDX Hawaii PPO	$67.90

PEG 3350-ELECTROLYTES 236 GRAM-22.74 GRAM-6.74 GRAM-5.86 GRAM SOLUTION [10839]

Facility

$80.00

Service Code	NDC 52268010001
Hospital Revenue Code	637
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$77.60
Rate for Payer: AlohaCare Medicaid	$40.00
Rate for Payer: AlohaCare Medicare	$24.80
Rate for Payer: Cash Price	$48.00
Rate for Payer: Devoted Health Medicare	$27.20
Rate for Payer: Hawaii Medical Service Association Medicare	$24.80
Rate for Payer: Hawaii Western Management Group Commercial	$76.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Humana Medicare	$24.80
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: Kaiser Permanente Medicaid	$40.80
Rate for Payer: Kaiser Permanente Medicare	$24.80
Rate for Payer: MDX Hawaii PPO	$77.60
Rate for Payer: Ohana Health Plan Medicaid	$24.80
Rate for Payer: Ohana Health Plan Medicare	$24.80
Rate for Payer: UnitedHealthcare Medicare	$24.80
Rate for Payer: University Health Alliance Commercial	$58.31

PEG CEMENTED 40MM 5542-P-0040

Facility

$9,208.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,854.48
Max. Negotiated Rate	$8,931.76
Rate for Payer: AlohaCare Medicaid	$4,604.00
Rate for Payer: AlohaCare Medicare	$2,854.48
Rate for Payer: Cash Price	$5,524.80
Rate for Payer: Devoted Health Medicare	$3,130.72
Rate for Payer: Hawaii Medical Service Association Medicare	$2,854.48
Rate for Payer: Hawaii Western Management Group Commercial	$6,445.60
Rate for Payer: Health Management Network Commercial	$7,826.80
Rate for Payer: Humana Medicare	$2,854.48
Rate for Payer: Kaiser Permanente Commercial	$8,287.20
Rate for Payer: Kaiser Permanente Medicaid	$4,696.08
Rate for Payer: Kaiser Permanente Medicare	$2,854.48
Rate for Payer: MDX Hawaii PPO	$8,931.76
Rate for Payer: Ohana Health Plan Medicaid	$2,854.48
Rate for Payer: Ohana Health Plan Medicare	$2,854.48
Rate for Payer: UnitedHealthcare Medicare	$2,854.48
Rate for Payer: University Health Alliance Commercial	$5,156.48

PEG CEMENTED 40MM 5542-P-0040

Facility

$9,208.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,156.48
Max. Negotiated Rate	$8,931.76
Rate for Payer: Cash Price	$5,524.80
Rate for Payer: Hawaii Western Management Group Commercial	$6,445.60
Rate for Payer: Health Management Network Commercial	$7,826.80
Rate for Payer: Kaiser Permanente Commercial	$8,287.20
Rate for Payer: MDX Hawaii PPO	$8,931.76
Rate for Payer: University Health Alliance Commercial	$5,156.48

PEG DRILL 1/4" #6541-4-525

Facility

$1,729.00

Hospital Revenue Code	272
Min. Negotiated Rate	$535.99
Max. Negotiated Rate	$1,677.13
Rate for Payer: AlohaCare Medicaid	$864.50
Rate for Payer: AlohaCare Medicare	$535.99
Rate for Payer: Cash Price	$1,037.40
Rate for Payer: Devoted Health Medicare	$587.86
Rate for Payer: Hawaii Medical Service Association Medicare	$535.99
Rate for Payer: Hawaii Western Management Group Commercial	$1,642.55
Rate for Payer: Health Management Network Commercial	$1,469.65
Rate for Payer: Humana Medicare	$535.99
Rate for Payer: Kaiser Permanente Commercial	$1,556.10
Rate for Payer: Kaiser Permanente Medicaid	$881.79
Rate for Payer: Kaiser Permanente Medicare	$535.99
Rate for Payer: MDX Hawaii PPO	$1,677.13
Rate for Payer: Ohana Health Plan Medicaid	$535.99
Rate for Payer: Ohana Health Plan Medicare	$535.99
Rate for Payer: UnitedHealthcare Medicare	$535.99
Rate for Payer: University Health Alliance Commercial	$1,260.27

PEG DRILL 1/4" #6541-4-525

Facility

$1,729.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,469.65
Max. Negotiated Rate	$1,677.13
Rate for Payer: Cash Price	$1,037.40
Rate for Payer: Health Management Network Commercial	$1,469.65
Rate for Payer: Kaiser Permanente Commercial	$1,556.10
Rate for Payer: MDX Hawaii PPO	$1,677.13

PEGFILGRASTIM 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUTANEOUS INJECTOR [129658]

Facility

$8,202.00

Service Code	HCPCS J2506
Hospital Revenue Code	636
Min. Negotiated Rate	$58.40
Max. Negotiated Rate	$7,955.94
Rate for Payer: AlohaCare Medicaid	$4,101.00
Rate for Payer: AlohaCare Medicare	$2,542.62
Rate for Payer: Cash Price	$4,921.20
Rate for Payer: Cash Price	$4,921.20
Rate for Payer: Devoted Health Medicare	$2,788.68
Rate for Payer: Hawaii Medical Service Association ABD	$58.40
Rate for Payer: Hawaii Medical Service Association Commercial	$159.22
Rate for Payer: Hawaii Medical Service Association Medicare	$2,542.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$58.40
Rate for Payer: Hawaii Western Management Group Commercial	$7,791.90
Rate for Payer: Health Management Network Commercial	$6,971.70
Rate for Payer: Humana Medicare	$2,542.62
Rate for Payer: Kaiser Permanente Commercial	$7,381.80
Rate for Payer: Kaiser Permanente Medicaid	$4,183.02
Rate for Payer: Kaiser Permanente Medicare	$2,542.62
Rate for Payer: MDX Hawaii PPO	$7,955.94
Rate for Payer: Ohana Health Plan Medicaid	$2,542.62
Rate for Payer: Ohana Health Plan Medicare	$2,542.62
Rate for Payer: UnitedHealthcare Medicaid	$4,921.20
Rate for Payer: UnitedHealthcare Medicare	$2,542.62
Rate for Payer: University Health Alliance Commercial	$5,978.44

PEGFILGRASTIM 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUTANEOUS INJECTOR [129658]

Facility

$8,202.00

Service Code	HCPCS J2506
Hospital Revenue Code	250
Min. Negotiated Rate	$6,971.70
Max. Negotiated Rate	$7,955.94
Rate for Payer: Cash Price	$4,921.20
Rate for Payer: Health Management Network Commercial	$6,971.70
Rate for Payer: Kaiser Permanente Commercial	$7,381.80
Rate for Payer: MDX Hawaii PPO	$7,955.94

PEGFILGRASTIM-APGF 6 MG/0.6 ML SUBCUTANEOUS SYRINGE [176068]

Facility

$5,210.00

Service Code	HCPCS Q5122
Hospital Revenue Code	636
Min. Negotiated Rate	$132.04
Max. Negotiated Rate	$5,053.70
Rate for Payer: AlohaCare Medicaid	$2,605.00
Rate for Payer: AlohaCare Medicare	$1,615.10
Rate for Payer: Cash Price	$3,126.00
Rate for Payer: Cash Price	$3,126.00
Rate for Payer: Devoted Health Medicare	$1,771.40
Rate for Payer: Hawaii Medical Service Association ABD	$132.04
Rate for Payer: Hawaii Medical Service Association Commercial	$166.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,615.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$132.04
Rate for Payer: Hawaii Western Management Group Commercial	$4,949.50
Rate for Payer: Health Management Network Commercial	$4,428.50
Rate for Payer: Humana Medicare	$1,615.10
Rate for Payer: Kaiser Permanente Commercial	$4,689.00
Rate for Payer: Kaiser Permanente Medicaid	$2,657.10
Rate for Payer: Kaiser Permanente Medicare	$1,615.10
Rate for Payer: MDX Hawaii PPO	$5,053.70
Rate for Payer: Ohana Health Plan Medicaid	$1,615.10
Rate for Payer: Ohana Health Plan Medicare	$1,615.10
Rate for Payer: UnitedHealthcare Medicaid	$3,126.00
Rate for Payer: UnitedHealthcare Medicare	$1,615.10
Rate for Payer: University Health Alliance Commercial	$3,797.57

PEGFILGRASTIM-APGF 6 MG/0.6 ML SUBCUTANEOUS SYRINGE [176068]

Facility

$5,210.00

Service Code	HCPCS Q5122
Hospital Revenue Code	250
Min. Negotiated Rate	$4,428.50
Max. Negotiated Rate	$5,053.70
Rate for Payer: Cash Price	$3,126.00
Rate for Payer: Health Management Network Commercial	$4,428.50
Rate for Payer: Kaiser Permanente Commercial	$4,689.00
Rate for Payer: MDX Hawaii PPO	$5,053.70

PEGFILGRASTIM-CBQV 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUT INJECTOR [196326]

Facility

$5,510.00

Service Code	HCPCS Q5111
Hospital Revenue Code	636
Min. Negotiated Rate	$136.04
Max. Negotiated Rate	$5,344.70
Rate for Payer: AlohaCare Medicaid	$2,755.00
Rate for Payer: AlohaCare Medicare	$1,708.10
Rate for Payer: Cash Price	$3,306.00
Rate for Payer: Cash Price	$3,306.00
Rate for Payer: Devoted Health Medicare	$1,873.40
Rate for Payer: Hawaii Medical Service Association ABD	$136.04
Rate for Payer: Hawaii Medical Service Association Commercial	$169.86
Rate for Payer: Hawaii Medical Service Association Medicare	$1,708.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$136.04
Rate for Payer: Hawaii Western Management Group Commercial	$5,234.50
Rate for Payer: Health Management Network Commercial	$4,683.50
Rate for Payer: Humana Medicare	$1,708.10
Rate for Payer: Kaiser Permanente Commercial	$4,959.00
Rate for Payer: Kaiser Permanente Medicaid	$2,810.10
Rate for Payer: Kaiser Permanente Medicare	$1,708.10
Rate for Payer: MDX Hawaii PPO	$5,344.70
Rate for Payer: Ohana Health Plan Medicaid	$1,708.10
Rate for Payer: Ohana Health Plan Medicare	$1,708.10
Rate for Payer: UnitedHealthcare Medicaid	$3,306.00
Rate for Payer: UnitedHealthcare Medicare	$1,708.10
Rate for Payer: University Health Alliance Commercial	$4,016.24

PEGFILGRASTIM-CBQV 6 MG/0.6 ML (DELIVERABLE) WEARABLE SUBCUT INJECTOR [196326]

Facility

$5,510.00

Service Code	HCPCS Q5111
Hospital Revenue Code	250
Min. Negotiated Rate	$4,683.50
Max. Negotiated Rate	$5,344.70
Rate for Payer: Cash Price	$3,306.00
Rate for Payer: Health Management Network Commercial	$4,683.50
Rate for Payer: Kaiser Permanente Commercial	$4,959.00
Rate for Payer: MDX Hawaii PPO	$5,344.70

PEGFILGRASTIM-CBQV 6 MG/0.6 ML SUBCUTANEOUS SYRINGE [164810]

Facility

$5,510.00

Service Code	HCPCS Q5111
Hospital Revenue Code	250
Min. Negotiated Rate	$4,683.50
Max. Negotiated Rate	$5,344.70
Rate for Payer: Cash Price	$3,306.00
Rate for Payer: Health Management Network Commercial	$4,683.50
Rate for Payer: Kaiser Permanente Commercial	$4,959.00
Rate for Payer: MDX Hawaii PPO	$5,344.70

PEGFILGRASTIM-CBQV 6 MG/0.6 ML SUBCUTANEOUS SYRINGE [164810]

Facility

$5,510.00

Service Code	HCPCS Q5111
Hospital Revenue Code	636
Min. Negotiated Rate	$136.04
Max. Negotiated Rate	$5,344.70
Rate for Payer: AlohaCare Medicaid	$2,755.00
Rate for Payer: AlohaCare Medicare	$1,708.10
Rate for Payer: Cash Price	$3,306.00
Rate for Payer: Cash Price	$3,306.00
Rate for Payer: Devoted Health Medicare	$1,873.40
Rate for Payer: Hawaii Medical Service Association ABD	$136.04
Rate for Payer: Hawaii Medical Service Association Commercial	$169.86
Rate for Payer: Hawaii Medical Service Association Medicare	$1,708.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$136.04
Rate for Payer: Hawaii Western Management Group Commercial	$5,234.50
Rate for Payer: Health Management Network Commercial	$4,683.50
Rate for Payer: Humana Medicare	$1,708.10
Rate for Payer: Kaiser Permanente Commercial	$4,959.00
Rate for Payer: Kaiser Permanente Medicaid	$2,810.10
Rate for Payer: Kaiser Permanente Medicare	$1,708.10
Rate for Payer: MDX Hawaii PPO	$5,344.70
Rate for Payer: Ohana Health Plan Medicaid	$1,708.10
Rate for Payer: Ohana Health Plan Medicare	$1,708.10
Rate for Payer: UnitedHealthcare Medicaid	$3,306.00
Rate for Payer: UnitedHealthcare Medicare	$1,708.10
Rate for Payer: University Health Alliance Commercial	$4,016.24

PEGINTERFERON ALFA-2A 180 MCG/ML SUBCUTANEOUS SOLUTION [34034]

Facility

$1,837.00

Service Code	HCPCS S0145
Hospital Revenue Code	250
Min. Negotiated Rate	$1,561.45
Max. Negotiated Rate	$1,781.89
Rate for Payer: Cash Price	$1,102.20
Rate for Payer: Health Management Network Commercial	$1,561.45
Rate for Payer: Kaiser Permanente Commercial	$1,653.30
Rate for Payer: MDX Hawaii PPO	$1,781.89

Know your out-of-pocket cost for care.

All Charges