Kau Hospital

All Charges

Charge

Type

Setting

Price

PERMACATH DURAFLOW 2 23CM

Facility

$1,050.00

Hospital Revenue Code	272
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	$997.50
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	$765.35

PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC

Facility

$53,519.12

Service Code	MSDRG 243
Min. Negotiated Rate	$53,519.12
Max. Negotiated Rate	$53,519.12
Rate for Payer: Hawaii Medical Service Association Commercial	$53,519.12

PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC

Facility

$71,580.04

Service Code	MSDRG 242
Min. Negotiated Rate	$71,580.04
Max. Negotiated Rate	$71,580.04
Rate for Payer: Hawaii Medical Service Association Commercial	$71,580.04

PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC

Facility

$43,967.21

Service Code	MSDRG 244
Min. Negotiated Rate	$43,967.21
Max. Negotiated Rate	$43,967.21
Rate for Payer: Hawaii Medical Service Association Commercial	$43,967.21

PERMETHRIN 1 % TOPICAL LIQUID [10918]

Facility

$39.00

Service Code	NDC 46122010846
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

PERMETHRIN 1 % TOPICAL LIQUID [10918]

Facility

$39.00

Service Code	NDC 46122010846
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

PERMETHRIN 5% CREAM (ELIMITE) (60 GRAM) (TAKE HOME) [4080388]

Facility

$15.00

Service Code	NDC 00004080176
Hospital Revenue Code	253
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

PERMETHRIN 5% CREAM (ELIMITE) (60 GRAM) (TAKE HOME) [4080388]

Facility

$15.00

Service Code	NDC 00004080176
Hospital Revenue Code	253
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$4.65
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$5.10
Rate for Payer: Hawaii Medical Service Association Medicare	$4.65
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$4.65
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$4.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$4.65
Rate for Payer: Ohana Health Plan Medicare	$4.65
Rate for Payer: UnitedHealthcare Medicare	$4.65
Rate for Payer: University Health Alliance Commercial	$10.93

PERMETHRIN 5 % TOPICAL CREAM [10917]

Facility

$414.00

Service Code	NDC 21922002107
Hospital Revenue Code	637
Min. Negotiated Rate	$128.34
Max. Negotiated Rate	$401.58
Rate for Payer: AlohaCare Medicaid	$207.00
Rate for Payer: AlohaCare Medicare	$128.34
Rate for Payer: Cash Price	$248.40
Rate for Payer: Devoted Health Medicare	$140.76
Rate for Payer: Hawaii Medical Service Association Medicare	$128.34
Rate for Payer: Hawaii Western Management Group Commercial	$393.30
Rate for Payer: Health Management Network Commercial	$351.90
Rate for Payer: Humana Medicare	$128.34
Rate for Payer: Kaiser Permanente Commercial	$372.60
Rate for Payer: Kaiser Permanente Medicaid	$211.14
Rate for Payer: Kaiser Permanente Medicare	$128.34
Rate for Payer: MDX Hawaii PPO	$401.58
Rate for Payer: Ohana Health Plan Medicaid	$128.34
Rate for Payer: Ohana Health Plan Medicare	$128.34
Rate for Payer: UnitedHealthcare Medicare	$128.34
Rate for Payer: University Health Alliance Commercial	$301.76

PERMETHRIN 5 % TOPICAL CREAM [10917]

Facility

$414.00

Service Code	NDC 21922002107
Hospital Revenue Code	250
Min. Negotiated Rate	$351.90
Max. Negotiated Rate	$401.58
Rate for Payer: Cash Price	$248.40
Rate for Payer: Health Management Network Commercial	$351.90
Rate for Payer: Kaiser Permanente Commercial	$372.60
Rate for Payer: MDX Hawaii PPO	$401.58

PERPHENAZINE 2 MG TABLET [6157]

Facility

$7.00

Service Code	NDC 64980029001
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$6.79

PERSONA 10MM 42-5282-009-10

Facility

$2,520.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,411.20
Max. Negotiated Rate	$2,444.40
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,764.00
Rate for Payer: Health Management Network Commercial	$2,142.00
Rate for Payer: Kaiser Permanente Commercial	$2,268.00
Rate for Payer: MDX Hawaii PPO	$2,444.40
Rate for Payer: University Health Alliance Commercial	$1,411.20

PERSONA 10MM 42-5282-009-10

Facility

$2,520.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$781.20
Max. Negotiated Rate	$2,444.40
Rate for Payer: AlohaCare Medicaid	$1,260.00
Rate for Payer: AlohaCare Medicare	$781.20
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Devoted Health Medicare	$856.80
Rate for Payer: Hawaii Medical Service Association Medicare	$781.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,764.00
Rate for Payer: Health Management Network Commercial	$2,142.00
Rate for Payer: Humana Medicare	$781.20
Rate for Payer: Kaiser Permanente Commercial	$2,268.00
Rate for Payer: Kaiser Permanente Medicaid	$1,285.20
Rate for Payer: Kaiser Permanente Medicare	$781.20
Rate for Payer: MDX Hawaii PPO	$2,444.40
Rate for Payer: Ohana Health Plan Medicaid	$781.20
Rate for Payer: Ohana Health Plan Medicare	$781.20
Rate for Payer: UnitedHealthcare Medicare	$781.20
Rate for Payer: University Health Alliance Commercial	$1,411.20

PERSONA FEM CMT CCR NRW SZ10 L

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ10 L

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,674.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: AlohaCare Medicaid	$2,700.00
Rate for Payer: AlohaCare Medicare	$1,674.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Devoted Health Medicare	$1,836.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,674.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Humana Medicare	$1,674.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: Kaiser Permanente Medicare	$1,674.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: Ohana Health Plan Medicaid	$1,674.00
Rate for Payer: Ohana Health Plan Medicare	$1,674.00
Rate for Payer: UnitedHealthcare Medicare	$1,674.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ10 R

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ10 R

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,674.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: AlohaCare Medicaid	$2,700.00
Rate for Payer: AlohaCare Medicare	$1,674.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Devoted Health Medicare	$1,836.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,674.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Humana Medicare	$1,674.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: Kaiser Permanente Medicare	$1,674.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: Ohana Health Plan Medicaid	$1,674.00
Rate for Payer: Ohana Health Plan Medicare	$1,674.00
Rate for Payer: UnitedHealthcare Medicare	$1,674.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ11 L

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,674.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: AlohaCare Medicaid	$2,700.00
Rate for Payer: AlohaCare Medicare	$1,674.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Devoted Health Medicare	$1,836.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,674.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Humana Medicare	$1,674.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: Kaiser Permanente Medicare	$1,674.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: Ohana Health Plan Medicaid	$1,674.00
Rate for Payer: Ohana Health Plan Medicare	$1,674.00
Rate for Payer: UnitedHealthcare Medicare	$1,674.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ11 L

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ11 R

Facility

$7,410.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,297.10
Max. Negotiated Rate	$7,187.70
Rate for Payer: AlohaCare Medicaid	$3,705.00
Rate for Payer: AlohaCare Medicare	$2,297.10
Rate for Payer: Cash Price	$4,446.00
Rate for Payer: Devoted Health Medicare	$2,519.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,297.10
Rate for Payer: Hawaii Western Management Group Commercial	$5,187.00
Rate for Payer: Health Management Network Commercial	$6,298.50
Rate for Payer: Humana Medicare	$2,297.10
Rate for Payer: Kaiser Permanente Commercial	$6,669.00
Rate for Payer: Kaiser Permanente Medicaid	$3,779.10
Rate for Payer: Kaiser Permanente Medicare	$2,297.10
Rate for Payer: MDX Hawaii PPO	$7,187.70
Rate for Payer: Ohana Health Plan Medicaid	$2,297.10
Rate for Payer: Ohana Health Plan Medicare	$2,297.10
Rate for Payer: UnitedHealthcare Medicare	$2,297.10
Rate for Payer: University Health Alliance Commercial	$4,149.60

PERSONA FEM CMT CCR NRW SZ11 R

Facility

$7,410.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,149.60
Max. Negotiated Rate	$7,187.70
Rate for Payer: Cash Price	$4,446.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,187.00
Rate for Payer: Health Management Network Commercial	$6,298.50
Rate for Payer: Kaiser Permanente Commercial	$6,669.00
Rate for Payer: MDX Hawaii PPO	$7,187.70
Rate for Payer: University Health Alliance Commercial	$4,149.60

PERSONA FEM CMT CCR NRW SZ1 L

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,674.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: AlohaCare Medicaid	$2,700.00
Rate for Payer: AlohaCare Medicare	$1,674.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Devoted Health Medicare	$1,836.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,674.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Humana Medicare	$1,674.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: Kaiser Permanente Medicare	$1,674.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: Ohana Health Plan Medicaid	$1,674.00
Rate for Payer: Ohana Health Plan Medicare	$1,674.00
Rate for Payer: UnitedHealthcare Medicare	$1,674.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ1 L

Facility

$5,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

PERSONA FEM CMT CCR NRW SZ1 R

Facility

$15,814.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$8,855.84
Max. Negotiated Rate	$15,339.58
Rate for Payer: Cash Price	$9,488.40
Rate for Payer: Hawaii Western Management Group Commercial	$11,069.80
Rate for Payer: Health Management Network Commercial	$13,441.90
Rate for Payer: Kaiser Permanente Commercial	$14,232.60
Rate for Payer: MDX Hawaii PPO	$15,339.58
Rate for Payer: University Health Alliance Commercial	$8,855.84

PERSONA FEM CMT CCR NRW SZ1 R

Facility

$15,814.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,902.34
Max. Negotiated Rate	$15,339.58
Rate for Payer: AlohaCare Medicaid	$7,907.00
Rate for Payer: AlohaCare Medicare	$4,902.34
Rate for Payer: Cash Price	$9,488.40
Rate for Payer: Devoted Health Medicare	$5,376.76
Rate for Payer: Hawaii Medical Service Association Medicare	$4,902.34
Rate for Payer: Hawaii Western Management Group Commercial	$11,069.80
Rate for Payer: Health Management Network Commercial	$13,441.90
Rate for Payer: Humana Medicare	$4,902.34
Rate for Payer: Kaiser Permanente Commercial	$14,232.60
Rate for Payer: Kaiser Permanente Medicaid	$8,065.14
Rate for Payer: Kaiser Permanente Medicare	$4,902.34
Rate for Payer: MDX Hawaii PPO	$15,339.58
Rate for Payer: Ohana Health Plan Medicaid	$4,902.34
Rate for Payer: Ohana Health Plan Medicare	$4,902.34
Rate for Payer: UnitedHealthcare Medicare	$4,902.34
Rate for Payer: University Health Alliance Commercial	$8,855.84

Know your out-of-pocket cost for care.

All Charges