Kau Hospital

All Charges

Charge

Type

Setting

Price

POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]

Facility

$6.00

Service Code	NDC 00904693176
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]

Facility

$6.00

Service Code	NDC 62559015730
Hospital Revenue Code	637
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$1.86
Rate for Payer: Cash Price	$3.60
Rate for Payer: Devoted Health Medicare	$2.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1.86
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$1.86
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$1.86
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$1.86
Rate for Payer: Ohana Health Plan Medicare	$1.86
Rate for Payer: UnitedHealthcare Medicare	$1.86
Rate for Payer: University Health Alliance Commercial	$4.37

POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]

Facility

$5.00

Service Code	NDC 00904693186
Hospital Revenue Code	637
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$1.55
Rate for Payer: Cash Price	$3.00
Rate for Payer: Devoted Health Medicare	$1.70
Rate for Payer: Hawaii Medical Service Association Medicare	$1.55
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$1.55
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$1.55
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$1.55
Rate for Payer: Ohana Health Plan Medicare	$1.55
Rate for Payer: UnitedHealthcare Medicare	$1.55
Rate for Payer: University Health Alliance Commercial	$3.64

POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET [25424]

Facility

$5.00

Service Code	NDC 00904693186
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

PORT ACCESS AIRSEAL 8X100MM

Facility

$351.00

Hospital Revenue Code	272
Min. Negotiated Rate	$108.81
Max. Negotiated Rate	$340.47
Rate for Payer: AlohaCare Medicaid	$175.50
Rate for Payer: AlohaCare Medicare	$108.81
Rate for Payer: Cash Price	$210.60
Rate for Payer: Devoted Health Medicare	$119.34
Rate for Payer: Hawaii Medical Service Association Medicare	$108.81
Rate for Payer: Hawaii Western Management Group Commercial	$333.45
Rate for Payer: Health Management Network Commercial	$298.35
Rate for Payer: Humana Medicare	$108.81
Rate for Payer: Kaiser Permanente Commercial	$315.90
Rate for Payer: Kaiser Permanente Medicaid	$179.01
Rate for Payer: Kaiser Permanente Medicare	$108.81
Rate for Payer: MDX Hawaii PPO	$340.47
Rate for Payer: Ohana Health Plan Medicaid	$108.81
Rate for Payer: Ohana Health Plan Medicare	$108.81
Rate for Payer: UnitedHealthcare Medicare	$108.81
Rate for Payer: University Health Alliance Commercial	$255.84

PORT ACCESS AIRSEAL 8X100MM

Facility

$351.00

Hospital Revenue Code	272
Min. Negotiated Rate	$298.35
Max. Negotiated Rate	$340.47
Rate for Payer: Cash Price	$210.60
Rate for Payer: Health Management Network Commercial	$298.35
Rate for Payer: Kaiser Permanente Commercial	$315.90
Rate for Payer: MDX Hawaii PPO	$340.47

PORTAL SKID AR-4505

Facility

$236.00

Hospital Revenue Code	272
Min. Negotiated Rate	$73.16
Max. Negotiated Rate	$228.92
Rate for Payer: AlohaCare Medicaid	$118.00
Rate for Payer: AlohaCare Medicare	$73.16
Rate for Payer: Cash Price	$141.60
Rate for Payer: Devoted Health Medicare	$80.24
Rate for Payer: Hawaii Medical Service Association Medicare	$73.16
Rate for Payer: Hawaii Western Management Group Commercial	$224.20
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Humana Medicare	$73.16
Rate for Payer: Kaiser Permanente Commercial	$212.40
Rate for Payer: Kaiser Permanente Medicaid	$120.36
Rate for Payer: Kaiser Permanente Medicare	$73.16
Rate for Payer: MDX Hawaii PPO	$228.92
Rate for Payer: Ohana Health Plan Medicaid	$73.16
Rate for Payer: Ohana Health Plan Medicare	$73.16
Rate for Payer: UnitedHealthcare Medicare	$73.16
Rate for Payer: University Health Alliance Commercial	$172.02

PORTAL SKID AR-4505

Facility

$236.00

Hospital Revenue Code	272
Min. Negotiated Rate	$200.60
Max. Negotiated Rate	$228.92
Rate for Payer: Cash Price	$141.60
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Kaiser Permanente Commercial	$212.40
Rate for Payer: MDX Hawaii PPO	$228.92

PORT INTERGRATED ALLOX2-FH11SE

Facility

$3,750.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,637.50
Rate for Payer: Cash Price	$2,250.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,625.00
Rate for Payer: Health Management Network Commercial	$3,187.50
Rate for Payer: Kaiser Permanente Commercial	$3,375.00
Rate for Payer: MDX Hawaii PPO	$3,637.50
Rate for Payer: University Health Alliance Commercial	$2,100.00

PORT INTERGRATED ALLOX2-FH11SE

Facility

$3,750.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$3,637.50
Rate for Payer: AlohaCare Medicaid	$1,875.00
Rate for Payer: AlohaCare Medicare	$1,162.50
Rate for Payer: Cash Price	$2,250.00
Rate for Payer: Devoted Health Medicare	$1,275.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,162.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,625.00
Rate for Payer: Health Management Network Commercial	$3,187.50
Rate for Payer: Humana Medicare	$1,162.50
Rate for Payer: Kaiser Permanente Commercial	$3,375.00
Rate for Payer: Kaiser Permanente Medicaid	$1,912.50
Rate for Payer: Kaiser Permanente Medicare	$1,162.50
Rate for Payer: MDX Hawaii PPO	$3,637.50
Rate for Payer: Ohana Health Plan Medicaid	$1,162.50
Rate for Payer: Ohana Health Plan Medicare	$1,162.50
Rate for Payer: UnitedHealthcare Medicare	$1,162.50
Rate for Payer: University Health Alliance Commercial	$2,100.00

POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [125429]

Facility

$1,592.00

Service Code	HCPCS J3490
Hospital Revenue Code	250
Min. Negotiated Rate	$1,353.20
Max. Negotiated Rate	$1,544.24
Rate for Payer: Cash Price	$955.20
Rate for Payer: Health Management Network Commercial	$1,353.20
Rate for Payer: Kaiser Permanente Commercial	$1,432.80
Rate for Payer: MDX Hawaii PPO	$1,544.24

POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION [125429]

Facility

$1,592.00

Service Code	HCPCS J3490
Hospital Revenue Code	636
Min. Negotiated Rate	$493.52
Max. Negotiated Rate	$1,544.24
Rate for Payer: AlohaCare Medicaid	$796.00
Rate for Payer: AlohaCare Medicare	$493.52
Rate for Payer: Cash Price	$955.20
Rate for Payer: Devoted Health Medicare	$541.28
Rate for Payer: Hawaii Medical Service Association Medicare	$493.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,512.40
Rate for Payer: Health Management Network Commercial	$1,353.20
Rate for Payer: Humana Medicare	$493.52
Rate for Payer: Kaiser Permanente Commercial	$1,432.80
Rate for Payer: Kaiser Permanente Medicaid	$811.92
Rate for Payer: Kaiser Permanente Medicare	$493.52
Rate for Payer: MDX Hawaii PPO	$1,544.24
Rate for Payer: Ohana Health Plan Medicaid	$493.52
Rate for Payer: Ohana Health Plan Medicare	$493.52
Rate for Payer: UnitedHealthcare Medicaid	$955.20
Rate for Payer: UnitedHealthcare Medicare	$493.52
Rate for Payer: University Health Alliance Commercial	$1,160.41

POSITIONER SAFE-T

Facility

$544.00

Hospital Revenue Code	272
Min. Negotiated Rate	$462.40
Max. Negotiated Rate	$527.68
Rate for Payer: Cash Price	$326.40
Rate for Payer: Health Management Network Commercial	$462.40
Rate for Payer: Kaiser Permanente Commercial	$489.60
Rate for Payer: MDX Hawaii PPO	$527.68

POSITIONER SAFE-T

Facility

$544.00

Hospital Revenue Code	272
Min. Negotiated Rate	$168.64
Max. Negotiated Rate	$527.68
Rate for Payer: AlohaCare Medicaid	$272.00
Rate for Payer: AlohaCare Medicare	$168.64
Rate for Payer: Cash Price	$326.40
Rate for Payer: Devoted Health Medicare	$184.96
Rate for Payer: Hawaii Medical Service Association Medicare	$168.64
Rate for Payer: Hawaii Western Management Group Commercial	$516.80
Rate for Payer: Health Management Network Commercial	$462.40
Rate for Payer: Humana Medicare	$168.64
Rate for Payer: Kaiser Permanente Commercial	$489.60
Rate for Payer: Kaiser Permanente Medicaid	$277.44
Rate for Payer: Kaiser Permanente Medicare	$168.64
Rate for Payer: MDX Hawaii PPO	$527.68
Rate for Payer: Ohana Health Plan Medicaid	$168.64
Rate for Payer: Ohana Health Plan Medicare	$168.64
Rate for Payer: UnitedHealthcare Medicare	$168.64
Rate for Payer: University Health Alliance Commercial	$396.52

POSITIONING REVERSE KIT 40642

Facility

$737.00

Hospital Revenue Code	272
Min. Negotiated Rate	$228.47
Max. Negotiated Rate	$714.89
Rate for Payer: AlohaCare Medicaid	$368.50
Rate for Payer: AlohaCare Medicare	$228.47
Rate for Payer: Cash Price	$442.20
Rate for Payer: Devoted Health Medicare	$250.58
Rate for Payer: Hawaii Medical Service Association Medicare	$228.47
Rate for Payer: Hawaii Western Management Group Commercial	$700.15
Rate for Payer: Health Management Network Commercial	$626.45
Rate for Payer: Humana Medicare	$228.47
Rate for Payer: Kaiser Permanente Commercial	$663.30
Rate for Payer: Kaiser Permanente Medicaid	$375.87
Rate for Payer: Kaiser Permanente Medicare	$228.47
Rate for Payer: MDX Hawaii PPO	$714.89
Rate for Payer: Ohana Health Plan Medicaid	$228.47
Rate for Payer: Ohana Health Plan Medicare	$228.47
Rate for Payer: UnitedHealthcare Medicare	$228.47
Rate for Payer: University Health Alliance Commercial	$537.20

POSITIONING REVERSE KIT 40642

Facility

$737.00

Hospital Revenue Code	272
Min. Negotiated Rate	$626.45
Max. Negotiated Rate	$714.89
Rate for Payer: Cash Price	$442.20
Rate for Payer: Health Management Network Commercial	$626.45
Rate for Payer: Kaiser Permanente Commercial	$663.30
Rate for Payer: MDX Hawaii PPO	$714.89

POST 30D ANGLE 11MM 4922-2-140

Facility

$488.00

Hospital Revenue Code	278
Min. Negotiated Rate	$273.28
Max. Negotiated Rate	$473.36
Rate for Payer: Cash Price	$292.80
Rate for Payer: Hawaii Western Management Group Commercial	$341.60
Rate for Payer: Health Management Network Commercial	$414.80
Rate for Payer: Kaiser Permanente Commercial	$439.20
Rate for Payer: MDX Hawaii PPO	$473.36
Rate for Payer: University Health Alliance Commercial	$273.28

POST 30D ANGLE 11MM 4922-2-140

Facility

$488.00

Hospital Revenue Code	278
Min. Negotiated Rate	$151.28
Max. Negotiated Rate	$473.36
Rate for Payer: AlohaCare Medicaid	$244.00
Rate for Payer: AlohaCare Medicare	$151.28
Rate for Payer: Cash Price	$292.80
Rate for Payer: Devoted Health Medicare	$165.92
Rate for Payer: Hawaii Medical Service Association Medicare	$151.28
Rate for Payer: Hawaii Western Management Group Commercial	$341.60
Rate for Payer: Health Management Network Commercial	$414.80
Rate for Payer: Humana Medicare	$151.28
Rate for Payer: Kaiser Permanente Commercial	$439.20
Rate for Payer: Kaiser Permanente Medicaid	$248.88
Rate for Payer: Kaiser Permanente Medicare	$151.28
Rate for Payer: MDX Hawaii PPO	$473.36
Rate for Payer: Ohana Health Plan Medicaid	$151.28
Rate for Payer: Ohana Health Plan Medicare	$151.28
Rate for Payer: UnitedHealthcare Medicare	$151.28
Rate for Payer: University Health Alliance Commercial	$273.28

POST 90 DEG 4922-2-160

Facility

$901.00

Hospital Revenue Code	272
Min. Negotiated Rate	$765.85
Max. Negotiated Rate	$873.97
Rate for Payer: Cash Price	$540.60
Rate for Payer: Health Management Network Commercial	$765.85
Rate for Payer: Kaiser Permanente Commercial	$810.90
Rate for Payer: MDX Hawaii PPO	$873.97

POST 90 DEG 4922-2-160

Facility

$901.00

Hospital Revenue Code	272
Min. Negotiated Rate	$279.31
Max. Negotiated Rate	$873.97
Rate for Payer: AlohaCare Medicaid	$450.50
Rate for Payer: AlohaCare Medicare	$279.31
Rate for Payer: Cash Price	$540.60
Rate for Payer: Devoted Health Medicare	$306.34
Rate for Payer: Hawaii Medical Service Association Medicare	$279.31
Rate for Payer: Hawaii Western Management Group Commercial	$855.95
Rate for Payer: Health Management Network Commercial	$765.85
Rate for Payer: Humana Medicare	$279.31
Rate for Payer: Kaiser Permanente Commercial	$810.90
Rate for Payer: Kaiser Permanente Medicaid	$459.51
Rate for Payer: Kaiser Permanente Medicare	$279.31
Rate for Payer: MDX Hawaii PPO	$873.97
Rate for Payer: Ohana Health Plan Medicaid	$279.31
Rate for Payer: Ohana Health Plan Medicare	$279.31
Rate for Payer: UnitedHealthcare Medicare	$279.31
Rate for Payer: University Health Alliance Commercial	$656.74

POSTLAT DSTL HUM 02.117.307

Facility

$2,749.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$852.19
Max. Negotiated Rate	$2,666.53
Rate for Payer: AlohaCare Medicaid	$1,374.50
Rate for Payer: AlohaCare Medicare	$852.19
Rate for Payer: Cash Price	$1,649.40
Rate for Payer: Devoted Health Medicare	$934.66
Rate for Payer: Hawaii Medical Service Association Medicare	$852.19
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.30
Rate for Payer: Health Management Network Commercial	$2,336.65
Rate for Payer: Humana Medicare	$852.19
Rate for Payer: Kaiser Permanente Commercial	$2,474.10
Rate for Payer: Kaiser Permanente Medicaid	$1,401.99
Rate for Payer: Kaiser Permanente Medicare	$852.19
Rate for Payer: MDX Hawaii PPO	$2,666.53
Rate for Payer: Ohana Health Plan Medicaid	$852.19
Rate for Payer: Ohana Health Plan Medicare	$852.19
Rate for Payer: UnitedHealthcare Medicare	$852.19
Rate for Payer: University Health Alliance Commercial	$1,539.44

POSTLAT DSTL HUM 02.117.307

Facility

$2,749.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,539.44
Max. Negotiated Rate	$2,666.53
Rate for Payer: Cash Price	$1,649.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.30
Rate for Payer: Health Management Network Commercial	$2,336.65
Rate for Payer: Kaiser Permanente Commercial	$2,474.10
Rate for Payer: MDX Hawaii PPO	$2,666.53
Rate for Payer: University Health Alliance Commercial	$1,539.44

POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC

Facility

$21,545.12

Service Code	MSDRG 862
Min. Negotiated Rate	$21,545.12
Max. Negotiated Rate	$21,545.12
Rate for Payer: Hawaii Medical Service Association Commercial	$21,545.12

POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC

Facility

$21,545.12

Service Code	MSDRG 863
Min. Negotiated Rate	$21,545.12
Max. Negotiated Rate	$21,545.12
Rate for Payer: Hawaii Medical Service Association Commercial	$21,545.12

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC

Facility

$37,899.50

Service Code	MSDRG 857
Min. Negotiated Rate	$37,899.50
Max. Negotiated Rate	$37,899.50
Rate for Payer: Hawaii Medical Service Association Commercial	$37,899.50

Know your out-of-pocket cost for care.

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