Kau Hospital

All Charges

Charge

Type

Setting

Price

SECUR-FIT MAX 6051-0935S

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,236.80
Max. Negotiated Rate	$5,606.60
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Kaiser Permanente Commercial	$5,202.00
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: University Health Alliance Commercial	$3,236.80

SEIZURES WITH MCC

Facility

$22,730.22

Service Code	MSDRG 100
Min. Negotiated Rate	$22,730.22
Max. Negotiated Rate	$22,730.22
Rate for Payer: Hawaii Medical Service Association Commercial	$22,730.22

SEIZURES WITHOUT MCC

Facility

$19,625.26

Service Code	MSDRG 101
Min. Negotiated Rate	$19,625.26
Max. Negotiated Rate	$19,625.26
Rate for Payer: Hawaii Medical Service Association Commercial	$19,625.26

SELEGILINE 5 MG CAPSULE [17280]

Facility

$9.00

Service Code	NDC 60505005501
Hospital Revenue Code	637
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$8.73
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$2.79
Rate for Payer: Cash Price	$5.40
Rate for Payer: Devoted Health Medicare	$3.06
Rate for Payer: Hawaii Medical Service Association Medicare	$2.79
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Humana Medicare	$2.79
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicare	$2.79
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$2.79
Rate for Payer: Ohana Health Plan Medicare	$2.79
Rate for Payer: UnitedHealthcare Medicare	$2.79
Rate for Payer: University Health Alliance Commercial	$6.56

SELEGILINE 5 MG CAPSULE [17280]

Facility

$9.00

Service Code	NDC 60505005501
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73

SELENIUM SULFIDE 2.5 % LOTION [37630]

Facility

$70.00

Service Code	NDC 45802004064
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

SELENIUM SULFIDE 2.5 % LOTION [37630]

Facility

$70.00

Service Code	NDC 45802004064
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

SELF-PRESSURIZING GLENOID SZ48

Facility

$4,721.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,463.51
Max. Negotiated Rate	$4,579.37
Rate for Payer: AlohaCare Medicaid	$2,360.50
Rate for Payer: AlohaCare Medicare	$1,463.51
Rate for Payer: Cash Price	$2,832.60
Rate for Payer: Devoted Health Medicare	$1,605.14
Rate for Payer: Hawaii Medical Service Association Medicare	$1,463.51
Rate for Payer: Hawaii Western Management Group Commercial	$3,304.70
Rate for Payer: Health Management Network Commercial	$4,012.85
Rate for Payer: Humana Medicare	$1,463.51
Rate for Payer: Kaiser Permanente Commercial	$4,248.90
Rate for Payer: Kaiser Permanente Medicaid	$2,407.71
Rate for Payer: Kaiser Permanente Medicare	$1,463.51
Rate for Payer: MDX Hawaii PPO	$4,579.37
Rate for Payer: Ohana Health Plan Medicaid	$1,463.51
Rate for Payer: Ohana Health Plan Medicare	$1,463.51
Rate for Payer: UnitedHealthcare Medicare	$1,463.51
Rate for Payer: University Health Alliance Commercial	$2,643.76

SELF-PRESSURIZING GLENOID SZ48

Facility

$4,721.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,643.76
Max. Negotiated Rate	$4,579.37
Rate for Payer: Cash Price	$2,832.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,304.70
Rate for Payer: Health Management Network Commercial	$4,012.85
Rate for Payer: Kaiser Permanente Commercial	$4,248.90
Rate for Payer: MDX Hawaii PPO	$4,579.37
Rate for Payer: University Health Alliance Commercial	$2,643.76

SEMI TENDINOSIS TENDON 453015

Facility

$4,300.00

Service Code	HCPCS C1762
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: AlohaCare Medicaid	$2,150.00
Rate for Payer: AlohaCare Medicare	$1,333.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Devoted Health Medicare	$1,462.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,333.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Humana Medicare	$1,333.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: Kaiser Permanente Medicare	$1,333.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: Ohana Health Plan Medicaid	$1,333.00
Rate for Payer: Ohana Health Plan Medicare	$1,333.00
Rate for Payer: UnitedHealthcare Medicare	$1,333.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

SEMI TENDINOSIS TENDON 453015

Facility

$4,300.00

Service Code	HCPCS C1762
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]

Facility

$1.00

Service Code	NDC 00536124801
Hospital Revenue Code	637
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.31
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.34
Rate for Payer: Hawaii Medical Service Association Medicare	$0.31
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.31
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.31
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.31
Rate for Payer: Ohana Health Plan Medicare	$0.31
Rate for Payer: UnitedHealthcare Medicare	$0.31
Rate for Payer: University Health Alliance Commercial	$0.73

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]

Facility

$1.00

Service Code	NDC 60687062211
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]

Facility

$1.00

Service Code	NDC 60687062201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]

Facility

$1.00

Service Code	NDC 60687062201
Hospital Revenue Code	637
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.31
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.34
Rate for Payer: Hawaii Medical Service Association Medicare	$0.31
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.31
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.31
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.31
Rate for Payer: Ohana Health Plan Medicare	$0.31
Rate for Payer: UnitedHealthcare Medicare	$0.31
Rate for Payer: University Health Alliance Commercial	$0.73

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]

Facility

$1.00

Service Code	NDC 60687062211
Hospital Revenue Code	637
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.31
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.34
Rate for Payer: Hawaii Medical Service Association Medicare	$0.31
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.31
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.31
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.31
Rate for Payer: Ohana Health Plan Medicare	$0.31
Rate for Payer: UnitedHealthcare Medicare	$0.31
Rate for Payer: University Health Alliance Commercial	$0.73

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET [24216]

Facility

$1.00

Service Code	NDC 00536124801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

SENNOSIDES 8.6 MG TABLET [11349]

Facility

$1.00

Service Code	NDC 71399824503
Hospital Revenue Code	637
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.31
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.34
Rate for Payer: Hawaii Medical Service Association Medicare	$0.31
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.31
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.31
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.31
Rate for Payer: Ohana Health Plan Medicare	$0.31
Rate for Payer: UnitedHealthcare Medicare	$0.31
Rate for Payer: University Health Alliance Commercial	$0.73

SENNOSIDES 8.6 MG TABLET [11349]

Facility

$1.00

Service Code	NDC 00904725261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

SENNOSIDES 8.6 MG TABLET [11349]

Facility

$1.00

Service Code	NDC 71399824503
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

SENNOSIDES 8.6 MG TABLET [11349]

Facility

$1.00

Service Code	NDC 00904725261
Hospital Revenue Code	637
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.31
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.34
Rate for Payer: Hawaii Medical Service Association Medicare	$0.31
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.31
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.31
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.31
Rate for Payer: Ohana Health Plan Medicare	$0.31
Rate for Payer: UnitedHealthcare Medicare	$0.31
Rate for Payer: University Health Alliance Commercial	$0.73

SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]

Facility

$9.00

Service Code	NDC 48433021940
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73

SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]

Facility

$11.00

Service Code	NDC 50268073111
Hospital Revenue Code	250
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Kaiser Permanente Commercial	$9.90
Rate for Payer: MDX Hawaii PPO	$10.67

SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]

Facility

$11.00

Service Code	NDC 57237031005
Hospital Revenue Code	637
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$10.67
Rate for Payer: AlohaCare Medicaid	$5.50
Rate for Payer: AlohaCare Medicare	$3.41
Rate for Payer: Cash Price	$6.60
Rate for Payer: Devoted Health Medicare	$3.74
Rate for Payer: Hawaii Medical Service Association Medicare	$3.41
Rate for Payer: Hawaii Western Management Group Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Humana Medicare	$3.41
Rate for Payer: Kaiser Permanente Commercial	$9.90
Rate for Payer: Kaiser Permanente Medicaid	$5.61
Rate for Payer: Kaiser Permanente Medicare	$3.41
Rate for Payer: MDX Hawaii PPO	$10.67
Rate for Payer: Ohana Health Plan Medicaid	$3.41
Rate for Payer: Ohana Health Plan Medicare	$3.41
Rate for Payer: UnitedHealthcare Medicare	$3.41
Rate for Payer: University Health Alliance Commercial	$8.02

SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]

Facility

$11.00

Service Code	NDC 57237031054
Hospital Revenue Code	250
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Kaiser Permanente Commercial	$9.90
Rate for Payer: MDX Hawaii PPO	$10.67

Know your out-of-pocket cost for care.

All Charges