Kau Hospital

All Charges

Charge

Type

Setting

Price

SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]

Facility

$11.00

Service Code	NDC 57237031005
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

$9.00

Service Code	NDC 48433021940
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

SENNOSIDES 8.8 MG/5 ML ORAL SYRUP [15168]

Facility

$11.00

Service Code	NDC 57237031054
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 50268073111
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

SENSIA DUAL CHMBR GNRTR SEDR01

Facility

$11,520.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$3,571.20
Max. Negotiated Rate	$11,174.40
Rate for Payer: AlohaCare Medicaid	$5,760.00
Rate for Payer: AlohaCare Medicare	$3,571.20
Rate for Payer: Cash Price	$6,912.00
Rate for Payer: Devoted Health Medicare	$3,916.80
Rate for Payer: Hawaii Medical Service Association Medicare	$3,571.20
Rate for Payer: Hawaii Western Management Group Commercial	$8,064.00
Rate for Payer: Health Management Network Commercial	$9,792.00
Rate for Payer: Humana Medicare	$3,571.20
Rate for Payer: Kaiser Permanente Commercial	$10,368.00
Rate for Payer: Kaiser Permanente Medicaid	$5,875.20
Rate for Payer: Kaiser Permanente Medicare	$3,571.20
Rate for Payer: MDX Hawaii PPO	$11,174.40
Rate for Payer: Ohana Health Plan Medicaid	$3,571.20
Rate for Payer: Ohana Health Plan Medicare	$3,571.20
Rate for Payer: UnitedHealthcare Medicare	$3,571.20
Rate for Payer: University Health Alliance Commercial	$6,451.20

SENSIA DUAL CHMBR GNRTR SEDR01

Facility

$11,520.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$6,451.20
Max. Negotiated Rate	$11,174.40
Rate for Payer: Cash Price	$6,912.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,064.00
Rate for Payer: Health Management Network Commercial	$9,792.00
Rate for Payer: Kaiser Permanente Commercial	$10,368.00
Rate for Payer: MDX Hawaii PPO	$11,174.40
Rate for Payer: University Health Alliance Commercial	$6,451.20

SENSIA DUAL CHMBR GNRTR SESR01

Facility

$9,720.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$3,013.20
Max. Negotiated Rate	$9,428.40
Rate for Payer: AlohaCare Medicaid	$4,860.00
Rate for Payer: AlohaCare Medicare	$3,013.20
Rate for Payer: Cash Price	$5,832.00
Rate for Payer: Devoted Health Medicare	$3,304.80
Rate for Payer: Hawaii Medical Service Association Medicare	$3,013.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.00
Rate for Payer: Health Management Network Commercial	$8,262.00
Rate for Payer: Humana Medicare	$3,013.20
Rate for Payer: Kaiser Permanente Commercial	$8,748.00
Rate for Payer: Kaiser Permanente Medicaid	$4,957.20
Rate for Payer: Kaiser Permanente Medicare	$3,013.20
Rate for Payer: MDX Hawaii PPO	$9,428.40
Rate for Payer: Ohana Health Plan Medicaid	$3,013.20
Rate for Payer: Ohana Health Plan Medicare	$3,013.20
Rate for Payer: UnitedHealthcare Medicare	$3,013.20
Rate for Payer: University Health Alliance Commercial	$5,443.20

SENSIA DUAL CHMBR GNRTR SESR01

Facility

$9,720.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$5,443.20
Max. Negotiated Rate	$9,428.40
Rate for Payer: Cash Price	$5,832.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,804.00
Rate for Payer: Health Management Network Commercial	$8,262.00
Rate for Payer: Kaiser Permanente Commercial	$8,748.00
Rate for Payer: MDX Hawaii PPO	$9,428.40
Rate for Payer: University Health Alliance Commercial	$5,443.20

SENSOR ANGLE TIP

Facility

$203.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$172.55
Max. Negotiated Rate	$196.91
Rate for Payer: Cash Price	$121.80
Rate for Payer: Health Management Network Commercial	$172.55
Rate for Payer: Kaiser Permanente Commercial	$182.70
Rate for Payer: MDX Hawaii PPO	$196.91

SENSOR ANGLE TIP

Facility

$203.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$62.93
Max. Negotiated Rate	$196.91
Rate for Payer: AlohaCare Medicaid	$101.50
Rate for Payer: AlohaCare Medicare	$62.93
Rate for Payer: Cash Price	$121.80
Rate for Payer: Devoted Health Medicare	$69.02
Rate for Payer: Hawaii Medical Service Association Medicare	$62.93
Rate for Payer: Hawaii Western Management Group Commercial	$192.85
Rate for Payer: Health Management Network Commercial	$172.55
Rate for Payer: Humana Medicare	$62.93
Rate for Payer: Kaiser Permanente Commercial	$182.70
Rate for Payer: Kaiser Permanente Medicaid	$103.53
Rate for Payer: Kaiser Permanente Medicare	$62.93
Rate for Payer: MDX Hawaii PPO	$196.91
Rate for Payer: Ohana Health Plan Medicaid	$62.93
Rate for Payer: Ohana Health Plan Medicare	$62.93
Rate for Payer: UnitedHealthcare Medicare	$62.93
Rate for Payer: University Health Alliance Commercial	$147.97

SENSOR PAD BED 10X30

Facility

$121.00

Service Code	HCPCS A9280
Hospital Revenue Code	271
Min. Negotiated Rate	$37.51
Max. Negotiated Rate	$117.37
Rate for Payer: AlohaCare Medicaid	$60.50
Rate for Payer: AlohaCare Medicare	$37.51
Rate for Payer: Cash Price	$72.60
Rate for Payer: Devoted Health Medicare	$41.14
Rate for Payer: Hawaii Medical Service Association Medicare	$37.51
Rate for Payer: Hawaii Western Management Group Commercial	$114.95
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Humana Medicare	$37.51
Rate for Payer: Kaiser Permanente Commercial	$108.90
Rate for Payer: Kaiser Permanente Medicaid	$61.71
Rate for Payer: Kaiser Permanente Medicare	$37.51
Rate for Payer: MDX Hawaii PPO	$117.37
Rate for Payer: Ohana Health Plan Medicaid	$37.51
Rate for Payer: Ohana Health Plan Medicare	$37.51
Rate for Payer: UnitedHealthcare Medicare	$37.51
Rate for Payer: University Health Alliance Commercial	$88.20

SENSOR PAD BED 10X30

Facility

$121.00

Service Code	HCPCS A9280
Hospital Revenue Code	271
Min. Negotiated Rate	$102.85
Max. Negotiated Rate	$117.37
Rate for Payer: Cash Price	$72.60
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Kaiser Permanente Commercial	$108.90
Rate for Payer: MDX Hawaii PPO	$117.37

SEPRA FILM ADH BARRIER 4301-02

Facility

$1,018.00

Service Code	HCPCS C1765
Hospital Revenue Code	278
Min. Negotiated Rate	$315.58
Max. Negotiated Rate	$987.46
Rate for Payer: AlohaCare Medicaid	$509.00
Rate for Payer: AlohaCare Medicare	$315.58
Rate for Payer: Cash Price	$610.80
Rate for Payer: Devoted Health Medicare	$346.12
Rate for Payer: Hawaii Medical Service Association Medicare	$315.58
Rate for Payer: Hawaii Western Management Group Commercial	$712.60
Rate for Payer: Health Management Network Commercial	$865.30
Rate for Payer: Humana Medicare	$315.58
Rate for Payer: Kaiser Permanente Commercial	$916.20
Rate for Payer: Kaiser Permanente Medicaid	$519.18
Rate for Payer: Kaiser Permanente Medicare	$315.58
Rate for Payer: MDX Hawaii PPO	$987.46
Rate for Payer: Ohana Health Plan Medicaid	$315.58
Rate for Payer: Ohana Health Plan Medicare	$315.58
Rate for Payer: UnitedHealthcare Medicare	$315.58
Rate for Payer: University Health Alliance Commercial	$570.08

SEPRA FILM ADH BARRIER 4301-02

Facility

$1,018.00

Service Code	HCPCS C1765
Hospital Revenue Code	278
Min. Negotiated Rate	$570.08
Max. Negotiated Rate	$987.46
Rate for Payer: Cash Price	$610.80
Rate for Payer: Hawaii Western Management Group Commercial	$712.60
Rate for Payer: Health Management Network Commercial	$865.30
Rate for Payer: Kaiser Permanente Commercial	$916.20
Rate for Payer: MDX Hawaii PPO	$987.46
Rate for Payer: University Health Alliance Commercial	$570.08

SEPTIC ARTHRITIS WITH CC

Facility

$24,460.46

Service Code	MSDRG 549
Min. Negotiated Rate	$24,460.46
Max. Negotiated Rate	$24,460.46
Rate for Payer: Hawaii Medical Service Association Commercial	$24,460.46

SEPTIC ARTHRITIS WITH MCC

Facility

$24,460.46

Service Code	MSDRG 548
Min. Negotiated Rate	$24,460.46
Max. Negotiated Rate	$24,460.46
Rate for Payer: Hawaii Medical Service Association Commercial	$24,460.46

SEPTIC ARTHRITIS WITHOUT CC/MCC

Facility

$24,460.46

Service Code	MSDRG 550
Min. Negotiated Rate	$24,460.46
Max. Negotiated Rate	$24,460.46
Rate for Payer: Hawaii Medical Service Association Commercial	$24,460.46

SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS

Facility

$182,695.02

Service Code	MSDRG 870
Min. Negotiated Rate	$182,695.02
Max. Negotiated Rate	$182,695.02
Rate for Payer: Hawaii Medical Service Association Commercial	$182,695.02

SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC

Facility

$40,814.84

Service Code	MSDRG 871
Min. Negotiated Rate	$40,814.84
Max. Negotiated Rate	$40,814.84
Rate for Payer: Hawaii Medical Service Association Commercial	$40,814.84

SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC

Facility

$40,791.14

Service Code	MSDRG 872
Min. Negotiated Rate	$40,791.14
Max. Negotiated Rate	$40,791.14
Rate for Payer: Hawaii Medical Service Association Commercial	$40,791.14

SERTRALINE 100 MG TABLET [11350]

Facility

$2.00

Service Code	NDC 60687025311
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

SERTRALINE 100 MG TABLET [11350]

Facility

$2.00

Service Code	NDC 60687025311
Hospital Revenue Code	637
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$0.62
Rate for Payer: Cash Price	$1.20
Rate for Payer: Devoted Health Medicare	$0.68
Rate for Payer: Hawaii Medical Service Association Medicare	$0.62
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$0.62
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$0.62
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$0.62
Rate for Payer: Ohana Health Plan Medicare	$0.62
Rate for Payer: UnitedHealthcare Medicare	$0.62
Rate for Payer: University Health Alliance Commercial	$1.46

SERTRALINE 100 MG TABLET [11350]

Facility

$2.00

Service Code	NDC 60687025301
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

SERTRALINE 100 MG TABLET [11350]

Facility

$2.00

Service Code	NDC 60687025301
Hospital Revenue Code	637
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$0.62
Rate for Payer: Cash Price	$1.20
Rate for Payer: Devoted Health Medicare	$0.68
Rate for Payer: Hawaii Medical Service Association Medicare	$0.62
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$0.62
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$0.62
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$0.62
Rate for Payer: Ohana Health Plan Medicare	$0.62
Rate for Payer: UnitedHealthcare Medicare	$0.62
Rate for Payer: University Health Alliance Commercial	$1.46

SERTRALINE 25 MG TABLET [19882]

Facility

$2.00

Service Code	NDC 60687023101
Hospital Revenue Code	637
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$0.62
Rate for Payer: Cash Price	$1.20
Rate for Payer: Devoted Health Medicare	$0.68
Rate for Payer: Hawaii Medical Service Association Medicare	$0.62
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$0.62
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$0.62
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$0.62
Rate for Payer: Ohana Health Plan Medicare	$0.62
Rate for Payer: UnitedHealthcare Medicare	$0.62
Rate for Payer: University Health Alliance Commercial	$1.46

Know your out-of-pocket cost for care.

All Charges