Kau Hospital

All Charges

Charge

Type

Setting

Price

SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [162642]

Facility

$87.00

Service Code	NDC 00310111030
Hospital Revenue Code	250
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39

SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET [162642]

Facility

$87.00

Service Code	NDC 00310111030
Hospital Revenue Code	637
Min. Negotiated Rate	$26.97
Max. Negotiated Rate	$84.39
Rate for Payer: AlohaCare Medicaid	$43.50
Rate for Payer: AlohaCare Medicare	$26.97
Rate for Payer: Cash Price	$52.20
Rate for Payer: Devoted Health Medicare	$29.58
Rate for Payer: Hawaii Medical Service Association Medicare	$26.97
Rate for Payer: Hawaii Western Management Group Commercial	$82.65
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$26.97
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$26.97
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$26.97
Rate for Payer: Ohana Health Plan Medicare	$26.97
Rate for Payer: UnitedHealthcare Medicare	$26.97
Rate for Payer: University Health Alliance Commercial	$63.41

SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [162641]

Facility

$87.00

Service Code	NDC 00310110501
Hospital Revenue Code	637
Min. Negotiated Rate	$26.97
Max. Negotiated Rate	$84.39
Rate for Payer: AlohaCare Medicaid	$43.50
Rate for Payer: AlohaCare Medicare	$26.97
Rate for Payer: Cash Price	$52.20
Rate for Payer: Devoted Health Medicare	$29.58
Rate for Payer: Hawaii Medical Service Association Medicare	$26.97
Rate for Payer: Hawaii Western Management Group Commercial	$82.65
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$26.97
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$26.97
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$26.97
Rate for Payer: Ohana Health Plan Medicare	$26.97
Rate for Payer: UnitedHealthcare Medicare	$26.97
Rate for Payer: University Health Alliance Commercial	$63.41

SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [162641]

Facility

$87.00

Service Code	NDC 00310110530
Hospital Revenue Code	250
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39

SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [162641]

Facility

$87.00

Service Code	NDC 00310110501
Hospital Revenue Code	250
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39

SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET [162641]

Facility

$87.00

Service Code	NDC 00310110530
Hospital Revenue Code	637
Min. Negotiated Rate	$26.97
Max. Negotiated Rate	$84.39
Rate for Payer: AlohaCare Medicaid	$43.50
Rate for Payer: AlohaCare Medicare	$26.97
Rate for Payer: Cash Price	$52.20
Rate for Payer: Devoted Health Medicare	$29.58
Rate for Payer: Hawaii Medical Service Association Medicare	$26.97
Rate for Payer: Hawaii Western Management Group Commercial	$82.65
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$26.97
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$26.97
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$26.97
Rate for Payer: Ohana Health Plan Medicare	$26.97
Rate for Payer: UnitedHealthcare Medicare	$26.97
Rate for Payer: University Health Alliance Commercial	$63.41

SOFT TISSUE PROCEDURES WITH CC

Facility

$46,408.52

Service Code	MSDRG 501
Min. Negotiated Rate	$46,408.52
Max. Negotiated Rate	$46,408.52
Rate for Payer: Hawaii Medical Service Association Commercial	$46,408.52

SOFT TISSUE PROCEDURES WITH MCC

Facility

$46,408.52

Service Code	MSDRG 500
Min. Negotiated Rate	$46,408.52
Max. Negotiated Rate	$46,408.52
Rate for Payer: Hawaii Medical Service Association Commercial	$46,408.52

SOFT TISSUE PROCEDURES WITHOUT CC/MCC

Facility

$22,896.13

Service Code	MSDRG 502
Min. Negotiated Rate	$22,896.13
Max. Negotiated Rate	$22,896.13
Rate for Payer: Hawaii Medical Service Association Commercial	$22,896.13

SOFT-VU MPA 5FX65

Facility

$145.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$87.00
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: MDX Hawaii PPO	$140.65

SOFT-VU MPA 5FX65

Facility

$145.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$44.95
Max. Negotiated Rate	$140.65
Rate for Payer: AlohaCare Medicaid	$72.50
Rate for Payer: AlohaCare Medicare	$44.95
Rate for Payer: Cash Price	$87.00
Rate for Payer: Devoted Health Medicare	$49.30
Rate for Payer: Hawaii Medical Service Association Medicare	$44.95
Rate for Payer: Hawaii Western Management Group Commercial	$137.75
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$44.95
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicare	$44.95
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$44.95
Rate for Payer: Ohana Health Plan Medicare	$44.95
Rate for Payer: UnitedHealthcare Medicare	$44.95
Rate for Payer: University Health Alliance Commercial	$105.69

SOLN LIFT AGENT 5ML

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$194.00
Rate for Payer: AlohaCare Medicaid	$100.00
Rate for Payer: AlohaCare Medicare	$62.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Devoted Health Medicare	$68.00
Rate for Payer: Hawaii Medical Service Association Medicare	$62.00
Rate for Payer: Hawaii Western Management Group Commercial	$190.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Humana Medicare	$62.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: Kaiser Permanente Medicare	$62.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: Ohana Health Plan Medicaid	$62.00
Rate for Payer: Ohana Health Plan Medicare	$62.00
Rate for Payer: UnitedHealthcare Medicare	$62.00
Rate for Payer: University Health Alliance Commercial	$145.78

SOLN LIFT AGENT 5ML

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: MDX Hawaii PPO	$194.00

SOLUTION 1.5% 2L PD

Facility

$163.00

Hospital Revenue Code	272
Min. Negotiated Rate	$50.53
Max. Negotiated Rate	$158.11
Rate for Payer: AlohaCare Medicaid	$81.50
Rate for Payer: AlohaCare Medicare	$50.53
Rate for Payer: Cash Price	$97.80
Rate for Payer: Devoted Health Medicare	$55.42
Rate for Payer: Hawaii Medical Service Association Medicare	$50.53
Rate for Payer: Hawaii Western Management Group Commercial	$154.85
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Humana Medicare	$50.53
Rate for Payer: Kaiser Permanente Commercial	$146.70
Rate for Payer: Kaiser Permanente Medicaid	$83.13
Rate for Payer: Kaiser Permanente Medicare	$50.53
Rate for Payer: MDX Hawaii PPO	$158.11
Rate for Payer: Ohana Health Plan Medicaid	$50.53
Rate for Payer: Ohana Health Plan Medicare	$50.53
Rate for Payer: UnitedHealthcare Medicare	$50.53
Rate for Payer: University Health Alliance Commercial	$118.81

SOLUTION 1.5% 2L PD

Facility

$163.00

Hospital Revenue Code	272
Min. Negotiated Rate	$138.55
Max. Negotiated Rate	$158.11
Rate for Payer: Cash Price	$97.80
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Kaiser Permanente Commercial	$146.70
Rate for Payer: MDX Hawaii PPO	$158.11

SOLUTION 2.5% 2L PD

Facility

$188.00

Hospital Revenue Code	272
Min. Negotiated Rate	$159.80
Max. Negotiated Rate	$182.36
Rate for Payer: Cash Price	$112.80
Rate for Payer: Health Management Network Commercial	$159.80
Rate for Payer: Kaiser Permanente Commercial	$169.20
Rate for Payer: MDX Hawaii PPO	$182.36

SOLUTION 2.5% 2L PD

Facility

$188.00

Hospital Revenue Code	272
Min. Negotiated Rate	$58.28
Max. Negotiated Rate	$182.36
Rate for Payer: AlohaCare Medicaid	$94.00
Rate for Payer: AlohaCare Medicare	$58.28
Rate for Payer: Cash Price	$112.80
Rate for Payer: Devoted Health Medicare	$63.92
Rate for Payer: Hawaii Medical Service Association Medicare	$58.28
Rate for Payer: Hawaii Western Management Group Commercial	$178.60
Rate for Payer: Health Management Network Commercial	$159.80
Rate for Payer: Humana Medicare	$58.28
Rate for Payer: Kaiser Permanente Commercial	$169.20
Rate for Payer: Kaiser Permanente Medicaid	$95.88
Rate for Payer: Kaiser Permanente Medicare	$58.28
Rate for Payer: MDX Hawaii PPO	$182.36
Rate for Payer: Ohana Health Plan Medicaid	$58.28
Rate for Payer: Ohana Health Plan Medicare	$58.28
Rate for Payer: UnitedHealthcare Medicare	$58.28
Rate for Payer: University Health Alliance Commercial	$137.03

SOLUTION 4.25% 2L PD

Facility

$148.00

Hospital Revenue Code	272
Min. Negotiated Rate	$45.88
Max. Negotiated Rate	$143.56
Rate for Payer: AlohaCare Medicaid	$74.00
Rate for Payer: AlohaCare Medicare	$45.88
Rate for Payer: Cash Price	$88.80
Rate for Payer: Devoted Health Medicare	$50.32
Rate for Payer: Hawaii Medical Service Association Medicare	$45.88
Rate for Payer: Hawaii Western Management Group Commercial	$140.60
Rate for Payer: Health Management Network Commercial	$125.80
Rate for Payer: Humana Medicare	$45.88
Rate for Payer: Kaiser Permanente Commercial	$133.20
Rate for Payer: Kaiser Permanente Medicaid	$75.48
Rate for Payer: Kaiser Permanente Medicare	$45.88
Rate for Payer: MDX Hawaii PPO	$143.56
Rate for Payer: Ohana Health Plan Medicaid	$45.88
Rate for Payer: Ohana Health Plan Medicare	$45.88
Rate for Payer: UnitedHealthcare Medicare	$45.88
Rate for Payer: University Health Alliance Commercial	$107.88

SOLUTION 4.25% 2L PD

Facility

$148.00

Hospital Revenue Code	272
Min. Negotiated Rate	$125.80
Max. Negotiated Rate	$143.56
Rate for Payer: Cash Price	$88.80
Rate for Payer: Health Management Network Commercial	$125.80
Rate for Payer: Kaiser Permanente Commercial	$133.20
Rate for Payer: MDX Hawaii PPO	$143.56

SOLUTION CR GREEN #5976-40-12

Facility

$2,228.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$690.68
Max. Negotiated Rate	$2,161.16
Rate for Payer: AlohaCare Medicaid	$1,114.00
Rate for Payer: AlohaCare Medicare	$690.68
Rate for Payer: Cash Price	$1,336.80
Rate for Payer: Devoted Health Medicare	$757.52
Rate for Payer: Hawaii Medical Service Association Medicare	$690.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,559.60
Rate for Payer: Health Management Network Commercial	$1,893.80
Rate for Payer: Humana Medicare	$690.68
Rate for Payer: Kaiser Permanente Commercial	$2,005.20
Rate for Payer: Kaiser Permanente Medicaid	$1,136.28
Rate for Payer: Kaiser Permanente Medicare	$690.68
Rate for Payer: MDX Hawaii PPO	$2,161.16
Rate for Payer: Ohana Health Plan Medicaid	$690.68
Rate for Payer: Ohana Health Plan Medicare	$690.68
Rate for Payer: UnitedHealthcare Medicare	$690.68
Rate for Payer: University Health Alliance Commercial	$1,247.68

SOLUTION CR GREEN #5976-40-12

Facility

$2,228.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,247.68
Max. Negotiated Rate	$2,161.16
Rate for Payer: Cash Price	$1,336.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,559.60
Rate for Payer: Health Management Network Commercial	$1,893.80
Rate for Payer: Kaiser Permanente Commercial	$2,005.20
Rate for Payer: MDX Hawaii PPO	$2,161.16
Rate for Payer: University Health Alliance Commercial	$1,247.68

SORBITOL 70 % SOLUTION [7413]

Facility

$15.00

Service Code	NDC 50030000000
Hospital Revenue Code	250
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

SORBITOL 70 % SOLUTION [7413]

Facility

$15.00

Service Code	NDC 50030000000
Hospital Revenue Code	637
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

SOTALOL 80 MG TABLET [11421]

Facility

$9.00

Service Code	NDC 68084065401
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

SOTALOL 80 MG TABLET [11421]

Facility

$9.00

Service Code	NDC 00093106101
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

Know your out-of-pocket cost for care.

All Charges