Kau Hospital

All Charges

Charge

Type

Setting

Price

SOTALOL 80 MG TABLET [11421]

Facility

$9.00

Service Code	NDC 00093106101
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

SOTALOL 80 MG TABLET [11421]

Facility

$9.00

Service Code	NDC 68084065401
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

SPACER FEMORAL 64MM RKFMMD

Facility

$9,460.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,297.60
Max. Negotiated Rate	$9,176.20
Rate for Payer: Cash Price	$5,676.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,622.00
Rate for Payer: Health Management Network Commercial	$8,041.00
Rate for Payer: Kaiser Permanente Commercial	$8,514.00
Rate for Payer: MDX Hawaii PPO	$9,176.20
Rate for Payer: University Health Alliance Commercial	$5,297.60

SPACER FEMORAL 64MM RKFMMD

Facility

$9,460.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,932.60
Max. Negotiated Rate	$9,176.20
Rate for Payer: AlohaCare Medicaid	$4,730.00
Rate for Payer: AlohaCare Medicare	$2,932.60
Rate for Payer: Cash Price	$5,676.00
Rate for Payer: Devoted Health Medicare	$3,216.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,932.60
Rate for Payer: Hawaii Western Management Group Commercial	$6,622.00
Rate for Payer: Health Management Network Commercial	$8,041.00
Rate for Payer: Humana Medicare	$2,932.60
Rate for Payer: Kaiser Permanente Commercial	$8,514.00
Rate for Payer: Kaiser Permanente Medicaid	$4,824.60
Rate for Payer: Kaiser Permanente Medicare	$2,932.60
Rate for Payer: MDX Hawaii PPO	$9,176.20
Rate for Payer: Ohana Health Plan Medicaid	$2,932.60
Rate for Payer: Ohana Health Plan Medicare	$2,932.60
Rate for Payer: UnitedHealthcare Medicare	$2,932.60
Rate for Payer: University Health Alliance Commercial	$5,297.60

SPEEDBRIDGE SYS AR-8928BC-CP

Facility

$3,480.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,948.80
Max. Negotiated Rate	$3,375.60
Rate for Payer: Cash Price	$2,088.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,436.00
Rate for Payer: Health Management Network Commercial	$2,958.00
Rate for Payer: Kaiser Permanente Commercial	$3,132.00
Rate for Payer: MDX Hawaii PPO	$3,375.60
Rate for Payer: University Health Alliance Commercial	$1,948.80

SPEEDBRIDGE SYS AR-8928BC-CP

Facility

$3,480.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,078.80
Max. Negotiated Rate	$3,375.60
Rate for Payer: AlohaCare Medicaid	$1,740.00
Rate for Payer: AlohaCare Medicare	$1,078.80
Rate for Payer: Cash Price	$2,088.00
Rate for Payer: Devoted Health Medicare	$1,183.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,078.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,436.00
Rate for Payer: Health Management Network Commercial	$2,958.00
Rate for Payer: Humana Medicare	$1,078.80
Rate for Payer: Kaiser Permanente Commercial	$3,132.00
Rate for Payer: Kaiser Permanente Medicaid	$1,774.80
Rate for Payer: Kaiser Permanente Medicare	$1,078.80
Rate for Payer: MDX Hawaii PPO	$3,375.60
Rate for Payer: Ohana Health Plan Medicaid	$1,078.80
Rate for Payer: Ohana Health Plan Medicare	$1,078.80
Rate for Payer: UnitedHealthcare Medicare	$1,078.80
Rate for Payer: University Health Alliance Commercial	$1,948.80

SPEEDGRAFT JRF 10MM #SPD-001

Facility

$4,650.00

Service Code	HCPCS C1762
Hospital Revenue Code	278
Min. Negotiated Rate	$2,604.00
Max. Negotiated Rate	$4,510.50
Rate for Payer: Cash Price	$2,790.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,255.00
Rate for Payer: Health Management Network Commercial	$3,952.50
Rate for Payer: Kaiser Permanente Commercial	$4,185.00
Rate for Payer: MDX Hawaii PPO	$4,510.50
Rate for Payer: University Health Alliance Commercial	$2,604.00

SPEEDGRAFT JRF 10MM #SPD-001

Facility

$4,650.00

Service Code	HCPCS C1762
Hospital Revenue Code	278
Min. Negotiated Rate	$1,441.50
Max. Negotiated Rate	$4,510.50
Rate for Payer: AlohaCare Medicaid	$2,325.00
Rate for Payer: AlohaCare Medicare	$1,441.50
Rate for Payer: Cash Price	$2,790.00
Rate for Payer: Devoted Health Medicare	$1,581.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,441.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,255.00
Rate for Payer: Health Management Network Commercial	$3,952.50
Rate for Payer: Humana Medicare	$1,441.50
Rate for Payer: Kaiser Permanente Commercial	$4,185.00
Rate for Payer: Kaiser Permanente Medicaid	$2,371.50
Rate for Payer: Kaiser Permanente Medicare	$1,441.50
Rate for Payer: MDX Hawaii PPO	$4,510.50
Rate for Payer: Ohana Health Plan Medicaid	$1,441.50
Rate for Payer: Ohana Health Plan Medicare	$1,441.50
Rate for Payer: UnitedHealthcare Medicare	$1,441.50
Rate for Payer: University Health Alliance Commercial	$2,604.00

SPHERE FEMUR LT 4+ 02.12.0024L

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,240.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

SPHERE FEMUR LT 4+ 02.12.0024L

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,240.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: AlohaCare Medicaid	$2,000.00
Rate for Payer: AlohaCare Medicare	$1,240.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Devoted Health Medicare	$1,360.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Humana Medicare	$1,240.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: Kaiser Permanente Medicaid	$2,040.00
Rate for Payer: Kaiser Permanente Medicare	$1,240.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: Ohana Health Plan Medicaid	$1,240.00
Rate for Payer: Ohana Health Plan Medicare	$1,240.00
Rate for Payer: UnitedHealthcare Medicare	$1,240.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

SPHERE FEMUR RT 5+ 02.12.0025R

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,240.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

SPHERE FEMUR RT 5+ 02.12.0025R

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,240.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: AlohaCare Medicaid	$2,000.00
Rate for Payer: AlohaCare Medicare	$1,240.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Devoted Health Medicare	$1,360.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Humana Medicare	$1,240.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: Kaiser Permanente Medicaid	$2,040.00
Rate for Payer: Kaiser Permanente Medicare	$1,240.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: Ohana Health Plan Medicaid	$1,240.00
Rate for Payer: Ohana Health Plan Medicare	$1,240.00
Rate for Payer: UnitedHealthcare Medicare	$1,240.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

SPHERE TIB 10MM 02.12.0410CRL

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$744.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: AlohaCare Medicaid	$1,200.00
Rate for Payer: AlohaCare Medicare	$744.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Devoted Health Medicare	$816.00
Rate for Payer: Hawaii Medical Service Association Medicare	$744.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Humana Medicare	$744.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: Kaiser Permanente Medicaid	$1,224.00
Rate for Payer: Kaiser Permanente Medicare	$744.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: Ohana Health Plan Medicaid	$744.00
Rate for Payer: Ohana Health Plan Medicare	$744.00
Rate for Payer: UnitedHealthcare Medicare	$744.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

SPHERE TIB 10MM 02.12.0410CRL

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

SPHERE TIB 10 S4 02.12.0410CRR

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

SPHERE TIB 10 S4 02.12.0410CRR

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$744.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: AlohaCare Medicaid	$1,200.00
Rate for Payer: AlohaCare Medicare	$744.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Devoted Health Medicare	$816.00
Rate for Payer: Hawaii Medical Service Association Medicare	$744.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Humana Medicare	$744.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: Kaiser Permanente Medicaid	$1,224.00
Rate for Payer: Kaiser Permanente Medicare	$744.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: Ohana Health Plan Medicaid	$744.00
Rate for Payer: Ohana Health Plan Medicare	$744.00
Rate for Payer: UnitedHealthcare Medicare	$744.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

SPINAL DISORDERS AND INJURIES WITH CC/MCC

Facility

$34,581.22

Service Code	MSDRG 052
Min. Negotiated Rate	$34,581.22
Max. Negotiated Rate	$34,581.22
Rate for Payer: Hawaii Medical Service Association Commercial	$34,581.22

SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC

Facility

$34,581.22

Service Code	MSDRG 053
Min. Negotiated Rate	$34,581.22
Max. Negotiated Rate	$34,581.22
Rate for Payer: Hawaii Medical Service Association Commercial	$34,581.22

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC

Facility

$137,281.98

Service Code	MSDRG 457
Min. Negotiated Rate	$137,281.98
Max. Negotiated Rate	$137,281.98
Rate for Payer: Hawaii Medical Service Association Commercial	$137,281.98

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC

Facility

$137,281.98

Service Code	MSDRG 456
Min. Negotiated Rate	$137,281.98
Max. Negotiated Rate	$137,281.98
Rate for Payer: Hawaii Medical Service Association Commercial	$137,281.98

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC

Facility

$137,281.98

Service Code	MSDRG 458
Min. Negotiated Rate	$137,281.98
Max. Negotiated Rate	$137,281.98
Rate for Payer: Hawaii Medical Service Association Commercial	$137,281.98

SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS

Facility

$71,177.11

Service Code	MSDRG 029
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$71,177.11
Rate for Payer: Hawaii Medical Service Association Commercial	$71,177.11
Rate for Payer: University Health Alliance Commercial	$10,400.00

SPINAL PROCEDURES WITH MCC

Facility

$86,038.26

Service Code	MSDRG 028
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$86,038.26
Rate for Payer: Hawaii Medical Service Association Commercial	$86,038.26
Rate for Payer: University Health Alliance Commercial	$10,400.00

SPINAL PROCEDURES WITHOUT CC/MCC

Facility

$47,190.68

Service Code	MSDRG 030
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$47,190.68
Rate for Payer: Hawaii Medical Service Association Commercial	$47,190.68
Rate for Payer: University Health Alliance Commercial	$10,400.00

SPIRONOLACTONE 100 MG TABLET [11425]

Facility

$5.00

Service Code	NDC 51079098008
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

Know your out-of-pocket cost for care.

All Charges