Kau Hospital

All Charges

Charge

Type

Setting

Price

TA 30-3.5 RELOADING STAPLER

Facility

$297.00

Hospital Revenue Code	272
Min. Negotiated Rate	$92.07
Max. Negotiated Rate	$288.09
Rate for Payer: AlohaCare Medicaid	$148.50
Rate for Payer: AlohaCare Medicare	$92.07
Rate for Payer: Cash Price	$178.20
Rate for Payer: Devoted Health Medicare	$100.98
Rate for Payer: Hawaii Medical Service Association Medicare	$92.07
Rate for Payer: Hawaii Western Management Group Commercial	$282.15
Rate for Payer: Health Management Network Commercial	$252.45
Rate for Payer: Humana Medicare	$92.07
Rate for Payer: Kaiser Permanente Commercial	$267.30
Rate for Payer: Kaiser Permanente Medicaid	$151.47
Rate for Payer: Kaiser Permanente Medicare	$92.07
Rate for Payer: MDX Hawaii PPO	$288.09
Rate for Payer: Ohana Health Plan Medicaid	$92.07
Rate for Payer: Ohana Health Plan Medicare	$92.07
Rate for Payer: UnitedHealthcare Medicare	$92.07
Rate for Payer: University Health Alliance Commercial	$216.48

TA 30 STAPLER 30MM-3.5MM

Facility

$184.00

Hospital Revenue Code	272
Min. Negotiated Rate	$156.40
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$110.40
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: MDX Hawaii PPO	$178.48

TA 30 STAPLER 30MM-3.5MM

Facility

$184.00

Hospital Revenue Code	272
Min. Negotiated Rate	$57.04
Max. Negotiated Rate	$178.48
Rate for Payer: AlohaCare Medicaid	$92.00
Rate for Payer: AlohaCare Medicare	$57.04
Rate for Payer: Cash Price	$110.40
Rate for Payer: Devoted Health Medicare	$62.56
Rate for Payer: Hawaii Medical Service Association Medicare	$57.04
Rate for Payer: Hawaii Western Management Group Commercial	$174.80
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Humana Medicare	$57.04
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: Kaiser Permanente Medicaid	$93.84
Rate for Payer: Kaiser Permanente Medicare	$57.04
Rate for Payer: MDX Hawaii PPO	$178.48
Rate for Payer: Ohana Health Plan Medicaid	$57.04
Rate for Payer: Ohana Health Plan Medicare	$57.04
Rate for Payer: UnitedHealthcare Medicare	$57.04
Rate for Payer: University Health Alliance Commercial	$134.12

TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE [24914]

Facility

$8.00

Service Code	HCPCS J7507
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$7.76
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$2.48
Rate for Payer: Cash Price	$4.80
Rate for Payer: Cash Price	$4.80
Rate for Payer: Devoted Health Medicare	$2.72
Rate for Payer: Hawaii Medical Service Association ABD	$0.15
Rate for Payer: Hawaii Medical Service Association Medicare	$2.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.15
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Humana Medicare	$2.48
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicare	$2.48
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: Ohana Health Plan Medicaid	$2.48
Rate for Payer: Ohana Health Plan Medicare	$2.48
Rate for Payer: UnitedHealthcare Medicaid	$4.80
Rate for Payer: UnitedHealthcare Medicare	$2.48
Rate for Payer: University Health Alliance Commercial	$5.83

TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE [24914]

Facility

$8.00

Service Code	HCPCS J7507
Hospital Revenue Code	250
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: MDX Hawaii PPO	$7.76

TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]

Facility

$16.00

Service Code	HCPCS J7507
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE [12933]

Facility

$16.00

Service Code	HCPCS J7507
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$15.52
Rate for Payer: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$4.96
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Devoted Health Medicare	$5.44
Rate for Payer: Hawaii Medical Service Association ABD	$0.15
Rate for Payer: Hawaii Medical Service Association Medicare	$4.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.15
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Humana Medicare	$4.96
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicare	$4.96
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: Ohana Health Plan Medicaid	$4.96
Rate for Payer: Ohana Health Plan Medicare	$4.96
Rate for Payer: UnitedHealthcare Medicaid	$9.60
Rate for Payer: UnitedHealthcare Medicare	$4.96
Rate for Payer: University Health Alliance Commercial	$11.66

TAKERU RX OTW 1.5X12

Facility

$529.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: MDX Hawaii PPO	$513.13

TAKERU RX OTW 1.5X12

Facility

$529.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$163.99
Max. Negotiated Rate	$513.13
Rate for Payer: AlohaCare Medicaid	$264.50
Rate for Payer: AlohaCare Medicare	$163.99
Rate for Payer: Cash Price	$317.40
Rate for Payer: Devoted Health Medicare	$179.86
Rate for Payer: Hawaii Medical Service Association Medicare	$163.99
Rate for Payer: Hawaii Western Management Group Commercial	$502.55
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Humana Medicare	$163.99
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: Kaiser Permanente Medicare	$163.99
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: Ohana Health Plan Medicaid	$163.99
Rate for Payer: Ohana Health Plan Medicare	$163.99
Rate for Payer: UnitedHealthcare Medicare	$163.99
Rate for Payer: University Health Alliance Commercial	$385.59

TAKERU RX OTW 2X12

Facility

$529.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$163.99
Max. Negotiated Rate	$513.13
Rate for Payer: AlohaCare Medicaid	$264.50
Rate for Payer: AlohaCare Medicare	$163.99
Rate for Payer: Cash Price	$317.40
Rate for Payer: Devoted Health Medicare	$179.86
Rate for Payer: Hawaii Medical Service Association Medicare	$163.99
Rate for Payer: Hawaii Western Management Group Commercial	$502.55
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Humana Medicare	$163.99
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: Kaiser Permanente Medicare	$163.99
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: Ohana Health Plan Medicaid	$163.99
Rate for Payer: Ohana Health Plan Medicare	$163.99
Rate for Payer: UnitedHealthcare Medicare	$163.99
Rate for Payer: University Health Alliance Commercial	$385.59

TAKERU RX OTW 2X12

Facility

$529.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: MDX Hawaii PPO	$513.13

TAMOXIFEN 10 MG TABLET [7711]

Facility

$7.00

Service Code	NDC 59651029960
Hospital Revenue Code	637
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$6.79
Rate for Payer: AlohaCare Medicaid	$3.50
Rate for Payer: AlohaCare Medicare	$2.17
Rate for Payer: Cash Price	$4.20
Rate for Payer: Devoted Health Medicare	$2.38
Rate for Payer: Hawaii Medical Service Association Medicare	$2.17
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Humana Medicare	$2.17
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: Kaiser Permanente Medicare	$2.17
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: Ohana Health Plan Medicaid	$2.17
Rate for Payer: Ohana Health Plan Medicare	$2.17
Rate for Payer: UnitedHealthcare Medicare	$2.17
Rate for Payer: University Health Alliance Commercial	$5.10

TAMOXIFEN 10 MG TABLET [7711]

Facility

$7.00

Service Code	NDC 59651029960
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$6.79

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

$15.00

Service Code	NDC 68084029901
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

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

$15.00

Service Code	NDC 68084029911
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

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

$15.00

Service Code	NDC 68084029901
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

TAMSULOSIN 0.4 MG CAPSULE [103890]

Facility

$15.00

Service Code	NDC 68084029911
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

TAMSULOSIN CAPSULES (FLOMAX) 0.4 MG (TAKE HOME) [4080397]

Facility

$15.00

Service Code	NDC 00004080189
Hospital Revenue Code	253
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

TAMSULOSIN CAPSULES (FLOMAX) 0.4 MG (TAKE HOME) [4080397]

Facility

$15.00

Service Code	NDC 00004080189
Hospital Revenue Code	253
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

TAP AO 703899

Facility

$1,690.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,436.50
Max. Negotiated Rate	$1,639.30
Rate for Payer: Cash Price	$1,014.00
Rate for Payer: Health Management Network Commercial	$1,436.50
Rate for Payer: Kaiser Permanente Commercial	$1,521.00
Rate for Payer: MDX Hawaii PPO	$1,639.30

TAP AO 703899

Facility

$1,690.00

Hospital Revenue Code	272
Min. Negotiated Rate	$523.90
Max. Negotiated Rate	$1,639.30
Rate for Payer: AlohaCare Medicaid	$845.00
Rate for Payer: AlohaCare Medicare	$523.90
Rate for Payer: Cash Price	$1,014.00
Rate for Payer: Devoted Health Medicare	$574.60
Rate for Payer: Hawaii Medical Service Association Medicare	$523.90
Rate for Payer: Hawaii Western Management Group Commercial	$1,605.50
Rate for Payer: Health Management Network Commercial	$1,436.50
Rate for Payer: Humana Medicare	$523.90
Rate for Payer: Kaiser Permanente Commercial	$1,521.00
Rate for Payer: Kaiser Permanente Medicaid	$861.90
Rate for Payer: Kaiser Permanente Medicare	$523.90
Rate for Payer: MDX Hawaii PPO	$1,639.30
Rate for Payer: Ohana Health Plan Medicaid	$523.90
Rate for Payer: Ohana Health Plan Medicare	$523.90
Rate for Payer: UnitedHealthcare Medicare	$523.90
Rate for Payer: University Health Alliance Commercial	$1,231.84

TAP CORTX SCREW 3.5/110 311.32

Facility

$529.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: MDX Hawaii PPO	$513.13

TAP CORTX SCREW 3.5/110 311.32

Facility

$529.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$163.99
Max. Negotiated Rate	$513.13
Rate for Payer: AlohaCare Medicaid	$264.50
Rate for Payer: AlohaCare Medicare	$163.99
Rate for Payer: Cash Price	$317.40
Rate for Payer: Devoted Health Medicare	$179.86
Rate for Payer: Hawaii Medical Service Association Medicare	$163.99
Rate for Payer: Hawaii Western Management Group Commercial	$502.55
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Humana Medicare	$163.99
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: Kaiser Permanente Medicare	$163.99
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: Ohana Health Plan Medicaid	$163.99
Rate for Payer: Ohana Health Plan Medicare	$163.99
Rate for Payer: UnitedHealthcare Medicare	$163.99
Rate for Payer: University Health Alliance Commercial	$385.59

TAPER M/L 6 EXT

Facility

$10,154.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,147.74
Max. Negotiated Rate	$9,849.38
Rate for Payer: AlohaCare Medicaid	$5,077.00
Rate for Payer: AlohaCare Medicare	$3,147.74
Rate for Payer: Cash Price	$6,092.40
Rate for Payer: Devoted Health Medicare	$3,452.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3,147.74
Rate for Payer: Hawaii Western Management Group Commercial	$7,107.80
Rate for Payer: Health Management Network Commercial	$8,630.90
Rate for Payer: Humana Medicare	$3,147.74
Rate for Payer: Kaiser Permanente Commercial	$9,138.60
Rate for Payer: Kaiser Permanente Medicaid	$5,178.54
Rate for Payer: Kaiser Permanente Medicare	$3,147.74
Rate for Payer: MDX Hawaii PPO	$9,849.38
Rate for Payer: Ohana Health Plan Medicaid	$3,147.74
Rate for Payer: Ohana Health Plan Medicare	$3,147.74
Rate for Payer: UnitedHealthcare Medicare	$3,147.74
Rate for Payer: University Health Alliance Commercial	$5,686.24

TAPER M/L 6 EXT

Facility

$10,154.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,686.24
Max. Negotiated Rate	$9,849.38
Rate for Payer: Cash Price	$6,092.40
Rate for Payer: Hawaii Western Management Group Commercial	$7,107.80
Rate for Payer: Health Management Network Commercial	$8,630.90
Rate for Payer: Kaiser Permanente Commercial	$9,138.60
Rate for Payer: MDX Hawaii PPO	$9,849.38
Rate for Payer: University Health Alliance Commercial	$5,686.24

Know your out-of-pocket cost for care.

All Charges