Kau Hospital

All Charges

Charge

Type

Setting

Price

HALOPERIDOL 0.5 MG TABLET [3578]

Facility

$2.00

Service Code	NDC 51079073320
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

HALOPERIDOL 0.5 MG TABLET [3578]

Facility

$2.00

Service Code	NDC 51079073320
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

HALOPERIDOL 1 MG TABLET [3579]

Facility

$2.00

Service Code	NDC 51079073420
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

HALOPERIDOL 1 MG TABLET [3579]

Facility

$2.00

Service Code	NDC 00378025701
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

HALOPERIDOL 1 MG TABLET [3579]

Facility

$3.00

Service Code	NDC 00904739061
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

HALOPERIDOL 1 MG TABLET [3579]

Facility

$2.00

Service Code	NDC 00378025701
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

HALOPERIDOL 1 MG TABLET [3579]

Facility

$3.00

Service Code	NDC 00904739061
Hospital Revenue Code	637
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$0.93
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$1.02
Rate for Payer: Hawaii Medical Service Association Medicare	$0.93
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$0.93
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$0.93
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$0.93
Rate for Payer: Ohana Health Plan Medicare	$0.93
Rate for Payer: UnitedHealthcare Medicare	$0.93
Rate for Payer: University Health Alliance Commercial	$2.19

HALOPERIDOL 1 MG TABLET [3579]

Facility

$2.00

Service Code	NDC 51079073420
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

HALOPERIDOL 5 MG TABLET [3583]

Facility

$4.00

Service Code	NDC 60687016111
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

HALOPERIDOL 5 MG TABLET [3583]

Facility

$4.00

Service Code	NDC 60687016101
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

HALOPERIDOL 5 MG TABLET [3583]

Facility

$4.00

Service Code	NDC 60687016111
Hospital Revenue Code	637
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$1.24
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$1.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$1.24
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$1.24
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$1.24
Rate for Payer: Ohana Health Plan Medicare	$1.24
Rate for Payer: UnitedHealthcare Medicare	$1.24
Rate for Payer: University Health Alliance Commercial	$2.92

HALOPERIDOL 5 MG TABLET [3583]

Facility

$4.00

Service Code	NDC 60687016101
Hospital Revenue Code	637
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$1.24
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$1.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$1.24
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$1.24
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$1.24
Rate for Payer: Ohana Health Plan Medicare	$1.24
Rate for Payer: UnitedHealthcare Medicare	$1.24
Rate for Payer: University Health Alliance Commercial	$2.92

HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION [10163]

Facility

$79.00

Service Code	HCPCS J1631
Hospital Revenue Code	250
Min. Negotiated Rate	$67.15
Max. Negotiated Rate	$76.63
Rate for Payer: Cash Price	$47.40
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Kaiser Permanente Commercial	$71.10
Rate for Payer: MDX Hawaii PPO	$76.63

HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION [10163]

Facility

$79.00

Service Code	HCPCS J1631
Hospital Revenue Code	636
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$76.63
Rate for Payer: AlohaCare Medicaid	$39.50
Rate for Payer: AlohaCare Medicare	$24.49
Rate for Payer: Cash Price	$47.40
Rate for Payer: Cash Price	$47.40
Rate for Payer: Devoted Health Medicare	$26.86
Rate for Payer: Hawaii Medical Service Association ABD	$4.68
Rate for Payer: Hawaii Medical Service Association Medicare	$24.49
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.68
Rate for Payer: Hawaii Western Management Group Commercial	$75.05
Rate for Payer: Health Management Network Commercial	$67.15
Rate for Payer: Humana Medicare	$24.49
Rate for Payer: Kaiser Permanente Commercial	$71.10
Rate for Payer: Kaiser Permanente Medicaid	$40.29
Rate for Payer: Kaiser Permanente Medicare	$24.49
Rate for Payer: MDX Hawaii PPO	$76.63
Rate for Payer: Ohana Health Plan Medicaid	$24.49
Rate for Payer: Ohana Health Plan Medicare	$24.49
Rate for Payer: UnitedHealthcare Medicaid	$47.40
Rate for Payer: UnitedHealthcare Medicare	$24.49
Rate for Payer: University Health Alliance Commercial	$57.58

HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE [3585]

Facility

$109.00

Service Code	NDC 00121058104
Hospital Revenue Code	250
Min. Negotiated Rate	$92.65
Max. Negotiated Rate	$105.73
Rate for Payer: Cash Price	$65.40
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: Kaiser Permanente Commercial	$98.10
Rate for Payer: MDX Hawaii PPO	$105.73

HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE [3585]

Facility

$109.00

Service Code	NDC 00121058104
Hospital Revenue Code	637
Min. Negotiated Rate	$33.79
Max. Negotiated Rate	$105.73
Rate for Payer: AlohaCare Medicaid	$54.50
Rate for Payer: AlohaCare Medicare	$33.79
Rate for Payer: Cash Price	$65.40
Rate for Payer: Devoted Health Medicare	$37.06
Rate for Payer: Hawaii Medical Service Association Medicare	$33.79
Rate for Payer: Hawaii Western Management Group Commercial	$103.55
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: Humana Medicare	$33.79
Rate for Payer: Kaiser Permanente Commercial	$98.10
Rate for Payer: Kaiser Permanente Medicaid	$55.59
Rate for Payer: Kaiser Permanente Medicare	$33.79
Rate for Payer: MDX Hawaii PPO	$105.73
Rate for Payer: Ohana Health Plan Medicaid	$33.79
Rate for Payer: Ohana Health Plan Medicare	$33.79
Rate for Payer: UnitedHealthcare Medicare	$33.79
Rate for Payer: University Health Alliance Commercial	$79.45

HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]

Facility

$22.00

Service Code	HCPCS J1630
Hospital Revenue Code	636
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$21.34
Rate for Payer: AlohaCare Medicaid	$11.00
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$1.86
Rate for Payer: AlohaCare Medicare	$6.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$13.20
Rate for Payer: Cash Price	$13.20
Rate for Payer: Cash Price	$3.60
Rate for Payer: Devoted Health Medicare	$7.48
Rate for Payer: Devoted Health Medicare	$2.04
Rate for Payer: Hawaii Medical Service Association ABD	$0.84
Rate for Payer: Hawaii Medical Service Association ABD	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1.86
Rate for Payer: Hawaii Medical Service Association Medicare	$6.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.84
Rate for Payer: Hawaii Western Management Group Commercial	$20.90
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Humana Medicare	$6.82
Rate for Payer: Humana Medicare	$1.86
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicaid	$11.22
Rate for Payer: Kaiser Permanente Medicare	$6.82
Rate for Payer: Kaiser Permanente Medicare	$1.86
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$1.86
Rate for Payer: Ohana Health Plan Medicaid	$6.82
Rate for Payer: Ohana Health Plan Medicare	$6.82
Rate for Payer: Ohana Health Plan Medicare	$1.86
Rate for Payer: UnitedHealthcare Medicaid	$3.60
Rate for Payer: UnitedHealthcare Medicaid	$13.20
Rate for Payer: UnitedHealthcare Medicare	$6.82
Rate for Payer: UnitedHealthcare Medicare	$1.86
Rate for Payer: University Health Alliance Commercial	$16.04
Rate for Payer: University Health Alliance Commercial	$4.37

HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION [3584]

Facility

$22.00

Service Code	HCPCS J1630
Hospital Revenue Code	250
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$13.20
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: MDX Hawaii PPO	$21.34

HANDLE SHORT EGIA NEXT GEN

Facility

$384.00

Hospital Revenue Code	272
Min. Negotiated Rate	$119.04
Max. Negotiated Rate	$372.48
Rate for Payer: AlohaCare Medicaid	$192.00
Rate for Payer: AlohaCare Medicare	$119.04
Rate for Payer: Cash Price	$230.40
Rate for Payer: Devoted Health Medicare	$130.56
Rate for Payer: Hawaii Medical Service Association Medicare	$119.04
Rate for Payer: Hawaii Western Management Group Commercial	$364.80
Rate for Payer: Health Management Network Commercial	$326.40
Rate for Payer: Humana Medicare	$119.04
Rate for Payer: Kaiser Permanente Commercial	$345.60
Rate for Payer: Kaiser Permanente Medicaid	$195.84
Rate for Payer: Kaiser Permanente Medicare	$119.04
Rate for Payer: MDX Hawaii PPO	$372.48
Rate for Payer: Ohana Health Plan Medicaid	$119.04
Rate for Payer: Ohana Health Plan Medicare	$119.04
Rate for Payer: UnitedHealthcare Medicare	$119.04
Rate for Payer: University Health Alliance Commercial	$279.90

HANDLE SHORT EGIA NEXT GEN

Facility

$384.00

Hospital Revenue Code	272
Min. Negotiated Rate	$326.40
Max. Negotiated Rate	$372.48
Rate for Payer: Cash Price	$230.40
Rate for Payer: Health Management Network Commercial	$326.40
Rate for Payer: Kaiser Permanente Commercial	$345.60
Rate for Payer: MDX Hawaii PPO	$372.48

HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC

Facility

$26,641.05

Service Code	MSDRG 513
Min. Negotiated Rate	$26,641.05
Max. Negotiated Rate	$26,641.05
Rate for Payer: Hawaii Medical Service Association Commercial	$26,641.05

HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$18,416.45

Service Code	MSDRG 514
Min. Negotiated Rate	$18,416.45
Max. Negotiated Rate	$18,416.45
Rate for Payer: Hawaii Medical Service Association Commercial	$18,416.45

HAND PROCEDURES FOR INJURIES

Facility

$22,161.37

Service Code	MSDRG 906
Min. Negotiated Rate	$22,161.37
Max. Negotiated Rate	$22,161.37
Rate for Payer: Hawaii Medical Service Association Commercial	$22,161.37

HAND REST ORHTOSIS LEFT REG

Facility

$268.00

Service Code	HCPCS L3809
Hospital Revenue Code	274
Min. Negotiated Rate	$83.08
Max. Negotiated Rate	$259.96
Rate for Payer: AlohaCare Medicaid	$134.00
Rate for Payer: AlohaCare Medicare	$83.08
Rate for Payer: Cash Price	$160.80
Rate for Payer: Cash Price	$160.80
Rate for Payer: Devoted Health Medicare	$91.12
Rate for Payer: Hawaii Medical Service Association Medicare	$83.08
Rate for Payer: Hawaii Western Management Group Commercial	$187.60
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: Humana Medicare	$83.08
Rate for Payer: Kaiser Permanente Commercial	$241.20
Rate for Payer: Kaiser Permanente Medicaid	$136.68
Rate for Payer: Kaiser Permanente Medicare	$83.08
Rate for Payer: MDX Hawaii PPO	$259.96
Rate for Payer: Ohana Health Plan Medicaid	$83.08
Rate for Payer: Ohana Health Plan Medicare	$83.08
Rate for Payer: UnitedHealthcare Medicaid	$209.46
Rate for Payer: UnitedHealthcare Medicare	$83.08
Rate for Payer: University Health Alliance Commercial	$150.08

HAND REST ORHTOSIS LEFT REG

Facility

$268.00

Service Code	HCPCS L3809
Hospital Revenue Code	274
Min. Negotiated Rate	$150.08
Max. Negotiated Rate	$259.96
Rate for Payer: Cash Price	$160.80
Rate for Payer: Hawaii Western Management Group Commercial	$187.60
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: Kaiser Permanente Commercial	$241.20
Rate for Payer: MDX Hawaii PPO	$259.96
Rate for Payer: University Health Alliance Commercial	$150.08

Know your out-of-pocket cost for care.

All Charges