Kau Hospital

All Charges

Charge

Type

Setting

Price

HYDROCORTISONE 1 % TOPICAL CREAM [3726]

Facility

$14.00

Service Code	NDC 45802043803
Hospital Revenue Code	250
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$8.40
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: MDX Hawaii PPO	$13.58

HYDROCORTISONE 1 % TOPICAL CREAM [3726]

Facility

$14.00

Service Code	NDC 68001047646
Hospital Revenue Code	637
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$13.58
Rate for Payer: AlohaCare Medicaid	$7.00
Rate for Payer: AlohaCare Medicare	$4.34
Rate for Payer: Cash Price	$8.40
Rate for Payer: Devoted Health Medicare	$4.76
Rate for Payer: Hawaii Medical Service Association Medicare	$4.34
Rate for Payer: Hawaii Western Management Group Commercial	$13.30
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Humana Medicare	$4.34
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: Kaiser Permanente Medicaid	$7.14
Rate for Payer: Kaiser Permanente Medicare	$4.34
Rate for Payer: MDX Hawaii PPO	$13.58
Rate for Payer: Ohana Health Plan Medicaid	$4.34
Rate for Payer: Ohana Health Plan Medicare	$4.34
Rate for Payer: UnitedHealthcare Medicare	$4.34
Rate for Payer: University Health Alliance Commercial	$10.20

HYDROCORTISONE 1 % TOPICAL OINTMENT [3731]

Facility

$14.00

Service Code	NDC 45802027603
Hospital Revenue Code	250
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$8.40
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: MDX Hawaii PPO	$13.58

HYDROCORTISONE 1 % TOPICAL OINTMENT [3731]

Facility

$14.00

Service Code	NDC 45802027603
Hospital Revenue Code	637
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$13.58
Rate for Payer: AlohaCare Medicaid	$7.00
Rate for Payer: AlohaCare Medicare	$4.34
Rate for Payer: Cash Price	$8.40
Rate for Payer: Devoted Health Medicare	$4.76
Rate for Payer: Hawaii Medical Service Association Medicare	$4.34
Rate for Payer: Hawaii Western Management Group Commercial	$13.30
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Humana Medicare	$4.34
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: Kaiser Permanente Medicaid	$7.14
Rate for Payer: Kaiser Permanente Medicare	$4.34
Rate for Payer: MDX Hawaii PPO	$13.58
Rate for Payer: Ohana Health Plan Medicaid	$4.34
Rate for Payer: Ohana Health Plan Medicare	$4.34
Rate for Payer: UnitedHealthcare Medicare	$4.34
Rate for Payer: University Health Alliance Commercial	$10.20

HYDROCORTISONE 20 MG TABLET [3734]

Facility

$4.00

Service Code	NDC 59762007501
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

HYDROCORTISONE 20 MG TABLET [3734]

Facility

$4.00

Service Code	NDC 00115170001
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

HYDROCORTISONE 20 MG TABLET [3734]

Facility

$4.00

Service Code	NDC 00115170001
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

HYDROCORTISONE 20 MG TABLET [3734]

Facility

$4.00

Service Code	NDC 59762007501
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

HYDROCORTISONE 2.5 % TOPICAL CREAM [3727]

Facility

$32.00

Service Code	NDC 51672300302
Hospital Revenue Code	637
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$31.04
Rate for Payer: AlohaCare Medicaid	$16.00
Rate for Payer: AlohaCare Medicare	$9.92
Rate for Payer: Cash Price	$19.20
Rate for Payer: Devoted Health Medicare	$10.88
Rate for Payer: Hawaii Medical Service Association Medicare	$9.92
Rate for Payer: Hawaii Western Management Group Commercial	$30.40
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Humana Medicare	$9.92
Rate for Payer: Kaiser Permanente Commercial	$28.80
Rate for Payer: Kaiser Permanente Medicaid	$16.32
Rate for Payer: Kaiser Permanente Medicare	$9.92
Rate for Payer: MDX Hawaii PPO	$31.04
Rate for Payer: Ohana Health Plan Medicaid	$9.92
Rate for Payer: Ohana Health Plan Medicare	$9.92
Rate for Payer: UnitedHealthcare Medicare	$9.92
Rate for Payer: University Health Alliance Commercial	$23.32

HYDROCORTISONE 2.5 % TOPICAL CREAM [3727]

Facility

$32.00

Service Code	NDC 51672300302
Hospital Revenue Code	250
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$31.04
Rate for Payer: Cash Price	$19.20
Rate for Payer: Health Management Network Commercial	$27.20
Rate for Payer: Kaiser Permanente Commercial	$28.80
Rate for Payer: MDX Hawaii PPO	$31.04

HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [172266]

Facility

$292.00

Service Code	NDC 62559043130
Hospital Revenue Code	250
Min. Negotiated Rate	$248.20
Max. Negotiated Rate	$283.24
Rate for Payer: Cash Price	$175.20
Rate for Payer: Health Management Network Commercial	$248.20
Rate for Payer: Kaiser Permanente Commercial	$262.80
Rate for Payer: MDX Hawaii PPO	$283.24

HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR [172266]

Facility

$292.00

Service Code	NDC 62559043130
Hospital Revenue Code	637
Min. Negotiated Rate	$90.52
Max. Negotiated Rate	$283.24
Rate for Payer: AlohaCare Medicaid	$146.00
Rate for Payer: AlohaCare Medicare	$90.52
Rate for Payer: Cash Price	$175.20
Rate for Payer: Devoted Health Medicare	$99.28
Rate for Payer: Hawaii Medical Service Association Medicare	$90.52
Rate for Payer: Hawaii Western Management Group Commercial	$277.40
Rate for Payer: Health Management Network Commercial	$248.20
Rate for Payer: Humana Medicare	$90.52
Rate for Payer: Kaiser Permanente Commercial	$262.80
Rate for Payer: Kaiser Permanente Medicaid	$148.92
Rate for Payer: Kaiser Permanente Medicare	$90.52
Rate for Payer: MDX Hawaii PPO	$283.24
Rate for Payer: Ohana Health Plan Medicaid	$90.52
Rate for Payer: Ohana Health Plan Medicare	$90.52
Rate for Payer: UnitedHealthcare Medicare	$90.52
Rate for Payer: University Health Alliance Commercial	$212.84

HYDROCORTISONE 2.5 % TOPICAL OINTMENT [3732]

Facility

$37.00

Service Code	NDC 00168014630
Hospital Revenue Code	637
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$35.89
Rate for Payer: AlohaCare Medicaid	$18.50
Rate for Payer: AlohaCare Medicare	$11.47
Rate for Payer: Cash Price	$22.20
Rate for Payer: Devoted Health Medicare	$12.58
Rate for Payer: Hawaii Medical Service Association Medicare	$11.47
Rate for Payer: Hawaii Western Management Group Commercial	$35.15
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Humana Medicare	$11.47
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: Kaiser Permanente Medicare	$11.47
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: Ohana Health Plan Medicaid	$11.47
Rate for Payer: Ohana Health Plan Medicare	$11.47
Rate for Payer: UnitedHealthcare Medicare	$11.47
Rate for Payer: University Health Alliance Commercial	$26.97

HYDROCORTISONE 2.5 % TOPICAL OINTMENT [3732]

Facility

$37.00

Service Code	NDC 00168014630
Hospital Revenue Code	250
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: MDX Hawaii PPO	$35.89

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]

Facility

$37.00

Service Code	NDC 50268041111
Hospital Revenue Code	637
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$35.89
Rate for Payer: AlohaCare Medicaid	$18.50
Rate for Payer: AlohaCare Medicare	$11.47
Rate for Payer: Cash Price	$22.20
Rate for Payer: Devoted Health Medicare	$12.58
Rate for Payer: Hawaii Medical Service Association Medicare	$11.47
Rate for Payer: Hawaii Western Management Group Commercial	$35.15
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Humana Medicare	$11.47
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: Kaiser Permanente Medicaid	$18.87
Rate for Payer: Kaiser Permanente Medicare	$11.47
Rate for Payer: MDX Hawaii PPO	$35.89
Rate for Payer: Ohana Health Plan Medicaid	$11.47
Rate for Payer: Ohana Health Plan Medicare	$11.47
Rate for Payer: UnitedHealthcare Medicare	$11.47
Rate for Payer: University Health Alliance Commercial	$26.97

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]

Facility

$57.00

Service Code	NDC 00713050312
Hospital Revenue Code	250
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$34.20
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Kaiser Permanente Commercial	$51.30
Rate for Payer: MDX Hawaii PPO	$55.29

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]

Facility

$57.00

Service Code	NDC 00713050306
Hospital Revenue Code	250
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$34.20
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Kaiser Permanente Commercial	$51.30
Rate for Payer: MDX Hawaii PPO	$55.29

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]

Facility

$57.00

Service Code	NDC 00713050312
Hospital Revenue Code	637
Min. Negotiated Rate	$17.67
Max. Negotiated Rate	$55.29
Rate for Payer: AlohaCare Medicaid	$28.50
Rate for Payer: AlohaCare Medicare	$17.67
Rate for Payer: Cash Price	$34.20
Rate for Payer: Devoted Health Medicare	$19.38
Rate for Payer: Hawaii Medical Service Association Medicare	$17.67
Rate for Payer: Hawaii Western Management Group Commercial	$54.15
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Humana Medicare	$17.67
Rate for Payer: Kaiser Permanente Commercial	$51.30
Rate for Payer: Kaiser Permanente Medicaid	$29.07
Rate for Payer: Kaiser Permanente Medicare	$17.67
Rate for Payer: MDX Hawaii PPO	$55.29
Rate for Payer: Ohana Health Plan Medicaid	$17.67
Rate for Payer: Ohana Health Plan Medicare	$17.67
Rate for Payer: UnitedHealthcare Medicare	$17.67
Rate for Payer: University Health Alliance Commercial	$41.55

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]

Facility

$57.00

Service Code	NDC 00713050306
Hospital Revenue Code	637
Min. Negotiated Rate	$17.67
Max. Negotiated Rate	$55.29
Rate for Payer: AlohaCare Medicaid	$28.50
Rate for Payer: AlohaCare Medicare	$17.67
Rate for Payer: Cash Price	$34.20
Rate for Payer: Devoted Health Medicare	$19.38
Rate for Payer: Hawaii Medical Service Association Medicare	$17.67
Rate for Payer: Hawaii Western Management Group Commercial	$54.15
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Humana Medicare	$17.67
Rate for Payer: Kaiser Permanente Commercial	$51.30
Rate for Payer: Kaiser Permanente Medicaid	$29.07
Rate for Payer: Kaiser Permanente Medicare	$17.67
Rate for Payer: MDX Hawaii PPO	$55.29
Rate for Payer: Ohana Health Plan Medicaid	$17.67
Rate for Payer: Ohana Health Plan Medicare	$17.67
Rate for Payer: UnitedHealthcare Medicare	$17.67
Rate for Payer: University Health Alliance Commercial	$41.55

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY [3738]

Facility

$37.00

Service Code	NDC 50268041111
Hospital Revenue Code	250
Min. Negotiated Rate	$31.45
Max. Negotiated Rate	$35.89
Rate for Payer: Cash Price	$22.20
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$33.30
Rate for Payer: MDX Hawaii PPO	$35.89

HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]

Facility

$565.00

Service Code	NDC 51672300701
Hospital Revenue Code	250
Min. Negotiated Rate	$480.25
Max. Negotiated Rate	$548.05
Rate for Payer: Cash Price	$339.00
Rate for Payer: Health Management Network Commercial	$480.25
Rate for Payer: Kaiser Permanente Commercial	$508.50
Rate for Payer: MDX Hawaii PPO	$548.05

HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS [24385]

Facility

$565.00

Service Code	NDC 51672300701
Hospital Revenue Code	637
Min. Negotiated Rate	$175.15
Max. Negotiated Rate	$548.05
Rate for Payer: AlohaCare Medicaid	$282.50
Rate for Payer: AlohaCare Medicare	$175.15
Rate for Payer: Cash Price	$339.00
Rate for Payer: Devoted Health Medicare	$192.10
Rate for Payer: Hawaii Medical Service Association Medicare	$175.15
Rate for Payer: Hawaii Western Management Group Commercial	$536.75
Rate for Payer: Health Management Network Commercial	$480.25
Rate for Payer: Humana Medicare	$175.15
Rate for Payer: Kaiser Permanente Commercial	$508.50
Rate for Payer: Kaiser Permanente Medicaid	$288.15
Rate for Payer: Kaiser Permanente Medicare	$175.15
Rate for Payer: MDX Hawaii PPO	$548.05
Rate for Payer: Ohana Health Plan Medicaid	$175.15
Rate for Payer: Ohana Health Plan Medicare	$175.15
Rate for Payer: UnitedHealthcare Medicare	$175.15
Rate for Payer: University Health Alliance Commercial	$411.83

HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION [204602]

Facility

$71.00

Service Code	HCPCS J1720
Hospital Revenue Code	250
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$42.60
Rate for Payer: Cash Price	$43.80
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Commercial	$65.70
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: MDX Hawaii PPO	$68.87

HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION [204602]

Facility

$71.00

Service Code	HCPCS J1720
Hospital Revenue Code	636
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: AlohaCare Medicaid	$36.50
Rate for Payer: AlohaCare Medicare	$22.63
Rate for Payer: AlohaCare Medicare	$22.01
Rate for Payer: Cash Price	$43.80
Rate for Payer: Cash Price	$42.60
Rate for Payer: Cash Price	$42.60
Rate for Payer: Cash Price	$43.80
Rate for Payer: Devoted Health Medicare	$24.14
Rate for Payer: Devoted Health Medicare	$24.82
Rate for Payer: Hawaii Medical Service Association ABD	$21.20
Rate for Payer: Hawaii Medical Service Association ABD	$21.20
Rate for Payer: Hawaii Medical Service Association Medicare	$22.63
Rate for Payer: Hawaii Medical Service Association Medicare	$22.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.20
Rate for Payer: Hawaii Western Management Group Commercial	$67.45
Rate for Payer: Hawaii Western Management Group Commercial	$69.35
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$22.01
Rate for Payer: Humana Medicare	$22.63
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Commercial	$65.70
Rate for Payer: Kaiser Permanente Medicaid	$37.23
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$22.01
Rate for Payer: Kaiser Permanente Medicare	$22.63
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: Ohana Health Plan Medicaid	$22.63
Rate for Payer: Ohana Health Plan Medicaid	$22.01
Rate for Payer: Ohana Health Plan Medicare	$22.01
Rate for Payer: Ohana Health Plan Medicare	$22.63
Rate for Payer: UnitedHealthcare Medicaid	$43.80
Rate for Payer: UnitedHealthcare Medicaid	$42.60
Rate for Payer: UnitedHealthcare Medicare	$22.01
Rate for Payer: UnitedHealthcare Medicare	$22.63
Rate for Payer: University Health Alliance Commercial	$51.75
Rate for Payer: University Health Alliance Commercial	$53.21

HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION [204601]

Facility

$107.00

Service Code	HCPCS J1720
Hospital Revenue Code	250
Min. Negotiated Rate	$90.95
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$64.20
Rate for Payer: Cash Price	$25.80
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Kaiser Permanente Commercial	$96.30
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: MDX Hawaii PPO	$103.79

Know your out-of-pocket cost for care.

All Charges