Kau Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$107.00

Service Code	HCPCS J1720
Hospital Revenue Code	636
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$103.79
Rate for Payer: AlohaCare Medicaid	$53.50
Rate for Payer: AlohaCare Medicaid	$21.50
Rate for Payer: AlohaCare Medicare	$13.33
Rate for Payer: AlohaCare Medicare	$33.17
Rate for Payer: Cash Price	$25.80
Rate for Payer: Cash Price	$64.20
Rate for Payer: Cash Price	$64.20
Rate for Payer: Cash Price	$25.80
Rate for Payer: Devoted Health Medicare	$36.38
Rate for Payer: Devoted Health Medicare	$14.62
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	$13.33
Rate for Payer: Hawaii Medical Service Association Medicare	$33.17
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	$101.65
Rate for Payer: Hawaii Western Management Group Commercial	$40.85
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: Humana Medicare	$33.17
Rate for Payer: Humana Medicare	$13.33
Rate for Payer: Kaiser Permanente Commercial	$96.30
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: Kaiser Permanente Medicaid	$54.57
Rate for Payer: Kaiser Permanente Medicare	$33.17
Rate for Payer: Kaiser Permanente Medicare	$13.33
Rate for Payer: MDX Hawaii PPO	$103.79
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: Ohana Health Plan Medicaid	$13.33
Rate for Payer: Ohana Health Plan Medicaid	$33.17
Rate for Payer: Ohana Health Plan Medicare	$33.17
Rate for Payer: Ohana Health Plan Medicare	$13.33
Rate for Payer: UnitedHealthcare Medicaid	$25.80
Rate for Payer: UnitedHealthcare Medicaid	$64.20
Rate for Payer: UnitedHealthcare Medicare	$33.17
Rate for Payer: UnitedHealthcare Medicare	$13.33
Rate for Payer: University Health Alliance Commercial	$77.99
Rate for Payer: University Health Alliance Commercial	$31.34

HYDROMORPHONE 2 MG/ML INJECTION SYRINGE [201344]

Facility

$15.00

Service Code	HCPCS J1171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
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: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$5.10
Rate for Payer: Hawaii Medical Service Association ABD	$0.09
Rate for Payer: Hawaii Medical Service Association Medicare	$4.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.09
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 Medicaid	$9.00
Rate for Payer: UnitedHealthcare Medicare	$4.65
Rate for Payer: University Health Alliance Commercial	$10.93

HYDROMORPHONE 2 MG/ML INJECTION SYRINGE [201344]

Facility

$15.00

Service Code	HCPCS J1171
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

HYDROMORPHONE 2 MG TABLET [3760]

Facility

$3.00

Service Code	NDC 00406324301
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

HYDROMORPHONE 2 MG TABLET [3760]

Facility

$3.00

Service Code	NDC 00406324301
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

HYDROMORPHONE 4 MG TABLET [3761]

Facility

$4.00

Service Code	NDC 00406324401
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

HYDROMORPHONE 4 MG TABLET [3761]

Facility

$3.00

Service Code	NDC 60687059001
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

HYDROMORPHONE 4 MG TABLET [3761]

Facility

$3.00

Service Code	NDC 60687059011
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

HYDROMORPHONE 4 MG TABLET [3761]

Facility

$3.00

Service Code	NDC 60687059011
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

HYDROMORPHONE 4 MG TABLET [3761]

Facility

$1.00

Service Code	NDC 42858030225
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

HYDROMORPHONE 4 MG TABLET [3761]

Facility

$4.00

Service Code	NDC 00406324401
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

HYDROMORPHONE 4 MG TABLET [3761]

Facility

$1.00

Service Code	NDC 42858030225
Hospital Revenue Code	637
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.31
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.34
Rate for Payer: Hawaii Medical Service Association Medicare	$0.31
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.31
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.31
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.31
Rate for Payer: Ohana Health Plan Medicare	$0.31
Rate for Payer: UnitedHealthcare Medicare	$0.31
Rate for Payer: University Health Alliance Commercial	$0.73

HYDROMORPHONE 4 MG TABLET [3761]

Facility

$3.00

Service Code	NDC 60687059001
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

HYDROMORPHONE (PF) 10 MG/50 ML (0.2 MG/ML) IN 0.9% NACL IV PCA SYRINGE [130244]

Facility

$30.00

Service Code	NDC 70092111450
Hospital Revenue Code	250
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: MDX Hawaii PPO	$29.10

HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION [116809]

Facility

$65.00

Service Code	HCPCS J1170
Hospital Revenue Code	250
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$39.00
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Kaiser Permanente Commercial	$58.50
Rate for Payer: MDX Hawaii PPO	$63.05

HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION [116809]

Facility

$65.00

Service Code	HCPCS J1170
Hospital Revenue Code	636
Min. Negotiated Rate	$20.15
Max. Negotiated Rate	$63.05
Rate for Payer: AlohaCare Medicaid	$32.50
Rate for Payer: AlohaCare Medicare	$20.15
Rate for Payer: Cash Price	$39.00
Rate for Payer: Devoted Health Medicare	$22.10
Rate for Payer: Hawaii Medical Service Association Medicare	$20.15
Rate for Payer: Hawaii Western Management Group Commercial	$61.75
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Humana Medicare	$20.15
Rate for Payer: Kaiser Permanente Commercial	$58.50
Rate for Payer: Kaiser Permanente Medicaid	$33.15
Rate for Payer: Kaiser Permanente Medicare	$20.15
Rate for Payer: MDX Hawaii PPO	$63.05
Rate for Payer: Ohana Health Plan Medicaid	$20.15
Rate for Payer: Ohana Health Plan Medicare	$20.15
Rate for Payer: UnitedHealthcare Medicaid	$39.00
Rate for Payer: UnitedHealthcare Medicare	$20.15
Rate for Payer: University Health Alliance Commercial	$47.38

HYDROMORPHONE (PF) 2 MG/ML INJECTION SOLUTION [116807]

Facility

$13.00

Service Code	HCPCS J1171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$12.61
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$4.03
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$4.42
Rate for Payer: Hawaii Medical Service Association ABD	$0.09
Rate for Payer: Hawaii Medical Service Association Medicare	$4.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.09
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Humana Medicare	$4.03
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$4.03
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: Ohana Health Plan Medicaid	$4.03
Rate for Payer: Ohana Health Plan Medicare	$4.03
Rate for Payer: UnitedHealthcare Medicaid	$7.80
Rate for Payer: UnitedHealthcare Medicare	$4.03
Rate for Payer: University Health Alliance Commercial	$9.48

HYDROMORPHONE (PF) 2 MG/ML INJECTION SOLUTION [116807]

Facility

$13.00

Service Code	HCPCS J1171
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION [111437]

Facility

$1,758.00

Service Code	HCPCS J3424
Hospital Revenue Code	250
Min. Negotiated Rate	$1,494.30
Max. Negotiated Rate	$1,705.26
Rate for Payer: Cash Price	$1,054.80
Rate for Payer: Health Management Network Commercial	$1,494.30
Rate for Payer: Kaiser Permanente Commercial	$1,582.20
Rate for Payer: MDX Hawaii PPO	$1,705.26

HYDROXYCHLOROQUINE 200 MG TABLET [10235]

Facility

$16.00

Service Code	NDC 50268041211
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

HYDROXYCHLOROQUINE 200 MG TABLET [10235]

Facility

$16.00

Service Code	NDC 50268041215
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

HYDROXYCHLOROQUINE 200 MG TABLET [10235]

Facility

$16.00

Service Code	NDC 50268041211
Hospital Revenue Code	637
Min. Negotiated Rate	$4.96
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: Devoted Health Medicare	$5.44
Rate for Payer: Hawaii Medical Service Association Medicare	$4.96
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 Medicare	$4.96
Rate for Payer: University Health Alliance Commercial	$11.66

HYDROXYCHLOROQUINE 200 MG TABLET [10235]

Facility

$16.00

Service Code	NDC 50268041215
Hospital Revenue Code	637
Min. Negotiated Rate	$4.96
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: Devoted Health Medicare	$5.44
Rate for Payer: Hawaii Medical Service Association Medicare	$4.96
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 Medicare	$4.96
Rate for Payer: University Health Alliance Commercial	$11.66

HYDROXYCHLOROQUINE 200 MG TABLET [10235]

Facility

$6.00

Service Code	NDC 00904704606
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

HYDROXYCHLOROQUINE 200 MG TABLET [10235]

Facility

$6.00

Service Code	NDC 00904704606
Hospital Revenue Code	637
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$1.86
Rate for Payer: Cash Price	$3.60
Rate for Payer: Devoted Health Medicare	$2.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1.86
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$1.86
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$1.86
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$1.86
Rate for Payer: Ohana Health Plan Medicare	$1.86
Rate for Payer: UnitedHealthcare Medicare	$1.86
Rate for Payer: University Health Alliance Commercial	$4.37

Know your out-of-pocket cost for care.

All Charges