Kau Hospital

All Charges

Charge

Type

Setting

Price

INDOMETHACIN 50 MG RECTAL SUPPOSITORY [3901]

Facility

$619.00

Service Code	NDC 70710185206
Hospital Revenue Code	637
Min. Negotiated Rate	$191.89
Max. Negotiated Rate	$600.43
Rate for Payer: AlohaCare Medicaid	$309.50
Rate for Payer: AlohaCare Medicare	$191.89
Rate for Payer: Cash Price	$371.40
Rate for Payer: Devoted Health Medicare	$210.46
Rate for Payer: Hawaii Medical Service Association Medicare	$191.89
Rate for Payer: Hawaii Western Management Group Commercial	$588.05
Rate for Payer: Health Management Network Commercial	$526.15
Rate for Payer: Humana Medicare	$191.89
Rate for Payer: Kaiser Permanente Commercial	$557.10
Rate for Payer: Kaiser Permanente Medicaid	$315.69
Rate for Payer: Kaiser Permanente Medicare	$191.89
Rate for Payer: MDX Hawaii PPO	$600.43
Rate for Payer: Ohana Health Plan Medicaid	$191.89
Rate for Payer: Ohana Health Plan Medicare	$191.89
Rate for Payer: UnitedHealthcare Medicare	$191.89
Rate for Payer: University Health Alliance Commercial	$451.19

INDOMETHACIN 50 MG RECTAL SUPPOSITORY [3901]

Facility

$619.00

Service Code	NDC 70710185207
Hospital Revenue Code	250
Min. Negotiated Rate	$526.15
Max. Negotiated Rate	$600.43
Rate for Payer: Cash Price	$371.40
Rate for Payer: Health Management Network Commercial	$526.15
Rate for Payer: Kaiser Permanente Commercial	$557.10
Rate for Payer: MDX Hawaii PPO	$600.43

INDOMETHACIN 50 MG RECTAL SUPPOSITORY [3901]

Facility

$619.00

Service Code	NDC 70710185206
Hospital Revenue Code	250
Min. Negotiated Rate	$526.15
Max. Negotiated Rate	$600.43
Rate for Payer: Cash Price	$371.40
Rate for Payer: Health Management Network Commercial	$526.15
Rate for Payer: Kaiser Permanente Commercial	$557.10
Rate for Payer: MDX Hawaii PPO	$600.43

INDOMETHACIN 50 MG RECTAL SUPPOSITORY [3901]

Facility

$652.00

Service Code	NDC 69344010233
Hospital Revenue Code	637
Min. Negotiated Rate	$202.12
Max. Negotiated Rate	$632.44
Rate for Payer: AlohaCare Medicaid	$326.00
Rate for Payer: AlohaCare Medicare	$202.12
Rate for Payer: Cash Price	$391.20
Rate for Payer: Devoted Health Medicare	$221.68
Rate for Payer: Hawaii Medical Service Association Medicare	$202.12
Rate for Payer: Hawaii Western Management Group Commercial	$619.40
Rate for Payer: Health Management Network Commercial	$554.20
Rate for Payer: Humana Medicare	$202.12
Rate for Payer: Kaiser Permanente Commercial	$586.80
Rate for Payer: Kaiser Permanente Medicaid	$332.52
Rate for Payer: Kaiser Permanente Medicare	$202.12
Rate for Payer: MDX Hawaii PPO	$632.44
Rate for Payer: Ohana Health Plan Medicaid	$202.12
Rate for Payer: Ohana Health Plan Medicare	$202.12
Rate for Payer: UnitedHealthcare Medicare	$202.12
Rate for Payer: University Health Alliance Commercial	$475.24

INDOMETHACIN 50 MG RECTAL SUPPOSITORY [3901]

Facility

$652.00

Service Code	NDC 69344010233
Hospital Revenue Code	250
Min. Negotiated Rate	$554.20
Max. Negotiated Rate	$632.44
Rate for Payer: Cash Price	$391.20
Rate for Payer: Health Management Network Commercial	$554.20
Rate for Payer: Kaiser Permanente Commercial	$586.80
Rate for Payer: MDX Hawaii PPO	$632.44

INDOMETHACIN CAPSULES (INDOCIN) 50 MG (TAKE HOME) [4080369]

Facility

$15.00

Service Code	NDC 00004080157
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

INDOMETHACIN CAPSULES (INDOCIN) 50 MG (TAKE HOME) [4080369]

Facility

$15.00

Service Code	NDC 00004080157
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

INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC

Facility

$13,652.35

Service Code	MSDRG 758
Min. Negotiated Rate	$13,652.35
Max. Negotiated Rate	$13,652.35
Rate for Payer: Hawaii Medical Service Association Commercial	$13,652.35

INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$13,652.35

Service Code	MSDRG 757
Min. Negotiated Rate	$13,652.35
Max. Negotiated Rate	$13,652.35
Rate for Payer: Hawaii Medical Service Association Commercial	$13,652.35

INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$13,652.35

Service Code	MSDRG 759
Min. Negotiated Rate	$13,652.35
Max. Negotiated Rate	$13,652.35
Rate for Payer: Hawaii Medical Service Association Commercial	$13,652.35

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC

Facility

$154,039.30

Service Code	MSDRG 854
Min. Negotiated Rate	$154,039.30
Max. Negotiated Rate	$154,039.30
Rate for Payer: Hawaii Medical Service Association Commercial	$154,039.30

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC

Facility

$154,039.30

Service Code	MSDRG 853
Min. Negotiated Rate	$154,039.30
Max. Negotiated Rate	$154,039.30
Rate for Payer: Hawaii Medical Service Association Commercial	$154,039.30

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$154,039.30

Service Code	MSDRG 855
Min. Negotiated Rate	$154,039.30
Max. Negotiated Rate	$154,039.30
Rate for Payer: Hawaii Medical Service Association Commercial	$154,039.30

INFILTRATION TUBING ASP-TB-TUM

Facility

$79.00

Hospital Revenue Code	272
Min. Negotiated Rate	$24.49
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: Devoted Health Medicare	$26.86
Rate for Payer: Hawaii Medical Service Association Medicare	$24.49
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 Medicare	$24.49
Rate for Payer: University Health Alliance Commercial	$57.58

INFILTRATION TUBING ASP-TB-TUM

Facility

$79.00

Hospital Revenue Code	272
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

INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$13,178.31

Service Code	MSDRG 727
Min. Negotiated Rate	$13,178.31
Max. Negotiated Rate	$13,178.31
Rate for Payer: Hawaii Medical Service Association Commercial	$13,178.31

INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC

Facility

$13,178.31

Service Code	MSDRG 728
Min. Negotiated Rate	$13,178.31
Max. Negotiated Rate	$13,178.31
Rate for Payer: Hawaii Medical Service Association Commercial	$13,178.31

INFLAMMATORY BOWEL DISEASE WITH CC

Facility

$19,435.64

Service Code	MSDRG 386
Min. Negotiated Rate	$19,435.64
Max. Negotiated Rate	$19,435.64
Rate for Payer: Hawaii Medical Service Association Commercial	$19,435.64

INFLAMMATORY BOWEL DISEASE WITH MCC

Facility

$19,435.64

Service Code	MSDRG 385
Min. Negotiated Rate	$19,435.64
Max. Negotiated Rate	$19,435.64
Rate for Payer: Hawaii Medical Service Association Commercial	$19,435.64

INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC

Facility

$19,435.64

Service Code	MSDRG 387
Min. Negotiated Rate	$19,435.64
Max. Negotiated Rate	$19,435.64
Rate for Payer: Hawaii Medical Service Association Commercial	$19,435.64

INFLATION DEVICE COOK G34903

Facility

$235.00

Hospital Revenue Code	272
Min. Negotiated Rate	$72.85
Max. Negotiated Rate	$227.95
Rate for Payer: AlohaCare Medicaid	$117.50
Rate for Payer: AlohaCare Medicare	$72.85
Rate for Payer: Cash Price	$141.00
Rate for Payer: Devoted Health Medicare	$79.90
Rate for Payer: Hawaii Medical Service Association Medicare	$72.85
Rate for Payer: Hawaii Western Management Group Commercial	$223.25
Rate for Payer: Health Management Network Commercial	$199.75
Rate for Payer: Humana Medicare	$72.85
Rate for Payer: Kaiser Permanente Commercial	$211.50
Rate for Payer: Kaiser Permanente Medicaid	$119.85
Rate for Payer: Kaiser Permanente Medicare	$72.85
Rate for Payer: MDX Hawaii PPO	$227.95
Rate for Payer: Ohana Health Plan Medicaid	$72.85
Rate for Payer: Ohana Health Plan Medicare	$72.85
Rate for Payer: UnitedHealthcare Medicare	$72.85
Rate for Payer: University Health Alliance Commercial	$171.29

INFLATION DEVICE COOK G34903

Facility

$235.00

Hospital Revenue Code	272
Min. Negotiated Rate	$199.75
Max. Negotiated Rate	$227.95
Rate for Payer: Cash Price	$141.00
Rate for Payer: Health Management Network Commercial	$199.75
Rate for Payer: Kaiser Permanente Commercial	$211.50
Rate for Payer: MDX Hawaii PPO	$227.95

INFLIXIMAB-DYYB 100 MG/10ML IV (WET SOLR VIAL) [430134057]

Facility

$1,636.00

Service Code	HCPCS Q5103
Hospital Revenue Code	250
Min. Negotiated Rate	$1,390.60
Max. Negotiated Rate	$1,586.92
Rate for Payer: Cash Price	$981.60
Rate for Payer: Health Management Network Commercial	$1,390.60
Rate for Payer: Kaiser Permanente Commercial	$1,472.40
Rate for Payer: MDX Hawaii PPO	$1,586.92

INFLIXIMAB-DYYB 100 MG/10ML IV (WET SOLR VIAL) [430134057]

Facility

$1,636.00

Service Code	HCPCS Q5103
Hospital Revenue Code	636
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$1,586.92
Rate for Payer: AlohaCare Medicaid	$818.00
Rate for Payer: AlohaCare Medicare	$507.16
Rate for Payer: Cash Price	$981.60
Rate for Payer: Cash Price	$981.60
Rate for Payer: Devoted Health Medicare	$556.24
Rate for Payer: Hawaii Medical Service Association ABD	$19.68
Rate for Payer: Hawaii Medical Service Association Commercial	$32.55
Rate for Payer: Hawaii Medical Service Association Medicare	$507.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,554.20
Rate for Payer: Health Management Network Commercial	$1,390.60
Rate for Payer: Humana Medicare	$507.16
Rate for Payer: Kaiser Permanente Commercial	$1,472.40
Rate for Payer: Kaiser Permanente Medicaid	$834.36
Rate for Payer: Kaiser Permanente Medicare	$507.16
Rate for Payer: MDX Hawaii PPO	$1,586.92
Rate for Payer: Ohana Health Plan Medicaid	$507.16
Rate for Payer: Ohana Health Plan Medicare	$507.16
Rate for Payer: UnitedHealthcare Medicaid	$981.60
Rate for Payer: UnitedHealthcare Medicare	$507.16
Rate for Payer: University Health Alliance Commercial	$1,192.48

INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION [134057]

Facility

$1,636.00

Service Code	HCPCS Q5103
Hospital Revenue Code	636
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$1,586.92
Rate for Payer: AlohaCare Medicaid	$818.00
Rate for Payer: AlohaCare Medicare	$507.16
Rate for Payer: Cash Price	$981.60
Rate for Payer: Cash Price	$981.60
Rate for Payer: Devoted Health Medicare	$556.24
Rate for Payer: Hawaii Medical Service Association ABD	$19.68
Rate for Payer: Hawaii Medical Service Association Commercial	$32.55
Rate for Payer: Hawaii Medical Service Association Medicare	$507.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,554.20
Rate for Payer: Health Management Network Commercial	$1,390.60
Rate for Payer: Humana Medicare	$507.16
Rate for Payer: Kaiser Permanente Commercial	$1,472.40
Rate for Payer: Kaiser Permanente Medicaid	$834.36
Rate for Payer: Kaiser Permanente Medicare	$507.16
Rate for Payer: MDX Hawaii PPO	$1,586.92
Rate for Payer: Ohana Health Plan Medicaid	$507.16
Rate for Payer: Ohana Health Plan Medicare	$507.16
Rate for Payer: UnitedHealthcare Medicaid	$981.60
Rate for Payer: UnitedHealthcare Medicare	$507.16
Rate for Payer: University Health Alliance Commercial	$1,192.48

Know your out-of-pocket cost for care.

All Charges