Kau Hospital

All Charges

Charge

Type

Setting

Price

ATORVASTATIN 10 MG TABLET [19176]

Facility

$3.00

Service Code	NDC 68084009701
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

ATORVASTATIN 10 MG TABLET [19176]

Facility

$3.00

Service Code	NDC 68084009711
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

ATORVASTATIN 10 MG TABLET [19176]

Facility

$3.00

Service Code	NDC 68084009711
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

ATORVASTATIN 20 MG TABLET [19178]

Facility

$3.00

Service Code	NDC 68084009801
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

ATORVASTATIN 20 MG TABLET [19178]

Facility

$3.00

Service Code	NDC 68084009801
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

ATORVASTATIN 20 MG TABLET [19178]

Facility

$3.00

Service Code	NDC 68084009811
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

ATORVASTATIN 20 MG TABLET [19178]

Facility

$3.00

Service Code	NDC 68084009811
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

ATORVASTATIN 40 MG TABLET [19177]

Facility

$3.00

Service Code	NDC 68084009911
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

ATORVASTATIN 40 MG TABLET [19177]

Facility

$3.00

Service Code	NDC 68084009901
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

ATORVASTATIN 40 MG TABLET [19177]

Facility

$3.00

Service Code	NDC 68084009901
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

ATORVASTATIN 40 MG TABLET [19177]

Facility

$3.00

Service Code	NDC 68084009911
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

ATORVASTATIN 80 MG TABLET [28645]

Facility

$7.00

Service Code	NDC 68084059025
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

ATORVASTATIN 80 MG TABLET [28645]

Facility

$7.00

Service Code	NDC 51079021103
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

ATORVASTATIN 80 MG TABLET [28645]

Facility

$7.00

Service Code	NDC 68084059095
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

ATORVASTATIN 80 MG TABLET [28645]

Facility

$7.00

Service Code	NDC 68084059095
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

ATORVASTATIN 80 MG TABLET [28645]

Facility

$7.00

Service Code	NDC 51079021103
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

ATORVASTATIN 80 MG TABLET [28645]

Facility

$7.00

Service Code	NDC 68084059025
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

ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION [14953]

Facility

$1,879.00

Service Code	NDC 65162069388
Hospital Revenue Code	637
Min. Negotiated Rate	$582.49
Max. Negotiated Rate	$1,822.63
Rate for Payer: AlohaCare Medicaid	$939.50
Rate for Payer: AlohaCare Medicare	$582.49
Rate for Payer: Cash Price	$1,127.40
Rate for Payer: Devoted Health Medicare	$638.86
Rate for Payer: Hawaii Medical Service Association Medicare	$582.49
Rate for Payer: Hawaii Western Management Group Commercial	$1,785.05
Rate for Payer: Health Management Network Commercial	$1,597.15
Rate for Payer: Humana Medicare	$582.49
Rate for Payer: Kaiser Permanente Commercial	$1,691.10
Rate for Payer: Kaiser Permanente Medicaid	$958.29
Rate for Payer: Kaiser Permanente Medicare	$582.49
Rate for Payer: MDX Hawaii PPO	$1,822.63
Rate for Payer: Ohana Health Plan Medicaid	$582.49
Rate for Payer: Ohana Health Plan Medicare	$582.49
Rate for Payer: UnitedHealthcare Medicare	$582.49
Rate for Payer: University Health Alliance Commercial	$1,369.60

ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION [14953]

Facility

$1,879.00

Service Code	NDC 65162069388
Hospital Revenue Code	250
Min. Negotiated Rate	$1,597.15
Max. Negotiated Rate	$1,822.63
Rate for Payer: Cash Price	$1,127.40
Rate for Payer: Health Management Network Commercial	$1,597.15
Rate for Payer: Kaiser Permanente Commercial	$1,691.10
Rate for Payer: MDX Hawaii PPO	$1,822.63

ATROPINE 0.1 MG/ML INJECTION SYRINGE [137071]

Facility

$44.00

Service Code	HCPCS J0461
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$42.68
Rate for Payer: AlohaCare Medicaid	$22.00
Rate for Payer: AlohaCare Medicaid	$24.50
Rate for Payer: AlohaCare Medicare	$15.19
Rate for Payer: AlohaCare Medicare	$13.64
Rate for Payer: Cash Price	$29.40
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$29.40
Rate for Payer: Devoted Health Medicare	$14.96
Rate for Payer: Devoted Health Medicare	$16.66
Rate for Payer: Hawaii Medical Service Association ABD	$0.07
Rate for Payer: Hawaii Medical Service Association ABD	$0.07
Rate for Payer: Hawaii Medical Service Association Medicare	$15.19
Rate for Payer: Hawaii Medical Service Association Medicare	$13.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.07
Rate for Payer: Hawaii Western Management Group Commercial	$41.80
Rate for Payer: Hawaii Western Management Group Commercial	$46.55
Rate for Payer: Health Management Network Commercial	$41.65
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Humana Medicare	$13.64
Rate for Payer: Humana Medicare	$15.19
Rate for Payer: Kaiser Permanente Commercial	$39.60
Rate for Payer: Kaiser Permanente Commercial	$44.10
Rate for Payer: Kaiser Permanente Medicaid	$24.99
Rate for Payer: Kaiser Permanente Medicaid	$22.44
Rate for Payer: Kaiser Permanente Medicare	$13.64
Rate for Payer: Kaiser Permanente Medicare	$15.19
Rate for Payer: MDX Hawaii PPO	$42.68
Rate for Payer: MDX Hawaii PPO	$47.53
Rate for Payer: Ohana Health Plan Medicaid	$15.19
Rate for Payer: Ohana Health Plan Medicaid	$13.64
Rate for Payer: Ohana Health Plan Medicare	$13.64
Rate for Payer: Ohana Health Plan Medicare	$15.19
Rate for Payer: UnitedHealthcare Medicaid	$29.40
Rate for Payer: UnitedHealthcare Medicaid	$26.40
Rate for Payer: UnitedHealthcare Medicare	$13.64
Rate for Payer: UnitedHealthcare Medicare	$15.19
Rate for Payer: University Health Alliance Commercial	$32.07
Rate for Payer: University Health Alliance Commercial	$35.72

ATROPINE 0.1 MG/ML INJECTION SYRINGE [137071]

Facility

$44.00

Service Code	HCPCS J0461
Hospital Revenue Code	250
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$42.68
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$29.40
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Health Management Network Commercial	$41.65
Rate for Payer: Kaiser Permanente Commercial	$39.60
Rate for Payer: Kaiser Permanente Commercial	$44.10
Rate for Payer: MDX Hawaii PPO	$47.53
Rate for Payer: MDX Hawaii PPO	$42.68

ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION [177367]

Facility

$34.00

Service Code	HCPCS J0461
Hospital Revenue Code	250
Min. Negotiated Rate	$28.90
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$20.40
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$32.98

ATROPINE 0.4 MG/ML INTRAVENOUS SOLUTION [177367]

Facility

$34.00

Service Code	HCPCS J0461
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$32.98
Rate for Payer: AlohaCare Medicaid	$17.00
Rate for Payer: AlohaCare Medicare	$10.54
Rate for Payer: Cash Price	$20.40
Rate for Payer: Cash Price	$20.40
Rate for Payer: Devoted Health Medicare	$11.56
Rate for Payer: Hawaii Medical Service Association ABD	$0.07
Rate for Payer: Hawaii Medical Service Association Medicare	$10.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.07
Rate for Payer: Hawaii Western Management Group Commercial	$32.30
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Humana Medicare	$10.54
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: Kaiser Permanente Medicaid	$17.34
Rate for Payer: Kaiser Permanente Medicare	$10.54
Rate for Payer: MDX Hawaii PPO	$32.98
Rate for Payer: Ohana Health Plan Medicaid	$10.54
Rate for Payer: Ohana Health Plan Medicare	$10.54
Rate for Payer: UnitedHealthcare Medicaid	$20.40
Rate for Payer: UnitedHealthcare Medicare	$10.54
Rate for Payer: University Health Alliance Commercial	$24.78

ATROPINE 1 % EYE DROPS [736]

Facility

$120.00

Service Code	NDC 60219174802
Hospital Revenue Code	637
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$116.40
Rate for Payer: AlohaCare Medicaid	$60.00
Rate for Payer: AlohaCare Medicare	$37.20
Rate for Payer: Cash Price	$72.00
Rate for Payer: Devoted Health Medicare	$40.80
Rate for Payer: Hawaii Medical Service Association Medicare	$37.20
Rate for Payer: Hawaii Western Management Group Commercial	$114.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Humana Medicare	$37.20
Rate for Payer: Kaiser Permanente Commercial	$108.00
Rate for Payer: Kaiser Permanente Medicaid	$61.20
Rate for Payer: Kaiser Permanente Medicare	$37.20
Rate for Payer: MDX Hawaii PPO	$116.40
Rate for Payer: Ohana Health Plan Medicaid	$37.20
Rate for Payer: Ohana Health Plan Medicare	$37.20
Rate for Payer: UnitedHealthcare Medicare	$37.20
Rate for Payer: University Health Alliance Commercial	$87.47

ATROPINE 1 % EYE DROPS [736]

Facility

$120.00

Service Code	NDC 60219174802
Hospital Revenue Code	250
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Kaiser Permanente Commercial	$108.00
Rate for Payer: MDX Hawaii PPO	$116.40

Know your out-of-pocket cost for care.

All Charges