Kau Hospital

All Charges

Charge

Type

Setting

Price

ISOSORBIDE DINITRATE 5 MG TABLET [4068]

Facility

$4.00

Service Code	NDC 00143176901
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

ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [24521]

Facility

$2.00

Service Code	NDC 60687078311
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

ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [24521]

Facility

$2.00

Service Code	NDC 60687078311
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

ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [24521]

Facility

$2.00

Service Code	NDC 60687078301
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

ISOSORBIDE MONONITRATE ER 30 MG TABLET,EXTENDED RELEASE 24 HR [24521]

Facility

$2.00

Service Code	NDC 60687078301
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

ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [24268]

Facility

$2.00

Service Code	NDC 60687079401
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

ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [24268]

Facility

$8.00

Service Code	NDC 00904645061
Hospital Revenue Code	250
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: MDX Hawaii PPO	$7.76

ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [24268]

Facility

$2.00

Service Code	NDC 60687079401
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

ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [24268]

Facility

$8.00

Service Code	NDC 00904645061
Hospital Revenue Code	637
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$7.76
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$2.48
Rate for Payer: Cash Price	$4.80
Rate for Payer: Devoted Health Medicare	$2.72
Rate for Payer: Hawaii Medical Service Association Medicare	$2.48
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Humana Medicare	$2.48
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicare	$2.48
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: Ohana Health Plan Medicaid	$2.48
Rate for Payer: Ohana Health Plan Medicare	$2.48
Rate for Payer: UnitedHealthcare Medicare	$2.48
Rate for Payer: University Health Alliance Commercial	$5.83

ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [24268]

Facility

$2.00

Service Code	NDC 60687079411
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

ISOSORBIDE MONONITRATE ER 60 MG TABLET,EXTENDED RELEASE 24 HR [24268]

Facility

$2.00

Service Code	NDC 60687079411
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

ITRACONAZOLE 100 MG CAPSULE [10364]

Facility

$61.00

Service Code	NDC 67877045430
Hospital Revenue Code	250
Min. Negotiated Rate	$51.85
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$36.60
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: MDX Hawaii PPO	$59.17

ITRACONAZOLE 100 MG CAPSULE [10364]

Facility

$20.00

Service Code	NDC 50268045012
Hospital Revenue Code	637
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$19.40
Rate for Payer: AlohaCare Medicaid	$10.00
Rate for Payer: AlohaCare Medicare	$6.20
Rate for Payer: Cash Price	$12.00
Rate for Payer: Devoted Health Medicare	$6.80
Rate for Payer: Hawaii Medical Service Association Medicare	$6.20
Rate for Payer: Hawaii Western Management Group Commercial	$19.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Humana Medicare	$6.20
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: Kaiser Permanente Medicaid	$10.20
Rate for Payer: Kaiser Permanente Medicare	$6.20
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: Ohana Health Plan Medicaid	$6.20
Rate for Payer: Ohana Health Plan Medicare	$6.20
Rate for Payer: UnitedHealthcare Medicare	$6.20
Rate for Payer: University Health Alliance Commercial	$14.58

ITRACONAZOLE 100 MG CAPSULE [10364]

Facility

$20.00

Service Code	NDC 50268045012
Hospital Revenue Code	250
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: MDX Hawaii PPO	$19.40

ITRACONAZOLE 100 MG CAPSULE [10364]

Facility

$61.00

Service Code	NDC 67877045430
Hospital Revenue Code	637
Min. Negotiated Rate	$18.91
Max. Negotiated Rate	$59.17
Rate for Payer: AlohaCare Medicaid	$30.50
Rate for Payer: AlohaCare Medicare	$18.91
Rate for Payer: Cash Price	$36.60
Rate for Payer: Devoted Health Medicare	$20.74
Rate for Payer: Hawaii Medical Service Association Medicare	$18.91
Rate for Payer: Hawaii Western Management Group Commercial	$57.95
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Humana Medicare	$18.91
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: Kaiser Permanente Medicaid	$31.11
Rate for Payer: Kaiser Permanente Medicare	$18.91
Rate for Payer: MDX Hawaii PPO	$59.17
Rate for Payer: Ohana Health Plan Medicaid	$18.91
Rate for Payer: Ohana Health Plan Medicare	$18.91
Rate for Payer: UnitedHealthcare Medicare	$18.91
Rate for Payer: University Health Alliance Commercial	$44.46

ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]

Facility

$551.00

Service Code	NDC 65162008774
Hospital Revenue Code	250
Min. Negotiated Rate	$468.35
Max. Negotiated Rate	$534.47
Rate for Payer: Cash Price	$330.60
Rate for Payer: Health Management Network Commercial	$468.35
Rate for Payer: Kaiser Permanente Commercial	$495.90
Rate for Payer: MDX Hawaii PPO	$534.47

ITRACONAZOLE 10 MG/ML ORAL SOLUTION [19928]

Facility

$551.00

Service Code	NDC 65162008774
Hospital Revenue Code	637
Min. Negotiated Rate	$170.81
Max. Negotiated Rate	$534.47
Rate for Payer: AlohaCare Medicaid	$275.50
Rate for Payer: AlohaCare Medicare	$170.81
Rate for Payer: Cash Price	$330.60
Rate for Payer: Devoted Health Medicare	$187.34
Rate for Payer: Hawaii Medical Service Association Medicare	$170.81
Rate for Payer: Hawaii Western Management Group Commercial	$523.45
Rate for Payer: Health Management Network Commercial	$468.35
Rate for Payer: Humana Medicare	$170.81
Rate for Payer: Kaiser Permanente Commercial	$495.90
Rate for Payer: Kaiser Permanente Medicaid	$281.01
Rate for Payer: Kaiser Permanente Medicare	$170.81
Rate for Payer: MDX Hawaii PPO	$534.47
Rate for Payer: Ohana Health Plan Medicaid	$170.81
Rate for Payer: Ohana Health Plan Medicare	$170.81
Rate for Payer: UnitedHealthcare Medicare	$170.81
Rate for Payer: University Health Alliance Commercial	$401.62

IVABRADINE 5 MG TABLET [128540]

Facility

$32.00

Service Code	NDC 55513080060
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

IVABRADINE 5 MG TABLET [128540]

Facility

$32.00

Service Code	NDC 55513080060
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

IVERMECTIN 3 MG TABLET [25820]

Facility

$18.00

Service Code	NDC 42799080601
Hospital Revenue Code	637
Min. Negotiated Rate	$5.58
Max. Negotiated Rate	$17.46
Rate for Payer: AlohaCare Medicaid	$9.00
Rate for Payer: AlohaCare Medicare	$5.58
Rate for Payer: Cash Price	$10.80
Rate for Payer: Devoted Health Medicare	$6.12
Rate for Payer: Hawaii Medical Service Association Medicare	$5.58
Rate for Payer: Hawaii Western Management Group Commercial	$17.10
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Humana Medicare	$5.58
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: Kaiser Permanente Medicaid	$9.18
Rate for Payer: Kaiser Permanente Medicare	$5.58
Rate for Payer: MDX Hawaii PPO	$17.46
Rate for Payer: Ohana Health Plan Medicaid	$5.58
Rate for Payer: Ohana Health Plan Medicare	$5.58
Rate for Payer: UnitedHealthcare Medicare	$5.58
Rate for Payer: University Health Alliance Commercial	$13.12

IVERMECTIN 3 MG TABLET [25820]

Facility

$18.00

Service Code	NDC 42799080601
Hospital Revenue Code	250
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$17.46
Rate for Payer: Cash Price	$10.80
Rate for Payer: Health Management Network Commercial	$15.30
Rate for Payer: Kaiser Permanente Commercial	$16.20
Rate for Payer: MDX Hawaii PPO	$17.46

IV PUSH EA ADDL SAME DRUG

Facility

$233.00

Service Code	HCPCS 96376
Hospital Charge Code	4509637601
Hospital Revenue Code	450
Min. Negotiated Rate	$72.23
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$116.50
Rate for Payer: AlohaCare Medicare	$72.23
Rate for Payer: Cash Price	$139.80
Rate for Payer: Cash Price	$139.80
Rate for Payer: Devoted Health Medicare	$79.22
Rate for Payer: Hawaii Medical Service Association ABD	$469.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$72.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$450.00
Rate for Payer: Hawaii Western Management Group Commercial	$221.35
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: Humana Medicare	$72.23
Rate for Payer: Kaiser Permanente Commercial	$209.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$72.23
Rate for Payer: MDX Hawaii PPO	$226.01
Rate for Payer: Ohana Health Plan Medicaid	$72.23
Rate for Payer: Ohana Health Plan Medicare	$72.23
Rate for Payer: UnitedHealthcare Medicare	$72.23
Rate for Payer: University Health Alliance Commercial	$169.83

IV PUSH EA ADDL SAME DRUG

Facility

$233.00

Service Code	HCPCS 96376
Hospital Charge Code	4509637601
Hospital Revenue Code	450
Min. Negotiated Rate	$198.05
Max. Negotiated Rate	$226.01
Rate for Payer: Cash Price	$139.80
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: Kaiser Permanente Commercial	$209.70
Rate for Payer: MDX Hawaii PPO	$226.01

J-TUBE FEEDING TUBE #0200-12LV

Facility

$536.00

Service Code	HCPCS B4087
Hospital Revenue Code	272
Min. Negotiated Rate	$455.60
Max. Negotiated Rate	$519.92
Rate for Payer: Cash Price	$321.60
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: Kaiser Permanente Commercial	$482.40
Rate for Payer: MDX Hawaii PPO	$519.92

J-TUBE FEEDING TUBE #0200-12LV

Facility

$536.00

Service Code	HCPCS B4087
Hospital Revenue Code	272
Min. Negotiated Rate	$38.22
Max. Negotiated Rate	$519.92
Rate for Payer: AlohaCare Medicaid	$268.00
Rate for Payer: AlohaCare Medicare	$166.16
Rate for Payer: Cash Price	$321.60
Rate for Payer: Cash Price	$321.60
Rate for Payer: Devoted Health Medicare	$182.24
Rate for Payer: Hawaii Medical Service Association Medicare	$166.16
Rate for Payer: Hawaii Western Management Group Commercial	$509.20
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: Humana Medicare	$166.16
Rate for Payer: Kaiser Permanente Commercial	$482.40
Rate for Payer: Kaiser Permanente Medicaid	$273.36
Rate for Payer: Kaiser Permanente Medicare	$166.16
Rate for Payer: MDX Hawaii PPO	$519.92
Rate for Payer: Ohana Health Plan Medicaid	$166.16
Rate for Payer: Ohana Health Plan Medicare	$166.16
Rate for Payer: UnitedHealthcare Medicaid	$38.22
Rate for Payer: UnitedHealthcare Medicare	$166.16
Rate for Payer: University Health Alliance Commercial	$390.69

Know your out-of-pocket cost for care.

All Charges