Kau Hospital

All Charges

Charge

Type

Setting

Price

MECLIZINE 25 MG CHEWABLE TABLET [4822]

Facility

$1.00

Service Code	NDC 00536129901
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

MECLIZINE 25 MG CHEWABLE TABLET [4822]

Facility

$1.00

Service Code	NDC 68001052900
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

MECLIZINE 25 MG CHEWABLE TABLET [4822]

Facility

$1.00

Service Code	NDC 00536129901
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

MECLIZINE 25 MG CHEWABLE TABLET [4822]

Facility

$1.00

Service Code	NDC 68001052900
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

MECLIZINE CHEWABLE TABLETS (ANTIVERT) 25 MG (TAKE HOME) [4080373]

Facility

$15.00

Service Code	NDC 00004080161
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

MECLIZINE CHEWABLE TABLETS (ANTIVERT) 25 MG (TAKE HOME) [4080373]

Facility

$15.00

Service Code	NDC 00004080161
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

MEDIALIZED DOME 1518-20-038

Facility

$1,650.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$511.50
Max. Negotiated Rate	$1,600.50
Rate for Payer: AlohaCare Medicaid	$825.00
Rate for Payer: AlohaCare Medicare	$511.50
Rate for Payer: Cash Price	$990.00
Rate for Payer: Devoted Health Medicare	$561.00
Rate for Payer: Hawaii Medical Service Association Medicare	$511.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,155.00
Rate for Payer: Health Management Network Commercial	$1,402.50
Rate for Payer: Humana Medicare	$511.50
Rate for Payer: Kaiser Permanente Commercial	$1,485.00
Rate for Payer: Kaiser Permanente Medicaid	$841.50
Rate for Payer: Kaiser Permanente Medicare	$511.50
Rate for Payer: MDX Hawaii PPO	$1,600.50
Rate for Payer: Ohana Health Plan Medicaid	$511.50
Rate for Payer: Ohana Health Plan Medicare	$511.50
Rate for Payer: UnitedHealthcare Medicare	$511.50
Rate for Payer: University Health Alliance Commercial	$924.00

MEDIALIZED DOME 1518-20-038

Facility

$1,650.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$924.00
Max. Negotiated Rate	$1,600.50
Rate for Payer: Cash Price	$990.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,155.00
Rate for Payer: Health Management Network Commercial	$1,402.50
Rate for Payer: Kaiser Permanente Commercial	$1,485.00
Rate for Payer: MDX Hawaii PPO	$1,600.50
Rate for Payer: University Health Alliance Commercial	$924.00

MEDIAL MALLEOLAR PIN PLATE

Facility

$2,895.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$897.45
Max. Negotiated Rate	$2,808.15
Rate for Payer: AlohaCare Medicaid	$1,447.50
Rate for Payer: AlohaCare Medicare	$897.45
Rate for Payer: Cash Price	$1,737.00
Rate for Payer: Devoted Health Medicare	$984.30
Rate for Payer: Hawaii Medical Service Association Medicare	$897.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,026.50
Rate for Payer: Health Management Network Commercial	$2,460.75
Rate for Payer: Humana Medicare	$897.45
Rate for Payer: Kaiser Permanente Commercial	$2,605.50
Rate for Payer: Kaiser Permanente Medicaid	$1,476.45
Rate for Payer: Kaiser Permanente Medicare	$897.45
Rate for Payer: MDX Hawaii PPO	$2,808.15
Rate for Payer: Ohana Health Plan Medicaid	$897.45
Rate for Payer: Ohana Health Plan Medicare	$897.45
Rate for Payer: UnitedHealthcare Medicare	$897.45
Rate for Payer: University Health Alliance Commercial	$1,621.20

MEDIAL MALLEOLAR PIN PLATE

Facility

$2,895.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,621.20
Max. Negotiated Rate	$2,808.15
Rate for Payer: Cash Price	$1,737.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,026.50
Rate for Payer: Health Management Network Commercial	$2,460.75
Rate for Payer: Kaiser Permanente Commercial	$2,605.50
Rate for Payer: MDX Hawaii PPO	$2,808.15
Rate for Payer: University Health Alliance Commercial	$1,621.20

MEDIAL MALLEOLAR PIN WIRE

Facility

$653.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$555.05
Max. Negotiated Rate	$633.41
Rate for Payer: Cash Price	$391.80
Rate for Payer: Health Management Network Commercial	$555.05
Rate for Payer: Kaiser Permanente Commercial	$587.70
Rate for Payer: MDX Hawaii PPO	$633.41

MEDIAL MALLEOLAR PIN WIRE

Facility

$653.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$202.43
Max. Negotiated Rate	$633.41
Rate for Payer: AlohaCare Medicaid	$326.50
Rate for Payer: AlohaCare Medicare	$202.43
Rate for Payer: Cash Price	$391.80
Rate for Payer: Devoted Health Medicare	$222.02
Rate for Payer: Hawaii Medical Service Association Medicare	$202.43
Rate for Payer: Hawaii Western Management Group Commercial	$620.35
Rate for Payer: Health Management Network Commercial	$555.05
Rate for Payer: Humana Medicare	$202.43
Rate for Payer: Kaiser Permanente Commercial	$587.70
Rate for Payer: Kaiser Permanente Medicaid	$333.03
Rate for Payer: Kaiser Permanente Medicare	$202.43
Rate for Payer: MDX Hawaii PPO	$633.41
Rate for Payer: Ohana Health Plan Medicaid	$202.43
Rate for Payer: Ohana Health Plan Medicare	$202.43
Rate for Payer: UnitedHealthcare Medicare	$202.43
Rate for Payer: University Health Alliance Commercial	$475.97

MEDIAL MALLEOLAR SLED

Facility

$2,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	272
Min. Negotiated Rate	$682.00
Max. Negotiated Rate	$2,134.00
Rate for Payer: AlohaCare Medicaid	$1,100.00
Rate for Payer: AlohaCare Medicare	$682.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Devoted Health Medicare	$748.00
Rate for Payer: Hawaii Medical Service Association Medicare	$682.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,090.00
Rate for Payer: Health Management Network Commercial	$1,870.00
Rate for Payer: Humana Medicare	$682.00
Rate for Payer: Kaiser Permanente Commercial	$1,980.00
Rate for Payer: Kaiser Permanente Medicaid	$1,122.00
Rate for Payer: Kaiser Permanente Medicare	$682.00
Rate for Payer: MDX Hawaii PPO	$2,134.00
Rate for Payer: Ohana Health Plan Medicaid	$682.00
Rate for Payer: Ohana Health Plan Medicare	$682.00
Rate for Payer: UnitedHealthcare Medicare	$682.00
Rate for Payer: University Health Alliance Commercial	$1,603.58

MEDIAL MALLEOLAR SLED

Facility

$2,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	272
Min. Negotiated Rate	$1,870.00
Max. Negotiated Rate	$2,134.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Health Management Network Commercial	$1,870.00
Rate for Payer: Kaiser Permanente Commercial	$1,980.00
Rate for Payer: MDX Hawaii PPO	$2,134.00

MEDICAL BACK PROBLEMS WITH MCC

Facility

$14,647.84

Service Code	MSDRG 551
Min. Negotiated Rate	$14,647.84
Max. Negotiated Rate	$14,647.84
Rate for Payer: Hawaii Medical Service Association Commercial	$14,647.84

MEDICAL BACK PROBLEMS WITHOUT MCC

Facility

$14,647.84

Service Code	MSDRG 552
Min. Negotiated Rate	$14,647.84
Max. Negotiated Rate	$14,647.84
Rate for Payer: Hawaii Medical Service Association Commercial	$14,647.84

MEDL MALLE SLED 35MM MMSLED-35

Facility

$2,895.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$897.45
Max. Negotiated Rate	$2,808.15
Rate for Payer: AlohaCare Medicaid	$1,447.50
Rate for Payer: AlohaCare Medicare	$897.45
Rate for Payer: Cash Price	$1,737.00
Rate for Payer: Devoted Health Medicare	$984.30
Rate for Payer: Hawaii Medical Service Association Medicare	$897.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,026.50
Rate for Payer: Health Management Network Commercial	$2,460.75
Rate for Payer: Humana Medicare	$897.45
Rate for Payer: Kaiser Permanente Commercial	$2,605.50
Rate for Payer: Kaiser Permanente Medicaid	$1,476.45
Rate for Payer: Kaiser Permanente Medicare	$897.45
Rate for Payer: MDX Hawaii PPO	$2,808.15
Rate for Payer: Ohana Health Plan Medicaid	$897.45
Rate for Payer: Ohana Health Plan Medicare	$897.45
Rate for Payer: UnitedHealthcare Medicare	$897.45
Rate for Payer: University Health Alliance Commercial	$1,621.20

MEDL MALLE SLED 35MM MMSLED-35

Facility

$2,895.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,621.20
Max. Negotiated Rate	$2,808.15
Rate for Payer: Cash Price	$1,737.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,026.50
Rate for Payer: Health Management Network Commercial	$2,460.75
Rate for Payer: Kaiser Permanente Commercial	$2,605.50
Rate for Payer: MDX Hawaii PPO	$2,808.15
Rate for Payer: University Health Alliance Commercial	$1,621.20

MEDL MALLE SLED 42MM MMSLED-42

Facility

$2,895.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$897.45
Max. Negotiated Rate	$2,808.15
Rate for Payer: AlohaCare Medicaid	$1,447.50
Rate for Payer: AlohaCare Medicare	$897.45
Rate for Payer: Cash Price	$1,737.00
Rate for Payer: Devoted Health Medicare	$984.30
Rate for Payer: Hawaii Medical Service Association Medicare	$897.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,026.50
Rate for Payer: Health Management Network Commercial	$2,460.75
Rate for Payer: Humana Medicare	$897.45
Rate for Payer: Kaiser Permanente Commercial	$2,605.50
Rate for Payer: Kaiser Permanente Medicaid	$1,476.45
Rate for Payer: Kaiser Permanente Medicare	$897.45
Rate for Payer: MDX Hawaii PPO	$2,808.15
Rate for Payer: Ohana Health Plan Medicaid	$897.45
Rate for Payer: Ohana Health Plan Medicare	$897.45
Rate for Payer: UnitedHealthcare Medicare	$897.45
Rate for Payer: University Health Alliance Commercial	$1,621.20

MEDL MALLE SLED 42MM MMSLED-42

Facility

$2,895.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,621.20
Max. Negotiated Rate	$2,808.15
Rate for Payer: Cash Price	$1,737.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,026.50
Rate for Payer: Health Management Network Commercial	$2,460.75
Rate for Payer: Kaiser Permanente Commercial	$2,605.50
Rate for Payer: MDX Hawaii PPO	$2,808.15
Rate for Payer: University Health Alliance Commercial	$1,621.20

MEDL MALLE SLED WASHER MMSLEDW

Facility

$788.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$244.28
Max. Negotiated Rate	$764.36
Rate for Payer: AlohaCare Medicaid	$394.00
Rate for Payer: AlohaCare Medicare	$244.28
Rate for Payer: Cash Price	$472.80
Rate for Payer: Devoted Health Medicare	$267.92
Rate for Payer: Hawaii Medical Service Association Medicare	$244.28
Rate for Payer: Hawaii Western Management Group Commercial	$551.60
Rate for Payer: Health Management Network Commercial	$669.80
Rate for Payer: Humana Medicare	$244.28
Rate for Payer: Kaiser Permanente Commercial	$709.20
Rate for Payer: Kaiser Permanente Medicaid	$401.88
Rate for Payer: Kaiser Permanente Medicare	$244.28
Rate for Payer: MDX Hawaii PPO	$764.36
Rate for Payer: Ohana Health Plan Medicaid	$244.28
Rate for Payer: Ohana Health Plan Medicare	$244.28
Rate for Payer: UnitedHealthcare Medicare	$244.28
Rate for Payer: University Health Alliance Commercial	$441.28

MEDL MALLE SLED WASHER MMSLEDW

Facility

$788.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$441.28
Max. Negotiated Rate	$764.36
Rate for Payer: Cash Price	$472.80
Rate for Payer: Hawaii Western Management Group Commercial	$551.60
Rate for Payer: Health Management Network Commercial	$669.80
Rate for Payer: Kaiser Permanente Commercial	$709.20
Rate for Payer: MDX Hawaii PPO	$764.36
Rate for Payer: University Health Alliance Commercial	$441.28

MEDROXYPROGESTERONE 10 MG TABLET [4854]

Facility

$2.00

Service Code	NDC 00555077902
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

MEDROXYPROGESTERONE 10 MG TABLET [4854]

Facility

$2.00

Service Code	NDC 00555077902
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

MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION [19736]

Facility

$196.00

Service Code	HCPCS J1050
Hospital Revenue Code	250
Min. Negotiated Rate	$166.60
Max. Negotiated Rate	$190.12
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cash Price	$62.40
Rate for Payer: Health Management Network Commercial	$166.60
Rate for Payer: Health Management Network Commercial	$88.40
Rate for Payer: Kaiser Permanente Commercial	$93.60
Rate for Payer: Kaiser Permanente Commercial	$176.40
Rate for Payer: MDX Hawaii PPO	$190.12
Rate for Payer: MDX Hawaii PPO	$100.88

Know your out-of-pocket cost for care.

All Charges