Kau Hospital

All Charges

Charge

Type

Setting

Price

MEROPENEM 500 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK [130366]

Facility

$62.00

Service Code	HCPCS J2184
Hospital Revenue Code	636
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$60.14
Rate for Payer: AlohaCare Medicaid	$31.00
Rate for Payer: AlohaCare Medicare	$19.22
Rate for Payer: Cash Price	$37.20
Rate for Payer: Cash Price	$37.20
Rate for Payer: Devoted Health Medicare	$21.08
Rate for Payer: Hawaii Medical Service Association ABD	$2.08
Rate for Payer: Hawaii Medical Service Association Medicare	$19.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.08
Rate for Payer: Hawaii Western Management Group Commercial	$58.90
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: Humana Medicare	$19.22
Rate for Payer: Kaiser Permanente Commercial	$55.80
Rate for Payer: Kaiser Permanente Medicaid	$31.62
Rate for Payer: Kaiser Permanente Medicare	$19.22
Rate for Payer: MDX Hawaii PPO	$60.14
Rate for Payer: Ohana Health Plan Medicaid	$19.22
Rate for Payer: Ohana Health Plan Medicare	$19.22
Rate for Payer: UnitedHealthcare Medicaid	$37.20
Rate for Payer: UnitedHealthcare Medicare	$19.22
Rate for Payer: University Health Alliance Commercial	$45.19

MEROPENEM 500 MG/50 ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS PIGGYBACK [130366]

Facility

$62.00

Service Code	HCPCS J2184
Hospital Revenue Code	250
Min. Negotiated Rate	$52.70
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$37.20
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: Kaiser Permanente Commercial	$55.80
Rate for Payer: MDX Hawaii PPO	$60.14

MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]

Facility

$22.00

Service Code	HCPCS J2185
Hospital Revenue Code	636
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$21.34
Rate for Payer: AlohaCare Medicaid	$11.00
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$4.03
Rate for Payer: AlohaCare Medicare	$6.82
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$13.20
Rate for Payer: Cash Price	$13.20
Rate for Payer: Devoted Health Medicare	$4.42
Rate for Payer: Devoted Health Medicare	$7.48
Rate for Payer: Hawaii Medical Service Association ABD	$0.44
Rate for Payer: Hawaii Medical Service Association ABD	$0.44
Rate for Payer: Hawaii Medical Service Association Medicare	$4.03
Rate for Payer: Hawaii Medical Service Association Medicare	$6.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.44
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Hawaii Western Management Group Commercial	$20.90
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Humana Medicare	$4.03
Rate for Payer: Humana Medicare	$6.82
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicaid	$11.22
Rate for Payer: Kaiser Permanente Medicare	$4.03
Rate for Payer: Kaiser Permanente Medicare	$6.82
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: Ohana Health Plan Medicaid	$6.82
Rate for Payer: Ohana Health Plan Medicaid	$4.03
Rate for Payer: Ohana Health Plan Medicare	$4.03
Rate for Payer: Ohana Health Plan Medicare	$6.82
Rate for Payer: UnitedHealthcare Medicaid	$7.80
Rate for Payer: UnitedHealthcare Medicaid	$13.20
Rate for Payer: UnitedHealthcare Medicare	$6.82
Rate for Payer: UnitedHealthcare Medicare	$4.03
Rate for Payer: University Health Alliance Commercial	$9.48
Rate for Payer: University Health Alliance Commercial	$16.04

MEROPENEM 500 MG INTRAVENOUS SOLUTION [17379]

Facility

$13.00

Service Code	HCPCS J2185
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$13.20
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: MDX Hawaii PPO	$21.34

MERSILENE 5 CTX 12" DBL RS22

Facility

$247.00

Hospital Revenue Code	272
Min. Negotiated Rate	$209.95
Max. Negotiated Rate	$239.59
Rate for Payer: Cash Price	$148.20
Rate for Payer: Health Management Network Commercial	$209.95
Rate for Payer: Kaiser Permanente Commercial	$222.30
Rate for Payer: MDX Hawaii PPO	$239.59

MERSILENE 5 CTX 12" DBL RS22

Facility

$247.00

Hospital Revenue Code	272
Min. Negotiated Rate	$76.57
Max. Negotiated Rate	$239.59
Rate for Payer: AlohaCare Medicaid	$123.50
Rate for Payer: AlohaCare Medicare	$76.57
Rate for Payer: Cash Price	$148.20
Rate for Payer: Devoted Health Medicare	$83.98
Rate for Payer: Hawaii Medical Service Association Medicare	$76.57
Rate for Payer: Hawaii Western Management Group Commercial	$234.65
Rate for Payer: Health Management Network Commercial	$209.95
Rate for Payer: Humana Medicare	$76.57
Rate for Payer: Kaiser Permanente Commercial	$222.30
Rate for Payer: Kaiser Permanente Medicaid	$125.97
Rate for Payer: Kaiser Permanente Medicare	$76.57
Rate for Payer: MDX Hawaii PPO	$239.59
Rate for Payer: Ohana Health Plan Medicaid	$76.57
Rate for Payer: Ohana Health Plan Medicare	$76.57
Rate for Payer: UnitedHealthcare Medicare	$76.57
Rate for Payer: University Health Alliance Commercial	$180.04

MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]

Facility

$33.00

Service Code	NDC 00591224522
Hospital Revenue Code	637
Min. Negotiated Rate	$10.23
Max. Negotiated Rate	$32.01
Rate for Payer: AlohaCare Medicaid	$16.50
Rate for Payer: AlohaCare Medicare	$10.23
Rate for Payer: Cash Price	$19.80
Rate for Payer: Devoted Health Medicare	$11.22
Rate for Payer: Hawaii Medical Service Association Medicare	$10.23
Rate for Payer: Hawaii Western Management Group Commercial	$31.35
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Humana Medicare	$10.23
Rate for Payer: Kaiser Permanente Commercial	$29.70
Rate for Payer: Kaiser Permanente Medicaid	$16.83
Rate for Payer: Kaiser Permanente Medicare	$10.23
Rate for Payer: MDX Hawaii PPO	$32.01
Rate for Payer: Ohana Health Plan Medicaid	$10.23
Rate for Payer: Ohana Health Plan Medicare	$10.23
Rate for Payer: UnitedHealthcare Medicare	$10.23
Rate for Payer: University Health Alliance Commercial	$24.05

MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]

Facility

$33.00

Service Code	NDC 00591224522
Hospital Revenue Code	250
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$19.80
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Kaiser Permanente Commercial	$29.70
Rate for Payer: MDX Hawaii PPO	$32.01

MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]

Facility

$31.00

Service Code	NDC 63304017513
Hospital Revenue Code	250
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: MDX Hawaii PPO	$30.07

MESALAMINE 1.2 GRAM TABLET,DELAYED RELEASE [78310]

Facility

$31.00

Service Code	NDC 63304017513
Hospital Revenue Code	637
Min. Negotiated Rate	$9.61
Max. Negotiated Rate	$30.07
Rate for Payer: AlohaCare Medicaid	$15.50
Rate for Payer: AlohaCare Medicare	$9.61
Rate for Payer: Cash Price	$18.60
Rate for Payer: Devoted Health Medicare	$10.54
Rate for Payer: Hawaii Medical Service Association Medicare	$9.61
Rate for Payer: Hawaii Western Management Group Commercial	$29.45
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Humana Medicare	$9.61
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: Kaiser Permanente Medicaid	$15.81
Rate for Payer: Kaiser Permanente Medicare	$9.61
Rate for Payer: MDX Hawaii PPO	$30.07
Rate for Payer: Ohana Health Plan Medicaid	$9.61
Rate for Payer: Ohana Health Plan Medicare	$9.61
Rate for Payer: UnitedHealthcare Medicare	$9.61
Rate for Payer: University Health Alliance Commercial	$22.60

MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE) [119913]

Facility

$16.00

Service Code	NDC 00093590786
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

MESALAMINE 400 MG CAPSULE (WITH DELAYED RELEASE TABLETS INSIDE) [119913]

Facility

$16.00

Service Code	NDC 00093590786
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

MESALAMINE 4 GRAM/60 ML ENEMA [10535]

Facility

$61.00

Service Code	NDC 45802009851
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

MESALAMINE 4 GRAM/60 ML ENEMA [10535]

Facility

$61.00

Service Code	NDC 45802009851
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

MESALAMINE 4 GRAM/60 ML ENEMA [10535]

Facility

$62.00

Service Code	NDC 62559042007
Hospital Revenue Code	250
Min. Negotiated Rate	$52.70
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$37.20
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: Kaiser Permanente Commercial	$55.80
Rate for Payer: MDX Hawaii PPO	$60.14

MESALAMINE 4 GRAM/60 ML ENEMA [10535]

Facility

$62.00

Service Code	NDC 62559042007
Hospital Revenue Code	637
Min. Negotiated Rate	$19.22
Max. Negotiated Rate	$60.14
Rate for Payer: AlohaCare Medicaid	$31.00
Rate for Payer: AlohaCare Medicare	$19.22
Rate for Payer: Cash Price	$37.20
Rate for Payer: Devoted Health Medicare	$21.08
Rate for Payer: Hawaii Medical Service Association Medicare	$19.22
Rate for Payer: Hawaii Western Management Group Commercial	$58.90
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: Humana Medicare	$19.22
Rate for Payer: Kaiser Permanente Commercial	$55.80
Rate for Payer: Kaiser Permanente Medicaid	$31.62
Rate for Payer: Kaiser Permanente Medicare	$19.22
Rate for Payer: MDX Hawaii PPO	$60.14
Rate for Payer: Ohana Health Plan Medicaid	$19.22
Rate for Payer: Ohana Health Plan Medicare	$19.22
Rate for Payer: UnitedHealthcare Medicare	$19.22
Rate for Payer: University Health Alliance Commercial	$45.19

MESH 10X15CM PROLENE GPSL

Facility

$2,528.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$783.68
Max. Negotiated Rate	$2,452.16
Rate for Payer: AlohaCare Medicaid	$1,264.00
Rate for Payer: AlohaCare Medicare	$783.68
Rate for Payer: Cash Price	$1,516.80
Rate for Payer: Devoted Health Medicare	$859.52
Rate for Payer: Hawaii Medical Service Association Medicare	$783.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,769.60
Rate for Payer: Health Management Network Commercial	$2,148.80
Rate for Payer: Humana Medicare	$783.68
Rate for Payer: Kaiser Permanente Commercial	$2,275.20
Rate for Payer: Kaiser Permanente Medicaid	$1,289.28
Rate for Payer: Kaiser Permanente Medicare	$783.68
Rate for Payer: MDX Hawaii PPO	$2,452.16
Rate for Payer: Ohana Health Plan Medicaid	$783.68
Rate for Payer: Ohana Health Plan Medicare	$783.68
Rate for Payer: UnitedHealthcare Medicare	$783.68
Rate for Payer: University Health Alliance Commercial	$1,415.68

MESH 10X15CM PROLENE GPSL

Facility

$2,528.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,415.68
Max. Negotiated Rate	$2,452.16
Rate for Payer: Cash Price	$1,516.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,769.60
Rate for Payer: Health Management Network Commercial	$2,148.80
Rate for Payer: Kaiser Permanente Commercial	$2,275.20
Rate for Payer: MDX Hawaii PPO	$2,452.16
Rate for Payer: University Health Alliance Commercial	$1,415.68

MESH 15X10CM

Facility

$1,509.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$467.79
Max. Negotiated Rate	$1,463.73
Rate for Payer: AlohaCare Medicaid	$754.50
Rate for Payer: AlohaCare Medicare	$467.79
Rate for Payer: Cash Price	$905.40
Rate for Payer: Devoted Health Medicare	$513.06
Rate for Payer: Hawaii Medical Service Association Medicare	$467.79
Rate for Payer: Hawaii Western Management Group Commercial	$1,056.30
Rate for Payer: Health Management Network Commercial	$1,282.65
Rate for Payer: Humana Medicare	$467.79
Rate for Payer: Kaiser Permanente Commercial	$1,358.10
Rate for Payer: Kaiser Permanente Medicaid	$769.59
Rate for Payer: Kaiser Permanente Medicare	$467.79
Rate for Payer: MDX Hawaii PPO	$1,463.73
Rate for Payer: Ohana Health Plan Medicaid	$467.79
Rate for Payer: Ohana Health Plan Medicare	$467.79
Rate for Payer: UnitedHealthcare Medicare	$467.79
Rate for Payer: University Health Alliance Commercial	$845.04

MESH 15X10CM

Facility

$1,509.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$845.04
Max. Negotiated Rate	$1,463.73
Rate for Payer: Cash Price	$905.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,056.30
Rate for Payer: Health Management Network Commercial	$1,282.65
Rate for Payer: Kaiser Permanente Commercial	$1,358.10
Rate for Payer: MDX Hawaii PPO	$1,463.73
Rate for Payer: University Health Alliance Commercial	$845.04

MESH 25X20CM

Facility

$2,102.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,177.12
Max. Negotiated Rate	$2,038.94
Rate for Payer: Cash Price	$1,261.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,471.40
Rate for Payer: Health Management Network Commercial	$1,786.70
Rate for Payer: Kaiser Permanente Commercial	$1,891.80
Rate for Payer: MDX Hawaii PPO	$2,038.94
Rate for Payer: University Health Alliance Commercial	$1,177.12

MESH 25X20CM

Facility

$2,102.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$651.62
Max. Negotiated Rate	$2,038.94
Rate for Payer: AlohaCare Medicaid	$1,051.00
Rate for Payer: AlohaCare Medicare	$651.62
Rate for Payer: Cash Price	$1,261.20
Rate for Payer: Devoted Health Medicare	$714.68
Rate for Payer: Hawaii Medical Service Association Medicare	$651.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,471.40
Rate for Payer: Health Management Network Commercial	$1,786.70
Rate for Payer: Humana Medicare	$651.62
Rate for Payer: Kaiser Permanente Commercial	$1,891.80
Rate for Payer: Kaiser Permanente Medicaid	$1,072.02
Rate for Payer: Kaiser Permanente Medicare	$651.62
Rate for Payer: MDX Hawaii PPO	$2,038.94
Rate for Payer: Ohana Health Plan Medicaid	$651.62
Rate for Payer: Ohana Health Plan Medicare	$651.62
Rate for Payer: UnitedHealthcare Medicare	$651.62
Rate for Payer: University Health Alliance Commercial	$1,177.12

MESH 3.2X3.2 CIRCLE 5950009

Facility

$2,520.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$781.20
Max. Negotiated Rate	$2,444.40
Rate for Payer: AlohaCare Medicaid	$1,260.00
Rate for Payer: AlohaCare Medicare	$781.20
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Devoted Health Medicare	$856.80
Rate for Payer: Hawaii Medical Service Association Medicare	$781.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,764.00
Rate for Payer: Health Management Network Commercial	$2,142.00
Rate for Payer: Humana Medicare	$781.20
Rate for Payer: Kaiser Permanente Commercial	$2,268.00
Rate for Payer: Kaiser Permanente Medicaid	$1,285.20
Rate for Payer: Kaiser Permanente Medicare	$781.20
Rate for Payer: MDX Hawaii PPO	$2,444.40
Rate for Payer: Ohana Health Plan Medicaid	$781.20
Rate for Payer: Ohana Health Plan Medicare	$781.20
Rate for Payer: UnitedHealthcare Medicare	$781.20
Rate for Payer: University Health Alliance Commercial	$1,411.20

MESH 3.2X3.2 CIRCLE 5950009

Facility

$2,520.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,411.20
Max. Negotiated Rate	$2,444.40
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,764.00
Rate for Payer: Health Management Network Commercial	$2,142.00
Rate for Payer: Kaiser Permanente Commercial	$2,268.00
Rate for Payer: MDX Hawaii PPO	$2,444.40
Rate for Payer: University Health Alliance Commercial	$1,411.20

MESH 3D EXTRA LARGE #0117322

Facility

$1,389.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$430.59
Max. Negotiated Rate	$1,347.33
Rate for Payer: AlohaCare Medicaid	$694.50
Rate for Payer: AlohaCare Medicare	$430.59
Rate for Payer: Cash Price	$833.40
Rate for Payer: Devoted Health Medicare	$472.26
Rate for Payer: Hawaii Medical Service Association Medicare	$430.59
Rate for Payer: Hawaii Western Management Group Commercial	$972.30
Rate for Payer: Health Management Network Commercial	$1,180.65
Rate for Payer: Humana Medicare	$430.59
Rate for Payer: Kaiser Permanente Commercial	$1,250.10
Rate for Payer: Kaiser Permanente Medicaid	$708.39
Rate for Payer: Kaiser Permanente Medicare	$430.59
Rate for Payer: MDX Hawaii PPO	$1,347.33
Rate for Payer: Ohana Health Plan Medicaid	$430.59
Rate for Payer: Ohana Health Plan Medicare	$430.59
Rate for Payer: UnitedHealthcare Medicare	$430.59
Rate for Payer: University Health Alliance Commercial	$777.84

Know your out-of-pocket cost for care.

All Charges