Kau Hospital

All Charges

Charge

Type

Setting

Price

MESH SYNTHETIC HERNIA TEM1509G

Facility

$923.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$516.88
Max. Negotiated Rate	$895.31
Rate for Payer: Cash Price	$553.80
Rate for Payer: Hawaii Western Management Group Commercial	$646.10
Rate for Payer: Health Management Network Commercial	$784.55
Rate for Payer: Kaiser Permanente Commercial	$830.70
Rate for Payer: MDX Hawaii PPO	$895.31
Rate for Payer: University Health Alliance Commercial	$516.88

MESH SYNTHETIC HERNIA TEM1509G

Facility

$923.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$286.13
Max. Negotiated Rate	$895.31
Rate for Payer: AlohaCare Medicaid	$461.50
Rate for Payer: AlohaCare Medicare	$286.13
Rate for Payer: Cash Price	$553.80
Rate for Payer: Devoted Health Medicare	$313.82
Rate for Payer: Hawaii Medical Service Association Medicare	$286.13
Rate for Payer: Hawaii Western Management Group Commercial	$646.10
Rate for Payer: Health Management Network Commercial	$784.55
Rate for Payer: Humana Medicare	$286.13
Rate for Payer: Kaiser Permanente Commercial	$830.70
Rate for Payer: Kaiser Permanente Medicaid	$470.73
Rate for Payer: Kaiser Permanente Medicare	$286.13
Rate for Payer: MDX Hawaii PPO	$895.31
Rate for Payer: Ohana Health Plan Medicaid	$286.13
Rate for Payer: Ohana Health Plan Medicare	$286.13
Rate for Payer: UnitedHealthcare Medicare	$286.13
Rate for Payer: University Health Alliance Commercial	$516.88

MESH SYNTHETIC NON AB LG

Facility

$2,016.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$624.96
Max. Negotiated Rate	$1,955.52
Rate for Payer: AlohaCare Medicaid	$1,008.00
Rate for Payer: AlohaCare Medicare	$624.96
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Devoted Health Medicare	$685.44
Rate for Payer: Hawaii Medical Service Association Medicare	$624.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: Humana Medicare	$624.96
Rate for Payer: Kaiser Permanente Commercial	$1,814.40
Rate for Payer: Kaiser Permanente Medicaid	$1,028.16
Rate for Payer: Kaiser Permanente Medicare	$624.96
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: Ohana Health Plan Medicaid	$624.96
Rate for Payer: Ohana Health Plan Medicare	$624.96
Rate for Payer: UnitedHealthcare Medicare	$624.96
Rate for Payer: University Health Alliance Commercial	$1,128.96

MESH SYNTHETIC NON AB LG

Facility

$2,016.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,128.96
Max. Negotiated Rate	$1,955.52
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: Kaiser Permanente Commercial	$1,814.40
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: University Health Alliance Commercial	$1,128.96

MESH VENTRALEX SMALL 5950007

Facility

$2,280.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,276.80
Max. Negotiated Rate	$2,211.60
Rate for Payer: Cash Price	$1,368.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,596.00
Rate for Payer: Health Management Network Commercial	$1,938.00
Rate for Payer: Kaiser Permanente Commercial	$2,052.00
Rate for Payer: MDX Hawaii PPO	$2,211.60
Rate for Payer: University Health Alliance Commercial	$1,276.80

MESH VENTRALEX SMALL 5950007

Facility

$2,280.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$706.80
Max. Negotiated Rate	$2,211.60
Rate for Payer: AlohaCare Medicaid	$1,140.00
Rate for Payer: AlohaCare Medicare	$706.80
Rate for Payer: Cash Price	$1,368.00
Rate for Payer: Devoted Health Medicare	$775.20
Rate for Payer: Hawaii Medical Service Association Medicare	$706.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,596.00
Rate for Payer: Health Management Network Commercial	$1,938.00
Rate for Payer: Humana Medicare	$706.80
Rate for Payer: Kaiser Permanente Commercial	$2,052.00
Rate for Payer: Kaiser Permanente Medicaid	$1,162.80
Rate for Payer: Kaiser Permanente Medicare	$706.80
Rate for Payer: MDX Hawaii PPO	$2,211.60
Rate for Payer: Ohana Health Plan Medicaid	$706.80
Rate for Payer: Ohana Health Plan Medicare	$706.80
Rate for Payer: UnitedHealthcare Medicare	$706.80
Rate for Payer: University Health Alliance Commercial	$1,276.80

MESNA 100 MG/ML INTRAVENOUS SOLUTION [10537]

Facility

$105.00

Service Code	HCPCS J9209
Hospital Revenue Code	250
Min. Negotiated Rate	$89.25
Max. Negotiated Rate	$101.85
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$37.80
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: MDX Hawaii PPO	$61.11
Rate for Payer: MDX Hawaii PPO	$101.85

MESNA 100 MG/ML INTRAVENOUS SOLUTION [10537]

Facility

$105.00

Service Code	HCPCS J9209
Hospital Revenue Code	636
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$101.85
Rate for Payer: AlohaCare Medicaid	$52.50
Rate for Payer: AlohaCare Medicaid	$31.50
Rate for Payer: AlohaCare Medicare	$19.53
Rate for Payer: AlohaCare Medicare	$32.55
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$37.80
Rate for Payer: Devoted Health Medicare	$35.70
Rate for Payer: Devoted Health Medicare	$21.42
Rate for Payer: Hawaii Medical Service Association ABD	$1.33
Rate for Payer: Hawaii Medical Service Association ABD	$1.33
Rate for Payer: Hawaii Medical Service Association Medicare	$19.53
Rate for Payer: Hawaii Medical Service Association Medicare	$32.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.33
Rate for Payer: Hawaii Western Management Group Commercial	$59.85
Rate for Payer: Hawaii Western Management Group Commercial	$99.75
Rate for Payer: Health Management Network Commercial	$89.25
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Humana Medicare	$19.53
Rate for Payer: Humana Medicare	$32.55
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: Kaiser Permanente Commercial	$94.50
Rate for Payer: Kaiser Permanente Medicaid	$32.13
Rate for Payer: Kaiser Permanente Medicaid	$53.55
Rate for Payer: Kaiser Permanente Medicare	$19.53
Rate for Payer: Kaiser Permanente Medicare	$32.55
Rate for Payer: MDX Hawaii PPO	$101.85
Rate for Payer: MDX Hawaii PPO	$61.11
Rate for Payer: Ohana Health Plan Medicaid	$32.55
Rate for Payer: Ohana Health Plan Medicaid	$19.53
Rate for Payer: Ohana Health Plan Medicare	$32.55
Rate for Payer: Ohana Health Plan Medicare	$19.53
Rate for Payer: UnitedHealthcare Medicaid	$63.00
Rate for Payer: UnitedHealthcare Medicaid	$37.80
Rate for Payer: UnitedHealthcare Medicare	$19.53
Rate for Payer: UnitedHealthcare Medicare	$32.55
Rate for Payer: University Health Alliance Commercial	$76.53
Rate for Payer: University Health Alliance Commercial	$45.92

METACARPOPHALANGEAL 5800-MD00

Facility

$7,650.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,371.50
Max. Negotiated Rate	$7,420.50
Rate for Payer: AlohaCare Medicaid	$3,825.00
Rate for Payer: AlohaCare Medicare	$2,371.50
Rate for Payer: Cash Price	$4,590.00
Rate for Payer: Devoted Health Medicare	$2,601.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,371.50
Rate for Payer: Hawaii Western Management Group Commercial	$5,355.00
Rate for Payer: Health Management Network Commercial	$6,502.50
Rate for Payer: Humana Medicare	$2,371.50
Rate for Payer: Kaiser Permanente Commercial	$6,885.00
Rate for Payer: Kaiser Permanente Medicaid	$3,901.50
Rate for Payer: Kaiser Permanente Medicare	$2,371.50
Rate for Payer: MDX Hawaii PPO	$7,420.50
Rate for Payer: Ohana Health Plan Medicaid	$2,371.50
Rate for Payer: Ohana Health Plan Medicare	$2,371.50
Rate for Payer: UnitedHealthcare Medicare	$2,371.50
Rate for Payer: University Health Alliance Commercial	$4,284.00

METACARPOPHALANGEAL 5800-MD00

Facility

$7,650.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,284.00
Max. Negotiated Rate	$7,420.50
Rate for Payer: Cash Price	$4,590.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,355.00
Rate for Payer: Health Management Network Commercial	$6,502.50
Rate for Payer: Kaiser Permanente Commercial	$6,885.00
Rate for Payer: MDX Hawaii PPO	$7,420.50
Rate for Payer: University Health Alliance Commercial	$4,284.00

METER COIL ERICH ARCH 6001303

Facility

$228.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$127.68
Max. Negotiated Rate	$221.16
Rate for Payer: Cash Price	$136.80
Rate for Payer: Hawaii Western Management Group Commercial	$159.60
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: Kaiser Permanente Commercial	$205.20
Rate for Payer: MDX Hawaii PPO	$221.16
Rate for Payer: University Health Alliance Commercial	$127.68

METER COIL ERICH ARCH 6001303

Facility

$228.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$70.68
Max. Negotiated Rate	$221.16
Rate for Payer: AlohaCare Medicaid	$114.00
Rate for Payer: AlohaCare Medicare	$70.68
Rate for Payer: Cash Price	$136.80
Rate for Payer: Devoted Health Medicare	$77.52
Rate for Payer: Hawaii Medical Service Association Medicare	$70.68
Rate for Payer: Hawaii Western Management Group Commercial	$159.60
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: Humana Medicare	$70.68
Rate for Payer: Kaiser Permanente Commercial	$205.20
Rate for Payer: Kaiser Permanente Medicaid	$116.28
Rate for Payer: Kaiser Permanente Medicare	$70.68
Rate for Payer: MDX Hawaii PPO	$221.16
Rate for Payer: Ohana Health Plan Medicaid	$70.68
Rate for Payer: Ohana Health Plan Medicare	$70.68
Rate for Payer: UnitedHealthcare Medicare	$70.68
Rate for Payer: University Health Alliance Commercial	$127.68

METFORMIN 1,000 MG TABLET [24398]

Facility

$6.00

Service Code	NDC 70010006501
Hospital Revenue Code	637
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$1.86
Rate for Payer: Cash Price	$3.60
Rate for Payer: Devoted Health Medicare	$2.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1.86
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$1.86
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$1.86
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$1.86
Rate for Payer: Ohana Health Plan Medicare	$1.86
Rate for Payer: UnitedHealthcare Medicare	$1.86
Rate for Payer: University Health Alliance Commercial	$4.37

METFORMIN 1,000 MG TABLET [24398]

Facility

$6.00

Service Code	NDC 70010006501
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

METFORMIN 500 MG TABLET [10544]

Facility

$1.00

Service Code	NDC 00904716261
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

METFORMIN 500 MG TABLET [10544]

Facility

$1.00

Service Code	NDC 00904716261
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

METFORMIN 850 MG TABLET [14719]

Facility

$5.00

Service Code	NDC 70010006401
Hospital Revenue Code	637
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$1.55
Rate for Payer: Cash Price	$3.00
Rate for Payer: Devoted Health Medicare	$1.70
Rate for Payer: Hawaii Medical Service Association Medicare	$1.55
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$1.55
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$1.55
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$1.55
Rate for Payer: Ohana Health Plan Medicare	$1.55
Rate for Payer: UnitedHealthcare Medicare	$1.55
Rate for Payer: University Health Alliance Commercial	$3.64

METFORMIN 850 MG TABLET [14719]

Facility

$5.00

Service Code	NDC 60687014311
Hospital Revenue Code	637
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$1.55
Rate for Payer: Cash Price	$3.00
Rate for Payer: Devoted Health Medicare	$1.70
Rate for Payer: Hawaii Medical Service Association Medicare	$1.55
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$1.55
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$1.55
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$1.55
Rate for Payer: Ohana Health Plan Medicare	$1.55
Rate for Payer: UnitedHealthcare Medicare	$1.55
Rate for Payer: University Health Alliance Commercial	$3.64

METFORMIN 850 MG TABLET [14719]

Facility

$5.00

Service Code	NDC 70010006401
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

METFORMIN 850 MG TABLET [14719]

Facility

$5.00

Service Code	NDC 60687014301
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

METFORMIN 850 MG TABLET [14719]

Facility

$5.00

Service Code	NDC 60687014301
Hospital Revenue Code	637
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$1.55
Rate for Payer: Cash Price	$3.00
Rate for Payer: Devoted Health Medicare	$1.70
Rate for Payer: Hawaii Medical Service Association Medicare	$1.55
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$1.55
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$1.55
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$1.55
Rate for Payer: Ohana Health Plan Medicare	$1.55
Rate for Payer: UnitedHealthcare Medicare	$1.55
Rate for Payer: University Health Alliance Commercial	$3.64

METFORMIN 850 MG TABLET [14719]

Facility

$5.00

Service Code	NDC 60687014311
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

METHACHOLINE 0 MG TO 48 MG/3 ML (0 MG TO 16 MG/ML) NEBULIZATION SOLN [174646]

Facility

$68.00

Service Code	HCPCS J7674
Hospital Revenue Code	636
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$34.00
Rate for Payer: AlohaCare Medicare	$21.08
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Devoted Health Medicare	$23.12
Rate for Payer: Hawaii Medical Service Association ABD	$1.73
Rate for Payer: Hawaii Medical Service Association Medicare	$21.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.73
Rate for Payer: Hawaii Western Management Group Commercial	$64.60
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$21.08
Rate for Payer: Kaiser Permanente Commercial	$61.20
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$21.08
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$21.08
Rate for Payer: Ohana Health Plan Medicare	$21.08
Rate for Payer: UnitedHealthcare Medicaid	$40.80
Rate for Payer: UnitedHealthcare Medicare	$21.08
Rate for Payer: University Health Alliance Commercial	$49.57

METHACHOLINE 0 MG TO 48 MG/3 ML (0 MG TO 16 MG/ML) NEBULIZATION SOLN [174646]

Facility

$68.00

Service Code	HCPCS J7674
Hospital Revenue Code	250
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$40.80
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Kaiser Permanente Commercial	$61.20
Rate for Payer: MDX Hawaii PPO	$65.96

METHACHOLINE CHLORIDE 0.1875 MG/3 ML (0.0625 MG/ML) NEBULIZATION SOLN [209711]

Facility

$16.00

Service Code	NDC 64281011200
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

Know your out-of-pocket cost for care.

All Charges