Kau Hospital

All Charges

Charge

Type

Setting

Price

METRONIDAZOLE 250 MG TABLET [5015]

Facility

$2.00

Service Code	NDC 68001036400
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

METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK [183828]

Facility

$9.00

Service Code	HCPCS J1836
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$8.73
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$2.79
Rate for Payer: Cash Price	$5.40
Rate for Payer: Cash Price	$5.40
Rate for Payer: Devoted Health Medicare	$3.06
Rate for Payer: Hawaii Medical Service Association ABD	$0.03
Rate for Payer: Hawaii Medical Service Association Medicare	$2.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.03
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Humana Medicare	$2.79
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicare	$2.79
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$2.79
Rate for Payer: Ohana Health Plan Medicare	$2.79
Rate for Payer: UnitedHealthcare Medicaid	$5.40
Rate for Payer: UnitedHealthcare Medicare	$2.79
Rate for Payer: University Health Alliance Commercial	$6.56

METRONIDAZOLE 500 MG/100 ML IN SODIUM CHLOR(ISO) INTRAVENOUS PIGGYBACK [183828]

Facility

$9.00

Service Code	HCPCS J1836
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73

METRONIDAZOLE 500 MG TABLET [5016]

Facility

$4.00

Service Code	NDC 60687055001
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

METRONIDAZOLE 500 MG TABLET [5016]

Facility

$4.00

Service Code	NDC 60687055001
Hospital Revenue Code	637
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$1.24
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$1.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$1.24
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$1.24
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$1.24
Rate for Payer: Ohana Health Plan Medicare	$1.24
Rate for Payer: UnitedHealthcare Medicare	$1.24
Rate for Payer: University Health Alliance Commercial	$2.92

METRONIDAZOLE 500 MG TABLET [5016]

Facility

$4.00

Service Code	NDC 60687055011
Hospital Revenue Code	637
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$1.24
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$1.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$1.24
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$1.24
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$1.24
Rate for Payer: Ohana Health Plan Medicare	$1.24
Rate for Payer: UnitedHealthcare Medicare	$1.24
Rate for Payer: University Health Alliance Commercial	$2.92

METRONIDAZOLE 500 MG TABLET [5016]

Facility

$4.00

Service Code	NDC 60687055011
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

METRONIDAZOLE TABLETS (FLAGYL) 500 MG (TAKE HOME) [4080376]

Facility

$15.00

Service Code	NDC 00004080164
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

METRONIDAZOLE TABLETS (FLAGYL) 500 MG (TAKE HOME) [4080376]

Facility

$15.00

Service Code	NDC 00004080164
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

MEXILETINE 150 MG CAPSULE [10595]

Facility

$9.00

Service Code	NDC 50742023901
Hospital Revenue Code	637
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$8.73
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$2.79
Rate for Payer: Cash Price	$5.40
Rate for Payer: Devoted Health Medicare	$3.06
Rate for Payer: Hawaii Medical Service Association Medicare	$2.79
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Humana Medicare	$2.79
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicare	$2.79
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$2.79
Rate for Payer: Ohana Health Plan Medicare	$2.79
Rate for Payer: UnitedHealthcare Medicare	$2.79
Rate for Payer: University Health Alliance Commercial	$6.56

MEXILETINE 150 MG CAPSULE [10595]

Facility

$9.00

Service Code	NDC 00093873901
Hospital Revenue Code	637
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$8.73
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$2.79
Rate for Payer: Cash Price	$5.40
Rate for Payer: Devoted Health Medicare	$3.06
Rate for Payer: Hawaii Medical Service Association Medicare	$2.79
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Humana Medicare	$2.79
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicare	$2.79
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$2.79
Rate for Payer: Ohana Health Plan Medicare	$2.79
Rate for Payer: UnitedHealthcare Medicare	$2.79
Rate for Payer: University Health Alliance Commercial	$6.56

MEXILETINE 150 MG CAPSULE [10595]

Facility

$9.00

Service Code	NDC 50742023901
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73

MEXILETINE 150 MG CAPSULE [10595]

Facility

$9.00

Service Code	NDC 00093873901
Hospital Revenue Code	250
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.40
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73

MIC G-12 LAP INTRODUCER KIT

Facility

$877.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$745.45
Max. Negotiated Rate	$850.69
Rate for Payer: Cash Price	$526.20
Rate for Payer: Health Management Network Commercial	$745.45
Rate for Payer: Kaiser Permanente Commercial	$789.30
Rate for Payer: MDX Hawaii PPO	$850.69

MIC G-12 LAP INTRODUCER KIT

Facility

$877.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$271.87
Max. Negotiated Rate	$850.69
Rate for Payer: AlohaCare Medicaid	$438.50
Rate for Payer: AlohaCare Medicare	$271.87
Rate for Payer: Cash Price	$526.20
Rate for Payer: Devoted Health Medicare	$298.18
Rate for Payer: Hawaii Medical Service Association Medicare	$271.87
Rate for Payer: Hawaii Western Management Group Commercial	$833.15
Rate for Payer: Health Management Network Commercial	$745.45
Rate for Payer: Humana Medicare	$271.87
Rate for Payer: Kaiser Permanente Commercial	$789.30
Rate for Payer: Kaiser Permanente Medicaid	$447.27
Rate for Payer: Kaiser Permanente Medicare	$271.87
Rate for Payer: MDX Hawaii PPO	$850.69
Rate for Payer: Ohana Health Plan Medicaid	$271.87
Rate for Payer: Ohana Health Plan Medicare	$271.87
Rate for Payer: UnitedHealthcare Medicare	$271.87
Rate for Payer: University Health Alliance Commercial	$639.25

MIC G-24 LAP INTRODUCER KIT

Facility

$930.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$790.50
Max. Negotiated Rate	$902.10
Rate for Payer: Cash Price	$558.00
Rate for Payer: Health Management Network Commercial	$790.50
Rate for Payer: Kaiser Permanente Commercial	$837.00
Rate for Payer: MDX Hawaii PPO	$902.10

MIC G-24 LAP INTRODUCER KIT

Facility

$930.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$288.30
Max. Negotiated Rate	$902.10
Rate for Payer: AlohaCare Medicaid	$465.00
Rate for Payer: AlohaCare Medicare	$288.30
Rate for Payer: Cash Price	$558.00
Rate for Payer: Devoted Health Medicare	$316.20
Rate for Payer: Hawaii Medical Service Association Medicare	$288.30
Rate for Payer: Hawaii Western Management Group Commercial	$883.50
Rate for Payer: Health Management Network Commercial	$790.50
Rate for Payer: Humana Medicare	$288.30
Rate for Payer: Kaiser Permanente Commercial	$837.00
Rate for Payer: Kaiser Permanente Medicaid	$474.30
Rate for Payer: Kaiser Permanente Medicare	$288.30
Rate for Payer: MDX Hawaii PPO	$902.10
Rate for Payer: Ohana Health Plan Medicaid	$288.30
Rate for Payer: Ohana Health Plan Medicare	$288.30
Rate for Payer: UnitedHealthcare Medicare	$288.30
Rate for Payer: University Health Alliance Commercial	$677.88

MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]

Facility

$10.00

Service Code	NDC 68001048145
Hospital Revenue Code	637
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$9.70
Rate for Payer: AlohaCare Medicaid	$5.00
Rate for Payer: AlohaCare Medicare	$3.10
Rate for Payer: Cash Price	$6.00
Rate for Payer: Devoted Health Medicare	$3.40
Rate for Payer: Hawaii Medical Service Association Medicare	$3.10
Rate for Payer: Hawaii Western Management Group Commercial	$9.50
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Humana Medicare	$3.10
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: Kaiser Permanente Medicaid	$5.10
Rate for Payer: Kaiser Permanente Medicare	$3.10
Rate for Payer: MDX Hawaii PPO	$9.70
Rate for Payer: Ohana Health Plan Medicaid	$3.10
Rate for Payer: Ohana Health Plan Medicare	$3.10
Rate for Payer: UnitedHealthcare Medicare	$3.10
Rate for Payer: University Health Alliance Commercial	$7.29

MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]

Facility

$26.00

Service Code	NDC 51672200102
Hospital Revenue Code	250
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$15.60
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Kaiser Permanente Commercial	$23.40
Rate for Payer: MDX Hawaii PPO	$25.22

MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]

Facility

$10.00

Service Code	NDC 68001048145
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.00
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: MDX Hawaii PPO	$9.70

MICONAZOLE NITRATE 2 % TOPICAL CREAM [5039]

Facility

$26.00

Service Code	NDC 51672200102
Hospital Revenue Code	637
Min. Negotiated Rate	$8.06
Max. Negotiated Rate	$25.22
Rate for Payer: AlohaCare Medicaid	$13.00
Rate for Payer: AlohaCare Medicare	$8.06
Rate for Payer: Cash Price	$15.60
Rate for Payer: Devoted Health Medicare	$8.84
Rate for Payer: Hawaii Medical Service Association Medicare	$8.06
Rate for Payer: Hawaii Western Management Group Commercial	$24.70
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Humana Medicare	$8.06
Rate for Payer: Kaiser Permanente Commercial	$23.40
Rate for Payer: Kaiser Permanente Medicaid	$13.26
Rate for Payer: Kaiser Permanente Medicare	$8.06
Rate for Payer: MDX Hawaii PPO	$25.22
Rate for Payer: Ohana Health Plan Medicaid	$8.06
Rate for Payer: Ohana Health Plan Medicare	$8.06
Rate for Payer: UnitedHealthcare Medicare	$8.06
Rate for Payer: University Health Alliance Commercial	$18.95

MICONAZOLE NITRATE 2 % TOPICAL OINTMENT [13651]

Facility

$15.00

Service Code	NDC 13551000000
Hospital Revenue Code	250
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

MICONAZOLE NITRATE 2 % TOPICAL OINTMENT [13651]

Facility

$15.00

Service Code	NDC 13551000000
Hospital Revenue Code	637
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

MICRA AV2 US

Facility

$2,844.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$881.64
Max. Negotiated Rate	$2,758.68
Rate for Payer: AlohaCare Medicaid	$1,422.00
Rate for Payer: AlohaCare Medicare	$881.64
Rate for Payer: Cash Price	$1,706.40
Rate for Payer: Devoted Health Medicare	$966.96
Rate for Payer: Hawaii Medical Service Association Medicare	$881.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,990.80
Rate for Payer: Health Management Network Commercial	$2,417.40
Rate for Payer: Humana Medicare	$881.64
Rate for Payer: Kaiser Permanente Commercial	$2,559.60
Rate for Payer: Kaiser Permanente Medicaid	$1,450.44
Rate for Payer: Kaiser Permanente Medicare	$881.64
Rate for Payer: MDX Hawaii PPO	$2,758.68
Rate for Payer: Ohana Health Plan Medicaid	$881.64
Rate for Payer: Ohana Health Plan Medicare	$881.64
Rate for Payer: UnitedHealthcare Medicare	$881.64
Rate for Payer: University Health Alliance Commercial	$1,592.64

MICRA AV2 US

Facility

$2,844.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$1,592.64
Max. Negotiated Rate	$2,758.68
Rate for Payer: Cash Price	$1,706.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,990.80
Rate for Payer: Health Management Network Commercial	$2,417.40
Rate for Payer: Kaiser Permanente Commercial	$2,559.60
Rate for Payer: MDX Hawaii PPO	$2,758.68
Rate for Payer: University Health Alliance Commercial	$1,592.64

Know your out-of-pocket cost for care.

All Charges