Kau Hospital

All Charges

Charge

Type

Setting

Price

MINIRAIL SHORT SSM160

Facility

$2,835.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,409.75
Max. Negotiated Rate	$2,749.95
Rate for Payer: Cash Price	$1,701.00
Rate for Payer: Health Management Network Commercial	$2,409.75
Rate for Payer: Kaiser Permanente Commercial	$2,551.50
Rate for Payer: MDX Hawaii PPO	$2,749.95

MINIRAIL SHORT SSM160

Facility

$2,835.00

Hospital Revenue Code	272
Min. Negotiated Rate	$878.85
Max. Negotiated Rate	$2,749.95
Rate for Payer: AlohaCare Medicaid	$1,417.50
Rate for Payer: AlohaCare Medicare	$878.85
Rate for Payer: Cash Price	$1,701.00
Rate for Payer: Devoted Health Medicare	$963.90
Rate for Payer: Hawaii Medical Service Association Medicare	$878.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,693.25
Rate for Payer: Health Management Network Commercial	$2,409.75
Rate for Payer: Humana Medicare	$878.85
Rate for Payer: Kaiser Permanente Commercial	$2,551.50
Rate for Payer: Kaiser Permanente Medicaid	$1,445.85
Rate for Payer: Kaiser Permanente Medicare	$878.85
Rate for Payer: MDX Hawaii PPO	$2,749.95
Rate for Payer: Ohana Health Plan Medicaid	$878.85
Rate for Payer: Ohana Health Plan Medicare	$878.85
Rate for Payer: UnitedHealthcare Medicare	$878.85
Rate for Payer: University Health Alliance Commercial	$2,066.43

MINIRAIL STD 57/5MM M101

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$770.04
Max. Negotiated Rate	$2,409.48
Rate for Payer: AlohaCare Medicaid	$1,242.00
Rate for Payer: AlohaCare Medicare	$770.04
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Devoted Health Medicare	$844.56
Rate for Payer: Hawaii Medical Service Association Medicare	$770.04
Rate for Payer: Hawaii Western Management Group Commercial	$2,359.80
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Humana Medicare	$770.04
Rate for Payer: Kaiser Permanente Commercial	$2,235.60
Rate for Payer: Kaiser Permanente Medicaid	$1,266.84
Rate for Payer: Kaiser Permanente Medicare	$770.04
Rate for Payer: MDX Hawaii PPO	$2,409.48
Rate for Payer: Ohana Health Plan Medicaid	$770.04
Rate for Payer: Ohana Health Plan Medicare	$770.04
Rate for Payer: UnitedHealthcare Medicare	$770.04
Rate for Payer: University Health Alliance Commercial	$1,810.59

MINIRAIL STD 57/5MM M101

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,111.40
Max. Negotiated Rate	$2,409.48
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Kaiser Permanente Commercial	$2,235.60
Rate for Payer: MDX Hawaii PPO	$2,409.48

MINIRAIL VERT ARTIC M122

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,111.40
Max. Negotiated Rate	$2,409.48
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Kaiser Permanente Commercial	$2,235.60
Rate for Payer: MDX Hawaii PPO	$2,409.48

MINIRAIL VERT ARTIC M122

Facility

$2,484.00

Hospital Revenue Code	272
Min. Negotiated Rate	$770.04
Max. Negotiated Rate	$2,409.48
Rate for Payer: AlohaCare Medicaid	$1,242.00
Rate for Payer: AlohaCare Medicare	$770.04
Rate for Payer: Cash Price	$1,490.40
Rate for Payer: Devoted Health Medicare	$844.56
Rate for Payer: Hawaii Medical Service Association Medicare	$770.04
Rate for Payer: Hawaii Western Management Group Commercial	$2,359.80
Rate for Payer: Health Management Network Commercial	$2,111.40
Rate for Payer: Humana Medicare	$770.04
Rate for Payer: Kaiser Permanente Commercial	$2,235.60
Rate for Payer: Kaiser Permanente Medicaid	$1,266.84
Rate for Payer: Kaiser Permanente Medicare	$770.04
Rate for Payer: MDX Hawaii PPO	$2,409.48
Rate for Payer: Ohana Health Plan Medicaid	$770.04
Rate for Payer: Ohana Health Plan Medicare	$770.04
Rate for Payer: UnitedHealthcare Medicare	$770.04
Rate for Payer: University Health Alliance Commercial	$1,810.59

MINIRAIL W/ HINGE #SSM512

Facility

$3,626.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,124.06
Max. Negotiated Rate	$3,517.22
Rate for Payer: AlohaCare Medicaid	$1,813.00
Rate for Payer: AlohaCare Medicare	$1,124.06
Rate for Payer: Cash Price	$2,175.60
Rate for Payer: Devoted Health Medicare	$1,232.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,124.06
Rate for Payer: Hawaii Western Management Group Commercial	$3,444.70
Rate for Payer: Health Management Network Commercial	$3,082.10
Rate for Payer: Humana Medicare	$1,124.06
Rate for Payer: Kaiser Permanente Commercial	$3,263.40
Rate for Payer: Kaiser Permanente Medicaid	$1,849.26
Rate for Payer: Kaiser Permanente Medicare	$1,124.06
Rate for Payer: MDX Hawaii PPO	$3,517.22
Rate for Payer: Ohana Health Plan Medicaid	$1,124.06
Rate for Payer: Ohana Health Plan Medicare	$1,124.06
Rate for Payer: UnitedHealthcare Medicare	$1,124.06
Rate for Payer: University Health Alliance Commercial	$2,642.99

MINIRAIL W/ HINGE #SSM512

Facility

$3,626.00

Hospital Revenue Code	272
Min. Negotiated Rate	$3,082.10
Max. Negotiated Rate	$3,517.22
Rate for Payer: Cash Price	$2,175.60
Rate for Payer: Health Management Network Commercial	$3,082.10
Rate for Payer: Kaiser Permanente Commercial	$3,263.40
Rate for Payer: MDX Hawaii PPO	$3,517.22

MINOR BLADDER PROCEDURES WITH CC

Facility

$24,365.66

Service Code	MSDRG 663
Min. Negotiated Rate	$24,365.66
Max. Negotiated Rate	$24,365.66
Rate for Payer: Hawaii Medical Service Association Commercial	$24,365.66

MINOR BLADDER PROCEDURES WITH MCC

Facility

$32,827.27

Service Code	MSDRG 662
Min. Negotiated Rate	$32,827.27
Max. Negotiated Rate	$32,827.27
Rate for Payer: Hawaii Medical Service Association Commercial	$32,827.27

MINOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$19,151.22

Service Code	MSDRG 664
Min. Negotiated Rate	$19,151.22
Max. Negotiated Rate	$19,151.22
Rate for Payer: Hawaii Medical Service Association Commercial	$19,151.22

MINOR SKIN DISORDERS WITH MCC

Facility

$13,913.07

Service Code	MSDRG 606
Min. Negotiated Rate	$13,913.07
Max. Negotiated Rate	$13,913.07
Rate for Payer: Hawaii Medical Service Association Commercial	$13,913.07

MINOR SKIN DISORDERS WITHOUT MCC

Facility

$12,538.36

Service Code	MSDRG 607
Min. Negotiated Rate	$12,538.36
Max. Negotiated Rate	$12,538.36
Rate for Payer: Hawaii Medical Service Association Commercial	$12,538.36

MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC

Facility

$32,448.04

Service Code	MSDRG 345
Min. Negotiated Rate	$32,448.04
Max. Negotiated Rate	$32,448.04
Rate for Payer: Hawaii Medical Service Association Commercial	$32,448.04

MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC

Facility

$36,287.76

Service Code	MSDRG 344
Min. Negotiated Rate	$36,287.76
Max. Negotiated Rate	$36,287.76
Rate for Payer: Hawaii Medical Service Association Commercial	$36,287.76

MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility

$26,688.45

Service Code	MSDRG 346
Min. Negotiated Rate	$26,688.45
Max. Negotiated Rate	$26,688.45
Rate for Payer: Hawaii Medical Service Association Commercial	$26,688.45

MINOXIDIL 10 MG TABLET [5114]

Facility

$6.00

Service Code	NDC 49884025701
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

MINOXIDIL 10 MG TABLET [5114]

Facility

$6.00

Service Code	NDC 49884025701
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

MINOXIDIL 2.5 MG TABLET [5115]

Facility

$3.00

Service Code	NDC 49884025601
Hospital Revenue Code	637
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$0.93
Rate for Payer: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$1.02
Rate for Payer: Hawaii Medical Service Association Medicare	$0.93
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$0.93
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$0.93
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$0.93
Rate for Payer: Ohana Health Plan Medicare	$0.93
Rate for Payer: UnitedHealthcare Medicare	$0.93
Rate for Payer: University Health Alliance Commercial	$2.19

MINOXIDIL 2.5 MG TABLET [5115]

Facility

$3.00

Service Code	NDC 49884025601
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

MIRTAZAPINE 15 MG TABLET [17466]

Facility

$4.00

Service Code	NDC 68084011911
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

MIRTAZAPINE 15 MG TABLET [17466]

Facility

$4.00

Service Code	NDC 68084011901
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

MIRTAZAPINE 15 MG TABLET [17466]

Facility

$4.00

Service Code	NDC 68084011911
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

MIRTAZAPINE 15 MG TABLET [17466]

Facility

$4.00

Service Code	NDC 68084011901
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

MIRTAZAPINE 30 MG TABLET [17465]

Facility

$5.00

Service Code	NDC 68084012011
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

Know your out-of-pocket cost for care.

All Charges