Kau Hospital

All Charges

Charge

Type

Setting

Price

MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [119248]

Facility

$28.00

Service Code	NDC 00406839023
Hospital Revenue Code	250
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$16.80
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: MDX Hawaii PPO	$27.16

MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [119248]

Facility

$4.00

Service Code	NDC 42858080401
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

MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [119248]

Facility

$28.00

Service Code	NDC 00406839023
Hospital Revenue Code	637
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$27.16
Rate for Payer: AlohaCare Medicaid	$14.00
Rate for Payer: AlohaCare Medicare	$8.68
Rate for Payer: Cash Price	$16.80
Rate for Payer: Devoted Health Medicare	$9.52
Rate for Payer: Hawaii Medical Service Association Medicare	$8.68
Rate for Payer: Hawaii Western Management Group Commercial	$26.60
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Humana Medicare	$8.68
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Medicaid	$14.28
Rate for Payer: Kaiser Permanente Medicare	$8.68
Rate for Payer: MDX Hawaii PPO	$27.16
Rate for Payer: Ohana Health Plan Medicaid	$8.68
Rate for Payer: Ohana Health Plan Medicare	$8.68
Rate for Payer: UnitedHealthcare Medicare	$8.68
Rate for Payer: University Health Alliance Commercial	$20.41

MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [119248]

Facility

$28.00

Service Code	NDC 00406839001
Hospital Revenue Code	250
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$16.80
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: MDX Hawaii PPO	$27.16

MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [119248]

Facility

$28.00

Service Code	NDC 00406839001
Hospital Revenue Code	637
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$27.16
Rate for Payer: AlohaCare Medicaid	$14.00
Rate for Payer: AlohaCare Medicare	$8.68
Rate for Payer: Cash Price	$16.80
Rate for Payer: Devoted Health Medicare	$9.52
Rate for Payer: Hawaii Medical Service Association Medicare	$8.68
Rate for Payer: Hawaii Western Management Group Commercial	$26.60
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Humana Medicare	$8.68
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Medicaid	$14.28
Rate for Payer: Kaiser Permanente Medicare	$8.68
Rate for Payer: MDX Hawaii PPO	$27.16
Rate for Payer: Ohana Health Plan Medicaid	$8.68
Rate for Payer: Ohana Health Plan Medicare	$8.68
Rate for Payer: UnitedHealthcare Medicare	$8.68
Rate for Payer: University Health Alliance Commercial	$20.41

MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [119246]

Facility

$7.00

Service Code	NDC 68084015711
Hospital Revenue Code	637
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$6.79
Rate for Payer: AlohaCare Medicaid	$3.50
Rate for Payer: AlohaCare Medicare	$2.17
Rate for Payer: Cash Price	$4.20
Rate for Payer: Devoted Health Medicare	$2.38
Rate for Payer: Hawaii Medical Service Association Medicare	$2.17
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Humana Medicare	$2.17
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: Kaiser Permanente Medicare	$2.17
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: Ohana Health Plan Medicaid	$2.17
Rate for Payer: Ohana Health Plan Medicare	$2.17
Rate for Payer: UnitedHealthcare Medicare	$2.17
Rate for Payer: University Health Alliance Commercial	$5.10

MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [119246]

Facility

$8.00

Service Code	NDC 00406831523
Hospital Revenue Code	250
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: MDX Hawaii PPO	$7.76

MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [119246]

Facility

$7.00

Service Code	NDC 68084015711
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$6.79

MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [119246]

Facility

$8.00

Service Code	NDC 00406831562
Hospital Revenue Code	250
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: MDX Hawaii PPO	$7.76

MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [119246]

Facility

$8.00

Service Code	NDC 00406831562
Hospital Revenue Code	637
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$7.76
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$2.48
Rate for Payer: Cash Price	$4.80
Rate for Payer: Devoted Health Medicare	$2.72
Rate for Payer: Hawaii Medical Service Association Medicare	$2.48
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Humana Medicare	$2.48
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicare	$2.48
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: Ohana Health Plan Medicaid	$2.48
Rate for Payer: Ohana Health Plan Medicare	$2.48
Rate for Payer: UnitedHealthcare Medicare	$2.48
Rate for Payer: University Health Alliance Commercial	$5.83

MORPHINE ER 15 MG TABLET,EXTENDED RELEASE [119246]

Facility

$8.00

Service Code	NDC 00406831523
Hospital Revenue Code	637
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$7.76
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$2.48
Rate for Payer: Cash Price	$4.80
Rate for Payer: Devoted Health Medicare	$2.72
Rate for Payer: Hawaii Medical Service Association Medicare	$2.48
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Humana Medicare	$2.48
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicare	$2.48
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: Ohana Health Plan Medicaid	$2.48
Rate for Payer: Ohana Health Plan Medicare	$2.48
Rate for Payer: UnitedHealthcare Medicare	$2.48
Rate for Payer: University Health Alliance Commercial	$5.83

MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]

Facility

$12.00

Service Code	NDC 68084015801
Hospital Revenue Code	637
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$11.64
Rate for Payer: AlohaCare Medicaid	$6.00
Rate for Payer: AlohaCare Medicare	$3.72
Rate for Payer: Cash Price	$7.20
Rate for Payer: Devoted Health Medicare	$4.08
Rate for Payer: Hawaii Medical Service Association Medicare	$3.72
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Humana Medicare	$3.72
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicare	$3.72
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: Ohana Health Plan Medicaid	$3.72
Rate for Payer: Ohana Health Plan Medicare	$3.72
Rate for Payer: UnitedHealthcare Medicare	$3.72
Rate for Payer: University Health Alliance Commercial	$8.75

MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]

Facility

$13.00

Service Code	NDC 00406833062
Hospital Revenue Code	637
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$12.61
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$4.03
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$4.42
Rate for Payer: Hawaii Medical Service Association Medicare	$4.03
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Humana Medicare	$4.03
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$4.03
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: Ohana Health Plan Medicaid	$4.03
Rate for Payer: Ohana Health Plan Medicare	$4.03
Rate for Payer: UnitedHealthcare Medicare	$4.03
Rate for Payer: University Health Alliance Commercial	$9.48

MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]

Facility

$13.00

Service Code	NDC 00406833023
Hospital Revenue Code	637
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$12.61
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$4.03
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$4.42
Rate for Payer: Hawaii Medical Service Association Medicare	$4.03
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Humana Medicare	$4.03
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$4.03
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: Ohana Health Plan Medicaid	$4.03
Rate for Payer: Ohana Health Plan Medicare	$4.03
Rate for Payer: UnitedHealthcare Medicare	$4.03
Rate for Payer: University Health Alliance Commercial	$9.48

MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]

Facility

$13.00

Service Code	NDC 00406833023
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]

Facility

$12.00

Service Code	NDC 68084015801
Hospital Revenue Code	250
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: MDX Hawaii PPO	$11.64

MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]

Facility

$12.00

Service Code	NDC 00406833001
Hospital Revenue Code	250
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.20
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: MDX Hawaii PPO	$11.64

MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]

Facility

$12.00

Service Code	NDC 00406833001
Hospital Revenue Code	637
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$11.64
Rate for Payer: AlohaCare Medicaid	$6.00
Rate for Payer: AlohaCare Medicare	$3.72
Rate for Payer: Cash Price	$7.20
Rate for Payer: Devoted Health Medicare	$4.08
Rate for Payer: Hawaii Medical Service Association Medicare	$3.72
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Humana Medicare	$3.72
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicare	$3.72
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: Ohana Health Plan Medicaid	$3.72
Rate for Payer: Ohana Health Plan Medicare	$3.72
Rate for Payer: UnitedHealthcare Medicare	$3.72
Rate for Payer: University Health Alliance Commercial	$8.75

MORPHINE ER 30 MG TABLET,EXTENDED RELEASE [119007]

Facility

$13.00

Service Code	NDC 00406833062
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

MORPHINE (PF) 1 MG/ML INJECTION SOLUTION [15852]

Facility

$122.00

Service Code	HCPCS J2274
Hospital Revenue Code	636
Min. Negotiated Rate	$10.79
Max. Negotiated Rate	$118.34
Rate for Payer: AlohaCare Medicaid	$61.00
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$27.59
Rate for Payer: AlohaCare Medicare	$37.82
Rate for Payer: Cash Price	$53.40
Rate for Payer: Cash Price	$73.20
Rate for Payer: Cash Price	$73.20
Rate for Payer: Cash Price	$53.40
Rate for Payer: Devoted Health Medicare	$41.48
Rate for Payer: Devoted Health Medicare	$30.26
Rate for Payer: Hawaii Medical Service Association ABD	$10.79
Rate for Payer: Hawaii Medical Service Association ABD	$10.79
Rate for Payer: Hawaii Medical Service Association Medicare	$37.82
Rate for Payer: Hawaii Medical Service Association Medicare	$27.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.79
Rate for Payer: Hawaii Western Management Group Commercial	$115.90
Rate for Payer: Hawaii Western Management Group Commercial	$84.55
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Humana Medicare	$37.82
Rate for Payer: Humana Medicare	$27.59
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicaid	$62.22
Rate for Payer: Kaiser Permanente Medicare	$27.59
Rate for Payer: Kaiser Permanente Medicare	$37.82
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$27.59
Rate for Payer: Ohana Health Plan Medicaid	$37.82
Rate for Payer: Ohana Health Plan Medicare	$37.82
Rate for Payer: Ohana Health Plan Medicare	$27.59
Rate for Payer: UnitedHealthcare Medicaid	$73.20
Rate for Payer: UnitedHealthcare Medicaid	$53.40
Rate for Payer: UnitedHealthcare Medicare	$37.82
Rate for Payer: UnitedHealthcare Medicare	$27.59
Rate for Payer: University Health Alliance Commercial	$88.93
Rate for Payer: University Health Alliance Commercial	$64.87

MORPHINE (PF) 1 MG/ML INJECTION SOLUTION [15852]

Facility

$122.00

Service Code	HCPCS J2274
Hospital Revenue Code	250
Min. Negotiated Rate	$103.70
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$73.20
Rate for Payer: Cash Price	$53.40
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: MDX Hawaii PPO	$118.34

MOUTH PROCEDURES WITH CC/MCC

Facility

$59,776.44

Service Code	MSDRG 137
Min. Negotiated Rate	$59,776.44
Max. Negotiated Rate	$59,776.44
Rate for Payer: Hawaii Medical Service Association Commercial	$59,776.44

MOUTH PROCEDURES WITHOUT CC/MCC

Facility

$31,760.68

Service Code	MSDRG 138
Min. Negotiated Rate	$31,760.68
Max. Negotiated Rate	$31,760.68
Rate for Payer: Hawaii Medical Service Association Commercial	$31,760.68

MOXIFLOXACIN 0.5 % EYE DROPS [35699]

Facility

$335.00

Service Code	NDC 60505058204
Hospital Revenue Code	250
Min. Negotiated Rate	$284.75
Max. Negotiated Rate	$324.95
Rate for Payer: Cash Price	$201.00
Rate for Payer: Health Management Network Commercial	$284.75
Rate for Payer: Kaiser Permanente Commercial	$301.50
Rate for Payer: MDX Hawaii PPO	$324.95

MOXIFLOXACIN 0.5 % EYE DROPS [35699]

Facility

$335.00

Service Code	NDC 68180042201
Hospital Revenue Code	637
Min. Negotiated Rate	$103.85
Max. Negotiated Rate	$324.95
Rate for Payer: AlohaCare Medicaid	$167.50
Rate for Payer: AlohaCare Medicare	$103.85
Rate for Payer: Cash Price	$201.00
Rate for Payer: Devoted Health Medicare	$113.90
Rate for Payer: Hawaii Medical Service Association Medicare	$103.85
Rate for Payer: Hawaii Western Management Group Commercial	$318.25
Rate for Payer: Health Management Network Commercial	$284.75
Rate for Payer: Humana Medicare	$103.85
Rate for Payer: Kaiser Permanente Commercial	$301.50
Rate for Payer: Kaiser Permanente Medicaid	$170.85
Rate for Payer: Kaiser Permanente Medicare	$103.85
Rate for Payer: MDX Hawaii PPO	$324.95
Rate for Payer: Ohana Health Plan Medicaid	$103.85
Rate for Payer: Ohana Health Plan Medicare	$103.85
Rate for Payer: UnitedHealthcare Medicare	$103.85
Rate for Payer: University Health Alliance Commercial	$244.18

Know your out-of-pocket cost for care.

All Charges