Kau Hospital

All Charges

Charge

Type

Setting

Price

MOXIFLOXACIN 0.5 % EYE DROPS [35699]

Facility

$335.00

Service Code	NDC 60505058204
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

MOXIFLOXACIN 0.5 % EYE DROPS [35699]

Facility

$335.00

Service Code	NDC 68180042201
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% OPHTH SOLUTION (VIGAMOX) (3 ML) (TAKE HOME) [4080377]

Facility

$15.00

Service Code	NDC 00004080165
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

MOXIFLOXACIN 0.5% OPHTH SOLUTION (VIGAMOX) (3 ML) (TAKE HOME) [4080377]

Facility

$15.00

Service Code	NDC 00004080165
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

MP CATH 14FR DRAINAGE APD

Facility

$400.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$124.00
Max. Negotiated Rate	$388.00
Rate for Payer: AlohaCare Medicaid	$200.00
Rate for Payer: AlohaCare Medicare	$124.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Devoted Health Medicare	$136.00
Rate for Payer: Hawaii Medical Service Association Medicare	$124.00
Rate for Payer: Hawaii Western Management Group Commercial	$380.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Humana Medicare	$124.00
Rate for Payer: Kaiser Permanente Commercial	$360.00
Rate for Payer: Kaiser Permanente Medicaid	$204.00
Rate for Payer: Kaiser Permanente Medicare	$124.00
Rate for Payer: MDX Hawaii PPO	$388.00
Rate for Payer: Ohana Health Plan Medicaid	$124.00
Rate for Payer: Ohana Health Plan Medicare	$124.00
Rate for Payer: UnitedHealthcare Medicare	$124.00
Rate for Payer: University Health Alliance Commercial	$291.56

MP CATH 14FR DRAINAGE APD

Facility

$400.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$340.00
Max. Negotiated Rate	$388.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Kaiser Permanente Commercial	$360.00
Rate for Payer: MDX Hawaii PPO	$388.00

MP DRAIN CATH 14X45 6SH

Facility

$381.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$323.85
Max. Negotiated Rate	$369.57
Rate for Payer: Cash Price	$228.60
Rate for Payer: Health Management Network Commercial	$323.85
Rate for Payer: Kaiser Permanente Commercial	$342.90
Rate for Payer: MDX Hawaii PPO	$369.57

MP DRAIN CATH 14X45 6SH

Facility

$381.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$118.11
Max. Negotiated Rate	$369.57
Rate for Payer: AlohaCare Medicaid	$190.50
Rate for Payer: AlohaCare Medicare	$118.11
Rate for Payer: Cash Price	$228.60
Rate for Payer: Devoted Health Medicare	$129.54
Rate for Payer: Hawaii Medical Service Association Medicare	$118.11
Rate for Payer: Hawaii Western Management Group Commercial	$361.95
Rate for Payer: Health Management Network Commercial	$323.85
Rate for Payer: Humana Medicare	$118.11
Rate for Payer: Kaiser Permanente Commercial	$342.90
Rate for Payer: Kaiser Permanente Medicaid	$194.31
Rate for Payer: Kaiser Permanente Medicare	$118.11
Rate for Payer: MDX Hawaii PPO	$369.57
Rate for Payer: Ohana Health Plan Medicaid	$118.11
Rate for Payer: Ohana Health Plan Medicare	$118.11
Rate for Payer: UnitedHealthcare Medicare	$118.11
Rate for Payer: University Health Alliance Commercial	$277.71

MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC

Facility

$115,594.65

Service Code	MSDRG 427
Min. Negotiated Rate	$115,594.65
Max. Negotiated Rate	$115,594.65
Rate for Payer: Hawaii Medical Service Association Commercial	$115,594.65

MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$115,594.65

Service Code	MSDRG 426
Min. Negotiated Rate	$115,594.65
Max. Negotiated Rate	$115,594.65
Rate for Payer: Hawaii Medical Service Association Commercial	$115,594.65

MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC

Facility

$115,594.65

Service Code	MSDRG 428
Min. Negotiated Rate	$115,594.65
Max. Negotiated Rate	$115,594.65
Rate for Payer: Hawaii Medical Service Association Commercial	$115,594.65

MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE

Facility

$84,260.61

Service Code	MSDRG 447
Min. Negotiated Rate	$84,260.61
Max. Negotiated Rate	$84,260.61
Rate for Payer: Hawaii Medical Service Association Commercial	$84,260.61

MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC

Facility

$79,283.19

Service Code	MSDRG 448
Min. Negotiated Rate	$79,283.19
Max. Negotiated Rate	$79,283.19
Rate for Payer: Hawaii Medical Service Association Commercial	$79,283.19

MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC

Facility

$20,170.40

Service Code	MSDRG 059
Min. Negotiated Rate	$20,170.40
Max. Negotiated Rate	$20,170.40
Rate for Payer: Hawaii Medical Service Association Commercial	$20,170.40

MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC

Facility

$20,170.40

Service Code	MSDRG 058
Min. Negotiated Rate	$20,170.40
Max. Negotiated Rate	$20,170.40
Rate for Payer: Hawaii Medical Service Association Commercial	$20,170.40

MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC

Facility

$20,170.40

Service Code	MSDRG 060
Min. Negotiated Rate	$20,170.40
Max. Negotiated Rate	$20,170.40
Rate for Payer: Hawaii Medical Service Association Commercial	$20,170.40

MULTITASC SIZE 6 #4500-04

Facility

$5,358.00

Hospital Revenue Code	272
Min. Negotiated Rate	$4,554.30
Max. Negotiated Rate	$5,197.26
Rate for Payer: Cash Price	$3,214.80
Rate for Payer: Health Management Network Commercial	$4,554.30
Rate for Payer: Kaiser Permanente Commercial	$4,822.20
Rate for Payer: MDX Hawaii PPO	$5,197.26

MULTITASC SIZE 6 #4500-04

Facility

$5,358.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,660.98
Max. Negotiated Rate	$5,197.26
Rate for Payer: AlohaCare Medicaid	$2,679.00
Rate for Payer: AlohaCare Medicare	$1,660.98
Rate for Payer: Cash Price	$3,214.80
Rate for Payer: Devoted Health Medicare	$1,821.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,660.98
Rate for Payer: Hawaii Western Management Group Commercial	$5,090.10
Rate for Payer: Health Management Network Commercial	$4,554.30
Rate for Payer: Humana Medicare	$1,660.98
Rate for Payer: Kaiser Permanente Commercial	$4,822.20
Rate for Payer: Kaiser Permanente Medicaid	$2,732.58
Rate for Payer: Kaiser Permanente Medicare	$1,660.98
Rate for Payer: MDX Hawaii PPO	$5,197.26
Rate for Payer: Ohana Health Plan Medicaid	$1,660.98
Rate for Payer: Ohana Health Plan Medicare	$1,660.98
Rate for Payer: UnitedHealthcare Medicare	$1,660.98
Rate for Payer: University Health Alliance Commercial	$3,905.45

MULTITASC SIZE 7 #4500-05

Facility

$5,358.00

Hospital Revenue Code	272
Min. Negotiated Rate	$4,554.30
Max. Negotiated Rate	$5,197.26
Rate for Payer: Cash Price	$3,214.80
Rate for Payer: Health Management Network Commercial	$4,554.30
Rate for Payer: Kaiser Permanente Commercial	$4,822.20
Rate for Payer: MDX Hawaii PPO	$5,197.26

MULTITASC SIZE 7 #4500-05

Facility

$5,358.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,660.98
Max. Negotiated Rate	$5,197.26
Rate for Payer: AlohaCare Medicaid	$2,679.00
Rate for Payer: AlohaCare Medicare	$1,660.98
Rate for Payer: Cash Price	$3,214.80
Rate for Payer: Devoted Health Medicare	$1,821.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,660.98
Rate for Payer: Hawaii Western Management Group Commercial	$5,090.10
Rate for Payer: Health Management Network Commercial	$4,554.30
Rate for Payer: Humana Medicare	$1,660.98
Rate for Payer: Kaiser Permanente Commercial	$4,822.20
Rate for Payer: Kaiser Permanente Medicaid	$2,732.58
Rate for Payer: Kaiser Permanente Medicare	$1,660.98
Rate for Payer: MDX Hawaii PPO	$5,197.26
Rate for Payer: Ohana Health Plan Medicaid	$1,660.98
Rate for Payer: Ohana Health Plan Medicare	$1,660.98
Rate for Payer: UnitedHealthcare Medicare	$1,660.98
Rate for Payer: University Health Alliance Commercial	$3,905.45

MULTI VAC 50 XL HIP

Facility

$1,586.00

Hospital Revenue Code	272
Min. Negotiated Rate	$491.66
Max. Negotiated Rate	$1,538.42
Rate for Payer: AlohaCare Medicaid	$793.00
Rate for Payer: AlohaCare Medicare	$491.66
Rate for Payer: Cash Price	$951.60
Rate for Payer: Devoted Health Medicare	$539.24
Rate for Payer: Hawaii Medical Service Association Medicare	$491.66
Rate for Payer: Hawaii Western Management Group Commercial	$1,506.70
Rate for Payer: Health Management Network Commercial	$1,348.10
Rate for Payer: Humana Medicare	$491.66
Rate for Payer: Kaiser Permanente Commercial	$1,427.40
Rate for Payer: Kaiser Permanente Medicaid	$808.86
Rate for Payer: Kaiser Permanente Medicare	$491.66
Rate for Payer: MDX Hawaii PPO	$1,538.42
Rate for Payer: Ohana Health Plan Medicaid	$491.66
Rate for Payer: Ohana Health Plan Medicare	$491.66
Rate for Payer: UnitedHealthcare Medicare	$491.66
Rate for Payer: University Health Alliance Commercial	$1,156.04

MULTI VAC 50 XL HIP

Facility

$1,586.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,348.10
Max. Negotiated Rate	$1,538.42
Rate for Payer: Cash Price	$951.60
Rate for Payer: Health Management Network Commercial	$1,348.10
Rate for Payer: Kaiser Permanente Commercial	$1,427.40
Rate for Payer: MDX Hawaii PPO	$1,538.42

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET [37053]

Facility

$1.00

Service Code	NDC 22368000000
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

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET [37053]

Facility

$1.00

Service Code	NDC 43233000000
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

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET [37053]

Facility

$1.00

Service Code	NDC 22368000000
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

Know your out-of-pocket cost for care.

All Charges