Kau Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$1.00

Service Code	NDC 43233000000
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 WITH FOLIC ACID 400 MCG TABLET [5821]

Facility

$1.00

Service Code	NDC 53061000000
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 WITH FOLIC ACID 400 MCG TABLET [5821]

Facility

$1.00

Service Code	NDC 53061000000
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

MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID [1481]

Facility

$19.00

Service Code	NDC 00858000000
Hospital Revenue Code	637
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$18.43
Rate for Payer: AlohaCare Medicaid	$9.50
Rate for Payer: AlohaCare Medicare	$5.89
Rate for Payer: Cash Price	$11.40
Rate for Payer: Devoted Health Medicare	$6.46
Rate for Payer: Hawaii Medical Service Association Medicare	$5.89
Rate for Payer: Hawaii Western Management Group Commercial	$18.05
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Humana Medicare	$5.89
Rate for Payer: Kaiser Permanente Commercial	$17.10
Rate for Payer: Kaiser Permanente Medicaid	$9.69
Rate for Payer: Kaiser Permanente Medicare	$5.89
Rate for Payer: MDX Hawaii PPO	$18.43
Rate for Payer: Ohana Health Plan Medicaid	$5.89
Rate for Payer: Ohana Health Plan Medicare	$5.89
Rate for Payer: UnitedHealthcare Medicare	$5.89
Rate for Payer: University Health Alliance Commercial	$13.85

MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID [1481]

Facility

$19.00

Service Code	NDC 00858000000
Hospital Revenue Code	250
Min. Negotiated Rate	$16.15
Max. Negotiated Rate	$18.43
Rate for Payer: Cash Price	$11.40
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Kaiser Permanente Commercial	$17.10
Rate for Payer: MDX Hawaii PPO	$18.43

MUPIROCIN 2% OINTMENT (BACTROBAN) (22 GRAM) (TAKE HOME) [4080378]

Facility

$15.00

Service Code	NDC 00004080166
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

MUPIROCIN 2% OINTMENT (BACTROBAN) (22 GRAM) (TAKE HOME) [4080378]

Facility

$15.00

Service Code	NDC 00004080166
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

MUPIROCIN 2 % TOPICAL OINTMENT [10674]

Facility

$150.00

Service Code	NDC 68462018022
Hospital Revenue Code	637
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$145.50
Rate for Payer: AlohaCare Medicaid	$75.00
Rate for Payer: AlohaCare Medicare	$46.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Devoted Health Medicare	$51.00
Rate for Payer: Hawaii Medical Service Association Medicare	$46.50
Rate for Payer: Hawaii Western Management Group Commercial	$142.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Humana Medicare	$46.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicare	$46.50
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: Ohana Health Plan Medicaid	$46.50
Rate for Payer: Ohana Health Plan Medicare	$46.50
Rate for Payer: UnitedHealthcare Medicare	$46.50
Rate for Payer: University Health Alliance Commercial	$109.33

MUPIROCIN 2 % TOPICAL OINTMENT [10674]

Facility

$150.00

Service Code	NDC 68462018022
Hospital Revenue Code	250
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: MDX Hawaii PPO	$145.50

MUPIROCIN CALCIUM 2 % TOPICAL CREAM [22251]

Facility

$613.00

Service Code	NDC 68462056417
Hospital Revenue Code	637
Min. Negotiated Rate	$190.03
Max. Negotiated Rate	$594.61
Rate for Payer: AlohaCare Medicaid	$306.50
Rate for Payer: AlohaCare Medicare	$190.03
Rate for Payer: Cash Price	$367.80
Rate for Payer: Devoted Health Medicare	$208.42
Rate for Payer: Hawaii Medical Service Association Medicare	$190.03
Rate for Payer: Hawaii Western Management Group Commercial	$582.35
Rate for Payer: Health Management Network Commercial	$521.05
Rate for Payer: Humana Medicare	$190.03
Rate for Payer: Kaiser Permanente Commercial	$551.70
Rate for Payer: Kaiser Permanente Medicaid	$312.63
Rate for Payer: Kaiser Permanente Medicare	$190.03
Rate for Payer: MDX Hawaii PPO	$594.61
Rate for Payer: Ohana Health Plan Medicaid	$190.03
Rate for Payer: Ohana Health Plan Medicare	$190.03
Rate for Payer: UnitedHealthcare Medicare	$190.03
Rate for Payer: University Health Alliance Commercial	$446.82

MUPIROCIN CALCIUM 2 % TOPICAL CREAM [22251]

Facility

$613.00

Service Code	NDC 51672137001
Hospital Revenue Code	637
Min. Negotiated Rate	$190.03
Max. Negotiated Rate	$594.61
Rate for Payer: AlohaCare Medicaid	$306.50
Rate for Payer: AlohaCare Medicare	$190.03
Rate for Payer: Cash Price	$367.80
Rate for Payer: Devoted Health Medicare	$208.42
Rate for Payer: Hawaii Medical Service Association Medicare	$190.03
Rate for Payer: Hawaii Western Management Group Commercial	$582.35
Rate for Payer: Health Management Network Commercial	$521.05
Rate for Payer: Humana Medicare	$190.03
Rate for Payer: Kaiser Permanente Commercial	$551.70
Rate for Payer: Kaiser Permanente Medicaid	$312.63
Rate for Payer: Kaiser Permanente Medicare	$190.03
Rate for Payer: MDX Hawaii PPO	$594.61
Rate for Payer: Ohana Health Plan Medicaid	$190.03
Rate for Payer: Ohana Health Plan Medicare	$190.03
Rate for Payer: UnitedHealthcare Medicare	$190.03
Rate for Payer: University Health Alliance Commercial	$446.82

MUPIROCIN CALCIUM 2 % TOPICAL CREAM [22251]

Facility

$613.00

Service Code	NDC 68462056417
Hospital Revenue Code	250
Min. Negotiated Rate	$521.05
Max. Negotiated Rate	$594.61
Rate for Payer: Cash Price	$367.80
Rate for Payer: Health Management Network Commercial	$521.05
Rate for Payer: Kaiser Permanente Commercial	$551.70
Rate for Payer: MDX Hawaii PPO	$594.61

MUPIROCIN CALCIUM 2 % TOPICAL CREAM [22251]

Facility

$613.00

Service Code	NDC 51672137001
Hospital Revenue Code	250
Min. Negotiated Rate	$521.05
Max. Negotiated Rate	$594.61
Rate for Payer: Cash Price	$367.80
Rate for Payer: Health Management Network Commercial	$521.05
Rate for Payer: Kaiser Permanente Commercial	$551.70
Rate for Payer: MDX Hawaii PPO	$594.61

MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION [119571]

Facility

$33.00

Service Code	NDC 54643564901
Hospital Revenue Code	250
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$32.01
Rate for Payer: Cash Price	$19.80
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Kaiser Permanente Commercial	$29.70
Rate for Payer: MDX Hawaii PPO	$32.01

MYCOPHENOLATE MOFETIL 250 MG CAPSULE [15113]

Facility

$3.00

Service Code	HCPCS J7517
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

MYCOPHENOLATE MOFETIL 250 MG CAPSULE [15113]

Facility

$3.00

Service Code	HCPCS J7517
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
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: Cash Price	$1.80
Rate for Payer: Devoted Health Medicare	$1.02
Rate for Payer: Hawaii Medical Service Association ABD	$0.16
Rate for Payer: Hawaii Medical Service Association Medicare	$0.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.16
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 Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$0.93
Rate for Payer: University Health Alliance Commercial	$2.19

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC

Facility

$73,452.50

Service Code	MSDRG 827
Min. Negotiated Rate	$73,452.50
Max. Negotiated Rate	$73,452.50
Rate for Payer: Hawaii Medical Service Association Commercial	$73,452.50

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC

Facility

$73,452.50

Service Code	MSDRG 826
Min. Negotiated Rate	$73,452.50
Max. Negotiated Rate	$73,452.50
Rate for Payer: Hawaii Medical Service Association Commercial	$73,452.50

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$37,069.93

Service Code	MSDRG 828
Min. Negotiated Rate	$37,069.93
Max. Negotiated Rate	$37,069.93
Rate for Payer: Hawaii Medical Service Association Commercial	$37,069.93

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC

Facility

$46,811.45

Service Code	MSDRG 829
Min. Negotiated Rate	$46,811.45
Max. Negotiated Rate	$46,811.45
Rate for Payer: Hawaii Medical Service Association Commercial	$46,811.45

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC

Facility

$46,811.45

Service Code	MSDRG 830
Min. Negotiated Rate	$46,811.45
Max. Negotiated Rate	$46,811.45
Rate for Payer: Hawaii Medical Service Association Commercial	$46,811.45

MYNX CONTROL VENOUS 6F-12F

Facility

$945.00

Service Code	HCPCS C1760
Hospital Revenue Code	272
Min. Negotiated Rate	$292.95
Max. Negotiated Rate	$916.65
Rate for Payer: AlohaCare Medicaid	$472.50
Rate for Payer: AlohaCare Medicare	$292.95
Rate for Payer: Cash Price	$567.00
Rate for Payer: Devoted Health Medicare	$321.30
Rate for Payer: Hawaii Medical Service Association Medicare	$292.95
Rate for Payer: Hawaii Western Management Group Commercial	$897.75
Rate for Payer: Health Management Network Commercial	$803.25
Rate for Payer: Humana Medicare	$292.95
Rate for Payer: Kaiser Permanente Commercial	$850.50
Rate for Payer: Kaiser Permanente Medicaid	$481.95
Rate for Payer: Kaiser Permanente Medicare	$292.95
Rate for Payer: MDX Hawaii PPO	$916.65
Rate for Payer: Ohana Health Plan Medicaid	$292.95
Rate for Payer: Ohana Health Plan Medicare	$292.95
Rate for Payer: UnitedHealthcare Medicare	$292.95
Rate for Payer: University Health Alliance Commercial	$688.81

MYNX CONTROL VENOUS 6F-12F

Facility

$945.00

Service Code	HCPCS C1760
Hospital Revenue Code	272
Min. Negotiated Rate	$803.25
Max. Negotiated Rate	$916.65
Rate for Payer: Cash Price	$567.00
Rate for Payer: Health Management Network Commercial	$803.25
Rate for Payer: Kaiser Permanente Commercial	$850.50
Rate for Payer: MDX Hawaii PPO	$916.65

MYOCARDIAL BIOPSY FORCEPS

Facility

$2,299.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,954.15
Max. Negotiated Rate	$2,230.03
Rate for Payer: Cash Price	$1,379.40
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Kaiser Permanente Commercial	$2,069.10
Rate for Payer: MDX Hawaii PPO	$2,230.03

MYOCARDIAL BIOPSY FORCEPS

Facility

$2,299.00

Hospital Revenue Code	272
Min. Negotiated Rate	$712.69
Max. Negotiated Rate	$2,230.03
Rate for Payer: AlohaCare Medicaid	$1,149.50
Rate for Payer: AlohaCare Medicare	$712.69
Rate for Payer: Cash Price	$1,379.40
Rate for Payer: Devoted Health Medicare	$781.66
Rate for Payer: Hawaii Medical Service Association Medicare	$712.69
Rate for Payer: Hawaii Western Management Group Commercial	$2,184.05
Rate for Payer: Health Management Network Commercial	$1,954.15
Rate for Payer: Humana Medicare	$712.69
Rate for Payer: Kaiser Permanente Commercial	$2,069.10
Rate for Payer: Kaiser Permanente Medicaid	$1,172.49
Rate for Payer: Kaiser Permanente Medicare	$712.69
Rate for Payer: MDX Hawaii PPO	$2,230.03
Rate for Payer: Ohana Health Plan Medicaid	$712.69
Rate for Payer: Ohana Health Plan Medicare	$712.69
Rate for Payer: UnitedHealthcare Medicare	$712.69
Rate for Payer: University Health Alliance Commercial	$1,675.74

Know your out-of-pocket cost for care.

All Charges