Kau Hospital

All Charges

Charge

Type

Setting

Price

NALTREXONE 50 MG TABLET [10685]

Facility

$15.00

Service Code	NDC 47335032683
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

NALTREXONE 50 MG TABLET [10685]

Facility

$16.00

Service Code	NDC 68084029111
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

NAPROXEN 250 MG TABLET [5391]

Facility

$3.00

Service Code	NDC 70010013701
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

NAPROXEN 250 MG TABLET [5391]

Facility

$3.00

Service Code	NDC 70010013701
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

NAPROXEN 250 MG TABLET [5391]

Facility

$3.00

Service Code	NDC 50268059415
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

NAPROXEN 250 MG TABLET [5391]

Facility

$3.00

Service Code	NDC 50268059415
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

NAPROXEN 375 MG TABLET [5392]

Facility

$4.00

Service Code	NDC 68462018901
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

NAPROXEN 375 MG TABLET [5392]

Facility

$4.00

Service Code	NDC 50268059515
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

NAPROXEN 375 MG TABLET [5392]

Facility

$4.00

Service Code	NDC 68462018901
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

NAPROXEN 375 MG TABLET [5392]

Facility

$4.00

Service Code	NDC 50268059515
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

NASAL PACKING W/STRING 440411

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$64.48
Max. Negotiated Rate	$201.76
Rate for Payer: AlohaCare Medicaid	$104.00
Rate for Payer: AlohaCare Medicare	$64.48
Rate for Payer: Cash Price	$124.80
Rate for Payer: Devoted Health Medicare	$70.72
Rate for Payer: Hawaii Medical Service Association Medicare	$64.48
Rate for Payer: Hawaii Western Management Group Commercial	$197.60
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Humana Medicare	$64.48
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: Kaiser Permanente Medicaid	$106.08
Rate for Payer: Kaiser Permanente Medicare	$64.48
Rate for Payer: MDX Hawaii PPO	$201.76
Rate for Payer: Ohana Health Plan Medicaid	$64.48
Rate for Payer: Ohana Health Plan Medicare	$64.48
Rate for Payer: UnitedHealthcare Medicare	$64.48
Rate for Payer: University Health Alliance Commercial	$151.61

NASAL PACKING W/STRING 440411

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: MDX Hawaii PPO	$201.76

NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION [40120]

Facility

$15,983.00

Service Code	HCPCS J2323
Hospital Revenue Code	250
Min. Negotiated Rate	$13,585.55
Max. Negotiated Rate	$15,503.51
Rate for Payer: Cash Price	$9,589.80
Rate for Payer: Health Management Network Commercial	$13,585.55
Rate for Payer: Kaiser Permanente Commercial	$14,384.70
Rate for Payer: MDX Hawaii PPO	$15,503.51

NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION [40120]

Facility

$15,983.00

Service Code	HCPCS J2323
Hospital Revenue Code	636
Min. Negotiated Rate	$24.13
Max. Negotiated Rate	$15,503.51
Rate for Payer: AlohaCare Medicaid	$7,991.50
Rate for Payer: AlohaCare Medicare	$4,954.73
Rate for Payer: Cash Price	$9,589.80
Rate for Payer: Cash Price	$9,589.80
Rate for Payer: Devoted Health Medicare	$5,434.22
Rate for Payer: Hawaii Medical Service Association ABD	$24.13
Rate for Payer: Hawaii Medical Service Association Commercial	$30.40
Rate for Payer: Hawaii Medical Service Association Medicare	$4,954.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.13
Rate for Payer: Hawaii Western Management Group Commercial	$15,183.85
Rate for Payer: Health Management Network Commercial	$13,585.55
Rate for Payer: Humana Medicare	$4,954.73
Rate for Payer: Kaiser Permanente Commercial	$14,384.70
Rate for Payer: Kaiser Permanente Medicaid	$8,151.33
Rate for Payer: Kaiser Permanente Medicare	$4,954.73
Rate for Payer: MDX Hawaii PPO	$15,503.51
Rate for Payer: Ohana Health Plan Medicaid	$4,954.73
Rate for Payer: Ohana Health Plan Medicare	$4,954.73
Rate for Payer: UnitedHealthcare Medicaid	$9,589.80
Rate for Payer: UnitedHealthcare Medicare	$4,954.73
Rate for Payer: University Health Alliance Commercial	$11,650.01

NATRELLE BREAST IMPLAN SCX-800

Facility

$2,190.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,226.40
Max. Negotiated Rate	$2,124.30
Rate for Payer: Cash Price	$1,314.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,533.00
Rate for Payer: Health Management Network Commercial	$1,861.50
Rate for Payer: Kaiser Permanente Commercial	$1,971.00
Rate for Payer: MDX Hawaii PPO	$2,124.30
Rate for Payer: University Health Alliance Commercial	$1,226.40

NATRELLE BREAST IMPLAN SCX-800

Facility

$2,190.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$678.90
Max. Negotiated Rate	$2,124.30
Rate for Payer: AlohaCare Medicaid	$1,095.00
Rate for Payer: AlohaCare Medicare	$678.90
Rate for Payer: Cash Price	$1,314.00
Rate for Payer: Devoted Health Medicare	$744.60
Rate for Payer: Hawaii Medical Service Association Medicare	$678.90
Rate for Payer: Hawaii Western Management Group Commercial	$1,533.00
Rate for Payer: Health Management Network Commercial	$1,861.50
Rate for Payer: Humana Medicare	$678.90
Rate for Payer: Kaiser Permanente Commercial	$1,971.00
Rate for Payer: Kaiser Permanente Medicaid	$1,116.90
Rate for Payer: Kaiser Permanente Medicare	$678.90
Rate for Payer: MDX Hawaii PPO	$2,124.30
Rate for Payer: Ohana Health Plan Medicaid	$678.90
Rate for Payer: Ohana Health Plan Medicare	$678.90
Rate for Payer: UnitedHealthcare Medicare	$678.90
Rate for Payer: University Health Alliance Commercial	$1,226.40

NATRELLE INSPIRA 110 SCL-110

Facility

$2,190.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$678.90
Max. Negotiated Rate	$2,124.30
Rate for Payer: AlohaCare Medicaid	$1,095.00
Rate for Payer: AlohaCare Medicare	$678.90
Rate for Payer: Cash Price	$1,314.00
Rate for Payer: Devoted Health Medicare	$744.60
Rate for Payer: Hawaii Medical Service Association Medicare	$678.90
Rate for Payer: Hawaii Western Management Group Commercial	$1,533.00
Rate for Payer: Health Management Network Commercial	$1,861.50
Rate for Payer: Humana Medicare	$678.90
Rate for Payer: Kaiser Permanente Commercial	$1,971.00
Rate for Payer: Kaiser Permanente Medicaid	$1,116.90
Rate for Payer: Kaiser Permanente Medicare	$678.90
Rate for Payer: MDX Hawaii PPO	$2,124.30
Rate for Payer: Ohana Health Plan Medicaid	$678.90
Rate for Payer: Ohana Health Plan Medicare	$678.90
Rate for Payer: UnitedHealthcare Medicare	$678.90
Rate for Payer: University Health Alliance Commercial	$1,226.40

NATRELLE INSPIRA 110 SCL-110

Facility

$2,190.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,226.40
Max. Negotiated Rate	$2,124.30
Rate for Payer: Cash Price	$1,314.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,533.00
Rate for Payer: Health Management Network Commercial	$1,861.50
Rate for Payer: Kaiser Permanente Commercial	$1,971.00
Rate for Payer: MDX Hawaii PPO	$2,124.30
Rate for Payer: University Health Alliance Commercial	$1,226.40

NATRELLE SALINE-FILLED 420MM

Facility

$1,050.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$588.00
Max. Negotiated Rate	$1,018.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Hawaii Western Management Group Commercial	$735.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Kaiser Permanente Commercial	$945.00
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: University Health Alliance Commercial	$588.00

NATRELLE SALINE-FILLED 420MM

Facility

$1,050.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$325.50
Max. Negotiated Rate	$1,018.50
Rate for Payer: AlohaCare Medicaid	$525.00
Rate for Payer: AlohaCare Medicare	$325.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Devoted Health Medicare	$357.00
Rate for Payer: Hawaii Medical Service Association Medicare	$325.50
Rate for Payer: Hawaii Western Management Group Commercial	$735.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Humana Medicare	$325.50
Rate for Payer: Kaiser Permanente Commercial	$945.00
Rate for Payer: Kaiser Permanente Medicaid	$535.50
Rate for Payer: Kaiser Permanente Medicare	$325.50
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: Ohana Health Plan Medicaid	$325.50
Rate for Payer: Ohana Health Plan Medicare	$325.50
Rate for Payer: UnitedHealthcare Medicare	$325.50
Rate for Payer: University Health Alliance Commercial	$588.00

NATRELLE SALINE-FILLED 800CC

Facility

$1,050.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$588.00
Max. Negotiated Rate	$1,018.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Hawaii Western Management Group Commercial	$735.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Kaiser Permanente Commercial	$945.00
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: University Health Alliance Commercial	$588.00

NATRELLE SALINE-FILLED 800CC

Facility

$1,050.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$325.50
Max. Negotiated Rate	$1,018.50
Rate for Payer: AlohaCare Medicaid	$525.00
Rate for Payer: AlohaCare Medicare	$325.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Devoted Health Medicare	$357.00
Rate for Payer: Hawaii Medical Service Association Medicare	$325.50
Rate for Payer: Hawaii Western Management Group Commercial	$735.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Humana Medicare	$325.50
Rate for Payer: Kaiser Permanente Commercial	$945.00
Rate for Payer: Kaiser Permanente Medicaid	$535.50
Rate for Payer: Kaiser Permanente Medicare	$325.50
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: Ohana Health Plan Medicaid	$325.50
Rate for Payer: Ohana Health Plan Medicare	$325.50
Rate for Payer: UnitedHealthcare Medicare	$325.50
Rate for Payer: University Health Alliance Commercial	$588.00

NATRELLE SIZER 550CC

Facility

$175.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$169.75
Rate for Payer: Cash Price	$105.00
Rate for Payer: Hawaii Western Management Group Commercial	$122.50
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: Kaiser Permanente Commercial	$157.50
Rate for Payer: MDX Hawaii PPO	$169.75
Rate for Payer: University Health Alliance Commercial	$98.00

NATRELLE SIZER 550CC

Facility

$175.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$54.25
Max. Negotiated Rate	$169.75
Rate for Payer: AlohaCare Medicaid	$87.50
Rate for Payer: AlohaCare Medicare	$54.25
Rate for Payer: Cash Price	$105.00
Rate for Payer: Devoted Health Medicare	$59.50
Rate for Payer: Hawaii Medical Service Association Medicare	$54.25
Rate for Payer: Hawaii Western Management Group Commercial	$122.50
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: Humana Medicare	$54.25
Rate for Payer: Kaiser Permanente Commercial	$157.50
Rate for Payer: Kaiser Permanente Medicaid	$89.25
Rate for Payer: Kaiser Permanente Medicare	$54.25
Rate for Payer: MDX Hawaii PPO	$169.75
Rate for Payer: Ohana Health Plan Medicaid	$54.25
Rate for Payer: Ohana Health Plan Medicare	$54.25
Rate for Payer: UnitedHealthcare Medicare	$54.25
Rate for Payer: University Health Alliance Commercial	$98.00

NATRELLE STY SALINE 68HP-700

Facility

$1,050.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$325.50
Max. Negotiated Rate	$1,018.50
Rate for Payer: AlohaCare Medicaid	$525.00
Rate for Payer: AlohaCare Medicare	$325.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Devoted Health Medicare	$357.00
Rate for Payer: Hawaii Medical Service Association Medicare	$325.50
Rate for Payer: Hawaii Western Management Group Commercial	$735.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Humana Medicare	$325.50
Rate for Payer: Kaiser Permanente Commercial	$945.00
Rate for Payer: Kaiser Permanente Medicaid	$535.50
Rate for Payer: Kaiser Permanente Medicare	$325.50
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: Ohana Health Plan Medicaid	$325.50
Rate for Payer: Ohana Health Plan Medicare	$325.50
Rate for Payer: UnitedHealthcare Medicare	$325.50
Rate for Payer: University Health Alliance Commercial	$588.00

Know your out-of-pocket cost for care.

All Charges