Kau Hospital

All Charges

Charge

Type

Setting

Price

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC

Facility

$37,543.97

Service Code	MSDRG 097
Min. Negotiated Rate	$37,543.97
Max. Negotiated Rate	$37,543.97
Rate for Payer: Hawaii Medical Service Association Commercial	$37,543.97

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$37,543.97

Service Code	MSDRG 099
Min. Negotiated Rate	$37,543.97
Max. Negotiated Rate	$37,543.97
Rate for Payer: Hawaii Medical Service Association Commercial	$37,543.97

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$38,018.01

Service Code	MSDRG 988
Min. Negotiated Rate	$38,018.01
Max. Negotiated Rate	$38,018.01
Rate for Payer: Hawaii Medical Service Association Commercial	$38,018.01

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$38,018.01

Service Code	MSDRG 987
Min. Negotiated Rate	$38,018.01
Max. Negotiated Rate	$38,018.01
Rate for Payer: Hawaii Medical Service Association Commercial	$38,018.01

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$38,018.01

Service Code	MSDRG 989
Min. Negotiated Rate	$38,018.01
Max. Negotiated Rate	$38,018.01
Rate for Payer: Hawaii Medical Service Association Commercial	$38,018.01

NON-MALIGNANT BREAST DISORDERS WITH CC/MCC

Facility

$15,998.85

Service Code	MSDRG 600
Min. Negotiated Rate	$15,998.85
Max. Negotiated Rate	$15,998.85
Rate for Payer: Hawaii Medical Service Association Commercial	$15,998.85

NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$15,998.85

Service Code	MSDRG 601
Min. Negotiated Rate	$15,998.85
Max. Negotiated Rate	$15,998.85
Rate for Payer: Hawaii Medical Service Association Commercial	$15,998.85

NONTRAUMATIC STUPOR AND COMA WITH MCC

Facility

$32,566.55

Service Code	MSDRG 080
Min. Negotiated Rate	$32,566.55
Max. Negotiated Rate	$32,566.55
Rate for Payer: Hawaii Medical Service Association Commercial	$32,566.55

NONTRAUMATIC STUPOR AND COMA WITHOUT MCC

Facility

$32,566.55

Service Code	MSDRG 081
Min. Negotiated Rate	$32,566.55
Max. Negotiated Rate	$32,566.55
Rate for Payer: Hawaii Medical Service Association Commercial	$32,566.55

NOREPINEPHRINE BITARTRATE 16 MG/250 ML (64 MCG/ML) IN 0.9 % NACL IV [136921]

Facility

$346.00

Service Code	NDC 44567064210
Hospital Revenue Code	250
Min. Negotiated Rate	$294.10
Max. Negotiated Rate	$335.62
Rate for Payer: Cash Price	$207.60
Rate for Payer: Health Management Network Commercial	$294.10
Rate for Payer: Kaiser Permanente Commercial	$311.40
Rate for Payer: MDX Hawaii PPO	$335.62

NOREPINEPHRINE BITARTRATE 16 MG/250 ML (64 MCG/ML) IN 0.9 % NACL IV [136921]

Facility

$346.00

Service Code	NDC 44567064201
Hospital Revenue Code	250
Min. Negotiated Rate	$294.10
Max. Negotiated Rate	$335.62
Rate for Payer: Cash Price	$207.60
Rate for Payer: Health Management Network Commercial	$294.10
Rate for Payer: Kaiser Permanente Commercial	$311.40
Rate for Payer: MDX Hawaii PPO	$335.62

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [128328]

Facility

$77.00

Service Code	NDC 67457085200
Hospital Revenue Code	250
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: MDX Hawaii PPO	$74.69

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION [128328]

Facility

$77.00

Service Code	NDC 67457085204
Hospital Revenue Code	250
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: MDX Hawaii PPO	$74.69

NOREPINEPHRINE BITARTRATE 4 MG/250 ML (16 MCG/ML) IN 0.9 % NACL IV [134605]

Facility

$162.00

Service Code	NDC 44567064001
Hospital Revenue Code	250
Min. Negotiated Rate	$137.70
Max. Negotiated Rate	$157.14
Rate for Payer: Cash Price	$97.20
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: Kaiser Permanente Commercial	$145.80
Rate for Payer: MDX Hawaii PPO	$157.14

NOREPINEPHRINE BITARTRATE 4 MG/250 ML (16 MCG/ML) IN 0.9 % NACL IV [134605]

Facility

$162.00

Service Code	NDC 44567064010
Hospital Revenue Code	250
Min. Negotiated Rate	$137.70
Max. Negotiated Rate	$157.14
Rate for Payer: Cash Price	$97.20
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: Kaiser Permanente Commercial	$145.80
Rate for Payer: MDX Hawaii PPO	$157.14

NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) IN 0.9 % NACL IV [134543]

Facility

$215.00

Service Code	NDC 44567064110
Hospital Revenue Code	250
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$129.00
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: MDX Hawaii PPO	$208.55

NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) IN 0.9 % NACL IV [134543]

Facility

$215.00

Service Code	NDC 44567064101
Hospital Revenue Code	250
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$129.00
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: MDX Hawaii PPO	$208.55

NORETHINDRONE 1 MG-ETHINYL ESTRADIOL 35 MCG TABLET [10742]

Facility

$4.00

Service Code	NDC 00555901079
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

NORETHINDRONE 1 MG-ETHINYL ESTRADIOL 35 MCG TABLET [10742]

Facility

$4.00

Service Code	NDC 00555901079
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

NORETHINDRONE 1 MG-ETHINYL ESTRADIOL 35 MCG TABLET [10742]

Facility

$4.00

Service Code	NDC 00555901058
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

NORETHINDRONE 1 MG-ETHINYL ESTRADIOL 35 MCG TABLET [10742]

Facility

$4.00

Service Code	NDC 00555901058
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

NORFLURANE-PENTAFLUOROPROPANE TOPICAL SPRAY [39802]

Facility

$118.00

Service Code	NDC 00803000000
Hospital Revenue Code	637
Min. Negotiated Rate	$36.58
Max. Negotiated Rate	$114.46
Rate for Payer: AlohaCare Medicaid	$59.00
Rate for Payer: AlohaCare Medicare	$36.58
Rate for Payer: Cash Price	$70.80
Rate for Payer: Devoted Health Medicare	$40.12
Rate for Payer: Hawaii Medical Service Association Medicare	$36.58
Rate for Payer: Hawaii Western Management Group Commercial	$112.10
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Humana Medicare	$36.58
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: Kaiser Permanente Medicaid	$60.18
Rate for Payer: Kaiser Permanente Medicare	$36.58
Rate for Payer: MDX Hawaii PPO	$114.46
Rate for Payer: Ohana Health Plan Medicaid	$36.58
Rate for Payer: Ohana Health Plan Medicare	$36.58
Rate for Payer: UnitedHealthcare Medicare	$36.58
Rate for Payer: University Health Alliance Commercial	$86.01

NORFLURANE-PENTAFLUOROPROPANE TOPICAL SPRAY [39802]

Facility

$123.00

Service Code	NDC 00802000000
Hospital Revenue Code	637
Min. Negotiated Rate	$38.13
Max. Negotiated Rate	$119.31
Rate for Payer: AlohaCare Medicaid	$61.50
Rate for Payer: AlohaCare Medicare	$38.13
Rate for Payer: Cash Price	$73.80
Rate for Payer: Devoted Health Medicare	$41.82
Rate for Payer: Hawaii Medical Service Association Medicare	$38.13
Rate for Payer: Hawaii Western Management Group Commercial	$116.85
Rate for Payer: Health Management Network Commercial	$104.55
Rate for Payer: Humana Medicare	$38.13
Rate for Payer: Kaiser Permanente Commercial	$110.70
Rate for Payer: Kaiser Permanente Medicaid	$62.73
Rate for Payer: Kaiser Permanente Medicare	$38.13
Rate for Payer: MDX Hawaii PPO	$119.31
Rate for Payer: Ohana Health Plan Medicaid	$38.13
Rate for Payer: Ohana Health Plan Medicare	$38.13
Rate for Payer: UnitedHealthcare Medicare	$38.13
Rate for Payer: University Health Alliance Commercial	$89.65

NORFLURANE-PENTAFLUOROPROPANE TOPICAL SPRAY [39802]

Facility

$123.00

Service Code	NDC 00802000000
Hospital Revenue Code	250
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$119.31
Rate for Payer: Cash Price	$73.80
Rate for Payer: Health Management Network Commercial	$104.55
Rate for Payer: Kaiser Permanente Commercial	$110.70
Rate for Payer: MDX Hawaii PPO	$119.31

NORFLURANE-PENTAFLUOROPROPANE TOPICAL SPRAY [39802]

Facility

$118.00

Service Code	NDC 00803000000
Hospital Revenue Code	250
Min. Negotiated Rate	$100.30
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$70.80
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: MDX Hawaii PPO	$114.46

Know your out-of-pocket cost for care.

All Charges