Kau Hospital

All Charges

Charge

Type

Setting

Price

NURSE VISIT ONLY - FACILITY ONLY

Facility

$513.00

Service Code	HCPCS G0463
Hospital Charge Code	761G046302
Hospital Revenue Code	761
Min. Negotiated Rate	$436.05
Max. Negotiated Rate	$497.61
Rate for Payer: Cash Price	$307.80
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Kaiser Permanente Commercial	$461.70
Rate for Payer: MDX Hawaii PPO	$497.61

NURSE VISIT ONLY - FACILITY ONLY

Facility

$513.00

Service Code	HCPCS G0463
Hospital Charge Code	761G046302
Hospital Revenue Code	761
Min. Negotiated Rate	$96.65
Max. Negotiated Rate	$497.61
Rate for Payer: AlohaCare Medicaid	$256.50
Rate for Payer: AlohaCare Medicare	$159.03
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Devoted Health Medicare	$174.42
Rate for Payer: Hawaii Medical Service Association Commercial	$170.03
Rate for Payer: Hawaii Medical Service Association Medicare	$159.03
Rate for Payer: Hawaii Western Management Group Commercial	$487.35
Rate for Payer: Health Management Network Commercial	$436.05
Rate for Payer: Humana Medicare	$159.03
Rate for Payer: Kaiser Permanente Commercial	$461.70
Rate for Payer: Kaiser Permanente Medicaid	$261.63
Rate for Payer: Kaiser Permanente Medicare	$159.03
Rate for Payer: MDX Hawaii PPO	$497.61
Rate for Payer: Ohana Health Plan Medicaid	$159.03
Rate for Payer: Ohana Health Plan Medicare	$159.03
Rate for Payer: UnitedHealthcare Medicaid	$96.65
Rate for Payer: UnitedHealthcare Medicare	$159.03
Rate for Payer: University Health Alliance Commercial	$373.93

NUSHIELD NO-1440

Facility

$2,850.00

Service Code	HCPCS Q4160
Hospital Revenue Code	636
Min. Negotiated Rate	$158.93
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$883.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$969.00
Rate for Payer: Hawaii Medical Service Association ABD	$530.00
Rate for Payer: Hawaii Medical Service Association Commercial	$158.93
Rate for Payer: Hawaii Medical Service Association Medicare	$883.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$530.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,707.50
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$883.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$883.50
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$883.50
Rate for Payer: Ohana Health Plan Medicare	$883.50
Rate for Payer: UnitedHealthcare Medicaid	$1,710.00
Rate for Payer: UnitedHealthcare Medicare	$883.50
Rate for Payer: University Health Alliance Commercial	$2,077.36

NUSHIELD NO-1440

Facility

$2,850.00

Service Code	HCPCS Q4160
Hospital Revenue Code	636
Min. Negotiated Rate	$2,422.50
Max. Negotiated Rate	$2,764.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: MDX Hawaii PPO	$2,764.50

NXGN GH 14MM 00-5964-050-14

Facility

$2,803.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.68
Max. Negotiated Rate	$2,718.91
Rate for Payer: Cash Price	$1,681.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,962.10
Rate for Payer: Health Management Network Commercial	$2,382.55
Rate for Payer: Kaiser Permanente Commercial	$2,522.70
Rate for Payer: MDX Hawaii PPO	$2,718.91
Rate for Payer: University Health Alliance Commercial	$1,569.68

NXGN GH 14MM 00-5964-050-14

Facility

$2,803.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$868.93
Max. Negotiated Rate	$2,718.91
Rate for Payer: AlohaCare Medicaid	$1,401.50
Rate for Payer: AlohaCare Medicare	$868.93
Rate for Payer: Cash Price	$1,681.80
Rate for Payer: Devoted Health Medicare	$953.02
Rate for Payer: Hawaii Medical Service Association Medicare	$868.93
Rate for Payer: Hawaii Western Management Group Commercial	$1,962.10
Rate for Payer: Health Management Network Commercial	$2,382.55
Rate for Payer: Humana Medicare	$868.93
Rate for Payer: Kaiser Permanente Commercial	$2,522.70
Rate for Payer: Kaiser Permanente Medicaid	$1,429.53
Rate for Payer: Kaiser Permanente Medicare	$868.93
Rate for Payer: MDX Hawaii PPO	$2,718.91
Rate for Payer: Ohana Health Plan Medicaid	$868.93
Rate for Payer: Ohana Health Plan Medicare	$868.93
Rate for Payer: UnitedHealthcare Medicare	$868.93
Rate for Payer: University Health Alliance Commercial	$1,569.68

NXGN PATEL 32MM 00-5972-066-32

Facility

$3,288.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,841.28
Max. Negotiated Rate	$3,189.36
Rate for Payer: Cash Price	$1,972.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,301.60
Rate for Payer: Health Management Network Commercial	$2,794.80
Rate for Payer: Kaiser Permanente Commercial	$2,959.20
Rate for Payer: MDX Hawaii PPO	$3,189.36
Rate for Payer: University Health Alliance Commercial	$1,841.28

NXGN PATEL 32MM 00-5972-066-32

Facility

$3,288.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,019.28
Max. Negotiated Rate	$3,189.36
Rate for Payer: AlohaCare Medicaid	$1,644.00
Rate for Payer: AlohaCare Medicare	$1,019.28
Rate for Payer: Cash Price	$1,972.80
Rate for Payer: Devoted Health Medicare	$1,117.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,019.28
Rate for Payer: Hawaii Western Management Group Commercial	$2,301.60
Rate for Payer: Health Management Network Commercial	$2,794.80
Rate for Payer: Humana Medicare	$1,019.28
Rate for Payer: Kaiser Permanente Commercial	$2,959.20
Rate for Payer: Kaiser Permanente Medicaid	$1,676.88
Rate for Payer: Kaiser Permanente Medicare	$1,019.28
Rate for Payer: MDX Hawaii PPO	$3,189.36
Rate for Payer: Ohana Health Plan Medicaid	$1,019.28
Rate for Payer: Ohana Health Plan Medicare	$1,019.28
Rate for Payer: UnitedHealthcare Medicare	$1,019.28
Rate for Payer: University Health Alliance Commercial	$1,841.28

NXGN PATEL 35MM 00-5972-066-35

Facility

$3,288.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,841.28
Max. Negotiated Rate	$3,189.36
Rate for Payer: Cash Price	$1,972.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,301.60
Rate for Payer: Health Management Network Commercial	$2,794.80
Rate for Payer: Kaiser Permanente Commercial	$2,959.20
Rate for Payer: MDX Hawaii PPO	$3,189.36
Rate for Payer: University Health Alliance Commercial	$1,841.28

NXGN PATEL 35MM 00-5972-066-35

Facility

$3,288.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,019.28
Max. Negotiated Rate	$3,189.36
Rate for Payer: AlohaCare Medicaid	$1,644.00
Rate for Payer: AlohaCare Medicare	$1,019.28
Rate for Payer: Cash Price	$1,972.80
Rate for Payer: Devoted Health Medicare	$1,117.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,019.28
Rate for Payer: Hawaii Western Management Group Commercial	$2,301.60
Rate for Payer: Health Management Network Commercial	$2,794.80
Rate for Payer: Humana Medicare	$1,019.28
Rate for Payer: Kaiser Permanente Commercial	$2,959.20
Rate for Payer: Kaiser Permanente Medicaid	$1,676.88
Rate for Payer: Kaiser Permanente Medicare	$1,019.28
Rate for Payer: MDX Hawaii PPO	$3,189.36
Rate for Payer: Ohana Health Plan Medicaid	$1,019.28
Rate for Payer: Ohana Health Plan Medicare	$1,019.28
Rate for Payer: UnitedHealthcare Medicare	$1,019.28
Rate for Payer: University Health Alliance Commercial	$1,841.28

NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM [5749]

Facility

$62.00

Service Code	NDC 00713067815
Hospital Revenue Code	637
Min. Negotiated Rate	$19.22
Max. Negotiated Rate	$60.14
Rate for Payer: AlohaCare Medicaid	$31.00
Rate for Payer: AlohaCare Medicare	$19.22
Rate for Payer: Cash Price	$37.20
Rate for Payer: Devoted Health Medicare	$21.08
Rate for Payer: Hawaii Medical Service Association Medicare	$19.22
Rate for Payer: Hawaii Western Management Group Commercial	$58.90
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: Humana Medicare	$19.22
Rate for Payer: Kaiser Permanente Commercial	$55.80
Rate for Payer: Kaiser Permanente Medicaid	$31.62
Rate for Payer: Kaiser Permanente Medicare	$19.22
Rate for Payer: MDX Hawaii PPO	$60.14
Rate for Payer: Ohana Health Plan Medicaid	$19.22
Rate for Payer: Ohana Health Plan Medicare	$19.22
Rate for Payer: UnitedHealthcare Medicare	$19.22
Rate for Payer: University Health Alliance Commercial	$45.19

NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM [5749]

Facility

$62.00

Service Code	NDC 00713067815
Hospital Revenue Code	250
Min. Negotiated Rate	$52.70
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$37.20
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: Kaiser Permanente Commercial	$55.80
Rate for Payer: MDX Hawaii PPO	$60.14

NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT [5750]

Facility

$62.00

Service Code	NDC 45802004835
Hospital Revenue Code	250
Min. Negotiated Rate	$52.70
Max. Negotiated Rate	$60.14
Rate for Payer: Cash Price	$37.20
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: Kaiser Permanente Commercial	$55.80
Rate for Payer: MDX Hawaii PPO	$60.14

NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT [5750]

Facility

$59.00

Service Code	NDC 72578008901
Hospital Revenue Code	637
Min. Negotiated Rate	$18.29
Max. Negotiated Rate	$57.23
Rate for Payer: AlohaCare Medicaid	$29.50
Rate for Payer: AlohaCare Medicare	$18.29
Rate for Payer: Cash Price	$35.40
Rate for Payer: Devoted Health Medicare	$20.06
Rate for Payer: Hawaii Medical Service Association Medicare	$18.29
Rate for Payer: Hawaii Western Management Group Commercial	$56.05
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: Humana Medicare	$18.29
Rate for Payer: Kaiser Permanente Commercial	$53.10
Rate for Payer: Kaiser Permanente Medicaid	$30.09
Rate for Payer: Kaiser Permanente Medicare	$18.29
Rate for Payer: MDX Hawaii PPO	$57.23
Rate for Payer: Ohana Health Plan Medicaid	$18.29
Rate for Payer: Ohana Health Plan Medicare	$18.29
Rate for Payer: UnitedHealthcare Medicare	$18.29
Rate for Payer: University Health Alliance Commercial	$43.01

NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT [5750]

Facility

$62.00

Service Code	NDC 45802004835
Hospital Revenue Code	637
Min. Negotiated Rate	$19.22
Max. Negotiated Rate	$60.14
Rate for Payer: AlohaCare Medicaid	$31.00
Rate for Payer: AlohaCare Medicare	$19.22
Rate for Payer: Cash Price	$37.20
Rate for Payer: Devoted Health Medicare	$21.08
Rate for Payer: Hawaii Medical Service Association Medicare	$19.22
Rate for Payer: Hawaii Western Management Group Commercial	$58.90
Rate for Payer: Health Management Network Commercial	$52.70
Rate for Payer: Humana Medicare	$19.22
Rate for Payer: Kaiser Permanente Commercial	$55.80
Rate for Payer: Kaiser Permanente Medicaid	$31.62
Rate for Payer: Kaiser Permanente Medicare	$19.22
Rate for Payer: MDX Hawaii PPO	$60.14
Rate for Payer: Ohana Health Plan Medicaid	$19.22
Rate for Payer: Ohana Health Plan Medicare	$19.22
Rate for Payer: UnitedHealthcare Medicare	$19.22
Rate for Payer: University Health Alliance Commercial	$45.19

NYSTATIN 100,000 UNIT/GRAM TOPICAL OINTMENT [5750]

Facility

$59.00

Service Code	NDC 72578008901
Hospital Revenue Code	250
Min. Negotiated Rate	$50.15
Max. Negotiated Rate	$57.23
Rate for Payer: Cash Price	$35.40
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: Kaiser Permanente Commercial	$53.10
Rate for Payer: MDX Hawaii PPO	$57.23

NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [39136]

Facility

$336.00

Service Code	NDC 00574200802
Hospital Revenue Code	250
Min. Negotiated Rate	$285.60
Max. Negotiated Rate	$325.92
Rate for Payer: Cash Price	$201.60
Rate for Payer: Health Management Network Commercial	$285.60
Rate for Payer: Kaiser Permanente Commercial	$302.40
Rate for Payer: MDX Hawaii PPO	$325.92

NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [39136]

Facility

$336.00

Service Code	NDC 00574200802
Hospital Revenue Code	637
Min. Negotiated Rate	$104.16
Max. Negotiated Rate	$325.92
Rate for Payer: AlohaCare Medicaid	$168.00
Rate for Payer: AlohaCare Medicare	$104.16
Rate for Payer: Cash Price	$201.60
Rate for Payer: Devoted Health Medicare	$114.24
Rate for Payer: Hawaii Medical Service Association Medicare	$104.16
Rate for Payer: Hawaii Western Management Group Commercial	$319.20
Rate for Payer: Health Management Network Commercial	$285.60
Rate for Payer: Humana Medicare	$104.16
Rate for Payer: Kaiser Permanente Commercial	$302.40
Rate for Payer: Kaiser Permanente Medicaid	$171.36
Rate for Payer: Kaiser Permanente Medicare	$104.16
Rate for Payer: MDX Hawaii PPO	$325.92
Rate for Payer: Ohana Health Plan Medicaid	$104.16
Rate for Payer: Ohana Health Plan Medicare	$104.16
Rate for Payer: UnitedHealthcare Medicare	$104.16
Rate for Payer: University Health Alliance Commercial	$244.91

NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [39136]

Facility

$77.00

Service Code	NDC 68308015215
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

NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [39136]

Facility

$97.00

Service Code	NDC 00574200815
Hospital Revenue Code	637
Min. Negotiated Rate	$30.07
Max. Negotiated Rate	$94.09
Rate for Payer: AlohaCare Medicaid	$48.50
Rate for Payer: AlohaCare Medicare	$30.07
Rate for Payer: Cash Price	$58.20
Rate for Payer: Devoted Health Medicare	$32.98
Rate for Payer: Hawaii Medical Service Association Medicare	$30.07
Rate for Payer: Hawaii Western Management Group Commercial	$92.15
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Humana Medicare	$30.07
Rate for Payer: Kaiser Permanente Commercial	$87.30
Rate for Payer: Kaiser Permanente Medicaid	$49.47
Rate for Payer: Kaiser Permanente Medicare	$30.07
Rate for Payer: MDX Hawaii PPO	$94.09
Rate for Payer: Ohana Health Plan Medicaid	$30.07
Rate for Payer: Ohana Health Plan Medicare	$30.07
Rate for Payer: UnitedHealthcare Medicare	$30.07
Rate for Payer: University Health Alliance Commercial	$70.70

NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [39136]

Facility

$77.00

Service Code	NDC 68308015215
Hospital Revenue Code	637
Min. Negotiated Rate	$23.87
Max. Negotiated Rate	$74.69
Rate for Payer: AlohaCare Medicaid	$38.50
Rate for Payer: AlohaCare Medicare	$23.87
Rate for Payer: Cash Price	$46.20
Rate for Payer: Devoted Health Medicare	$26.18
Rate for Payer: Hawaii Medical Service Association Medicare	$23.87
Rate for Payer: Hawaii Western Management Group Commercial	$73.15
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Humana Medicare	$23.87
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: Kaiser Permanente Medicaid	$39.27
Rate for Payer: Kaiser Permanente Medicare	$23.87
Rate for Payer: MDX Hawaii PPO	$74.69
Rate for Payer: Ohana Health Plan Medicaid	$23.87
Rate for Payer: Ohana Health Plan Medicare	$23.87
Rate for Payer: UnitedHealthcare Medicare	$23.87
Rate for Payer: University Health Alliance Commercial	$56.13

NYSTATIN 100,000 UNIT/GRAM TOPICAL POWDER [39136]

Facility

$97.00

Service Code	NDC 00574200815
Hospital Revenue Code	250
Min. Negotiated Rate	$82.45
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$58.20
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Kaiser Permanente Commercial	$87.30
Rate for Payer: MDX Hawaii PPO	$94.09

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]

Facility

$51.00

Service Code	NDC 66689000802
Hospital Revenue Code	637
Min. Negotiated Rate	$15.81
Max. Negotiated Rate	$49.47
Rate for Payer: AlohaCare Medicaid	$25.50
Rate for Payer: AlohaCare Medicare	$15.81
Rate for Payer: Cash Price	$30.60
Rate for Payer: Devoted Health Medicare	$17.34
Rate for Payer: Hawaii Medical Service Association Medicare	$15.81
Rate for Payer: Hawaii Western Management Group Commercial	$48.45
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Humana Medicare	$15.81
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: Kaiser Permanente Medicaid	$26.01
Rate for Payer: Kaiser Permanente Medicare	$15.81
Rate for Payer: MDX Hawaii PPO	$49.47
Rate for Payer: Ohana Health Plan Medicaid	$15.81
Rate for Payer: Ohana Health Plan Medicare	$15.81
Rate for Payer: UnitedHealthcare Medicare	$15.81
Rate for Payer: University Health Alliance Commercial	$37.17

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]

Facility

$51.00

Service Code	NDC 66689000802
Hospital Revenue Code	250
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$49.47
Rate for Payer: Cash Price	$30.60
Rate for Payer: Health Management Network Commercial	$43.35
Rate for Payer: Kaiser Permanente Commercial	$45.90
Rate for Payer: MDX Hawaii PPO	$49.47

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION [5751]

Facility

$8.00

Service Code	NDC 60687080040
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

Know your out-of-pocket cost for care.

All Charges