Kau Hospital

All Charges

Charge

Type

Setting

Price

OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]

Facility

$7.00

Service Code	NDC 00406051223
Hospital Revenue Code	637
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$6.79
Rate for Payer: AlohaCare Medicaid	$3.50
Rate for Payer: AlohaCare Medicare	$2.17
Rate for Payer: Cash Price	$4.20
Rate for Payer: Devoted Health Medicare	$2.38
Rate for Payer: Hawaii Medical Service Association Medicare	$2.17
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Humana Medicare	$2.17
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: Kaiser Permanente Medicare	$2.17
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: Ohana Health Plan Medicaid	$2.17
Rate for Payer: Ohana Health Plan Medicare	$2.17
Rate for Payer: UnitedHealthcare Medicare	$2.17
Rate for Payer: University Health Alliance Commercial	$5.10

OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET [5940]

Facility

$5.00

Service Code	NDC 60687064201
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.00
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [122363]

Facility

$21.00

Service Code	NDC 59011041020
Hospital Revenue Code	637
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$20.37
Rate for Payer: AlohaCare Medicaid	$10.50
Rate for Payer: AlohaCare Medicare	$6.51
Rate for Payer: Cash Price	$12.60
Rate for Payer: Devoted Health Medicare	$7.14
Rate for Payer: Hawaii Medical Service Association Medicare	$6.51
Rate for Payer: Hawaii Western Management Group Commercial	$19.95
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Humana Medicare	$6.51
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: Kaiser Permanente Medicare	$6.51
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: Ohana Health Plan Medicaid	$6.51
Rate for Payer: Ohana Health Plan Medicare	$6.51
Rate for Payer: UnitedHealthcare Medicare	$6.51
Rate for Payer: University Health Alliance Commercial	$15.31

OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [122363]

Facility

$21.00

Service Code	NDC 59011041020
Hospital Revenue Code	250
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$12.60
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: MDX Hawaii PPO	$20.37

OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [122366]

Facility

$33.00

Service Code	NDC 59011042020
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

OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [122366]

Facility

$33.00

Service Code	NDC 59011042020
Hospital Revenue Code	637
Min. Negotiated Rate	$10.23
Max. Negotiated Rate	$32.01
Rate for Payer: AlohaCare Medicaid	$16.50
Rate for Payer: AlohaCare Medicare	$10.23
Rate for Payer: Cash Price	$19.80
Rate for Payer: Devoted Health Medicare	$11.22
Rate for Payer: Hawaii Medical Service Association Medicare	$10.23
Rate for Payer: Hawaii Western Management Group Commercial	$31.35
Rate for Payer: Health Management Network Commercial	$28.05
Rate for Payer: Humana Medicare	$10.23
Rate for Payer: Kaiser Permanente Commercial	$29.70
Rate for Payer: Kaiser Permanente Medicaid	$16.83
Rate for Payer: Kaiser Permanente Medicare	$10.23
Rate for Payer: MDX Hawaii PPO	$32.01
Rate for Payer: Ohana Health Plan Medicaid	$10.23
Rate for Payer: Ohana Health Plan Medicare	$10.23
Rate for Payer: UnitedHealthcare Medicare	$10.23
Rate for Payer: University Health Alliance Commercial	$24.05

OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [122368]

Facility

$56.00

Service Code	NDC 59011044020
Hospital Revenue Code	250
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$33.60
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Kaiser Permanente Commercial	$50.40
Rate for Payer: MDX Hawaii PPO	$54.32

OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR [122368]

Facility

$56.00

Service Code	NDC 59011044020
Hospital Revenue Code	637
Min. Negotiated Rate	$17.36
Max. Negotiated Rate	$54.32
Rate for Payer: AlohaCare Medicaid	$28.00
Rate for Payer: AlohaCare Medicare	$17.36
Rate for Payer: Cash Price	$33.60
Rate for Payer: Devoted Health Medicare	$19.04
Rate for Payer: Hawaii Medical Service Association Medicare	$17.36
Rate for Payer: Hawaii Western Management Group Commercial	$53.20
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Humana Medicare	$17.36
Rate for Payer: Kaiser Permanente Commercial	$50.40
Rate for Payer: Kaiser Permanente Medicaid	$28.56
Rate for Payer: Kaiser Permanente Medicare	$17.36
Rate for Payer: MDX Hawaii PPO	$54.32
Rate for Payer: Ohana Health Plan Medicaid	$17.36
Rate for Payer: Ohana Health Plan Medicare	$17.36
Rate for Payer: UnitedHealthcare Medicare	$17.36
Rate for Payer: University Health Alliance Commercial	$40.82

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

$24.00

Service Code	NDC 46122016510
Hospital Revenue Code	250
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$14.40
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Kaiser Permanente Commercial	$21.60
Rate for Payer: MDX Hawaii PPO	$23.28

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

$10.00

Service Code	NDC 00904742730
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.00
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: MDX Hawaii PPO	$9.70

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

$24.00

Service Code	NDC 46122016510
Hospital Revenue Code	637
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$23.28
Rate for Payer: AlohaCare Medicaid	$12.00
Rate for Payer: AlohaCare Medicare	$7.44
Rate for Payer: Cash Price	$14.40
Rate for Payer: Devoted Health Medicare	$8.16
Rate for Payer: Hawaii Medical Service Association Medicare	$7.44
Rate for Payer: Hawaii Western Management Group Commercial	$22.80
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Humana Medicare	$7.44
Rate for Payer: Kaiser Permanente Commercial	$21.60
Rate for Payer: Kaiser Permanente Medicaid	$12.24
Rate for Payer: Kaiser Permanente Medicare	$7.44
Rate for Payer: MDX Hawaii PPO	$23.28
Rate for Payer: Ohana Health Plan Medicaid	$7.44
Rate for Payer: Ohana Health Plan Medicare	$7.44
Rate for Payer: UnitedHealthcare Medicare	$7.44
Rate for Payer: University Health Alliance Commercial	$17.49

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

$23.00

Service Code	NDC 81127000000
Hospital Revenue Code	637
Min. Negotiated Rate	$7.13
Max. Negotiated Rate	$22.31
Rate for Payer: AlohaCare Medicaid	$11.50
Rate for Payer: AlohaCare Medicare	$7.13
Rate for Payer: Cash Price	$13.80
Rate for Payer: Devoted Health Medicare	$7.82
Rate for Payer: Hawaii Medical Service Association Medicare	$7.13
Rate for Payer: Hawaii Western Management Group Commercial	$21.85
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Humana Medicare	$7.13
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: Kaiser Permanente Medicaid	$11.73
Rate for Payer: Kaiser Permanente Medicare	$7.13
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: Ohana Health Plan Medicaid	$7.13
Rate for Payer: Ohana Health Plan Medicare	$7.13
Rate for Payer: UnitedHealthcare Medicare	$7.13
Rate for Payer: University Health Alliance Commercial	$16.76

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

$10.00

Service Code	NDC 00904742730
Hospital Revenue Code	637
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$9.70
Rate for Payer: AlohaCare Medicaid	$5.00
Rate for Payer: AlohaCare Medicare	$3.10
Rate for Payer: Cash Price	$6.00
Rate for Payer: Devoted Health Medicare	$3.40
Rate for Payer: Hawaii Medical Service Association Medicare	$3.10
Rate for Payer: Hawaii Western Management Group Commercial	$9.50
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Humana Medicare	$3.10
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: Kaiser Permanente Medicaid	$5.10
Rate for Payer: Kaiser Permanente Medicare	$3.10
Rate for Payer: MDX Hawaii PPO	$9.70
Rate for Payer: Ohana Health Plan Medicaid	$3.10
Rate for Payer: Ohana Health Plan Medicare	$3.10
Rate for Payer: UnitedHealthcare Medicare	$3.10
Rate for Payer: University Health Alliance Commercial	$7.29

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

$1.00

Service Code	NDC 00904676130
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

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

$1.00

Service Code	NDC 00904676130
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

OXYMETAZOLINE 0.05 % NASAL SPRAY [5943]

Facility

$23.00

Service Code	NDC 81127000000
Hospital Revenue Code	250
Min. Negotiated Rate	$19.55
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$13.80
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: MDX Hawaii PPO	$22.31

OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]

Facility

$15.00

Service Code	NDC 63323001211
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$26.40
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Commercial	$39.60
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: MDX Hawaii PPO	$42.68

OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]

Facility

$15.00

Service Code	NDC 63323001203
Hospital Revenue Code	250
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

OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]

Facility

$59.00

Service Code	NDC 42023011602
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

OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]

Facility

$43.00

Service Code	NDC 63323001210
Hospital Revenue Code	250
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: MDX Hawaii PPO	$41.71

OXYTOCIN 10 UNIT/ML INJECTION SOLUTION [5944]

Facility

$7.00

Service Code	NDC 63323001207
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.20
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$6.79

OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS [136947]

Facility

$81.00

Service Code	NDC 70092106807
Hospital Revenue Code	250
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$48.60
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: Kaiser Permanente Commercial	$72.90
Rate for Payer: MDX Hawaii PPO	$78.57

OXYTOCIN 30 UNIT/500 ML IN NS BOLUS [4080179]

Facility

$81.00

Service Code	NDC 70092106807
Hospital Revenue Code	250
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$78.57
Rate for Payer: Cash Price	$48.60
Rate for Payer: Health Management Network Commercial	$68.85
Rate for Payer: Kaiser Permanente Commercial	$72.90
Rate for Payer: MDX Hawaii PPO	$78.57

OXYTOCIN 30 UNITS IN 500 ML NS (SIMPLE) [4080272]

Facility

$58.00

Service Code	NDC 00004080196
Hospital Revenue Code	250
Min. Negotiated Rate	$49.30
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$34.80
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Kaiser Permanente Commercial	$52.20
Rate for Payer: MDX Hawaii PPO	$56.26

PACEL BIPOLAR PACING CATH 5FR

Facility

$536.00

Hospital Revenue Code	272
Min. Negotiated Rate	$166.16
Max. Negotiated Rate	$519.92
Rate for Payer: AlohaCare Medicaid	$268.00
Rate for Payer: AlohaCare Medicare	$166.16
Rate for Payer: Cash Price	$321.60
Rate for Payer: Devoted Health Medicare	$182.24
Rate for Payer: Hawaii Medical Service Association Medicare	$166.16
Rate for Payer: Hawaii Western Management Group Commercial	$509.20
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: Humana Medicare	$166.16
Rate for Payer: Kaiser Permanente Commercial	$482.40
Rate for Payer: Kaiser Permanente Medicaid	$273.36
Rate for Payer: Kaiser Permanente Medicare	$166.16
Rate for Payer: MDX Hawaii PPO	$519.92
Rate for Payer: Ohana Health Plan Medicaid	$166.16
Rate for Payer: Ohana Health Plan Medicare	$166.16
Rate for Payer: UnitedHealthcare Medicare	$166.16
Rate for Payer: University Health Alliance Commercial	$390.69

Know your out-of-pocket cost for care.

All Charges