Kau Hospital

All Charges

Charge

Type

Setting

Price

SPIRONOLACTONE 100 MG TABLET [11425]

Facility

$5.00

Service Code	NDC 53489032901
Hospital Revenue Code	637
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$1.55
Rate for Payer: Cash Price	$3.00
Rate for Payer: Devoted Health Medicare	$1.70
Rate for Payer: Hawaii Medical Service Association Medicare	$1.55
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$1.55
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$1.55
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$1.55
Rate for Payer: Ohana Health Plan Medicare	$1.55
Rate for Payer: UnitedHealthcare Medicare	$1.55
Rate for Payer: University Health Alliance Commercial	$3.64

SPIRONOLACTONE 100 MG TABLET [11425]

Facility

$5.00

Service Code	NDC 16729022701
Hospital Revenue Code	637
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$1.55
Rate for Payer: Cash Price	$3.00
Rate for Payer: Devoted Health Medicare	$1.70
Rate for Payer: Hawaii Medical Service Association Medicare	$1.55
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$1.55
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$1.55
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$1.55
Rate for Payer: Ohana Health Plan Medicare	$1.55
Rate for Payer: UnitedHealthcare Medicare	$1.55
Rate for Payer: University Health Alliance Commercial	$3.64

SPIRONOLACTONE 100 MG TABLET [11425]

Facility

$5.00

Service Code	NDC 51079098008
Hospital Revenue Code	637
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$1.55
Rate for Payer: Cash Price	$3.00
Rate for Payer: Devoted Health Medicare	$1.70
Rate for Payer: Hawaii Medical Service Association Medicare	$1.55
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$1.55
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$1.55
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$1.55
Rate for Payer: Ohana Health Plan Medicare	$1.55
Rate for Payer: UnitedHealthcare Medicare	$1.55
Rate for Payer: University Health Alliance Commercial	$3.64

SPIRONOLACTONE 100 MG TABLET [11425]

Facility

$5.00

Service Code	NDC 53489032901
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

SPIRONOLACTONE 100 MG TABLET [11425]

Facility

$5.00

Service Code	NDC 51079098008
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

SPIRONOLACTONE 25 MG TABLET [7437]

Facility

$1.00

Service Code	NDC 60687046511
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

SPIRONOLACTONE 25 MG TABLET [7437]

Facility

$1.00

Service Code	NDC 60687046501
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

SPIRONOLACTONE 25 MG TABLET [7437]

Facility

$1.00

Service Code	NDC 60687046511
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

SPIRONOLACTONE 25 MG TABLET [7437]

Facility

$1.00

Service Code	NDC 60687046501
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

SPLENIC PROCEDURES WITH CC

Facility

$43,730.19

Service Code	MSDRG 800
Min. Negotiated Rate	$43,730.19
Max. Negotiated Rate	$43,730.19
Rate for Payer: Hawaii Medical Service Association Commercial	$43,730.19

SPLENIC PROCEDURES WITH MCC

Facility

$43,730.19

Service Code	MSDRG 799
Min. Negotiated Rate	$43,730.19
Max. Negotiated Rate	$43,730.19
Rate for Payer: Hawaii Medical Service Association Commercial	$43,730.19

SPLENIC PROCEDURES WITHOUT CC/MCC

Facility

$43,730.19

Service Code	MSDRG 801
Min. Negotiated Rate	$43,730.19
Max. Negotiated Rate	$43,730.19
Rate for Payer: Hawaii Medical Service Association Commercial	$43,730.19

SPLINT #10-1500-10NKL

Facility

$157.00

Hospital Revenue Code	272
Min. Negotiated Rate	$133.45
Max. Negotiated Rate	$152.29
Rate for Payer: Cash Price	$94.20
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: Kaiser Permanente Commercial	$141.30
Rate for Payer: MDX Hawaii PPO	$152.29

SPLINT #10-1500-10NKL

Facility

$157.00

Hospital Revenue Code	272
Min. Negotiated Rate	$48.67
Max. Negotiated Rate	$152.29
Rate for Payer: AlohaCare Medicaid	$78.50
Rate for Payer: AlohaCare Medicare	$48.67
Rate for Payer: Cash Price	$94.20
Rate for Payer: Devoted Health Medicare	$53.38
Rate for Payer: Hawaii Medical Service Association Medicare	$48.67
Rate for Payer: Hawaii Western Management Group Commercial	$149.15
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: Humana Medicare	$48.67
Rate for Payer: Kaiser Permanente Commercial	$141.30
Rate for Payer: Kaiser Permanente Medicaid	$80.07
Rate for Payer: Kaiser Permanente Medicare	$48.67
Rate for Payer: MDX Hawaii PPO	$152.29
Rate for Payer: Ohana Health Plan Medicaid	$48.67
Rate for Payer: Ohana Health Plan Medicare	$48.67
Rate for Payer: UnitedHealthcare Medicare	$48.67
Rate for Payer: University Health Alliance Commercial	$114.44

SPLINT DENVER SM 10-1500-05KS

Facility

$260.00

Hospital Revenue Code	272
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$252.20
Rate for Payer: Cash Price	$156.00
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: Kaiser Permanente Commercial	$234.00
Rate for Payer: MDX Hawaii PPO	$252.20

SPLINT DENVER SM 10-1500-05KS

Facility

$260.00

Hospital Revenue Code	272
Min. Negotiated Rate	$80.60
Max. Negotiated Rate	$252.20
Rate for Payer: AlohaCare Medicaid	$130.00
Rate for Payer: AlohaCare Medicare	$80.60
Rate for Payer: Cash Price	$156.00
Rate for Payer: Devoted Health Medicare	$88.40
Rate for Payer: Hawaii Medical Service Association Medicare	$80.60
Rate for Payer: Hawaii Western Management Group Commercial	$247.00
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: Humana Medicare	$80.60
Rate for Payer: Kaiser Permanente Commercial	$234.00
Rate for Payer: Kaiser Permanente Medicaid	$132.60
Rate for Payer: Kaiser Permanente Medicare	$80.60
Rate for Payer: MDX Hawaii PPO	$252.20
Rate for Payer: Ohana Health Plan Medicaid	$80.60
Rate for Payer: Ohana Health Plan Medicare	$80.60
Rate for Payer: UnitedHealthcare Medicare	$80.60
Rate for Payer: University Health Alliance Commercial	$189.51

SPLINT EXTERNAL NASAL

Facility

$246.00

Hospital Revenue Code	272
Min. Negotiated Rate	$76.26
Max. Negotiated Rate	$238.62
Rate for Payer: AlohaCare Medicaid	$123.00
Rate for Payer: AlohaCare Medicare	$76.26
Rate for Payer: Cash Price	$147.60
Rate for Payer: Devoted Health Medicare	$83.64
Rate for Payer: Hawaii Medical Service Association Medicare	$76.26
Rate for Payer: Hawaii Western Management Group Commercial	$233.70
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: Humana Medicare	$76.26
Rate for Payer: Kaiser Permanente Commercial	$221.40
Rate for Payer: Kaiser Permanente Medicaid	$125.46
Rate for Payer: Kaiser Permanente Medicare	$76.26
Rate for Payer: MDX Hawaii PPO	$238.62
Rate for Payer: Ohana Health Plan Medicaid	$76.26
Rate for Payer: Ohana Health Plan Medicare	$76.26
Rate for Payer: UnitedHealthcare Medicare	$76.26
Rate for Payer: University Health Alliance Commercial	$179.31

SPLINT EXTERNAL NASAL

Facility

$246.00

Hospital Revenue Code	272
Min. Negotiated Rate	$209.10
Max. Negotiated Rate	$238.62
Rate for Payer: Cash Price	$147.60
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: Kaiser Permanente Commercial	$221.40
Rate for Payer: MDX Hawaii PPO	$238.62

SPLINT INTRANASAL

Facility

$340.00

Hospital Revenue Code	272
Min. Negotiated Rate	$289.00
Max. Negotiated Rate	$329.80
Rate for Payer: Cash Price	$204.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Kaiser Permanente Commercial	$306.00
Rate for Payer: MDX Hawaii PPO	$329.80

SPLINT INTRANASAL

Facility

$340.00

Hospital Revenue Code	272
Min. Negotiated Rate	$105.40
Max. Negotiated Rate	$329.80
Rate for Payer: AlohaCare Medicaid	$170.00
Rate for Payer: AlohaCare Medicare	$105.40
Rate for Payer: Cash Price	$204.00
Rate for Payer: Devoted Health Medicare	$115.60
Rate for Payer: Hawaii Medical Service Association Medicare	$105.40
Rate for Payer: Hawaii Western Management Group Commercial	$323.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Humana Medicare	$105.40
Rate for Payer: Kaiser Permanente Commercial	$306.00
Rate for Payer: Kaiser Permanente Medicaid	$173.40
Rate for Payer: Kaiser Permanente Medicare	$105.40
Rate for Payer: MDX Hawaii PPO	$329.80
Rate for Payer: Ohana Health Plan Medicaid	$105.40
Rate for Payer: Ohana Health Plan Medicare	$105.40
Rate for Payer: UnitedHealthcare Medicare	$105.40
Rate for Payer: University Health Alliance Commercial	$247.83

SPLINT NASAL FIRM 4CM

Facility

$562.00

Hospital Revenue Code	272
Min. Negotiated Rate	$477.70
Max. Negotiated Rate	$545.14
Rate for Payer: Cash Price	$337.20
Rate for Payer: Health Management Network Commercial	$477.70
Rate for Payer: Kaiser Permanente Commercial	$505.80
Rate for Payer: MDX Hawaii PPO	$545.14

SPLINT NASAL FIRM 4CM

Facility

$562.00

Hospital Revenue Code	272
Min. Negotiated Rate	$174.22
Max. Negotiated Rate	$545.14
Rate for Payer: AlohaCare Medicaid	$281.00
Rate for Payer: AlohaCare Medicare	$174.22
Rate for Payer: Cash Price	$337.20
Rate for Payer: Devoted Health Medicare	$191.08
Rate for Payer: Hawaii Medical Service Association Medicare	$174.22
Rate for Payer: Hawaii Western Management Group Commercial	$533.90
Rate for Payer: Health Management Network Commercial	$477.70
Rate for Payer: Humana Medicare	$174.22
Rate for Payer: Kaiser Permanente Commercial	$505.80
Rate for Payer: Kaiser Permanente Medicaid	$286.62
Rate for Payer: Kaiser Permanente Medicare	$174.22
Rate for Payer: MDX Hawaii PPO	$545.14
Rate for Payer: Ohana Health Plan Medicaid	$174.22
Rate for Payer: Ohana Health Plan Medicare	$174.22
Rate for Payer: UnitedHealthcare Medicare	$174.22
Rate for Payer: University Health Alliance Commercial	$409.64

SPLINT NASAL MED

Facility

$184.00

Hospital Revenue Code	272
Min. Negotiated Rate	$156.40
Max. Negotiated Rate	$178.48
Rate for Payer: Cash Price	$110.40
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: MDX Hawaii PPO	$178.48

SPLINT NASAL MED

Facility

$184.00

Hospital Revenue Code	272
Min. Negotiated Rate	$57.04
Max. Negotiated Rate	$178.48
Rate for Payer: AlohaCare Medicaid	$92.00
Rate for Payer: AlohaCare Medicare	$57.04
Rate for Payer: Cash Price	$110.40
Rate for Payer: Devoted Health Medicare	$62.56
Rate for Payer: Hawaii Medical Service Association Medicare	$57.04
Rate for Payer: Hawaii Western Management Group Commercial	$174.80
Rate for Payer: Health Management Network Commercial	$156.40
Rate for Payer: Humana Medicare	$57.04
Rate for Payer: Kaiser Permanente Commercial	$165.60
Rate for Payer: Kaiser Permanente Medicaid	$93.84
Rate for Payer: Kaiser Permanente Medicare	$57.04
Rate for Payer: MDX Hawaii PPO	$178.48
Rate for Payer: Ohana Health Plan Medicaid	$57.04
Rate for Payer: Ohana Health Plan Medicare	$57.04
Rate for Payer: UnitedHealthcare Medicare	$57.04
Rate for Payer: University Health Alliance Commercial	$134.12

SPONGE ENDO PEANUT

Facility

$88.00

Hospital Revenue Code	272
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$52.80
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Kaiser Permanente Commercial	$79.20
Rate for Payer: MDX Hawaii PPO	$85.36

Know your out-of-pocket cost for care.

All Charges