Kau Hospital

All Charges

Charge

Type

Setting

Price

RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [125686]

Facility

$13,508.00

Service Code	HCPCS J9308
Hospital Revenue Code	636
Min. Negotiated Rate	$74.45
Max. Negotiated Rate	$13,102.76
Rate for Payer: AlohaCare Medicaid	$6,754.00
Rate for Payer: AlohaCare Medicaid	$1,351.00
Rate for Payer: AlohaCare Medicare	$837.62
Rate for Payer: AlohaCare Medicare	$4,187.48
Rate for Payer: Cash Price	$1,621.20
Rate for Payer: Cash Price	$8,104.80
Rate for Payer: Cash Price	$8,104.80
Rate for Payer: Cash Price	$1,621.20
Rate for Payer: Devoted Health Medicare	$918.68
Rate for Payer: Devoted Health Medicare	$4,592.72
Rate for Payer: Hawaii Medical Service Association ABD	$74.45
Rate for Payer: Hawaii Medical Service Association ABD	$74.45
Rate for Payer: Hawaii Medical Service Association Commercial	$94.34
Rate for Payer: Hawaii Medical Service Association Commercial	$94.34
Rate for Payer: Hawaii Medical Service Association Medicare	$4,187.48
Rate for Payer: Hawaii Medical Service Association Medicare	$837.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$74.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$74.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,566.90
Rate for Payer: Hawaii Western Management Group Commercial	$12,832.60
Rate for Payer: Health Management Network Commercial	$2,296.70
Rate for Payer: Health Management Network Commercial	$11,481.80
Rate for Payer: Humana Medicare	$837.62
Rate for Payer: Humana Medicare	$4,187.48
Rate for Payer: Kaiser Permanente Commercial	$12,157.20
Rate for Payer: Kaiser Permanente Commercial	$2,431.80
Rate for Payer: Kaiser Permanente Medicaid	$1,378.02
Rate for Payer: Kaiser Permanente Medicaid	$6,889.08
Rate for Payer: Kaiser Permanente Medicare	$4,187.48
Rate for Payer: Kaiser Permanente Medicare	$837.62
Rate for Payer: MDX Hawaii PPO	$13,102.76
Rate for Payer: MDX Hawaii PPO	$2,620.94
Rate for Payer: Ohana Health Plan Medicaid	$4,187.48
Rate for Payer: Ohana Health Plan Medicaid	$837.62
Rate for Payer: Ohana Health Plan Medicare	$837.62
Rate for Payer: Ohana Health Plan Medicare	$4,187.48
Rate for Payer: UnitedHealthcare Medicaid	$1,621.20
Rate for Payer: UnitedHealthcare Medicaid	$8,104.80
Rate for Payer: UnitedHealthcare Medicare	$837.62
Rate for Payer: UnitedHealthcare Medicare	$4,187.48
Rate for Payer: University Health Alliance Commercial	$9,845.98
Rate for Payer: University Health Alliance Commercial	$1,969.49

RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION [125686]

Facility

$2,702.00

Service Code	HCPCS J9308
Hospital Revenue Code	250
Min. Negotiated Rate	$2,296.70
Max. Negotiated Rate	$2,620.94
Rate for Payer: Cash Price	$1,621.20
Rate for Payer: Cash Price	$8,104.80
Rate for Payer: Health Management Network Commercial	$2,296.70
Rate for Payer: Health Management Network Commercial	$11,481.80
Rate for Payer: Kaiser Permanente Commercial	$12,157.20
Rate for Payer: Kaiser Permanente Commercial	$2,431.80
Rate for Payer: MDX Hawaii PPO	$13,102.76
Rate for Payer: MDX Hawaii PPO	$2,620.94

RANGER DCB 4X100X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,054.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: AlohaCare Medicaid	$1,700.00
Rate for Payer: AlohaCare Medicare	$1,054.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Devoted Health Medicare	$1,156.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,054.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,230.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Humana Medicare	$1,054.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Medicaid	$1,734.00
Rate for Payer: Kaiser Permanente Medicare	$1,054.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: Ohana Health Plan Medicaid	$1,054.00
Rate for Payer: Ohana Health Plan Medicare	$1,054.00
Rate for Payer: UnitedHealthcare Medicare	$1,054.00
Rate for Payer: University Health Alliance Commercial	$2,478.26

RANGER DCB 4X100X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: MDX Hawaii PPO	$3,298.00

RANGER DCB 4X150X150

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: MDX Hawaii PPO	$3,298.00

RANGER DCB 4X150X150

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,054.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: AlohaCare Medicaid	$1,700.00
Rate for Payer: AlohaCare Medicare	$1,054.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Devoted Health Medicare	$1,156.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,054.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,230.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Humana Medicare	$1,054.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Medicaid	$1,734.00
Rate for Payer: Kaiser Permanente Medicare	$1,054.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: Ohana Health Plan Medicaid	$1,054.00
Rate for Payer: Ohana Health Plan Medicare	$1,054.00
Rate for Payer: UnitedHealthcare Medicare	$1,054.00
Rate for Payer: University Health Alliance Commercial	$2,478.26

RANGER DCB 4X40X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: MDX Hawaii PPO	$3,298.00

RANGER DCB 4X40X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,054.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: AlohaCare Medicaid	$1,700.00
Rate for Payer: AlohaCare Medicare	$1,054.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Devoted Health Medicare	$1,156.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,054.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,230.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Humana Medicare	$1,054.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Medicaid	$1,734.00
Rate for Payer: Kaiser Permanente Medicare	$1,054.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: Ohana Health Plan Medicaid	$1,054.00
Rate for Payer: Ohana Health Plan Medicare	$1,054.00
Rate for Payer: UnitedHealthcare Medicare	$1,054.00
Rate for Payer: University Health Alliance Commercial	$2,478.26

RANGER DCB 4X60X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,054.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: AlohaCare Medicaid	$1,700.00
Rate for Payer: AlohaCare Medicare	$1,054.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Devoted Health Medicare	$1,156.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,054.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,230.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Humana Medicare	$1,054.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Medicaid	$1,734.00
Rate for Payer: Kaiser Permanente Medicare	$1,054.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: Ohana Health Plan Medicaid	$1,054.00
Rate for Payer: Ohana Health Plan Medicare	$1,054.00
Rate for Payer: UnitedHealthcare Medicare	$1,054.00
Rate for Payer: University Health Alliance Commercial	$2,478.26

RANGER DCB 4X60X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: MDX Hawaii PPO	$3,298.00

RANGER DCB 5X100X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,054.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: AlohaCare Medicaid	$1,700.00
Rate for Payer: AlohaCare Medicare	$1,054.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Devoted Health Medicare	$1,156.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,054.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,230.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Humana Medicare	$1,054.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Medicaid	$1,734.00
Rate for Payer: Kaiser Permanente Medicare	$1,054.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: Ohana Health Plan Medicaid	$1,054.00
Rate for Payer: Ohana Health Plan Medicare	$1,054.00
Rate for Payer: UnitedHealthcare Medicare	$1,054.00
Rate for Payer: University Health Alliance Commercial	$2,478.26

RANGER DCB 5X100X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: MDX Hawaii PPO	$3,298.00

RANGER DCB 5X120X150

Facility

$3,590.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$3,051.50
Max. Negotiated Rate	$3,482.30
Rate for Payer: Cash Price	$2,154.00
Rate for Payer: Health Management Network Commercial	$3,051.50
Rate for Payer: Kaiser Permanente Commercial	$3,231.00
Rate for Payer: MDX Hawaii PPO	$3,482.30

RANGER DCB 5X120X150

Facility

$3,590.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,112.90
Max. Negotiated Rate	$3,482.30
Rate for Payer: AlohaCare Medicaid	$1,795.00
Rate for Payer: AlohaCare Medicare	$1,112.90
Rate for Payer: Cash Price	$2,154.00
Rate for Payer: Devoted Health Medicare	$1,220.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,112.90
Rate for Payer: Hawaii Western Management Group Commercial	$3,410.50
Rate for Payer: Health Management Network Commercial	$3,051.50
Rate for Payer: Humana Medicare	$1,112.90
Rate for Payer: Kaiser Permanente Commercial	$3,231.00
Rate for Payer: Kaiser Permanente Medicaid	$1,830.90
Rate for Payer: Kaiser Permanente Medicare	$1,112.90
Rate for Payer: MDX Hawaii PPO	$3,482.30
Rate for Payer: Ohana Health Plan Medicaid	$1,112.90
Rate for Payer: Ohana Health Plan Medicare	$1,112.90
Rate for Payer: UnitedHealthcare Medicare	$1,112.90
Rate for Payer: University Health Alliance Commercial	$2,616.75

RANGER DCB 5X150X150

Facility

$3,700.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,147.00
Max. Negotiated Rate	$3,589.00
Rate for Payer: AlohaCare Medicaid	$1,850.00
Rate for Payer: AlohaCare Medicare	$1,147.00
Rate for Payer: Cash Price	$2,220.00
Rate for Payer: Devoted Health Medicare	$1,258.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,147.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,515.00
Rate for Payer: Health Management Network Commercial	$3,145.00
Rate for Payer: Humana Medicare	$1,147.00
Rate for Payer: Kaiser Permanente Commercial	$3,330.00
Rate for Payer: Kaiser Permanente Medicaid	$1,887.00
Rate for Payer: Kaiser Permanente Medicare	$1,147.00
Rate for Payer: MDX Hawaii PPO	$3,589.00
Rate for Payer: Ohana Health Plan Medicaid	$1,147.00
Rate for Payer: Ohana Health Plan Medicare	$1,147.00
Rate for Payer: UnitedHealthcare Medicare	$1,147.00
Rate for Payer: University Health Alliance Commercial	$2,696.93

RANGER DCB 5X150X150

Facility

$3,700.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$3,145.00
Max. Negotiated Rate	$3,589.00
Rate for Payer: Cash Price	$2,220.00
Rate for Payer: Health Management Network Commercial	$3,145.00
Rate for Payer: Kaiser Permanente Commercial	$3,330.00
Rate for Payer: MDX Hawaii PPO	$3,589.00

RANGER DCB 5X200X150

Facility

$4,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,364.00
Max. Negotiated Rate	$4,268.00
Rate for Payer: AlohaCare Medicaid	$2,200.00
Rate for Payer: AlohaCare Medicare	$1,364.00
Rate for Payer: Cash Price	$2,640.00
Rate for Payer: Devoted Health Medicare	$1,496.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,364.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,180.00
Rate for Payer: Health Management Network Commercial	$3,740.00
Rate for Payer: Humana Medicare	$1,364.00
Rate for Payer: Kaiser Permanente Commercial	$3,960.00
Rate for Payer: Kaiser Permanente Medicaid	$2,244.00
Rate for Payer: Kaiser Permanente Medicare	$1,364.00
Rate for Payer: MDX Hawaii PPO	$4,268.00
Rate for Payer: Ohana Health Plan Medicaid	$1,364.00
Rate for Payer: Ohana Health Plan Medicare	$1,364.00
Rate for Payer: UnitedHealthcare Medicare	$1,364.00
Rate for Payer: University Health Alliance Commercial	$3,207.16

RANGER DCB 5X200X150

Facility

$4,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$3,740.00
Max. Negotiated Rate	$4,268.00
Rate for Payer: Cash Price	$2,640.00
Rate for Payer: Health Management Network Commercial	$3,740.00
Rate for Payer: Kaiser Permanente Commercial	$3,960.00
Rate for Payer: MDX Hawaii PPO	$4,268.00

RANGER DCB 5X40X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,054.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: AlohaCare Medicaid	$1,700.00
Rate for Payer: AlohaCare Medicare	$1,054.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Devoted Health Medicare	$1,156.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,054.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,230.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Humana Medicare	$1,054.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Medicaid	$1,734.00
Rate for Payer: Kaiser Permanente Medicare	$1,054.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: Ohana Health Plan Medicaid	$1,054.00
Rate for Payer: Ohana Health Plan Medicare	$1,054.00
Rate for Payer: UnitedHealthcare Medicare	$1,054.00
Rate for Payer: University Health Alliance Commercial	$2,478.26

RANGER DCB 5X40X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: MDX Hawaii PPO	$3,298.00

RANGER DCB 5X60X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,054.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: AlohaCare Medicaid	$1,700.00
Rate for Payer: AlohaCare Medicare	$1,054.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Devoted Health Medicare	$1,156.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,054.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,230.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Humana Medicare	$1,054.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Medicaid	$1,734.00
Rate for Payer: Kaiser Permanente Medicare	$1,054.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: Ohana Health Plan Medicaid	$1,054.00
Rate for Payer: Ohana Health Plan Medicare	$1,054.00
Rate for Payer: UnitedHealthcare Medicare	$1,054.00
Rate for Payer: University Health Alliance Commercial	$2,478.26

RANGER DCB 5X60X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: MDX Hawaii PPO	$3,298.00

RANGER DCB 5X80X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: MDX Hawaii PPO	$3,298.00

RANGER DCB 5X80X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,054.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: AlohaCare Medicaid	$1,700.00
Rate for Payer: AlohaCare Medicare	$1,054.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Devoted Health Medicare	$1,156.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,054.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,230.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Humana Medicare	$1,054.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Medicaid	$1,734.00
Rate for Payer: Kaiser Permanente Medicare	$1,054.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: Ohana Health Plan Medicaid	$1,054.00
Rate for Payer: Ohana Health Plan Medicare	$1,054.00
Rate for Payer: UnitedHealthcare Medicare	$1,054.00
Rate for Payer: University Health Alliance Commercial	$2,478.26

RANGER DCB 6X100X135

Facility

$3,400.00

Service Code	HCPCS C2623
Hospital Revenue Code	272
Min. Negotiated Rate	$1,054.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: AlohaCare Medicaid	$1,700.00
Rate for Payer: AlohaCare Medicare	$1,054.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Devoted Health Medicare	$1,156.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,054.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,230.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Humana Medicare	$1,054.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Medicaid	$1,734.00
Rate for Payer: Kaiser Permanente Medicare	$1,054.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: Ohana Health Plan Medicaid	$1,054.00
Rate for Payer: Ohana Health Plan Medicare	$1,054.00
Rate for Payer: UnitedHealthcare Medicare	$1,054.00
Rate for Payer: University Health Alliance Commercial	$2,478.26

Know your out-of-pocket cost for care.

All Charges