Kau Hospital

All Charges

Charge

Type

Setting

Price

RANGER DCB 6X100X135

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 6X120X150

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 6X120X150

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 6X150X150

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 6X150X150

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 6X200X150

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 6X200X150

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 6X40X135

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 6X40X135

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 6X60X135

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 6X60X135

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 6X80X135

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 6X80X135

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 7X120X150

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 7X120X150

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 7X200X150

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 7X200X150

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 7X40X135

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 7X40X135

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 7X60X135

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 7X60X135

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 7X80X135

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 7X80X135

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 IRR FLUID WMG SET 24750

Facility

$209.00

Hospital Revenue Code	272
Min. Negotiated Rate	$64.79
Max. Negotiated Rate	$202.73
Rate for Payer: AlohaCare Medicaid	$104.50
Rate for Payer: AlohaCare Medicare	$64.79
Rate for Payer: Cash Price	$125.40
Rate for Payer: Devoted Health Medicare	$71.06
Rate for Payer: Hawaii Medical Service Association Medicare	$64.79
Rate for Payer: Hawaii Western Management Group Commercial	$198.55
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: Humana Medicare	$64.79
Rate for Payer: Kaiser Permanente Commercial	$188.10
Rate for Payer: Kaiser Permanente Medicaid	$106.59
Rate for Payer: Kaiser Permanente Medicare	$64.79
Rate for Payer: MDX Hawaii PPO	$202.73
Rate for Payer: Ohana Health Plan Medicaid	$64.79
Rate for Payer: Ohana Health Plan Medicare	$64.79
Rate for Payer: UnitedHealthcare Medicare	$64.79
Rate for Payer: University Health Alliance Commercial	$152.34

RANGER IRR FLUID WMG SET 24750

Facility

$209.00

Hospital Revenue Code	272
Min. Negotiated Rate	$177.65
Max. Negotiated Rate	$202.73
Rate for Payer: Cash Price	$125.40
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: Kaiser Permanente Commercial	$188.10
Rate for Payer: MDX Hawaii PPO	$202.73

Know your out-of-pocket cost for care.

All Charges