Kau Hospital

All Charges

Charge

Type

Setting

Price

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]

Facility

$6.00

Service Code	NDC 60687054921
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]

Facility

$20.00

Service Code	NDC 67877052560
Hospital Revenue Code	250
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$12.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: MDX Hawaii PPO	$19.40

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]

Facility

$20.00

Service Code	NDC 67877052560
Hospital Revenue Code	637
Min. Negotiated Rate	$6.20
Max. Negotiated Rate	$19.40
Rate for Payer: AlohaCare Medicaid	$10.00
Rate for Payer: AlohaCare Medicare	$6.20
Rate for Payer: Cash Price	$12.00
Rate for Payer: Devoted Health Medicare	$6.80
Rate for Payer: Hawaii Medical Service Association Medicare	$6.20
Rate for Payer: Hawaii Western Management Group Commercial	$19.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Humana Medicare	$6.20
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: Kaiser Permanente Medicaid	$10.20
Rate for Payer: Kaiser Permanente Medicare	$6.20
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: Ohana Health Plan Medicaid	$6.20
Rate for Payer: Ohana Health Plan Medicare	$6.20
Rate for Payer: UnitedHealthcare Medicare	$6.20
Rate for Payer: University Health Alliance Commercial	$14.58

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]

Facility

$21.00

Service Code	NDC 27241012502
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

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]

Facility

$6.00

Service Code	NDC 60687054921
Hospital Revenue Code	637
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$1.86
Rate for Payer: Cash Price	$3.60
Rate for Payer: Devoted Health Medicare	$2.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1.86
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$1.86
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$1.86
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$1.86
Rate for Payer: Ohana Health Plan Medicare	$1.86
Rate for Payer: UnitedHealthcare Medicare	$1.86
Rate for Payer: University Health Alliance Commercial	$4.37

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR [70434]

Facility

$21.00

Service Code	NDC 27241012502
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

RAPID STRUT TL LONG 50-10190

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$816.23
Max. Negotiated Rate	$2,554.01
Rate for Payer: AlohaCare Medicaid	$1,316.50
Rate for Payer: AlohaCare Medicare	$816.23
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Devoted Health Medicare	$895.22
Rate for Payer: Hawaii Medical Service Association Medicare	$816.23
Rate for Payer: Hawaii Western Management Group Commercial	$2,501.35
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Humana Medicare	$816.23
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: Kaiser Permanente Medicaid	$1,342.83
Rate for Payer: Kaiser Permanente Medicare	$816.23
Rate for Payer: MDX Hawaii PPO	$2,554.01
Rate for Payer: Ohana Health Plan Medicaid	$816.23
Rate for Payer: Ohana Health Plan Medicare	$816.23
Rate for Payer: UnitedHealthcare Medicare	$816.23
Rate for Payer: University Health Alliance Commercial	$1,919.19

RAPID STRUT TL LONG 50-10190

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,238.05
Max. Negotiated Rate	$2,554.01
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: MDX Hawaii PPO	$2,554.01

RAPID STRUT TL LONG 50-10190CE

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,238.05
Max. Negotiated Rate	$2,554.01
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: MDX Hawaii PPO	$2,554.01

RAPID STRUT TL LONG 50-10190CE

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$816.23
Max. Negotiated Rate	$2,554.01
Rate for Payer: AlohaCare Medicaid	$1,316.50
Rate for Payer: AlohaCare Medicare	$816.23
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Devoted Health Medicare	$895.22
Rate for Payer: Hawaii Medical Service Association Medicare	$816.23
Rate for Payer: Hawaii Western Management Group Commercial	$2,501.35
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Humana Medicare	$816.23
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: Kaiser Permanente Medicaid	$1,342.83
Rate for Payer: Kaiser Permanente Medicare	$816.23
Rate for Payer: MDX Hawaii PPO	$2,554.01
Rate for Payer: Ohana Health Plan Medicaid	$816.23
Rate for Payer: Ohana Health Plan Medicare	$816.23
Rate for Payer: UnitedHealthcare Medicare	$816.23
Rate for Payer: University Health Alliance Commercial	$1,919.19

RAPID STRUT TL MED 50-10180

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$816.23
Max. Negotiated Rate	$2,554.01
Rate for Payer: AlohaCare Medicaid	$1,316.50
Rate for Payer: AlohaCare Medicare	$816.23
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Devoted Health Medicare	$895.22
Rate for Payer: Hawaii Medical Service Association Medicare	$816.23
Rate for Payer: Hawaii Western Management Group Commercial	$2,501.35
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Humana Medicare	$816.23
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: Kaiser Permanente Medicaid	$1,342.83
Rate for Payer: Kaiser Permanente Medicare	$816.23
Rate for Payer: MDX Hawaii PPO	$2,554.01
Rate for Payer: Ohana Health Plan Medicaid	$816.23
Rate for Payer: Ohana Health Plan Medicare	$816.23
Rate for Payer: UnitedHealthcare Medicare	$816.23
Rate for Payer: University Health Alliance Commercial	$1,919.19

RAPID STRUT TL MED 50-10180

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,238.05
Max. Negotiated Rate	$2,554.01
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: MDX Hawaii PPO	$2,554.01

RAPID STRUT TL SHORT 50-10170

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$816.23
Max. Negotiated Rate	$2,554.01
Rate for Payer: AlohaCare Medicaid	$1,316.50
Rate for Payer: AlohaCare Medicare	$816.23
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Devoted Health Medicare	$895.22
Rate for Payer: Hawaii Medical Service Association Medicare	$816.23
Rate for Payer: Hawaii Western Management Group Commercial	$2,501.35
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Humana Medicare	$816.23
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: Kaiser Permanente Medicaid	$1,342.83
Rate for Payer: Kaiser Permanente Medicare	$816.23
Rate for Payer: MDX Hawaii PPO	$2,554.01
Rate for Payer: Ohana Health Plan Medicaid	$816.23
Rate for Payer: Ohana Health Plan Medicare	$816.23
Rate for Payer: UnitedHealthcare Medicare	$816.23
Rate for Payer: University Health Alliance Commercial	$1,919.19

RAPID STRUT TL SHORT 50-10170

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,238.05
Max. Negotiated Rate	$2,554.01
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: MDX Hawaii PPO	$2,554.01

RAPID STRUT TL SHRT 50-10170CE

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,238.05
Max. Negotiated Rate	$2,554.01
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: MDX Hawaii PPO	$2,554.01

RAPID STRUT TL SHRT 50-10170CE

Facility

$2,633.00

Hospital Revenue Code	272
Min. Negotiated Rate	$816.23
Max. Negotiated Rate	$2,554.01
Rate for Payer: AlohaCare Medicaid	$1,316.50
Rate for Payer: AlohaCare Medicare	$816.23
Rate for Payer: Cash Price	$1,579.80
Rate for Payer: Devoted Health Medicare	$895.22
Rate for Payer: Hawaii Medical Service Association Medicare	$816.23
Rate for Payer: Hawaii Western Management Group Commercial	$2,501.35
Rate for Payer: Health Management Network Commercial	$2,238.05
Rate for Payer: Humana Medicare	$816.23
Rate for Payer: Kaiser Permanente Commercial	$2,369.70
Rate for Payer: Kaiser Permanente Medicaid	$1,342.83
Rate for Payer: Kaiser Permanente Medicare	$816.23
Rate for Payer: MDX Hawaii PPO	$2,554.01
Rate for Payer: Ohana Health Plan Medicaid	$816.23
Rate for Payer: Ohana Health Plan Medicare	$816.23
Rate for Payer: UnitedHealthcare Medicare	$816.23
Rate for Payer: University Health Alliance Commercial	$1,919.19

RASBURICASE 1.5 MG INTRAVENOUS SOLUTION [33591]

Facility

$1,829.00

Service Code	HCPCS J2783
Hospital Revenue Code	250
Min. Negotiated Rate	$1,554.65
Max. Negotiated Rate	$1,774.13
Rate for Payer: Cash Price	$1,097.40
Rate for Payer: Health Management Network Commercial	$1,554.65
Rate for Payer: Kaiser Permanente Commercial	$1,646.10
Rate for Payer: MDX Hawaii PPO	$1,774.13

RASBURICASE 1.5 MG INTRAVENOUS SOLUTION [33591]

Facility

$1,829.00

Service Code	HCPCS J2783
Hospital Revenue Code	636
Min. Negotiated Rate	$376.48
Max. Negotiated Rate	$1,774.13
Rate for Payer: AlohaCare Medicaid	$914.50
Rate for Payer: AlohaCare Medicare	$566.99
Rate for Payer: Cash Price	$1,097.40
Rate for Payer: Cash Price	$1,097.40
Rate for Payer: Devoted Health Medicare	$621.86
Rate for Payer: Hawaii Medical Service Association ABD	$376.48
Rate for Payer: Hawaii Medical Service Association Commercial	$477.74
Rate for Payer: Hawaii Medical Service Association Medicare	$566.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$376.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,737.55
Rate for Payer: Health Management Network Commercial	$1,554.65
Rate for Payer: Humana Medicare	$566.99
Rate for Payer: Kaiser Permanente Commercial	$1,646.10
Rate for Payer: Kaiser Permanente Medicaid	$932.79
Rate for Payer: Kaiser Permanente Medicare	$566.99
Rate for Payer: MDX Hawaii PPO	$1,774.13
Rate for Payer: Ohana Health Plan Medicaid	$566.99
Rate for Payer: Ohana Health Plan Medicare	$566.99
Rate for Payer: UnitedHealthcare Medicaid	$1,097.40
Rate for Payer: UnitedHealthcare Medicare	$566.99
Rate for Payer: University Health Alliance Commercial	$1,333.16

RASBURICASE 7.5 MG/5ML IV (WET SOLR VIAL) [43076868]

Facility

$7,142.00

Service Code	HCPCS J2783
Hospital Revenue Code	250
Min. Negotiated Rate	$6,070.70
Max. Negotiated Rate	$6,927.74
Rate for Payer: Cash Price	$4,285.20
Rate for Payer: Health Management Network Commercial	$6,070.70
Rate for Payer: Kaiser Permanente Commercial	$6,427.80
Rate for Payer: MDX Hawaii PPO	$6,927.74

RASBURICASE 7.5 MG/5ML IV (WET SOLR VIAL) [43076868]

Facility

$7,142.00

Service Code	HCPCS J2783
Hospital Revenue Code	636
Min. Negotiated Rate	$376.48
Max. Negotiated Rate	$6,927.74
Rate for Payer: AlohaCare Medicaid	$3,571.00
Rate for Payer: AlohaCare Medicare	$2,214.02
Rate for Payer: Cash Price	$4,285.20
Rate for Payer: Cash Price	$4,285.20
Rate for Payer: Devoted Health Medicare	$2,428.28
Rate for Payer: Hawaii Medical Service Association ABD	$376.48
Rate for Payer: Hawaii Medical Service Association Commercial	$477.74
Rate for Payer: Hawaii Medical Service Association Medicare	$2,214.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$376.48
Rate for Payer: Hawaii Western Management Group Commercial	$6,784.90
Rate for Payer: Health Management Network Commercial	$6,070.70
Rate for Payer: Humana Medicare	$2,214.02
Rate for Payer: Kaiser Permanente Commercial	$6,427.80
Rate for Payer: Kaiser Permanente Medicaid	$3,642.42
Rate for Payer: Kaiser Permanente Medicare	$2,214.02
Rate for Payer: MDX Hawaii PPO	$6,927.74
Rate for Payer: Ohana Health Plan Medicaid	$2,214.02
Rate for Payer: Ohana Health Plan Medicare	$2,214.02
Rate for Payer: UnitedHealthcare Medicaid	$4,285.20
Rate for Payer: UnitedHealthcare Medicare	$2,214.02
Rate for Payer: University Health Alliance Commercial	$5,205.80

RASBURICASE 7.5 MG INTRAVENOUS SOLUTION [76868]

Facility

$7,142.00

Service Code	HCPCS J2783
Hospital Revenue Code	250
Min. Negotiated Rate	$6,070.70
Max. Negotiated Rate	$6,927.74
Rate for Payer: Cash Price	$4,285.20
Rate for Payer: Health Management Network Commercial	$6,070.70
Rate for Payer: Kaiser Permanente Commercial	$6,427.80
Rate for Payer: MDX Hawaii PPO	$6,927.74

RASBURICASE 7.5 MG INTRAVENOUS SOLUTION [76868]

Facility

$7,142.00

Service Code	HCPCS J2783
Hospital Revenue Code	636
Min. Negotiated Rate	$376.48
Max. Negotiated Rate	$6,927.74
Rate for Payer: AlohaCare Medicaid	$3,571.00
Rate for Payer: AlohaCare Medicare	$2,214.02
Rate for Payer: Cash Price	$4,285.20
Rate for Payer: Cash Price	$4,285.20
Rate for Payer: Devoted Health Medicare	$2,428.28
Rate for Payer: Hawaii Medical Service Association ABD	$376.48
Rate for Payer: Hawaii Medical Service Association Commercial	$477.74
Rate for Payer: Hawaii Medical Service Association Medicare	$2,214.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$376.48
Rate for Payer: Hawaii Western Management Group Commercial	$6,784.90
Rate for Payer: Health Management Network Commercial	$6,070.70
Rate for Payer: Humana Medicare	$2,214.02
Rate for Payer: Kaiser Permanente Commercial	$6,427.80
Rate for Payer: Kaiser Permanente Medicaid	$3,642.42
Rate for Payer: Kaiser Permanente Medicare	$2,214.02
Rate for Payer: MDX Hawaii PPO	$6,927.74
Rate for Payer: Ohana Health Plan Medicaid	$2,214.02
Rate for Payer: Ohana Health Plan Medicare	$2,214.02
Rate for Payer: UnitedHealthcare Medicaid	$4,285.20
Rate for Payer: UnitedHealthcare Medicare	$2,214.02
Rate for Payer: University Health Alliance Commercial	$5,205.80

RASP PROXIMAL OSFT-1P

Facility

$1,147.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$642.32
Max. Negotiated Rate	$1,112.59
Rate for Payer: Cash Price	$688.20
Rate for Payer: Hawaii Western Management Group Commercial	$802.90
Rate for Payer: Health Management Network Commercial	$974.95
Rate for Payer: Kaiser Permanente Commercial	$1,032.30
Rate for Payer: MDX Hawaii PPO	$1,112.59
Rate for Payer: University Health Alliance Commercial	$642.32

RASP PROXIMAL OSFT-1P

Facility

$1,147.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$355.57
Max. Negotiated Rate	$1,112.59
Rate for Payer: AlohaCare Medicaid	$573.50
Rate for Payer: AlohaCare Medicare	$355.57
Rate for Payer: Cash Price	$688.20
Rate for Payer: Devoted Health Medicare	$389.98
Rate for Payer: Hawaii Medical Service Association Medicare	$355.57
Rate for Payer: Hawaii Western Management Group Commercial	$802.90
Rate for Payer: Health Management Network Commercial	$974.95
Rate for Payer: Humana Medicare	$355.57
Rate for Payer: Kaiser Permanente Commercial	$1,032.30
Rate for Payer: Kaiser Permanente Medicaid	$584.97
Rate for Payer: Kaiser Permanente Medicare	$355.57
Rate for Payer: MDX Hawaii PPO	$1,112.59
Rate for Payer: Ohana Health Plan Medicaid	$355.57
Rate for Payer: Ohana Health Plan Medicare	$355.57
Rate for Payer: UnitedHealthcare Medicare	$355.57
Rate for Payer: University Health Alliance Commercial	$642.32

REAMER 16MM METATARSL 323-1416

Facility

$2,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$804.76
Max. Negotiated Rate	$2,518.12
Rate for Payer: AlohaCare Medicaid	$1,298.00
Rate for Payer: AlohaCare Medicare	$804.76
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Devoted Health Medicare	$882.64
Rate for Payer: Hawaii Medical Service Association Medicare	$804.76
Rate for Payer: Hawaii Western Management Group Commercial	$2,466.20
Rate for Payer: Health Management Network Commercial	$2,206.60
Rate for Payer: Humana Medicare	$804.76
Rate for Payer: Kaiser Permanente Commercial	$2,336.40
Rate for Payer: Kaiser Permanente Medicaid	$1,323.96
Rate for Payer: Kaiser Permanente Medicare	$804.76
Rate for Payer: MDX Hawaii PPO	$2,518.12
Rate for Payer: Ohana Health Plan Medicaid	$804.76
Rate for Payer: Ohana Health Plan Medicare	$804.76
Rate for Payer: UnitedHealthcare Medicare	$804.76
Rate for Payer: University Health Alliance Commercial	$1,892.22

Know your out-of-pocket cost for care.

All Charges