Kau Hospital

All Charges

Charge

Type

Setting

Price

REAMING ROD 2.5X850MM 359.083S

Facility

$843.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$261.33
Max. Negotiated Rate	$817.71
Rate for Payer: AlohaCare Medicaid	$421.50
Rate for Payer: AlohaCare Medicare	$261.33
Rate for Payer: Cash Price	$505.80
Rate for Payer: Devoted Health Medicare	$286.62
Rate for Payer: Hawaii Medical Service Association Medicare	$261.33
Rate for Payer: Hawaii Western Management Group Commercial	$800.85
Rate for Payer: Health Management Network Commercial	$716.55
Rate for Payer: Humana Medicare	$261.33
Rate for Payer: Kaiser Permanente Commercial	$758.70
Rate for Payer: Kaiser Permanente Medicaid	$429.93
Rate for Payer: Kaiser Permanente Medicare	$261.33
Rate for Payer: MDX Hawaii PPO	$817.71
Rate for Payer: Ohana Health Plan Medicaid	$261.33
Rate for Payer: Ohana Health Plan Medicare	$261.33
Rate for Payer: UnitedHealthcare Medicare	$261.33
Rate for Payer: University Health Alliance Commercial	$614.46

REAMING ROD 2.5X850MM 359.083S

Facility

$843.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$716.55
Max. Negotiated Rate	$817.71
Rate for Payer: Cash Price	$505.80
Rate for Payer: Health Management Network Commercial	$716.55
Rate for Payer: Kaiser Permanente Commercial	$758.70
Rate for Payer: MDX Hawaii PPO	$817.71

REAMING ROD 2.5X950MM 351.706S

Facility

$518.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$440.30
Max. Negotiated Rate	$502.46
Rate for Payer: Cash Price	$310.80
Rate for Payer: Health Management Network Commercial	$440.30
Rate for Payer: Kaiser Permanente Commercial	$466.20
Rate for Payer: MDX Hawaii PPO	$502.46

REAMING ROD 2.5X950MM 351.706S

Facility

$518.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$160.58
Max. Negotiated Rate	$502.46
Rate for Payer: AlohaCare Medicaid	$259.00
Rate for Payer: AlohaCare Medicare	$160.58
Rate for Payer: Cash Price	$310.80
Rate for Payer: Devoted Health Medicare	$176.12
Rate for Payer: Hawaii Medical Service Association Medicare	$160.58
Rate for Payer: Hawaii Western Management Group Commercial	$492.10
Rate for Payer: Health Management Network Commercial	$440.30
Rate for Payer: Humana Medicare	$160.58
Rate for Payer: Kaiser Permanente Commercial	$466.20
Rate for Payer: Kaiser Permanente Medicaid	$264.18
Rate for Payer: Kaiser Permanente Medicare	$160.58
Rate for Payer: MDX Hawaii PPO	$502.46
Rate for Payer: Ohana Health Plan Medicaid	$160.58
Rate for Payer: Ohana Health Plan Medicare	$160.58
Rate for Payer: UnitedHealthcare Medicare	$160.58
Rate for Payer: University Health Alliance Commercial	$377.57

REAMING ROD 3.0X950MM 351.71S

Facility

$784.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$243.04
Max. Negotiated Rate	$760.48
Rate for Payer: AlohaCare Medicaid	$392.00
Rate for Payer: AlohaCare Medicare	$243.04
Rate for Payer: Cash Price	$470.40
Rate for Payer: Devoted Health Medicare	$266.56
Rate for Payer: Hawaii Medical Service Association Medicare	$243.04
Rate for Payer: Hawaii Western Management Group Commercial	$744.80
Rate for Payer: Health Management Network Commercial	$666.40
Rate for Payer: Humana Medicare	$243.04
Rate for Payer: Kaiser Permanente Commercial	$705.60
Rate for Payer: Kaiser Permanente Medicaid	$399.84
Rate for Payer: Kaiser Permanente Medicare	$243.04
Rate for Payer: MDX Hawaii PPO	$760.48
Rate for Payer: Ohana Health Plan Medicaid	$243.04
Rate for Payer: Ohana Health Plan Medicare	$243.04
Rate for Payer: UnitedHealthcare Medicare	$243.04
Rate for Payer: University Health Alliance Commercial	$571.46

REAMING ROD 3.0X950MM 351.71S

Facility

$784.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$666.40
Max. Negotiated Rate	$760.48
Rate for Payer: Cash Price	$470.40
Rate for Payer: Health Management Network Commercial	$666.40
Rate for Payer: Kaiser Permanente Commercial	$705.60
Rate for Payer: MDX Hawaii PPO	$760.48

REAMING ROD 3.0X950MM 351.76S

Facility

$1,023.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$317.13
Max. Negotiated Rate	$992.31
Rate for Payer: AlohaCare Medicaid	$511.50
Rate for Payer: AlohaCare Medicare	$317.13
Rate for Payer: Cash Price	$613.80
Rate for Payer: Devoted Health Medicare	$347.82
Rate for Payer: Hawaii Medical Service Association Medicare	$317.13
Rate for Payer: Hawaii Western Management Group Commercial	$971.85
Rate for Payer: Health Management Network Commercial	$869.55
Rate for Payer: Humana Medicare	$317.13
Rate for Payer: Kaiser Permanente Commercial	$920.70
Rate for Payer: Kaiser Permanente Medicaid	$521.73
Rate for Payer: Kaiser Permanente Medicare	$317.13
Rate for Payer: MDX Hawaii PPO	$992.31
Rate for Payer: Ohana Health Plan Medicaid	$317.13
Rate for Payer: Ohana Health Plan Medicare	$317.13
Rate for Payer: UnitedHealthcare Medicare	$317.13
Rate for Payer: University Health Alliance Commercial	$745.66

REAMING ROD 3.0X950MM 351.76S

Facility

$1,023.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$869.55
Max. Negotiated Rate	$992.31
Rate for Payer: Cash Price	$613.80
Rate for Payer: Health Management Network Commercial	$869.55
Rate for Payer: Kaiser Permanente Commercial	$920.70
Rate for Payer: MDX Hawaii PPO	$992.31

RECHARGER 97755

Facility

$3,400.00

Service Code	HCPCS C1820
Hospital Revenue Code	278
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	$2,380.00
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	$1,904.00

RECHARGER 97755

Facility

$3,400.00

Service Code	HCPCS C1820
Hospital Revenue Code	278
Min. Negotiated Rate	$1,904.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,380.00
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
Rate for Payer: University Health Alliance Commercial	$1,904.00

RECIP BLADE, HEAVY 277-96-327

Facility

$215.00

Hospital Revenue Code	272
Min. Negotiated Rate	$66.65
Max. Negotiated Rate	$208.55
Rate for Payer: AlohaCare Medicaid	$107.50
Rate for Payer: AlohaCare Medicare	$66.65
Rate for Payer: Cash Price	$129.00
Rate for Payer: Devoted Health Medicare	$73.10
Rate for Payer: Hawaii Medical Service Association Medicare	$66.65
Rate for Payer: Hawaii Western Management Group Commercial	$204.25
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Humana Medicare	$66.65
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: Kaiser Permanente Medicaid	$109.65
Rate for Payer: Kaiser Permanente Medicare	$66.65
Rate for Payer: MDX Hawaii PPO	$208.55
Rate for Payer: Ohana Health Plan Medicaid	$66.65
Rate for Payer: Ohana Health Plan Medicare	$66.65
Rate for Payer: UnitedHealthcare Medicare	$66.65
Rate for Payer: University Health Alliance Commercial	$156.71

RECIP BLADE, HEAVY 277-96-327

Facility

$215.00

Hospital Revenue Code	272
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$129.00
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: MDX Hawaii PPO	$208.55

RECTAL RESECTION WITH CC

Facility

$71,224.51

Service Code	MSDRG 333
Min. Negotiated Rate	$71,224.51
Max. Negotiated Rate	$71,224.51
Rate for Payer: Hawaii Medical Service Association Commercial	$71,224.51

RECTAL RESECTION WITH MCC

Facility

$71,224.51

Service Code	MSDRG 332
Min. Negotiated Rate	$71,224.51
Max. Negotiated Rate	$71,224.51
Rate for Payer: Hawaii Medical Service Association Commercial	$71,224.51

RECTAL RESECTION WITHOUT CC/MCC

Facility

$34,083.48

Service Code	MSDRG 334
Min. Negotiated Rate	$34,083.48
Max. Negotiated Rate	$34,083.48
Rate for Payer: Hawaii Medical Service Association Commercial	$34,083.48

RED BLOOD CELL DISORDERS WITH MCC

Facility

$31,049.62

Service Code	MSDRG 811
Min. Negotiated Rate	$31,049.62
Max. Negotiated Rate	$31,049.62
Rate for Payer: Hawaii Medical Service Association Commercial	$31,049.62

RED BLOOD CELL DISORDERS WITHOUT MCC

Facility

$16,638.80

Service Code	MSDRG 812
Min. Negotiated Rate	$16,638.80
Max. Negotiated Rate	$16,638.80
Rate for Payer: Hawaii Medical Service Association Commercial	$16,638.80

REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]

Facility

$451.00

Service Code	HCPCS J2785
Hospital Revenue Code	250
Min. Negotiated Rate	$383.35
Max. Negotiated Rate	$437.47
Rate for Payer: Cash Price	$270.60
Rate for Payer: Cash Price	$278.40
Rate for Payer: Health Management Network Commercial	$394.40
Rate for Payer: Health Management Network Commercial	$383.35
Rate for Payer: Kaiser Permanente Commercial	$405.90
Rate for Payer: Kaiser Permanente Commercial	$417.60
Rate for Payer: MDX Hawaii PPO	$437.47
Rate for Payer: MDX Hawaii PPO	$450.08

REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE [91408]

Facility

$464.00

Service Code	HCPCS J2785
Hospital Revenue Code	636
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$450.08
Rate for Payer: AlohaCare Medicaid	$232.00
Rate for Payer: AlohaCare Medicaid	$225.50
Rate for Payer: AlohaCare Medicare	$139.81
Rate for Payer: AlohaCare Medicare	$143.84
Rate for Payer: Cash Price	$270.60
Rate for Payer: Cash Price	$270.60
Rate for Payer: Cash Price	$278.40
Rate for Payer: Cash Price	$278.40
Rate for Payer: Devoted Health Medicare	$153.34
Rate for Payer: Devoted Health Medicare	$157.76
Rate for Payer: Hawaii Medical Service Association ABD	$2.89
Rate for Payer: Hawaii Medical Service Association ABD	$2.89
Rate for Payer: Hawaii Medical Service Association Medicare	$139.81
Rate for Payer: Hawaii Medical Service Association Medicare	$143.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.89
Rate for Payer: Hawaii Western Management Group Commercial	$428.45
Rate for Payer: Hawaii Western Management Group Commercial	$440.80
Rate for Payer: Health Management Network Commercial	$383.35
Rate for Payer: Health Management Network Commercial	$394.40
Rate for Payer: Humana Medicare	$139.81
Rate for Payer: Humana Medicare	$143.84
Rate for Payer: Kaiser Permanente Commercial	$417.60
Rate for Payer: Kaiser Permanente Commercial	$405.90
Rate for Payer: Kaiser Permanente Medicaid	$230.01
Rate for Payer: Kaiser Permanente Medicaid	$236.64
Rate for Payer: Kaiser Permanente Medicare	$139.81
Rate for Payer: Kaiser Permanente Medicare	$143.84
Rate for Payer: MDX Hawaii PPO	$437.47
Rate for Payer: MDX Hawaii PPO	$450.08
Rate for Payer: Ohana Health Plan Medicaid	$143.84
Rate for Payer: Ohana Health Plan Medicaid	$139.81
Rate for Payer: Ohana Health Plan Medicare	$139.81
Rate for Payer: Ohana Health Plan Medicare	$143.84
Rate for Payer: UnitedHealthcare Medicaid	$270.60
Rate for Payer: UnitedHealthcare Medicaid	$278.40
Rate for Payer: UnitedHealthcare Medicare	$143.84
Rate for Payer: UnitedHealthcare Medicare	$139.81
Rate for Payer: University Health Alliance Commercial	$328.73
Rate for Payer: University Health Alliance Commercial	$338.21

REHABILITATION WITH CC/MCC

Facility

$9,765.22

Service Code	MSDRG 945
Min. Negotiated Rate	$9,765.22
Max. Negotiated Rate	$9,765.22
Rate for Payer: Hawaii Medical Service Association Commercial	$9,765.22

REHABILITATION WITHOUT CC/MCC

Facility

$9,765.22

Service Code	MSDRG 946
Min. Negotiated Rate	$9,765.22
Max. Negotiated Rate	$9,765.22
Rate for Payer: Hawaii Medical Service Association Commercial	$9,765.22

RELIANCE 4 FRONT COIL 64CM

Facility

$6,208.00

Service Code	HCPCS C1895
Hospital Revenue Code	278
Min. Negotiated Rate	$1,924.48
Max. Negotiated Rate	$6,021.76
Rate for Payer: AlohaCare Medicaid	$3,104.00
Rate for Payer: AlohaCare Medicare	$1,924.48
Rate for Payer: Cash Price	$3,724.80
Rate for Payer: Devoted Health Medicare	$2,110.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,924.48
Rate for Payer: Hawaii Western Management Group Commercial	$4,345.60
Rate for Payer: Health Management Network Commercial	$5,276.80
Rate for Payer: Humana Medicare	$1,924.48
Rate for Payer: Kaiser Permanente Commercial	$5,587.20
Rate for Payer: Kaiser Permanente Medicaid	$3,166.08
Rate for Payer: Kaiser Permanente Medicare	$1,924.48
Rate for Payer: MDX Hawaii PPO	$6,021.76
Rate for Payer: Ohana Health Plan Medicaid	$1,924.48
Rate for Payer: Ohana Health Plan Medicare	$1,924.48
Rate for Payer: UnitedHealthcare Medicare	$1,924.48
Rate for Payer: University Health Alliance Commercial	$3,476.48

RELIANCE 4 FRONT COIL 64CM

Facility

$6,208.00

Service Code	HCPCS C1895
Hospital Revenue Code	278
Min. Negotiated Rate	$3,476.48
Max. Negotiated Rate	$6,021.76
Rate for Payer: Cash Price	$3,724.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,345.60
Rate for Payer: Health Management Network Commercial	$5,276.80
Rate for Payer: Kaiser Permanente Commercial	$5,587.20
Rate for Payer: MDX Hawaii PPO	$6,021.76
Rate for Payer: University Health Alliance Commercial	$3,476.48

RELIANCE LEAD 59CM

Facility

$6,208.00

Service Code	HCPCS C1777
Hospital Revenue Code	278
Min. Negotiated Rate	$1,924.48
Max. Negotiated Rate	$6,021.76
Rate for Payer: AlohaCare Medicaid	$3,104.00
Rate for Payer: AlohaCare Medicare	$1,924.48
Rate for Payer: Cash Price	$3,724.80
Rate for Payer: Devoted Health Medicare	$2,110.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,924.48
Rate for Payer: Hawaii Western Management Group Commercial	$4,345.60
Rate for Payer: Health Management Network Commercial	$5,276.80
Rate for Payer: Humana Medicare	$1,924.48
Rate for Payer: Kaiser Permanente Commercial	$5,587.20
Rate for Payer: Kaiser Permanente Medicaid	$3,166.08
Rate for Payer: Kaiser Permanente Medicare	$1,924.48
Rate for Payer: MDX Hawaii PPO	$6,021.76
Rate for Payer: Ohana Health Plan Medicaid	$1,924.48
Rate for Payer: Ohana Health Plan Medicare	$1,924.48
Rate for Payer: UnitedHealthcare Medicare	$1,924.48
Rate for Payer: University Health Alliance Commercial	$3,476.48

RELIANCE LEAD 59CM

Facility

$6,208.00

Service Code	HCPCS C1777
Hospital Revenue Code	278
Min. Negotiated Rate	$3,476.48
Max. Negotiated Rate	$6,021.76
Rate for Payer: Cash Price	$3,724.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,345.60
Rate for Payer: Health Management Network Commercial	$5,276.80
Rate for Payer: Kaiser Permanente Commercial	$5,587.20
Rate for Payer: MDX Hawaii PPO	$6,021.76
Rate for Payer: University Health Alliance Commercial	$3,476.48

Know your out-of-pocket cost for care.

All Charges