Kau Hospital

All Charges

Charge

Type

Setting

Price

REMIFENTANIL HCL 2 MG/2ML IV (WET SOLR VIAL) [43018400]

Facility

$243.00

Service Code	NDC 72078003500
Hospital Revenue Code	250
Min. Negotiated Rate	$206.55
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$145.80
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Kaiser Permanente Commercial	$218.70
Rate for Payer: MDX Hawaii PPO	$235.71

REMIFENTANIL HCL 2 MG/2ML IV (WET SOLR VIAL) [43018400]

Facility

$243.00

Service Code	NDC 72078003502
Hospital Revenue Code	250
Min. Negotiated Rate	$206.55
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$145.80
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Kaiser Permanente Commercial	$218.70
Rate for Payer: MDX Hawaii PPO	$235.71

REMIFENTANIL HCL 2 MG/2ML IV (WET SOLR VIAL) [43018400]

Facility

$221.00

Service Code	NDC 00143939210
Hospital Revenue Code	250
Min. Negotiated Rate	$187.85
Max. Negotiated Rate	$214.37
Rate for Payer: Cash Price	$132.60
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: Kaiser Permanente Commercial	$198.90
Rate for Payer: MDX Hawaii PPO	$214.37

REMIFENTANIL HCL 2 MG/2ML IV (WET SOLR VIAL) [43018400]

Facility

$221.00

Service Code	NDC 00143939201
Hospital Revenue Code	250
Min. Negotiated Rate	$187.85
Max. Negotiated Rate	$214.37
Rate for Payer: Cash Price	$132.60
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: Kaiser Permanente Commercial	$198.90
Rate for Payer: MDX Hawaii PPO	$214.37

REMOVAL DEVICE POLYP

Facility

$324.00

Hospital Revenue Code	272
Min. Negotiated Rate	$275.40
Max. Negotiated Rate	$314.28
Rate for Payer: Cash Price	$194.40
Rate for Payer: Health Management Network Commercial	$275.40
Rate for Payer: Kaiser Permanente Commercial	$291.60
Rate for Payer: MDX Hawaii PPO	$314.28

REMOVAL DEVICE POLYP

Facility

$324.00

Hospital Revenue Code	272
Min. Negotiated Rate	$100.44
Max. Negotiated Rate	$314.28
Rate for Payer: AlohaCare Medicaid	$162.00
Rate for Payer: AlohaCare Medicare	$100.44
Rate for Payer: Cash Price	$194.40
Rate for Payer: Devoted Health Medicare	$110.16
Rate for Payer: Hawaii Medical Service Association Medicare	$100.44
Rate for Payer: Hawaii Western Management Group Commercial	$307.80
Rate for Payer: Health Management Network Commercial	$275.40
Rate for Payer: Humana Medicare	$100.44
Rate for Payer: Kaiser Permanente Commercial	$291.60
Rate for Payer: Kaiser Permanente Medicaid	$165.24
Rate for Payer: Kaiser Permanente Medicare	$100.44
Rate for Payer: MDX Hawaii PPO	$314.28
Rate for Payer: Ohana Health Plan Medicaid	$100.44
Rate for Payer: Ohana Health Plan Medicare	$100.44
Rate for Payer: UnitedHealthcare Medicare	$100.44
Rate for Payer: University Health Alliance Commercial	$236.16

RENAL FAILURE WITH CC

Facility

$30,006.73

Service Code	MSDRG 683
Min. Negotiated Rate	$30,006.73
Max. Negotiated Rate	$30,006.73
Rate for Payer: Hawaii Medical Service Association Commercial	$30,006.73

RENAL FAILURE WITH MCC

Facility

$30,006.73

Service Code	MSDRG 682
Min. Negotiated Rate	$30,006.73
Max. Negotiated Rate	$30,006.73
Rate for Payer: Hawaii Medical Service Association Commercial	$30,006.73

RENAL FAILURE WITHOUT CC/MCC

Facility

$30,006.73

Service Code	MSDRG 684
Min. Negotiated Rate	$30,006.73
Max. Negotiated Rate	$30,006.73
Rate for Payer: Hawaii Medical Service Association Commercial	$30,006.73

RENEGADE HI-FLO 20X135

Facility

$1,009.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$857.65
Max. Negotiated Rate	$978.73
Rate for Payer: Cash Price	$605.40
Rate for Payer: Health Management Network Commercial	$857.65
Rate for Payer: Kaiser Permanente Commercial	$908.10
Rate for Payer: MDX Hawaii PPO	$978.73

RENEGADE HI-FLO 20X135

Facility

$1,009.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$312.79
Max. Negotiated Rate	$978.73
Rate for Payer: AlohaCare Medicaid	$504.50
Rate for Payer: AlohaCare Medicare	$312.79
Rate for Payer: Cash Price	$605.40
Rate for Payer: Devoted Health Medicare	$343.06
Rate for Payer: Hawaii Medical Service Association Medicare	$312.79
Rate for Payer: Hawaii Western Management Group Commercial	$958.55
Rate for Payer: Health Management Network Commercial	$857.65
Rate for Payer: Humana Medicare	$312.79
Rate for Payer: Kaiser Permanente Commercial	$908.10
Rate for Payer: Kaiser Permanente Medicaid	$514.59
Rate for Payer: Kaiser Permanente Medicare	$312.79
Rate for Payer: MDX Hawaii PPO	$978.73
Rate for Payer: Ohana Health Plan Medicaid	$312.79
Rate for Payer: Ohana Health Plan Medicare	$312.79
Rate for Payer: UnitedHealthcare Medicare	$312.79
Rate for Payer: University Health Alliance Commercial	$735.46

RESERVOIR PROCEDURE SET 04361

Facility

$735.00

Hospital Revenue Code	272
Min. Negotiated Rate	$227.85
Max. Negotiated Rate	$712.95
Rate for Payer: AlohaCare Medicaid	$367.50
Rate for Payer: AlohaCare Medicare	$227.85
Rate for Payer: Cash Price	$441.00
Rate for Payer: Devoted Health Medicare	$249.90
Rate for Payer: Hawaii Medical Service Association Medicare	$227.85
Rate for Payer: Hawaii Western Management Group Commercial	$698.25
Rate for Payer: Health Management Network Commercial	$624.75
Rate for Payer: Humana Medicare	$227.85
Rate for Payer: Kaiser Permanente Commercial	$661.50
Rate for Payer: Kaiser Permanente Medicaid	$374.85
Rate for Payer: Kaiser Permanente Medicare	$227.85
Rate for Payer: MDX Hawaii PPO	$712.95
Rate for Payer: Ohana Health Plan Medicaid	$227.85
Rate for Payer: Ohana Health Plan Medicare	$227.85
Rate for Payer: UnitedHealthcare Medicare	$227.85
Rate for Payer: University Health Alliance Commercial	$535.74

RESERVOIR PROCEDURE SET 04361

Facility

$735.00

Hospital Revenue Code	272
Min. Negotiated Rate	$624.75
Max. Negotiated Rate	$712.95
Rate for Payer: Cash Price	$441.00
Rate for Payer: Health Management Network Commercial	$624.75
Rate for Payer: Kaiser Permanente Commercial	$661.50
Rate for Payer: MDX Hawaii PPO	$712.95

RESONATE HF ICD DR

Facility

$33,982.00

Service Code	HCPCS C1721
Hospital Revenue Code	275
Min. Negotiated Rate	$10,534.42
Max. Negotiated Rate	$32,962.54
Rate for Payer: AlohaCare Medicaid	$16,991.00
Rate for Payer: AlohaCare Medicare	$10,534.42
Rate for Payer: Cash Price	$20,389.20
Rate for Payer: Devoted Health Medicare	$11,553.88
Rate for Payer: Hawaii Medical Service Association Medicare	$10,534.42
Rate for Payer: Hawaii Western Management Group Commercial	$23,787.40
Rate for Payer: Health Management Network Commercial	$28,884.70
Rate for Payer: Humana Medicare	$10,534.42
Rate for Payer: Kaiser Permanente Commercial	$30,583.80
Rate for Payer: Kaiser Permanente Medicaid	$17,330.82
Rate for Payer: Kaiser Permanente Medicare	$10,534.42
Rate for Payer: MDX Hawaii PPO	$32,962.54
Rate for Payer: Ohana Health Plan Medicaid	$10,534.42
Rate for Payer: Ohana Health Plan Medicare	$10,534.42
Rate for Payer: UnitedHealthcare Medicare	$10,534.42
Rate for Payer: University Health Alliance Commercial	$19,029.92

RESONATE HF ICD DR

Facility

$33,982.00

Service Code	HCPCS C1721
Hospital Revenue Code	275
Min. Negotiated Rate	$19,029.92
Max. Negotiated Rate	$32,962.54
Rate for Payer: Cash Price	$20,389.20
Rate for Payer: Hawaii Western Management Group Commercial	$23,787.40
Rate for Payer: Health Management Network Commercial	$28,884.70
Rate for Payer: Kaiser Permanente Commercial	$30,583.80
Rate for Payer: MDX Hawaii PPO	$32,962.54
Rate for Payer: University Health Alliance Commercial	$19,029.92

RESONATE HF ICD VR

Facility

$28,226.00

Service Code	HCPCS C1722
Hospital Revenue Code	275
Min. Negotiated Rate	$8,750.06
Max. Negotiated Rate	$27,379.22
Rate for Payer: AlohaCare Medicaid	$14,113.00
Rate for Payer: AlohaCare Medicare	$8,750.06
Rate for Payer: Cash Price	$16,935.60
Rate for Payer: Devoted Health Medicare	$9,596.84
Rate for Payer: Hawaii Medical Service Association Medicare	$8,750.06
Rate for Payer: Hawaii Western Management Group Commercial	$19,758.20
Rate for Payer: Health Management Network Commercial	$23,992.10
Rate for Payer: Humana Medicare	$8,750.06
Rate for Payer: Kaiser Permanente Commercial	$25,403.40
Rate for Payer: Kaiser Permanente Medicaid	$14,395.26
Rate for Payer: Kaiser Permanente Medicare	$8,750.06
Rate for Payer: MDX Hawaii PPO	$27,379.22
Rate for Payer: Ohana Health Plan Medicaid	$8,750.06
Rate for Payer: Ohana Health Plan Medicare	$8,750.06
Rate for Payer: UnitedHealthcare Medicare	$8,750.06
Rate for Payer: University Health Alliance Commercial	$15,806.56

RESONATE HF ICD VR

Facility

$28,226.00

Service Code	HCPCS C1722
Hospital Revenue Code	275
Min. Negotiated Rate	$15,806.56
Max. Negotiated Rate	$27,379.22
Rate for Payer: Cash Price	$16,935.60
Rate for Payer: Hawaii Western Management Group Commercial	$19,758.20
Rate for Payer: Health Management Network Commercial	$23,992.10
Rate for Payer: Kaiser Permanente Commercial	$25,403.40
Rate for Payer: MDX Hawaii PPO	$27,379.22
Rate for Payer: University Health Alliance Commercial	$15,806.56

RESONATE PACER HF CRT-D

Facility

$38,668.00

Service Code	HCPCS C1882
Hospital Revenue Code	275
Min. Negotiated Rate	$11,987.08
Max. Negotiated Rate	$37,507.96
Rate for Payer: AlohaCare Medicaid	$19,334.00
Rate for Payer: AlohaCare Medicare	$11,987.08
Rate for Payer: Cash Price	$23,200.80
Rate for Payer: Devoted Health Medicare	$13,147.12
Rate for Payer: Hawaii Medical Service Association Medicare	$11,987.08
Rate for Payer: Hawaii Western Management Group Commercial	$27,067.60
Rate for Payer: Health Management Network Commercial	$32,867.80
Rate for Payer: Humana Medicare	$11,987.08
Rate for Payer: Kaiser Permanente Commercial	$34,801.20
Rate for Payer: Kaiser Permanente Medicaid	$19,720.68
Rate for Payer: Kaiser Permanente Medicare	$11,987.08
Rate for Payer: MDX Hawaii PPO	$37,507.96
Rate for Payer: Ohana Health Plan Medicaid	$11,987.08
Rate for Payer: Ohana Health Plan Medicare	$11,987.08
Rate for Payer: UnitedHealthcare Medicare	$11,987.08
Rate for Payer: University Health Alliance Commercial	$21,654.08

RESONATE PACER HF CRT-D

Facility

$38,668.00

Service Code	HCPCS C1882
Hospital Revenue Code	275
Min. Negotiated Rate	$21,654.08
Max. Negotiated Rate	$37,507.96
Rate for Payer: Cash Price	$23,200.80
Rate for Payer: Hawaii Western Management Group Commercial	$27,067.60
Rate for Payer: Health Management Network Commercial	$32,867.80
Rate for Payer: Kaiser Permanente Commercial	$34,801.20
Rate for Payer: MDX Hawaii PPO	$37,507.96
Rate for Payer: University Health Alliance Commercial	$21,654.08

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC

Facility

$42,142.16

Service Code	MSDRG 178
Min. Negotiated Rate	$42,142.16
Max. Negotiated Rate	$42,142.16
Rate for Payer: Hawaii Medical Service Association Commercial	$42,142.16

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC

Facility

$42,142.16

Service Code	MSDRG 177
Min. Negotiated Rate	$42,142.16
Max. Negotiated Rate	$42,142.16
Rate for Payer: Hawaii Medical Service Association Commercial	$42,142.16

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC

Facility

$33,277.61

Service Code	MSDRG 179
Min. Negotiated Rate	$33,277.61
Max. Negotiated Rate	$33,277.61
Rate for Payer: Hawaii Medical Service Association Commercial	$33,277.61

RESPIRATORY NEOPLASMS WITH CC

Facility

$35,932.23

Service Code	MSDRG 181
Min. Negotiated Rate	$35,932.23
Max. Negotiated Rate	$35,932.23
Rate for Payer: Hawaii Medical Service Association Commercial	$35,932.23

RESPIRATORY NEOPLASMS WITH MCC

Facility

$35,932.23

Service Code	MSDRG 180
Min. Negotiated Rate	$35,932.23
Max. Negotiated Rate	$35,932.23
Rate for Payer: Hawaii Medical Service Association Commercial	$35,932.23

RESPIRATORY NEOPLASMS WITHOUT CC/MCC

Facility

$35,932.23

Service Code	MSDRG 182
Min. Negotiated Rate	$35,932.23
Max. Negotiated Rate	$35,932.23
Rate for Payer: Hawaii Medical Service Association Commercial	$35,932.23

Know your out-of-pocket cost for care.

All Charges