Kau Hospital

All Charges

Charge

Type

Setting

Price

REUNION RSA SYS 5571-S-3604-E

Facility

$3,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.00
Max. Negotiated Rate	$3,104.00
Rate for Payer: Cash Price	$1,920.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,240.00
Rate for Payer: Health Management Network Commercial	$2,720.00
Rate for Payer: Kaiser Permanente Commercial	$2,880.00
Rate for Payer: MDX Hawaii PPO	$3,104.00
Rate for Payer: University Health Alliance Commercial	$1,792.00

REUNION RSA SYS 5571-S-3604-E

Facility

$3,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$992.00
Max. Negotiated Rate	$3,104.00
Rate for Payer: AlohaCare Medicaid	$1,600.00
Rate for Payer: AlohaCare Medicare	$992.00
Rate for Payer: Cash Price	$1,920.00
Rate for Payer: Devoted Health Medicare	$1,088.00
Rate for Payer: Hawaii Medical Service Association Medicare	$992.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,240.00
Rate for Payer: Health Management Network Commercial	$2,720.00
Rate for Payer: Humana Medicare	$992.00
Rate for Payer: Kaiser Permanente Commercial	$2,880.00
Rate for Payer: Kaiser Permanente Medicaid	$1,632.00
Rate for Payer: Kaiser Permanente Medicare	$992.00
Rate for Payer: MDX Hawaii PPO	$3,104.00
Rate for Payer: Ohana Health Plan Medicaid	$992.00
Rate for Payer: Ohana Health Plan Medicare	$992.00
Rate for Payer: UnitedHealthcare Medicare	$992.00
Rate for Payer: University Health Alliance Commercial	$1,792.00

REVERSED GLENOID DWJ013

Facility

$6,028.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,868.68
Max. Negotiated Rate	$5,847.16
Rate for Payer: AlohaCare Medicaid	$3,014.00
Rate for Payer: AlohaCare Medicare	$1,868.68
Rate for Payer: Cash Price	$3,616.80
Rate for Payer: Devoted Health Medicare	$2,049.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,868.68
Rate for Payer: Hawaii Western Management Group Commercial	$4,219.60
Rate for Payer: Health Management Network Commercial	$5,123.80
Rate for Payer: Humana Medicare	$1,868.68
Rate for Payer: Kaiser Permanente Commercial	$5,425.20
Rate for Payer: Kaiser Permanente Medicaid	$3,074.28
Rate for Payer: Kaiser Permanente Medicare	$1,868.68
Rate for Payer: MDX Hawaii PPO	$5,847.16
Rate for Payer: Ohana Health Plan Medicaid	$1,868.68
Rate for Payer: Ohana Health Plan Medicare	$1,868.68
Rate for Payer: UnitedHealthcare Medicare	$1,868.68
Rate for Payer: University Health Alliance Commercial	$3,375.68

REVERSED GLENOID DWJ013

Facility

$6,028.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,375.68
Max. Negotiated Rate	$5,847.16
Rate for Payer: Cash Price	$3,616.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,219.60
Rate for Payer: Health Management Network Commercial	$5,123.80
Rate for Payer: Kaiser Permanente Commercial	$5,425.20
Rate for Payer: MDX Hawaii PPO	$5,847.16
Rate for Payer: University Health Alliance Commercial	$3,375.68

REVERSED INSERT DWF421B

Facility

$2,768.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$858.08
Max. Negotiated Rate	$2,684.96
Rate for Payer: AlohaCare Medicaid	$1,384.00
Rate for Payer: AlohaCare Medicare	$858.08
Rate for Payer: Cash Price	$1,660.80
Rate for Payer: Devoted Health Medicare	$941.12
Rate for Payer: Hawaii Medical Service Association Medicare	$858.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,937.60
Rate for Payer: Health Management Network Commercial	$2,352.80
Rate for Payer: Humana Medicare	$858.08
Rate for Payer: Kaiser Permanente Commercial	$2,491.20
Rate for Payer: Kaiser Permanente Medicaid	$1,411.68
Rate for Payer: Kaiser Permanente Medicare	$858.08
Rate for Payer: MDX Hawaii PPO	$2,684.96
Rate for Payer: Ohana Health Plan Medicaid	$858.08
Rate for Payer: Ohana Health Plan Medicare	$858.08
Rate for Payer: UnitedHealthcare Medicare	$858.08
Rate for Payer: University Health Alliance Commercial	$1,550.08

REVERSED INSERT DWF421B

Facility

$2,768.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.08
Max. Negotiated Rate	$2,684.96
Rate for Payer: Cash Price	$1,660.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,937.60
Rate for Payer: Health Management Network Commercial	$2,352.80
Rate for Payer: Kaiser Permanente Commercial	$2,491.20
Rate for Payer: MDX Hawaii PPO	$2,684.96
Rate for Payer: University Health Alliance Commercial	$1,550.08

REVISION OF HIP OR KNEE REPLACEMENT WITH CC

Facility

$56,576.67

Service Code	MSDRG 467
Min. Negotiated Rate	$56,576.67
Max. Negotiated Rate	$56,576.67
Rate for Payer: Hawaii Medical Service Association Commercial	$56,576.67

REVISION OF HIP OR KNEE REPLACEMENT WITH MCC

Facility

$56,576.67

Service Code	MSDRG 466
Min. Negotiated Rate	$56,576.67
Max. Negotiated Rate	$56,576.67
Rate for Payer: Hawaii Medical Service Association Commercial	$56,576.67

REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC

Facility

$56,576.67

Service Code	MSDRG 468
Min. Negotiated Rate	$56,576.67
Max. Negotiated Rate	$56,576.67
Rate for Payer: Hawaii Medical Service Association Commercial	$56,576.67

RFX HUMERAL 10X123MM 5568-0010

Facility

$8,462.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,738.72
Max. Negotiated Rate	$8,208.14
Rate for Payer: Cash Price	$5,077.20
Rate for Payer: Hawaii Western Management Group Commercial	$5,923.40
Rate for Payer: Health Management Network Commercial	$7,192.70
Rate for Payer: Kaiser Permanente Commercial	$7,615.80
Rate for Payer: MDX Hawaii PPO	$8,208.14
Rate for Payer: University Health Alliance Commercial	$4,738.72

RFX HUMERAL 10X123MM 5568-0010

Facility

$8,462.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,623.22
Max. Negotiated Rate	$8,208.14
Rate for Payer: AlohaCare Medicaid	$4,231.00
Rate for Payer: AlohaCare Medicare	$2,623.22
Rate for Payer: Cash Price	$5,077.20
Rate for Payer: Devoted Health Medicare	$2,877.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,623.22
Rate for Payer: Hawaii Western Management Group Commercial	$5,923.40
Rate for Payer: Health Management Network Commercial	$7,192.70
Rate for Payer: Humana Medicare	$2,623.22
Rate for Payer: Kaiser Permanente Commercial	$7,615.80
Rate for Payer: Kaiser Permanente Medicaid	$4,315.62
Rate for Payer: Kaiser Permanente Medicare	$2,623.22
Rate for Payer: MDX Hawaii PPO	$8,208.14
Rate for Payer: Ohana Health Plan Medicaid	$2,623.22
Rate for Payer: Ohana Health Plan Medicare	$2,623.22
Rate for Payer: UnitedHealthcare Medicare	$2,623.22
Rate for Payer: University Health Alliance Commercial	$4,738.72

RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE [127772]

Facility

$307.00

Service Code	HCPCS J2791
Hospital Revenue Code	636
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$297.79
Rate for Payer: AlohaCare Medicaid	$153.50
Rate for Payer: AlohaCare Medicaid	$186.00
Rate for Payer: AlohaCare Medicare	$115.32
Rate for Payer: AlohaCare Medicare	$95.17
Rate for Payer: Cash Price	$223.20
Rate for Payer: Cash Price	$184.20
Rate for Payer: Cash Price	$184.20
Rate for Payer: Cash Price	$223.20
Rate for Payer: Devoted Health Medicare	$104.38
Rate for Payer: Devoted Health Medicare	$126.48
Rate for Payer: Hawaii Medical Service Association ABD	$4.97
Rate for Payer: Hawaii Medical Service Association ABD	$4.97
Rate for Payer: Hawaii Medical Service Association Medicare	$115.32
Rate for Payer: Hawaii Medical Service Association Medicare	$95.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.97
Rate for Payer: Hawaii Western Management Group Commercial	$291.65
Rate for Payer: Hawaii Western Management Group Commercial	$353.40
Rate for Payer: Health Management Network Commercial	$316.20
Rate for Payer: Health Management Network Commercial	$260.95
Rate for Payer: Humana Medicare	$95.17
Rate for Payer: Humana Medicare	$115.32
Rate for Payer: Kaiser Permanente Commercial	$276.30
Rate for Payer: Kaiser Permanente Commercial	$334.80
Rate for Payer: Kaiser Permanente Medicaid	$189.72
Rate for Payer: Kaiser Permanente Medicaid	$156.57
Rate for Payer: Kaiser Permanente Medicare	$95.17
Rate for Payer: Kaiser Permanente Medicare	$115.32
Rate for Payer: MDX Hawaii PPO	$297.79
Rate for Payer: MDX Hawaii PPO	$360.84
Rate for Payer: Ohana Health Plan Medicaid	$115.32
Rate for Payer: Ohana Health Plan Medicaid	$95.17
Rate for Payer: Ohana Health Plan Medicare	$95.17
Rate for Payer: Ohana Health Plan Medicare	$115.32
Rate for Payer: UnitedHealthcare Medicaid	$223.20
Rate for Payer: UnitedHealthcare Medicaid	$184.20
Rate for Payer: UnitedHealthcare Medicare	$95.17
Rate for Payer: UnitedHealthcare Medicare	$115.32
Rate for Payer: University Health Alliance Commercial	$223.77
Rate for Payer: University Health Alliance Commercial	$271.15

RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJECTION SYRINGE [127772]

Facility

$307.00

Service Code	HCPCS J2791
Hospital Revenue Code	250
Min. Negotiated Rate	$260.95
Max. Negotiated Rate	$297.79
Rate for Payer: Cash Price	$184.20
Rate for Payer: Cash Price	$223.20
Rate for Payer: Health Management Network Commercial	$260.95
Rate for Payer: Health Management Network Commercial	$316.20
Rate for Payer: Kaiser Permanente Commercial	$276.30
Rate for Payer: Kaiser Permanente Commercial	$334.80
Rate for Payer: MDX Hawaii PPO	$360.84
Rate for Payer: MDX Hawaii PPO	$297.79

RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) INTRAMUSCULAR SYRINGE [127771]

Facility

$222.00

Service Code	HCPCS J2790
Hospital Revenue Code	636
Min. Negotiated Rate	$68.82
Max. Negotiated Rate	$215.34
Rate for Payer: AlohaCare Medicaid	$111.00
Rate for Payer: AlohaCare Medicare	$68.82
Rate for Payer: Cash Price	$133.20
Rate for Payer: Cash Price	$133.20
Rate for Payer: Devoted Health Medicare	$75.48
Rate for Payer: Hawaii Medical Service Association ABD	$82.42
Rate for Payer: Hawaii Medical Service Association Medicare	$68.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$82.42
Rate for Payer: Hawaii Western Management Group Commercial	$210.90
Rate for Payer: Health Management Network Commercial	$188.70
Rate for Payer: Humana Medicare	$68.82
Rate for Payer: Kaiser Permanente Commercial	$199.80
Rate for Payer: Kaiser Permanente Medicaid	$113.22
Rate for Payer: Kaiser Permanente Medicare	$68.82
Rate for Payer: MDX Hawaii PPO	$215.34
Rate for Payer: Ohana Health Plan Medicaid	$68.82
Rate for Payer: Ohana Health Plan Medicare	$68.82
Rate for Payer: UnitedHealthcare Medicaid	$133.20
Rate for Payer: UnitedHealthcare Medicare	$68.82
Rate for Payer: University Health Alliance Commercial	$161.82

RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) INTRAMUSCULAR SYRINGE [127771]

Facility

$222.00

Service Code	HCPCS J2790
Hospital Revenue Code	250
Min. Negotiated Rate	$188.70
Max. Negotiated Rate	$215.34
Rate for Payer: Cash Price	$133.20
Rate for Payer: Health Management Network Commercial	$188.70
Rate for Payer: Kaiser Permanente Commercial	$199.80
Rate for Payer: MDX Hawaii PPO	$215.34

RIFAMPIN 300 MG CAPSULE [11293]

Facility

$8.00

Service Code	NDC 60687058611
Hospital Revenue Code	637
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$7.76
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$2.48
Rate for Payer: Cash Price	$4.80
Rate for Payer: Devoted Health Medicare	$2.72
Rate for Payer: Hawaii Medical Service Association Medicare	$2.48
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Humana Medicare	$2.48
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicare	$2.48
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: Ohana Health Plan Medicaid	$2.48
Rate for Payer: Ohana Health Plan Medicare	$2.48
Rate for Payer: UnitedHealthcare Medicare	$2.48
Rate for Payer: University Health Alliance Commercial	$5.83

RIFAMPIN 300 MG CAPSULE [11293]

Facility

$8.00

Service Code	NDC 60687058611
Hospital Revenue Code	250
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: MDX Hawaii PPO	$7.76

RIFAMPIN 300 MG CAPSULE [11293]

Facility

$8.00

Service Code	NDC 60687058601
Hospital Revenue Code	250
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$7.76
Rate for Payer: Cash Price	$4.80
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: MDX Hawaii PPO	$7.76

RIFAMPIN 300 MG CAPSULE [11293]

Facility

$8.00

Service Code	NDC 60687058601
Hospital Revenue Code	637
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$7.76
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: AlohaCare Medicare	$2.48
Rate for Payer: Cash Price	$4.80
Rate for Payer: Devoted Health Medicare	$2.72
Rate for Payer: Hawaii Medical Service Association Medicare	$2.48
Rate for Payer: Hawaii Western Management Group Commercial	$7.60
Rate for Payer: Health Management Network Commercial	$6.80
Rate for Payer: Humana Medicare	$2.48
Rate for Payer: Kaiser Permanente Commercial	$7.20
Rate for Payer: Kaiser Permanente Medicaid	$4.08
Rate for Payer: Kaiser Permanente Medicare	$2.48
Rate for Payer: MDX Hawaii PPO	$7.76
Rate for Payer: Ohana Health Plan Medicaid	$2.48
Rate for Payer: Ohana Health Plan Medicare	$2.48
Rate for Payer: UnitedHealthcare Medicare	$2.48
Rate for Payer: University Health Alliance Commercial	$5.83

RIFAMPIN 600 MG/10ML IV (WET SOLR VIAL) [43011291]

Facility

$276.00

Service Code	NDC 63323035120
Hospital Revenue Code	250
Min. Negotiated Rate	$234.60
Max. Negotiated Rate	$267.72
Rate for Payer: Cash Price	$165.60
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Kaiser Permanente Commercial	$248.40
Rate for Payer: MDX Hawaii PPO	$267.72

RIFAMPIN 600 MG/10ML IV (WET SOLR VIAL) [43011291]

Facility

$161.00

Service Code	NDC 00068059701
Hospital Revenue Code	250
Min. Negotiated Rate	$136.85
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$96.60
Rate for Payer: Cash Price	$193.20
Rate for Payer: Health Management Network Commercial	$273.70
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Kaiser Permanente Commercial	$144.90
Rate for Payer: Kaiser Permanente Commercial	$289.80
Rate for Payer: MDX Hawaii PPO	$156.17
Rate for Payer: MDX Hawaii PPO	$312.34

RIFAMPIN 600 MG INTRAVENOUS SOLUTION [11291]

Facility

$322.00

Service Code	HCPCS J2804
Hospital Revenue Code	250
Min. Negotiated Rate	$273.70
Max. Negotiated Rate	$312.34
Rate for Payer: Cash Price	$193.20
Rate for Payer: Cash Price	$165.60
Rate for Payer: Health Management Network Commercial	$273.70
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Kaiser Permanente Commercial	$248.40
Rate for Payer: Kaiser Permanente Commercial	$289.80
Rate for Payer: MDX Hawaii PPO	$312.34
Rate for Payer: MDX Hawaii PPO	$267.72

RIFAXIMIN 550 MG TABLET [104604]

Facility

$139.00

Service Code	NDC 65649030303
Hospital Revenue Code	250
Min. Negotiated Rate	$118.15
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$83.40
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: MDX Hawaii PPO	$134.83

RIFAXIMIN 550 MG TABLET [104604]

Facility

$139.00

Service Code	NDC 65649030303
Hospital Revenue Code	637
Min. Negotiated Rate	$43.09
Max. Negotiated Rate	$134.83
Rate for Payer: AlohaCare Medicaid	$69.50
Rate for Payer: AlohaCare Medicare	$43.09
Rate for Payer: Cash Price	$83.40
Rate for Payer: Devoted Health Medicare	$47.26
Rate for Payer: Hawaii Medical Service Association Medicare	$43.09
Rate for Payer: Hawaii Western Management Group Commercial	$132.05
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Humana Medicare	$43.09
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: Kaiser Permanente Medicaid	$70.89
Rate for Payer: Kaiser Permanente Medicare	$43.09
Rate for Payer: MDX Hawaii PPO	$134.83
Rate for Payer: Ohana Health Plan Medicaid	$43.09
Rate for Payer: Ohana Health Plan Medicare	$43.09
Rate for Payer: UnitedHealthcare Medicare	$43.09
Rate for Payer: University Health Alliance Commercial	$101.32

RIGIFLEX 35/10 BLN M00554510

Facility

$1,854.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$574.74
Max. Negotiated Rate	$1,798.38
Rate for Payer: AlohaCare Medicaid	$927.00
Rate for Payer: AlohaCare Medicare	$574.74
Rate for Payer: Cash Price	$1,112.40
Rate for Payer: Devoted Health Medicare	$630.36
Rate for Payer: Hawaii Medical Service Association Medicare	$574.74
Rate for Payer: Hawaii Western Management Group Commercial	$1,761.30
Rate for Payer: Health Management Network Commercial	$1,575.90
Rate for Payer: Humana Medicare	$574.74
Rate for Payer: Kaiser Permanente Commercial	$1,668.60
Rate for Payer: Kaiser Permanente Medicaid	$945.54
Rate for Payer: Kaiser Permanente Medicare	$574.74
Rate for Payer: MDX Hawaii PPO	$1,798.38
Rate for Payer: Ohana Health Plan Medicaid	$574.74
Rate for Payer: Ohana Health Plan Medicare	$574.74
Rate for Payer: UnitedHealthcare Medicare	$574.74
Rate for Payer: University Health Alliance Commercial	$1,351.38

Know your out-of-pocket cost for care.

All Charges