Kau Hospital

All Charges

Charge

Type

Setting

Price

RIVAROXABAN 20 MG TABLET [112835]

Facility

$60.00

Service Code	NDC 50458057910
Hospital Revenue Code	250
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: MDX Hawaii PPO	$58.20

RIVAROXABAN 2.5 MG TABLET [164486]

Facility

$30.00

Service Code	NDC 50458057710
Hospital Revenue Code	250
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: MDX Hawaii PPO	$29.10

RIVAROXABAN 2.5 MG TABLET [164486]

Facility

$30.00

Service Code	NDC 50458057760
Hospital Revenue Code	637
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$29.10
Rate for Payer: AlohaCare Medicaid	$15.00
Rate for Payer: AlohaCare Medicare	$9.30
Rate for Payer: Cash Price	$18.00
Rate for Payer: Devoted Health Medicare	$10.20
Rate for Payer: Hawaii Medical Service Association Medicare	$9.30
Rate for Payer: Hawaii Western Management Group Commercial	$28.50
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Humana Medicare	$9.30
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: Kaiser Permanente Medicaid	$15.30
Rate for Payer: Kaiser Permanente Medicare	$9.30
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: Ohana Health Plan Medicaid	$9.30
Rate for Payer: Ohana Health Plan Medicare	$9.30
Rate for Payer: UnitedHealthcare Medicare	$9.30
Rate for Payer: University Health Alliance Commercial	$21.87

RIVAROXABAN 2.5 MG TABLET [164486]

Facility

$30.00

Service Code	NDC 50458057710
Hospital Revenue Code	637
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$29.10
Rate for Payer: AlohaCare Medicaid	$15.00
Rate for Payer: AlohaCare Medicare	$9.30
Rate for Payer: Cash Price	$18.00
Rate for Payer: Devoted Health Medicare	$10.20
Rate for Payer: Hawaii Medical Service Association Medicare	$9.30
Rate for Payer: Hawaii Western Management Group Commercial	$28.50
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Humana Medicare	$9.30
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: Kaiser Permanente Medicaid	$15.30
Rate for Payer: Kaiser Permanente Medicare	$9.30
Rate for Payer: MDX Hawaii PPO	$29.10
Rate for Payer: Ohana Health Plan Medicaid	$9.30
Rate for Payer: Ohana Health Plan Medicare	$9.30
Rate for Payer: UnitedHealthcare Medicare	$9.30
Rate for Payer: University Health Alliance Commercial	$21.87

RIVAROXABAN 2.5 MG TABLET [164486]

Facility

$30.00

Service Code	NDC 50458057760
Hospital Revenue Code	250
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$29.10
Rate for Payer: Cash Price	$18.00
Rate for Payer: Health Management Network Commercial	$25.50
Rate for Payer: Kaiser Permanente Commercial	$27.00
Rate for Payer: MDX Hawaii PPO	$29.10

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$43.00

Service Code	NDC 00781730431
Hospital Revenue Code	250
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: MDX Hawaii PPO	$41.71

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$43.00

Service Code	NDC 00781730458
Hospital Revenue Code	250
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: MDX Hawaii PPO	$41.71

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$43.00

Service Code	NDC 00781730458
Hospital Revenue Code	637
Min. Negotiated Rate	$13.33
Max. Negotiated Rate	$41.71
Rate for Payer: AlohaCare Medicaid	$21.50
Rate for Payer: AlohaCare Medicare	$13.33
Rate for Payer: Cash Price	$25.80
Rate for Payer: Devoted Health Medicare	$14.62
Rate for Payer: Hawaii Medical Service Association Medicare	$13.33
Rate for Payer: Hawaii Western Management Group Commercial	$40.85
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Humana Medicare	$13.33
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: Kaiser Permanente Medicare	$13.33
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: Ohana Health Plan Medicaid	$13.33
Rate for Payer: Ohana Health Plan Medicare	$13.33
Rate for Payer: UnitedHealthcare Medicare	$13.33
Rate for Payer: University Health Alliance Commercial	$31.34

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH [82504]

Facility

$43.00

Service Code	NDC 00781730431
Hospital Revenue Code	637
Min. Negotiated Rate	$13.33
Max. Negotiated Rate	$41.71
Rate for Payer: AlohaCare Medicaid	$21.50
Rate for Payer: AlohaCare Medicare	$13.33
Rate for Payer: Cash Price	$25.80
Rate for Payer: Devoted Health Medicare	$14.62
Rate for Payer: Hawaii Medical Service Association Medicare	$13.33
Rate for Payer: Hawaii Western Management Group Commercial	$40.85
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Humana Medicare	$13.33
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: Kaiser Permanente Medicare	$13.33
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: Ohana Health Plan Medicaid	$13.33
Rate for Payer: Ohana Health Plan Medicare	$13.33
Rate for Payer: UnitedHealthcare Medicare	$13.33
Rate for Payer: University Health Alliance Commercial	$31.34

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH [82505]

Facility

$43.00

Service Code	NDC 00781730931
Hospital Revenue Code	250
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: MDX Hawaii PPO	$41.71

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH [82505]

Facility

$43.00

Service Code	NDC 00781730958
Hospital Revenue Code	250
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$25.80
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: MDX Hawaii PPO	$41.71

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH [82505]

Facility

$43.00

Service Code	NDC 00781730958
Hospital Revenue Code	637
Min. Negotiated Rate	$13.33
Max. Negotiated Rate	$41.71
Rate for Payer: AlohaCare Medicaid	$21.50
Rate for Payer: AlohaCare Medicare	$13.33
Rate for Payer: Cash Price	$25.80
Rate for Payer: Devoted Health Medicare	$14.62
Rate for Payer: Hawaii Medical Service Association Medicare	$13.33
Rate for Payer: Hawaii Western Management Group Commercial	$40.85
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Humana Medicare	$13.33
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: Kaiser Permanente Medicare	$13.33
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: Ohana Health Plan Medicaid	$13.33
Rate for Payer: Ohana Health Plan Medicare	$13.33
Rate for Payer: UnitedHealthcare Medicare	$13.33
Rate for Payer: University Health Alliance Commercial	$31.34

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH [82505]

Facility

$43.00

Service Code	NDC 00781730931
Hospital Revenue Code	637
Min. Negotiated Rate	$13.33
Max. Negotiated Rate	$41.71
Rate for Payer: AlohaCare Medicaid	$21.50
Rate for Payer: AlohaCare Medicare	$13.33
Rate for Payer: Cash Price	$25.80
Rate for Payer: Devoted Health Medicare	$14.62
Rate for Payer: Hawaii Medical Service Association Medicare	$13.33
Rate for Payer: Hawaii Western Management Group Commercial	$40.85
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Humana Medicare	$13.33
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: Kaiser Permanente Medicare	$13.33
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: Ohana Health Plan Medicaid	$13.33
Rate for Payer: Ohana Health Plan Medicare	$13.33
Rate for Payer: UnitedHealthcare Medicare	$13.33
Rate for Payer: University Health Alliance Commercial	$31.34

R MEDIUM 3D MAX LIGHT MESH

Facility

$1,233.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$382.23
Max. Negotiated Rate	$1,196.01
Rate for Payer: AlohaCare Medicaid	$616.50
Rate for Payer: AlohaCare Medicare	$382.23
Rate for Payer: Cash Price	$739.80
Rate for Payer: Devoted Health Medicare	$419.22
Rate for Payer: Hawaii Medical Service Association Medicare	$382.23
Rate for Payer: Hawaii Western Management Group Commercial	$863.10
Rate for Payer: Health Management Network Commercial	$1,048.05
Rate for Payer: Humana Medicare	$382.23
Rate for Payer: Kaiser Permanente Commercial	$1,109.70
Rate for Payer: Kaiser Permanente Medicaid	$628.83
Rate for Payer: Kaiser Permanente Medicare	$382.23
Rate for Payer: MDX Hawaii PPO	$1,196.01
Rate for Payer: Ohana Health Plan Medicaid	$382.23
Rate for Payer: Ohana Health Plan Medicare	$382.23
Rate for Payer: UnitedHealthcare Medicare	$382.23
Rate for Payer: University Health Alliance Commercial	$690.48

R MEDIUM 3D MAX LIGHT MESH

Facility

$1,233.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$690.48
Max. Negotiated Rate	$1,196.01
Rate for Payer: Cash Price	$739.80
Rate for Payer: Hawaii Western Management Group Commercial	$863.10
Rate for Payer: Health Management Network Commercial	$1,048.05
Rate for Payer: Kaiser Permanente Commercial	$1,109.70
Rate for Payer: MDX Hawaii PPO	$1,196.01
Rate for Payer: University Health Alliance Commercial	$690.48

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [95811]

Facility

$16.00

Service Code	NDC 00409318905
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [95811]

Facility

$16.00

Service Code	NDC 00409318910
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$9.60
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION [95811]

Facility

$34.00

Service Code	NDC 71288071811
Hospital Revenue Code	250
Min. Negotiated Rate	$28.90
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$20.40
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$32.98

ROD 11MM X 500MM

Facility

$1,713.00

Hospital Revenue Code	278
Min. Negotiated Rate	$959.28
Max. Negotiated Rate	$1,661.61
Rate for Payer: Cash Price	$1,027.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,199.10
Rate for Payer: Health Management Network Commercial	$1,456.05
Rate for Payer: Kaiser Permanente Commercial	$1,541.70
Rate for Payer: MDX Hawaii PPO	$1,661.61
Rate for Payer: University Health Alliance Commercial	$959.28

ROD 11MM X 500MM

Facility

$1,713.00

Hospital Revenue Code	278
Min. Negotiated Rate	$531.03
Max. Negotiated Rate	$1,661.61
Rate for Payer: AlohaCare Medicaid	$856.50
Rate for Payer: AlohaCare Medicare	$531.03
Rate for Payer: Cash Price	$1,027.80
Rate for Payer: Devoted Health Medicare	$582.42
Rate for Payer: Hawaii Medical Service Association Medicare	$531.03
Rate for Payer: Hawaii Western Management Group Commercial	$1,199.10
Rate for Payer: Health Management Network Commercial	$1,456.05
Rate for Payer: Humana Medicare	$531.03
Rate for Payer: Kaiser Permanente Commercial	$1,541.70
Rate for Payer: Kaiser Permanente Medicaid	$873.63
Rate for Payer: Kaiser Permanente Medicare	$531.03
Rate for Payer: MDX Hawaii PPO	$1,661.61
Rate for Payer: Ohana Health Plan Medicaid	$531.03
Rate for Payer: Ohana Health Plan Medicare	$531.03
Rate for Payer: UnitedHealthcare Medicare	$531.03
Rate for Payer: University Health Alliance Commercial	$959.28

ROD 11X450MM 4922-8-450

Facility

$1,502.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,276.70
Max. Negotiated Rate	$1,456.94
Rate for Payer: Cash Price	$901.20
Rate for Payer: Health Management Network Commercial	$1,276.70
Rate for Payer: Kaiser Permanente Commercial	$1,351.80
Rate for Payer: MDX Hawaii PPO	$1,456.94

ROD 11X450MM 4922-8-450

Facility

$1,502.00

Hospital Revenue Code	272
Min. Negotiated Rate	$465.62
Max. Negotiated Rate	$1,456.94
Rate for Payer: AlohaCare Medicaid	$751.00
Rate for Payer: AlohaCare Medicare	$465.62
Rate for Payer: Cash Price	$901.20
Rate for Payer: Devoted Health Medicare	$510.68
Rate for Payer: Hawaii Medical Service Association Medicare	$465.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,426.90
Rate for Payer: Health Management Network Commercial	$1,276.70
Rate for Payer: Humana Medicare	$465.62
Rate for Payer: Kaiser Permanente Commercial	$1,351.80
Rate for Payer: Kaiser Permanente Medicaid	$766.02
Rate for Payer: Kaiser Permanente Medicare	$465.62
Rate for Payer: MDX Hawaii PPO	$1,456.94
Rate for Payer: Ohana Health Plan Medicaid	$465.62
Rate for Payer: Ohana Health Plan Medicare	$465.62
Rate for Payer: UnitedHealthcare Medicare	$465.62
Rate for Payer: University Health Alliance Commercial	$1,094.81

ROD ATTCHMT MULTI PIN 390.003

Facility

$1,617.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$905.52
Max. Negotiated Rate	$1,568.49
Rate for Payer: Cash Price	$970.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,131.90
Rate for Payer: Health Management Network Commercial	$1,374.45
Rate for Payer: Kaiser Permanente Commercial	$1,455.30
Rate for Payer: MDX Hawaii PPO	$1,568.49
Rate for Payer: University Health Alliance Commercial	$905.52

ROD ATTCHMT MULTI PIN 390.003

Facility

$1,617.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$501.27
Max. Negotiated Rate	$1,568.49
Rate for Payer: AlohaCare Medicaid	$808.50
Rate for Payer: AlohaCare Medicare	$501.27
Rate for Payer: Cash Price	$970.20
Rate for Payer: Devoted Health Medicare	$549.78
Rate for Payer: Hawaii Medical Service Association Medicare	$501.27
Rate for Payer: Hawaii Western Management Group Commercial	$1,131.90
Rate for Payer: Health Management Network Commercial	$1,374.45
Rate for Payer: Humana Medicare	$501.27
Rate for Payer: Kaiser Permanente Commercial	$1,455.30
Rate for Payer: Kaiser Permanente Medicaid	$824.67
Rate for Payer: Kaiser Permanente Medicare	$501.27
Rate for Payer: MDX Hawaii PPO	$1,568.49
Rate for Payer: Ohana Health Plan Medicaid	$501.27
Rate for Payer: Ohana Health Plan Medicare	$501.27
Rate for Payer: UnitedHealthcare Medicare	$501.27
Rate for Payer: University Health Alliance Commercial	$905.52

ROD CARBON FIBER 8.0M #395.792

Facility

$735.00

Service Code	HCPCS C1713
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

Know your out-of-pocket cost for care.

All Charges