Kau Hospital

All Charges

Charge

Type

Setting

Price

ROSUVASTATIN 20 MG TABLET [35135]

Facility

$6.00

Service Code	NDC 50268071011
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

ROSUVASTATIN 20 MG TABLET [35135]

Facility

$6.00

Service Code	NDC 50268071015
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

ROSUVASTATIN 20 MG TABLET [35135]

Facility

$6.00

Service Code	NDC 50268071015
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

ROSUVASTATIN 20 MG TABLET [35135]

Facility

$6.00

Service Code	NDC 50268071011
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

ROSUVASTATIN 40 MG TABLET [35136]

Facility

$6.00

Service Code	NDC 50268071115
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

ROSUVASTATIN 40 MG TABLET [35136]

Facility

$6.00

Service Code	NDC 50268071115
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

ROSUVASTATIN 40 MG TABLET [35136]

Facility

$6.00

Service Code	NDC 50268071111
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

ROSUVASTATIN 40 MG TABLET [35136]

Facility

$6.00

Service Code	NDC 50268071111
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

ROTATIONAL THROMBECTOMY 6FX65

Facility

$6,710.00

Service Code	HCPCS C1724
Hospital Revenue Code	272
Min. Negotiated Rate	$5,703.50
Max. Negotiated Rate	$6,508.70
Rate for Payer: Cash Price	$4,026.00
Rate for Payer: Health Management Network Commercial	$5,703.50
Rate for Payer: Kaiser Permanente Commercial	$6,039.00
Rate for Payer: MDX Hawaii PPO	$6,508.70

ROTATIONAL THROMBECTOMY 6FX65

Facility

$6,710.00

Service Code	HCPCS C1724
Hospital Revenue Code	272
Min. Negotiated Rate	$2,080.10
Max. Negotiated Rate	$6,508.70
Rate for Payer: AlohaCare Medicaid	$3,355.00
Rate for Payer: AlohaCare Medicare	$2,080.10
Rate for Payer: Cash Price	$4,026.00
Rate for Payer: Devoted Health Medicare	$2,281.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,080.10
Rate for Payer: Hawaii Western Management Group Commercial	$6,374.50
Rate for Payer: Health Management Network Commercial	$5,703.50
Rate for Payer: Humana Medicare	$2,080.10
Rate for Payer: Kaiser Permanente Commercial	$6,039.00
Rate for Payer: Kaiser Permanente Medicaid	$3,422.10
Rate for Payer: Kaiser Permanente Medicare	$2,080.10
Rate for Payer: MDX Hawaii PPO	$6,508.70
Rate for Payer: Ohana Health Plan Medicaid	$2,080.10
Rate for Payer: Ohana Health Plan Medicare	$2,080.10
Rate for Payer: UnitedHealthcare Medicare	$2,080.10
Rate for Payer: University Health Alliance Commercial	$4,890.92

ROTATIONAL THROMBECTOMY 7FX65

Facility

$6,710.00

Service Code	HCPCS C1724
Hospital Revenue Code	272
Min. Negotiated Rate	$2,080.10
Max. Negotiated Rate	$6,508.70
Rate for Payer: AlohaCare Medicaid	$3,355.00
Rate for Payer: AlohaCare Medicare	$2,080.10
Rate for Payer: Cash Price	$4,026.00
Rate for Payer: Devoted Health Medicare	$2,281.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,080.10
Rate for Payer: Hawaii Western Management Group Commercial	$6,374.50
Rate for Payer: Health Management Network Commercial	$5,703.50
Rate for Payer: Humana Medicare	$2,080.10
Rate for Payer: Kaiser Permanente Commercial	$6,039.00
Rate for Payer: Kaiser Permanente Medicaid	$3,422.10
Rate for Payer: Kaiser Permanente Medicare	$2,080.10
Rate for Payer: MDX Hawaii PPO	$6,508.70
Rate for Payer: Ohana Health Plan Medicaid	$2,080.10
Rate for Payer: Ohana Health Plan Medicare	$2,080.10
Rate for Payer: UnitedHealthcare Medicare	$2,080.10
Rate for Payer: University Health Alliance Commercial	$4,890.92

ROTATIONAL THROMBECTOMY 7FX65

Facility

$6,710.00

Service Code	HCPCS C1724
Hospital Revenue Code	272
Min. Negotiated Rate	$5,703.50
Max. Negotiated Rate	$6,508.70
Rate for Payer: Cash Price	$4,026.00
Rate for Payer: Health Management Network Commercial	$5,703.50
Rate for Payer: Kaiser Permanente Commercial	$6,039.00
Rate for Payer: MDX Hawaii PPO	$6,508.70

ROTICULATOR 30.2-0 GRY END GIA

Facility

$698.00

Hospital Revenue Code	272
Min. Negotiated Rate	$216.38
Max. Negotiated Rate	$677.06
Rate for Payer: AlohaCare Medicaid	$349.00
Rate for Payer: AlohaCare Medicare	$216.38
Rate for Payer: Cash Price	$418.80
Rate for Payer: Devoted Health Medicare	$237.32
Rate for Payer: Hawaii Medical Service Association Medicare	$216.38
Rate for Payer: Hawaii Western Management Group Commercial	$663.10
Rate for Payer: Health Management Network Commercial	$593.30
Rate for Payer: Humana Medicare	$216.38
Rate for Payer: Kaiser Permanente Commercial	$628.20
Rate for Payer: Kaiser Permanente Medicaid	$355.98
Rate for Payer: Kaiser Permanente Medicare	$216.38
Rate for Payer: MDX Hawaii PPO	$677.06
Rate for Payer: Ohana Health Plan Medicaid	$216.38
Rate for Payer: Ohana Health Plan Medicare	$216.38
Rate for Payer: UnitedHealthcare Medicare	$216.38
Rate for Payer: University Health Alliance Commercial	$508.77

ROTICULATOR 30.2-0 GRY END GIA

Facility

$698.00

Hospital Revenue Code	272
Min. Negotiated Rate	$593.30
Max. Negotiated Rate	$677.06
Rate for Payer: Cash Price	$418.80
Rate for Payer: Health Management Network Commercial	$593.30
Rate for Payer: Kaiser Permanente Commercial	$628.20
Rate for Payer: MDX Hawaii PPO	$677.06

ROTIGOTINE 4 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82101]

Facility

$87.00

Service Code	NDC 50474080403
Hospital Revenue Code	637
Min. Negotiated Rate	$26.97
Max. Negotiated Rate	$84.39
Rate for Payer: AlohaCare Medicaid	$43.50
Rate for Payer: AlohaCare Medicare	$26.97
Rate for Payer: Cash Price	$52.20
Rate for Payer: Devoted Health Medicare	$29.58
Rate for Payer: Hawaii Medical Service Association Medicare	$26.97
Rate for Payer: Hawaii Western Management Group Commercial	$82.65
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$26.97
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$26.97
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$26.97
Rate for Payer: Ohana Health Plan Medicare	$26.97
Rate for Payer: UnitedHealthcare Medicare	$26.97
Rate for Payer: University Health Alliance Commercial	$63.41

ROTIGOTINE 4 MG/24 HOUR TRANSDERMAL 24 HOUR PATCH [82101]

Facility

$87.00

Service Code	NDC 50474080403
Hospital Revenue Code	250
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$52.20
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39

ROUND GIGLI SAW BLADE 12

Facility

$144.00

Hospital Revenue Code	272
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$139.68
Rate for Payer: Cash Price	$86.40
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Kaiser Permanente Commercial	$129.60
Rate for Payer: MDX Hawaii PPO	$139.68

ROUND GIGLI SAW BLADE 12

Facility

$144.00

Hospital Revenue Code	272
Min. Negotiated Rate	$44.64
Max. Negotiated Rate	$139.68
Rate for Payer: AlohaCare Medicaid	$72.00
Rate for Payer: AlohaCare Medicare	$44.64
Rate for Payer: Cash Price	$86.40
Rate for Payer: Devoted Health Medicare	$48.96
Rate for Payer: Hawaii Medical Service Association Medicare	$44.64
Rate for Payer: Hawaii Western Management Group Commercial	$136.80
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Humana Medicare	$44.64
Rate for Payer: Kaiser Permanente Commercial	$129.60
Rate for Payer: Kaiser Permanente Medicaid	$73.44
Rate for Payer: Kaiser Permanente Medicare	$44.64
Rate for Payer: MDX Hawaii PPO	$139.68
Rate for Payer: Ohana Health Plan Medicaid	$44.64
Rate for Payer: Ohana Health Plan Medicare	$44.64
Rate for Payer: UnitedHealthcare Medicare	$44.64
Rate for Payer: University Health Alliance Commercial	$104.96

ROUND SILICONE GS10621-620HP

Facility

$694.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$388.64
Max. Negotiated Rate	$673.18
Rate for Payer: Cash Price	$416.40
Rate for Payer: Hawaii Western Management Group Commercial	$485.80
Rate for Payer: Health Management Network Commercial	$589.90
Rate for Payer: Kaiser Permanente Commercial	$624.60
Rate for Payer: MDX Hawaii PPO	$673.18
Rate for Payer: University Health Alliance Commercial	$388.64

ROUND SILICONE GS10621-620HP

Facility

$694.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$215.14
Max. Negotiated Rate	$673.18
Rate for Payer: AlohaCare Medicaid	$347.00
Rate for Payer: AlohaCare Medicare	$215.14
Rate for Payer: Cash Price	$416.40
Rate for Payer: Devoted Health Medicare	$235.96
Rate for Payer: Hawaii Medical Service Association Medicare	$215.14
Rate for Payer: Hawaii Western Management Group Commercial	$485.80
Rate for Payer: Health Management Network Commercial	$589.90
Rate for Payer: Humana Medicare	$215.14
Rate for Payer: Kaiser Permanente Commercial	$624.60
Rate for Payer: Kaiser Permanente Medicaid	$353.94
Rate for Payer: Kaiser Permanente Medicare	$215.14
Rate for Payer: MDX Hawaii PPO	$673.18
Rate for Payer: Ohana Health Plan Medicaid	$215.14
Rate for Payer: Ohana Health Plan Medicare	$215.14
Rate for Payer: UnitedHealthcare Medicare	$215.14
Rate for Payer: University Health Alliance Commercial	$388.64

ROUND SILICONE GS10621-625MP

Facility

$694.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$388.64
Max. Negotiated Rate	$673.18
Rate for Payer: Cash Price	$416.40
Rate for Payer: Hawaii Western Management Group Commercial	$485.80
Rate for Payer: Health Management Network Commercial	$589.90
Rate for Payer: Kaiser Permanente Commercial	$624.60
Rate for Payer: MDX Hawaii PPO	$673.18
Rate for Payer: University Health Alliance Commercial	$388.64

ROUND SILICONE GS10621-625MP

Facility

$694.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$215.14
Max. Negotiated Rate	$673.18
Rate for Payer: AlohaCare Medicaid	$347.00
Rate for Payer: AlohaCare Medicare	$215.14
Rate for Payer: Cash Price	$416.40
Rate for Payer: Devoted Health Medicare	$235.96
Rate for Payer: Hawaii Medical Service Association Medicare	$215.14
Rate for Payer: Hawaii Western Management Group Commercial	$485.80
Rate for Payer: Health Management Network Commercial	$589.90
Rate for Payer: Humana Medicare	$215.14
Rate for Payer: Kaiser Permanente Commercial	$624.60
Rate for Payer: Kaiser Permanente Medicaid	$353.94
Rate for Payer: Kaiser Permanente Medicare	$215.14
Rate for Payer: MDX Hawaii PPO	$673.18
Rate for Payer: Ohana Health Plan Medicaid	$215.14
Rate for Payer: Ohana Health Plan Medicare	$215.14
Rate for Payer: UnitedHealthcare Medicare	$215.14
Rate for Payer: University Health Alliance Commercial	$388.64

ROUTER QC 130MM #332.062

Facility

$945.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$292.95
Max. Negotiated Rate	$916.65
Rate for Payer: AlohaCare Medicaid	$472.50
Rate for Payer: AlohaCare Medicare	$292.95
Rate for Payer: Cash Price	$567.00
Rate for Payer: Devoted Health Medicare	$321.30
Rate for Payer: Hawaii Medical Service Association Medicare	$292.95
Rate for Payer: Hawaii Western Management Group Commercial	$897.75
Rate for Payer: Health Management Network Commercial	$803.25
Rate for Payer: Humana Medicare	$292.95
Rate for Payer: Kaiser Permanente Commercial	$850.50
Rate for Payer: Kaiser Permanente Medicaid	$481.95
Rate for Payer: Kaiser Permanente Medicare	$292.95
Rate for Payer: MDX Hawaii PPO	$916.65
Rate for Payer: Ohana Health Plan Medicaid	$292.95
Rate for Payer: Ohana Health Plan Medicare	$292.95
Rate for Payer: UnitedHealthcare Medicare	$292.95
Rate for Payer: University Health Alliance Commercial	$688.81

ROUTER QC 130MM #332.062

Facility

$945.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$803.25
Max. Negotiated Rate	$916.65
Rate for Payer: Cash Price	$567.00
Rate for Payer: Health Management Network Commercial	$803.25
Rate for Payer: Kaiser Permanente Commercial	$850.50
Rate for Payer: MDX Hawaii PPO	$916.65

RSA GLENOID 28MM 5572-2802

Facility

$4,400.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,464.00
Max. Negotiated Rate	$4,268.00
Rate for Payer: Cash Price	$2,640.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,080.00
Rate for Payer: Health Management Network Commercial	$3,740.00
Rate for Payer: Kaiser Permanente Commercial	$3,960.00
Rate for Payer: MDX Hawaii PPO	$4,268.00
Rate for Payer: University Health Alliance Commercial	$2,464.00

Know your out-of-pocket cost for care.

All Charges