Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

rocuronium 50 mg/5 ml vial [HHSC]

Facility

OP

$24.35

Service Code	NDC 00409955849
Hospital Charge Code	2500733
Hospital Revenue Code	250
Min. Negotiated Rate	$12.18
Max. Negotiated Rate	$23.62
Rate for Payer: AlohaCare Medicaid	$12.18
Rate for Payer: AlohaCare Medicare	$12.18
Rate for Payer: Cash Price	$15.83
Rate for Payer: Devoted Health Medicare	$13.39
Rate for Payer: Hawaii Medical Service Association Medicare	$12.18
Rate for Payer: Hawaii Western Management Group Commercial	$23.13
Rate for Payer: Health Management Network Commercial	$20.70
Rate for Payer: Humana Medicare	$12.18
Rate for Payer: Kaiser Permanente Commercial	$21.91
Rate for Payer: Kaiser Permanente Medicaid	$12.42
Rate for Payer: Kaiser Permanente Medicare	$12.18
Rate for Payer: MDX Hawaii PPO	$23.62
Rate for Payer: Ohana Health Plan Medicaid	$12.18
Rate for Payer: Ohana Health Plan Medicare	$12.18
Rate for Payer: UnitedHealthcare Medicaid	$14.61
Rate for Payer: UnitedHealthcare Medicare	$12.18
Rate for Payer: University Health Alliance Commercial	$17.75

rocuronium 50 mg/5 ml vial [HHSC]

Facility

IP

$24.35

Service Code	NDC 00409955849
Hospital Charge Code	2500733
Hospital Revenue Code	250
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$23.62
Rate for Payer: Cash Price	$15.83
Rate for Payer: Health Management Network Commercial	$20.70
Rate for Payer: Kaiser Permanente Commercial	$21.91
Rate for Payer: MDX Hawaii PPO	$23.62

rocuronium 50 mg/5 ml vial [HHSC]

Facility

IP

$60.82

Service Code	NDC 55150022505
Hospital Charge Code	2500733
Hospital Revenue Code	250
Min. Negotiated Rate	$51.70
Max. Negotiated Rate	$59.00
Rate for Payer: Cash Price	$39.53
Rate for Payer: Health Management Network Commercial	$51.70
Rate for Payer: Kaiser Permanente Commercial	$54.74
Rate for Payer: MDX Hawaii PPO	$59.00

rocuronium 50 mg/5 ml vial [HHSC]

Facility

OP

$24.60

Service Code	NDC 00409140310
Hospital Charge Code	2500733
Hospital Revenue Code	250
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$23.86
Rate for Payer: AlohaCare Medicaid	$12.30
Rate for Payer: AlohaCare Medicare	$12.30
Rate for Payer: Cash Price	$15.99
Rate for Payer: Devoted Health Medicare	$13.53
Rate for Payer: Hawaii Medical Service Association Medicare	$12.30
Rate for Payer: Hawaii Western Management Group Commercial	$23.37
Rate for Payer: Health Management Network Commercial	$20.91
Rate for Payer: Humana Medicare	$12.30
Rate for Payer: Kaiser Permanente Commercial	$22.14
Rate for Payer: Kaiser Permanente Medicaid	$12.55
Rate for Payer: Kaiser Permanente Medicare	$12.30
Rate for Payer: MDX Hawaii PPO	$23.86
Rate for Payer: Ohana Health Plan Medicaid	$12.30
Rate for Payer: Ohana Health Plan Medicare	$12.30
Rate for Payer: UnitedHealthcare Medicaid	$14.76
Rate for Payer: UnitedHealthcare Medicare	$12.30
Rate for Payer: University Health Alliance Commercial	$17.93

rocuronium 50 mg/5 ml vial [HHSC]

Facility

IP

$39.70

Service Code	NDC 00143925010
Hospital Charge Code	2500733
Hospital Revenue Code	250
Min. Negotiated Rate	$33.74
Max. Negotiated Rate	$38.51
Rate for Payer: Cash Price	$25.81
Rate for Payer: Health Management Network Commercial	$33.74
Rate for Payer: Kaiser Permanente Commercial	$35.73
Rate for Payer: MDX Hawaii PPO	$38.51

rocuronium 50 mg/5 ml vial [HHSC]

Facility

OP

$39.70

Service Code	NDC 00143925010
Hospital Charge Code	2500733
Hospital Revenue Code	250
Min. Negotiated Rate	$19.85
Max. Negotiated Rate	$38.51
Rate for Payer: AlohaCare Medicaid	$19.85
Rate for Payer: AlohaCare Medicare	$19.85
Rate for Payer: Cash Price	$25.81
Rate for Payer: Devoted Health Medicare	$21.84
Rate for Payer: Hawaii Medical Service Association Medicare	$19.85
Rate for Payer: Hawaii Western Management Group Commercial	$37.72
Rate for Payer: Health Management Network Commercial	$33.74
Rate for Payer: Humana Medicare	$19.85
Rate for Payer: Kaiser Permanente Commercial	$35.73
Rate for Payer: Kaiser Permanente Medicaid	$20.25
Rate for Payer: Kaiser Permanente Medicare	$19.85
Rate for Payer: MDX Hawaii PPO	$38.51
Rate for Payer: Ohana Health Plan Medicaid	$19.85
Rate for Payer: Ohana Health Plan Medicare	$19.85
Rate for Payer: UnitedHealthcare Medicaid	$23.82
Rate for Payer: UnitedHealthcare Medicare	$19.85
Rate for Payer: University Health Alliance Commercial	$28.94

rocuronium 50 mg/5 ml vial [HHSC]

Facility

IP

$24.80

Service Code	NDC 00409318910
Hospital Charge Code	2500733
Hospital Revenue Code	250
Min. Negotiated Rate	$21.08
Max. Negotiated Rate	$24.06
Rate for Payer: Cash Price	$16.12
Rate for Payer: Health Management Network Commercial	$21.08
Rate for Payer: Kaiser Permanente Commercial	$22.32
Rate for Payer: MDX Hawaii PPO	$24.06

rocuronium 50 mg/5 ml vial [HHSC]

Facility

IP

$24.60

Service Code	NDC 00409140310
Hospital Charge Code	2500733
Hospital Revenue Code	250
Min. Negotiated Rate	$20.91
Max. Negotiated Rate	$23.86
Rate for Payer: Cash Price	$15.99
Rate for Payer: Health Management Network Commercial	$20.91
Rate for Payer: Kaiser Permanente Commercial	$22.14
Rate for Payer: MDX Hawaii PPO	$23.86

rocuronium 50 mg/5 ml vial [HHSC]

Facility

OP

$24.80

Service Code	NDC 00409318910
Hospital Charge Code	2500733
Hospital Revenue Code	250
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$24.06
Rate for Payer: AlohaCare Medicaid	$12.40
Rate for Payer: AlohaCare Medicare	$12.40
Rate for Payer: Cash Price	$16.12
Rate for Payer: Devoted Health Medicare	$13.64
Rate for Payer: Hawaii Medical Service Association Medicare	$12.40
Rate for Payer: Hawaii Western Management Group Commercial	$23.56
Rate for Payer: Health Management Network Commercial	$21.08
Rate for Payer: Humana Medicare	$12.40
Rate for Payer: Kaiser Permanente Commercial	$22.32
Rate for Payer: Kaiser Permanente Medicaid	$12.65
Rate for Payer: Kaiser Permanente Medicare	$12.40
Rate for Payer: MDX Hawaii PPO	$24.06
Rate for Payer: Ohana Health Plan Medicaid	$12.40
Rate for Payer: Ohana Health Plan Medicare	$12.40
Rate for Payer: UnitedHealthcare Medicaid	$14.88
Rate for Payer: UnitedHealthcare Medicare	$12.40
Rate for Payer: University Health Alliance Commercial	$18.08

rocuronium 50 mg/5 ml vial [HHSC]

Facility

IP

$29.62

Service Code	NDC 00409955805
Hospital Charge Code	2500733
Hospital Revenue Code	250
Min. Negotiated Rate	$25.18
Max. Negotiated Rate	$28.73
Rate for Payer: Cash Price	$19.25
Rate for Payer: Health Management Network Commercial	$25.18
Rate for Payer: Kaiser Permanente Commercial	$26.66
Rate for Payer: MDX Hawaii PPO	$28.73

rocuronium 50 mg/5 ml vial [HHSC]

Facility

OP

$29.62

Service Code	NDC 00409955805
Hospital Charge Code	2500733
Hospital Revenue Code	250
Min. Negotiated Rate	$14.81
Max. Negotiated Rate	$28.73
Rate for Payer: AlohaCare Medicaid	$14.81
Rate for Payer: AlohaCare Medicare	$14.81
Rate for Payer: Cash Price	$19.25
Rate for Payer: Devoted Health Medicare	$16.29
Rate for Payer: Hawaii Medical Service Association Medicare	$14.81
Rate for Payer: Hawaii Western Management Group Commercial	$28.14
Rate for Payer: Health Management Network Commercial	$25.18
Rate for Payer: Humana Medicare	$14.81
Rate for Payer: Kaiser Permanente Commercial	$26.66
Rate for Payer: Kaiser Permanente Medicaid	$15.11
Rate for Payer: Kaiser Permanente Medicare	$14.81
Rate for Payer: MDX Hawaii PPO	$28.73
Rate for Payer: Ohana Health Plan Medicaid	$14.81
Rate for Payer: Ohana Health Plan Medicare	$14.81
Rate for Payer: UnitedHealthcare Medicaid	$17.77
Rate for Payer: UnitedHealthcare Medicare	$14.81
Rate for Payer: University Health Alliance Commercial	$21.59

ROM Each Extremity/Trunk Charges

Facility

IP

$100.00

Service Code	HCPCS 95851 GO
Hospital Charge Code	8123865
Hospital Revenue Code	430
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: Kaiser Permanente Commercial	$90.00
Rate for Payer: MDX Hawaii PPO	$97.00

ROM Each Extremity/Trunk Charges

Facility

OP

$100.00

Service Code	HCPCS 95851 GO
Hospital Charge Code	8123865
Hospital Revenue Code	430
Min. Negotiated Rate	$7.89
Max. Negotiated Rate	$97.00
Rate for Payer: AlohaCare Medicaid	$50.00
Rate for Payer: AlohaCare Medicare	$50.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Devoted Health Medicare	$55.00
Rate for Payer: Hawaii Medical Service Association Medicare	$50.00
Rate for Payer: Hawaii Western Management Group Commercial	$95.00
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: Humana Medicare	$50.00
Rate for Payer: Kaiser Permanente Commercial	$90.00
Rate for Payer: Kaiser Permanente Medicaid	$51.00
Rate for Payer: Kaiser Permanente Medicare	$50.00
Rate for Payer: MDX Hawaii PPO	$97.00
Rate for Payer: Ohana Health Plan Medicaid	$50.00
Rate for Payer: Ohana Health Plan Medicare	$50.00
Rate for Payer: UnitedHealthcare Medicaid	$7.89
Rate for Payer: UnitedHealthcare Medicare	$50.00
Rate for Payer: University Health Alliance Commercial	$72.89

ROM Hand Charges

Facility

OP

$65.00

Service Code	HCPCS 95852 GO
Hospital Charge Code	8123864
Hospital Revenue Code	430
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$63.05
Rate for Payer: AlohaCare Medicaid	$32.50
Rate for Payer: AlohaCare Medicare	$32.50
Rate for Payer: Cash Price	$42.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Devoted Health Medicare	$35.75
Rate for Payer: Hawaii Medical Service Association Medicare	$32.50
Rate for Payer: Hawaii Western Management Group Commercial	$61.75
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Humana Medicare	$32.50
Rate for Payer: Kaiser Permanente Commercial	$58.50
Rate for Payer: Kaiser Permanente Medicaid	$33.15
Rate for Payer: Kaiser Permanente Medicare	$32.50
Rate for Payer: MDX Hawaii PPO	$63.05
Rate for Payer: Ohana Health Plan Medicaid	$32.50
Rate for Payer: Ohana Health Plan Medicare	$32.50
Rate for Payer: UnitedHealthcare Medicaid	$5.33
Rate for Payer: UnitedHealthcare Medicare	$32.50
Rate for Payer: University Health Alliance Commercial	$47.38

ROM Hand Charges

Facility

IP

$65.00

Service Code	HCPCS 95852 GO
Hospital Charge Code	8123864
Hospital Revenue Code	430
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$42.25
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Kaiser Permanente Commercial	$58.50
Rate for Payer: MDX Hawaii PPO	$63.05

ROOM/BED: ICU

Facility

IP

$8,090.00

Hospital Charge Code	2120844
Hospital Revenue Code	200
Min. Negotiated Rate	$6,369.00
Max. Negotiated Rate	$12,050.00
Rate for Payer: AlohaCare Medicaid	$6,811.27
Rate for Payer: AlohaCare Medicare	$6,869.00
Rate for Payer: Cash Price	$5,258.50
Rate for Payer: Cash Price	$5,258.50
Rate for Payer: Devoted Health Medicare	$7,555.90
Rate for Payer: Hawaii Medical Service Association ABD	$6,811.27
Rate for Payer: Hawaii Medical Service Association Medicare	$6,869.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,811.27
Rate for Payer: Hawaii Western Management Group Commercial	$12,050.00
Rate for Payer: Health Management Network Commercial	$6,876.50
Rate for Payer: Humana Medicare	$6,869.00
Rate for Payer: Kaiser Permanente Commercial	$7,281.00
Rate for Payer: Kaiser Permanente Medicaid	$6,811.27
Rate for Payer: Kaiser Permanente Medicare	$6,869.00
Rate for Payer: MDX Hawaii PPO	$7,847.30
Rate for Payer: Ohana Health Plan Medicaid	$6,811.27
Rate for Payer: Ohana Health Plan Medicare	$6,869.00
Rate for Payer: UnitedHealthcare Medicaid	$6,811.27
Rate for Payer: UnitedHealthcare Medicare	$6,869.00
Rate for Payer: University Health Alliance Commercial	$6,369.00

ROOM/BED: Isolation

Facility

IP

$4,620.00

Hospital Charge Code	8163853
Hospital Revenue Code	164
Min. Negotiated Rate	$3,927.00
Max. Negotiated Rate	$7,555.90
Rate for Payer: AlohaCare Medicaid	$6,811.27
Rate for Payer: AlohaCare Medicare	$6,869.00
Rate for Payer: Cash Price	$3,003.00
Rate for Payer: Cash Price	$3,003.00
Rate for Payer: Devoted Health Medicare	$7,555.90
Rate for Payer: Hawaii Medical Service Association ABD	$6,811.27
Rate for Payer: Hawaii Medical Service Association Medicare	$6,869.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,811.27
Rate for Payer: Hawaii Western Management Group Commercial	$7,250.00
Rate for Payer: Health Management Network Commercial	$3,927.00
Rate for Payer: Humana Medicare	$6,869.00
Rate for Payer: Kaiser Permanente Commercial	$4,158.00
Rate for Payer: Kaiser Permanente Medicaid	$6,811.27
Rate for Payer: Kaiser Permanente Medicare	$6,869.00
Rate for Payer: MDX Hawaii PPO	$4,481.40
Rate for Payer: Ohana Health Plan Medicaid	$6,811.27
Rate for Payer: Ohana Health Plan Medicare	$6,869.00
Rate for Payer: UnitedHealthcare Medicaid	$6,811.27
Rate for Payer: UnitedHealthcare Medicare	$6,869.00
Rate for Payer: University Health Alliance Commercial	$5,923.00

ROOM/BED: Isolation Swing/SNF

Facility

IP

$3,500.00

Hospital Charge Code	8163853
Hospital Revenue Code	164
Min. Negotiated Rate	$486.76
Max. Negotiated Rate	$5,923.00
Rate for Payer: AlohaCare Medicaid	$486.76
Rate for Payer: AlohaCare Medicare	$4,757.00
Rate for Payer: Cash Price	$2,275.00
Rate for Payer: Cash Price	$2,275.00
Rate for Payer: Devoted Health Medicare	$5,232.70
Rate for Payer: Hawaii Medical Service Association ABD	$486.76
Rate for Payer: Hawaii Medical Service Association Commercial	$893.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,757.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$486.76
Rate for Payer: Hawaii Western Management Group Commercial	$2,350.00
Rate for Payer: Health Management Network Commercial	$2,975.00
Rate for Payer: Humana Medicare	$4,757.00
Rate for Payer: Kaiser Permanente Commercial	$3,150.00
Rate for Payer: Kaiser Permanente Medicaid	$486.76
Rate for Payer: Kaiser Permanente Medicare	$4,757.00
Rate for Payer: MDX Hawaii PPO	$3,395.00
Rate for Payer: Ohana Health Plan Medicaid	$486.76
Rate for Payer: Ohana Health Plan Medicare	$4,757.00
Rate for Payer: UnitedHealthcare Medicaid	$486.76
Rate for Payer: UnitedHealthcare Medicare	$4,757.00
Rate for Payer: University Health Alliance Commercial	$5,923.00

ROOM/BED: Nursery Level 1

Facility

IP

$2,525.00

Hospital Charge Code	2120838
Hospital Revenue Code	171
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$7,555.90
Rate for Payer: AlohaCare Medicaid	$6,811.27
Rate for Payer: AlohaCare Medicare	$6,869.00
Rate for Payer: Cash Price	$1,641.25
Rate for Payer: Cash Price	$1,641.25
Rate for Payer: Devoted Health Medicare	$7,555.90
Rate for Payer: Hawaii Medical Service Association ABD	$6,811.27
Rate for Payer: Hawaii Medical Service Association Medicare	$6,869.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,811.27
Rate for Payer: Hawaii Western Management Group Commercial	$2,250.00
Rate for Payer: Health Management Network Commercial	$2,146.25
Rate for Payer: Humana Medicare	$6,869.00
Rate for Payer: Kaiser Permanente Commercial	$2,272.50
Rate for Payer: Kaiser Permanente Medicaid	$6,811.27
Rate for Payer: Kaiser Permanente Medicare	$6,869.00
Rate for Payer: MDX Hawaii PPO	$2,449.25
Rate for Payer: Ohana Health Plan Medicaid	$6,811.27
Rate for Payer: Ohana Health Plan Medicare	$6,869.00
Rate for Payer: UnitedHealthcare Medicaid	$6,811.27
Rate for Payer: UnitedHealthcare Medicare	$6,869.00
Rate for Payer: University Health Alliance Commercial	$1,875.00

ROOM/BED: Nursery Level 2

Facility

IP

$4,525.00

Hospital Charge Code	4232587
Hospital Revenue Code	172
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$7,555.90
Rate for Payer: AlohaCare Medicaid	$6,811.27
Rate for Payer: AlohaCare Medicare	$6,869.00
Rate for Payer: Cash Price	$2,941.25
Rate for Payer: Cash Price	$2,941.25
Rate for Payer: Devoted Health Medicare	$7,555.90
Rate for Payer: Hawaii Medical Service Association ABD	$6,811.27
Rate for Payer: Hawaii Medical Service Association Medicare	$6,869.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,811.27
Rate for Payer: Hawaii Western Management Group Commercial	$2,250.00
Rate for Payer: Health Management Network Commercial	$3,846.25
Rate for Payer: Humana Medicare	$6,869.00
Rate for Payer: Kaiser Permanente Commercial	$4,072.50
Rate for Payer: Kaiser Permanente Medicaid	$6,811.27
Rate for Payer: Kaiser Permanente Medicare	$6,869.00
Rate for Payer: MDX Hawaii PPO	$4,389.25
Rate for Payer: Ohana Health Plan Medicaid	$6,811.27
Rate for Payer: Ohana Health Plan Medicare	$6,869.00
Rate for Payer: UnitedHealthcare Medicaid	$6,811.27
Rate for Payer: UnitedHealthcare Medicare	$6,869.00
Rate for Payer: University Health Alliance Commercial	$1,875.00

ROOM/BED: Nursery Level 3

Facility

IP

$7,525.00

Hospital Charge Code	4232588
Hospital Revenue Code	173
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$7,555.90
Rate for Payer: AlohaCare Medicaid	$6,811.27
Rate for Payer: AlohaCare Medicare	$6,869.00
Rate for Payer: Cash Price	$4,891.25
Rate for Payer: Cash Price	$4,891.25
Rate for Payer: Devoted Health Medicare	$7,555.90
Rate for Payer: Hawaii Medical Service Association ABD	$6,811.27
Rate for Payer: Hawaii Medical Service Association Medicare	$6,869.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,811.27
Rate for Payer: Hawaii Western Management Group Commercial	$2,250.00
Rate for Payer: Health Management Network Commercial	$6,396.25
Rate for Payer: Humana Medicare	$6,869.00
Rate for Payer: Kaiser Permanente Commercial	$6,772.50
Rate for Payer: Kaiser Permanente Medicaid	$6,811.27
Rate for Payer: Kaiser Permanente Medicare	$6,869.00
Rate for Payer: MDX Hawaii PPO	$7,299.25
Rate for Payer: Ohana Health Plan Medicaid	$6,811.27
Rate for Payer: Ohana Health Plan Medicare	$6,869.00
Rate for Payer: UnitedHealthcare Medicaid	$6,811.27
Rate for Payer: UnitedHealthcare Medicare	$6,869.00
Rate for Payer: University Health Alliance Commercial	$1,875.00

ROOM/BED: Nursery Level 4

Facility

IP

$7,725.00

Hospital Charge Code	4232589
Hospital Revenue Code	174
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$7,555.90
Rate for Payer: AlohaCare Medicaid	$6,811.27
Rate for Payer: AlohaCare Medicare	$6,869.00
Rate for Payer: Cash Price	$5,021.25
Rate for Payer: Cash Price	$5,021.25
Rate for Payer: Devoted Health Medicare	$7,555.90
Rate for Payer: Hawaii Medical Service Association ABD	$6,811.27
Rate for Payer: Hawaii Medical Service Association Medicare	$6,869.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,811.27
Rate for Payer: Hawaii Western Management Group Commercial	$2,250.00
Rate for Payer: Health Management Network Commercial	$6,566.25
Rate for Payer: Humana Medicare	$6,869.00
Rate for Payer: Kaiser Permanente Commercial	$6,952.50
Rate for Payer: Kaiser Permanente Medicaid	$6,811.27
Rate for Payer: Kaiser Permanente Medicare	$6,869.00
Rate for Payer: MDX Hawaii PPO	$7,493.25
Rate for Payer: Ohana Health Plan Medicaid	$6,811.27
Rate for Payer: Ohana Health Plan Medicare	$6,869.00
Rate for Payer: UnitedHealthcare Medicaid	$6,811.27
Rate for Payer: UnitedHealthcare Medicare	$6,869.00
Rate for Payer: University Health Alliance Commercial	$1,875.00

ROOM/BED: Observation

Facility

IP

$163.00

Service Code	HCPCS G0378
Hospital Charge Code	2120846
Hospital Revenue Code	762
Min. Negotiated Rate	$138.55
Max. Negotiated Rate	$158.11
Rate for Payer: Cash Price	$105.95
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Kaiser Permanente Commercial	$146.70
Rate for Payer: MDX Hawaii PPO	$158.11

ROOM/BED: Observation

Facility

OP

$163.00

Service Code	HCPCS G0378
Hospital Charge Code	2120846
Hospital Revenue Code	762
Min. Negotiated Rate	$81.50
Max. Negotiated Rate	$1,200.00
Rate for Payer: AlohaCare Medicaid	$81.50
Rate for Payer: AlohaCare Medicare	$81.50
Rate for Payer: Cash Price	$105.95
Rate for Payer: Cash Price	$105.95
Rate for Payer: Devoted Health Medicare	$89.65
Rate for Payer: Hawaii Medical Service Association Commercial	$1,200.00
Rate for Payer: Hawaii Medical Service Association Medicare	$81.50
Rate for Payer: Hawaii Western Management Group Commercial	$154.85
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Humana Medicare	$81.50
Rate for Payer: Kaiser Permanente Commercial	$146.70
Rate for Payer: Kaiser Permanente Medicaid	$83.13
Rate for Payer: Kaiser Permanente Medicare	$81.50
Rate for Payer: MDX Hawaii PPO	$158.11
Rate for Payer: Ohana Health Plan Medicaid	$81.50
Rate for Payer: Ohana Health Plan Medicare	$81.50
Rate for Payer: UnitedHealthcare Medicare	$81.50
Rate for Payer: University Health Alliance Commercial	$118.81

ROOM/BED: Private

Facility

IP

$3,725.00

Hospital Charge Code	8081565
Hospital Revenue Code	111
Min. Negotiated Rate	$3,166.25
Max. Negotiated Rate	$7,555.90
Rate for Payer: AlohaCare Medicaid	$6,811.27
Rate for Payer: AlohaCare Medicare	$6,869.00
Rate for Payer: Cash Price	$2,421.25
Rate for Payer: Cash Price	$2,421.25
Rate for Payer: Devoted Health Medicare	$7,555.90
Rate for Payer: Hawaii Medical Service Association ABD	$6,811.27
Rate for Payer: Hawaii Medical Service Association Medicare	$6,869.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,811.27
Rate for Payer: Hawaii Western Management Group Commercial	$7,250.00
Rate for Payer: Health Management Network Commercial	$3,166.25
Rate for Payer: Humana Medicare	$6,869.00
Rate for Payer: Kaiser Permanente Commercial	$3,352.50
Rate for Payer: Kaiser Permanente Medicaid	$6,811.27
Rate for Payer: Kaiser Permanente Medicare	$6,869.00
Rate for Payer: MDX Hawaii PPO	$3,613.25
Rate for Payer: Ohana Health Plan Medicaid	$6,811.27
Rate for Payer: Ohana Health Plan Medicare	$6,869.00
Rate for Payer: UnitedHealthcare Medicaid	$6,811.27
Rate for Payer: UnitedHealthcare Medicare	$6,869.00
Rate for Payer: University Health Alliance Commercial	$5,923.00

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