Kau Hospital

All Charges

Charge

Type

Setting

Price

GUIDE WIRE 2.5MMX220MM DWD017

Facility

$435.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$134.85
Max. Negotiated Rate	$421.95
Rate for Payer: AlohaCare Medicaid	$217.50
Rate for Payer: AlohaCare Medicare	$134.85
Rate for Payer: Cash Price	$261.00
Rate for Payer: Devoted Health Medicare	$147.90
Rate for Payer: Hawaii Medical Service Association Medicare	$134.85
Rate for Payer: Hawaii Western Management Group Commercial	$413.25
Rate for Payer: Health Management Network Commercial	$369.75
Rate for Payer: Humana Medicare	$134.85
Rate for Payer: Kaiser Permanente Commercial	$391.50
Rate for Payer: Kaiser Permanente Medicaid	$221.85
Rate for Payer: Kaiser Permanente Medicare	$134.85
Rate for Payer: MDX Hawaii PPO	$421.95
Rate for Payer: Ohana Health Plan Medicaid	$134.85
Rate for Payer: Ohana Health Plan Medicare	$134.85
Rate for Payer: UnitedHealthcare Medicare	$134.85
Rate for Payer: University Health Alliance Commercial	$317.07

GUIDEWIRE 2.5X230MM 900.723

Facility

$294.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$91.14
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$147.00
Rate for Payer: AlohaCare Medicare	$91.14
Rate for Payer: Cash Price	$176.40
Rate for Payer: Devoted Health Medicare	$99.96
Rate for Payer: Hawaii Medical Service Association Medicare	$91.14
Rate for Payer: Hawaii Western Management Group Commercial	$279.30
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$91.14
Rate for Payer: Kaiser Permanente Commercial	$264.60
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$91.14
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$91.14
Rate for Payer: Ohana Health Plan Medicare	$91.14
Rate for Payer: UnitedHealthcare Medicare	$91.14
Rate for Payer: University Health Alliance Commercial	$214.30

GUIDEWIRE 2.5X230MM 900.723

Facility

$294.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$176.40
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Kaiser Permanente Commercial	$264.60
Rate for Payer: MDX Hawaii PPO	$285.18

GUIDE WIRE 2.8X300MM 292.68

Facility

$221.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$68.51
Max. Negotiated Rate	$214.37
Rate for Payer: AlohaCare Medicaid	$110.50
Rate for Payer: AlohaCare Medicare	$68.51
Rate for Payer: Cash Price	$132.60
Rate for Payer: Devoted Health Medicare	$75.14
Rate for Payer: Hawaii Medical Service Association Medicare	$68.51
Rate for Payer: Hawaii Western Management Group Commercial	$209.95
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: Humana Medicare	$68.51
Rate for Payer: Kaiser Permanente Commercial	$198.90
Rate for Payer: Kaiser Permanente Medicaid	$112.71
Rate for Payer: Kaiser Permanente Medicare	$68.51
Rate for Payer: MDX Hawaii PPO	$214.37
Rate for Payer: Ohana Health Plan Medicaid	$68.51
Rate for Payer: Ohana Health Plan Medicare	$68.51
Rate for Payer: UnitedHealthcare Medicare	$68.51
Rate for Payer: University Health Alliance Commercial	$161.09

GUIDE WIRE 2.8X300MM 292.68

Facility

$221.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
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

GUIDE WIRE 2.8X300MM 900.726

Facility

$409.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$126.79
Max. Negotiated Rate	$396.73
Rate for Payer: AlohaCare Medicaid	$204.50
Rate for Payer: AlohaCare Medicare	$126.79
Rate for Payer: Cash Price	$245.40
Rate for Payer: Devoted Health Medicare	$139.06
Rate for Payer: Hawaii Medical Service Association Medicare	$126.79
Rate for Payer: Hawaii Western Management Group Commercial	$388.55
Rate for Payer: Health Management Network Commercial	$347.65
Rate for Payer: Humana Medicare	$126.79
Rate for Payer: Kaiser Permanente Commercial	$368.10
Rate for Payer: Kaiser Permanente Medicaid	$208.59
Rate for Payer: Kaiser Permanente Medicare	$126.79
Rate for Payer: MDX Hawaii PPO	$396.73
Rate for Payer: Ohana Health Plan Medicaid	$126.79
Rate for Payer: Ohana Health Plan Medicare	$126.79
Rate for Payer: UnitedHealthcare Medicare	$126.79
Rate for Payer: University Health Alliance Commercial	$298.12

GUIDE WIRE 2.8X300MM 900.726

Facility

$409.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$347.65
Max. Negotiated Rate	$396.73
Rate for Payer: Cash Price	$245.40
Rate for Payer: Health Management Network Commercial	$347.65
Rate for Payer: Kaiser Permanente Commercial	$368.10
Rate for Payer: MDX Hawaii PPO	$396.73

GUIDEWIRE 2.8X450 02.207.001

Facility

$404.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$125.24
Max. Negotiated Rate	$391.88
Rate for Payer: AlohaCare Medicaid	$202.00
Rate for Payer: AlohaCare Medicare	$125.24
Rate for Payer: Cash Price	$242.40
Rate for Payer: Devoted Health Medicare	$137.36
Rate for Payer: Hawaii Medical Service Association Medicare	$125.24
Rate for Payer: Hawaii Western Management Group Commercial	$383.80
Rate for Payer: Health Management Network Commercial	$343.40
Rate for Payer: Humana Medicare	$125.24
Rate for Payer: Kaiser Permanente Commercial	$363.60
Rate for Payer: Kaiser Permanente Medicaid	$206.04
Rate for Payer: Kaiser Permanente Medicare	$125.24
Rate for Payer: MDX Hawaii PPO	$391.88
Rate for Payer: Ohana Health Plan Medicaid	$125.24
Rate for Payer: Ohana Health Plan Medicare	$125.24
Rate for Payer: UnitedHealthcare Medicare	$125.24
Rate for Payer: University Health Alliance Commercial	$294.48

GUIDEWIRE 2.8X450 02.207.001

Facility

$404.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$343.40
Max. Negotiated Rate	$391.88
Rate for Payer: Cash Price	$242.40
Rate for Payer: Health Management Network Commercial	$343.40
Rate for Payer: Kaiser Permanente Commercial	$363.60
Rate for Payer: MDX Hawaii PPO	$391.88

GUIDE WIRE 2.8X450MM 292.81

Facility

$458.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$141.98
Max. Negotiated Rate	$444.26
Rate for Payer: AlohaCare Medicaid	$229.00
Rate for Payer: AlohaCare Medicare	$141.98
Rate for Payer: Cash Price	$274.80
Rate for Payer: Devoted Health Medicare	$155.72
Rate for Payer: Hawaii Medical Service Association Medicare	$141.98
Rate for Payer: Hawaii Western Management Group Commercial	$435.10
Rate for Payer: Health Management Network Commercial	$389.30
Rate for Payer: Humana Medicare	$141.98
Rate for Payer: Kaiser Permanente Commercial	$412.20
Rate for Payer: Kaiser Permanente Medicaid	$233.58
Rate for Payer: Kaiser Permanente Medicare	$141.98
Rate for Payer: MDX Hawaii PPO	$444.26
Rate for Payer: Ohana Health Plan Medicaid	$141.98
Rate for Payer: Ohana Health Plan Medicare	$141.98
Rate for Payer: UnitedHealthcare Medicare	$141.98
Rate for Payer: University Health Alliance Commercial	$333.84

GUIDE WIRE 2.8X450MM 292.81

Facility

$458.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$389.30
Max. Negotiated Rate	$444.26
Rate for Payer: Cash Price	$274.80
Rate for Payer: Health Management Network Commercial	$389.30
Rate for Payer: Kaiser Permanente Commercial	$412.20
Rate for Payer: MDX Hawaii PPO	$444.26

GUIDEWIRE 3.2X290MM 03.010.115

Facility

$427.00

Hospital Revenue Code	272
Min. Negotiated Rate	$362.95
Max. Negotiated Rate	$414.19
Rate for Payer: Cash Price	$256.20
Rate for Payer: Health Management Network Commercial	$362.95
Rate for Payer: Kaiser Permanente Commercial	$384.30
Rate for Payer: MDX Hawaii PPO	$414.19

GUIDEWIRE 3.2X290MM 03.010.115

Facility

$427.00

Hospital Revenue Code	272
Min. Negotiated Rate	$132.37
Max. Negotiated Rate	$414.19
Rate for Payer: AlohaCare Medicaid	$213.50
Rate for Payer: AlohaCare Medicare	$132.37
Rate for Payer: Cash Price	$256.20
Rate for Payer: Devoted Health Medicare	$145.18
Rate for Payer: Hawaii Medical Service Association Medicare	$132.37
Rate for Payer: Hawaii Western Management Group Commercial	$405.65
Rate for Payer: Health Management Network Commercial	$362.95
Rate for Payer: Humana Medicare	$132.37
Rate for Payer: Kaiser Permanente Commercial	$384.30
Rate for Payer: Kaiser Permanente Medicaid	$217.77
Rate for Payer: Kaiser Permanente Medicare	$132.37
Rate for Payer: MDX Hawaii PPO	$414.19
Rate for Payer: Ohana Health Plan Medicaid	$132.37
Rate for Payer: Ohana Health Plan Medicare	$132.37
Rate for Payer: UnitedHealthcare Medicare	$132.37
Rate for Payer: University Health Alliance Commercial	$311.24

GUIDE WIRE 3.2X30 ST 702462S

Facility

$567.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$175.77
Max. Negotiated Rate	$549.99
Rate for Payer: AlohaCare Medicaid	$283.50
Rate for Payer: AlohaCare Medicare	$175.77
Rate for Payer: Cash Price	$340.20
Rate for Payer: Devoted Health Medicare	$192.78
Rate for Payer: Hawaii Medical Service Association Medicare	$175.77
Rate for Payer: Hawaii Western Management Group Commercial	$538.65
Rate for Payer: Health Management Network Commercial	$481.95
Rate for Payer: Humana Medicare	$175.77
Rate for Payer: Kaiser Permanente Commercial	$510.30
Rate for Payer: Kaiser Permanente Medicaid	$289.17
Rate for Payer: Kaiser Permanente Medicare	$175.77
Rate for Payer: MDX Hawaii PPO	$549.99
Rate for Payer: Ohana Health Plan Medicaid	$175.77
Rate for Payer: Ohana Health Plan Medicare	$175.77
Rate for Payer: UnitedHealthcare Medicare	$175.77
Rate for Payer: University Health Alliance Commercial	$413.29

GUIDE WIRE 3.2X30 ST 702462S

Facility

$567.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$481.95
Max. Negotiated Rate	$549.99
Rate for Payer: Cash Price	$340.20
Rate for Payer: Health Management Network Commercial	$481.95
Rate for Payer: Kaiser Permanente Commercial	$510.30
Rate for Payer: MDX Hawaii PPO	$549.99

GUIDE WIRE 3.2X400MM 357.399

Facility

$505.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$429.25
Max. Negotiated Rate	$489.85
Rate for Payer: Cash Price	$303.00
Rate for Payer: Health Management Network Commercial	$429.25
Rate for Payer: Kaiser Permanente Commercial	$454.50
Rate for Payer: MDX Hawaii PPO	$489.85

GUIDE WIRE 3.2X400MM 357.399

Facility

$505.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$156.55
Max. Negotiated Rate	$489.85
Rate for Payer: AlohaCare Medicaid	$252.50
Rate for Payer: AlohaCare Medicare	$156.55
Rate for Payer: Cash Price	$303.00
Rate for Payer: Devoted Health Medicare	$171.70
Rate for Payer: Hawaii Medical Service Association Medicare	$156.55
Rate for Payer: Hawaii Western Management Group Commercial	$479.75
Rate for Payer: Health Management Network Commercial	$429.25
Rate for Payer: Humana Medicare	$156.55
Rate for Payer: Kaiser Permanente Commercial	$454.50
Rate for Payer: Kaiser Permanente Medicaid	$257.55
Rate for Payer: Kaiser Permanente Medicare	$156.55
Rate for Payer: MDX Hawaii PPO	$489.85
Rate for Payer: Ohana Health Plan Medicaid	$156.55
Rate for Payer: Ohana Health Plan Medicare	$156.55
Rate for Payer: UnitedHealthcare Medicare	$156.55
Rate for Payer: University Health Alliance Commercial	$368.09

GUIDEWIRE AMPL 035X80CM

Facility

$147.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$45.57
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$45.57
Rate for Payer: Cash Price	$88.20
Rate for Payer: Devoted Health Medicare	$49.98
Rate for Payer: Hawaii Medical Service Association Medicare	$45.57
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$45.57
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$45.57
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$45.57
Rate for Payer: Ohana Health Plan Medicare	$45.57
Rate for Payer: UnitedHealthcare Medicare	$45.57
Rate for Payer: University Health Alliance Commercial	$107.15

GUIDEWIRE AMPL 035X80CM

Facility

$147.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59

GUIDEWIRE AMPLATZ STR TIP .035

Facility

$127.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$39.37
Max. Negotiated Rate	$123.19
Rate for Payer: AlohaCare Medicaid	$63.50
Rate for Payer: AlohaCare Medicare	$39.37
Rate for Payer: Cash Price	$76.20
Rate for Payer: Devoted Health Medicare	$43.18
Rate for Payer: Hawaii Medical Service Association Medicare	$39.37
Rate for Payer: Hawaii Western Management Group Commercial	$120.65
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Humana Medicare	$39.37
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: Kaiser Permanente Medicaid	$64.77
Rate for Payer: Kaiser Permanente Medicare	$39.37
Rate for Payer: MDX Hawaii PPO	$123.19
Rate for Payer: Ohana Health Plan Medicaid	$39.37
Rate for Payer: Ohana Health Plan Medicare	$39.37
Rate for Payer: UnitedHealthcare Medicare	$39.37
Rate for Payer: University Health Alliance Commercial	$92.57

GUIDEWIRE AMPLATZ STR TIP .035

Facility

$127.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$76.20
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: MDX Hawaii PPO	$123.19

GUIDEWIRE ANG 035X450CM

Facility

$695.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$215.45
Max. Negotiated Rate	$674.15
Rate for Payer: AlohaCare Medicaid	$347.50
Rate for Payer: AlohaCare Medicare	$215.45
Rate for Payer: Cash Price	$417.00
Rate for Payer: Devoted Health Medicare	$236.30
Rate for Payer: Hawaii Medical Service Association Medicare	$215.45
Rate for Payer: Hawaii Western Management Group Commercial	$660.25
Rate for Payer: Health Management Network Commercial	$590.75
Rate for Payer: Humana Medicare	$215.45
Rate for Payer: Kaiser Permanente Commercial	$625.50
Rate for Payer: Kaiser Permanente Medicaid	$354.45
Rate for Payer: Kaiser Permanente Medicare	$215.45
Rate for Payer: MDX Hawaii PPO	$674.15
Rate for Payer: Ohana Health Plan Medicaid	$215.45
Rate for Payer: Ohana Health Plan Medicare	$215.45
Rate for Payer: UnitedHealthcare Medicare	$215.45
Rate for Payer: University Health Alliance Commercial	$506.59

GUIDEWIRE ANG 035X450CM

Facility

$695.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$590.75
Max. Negotiated Rate	$674.15
Rate for Payer: Cash Price	$417.00
Rate for Payer: Health Management Network Commercial	$590.75
Rate for Payer: Kaiser Permanente Commercial	$625.50
Rate for Payer: MDX Hawaii PPO	$674.15

GUIDEWIRE BENTSON 035X80CM

Facility

$117.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$36.27
Max. Negotiated Rate	$113.49
Rate for Payer: AlohaCare Medicaid	$58.50
Rate for Payer: AlohaCare Medicare	$36.27
Rate for Payer: Cash Price	$70.20
Rate for Payer: Devoted Health Medicare	$39.78
Rate for Payer: Hawaii Medical Service Association Medicare	$36.27
Rate for Payer: Hawaii Western Management Group Commercial	$111.15
Rate for Payer: Health Management Network Commercial	$99.45
Rate for Payer: Humana Medicare	$36.27
Rate for Payer: Kaiser Permanente Commercial	$105.30
Rate for Payer: Kaiser Permanente Medicaid	$59.67
Rate for Payer: Kaiser Permanente Medicare	$36.27
Rate for Payer: MDX Hawaii PPO	$113.49
Rate for Payer: Ohana Health Plan Medicaid	$36.27
Rate for Payer: Ohana Health Plan Medicare	$36.27
Rate for Payer: UnitedHealthcare Medicare	$36.27
Rate for Payer: University Health Alliance Commercial	$85.28

GUIDEWIRE BENTSON 035X80CM

Facility

$117.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$113.49
Rate for Payer: Cash Price	$70.20
Rate for Payer: Health Management Network Commercial	$99.45
Rate for Payer: Kaiser Permanente Commercial	$105.30
Rate for Payer: MDX Hawaii PPO	$113.49

Know your out-of-pocket cost for care.

All Charges