Kau Hospital

All Charges

Charge

Type

Setting

Price

HC X-RAY STERNO-CLAVICLUAR JT - XR STERNOCLAVICULAR JOINTS 3+ VIEWS

Facility

$438.00

Service Code	HCPCS 71130
Hospital Charge Code	3207113001
Hospital Revenue Code	320
Min. Negotiated Rate	$372.30
Max. Negotiated Rate	$424.86
Rate for Payer: Cash Price	$262.80
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: MDX Hawaii PPO	$424.86

HC X-RAY STERNO-CLAVICLUAR JT - XR STERNOCLAVICULAR JOINTS 3+ VIEWS

Facility

$438.00

Service Code	HCPCS 71130
Hospital Charge Code	3207113001
Hospital Revenue Code	320
Min. Negotiated Rate	$23.21
Max. Negotiated Rate	$424.86
Rate for Payer: AlohaCare Medicaid	$219.00
Rate for Payer: AlohaCare Medicare	$135.78
Rate for Payer: Cash Price	$262.80
Rate for Payer: Cash Price	$262.80
Rate for Payer: Devoted Health Medicare	$148.92
Rate for Payer: Hawaii Medical Service Association ABD	$23.21
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$135.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$25.49
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Humana Medicare	$135.78
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: Kaiser Permanente Medicaid	$223.38
Rate for Payer: Kaiser Permanente Medicare	$135.78
Rate for Payer: MDX Hawaii PPO	$424.86
Rate for Payer: Ohana Health Plan Medicaid	$135.78
Rate for Payer: Ohana Health Plan Medicare	$135.78
Rate for Payer: UnitedHealthcare Medicaid	$23.21
Rate for Payer: UnitedHealthcare Medicare	$135.78
Rate for Payer: University Health Alliance Commercial	$76.85

HC X-RAY STERNUM 2+ VW - XR STERNUM 2+ VIEWS

Facility

$438.00

Service Code	HCPCS 71120
Hospital Charge Code	3207112001
Hospital Revenue Code	320
Min. Negotiated Rate	$372.30
Max. Negotiated Rate	$424.86
Rate for Payer: Cash Price	$262.80
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: MDX Hawaii PPO	$424.86

HC X-RAY STERNUM 2+ VW - XR STERNUM 2+ VIEWS

Facility

$438.00

Service Code	HCPCS 71120
Hospital Charge Code	3207112001
Hospital Revenue Code	320
Min. Negotiated Rate	$21.34
Max. Negotiated Rate	$424.86
Rate for Payer: AlohaCare Medicaid	$219.00
Rate for Payer: AlohaCare Medicare	$135.78
Rate for Payer: Cash Price	$262.80
Rate for Payer: Cash Price	$262.80
Rate for Payer: Devoted Health Medicare	$148.92
Rate for Payer: Hawaii Medical Service Association ABD	$21.34
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$135.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.43
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Humana Medicare	$135.78
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: Kaiser Permanente Medicaid	$223.38
Rate for Payer: Kaiser Permanente Medicare	$135.78
Rate for Payer: MDX Hawaii PPO	$424.86
Rate for Payer: Ohana Health Plan Medicaid	$135.78
Rate for Payer: Ohana Health Plan Medicare	$135.78
Rate for Payer: UnitedHealthcare Medicaid	$21.34
Rate for Payer: UnitedHealthcare Medicare	$135.78
Rate for Payer: University Health Alliance Commercial	$69.73

HC X-RAY THORACIC SPINE 2 VW - XR THORACIC SPINE 2 VIEWS

Facility

$529.00

Service Code	HCPCS 72070
Hospital Charge Code	3207207001
Hospital Revenue Code	320
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: MDX Hawaii PPO	$513.13

HC X-RAY THORACIC SPINE 2 VW - XR THORACIC SPINE 2 VIEWS

Facility

$529.00

Service Code	HCPCS 72070
Hospital Charge Code	3207207001
Hospital Revenue Code	320
Min. Negotiated Rate	$21.34
Max. Negotiated Rate	$513.13
Rate for Payer: AlohaCare Medicaid	$264.50
Rate for Payer: AlohaCare Medicare	$163.99
Rate for Payer: Cash Price	$317.40
Rate for Payer: Cash Price	$317.40
Rate for Payer: Devoted Health Medicare	$179.86
Rate for Payer: Hawaii Medical Service Association ABD	$21.34
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$163.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.43
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Humana Medicare	$163.99
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: Kaiser Permanente Medicare	$163.99
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: Ohana Health Plan Medicaid	$163.99
Rate for Payer: Ohana Health Plan Medicare	$163.99
Rate for Payer: UnitedHealthcare Medicaid	$21.34
Rate for Payer: UnitedHealthcare Medicare	$163.99
Rate for Payer: University Health Alliance Commercial	$70.43

HC X-RAY THORACIC SPINE 4 VW - XR THORACIC SPINE COMPLETE 4+ VIEWS

Facility

$529.00

Service Code	HCPCS 72074
Hospital Charge Code	3207207401
Hospital Revenue Code	320
Min. Negotiated Rate	$30.26
Max. Negotiated Rate	$513.13
Rate for Payer: AlohaCare Medicaid	$264.50
Rate for Payer: AlohaCare Medicare	$163.99
Rate for Payer: Cash Price	$317.40
Rate for Payer: Cash Price	$317.40
Rate for Payer: Devoted Health Medicare	$179.86
Rate for Payer: Hawaii Medical Service Association ABD	$30.26
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$163.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$32.95
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Humana Medicare	$163.99
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: Kaiser Permanente Medicare	$163.99
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: Ohana Health Plan Medicaid	$163.99
Rate for Payer: Ohana Health Plan Medicare	$163.99
Rate for Payer: UnitedHealthcare Medicaid	$30.26
Rate for Payer: UnitedHealthcare Medicare	$163.99
Rate for Payer: University Health Alliance Commercial	$93.89

HC X-RAY THORACIC SPINE 4 VW - XR THORACIC SPINE COMPLETE 4+ VIEWS

Facility

$529.00

Service Code	HCPCS 72074
Hospital Charge Code	3207207401
Hospital Revenue Code	320
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: MDX Hawaii PPO	$513.13

HC X-RAY THORACIC SPINE+SWIM 3 VW - XR THORACIC SPINE 3 VIEWS

Facility

$529.00

Service Code	HCPCS 72072
Hospital Charge Code	3207207201
Hospital Revenue Code	320
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: MDX Hawaii PPO	$513.13

HC X-RAY THORACIC SPINE+SWIM 3 VW - XR THORACIC SPINE 3 VIEWS

Facility

$529.00

Service Code	HCPCS 72072
Hospital Charge Code	3207207201
Hospital Revenue Code	320
Min. Negotiated Rate	$24.39
Max. Negotiated Rate	$513.13
Rate for Payer: AlohaCare Medicaid	$264.50
Rate for Payer: AlohaCare Medicare	$163.99
Rate for Payer: Cash Price	$317.40
Rate for Payer: Cash Price	$317.40
Rate for Payer: Devoted Health Medicare	$179.86
Rate for Payer: Hawaii Medical Service Association ABD	$24.39
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$163.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.81
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Humana Medicare	$163.99
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: Kaiser Permanente Medicare	$163.99
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: Ohana Health Plan Medicaid	$163.99
Rate for Payer: Ohana Health Plan Medicare	$163.99
Rate for Payer: UnitedHealthcare Medicaid	$24.39
Rate for Payer: UnitedHealthcare Medicare	$163.99
Rate for Payer: University Health Alliance Commercial	$78.96

HC X-RAY TIB + FIB, 2VW - XR TIBIA FIBULA 2 VIEWS

Facility

$438.00

Service Code	HCPCS 73590
Hospital Charge Code	3207359001
Hospital Revenue Code	320
Min. Negotiated Rate	$372.30
Max. Negotiated Rate	$424.86
Rate for Payer: Cash Price	$262.80
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: MDX Hawaii PPO	$424.86

HC X-RAY TIB + FIB, 2VW - XR TIBIA FIBULA 2 VIEWS

Facility

$438.00

Service Code	HCPCS 73590
Hospital Charge Code	3207359001
Hospital Revenue Code	320
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$424.86
Rate for Payer: AlohaCare Medicaid	$219.00
Rate for Payer: AlohaCare Medicare	$135.78
Rate for Payer: Cash Price	$262.80
Rate for Payer: Cash Price	$262.80
Rate for Payer: Devoted Health Medicare	$148.92
Rate for Payer: Hawaii Medical Service Association ABD	$18.46
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$135.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.38
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Humana Medicare	$135.78
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: Kaiser Permanente Medicaid	$223.38
Rate for Payer: Kaiser Permanente Medicare	$135.78
Rate for Payer: MDX Hawaii PPO	$424.86
Rate for Payer: Ohana Health Plan Medicaid	$135.78
Rate for Payer: Ohana Health Plan Medicare	$135.78
Rate for Payer: UnitedHealthcare Medicaid	$18.46
Rate for Payer: UnitedHealthcare Medicare	$135.78
Rate for Payer: University Health Alliance Commercial	$56.98

HC X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS BILATERAL

Facility

$438.00

Service Code	HCPCS 73100
Hospital Charge Code	3207310003
Hospital Revenue Code	320
Min. Negotiated Rate	$372.30
Max. Negotiated Rate	$424.86
Rate for Payer: Cash Price	$262.80
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: MDX Hawaii PPO	$424.86

HC X-RAY WRIST 2 VW - XR WRIST 1-2 VIEWS BILATERAL

Facility

$438.00

Service Code	HCPCS 73100
Hospital Charge Code	3207310003
Hospital Revenue Code	320
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$424.86
Rate for Payer: AlohaCare Medicaid	$219.00
Rate for Payer: AlohaCare Medicare	$135.78
Rate for Payer: Cash Price	$262.80
Rate for Payer: Cash Price	$262.80
Rate for Payer: Devoted Health Medicare	$148.92
Rate for Payer: Hawaii Medical Service Association ABD	$16.41
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$135.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.57
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Humana Medicare	$135.78
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: Kaiser Permanente Medicaid	$223.38
Rate for Payer: Kaiser Permanente Medicare	$135.78
Rate for Payer: MDX Hawaii PPO	$424.86
Rate for Payer: Ohana Health Plan Medicaid	$135.78
Rate for Payer: Ohana Health Plan Medicare	$135.78
Rate for Payer: UnitedHealthcare Medicaid	$16.41
Rate for Payer: UnitedHealthcare Medicare	$135.78
Rate for Payer: University Health Alliance Commercial	$57.07

HC X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS BILATERAL

Facility

$438.00

Service Code	HCPCS 73110
Hospital Charge Code	3207311003
Hospital Revenue Code	320
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$424.86
Rate for Payer: AlohaCare Medicaid	$219.00
Rate for Payer: AlohaCare Medicare	$135.78
Rate for Payer: Cash Price	$262.80
Rate for Payer: Cash Price	$262.80
Rate for Payer: Devoted Health Medicare	$148.92
Rate for Payer: Hawaii Medical Service Association ABD	$17.34
Rate for Payer: Hawaii Medical Service Association Commercial	$111.14
Rate for Payer: Hawaii Medical Service Association Medicare	$135.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.95
Rate for Payer: Hawaii Western Management Group Commercial	$88.91
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Humana Medicare	$135.78
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: Kaiser Permanente Medicaid	$223.38
Rate for Payer: Kaiser Permanente Medicare	$135.78
Rate for Payer: MDX Hawaii PPO	$424.86
Rate for Payer: Ohana Health Plan Medicaid	$135.78
Rate for Payer: Ohana Health Plan Medicare	$135.78
Rate for Payer: UnitedHealthcare Medicaid	$17.34
Rate for Payer: UnitedHealthcare Medicare	$135.78
Rate for Payer: University Health Alliance Commercial	$66.60

HC X-RAY WRIST 3+ VW - XR WRIST 3+ VIEWS BILATERAL

Facility

$438.00

Service Code	HCPCS 73110
Hospital Charge Code	3207311003
Hospital Revenue Code	320
Min. Negotiated Rate	$372.30
Max. Negotiated Rate	$424.86
Rate for Payer: Cash Price	$262.80
Rate for Payer: Health Management Network Commercial	$372.30
Rate for Payer: Kaiser Permanente Commercial	$394.20
Rate for Payer: MDX Hawaii PPO	$424.86

HEADACHES WITH MCC

Facility

$15,667.02

Service Code	MSDRG 102
Min. Negotiated Rate	$15,667.02
Max. Negotiated Rate	$15,667.02
Rate for Payer: Hawaii Medical Service Association Commercial	$15,667.02

HEADACHES WITHOUT MCC

Facility

$15,667.02

Service Code	MSDRG 103
Min. Negotiated Rate	$15,667.02
Max. Negotiated Rate	$15,667.02
Rate for Payer: Hawaii Medical Service Association Commercial	$15,667.02

HEAD EVOLVE PROLINE 20 496H020

Facility

$4,452.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,493.12
Max. Negotiated Rate	$4,318.44
Rate for Payer: Cash Price	$2,671.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,116.40
Rate for Payer: Health Management Network Commercial	$3,784.20
Rate for Payer: Kaiser Permanente Commercial	$4,006.80
Rate for Payer: MDX Hawaii PPO	$4,318.44
Rate for Payer: University Health Alliance Commercial	$2,493.12

HEAD EVOLVE PROLINE 20 496H020

Facility

$4,452.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,380.12
Max. Negotiated Rate	$4,318.44
Rate for Payer: AlohaCare Medicaid	$2,226.00
Rate for Payer: AlohaCare Medicare	$1,380.12
Rate for Payer: Cash Price	$2,671.20
Rate for Payer: Devoted Health Medicare	$1,513.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,380.12
Rate for Payer: Hawaii Western Management Group Commercial	$3,116.40
Rate for Payer: Health Management Network Commercial	$3,784.20
Rate for Payer: Humana Medicare	$1,380.12
Rate for Payer: Kaiser Permanente Commercial	$4,006.80
Rate for Payer: Kaiser Permanente Medicaid	$2,270.52
Rate for Payer: Kaiser Permanente Medicare	$1,380.12
Rate for Payer: MDX Hawaii PPO	$4,318.44
Rate for Payer: Ohana Health Plan Medicaid	$1,380.12
Rate for Payer: Ohana Health Plan Medicare	$1,380.12
Rate for Payer: UnitedHealthcare Medicare	$1,380.12
Rate for Payer: University Health Alliance Commercial	$2,493.12

HEAD FEMORAL 26MM 6260-9-226

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$611.01
Max. Negotiated Rate	$1,911.87
Rate for Payer: AlohaCare Medicaid	$985.50
Rate for Payer: AlohaCare Medicare	$611.01
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Devoted Health Medicare	$670.14
Rate for Payer: Hawaii Medical Service Association Medicare	$611.01
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Humana Medicare	$611.01
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: Kaiser Permanente Medicaid	$1,005.21
Rate for Payer: Kaiser Permanente Medicare	$611.01
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: Ohana Health Plan Medicaid	$611.01
Rate for Payer: Ohana Health Plan Medicare	$611.01
Rate for Payer: UnitedHealthcare Medicare	$611.01
Rate for Payer: University Health Alliance Commercial	$1,103.76

HEAD FEMORAL 26MM 6260-9-226

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,103.76
Max. Negotiated Rate	$1,911.87
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: University Health Alliance Commercial	$1,103.76

HEAD FEMORAL 28MM 6260-9-228

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$611.01
Max. Negotiated Rate	$1,911.87
Rate for Payer: AlohaCare Medicaid	$985.50
Rate for Payer: AlohaCare Medicare	$611.01
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Devoted Health Medicare	$670.14
Rate for Payer: Hawaii Medical Service Association Medicare	$611.01
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Humana Medicare	$611.01
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: Kaiser Permanente Medicaid	$1,005.21
Rate for Payer: Kaiser Permanente Medicare	$611.01
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: Ohana Health Plan Medicaid	$611.01
Rate for Payer: Ohana Health Plan Medicare	$611.01
Rate for Payer: UnitedHealthcare Medicare	$611.01
Rate for Payer: University Health Alliance Commercial	$1,103.76

HEAD FEMORAL 28MM 6260-9-228

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,103.76
Max. Negotiated Rate	$1,911.87
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: University Health Alliance Commercial	$1,103.76

HEAD FEMORAL 28MM 6570-0-028

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

Know your out-of-pocket cost for care.

All Charges