Kau Hospital

All Charges

Charge

Type

Setting

Price

HIP SYS RESTORATION 6276-7-019

Facility

$6,428.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,599.68
Max. Negotiated Rate	$6,235.16
Rate for Payer: Cash Price	$3,856.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,499.60
Rate for Payer: Health Management Network Commercial	$5,463.80
Rate for Payer: Kaiser Permanente Commercial	$5,785.20
Rate for Payer: MDX Hawaii PPO	$6,235.16
Rate for Payer: University Health Alliance Commercial	$3,599.68

HIP SYS RESTORATION 6276-7-019

Facility

$6,428.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,992.68
Max. Negotiated Rate	$6,235.16
Rate for Payer: AlohaCare Medicaid	$3,214.00
Rate for Payer: AlohaCare Medicare	$1,992.68
Rate for Payer: Cash Price	$3,856.80
Rate for Payer: Devoted Health Medicare	$2,185.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,992.68
Rate for Payer: Hawaii Western Management Group Commercial	$4,499.60
Rate for Payer: Health Management Network Commercial	$5,463.80
Rate for Payer: Humana Medicare	$1,992.68
Rate for Payer: Kaiser Permanente Commercial	$5,785.20
Rate for Payer: Kaiser Permanente Medicaid	$3,278.28
Rate for Payer: Kaiser Permanente Medicare	$1,992.68
Rate for Payer: MDX Hawaii PPO	$6,235.16
Rate for Payer: Ohana Health Plan Medicaid	$1,992.68
Rate for Payer: Ohana Health Plan Medicare	$1,992.68
Rate for Payer: UnitedHealthcare Medicare	$1,992.68
Rate for Payer: University Health Alliance Commercial	$3,599.68

HIP SYS RESTORATION 6276-7-418

Facility

$6,363.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,972.53
Max. Negotiated Rate	$6,172.11
Rate for Payer: AlohaCare Medicaid	$3,181.50
Rate for Payer: AlohaCare Medicare	$1,972.53
Rate for Payer: Cash Price	$3,817.80
Rate for Payer: Devoted Health Medicare	$2,163.42
Rate for Payer: Hawaii Medical Service Association Medicare	$1,972.53
Rate for Payer: Hawaii Western Management Group Commercial	$4,454.10
Rate for Payer: Health Management Network Commercial	$5,408.55
Rate for Payer: Humana Medicare	$1,972.53
Rate for Payer: Kaiser Permanente Commercial	$5,726.70
Rate for Payer: Kaiser Permanente Medicaid	$3,245.13
Rate for Payer: Kaiser Permanente Medicare	$1,972.53
Rate for Payer: MDX Hawaii PPO	$6,172.11
Rate for Payer: Ohana Health Plan Medicaid	$1,972.53
Rate for Payer: Ohana Health Plan Medicare	$1,972.53
Rate for Payer: UnitedHealthcare Medicare	$1,972.53
Rate for Payer: University Health Alliance Commercial	$3,563.28

HIP SYS RESTORATION 6276-7-418

Facility

$6,363.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,563.28
Max. Negotiated Rate	$6,172.11
Rate for Payer: Cash Price	$3,817.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,454.10
Rate for Payer: Health Management Network Commercial	$5,408.55
Rate for Payer: Kaiser Permanente Commercial	$5,726.70
Rate for Payer: MDX Hawaii PPO	$6,172.11
Rate for Payer: University Health Alliance Commercial	$3,563.28

HIP SYS SZE 23MM 62726-1-123

Facility

$8,879.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,972.24
Max. Negotiated Rate	$8,612.63
Rate for Payer: Cash Price	$5,327.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,215.30
Rate for Payer: Health Management Network Commercial	$7,547.15
Rate for Payer: Kaiser Permanente Commercial	$7,991.10
Rate for Payer: MDX Hawaii PPO	$8,612.63
Rate for Payer: University Health Alliance Commercial	$4,972.24

HIP SYS SZE 23MM 62726-1-123

Facility

$8,879.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,752.49
Max. Negotiated Rate	$8,612.63
Rate for Payer: AlohaCare Medicaid	$4,439.50
Rate for Payer: AlohaCare Medicare	$2,752.49
Rate for Payer: Cash Price	$5,327.40
Rate for Payer: Devoted Health Medicare	$3,018.86
Rate for Payer: Hawaii Medical Service Association Medicare	$2,752.49
Rate for Payer: Hawaii Western Management Group Commercial	$6,215.30
Rate for Payer: Health Management Network Commercial	$7,547.15
Rate for Payer: Humana Medicare	$2,752.49
Rate for Payer: Kaiser Permanente Commercial	$7,991.10
Rate for Payer: Kaiser Permanente Medicaid	$4,528.29
Rate for Payer: Kaiser Permanente Medicare	$2,752.49
Rate for Payer: MDX Hawaii PPO	$8,612.63
Rate for Payer: Ohana Health Plan Medicaid	$2,752.49
Rate for Payer: Ohana Health Plan Medicare	$2,752.49
Rate for Payer: UnitedHealthcare Medicare	$2,752.49
Rate for Payer: University Health Alliance Commercial	$4,972.24

HIP SYSYTEM 6276-7-022

Facility

$6,428.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,599.68
Max. Negotiated Rate	$6,235.16
Rate for Payer: Cash Price	$3,856.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,499.60
Rate for Payer: Health Management Network Commercial	$5,463.80
Rate for Payer: Kaiser Permanente Commercial	$5,785.20
Rate for Payer: MDX Hawaii PPO	$6,235.16
Rate for Payer: University Health Alliance Commercial	$3,599.68

HIP SYSYTEM 6276-7-022

Facility

$6,428.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,992.68
Max. Negotiated Rate	$6,235.16
Rate for Payer: AlohaCare Medicaid	$3,214.00
Rate for Payer: AlohaCare Medicare	$1,992.68
Rate for Payer: Cash Price	$3,856.80
Rate for Payer: Devoted Health Medicare	$2,185.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,992.68
Rate for Payer: Hawaii Western Management Group Commercial	$4,499.60
Rate for Payer: Health Management Network Commercial	$5,463.80
Rate for Payer: Humana Medicare	$1,992.68
Rate for Payer: Kaiser Permanente Commercial	$5,785.20
Rate for Payer: Kaiser Permanente Medicaid	$3,278.28
Rate for Payer: Kaiser Permanente Medicare	$1,992.68
Rate for Payer: MDX Hawaii PPO	$6,235.16
Rate for Payer: Ohana Health Plan Medicaid	$1,992.68
Rate for Payer: Ohana Health Plan Medicare	$1,992.68
Rate for Payer: UnitedHealthcare Medicare	$1,992.68
Rate for Payer: University Health Alliance Commercial	$3,599.68

HI-TORQUE BALANCE 014X190

Facility

$1,488.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$461.28
Max. Negotiated Rate	$1,443.36
Rate for Payer: AlohaCare Medicaid	$744.00
Rate for Payer: AlohaCare Medicare	$461.28
Rate for Payer: Cash Price	$892.80
Rate for Payer: Devoted Health Medicare	$505.92
Rate for Payer: Hawaii Medical Service Association Medicare	$461.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,413.60
Rate for Payer: Health Management Network Commercial	$1,264.80
Rate for Payer: Humana Medicare	$461.28
Rate for Payer: Kaiser Permanente Commercial	$1,339.20
Rate for Payer: Kaiser Permanente Medicaid	$758.88
Rate for Payer: Kaiser Permanente Medicare	$461.28
Rate for Payer: MDX Hawaii PPO	$1,443.36
Rate for Payer: Ohana Health Plan Medicaid	$461.28
Rate for Payer: Ohana Health Plan Medicare	$461.28
Rate for Payer: UnitedHealthcare Medicare	$461.28
Rate for Payer: University Health Alliance Commercial	$1,084.60

HI-TORQUE BALANCE 014X190

Facility

$1,488.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$1,264.80
Max. Negotiated Rate	$1,443.36
Rate for Payer: Cash Price	$892.80
Rate for Payer: Health Management Network Commercial	$1,264.80
Rate for Payer: Kaiser Permanente Commercial	$1,339.20
Rate for Payer: MDX Hawaii PPO	$1,443.36

HI-TORQUE PILOT 50 STRT 300

Facility

$360.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$306.00
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Kaiser Permanente Commercial	$324.00
Rate for Payer: MDX Hawaii PPO	$349.20

HI-TORQUE PILOT 50 STRT 300

Facility

$360.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$349.20
Rate for Payer: AlohaCare Medicaid	$180.00
Rate for Payer: AlohaCare Medicare	$111.60
Rate for Payer: Cash Price	$216.00
Rate for Payer: Devoted Health Medicare	$122.40
Rate for Payer: Hawaii Medical Service Association Medicare	$111.60
Rate for Payer: Hawaii Western Management Group Commercial	$342.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Humana Medicare	$111.60
Rate for Payer: Kaiser Permanente Commercial	$324.00
Rate for Payer: Kaiser Permanente Medicaid	$183.60
Rate for Payer: Kaiser Permanente Medicare	$111.60
Rate for Payer: MDX Hawaii PPO	$349.20
Rate for Payer: Ohana Health Plan Medicaid	$111.60
Rate for Payer: Ohana Health Plan Medicare	$111.60
Rate for Payer: UnitedHealthcare Medicare	$111.60
Rate for Payer: University Health Alliance Commercial	$262.40

HI VIS HIP BURR 4.0 #7220312

Facility

$426.00

Hospital Revenue Code	272
Min. Negotiated Rate	$362.10
Max. Negotiated Rate	$413.22
Rate for Payer: Cash Price	$255.60
Rate for Payer: Health Management Network Commercial	$362.10
Rate for Payer: Kaiser Permanente Commercial	$383.40
Rate for Payer: MDX Hawaii PPO	$413.22

HI VIS HIP BURR 4.0 #7220312

Facility

$426.00

Hospital Revenue Code	272
Min. Negotiated Rate	$132.06
Max. Negotiated Rate	$413.22
Rate for Payer: AlohaCare Medicaid	$213.00
Rate for Payer: AlohaCare Medicare	$132.06
Rate for Payer: Cash Price	$255.60
Rate for Payer: Devoted Health Medicare	$144.84
Rate for Payer: Hawaii Medical Service Association Medicare	$132.06
Rate for Payer: Hawaii Western Management Group Commercial	$404.70
Rate for Payer: Health Management Network Commercial	$362.10
Rate for Payer: Humana Medicare	$132.06
Rate for Payer: Kaiser Permanente Commercial	$383.40
Rate for Payer: Kaiser Permanente Medicaid	$217.26
Rate for Payer: Kaiser Permanente Medicare	$132.06
Rate for Payer: MDX Hawaii PPO	$413.22
Rate for Payer: Ohana Health Plan Medicaid	$132.06
Rate for Payer: Ohana Health Plan Medicare	$132.06
Rate for Payer: UnitedHealthcare Medicare	$132.06
Rate for Payer: University Health Alliance Commercial	$310.51

HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC

Facility

$99,074.36

Service Code	MSDRG 969
Min. Negotiated Rate	$99,074.36
Max. Negotiated Rate	$99,074.36
Rate for Payer: Hawaii Medical Service Association Commercial	$99,074.36

HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC

Facility

$99,074.36

Service Code	MSDRG 970
Min. Negotiated Rate	$99,074.36
Max. Negotiated Rate	$99,074.36
Rate for Payer: Hawaii Medical Service Association Commercial	$99,074.36

HIV WITH MAJOR RELATED CONDITION WITH CC

Facility

$57,643.26

Service Code	MSDRG 975
Min. Negotiated Rate	$57,643.26
Max. Negotiated Rate	$57,643.26
Rate for Payer: Hawaii Medical Service Association Commercial	$57,643.26

HIV WITH MAJOR RELATED CONDITION WITH MCC

Facility

$57,643.26

Service Code	MSDRG 974
Min. Negotiated Rate	$57,643.26
Max. Negotiated Rate	$57,643.26
Rate for Payer: Hawaii Medical Service Association Commercial	$57,643.26

HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC

Facility

$57,643.26

Service Code	MSDRG 976
Min. Negotiated Rate	$57,643.26
Max. Negotiated Rate	$57,643.26
Rate for Payer: Hawaii Medical Service Association Commercial	$57,643.26

HIV WITH OR WITHOUT OTHER RELATED CONDITION

Facility

$41,431.10

Service Code	MSDRG 977
Min. Negotiated Rate	$41,431.10
Max. Negotiated Rate	$41,431.10
Rate for Payer: Hawaii Medical Service Association Commercial	$41,431.10

HMRL RADIUS 52X17MM 5552-S-521

Facility

$6,838.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,829.28
Max. Negotiated Rate	$6,632.86
Rate for Payer: Cash Price	$4,102.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,786.60
Rate for Payer: Health Management Network Commercial	$5,812.30
Rate for Payer: Kaiser Permanente Commercial	$6,154.20
Rate for Payer: MDX Hawaii PPO	$6,632.86
Rate for Payer: University Health Alliance Commercial	$3,829.28

HMRL RADIUS 52X17MM 5552-S-521

Facility

$6,838.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,119.78
Max. Negotiated Rate	$6,632.86
Rate for Payer: AlohaCare Medicaid	$3,419.00
Rate for Payer: AlohaCare Medicare	$2,119.78
Rate for Payer: Cash Price	$4,102.80
Rate for Payer: Devoted Health Medicare	$2,324.92
Rate for Payer: Hawaii Medical Service Association Medicare	$2,119.78
Rate for Payer: Hawaii Western Management Group Commercial	$4,786.60
Rate for Payer: Health Management Network Commercial	$5,812.30
Rate for Payer: Humana Medicare	$2,119.78
Rate for Payer: Kaiser Permanente Commercial	$6,154.20
Rate for Payer: Kaiser Permanente Medicaid	$3,487.38
Rate for Payer: Kaiser Permanente Medicare	$2,119.78
Rate for Payer: MDX Hawaii PPO	$6,632.86
Rate for Payer: Ohana Health Plan Medicaid	$2,119.78
Rate for Payer: Ohana Health Plan Medicare	$2,119.78
Rate for Payer: UnitedHealthcare Medicare	$2,119.78
Rate for Payer: University Health Alliance Commercial	$3,829.28

HOOPLATE LCP PROXI FEM 4.5MM

Facility

$4,572.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,560.32
Max. Negotiated Rate	$4,434.84
Rate for Payer: Cash Price	$2,743.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,200.40
Rate for Payer: Health Management Network Commercial	$3,886.20
Rate for Payer: Kaiser Permanente Commercial	$4,114.80
Rate for Payer: MDX Hawaii PPO	$4,434.84
Rate for Payer: University Health Alliance Commercial	$2,560.32

HOOPLATE LCP PROXI FEM 4.5MM

Facility

$4,572.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,417.32
Max. Negotiated Rate	$4,434.84
Rate for Payer: AlohaCare Medicaid	$2,286.00
Rate for Payer: AlohaCare Medicare	$1,417.32
Rate for Payer: Cash Price	$2,743.20
Rate for Payer: Devoted Health Medicare	$1,554.48
Rate for Payer: Hawaii Medical Service Association Medicare	$1,417.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,200.40
Rate for Payer: Health Management Network Commercial	$3,886.20
Rate for Payer: Humana Medicare	$1,417.32
Rate for Payer: Kaiser Permanente Commercial	$4,114.80
Rate for Payer: Kaiser Permanente Medicaid	$2,331.72
Rate for Payer: Kaiser Permanente Medicare	$1,417.32
Rate for Payer: MDX Hawaii PPO	$4,434.84
Rate for Payer: Ohana Health Plan Medicaid	$1,417.32
Rate for Payer: Ohana Health Plan Medicare	$1,417.32
Rate for Payer: UnitedHealthcare Medicare	$1,417.32
Rate for Payer: University Health Alliance Commercial	$2,560.32

HSC+ 285CC 10721-285MP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,596.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

Know your out-of-pocket cost for care.

All Charges