Kau Hospital

All Charges

Charge

Type

Setting

Price

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

HSC GEL BREAST 440 10621-440HP

Facility

$2,085.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,167.60
Max. Negotiated Rate	$2,022.45
Rate for Payer: Cash Price	$1,251.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,459.50
Rate for Payer: Health Management Network Commercial	$1,772.25
Rate for Payer: Kaiser Permanente Commercial	$1,876.50
Rate for Payer: MDX Hawaii PPO	$2,022.45
Rate for Payer: University Health Alliance Commercial	$1,167.60

HSC GEL BREAST 440 10621-440HP

Facility

$2,085.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$646.35
Max. Negotiated Rate	$2,022.45
Rate for Payer: AlohaCare Medicaid	$1,042.50
Rate for Payer: AlohaCare Medicare	$646.35
Rate for Payer: Cash Price	$1,251.00
Rate for Payer: Devoted Health Medicare	$708.90
Rate for Payer: Hawaii Medical Service Association Medicare	$646.35
Rate for Payer: Hawaii Western Management Group Commercial	$1,459.50
Rate for Payer: Health Management Network Commercial	$1,772.25
Rate for Payer: Humana Medicare	$646.35
Rate for Payer: Kaiser Permanente Commercial	$1,876.50
Rate for Payer: Kaiser Permanente Medicaid	$1,063.35
Rate for Payer: Kaiser Permanente Medicare	$646.35
Rate for Payer: MDX Hawaii PPO	$2,022.45
Rate for Payer: Ohana Health Plan Medicaid	$646.35
Rate for Payer: Ohana Health Plan Medicare	$646.35
Rate for Payer: UnitedHealthcare Medicare	$646.35
Rate for Payer: University Health Alliance Commercial	$1,167.60

HSC GEL BREAST LF 10621-470HP

Facility

$2,250.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$697.50
Max. Negotiated Rate	$2,182.50
Rate for Payer: AlohaCare Medicaid	$1,125.00
Rate for Payer: AlohaCare Medicare	$697.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Devoted Health Medicare	$765.00
Rate for Payer: Hawaii Medical Service Association Medicare	$697.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,575.00
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Humana Medicare	$697.50
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: Kaiser Permanente Medicaid	$1,147.50
Rate for Payer: Kaiser Permanente Medicare	$697.50
Rate for Payer: MDX Hawaii PPO	$2,182.50
Rate for Payer: Ohana Health Plan Medicaid	$697.50
Rate for Payer: Ohana Health Plan Medicare	$697.50
Rate for Payer: UnitedHealthcare Medicare	$697.50
Rate for Payer: University Health Alliance Commercial	$1,260.00

HSC GEL BREAST LF 10621-470HP

Facility

$2,250.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,260.00
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,575.00
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: MDX Hawaii PPO	$2,182.50
Rate for Payer: University Health Alliance Commercial	$1,260.00

HSC+ RND HI RT 10721-565HP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$883.50
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$883.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$969.00
Rate for Payer: Hawaii Medical Service Association Medicare	$883.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$883.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$883.50
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$883.50
Rate for Payer: Ohana Health Plan Medicare	$883.50
Rate for Payer: UnitedHealthcare Medicare	$883.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC+ RND HI RT 10721-565HP

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

HSC+ SMOOTH RND 10721-325MP

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

HSC+ SMOOTH RND 10721-325MP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$883.50
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$883.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$969.00
Rate for Payer: Hawaii Medical Service Association Medicare	$883.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$883.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$883.50
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$883.50
Rate for Payer: Ohana Health Plan Medicare	$883.50
Rate for Payer: UnitedHealthcare Medicare	$883.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC+ SMOOTH RND 10721-385MP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$883.50
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$883.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$969.00
Rate for Payer: Hawaii Medical Service Association Medicare	$883.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$883.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$883.50
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$883.50
Rate for Payer: Ohana Health Plan Medicare	$883.50
Rate for Payer: UnitedHealthcare Medicare	$883.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC+ SMOOTH RND 10721-385MP

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

HSC+ SMOOTH RND 10721-435MP

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

HSC+ SMOOTH RND 10721-435MP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$883.50
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$883.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$969.00
Rate for Payer: Hawaii Medical Service Association Medicare	$883.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$883.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$883.50
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$883.50
Rate for Payer: Ohana Health Plan Medicare	$883.50
Rate for Payer: UnitedHealthcare Medicare	$883.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC SMOOTH RND 10721-455MP

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

HSC SMOOTH RND 10721-455MP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$883.50
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$883.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$969.00
Rate for Payer: Hawaii Medical Service Association Medicare	$883.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$883.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$883.50
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$883.50
Rate for Payer: Ohana Health Plan Medicare	$883.50
Rate for Payer: UnitedHealthcare Medicare	$883.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC+ SMOOTH RND 10721-535HP

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

HSC+ SMOOTH RND 10721-535HP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$883.50
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$883.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$969.00
Rate for Payer: Hawaii Medical Service Association Medicare	$883.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$883.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$883.50
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$883.50
Rate for Payer: Ohana Health Plan Medicare	$883.50
Rate for Payer: UnitedHealthcare Medicare	$883.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC+ SMOOTH RND 10721-650HP

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$883.50
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$883.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$969.00
Rate for Payer: Hawaii Medical Service Association Medicare	$883.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$883.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$883.50
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$883.50
Rate for Payer: Ohana Health Plan Medicare	$883.50
Rate for Payer: UnitedHealthcare Medicare	$883.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC+ SMOOTH RND 10721-650HP

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

HSC+ SMOOTH RND 510CC

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$883.50
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$883.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$969.00
Rate for Payer: Hawaii Medical Service Association Medicare	$883.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$883.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$883.50
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$883.50
Rate for Payer: Ohana Health Plan Medicare	$883.50
Rate for Payer: UnitedHealthcare Medicare	$883.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC+ SMOOTH RND 510CC

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

HSC+ SMOOTH RND HIGH 415CC

Facility

$2,850.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$883.50
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$883.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$969.00
Rate for Payer: Hawaii Medical Service Association Medicare	$883.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$883.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$883.50
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$883.50
Rate for Payer: Ohana Health Plan Medicare	$883.50
Rate for Payer: UnitedHealthcare Medicare	$883.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

HSC+ SMOOTH RND HIGH 415CC

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

HSC SMOOTH ROUND 10621-620HP

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

HSC SMOOTH ROUND 10621-620HP

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

Know your out-of-pocket cost for care.

All Charges