Kau Hospital

All Charges

Charge

Type

Setting

Price

INSTR 10MM ENDO RETRACT II

Facility

$395.00

Hospital Revenue Code	272
Min. Negotiated Rate	$122.45
Max. Negotiated Rate	$383.15
Rate for Payer: AlohaCare Medicaid	$197.50
Rate for Payer: AlohaCare Medicare	$122.45
Rate for Payer: Cash Price	$237.00
Rate for Payer: Devoted Health Medicare	$134.30
Rate for Payer: Hawaii Medical Service Association Medicare	$122.45
Rate for Payer: Hawaii Western Management Group Commercial	$375.25
Rate for Payer: Health Management Network Commercial	$335.75
Rate for Payer: Humana Medicare	$122.45
Rate for Payer: Kaiser Permanente Commercial	$355.50
Rate for Payer: Kaiser Permanente Medicaid	$201.45
Rate for Payer: Kaiser Permanente Medicare	$122.45
Rate for Payer: MDX Hawaii PPO	$383.15
Rate for Payer: Ohana Health Plan Medicaid	$122.45
Rate for Payer: Ohana Health Plan Medicare	$122.45
Rate for Payer: UnitedHealthcare Medicare	$122.45
Rate for Payer: University Health Alliance Commercial	$287.92

INSTR 5MM ENDO GRASPER

Facility

$234.00

Hospital Revenue Code	272
Min. Negotiated Rate	$72.54
Max. Negotiated Rate	$226.98
Rate for Payer: AlohaCare Medicaid	$117.00
Rate for Payer: AlohaCare Medicare	$72.54
Rate for Payer: Cash Price	$140.40
Rate for Payer: Devoted Health Medicare	$79.56
Rate for Payer: Hawaii Medical Service Association Medicare	$72.54
Rate for Payer: Hawaii Western Management Group Commercial	$222.30
Rate for Payer: Health Management Network Commercial	$198.90
Rate for Payer: Humana Medicare	$72.54
Rate for Payer: Kaiser Permanente Commercial	$210.60
Rate for Payer: Kaiser Permanente Medicaid	$119.34
Rate for Payer: Kaiser Permanente Medicare	$72.54
Rate for Payer: MDX Hawaii PPO	$226.98
Rate for Payer: Ohana Health Plan Medicaid	$72.54
Rate for Payer: Ohana Health Plan Medicare	$72.54
Rate for Payer: UnitedHealthcare Medicare	$72.54
Rate for Payer: University Health Alliance Commercial	$170.56

INSTR 5MM ENDO GRASPER

Facility

$234.00

Hospital Revenue Code	272
Min. Negotiated Rate	$198.90
Max. Negotiated Rate	$226.98
Rate for Payer: Cash Price	$140.40
Rate for Payer: Health Management Network Commercial	$198.90
Rate for Payer: Kaiser Permanente Commercial	$210.60
Rate for Payer: MDX Hawaii PPO	$226.98

INSTR 5MM MINI SHEARS

Facility

$149.00

Hospital Revenue Code	272
Min. Negotiated Rate	$46.19
Max. Negotiated Rate	$144.53
Rate for Payer: AlohaCare Medicaid	$74.50
Rate for Payer: AlohaCare Medicare	$46.19
Rate for Payer: Cash Price	$89.40
Rate for Payer: Devoted Health Medicare	$50.66
Rate for Payer: Hawaii Medical Service Association Medicare	$46.19
Rate for Payer: Hawaii Western Management Group Commercial	$141.55
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Humana Medicare	$46.19
Rate for Payer: Kaiser Permanente Commercial	$134.10
Rate for Payer: Kaiser Permanente Medicaid	$75.99
Rate for Payer: Kaiser Permanente Medicare	$46.19
Rate for Payer: MDX Hawaii PPO	$144.53
Rate for Payer: Ohana Health Plan Medicaid	$46.19
Rate for Payer: Ohana Health Plan Medicare	$46.19
Rate for Payer: UnitedHealthcare Medicare	$46.19
Rate for Payer: University Health Alliance Commercial	$108.61

INSTR 5MM MINI SHEARS

Facility

$149.00

Hospital Revenue Code	272
Min. Negotiated Rate	$126.65
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$89.40
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Kaiser Permanente Commercial	$134.10
Rate for Payer: MDX Hawaii PPO	$144.53

INSTR BIOPSY NEEDLE MONOPTY

Facility

$162.00

Hospital Revenue Code	272
Min. Negotiated Rate	$50.22
Max. Negotiated Rate	$157.14
Rate for Payer: AlohaCare Medicaid	$81.00
Rate for Payer: AlohaCare Medicare	$50.22
Rate for Payer: Cash Price	$97.20
Rate for Payer: Devoted Health Medicare	$55.08
Rate for Payer: Hawaii Medical Service Association Medicare	$50.22
Rate for Payer: Hawaii Western Management Group Commercial	$153.90
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: Humana Medicare	$50.22
Rate for Payer: Kaiser Permanente Commercial	$145.80
Rate for Payer: Kaiser Permanente Medicaid	$82.62
Rate for Payer: Kaiser Permanente Medicare	$50.22
Rate for Payer: MDX Hawaii PPO	$157.14
Rate for Payer: Ohana Health Plan Medicaid	$50.22
Rate for Payer: Ohana Health Plan Medicare	$50.22
Rate for Payer: UnitedHealthcare Medicare	$50.22
Rate for Payer: University Health Alliance Commercial	$118.08

INSTR BIOPSY NEEDLE MONOPTY

Facility

$162.00

Hospital Revenue Code	272
Min. Negotiated Rate	$137.70
Max. Negotiated Rate	$157.14
Rate for Payer: Cash Price	$97.20
Rate for Payer: Health Management Network Commercial	$137.70
Rate for Payer: Kaiser Permanente Commercial	$145.80
Rate for Payer: MDX Hawaii PPO	$157.14

INSTR DUODENOSCOPE

Facility

$7,650.00

Service Code	HCPCS C1748
Hospital Revenue Code	272
Min. Negotiated Rate	$2,371.50
Max. Negotiated Rate	$7,420.50
Rate for Payer: AlohaCare Medicaid	$3,825.00
Rate for Payer: AlohaCare Medicare	$2,371.50
Rate for Payer: Cash Price	$4,590.00
Rate for Payer: Devoted Health Medicare	$2,601.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,371.50
Rate for Payer: Hawaii Western Management Group Commercial	$7,267.50
Rate for Payer: Health Management Network Commercial	$6,502.50
Rate for Payer: Humana Medicare	$2,371.50
Rate for Payer: Kaiser Permanente Commercial	$6,885.00
Rate for Payer: Kaiser Permanente Medicaid	$3,901.50
Rate for Payer: Kaiser Permanente Medicare	$2,371.50
Rate for Payer: MDX Hawaii PPO	$7,420.50
Rate for Payer: Ohana Health Plan Medicaid	$2,371.50
Rate for Payer: Ohana Health Plan Medicare	$2,371.50
Rate for Payer: UnitedHealthcare Medicare	$2,371.50
Rate for Payer: University Health Alliance Commercial	$5,576.09

INSTR DUODENOSCOPE

Facility

$7,650.00

Service Code	HCPCS C1748
Hospital Revenue Code	272
Min. Negotiated Rate	$6,502.50
Max. Negotiated Rate	$7,420.50
Rate for Payer: Cash Price	$4,590.00
Rate for Payer: Health Management Network Commercial	$6,502.50
Rate for Payer: Kaiser Permanente Commercial	$6,885.00
Rate for Payer: MDX Hawaii PPO	$7,420.50

INSTR ENDO BABCOCK

Facility

$293.00

Hospital Revenue Code	272
Min. Negotiated Rate	$90.83
Max. Negotiated Rate	$284.21
Rate for Payer: AlohaCare Medicaid	$146.50
Rate for Payer: AlohaCare Medicare	$90.83
Rate for Payer: Cash Price	$175.80
Rate for Payer: Devoted Health Medicare	$99.62
Rate for Payer: Hawaii Medical Service Association Medicare	$90.83
Rate for Payer: Hawaii Western Management Group Commercial	$278.35
Rate for Payer: Health Management Network Commercial	$249.05
Rate for Payer: Humana Medicare	$90.83
Rate for Payer: Kaiser Permanente Commercial	$263.70
Rate for Payer: Kaiser Permanente Medicaid	$149.43
Rate for Payer: Kaiser Permanente Medicare	$90.83
Rate for Payer: MDX Hawaii PPO	$284.21
Rate for Payer: Ohana Health Plan Medicaid	$90.83
Rate for Payer: Ohana Health Plan Medicare	$90.83
Rate for Payer: UnitedHealthcare Medicare	$90.83
Rate for Payer: University Health Alliance Commercial	$213.57

INSTR ENDO BABCOCK

Facility

$293.00

Hospital Revenue Code	272
Min. Negotiated Rate	$249.05
Max. Negotiated Rate	$284.21
Rate for Payer: Cash Price	$175.80
Rate for Payer: Health Management Network Commercial	$249.05
Rate for Payer: Kaiser Permanente Commercial	$263.70
Rate for Payer: MDX Hawaii PPO	$284.21

INSTR FORCEP ALLIGA RESCUE

Facility

$309.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$95.79
Max. Negotiated Rate	$299.73
Rate for Payer: AlohaCare Medicaid	$154.50
Rate for Payer: AlohaCare Medicare	$95.79
Rate for Payer: Cash Price	$185.40
Rate for Payer: Devoted Health Medicare	$105.06
Rate for Payer: Hawaii Medical Service Association Medicare	$95.79
Rate for Payer: Hawaii Western Management Group Commercial	$293.55
Rate for Payer: Health Management Network Commercial	$262.65
Rate for Payer: Humana Medicare	$95.79
Rate for Payer: Kaiser Permanente Commercial	$278.10
Rate for Payer: Kaiser Permanente Medicaid	$157.59
Rate for Payer: Kaiser Permanente Medicare	$95.79
Rate for Payer: MDX Hawaii PPO	$299.73
Rate for Payer: Ohana Health Plan Medicaid	$95.79
Rate for Payer: Ohana Health Plan Medicare	$95.79
Rate for Payer: UnitedHealthcare Medicare	$95.79
Rate for Payer: University Health Alliance Commercial	$225.23

INSTR FORCEP ALLIGA RESCUE

Facility

$309.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$262.65
Max. Negotiated Rate	$299.73
Rate for Payer: Cash Price	$185.40
Rate for Payer: Health Management Network Commercial	$262.65
Rate for Payer: Kaiser Permanente Commercial	$278.10
Rate for Payer: MDX Hawaii PPO	$299.73

INSTR FORCEP BIOP ENDOJAW

Facility

$145.00

Hospital Revenue Code	272
Min. Negotiated Rate	$44.95
Max. Negotiated Rate	$140.65
Rate for Payer: AlohaCare Medicaid	$72.50
Rate for Payer: AlohaCare Medicare	$44.95
Rate for Payer: Cash Price	$87.00
Rate for Payer: Devoted Health Medicare	$49.30
Rate for Payer: Hawaii Medical Service Association Medicare	$44.95
Rate for Payer: Hawaii Western Management Group Commercial	$137.75
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$44.95
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicare	$44.95
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$44.95
Rate for Payer: Ohana Health Plan Medicare	$44.95
Rate for Payer: UnitedHealthcare Medicare	$44.95
Rate for Payer: University Health Alliance Commercial	$105.69

INSTR FORCEP BIOP ENDOJAW

Facility

$145.00

Hospital Revenue Code	272
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$87.00
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: MDX Hawaii PPO	$140.65

INSTR FORCEP BIOPSY PULM

Facility

$201.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$62.31
Max. Negotiated Rate	$194.97
Rate for Payer: AlohaCare Medicaid	$100.50
Rate for Payer: AlohaCare Medicare	$62.31
Rate for Payer: Cash Price	$120.60
Rate for Payer: Devoted Health Medicare	$68.34
Rate for Payer: Hawaii Medical Service Association Medicare	$62.31
Rate for Payer: Hawaii Western Management Group Commercial	$190.95
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Humana Medicare	$62.31
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: Kaiser Permanente Medicaid	$102.51
Rate for Payer: Kaiser Permanente Medicare	$62.31
Rate for Payer: MDX Hawaii PPO	$194.97
Rate for Payer: Ohana Health Plan Medicaid	$62.31
Rate for Payer: Ohana Health Plan Medicare	$62.31
Rate for Payer: UnitedHealthcare Medicare	$62.31
Rate for Payer: University Health Alliance Commercial	$146.51

INSTR FORCEP BIOPSY PULM

Facility

$201.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$170.85
Max. Negotiated Rate	$194.97
Rate for Payer: Cash Price	$120.60
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: MDX Hawaii PPO	$194.97

INSTR FORCEP GRASPING

Facility

$288.00

Hospital Revenue Code	272
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$279.36
Rate for Payer: Cash Price	$172.80
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: Kaiser Permanente Commercial	$259.20
Rate for Payer: MDX Hawaii PPO	$279.36

INSTR FORCEP GRASPING

Facility

$288.00

Hospital Revenue Code	272
Min. Negotiated Rate	$89.28
Max. Negotiated Rate	$279.36
Rate for Payer: AlohaCare Medicaid	$144.00
Rate for Payer: AlohaCare Medicare	$89.28
Rate for Payer: Cash Price	$172.80
Rate for Payer: Devoted Health Medicare	$97.92
Rate for Payer: Hawaii Medical Service Association Medicare	$89.28
Rate for Payer: Hawaii Western Management Group Commercial	$273.60
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: Humana Medicare	$89.28
Rate for Payer: Kaiser Permanente Commercial	$259.20
Rate for Payer: Kaiser Permanente Medicaid	$146.88
Rate for Payer: Kaiser Permanente Medicare	$89.28
Rate for Payer: MDX Hawaii PPO	$279.36
Rate for Payer: Ohana Health Plan Medicaid	$89.28
Rate for Payer: Ohana Health Plan Medicare	$89.28
Rate for Payer: UnitedHealthcare Medicare	$89.28
Rate for Payer: University Health Alliance Commercial	$209.92

INSTR FORCEP RAPTOR GRASPING

Facility

$396.00

Hospital Revenue Code	272
Min. Negotiated Rate	$336.60
Max. Negotiated Rate	$384.12
Rate for Payer: Cash Price	$237.60
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: Kaiser Permanente Commercial	$356.40
Rate for Payer: MDX Hawaii PPO	$384.12

INSTR FORCEP RAPTOR GRASPING

Facility

$396.00

Hospital Revenue Code	272
Min. Negotiated Rate	$122.76
Max. Negotiated Rate	$384.12
Rate for Payer: AlohaCare Medicaid	$198.00
Rate for Payer: AlohaCare Medicare	$122.76
Rate for Payer: Cash Price	$237.60
Rate for Payer: Devoted Health Medicare	$134.64
Rate for Payer: Hawaii Medical Service Association Medicare	$122.76
Rate for Payer: Hawaii Western Management Group Commercial	$376.20
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: Humana Medicare	$122.76
Rate for Payer: Kaiser Permanente Commercial	$356.40
Rate for Payer: Kaiser Permanente Medicaid	$201.96
Rate for Payer: Kaiser Permanente Medicare	$122.76
Rate for Payer: MDX Hawaii PPO	$384.12
Rate for Payer: Ohana Health Plan Medicaid	$122.76
Rate for Payer: Ohana Health Plan Medicare	$122.76
Rate for Payer: UnitedHealthcare Medicare	$122.76
Rate for Payer: University Health Alliance Commercial	$288.64

INSTR FORCEP RESCUE GRASP

Facility

$309.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$262.65
Max. Negotiated Rate	$299.73
Rate for Payer: Cash Price	$185.40
Rate for Payer: Health Management Network Commercial	$262.65
Rate for Payer: Kaiser Permanente Commercial	$278.10
Rate for Payer: MDX Hawaii PPO	$299.73

INSTR FORCEP RESCUE GRASP

Facility

$309.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$95.79
Max. Negotiated Rate	$299.73
Rate for Payer: AlohaCare Medicaid	$154.50
Rate for Payer: AlohaCare Medicare	$95.79
Rate for Payer: Cash Price	$185.40
Rate for Payer: Devoted Health Medicare	$105.06
Rate for Payer: Hawaii Medical Service Association Medicare	$95.79
Rate for Payer: Hawaii Western Management Group Commercial	$293.55
Rate for Payer: Health Management Network Commercial	$262.65
Rate for Payer: Humana Medicare	$95.79
Rate for Payer: Kaiser Permanente Commercial	$278.10
Rate for Payer: Kaiser Permanente Medicaid	$157.59
Rate for Payer: Kaiser Permanente Medicare	$95.79
Rate for Payer: MDX Hawaii PPO	$299.73
Rate for Payer: Ohana Health Plan Medicaid	$95.79
Rate for Payer: Ohana Health Plan Medicare	$95.79
Rate for Payer: UnitedHealthcare Medicare	$95.79
Rate for Payer: University Health Alliance Commercial	$225.23

INSTR FORCEPS BIOPSY

Facility

$1,364.00

Hospital Revenue Code	272
Min. Negotiated Rate	$422.84
Max. Negotiated Rate	$1,323.08
Rate for Payer: AlohaCare Medicaid	$682.00
Rate for Payer: AlohaCare Medicaid	$784.00
Rate for Payer: AlohaCare Medicare	$422.84
Rate for Payer: AlohaCare Medicare	$486.08
Rate for Payer: Cash Price	$940.80
Rate for Payer: Cash Price	$818.40
Rate for Payer: Devoted Health Medicare	$463.76
Rate for Payer: Devoted Health Medicare	$533.12
Rate for Payer: Hawaii Medical Service Association Medicare	$486.08
Rate for Payer: Hawaii Medical Service Association Medicare	$422.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,489.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,295.80
Rate for Payer: Health Management Network Commercial	$1,159.40
Rate for Payer: Health Management Network Commercial	$1,332.80
Rate for Payer: Humana Medicare	$486.08
Rate for Payer: Humana Medicare	$422.84
Rate for Payer: Kaiser Permanente Commercial	$1,227.60
Rate for Payer: Kaiser Permanente Commercial	$1,411.20
Rate for Payer: Kaiser Permanente Medicaid	$799.68
Rate for Payer: Kaiser Permanente Medicaid	$695.64
Rate for Payer: Kaiser Permanente Medicare	$486.08
Rate for Payer: Kaiser Permanente Medicare	$422.84
Rate for Payer: MDX Hawaii PPO	$1,520.96
Rate for Payer: MDX Hawaii PPO	$1,323.08
Rate for Payer: Ohana Health Plan Medicaid	$422.84
Rate for Payer: Ohana Health Plan Medicaid	$486.08
Rate for Payer: Ohana Health Plan Medicare	$422.84
Rate for Payer: Ohana Health Plan Medicare	$486.08
Rate for Payer: UnitedHealthcare Medicare	$422.84
Rate for Payer: UnitedHealthcare Medicare	$486.08
Rate for Payer: University Health Alliance Commercial	$1,142.92
Rate for Payer: University Health Alliance Commercial	$994.22

INSTR FORCEPS BIOPSY

Facility

$1,568.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,332.80
Max. Negotiated Rate	$1,520.96
Rate for Payer: Cash Price	$940.80
Rate for Payer: Cash Price	$818.40
Rate for Payer: Health Management Network Commercial	$1,332.80
Rate for Payer: Health Management Network Commercial	$1,159.40
Rate for Payer: Kaiser Permanente Commercial	$1,411.20
Rate for Payer: Kaiser Permanente Commercial	$1,227.60
Rate for Payer: MDX Hawaii PPO	$1,323.08
Rate for Payer: MDX Hawaii PPO	$1,520.96

Know your out-of-pocket cost for care.

All Charges