Kau Hospital

All Charges

Charge

Type

Setting

Price

INSTR GRASPING DEVICE MINI

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 GRASPING DEVICE MINI

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 LITHOTRIPTOR MECH

Facility

$1,830.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,555.50
Max. Negotiated Rate	$1,775.10
Rate for Payer: Cash Price	$1,098.00
Rate for Payer: Health Management Network Commercial	$1,555.50
Rate for Payer: Kaiser Permanente Commercial	$1,647.00
Rate for Payer: MDX Hawaii PPO	$1,775.10

INSTR LITHOTRIPTOR MECH

Facility

$1,830.00

Hospital Revenue Code	272
Min. Negotiated Rate	$567.30
Max. Negotiated Rate	$1,775.10
Rate for Payer: AlohaCare Medicaid	$915.00
Rate for Payer: AlohaCare Medicare	$567.30
Rate for Payer: Cash Price	$1,098.00
Rate for Payer: Devoted Health Medicare	$622.20
Rate for Payer: Hawaii Medical Service Association Medicare	$567.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.50
Rate for Payer: Health Management Network Commercial	$1,555.50
Rate for Payer: Humana Medicare	$567.30
Rate for Payer: Kaiser Permanente Commercial	$1,647.00
Rate for Payer: Kaiser Permanente Medicaid	$933.30
Rate for Payer: Kaiser Permanente Medicare	$567.30
Rate for Payer: MDX Hawaii PPO	$1,775.10
Rate for Payer: Ohana Health Plan Medicaid	$567.30
Rate for Payer: Ohana Health Plan Medicare	$567.30
Rate for Payer: UnitedHealthcare Medicare	$567.30
Rate for Payer: University Health Alliance Commercial	$1,333.89

INSTR RADIAL JAW FORCEP LG

Facility

$93.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$28.83
Max. Negotiated Rate	$90.21
Rate for Payer: AlohaCare Medicaid	$46.50
Rate for Payer: AlohaCare Medicare	$28.83
Rate for Payer: Cash Price	$55.80
Rate for Payer: Devoted Health Medicare	$31.62
Rate for Payer: Hawaii Medical Service Association Medicare	$28.83
Rate for Payer: Hawaii Western Management Group Commercial	$88.35
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Humana Medicare	$28.83
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: Kaiser Permanente Medicare	$28.83
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: Ohana Health Plan Medicaid	$28.83
Rate for Payer: Ohana Health Plan Medicare	$28.83
Rate for Payer: UnitedHealthcare Medicare	$28.83
Rate for Payer: University Health Alliance Commercial	$67.79

INSTR RADIAL JAW FORCEP LG

Facility

$93.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$55.80
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: MDX Hawaii PPO	$90.21

INSTR RADIAL JAW JUMBO 3.2MM

Facility

$164.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$139.40
Max. Negotiated Rate	$159.08
Rate for Payer: Cash Price	$98.40
Rate for Payer: Health Management Network Commercial	$139.40
Rate for Payer: Kaiser Permanente Commercial	$147.60
Rate for Payer: MDX Hawaii PPO	$159.08

INSTR RADIAL JAW JUMBO 3.2MM

Facility

$164.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$50.84
Max. Negotiated Rate	$159.08
Rate for Payer: AlohaCare Medicaid	$82.00
Rate for Payer: AlohaCare Medicare	$50.84
Rate for Payer: Cash Price	$98.40
Rate for Payer: Devoted Health Medicare	$55.76
Rate for Payer: Hawaii Medical Service Association Medicare	$50.84
Rate for Payer: Hawaii Western Management Group Commercial	$155.80
Rate for Payer: Health Management Network Commercial	$139.40
Rate for Payer: Humana Medicare	$50.84
Rate for Payer: Kaiser Permanente Commercial	$147.60
Rate for Payer: Kaiser Permanente Medicaid	$83.64
Rate for Payer: Kaiser Permanente Medicare	$50.84
Rate for Payer: MDX Hawaii PPO	$159.08
Rate for Payer: Ohana Health Plan Medicaid	$50.84
Rate for Payer: Ohana Health Plan Medicare	$50.84
Rate for Payer: UnitedHealthcare Medicare	$50.84
Rate for Payer: University Health Alliance Commercial	$119.54

INSTR RADIAL JAW PEDS 2MM

Facility

$171.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$145.35
Max. Negotiated Rate	$165.87
Rate for Payer: Cash Price	$102.60
Rate for Payer: Health Management Network Commercial	$145.35
Rate for Payer: Kaiser Permanente Commercial	$153.90
Rate for Payer: MDX Hawaii PPO	$165.87

INSTR RADIAL JAW PEDS 2MM

Facility

$171.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$53.01
Max. Negotiated Rate	$165.87
Rate for Payer: AlohaCare Medicaid	$85.50
Rate for Payer: AlohaCare Medicare	$53.01
Rate for Payer: Cash Price	$102.60
Rate for Payer: Devoted Health Medicare	$58.14
Rate for Payer: Hawaii Medical Service Association Medicare	$53.01
Rate for Payer: Hawaii Western Management Group Commercial	$162.45
Rate for Payer: Health Management Network Commercial	$145.35
Rate for Payer: Humana Medicare	$53.01
Rate for Payer: Kaiser Permanente Commercial	$153.90
Rate for Payer: Kaiser Permanente Medicaid	$87.21
Rate for Payer: Kaiser Permanente Medicare	$53.01
Rate for Payer: MDX Hawaii PPO	$165.87
Rate for Payer: Ohana Health Plan Medicaid	$53.01
Rate for Payer: Ohana Health Plan Medicare	$53.01
Rate for Payer: UnitedHealthcare Medicare	$53.01
Rate for Payer: University Health Alliance Commercial	$124.64

INSTR ROUTER 2.3MM TAPERED

Facility

$566.00

Hospital Revenue Code	272
Min. Negotiated Rate	$175.46
Max. Negotiated Rate	$549.02
Rate for Payer: AlohaCare Medicaid	$283.00
Rate for Payer: AlohaCare Medicare	$175.46
Rate for Payer: Cash Price	$339.60
Rate for Payer: Devoted Health Medicare	$192.44
Rate for Payer: Hawaii Medical Service Association Medicare	$175.46
Rate for Payer: Hawaii Western Management Group Commercial	$537.70
Rate for Payer: Health Management Network Commercial	$481.10
Rate for Payer: Humana Medicare	$175.46
Rate for Payer: Kaiser Permanente Commercial	$509.40
Rate for Payer: Kaiser Permanente Medicaid	$288.66
Rate for Payer: Kaiser Permanente Medicare	$175.46
Rate for Payer: MDX Hawaii PPO	$549.02
Rate for Payer: Ohana Health Plan Medicaid	$175.46
Rate for Payer: Ohana Health Plan Medicare	$175.46
Rate for Payer: UnitedHealthcare Medicare	$175.46
Rate for Payer: University Health Alliance Commercial	$412.56

INSTR ROUTER 2.3MM TAPERED

Facility

$566.00

Hospital Revenue Code	272
Min. Negotiated Rate	$481.10
Max. Negotiated Rate	$549.02
Rate for Payer: Cash Price	$339.60
Rate for Payer: Health Management Network Commercial	$481.10
Rate for Payer: Kaiser Permanente Commercial	$509.40
Rate for Payer: MDX Hawaii PPO	$549.02

INSTR SCISSOR METZ TIP

Facility

$221.00

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

INSTR SCISSOR METZ TIP

Facility

$221.00

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

INSULIN ASPAR PROT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS PEN [124856]

Facility

$84.00

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$81.48
Rate for Payer: AlohaCare Medicaid	$42.00
Rate for Payer: AlohaCare Medicare	$26.04
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Devoted Health Medicare	$28.56
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Medicare	$26.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$79.80
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Humana Medicare	$26.04
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: Kaiser Permanente Medicaid	$42.84
Rate for Payer: Kaiser Permanente Medicare	$26.04
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: Ohana Health Plan Medicaid	$26.04
Rate for Payer: Ohana Health Plan Medicare	$26.04
Rate for Payer: UnitedHealthcare Medicaid	$50.40
Rate for Payer: UnitedHealthcare Medicare	$26.04
Rate for Payer: University Health Alliance Commercial	$61.23

INSULIN ASPAR PROT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS PEN [124856]

Facility

$84.00

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: MDX Hawaii PPO	$81.48

INSULIN ASPAR PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS SOLN [33666]

Facility

$174.00

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$147.90
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$104.40
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: MDX Hawaii PPO	$168.78

INSULIN ASPAR PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBCUTANEOUS SOLN [33666]

Facility

$174.00

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$168.78
Rate for Payer: AlohaCare Medicaid	$87.00
Rate for Payer: AlohaCare Medicare	$53.94
Rate for Payer: Cash Price	$104.40
Rate for Payer: Cash Price	$104.40
Rate for Payer: Devoted Health Medicare	$59.16
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Medicare	$53.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$165.30
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Humana Medicare	$53.94
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: Kaiser Permanente Medicaid	$88.74
Rate for Payer: Kaiser Permanente Medicare	$53.94
Rate for Payer: MDX Hawaii PPO	$168.78
Rate for Payer: Ohana Health Plan Medicaid	$53.94
Rate for Payer: Ohana Health Plan Medicare	$53.94
Rate for Payer: UnitedHealthcare Medicaid	$104.40
Rate for Payer: UnitedHealthcare Medicare	$53.94
Rate for Payer: University Health Alliance Commercial	$126.83

INSULIN ASPART 100 UNIT/ML SQ GLUCOSE CORRECTION SCALE [400930]

Facility

$174.00

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$168.78
Rate for Payer: AlohaCare Medicaid	$87.00
Rate for Payer: AlohaCare Medicare	$53.94
Rate for Payer: Cash Price	$104.40
Rate for Payer: Cash Price	$104.40
Rate for Payer: Devoted Health Medicare	$59.16
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Medicare	$53.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$165.30
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Humana Medicare	$53.94
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: Kaiser Permanente Medicaid	$88.74
Rate for Payer: Kaiser Permanente Medicare	$53.94
Rate for Payer: MDX Hawaii PPO	$168.78
Rate for Payer: Ohana Health Plan Medicaid	$53.94
Rate for Payer: Ohana Health Plan Medicare	$53.94
Rate for Payer: UnitedHealthcare Medicaid	$104.40
Rate for Payer: UnitedHealthcare Medicare	$53.94
Rate for Payer: University Health Alliance Commercial	$126.83

INSULIN ASPART 100 UNIT/ML SQ GLUCOSE CORRECTION SCALE [400930]

Facility

$174.00

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$147.90
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$104.40
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: MDX Hawaii PPO	$168.78

INSULIN ASPART 100 UNIT/ML SQ PEN GLUCOSE CORRECTION SCALE [4080155]

Facility

$84.00

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$81.48
Rate for Payer: AlohaCare Medicaid	$42.00
Rate for Payer: AlohaCare Medicare	$26.04
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Devoted Health Medicare	$28.56
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Medicare	$26.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$79.80
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Humana Medicare	$26.04
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: Kaiser Permanente Medicaid	$42.84
Rate for Payer: Kaiser Permanente Medicare	$26.04
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: Ohana Health Plan Medicaid	$26.04
Rate for Payer: Ohana Health Plan Medicare	$26.04
Rate for Payer: UnitedHealthcare Medicaid	$50.40
Rate for Payer: UnitedHealthcare Medicare	$26.04
Rate for Payer: University Health Alliance Commercial	$61.23

INSULIN ASPART 100 UNIT/ML SQ PEN GLUCOSE CORRECTION SCALE [4080155]

Facility

$84.00

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: MDX Hawaii PPO	$81.48

INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [124838]

Facility

$84.00

Service Code	HCPCS J1817
Hospital Revenue Code	636
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$81.48
Rate for Payer: AlohaCare Medicaid	$42.00
Rate for Payer: AlohaCare Medicare	$26.04
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Devoted Health Medicare	$28.56
Rate for Payer: Hawaii Medical Service Association ABD	$3.24
Rate for Payer: Hawaii Medical Service Association Medicare	$26.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.24
Rate for Payer: Hawaii Western Management Group Commercial	$79.80
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Humana Medicare	$26.04
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: Kaiser Permanente Medicaid	$42.84
Rate for Payer: Kaiser Permanente Medicare	$26.04
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: Ohana Health Plan Medicaid	$26.04
Rate for Payer: Ohana Health Plan Medicare	$26.04
Rate for Payer: UnitedHealthcare Medicaid	$50.40
Rate for Payer: UnitedHealthcare Medicare	$26.04
Rate for Payer: University Health Alliance Commercial	$61.23

INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) SUBCUTANEOUS PEN [124838]

Facility

$84.00

Service Code	HCPCS J1817
Hospital Revenue Code	250
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: MDX Hawaii PPO	$81.48

INSULIN ASPART U-100 100 UNIT/ML SUBCUTANEOUS SOLUTION [183769]

Facility

$174.00

Service Code	HCPCS J1817
Hospital Revenue Code	250
Min. Negotiated Rate	$147.90
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$104.40
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: MDX Hawaii PPO	$168.78

Know your out-of-pocket cost for care.

All Charges