Kau Hospital

All Charges

Charge

Type

Setting

Price

INTEGRATED PORT ALLOX2-FH12SE

Facility

$3,300.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,848.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

INTELLIS ADAPTIVESTIM 97715

Facility

$45,900.00

Service Code	HCPCS C1820
Hospital Revenue Code	278
Min. Negotiated Rate	$14,229.00
Max. Negotiated Rate	$44,523.00
Rate for Payer: AlohaCare Medicaid	$22,950.00
Rate for Payer: AlohaCare Medicare	$14,229.00
Rate for Payer: Cash Price	$27,540.00
Rate for Payer: Devoted Health Medicare	$15,606.00
Rate for Payer: Hawaii Medical Service Association Medicare	$14,229.00
Rate for Payer: Hawaii Western Management Group Commercial	$32,130.00
Rate for Payer: Health Management Network Commercial	$39,015.00
Rate for Payer: Humana Medicare	$14,229.00
Rate for Payer: Kaiser Permanente Commercial	$41,310.00
Rate for Payer: Kaiser Permanente Medicaid	$23,409.00
Rate for Payer: Kaiser Permanente Medicare	$14,229.00
Rate for Payer: MDX Hawaii PPO	$44,523.00
Rate for Payer: Ohana Health Plan Medicaid	$14,229.00
Rate for Payer: Ohana Health Plan Medicare	$14,229.00
Rate for Payer: UnitedHealthcare Medicare	$14,229.00
Rate for Payer: University Health Alliance Commercial	$25,704.00

INTELLIS ADAPTIVESTIM 97715

Facility

$45,900.00

Service Code	HCPCS C1820
Hospital Revenue Code	278
Min. Negotiated Rate	$25,704.00
Max. Negotiated Rate	$44,523.00
Rate for Payer: Cash Price	$27,540.00
Rate for Payer: Hawaii Western Management Group Commercial	$32,130.00
Rate for Payer: Health Management Network Commercial	$39,015.00
Rate for Payer: Kaiser Permanente Commercial	$41,310.00
Rate for Payer: MDX Hawaii PPO	$44,523.00
Rate for Payer: University Health Alliance Commercial	$25,704.00

INTERCEED BARRIER 3X4IN

Facility

$1,741.00

Hospital Revenue Code	272
Min. Negotiated Rate	$539.71
Max. Negotiated Rate	$1,688.77
Rate for Payer: AlohaCare Medicaid	$870.50
Rate for Payer: AlohaCare Medicare	$539.71
Rate for Payer: Cash Price	$1,044.60
Rate for Payer: Devoted Health Medicare	$591.94
Rate for Payer: Hawaii Medical Service Association Medicare	$539.71
Rate for Payer: Hawaii Western Management Group Commercial	$1,653.95
Rate for Payer: Health Management Network Commercial	$1,479.85
Rate for Payer: Humana Medicare	$539.71
Rate for Payer: Kaiser Permanente Commercial	$1,566.90
Rate for Payer: Kaiser Permanente Medicaid	$887.91
Rate for Payer: Kaiser Permanente Medicare	$539.71
Rate for Payer: MDX Hawaii PPO	$1,688.77
Rate for Payer: Ohana Health Plan Medicaid	$539.71
Rate for Payer: Ohana Health Plan Medicare	$539.71
Rate for Payer: UnitedHealthcare Medicare	$539.71
Rate for Payer: University Health Alliance Commercial	$1,269.01

INTERCEED BARRIER 3X4IN

Facility

$1,741.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,479.85
Max. Negotiated Rate	$1,688.77
Rate for Payer: Cash Price	$1,044.60
Rate for Payer: Health Management Network Commercial	$1,479.85
Rate for Payer: Kaiser Permanente Commercial	$1,566.90
Rate for Payer: MDX Hawaii PPO	$1,688.77

INTERGARD KNITTED IGK0022-40

Facility

$1,953.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,093.68
Max. Negotiated Rate	$1,894.41
Rate for Payer: Cash Price	$1,171.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,367.10
Rate for Payer: Health Management Network Commercial	$1,660.05
Rate for Payer: Kaiser Permanente Commercial	$1,757.70
Rate for Payer: MDX Hawaii PPO	$1,894.41
Rate for Payer: University Health Alliance Commercial	$1,093.68

INTERGARD KNITTED IGK0022-40

Facility

$1,953.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$605.43
Max. Negotiated Rate	$1,894.41
Rate for Payer: AlohaCare Medicaid	$976.50
Rate for Payer: AlohaCare Medicare	$605.43
Rate for Payer: Cash Price	$1,171.80
Rate for Payer: Devoted Health Medicare	$664.02
Rate for Payer: Hawaii Medical Service Association Medicare	$605.43
Rate for Payer: Hawaii Western Management Group Commercial	$1,367.10
Rate for Payer: Health Management Network Commercial	$1,660.05
Rate for Payer: Humana Medicare	$605.43
Rate for Payer: Kaiser Permanente Commercial	$1,757.70
Rate for Payer: Kaiser Permanente Medicaid	$996.03
Rate for Payer: Kaiser Permanente Medicare	$605.43
Rate for Payer: MDX Hawaii PPO	$1,894.41
Rate for Payer: Ohana Health Plan Medicaid	$605.43
Rate for Payer: Ohana Health Plan Medicare	$605.43
Rate for Payer: UnitedHealthcare Medicare	$605.43
Rate for Payer: University Health Alliance Commercial	$1,093.68

INTERGARD KNITTED IGK2211

Facility

$1,570.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$879.20
Max. Negotiated Rate	$1,522.90
Rate for Payer: Cash Price	$942.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,099.00
Rate for Payer: Health Management Network Commercial	$1,334.50
Rate for Payer: Kaiser Permanente Commercial	$1,413.00
Rate for Payer: MDX Hawaii PPO	$1,522.90
Rate for Payer: University Health Alliance Commercial	$879.20

INTERGARD KNITTED IGK2211

Facility

$1,570.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$486.70
Max. Negotiated Rate	$1,522.90
Rate for Payer: AlohaCare Medicaid	$785.00
Rate for Payer: AlohaCare Medicare	$486.70
Rate for Payer: Cash Price	$942.00
Rate for Payer: Devoted Health Medicare	$533.80
Rate for Payer: Hawaii Medical Service Association Medicare	$486.70
Rate for Payer: Hawaii Western Management Group Commercial	$1,099.00
Rate for Payer: Health Management Network Commercial	$1,334.50
Rate for Payer: Humana Medicare	$486.70
Rate for Payer: Kaiser Permanente Commercial	$1,413.00
Rate for Payer: Kaiser Permanente Medicaid	$800.70
Rate for Payer: Kaiser Permanente Medicare	$486.70
Rate for Payer: MDX Hawaii PPO	$1,522.90
Rate for Payer: Ohana Health Plan Medicaid	$486.70
Rate for Payer: Ohana Health Plan Medicare	$486.70
Rate for Payer: UnitedHealthcare Medicare	$486.70
Rate for Payer: University Health Alliance Commercial	$879.20

INTERGARD KNITTED, IGK2412

Facility

$2,886.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,616.16
Max. Negotiated Rate	$2,799.42
Rate for Payer: Cash Price	$1,731.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,020.20
Rate for Payer: Health Management Network Commercial	$2,453.10
Rate for Payer: Kaiser Permanente Commercial	$2,597.40
Rate for Payer: MDX Hawaii PPO	$2,799.42
Rate for Payer: University Health Alliance Commercial	$1,616.16

INTERGARD KNITTED, IGK2412

Facility

$2,886.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$894.66
Max. Negotiated Rate	$2,799.42
Rate for Payer: AlohaCare Medicaid	$1,443.00
Rate for Payer: AlohaCare Medicare	$894.66
Rate for Payer: Cash Price	$1,731.60
Rate for Payer: Devoted Health Medicare	$981.24
Rate for Payer: Hawaii Medical Service Association Medicare	$894.66
Rate for Payer: Hawaii Western Management Group Commercial	$2,020.20
Rate for Payer: Health Management Network Commercial	$2,453.10
Rate for Payer: Humana Medicare	$894.66
Rate for Payer: Kaiser Permanente Commercial	$2,597.40
Rate for Payer: Kaiser Permanente Medicaid	$1,471.86
Rate for Payer: Kaiser Permanente Medicare	$894.66
Rate for Payer: MDX Hawaii PPO	$2,799.42
Rate for Payer: Ohana Health Plan Medicaid	$894.66
Rate for Payer: Ohana Health Plan Medicare	$894.66
Rate for Payer: UnitedHealthcare Medicare	$894.66
Rate for Payer: University Health Alliance Commercial	$1,616.16

INTERGUARD KNITTED IGK0020-40

Facility

$1,497.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$464.07
Max. Negotiated Rate	$1,452.09
Rate for Payer: AlohaCare Medicaid	$748.50
Rate for Payer: AlohaCare Medicare	$464.07
Rate for Payer: Cash Price	$898.20
Rate for Payer: Devoted Health Medicare	$508.98
Rate for Payer: Hawaii Medical Service Association Medicare	$464.07
Rate for Payer: Hawaii Western Management Group Commercial	$1,047.90
Rate for Payer: Health Management Network Commercial	$1,272.45
Rate for Payer: Humana Medicare	$464.07
Rate for Payer: Kaiser Permanente Commercial	$1,347.30
Rate for Payer: Kaiser Permanente Medicaid	$763.47
Rate for Payer: Kaiser Permanente Medicare	$464.07
Rate for Payer: MDX Hawaii PPO	$1,452.09
Rate for Payer: Ohana Health Plan Medicaid	$464.07
Rate for Payer: Ohana Health Plan Medicare	$464.07
Rate for Payer: UnitedHealthcare Medicare	$464.07
Rate for Payer: University Health Alliance Commercial	$838.32

INTERGUARD KNITTED IGK0020-40

Facility

$1,497.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$838.32
Max. Negotiated Rate	$1,452.09
Rate for Payer: Cash Price	$898.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,047.90
Rate for Payer: Health Management Network Commercial	$1,272.45
Rate for Payer: Kaiser Permanente Commercial	$1,347.30
Rate for Payer: MDX Hawaii PPO	$1,452.09
Rate for Payer: University Health Alliance Commercial	$838.32

INTERNALBRACE KIT AR-1688-CP

Facility

$2,150.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,204.00
Max. Negotiated Rate	$2,085.50
Rate for Payer: Cash Price	$1,290.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,505.00
Rate for Payer: Health Management Network Commercial	$1,827.50
Rate for Payer: Kaiser Permanente Commercial	$1,935.00
Rate for Payer: MDX Hawaii PPO	$2,085.50
Rate for Payer: University Health Alliance Commercial	$1,204.00

INTERNALBRACE KIT AR-1688-CP

Facility

$2,150.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$666.50
Max. Negotiated Rate	$2,085.50
Rate for Payer: AlohaCare Medicaid	$1,075.00
Rate for Payer: AlohaCare Medicare	$666.50
Rate for Payer: Cash Price	$1,290.00
Rate for Payer: Devoted Health Medicare	$731.00
Rate for Payer: Hawaii Medical Service Association Medicare	$666.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,505.00
Rate for Payer: Health Management Network Commercial	$1,827.50
Rate for Payer: Humana Medicare	$666.50
Rate for Payer: Kaiser Permanente Commercial	$1,935.00
Rate for Payer: Kaiser Permanente Medicaid	$1,096.50
Rate for Payer: Kaiser Permanente Medicare	$666.50
Rate for Payer: MDX Hawaii PPO	$2,085.50
Rate for Payer: Ohana Health Plan Medicaid	$666.50
Rate for Payer: Ohana Health Plan Medicare	$666.50
Rate for Payer: UnitedHealthcare Medicare	$666.50
Rate for Payer: University Health Alliance Commercial	$1,204.00

INTERSTITIAL LUNG DISEASE WITH CC

Facility

$34,391.60

Service Code	MSDRG 197
Min. Negotiated Rate	$34,391.60
Max. Negotiated Rate	$34,391.60
Rate for Payer: Hawaii Medical Service Association Commercial	$34,391.60

INTERSTITIAL LUNG DISEASE WITH MCC

Facility

$34,391.60

Service Code	MSDRG 196
Min. Negotiated Rate	$34,391.60
Max. Negotiated Rate	$34,391.60
Rate for Payer: Hawaii Medical Service Association Commercial	$34,391.60

INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC

Facility

$34,391.60

Service Code	MSDRG 198
Min. Negotiated Rate	$34,391.60
Max. Negotiated Rate	$34,391.60
Rate for Payer: Hawaii Medical Service Association Commercial	$34,391.60

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS

Facility

$34,415.30

Service Code	MSDRG 065
Min. Negotiated Rate	$34,415.30
Max. Negotiated Rate	$34,415.30
Rate for Payer: Hawaii Medical Service Association Commercial	$34,415.30

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC

Facility

$34,415.30

Service Code	MSDRG 064
Min. Negotiated Rate	$34,415.30
Max. Negotiated Rate	$34,415.30
Rate for Payer: Hawaii Medical Service Association Commercial	$34,415.30

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC

Facility

$34,415.30

Service Code	MSDRG 066
Min. Negotiated Rate	$34,415.30
Max. Negotiated Rate	$34,415.30
Rate for Payer: Hawaii Medical Service Association Commercial	$34,415.30

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC

Facility

$245,292.00

Service Code	MSDRG 021
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$245,292.00
Rate for Payer: Hawaii Medical Service Association Commercial	$245,292.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC

Facility

$245,292.00

Service Code	MSDRG 020
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$245,292.00
Rate for Payer: Hawaii Medical Service Association Commercial	$245,292.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC

Facility

$245,292.00

Service Code	MSDRG 022
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$245,292.00
Rate for Payer: Hawaii Medical Service Association Commercial	$245,292.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRAOCULAR PROCEDURES WITH CC/MCC

Facility

$18,511.26

Service Code	MSDRG 116
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$18,511.26
Rate for Payer: Hawaii Medical Service Association Commercial	$18,511.26
Rate for Payer: University Health Alliance Commercial	$10,400.00

Know your out-of-pocket cost for care.

All Charges