Kau Hospital

All Charges

Charge

Type

Setting

Price

INTRAOCULAR PROCEDURES WITHOUT CC/MCC

Facility

$18,345.35

Service Code	MSDRG 117
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$18,345.35
Rate for Payer: Hawaii Medical Service Association Commercial	$18,345.35
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRAUTERINE PRESSURE CATHETER

Facility

$232.00

Hospital Revenue Code	272
Min. Negotiated Rate	$71.92
Max. Negotiated Rate	$225.04
Rate for Payer: AlohaCare Medicaid	$116.00
Rate for Payer: AlohaCare Medicare	$71.92
Rate for Payer: Cash Price	$139.20
Rate for Payer: Devoted Health Medicare	$78.88
Rate for Payer: Hawaii Medical Service Association Medicare	$71.92
Rate for Payer: Hawaii Western Management Group Commercial	$220.40
Rate for Payer: Health Management Network Commercial	$197.20
Rate for Payer: Humana Medicare	$71.92
Rate for Payer: Kaiser Permanente Commercial	$208.80
Rate for Payer: Kaiser Permanente Medicaid	$118.32
Rate for Payer: Kaiser Permanente Medicare	$71.92
Rate for Payer: MDX Hawaii PPO	$225.04
Rate for Payer: Ohana Health Plan Medicaid	$71.92
Rate for Payer: Ohana Health Plan Medicare	$71.92
Rate for Payer: UnitedHealthcare Medicare	$71.92
Rate for Payer: University Health Alliance Commercial	$169.10

INTRAUTERINE PRESSURE CATHETER

Facility

$232.00

Hospital Revenue Code	272
Min. Negotiated Rate	$197.20
Max. Negotiated Rate	$225.04
Rate for Payer: Cash Price	$139.20
Rate for Payer: Health Management Network Commercial	$197.20
Rate for Payer: Kaiser Permanente Commercial	$208.80
Rate for Payer: MDX Hawaii PPO	$225.04

INTRO 10FR SAFESHEATH

Facility

$260.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$252.20
Rate for Payer: Cash Price	$156.00
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: Kaiser Permanente Commercial	$234.00
Rate for Payer: MDX Hawaii PPO	$252.20

INTRO 10FR SAFESHEATH

Facility

$260.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$80.60
Max. Negotiated Rate	$252.20
Rate for Payer: AlohaCare Medicaid	$130.00
Rate for Payer: AlohaCare Medicare	$80.60
Rate for Payer: Cash Price	$156.00
Rate for Payer: Devoted Health Medicare	$88.40
Rate for Payer: Hawaii Medical Service Association Medicare	$80.60
Rate for Payer: Hawaii Western Management Group Commercial	$247.00
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: Humana Medicare	$80.60
Rate for Payer: Kaiser Permanente Commercial	$234.00
Rate for Payer: Kaiser Permanente Medicaid	$132.60
Rate for Payer: Kaiser Permanente Medicare	$80.60
Rate for Payer: MDX Hawaii PPO	$252.20
Rate for Payer: Ohana Health Plan Medicaid	$80.60
Rate for Payer: Ohana Health Plan Medicare	$80.60
Rate for Payer: UnitedHealthcare Medicare	$80.60
Rate for Payer: University Health Alliance Commercial	$189.51

INTRO 9FR SAFESHEATH

Facility

$260.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$80.60
Max. Negotiated Rate	$252.20
Rate for Payer: AlohaCare Medicaid	$130.00
Rate for Payer: AlohaCare Medicare	$80.60
Rate for Payer: Cash Price	$156.00
Rate for Payer: Devoted Health Medicare	$88.40
Rate for Payer: Hawaii Medical Service Association Medicare	$80.60
Rate for Payer: Hawaii Western Management Group Commercial	$247.00
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: Humana Medicare	$80.60
Rate for Payer: Kaiser Permanente Commercial	$234.00
Rate for Payer: Kaiser Permanente Medicaid	$132.60
Rate for Payer: Kaiser Permanente Medicare	$80.60
Rate for Payer: MDX Hawaii PPO	$252.20
Rate for Payer: Ohana Health Plan Medicaid	$80.60
Rate for Payer: Ohana Health Plan Medicare	$80.60
Rate for Payer: UnitedHealthcare Medicare	$80.60
Rate for Payer: University Health Alliance Commercial	$189.51

INTRO 9FR SAFESHEATH

Facility

$260.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$252.20
Rate for Payer: Cash Price	$156.00
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: Kaiser Permanente Commercial	$234.00
Rate for Payer: MDX Hawaii PPO	$252.20

INTROD 4FR MICRO SET STIFF

Facility

$259.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$80.29
Max. Negotiated Rate	$251.23
Rate for Payer: AlohaCare Medicaid	$129.50
Rate for Payer: AlohaCare Medicare	$80.29
Rate for Payer: Cash Price	$155.40
Rate for Payer: Devoted Health Medicare	$88.06
Rate for Payer: Hawaii Medical Service Association Medicare	$80.29
Rate for Payer: Hawaii Western Management Group Commercial	$246.05
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Humana Medicare	$80.29
Rate for Payer: Kaiser Permanente Commercial	$233.10
Rate for Payer: Kaiser Permanente Medicaid	$132.09
Rate for Payer: Kaiser Permanente Medicare	$80.29
Rate for Payer: MDX Hawaii PPO	$251.23
Rate for Payer: Ohana Health Plan Medicaid	$80.29
Rate for Payer: Ohana Health Plan Medicare	$80.29
Rate for Payer: UnitedHealthcare Medicare	$80.29
Rate for Payer: University Health Alliance Commercial	$188.79

INTROD 4FR MICRO SET STIFF

Facility

$259.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$220.15
Max. Negotiated Rate	$251.23
Rate for Payer: Cash Price	$155.40
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Kaiser Permanente Commercial	$233.10
Rate for Payer: MDX Hawaii PPO	$251.23

INTROD 6FX45CM FLEXOR CHECKFLO

Facility

$310.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$96.10
Max. Negotiated Rate	$300.70
Rate for Payer: AlohaCare Medicaid	$155.00
Rate for Payer: AlohaCare Medicare	$96.10
Rate for Payer: Cash Price	$186.00
Rate for Payer: Devoted Health Medicare	$105.40
Rate for Payer: Hawaii Medical Service Association Medicare	$96.10
Rate for Payer: Hawaii Western Management Group Commercial	$294.50
Rate for Payer: Health Management Network Commercial	$263.50
Rate for Payer: Humana Medicare	$96.10
Rate for Payer: Kaiser Permanente Commercial	$279.00
Rate for Payer: Kaiser Permanente Medicaid	$158.10
Rate for Payer: Kaiser Permanente Medicare	$96.10
Rate for Payer: MDX Hawaii PPO	$300.70
Rate for Payer: Ohana Health Plan Medicaid	$96.10
Rate for Payer: Ohana Health Plan Medicare	$96.10
Rate for Payer: UnitedHealthcare Medicare	$96.10
Rate for Payer: University Health Alliance Commercial	$225.96

INTROD 6FX45CM FLEXOR CHECKFLO

Facility

$310.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$263.50
Max. Negotiated Rate	$300.70
Rate for Payer: Cash Price	$186.00
Rate for Payer: Health Management Network Commercial	$263.50
Rate for Payer: Kaiser Permanente Commercial	$279.00
Rate for Payer: MDX Hawaii PPO	$300.70

INTROD PERCUTANEOUS TRACH

Facility

$1,712.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$1,455.20
Max. Negotiated Rate	$1,660.64
Rate for Payer: Cash Price	$1,027.20
Rate for Payer: Health Management Network Commercial	$1,455.20
Rate for Payer: Kaiser Permanente Commercial	$1,540.80
Rate for Payer: MDX Hawaii PPO	$1,660.64

INTROD PERCUTANEOUS TRACH

Facility

$1,712.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$530.72
Max. Negotiated Rate	$1,660.64
Rate for Payer: AlohaCare Medicaid	$856.00
Rate for Payer: AlohaCare Medicare	$530.72
Rate for Payer: Cash Price	$1,027.20
Rate for Payer: Devoted Health Medicare	$582.08
Rate for Payer: Hawaii Medical Service Association Medicare	$530.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,626.40
Rate for Payer: Health Management Network Commercial	$1,455.20
Rate for Payer: Humana Medicare	$530.72
Rate for Payer: Kaiser Permanente Commercial	$1,540.80
Rate for Payer: Kaiser Permanente Medicaid	$873.12
Rate for Payer: Kaiser Permanente Medicare	$530.72
Rate for Payer: MDX Hawaii PPO	$1,660.64
Rate for Payer: Ohana Health Plan Medicaid	$530.72
Rate for Payer: Ohana Health Plan Medicare	$530.72
Rate for Payer: UnitedHealthcare Medicare	$530.72
Rate for Payer: University Health Alliance Commercial	$1,247.88

INTROD STENT INTRO SYSTEM

Facility

$332.00

Hospital Revenue Code	272
Min. Negotiated Rate	$102.92
Max. Negotiated Rate	$322.04
Rate for Payer: AlohaCare Medicaid	$166.00
Rate for Payer: AlohaCare Medicare	$102.92
Rate for Payer: Cash Price	$199.20
Rate for Payer: Devoted Health Medicare	$112.88
Rate for Payer: Hawaii Medical Service Association Medicare	$102.92
Rate for Payer: Hawaii Western Management Group Commercial	$315.40
Rate for Payer: Health Management Network Commercial	$282.20
Rate for Payer: Humana Medicare	$102.92
Rate for Payer: Kaiser Permanente Commercial	$298.80
Rate for Payer: Kaiser Permanente Medicaid	$169.32
Rate for Payer: Kaiser Permanente Medicare	$102.92
Rate for Payer: MDX Hawaii PPO	$322.04
Rate for Payer: Ohana Health Plan Medicaid	$102.92
Rate for Payer: Ohana Health Plan Medicare	$102.92
Rate for Payer: UnitedHealthcare Medicare	$102.92
Rate for Payer: University Health Alliance Commercial	$241.99

INTROD STENT INTRO SYSTEM

Facility

$332.00

Hospital Revenue Code	272
Min. Negotiated Rate	$282.20
Max. Negotiated Rate	$322.04
Rate for Payer: Cash Price	$199.20
Rate for Payer: Health Management Network Commercial	$282.20
Rate for Payer: Kaiser Permanente Commercial	$298.80
Rate for Payer: MDX Hawaii PPO	$322.04

INTRODUCER 12FRX30 PERFORMER

Facility

$240.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$74.40
Max. Negotiated Rate	$232.80
Rate for Payer: AlohaCare Medicaid	$120.00
Rate for Payer: AlohaCare Medicare	$74.40
Rate for Payer: Cash Price	$144.00
Rate for Payer: Devoted Health Medicare	$81.60
Rate for Payer: Hawaii Medical Service Association Medicare	$74.40
Rate for Payer: Hawaii Western Management Group Commercial	$228.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Humana Medicare	$74.40
Rate for Payer: Kaiser Permanente Commercial	$216.00
Rate for Payer: Kaiser Permanente Medicaid	$122.40
Rate for Payer: Kaiser Permanente Medicare	$74.40
Rate for Payer: MDX Hawaii PPO	$232.80
Rate for Payer: Ohana Health Plan Medicaid	$74.40
Rate for Payer: Ohana Health Plan Medicare	$74.40
Rate for Payer: UnitedHealthcare Medicare	$74.40
Rate for Payer: University Health Alliance Commercial	$174.94

INTRODUCER 12FRX30 PERFORMER

Facility

$240.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$232.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Kaiser Permanente Commercial	$216.00
Rate for Payer: MDX Hawaii PPO	$232.80

INTRODUCER 6X10 PINNACLE

Facility

$140.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$43.40
Max. Negotiated Rate	$135.80
Rate for Payer: AlohaCare Medicaid	$70.00
Rate for Payer: AlohaCare Medicare	$43.40
Rate for Payer: Cash Price	$84.00
Rate for Payer: Devoted Health Medicare	$47.60
Rate for Payer: Hawaii Medical Service Association Medicare	$43.40
Rate for Payer: Hawaii Western Management Group Commercial	$133.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Humana Medicare	$43.40
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: Kaiser Permanente Medicaid	$71.40
Rate for Payer: Kaiser Permanente Medicare	$43.40
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: Ohana Health Plan Medicaid	$43.40
Rate for Payer: Ohana Health Plan Medicare	$43.40
Rate for Payer: UnitedHealthcare Medicare	$43.40
Rate for Payer: University Health Alliance Commercial	$102.05

INTRODUCER 6X10 PINNACLE

Facility

$140.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: MDX Hawaii PPO	$135.80

INTRODUCER KIT 5FR MICRO

Facility

$125.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$38.75
Max. Negotiated Rate	$121.25
Rate for Payer: AlohaCare Medicaid	$62.50
Rate for Payer: AlohaCare Medicare	$38.75
Rate for Payer: Cash Price	$75.00
Rate for Payer: Devoted Health Medicare	$42.50
Rate for Payer: Hawaii Medical Service Association Medicare	$38.75
Rate for Payer: Hawaii Western Management Group Commercial	$118.75
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Humana Medicare	$38.75
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: Kaiser Permanente Medicare	$38.75
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: Ohana Health Plan Medicaid	$38.75
Rate for Payer: Ohana Health Plan Medicare	$38.75
Rate for Payer: UnitedHealthcare Medicare	$38.75
Rate for Payer: University Health Alliance Commercial	$91.11

INTRODUCER KIT 5FR MICRO

Facility

$125.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$75.00
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: MDX Hawaii PPO	$121.25

INTRODUCER KIT SR-4F21G7D-MP

Facility

$713.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$606.05
Max. Negotiated Rate	$691.61
Rate for Payer: Cash Price	$427.80
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: Kaiser Permanente Commercial	$641.70
Rate for Payer: MDX Hawaii PPO	$691.61

INTRODUCER KIT SR-4F21G7D-MP

Facility

$713.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$221.03
Max. Negotiated Rate	$691.61
Rate for Payer: AlohaCare Medicaid	$356.50
Rate for Payer: AlohaCare Medicare	$221.03
Rate for Payer: Cash Price	$427.80
Rate for Payer: Devoted Health Medicare	$242.42
Rate for Payer: Hawaii Medical Service Association Medicare	$221.03
Rate for Payer: Hawaii Western Management Group Commercial	$677.35
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: Humana Medicare	$221.03
Rate for Payer: Kaiser Permanente Commercial	$641.70
Rate for Payer: Kaiser Permanente Medicaid	$363.63
Rate for Payer: Kaiser Permanente Medicare	$221.03
Rate for Payer: MDX Hawaii PPO	$691.61
Rate for Payer: Ohana Health Plan Medicaid	$221.03
Rate for Payer: Ohana Health Plan Medicare	$221.03
Rate for Payer: UnitedHealthcare Medicare	$221.03
Rate for Payer: University Health Alliance Commercial	$519.71

INTRODUCER SHEATH DSF1033

Facility

$2,322.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$719.82
Max. Negotiated Rate	$2,252.34
Rate for Payer: AlohaCare Medicaid	$1,161.00
Rate for Payer: AlohaCare Medicare	$719.82
Rate for Payer: Cash Price	$1,393.20
Rate for Payer: Devoted Health Medicare	$789.48
Rate for Payer: Hawaii Medical Service Association Medicare	$719.82
Rate for Payer: Hawaii Western Management Group Commercial	$2,205.90
Rate for Payer: Health Management Network Commercial	$1,973.70
Rate for Payer: Humana Medicare	$719.82
Rate for Payer: Kaiser Permanente Commercial	$2,089.80
Rate for Payer: Kaiser Permanente Medicaid	$1,184.22
Rate for Payer: Kaiser Permanente Medicare	$719.82
Rate for Payer: MDX Hawaii PPO	$2,252.34
Rate for Payer: Ohana Health Plan Medicaid	$719.82
Rate for Payer: Ohana Health Plan Medicare	$719.82
Rate for Payer: UnitedHealthcare Medicare	$719.82
Rate for Payer: University Health Alliance Commercial	$1,692.51

INTRODUCER SHEATH DSF1033

Facility

$2,322.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$1,973.70
Max. Negotiated Rate	$2,252.34
Rate for Payer: Cash Price	$1,393.20
Rate for Payer: Health Management Network Commercial	$1,973.70
Rate for Payer: Kaiser Permanente Commercial	$2,089.80
Rate for Payer: MDX Hawaii PPO	$2,252.34

Know your out-of-pocket cost for care.

All Charges