Kau Hospital

All Charges

Charge

Type

Setting

Price

KIT LEAD SURESCAN MRUI 978B128

Facility

$9,563.00

Service Code	HCPCS C1788
Hospital Revenue Code	278
Min. Negotiated Rate	$5,355.28
Max. Negotiated Rate	$9,276.11
Rate for Payer: Cash Price	$5,737.80
Rate for Payer: Hawaii Western Management Group Commercial	$6,694.10
Rate for Payer: Health Management Network Commercial	$8,128.55
Rate for Payer: Kaiser Permanente Commercial	$8,606.70
Rate for Payer: MDX Hawaii PPO	$9,276.11
Rate for Payer: University Health Alliance Commercial	$5,355.28

KIT LEAD SURESCAN MRUI 978B128

Facility

$9,563.00

Service Code	HCPCS C1788
Hospital Revenue Code	278
Min. Negotiated Rate	$2,964.53
Max. Negotiated Rate	$9,276.11
Rate for Payer: AlohaCare Medicaid	$4,781.50
Rate for Payer: AlohaCare Medicare	$2,964.53
Rate for Payer: Cash Price	$5,737.80
Rate for Payer: Devoted Health Medicare	$3,251.42
Rate for Payer: Hawaii Medical Service Association Medicare	$2,964.53
Rate for Payer: Hawaii Western Management Group Commercial	$6,694.10
Rate for Payer: Health Management Network Commercial	$8,128.55
Rate for Payer: Humana Medicare	$2,964.53
Rate for Payer: Kaiser Permanente Commercial	$8,606.70
Rate for Payer: Kaiser Permanente Medicaid	$4,877.13
Rate for Payer: Kaiser Permanente Medicare	$2,964.53
Rate for Payer: MDX Hawaii PPO	$9,276.11
Rate for Payer: Ohana Health Plan Medicaid	$2,964.53
Rate for Payer: Ohana Health Plan Medicare	$2,964.53
Rate for Payer: UnitedHealthcare Medicare	$2,964.53
Rate for Payer: University Health Alliance Commercial	$5,355.28

KIT LEEP REDIKIT

Facility

$202.00

Hospital Revenue Code	272
Min. Negotiated Rate	$171.70
Max. Negotiated Rate	$195.94
Rate for Payer: Cash Price	$121.20
Rate for Payer: Health Management Network Commercial	$171.70
Rate for Payer: Kaiser Permanente Commercial	$181.80
Rate for Payer: MDX Hawaii PPO	$195.94

KIT LEEP REDIKIT

Facility

$202.00

Hospital Revenue Code	272
Min. Negotiated Rate	$62.62
Max. Negotiated Rate	$195.94
Rate for Payer: AlohaCare Medicaid	$101.00
Rate for Payer: AlohaCare Medicare	$62.62
Rate for Payer: Cash Price	$121.20
Rate for Payer: Devoted Health Medicare	$68.68
Rate for Payer: Hawaii Medical Service Association Medicare	$62.62
Rate for Payer: Hawaii Western Management Group Commercial	$191.90
Rate for Payer: Health Management Network Commercial	$171.70
Rate for Payer: Humana Medicare	$62.62
Rate for Payer: Kaiser Permanente Commercial	$181.80
Rate for Payer: Kaiser Permanente Medicaid	$103.02
Rate for Payer: Kaiser Permanente Medicare	$62.62
Rate for Payer: MDX Hawaii PPO	$195.94
Rate for Payer: Ohana Health Plan Medicaid	$62.62
Rate for Payer: Ohana Health Plan Medicare	$62.62
Rate for Payer: UnitedHealthcare Medicare	$62.62
Rate for Payer: University Health Alliance Commercial	$147.24

KIT MISCARRIAGE MANAGE #UEK

Facility

$392.00

Hospital Revenue Code	272
Min. Negotiated Rate	$121.52
Max. Negotiated Rate	$380.24
Rate for Payer: AlohaCare Medicaid	$196.00
Rate for Payer: AlohaCare Medicare	$121.52
Rate for Payer: Cash Price	$235.20
Rate for Payer: Devoted Health Medicare	$133.28
Rate for Payer: Hawaii Medical Service Association Medicare	$121.52
Rate for Payer: Hawaii Western Management Group Commercial	$372.40
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Humana Medicare	$121.52
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: Kaiser Permanente Medicaid	$199.92
Rate for Payer: Kaiser Permanente Medicare	$121.52
Rate for Payer: MDX Hawaii PPO	$380.24
Rate for Payer: Ohana Health Plan Medicaid	$121.52
Rate for Payer: Ohana Health Plan Medicare	$121.52
Rate for Payer: UnitedHealthcare Medicare	$121.52
Rate for Payer: University Health Alliance Commercial	$285.73

KIT MISCARRIAGE MANAGE #UEK

Facility

$392.00

Hospital Revenue Code	272
Min. Negotiated Rate	$333.20
Max. Negotiated Rate	$380.24
Rate for Payer: Cash Price	$235.20
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: MDX Hawaii PPO	$380.24

KIT NEPHROSTOMY BALLOON

Facility

$913.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$776.05
Max. Negotiated Rate	$885.61
Rate for Payer: Cash Price	$547.80
Rate for Payer: Health Management Network Commercial	$776.05
Rate for Payer: Kaiser Permanente Commercial	$821.70
Rate for Payer: MDX Hawaii PPO	$885.61

KIT NEPHROSTOMY BALLOON

Facility

$913.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$283.03
Max. Negotiated Rate	$885.61
Rate for Payer: AlohaCare Medicaid	$456.50
Rate for Payer: AlohaCare Medicare	$283.03
Rate for Payer: Cash Price	$547.80
Rate for Payer: Devoted Health Medicare	$310.42
Rate for Payer: Hawaii Medical Service Association Medicare	$283.03
Rate for Payer: Hawaii Western Management Group Commercial	$867.35
Rate for Payer: Health Management Network Commercial	$776.05
Rate for Payer: Humana Medicare	$283.03
Rate for Payer: Kaiser Permanente Commercial	$821.70
Rate for Payer: Kaiser Permanente Medicaid	$465.63
Rate for Payer: Kaiser Permanente Medicare	$283.03
Rate for Payer: MDX Hawaii PPO	$885.61
Rate for Payer: Ohana Health Plan Medicaid	$283.03
Rate for Payer: Ohana Health Plan Medicare	$283.03
Rate for Payer: UnitedHealthcare Medicare	$283.03
Rate for Payer: University Health Alliance Commercial	$665.49

KIT PERC ACCESS

Facility

$507.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$157.17
Max. Negotiated Rate	$491.79
Rate for Payer: AlohaCare Medicaid	$253.50
Rate for Payer: AlohaCare Medicare	$157.17
Rate for Payer: Cash Price	$304.20
Rate for Payer: Devoted Health Medicare	$172.38
Rate for Payer: Hawaii Medical Service Association Medicare	$157.17
Rate for Payer: Hawaii Western Management Group Commercial	$481.65
Rate for Payer: Health Management Network Commercial	$430.95
Rate for Payer: Humana Medicare	$157.17
Rate for Payer: Kaiser Permanente Commercial	$456.30
Rate for Payer: Kaiser Permanente Medicaid	$258.57
Rate for Payer: Kaiser Permanente Medicare	$157.17
Rate for Payer: MDX Hawaii PPO	$491.79
Rate for Payer: Ohana Health Plan Medicaid	$157.17
Rate for Payer: Ohana Health Plan Medicare	$157.17
Rate for Payer: UnitedHealthcare Medicare	$157.17
Rate for Payer: University Health Alliance Commercial	$369.55

KIT PERC ACCESS

Facility

$507.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$430.95
Max. Negotiated Rate	$491.79
Rate for Payer: Cash Price	$304.20
Rate for Payer: Health Management Network Commercial	$430.95
Rate for Payer: Kaiser Permanente Commercial	$456.30
Rate for Payer: MDX Hawaii PPO	$491.79

KIT PERCUTANEOUS INTRO SET

Facility

$249.00

Service Code	HCPCS C1892
Hospital Revenue Code	272
Min. Negotiated Rate	$77.19
Max. Negotiated Rate	$241.53
Rate for Payer: AlohaCare Medicaid	$124.50
Rate for Payer: AlohaCare Medicare	$77.19
Rate for Payer: Cash Price	$149.40
Rate for Payer: Devoted Health Medicare	$84.66
Rate for Payer: Hawaii Medical Service Association Medicare	$77.19
Rate for Payer: Hawaii Western Management Group Commercial	$236.55
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: Humana Medicare	$77.19
Rate for Payer: Kaiser Permanente Commercial	$224.10
Rate for Payer: Kaiser Permanente Medicaid	$126.99
Rate for Payer: Kaiser Permanente Medicare	$77.19
Rate for Payer: MDX Hawaii PPO	$241.53
Rate for Payer: Ohana Health Plan Medicaid	$77.19
Rate for Payer: Ohana Health Plan Medicare	$77.19
Rate for Payer: UnitedHealthcare Medicare	$77.19
Rate for Payer: University Health Alliance Commercial	$181.50

KIT PERCUTANEOUS INTRO SET

Facility

$249.00

Service Code	HCPCS C1892
Hospital Revenue Code	272
Min. Negotiated Rate	$211.65
Max. Negotiated Rate	$241.53
Rate for Payer: Cash Price	$149.40
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: Kaiser Permanente Commercial	$224.10
Rate for Payer: MDX Hawaii PPO	$241.53

KIT PERICARDIOCENTESIS

Facility

$530.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$164.30
Max. Negotiated Rate	$514.10
Rate for Payer: AlohaCare Medicaid	$265.00
Rate for Payer: AlohaCare Medicare	$164.30
Rate for Payer: Cash Price	$318.00
Rate for Payer: Devoted Health Medicare	$180.20
Rate for Payer: Hawaii Medical Service Association Medicare	$164.30
Rate for Payer: Hawaii Western Management Group Commercial	$503.50
Rate for Payer: Health Management Network Commercial	$450.50
Rate for Payer: Humana Medicare	$164.30
Rate for Payer: Kaiser Permanente Commercial	$477.00
Rate for Payer: Kaiser Permanente Medicaid	$270.30
Rate for Payer: Kaiser Permanente Medicare	$164.30
Rate for Payer: MDX Hawaii PPO	$514.10
Rate for Payer: Ohana Health Plan Medicaid	$164.30
Rate for Payer: Ohana Health Plan Medicare	$164.30
Rate for Payer: UnitedHealthcare Medicare	$164.30
Rate for Payer: University Health Alliance Commercial	$386.32

KIT PERICARDIOCENTESIS

Facility

$530.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$450.50
Max. Negotiated Rate	$514.10
Rate for Payer: Cash Price	$318.00
Rate for Payer: Health Management Network Commercial	$450.50
Rate for Payer: Kaiser Permanente Commercial	$477.00
Rate for Payer: MDX Hawaii PPO	$514.10

KIT PREPARATION OF TC 99M-SESTAMIBI COMBO NO.1 IV SOLUTION [134046]

Facility

$463.00

Service Code	HCPCS A9500
Hospital Revenue Code	343
Min. Negotiated Rate	$393.55
Max. Negotiated Rate	$449.11
Rate for Payer: Cash Price	$277.80
Rate for Payer: Health Management Network Commercial	$393.55
Rate for Payer: Kaiser Permanente Commercial	$416.70
Rate for Payer: MDX Hawaii PPO	$449.11

KIT PREPARATION OF TC 99M-SESTAMIBI COMBO NO.1 IV SOLUTION [134046]

Facility

$463.00

Service Code	HCPCS A9500
Hospital Revenue Code	343
Min. Negotiated Rate	$83.20
Max. Negotiated Rate	$449.11
Rate for Payer: AlohaCare Medicaid	$231.50
Rate for Payer: AlohaCare Medicare	$143.53
Rate for Payer: Cash Price	$277.80
Rate for Payer: Cash Price	$277.80
Rate for Payer: Devoted Health Medicare	$157.42
Rate for Payer: Hawaii Medical Service Association Medicare	$143.53
Rate for Payer: Hawaii Western Management Group Commercial	$439.85
Rate for Payer: Health Management Network Commercial	$393.55
Rate for Payer: Humana Medicare	$143.53
Rate for Payer: Kaiser Permanente Commercial	$416.70
Rate for Payer: Kaiser Permanente Medicaid	$236.13
Rate for Payer: Kaiser Permanente Medicare	$143.53
Rate for Payer: MDX Hawaii PPO	$449.11
Rate for Payer: Ohana Health Plan Medicaid	$143.53
Rate for Payer: Ohana Health Plan Medicare	$143.53
Rate for Payer: UnitedHealthcare Medicaid	$83.20
Rate for Payer: UnitedHealthcare Medicare	$143.53
Rate for Payer: University Health Alliance Commercial	$337.48

KIT PREPARATION OF TC-99M-SODIUM PYROPHOSPHATE 12 MG IV SOLUTION [134584]

Facility

$72.00

Service Code	HCPCS A9558
Hospital Revenue Code	343
Min. Negotiated Rate	$22.32
Max. Negotiated Rate	$69.84
Rate for Payer: AlohaCare Medicaid	$36.00
Rate for Payer: AlohaCare Medicare	$22.32
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Devoted Health Medicare	$24.48
Rate for Payer: Hawaii Medical Service Association Medicare	$22.32
Rate for Payer: Hawaii Western Management Group Commercial	$68.40
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Humana Medicare	$22.32
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$22.32
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$22.32
Rate for Payer: Ohana Health Plan Medicare	$22.32
Rate for Payer: UnitedHealthcare Medicaid	$40.00
Rate for Payer: UnitedHealthcare Medicare	$22.32
Rate for Payer: University Health Alliance Commercial	$52.48

KIT PREPARATION OF TC-99M-SODIUM PYROPHOSPHATE 12 MG IV SOLUTION [134584]

Facility

$72.00

Service Code	HCPCS A9558
Hospital Revenue Code	343
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: MDX Hawaii PPO	$69.84

KIT RADIAL HEAD 03.405.000S

Facility

$1,509.00

Hospital Revenue Code	272
Min. Negotiated Rate	$467.79
Max. Negotiated Rate	$1,463.73
Rate for Payer: AlohaCare Medicaid	$754.50
Rate for Payer: AlohaCare Medicare	$467.79
Rate for Payer: Cash Price	$905.40
Rate for Payer: Devoted Health Medicare	$513.06
Rate for Payer: Hawaii Medical Service Association Medicare	$467.79
Rate for Payer: Hawaii Western Management Group Commercial	$1,433.55
Rate for Payer: Health Management Network Commercial	$1,282.65
Rate for Payer: Humana Medicare	$467.79
Rate for Payer: Kaiser Permanente Commercial	$1,358.10
Rate for Payer: Kaiser Permanente Medicaid	$769.59
Rate for Payer: Kaiser Permanente Medicare	$467.79
Rate for Payer: MDX Hawaii PPO	$1,463.73
Rate for Payer: Ohana Health Plan Medicaid	$467.79
Rate for Payer: Ohana Health Plan Medicare	$467.79
Rate for Payer: UnitedHealthcare Medicare	$467.79
Rate for Payer: University Health Alliance Commercial	$1,099.91

KIT RADIAL HEAD 03.405.000S

Facility

$1,509.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,282.65
Max. Negotiated Rate	$1,463.73
Rate for Payer: Cash Price	$905.40
Rate for Payer: Health Management Network Commercial	$1,282.65
Rate for Payer: Kaiser Permanente Commercial	$1,358.10
Rate for Payer: MDX Hawaii PPO	$1,463.73

KIT REPAIR ACUTE AC AR-2271

Facility

$3,750.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$3,637.50
Rate for Payer: AlohaCare Medicaid	$1,875.00
Rate for Payer: AlohaCare Medicare	$1,162.50
Rate for Payer: Cash Price	$2,250.00
Rate for Payer: Devoted Health Medicare	$1,275.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,162.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,562.50
Rate for Payer: Health Management Network Commercial	$3,187.50
Rate for Payer: Humana Medicare	$1,162.50
Rate for Payer: Kaiser Permanente Commercial	$3,375.00
Rate for Payer: Kaiser Permanente Medicaid	$1,912.50
Rate for Payer: Kaiser Permanente Medicare	$1,162.50
Rate for Payer: MDX Hawaii PPO	$3,637.50
Rate for Payer: Ohana Health Plan Medicaid	$1,162.50
Rate for Payer: Ohana Health Plan Medicare	$1,162.50
Rate for Payer: UnitedHealthcare Medicare	$1,162.50
Rate for Payer: University Health Alliance Commercial	$2,733.38

KIT REPAIR ACUTE AC AR-2271

Facility

$3,750.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$3,187.50
Max. Negotiated Rate	$3,637.50
Rate for Payer: Cash Price	$2,250.00
Rate for Payer: Health Management Network Commercial	$3,187.50
Rate for Payer: Kaiser Permanente Commercial	$3,375.00
Rate for Payer: MDX Hawaii PPO	$3,637.50

KIT SMALL PARTS PHACO

Facility

$179.00

Hospital Revenue Code	272
Min. Negotiated Rate	$152.15
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$107.40
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63

KIT SMALL PARTS PHACO

Facility

$179.00

Hospital Revenue Code	272
Min. Negotiated Rate	$55.49
Max. Negotiated Rate	$173.63
Rate for Payer: AlohaCare Medicaid	$89.50
Rate for Payer: AlohaCare Medicare	$55.49
Rate for Payer: Cash Price	$107.40
Rate for Payer: Devoted Health Medicare	$60.86
Rate for Payer: Hawaii Medical Service Association Medicare	$55.49
Rate for Payer: Hawaii Western Management Group Commercial	$170.05
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Humana Medicare	$55.49
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: Kaiser Permanente Medicaid	$91.29
Rate for Payer: Kaiser Permanente Medicare	$55.49
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: Ohana Health Plan Medicaid	$55.49
Rate for Payer: Ohana Health Plan Medicare	$55.49
Rate for Payer: UnitedHealthcare Medicare	$55.49
Rate for Payer: University Health Alliance Commercial	$130.47

KIT TRANS-TIBIAL #AR-1898S

Facility

$780.00

Hospital Revenue Code	272
Min. Negotiated Rate	$663.00
Max. Negotiated Rate	$756.60
Rate for Payer: Cash Price	$468.00
Rate for Payer: Health Management Network Commercial	$663.00
Rate for Payer: Kaiser Permanente Commercial	$702.00
Rate for Payer: MDX Hawaii PPO	$756.60

Know your out-of-pocket cost for care.

All Charges