Kau Hospital

All Charges

Charge

Type

Setting

Price

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

KIT URETERAL 6FX70 FIBEROPTIC

Facility

$997.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$309.07
Max. Negotiated Rate	$967.09
Rate for Payer: AlohaCare Medicaid	$498.50
Rate for Payer: AlohaCare Medicare	$309.07
Rate for Payer: Cash Price	$598.20
Rate for Payer: Devoted Health Medicare	$338.98
Rate for Payer: Hawaii Medical Service Association Medicare	$309.07
Rate for Payer: Hawaii Western Management Group Commercial	$697.90
Rate for Payer: Health Management Network Commercial	$847.45
Rate for Payer: Humana Medicare	$309.07
Rate for Payer: Kaiser Permanente Commercial	$897.30
Rate for Payer: Kaiser Permanente Medicaid	$508.47
Rate for Payer: Kaiser Permanente Medicare	$309.07
Rate for Payer: MDX Hawaii PPO	$967.09
Rate for Payer: Ohana Health Plan Medicaid	$309.07
Rate for Payer: Ohana Health Plan Medicare	$309.07
Rate for Payer: UnitedHealthcare Medicare	$309.07
Rate for Payer: University Health Alliance Commercial	$558.32

KIT URETERAL 6FX70 FIBEROPTIC

Facility

$997.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$558.32
Max. Negotiated Rate	$967.09
Rate for Payer: Cash Price	$598.20
Rate for Payer: Hawaii Western Management Group Commercial	$697.90
Rate for Payer: Health Management Network Commercial	$847.45
Rate for Payer: Kaiser Permanente Commercial	$897.30
Rate for Payer: MDX Hawaii PPO	$967.09
Rate for Payer: University Health Alliance Commercial	$558.32

KL 1.8 FIBERTAK SHOULD AR-3636

Facility

$1,617.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$501.27
Max. Negotiated Rate	$1,568.49
Rate for Payer: AlohaCare Medicaid	$808.50
Rate for Payer: AlohaCare Medicare	$501.27
Rate for Payer: Cash Price	$970.20
Rate for Payer: Devoted Health Medicare	$549.78
Rate for Payer: Hawaii Medical Service Association Medicare	$501.27
Rate for Payer: Hawaii Western Management Group Commercial	$1,131.90
Rate for Payer: Health Management Network Commercial	$1,374.45
Rate for Payer: Humana Medicare	$501.27
Rate for Payer: Kaiser Permanente Commercial	$1,455.30
Rate for Payer: Kaiser Permanente Medicaid	$824.67
Rate for Payer: Kaiser Permanente Medicare	$501.27
Rate for Payer: MDX Hawaii PPO	$1,568.49
Rate for Payer: Ohana Health Plan Medicaid	$501.27
Rate for Payer: Ohana Health Plan Medicare	$501.27
Rate for Payer: UnitedHealthcare Medicare	$501.27
Rate for Payer: University Health Alliance Commercial	$905.52

KL 1.8 FIBERTAK SHOULD AR-3636

Facility

$1,617.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$905.52
Max. Negotiated Rate	$1,568.49
Rate for Payer: Cash Price	$970.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,131.90
Rate for Payer: Health Management Network Commercial	$1,374.45
Rate for Payer: Kaiser Permanente Commercial	$1,455.30
Rate for Payer: MDX Hawaii PPO	$1,568.49
Rate for Payer: University Health Alliance Commercial	$905.52

KNEE-CONSTRAINE 00-5994-040-10

Facility

$4,257.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,383.92
Max. Negotiated Rate	$4,129.29
Rate for Payer: Cash Price	$2,554.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,979.90
Rate for Payer: Health Management Network Commercial	$3,618.45
Rate for Payer: Kaiser Permanente Commercial	$3,831.30
Rate for Payer: MDX Hawaii PPO	$4,129.29
Rate for Payer: University Health Alliance Commercial	$2,383.92

KNEE-CONSTRAINE 00-5994-040-10

Facility

$4,257.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,319.67
Max. Negotiated Rate	$4,129.29
Rate for Payer: AlohaCare Medicaid	$2,128.50
Rate for Payer: AlohaCare Medicare	$1,319.67
Rate for Payer: Cash Price	$2,554.20
Rate for Payer: Devoted Health Medicare	$1,447.38
Rate for Payer: Hawaii Medical Service Association Medicare	$1,319.67
Rate for Payer: Hawaii Western Management Group Commercial	$2,979.90
Rate for Payer: Health Management Network Commercial	$3,618.45
Rate for Payer: Humana Medicare	$1,319.67
Rate for Payer: Kaiser Permanente Commercial	$3,831.30
Rate for Payer: Kaiser Permanente Medicaid	$2,171.07
Rate for Payer: Kaiser Permanente Medicare	$1,319.67
Rate for Payer: MDX Hawaii PPO	$4,129.29
Rate for Payer: Ohana Health Plan Medicaid	$1,319.67
Rate for Payer: Ohana Health Plan Medicare	$1,319.67
Rate for Payer: UnitedHealthcare Medicare	$1,319.67
Rate for Payer: University Health Alliance Commercial	$2,383.92

KNEE CRYO CUFF ONLY MED 11A01

Facility

$181.00

Hospital Revenue Code	272
Min. Negotiated Rate	$56.11
Max. Negotiated Rate	$175.57
Rate for Payer: AlohaCare Medicaid	$90.50
Rate for Payer: AlohaCare Medicare	$56.11
Rate for Payer: Cash Price	$108.60
Rate for Payer: Devoted Health Medicare	$61.54
Rate for Payer: Hawaii Medical Service Association Medicare	$56.11
Rate for Payer: Hawaii Western Management Group Commercial	$171.95
Rate for Payer: Health Management Network Commercial	$153.85
Rate for Payer: Humana Medicare	$56.11
Rate for Payer: Kaiser Permanente Commercial	$162.90
Rate for Payer: Kaiser Permanente Medicaid	$92.31
Rate for Payer: Kaiser Permanente Medicare	$56.11
Rate for Payer: MDX Hawaii PPO	$175.57
Rate for Payer: Ohana Health Plan Medicaid	$56.11
Rate for Payer: Ohana Health Plan Medicare	$56.11
Rate for Payer: UnitedHealthcare Medicare	$56.11
Rate for Payer: University Health Alliance Commercial	$131.93

KNEE CRYO CUFF ONLY MED 11A01

Facility

$181.00

Hospital Revenue Code	272
Min. Negotiated Rate	$153.85
Max. Negotiated Rate	$175.57
Rate for Payer: Cash Price	$108.60
Rate for Payer: Health Management Network Commercial	$153.85
Rate for Payer: Kaiser Permanente Commercial	$162.90
Rate for Payer: MDX Hawaii PPO	$175.57

KNEE IMMOBILIZER, TROM COOL

Facility

$384.00

Service Code	HCPCS L1833
Hospital Revenue Code	274
Min. Negotiated Rate	$215.04
Max. Negotiated Rate	$372.48
Rate for Payer: Cash Price	$230.40
Rate for Payer: Hawaii Western Management Group Commercial	$268.80
Rate for Payer: Health Management Network Commercial	$326.40
Rate for Payer: Kaiser Permanente Commercial	$345.60
Rate for Payer: MDX Hawaii PPO	$372.48
Rate for Payer: University Health Alliance Commercial	$215.04

KNEE IMMOBILIZER, TROM COOL

Facility

$356.00

Service Code	HCPCS L1830
Hospital Revenue Code	274
Min. Negotiated Rate	$87.51
Max. Negotiated Rate	$345.32
Rate for Payer: AlohaCare Medicaid	$178.00
Rate for Payer: AlohaCare Medicare	$110.36
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Devoted Health Medicare	$121.04
Rate for Payer: Hawaii Medical Service Association Medicare	$110.36
Rate for Payer: Hawaii Western Management Group Commercial	$249.20
Rate for Payer: Health Management Network Commercial	$302.60
Rate for Payer: Humana Medicare	$110.36
Rate for Payer: Kaiser Permanente Commercial	$320.40
Rate for Payer: Kaiser Permanente Medicaid	$181.56
Rate for Payer: Kaiser Permanente Medicare	$110.36
Rate for Payer: MDX Hawaii PPO	$345.32
Rate for Payer: Ohana Health Plan Medicaid	$110.36
Rate for Payer: Ohana Health Plan Medicare	$110.36
Rate for Payer: UnitedHealthcare Medicaid	$87.51
Rate for Payer: UnitedHealthcare Medicare	$110.36
Rate for Payer: University Health Alliance Commercial	$199.36

KNEE IMMOBILIZER, TROM COOL

Facility

$384.00

Service Code	HCPCS L1833
Hospital Revenue Code	274
Min. Negotiated Rate	$119.04
Max. Negotiated Rate	$668.79
Rate for Payer: AlohaCare Medicaid	$192.00
Rate for Payer: AlohaCare Medicare	$119.04
Rate for Payer: Cash Price	$230.40
Rate for Payer: Cash Price	$230.40
Rate for Payer: Devoted Health Medicare	$130.56
Rate for Payer: Hawaii Medical Service Association Medicare	$119.04
Rate for Payer: Hawaii Western Management Group Commercial	$268.80
Rate for Payer: Health Management Network Commercial	$326.40
Rate for Payer: Humana Medicare	$119.04
Rate for Payer: Kaiser Permanente Commercial	$345.60
Rate for Payer: Kaiser Permanente Medicaid	$195.84
Rate for Payer: Kaiser Permanente Medicare	$119.04
Rate for Payer: MDX Hawaii PPO	$372.48
Rate for Payer: Ohana Health Plan Medicaid	$119.04
Rate for Payer: Ohana Health Plan Medicare	$119.04
Rate for Payer: UnitedHealthcare Medicaid	$668.79
Rate for Payer: UnitedHealthcare Medicare	$119.04
Rate for Payer: University Health Alliance Commercial	$215.04

KNEE IMMOBILIZER, TROM COOL

Facility

$356.00

Service Code	HCPCS L1830
Hospital Revenue Code	274
Min. Negotiated Rate	$199.36
Max. Negotiated Rate	$345.32
Rate for Payer: Cash Price	$213.60
Rate for Payer: Hawaii Western Management Group Commercial	$249.20
Rate for Payer: Health Management Network Commercial	$302.60
Rate for Payer: Kaiser Permanente Commercial	$320.40
Rate for Payer: MDX Hawaii PPO	$345.32
Rate for Payer: University Health Alliance Commercial	$199.36

KNEE LEFT SZ6 42-5580-006-01

Facility

$4,410.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,367.10
Max. Negotiated Rate	$4,277.70
Rate for Payer: AlohaCare Medicaid	$2,205.00
Rate for Payer: AlohaCare Medicare	$1,367.10
Rate for Payer: Cash Price	$2,646.00
Rate for Payer: Devoted Health Medicare	$1,499.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,367.10
Rate for Payer: Hawaii Western Management Group Commercial	$3,087.00
Rate for Payer: Health Management Network Commercial	$3,748.50
Rate for Payer: Humana Medicare	$1,367.10
Rate for Payer: Kaiser Permanente Commercial	$3,969.00
Rate for Payer: Kaiser Permanente Medicaid	$2,249.10
Rate for Payer: Kaiser Permanente Medicare	$1,367.10
Rate for Payer: MDX Hawaii PPO	$4,277.70
Rate for Payer: Ohana Health Plan Medicaid	$1,367.10
Rate for Payer: Ohana Health Plan Medicare	$1,367.10
Rate for Payer: UnitedHealthcare Medicare	$1,367.10
Rate for Payer: University Health Alliance Commercial	$2,469.60

KNEE LEFT SZ6 42-5580-006-01

Facility

$4,410.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,469.60
Max. Negotiated Rate	$4,277.70
Rate for Payer: Cash Price	$2,646.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,087.00
Rate for Payer: Health Management Network Commercial	$3,748.50
Rate for Payer: Kaiser Permanente Commercial	$3,969.00
Rate for Payer: MDX Hawaii PPO	$4,277.70
Rate for Payer: University Health Alliance Commercial	$2,469.60

KNEE LEFT SZH 42-5380-008-01

Facility

$2,940.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,646.40
Max. Negotiated Rate	$2,851.80
Rate for Payer: Cash Price	$1,764.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,058.00
Rate for Payer: Health Management Network Commercial	$2,499.00
Rate for Payer: Kaiser Permanente Commercial	$2,646.00
Rate for Payer: MDX Hawaii PPO	$2,851.80
Rate for Payer: University Health Alliance Commercial	$1,646.40

KNEE LEFT SZH 42-5380-008-01

Facility

$2,940.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$911.40
Max. Negotiated Rate	$2,851.80
Rate for Payer: AlohaCare Medicaid	$1,470.00
Rate for Payer: AlohaCare Medicare	$911.40
Rate for Payer: Cash Price	$1,764.00
Rate for Payer: Devoted Health Medicare	$999.60
Rate for Payer: Hawaii Medical Service Association Medicare	$911.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,058.00
Rate for Payer: Health Management Network Commercial	$2,499.00
Rate for Payer: Humana Medicare	$911.40
Rate for Payer: Kaiser Permanente Commercial	$2,646.00
Rate for Payer: Kaiser Permanente Medicaid	$1,499.40
Rate for Payer: Kaiser Permanente Medicare	$911.40
Rate for Payer: MDX Hawaii PPO	$2,851.80
Rate for Payer: Ohana Health Plan Medicaid	$911.40
Rate for Payer: Ohana Health Plan Medicare	$911.40
Rate for Payer: UnitedHealthcare Medicare	$911.40
Rate for Payer: University Health Alliance Commercial	$1,646.40

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC

Facility

$24,934.50

Service Code	MSDRG 488
Min. Negotiated Rate	$24,934.50
Max. Negotiated Rate	$24,934.50
Rate for Payer: Hawaii Medical Service Association Commercial	$24,934.50

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$24,934.50

Service Code	MSDRG 489
Min. Negotiated Rate	$24,934.50
Max. Negotiated Rate	$24,934.50
Rate for Payer: Hawaii Medical Service Association Commercial	$24,934.50

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC

Facility

$44,156.83

Service Code	MSDRG 486
Min. Negotiated Rate	$44,156.83
Max. Negotiated Rate	$44,156.83
Rate for Payer: Hawaii Medical Service Association Commercial	$44,156.83

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC

Facility

$44,156.83

Service Code	MSDRG 485
Min. Negotiated Rate	$44,156.83
Max. Negotiated Rate	$44,156.83
Rate for Payer: Hawaii Medical Service Association Commercial	$44,156.83

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$31,547.36

Service Code	MSDRG 487
Min. Negotiated Rate	$31,547.36
Max. Negotiated Rate	$31,547.36
Rate for Payer: Hawaii Medical Service Association Commercial	$31,547.36

KNEE SYS SZ/3 L 42-5182-005-08

Facility

$2,661.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$824.91
Max. Negotiated Rate	$2,581.17
Rate for Payer: AlohaCare Medicaid	$1,330.50
Rate for Payer: AlohaCare Medicare	$824.91
Rate for Payer: Cash Price	$1,596.60
Rate for Payer: Devoted Health Medicare	$904.74
Rate for Payer: Hawaii Medical Service Association Medicare	$824.91
Rate for Payer: Hawaii Western Management Group Commercial	$1,862.70
Rate for Payer: Health Management Network Commercial	$2,261.85
Rate for Payer: Humana Medicare	$824.91
Rate for Payer: Kaiser Permanente Commercial	$2,394.90
Rate for Payer: Kaiser Permanente Medicaid	$1,357.11
Rate for Payer: Kaiser Permanente Medicare	$824.91
Rate for Payer: MDX Hawaii PPO	$2,581.17
Rate for Payer: Ohana Health Plan Medicaid	$824.91
Rate for Payer: Ohana Health Plan Medicare	$824.91
Rate for Payer: UnitedHealthcare Medicare	$824.91
Rate for Payer: University Health Alliance Commercial	$1,490.16

KNEE SYS SZ/3 L 42-5182-005-08

Facility

$2,661.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,490.16
Max. Negotiated Rate	$2,581.17
Rate for Payer: Cash Price	$1,596.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,862.70
Rate for Payer: Health Management Network Commercial	$2,261.85
Rate for Payer: Kaiser Permanente Commercial	$2,394.90
Rate for Payer: MDX Hawaii PPO	$2,581.17
Rate for Payer: University Health Alliance Commercial	$1,490.16

KNEE SYS SZ/E L 42-5380-005-01

Facility

$3,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,038.50
Max. Negotiated Rate	$3,249.50
Rate for Payer: AlohaCare Medicaid	$1,675.00
Rate for Payer: AlohaCare Medicare	$1,038.50
Rate for Payer: Cash Price	$2,010.00
Rate for Payer: Devoted Health Medicare	$1,139.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,038.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,345.00
Rate for Payer: Health Management Network Commercial	$2,847.50
Rate for Payer: Humana Medicare	$1,038.50
Rate for Payer: Kaiser Permanente Commercial	$3,015.00
Rate for Payer: Kaiser Permanente Medicaid	$1,708.50
Rate for Payer: Kaiser Permanente Medicare	$1,038.50
Rate for Payer: MDX Hawaii PPO	$3,249.50
Rate for Payer: Ohana Health Plan Medicaid	$1,038.50
Rate for Payer: Ohana Health Plan Medicare	$1,038.50
Rate for Payer: UnitedHealthcare Medicare	$1,038.50
Rate for Payer: University Health Alliance Commercial	$1,876.00

Know your out-of-pocket cost for care.

All Charges