Kau Hospital

All Charges

Charge

Type

Setting

Price

KNE FEM SZ:G/LT 00-5956-017-01

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$1,550.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$1,700.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$1,550.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$1,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$1,550.00
Rate for Payer: Ohana Health Plan Medicare	$1,550.00
Rate for Payer: UnitedHealthcare Medicare	$1,550.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:G/LT 00-5956-017-01

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:G/LT 00-5956-017-02

Facility

$7,308.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,092.48
Max. Negotiated Rate	$7,088.76
Rate for Payer: Cash Price	$4,384.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,115.60
Rate for Payer: Health Management Network Commercial	$6,211.80
Rate for Payer: Kaiser Permanente Commercial	$6,577.20
Rate for Payer: MDX Hawaii PPO	$7,088.76
Rate for Payer: University Health Alliance Commercial	$4,092.48

KNE FEM SZ:G/LT 00-5956-017-02

Facility

$7,308.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,265.48
Max. Negotiated Rate	$7,088.76
Rate for Payer: AlohaCare Medicaid	$3,654.00
Rate for Payer: AlohaCare Medicare	$2,265.48
Rate for Payer: Cash Price	$4,384.80
Rate for Payer: Devoted Health Medicare	$2,484.72
Rate for Payer: Hawaii Medical Service Association Medicare	$2,265.48
Rate for Payer: Hawaii Western Management Group Commercial	$5,115.60
Rate for Payer: Health Management Network Commercial	$6,211.80
Rate for Payer: Humana Medicare	$2,265.48
Rate for Payer: Kaiser Permanente Commercial	$6,577.20
Rate for Payer: Kaiser Permanente Medicaid	$3,727.08
Rate for Payer: Kaiser Permanente Medicare	$2,265.48
Rate for Payer: MDX Hawaii PPO	$7,088.76
Rate for Payer: Ohana Health Plan Medicaid	$2,265.48
Rate for Payer: Ohana Health Plan Medicare	$2,265.48
Rate for Payer: UnitedHealthcare Medicare	$2,265.48
Rate for Payer: University Health Alliance Commercial	$4,092.48

KNE FEM SZ:G/LT 00-5964-017-51

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$1,550.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$1,700.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$1,550.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$1,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$1,550.00
Rate for Payer: Ohana Health Plan Medicare	$1,550.00
Rate for Payer: UnitedHealthcare Medicare	$1,550.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:G/LT 00-5964-017-51

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNIFE RX NEEDLE KNIFE XL

Facility

$720.00

Hospital Revenue Code	272
Min. Negotiated Rate	$612.00
Max. Negotiated Rate	$698.40
Rate for Payer: Cash Price	$432.00
Rate for Payer: Health Management Network Commercial	$612.00
Rate for Payer: Kaiser Permanente Commercial	$648.00
Rate for Payer: MDX Hawaii PPO	$698.40

KNIFE RX NEEDLE KNIFE XL

Facility

$720.00

Hospital Revenue Code	272
Min. Negotiated Rate	$223.20
Max. Negotiated Rate	$698.40
Rate for Payer: AlohaCare Medicaid	$360.00
Rate for Payer: AlohaCare Medicare	$223.20
Rate for Payer: Cash Price	$432.00
Rate for Payer: Devoted Health Medicare	$244.80
Rate for Payer: Hawaii Medical Service Association Medicare	$223.20
Rate for Payer: Hawaii Western Management Group Commercial	$684.00
Rate for Payer: Health Management Network Commercial	$612.00
Rate for Payer: Humana Medicare	$223.20
Rate for Payer: Kaiser Permanente Commercial	$648.00
Rate for Payer: Kaiser Permanente Medicaid	$367.20
Rate for Payer: Kaiser Permanente Medicare	$223.20
Rate for Payer: MDX Hawaii PPO	$698.40
Rate for Payer: Ohana Health Plan Medicaid	$223.20
Rate for Payer: Ohana Health Plan Medicare	$223.20
Rate for Payer: UnitedHealthcare Medicare	$223.20
Rate for Payer: University Health Alliance Commercial	$524.81

KNIFE SLIT ANG 2.75

Facility

$134.00

Hospital Revenue Code	272
Min. Negotiated Rate	$41.54
Max. Negotiated Rate	$129.98
Rate for Payer: AlohaCare Medicaid	$67.00
Rate for Payer: AlohaCare Medicare	$41.54
Rate for Payer: Cash Price	$80.40
Rate for Payer: Devoted Health Medicare	$45.56
Rate for Payer: Hawaii Medical Service Association Medicare	$41.54
Rate for Payer: Hawaii Western Management Group Commercial	$127.30
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Humana Medicare	$41.54
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: Kaiser Permanente Medicaid	$68.34
Rate for Payer: Kaiser Permanente Medicare	$41.54
Rate for Payer: MDX Hawaii PPO	$129.98
Rate for Payer: Ohana Health Plan Medicaid	$41.54
Rate for Payer: Ohana Health Plan Medicare	$41.54
Rate for Payer: UnitedHealthcare Medicare	$41.54
Rate for Payer: University Health Alliance Commercial	$97.67

KNIFE SLIT ANG 2.75

Facility

$134.00

Hospital Revenue Code	272
Min. Negotiated Rate	$113.90
Max. Negotiated Rate	$129.98
Rate for Payer: Cash Price	$80.40
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: MDX Hawaii PPO	$129.98

KNOTLESS FIBERTAK AR-2600FSB-2

Facility

$9,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,867.50
Max. Negotiated Rate	$8,972.50
Rate for Payer: AlohaCare Medicaid	$4,625.00
Rate for Payer: AlohaCare Medicare	$2,867.50
Rate for Payer: Cash Price	$5,550.00
Rate for Payer: Devoted Health Medicare	$3,145.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,867.50
Rate for Payer: Hawaii Western Management Group Commercial	$6,475.00
Rate for Payer: Health Management Network Commercial	$7,862.50
Rate for Payer: Humana Medicare	$2,867.50
Rate for Payer: Kaiser Permanente Commercial	$8,325.00
Rate for Payer: Kaiser Permanente Medicaid	$4,717.50
Rate for Payer: Kaiser Permanente Medicare	$2,867.50
Rate for Payer: MDX Hawaii PPO	$8,972.50
Rate for Payer: Ohana Health Plan Medicaid	$2,867.50
Rate for Payer: Ohana Health Plan Medicare	$2,867.50
Rate for Payer: UnitedHealthcare Medicare	$2,867.50
Rate for Payer: University Health Alliance Commercial	$5,180.00

KNOTLESS FIBERTAK AR-2600FSB-2

Facility

$9,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$5,180.00
Max. Negotiated Rate	$8,972.50
Rate for Payer: Cash Price	$5,550.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,475.00
Rate for Payer: Health Management Network Commercial	$7,862.50
Rate for Payer: Kaiser Permanente Commercial	$8,325.00
Rate for Payer: MDX Hawaii PPO	$8,972.50
Rate for Payer: University Health Alliance Commercial	$5,180.00

KNOTLESS TIGHTROPE AR-8925SS

Facility

$2,990.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,674.40
Max. Negotiated Rate	$2,900.30
Rate for Payer: Cash Price	$1,794.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,093.00
Rate for Payer: Health Management Network Commercial	$2,541.50
Rate for Payer: Kaiser Permanente Commercial	$2,691.00
Rate for Payer: MDX Hawaii PPO	$2,900.30
Rate for Payer: University Health Alliance Commercial	$1,674.40

KNOTLESS TIGHTROPE AR-8925SS

Facility

$2,990.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$926.90
Max. Negotiated Rate	$2,900.30
Rate for Payer: AlohaCare Medicaid	$1,495.00
Rate for Payer: AlohaCare Medicare	$926.90
Rate for Payer: Cash Price	$1,794.00
Rate for Payer: Devoted Health Medicare	$1,016.60
Rate for Payer: Hawaii Medical Service Association Medicare	$926.90
Rate for Payer: Hawaii Western Management Group Commercial	$2,093.00
Rate for Payer: Health Management Network Commercial	$2,541.50
Rate for Payer: Humana Medicare	$926.90
Rate for Payer: Kaiser Permanente Commercial	$2,691.00
Rate for Payer: Kaiser Permanente Medicaid	$1,524.90
Rate for Payer: Kaiser Permanente Medicare	$926.90
Rate for Payer: MDX Hawaii PPO	$2,900.30
Rate for Payer: Ohana Health Plan Medicaid	$926.90
Rate for Payer: Ohana Health Plan Medicare	$926.90
Rate for Payer: UnitedHealthcare Medicare	$926.90
Rate for Payer: University Health Alliance Commercial	$1,674.40

KNOTLESS TIGHTROPE #AR-8926SSK

Facility

$2,516.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,408.96
Max. Negotiated Rate	$2,440.52
Rate for Payer: Cash Price	$1,509.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,761.20
Rate for Payer: Health Management Network Commercial	$2,138.60
Rate for Payer: Kaiser Permanente Commercial	$2,264.40
Rate for Payer: MDX Hawaii PPO	$2,440.52
Rate for Payer: University Health Alliance Commercial	$1,408.96

KNOTLESS TIGHTROPE #AR-8926SSK

Facility

$2,516.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$779.96
Max. Negotiated Rate	$2,440.52
Rate for Payer: AlohaCare Medicaid	$1,258.00
Rate for Payer: AlohaCare Medicare	$779.96
Rate for Payer: Cash Price	$1,509.60
Rate for Payer: Devoted Health Medicare	$855.44
Rate for Payer: Hawaii Medical Service Association Medicare	$779.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,761.20
Rate for Payer: Health Management Network Commercial	$2,138.60
Rate for Payer: Humana Medicare	$779.96
Rate for Payer: Kaiser Permanente Commercial	$2,264.40
Rate for Payer: Kaiser Permanente Medicaid	$1,283.16
Rate for Payer: Kaiser Permanente Medicare	$779.96
Rate for Payer: MDX Hawaii PPO	$2,440.52
Rate for Payer: Ohana Health Plan Medicaid	$779.96
Rate for Payer: Ohana Health Plan Medicare	$779.96
Rate for Payer: UnitedHealthcare Medicare	$779.96
Rate for Payer: University Health Alliance Commercial	$1,408.96

K-WIRE 0.062X3 AR-2663

Facility

$126.00

Hospital Revenue Code	272
Min. Negotiated Rate	$39.06
Max. Negotiated Rate	$122.22
Rate for Payer: AlohaCare Medicaid	$63.00
Rate for Payer: AlohaCare Medicare	$39.06
Rate for Payer: Cash Price	$75.60
Rate for Payer: Devoted Health Medicare	$42.84
Rate for Payer: Hawaii Medical Service Association Medicare	$39.06
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Humana Medicare	$39.06
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicare	$39.06
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: Ohana Health Plan Medicaid	$39.06
Rate for Payer: Ohana Health Plan Medicare	$39.06
Rate for Payer: UnitedHealthcare Medicare	$39.06
Rate for Payer: University Health Alliance Commercial	$91.84

K-WIRE 0.062X3 AR-2663

Facility

$126.00

Hospital Revenue Code	272
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: MDX Hawaii PPO	$122.22

K-WIRE .035X4" 316-0114

Facility

$147.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59

K-WIRE .035X4" 316-0114

Facility

$147.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$45.57
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$45.57
Rate for Payer: Cash Price	$88.20
Rate for Payer: Devoted Health Medicare	$49.98
Rate for Payer: Hawaii Medical Service Association Medicare	$45.57
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$45.57
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$45.57
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$45.57
Rate for Payer: Ohana Health Plan Medicare	$45.57
Rate for Payer: UnitedHealthcare Medicare	$45.57
Rate for Payer: University Health Alliance Commercial	$107.15

K-WIRE .035X4" DBL 316-0119

Facility

$147.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59

K-WIRE .035X4" DBL 316-0119

Facility

$147.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$45.57
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$45.57
Rate for Payer: Cash Price	$88.20
Rate for Payer: Devoted Health Medicare	$49.98
Rate for Payer: Hawaii Medical Service Association Medicare	$45.57
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$45.57
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$45.57
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$45.57
Rate for Payer: Ohana Health Plan Medicare	$45.57
Rate for Payer: UnitedHealthcare Medicare	$45.57
Rate for Payer: University Health Alliance Commercial	$107.15

K-WIRE .035X6" 316-0106

Facility

$126.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: MDX Hawaii PPO	$122.22

K-WIRE .035X6" 316-0106

Facility

$126.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$39.06
Max. Negotiated Rate	$122.22
Rate for Payer: AlohaCare Medicaid	$63.00
Rate for Payer: AlohaCare Medicare	$39.06
Rate for Payer: Cash Price	$75.60
Rate for Payer: Devoted Health Medicare	$42.84
Rate for Payer: Hawaii Medical Service Association Medicare	$39.06
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Humana Medicare	$39.06
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicare	$39.06
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: Ohana Health Plan Medicaid	$39.06
Rate for Payer: Ohana Health Plan Medicare	$39.06
Rate for Payer: UnitedHealthcare Medicare	$39.06
Rate for Payer: University Health Alliance Commercial	$91.84

K-WIRE .035X6" DBL 316-0117

Facility

$147.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$45.57
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$45.57
Rate for Payer: Cash Price	$88.20
Rate for Payer: Devoted Health Medicare	$49.98
Rate for Payer: Hawaii Medical Service Association Medicare	$45.57
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$45.57
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$45.57
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$45.57
Rate for Payer: Ohana Health Plan Medicare	$45.57
Rate for Payer: UnitedHealthcare Medicare	$45.57
Rate for Payer: University Health Alliance Commercial	$107.15

Know your out-of-pocket cost for care.

All Charges