Kau Hospital

All Charges

Charge

Type

Setting

Price

LCP PROX HUM PL 241.921

Facility

$3,834.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,147.04
Max. Negotiated Rate	$3,718.98
Rate for Payer: Cash Price	$2,300.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,683.80
Rate for Payer: Health Management Network Commercial	$3,258.90
Rate for Payer: Kaiser Permanente Commercial	$3,450.60
Rate for Payer: MDX Hawaii PPO	$3,718.98
Rate for Payer: University Health Alliance Commercial	$2,147.04

LEAD BASIC EVALUATION 306001

Facility

$240.00

Service Code	HCPCS C1897
Hospital Revenue Code	278
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	$168.00
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	$134.40

LEAD BASIC EVALUATION 306001

Facility

$240.00

Service Code	HCPCS C1897
Hospital Revenue Code	278
Min. Negotiated Rate	$134.40
Max. Negotiated Rate	$232.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Hawaii Western Management Group Commercial	$168.00
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
Rate for Payer: University Health Alliance Commercial	$134.40

LEAD CAP 109185

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$194.00
Rate for Payer: AlohaCare Medicaid	$100.00
Rate for Payer: AlohaCare Medicare	$62.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Devoted Health Medicare	$68.00
Rate for Payer: Hawaii Medical Service Association Medicare	$62.00
Rate for Payer: Hawaii Western Management Group Commercial	$190.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Humana Medicare	$62.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: Kaiser Permanente Medicare	$62.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: Ohana Health Plan Medicaid	$62.00
Rate for Payer: Ohana Health Plan Medicare	$62.00
Rate for Payer: UnitedHealthcare Medicare	$62.00
Rate for Payer: University Health Alliance Commercial	$145.78

LEAD CAP 109185

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: MDX Hawaii PPO	$194.00

LEAD KIT INTRODUCER 3550-18

Facility

$980.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$303.80
Max. Negotiated Rate	$950.60
Rate for Payer: AlohaCare Medicaid	$490.00
Rate for Payer: AlohaCare Medicare	$303.80
Rate for Payer: Cash Price	$588.00
Rate for Payer: Devoted Health Medicare	$333.20
Rate for Payer: Hawaii Medical Service Association Medicare	$303.80
Rate for Payer: Hawaii Western Management Group Commercial	$931.00
Rate for Payer: Health Management Network Commercial	$833.00
Rate for Payer: Humana Medicare	$303.80
Rate for Payer: Kaiser Permanente Commercial	$882.00
Rate for Payer: Kaiser Permanente Medicaid	$499.80
Rate for Payer: Kaiser Permanente Medicare	$303.80
Rate for Payer: MDX Hawaii PPO	$950.60
Rate for Payer: Ohana Health Plan Medicaid	$303.80
Rate for Payer: Ohana Health Plan Medicare	$303.80
Rate for Payer: UnitedHealthcare Medicare	$303.80
Rate for Payer: University Health Alliance Commercial	$714.32

LEAD KIT INTRODUCER 3550-18

Facility

$980.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$833.00
Max. Negotiated Rate	$950.60
Rate for Payer: Cash Price	$588.00
Rate for Payer: Health Management Network Commercial	$833.00
Rate for Payer: Kaiser Permanente Commercial	$882.00
Rate for Payer: MDX Hawaii PPO	$950.60

LEAD KIT QUADRIPOLAR 3889-28

Facility

$7,110.00

Service Code	HCPCS C1778
Hospital Revenue Code	278
Min. Negotiated Rate	$2,204.10
Max. Negotiated Rate	$6,896.70
Rate for Payer: AlohaCare Medicaid	$3,555.00
Rate for Payer: AlohaCare Medicare	$2,204.10
Rate for Payer: Cash Price	$4,266.00
Rate for Payer: Devoted Health Medicare	$2,417.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,204.10
Rate for Payer: Hawaii Western Management Group Commercial	$4,977.00
Rate for Payer: Health Management Network Commercial	$6,043.50
Rate for Payer: Humana Medicare	$2,204.10
Rate for Payer: Kaiser Permanente Commercial	$6,399.00
Rate for Payer: Kaiser Permanente Medicaid	$3,626.10
Rate for Payer: Kaiser Permanente Medicare	$2,204.10
Rate for Payer: MDX Hawaii PPO	$6,896.70
Rate for Payer: Ohana Health Plan Medicaid	$2,204.10
Rate for Payer: Ohana Health Plan Medicare	$2,204.10
Rate for Payer: UnitedHealthcare Medicare	$2,204.10
Rate for Payer: University Health Alliance Commercial	$3,981.60

LEAD KIT QUADRIPOLAR 3889-28

Facility

$7,110.00

Service Code	HCPCS C1778
Hospital Revenue Code	278
Min. Negotiated Rate	$3,981.60
Max. Negotiated Rate	$6,896.70
Rate for Payer: Cash Price	$4,266.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,977.00
Rate for Payer: Health Management Network Commercial	$6,043.50
Rate for Payer: Kaiser Permanente Commercial	$6,399.00
Rate for Payer: MDX Hawaii PPO	$6,896.70
Rate for Payer: University Health Alliance Commercial	$3,981.60

LEAD PLEXA PROMRI 413997

Facility

$8,000.00

Service Code	HCPCS C1777
Hospital Revenue Code	278
Min. Negotiated Rate	$2,480.00
Max. Negotiated Rate	$7,760.00
Rate for Payer: AlohaCare Medicaid	$4,000.00
Rate for Payer: AlohaCare Medicare	$2,480.00
Rate for Payer: Cash Price	$4,800.00
Rate for Payer: Devoted Health Medicare	$2,720.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,480.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,600.00
Rate for Payer: Health Management Network Commercial	$6,800.00
Rate for Payer: Humana Medicare	$2,480.00
Rate for Payer: Kaiser Permanente Commercial	$7,200.00
Rate for Payer: Kaiser Permanente Medicaid	$4,080.00
Rate for Payer: Kaiser Permanente Medicare	$2,480.00
Rate for Payer: MDX Hawaii PPO	$7,760.00
Rate for Payer: Ohana Health Plan Medicaid	$2,480.00
Rate for Payer: Ohana Health Plan Medicare	$2,480.00
Rate for Payer: UnitedHealthcare Medicare	$2,480.00
Rate for Payer: University Health Alliance Commercial	$4,480.00

LEAD PLEXA PROMRI 413997

Facility

$8,000.00

Service Code	HCPCS C1777
Hospital Revenue Code	278
Min. Negotiated Rate	$4,480.00
Max. Negotiated Rate	$7,760.00
Rate for Payer: Cash Price	$4,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,600.00
Rate for Payer: Health Management Network Commercial	$6,800.00
Rate for Payer: Kaiser Permanente Commercial	$7,200.00
Rate for Payer: MDX Hawaii PPO	$7,760.00
Rate for Payer: University Health Alliance Commercial	$4,480.00

LEAD RESPIRATORY SENSING

Facility

$6,750.00

Service Code	HCPCS C1778
Hospital Revenue Code	278
Min. Negotiated Rate	$2,092.50
Max. Negotiated Rate	$6,547.50
Rate for Payer: AlohaCare Medicaid	$3,375.00
Rate for Payer: AlohaCare Medicare	$2,092.50
Rate for Payer: Cash Price	$4,050.00
Rate for Payer: Devoted Health Medicare	$2,295.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,092.50
Rate for Payer: Hawaii Western Management Group Commercial	$4,725.00
Rate for Payer: Health Management Network Commercial	$5,737.50
Rate for Payer: Humana Medicare	$2,092.50
Rate for Payer: Kaiser Permanente Commercial	$6,075.00
Rate for Payer: Kaiser Permanente Medicaid	$3,442.50
Rate for Payer: Kaiser Permanente Medicare	$2,092.50
Rate for Payer: MDX Hawaii PPO	$6,547.50
Rate for Payer: Ohana Health Plan Medicaid	$2,092.50
Rate for Payer: Ohana Health Plan Medicare	$2,092.50
Rate for Payer: UnitedHealthcare Medicare	$2,092.50
Rate for Payer: University Health Alliance Commercial	$3,780.00

LEAD RESPIRATORY SENSING

Facility

$6,750.00

Service Code	HCPCS C1778
Hospital Revenue Code	278
Min. Negotiated Rate	$3,780.00
Max. Negotiated Rate	$6,547.50
Rate for Payer: Cash Price	$4,050.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,725.00
Rate for Payer: Health Management Network Commercial	$5,737.50
Rate for Payer: Kaiser Permanente Commercial	$6,075.00
Rate for Payer: MDX Hawaii PPO	$6,547.50
Rate for Payer: University Health Alliance Commercial	$3,780.00

LEAD TEMP PACING 5FR

Facility

$394.00

Service Code	HCPCS C1883
Hospital Revenue Code	275
Min. Negotiated Rate	$122.14
Max. Negotiated Rate	$382.18
Rate for Payer: AlohaCare Medicaid	$197.00
Rate for Payer: AlohaCare Medicare	$122.14
Rate for Payer: Cash Price	$236.40
Rate for Payer: Devoted Health Medicare	$133.96
Rate for Payer: Hawaii Medical Service Association Medicare	$122.14
Rate for Payer: Hawaii Western Management Group Commercial	$275.80
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Humana Medicare	$122.14
Rate for Payer: Kaiser Permanente Commercial	$354.60
Rate for Payer: Kaiser Permanente Medicaid	$200.94
Rate for Payer: Kaiser Permanente Medicare	$122.14
Rate for Payer: MDX Hawaii PPO	$382.18
Rate for Payer: Ohana Health Plan Medicaid	$122.14
Rate for Payer: Ohana Health Plan Medicare	$122.14
Rate for Payer: UnitedHealthcare Medicare	$122.14
Rate for Payer: University Health Alliance Commercial	$220.64

LEAD TEMP PACING 5FR

Facility

$394.00

Service Code	HCPCS C1883
Hospital Revenue Code	275
Min. Negotiated Rate	$220.64
Max. Negotiated Rate	$382.18
Rate for Payer: Cash Price	$236.40
Rate for Payer: Hawaii Western Management Group Commercial	$275.80
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Kaiser Permanente Commercial	$354.60
Rate for Payer: MDX Hawaii PPO	$382.18
Rate for Payer: University Health Alliance Commercial	$220.64

LEAD TEMP PACING 6FR

Facility

$394.00

Service Code	HCPCS C1883
Hospital Revenue Code	275
Min. Negotiated Rate	$122.14
Max. Negotiated Rate	$382.18
Rate for Payer: AlohaCare Medicaid	$197.00
Rate for Payer: AlohaCare Medicare	$122.14
Rate for Payer: Cash Price	$236.40
Rate for Payer: Devoted Health Medicare	$133.96
Rate for Payer: Hawaii Medical Service Association Medicare	$122.14
Rate for Payer: Hawaii Western Management Group Commercial	$275.80
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Humana Medicare	$122.14
Rate for Payer: Kaiser Permanente Commercial	$354.60
Rate for Payer: Kaiser Permanente Medicaid	$200.94
Rate for Payer: Kaiser Permanente Medicare	$122.14
Rate for Payer: MDX Hawaii PPO	$382.18
Rate for Payer: Ohana Health Plan Medicaid	$122.14
Rate for Payer: Ohana Health Plan Medicare	$122.14
Rate for Payer: UnitedHealthcare Medicare	$122.14
Rate for Payer: University Health Alliance Commercial	$220.64

LEAD TEMP PACING 6FR

Facility

$394.00

Service Code	HCPCS C1883
Hospital Revenue Code	275
Min. Negotiated Rate	$220.64
Max. Negotiated Rate	$382.18
Rate for Payer: Cash Price	$236.40
Rate for Payer: Hawaii Western Management Group Commercial	$275.80
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Kaiser Permanente Commercial	$354.60
Rate for Payer: MDX Hawaii PPO	$382.18
Rate for Payer: University Health Alliance Commercial	$220.64

LEAD TEMP PACING 7FR

Facility

$394.00

Service Code	HCPCS C1883
Hospital Revenue Code	275
Min. Negotiated Rate	$122.14
Max. Negotiated Rate	$382.18
Rate for Payer: AlohaCare Medicaid	$197.00
Rate for Payer: AlohaCare Medicare	$122.14
Rate for Payer: Cash Price	$236.40
Rate for Payer: Devoted Health Medicare	$133.96
Rate for Payer: Hawaii Medical Service Association Medicare	$122.14
Rate for Payer: Hawaii Western Management Group Commercial	$275.80
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Humana Medicare	$122.14
Rate for Payer: Kaiser Permanente Commercial	$354.60
Rate for Payer: Kaiser Permanente Medicaid	$200.94
Rate for Payer: Kaiser Permanente Medicare	$122.14
Rate for Payer: MDX Hawaii PPO	$382.18
Rate for Payer: Ohana Health Plan Medicaid	$122.14
Rate for Payer: Ohana Health Plan Medicare	$122.14
Rate for Payer: UnitedHealthcare Medicare	$122.14
Rate for Payer: University Health Alliance Commercial	$220.64

LEAD TEMP PACING 7FR

Facility

$394.00

Service Code	HCPCS C1883
Hospital Revenue Code	275
Min. Negotiated Rate	$220.64
Max. Negotiated Rate	$382.18
Rate for Payer: Cash Price	$236.40
Rate for Payer: Hawaii Western Management Group Commercial	$275.80
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Kaiser Permanente Commercial	$354.60
Rate for Payer: MDX Hawaii PPO	$382.18
Rate for Payer: University Health Alliance Commercial	$220.64

LEAD TENDRIL 2088TC/46

Facility

$1,575.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$1,527.75
Rate for Payer: Cash Price	$945.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,102.50
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: MDX Hawaii PPO	$1,527.75
Rate for Payer: University Health Alliance Commercial	$882.00

LEAD TENDRIL 2088TC/46

Facility

$1,575.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$488.25
Max. Negotiated Rate	$1,527.75
Rate for Payer: AlohaCare Medicaid	$787.50
Rate for Payer: AlohaCare Medicare	$488.25
Rate for Payer: Cash Price	$945.00
Rate for Payer: Devoted Health Medicare	$535.50
Rate for Payer: Hawaii Medical Service Association Medicare	$488.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,102.50
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: Humana Medicare	$488.25
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: Kaiser Permanente Medicaid	$803.25
Rate for Payer: Kaiser Permanente Medicare	$488.25
Rate for Payer: MDX Hawaii PPO	$1,527.75
Rate for Payer: Ohana Health Plan Medicaid	$488.25
Rate for Payer: Ohana Health Plan Medicare	$488.25
Rate for Payer: UnitedHealthcare Medicare	$488.25
Rate for Payer: University Health Alliance Commercial	$882.00

LEAD TENDRIL 2088TC/52

Facility

$1,575.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$1,527.75
Rate for Payer: Cash Price	$945.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,102.50
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: MDX Hawaii PPO	$1,527.75
Rate for Payer: University Health Alliance Commercial	$882.00

LEAD TENDRIL 2088TC/52

Facility

$1,575.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$488.25
Max. Negotiated Rate	$1,527.75
Rate for Payer: AlohaCare Medicaid	$787.50
Rate for Payer: AlohaCare Medicare	$488.25
Rate for Payer: Cash Price	$945.00
Rate for Payer: Devoted Health Medicare	$535.50
Rate for Payer: Hawaii Medical Service Association Medicare	$488.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,102.50
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: Humana Medicare	$488.25
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: Kaiser Permanente Medicaid	$803.25
Rate for Payer: Kaiser Permanente Medicare	$488.25
Rate for Payer: MDX Hawaii PPO	$1,527.75
Rate for Payer: Ohana Health Plan Medicaid	$488.25
Rate for Payer: Ohana Health Plan Medicare	$488.25
Rate for Payer: UnitedHealthcare Medicare	$488.25
Rate for Payer: University Health Alliance Commercial	$882.00

LEMAITRE VALVULOTOME 1009-00

Facility

$6,598.00

Hospital Revenue Code	272
Min. Negotiated Rate	$5,608.30
Max. Negotiated Rate	$6,400.06
Rate for Payer: Cash Price	$3,958.80
Rate for Payer: Health Management Network Commercial	$5,608.30
Rate for Payer: Kaiser Permanente Commercial	$5,938.20
Rate for Payer: MDX Hawaii PPO	$6,400.06

LEMAITRE VALVULOTOME 1009-00

Facility

$6,598.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,045.38
Max. Negotiated Rate	$6,400.06
Rate for Payer: AlohaCare Medicaid	$3,299.00
Rate for Payer: AlohaCare Medicare	$2,045.38
Rate for Payer: Cash Price	$3,958.80
Rate for Payer: Devoted Health Medicare	$2,243.32
Rate for Payer: Hawaii Medical Service Association Medicare	$2,045.38
Rate for Payer: Hawaii Western Management Group Commercial	$6,268.10
Rate for Payer: Health Management Network Commercial	$5,608.30
Rate for Payer: Humana Medicare	$2,045.38
Rate for Payer: Kaiser Permanente Commercial	$5,938.20
Rate for Payer: Kaiser Permanente Medicaid	$3,364.98
Rate for Payer: Kaiser Permanente Medicare	$2,045.38
Rate for Payer: MDX Hawaii PPO	$6,400.06
Rate for Payer: Ohana Health Plan Medicaid	$2,045.38
Rate for Payer: Ohana Health Plan Medicare	$2,045.38
Rate for Payer: UnitedHealthcare Medicare	$2,045.38
Rate for Payer: University Health Alliance Commercial	$4,809.28

Know your out-of-pocket cost for care.

All Charges