Kau Hospital

All Charges

Charge

Type

Setting

Price

BALLOON 2X12 AGENT DCB

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$3,828.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: AlohaCare Medicaid	$6,175.00
Rate for Payer: AlohaCare Medicare	$3,828.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Devoted Health Medicare	$4,199.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,828.50
Rate for Payer: Hawaii Western Management Group Commercial	$11,732.50
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Humana Medicare	$3,828.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: Kaiser Permanente Medicaid	$6,298.50
Rate for Payer: Kaiser Permanente Medicare	$3,828.50
Rate for Payer: MDX Hawaii PPO	$11,979.50
Rate for Payer: Ohana Health Plan Medicaid	$3,828.50
Rate for Payer: Ohana Health Plan Medicare	$3,828.50
Rate for Payer: UnitedHealthcare Medicare	$3,828.50
Rate for Payer: University Health Alliance Commercial	$9,001.92

BALLOON 2X15 AGENT DCB

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$3,828.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: AlohaCare Medicaid	$6,175.00
Rate for Payer: AlohaCare Medicare	$3,828.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Devoted Health Medicare	$4,199.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,828.50
Rate for Payer: Hawaii Western Management Group Commercial	$11,732.50
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Humana Medicare	$3,828.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: Kaiser Permanente Medicaid	$6,298.50
Rate for Payer: Kaiser Permanente Medicare	$3,828.50
Rate for Payer: MDX Hawaii PPO	$11,979.50
Rate for Payer: Ohana Health Plan Medicaid	$3,828.50
Rate for Payer: Ohana Health Plan Medicare	$3,828.50
Rate for Payer: UnitedHealthcare Medicare	$3,828.50
Rate for Payer: University Health Alliance Commercial	$9,001.92

BALLOON 2X15 AGENT DCB

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$10,497.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: MDX Hawaii PPO	$11,979.50

BALLOON 3.5X20 AGENT DCB

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$10,497.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: MDX Hawaii PPO	$11,979.50

BALLOON 3.5X20 AGENT DCB

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$3,828.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: AlohaCare Medicaid	$6,175.00
Rate for Payer: AlohaCare Medicare	$3,828.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Devoted Health Medicare	$4,199.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,828.50
Rate for Payer: Hawaii Western Management Group Commercial	$11,732.50
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Humana Medicare	$3,828.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: Kaiser Permanente Medicaid	$6,298.50
Rate for Payer: Kaiser Permanente Medicare	$3,828.50
Rate for Payer: MDX Hawaii PPO	$11,979.50
Rate for Payer: Ohana Health Plan Medicaid	$3,828.50
Rate for Payer: Ohana Health Plan Medicare	$3,828.50
Rate for Payer: UnitedHealthcare Medicare	$3,828.50
Rate for Payer: University Health Alliance Commercial	$9,001.92

BALLOON 3.5X30 AGENT DCB

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$10,497.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: MDX Hawaii PPO	$11,979.50

BALLOON 3.5X30 AGENT DCB

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$3,828.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: AlohaCare Medicaid	$6,175.00
Rate for Payer: AlohaCare Medicare	$3,828.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Devoted Health Medicare	$4,199.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,828.50
Rate for Payer: Hawaii Western Management Group Commercial	$11,732.50
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Humana Medicare	$3,828.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: Kaiser Permanente Medicaid	$6,298.50
Rate for Payer: Kaiser Permanente Medicare	$3,828.50
Rate for Payer: MDX Hawaii PPO	$11,979.50
Rate for Payer: Ohana Health Plan Medicaid	$3,828.50
Rate for Payer: Ohana Health Plan Medicare	$3,828.50
Rate for Payer: UnitedHealthcare Medicare	$3,828.50
Rate for Payer: University Health Alliance Commercial	$9,001.92

BALLOON 3X20 AGENT DCB

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$3,828.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: AlohaCare Medicaid	$6,175.00
Rate for Payer: AlohaCare Medicare	$3,828.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Devoted Health Medicare	$4,199.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,828.50
Rate for Payer: Hawaii Western Management Group Commercial	$11,732.50
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Humana Medicare	$3,828.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: Kaiser Permanente Medicaid	$6,298.50
Rate for Payer: Kaiser Permanente Medicare	$3,828.50
Rate for Payer: MDX Hawaii PPO	$11,979.50
Rate for Payer: Ohana Health Plan Medicaid	$3,828.50
Rate for Payer: Ohana Health Plan Medicare	$3,828.50
Rate for Payer: UnitedHealthcare Medicare	$3,828.50
Rate for Payer: University Health Alliance Commercial	$9,001.92

BALLOON 3X20 AGENT DCB

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$10,497.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: MDX Hawaii PPO	$11,979.50

BALLOON 3X30 AGENT DCB

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$10,497.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: MDX Hawaii PPO	$11,979.50

BALLOON 3X30 AGENT DCB

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$3,828.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: AlohaCare Medicaid	$6,175.00
Rate for Payer: AlohaCare Medicare	$3,828.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Devoted Health Medicare	$4,199.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,828.50
Rate for Payer: Hawaii Western Management Group Commercial	$11,732.50
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Humana Medicare	$3,828.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: Kaiser Permanente Medicaid	$6,298.50
Rate for Payer: Kaiser Permanente Medicare	$3,828.50
Rate for Payer: MDX Hawaii PPO	$11,979.50
Rate for Payer: Ohana Health Plan Medicaid	$3,828.50
Rate for Payer: Ohana Health Plan Medicare	$3,828.50
Rate for Payer: UnitedHealthcare Medicare	$3,828.50
Rate for Payer: University Health Alliance Commercial	$9,001.92

BALLOON 4X15 AGENT DCB

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$10,497.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: MDX Hawaii PPO	$11,979.50

BALLOON 4X15 AGENT DCB

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$3,828.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: AlohaCare Medicaid	$6,175.00
Rate for Payer: AlohaCare Medicare	$3,828.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Devoted Health Medicare	$4,199.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,828.50
Rate for Payer: Hawaii Western Management Group Commercial	$11,732.50
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Humana Medicare	$3,828.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: Kaiser Permanente Medicaid	$6,298.50
Rate for Payer: Kaiser Permanente Medicare	$3,828.50
Rate for Payer: MDX Hawaii PPO	$11,979.50
Rate for Payer: Ohana Health Plan Medicaid	$3,828.50
Rate for Payer: Ohana Health Plan Medicare	$3,828.50
Rate for Payer: UnitedHealthcare Medicare	$3,828.50
Rate for Payer: University Health Alliance Commercial	$9,001.92

BALLOON 4X20 AGENT DCB

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$3,828.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: AlohaCare Medicaid	$6,175.00
Rate for Payer: AlohaCare Medicare	$3,828.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Devoted Health Medicare	$4,199.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,828.50
Rate for Payer: Hawaii Western Management Group Commercial	$11,732.50
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Humana Medicare	$3,828.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: Kaiser Permanente Medicaid	$6,298.50
Rate for Payer: Kaiser Permanente Medicare	$3,828.50
Rate for Payer: MDX Hawaii PPO	$11,979.50
Rate for Payer: Ohana Health Plan Medicaid	$3,828.50
Rate for Payer: Ohana Health Plan Medicare	$3,828.50
Rate for Payer: UnitedHealthcare Medicare	$3,828.50
Rate for Payer: University Health Alliance Commercial	$9,001.92

BALLOON 4X20 AGENT DCB

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$10,497.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: MDX Hawaii PPO	$11,979.50

BALLOON 4X30 AGENT DCB

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$10,497.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: MDX Hawaii PPO	$11,979.50

BALLOON 4X30 AGENT DCB

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$3,828.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: AlohaCare Medicaid	$6,175.00
Rate for Payer: AlohaCare Medicare	$3,828.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Devoted Health Medicare	$4,199.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,828.50
Rate for Payer: Hawaii Western Management Group Commercial	$11,732.50
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Humana Medicare	$3,828.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: Kaiser Permanente Medicaid	$6,298.50
Rate for Payer: Kaiser Permanente Medicare	$3,828.50
Rate for Payer: MDX Hawaii PPO	$11,979.50
Rate for Payer: Ohana Health Plan Medicaid	$3,828.50
Rate for Payer: Ohana Health Plan Medicare	$3,828.50
Rate for Payer: UnitedHealthcare Medicare	$3,828.50
Rate for Payer: University Health Alliance Commercial	$9,001.92

BALLOON 6X40X75 MUSTANG PTA

Facility

$619.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$526.15
Max. Negotiated Rate	$600.43
Rate for Payer: Cash Price	$371.40
Rate for Payer: Health Management Network Commercial	$526.15
Rate for Payer: Kaiser Permanente Commercial	$557.10
Rate for Payer: MDX Hawaii PPO	$600.43

BALLOON 6X40X75 MUSTANG PTA

Facility

$619.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$191.89
Max. Negotiated Rate	$600.43
Rate for Payer: AlohaCare Medicaid	$309.50
Rate for Payer: AlohaCare Medicare	$191.89
Rate for Payer: Cash Price	$371.40
Rate for Payer: Devoted Health Medicare	$210.46
Rate for Payer: Hawaii Medical Service Association Medicare	$191.89
Rate for Payer: Hawaii Western Management Group Commercial	$588.05
Rate for Payer: Health Management Network Commercial	$526.15
Rate for Payer: Humana Medicare	$191.89
Rate for Payer: Kaiser Permanente Commercial	$557.10
Rate for Payer: Kaiser Permanente Medicaid	$315.69
Rate for Payer: Kaiser Permanente Medicare	$191.89
Rate for Payer: MDX Hawaii PPO	$600.43
Rate for Payer: Ohana Health Plan Medicaid	$191.89
Rate for Payer: Ohana Health Plan Medicare	$191.89
Rate for Payer: UnitedHealthcare Medicare	$191.89
Rate for Payer: University Health Alliance Commercial	$451.19

BALLOON 7X40X75 MUSTANG PTA

Facility

$619.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$191.89
Max. Negotiated Rate	$600.43
Rate for Payer: AlohaCare Medicaid	$309.50
Rate for Payer: AlohaCare Medicare	$191.89
Rate for Payer: Cash Price	$371.40
Rate for Payer: Devoted Health Medicare	$210.46
Rate for Payer: Hawaii Medical Service Association Medicare	$191.89
Rate for Payer: Hawaii Western Management Group Commercial	$588.05
Rate for Payer: Health Management Network Commercial	$526.15
Rate for Payer: Humana Medicare	$191.89
Rate for Payer: Kaiser Permanente Commercial	$557.10
Rate for Payer: Kaiser Permanente Medicaid	$315.69
Rate for Payer: Kaiser Permanente Medicare	$191.89
Rate for Payer: MDX Hawaii PPO	$600.43
Rate for Payer: Ohana Health Plan Medicaid	$191.89
Rate for Payer: Ohana Health Plan Medicare	$191.89
Rate for Payer: UnitedHealthcare Medicare	$191.89
Rate for Payer: University Health Alliance Commercial	$451.19

BALLOON 7X40X75 MUSTANG PTA

Facility

$619.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$526.15
Max. Negotiated Rate	$600.43
Rate for Payer: Cash Price	$371.40
Rate for Payer: Health Management Network Commercial	$526.15
Rate for Payer: Kaiser Permanente Commercial	$557.10
Rate for Payer: MDX Hawaii PPO	$600.43

BALLOON 8X40X75 MUSTANG PTA

Facility

$619.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$191.89
Max. Negotiated Rate	$600.43
Rate for Payer: AlohaCare Medicaid	$309.50
Rate for Payer: AlohaCare Medicare	$191.89
Rate for Payer: Cash Price	$371.40
Rate for Payer: Devoted Health Medicare	$210.46
Rate for Payer: Hawaii Medical Service Association Medicare	$191.89
Rate for Payer: Hawaii Western Management Group Commercial	$588.05
Rate for Payer: Health Management Network Commercial	$526.15
Rate for Payer: Humana Medicare	$191.89
Rate for Payer: Kaiser Permanente Commercial	$557.10
Rate for Payer: Kaiser Permanente Medicaid	$315.69
Rate for Payer: Kaiser Permanente Medicare	$191.89
Rate for Payer: MDX Hawaii PPO	$600.43
Rate for Payer: Ohana Health Plan Medicaid	$191.89
Rate for Payer: Ohana Health Plan Medicare	$191.89
Rate for Payer: UnitedHealthcare Medicare	$191.89
Rate for Payer: University Health Alliance Commercial	$451.19

BALLOON 8X40X75 MUSTANG PTA

Facility

$619.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$526.15
Max. Negotiated Rate	$600.43
Rate for Payer: Cash Price	$371.40
Rate for Payer: Health Management Network Commercial	$526.15
Rate for Payer: Kaiser Permanente Commercial	$557.10
Rate for Payer: MDX Hawaii PPO	$600.43

BALLOON ACHALASIA 30MM

Facility

$1,845.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$1,568.25
Max. Negotiated Rate	$1,789.65
Rate for Payer: Cash Price	$1,107.00
Rate for Payer: Health Management Network Commercial	$1,568.25
Rate for Payer: Kaiser Permanente Commercial	$1,660.50
Rate for Payer: MDX Hawaii PPO	$1,789.65

BALLOON ACHALASIA 30MM

Facility

$1,845.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$571.95
Max. Negotiated Rate	$1,789.65
Rate for Payer: AlohaCare Medicaid	$922.50
Rate for Payer: AlohaCare Medicare	$571.95
Rate for Payer: Cash Price	$1,107.00
Rate for Payer: Devoted Health Medicare	$627.30
Rate for Payer: Hawaii Medical Service Association Medicare	$571.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,752.75
Rate for Payer: Health Management Network Commercial	$1,568.25
Rate for Payer: Humana Medicare	$571.95
Rate for Payer: Kaiser Permanente Commercial	$1,660.50
Rate for Payer: Kaiser Permanente Medicaid	$940.95
Rate for Payer: Kaiser Permanente Medicare	$571.95
Rate for Payer: MDX Hawaii PPO	$1,789.65
Rate for Payer: Ohana Health Plan Medicaid	$571.95
Rate for Payer: Ohana Health Plan Medicare	$571.95
Rate for Payer: UnitedHealthcare Medicare	$571.95
Rate for Payer: University Health Alliance Commercial	$1,344.82

Know your out-of-pocket cost for care.

All Charges