Kau Hospital

All Charges

Charge

Type

Setting

Price

BALLOON BUTTON MINI M1-5-1820

Facility

$368.00

Hospital Revenue Code	272
Min. Negotiated Rate	$312.80
Max. Negotiated Rate	$356.96
Rate for Payer: Cash Price	$220.80
Rate for Payer: Health Management Network Commercial	$312.80
Rate for Payer: Kaiser Permanente Commercial	$331.20
Rate for Payer: MDX Hawaii PPO	$356.96

BALLOON BUTTON MINI M1-5-1820

Facility

$368.00

Hospital Revenue Code	272
Min. Negotiated Rate	$114.08
Max. Negotiated Rate	$356.96
Rate for Payer: AlohaCare Medicaid	$184.00
Rate for Payer: AlohaCare Medicare	$114.08
Rate for Payer: Cash Price	$220.80
Rate for Payer: Devoted Health Medicare	$125.12
Rate for Payer: Hawaii Medical Service Association Medicare	$114.08
Rate for Payer: Hawaii Western Management Group Commercial	$349.60
Rate for Payer: Health Management Network Commercial	$312.80
Rate for Payer: Humana Medicare	$114.08
Rate for Payer: Kaiser Permanente Commercial	$331.20
Rate for Payer: Kaiser Permanente Medicaid	$187.68
Rate for Payer: Kaiser Permanente Medicare	$114.08
Rate for Payer: MDX Hawaii PPO	$356.96
Rate for Payer: Ohana Health Plan Medicaid	$114.08
Rate for Payer: Ohana Health Plan Medicare	$114.08
Rate for Payer: UnitedHealthcare Medicare	$114.08
Rate for Payer: University Health Alliance Commercial	$268.24

BALLOON CATH 4.5X35 SR-4535-BC

Facility

$1,397.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$1,187.45
Max. Negotiated Rate	$1,355.09
Rate for Payer: Cash Price	$838.20
Rate for Payer: Health Management Network Commercial	$1,187.45
Rate for Payer: Kaiser Permanente Commercial	$1,257.30
Rate for Payer: MDX Hawaii PPO	$1,355.09

BALLOON CATH 4.5X35 SR-4535-BC

Facility

$1,397.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$433.07
Max. Negotiated Rate	$1,355.09
Rate for Payer: AlohaCare Medicaid	$698.50
Rate for Payer: AlohaCare Medicare	$433.07
Rate for Payer: Cash Price	$838.20
Rate for Payer: Devoted Health Medicare	$474.98
Rate for Payer: Hawaii Medical Service Association Medicare	$433.07
Rate for Payer: Hawaii Western Management Group Commercial	$1,327.15
Rate for Payer: Health Management Network Commercial	$1,187.45
Rate for Payer: Humana Medicare	$433.07
Rate for Payer: Kaiser Permanente Commercial	$1,257.30
Rate for Payer: Kaiser Permanente Medicaid	$712.47
Rate for Payer: Kaiser Permanente Medicare	$433.07
Rate for Payer: MDX Hawaii PPO	$1,355.09
Rate for Payer: Ohana Health Plan Medicaid	$433.07
Rate for Payer: Ohana Health Plan Medicare	$433.07
Rate for Payer: UnitedHealthcare Medicare	$433.07
Rate for Payer: University Health Alliance Commercial	$1,018.27

BALLOON CATH 5.0X35 SR-5035-BC

Facility

$2,565.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$2,180.25
Max. Negotiated Rate	$2,488.05
Rate for Payer: Cash Price	$1,539.00
Rate for Payer: Health Management Network Commercial	$2,180.25
Rate for Payer: Kaiser Permanente Commercial	$2,308.50
Rate for Payer: MDX Hawaii PPO	$2,488.05

BALLOON CATH 5.0X35 SR-5035-BC

Facility

$2,565.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$795.15
Max. Negotiated Rate	$2,488.05
Rate for Payer: AlohaCare Medicaid	$1,282.50
Rate for Payer: AlohaCare Medicare	$795.15
Rate for Payer: Cash Price	$1,539.00
Rate for Payer: Devoted Health Medicare	$872.10
Rate for Payer: Hawaii Medical Service Association Medicare	$795.15
Rate for Payer: Hawaii Western Management Group Commercial	$2,436.75
Rate for Payer: Health Management Network Commercial	$2,180.25
Rate for Payer: Humana Medicare	$795.15
Rate for Payer: Kaiser Permanente Commercial	$2,308.50
Rate for Payer: Kaiser Permanente Medicaid	$1,308.15
Rate for Payer: Kaiser Permanente Medicare	$795.15
Rate for Payer: MDX Hawaii PPO	$2,488.05
Rate for Payer: Ohana Health Plan Medicaid	$795.15
Rate for Payer: Ohana Health Plan Medicare	$795.15
Rate for Payer: UnitedHealthcare Medicare	$795.15
Rate for Payer: University Health Alliance Commercial	$1,869.63

BALLOON CATH 5.5X35 SR-5535-BC

Facility

$1,397.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$433.07
Max. Negotiated Rate	$1,355.09
Rate for Payer: AlohaCare Medicaid	$698.50
Rate for Payer: AlohaCare Medicare	$433.07
Rate for Payer: Cash Price	$838.20
Rate for Payer: Devoted Health Medicare	$474.98
Rate for Payer: Hawaii Medical Service Association Medicare	$433.07
Rate for Payer: Hawaii Western Management Group Commercial	$1,327.15
Rate for Payer: Health Management Network Commercial	$1,187.45
Rate for Payer: Humana Medicare	$433.07
Rate for Payer: Kaiser Permanente Commercial	$1,257.30
Rate for Payer: Kaiser Permanente Medicaid	$712.47
Rate for Payer: Kaiser Permanente Medicare	$433.07
Rate for Payer: MDX Hawaii PPO	$1,355.09
Rate for Payer: Ohana Health Plan Medicaid	$433.07
Rate for Payer: Ohana Health Plan Medicare	$433.07
Rate for Payer: UnitedHealthcare Medicare	$433.07
Rate for Payer: University Health Alliance Commercial	$1,018.27

BALLOON CATH 5.5X35 SR-5535-BC

Facility

$1,397.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$1,187.45
Max. Negotiated Rate	$1,355.09
Rate for Payer: Cash Price	$838.20
Rate for Payer: Health Management Network Commercial	$1,187.45
Rate for Payer: Kaiser Permanente Commercial	$1,257.30
Rate for Payer: MDX Hawaii PPO	$1,355.09

BALLOON DILATION CATH 4.0X35

Facility

$2,565.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$2,180.25
Max. Negotiated Rate	$2,488.05
Rate for Payer: Cash Price	$1,539.00
Rate for Payer: Health Management Network Commercial	$2,180.25
Rate for Payer: Kaiser Permanente Commercial	$2,308.50
Rate for Payer: MDX Hawaii PPO	$2,488.05

BALLOON DILATION CATH 4.0X35

Facility

$2,565.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$795.15
Max. Negotiated Rate	$2,488.05
Rate for Payer: AlohaCare Medicaid	$1,282.50
Rate for Payer: AlohaCare Medicare	$795.15
Rate for Payer: Cash Price	$1,539.00
Rate for Payer: Devoted Health Medicare	$872.10
Rate for Payer: Hawaii Medical Service Association Medicare	$795.15
Rate for Payer: Hawaii Western Management Group Commercial	$2,436.75
Rate for Payer: Health Management Network Commercial	$2,180.25
Rate for Payer: Humana Medicare	$795.15
Rate for Payer: Kaiser Permanente Commercial	$2,308.50
Rate for Payer: Kaiser Permanente Medicaid	$1,308.15
Rate for Payer: Kaiser Permanente Medicare	$795.15
Rate for Payer: MDX Hawaii PPO	$2,488.05
Rate for Payer: Ohana Health Plan Medicaid	$795.15
Rate for Payer: Ohana Health Plan Medicare	$795.15
Rate for Payer: UnitedHealthcare Medicare	$795.15
Rate for Payer: University Health Alliance Commercial	$1,869.63

BALLOON ENFLATE SR-6025-BC

Facility

$1,397.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$433.07
Max. Negotiated Rate	$1,355.09
Rate for Payer: AlohaCare Medicaid	$698.50
Rate for Payer: AlohaCare Medicare	$433.07
Rate for Payer: Cash Price	$838.20
Rate for Payer: Devoted Health Medicare	$474.98
Rate for Payer: Hawaii Medical Service Association Medicare	$433.07
Rate for Payer: Hawaii Western Management Group Commercial	$1,327.15
Rate for Payer: Health Management Network Commercial	$1,187.45
Rate for Payer: Humana Medicare	$433.07
Rate for Payer: Kaiser Permanente Commercial	$1,257.30
Rate for Payer: Kaiser Permanente Medicaid	$712.47
Rate for Payer: Kaiser Permanente Medicare	$433.07
Rate for Payer: MDX Hawaii PPO	$1,355.09
Rate for Payer: Ohana Health Plan Medicaid	$433.07
Rate for Payer: Ohana Health Plan Medicare	$433.07
Rate for Payer: UnitedHealthcare Medicare	$433.07
Rate for Payer: University Health Alliance Commercial	$1,018.27

BALLOON ENFLATE SR-6025-BC

Facility

$1,397.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$1,187.45
Max. Negotiated Rate	$1,355.09
Rate for Payer: Cash Price	$838.20
Rate for Payer: Health Management Network Commercial	$1,187.45
Rate for Payer: Kaiser Permanente Commercial	$1,257.30
Rate for Payer: MDX Hawaii PPO	$1,355.09

BALLOON ESOPHA/COLON 10-12

Facility

$825.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$701.25
Max. Negotiated Rate	$800.25
Rate for Payer: Cash Price	$495.00
Rate for Payer: Health Management Network Commercial	$701.25
Rate for Payer: Kaiser Permanente Commercial	$742.50
Rate for Payer: MDX Hawaii PPO	$800.25

BALLOON ESOPHA/COLON 10-12

Facility

$825.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$255.75
Max. Negotiated Rate	$800.25
Rate for Payer: AlohaCare Medicaid	$412.50
Rate for Payer: AlohaCare Medicare	$255.75
Rate for Payer: Cash Price	$495.00
Rate for Payer: Devoted Health Medicare	$280.50
Rate for Payer: Hawaii Medical Service Association Medicare	$255.75
Rate for Payer: Hawaii Western Management Group Commercial	$783.75
Rate for Payer: Health Management Network Commercial	$701.25
Rate for Payer: Humana Medicare	$255.75
Rate for Payer: Kaiser Permanente Commercial	$742.50
Rate for Payer: Kaiser Permanente Medicaid	$420.75
Rate for Payer: Kaiser Permanente Medicare	$255.75
Rate for Payer: MDX Hawaii PPO	$800.25
Rate for Payer: Ohana Health Plan Medicaid	$255.75
Rate for Payer: Ohana Health Plan Medicare	$255.75
Rate for Payer: UnitedHealthcare Medicare	$255.75
Rate for Payer: University Health Alliance Commercial	$601.34

BALLOON ESOPHA/COLON 15-18

Facility

$825.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$701.25
Max. Negotiated Rate	$800.25
Rate for Payer: Cash Price	$495.00
Rate for Payer: Health Management Network Commercial	$701.25
Rate for Payer: Kaiser Permanente Commercial	$742.50
Rate for Payer: MDX Hawaii PPO	$800.25

BALLOON ESOPHA/COLON 15-18

Facility

$825.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$255.75
Max. Negotiated Rate	$800.25
Rate for Payer: AlohaCare Medicaid	$412.50
Rate for Payer: AlohaCare Medicare	$255.75
Rate for Payer: Cash Price	$495.00
Rate for Payer: Devoted Health Medicare	$280.50
Rate for Payer: Hawaii Medical Service Association Medicare	$255.75
Rate for Payer: Hawaii Western Management Group Commercial	$783.75
Rate for Payer: Health Management Network Commercial	$701.25
Rate for Payer: Humana Medicare	$255.75
Rate for Payer: Kaiser Permanente Commercial	$742.50
Rate for Payer: Kaiser Permanente Medicaid	$420.75
Rate for Payer: Kaiser Permanente Medicare	$255.75
Rate for Payer: MDX Hawaii PPO	$800.25
Rate for Payer: Ohana Health Plan Medicaid	$255.75
Rate for Payer: Ohana Health Plan Medicare	$255.75
Rate for Payer: UnitedHealthcare Medicare	$255.75
Rate for Payer: University Health Alliance Commercial	$601.34

BALLOON ESOPHA/COLON 18-20

Facility

$825.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$701.25
Max. Negotiated Rate	$800.25
Rate for Payer: Cash Price	$495.00
Rate for Payer: Health Management Network Commercial	$701.25
Rate for Payer: Kaiser Permanente Commercial	$742.50
Rate for Payer: MDX Hawaii PPO	$800.25

BALLOON ESOPHA/COLON 18-20

Facility

$825.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$255.75
Max. Negotiated Rate	$800.25
Rate for Payer: AlohaCare Medicaid	$412.50
Rate for Payer: AlohaCare Medicare	$255.75
Rate for Payer: Cash Price	$495.00
Rate for Payer: Devoted Health Medicare	$280.50
Rate for Payer: Hawaii Medical Service Association Medicare	$255.75
Rate for Payer: Hawaii Western Management Group Commercial	$783.75
Rate for Payer: Health Management Network Commercial	$701.25
Rate for Payer: Humana Medicare	$255.75
Rate for Payer: Kaiser Permanente Commercial	$742.50
Rate for Payer: Kaiser Permanente Medicaid	$420.75
Rate for Payer: Kaiser Permanente Medicare	$255.75
Rate for Payer: MDX Hawaii PPO	$800.25
Rate for Payer: Ohana Health Plan Medicaid	$255.75
Rate for Payer: Ohana Health Plan Medicare	$255.75
Rate for Payer: UnitedHealthcare Medicare	$255.75
Rate for Payer: University Health Alliance Commercial	$601.34

BALLOON ESOPHA/COLON 6-8

Facility

$825.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$701.25
Max. Negotiated Rate	$800.25
Rate for Payer: Cash Price	$495.00
Rate for Payer: Health Management Network Commercial	$701.25
Rate for Payer: Kaiser Permanente Commercial	$742.50
Rate for Payer: MDX Hawaii PPO	$800.25

BALLOON ESOPHA/COLON 6-8

Facility

$825.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$255.75
Max. Negotiated Rate	$800.25
Rate for Payer: AlohaCare Medicaid	$412.50
Rate for Payer: AlohaCare Medicare	$255.75
Rate for Payer: Cash Price	$495.00
Rate for Payer: Devoted Health Medicare	$280.50
Rate for Payer: Hawaii Medical Service Association Medicare	$255.75
Rate for Payer: Hawaii Western Management Group Commercial	$783.75
Rate for Payer: Health Management Network Commercial	$701.25
Rate for Payer: Humana Medicare	$255.75
Rate for Payer: Kaiser Permanente Commercial	$742.50
Rate for Payer: Kaiser Permanente Medicaid	$420.75
Rate for Payer: Kaiser Permanente Medicare	$255.75
Rate for Payer: MDX Hawaii PPO	$800.25
Rate for Payer: Ohana Health Plan Medicaid	$255.75
Rate for Payer: Ohana Health Plan Medicare	$255.75
Rate for Payer: UnitedHealthcare Medicare	$255.75
Rate for Payer: University Health Alliance Commercial	$601.34

BALLOON RETRIEVAL 12X15

Facility

$560.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$476.00
Max. Negotiated Rate	$543.20
Rate for Payer: Cash Price	$336.00
Rate for Payer: Health Management Network Commercial	$476.00
Rate for Payer: Kaiser Permanente Commercial	$504.00
Rate for Payer: MDX Hawaii PPO	$543.20

BALLOON RETRIEVAL 12X15

Facility

$560.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$173.60
Max. Negotiated Rate	$543.20
Rate for Payer: AlohaCare Medicaid	$280.00
Rate for Payer: AlohaCare Medicare	$173.60
Rate for Payer: Cash Price	$336.00
Rate for Payer: Devoted Health Medicare	$190.40
Rate for Payer: Hawaii Medical Service Association Medicare	$173.60
Rate for Payer: Hawaii Western Management Group Commercial	$532.00
Rate for Payer: Health Management Network Commercial	$476.00
Rate for Payer: Humana Medicare	$173.60
Rate for Payer: Kaiser Permanente Commercial	$504.00
Rate for Payer: Kaiser Permanente Medicaid	$285.60
Rate for Payer: Kaiser Permanente Medicare	$173.60
Rate for Payer: MDX Hawaii PPO	$543.20
Rate for Payer: Ohana Health Plan Medicaid	$173.60
Rate for Payer: Ohana Health Plan Medicare	$173.60
Rate for Payer: UnitedHealthcare Medicare	$173.60
Rate for Payer: University Health Alliance Commercial	$408.18

BALLOON RETRIEVAL 12X9

Facility

$560.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$476.00
Max. Negotiated Rate	$543.20
Rate for Payer: Cash Price	$336.00
Rate for Payer: Health Management Network Commercial	$476.00
Rate for Payer: Kaiser Permanente Commercial	$504.00
Rate for Payer: MDX Hawaii PPO	$543.20

BALLOON RETRIEVAL 12X9

Facility

$560.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$173.60
Max. Negotiated Rate	$543.20
Rate for Payer: AlohaCare Medicaid	$280.00
Rate for Payer: AlohaCare Medicare	$173.60
Rate for Payer: Cash Price	$336.00
Rate for Payer: Devoted Health Medicare	$190.40
Rate for Payer: Hawaii Medical Service Association Medicare	$173.60
Rate for Payer: Hawaii Western Management Group Commercial	$532.00
Rate for Payer: Health Management Network Commercial	$476.00
Rate for Payer: Humana Medicare	$173.60
Rate for Payer: Kaiser Permanente Commercial	$504.00
Rate for Payer: Kaiser Permanente Medicaid	$285.60
Rate for Payer: Kaiser Permanente Medicare	$173.60
Rate for Payer: MDX Hawaii PPO	$543.20
Rate for Payer: Ohana Health Plan Medicaid	$173.60
Rate for Payer: Ohana Health Plan Medicare	$173.60
Rate for Payer: UnitedHealthcare Medicare	$173.60
Rate for Payer: University Health Alliance Commercial	$408.18

BALLOON RETRIEVAL 15X18

Facility

$560.00

Service Code	HCPCS C1889
Hospital Revenue Code	278
Min. Negotiated Rate	$313.60
Max. Negotiated Rate	$543.20
Rate for Payer: Cash Price	$336.00
Rate for Payer: Hawaii Western Management Group Commercial	$392.00
Rate for Payer: Health Management Network Commercial	$476.00
Rate for Payer: Kaiser Permanente Commercial	$504.00
Rate for Payer: MDX Hawaii PPO	$543.20
Rate for Payer: University Health Alliance Commercial	$313.60

Know your out-of-pocket cost for care.

All Charges