Kau Hospital

All Charges

Charge

Type

Setting

Price

MYOSURE POLYP RMVL SIMPLIFIED

Facility

$2,085.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$646.35
Max. Negotiated Rate	$2,022.45
Rate for Payer: AlohaCare Medicaid	$1,042.50
Rate for Payer: AlohaCare Medicare	$646.35
Rate for Payer: Cash Price	$1,251.00
Rate for Payer: Devoted Health Medicare	$708.90
Rate for Payer: Hawaii Medical Service Association Medicare	$646.35
Rate for Payer: Hawaii Western Management Group Commercial	$1,980.75
Rate for Payer: Health Management Network Commercial	$1,772.25
Rate for Payer: Humana Medicare	$646.35
Rate for Payer: Kaiser Permanente Commercial	$1,876.50
Rate for Payer: Kaiser Permanente Medicaid	$1,063.35
Rate for Payer: Kaiser Permanente Medicare	$646.35
Rate for Payer: MDX Hawaii PPO	$2,022.45
Rate for Payer: Ohana Health Plan Medicaid	$646.35
Rate for Payer: Ohana Health Plan Medicare	$646.35
Rate for Payer: UnitedHealthcare Medicare	$646.35
Rate for Payer: University Health Alliance Commercial	$1,519.76

MYOSURE POLYP RMVL SIMPLIFIED

Facility

$2,085.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$1,772.25
Max. Negotiated Rate	$2,022.45
Rate for Payer: Cash Price	$1,251.00
Rate for Payer: Health Management Network Commercial	$1,772.25
Rate for Payer: Kaiser Permanente Commercial	$1,876.50
Rate for Payer: MDX Hawaii PPO	$2,022.45

MYOSURE TISSUE REMOVAL SIMPLIF

Facility

$2,590.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$2,201.50
Max. Negotiated Rate	$2,512.30
Rate for Payer: Cash Price	$1,554.00
Rate for Payer: Health Management Network Commercial	$2,201.50
Rate for Payer: Kaiser Permanente Commercial	$2,331.00
Rate for Payer: MDX Hawaii PPO	$2,512.30

MYOSURE TISSUE REMOVAL SIMPLIF

Facility

$2,590.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$802.90
Max. Negotiated Rate	$2,512.30
Rate for Payer: AlohaCare Medicaid	$1,295.00
Rate for Payer: AlohaCare Medicare	$802.90
Rate for Payer: Cash Price	$1,554.00
Rate for Payer: Devoted Health Medicare	$880.60
Rate for Payer: Hawaii Medical Service Association Medicare	$802.90
Rate for Payer: Hawaii Western Management Group Commercial	$2,460.50
Rate for Payer: Health Management Network Commercial	$2,201.50
Rate for Payer: Humana Medicare	$802.90
Rate for Payer: Kaiser Permanente Commercial	$2,331.00
Rate for Payer: Kaiser Permanente Medicaid	$1,320.90
Rate for Payer: Kaiser Permanente Medicare	$802.90
Rate for Payer: MDX Hawaii PPO	$2,512.30
Rate for Payer: Ohana Health Plan Medicaid	$802.90
Rate for Payer: Ohana Health Plan Medicare	$802.90
Rate for Payer: UnitedHealthcare Medicare	$802.90
Rate for Payer: University Health Alliance Commercial	$1,887.85

MYRIAD MATRIX 5X5 SR02LG0505US

Facility

$861.00

Service Code	HCPCS A2032
Hospital Revenue Code	636
Min. Negotiated Rate	$266.91
Max. Negotiated Rate	$835.17
Rate for Payer: AlohaCare Medicaid	$430.50
Rate for Payer: AlohaCare Medicare	$266.91
Rate for Payer: Cash Price	$516.60
Rate for Payer: Devoted Health Medicare	$292.74
Rate for Payer: Hawaii Medical Service Association Medicare	$266.91
Rate for Payer: Hawaii Western Management Group Commercial	$817.95
Rate for Payer: Health Management Network Commercial	$731.85
Rate for Payer: Humana Medicare	$266.91
Rate for Payer: Kaiser Permanente Commercial	$774.90
Rate for Payer: Kaiser Permanente Medicaid	$439.11
Rate for Payer: Kaiser Permanente Medicare	$266.91
Rate for Payer: MDX Hawaii PPO	$835.17
Rate for Payer: Ohana Health Plan Medicaid	$266.91
Rate for Payer: Ohana Health Plan Medicare	$266.91
Rate for Payer: UnitedHealthcare Medicaid	$516.60
Rate for Payer: UnitedHealthcare Medicare	$266.91
Rate for Payer: University Health Alliance Commercial	$627.58

MYRIAD MATRIX 5X5 SR02LG0505US

Facility

$861.00

Service Code	HCPCS A2032
Hospital Revenue Code	636
Min. Negotiated Rate	$731.85
Max. Negotiated Rate	$835.17
Rate for Payer: Cash Price	$516.60
Rate for Payer: Health Management Network Commercial	$731.85
Rate for Payer: Kaiser Permanente Commercial	$774.90
Rate for Payer: MDX Hawaii PPO	$835.17

MYRIAD MATRIX SR02LG1010US

Facility

$2,756.00

Service Code	HCPCS A2032
Hospital Revenue Code	636
Min. Negotiated Rate	$2,342.60
Max. Negotiated Rate	$2,673.32
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Kaiser Permanente Commercial	$2,480.40
Rate for Payer: MDX Hawaii PPO	$2,673.32

MYRIAD MATRIX SR02LG1010US

Facility

$2,756.00

Service Code	HCPCS A2032
Hospital Revenue Code	636
Min. Negotiated Rate	$854.36
Max. Negotiated Rate	$2,673.32
Rate for Payer: AlohaCare Medicaid	$1,378.00
Rate for Payer: AlohaCare Medicare	$854.36
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Devoted Health Medicare	$937.04
Rate for Payer: Hawaii Medical Service Association Medicare	$854.36
Rate for Payer: Hawaii Western Management Group Commercial	$2,618.20
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Humana Medicare	$854.36
Rate for Payer: Kaiser Permanente Commercial	$2,480.40
Rate for Payer: Kaiser Permanente Medicaid	$1,405.56
Rate for Payer: Kaiser Permanente Medicare	$854.36
Rate for Payer: MDX Hawaii PPO	$2,673.32
Rate for Payer: Ohana Health Plan Medicaid	$854.36
Rate for Payer: Ohana Health Plan Medicare	$854.36
Rate for Payer: UnitedHealthcare Medicaid	$1,653.60
Rate for Payer: UnitedHealthcare Medicare	$854.36
Rate for Payer: University Health Alliance Commercial	$2,008.85

MYRIAD MATRIX SR02LG2020US

Facility

$7,350.00

Service Code	HCPCS A2032
Hospital Revenue Code	636
Min. Negotiated Rate	$2,278.50
Max. Negotiated Rate	$7,129.50
Rate for Payer: AlohaCare Medicaid	$3,675.00
Rate for Payer: AlohaCare Medicare	$2,278.50
Rate for Payer: Cash Price	$4,410.00
Rate for Payer: Devoted Health Medicare	$2,499.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,278.50
Rate for Payer: Hawaii Western Management Group Commercial	$6,982.50
Rate for Payer: Health Management Network Commercial	$6,247.50
Rate for Payer: Humana Medicare	$2,278.50
Rate for Payer: Kaiser Permanente Commercial	$6,615.00
Rate for Payer: Kaiser Permanente Medicaid	$3,748.50
Rate for Payer: Kaiser Permanente Medicare	$2,278.50
Rate for Payer: MDX Hawaii PPO	$7,129.50
Rate for Payer: Ohana Health Plan Medicaid	$2,278.50
Rate for Payer: Ohana Health Plan Medicare	$2,278.50
Rate for Payer: UnitedHealthcare Medicaid	$4,410.00
Rate for Payer: UnitedHealthcare Medicare	$2,278.50
Rate for Payer: University Health Alliance Commercial	$5,357.41

MYRIAD MATRIX SR02LG2020US

Facility

$7,350.00

Service Code	HCPCS A2032
Hospital Revenue Code	636
Min. Negotiated Rate	$6,247.50
Max. Negotiated Rate	$7,129.50
Rate for Payer: Cash Price	$4,410.00
Rate for Payer: Health Management Network Commercial	$6,247.50
Rate for Payer: Kaiser Permanente Commercial	$6,615.00
Rate for Payer: MDX Hawaii PPO	$7,129.50

NADOLOL 20 MG TABLET [5330]

Facility

$13.00

Service Code	NDC 60687030295
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

NADOLOL 20 MG TABLET [5330]

Facility

$13.00

Service Code	NDC 60687030295
Hospital Revenue Code	637
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$12.61
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$4.03
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$4.42
Rate for Payer: Hawaii Medical Service Association Medicare	$4.03
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Humana Medicare	$4.03
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$4.03
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: Ohana Health Plan Medicaid	$4.03
Rate for Payer: Ohana Health Plan Medicare	$4.03
Rate for Payer: UnitedHealthcare Medicare	$4.03
Rate for Payer: University Health Alliance Commercial	$9.48

NADOLOL 20 MG TABLET [5330]

Facility

$13.00

Service Code	NDC 60687030225
Hospital Revenue Code	637
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$12.61
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$4.03
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$4.42
Rate for Payer: Hawaii Medical Service Association Medicare	$4.03
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Humana Medicare	$4.03
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$4.03
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: Ohana Health Plan Medicaid	$4.03
Rate for Payer: Ohana Health Plan Medicare	$4.03
Rate for Payer: UnitedHealthcare Medicare	$4.03
Rate for Payer: University Health Alliance Commercial	$9.48

NADOLOL 20 MG TABLET [5330]

Facility

$13.00

Service Code	NDC 00904707007
Hospital Revenue Code	637
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$12.61
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$4.03
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$4.42
Rate for Payer: Hawaii Medical Service Association Medicare	$4.03
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Humana Medicare	$4.03
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$4.03
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: Ohana Health Plan Medicaid	$4.03
Rate for Payer: Ohana Health Plan Medicare	$4.03
Rate for Payer: UnitedHealthcare Medicare	$4.03
Rate for Payer: University Health Alliance Commercial	$9.48

NADOLOL 20 MG TABLET [5330]

Facility

$13.00

Service Code	NDC 60687030225
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

NADOLOL 20 MG TABLET [5330]

Facility

$13.00

Service Code	NDC 00904707007
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

NAIL 011X400 125° 3525-1400S

Facility

$6,402.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,585.12
Max. Negotiated Rate	$6,209.94
Rate for Payer: Cash Price	$3,841.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,481.40
Rate for Payer: Health Management Network Commercial	$5,441.70
Rate for Payer: Kaiser Permanente Commercial	$5,761.80
Rate for Payer: MDX Hawaii PPO	$6,209.94
Rate for Payer: University Health Alliance Commercial	$3,585.12

NAIL 011X400 125° 3525-1400S

Facility

$6,402.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,984.62
Max. Negotiated Rate	$6,209.94
Rate for Payer: AlohaCare Medicaid	$3,201.00
Rate for Payer: AlohaCare Medicare	$1,984.62
Rate for Payer: Cash Price	$3,841.20
Rate for Payer: Devoted Health Medicare	$2,176.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,984.62
Rate for Payer: Hawaii Western Management Group Commercial	$4,481.40
Rate for Payer: Health Management Network Commercial	$5,441.70
Rate for Payer: Humana Medicare	$1,984.62
Rate for Payer: Kaiser Permanente Commercial	$5,761.80
Rate for Payer: Kaiser Permanente Medicaid	$3,265.02
Rate for Payer: Kaiser Permanente Medicare	$1,984.62
Rate for Payer: MDX Hawaii PPO	$6,209.94
Rate for Payer: Ohana Health Plan Medicaid	$1,984.62
Rate for Payer: Ohana Health Plan Medicare	$1,984.62
Rate for Payer: UnitedHealthcare Medicare	$1,984.62
Rate for Payer: University Health Alliance Commercial	$3,585.12

NAIL 10MM CANN LF 04.033.067S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.12
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

NAIL 10MM CANN LF 04.033.067S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.62
Max. Negotiated Rate	$4,851.94
Rate for Payer: AlohaCare Medicaid	$2,501.00
Rate for Payer: AlohaCare Medicare	$1,550.62
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Devoted Health Medicare	$1,700.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.62
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Humana Medicare	$1,550.62
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: Kaiser Permanente Medicaid	$2,551.02
Rate for Payer: Kaiser Permanente Medicare	$1,550.62
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: Ohana Health Plan Medicaid	$1,550.62
Rate for Payer: Ohana Health Plan Medicare	$1,550.62
Rate for Payer: UnitedHealthcare Medicare	$1,550.62
Rate for Payer: University Health Alliance Commercial	$2,801.12

NAIL 10MM TI CANN 04.008.066S

Facility

$3,860.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,161.60
Max. Negotiated Rate	$3,744.20
Rate for Payer: Cash Price	$2,316.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,702.00
Rate for Payer: Health Management Network Commercial	$3,281.00
Rate for Payer: Kaiser Permanente Commercial	$3,474.00
Rate for Payer: MDX Hawaii PPO	$3,744.20
Rate for Payer: University Health Alliance Commercial	$2,161.60

NAIL 10MM TI CANN 04.008.066S

Facility

$3,860.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.60
Max. Negotiated Rate	$3,744.20
Rate for Payer: AlohaCare Medicaid	$1,930.00
Rate for Payer: AlohaCare Medicare	$1,196.60
Rate for Payer: Cash Price	$2,316.00
Rate for Payer: Devoted Health Medicare	$1,312.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,196.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,702.00
Rate for Payer: Health Management Network Commercial	$3,281.00
Rate for Payer: Humana Medicare	$1,196.60
Rate for Payer: Kaiser Permanente Commercial	$3,474.00
Rate for Payer: Kaiser Permanente Medicaid	$1,968.60
Rate for Payer: Kaiser Permanente Medicare	$1,196.60
Rate for Payer: MDX Hawaii PPO	$3,744.20
Rate for Payer: Ohana Health Plan Medicaid	$1,196.60
Rate for Payer: Ohana Health Plan Medicare	$1,196.60
Rate for Payer: UnitedHealthcare Medicare	$1,196.60
Rate for Payer: University Health Alliance Commercial	$2,161.60

NAIL 10MMX285 ST 04.004.437S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,126.85
Max. Negotiated Rate	$3,525.95
Rate for Payer: AlohaCare Medicaid	$1,817.50
Rate for Payer: AlohaCare Medicare	$1,126.85
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Devoted Health Medicare	$1,235.90
Rate for Payer: Hawaii Medical Service Association Medicare	$1,126.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: Humana Medicare	$1,126.85
Rate for Payer: Kaiser Permanente Commercial	$3,271.50
Rate for Payer: Kaiser Permanente Medicaid	$1,853.85
Rate for Payer: Kaiser Permanente Medicare	$1,126.85
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: Ohana Health Plan Medicaid	$1,126.85
Rate for Payer: Ohana Health Plan Medicare	$1,126.85
Rate for Payer: UnitedHealthcare Medicare	$1,126.85
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL 10MMX285 ST 04.004.437S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.60
Max. Negotiated Rate	$3,525.95
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: Kaiser Permanente Commercial	$3,271.50
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL 10X170 125 DEG 8125-0170S

Facility

$4,781.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,482.11
Max. Negotiated Rate	$4,637.57
Rate for Payer: AlohaCare Medicaid	$2,390.50
Rate for Payer: AlohaCare Medicare	$1,482.11
Rate for Payer: Cash Price	$2,868.60
Rate for Payer: Devoted Health Medicare	$1,625.54
Rate for Payer: Hawaii Medical Service Association Medicare	$1,482.11
Rate for Payer: Hawaii Western Management Group Commercial	$3,346.70
Rate for Payer: Health Management Network Commercial	$4,063.85
Rate for Payer: Humana Medicare	$1,482.11
Rate for Payer: Kaiser Permanente Commercial	$4,302.90
Rate for Payer: Kaiser Permanente Medicaid	$2,438.31
Rate for Payer: Kaiser Permanente Medicare	$1,482.11
Rate for Payer: MDX Hawaii PPO	$4,637.57
Rate for Payer: Ohana Health Plan Medicaid	$1,482.11
Rate for Payer: Ohana Health Plan Medicare	$1,482.11
Rate for Payer: UnitedHealthcare Medicare	$1,482.11
Rate for Payer: University Health Alliance Commercial	$2,677.36

Know your out-of-pocket cost for care.

All Charges