Kau Hospital

All Charges

Charge

Type

Setting

Price

NAIL CANN 10X300MM 04.004.440S

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 CANN 10X300MM 04.004.440S

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 CANN 10X330MM 04.004.446S

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 CANN 10X330MM 04.004.446S

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 CANN RT 9X360 04.033.966S

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 CANN RT 9X360 04.033.966S

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 CANNULATE 10M 04.004.458S

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 CANNULATE 10M 04.004.458S

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 FEMORA 11X300 04.013.540S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,223.20
Max. Negotiated Rate	$3,850.90
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORA 11X300 04.013.540S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,230.70
Max. Negotiated Rate	$3,850.90
Rate for Payer: AlohaCare Medicaid	$1,985.00
Rate for Payer: AlohaCare Medicare	$1,230.70
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Devoted Health Medicare	$1,349.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,230.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Humana Medicare	$1,230.70
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: Kaiser Permanente Medicaid	$2,024.70
Rate for Payer: Kaiser Permanente Medicare	$1,230.70
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: Ohana Health Plan Medicaid	$1,230.70
Rate for Payer: Ohana Health Plan Medicare	$1,230.70
Rate for Payer: UnitedHealthcare Medicare	$1,230.70
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORA 11X320 04.013.544S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,230.70
Max. Negotiated Rate	$3,850.90
Rate for Payer: AlohaCare Medicaid	$1,985.00
Rate for Payer: AlohaCare Medicare	$1,230.70
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Devoted Health Medicare	$1,349.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,230.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Humana Medicare	$1,230.70
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: Kaiser Permanente Medicaid	$2,024.70
Rate for Payer: Kaiser Permanente Medicare	$1,230.70
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: Ohana Health Plan Medicaid	$1,230.70
Rate for Payer: Ohana Health Plan Medicare	$1,230.70
Rate for Payer: UnitedHealthcare Medicare	$1,230.70
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORA 11X320 04.013.544S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,223.20
Max. Negotiated Rate	$3,850.90
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORA 11X340 04.013.548S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,223.20
Max. Negotiated Rate	$3,850.90
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORA 11X340 04.013.548S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,230.70
Max. Negotiated Rate	$3,850.90
Rate for Payer: AlohaCare Medicaid	$1,985.00
Rate for Payer: AlohaCare Medicare	$1,230.70
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Devoted Health Medicare	$1,349.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,230.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Humana Medicare	$1,230.70
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: Kaiser Permanente Medicaid	$2,024.70
Rate for Payer: Kaiser Permanente Medicare	$1,230.70
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: Ohana Health Plan Medicaid	$1,230.70
Rate for Payer: Ohana Health Plan Medicare	$1,230.70
Rate for Payer: UnitedHealthcare Medicare	$1,230.70
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORA 11X360 04.013.552S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,223.20
Max. Negotiated Rate	$3,850.90
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORA 11X360 04.013.552S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,230.70
Max. Negotiated Rate	$3,850.90
Rate for Payer: AlohaCare Medicaid	$1,985.00
Rate for Payer: AlohaCare Medicare	$1,230.70
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Devoted Health Medicare	$1,349.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,230.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Humana Medicare	$1,230.70
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: Kaiser Permanente Medicaid	$2,024.70
Rate for Payer: Kaiser Permanente Medicare	$1,230.70
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: Ohana Health Plan Medicaid	$1,230.70
Rate for Payer: Ohana Health Plan Medicare	$1,230.70
Rate for Payer: UnitedHealthcare Medicare	$1,230.70
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORA 11X380 04.013.556S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,230.70
Max. Negotiated Rate	$3,850.90
Rate for Payer: AlohaCare Medicaid	$1,985.00
Rate for Payer: AlohaCare Medicare	$1,230.70
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Devoted Health Medicare	$1,349.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,230.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Humana Medicare	$1,230.70
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: Kaiser Permanente Medicaid	$2,024.70
Rate for Payer: Kaiser Permanente Medicare	$1,230.70
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: Ohana Health Plan Medicaid	$1,230.70
Rate for Payer: Ohana Health Plan Medicare	$1,230.70
Rate for Payer: UnitedHealthcare Medicare	$1,230.70
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORA 11X380 04.013.556S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,223.20
Max. Negotiated Rate	$3,850.90
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORA 11X400 04.013.560S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,230.70
Max. Negotiated Rate	$3,850.90
Rate for Payer: AlohaCare Medicaid	$1,985.00
Rate for Payer: AlohaCare Medicare	$1,230.70
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Devoted Health Medicare	$1,349.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,230.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Humana Medicare	$1,230.70
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: Kaiser Permanente Medicaid	$2,024.70
Rate for Payer: Kaiser Permanente Medicare	$1,230.70
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: Ohana Health Plan Medicaid	$1,230.70
Rate for Payer: Ohana Health Plan Medicare	$1,230.70
Rate for Payer: UnitedHealthcare Medicare	$1,230.70
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORA 11X400 04.013.560S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,223.20
Max. Negotiated Rate	$3,850.90
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORA 11X420 04.013.564S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,230.70
Max. Negotiated Rate	$3,850.90
Rate for Payer: AlohaCare Medicaid	$1,985.00
Rate for Payer: AlohaCare Medicare	$1,230.70
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Devoted Health Medicare	$1,349.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,230.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Humana Medicare	$1,230.70
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: Kaiser Permanente Medicaid	$2,024.70
Rate for Payer: Kaiser Permanente Medicare	$1,230.70
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: Ohana Health Plan Medicaid	$1,230.70
Rate for Payer: Ohana Health Plan Medicare	$1,230.70
Rate for Payer: UnitedHealthcare Medicare	$1,230.70
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORA 11X420 04.013.564S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,223.20
Max. Negotiated Rate	$3,850.90
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORAL 12X300 2339-1230S

Facility

$6,838.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,829.28
Max. Negotiated Rate	$6,632.86
Rate for Payer: Cash Price	$4,102.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,786.60
Rate for Payer: Health Management Network Commercial	$5,812.30
Rate for Payer: Kaiser Permanente Commercial	$6,154.20
Rate for Payer: MDX Hawaii PPO	$6,632.86
Rate for Payer: University Health Alliance Commercial	$3,829.28

NAIL FEMORAL 12X300 2339-1230S

Facility

$6,838.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,119.78
Max. Negotiated Rate	$6,632.86
Rate for Payer: AlohaCare Medicaid	$3,419.00
Rate for Payer: AlohaCare Medicare	$2,119.78
Rate for Payer: Cash Price	$4,102.80
Rate for Payer: Devoted Health Medicare	$2,324.92
Rate for Payer: Hawaii Medical Service Association Medicare	$2,119.78
Rate for Payer: Hawaii Western Management Group Commercial	$4,786.60
Rate for Payer: Health Management Network Commercial	$5,812.30
Rate for Payer: Humana Medicare	$2,119.78
Rate for Payer: Kaiser Permanente Commercial	$6,154.20
Rate for Payer: Kaiser Permanente Medicaid	$3,487.38
Rate for Payer: Kaiser Permanente Medicare	$2,119.78
Rate for Payer: MDX Hawaii PPO	$6,632.86
Rate for Payer: Ohana Health Plan Medicaid	$2,119.78
Rate for Payer: Ohana Health Plan Medicare	$2,119.78
Rate for Payer: UnitedHealthcare Medicare	$2,119.78
Rate for Payer: University Health Alliance Commercial	$3,829.28

NAIL FEMORAL 13X380 2339-1336S

Facility

$5,463.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,693.53
Max. Negotiated Rate	$5,299.11
Rate for Payer: AlohaCare Medicaid	$2,731.50
Rate for Payer: AlohaCare Medicare	$1,693.53
Rate for Payer: Cash Price	$3,277.80
Rate for Payer: Devoted Health Medicare	$1,857.42
Rate for Payer: Hawaii Medical Service Association Medicare	$1,693.53
Rate for Payer: Hawaii Western Management Group Commercial	$3,824.10
Rate for Payer: Health Management Network Commercial	$4,643.55
Rate for Payer: Humana Medicare	$1,693.53
Rate for Payer: Kaiser Permanente Commercial	$4,916.70
Rate for Payer: Kaiser Permanente Medicaid	$2,786.13
Rate for Payer: Kaiser Permanente Medicare	$1,693.53
Rate for Payer: MDX Hawaii PPO	$5,299.11
Rate for Payer: Ohana Health Plan Medicaid	$1,693.53
Rate for Payer: Ohana Health Plan Medicare	$1,693.53
Rate for Payer: UnitedHealthcare Medicare	$1,693.53
Rate for Payer: University Health Alliance Commercial	$3,059.28

Know your out-of-pocket cost for care.

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