Kau Hospital

All Charges

Charge

Type

Setting

Price

NAIL TI 10X320/LT 04.003.345S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X320/LT 04.003.345S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: AlohaCare Medicaid	$2,150.00
Rate for Payer: AlohaCare Medicare	$1,333.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Devoted Health Medicare	$1,462.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,333.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Humana Medicare	$1,333.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: Kaiser Permanente Medicare	$1,333.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: Ohana Health Plan Medicaid	$1,333.00
Rate for Payer: Ohana Health Plan Medicare	$1,333.00
Rate for Payer: UnitedHealthcare Medicare	$1,333.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X340/LT 04.003.349S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X340/LT 04.003.349S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: AlohaCare Medicaid	$2,150.00
Rate for Payer: AlohaCare Medicare	$1,333.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Devoted Health Medicare	$1,462.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,333.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Humana Medicare	$1,333.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: Kaiser Permanente Medicare	$1,333.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: Ohana Health Plan Medicaid	$1,333.00
Rate for Payer: Ohana Health Plan Medicare	$1,333.00
Rate for Payer: UnitedHealthcare Medicare	$1,333.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X340/RT 04.003.348S

Facility

$4,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,373.30
Max. Negotiated Rate	$4,297.10
Rate for Payer: AlohaCare Medicaid	$2,215.00
Rate for Payer: AlohaCare Medicare	$1,373.30
Rate for Payer: Cash Price	$2,658.00
Rate for Payer: Devoted Health Medicare	$1,506.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,373.30
Rate for Payer: Hawaii Western Management Group Commercial	$3,101.00
Rate for Payer: Health Management Network Commercial	$3,765.50
Rate for Payer: Humana Medicare	$1,373.30
Rate for Payer: Kaiser Permanente Commercial	$3,987.00
Rate for Payer: Kaiser Permanente Medicaid	$2,259.30
Rate for Payer: Kaiser Permanente Medicare	$1,373.30
Rate for Payer: MDX Hawaii PPO	$4,297.10
Rate for Payer: Ohana Health Plan Medicaid	$1,373.30
Rate for Payer: Ohana Health Plan Medicare	$1,373.30
Rate for Payer: UnitedHealthcare Medicare	$1,373.30
Rate for Payer: University Health Alliance Commercial	$2,480.80

NAIL TI 10X340/RT 04.003.348S

Facility

$4,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,480.80
Max. Negotiated Rate	$4,297.10
Rate for Payer: Cash Price	$2,658.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,101.00
Rate for Payer: Health Management Network Commercial	$3,765.50
Rate for Payer: Kaiser Permanente Commercial	$3,987.00
Rate for Payer: MDX Hawaii PPO	$4,297.10
Rate for Payer: University Health Alliance Commercial	$2,480.80

NAIL TI 10X360/LT 04.003.353S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X360/LT 04.003.353S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: AlohaCare Medicaid	$2,150.00
Rate for Payer: AlohaCare Medicare	$1,333.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Devoted Health Medicare	$1,462.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,333.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Humana Medicare	$1,333.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: Kaiser Permanente Medicare	$1,333.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: Ohana Health Plan Medicaid	$1,333.00
Rate for Payer: Ohana Health Plan Medicare	$1,333.00
Rate for Payer: UnitedHealthcare Medicare	$1,333.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X360/RT 04.003.352S

Facility

$4,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,480.80
Max. Negotiated Rate	$4,297.10
Rate for Payer: Cash Price	$2,658.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,101.00
Rate for Payer: Health Management Network Commercial	$3,765.50
Rate for Payer: Kaiser Permanente Commercial	$3,987.00
Rate for Payer: MDX Hawaii PPO	$4,297.10
Rate for Payer: University Health Alliance Commercial	$2,480.80

NAIL TI 10X360/RT 04.003.352S

Facility

$4,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,373.30
Max. Negotiated Rate	$4,297.10
Rate for Payer: AlohaCare Medicaid	$2,215.00
Rate for Payer: AlohaCare Medicare	$1,373.30
Rate for Payer: Cash Price	$2,658.00
Rate for Payer: Devoted Health Medicare	$1,506.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,373.30
Rate for Payer: Hawaii Western Management Group Commercial	$3,101.00
Rate for Payer: Health Management Network Commercial	$3,765.50
Rate for Payer: Humana Medicare	$1,373.30
Rate for Payer: Kaiser Permanente Commercial	$3,987.00
Rate for Payer: Kaiser Permanente Medicaid	$2,259.30
Rate for Payer: Kaiser Permanente Medicare	$1,373.30
Rate for Payer: MDX Hawaii PPO	$4,297.10
Rate for Payer: Ohana Health Plan Medicaid	$1,373.30
Rate for Payer: Ohana Health Plan Medicare	$1,373.30
Rate for Payer: UnitedHealthcare Medicare	$1,373.30
Rate for Payer: University Health Alliance Commercial	$2,480.80

NAIL TI 10X380/LT 04.003.357S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X380/LT 04.003.357S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: AlohaCare Medicaid	$2,150.00
Rate for Payer: AlohaCare Medicare	$1,333.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Devoted Health Medicare	$1,462.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,333.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Humana Medicare	$1,333.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: Kaiser Permanente Medicare	$1,333.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: Ohana Health Plan Medicaid	$1,333.00
Rate for Payer: Ohana Health Plan Medicare	$1,333.00
Rate for Payer: UnitedHealthcare Medicare	$1,333.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X400/LT 04.003.361S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: AlohaCare Medicaid	$2,150.00
Rate for Payer: AlohaCare Medicare	$1,333.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Devoted Health Medicare	$1,462.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,333.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Humana Medicare	$1,333.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: Kaiser Permanente Medicare	$1,333.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: Ohana Health Plan Medicaid	$1,333.00
Rate for Payer: Ohana Health Plan Medicare	$1,333.00
Rate for Payer: UnitedHealthcare Medicare	$1,333.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X400/LT 04.003.361S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X420/LT 04.003.365S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X420/LT 04.003.365S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: AlohaCare Medicaid	$2,150.00
Rate for Payer: AlohaCare Medicare	$1,333.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Devoted Health Medicare	$1,462.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,333.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Humana Medicare	$1,333.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: Kaiser Permanente Medicare	$1,333.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: Ohana Health Plan Medicaid	$1,333.00
Rate for Payer: Ohana Health Plan Medicare	$1,333.00
Rate for Payer: UnitedHealthcare Medicare	$1,333.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X420/RT 04.003.364S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: AlohaCare Medicaid	$2,150.00
Rate for Payer: AlohaCare Medicare	$1,333.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Devoted Health Medicare	$1,462.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,333.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Humana Medicare	$1,333.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: Kaiser Permanente Medicare	$1,333.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: Ohana Health Plan Medicaid	$1,333.00
Rate for Payer: Ohana Health Plan Medicare	$1,333.00
Rate for Payer: UnitedHealthcare Medicare	$1,333.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 10X420/RT 04.003.364S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 11X320/LT 04.003.445S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 11X320/LT 04.003.445S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: AlohaCare Medicaid	$2,150.00
Rate for Payer: AlohaCare Medicare	$1,333.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Devoted Health Medicare	$1,462.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,333.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Humana Medicare	$1,333.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: Kaiser Permanente Medicare	$1,333.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: Ohana Health Plan Medicaid	$1,333.00
Rate for Payer: Ohana Health Plan Medicare	$1,333.00
Rate for Payer: UnitedHealthcare Medicare	$1,333.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 11X320/RT 04.003.444S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: AlohaCare Medicaid	$2,150.00
Rate for Payer: AlohaCare Medicare	$1,333.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Devoted Health Medicare	$1,462.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,333.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Humana Medicare	$1,333.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: Kaiser Permanente Medicare	$1,333.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: Ohana Health Plan Medicaid	$1,333.00
Rate for Payer: Ohana Health Plan Medicare	$1,333.00
Rate for Payer: UnitedHealthcare Medicare	$1,333.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 11X320/RT 04.003.444S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 11X340/LT 04.003.449S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: AlohaCare Medicaid	$2,150.00
Rate for Payer: AlohaCare Medicare	$1,333.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Devoted Health Medicare	$1,462.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,333.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Humana Medicare	$1,333.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: Kaiser Permanente Medicare	$1,333.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: Ohana Health Plan Medicaid	$1,333.00
Rate for Payer: Ohana Health Plan Medicare	$1,333.00
Rate for Payer: UnitedHealthcare Medicare	$1,333.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 11X340/LT 04.003.449S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

NAIL TI 11X340/RT 04.003.448S

Facility

$4,300.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: AlohaCare Medicaid	$2,150.00
Rate for Payer: AlohaCare Medicare	$1,333.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Devoted Health Medicare	$1,462.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,333.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Humana Medicare	$1,333.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: Kaiser Permanente Medicare	$1,333.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: Ohana Health Plan Medicaid	$1,333.00
Rate for Payer: Ohana Health Plan Medicare	$1,333.00
Rate for Payer: UnitedHealthcare Medicare	$1,333.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

Know your out-of-pocket cost for care.

All Charges