Kau Hospital

All Charges

Charge

Type

Setting

Price

NEEDLE ACCESS PERC 18X12

Facility

$379.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$117.49
Max. Negotiated Rate	$367.63
Rate for Payer: AlohaCare Medicaid	$189.50
Rate for Payer: AlohaCare Medicare	$117.49
Rate for Payer: Cash Price	$227.40
Rate for Payer: Devoted Health Medicare	$128.86
Rate for Payer: Hawaii Medical Service Association Medicare	$117.49
Rate for Payer: Hawaii Western Management Group Commercial	$360.05
Rate for Payer: Health Management Network Commercial	$322.15
Rate for Payer: Humana Medicare	$117.49
Rate for Payer: Kaiser Permanente Commercial	$341.10
Rate for Payer: Kaiser Permanente Medicaid	$193.29
Rate for Payer: Kaiser Permanente Medicare	$117.49
Rate for Payer: MDX Hawaii PPO	$367.63
Rate for Payer: Ohana Health Plan Medicaid	$117.49
Rate for Payer: Ohana Health Plan Medicare	$117.49
Rate for Payer: UnitedHealthcare Medicare	$117.49
Rate for Payer: University Health Alliance Commercial	$276.25

NEEDLE ACCESS PERC 18X12

Facility

$379.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$322.15
Max. Negotiated Rate	$367.63
Rate for Payer: Cash Price	$227.40
Rate for Payer: Health Management Network Commercial	$322.15
Rate for Payer: Kaiser Permanente Commercial	$341.10
Rate for Payer: MDX Hawaii PPO	$367.63

NEEDLE ACCESS PERC 18X20

Facility

$155.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$93.00
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: MDX Hawaii PPO	$150.35

NEEDLE ACCESS PERC 18X20

Facility

$155.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$48.05
Max. Negotiated Rate	$150.35
Rate for Payer: AlohaCare Medicaid	$77.50
Rate for Payer: AlohaCare Medicare	$48.05
Rate for Payer: Cash Price	$93.00
Rate for Payer: Devoted Health Medicare	$52.70
Rate for Payer: Hawaii Medical Service Association Medicare	$48.05
Rate for Payer: Hawaii Western Management Group Commercial	$147.25
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Humana Medicare	$48.05
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: Kaiser Permanente Medicare	$48.05
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: Ohana Health Plan Medicaid	$48.05
Rate for Payer: Ohana Health Plan Medicare	$48.05
Rate for Payer: UnitedHealthcare Medicare	$48.05
Rate for Payer: University Health Alliance Commercial	$112.98

NEEDLE BIOPSY 18GX11

Facility

$214.00

Hospital Revenue Code	270
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$128.40
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: MDX Hawaii PPO	$207.58

NEEDLE BIOPSY 18GX11

Facility

$214.00

Hospital Revenue Code	270
Min. Negotiated Rate	$66.34
Max. Negotiated Rate	$207.58
Rate for Payer: AlohaCare Medicaid	$107.00
Rate for Payer: AlohaCare Medicare	$66.34
Rate for Payer: Cash Price	$128.40
Rate for Payer: Devoted Health Medicare	$72.76
Rate for Payer: Hawaii Medical Service Association Medicare	$66.34
Rate for Payer: Hawaii Western Management Group Commercial	$203.30
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Humana Medicare	$66.34
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: Kaiser Permanente Medicaid	$109.14
Rate for Payer: Kaiser Permanente Medicare	$66.34
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: Ohana Health Plan Medicaid	$66.34
Rate for Payer: Ohana Health Plan Medicare	$66.34
Rate for Payer: UnitedHealthcare Medicare	$66.34
Rate for Payer: University Health Alliance Commercial	$155.98

NEEDLE BIOPSY 18GX15

Facility

$243.00

Hospital Revenue Code	270
Min. Negotiated Rate	$206.55
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$145.80
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Kaiser Permanente Commercial	$218.70
Rate for Payer: MDX Hawaii PPO	$235.71

NEEDLE BIOPSY 18GX15

Facility

$243.00

Hospital Revenue Code	270
Min. Negotiated Rate	$75.33
Max. Negotiated Rate	$235.71
Rate for Payer: AlohaCare Medicaid	$121.50
Rate for Payer: AlohaCare Medicare	$75.33
Rate for Payer: Cash Price	$145.80
Rate for Payer: Devoted Health Medicare	$82.62
Rate for Payer: Hawaii Medical Service Association Medicare	$75.33
Rate for Payer: Hawaii Western Management Group Commercial	$230.85
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Humana Medicare	$75.33
Rate for Payer: Kaiser Permanente Commercial	$218.70
Rate for Payer: Kaiser Permanente Medicaid	$123.93
Rate for Payer: Kaiser Permanente Medicare	$75.33
Rate for Payer: MDX Hawaii PPO	$235.71
Rate for Payer: Ohana Health Plan Medicaid	$75.33
Rate for Payer: Ohana Health Plan Medicare	$75.33
Rate for Payer: UnitedHealthcare Medicare	$75.33
Rate for Payer: University Health Alliance Commercial	$177.12

NEEDLE BIOPSY 18GX20

Facility

$209.00

Hospital Revenue Code	272
Min. Negotiated Rate	$177.65
Max. Negotiated Rate	$202.73
Rate for Payer: Cash Price	$125.40
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: Kaiser Permanente Commercial	$188.10
Rate for Payer: MDX Hawaii PPO	$202.73

NEEDLE BIOPSY 18GX20

Facility

$209.00

Hospital Revenue Code	272
Min. Negotiated Rate	$64.79
Max. Negotiated Rate	$202.73
Rate for Payer: AlohaCare Medicaid	$104.50
Rate for Payer: AlohaCare Medicare	$64.79
Rate for Payer: Cash Price	$125.40
Rate for Payer: Devoted Health Medicare	$71.06
Rate for Payer: Hawaii Medical Service Association Medicare	$64.79
Rate for Payer: Hawaii Western Management Group Commercial	$198.55
Rate for Payer: Health Management Network Commercial	$177.65
Rate for Payer: Humana Medicare	$64.79
Rate for Payer: Kaiser Permanente Commercial	$188.10
Rate for Payer: Kaiser Permanente Medicaid	$106.59
Rate for Payer: Kaiser Permanente Medicare	$64.79
Rate for Payer: MDX Hawaii PPO	$202.73
Rate for Payer: Ohana Health Plan Medicaid	$64.79
Rate for Payer: Ohana Health Plan Medicare	$64.79
Rate for Payer: UnitedHealthcare Medicare	$64.79
Rate for Payer: University Health Alliance Commercial	$152.34

NEEDLE BONE MARROW 15G

Facility

$78.00

Hospital Revenue Code	272
Min. Negotiated Rate	$24.18
Max. Negotiated Rate	$75.66
Rate for Payer: AlohaCare Medicaid	$39.00
Rate for Payer: AlohaCare Medicare	$24.18
Rate for Payer: Cash Price	$46.80
Rate for Payer: Devoted Health Medicare	$26.52
Rate for Payer: Hawaii Medical Service Association Medicare	$24.18
Rate for Payer: Hawaii Western Management Group Commercial	$74.10
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Humana Medicare	$24.18
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: Kaiser Permanente Medicaid	$39.78
Rate for Payer: Kaiser Permanente Medicare	$24.18
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: Ohana Health Plan Medicaid	$24.18
Rate for Payer: Ohana Health Plan Medicare	$24.18
Rate for Payer: UnitedHealthcare Medicare	$24.18
Rate for Payer: University Health Alliance Commercial	$56.85

NEEDLE BONE MARROW 15G

Facility

$78.00

Hospital Revenue Code	272
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: MDX Hawaii PPO	$75.66

NEEDLE BONE MARROW 18G

Facility

$83.00

Hospital Revenue Code	272
Min. Negotiated Rate	$70.55
Max. Negotiated Rate	$80.51
Rate for Payer: Cash Price	$49.80
Rate for Payer: Health Management Network Commercial	$70.55
Rate for Payer: Kaiser Permanente Commercial	$74.70
Rate for Payer: MDX Hawaii PPO	$80.51

NEEDLE BONE MARROW 18G

Facility

$83.00

Hospital Revenue Code	272
Min. Negotiated Rate	$25.73
Max. Negotiated Rate	$80.51
Rate for Payer: AlohaCare Medicaid	$41.50
Rate for Payer: AlohaCare Medicare	$25.73
Rate for Payer: Cash Price	$49.80
Rate for Payer: Devoted Health Medicare	$28.22
Rate for Payer: Hawaii Medical Service Association Medicare	$25.73
Rate for Payer: Hawaii Western Management Group Commercial	$78.85
Rate for Payer: Health Management Network Commercial	$70.55
Rate for Payer: Humana Medicare	$25.73
Rate for Payer: Kaiser Permanente Commercial	$74.70
Rate for Payer: Kaiser Permanente Medicaid	$42.33
Rate for Payer: Kaiser Permanente Medicare	$25.73
Rate for Payer: MDX Hawaii PPO	$80.51
Rate for Payer: Ohana Health Plan Medicaid	$25.73
Rate for Payer: Ohana Health Plan Medicare	$25.73
Rate for Payer: UnitedHealthcare Medicare	$25.73
Rate for Payer: University Health Alliance Commercial	$60.50

NEEDLE BX STNRD 20GX6

Facility

$196.00

Hospital Revenue Code	272
Min. Negotiated Rate	$166.60
Max. Negotiated Rate	$190.12
Rate for Payer: Cash Price	$117.60
Rate for Payer: Health Management Network Commercial	$166.60
Rate for Payer: Kaiser Permanente Commercial	$176.40
Rate for Payer: MDX Hawaii PPO	$190.12

NEEDLE BX STNRD 20GX6

Facility

$196.00

Hospital Revenue Code	272
Min. Negotiated Rate	$60.76
Max. Negotiated Rate	$190.12
Rate for Payer: AlohaCare Medicaid	$98.00
Rate for Payer: AlohaCare Medicare	$60.76
Rate for Payer: Cash Price	$117.60
Rate for Payer: Devoted Health Medicare	$66.64
Rate for Payer: Hawaii Medical Service Association Medicare	$60.76
Rate for Payer: Hawaii Western Management Group Commercial	$186.20
Rate for Payer: Health Management Network Commercial	$166.60
Rate for Payer: Humana Medicare	$60.76
Rate for Payer: Kaiser Permanente Commercial	$176.40
Rate for Payer: Kaiser Permanente Medicaid	$99.96
Rate for Payer: Kaiser Permanente Medicare	$60.76
Rate for Payer: MDX Hawaii PPO	$190.12
Rate for Payer: Ohana Health Plan Medicaid	$60.76
Rate for Payer: Ohana Health Plan Medicare	$60.76
Rate for Payer: UnitedHealthcare Medicare	$60.76
Rate for Payer: University Health Alliance Commercial	$142.86

NEEDLE CHIBA BIOPSY 19GX15

Facility

$114.00

Hospital Revenue Code	272
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$68.40
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Kaiser Permanente Commercial	$102.60
Rate for Payer: MDX Hawaii PPO	$110.58

NEEDLE CHIBA BIOPSY 19GX15

Facility

$114.00

Hospital Revenue Code	272
Min. Negotiated Rate	$35.34
Max. Negotiated Rate	$110.58
Rate for Payer: AlohaCare Medicaid	$57.00
Rate for Payer: AlohaCare Medicare	$35.34
Rate for Payer: Cash Price	$68.40
Rate for Payer: Devoted Health Medicare	$38.76
Rate for Payer: Hawaii Medical Service Association Medicare	$35.34
Rate for Payer: Hawaii Western Management Group Commercial	$108.30
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Humana Medicare	$35.34
Rate for Payer: Kaiser Permanente Commercial	$102.60
Rate for Payer: Kaiser Permanente Medicaid	$58.14
Rate for Payer: Kaiser Permanente Medicare	$35.34
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: Ohana Health Plan Medicaid	$35.34
Rate for Payer: Ohana Health Plan Medicare	$35.34
Rate for Payer: UnitedHealthcare Medicare	$35.34
Rate for Payer: University Health Alliance Commercial	$83.09

NEEDLE CHIBA BIOPSY 22GX10

Facility

$73.00

Hospital Revenue Code	272
Min. Negotiated Rate	$22.63
Max. Negotiated Rate	$70.81
Rate for Payer: AlohaCare Medicaid	$36.50
Rate for Payer: AlohaCare Medicare	$22.63
Rate for Payer: Cash Price	$43.80
Rate for Payer: Devoted Health Medicare	$24.82
Rate for Payer: Hawaii Medical Service Association Medicare	$22.63
Rate for Payer: Hawaii Western Management Group Commercial	$69.35
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Humana Medicare	$22.63
Rate for Payer: Kaiser Permanente Commercial	$65.70
Rate for Payer: Kaiser Permanente Medicaid	$37.23
Rate for Payer: Kaiser Permanente Medicare	$22.63
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: Ohana Health Plan Medicaid	$22.63
Rate for Payer: Ohana Health Plan Medicare	$22.63
Rate for Payer: UnitedHealthcare Medicare	$22.63
Rate for Payer: University Health Alliance Commercial	$53.21

NEEDLE CHIBA BIOPSY 22GX10

Facility

$73.00

Hospital Revenue Code	272
Min. Negotiated Rate	$62.05
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$43.80
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Kaiser Permanente Commercial	$65.70
Rate for Payer: MDX Hawaii PPO	$70.81

NEEDLE CHIBA BIOPSY 22GX20

Facility

$84.00

Hospital Revenue Code	272
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: MDX Hawaii PPO	$81.48

NEEDLE CHIBA BIOPSY 22GX20

Facility

$84.00

Hospital Revenue Code	272
Min. Negotiated Rate	$26.04
Max. Negotiated Rate	$81.48
Rate for Payer: AlohaCare Medicaid	$42.00
Rate for Payer: AlohaCare Medicare	$26.04
Rate for Payer: Cash Price	$50.40
Rate for Payer: Devoted Health Medicare	$28.56
Rate for Payer: Hawaii Medical Service Association Medicare	$26.04
Rate for Payer: Hawaii Western Management Group Commercial	$79.80
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Humana Medicare	$26.04
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: Kaiser Permanente Medicaid	$42.84
Rate for Payer: Kaiser Permanente Medicare	$26.04
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: Ohana Health Plan Medicaid	$26.04
Rate for Payer: Ohana Health Plan Medicare	$26.04
Rate for Payer: UnitedHealthcare Medicare	$26.04
Rate for Payer: University Health Alliance Commercial	$61.23

NEEDLE CHIBA SINGLE 22GX15

Facility

$84.00

Hospital Revenue Code	272
Min. Negotiated Rate	$26.04
Max. Negotiated Rate	$81.48
Rate for Payer: AlohaCare Medicaid	$42.00
Rate for Payer: AlohaCare Medicare	$26.04
Rate for Payer: Cash Price	$50.40
Rate for Payer: Devoted Health Medicare	$28.56
Rate for Payer: Hawaii Medical Service Association Medicare	$26.04
Rate for Payer: Hawaii Western Management Group Commercial	$79.80
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Humana Medicare	$26.04
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: Kaiser Permanente Medicaid	$42.84
Rate for Payer: Kaiser Permanente Medicare	$26.04
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: Ohana Health Plan Medicaid	$26.04
Rate for Payer: Ohana Health Plan Medicare	$26.04
Rate for Payer: UnitedHealthcare Medicare	$26.04
Rate for Payer: University Health Alliance Commercial	$61.23

NEEDLE CHIBA SINGLE 22GX15

Facility

$84.00

Hospital Revenue Code	272
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$50.40
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: MDX Hawaii PPO	$81.48

NEEDLE DELIVERY SYSTEM 8GA

Facility

$282.00

Hospital Revenue Code	272
Min. Negotiated Rate	$239.70
Max. Negotiated Rate	$273.54
Rate for Payer: Cash Price	$169.20
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: Kaiser Permanente Commercial	$253.80
Rate for Payer: MDX Hawaii PPO	$273.54

Know your out-of-pocket cost for care.

All Charges