Kau Hospital

All Charges

Charge

Type

Setting

Price

NERVE CONNECTOR 3X15 AGX315

Facility

$3,850.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$1,193.50
Max. Negotiated Rate	$3,734.50
Rate for Payer: AlohaCare Medicaid	$1,925.00
Rate for Payer: AlohaCare Medicare	$1,193.50
Rate for Payer: Cash Price	$2,310.00
Rate for Payer: Devoted Health Medicare	$1,309.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,193.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,695.00
Rate for Payer: Health Management Network Commercial	$3,272.50
Rate for Payer: Humana Medicare	$1,193.50
Rate for Payer: Kaiser Permanente Commercial	$3,465.00
Rate for Payer: Kaiser Permanente Medicaid	$1,963.50
Rate for Payer: Kaiser Permanente Medicare	$1,193.50
Rate for Payer: MDX Hawaii PPO	$3,734.50
Rate for Payer: Ohana Health Plan Medicaid	$1,193.50
Rate for Payer: Ohana Health Plan Medicare	$1,193.50
Rate for Payer: UnitedHealthcare Medicare	$1,193.50
Rate for Payer: University Health Alliance Commercial	$2,156.00

NERVE CONNECTOR 4X15 AGX415

Facility

$3,996.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,237.76
Max. Negotiated Rate	$3,876.12
Rate for Payer: Cash Price	$2,397.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,797.20
Rate for Payer: Health Management Network Commercial	$3,396.60
Rate for Payer: Kaiser Permanente Commercial	$3,596.40
Rate for Payer: MDX Hawaii PPO	$3,876.12
Rate for Payer: University Health Alliance Commercial	$2,237.76

NERVE CONNECTOR 4X15 AGX415

Facility

$3,996.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$1,238.76
Max. Negotiated Rate	$3,876.12
Rate for Payer: AlohaCare Medicaid	$1,998.00
Rate for Payer: AlohaCare Medicare	$1,238.76
Rate for Payer: Cash Price	$2,397.60
Rate for Payer: Devoted Health Medicare	$1,358.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,238.76
Rate for Payer: Hawaii Western Management Group Commercial	$2,797.20
Rate for Payer: Health Management Network Commercial	$3,396.60
Rate for Payer: Humana Medicare	$1,238.76
Rate for Payer: Kaiser Permanente Commercial	$3,596.40
Rate for Payer: Kaiser Permanente Medicaid	$2,037.96
Rate for Payer: Kaiser Permanente Medicare	$1,238.76
Rate for Payer: MDX Hawaii PPO	$3,876.12
Rate for Payer: Ohana Health Plan Medicaid	$1,238.76
Rate for Payer: Ohana Health Plan Medicare	$1,238.76
Rate for Payer: UnitedHealthcare Medicare	$1,238.76
Rate for Payer: University Health Alliance Commercial	$2,237.76

NERVE CONNECTOR 5X40 AG0540

Facility

$5,344.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,992.64
Max. Negotiated Rate	$5,183.68
Rate for Payer: Cash Price	$3,206.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,740.80
Rate for Payer: Health Management Network Commercial	$4,542.40
Rate for Payer: Kaiser Permanente Commercial	$4,809.60
Rate for Payer: MDX Hawaii PPO	$5,183.68
Rate for Payer: University Health Alliance Commercial	$2,992.64

NERVE CONNECTOR 5X40 AG0540

Facility

$5,344.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$1,656.64
Max. Negotiated Rate	$5,183.68
Rate for Payer: AlohaCare Medicaid	$2,672.00
Rate for Payer: AlohaCare Medicare	$1,656.64
Rate for Payer: Cash Price	$3,206.40
Rate for Payer: Devoted Health Medicare	$1,816.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,656.64
Rate for Payer: Hawaii Western Management Group Commercial	$3,740.80
Rate for Payer: Health Management Network Commercial	$4,542.40
Rate for Payer: Humana Medicare	$1,656.64
Rate for Payer: Kaiser Permanente Commercial	$4,809.60
Rate for Payer: Kaiser Permanente Medicaid	$2,725.44
Rate for Payer: Kaiser Permanente Medicare	$1,656.64
Rate for Payer: MDX Hawaii PPO	$5,183.68
Rate for Payer: Ohana Health Plan Medicaid	$1,656.64
Rate for Payer: Ohana Health Plan Medicare	$1,656.64
Rate for Payer: UnitedHealthcare Medicare	$1,656.64
Rate for Payer: University Health Alliance Commercial	$2,992.64

NERVE CONNECTOR 6X15 AGX615

Facility

$3,996.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$1,238.76
Max. Negotiated Rate	$3,876.12
Rate for Payer: AlohaCare Medicaid	$1,998.00
Rate for Payer: AlohaCare Medicare	$1,238.76
Rate for Payer: Cash Price	$2,397.60
Rate for Payer: Devoted Health Medicare	$1,358.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,238.76
Rate for Payer: Hawaii Western Management Group Commercial	$2,797.20
Rate for Payer: Health Management Network Commercial	$3,396.60
Rate for Payer: Humana Medicare	$1,238.76
Rate for Payer: Kaiser Permanente Commercial	$3,596.40
Rate for Payer: Kaiser Permanente Medicaid	$2,037.96
Rate for Payer: Kaiser Permanente Medicare	$1,238.76
Rate for Payer: MDX Hawaii PPO	$3,876.12
Rate for Payer: Ohana Health Plan Medicaid	$1,238.76
Rate for Payer: Ohana Health Plan Medicare	$1,238.76
Rate for Payer: UnitedHealthcare Medicare	$1,238.76
Rate for Payer: University Health Alliance Commercial	$2,237.76

NERVE CONNECTOR 6X15 AGX615

Facility

$3,996.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,237.76
Max. Negotiated Rate	$3,876.12
Rate for Payer: Cash Price	$2,397.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,797.20
Rate for Payer: Health Management Network Commercial	$3,396.60
Rate for Payer: Kaiser Permanente Commercial	$3,596.40
Rate for Payer: MDX Hawaii PPO	$3,876.12
Rate for Payer: University Health Alliance Commercial	$2,237.76

NERVE GRAFT 3MM DIAM 311270

Facility

$16,378.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$9,171.68
Max. Negotiated Rate	$15,886.66
Rate for Payer: Cash Price	$9,826.80
Rate for Payer: Hawaii Western Management Group Commercial	$11,464.60
Rate for Payer: Health Management Network Commercial	$13,921.30
Rate for Payer: Kaiser Permanente Commercial	$14,740.20
Rate for Payer: MDX Hawaii PPO	$15,886.66
Rate for Payer: University Health Alliance Commercial	$9,171.68

NERVE GRAFT 3MM DIAM 311270

Facility

$16,378.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$5,077.18
Max. Negotiated Rate	$15,886.66
Rate for Payer: AlohaCare Medicaid	$8,189.00
Rate for Payer: AlohaCare Medicare	$5,077.18
Rate for Payer: Cash Price	$9,826.80
Rate for Payer: Devoted Health Medicare	$5,568.52
Rate for Payer: Hawaii Medical Service Association Medicare	$5,077.18
Rate for Payer: Hawaii Western Management Group Commercial	$11,464.60
Rate for Payer: Health Management Network Commercial	$13,921.30
Rate for Payer: Humana Medicare	$5,077.18
Rate for Payer: Kaiser Permanente Commercial	$14,740.20
Rate for Payer: Kaiser Permanente Medicaid	$8,352.78
Rate for Payer: Kaiser Permanente Medicare	$5,077.18
Rate for Payer: MDX Hawaii PPO	$15,886.66
Rate for Payer: Ohana Health Plan Medicaid	$5,077.18
Rate for Payer: Ohana Health Plan Medicare	$5,077.18
Rate for Payer: UnitedHealthcare Medicare	$5,077.18
Rate for Payer: University Health Alliance Commercial	$9,171.68

NERVE PROTECTOR 2X15MM AGX215

Facility

$3,996.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$1,238.76
Max. Negotiated Rate	$3,876.12
Rate for Payer: AlohaCare Medicaid	$1,998.00
Rate for Payer: AlohaCare Medicare	$1,238.76
Rate for Payer: Cash Price	$2,397.60
Rate for Payer: Devoted Health Medicare	$1,358.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,238.76
Rate for Payer: Hawaii Western Management Group Commercial	$2,797.20
Rate for Payer: Health Management Network Commercial	$3,396.60
Rate for Payer: Humana Medicare	$1,238.76
Rate for Payer: Kaiser Permanente Commercial	$3,596.40
Rate for Payer: Kaiser Permanente Medicaid	$2,037.96
Rate for Payer: Kaiser Permanente Medicare	$1,238.76
Rate for Payer: MDX Hawaii PPO	$3,876.12
Rate for Payer: Ohana Health Plan Medicaid	$1,238.76
Rate for Payer: Ohana Health Plan Medicare	$1,238.76
Rate for Payer: UnitedHealthcare Medicare	$1,238.76
Rate for Payer: University Health Alliance Commercial	$2,237.76

NERVE PROTECTOR 2X15MM AGX215

Facility

$3,996.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,237.76
Max. Negotiated Rate	$3,876.12
Rate for Payer: Cash Price	$2,397.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,797.20
Rate for Payer: Health Management Network Commercial	$3,396.60
Rate for Payer: Kaiser Permanente Commercial	$3,596.40
Rate for Payer: MDX Hawaii PPO	$3,876.12
Rate for Payer: University Health Alliance Commercial	$2,237.76

NERVE PROTECTOR 7X40MM AG0740

Facility

$5,670.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$3,175.20
Max. Negotiated Rate	$5,499.90
Rate for Payer: Cash Price	$3,402.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,969.00
Rate for Payer: Health Management Network Commercial	$4,819.50
Rate for Payer: Kaiser Permanente Commercial	$5,103.00
Rate for Payer: MDX Hawaii PPO	$5,499.90
Rate for Payer: University Health Alliance Commercial	$3,175.20

NERVE PROTECTOR 7X40MM AG0740

Facility

$5,670.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$1,757.70
Max. Negotiated Rate	$5,499.90
Rate for Payer: AlohaCare Medicaid	$2,835.00
Rate for Payer: AlohaCare Medicare	$1,757.70
Rate for Payer: Cash Price	$3,402.00
Rate for Payer: Devoted Health Medicare	$1,927.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,757.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,969.00
Rate for Payer: Health Management Network Commercial	$4,819.50
Rate for Payer: Humana Medicare	$1,757.70
Rate for Payer: Kaiser Permanente Commercial	$5,103.00
Rate for Payer: Kaiser Permanente Medicaid	$2,891.70
Rate for Payer: Kaiser Permanente Medicare	$1,757.70
Rate for Payer: MDX Hawaii PPO	$5,499.90
Rate for Payer: Ohana Health Plan Medicaid	$1,757.70
Rate for Payer: Ohana Health Plan Medicare	$1,757.70
Rate for Payer: UnitedHealthcare Medicare	$1,757.70
Rate for Payer: University Health Alliance Commercial	$3,175.20

NERVE PROTECTOR AG0340

Facility

$5,344.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,992.64
Max. Negotiated Rate	$5,183.68
Rate for Payer: Cash Price	$3,206.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,740.80
Rate for Payer: Health Management Network Commercial	$4,542.40
Rate for Payer: Kaiser Permanente Commercial	$4,809.60
Rate for Payer: MDX Hawaii PPO	$5,183.68
Rate for Payer: University Health Alliance Commercial	$2,992.64

NERVE PROTECTOR AG0340

Facility

$5,344.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$1,656.64
Max. Negotiated Rate	$5,183.68
Rate for Payer: AlohaCare Medicaid	$2,672.00
Rate for Payer: AlohaCare Medicare	$1,656.64
Rate for Payer: Cash Price	$3,206.40
Rate for Payer: Devoted Health Medicare	$1,816.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,656.64
Rate for Payer: Hawaii Western Management Group Commercial	$3,740.80
Rate for Payer: Health Management Network Commercial	$4,542.40
Rate for Payer: Humana Medicare	$1,656.64
Rate for Payer: Kaiser Permanente Commercial	$4,809.60
Rate for Payer: Kaiser Permanente Medicaid	$2,725.44
Rate for Payer: Kaiser Permanente Medicare	$1,656.64
Rate for Payer: MDX Hawaii PPO	$5,183.68
Rate for Payer: Ohana Health Plan Medicaid	$1,656.64
Rate for Payer: Ohana Health Plan Medicare	$1,656.64
Rate for Payer: UnitedHealthcare Medicare	$1,656.64
Rate for Payer: University Health Alliance Commercial	$2,992.64

NERVOUS SYSTEM NEOPLASMS WITH MCC

Facility

$23,915.32

Service Code	MSDRG 054
Min. Negotiated Rate	$23,915.32
Max. Negotiated Rate	$23,915.32
Rate for Payer: Hawaii Medical Service Association Commercial	$23,915.32

NERVOUS SYSTEM NEOPLASMS WITHOUT MCC

Facility

$23,678.30

Service Code	MSDRG 055
Min. Negotiated Rate	$23,678.30
Max. Negotiated Rate	$23,678.30
Rate for Payer: Hawaii Medical Service Association Commercial	$23,678.30

NEUROLOGICAL EYE DISORDERS

Facility

$16,638.80

Service Code	MSDRG 123
Min. Negotiated Rate	$16,638.80
Max. Negotiated Rate	$16,638.80
Rate for Payer: Hawaii Medical Service Association Commercial	$16,638.80

NEUROSES EXCEPT DEPRESSIVE

Facility

$9,528.20

Service Code	MSDRG 882
Min. Negotiated Rate	$9,528.20
Max. Negotiated Rate	$9,528.20
Rate for Payer: Hawaii Medical Service Association Commercial	$9,528.20

NEUROSTIMULATOR EXTERNL 353101

Facility

$1,470.00

Service Code	HCPCS C1787
Hospital Revenue Code	272
Min. Negotiated Rate	$455.70
Max. Negotiated Rate	$1,425.90
Rate for Payer: AlohaCare Medicaid	$735.00
Rate for Payer: AlohaCare Medicare	$455.70
Rate for Payer: Cash Price	$882.00
Rate for Payer: Devoted Health Medicare	$499.80
Rate for Payer: Hawaii Medical Service Association Medicare	$455.70
Rate for Payer: Hawaii Western Management Group Commercial	$1,396.50
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: Humana Medicare	$455.70
Rate for Payer: Kaiser Permanente Commercial	$1,323.00
Rate for Payer: Kaiser Permanente Medicaid	$749.70
Rate for Payer: Kaiser Permanente Medicare	$455.70
Rate for Payer: MDX Hawaii PPO	$1,425.90
Rate for Payer: Ohana Health Plan Medicaid	$455.70
Rate for Payer: Ohana Health Plan Medicare	$455.70
Rate for Payer: UnitedHealthcare Medicare	$455.70
Rate for Payer: University Health Alliance Commercial	$1,071.48

NEUROSTIMULATOR EXTERNL 353101

Facility

$1,470.00

Service Code	HCPCS C1787
Hospital Revenue Code	272
Min. Negotiated Rate	$1,249.50
Max. Negotiated Rate	$1,425.90
Rate for Payer: Cash Price	$882.00
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: Kaiser Permanente Commercial	$1,323.00
Rate for Payer: MDX Hawaii PPO	$1,425.90

NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION [24119]

Facility

$285.00

Service Code	NDC 65862005724
Hospital Revenue Code	637
Min. Negotiated Rate	$88.35
Max. Negotiated Rate	$276.45
Rate for Payer: AlohaCare Medicaid	$142.50
Rate for Payer: AlohaCare Medicare	$88.35
Rate for Payer: Cash Price	$171.00
Rate for Payer: Devoted Health Medicare	$96.90
Rate for Payer: Hawaii Medical Service Association Medicare	$88.35
Rate for Payer: Hawaii Western Management Group Commercial	$270.75
Rate for Payer: Health Management Network Commercial	$242.25
Rate for Payer: Humana Medicare	$88.35
Rate for Payer: Kaiser Permanente Commercial	$256.50
Rate for Payer: Kaiser Permanente Medicaid	$145.35
Rate for Payer: Kaiser Permanente Medicare	$88.35
Rate for Payer: MDX Hawaii PPO	$276.45
Rate for Payer: Ohana Health Plan Medicaid	$88.35
Rate for Payer: Ohana Health Plan Medicare	$88.35
Rate for Payer: UnitedHealthcare Medicare	$88.35
Rate for Payer: University Health Alliance Commercial	$207.74

NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION [24119]

Facility

$285.00

Service Code	NDC 65862005724
Hospital Revenue Code	250
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$276.45
Rate for Payer: Cash Price	$171.00
Rate for Payer: Health Management Network Commercial	$242.25
Rate for Payer: Kaiser Permanente Commercial	$256.50
Rate for Payer: MDX Hawaii PPO	$276.45

NEXGEN 12X155MM STR 5988-11-12

Facility

$2,239.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$694.09
Max. Negotiated Rate	$2,171.83
Rate for Payer: AlohaCare Medicaid	$1,119.50
Rate for Payer: AlohaCare Medicare	$694.09
Rate for Payer: Cash Price	$1,343.40
Rate for Payer: Devoted Health Medicare	$761.26
Rate for Payer: Hawaii Medical Service Association Medicare	$694.09
Rate for Payer: Hawaii Western Management Group Commercial	$1,567.30
Rate for Payer: Health Management Network Commercial	$1,903.15
Rate for Payer: Humana Medicare	$694.09
Rate for Payer: Kaiser Permanente Commercial	$2,015.10
Rate for Payer: Kaiser Permanente Medicaid	$1,141.89
Rate for Payer: Kaiser Permanente Medicare	$694.09
Rate for Payer: MDX Hawaii PPO	$2,171.83
Rate for Payer: Ohana Health Plan Medicaid	$694.09
Rate for Payer: Ohana Health Plan Medicare	$694.09
Rate for Payer: UnitedHealthcare Medicare	$694.09
Rate for Payer: University Health Alliance Commercial	$1,253.84

NEXGEN 12X155MM STR 5988-11-12

Facility

$2,239.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,253.84
Max. Negotiated Rate	$2,171.83
Rate for Payer: Cash Price	$1,343.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,567.30
Rate for Payer: Health Management Network Commercial	$1,903.15
Rate for Payer: Kaiser Permanente Commercial	$2,015.10
Rate for Payer: MDX Hawaii PPO	$2,171.83
Rate for Payer: University Health Alliance Commercial	$1,253.84

Know your out-of-pocket cost for care.

All Charges