Kau Hospital

All Charges

Charge

Type

Setting

Price

PACEL BIPOLAR PACING CATH 5FR

Facility

$536.00

Hospital Revenue Code	272
Min. Negotiated Rate	$455.60
Max. Negotiated Rate	$519.92
Rate for Payer: Cash Price	$321.60
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: Kaiser Permanente Commercial	$482.40
Rate for Payer: MDX Hawaii PPO	$519.92

PACEMAKER ASSURITY MRI PM2272

Facility

$10,000.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$5,600.00
Max. Negotiated Rate	$9,700.00
Rate for Payer: Cash Price	$6,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,000.00
Rate for Payer: Health Management Network Commercial	$8,500.00
Rate for Payer: Kaiser Permanente Commercial	$9,000.00
Rate for Payer: MDX Hawaii PPO	$9,700.00
Rate for Payer: University Health Alliance Commercial	$5,600.00

PACEMAKER ASSURITY MRI PM2272

Facility

$10,000.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$3,100.00
Max. Negotiated Rate	$9,700.00
Rate for Payer: AlohaCare Medicaid	$5,000.00
Rate for Payer: AlohaCare Medicare	$3,100.00
Rate for Payer: Cash Price	$6,000.00
Rate for Payer: Devoted Health Medicare	$3,400.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,100.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,000.00
Rate for Payer: Health Management Network Commercial	$8,500.00
Rate for Payer: Humana Medicare	$3,100.00
Rate for Payer: Kaiser Permanente Commercial	$9,000.00
Rate for Payer: Kaiser Permanente Medicaid	$5,100.00
Rate for Payer: Kaiser Permanente Medicare	$3,100.00
Rate for Payer: MDX Hawaii PPO	$9,700.00
Rate for Payer: Ohana Health Plan Medicaid	$3,100.00
Rate for Payer: Ohana Health Plan Medicare	$3,100.00
Rate for Payer: UnitedHealthcare Medicare	$3,100.00
Rate for Payer: University Health Alliance Commercial	$5,600.00

PACEMAKER DUAL ASSURITY PM2240

Facility

$9,200.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$2,852.00
Max. Negotiated Rate	$8,924.00
Rate for Payer: AlohaCare Medicaid	$4,600.00
Rate for Payer: AlohaCare Medicare	$2,852.00
Rate for Payer: Cash Price	$5,520.00
Rate for Payer: Devoted Health Medicare	$3,128.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,852.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,440.00
Rate for Payer: Health Management Network Commercial	$7,820.00
Rate for Payer: Humana Medicare	$2,852.00
Rate for Payer: Kaiser Permanente Commercial	$8,280.00
Rate for Payer: Kaiser Permanente Medicaid	$4,692.00
Rate for Payer: Kaiser Permanente Medicare	$2,852.00
Rate for Payer: MDX Hawaii PPO	$8,924.00
Rate for Payer: Ohana Health Plan Medicaid	$2,852.00
Rate for Payer: Ohana Health Plan Medicare	$2,852.00
Rate for Payer: UnitedHealthcare Medicare	$2,852.00
Rate for Payer: University Health Alliance Commercial	$5,152.00

PACEMAKER DUAL ASSURITY PM2240

Facility

$9,200.00

Service Code	HCPCS C1785
Hospital Revenue Code	275
Min. Negotiated Rate	$5,152.00
Max. Negotiated Rate	$8,924.00
Rate for Payer: Cash Price	$5,520.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,440.00
Rate for Payer: Health Management Network Commercial	$7,820.00
Rate for Payer: Kaiser Permanente Commercial	$8,280.00
Rate for Payer: MDX Hawaii PPO	$8,924.00
Rate for Payer: University Health Alliance Commercial	$5,152.00

PACEMAKER PM1272SYSCELL

Facility

$10,850.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$6,076.00
Max. Negotiated Rate	$10,524.50
Rate for Payer: Cash Price	$6,510.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,595.00
Rate for Payer: Health Management Network Commercial	$9,222.50
Rate for Payer: Kaiser Permanente Commercial	$9,765.00
Rate for Payer: MDX Hawaii PPO	$10,524.50
Rate for Payer: University Health Alliance Commercial	$6,076.00

PACEMAKER PM1272SYSCELL

Facility

$10,850.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$3,363.50
Max. Negotiated Rate	$10,524.50
Rate for Payer: AlohaCare Medicaid	$5,425.00
Rate for Payer: AlohaCare Medicare	$3,363.50
Rate for Payer: Cash Price	$6,510.00
Rate for Payer: Devoted Health Medicare	$3,689.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,363.50
Rate for Payer: Hawaii Western Management Group Commercial	$7,595.00
Rate for Payer: Health Management Network Commercial	$9,222.50
Rate for Payer: Humana Medicare	$3,363.50
Rate for Payer: Kaiser Permanente Commercial	$9,765.00
Rate for Payer: Kaiser Permanente Medicaid	$5,533.50
Rate for Payer: Kaiser Permanente Medicare	$3,363.50
Rate for Payer: MDX Hawaii PPO	$10,524.50
Rate for Payer: Ohana Health Plan Medicaid	$3,363.50
Rate for Payer: Ohana Health Plan Medicare	$3,363.50
Rate for Payer: UnitedHealthcare Medicare	$3,363.50
Rate for Payer: University Health Alliance Commercial	$6,076.00

PACEMAKER SINGLE CHAMBER

Facility

$12,004.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$6,722.24
Max. Negotiated Rate	$11,643.88
Rate for Payer: Cash Price	$7,202.40
Rate for Payer: Hawaii Western Management Group Commercial	$8,402.80
Rate for Payer: Health Management Network Commercial	$10,203.40
Rate for Payer: Kaiser Permanente Commercial	$10,803.60
Rate for Payer: MDX Hawaii PPO	$11,643.88
Rate for Payer: University Health Alliance Commercial	$6,722.24

PACEMAKER SINGLE CHAMBER

Facility

$12,004.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$3,721.24
Max. Negotiated Rate	$11,643.88
Rate for Payer: AlohaCare Medicaid	$6,002.00
Rate for Payer: AlohaCare Medicare	$3,721.24
Rate for Payer: Cash Price	$7,202.40
Rate for Payer: Devoted Health Medicare	$4,081.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3,721.24
Rate for Payer: Hawaii Western Management Group Commercial	$8,402.80
Rate for Payer: Health Management Network Commercial	$10,203.40
Rate for Payer: Humana Medicare	$3,721.24
Rate for Payer: Kaiser Permanente Commercial	$10,803.60
Rate for Payer: Kaiser Permanente Medicaid	$6,122.04
Rate for Payer: Kaiser Permanente Medicare	$3,721.24
Rate for Payer: MDX Hawaii PPO	$11,643.88
Rate for Payer: Ohana Health Plan Medicaid	$3,721.24
Rate for Payer: Ohana Health Plan Medicare	$3,721.24
Rate for Payer: UnitedHealthcare Medicare	$3,721.24
Rate for Payer: University Health Alliance Commercial	$6,722.24

PACEMAKER SNGL CD135-740C

Facility

$27,900.00

Service Code	HCPCS C1722
Hospital Revenue Code	275
Min. Negotiated Rate	$15,624.00
Max. Negotiated Rate	$27,063.00
Rate for Payer: Cash Price	$16,740.00
Rate for Payer: Hawaii Western Management Group Commercial	$19,530.00
Rate for Payer: Health Management Network Commercial	$23,715.00
Rate for Payer: Kaiser Permanente Commercial	$25,110.00
Rate for Payer: MDX Hawaii PPO	$27,063.00
Rate for Payer: University Health Alliance Commercial	$15,624.00

PACEMAKER SNGL CD135-740C

Facility

$27,900.00

Service Code	HCPCS C1722
Hospital Revenue Code	275
Min. Negotiated Rate	$8,649.00
Max. Negotiated Rate	$27,063.00
Rate for Payer: AlohaCare Medicaid	$13,950.00
Rate for Payer: AlohaCare Medicare	$8,649.00
Rate for Payer: Cash Price	$16,740.00
Rate for Payer: Devoted Health Medicare	$9,486.00
Rate for Payer: Hawaii Medical Service Association Medicare	$8,649.00
Rate for Payer: Hawaii Western Management Group Commercial	$19,530.00
Rate for Payer: Health Management Network Commercial	$23,715.00
Rate for Payer: Humana Medicare	$8,649.00
Rate for Payer: Kaiser Permanente Commercial	$25,110.00
Rate for Payer: Kaiser Permanente Medicaid	$14,229.00
Rate for Payer: Kaiser Permanente Medicare	$8,649.00
Rate for Payer: MDX Hawaii PPO	$27,063.00
Rate for Payer: Ohana Health Plan Medicaid	$8,649.00
Rate for Payer: Ohana Health Plan Medicare	$8,649.00
Rate for Payer: UnitedHealthcare Medicare	$8,649.00
Rate for Payer: University Health Alliance Commercial	$15,624.00

PACK ARTHRO SHOULDER/KNEE

Facility

$496.00

Hospital Revenue Code	272
Min. Negotiated Rate	$153.76
Max. Negotiated Rate	$481.12
Rate for Payer: AlohaCare Medicaid	$248.00
Rate for Payer: AlohaCare Medicare	$153.76
Rate for Payer: Cash Price	$297.60
Rate for Payer: Devoted Health Medicare	$168.64
Rate for Payer: Hawaii Medical Service Association Medicare	$153.76
Rate for Payer: Hawaii Western Management Group Commercial	$471.20
Rate for Payer: Health Management Network Commercial	$421.60
Rate for Payer: Humana Medicare	$153.76
Rate for Payer: Kaiser Permanente Commercial	$446.40
Rate for Payer: Kaiser Permanente Medicaid	$252.96
Rate for Payer: Kaiser Permanente Medicare	$153.76
Rate for Payer: MDX Hawaii PPO	$481.12
Rate for Payer: Ohana Health Plan Medicaid	$153.76
Rate for Payer: Ohana Health Plan Medicare	$153.76
Rate for Payer: UnitedHealthcare Medicare	$153.76
Rate for Payer: University Health Alliance Commercial	$361.53

PACK ARTHRO SHOULDER/KNEE

Facility

$496.00

Hospital Revenue Code	272
Min. Negotiated Rate	$421.60
Max. Negotiated Rate	$481.12
Rate for Payer: Cash Price	$297.60
Rate for Payer: Health Management Network Commercial	$421.60
Rate for Payer: Kaiser Permanente Commercial	$446.40
Rate for Payer: MDX Hawaii PPO	$481.12

PACK AV FISTULA

Facility

$641.00

Hospital Revenue Code	272
Min. Negotiated Rate	$544.85
Max. Negotiated Rate	$621.77
Rate for Payer: Cash Price	$384.60
Rate for Payer: Health Management Network Commercial	$544.85
Rate for Payer: Kaiser Permanente Commercial	$576.90
Rate for Payer: MDX Hawaii PPO	$621.77

PACK AV FISTULA

Facility

$641.00

Hospital Revenue Code	272
Min. Negotiated Rate	$198.71
Max. Negotiated Rate	$621.77
Rate for Payer: AlohaCare Medicaid	$320.50
Rate for Payer: AlohaCare Medicare	$198.71
Rate for Payer: Cash Price	$384.60
Rate for Payer: Devoted Health Medicare	$217.94
Rate for Payer: Hawaii Medical Service Association Medicare	$198.71
Rate for Payer: Hawaii Western Management Group Commercial	$608.95
Rate for Payer: Health Management Network Commercial	$544.85
Rate for Payer: Humana Medicare	$198.71
Rate for Payer: Kaiser Permanente Commercial	$576.90
Rate for Payer: Kaiser Permanente Medicaid	$326.91
Rate for Payer: Kaiser Permanente Medicare	$198.71
Rate for Payer: MDX Hawaii PPO	$621.77
Rate for Payer: Ohana Health Plan Medicaid	$198.71
Rate for Payer: Ohana Health Plan Medicare	$198.71
Rate for Payer: UnitedHealthcare Medicare	$198.71
Rate for Payer: University Health Alliance Commercial	$467.22

PACK BASIC CATARACT

Facility

$80.00

Hospital Revenue Code	272
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$77.60
Rate for Payer: AlohaCare Medicaid	$40.00
Rate for Payer: AlohaCare Medicare	$24.80
Rate for Payer: Cash Price	$48.00
Rate for Payer: Devoted Health Medicare	$27.20
Rate for Payer: Hawaii Medical Service Association Medicare	$24.80
Rate for Payer: Hawaii Western Management Group Commercial	$76.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Humana Medicare	$24.80
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: Kaiser Permanente Medicaid	$40.80
Rate for Payer: Kaiser Permanente Medicare	$24.80
Rate for Payer: MDX Hawaii PPO	$77.60
Rate for Payer: Ohana Health Plan Medicaid	$24.80
Rate for Payer: Ohana Health Plan Medicare	$24.80
Rate for Payer: UnitedHealthcare Medicare	$24.80
Rate for Payer: University Health Alliance Commercial	$58.31

PACK BASIC CATARACT

Facility

$80.00

Hospital Revenue Code	272
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$48.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: MDX Hawaii PPO	$77.60

PACK CESAREAN

Facility

$291.00

Hospital Revenue Code	272
Min. Negotiated Rate	$90.21
Max. Negotiated Rate	$282.27
Rate for Payer: AlohaCare Medicaid	$145.50
Rate for Payer: AlohaCare Medicare	$90.21
Rate for Payer: Cash Price	$174.60
Rate for Payer: Devoted Health Medicare	$98.94
Rate for Payer: Hawaii Medical Service Association Medicare	$90.21
Rate for Payer: Hawaii Western Management Group Commercial	$276.45
Rate for Payer: Health Management Network Commercial	$247.35
Rate for Payer: Humana Medicare	$90.21
Rate for Payer: Kaiser Permanente Commercial	$261.90
Rate for Payer: Kaiser Permanente Medicaid	$148.41
Rate for Payer: Kaiser Permanente Medicare	$90.21
Rate for Payer: MDX Hawaii PPO	$282.27
Rate for Payer: Ohana Health Plan Medicaid	$90.21
Rate for Payer: Ohana Health Plan Medicare	$90.21
Rate for Payer: UnitedHealthcare Medicare	$90.21
Rate for Payer: University Health Alliance Commercial	$212.11

PACK CESAREAN

Facility

$291.00

Hospital Revenue Code	272
Min. Negotiated Rate	$247.35
Max. Negotiated Rate	$282.27
Rate for Payer: Cash Price	$174.60
Rate for Payer: Health Management Network Commercial	$247.35
Rate for Payer: Kaiser Permanente Commercial	$261.90
Rate for Payer: MDX Hawaii PPO	$282.27

PACK CYSTO

Facility

$225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

PACK CYSTO

Facility

$225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$69.75
Rate for Payer: Cash Price	$135.00
Rate for Payer: Devoted Health Medicare	$76.50
Rate for Payer: Hawaii Medical Service Association Medicare	$69.75
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$69.75
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$69.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$69.75
Rate for Payer: Ohana Health Plan Medicare	$69.75
Rate for Payer: UnitedHealthcare Medicare	$69.75
Rate for Payer: University Health Alliance Commercial	$164.00

PACK ENDO TYMPANOPLASTY

Facility

$745.00

Hospital Revenue Code	272
Min. Negotiated Rate	$230.95
Max. Negotiated Rate	$722.65
Rate for Payer: AlohaCare Medicaid	$372.50
Rate for Payer: AlohaCare Medicare	$230.95
Rate for Payer: Cash Price	$447.00
Rate for Payer: Devoted Health Medicare	$253.30
Rate for Payer: Hawaii Medical Service Association Medicare	$230.95
Rate for Payer: Hawaii Western Management Group Commercial	$707.75
Rate for Payer: Health Management Network Commercial	$633.25
Rate for Payer: Humana Medicare	$230.95
Rate for Payer: Kaiser Permanente Commercial	$670.50
Rate for Payer: Kaiser Permanente Medicaid	$379.95
Rate for Payer: Kaiser Permanente Medicare	$230.95
Rate for Payer: MDX Hawaii PPO	$722.65
Rate for Payer: Ohana Health Plan Medicaid	$230.95
Rate for Payer: Ohana Health Plan Medicare	$230.95
Rate for Payer: UnitedHealthcare Medicare	$230.95
Rate for Payer: University Health Alliance Commercial	$543.03

PACK ENDO TYMPANOPLASTY

Facility

$745.00

Hospital Revenue Code	272
Min. Negotiated Rate	$633.25
Max. Negotiated Rate	$722.65
Rate for Payer: Cash Price	$447.00
Rate for Payer: Health Management Network Commercial	$633.25
Rate for Payer: Kaiser Permanente Commercial	$670.50
Rate for Payer: MDX Hawaii PPO	$722.65

PACK GENERAL

Facility

$342.00

Hospital Revenue Code	272
Min. Negotiated Rate	$290.70
Max. Negotiated Rate	$331.74
Rate for Payer: Cash Price	$205.20
Rate for Payer: Health Management Network Commercial	$290.70
Rate for Payer: Kaiser Permanente Commercial	$307.80
Rate for Payer: MDX Hawaii PPO	$331.74

PACK GENERAL

Facility

$342.00

Hospital Revenue Code	272
Min. Negotiated Rate	$106.02
Max. Negotiated Rate	$331.74
Rate for Payer: AlohaCare Medicaid	$171.00
Rate for Payer: AlohaCare Medicare	$106.02
Rate for Payer: Cash Price	$205.20
Rate for Payer: Devoted Health Medicare	$116.28
Rate for Payer: Hawaii Medical Service Association Medicare	$106.02
Rate for Payer: Hawaii Western Management Group Commercial	$324.90
Rate for Payer: Health Management Network Commercial	$290.70
Rate for Payer: Humana Medicare	$106.02
Rate for Payer: Kaiser Permanente Commercial	$307.80
Rate for Payer: Kaiser Permanente Medicaid	$174.42
Rate for Payer: Kaiser Permanente Medicare	$106.02
Rate for Payer: MDX Hawaii PPO	$331.74
Rate for Payer: Ohana Health Plan Medicaid	$106.02
Rate for Payer: Ohana Health Plan Medicare	$106.02
Rate for Payer: UnitedHealthcare Medicare	$106.02
Rate for Payer: University Health Alliance Commercial	$249.28

Know your out-of-pocket cost for care.

All Charges