Kau Hospital

All Charges

Charge

Type

Setting

Price

PERCUTANEOUS INST AR-1934PI-30

Facility

$977.00

Hospital Revenue Code	272
Min. Negotiated Rate	$302.87
Max. Negotiated Rate	$947.69
Rate for Payer: AlohaCare Medicaid	$488.50
Rate for Payer: AlohaCare Medicare	$302.87
Rate for Payer: Cash Price	$586.20
Rate for Payer: Devoted Health Medicare	$332.18
Rate for Payer: Hawaii Medical Service Association Medicare	$302.87
Rate for Payer: Hawaii Western Management Group Commercial	$928.15
Rate for Payer: Health Management Network Commercial	$830.45
Rate for Payer: Humana Medicare	$302.87
Rate for Payer: Kaiser Permanente Commercial	$879.30
Rate for Payer: Kaiser Permanente Medicaid	$498.27
Rate for Payer: Kaiser Permanente Medicare	$302.87
Rate for Payer: MDX Hawaii PPO	$947.69
Rate for Payer: Ohana Health Plan Medicaid	$302.87
Rate for Payer: Ohana Health Plan Medicare	$302.87
Rate for Payer: UnitedHealthcare Medicare	$302.87
Rate for Payer: University Health Alliance Commercial	$712.14

PERFIX PLUG SMALL 0112950

Facility

$1,057.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$591.92
Max. Negotiated Rate	$1,025.29
Rate for Payer: Cash Price	$634.20
Rate for Payer: Hawaii Western Management Group Commercial	$739.90
Rate for Payer: Health Management Network Commercial	$898.45
Rate for Payer: Kaiser Permanente Commercial	$951.30
Rate for Payer: MDX Hawaii PPO	$1,025.29
Rate for Payer: University Health Alliance Commercial	$591.92

PERFIX PLUG SMALL 0112950

Facility

$1,057.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$327.67
Max. Negotiated Rate	$1,025.29
Rate for Payer: AlohaCare Medicaid	$528.50
Rate for Payer: AlohaCare Medicare	$327.67
Rate for Payer: Cash Price	$634.20
Rate for Payer: Devoted Health Medicare	$359.38
Rate for Payer: Hawaii Medical Service Association Medicare	$327.67
Rate for Payer: Hawaii Western Management Group Commercial	$739.90
Rate for Payer: Health Management Network Commercial	$898.45
Rate for Payer: Humana Medicare	$327.67
Rate for Payer: Kaiser Permanente Commercial	$951.30
Rate for Payer: Kaiser Permanente Medicaid	$539.07
Rate for Payer: Kaiser Permanente Medicare	$327.67
Rate for Payer: MDX Hawaii PPO	$1,025.29
Rate for Payer: Ohana Health Plan Medicaid	$327.67
Rate for Payer: Ohana Health Plan Medicare	$327.67
Rate for Payer: UnitedHealthcare Medicare	$327.67
Rate for Payer: University Health Alliance Commercial	$591.92

PERFORATOR DISP 14/11 200-241

Facility

$791.00

Hospital Revenue Code	272
Min. Negotiated Rate	$245.21
Max. Negotiated Rate	$767.27
Rate for Payer: AlohaCare Medicaid	$395.50
Rate for Payer: AlohaCare Medicare	$245.21
Rate for Payer: Cash Price	$474.60
Rate for Payer: Devoted Health Medicare	$268.94
Rate for Payer: Hawaii Medical Service Association Medicare	$245.21
Rate for Payer: Hawaii Western Management Group Commercial	$751.45
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Humana Medicare	$245.21
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: Kaiser Permanente Medicaid	$403.41
Rate for Payer: Kaiser Permanente Medicare	$245.21
Rate for Payer: MDX Hawaii PPO	$767.27
Rate for Payer: Ohana Health Plan Medicaid	$245.21
Rate for Payer: Ohana Health Plan Medicare	$245.21
Rate for Payer: UnitedHealthcare Medicare	$245.21
Rate for Payer: University Health Alliance Commercial	$576.56

PERFORATOR DISP 14/11 200-241

Facility

$791.00

Hospital Revenue Code	272
Min. Negotiated Rate	$672.35
Max. Negotiated Rate	$767.27
Rate for Payer: Cash Price	$474.60
Rate for Payer: Health Management Network Commercial	$672.35
Rate for Payer: Kaiser Permanente Commercial	$711.90
Rate for Payer: MDX Hawaii PPO	$767.27

PERFORM ANOTOM GLENOID DWE403

Facility

$4,628.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,591.68
Max. Negotiated Rate	$4,489.16
Rate for Payer: Cash Price	$2,776.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,239.60
Rate for Payer: Health Management Network Commercial	$3,933.80
Rate for Payer: Kaiser Permanente Commercial	$4,165.20
Rate for Payer: MDX Hawaii PPO	$4,489.16
Rate for Payer: University Health Alliance Commercial	$2,591.68

PERFORM ANOTOM GLENOID DWE403

Facility

$4,628.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,434.68
Max. Negotiated Rate	$4,489.16
Rate for Payer: AlohaCare Medicaid	$2,314.00
Rate for Payer: AlohaCare Medicare	$1,434.68
Rate for Payer: Cash Price	$2,776.80
Rate for Payer: Devoted Health Medicare	$1,573.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,434.68
Rate for Payer: Hawaii Western Management Group Commercial	$3,239.60
Rate for Payer: Health Management Network Commercial	$3,933.80
Rate for Payer: Humana Medicare	$1,434.68
Rate for Payer: Kaiser Permanente Commercial	$4,165.20
Rate for Payer: Kaiser Permanente Medicaid	$2,360.28
Rate for Payer: Kaiser Permanente Medicare	$1,434.68
Rate for Payer: MDX Hawaii PPO	$4,489.16
Rate for Payer: Ohana Health Plan Medicaid	$1,434.68
Rate for Payer: Ohana Health Plan Medicare	$1,434.68
Rate for Payer: UnitedHealthcare Medicare	$1,434.68
Rate for Payer: University Health Alliance Commercial	$2,591.68

PERFORM HUMERAL SYSTEM DWP2420

Facility

$2,768.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$858.08
Max. Negotiated Rate	$2,684.96
Rate for Payer: AlohaCare Medicaid	$1,384.00
Rate for Payer: AlohaCare Medicare	$858.08
Rate for Payer: Cash Price	$1,660.80
Rate for Payer: Devoted Health Medicare	$941.12
Rate for Payer: Hawaii Medical Service Association Medicare	$858.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,937.60
Rate for Payer: Health Management Network Commercial	$2,352.80
Rate for Payer: Humana Medicare	$858.08
Rate for Payer: Kaiser Permanente Commercial	$2,491.20
Rate for Payer: Kaiser Permanente Medicaid	$1,411.68
Rate for Payer: Kaiser Permanente Medicare	$858.08
Rate for Payer: MDX Hawaii PPO	$2,684.96
Rate for Payer: Ohana Health Plan Medicaid	$858.08
Rate for Payer: Ohana Health Plan Medicare	$858.08
Rate for Payer: UnitedHealthcare Medicare	$858.08
Rate for Payer: University Health Alliance Commercial	$1,550.08

PERFORM HUMERAL SYSTEM DWP2420

Facility

$2,768.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.08
Max. Negotiated Rate	$2,684.96
Rate for Payer: Cash Price	$1,660.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,937.60
Rate for Payer: Health Management Network Commercial	$2,352.80
Rate for Payer: Kaiser Permanente Commercial	$2,491.20
Rate for Payer: MDX Hawaii PPO	$2,684.96
Rate for Payer: University Health Alliance Commercial	$1,550.08

PERFORM HUMERAL SYSTEM DWX3SS

Facility

$10,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,026.72
Max. Negotiated Rate	$10,439.14
Rate for Payer: Cash Price	$6,457.20
Rate for Payer: Hawaii Western Management Group Commercial	$7,533.40
Rate for Payer: Health Management Network Commercial	$9,147.70
Rate for Payer: Kaiser Permanente Commercial	$9,685.80
Rate for Payer: MDX Hawaii PPO	$10,439.14
Rate for Payer: University Health Alliance Commercial	$6,026.72

PERFORM HUMERAL SYSTEM DWX3SS

Facility

$10,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,336.22
Max. Negotiated Rate	$10,439.14
Rate for Payer: AlohaCare Medicaid	$5,381.00
Rate for Payer: AlohaCare Medicare	$3,336.22
Rate for Payer: Cash Price	$6,457.20
Rate for Payer: Devoted Health Medicare	$3,659.08
Rate for Payer: Hawaii Medical Service Association Medicare	$3,336.22
Rate for Payer: Hawaii Western Management Group Commercial	$7,533.40
Rate for Payer: Health Management Network Commercial	$9,147.70
Rate for Payer: Humana Medicare	$3,336.22
Rate for Payer: Kaiser Permanente Commercial	$9,685.80
Rate for Payer: Kaiser Permanente Medicaid	$5,488.62
Rate for Payer: Kaiser Permanente Medicare	$3,336.22
Rate for Payer: MDX Hawaii PPO	$10,439.14
Rate for Payer: Ohana Health Plan Medicaid	$3,336.22
Rate for Payer: Ohana Health Plan Medicare	$3,336.22
Rate for Payer: UnitedHealthcare Medicare	$3,336.22
Rate for Payer: University Health Alliance Commercial	$6,026.72

PERFORM REVERSE GLENOID DWJ012

Facility

$6,028.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,375.68
Max. Negotiated Rate	$5,847.16
Rate for Payer: Cash Price	$3,616.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,219.60
Rate for Payer: Health Management Network Commercial	$5,123.80
Rate for Payer: Kaiser Permanente Commercial	$5,425.20
Rate for Payer: MDX Hawaii PPO	$5,847.16
Rate for Payer: University Health Alliance Commercial	$3,375.68

PERFORM REVERSE GLENOID DWJ012

Facility

$6,028.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,868.68
Max. Negotiated Rate	$5,847.16
Rate for Payer: AlohaCare Medicaid	$3,014.00
Rate for Payer: AlohaCare Medicare	$1,868.68
Rate for Payer: Cash Price	$3,616.80
Rate for Payer: Devoted Health Medicare	$2,049.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,868.68
Rate for Payer: Hawaii Western Management Group Commercial	$4,219.60
Rate for Payer: Health Management Network Commercial	$5,123.80
Rate for Payer: Humana Medicare	$1,868.68
Rate for Payer: Kaiser Permanente Commercial	$5,425.20
Rate for Payer: Kaiser Permanente Medicaid	$3,074.28
Rate for Payer: Kaiser Permanente Medicare	$1,868.68
Rate for Payer: MDX Hawaii PPO	$5,847.16
Rate for Payer: Ohana Health Plan Medicaid	$1,868.68
Rate for Payer: Ohana Health Plan Medicare	$1,868.68
Rate for Payer: UnitedHealthcare Medicare	$1,868.68
Rate for Payer: University Health Alliance Commercial	$3,375.68

PERINEAL PAD SUPINE 72200634

Facility

$354.00

Hospital Revenue Code	272
Min. Negotiated Rate	$300.90
Max. Negotiated Rate	$343.38
Rate for Payer: Cash Price	$212.40
Rate for Payer: Health Management Network Commercial	$300.90
Rate for Payer: Kaiser Permanente Commercial	$318.60
Rate for Payer: MDX Hawaii PPO	$343.38

PERINEAL PAD SUPINE 72200634

Facility

$354.00

Hospital Revenue Code	272
Min. Negotiated Rate	$109.74
Max. Negotiated Rate	$343.38
Rate for Payer: AlohaCare Medicaid	$177.00
Rate for Payer: AlohaCare Medicare	$109.74
Rate for Payer: Cash Price	$212.40
Rate for Payer: Devoted Health Medicare	$120.36
Rate for Payer: Hawaii Medical Service Association Medicare	$109.74
Rate for Payer: Hawaii Western Management Group Commercial	$336.30
Rate for Payer: Health Management Network Commercial	$300.90
Rate for Payer: Humana Medicare	$109.74
Rate for Payer: Kaiser Permanente Commercial	$318.60
Rate for Payer: Kaiser Permanente Medicaid	$180.54
Rate for Payer: Kaiser Permanente Medicare	$109.74
Rate for Payer: MDX Hawaii PPO	$343.38
Rate for Payer: Ohana Health Plan Medicaid	$109.74
Rate for Payer: Ohana Health Plan Medicare	$109.74
Rate for Payer: UnitedHealthcare Medicare	$109.74
Rate for Payer: University Health Alliance Commercial	$258.03

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR

Facility

$58,093.60

Service Code	MSDRG 041
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$58,093.60
Rate for Payer: Hawaii Medical Service Association Commercial	$58,093.60
Rate for Payer: University Health Alliance Commercial	$10,400.00

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC

Facility

$66,057.47

Service Code	MSDRG 040
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$66,057.47
Rate for Payer: Hawaii Medical Service Association Commercial	$66,057.47
Rate for Payer: University Health Alliance Commercial	$10,400.00

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC

Facility

$50,106.03

Service Code	MSDRG 042
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$50,106.03
Rate for Payer: Hawaii Medical Service Association Commercial	$50,106.03
Rate for Payer: University Health Alliance Commercial	$10,400.00

PERIPHERAL VASCULAR DISORDERS WITH CC

Facility

$24,531.57

Service Code	MSDRG 300
Min. Negotiated Rate	$24,531.57
Max. Negotiated Rate	$24,531.57
Rate for Payer: Hawaii Medical Service Association Commercial	$24,531.57

PERIPHERAL VASCULAR DISORDERS WITH MCC

Facility

$26,024.80

Service Code	MSDRG 299
Min. Negotiated Rate	$26,024.80
Max. Negotiated Rate	$26,024.80
Rate for Payer: Hawaii Medical Service Association Commercial	$26,024.80

PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC

Facility

$18,060.92

Service Code	MSDRG 301
Min. Negotiated Rate	$18,060.92
Max. Negotiated Rate	$18,060.92
Rate for Payer: Hawaii Medical Service Association Commercial	$18,060.92

PERITONEAL ADHESIOLYSIS WITH CC

Facility

$53,400.61

Service Code	MSDRG 336
Min. Negotiated Rate	$53,400.61
Max. Negotiated Rate	$53,400.61
Rate for Payer: Hawaii Medical Service Association Commercial	$53,400.61

PERITONEAL ADHESIOLYSIS WITH MCC

Facility

$60,416.40

Service Code	MSDRG 335
Min. Negotiated Rate	$60,416.40
Max. Negotiated Rate	$60,416.40
Rate for Payer: Hawaii Medical Service Association Commercial	$60,416.40

PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC

Facility

$32,779.87

Service Code	MSDRG 337
Min. Negotiated Rate	$32,779.87
Max. Negotiated Rate	$32,779.87
Rate for Payer: Hawaii Medical Service Association Commercial	$32,779.87

PERMACATH DURAFLOW 2 23CM

Facility

$1,050.00

Hospital Revenue Code	272
Min. Negotiated Rate	$892.50
Max. Negotiated Rate	$1,018.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Kaiser Permanente Commercial	$945.00
Rate for Payer: MDX Hawaii PPO	$1,018.50

Know your out-of-pocket cost for care.

All Charges