Kau Hospital

All Charges

Charge

Type

Setting

Price

PLAT LCP 20H 4.5X368MM 226.701

Facility

$3,820.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,184.20
Max. Negotiated Rate	$3,705.40
Rate for Payer: AlohaCare Medicaid	$1,910.00
Rate for Payer: AlohaCare Medicare	$1,184.20
Rate for Payer: Cash Price	$2,292.00
Rate for Payer: Devoted Health Medicare	$1,298.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,184.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,674.00
Rate for Payer: Health Management Network Commercial	$3,247.00
Rate for Payer: Humana Medicare	$1,184.20
Rate for Payer: Kaiser Permanente Commercial	$3,438.00
Rate for Payer: Kaiser Permanente Medicaid	$1,948.20
Rate for Payer: Kaiser Permanente Medicare	$1,184.20
Rate for Payer: MDX Hawaii PPO	$3,705.40
Rate for Payer: Ohana Health Plan Medicaid	$1,184.20
Rate for Payer: Ohana Health Plan Medicare	$1,184.20
Rate for Payer: UnitedHealthcare Medicare	$1,184.20
Rate for Payer: University Health Alliance Commercial	$2,139.20

PLAT LCP 22H 4.5X404MM 224.721

Facility

$4,108.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,273.48
Max. Negotiated Rate	$3,984.76
Rate for Payer: AlohaCare Medicaid	$2,054.00
Rate for Payer: AlohaCare Medicare	$1,273.48
Rate for Payer: Cash Price	$2,464.80
Rate for Payer: Devoted Health Medicare	$1,396.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,273.48
Rate for Payer: Hawaii Western Management Group Commercial	$2,875.60
Rate for Payer: Health Management Network Commercial	$3,491.80
Rate for Payer: Humana Medicare	$1,273.48
Rate for Payer: Kaiser Permanente Commercial	$3,697.20
Rate for Payer: Kaiser Permanente Medicaid	$2,095.08
Rate for Payer: Kaiser Permanente Medicare	$1,273.48
Rate for Payer: MDX Hawaii PPO	$3,984.76
Rate for Payer: Ohana Health Plan Medicaid	$1,273.48
Rate for Payer: Ohana Health Plan Medicare	$1,273.48
Rate for Payer: UnitedHealthcare Medicare	$1,273.48
Rate for Payer: University Health Alliance Commercial	$2,300.48

PLAT LCP 22H 4.5X404MM 224.721

Facility

$4,108.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,300.48
Max. Negotiated Rate	$3,984.76
Rate for Payer: Cash Price	$2,464.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,875.60
Rate for Payer: Health Management Network Commercial	$3,491.80
Rate for Payer: Kaiser Permanente Commercial	$3,697.20
Rate for Payer: MDX Hawaii PPO	$3,984.76
Rate for Payer: University Health Alliance Commercial	$2,300.48

PLAT LCP 22H 4.5X404MM 226.721

Facility

$4,186.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,297.66
Max. Negotiated Rate	$4,060.42
Rate for Payer: AlohaCare Medicaid	$2,093.00
Rate for Payer: AlohaCare Medicare	$1,297.66
Rate for Payer: Cash Price	$2,511.60
Rate for Payer: Devoted Health Medicare	$1,423.24
Rate for Payer: Hawaii Medical Service Association Medicare	$1,297.66
Rate for Payer: Hawaii Western Management Group Commercial	$2,930.20
Rate for Payer: Health Management Network Commercial	$3,558.10
Rate for Payer: Humana Medicare	$1,297.66
Rate for Payer: Kaiser Permanente Commercial	$3,767.40
Rate for Payer: Kaiser Permanente Medicaid	$2,134.86
Rate for Payer: Kaiser Permanente Medicare	$1,297.66
Rate for Payer: MDX Hawaii PPO	$4,060.42
Rate for Payer: Ohana Health Plan Medicaid	$1,297.66
Rate for Payer: Ohana Health Plan Medicare	$1,297.66
Rate for Payer: UnitedHealthcare Medicare	$1,297.66
Rate for Payer: University Health Alliance Commercial	$2,344.16

PLAT LCP 22H 4.5X404MM 226.721

Facility

$4,186.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,344.16
Max. Negotiated Rate	$4,060.42
Rate for Payer: Cash Price	$2,511.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,930.20
Rate for Payer: Health Management Network Commercial	$3,558.10
Rate for Payer: Kaiser Permanente Commercial	$3,767.40
Rate for Payer: MDX Hawaii PPO	$4,060.42
Rate for Payer: University Health Alliance Commercial	$2,344.16

PLAT LCP 4H 3.5X116MM 238.701

Facility

$3,570.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,999.20
Max. Negotiated Rate	$3,462.90
Rate for Payer: Cash Price	$2,142.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,499.00
Rate for Payer: Health Management Network Commercial	$3,034.50
Rate for Payer: Kaiser Permanente Commercial	$3,213.00
Rate for Payer: MDX Hawaii PPO	$3,462.90
Rate for Payer: University Health Alliance Commercial	$1,999.20

PLAT LCP 4H 3.5X116MM 238.701

Facility

$3,570.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,106.70
Max. Negotiated Rate	$3,462.90
Rate for Payer: AlohaCare Medicaid	$1,785.00
Rate for Payer: AlohaCare Medicare	$1,106.70
Rate for Payer: Cash Price	$2,142.00
Rate for Payer: Devoted Health Medicare	$1,213.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,106.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,499.00
Rate for Payer: Health Management Network Commercial	$3,034.50
Rate for Payer: Humana Medicare	$1,106.70
Rate for Payer: Kaiser Permanente Commercial	$3,213.00
Rate for Payer: Kaiser Permanente Medicaid	$1,820.70
Rate for Payer: Kaiser Permanente Medicare	$1,106.70
Rate for Payer: MDX Hawaii PPO	$3,462.90
Rate for Payer: Ohana Health Plan Medicaid	$1,106.70
Rate for Payer: Ohana Health Plan Medicare	$1,106.70
Rate for Payer: UnitedHealthcare Medicare	$1,106.70
Rate for Payer: University Health Alliance Commercial	$1,999.20

PLAT LCP 6H 3.5X142MM 238.702

Facility

$3,610.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,021.60
Max. Negotiated Rate	$3,501.70
Rate for Payer: Cash Price	$2,166.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,527.00
Rate for Payer: Health Management Network Commercial	$3,068.50
Rate for Payer: Kaiser Permanente Commercial	$3,249.00
Rate for Payer: MDX Hawaii PPO	$3,501.70
Rate for Payer: University Health Alliance Commercial	$2,021.60

PLAT LCP 6H 3.5X142MM 238.702

Facility

$3,610.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,119.10
Max. Negotiated Rate	$3,501.70
Rate for Payer: AlohaCare Medicaid	$1,805.00
Rate for Payer: AlohaCare Medicare	$1,119.10
Rate for Payer: Cash Price	$2,166.00
Rate for Payer: Devoted Health Medicare	$1,227.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,119.10
Rate for Payer: Hawaii Western Management Group Commercial	$2,527.00
Rate for Payer: Health Management Network Commercial	$3,068.50
Rate for Payer: Humana Medicare	$1,119.10
Rate for Payer: Kaiser Permanente Commercial	$3,249.00
Rate for Payer: Kaiser Permanente Medicaid	$1,841.10
Rate for Payer: Kaiser Permanente Medicare	$1,119.10
Rate for Payer: MDX Hawaii PPO	$3,501.70
Rate for Payer: Ohana Health Plan Medicaid	$1,119.10
Rate for Payer: Ohana Health Plan Medicare	$1,119.10
Rate for Payer: UnitedHealthcare Medicare	$1,119.10
Rate for Payer: University Health Alliance Commercial	$2,021.60

PLAT LCP 6H 3.5X142MM 238.703

Facility

$3,610.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,021.60
Max. Negotiated Rate	$3,501.70
Rate for Payer: Cash Price	$2,166.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,527.00
Rate for Payer: Health Management Network Commercial	$3,068.50
Rate for Payer: Kaiser Permanente Commercial	$3,249.00
Rate for Payer: MDX Hawaii PPO	$3,501.70
Rate for Payer: University Health Alliance Commercial	$2,021.60

PLAT LCP 6H 3.5X142MM 238.703

Facility

$3,610.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,119.10
Max. Negotiated Rate	$3,501.70
Rate for Payer: AlohaCare Medicaid	$1,805.00
Rate for Payer: AlohaCare Medicare	$1,119.10
Rate for Payer: Cash Price	$2,166.00
Rate for Payer: Devoted Health Medicare	$1,227.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,119.10
Rate for Payer: Hawaii Western Management Group Commercial	$2,527.00
Rate for Payer: Health Management Network Commercial	$3,068.50
Rate for Payer: Humana Medicare	$1,119.10
Rate for Payer: Kaiser Permanente Commercial	$3,249.00
Rate for Payer: Kaiser Permanente Medicaid	$1,841.10
Rate for Payer: Kaiser Permanente Medicare	$1,119.10
Rate for Payer: MDX Hawaii PPO	$3,501.70
Rate for Payer: Ohana Health Plan Medicaid	$1,119.10
Rate for Payer: Ohana Health Plan Medicare	$1,119.10
Rate for Payer: UnitedHealthcare Medicare	$1,119.10
Rate for Payer: University Health Alliance Commercial	$2,021.60

PLAT LCP 8H 3.5X168MM 238.704

Facility

$3,646.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,041.76
Max. Negotiated Rate	$3,536.62
Rate for Payer: Cash Price	$2,187.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,552.20
Rate for Payer: Health Management Network Commercial	$3,099.10
Rate for Payer: Kaiser Permanente Commercial	$3,281.40
Rate for Payer: MDX Hawaii PPO	$3,536.62
Rate for Payer: University Health Alliance Commercial	$2,041.76

PLAT LCP 8H 3.5X168MM 238.704

Facility

$3,646.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,130.26
Max. Negotiated Rate	$3,536.62
Rate for Payer: AlohaCare Medicaid	$1,823.00
Rate for Payer: AlohaCare Medicare	$1,130.26
Rate for Payer: Cash Price	$2,187.60
Rate for Payer: Devoted Health Medicare	$1,239.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,130.26
Rate for Payer: Hawaii Western Management Group Commercial	$2,552.20
Rate for Payer: Health Management Network Commercial	$3,099.10
Rate for Payer: Humana Medicare	$1,130.26
Rate for Payer: Kaiser Permanente Commercial	$3,281.40
Rate for Payer: Kaiser Permanente Medicaid	$1,859.46
Rate for Payer: Kaiser Permanente Medicare	$1,130.26
Rate for Payer: MDX Hawaii PPO	$3,536.62
Rate for Payer: Ohana Health Plan Medicaid	$1,130.26
Rate for Payer: Ohana Health Plan Medicare	$1,130.26
Rate for Payer: UnitedHealthcare Medicare	$1,130.26
Rate for Payer: University Health Alliance Commercial	$2,041.76

PLAT LCP-T 3H 3.5X50MM 241.131

Facility

$1,292.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$400.52
Max. Negotiated Rate	$1,253.24
Rate for Payer: AlohaCare Medicaid	$646.00
Rate for Payer: AlohaCare Medicare	$400.52
Rate for Payer: Cash Price	$775.20
Rate for Payer: Devoted Health Medicare	$439.28
Rate for Payer: Hawaii Medical Service Association Medicare	$400.52
Rate for Payer: Hawaii Western Management Group Commercial	$904.40
Rate for Payer: Health Management Network Commercial	$1,098.20
Rate for Payer: Humana Medicare	$400.52
Rate for Payer: Kaiser Permanente Commercial	$1,162.80
Rate for Payer: Kaiser Permanente Medicaid	$658.92
Rate for Payer: Kaiser Permanente Medicare	$400.52
Rate for Payer: MDX Hawaii PPO	$1,253.24
Rate for Payer: Ohana Health Plan Medicaid	$400.52
Rate for Payer: Ohana Health Plan Medicare	$400.52
Rate for Payer: UnitedHealthcare Medicare	$400.52
Rate for Payer: University Health Alliance Commercial	$723.52

PLAT LCP-T 3H 3.5X50MM 241.131

Facility

$1,292.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$723.52
Max. Negotiated Rate	$1,253.24
Rate for Payer: Cash Price	$775.20
Rate for Payer: Hawaii Western Management Group Commercial	$904.40
Rate for Payer: Health Management Network Commercial	$1,098.20
Rate for Payer: Kaiser Permanente Commercial	$1,162.80
Rate for Payer: MDX Hawaii PPO	$1,253.24
Rate for Payer: University Health Alliance Commercial	$723.52

PLAT LCP-T 3H 3.5X52MM 241.931

Facility

$1,596.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$494.76
Max. Negotiated Rate	$1,548.12
Rate for Payer: AlohaCare Medicaid	$798.00
Rate for Payer: AlohaCare Medicare	$494.76
Rate for Payer: Cash Price	$957.60
Rate for Payer: Devoted Health Medicare	$542.64
Rate for Payer: Hawaii Medical Service Association Medicare	$494.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,117.20
Rate for Payer: Health Management Network Commercial	$1,356.60
Rate for Payer: Humana Medicare	$494.76
Rate for Payer: Kaiser Permanente Commercial	$1,436.40
Rate for Payer: Kaiser Permanente Medicaid	$813.96
Rate for Payer: Kaiser Permanente Medicare	$494.76
Rate for Payer: MDX Hawaii PPO	$1,548.12
Rate for Payer: Ohana Health Plan Medicaid	$494.76
Rate for Payer: Ohana Health Plan Medicare	$494.76
Rate for Payer: UnitedHealthcare Medicare	$494.76
Rate for Payer: University Health Alliance Commercial	$893.76

PLAT LCP-T 3H 3.5X52MM 241.931

Facility

$1,596.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$893.76
Max. Negotiated Rate	$1,548.12
Rate for Payer: Cash Price	$957.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,117.20
Rate for Payer: Health Management Network Commercial	$1,356.60
Rate for Payer: Kaiser Permanente Commercial	$1,436.40
Rate for Payer: MDX Hawaii PPO	$1,548.12
Rate for Payer: University Health Alliance Commercial	$893.76

PLAT LCP-T 4H 3.5X52MM 241.031

Facility

$1,593.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$493.83
Max. Negotiated Rate	$1,545.21
Rate for Payer: AlohaCare Medicaid	$796.50
Rate for Payer: AlohaCare Medicare	$493.83
Rate for Payer: Cash Price	$955.80
Rate for Payer: Devoted Health Medicare	$541.62
Rate for Payer: Hawaii Medical Service Association Medicare	$493.83
Rate for Payer: Hawaii Western Management Group Commercial	$1,115.10
Rate for Payer: Health Management Network Commercial	$1,354.05
Rate for Payer: Humana Medicare	$493.83
Rate for Payer: Kaiser Permanente Commercial	$1,433.70
Rate for Payer: Kaiser Permanente Medicaid	$812.43
Rate for Payer: Kaiser Permanente Medicare	$493.83
Rate for Payer: MDX Hawaii PPO	$1,545.21
Rate for Payer: Ohana Health Plan Medicaid	$493.83
Rate for Payer: Ohana Health Plan Medicare	$493.83
Rate for Payer: UnitedHealthcare Medicare	$493.83
Rate for Payer: University Health Alliance Commercial	$892.08

PLAT LCP-T 4H 3.5X52MM 241.031

Facility

$1,593.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$892.08
Max. Negotiated Rate	$1,545.21
Rate for Payer: Cash Price	$955.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,115.10
Rate for Payer: Health Management Network Commercial	$1,354.05
Rate for Payer: Kaiser Permanente Commercial	$1,433.70
Rate for Payer: MDX Hawaii PPO	$1,545.21
Rate for Payer: University Health Alliance Commercial	$892.08

PLAT LCP-T 4H 3.5X56MM 241.141

Facility

$1,335.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$413.85
Max. Negotiated Rate	$1,294.95
Rate for Payer: AlohaCare Medicaid	$667.50
Rate for Payer: AlohaCare Medicare	$413.85
Rate for Payer: Cash Price	$801.00
Rate for Payer: Devoted Health Medicare	$453.90
Rate for Payer: Hawaii Medical Service Association Medicare	$413.85
Rate for Payer: Hawaii Western Management Group Commercial	$934.50
Rate for Payer: Health Management Network Commercial	$1,134.75
Rate for Payer: Humana Medicare	$413.85
Rate for Payer: Kaiser Permanente Commercial	$1,201.50
Rate for Payer: Kaiser Permanente Medicaid	$680.85
Rate for Payer: Kaiser Permanente Medicare	$413.85
Rate for Payer: MDX Hawaii PPO	$1,294.95
Rate for Payer: Ohana Health Plan Medicaid	$413.85
Rate for Payer: Ohana Health Plan Medicare	$413.85
Rate for Payer: UnitedHealthcare Medicare	$413.85
Rate for Payer: University Health Alliance Commercial	$747.60

PLAT LCP-T 4H 3.5X56MM 241.141

Facility

$1,335.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$747.60
Max. Negotiated Rate	$1,294.95
Rate for Payer: Cash Price	$801.00
Rate for Payer: Hawaii Western Management Group Commercial	$934.50
Rate for Payer: Health Management Network Commercial	$1,134.75
Rate for Payer: Kaiser Permanente Commercial	$1,201.50
Rate for Payer: MDX Hawaii PPO	$1,294.95
Rate for Payer: University Health Alliance Commercial	$747.60

PLAT LCP-T 4H 3.5X63MM 241.041

Facility

$1,666.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$516.46
Max. Negotiated Rate	$1,616.02
Rate for Payer: AlohaCare Medicaid	$833.00
Rate for Payer: AlohaCare Medicare	$516.46
Rate for Payer: Cash Price	$999.60
Rate for Payer: Devoted Health Medicare	$566.44
Rate for Payer: Hawaii Medical Service Association Medicare	$516.46
Rate for Payer: Hawaii Western Management Group Commercial	$1,166.20
Rate for Payer: Health Management Network Commercial	$1,416.10
Rate for Payer: Humana Medicare	$516.46
Rate for Payer: Kaiser Permanente Commercial	$1,499.40
Rate for Payer: Kaiser Permanente Medicaid	$849.66
Rate for Payer: Kaiser Permanente Medicare	$516.46
Rate for Payer: MDX Hawaii PPO	$1,616.02
Rate for Payer: Ohana Health Plan Medicaid	$516.46
Rate for Payer: Ohana Health Plan Medicare	$516.46
Rate for Payer: UnitedHealthcare Medicare	$516.46
Rate for Payer: University Health Alliance Commercial	$932.96

PLAT LCP-T 4H 3.5X63MM 241.041

Facility

$1,666.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$932.96
Max. Negotiated Rate	$1,616.02
Rate for Payer: Cash Price	$999.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,166.20
Rate for Payer: Health Management Network Commercial	$1,416.10
Rate for Payer: Kaiser Permanente Commercial	$1,499.40
Rate for Payer: MDX Hawaii PPO	$1,616.02
Rate for Payer: University Health Alliance Commercial	$932.96

PLAT LCP-T 4H 3.5X63MM 241.941

Facility

$1,673.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$936.88
Max. Negotiated Rate	$1,622.81
Rate for Payer: Cash Price	$1,003.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,171.10
Rate for Payer: Health Management Network Commercial	$1,422.05
Rate for Payer: Kaiser Permanente Commercial	$1,505.70
Rate for Payer: MDX Hawaii PPO	$1,622.81
Rate for Payer: University Health Alliance Commercial	$936.88

PLAT LCP-T 4H 3.5X63MM 241.941

Facility

$1,673.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$518.63
Max. Negotiated Rate	$1,622.81
Rate for Payer: AlohaCare Medicaid	$836.50
Rate for Payer: AlohaCare Medicare	$518.63
Rate for Payer: Cash Price	$1,003.80
Rate for Payer: Devoted Health Medicare	$568.82
Rate for Payer: Hawaii Medical Service Association Medicare	$518.63
Rate for Payer: Hawaii Western Management Group Commercial	$1,171.10
Rate for Payer: Health Management Network Commercial	$1,422.05
Rate for Payer: Humana Medicare	$518.63
Rate for Payer: Kaiser Permanente Commercial	$1,505.70
Rate for Payer: Kaiser Permanente Medicaid	$853.23
Rate for Payer: Kaiser Permanente Medicare	$518.63
Rate for Payer: MDX Hawaii PPO	$1,622.81
Rate for Payer: Ohana Health Plan Medicaid	$518.63
Rate for Payer: Ohana Health Plan Medicare	$518.63
Rate for Payer: UnitedHealthcare Medicare	$518.63
Rate for Payer: University Health Alliance Commercial	$936.88

Know your out-of-pocket cost for care.

All Charges