Kau Hospital

All Charges

Charge

Type

Setting

Price

PR DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY

Professional

Both

$212.00

Service Code	HCPCS 93926 TC
Min. Negotiated Rate	$131.13
Max. Negotiated Rate	$180.20
Rate for Payer: AlohaCare Medicaid	$161.18
Rate for Payer: AlohaCare Medicare	$133.12
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cash Price	$127.20
Rate for Payer: Devoted Health Medicare	$146.43
Rate for Payer: Hawaii Medical Service Association Medicare	$133.12
Rate for Payer: Hawaii Western Management Group Commercial	$131.13
Rate for Payer: Health Management Network Commercial	$180.20
Rate for Payer: Kaiser Permanente Commercial	$159.74
Rate for Payer: Kaiser Permanente Medicaid	$159.74
Rate for Payer: Kaiser Permanente Medicare	$159.74
Rate for Payer: Ohana Health Plan Medicaid	$161.18
Rate for Payer: Ohana Health Plan Medicare	$133.12
Rate for Payer: UnitedHealthcare Medicaid	$161.18
Rate for Payer: UnitedHealthcare Medicare	$133.12

PR DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY

Professional

Both

$251.00

Service Code	HCPCS 93926
Min. Negotiated Rate	$131.13
Max. Negotiated Rate	$213.35
Rate for Payer: AlohaCare Medicaid	$161.18
Rate for Payer: AlohaCare Medicare	$155.39
Rate for Payer: Cash Price	$150.60
Rate for Payer: Cash Price	$150.60
Rate for Payer: Devoted Health Medicare	$170.93
Rate for Payer: Hawaii Medical Service Association Medicare	$155.39
Rate for Payer: Hawaii Western Management Group Commercial	$131.13
Rate for Payer: Health Management Network Commercial	$213.35
Rate for Payer: Kaiser Permanente Commercial	$186.47
Rate for Payer: Kaiser Permanente Medicaid	$186.47
Rate for Payer: Kaiser Permanente Medicare	$186.47
Rate for Payer: Ohana Health Plan Medicaid	$161.18
Rate for Payer: Ohana Health Plan Medicare	$155.39
Rate for Payer: UnitedHealthcare Medicaid	$161.18
Rate for Payer: UnitedHealthcare Medicare	$155.39

PR DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY

Professional

Both

$39.00

Service Code	HCPCS 93926 26
Min. Negotiated Rate	$22.27
Max. Negotiated Rate	$161.18
Rate for Payer: AlohaCare Medicaid	$161.18
Rate for Payer: AlohaCare Medicare	$22.27
Rate for Payer: Cash Price	$23.40
Rate for Payer: Cash Price	$23.40
Rate for Payer: Devoted Health Medicare	$24.50
Rate for Payer: Hawaii Medical Service Association Medicare	$22.27
Rate for Payer: Hawaii Western Management Group Commercial	$131.13
Rate for Payer: Health Management Network Commercial	$33.15
Rate for Payer: Kaiser Permanente Commercial	$26.72
Rate for Payer: Kaiser Permanente Medicaid	$26.72
Rate for Payer: Kaiser Permanente Medicare	$26.72
Rate for Payer: Ohana Health Plan Medicaid	$161.18
Rate for Payer: Ohana Health Plan Medicare	$22.27
Rate for Payer: UnitedHealthcare Medicaid	$161.18
Rate for Payer: UnitedHealthcare Medicare	$22.27

PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY

Professional

Both

$56.00

Service Code	HCPCS 93970 26
Min. Negotiated Rate	$32.23
Max. Negotiated Rate	$209.33
Rate for Payer: AlohaCare Medicaid	$209.33
Rate for Payer: AlohaCare Medicare	$32.23
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$33.60
Rate for Payer: Devoted Health Medicare	$35.45
Rate for Payer: Hawaii Medical Service Association Medicare	$32.23
Rate for Payer: Hawaii Western Management Group Commercial	$161.05
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Kaiser Permanente Commercial	$38.68
Rate for Payer: Kaiser Permanente Medicaid	$38.68
Rate for Payer: Kaiser Permanente Medicare	$38.68
Rate for Payer: Ohana Health Plan Medicaid	$209.33
Rate for Payer: Ohana Health Plan Medicare	$32.23
Rate for Payer: UnitedHealthcare Medicaid	$209.33
Rate for Payer: UnitedHealthcare Medicare	$32.23

PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY

Professional

Both

$625.00

Service Code	HCPCS 93970
Min. Negotiated Rate	$161.05
Max. Negotiated Rate	$531.25
Rate for Payer: AlohaCare Medicaid	$209.33
Rate for Payer: AlohaCare Medicare	$204.46
Rate for Payer: Cash Price	$375.00
Rate for Payer: Cash Price	$375.00
Rate for Payer: Devoted Health Medicare	$224.91
Rate for Payer: Hawaii Medical Service Association Medicare	$204.46
Rate for Payer: Hawaii Western Management Group Commercial	$161.05
Rate for Payer: Health Management Network Commercial	$531.25
Rate for Payer: Kaiser Permanente Commercial	$245.35
Rate for Payer: Kaiser Permanente Medicaid	$245.35
Rate for Payer: Kaiser Permanente Medicare	$245.35
Rate for Payer: Ohana Health Plan Medicaid	$209.33
Rate for Payer: Ohana Health Plan Medicare	$204.46
Rate for Payer: UnitedHealthcare Medicaid	$209.33
Rate for Payer: UnitedHealthcare Medicare	$204.46

PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY

Professional

Both

$569.00

Service Code	HCPCS 93970 TC
Min. Negotiated Rate	$161.05
Max. Negotiated Rate	$483.65
Rate for Payer: AlohaCare Medicaid	$209.33
Rate for Payer: AlohaCare Medicare	$172.24
Rate for Payer: Cash Price	$341.40
Rate for Payer: Cash Price	$341.40
Rate for Payer: Devoted Health Medicare	$189.46
Rate for Payer: Hawaii Medical Service Association Medicare	$172.24
Rate for Payer: Hawaii Western Management Group Commercial	$161.05
Rate for Payer: Health Management Network Commercial	$483.65
Rate for Payer: Kaiser Permanente Commercial	$206.69
Rate for Payer: Kaiser Permanente Medicaid	$206.69
Rate for Payer: Kaiser Permanente Medicare	$206.69
Rate for Payer: Ohana Health Plan Medicaid	$209.33
Rate for Payer: Ohana Health Plan Medicare	$172.24
Rate for Payer: UnitedHealthcare Medicaid	$209.33
Rate for Payer: UnitedHealthcare Medicare	$172.24

PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY

Professional

Both

$364.00

Service Code	HCPCS 93971 TC
Min. Negotiated Rate	$108.62
Max. Negotiated Rate	$309.40
Rate for Payer: AlohaCare Medicaid	$133.33
Rate for Payer: AlohaCare Medicare	$108.62
Rate for Payer: Cash Price	$218.40
Rate for Payer: Cash Price	$218.40
Rate for Payer: Devoted Health Medicare	$119.48
Rate for Payer: Hawaii Medical Service Association Medicare	$108.62
Rate for Payer: Hawaii Western Management Group Commercial	$130.82
Rate for Payer: Health Management Network Commercial	$309.40
Rate for Payer: Kaiser Permanente Commercial	$130.34
Rate for Payer: Kaiser Permanente Medicaid	$130.34
Rate for Payer: Kaiser Permanente Medicare	$130.34
Rate for Payer: Ohana Health Plan Medicaid	$133.33
Rate for Payer: Ohana Health Plan Medicare	$108.62
Rate for Payer: UnitedHealthcare Medicaid	$133.33
Rate for Payer: UnitedHealthcare Medicare	$108.62

PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY

Professional

Both

$400.00

Service Code	HCPCS 93971 LT
Min. Negotiated Rate	$129.21
Max. Negotiated Rate	$340.00
Rate for Payer: AlohaCare Medicaid	$133.33
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Hawaii Western Management Group Commercial	$130.82
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Ohana Health Plan Medicaid	$133.33
Rate for Payer: UnitedHealthcare Medicaid	$133.33

PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY

Professional

Both

$400.00

Service Code	HCPCS 93971 RT
Min. Negotiated Rate	$129.21
Max. Negotiated Rate	$340.00
Rate for Payer: AlohaCare Medicaid	$133.33
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Hawaii Western Management Group Commercial	$130.82
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Ohana Health Plan Medicaid	$133.33
Rate for Payer: UnitedHealthcare Medicaid	$133.33

PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY

Professional

Both

$400.00

Service Code	HCPCS 93971
Min. Negotiated Rate	$129.21
Max. Negotiated Rate	$340.00
Rate for Payer: AlohaCare Medicaid	$133.33
Rate for Payer: AlohaCare Medicare	$129.21
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Devoted Health Medicare	$142.13
Rate for Payer: Hawaii Medical Service Association Medicare	$129.21
Rate for Payer: Hawaii Western Management Group Commercial	$130.82
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Kaiser Permanente Commercial	$155.05
Rate for Payer: Kaiser Permanente Medicaid	$155.05
Rate for Payer: Kaiser Permanente Medicare	$155.05
Rate for Payer: Ohana Health Plan Medicaid	$133.33
Rate for Payer: Ohana Health Plan Medicare	$129.21
Rate for Payer: UnitedHealthcare Medicaid	$133.33
Rate for Payer: UnitedHealthcare Medicare	$129.21

PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY

Professional

Both

$36.00

Service Code	HCPCS 93971 26
Min. Negotiated Rate	$20.59
Max. Negotiated Rate	$133.33
Rate for Payer: AlohaCare Medicaid	$133.33
Rate for Payer: AlohaCare Medicare	$20.59
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Devoted Health Medicare	$22.65
Rate for Payer: Hawaii Medical Service Association Medicare	$20.59
Rate for Payer: Hawaii Western Management Group Commercial	$130.82
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Kaiser Permanente Commercial	$24.71
Rate for Payer: Kaiser Permanente Medicaid	$24.71
Rate for Payer: Kaiser Permanente Medicare	$24.71
Rate for Payer: Ohana Health Plan Medicaid	$133.33
Rate for Payer: Ohana Health Plan Medicare	$20.59
Rate for Payer: UnitedHealthcare Medicaid	$133.33
Rate for Payer: UnitedHealthcare Medicare	$20.59

PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC

Facility

$20,407.42

Service Code	MSDRG 067
Min. Negotiated Rate	$20,407.42
Max. Negotiated Rate	$20,407.42
Rate for Payer: Hawaii Medical Service Association Commercial	$20,407.42

PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC

Facility

$20,407.42

Service Code	MSDRG 068
Min. Negotiated Rate	$20,407.42
Max. Negotiated Rate	$20,407.42
Rate for Payer: Hawaii Medical Service Association Commercial	$20,407.42

PR ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY

Professional

Both

$14.93

Service Code	HCPCS 93010
Min. Negotiated Rate	$8.14
Max. Negotiated Rate	$12.69
Rate for Payer: AlohaCare Medicaid	$8.14
Rate for Payer: AlohaCare Medicare	$8.53
Rate for Payer: Cash Price	$8.96
Rate for Payer: Cash Price	$8.96
Rate for Payer: Devoted Health Medicare	$9.38
Rate for Payer: Hawaii Medical Service Association Medicare	$8.53
Rate for Payer: Hawaii Western Management Group Commercial	$11.56
Rate for Payer: Health Management Network Commercial	$12.69
Rate for Payer: Kaiser Permanente Commercial	$10.24
Rate for Payer: Kaiser Permanente Medicaid	$10.24
Rate for Payer: Kaiser Permanente Medicare	$10.24
Rate for Payer: Ohana Health Plan Medicaid	$8.14
Rate for Payer: Ohana Health Plan Medicare	$8.53
Rate for Payer: UnitedHealthcare Medicaid	$8.14
Rate for Payer: UnitedHealthcare Medicare	$8.53

PR ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R

Professional

Both

$236.00

Service Code	HCPCS 93005
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$200.60
Rate for Payer: AlohaCare Medicaid	$7.07
Rate for Payer: AlohaCare Medicare	$7.79
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Devoted Health Medicare	$8.57
Rate for Payer: Hawaii Medical Service Association Medicare	$7.79
Rate for Payer: Hawaii Western Management Group Commercial	$19.01
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Kaiser Permanente Commercial	$9.35
Rate for Payer: Kaiser Permanente Medicaid	$9.35
Rate for Payer: Kaiser Permanente Medicare	$9.35
Rate for Payer: Ohana Health Plan Medicaid	$7.07
Rate for Payer: Ohana Health Plan Medicare	$7.79
Rate for Payer: UnitedHealthcare Medicaid	$7.07
Rate for Payer: UnitedHealthcare Medicare	$7.79

PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R

Professional

Both

$251.00

Service Code	HCPCS 93000
Min. Negotiated Rate	$15.21
Max. Negotiated Rate	$213.35
Rate for Payer: AlohaCare Medicaid	$15.21
Rate for Payer: AlohaCare Medicare	$16.32
Rate for Payer: Cash Price	$150.60
Rate for Payer: Cash Price	$150.60
Rate for Payer: Devoted Health Medicare	$17.95
Rate for Payer: Hawaii Medical Service Association Medicare	$16.32
Rate for Payer: Hawaii Western Management Group Commercial	$30.55
Rate for Payer: Health Management Network Commercial	$213.35
Rate for Payer: Kaiser Permanente Commercial	$19.58
Rate for Payer: Kaiser Permanente Medicaid	$19.58
Rate for Payer: Kaiser Permanente Medicare	$19.58
Rate for Payer: Ohana Health Plan Medicaid	$15.21
Rate for Payer: Ohana Health Plan Medicare	$16.32
Rate for Payer: UnitedHealthcare Medicaid	$15.21
Rate for Payer: UnitedHealthcare Medicare	$16.32

PR ECHO R-T 2D W/PROBE PLACEMENT ONLY

Professional

Both

$19.00

Service Code	HCPCS 93313
Min. Negotiated Rate	$10.26
Max. Negotiated Rate	$110.78
Rate for Payer: AlohaCare Medicaid	$10.94
Rate for Payer: AlohaCare Medicare	$10.26
Rate for Payer: Cash Price	$11.40
Rate for Payer: Cash Price	$11.40
Rate for Payer: Devoted Health Medicare	$11.29
Rate for Payer: Hawaii Medical Service Association Medicare	$10.26
Rate for Payer: Hawaii Western Management Group Commercial	$110.78
Rate for Payer: Health Management Network Commercial	$16.15
Rate for Payer: Kaiser Permanente Commercial	$12.31
Rate for Payer: Kaiser Permanente Medicaid	$12.31
Rate for Payer: Kaiser Permanente Medicare	$12.31
Rate for Payer: Ohana Health Plan Medicaid	$10.94
Rate for Payer: Ohana Health Plan Medicare	$10.26
Rate for Payer: UnitedHealthcare Medicaid	$10.94
Rate for Payer: UnitedHealthcare Medicare	$10.26

PR ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN

Professional

Both

$379.00

Service Code	HCPCS 93355
Min. Negotiated Rate	$191.26
Max. Negotiated Rate	$322.15
Rate for Payer: AlohaCare Medicaid	$222.10
Rate for Payer: AlohaCare Medicare	$191.26
Rate for Payer: Cash Price	$227.40
Rate for Payer: Cash Price	$227.40
Rate for Payer: Devoted Health Medicare	$210.39
Rate for Payer: Hawaii Medical Service Association Medicare	$191.26
Rate for Payer: Hawaii Western Management Group Commercial	$236.36
Rate for Payer: Health Management Network Commercial	$322.15
Rate for Payer: Kaiser Permanente Commercial	$229.51
Rate for Payer: Kaiser Permanente Medicaid	$229.51
Rate for Payer: Kaiser Permanente Medicare	$229.51
Rate for Payer: Ohana Health Plan Medicaid	$222.10
Rate for Payer: Ohana Health Plan Medicare	$191.26
Rate for Payer: UnitedHealthcare Medicaid	$222.10
Rate for Payer: UnitedHealthcare Medicare	$191.26

PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R

Professional

Both

$222.30

Service Code	HCPCS 93315
Min. Negotiated Rate	$32.78
Max. Negotiated Rate	$242.18
Rate for Payer: AlohaCare Medicaid	$242.18
Rate for Payer: Cash Price	$133.38
Rate for Payer: Cash Price	$133.38
Rate for Payer: Hawaii Western Management Group Commercial	$32.78
Rate for Payer: Health Management Network Commercial	$188.96
Rate for Payer: Ohana Health Plan Medicaid	$242.18
Rate for Payer: UnitedHealthcare Medicaid	$242.18

PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY

Professional

Both

$42.16

Service Code	HCPCS 93316
Min. Negotiated Rate	$24.09
Max. Negotiated Rate	$48.62
Rate for Payer: AlohaCare Medicaid	$25.11
Rate for Payer: AlohaCare Medicare	$24.09
Rate for Payer: Cash Price	$25.30
Rate for Payer: Cash Price	$25.30
Rate for Payer: Devoted Health Medicare	$26.50
Rate for Payer: Hawaii Medical Service Association Medicare	$24.09
Rate for Payer: Hawaii Western Management Group Commercial	$48.62
Rate for Payer: Health Management Network Commercial	$35.84
Rate for Payer: Kaiser Permanente Commercial	$28.91
Rate for Payer: Kaiser Permanente Medicaid	$28.91
Rate for Payer: Kaiser Permanente Medicare	$28.91
Rate for Payer: Ohana Health Plan Medicaid	$25.11
Rate for Payer: Ohana Health Plan Medicare	$24.09
Rate for Payer: UnitedHealthcare Medicaid	$25.11
Rate for Payer: UnitedHealthcare Medicare	$24.09

PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT

Professional

Both

$153.86

Service Code	HCPCS 93317
Min. Negotiated Rate	$130.78
Max. Negotiated Rate	$199.34
Rate for Payer: AlohaCare Medicaid	$199.34
Rate for Payer: Cash Price	$92.32
Rate for Payer: Cash Price	$92.32
Rate for Payer: Hawaii Western Management Group Commercial	$163.65
Rate for Payer: Health Management Network Commercial	$130.78
Rate for Payer: Ohana Health Plan Medicaid	$199.34
Rate for Payer: UnitedHealthcare Medicaid	$199.34

PR ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ

Professional

Both

$181.32

Service Code	HCPCS 93318
Min. Negotiated Rate	$154.12
Max. Negotiated Rate	$154.12
Rate for Payer: Cash Price	$108.79
Rate for Payer: Health Management Network Commercial	$154.12

PR ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY

Professional

Both

$497.00

Service Code	HCPCS 93314 TC
Min. Negotiated Rate	$131.15
Max. Negotiated Rate	$422.45
Rate for Payer: AlohaCare Medicaid	$246.04
Rate for Payer: AlohaCare Medicare	$161.98
Rate for Payer: Cash Price	$298.20
Rate for Payer: Cash Price	$298.20
Rate for Payer: Devoted Health Medicare	$178.18
Rate for Payer: Hawaii Medical Service Association Medicare	$161.98
Rate for Payer: Hawaii Western Management Group Commercial	$131.15
Rate for Payer: Health Management Network Commercial	$422.45
Rate for Payer: Kaiser Permanente Commercial	$194.38
Rate for Payer: Kaiser Permanente Medicaid	$194.38
Rate for Payer: Kaiser Permanente Medicare	$194.38
Rate for Payer: Ohana Health Plan Medicaid	$246.04
Rate for Payer: Ohana Health Plan Medicare	$161.98
Rate for Payer: UnitedHealthcare Medicaid	$246.04
Rate for Payer: UnitedHealthcare Medicare	$161.98

PR ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY

Professional

Both

$157.00

Service Code	HCPCS 93314 26
Min. Negotiated Rate	$89.61
Max. Negotiated Rate	$246.04
Rate for Payer: AlohaCare Medicaid	$246.04
Rate for Payer: AlohaCare Medicare	$89.61
Rate for Payer: Cash Price	$94.20
Rate for Payer: Cash Price	$94.20
Rate for Payer: Devoted Health Medicare	$98.57
Rate for Payer: Hawaii Medical Service Association Medicare	$89.61
Rate for Payer: Hawaii Western Management Group Commercial	$131.15
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: Kaiser Permanente Commercial	$107.53
Rate for Payer: Kaiser Permanente Medicaid	$107.53
Rate for Payer: Kaiser Permanente Medicare	$107.53
Rate for Payer: Ohana Health Plan Medicaid	$246.04
Rate for Payer: Ohana Health Plan Medicare	$89.61
Rate for Payer: UnitedHealthcare Medicaid	$246.04
Rate for Payer: UnitedHealthcare Medicare	$89.61

PR ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY

Professional

Both

$654.00

Service Code	HCPCS 93314
Min. Negotiated Rate	$131.15
Max. Negotiated Rate	$555.90
Rate for Payer: AlohaCare Medicaid	$246.04
Rate for Payer: AlohaCare Medicare	$251.59
Rate for Payer: Cash Price	$392.40
Rate for Payer: Cash Price	$392.40
Rate for Payer: Devoted Health Medicare	$276.75
Rate for Payer: Hawaii Medical Service Association Medicare	$251.59
Rate for Payer: Hawaii Western Management Group Commercial	$131.15
Rate for Payer: Health Management Network Commercial	$555.90
Rate for Payer: Kaiser Permanente Commercial	$301.91
Rate for Payer: Kaiser Permanente Medicaid	$301.91
Rate for Payer: Kaiser Permanente Medicare	$301.91
Rate for Payer: Ohana Health Plan Medicaid	$246.04
Rate for Payer: Ohana Health Plan Medicare	$251.59
Rate for Payer: UnitedHealthcare Medicaid	$246.04
Rate for Payer: UnitedHealthcare Medicare	$251.59

Know your out-of-pocket cost for care.

All Charges