Kau Hospital

All Charges

Charge

Type

Setting

Price

PR MED GENETICS&GENETIC COUNSELING SVCS EACH 30 MIN

Professional

Both

$99.00

Service Code	HCPCS 96041
Min. Negotiated Rate	$84.15
Max. Negotiated Rate	$84.15
Rate for Payer: Cash Price	$59.40
Rate for Payer: Health Management Network Commercial	$84.15

PR MEDICAL RECORDS REVIEW

Professional

Both

$150.00

Service Code	HCPCS 98394
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$127.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Management Network Commercial	$127.50

PR MEDICATION ADMIN & HEMODYNAMIC MEASURMENT

Professional

Both

$170.56

Service Code	HCPCS 93463
Min. Negotiated Rate	$82.65
Max. Negotiated Rate	$144.98
Rate for Payer: AlohaCare Medicaid	$96.34
Rate for Payer: AlohaCare Medicare	$82.65
Rate for Payer: Cash Price	$102.34
Rate for Payer: Cash Price	$102.34
Rate for Payer: Devoted Health Medicare	$90.92
Rate for Payer: Hawaii Medical Service Association Medicare	$82.65
Rate for Payer: Hawaii Western Management Group Commercial	$105.61
Rate for Payer: Health Management Network Commercial	$144.98
Rate for Payer: Kaiser Permanente Commercial	$99.18
Rate for Payer: Kaiser Permanente Medicaid	$99.18
Rate for Payer: Kaiser Permanente Medicare	$99.18
Rate for Payer: Ohana Health Plan Medicaid	$96.34
Rate for Payer: Ohana Health Plan Medicare	$82.65
Rate for Payer: UnitedHealthcare Medicaid	$96.34
Rate for Payer: UnitedHealthcare Medicare	$82.65

PR MEDICATION THERAPY EACH ADDITIONAL 15 MIN

Professional

Both

$44.00

Service Code	HCPCS 99607
Min. Negotiated Rate	$37.40
Max. Negotiated Rate	$37.40
Rate for Payer: Cash Price	$26.40
Rate for Payer: Health Management Network Commercial	$37.40

PR MEDICATION THERAPY INITIAL 15 MIN ESTABLISHED PT

Professional

Both

$107.00

Service Code	HCPCS 99606
Min. Negotiated Rate	$90.95
Max. Negotiated Rate	$90.95
Rate for Payer: Cash Price	$64.20
Rate for Payer: Health Management Network Commercial	$90.95

PR MEDICATION THERAPY INITIAL 15 MIN NEW PATIENT

Professional

Both

$138.00

Service Code	HCPCS 99605
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$117.30
Rate for Payer: Cash Price	$82.80
Rate for Payer: Health Management Network Commercial	$117.30

PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE

Professional

Both

$700.00

Service Code	HCPCS 90734
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$595.00
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Hawaii Western Management Group Commercial	$125.47
Rate for Payer: Health Management Network Commercial	$595.00
Rate for Payer: Ohana Health Plan Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicaid	$4.00

PR MENACWY-TT CONJ VACC SEROGROUPS ACWY FOR IM USE

Professional

Both

$624.00

Service Code	HCPCS 90619
Min. Negotiated Rate	$530.40
Max. Negotiated Rate	$530.40
Rate for Payer: Cash Price	$374.40
Rate for Payer: Health Management Network Commercial	$530.40

PR MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM

Professional

Both

$304.00

Service Code	HCPCS 90620
Min. Negotiated Rate	$193.50
Max. Negotiated Rate	$258.40
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cash Price	$182.40
Rate for Payer: Hawaii Western Management Group Commercial	$193.50
Rate for Payer: Health Management Network Commercial	$258.40

PR MENIGCCAL PNTVLNT MENACWY TT MENB FHBP VACC IM

Professional

Both

$624.00

Service Code	HCPCS 90623
Min. Negotiated Rate	$530.40
Max. Negotiated Rate	$530.40
Rate for Payer: Cash Price	$374.40
Rate for Payer: Health Management Network Commercial	$530.40

PR METACARP FX ORTHOSIS PRE OTS

Professional

Both

$198.00

Service Code	HCPCS L3918
Min. Negotiated Rate	$84.77
Max. Negotiated Rate	$168.30
Rate for Payer: AlohaCare Medicaid	$88.51
Rate for Payer: AlohaCare Medicare	$115.37
Rate for Payer: Cash Price	$118.80
Rate for Payer: Cash Price	$118.80
Rate for Payer: Devoted Health Medicare	$126.91
Rate for Payer: Hawaii Medical Service Association Medicare	$115.37
Rate for Payer: Hawaii Western Management Group Commercial	$84.77
Rate for Payer: Health Management Network Commercial	$168.30
Rate for Payer: Kaiser Permanente Commercial	$138.44
Rate for Payer: Kaiser Permanente Medicaid	$138.44
Rate for Payer: Kaiser Permanente Medicare	$138.44
Rate for Payer: Ohana Health Plan Medicaid	$88.51
Rate for Payer: Ohana Health Plan Medicare	$115.37
Rate for Payer: UnitedHealthcare Medicaid	$88.51
Rate for Payer: UnitedHealthcare Medicare	$115.37

PR METATARSECTOMY

Professional

Both

$1,033.08

Service Code	HCPCS 28140
Min. Negotiated Rate	$368.16
Max. Negotiated Rate	$878.12
Rate for Payer: AlohaCare Medicaid	$437.48
Rate for Payer: AlohaCare Medicare	$401.97
Rate for Payer: Cash Price	$619.85
Rate for Payer: Cash Price	$619.85
Rate for Payer: Devoted Health Medicare	$442.17
Rate for Payer: Hawaii Medical Service Association ABD	$437.48
Rate for Payer: Hawaii Medical Service Association Commercial	$679.97
Rate for Payer: Hawaii Medical Service Association Medicare	$401.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$437.48
Rate for Payer: Hawaii Western Management Group Commercial	$368.16
Rate for Payer: Health Management Network Commercial	$878.12
Rate for Payer: Kaiser Permanente Commercial	$482.36
Rate for Payer: Kaiser Permanente Medicaid	$482.36
Rate for Payer: Kaiser Permanente Medicare	$482.36
Rate for Payer: Ohana Health Plan Medicaid	$437.48
Rate for Payer: Ohana Health Plan Medicare	$401.97
Rate for Payer: UnitedHealthcare Medicaid	$437.48
Rate for Payer: UnitedHealthcare Medicare	$401.97
Rate for Payer: University Health Alliance Commercial	$575.70

PR MGMT LVR HEMRRG EXPL WND DBRDMT COAGJ/SUTR

Professional

Both

$5,006.00

Service Code	HCPCS 47361
Min. Negotiated Rate	$1,322.10
Max. Negotiated Rate	$4,255.10
Rate for Payer: AlohaCare Medicaid	$2,922.09
Rate for Payer: AlohaCare Medicare	$2,671.86
Rate for Payer: Cash Price	$3,003.60
Rate for Payer: Cash Price	$3,003.60
Rate for Payer: Devoted Health Medicare	$2,939.05
Rate for Payer: Hawaii Medical Service Association Medicare	$2,671.86
Rate for Payer: Hawaii Western Management Group Commercial	$1,322.10
Rate for Payer: Health Management Network Commercial	$4,255.10
Rate for Payer: Kaiser Permanente Commercial	$3,206.23
Rate for Payer: Kaiser Permanente Medicaid	$3,206.23
Rate for Payer: Kaiser Permanente Medicare	$3,206.23
Rate for Payer: Ohana Health Plan Medicaid	$2,922.09
Rate for Payer: Ohana Health Plan Medicare	$2,671.86
Rate for Payer: UnitedHealthcare Medicaid	$2,922.09
Rate for Payer: UnitedHealthcare Medicare	$2,671.86

PR MICROSURG TQS REQ USE OPERATING MICROSCOPE

Professional

Both

$351.00

Service Code	HCPCS 69990
Min. Negotiated Rate	$183.88
Max. Negotiated Rate	$298.35
Rate for Payer: AlohaCare Medicaid	$204.81
Rate for Payer: AlohaCare Medicare	$183.88
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: Devoted Health Medicare	$202.27
Rate for Payer: Hawaii Medical Service Association Medicare	$183.88
Rate for Payer: Hawaii Western Management Group Commercial	$213.72
Rate for Payer: Health Management Network Commercial	$298.35
Rate for Payer: Kaiser Permanente Commercial	$220.66
Rate for Payer: Kaiser Permanente Medicaid	$220.66
Rate for Payer: Kaiser Permanente Medicare	$220.66
Rate for Payer: Ohana Health Plan Medicaid	$204.81
Rate for Payer: Ohana Health Plan Medicare	$183.88
Rate for Payer: UnitedHealthcare Medicaid	$204.81
Rate for Payer: UnitedHealthcare Medicare	$183.88

PR MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC

Professional

Both

$1,245.00

Service Code	HCPCS 69440
Min. Negotiated Rate	$95.16
Max. Negotiated Rate	$1,058.25
Rate for Payer: AlohaCare Medicaid	$740.15
Rate for Payer: AlohaCare Medicare	$654.69
Rate for Payer: Cash Price	$747.00
Rate for Payer: Cash Price	$747.00
Rate for Payer: Devoted Health Medicare	$720.16
Rate for Payer: Hawaii Medical Service Association Medicare	$654.69
Rate for Payer: Hawaii Western Management Group Commercial	$95.16
Rate for Payer: Health Management Network Commercial	$1,058.25
Rate for Payer: Kaiser Permanente Commercial	$785.63
Rate for Payer: Kaiser Permanente Medicaid	$785.63
Rate for Payer: Kaiser Permanente Medicare	$785.63
Rate for Payer: Ohana Health Plan Medicaid	$740.15
Rate for Payer: Ohana Health Plan Medicare	$654.69
Rate for Payer: UnitedHealthcare Medicaid	$740.15
Rate for Payer: UnitedHealthcare Medicare	$654.69

PR MIFEPRISTONE, ORAL, 200 MG

Professional

Both

$140.00

Service Code	HCPCS S0190
Min. Negotiated Rate	$81.05
Max. Negotiated Rate	$119.00
Rate for Payer: AlohaCare Medicaid	$81.05
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Hawaii Western Management Group Commercial	$90.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Ohana Health Plan Medicaid	$81.05
Rate for Payer: UnitedHealthcare Medicaid	$81.05

PR MISOPROSTOL, ORAL, 200 MCG

Professional

Both

$53.00

Service Code	HCPCS S0191
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$45.05
Rate for Payer: AlohaCare Medicaid	$2.36
Rate for Payer: Cash Price	$31.80
Rate for Payer: Cash Price	$31.80
Rate for Payer: Hawaii Western Management Group Commercial	$1.17
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Ohana Health Plan Medicaid	$2.36
Rate for Payer: UnitedHealthcare Medicaid	$2.36

PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS

Professional

Both

$353.00

Service Code	HCPCS 23700
Min. Negotiated Rate	$119.08
Max. Negotiated Rate	$300.05
Rate for Payer: AlohaCare Medicaid	$205.42
Rate for Payer: AlohaCare Medicare	$189.39
Rate for Payer: Cash Price	$211.80
Rate for Payer: Cash Price	$211.80
Rate for Payer: Devoted Health Medicare	$208.33
Rate for Payer: Hawaii Medical Service Association Medicare	$189.39
Rate for Payer: Hawaii Western Management Group Commercial	$119.08
Rate for Payer: Health Management Network Commercial	$300.05
Rate for Payer: Kaiser Permanente Commercial	$227.27
Rate for Payer: Kaiser Permanente Medicaid	$227.27
Rate for Payer: Kaiser Permanente Medicare	$227.27
Rate for Payer: Ohana Health Plan Medicaid	$205.42
Rate for Payer: Ohana Health Plan Medicare	$189.39
Rate for Payer: UnitedHealthcare Medicaid	$205.42
Rate for Payer: UnitedHealthcare Medicare	$189.39

PR MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT

Professional

Both

$197.00

Service Code	HCPCS 44139
Min. Negotiated Rate	$102.46
Max. Negotiated Rate	$167.45
Rate for Payer: AlohaCare Medicaid	$115.31
Rate for Payer: AlohaCare Medicare	$102.46
Rate for Payer: Cash Price	$118.20
Rate for Payer: Cash Price	$118.20
Rate for Payer: Devoted Health Medicare	$112.71
Rate for Payer: Hawaii Medical Service Association Medicare	$102.46
Rate for Payer: Hawaii Western Management Group Commercial	$130.00
Rate for Payer: Health Management Network Commercial	$167.45
Rate for Payer: Kaiser Permanente Commercial	$122.95
Rate for Payer: Kaiser Permanente Medicaid	$122.95
Rate for Payer: Kaiser Permanente Medicare	$122.95
Rate for Payer: Ohana Health Plan Medicaid	$115.31
Rate for Payer: Ohana Health Plan Medicare	$102.46
Rate for Payer: UnitedHealthcare Medicaid	$115.31
Rate for Payer: UnitedHealthcare Medicare	$102.46

PR MOD SEDAT ENDO SERVICE >5YRS

Professional

Both

$131.15

Service Code	HCPCS G0500
Min. Negotiated Rate	$5.06
Max. Negotiated Rate	$111.48
Rate for Payer: AlohaCare Medicaid	$5.42
Rate for Payer: AlohaCare Medicare	$5.06
Rate for Payer: Cash Price	$78.69
Rate for Payer: Cash Price	$78.69
Rate for Payer: Devoted Health Medicare	$5.57
Rate for Payer: Hawaii Medical Service Association ABD	$5.42
Rate for Payer: Hawaii Medical Service Association Medicare	$5.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.42
Rate for Payer: Hawaii Western Management Group Commercial	$67.40
Rate for Payer: Health Management Network Commercial	$111.48
Rate for Payer: Kaiser Permanente Commercial	$6.07
Rate for Payer: Kaiser Permanente Medicaid	$6.07
Rate for Payer: Kaiser Permanente Medicare	$6.07
Rate for Payer: Ohana Health Plan Medicaid	$5.42
Rate for Payer: Ohana Health Plan Medicare	$5.06
Rate for Payer: UnitedHealthcare Medicaid	$5.42
Rate for Payer: UnitedHealthcare Medicare	$5.06
Rate for Payer: University Health Alliance Commercial	$5.27

PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS

Professional

Both

$59.00

Service Code	HCPCS 99153
Min. Negotiated Rate	$12.64
Max. Negotiated Rate	$50.15
Rate for Payer: AlohaCare Medicaid	$13.00
Rate for Payer: AlohaCare Medicare	$13.68
Rate for Payer: Cash Price	$35.40
Rate for Payer: Cash Price	$35.40
Rate for Payer: Devoted Health Medicare	$15.05
Rate for Payer: Hawaii Medical Service Association Medicare	$13.68
Rate for Payer: Hawaii Western Management Group Commercial	$12.64
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: Kaiser Permanente Commercial	$16.42
Rate for Payer: Kaiser Permanente Medicaid	$16.42
Rate for Payer: Kaiser Permanente Medicare	$16.42
Rate for Payer: Ohana Health Plan Medicaid	$13.00
Rate for Payer: Ohana Health Plan Medicare	$13.68
Rate for Payer: UnitedHealthcare Medicaid	$13.00
Rate for Payer: UnitedHealthcare Medicare	$13.68

PR MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS

Professional

Both

$118.63

Service Code	HCPCS 99151
Min. Negotiated Rate	$21.08
Max. Negotiated Rate	$100.84
Rate for Payer: AlohaCare Medicaid	$24.09
Rate for Payer: AlohaCare Medicare	$21.08
Rate for Payer: Cash Price	$71.18
Rate for Payer: Cash Price	$71.18
Rate for Payer: Devoted Health Medicare	$23.19
Rate for Payer: Hawaii Medical Service Association ABD	$24.09
Rate for Payer: Hawaii Medical Service Association Medicare	$21.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.09
Rate for Payer: Hawaii Western Management Group Commercial	$86.60
Rate for Payer: Health Management Network Commercial	$100.84
Rate for Payer: Kaiser Permanente Commercial	$25.30
Rate for Payer: Kaiser Permanente Medicaid	$25.30
Rate for Payer: Kaiser Permanente Medicare	$25.30
Rate for Payer: Ohana Health Plan Medicaid	$24.09
Rate for Payer: Ohana Health Plan Medicare	$21.08
Rate for Payer: UnitedHealthcare Medicaid	$24.09
Rate for Payer: UnitedHealthcare Medicare	$21.08
Rate for Payer: University Health Alliance Commercial	$30.08

PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS

Professional

Both

$99.36

Service Code	HCPCS 99152
Min. Negotiated Rate	$10.83
Max. Negotiated Rate	$84.46
Rate for Payer: AlohaCare Medicaid	$11.94
Rate for Payer: AlohaCare Medicare	$10.83
Rate for Payer: Cash Price	$59.62
Rate for Payer: Cash Price	$59.62
Rate for Payer: Devoted Health Medicare	$11.91
Rate for Payer: Hawaii Medical Service Association ABD	$11.94
Rate for Payer: Hawaii Medical Service Association Medicare	$10.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.94
Rate for Payer: Hawaii Western Management Group Commercial	$58.30
Rate for Payer: Health Management Network Commercial	$84.46
Rate for Payer: Kaiser Permanente Commercial	$13.00
Rate for Payer: Kaiser Permanente Medicaid	$13.00
Rate for Payer: Kaiser Permanente Medicare	$13.00
Rate for Payer: Ohana Health Plan Medicaid	$11.94
Rate for Payer: Ohana Health Plan Medicare	$10.83
Rate for Payer: UnitedHealthcare Medicaid	$11.94
Rate for Payer: UnitedHealthcare Medicare	$10.83

PR MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB

Professional

Both

$5.00

Service Code	HCPCS 95905 26
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$81.50
Rate for Payer: AlohaCare Medicaid	$37.99
Rate for Payer: AlohaCare Medicare	$2.62
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cash Price	$3.00
Rate for Payer: Devoted Health Medicare	$2.88
Rate for Payer: Hawaii Medical Service Association Medicare	$2.62
Rate for Payer: Hawaii Western Management Group Commercial	$81.50
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$3.14
Rate for Payer: Kaiser Permanente Medicaid	$3.14
Rate for Payer: Kaiser Permanente Medicare	$3.14
Rate for Payer: Ohana Health Plan Medicaid	$37.99
Rate for Payer: Ohana Health Plan Medicare	$2.62
Rate for Payer: UnitedHealthcare Medicaid	$37.99
Rate for Payer: UnitedHealthcare Medicare	$2.62

PR MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB

Professional

Both

$111.00

Service Code	HCPCS 95905 TC
Min. Negotiated Rate	$34.75
Max. Negotiated Rate	$94.35
Rate for Payer: AlohaCare Medicaid	$37.99
Rate for Payer: AlohaCare Medicare	$34.75
Rate for Payer: Cash Price	$66.60
Rate for Payer: Cash Price	$66.60
Rate for Payer: Devoted Health Medicare	$38.23
Rate for Payer: Hawaii Medical Service Association Medicare	$34.75
Rate for Payer: Hawaii Western Management Group Commercial	$81.50
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Kaiser Permanente Commercial	$41.70
Rate for Payer: Kaiser Permanente Medicaid	$41.70
Rate for Payer: Kaiser Permanente Medicare	$41.70
Rate for Payer: Ohana Health Plan Medicaid	$37.99
Rate for Payer: Ohana Health Plan Medicare	$34.75
Rate for Payer: UnitedHealthcare Medicaid	$37.99
Rate for Payer: UnitedHealthcare Medicare	$34.75

Know your out-of-pocket cost for care.

All Charges