Kau Hospital

All Charges

Charge

Type

Setting

Price

PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 21-30 MIN

Professional

Both

$101.64

Service Code	HCPCS 99448
Min. Negotiated Rate	$47.82
Max. Negotiated Rate	$86.39
Rate for Payer: AlohaCare Medicare	$47.82
Rate for Payer: Cash Price	$60.98
Rate for Payer: Cash Price	$60.98
Rate for Payer: Devoted Health Medicare	$52.60
Rate for Payer: Hawaii Medical Service Association Medicare	$47.82
Rate for Payer: Hawaii Western Management Group Commercial	$56.73
Rate for Payer: Health Management Network Commercial	$86.39
Rate for Payer: Kaiser Permanente Commercial	$57.38
Rate for Payer: Kaiser Permanente Medicaid	$57.38
Rate for Payer: Kaiser Permanente Medicare	$57.38
Rate for Payer: Ohana Health Plan Medicare	$47.82
Rate for Payer: UnitedHealthcare Medicare	$47.82

PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 31/> MIN

Professional

Both

$136.40

Service Code	HCPCS 99449
Min. Negotiated Rate	$63.51
Max. Negotiated Rate	$115.94
Rate for Payer: AlohaCare Medicare	$63.51
Rate for Payer: Cash Price	$81.84
Rate for Payer: Cash Price	$81.84
Rate for Payer: Devoted Health Medicare	$69.86
Rate for Payer: Hawaii Medical Service Association Medicare	$63.51
Rate for Payer: Hawaii Western Management Group Commercial	$75.67
Rate for Payer: Health Management Network Commercial	$115.94
Rate for Payer: Kaiser Permanente Commercial	$76.21
Rate for Payer: Kaiser Permanente Medicaid	$76.21
Rate for Payer: Kaiser Permanente Medicare	$76.21
Rate for Payer: Ohana Health Plan Medicare	$63.51
Rate for Payer: UnitedHealthcare Medicare	$63.51

PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 5-10 MIN

Professional

Both

$33.78

Service Code	HCPCS 99446
Min. Negotiated Rate	$15.88
Max. Negotiated Rate	$28.71
Rate for Payer: AlohaCare Medicare	$15.88
Rate for Payer: Cash Price	$20.27
Rate for Payer: Cash Price	$20.27
Rate for Payer: Devoted Health Medicare	$17.47
Rate for Payer: Hawaii Medical Service Association Medicare	$15.88
Rate for Payer: Hawaii Western Management Group Commercial	$18.78
Rate for Payer: Health Management Network Commercial	$28.71
Rate for Payer: Kaiser Permanente Commercial	$19.06
Rate for Payer: Kaiser Permanente Medicaid	$19.06
Rate for Payer: Kaiser Permanente Medicare	$19.06
Rate for Payer: Ohana Health Plan Medicare	$15.88
Rate for Payer: UnitedHealthcare Medicare	$15.88

PR NURSING FACILITY DSCHRG MGMT 30 MIN+ TOT TIME

Professional

Both

$249.58

Service Code	HCPCS 99316
Min. Negotiated Rate	$73.13
Max. Negotiated Rate	$212.14
Rate for Payer: AlohaCare Medicaid	$133.44
Rate for Payer: AlohaCare Medicare	$119.07
Rate for Payer: Cash Price	$149.75
Rate for Payer: Cash Price	$149.75
Rate for Payer: Devoted Health Medicare	$130.98
Rate for Payer: Hawaii Medical Service Association Medicare	$119.07
Rate for Payer: Hawaii Western Management Group Commercial	$73.13
Rate for Payer: Health Management Network Commercial	$212.14
Rate for Payer: Kaiser Permanente Commercial	$142.88
Rate for Payer: Kaiser Permanente Medicaid	$142.88
Rate for Payer: Kaiser Permanente Medicare	$142.88
Rate for Payer: Ohana Health Plan Medicaid	$133.44
Rate for Payer: Ohana Health Plan Medicare	$119.07
Rate for Payer: UnitedHealthcare Medicaid	$133.44
Rate for Payer: UnitedHealthcare Medicare	$119.07

PR NURSING FACILITY DSCHRG MGMT 30 MIN/< TOT TIME

Professional

Both

$155.85

Service Code	HCPCS 99315
Min. Negotiated Rate	$45.97
Max. Negotiated Rate	$132.47
Rate for Payer: AlohaCare Medicaid	$83.54
Rate for Payer: AlohaCare Medicare	$74.63
Rate for Payer: Cash Price	$93.51
Rate for Payer: Cash Price	$93.51
Rate for Payer: Devoted Health Medicare	$82.09
Rate for Payer: Hawaii Medical Service Association Medicare	$74.63
Rate for Payer: Hawaii Western Management Group Commercial	$45.97
Rate for Payer: Health Management Network Commercial	$132.47
Rate for Payer: Kaiser Permanente Commercial	$89.56
Rate for Payer: Kaiser Permanente Medicaid	$89.56
Rate for Payer: Kaiser Permanente Medicare	$89.56
Rate for Payer: Ohana Health Plan Medicaid	$83.54
Rate for Payer: Ohana Health Plan Medicare	$74.63
Rate for Payer: UnitedHealthcare Medicaid	$83.54
Rate for Payer: UnitedHealthcare Medicare	$74.63

PR NUSHIELD 1 SQUARE CM

Professional

Both

$253.21

Service Code	HCPCS Q4160
Min. Negotiated Rate	$144.69
Max. Negotiated Rate	$215.23
Rate for Payer: AlohaCare Medicare	$144.69
Rate for Payer: Cash Price	$151.93
Rate for Payer: Cash Price	$151.93
Rate for Payer: Devoted Health Medicare	$159.16
Rate for Payer: Hawaii Medical Service Association Medicare	$144.69
Rate for Payer: Health Management Network Commercial	$215.23
Rate for Payer: Kaiser Permanente Commercial	$173.63
Rate for Payer: Kaiser Permanente Medicaid	$173.63
Rate for Payer: Kaiser Permanente Medicare	$173.63
Rate for Payer: Ohana Health Plan Medicare	$144.69
Rate for Payer: UnitedHealthcare Medicare	$144.69

PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM

Professional

Both

$4,506.00

Service Code	HCPCS 59510
Min. Negotiated Rate	$1,448.98
Max. Negotiated Rate	$3,830.10
Rate for Payer: AlohaCare Medicaid	$2,656.47
Rate for Payer: AlohaCare Medicare	$2,382.05
Rate for Payer: Cash Price	$2,703.60
Rate for Payer: Cash Price	$2,703.60
Rate for Payer: Devoted Health Medicare	$2,620.26
Rate for Payer: Hawaii Medical Service Association Medicare	$2,382.05
Rate for Payer: Hawaii Western Management Group Commercial	$1,448.98
Rate for Payer: Health Management Network Commercial	$3,830.10
Rate for Payer: Kaiser Permanente Commercial	$2,858.46
Rate for Payer: Kaiser Permanente Medicaid	$2,858.46
Rate for Payer: Kaiser Permanente Medicare	$2,858.46
Rate for Payer: Ohana Health Plan Medicaid	$2,656.47
Rate for Payer: Ohana Health Plan Medicare	$2,382.05
Rate for Payer: UnitedHealthcare Medicaid	$2,656.47
Rate for Payer: UnitedHealthcare Medicare	$2,382.05

PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM

Professional

Both

$4,089.00

Service Code	HCPCS 59400
Min. Negotiated Rate	$1,053.78
Max. Negotiated Rate	$3,475.65
Rate for Payer: AlohaCare Medicaid	$2,408.90
Rate for Payer: AlohaCare Medicare	$2,152.11
Rate for Payer: Cash Price	$2,453.40
Rate for Payer: Cash Price	$2,453.40
Rate for Payer: Devoted Health Medicare	$2,367.32
Rate for Payer: Hawaii Medical Service Association Medicare	$2,152.11
Rate for Payer: Hawaii Western Management Group Commercial	$1,053.78
Rate for Payer: Health Management Network Commercial	$3,475.65
Rate for Payer: Kaiser Permanente Commercial	$2,582.53
Rate for Payer: Kaiser Permanente Medicaid	$2,582.53
Rate for Payer: Kaiser Permanente Medicare	$2,582.53
Rate for Payer: Ohana Health Plan Medicaid	$2,408.90
Rate for Payer: Ohana Health Plan Medicare	$2,152.11
Rate for Payer: UnitedHealthcare Medicaid	$2,408.90
Rate for Payer: UnitedHealthcare Medicare	$2,152.11

PROBE ARTHROSCOPIC AR-4070-01

Facility

$1,001.00

Hospital Revenue Code	272
Min. Negotiated Rate	$310.31
Max. Negotiated Rate	$970.97
Rate for Payer: AlohaCare Medicaid	$500.50
Rate for Payer: AlohaCare Medicare	$310.31
Rate for Payer: Cash Price	$600.60
Rate for Payer: Devoted Health Medicare	$340.34
Rate for Payer: Hawaii Medical Service Association Medicare	$310.31
Rate for Payer: Hawaii Western Management Group Commercial	$950.95
Rate for Payer: Health Management Network Commercial	$850.85
Rate for Payer: Humana Medicare	$310.31
Rate for Payer: Kaiser Permanente Commercial	$900.90
Rate for Payer: Kaiser Permanente Medicaid	$510.51
Rate for Payer: Kaiser Permanente Medicare	$310.31
Rate for Payer: MDX Hawaii PPO	$970.97
Rate for Payer: Ohana Health Plan Medicaid	$310.31
Rate for Payer: Ohana Health Plan Medicare	$310.31
Rate for Payer: UnitedHealthcare Medicare	$310.31
Rate for Payer: University Health Alliance Commercial	$729.63

PROBE ARTHROSCOPIC AR-4070-01

Facility

$1,001.00

Hospital Revenue Code	272
Min. Negotiated Rate	$850.85
Max. Negotiated Rate	$970.97
Rate for Payer: Cash Price	$600.60
Rate for Payer: Health Management Network Commercial	$850.85
Rate for Payer: Kaiser Permanente Commercial	$900.90
Rate for Payer: MDX Hawaii PPO	$970.97

PROBE BIOPLAR STIMULATOR

Facility

$704.00

Hospital Revenue Code	270
Min. Negotiated Rate	$598.40
Max. Negotiated Rate	$682.88
Rate for Payer: Cash Price	$422.40
Rate for Payer: Health Management Network Commercial	$598.40
Rate for Payer: Kaiser Permanente Commercial	$633.60
Rate for Payer: MDX Hawaii PPO	$682.88

PROBE BIOPLAR STIMULATOR

Facility

$704.00

Hospital Revenue Code	270
Min. Negotiated Rate	$218.24
Max. Negotiated Rate	$682.88
Rate for Payer: AlohaCare Medicaid	$352.00
Rate for Payer: AlohaCare Medicare	$218.24
Rate for Payer: Cash Price	$422.40
Rate for Payer: Devoted Health Medicare	$239.36
Rate for Payer: Hawaii Medical Service Association Medicare	$218.24
Rate for Payer: Hawaii Western Management Group Commercial	$668.80
Rate for Payer: Health Management Network Commercial	$598.40
Rate for Payer: Humana Medicare	$218.24
Rate for Payer: Kaiser Permanente Commercial	$633.60
Rate for Payer: Kaiser Permanente Medicaid	$359.04
Rate for Payer: Kaiser Permanente Medicare	$218.24
Rate for Payer: MDX Hawaii PPO	$682.88
Rate for Payer: Ohana Health Plan Medicaid	$218.24
Rate for Payer: Ohana Health Plan Medicare	$218.24
Rate for Payer: UnitedHealthcare Medicare	$218.24
Rate for Payer: University Health Alliance Commercial	$513.15

PROBE BIPOLAR GOLD 7FR

Facility

$640.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$544.00
Max. Negotiated Rate	$620.80
Rate for Payer: Cash Price	$384.00
Rate for Payer: Health Management Network Commercial	$544.00
Rate for Payer: Kaiser Permanente Commercial	$576.00
Rate for Payer: MDX Hawaii PPO	$620.80

PROBE BIPOLAR GOLD 7FR

Facility

$640.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$198.40
Max. Negotiated Rate	$620.80
Rate for Payer: AlohaCare Medicaid	$320.00
Rate for Payer: AlohaCare Medicare	$198.40
Rate for Payer: Cash Price	$384.00
Rate for Payer: Devoted Health Medicare	$217.60
Rate for Payer: Hawaii Medical Service Association Medicare	$198.40
Rate for Payer: Hawaii Western Management Group Commercial	$608.00
Rate for Payer: Health Management Network Commercial	$544.00
Rate for Payer: Humana Medicare	$198.40
Rate for Payer: Kaiser Permanente Commercial	$576.00
Rate for Payer: Kaiser Permanente Medicaid	$326.40
Rate for Payer: Kaiser Permanente Medicare	$198.40
Rate for Payer: MDX Hawaii PPO	$620.80
Rate for Payer: Ohana Health Plan Medicaid	$198.40
Rate for Payer: Ohana Health Plan Medicare	$198.40
Rate for Payer: UnitedHealthcare Medicare	$198.40
Rate for Payer: University Health Alliance Commercial	$466.50

PROBE GOLD ELECTRO 10FR

Facility

$585.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$497.25
Max. Negotiated Rate	$567.45
Rate for Payer: Cash Price	$351.00
Rate for Payer: Health Management Network Commercial	$497.25
Rate for Payer: Kaiser Permanente Commercial	$526.50
Rate for Payer: MDX Hawaii PPO	$567.45

PROBE GOLD ELECTRO 10FR

Facility

$585.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$181.35
Max. Negotiated Rate	$567.45
Rate for Payer: AlohaCare Medicaid	$292.50
Rate for Payer: AlohaCare Medicare	$181.35
Rate for Payer: Cash Price	$351.00
Rate for Payer: Devoted Health Medicare	$198.90
Rate for Payer: Hawaii Medical Service Association Medicare	$181.35
Rate for Payer: Hawaii Western Management Group Commercial	$555.75
Rate for Payer: Health Management Network Commercial	$497.25
Rate for Payer: Humana Medicare	$181.35
Rate for Payer: Kaiser Permanente Commercial	$526.50
Rate for Payer: Kaiser Permanente Medicaid	$298.35
Rate for Payer: Kaiser Permanente Medicare	$181.35
Rate for Payer: MDX Hawaii PPO	$567.45
Rate for Payer: Ohana Health Plan Medicaid	$181.35
Rate for Payer: Ohana Health Plan Medicare	$181.35
Rate for Payer: UnitedHealthcare Medicare	$181.35
Rate for Payer: University Health Alliance Commercial	$426.41

PROBE GOLD INJ 10FR

Facility

$788.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$669.80
Max. Negotiated Rate	$764.36
Rate for Payer: Cash Price	$472.80
Rate for Payer: Health Management Network Commercial	$669.80
Rate for Payer: Kaiser Permanente Commercial	$709.20
Rate for Payer: MDX Hawaii PPO	$764.36

PROBE GOLD INJ 10FR

Facility

$788.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$244.28
Max. Negotiated Rate	$764.36
Rate for Payer: AlohaCare Medicaid	$394.00
Rate for Payer: AlohaCare Medicare	$244.28
Rate for Payer: Cash Price	$472.80
Rate for Payer: Devoted Health Medicare	$267.92
Rate for Payer: Hawaii Medical Service Association Medicare	$244.28
Rate for Payer: Hawaii Western Management Group Commercial	$748.60
Rate for Payer: Health Management Network Commercial	$669.80
Rate for Payer: Humana Medicare	$244.28
Rate for Payer: Kaiser Permanente Commercial	$709.20
Rate for Payer: Kaiser Permanente Medicaid	$401.88
Rate for Payer: Kaiser Permanente Medicare	$244.28
Rate for Payer: MDX Hawaii PPO	$764.36
Rate for Payer: Ohana Health Plan Medicaid	$244.28
Rate for Payer: Ohana Health Plan Medicare	$244.28
Rate for Payer: UnitedHealthcare Medicare	$244.28
Rate for Payer: University Health Alliance Commercial	$574.37

PROBE GOLD INJ 7FR

Facility

$811.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$689.35
Max. Negotiated Rate	$786.67
Rate for Payer: Cash Price	$486.60
Rate for Payer: Health Management Network Commercial	$689.35
Rate for Payer: Kaiser Permanente Commercial	$729.90
Rate for Payer: MDX Hawaii PPO	$786.67

PROBE GOLD INJ 7FR

Facility

$811.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$251.41
Max. Negotiated Rate	$786.67
Rate for Payer: AlohaCare Medicaid	$405.50
Rate for Payer: AlohaCare Medicare	$251.41
Rate for Payer: Cash Price	$486.60
Rate for Payer: Devoted Health Medicare	$275.74
Rate for Payer: Hawaii Medical Service Association Medicare	$251.41
Rate for Payer: Hawaii Western Management Group Commercial	$770.45
Rate for Payer: Health Management Network Commercial	$689.35
Rate for Payer: Humana Medicare	$251.41
Rate for Payer: Kaiser Permanente Commercial	$729.90
Rate for Payer: Kaiser Permanente Medicaid	$413.61
Rate for Payer: Kaiser Permanente Medicare	$251.41
Rate for Payer: MDX Hawaii PPO	$786.67
Rate for Payer: Ohana Health Plan Medicaid	$251.41
Rate for Payer: Ohana Health Plan Medicare	$251.41
Rate for Payer: UnitedHealthcare Medicare	$251.41
Rate for Payer: University Health Alliance Commercial	$591.14

PROBE LITHOTRISPY 11.3FR

Facility

$1,935.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,644.75
Max. Negotiated Rate	$1,876.95
Rate for Payer: Cash Price	$1,161.00
Rate for Payer: Health Management Network Commercial	$1,644.75
Rate for Payer: Kaiser Permanente Commercial	$1,741.50
Rate for Payer: MDX Hawaii PPO	$1,876.95

PROBE LITHOTRISPY 11.3FR

Facility

$1,935.00

Hospital Revenue Code	272
Min. Negotiated Rate	$599.85
Max. Negotiated Rate	$1,876.95
Rate for Payer: AlohaCare Medicaid	$967.50
Rate for Payer: AlohaCare Medicare	$599.85
Rate for Payer: Cash Price	$1,161.00
Rate for Payer: Devoted Health Medicare	$657.90
Rate for Payer: Hawaii Medical Service Association Medicare	$599.85
Rate for Payer: Hawaii Western Management Group Commercial	$1,838.25
Rate for Payer: Health Management Network Commercial	$1,644.75
Rate for Payer: Humana Medicare	$599.85
Rate for Payer: Kaiser Permanente Commercial	$1,741.50
Rate for Payer: Kaiser Permanente Medicaid	$986.85
Rate for Payer: Kaiser Permanente Medicare	$599.85
Rate for Payer: MDX Hawaii PPO	$1,876.95
Rate for Payer: Ohana Health Plan Medicaid	$599.85
Rate for Payer: Ohana Health Plan Medicare	$599.85
Rate for Payer: UnitedHealthcare Medicare	$599.85
Rate for Payer: University Health Alliance Commercial	$1,410.42

PROBE LITHROTRIPSY 1.9FR

Facility

$1,502.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$1,276.70
Max. Negotiated Rate	$1,456.94
Rate for Payer: Cash Price	$901.20
Rate for Payer: Health Management Network Commercial	$1,276.70
Rate for Payer: Kaiser Permanente Commercial	$1,351.80
Rate for Payer: MDX Hawaii PPO	$1,456.94

PROBE LITHROTRIPSY 1.9FR

Facility

$1,502.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$465.62
Max. Negotiated Rate	$1,456.94
Rate for Payer: AlohaCare Medicaid	$751.00
Rate for Payer: AlohaCare Medicare	$465.62
Rate for Payer: Cash Price	$901.20
Rate for Payer: Devoted Health Medicare	$510.68
Rate for Payer: Hawaii Medical Service Association Medicare	$465.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,426.90
Rate for Payer: Health Management Network Commercial	$1,276.70
Rate for Payer: Humana Medicare	$465.62
Rate for Payer: Kaiser Permanente Commercial	$1,351.80
Rate for Payer: Kaiser Permanente Medicaid	$766.02
Rate for Payer: Kaiser Permanente Medicare	$465.62
Rate for Payer: MDX Hawaii PPO	$1,456.94
Rate for Payer: Ohana Health Plan Medicaid	$465.62
Rate for Payer: Ohana Health Plan Medicare	$465.62
Rate for Payer: UnitedHealthcare Medicare	$465.62
Rate for Payer: University Health Alliance Commercial	$1,094.81

PROBENECID 500 MG TABLET [6561]

Facility

$4.00

Service Code	NDC 00591534701
Hospital Revenue Code	637
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$1.24
Rate for Payer: Cash Price	$2.40
Rate for Payer: Devoted Health Medicare	$1.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$1.24
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$1.24
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$1.24
Rate for Payer: Ohana Health Plan Medicare	$1.24
Rate for Payer: UnitedHealthcare Medicare	$1.24
Rate for Payer: University Health Alliance Commercial	$2.92

Know your out-of-pocket cost for care.

All Charges