Kau Hospital

All Charges

Charge

Type

Setting

Price

PSN TIB STEM LT 42-5320-075-01

Facility

$2,600.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

PSN TIB STEM RT 42-5320-075-02

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,120.00
Max. Negotiated Rate	$1,940.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.00
Rate for Payer: Health Management Network Commercial	$1,700.00
Rate for Payer: Kaiser Permanente Commercial	$1,800.00
Rate for Payer: MDX Hawaii PPO	$1,940.00
Rate for Payer: University Health Alliance Commercial	$1,120.00

PSN TIB STEM RT 42-5320-075-02

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$620.00
Max. Negotiated Rate	$1,940.00
Rate for Payer: AlohaCare Medicaid	$1,000.00
Rate for Payer: AlohaCare Medicare	$620.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Devoted Health Medicare	$680.00
Rate for Payer: Hawaii Medical Service Association Medicare	$620.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.00
Rate for Payer: Health Management Network Commercial	$1,700.00
Rate for Payer: Humana Medicare	$620.00
Rate for Payer: Kaiser Permanente Commercial	$1,800.00
Rate for Payer: Kaiser Permanente Medicaid	$1,020.00
Rate for Payer: Kaiser Permanente Medicare	$620.00
Rate for Payer: MDX Hawaii PPO	$1,940.00
Rate for Payer: Ohana Health Plan Medicaid	$620.00
Rate for Payer: Ohana Health Plan Medicare	$620.00
Rate for Payer: UnitedHealthcare Medicare	$620.00
Rate for Payer: University Health Alliance Commercial	$1,120.00

PSN TIB ST LEFT 42-5320-067-01

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

PSN TIB ST LEFT 42-5320-067-01

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$806.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: AlohaCare Medicaid	$1,300.00
Rate for Payer: AlohaCare Medicare	$806.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Devoted Health Medicare	$884.00
Rate for Payer: Hawaii Medical Service Association Medicare	$806.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Humana Medicare	$806.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: Kaiser Permanente Medicaid	$1,326.00
Rate for Payer: Kaiser Permanente Medicare	$806.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: Ohana Health Plan Medicaid	$806.00
Rate for Payer: Ohana Health Plan Medicare	$806.00
Rate for Payer: UnitedHealthcare Medicare	$806.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

PSN TIB STM 5 DEG SZ C R

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$806.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: AlohaCare Medicaid	$1,300.00
Rate for Payer: AlohaCare Medicare	$806.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Devoted Health Medicare	$884.00
Rate for Payer: Hawaii Medical Service Association Medicare	$806.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Humana Medicare	$806.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: Kaiser Permanente Medicaid	$1,326.00
Rate for Payer: Kaiser Permanente Medicare	$806.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: Ohana Health Plan Medicaid	$806.00
Rate for Payer: Ohana Health Plan Medicare	$806.00
Rate for Payer: UnitedHealthcare Medicare	$806.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

PSN TIB STM 5 DEG SZ C R

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

PSYCHOSES

Facility

$15,761.83

Service Code	MSDRG 885
Min. Negotiated Rate	$15,761.83
Max. Negotiated Rate	$15,761.83
Rate for Payer: Hawaii Medical Service Association Commercial	$15,761.83

PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET [95957]

Facility

$2.00

Service Code	NDC 37000002310
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.94
Rate for Payer: Cash Price	$1.20
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: MDX Hawaii PPO	$1.94

PSYLLIUM HUSK (WITH SUGAR) 3.4 GRAM ORAL POWDER PACKET [95957]

Facility

$2.00

Service Code	NDC 37000002310
Hospital Revenue Code	637
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$1.94
Rate for Payer: AlohaCare Medicaid	$1.00
Rate for Payer: AlohaCare Medicare	$0.62
Rate for Payer: Cash Price	$1.20
Rate for Payer: Devoted Health Medicare	$0.68
Rate for Payer: Hawaii Medical Service Association Medicare	$0.62
Rate for Payer: Hawaii Western Management Group Commercial	$1.90
Rate for Payer: Health Management Network Commercial	$1.70
Rate for Payer: Humana Medicare	$0.62
Rate for Payer: Kaiser Permanente Commercial	$1.80
Rate for Payer: Kaiser Permanente Medicaid	$1.02
Rate for Payer: Kaiser Permanente Medicare	$0.62
Rate for Payer: MDX Hawaii PPO	$1.94
Rate for Payer: Ohana Health Plan Medicaid	$0.62
Rate for Payer: Ohana Health Plan Medicare	$0.62
Rate for Payer: UnitedHealthcare Medicare	$0.62
Rate for Payer: University Health Alliance Commercial	$1.46

PULMONARY EDEMA AND RESPIRATORY FAILURE

Facility

$45,602.65

Service Code	MSDRG 189
Min. Negotiated Rate	$45,602.65
Max. Negotiated Rate	$45,602.65
Rate for Payer: Hawaii Medical Service Association Commercial	$45,602.65

PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE

Facility

$30,954.81

Service Code	MSDRG 175
Min. Negotiated Rate	$30,954.81
Max. Negotiated Rate	$30,954.81
Rate for Payer: Hawaii Medical Service Association Commercial	$30,954.81

PULMONARY EMBOLISM WITHOUT MCC

Facility

$30,954.81

Service Code	MSDRG 176
Min. Negotiated Rate	$30,954.81
Max. Negotiated Rate	$30,954.81
Rate for Payer: Hawaii Medical Service Association Commercial	$30,954.81

PULSE GENERATOR V 3150

Facility

$43,200.00

Service Code	HCPCS C1767
Hospital Revenue Code	278
Min. Negotiated Rate	$24,192.00
Max. Negotiated Rate	$41,904.00
Rate for Payer: Cash Price	$25,920.00
Rate for Payer: Hawaii Western Management Group Commercial	$30,240.00
Rate for Payer: Health Management Network Commercial	$36,720.00
Rate for Payer: Kaiser Permanente Commercial	$38,880.00
Rate for Payer: MDX Hawaii PPO	$41,904.00
Rate for Payer: University Health Alliance Commercial	$24,192.00

PULSE GENERATOR V 3150

Facility

$43,200.00

Service Code	HCPCS C1767
Hospital Revenue Code	278
Min. Negotiated Rate	$13,392.00
Max. Negotiated Rate	$41,904.00
Rate for Payer: AlohaCare Medicaid	$21,600.00
Rate for Payer: AlohaCare Medicare	$13,392.00
Rate for Payer: Cash Price	$25,920.00
Rate for Payer: Devoted Health Medicare	$14,688.00
Rate for Payer: Hawaii Medical Service Association Medicare	$13,392.00
Rate for Payer: Hawaii Western Management Group Commercial	$30,240.00
Rate for Payer: Health Management Network Commercial	$36,720.00
Rate for Payer: Humana Medicare	$13,392.00
Rate for Payer: Kaiser Permanente Commercial	$38,880.00
Rate for Payer: Kaiser Permanente Medicaid	$22,032.00
Rate for Payer: Kaiser Permanente Medicare	$13,392.00
Rate for Payer: MDX Hawaii PPO	$41,904.00
Rate for Payer: Ohana Health Plan Medicaid	$13,392.00
Rate for Payer: Ohana Health Plan Medicare	$13,392.00
Rate for Payer: UnitedHealthcare Medicare	$13,392.00
Rate for Payer: University Health Alliance Commercial	$24,192.00

PUMP AMS 700 LGX 18CM

Facility

$25,458.00

Service Code	HCPCS C1813
Hospital Revenue Code	278
Min. Negotiated Rate	$7,891.98
Max. Negotiated Rate	$24,694.26
Rate for Payer: AlohaCare Medicaid	$12,729.00
Rate for Payer: AlohaCare Medicare	$7,891.98
Rate for Payer: Cash Price	$15,274.80
Rate for Payer: Devoted Health Medicare	$8,655.72
Rate for Payer: Hawaii Medical Service Association Medicare	$7,891.98
Rate for Payer: Hawaii Western Management Group Commercial	$17,820.60
Rate for Payer: Health Management Network Commercial	$21,639.30
Rate for Payer: Humana Medicare	$7,891.98
Rate for Payer: Kaiser Permanente Commercial	$22,912.20
Rate for Payer: Kaiser Permanente Medicaid	$12,983.58
Rate for Payer: Kaiser Permanente Medicare	$7,891.98
Rate for Payer: MDX Hawaii PPO	$24,694.26
Rate for Payer: Ohana Health Plan Medicaid	$7,891.98
Rate for Payer: Ohana Health Plan Medicare	$7,891.98
Rate for Payer: UnitedHealthcare Medicare	$7,891.98
Rate for Payer: University Health Alliance Commercial	$14,256.48

PUMP AMS 700 LGX 18CM

Facility

$25,458.00

Service Code	HCPCS C1813
Hospital Revenue Code	278
Min. Negotiated Rate	$14,256.48
Max. Negotiated Rate	$24,694.26
Rate for Payer: Cash Price	$15,274.80
Rate for Payer: Hawaii Western Management Group Commercial	$17,820.60
Rate for Payer: Health Management Network Commercial	$21,639.30
Rate for Payer: Kaiser Permanente Commercial	$22,912.20
Rate for Payer: MDX Hawaii PPO	$24,694.26
Rate for Payer: University Health Alliance Commercial	$14,256.48

PUNCH DISP 4.75/5.5 AR-1927PBS

Facility

$405.00

Hospital Revenue Code	272
Min. Negotiated Rate	$125.55
Max. Negotiated Rate	$392.85
Rate for Payer: AlohaCare Medicaid	$202.50
Rate for Payer: AlohaCare Medicare	$125.55
Rate for Payer: Cash Price	$243.00
Rate for Payer: Devoted Health Medicare	$137.70
Rate for Payer: Hawaii Medical Service Association Medicare	$125.55
Rate for Payer: Hawaii Western Management Group Commercial	$384.75
Rate for Payer: Health Management Network Commercial	$344.25
Rate for Payer: Humana Medicare	$125.55
Rate for Payer: Kaiser Permanente Commercial	$364.50
Rate for Payer: Kaiser Permanente Medicaid	$206.55
Rate for Payer: Kaiser Permanente Medicare	$125.55
Rate for Payer: MDX Hawaii PPO	$392.85
Rate for Payer: Ohana Health Plan Medicaid	$125.55
Rate for Payer: Ohana Health Plan Medicare	$125.55
Rate for Payer: UnitedHealthcare Medicare	$125.55
Rate for Payer: University Health Alliance Commercial	$295.20

PUNCH DISP 4.75/5.5 AR-1927PBS

Facility

$405.00

Hospital Revenue Code	272
Min. Negotiated Rate	$344.25
Max. Negotiated Rate	$392.85
Rate for Payer: Cash Price	$243.00
Rate for Payer: Health Management Network Commercial	$344.25
Rate for Payer: Kaiser Permanente Commercial	$364.50
Rate for Payer: MDX Hawaii PPO	$392.85

PUSHER

Facility

$555.00

Hospital Revenue Code	272
Min. Negotiated Rate	$471.75
Max. Negotiated Rate	$538.35
Rate for Payer: Cash Price	$333.00
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: MDX Hawaii PPO	$538.35

PUSHER

Facility

$555.00

Hospital Revenue Code	272
Min. Negotiated Rate	$172.05
Max. Negotiated Rate	$538.35
Rate for Payer: AlohaCare Medicaid	$277.50
Rate for Payer: AlohaCare Medicare	$172.05
Rate for Payer: Cash Price	$333.00
Rate for Payer: Devoted Health Medicare	$188.70
Rate for Payer: Hawaii Medical Service Association Medicare	$172.05
Rate for Payer: Hawaii Western Management Group Commercial	$527.25
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Humana Medicare	$172.05
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: Kaiser Permanente Medicaid	$283.05
Rate for Payer: Kaiser Permanente Medicare	$172.05
Rate for Payer: MDX Hawaii PPO	$538.35
Rate for Payer: Ohana Health Plan Medicaid	$172.05
Rate for Payer: Ohana Health Plan Medicare	$172.05
Rate for Payer: UnitedHealthcare Medicare	$172.05
Rate for Payer: University Health Alliance Commercial	$404.54

PUSHLOCK KIT 2.9MM #AR-1923PK

Facility

$1,278.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,086.30
Max. Negotiated Rate	$1,239.66
Rate for Payer: Cash Price	$766.80
Rate for Payer: Health Management Network Commercial	$1,086.30
Rate for Payer: Kaiser Permanente Commercial	$1,150.20
Rate for Payer: MDX Hawaii PPO	$1,239.66

PUSHLOCK KIT 2.9MM #AR-1923PK

Facility

$1,278.00

Hospital Revenue Code	272
Min. Negotiated Rate	$396.18
Max. Negotiated Rate	$1,239.66
Rate for Payer: AlohaCare Medicaid	$639.00
Rate for Payer: AlohaCare Medicare	$396.18
Rate for Payer: Cash Price	$766.80
Rate for Payer: Devoted Health Medicare	$434.52
Rate for Payer: Hawaii Medical Service Association Medicare	$396.18
Rate for Payer: Hawaii Western Management Group Commercial	$1,214.10
Rate for Payer: Health Management Network Commercial	$1,086.30
Rate for Payer: Humana Medicare	$396.18
Rate for Payer: Kaiser Permanente Commercial	$1,150.20
Rate for Payer: Kaiser Permanente Medicaid	$651.78
Rate for Payer: Kaiser Permanente Medicare	$396.18
Rate for Payer: MDX Hawaii PPO	$1,239.66
Rate for Payer: Ohana Health Plan Medicaid	$396.18
Rate for Payer: Ohana Health Plan Medicare	$396.18
Rate for Payer: UnitedHealthcare Medicare	$396.18
Rate for Payer: University Health Alliance Commercial	$931.53

PUTTY BONE DBX 10CC 038100

Facility

$2,760.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,545.60
Max. Negotiated Rate	$2,677.20
Rate for Payer: Cash Price	$1,656.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,932.00
Rate for Payer: Health Management Network Commercial	$2,346.00
Rate for Payer: Kaiser Permanente Commercial	$2,484.00
Rate for Payer: MDX Hawaii PPO	$2,677.20
Rate for Payer: University Health Alliance Commercial	$1,545.60

PUTTY BONE DBX 10CC 038100

Facility

$2,760.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$855.60
Max. Negotiated Rate	$2,677.20
Rate for Payer: AlohaCare Medicaid	$1,380.00
Rate for Payer: AlohaCare Medicare	$855.60
Rate for Payer: Cash Price	$1,656.00
Rate for Payer: Devoted Health Medicare	$938.40
Rate for Payer: Hawaii Medical Service Association Medicare	$855.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,932.00
Rate for Payer: Health Management Network Commercial	$2,346.00
Rate for Payer: Humana Medicare	$855.60
Rate for Payer: Kaiser Permanente Commercial	$2,484.00
Rate for Payer: Kaiser Permanente Medicaid	$1,407.60
Rate for Payer: Kaiser Permanente Medicare	$855.60
Rate for Payer: MDX Hawaii PPO	$2,677.20
Rate for Payer: Ohana Health Plan Medicaid	$855.60
Rate for Payer: Ohana Health Plan Medicare	$855.60
Rate for Payer: UnitedHealthcare Medicare	$855.60
Rate for Payer: University Health Alliance Commercial	$1,545.60

Know your out-of-pocket cost for care.

All Charges