Kau Hospital

All Charges

Charge

Type

Setting

Price

RESPIRATORY SIGNS AND SYMPTOMS

Facility

$13,486.44

Service Code	MSDRG 204
Min. Negotiated Rate	$13,486.44
Max. Negotiated Rate	$13,486.44
Rate for Payer: Hawaii Medical Service Association Commercial	$13,486.44

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS

Facility

$70,205.32

Service Code	MSDRG 208
Min. Negotiated Rate	$70,205.32
Max. Negotiated Rate	$70,205.32
Rate for Payer: Hawaii Medical Service Association Commercial	$70,205.32

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS

Facility

$185,231.13

Service Code	MSDRG 207
Min. Negotiated Rate	$185,231.13
Max. Negotiated Rate	$185,231.13
Rate for Payer: Hawaii Medical Service Association Commercial	$185,231.13

RESTORATION MODULAR 6276-7-017

Facility

$6,363.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,972.53
Max. Negotiated Rate	$6,172.11
Rate for Payer: AlohaCare Medicaid	$3,181.50
Rate for Payer: AlohaCare Medicare	$1,972.53
Rate for Payer: Cash Price	$3,817.80
Rate for Payer: Devoted Health Medicare	$2,163.42
Rate for Payer: Hawaii Medical Service Association Medicare	$1,972.53
Rate for Payer: Hawaii Western Management Group Commercial	$4,454.10
Rate for Payer: Health Management Network Commercial	$5,408.55
Rate for Payer: Humana Medicare	$1,972.53
Rate for Payer: Kaiser Permanente Commercial	$5,726.70
Rate for Payer: Kaiser Permanente Medicaid	$3,245.13
Rate for Payer: Kaiser Permanente Medicare	$1,972.53
Rate for Payer: MDX Hawaii PPO	$6,172.11
Rate for Payer: Ohana Health Plan Medicaid	$1,972.53
Rate for Payer: Ohana Health Plan Medicare	$1,972.53
Rate for Payer: UnitedHealthcare Medicare	$1,972.53
Rate for Payer: University Health Alliance Commercial	$3,563.28

RESTORATION MODULAR 6276-7-017

Facility

$6,363.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,563.28
Max. Negotiated Rate	$6,172.11
Rate for Payer: Cash Price	$3,817.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,454.10
Rate for Payer: Health Management Network Commercial	$5,408.55
Rate for Payer: Kaiser Permanente Commercial	$5,726.70
Rate for Payer: MDX Hawaii PPO	$6,172.11
Rate for Payer: University Health Alliance Commercial	$3,563.28

RESTORATION MODULAR 6276-7-018

Facility

$6,363.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,563.28
Max. Negotiated Rate	$6,172.11
Rate for Payer: Cash Price	$3,817.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,454.10
Rate for Payer: Health Management Network Commercial	$5,408.55
Rate for Payer: Kaiser Permanente Commercial	$5,726.70
Rate for Payer: MDX Hawaii PPO	$6,172.11
Rate for Payer: University Health Alliance Commercial	$3,563.28

RESTORATION MODULAR 6276-7-018

Facility

$6,363.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,972.53
Max. Negotiated Rate	$6,172.11
Rate for Payer: AlohaCare Medicaid	$3,181.50
Rate for Payer: AlohaCare Medicare	$1,972.53
Rate for Payer: Cash Price	$3,817.80
Rate for Payer: Devoted Health Medicare	$2,163.42
Rate for Payer: Hawaii Medical Service Association Medicare	$1,972.53
Rate for Payer: Hawaii Western Management Group Commercial	$4,454.10
Rate for Payer: Health Management Network Commercial	$5,408.55
Rate for Payer: Humana Medicare	$1,972.53
Rate for Payer: Kaiser Permanente Commercial	$5,726.70
Rate for Payer: Kaiser Permanente Medicaid	$3,245.13
Rate for Payer: Kaiser Permanente Medicare	$1,972.53
Rate for Payer: MDX Hawaii PPO	$6,172.11
Rate for Payer: Ohana Health Plan Medicaid	$1,972.53
Rate for Payer: Ohana Health Plan Medicare	$1,972.53
Rate for Payer: UnitedHealthcare Medicare	$1,972.53
Rate for Payer: University Health Alliance Commercial	$3,563.28

RESTORATION MODULAR HIP SYSTEM

Facility

$8,879.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,972.24
Max. Negotiated Rate	$8,612.63
Rate for Payer: Cash Price	$5,327.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,215.30
Rate for Payer: Health Management Network Commercial	$7,547.15
Rate for Payer: Kaiser Permanente Commercial	$7,991.10
Rate for Payer: MDX Hawaii PPO	$8,612.63
Rate for Payer: University Health Alliance Commercial	$4,972.24

RESTORATION MODULAR HIP SYSTEM

Facility

$8,879.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,752.49
Max. Negotiated Rate	$8,612.63
Rate for Payer: AlohaCare Medicaid	$4,439.50
Rate for Payer: AlohaCare Medicare	$2,752.49
Rate for Payer: Cash Price	$5,327.40
Rate for Payer: Devoted Health Medicare	$3,018.86
Rate for Payer: Hawaii Medical Service Association Medicare	$2,752.49
Rate for Payer: Hawaii Western Management Group Commercial	$6,215.30
Rate for Payer: Health Management Network Commercial	$7,547.15
Rate for Payer: Humana Medicare	$2,752.49
Rate for Payer: Kaiser Permanente Commercial	$7,991.10
Rate for Payer: Kaiser Permanente Medicaid	$4,528.29
Rate for Payer: Kaiser Permanente Medicare	$2,752.49
Rate for Payer: MDX Hawaii PPO	$8,612.63
Rate for Payer: Ohana Health Plan Medicaid	$2,752.49
Rate for Payer: Ohana Health Plan Medicare	$2,752.49
Rate for Payer: UnitedHealthcare Medicare	$2,752.49
Rate for Payer: University Health Alliance Commercial	$4,972.24

RESTORELLE Y SMARTMESH 501430

Facility

$3,762.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$2,106.72
Max. Negotiated Rate	$3,649.14
Rate for Payer: Cash Price	$2,257.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,633.40
Rate for Payer: Health Management Network Commercial	$3,197.70
Rate for Payer: Kaiser Permanente Commercial	$3,385.80
Rate for Payer: MDX Hawaii PPO	$3,649.14
Rate for Payer: University Health Alliance Commercial	$2,106.72

RESTORELLE Y SMARTMESH 501430

Facility

$3,762.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,166.22
Max. Negotiated Rate	$3,649.14
Rate for Payer: AlohaCare Medicaid	$1,881.00
Rate for Payer: AlohaCare Medicare	$1,166.22
Rate for Payer: Cash Price	$2,257.20
Rate for Payer: Devoted Health Medicare	$1,279.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,166.22
Rate for Payer: Hawaii Western Management Group Commercial	$2,633.40
Rate for Payer: Health Management Network Commercial	$3,197.70
Rate for Payer: Humana Medicare	$1,166.22
Rate for Payer: Kaiser Permanente Commercial	$3,385.80
Rate for Payer: Kaiser Permanente Medicaid	$1,918.62
Rate for Payer: Kaiser Permanente Medicare	$1,166.22
Rate for Payer: MDX Hawaii PPO	$3,649.14
Rate for Payer: Ohana Health Plan Medicaid	$1,166.22
Rate for Payer: Ohana Health Plan Medicare	$1,166.22
Rate for Payer: UnitedHealthcare Medicare	$1,166.22
Rate for Payer: University Health Alliance Commercial	$2,106.72

RETAINER VISCERA CENTER SPINE

Facility

$221.00

Hospital Revenue Code	272
Min. Negotiated Rate	$68.51
Max. Negotiated Rate	$214.37
Rate for Payer: AlohaCare Medicaid	$110.50
Rate for Payer: AlohaCare Medicare	$68.51
Rate for Payer: Cash Price	$132.60
Rate for Payer: Devoted Health Medicare	$75.14
Rate for Payer: Hawaii Medical Service Association Medicare	$68.51
Rate for Payer: Hawaii Western Management Group Commercial	$209.95
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: Humana Medicare	$68.51
Rate for Payer: Kaiser Permanente Commercial	$198.90
Rate for Payer: Kaiser Permanente Medicaid	$112.71
Rate for Payer: Kaiser Permanente Medicare	$68.51
Rate for Payer: MDX Hawaii PPO	$214.37
Rate for Payer: Ohana Health Plan Medicaid	$68.51
Rate for Payer: Ohana Health Plan Medicare	$68.51
Rate for Payer: UnitedHealthcare Medicare	$68.51
Rate for Payer: University Health Alliance Commercial	$161.09

RETAINER VISCERA CENTER SPINE

Facility

$221.00

Hospital Revenue Code	272
Min. Negotiated Rate	$187.85
Max. Negotiated Rate	$214.37
Rate for Payer: Cash Price	$132.60
Rate for Payer: Health Management Network Commercial	$187.85
Rate for Payer: Kaiser Permanente Commercial	$198.90
Rate for Payer: MDX Hawaii PPO	$214.37

RETAIN FEMORAL SZ.5 5517-F-501

Facility

$15,986.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,955.66
Max. Negotiated Rate	$15,506.42
Rate for Payer: AlohaCare Medicaid	$7,993.00
Rate for Payer: AlohaCare Medicare	$4,955.66
Rate for Payer: Cash Price	$9,591.60
Rate for Payer: Devoted Health Medicare	$5,435.24
Rate for Payer: Hawaii Medical Service Association Medicare	$4,955.66
Rate for Payer: Hawaii Western Management Group Commercial	$11,190.20
Rate for Payer: Health Management Network Commercial	$13,588.10
Rate for Payer: Humana Medicare	$4,955.66
Rate for Payer: Kaiser Permanente Commercial	$14,387.40
Rate for Payer: Kaiser Permanente Medicaid	$8,152.86
Rate for Payer: Kaiser Permanente Medicare	$4,955.66
Rate for Payer: MDX Hawaii PPO	$15,506.42
Rate for Payer: Ohana Health Plan Medicaid	$4,955.66
Rate for Payer: Ohana Health Plan Medicare	$4,955.66
Rate for Payer: UnitedHealthcare Medicare	$4,955.66
Rate for Payer: University Health Alliance Commercial	$8,952.16

RETAIN FEMORAL SZ.5 5517-F-501

Facility

$15,986.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$8,952.16
Max. Negotiated Rate	$15,506.42
Rate for Payer: Cash Price	$9,591.60
Rate for Payer: Hawaii Western Management Group Commercial	$11,190.20
Rate for Payer: Health Management Network Commercial	$13,588.10
Rate for Payer: Kaiser Permanente Commercial	$14,387.40
Rate for Payer: MDX Hawaii PPO	$15,506.42
Rate for Payer: University Health Alliance Commercial	$8,952.16

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC

Facility

$15,975.15

Service Code	MSDRG 815
Min. Negotiated Rate	$15,975.15
Max. Negotiated Rate	$15,975.15
Rate for Payer: Hawaii Medical Service Association Commercial	$15,975.15

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC

Facility

$15,975.15

Service Code	MSDRG 814
Min. Negotiated Rate	$15,975.15
Max. Negotiated Rate	$15,975.15
Rate for Payer: Hawaii Medical Service Association Commercial	$15,975.15

RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC

Facility

$11,685.09

Service Code	MSDRG 816
Min. Negotiated Rate	$11,685.09
Max. Negotiated Rate	$11,685.09
Rate for Payer: Hawaii Medical Service Association Commercial	$11,685.09

RETRACT ENDO PADDLE 12MM

Facility

$1,024.00

Hospital Revenue Code	272
Min. Negotiated Rate	$317.44
Max. Negotiated Rate	$993.28
Rate for Payer: AlohaCare Medicaid	$512.00
Rate for Payer: AlohaCare Medicare	$317.44
Rate for Payer: Cash Price	$614.40
Rate for Payer: Devoted Health Medicare	$348.16
Rate for Payer: Hawaii Medical Service Association Medicare	$317.44
Rate for Payer: Hawaii Western Management Group Commercial	$972.80
Rate for Payer: Health Management Network Commercial	$870.40
Rate for Payer: Humana Medicare	$317.44
Rate for Payer: Kaiser Permanente Commercial	$921.60
Rate for Payer: Kaiser Permanente Medicaid	$522.24
Rate for Payer: Kaiser Permanente Medicare	$317.44
Rate for Payer: MDX Hawaii PPO	$993.28
Rate for Payer: Ohana Health Plan Medicaid	$317.44
Rate for Payer: Ohana Health Plan Medicare	$317.44
Rate for Payer: UnitedHealthcare Medicare	$317.44
Rate for Payer: University Health Alliance Commercial	$746.39

RETRACT ENDO PADDLE 12MM

Facility

$1,024.00

Hospital Revenue Code	272
Min. Negotiated Rate	$870.40
Max. Negotiated Rate	$993.28
Rate for Payer: Cash Price	$614.40
Rate for Payer: Health Management Network Commercial	$870.40
Rate for Payer: Kaiser Permanente Commercial	$921.60
Rate for Payer: MDX Hawaii PPO	$993.28

RETRACTOR ALEXIS-O LG

Facility

$344.00

Hospital Revenue Code	272
Min. Negotiated Rate	$292.40
Max. Negotiated Rate	$333.68
Rate for Payer: Cash Price	$206.40
Rate for Payer: Health Management Network Commercial	$292.40
Rate for Payer: Kaiser Permanente Commercial	$309.60
Rate for Payer: MDX Hawaii PPO	$333.68

RETRACTOR ALEXIS-O LG

Facility

$344.00

Hospital Revenue Code	272
Min. Negotiated Rate	$106.64
Max. Negotiated Rate	$333.68
Rate for Payer: AlohaCare Medicaid	$172.00
Rate for Payer: AlohaCare Medicare	$106.64
Rate for Payer: Cash Price	$206.40
Rate for Payer: Devoted Health Medicare	$116.96
Rate for Payer: Hawaii Medical Service Association Medicare	$106.64
Rate for Payer: Hawaii Western Management Group Commercial	$326.80
Rate for Payer: Health Management Network Commercial	$292.40
Rate for Payer: Humana Medicare	$106.64
Rate for Payer: Kaiser Permanente Commercial	$309.60
Rate for Payer: Kaiser Permanente Medicaid	$175.44
Rate for Payer: Kaiser Permanente Medicare	$106.64
Rate for Payer: MDX Hawaii PPO	$333.68
Rate for Payer: Ohana Health Plan Medicaid	$106.64
Rate for Payer: Ohana Health Plan Medicare	$106.64
Rate for Payer: UnitedHealthcare Medicare	$106.64
Rate for Payer: University Health Alliance Commercial	$250.74

RETRACTOR ALEXIS-O MED

Facility

$248.00

Hospital Revenue Code	272
Min. Negotiated Rate	$76.88
Max. Negotiated Rate	$240.56
Rate for Payer: AlohaCare Medicaid	$124.00
Rate for Payer: AlohaCare Medicare	$76.88
Rate for Payer: Cash Price	$148.80
Rate for Payer: Devoted Health Medicare	$84.32
Rate for Payer: Hawaii Medical Service Association Medicare	$76.88
Rate for Payer: Hawaii Western Management Group Commercial	$235.60
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Humana Medicare	$76.88
Rate for Payer: Kaiser Permanente Commercial	$223.20
Rate for Payer: Kaiser Permanente Medicaid	$126.48
Rate for Payer: Kaiser Permanente Medicare	$76.88
Rate for Payer: MDX Hawaii PPO	$240.56
Rate for Payer: Ohana Health Plan Medicaid	$76.88
Rate for Payer: Ohana Health Plan Medicare	$76.88
Rate for Payer: UnitedHealthcare Medicare	$76.88
Rate for Payer: University Health Alliance Commercial	$180.77

RETRACTOR ALEXIS-O MED

Facility

$248.00

Hospital Revenue Code	272
Min. Negotiated Rate	$210.80
Max. Negotiated Rate	$240.56
Rate for Payer: Cash Price	$148.80
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Kaiser Permanente Commercial	$223.20
Rate for Payer: MDX Hawaii PPO	$240.56

RETRACTOR ALEXIS-O SM

Facility

$248.00

Hospital Revenue Code	272
Min. Negotiated Rate	$210.80
Max. Negotiated Rate	$240.56
Rate for Payer: Cash Price	$148.80
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Kaiser Permanente Commercial	$223.20
Rate for Payer: MDX Hawaii PPO	$240.56

Know your out-of-pocket cost for care.

All Charges