Kau Hospital

All Charges

Charge

Type

Setting

Price

RETRACTOR ALEXIS-O SM

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 XLG

Facility

$413.00

Hospital Revenue Code	272
Min. Negotiated Rate	$128.03
Max. Negotiated Rate	$400.61
Rate for Payer: AlohaCare Medicaid	$206.50
Rate for Payer: AlohaCare Medicare	$128.03
Rate for Payer: Cash Price	$247.80
Rate for Payer: Devoted Health Medicare	$140.42
Rate for Payer: Hawaii Medical Service Association Medicare	$128.03
Rate for Payer: Hawaii Western Management Group Commercial	$392.35
Rate for Payer: Health Management Network Commercial	$351.05
Rate for Payer: Humana Medicare	$128.03
Rate for Payer: Kaiser Permanente Commercial	$371.70
Rate for Payer: Kaiser Permanente Medicaid	$210.63
Rate for Payer: Kaiser Permanente Medicare	$128.03
Rate for Payer: MDX Hawaii PPO	$400.61
Rate for Payer: Ohana Health Plan Medicaid	$128.03
Rate for Payer: Ohana Health Plan Medicare	$128.03
Rate for Payer: UnitedHealthcare Medicare	$128.03
Rate for Payer: University Health Alliance Commercial	$301.04

RETRACTOR ALEXIS-O XLG

Facility

$413.00

Hospital Revenue Code	272
Min. Negotiated Rate	$351.05
Max. Negotiated Rate	$400.61
Rate for Payer: Cash Price	$247.80
Rate for Payer: Health Management Network Commercial	$351.05
Rate for Payer: Kaiser Permanente Commercial	$371.70
Rate for Payer: MDX Hawaii PPO	$400.61

RETRACTOR ELASTIC 12MM

Facility

$82.00

Hospital Revenue Code	272
Min. Negotiated Rate	$25.42
Max. Negotiated Rate	$79.54
Rate for Payer: AlohaCare Medicaid	$41.00
Rate for Payer: AlohaCare Medicare	$25.42
Rate for Payer: Cash Price	$49.20
Rate for Payer: Devoted Health Medicare	$27.88
Rate for Payer: Hawaii Medical Service Association Medicare	$25.42
Rate for Payer: Hawaii Western Management Group Commercial	$77.90
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Humana Medicare	$25.42
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: Kaiser Permanente Medicaid	$41.82
Rate for Payer: Kaiser Permanente Medicare	$25.42
Rate for Payer: MDX Hawaii PPO	$79.54
Rate for Payer: Ohana Health Plan Medicaid	$25.42
Rate for Payer: Ohana Health Plan Medicare	$25.42
Rate for Payer: UnitedHealthcare Medicare	$25.42
Rate for Payer: University Health Alliance Commercial	$59.77

RETRACTOR ELASTIC 12MM

Facility

$82.00

Hospital Revenue Code	272
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$49.20
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: MDX Hawaii PPO	$79.54

RETRACTOR ELASTIC STAYS 5MM

Facility

$85.00

Hospital Revenue Code	272
Min. Negotiated Rate	$72.25
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$51.00
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: Kaiser Permanente Commercial	$76.50
Rate for Payer: MDX Hawaii PPO	$82.45

RETRACTOR ELASTIC STAYS 5MM

Facility

$85.00

Hospital Revenue Code	272
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$82.45
Rate for Payer: AlohaCare Medicaid	$42.50
Rate for Payer: AlohaCare Medicare	$26.35
Rate for Payer: Cash Price	$51.00
Rate for Payer: Devoted Health Medicare	$28.90
Rate for Payer: Hawaii Medical Service Association Medicare	$26.35
Rate for Payer: Hawaii Western Management Group Commercial	$80.75
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: Humana Medicare	$26.35
Rate for Payer: Kaiser Permanente Commercial	$76.50
Rate for Payer: Kaiser Permanente Medicaid	$43.35
Rate for Payer: Kaiser Permanente Medicare	$26.35
Rate for Payer: MDX Hawaii PPO	$82.45
Rate for Payer: Ohana Health Plan Medicaid	$26.35
Rate for Payer: Ohana Health Plan Medicare	$26.35
Rate for Payer: UnitedHealthcare Medicare	$26.35
Rate for Payer: University Health Alliance Commercial	$61.96

RETRACTOR RING LONE STAR 3715

Facility

$478.00

Hospital Revenue Code	272
Min. Negotiated Rate	$148.18
Max. Negotiated Rate	$463.66
Rate for Payer: AlohaCare Medicaid	$239.00
Rate for Payer: AlohaCare Medicare	$148.18
Rate for Payer: Cash Price	$286.80
Rate for Payer: Devoted Health Medicare	$162.52
Rate for Payer: Hawaii Medical Service Association Medicare	$148.18
Rate for Payer: Hawaii Western Management Group Commercial	$454.10
Rate for Payer: Health Management Network Commercial	$406.30
Rate for Payer: Humana Medicare	$148.18
Rate for Payer: Kaiser Permanente Commercial	$430.20
Rate for Payer: Kaiser Permanente Medicaid	$243.78
Rate for Payer: Kaiser Permanente Medicare	$148.18
Rate for Payer: MDX Hawaii PPO	$463.66
Rate for Payer: Ohana Health Plan Medicaid	$148.18
Rate for Payer: Ohana Health Plan Medicare	$148.18
Rate for Payer: UnitedHealthcare Medicare	$148.18
Rate for Payer: University Health Alliance Commercial	$348.41

RETRACTOR RING LONE STAR 3715

Facility

$478.00

Hospital Revenue Code	272
Min. Negotiated Rate	$406.30
Max. Negotiated Rate	$463.66
Rate for Payer: Cash Price	$286.80
Rate for Payer: Health Management Network Commercial	$406.30
Rate for Payer: Kaiser Permanente Commercial	$430.20
Rate for Payer: MDX Hawaii PPO	$463.66

RETREV 10MM ENDO CATCH

Facility

$201.00

Hospital Revenue Code	272
Min. Negotiated Rate	$62.31
Max. Negotiated Rate	$194.97
Rate for Payer: AlohaCare Medicaid	$100.50
Rate for Payer: AlohaCare Medicare	$62.31
Rate for Payer: Cash Price	$120.60
Rate for Payer: Devoted Health Medicare	$68.34
Rate for Payer: Hawaii Medical Service Association Medicare	$62.31
Rate for Payer: Hawaii Western Management Group Commercial	$190.95
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Humana Medicare	$62.31
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: Kaiser Permanente Medicaid	$102.51
Rate for Payer: Kaiser Permanente Medicare	$62.31
Rate for Payer: MDX Hawaii PPO	$194.97
Rate for Payer: Ohana Health Plan Medicaid	$62.31
Rate for Payer: Ohana Health Plan Medicare	$62.31
Rate for Payer: UnitedHealthcare Medicare	$62.31
Rate for Payer: University Health Alliance Commercial	$146.51

RETREV 10MM ENDO CATCH

Facility

$201.00

Hospital Revenue Code	272
Min. Negotiated Rate	$170.85
Max. Negotiated Rate	$194.97
Rate for Payer: Cash Price	$120.60
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: MDX Hawaii PPO	$194.97

RETRIEVAL NET DGN-538-5

Facility

$350.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$108.50
Max. Negotiated Rate	$339.50
Rate for Payer: AlohaCare Medicaid	$175.00
Rate for Payer: AlohaCare Medicare	$108.50
Rate for Payer: Cash Price	$210.00
Rate for Payer: Devoted Health Medicare	$119.00
Rate for Payer: Hawaii Medical Service Association Medicare	$108.50
Rate for Payer: Hawaii Western Management Group Commercial	$332.50
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Humana Medicare	$108.50
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: Kaiser Permanente Medicaid	$178.50
Rate for Payer: Kaiser Permanente Medicare	$108.50
Rate for Payer: MDX Hawaii PPO	$339.50
Rate for Payer: Ohana Health Plan Medicaid	$108.50
Rate for Payer: Ohana Health Plan Medicare	$108.50
Rate for Payer: UnitedHealthcare Medicare	$108.50
Rate for Payer: University Health Alliance Commercial	$255.12

RETRIEVAL NET DGN-538-5

Facility

$350.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$210.00
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: MDX Hawaii PPO	$339.50

RETRIEVER 2.5MM FOREIGN BODY

Facility

$376.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$319.60
Max. Negotiated Rate	$364.72
Rate for Payer: Cash Price	$225.60
Rate for Payer: Health Management Network Commercial	$319.60
Rate for Payer: Kaiser Permanente Commercial	$338.40
Rate for Payer: MDX Hawaii PPO	$364.72

RETRIEVER 2.5MM FOREIGN BODY

Facility

$376.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$116.56
Max. Negotiated Rate	$364.72
Rate for Payer: AlohaCare Medicaid	$188.00
Rate for Payer: AlohaCare Medicare	$116.56
Rate for Payer: Cash Price	$225.60
Rate for Payer: Devoted Health Medicare	$127.84
Rate for Payer: Hawaii Medical Service Association Medicare	$116.56
Rate for Payer: Hawaii Western Management Group Commercial	$357.20
Rate for Payer: Health Management Network Commercial	$319.60
Rate for Payer: Humana Medicare	$116.56
Rate for Payer: Kaiser Permanente Commercial	$338.40
Rate for Payer: Kaiser Permanente Medicaid	$191.76
Rate for Payer: Kaiser Permanente Medicare	$116.56
Rate for Payer: MDX Hawaii PPO	$364.72
Rate for Payer: Ohana Health Plan Medicaid	$116.56
Rate for Payer: Ohana Health Plan Medicare	$116.56
Rate for Payer: UnitedHealthcare Medicare	$116.56
Rate for Payer: University Health Alliance Commercial	$274.07

RETRIEVER 3.0MM ROTH ENDO

Facility

$454.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$385.90
Max. Negotiated Rate	$440.38
Rate for Payer: Cash Price	$272.40
Rate for Payer: Health Management Network Commercial	$385.90
Rate for Payer: Kaiser Permanente Commercial	$408.60
Rate for Payer: MDX Hawaii PPO	$440.38

RETRIEVER 3.0MM ROTH ENDO

Facility

$454.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$140.74
Max. Negotiated Rate	$440.38
Rate for Payer: AlohaCare Medicaid	$227.00
Rate for Payer: AlohaCare Medicare	$140.74
Rate for Payer: Cash Price	$272.40
Rate for Payer: Devoted Health Medicare	$154.36
Rate for Payer: Hawaii Medical Service Association Medicare	$140.74
Rate for Payer: Hawaii Western Management Group Commercial	$431.30
Rate for Payer: Health Management Network Commercial	$385.90
Rate for Payer: Humana Medicare	$140.74
Rate for Payer: Kaiser Permanente Commercial	$408.60
Rate for Payer: Kaiser Permanente Medicaid	$231.54
Rate for Payer: Kaiser Permanente Medicare	$140.74
Rate for Payer: MDX Hawaii PPO	$440.38
Rate for Payer: Ohana Health Plan Medicaid	$140.74
Rate for Payer: Ohana Health Plan Medicare	$140.74
Rate for Payer: UnitedHealthcare Medicare	$140.74
Rate for Payer: University Health Alliance Commercial	$330.92

RETRIEVER ENDO GRASP

Facility

$147.00

Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$88.20
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59

RETRIEVER ENDO GRASP

Facility

$147.00

Hospital Revenue Code	272
Min. Negotiated Rate	$45.57
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$45.57
Rate for Payer: Cash Price	$88.20
Rate for Payer: Devoted Health Medicare	$49.98
Rate for Payer: Hawaii Medical Service Association Medicare	$45.57
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$45.57
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$45.57
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$45.57
Rate for Payer: Ohana Health Plan Medicare	$45.57
Rate for Payer: UnitedHealthcare Medicare	$45.57
Rate for Payer: University Health Alliance Commercial	$107.15

RETRIEVER FOREIGN BODY

Facility

$924.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$785.40
Max. Negotiated Rate	$896.28
Rate for Payer: Cash Price	$554.40
Rate for Payer: Health Management Network Commercial	$785.40
Rate for Payer: Kaiser Permanente Commercial	$831.60
Rate for Payer: MDX Hawaii PPO	$896.28

RETRIEVER FOREIGN BODY

Facility

$924.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$286.44
Max. Negotiated Rate	$896.28
Rate for Payer: AlohaCare Medicaid	$462.00
Rate for Payer: AlohaCare Medicare	$286.44
Rate for Payer: Cash Price	$554.40
Rate for Payer: Devoted Health Medicare	$314.16
Rate for Payer: Hawaii Medical Service Association Medicare	$286.44
Rate for Payer: Hawaii Western Management Group Commercial	$877.80
Rate for Payer: Health Management Network Commercial	$785.40
Rate for Payer: Humana Medicare	$286.44
Rate for Payer: Kaiser Permanente Commercial	$831.60
Rate for Payer: Kaiser Permanente Medicaid	$471.24
Rate for Payer: Kaiser Permanente Medicare	$286.44
Rate for Payer: MDX Hawaii PPO	$896.28
Rate for Payer: Ohana Health Plan Medicaid	$286.44
Rate for Payer: Ohana Health Plan Medicare	$286.44
Rate for Payer: UnitedHealthcare Medicare	$286.44
Rate for Payer: University Health Alliance Commercial	$673.50

REUNION HUMERAL 5569-P-2017

Facility

$9,010.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,793.10
Max. Negotiated Rate	$8,739.70
Rate for Payer: AlohaCare Medicaid	$4,505.00
Rate for Payer: AlohaCare Medicare	$2,793.10
Rate for Payer: Cash Price	$5,406.00
Rate for Payer: Devoted Health Medicare	$3,063.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,793.10
Rate for Payer: Hawaii Western Management Group Commercial	$6,307.00
Rate for Payer: Health Management Network Commercial	$7,658.50
Rate for Payer: Humana Medicare	$2,793.10
Rate for Payer: Kaiser Permanente Commercial	$8,109.00
Rate for Payer: Kaiser Permanente Medicaid	$4,595.10
Rate for Payer: Kaiser Permanente Medicare	$2,793.10
Rate for Payer: MDX Hawaii PPO	$8,739.70
Rate for Payer: Ohana Health Plan Medicaid	$2,793.10
Rate for Payer: Ohana Health Plan Medicare	$2,793.10
Rate for Payer: UnitedHealthcare Medicare	$2,793.10
Rate for Payer: University Health Alliance Commercial	$5,045.60

REUNION HUMERAL 5569-P-2017

Facility

$9,010.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,045.60
Max. Negotiated Rate	$8,739.70
Rate for Payer: Cash Price	$5,406.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,307.00
Rate for Payer: Health Management Network Commercial	$7,658.50
Rate for Payer: Kaiser Permanente Commercial	$8,109.00
Rate for Payer: MDX Hawaii PPO	$8,739.70
Rate for Payer: University Health Alliance Commercial	$5,045.60

REUNION INSERT 5571-S-3606

Facility

$3,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.00
Max. Negotiated Rate	$3,104.00
Rate for Payer: Cash Price	$1,920.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,240.00
Rate for Payer: Health Management Network Commercial	$2,720.00
Rate for Payer: Kaiser Permanente Commercial	$2,880.00
Rate for Payer: MDX Hawaii PPO	$3,104.00
Rate for Payer: University Health Alliance Commercial	$1,792.00

REUNION INSERT 5571-S-3606

Facility

$3,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$992.00
Max. Negotiated Rate	$3,104.00
Rate for Payer: AlohaCare Medicaid	$1,600.00
Rate for Payer: AlohaCare Medicare	$992.00
Rate for Payer: Cash Price	$1,920.00
Rate for Payer: Devoted Health Medicare	$1,088.00
Rate for Payer: Hawaii Medical Service Association Medicare	$992.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,240.00
Rate for Payer: Health Management Network Commercial	$2,720.00
Rate for Payer: Humana Medicare	$992.00
Rate for Payer: Kaiser Permanente Commercial	$2,880.00
Rate for Payer: Kaiser Permanente Medicaid	$1,632.00
Rate for Payer: Kaiser Permanente Medicare	$992.00
Rate for Payer: MDX Hawaii PPO	$3,104.00
Rate for Payer: Ohana Health Plan Medicaid	$992.00
Rate for Payer: Ohana Health Plan Medicare	$992.00
Rate for Payer: UnitedHealthcare Medicare	$992.00
Rate for Payer: University Health Alliance Commercial	$1,792.00

Know your out-of-pocket cost for care.

All Charges