Kau Hospital

All Charges

Charge

Type

Setting

Price

ROD CARBON FIBER 8.0M #395.792

Facility

$735.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$227.85
Max. Negotiated Rate	$712.95
Rate for Payer: AlohaCare Medicaid	$367.50
Rate for Payer: AlohaCare Medicare	$227.85
Rate for Payer: Cash Price	$441.00
Rate for Payer: Devoted Health Medicare	$249.90
Rate for Payer: Hawaii Medical Service Association Medicare	$227.85
Rate for Payer: Hawaii Western Management Group Commercial	$698.25
Rate for Payer: Health Management Network Commercial	$624.75
Rate for Payer: Humana Medicare	$227.85
Rate for Payer: Kaiser Permanente Commercial	$661.50
Rate for Payer: Kaiser Permanente Medicaid	$374.85
Rate for Payer: Kaiser Permanente Medicare	$227.85
Rate for Payer: MDX Hawaii PPO	$712.95
Rate for Payer: Ohana Health Plan Medicaid	$227.85
Rate for Payer: Ohana Health Plan Medicare	$227.85
Rate for Payer: UnitedHealthcare Medicare	$227.85
Rate for Payer: University Health Alliance Commercial	$535.74

ROD CONNECTING 4922-8-350

Facility

$1,312.00

Hospital Revenue Code	272
Min. Negotiated Rate	$406.72
Max. Negotiated Rate	$1,272.64
Rate for Payer: AlohaCare Medicaid	$656.00
Rate for Payer: AlohaCare Medicare	$406.72
Rate for Payer: Cash Price	$787.20
Rate for Payer: Devoted Health Medicare	$446.08
Rate for Payer: Hawaii Medical Service Association Medicare	$406.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,246.40
Rate for Payer: Health Management Network Commercial	$1,115.20
Rate for Payer: Humana Medicare	$406.72
Rate for Payer: Kaiser Permanente Commercial	$1,180.80
Rate for Payer: Kaiser Permanente Medicaid	$669.12
Rate for Payer: Kaiser Permanente Medicare	$406.72
Rate for Payer: MDX Hawaii PPO	$1,272.64
Rate for Payer: Ohana Health Plan Medicaid	$406.72
Rate for Payer: Ohana Health Plan Medicare	$406.72
Rate for Payer: UnitedHealthcare Medicare	$406.72
Rate for Payer: University Health Alliance Commercial	$956.32

ROD CONNECTING 4922-8-350

Facility

$1,312.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,115.20
Max. Negotiated Rate	$1,272.64
Rate for Payer: Cash Price	$787.20
Rate for Payer: Health Management Network Commercial	$1,115.20
Rate for Payer: Kaiser Permanente Commercial	$1,180.80
Rate for Payer: MDX Hawaii PPO	$1,272.64

ROD EX-FIX 11X150MM 394.82

Facility

$1,012.00

Hospital Revenue Code	272
Min. Negotiated Rate	$313.72
Max. Negotiated Rate	$981.64
Rate for Payer: AlohaCare Medicaid	$506.00
Rate for Payer: AlohaCare Medicare	$313.72
Rate for Payer: Cash Price	$607.20
Rate for Payer: Devoted Health Medicare	$344.08
Rate for Payer: Hawaii Medical Service Association Medicare	$313.72
Rate for Payer: Hawaii Western Management Group Commercial	$961.40
Rate for Payer: Health Management Network Commercial	$860.20
Rate for Payer: Humana Medicare	$313.72
Rate for Payer: Kaiser Permanente Commercial	$910.80
Rate for Payer: Kaiser Permanente Medicaid	$516.12
Rate for Payer: Kaiser Permanente Medicare	$313.72
Rate for Payer: MDX Hawaii PPO	$981.64
Rate for Payer: Ohana Health Plan Medicaid	$313.72
Rate for Payer: Ohana Health Plan Medicare	$313.72
Rate for Payer: UnitedHealthcare Medicare	$313.72
Rate for Payer: University Health Alliance Commercial	$737.65

ROD EX-FIX 11X150MM 394.82

Facility

$1,012.00

Hospital Revenue Code	272
Min. Negotiated Rate	$860.20
Max. Negotiated Rate	$981.64
Rate for Payer: Cash Price	$607.20
Rate for Payer: Health Management Network Commercial	$860.20
Rate for Payer: Kaiser Permanente Commercial	$910.80
Rate for Payer: MDX Hawaii PPO	$981.64

ROD EX-FIX 11X200MM 394.83

Facility

$1,012.00

Hospital Revenue Code	272
Min. Negotiated Rate	$313.72
Max. Negotiated Rate	$981.64
Rate for Payer: AlohaCare Medicaid	$506.00
Rate for Payer: AlohaCare Medicare	$313.72
Rate for Payer: Cash Price	$607.20
Rate for Payer: Devoted Health Medicare	$344.08
Rate for Payer: Hawaii Medical Service Association Medicare	$313.72
Rate for Payer: Hawaii Western Management Group Commercial	$961.40
Rate for Payer: Health Management Network Commercial	$860.20
Rate for Payer: Humana Medicare	$313.72
Rate for Payer: Kaiser Permanente Commercial	$910.80
Rate for Payer: Kaiser Permanente Medicaid	$516.12
Rate for Payer: Kaiser Permanente Medicare	$313.72
Rate for Payer: MDX Hawaii PPO	$981.64
Rate for Payer: Ohana Health Plan Medicaid	$313.72
Rate for Payer: Ohana Health Plan Medicare	$313.72
Rate for Payer: UnitedHealthcare Medicare	$313.72
Rate for Payer: University Health Alliance Commercial	$737.65

ROD EX-FIX 11X200MM 394.83

Facility

$1,012.00

Hospital Revenue Code	272
Min. Negotiated Rate	$860.20
Max. Negotiated Rate	$981.64
Rate for Payer: Cash Price	$607.20
Rate for Payer: Health Management Network Commercial	$860.20
Rate for Payer: Kaiser Permanente Commercial	$910.80
Rate for Payer: MDX Hawaii PPO	$981.64

ROD EX-FIX 11X250MM 394.84

Facility

$1,085.00

Hospital Revenue Code	272
Min. Negotiated Rate	$336.35
Max. Negotiated Rate	$1,052.45
Rate for Payer: AlohaCare Medicaid	$542.50
Rate for Payer: AlohaCare Medicare	$336.35
Rate for Payer: Cash Price	$651.00
Rate for Payer: Devoted Health Medicare	$368.90
Rate for Payer: Hawaii Medical Service Association Medicare	$336.35
Rate for Payer: Hawaii Western Management Group Commercial	$1,030.75
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: Humana Medicare	$336.35
Rate for Payer: Kaiser Permanente Commercial	$976.50
Rate for Payer: Kaiser Permanente Medicaid	$553.35
Rate for Payer: Kaiser Permanente Medicare	$336.35
Rate for Payer: MDX Hawaii PPO	$1,052.45
Rate for Payer: Ohana Health Plan Medicaid	$336.35
Rate for Payer: Ohana Health Plan Medicare	$336.35
Rate for Payer: UnitedHealthcare Medicare	$336.35
Rate for Payer: University Health Alliance Commercial	$790.86

ROD EX-FIX 11X250MM 394.84

Facility

$1,085.00

Hospital Revenue Code	272
Min. Negotiated Rate	$922.25
Max. Negotiated Rate	$1,052.45
Rate for Payer: Cash Price	$651.00
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: Kaiser Permanente Commercial	$976.50
Rate for Payer: MDX Hawaii PPO	$1,052.45

ROD EX-FIX 11X300MM 394.85

Facility

$1,085.00

Hospital Revenue Code	272
Min. Negotiated Rate	$336.35
Max. Negotiated Rate	$1,052.45
Rate for Payer: AlohaCare Medicaid	$542.50
Rate for Payer: AlohaCare Medicare	$336.35
Rate for Payer: Cash Price	$651.00
Rate for Payer: Devoted Health Medicare	$368.90
Rate for Payer: Hawaii Medical Service Association Medicare	$336.35
Rate for Payer: Hawaii Western Management Group Commercial	$1,030.75
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: Humana Medicare	$336.35
Rate for Payer: Kaiser Permanente Commercial	$976.50
Rate for Payer: Kaiser Permanente Medicaid	$553.35
Rate for Payer: Kaiser Permanente Medicare	$336.35
Rate for Payer: MDX Hawaii PPO	$1,052.45
Rate for Payer: Ohana Health Plan Medicaid	$336.35
Rate for Payer: Ohana Health Plan Medicare	$336.35
Rate for Payer: UnitedHealthcare Medicare	$336.35
Rate for Payer: University Health Alliance Commercial	$790.86

ROD EX-FIX 11X300MM 394.85

Facility

$1,085.00

Hospital Revenue Code	272
Min. Negotiated Rate	$922.25
Max. Negotiated Rate	$1,052.45
Rate for Payer: Cash Price	$651.00
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: Kaiser Permanente Commercial	$976.50
Rate for Payer: MDX Hawaii PPO	$1,052.45

ROD EX-FIX 11X350MM 394.86

Facility

$1,085.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$607.60
Max. Negotiated Rate	$1,052.45
Rate for Payer: Cash Price	$651.00
Rate for Payer: Hawaii Western Management Group Commercial	$759.50
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: Kaiser Permanente Commercial	$976.50
Rate for Payer: MDX Hawaii PPO	$1,052.45
Rate for Payer: University Health Alliance Commercial	$607.60

ROD EX-FIX 11X350MM 394.86

Facility

$1,085.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$336.35
Max. Negotiated Rate	$1,052.45
Rate for Payer: AlohaCare Medicaid	$542.50
Rate for Payer: AlohaCare Medicare	$336.35
Rate for Payer: Cash Price	$651.00
Rate for Payer: Devoted Health Medicare	$368.90
Rate for Payer: Hawaii Medical Service Association Medicare	$336.35
Rate for Payer: Hawaii Western Management Group Commercial	$759.50
Rate for Payer: Health Management Network Commercial	$922.25
Rate for Payer: Humana Medicare	$336.35
Rate for Payer: Kaiser Permanente Commercial	$976.50
Rate for Payer: Kaiser Permanente Medicaid	$553.35
Rate for Payer: Kaiser Permanente Medicare	$336.35
Rate for Payer: MDX Hawaii PPO	$1,052.45
Rate for Payer: Ohana Health Plan Medicaid	$336.35
Rate for Payer: Ohana Health Plan Medicare	$336.35
Rate for Payer: UnitedHealthcare Medicare	$336.35
Rate for Payer: University Health Alliance Commercial	$607.60

ROD EX-FIX 11X400MM 394.87

Facility

$1,191.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,012.35
Max. Negotiated Rate	$1,155.27
Rate for Payer: Cash Price	$714.60
Rate for Payer: Health Management Network Commercial	$1,012.35
Rate for Payer: Kaiser Permanente Commercial	$1,071.90
Rate for Payer: MDX Hawaii PPO	$1,155.27

ROD EX-FIX 11X400MM 394.87

Facility

$1,191.00

Hospital Revenue Code	272
Min. Negotiated Rate	$369.21
Max. Negotiated Rate	$1,155.27
Rate for Payer: AlohaCare Medicaid	$595.50
Rate for Payer: AlohaCare Medicare	$369.21
Rate for Payer: Cash Price	$714.60
Rate for Payer: Devoted Health Medicare	$404.94
Rate for Payer: Hawaii Medical Service Association Medicare	$369.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,131.45
Rate for Payer: Health Management Network Commercial	$1,012.35
Rate for Payer: Humana Medicare	$369.21
Rate for Payer: Kaiser Permanente Commercial	$1,071.90
Rate for Payer: Kaiser Permanente Medicaid	$607.41
Rate for Payer: Kaiser Permanente Medicare	$369.21
Rate for Payer: MDX Hawaii PPO	$1,155.27
Rate for Payer: Ohana Health Plan Medicaid	$369.21
Rate for Payer: Ohana Health Plan Medicare	$369.21
Rate for Payer: UnitedHealthcare Medicare	$369.21
Rate for Payer: University Health Alliance Commercial	$868.12

ROD EXTERN FIX CONNECT 200MM

Facility

$1,279.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$716.24
Max. Negotiated Rate	$1,240.63
Rate for Payer: Cash Price	$767.40
Rate for Payer: Hawaii Western Management Group Commercial	$895.30
Rate for Payer: Health Management Network Commercial	$1,087.15
Rate for Payer: Kaiser Permanente Commercial	$1,151.10
Rate for Payer: MDX Hawaii PPO	$1,240.63
Rate for Payer: University Health Alliance Commercial	$716.24

ROD EXTERN FIX CONNECT 200MM

Facility

$1,279.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$396.49
Max. Negotiated Rate	$1,240.63
Rate for Payer: AlohaCare Medicaid	$639.50
Rate for Payer: AlohaCare Medicare	$396.49
Rate for Payer: Cash Price	$767.40
Rate for Payer: Devoted Health Medicare	$434.86
Rate for Payer: Hawaii Medical Service Association Medicare	$396.49
Rate for Payer: Hawaii Western Management Group Commercial	$895.30
Rate for Payer: Health Management Network Commercial	$1,087.15
Rate for Payer: Humana Medicare	$396.49
Rate for Payer: Kaiser Permanente Commercial	$1,151.10
Rate for Payer: Kaiser Permanente Medicaid	$652.29
Rate for Payer: Kaiser Permanente Medicare	$396.49
Rate for Payer: MDX Hawaii PPO	$1,240.63
Rate for Payer: Ohana Health Plan Medicaid	$396.49
Rate for Payer: Ohana Health Plan Medicare	$396.49
Rate for Payer: UnitedHealthcare Medicare	$396.49
Rate for Payer: University Health Alliance Commercial	$716.24

ROD FIBER 8.0X120 395.780

Facility

$735.00

Hospital Revenue Code	272
Min. Negotiated Rate	$227.85
Max. Negotiated Rate	$712.95
Rate for Payer: AlohaCare Medicaid	$367.50
Rate for Payer: AlohaCare Medicare	$227.85
Rate for Payer: Cash Price	$441.00
Rate for Payer: Devoted Health Medicare	$249.90
Rate for Payer: Hawaii Medical Service Association Medicare	$227.85
Rate for Payer: Hawaii Western Management Group Commercial	$698.25
Rate for Payer: Health Management Network Commercial	$624.75
Rate for Payer: Humana Medicare	$227.85
Rate for Payer: Kaiser Permanente Commercial	$661.50
Rate for Payer: Kaiser Permanente Medicaid	$374.85
Rate for Payer: Kaiser Permanente Medicare	$227.85
Rate for Payer: MDX Hawaii PPO	$712.95
Rate for Payer: Ohana Health Plan Medicaid	$227.85
Rate for Payer: Ohana Health Plan Medicare	$227.85
Rate for Payer: UnitedHealthcare Medicare	$227.85
Rate for Payer: University Health Alliance Commercial	$535.74

ROD FIBER 8.0X120 395.780

Facility

$735.00

Hospital Revenue Code	272
Min. Negotiated Rate	$624.75
Max. Negotiated Rate	$712.95
Rate for Payer: Cash Price	$441.00
Rate for Payer: Health Management Network Commercial	$624.75
Rate for Payer: Kaiser Permanente Commercial	$661.50
Rate for Payer: MDX Hawaii PPO	$712.95

ROD REAMING 3.0, 950MM

Facility

$709.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$219.79
Max. Negotiated Rate	$687.73
Rate for Payer: AlohaCare Medicaid	$354.50
Rate for Payer: AlohaCare Medicare	$219.79
Rate for Payer: Cash Price	$425.40
Rate for Payer: Devoted Health Medicare	$241.06
Rate for Payer: Hawaii Medical Service Association Medicare	$219.79
Rate for Payer: Hawaii Western Management Group Commercial	$673.55
Rate for Payer: Health Management Network Commercial	$602.65
Rate for Payer: Humana Medicare	$219.79
Rate for Payer: Kaiser Permanente Commercial	$638.10
Rate for Payer: Kaiser Permanente Medicaid	$361.59
Rate for Payer: Kaiser Permanente Medicare	$219.79
Rate for Payer: MDX Hawaii PPO	$687.73
Rate for Payer: Ohana Health Plan Medicaid	$219.79
Rate for Payer: Ohana Health Plan Medicare	$219.79
Rate for Payer: UnitedHealthcare Medicare	$219.79
Rate for Payer: University Health Alliance Commercial	$516.79

ROD REAMING 3.0, 950MM

Facility

$709.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$602.65
Max. Negotiated Rate	$687.73
Rate for Payer: Cash Price	$425.40
Rate for Payer: Health Management Network Commercial	$602.65
Rate for Payer: Kaiser Permanente Commercial	$638.10
Rate for Payer: MDX Hawaii PPO	$687.73

RODS 8MM 500MM 5028-8-500

Facility

$1,399.00

Hospital Revenue Code	278
Min. Negotiated Rate	$433.69
Max. Negotiated Rate	$1,357.03
Rate for Payer: AlohaCare Medicaid	$699.50
Rate for Payer: AlohaCare Medicare	$433.69
Rate for Payer: Cash Price	$839.40
Rate for Payer: Devoted Health Medicare	$475.66
Rate for Payer: Hawaii Medical Service Association Medicare	$433.69
Rate for Payer: Hawaii Western Management Group Commercial	$979.30
Rate for Payer: Health Management Network Commercial	$1,189.15
Rate for Payer: Humana Medicare	$433.69
Rate for Payer: Kaiser Permanente Commercial	$1,259.10
Rate for Payer: Kaiser Permanente Medicaid	$713.49
Rate for Payer: Kaiser Permanente Medicare	$433.69
Rate for Payer: MDX Hawaii PPO	$1,357.03
Rate for Payer: Ohana Health Plan Medicaid	$433.69
Rate for Payer: Ohana Health Plan Medicare	$433.69
Rate for Payer: UnitedHealthcare Medicare	$433.69
Rate for Payer: University Health Alliance Commercial	$783.44

RODS 8MM 500MM 5028-8-500

Facility

$1,399.00

Hospital Revenue Code	278
Min. Negotiated Rate	$783.44
Max. Negotiated Rate	$1,357.03
Rate for Payer: Cash Price	$839.40
Rate for Payer: Hawaii Western Management Group Commercial	$979.30
Rate for Payer: Health Management Network Commercial	$1,189.15
Rate for Payer: Kaiser Permanente Commercial	$1,259.10
Rate for Payer: MDX Hawaii PPO	$1,357.03
Rate for Payer: University Health Alliance Commercial	$783.44

ROD THREADED 115MM 55-10060

Facility

$225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$69.75
Rate for Payer: Cash Price	$135.00
Rate for Payer: Devoted Health Medicare	$76.50
Rate for Payer: Hawaii Medical Service Association Medicare	$69.75
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$69.75
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$69.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$69.75
Rate for Payer: Ohana Health Plan Medicare	$69.75
Rate for Payer: UnitedHealthcare Medicare	$69.75
Rate for Payer: University Health Alliance Commercial	$164.00

ROD THREADED 115MM 55-10060

Facility

$225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

Know your out-of-pocket cost for care.

All Charges