Kau Hospital

All Charges

Charge

Type

Setting

Price

SCD FOOT CUFF MED

Facility

$92.00

Hospital Revenue Code	271
Min. Negotiated Rate	$28.52
Max. Negotiated Rate	$89.24
Rate for Payer: AlohaCare Medicaid	$46.00
Rate for Payer: AlohaCare Medicare	$28.52
Rate for Payer: Cash Price	$55.20
Rate for Payer: Devoted Health Medicare	$31.28
Rate for Payer: Hawaii Medical Service Association Medicare	$28.52
Rate for Payer: Hawaii Western Management Group Commercial	$87.40
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Humana Medicare	$28.52
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: Kaiser Permanente Medicaid	$46.92
Rate for Payer: Kaiser Permanente Medicare	$28.52
Rate for Payer: MDX Hawaii PPO	$89.24
Rate for Payer: Ohana Health Plan Medicaid	$28.52
Rate for Payer: Ohana Health Plan Medicare	$28.52
Rate for Payer: UnitedHealthcare Medicare	$28.52
Rate for Payer: University Health Alliance Commercial	$67.06

SCD FOOT CUFF MED

Facility

$92.00

Hospital Revenue Code	271
Min. Negotiated Rate	$78.20
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$55.20
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: MDX Hawaii PPO	$89.24

SCD KNEE SLEEVE XL

Facility

$102.00

Hospital Revenue Code	271
Min. Negotiated Rate	$86.70
Max. Negotiated Rate	$98.94
Rate for Payer: Cash Price	$61.20
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: Kaiser Permanente Commercial	$91.80
Rate for Payer: MDX Hawaii PPO	$98.94

SCD KNEE SLEEVE XL

Facility

$102.00

Hospital Revenue Code	271
Min. Negotiated Rate	$31.62
Max. Negotiated Rate	$98.94
Rate for Payer: AlohaCare Medicaid	$51.00
Rate for Payer: AlohaCare Medicare	$31.62
Rate for Payer: Cash Price	$61.20
Rate for Payer: Devoted Health Medicare	$34.68
Rate for Payer: Hawaii Medical Service Association Medicare	$31.62
Rate for Payer: Hawaii Western Management Group Commercial	$96.90
Rate for Payer: Health Management Network Commercial	$86.70
Rate for Payer: Humana Medicare	$31.62
Rate for Payer: Kaiser Permanente Commercial	$91.80
Rate for Payer: Kaiser Permanente Medicaid	$52.02
Rate for Payer: Kaiser Permanente Medicare	$31.62
Rate for Payer: MDX Hawaii PPO	$98.94
Rate for Payer: Ohana Health Plan Medicaid	$31.62
Rate for Payer: Ohana Health Plan Medicare	$31.62
Rate for Payer: UnitedHealthcare Medicare	$31.62
Rate for Payer: University Health Alliance Commercial	$74.35

SCD SLEEVE THIGH STERILE 9736

Facility

$204.00

Hospital Revenue Code	271
Min. Negotiated Rate	$63.24
Max. Negotiated Rate	$197.88
Rate for Payer: AlohaCare Medicaid	$102.00
Rate for Payer: AlohaCare Medicare	$63.24
Rate for Payer: Cash Price	$122.40
Rate for Payer: Devoted Health Medicare	$69.36
Rate for Payer: Hawaii Medical Service Association Medicare	$63.24
Rate for Payer: Hawaii Western Management Group Commercial	$193.80
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Humana Medicare	$63.24
Rate for Payer: Kaiser Permanente Commercial	$183.60
Rate for Payer: Kaiser Permanente Medicaid	$104.04
Rate for Payer: Kaiser Permanente Medicare	$63.24
Rate for Payer: MDX Hawaii PPO	$197.88
Rate for Payer: Ohana Health Plan Medicaid	$63.24
Rate for Payer: Ohana Health Plan Medicare	$63.24
Rate for Payer: UnitedHealthcare Medicare	$63.24
Rate for Payer: University Health Alliance Commercial	$148.70

SCD SLEEVE THIGH STERILE 9736

Facility

$204.00

Hospital Revenue Code	271
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$197.88
Rate for Payer: Cash Price	$122.40
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Kaiser Permanente Commercial	$183.60
Rate for Payer: MDX Hawaii PPO	$197.88

SCD THIGH SLEEVE LG

Facility

$96.00

Hospital Revenue Code	271
Min. Negotiated Rate	$29.76
Max. Negotiated Rate	$93.12
Rate for Payer: AlohaCare Medicaid	$48.00
Rate for Payer: AlohaCare Medicare	$29.76
Rate for Payer: Cash Price	$57.60
Rate for Payer: Devoted Health Medicare	$32.64
Rate for Payer: Hawaii Medical Service Association Medicare	$29.76
Rate for Payer: Hawaii Western Management Group Commercial	$91.20
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Humana Medicare	$29.76
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: Kaiser Permanente Medicare	$29.76
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: Ohana Health Plan Medicaid	$29.76
Rate for Payer: Ohana Health Plan Medicare	$29.76
Rate for Payer: UnitedHealthcare Medicare	$29.76
Rate for Payer: University Health Alliance Commercial	$69.97

SCD THIGH SLEEVE LG

Facility

$96.00

Hospital Revenue Code	271
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$57.60
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12

SCISSOR ENDSIZER ES26235-3

Facility

$2,190.00

Hospital Revenue Code	272
Min. Negotiated Rate	$678.90
Max. Negotiated Rate	$2,124.30
Rate for Payer: AlohaCare Medicaid	$1,095.00
Rate for Payer: AlohaCare Medicare	$678.90
Rate for Payer: Cash Price	$1,314.00
Rate for Payer: Devoted Health Medicare	$744.60
Rate for Payer: Hawaii Medical Service Association Medicare	$678.90
Rate for Payer: Hawaii Western Management Group Commercial	$2,080.50
Rate for Payer: Health Management Network Commercial	$1,861.50
Rate for Payer: Humana Medicare	$678.90
Rate for Payer: Kaiser Permanente Commercial	$1,971.00
Rate for Payer: Kaiser Permanente Medicaid	$1,116.90
Rate for Payer: Kaiser Permanente Medicare	$678.90
Rate for Payer: MDX Hawaii PPO	$2,124.30
Rate for Payer: Ohana Health Plan Medicaid	$678.90
Rate for Payer: Ohana Health Plan Medicare	$678.90
Rate for Payer: UnitedHealthcare Medicare	$678.90
Rate for Payer: University Health Alliance Commercial	$1,596.29

SCISSOR ENDSIZER ES26235-3

Facility

$2,190.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,861.50
Max. Negotiated Rate	$2,124.30
Rate for Payer: Cash Price	$1,314.00
Rate for Payer: Health Management Network Commercial	$1,861.50
Rate for Payer: Kaiser Permanente Commercial	$1,971.00
Rate for Payer: MDX Hawaii PPO	$2,124.30

SCOPE URETEROSCOPE FLEXIBLE

Facility

$3,000.00

Service Code	HCPCS C1747
Hospital Revenue Code	272
Min. Negotiated Rate	$2,550.00
Max. Negotiated Rate	$2,910.00
Rate for Payer: Cash Price	$1,800.00
Rate for Payer: Health Management Network Commercial	$2,550.00
Rate for Payer: Kaiser Permanente Commercial	$2,700.00
Rate for Payer: MDX Hawaii PPO	$2,910.00

SCOPE URETEROSCOPE FLEXIBLE

Facility

$3,000.00

Service Code	HCPCS C1747
Hospital Revenue Code	272
Min. Negotiated Rate	$930.00
Max. Negotiated Rate	$2,910.00
Rate for Payer: AlohaCare Medicaid	$1,500.00
Rate for Payer: AlohaCare Medicare	$930.00
Rate for Payer: Cash Price	$1,800.00
Rate for Payer: Devoted Health Medicare	$1,020.00
Rate for Payer: Hawaii Medical Service Association Medicare	$930.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,850.00
Rate for Payer: Health Management Network Commercial	$2,550.00
Rate for Payer: Humana Medicare	$930.00
Rate for Payer: Kaiser Permanente Commercial	$2,700.00
Rate for Payer: Kaiser Permanente Medicaid	$1,530.00
Rate for Payer: Kaiser Permanente Medicare	$930.00
Rate for Payer: MDX Hawaii PPO	$2,910.00
Rate for Payer: Ohana Health Plan Medicaid	$930.00
Rate for Payer: Ohana Health Plan Medicare	$930.00
Rate for Payer: UnitedHealthcare Medicare	$930.00
Rate for Payer: University Health Alliance Commercial	$2,186.70

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [128147]

Facility

$58.00

Service Code	NDC 45802058046
Hospital Revenue Code	637
Min. Negotiated Rate	$17.98
Max. Negotiated Rate	$56.26
Rate for Payer: AlohaCare Medicaid	$29.00
Rate for Payer: AlohaCare Medicare	$17.98
Rate for Payer: Cash Price	$34.80
Rate for Payer: Devoted Health Medicare	$19.72
Rate for Payer: Hawaii Medical Service Association Medicare	$17.98
Rate for Payer: Hawaii Western Management Group Commercial	$55.10
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Humana Medicare	$17.98
Rate for Payer: Kaiser Permanente Commercial	$52.20
Rate for Payer: Kaiser Permanente Medicaid	$29.58
Rate for Payer: Kaiser Permanente Medicare	$17.98
Rate for Payer: MDX Hawaii PPO	$56.26
Rate for Payer: Ohana Health Plan Medicaid	$17.98
Rate for Payer: Ohana Health Plan Medicare	$17.98
Rate for Payer: UnitedHealthcare Medicare	$17.98
Rate for Payer: University Health Alliance Commercial	$42.28

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [128147]

Facility

$58.00

Service Code	NDC 50742050510
Hospital Revenue Code	250
Min. Negotiated Rate	$49.30
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$34.80
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Kaiser Permanente Commercial	$52.20
Rate for Payer: MDX Hawaii PPO	$56.26

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [128147]

Facility

$58.00

Service Code	NDC 50742050510
Hospital Revenue Code	637
Min. Negotiated Rate	$17.98
Max. Negotiated Rate	$56.26
Rate for Payer: AlohaCare Medicaid	$29.00
Rate for Payer: AlohaCare Medicare	$17.98
Rate for Payer: Cash Price	$34.80
Rate for Payer: Devoted Health Medicare	$19.72
Rate for Payer: Hawaii Medical Service Association Medicare	$17.98
Rate for Payer: Hawaii Western Management Group Commercial	$55.10
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Humana Medicare	$17.98
Rate for Payer: Kaiser Permanente Commercial	$52.20
Rate for Payer: Kaiser Permanente Medicaid	$29.58
Rate for Payer: Kaiser Permanente Medicare	$17.98
Rate for Payer: MDX Hawaii PPO	$56.26
Rate for Payer: Ohana Health Plan Medicaid	$17.98
Rate for Payer: Ohana Health Plan Medicare	$17.98
Rate for Payer: UnitedHealthcare Medicare	$17.98
Rate for Payer: University Health Alliance Commercial	$42.28

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [128147]

Facility

$58.00

Service Code	NDC 45802058046
Hospital Revenue Code	250
Min. Negotiated Rate	$49.30
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$34.80
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Kaiser Permanente Commercial	$52.20
Rate for Payer: MDX Hawaii PPO	$56.26

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [128147]

Facility

$58.00

Service Code	NDC 45802058001
Hospital Revenue Code	637
Min. Negotiated Rate	$17.98
Max. Negotiated Rate	$56.26
Rate for Payer: AlohaCare Medicaid	$29.00
Rate for Payer: AlohaCare Medicare	$17.98
Rate for Payer: Cash Price	$34.80
Rate for Payer: Devoted Health Medicare	$19.72
Rate for Payer: Hawaii Medical Service Association Medicare	$17.98
Rate for Payer: Hawaii Western Management Group Commercial	$55.10
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Humana Medicare	$17.98
Rate for Payer: Kaiser Permanente Commercial	$52.20
Rate for Payer: Kaiser Permanente Medicaid	$29.58
Rate for Payer: Kaiser Permanente Medicare	$17.98
Rate for Payer: MDX Hawaii PPO	$56.26
Rate for Payer: Ohana Health Plan Medicaid	$17.98
Rate for Payer: Ohana Health Plan Medicare	$17.98
Rate for Payer: UnitedHealthcare Medicare	$17.98
Rate for Payer: University Health Alliance Commercial	$42.28

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH [128147]

Facility

$58.00

Service Code	NDC 45802058001
Hospital Revenue Code	250
Min. Negotiated Rate	$49.30
Max. Negotiated Rate	$56.26
Rate for Payer: Cash Price	$34.80
Rate for Payer: Health Management Network Commercial	$49.30
Rate for Payer: Kaiser Permanente Commercial	$52.20
Rate for Payer: MDX Hawaii PPO	$56.26

SCREW 1.7MM LCK 6MM

Facility

$664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$371.84
Max. Negotiated Rate	$644.08
Rate for Payer: Cash Price	$398.40
Rate for Payer: Hawaii Western Management Group Commercial	$464.80
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: Kaiser Permanente Commercial	$597.60
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: University Health Alliance Commercial	$371.84

SCREW 1.7MM LCK 6MM

Facility

$664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$205.84
Max. Negotiated Rate	$644.08
Rate for Payer: AlohaCare Medicaid	$332.00
Rate for Payer: AlohaCare Medicare	$205.84
Rate for Payer: Cash Price	$398.40
Rate for Payer: Devoted Health Medicare	$225.76
Rate for Payer: Hawaii Medical Service Association Medicare	$205.84
Rate for Payer: Hawaii Western Management Group Commercial	$464.80
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: Humana Medicare	$205.84
Rate for Payer: Kaiser Permanente Commercial	$597.60
Rate for Payer: Kaiser Permanente Medicaid	$338.64
Rate for Payer: Kaiser Permanente Medicare	$205.84
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: Ohana Health Plan Medicaid	$205.84
Rate for Payer: Ohana Health Plan Medicare	$205.84
Rate for Payer: UnitedHealthcare Medicare	$205.84
Rate for Payer: University Health Alliance Commercial	$371.84

SCREW 1.7MM NON-LCK 10MM

Facility

$417.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$129.27
Max. Negotiated Rate	$404.49
Rate for Payer: AlohaCare Medicaid	$208.50
Rate for Payer: AlohaCare Medicare	$129.27
Rate for Payer: Cash Price	$250.20
Rate for Payer: Devoted Health Medicare	$141.78
Rate for Payer: Hawaii Medical Service Association Medicare	$129.27
Rate for Payer: Hawaii Western Management Group Commercial	$291.90
Rate for Payer: Health Management Network Commercial	$354.45
Rate for Payer: Humana Medicare	$129.27
Rate for Payer: Kaiser Permanente Commercial	$375.30
Rate for Payer: Kaiser Permanente Medicaid	$212.67
Rate for Payer: Kaiser Permanente Medicare	$129.27
Rate for Payer: MDX Hawaii PPO	$404.49
Rate for Payer: Ohana Health Plan Medicaid	$129.27
Rate for Payer: Ohana Health Plan Medicare	$129.27
Rate for Payer: UnitedHealthcare Medicare	$129.27
Rate for Payer: University Health Alliance Commercial	$233.52

SCREW 1.7MM NON-LCK 10MM

Facility

$417.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$233.52
Max. Negotiated Rate	$404.49
Rate for Payer: Cash Price	$250.20
Rate for Payer: Hawaii Western Management Group Commercial	$291.90
Rate for Payer: Health Management Network Commercial	$354.45
Rate for Payer: Kaiser Permanente Commercial	$375.30
Rate for Payer: MDX Hawaii PPO	$404.49
Rate for Payer: University Health Alliance Commercial	$233.52

SCREW 1.7MM NON-LCK 8MM

Facility

$417.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$129.27
Max. Negotiated Rate	$404.49
Rate for Payer: AlohaCare Medicaid	$208.50
Rate for Payer: AlohaCare Medicare	$129.27
Rate for Payer: Cash Price	$250.20
Rate for Payer: Devoted Health Medicare	$141.78
Rate for Payer: Hawaii Medical Service Association Medicare	$129.27
Rate for Payer: Hawaii Western Management Group Commercial	$291.90
Rate for Payer: Health Management Network Commercial	$354.45
Rate for Payer: Humana Medicare	$129.27
Rate for Payer: Kaiser Permanente Commercial	$375.30
Rate for Payer: Kaiser Permanente Medicaid	$212.67
Rate for Payer: Kaiser Permanente Medicare	$129.27
Rate for Payer: MDX Hawaii PPO	$404.49
Rate for Payer: Ohana Health Plan Medicaid	$129.27
Rate for Payer: Ohana Health Plan Medicare	$129.27
Rate for Payer: UnitedHealthcare Medicare	$129.27
Rate for Payer: University Health Alliance Commercial	$233.52

SCREW 1.7MM NON-LCK 8MM

Facility

$417.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$233.52
Max. Negotiated Rate	$404.49
Rate for Payer: Cash Price	$250.20
Rate for Payer: Hawaii Western Management Group Commercial	$291.90
Rate for Payer: Health Management Network Commercial	$354.45
Rate for Payer: Kaiser Permanente Commercial	$375.30
Rate for Payer: MDX Hawaii PPO	$404.49
Rate for Payer: University Health Alliance Commercial	$233.52

SCREW 2.4MM LCK 40MM

Facility

$806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$451.36
Max. Negotiated Rate	$781.82
Rate for Payer: Cash Price	$483.60
Rate for Payer: Hawaii Western Management Group Commercial	$564.20
Rate for Payer: Health Management Network Commercial	$685.10
Rate for Payer: Kaiser Permanente Commercial	$725.40
Rate for Payer: MDX Hawaii PPO	$781.82
Rate for Payer: University Health Alliance Commercial	$451.36

Know your out-of-pocket cost for care.

All Charges