Kau Hospital

All Charges

Charge

Type

Setting

Price

SHAFT DRIVR T15 AR-9545-T15-02

Facility

$1,575.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,338.75
Max. Negotiated Rate	$1,527.75
Rate for Payer: Cash Price	$945.00
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: MDX Hawaii PPO	$1,527.75

SHAFT DRIVR T15 AR-9545-T15-02

Facility

$1,575.00

Hospital Revenue Code	272
Min. Negotiated Rate	$488.25
Max. Negotiated Rate	$1,527.75
Rate for Payer: AlohaCare Medicaid	$787.50
Rate for Payer: AlohaCare Medicare	$488.25
Rate for Payer: Cash Price	$945.00
Rate for Payer: Devoted Health Medicare	$535.50
Rate for Payer: Hawaii Medical Service Association Medicare	$488.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,496.25
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: Humana Medicare	$488.25
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: Kaiser Permanente Medicaid	$803.25
Rate for Payer: Kaiser Permanente Medicare	$488.25
Rate for Payer: MDX Hawaii PPO	$1,527.75
Rate for Payer: Ohana Health Plan Medicaid	$488.25
Rate for Payer: Ohana Health Plan Medicare	$488.25
Rate for Payer: UnitedHealthcare Medicare	$488.25
Rate for Payer: University Health Alliance Commercial	$1,148.02

SHAFT REAMER 08X510 0227-8510S

Facility

$1,971.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,675.35
Max. Negotiated Rate	$1,911.87
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: MDX Hawaii PPO	$1,911.87

SHAFT REAMER 08X510 0227-8510S

Facility

$1,971.00

Hospital Revenue Code	272
Min. Negotiated Rate	$611.01
Max. Negotiated Rate	$1,911.87
Rate for Payer: AlohaCare Medicaid	$985.50
Rate for Payer: AlohaCare Medicare	$611.01
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Devoted Health Medicare	$670.14
Rate for Payer: Hawaii Medical Service Association Medicare	$611.01
Rate for Payer: Hawaii Western Management Group Commercial	$1,872.45
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Humana Medicare	$611.01
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: Kaiser Permanente Medicaid	$1,005.21
Rate for Payer: Kaiser Permanente Medicare	$611.01
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: Ohana Health Plan Medicaid	$611.01
Rate for Payer: Ohana Health Plan Medicare	$611.01
Rate for Payer: UnitedHealthcare Medicare	$611.01
Rate for Payer: University Health Alliance Commercial	$1,436.66

SHAVER EXCALIBER AR-8400EX

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$64.48
Max. Negotiated Rate	$201.76
Rate for Payer: AlohaCare Medicaid	$104.00
Rate for Payer: AlohaCare Medicare	$64.48
Rate for Payer: Cash Price	$124.80
Rate for Payer: Devoted Health Medicare	$70.72
Rate for Payer: Hawaii Medical Service Association Medicare	$64.48
Rate for Payer: Hawaii Western Management Group Commercial	$197.60
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Humana Medicare	$64.48
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: Kaiser Permanente Medicaid	$106.08
Rate for Payer: Kaiser Permanente Medicare	$64.48
Rate for Payer: MDX Hawaii PPO	$201.76
Rate for Payer: Ohana Health Plan Medicaid	$64.48
Rate for Payer: Ohana Health Plan Medicare	$64.48
Rate for Payer: UnitedHealthcare Medicare	$64.48
Rate for Payer: University Health Alliance Commercial	$151.61

SHAVER EXCALIBER AR-8400EX

Facility

$208.00

Hospital Revenue Code	272
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$201.76
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$176.80
Rate for Payer: Kaiser Permanente Commercial	$187.20
Rate for Payer: MDX Hawaii PPO	$201.76

SHEARS HARMONIC 1100 HAR1136

Facility

$2,965.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,520.25
Max. Negotiated Rate	$2,876.05
Rate for Payer: Cash Price	$1,779.00
Rate for Payer: Health Management Network Commercial	$2,520.25
Rate for Payer: Kaiser Permanente Commercial	$2,668.50
Rate for Payer: MDX Hawaii PPO	$2,876.05

SHEARS HARMONIC 1100 HAR1136

Facility

$2,965.00

Hospital Revenue Code	272
Min. Negotiated Rate	$919.15
Max. Negotiated Rate	$2,876.05
Rate for Payer: AlohaCare Medicaid	$1,482.50
Rate for Payer: AlohaCare Medicare	$919.15
Rate for Payer: Cash Price	$1,779.00
Rate for Payer: Devoted Health Medicare	$1,008.10
Rate for Payer: Hawaii Medical Service Association Medicare	$919.15
Rate for Payer: Hawaii Western Management Group Commercial	$2,816.75
Rate for Payer: Health Management Network Commercial	$2,520.25
Rate for Payer: Humana Medicare	$919.15
Rate for Payer: Kaiser Permanente Commercial	$2,668.50
Rate for Payer: Kaiser Permanente Medicaid	$1,512.15
Rate for Payer: Kaiser Permanente Medicare	$919.15
Rate for Payer: MDX Hawaii PPO	$2,876.05
Rate for Payer: Ohana Health Plan Medicaid	$919.15
Rate for Payer: Ohana Health Plan Medicare	$919.15
Rate for Payer: UnitedHealthcare Medicare	$919.15
Rate for Payer: University Health Alliance Commercial	$2,161.19

SHEARS LAPARASCOPE HAR736

Facility

$2,348.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,995.80
Max. Negotiated Rate	$2,277.56
Rate for Payer: Cash Price	$1,408.80
Rate for Payer: Health Management Network Commercial	$1,995.80
Rate for Payer: Kaiser Permanente Commercial	$2,113.20
Rate for Payer: MDX Hawaii PPO	$2,277.56

SHEARS LAPARASCOPE HAR736

Facility

$2,348.00

Hospital Revenue Code	272
Min. Negotiated Rate	$727.88
Max. Negotiated Rate	$2,277.56
Rate for Payer: AlohaCare Medicaid	$1,174.00
Rate for Payer: AlohaCare Medicare	$727.88
Rate for Payer: Cash Price	$1,408.80
Rate for Payer: Devoted Health Medicare	$798.32
Rate for Payer: Hawaii Medical Service Association Medicare	$727.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,230.60
Rate for Payer: Health Management Network Commercial	$1,995.80
Rate for Payer: Humana Medicare	$727.88
Rate for Payer: Kaiser Permanente Commercial	$2,113.20
Rate for Payer: Kaiser Permanente Medicaid	$1,197.48
Rate for Payer: Kaiser Permanente Medicare	$727.88
Rate for Payer: MDX Hawaii PPO	$2,277.56
Rate for Payer: Ohana Health Plan Medicaid	$727.88
Rate for Payer: Ohana Health Plan Medicare	$727.88
Rate for Payer: UnitedHealthcare Medicare	$727.88
Rate for Payer: University Health Alliance Commercial	$1,711.46

SHEARS MONOPOLOAR 470179

Facility

$6,720.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,083.20
Max. Negotiated Rate	$6,518.40
Rate for Payer: AlohaCare Medicaid	$3,360.00
Rate for Payer: AlohaCare Medicare	$2,083.20
Rate for Payer: Cash Price	$4,032.00
Rate for Payer: Devoted Health Medicare	$2,284.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,083.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,384.00
Rate for Payer: Health Management Network Commercial	$5,712.00
Rate for Payer: Humana Medicare	$2,083.20
Rate for Payer: Kaiser Permanente Commercial	$6,048.00
Rate for Payer: Kaiser Permanente Medicaid	$3,427.20
Rate for Payer: Kaiser Permanente Medicare	$2,083.20
Rate for Payer: MDX Hawaii PPO	$6,518.40
Rate for Payer: Ohana Health Plan Medicaid	$2,083.20
Rate for Payer: Ohana Health Plan Medicare	$2,083.20
Rate for Payer: UnitedHealthcare Medicare	$2,083.20
Rate for Payer: University Health Alliance Commercial	$4,898.21

SHEARS MONOPOLOAR 470179

Facility

$6,720.00

Hospital Revenue Code	272
Min. Negotiated Rate	$5,712.00
Max. Negotiated Rate	$6,518.40
Rate for Payer: Cash Price	$4,032.00
Rate for Payer: Health Management Network Commercial	$5,712.00
Rate for Payer: Kaiser Permanente Commercial	$6,048.00
Rate for Payer: MDX Hawaii PPO	$6,518.40

SHEATH 5FX10 PINNACLE ROII

Facility

$140.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: MDX Hawaii PPO	$135.80

SHEATH 5FX10 PINNACLE ROII

Facility

$140.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$43.40
Max. Negotiated Rate	$135.80
Rate for Payer: AlohaCare Medicaid	$70.00
Rate for Payer: AlohaCare Medicare	$43.40
Rate for Payer: Cash Price	$84.00
Rate for Payer: Devoted Health Medicare	$47.60
Rate for Payer: Hawaii Medical Service Association Medicare	$43.40
Rate for Payer: Hawaii Western Management Group Commercial	$133.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Humana Medicare	$43.40
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: Kaiser Permanente Medicaid	$71.40
Rate for Payer: Kaiser Permanente Medicare	$43.40
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: Ohana Health Plan Medicaid	$43.40
Rate for Payer: Ohana Health Plan Medicare	$43.40
Rate for Payer: UnitedHealthcare Medicare	$43.40
Rate for Payer: University Health Alliance Commercial	$102.05

SHEATH 6FX10 PINNACLE ROII

Facility

$138.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$82.80
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: MDX Hawaii PPO	$133.86

SHEATH 6FX10 PINNACLE ROII

Facility

$138.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$42.78
Max. Negotiated Rate	$133.86
Rate for Payer: AlohaCare Medicaid	$69.00
Rate for Payer: AlohaCare Medicare	$42.78
Rate for Payer: Cash Price	$82.80
Rate for Payer: Devoted Health Medicare	$46.92
Rate for Payer: Hawaii Medical Service Association Medicare	$42.78
Rate for Payer: Hawaii Western Management Group Commercial	$131.10
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Humana Medicare	$42.78
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: Kaiser Permanente Medicaid	$70.38
Rate for Payer: Kaiser Permanente Medicare	$42.78
Rate for Payer: MDX Hawaii PPO	$133.86
Rate for Payer: Ohana Health Plan Medicaid	$42.78
Rate for Payer: Ohana Health Plan Medicare	$42.78
Rate for Payer: UnitedHealthcare Medicare	$42.78
Rate for Payer: University Health Alliance Commercial	$100.59

SHEATH 7FX10 PINNACLE ROII

Facility

$138.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$82.80
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: MDX Hawaii PPO	$133.86

SHEATH 7FX10 PINNACLE ROII

Facility

$138.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$42.78
Max. Negotiated Rate	$133.86
Rate for Payer: AlohaCare Medicaid	$69.00
Rate for Payer: AlohaCare Medicare	$42.78
Rate for Payer: Cash Price	$82.80
Rate for Payer: Devoted Health Medicare	$46.92
Rate for Payer: Hawaii Medical Service Association Medicare	$42.78
Rate for Payer: Hawaii Western Management Group Commercial	$131.10
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Humana Medicare	$42.78
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: Kaiser Permanente Medicaid	$70.38
Rate for Payer: Kaiser Permanente Medicare	$42.78
Rate for Payer: MDX Hawaii PPO	$133.86
Rate for Payer: Ohana Health Plan Medicaid	$42.78
Rate for Payer: Ohana Health Plan Medicare	$42.78
Rate for Payer: UnitedHealthcare Medicare	$42.78
Rate for Payer: University Health Alliance Commercial	$100.59

SHEATH 8FX10 PINNACLE ROII

Facility

$138.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$42.78
Max. Negotiated Rate	$133.86
Rate for Payer: AlohaCare Medicaid	$69.00
Rate for Payer: AlohaCare Medicare	$42.78
Rate for Payer: Cash Price	$82.80
Rate for Payer: Devoted Health Medicare	$46.92
Rate for Payer: Hawaii Medical Service Association Medicare	$42.78
Rate for Payer: Hawaii Western Management Group Commercial	$131.10
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Humana Medicare	$42.78
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: Kaiser Permanente Medicaid	$70.38
Rate for Payer: Kaiser Permanente Medicare	$42.78
Rate for Payer: MDX Hawaii PPO	$133.86
Rate for Payer: Ohana Health Plan Medicaid	$42.78
Rate for Payer: Ohana Health Plan Medicare	$42.78
Rate for Payer: UnitedHealthcare Medicare	$42.78
Rate for Payer: University Health Alliance Commercial	$100.59

SHEATH 8FX10 PINNACLE ROII

Facility

$138.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$82.80
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: MDX Hawaii PPO	$133.86

SHEATH CYSTOSCOPE 22.5FR

Facility

$2,022.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$1,718.70
Max. Negotiated Rate	$1,961.34
Rate for Payer: Cash Price	$1,213.20
Rate for Payer: Health Management Network Commercial	$1,718.70
Rate for Payer: Kaiser Permanente Commercial	$1,819.80
Rate for Payer: MDX Hawaii PPO	$1,961.34

SHEATH CYSTOSCOPE 22.5FR

Facility

$2,022.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$626.82
Max. Negotiated Rate	$1,961.34
Rate for Payer: AlohaCare Medicaid	$1,011.00
Rate for Payer: AlohaCare Medicare	$626.82
Rate for Payer: Cash Price	$1,213.20
Rate for Payer: Devoted Health Medicare	$687.48
Rate for Payer: Hawaii Medical Service Association Medicare	$626.82
Rate for Payer: Hawaii Western Management Group Commercial	$1,920.90
Rate for Payer: Health Management Network Commercial	$1,718.70
Rate for Payer: Humana Medicare	$626.82
Rate for Payer: Kaiser Permanente Commercial	$1,819.80
Rate for Payer: Kaiser Permanente Medicaid	$1,031.22
Rate for Payer: Kaiser Permanente Medicare	$626.82
Rate for Payer: MDX Hawaii PPO	$1,961.34
Rate for Payer: Ohana Health Plan Medicaid	$626.82
Rate for Payer: Ohana Health Plan Medicare	$626.82
Rate for Payer: UnitedHealthcare Medicare	$626.82
Rate for Payer: University Health Alliance Commercial	$1,473.84

SHEATH DRYSEAL 20X30 GDSF2033

Facility

$2,200.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$1,870.00
Max. Negotiated Rate	$2,134.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Health Management Network Commercial	$1,870.00
Rate for Payer: Kaiser Permanente Commercial	$1,980.00
Rate for Payer: MDX Hawaii PPO	$2,134.00

SHEATH DRYSEAL 20X30 GDSF2033

Facility

$2,200.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$682.00
Max. Negotiated Rate	$2,134.00
Rate for Payer: AlohaCare Medicaid	$1,100.00
Rate for Payer: AlohaCare Medicare	$682.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Devoted Health Medicare	$748.00
Rate for Payer: Hawaii Medical Service Association Medicare	$682.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,090.00
Rate for Payer: Health Management Network Commercial	$1,870.00
Rate for Payer: Humana Medicare	$682.00
Rate for Payer: Kaiser Permanente Commercial	$1,980.00
Rate for Payer: Kaiser Permanente Medicaid	$1,122.00
Rate for Payer: Kaiser Permanente Medicare	$682.00
Rate for Payer: MDX Hawaii PPO	$2,134.00
Rate for Payer: Ohana Health Plan Medicaid	$682.00
Rate for Payer: Ohana Health Plan Medicare	$682.00
Rate for Payer: UnitedHealthcare Medicare	$682.00
Rate for Payer: University Health Alliance Commercial	$1,603.58

SHEATH DRYSEAL 22X33CM DSF2233

Facility

$2,200.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$1,870.00
Max. Negotiated Rate	$2,134.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Health Management Network Commercial	$1,870.00
Rate for Payer: Kaiser Permanente Commercial	$1,980.00
Rate for Payer: MDX Hawaii PPO	$2,134.00

Know your out-of-pocket cost for care.

All Charges