Kau Hospital

All Charges

Charge

Type

Setting

Price

SKIN ULCERS WITH MCC

Facility

$23,038.34

Service Code	MSDRG 592
Min. Negotiated Rate	$23,038.34
Max. Negotiated Rate	$23,038.34
Rate for Payer: Hawaii Medical Service Association Commercial	$23,038.34

SKIN ULCERS WITHOUT CC/MCC

Facility

$23,038.34

Service Code	MSDRG 594
Min. Negotiated Rate	$23,038.34
Max. Negotiated Rate	$23,038.34
Rate for Payer: Hawaii Medical Service Association Commercial	$23,038.34

SLED OLECRANON OSN-70

Facility

$2,775.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$860.25
Max. Negotiated Rate	$2,691.75
Rate for Payer: AlohaCare Medicaid	$1,387.50
Rate for Payer: AlohaCare Medicare	$860.25
Rate for Payer: Cash Price	$1,665.00
Rate for Payer: Devoted Health Medicare	$943.50
Rate for Payer: Hawaii Medical Service Association Medicare	$860.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,942.50
Rate for Payer: Health Management Network Commercial	$2,358.75
Rate for Payer: Humana Medicare	$860.25
Rate for Payer: Kaiser Permanente Commercial	$2,497.50
Rate for Payer: Kaiser Permanente Medicaid	$1,415.25
Rate for Payer: Kaiser Permanente Medicare	$860.25
Rate for Payer: MDX Hawaii PPO	$2,691.75
Rate for Payer: Ohana Health Plan Medicaid	$860.25
Rate for Payer: Ohana Health Plan Medicare	$860.25
Rate for Payer: UnitedHealthcare Medicare	$860.25
Rate for Payer: University Health Alliance Commercial	$1,554.00

SLED OLECRANON OSN-70

Facility

$2,775.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,554.00
Max. Negotiated Rate	$2,691.75
Rate for Payer: Cash Price	$1,665.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,942.50
Rate for Payer: Health Management Network Commercial	$2,358.75
Rate for Payer: Kaiser Permanente Commercial	$2,497.50
Rate for Payer: MDX Hawaii PPO	$2,691.75
Rate for Payer: University Health Alliance Commercial	$1,554.00

SLEEVE 12.0MM ST 03.010.437S

Facility

$476.00

Hospital Revenue Code	272
Min. Negotiated Rate	$404.60
Max. Negotiated Rate	$461.72
Rate for Payer: Cash Price	$285.60
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: Kaiser Permanente Commercial	$428.40
Rate for Payer: MDX Hawaii PPO	$461.72

SLEEVE 12.0MM ST 03.010.437S

Facility

$476.00

Hospital Revenue Code	272
Min. Negotiated Rate	$147.56
Max. Negotiated Rate	$461.72
Rate for Payer: AlohaCare Medicaid	$238.00
Rate for Payer: AlohaCare Medicare	$147.56
Rate for Payer: Cash Price	$285.60
Rate for Payer: Devoted Health Medicare	$161.84
Rate for Payer: Hawaii Medical Service Association Medicare	$147.56
Rate for Payer: Hawaii Western Management Group Commercial	$452.20
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: Humana Medicare	$147.56
Rate for Payer: Kaiser Permanente Commercial	$428.40
Rate for Payer: Kaiser Permanente Medicaid	$242.76
Rate for Payer: Kaiser Permanente Medicare	$147.56
Rate for Payer: MDX Hawaii PPO	$461.72
Rate for Payer: Ohana Health Plan Medicaid	$147.56
Rate for Payer: Ohana Health Plan Medicare	$147.56
Rate for Payer: UnitedHealthcare Medicare	$147.56
Rate for Payer: University Health Alliance Commercial	$346.96

SLEEVE LG SCD THIGH

Facility

$131.00

Hospital Revenue Code	271
Min. Negotiated Rate	$40.61
Max. Negotiated Rate	$127.07
Rate for Payer: AlohaCare Medicaid	$65.50
Rate for Payer: AlohaCare Medicare	$40.61
Rate for Payer: Cash Price	$78.60
Rate for Payer: Devoted Health Medicare	$44.54
Rate for Payer: Hawaii Medical Service Association Medicare	$40.61
Rate for Payer: Hawaii Western Management Group Commercial	$124.45
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Humana Medicare	$40.61
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: Kaiser Permanente Medicaid	$66.81
Rate for Payer: Kaiser Permanente Medicare	$40.61
Rate for Payer: MDX Hawaii PPO	$127.07
Rate for Payer: Ohana Health Plan Medicaid	$40.61
Rate for Payer: Ohana Health Plan Medicare	$40.61
Rate for Payer: UnitedHealthcare Medicare	$40.61
Rate for Payer: University Health Alliance Commercial	$95.49

SLEEVE LG SCD THIGH

Facility

$131.00

Hospital Revenue Code	271
Min. Negotiated Rate	$111.35
Max. Negotiated Rate	$127.07
Rate for Payer: Cash Price	$78.60
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: MDX Hawaii PPO	$127.07

SLEEVE NAIL INSERT 1806-1406S

Facility

$538.00

Hospital Revenue Code	272
Min. Negotiated Rate	$457.30
Max. Negotiated Rate	$521.86
Rate for Payer: Cash Price	$322.80
Rate for Payer: Health Management Network Commercial	$457.30
Rate for Payer: Kaiser Permanente Commercial	$484.20
Rate for Payer: MDX Hawaii PPO	$521.86

SLEEVE NAIL INSERT 1806-1406S

Facility

$538.00

Hospital Revenue Code	272
Min. Negotiated Rate	$166.78
Max. Negotiated Rate	$521.86
Rate for Payer: AlohaCare Medicaid	$269.00
Rate for Payer: AlohaCare Medicare	$166.78
Rate for Payer: Cash Price	$322.80
Rate for Payer: Devoted Health Medicare	$182.92
Rate for Payer: Hawaii Medical Service Association Medicare	$166.78
Rate for Payer: Hawaii Western Management Group Commercial	$511.10
Rate for Payer: Health Management Network Commercial	$457.30
Rate for Payer: Humana Medicare	$166.78
Rate for Payer: Kaiser Permanente Commercial	$484.20
Rate for Payer: Kaiser Permanente Medicaid	$274.38
Rate for Payer: Kaiser Permanente Medicare	$166.78
Rate for Payer: MDX Hawaii PPO	$521.86
Rate for Payer: Ohana Health Plan Medicaid	$166.78
Rate for Payer: Ohana Health Plan Medicare	$166.78
Rate for Payer: UnitedHealthcare Medicare	$166.78
Rate for Payer: University Health Alliance Commercial	$392.15

SLEEVE PROTCTN 10MM 03.010.038

Facility

$1,674.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$518.94
Max. Negotiated Rate	$1,623.78
Rate for Payer: AlohaCare Medicaid	$837.00
Rate for Payer: AlohaCare Medicare	$518.94
Rate for Payer: Cash Price	$1,004.40
Rate for Payer: Devoted Health Medicare	$569.16
Rate for Payer: Hawaii Medical Service Association Medicare	$518.94
Rate for Payer: Hawaii Western Management Group Commercial	$1,590.30
Rate for Payer: Health Management Network Commercial	$1,422.90
Rate for Payer: Humana Medicare	$518.94
Rate for Payer: Kaiser Permanente Commercial	$1,506.60
Rate for Payer: Kaiser Permanente Medicaid	$853.74
Rate for Payer: Kaiser Permanente Medicare	$518.94
Rate for Payer: MDX Hawaii PPO	$1,623.78
Rate for Payer: Ohana Health Plan Medicaid	$518.94
Rate for Payer: Ohana Health Plan Medicare	$518.94
Rate for Payer: UnitedHealthcare Medicare	$518.94
Rate for Payer: University Health Alliance Commercial	$1,220.18

SLEEVE PROTCTN 10MM 03.010.038

Facility

$1,674.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$1,422.90
Max. Negotiated Rate	$1,623.78
Rate for Payer: Cash Price	$1,004.40
Rate for Payer: Health Management Network Commercial	$1,422.90
Rate for Payer: Kaiser Permanente Commercial	$1,506.60
Rate for Payer: MDX Hawaii PPO	$1,623.78

SLEEVE SCD KNEE XLG EXPRESS

Facility

$249.00

Hospital Revenue Code	271
Min. Negotiated Rate	$211.65
Max. Negotiated Rate	$241.53
Rate for Payer: Cash Price	$149.40
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: Kaiser Permanente Commercial	$224.10
Rate for Payer: MDX Hawaii PPO	$241.53

SLEEVE SCD KNEE XLG EXPRESS

Facility

$249.00

Hospital Revenue Code	271
Min. Negotiated Rate	$77.19
Max. Negotiated Rate	$241.53
Rate for Payer: AlohaCare Medicaid	$124.50
Rate for Payer: AlohaCare Medicare	$77.19
Rate for Payer: Cash Price	$149.40
Rate for Payer: Devoted Health Medicare	$84.66
Rate for Payer: Hawaii Medical Service Association Medicare	$77.19
Rate for Payer: Hawaii Western Management Group Commercial	$236.55
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: Humana Medicare	$77.19
Rate for Payer: Kaiser Permanente Commercial	$224.10
Rate for Payer: Kaiser Permanente Medicaid	$126.99
Rate for Payer: Kaiser Permanente Medicare	$77.19
Rate for Payer: MDX Hawaii PPO	$241.53
Rate for Payer: Ohana Health Plan Medicaid	$77.19
Rate for Payer: Ohana Health Plan Medicare	$77.19
Rate for Payer: UnitedHealthcare Medicare	$77.19
Rate for Payer: University Health Alliance Commercial	$181.50

SLING ABBREVO URETHRAL

Facility

$3,439.00

Service Code	HCPCS C1771
Hospital Revenue Code	278
Min. Negotiated Rate	$1,925.84
Max. Negotiated Rate	$3,335.83
Rate for Payer: Cash Price	$2,063.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,407.30
Rate for Payer: Health Management Network Commercial	$2,923.15
Rate for Payer: Kaiser Permanente Commercial	$3,095.10
Rate for Payer: MDX Hawaii PPO	$3,335.83
Rate for Payer: University Health Alliance Commercial	$1,925.84

SLING ABBREVO URETHRAL

Facility

$3,439.00

Service Code	HCPCS C1771
Hospital Revenue Code	278
Min. Negotiated Rate	$1,066.09
Max. Negotiated Rate	$3,335.83
Rate for Payer: AlohaCare Medicaid	$1,719.50
Rate for Payer: AlohaCare Medicare	$1,066.09
Rate for Payer: Cash Price	$2,063.40
Rate for Payer: Devoted Health Medicare	$1,169.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1,066.09
Rate for Payer: Hawaii Western Management Group Commercial	$2,407.30
Rate for Payer: Health Management Network Commercial	$2,923.15
Rate for Payer: Humana Medicare	$1,066.09
Rate for Payer: Kaiser Permanente Commercial	$3,095.10
Rate for Payer: Kaiser Permanente Medicaid	$1,753.89
Rate for Payer: Kaiser Permanente Medicare	$1,066.09
Rate for Payer: MDX Hawaii PPO	$3,335.83
Rate for Payer: Ohana Health Plan Medicaid	$1,066.09
Rate for Payer: Ohana Health Plan Medicare	$1,066.09
Rate for Payer: UnitedHealthcare Medicare	$1,066.09
Rate for Payer: University Health Alliance Commercial	$1,925.84

SLING LATERAL TRACT S3 AR-1652

Facility

$344.00

Hospital Revenue Code	271
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

SLING LATERAL TRACT S3 AR-1652

Facility

$344.00

Hospital Revenue Code	271
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

SLING SUPER PLUS LG

Facility

$218.00

Service Code	HCPCS L0625
Hospital Revenue Code	274
Min. Negotiated Rate	$122.08
Max. Negotiated Rate	$211.46
Rate for Payer: Cash Price	$130.80
Rate for Payer: Hawaii Western Management Group Commercial	$152.60
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Kaiser Permanente Commercial	$196.20
Rate for Payer: MDX Hawaii PPO	$211.46
Rate for Payer: University Health Alliance Commercial	$122.08

SLING SUPER PLUS LG

Facility

$218.00

Service Code	HCPCS L0625
Hospital Revenue Code	274
Min. Negotiated Rate	$43.27
Max. Negotiated Rate	$211.46
Rate for Payer: AlohaCare Medicaid	$109.00
Rate for Payer: AlohaCare Medicare	$67.58
Rate for Payer: Cash Price	$130.80
Rate for Payer: Cash Price	$130.80
Rate for Payer: Devoted Health Medicare	$74.12
Rate for Payer: Hawaii Medical Service Association Medicare	$67.58
Rate for Payer: Hawaii Western Management Group Commercial	$152.60
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Humana Medicare	$67.58
Rate for Payer: Kaiser Permanente Commercial	$196.20
Rate for Payer: Kaiser Permanente Medicaid	$111.18
Rate for Payer: Kaiser Permanente Medicare	$67.58
Rate for Payer: MDX Hawaii PPO	$211.46
Rate for Payer: Ohana Health Plan Medicaid	$67.58
Rate for Payer: Ohana Health Plan Medicare	$67.58
Rate for Payer: UnitedHealthcare Medicaid	$43.27
Rate for Payer: UnitedHealthcare Medicare	$67.58
Rate for Payer: University Health Alliance Commercial	$122.08

SLING SUPER PLUS XLG

Facility

$218.00

Service Code	HCPCS L0625
Hospital Revenue Code	274
Min. Negotiated Rate	$122.08
Max. Negotiated Rate	$211.46
Rate for Payer: Cash Price	$130.80
Rate for Payer: Hawaii Western Management Group Commercial	$152.60
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Kaiser Permanente Commercial	$196.20
Rate for Payer: MDX Hawaii PPO	$211.46
Rate for Payer: University Health Alliance Commercial	$122.08

SLING SUPER PLUS XLG

Facility

$218.00

Service Code	HCPCS L0625
Hospital Revenue Code	274
Min. Negotiated Rate	$43.27
Max. Negotiated Rate	$211.46
Rate for Payer: AlohaCare Medicaid	$109.00
Rate for Payer: AlohaCare Medicare	$67.58
Rate for Payer: Cash Price	$130.80
Rate for Payer: Cash Price	$130.80
Rate for Payer: Devoted Health Medicare	$74.12
Rate for Payer: Hawaii Medical Service Association Medicare	$67.58
Rate for Payer: Hawaii Western Management Group Commercial	$152.60
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Humana Medicare	$67.58
Rate for Payer: Kaiser Permanente Commercial	$196.20
Rate for Payer: Kaiser Permanente Medicaid	$111.18
Rate for Payer: Kaiser Permanente Medicare	$67.58
Rate for Payer: MDX Hawaii PPO	$211.46
Rate for Payer: Ohana Health Plan Medicaid	$67.58
Rate for Payer: Ohana Health Plan Medicare	$67.58
Rate for Payer: UnitedHealthcare Medicaid	$43.27
Rate for Payer: UnitedHealthcare Medicare	$67.58
Rate for Payer: University Health Alliance Commercial	$122.08

SLING SWATHE LG

Facility

$48.00

Service Code	HCPCS L3650
Hospital Revenue Code	274
Min. Negotiated Rate	$14.88
Max. Negotiated Rate	$46.56
Rate for Payer: AlohaCare Medicaid	$24.00
Rate for Payer: AlohaCare Medicare	$14.88
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Devoted Health Medicare	$16.32
Rate for Payer: Hawaii Medical Service Association Medicare	$14.88
Rate for Payer: Hawaii Western Management Group Commercial	$33.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Humana Medicare	$14.88
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: Kaiser Permanente Medicare	$14.88
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: Ohana Health Plan Medicaid	$14.88
Rate for Payer: Ohana Health Plan Medicare	$14.88
Rate for Payer: UnitedHealthcare Medicaid	$41.53
Rate for Payer: UnitedHealthcare Medicare	$14.88
Rate for Payer: University Health Alliance Commercial	$26.88

SLING SWATHE LG

Facility

$48.00

Service Code	HCPCS L3650
Hospital Revenue Code	274
Min. Negotiated Rate	$26.88
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$28.80
Rate for Payer: Hawaii Western Management Group Commercial	$33.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: University Health Alliance Commercial	$26.88

SLING SWATHE SM

Facility

$48.00

Service Code	HCPCS L3650
Hospital Revenue Code	274
Min. Negotiated Rate	$26.88
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$28.80
Rate for Payer: Hawaii Western Management Group Commercial	$33.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: University Health Alliance Commercial	$26.88

Know your out-of-pocket cost for care.

All Charges