Kau Hospital

All Charges

Charge

Type

Setting

Price

SLING SWATHE SM

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

SLOTTED WHISKER 3.8M AR-8380SW

Facility

$340.00

Hospital Revenue Code	272
Min. Negotiated Rate	$289.00
Max. Negotiated Rate	$329.80
Rate for Payer: Cash Price	$204.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Kaiser Permanente Commercial	$306.00
Rate for Payer: MDX Hawaii PPO	$329.80

SLOTTED WHISKER 3.8M AR-8380SW

Facility

$340.00

Hospital Revenue Code	272
Min. Negotiated Rate	$105.40
Max. Negotiated Rate	$329.80
Rate for Payer: AlohaCare Medicaid	$170.00
Rate for Payer: AlohaCare Medicare	$105.40
Rate for Payer: Cash Price	$204.00
Rate for Payer: Devoted Health Medicare	$115.60
Rate for Payer: Hawaii Medical Service Association Medicare	$105.40
Rate for Payer: Hawaii Western Management Group Commercial	$323.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Humana Medicare	$105.40
Rate for Payer: Kaiser Permanente Commercial	$306.00
Rate for Payer: Kaiser Permanente Medicaid	$173.40
Rate for Payer: Kaiser Permanente Medicare	$105.40
Rate for Payer: MDX Hawaii PPO	$329.80
Rate for Payer: Ohana Health Plan Medicaid	$105.40
Rate for Payer: Ohana Health Plan Medicare	$105.40
Rate for Payer: UnitedHealthcare Medicare	$105.40
Rate for Payer: University Health Alliance Commercial	$247.83

SMART PROGRAMMER TH90Q01

Facility

$4,095.00

Service Code	HCPCS C1787
Hospital Revenue Code	272
Min. Negotiated Rate	$3,480.75
Max. Negotiated Rate	$3,972.15
Rate for Payer: Cash Price	$2,457.00
Rate for Payer: Health Management Network Commercial	$3,480.75
Rate for Payer: Kaiser Permanente Commercial	$3,685.50
Rate for Payer: MDX Hawaii PPO	$3,972.15

SMART PROGRAMMER TH90Q01

Facility

$4,095.00

Service Code	HCPCS C1787
Hospital Revenue Code	272
Min. Negotiated Rate	$1,269.45
Max. Negotiated Rate	$3,972.15
Rate for Payer: AlohaCare Medicaid	$2,047.50
Rate for Payer: AlohaCare Medicare	$1,269.45
Rate for Payer: Cash Price	$2,457.00
Rate for Payer: Devoted Health Medicare	$1,392.30
Rate for Payer: Hawaii Medical Service Association Medicare	$1,269.45
Rate for Payer: Hawaii Western Management Group Commercial	$3,890.25
Rate for Payer: Health Management Network Commercial	$3,480.75
Rate for Payer: Humana Medicare	$1,269.45
Rate for Payer: Kaiser Permanente Commercial	$3,685.50
Rate for Payer: Kaiser Permanente Medicaid	$2,088.45
Rate for Payer: Kaiser Permanente Medicare	$1,269.45
Rate for Payer: MDX Hawaii PPO	$3,972.15
Rate for Payer: Ohana Health Plan Medicaid	$1,269.45
Rate for Payer: Ohana Health Plan Medicare	$1,269.45
Rate for Payer: UnitedHealthcare Medicare	$1,269.45
Rate for Payer: University Health Alliance Commercial	$2,984.85

SMETRIC PTLA 33x9MM 5550-G-339

Facility

$3,628.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,124.68
Max. Negotiated Rate	$3,519.16
Rate for Payer: AlohaCare Medicaid	$1,814.00
Rate for Payer: AlohaCare Medicare	$1,124.68
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Devoted Health Medicare	$1,233.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,124.68
Rate for Payer: Hawaii Western Management Group Commercial	$2,539.60
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: Humana Medicare	$1,124.68
Rate for Payer: Kaiser Permanente Commercial	$3,265.20
Rate for Payer: Kaiser Permanente Medicaid	$1,850.28
Rate for Payer: Kaiser Permanente Medicare	$1,124.68
Rate for Payer: MDX Hawaii PPO	$3,519.16
Rate for Payer: Ohana Health Plan Medicaid	$1,124.68
Rate for Payer: Ohana Health Plan Medicare	$1,124.68
Rate for Payer: UnitedHealthcare Medicare	$1,124.68
Rate for Payer: University Health Alliance Commercial	$2,031.68

SMETRIC PTLA 33x9MM 5550-G-339

Facility

$3,628.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,031.68
Max. Negotiated Rate	$3,519.16
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,539.60
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: Kaiser Permanente Commercial	$3,265.20
Rate for Payer: MDX Hawaii PPO	$3,519.16
Rate for Payer: University Health Alliance Commercial	$2,031.68

SMOKE PENCIL W/EDGE 10FT

Facility

$155.00

Hospital Revenue Code	272
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$93.00
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: MDX Hawaii PPO	$150.35

SMOKE PENCIL W/EDGE 10FT

Facility

$155.00

Hospital Revenue Code	272
Min. Negotiated Rate	$48.05
Max. Negotiated Rate	$150.35
Rate for Payer: AlohaCare Medicaid	$77.50
Rate for Payer: AlohaCare Medicare	$48.05
Rate for Payer: Cash Price	$93.00
Rate for Payer: Devoted Health Medicare	$52.70
Rate for Payer: Hawaii Medical Service Association Medicare	$48.05
Rate for Payer: Hawaii Western Management Group Commercial	$147.25
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Humana Medicare	$48.05
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: Kaiser Permanente Medicare	$48.05
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: Ohana Health Plan Medicaid	$48.05
Rate for Payer: Ohana Health Plan Medicare	$48.05
Rate for Payer: UnitedHealthcare Medicare	$48.05
Rate for Payer: University Health Alliance Commercial	$112.98

SMOOTH RND MODE RT 10721-255MP

Facility

$2,685.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,503.60
Max. Negotiated Rate	$2,604.45
Rate for Payer: Cash Price	$1,611.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,879.50
Rate for Payer: Health Management Network Commercial	$2,282.25
Rate for Payer: Kaiser Permanente Commercial	$2,416.50
Rate for Payer: MDX Hawaii PPO	$2,604.45
Rate for Payer: University Health Alliance Commercial	$1,503.60

SMOOTH RND MODE RT 10721-255MP

Facility

$2,685.00

Service Code	HCPCS C1789
Hospital Revenue Code	278
Min. Negotiated Rate	$832.35
Max. Negotiated Rate	$2,604.45
Rate for Payer: AlohaCare Medicaid	$1,342.50
Rate for Payer: AlohaCare Medicare	$832.35
Rate for Payer: Cash Price	$1,611.00
Rate for Payer: Devoted Health Medicare	$912.90
Rate for Payer: Hawaii Medical Service Association Medicare	$832.35
Rate for Payer: Hawaii Western Management Group Commercial	$1,879.50
Rate for Payer: Health Management Network Commercial	$2,282.25
Rate for Payer: Humana Medicare	$832.35
Rate for Payer: Kaiser Permanente Commercial	$2,416.50
Rate for Payer: Kaiser Permanente Medicaid	$1,369.35
Rate for Payer: Kaiser Permanente Medicare	$832.35
Rate for Payer: MDX Hawaii PPO	$2,604.45
Rate for Payer: Ohana Health Plan Medicaid	$832.35
Rate for Payer: Ohana Health Plan Medicare	$832.35
Rate for Payer: UnitedHealthcare Medicare	$832.35
Rate for Payer: University Health Alliance Commercial	$1,503.60

SNARE 10MM ROTATABLE

Facility

$90.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$54.00
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: MDX Hawaii PPO	$87.30

SNARE 10MM ROTATABLE

Facility

$90.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$87.30
Rate for Payer: AlohaCare Medicaid	$45.00
Rate for Payer: AlohaCare Medicare	$27.90
Rate for Payer: Cash Price	$54.00
Rate for Payer: Devoted Health Medicare	$30.60
Rate for Payer: Hawaii Medical Service Association Medicare	$27.90
Rate for Payer: Hawaii Western Management Group Commercial	$85.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Humana Medicare	$27.90
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: Kaiser Permanente Medicare	$27.90
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: Ohana Health Plan Medicaid	$27.90
Rate for Payer: Ohana Health Plan Medicare	$27.90
Rate for Payer: UnitedHealthcare Medicare	$27.90
Rate for Payer: University Health Alliance Commercial	$65.60

SNARE 6FR ATRIEVE VASCULAR

Facility

$1,770.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$1,504.50
Max. Negotiated Rate	$1,716.90
Rate for Payer: Cash Price	$1,062.00
Rate for Payer: Health Management Network Commercial	$1,504.50
Rate for Payer: Kaiser Permanente Commercial	$1,593.00
Rate for Payer: MDX Hawaii PPO	$1,716.90

SNARE 6FR ATRIEVE VASCULAR

Facility

$1,770.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$548.70
Max. Negotiated Rate	$1,716.90
Rate for Payer: AlohaCare Medicaid	$885.00
Rate for Payer: AlohaCare Medicare	$548.70
Rate for Payer: Cash Price	$1,062.00
Rate for Payer: Devoted Health Medicare	$601.80
Rate for Payer: Hawaii Medical Service Association Medicare	$548.70
Rate for Payer: Hawaii Western Management Group Commercial	$1,681.50
Rate for Payer: Health Management Network Commercial	$1,504.50
Rate for Payer: Humana Medicare	$548.70
Rate for Payer: Kaiser Permanente Commercial	$1,593.00
Rate for Payer: Kaiser Permanente Medicaid	$902.70
Rate for Payer: Kaiser Permanente Medicare	$548.70
Rate for Payer: MDX Hawaii PPO	$1,716.90
Rate for Payer: Ohana Health Plan Medicaid	$548.70
Rate for Payer: Ohana Health Plan Medicare	$548.70
Rate for Payer: UnitedHealthcare Medicare	$548.70
Rate for Payer: University Health Alliance Commercial	$1,290.15

SNARE 6FX15X120 AMPLATZ GN

Facility

$631.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$195.61
Max. Negotiated Rate	$612.07
Rate for Payer: AlohaCare Medicaid	$315.50
Rate for Payer: AlohaCare Medicare	$195.61
Rate for Payer: Cash Price	$378.60
Rate for Payer: Devoted Health Medicare	$214.54
Rate for Payer: Hawaii Medical Service Association Medicare	$195.61
Rate for Payer: Hawaii Western Management Group Commercial	$599.45
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: Humana Medicare	$195.61
Rate for Payer: Kaiser Permanente Commercial	$567.90
Rate for Payer: Kaiser Permanente Medicaid	$321.81
Rate for Payer: Kaiser Permanente Medicare	$195.61
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: Ohana Health Plan Medicaid	$195.61
Rate for Payer: Ohana Health Plan Medicare	$195.61
Rate for Payer: UnitedHealthcare Medicare	$195.61
Rate for Payer: University Health Alliance Commercial	$459.94

SNARE 6FX15X120 AMPLATZ GN

Facility

$631.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$536.35
Max. Negotiated Rate	$612.07
Rate for Payer: Cash Price	$378.60
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: Kaiser Permanente Commercial	$567.90
Rate for Payer: MDX Hawaii PPO	$612.07

SNARE 6FX25X120 AMPLATZ GN

Facility

$630.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$195.30
Max. Negotiated Rate	$611.10
Rate for Payer: AlohaCare Medicaid	$315.00
Rate for Payer: AlohaCare Medicare	$195.30
Rate for Payer: Cash Price	$378.00
Rate for Payer: Devoted Health Medicare	$214.20
Rate for Payer: Hawaii Medical Service Association Medicare	$195.30
Rate for Payer: Hawaii Western Management Group Commercial	$598.50
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Humana Medicare	$195.30
Rate for Payer: Kaiser Permanente Commercial	$567.00
Rate for Payer: Kaiser Permanente Medicaid	$321.30
Rate for Payer: Kaiser Permanente Medicare	$195.30
Rate for Payer: MDX Hawaii PPO	$611.10
Rate for Payer: Ohana Health Plan Medicaid	$195.30
Rate for Payer: Ohana Health Plan Medicare	$195.30
Rate for Payer: UnitedHealthcare Medicare	$195.30
Rate for Payer: University Health Alliance Commercial	$459.21

SNARE 6FX25X120 AMPLATZ GN

Facility

$630.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$611.10
Rate for Payer: Cash Price	$378.00
Rate for Payer: Health Management Network Commercial	$535.50
Rate for Payer: Kaiser Permanente Commercial	$567.00
Rate for Payer: MDX Hawaii PPO	$611.10

SNARE COLD EXACTO

Facility

$72.00

Hospital Revenue Code	272
Min. Negotiated Rate	$22.32
Max. Negotiated Rate	$69.84
Rate for Payer: AlohaCare Medicaid	$36.00
Rate for Payer: AlohaCare Medicare	$22.32
Rate for Payer: Cash Price	$43.20
Rate for Payer: Devoted Health Medicare	$24.48
Rate for Payer: Hawaii Medical Service Association Medicare	$22.32
Rate for Payer: Hawaii Western Management Group Commercial	$68.40
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Humana Medicare	$22.32
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$22.32
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$22.32
Rate for Payer: Ohana Health Plan Medicare	$22.32
Rate for Payer: UnitedHealthcare Medicare	$22.32
Rate for Payer: University Health Alliance Commercial	$52.48

SNARE COLD EXACTO

Facility

$72.00

Hospital Revenue Code	272
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$43.20
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: MDX Hawaii PPO	$69.84

SNARE FOREIGN BODY KATZ

Facility

$320.00

Service Code	HCPCS L8499
Hospital Revenue Code	274
Min. Negotiated Rate	$179.20
Max. Negotiated Rate	$310.40
Rate for Payer: Cash Price	$192.00
Rate for Payer: Hawaii Western Management Group Commercial	$224.00
Rate for Payer: Health Management Network Commercial	$272.00
Rate for Payer: Kaiser Permanente Commercial	$288.00
Rate for Payer: MDX Hawaii PPO	$310.40
Rate for Payer: University Health Alliance Commercial	$179.20

SNARE FOREIGN BODY KATZ

Facility

$320.00

Service Code	HCPCS L8499
Hospital Revenue Code	274
Min. Negotiated Rate	$38.93
Max. Negotiated Rate	$310.40
Rate for Payer: AlohaCare Medicaid	$160.00
Rate for Payer: AlohaCare Medicare	$99.20
Rate for Payer: Cash Price	$192.00
Rate for Payer: Cash Price	$192.00
Rate for Payer: Devoted Health Medicare	$108.80
Rate for Payer: Hawaii Medical Service Association Medicare	$99.20
Rate for Payer: Hawaii Western Management Group Commercial	$224.00
Rate for Payer: Health Management Network Commercial	$272.00
Rate for Payer: Humana Medicare	$99.20
Rate for Payer: Kaiser Permanente Commercial	$288.00
Rate for Payer: Kaiser Permanente Medicaid	$163.20
Rate for Payer: Kaiser Permanente Medicare	$99.20
Rate for Payer: MDX Hawaii PPO	$310.40
Rate for Payer: Ohana Health Plan Medicaid	$99.20
Rate for Payer: Ohana Health Plan Medicare	$99.20
Rate for Payer: UnitedHealthcare Medicaid	$38.93
Rate for Payer: UnitedHealthcare Medicare	$99.20
Rate for Payer: University Health Alliance Commercial	$179.20

SNARE POLYP 10MM

Facility

$94.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$29.14
Max. Negotiated Rate	$91.18
Rate for Payer: AlohaCare Medicaid	$47.00
Rate for Payer: AlohaCare Medicare	$29.14
Rate for Payer: Cash Price	$56.40
Rate for Payer: Devoted Health Medicare	$31.96
Rate for Payer: Hawaii Medical Service Association Medicare	$29.14
Rate for Payer: Hawaii Western Management Group Commercial	$89.30
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Humana Medicare	$29.14
Rate for Payer: Kaiser Permanente Commercial	$84.60
Rate for Payer: Kaiser Permanente Medicaid	$47.94
Rate for Payer: Kaiser Permanente Medicare	$29.14
Rate for Payer: MDX Hawaii PPO	$91.18
Rate for Payer: Ohana Health Plan Medicaid	$29.14
Rate for Payer: Ohana Health Plan Medicare	$29.14
Rate for Payer: UnitedHealthcare Medicare	$29.14
Rate for Payer: University Health Alliance Commercial	$68.52

SNARE POLYP 10MM

Facility

$94.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$79.90
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$56.40
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Kaiser Permanente Commercial	$84.60
Rate for Payer: MDX Hawaii PPO	$91.18

Know your out-of-pocket cost for care.

All Charges