Kau Hospital

All Charges

Charge

Type

Setting

Price

SUTURE ANCHOR 5.5 72205135

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$931.28
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR 5.5 72205135

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$515.53
Max. Negotiated Rate	$1,613.11
Rate for Payer: AlohaCare Medicaid	$831.50
Rate for Payer: AlohaCare Medicare	$515.53
Rate for Payer: Cash Price	$997.80
Rate for Payer: Devoted Health Medicare	$565.42
Rate for Payer: Hawaii Medical Service Association Medicare	$515.53
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Humana Medicare	$515.53
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: Kaiser Permanente Medicaid	$848.13
Rate for Payer: Kaiser Permanente Medicare	$515.53
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: Ohana Health Plan Medicaid	$515.53
Rate for Payer: Ohana Health Plan Medicare	$515.53
Rate for Payer: UnitedHealthcare Medicare	$515.53
Rate for Payer: University Health Alliance Commercial	$931.28

SUTURE ANCHOR #AR-1662BC

Facility

$1,435.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$803.60
Max. Negotiated Rate	$1,391.95
Rate for Payer: Cash Price	$861.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,004.50
Rate for Payer: Health Management Network Commercial	$1,219.75
Rate for Payer: Kaiser Permanente Commercial	$1,291.50
Rate for Payer: MDX Hawaii PPO	$1,391.95
Rate for Payer: University Health Alliance Commercial	$803.60

SUTURE ANCHOR #AR-1662BC

Facility

$1,435.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$444.85
Max. Negotiated Rate	$1,391.95
Rate for Payer: AlohaCare Medicaid	$717.50
Rate for Payer: AlohaCare Medicare	$444.85
Rate for Payer: Cash Price	$861.00
Rate for Payer: Devoted Health Medicare	$487.90
Rate for Payer: Hawaii Medical Service Association Medicare	$444.85
Rate for Payer: Hawaii Western Management Group Commercial	$1,004.50
Rate for Payer: Health Management Network Commercial	$1,219.75
Rate for Payer: Humana Medicare	$444.85
Rate for Payer: Kaiser Permanente Commercial	$1,291.50
Rate for Payer: Kaiser Permanente Medicaid	$731.85
Rate for Payer: Kaiser Permanente Medicare	$444.85
Rate for Payer: MDX Hawaii PPO	$1,391.95
Rate for Payer: Ohana Health Plan Medicaid	$444.85
Rate for Payer: Ohana Health Plan Medicare	$444.85
Rate for Payer: UnitedHealthcare Medicare	$444.85
Rate for Payer: University Health Alliance Commercial	$803.60

SUTURE ANCHOR #AR-1927BCFT-45

Facility

$1,208.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$676.48
Max. Negotiated Rate	$1,171.76
Rate for Payer: Cash Price	$724.80
Rate for Payer: Hawaii Western Management Group Commercial	$845.60
Rate for Payer: Health Management Network Commercial	$1,026.80
Rate for Payer: Kaiser Permanente Commercial	$1,087.20
Rate for Payer: MDX Hawaii PPO	$1,171.76
Rate for Payer: University Health Alliance Commercial	$676.48

SUTURE ANCHOR #AR-1927BCFT-45

Facility

$1,208.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$374.48
Max. Negotiated Rate	$1,171.76
Rate for Payer: AlohaCare Medicaid	$604.00
Rate for Payer: AlohaCare Medicare	$374.48
Rate for Payer: Cash Price	$724.80
Rate for Payer: Devoted Health Medicare	$410.72
Rate for Payer: Hawaii Medical Service Association Medicare	$374.48
Rate for Payer: Hawaii Western Management Group Commercial	$845.60
Rate for Payer: Health Management Network Commercial	$1,026.80
Rate for Payer: Humana Medicare	$374.48
Rate for Payer: Kaiser Permanente Commercial	$1,087.20
Rate for Payer: Kaiser Permanente Medicaid	$616.08
Rate for Payer: Kaiser Permanente Medicare	$374.48
Rate for Payer: MDX Hawaii PPO	$1,171.76
Rate for Payer: Ohana Health Plan Medicaid	$374.48
Rate for Payer: Ohana Health Plan Medicare	$374.48
Rate for Payer: UnitedHealthcare Medicare	$374.48
Rate for Payer: University Health Alliance Commercial	$676.48

SUTURE ANCHOR #AR-1928SF-45

Facility

$1,152.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$357.12
Max. Negotiated Rate	$1,117.44
Rate for Payer: AlohaCare Medicaid	$576.00
Rate for Payer: AlohaCare Medicare	$357.12
Rate for Payer: Cash Price	$691.20
Rate for Payer: Devoted Health Medicare	$391.68
Rate for Payer: Hawaii Medical Service Association Medicare	$357.12
Rate for Payer: Hawaii Western Management Group Commercial	$806.40
Rate for Payer: Health Management Network Commercial	$979.20
Rate for Payer: Humana Medicare	$357.12
Rate for Payer: Kaiser Permanente Commercial	$1,036.80
Rate for Payer: Kaiser Permanente Medicaid	$587.52
Rate for Payer: Kaiser Permanente Medicare	$357.12
Rate for Payer: MDX Hawaii PPO	$1,117.44
Rate for Payer: Ohana Health Plan Medicaid	$357.12
Rate for Payer: Ohana Health Plan Medicare	$357.12
Rate for Payer: UnitedHealthcare Medicare	$357.12
Rate for Payer: University Health Alliance Commercial	$645.12

SUTURE ANCHOR #AR-1928SF-45

Facility

$1,152.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$645.12
Max. Negotiated Rate	$1,117.44
Rate for Payer: Cash Price	$691.20
Rate for Payer: Hawaii Western Management Group Commercial	$806.40
Rate for Payer: Health Management Network Commercial	$979.20
Rate for Payer: Kaiser Permanente Commercial	$1,036.80
Rate for Payer: MDX Hawaii PPO	$1,117.44
Rate for Payer: University Health Alliance Commercial	$645.12

SUTURE ANCHOR #AR-1929SF-3

Facility

$919.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$514.64
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Hawaii Western Management Group Commercial	$643.30
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: MDX Hawaii PPO	$891.43
Rate for Payer: University Health Alliance Commercial	$514.64

SUTURE ANCHOR #AR-1929SF-3

Facility

$919.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$284.89
Max. Negotiated Rate	$891.43
Rate for Payer: AlohaCare Medicaid	$459.50
Rate for Payer: AlohaCare Medicare	$284.89
Rate for Payer: Cash Price	$551.40
Rate for Payer: Devoted Health Medicare	$312.46
Rate for Payer: Hawaii Medical Service Association Medicare	$284.89
Rate for Payer: Hawaii Western Management Group Commercial	$643.30
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Humana Medicare	$284.89
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: Kaiser Permanente Medicaid	$468.69
Rate for Payer: Kaiser Permanente Medicare	$284.89
Rate for Payer: MDX Hawaii PPO	$891.43
Rate for Payer: Ohana Health Plan Medicaid	$284.89
Rate for Payer: Ohana Health Plan Medicare	$284.89
Rate for Payer: UnitedHealthcare Medicare	$284.89
Rate for Payer: University Health Alliance Commercial	$514.64

SUTURE ANCHOR #AR-1938BC

Facility

$1,562.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$874.72
Max. Negotiated Rate	$1,515.14
Rate for Payer: Cash Price	$937.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.40
Rate for Payer: Health Management Network Commercial	$1,327.70
Rate for Payer: Kaiser Permanente Commercial	$1,405.80
Rate for Payer: MDX Hawaii PPO	$1,515.14
Rate for Payer: University Health Alliance Commercial	$874.72

SUTURE ANCHOR #AR-1938BC

Facility

$1,562.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$484.22
Max. Negotiated Rate	$1,515.14
Rate for Payer: AlohaCare Medicaid	$781.00
Rate for Payer: AlohaCare Medicare	$484.22
Rate for Payer: Cash Price	$937.20
Rate for Payer: Devoted Health Medicare	$531.08
Rate for Payer: Hawaii Medical Service Association Medicare	$484.22
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.40
Rate for Payer: Health Management Network Commercial	$1,327.70
Rate for Payer: Humana Medicare	$484.22
Rate for Payer: Kaiser Permanente Commercial	$1,405.80
Rate for Payer: Kaiser Permanente Medicaid	$796.62
Rate for Payer: Kaiser Permanente Medicare	$484.22
Rate for Payer: MDX Hawaii PPO	$1,515.14
Rate for Payer: Ohana Health Plan Medicaid	$484.22
Rate for Payer: Ohana Health Plan Medicare	$484.22
Rate for Payer: UnitedHealthcare Medicare	$484.22
Rate for Payer: University Health Alliance Commercial	$874.72

SUTURE ANCHOR #AR-2324BCC-2

Facility

$1,788.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,001.28
Max. Negotiated Rate	$1,734.36
Rate for Payer: Cash Price	$1,072.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,251.60
Rate for Payer: Health Management Network Commercial	$1,519.80
Rate for Payer: Kaiser Permanente Commercial	$1,609.20
Rate for Payer: MDX Hawaii PPO	$1,734.36
Rate for Payer: University Health Alliance Commercial	$1,001.28

SUTURE ANCHOR #AR-2324BCC-2

Facility

$1,788.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$554.28
Max. Negotiated Rate	$1,734.36
Rate for Payer: AlohaCare Medicaid	$894.00
Rate for Payer: AlohaCare Medicare	$554.28
Rate for Payer: Cash Price	$1,072.80
Rate for Payer: Devoted Health Medicare	$607.92
Rate for Payer: Hawaii Medical Service Association Medicare	$554.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,251.60
Rate for Payer: Health Management Network Commercial	$1,519.80
Rate for Payer: Humana Medicare	$554.28
Rate for Payer: Kaiser Permanente Commercial	$1,609.20
Rate for Payer: Kaiser Permanente Medicaid	$911.88
Rate for Payer: Kaiser Permanente Medicare	$554.28
Rate for Payer: MDX Hawaii PPO	$1,734.36
Rate for Payer: Ohana Health Plan Medicaid	$554.28
Rate for Payer: Ohana Health Plan Medicare	$554.28
Rate for Payer: UnitedHealthcare Medicare	$554.28
Rate for Payer: University Health Alliance Commercial	$1,001.28

SUTURE ANCHOR #AR-2325PSLC

Facility

$1,524.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$472.44
Max. Negotiated Rate	$1,478.28
Rate for Payer: AlohaCare Medicaid	$762.00
Rate for Payer: AlohaCare Medicare	$472.44
Rate for Payer: Cash Price	$914.40
Rate for Payer: Devoted Health Medicare	$518.16
Rate for Payer: Hawaii Medical Service Association Medicare	$472.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,066.80
Rate for Payer: Health Management Network Commercial	$1,295.40
Rate for Payer: Humana Medicare	$472.44
Rate for Payer: Kaiser Permanente Commercial	$1,371.60
Rate for Payer: Kaiser Permanente Medicaid	$777.24
Rate for Payer: Kaiser Permanente Medicare	$472.44
Rate for Payer: MDX Hawaii PPO	$1,478.28
Rate for Payer: Ohana Health Plan Medicaid	$472.44
Rate for Payer: Ohana Health Plan Medicare	$472.44
Rate for Payer: UnitedHealthcare Medicare	$472.44
Rate for Payer: University Health Alliance Commercial	$853.44

SUTURE ANCHOR #AR-2325PSLC

Facility

$1,524.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$853.44
Max. Negotiated Rate	$1,478.28
Rate for Payer: Cash Price	$914.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,066.80
Rate for Payer: Health Management Network Commercial	$1,295.40
Rate for Payer: Kaiser Permanente Commercial	$1,371.60
Rate for Payer: MDX Hawaii PPO	$1,478.28
Rate for Payer: University Health Alliance Commercial	$853.44

SUTURE ANCHOR AR-8934BCST

Facility

$1,562.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$484.22
Max. Negotiated Rate	$1,515.14
Rate for Payer: AlohaCare Medicaid	$781.00
Rate for Payer: AlohaCare Medicare	$484.22
Rate for Payer: Cash Price	$937.20
Rate for Payer: Devoted Health Medicare	$531.08
Rate for Payer: Hawaii Medical Service Association Medicare	$484.22
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.40
Rate for Payer: Health Management Network Commercial	$1,327.70
Rate for Payer: Humana Medicare	$484.22
Rate for Payer: Kaiser Permanente Commercial	$1,405.80
Rate for Payer: Kaiser Permanente Medicaid	$796.62
Rate for Payer: Kaiser Permanente Medicare	$484.22
Rate for Payer: MDX Hawaii PPO	$1,515.14
Rate for Payer: Ohana Health Plan Medicaid	$484.22
Rate for Payer: Ohana Health Plan Medicare	$484.22
Rate for Payer: UnitedHealthcare Medicare	$484.22
Rate for Payer: University Health Alliance Commercial	$874.72

SUTURE ANCHOR AR-8934BCST

Facility

$1,562.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$874.72
Max. Negotiated Rate	$1,515.14
Rate for Payer: Cash Price	$937.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.40
Rate for Payer: Health Management Network Commercial	$1,327.70
Rate for Payer: Kaiser Permanente Commercial	$1,405.80
Rate for Payer: MDX Hawaii PPO	$1,515.14
Rate for Payer: University Health Alliance Commercial	$874.72

SUTURE ANCHOR BIOCOMPOSITE

Facility

$1,288.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$399.28
Max. Negotiated Rate	$1,249.36
Rate for Payer: AlohaCare Medicaid	$644.00
Rate for Payer: AlohaCare Medicare	$399.28
Rate for Payer: Cash Price	$772.80
Rate for Payer: Devoted Health Medicare	$437.92
Rate for Payer: Hawaii Medical Service Association Medicare	$399.28
Rate for Payer: Hawaii Western Management Group Commercial	$901.60
Rate for Payer: Health Management Network Commercial	$1,094.80
Rate for Payer: Humana Medicare	$399.28
Rate for Payer: Kaiser Permanente Commercial	$1,159.20
Rate for Payer: Kaiser Permanente Medicaid	$656.88
Rate for Payer: Kaiser Permanente Medicare	$399.28
Rate for Payer: MDX Hawaii PPO	$1,249.36
Rate for Payer: Ohana Health Plan Medicaid	$399.28
Rate for Payer: Ohana Health Plan Medicare	$399.28
Rate for Payer: UnitedHealthcare Medicare	$399.28
Rate for Payer: University Health Alliance Commercial	$721.28

SUTURE ANCHOR BIOCOMPOSITE

Facility

$1,288.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$721.28
Max. Negotiated Rate	$1,249.36
Rate for Payer: Cash Price	$772.80
Rate for Payer: Hawaii Western Management Group Commercial	$901.60
Rate for Payer: Health Management Network Commercial	$1,094.80
Rate for Payer: Kaiser Permanente Commercial	$1,159.20
Rate for Payer: MDX Hawaii PPO	$1,249.36
Rate for Payer: University Health Alliance Commercial	$721.28

SUTURE ANCHOR BIO-PUSHLOCK

Facility

$1,701.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$527.31
Max. Negotiated Rate	$1,649.97
Rate for Payer: AlohaCare Medicaid	$850.50
Rate for Payer: AlohaCare Medicare	$527.31
Rate for Payer: Cash Price	$1,020.60
Rate for Payer: Devoted Health Medicare	$578.34
Rate for Payer: Hawaii Medical Service Association Medicare	$527.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,190.70
Rate for Payer: Health Management Network Commercial	$1,445.85
Rate for Payer: Humana Medicare	$527.31
Rate for Payer: Kaiser Permanente Commercial	$1,530.90
Rate for Payer: Kaiser Permanente Medicaid	$867.51
Rate for Payer: Kaiser Permanente Medicare	$527.31
Rate for Payer: MDX Hawaii PPO	$1,649.97
Rate for Payer: Ohana Health Plan Medicaid	$527.31
Rate for Payer: Ohana Health Plan Medicare	$527.31
Rate for Payer: UnitedHealthcare Medicare	$527.31
Rate for Payer: University Health Alliance Commercial	$952.56

SUTURE ANCHOR BIO-PUSHLOCK

Facility

$1,701.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$952.56
Max. Negotiated Rate	$1,649.97
Rate for Payer: Cash Price	$1,020.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,190.70
Rate for Payer: Health Management Network Commercial	$1,445.85
Rate for Payer: Kaiser Permanente Commercial	$1,530.90
Rate for Payer: MDX Hawaii PPO	$1,649.97
Rate for Payer: University Health Alliance Commercial	$952.56

SUTURE BUTTON 12MM #AR-8922

Facility

$536.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$300.16
Max. Negotiated Rate	$519.92
Rate for Payer: Cash Price	$321.60
Rate for Payer: Hawaii Western Management Group Commercial	$375.20
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: Kaiser Permanente Commercial	$482.40
Rate for Payer: MDX Hawaii PPO	$519.92
Rate for Payer: University Health Alliance Commercial	$300.16

SUTURE BUTTON 12MM #AR-8922

Facility

$536.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$166.16
Max. Negotiated Rate	$519.92
Rate for Payer: AlohaCare Medicaid	$268.00
Rate for Payer: AlohaCare Medicare	$166.16
Rate for Payer: Cash Price	$321.60
Rate for Payer: Devoted Health Medicare	$182.24
Rate for Payer: Hawaii Medical Service Association Medicare	$166.16
Rate for Payer: Hawaii Western Management Group Commercial	$375.20
Rate for Payer: Health Management Network Commercial	$455.60
Rate for Payer: Humana Medicare	$166.16
Rate for Payer: Kaiser Permanente Commercial	$482.40
Rate for Payer: Kaiser Permanente Medicaid	$273.36
Rate for Payer: Kaiser Permanente Medicare	$166.16
Rate for Payer: MDX Hawaii PPO	$519.92
Rate for Payer: Ohana Health Plan Medicaid	$166.16
Rate for Payer: Ohana Health Plan Medicare	$166.16
Rate for Payer: UnitedHealthcare Medicare	$166.16
Rate for Payer: University Health Alliance Commercial	$300.16

SUTURE CINCH-LNG M00505550

Facility

$684.00

Hospital Revenue Code	272
Min. Negotiated Rate	$581.40
Max. Negotiated Rate	$663.48
Rate for Payer: Cash Price	$410.40
Rate for Payer: Health Management Network Commercial	$581.40
Rate for Payer: Kaiser Permanente Commercial	$615.60
Rate for Payer: MDX Hawaii PPO	$663.48

Know your out-of-pocket cost for care.

All Charges