Kau Hospital

All Charges

Charge

Type

Setting

Price

SUTURE CINCH-LNG M00505550

Facility

$684.00

Hospital Revenue Code	272
Min. Negotiated Rate	$212.04
Max. Negotiated Rate	$663.48
Rate for Payer: AlohaCare Medicaid	$342.00
Rate for Payer: AlohaCare Medicare	$212.04
Rate for Payer: Cash Price	$410.40
Rate for Payer: Devoted Health Medicare	$232.56
Rate for Payer: Hawaii Medical Service Association Medicare	$212.04
Rate for Payer: Hawaii Western Management Group Commercial	$649.80
Rate for Payer: Health Management Network Commercial	$581.40
Rate for Payer: Humana Medicare	$212.04
Rate for Payer: Kaiser Permanente Commercial	$615.60
Rate for Payer: Kaiser Permanente Medicaid	$348.84
Rate for Payer: Kaiser Permanente Medicare	$212.04
Rate for Payer: MDX Hawaii PPO	$663.48
Rate for Payer: Ohana Health Plan Medicaid	$212.04
Rate for Payer: Ohana Health Plan Medicare	$212.04
Rate for Payer: UnitedHealthcare Medicare	$212.04
Rate for Payer: University Health Alliance Commercial	$498.57

SUTURE FIX ANCHOR #72203853

Facility

$1,188.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$368.28
Max. Negotiated Rate	$1,152.36
Rate for Payer: AlohaCare Medicaid	$594.00
Rate for Payer: AlohaCare Medicare	$368.28
Rate for Payer: Cash Price	$712.80
Rate for Payer: Devoted Health Medicare	$403.92
Rate for Payer: Hawaii Medical Service Association Medicare	$368.28
Rate for Payer: Hawaii Western Management Group Commercial	$831.60
Rate for Payer: Health Management Network Commercial	$1,009.80
Rate for Payer: Humana Medicare	$368.28
Rate for Payer: Kaiser Permanente Commercial	$1,069.20
Rate for Payer: Kaiser Permanente Medicaid	$605.88
Rate for Payer: Kaiser Permanente Medicare	$368.28
Rate for Payer: MDX Hawaii PPO	$1,152.36
Rate for Payer: Ohana Health Plan Medicaid	$368.28
Rate for Payer: Ohana Health Plan Medicare	$368.28
Rate for Payer: UnitedHealthcare Medicare	$368.28
Rate for Payer: University Health Alliance Commercial	$665.28

SUTURE FIX ANCHOR #72203853

Facility

$1,188.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$665.28
Max. Negotiated Rate	$1,152.36
Rate for Payer: Cash Price	$712.80
Rate for Payer: Hawaii Western Management Group Commercial	$831.60
Rate for Payer: Health Management Network Commercial	$1,009.80
Rate for Payer: Kaiser Permanente Commercial	$1,069.20
Rate for Payer: MDX Hawaii PPO	$1,152.36
Rate for Payer: University Health Alliance Commercial	$665.28

SUTURE KIT UNIV APEX AR-7298

Facility

$1,400.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,190.00
Max. Negotiated Rate	$1,358.00
Rate for Payer: Cash Price	$840.00
Rate for Payer: Health Management Network Commercial	$1,190.00
Rate for Payer: Kaiser Permanente Commercial	$1,260.00
Rate for Payer: MDX Hawaii PPO	$1,358.00

SUTURE KIT UNIV APEX AR-7298

Facility

$1,400.00

Hospital Revenue Code	272
Min. Negotiated Rate	$434.00
Max. Negotiated Rate	$1,358.00
Rate for Payer: AlohaCare Medicaid	$700.00
Rate for Payer: AlohaCare Medicare	$434.00
Rate for Payer: Cash Price	$840.00
Rate for Payer: Devoted Health Medicare	$476.00
Rate for Payer: Hawaii Medical Service Association Medicare	$434.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,330.00
Rate for Payer: Health Management Network Commercial	$1,190.00
Rate for Payer: Humana Medicare	$434.00
Rate for Payer: Kaiser Permanente Commercial	$1,260.00
Rate for Payer: Kaiser Permanente Medicaid	$714.00
Rate for Payer: Kaiser Permanente Medicare	$434.00
Rate for Payer: MDX Hawaii PPO	$1,358.00
Rate for Payer: Ohana Health Plan Medicaid	$434.00
Rate for Payer: Ohana Health Plan Medicare	$434.00
Rate for Payer: UnitedHealthcare Medicare	$434.00
Rate for Payer: University Health Alliance Commercial	$1,020.46

SUTURE LASSO #AR-4068-25TLF

Facility

$893.00

Hospital Revenue Code	272
Min. Negotiated Rate	$759.05
Max. Negotiated Rate	$866.21
Rate for Payer: Cash Price	$535.80
Rate for Payer: Health Management Network Commercial	$759.05
Rate for Payer: Kaiser Permanente Commercial	$803.70
Rate for Payer: MDX Hawaii PPO	$866.21

SUTURE LASSO #AR-4068-25TLF

Facility

$893.00

Hospital Revenue Code	272
Min. Negotiated Rate	$276.83
Max. Negotiated Rate	$866.21
Rate for Payer: AlohaCare Medicaid	$446.50
Rate for Payer: AlohaCare Medicare	$276.83
Rate for Payer: Cash Price	$535.80
Rate for Payer: Devoted Health Medicare	$303.62
Rate for Payer: Hawaii Medical Service Association Medicare	$276.83
Rate for Payer: Hawaii Western Management Group Commercial	$848.35
Rate for Payer: Health Management Network Commercial	$759.05
Rate for Payer: Humana Medicare	$276.83
Rate for Payer: Kaiser Permanente Commercial	$803.70
Rate for Payer: Kaiser Permanente Medicaid	$455.43
Rate for Payer: Kaiser Permanente Medicare	$276.83
Rate for Payer: MDX Hawaii PPO	$866.21
Rate for Payer: Ohana Health Plan Medicaid	$276.83
Rate for Payer: Ohana Health Plan Medicare	$276.83
Rate for Payer: UnitedHealthcare Medicare	$276.83
Rate for Payer: University Health Alliance Commercial	$650.91

SUTURE LASSO #AR-4068-45R

Facility

$525.00

Hospital Revenue Code	272
Min. Negotiated Rate	$162.75
Max. Negotiated Rate	$509.25
Rate for Payer: AlohaCare Medicaid	$262.50
Rate for Payer: AlohaCare Medicare	$162.75
Rate for Payer: Cash Price	$315.00
Rate for Payer: Devoted Health Medicare	$178.50
Rate for Payer: Hawaii Medical Service Association Medicare	$162.75
Rate for Payer: Hawaii Western Management Group Commercial	$498.75
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Humana Medicare	$162.75
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: Kaiser Permanente Medicaid	$267.75
Rate for Payer: Kaiser Permanente Medicare	$162.75
Rate for Payer: MDX Hawaii PPO	$509.25
Rate for Payer: Ohana Health Plan Medicaid	$162.75
Rate for Payer: Ohana Health Plan Medicare	$162.75
Rate for Payer: UnitedHealthcare Medicare	$162.75
Rate for Payer: University Health Alliance Commercial	$382.67

SUTURE LASSO #AR-4068-45R

Facility

$525.00

Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$509.25
Rate for Payer: Cash Price	$315.00
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: MDX Hawaii PPO	$509.25

SUTURE LASSO #AR-6069-90

Facility

$630.00

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

SUTURE LASSO #AR-6069-90

Facility

$630.00

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

SUTURE LASSO AR-8703

Facility

$551.00

Hospital Revenue Code	272
Min. Negotiated Rate	$468.35
Max. Negotiated Rate	$534.47
Rate for Payer: Cash Price	$330.60
Rate for Payer: Health Management Network Commercial	$468.35
Rate for Payer: Kaiser Permanente Commercial	$495.90
Rate for Payer: MDX Hawaii PPO	$534.47

SUTURE LASSO AR-8703

Facility

$551.00

Hospital Revenue Code	272
Min. Negotiated Rate	$170.81
Max. Negotiated Rate	$534.47
Rate for Payer: AlohaCare Medicaid	$275.50
Rate for Payer: AlohaCare Medicare	$170.81
Rate for Payer: Cash Price	$330.60
Rate for Payer: Devoted Health Medicare	$187.34
Rate for Payer: Hawaii Medical Service Association Medicare	$170.81
Rate for Payer: Hawaii Western Management Group Commercial	$523.45
Rate for Payer: Health Management Network Commercial	$468.35
Rate for Payer: Humana Medicare	$170.81
Rate for Payer: Kaiser Permanente Commercial	$495.90
Rate for Payer: Kaiser Permanente Medicaid	$281.01
Rate for Payer: Kaiser Permanente Medicare	$170.81
Rate for Payer: MDX Hawaii PPO	$534.47
Rate for Payer: Ohana Health Plan Medicaid	$170.81
Rate for Payer: Ohana Health Plan Medicare	$170.81
Rate for Payer: UnitedHealthcare Medicare	$170.81
Rate for Payer: University Health Alliance Commercial	$401.62

SUTURELOC SYSTEM AR-4551

Facility

$4,201.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,302.31
Max. Negotiated Rate	$4,074.97
Rate for Payer: AlohaCare Medicaid	$2,100.50
Rate for Payer: AlohaCare Medicare	$1,302.31
Rate for Payer: Cash Price	$2,520.60
Rate for Payer: Devoted Health Medicare	$1,428.34
Rate for Payer: Hawaii Medical Service Association Medicare	$1,302.31
Rate for Payer: Hawaii Western Management Group Commercial	$2,940.70
Rate for Payer: Health Management Network Commercial	$3,570.85
Rate for Payer: Humana Medicare	$1,302.31
Rate for Payer: Kaiser Permanente Commercial	$3,780.90
Rate for Payer: Kaiser Permanente Medicaid	$2,142.51
Rate for Payer: Kaiser Permanente Medicare	$1,302.31
Rate for Payer: MDX Hawaii PPO	$4,074.97
Rate for Payer: Ohana Health Plan Medicaid	$1,302.31
Rate for Payer: Ohana Health Plan Medicare	$1,302.31
Rate for Payer: UnitedHealthcare Medicare	$1,302.31
Rate for Payer: University Health Alliance Commercial	$2,352.56

SUTURELOC SYSTEM AR-4551

Facility

$4,201.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,352.56
Max. Negotiated Rate	$4,074.97
Rate for Payer: Cash Price	$2,520.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,940.70
Rate for Payer: Health Management Network Commercial	$3,570.85
Rate for Payer: Kaiser Permanente Commercial	$3,780.90
Rate for Payer: MDX Hawaii PPO	$4,074.97
Rate for Payer: University Health Alliance Commercial	$2,352.56

SUTURE PASSER AR-1000

Facility

$273.00

Hospital Revenue Code	272
Min. Negotiated Rate	$232.05
Max. Negotiated Rate	$264.81
Rate for Payer: Cash Price	$163.80
Rate for Payer: Health Management Network Commercial	$232.05
Rate for Payer: Kaiser Permanente Commercial	$245.70
Rate for Payer: MDX Hawaii PPO	$264.81

SUTURE PASSER AR-1000

Facility

$273.00

Hospital Revenue Code	272
Min. Negotiated Rate	$84.63
Max. Negotiated Rate	$264.81
Rate for Payer: AlohaCare Medicaid	$136.50
Rate for Payer: AlohaCare Medicare	$84.63
Rate for Payer: Cash Price	$163.80
Rate for Payer: Devoted Health Medicare	$92.82
Rate for Payer: Hawaii Medical Service Association Medicare	$84.63
Rate for Payer: Hawaii Western Management Group Commercial	$259.35
Rate for Payer: Health Management Network Commercial	$232.05
Rate for Payer: Humana Medicare	$84.63
Rate for Payer: Kaiser Permanente Commercial	$245.70
Rate for Payer: Kaiser Permanente Medicaid	$139.23
Rate for Payer: Kaiser Permanente Medicare	$84.63
Rate for Payer: MDX Hawaii PPO	$264.81
Rate for Payer: Ohana Health Plan Medicaid	$84.63
Rate for Payer: Ohana Health Plan Medicare	$84.63
Rate for Payer: UnitedHealthcare Medicare	$84.63
Rate for Payer: University Health Alliance Commercial	$198.99

SUTURE PASSER COBRA 3910900097

Facility

$844.00

Hospital Revenue Code	272
Min. Negotiated Rate	$261.64
Max. Negotiated Rate	$818.68
Rate for Payer: AlohaCare Medicaid	$422.00
Rate for Payer: AlohaCare Medicare	$261.64
Rate for Payer: Cash Price	$506.40
Rate for Payer: Devoted Health Medicare	$286.96
Rate for Payer: Hawaii Medical Service Association Medicare	$261.64
Rate for Payer: Hawaii Western Management Group Commercial	$801.80
Rate for Payer: Health Management Network Commercial	$717.40
Rate for Payer: Humana Medicare	$261.64
Rate for Payer: Kaiser Permanente Commercial	$759.60
Rate for Payer: Kaiser Permanente Medicaid	$430.44
Rate for Payer: Kaiser Permanente Medicare	$261.64
Rate for Payer: MDX Hawaii PPO	$818.68
Rate for Payer: Ohana Health Plan Medicaid	$261.64
Rate for Payer: Ohana Health Plan Medicare	$261.64
Rate for Payer: UnitedHealthcare Medicare	$261.64
Rate for Payer: University Health Alliance Commercial	$615.19

SUTURE PASSER COBRA 3910900097

Facility

$844.00

Hospital Revenue Code	272
Min. Negotiated Rate	$717.40
Max. Negotiated Rate	$818.68
Rate for Payer: Cash Price	$506.40
Rate for Payer: Health Management Network Commercial	$717.40
Rate for Payer: Kaiser Permanente Commercial	$759.60
Rate for Payer: MDX Hawaii PPO	$818.68

SUTURE PASSER NDL 3910900091

Facility

$653.00

Hospital Revenue Code	272
Min. Negotiated Rate	$555.05
Max. Negotiated Rate	$633.41
Rate for Payer: Cash Price	$391.80
Rate for Payer: Health Management Network Commercial	$555.05
Rate for Payer: Kaiser Permanente Commercial	$587.70
Rate for Payer: MDX Hawaii PPO	$633.41

SUTURE PASSER NDL 3910900091

Facility

$653.00

Hospital Revenue Code	272
Min. Negotiated Rate	$202.43
Max. Negotiated Rate	$633.41
Rate for Payer: AlohaCare Medicaid	$326.50
Rate for Payer: AlohaCare Medicare	$202.43
Rate for Payer: Cash Price	$391.80
Rate for Payer: Devoted Health Medicare	$222.02
Rate for Payer: Hawaii Medical Service Association Medicare	$202.43
Rate for Payer: Hawaii Western Management Group Commercial	$620.35
Rate for Payer: Health Management Network Commercial	$555.05
Rate for Payer: Humana Medicare	$202.43
Rate for Payer: Kaiser Permanente Commercial	$587.70
Rate for Payer: Kaiser Permanente Medicaid	$333.03
Rate for Payer: Kaiser Permanente Medicare	$202.43
Rate for Payer: MDX Hawaii PPO	$633.41
Rate for Payer: Ohana Health Plan Medicaid	$202.43
Rate for Payer: Ohana Health Plan Medicare	$202.43
Rate for Payer: UnitedHealthcare Medicare	$202.43
Rate for Payer: University Health Alliance Commercial	$475.97

SUTURE PASSER ST 72290128

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$271.25
Max. Negotiated Rate	$848.75
Rate for Payer: AlohaCare Medicaid	$437.50
Rate for Payer: AlohaCare Medicare	$271.25
Rate for Payer: Cash Price	$525.00
Rate for Payer: Devoted Health Medicare	$297.50
Rate for Payer: Hawaii Medical Service Association Medicare	$271.25
Rate for Payer: Hawaii Western Management Group Commercial	$831.25
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Humana Medicare	$271.25
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: Kaiser Permanente Medicare	$271.25
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: Ohana Health Plan Medicaid	$271.25
Rate for Payer: Ohana Health Plan Medicare	$271.25
Rate for Payer: UnitedHealthcare Medicare	$271.25
Rate for Payer: University Health Alliance Commercial	$637.79

SUTURE PASSER ST 72290128

Facility

$875.00

Hospital Revenue Code	272
Min. Negotiated Rate	$743.75
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: MDX Hawaii PPO	$848.75

SUTURETAK 3.0 #AR-1934BCFT-2

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$387.50
Max. Negotiated Rate	$1,212.50
Rate for Payer: AlohaCare Medicaid	$625.00
Rate for Payer: AlohaCare Medicare	$387.50
Rate for Payer: Cash Price	$750.00
Rate for Payer: Devoted Health Medicare	$425.00
Rate for Payer: Hawaii Medical Service Association Medicare	$387.50
Rate for Payer: Hawaii Western Management Group Commercial	$875.00
Rate for Payer: Health Management Network Commercial	$1,062.50
Rate for Payer: Humana Medicare	$387.50
Rate for Payer: Kaiser Permanente Commercial	$1,125.00
Rate for Payer: Kaiser Permanente Medicaid	$637.50
Rate for Payer: Kaiser Permanente Medicare	$387.50
Rate for Payer: MDX Hawaii PPO	$1,212.50
Rate for Payer: Ohana Health Plan Medicaid	$387.50
Rate for Payer: Ohana Health Plan Medicare	$387.50
Rate for Payer: UnitedHealthcare Medicare	$387.50
Rate for Payer: University Health Alliance Commercial	$700.00

SUTURETAK 3.0 #AR-1934BCFT-2

Facility

$1,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$700.00
Max. Negotiated Rate	$1,212.50
Rate for Payer: Cash Price	$750.00
Rate for Payer: Hawaii Western Management Group Commercial	$875.00
Rate for Payer: Health Management Network Commercial	$1,062.50
Rate for Payer: Kaiser Permanente Commercial	$1,125.00
Rate for Payer: MDX Hawaii PPO	$1,212.50
Rate for Payer: University Health Alliance Commercial	$700.00

Know your out-of-pocket cost for care.

All Charges