Kau Hospital

All Charges

Charge

Type

Setting

Price

SUTURETAK 3X14.5 #AR-1934BCFT

Facility

$1,628.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$504.68
Max. Negotiated Rate	$1,579.16
Rate for Payer: AlohaCare Medicaid	$814.00
Rate for Payer: AlohaCare Medicare	$504.68
Rate for Payer: Cash Price	$976.80
Rate for Payer: Devoted Health Medicare	$553.52
Rate for Payer: Hawaii Medical Service Association Medicare	$504.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,139.60
Rate for Payer: Health Management Network Commercial	$1,383.80
Rate for Payer: Humana Medicare	$504.68
Rate for Payer: Kaiser Permanente Commercial	$1,465.20
Rate for Payer: Kaiser Permanente Medicaid	$830.28
Rate for Payer: Kaiser Permanente Medicare	$504.68
Rate for Payer: MDX Hawaii PPO	$1,579.16
Rate for Payer: Ohana Health Plan Medicaid	$504.68
Rate for Payer: Ohana Health Plan Medicare	$504.68
Rate for Payer: UnitedHealthcare Medicare	$504.68
Rate for Payer: University Health Alliance Commercial	$911.68

SUTURETAK 3X14.5 #AR-1934BCFT

Facility

$1,628.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$911.68
Max. Negotiated Rate	$1,579.16
Rate for Payer: Cash Price	$976.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,139.60
Rate for Payer: Health Management Network Commercial	$1,383.80
Rate for Payer: Kaiser Permanente Commercial	$1,465.20
Rate for Payer: MDX Hawaii PPO	$1,579.16
Rate for Payer: University Health Alliance Commercial	$911.68

SUTURETAK KIT 23MM AR-1938PK

Facility

$1,305.00

Hospital Revenue Code	272
Min. Negotiated Rate	$404.55
Max. Negotiated Rate	$1,265.85
Rate for Payer: AlohaCare Medicaid	$652.50
Rate for Payer: AlohaCare Medicare	$404.55
Rate for Payer: Cash Price	$783.00
Rate for Payer: Devoted Health Medicare	$443.70
Rate for Payer: Hawaii Medical Service Association Medicare	$404.55
Rate for Payer: Hawaii Western Management Group Commercial	$1,239.75
Rate for Payer: Health Management Network Commercial	$1,109.25
Rate for Payer: Humana Medicare	$404.55
Rate for Payer: Kaiser Permanente Commercial	$1,174.50
Rate for Payer: Kaiser Permanente Medicaid	$665.55
Rate for Payer: Kaiser Permanente Medicare	$404.55
Rate for Payer: MDX Hawaii PPO	$1,265.85
Rate for Payer: Ohana Health Plan Medicaid	$404.55
Rate for Payer: Ohana Health Plan Medicare	$404.55
Rate for Payer: UnitedHealthcare Medicare	$404.55
Rate for Payer: University Health Alliance Commercial	$951.21

SUTURETAK KIT 23MM AR-1938PK

Facility

$1,305.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,109.25
Max. Negotiated Rate	$1,265.85
Rate for Payer: Cash Price	$783.00
Rate for Payer: Health Management Network Commercial	$1,109.25
Rate for Payer: Kaiser Permanente Commercial	$1,174.50
Rate for Payer: MDX Hawaii PPO	$1,265.85

SUTURE TAPE FIBERLOOP AR-7534

Facility

$294.00

Hospital Revenue Code	272
Min. Negotiated Rate	$249.90
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$176.40
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Kaiser Permanente Commercial	$264.60
Rate for Payer: MDX Hawaii PPO	$285.18

SUTURE TAPE FIBERLOOP AR-7534

Facility

$294.00

Hospital Revenue Code	272
Min. Negotiated Rate	$91.14
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$147.00
Rate for Payer: AlohaCare Medicare	$91.14
Rate for Payer: Cash Price	$176.40
Rate for Payer: Devoted Health Medicare	$99.96
Rate for Payer: Hawaii Medical Service Association Medicare	$91.14
Rate for Payer: Hawaii Western Management Group Commercial	$279.30
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$91.14
Rate for Payer: Kaiser Permanente Commercial	$264.60
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$91.14
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$91.14
Rate for Payer: Ohana Health Plan Medicare	$91.14
Rate for Payer: UnitedHealthcare Medicare	$91.14
Rate for Payer: University Health Alliance Commercial	$214.30

SUTURE TAPE TIGERLOOP AR-7534T

Facility

$280.00

Hospital Revenue Code	272
Min. Negotiated Rate	$238.00
Max. Negotiated Rate	$271.60
Rate for Payer: Cash Price	$168.00
Rate for Payer: Health Management Network Commercial	$238.00
Rate for Payer: Kaiser Permanente Commercial	$252.00
Rate for Payer: MDX Hawaii PPO	$271.60

SUTURE TAPE TIGERLOOP AR-7534T

Facility

$280.00

Hospital Revenue Code	272
Min. Negotiated Rate	$86.80
Max. Negotiated Rate	$271.60
Rate for Payer: AlohaCare Medicaid	$140.00
Rate for Payer: AlohaCare Medicare	$86.80
Rate for Payer: Cash Price	$168.00
Rate for Payer: Devoted Health Medicare	$95.20
Rate for Payer: Hawaii Medical Service Association Medicare	$86.80
Rate for Payer: Hawaii Western Management Group Commercial	$266.00
Rate for Payer: Health Management Network Commercial	$238.00
Rate for Payer: Humana Medicare	$86.80
Rate for Payer: Kaiser Permanente Commercial	$252.00
Rate for Payer: Kaiser Permanente Medicaid	$142.80
Rate for Payer: Kaiser Permanente Medicare	$86.80
Rate for Payer: MDX Hawaii PPO	$271.60
Rate for Payer: Ohana Health Plan Medicaid	$86.80
Rate for Payer: Ohana Health Plan Medicare	$86.80
Rate for Payer: UnitedHealthcare Medicare	$86.80
Rate for Payer: University Health Alliance Commercial	$204.09

SUTURE TISSUE HELIX

Facility

$809.00

Hospital Revenue Code	272
Min. Negotiated Rate	$687.65
Max. Negotiated Rate	$784.73
Rate for Payer: Cash Price	$485.40
Rate for Payer: Health Management Network Commercial	$687.65
Rate for Payer: Kaiser Permanente Commercial	$728.10
Rate for Payer: MDX Hawaii PPO	$784.73

SUTURE TISSUE HELIX

Facility

$809.00

Hospital Revenue Code	272
Min. Negotiated Rate	$250.79
Max. Negotiated Rate	$784.73
Rate for Payer: AlohaCare Medicaid	$404.50
Rate for Payer: AlohaCare Medicare	$250.79
Rate for Payer: Cash Price	$485.40
Rate for Payer: Devoted Health Medicare	$275.06
Rate for Payer: Hawaii Medical Service Association Medicare	$250.79
Rate for Payer: Hawaii Western Management Group Commercial	$768.55
Rate for Payer: Health Management Network Commercial	$687.65
Rate for Payer: Humana Medicare	$250.79
Rate for Payer: Kaiser Permanente Commercial	$728.10
Rate for Payer: Kaiser Permanente Medicaid	$412.59
Rate for Payer: Kaiser Permanente Medicare	$250.79
Rate for Payer: MDX Hawaii PPO	$784.73
Rate for Payer: Ohana Health Plan Medicaid	$250.79
Rate for Payer: Ohana Health Plan Medicare	$250.79
Rate for Payer: UnitedHealthcare Medicare	$250.79
Rate for Payer: University Health Alliance Commercial	$589.68

SWIVELOCK AR-2600SBS-4

Facility

$3,654.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,132.74
Max. Negotiated Rate	$3,544.38
Rate for Payer: AlohaCare Medicaid	$1,827.00
Rate for Payer: AlohaCare Medicare	$1,132.74
Rate for Payer: Cash Price	$2,192.40
Rate for Payer: Devoted Health Medicare	$1,242.36
Rate for Payer: Hawaii Medical Service Association Medicare	$1,132.74
Rate for Payer: Hawaii Western Management Group Commercial	$2,557.80
Rate for Payer: Health Management Network Commercial	$3,105.90
Rate for Payer: Humana Medicare	$1,132.74
Rate for Payer: Kaiser Permanente Commercial	$3,288.60
Rate for Payer: Kaiser Permanente Medicaid	$1,863.54
Rate for Payer: Kaiser Permanente Medicare	$1,132.74
Rate for Payer: MDX Hawaii PPO	$3,544.38
Rate for Payer: Ohana Health Plan Medicaid	$1,132.74
Rate for Payer: Ohana Health Plan Medicare	$1,132.74
Rate for Payer: UnitedHealthcare Medicare	$1,132.74
Rate for Payer: University Health Alliance Commercial	$2,046.24

SWIVELOCK AR-2600SBS-4

Facility

$3,654.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,046.24
Max. Negotiated Rate	$3,544.38
Rate for Payer: Cash Price	$2,192.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,557.80
Rate for Payer: Health Management Network Commercial	$3,105.90
Rate for Payer: Kaiser Permanente Commercial	$3,288.60
Rate for Payer: MDX Hawaii PPO	$3,544.38
Rate for Payer: University Health Alliance Commercial	$2,046.24

SWIVELOCK C 3.5 #AR-2325BCC

Facility

$1,400.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$784.00
Max. Negotiated Rate	$1,358.00
Rate for Payer: Cash Price	$840.00
Rate for Payer: Hawaii Western Management Group Commercial	$980.00
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
Rate for Payer: University Health Alliance Commercial	$784.00

SWIVELOCK C 3.5 #AR-2325BCC

Facility

$1,400.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
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	$980.00
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	$784.00

SWIVELOCK C 4.75 #AR-2324BCC

Facility

$1,716.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$960.96
Max. Negotiated Rate	$1,664.52
Rate for Payer: Cash Price	$1,029.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,201.20
Rate for Payer: Health Management Network Commercial	$1,458.60
Rate for Payer: Kaiser Permanente Commercial	$1,544.40
Rate for Payer: MDX Hawaii PPO	$1,664.52
Rate for Payer: University Health Alliance Commercial	$960.96

SWIVELOCK C 4.75 #AR-2324BCC

Facility

$1,716.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$531.96
Max. Negotiated Rate	$1,664.52
Rate for Payer: AlohaCare Medicaid	$858.00
Rate for Payer: AlohaCare Medicare	$531.96
Rate for Payer: Cash Price	$1,029.60
Rate for Payer: Devoted Health Medicare	$583.44
Rate for Payer: Hawaii Medical Service Association Medicare	$531.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,201.20
Rate for Payer: Health Management Network Commercial	$1,458.60
Rate for Payer: Humana Medicare	$531.96
Rate for Payer: Kaiser Permanente Commercial	$1,544.40
Rate for Payer: Kaiser Permanente Medicaid	$875.16
Rate for Payer: Kaiser Permanente Medicare	$531.96
Rate for Payer: MDX Hawaii PPO	$1,664.52
Rate for Payer: Ohana Health Plan Medicaid	$531.96
Rate for Payer: Ohana Health Plan Medicare	$531.96
Rate for Payer: UnitedHealthcare Medicare	$531.96
Rate for Payer: University Health Alliance Commercial	$960.96

SWIVELOCK C 5.5 #AR-2323BCC

Facility

$1,716.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$531.96
Max. Negotiated Rate	$1,664.52
Rate for Payer: AlohaCare Medicaid	$858.00
Rate for Payer: AlohaCare Medicare	$531.96
Rate for Payer: Cash Price	$1,029.60
Rate for Payer: Devoted Health Medicare	$583.44
Rate for Payer: Hawaii Medical Service Association Medicare	$531.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,201.20
Rate for Payer: Health Management Network Commercial	$1,458.60
Rate for Payer: Humana Medicare	$531.96
Rate for Payer: Kaiser Permanente Commercial	$1,544.40
Rate for Payer: Kaiser Permanente Medicaid	$875.16
Rate for Payer: Kaiser Permanente Medicare	$531.96
Rate for Payer: MDX Hawaii PPO	$1,664.52
Rate for Payer: Ohana Health Plan Medicaid	$531.96
Rate for Payer: Ohana Health Plan Medicare	$531.96
Rate for Payer: UnitedHealthcare Medicare	$531.96
Rate for Payer: University Health Alliance Commercial	$960.96

SWIVELOCK C 5.5 #AR-2323BCC

Facility

$1,716.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$960.96
Max. Negotiated Rate	$1,664.52
Rate for Payer: Cash Price	$1,029.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,201.20
Rate for Payer: Health Management Network Commercial	$1,458.60
Rate for Payer: Kaiser Permanente Commercial	$1,544.40
Rate for Payer: MDX Hawaii PPO	$1,664.52
Rate for Payer: University Health Alliance Commercial	$960.96

SWIVELOCK SP PUNCH #AR-2324BCM

Facility

$1,610.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$901.60
Max. Negotiated Rate	$1,561.70
Rate for Payer: Cash Price	$966.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,127.00
Rate for Payer: Health Management Network Commercial	$1,368.50
Rate for Payer: Kaiser Permanente Commercial	$1,449.00
Rate for Payer: MDX Hawaii PPO	$1,561.70
Rate for Payer: University Health Alliance Commercial	$901.60

SWIVELOCK SP PUNCH #AR-2324BCM

Facility

$1,610.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$499.10
Max. Negotiated Rate	$1,561.70
Rate for Payer: AlohaCare Medicaid	$805.00
Rate for Payer: AlohaCare Medicare	$499.10
Rate for Payer: Cash Price	$966.00
Rate for Payer: Devoted Health Medicare	$547.40
Rate for Payer: Hawaii Medical Service Association Medicare	$499.10
Rate for Payer: Hawaii Western Management Group Commercial	$1,127.00
Rate for Payer: Health Management Network Commercial	$1,368.50
Rate for Payer: Humana Medicare	$499.10
Rate for Payer: Kaiser Permanente Commercial	$1,449.00
Rate for Payer: Kaiser Permanente Medicaid	$821.10
Rate for Payer: Kaiser Permanente Medicare	$499.10
Rate for Payer: MDX Hawaii PPO	$1,561.70
Rate for Payer: Ohana Health Plan Medicaid	$499.10
Rate for Payer: Ohana Health Plan Medicare	$499.10
Rate for Payer: UnitedHealthcare Medicare	$499.10
Rate for Payer: University Health Alliance Commercial	$901.60

SWIVELOCK W/FIBER #AR-2324BCCT

Facility

$2,016.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,128.96
Max. Negotiated Rate	$1,955.52
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: Kaiser Permanente Commercial	$1,814.40
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: University Health Alliance Commercial	$1,128.96

SWIVELOCK W/FIBER #AR-2324BCCT

Facility

$2,016.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$624.96
Max. Negotiated Rate	$1,955.52
Rate for Payer: AlohaCare Medicaid	$1,008.00
Rate for Payer: AlohaCare Medicare	$624.96
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Devoted Health Medicare	$685.44
Rate for Payer: Hawaii Medical Service Association Medicare	$624.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: Humana Medicare	$624.96
Rate for Payer: Kaiser Permanente Commercial	$1,814.40
Rate for Payer: Kaiser Permanente Medicaid	$1,028.16
Rate for Payer: Kaiser Permanente Medicare	$624.96
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: Ohana Health Plan Medicaid	$624.96
Rate for Payer: Ohana Health Plan Medicare	$624.96
Rate for Payer: UnitedHealthcare Medicare	$624.96
Rate for Payer: University Health Alliance Commercial	$1,128.96

SWIVELOCK W/TIGER#AR2324BCCTT

Facility

$2,016.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$624.96
Max. Negotiated Rate	$1,955.52
Rate for Payer: AlohaCare Medicaid	$1,008.00
Rate for Payer: AlohaCare Medicare	$624.96
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Devoted Health Medicare	$685.44
Rate for Payer: Hawaii Medical Service Association Medicare	$624.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: Humana Medicare	$624.96
Rate for Payer: Kaiser Permanente Commercial	$1,814.40
Rate for Payer: Kaiser Permanente Medicaid	$1,028.16
Rate for Payer: Kaiser Permanente Medicare	$624.96
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: Ohana Health Plan Medicaid	$624.96
Rate for Payer: Ohana Health Plan Medicare	$624.96
Rate for Payer: UnitedHealthcare Medicare	$624.96
Rate for Payer: University Health Alliance Commercial	$1,128.96

SWIVELOCK W/TIGER#AR2324BCCTT

Facility

$2,016.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,128.96
Max. Negotiated Rate	$1,955.52
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.20
Rate for Payer: Health Management Network Commercial	$1,713.60
Rate for Payer: Kaiser Permanente Commercial	$1,814.40
Rate for Payer: MDX Hawaii PPO	$1,955.52
Rate for Payer: University Health Alliance Commercial	$1,128.96

SW JAVELIN FLX IVL 1.5X25

Facility

$9,400.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$2,914.00
Max. Negotiated Rate	$9,118.00
Rate for Payer: AlohaCare Medicaid	$4,700.00
Rate for Payer: AlohaCare Medicare	$2,914.00
Rate for Payer: Cash Price	$5,640.00
Rate for Payer: Devoted Health Medicare	$3,196.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,914.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,930.00
Rate for Payer: Health Management Network Commercial	$7,990.00
Rate for Payer: Humana Medicare	$2,914.00
Rate for Payer: Kaiser Permanente Commercial	$8,460.00
Rate for Payer: Kaiser Permanente Medicaid	$4,794.00
Rate for Payer: Kaiser Permanente Medicare	$2,914.00
Rate for Payer: MDX Hawaii PPO	$9,118.00
Rate for Payer: Ohana Health Plan Medicaid	$2,914.00
Rate for Payer: Ohana Health Plan Medicare	$2,914.00
Rate for Payer: UnitedHealthcare Medicare	$2,914.00
Rate for Payer: University Health Alliance Commercial	$6,851.66

Know your out-of-pocket cost for care.

All Charges