Kau Hospital

All Charges

Charge

Type

Setting

Price

TOURN CUFF STERILE 30X5 15-150

Facility

$225.00

Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

TOURN CUFF STERILE 34X5 15-160

Facility

$238.00

Hospital Revenue Code	272
Min. Negotiated Rate	$73.78
Max. Negotiated Rate	$230.86
Rate for Payer: AlohaCare Medicaid	$119.00
Rate for Payer: AlohaCare Medicare	$73.78
Rate for Payer: Cash Price	$142.80
Rate for Payer: Devoted Health Medicare	$80.92
Rate for Payer: Hawaii Medical Service Association Medicare	$73.78
Rate for Payer: Hawaii Western Management Group Commercial	$226.10
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Humana Medicare	$73.78
Rate for Payer: Kaiser Permanente Commercial	$214.20
Rate for Payer: Kaiser Permanente Medicaid	$121.38
Rate for Payer: Kaiser Permanente Medicare	$73.78
Rate for Payer: MDX Hawaii PPO	$230.86
Rate for Payer: Ohana Health Plan Medicaid	$73.78
Rate for Payer: Ohana Health Plan Medicare	$73.78
Rate for Payer: UnitedHealthcare Medicare	$73.78
Rate for Payer: University Health Alliance Commercial	$173.48

TOURN CUFF STERILE 34X5 15-160

Facility

$238.00

Hospital Revenue Code	272
Min. Negotiated Rate	$202.30
Max. Negotiated Rate	$230.86
Rate for Payer: Cash Price	$142.80
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Kaiser Permanente Commercial	$214.20
Rate for Payer: MDX Hawaii PPO	$230.86

TOURNIQUET 12IN

Facility

$94.00

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

TOURNIQUET 12IN

Facility

$94.00

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

TOURNIQUET 18" 5921-218-135

Facility

$107.00

Hospital Revenue Code	272
Min. Negotiated Rate	$33.17
Max. Negotiated Rate	$103.79
Rate for Payer: AlohaCare Medicaid	$53.50
Rate for Payer: AlohaCare Medicare	$33.17
Rate for Payer: Cash Price	$64.20
Rate for Payer: Devoted Health Medicare	$36.38
Rate for Payer: Hawaii Medical Service Association Medicare	$33.17
Rate for Payer: Hawaii Western Management Group Commercial	$101.65
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: Humana Medicare	$33.17
Rate for Payer: Kaiser Permanente Commercial	$96.30
Rate for Payer: Kaiser Permanente Medicaid	$54.57
Rate for Payer: Kaiser Permanente Medicare	$33.17
Rate for Payer: MDX Hawaii PPO	$103.79
Rate for Payer: Ohana Health Plan Medicaid	$33.17
Rate for Payer: Ohana Health Plan Medicare	$33.17
Rate for Payer: UnitedHealthcare Medicare	$33.17
Rate for Payer: University Health Alliance Commercial	$77.99

TOURNIQUET 18" 5921-218-135

Facility

$107.00

Hospital Revenue Code	272
Min. Negotiated Rate	$90.95
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$64.20
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: Kaiser Permanente Commercial	$96.30
Rate for Payer: MDX Hawaii PPO	$103.79

TOURNIQUET 30" 5921-030-135

Facility

$55.00

Hospital Revenue Code	272
Min. Negotiated Rate	$17.05
Max. Negotiated Rate	$53.35
Rate for Payer: AlohaCare Medicaid	$27.50
Rate for Payer: AlohaCare Medicare	$17.05
Rate for Payer: Cash Price	$33.00
Rate for Payer: Devoted Health Medicare	$18.70
Rate for Payer: Hawaii Medical Service Association Medicare	$17.05
Rate for Payer: Hawaii Western Management Group Commercial	$52.25
Rate for Payer: Health Management Network Commercial	$46.75
Rate for Payer: Humana Medicare	$17.05
Rate for Payer: Kaiser Permanente Commercial	$49.50
Rate for Payer: Kaiser Permanente Medicaid	$28.05
Rate for Payer: Kaiser Permanente Medicare	$17.05
Rate for Payer: MDX Hawaii PPO	$53.35
Rate for Payer: Ohana Health Plan Medicaid	$17.05
Rate for Payer: Ohana Health Plan Medicare	$17.05
Rate for Payer: UnitedHealthcare Medicare	$17.05
Rate for Payer: University Health Alliance Commercial	$40.09

TOURNIQUET 30" 5921-030-135

Facility

$55.00

Hospital Revenue Code	272
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$33.00
Rate for Payer: Health Management Network Commercial	$46.75
Rate for Payer: Kaiser Permanente Commercial	$49.50
Rate for Payer: MDX Hawaii PPO	$53.35

TOURNIQUET 34" 5921-034-135

Facility

$139.00

Hospital Revenue Code	272
Min. Negotiated Rate	$118.15
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$83.40
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: MDX Hawaii PPO	$134.83

TOURNIQUET 34" 5921-034-135

Facility

$139.00

Hospital Revenue Code	272
Min. Negotiated Rate	$43.09
Max. Negotiated Rate	$134.83
Rate for Payer: AlohaCare Medicaid	$69.50
Rate for Payer: AlohaCare Medicare	$43.09
Rate for Payer: Cash Price	$83.40
Rate for Payer: Devoted Health Medicare	$47.26
Rate for Payer: Hawaii Medical Service Association Medicare	$43.09
Rate for Payer: Hawaii Western Management Group Commercial	$132.05
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Humana Medicare	$43.09
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: Kaiser Permanente Medicaid	$70.89
Rate for Payer: Kaiser Permanente Medicare	$43.09
Rate for Payer: MDX Hawaii PPO	$134.83
Rate for Payer: Ohana Health Plan Medicaid	$43.09
Rate for Payer: Ohana Health Plan Medicare	$43.09
Rate for Payer: UnitedHealthcare Medicare	$43.09
Rate for Payer: University Health Alliance Commercial	$101.32

TOURNIQUET 44IN

Facility

$127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$39.37
Max. Negotiated Rate	$123.19
Rate for Payer: AlohaCare Medicaid	$63.50
Rate for Payer: AlohaCare Medicare	$39.37
Rate for Payer: Cash Price	$76.20
Rate for Payer: Devoted Health Medicare	$43.18
Rate for Payer: Hawaii Medical Service Association Medicare	$39.37
Rate for Payer: Hawaii Western Management Group Commercial	$120.65
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Humana Medicare	$39.37
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: Kaiser Permanente Medicaid	$64.77
Rate for Payer: Kaiser Permanente Medicare	$39.37
Rate for Payer: MDX Hawaii PPO	$123.19
Rate for Payer: Ohana Health Plan Medicaid	$39.37
Rate for Payer: Ohana Health Plan Medicare	$39.37
Rate for Payer: UnitedHealthcare Medicare	$39.37
Rate for Payer: University Health Alliance Commercial	$92.57

TOURNIQUET 44IN

Facility

$127.00

Hospital Revenue Code	272
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$76.20
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: MDX Hawaii PPO	$123.19

TOURNIQUET CUFF

Facility

$94.00

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

TOURNIQUET CUFF

Facility

$94.00

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

TOURNQ NS 18X4 5921-218-135NS

Facility

$107.00

Hospital Revenue Code	272
Min. Negotiated Rate	$90.95
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$64.20
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: Kaiser Permanente Commercial	$96.30
Rate for Payer: MDX Hawaii PPO	$103.79

TOURNQ NS 18X4 5921-218-135NS

Facility

$107.00

Hospital Revenue Code	272
Min. Negotiated Rate	$33.17
Max. Negotiated Rate	$103.79
Rate for Payer: AlohaCare Medicaid	$53.50
Rate for Payer: AlohaCare Medicare	$33.17
Rate for Payer: Cash Price	$64.20
Rate for Payer: Devoted Health Medicare	$36.38
Rate for Payer: Hawaii Medical Service Association Medicare	$33.17
Rate for Payer: Hawaii Western Management Group Commercial	$101.65
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: Humana Medicare	$33.17
Rate for Payer: Kaiser Permanente Commercial	$96.30
Rate for Payer: Kaiser Permanente Medicaid	$54.57
Rate for Payer: Kaiser Permanente Medicare	$33.17
Rate for Payer: MDX Hawaii PPO	$103.79
Rate for Payer: Ohana Health Plan Medicaid	$33.17
Rate for Payer: Ohana Health Plan Medicare	$33.17
Rate for Payer: UnitedHealthcare Medicare	$33.17
Rate for Payer: University Health Alliance Commercial	$77.99

TOURNQ NS 30X4 5921-030-135NS

Facility

$129.00

Hospital Revenue Code	272
Min. Negotiated Rate	$39.99
Max. Negotiated Rate	$125.13
Rate for Payer: AlohaCare Medicaid	$64.50
Rate for Payer: AlohaCare Medicare	$39.99
Rate for Payer: Cash Price	$77.40
Rate for Payer: Devoted Health Medicare	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$39.99
Rate for Payer: Hawaii Western Management Group Commercial	$122.55
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Humana Medicare	$39.99
Rate for Payer: Kaiser Permanente Commercial	$116.10
Rate for Payer: Kaiser Permanente Medicaid	$65.79
Rate for Payer: Kaiser Permanente Medicare	$39.99
Rate for Payer: MDX Hawaii PPO	$125.13
Rate for Payer: Ohana Health Plan Medicaid	$39.99
Rate for Payer: Ohana Health Plan Medicare	$39.99
Rate for Payer: UnitedHealthcare Medicare	$39.99
Rate for Payer: University Health Alliance Commercial	$94.03

TOURNQ NS 30X4 5921-030-135NS

Facility

$129.00

Hospital Revenue Code	272
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$125.13
Rate for Payer: Cash Price	$77.40
Rate for Payer: Health Management Network Commercial	$109.65
Rate for Payer: Kaiser Permanente Commercial	$116.10
Rate for Payer: MDX Hawaii PPO	$125.13

TOURNQ NS 34X4 5921-034-135NS

Facility

$137.00

Hospital Revenue Code	272
Min. Negotiated Rate	$42.47
Max. Negotiated Rate	$132.89
Rate for Payer: AlohaCare Medicaid	$68.50
Rate for Payer: AlohaCare Medicare	$42.47
Rate for Payer: Cash Price	$82.20
Rate for Payer: Devoted Health Medicare	$46.58
Rate for Payer: Hawaii Medical Service Association Medicare	$42.47
Rate for Payer: Hawaii Western Management Group Commercial	$130.15
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: Humana Medicare	$42.47
Rate for Payer: Kaiser Permanente Commercial	$123.30
Rate for Payer: Kaiser Permanente Medicaid	$69.87
Rate for Payer: Kaiser Permanente Medicare	$42.47
Rate for Payer: MDX Hawaii PPO	$132.89
Rate for Payer: Ohana Health Plan Medicaid	$42.47
Rate for Payer: Ohana Health Plan Medicare	$42.47
Rate for Payer: UnitedHealthcare Medicare	$42.47
Rate for Payer: University Health Alliance Commercial	$99.86

TOURNQ NS 34X4 5921-034-135NS

Facility

$137.00

Hospital Revenue Code	272
Min. Negotiated Rate	$116.45
Max. Negotiated Rate	$132.89
Rate for Payer: Cash Price	$82.20
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: Kaiser Permanente Commercial	$123.30
Rate for Payer: MDX Hawaii PPO	$132.89

T-PLATE 2.0 6 HOLE MCT-6N

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

T-PLATE 2.0 6 HOLE MCT-6N

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

T-PLATE 2.4 LCP 249.615

Facility

$2,525.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$782.75
Max. Negotiated Rate	$2,449.25
Rate for Payer: AlohaCare Medicaid	$1,262.50
Rate for Payer: AlohaCare Medicare	$782.75
Rate for Payer: Cash Price	$1,515.00
Rate for Payer: Devoted Health Medicare	$858.50
Rate for Payer: Hawaii Medical Service Association Medicare	$782.75
Rate for Payer: Hawaii Western Management Group Commercial	$1,767.50
Rate for Payer: Health Management Network Commercial	$2,146.25
Rate for Payer: Humana Medicare	$782.75
Rate for Payer: Kaiser Permanente Commercial	$2,272.50
Rate for Payer: Kaiser Permanente Medicaid	$1,287.75
Rate for Payer: Kaiser Permanente Medicare	$782.75
Rate for Payer: MDX Hawaii PPO	$2,449.25
Rate for Payer: Ohana Health Plan Medicaid	$782.75
Rate for Payer: Ohana Health Plan Medicare	$782.75
Rate for Payer: UnitedHealthcare Medicare	$782.75
Rate for Payer: University Health Alliance Commercial	$1,414.00

T-PLATE 2.4 LCP 249.615

Facility

$2,525.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,414.00
Max. Negotiated Rate	$2,449.25
Rate for Payer: Cash Price	$1,515.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,767.50
Rate for Payer: Health Management Network Commercial	$2,146.25
Rate for Payer: Kaiser Permanente Commercial	$2,272.50
Rate for Payer: MDX Hawaii PPO	$2,449.25
Rate for Payer: University Health Alliance Commercial	$1,414.00

Know your out-of-pocket cost for care.

All Charges