Kau Hospital

All Charges

Charge

Type

Setting

Price

TUNNELER SHEATH LG BLU 9009-16

Facility

$257.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$218.45
Max. Negotiated Rate	$249.29
Rate for Payer: Cash Price	$154.20
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Kaiser Permanente Commercial	$231.30
Rate for Payer: MDX Hawaii PPO	$249.29

TUNNELER SHEATH LG ORG 9009-20

Facility

$257.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$218.45
Max. Negotiated Rate	$249.29
Rate for Payer: Cash Price	$154.20
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Kaiser Permanente Commercial	$231.30
Rate for Payer: MDX Hawaii PPO	$249.29

TUNNELER SHEATH LG ORG 9009-20

Facility

$257.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$79.67
Max. Negotiated Rate	$249.29
Rate for Payer: AlohaCare Medicaid	$128.50
Rate for Payer: AlohaCare Medicare	$79.67
Rate for Payer: Cash Price	$154.20
Rate for Payer: Devoted Health Medicare	$87.38
Rate for Payer: Hawaii Medical Service Association Medicare	$79.67
Rate for Payer: Hawaii Western Management Group Commercial	$244.15
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Humana Medicare	$79.67
Rate for Payer: Kaiser Permanente Commercial	$231.30
Rate for Payer: Kaiser Permanente Medicaid	$131.07
Rate for Payer: Kaiser Permanente Medicare	$79.67
Rate for Payer: MDX Hawaii PPO	$249.29
Rate for Payer: Ohana Health Plan Medicaid	$79.67
Rate for Payer: Ohana Health Plan Medicare	$79.67
Rate for Payer: UnitedHealthcare Medicare	$79.67
Rate for Payer: University Health Alliance Commercial	$187.33

TUNNELER SHEATH SM YEL 9009-22

Facility

$211.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$179.35
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$126.60
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: MDX Hawaii PPO	$204.67

TUNNELER SHEATH SM YEL 9009-22

Facility

$211.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$65.41
Max. Negotiated Rate	$204.67
Rate for Payer: AlohaCare Medicaid	$105.50
Rate for Payer: AlohaCare Medicare	$65.41
Rate for Payer: Cash Price	$126.60
Rate for Payer: Devoted Health Medicare	$71.74
Rate for Payer: Hawaii Medical Service Association Medicare	$65.41
Rate for Payer: Hawaii Western Management Group Commercial	$200.45
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Humana Medicare	$65.41
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: Kaiser Permanente Medicaid	$107.61
Rate for Payer: Kaiser Permanente Medicare	$65.41
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: Ohana Health Plan Medicaid	$65.41
Rate for Payer: Ohana Health Plan Medicare	$65.41
Rate for Payer: UnitedHealthcare Medicare	$65.41
Rate for Payer: University Health Alliance Commercial	$153.80

TURBOVAC 90 XL ASC1336-01

Facility

$1,642.00

Hospital Revenue Code	272
Min. Negotiated Rate	$509.02
Max. Negotiated Rate	$1,592.74
Rate for Payer: AlohaCare Medicaid	$821.00
Rate for Payer: AlohaCare Medicare	$509.02
Rate for Payer: Cash Price	$985.20
Rate for Payer: Devoted Health Medicare	$558.28
Rate for Payer: Hawaii Medical Service Association Medicare	$509.02
Rate for Payer: Hawaii Western Management Group Commercial	$1,559.90
Rate for Payer: Health Management Network Commercial	$1,395.70
Rate for Payer: Humana Medicare	$509.02
Rate for Payer: Kaiser Permanente Commercial	$1,477.80
Rate for Payer: Kaiser Permanente Medicaid	$837.42
Rate for Payer: Kaiser Permanente Medicare	$509.02
Rate for Payer: MDX Hawaii PPO	$1,592.74
Rate for Payer: Ohana Health Plan Medicaid	$509.02
Rate for Payer: Ohana Health Plan Medicare	$509.02
Rate for Payer: UnitedHealthcare Medicare	$509.02
Rate for Payer: University Health Alliance Commercial	$1,196.85

TURBOVAC 90 XL ASC1336-01

Facility

$1,642.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,395.70
Max. Negotiated Rate	$1,592.74
Rate for Payer: Cash Price	$985.20
Rate for Payer: Health Management Network Commercial	$1,395.70
Rate for Payer: Kaiser Permanente Commercial	$1,477.80
Rate for Payer: MDX Hawaii PPO	$1,592.74

TVT OBTURATOR SYSTEM 810081L

Facility

$4,486.00

Service Code	HCPCS C1771
Hospital Revenue Code	278
Min. Negotiated Rate	$1,390.66
Max. Negotiated Rate	$4,351.42
Rate for Payer: AlohaCare Medicaid	$2,243.00
Rate for Payer: AlohaCare Medicare	$1,390.66
Rate for Payer: Cash Price	$2,691.60
Rate for Payer: Devoted Health Medicare	$1,525.24
Rate for Payer: Hawaii Medical Service Association Medicare	$1,390.66
Rate for Payer: Hawaii Western Management Group Commercial	$3,140.20
Rate for Payer: Health Management Network Commercial	$3,813.10
Rate for Payer: Humana Medicare	$1,390.66
Rate for Payer: Kaiser Permanente Commercial	$4,037.40
Rate for Payer: Kaiser Permanente Medicaid	$2,287.86
Rate for Payer: Kaiser Permanente Medicare	$1,390.66
Rate for Payer: MDX Hawaii PPO	$4,351.42
Rate for Payer: Ohana Health Plan Medicaid	$1,390.66
Rate for Payer: Ohana Health Plan Medicare	$1,390.66
Rate for Payer: UnitedHealthcare Medicare	$1,390.66
Rate for Payer: University Health Alliance Commercial	$2,512.16

TVT OBTURATOR SYSTEM 810081L

Facility

$4,486.00

Service Code	HCPCS C1771
Hospital Revenue Code	278
Min. Negotiated Rate	$2,512.16
Max. Negotiated Rate	$4,351.42
Rate for Payer: Cash Price	$2,691.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,140.20
Rate for Payer: Health Management Network Commercial	$3,813.10
Rate for Payer: Kaiser Permanente Commercial	$4,037.40
Rate for Payer: MDX Hawaii PPO	$4,351.42
Rate for Payer: University Health Alliance Commercial	$2,512.16

UCL SYSTEM INTER BRACE AR-7715

Facility

$2,476.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$767.56
Max. Negotiated Rate	$2,401.72
Rate for Payer: AlohaCare Medicaid	$1,238.00
Rate for Payer: AlohaCare Medicare	$767.56
Rate for Payer: Cash Price	$1,485.60
Rate for Payer: Devoted Health Medicare	$841.84
Rate for Payer: Hawaii Medical Service Association Medicare	$767.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,733.20
Rate for Payer: Health Management Network Commercial	$2,104.60
Rate for Payer: Humana Medicare	$767.56
Rate for Payer: Kaiser Permanente Commercial	$2,228.40
Rate for Payer: Kaiser Permanente Medicaid	$1,262.76
Rate for Payer: Kaiser Permanente Medicare	$767.56
Rate for Payer: MDX Hawaii PPO	$2,401.72
Rate for Payer: Ohana Health Plan Medicaid	$767.56
Rate for Payer: Ohana Health Plan Medicare	$767.56
Rate for Payer: UnitedHealthcare Medicare	$767.56
Rate for Payer: University Health Alliance Commercial	$1,386.56

UCL SYSTEM INTER BRACE AR-7715

Facility

$2,476.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,386.56
Max. Negotiated Rate	$2,401.72
Rate for Payer: Cash Price	$1,485.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,733.20
Rate for Payer: Health Management Network Commercial	$2,104.60
Rate for Payer: Kaiser Permanente Commercial	$2,228.40
Rate for Payer: MDX Hawaii PPO	$2,401.72
Rate for Payer: University Health Alliance Commercial	$1,386.56

UHR BIPOLAR 28X44MM UH1-44-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$746.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$746.48
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$818.72
Rate for Payer: Hawaii Medical Service Association Medicare	$746.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$746.48
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$746.48
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$746.48
Rate for Payer: Ohana Health Plan Medicare	$746.48
Rate for Payer: UnitedHealthcare Medicare	$746.48
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X44MM UH1-44-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X45MM UH1-45-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X45MM UH1-45-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$746.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$746.48
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$818.72
Rate for Payer: Hawaii Medical Service Association Medicare	$746.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$746.48
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$746.48
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$746.48
Rate for Payer: Ohana Health Plan Medicare	$746.48
Rate for Payer: UnitedHealthcare Medicare	$746.48
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X46MM UH1-46-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X46MM UH1-46-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$746.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$746.48
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$818.72
Rate for Payer: Hawaii Medical Service Association Medicare	$746.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$746.48
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$746.48
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$746.48
Rate for Payer: Ohana Health Plan Medicare	$746.48
Rate for Payer: UnitedHealthcare Medicare	$746.48
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X47MM UH1-47-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$746.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$746.48
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$818.72
Rate for Payer: Hawaii Medical Service Association Medicare	$746.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$746.48
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$746.48
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$746.48
Rate for Payer: Ohana Health Plan Medicare	$746.48
Rate for Payer: UnitedHealthcare Medicare	$746.48
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X47MM UH1-47-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X48MM UH1-48-28

Facility

$2,433.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,362.48
Max. Negotiated Rate	$2,360.01
Rate for Payer: Cash Price	$1,459.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,703.10
Rate for Payer: Health Management Network Commercial	$2,068.05
Rate for Payer: Kaiser Permanente Commercial	$2,189.70
Rate for Payer: MDX Hawaii PPO	$2,360.01
Rate for Payer: University Health Alliance Commercial	$1,362.48

UHR BIPOLAR 28X48MM UH1-48-28

Facility

$2,433.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$754.23
Max. Negotiated Rate	$2,360.01
Rate for Payer: AlohaCare Medicaid	$1,216.50
Rate for Payer: AlohaCare Medicare	$754.23
Rate for Payer: Cash Price	$1,459.80
Rate for Payer: Devoted Health Medicare	$827.22
Rate for Payer: Hawaii Medical Service Association Medicare	$754.23
Rate for Payer: Hawaii Western Management Group Commercial	$1,703.10
Rate for Payer: Health Management Network Commercial	$2,068.05
Rate for Payer: Humana Medicare	$754.23
Rate for Payer: Kaiser Permanente Commercial	$2,189.70
Rate for Payer: Kaiser Permanente Medicaid	$1,240.83
Rate for Payer: Kaiser Permanente Medicare	$754.23
Rate for Payer: MDX Hawaii PPO	$2,360.01
Rate for Payer: Ohana Health Plan Medicaid	$754.23
Rate for Payer: Ohana Health Plan Medicare	$754.23
Rate for Payer: UnitedHealthcare Medicare	$754.23
Rate for Payer: University Health Alliance Commercial	$1,362.48

UHR BIPOLAR 28X49MM UH1-49-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$746.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$746.48
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$818.72
Rate for Payer: Hawaii Medical Service Association Medicare	$746.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$746.48
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$746.48
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$746.48
Rate for Payer: Ohana Health Plan Medicare	$746.48
Rate for Payer: UnitedHealthcare Medicare	$746.48
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X49MM UH1-49-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X50MM UH1-50-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$746.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: AlohaCare Medicaid	$1,204.00
Rate for Payer: AlohaCare Medicare	$746.48
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Devoted Health Medicare	$818.72
Rate for Payer: Hawaii Medical Service Association Medicare	$746.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Humana Medicare	$746.48
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: Kaiser Permanente Medicaid	$1,228.08
Rate for Payer: Kaiser Permanente Medicare	$746.48
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: Ohana Health Plan Medicaid	$746.48
Rate for Payer: Ohana Health Plan Medicare	$746.48
Rate for Payer: UnitedHealthcare Medicare	$746.48
Rate for Payer: University Health Alliance Commercial	$1,348.48

UHR BIPOLAR 28X50MM UH1-50-28

Facility

$2,408.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,348.48
Max. Negotiated Rate	$2,335.76
Rate for Payer: Cash Price	$1,444.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,685.60
Rate for Payer: Health Management Network Commercial	$2,046.80
Rate for Payer: Kaiser Permanente Commercial	$2,167.20
Rate for Payer: MDX Hawaii PPO	$2,335.76
Rate for Payer: University Health Alliance Commercial	$1,348.48

Know your out-of-pocket cost for care.

All Charges