Kau Hospital

All Charges

Charge

Type

Setting

Price

UHR BIPOLAR 28X51MM UH1-51-28

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 28X51MM UH1-51-28

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 28X52MM UH1-52-28

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 28X52MM UH1-52-28

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 28X53MM UH1-53-28

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 28X53MM UH1-53-28

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 28X54MM UH1-54-28

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 28X54MM UH1-54-28

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 28X55MM UH1-55-28

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 28X55MM UH1-55-28

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 28X56MM UH1-56-28

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 28X56MM UH1-56-28

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 28X58MM UH1-58-28

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 28X58MM UH1-58-28

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 28X61MM UH1-61-28

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 28X61MM UH1-61-28

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

ULNAR CAP COCR + UHMWPE SMALL

Facility

$2,838.00

Service Code	HCPCS C1889
Hospital Revenue Code	278
Min. Negotiated Rate	$1,589.28
Max. Negotiated Rate	$2,752.86
Rate for Payer: Cash Price	$1,702.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,986.60
Rate for Payer: Health Management Network Commercial	$2,412.30
Rate for Payer: Kaiser Permanente Commercial	$2,554.20
Rate for Payer: MDX Hawaii PPO	$2,752.86
Rate for Payer: University Health Alliance Commercial	$1,589.28

ULNAR CAP COCR + UHMWPE SMALL

Facility

$2,838.00

Service Code	HCPCS C1889
Hospital Revenue Code	278
Min. Negotiated Rate	$879.78
Max. Negotiated Rate	$2,752.86
Rate for Payer: AlohaCare Medicaid	$1,419.00
Rate for Payer: AlohaCare Medicare	$879.78
Rate for Payer: Cash Price	$1,702.80
Rate for Payer: Devoted Health Medicare	$964.92
Rate for Payer: Hawaii Medical Service Association Medicare	$879.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,986.60
Rate for Payer: Health Management Network Commercial	$2,412.30
Rate for Payer: Humana Medicare	$879.78
Rate for Payer: Kaiser Permanente Commercial	$2,554.20
Rate for Payer: Kaiser Permanente Medicaid	$1,447.38
Rate for Payer: Kaiser Permanente Medicare	$879.78
Rate for Payer: MDX Hawaii PPO	$2,752.86
Rate for Payer: Ohana Health Plan Medicaid	$879.78
Rate for Payer: Ohana Health Plan Medicare	$879.78
Rate for Payer: UnitedHealthcare Medicare	$879.78
Rate for Payer: University Health Alliance Commercial	$1,589.28

ULNAR SLED 38MM US.38

Facility

$1,593.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$892.08
Max. Negotiated Rate	$1,545.21
Rate for Payer: Cash Price	$955.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,115.10
Rate for Payer: Health Management Network Commercial	$1,354.05
Rate for Payer: Kaiser Permanente Commercial	$1,433.70
Rate for Payer: MDX Hawaii PPO	$1,545.21
Rate for Payer: University Health Alliance Commercial	$892.08

ULNAR SLED 38MM US.38

Facility

$1,593.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$493.83
Max. Negotiated Rate	$1,545.21
Rate for Payer: AlohaCare Medicaid	$796.50
Rate for Payer: AlohaCare Medicare	$493.83
Rate for Payer: Cash Price	$955.80
Rate for Payer: Devoted Health Medicare	$541.62
Rate for Payer: Hawaii Medical Service Association Medicare	$493.83
Rate for Payer: Hawaii Western Management Group Commercial	$1,115.10
Rate for Payer: Health Management Network Commercial	$1,354.05
Rate for Payer: Humana Medicare	$493.83
Rate for Payer: Kaiser Permanente Commercial	$1,433.70
Rate for Payer: Kaiser Permanente Medicaid	$812.43
Rate for Payer: Kaiser Permanente Medicare	$493.83
Rate for Payer: MDX Hawaii PPO	$1,545.21
Rate for Payer: Ohana Health Plan Medicaid	$493.83
Rate for Payer: Ohana Health Plan Medicare	$493.83
Rate for Payer: UnitedHealthcare Medicare	$493.83
Rate for Payer: University Health Alliance Commercial	$892.08

ULTIMUM EV HEMOSTASIS INTRO 16

Facility

$288.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$279.36
Rate for Payer: Cash Price	$172.80
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: Kaiser Permanente Commercial	$259.20
Rate for Payer: MDX Hawaii PPO	$279.36

ULTIMUM EV HEMOSTASIS INTRO 16

Facility

$288.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$89.28
Max. Negotiated Rate	$279.36
Rate for Payer: AlohaCare Medicaid	$144.00
Rate for Payer: AlohaCare Medicare	$89.28
Rate for Payer: Cash Price	$172.80
Rate for Payer: Devoted Health Medicare	$97.92
Rate for Payer: Hawaii Medical Service Association Medicare	$89.28
Rate for Payer: Hawaii Western Management Group Commercial	$273.60
Rate for Payer: Health Management Network Commercial	$244.80
Rate for Payer: Humana Medicare	$89.28
Rate for Payer: Kaiser Permanente Commercial	$259.20
Rate for Payer: Kaiser Permanente Medicaid	$146.88
Rate for Payer: Kaiser Permanente Medicare	$89.28
Rate for Payer: MDX Hawaii PPO	$279.36
Rate for Payer: Ohana Health Plan Medicaid	$89.28
Rate for Payer: Ohana Health Plan Medicare	$89.28
Rate for Payer: UnitedHealthcare Medicare	$89.28
Rate for Payer: University Health Alliance Commercial	$209.92

ULTRASLING IV SMALL 11-0445-2

Facility

$239.00

Service Code	HCPCS L3670
Hospital Revenue Code	274
Min. Negotiated Rate	$133.84
Max. Negotiated Rate	$231.83
Rate for Payer: Cash Price	$143.40
Rate for Payer: Hawaii Western Management Group Commercial	$167.30
Rate for Payer: Health Management Network Commercial	$203.15
Rate for Payer: Kaiser Permanente Commercial	$215.10
Rate for Payer: MDX Hawaii PPO	$231.83
Rate for Payer: University Health Alliance Commercial	$133.84

ULTRASLING IV SMALL 11-0445-2

Facility

$239.00

Service Code	HCPCS L3670
Hospital Revenue Code	274
Min. Negotiated Rate	$74.09
Max. Negotiated Rate	$231.83
Rate for Payer: AlohaCare Medicaid	$119.50
Rate for Payer: AlohaCare Medicare	$74.09
Rate for Payer: Cash Price	$143.40
Rate for Payer: Cash Price	$143.40
Rate for Payer: Devoted Health Medicare	$81.26
Rate for Payer: Hawaii Medical Service Association Medicare	$74.09
Rate for Payer: Hawaii Western Management Group Commercial	$167.30
Rate for Payer: Health Management Network Commercial	$203.15
Rate for Payer: Humana Medicare	$74.09
Rate for Payer: Kaiser Permanente Commercial	$215.10
Rate for Payer: Kaiser Permanente Medicaid	$121.89
Rate for Payer: Kaiser Permanente Medicare	$74.09
Rate for Payer: MDX Hawaii PPO	$231.83
Rate for Payer: Ohana Health Plan Medicaid	$74.09
Rate for Payer: Ohana Health Plan Medicare	$74.09
Rate for Payer: UnitedHealthcare Medicaid	$84.70
Rate for Payer: UnitedHealthcare Medicare	$74.09
Rate for Payer: University Health Alliance Commercial	$133.84

ULTRASLING UNISX LRG 11-0445-4

Facility

$239.00

Service Code	HCPCS L3670
Hospital Revenue Code	274
Min. Negotiated Rate	$74.09
Max. Negotiated Rate	$231.83
Rate for Payer: AlohaCare Medicaid	$119.50
Rate for Payer: AlohaCare Medicare	$74.09
Rate for Payer: Cash Price	$143.40
Rate for Payer: Cash Price	$143.40
Rate for Payer: Devoted Health Medicare	$81.26
Rate for Payer: Hawaii Medical Service Association Medicare	$74.09
Rate for Payer: Hawaii Western Management Group Commercial	$167.30
Rate for Payer: Health Management Network Commercial	$203.15
Rate for Payer: Humana Medicare	$74.09
Rate for Payer: Kaiser Permanente Commercial	$215.10
Rate for Payer: Kaiser Permanente Medicaid	$121.89
Rate for Payer: Kaiser Permanente Medicare	$74.09
Rate for Payer: MDX Hawaii PPO	$231.83
Rate for Payer: Ohana Health Plan Medicaid	$74.09
Rate for Payer: Ohana Health Plan Medicare	$74.09
Rate for Payer: UnitedHealthcare Medicaid	$84.70
Rate for Payer: UnitedHealthcare Medicare	$74.09
Rate for Payer: University Health Alliance Commercial	$133.84

Know your out-of-pocket cost for care.

All Charges