Kau Hospital

All Charges

Charge

Type

Setting

Price

WIRE GUIDE 200CM SAVARY

Facility

$380.00

Hospital Revenue Code	272
Min. Negotiated Rate	$117.80
Max. Negotiated Rate	$368.60
Rate for Payer: AlohaCare Medicaid	$190.00
Rate for Payer: AlohaCare Medicare	$117.80
Rate for Payer: Cash Price	$228.00
Rate for Payer: Devoted Health Medicare	$129.20
Rate for Payer: Hawaii Medical Service Association Medicare	$117.80
Rate for Payer: Hawaii Western Management Group Commercial	$361.00
Rate for Payer: Health Management Network Commercial	$323.00
Rate for Payer: Humana Medicare	$117.80
Rate for Payer: Kaiser Permanente Commercial	$342.00
Rate for Payer: Kaiser Permanente Medicaid	$193.80
Rate for Payer: Kaiser Permanente Medicare	$117.80
Rate for Payer: MDX Hawaii PPO	$368.60
Rate for Payer: Ohana Health Plan Medicaid	$117.80
Rate for Payer: Ohana Health Plan Medicare	$117.80
Rate for Payer: UnitedHealthcare Medicare	$117.80
Rate for Payer: University Health Alliance Commercial	$276.98

WIRE GUIDE 200CM SAVARY

Facility

$380.00

Hospital Revenue Code	272
Min. Negotiated Rate	$323.00
Max. Negotiated Rate	$368.60
Rate for Payer: Cash Price	$228.00
Rate for Payer: Health Management Network Commercial	$323.00
Rate for Payer: Kaiser Permanente Commercial	$342.00
Rate for Payer: MDX Hawaii PPO	$368.60

WIRE GUIDE 2.5X300 03.120.026

Facility

$331.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$102.61
Max. Negotiated Rate	$321.07
Rate for Payer: AlohaCare Medicaid	$165.50
Rate for Payer: AlohaCare Medicare	$102.61
Rate for Payer: Cash Price	$198.60
Rate for Payer: Devoted Health Medicare	$112.54
Rate for Payer: Hawaii Medical Service Association Medicare	$102.61
Rate for Payer: Hawaii Western Management Group Commercial	$314.45
Rate for Payer: Health Management Network Commercial	$281.35
Rate for Payer: Humana Medicare	$102.61
Rate for Payer: Kaiser Permanente Commercial	$297.90
Rate for Payer: Kaiser Permanente Medicaid	$168.81
Rate for Payer: Kaiser Permanente Medicare	$102.61
Rate for Payer: MDX Hawaii PPO	$321.07
Rate for Payer: Ohana Health Plan Medicaid	$102.61
Rate for Payer: Ohana Health Plan Medicare	$102.61
Rate for Payer: UnitedHealthcare Medicare	$102.61
Rate for Payer: University Health Alliance Commercial	$241.27

WIRE GUIDE 2.5X300 03.120.026

Facility

$331.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$281.35
Max. Negotiated Rate	$321.07
Rate for Payer: Cash Price	$198.60
Rate for Payer: Health Management Network Commercial	$281.35
Rate for Payer: Kaiser Permanente Commercial	$297.90
Rate for Payer: MDX Hawaii PPO	$321.07

WIRE GUIDE 3X800 ST 1806-0080S

Facility

$751.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$232.81
Max. Negotiated Rate	$728.47
Rate for Payer: AlohaCare Medicaid	$375.50
Rate for Payer: AlohaCare Medicare	$232.81
Rate for Payer: Cash Price	$450.60
Rate for Payer: Devoted Health Medicare	$255.34
Rate for Payer: Hawaii Medical Service Association Medicare	$232.81
Rate for Payer: Hawaii Western Management Group Commercial	$713.45
Rate for Payer: Health Management Network Commercial	$638.35
Rate for Payer: Humana Medicare	$232.81
Rate for Payer: Kaiser Permanente Commercial	$675.90
Rate for Payer: Kaiser Permanente Medicaid	$383.01
Rate for Payer: Kaiser Permanente Medicare	$232.81
Rate for Payer: MDX Hawaii PPO	$728.47
Rate for Payer: Ohana Health Plan Medicaid	$232.81
Rate for Payer: Ohana Health Plan Medicare	$232.81
Rate for Payer: UnitedHealthcare Medicare	$232.81
Rate for Payer: University Health Alliance Commercial	$547.40

WIRE GUIDE 3X800 ST 1806-0080S

Facility

$751.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$638.35
Max. Negotiated Rate	$728.47
Rate for Payer: Cash Price	$450.60
Rate for Payer: Health Management Network Commercial	$638.35
Rate for Payer: Kaiser Permanente Commercial	$675.90
Rate for Payer: MDX Hawaii PPO	$728.47

WIRE GUIDE 3X800 ST 1806-0090S

Facility

$986.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$838.10
Max. Negotiated Rate	$956.42
Rate for Payer: Cash Price	$591.60
Rate for Payer: Health Management Network Commercial	$838.10
Rate for Payer: Kaiser Permanente Commercial	$887.40
Rate for Payer: MDX Hawaii PPO	$956.42

WIRE GUIDE 3X800 ST 1806-0090S

Facility

$986.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$305.66
Max. Negotiated Rate	$956.42
Rate for Payer: AlohaCare Medicaid	$493.00
Rate for Payer: AlohaCare Medicare	$305.66
Rate for Payer: Cash Price	$591.60
Rate for Payer: Devoted Health Medicare	$335.24
Rate for Payer: Hawaii Medical Service Association Medicare	$305.66
Rate for Payer: Hawaii Western Management Group Commercial	$936.70
Rate for Payer: Health Management Network Commercial	$838.10
Rate for Payer: Humana Medicare	$305.66
Rate for Payer: Kaiser Permanente Commercial	$887.40
Rate for Payer: Kaiser Permanente Medicaid	$502.86
Rate for Payer: Kaiser Permanente Medicare	$305.66
Rate for Payer: MDX Hawaii PPO	$956.42
Rate for Payer: Ohana Health Plan Medicaid	$305.66
Rate for Payer: Ohana Health Plan Medicare	$305.66
Rate for Payer: UnitedHealthcare Medicare	$305.66
Rate for Payer: University Health Alliance Commercial	$718.70

WIRE GUIDE W/TROCAR AR-8941K

Facility

$95.00

Hospital Revenue Code	272
Min. Negotiated Rate	$80.75
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$57.00
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Kaiser Permanente Commercial	$85.50
Rate for Payer: MDX Hawaii PPO	$92.15

WIRE GUIDE W/TROCAR AR-8941K

Facility

$95.00

Hospital Revenue Code	272
Min. Negotiated Rate	$29.45
Max. Negotiated Rate	$92.15
Rate for Payer: AlohaCare Medicaid	$47.50
Rate for Payer: AlohaCare Medicare	$29.45
Rate for Payer: Cash Price	$57.00
Rate for Payer: Devoted Health Medicare	$32.30
Rate for Payer: Hawaii Medical Service Association Medicare	$29.45
Rate for Payer: Hawaii Western Management Group Commercial	$90.25
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Humana Medicare	$29.45
Rate for Payer: Kaiser Permanente Commercial	$85.50
Rate for Payer: Kaiser Permanente Medicaid	$48.45
Rate for Payer: Kaiser Permanente Medicare	$29.45
Rate for Payer: MDX Hawaii PPO	$92.15
Rate for Payer: Ohana Health Plan Medicaid	$29.45
Rate for Payer: Ohana Health Plan Medicare	$29.45
Rate for Payer: UnitedHealthcare Medicare	$29.45
Rate for Payer: University Health Alliance Commercial	$69.25

WIRE K 1.6MM AR-5050K-1

Facility

$230.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$195.50
Max. Negotiated Rate	$223.10
Rate for Payer: Cash Price	$138.00
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: MDX Hawaii PPO	$223.10

WIRE K 1.6MM AR-5050K-1

Facility

$230.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$71.30
Max. Negotiated Rate	$223.10
Rate for Payer: AlohaCare Medicaid	$115.00
Rate for Payer: AlohaCare Medicare	$71.30
Rate for Payer: Cash Price	$138.00
Rate for Payer: Devoted Health Medicare	$78.20
Rate for Payer: Hawaii Medical Service Association Medicare	$71.30
Rate for Payer: Hawaii Western Management Group Commercial	$218.50
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Humana Medicare	$71.30
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: Kaiser Permanente Medicaid	$117.30
Rate for Payer: Kaiser Permanente Medicare	$71.30
Rate for Payer: MDX Hawaii PPO	$223.10
Rate for Payer: Ohana Health Plan Medicaid	$71.30
Rate for Payer: Ohana Health Plan Medicare	$71.30
Rate for Payer: UnitedHealthcare Medicare	$71.30
Rate for Payer: University Health Alliance Commercial	$167.65

WIRE-K 1.6X150MM 292.16

Facility

$70.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$67.90
Rate for Payer: AlohaCare Medicaid	$35.00
Rate for Payer: AlohaCare Medicare	$21.70
Rate for Payer: Cash Price	$42.00
Rate for Payer: Devoted Health Medicare	$23.80
Rate for Payer: Hawaii Medical Service Association Medicare	$21.70
Rate for Payer: Hawaii Western Management Group Commercial	$66.50
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Humana Medicare	$21.70
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: Kaiser Permanente Medicaid	$35.70
Rate for Payer: Kaiser Permanente Medicare	$21.70
Rate for Payer: MDX Hawaii PPO	$67.90
Rate for Payer: Ohana Health Plan Medicaid	$21.70
Rate for Payer: Ohana Health Plan Medicare	$21.70
Rate for Payer: UnitedHealthcare Medicare	$21.70
Rate for Payer: University Health Alliance Commercial	$51.02

WIRE-K 1.6X150MM 292.16

Facility

$70.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$67.90
Rate for Payer: Cash Price	$42.00
Rate for Payer: Health Management Network Commercial	$59.50
Rate for Payer: Kaiser Permanente Commercial	$63.00
Rate for Payer: MDX Hawaii PPO	$67.90

WIRE KIRSCHNER 2.0 290.20.280

Facility

$260.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$80.60
Max. Negotiated Rate	$252.20
Rate for Payer: AlohaCare Medicaid	$130.00
Rate for Payer: AlohaCare Medicare	$80.60
Rate for Payer: Cash Price	$156.00
Rate for Payer: Devoted Health Medicare	$88.40
Rate for Payer: Hawaii Medical Service Association Medicare	$80.60
Rate for Payer: Hawaii Western Management Group Commercial	$247.00
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: Humana Medicare	$80.60
Rate for Payer: Kaiser Permanente Commercial	$234.00
Rate for Payer: Kaiser Permanente Medicaid	$132.60
Rate for Payer: Kaiser Permanente Medicare	$80.60
Rate for Payer: MDX Hawaii PPO	$252.20
Rate for Payer: Ohana Health Plan Medicaid	$80.60
Rate for Payer: Ohana Health Plan Medicare	$80.60
Rate for Payer: UnitedHealthcare Medicare	$80.60
Rate for Payer: University Health Alliance Commercial	$189.51

WIRE KIRSCHNER 2.0 290.20.280

Facility

$260.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$221.00
Max. Negotiated Rate	$252.20
Rate for Payer: Cash Price	$156.00
Rate for Payer: Health Management Network Commercial	$221.00
Rate for Payer: Kaiser Permanente Commercial	$234.00
Rate for Payer: MDX Hawaii PPO	$252.20

WIRE K #WIRE-1.1/120

Facility

$140.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$43.40
Max. Negotiated Rate	$135.80
Rate for Payer: AlohaCare Medicaid	$70.00
Rate for Payer: AlohaCare Medicare	$43.40
Rate for Payer: Cash Price	$84.00
Rate for Payer: Devoted Health Medicare	$47.60
Rate for Payer: Hawaii Medical Service Association Medicare	$43.40
Rate for Payer: Hawaii Western Management Group Commercial	$133.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Humana Medicare	$43.40
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: Kaiser Permanente Medicaid	$71.40
Rate for Payer: Kaiser Permanente Medicare	$43.40
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: Ohana Health Plan Medicaid	$43.40
Rate for Payer: Ohana Health Plan Medicare	$43.40
Rate for Payer: UnitedHealthcare Medicare	$43.40
Rate for Payer: University Health Alliance Commercial	$102.05

WIRE K #WIRE-1.1/120

Facility

$140.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: MDX Hawaii PPO	$135.80

WIRE LOOP 2.4MM AR-1594D-24

Facility

$1,722.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,463.70
Max. Negotiated Rate	$1,670.34
Rate for Payer: Cash Price	$1,033.20
Rate for Payer: Health Management Network Commercial	$1,463.70
Rate for Payer: Kaiser Permanente Commercial	$1,549.80
Rate for Payer: MDX Hawaii PPO	$1,670.34

WIRE LOOP 2.4MM AR-1594D-24

Facility

$1,722.00

Hospital Revenue Code	272
Min. Negotiated Rate	$533.82
Max. Negotiated Rate	$1,670.34
Rate for Payer: AlohaCare Medicaid	$861.00
Rate for Payer: AlohaCare Medicare	$533.82
Rate for Payer: Cash Price	$1,033.20
Rate for Payer: Devoted Health Medicare	$585.48
Rate for Payer: Hawaii Medical Service Association Medicare	$533.82
Rate for Payer: Hawaii Western Management Group Commercial	$1,635.90
Rate for Payer: Health Management Network Commercial	$1,463.70
Rate for Payer: Humana Medicare	$533.82
Rate for Payer: Kaiser Permanente Commercial	$1,549.80
Rate for Payer: Kaiser Permanente Medicaid	$878.22
Rate for Payer: Kaiser Permanente Medicare	$533.82
Rate for Payer: MDX Hawaii PPO	$1,670.34
Rate for Payer: Ohana Health Plan Medicaid	$533.82
Rate for Payer: Ohana Health Plan Medicare	$533.82
Rate for Payer: UnitedHealthcare Medicare	$533.82
Rate for Payer: University Health Alliance Commercial	$1,255.17

WIRE OLIVE 1.3MM P99-200-1306

Facility

$478.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$406.30
Max. Negotiated Rate	$463.66
Rate for Payer: Cash Price	$286.80
Rate for Payer: Health Management Network Commercial	$406.30
Rate for Payer: Kaiser Permanente Commercial	$430.20
Rate for Payer: MDX Hawaii PPO	$463.66

WIRE OLIVE 1.3MM P99-200-1306

Facility

$478.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$148.18
Max. Negotiated Rate	$463.66
Rate for Payer: AlohaCare Medicaid	$239.00
Rate for Payer: AlohaCare Medicare	$148.18
Rate for Payer: Cash Price	$286.80
Rate for Payer: Devoted Health Medicare	$162.52
Rate for Payer: Hawaii Medical Service Association Medicare	$148.18
Rate for Payer: Hawaii Western Management Group Commercial	$454.10
Rate for Payer: Health Management Network Commercial	$406.30
Rate for Payer: Humana Medicare	$148.18
Rate for Payer: Kaiser Permanente Commercial	$430.20
Rate for Payer: Kaiser Permanente Medicaid	$243.78
Rate for Payer: Kaiser Permanente Medicare	$148.18
Rate for Payer: MDX Hawaii PPO	$463.66
Rate for Payer: Ohana Health Plan Medicaid	$148.18
Rate for Payer: Ohana Health Plan Medicare	$148.18
Rate for Payer: UnitedHealthcare Medicare	$148.18
Rate for Payer: University Health Alliance Commercial	$348.41

WIRE PILOT NITINOL 5901-6072

Facility

$150.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: MDX Hawaii PPO	$145.50

WIRE PILOT NITINOL 5901-6072

Facility

$150.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$145.50
Rate for Payer: AlohaCare Medicaid	$75.00
Rate for Payer: AlohaCare Medicare	$46.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Devoted Health Medicare	$51.00
Rate for Payer: Hawaii Medical Service Association Medicare	$46.50
Rate for Payer: Hawaii Western Management Group Commercial	$142.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Humana Medicare	$46.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicare	$46.50
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: Ohana Health Plan Medicaid	$46.50
Rate for Payer: Ohana Health Plan Medicare	$46.50
Rate for Payer: UnitedHealthcare Medicare	$46.50
Rate for Payer: University Health Alliance Commercial	$109.33

WIRE PRECUT 0.6X175 291.240.98

Facility

$121.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$67.76
Max. Negotiated Rate	$117.37
Rate for Payer: Cash Price	$72.60
Rate for Payer: Hawaii Western Management Group Commercial	$84.70
Rate for Payer: Health Management Network Commercial	$102.85
Rate for Payer: Kaiser Permanente Commercial	$108.90
Rate for Payer: MDX Hawaii PPO	$117.37
Rate for Payer: University Health Alliance Commercial	$67.76

Know your out-of-pocket cost for care.

All Charges