Kau Hospital

All Charges

Charge

Type

Setting

Price

WRAP EAR FLENTS EAVEY

Facility

$98.00

Hospital Revenue Code	272
Min. Negotiated Rate	$30.38
Max. Negotiated Rate	$95.06
Rate for Payer: AlohaCare Medicaid	$49.00
Rate for Payer: AlohaCare Medicare	$30.38
Rate for Payer: Cash Price	$58.80
Rate for Payer: Devoted Health Medicare	$33.32
Rate for Payer: Hawaii Medical Service Association Medicare	$30.38
Rate for Payer: Hawaii Western Management Group Commercial	$93.10
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: Humana Medicare	$30.38
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: Kaiser Permanente Medicaid	$49.98
Rate for Payer: Kaiser Permanente Medicare	$30.38
Rate for Payer: MDX Hawaii PPO	$95.06
Rate for Payer: Ohana Health Plan Medicaid	$30.38
Rate for Payer: Ohana Health Plan Medicare	$30.38
Rate for Payer: UnitedHealthcare Medicare	$30.38
Rate for Payer: University Health Alliance Commercial	$71.43

WRAP EAR FLENTS EAVEY

Facility

$98.00

Hospital Revenue Code	272
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$95.06
Rate for Payer: Cash Price	$58.80
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: MDX Hawaii PPO	$95.06

WRENCH ALLEN 3MM 10.012

Facility

$88.00

Hospital Revenue Code	272
Min. Negotiated Rate	$27.28
Max. Negotiated Rate	$85.36
Rate for Payer: AlohaCare Medicaid	$44.00
Rate for Payer: AlohaCare Medicare	$27.28
Rate for Payer: Cash Price	$52.80
Rate for Payer: Devoted Health Medicare	$29.92
Rate for Payer: Hawaii Medical Service Association Medicare	$27.28
Rate for Payer: Hawaii Western Management Group Commercial	$83.60
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Humana Medicare	$27.28
Rate for Payer: Kaiser Permanente Commercial	$79.20
Rate for Payer: Kaiser Permanente Medicaid	$44.88
Rate for Payer: Kaiser Permanente Medicare	$27.28
Rate for Payer: MDX Hawaii PPO	$85.36
Rate for Payer: Ohana Health Plan Medicaid	$27.28
Rate for Payer: Ohana Health Plan Medicare	$27.28
Rate for Payer: UnitedHealthcare Medicare	$27.28
Rate for Payer: University Health Alliance Commercial	$64.14

WRENCH ALLEN 3MM 10.012

Facility

$88.00

Hospital Revenue Code	272
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$85.36
Rate for Payer: Cash Price	$52.80
Rate for Payer: Health Management Network Commercial	$74.80
Rate for Payer: Kaiser Permanente Commercial	$79.20
Rate for Payer: MDX Hawaii PPO	$85.36

WRENCH TORQUE 108984

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$194.00
Rate for Payer: AlohaCare Medicaid	$100.00
Rate for Payer: AlohaCare Medicare	$62.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Devoted Health Medicare	$68.00
Rate for Payer: Hawaii Medical Service Association Medicare	$62.00
Rate for Payer: Hawaii Western Management Group Commercial	$190.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Humana Medicare	$62.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: Kaiser Permanente Medicare	$62.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: Ohana Health Plan Medicaid	$62.00
Rate for Payer: Ohana Health Plan Medicare	$62.00
Rate for Payer: UnitedHealthcare Medicare	$62.00
Rate for Payer: University Health Alliance Commercial	$145.78

WRENCH TORQUE 108984

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: MDX Hawaii PPO	$194.00

XEN AB 19CMx35CM 1151935

Facility

$40,520.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$22,691.20
Max. Negotiated Rate	$39,304.40
Rate for Payer: Cash Price	$24,312.00
Rate for Payer: Hawaii Western Management Group Commercial	$28,364.00
Rate for Payer: Health Management Network Commercial	$34,442.00
Rate for Payer: Kaiser Permanente Commercial	$36,468.00
Rate for Payer: MDX Hawaii PPO	$39,304.40
Rate for Payer: University Health Alliance Commercial	$22,691.20

XEN AB 19CMx35CM 1151935

Facility

$40,520.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$12,561.20
Max. Negotiated Rate	$39,304.40
Rate for Payer: AlohaCare Medicaid	$20,260.00
Rate for Payer: AlohaCare Medicare	$12,561.20
Rate for Payer: Cash Price	$24,312.00
Rate for Payer: Devoted Health Medicare	$13,776.80
Rate for Payer: Hawaii Medical Service Association Medicare	$12,561.20
Rate for Payer: Hawaii Western Management Group Commercial	$28,364.00
Rate for Payer: Health Management Network Commercial	$34,442.00
Rate for Payer: Humana Medicare	$12,561.20
Rate for Payer: Kaiser Permanente Commercial	$36,468.00
Rate for Payer: Kaiser Permanente Medicaid	$20,665.20
Rate for Payer: Kaiser Permanente Medicare	$12,561.20
Rate for Payer: MDX Hawaii PPO	$39,304.40
Rate for Payer: Ohana Health Plan Medicaid	$12,561.20
Rate for Payer: Ohana Health Plan Medicare	$12,561.20
Rate for Payer: UnitedHealthcare Medicare	$12,561.20
Rate for Payer: University Health Alliance Commercial	$22,691.20

XENMATRIX 10X15 BIOLOGY GRAFT

Facility

$8,620.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$2,672.20
Max. Negotiated Rate	$8,361.40
Rate for Payer: AlohaCare Medicaid	$4,310.00
Rate for Payer: AlohaCare Medicare	$2,672.20
Rate for Payer: Cash Price	$5,172.00
Rate for Payer: Devoted Health Medicare	$2,930.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,672.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,034.00
Rate for Payer: Health Management Network Commercial	$7,327.00
Rate for Payer: Humana Medicare	$2,672.20
Rate for Payer: Kaiser Permanente Commercial	$7,758.00
Rate for Payer: Kaiser Permanente Medicaid	$4,396.20
Rate for Payer: Kaiser Permanente Medicare	$2,672.20
Rate for Payer: MDX Hawaii PPO	$8,361.40
Rate for Payer: Ohana Health Plan Medicaid	$2,672.20
Rate for Payer: Ohana Health Plan Medicare	$2,672.20
Rate for Payer: UnitedHealthcare Medicare	$2,672.20
Rate for Payer: University Health Alliance Commercial	$4,827.20

XENMATRIX 10X15 BIOLOGY GRAFT

Facility

$8,620.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$4,827.20
Max. Negotiated Rate	$8,361.40
Rate for Payer: Cash Price	$5,172.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,034.00
Rate for Payer: Health Management Network Commercial	$7,327.00
Rate for Payer: Kaiser Permanente Commercial	$7,758.00
Rate for Payer: MDX Hawaii PPO	$8,361.40
Rate for Payer: University Health Alliance Commercial	$4,827.20

XENMATRIX 19X35 BIOLOGIC GRAFT

Facility

$38,529.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$11,943.99
Max. Negotiated Rate	$37,373.13
Rate for Payer: AlohaCare Medicaid	$19,264.50
Rate for Payer: AlohaCare Medicare	$11,943.99
Rate for Payer: Cash Price	$23,117.40
Rate for Payer: Devoted Health Medicare	$13,099.86
Rate for Payer: Hawaii Medical Service Association Medicare	$11,943.99
Rate for Payer: Hawaii Western Management Group Commercial	$26,970.30
Rate for Payer: Health Management Network Commercial	$32,749.65
Rate for Payer: Humana Medicare	$11,943.99
Rate for Payer: Kaiser Permanente Commercial	$34,676.10
Rate for Payer: Kaiser Permanente Medicaid	$19,649.79
Rate for Payer: Kaiser Permanente Medicare	$11,943.99
Rate for Payer: MDX Hawaii PPO	$37,373.13
Rate for Payer: Ohana Health Plan Medicaid	$11,943.99
Rate for Payer: Ohana Health Plan Medicare	$11,943.99
Rate for Payer: UnitedHealthcare Medicare	$11,943.99
Rate for Payer: University Health Alliance Commercial	$21,576.24

XENMATRIX 19X35 BIOLOGIC GRAFT

Facility

$38,529.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$21,576.24
Max. Negotiated Rate	$37,373.13
Rate for Payer: Cash Price	$23,117.40
Rate for Payer: Hawaii Western Management Group Commercial	$26,970.30
Rate for Payer: Health Management Network Commercial	$32,749.65
Rate for Payer: Kaiser Permanente Commercial	$34,676.10
Rate for Payer: MDX Hawaii PPO	$37,373.13
Rate for Payer: University Health Alliance Commercial	$21,576.24

XENMATRIX XEN AB 10X15 1151015

Facility

$9,480.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$5,308.80
Max. Negotiated Rate	$9,195.60
Rate for Payer: Cash Price	$5,688.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,636.00
Rate for Payer: Health Management Network Commercial	$8,058.00
Rate for Payer: Kaiser Permanente Commercial	$8,532.00
Rate for Payer: MDX Hawaii PPO	$9,195.60
Rate for Payer: University Health Alliance Commercial	$5,308.80

XENMATRIX XEN AB 10X15 1151015

Facility

$9,480.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$2,938.80
Max. Negotiated Rate	$9,195.60
Rate for Payer: AlohaCare Medicaid	$4,740.00
Rate for Payer: AlohaCare Medicare	$2,938.80
Rate for Payer: Cash Price	$5,688.00
Rate for Payer: Devoted Health Medicare	$3,223.20
Rate for Payer: Hawaii Medical Service Association Medicare	$2,938.80
Rate for Payer: Hawaii Western Management Group Commercial	$6,636.00
Rate for Payer: Health Management Network Commercial	$8,058.00
Rate for Payer: Humana Medicare	$2,938.80
Rate for Payer: Kaiser Permanente Commercial	$8,532.00
Rate for Payer: Kaiser Permanente Medicaid	$4,834.80
Rate for Payer: Kaiser Permanente Medicare	$2,938.80
Rate for Payer: MDX Hawaii PPO	$9,195.60
Rate for Payer: Ohana Health Plan Medicaid	$2,938.80
Rate for Payer: Ohana Health Plan Medicare	$2,938.80
Rate for Payer: UnitedHealthcare Medicare	$2,938.80
Rate for Payer: University Health Alliance Commercial	$5,308.80

XENOSURE BIOLOGIC PATCH 1.5X10

Facility

$1,047.00

Hospital Revenue Code	278
Min. Negotiated Rate	$586.32
Max. Negotiated Rate	$1,015.59
Rate for Payer: Cash Price	$628.20
Rate for Payer: Hawaii Western Management Group Commercial	$732.90
Rate for Payer: Health Management Network Commercial	$889.95
Rate for Payer: Kaiser Permanente Commercial	$942.30
Rate for Payer: MDX Hawaii PPO	$1,015.59
Rate for Payer: University Health Alliance Commercial	$586.32

XENOSURE BIOLOGIC PATCH 1.5X10

Facility

$1,047.00

Hospital Revenue Code	278
Min. Negotiated Rate	$324.57
Max. Negotiated Rate	$1,015.59
Rate for Payer: AlohaCare Medicaid	$523.50
Rate for Payer: AlohaCare Medicare	$324.57
Rate for Payer: Cash Price	$628.20
Rate for Payer: Devoted Health Medicare	$355.98
Rate for Payer: Hawaii Medical Service Association Medicare	$324.57
Rate for Payer: Hawaii Western Management Group Commercial	$732.90
Rate for Payer: Health Management Network Commercial	$889.95
Rate for Payer: Humana Medicare	$324.57
Rate for Payer: Kaiser Permanente Commercial	$942.30
Rate for Payer: Kaiser Permanente Medicaid	$533.97
Rate for Payer: Kaiser Permanente Medicare	$324.57
Rate for Payer: MDX Hawaii PPO	$1,015.59
Rate for Payer: Ohana Health Plan Medicaid	$324.57
Rate for Payer: Ohana Health Plan Medicare	$324.57
Rate for Payer: UnitedHealthcare Medicare	$324.57
Rate for Payer: University Health Alliance Commercial	$586.32

XENOSURE BIOLOGIC PATCH 1.5X14

Facility

$1,190.00

Hospital Revenue Code	278
Min. Negotiated Rate	$666.40
Max. Negotiated Rate	$1,154.30
Rate for Payer: Cash Price	$714.00
Rate for Payer: Hawaii Western Management Group Commercial	$833.00
Rate for Payer: Health Management Network Commercial	$1,011.50
Rate for Payer: Kaiser Permanente Commercial	$1,071.00
Rate for Payer: MDX Hawaii PPO	$1,154.30
Rate for Payer: University Health Alliance Commercial	$666.40

XENOSURE BIOLOGIC PATCH 1.5X14

Facility

$1,190.00

Hospital Revenue Code	278
Min. Negotiated Rate	$368.90
Max. Negotiated Rate	$1,154.30
Rate for Payer: AlohaCare Medicaid	$595.00
Rate for Payer: AlohaCare Medicare	$368.90
Rate for Payer: Cash Price	$714.00
Rate for Payer: Devoted Health Medicare	$404.60
Rate for Payer: Hawaii Medical Service Association Medicare	$368.90
Rate for Payer: Hawaii Western Management Group Commercial	$833.00
Rate for Payer: Health Management Network Commercial	$1,011.50
Rate for Payer: Humana Medicare	$368.90
Rate for Payer: Kaiser Permanente Commercial	$1,071.00
Rate for Payer: Kaiser Permanente Medicaid	$606.90
Rate for Payer: Kaiser Permanente Medicare	$368.90
Rate for Payer: MDX Hawaii PPO	$1,154.30
Rate for Payer: Ohana Health Plan Medicaid	$368.90
Rate for Payer: Ohana Health Plan Medicare	$368.90
Rate for Payer: UnitedHealthcare Medicare	$368.90
Rate for Payer: University Health Alliance Commercial	$666.40

XENOSURE BIOLOGIC VAS PATCH

Facility

$859.00

Hospital Revenue Code	278
Min. Negotiated Rate	$266.29
Max. Negotiated Rate	$833.23
Rate for Payer: AlohaCare Medicaid	$429.50
Rate for Payer: AlohaCare Medicare	$266.29
Rate for Payer: Cash Price	$515.40
Rate for Payer: Devoted Health Medicare	$292.06
Rate for Payer: Hawaii Medical Service Association Medicare	$266.29
Rate for Payer: Hawaii Western Management Group Commercial	$601.30
Rate for Payer: Health Management Network Commercial	$730.15
Rate for Payer: Humana Medicare	$266.29
Rate for Payer: Kaiser Permanente Commercial	$773.10
Rate for Payer: Kaiser Permanente Medicaid	$438.09
Rate for Payer: Kaiser Permanente Medicare	$266.29
Rate for Payer: MDX Hawaii PPO	$833.23
Rate for Payer: Ohana Health Plan Medicaid	$266.29
Rate for Payer: Ohana Health Plan Medicare	$266.29
Rate for Payer: UnitedHealthcare Medicare	$266.29
Rate for Payer: University Health Alliance Commercial	$481.04

XENOSURE BIOLOGIC VAS PATCH

Facility

$859.00

Hospital Revenue Code	278
Min. Negotiated Rate	$481.04
Max. Negotiated Rate	$833.23
Rate for Payer: Cash Price	$515.40
Rate for Payer: Hawaii Western Management Group Commercial	$601.30
Rate for Payer: Health Management Network Commercial	$730.15
Rate for Payer: Kaiser Permanente Commercial	$773.10
Rate for Payer: MDX Hawaii PPO	$833.23
Rate for Payer: University Health Alliance Commercial	$481.04

XXL ESOPHAGEAL 18X4X75

Facility

$851.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$723.35
Max. Negotiated Rate	$825.47
Rate for Payer: Cash Price	$510.60
Rate for Payer: Health Management Network Commercial	$723.35
Rate for Payer: Kaiser Permanente Commercial	$765.90
Rate for Payer: MDX Hawaii PPO	$825.47

XXL ESOPHAGEAL 18X4X75

Facility

$851.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$263.81
Max. Negotiated Rate	$825.47
Rate for Payer: AlohaCare Medicaid	$425.50
Rate for Payer: AlohaCare Medicare	$263.81
Rate for Payer: Cash Price	$510.60
Rate for Payer: Devoted Health Medicare	$289.34
Rate for Payer: Hawaii Medical Service Association Medicare	$263.81
Rate for Payer: Hawaii Western Management Group Commercial	$808.45
Rate for Payer: Health Management Network Commercial	$723.35
Rate for Payer: Humana Medicare	$263.81
Rate for Payer: Kaiser Permanente Commercial	$765.90
Rate for Payer: Kaiser Permanente Medicaid	$434.01
Rate for Payer: Kaiser Permanente Medicare	$263.81
Rate for Payer: MDX Hawaii PPO	$825.47
Rate for Payer: Ohana Health Plan Medicaid	$263.81
Rate for Payer: Ohana Health Plan Medicare	$263.81
Rate for Payer: UnitedHealthcare Medicare	$263.81
Rate for Payer: University Health Alliance Commercial	$620.29

Y-ADAPTER NS SGL 5920-000-304

Facility

$132.00

Hospital Revenue Code	272
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$128.04
Rate for Payer: Cash Price	$79.20
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: Kaiser Permanente Commercial	$118.80
Rate for Payer: MDX Hawaii PPO	$128.04

Y-ADAPTER NS SGL 5920-000-304

Facility

$132.00

Hospital Revenue Code	272
Min. Negotiated Rate	$40.92
Max. Negotiated Rate	$128.04
Rate for Payer: AlohaCare Medicaid	$66.00
Rate for Payer: AlohaCare Medicare	$40.92
Rate for Payer: Cash Price	$79.20
Rate for Payer: Devoted Health Medicare	$44.88
Rate for Payer: Hawaii Medical Service Association Medicare	$40.92
Rate for Payer: Hawaii Western Management Group Commercial	$125.40
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: Humana Medicare	$40.92
Rate for Payer: Kaiser Permanente Commercial	$118.80
Rate for Payer: Kaiser Permanente Medicaid	$67.32
Rate for Payer: Kaiser Permanente Medicare	$40.92
Rate for Payer: MDX Hawaii PPO	$128.04
Rate for Payer: Ohana Health Plan Medicaid	$40.92
Rate for Payer: Ohana Health Plan Medicare	$40.92
Rate for Payer: UnitedHealthcare Medicare	$40.92
Rate for Payer: University Health Alliance Commercial	$96.21

YOUNGSWICK 1MM ACCUCUT 19506

Facility

$469.00

Hospital Revenue Code	272
Min. Negotiated Rate	$145.39
Max. Negotiated Rate	$454.93
Rate for Payer: AlohaCare Medicaid	$234.50
Rate for Payer: AlohaCare Medicare	$145.39
Rate for Payer: Cash Price	$281.40
Rate for Payer: Devoted Health Medicare	$159.46
Rate for Payer: Hawaii Medical Service Association Medicare	$145.39
Rate for Payer: Hawaii Western Management Group Commercial	$445.55
Rate for Payer: Health Management Network Commercial	$398.65
Rate for Payer: Humana Medicare	$145.39
Rate for Payer: Kaiser Permanente Commercial	$422.10
Rate for Payer: Kaiser Permanente Medicaid	$239.19
Rate for Payer: Kaiser Permanente Medicare	$145.39
Rate for Payer: MDX Hawaii PPO	$454.93
Rate for Payer: Ohana Health Plan Medicaid	$145.39
Rate for Payer: Ohana Health Plan Medicare	$145.39
Rate for Payer: UnitedHealthcare Medicare	$145.39
Rate for Payer: University Health Alliance Commercial	$341.85

Know your out-of-pocket cost for care.

All Charges