Kau Hospital

All Charges

Charge

Type

Setting

Price

CATH FOLEY COUDE 2WAY 18F

Facility

$66.00

Hospital Revenue Code	272
Min. Negotiated Rate	$20.46
Max. Negotiated Rate	$64.02
Rate for Payer: AlohaCare Medicaid	$33.00
Rate for Payer: AlohaCare Medicare	$20.46
Rate for Payer: Cash Price	$39.60
Rate for Payer: Devoted Health Medicare	$22.44
Rate for Payer: Hawaii Medical Service Association Medicare	$20.46
Rate for Payer: Hawaii Western Management Group Commercial	$62.70
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Humana Medicare	$20.46
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: Kaiser Permanente Medicare	$20.46
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: Ohana Health Plan Medicaid	$20.46
Rate for Payer: Ohana Health Plan Medicare	$20.46
Rate for Payer: UnitedHealthcare Medicare	$20.46
Rate for Payer: University Health Alliance Commercial	$48.11

CATH FOLEY COUDE 2WAY 20F

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

CATH FOLEY COUDE 2WAY 20F

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

CATH FOLEY COUNCIL

Facility

$114.00

Hospital Revenue Code	272
Min. Negotiated Rate	$35.34
Max. Negotiated Rate	$110.58
Rate for Payer: AlohaCare Medicaid	$57.00
Rate for Payer: AlohaCare Medicare	$35.34
Rate for Payer: Cash Price	$68.40
Rate for Payer: Devoted Health Medicare	$38.76
Rate for Payer: Hawaii Medical Service Association Medicare	$35.34
Rate for Payer: Hawaii Western Management Group Commercial	$108.30
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Humana Medicare	$35.34
Rate for Payer: Kaiser Permanente Commercial	$102.60
Rate for Payer: Kaiser Permanente Medicaid	$58.14
Rate for Payer: Kaiser Permanente Medicare	$35.34
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: Ohana Health Plan Medicaid	$35.34
Rate for Payer: Ohana Health Plan Medicare	$35.34
Rate for Payer: UnitedHealthcare Medicare	$35.34
Rate for Payer: University Health Alliance Commercial	$83.09

CATH FOLEY COUNCIL

Facility

$114.00

Hospital Revenue Code	272
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$68.40
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Kaiser Permanente Commercial	$102.60
Rate for Payer: MDX Hawaii PPO	$110.58

CATH LATEX 2W 25FR 30CC

Facility

$82.00

Hospital Revenue Code	272
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$49.20
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: MDX Hawaii PPO	$79.54

CATH LATEX 2W 25FR 30CC

Facility

$82.00

Hospital Revenue Code	272
Min. Negotiated Rate	$25.42
Max. Negotiated Rate	$79.54
Rate for Payer: AlohaCare Medicaid	$41.00
Rate for Payer: AlohaCare Medicare	$25.42
Rate for Payer: Cash Price	$49.20
Rate for Payer: Devoted Health Medicare	$27.88
Rate for Payer: Hawaii Medical Service Association Medicare	$25.42
Rate for Payer: Hawaii Western Management Group Commercial	$77.90
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Humana Medicare	$25.42
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: Kaiser Permanente Medicaid	$41.82
Rate for Payer: Kaiser Permanente Medicare	$25.42
Rate for Payer: MDX Hawaii PPO	$79.54
Rate for Payer: Ohana Health Plan Medicaid	$25.42
Rate for Payer: Ohana Health Plan Medicare	$25.42
Rate for Payer: UnitedHealthcare Medicare	$25.42
Rate for Payer: University Health Alliance Commercial	$59.77

CATH MAHURKAR HP 3LUMEN

Facility

$509.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$157.79
Max. Negotiated Rate	$493.73
Rate for Payer: AlohaCare Medicaid	$254.50
Rate for Payer: AlohaCare Medicare	$157.79
Rate for Payer: Cash Price	$305.40
Rate for Payer: Devoted Health Medicare	$173.06
Rate for Payer: Hawaii Medical Service Association Medicare	$157.79
Rate for Payer: Hawaii Western Management Group Commercial	$483.55
Rate for Payer: Health Management Network Commercial	$432.65
Rate for Payer: Humana Medicare	$157.79
Rate for Payer: Kaiser Permanente Commercial	$458.10
Rate for Payer: Kaiser Permanente Medicaid	$259.59
Rate for Payer: Kaiser Permanente Medicare	$157.79
Rate for Payer: MDX Hawaii PPO	$493.73
Rate for Payer: Ohana Health Plan Medicaid	$157.79
Rate for Payer: Ohana Health Plan Medicare	$157.79
Rate for Payer: UnitedHealthcare Medicare	$157.79
Rate for Payer: University Health Alliance Commercial	$371.01

CATH MAHURKAR HP 3LUMEN

Facility

$509.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$432.65
Max. Negotiated Rate	$493.73
Rate for Payer: Cash Price	$305.40
Rate for Payer: Health Management Network Commercial	$432.65
Rate for Payer: Kaiser Permanente Commercial	$458.10
Rate for Payer: MDX Hawaii PPO	$493.73

CATH NASAL CATH EPISTAT

Facility

$653.00

Hospital Revenue Code	272
Min. Negotiated Rate	$555.05
Max. Negotiated Rate	$633.41
Rate for Payer: Cash Price	$391.80
Rate for Payer: Health Management Network Commercial	$555.05
Rate for Payer: Kaiser Permanente Commercial	$587.70
Rate for Payer: MDX Hawaii PPO	$633.41

CATH NASAL CATH EPISTAT

Facility

$653.00

Hospital Revenue Code	272
Min. Negotiated Rate	$202.43
Max. Negotiated Rate	$633.41
Rate for Payer: AlohaCare Medicaid	$326.50
Rate for Payer: AlohaCare Medicare	$202.43
Rate for Payer: Cash Price	$391.80
Rate for Payer: Devoted Health Medicare	$222.02
Rate for Payer: Hawaii Medical Service Association Medicare	$202.43
Rate for Payer: Hawaii Western Management Group Commercial	$620.35
Rate for Payer: Health Management Network Commercial	$555.05
Rate for Payer: Humana Medicare	$202.43
Rate for Payer: Kaiser Permanente Commercial	$587.70
Rate for Payer: Kaiser Permanente Medicaid	$333.03
Rate for Payer: Kaiser Permanente Medicare	$202.43
Rate for Payer: MDX Hawaii PPO	$633.41
Rate for Payer: Ohana Health Plan Medicaid	$202.43
Rate for Payer: Ohana Health Plan Medicare	$202.43
Rate for Payer: UnitedHealthcare Medicare	$202.43
Rate for Payer: University Health Alliance Commercial	$475.97

CATH PALIN RIGHT #8888145063P

Facility

$1,470.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$1,249.50
Max. Negotiated Rate	$1,425.90
Rate for Payer: Cash Price	$882.00
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: Kaiser Permanente Commercial	$1,323.00
Rate for Payer: MDX Hawaii PPO	$1,425.90

CATH PALIN RIGHT #8888145063P

Facility

$1,470.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$455.70
Max. Negotiated Rate	$1,425.90
Rate for Payer: AlohaCare Medicaid	$735.00
Rate for Payer: AlohaCare Medicare	$455.70
Rate for Payer: Cash Price	$882.00
Rate for Payer: Devoted Health Medicare	$499.80
Rate for Payer: Hawaii Medical Service Association Medicare	$455.70
Rate for Payer: Hawaii Western Management Group Commercial	$1,396.50
Rate for Payer: Health Management Network Commercial	$1,249.50
Rate for Payer: Humana Medicare	$455.70
Rate for Payer: Kaiser Permanente Commercial	$1,323.00
Rate for Payer: Kaiser Permanente Medicaid	$749.70
Rate for Payer: Kaiser Permanente Medicare	$455.70
Rate for Payer: MDX Hawaii PPO	$1,425.90
Rate for Payer: Ohana Health Plan Medicaid	$455.70
Rate for Payer: Ohana Health Plan Medicare	$455.70
Rate for Payer: UnitedHealthcare Medicare	$455.70
Rate for Payer: University Health Alliance Commercial	$1,071.48

CATH PD TITANI EXT 8888415612

Facility

$391.00

Hospital Revenue Code	272
Min. Negotiated Rate	$332.35
Max. Negotiated Rate	$379.27
Rate for Payer: Cash Price	$234.60
Rate for Payer: Health Management Network Commercial	$332.35
Rate for Payer: Kaiser Permanente Commercial	$351.90
Rate for Payer: MDX Hawaii PPO	$379.27

CATH PD TITANI EXT 8888415612

Facility

$391.00

Hospital Revenue Code	272
Min. Negotiated Rate	$121.21
Max. Negotiated Rate	$379.27
Rate for Payer: AlohaCare Medicaid	$195.50
Rate for Payer: AlohaCare Medicare	$121.21
Rate for Payer: Cash Price	$234.60
Rate for Payer: Devoted Health Medicare	$132.94
Rate for Payer: Hawaii Medical Service Association Medicare	$121.21
Rate for Payer: Hawaii Western Management Group Commercial	$371.45
Rate for Payer: Health Management Network Commercial	$332.35
Rate for Payer: Humana Medicare	$121.21
Rate for Payer: Kaiser Permanente Commercial	$351.90
Rate for Payer: Kaiser Permanente Medicaid	$199.41
Rate for Payer: Kaiser Permanente Medicare	$121.21
Rate for Payer: MDX Hawaii PPO	$379.27
Rate for Payer: Ohana Health Plan Medicaid	$121.21
Rate for Payer: Ohana Health Plan Medicare	$121.21
Rate for Payer: UnitedHealthcare Medicare	$121.21
Rate for Payer: University Health Alliance Commercial	$285.00

CATH PERITONEAL 8888414011

Facility

$1,680.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$1,428.00
Max. Negotiated Rate	$1,629.60
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Health Management Network Commercial	$1,428.00
Rate for Payer: Kaiser Permanente Commercial	$1,512.00
Rate for Payer: MDX Hawaii PPO	$1,629.60

CATH PERITONEAL 8888414011

Facility

$1,680.00

Service Code	HCPCS C1750
Hospital Revenue Code	272
Min. Negotiated Rate	$520.80
Max. Negotiated Rate	$1,629.60
Rate for Payer: AlohaCare Medicaid	$840.00
Rate for Payer: AlohaCare Medicare	$520.80
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Devoted Health Medicare	$571.20
Rate for Payer: Hawaii Medical Service Association Medicare	$520.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,596.00
Rate for Payer: Health Management Network Commercial	$1,428.00
Rate for Payer: Humana Medicare	$520.80
Rate for Payer: Kaiser Permanente Commercial	$1,512.00
Rate for Payer: Kaiser Permanente Medicaid	$856.80
Rate for Payer: Kaiser Permanente Medicare	$520.80
Rate for Payer: MDX Hawaii PPO	$1,629.60
Rate for Payer: Ohana Health Plan Medicaid	$520.80
Rate for Payer: Ohana Health Plan Medicare	$520.80
Rate for Payer: UnitedHealthcare Medicare	$520.80
Rate for Payer: University Health Alliance Commercial	$1,224.55

CATH PNEUMOTHORAX PIGTAIL

Facility

$933.00

Hospital Revenue Code	272
Min. Negotiated Rate	$289.23
Max. Negotiated Rate	$905.01
Rate for Payer: AlohaCare Medicaid	$466.50
Rate for Payer: AlohaCare Medicare	$289.23
Rate for Payer: Cash Price	$559.80
Rate for Payer: Devoted Health Medicare	$317.22
Rate for Payer: Hawaii Medical Service Association Medicare	$289.23
Rate for Payer: Hawaii Western Management Group Commercial	$886.35
Rate for Payer: Health Management Network Commercial	$793.05
Rate for Payer: Humana Medicare	$289.23
Rate for Payer: Kaiser Permanente Commercial	$839.70
Rate for Payer: Kaiser Permanente Medicaid	$475.83
Rate for Payer: Kaiser Permanente Medicare	$289.23
Rate for Payer: MDX Hawaii PPO	$905.01
Rate for Payer: Ohana Health Plan Medicaid	$289.23
Rate for Payer: Ohana Health Plan Medicare	$289.23
Rate for Payer: UnitedHealthcare Medicare	$289.23
Rate for Payer: University Health Alliance Commercial	$680.06

CATH PNEUMOTHORAX PIGTAIL

Facility

$933.00

Hospital Revenue Code	272
Min. Negotiated Rate	$793.05
Max. Negotiated Rate	$905.01
Rate for Payer: Cash Price	$559.80
Rate for Payer: Health Management Network Commercial	$793.05
Rate for Payer: Kaiser Permanente Commercial	$839.70
Rate for Payer: MDX Hawaii PPO	$905.01

CATH RED 18FRX5CC FOLEY

Facility

$118.00

Hospital Revenue Code	272
Min. Negotiated Rate	$100.30
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$70.80
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: MDX Hawaii PPO	$114.46

CATH RED 18FRX5CC FOLEY

Facility

$118.00

Hospital Revenue Code	272
Min. Negotiated Rate	$36.58
Max. Negotiated Rate	$114.46
Rate for Payer: AlohaCare Medicaid	$59.00
Rate for Payer: AlohaCare Medicare	$36.58
Rate for Payer: Cash Price	$70.80
Rate for Payer: Devoted Health Medicare	$40.12
Rate for Payer: Hawaii Medical Service Association Medicare	$36.58
Rate for Payer: Hawaii Western Management Group Commercial	$112.10
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Humana Medicare	$36.58
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: Kaiser Permanente Medicaid	$60.18
Rate for Payer: Kaiser Permanente Medicare	$36.58
Rate for Payer: MDX Hawaii PPO	$114.46
Rate for Payer: Ohana Health Plan Medicaid	$36.58
Rate for Payer: Ohana Health Plan Medicare	$36.58
Rate for Payer: UnitedHealthcare Medicare	$36.58
Rate for Payer: University Health Alliance Commercial	$86.01

CATH SUPRAPUBC 14FR SET G26648

Facility

$304.00

Service Code	HCPCS C2627
Hospital Revenue Code	272
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$294.88
Rate for Payer: AlohaCare Medicaid	$152.00
Rate for Payer: AlohaCare Medicare	$94.24
Rate for Payer: Cash Price	$182.40
Rate for Payer: Devoted Health Medicare	$103.36
Rate for Payer: Hawaii Medical Service Association Medicare	$94.24
Rate for Payer: Hawaii Western Management Group Commercial	$288.80
Rate for Payer: Health Management Network Commercial	$258.40
Rate for Payer: Humana Medicare	$94.24
Rate for Payer: Kaiser Permanente Commercial	$273.60
Rate for Payer: Kaiser Permanente Medicaid	$155.04
Rate for Payer: Kaiser Permanente Medicare	$94.24
Rate for Payer: MDX Hawaii PPO	$294.88
Rate for Payer: Ohana Health Plan Medicaid	$94.24
Rate for Payer: Ohana Health Plan Medicare	$94.24
Rate for Payer: UnitedHealthcare Medicare	$94.24
Rate for Payer: University Health Alliance Commercial	$221.59

CATH SUPRAPUBC 14FR SET G26648

Facility

$304.00

Service Code	HCPCS C2627
Hospital Revenue Code	272
Min. Negotiated Rate	$258.40
Max. Negotiated Rate	$294.88
Rate for Payer: Cash Price	$182.40
Rate for Payer: Health Management Network Commercial	$258.40
Rate for Payer: Kaiser Permanente Commercial	$273.60
Rate for Payer: MDX Hawaii PPO	$294.88

CATH SUPRAPUBC 16FR SET

Facility

$349.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$108.19
Max. Negotiated Rate	$338.53
Rate for Payer: AlohaCare Medicaid	$174.50
Rate for Payer: AlohaCare Medicare	$108.19
Rate for Payer: Cash Price	$209.40
Rate for Payer: Devoted Health Medicare	$118.66
Rate for Payer: Hawaii Medical Service Association Medicare	$108.19
Rate for Payer: Hawaii Western Management Group Commercial	$331.55
Rate for Payer: Health Management Network Commercial	$296.65
Rate for Payer: Humana Medicare	$108.19
Rate for Payer: Kaiser Permanente Commercial	$314.10
Rate for Payer: Kaiser Permanente Medicaid	$177.99
Rate for Payer: Kaiser Permanente Medicare	$108.19
Rate for Payer: MDX Hawaii PPO	$338.53
Rate for Payer: Ohana Health Plan Medicaid	$108.19
Rate for Payer: Ohana Health Plan Medicare	$108.19
Rate for Payer: UnitedHealthcare Medicare	$108.19
Rate for Payer: University Health Alliance Commercial	$254.39

CATH SUPRAPUBC 16FR SET

Facility

$349.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$296.65
Max. Negotiated Rate	$338.53
Rate for Payer: Cash Price	$209.40
Rate for Payer: Health Management Network Commercial	$296.65
Rate for Payer: Kaiser Permanente Commercial	$314.10
Rate for Payer: MDX Hawaii PPO	$338.53

Know your out-of-pocket cost for care.

All Charges