Kau Hospital

All Charges

Charge

Type

Setting

Price

CATH UMBIL 5FR

Facility

$74.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$22.94
Max. Negotiated Rate	$71.78
Rate for Payer: AlohaCare Medicaid	$37.00
Rate for Payer: AlohaCare Medicare	$22.94
Rate for Payer: Cash Price	$44.40
Rate for Payer: Devoted Health Medicare	$25.16
Rate for Payer: Hawaii Medical Service Association Medicare	$22.94
Rate for Payer: Hawaii Western Management Group Commercial	$70.30
Rate for Payer: Health Management Network Commercial	$62.90
Rate for Payer: Humana Medicare	$22.94
Rate for Payer: Kaiser Permanente Commercial	$66.60
Rate for Payer: Kaiser Permanente Medicaid	$37.74
Rate for Payer: Kaiser Permanente Medicare	$22.94
Rate for Payer: MDX Hawaii PPO	$71.78
Rate for Payer: Ohana Health Plan Medicaid	$22.94
Rate for Payer: Ohana Health Plan Medicare	$22.94
Rate for Payer: UnitedHealthcare Medicare	$22.94
Rate for Payer: University Health Alliance Commercial	$53.94

CATH UMBIL 5FR

Facility

$74.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$62.90
Max. Negotiated Rate	$71.78
Rate for Payer: Cash Price	$44.40
Rate for Payer: Health Management Network Commercial	$62.90
Rate for Payer: Kaiser Permanente Commercial	$66.60
Rate for Payer: MDX Hawaii PPO	$71.78

CATH UMBILICAL 3.5FR

Facility

$77.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$23.87
Max. Negotiated Rate	$74.69
Rate for Payer: AlohaCare Medicaid	$38.50
Rate for Payer: AlohaCare Medicare	$23.87
Rate for Payer: Cash Price	$46.20
Rate for Payer: Devoted Health Medicare	$26.18
Rate for Payer: Hawaii Medical Service Association Medicare	$23.87
Rate for Payer: Hawaii Western Management Group Commercial	$73.15
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Humana Medicare	$23.87
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: Kaiser Permanente Medicaid	$39.27
Rate for Payer: Kaiser Permanente Medicare	$23.87
Rate for Payer: MDX Hawaii PPO	$74.69
Rate for Payer: Ohana Health Plan Medicaid	$23.87
Rate for Payer: Ohana Health Plan Medicare	$23.87
Rate for Payer: UnitedHealthcare Medicare	$23.87
Rate for Payer: University Health Alliance Commercial	$56.13

CATH UMBILICAL 3.5FR

Facility

$77.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$46.20
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: MDX Hawaii PPO	$74.69

CATH UROMAX ULTRA BALLOON

Facility

$919.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$781.15
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$551.40
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: MDX Hawaii PPO	$891.43

CATH UROMAX ULTRA BALLOON

Facility

$919.00

Service Code	HCPCS C1726
Hospital Revenue Code	272
Min. Negotiated Rate	$284.89
Max. Negotiated Rate	$891.43
Rate for Payer: AlohaCare Medicaid	$459.50
Rate for Payer: AlohaCare Medicare	$284.89
Rate for Payer: Cash Price	$551.40
Rate for Payer: Devoted Health Medicare	$312.46
Rate for Payer: Hawaii Medical Service Association Medicare	$284.89
Rate for Payer: Hawaii Western Management Group Commercial	$873.05
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Humana Medicare	$284.89
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: Kaiser Permanente Medicaid	$468.69
Rate for Payer: Kaiser Permanente Medicare	$284.89
Rate for Payer: MDX Hawaii PPO	$891.43
Rate for Payer: Ohana Health Plan Medicaid	$284.89
Rate for Payer: Ohana Health Plan Medicare	$284.89
Rate for Payer: UnitedHealthcare Medicare	$284.89
Rate for Payer: University Health Alliance Commercial	$669.86

CATH VIDEO CHOLEDOCHOSCOPE

Facility

$5,500.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$4,675.00
Max. Negotiated Rate	$5,335.00
Rate for Payer: Cash Price	$3,300.00
Rate for Payer: Health Management Network Commercial	$4,675.00
Rate for Payer: Kaiser Permanente Commercial	$4,950.00
Rate for Payer: MDX Hawaii PPO	$5,335.00

CATH VIDEO CHOLEDOCHOSCOPE

Facility

$5,500.00

Service Code	HCPCS C1889
Hospital Revenue Code	272
Min. Negotiated Rate	$1,705.00
Max. Negotiated Rate	$5,335.00
Rate for Payer: AlohaCare Medicaid	$2,750.00
Rate for Payer: AlohaCare Medicare	$1,705.00
Rate for Payer: Cash Price	$3,300.00
Rate for Payer: Devoted Health Medicare	$1,870.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,705.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,225.00
Rate for Payer: Health Management Network Commercial	$4,675.00
Rate for Payer: Humana Medicare	$1,705.00
Rate for Payer: Kaiser Permanente Commercial	$4,950.00
Rate for Payer: Kaiser Permanente Medicaid	$2,805.00
Rate for Payer: Kaiser Permanente Medicare	$1,705.00
Rate for Payer: MDX Hawaii PPO	$5,335.00
Rate for Payer: Ohana Health Plan Medicaid	$1,705.00
Rate for Payer: Ohana Health Plan Medicare	$1,705.00
Rate for Payer: UnitedHealthcare Medicare	$1,705.00
Rate for Payer: University Health Alliance Commercial	$4,008.95

CAUT ELECTROD 5X58 FULGURATING

Facility

$286.00

Hospital Revenue Code	272
Min. Negotiated Rate	$88.66
Max. Negotiated Rate	$277.42
Rate for Payer: AlohaCare Medicaid	$143.00
Rate for Payer: AlohaCare Medicare	$88.66
Rate for Payer: Cash Price	$171.60
Rate for Payer: Devoted Health Medicare	$97.24
Rate for Payer: Hawaii Medical Service Association Medicare	$88.66
Rate for Payer: Hawaii Western Management Group Commercial	$271.70
Rate for Payer: Health Management Network Commercial	$243.10
Rate for Payer: Humana Medicare	$88.66
Rate for Payer: Kaiser Permanente Commercial	$257.40
Rate for Payer: Kaiser Permanente Medicaid	$145.86
Rate for Payer: Kaiser Permanente Medicare	$88.66
Rate for Payer: MDX Hawaii PPO	$277.42
Rate for Payer: Ohana Health Plan Medicaid	$88.66
Rate for Payer: Ohana Health Plan Medicare	$88.66
Rate for Payer: UnitedHealthcare Medicare	$88.66
Rate for Payer: University Health Alliance Commercial	$208.47

CAUT ELECTROD 5X58 FULGURATING

Facility

$286.00

Hospital Revenue Code	272
Min. Negotiated Rate	$243.10
Max. Negotiated Rate	$277.42
Rate for Payer: Cash Price	$171.60
Rate for Payer: Health Management Network Commercial	$243.10
Rate for Payer: Kaiser Permanente Commercial	$257.40
Rate for Payer: MDX Hawaii PPO	$277.42

CAUTERY BLADE

Facility

$108.00

Hospital Revenue Code	272
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$104.76
Rate for Payer: Cash Price	$64.80
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Kaiser Permanente Commercial	$97.20
Rate for Payer: MDX Hawaii PPO	$104.76

CAUTERY BLADE

Facility

$108.00

Hospital Revenue Code	272
Min. Negotiated Rate	$33.48
Max. Negotiated Rate	$104.76
Rate for Payer: AlohaCare Medicaid	$54.00
Rate for Payer: AlohaCare Medicare	$33.48
Rate for Payer: Cash Price	$64.80
Rate for Payer: Devoted Health Medicare	$36.72
Rate for Payer: Hawaii Medical Service Association Medicare	$33.48
Rate for Payer: Hawaii Western Management Group Commercial	$102.60
Rate for Payer: Health Management Network Commercial	$91.80
Rate for Payer: Humana Medicare	$33.48
Rate for Payer: Kaiser Permanente Commercial	$97.20
Rate for Payer: Kaiser Permanente Medicaid	$55.08
Rate for Payer: Kaiser Permanente Medicare	$33.48
Rate for Payer: MDX Hawaii PPO	$104.76
Rate for Payer: Ohana Health Plan Medicaid	$33.48
Rate for Payer: Ohana Health Plan Medicare	$33.48
Rate for Payer: UnitedHealthcare Medicare	$33.48
Rate for Payer: University Health Alliance Commercial	$78.72

CAUTERY L HOOK

Facility

$233.00

Hospital Revenue Code	272
Min. Negotiated Rate	$198.05
Max. Negotiated Rate	$226.01
Rate for Payer: Cash Price	$139.80
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: Kaiser Permanente Commercial	$209.70
Rate for Payer: MDX Hawaii PPO	$226.01

CAUTERY L HOOK

Facility

$233.00

Hospital Revenue Code	272
Min. Negotiated Rate	$72.23
Max. Negotiated Rate	$226.01
Rate for Payer: AlohaCare Medicaid	$116.50
Rate for Payer: AlohaCare Medicare	$72.23
Rate for Payer: Cash Price	$139.80
Rate for Payer: Devoted Health Medicare	$79.22
Rate for Payer: Hawaii Medical Service Association Medicare	$72.23
Rate for Payer: Hawaii Western Management Group Commercial	$221.35
Rate for Payer: Health Management Network Commercial	$198.05
Rate for Payer: Humana Medicare	$72.23
Rate for Payer: Kaiser Permanente Commercial	$209.70
Rate for Payer: Kaiser Permanente Medicaid	$118.83
Rate for Payer: Kaiser Permanente Medicare	$72.23
Rate for Payer: MDX Hawaii PPO	$226.01
Rate for Payer: Ohana Health Plan Medicaid	$72.23
Rate for Payer: Ohana Health Plan Medicare	$72.23
Rate for Payer: UnitedHealthcare Medicare	$72.23
Rate for Payer: University Health Alliance Commercial	$169.83

CAUTERY PENVAC MEGADYNE

Facility

$218.00

Hospital Revenue Code	272
Min. Negotiated Rate	$185.30
Max. Negotiated Rate	$211.46
Rate for Payer: Cash Price	$130.80
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Kaiser Permanente Commercial	$196.20
Rate for Payer: MDX Hawaii PPO	$211.46

CAUTERY PENVAC MEGADYNE

Facility

$218.00

Hospital Revenue Code	272
Min. Negotiated Rate	$67.58
Max. Negotiated Rate	$211.46
Rate for Payer: AlohaCare Medicaid	$109.00
Rate for Payer: AlohaCare Medicare	$67.58
Rate for Payer: Cash Price	$130.80
Rate for Payer: Devoted Health Medicare	$74.12
Rate for Payer: Hawaii Medical Service Association Medicare	$67.58
Rate for Payer: Hawaii Western Management Group Commercial	$207.10
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Humana Medicare	$67.58
Rate for Payer: Kaiser Permanente Commercial	$196.20
Rate for Payer: Kaiser Permanente Medicaid	$111.18
Rate for Payer: Kaiser Permanente Medicare	$67.58
Rate for Payer: MDX Hawaii PPO	$211.46
Rate for Payer: Ohana Health Plan Medicaid	$67.58
Rate for Payer: Ohana Health Plan Medicare	$67.58
Rate for Payer: UnitedHealthcare Medicare	$67.58
Rate for Payer: University Health Alliance Commercial	$158.90

CAUT HOOK HAND CONTROL

Facility

$191.00

Hospital Revenue Code	272
Min. Negotiated Rate	$162.35
Max. Negotiated Rate	$185.27
Rate for Payer: Cash Price	$114.60
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: Kaiser Permanente Commercial	$171.90
Rate for Payer: MDX Hawaii PPO	$185.27

CAUT HOOK HAND CONTROL

Facility

$191.00

Hospital Revenue Code	272
Min. Negotiated Rate	$59.21
Max. Negotiated Rate	$185.27
Rate for Payer: AlohaCare Medicaid	$95.50
Rate for Payer: AlohaCare Medicare	$59.21
Rate for Payer: Cash Price	$114.60
Rate for Payer: Devoted Health Medicare	$64.94
Rate for Payer: Hawaii Medical Service Association Medicare	$59.21
Rate for Payer: Hawaii Western Management Group Commercial	$181.45
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: Humana Medicare	$59.21
Rate for Payer: Kaiser Permanente Commercial	$171.90
Rate for Payer: Kaiser Permanente Medicaid	$97.41
Rate for Payer: Kaiser Permanente Medicare	$59.21
Rate for Payer: MDX Hawaii PPO	$185.27
Rate for Payer: Ohana Health Plan Medicaid	$59.21
Rate for Payer: Ohana Health Plan Medicare	$59.21
Rate for Payer: UnitedHealthcare Medicare	$59.21
Rate for Payer: University Health Alliance Commercial	$139.22

CAUT HOOK LAP ELECTRODE

Facility

$325.00

Hospital Revenue Code	272
Min. Negotiated Rate	$276.25
Max. Negotiated Rate	$315.25
Rate for Payer: Cash Price	$195.00
Rate for Payer: Health Management Network Commercial	$276.25
Rate for Payer: Kaiser Permanente Commercial	$292.50
Rate for Payer: MDX Hawaii PPO	$315.25

CAUT HOOK LAP ELECTRODE

Facility

$325.00

Hospital Revenue Code	272
Min. Negotiated Rate	$100.75
Max. Negotiated Rate	$315.25
Rate for Payer: AlohaCare Medicaid	$162.50
Rate for Payer: AlohaCare Medicare	$100.75
Rate for Payer: Cash Price	$195.00
Rate for Payer: Devoted Health Medicare	$110.50
Rate for Payer: Hawaii Medical Service Association Medicare	$100.75
Rate for Payer: Hawaii Western Management Group Commercial	$308.75
Rate for Payer: Health Management Network Commercial	$276.25
Rate for Payer: Humana Medicare	$100.75
Rate for Payer: Kaiser Permanente Commercial	$292.50
Rate for Payer: Kaiser Permanente Medicaid	$165.75
Rate for Payer: Kaiser Permanente Medicare	$100.75
Rate for Payer: MDX Hawaii PPO	$315.25
Rate for Payer: Ohana Health Plan Medicaid	$100.75
Rate for Payer: Ohana Health Plan Medicare	$100.75
Rate for Payer: UnitedHealthcare Medicare	$100.75
Rate for Payer: University Health Alliance Commercial	$236.89

CAUT LIGASURE 5MM BLUNT

Facility

$1,507.00

Hospital Revenue Code	272
Min. Negotiated Rate	$467.17
Max. Negotiated Rate	$1,461.79
Rate for Payer: AlohaCare Medicaid	$753.50
Rate for Payer: AlohaCare Medicare	$467.17
Rate for Payer: Cash Price	$904.20
Rate for Payer: Devoted Health Medicare	$512.38
Rate for Payer: Hawaii Medical Service Association Medicare	$467.17
Rate for Payer: Hawaii Western Management Group Commercial	$1,431.65
Rate for Payer: Health Management Network Commercial	$1,280.95
Rate for Payer: Humana Medicare	$467.17
Rate for Payer: Kaiser Permanente Commercial	$1,356.30
Rate for Payer: Kaiser Permanente Medicaid	$768.57
Rate for Payer: Kaiser Permanente Medicare	$467.17
Rate for Payer: MDX Hawaii PPO	$1,461.79
Rate for Payer: Ohana Health Plan Medicaid	$467.17
Rate for Payer: Ohana Health Plan Medicare	$467.17
Rate for Payer: UnitedHealthcare Medicare	$467.17
Rate for Payer: University Health Alliance Commercial	$1,098.45

CAUT LIGASURE 5MM BLUNT

Facility

$1,507.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,280.95
Max. Negotiated Rate	$1,461.79
Rate for Payer: Cash Price	$904.20
Rate for Payer: Health Management Network Commercial	$1,280.95
Rate for Payer: Kaiser Permanente Commercial	$1,356.30
Rate for Payer: MDX Hawaii PPO	$1,461.79

CAUT LIGASURE ATLAS HANDHELD

Facility

$1,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$494.76
Max. Negotiated Rate	$1,548.12
Rate for Payer: AlohaCare Medicaid	$798.00
Rate for Payer: AlohaCare Medicare	$494.76
Rate for Payer: Cash Price	$957.60
Rate for Payer: Devoted Health Medicare	$542.64
Rate for Payer: Hawaii Medical Service Association Medicare	$494.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,516.20
Rate for Payer: Health Management Network Commercial	$1,356.60
Rate for Payer: Humana Medicare	$494.76
Rate for Payer: Kaiser Permanente Commercial	$1,436.40
Rate for Payer: Kaiser Permanente Medicaid	$813.96
Rate for Payer: Kaiser Permanente Medicare	$494.76
Rate for Payer: MDX Hawaii PPO	$1,548.12
Rate for Payer: Ohana Health Plan Medicaid	$494.76
Rate for Payer: Ohana Health Plan Medicare	$494.76
Rate for Payer: UnitedHealthcare Medicare	$494.76
Rate for Payer: University Health Alliance Commercial	$1,163.32

CAUT LIGASURE ATLAS HANDHELD

Facility

$1,596.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,356.60
Max. Negotiated Rate	$1,548.12
Rate for Payer: Cash Price	$957.60
Rate for Payer: Health Management Network Commercial	$1,356.60
Rate for Payer: Kaiser Permanente Commercial	$1,436.40
Rate for Payer: MDX Hawaii PPO	$1,548.12

CAUT SURGIWAND II 5M

Facility

$340.00

Hospital Revenue Code	272
Min. Negotiated Rate	$289.00
Max. Negotiated Rate	$329.80
Rate for Payer: Cash Price	$204.00
Rate for Payer: Health Management Network Commercial	$289.00
Rate for Payer: Kaiser Permanente Commercial	$306.00
Rate for Payer: MDX Hawaii PPO	$329.80

Know your out-of-pocket cost for care.

All Charges