Kau Hospital

All Charges

Charge

Type

Setting

Price

ENDOPROSTHESIS VBHR131002A

Facility

$7,138.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$2,212.78
Max. Negotiated Rate	$6,923.86
Rate for Payer: AlohaCare Medicaid	$3,569.00
Rate for Payer: AlohaCare Medicare	$2,212.78
Rate for Payer: Cash Price	$4,282.80
Rate for Payer: Devoted Health Medicare	$2,426.92
Rate for Payer: Hawaii Medical Service Association Medicare	$2,212.78
Rate for Payer: Hawaii Western Management Group Commercial	$4,996.60
Rate for Payer: Health Management Network Commercial	$6,067.30
Rate for Payer: Humana Medicare	$2,212.78
Rate for Payer: Kaiser Permanente Commercial	$6,424.20
Rate for Payer: Kaiser Permanente Medicaid	$3,640.38
Rate for Payer: Kaiser Permanente Medicare	$2,212.78
Rate for Payer: MDX Hawaii PPO	$6,923.86
Rate for Payer: Ohana Health Plan Medicaid	$2,212.78
Rate for Payer: Ohana Health Plan Medicare	$2,212.78
Rate for Payer: UnitedHealthcare Medicare	$2,212.78
Rate for Payer: University Health Alliance Commercial	$3,997.28

ENDOPROSTHESIS VBHR131002A

Facility

$7,138.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,997.28
Max. Negotiated Rate	$6,923.86
Rate for Payer: Cash Price	$4,282.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,996.60
Rate for Payer: Health Management Network Commercial	$6,067.30
Rate for Payer: Kaiser Permanente Commercial	$6,424.20
Rate for Payer: MDX Hawaii PPO	$6,923.86
Rate for Payer: University Health Alliance Commercial	$3,997.28

ENDOPROSTHE VIABHN VBHR111002A

Facility

$8,242.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$2,555.02
Max. Negotiated Rate	$7,994.74
Rate for Payer: AlohaCare Medicaid	$4,121.00
Rate for Payer: AlohaCare Medicare	$2,555.02
Rate for Payer: Cash Price	$4,945.20
Rate for Payer: Devoted Health Medicare	$2,802.28
Rate for Payer: Hawaii Medical Service Association Medicare	$2,555.02
Rate for Payer: Hawaii Western Management Group Commercial	$5,769.40
Rate for Payer: Health Management Network Commercial	$7,005.70
Rate for Payer: Humana Medicare	$2,555.02
Rate for Payer: Kaiser Permanente Commercial	$7,417.80
Rate for Payer: Kaiser Permanente Medicaid	$4,203.42
Rate for Payer: Kaiser Permanente Medicare	$2,555.02
Rate for Payer: MDX Hawaii PPO	$7,994.74
Rate for Payer: Ohana Health Plan Medicaid	$2,555.02
Rate for Payer: Ohana Health Plan Medicare	$2,555.02
Rate for Payer: UnitedHealthcare Medicare	$2,555.02
Rate for Payer: University Health Alliance Commercial	$4,615.52

ENDOPROSTHE VIABHN VBHR111002A

Facility

$8,242.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,615.52
Max. Negotiated Rate	$7,994.74
Rate for Payer: Cash Price	$4,945.20
Rate for Payer: Hawaii Western Management Group Commercial	$5,769.40
Rate for Payer: Health Management Network Commercial	$7,005.70
Rate for Payer: Kaiser Permanente Commercial	$7,417.80
Rate for Payer: MDX Hawaii PPO	$7,994.74
Rate for Payer: University Health Alliance Commercial	$4,615.52

ENDORA 8 SR-T 407157

Facility

$9,600.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$2,976.00
Max. Negotiated Rate	$9,312.00
Rate for Payer: AlohaCare Medicaid	$4,800.00
Rate for Payer: AlohaCare Medicare	$2,976.00
Rate for Payer: Cash Price	$5,760.00
Rate for Payer: Devoted Health Medicare	$3,264.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,976.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,720.00
Rate for Payer: Health Management Network Commercial	$8,160.00
Rate for Payer: Humana Medicare	$2,976.00
Rate for Payer: Kaiser Permanente Commercial	$8,640.00
Rate for Payer: Kaiser Permanente Medicaid	$4,896.00
Rate for Payer: Kaiser Permanente Medicare	$2,976.00
Rate for Payer: MDX Hawaii PPO	$9,312.00
Rate for Payer: Ohana Health Plan Medicaid	$2,976.00
Rate for Payer: Ohana Health Plan Medicare	$2,976.00
Rate for Payer: UnitedHealthcare Medicare	$2,976.00
Rate for Payer: University Health Alliance Commercial	$5,376.00

ENDORA 8 SR-T 407157

Facility

$9,600.00

Service Code	HCPCS C1786
Hospital Revenue Code	275
Min. Negotiated Rate	$5,376.00
Max. Negotiated Rate	$9,312.00
Rate for Payer: Cash Price	$5,760.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,720.00
Rate for Payer: Health Management Network Commercial	$8,160.00
Rate for Payer: Kaiser Permanente Commercial	$8,640.00
Rate for Payer: MDX Hawaii PPO	$9,312.00
Rate for Payer: University Health Alliance Commercial	$5,376.00

ENDOSCOPIC HELIX M00505500

Facility

$2,612.00

Hospital Revenue Code	272
Min. Negotiated Rate	$809.72
Max. Negotiated Rate	$2,533.64
Rate for Payer: AlohaCare Medicaid	$1,306.00
Rate for Payer: AlohaCare Medicare	$809.72
Rate for Payer: Cash Price	$1,567.20
Rate for Payer: Devoted Health Medicare	$888.08
Rate for Payer: Hawaii Medical Service Association Medicare	$809.72
Rate for Payer: Hawaii Western Management Group Commercial	$2,481.40
Rate for Payer: Health Management Network Commercial	$2,220.20
Rate for Payer: Humana Medicare	$809.72
Rate for Payer: Kaiser Permanente Commercial	$2,350.80
Rate for Payer: Kaiser Permanente Medicaid	$1,332.12
Rate for Payer: Kaiser Permanente Medicare	$809.72
Rate for Payer: MDX Hawaii PPO	$2,533.64
Rate for Payer: Ohana Health Plan Medicaid	$809.72
Rate for Payer: Ohana Health Plan Medicare	$809.72
Rate for Payer: UnitedHealthcare Medicare	$809.72
Rate for Payer: University Health Alliance Commercial	$1,903.89

ENDOSCOPIC HELIX M00505500

Facility

$2,612.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,220.20
Max. Negotiated Rate	$2,533.64
Rate for Payer: Cash Price	$1,567.20
Rate for Payer: Health Management Network Commercial	$2,220.20
Rate for Payer: Kaiser Permanente Commercial	$2,350.80
Rate for Payer: MDX Hawaii PPO	$2,533.64

ENDO STITCH 10MM

Facility

$408.00

Hospital Revenue Code	272
Min. Negotiated Rate	$346.80
Max. Negotiated Rate	$395.76
Rate for Payer: Cash Price	$244.80
Rate for Payer: Health Management Network Commercial	$346.80
Rate for Payer: Kaiser Permanente Commercial	$367.20
Rate for Payer: MDX Hawaii PPO	$395.76

ENDO STITCH 10MM

Facility

$408.00

Hospital Revenue Code	272
Min. Negotiated Rate	$126.48
Max. Negotiated Rate	$395.76
Rate for Payer: AlohaCare Medicaid	$204.00
Rate for Payer: AlohaCare Medicare	$126.48
Rate for Payer: Cash Price	$244.80
Rate for Payer: Devoted Health Medicare	$138.72
Rate for Payer: Hawaii Medical Service Association Medicare	$126.48
Rate for Payer: Hawaii Western Management Group Commercial	$387.60
Rate for Payer: Health Management Network Commercial	$346.80
Rate for Payer: Humana Medicare	$126.48
Rate for Payer: Kaiser Permanente Commercial	$367.20
Rate for Payer: Kaiser Permanente Medicaid	$208.08
Rate for Payer: Kaiser Permanente Medicare	$126.48
Rate for Payer: MDX Hawaii PPO	$395.76
Rate for Payer: Ohana Health Plan Medicaid	$126.48
Rate for Payer: Ohana Health Plan Medicare	$126.48
Rate for Payer: UnitedHealthcare Medicare	$126.48
Rate for Payer: University Health Alliance Commercial	$297.39

ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES

Facility

$96,040.50

Service Code	MSDRG 213
Min. Negotiated Rate	$96,040.50
Max. Negotiated Rate	$96,040.50
Rate for Payer: Hawaii Medical Service Association Commercial	$96,040.50

ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC

Facility

$92,366.69

Service Code	MSDRG 266
Min. Negotiated Rate	$92,366.69
Max. Negotiated Rate	$92,366.69
Rate for Payer: Hawaii Medical Service Association Commercial	$92,366.69

ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC

Facility

$80,444.59

Service Code	MSDRG 267
Min. Negotiated Rate	$80,444.59
Max. Negotiated Rate	$80,444.59
Rate for Payer: Hawaii Medical Service Association Commercial	$80,444.59

ENDURANT BIFOR #ESBF2514C103E

Facility

$19,950.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$11,172.00
Max. Negotiated Rate	$19,351.50
Rate for Payer: Cash Price	$11,970.00
Rate for Payer: Hawaii Western Management Group Commercial	$13,965.00
Rate for Payer: Health Management Network Commercial	$16,957.50
Rate for Payer: Kaiser Permanente Commercial	$17,955.00
Rate for Payer: MDX Hawaii PPO	$19,351.50
Rate for Payer: University Health Alliance Commercial	$11,172.00

ENDURANT BIFOR #ESBF2514C103E

Facility

$19,950.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$6,184.50
Max. Negotiated Rate	$19,351.50
Rate for Payer: AlohaCare Medicaid	$9,975.00
Rate for Payer: AlohaCare Medicare	$6,184.50
Rate for Payer: Cash Price	$11,970.00
Rate for Payer: Devoted Health Medicare	$6,783.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,184.50
Rate for Payer: Hawaii Western Management Group Commercial	$13,965.00
Rate for Payer: Health Management Network Commercial	$16,957.50
Rate for Payer: Humana Medicare	$6,184.50
Rate for Payer: Kaiser Permanente Commercial	$17,955.00
Rate for Payer: Kaiser Permanente Medicaid	$10,174.50
Rate for Payer: Kaiser Permanente Medicare	$6,184.50
Rate for Payer: MDX Hawaii PPO	$19,351.50
Rate for Payer: Ohana Health Plan Medicaid	$6,184.50
Rate for Payer: Ohana Health Plan Medicare	$6,184.50
Rate for Payer: UnitedHealthcare Medicare	$6,184.50
Rate for Payer: University Health Alliance Commercial	$11,172.00

ENDURANT GRAFT #ETLW1616C124E

Facility

$9,300.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$2,883.00
Max. Negotiated Rate	$9,021.00
Rate for Payer: AlohaCare Medicaid	$4,650.00
Rate for Payer: AlohaCare Medicare	$2,883.00
Rate for Payer: Cash Price	$5,580.00
Rate for Payer: Devoted Health Medicare	$3,162.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,883.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,510.00
Rate for Payer: Health Management Network Commercial	$7,905.00
Rate for Payer: Humana Medicare	$2,883.00
Rate for Payer: Kaiser Permanente Commercial	$8,370.00
Rate for Payer: Kaiser Permanente Medicaid	$4,743.00
Rate for Payer: Kaiser Permanente Medicare	$2,883.00
Rate for Payer: MDX Hawaii PPO	$9,021.00
Rate for Payer: Ohana Health Plan Medicaid	$2,883.00
Rate for Payer: Ohana Health Plan Medicare	$2,883.00
Rate for Payer: UnitedHealthcare Medicare	$2,883.00
Rate for Payer: University Health Alliance Commercial	$5,208.00

ENDURANT GRAFT #ETLW1616C124E

Facility

$9,300.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$5,208.00
Max. Negotiated Rate	$9,021.00
Rate for Payer: Cash Price	$5,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,510.00
Rate for Payer: Health Management Network Commercial	$7,905.00
Rate for Payer: Kaiser Permanente Commercial	$8,370.00
Rate for Payer: MDX Hawaii PPO	$9,021.00
Rate for Payer: University Health Alliance Commercial	$5,208.00

ENDURANT GRAFT #ETLW1616C93E

Facility

$9,300.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$5,208.00
Max. Negotiated Rate	$9,021.00
Rate for Payer: Cash Price	$5,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,510.00
Rate for Payer: Health Management Network Commercial	$7,905.00
Rate for Payer: Kaiser Permanente Commercial	$8,370.00
Rate for Payer: MDX Hawaii PPO	$9,021.00
Rate for Payer: University Health Alliance Commercial	$5,208.00

ENDURANT GRAFT #ETLW1616C93E

Facility

$9,300.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$2,883.00
Max. Negotiated Rate	$9,021.00
Rate for Payer: AlohaCare Medicaid	$4,650.00
Rate for Payer: AlohaCare Medicare	$2,883.00
Rate for Payer: Cash Price	$5,580.00
Rate for Payer: Devoted Health Medicare	$3,162.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,883.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,510.00
Rate for Payer: Health Management Network Commercial	$7,905.00
Rate for Payer: Humana Medicare	$2,883.00
Rate for Payer: Kaiser Permanente Commercial	$8,370.00
Rate for Payer: Kaiser Permanente Medicaid	$4,743.00
Rate for Payer: Kaiser Permanente Medicare	$2,883.00
Rate for Payer: MDX Hawaii PPO	$9,021.00
Rate for Payer: Ohana Health Plan Medicaid	$2,883.00
Rate for Payer: Ohana Health Plan Medicare	$2,883.00
Rate for Payer: UnitedHealthcare Medicare	$2,883.00
Rate for Payer: University Health Alliance Commercial	$5,208.00

ENDURANT SHEATH 12F SENSH1228W

Facility

$563.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$478.55
Max. Negotiated Rate	$546.11
Rate for Payer: Cash Price	$337.80
Rate for Payer: Health Management Network Commercial	$478.55
Rate for Payer: Kaiser Permanente Commercial	$506.70
Rate for Payer: MDX Hawaii PPO	$546.11

ENDURANT SHEATH 12F SENSH1228W

Facility

$563.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$174.53
Max. Negotiated Rate	$546.11
Rate for Payer: AlohaCare Medicaid	$281.50
Rate for Payer: AlohaCare Medicare	$174.53
Rate for Payer: Cash Price	$337.80
Rate for Payer: Devoted Health Medicare	$191.42
Rate for Payer: Hawaii Medical Service Association Medicare	$174.53
Rate for Payer: Hawaii Western Management Group Commercial	$534.85
Rate for Payer: Health Management Network Commercial	$478.55
Rate for Payer: Humana Medicare	$174.53
Rate for Payer: Kaiser Permanente Commercial	$506.70
Rate for Payer: Kaiser Permanente Medicaid	$287.13
Rate for Payer: Kaiser Permanente Medicare	$174.53
Rate for Payer: MDX Hawaii PPO	$546.11
Rate for Payer: Ohana Health Plan Medicaid	$174.53
Rate for Payer: Ohana Health Plan Medicare	$174.53
Rate for Payer: UnitedHealthcare Medicare	$174.53
Rate for Payer: University Health Alliance Commercial	$410.37

ENDURANT SHEATH 14F SENSH1428W

Facility

$750.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$450.00
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: Kaiser Permanente Commercial	$675.00
Rate for Payer: MDX Hawaii PPO	$727.50

ENDURANT SHEATH 14F SENSH1428W

Facility

$750.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$232.50
Max. Negotiated Rate	$727.50
Rate for Payer: AlohaCare Medicaid	$375.00
Rate for Payer: AlohaCare Medicare	$232.50
Rate for Payer: Cash Price	$450.00
Rate for Payer: Devoted Health Medicare	$255.00
Rate for Payer: Hawaii Medical Service Association Medicare	$232.50
Rate for Payer: Hawaii Western Management Group Commercial	$712.50
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: Humana Medicare	$232.50
Rate for Payer: Kaiser Permanente Commercial	$675.00
Rate for Payer: Kaiser Permanente Medicaid	$382.50
Rate for Payer: Kaiser Permanente Medicare	$232.50
Rate for Payer: MDX Hawaii PPO	$727.50
Rate for Payer: Ohana Health Plan Medicaid	$232.50
Rate for Payer: Ohana Health Plan Medicare	$232.50
Rate for Payer: UnitedHealthcare Medicare	$232.50
Rate for Payer: University Health Alliance Commercial	$546.67

ENDURANT SHEATH 16F SENSH1628W

Facility

$750.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$727.50
Rate for Payer: Cash Price	$450.00
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: Kaiser Permanente Commercial	$675.00
Rate for Payer: MDX Hawaii PPO	$727.50

ENDURANT SHEATH 16F SENSH1628W

Facility

$750.00

Service Code	HCPCS C1894
Hospital Revenue Code	272
Min. Negotiated Rate	$232.50
Max. Negotiated Rate	$727.50
Rate for Payer: AlohaCare Medicaid	$375.00
Rate for Payer: AlohaCare Medicare	$232.50
Rate for Payer: Cash Price	$450.00
Rate for Payer: Devoted Health Medicare	$255.00
Rate for Payer: Hawaii Medical Service Association Medicare	$232.50
Rate for Payer: Hawaii Western Management Group Commercial	$712.50
Rate for Payer: Health Management Network Commercial	$637.50
Rate for Payer: Humana Medicare	$232.50
Rate for Payer: Kaiser Permanente Commercial	$675.00
Rate for Payer: Kaiser Permanente Medicaid	$382.50
Rate for Payer: Kaiser Permanente Medicare	$232.50
Rate for Payer: MDX Hawaii PPO	$727.50
Rate for Payer: Ohana Health Plan Medicaid	$232.50
Rate for Payer: Ohana Health Plan Medicare	$232.50
Rate for Payer: UnitedHealthcare Medicare	$232.50
Rate for Payer: University Health Alliance Commercial	$546.67

Know your out-of-pocket cost for care.

All Charges