Kau Hospital

All Charges

Charge

Type

Setting

Price

IMPLAN BUCKET HANDLE .4X4.25

Facility

$930.00

Hospital Revenue Code	278
Min. Negotiated Rate	$520.80
Max. Negotiated Rate	$902.10
Rate for Payer: Cash Price	$558.00
Rate for Payer: Hawaii Western Management Group Commercial	$651.00
Rate for Payer: Health Management Network Commercial	$790.50
Rate for Payer: Kaiser Permanente Commercial	$837.00
Rate for Payer: MDX Hawaii PPO	$902.10
Rate for Payer: University Health Alliance Commercial	$520.80

IMPLAN BUCKET HANDLE .5X4.5

Facility

$930.00

Hospital Revenue Code	278
Min. Negotiated Rate	$520.80
Max. Negotiated Rate	$902.10
Rate for Payer: Cash Price	$558.00
Rate for Payer: Hawaii Western Management Group Commercial	$651.00
Rate for Payer: Health Management Network Commercial	$790.50
Rate for Payer: Kaiser Permanente Commercial	$837.00
Rate for Payer: MDX Hawaii PPO	$902.10
Rate for Payer: University Health Alliance Commercial	$520.80

IMPLAN BUCKET HANDLE .5X4.5

Facility

$930.00

Hospital Revenue Code	278
Min. Negotiated Rate	$288.30
Max. Negotiated Rate	$902.10
Rate for Payer: AlohaCare Medicaid	$465.00
Rate for Payer: AlohaCare Medicare	$288.30
Rate for Payer: Cash Price	$558.00
Rate for Payer: Devoted Health Medicare	$316.20
Rate for Payer: Hawaii Medical Service Association Medicare	$288.30
Rate for Payer: Hawaii Western Management Group Commercial	$651.00
Rate for Payer: Health Management Network Commercial	$790.50
Rate for Payer: Humana Medicare	$288.30
Rate for Payer: Kaiser Permanente Commercial	$837.00
Rate for Payer: Kaiser Permanente Medicaid	$474.30
Rate for Payer: Kaiser Permanente Medicare	$288.30
Rate for Payer: MDX Hawaii PPO	$902.10
Rate for Payer: Ohana Health Plan Medicaid	$288.30
Rate for Payer: Ohana Health Plan Medicare	$288.30
Rate for Payer: UnitedHealthcare Medicare	$288.30
Rate for Payer: University Health Alliance Commercial	$520.80

IMPLAN CATHETER PASSER 38CM

Facility

$776.00

Hospital Revenue Code	278
Min. Negotiated Rate	$434.56
Max. Negotiated Rate	$752.72
Rate for Payer: Cash Price	$465.60
Rate for Payer: Hawaii Western Management Group Commercial	$543.20
Rate for Payer: Health Management Network Commercial	$659.60
Rate for Payer: Kaiser Permanente Commercial	$698.40
Rate for Payer: MDX Hawaii PPO	$752.72
Rate for Payer: University Health Alliance Commercial	$434.56

IMPLAN CATHETER PASSER 38CM

Facility

$776.00

Hospital Revenue Code	278
Min. Negotiated Rate	$240.56
Max. Negotiated Rate	$752.72
Rate for Payer: AlohaCare Medicaid	$388.00
Rate for Payer: AlohaCare Medicare	$240.56
Rate for Payer: Cash Price	$465.60
Rate for Payer: Devoted Health Medicare	$263.84
Rate for Payer: Hawaii Medical Service Association Medicare	$240.56
Rate for Payer: Hawaii Western Management Group Commercial	$543.20
Rate for Payer: Health Management Network Commercial	$659.60
Rate for Payer: Humana Medicare	$240.56
Rate for Payer: Kaiser Permanente Commercial	$698.40
Rate for Payer: Kaiser Permanente Medicaid	$395.76
Rate for Payer: Kaiser Permanente Medicare	$240.56
Rate for Payer: MDX Hawaii PPO	$752.72
Rate for Payer: Ohana Health Plan Medicaid	$240.56
Rate for Payer: Ohana Health Plan Medicare	$240.56
Rate for Payer: UnitedHealthcare Medicare	$240.56
Rate for Payer: University Health Alliance Commercial	$434.56

IMPLAN CUFF OCCLUSIVE

Facility

$15,800.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$4,898.00
Max. Negotiated Rate	$15,326.00
Rate for Payer: AlohaCare Medicaid	$7,900.00
Rate for Payer: AlohaCare Medicare	$4,898.00
Rate for Payer: Cash Price	$9,480.00
Rate for Payer: Devoted Health Medicare	$5,372.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,898.00
Rate for Payer: Hawaii Western Management Group Commercial	$11,060.00
Rate for Payer: Health Management Network Commercial	$13,430.00
Rate for Payer: Humana Medicare	$4,898.00
Rate for Payer: Kaiser Permanente Commercial	$14,220.00
Rate for Payer: Kaiser Permanente Medicaid	$8,058.00
Rate for Payer: Kaiser Permanente Medicare	$4,898.00
Rate for Payer: MDX Hawaii PPO	$15,326.00
Rate for Payer: Ohana Health Plan Medicaid	$4,898.00
Rate for Payer: Ohana Health Plan Medicare	$4,898.00
Rate for Payer: UnitedHealthcare Medicare	$4,898.00
Rate for Payer: University Health Alliance Commercial	$8,848.00

IMPLAN CUFF OCCLUSIVE

Facility

$15,800.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$8,848.00
Max. Negotiated Rate	$15,326.00
Rate for Payer: Cash Price	$9,480.00
Rate for Payer: Hawaii Western Management Group Commercial	$11,060.00
Rate for Payer: Health Management Network Commercial	$13,430.00
Rate for Payer: Kaiser Permanente Commercial	$14,220.00
Rate for Payer: MDX Hawaii PPO	$15,326.00
Rate for Payer: University Health Alliance Commercial	$8,848.00

IMPLAN DEACTIV PENILE PROT

Facility

$827.00

Hospital Revenue Code	278
Min. Negotiated Rate	$256.37
Max. Negotiated Rate	$802.19
Rate for Payer: AlohaCare Medicaid	$413.50
Rate for Payer: AlohaCare Medicare	$256.37
Rate for Payer: Cash Price	$496.20
Rate for Payer: Devoted Health Medicare	$281.18
Rate for Payer: Hawaii Medical Service Association Medicare	$256.37
Rate for Payer: Hawaii Western Management Group Commercial	$578.90
Rate for Payer: Health Management Network Commercial	$702.95
Rate for Payer: Humana Medicare	$256.37
Rate for Payer: Kaiser Permanente Commercial	$744.30
Rate for Payer: Kaiser Permanente Medicaid	$421.77
Rate for Payer: Kaiser Permanente Medicare	$256.37
Rate for Payer: MDX Hawaii PPO	$802.19
Rate for Payer: Ohana Health Plan Medicaid	$256.37
Rate for Payer: Ohana Health Plan Medicare	$256.37
Rate for Payer: UnitedHealthcare Medicare	$256.37
Rate for Payer: University Health Alliance Commercial	$463.12

IMPLAN DEACTIV PENILE PROT

Facility

$827.00

Hospital Revenue Code	278
Min. Negotiated Rate	$463.12
Max. Negotiated Rate	$802.19
Rate for Payer: Cash Price	$496.20
Rate for Payer: Hawaii Western Management Group Commercial	$578.90
Rate for Payer: Health Management Network Commercial	$702.95
Rate for Payer: Kaiser Permanente Commercial	$744.30
Rate for Payer: MDX Hawaii PPO	$802.19
Rate for Payer: University Health Alliance Commercial	$463.12

IMPLAN ESOPH 23X101 STENT

Facility

$5,800.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$1,798.00
Max. Negotiated Rate	$5,626.00
Rate for Payer: AlohaCare Medicaid	$2,900.00
Rate for Payer: AlohaCare Medicare	$1,798.00
Rate for Payer: Cash Price	$3,480.00
Rate for Payer: Devoted Health Medicare	$1,972.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,798.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,060.00
Rate for Payer: Health Management Network Commercial	$4,930.00
Rate for Payer: Humana Medicare	$1,798.00
Rate for Payer: Kaiser Permanente Commercial	$5,220.00
Rate for Payer: Kaiser Permanente Medicaid	$2,958.00
Rate for Payer: Kaiser Permanente Medicare	$1,798.00
Rate for Payer: MDX Hawaii PPO	$5,626.00
Rate for Payer: Ohana Health Plan Medicaid	$1,798.00
Rate for Payer: Ohana Health Plan Medicare	$1,798.00
Rate for Payer: UnitedHealthcare Medicare	$1,798.00
Rate for Payer: University Health Alliance Commercial	$3,248.00

IMPLAN ESOPH 23X101 STENT

Facility

$5,800.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$3,248.00
Max. Negotiated Rate	$5,626.00
Rate for Payer: Cash Price	$3,480.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,060.00
Rate for Payer: Health Management Network Commercial	$4,930.00
Rate for Payer: Kaiser Permanente Commercial	$5,220.00
Rate for Payer: MDX Hawaii PPO	$5,626.00
Rate for Payer: University Health Alliance Commercial	$3,248.00

IMPLAN EXCLUDER AAA 16X12X7

Facility

$7,288.00

Hospital Revenue Code	278
Min. Negotiated Rate	$2,259.28
Max. Negotiated Rate	$7,069.36
Rate for Payer: AlohaCare Medicaid	$3,644.00
Rate for Payer: AlohaCare Medicare	$2,259.28
Rate for Payer: Cash Price	$4,372.80
Rate for Payer: Devoted Health Medicare	$2,477.92
Rate for Payer: Hawaii Medical Service Association Medicare	$2,259.28
Rate for Payer: Hawaii Western Management Group Commercial	$5,101.60
Rate for Payer: Health Management Network Commercial	$6,194.80
Rate for Payer: Humana Medicare	$2,259.28
Rate for Payer: Kaiser Permanente Commercial	$6,559.20
Rate for Payer: Kaiser Permanente Medicaid	$3,716.88
Rate for Payer: Kaiser Permanente Medicare	$2,259.28
Rate for Payer: MDX Hawaii PPO	$7,069.36
Rate for Payer: Ohana Health Plan Medicaid	$2,259.28
Rate for Payer: Ohana Health Plan Medicare	$2,259.28
Rate for Payer: UnitedHealthcare Medicare	$2,259.28
Rate for Payer: University Health Alliance Commercial	$4,081.28

IMPLAN EXCLUDER AAA 16X12X7

Facility

$7,288.00

Hospital Revenue Code	278
Min. Negotiated Rate	$4,081.28
Max. Negotiated Rate	$7,069.36
Rate for Payer: Cash Price	$4,372.80
Rate for Payer: Hawaii Western Management Group Commercial	$5,101.60
Rate for Payer: Health Management Network Commercial	$6,194.80
Rate for Payer: Kaiser Permanente Commercial	$6,559.20
Rate for Payer: MDX Hawaii PPO	$7,069.36
Rate for Payer: University Health Alliance Commercial	$4,081.28

IMPLAN GASTRO CLIP 16MM

Facility

$360.00

Hospital Revenue Code	278
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$349.20
Rate for Payer: AlohaCare Medicaid	$180.00
Rate for Payer: AlohaCare Medicare	$111.60
Rate for Payer: Cash Price	$216.00
Rate for Payer: Devoted Health Medicare	$122.40
Rate for Payer: Hawaii Medical Service Association Medicare	$111.60
Rate for Payer: Hawaii Western Management Group Commercial	$252.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Humana Medicare	$111.60
Rate for Payer: Kaiser Permanente Commercial	$324.00
Rate for Payer: Kaiser Permanente Medicaid	$183.60
Rate for Payer: Kaiser Permanente Medicare	$111.60
Rate for Payer: MDX Hawaii PPO	$349.20
Rate for Payer: Ohana Health Plan Medicaid	$111.60
Rate for Payer: Ohana Health Plan Medicare	$111.60
Rate for Payer: UnitedHealthcare Medicare	$111.60
Rate for Payer: University Health Alliance Commercial	$201.60

IMPLAN GASTRO CLIP 16MM

Facility

$360.00

Hospital Revenue Code	278
Min. Negotiated Rate	$201.60
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Hawaii Western Management Group Commercial	$252.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Kaiser Permanente Commercial	$324.00
Rate for Payer: MDX Hawaii PPO	$349.20
Rate for Payer: University Health Alliance Commercial	$201.60

IMPLAN GASTRO PADLOCK CLIP

Facility

$1,977.00

Hospital Revenue Code	278
Min. Negotiated Rate	$612.87
Max. Negotiated Rate	$1,917.69
Rate for Payer: AlohaCare Medicaid	$988.50
Rate for Payer: AlohaCare Medicare	$612.87
Rate for Payer: Cash Price	$1,186.20
Rate for Payer: Devoted Health Medicare	$672.18
Rate for Payer: Hawaii Medical Service Association Medicare	$612.87
Rate for Payer: Hawaii Western Management Group Commercial	$1,383.90
Rate for Payer: Health Management Network Commercial	$1,680.45
Rate for Payer: Humana Medicare	$612.87
Rate for Payer: Kaiser Permanente Commercial	$1,779.30
Rate for Payer: Kaiser Permanente Medicaid	$1,008.27
Rate for Payer: Kaiser Permanente Medicare	$612.87
Rate for Payer: MDX Hawaii PPO	$1,917.69
Rate for Payer: Ohana Health Plan Medicaid	$612.87
Rate for Payer: Ohana Health Plan Medicare	$612.87
Rate for Payer: UnitedHealthcare Medicare	$612.87
Rate for Payer: University Health Alliance Commercial	$1,107.12

IMPLAN GASTRO PADLOCK CLIP

Facility

$1,977.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,107.12
Max. Negotiated Rate	$1,917.69
Rate for Payer: Cash Price	$1,186.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,383.90
Rate for Payer: Health Management Network Commercial	$1,680.45
Rate for Payer: Kaiser Permanente Commercial	$1,779.30
Rate for Payer: MDX Hawaii PPO	$1,917.69
Rate for Payer: University Health Alliance Commercial	$1,107.12

IMPLAN GASTRO PADLOCK CLIP PRO

Facility

$2,157.00

Hospital Revenue Code	278
Min. Negotiated Rate	$1,207.92
Max. Negotiated Rate	$2,092.29
Rate for Payer: Cash Price	$1,294.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,509.90
Rate for Payer: Health Management Network Commercial	$1,833.45
Rate for Payer: Kaiser Permanente Commercial	$1,941.30
Rate for Payer: MDX Hawaii PPO	$2,092.29
Rate for Payer: University Health Alliance Commercial	$1,207.92

IMPLAN GASTRO PADLOCK CLIP PRO

Facility

$2,157.00

Hospital Revenue Code	278
Min. Negotiated Rate	$668.67
Max. Negotiated Rate	$2,092.29
Rate for Payer: AlohaCare Medicaid	$1,078.50
Rate for Payer: AlohaCare Medicare	$668.67
Rate for Payer: Cash Price	$1,294.20
Rate for Payer: Devoted Health Medicare	$733.38
Rate for Payer: Hawaii Medical Service Association Medicare	$668.67
Rate for Payer: Hawaii Western Management Group Commercial	$1,509.90
Rate for Payer: Health Management Network Commercial	$1,833.45
Rate for Payer: Humana Medicare	$668.67
Rate for Payer: Kaiser Permanente Commercial	$1,941.30
Rate for Payer: Kaiser Permanente Medicaid	$1,100.07
Rate for Payer: Kaiser Permanente Medicare	$668.67
Rate for Payer: MDX Hawaii PPO	$2,092.29
Rate for Payer: Ohana Health Plan Medicaid	$668.67
Rate for Payer: Ohana Health Plan Medicare	$668.67
Rate for Payer: UnitedHealthcare Medicare	$668.67
Rate for Payer: University Health Alliance Commercial	$1,207.92

IMPLAN GEL PROLARYN 1.0CC

Facility

$2,205.00

Service Code	HCPCS L8607
Hospital Revenue Code	278
Min. Negotiated Rate	$683.55
Max. Negotiated Rate	$2,138.85
Rate for Payer: AlohaCare Medicaid	$1,102.50
Rate for Payer: AlohaCare Medicare	$683.55
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Devoted Health Medicare	$749.70
Rate for Payer: Hawaii Medical Service Association Medicare	$683.55
Rate for Payer: Hawaii Western Management Group Commercial	$1,543.50
Rate for Payer: Health Management Network Commercial	$1,874.25
Rate for Payer: Humana Medicare	$683.55
Rate for Payer: Kaiser Permanente Commercial	$1,984.50
Rate for Payer: Kaiser Permanente Medicaid	$1,124.55
Rate for Payer: Kaiser Permanente Medicare	$683.55
Rate for Payer: MDX Hawaii PPO	$2,138.85
Rate for Payer: Ohana Health Plan Medicaid	$683.55
Rate for Payer: Ohana Health Plan Medicare	$683.55
Rate for Payer: UnitedHealthcare Medicare	$683.55
Rate for Payer: University Health Alliance Commercial	$1,234.80

IMPLAN GEL PROLARYN 1.0CC

Facility

$2,205.00

Service Code	HCPCS L8607
Hospital Revenue Code	278
Min. Negotiated Rate	$1,234.80
Max. Negotiated Rate	$2,138.85
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,543.50
Rate for Payer: Health Management Network Commercial	$1,874.25
Rate for Payer: Kaiser Permanente Commercial	$1,984.50
Rate for Payer: MDX Hawaii PPO	$2,138.85
Rate for Payer: University Health Alliance Commercial	$1,234.80

IMPLAN GEL PROLARYN PLUS 1CC

Facility

$2,205.00

Service Code	HCPCS L8607
Hospital Revenue Code	278
Min. Negotiated Rate	$1,234.80
Max. Negotiated Rate	$2,138.85
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,543.50
Rate for Payer: Health Management Network Commercial	$1,874.25
Rate for Payer: Kaiser Permanente Commercial	$1,984.50
Rate for Payer: MDX Hawaii PPO	$2,138.85
Rate for Payer: University Health Alliance Commercial	$1,234.80

IMPLAN GEL PROLARYN PLUS 1CC

Facility

$2,205.00

Service Code	HCPCS L8607
Hospital Revenue Code	278
Min. Negotiated Rate	$683.55
Max. Negotiated Rate	$2,138.85
Rate for Payer: AlohaCare Medicaid	$1,102.50
Rate for Payer: AlohaCare Medicare	$683.55
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Devoted Health Medicare	$749.70
Rate for Payer: Hawaii Medical Service Association Medicare	$683.55
Rate for Payer: Hawaii Western Management Group Commercial	$1,543.50
Rate for Payer: Health Management Network Commercial	$1,874.25
Rate for Payer: Humana Medicare	$683.55
Rate for Payer: Kaiser Permanente Commercial	$1,984.50
Rate for Payer: Kaiser Permanente Medicaid	$1,124.55
Rate for Payer: Kaiser Permanente Medicare	$683.55
Rate for Payer: MDX Hawaii PPO	$2,138.85
Rate for Payer: Ohana Health Plan Medicaid	$683.55
Rate for Payer: Ohana Health Plan Medicare	$683.55
Rate for Payer: UnitedHealthcare Medicare	$683.55
Rate for Payer: University Health Alliance Commercial	$1,234.80

IMPLAN INTRANASAL SPLINT

Facility

$445.00

Hospital Revenue Code	278
Min. Negotiated Rate	$137.95
Max. Negotiated Rate	$431.65
Rate for Payer: AlohaCare Medicaid	$222.50
Rate for Payer: AlohaCare Medicare	$137.95
Rate for Payer: Cash Price	$267.00
Rate for Payer: Devoted Health Medicare	$151.30
Rate for Payer: Hawaii Medical Service Association Medicare	$137.95
Rate for Payer: Hawaii Western Management Group Commercial	$311.50
Rate for Payer: Health Management Network Commercial	$378.25
Rate for Payer: Humana Medicare	$137.95
Rate for Payer: Kaiser Permanente Commercial	$400.50
Rate for Payer: Kaiser Permanente Medicaid	$226.95
Rate for Payer: Kaiser Permanente Medicare	$137.95
Rate for Payer: MDX Hawaii PPO	$431.65
Rate for Payer: Ohana Health Plan Medicaid	$137.95
Rate for Payer: Ohana Health Plan Medicare	$137.95
Rate for Payer: UnitedHealthcare Medicare	$137.95
Rate for Payer: University Health Alliance Commercial	$249.20

IMPLAN INTRANASAL SPLINT

Facility

$445.00

Hospital Revenue Code	278
Min. Negotiated Rate	$249.20
Max. Negotiated Rate	$431.65
Rate for Payer: Cash Price	$267.00
Rate for Payer: Hawaii Western Management Group Commercial	$311.50
Rate for Payer: Health Management Network Commercial	$378.25
Rate for Payer: Kaiser Permanente Commercial	$400.50
Rate for Payer: MDX Hawaii PPO	$431.65
Rate for Payer: University Health Alliance Commercial	$249.20

Know your out-of-pocket cost for care.

All Charges