Kau Hospital

All Charges

Charge

Type

Setting

Price

IMPLAN SILICONE SHEETING

Facility

$225.00

Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Hawaii Western Management Group Commercial	$157.50
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: University Health Alliance Commercial	$126.00

IMPLAN SLEEP REMOTE

Facility

$2,800.00

Service Code	HCPCS C1787
Hospital Revenue Code	278
Min. Negotiated Rate	$868.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: AlohaCare Medicaid	$1,400.00
Rate for Payer: AlohaCare Medicare	$868.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$952.00
Rate for Payer: Hawaii Medical Service Association Medicare	$868.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$868.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: Kaiser Permanente Medicare	$868.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: Ohana Health Plan Medicaid	$868.00
Rate for Payer: Ohana Health Plan Medicare	$868.00
Rate for Payer: UnitedHealthcare Medicare	$868.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

IMPLAN SLEEP REMOTE

Facility

$2,800.00

Service Code	HCPCS C1787
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

IMPLAN SPHINCTER URINE CUFF

Facility

$15,040.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$4,662.40
Max. Negotiated Rate	$14,588.80
Rate for Payer: AlohaCare Medicaid	$7,520.00
Rate for Payer: AlohaCare Medicare	$4,662.40
Rate for Payer: Cash Price	$9,024.00
Rate for Payer: Devoted Health Medicare	$5,113.60
Rate for Payer: Hawaii Medical Service Association Medicare	$4,662.40
Rate for Payer: Hawaii Western Management Group Commercial	$10,528.00
Rate for Payer: Health Management Network Commercial	$12,784.00
Rate for Payer: Humana Medicare	$4,662.40
Rate for Payer: Kaiser Permanente Commercial	$13,536.00
Rate for Payer: Kaiser Permanente Medicaid	$7,670.40
Rate for Payer: Kaiser Permanente Medicare	$4,662.40
Rate for Payer: MDX Hawaii PPO	$14,588.80
Rate for Payer: Ohana Health Plan Medicaid	$4,662.40
Rate for Payer: Ohana Health Plan Medicare	$4,662.40
Rate for Payer: UnitedHealthcare Medicare	$4,662.40
Rate for Payer: University Health Alliance Commercial	$8,422.40

IMPLAN SPHINCTER URINE CUFF

Facility

$15,040.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$8,422.40
Max. Negotiated Rate	$14,588.80
Rate for Payer: Cash Price	$9,024.00
Rate for Payer: Hawaii Western Management Group Commercial	$10,528.00
Rate for Payer: Health Management Network Commercial	$12,784.00
Rate for Payer: Kaiser Permanente Commercial	$13,536.00
Rate for Payer: MDX Hawaii PPO	$14,588.80
Rate for Payer: University Health Alliance Commercial	$8,422.40

IMPLAN SPHINCTER URINE KIT

Facility

$3,030.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,575.50
Max. Negotiated Rate	$2,939.10
Rate for Payer: Cash Price	$1,818.00
Rate for Payer: Health Management Network Commercial	$2,575.50
Rate for Payer: Kaiser Permanente Commercial	$2,727.00
Rate for Payer: MDX Hawaii PPO	$2,939.10

IMPLAN SPHINCTER URINE KIT

Facility

$3,030.00

Hospital Revenue Code	272
Min. Negotiated Rate	$939.30
Max. Negotiated Rate	$2,939.10
Rate for Payer: AlohaCare Medicaid	$1,515.00
Rate for Payer: AlohaCare Medicare	$939.30
Rate for Payer: Cash Price	$1,818.00
Rate for Payer: Devoted Health Medicare	$1,030.20
Rate for Payer: Hawaii Medical Service Association Medicare	$939.30
Rate for Payer: Hawaii Western Management Group Commercial	$2,878.50
Rate for Payer: Health Management Network Commercial	$2,575.50
Rate for Payer: Humana Medicare	$939.30
Rate for Payer: Kaiser Permanente Commercial	$2,727.00
Rate for Payer: Kaiser Permanente Medicaid	$1,545.30
Rate for Payer: Kaiser Permanente Medicare	$939.30
Rate for Payer: MDX Hawaii PPO	$2,939.10
Rate for Payer: Ohana Health Plan Medicaid	$939.30
Rate for Payer: Ohana Health Plan Medicare	$939.30
Rate for Payer: UnitedHealthcare Medicare	$939.30
Rate for Payer: University Health Alliance Commercial	$2,208.57

IMPLAN SPHINCTER URINE PUMP

Facility

$14,490.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$8,114.40
Max. Negotiated Rate	$14,055.30
Rate for Payer: Cash Price	$8,694.00
Rate for Payer: Hawaii Western Management Group Commercial	$10,143.00
Rate for Payer: Health Management Network Commercial	$12,316.50
Rate for Payer: Kaiser Permanente Commercial	$13,041.00
Rate for Payer: MDX Hawaii PPO	$14,055.30
Rate for Payer: University Health Alliance Commercial	$8,114.40

IMPLAN SPHINCTER URINE PUMP

Facility

$14,490.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$4,491.90
Max. Negotiated Rate	$14,055.30
Rate for Payer: AlohaCare Medicaid	$7,245.00
Rate for Payer: AlohaCare Medicare	$4,491.90
Rate for Payer: Cash Price	$8,694.00
Rate for Payer: Devoted Health Medicare	$4,926.60
Rate for Payer: Hawaii Medical Service Association Medicare	$4,491.90
Rate for Payer: Hawaii Western Management Group Commercial	$10,143.00
Rate for Payer: Health Management Network Commercial	$12,316.50
Rate for Payer: Humana Medicare	$4,491.90
Rate for Payer: Kaiser Permanente Commercial	$13,041.00
Rate for Payer: Kaiser Permanente Medicaid	$7,389.90
Rate for Payer: Kaiser Permanente Medicare	$4,491.90
Rate for Payer: MDX Hawaii PPO	$14,055.30
Rate for Payer: Ohana Health Plan Medicaid	$4,491.90
Rate for Payer: Ohana Health Plan Medicare	$4,491.90
Rate for Payer: UnitedHealthcare Medicare	$4,491.90
Rate for Payer: University Health Alliance Commercial	$8,114.40

IMPLAN SPHINCTER URINE SYS

Facility

$6,890.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$2,135.90
Max. Negotiated Rate	$6,683.30
Rate for Payer: AlohaCare Medicaid	$3,445.00
Rate for Payer: AlohaCare Medicare	$2,135.90
Rate for Payer: Cash Price	$4,134.00
Rate for Payer: Devoted Health Medicare	$2,342.60
Rate for Payer: Hawaii Medical Service Association Medicare	$2,135.90
Rate for Payer: Hawaii Western Management Group Commercial	$4,823.00
Rate for Payer: Health Management Network Commercial	$5,856.50
Rate for Payer: Humana Medicare	$2,135.90
Rate for Payer: Kaiser Permanente Commercial	$6,201.00
Rate for Payer: Kaiser Permanente Medicaid	$3,513.90
Rate for Payer: Kaiser Permanente Medicare	$2,135.90
Rate for Payer: MDX Hawaii PPO	$6,683.30
Rate for Payer: Ohana Health Plan Medicaid	$2,135.90
Rate for Payer: Ohana Health Plan Medicare	$2,135.90
Rate for Payer: UnitedHealthcare Medicare	$2,135.90
Rate for Payer: University Health Alliance Commercial	$3,858.40

IMPLAN SPHINCTER URINE SYS

Facility

$6,890.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$3,858.40
Max. Negotiated Rate	$6,683.30
Rate for Payer: Cash Price	$4,134.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,823.00
Rate for Payer: Health Management Network Commercial	$5,856.50
Rate for Payer: Kaiser Permanente Commercial	$6,201.00
Rate for Payer: MDX Hawaii PPO	$6,683.30
Rate for Payer: University Health Alliance Commercial	$3,858.40

IMPLAN STENT COLONIC 25X60

Facility

$4,928.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$2,759.68
Max. Negotiated Rate	$4,780.16
Rate for Payer: Cash Price	$2,956.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,449.60
Rate for Payer: Health Management Network Commercial	$4,188.80
Rate for Payer: Kaiser Permanente Commercial	$4,435.20
Rate for Payer: MDX Hawaii PPO	$4,780.16
Rate for Payer: University Health Alliance Commercial	$2,759.68

IMPLAN STENT COLONIC 25X60

Facility

$4,928.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,527.68
Max. Negotiated Rate	$4,780.16
Rate for Payer: AlohaCare Medicaid	$2,464.00
Rate for Payer: AlohaCare Medicare	$1,527.68
Rate for Payer: Cash Price	$2,956.80
Rate for Payer: Devoted Health Medicare	$1,675.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,527.68
Rate for Payer: Hawaii Western Management Group Commercial	$3,449.60
Rate for Payer: Health Management Network Commercial	$4,188.80
Rate for Payer: Humana Medicare	$1,527.68
Rate for Payer: Kaiser Permanente Commercial	$4,435.20
Rate for Payer: Kaiser Permanente Medicaid	$2,513.28
Rate for Payer: Kaiser Permanente Medicare	$1,527.68
Rate for Payer: MDX Hawaii PPO	$4,780.16
Rate for Payer: Ohana Health Plan Medicaid	$1,527.68
Rate for Payer: Ohana Health Plan Medicare	$1,527.68
Rate for Payer: UnitedHealthcare Medicare	$1,527.68
Rate for Payer: University Health Alliance Commercial	$2,759.68

IMPLAN STENT DRUG ELUTING

Facility

$2,606.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$807.86
Max. Negotiated Rate	$2,527.82
Rate for Payer: AlohaCare Medicaid	$1,303.00
Rate for Payer: AlohaCare Medicare	$807.86
Rate for Payer: Cash Price	$1,563.60
Rate for Payer: Devoted Health Medicare	$886.04
Rate for Payer: Hawaii Medical Service Association Medicare	$807.86
Rate for Payer: Hawaii Western Management Group Commercial	$1,824.20
Rate for Payer: Health Management Network Commercial	$2,215.10
Rate for Payer: Humana Medicare	$807.86
Rate for Payer: Kaiser Permanente Commercial	$2,345.40
Rate for Payer: Kaiser Permanente Medicaid	$1,329.06
Rate for Payer: Kaiser Permanente Medicare	$807.86
Rate for Payer: MDX Hawaii PPO	$2,527.82
Rate for Payer: Ohana Health Plan Medicaid	$807.86
Rate for Payer: Ohana Health Plan Medicare	$807.86
Rate for Payer: UnitedHealthcare Medicare	$807.86
Rate for Payer: University Health Alliance Commercial	$1,459.36

IMPLAN STENT DRUG ELUTING

Facility

$2,606.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,459.36
Max. Negotiated Rate	$2,527.82
Rate for Payer: Cash Price	$1,563.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,824.20
Rate for Payer: Health Management Network Commercial	$2,215.10
Rate for Payer: Kaiser Permanente Commercial	$2,345.40
Rate for Payer: MDX Hawaii PPO	$2,527.82
Rate for Payer: University Health Alliance Commercial	$1,459.36

IMPLAN STENT DRUG ELUTING MINI

Facility

$2,606.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$807.86
Max. Negotiated Rate	$2,527.82
Rate for Payer: AlohaCare Medicaid	$1,303.00
Rate for Payer: AlohaCare Medicare	$807.86
Rate for Payer: Cash Price	$1,563.60
Rate for Payer: Devoted Health Medicare	$886.04
Rate for Payer: Hawaii Medical Service Association Medicare	$807.86
Rate for Payer: Hawaii Western Management Group Commercial	$1,824.20
Rate for Payer: Health Management Network Commercial	$2,215.10
Rate for Payer: Humana Medicare	$807.86
Rate for Payer: Kaiser Permanente Commercial	$2,345.40
Rate for Payer: Kaiser Permanente Medicaid	$1,329.06
Rate for Payer: Kaiser Permanente Medicare	$807.86
Rate for Payer: MDX Hawaii PPO	$2,527.82
Rate for Payer: Ohana Health Plan Medicaid	$807.86
Rate for Payer: Ohana Health Plan Medicare	$807.86
Rate for Payer: UnitedHealthcare Medicare	$807.86
Rate for Payer: University Health Alliance Commercial	$1,459.36

IMPLAN STENT DRUG ELUTING MINI

Facility

$2,606.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,459.36
Max. Negotiated Rate	$2,527.82
Rate for Payer: Cash Price	$1,563.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,824.20
Rate for Payer: Health Management Network Commercial	$2,215.10
Rate for Payer: Kaiser Permanente Commercial	$2,345.40
Rate for Payer: MDX Hawaii PPO	$2,527.82
Rate for Payer: University Health Alliance Commercial	$1,459.36

IMPLAN STENT/INTROD 6FRX20

Facility

$2,198.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$681.38
Max. Negotiated Rate	$2,132.06
Rate for Payer: AlohaCare Medicaid	$1,099.00
Rate for Payer: AlohaCare Medicare	$681.38
Rate for Payer: Cash Price	$1,318.80
Rate for Payer: Devoted Health Medicare	$747.32
Rate for Payer: Hawaii Medical Service Association Medicare	$681.38
Rate for Payer: Hawaii Western Management Group Commercial	$1,538.60
Rate for Payer: Health Management Network Commercial	$1,868.30
Rate for Payer: Humana Medicare	$681.38
Rate for Payer: Kaiser Permanente Commercial	$1,978.20
Rate for Payer: Kaiser Permanente Medicaid	$1,120.98
Rate for Payer: Kaiser Permanente Medicare	$681.38
Rate for Payer: MDX Hawaii PPO	$2,132.06
Rate for Payer: Ohana Health Plan Medicaid	$681.38
Rate for Payer: Ohana Health Plan Medicare	$681.38
Rate for Payer: UnitedHealthcare Medicare	$681.38
Rate for Payer: University Health Alliance Commercial	$1,230.88

IMPLAN STENT/INTROD 6FRX20

Facility

$2,198.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,230.88
Max. Negotiated Rate	$2,132.06
Rate for Payer: Cash Price	$1,318.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,538.60
Rate for Payer: Health Management Network Commercial	$1,868.30
Rate for Payer: Kaiser Permanente Commercial	$1,978.20
Rate for Payer: MDX Hawaii PPO	$2,132.06
Rate for Payer: University Health Alliance Commercial	$1,230.88

IMPLAN STENT/INTROD 6FRX22

Facility

$2,198.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$681.38
Max. Negotiated Rate	$2,132.06
Rate for Payer: AlohaCare Medicaid	$1,099.00
Rate for Payer: AlohaCare Medicare	$681.38
Rate for Payer: Cash Price	$1,318.80
Rate for Payer: Devoted Health Medicare	$747.32
Rate for Payer: Hawaii Medical Service Association Medicare	$681.38
Rate for Payer: Hawaii Western Management Group Commercial	$1,538.60
Rate for Payer: Health Management Network Commercial	$1,868.30
Rate for Payer: Humana Medicare	$681.38
Rate for Payer: Kaiser Permanente Commercial	$1,978.20
Rate for Payer: Kaiser Permanente Medicaid	$1,120.98
Rate for Payer: Kaiser Permanente Medicare	$681.38
Rate for Payer: MDX Hawaii PPO	$2,132.06
Rate for Payer: Ohana Health Plan Medicaid	$681.38
Rate for Payer: Ohana Health Plan Medicare	$681.38
Rate for Payer: UnitedHealthcare Medicare	$681.38
Rate for Payer: University Health Alliance Commercial	$1,230.88

IMPLAN STENT/INTROD 6FRX22

Facility

$2,198.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,230.88
Max. Negotiated Rate	$2,132.06
Rate for Payer: Cash Price	$1,318.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,538.60
Rate for Payer: Health Management Network Commercial	$1,868.30
Rate for Payer: Kaiser Permanente Commercial	$1,978.20
Rate for Payer: MDX Hawaii PPO	$2,132.06
Rate for Payer: University Health Alliance Commercial	$1,230.88

IMPLAN STENT/INTROD 6FRX24

Facility

$2,286.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,280.16
Max. Negotiated Rate	$2,217.42
Rate for Payer: Cash Price	$1,371.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,600.20
Rate for Payer: Health Management Network Commercial	$1,943.10
Rate for Payer: Kaiser Permanente Commercial	$2,057.40
Rate for Payer: MDX Hawaii PPO	$2,217.42
Rate for Payer: University Health Alliance Commercial	$1,280.16

IMPLAN STENT/INTROD 6FRX24

Facility

$2,286.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$708.66
Max. Negotiated Rate	$2,217.42
Rate for Payer: AlohaCare Medicaid	$1,143.00
Rate for Payer: AlohaCare Medicare	$708.66
Rate for Payer: Cash Price	$1,371.60
Rate for Payer: Devoted Health Medicare	$777.24
Rate for Payer: Hawaii Medical Service Association Medicare	$708.66
Rate for Payer: Hawaii Western Management Group Commercial	$1,600.20
Rate for Payer: Health Management Network Commercial	$1,943.10
Rate for Payer: Humana Medicare	$708.66
Rate for Payer: Kaiser Permanente Commercial	$2,057.40
Rate for Payer: Kaiser Permanente Medicaid	$1,165.86
Rate for Payer: Kaiser Permanente Medicare	$708.66
Rate for Payer: MDX Hawaii PPO	$2,217.42
Rate for Payer: Ohana Health Plan Medicaid	$708.66
Rate for Payer: Ohana Health Plan Medicare	$708.66
Rate for Payer: UnitedHealthcare Medicare	$708.66
Rate for Payer: University Health Alliance Commercial	$1,280.16

IMPLAN STENT/INTROD 6FRX26

Facility

$2,286.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,280.16
Max. Negotiated Rate	$2,217.42
Rate for Payer: Cash Price	$1,371.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,600.20
Rate for Payer: Health Management Network Commercial	$1,943.10
Rate for Payer: Kaiser Permanente Commercial	$2,057.40
Rate for Payer: MDX Hawaii PPO	$2,217.42
Rate for Payer: University Health Alliance Commercial	$1,280.16

IMPLAN STENT/INTROD 6FRX26

Facility

$2,286.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$708.66
Max. Negotiated Rate	$2,217.42
Rate for Payer: AlohaCare Medicaid	$1,143.00
Rate for Payer: AlohaCare Medicare	$708.66
Rate for Payer: Cash Price	$1,371.60
Rate for Payer: Devoted Health Medicare	$777.24
Rate for Payer: Hawaii Medical Service Association Medicare	$708.66
Rate for Payer: Hawaii Western Management Group Commercial	$1,600.20
Rate for Payer: Health Management Network Commercial	$1,943.10
Rate for Payer: Humana Medicare	$708.66
Rate for Payer: Kaiser Permanente Commercial	$2,057.40
Rate for Payer: Kaiser Permanente Medicaid	$1,165.86
Rate for Payer: Kaiser Permanente Medicare	$708.66
Rate for Payer: MDX Hawaii PPO	$2,217.42
Rate for Payer: Ohana Health Plan Medicaid	$708.66
Rate for Payer: Ohana Health Plan Medicare	$708.66
Rate for Payer: UnitedHealthcare Medicare	$708.66
Rate for Payer: University Health Alliance Commercial	$1,280.16

Know your out-of-pocket cost for care.

All Charges