Kau Hospital

All Charges

Charge

Type

Setting

Price

IMPLAN STENT/INTROD 6FRX28

Facility

$2,199.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$681.69
Max. Negotiated Rate	$2,133.03
Rate for Payer: AlohaCare Medicaid	$1,099.50
Rate for Payer: AlohaCare Medicare	$681.69
Rate for Payer: Cash Price	$1,319.40
Rate for Payer: Devoted Health Medicare	$747.66
Rate for Payer: Hawaii Medical Service Association Medicare	$681.69
Rate for Payer: Hawaii Western Management Group Commercial	$1,539.30
Rate for Payer: Health Management Network Commercial	$1,869.15
Rate for Payer: Humana Medicare	$681.69
Rate for Payer: Kaiser Permanente Commercial	$1,979.10
Rate for Payer: Kaiser Permanente Medicaid	$1,121.49
Rate for Payer: Kaiser Permanente Medicare	$681.69
Rate for Payer: MDX Hawaii PPO	$2,133.03
Rate for Payer: Ohana Health Plan Medicaid	$681.69
Rate for Payer: Ohana Health Plan Medicare	$681.69
Rate for Payer: UnitedHealthcare Medicare	$681.69
Rate for Payer: University Health Alliance Commercial	$1,231.44

IMPLAN STENT/INTROD 6FRX28

Facility

$2,199.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,231.44
Max. Negotiated Rate	$2,133.03
Rate for Payer: Cash Price	$1,319.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,539.30
Rate for Payer: Health Management Network Commercial	$1,869.15
Rate for Payer: Kaiser Permanente Commercial	$1,979.10
Rate for Payer: MDX Hawaii PPO	$2,133.03
Rate for Payer: University Health Alliance Commercial	$1,231.44

IMPLAN STENT/INTROD 6FRX30

Facility

$2,919.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,634.64
Max. Negotiated Rate	$2,831.43
Rate for Payer: Cash Price	$1,751.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,043.30
Rate for Payer: Health Management Network Commercial	$2,481.15
Rate for Payer: Kaiser Permanente Commercial	$2,627.10
Rate for Payer: MDX Hawaii PPO	$2,831.43
Rate for Payer: University Health Alliance Commercial	$1,634.64

IMPLAN STENT/INTROD 6FRX30

Facility

$2,919.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$904.89
Max. Negotiated Rate	$2,831.43
Rate for Payer: AlohaCare Medicaid	$1,459.50
Rate for Payer: AlohaCare Medicare	$904.89
Rate for Payer: Cash Price	$1,751.40
Rate for Payer: Devoted Health Medicare	$992.46
Rate for Payer: Hawaii Medical Service Association Medicare	$904.89
Rate for Payer: Hawaii Western Management Group Commercial	$2,043.30
Rate for Payer: Health Management Network Commercial	$2,481.15
Rate for Payer: Humana Medicare	$904.89
Rate for Payer: Kaiser Permanente Commercial	$2,627.10
Rate for Payer: Kaiser Permanente Medicaid	$1,488.69
Rate for Payer: Kaiser Permanente Medicare	$904.89
Rate for Payer: MDX Hawaii PPO	$2,831.43
Rate for Payer: Ohana Health Plan Medicaid	$904.89
Rate for Payer: Ohana Health Plan Medicare	$904.89
Rate for Payer: UnitedHealthcare Medicare	$904.89
Rate for Payer: University Health Alliance Commercial	$1,634.64

IMPLAN STENT PANCREATIC 4FX3

Facility

$316.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$176.96
Max. Negotiated Rate	$306.52
Rate for Payer: Cash Price	$189.60
Rate for Payer: Hawaii Western Management Group Commercial	$221.20
Rate for Payer: Health Management Network Commercial	$268.60
Rate for Payer: Kaiser Permanente Commercial	$284.40
Rate for Payer: MDX Hawaii PPO	$306.52
Rate for Payer: University Health Alliance Commercial	$176.96

IMPLAN STENT PANCREATIC 4FX3

Facility

$316.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$97.96
Max. Negotiated Rate	$306.52
Rate for Payer: AlohaCare Medicaid	$158.00
Rate for Payer: AlohaCare Medicare	$97.96
Rate for Payer: Cash Price	$189.60
Rate for Payer: Devoted Health Medicare	$107.44
Rate for Payer: Hawaii Medical Service Association Medicare	$97.96
Rate for Payer: Hawaii Western Management Group Commercial	$221.20
Rate for Payer: Health Management Network Commercial	$268.60
Rate for Payer: Humana Medicare	$97.96
Rate for Payer: Kaiser Permanente Commercial	$284.40
Rate for Payer: Kaiser Permanente Medicaid	$161.16
Rate for Payer: Kaiser Permanente Medicare	$97.96
Rate for Payer: MDX Hawaii PPO	$306.52
Rate for Payer: Ohana Health Plan Medicaid	$97.96
Rate for Payer: Ohana Health Plan Medicare	$97.96
Rate for Payer: UnitedHealthcare Medicare	$97.96
Rate for Payer: University Health Alliance Commercial	$176.96

IMPLAN STENT PANCREATIC DUCT

Facility

$294.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$91.14
Max. Negotiated Rate	$285.18
Rate for Payer: AlohaCare Medicaid	$147.00
Rate for Payer: AlohaCare Medicare	$91.14
Rate for Payer: Cash Price	$176.40
Rate for Payer: Devoted Health Medicare	$99.96
Rate for Payer: Hawaii Medical Service Association Medicare	$91.14
Rate for Payer: Hawaii Western Management Group Commercial	$205.80
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Humana Medicare	$91.14
Rate for Payer: Kaiser Permanente Commercial	$264.60
Rate for Payer: Kaiser Permanente Medicaid	$149.94
Rate for Payer: Kaiser Permanente Medicare	$91.14
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: Ohana Health Plan Medicaid	$91.14
Rate for Payer: Ohana Health Plan Medicare	$91.14
Rate for Payer: UnitedHealthcare Medicare	$91.14
Rate for Payer: University Health Alliance Commercial	$164.64

IMPLAN STENT PANCREATIC DUCT

Facility

$294.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$164.64
Max. Negotiated Rate	$285.18
Rate for Payer: Cash Price	$176.40
Rate for Payer: Hawaii Western Management Group Commercial	$205.80
Rate for Payer: Health Management Network Commercial	$249.90
Rate for Payer: Kaiser Permanente Commercial	$264.60
Rate for Payer: MDX Hawaii PPO	$285.18
Rate for Payer: University Health Alliance Commercial	$164.64

IMPLAN STIMULATION LEAD

Facility

$3,900.00

Service Code	HCPCS C1778
Hospital Revenue Code	278
Min. Negotiated Rate	$1,209.00
Max. Negotiated Rate	$3,783.00
Rate for Payer: AlohaCare Medicaid	$1,950.00
Rate for Payer: AlohaCare Medicare	$1,209.00
Rate for Payer: Cash Price	$2,340.00
Rate for Payer: Devoted Health Medicare	$1,326.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,209.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,730.00
Rate for Payer: Health Management Network Commercial	$3,315.00
Rate for Payer: Humana Medicare	$1,209.00
Rate for Payer: Kaiser Permanente Commercial	$3,510.00
Rate for Payer: Kaiser Permanente Medicaid	$1,989.00
Rate for Payer: Kaiser Permanente Medicare	$1,209.00
Rate for Payer: MDX Hawaii PPO	$3,783.00
Rate for Payer: Ohana Health Plan Medicaid	$1,209.00
Rate for Payer: Ohana Health Plan Medicare	$1,209.00
Rate for Payer: UnitedHealthcare Medicare	$1,209.00
Rate for Payer: University Health Alliance Commercial	$2,184.00

IMPLAN STIMULATION LEAD

Facility

$3,900.00

Service Code	HCPCS C1778
Hospital Revenue Code	278
Min. Negotiated Rate	$2,184.00
Max. Negotiated Rate	$3,783.00
Rate for Payer: Cash Price	$2,340.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,730.00
Rate for Payer: Health Management Network Commercial	$3,315.00
Rate for Payer: Kaiser Permanente Commercial	$3,510.00
Rate for Payer: MDX Hawaii PPO	$3,783.00
Rate for Payer: University Health Alliance Commercial	$2,184.00

IMPLANT ALLODERM 2X4CM

Facility

$1,650.00

Service Code	HCPCS Q4116
Hospital Revenue Code	278
Min. Negotiated Rate	$158.93
Max. Negotiated Rate	$1,600.50
Rate for Payer: AlohaCare Medicaid	$825.00
Rate for Payer: AlohaCare Medicare	$511.50
Rate for Payer: Cash Price	$990.00
Rate for Payer: Cash Price	$990.00
Rate for Payer: Devoted Health Medicare	$561.00
Rate for Payer: Hawaii Medical Service Association Commercial	$158.93
Rate for Payer: Hawaii Medical Service Association Medicare	$511.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,155.00
Rate for Payer: Health Management Network Commercial	$1,402.50
Rate for Payer: Humana Medicare	$511.50
Rate for Payer: Kaiser Permanente Commercial	$1,485.00
Rate for Payer: Kaiser Permanente Medicaid	$841.50
Rate for Payer: Kaiser Permanente Medicare	$511.50
Rate for Payer: MDX Hawaii PPO	$1,600.50
Rate for Payer: Ohana Health Plan Medicaid	$511.50
Rate for Payer: Ohana Health Plan Medicare	$511.50
Rate for Payer: UnitedHealthcare Medicare	$511.50
Rate for Payer: University Health Alliance Commercial	$924.00

IMPLANT ALLODERM 2X4CM

Facility

$1,650.00

Service Code	HCPCS Q4116
Hospital Revenue Code	278
Min. Negotiated Rate	$924.00
Max. Negotiated Rate	$1,600.50
Rate for Payer: Cash Price	$990.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,155.00
Rate for Payer: Health Management Network Commercial	$1,402.50
Rate for Payer: Kaiser Permanente Commercial	$1,485.00
Rate for Payer: MDX Hawaii PPO	$1,600.50
Rate for Payer: University Health Alliance Commercial	$924.00

IMPLANT BIOINDUCTIVE LG 4566

Facility

$4,000.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,240.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

IMPLANT BIOINDUCTIVE LG 4566

Facility

$4,000.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$1,240.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: AlohaCare Medicaid	$2,000.00
Rate for Payer: AlohaCare Medicare	$1,240.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Devoted Health Medicare	$1,360.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Humana Medicare	$1,240.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: Kaiser Permanente Medicaid	$2,040.00
Rate for Payer: Kaiser Permanente Medicare	$1,240.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: Ohana Health Plan Medicaid	$1,240.00
Rate for Payer: Ohana Health Plan Medicare	$1,240.00
Rate for Payer: UnitedHealthcare Medicare	$1,240.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

IMPLANT PENILE PROSTHSEIS

Facility

$25,110.00

Service Code	HCPCS C2622
Hospital Revenue Code	278
Min. Negotiated Rate	$7,784.10
Max. Negotiated Rate	$24,356.70
Rate for Payer: AlohaCare Medicaid	$12,555.00
Rate for Payer: AlohaCare Medicare	$7,784.10
Rate for Payer: Cash Price	$15,066.00
Rate for Payer: Devoted Health Medicare	$8,537.40
Rate for Payer: Hawaii Medical Service Association Medicare	$7,784.10
Rate for Payer: Hawaii Western Management Group Commercial	$17,577.00
Rate for Payer: Health Management Network Commercial	$21,343.50
Rate for Payer: Humana Medicare	$7,784.10
Rate for Payer: Kaiser Permanente Commercial	$22,599.00
Rate for Payer: Kaiser Permanente Medicaid	$12,806.10
Rate for Payer: Kaiser Permanente Medicare	$7,784.10
Rate for Payer: MDX Hawaii PPO	$24,356.70
Rate for Payer: Ohana Health Plan Medicaid	$7,784.10
Rate for Payer: Ohana Health Plan Medicare	$7,784.10
Rate for Payer: UnitedHealthcare Medicare	$7,784.10
Rate for Payer: University Health Alliance Commercial	$14,061.60

IMPLANT PENILE PROSTHSEIS

Facility

$25,110.00

Service Code	HCPCS C2622
Hospital Revenue Code	278
Min. Negotiated Rate	$14,061.60
Max. Negotiated Rate	$24,356.70
Rate for Payer: Cash Price	$15,066.00
Rate for Payer: Hawaii Western Management Group Commercial	$17,577.00
Rate for Payer: Health Management Network Commercial	$21,343.50
Rate for Payer: Kaiser Permanente Commercial	$22,599.00
Rate for Payer: MDX Hawaii PPO	$24,356.70
Rate for Payer: University Health Alliance Commercial	$14,061.60

IMPLANT SYS LNT AR-1665KBCSL

Facility

$2,458.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,376.48
Max. Negotiated Rate	$2,384.26
Rate for Payer: Cash Price	$1,474.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,720.60
Rate for Payer: Health Management Network Commercial	$2,089.30
Rate for Payer: Kaiser Permanente Commercial	$2,212.20
Rate for Payer: MDX Hawaii PPO	$2,384.26
Rate for Payer: University Health Alliance Commercial	$1,376.48

IMPLANT SYS LNT AR-1665KBCSL

Facility

$2,458.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$761.98
Max. Negotiated Rate	$2,384.26
Rate for Payer: AlohaCare Medicaid	$1,229.00
Rate for Payer: AlohaCare Medicare	$761.98
Rate for Payer: Cash Price	$1,474.80
Rate for Payer: Devoted Health Medicare	$835.72
Rate for Payer: Hawaii Medical Service Association Medicare	$761.98
Rate for Payer: Hawaii Western Management Group Commercial	$1,720.60
Rate for Payer: Health Management Network Commercial	$2,089.30
Rate for Payer: Humana Medicare	$761.98
Rate for Payer: Kaiser Permanente Commercial	$2,212.20
Rate for Payer: Kaiser Permanente Medicaid	$1,253.58
Rate for Payer: Kaiser Permanente Medicare	$761.98
Rate for Payer: MDX Hawaii PPO	$2,384.26
Rate for Payer: Ohana Health Plan Medicaid	$761.98
Rate for Payer: Ohana Health Plan Medicare	$761.98
Rate for Payer: UnitedHealthcare Medicare	$761.98
Rate for Payer: University Health Alliance Commercial	$1,376.48

IMPLANT SYS MPFL AR-1360CST-CP

Facility

$3,543.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,984.08
Max. Negotiated Rate	$3,436.71
Rate for Payer: Cash Price	$2,125.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,480.10
Rate for Payer: Health Management Network Commercial	$3,011.55
Rate for Payer: Kaiser Permanente Commercial	$3,188.70
Rate for Payer: MDX Hawaii PPO	$3,436.71
Rate for Payer: University Health Alliance Commercial	$1,984.08

IMPLANT SYS MPFL AR-1360CST-CP

Facility

$3,543.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,098.33
Max. Negotiated Rate	$3,436.71
Rate for Payer: AlohaCare Medicaid	$1,771.50
Rate for Payer: AlohaCare Medicare	$1,098.33
Rate for Payer: Cash Price	$2,125.80
Rate for Payer: Devoted Health Medicare	$1,204.62
Rate for Payer: Hawaii Medical Service Association Medicare	$1,098.33
Rate for Payer: Hawaii Western Management Group Commercial	$2,480.10
Rate for Payer: Health Management Network Commercial	$3,011.55
Rate for Payer: Humana Medicare	$1,098.33
Rate for Payer: Kaiser Permanente Commercial	$3,188.70
Rate for Payer: Kaiser Permanente Medicaid	$1,806.93
Rate for Payer: Kaiser Permanente Medicare	$1,098.33
Rate for Payer: MDX Hawaii PPO	$3,436.71
Rate for Payer: Ohana Health Plan Medicaid	$1,098.33
Rate for Payer: Ohana Health Plan Medicare	$1,098.33
Rate for Payer: UnitedHealthcare Medicare	$1,098.33
Rate for Payer: University Health Alliance Commercial	$1,984.08

IMPLANT SYSTEM AR-8978-CP

Facility

$3,140.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,758.40
Max. Negotiated Rate	$3,045.80
Rate for Payer: Cash Price	$1,884.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,198.00
Rate for Payer: Health Management Network Commercial	$2,669.00
Rate for Payer: Kaiser Permanente Commercial	$2,826.00
Rate for Payer: MDX Hawaii PPO	$3,045.80
Rate for Payer: University Health Alliance Commercial	$1,758.40

IMPLANT SYSTEM AR-8978-CP

Facility

$3,140.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$973.40
Max. Negotiated Rate	$3,045.80
Rate for Payer: AlohaCare Medicaid	$1,570.00
Rate for Payer: AlohaCare Medicare	$973.40
Rate for Payer: Cash Price	$1,884.00
Rate for Payer: Devoted Health Medicare	$1,067.60
Rate for Payer: Hawaii Medical Service Association Medicare	$973.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,198.00
Rate for Payer: Health Management Network Commercial	$2,669.00
Rate for Payer: Humana Medicare	$973.40
Rate for Payer: Kaiser Permanente Commercial	$2,826.00
Rate for Payer: Kaiser Permanente Medicaid	$1,601.40
Rate for Payer: Kaiser Permanente Medicare	$973.40
Rate for Payer: MDX Hawaii PPO	$3,045.80
Rate for Payer: Ohana Health Plan Medicaid	$973.40
Rate for Payer: Ohana Health Plan Medicare	$973.40
Rate for Payer: UnitedHealthcare Medicare	$973.40
Rate for Payer: University Health Alliance Commercial	$1,758.40

IMPLAN TYMPANOST 1.14MM

Facility

$194.00

Hospital Revenue Code	278
Min. Negotiated Rate	$60.14
Max. Negotiated Rate	$188.18
Rate for Payer: AlohaCare Medicaid	$97.00
Rate for Payer: AlohaCare Medicare	$60.14
Rate for Payer: Cash Price	$116.40
Rate for Payer: Devoted Health Medicare	$65.96
Rate for Payer: Hawaii Medical Service Association Medicare	$60.14
Rate for Payer: Hawaii Western Management Group Commercial	$135.80
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: Humana Medicare	$60.14
Rate for Payer: Kaiser Permanente Commercial	$174.60
Rate for Payer: Kaiser Permanente Medicaid	$98.94
Rate for Payer: Kaiser Permanente Medicare	$60.14
Rate for Payer: MDX Hawaii PPO	$188.18
Rate for Payer: Ohana Health Plan Medicaid	$60.14
Rate for Payer: Ohana Health Plan Medicare	$60.14
Rate for Payer: UnitedHealthcare Medicare	$60.14
Rate for Payer: University Health Alliance Commercial	$108.64

IMPLAN TYMPANOST 1.14MM

Facility

$194.00

Hospital Revenue Code	278
Min. Negotiated Rate	$108.64
Max. Negotiated Rate	$188.18
Rate for Payer: Cash Price	$116.40
Rate for Payer: Hawaii Western Management Group Commercial	$135.80
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: Kaiser Permanente Commercial	$174.60
Rate for Payer: MDX Hawaii PPO	$188.18
Rate for Payer: University Health Alliance Commercial	$108.64

IMPLAN TYMPANOST W/TAB 1.14

Facility

$126.00

Hospital Revenue Code	278
Min. Negotiated Rate	$70.56
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
Rate for Payer: Hawaii Western Management Group Commercial	$88.20
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: University Health Alliance Commercial	$70.56

Know your out-of-pocket cost for care.

All Charges