Kau Hospital

All Charges

Charge

Type

Setting

Price

STABILIZER SZ.6 5515-F-602

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

STABILIZER SZ.6 5515-F-602

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,327.42
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$1,327.42
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$1,455.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,327.42
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$1,327.42
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$1,327.42
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$1,327.42
Rate for Payer: Ohana Health Plan Medicare	$1,327.42
Rate for Payer: UnitedHealthcare Medicare	$1,327.42
Rate for Payer: University Health Alliance Commercial	$2,397.92

STABILIZER TIBIAL 5537-G-513-E

Facility

$4,903.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,519.93
Max. Negotiated Rate	$4,755.91
Rate for Payer: AlohaCare Medicaid	$2,451.50
Rate for Payer: AlohaCare Medicare	$1,519.93
Rate for Payer: Cash Price	$2,941.80
Rate for Payer: Devoted Health Medicare	$1,667.02
Rate for Payer: Hawaii Medical Service Association Medicare	$1,519.93
Rate for Payer: Hawaii Western Management Group Commercial	$3,432.10
Rate for Payer: Health Management Network Commercial	$4,167.55
Rate for Payer: Humana Medicare	$1,519.93
Rate for Payer: Kaiser Permanente Commercial	$4,412.70
Rate for Payer: Kaiser Permanente Medicaid	$2,500.53
Rate for Payer: Kaiser Permanente Medicare	$1,519.93
Rate for Payer: MDX Hawaii PPO	$4,755.91
Rate for Payer: Ohana Health Plan Medicaid	$1,519.93
Rate for Payer: Ohana Health Plan Medicare	$1,519.93
Rate for Payer: UnitedHealthcare Medicare	$1,519.93
Rate for Payer: University Health Alliance Commercial	$2,745.68

STABILIZER TIBIAL 5537-G-513-E

Facility

$4,903.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,745.68
Max. Negotiated Rate	$4,755.91
Rate for Payer: Cash Price	$2,941.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,432.10
Rate for Payer: Health Management Network Commercial	$4,167.55
Rate for Payer: Kaiser Permanente Commercial	$4,412.70
Rate for Payer: MDX Hawaii PPO	$4,755.91
Rate for Payer: University Health Alliance Commercial	$2,745.68

STANDARD INTENSITY HEPARIN CALCULATOR PRN BOLUS [4080208]

Facility

$31.00

Service Code	HCPCS J1644
Hospital Revenue Code	250
Min. Negotiated Rate	$26.35
Max. Negotiated Rate	$30.07
Rate for Payer: Cash Price	$18.60
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: MDX Hawaii PPO	$30.07

STANDARD INTENSITY HEPARIN CALCULATOR PRN BOLUS [4080208]

Facility

$31.00

Service Code	HCPCS J1644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$30.07
Rate for Payer: AlohaCare Medicaid	$15.50
Rate for Payer: AlohaCare Medicare	$9.61
Rate for Payer: Cash Price	$18.60
Rate for Payer: Cash Price	$18.60
Rate for Payer: Devoted Health Medicare	$10.54
Rate for Payer: Hawaii Medical Service Association ABD	$0.22
Rate for Payer: Hawaii Medical Service Association Medicare	$9.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.22
Rate for Payer: Hawaii Western Management Group Commercial	$29.45
Rate for Payer: Health Management Network Commercial	$26.35
Rate for Payer: Humana Medicare	$9.61
Rate for Payer: Kaiser Permanente Commercial	$27.90
Rate for Payer: Kaiser Permanente Medicaid	$15.81
Rate for Payer: Kaiser Permanente Medicare	$9.61
Rate for Payer: MDX Hawaii PPO	$30.07
Rate for Payer: Ohana Health Plan Medicaid	$9.61
Rate for Payer: Ohana Health Plan Medicare	$9.61
Rate for Payer: UnitedHealthcare Medicaid	$18.60
Rate for Payer: UnitedHealthcare Medicare	$9.61
Rate for Payer: University Health Alliance Commercial	$22.60

STAPLE CEEA PREM PLUS 21MM

Facility

$944.00

Hospital Revenue Code	272
Min. Negotiated Rate	$802.40
Max. Negotiated Rate	$915.68
Rate for Payer: Cash Price	$566.40
Rate for Payer: Health Management Network Commercial	$802.40
Rate for Payer: Kaiser Permanente Commercial	$849.60
Rate for Payer: MDX Hawaii PPO	$915.68

STAPLE CEEA PREM PLUS 21MM

Facility

$944.00

Hospital Revenue Code	272
Min. Negotiated Rate	$292.64
Max. Negotiated Rate	$915.68
Rate for Payer: AlohaCare Medicaid	$472.00
Rate for Payer: AlohaCare Medicare	$292.64
Rate for Payer: Cash Price	$566.40
Rate for Payer: Devoted Health Medicare	$320.96
Rate for Payer: Hawaii Medical Service Association Medicare	$292.64
Rate for Payer: Hawaii Western Management Group Commercial	$896.80
Rate for Payer: Health Management Network Commercial	$802.40
Rate for Payer: Humana Medicare	$292.64
Rate for Payer: Kaiser Permanente Commercial	$849.60
Rate for Payer: Kaiser Permanente Medicaid	$481.44
Rate for Payer: Kaiser Permanente Medicare	$292.64
Rate for Payer: MDX Hawaii PPO	$915.68
Rate for Payer: Ohana Health Plan Medicaid	$292.64
Rate for Payer: Ohana Health Plan Medicare	$292.64
Rate for Payer: UnitedHealthcare Medicare	$292.64
Rate for Payer: University Health Alliance Commercial	$688.08

STAPLE CEEA PREM PLUS 25MM

Facility

$999.00

Hospital Revenue Code	272
Min. Negotiated Rate	$309.69
Max. Negotiated Rate	$969.03
Rate for Payer: AlohaCare Medicaid	$499.50
Rate for Payer: AlohaCare Medicare	$309.69
Rate for Payer: Cash Price	$599.40
Rate for Payer: Devoted Health Medicare	$339.66
Rate for Payer: Hawaii Medical Service Association Medicare	$309.69
Rate for Payer: Hawaii Western Management Group Commercial	$949.05
Rate for Payer: Health Management Network Commercial	$849.15
Rate for Payer: Humana Medicare	$309.69
Rate for Payer: Kaiser Permanente Commercial	$899.10
Rate for Payer: Kaiser Permanente Medicaid	$509.49
Rate for Payer: Kaiser Permanente Medicare	$309.69
Rate for Payer: MDX Hawaii PPO	$969.03
Rate for Payer: Ohana Health Plan Medicaid	$309.69
Rate for Payer: Ohana Health Plan Medicare	$309.69
Rate for Payer: UnitedHealthcare Medicare	$309.69
Rate for Payer: University Health Alliance Commercial	$728.17

STAPLE CEEA PREM PLUS 25MM

Facility

$999.00

Hospital Revenue Code	272
Min. Negotiated Rate	$849.15
Max. Negotiated Rate	$969.03
Rate for Payer: Cash Price	$599.40
Rate for Payer: Health Management Network Commercial	$849.15
Rate for Payer: Kaiser Permanente Commercial	$899.10
Rate for Payer: MDX Hawaii PPO	$969.03

STAPLE CEEA PREM PLUS 28MM

Facility

$1,019.00

Hospital Revenue Code	272
Min. Negotiated Rate	$866.15
Max. Negotiated Rate	$988.43
Rate for Payer: Cash Price	$611.40
Rate for Payer: Health Management Network Commercial	$866.15
Rate for Payer: Kaiser Permanente Commercial	$917.10
Rate for Payer: MDX Hawaii PPO	$988.43

STAPLE CEEA PREM PLUS 28MM

Facility

$1,019.00

Hospital Revenue Code	272
Min. Negotiated Rate	$315.89
Max. Negotiated Rate	$988.43
Rate for Payer: AlohaCare Medicaid	$509.50
Rate for Payer: AlohaCare Medicare	$315.89
Rate for Payer: Cash Price	$611.40
Rate for Payer: Devoted Health Medicare	$346.46
Rate for Payer: Hawaii Medical Service Association Medicare	$315.89
Rate for Payer: Hawaii Western Management Group Commercial	$968.05
Rate for Payer: Health Management Network Commercial	$866.15
Rate for Payer: Humana Medicare	$315.89
Rate for Payer: Kaiser Permanente Commercial	$917.10
Rate for Payer: Kaiser Permanente Medicaid	$519.69
Rate for Payer: Kaiser Permanente Medicare	$315.89
Rate for Payer: MDX Hawaii PPO	$988.43
Rate for Payer: Ohana Health Plan Medicaid	$315.89
Rate for Payer: Ohana Health Plan Medicare	$315.89
Rate for Payer: UnitedHealthcare Medicare	$315.89
Rate for Payer: University Health Alliance Commercial	$742.75

STAPLE CEEA PREM PLUS 31MM

Facility

$1,183.00

Hospital Revenue Code	272
Min. Negotiated Rate	$366.73
Max. Negotiated Rate	$1,147.51
Rate for Payer: AlohaCare Medicaid	$591.50
Rate for Payer: AlohaCare Medicare	$366.73
Rate for Payer: Cash Price	$709.80
Rate for Payer: Devoted Health Medicare	$402.22
Rate for Payer: Hawaii Medical Service Association Medicare	$366.73
Rate for Payer: Hawaii Western Management Group Commercial	$1,123.85
Rate for Payer: Health Management Network Commercial	$1,005.55
Rate for Payer: Humana Medicare	$366.73
Rate for Payer: Kaiser Permanente Commercial	$1,064.70
Rate for Payer: Kaiser Permanente Medicaid	$603.33
Rate for Payer: Kaiser Permanente Medicare	$366.73
Rate for Payer: MDX Hawaii PPO	$1,147.51
Rate for Payer: Ohana Health Plan Medicaid	$366.73
Rate for Payer: Ohana Health Plan Medicare	$366.73
Rate for Payer: UnitedHealthcare Medicare	$366.73
Rate for Payer: University Health Alliance Commercial	$862.29

STAPLE CEEA PREM PLUS 31MM

Facility

$1,183.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,005.55
Max. Negotiated Rate	$1,147.51
Rate for Payer: Cash Price	$709.80
Rate for Payer: Health Management Network Commercial	$1,005.55
Rate for Payer: Kaiser Permanente Commercial	$1,064.70
Rate for Payer: MDX Hawaii PPO	$1,147.51

STAPLER 12MM BLADELESS 470395

Facility

$2,457.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,088.45
Max. Negotiated Rate	$2,383.29
Rate for Payer: Cash Price	$1,474.20
Rate for Payer: Health Management Network Commercial	$2,088.45
Rate for Payer: Kaiser Permanente Commercial	$2,211.30
Rate for Payer: MDX Hawaii PPO	$2,383.29

STAPLER 12MM BLADELESS 470395

Facility

$2,457.00

Hospital Revenue Code	272
Min. Negotiated Rate	$761.67
Max. Negotiated Rate	$2,383.29
Rate for Payer: AlohaCare Medicaid	$1,228.50
Rate for Payer: AlohaCare Medicare	$761.67
Rate for Payer: Cash Price	$1,474.20
Rate for Payer: Devoted Health Medicare	$835.38
Rate for Payer: Hawaii Medical Service Association Medicare	$761.67
Rate for Payer: Hawaii Western Management Group Commercial	$2,334.15
Rate for Payer: Health Management Network Commercial	$2,088.45
Rate for Payer: Humana Medicare	$761.67
Rate for Payer: Kaiser Permanente Commercial	$2,211.30
Rate for Payer: Kaiser Permanente Medicaid	$1,253.07
Rate for Payer: Kaiser Permanente Medicare	$761.67
Rate for Payer: MDX Hawaii PPO	$2,383.29
Rate for Payer: Ohana Health Plan Medicaid	$761.67
Rate for Payer: Ohana Health Plan Medicare	$761.67
Rate for Payer: UnitedHealthcare Medicare	$761.67
Rate for Payer: University Health Alliance Commercial	$1,790.91

STAPLER 12MM CANN SEAL 470380

Facility

$126.00

Hospital Revenue Code	272
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$122.22
Rate for Payer: Cash Price	$75.60
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

STAPLER 12MM CANN SEAL 470380

Facility

$126.00

Hospital Revenue Code	272
Min. Negotiated Rate	$39.06
Max. Negotiated Rate	$122.22
Rate for Payer: AlohaCare Medicaid	$63.00
Rate for Payer: AlohaCare Medicare	$39.06
Rate for Payer: Cash Price	$75.60
Rate for Payer: Devoted Health Medicare	$42.84
Rate for Payer: Hawaii Medical Service Association Medicare	$39.06
Rate for Payer: Hawaii Western Management Group Commercial	$119.70
Rate for Payer: Health Management Network Commercial	$107.10
Rate for Payer: Humana Medicare	$39.06
Rate for Payer: Kaiser Permanente Commercial	$113.40
Rate for Payer: Kaiser Permanente Medicaid	$64.26
Rate for Payer: Kaiser Permanente Medicare	$39.06
Rate for Payer: MDX Hawaii PPO	$122.22
Rate for Payer: Ohana Health Plan Medicaid	$39.06
Rate for Payer: Ohana Health Plan Medicare	$39.06
Rate for Payer: UnitedHealthcare Medicare	$39.06
Rate for Payer: University Health Alliance Commercial	$91.84

STAPLER 5MM JR-ST25-2.0-6

Facility

$2,475.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,103.75
Max. Negotiated Rate	$2,400.75
Rate for Payer: Cash Price	$1,485.00
Rate for Payer: Health Management Network Commercial	$2,103.75
Rate for Payer: Kaiser Permanente Commercial	$2,227.50
Rate for Payer: MDX Hawaii PPO	$2,400.75

STAPLER 5MM JR-ST25-2.0-6

Facility

$2,475.00

Hospital Revenue Code	272
Min. Negotiated Rate	$767.25
Max. Negotiated Rate	$2,400.75
Rate for Payer: AlohaCare Medicaid	$1,237.50
Rate for Payer: AlohaCare Medicare	$767.25
Rate for Payer: Cash Price	$1,485.00
Rate for Payer: Devoted Health Medicare	$841.50
Rate for Payer: Hawaii Medical Service Association Medicare	$767.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,351.25
Rate for Payer: Health Management Network Commercial	$2,103.75
Rate for Payer: Humana Medicare	$767.25
Rate for Payer: Kaiser Permanente Commercial	$2,227.50
Rate for Payer: Kaiser Permanente Medicaid	$1,262.25
Rate for Payer: Kaiser Permanente Medicare	$767.25
Rate for Payer: MDX Hawaii PPO	$2,400.75
Rate for Payer: Ohana Health Plan Medicaid	$767.25
Rate for Payer: Ohana Health Plan Medicare	$767.25
Rate for Payer: UnitedHealthcare Medicare	$767.25
Rate for Payer: University Health Alliance Commercial	$1,804.03

STAPLER 60MM TRI 2.0 SIG60AXT

Facility

$939.00

Hospital Revenue Code	272
Min. Negotiated Rate	$798.15
Max. Negotiated Rate	$910.83
Rate for Payer: Cash Price	$563.40
Rate for Payer: Health Management Network Commercial	$798.15
Rate for Payer: Kaiser Permanente Commercial	$845.10
Rate for Payer: MDX Hawaii PPO	$910.83

STAPLER 60MM TRI 2.0 SIG60AXT

Facility

$939.00

Hospital Revenue Code	272
Min. Negotiated Rate	$291.09
Max. Negotiated Rate	$910.83
Rate for Payer: AlohaCare Medicaid	$469.50
Rate for Payer: AlohaCare Medicare	$291.09
Rate for Payer: Cash Price	$563.40
Rate for Payer: Devoted Health Medicare	$319.26
Rate for Payer: Hawaii Medical Service Association Medicare	$291.09
Rate for Payer: Hawaii Western Management Group Commercial	$892.05
Rate for Payer: Health Management Network Commercial	$798.15
Rate for Payer: Humana Medicare	$291.09
Rate for Payer: Kaiser Permanente Commercial	$845.10
Rate for Payer: Kaiser Permanente Medicaid	$478.89
Rate for Payer: Kaiser Permanente Medicare	$291.09
Rate for Payer: MDX Hawaii PPO	$910.83
Rate for Payer: Ohana Health Plan Medicaid	$291.09
Rate for Payer: Ohana Health Plan Medicare	$291.09
Rate for Payer: UnitedHealthcare Medicare	$291.09
Rate for Payer: University Health Alliance Commercial	$684.44

STAPLER ENDO GIA 60MM ART MED

Facility

$713.00

Hospital Revenue Code	272
Min. Negotiated Rate	$221.03
Max. Negotiated Rate	$691.61
Rate for Payer: AlohaCare Medicaid	$356.50
Rate for Payer: AlohaCare Medicare	$221.03
Rate for Payer: Cash Price	$427.80
Rate for Payer: Devoted Health Medicare	$242.42
Rate for Payer: Hawaii Medical Service Association Medicare	$221.03
Rate for Payer: Hawaii Western Management Group Commercial	$677.35
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: Humana Medicare	$221.03
Rate for Payer: Kaiser Permanente Commercial	$641.70
Rate for Payer: Kaiser Permanente Medicaid	$363.63
Rate for Payer: Kaiser Permanente Medicare	$221.03
Rate for Payer: MDX Hawaii PPO	$691.61
Rate for Payer: Ohana Health Plan Medicaid	$221.03
Rate for Payer: Ohana Health Plan Medicare	$221.03
Rate for Payer: UnitedHealthcare Medicare	$221.03
Rate for Payer: University Health Alliance Commercial	$519.71

STAPLER ENDO GIA 60MM ART MED

Facility

$713.00

Hospital Revenue Code	272
Min. Negotiated Rate	$606.05
Max. Negotiated Rate	$691.61
Rate for Payer: Cash Price	$427.80
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: Kaiser Permanente Commercial	$641.70
Rate for Payer: MDX Hawaii PPO	$691.61

STAPLER LINEAR 40MM GCS40B

Facility

$2,964.00

Hospital Revenue Code	272
Min. Negotiated Rate	$918.84
Max. Negotiated Rate	$2,875.08
Rate for Payer: AlohaCare Medicaid	$1,482.00
Rate for Payer: AlohaCare Medicare	$918.84
Rate for Payer: Cash Price	$1,778.40
Rate for Payer: Devoted Health Medicare	$1,007.76
Rate for Payer: Hawaii Medical Service Association Medicare	$918.84
Rate for Payer: Hawaii Western Management Group Commercial	$2,815.80
Rate for Payer: Health Management Network Commercial	$2,519.40
Rate for Payer: Humana Medicare	$918.84
Rate for Payer: Kaiser Permanente Commercial	$2,667.60
Rate for Payer: Kaiser Permanente Medicaid	$1,511.64
Rate for Payer: Kaiser Permanente Medicare	$918.84
Rate for Payer: MDX Hawaii PPO	$2,875.08
Rate for Payer: Ohana Health Plan Medicaid	$918.84
Rate for Payer: Ohana Health Plan Medicare	$918.84
Rate for Payer: UnitedHealthcare Medicare	$918.84
Rate for Payer: University Health Alliance Commercial	$2,160.46

Know your out-of-pocket cost for care.

All Charges