Kau Hospital

All Charges

Charge

Type

Setting

Price

STAPLE TA 90-4.8 LOAD TA9048L

Facility

$214.00

Hospital Revenue Code	272
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$128.40
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: MDX Hawaii PPO	$207.58

STAPLE TA 90-4.8 LOAD TA9048L

Facility

$214.00

Hospital Revenue Code	272
Min. Negotiated Rate	$66.34
Max. Negotiated Rate	$207.58
Rate for Payer: AlohaCare Medicaid	$107.00
Rate for Payer: AlohaCare Medicare	$66.34
Rate for Payer: Cash Price	$128.40
Rate for Payer: Devoted Health Medicare	$72.76
Rate for Payer: Hawaii Medical Service Association Medicare	$66.34
Rate for Payer: Hawaii Western Management Group Commercial	$203.30
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Humana Medicare	$66.34
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: Kaiser Permanente Medicaid	$109.14
Rate for Payer: Kaiser Permanente Medicare	$66.34
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: Ohana Health Plan Medicaid	$66.34
Rate for Payer: Ohana Health Plan Medicare	$66.34
Rate for Payer: UnitedHealthcare Medicare	$66.34
Rate for Payer: University Health Alliance Commercial	$155.98

STEINMANN 2.0X229MM 262-07-04

Facility

$900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$279.00
Max. Negotiated Rate	$873.00
Rate for Payer: AlohaCare Medicaid	$450.00
Rate for Payer: AlohaCare Medicare	$279.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Devoted Health Medicare	$306.00
Rate for Payer: Hawaii Medical Service Association Medicare	$279.00
Rate for Payer: Hawaii Western Management Group Commercial	$630.00
Rate for Payer: Health Management Network Commercial	$765.00
Rate for Payer: Humana Medicare	$279.00
Rate for Payer: Kaiser Permanente Commercial	$810.00
Rate for Payer: Kaiser Permanente Medicaid	$459.00
Rate for Payer: Kaiser Permanente Medicare	$279.00
Rate for Payer: MDX Hawaii PPO	$873.00
Rate for Payer: Ohana Health Plan Medicaid	$279.00
Rate for Payer: Ohana Health Plan Medicare	$279.00
Rate for Payer: UnitedHealthcare Medicare	$279.00
Rate for Payer: University Health Alliance Commercial	$504.00

STEINMANN 2.0X229MM 262-07-04

Facility

$900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$504.00
Max. Negotiated Rate	$873.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Hawaii Western Management Group Commercial	$630.00
Rate for Payer: Health Management Network Commercial	$765.00
Rate for Payer: Kaiser Permanente Commercial	$810.00
Rate for Payer: MDX Hawaii PPO	$873.00
Rate for Payer: University Health Alliance Commercial	$504.00

STEINMANN 2.4X229MM 262-06-04

Facility

$713.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
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	$499.10
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	$399.28

STEINMANN 2.4X229MM 262-06-04

Facility

$713.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$399.28
Max. Negotiated Rate	$691.61
Rate for Payer: Cash Price	$427.80
Rate for Payer: Hawaii Western Management Group Commercial	$499.10
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
Rate for Payer: University Health Alliance Commercial	$399.28

STEINMANN 2.8X229MM 262-05-04

Facility

$713.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$399.28
Max. Negotiated Rate	$691.61
Rate for Payer: Cash Price	$427.80
Rate for Payer: Hawaii Western Management Group Commercial	$499.10
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
Rate for Payer: University Health Alliance Commercial	$399.28

STEINMANN 2.8X229MM 262-05-04

Facility

$713.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
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	$499.10
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	$399.28

STEINMANN 3.2X229MM 262-04-04

Facility

$900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$279.00
Max. Negotiated Rate	$873.00
Rate for Payer: AlohaCare Medicaid	$450.00
Rate for Payer: AlohaCare Medicare	$279.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Devoted Health Medicare	$306.00
Rate for Payer: Hawaii Medical Service Association Medicare	$279.00
Rate for Payer: Hawaii Western Management Group Commercial	$630.00
Rate for Payer: Health Management Network Commercial	$765.00
Rate for Payer: Humana Medicare	$279.00
Rate for Payer: Kaiser Permanente Commercial	$810.00
Rate for Payer: Kaiser Permanente Medicaid	$459.00
Rate for Payer: Kaiser Permanente Medicare	$279.00
Rate for Payer: MDX Hawaii PPO	$873.00
Rate for Payer: Ohana Health Plan Medicaid	$279.00
Rate for Payer: Ohana Health Plan Medicare	$279.00
Rate for Payer: UnitedHealthcare Medicare	$279.00
Rate for Payer: University Health Alliance Commercial	$504.00

STEINMANN 3.2X229MM 262-04-04

Facility

$900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$504.00
Max. Negotiated Rate	$873.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Hawaii Western Management Group Commercial	$630.00
Rate for Payer: Health Management Network Commercial	$765.00
Rate for Payer: Kaiser Permanente Commercial	$810.00
Rate for Payer: MDX Hawaii PPO	$873.00
Rate for Payer: University Health Alliance Commercial	$504.00

STEINMANN 3.6X229MM 262-03-04

Facility

$713.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
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	$499.10
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	$399.28

STEINMANN 3.6X229MM 262-03-04

Facility

$713.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$399.28
Max. Negotiated Rate	$691.61
Rate for Payer: Cash Price	$427.80
Rate for Payer: Hawaii Western Management Group Commercial	$499.10
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
Rate for Payer: University Health Alliance Commercial	$399.28

STEINMANN 4.0X229MM 262-02-04

Facility

$160.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$49.60
Max. Negotiated Rate	$155.20
Rate for Payer: AlohaCare Medicaid	$80.00
Rate for Payer: AlohaCare Medicare	$49.60
Rate for Payer: Cash Price	$96.00
Rate for Payer: Devoted Health Medicare	$54.40
Rate for Payer: Hawaii Medical Service Association Medicare	$49.60
Rate for Payer: Hawaii Western Management Group Commercial	$112.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Humana Medicare	$49.60
Rate for Payer: Kaiser Permanente Commercial	$144.00
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: Kaiser Permanente Medicare	$49.60
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: Ohana Health Plan Medicaid	$49.60
Rate for Payer: Ohana Health Plan Medicare	$49.60
Rate for Payer: UnitedHealthcare Medicare	$49.60
Rate for Payer: University Health Alliance Commercial	$89.60

STEINMANN 4.0X229MM 262-02-04

Facility

$160.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$89.60
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Hawaii Western Management Group Commercial	$112.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Kaiser Permanente Commercial	$144.00
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: University Health Alliance Commercial	$89.60

STEINMANN 4.8MM 00-0187-007-69

Facility

$120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$116.40
Rate for Payer: AlohaCare Medicaid	$60.00
Rate for Payer: AlohaCare Medicare	$37.20
Rate for Payer: Cash Price	$72.00
Rate for Payer: Devoted Health Medicare	$40.80
Rate for Payer: Hawaii Medical Service Association Medicare	$37.20
Rate for Payer: Hawaii Western Management Group Commercial	$84.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Humana Medicare	$37.20
Rate for Payer: Kaiser Permanente Commercial	$108.00
Rate for Payer: Kaiser Permanente Medicaid	$61.20
Rate for Payer: Kaiser Permanente Medicare	$37.20
Rate for Payer: MDX Hawaii PPO	$116.40
Rate for Payer: Ohana Health Plan Medicaid	$37.20
Rate for Payer: Ohana Health Plan Medicare	$37.20
Rate for Payer: UnitedHealthcare Medicare	$37.20
Rate for Payer: University Health Alliance Commercial	$67.20

STEINMANN 4.8MM 00-0187-007-69

Facility

$120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Hawaii Western Management Group Commercial	$84.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Kaiser Permanente Commercial	$108.00
Rate for Payer: MDX Hawaii PPO	$116.40
Rate for Payer: University Health Alliance Commercial	$67.20

STEINMANN 4.8X229MM 262-01-04

Facility

$160.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$89.60
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$96.00
Rate for Payer: Hawaii Western Management Group Commercial	$112.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Kaiser Permanente Commercial	$144.00
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: University Health Alliance Commercial	$89.60

STEINMANN 4.8X229MM 262-01-04

Facility

$160.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$49.60
Max. Negotiated Rate	$155.20
Rate for Payer: AlohaCare Medicaid	$80.00
Rate for Payer: AlohaCare Medicare	$49.60
Rate for Payer: Cash Price	$96.00
Rate for Payer: Devoted Health Medicare	$54.40
Rate for Payer: Hawaii Medical Service Association Medicare	$49.60
Rate for Payer: Hawaii Western Management Group Commercial	$112.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Humana Medicare	$49.60
Rate for Payer: Kaiser Permanente Commercial	$144.00
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: Kaiser Permanente Medicare	$49.60
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: Ohana Health Plan Medicaid	$49.60
Rate for Payer: Ohana Health Plan Medicare	$49.60
Rate for Payer: UnitedHealthcare Medicare	$49.60
Rate for Payer: University Health Alliance Commercial	$89.60

STEINMAN PIN 2.4MM 187-02-59

Facility

$120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Hawaii Western Management Group Commercial	$84.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Kaiser Permanente Commercial	$108.00
Rate for Payer: MDX Hawaii PPO	$116.40
Rate for Payer: University Health Alliance Commercial	$67.20

STEINMAN PIN 2.4MM 187-02-59

Facility

$120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$116.40
Rate for Payer: AlohaCare Medicaid	$60.00
Rate for Payer: AlohaCare Medicare	$37.20
Rate for Payer: Cash Price	$72.00
Rate for Payer: Devoted Health Medicare	$40.80
Rate for Payer: Hawaii Medical Service Association Medicare	$37.20
Rate for Payer: Hawaii Western Management Group Commercial	$84.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Humana Medicare	$37.20
Rate for Payer: Kaiser Permanente Commercial	$108.00
Rate for Payer: Kaiser Permanente Medicaid	$61.20
Rate for Payer: Kaiser Permanente Medicare	$37.20
Rate for Payer: MDX Hawaii PPO	$116.40
Rate for Payer: Ohana Health Plan Medicaid	$37.20
Rate for Payer: Ohana Health Plan Medicare	$37.20
Rate for Payer: UnitedHealthcare Medicare	$37.20
Rate for Payer: University Health Alliance Commercial	$67.20

STEINMAN PIN 2.8MM 187-03-59

Facility

$120.00

Service Code	HCPCS C1769
Hospital Revenue Code	278
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$116.40
Rate for Payer: AlohaCare Medicaid	$60.00
Rate for Payer: AlohaCare Medicare	$37.20
Rate for Payer: Cash Price	$72.00
Rate for Payer: Devoted Health Medicare	$40.80
Rate for Payer: Hawaii Medical Service Association Medicare	$37.20
Rate for Payer: Hawaii Western Management Group Commercial	$84.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Humana Medicare	$37.20
Rate for Payer: Kaiser Permanente Commercial	$108.00
Rate for Payer: Kaiser Permanente Medicaid	$61.20
Rate for Payer: Kaiser Permanente Medicare	$37.20
Rate for Payer: MDX Hawaii PPO	$116.40
Rate for Payer: Ohana Health Plan Medicaid	$37.20
Rate for Payer: Ohana Health Plan Medicare	$37.20
Rate for Payer: UnitedHealthcare Medicare	$37.20
Rate for Payer: University Health Alliance Commercial	$67.20

STEINMAN PIN 2.8MM 187-03-59

Facility

$120.00

Service Code	HCPCS C1769
Hospital Revenue Code	278
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$72.00
Rate for Payer: Hawaii Western Management Group Commercial	$84.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Kaiser Permanente Commercial	$108.00
Rate for Payer: MDX Hawaii PPO	$116.40
Rate for Payer: University Health Alliance Commercial	$67.20

STEINMAN PIN 3.2MM 187-04-59

Facility

$140.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Hawaii Western Management Group Commercial	$98.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: University Health Alliance Commercial	$78.40

STEINMAN PIN 3.2MM 187-04-59

Facility

$140.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$43.40
Max. Negotiated Rate	$135.80
Rate for Payer: AlohaCare Medicaid	$70.00
Rate for Payer: AlohaCare Medicare	$43.40
Rate for Payer: Cash Price	$84.00
Rate for Payer: Devoted Health Medicare	$47.60
Rate for Payer: Hawaii Medical Service Association Medicare	$43.40
Rate for Payer: Hawaii Western Management Group Commercial	$98.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Humana Medicare	$43.40
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: Kaiser Permanente Medicaid	$71.40
Rate for Payer: Kaiser Permanente Medicare	$43.40
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: Ohana Health Plan Medicaid	$43.40
Rate for Payer: Ohana Health Plan Medicare	$43.40
Rate for Payer: UnitedHealthcare Medicare	$43.40
Rate for Payer: University Health Alliance Commercial	$78.40

STEINMAN PIN 3.6MM 187-05-59

Facility

$110.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$61.60
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$66.00
Rate for Payer: Hawaii Western Management Group Commercial	$77.00
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: Kaiser Permanente Commercial	$99.00
Rate for Payer: MDX Hawaii PPO	$106.70
Rate for Payer: University Health Alliance Commercial	$61.60

Know your out-of-pocket cost for care.

All Charges