Kau Hospital

All Charges

Charge

Type

Setting

Price

STENT 10X60 BILIARY RX BARE

Facility

$3,357.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,879.92
Max. Negotiated Rate	$3,256.29
Rate for Payer: Cash Price	$2,014.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,349.90
Rate for Payer: Health Management Network Commercial	$2,853.45
Rate for Payer: Kaiser Permanente Commercial	$3,021.30
Rate for Payer: MDX Hawaii PPO	$3,256.29
Rate for Payer: University Health Alliance Commercial	$1,879.92

STENT 10X7 ADVANIX BILIARY RX

Facility

$490.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$151.90
Max. Negotiated Rate	$475.30
Rate for Payer: AlohaCare Medicaid	$245.00
Rate for Payer: AlohaCare Medicare	$151.90
Rate for Payer: Cash Price	$294.00
Rate for Payer: Devoted Health Medicare	$166.60
Rate for Payer: Hawaii Medical Service Association Medicare	$151.90
Rate for Payer: Hawaii Western Management Group Commercial	$343.00
Rate for Payer: Health Management Network Commercial	$416.50
Rate for Payer: Humana Medicare	$151.90
Rate for Payer: Kaiser Permanente Commercial	$441.00
Rate for Payer: Kaiser Permanente Medicaid	$249.90
Rate for Payer: Kaiser Permanente Medicare	$151.90
Rate for Payer: MDX Hawaii PPO	$475.30
Rate for Payer: Ohana Health Plan Medicaid	$151.90
Rate for Payer: Ohana Health Plan Medicare	$151.90
Rate for Payer: UnitedHealthcare Medicare	$151.90
Rate for Payer: University Health Alliance Commercial	$274.40

STENT 10X7 ADVANIX BILIARY RX

Facility

$490.00

Service Code	HCPCS C2625
Hospital Revenue Code	278
Min. Negotiated Rate	$274.40
Max. Negotiated Rate	$475.30
Rate for Payer: Cash Price	$294.00
Rate for Payer: Hawaii Western Management Group Commercial	$343.00
Rate for Payer: Health Management Network Commercial	$416.50
Rate for Payer: Kaiser Permanente Commercial	$441.00
Rate for Payer: MDX Hawaii PPO	$475.30
Rate for Payer: University Health Alliance Commercial	$274.40

STENT 10X80 8F WALLFLEX

Facility

$2,849.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$883.19
Max. Negotiated Rate	$2,763.53
Rate for Payer: AlohaCare Medicaid	$1,424.50
Rate for Payer: AlohaCare Medicare	$883.19
Rate for Payer: Cash Price	$1,709.40
Rate for Payer: Devoted Health Medicare	$968.66
Rate for Payer: Hawaii Medical Service Association Medicare	$883.19
Rate for Payer: Hawaii Western Management Group Commercial	$1,994.30
Rate for Payer: Health Management Network Commercial	$2,421.65
Rate for Payer: Humana Medicare	$883.19
Rate for Payer: Kaiser Permanente Commercial	$2,564.10
Rate for Payer: Kaiser Permanente Medicaid	$1,452.99
Rate for Payer: Kaiser Permanente Medicare	$883.19
Rate for Payer: MDX Hawaii PPO	$2,763.53
Rate for Payer: Ohana Health Plan Medicaid	$883.19
Rate for Payer: Ohana Health Plan Medicare	$883.19
Rate for Payer: UnitedHealthcare Medicare	$883.19
Rate for Payer: University Health Alliance Commercial	$1,595.44

STENT 10X80 8F WALLFLEX

Facility

$2,849.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,595.44
Max. Negotiated Rate	$2,763.53
Rate for Payer: Cash Price	$1,709.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,994.30
Rate for Payer: Health Management Network Commercial	$2,421.65
Rate for Payer: Kaiser Permanente Commercial	$2,564.10
Rate for Payer: MDX Hawaii PPO	$2,763.53
Rate for Payer: University Health Alliance Commercial	$1,595.44

STENT 18X97 ESOPHAGEAL

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

STENT 18X97 ESOPHAGEAL

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

STENT 22X90 WALLFLEX

Facility

$5,075.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,573.25
Max. Negotiated Rate	$4,922.75
Rate for Payer: AlohaCare Medicaid	$2,537.50
Rate for Payer: AlohaCare Medicare	$1,573.25
Rate for Payer: Cash Price	$3,045.00
Rate for Payer: Devoted Health Medicare	$1,725.50
Rate for Payer: Hawaii Medical Service Association Medicare	$1,573.25
Rate for Payer: Hawaii Western Management Group Commercial	$3,552.50
Rate for Payer: Health Management Network Commercial	$4,313.75
Rate for Payer: Humana Medicare	$1,573.25
Rate for Payer: Kaiser Permanente Commercial	$4,567.50
Rate for Payer: Kaiser Permanente Medicaid	$2,588.25
Rate for Payer: Kaiser Permanente Medicare	$1,573.25
Rate for Payer: MDX Hawaii PPO	$4,922.75
Rate for Payer: Ohana Health Plan Medicaid	$1,573.25
Rate for Payer: Ohana Health Plan Medicare	$1,573.25
Rate for Payer: UnitedHealthcare Medicare	$1,573.25
Rate for Payer: University Health Alliance Commercial	$2,842.00

STENT 22X90 WALLFLEX

Facility

$5,075.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$2,842.00
Max. Negotiated Rate	$4,922.75
Rate for Payer: Cash Price	$3,045.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,552.50
Rate for Payer: Health Management Network Commercial	$4,313.75
Rate for Payer: Kaiser Permanente Commercial	$4,567.50
Rate for Payer: MDX Hawaii PPO	$4,922.75
Rate for Payer: University Health Alliance Commercial	$2,842.00

STENT 4.5FRX20 URETER OPEN TIP

Facility

$555.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$310.80
Max. Negotiated Rate	$538.35
Rate for Payer: Cash Price	$333.00
Rate for Payer: Hawaii Western Management Group Commercial	$388.50
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: MDX Hawaii PPO	$538.35
Rate for Payer: University Health Alliance Commercial	$310.80

STENT 4.5FRX20 URETER OPEN TIP

Facility

$555.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$172.05
Max. Negotiated Rate	$538.35
Rate for Payer: AlohaCare Medicaid	$277.50
Rate for Payer: AlohaCare Medicare	$172.05
Rate for Payer: Cash Price	$333.00
Rate for Payer: Devoted Health Medicare	$188.70
Rate for Payer: Hawaii Medical Service Association Medicare	$172.05
Rate for Payer: Hawaii Western Management Group Commercial	$388.50
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Humana Medicare	$172.05
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: Kaiser Permanente Medicaid	$283.05
Rate for Payer: Kaiser Permanente Medicare	$172.05
Rate for Payer: MDX Hawaii PPO	$538.35
Rate for Payer: Ohana Health Plan Medicaid	$172.05
Rate for Payer: Ohana Health Plan Medicare	$172.05
Rate for Payer: UnitedHealthcare Medicare	$172.05
Rate for Payer: University Health Alliance Commercial	$310.80

STENT 4.5FRX22 URETER OPEN TIP

Facility

$769.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$430.64
Max. Negotiated Rate	$745.93
Rate for Payer: Cash Price	$461.40
Rate for Payer: Hawaii Western Management Group Commercial	$538.30
Rate for Payer: Health Management Network Commercial	$653.65
Rate for Payer: Kaiser Permanente Commercial	$692.10
Rate for Payer: MDX Hawaii PPO	$745.93
Rate for Payer: University Health Alliance Commercial	$430.64

STENT 4.5FRX22 URETER OPEN TIP

Facility

$769.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$238.39
Max. Negotiated Rate	$745.93
Rate for Payer: AlohaCare Medicaid	$384.50
Rate for Payer: AlohaCare Medicare	$238.39
Rate for Payer: Cash Price	$461.40
Rate for Payer: Devoted Health Medicare	$261.46
Rate for Payer: Hawaii Medical Service Association Medicare	$238.39
Rate for Payer: Hawaii Western Management Group Commercial	$538.30
Rate for Payer: Health Management Network Commercial	$653.65
Rate for Payer: Humana Medicare	$238.39
Rate for Payer: Kaiser Permanente Commercial	$692.10
Rate for Payer: Kaiser Permanente Medicaid	$392.19
Rate for Payer: Kaiser Permanente Medicare	$238.39
Rate for Payer: MDX Hawaii PPO	$745.93
Rate for Payer: Ohana Health Plan Medicaid	$238.39
Rate for Payer: Ohana Health Plan Medicare	$238.39
Rate for Payer: UnitedHealthcare Medicare	$238.39
Rate for Payer: University Health Alliance Commercial	$430.64

STENT 4.5FRX24 URETER OPEN TIP

Facility

$555.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$172.05
Max. Negotiated Rate	$538.35
Rate for Payer: AlohaCare Medicaid	$277.50
Rate for Payer: AlohaCare Medicare	$172.05
Rate for Payer: Cash Price	$333.00
Rate for Payer: Devoted Health Medicare	$188.70
Rate for Payer: Hawaii Medical Service Association Medicare	$172.05
Rate for Payer: Hawaii Western Management Group Commercial	$388.50
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Humana Medicare	$172.05
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: Kaiser Permanente Medicaid	$283.05
Rate for Payer: Kaiser Permanente Medicare	$172.05
Rate for Payer: MDX Hawaii PPO	$538.35
Rate for Payer: Ohana Health Plan Medicaid	$172.05
Rate for Payer: Ohana Health Plan Medicare	$172.05
Rate for Payer: UnitedHealthcare Medicare	$172.05
Rate for Payer: University Health Alliance Commercial	$310.80

STENT 4.5FRX24 URETER OPEN TIP

Facility

$555.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$310.80
Max. Negotiated Rate	$538.35
Rate for Payer: Cash Price	$333.00
Rate for Payer: Hawaii Western Management Group Commercial	$388.50
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: MDX Hawaii PPO	$538.35
Rate for Payer: University Health Alliance Commercial	$310.80

STENT 4.5FRX26 URETER OPEN TIP

Facility

$555.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$172.05
Max. Negotiated Rate	$538.35
Rate for Payer: AlohaCare Medicaid	$277.50
Rate for Payer: AlohaCare Medicare	$172.05
Rate for Payer: Cash Price	$333.00
Rate for Payer: Devoted Health Medicare	$188.70
Rate for Payer: Hawaii Medical Service Association Medicare	$172.05
Rate for Payer: Hawaii Western Management Group Commercial	$388.50
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Humana Medicare	$172.05
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: Kaiser Permanente Medicaid	$283.05
Rate for Payer: Kaiser Permanente Medicare	$172.05
Rate for Payer: MDX Hawaii PPO	$538.35
Rate for Payer: Ohana Health Plan Medicaid	$172.05
Rate for Payer: Ohana Health Plan Medicare	$172.05
Rate for Payer: UnitedHealthcare Medicare	$172.05
Rate for Payer: University Health Alliance Commercial	$310.80

STENT 4.5FRX26 URETER OPEN TIP

Facility

$555.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$310.80
Max. Negotiated Rate	$538.35
Rate for Payer: Cash Price	$333.00
Rate for Payer: Hawaii Western Management Group Commercial	$388.50
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: MDX Hawaii PPO	$538.35
Rate for Payer: University Health Alliance Commercial	$310.80

STENT 4.5FRX28 URETER OPEN TIP

Facility

$555.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$172.05
Max. Negotiated Rate	$538.35
Rate for Payer: AlohaCare Medicaid	$277.50
Rate for Payer: AlohaCare Medicare	$172.05
Rate for Payer: Cash Price	$333.00
Rate for Payer: Devoted Health Medicare	$188.70
Rate for Payer: Hawaii Medical Service Association Medicare	$172.05
Rate for Payer: Hawaii Western Management Group Commercial	$388.50
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Humana Medicare	$172.05
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: Kaiser Permanente Medicaid	$283.05
Rate for Payer: Kaiser Permanente Medicare	$172.05
Rate for Payer: MDX Hawaii PPO	$538.35
Rate for Payer: Ohana Health Plan Medicaid	$172.05
Rate for Payer: Ohana Health Plan Medicare	$172.05
Rate for Payer: UnitedHealthcare Medicare	$172.05
Rate for Payer: University Health Alliance Commercial	$310.80

STENT 4.5FRX28 URETER OPEN TIP

Facility

$555.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$310.80
Max. Negotiated Rate	$538.35
Rate for Payer: Cash Price	$333.00
Rate for Payer: Hawaii Western Management Group Commercial	$388.50
Rate for Payer: Health Management Network Commercial	$471.75
Rate for Payer: Kaiser Permanente Commercial	$499.50
Rate for Payer: MDX Hawaii PPO	$538.35
Rate for Payer: University Health Alliance Commercial	$310.80

STENT 5FRX5 PANREATIC FLEXI

Facility

$240.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$74.40
Max. Negotiated Rate	$232.80
Rate for Payer: AlohaCare Medicaid	$120.00
Rate for Payer: AlohaCare Medicare	$74.40
Rate for Payer: Cash Price	$144.00
Rate for Payer: Devoted Health Medicare	$81.60
Rate for Payer: Hawaii Medical Service Association Medicare	$74.40
Rate for Payer: Hawaii Western Management Group Commercial	$168.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Humana Medicare	$74.40
Rate for Payer: Kaiser Permanente Commercial	$216.00
Rate for Payer: Kaiser Permanente Medicaid	$122.40
Rate for Payer: Kaiser Permanente Medicare	$74.40
Rate for Payer: MDX Hawaii PPO	$232.80
Rate for Payer: Ohana Health Plan Medicaid	$74.40
Rate for Payer: Ohana Health Plan Medicare	$74.40
Rate for Payer: UnitedHealthcare Medicare	$74.40
Rate for Payer: University Health Alliance Commercial	$134.40

STENT 5FRX5 PANREATIC FLEXI

Facility

$240.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$134.40
Max. Negotiated Rate	$232.80
Rate for Payer: Cash Price	$144.00
Rate for Payer: Hawaii Western Management Group Commercial	$168.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Kaiser Permanente Commercial	$216.00
Rate for Payer: MDX Hawaii PPO	$232.80
Rate for Payer: University Health Alliance Commercial	$134.40

STENT 6X20 URETERAL DBL PIG

Facility

$532.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$297.92
Max. Negotiated Rate	$516.04
Rate for Payer: Cash Price	$319.20
Rate for Payer: Hawaii Western Management Group Commercial	$372.40
Rate for Payer: Health Management Network Commercial	$452.20
Rate for Payer: Kaiser Permanente Commercial	$478.80
Rate for Payer: MDX Hawaii PPO	$516.04
Rate for Payer: University Health Alliance Commercial	$297.92

STENT 6X20 URETERAL DBL PIG

Facility

$532.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$164.92
Max. Negotiated Rate	$516.04
Rate for Payer: AlohaCare Medicaid	$266.00
Rate for Payer: AlohaCare Medicare	$164.92
Rate for Payer: Cash Price	$319.20
Rate for Payer: Devoted Health Medicare	$180.88
Rate for Payer: Hawaii Medical Service Association Medicare	$164.92
Rate for Payer: Hawaii Western Management Group Commercial	$372.40
Rate for Payer: Health Management Network Commercial	$452.20
Rate for Payer: Humana Medicare	$164.92
Rate for Payer: Kaiser Permanente Commercial	$478.80
Rate for Payer: Kaiser Permanente Medicaid	$271.32
Rate for Payer: Kaiser Permanente Medicare	$164.92
Rate for Payer: MDX Hawaii PPO	$516.04
Rate for Payer: Ohana Health Plan Medicaid	$164.92
Rate for Payer: Ohana Health Plan Medicare	$164.92
Rate for Payer: UnitedHealthcare Medicare	$164.92
Rate for Payer: University Health Alliance Commercial	$297.92

STENT 6X24 FILIFORM DBL PIG

Facility

$532.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$164.92
Max. Negotiated Rate	$516.04
Rate for Payer: AlohaCare Medicaid	$266.00
Rate for Payer: AlohaCare Medicare	$164.92
Rate for Payer: Cash Price	$319.20
Rate for Payer: Devoted Health Medicare	$180.88
Rate for Payer: Hawaii Medical Service Association Medicare	$164.92
Rate for Payer: Hawaii Western Management Group Commercial	$372.40
Rate for Payer: Health Management Network Commercial	$452.20
Rate for Payer: Humana Medicare	$164.92
Rate for Payer: Kaiser Permanente Commercial	$478.80
Rate for Payer: Kaiser Permanente Medicaid	$271.32
Rate for Payer: Kaiser Permanente Medicare	$164.92
Rate for Payer: MDX Hawaii PPO	$516.04
Rate for Payer: Ohana Health Plan Medicaid	$164.92
Rate for Payer: Ohana Health Plan Medicare	$164.92
Rate for Payer: UnitedHealthcare Medicare	$164.92
Rate for Payer: University Health Alliance Commercial	$297.92

STENT 6X24 FILIFORM DBL PIG

Facility

$532.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$297.92
Max. Negotiated Rate	$516.04
Rate for Payer: Cash Price	$319.20
Rate for Payer: Hawaii Western Management Group Commercial	$372.40
Rate for Payer: Health Management Network Commercial	$452.20
Rate for Payer: Kaiser Permanente Commercial	$478.80
Rate for Payer: MDX Hawaii PPO	$516.04
Rate for Payer: University Health Alliance Commercial	$297.92

Know your out-of-pocket cost for care.

All Charges