Kau Hospital

All Charges

Charge

Type

Setting

Price

STENT SET FILIFORM DBL PIG

Facility

$473.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$264.88
Max. Negotiated Rate	$458.81
Rate for Payer: Cash Price	$283.80
Rate for Payer: Cash Price	$319.20
Rate for Payer: Hawaii Western Management Group Commercial	$331.10
Rate for Payer: Hawaii Western Management Group Commercial	$372.40
Rate for Payer: Health Management Network Commercial	$402.05
Rate for Payer: Health Management Network Commercial	$452.20
Rate for Payer: Kaiser Permanente Commercial	$478.80
Rate for Payer: Kaiser Permanente Commercial	$425.70
Rate for Payer: MDX Hawaii PPO	$458.81
Rate for Payer: MDX Hawaii PPO	$516.04
Rate for Payer: University Health Alliance Commercial	$297.92
Rate for Payer: University Health Alliance Commercial	$264.88

STENT SYSTEM 7X40 SR-0740-CS

Facility

$5,400.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,674.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: AlohaCare Medicaid	$2,700.00
Rate for Payer: AlohaCare Medicare	$1,674.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Devoted Health Medicare	$1,836.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,674.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Humana Medicare	$1,674.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: Kaiser Permanente Medicare	$1,674.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: Ohana Health Plan Medicaid	$1,674.00
Rate for Payer: Ohana Health Plan Medicare	$1,674.00
Rate for Payer: UnitedHealthcare Medicare	$1,674.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

STENT SYSTEM 7X40 SR-0740-CS

Facility

$5,400.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

STENT URETERAL 6FRX22-30CM

Facility

$415.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$128.65
Max. Negotiated Rate	$402.55
Rate for Payer: AlohaCare Medicaid	$207.50
Rate for Payer: AlohaCare Medicare	$128.65
Rate for Payer: Cash Price	$249.00
Rate for Payer: Devoted Health Medicare	$141.10
Rate for Payer: Hawaii Medical Service Association Medicare	$128.65
Rate for Payer: Hawaii Western Management Group Commercial	$290.50
Rate for Payer: Health Management Network Commercial	$352.75
Rate for Payer: Humana Medicare	$128.65
Rate for Payer: Kaiser Permanente Commercial	$373.50
Rate for Payer: Kaiser Permanente Medicaid	$211.65
Rate for Payer: Kaiser Permanente Medicare	$128.65
Rate for Payer: MDX Hawaii PPO	$402.55
Rate for Payer: Ohana Health Plan Medicaid	$128.65
Rate for Payer: Ohana Health Plan Medicare	$128.65
Rate for Payer: UnitedHealthcare Medicare	$128.65
Rate for Payer: University Health Alliance Commercial	$232.40

STENT URETERAL 6FRX22-30CM

Facility

$415.00

Service Code	HCPCS C2617
Hospital Revenue Code	278
Min. Negotiated Rate	$232.40
Max. Negotiated Rate	$402.55
Rate for Payer: Cash Price	$249.00
Rate for Payer: Hawaii Western Management Group Commercial	$290.50
Rate for Payer: Health Management Network Commercial	$352.75
Rate for Payer: Kaiser Permanente Commercial	$373.50
Rate for Payer: MDX Hawaii PPO	$402.55
Rate for Payer: University Health Alliance Commercial	$232.40

STERLING MONORAIL 4.5X20X135

Facility

$875.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$271.25
Max. Negotiated Rate	$848.75
Rate for Payer: AlohaCare Medicaid	$437.50
Rate for Payer: AlohaCare Medicare	$271.25
Rate for Payer: Cash Price	$525.00
Rate for Payer: Devoted Health Medicare	$297.50
Rate for Payer: Hawaii Medical Service Association Medicare	$271.25
Rate for Payer: Hawaii Western Management Group Commercial	$831.25
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Humana Medicare	$271.25
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: Kaiser Permanente Medicare	$271.25
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: Ohana Health Plan Medicaid	$271.25
Rate for Payer: Ohana Health Plan Medicare	$271.25
Rate for Payer: UnitedHealthcare Medicare	$271.25
Rate for Payer: University Health Alliance Commercial	$637.79

STERLING MONORAIL 4.5X20X135

Facility

$875.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$743.75
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: MDX Hawaii PPO	$848.75

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC

Facility

$89,640.96

Service Code	MSDRG 327
Min. Negotiated Rate	$89,640.96
Max. Negotiated Rate	$89,640.96
Rate for Payer: Hawaii Medical Service Association Commercial	$89,640.96

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC

Facility

$126,639.79

Service Code	MSDRG 326
Min. Negotiated Rate	$126,639.79
Max. Negotiated Rate	$126,639.79
Rate for Payer: Hawaii Medical Service Association Commercial	$126,639.79

STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC

Facility

$38,373.54

Service Code	MSDRG 328
Min. Negotiated Rate	$38,373.54
Max. Negotiated Rate	$38,373.54
Rate for Payer: Hawaii Medical Service Association Commercial	$38,373.54

STRATAFIX 2-0 CT-2 9 SXPP1B432

Facility

$124.00

Hospital Revenue Code	272
Min. Negotiated Rate	$38.44
Max. Negotiated Rate	$120.28
Rate for Payer: AlohaCare Medicaid	$62.00
Rate for Payer: AlohaCare Medicare	$38.44
Rate for Payer: Cash Price	$74.40
Rate for Payer: Devoted Health Medicare	$42.16
Rate for Payer: Hawaii Medical Service Association Medicare	$38.44
Rate for Payer: Hawaii Western Management Group Commercial	$117.80
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Humana Medicare	$38.44
Rate for Payer: Kaiser Permanente Commercial	$111.60
Rate for Payer: Kaiser Permanente Medicaid	$63.24
Rate for Payer: Kaiser Permanente Medicare	$38.44
Rate for Payer: MDX Hawaii PPO	$120.28
Rate for Payer: Ohana Health Plan Medicaid	$38.44
Rate for Payer: Ohana Health Plan Medicare	$38.44
Rate for Payer: UnitedHealthcare Medicare	$38.44
Rate for Payer: University Health Alliance Commercial	$90.38

STRATAFIX 2-0 CT-2 9 SXPP1B432

Facility

$124.00

Hospital Revenue Code	272
Min. Negotiated Rate	$105.40
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$74.40
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Kaiser Permanente Commercial	$111.60
Rate for Payer: MDX Hawaii PPO	$120.28

STRATAFIX SPIRAL SXPP1B450

Facility

$124.00

Hospital Revenue Code	272
Min. Negotiated Rate	$105.40
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$74.40
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Kaiser Permanente Commercial	$111.60
Rate for Payer: MDX Hawaii PPO	$120.28

STRATAFIX SPIRAL SXPP1B450

Facility

$124.00

Hospital Revenue Code	272
Min. Negotiated Rate	$38.44
Max. Negotiated Rate	$120.28
Rate for Payer: AlohaCare Medicaid	$62.00
Rate for Payer: AlohaCare Medicare	$38.44
Rate for Payer: Cash Price	$74.40
Rate for Payer: Devoted Health Medicare	$42.16
Rate for Payer: Hawaii Medical Service Association Medicare	$38.44
Rate for Payer: Hawaii Western Management Group Commercial	$117.80
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Humana Medicare	$38.44
Rate for Payer: Kaiser Permanente Commercial	$111.60
Rate for Payer: Kaiser Permanente Medicaid	$63.24
Rate for Payer: Kaiser Permanente Medicare	$38.44
Rate for Payer: MDX Hawaii PPO	$120.28
Rate for Payer: Ohana Health Plan Medicaid	$38.44
Rate for Payer: Ohana Health Plan Medicare	$38.44
Rate for Payer: UnitedHealthcare Medicare	$38.44
Rate for Payer: University Health Alliance Commercial	$90.38

STREPTOMYCIN 1 GRAM INTRAMUSCULAR SOLUTION [7508]

Facility

$188.00

Service Code	HCPCS J3000
Hospital Revenue Code	636
Min. Negotiated Rate	$31.35
Max. Negotiated Rate	$182.36
Rate for Payer: AlohaCare Medicaid	$94.00
Rate for Payer: AlohaCare Medicare	$58.28
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cash Price	$112.80
Rate for Payer: Devoted Health Medicare	$63.92
Rate for Payer: Hawaii Medical Service Association ABD	$31.35
Rate for Payer: Hawaii Medical Service Association Medicare	$58.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$31.35
Rate for Payer: Hawaii Western Management Group Commercial	$178.60
Rate for Payer: Health Management Network Commercial	$159.80
Rate for Payer: Humana Medicare	$58.28
Rate for Payer: Kaiser Permanente Commercial	$169.20
Rate for Payer: Kaiser Permanente Medicaid	$95.88
Rate for Payer: Kaiser Permanente Medicare	$58.28
Rate for Payer: MDX Hawaii PPO	$182.36
Rate for Payer: Ohana Health Plan Medicaid	$58.28
Rate for Payer: Ohana Health Plan Medicare	$58.28
Rate for Payer: UnitedHealthcare Medicaid	$112.80
Rate for Payer: UnitedHealthcare Medicare	$58.28
Rate for Payer: University Health Alliance Commercial	$137.03

STREPTOMYCIN 1 GRAM INTRAMUSCULAR SOLUTION [7508]

Facility

$188.00

Service Code	HCPCS J3000
Hospital Revenue Code	250
Min. Negotiated Rate	$159.80
Max. Negotiated Rate	$182.36
Rate for Payer: Cash Price	$112.80
Rate for Payer: Health Management Network Commercial	$159.80
Rate for Payer: Kaiser Permanente Commercial	$169.20
Rate for Payer: MDX Hawaii PPO	$182.36

STRETCH VASCULA GRAFT SBT1201D

Facility

$2,802.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.12
Max. Negotiated Rate	$2,717.94
Rate for Payer: Cash Price	$1,681.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,961.40
Rate for Payer: Health Management Network Commercial	$2,381.70
Rate for Payer: Kaiser Permanente Commercial	$2,521.80
Rate for Payer: MDX Hawaii PPO	$2,717.94
Rate for Payer: University Health Alliance Commercial	$1,569.12

STRETCH VASCULA GRAFT SBT1201D

Facility

$2,802.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$868.62
Max. Negotiated Rate	$2,717.94
Rate for Payer: AlohaCare Medicaid	$1,401.00
Rate for Payer: AlohaCare Medicare	$868.62
Rate for Payer: Cash Price	$1,681.20
Rate for Payer: Devoted Health Medicare	$952.68
Rate for Payer: Hawaii Medical Service Association Medicare	$868.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,961.40
Rate for Payer: Health Management Network Commercial	$2,381.70
Rate for Payer: Humana Medicare	$868.62
Rate for Payer: Kaiser Permanente Commercial	$2,521.80
Rate for Payer: Kaiser Permanente Medicaid	$1,429.02
Rate for Payer: Kaiser Permanente Medicare	$868.62
Rate for Payer: MDX Hawaii PPO	$2,717.94
Rate for Payer: Ohana Health Plan Medicaid	$868.62
Rate for Payer: Ohana Health Plan Medicare	$868.62
Rate for Payer: UnitedHealthcare Medicare	$868.62
Rate for Payer: University Health Alliance Commercial	$1,569.12

STRETCH VASCULA GRAFT SBT1401D

Facility

$2,802.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.12
Max. Negotiated Rate	$2,717.94
Rate for Payer: Cash Price	$1,681.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,961.40
Rate for Payer: Health Management Network Commercial	$2,381.70
Rate for Payer: Kaiser Permanente Commercial	$2,521.80
Rate for Payer: MDX Hawaii PPO	$2,717.94
Rate for Payer: University Health Alliance Commercial	$1,569.12

STRETCH VASCULA GRAFT SBT1401D

Facility

$2,802.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$868.62
Max. Negotiated Rate	$2,717.94
Rate for Payer: AlohaCare Medicaid	$1,401.00
Rate for Payer: AlohaCare Medicare	$868.62
Rate for Payer: Cash Price	$1,681.20
Rate for Payer: Devoted Health Medicare	$952.68
Rate for Payer: Hawaii Medical Service Association Medicare	$868.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,961.40
Rate for Payer: Health Management Network Commercial	$2,381.70
Rate for Payer: Humana Medicare	$868.62
Rate for Payer: Kaiser Permanente Commercial	$2,521.80
Rate for Payer: Kaiser Permanente Medicaid	$1,429.02
Rate for Payer: Kaiser Permanente Medicare	$868.62
Rate for Payer: MDX Hawaii PPO	$2,717.94
Rate for Payer: Ohana Health Plan Medicaid	$868.62
Rate for Payer: Ohana Health Plan Medicare	$868.62
Rate for Payer: UnitedHealthcare Medicare	$868.62
Rate for Payer: University Health Alliance Commercial	$1,569.12

STRETCH VASCULA GRAFT SBT1801D

Facility

$2,802.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.12
Max. Negotiated Rate	$2,717.94
Rate for Payer: Cash Price	$1,681.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,961.40
Rate for Payer: Health Management Network Commercial	$2,381.70
Rate for Payer: Kaiser Permanente Commercial	$2,521.80
Rate for Payer: MDX Hawaii PPO	$2,717.94
Rate for Payer: University Health Alliance Commercial	$1,569.12

STRETCH VASCULA GRAFT SBT1801D

Facility

$2,802.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$868.62
Max. Negotiated Rate	$2,717.94
Rate for Payer: AlohaCare Medicaid	$1,401.00
Rate for Payer: AlohaCare Medicare	$868.62
Rate for Payer: Cash Price	$1,681.20
Rate for Payer: Devoted Health Medicare	$952.68
Rate for Payer: Hawaii Medical Service Association Medicare	$868.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,961.40
Rate for Payer: Health Management Network Commercial	$2,381.70
Rate for Payer: Humana Medicare	$868.62
Rate for Payer: Kaiser Permanente Commercial	$2,521.80
Rate for Payer: Kaiser Permanente Medicaid	$1,429.02
Rate for Payer: Kaiser Permanente Medicare	$868.62
Rate for Payer: MDX Hawaii PPO	$2,717.94
Rate for Payer: Ohana Health Plan Medicaid	$868.62
Rate for Payer: Ohana Health Plan Medicare	$868.62
Rate for Payer: UnitedHealthcare Medicare	$868.62
Rate for Payer: University Health Alliance Commercial	$1,569.12

STRETCH VASCULA GRAFT SBT2001D

Facility

$2,802.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.12
Max. Negotiated Rate	$2,717.94
Rate for Payer: Cash Price	$1,681.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,961.40
Rate for Payer: Health Management Network Commercial	$2,381.70
Rate for Payer: Kaiser Permanente Commercial	$2,521.80
Rate for Payer: MDX Hawaii PPO	$2,717.94
Rate for Payer: University Health Alliance Commercial	$1,569.12

STRETCH VASCULA GRAFT SBT2001D

Facility

$2,802.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$868.62
Max. Negotiated Rate	$2,717.94
Rate for Payer: AlohaCare Medicaid	$1,401.00
Rate for Payer: AlohaCare Medicare	$868.62
Rate for Payer: Cash Price	$1,681.20
Rate for Payer: Devoted Health Medicare	$952.68
Rate for Payer: Hawaii Medical Service Association Medicare	$868.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,961.40
Rate for Payer: Health Management Network Commercial	$2,381.70
Rate for Payer: Humana Medicare	$868.62
Rate for Payer: Kaiser Permanente Commercial	$2,521.80
Rate for Payer: Kaiser Permanente Medicaid	$1,429.02
Rate for Payer: Kaiser Permanente Medicare	$868.62
Rate for Payer: MDX Hawaii PPO	$2,717.94
Rate for Payer: Ohana Health Plan Medicaid	$868.62
Rate for Payer: Ohana Health Plan Medicare	$868.62
Rate for Payer: UnitedHealthcare Medicare	$868.62
Rate for Payer: University Health Alliance Commercial	$1,569.12

STRETCH VASCULAR GRAFT S0602

Facility

$1,103.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$341.93
Max. Negotiated Rate	$1,069.91
Rate for Payer: AlohaCare Medicaid	$551.50
Rate for Payer: AlohaCare Medicare	$341.93
Rate for Payer: Cash Price	$661.80
Rate for Payer: Devoted Health Medicare	$375.02
Rate for Payer: Hawaii Medical Service Association Medicare	$341.93
Rate for Payer: Hawaii Western Management Group Commercial	$772.10
Rate for Payer: Health Management Network Commercial	$937.55
Rate for Payer: Humana Medicare	$341.93
Rate for Payer: Kaiser Permanente Commercial	$992.70
Rate for Payer: Kaiser Permanente Medicaid	$562.53
Rate for Payer: Kaiser Permanente Medicare	$341.93
Rate for Payer: MDX Hawaii PPO	$1,069.91
Rate for Payer: Ohana Health Plan Medicaid	$341.93
Rate for Payer: Ohana Health Plan Medicare	$341.93
Rate for Payer: UnitedHealthcare Medicare	$341.93
Rate for Payer: University Health Alliance Commercial	$617.68

Know your out-of-pocket cost for care.

All Charges