Kau Hospital

All Charges

Charge

Type

Setting

Price

STRETCH VASCULAR GRAFT S0602

Facility

$1,103.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$617.68
Max. Negotiated Rate	$1,069.91
Rate for Payer: Cash Price	$661.80
Rate for Payer: Hawaii Western Management Group Commercial	$772.10
Rate for Payer: Health Management Network Commercial	$937.55
Rate for Payer: Kaiser Permanente Commercial	$992.70
Rate for Payer: MDX Hawaii PPO	$1,069.91
Rate for Payer: University Health Alliance Commercial	$617.68

STRETCH VASCULAR GRAFT S0607

Facility

$2,598.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,454.88
Max. Negotiated Rate	$2,520.06
Rate for Payer: Cash Price	$1,558.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,818.60
Rate for Payer: Health Management Network Commercial	$2,208.30
Rate for Payer: Kaiser Permanente Commercial	$2,338.20
Rate for Payer: MDX Hawaii PPO	$2,520.06
Rate for Payer: University Health Alliance Commercial	$1,454.88

STRETCH VASCULAR GRAFT S0607

Facility

$2,598.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$805.38
Max. Negotiated Rate	$2,520.06
Rate for Payer: AlohaCare Medicaid	$1,299.00
Rate for Payer: AlohaCare Medicare	$805.38
Rate for Payer: Cash Price	$1,558.80
Rate for Payer: Devoted Health Medicare	$883.32
Rate for Payer: Hawaii Medical Service Association Medicare	$805.38
Rate for Payer: Hawaii Western Management Group Commercial	$1,818.60
Rate for Payer: Health Management Network Commercial	$2,208.30
Rate for Payer: Humana Medicare	$805.38
Rate for Payer: Kaiser Permanente Commercial	$2,338.20
Rate for Payer: Kaiser Permanente Medicaid	$1,324.98
Rate for Payer: Kaiser Permanente Medicare	$805.38
Rate for Payer: MDX Hawaii PPO	$2,520.06
Rate for Payer: Ohana Health Plan Medicaid	$805.38
Rate for Payer: Ohana Health Plan Medicare	$805.38
Rate for Payer: UnitedHealthcare Medicare	$805.38
Rate for Payer: University Health Alliance Commercial	$1,454.88

STRETCH VASCULAR GRAFT S0804

Facility

$1,584.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$887.04
Max. Negotiated Rate	$1,536.48
Rate for Payer: Cash Price	$950.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,108.80
Rate for Payer: Health Management Network Commercial	$1,346.40
Rate for Payer: Kaiser Permanente Commercial	$1,425.60
Rate for Payer: MDX Hawaii PPO	$1,536.48
Rate for Payer: University Health Alliance Commercial	$887.04

STRETCH VASCULAR GRAFT S0804

Facility

$1,584.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$491.04
Max. Negotiated Rate	$1,536.48
Rate for Payer: AlohaCare Medicaid	$792.00
Rate for Payer: AlohaCare Medicare	$491.04
Rate for Payer: Cash Price	$950.40
Rate for Payer: Devoted Health Medicare	$538.56
Rate for Payer: Hawaii Medical Service Association Medicare	$491.04
Rate for Payer: Hawaii Western Management Group Commercial	$1,108.80
Rate for Payer: Health Management Network Commercial	$1,346.40
Rate for Payer: Humana Medicare	$491.04
Rate for Payer: Kaiser Permanente Commercial	$1,425.60
Rate for Payer: Kaiser Permanente Medicaid	$807.84
Rate for Payer: Kaiser Permanente Medicare	$491.04
Rate for Payer: MDX Hawaii PPO	$1,536.48
Rate for Payer: Ohana Health Plan Medicaid	$491.04
Rate for Payer: Ohana Health Plan Medicare	$491.04
Rate for Payer: UnitedHealthcare Medicare	$491.04
Rate for Payer: University Health Alliance Commercial	$887.04

STRETCH VASCULAR GRAFT S47045

Facility

$2,139.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,197.84
Max. Negotiated Rate	$2,074.83
Rate for Payer: Cash Price	$1,283.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,497.30
Rate for Payer: Health Management Network Commercial	$1,818.15
Rate for Payer: Kaiser Permanente Commercial	$1,925.10
Rate for Payer: MDX Hawaii PPO	$2,074.83
Rate for Payer: University Health Alliance Commercial	$1,197.84

STRETCH VASCULAR GRAFT S47045

Facility

$2,139.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$663.09
Max. Negotiated Rate	$2,074.83
Rate for Payer: AlohaCare Medicaid	$1,069.50
Rate for Payer: AlohaCare Medicare	$663.09
Rate for Payer: Cash Price	$1,283.40
Rate for Payer: Devoted Health Medicare	$727.26
Rate for Payer: Hawaii Medical Service Association Medicare	$663.09
Rate for Payer: Hawaii Western Management Group Commercial	$1,497.30
Rate for Payer: Health Management Network Commercial	$1,818.15
Rate for Payer: Humana Medicare	$663.09
Rate for Payer: Kaiser Permanente Commercial	$1,925.10
Rate for Payer: Kaiser Permanente Medicaid	$1,090.89
Rate for Payer: Kaiser Permanente Medicare	$663.09
Rate for Payer: MDX Hawaii PPO	$2,074.83
Rate for Payer: Ohana Health Plan Medicaid	$663.09
Rate for Payer: Ohana Health Plan Medicare	$663.09
Rate for Payer: UnitedHealthcare Medicare	$663.09
Rate for Payer: University Health Alliance Commercial	$1,197.84

STRETCH VASCULAR GRAFT S47070

Facility

$2,196.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$1,229.76
Max. Negotiated Rate	$2,130.12
Rate for Payer: Cash Price	$1,317.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,537.20
Rate for Payer: Health Management Network Commercial	$1,866.60
Rate for Payer: Kaiser Permanente Commercial	$1,976.40
Rate for Payer: MDX Hawaii PPO	$2,130.12
Rate for Payer: University Health Alliance Commercial	$1,229.76

STRETCH VASCULAR GRAFT S47070

Facility

$2,196.00

Service Code	HCPCS C1768
Hospital Revenue Code	278
Min. Negotiated Rate	$680.76
Max. Negotiated Rate	$2,130.12
Rate for Payer: AlohaCare Medicaid	$1,098.00
Rate for Payer: AlohaCare Medicare	$680.76
Rate for Payer: Cash Price	$1,317.60
Rate for Payer: Devoted Health Medicare	$746.64
Rate for Payer: Hawaii Medical Service Association Medicare	$680.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,537.20
Rate for Payer: Health Management Network Commercial	$1,866.60
Rate for Payer: Humana Medicare	$680.76
Rate for Payer: Kaiser Permanente Commercial	$1,976.40
Rate for Payer: Kaiser Permanente Medicaid	$1,119.96
Rate for Payer: Kaiser Permanente Medicare	$680.76
Rate for Payer: MDX Hawaii PPO	$2,130.12
Rate for Payer: Ohana Health Plan Medicaid	$680.76
Rate for Payer: Ohana Health Plan Medicare	$680.76
Rate for Payer: UnitedHealthcare Medicare	$680.76
Rate for Payer: University Health Alliance Commercial	$1,229.76

STRUTS RAPID ADJUST 50-10180CE

Facility

$263.00

Hospital Revenue Code	272
Min. Negotiated Rate	$81.53
Max. Negotiated Rate	$255.11
Rate for Payer: AlohaCare Medicaid	$131.50
Rate for Payer: AlohaCare Medicare	$81.53
Rate for Payer: Cash Price	$157.80
Rate for Payer: Devoted Health Medicare	$89.42
Rate for Payer: Hawaii Medical Service Association Medicare	$81.53
Rate for Payer: Hawaii Western Management Group Commercial	$249.85
Rate for Payer: Health Management Network Commercial	$223.55
Rate for Payer: Humana Medicare	$81.53
Rate for Payer: Kaiser Permanente Commercial	$236.70
Rate for Payer: Kaiser Permanente Medicaid	$134.13
Rate for Payer: Kaiser Permanente Medicare	$81.53
Rate for Payer: MDX Hawaii PPO	$255.11
Rate for Payer: Ohana Health Plan Medicaid	$81.53
Rate for Payer: Ohana Health Plan Medicare	$81.53
Rate for Payer: UnitedHealthcare Medicare	$81.53
Rate for Payer: University Health Alliance Commercial	$191.70

STRUTS RAPID ADJUST 50-10180CE

Facility

$263.00

Hospital Revenue Code	272
Min. Negotiated Rate	$223.55
Max. Negotiated Rate	$255.11
Rate for Payer: Cash Price	$157.80
Rate for Payer: Health Management Network Commercial	$223.55
Rate for Payer: Kaiser Permanente Commercial	$236.70
Rate for Payer: MDX Hawaii PPO	$255.11

STYLET-BALL TIP 45CM 6057-45

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$194.00
Rate for Payer: AlohaCare Medicaid	$100.00
Rate for Payer: AlohaCare Medicare	$62.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Devoted Health Medicare	$68.00
Rate for Payer: Hawaii Medical Service Association Medicare	$62.00
Rate for Payer: Hawaii Western Management Group Commercial	$190.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Humana Medicare	$62.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: Kaiser Permanente Medicare	$62.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: Ohana Health Plan Medicaid	$62.00
Rate for Payer: Ohana Health Plan Medicare	$62.00
Rate for Payer: UnitedHealthcare Medicare	$62.00
Rate for Payer: University Health Alliance Commercial	$145.78

STYLET-BALL TIP 45CM 6057-45

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: MDX Hawaii PPO	$194.00

STYLET-BLUE KIT 0.014 6057-58

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: MDX Hawaii PPO	$194.00

STYLET-BLUE KIT 0.014 6057-58

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$194.00
Rate for Payer: AlohaCare Medicaid	$100.00
Rate for Payer: AlohaCare Medicare	$62.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Devoted Health Medicare	$68.00
Rate for Payer: Hawaii Medical Service Association Medicare	$62.00
Rate for Payer: Hawaii Western Management Group Commercial	$190.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Humana Medicare	$62.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: Kaiser Permanente Medicare	$62.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: Ohana Health Plan Medicaid	$62.00
Rate for Payer: Ohana Health Plan Medicare	$62.00
Rate for Payer: UnitedHealthcare Medicare	$62.00
Rate for Payer: University Health Alliance Commercial	$145.78

STYLET-GREY KIT 0.014 6082-52

Facility

$160.00

Hospital Revenue Code	272
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$96.00
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

STYLET-GREY KIT 0.014 6082-52

Facility

$160.00

Hospital Revenue Code	272
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	$152.00
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	$116.62

STYLET-GREY KIT 6091-45

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$194.00
Rate for Payer: AlohaCare Medicaid	$100.00
Rate for Payer: AlohaCare Medicare	$62.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Devoted Health Medicare	$68.00
Rate for Payer: Hawaii Medical Service Association Medicare	$62.00
Rate for Payer: Hawaii Western Management Group Commercial	$190.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Humana Medicare	$62.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: Kaiser Permanente Medicare	$62.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: Ohana Health Plan Medicaid	$62.00
Rate for Payer: Ohana Health Plan Medicare	$62.00
Rate for Payer: UnitedHealthcare Medicare	$62.00
Rate for Payer: University Health Alliance Commercial	$145.78

STYLET-GREY KIT 6091-45

Facility

$200.00

Hospital Revenue Code	272
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: MDX Hawaii PPO	$194.00

STYLET KIT-46CM DS06003/46

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: MDX Hawaii PPO	$291.00

STYLET KIT-46CM DS06003/46

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$291.00
Rate for Payer: AlohaCare Medicaid	$150.00
Rate for Payer: AlohaCare Medicare	$93.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Devoted Health Medicare	$102.00
Rate for Payer: Hawaii Medical Service Association Medicare	$93.00
Rate for Payer: Hawaii Western Management Group Commercial	$285.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Humana Medicare	$93.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: Kaiser Permanente Medicaid	$153.00
Rate for Payer: Kaiser Permanente Medicare	$93.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: Ohana Health Plan Medicaid	$93.00
Rate for Payer: Ohana Health Plan Medicare	$93.00
Rate for Payer: UnitedHealthcare Medicare	$93.00
Rate for Payer: University Health Alliance Commercial	$218.67

STYLET KIT-52CM DS06001/52

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: MDX Hawaii PPO	$291.00

STYLET KIT-52CM DS06001/52

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$291.00
Rate for Payer: AlohaCare Medicaid	$150.00
Rate for Payer: AlohaCare Medicare	$93.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Devoted Health Medicare	$102.00
Rate for Payer: Hawaii Medical Service Association Medicare	$93.00
Rate for Payer: Hawaii Western Management Group Commercial	$285.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Humana Medicare	$93.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: Kaiser Permanente Medicaid	$153.00
Rate for Payer: Kaiser Permanente Medicare	$93.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: Ohana Health Plan Medicaid	$93.00
Rate for Payer: Ohana Health Plan Medicare	$93.00
Rate for Payer: UnitedHealthcare Medicare	$93.00
Rate for Payer: University Health Alliance Commercial	$218.67

STYLET KIT-58CM DS06003/58

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: MDX Hawaii PPO	$291.00

STYLET KIT-58CM DS06003/58

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$291.00
Rate for Payer: AlohaCare Medicaid	$150.00
Rate for Payer: AlohaCare Medicare	$93.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Devoted Health Medicare	$102.00
Rate for Payer: Hawaii Medical Service Association Medicare	$93.00
Rate for Payer: Hawaii Western Management Group Commercial	$285.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Humana Medicare	$93.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: Kaiser Permanente Medicaid	$153.00
Rate for Payer: Kaiser Permanente Medicare	$93.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: Ohana Health Plan Medicaid	$93.00
Rate for Payer: Ohana Health Plan Medicare	$93.00
Rate for Payer: UnitedHealthcare Medicare	$93.00
Rate for Payer: University Health Alliance Commercial	$218.67

Know your out-of-pocket cost for care.

All Charges