Kau Hospital

All Charges

Charge

Type

Setting

Price

SW JAVELIN FLX IVL 1.5X25

Facility

$9,400.00

Service Code	HCPCS C1725
Hospital Revenue Code	272
Min. Negotiated Rate	$7,990.00
Max. Negotiated Rate	$9,118.00
Rate for Payer: Cash Price	$5,640.00
Rate for Payer: Health Management Network Commercial	$7,990.00
Rate for Payer: Kaiser Permanente Commercial	$8,460.00
Rate for Payer: MDX Hawaii PPO	$9,118.00

SWVLLCK 3.5X8.5MM AR-8978P

Facility

$1,488.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$833.28
Max. Negotiated Rate	$1,443.36
Rate for Payer: Cash Price	$892.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,041.60
Rate for Payer: Health Management Network Commercial	$1,264.80
Rate for Payer: Kaiser Permanente Commercial	$1,339.20
Rate for Payer: MDX Hawaii PPO	$1,443.36
Rate for Payer: University Health Alliance Commercial	$833.28

SWVLLCK 3.5X8.5MM AR-8978P

Facility

$1,488.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$461.28
Max. Negotiated Rate	$1,443.36
Rate for Payer: AlohaCare Medicaid	$744.00
Rate for Payer: AlohaCare Medicare	$461.28
Rate for Payer: Cash Price	$892.80
Rate for Payer: Devoted Health Medicare	$505.92
Rate for Payer: Hawaii Medical Service Association Medicare	$461.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,041.60
Rate for Payer: Health Management Network Commercial	$1,264.80
Rate for Payer: Humana Medicare	$461.28
Rate for Payer: Kaiser Permanente Commercial	$1,339.20
Rate for Payer: Kaiser Permanente Medicaid	$758.88
Rate for Payer: Kaiser Permanente Medicare	$461.28
Rate for Payer: MDX Hawaii PPO	$1,443.36
Rate for Payer: Ohana Health Plan Medicaid	$461.28
Rate for Payer: Ohana Health Plan Medicare	$461.28
Rate for Payer: UnitedHealthcare Medicare	$461.28
Rate for Payer: University Health Alliance Commercial	$833.28

SYNCHFIX GRAVITY SUT 86SYN005

Facility

$2,455.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$761.05
Max. Negotiated Rate	$2,381.35
Rate for Payer: AlohaCare Medicaid	$1,227.50
Rate for Payer: AlohaCare Medicare	$761.05
Rate for Payer: Cash Price	$1,473.00
Rate for Payer: Devoted Health Medicare	$834.70
Rate for Payer: Hawaii Medical Service Association Medicare	$761.05
Rate for Payer: Hawaii Western Management Group Commercial	$1,718.50
Rate for Payer: Health Management Network Commercial	$2,086.75
Rate for Payer: Humana Medicare	$761.05
Rate for Payer: Kaiser Permanente Commercial	$2,209.50
Rate for Payer: Kaiser Permanente Medicaid	$1,252.05
Rate for Payer: Kaiser Permanente Medicare	$761.05
Rate for Payer: MDX Hawaii PPO	$2,381.35
Rate for Payer: Ohana Health Plan Medicaid	$761.05
Rate for Payer: Ohana Health Plan Medicare	$761.05
Rate for Payer: UnitedHealthcare Medicare	$761.05
Rate for Payer: University Health Alliance Commercial	$1,374.80

SYNCHFIX GRAVITY SUT 86SYN005

Facility

$2,455.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,374.80
Max. Negotiated Rate	$2,381.35
Rate for Payer: Cash Price	$1,473.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,718.50
Rate for Payer: Health Management Network Commercial	$2,086.75
Rate for Payer: Kaiser Permanente Commercial	$2,209.50
Rate for Payer: MDX Hawaii PPO	$2,381.35
Rate for Payer: University Health Alliance Commercial	$1,374.80

SYNCHROSEAL 480440

Facility

$2,070.00

Hospital Revenue Code	272
Min. Negotiated Rate	$641.70
Max. Negotiated Rate	$2,007.90
Rate for Payer: AlohaCare Medicaid	$1,035.00
Rate for Payer: AlohaCare Medicare	$641.70
Rate for Payer: Cash Price	$1,242.00
Rate for Payer: Devoted Health Medicare	$703.80
Rate for Payer: Hawaii Medical Service Association Medicare	$641.70
Rate for Payer: Hawaii Western Management Group Commercial	$1,966.50
Rate for Payer: Health Management Network Commercial	$1,759.50
Rate for Payer: Humana Medicare	$641.70
Rate for Payer: Kaiser Permanente Commercial	$1,863.00
Rate for Payer: Kaiser Permanente Medicaid	$1,055.70
Rate for Payer: Kaiser Permanente Medicare	$641.70
Rate for Payer: MDX Hawaii PPO	$2,007.90
Rate for Payer: Ohana Health Plan Medicaid	$641.70
Rate for Payer: Ohana Health Plan Medicare	$641.70
Rate for Payer: UnitedHealthcare Medicare	$641.70
Rate for Payer: University Health Alliance Commercial	$1,508.82

SYNCHROSEAL 480440

Facility

$2,070.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,759.50
Max. Negotiated Rate	$2,007.90
Rate for Payer: Cash Price	$1,242.00
Rate for Payer: Health Management Network Commercial	$1,759.50
Rate for Payer: Kaiser Permanente Commercial	$1,863.00
Rate for Payer: MDX Hawaii PPO	$2,007.90

SYNCOPE AND COLLAPSE

Facility

$14,007.88

Service Code	MSDRG 312
Min. Negotiated Rate	$14,007.88
Max. Negotiated Rate	$14,007.88
Rate for Payer: Hawaii Medical Service Association Commercial	$14,007.88

SYNTEL ART EMBOLECTOMY CATH 80

Facility

$521.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$442.85
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$312.60
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: MDX Hawaii PPO	$505.37

SYNTEL ART EMBOLECTOMY CATH 80

Facility

$521.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$161.51
Max. Negotiated Rate	$505.37
Rate for Payer: AlohaCare Medicaid	$260.50
Rate for Payer: AlohaCare Medicare	$161.51
Rate for Payer: Cash Price	$312.60
Rate for Payer: Devoted Health Medicare	$177.14
Rate for Payer: Hawaii Medical Service Association Medicare	$161.51
Rate for Payer: Hawaii Western Management Group Commercial	$494.95
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Humana Medicare	$161.51
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: Kaiser Permanente Medicaid	$265.71
Rate for Payer: Kaiser Permanente Medicare	$161.51
Rate for Payer: MDX Hawaii PPO	$505.37
Rate for Payer: Ohana Health Plan Medicaid	$161.51
Rate for Payer: Ohana Health Plan Medicare	$161.51
Rate for Payer: UnitedHealthcare Medicare	$161.51
Rate for Payer: University Health Alliance Commercial	$379.76

SYNTEL ARTERIAL EMBOLECTOMY

Facility

$521.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$161.51
Max. Negotiated Rate	$505.37
Rate for Payer: AlohaCare Medicaid	$260.50
Rate for Payer: AlohaCare Medicare	$161.51
Rate for Payer: Cash Price	$312.60
Rate for Payer: Devoted Health Medicare	$177.14
Rate for Payer: Hawaii Medical Service Association Medicare	$161.51
Rate for Payer: Hawaii Western Management Group Commercial	$494.95
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Humana Medicare	$161.51
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: Kaiser Permanente Medicaid	$265.71
Rate for Payer: Kaiser Permanente Medicare	$161.51
Rate for Payer: MDX Hawaii PPO	$505.37
Rate for Payer: Ohana Health Plan Medicaid	$161.51
Rate for Payer: Ohana Health Plan Medicare	$161.51
Rate for Payer: UnitedHealthcare Medicare	$161.51
Rate for Payer: University Health Alliance Commercial	$379.76

SYNTEL ARTERIAL EMBOLECTOMY

Facility

$521.00

Service Code	HCPCS C1757
Hospital Revenue Code	272
Min. Negotiated Rate	$442.85
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$312.60
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: MDX Hawaii PPO	$505.37

SYRINGE CONTINUOUS INJECTION

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

SYRINGE CONTINUOUS INJECTION

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

SYRINGE INFLATION DEVICE

Facility

$167.00

Hospital Revenue Code	272
Min. Negotiated Rate	$51.77
Max. Negotiated Rate	$161.99
Rate for Payer: AlohaCare Medicaid	$83.50
Rate for Payer: AlohaCare Medicare	$51.77
Rate for Payer: Cash Price	$100.20
Rate for Payer: Devoted Health Medicare	$56.78
Rate for Payer: Hawaii Medical Service Association Medicare	$51.77
Rate for Payer: Hawaii Western Management Group Commercial	$158.65
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: Humana Medicare	$51.77
Rate for Payer: Kaiser Permanente Commercial	$150.30
Rate for Payer: Kaiser Permanente Medicaid	$85.17
Rate for Payer: Kaiser Permanente Medicare	$51.77
Rate for Payer: MDX Hawaii PPO	$161.99
Rate for Payer: Ohana Health Plan Medicaid	$51.77
Rate for Payer: Ohana Health Plan Medicare	$51.77
Rate for Payer: UnitedHealthcare Medicare	$51.77
Rate for Payer: University Health Alliance Commercial	$121.73

SYRINGE INFLATION DEVICE

Facility

$167.00

Hospital Revenue Code	272
Min. Negotiated Rate	$141.95
Max. Negotiated Rate	$161.99
Rate for Payer: Cash Price	$100.20
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: Kaiser Permanente Commercial	$150.30
Rate for Payer: MDX Hawaii PPO	$161.99

SYRINGE INFLATOR ALLIANCE

Facility

$152.00

Hospital Revenue Code	272
Min. Negotiated Rate	$129.20
Max. Negotiated Rate	$147.44
Rate for Payer: Cash Price	$91.20
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: MDX Hawaii PPO	$147.44

SYRINGE INFLATOR ALLIANCE

Facility

$152.00

Hospital Revenue Code	272
Min. Negotiated Rate	$47.12
Max. Negotiated Rate	$147.44
Rate for Payer: AlohaCare Medicaid	$76.00
Rate for Payer: AlohaCare Medicare	$47.12
Rate for Payer: Cash Price	$91.20
Rate for Payer: Devoted Health Medicare	$51.68
Rate for Payer: Hawaii Medical Service Association Medicare	$47.12
Rate for Payer: Hawaii Western Management Group Commercial	$144.40
Rate for Payer: Health Management Network Commercial	$129.20
Rate for Payer: Humana Medicare	$47.12
Rate for Payer: Kaiser Permanente Commercial	$136.80
Rate for Payer: Kaiser Permanente Medicaid	$77.52
Rate for Payer: Kaiser Permanente Medicare	$47.12
Rate for Payer: MDX Hawaii PPO	$147.44
Rate for Payer: Ohana Health Plan Medicaid	$47.12
Rate for Payer: Ohana Health Plan Medicare	$47.12
Rate for Payer: UnitedHealthcare Medicare	$47.12
Rate for Payer: University Health Alliance Commercial	$110.79

SYRINGE THERACAL PT H-34110P

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

SYRINGE THERACAL PT H-34110P

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

SYSTEM IMPLANT AR-1360FT-BC

Facility

$6,650.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,724.00
Max. Negotiated Rate	$6,450.50
Rate for Payer: Cash Price	$3,990.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,655.00
Rate for Payer: Health Management Network Commercial	$5,652.50
Rate for Payer: Kaiser Permanente Commercial	$5,985.00
Rate for Payer: MDX Hawaii PPO	$6,450.50
Rate for Payer: University Health Alliance Commercial	$3,724.00

SYSTEM IMPLANT AR-1360FT-BC

Facility

$6,650.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,061.50
Max. Negotiated Rate	$6,450.50
Rate for Payer: AlohaCare Medicaid	$3,325.00
Rate for Payer: AlohaCare Medicare	$2,061.50
Rate for Payer: Cash Price	$3,990.00
Rate for Payer: Devoted Health Medicare	$2,261.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,061.50
Rate for Payer: Hawaii Western Management Group Commercial	$4,655.00
Rate for Payer: Health Management Network Commercial	$5,652.50
Rate for Payer: Humana Medicare	$2,061.50
Rate for Payer: Kaiser Permanente Commercial	$5,985.00
Rate for Payer: Kaiser Permanente Medicaid	$3,391.50
Rate for Payer: Kaiser Permanente Medicare	$2,061.50
Rate for Payer: MDX Hawaii PPO	$6,450.50
Rate for Payer: Ohana Health Plan Medicaid	$2,061.50
Rate for Payer: Ohana Health Plan Medicare	$2,061.50
Rate for Payer: UnitedHealthcare Medicare	$2,061.50
Rate for Payer: University Health Alliance Commercial	$3,724.00

SYSTEM VEIN HARVEST VH-2004

Facility

$3,998.00

Hospital Revenue Code	272
Min. Negotiated Rate	$3,398.30
Max. Negotiated Rate	$3,878.06
Rate for Payer: Cash Price	$2,398.80
Rate for Payer: Health Management Network Commercial	$3,398.30
Rate for Payer: Kaiser Permanente Commercial	$3,598.20
Rate for Payer: MDX Hawaii PPO	$3,878.06

SYSTEM VEIN HARVEST VH-2004

Facility

$3,998.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,239.38
Max. Negotiated Rate	$3,878.06
Rate for Payer: AlohaCare Medicaid	$1,999.00
Rate for Payer: AlohaCare Medicare	$1,239.38
Rate for Payer: Cash Price	$2,398.80
Rate for Payer: Devoted Health Medicare	$1,359.32
Rate for Payer: Hawaii Medical Service Association Medicare	$1,239.38
Rate for Payer: Hawaii Western Management Group Commercial	$3,798.10
Rate for Payer: Health Management Network Commercial	$3,398.30
Rate for Payer: Humana Medicare	$1,239.38
Rate for Payer: Kaiser Permanente Commercial	$3,598.20
Rate for Payer: Kaiser Permanente Medicaid	$2,038.98
Rate for Payer: Kaiser Permanente Medicare	$1,239.38
Rate for Payer: MDX Hawaii PPO	$3,878.06
Rate for Payer: Ohana Health Plan Medicaid	$1,239.38
Rate for Payer: Ohana Health Plan Medicare	$1,239.38
Rate for Payer: UnitedHealthcare Medicare	$1,239.38
Rate for Payer: University Health Alliance Commercial	$2,914.14

TA 30-3.5 RELOADING STAPLER

Facility

$297.00

Hospital Revenue Code	272
Min. Negotiated Rate	$252.45
Max. Negotiated Rate	$288.09
Rate for Payer: Cash Price	$178.20
Rate for Payer: Health Management Network Commercial	$252.45
Rate for Payer: Kaiser Permanente Commercial	$267.30
Rate for Payer: MDX Hawaii PPO	$288.09

Know your out-of-pocket cost for care.

All Charges