Kau Hospital

All Charges

Charge

Type

Setting

Price

AEQUALIS ASCEND FLEX DWF607B

Facility

$11,368.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,366.08
Max. Negotiated Rate	$11,026.96
Rate for Payer: Cash Price	$6,820.80
Rate for Payer: Hawaii Western Management Group Commercial	$7,957.60
Rate for Payer: Health Management Network Commercial	$9,662.80
Rate for Payer: Kaiser Permanente Commercial	$10,231.20
Rate for Payer: MDX Hawaii PPO	$11,026.96
Rate for Payer: University Health Alliance Commercial	$6,366.08

AEQUALIS ASCEND FLEX DWF607B

Facility

$11,368.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.08
Max. Negotiated Rate	$11,026.96
Rate for Payer: AlohaCare Medicaid	$5,684.00
Rate for Payer: AlohaCare Medicare	$3,524.08
Rate for Payer: Cash Price	$6,820.80
Rate for Payer: Devoted Health Medicare	$3,865.12
Rate for Payer: Hawaii Medical Service Association Medicare	$3,524.08
Rate for Payer: Hawaii Western Management Group Commercial	$7,957.60
Rate for Payer: Health Management Network Commercial	$9,662.80
Rate for Payer: Humana Medicare	$3,524.08
Rate for Payer: Kaiser Permanente Commercial	$10,231.20
Rate for Payer: Kaiser Permanente Medicaid	$5,797.68
Rate for Payer: Kaiser Permanente Medicare	$3,524.08
Rate for Payer: MDX Hawaii PPO	$11,026.96
Rate for Payer: Ohana Health Plan Medicaid	$3,524.08
Rate for Payer: Ohana Health Plan Medicare	$3,524.08
Rate for Payer: UnitedHealthcare Medicare	$3,524.08
Rate for Payer: University Health Alliance Commercial	$6,366.08

AEQUALIS PERFORM+ DWE413

Facility

$4,628.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,591.68
Max. Negotiated Rate	$4,489.16
Rate for Payer: Cash Price	$2,776.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,239.60
Rate for Payer: Health Management Network Commercial	$3,933.80
Rate for Payer: Kaiser Permanente Commercial	$4,165.20
Rate for Payer: MDX Hawaii PPO	$4,489.16
Rate for Payer: University Health Alliance Commercial	$2,591.68

AEQUALIS PERFORM+ DWE413

Facility

$4,628.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,434.68
Max. Negotiated Rate	$4,489.16
Rate for Payer: AlohaCare Medicaid	$2,314.00
Rate for Payer: AlohaCare Medicare	$1,434.68
Rate for Payer: Cash Price	$2,776.80
Rate for Payer: Devoted Health Medicare	$1,573.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,434.68
Rate for Payer: Hawaii Western Management Group Commercial	$3,239.60
Rate for Payer: Health Management Network Commercial	$3,933.80
Rate for Payer: Humana Medicare	$1,434.68
Rate for Payer: Kaiser Permanente Commercial	$4,165.20
Rate for Payer: Kaiser Permanente Medicaid	$2,360.28
Rate for Payer: Kaiser Permanente Medicare	$1,434.68
Rate for Payer: MDX Hawaii PPO	$4,489.16
Rate for Payer: Ohana Health Plan Medicaid	$1,434.68
Rate for Payer: Ohana Health Plan Medicare	$1,434.68
Rate for Payer: UnitedHealthcare Medicare	$1,434.68
Rate for Payer: University Health Alliance Commercial	$2,591.68

AEQUALIS PERFORM DWE422

Facility

$6,394.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,982.14
Max. Negotiated Rate	$6,202.18
Rate for Payer: AlohaCare Medicaid	$3,197.00
Rate for Payer: AlohaCare Medicare	$1,982.14
Rate for Payer: Cash Price	$3,836.40
Rate for Payer: Devoted Health Medicare	$2,173.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,982.14
Rate for Payer: Hawaii Western Management Group Commercial	$4,475.80
Rate for Payer: Health Management Network Commercial	$5,434.90
Rate for Payer: Humana Medicare	$1,982.14
Rate for Payer: Kaiser Permanente Commercial	$5,754.60
Rate for Payer: Kaiser Permanente Medicaid	$3,260.94
Rate for Payer: Kaiser Permanente Medicare	$1,982.14
Rate for Payer: MDX Hawaii PPO	$6,202.18
Rate for Payer: Ohana Health Plan Medicaid	$1,982.14
Rate for Payer: Ohana Health Plan Medicare	$1,982.14
Rate for Payer: UnitedHealthcare Medicare	$1,982.14
Rate for Payer: University Health Alliance Commercial	$3,580.64

AEQUALIS PERFORM DWE422

Facility

$6,394.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,580.64
Max. Negotiated Rate	$6,202.18
Rate for Payer: Cash Price	$3,836.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,475.80
Rate for Payer: Health Management Network Commercial	$5,434.90
Rate for Payer: Kaiser Permanente Commercial	$5,754.60
Rate for Payer: MDX Hawaii PPO	$6,202.18
Rate for Payer: University Health Alliance Commercial	$3,580.64

AEQUALIS PERFORM DWJ014

Facility

$6,028.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,375.68
Max. Negotiated Rate	$5,847.16
Rate for Payer: Cash Price	$3,616.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,219.60
Rate for Payer: Health Management Network Commercial	$5,123.80
Rate for Payer: Kaiser Permanente Commercial	$5,425.20
Rate for Payer: MDX Hawaii PPO	$5,847.16
Rate for Payer: University Health Alliance Commercial	$3,375.68

AEQUALIS PERFORM DWJ014

Facility

$6,028.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,868.68
Max. Negotiated Rate	$5,847.16
Rate for Payer: AlohaCare Medicaid	$3,014.00
Rate for Payer: AlohaCare Medicare	$1,868.68
Rate for Payer: Cash Price	$3,616.80
Rate for Payer: Devoted Health Medicare	$2,049.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,868.68
Rate for Payer: Hawaii Western Management Group Commercial	$4,219.60
Rate for Payer: Health Management Network Commercial	$5,123.80
Rate for Payer: Humana Medicare	$1,868.68
Rate for Payer: Kaiser Permanente Commercial	$5,425.20
Rate for Payer: Kaiser Permanente Medicaid	$3,074.28
Rate for Payer: Kaiser Permanente Medicare	$1,868.68
Rate for Payer: MDX Hawaii PPO	$5,847.16
Rate for Payer: Ohana Health Plan Medicaid	$1,868.68
Rate for Payer: Ohana Health Plan Medicare	$1,868.68
Rate for Payer: UnitedHealthcare Medicare	$1,868.68
Rate for Payer: University Health Alliance Commercial	$3,375.68

AEQUALIS PERFORM DWJ513

Facility

$7,356.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,119.36
Max. Negotiated Rate	$7,135.32
Rate for Payer: Cash Price	$4,413.60
Rate for Payer: Hawaii Western Management Group Commercial	$5,149.20
Rate for Payer: Health Management Network Commercial	$6,252.60
Rate for Payer: Kaiser Permanente Commercial	$6,620.40
Rate for Payer: MDX Hawaii PPO	$7,135.32
Rate for Payer: University Health Alliance Commercial	$4,119.36

AEQUALIS PERFORM DWJ513

Facility

$7,356.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,280.36
Max. Negotiated Rate	$7,135.32
Rate for Payer: AlohaCare Medicaid	$3,678.00
Rate for Payer: AlohaCare Medicare	$2,280.36
Rate for Payer: Cash Price	$4,413.60
Rate for Payer: Devoted Health Medicare	$2,501.04
Rate for Payer: Hawaii Medical Service Association Medicare	$2,280.36
Rate for Payer: Hawaii Western Management Group Commercial	$5,149.20
Rate for Payer: Health Management Network Commercial	$6,252.60
Rate for Payer: Humana Medicare	$2,280.36
Rate for Payer: Kaiser Permanente Commercial	$6,620.40
Rate for Payer: Kaiser Permanente Medicaid	$3,751.56
Rate for Payer: Kaiser Permanente Medicare	$2,280.36
Rate for Payer: MDX Hawaii PPO	$7,135.32
Rate for Payer: Ohana Health Plan Medicaid	$2,280.36
Rate for Payer: Ohana Health Plan Medicare	$2,280.36
Rate for Payer: UnitedHealthcare Medicare	$2,280.36
Rate for Payer: University Health Alliance Commercial	$4,119.36

AEQUALIS PERFORM REV DWJ401

Facility

$3,208.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$994.48
Max. Negotiated Rate	$3,111.76
Rate for Payer: AlohaCare Medicaid	$1,604.00
Rate for Payer: AlohaCare Medicare	$994.48
Rate for Payer: Cash Price	$1,924.80
Rate for Payer: Devoted Health Medicare	$1,090.72
Rate for Payer: Hawaii Medical Service Association Medicare	$994.48
Rate for Payer: Hawaii Western Management Group Commercial	$2,245.60
Rate for Payer: Health Management Network Commercial	$2,726.80
Rate for Payer: Humana Medicare	$994.48
Rate for Payer: Kaiser Permanente Commercial	$2,887.20
Rate for Payer: Kaiser Permanente Medicaid	$1,636.08
Rate for Payer: Kaiser Permanente Medicare	$994.48
Rate for Payer: MDX Hawaii PPO	$3,111.76
Rate for Payer: Ohana Health Plan Medicaid	$994.48
Rate for Payer: Ohana Health Plan Medicare	$994.48
Rate for Payer: UnitedHealthcare Medicare	$994.48
Rate for Payer: University Health Alliance Commercial	$1,796.48

AEQUALIS PERFORM REV DWJ401

Facility

$3,208.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.48
Max. Negotiated Rate	$3,111.76
Rate for Payer: Cash Price	$1,924.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,245.60
Rate for Payer: Health Management Network Commercial	$2,726.80
Rate for Payer: Kaiser Permanente Commercial	$2,887.20
Rate for Payer: MDX Hawaii PPO	$3,111.76
Rate for Payer: University Health Alliance Commercial	$1,796.48

AEQUALIS SCREW DRILL BT MWJ126

Facility

$454.00

Service Code	HCPCS C1776
Hospital Revenue Code	272
Min. Negotiated Rate	$385.90
Max. Negotiated Rate	$440.38
Rate for Payer: Cash Price	$272.40
Rate for Payer: Health Management Network Commercial	$385.90
Rate for Payer: Kaiser Permanente Commercial	$408.60
Rate for Payer: MDX Hawaii PPO	$440.38

AEQUALIS SCREW DRILL BT MWJ126

Facility

$454.00

Service Code	HCPCS C1776
Hospital Revenue Code	272
Min. Negotiated Rate	$140.74
Max. Negotiated Rate	$440.38
Rate for Payer: AlohaCare Medicaid	$227.00
Rate for Payer: AlohaCare Medicare	$140.74
Rate for Payer: Cash Price	$272.40
Rate for Payer: Devoted Health Medicare	$154.36
Rate for Payer: Hawaii Medical Service Association Medicare	$140.74
Rate for Payer: Hawaii Western Management Group Commercial	$431.30
Rate for Payer: Health Management Network Commercial	$385.90
Rate for Payer: Humana Medicare	$140.74
Rate for Payer: Kaiser Permanente Commercial	$408.60
Rate for Payer: Kaiser Permanente Medicaid	$231.54
Rate for Payer: Kaiser Permanente Medicare	$140.74
Rate for Payer: MDX Hawaii PPO	$440.38
Rate for Payer: Ohana Health Plan Medicaid	$140.74
Rate for Payer: Ohana Health Plan Medicare	$140.74
Rate for Payer: UnitedHealthcare Medicare	$140.74
Rate for Payer: University Health Alliance Commercial	$330.92

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$16,567.70

Service Code	MSDRG 560
Min. Negotiated Rate	$16,567.70
Max. Negotiated Rate	$16,567.70
Rate for Payer: Hawaii Medical Service Association Commercial	$16,567.70

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$16,567.70

Service Code	MSDRG 559
Min. Negotiated Rate	$16,567.70
Max. Negotiated Rate	$16,567.70
Rate for Payer: Hawaii Medical Service Association Commercial	$16,567.70

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$16,567.70

Service Code	MSDRG 561
Min. Negotiated Rate	$16,567.70
Max. Negotiated Rate	$16,567.70
Rate for Payer: Hawaii Medical Service Association Commercial	$16,567.70

AFTERCARE WITH CC/MCC

Facility

$17,610.59

Service Code	MSDRG 949
Min. Negotiated Rate	$17,610.59
Max. Negotiated Rate	$17,610.59
Rate for Payer: Hawaii Medical Service Association Commercial	$17,610.59

AFTERCARE WITHOUT CC/MCC

Facility

$5,214.44

Service Code	MSDRG 950
Min. Negotiated Rate	$5,214.44
Max. Negotiated Rate	$5,214.44
Rate for Payer: Hawaii Medical Service Association Commercial	$5,214.44

AGENT DCB 2.5X15

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$10,497.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: MDX Hawaii PPO	$11,979.50

AGENT DCB 2.5X15

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$3,828.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: AlohaCare Medicaid	$6,175.00
Rate for Payer: AlohaCare Medicare	$3,828.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Devoted Health Medicare	$4,199.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,828.50
Rate for Payer: Hawaii Western Management Group Commercial	$11,732.50
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Humana Medicare	$3,828.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: Kaiser Permanente Medicaid	$6,298.50
Rate for Payer: Kaiser Permanente Medicare	$3,828.50
Rate for Payer: MDX Hawaii PPO	$11,979.50
Rate for Payer: Ohana Health Plan Medicaid	$3,828.50
Rate for Payer: Ohana Health Plan Medicare	$3,828.50
Rate for Payer: UnitedHealthcare Medicare	$3,828.50
Rate for Payer: University Health Alliance Commercial	$9,001.92

AGENT DCB 3.5X15

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$10,497.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: MDX Hawaii PPO	$11,979.50

AGENT DCB 3.5X15

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$3,828.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: AlohaCare Medicaid	$6,175.00
Rate for Payer: AlohaCare Medicare	$3,828.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Devoted Health Medicare	$4,199.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,828.50
Rate for Payer: Hawaii Western Management Group Commercial	$11,732.50
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Humana Medicare	$3,828.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: Kaiser Permanente Medicaid	$6,298.50
Rate for Payer: Kaiser Permanente Medicare	$3,828.50
Rate for Payer: MDX Hawaii PPO	$11,979.50
Rate for Payer: Ohana Health Plan Medicaid	$3,828.50
Rate for Payer: Ohana Health Plan Medicare	$3,828.50
Rate for Payer: UnitedHealthcare Medicare	$3,828.50
Rate for Payer: University Health Alliance Commercial	$9,001.92

AGENT DCB 3X15

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$3,828.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: AlohaCare Medicaid	$6,175.00
Rate for Payer: AlohaCare Medicare	$3,828.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Devoted Health Medicare	$4,199.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,828.50
Rate for Payer: Hawaii Western Management Group Commercial	$11,732.50
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Humana Medicare	$3,828.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: Kaiser Permanente Medicaid	$6,298.50
Rate for Payer: Kaiser Permanente Medicare	$3,828.50
Rate for Payer: MDX Hawaii PPO	$11,979.50
Rate for Payer: Ohana Health Plan Medicaid	$3,828.50
Rate for Payer: Ohana Health Plan Medicare	$3,828.50
Rate for Payer: UnitedHealthcare Medicare	$3,828.50
Rate for Payer: University Health Alliance Commercial	$9,001.92

AGENT DCB 3X15

Facility

$12,350.00

Service Code	HCPCS C9610
Hospital Revenue Code	272
Min. Negotiated Rate	$10,497.50
Max. Negotiated Rate	$11,979.50
Rate for Payer: Cash Price	$7,410.00
Rate for Payer: Health Management Network Commercial	$10,497.50
Rate for Payer: Kaiser Permanente Commercial	$11,115.00
Rate for Payer: MDX Hawaii PPO	$11,979.50

Know your out-of-pocket cost for care.

All Charges