Kau Hospital

All Charges

Charge

Type

Setting

Price

FRACTURES OF FEMUR WITH MCC

Facility

$12,182.83

Service Code	MSDRG 533
Min. Negotiated Rate	$12,182.83
Max. Negotiated Rate	$12,182.83
Rate for Payer: Hawaii Medical Service Association Commercial	$12,182.83

FRACTURES OF FEMUR WITHOUT MCC

Facility

$12,182.83

Service Code	MSDRG 534
Min. Negotiated Rate	$12,182.83
Max. Negotiated Rate	$12,182.83
Rate for Payer: Hawaii Medical Service Association Commercial	$12,182.83

FRACTURES OF HIP AND PELVIS WITH MCC

Facility

$17,444.67

Service Code	MSDRG 535
Min. Negotiated Rate	$17,444.67
Max. Negotiated Rate	$17,444.67
Rate for Payer: Hawaii Medical Service Association Commercial	$17,444.67

FRACTURES OF HIP AND PELVIS WITHOUT MCC

Facility

$17,444.67

Service Code	MSDRG 536
Min. Negotiated Rate	$17,444.67
Max. Negotiated Rate	$17,444.67
Rate for Payer: Hawaii Medical Service Association Commercial	$17,444.67

FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC

Facility

$13,154.61

Service Code	MSDRG 562
Min. Negotiated Rate	$13,154.61
Max. Negotiated Rate	$13,154.61
Rate for Payer: Hawaii Medical Service Association Commercial	$13,154.61

FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC

Facility

$13,154.61

Service Code	MSDRG 563
Min. Negotiated Rate	$13,154.61
Max. Negotiated Rate	$13,154.61
Rate for Payer: Hawaii Medical Service Association Commercial	$13,154.61

FRN/GT 10X300 LF 04.033.061S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.12
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X300 LF 04.033.061S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.62
Max. Negotiated Rate	$4,851.94
Rate for Payer: AlohaCare Medicaid	$2,501.00
Rate for Payer: AlohaCare Medicare	$1,550.62
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Devoted Health Medicare	$1,700.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.62
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Humana Medicare	$1,550.62
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: Kaiser Permanente Medicaid	$2,551.02
Rate for Payer: Kaiser Permanente Medicare	$1,550.62
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: Ohana Health Plan Medicaid	$1,550.62
Rate for Payer: Ohana Health Plan Medicare	$1,550.62
Rate for Payer: UnitedHealthcare Medicare	$1,550.62
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X300 RT 04.033.060S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.62
Max. Negotiated Rate	$4,851.94
Rate for Payer: AlohaCare Medicaid	$2,501.00
Rate for Payer: AlohaCare Medicare	$1,550.62
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Devoted Health Medicare	$1,700.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.62
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Humana Medicare	$1,550.62
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: Kaiser Permanente Medicaid	$2,551.02
Rate for Payer: Kaiser Permanente Medicare	$1,550.62
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: Ohana Health Plan Medicaid	$1,550.62
Rate for Payer: Ohana Health Plan Medicare	$1,550.62
Rate for Payer: UnitedHealthcare Medicare	$1,550.62
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X300 RT 04.033.060S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.12
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X320 RT 04.033.062S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.12
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X320 RT 04.033.062S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.62
Max. Negotiated Rate	$4,851.94
Rate for Payer: AlohaCare Medicaid	$2,501.00
Rate for Payer: AlohaCare Medicare	$1,550.62
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Devoted Health Medicare	$1,700.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.62
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Humana Medicare	$1,550.62
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: Kaiser Permanente Medicaid	$2,551.02
Rate for Payer: Kaiser Permanente Medicare	$1,550.62
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: Ohana Health Plan Medicaid	$1,550.62
Rate for Payer: Ohana Health Plan Medicare	$1,550.62
Rate for Payer: UnitedHealthcare Medicare	$1,550.62
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X360 RT 04.033.066S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.62
Max. Negotiated Rate	$4,851.94
Rate for Payer: AlohaCare Medicaid	$2,501.00
Rate for Payer: AlohaCare Medicare	$1,550.62
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Devoted Health Medicare	$1,700.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.62
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Humana Medicare	$1,550.62
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: Kaiser Permanente Medicaid	$2,551.02
Rate for Payer: Kaiser Permanente Medicare	$1,550.62
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: Ohana Health Plan Medicaid	$1,550.62
Rate for Payer: Ohana Health Plan Medicare	$1,550.62
Rate for Payer: UnitedHealthcare Medicare	$1,550.62
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X360 RT 04.033.066S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.12
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X380MM 04.033.069S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.62
Max. Negotiated Rate	$4,851.94
Rate for Payer: AlohaCare Medicaid	$2,501.00
Rate for Payer: AlohaCare Medicare	$1,550.62
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Devoted Health Medicare	$1,700.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.62
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Humana Medicare	$1,550.62
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: Kaiser Permanente Medicaid	$2,551.02
Rate for Payer: Kaiser Permanente Medicare	$1,550.62
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: Ohana Health Plan Medicaid	$1,550.62
Rate for Payer: Ohana Health Plan Medicare	$1,550.62
Rate for Payer: UnitedHealthcare Medicare	$1,550.62
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X380MM 04.033.069S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.12
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X400MM 04.033.070S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.62
Max. Negotiated Rate	$4,851.94
Rate for Payer: AlohaCare Medicaid	$2,501.00
Rate for Payer: AlohaCare Medicare	$1,550.62
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Devoted Health Medicare	$1,700.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.62
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Humana Medicare	$1,550.62
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: Kaiser Permanente Medicaid	$2,551.02
Rate for Payer: Kaiser Permanente Medicare	$1,550.62
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: Ohana Health Plan Medicaid	$1,550.62
Rate for Payer: Ohana Health Plan Medicare	$1,550.62
Rate for Payer: UnitedHealthcare Medicare	$1,550.62
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X400MM 04.033.070S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.12
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X400MM LF 04.033.071S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.12
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X400MM LF 04.033.071S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.62
Max. Negotiated Rate	$4,851.94
Rate for Payer: AlohaCare Medicaid	$2,501.00
Rate for Payer: AlohaCare Medicare	$1,550.62
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Devoted Health Medicare	$1,700.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.62
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Humana Medicare	$1,550.62
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: Kaiser Permanente Medicaid	$2,551.02
Rate for Payer: Kaiser Permanente Medicare	$1,550.62
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: Ohana Health Plan Medicaid	$1,550.62
Rate for Payer: Ohana Health Plan Medicare	$1,550.62
Rate for Payer: UnitedHealthcare Medicare	$1,550.62
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X420MM LF 04.033.073S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.62
Max. Negotiated Rate	$4,851.94
Rate for Payer: AlohaCare Medicaid	$2,501.00
Rate for Payer: AlohaCare Medicare	$1,550.62
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Devoted Health Medicare	$1,700.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.62
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Humana Medicare	$1,550.62
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: Kaiser Permanente Medicaid	$2,551.02
Rate for Payer: Kaiser Permanente Medicare	$1,550.62
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: Ohana Health Plan Medicaid	$1,550.62
Rate for Payer: Ohana Health Plan Medicare	$1,550.62
Rate for Payer: UnitedHealthcare Medicare	$1,550.62
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X420MM LF 04.033.073S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.12
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X420MM RT 04.033.072S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.12
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 10X420MM RT 04.033.072S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.62
Max. Negotiated Rate	$4,851.94
Rate for Payer: AlohaCare Medicaid	$2,501.00
Rate for Payer: AlohaCare Medicare	$1,550.62
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Devoted Health Medicare	$1,700.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.62
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Humana Medicare	$1,550.62
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: Kaiser Permanente Medicaid	$2,551.02
Rate for Payer: Kaiser Permanente Medicare	$1,550.62
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: Ohana Health Plan Medicaid	$1,550.62
Rate for Payer: Ohana Health Plan Medicare	$1,550.62
Rate for Payer: UnitedHealthcare Medicare	$1,550.62
Rate for Payer: University Health Alliance Commercial	$2,801.12

FRN/GT 11X300MM LF 04.033.161S

Facility

$5,002.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.12
Max. Negotiated Rate	$4,851.94
Rate for Payer: Cash Price	$3,001.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,501.40
Rate for Payer: Health Management Network Commercial	$4,251.70
Rate for Payer: Kaiser Permanente Commercial	$4,501.80
Rate for Payer: MDX Hawaii PPO	$4,851.94
Rate for Payer: University Health Alliance Commercial	$2,801.12

Know your out-of-pocket cost for care.

All Charges