Kau Hospital

All Charges

Charge

Type

Setting

Price

MESHED DERMAL 5CMX5CM MDRT2021

Facility

$7,560.00

Service Code	HCPCS Q4105
Hospital Revenue Code	636
Min. Negotiated Rate	$6,426.00
Max. Negotiated Rate	$7,333.20
Rate for Payer: Cash Price	$4,536.00
Rate for Payer: Health Management Network Commercial	$6,426.00
Rate for Payer: Kaiser Permanente Commercial	$6,804.00
Rate for Payer: MDX Hawaii PPO	$7,333.20

MESHED DERMAL 5CMX5CM MDRT2021

Facility

$7,560.00

Service Code	HCPCS Q4105
Hospital Revenue Code	636
Min. Negotiated Rate	$26.09
Max. Negotiated Rate	$7,333.20
Rate for Payer: AlohaCare Medicaid	$3,780.00
Rate for Payer: AlohaCare Medicare	$2,343.60
Rate for Payer: Cash Price	$4,536.00
Rate for Payer: Cash Price	$4,536.00
Rate for Payer: Devoted Health Medicare	$2,570.40
Rate for Payer: Hawaii Medical Service Association ABD	$26.09
Rate for Payer: Hawaii Medical Service Association Commercial	$158.93
Rate for Payer: Hawaii Medical Service Association Medicare	$2,343.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.09
Rate for Payer: Hawaii Western Management Group Commercial	$7,182.00
Rate for Payer: Health Management Network Commercial	$6,426.00
Rate for Payer: Humana Medicare	$2,343.60
Rate for Payer: Kaiser Permanente Commercial	$6,804.00
Rate for Payer: Kaiser Permanente Medicaid	$3,855.60
Rate for Payer: Kaiser Permanente Medicare	$2,343.60
Rate for Payer: MDX Hawaii PPO	$7,333.20
Rate for Payer: Ohana Health Plan Medicaid	$2,343.60
Rate for Payer: Ohana Health Plan Medicare	$2,343.60
Rate for Payer: UnitedHealthcare Medicaid	$4,536.00
Rate for Payer: UnitedHealthcare Medicare	$2,343.60
Rate for Payer: University Health Alliance Commercial	$5,510.48

MESH FLEX HD 6X16 PF2616

Facility

$8,106.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$2,512.86
Max. Negotiated Rate	$7,862.82
Rate for Payer: AlohaCare Medicaid	$4,053.00
Rate for Payer: AlohaCare Medicare	$2,512.86
Rate for Payer: Cash Price	$4,863.60
Rate for Payer: Devoted Health Medicare	$2,756.04
Rate for Payer: Hawaii Medical Service Association Medicare	$2,512.86
Rate for Payer: Hawaii Western Management Group Commercial	$5,674.20
Rate for Payer: Health Management Network Commercial	$6,890.10
Rate for Payer: Humana Medicare	$2,512.86
Rate for Payer: Kaiser Permanente Commercial	$7,295.40
Rate for Payer: Kaiser Permanente Medicaid	$4,134.06
Rate for Payer: Kaiser Permanente Medicare	$2,512.86
Rate for Payer: MDX Hawaii PPO	$7,862.82
Rate for Payer: Ohana Health Plan Medicaid	$2,512.86
Rate for Payer: Ohana Health Plan Medicare	$2,512.86
Rate for Payer: UnitedHealthcare Medicare	$2,512.86
Rate for Payer: University Health Alliance Commercial	$4,539.36

MESH FLEX HD 6X16 PF2616

Facility

$8,106.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$4,539.36
Max. Negotiated Rate	$7,862.82
Rate for Payer: Cash Price	$4,863.60
Rate for Payer: Hawaii Western Management Group Commercial	$5,674.20
Rate for Payer: Health Management Network Commercial	$6,890.10
Rate for Payer: Kaiser Permanente Commercial	$7,295.40
Rate for Payer: MDX Hawaii PPO	$7,862.82
Rate for Payer: University Health Alliance Commercial	$4,539.36

MESH FLEX HD 8X16 PF2618

Facility

$11,412.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$3,537.72
Max. Negotiated Rate	$11,069.64
Rate for Payer: AlohaCare Medicaid	$5,706.00
Rate for Payer: AlohaCare Medicare	$3,537.72
Rate for Payer: Cash Price	$6,847.20
Rate for Payer: Devoted Health Medicare	$3,880.08
Rate for Payer: Hawaii Medical Service Association Medicare	$3,537.72
Rate for Payer: Hawaii Western Management Group Commercial	$7,988.40
Rate for Payer: Health Management Network Commercial	$9,700.20
Rate for Payer: Humana Medicare	$3,537.72
Rate for Payer: Kaiser Permanente Commercial	$10,270.80
Rate for Payer: Kaiser Permanente Medicaid	$5,820.12
Rate for Payer: Kaiser Permanente Medicare	$3,537.72
Rate for Payer: MDX Hawaii PPO	$11,069.64
Rate for Payer: Ohana Health Plan Medicaid	$3,537.72
Rate for Payer: Ohana Health Plan Medicare	$3,537.72
Rate for Payer: UnitedHealthcare Medicare	$3,537.72
Rate for Payer: University Health Alliance Commercial	$6,390.72

MESH FLEX HD 8X16 PF2618

Facility

$11,412.00

Service Code	HCPCS C1763
Hospital Revenue Code	278
Min. Negotiated Rate	$6,390.72
Max. Negotiated Rate	$11,069.64
Rate for Payer: Cash Price	$6,847.20
Rate for Payer: Hawaii Western Management Group Commercial	$7,988.40
Rate for Payer: Health Management Network Commercial	$9,700.20
Rate for Payer: Kaiser Permanente Commercial	$10,270.80
Rate for Payer: MDX Hawaii PPO	$11,069.64
Rate for Payer: University Health Alliance Commercial	$6,390.72

MESH HERNIA PLUG AND PATCH

Facility

$391.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$218.96
Max. Negotiated Rate	$379.27
Rate for Payer: Cash Price	$234.60
Rate for Payer: Hawaii Western Management Group Commercial	$273.70
Rate for Payer: Health Management Network Commercial	$332.35
Rate for Payer: Kaiser Permanente Commercial	$351.90
Rate for Payer: MDX Hawaii PPO	$379.27
Rate for Payer: University Health Alliance Commercial	$218.96

MESH HERNIA PLUG AND PATCH

Facility

$391.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$121.21
Max. Negotiated Rate	$379.27
Rate for Payer: AlohaCare Medicaid	$195.50
Rate for Payer: AlohaCare Medicare	$121.21
Rate for Payer: Cash Price	$234.60
Rate for Payer: Devoted Health Medicare	$132.94
Rate for Payer: Hawaii Medical Service Association Medicare	$121.21
Rate for Payer: Hawaii Western Management Group Commercial	$273.70
Rate for Payer: Health Management Network Commercial	$332.35
Rate for Payer: Humana Medicare	$121.21
Rate for Payer: Kaiser Permanente Commercial	$351.90
Rate for Payer: Kaiser Permanente Medicaid	$199.41
Rate for Payer: Kaiser Permanente Medicare	$121.21
Rate for Payer: MDX Hawaii PPO	$379.27
Rate for Payer: Ohana Health Plan Medicaid	$121.21
Rate for Payer: Ohana Health Plan Medicare	$121.21
Rate for Payer: UnitedHealthcare Medicare	$121.21
Rate for Payer: University Health Alliance Commercial	$218.96

MESH HERNIA SYNECOR 12C GKFC12

Facility

$1,863.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$577.53
Max. Negotiated Rate	$1,807.11
Rate for Payer: AlohaCare Medicaid	$931.50
Rate for Payer: AlohaCare Medicare	$577.53
Rate for Payer: Cash Price	$1,117.80
Rate for Payer: Devoted Health Medicare	$633.42
Rate for Payer: Hawaii Medical Service Association Medicare	$577.53
Rate for Payer: Hawaii Western Management Group Commercial	$1,304.10
Rate for Payer: Health Management Network Commercial	$1,583.55
Rate for Payer: Humana Medicare	$577.53
Rate for Payer: Kaiser Permanente Commercial	$1,676.70
Rate for Payer: Kaiser Permanente Medicaid	$950.13
Rate for Payer: Kaiser Permanente Medicare	$577.53
Rate for Payer: MDX Hawaii PPO	$1,807.11
Rate for Payer: Ohana Health Plan Medicaid	$577.53
Rate for Payer: Ohana Health Plan Medicare	$577.53
Rate for Payer: UnitedHealthcare Medicare	$577.53
Rate for Payer: University Health Alliance Commercial	$1,043.28

MESH HERNIA SYNECOR 12C GKFC12

Facility

$1,863.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,043.28
Max. Negotiated Rate	$1,807.11
Rate for Payer: Cash Price	$1,117.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,304.10
Rate for Payer: Health Management Network Commercial	$1,583.55
Rate for Payer: Kaiser Permanente Commercial	$1,676.70
Rate for Payer: MDX Hawaii PPO	$1,807.11
Rate for Payer: University Health Alliance Commercial	$1,043.28

MESH LF NON ABS 0115311

Facility

$910.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$509.60
Max. Negotiated Rate	$882.70
Rate for Payer: Cash Price	$546.00
Rate for Payer: Hawaii Western Management Group Commercial	$637.00
Rate for Payer: Health Management Network Commercial	$773.50
Rate for Payer: Kaiser Permanente Commercial	$819.00
Rate for Payer: MDX Hawaii PPO	$882.70
Rate for Payer: University Health Alliance Commercial	$509.60

MESH LF NON ABS 0115311

Facility

$910.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$282.10
Max. Negotiated Rate	$882.70
Rate for Payer: AlohaCare Medicaid	$455.00
Rate for Payer: AlohaCare Medicare	$282.10
Rate for Payer: Cash Price	$546.00
Rate for Payer: Devoted Health Medicare	$309.40
Rate for Payer: Hawaii Medical Service Association Medicare	$282.10
Rate for Payer: Hawaii Western Management Group Commercial	$637.00
Rate for Payer: Health Management Network Commercial	$773.50
Rate for Payer: Humana Medicare	$282.10
Rate for Payer: Kaiser Permanente Commercial	$819.00
Rate for Payer: Kaiser Permanente Medicaid	$464.10
Rate for Payer: Kaiser Permanente Medicare	$282.10
Rate for Payer: MDX Hawaii PPO	$882.70
Rate for Payer: Ohana Health Plan Medicaid	$282.10
Rate for Payer: Ohana Health Plan Medicare	$282.10
Rate for Payer: UnitedHealthcare Medicare	$282.10
Rate for Payer: University Health Alliance Commercial	$509.60

MESH LF NON ABS 0115312

Facility

$1,220.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$378.20
Max. Negotiated Rate	$1,183.40
Rate for Payer: AlohaCare Medicaid	$610.00
Rate for Payer: AlohaCare Medicare	$378.20
Rate for Payer: Cash Price	$732.00
Rate for Payer: Devoted Health Medicare	$414.80
Rate for Payer: Hawaii Medical Service Association Medicare	$378.20
Rate for Payer: Hawaii Western Management Group Commercial	$854.00
Rate for Payer: Health Management Network Commercial	$1,037.00
Rate for Payer: Humana Medicare	$378.20
Rate for Payer: Kaiser Permanente Commercial	$1,098.00
Rate for Payer: Kaiser Permanente Medicaid	$622.20
Rate for Payer: Kaiser Permanente Medicare	$378.20
Rate for Payer: MDX Hawaii PPO	$1,183.40
Rate for Payer: Ohana Health Plan Medicaid	$378.20
Rate for Payer: Ohana Health Plan Medicare	$378.20
Rate for Payer: UnitedHealthcare Medicare	$378.20
Rate for Payer: University Health Alliance Commercial	$683.20

MESH LF NON ABS 0115312

Facility

$1,220.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$683.20
Max. Negotiated Rate	$1,183.40
Rate for Payer: Cash Price	$732.00
Rate for Payer: Hawaii Western Management Group Commercial	$854.00
Rate for Payer: Health Management Network Commercial	$1,037.00
Rate for Payer: Kaiser Permanente Commercial	$1,098.00
Rate for Payer: MDX Hawaii PPO	$1,183.40
Rate for Payer: University Health Alliance Commercial	$683.20

MESH M FLAT 15X10 501320

Facility

$2,076.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.56
Max. Negotiated Rate	$2,013.72
Rate for Payer: Cash Price	$1,245.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,453.20
Rate for Payer: Health Management Network Commercial	$1,764.60
Rate for Payer: Kaiser Permanente Commercial	$1,868.40
Rate for Payer: MDX Hawaii PPO	$2,013.72
Rate for Payer: University Health Alliance Commercial	$1,162.56

MESH M FLAT 15X10 501320

Facility

$2,076.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$643.56
Max. Negotiated Rate	$2,013.72
Rate for Payer: AlohaCare Medicaid	$1,038.00
Rate for Payer: AlohaCare Medicare	$643.56
Rate for Payer: Cash Price	$1,245.60
Rate for Payer: Devoted Health Medicare	$705.84
Rate for Payer: Hawaii Medical Service Association Medicare	$643.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,453.20
Rate for Payer: Health Management Network Commercial	$1,764.60
Rate for Payer: Humana Medicare	$643.56
Rate for Payer: Kaiser Permanente Commercial	$1,868.40
Rate for Payer: Kaiser Permanente Medicaid	$1,058.76
Rate for Payer: Kaiser Permanente Medicare	$643.56
Rate for Payer: MDX Hawaii PPO	$2,013.72
Rate for Payer: Ohana Health Plan Medicaid	$643.56
Rate for Payer: Ohana Health Plan Medicare	$643.56
Rate for Payer: UnitedHealthcare Medicare	$643.56
Rate for Payer: University Health Alliance Commercial	$1,162.56

MESH MONOFILAMENT POLY 0112660

Facility

$523.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$162.13
Max. Negotiated Rate	$507.31
Rate for Payer: AlohaCare Medicaid	$261.50
Rate for Payer: AlohaCare Medicare	$162.13
Rate for Payer: Cash Price	$313.80
Rate for Payer: Devoted Health Medicare	$177.82
Rate for Payer: Hawaii Medical Service Association Medicare	$162.13
Rate for Payer: Hawaii Western Management Group Commercial	$366.10
Rate for Payer: Health Management Network Commercial	$444.55
Rate for Payer: Humana Medicare	$162.13
Rate for Payer: Kaiser Permanente Commercial	$470.70
Rate for Payer: Kaiser Permanente Medicaid	$266.73
Rate for Payer: Kaiser Permanente Medicare	$162.13
Rate for Payer: MDX Hawaii PPO	$507.31
Rate for Payer: Ohana Health Plan Medicaid	$162.13
Rate for Payer: Ohana Health Plan Medicare	$162.13
Rate for Payer: UnitedHealthcare Medicare	$162.13
Rate for Payer: University Health Alliance Commercial	$292.88

MESH MONOFILAMENT POLY 0112660

Facility

$523.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$292.88
Max. Negotiated Rate	$507.31
Rate for Payer: Cash Price	$313.80
Rate for Payer: Hawaii Western Management Group Commercial	$366.10
Rate for Payer: Health Management Network Commercial	$444.55
Rate for Payer: Kaiser Permanente Commercial	$470.70
Rate for Payer: MDX Hawaii PPO	$507.31
Rate for Payer: University Health Alliance Commercial	$292.88

MESH PARIETEX HERNIA PCO20X

Facility

$2,828.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,583.68
Max. Negotiated Rate	$2,743.16
Rate for Payer: Cash Price	$1,696.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,979.60
Rate for Payer: Health Management Network Commercial	$2,403.80
Rate for Payer: Kaiser Permanente Commercial	$2,545.20
Rate for Payer: MDX Hawaii PPO	$2,743.16
Rate for Payer: University Health Alliance Commercial	$1,583.68

MESH PARIETEX HERNIA PCO20X

Facility

$2,828.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$876.68
Max. Negotiated Rate	$2,743.16
Rate for Payer: AlohaCare Medicaid	$1,414.00
Rate for Payer: AlohaCare Medicare	$876.68
Rate for Payer: Cash Price	$1,696.80
Rate for Payer: Devoted Health Medicare	$961.52
Rate for Payer: Hawaii Medical Service Association Medicare	$876.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,979.60
Rate for Payer: Health Management Network Commercial	$2,403.80
Rate for Payer: Humana Medicare	$876.68
Rate for Payer: Kaiser Permanente Commercial	$2,545.20
Rate for Payer: Kaiser Permanente Medicaid	$1,442.28
Rate for Payer: Kaiser Permanente Medicare	$876.68
Rate for Payer: MDX Hawaii PPO	$2,743.16
Rate for Payer: Ohana Health Plan Medicaid	$876.68
Rate for Payer: Ohana Health Plan Medicare	$876.68
Rate for Payer: UnitedHealthcare Medicare	$876.68
Rate for Payer: University Health Alliance Commercial	$1,583.68

MESH PERFIX PLUG, LG 0112970

Facility

$1,025.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$574.00
Max. Negotiated Rate	$994.25
Rate for Payer: Cash Price	$615.00
Rate for Payer: Hawaii Western Management Group Commercial	$717.50
Rate for Payer: Health Management Network Commercial	$871.25
Rate for Payer: Kaiser Permanente Commercial	$922.50
Rate for Payer: MDX Hawaii PPO	$994.25
Rate for Payer: University Health Alliance Commercial	$574.00

MESH PERFIX PLUG, LG 0112970

Facility

$1,025.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$317.75
Max. Negotiated Rate	$994.25
Rate for Payer: AlohaCare Medicaid	$512.50
Rate for Payer: AlohaCare Medicare	$317.75
Rate for Payer: Cash Price	$615.00
Rate for Payer: Devoted Health Medicare	$348.50
Rate for Payer: Hawaii Medical Service Association Medicare	$317.75
Rate for Payer: Hawaii Western Management Group Commercial	$717.50
Rate for Payer: Health Management Network Commercial	$871.25
Rate for Payer: Humana Medicare	$317.75
Rate for Payer: Kaiser Permanente Commercial	$922.50
Rate for Payer: Kaiser Permanente Medicaid	$522.75
Rate for Payer: Kaiser Permanente Medicare	$317.75
Rate for Payer: MDX Hawaii PPO	$994.25
Rate for Payer: Ohana Health Plan Medicaid	$317.75
Rate for Payer: Ohana Health Plan Medicare	$317.75
Rate for Payer: UnitedHealthcare Medicare	$317.75
Rate for Payer: University Health Alliance Commercial	$574.00

MESH PHASIX 20X25 1202025

Facility

$28,644.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$8,879.64
Max. Negotiated Rate	$27,784.68
Rate for Payer: AlohaCare Medicaid	$14,322.00
Rate for Payer: AlohaCare Medicare	$8,879.64
Rate for Payer: Cash Price	$17,186.40
Rate for Payer: Devoted Health Medicare	$9,738.96
Rate for Payer: Hawaii Medical Service Association Medicare	$8,879.64
Rate for Payer: Hawaii Western Management Group Commercial	$20,050.80
Rate for Payer: Health Management Network Commercial	$24,347.40
Rate for Payer: Humana Medicare	$8,879.64
Rate for Payer: Kaiser Permanente Commercial	$25,779.60
Rate for Payer: Kaiser Permanente Medicaid	$14,608.44
Rate for Payer: Kaiser Permanente Medicare	$8,879.64
Rate for Payer: MDX Hawaii PPO	$27,784.68
Rate for Payer: Ohana Health Plan Medicaid	$8,879.64
Rate for Payer: Ohana Health Plan Medicare	$8,879.64
Rate for Payer: UnitedHealthcare Medicare	$8,879.64
Rate for Payer: University Health Alliance Commercial	$16,040.64

MESH PHASIX 20X25 1202025

Facility

$28,644.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$16,040.64
Max. Negotiated Rate	$27,784.68
Rate for Payer: Cash Price	$17,186.40
Rate for Payer: Hawaii Western Management Group Commercial	$20,050.80
Rate for Payer: Health Management Network Commercial	$24,347.40
Rate for Payer: Kaiser Permanente Commercial	$25,779.60
Rate for Payer: MDX Hawaii PPO	$27,784.68
Rate for Payer: University Health Alliance Commercial	$16,040.64

MESH PHSM SYNTHETIC NON AB

Facility

$1,842.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$571.02
Max. Negotiated Rate	$1,786.74
Rate for Payer: AlohaCare Medicaid	$921.00
Rate for Payer: AlohaCare Medicare	$571.02
Rate for Payer: Cash Price	$1,105.20
Rate for Payer: Devoted Health Medicare	$626.28
Rate for Payer: Hawaii Medical Service Association Medicare	$571.02
Rate for Payer: Hawaii Western Management Group Commercial	$1,289.40
Rate for Payer: Health Management Network Commercial	$1,565.70
Rate for Payer: Humana Medicare	$571.02
Rate for Payer: Kaiser Permanente Commercial	$1,657.80
Rate for Payer: Kaiser Permanente Medicaid	$939.42
Rate for Payer: Kaiser Permanente Medicare	$571.02
Rate for Payer: MDX Hawaii PPO	$1,786.74
Rate for Payer: Ohana Health Plan Medicaid	$571.02
Rate for Payer: Ohana Health Plan Medicare	$571.02
Rate for Payer: UnitedHealthcare Medicare	$571.02
Rate for Payer: University Health Alliance Commercial	$1,031.52

Know your out-of-pocket cost for care.

All Charges