Kau Hospital

All Charges

Charge

Type

Setting

Price

MESH PHSM SYNTHETIC NON AB

Facility

$1,842.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,031.52
Max. Negotiated Rate	$1,786.74
Rate for Payer: Cash Price	$1,105.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,289.40
Rate for Payer: Health Management Network Commercial	$1,565.70
Rate for Payer: Kaiser Permanente Commercial	$1,657.80
Rate for Payer: MDX Hawaii PPO	$1,786.74
Rate for Payer: University Health Alliance Commercial	$1,031.52

MESH POLY 15CM W/COLLAGEN

Facility

$2,884.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$894.04
Max. Negotiated Rate	$2,797.48
Rate for Payer: AlohaCare Medicaid	$1,442.00
Rate for Payer: AlohaCare Medicare	$894.04
Rate for Payer: Cash Price	$1,730.40
Rate for Payer: Devoted Health Medicare	$980.56
Rate for Payer: Hawaii Medical Service Association Medicare	$894.04
Rate for Payer: Hawaii Western Management Group Commercial	$2,018.80
Rate for Payer: Health Management Network Commercial	$2,451.40
Rate for Payer: Humana Medicare	$894.04
Rate for Payer: Kaiser Permanente Commercial	$2,595.60
Rate for Payer: Kaiser Permanente Medicaid	$1,470.84
Rate for Payer: Kaiser Permanente Medicare	$894.04
Rate for Payer: MDX Hawaii PPO	$2,797.48
Rate for Payer: Ohana Health Plan Medicaid	$894.04
Rate for Payer: Ohana Health Plan Medicare	$894.04
Rate for Payer: UnitedHealthcare Medicare	$894.04
Rate for Payer: University Health Alliance Commercial	$1,615.04

MESH POLY 15CM W/COLLAGEN

Facility

$2,884.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,615.04
Max. Negotiated Rate	$2,797.48
Rate for Payer: Cash Price	$1,730.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,018.80
Rate for Payer: Health Management Network Commercial	$2,451.40
Rate for Payer: Kaiser Permanente Commercial	$2,595.60
Rate for Payer: MDX Hawaii PPO	$2,797.48
Rate for Payer: University Health Alliance Commercial	$1,615.04

MESH POLY 20X15 W/COLLAGEN

Facility

$2,074.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$642.94
Max. Negotiated Rate	$2,011.78
Rate for Payer: AlohaCare Medicaid	$1,037.00
Rate for Payer: AlohaCare Medicare	$642.94
Rate for Payer: Cash Price	$1,244.40
Rate for Payer: Devoted Health Medicare	$705.16
Rate for Payer: Hawaii Medical Service Association Medicare	$642.94
Rate for Payer: Hawaii Western Management Group Commercial	$1,451.80
Rate for Payer: Health Management Network Commercial	$1,762.90
Rate for Payer: Humana Medicare	$642.94
Rate for Payer: Kaiser Permanente Commercial	$1,866.60
Rate for Payer: Kaiser Permanente Medicaid	$1,057.74
Rate for Payer: Kaiser Permanente Medicare	$642.94
Rate for Payer: MDX Hawaii PPO	$2,011.78
Rate for Payer: Ohana Health Plan Medicaid	$642.94
Rate for Payer: Ohana Health Plan Medicare	$642.94
Rate for Payer: UnitedHealthcare Medicare	$642.94
Rate for Payer: University Health Alliance Commercial	$1,161.44

MESH POLY 20X15 W/COLLAGEN

Facility

$2,074.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,161.44
Max. Negotiated Rate	$2,011.78
Rate for Payer: Cash Price	$1,244.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,451.80
Rate for Payer: Health Management Network Commercial	$1,762.90
Rate for Payer: Kaiser Permanente Commercial	$1,866.60
Rate for Payer: MDX Hawaii PPO	$2,011.78
Rate for Payer: University Health Alliance Commercial	$1,161.44

MESH POLY 9CM DIA W/COLLAGEN

Facility

$1,100.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$616.00
Max. Negotiated Rate	$1,067.00
Rate for Payer: Cash Price	$660.00
Rate for Payer: Hawaii Western Management Group Commercial	$770.00
Rate for Payer: Health Management Network Commercial	$935.00
Rate for Payer: Kaiser Permanente Commercial	$990.00
Rate for Payer: MDX Hawaii PPO	$1,067.00
Rate for Payer: University Health Alliance Commercial	$616.00

MESH POLY 9CM DIA W/COLLAGEN

Facility

$1,100.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$341.00
Max. Negotiated Rate	$1,067.00
Rate for Payer: AlohaCare Medicaid	$550.00
Rate for Payer: AlohaCare Medicare	$341.00
Rate for Payer: Cash Price	$660.00
Rate for Payer: Devoted Health Medicare	$374.00
Rate for Payer: Hawaii Medical Service Association Medicare	$341.00
Rate for Payer: Hawaii Western Management Group Commercial	$770.00
Rate for Payer: Health Management Network Commercial	$935.00
Rate for Payer: Humana Medicare	$341.00
Rate for Payer: Kaiser Permanente Commercial	$990.00
Rate for Payer: Kaiser Permanente Medicaid	$561.00
Rate for Payer: Kaiser Permanente Medicare	$341.00
Rate for Payer: MDX Hawaii PPO	$1,067.00
Rate for Payer: Ohana Health Plan Medicaid	$341.00
Rate for Payer: Ohana Health Plan Medicare	$341.00
Rate for Payer: UnitedHealthcare Medicare	$341.00
Rate for Payer: University Health Alliance Commercial	$616.00

MESH POLYESTER 30X20CM PCO3020

Facility

$2,874.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$890.94
Max. Negotiated Rate	$2,787.78
Rate for Payer: AlohaCare Medicaid	$1,437.00
Rate for Payer: AlohaCare Medicare	$890.94
Rate for Payer: Cash Price	$1,724.40
Rate for Payer: Devoted Health Medicare	$977.16
Rate for Payer: Hawaii Medical Service Association Medicare	$890.94
Rate for Payer: Hawaii Western Management Group Commercial	$2,011.80
Rate for Payer: Health Management Network Commercial	$2,442.90
Rate for Payer: Humana Medicare	$890.94
Rate for Payer: Kaiser Permanente Commercial	$2,586.60
Rate for Payer: Kaiser Permanente Medicaid	$1,465.74
Rate for Payer: Kaiser Permanente Medicare	$890.94
Rate for Payer: MDX Hawaii PPO	$2,787.78
Rate for Payer: Ohana Health Plan Medicaid	$890.94
Rate for Payer: Ohana Health Plan Medicare	$890.94
Rate for Payer: UnitedHealthcare Medicare	$890.94
Rate for Payer: University Health Alliance Commercial	$1,609.44

MESH POLYESTER 30X20CM PCO3020

Facility

$2,874.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,609.44
Max. Negotiated Rate	$2,787.78
Rate for Payer: Cash Price	$1,724.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,011.80
Rate for Payer: Health Management Network Commercial	$2,442.90
Rate for Payer: Kaiser Permanente Commercial	$2,586.60
Rate for Payer: MDX Hawaii PPO	$2,787.78
Rate for Payer: University Health Alliance Commercial	$1,609.44

MESH PTEX PCOX ROUND 12CM

Facility

$1,584.00

Service Code	HCPCS C1781
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

MESH PTEX PCOX ROUND 12CM

Facility

$1,584.00

Service Code	HCPCS C1781
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

MESH RT NON ABS 0115321

Facility

$1,106.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$619.36
Max. Negotiated Rate	$1,072.82
Rate for Payer: Cash Price	$663.60
Rate for Payer: Hawaii Western Management Group Commercial	$774.20
Rate for Payer: Health Management Network Commercial	$940.10
Rate for Payer: Kaiser Permanente Commercial	$995.40
Rate for Payer: MDX Hawaii PPO	$1,072.82
Rate for Payer: University Health Alliance Commercial	$619.36

MESH RT NON ABS 0115321

Facility

$1,106.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$342.86
Max. Negotiated Rate	$1,072.82
Rate for Payer: AlohaCare Medicaid	$553.00
Rate for Payer: AlohaCare Medicare	$342.86
Rate for Payer: Cash Price	$663.60
Rate for Payer: Devoted Health Medicare	$376.04
Rate for Payer: Hawaii Medical Service Association Medicare	$342.86
Rate for Payer: Hawaii Western Management Group Commercial	$774.20
Rate for Payer: Health Management Network Commercial	$940.10
Rate for Payer: Humana Medicare	$342.86
Rate for Payer: Kaiser Permanente Commercial	$995.40
Rate for Payer: Kaiser Permanente Medicaid	$564.06
Rate for Payer: Kaiser Permanente Medicare	$342.86
Rate for Payer: MDX Hawaii PPO	$1,072.82
Rate for Payer: Ohana Health Plan Medicaid	$342.86
Rate for Payer: Ohana Health Plan Medicare	$342.86
Rate for Payer: UnitedHealthcare Medicare	$342.86
Rate for Payer: University Health Alliance Commercial	$619.36

MESH RT NON ABS 0115322

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 RT NON ABS 0115322

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 SELF GRIPPING LT 12X8

Facility

$981.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$549.36
Max. Negotiated Rate	$951.57
Rate for Payer: Cash Price	$588.60
Rate for Payer: Hawaii Western Management Group Commercial	$686.70
Rate for Payer: Health Management Network Commercial	$833.85
Rate for Payer: Kaiser Permanente Commercial	$882.90
Rate for Payer: MDX Hawaii PPO	$951.57
Rate for Payer: University Health Alliance Commercial	$549.36

MESH SELF GRIPPING LT 12X8

Facility

$981.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$304.11
Max. Negotiated Rate	$951.57
Rate for Payer: AlohaCare Medicaid	$490.50
Rate for Payer: AlohaCare Medicare	$304.11
Rate for Payer: Cash Price	$588.60
Rate for Payer: Devoted Health Medicare	$333.54
Rate for Payer: Hawaii Medical Service Association Medicare	$304.11
Rate for Payer: Hawaii Western Management Group Commercial	$686.70
Rate for Payer: Health Management Network Commercial	$833.85
Rate for Payer: Humana Medicare	$304.11
Rate for Payer: Kaiser Permanente Commercial	$882.90
Rate for Payer: Kaiser Permanente Medicaid	$500.31
Rate for Payer: Kaiser Permanente Medicare	$304.11
Rate for Payer: MDX Hawaii PPO	$951.57
Rate for Payer: Ohana Health Plan Medicaid	$304.11
Rate for Payer: Ohana Health Plan Medicare	$304.11
Rate for Payer: UnitedHealthcare Medicare	$304.11
Rate for Payer: University Health Alliance Commercial	$549.36

MESH SELF GRIPPING RT 12X9

Facility

$1,665.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$516.15
Max. Negotiated Rate	$1,615.05
Rate for Payer: AlohaCare Medicaid	$832.50
Rate for Payer: AlohaCare Medicare	$516.15
Rate for Payer: Cash Price	$999.00
Rate for Payer: Devoted Health Medicare	$566.10
Rate for Payer: Hawaii Medical Service Association Medicare	$516.15
Rate for Payer: Hawaii Western Management Group Commercial	$1,165.50
Rate for Payer: Health Management Network Commercial	$1,415.25
Rate for Payer: Humana Medicare	$516.15
Rate for Payer: Kaiser Permanente Commercial	$1,498.50
Rate for Payer: Kaiser Permanente Medicaid	$849.15
Rate for Payer: Kaiser Permanente Medicare	$516.15
Rate for Payer: MDX Hawaii PPO	$1,615.05
Rate for Payer: Ohana Health Plan Medicaid	$516.15
Rate for Payer: Ohana Health Plan Medicare	$516.15
Rate for Payer: UnitedHealthcare Medicare	$516.15
Rate for Payer: University Health Alliance Commercial	$932.40

MESH SELF GRIPPING RT 12X9

Facility

$1,665.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$932.40
Max. Negotiated Rate	$1,615.05
Rate for Payer: Cash Price	$999.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,165.50
Rate for Payer: Health Management Network Commercial	$1,415.25
Rate for Payer: Kaiser Permanente Commercial	$1,498.50
Rate for Payer: MDX Hawaii PPO	$1,615.05
Rate for Payer: University Health Alliance Commercial	$932.40

MESH STEX 15X10CM

Facility

$2,099.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,175.44
Max. Negotiated Rate	$2,036.03
Rate for Payer: Cash Price	$1,259.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,469.30
Rate for Payer: Health Management Network Commercial	$1,784.15
Rate for Payer: Kaiser Permanente Commercial	$1,889.10
Rate for Payer: MDX Hawaii PPO	$2,036.03
Rate for Payer: University Health Alliance Commercial	$1,175.44

MESH STEX 15X10CM

Facility

$2,099.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$650.69
Max. Negotiated Rate	$2,036.03
Rate for Payer: AlohaCare Medicaid	$1,049.50
Rate for Payer: AlohaCare Medicare	$650.69
Rate for Payer: Cash Price	$1,259.40
Rate for Payer: Devoted Health Medicare	$713.66
Rate for Payer: Hawaii Medical Service Association Medicare	$650.69
Rate for Payer: Hawaii Western Management Group Commercial	$1,469.30
Rate for Payer: Health Management Network Commercial	$1,784.15
Rate for Payer: Humana Medicare	$650.69
Rate for Payer: Kaiser Permanente Commercial	$1,889.10
Rate for Payer: Kaiser Permanente Medicaid	$1,070.49
Rate for Payer: Kaiser Permanente Medicare	$650.69
Rate for Payer: MDX Hawaii PPO	$2,036.03
Rate for Payer: Ohana Health Plan Medicaid	$650.69
Rate for Payer: Ohana Health Plan Medicare	$650.69
Rate for Payer: UnitedHealthcare Medicare	$650.69
Rate for Payer: University Health Alliance Commercial	$1,175.44

MESH SURGICL W10XL10 GBWR1010

Facility

$2,688.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$833.28
Max. Negotiated Rate	$2,607.36
Rate for Payer: AlohaCare Medicaid	$1,344.00
Rate for Payer: AlohaCare Medicare	$833.28
Rate for Payer: Cash Price	$1,612.80
Rate for Payer: Devoted Health Medicare	$913.92
Rate for Payer: Hawaii Medical Service Association Medicare	$833.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,881.60
Rate for Payer: Health Management Network Commercial	$2,284.80
Rate for Payer: Humana Medicare	$833.28
Rate for Payer: Kaiser Permanente Commercial	$2,419.20
Rate for Payer: Kaiser Permanente Medicaid	$1,370.88
Rate for Payer: Kaiser Permanente Medicare	$833.28
Rate for Payer: MDX Hawaii PPO	$2,607.36
Rate for Payer: Ohana Health Plan Medicaid	$833.28
Rate for Payer: Ohana Health Plan Medicare	$833.28
Rate for Payer: UnitedHealthcare Medicare	$833.28
Rate for Payer: University Health Alliance Commercial	$1,505.28

MESH SURGICL W10XL10 GBWR1010

Facility

$2,688.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,505.28
Max. Negotiated Rate	$2,607.36
Rate for Payer: Cash Price	$1,612.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,881.60
Rate for Payer: Health Management Network Commercial	$2,284.80
Rate for Payer: Kaiser Permanente Commercial	$2,419.20
Rate for Payer: MDX Hawaii PPO	$2,607.36
Rate for Payer: University Health Alliance Commercial	$1,505.28

MESH SYNECOR 10X15CM GKFV1015

Facility

$2,295.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$711.45
Max. Negotiated Rate	$2,226.15
Rate for Payer: AlohaCare Medicaid	$1,147.50
Rate for Payer: AlohaCare Medicare	$711.45
Rate for Payer: Cash Price	$1,377.00
Rate for Payer: Devoted Health Medicare	$780.30
Rate for Payer: Hawaii Medical Service Association Medicare	$711.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,606.50
Rate for Payer: Health Management Network Commercial	$1,950.75
Rate for Payer: Humana Medicare	$711.45
Rate for Payer: Kaiser Permanente Commercial	$2,065.50
Rate for Payer: Kaiser Permanente Medicaid	$1,170.45
Rate for Payer: Kaiser Permanente Medicare	$711.45
Rate for Payer: MDX Hawaii PPO	$2,226.15
Rate for Payer: Ohana Health Plan Medicaid	$711.45
Rate for Payer: Ohana Health Plan Medicare	$711.45
Rate for Payer: UnitedHealthcare Medicare	$711.45
Rate for Payer: University Health Alliance Commercial	$1,285.20

MESH SYNECOR 10X15CM GKFV1015

Facility

$2,295.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,285.20
Max. Negotiated Rate	$2,226.15
Rate for Payer: Cash Price	$1,377.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,606.50
Rate for Payer: Health Management Network Commercial	$1,950.75
Rate for Payer: Kaiser Permanente Commercial	$2,065.50
Rate for Payer: MDX Hawaii PPO	$2,226.15
Rate for Payer: University Health Alliance Commercial	$1,285.20

Know your out-of-pocket cost for care.

All Charges