Kau Hospital

All Charges

Charge

Type

Setting

Price

OXFORD SAWBLADE STABLE 506298

Facility

$1,800.00

Hospital Revenue Code	272
Min. Negotiated Rate	$558.00
Max. Negotiated Rate	$1,746.00
Rate for Payer: AlohaCare Medicaid	$900.00
Rate for Payer: AlohaCare Medicare	$558.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Devoted Health Medicare	$612.00
Rate for Payer: Hawaii Medical Service Association Medicare	$558.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,710.00
Rate for Payer: Health Management Network Commercial	$1,530.00
Rate for Payer: Humana Medicare	$558.00
Rate for Payer: Kaiser Permanente Commercial	$1,620.00
Rate for Payer: Kaiser Permanente Medicaid	$918.00
Rate for Payer: Kaiser Permanente Medicare	$558.00
Rate for Payer: MDX Hawaii PPO	$1,746.00
Rate for Payer: Ohana Health Plan Medicaid	$558.00
Rate for Payer: Ohana Health Plan Medicare	$558.00
Rate for Payer: UnitedHealthcare Medicare	$558.00
Rate for Payer: University Health Alliance Commercial	$1,312.02

OXFORD SAWBLADE STABLE 506298

Facility

$1,800.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,530.00
Max. Negotiated Rate	$1,746.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Health Management Network Commercial	$1,530.00
Rate for Payer: Kaiser Permanente Commercial	$1,620.00
Rate for Payer: MDX Hawaii PPO	$1,746.00

OXFORD UNI TIB LM

Facility

$3,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,848.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

OXFORD UNI TIB LM

Facility

$3,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,023.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: AlohaCare Medicaid	$1,650.00
Rate for Payer: AlohaCare Medicare	$1,023.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Devoted Health Medicare	$1,122.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,023.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Humana Medicare	$1,023.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: Kaiser Permanente Medicaid	$1,683.00
Rate for Payer: Kaiser Permanente Medicare	$1,023.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: Ohana Health Plan Medicaid	$1,023.00
Rate for Payer: Ohana Health Plan Medicare	$1,023.00
Rate for Payer: UnitedHealthcare Medicare	$1,023.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

OXFORD UNI TIB SZ:D RM 154725

Facility

$3,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,023.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: AlohaCare Medicaid	$1,650.00
Rate for Payer: AlohaCare Medicare	$1,023.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Devoted Health Medicare	$1,122.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,023.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Humana Medicare	$1,023.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: Kaiser Permanente Medicaid	$1,683.00
Rate for Payer: Kaiser Permanente Medicare	$1,023.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: Ohana Health Plan Medicaid	$1,023.00
Rate for Payer: Ohana Health Plan Medicare	$1,023.00
Rate for Payer: UnitedHealthcare Medicare	$1,023.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

OXFORD UNI TIB SZ:D RM 154725

Facility

$3,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,848.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

OXFRD ANAT BRG LT SM SZ5

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$744.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: AlohaCare Medicaid	$1,200.00
Rate for Payer: AlohaCare Medicare	$744.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Devoted Health Medicare	$816.00
Rate for Payer: Hawaii Medical Service Association Medicare	$744.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Humana Medicare	$744.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: Kaiser Permanente Medicaid	$1,224.00
Rate for Payer: Kaiser Permanente Medicare	$744.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: Ohana Health Plan Medicaid	$744.00
Rate for Payer: Ohana Health Plan Medicare	$744.00
Rate for Payer: UnitedHealthcare Medicare	$744.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

OXFRD ANAT BRG LT SM SZ5

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

OXFRD ANAT BRG LT SM SZ6

Facility

$2,880.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$892.80
Max. Negotiated Rate	$2,793.60
Rate for Payer: AlohaCare Medicaid	$1,440.00
Rate for Payer: AlohaCare Medicare	$892.80
Rate for Payer: Cash Price	$1,728.00
Rate for Payer: Devoted Health Medicare	$979.20
Rate for Payer: Hawaii Medical Service Association Medicare	$892.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,016.00
Rate for Payer: Health Management Network Commercial	$2,448.00
Rate for Payer: Humana Medicare	$892.80
Rate for Payer: Kaiser Permanente Commercial	$2,592.00
Rate for Payer: Kaiser Permanente Medicaid	$1,468.80
Rate for Payer: Kaiser Permanente Medicare	$892.80
Rate for Payer: MDX Hawaii PPO	$2,793.60
Rate for Payer: Ohana Health Plan Medicaid	$892.80
Rate for Payer: Ohana Health Plan Medicare	$892.80
Rate for Payer: UnitedHealthcare Medicare	$892.80
Rate for Payer: University Health Alliance Commercial	$1,612.80

OXFRD ANAT BRG LT SM SZ6

Facility

$2,880.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.80
Max. Negotiated Rate	$2,793.60
Rate for Payer: Cash Price	$1,728.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,016.00
Rate for Payer: Health Management Network Commercial	$2,448.00
Rate for Payer: Kaiser Permanente Commercial	$2,592.00
Rate for Payer: MDX Hawaii PPO	$2,793.60
Rate for Payer: University Health Alliance Commercial	$1,612.80

OXFRD ANAT BRG RT LG SZ4

Facility

$2,649.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,483.44
Max. Negotiated Rate	$2,569.53
Rate for Payer: Cash Price	$1,589.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,854.30
Rate for Payer: Health Management Network Commercial	$2,251.65
Rate for Payer: Kaiser Permanente Commercial	$2,384.10
Rate for Payer: MDX Hawaii PPO	$2,569.53
Rate for Payer: University Health Alliance Commercial	$1,483.44

OXFRD ANAT BRG RT LG SZ4

Facility

$2,649.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$821.19
Max. Negotiated Rate	$2,569.53
Rate for Payer: AlohaCare Medicaid	$1,324.50
Rate for Payer: AlohaCare Medicare	$821.19
Rate for Payer: Cash Price	$1,589.40
Rate for Payer: Devoted Health Medicare	$900.66
Rate for Payer: Hawaii Medical Service Association Medicare	$821.19
Rate for Payer: Hawaii Western Management Group Commercial	$1,854.30
Rate for Payer: Health Management Network Commercial	$2,251.65
Rate for Payer: Humana Medicare	$821.19
Rate for Payer: Kaiser Permanente Commercial	$2,384.10
Rate for Payer: Kaiser Permanente Medicaid	$1,350.99
Rate for Payer: Kaiser Permanente Medicare	$821.19
Rate for Payer: MDX Hawaii PPO	$2,569.53
Rate for Payer: Ohana Health Plan Medicaid	$821.19
Rate for Payer: Ohana Health Plan Medicare	$821.19
Rate for Payer: UnitedHealthcare Medicare	$821.19
Rate for Payer: University Health Alliance Commercial	$1,483.44

OXFRD UNI TIB SZ:B LM 154720

Facility

$3,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,023.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: AlohaCare Medicaid	$1,650.00
Rate for Payer: AlohaCare Medicare	$1,023.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Devoted Health Medicare	$1,122.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,023.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Humana Medicare	$1,023.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: Kaiser Permanente Medicaid	$1,683.00
Rate for Payer: Kaiser Permanente Medicare	$1,023.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: Ohana Health Plan Medicaid	$1,023.00
Rate for Payer: Ohana Health Plan Medicare	$1,023.00
Rate for Payer: UnitedHealthcare Medicare	$1,023.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

OXFRD UNI TIB SZ:B LM 154720

Facility

$3,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,848.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

OXFRD UNI TIB SZ:B RM 154721

Facility

$3,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,038.50
Max. Negotiated Rate	$3,249.50
Rate for Payer: AlohaCare Medicaid	$1,675.00
Rate for Payer: AlohaCare Medicare	$1,038.50
Rate for Payer: Cash Price	$2,010.00
Rate for Payer: Devoted Health Medicare	$1,139.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,038.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,345.00
Rate for Payer: Health Management Network Commercial	$2,847.50
Rate for Payer: Humana Medicare	$1,038.50
Rate for Payer: Kaiser Permanente Commercial	$3,015.00
Rate for Payer: Kaiser Permanente Medicaid	$1,708.50
Rate for Payer: Kaiser Permanente Medicare	$1,038.50
Rate for Payer: MDX Hawaii PPO	$3,249.50
Rate for Payer: Ohana Health Plan Medicaid	$1,038.50
Rate for Payer: Ohana Health Plan Medicare	$1,038.50
Rate for Payer: UnitedHealthcare Medicare	$1,038.50
Rate for Payer: University Health Alliance Commercial	$1,876.00

OXFRD UNI TIB SZ:B RM 154721

Facility

$3,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,876.00
Max. Negotiated Rate	$3,249.50
Rate for Payer: Cash Price	$2,010.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,345.00
Rate for Payer: Health Management Network Commercial	$2,847.50
Rate for Payer: Kaiser Permanente Commercial	$3,015.00
Rate for Payer: MDX Hawaii PPO	$3,249.50
Rate for Payer: University Health Alliance Commercial	$1,876.00

OXFRD UNI TIB SZ:C RM 154723

Facility

$3,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,038.50
Max. Negotiated Rate	$3,249.50
Rate for Payer: AlohaCare Medicaid	$1,675.00
Rate for Payer: AlohaCare Medicare	$1,038.50
Rate for Payer: Cash Price	$2,010.00
Rate for Payer: Devoted Health Medicare	$1,139.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,038.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,345.00
Rate for Payer: Health Management Network Commercial	$2,847.50
Rate for Payer: Humana Medicare	$1,038.50
Rate for Payer: Kaiser Permanente Commercial	$3,015.00
Rate for Payer: Kaiser Permanente Medicaid	$1,708.50
Rate for Payer: Kaiser Permanente Medicare	$1,038.50
Rate for Payer: MDX Hawaii PPO	$3,249.50
Rate for Payer: Ohana Health Plan Medicaid	$1,038.50
Rate for Payer: Ohana Health Plan Medicare	$1,038.50
Rate for Payer: UnitedHealthcare Medicare	$1,038.50
Rate for Payer: University Health Alliance Commercial	$1,876.00

OXFRD UNI TIB SZ:C RM 154723

Facility

$3,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,876.00
Max. Negotiated Rate	$3,249.50
Rate for Payer: Cash Price	$2,010.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,345.00
Rate for Payer: Health Management Network Commercial	$2,847.50
Rate for Payer: Kaiser Permanente Commercial	$3,015.00
Rate for Payer: MDX Hawaii PPO	$3,249.50
Rate for Payer: University Health Alliance Commercial	$1,876.00

OXFRD UNI TIB SZ:D LM 154724

Facility

$3,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,023.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: AlohaCare Medicaid	$1,650.00
Rate for Payer: AlohaCare Medicare	$1,023.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Devoted Health Medicare	$1,122.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,023.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Humana Medicare	$1,023.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: Kaiser Permanente Medicaid	$1,683.00
Rate for Payer: Kaiser Permanente Medicare	$1,023.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: Ohana Health Plan Medicaid	$1,023.00
Rate for Payer: Ohana Health Plan Medicare	$1,023.00
Rate for Payer: UnitedHealthcare Medicare	$1,023.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

OXFRD UNI TIB SZ:D LM 154724

Facility

$3,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,848.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

OXFRD UNI TIB SZ:E RM 154727

Facility

$3,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,023.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: AlohaCare Medicaid	$1,650.00
Rate for Payer: AlohaCare Medicare	$1,023.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Devoted Health Medicare	$1,122.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,023.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Humana Medicare	$1,023.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: Kaiser Permanente Medicaid	$1,683.00
Rate for Payer: Kaiser Permanente Medicare	$1,023.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: Ohana Health Plan Medicaid	$1,023.00
Rate for Payer: Ohana Health Plan Medicare	$1,023.00
Rate for Payer: UnitedHealthcare Medicare	$1,023.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

OXFRD UNI TIB SZ:E RM 154727

Facility

$3,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,848.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

OXFRD UNI TIB SZ:F RM 154776

Facility

$3,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,038.50
Max. Negotiated Rate	$3,249.50
Rate for Payer: AlohaCare Medicaid	$1,675.00
Rate for Payer: AlohaCare Medicare	$1,038.50
Rate for Payer: Cash Price	$2,010.00
Rate for Payer: Devoted Health Medicare	$1,139.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,038.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,345.00
Rate for Payer: Health Management Network Commercial	$2,847.50
Rate for Payer: Humana Medicare	$1,038.50
Rate for Payer: Kaiser Permanente Commercial	$3,015.00
Rate for Payer: Kaiser Permanente Medicaid	$1,708.50
Rate for Payer: Kaiser Permanente Medicare	$1,038.50
Rate for Payer: MDX Hawaii PPO	$3,249.50
Rate for Payer: Ohana Health Plan Medicaid	$1,038.50
Rate for Payer: Ohana Health Plan Medicare	$1,038.50
Rate for Payer: UnitedHealthcare Medicare	$1,038.50
Rate for Payer: University Health Alliance Commercial	$1,876.00

OXFRD UNI TIB SZ:F RM 154776

Facility

$3,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,876.00
Max. Negotiated Rate	$3,249.50
Rate for Payer: Cash Price	$2,010.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,345.00
Rate for Payer: Health Management Network Commercial	$2,847.50
Rate for Payer: Kaiser Permanente Commercial	$3,015.00
Rate for Payer: MDX Hawaii PPO	$3,249.50
Rate for Payer: University Health Alliance Commercial	$1,876.00

OXYBUTYNIN CHLORIDE 5 MG TABLET [5938]

Facility

$3.00

Service Code	NDC 10702020101
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.80
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

Know your out-of-pocket cost for care.

All Charges