Kau Hospital

All Charges

Charge

Type

Setting

Price

FEM KNE SZ:D/RT 00-5956-014-02

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$1,550.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$1,700.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$1,550.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$1,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$1,550.00
Rate for Payer: Ohana Health Plan Medicare	$1,550.00
Rate for Payer: UnitedHealthcare Medicare	$1,550.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

FEMORAL #6 RETAIN 5517-F-602

Facility

$5,947.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,843.57
Max. Negotiated Rate	$5,768.59
Rate for Payer: AlohaCare Medicaid	$2,973.50
Rate for Payer: AlohaCare Medicare	$1,843.57
Rate for Payer: Cash Price	$3,568.20
Rate for Payer: Devoted Health Medicare	$2,021.98
Rate for Payer: Hawaii Medical Service Association Medicare	$1,843.57
Rate for Payer: Hawaii Western Management Group Commercial	$4,162.90
Rate for Payer: Health Management Network Commercial	$5,054.95
Rate for Payer: Humana Medicare	$1,843.57
Rate for Payer: Kaiser Permanente Commercial	$5,352.30
Rate for Payer: Kaiser Permanente Medicaid	$3,032.97
Rate for Payer: Kaiser Permanente Medicare	$1,843.57
Rate for Payer: MDX Hawaii PPO	$5,768.59
Rate for Payer: Ohana Health Plan Medicaid	$1,843.57
Rate for Payer: Ohana Health Plan Medicare	$1,843.57
Rate for Payer: UnitedHealthcare Medicare	$1,843.57
Rate for Payer: University Health Alliance Commercial	$3,330.32

FEMORAL #6 RETAIN 5517-F-602

Facility

$5,947.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,330.32
Max. Negotiated Rate	$5,768.59
Rate for Payer: Cash Price	$3,568.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,162.90
Rate for Payer: Health Management Network Commercial	$5,054.95
Rate for Payer: Kaiser Permanente Commercial	$5,352.30
Rate for Payer: MDX Hawaii PPO	$5,768.59
Rate for Payer: University Health Alliance Commercial	$3,330.32

FEMORAL 8MM LEFT PS 5516-F-801

Facility

$16,152.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$9,045.12
Max. Negotiated Rate	$15,667.44
Rate for Payer: Cash Price	$9,691.20
Rate for Payer: Hawaii Western Management Group Commercial	$11,306.40
Rate for Payer: Health Management Network Commercial	$13,729.20
Rate for Payer: Kaiser Permanente Commercial	$14,536.80
Rate for Payer: MDX Hawaii PPO	$15,667.44
Rate for Payer: University Health Alliance Commercial	$9,045.12

FEMORAL 8MM LEFT PS 5516-F-801

Facility

$16,152.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,007.12
Max. Negotiated Rate	$15,667.44
Rate for Payer: AlohaCare Medicaid	$8,076.00
Rate for Payer: AlohaCare Medicare	$5,007.12
Rate for Payer: Cash Price	$9,691.20
Rate for Payer: Devoted Health Medicare	$5,491.68
Rate for Payer: Hawaii Medical Service Association Medicare	$5,007.12
Rate for Payer: Hawaii Western Management Group Commercial	$11,306.40
Rate for Payer: Health Management Network Commercial	$13,729.20
Rate for Payer: Humana Medicare	$5,007.12
Rate for Payer: Kaiser Permanente Commercial	$14,536.80
Rate for Payer: Kaiser Permanente Medicaid	$8,237.52
Rate for Payer: Kaiser Permanente Medicare	$5,007.12
Rate for Payer: MDX Hawaii PPO	$15,667.44
Rate for Payer: Ohana Health Plan Medicaid	$5,007.12
Rate for Payer: Ohana Health Plan Medicare	$5,007.12
Rate for Payer: UnitedHealthcare Medicare	$5,007.12
Rate for Payer: University Health Alliance Commercial	$9,045.12

FEMORAL AUGMENT LF 5541-A-201

Facility

$2,438.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,365.28
Max. Negotiated Rate	$2,364.86
Rate for Payer: Cash Price	$1,462.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,706.60
Rate for Payer: Health Management Network Commercial	$2,072.30
Rate for Payer: Kaiser Permanente Commercial	$2,194.20
Rate for Payer: MDX Hawaii PPO	$2,364.86
Rate for Payer: University Health Alliance Commercial	$1,365.28

FEMORAL AUGMENT LF 5541-A-201

Facility

$2,438.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$755.78
Max. Negotiated Rate	$2,364.86
Rate for Payer: AlohaCare Medicaid	$1,219.00
Rate for Payer: AlohaCare Medicare	$755.78
Rate for Payer: Cash Price	$1,462.80
Rate for Payer: Devoted Health Medicare	$828.92
Rate for Payer: Hawaii Medical Service Association Medicare	$755.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,706.60
Rate for Payer: Health Management Network Commercial	$2,072.30
Rate for Payer: Humana Medicare	$755.78
Rate for Payer: Kaiser Permanente Commercial	$2,194.20
Rate for Payer: Kaiser Permanente Medicaid	$1,243.38
Rate for Payer: Kaiser Permanente Medicare	$755.78
Rate for Payer: MDX Hawaii PPO	$2,364.86
Rate for Payer: Ohana Health Plan Medicaid	$755.78
Rate for Payer: Ohana Health Plan Medicare	$755.78
Rate for Payer: UnitedHealthcare Medicare	$755.78
Rate for Payer: University Health Alliance Commercial	$1,365.28

FEMORAL CEMENT SZ6 1504-00-206

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$1,550.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$1,700.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$1,550.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$1,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$1,550.00
Rate for Payer: Ohana Health Plan Medicare	$1,550.00
Rate for Payer: UnitedHealthcare Medicare	$1,550.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

FEMORAL CEMENT SZ6 1504-00-206

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

FEMORAL CEMENT SZ6 1504-10-206

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$1,550.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$1,700.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$1,550.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$1,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$1,550.00
Rate for Payer: Ohana Health Plan Medicare	$1,550.00
Rate for Payer: UnitedHealthcare Medicare	$1,550.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

FEMORAL CEMENT SZ6 1504-10-206

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

FEMORAL CEMENT SZ7 1504-00-107

Facility

$3,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,904.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,380.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: University Health Alliance Commercial	$1,904.00

FEMORAL CEMENT SZ7 1504-00-107

Facility

$3,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,054.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: AlohaCare Medicaid	$1,700.00
Rate for Payer: AlohaCare Medicare	$1,054.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Devoted Health Medicare	$1,156.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,054.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,380.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Humana Medicare	$1,054.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Medicaid	$1,734.00
Rate for Payer: Kaiser Permanente Medicare	$1,054.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: Ohana Health Plan Medicaid	$1,054.00
Rate for Payer: Ohana Health Plan Medicare	$1,054.00
Rate for Payer: UnitedHealthcare Medicare	$1,054.00
Rate for Payer: University Health Alliance Commercial	$1,904.00

FEMORAL COMPO HINGE 5612-F-501

Facility

$19,073.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,912.63
Max. Negotiated Rate	$18,500.81
Rate for Payer: AlohaCare Medicaid	$9,536.50
Rate for Payer: AlohaCare Medicare	$5,912.63
Rate for Payer: Cash Price	$11,443.80
Rate for Payer: Devoted Health Medicare	$6,484.82
Rate for Payer: Hawaii Medical Service Association Medicare	$5,912.63
Rate for Payer: Hawaii Western Management Group Commercial	$13,351.10
Rate for Payer: Health Management Network Commercial	$16,212.05
Rate for Payer: Humana Medicare	$5,912.63
Rate for Payer: Kaiser Permanente Commercial	$17,165.70
Rate for Payer: Kaiser Permanente Medicaid	$9,727.23
Rate for Payer: Kaiser Permanente Medicare	$5,912.63
Rate for Payer: MDX Hawaii PPO	$18,500.81
Rate for Payer: Ohana Health Plan Medicaid	$5,912.63
Rate for Payer: Ohana Health Plan Medicare	$5,912.63
Rate for Payer: UnitedHealthcare Medicare	$5,912.63
Rate for Payer: University Health Alliance Commercial	$10,680.88

FEMORAL COMPO HINGE 5612-F-501

Facility

$19,073.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$10,680.88
Max. Negotiated Rate	$18,500.81
Rate for Payer: Cash Price	$11,443.80
Rate for Payer: Hawaii Western Management Group Commercial	$13,351.10
Rate for Payer: Health Management Network Commercial	$16,212.05
Rate for Payer: Kaiser Permanente Commercial	$17,165.70
Rate for Payer: MDX Hawaii PPO	$18,500.81
Rate for Payer: University Health Alliance Commercial	$10,680.88

FEMORAL CR SZ 6 LF 1504-00-106

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$1,550.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$1,700.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$1,550.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$1,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$1,550.00
Rate for Payer: Ohana Health Plan Medicare	$1,550.00
Rate for Payer: UnitedHealthcare Medicare	$1,550.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

FEMORAL CR SZ 6 LF 1504-00-106

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

FEMORAL DISTAL LF 5540-A-501

Facility

$2,322.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$719.82
Max. Negotiated Rate	$2,252.34
Rate for Payer: AlohaCare Medicaid	$1,161.00
Rate for Payer: AlohaCare Medicare	$719.82
Rate for Payer: Cash Price	$1,393.20
Rate for Payer: Devoted Health Medicare	$789.48
Rate for Payer: Hawaii Medical Service Association Medicare	$719.82
Rate for Payer: Hawaii Western Management Group Commercial	$1,625.40
Rate for Payer: Health Management Network Commercial	$1,973.70
Rate for Payer: Humana Medicare	$719.82
Rate for Payer: Kaiser Permanente Commercial	$2,089.80
Rate for Payer: Kaiser Permanente Medicaid	$1,184.22
Rate for Payer: Kaiser Permanente Medicare	$719.82
Rate for Payer: MDX Hawaii PPO	$2,252.34
Rate for Payer: Ohana Health Plan Medicaid	$719.82
Rate for Payer: Ohana Health Plan Medicare	$719.82
Rate for Payer: UnitedHealthcare Medicare	$719.82
Rate for Payer: University Health Alliance Commercial	$1,300.32

FEMORAL DISTAL LF 5540-A-501

Facility

$2,322.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,300.32
Max. Negotiated Rate	$2,252.34
Rate for Payer: Cash Price	$1,393.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,625.40
Rate for Payer: Health Management Network Commercial	$1,973.70
Rate for Payer: Kaiser Permanente Commercial	$2,089.80
Rate for Payer: MDX Hawaii PPO	$2,252.34
Rate for Payer: University Health Alliance Commercial	$1,300.32

FEMORAL DISTAL LF 5542-A-501

Facility

$2,559.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,433.04
Max. Negotiated Rate	$2,482.23
Rate for Payer: Cash Price	$1,535.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,791.30
Rate for Payer: Health Management Network Commercial	$2,175.15
Rate for Payer: Kaiser Permanente Commercial	$2,303.10
Rate for Payer: MDX Hawaii PPO	$2,482.23
Rate for Payer: University Health Alliance Commercial	$1,433.04

FEMORAL DISTAL LF 5542-A-501

Facility

$2,559.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$793.29
Max. Negotiated Rate	$2,482.23
Rate for Payer: AlohaCare Medicaid	$1,279.50
Rate for Payer: AlohaCare Medicare	$793.29
Rate for Payer: Cash Price	$1,535.40
Rate for Payer: Devoted Health Medicare	$870.06
Rate for Payer: Hawaii Medical Service Association Medicare	$793.29
Rate for Payer: Hawaii Western Management Group Commercial	$1,791.30
Rate for Payer: Health Management Network Commercial	$2,175.15
Rate for Payer: Humana Medicare	$793.29
Rate for Payer: Kaiser Permanente Commercial	$2,303.10
Rate for Payer: Kaiser Permanente Medicaid	$1,305.09
Rate for Payer: Kaiser Permanente Medicare	$793.29
Rate for Payer: MDX Hawaii PPO	$2,482.23
Rate for Payer: Ohana Health Plan Medicaid	$793.29
Rate for Payer: Ohana Health Plan Medicare	$793.29
Rate for Payer: UnitedHealthcare Medicare	$793.29
Rate for Payer: University Health Alliance Commercial	$1,433.04

FEMORAL DISTAL RT 5 5540-A-502

Facility

$2,322.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$719.82
Max. Negotiated Rate	$2,252.34
Rate for Payer: AlohaCare Medicaid	$1,161.00
Rate for Payer: AlohaCare Medicare	$719.82
Rate for Payer: Cash Price	$1,393.20
Rate for Payer: Devoted Health Medicare	$789.48
Rate for Payer: Hawaii Medical Service Association Medicare	$719.82
Rate for Payer: Hawaii Western Management Group Commercial	$1,625.40
Rate for Payer: Health Management Network Commercial	$1,973.70
Rate for Payer: Humana Medicare	$719.82
Rate for Payer: Kaiser Permanente Commercial	$2,089.80
Rate for Payer: Kaiser Permanente Medicaid	$1,184.22
Rate for Payer: Kaiser Permanente Medicare	$719.82
Rate for Payer: MDX Hawaii PPO	$2,252.34
Rate for Payer: Ohana Health Plan Medicaid	$719.82
Rate for Payer: Ohana Health Plan Medicare	$719.82
Rate for Payer: UnitedHealthcare Medicare	$719.82
Rate for Payer: University Health Alliance Commercial	$1,300.32

FEMORAL DISTAL RT 5 5540-A-502

Facility

$2,322.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,300.32
Max. Negotiated Rate	$2,252.34
Rate for Payer: Cash Price	$1,393.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,625.40
Rate for Payer: Health Management Network Commercial	$1,973.70
Rate for Payer: Kaiser Permanente Commercial	$2,089.80
Rate for Payer: MDX Hawaii PPO	$2,252.34
Rate for Payer: University Health Alliance Commercial	$1,300.32

FEMORAL DIST AUG RT 5540-A-402

Facility

$2,322.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,300.32
Max. Negotiated Rate	$2,252.34
Rate for Payer: Cash Price	$1,393.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,625.40
Rate for Payer: Health Management Network Commercial	$1,973.70
Rate for Payer: Kaiser Permanente Commercial	$2,089.80
Rate for Payer: MDX Hawaii PPO	$2,252.34
Rate for Payer: University Health Alliance Commercial	$1,300.32

FEMORAL DIST AUG RT 5540-A-402

Facility

$2,322.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$719.82
Max. Negotiated Rate	$2,252.34
Rate for Payer: AlohaCare Medicaid	$1,161.00
Rate for Payer: AlohaCare Medicare	$719.82
Rate for Payer: Cash Price	$1,393.20
Rate for Payer: Devoted Health Medicare	$789.48
Rate for Payer: Hawaii Medical Service Association Medicare	$719.82
Rate for Payer: Hawaii Western Management Group Commercial	$1,625.40
Rate for Payer: Health Management Network Commercial	$1,973.70
Rate for Payer: Humana Medicare	$719.82
Rate for Payer: Kaiser Permanente Commercial	$2,089.80
Rate for Payer: Kaiser Permanente Medicaid	$1,184.22
Rate for Payer: Kaiser Permanente Medicare	$719.82
Rate for Payer: MDX Hawaii PPO	$2,252.34
Rate for Payer: Ohana Health Plan Medicaid	$719.82
Rate for Payer: Ohana Health Plan Medicare	$719.82
Rate for Payer: UnitedHealthcare Medicare	$719.82
Rate for Payer: University Health Alliance Commercial	$1,300.32

Know your out-of-pocket cost for care.

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