Kau Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL DIST AUG RT 5542-A-402

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 DIST AUG RT 5542-A-402

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 HEAD 12/14, 46MM

Facility

$2,550.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,428.00
Max. Negotiated Rate	$2,473.50
Rate for Payer: Cash Price	$1,530.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,785.00
Rate for Payer: Health Management Network Commercial	$2,167.50
Rate for Payer: Kaiser Permanente Commercial	$2,295.00
Rate for Payer: MDX Hawaii PPO	$2,473.50
Rate for Payer: University Health Alliance Commercial	$1,428.00

FEMORAL HEAD 12/14, 46MM

Facility

$2,550.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$790.50
Max. Negotiated Rate	$2,473.50
Rate for Payer: AlohaCare Medicaid	$1,275.00
Rate for Payer: AlohaCare Medicare	$790.50
Rate for Payer: Cash Price	$1,530.00
Rate for Payer: Devoted Health Medicare	$867.00
Rate for Payer: Hawaii Medical Service Association Medicare	$790.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,785.00
Rate for Payer: Health Management Network Commercial	$2,167.50
Rate for Payer: Humana Medicare	$790.50
Rate for Payer: Kaiser Permanente Commercial	$2,295.00
Rate for Payer: Kaiser Permanente Medicaid	$1,300.50
Rate for Payer: Kaiser Permanente Medicare	$790.50
Rate for Payer: MDX Hawaii PPO	$2,473.50
Rate for Payer: Ohana Health Plan Medicaid	$790.50
Rate for Payer: Ohana Health Plan Medicare	$790.50
Rate for Payer: UnitedHealthcare Medicare	$790.50
Rate for Payer: University Health Alliance Commercial	$1,428.00

FEMORAL HEAD 12/14 COCR

Facility

$1,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,008.00
Max. Negotiated Rate	$1,746.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,260.00
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
Rate for Payer: University Health Alliance Commercial	$1,008.00

FEMORAL HEAD 12/14 COCR

Facility

$1,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
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	$1,260.00
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	$1,008.00

FEMORAL HEAD 12/14 COCR 22MM

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

FEMORAL HEAD 12/14 COCR 22MM

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

FEMORAL HEAD 26MM 6260-9-026

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,103.76
Max. Negotiated Rate	$1,911.87
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: University Health Alliance Commercial	$1,103.76

FEMORAL HEAD 26MM 6260-9-026

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$611.01
Max. Negotiated Rate	$1,911.87
Rate for Payer: AlohaCare Medicaid	$985.50
Rate for Payer: AlohaCare Medicare	$611.01
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Devoted Health Medicare	$670.14
Rate for Payer: Hawaii Medical Service Association Medicare	$611.01
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Humana Medicare	$611.01
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: Kaiser Permanente Medicaid	$1,005.21
Rate for Payer: Kaiser Permanente Medicare	$611.01
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: Ohana Health Plan Medicaid	$611.01
Rate for Payer: Ohana Health Plan Medicare	$611.01
Rate for Payer: UnitedHealthcare Medicare	$611.01
Rate for Payer: University Health Alliance Commercial	$1,103.76

FEMORAL HEAD 28X3.5 8018-28-03

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

FEMORAL HEAD 28X3.5 8018-28-03

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

FEMORAL HEAD 36MM 650-0662

Facility

$2,700.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$837.00
Max. Negotiated Rate	$2,619.00
Rate for Payer: AlohaCare Medicaid	$1,350.00
Rate for Payer: AlohaCare Medicare	$837.00
Rate for Payer: Cash Price	$1,620.00
Rate for Payer: Devoted Health Medicare	$918.00
Rate for Payer: Hawaii Medical Service Association Medicare	$837.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,890.00
Rate for Payer: Health Management Network Commercial	$2,295.00
Rate for Payer: Humana Medicare	$837.00
Rate for Payer: Kaiser Permanente Commercial	$2,430.00
Rate for Payer: Kaiser Permanente Medicaid	$1,377.00
Rate for Payer: Kaiser Permanente Medicare	$837.00
Rate for Payer: MDX Hawaii PPO	$2,619.00
Rate for Payer: Ohana Health Plan Medicaid	$837.00
Rate for Payer: Ohana Health Plan Medicare	$837.00
Rate for Payer: UnitedHealthcare Medicare	$837.00
Rate for Payer: University Health Alliance Commercial	$1,512.00

FEMORAL HEAD 36MM 650-0662

Facility

$2,700.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,512.00
Max. Negotiated Rate	$2,619.00
Rate for Payer: Cash Price	$1,620.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,890.00
Rate for Payer: Health Management Network Commercial	$2,295.00
Rate for Payer: Kaiser Permanente Commercial	$2,430.00
Rate for Payer: MDX Hawaii PPO	$2,619.00
Rate for Payer: University Health Alliance Commercial	$1,512.00

FEMORAL HEAD 36MM 650-1057

Facility

$2,850.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$883.50
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$883.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$969.00
Rate for Payer: Hawaii Medical Service Association Medicare	$883.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$883.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$883.50
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$883.50
Rate for Payer: Ohana Health Plan Medicare	$883.50
Rate for Payer: UnitedHealthcare Medicare	$883.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

FEMORAL HEAD 36MM 650-1057

Facility

$2,850.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,596.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

FEMORAL HEAD 36X2.5 6570-0-536

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$829.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: AlohaCare Medicaid	$1,338.00
Rate for Payer: AlohaCare Medicare	$829.56
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Devoted Health Medicare	$909.84
Rate for Payer: Hawaii Medical Service Association Medicare	$829.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Humana Medicare	$829.56
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: Kaiser Permanente Medicare	$829.56
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: Ohana Health Plan Medicaid	$829.56
Rate for Payer: Ohana Health Plan Medicare	$829.56
Rate for Payer: UnitedHealthcare Medicare	$829.56
Rate for Payer: University Health Alliance Commercial	$1,498.56

FEMORAL HEAD 36X2.5 6570-0-536

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

FEMORAL HEAD 36X7.5 6570-0-736

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$829.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: AlohaCare Medicaid	$1,338.00
Rate for Payer: AlohaCare Medicare	$829.56
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Devoted Health Medicare	$909.84
Rate for Payer: Hawaii Medical Service Association Medicare	$829.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Humana Medicare	$829.56
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: Kaiser Permanente Medicare	$829.56
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: Ohana Health Plan Medicaid	$829.56
Rate for Payer: Ohana Health Plan Medicare	$829.56
Rate for Payer: UnitedHealthcare Medicare	$829.56
Rate for Payer: University Health Alliance Commercial	$1,498.56

FEMORAL HEAD 36X7.5 6570-0-736

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

FEMORAL HEAD 6260-9-126

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,103.76
Max. Negotiated Rate	$1,911.87
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: University Health Alliance Commercial	$1,103.76

FEMORAL HEAD 6260-9-126

Facility

$1,971.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$611.01
Max. Negotiated Rate	$1,911.87
Rate for Payer: AlohaCare Medicaid	$985.50
Rate for Payer: AlohaCare Medicare	$611.01
Rate for Payer: Cash Price	$1,182.60
Rate for Payer: Devoted Health Medicare	$670.14
Rate for Payer: Hawaii Medical Service Association Medicare	$611.01
Rate for Payer: Hawaii Western Management Group Commercial	$1,379.70
Rate for Payer: Health Management Network Commercial	$1,675.35
Rate for Payer: Humana Medicare	$611.01
Rate for Payer: Kaiser Permanente Commercial	$1,773.90
Rate for Payer: Kaiser Permanente Medicaid	$1,005.21
Rate for Payer: Kaiser Permanente Medicare	$611.01
Rate for Payer: MDX Hawaii PPO	$1,911.87
Rate for Payer: Ohana Health Plan Medicaid	$611.01
Rate for Payer: Ohana Health Plan Medicare	$611.01
Rate for Payer: UnitedHealthcare Medicare	$611.01
Rate for Payer: University Health Alliance Commercial	$1,103.76

FEMORAL HEAD BIOLOX 6570-0-128

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$829.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: AlohaCare Medicaid	$1,338.00
Rate for Payer: AlohaCare Medicare	$829.56
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Devoted Health Medicare	$909.84
Rate for Payer: Hawaii Medical Service Association Medicare	$829.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Humana Medicare	$829.56
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: Kaiser Permanente Medicare	$829.56
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: Ohana Health Plan Medicaid	$829.56
Rate for Payer: Ohana Health Plan Medicare	$829.56
Rate for Payer: UnitedHealthcare Medicare	$829.56
Rate for Payer: University Health Alliance Commercial	$1,498.56

FEMORAL HEAD BIOLOX 6570-0-128

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

FEMORAL HEAD COCR 12/14, 32MM

Facility

$2,528.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$783.68
Max. Negotiated Rate	$2,452.16
Rate for Payer: AlohaCare Medicaid	$1,264.00
Rate for Payer: AlohaCare Medicare	$783.68
Rate for Payer: Cash Price	$1,516.80
Rate for Payer: Devoted Health Medicare	$859.52
Rate for Payer: Hawaii Medical Service Association Medicare	$783.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,769.60
Rate for Payer: Health Management Network Commercial	$2,148.80
Rate for Payer: Humana Medicare	$783.68
Rate for Payer: Kaiser Permanente Commercial	$2,275.20
Rate for Payer: Kaiser Permanente Medicaid	$1,289.28
Rate for Payer: Kaiser Permanente Medicare	$783.68
Rate for Payer: MDX Hawaii PPO	$2,452.16
Rate for Payer: Ohana Health Plan Medicaid	$783.68
Rate for Payer: Ohana Health Plan Medicare	$783.68
Rate for Payer: UnitedHealthcare Medicare	$783.68
Rate for Payer: University Health Alliance Commercial	$1,415.68

Know your out-of-pocket cost for care.

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