Kau Hospital

All Charges

Charge

Type

Setting

Price

HEAD FEMORAL 28MM 6570-0-028

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

HEAD FEMORAL 36+5MM 6570-0-236

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

HEAD FEMORAL 36+5MM 6570-0-236

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

HEAD FEMORAL 36MM 6260-9-136

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$616.90
Max. Negotiated Rate	$1,930.30
Rate for Payer: AlohaCare Medicaid	$995.00
Rate for Payer: AlohaCare Medicare	$616.90
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Devoted Health Medicare	$676.60
Rate for Payer: Hawaii Medical Service Association Medicare	$616.90
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Humana Medicare	$616.90
Rate for Payer: Kaiser Permanente Commercial	$1,791.00
Rate for Payer: Kaiser Permanente Medicaid	$1,014.90
Rate for Payer: Kaiser Permanente Medicare	$616.90
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: Ohana Health Plan Medicaid	$616.90
Rate for Payer: Ohana Health Plan Medicare	$616.90
Rate for Payer: UnitedHealthcare Medicare	$616.90
Rate for Payer: University Health Alliance Commercial	$1,114.40

HEAD FEMORAL 36MM 6260-9-136

Facility

$1,990.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,114.40
Max. Negotiated Rate	$1,930.30
Rate for Payer: Cash Price	$1,194.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,393.00
Rate for Payer: Health Management Network Commercial	$1,691.50
Rate for Payer: Kaiser Permanente Commercial	$1,791.00
Rate for Payer: MDX Hawaii PPO	$1,930.30
Rate for Payer: University Health Alliance Commercial	$1,114.40

HEAD FEMOR LFIT V40 6260-9-328

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

HEAD FEMOR LFIT V40 6260-9-328

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

HEAD HUM 48X15MM 5552-S-4815

Facility

$4,067.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,277.52
Max. Negotiated Rate	$3,944.99
Rate for Payer: Cash Price	$2,440.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,846.90
Rate for Payer: Health Management Network Commercial	$3,456.95
Rate for Payer: Kaiser Permanente Commercial	$3,660.30
Rate for Payer: MDX Hawaii PPO	$3,944.99
Rate for Payer: University Health Alliance Commercial	$2,277.52

HEAD HUM 48X15MM 5552-S-4815

Facility

$4,067.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,260.77
Max. Negotiated Rate	$3,944.99
Rate for Payer: AlohaCare Medicaid	$2,033.50
Rate for Payer: AlohaCare Medicare	$1,260.77
Rate for Payer: Cash Price	$2,440.20
Rate for Payer: Devoted Health Medicare	$1,382.78
Rate for Payer: Hawaii Medical Service Association Medicare	$1,260.77
Rate for Payer: Hawaii Western Management Group Commercial	$2,846.90
Rate for Payer: Health Management Network Commercial	$3,456.95
Rate for Payer: Humana Medicare	$1,260.77
Rate for Payer: Kaiser Permanente Commercial	$3,660.30
Rate for Payer: Kaiser Permanente Medicaid	$2,074.17
Rate for Payer: Kaiser Permanente Medicare	$1,260.77
Rate for Payer: MDX Hawaii PPO	$3,944.99
Rate for Payer: Ohana Health Plan Medicaid	$1,260.77
Rate for Payer: Ohana Health Plan Medicare	$1,260.77
Rate for Payer: UnitedHealthcare Medicare	$1,260.77
Rate for Payer: University Health Alliance Commercial	$2,277.52

HEAD HUM 48X18MM 5552-S-4818

Facility

$4,067.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,277.52
Max. Negotiated Rate	$3,944.99
Rate for Payer: Cash Price	$2,440.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,846.90
Rate for Payer: Health Management Network Commercial	$3,456.95
Rate for Payer: Kaiser Permanente Commercial	$3,660.30
Rate for Payer: MDX Hawaii PPO	$3,944.99
Rate for Payer: University Health Alliance Commercial	$2,277.52

HEAD HUM 48X18MM 5552-S-4818

Facility

$4,067.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,260.77
Max. Negotiated Rate	$3,944.99
Rate for Payer: AlohaCare Medicaid	$2,033.50
Rate for Payer: AlohaCare Medicare	$1,260.77
Rate for Payer: Cash Price	$2,440.20
Rate for Payer: Devoted Health Medicare	$1,382.78
Rate for Payer: Hawaii Medical Service Association Medicare	$1,260.77
Rate for Payer: Hawaii Western Management Group Commercial	$2,846.90
Rate for Payer: Health Management Network Commercial	$3,456.95
Rate for Payer: Humana Medicare	$1,260.77
Rate for Payer: Kaiser Permanente Commercial	$3,660.30
Rate for Payer: Kaiser Permanente Medicaid	$2,074.17
Rate for Payer: Kaiser Permanente Medicare	$1,260.77
Rate for Payer: MDX Hawaii PPO	$3,944.99
Rate for Payer: Ohana Health Plan Medicaid	$1,260.77
Rate for Payer: Ohana Health Plan Medicare	$1,260.77
Rate for Payer: UnitedHealthcare Medicare	$1,260.77
Rate for Payer: University Health Alliance Commercial	$2,277.52

HEAD HUMERAL 44/17 AR-9144-17P

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

HEAD HUMERAL 44/17 AR-9144-17P

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

HEAD HUMERAL X36-12

Facility

$4,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,576.00
Max. Negotiated Rate	$4,462.00
Rate for Payer: Cash Price	$2,760.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,220.00
Rate for Payer: Health Management Network Commercial	$3,910.00
Rate for Payer: Kaiser Permanente Commercial	$4,140.00
Rate for Payer: MDX Hawaii PPO	$4,462.00
Rate for Payer: University Health Alliance Commercial	$2,576.00

HEAD HUMERAL X36-12

Facility

$4,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,426.00
Max. Negotiated Rate	$4,462.00
Rate for Payer: AlohaCare Medicaid	$2,300.00
Rate for Payer: AlohaCare Medicare	$1,426.00
Rate for Payer: Cash Price	$2,760.00
Rate for Payer: Devoted Health Medicare	$1,564.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,426.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,220.00
Rate for Payer: Health Management Network Commercial	$3,910.00
Rate for Payer: Humana Medicare	$1,426.00
Rate for Payer: Kaiser Permanente Commercial	$4,140.00
Rate for Payer: Kaiser Permanente Medicaid	$2,346.00
Rate for Payer: Kaiser Permanente Medicare	$1,426.00
Rate for Payer: MDX Hawaii PPO	$4,462.00
Rate for Payer: Ohana Health Plan Medicaid	$1,426.00
Rate for Payer: Ohana Health Plan Medicare	$1,426.00
Rate for Payer: UnitedHealthcare Medicare	$1,426.00
Rate for Payer: University Health Alliance Commercial	$2,576.00

HEAD HUMERAL X38-13

Facility

$4,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,576.00
Max. Negotiated Rate	$4,462.00
Rate for Payer: Cash Price	$2,760.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,220.00
Rate for Payer: Health Management Network Commercial	$3,910.00
Rate for Payer: Kaiser Permanente Commercial	$4,140.00
Rate for Payer: MDX Hawaii PPO	$4,462.00
Rate for Payer: University Health Alliance Commercial	$2,576.00

HEAD HUMERAL X38-13

Facility

$4,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,426.00
Max. Negotiated Rate	$4,462.00
Rate for Payer: AlohaCare Medicaid	$2,300.00
Rate for Payer: AlohaCare Medicare	$1,426.00
Rate for Payer: Cash Price	$2,760.00
Rate for Payer: Devoted Health Medicare	$1,564.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,426.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,220.00
Rate for Payer: Health Management Network Commercial	$3,910.00
Rate for Payer: Humana Medicare	$1,426.00
Rate for Payer: Kaiser Permanente Commercial	$4,140.00
Rate for Payer: Kaiser Permanente Medicaid	$2,346.00
Rate for Payer: Kaiser Permanente Medicare	$1,426.00
Rate for Payer: MDX Hawaii PPO	$4,462.00
Rate for Payer: Ohana Health Plan Medicaid	$1,426.00
Rate for Payer: Ohana Health Plan Medicare	$1,426.00
Rate for Payer: UnitedHealthcare Medicare	$1,426.00
Rate for Payer: University Health Alliance Commercial	$2,576.00

HEAD PROLINE EVOLVE 496H018

Facility

$3,846.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,153.76
Max. Negotiated Rate	$3,730.62
Rate for Payer: Cash Price	$2,307.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,692.20
Rate for Payer: Health Management Network Commercial	$3,269.10
Rate for Payer: Kaiser Permanente Commercial	$3,461.40
Rate for Payer: MDX Hawaii PPO	$3,730.62
Rate for Payer: University Health Alliance Commercial	$2,153.76

HEAD PROLINE EVOLVE 496H018

Facility

$3,846.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,192.26
Max. Negotiated Rate	$3,730.62
Rate for Payer: AlohaCare Medicaid	$1,923.00
Rate for Payer: AlohaCare Medicare	$1,192.26
Rate for Payer: Cash Price	$2,307.60
Rate for Payer: Devoted Health Medicare	$1,307.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,192.26
Rate for Payer: Hawaii Western Management Group Commercial	$2,692.20
Rate for Payer: Health Management Network Commercial	$3,269.10
Rate for Payer: Humana Medicare	$1,192.26
Rate for Payer: Kaiser Permanente Commercial	$3,461.40
Rate for Payer: Kaiser Permanente Medicaid	$1,961.46
Rate for Payer: Kaiser Permanente Medicare	$1,192.26
Rate for Payer: MDX Hawaii PPO	$3,730.62
Rate for Payer: Ohana Health Plan Medicaid	$1,192.26
Rate for Payer: Ohana Health Plan Medicare	$1,192.26
Rate for Payer: UnitedHealthcare Medicare	$1,192.26
Rate for Payer: University Health Alliance Commercial	$2,153.76

HEAD RADIAL 09.405.580S

Facility

$8,625.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,830.00
Max. Negotiated Rate	$8,366.25
Rate for Payer: Cash Price	$5,175.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,037.50
Rate for Payer: Health Management Network Commercial	$7,331.25
Rate for Payer: Kaiser Permanente Commercial	$7,762.50
Rate for Payer: MDX Hawaii PPO	$8,366.25
Rate for Payer: University Health Alliance Commercial	$4,830.00

HEAD RADIAL 09.405.580S

Facility

$8,625.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,673.75
Max. Negotiated Rate	$8,366.25
Rate for Payer: AlohaCare Medicaid	$4,312.50
Rate for Payer: AlohaCare Medicare	$2,673.75
Rate for Payer: Cash Price	$5,175.00
Rate for Payer: Devoted Health Medicare	$2,932.50
Rate for Payer: Hawaii Medical Service Association Medicare	$2,673.75
Rate for Payer: Hawaii Western Management Group Commercial	$6,037.50
Rate for Payer: Health Management Network Commercial	$7,331.25
Rate for Payer: Humana Medicare	$2,673.75
Rate for Payer: Kaiser Permanente Commercial	$7,762.50
Rate for Payer: Kaiser Permanente Medicaid	$4,398.75
Rate for Payer: Kaiser Permanente Medicare	$2,673.75
Rate for Payer: MDX Hawaii PPO	$8,366.25
Rate for Payer: Ohana Health Plan Medicaid	$2,673.75
Rate for Payer: Ohana Health Plan Medicare	$2,673.75
Rate for Payer: UnitedHealthcare Medicare	$2,673.75
Rate for Payer: University Health Alliance Commercial	$4,830.00

HEALICOIL RG DILATOR 72203951

Facility

$875.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$490.00
Max. Negotiated Rate	$848.75
Rate for Payer: Cash Price	$525.00
Rate for Payer: Hawaii Western Management Group Commercial	$612.50
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: University Health Alliance Commercial	$490.00

HEALICOIL RG DILATOR 72203951

Facility

$875.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$271.25
Max. Negotiated Rate	$848.75
Rate for Payer: AlohaCare Medicaid	$437.50
Rate for Payer: AlohaCare Medicare	$271.25
Rate for Payer: Cash Price	$525.00
Rate for Payer: Devoted Health Medicare	$297.50
Rate for Payer: Hawaii Medical Service Association Medicare	$271.25
Rate for Payer: Hawaii Western Management Group Commercial	$612.50
Rate for Payer: Health Management Network Commercial	$743.75
Rate for Payer: Humana Medicare	$271.25
Rate for Payer: Kaiser Permanente Commercial	$787.50
Rate for Payer: Kaiser Permanente Medicaid	$446.25
Rate for Payer: Kaiser Permanente Medicare	$271.25
Rate for Payer: MDX Hawaii PPO	$848.75
Rate for Payer: Ohana Health Plan Medicaid	$271.25
Rate for Payer: Ohana Health Plan Medicare	$271.25
Rate for Payer: UnitedHealthcare Medicare	$271.25
Rate for Payer: University Health Alliance Commercial	$490.00

HEALICOIL RSB SA 4.75 72203697

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$931.28
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

HEALICOIL RSB SA 4.75 72203697

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$515.53
Max. Negotiated Rate	$1,613.11
Rate for Payer: AlohaCare Medicaid	$831.50
Rate for Payer: AlohaCare Medicare	$515.53
Rate for Payer: Cash Price	$997.80
Rate for Payer: Devoted Health Medicare	$565.42
Rate for Payer: Hawaii Medical Service Association Medicare	$515.53
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Humana Medicare	$515.53
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: Kaiser Permanente Medicaid	$848.13
Rate for Payer: Kaiser Permanente Medicare	$515.53
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: Ohana Health Plan Medicaid	$515.53
Rate for Payer: Ohana Health Plan Medicare	$515.53
Rate for Payer: UnitedHealthcare Medicare	$515.53
Rate for Payer: University Health Alliance Commercial	$931.28

Know your out-of-pocket cost for care.

All Charges