Kau Hospital

All Charges

Charge

Type

Setting

Price

HUMERAL 10.5 STEM 01.04201.103

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,480.00
Max. Negotiated Rate	$7,760.00
Rate for Payer: AlohaCare Medicaid	$4,000.00
Rate for Payer: AlohaCare Medicare	$2,480.00
Rate for Payer: Cash Price	$4,800.00
Rate for Payer: Devoted Health Medicare	$2,720.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,480.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,600.00
Rate for Payer: Health Management Network Commercial	$6,800.00
Rate for Payer: Humana Medicare	$2,480.00
Rate for Payer: Kaiser Permanente Commercial	$7,200.00
Rate for Payer: Kaiser Permanente Medicaid	$4,080.00
Rate for Payer: Kaiser Permanente Medicare	$2,480.00
Rate for Payer: MDX Hawaii PPO	$7,760.00
Rate for Payer: Ohana Health Plan Medicaid	$2,480.00
Rate for Payer: Ohana Health Plan Medicare	$2,480.00
Rate for Payer: UnitedHealthcare Medicare	$2,480.00
Rate for Payer: University Health Alliance Commercial	$4,480.00

HUMERAL 120MM 01.04201.163

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,480.00
Max. Negotiated Rate	$7,760.00
Rate for Payer: Cash Price	$4,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,600.00
Rate for Payer: Health Management Network Commercial	$6,800.00
Rate for Payer: Kaiser Permanente Commercial	$7,200.00
Rate for Payer: MDX Hawaii PPO	$7,760.00
Rate for Payer: University Health Alliance Commercial	$4,480.00

HUMERAL 120MM 01.04201.163

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,480.00
Max. Negotiated Rate	$7,760.00
Rate for Payer: AlohaCare Medicaid	$4,000.00
Rate for Payer: AlohaCare Medicare	$2,480.00
Rate for Payer: Cash Price	$4,800.00
Rate for Payer: Devoted Health Medicare	$2,720.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,480.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,600.00
Rate for Payer: Health Management Network Commercial	$6,800.00
Rate for Payer: Humana Medicare	$2,480.00
Rate for Payer: Kaiser Permanente Commercial	$7,200.00
Rate for Payer: Kaiser Permanente Medicaid	$4,080.00
Rate for Payer: Kaiser Permanente Medicare	$2,480.00
Rate for Payer: MDX Hawaii PPO	$7,760.00
Rate for Payer: Ohana Health Plan Medicaid	$2,480.00
Rate for Payer: Ohana Health Plan Medicare	$2,480.00
Rate for Payer: UnitedHealthcare Medicare	$2,480.00
Rate for Payer: University Health Alliance Commercial	$4,480.00

HUMERAL 44X16MM 5552-S-4416

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

HUMERAL 44X16MM 5552-S-4416

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

HUMERAL CUP 32X2 5570-3202

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,240.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: AlohaCare Medicaid	$2,000.00
Rate for Payer: AlohaCare Medicare	$1,240.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Devoted Health Medicare	$1,360.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Humana Medicare	$1,240.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: Kaiser Permanente Medicaid	$2,040.00
Rate for Payer: Kaiser Permanente Medicare	$1,240.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: Ohana Health Plan Medicaid	$1,240.00
Rate for Payer: Ohana Health Plan Medicare	$1,240.00
Rate for Payer: UnitedHealthcare Medicare	$1,240.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

HUMERAL CUP 32X2 5570-3202

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,240.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

HUMERAL CUP 36X4MM 5570-3604

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,240.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: AlohaCare Medicaid	$2,000.00
Rate for Payer: AlohaCare Medicare	$1,240.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Devoted Health Medicare	$1,360.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Humana Medicare	$1,240.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: Kaiser Permanente Medicaid	$2,040.00
Rate for Payer: Kaiser Permanente Medicare	$1,240.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: Ohana Health Plan Medicaid	$1,240.00
Rate for Payer: Ohana Health Plan Medicare	$1,240.00
Rate for Payer: UnitedHealthcare Medicare	$1,240.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

HUMERAL CUP 36X4MM 5570-3604

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,240.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

HUMERAL CUP 40 STD 110031427

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$806.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: AlohaCare Medicaid	$1,300.00
Rate for Payer: AlohaCare Medicare	$806.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Devoted Health Medicare	$884.00
Rate for Payer: Hawaii Medical Service Association Medicare	$806.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Humana Medicare	$806.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: Kaiser Permanente Medicaid	$1,326.00
Rate for Payer: Kaiser Permanente Medicare	$806.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: Ohana Health Plan Medicaid	$806.00
Rate for Payer: Ohana Health Plan Medicare	$806.00
Rate for Payer: UnitedHealthcare Medicare	$806.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

HUMERAL CUP 40 STD 110031427

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

HUMERAL CUP AS 01.04223.100

Facility

$2,302.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$713.62
Max. Negotiated Rate	$2,232.94
Rate for Payer: AlohaCare Medicaid	$1,151.00
Rate for Payer: AlohaCare Medicare	$713.62
Rate for Payer: Cash Price	$1,381.20
Rate for Payer: Devoted Health Medicare	$782.68
Rate for Payer: Hawaii Medical Service Association Medicare	$713.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,611.40
Rate for Payer: Health Management Network Commercial	$1,956.70
Rate for Payer: Humana Medicare	$713.62
Rate for Payer: Kaiser Permanente Commercial	$2,071.80
Rate for Payer: Kaiser Permanente Medicaid	$1,174.02
Rate for Payer: Kaiser Permanente Medicare	$713.62
Rate for Payer: MDX Hawaii PPO	$2,232.94
Rate for Payer: Ohana Health Plan Medicaid	$713.62
Rate for Payer: Ohana Health Plan Medicare	$713.62
Rate for Payer: UnitedHealthcare Medicare	$713.62
Rate for Payer: University Health Alliance Commercial	$1,289.12

HUMERAL CUP AS 01.04223.100

Facility

$2,302.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,289.12
Max. Negotiated Rate	$2,232.94
Rate for Payer: Cash Price	$1,381.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,611.40
Rate for Payer: Health Management Network Commercial	$1,956.70
Rate for Payer: Kaiser Permanente Commercial	$2,071.80
Rate for Payer: MDX Hawaii PPO	$2,232.94
Rate for Payer: University Health Alliance Commercial	$1,289.12

HUMERAL CUP AS 01.04223.106

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,680.00
Max. Negotiated Rate	$2,910.00
Rate for Payer: Cash Price	$1,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,100.00
Rate for Payer: Health Management Network Commercial	$2,550.00
Rate for Payer: Kaiser Permanente Commercial	$2,700.00
Rate for Payer: MDX Hawaii PPO	$2,910.00
Rate for Payer: University Health Alliance Commercial	$1,680.00

HUMERAL CUP AS 01.04223.106

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$930.00
Max. Negotiated Rate	$2,910.00
Rate for Payer: AlohaCare Medicaid	$1,500.00
Rate for Payer: AlohaCare Medicare	$930.00
Rate for Payer: Cash Price	$1,800.00
Rate for Payer: Devoted Health Medicare	$1,020.00
Rate for Payer: Hawaii Medical Service Association Medicare	$930.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,100.00
Rate for Payer: Health Management Network Commercial	$2,550.00
Rate for Payer: Humana Medicare	$930.00
Rate for Payer: Kaiser Permanente Commercial	$2,700.00
Rate for Payer: Kaiser Permanente Medicaid	$1,530.00
Rate for Payer: Kaiser Permanente Medicare	$930.00
Rate for Payer: MDX Hawaii PPO	$2,910.00
Rate for Payer: Ohana Health Plan Medicaid	$930.00
Rate for Payer: Ohana Health Plan Medicare	$930.00
Rate for Payer: UnitedHealthcare Medicare	$930.00
Rate for Payer: University Health Alliance Commercial	$1,680.00

HUMERAL FRACT STEM 5568-0006

Facility

$8,462.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,738.72
Max. Negotiated Rate	$8,208.14
Rate for Payer: Cash Price	$5,077.20
Rate for Payer: Hawaii Western Management Group Commercial	$5,923.40
Rate for Payer: Health Management Network Commercial	$7,192.70
Rate for Payer: Kaiser Permanente Commercial	$7,615.80
Rate for Payer: MDX Hawaii PPO	$8,208.14
Rate for Payer: University Health Alliance Commercial	$4,738.72

HUMERAL FRACT STEM 5568-0006

Facility

$8,462.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,623.22
Max. Negotiated Rate	$8,208.14
Rate for Payer: AlohaCare Medicaid	$4,231.00
Rate for Payer: AlohaCare Medicare	$2,623.22
Rate for Payer: Cash Price	$5,077.20
Rate for Payer: Devoted Health Medicare	$2,877.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,623.22
Rate for Payer: Hawaii Western Management Group Commercial	$5,923.40
Rate for Payer: Health Management Network Commercial	$7,192.70
Rate for Payer: Humana Medicare	$2,623.22
Rate for Payer: Kaiser Permanente Commercial	$7,615.80
Rate for Payer: Kaiser Permanente Medicaid	$4,315.62
Rate for Payer: Kaiser Permanente Medicare	$2,623.22
Rate for Payer: MDX Hawaii PPO	$8,208.14
Rate for Payer: Ohana Health Plan Medicaid	$2,623.22
Rate for Payer: Ohana Health Plan Medicare	$2,623.22
Rate for Payer: UnitedHealthcare Medicare	$2,623.22
Rate for Payer: University Health Alliance Commercial	$4,738.72

HUMERAL FRACTUR STEM 5568-0013

Facility

$8,462.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,738.72
Max. Negotiated Rate	$8,208.14
Rate for Payer: Cash Price	$5,077.20
Rate for Payer: Hawaii Western Management Group Commercial	$5,923.40
Rate for Payer: Health Management Network Commercial	$7,192.70
Rate for Payer: Kaiser Permanente Commercial	$7,615.80
Rate for Payer: MDX Hawaii PPO	$8,208.14
Rate for Payer: University Health Alliance Commercial	$4,738.72

HUMERAL FRACTUR STEM 5568-0013

Facility

$8,462.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,623.22
Max. Negotiated Rate	$8,208.14
Rate for Payer: AlohaCare Medicaid	$4,231.00
Rate for Payer: AlohaCare Medicare	$2,623.22
Rate for Payer: Cash Price	$5,077.20
Rate for Payer: Devoted Health Medicare	$2,877.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,623.22
Rate for Payer: Hawaii Western Management Group Commercial	$5,923.40
Rate for Payer: Health Management Network Commercial	$7,192.70
Rate for Payer: Humana Medicare	$2,623.22
Rate for Payer: Kaiser Permanente Commercial	$7,615.80
Rate for Payer: Kaiser Permanente Medicaid	$4,315.62
Rate for Payer: Kaiser Permanente Medicare	$2,623.22
Rate for Payer: MDX Hawaii PPO	$8,208.14
Rate for Payer: Ohana Health Plan Medicaid	$2,623.22
Rate for Payer: Ohana Health Plan Medicare	$2,623.22
Rate for Payer: UnitedHealthcare Medicare	$2,623.22
Rate for Payer: University Health Alliance Commercial	$4,738.72

HUMERAL HD X42-15 01.04212.425

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

HUMERAL HD X42-15 01.04212.425

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

HUMERAL HEAD 19X56 5552-S-5619

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

HUMERAL HEAD 19X56 5552-S-5619

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

HUMERAL HEAD 40MM 110030776

Facility

$2,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$728.50
Max. Negotiated Rate	$2,279.50
Rate for Payer: AlohaCare Medicaid	$1,175.00
Rate for Payer: AlohaCare Medicare	$728.50
Rate for Payer: Cash Price	$1,410.00
Rate for Payer: Devoted Health Medicare	$799.00
Rate for Payer: Hawaii Medical Service Association Medicare	$728.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,645.00
Rate for Payer: Health Management Network Commercial	$1,997.50
Rate for Payer: Humana Medicare	$728.50
Rate for Payer: Kaiser Permanente Commercial	$2,115.00
Rate for Payer: Kaiser Permanente Medicaid	$1,198.50
Rate for Payer: Kaiser Permanente Medicare	$728.50
Rate for Payer: MDX Hawaii PPO	$2,279.50
Rate for Payer: Ohana Health Plan Medicaid	$728.50
Rate for Payer: Ohana Health Plan Medicare	$728.50
Rate for Payer: UnitedHealthcare Medicare	$728.50
Rate for Payer: University Health Alliance Commercial	$1,316.00

HUMERAL HEAD 40MM 110030776

Facility

$2,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,316.00
Max. Negotiated Rate	$2,279.50
Rate for Payer: Cash Price	$1,410.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,645.00
Rate for Payer: Health Management Network Commercial	$1,997.50
Rate for Payer: Kaiser Permanente Commercial	$2,115.00
Rate for Payer: MDX Hawaii PPO	$2,279.50
Rate for Payer: University Health Alliance Commercial	$1,316.00

Know your out-of-pocket cost for care.

All Charges