Kau Hospital

All Charges

Charge

Type

Setting

Price

HUMERAL HEAD 44X19 5552-S-4419

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 44X19 5552-S-4419

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 50/19 AR-9150-19P

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.00
Max. Negotiated Rate	$3,395.00
Rate for Payer: AlohaCare Medicaid	$1,750.00
Rate for Payer: AlohaCare Medicare	$1,085.00
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Devoted Health Medicare	$1,190.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,085.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,450.00
Rate for Payer: Health Management Network Commercial	$2,975.00
Rate for Payer: Humana Medicare	$1,085.00
Rate for Payer: Kaiser Permanente Commercial	$3,150.00
Rate for Payer: Kaiser Permanente Medicaid	$1,785.00
Rate for Payer: Kaiser Permanente Medicare	$1,085.00
Rate for Payer: MDX Hawaii PPO	$3,395.00
Rate for Payer: Ohana Health Plan Medicaid	$1,085.00
Rate for Payer: Ohana Health Plan Medicare	$1,085.00
Rate for Payer: UnitedHealthcare Medicare	$1,085.00
Rate for Payer: University Health Alliance Commercial	$1,960.00

HUMERAL HEAD 50/19 AR-9150-19P

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,960.00
Max. Negotiated Rate	$3,395.00
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,450.00
Rate for Payer: Health Management Network Commercial	$2,975.00
Rate for Payer: Kaiser Permanente Commercial	$3,150.00
Rate for Payer: MDX Hawaii PPO	$3,395.00
Rate for Payer: University Health Alliance Commercial	$1,960.00

HUMERAL HEAD 52/20 AR-9152-20P

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.00
Max. Negotiated Rate	$3,395.00
Rate for Payer: AlohaCare Medicaid	$1,750.00
Rate for Payer: AlohaCare Medicare	$1,085.00
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Devoted Health Medicare	$1,190.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,085.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,450.00
Rate for Payer: Health Management Network Commercial	$2,975.00
Rate for Payer: Humana Medicare	$1,085.00
Rate for Payer: Kaiser Permanente Commercial	$3,150.00
Rate for Payer: Kaiser Permanente Medicaid	$1,785.00
Rate for Payer: Kaiser Permanente Medicare	$1,085.00
Rate for Payer: MDX Hawaii PPO	$3,395.00
Rate for Payer: Ohana Health Plan Medicaid	$1,085.00
Rate for Payer: Ohana Health Plan Medicare	$1,085.00
Rate for Payer: UnitedHealthcare Medicare	$1,085.00
Rate for Payer: University Health Alliance Commercial	$1,960.00

HUMERAL HEAD 52/20 AR-9152-20P

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,960.00
Max. Negotiated Rate	$3,395.00
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,450.00
Rate for Payer: Health Management Network Commercial	$2,975.00
Rate for Payer: Kaiser Permanente Commercial	$3,150.00
Rate for Payer: MDX Hawaii PPO	$3,395.00
Rate for Payer: University Health Alliance Commercial	$1,960.00

HUMERAL HEAD 7122872

Facility

$11,146.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,455.26
Max. Negotiated Rate	$10,811.62
Rate for Payer: AlohaCare Medicaid	$5,573.00
Rate for Payer: AlohaCare Medicare	$3,455.26
Rate for Payer: Cash Price	$6,687.60
Rate for Payer: Devoted Health Medicare	$3,789.64
Rate for Payer: Hawaii Medical Service Association Medicare	$3,455.26
Rate for Payer: Hawaii Western Management Group Commercial	$7,802.20
Rate for Payer: Health Management Network Commercial	$9,474.10
Rate for Payer: Humana Medicare	$3,455.26
Rate for Payer: Kaiser Permanente Commercial	$10,031.40
Rate for Payer: Kaiser Permanente Medicaid	$5,684.46
Rate for Payer: Kaiser Permanente Medicare	$3,455.26
Rate for Payer: MDX Hawaii PPO	$10,811.62
Rate for Payer: Ohana Health Plan Medicaid	$3,455.26
Rate for Payer: Ohana Health Plan Medicare	$3,455.26
Rate for Payer: UnitedHealthcare Medicare	$3,455.26
Rate for Payer: University Health Alliance Commercial	$6,241.76

HUMERAL HEAD 7122872

Facility

$11,146.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,241.76
Max. Negotiated Rate	$10,811.62
Rate for Payer: Cash Price	$6,687.60
Rate for Payer: Hawaii Western Management Group Commercial	$7,802.20
Rate for Payer: Health Management Network Commercial	$9,474.10
Rate for Payer: Kaiser Permanente Commercial	$10,031.40
Rate for Payer: MDX Hawaii PPO	$10,811.62
Rate for Payer: University Health Alliance Commercial	$6,241.76

HUMERAL HEAD AS #01.04212.500

Facility

$4,794.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,684.64
Max. Negotiated Rate	$4,650.18
Rate for Payer: Cash Price	$2,876.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,355.80
Rate for Payer: Health Management Network Commercial	$4,074.90
Rate for Payer: Kaiser Permanente Commercial	$4,314.60
Rate for Payer: MDX Hawaii PPO	$4,650.18
Rate for Payer: University Health Alliance Commercial	$2,684.64

HUMERAL HEAD AS #01.04212.500

Facility

$4,794.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,486.14
Max. Negotiated Rate	$4,650.18
Rate for Payer: AlohaCare Medicaid	$2,397.00
Rate for Payer: AlohaCare Medicare	$1,486.14
Rate for Payer: Cash Price	$2,876.40
Rate for Payer: Devoted Health Medicare	$1,629.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,486.14
Rate for Payer: Hawaii Western Management Group Commercial	$3,355.80
Rate for Payer: Health Management Network Commercial	$4,074.90
Rate for Payer: Humana Medicare	$1,486.14
Rate for Payer: Kaiser Permanente Commercial	$4,314.60
Rate for Payer: Kaiser Permanente Medicaid	$2,444.94
Rate for Payer: Kaiser Permanente Medicare	$1,486.14
Rate for Payer: MDX Hawaii PPO	$4,650.18
Rate for Payer: Ohana Health Plan Medicaid	$1,486.14
Rate for Payer: Ohana Health Plan Medicare	$1,486.14
Rate for Payer: UnitedHealthcare Medicare	$1,486.14
Rate for Payer: University Health Alliance Commercial	$2,684.64

HUMERAL HEAD COCR 7122880

Facility

$6,032.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,869.92
Max. Negotiated Rate	$5,851.04
Rate for Payer: AlohaCare Medicaid	$3,016.00
Rate for Payer: AlohaCare Medicare	$1,869.92
Rate for Payer: Cash Price	$3,619.20
Rate for Payer: Devoted Health Medicare	$2,050.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,869.92
Rate for Payer: Hawaii Western Management Group Commercial	$4,222.40
Rate for Payer: Health Management Network Commercial	$5,127.20
Rate for Payer: Humana Medicare	$1,869.92
Rate for Payer: Kaiser Permanente Commercial	$5,428.80
Rate for Payer: Kaiser Permanente Medicaid	$3,076.32
Rate for Payer: Kaiser Permanente Medicare	$1,869.92
Rate for Payer: MDX Hawaii PPO	$5,851.04
Rate for Payer: Ohana Health Plan Medicaid	$1,869.92
Rate for Payer: Ohana Health Plan Medicare	$1,869.92
Rate for Payer: UnitedHealthcare Medicare	$1,869.92
Rate for Payer: University Health Alliance Commercial	$3,377.92

HUMERAL HEAD COCR 7122880

Facility

$6,032.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,377.92
Max. Negotiated Rate	$5,851.04
Rate for Payer: Cash Price	$3,619.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,222.40
Rate for Payer: Health Management Network Commercial	$5,127.20
Rate for Payer: Kaiser Permanente Commercial	$5,428.80
Rate for Payer: MDX Hawaii PPO	$5,851.04
Rate for Payer: University Health Alliance Commercial	$3,377.92

HUMERAL HEAD COCR DWG048

Facility

$8,306.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,574.86
Max. Negotiated Rate	$8,056.82
Rate for Payer: AlohaCare Medicaid	$4,153.00
Rate for Payer: AlohaCare Medicare	$2,574.86
Rate for Payer: Cash Price	$4,983.60
Rate for Payer: Devoted Health Medicare	$2,824.04
Rate for Payer: Hawaii Medical Service Association Medicare	$2,574.86
Rate for Payer: Hawaii Western Management Group Commercial	$5,814.20
Rate for Payer: Health Management Network Commercial	$7,060.10
Rate for Payer: Humana Medicare	$2,574.86
Rate for Payer: Kaiser Permanente Commercial	$7,475.40
Rate for Payer: Kaiser Permanente Medicaid	$4,236.06
Rate for Payer: Kaiser Permanente Medicare	$2,574.86
Rate for Payer: MDX Hawaii PPO	$8,056.82
Rate for Payer: Ohana Health Plan Medicaid	$2,574.86
Rate for Payer: Ohana Health Plan Medicare	$2,574.86
Rate for Payer: UnitedHealthcare Medicare	$2,574.86
Rate for Payer: University Health Alliance Commercial	$4,651.36

HUMERAL HEAD COCR DWG048

Facility

$8,306.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,651.36
Max. Negotiated Rate	$8,056.82
Rate for Payer: Cash Price	$4,983.60
Rate for Payer: Hawaii Western Management Group Commercial	$5,814.20
Rate for Payer: Health Management Network Commercial	$7,060.10
Rate for Payer: Kaiser Permanente Commercial	$7,475.40
Rate for Payer: MDX Hawaii PPO	$8,056.82
Rate for Payer: University Health Alliance Commercial	$4,651.36

HUMERAL HEAD COCR DWN4314

Facility

$6,032.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,869.92
Max. Negotiated Rate	$5,851.04
Rate for Payer: AlohaCare Medicaid	$3,016.00
Rate for Payer: AlohaCare Medicare	$1,869.92
Rate for Payer: Cash Price	$3,619.20
Rate for Payer: Devoted Health Medicare	$2,050.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,869.92
Rate for Payer: Hawaii Western Management Group Commercial	$4,222.40
Rate for Payer: Health Management Network Commercial	$5,127.20
Rate for Payer: Humana Medicare	$1,869.92
Rate for Payer: Kaiser Permanente Commercial	$5,428.80
Rate for Payer: Kaiser Permanente Medicaid	$3,076.32
Rate for Payer: Kaiser Permanente Medicare	$1,869.92
Rate for Payer: MDX Hawaii PPO	$5,851.04
Rate for Payer: Ohana Health Plan Medicaid	$1,869.92
Rate for Payer: Ohana Health Plan Medicare	$1,869.92
Rate for Payer: UnitedHealthcare Medicare	$1,869.92
Rate for Payer: University Health Alliance Commercial	$3,377.92

HUMERAL HEAD COCR DWN4314

Facility

$6,032.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,377.92
Max. Negotiated Rate	$5,851.04
Rate for Payer: Cash Price	$3,619.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,222.40
Rate for Payer: Health Management Network Commercial	$5,127.20
Rate for Payer: Kaiser Permanente Commercial	$5,428.80
Rate for Payer: MDX Hawaii PPO	$5,851.04
Rate for Payer: University Health Alliance Commercial	$3,377.92

HUMERAL HEAD COCR DWN4615

Facility

$6,032.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,869.92
Max. Negotiated Rate	$5,851.04
Rate for Payer: AlohaCare Medicaid	$3,016.00
Rate for Payer: AlohaCare Medicare	$1,869.92
Rate for Payer: Cash Price	$3,619.20
Rate for Payer: Devoted Health Medicare	$2,050.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,869.92
Rate for Payer: Hawaii Western Management Group Commercial	$4,222.40
Rate for Payer: Health Management Network Commercial	$5,127.20
Rate for Payer: Humana Medicare	$1,869.92
Rate for Payer: Kaiser Permanente Commercial	$5,428.80
Rate for Payer: Kaiser Permanente Medicaid	$3,076.32
Rate for Payer: Kaiser Permanente Medicare	$1,869.92
Rate for Payer: MDX Hawaii PPO	$5,851.04
Rate for Payer: Ohana Health Plan Medicaid	$1,869.92
Rate for Payer: Ohana Health Plan Medicare	$1,869.92
Rate for Payer: UnitedHealthcare Medicare	$1,869.92
Rate for Payer: University Health Alliance Commercial	$3,377.92

HUMERAL HEAD COCR DWN4615

Facility

$6,032.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,377.92
Max. Negotiated Rate	$5,851.04
Rate for Payer: Cash Price	$3,619.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,222.40
Rate for Payer: Health Management Network Commercial	$5,127.20
Rate for Payer: Kaiser Permanente Commercial	$5,428.80
Rate for Payer: MDX Hawaii PPO	$5,851.04
Rate for Payer: University Health Alliance Commercial	$3,377.92

HUMERAL HEAD COUPLER DWT100

Facility

$1,593.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$892.08
Max. Negotiated Rate	$1,545.21
Rate for Payer: Cash Price	$955.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,115.10
Rate for Payer: Health Management Network Commercial	$1,354.05
Rate for Payer: Kaiser Permanente Commercial	$1,433.70
Rate for Payer: MDX Hawaii PPO	$1,545.21
Rate for Payer: University Health Alliance Commercial	$892.08

HUMERAL HEAD COUPLER DWT100

Facility

$1,593.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$493.83
Max. Negotiated Rate	$1,545.21
Rate for Payer: AlohaCare Medicaid	$796.50
Rate for Payer: AlohaCare Medicare	$493.83
Rate for Payer: Cash Price	$955.80
Rate for Payer: Devoted Health Medicare	$541.62
Rate for Payer: Hawaii Medical Service Association Medicare	$493.83
Rate for Payer: Hawaii Western Management Group Commercial	$1,115.10
Rate for Payer: Health Management Network Commercial	$1,354.05
Rate for Payer: Humana Medicare	$493.83
Rate for Payer: Kaiser Permanente Commercial	$1,433.70
Rate for Payer: Kaiser Permanente Medicaid	$812.43
Rate for Payer: Kaiser Permanente Medicare	$493.83
Rate for Payer: MDX Hawaii PPO	$1,545.21
Rate for Payer: Ohana Health Plan Medicaid	$493.83
Rate for Payer: Ohana Health Plan Medicare	$493.83
Rate for Payer: UnitedHealthcare Medicare	$493.83
Rate for Payer: University Health Alliance Commercial	$892.08

HUMERAL HEAD REMV AS 16X46

Facility

$3,356.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,040.36
Max. Negotiated Rate	$3,255.32
Rate for Payer: AlohaCare Medicaid	$1,678.00
Rate for Payer: AlohaCare Medicare	$1,040.36
Rate for Payer: Cash Price	$2,013.60
Rate for Payer: Devoted Health Medicare	$1,141.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1,040.36
Rate for Payer: Hawaii Western Management Group Commercial	$2,349.20
Rate for Payer: Health Management Network Commercial	$2,852.60
Rate for Payer: Humana Medicare	$1,040.36
Rate for Payer: Kaiser Permanente Commercial	$3,020.40
Rate for Payer: Kaiser Permanente Medicaid	$1,711.56
Rate for Payer: Kaiser Permanente Medicare	$1,040.36
Rate for Payer: MDX Hawaii PPO	$3,255.32
Rate for Payer: Ohana Health Plan Medicaid	$1,040.36
Rate for Payer: Ohana Health Plan Medicare	$1,040.36
Rate for Payer: UnitedHealthcare Medicare	$1,040.36
Rate for Payer: University Health Alliance Commercial	$1,879.36

HUMERAL HEAD REMV AS 16X46

Facility

$3,356.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,879.36
Max. Negotiated Rate	$3,255.32
Rate for Payer: Cash Price	$2,013.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,349.20
Rate for Payer: Health Management Network Commercial	$2,852.60
Rate for Payer: Kaiser Permanente Commercial	$3,020.40
Rate for Payer: MDX Hawaii PPO	$3,255.32
Rate for Payer: University Health Alliance Commercial	$1,879.36

HUMERALHEAD SINGLE 5552-S-5622

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

HUMERALHEAD SINGLE 5552-S-5622

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 SNGL 5552-S-5220

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

Know your out-of-pocket cost for care.

All Charges