Kau Hospital

All Charges

Charge

Type

Setting

Price

HUMERAL HEAD SNGL 5552-S-5220

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 STB - COCR DWG044

Facility

$8,834.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,738.54
Max. Negotiated Rate	$8,568.98
Rate for Payer: AlohaCare Medicaid	$4,417.00
Rate for Payer: AlohaCare Medicare	$2,738.54
Rate for Payer: Cash Price	$5,300.40
Rate for Payer: Devoted Health Medicare	$3,003.56
Rate for Payer: Hawaii Medical Service Association Medicare	$2,738.54
Rate for Payer: Hawaii Western Management Group Commercial	$6,183.80
Rate for Payer: Health Management Network Commercial	$7,508.90
Rate for Payer: Humana Medicare	$2,738.54
Rate for Payer: Kaiser Permanente Commercial	$7,950.60
Rate for Payer: Kaiser Permanente Medicaid	$4,505.34
Rate for Payer: Kaiser Permanente Medicare	$2,738.54
Rate for Payer: MDX Hawaii PPO	$8,568.98
Rate for Payer: Ohana Health Plan Medicaid	$2,738.54
Rate for Payer: Ohana Health Plan Medicare	$2,738.54
Rate for Payer: UnitedHealthcare Medicare	$2,738.54
Rate for Payer: University Health Alliance Commercial	$4,947.04

HUMERAL HEAD STB - COCR DWG044

Facility

$8,834.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,947.04
Max. Negotiated Rate	$8,568.98
Rate for Payer: Cash Price	$5,300.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,183.80
Rate for Payer: Health Management Network Commercial	$7,508.90
Rate for Payer: Kaiser Permanente Commercial	$7,950.60
Rate for Payer: MDX Hawaii PPO	$8,568.98
Rate for Payer: University Health Alliance Commercial	$4,947.04

HUMERAL HEAD STB COCR DWG047

Facility

$9,036.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,060.16
Max. Negotiated Rate	$8,764.92
Rate for Payer: Cash Price	$5,421.60
Rate for Payer: Hawaii Western Management Group Commercial	$6,325.20
Rate for Payer: Health Management Network Commercial	$7,680.60
Rate for Payer: Kaiser Permanente Commercial	$8,132.40
Rate for Payer: MDX Hawaii PPO	$8,764.92
Rate for Payer: University Health Alliance Commercial	$5,060.16

HUMERAL HEAD STB COCR DWG047

Facility

$9,036.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.16
Max. Negotiated Rate	$8,764.92
Rate for Payer: AlohaCare Medicaid	$4,518.00
Rate for Payer: AlohaCare Medicare	$2,801.16
Rate for Payer: Cash Price	$5,421.60
Rate for Payer: Devoted Health Medicare	$3,072.24
Rate for Payer: Hawaii Medical Service Association Medicare	$2,801.16
Rate for Payer: Hawaii Western Management Group Commercial	$6,325.20
Rate for Payer: Health Management Network Commercial	$7,680.60
Rate for Payer: Humana Medicare	$2,801.16
Rate for Payer: Kaiser Permanente Commercial	$8,132.40
Rate for Payer: Kaiser Permanente Medicaid	$4,608.36
Rate for Payer: Kaiser Permanente Medicare	$2,801.16
Rate for Payer: MDX Hawaii PPO	$8,764.92
Rate for Payer: Ohana Health Plan Medicaid	$2,801.16
Rate for Payer: Ohana Health Plan Medicare	$2,801.16
Rate for Payer: UnitedHealthcare Medicare	$2,801.16
Rate for Payer: University Health Alliance Commercial	$5,060.16

HUMERAL HEAD STB - COCR DWG151

Facility

$8,834.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,947.04
Max. Negotiated Rate	$8,568.98
Rate for Payer: Cash Price	$5,300.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,183.80
Rate for Payer: Health Management Network Commercial	$7,508.90
Rate for Payer: Kaiser Permanente Commercial	$7,950.60
Rate for Payer: MDX Hawaii PPO	$8,568.98
Rate for Payer: University Health Alliance Commercial	$4,947.04

HUMERAL HEAD STB - COCR DWG151

Facility

$8,834.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,738.54
Max. Negotiated Rate	$8,568.98
Rate for Payer: AlohaCare Medicaid	$4,417.00
Rate for Payer: AlohaCare Medicare	$2,738.54
Rate for Payer: Cash Price	$5,300.40
Rate for Payer: Devoted Health Medicare	$3,003.56
Rate for Payer: Hawaii Medical Service Association Medicare	$2,738.54
Rate for Payer: Hawaii Western Management Group Commercial	$6,183.80
Rate for Payer: Health Management Network Commercial	$7,508.90
Rate for Payer: Humana Medicare	$2,738.54
Rate for Payer: Kaiser Permanente Commercial	$7,950.60
Rate for Payer: Kaiser Permanente Medicaid	$4,505.34
Rate for Payer: Kaiser Permanente Medicare	$2,738.54
Rate for Payer: MDX Hawaii PPO	$8,568.98
Rate for Payer: Ohana Health Plan Medicaid	$2,738.54
Rate for Payer: Ohana Health Plan Medicare	$2,738.54
Rate for Payer: UnitedHealthcare Medicare	$2,738.54
Rate for Payer: University Health Alliance Commercial	$4,947.04

HUMERAL HEAD STB DWG152

Facility

$9,540.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,957.40
Max. Negotiated Rate	$9,253.80
Rate for Payer: AlohaCare Medicaid	$4,770.00
Rate for Payer: AlohaCare Medicare	$2,957.40
Rate for Payer: Cash Price	$5,724.00
Rate for Payer: Devoted Health Medicare	$3,243.60
Rate for Payer: Hawaii Medical Service Association Medicare	$2,957.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,678.00
Rate for Payer: Health Management Network Commercial	$8,109.00
Rate for Payer: Humana Medicare	$2,957.40
Rate for Payer: Kaiser Permanente Commercial	$8,586.00
Rate for Payer: Kaiser Permanente Medicaid	$4,865.40
Rate for Payer: Kaiser Permanente Medicare	$2,957.40
Rate for Payer: MDX Hawaii PPO	$9,253.80
Rate for Payer: Ohana Health Plan Medicaid	$2,957.40
Rate for Payer: Ohana Health Plan Medicare	$2,957.40
Rate for Payer: UnitedHealthcare Medicare	$2,957.40
Rate for Payer: University Health Alliance Commercial	$5,342.40

HUMERAL HEAD STB DWG152

Facility

$9,540.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,342.40
Max. Negotiated Rate	$9,253.80
Rate for Payer: Cash Price	$5,724.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,678.00
Rate for Payer: Health Management Network Commercial	$8,109.00
Rate for Payer: Kaiser Permanente Commercial	$8,586.00
Rate for Payer: MDX Hawaii PPO	$9,253.80
Rate for Payer: University Health Alliance Commercial	$5,342.40

HUMERAL INSERT 5571-S-3204-E

Facility

$3,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.00
Max. Negotiated Rate	$3,104.00
Rate for Payer: Cash Price	$1,920.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,240.00
Rate for Payer: Health Management Network Commercial	$2,720.00
Rate for Payer: Kaiser Permanente Commercial	$2,880.00
Rate for Payer: MDX Hawaii PPO	$3,104.00
Rate for Payer: University Health Alliance Commercial	$1,792.00

HUMERAL INSERT 5571-S-3204-E

Facility

$3,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$992.00
Max. Negotiated Rate	$3,104.00
Rate for Payer: AlohaCare Medicaid	$1,600.00
Rate for Payer: AlohaCare Medicare	$992.00
Rate for Payer: Cash Price	$1,920.00
Rate for Payer: Devoted Health Medicare	$1,088.00
Rate for Payer: Hawaii Medical Service Association Medicare	$992.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,240.00
Rate for Payer: Health Management Network Commercial	$2,720.00
Rate for Payer: Humana Medicare	$992.00
Rate for Payer: Kaiser Permanente Commercial	$2,880.00
Rate for Payer: Kaiser Permanente Medicaid	$1,632.00
Rate for Payer: Kaiser Permanente Medicare	$992.00
Rate for Payer: MDX Hawaii PPO	$3,104.00
Rate for Payer: Ohana Health Plan Medicaid	$992.00
Rate for Payer: Ohana Health Plan Medicare	$992.00
Rate for Payer: UnitedHealthcare Medicare	$992.00
Rate for Payer: University Health Alliance Commercial	$1,792.00

HUMERAL INSRT 36X4 5571-S-3604

Facility

$3,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.00
Max. Negotiated Rate	$3,104.00
Rate for Payer: Cash Price	$1,920.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,240.00
Rate for Payer: Health Management Network Commercial	$2,720.00
Rate for Payer: Kaiser Permanente Commercial	$2,880.00
Rate for Payer: MDX Hawaii PPO	$3,104.00
Rate for Payer: University Health Alliance Commercial	$1,792.00

HUMERAL INSRT 36X4 5571-S-3604

Facility

$3,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$992.00
Max. Negotiated Rate	$3,104.00
Rate for Payer: AlohaCare Medicaid	$1,600.00
Rate for Payer: AlohaCare Medicare	$992.00
Rate for Payer: Cash Price	$1,920.00
Rate for Payer: Devoted Health Medicare	$1,088.00
Rate for Payer: Hawaii Medical Service Association Medicare	$992.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,240.00
Rate for Payer: Health Management Network Commercial	$2,720.00
Rate for Payer: Humana Medicare	$992.00
Rate for Payer: Kaiser Permanente Commercial	$2,880.00
Rate for Payer: Kaiser Permanente Medicaid	$1,632.00
Rate for Payer: Kaiser Permanente Medicare	$992.00
Rate for Payer: MDX Hawaii PPO	$3,104.00
Rate for Payer: Ohana Health Plan Medicaid	$992.00
Rate for Payer: Ohana Health Plan Medicare	$992.00
Rate for Payer: UnitedHealthcare Medicare	$992.00
Rate for Payer: University Health Alliance Commercial	$1,792.00

HUMERAL LF 72MM 02.117.701

Facility

$2,837.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$879.47
Max. Negotiated Rate	$2,751.89
Rate for Payer: AlohaCare Medicaid	$1,418.50
Rate for Payer: AlohaCare Medicare	$879.47
Rate for Payer: Cash Price	$1,702.20
Rate for Payer: Devoted Health Medicare	$964.58
Rate for Payer: Hawaii Medical Service Association Medicare	$879.47
Rate for Payer: Hawaii Western Management Group Commercial	$1,985.90
Rate for Payer: Health Management Network Commercial	$2,411.45
Rate for Payer: Humana Medicare	$879.47
Rate for Payer: Kaiser Permanente Commercial	$2,553.30
Rate for Payer: Kaiser Permanente Medicaid	$1,446.87
Rate for Payer: Kaiser Permanente Medicare	$879.47
Rate for Payer: MDX Hawaii PPO	$2,751.89
Rate for Payer: Ohana Health Plan Medicaid	$879.47
Rate for Payer: Ohana Health Plan Medicare	$879.47
Rate for Payer: UnitedHealthcare Medicare	$879.47
Rate for Payer: University Health Alliance Commercial	$1,588.72

HUMERAL LF 72MM 02.117.701

Facility

$2,837.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,588.72
Max. Negotiated Rate	$2,751.89
Rate for Payer: Cash Price	$1,702.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,985.90
Rate for Payer: Health Management Network Commercial	$2,411.45
Rate for Payer: Kaiser Permanente Commercial	$2,553.30
Rate for Payer: MDX Hawaii PPO	$2,751.89
Rate for Payer: University Health Alliance Commercial	$1,588.72

HUMERAL LF 88MM 02.117.304

Facility

$2,749.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$852.19
Max. Negotiated Rate	$2,666.53
Rate for Payer: AlohaCare Medicaid	$1,374.50
Rate for Payer: AlohaCare Medicare	$852.19
Rate for Payer: Cash Price	$1,649.40
Rate for Payer: Devoted Health Medicare	$934.66
Rate for Payer: Hawaii Medical Service Association Medicare	$852.19
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.30
Rate for Payer: Health Management Network Commercial	$2,336.65
Rate for Payer: Humana Medicare	$852.19
Rate for Payer: Kaiser Permanente Commercial	$2,474.10
Rate for Payer: Kaiser Permanente Medicaid	$1,401.99
Rate for Payer: Kaiser Permanente Medicare	$852.19
Rate for Payer: MDX Hawaii PPO	$2,666.53
Rate for Payer: Ohana Health Plan Medicaid	$852.19
Rate for Payer: Ohana Health Plan Medicare	$852.19
Rate for Payer: UnitedHealthcare Medicare	$852.19
Rate for Payer: University Health Alliance Commercial	$1,539.44

HUMERAL LF 88MM 02.117.304

Facility

$2,749.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,539.44
Max. Negotiated Rate	$2,666.53
Rate for Payer: Cash Price	$1,649.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.30
Rate for Payer: Health Management Network Commercial	$2,336.65
Rate for Payer: Kaiser Permanente Commercial	$2,474.10
Rate for Payer: MDX Hawaii PPO	$2,666.53
Rate for Payer: University Health Alliance Commercial	$1,539.44

HUMERAL PF STEM #01.04201.092

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 PF STEM #01.04201.092

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 PIN 7000-35-130

Facility

$480.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$148.80
Max. Negotiated Rate	$465.60
Rate for Payer: AlohaCare Medicaid	$240.00
Rate for Payer: AlohaCare Medicare	$148.80
Rate for Payer: Cash Price	$288.00
Rate for Payer: Devoted Health Medicare	$163.20
Rate for Payer: Hawaii Medical Service Association Medicare	$148.80
Rate for Payer: Hawaii Western Management Group Commercial	$456.00
Rate for Payer: Health Management Network Commercial	$408.00
Rate for Payer: Humana Medicare	$148.80
Rate for Payer: Kaiser Permanente Commercial	$432.00
Rate for Payer: Kaiser Permanente Medicaid	$244.80
Rate for Payer: Kaiser Permanente Medicare	$148.80
Rate for Payer: MDX Hawaii PPO	$465.60
Rate for Payer: Ohana Health Plan Medicaid	$148.80
Rate for Payer: Ohana Health Plan Medicare	$148.80
Rate for Payer: UnitedHealthcare Medicare	$148.80
Rate for Payer: University Health Alliance Commercial	$349.87

HUMERAL PIN 7000-35-130

Facility

$480.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$408.00
Max. Negotiated Rate	$465.60
Rate for Payer: Cash Price	$288.00
Rate for Payer: Health Management Network Commercial	$408.00
Rate for Payer: Kaiser Permanente Commercial	$432.00
Rate for Payer: MDX Hawaii PPO	$465.60

HUMERAL REVERSE INSERT DWP1360

Facility

$2,768.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$858.08
Max. Negotiated Rate	$2,684.96
Rate for Payer: AlohaCare Medicaid	$1,384.00
Rate for Payer: AlohaCare Medicare	$858.08
Rate for Payer: Cash Price	$1,660.80
Rate for Payer: Devoted Health Medicare	$941.12
Rate for Payer: Hawaii Medical Service Association Medicare	$858.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,937.60
Rate for Payer: Health Management Network Commercial	$2,352.80
Rate for Payer: Humana Medicare	$858.08
Rate for Payer: Kaiser Permanente Commercial	$2,491.20
Rate for Payer: Kaiser Permanente Medicaid	$1,411.68
Rate for Payer: Kaiser Permanente Medicare	$858.08
Rate for Payer: MDX Hawaii PPO	$2,684.96
Rate for Payer: Ohana Health Plan Medicaid	$858.08
Rate for Payer: Ohana Health Plan Medicare	$858.08
Rate for Payer: UnitedHealthcare Medicare	$858.08
Rate for Payer: University Health Alliance Commercial	$1,550.08

HUMERAL REVERSE INSERT DWP1360

Facility

$2,768.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.08
Max. Negotiated Rate	$2,684.96
Rate for Payer: Cash Price	$1,660.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,937.60
Rate for Payer: Health Management Network Commercial	$2,352.80
Rate for Payer: Kaiser Permanente Commercial	$2,491.20
Rate for Payer: MDX Hawaii PPO	$2,684.96
Rate for Payer: University Health Alliance Commercial	$1,550.08

HUMERAL SPOOL SMALL LEFT

Facility

$6,622.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,052.82
Max. Negotiated Rate	$6,423.34
Rate for Payer: AlohaCare Medicaid	$3,311.00
Rate for Payer: AlohaCare Medicare	$2,052.82
Rate for Payer: Cash Price	$3,973.20
Rate for Payer: Devoted Health Medicare	$2,251.48
Rate for Payer: Hawaii Medical Service Association Medicare	$2,052.82
Rate for Payer: Hawaii Western Management Group Commercial	$4,635.40
Rate for Payer: Health Management Network Commercial	$5,628.70
Rate for Payer: Humana Medicare	$2,052.82
Rate for Payer: Kaiser Permanente Commercial	$5,959.80
Rate for Payer: Kaiser Permanente Medicaid	$3,377.22
Rate for Payer: Kaiser Permanente Medicare	$2,052.82
Rate for Payer: MDX Hawaii PPO	$6,423.34
Rate for Payer: Ohana Health Plan Medicaid	$2,052.82
Rate for Payer: Ohana Health Plan Medicare	$2,052.82
Rate for Payer: UnitedHealthcare Medicare	$2,052.82
Rate for Payer: University Health Alliance Commercial	$3,708.32

HUMERAL SPOOL SMALL LEFT

Facility

$6,622.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,708.32
Max. Negotiated Rate	$6,423.34
Rate for Payer: Cash Price	$3,973.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,635.40
Rate for Payer: Health Management Network Commercial	$5,628.70
Rate for Payer: Kaiser Permanente Commercial	$5,959.80
Rate for Payer: MDX Hawaii PPO	$6,423.34
Rate for Payer: University Health Alliance Commercial	$3,708.32

Know your out-of-pocket cost for care.

All Charges