Kau Hospital

All Charges

Charge

Type

Setting

Price

HUMERAL STB HEAD 51MM DWG051

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 STB HEAD 51MM DWG051

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 STEM 11MM AR-9100-11S

Facility

$8,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,588.50
Max. Negotiated Rate	$8,099.50
Rate for Payer: AlohaCare Medicaid	$4,175.00
Rate for Payer: AlohaCare Medicare	$2,588.50
Rate for Payer: Cash Price	$5,010.00
Rate for Payer: Devoted Health Medicare	$2,839.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,588.50
Rate for Payer: Hawaii Western Management Group Commercial	$5,845.00
Rate for Payer: Health Management Network Commercial	$7,097.50
Rate for Payer: Humana Medicare	$2,588.50
Rate for Payer: Kaiser Permanente Commercial	$7,515.00
Rate for Payer: Kaiser Permanente Medicaid	$4,258.50
Rate for Payer: Kaiser Permanente Medicare	$2,588.50
Rate for Payer: MDX Hawaii PPO	$8,099.50
Rate for Payer: Ohana Health Plan Medicaid	$2,588.50
Rate for Payer: Ohana Health Plan Medicare	$2,588.50
Rate for Payer: UnitedHealthcare Medicare	$2,588.50
Rate for Payer: University Health Alliance Commercial	$4,676.00

HUMERAL STEM 11MM AR-9100-11S

Facility

$8,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,676.00
Max. Negotiated Rate	$8,099.50
Rate for Payer: Cash Price	$5,010.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,845.00
Rate for Payer: Health Management Network Commercial	$7,097.50
Rate for Payer: Kaiser Permanente Commercial	$7,515.00
Rate for Payer: MDX Hawaii PPO	$8,099.50
Rate for Payer: University Health Alliance Commercial	$4,676.00

HUMERAL STEM 12-1 01.04201.123

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 STEM 12-1 01.04201.123

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 STEM 13MM AR-9100-13S

Facility

$8,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,588.50
Max. Negotiated Rate	$8,099.50
Rate for Payer: AlohaCare Medicaid	$4,175.00
Rate for Payer: AlohaCare Medicare	$2,588.50
Rate for Payer: Cash Price	$5,010.00
Rate for Payer: Devoted Health Medicare	$2,839.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,588.50
Rate for Payer: Hawaii Western Management Group Commercial	$5,845.00
Rate for Payer: Health Management Network Commercial	$7,097.50
Rate for Payer: Humana Medicare	$2,588.50
Rate for Payer: Kaiser Permanente Commercial	$7,515.00
Rate for Payer: Kaiser Permanente Medicaid	$4,258.50
Rate for Payer: Kaiser Permanente Medicare	$2,588.50
Rate for Payer: MDX Hawaii PPO	$8,099.50
Rate for Payer: Ohana Health Plan Medicaid	$2,588.50
Rate for Payer: Ohana Health Plan Medicare	$2,588.50
Rate for Payer: UnitedHealthcare Medicare	$2,588.50
Rate for Payer: University Health Alliance Commercial	$4,676.00

HUMERAL STEM 13MM AR-9100-13S

Facility

$8,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,676.00
Max. Negotiated Rate	$8,099.50
Rate for Payer: Cash Price	$5,010.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,845.00
Rate for Payer: Health Management Network Commercial	$7,097.50
Rate for Payer: Kaiser Permanente Commercial	$7,515.00
Rate for Payer: MDX Hawaii PPO	$8,099.50
Rate for Payer: University Health Alliance Commercial	$4,676.00

HUMERAL STEM 8X118MM 5568-0008

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 STEM 8X118MM 5568-0008

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 STEM 9X118 5569-P-2009

Facility

$9,010.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,793.10
Max. Negotiated Rate	$8,739.70
Rate for Payer: AlohaCare Medicaid	$4,505.00
Rate for Payer: AlohaCare Medicare	$2,793.10
Rate for Payer: Cash Price	$5,406.00
Rate for Payer: Devoted Health Medicare	$3,063.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,793.10
Rate for Payer: Hawaii Western Management Group Commercial	$6,307.00
Rate for Payer: Health Management Network Commercial	$7,658.50
Rate for Payer: Humana Medicare	$2,793.10
Rate for Payer: Kaiser Permanente Commercial	$8,109.00
Rate for Payer: Kaiser Permanente Medicaid	$4,595.10
Rate for Payer: Kaiser Permanente Medicare	$2,793.10
Rate for Payer: MDX Hawaii PPO	$8,739.70
Rate for Payer: Ohana Health Plan Medicaid	$2,793.10
Rate for Payer: Ohana Health Plan Medicare	$2,793.10
Rate for Payer: UnitedHealthcare Medicare	$2,793.10
Rate for Payer: University Health Alliance Commercial	$5,045.60

HUMERAL STEM 9X118 5569-P-2009

Facility

$9,010.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,045.60
Max. Negotiated Rate	$8,739.70
Rate for Payer: Cash Price	$5,406.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,307.00
Rate for Payer: Health Management Network Commercial	$7,658.50
Rate for Payer: Kaiser Permanente Commercial	$8,109.00
Rate for Payer: MDX Hawaii PPO	$8,739.70
Rate for Payer: University Health Alliance Commercial	$5,045.60

HUMERAL STEM AS PRESS-FIT

Facility

$10,976.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,146.56
Max. Negotiated Rate	$10,646.72
Rate for Payer: Cash Price	$6,585.60
Rate for Payer: Hawaii Western Management Group Commercial	$7,683.20
Rate for Payer: Health Management Network Commercial	$9,329.60
Rate for Payer: Kaiser Permanente Commercial	$9,878.40
Rate for Payer: MDX Hawaii PPO	$10,646.72
Rate for Payer: University Health Alliance Commercial	$6,146.56

HUMERAL STEM AS PRESS-FIT

Facility

$10,976.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,402.56
Max. Negotiated Rate	$10,646.72
Rate for Payer: AlohaCare Medicaid	$5,488.00
Rate for Payer: AlohaCare Medicare	$3,402.56
Rate for Payer: Cash Price	$6,585.60
Rate for Payer: Devoted Health Medicare	$3,731.84
Rate for Payer: Hawaii Medical Service Association Medicare	$3,402.56
Rate for Payer: Hawaii Western Management Group Commercial	$7,683.20
Rate for Payer: Health Management Network Commercial	$9,329.60
Rate for Payer: Humana Medicare	$3,402.56
Rate for Payer: Kaiser Permanente Commercial	$9,878.40
Rate for Payer: Kaiser Permanente Medicaid	$5,597.76
Rate for Payer: Kaiser Permanente Medicare	$3,402.56
Rate for Payer: MDX Hawaii PPO	$10,646.72
Rate for Payer: Ohana Health Plan Medicaid	$3,402.56
Rate for Payer: Ohana Health Plan Medicare	$3,402.56
Rate for Payer: UnitedHealthcare Medicare	$3,402.56
Rate for Payer: University Health Alliance Commercial	$6,146.56

HUMERAL STEM C9#01.04211.092

Facility

$6,608.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,700.48
Max. Negotiated Rate	$6,409.76
Rate for Payer: Cash Price	$3,964.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,625.60
Rate for Payer: Health Management Network Commercial	$5,616.80
Rate for Payer: Kaiser Permanente Commercial	$5,947.20
Rate for Payer: MDX Hawaii PPO	$6,409.76
Rate for Payer: University Health Alliance Commercial	$3,700.48

HUMERAL STEM C9#01.04211.092

Facility

$6,608.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,048.48
Max. Negotiated Rate	$6,409.76
Rate for Payer: AlohaCare Medicaid	$3,304.00
Rate for Payer: AlohaCare Medicare	$2,048.48
Rate for Payer: Cash Price	$3,964.80
Rate for Payer: Devoted Health Medicare	$2,246.72
Rate for Payer: Hawaii Medical Service Association Medicare	$2,048.48
Rate for Payer: Hawaii Western Management Group Commercial	$4,625.60
Rate for Payer: Health Management Network Commercial	$5,616.80
Rate for Payer: Humana Medicare	$2,048.48
Rate for Payer: Kaiser Permanente Commercial	$5,947.20
Rate for Payer: Kaiser Permanente Medicaid	$3,370.08
Rate for Payer: Kaiser Permanente Medicare	$2,048.48
Rate for Payer: MDX Hawaii PPO	$6,409.76
Rate for Payer: Ohana Health Plan Medicaid	$2,048.48
Rate for Payer: Ohana Health Plan Medicare	$2,048.48
Rate for Payer: UnitedHealthcare Medicare	$2,048.48
Rate for Payer: University Health Alliance Commercial	$3,700.48

HUMERAL STEM CEMENTED DWF702B

Facility

$10,750.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,332.50
Max. Negotiated Rate	$10,427.50
Rate for Payer: AlohaCare Medicaid	$5,375.00
Rate for Payer: AlohaCare Medicare	$3,332.50
Rate for Payer: Cash Price	$6,450.00
Rate for Payer: Devoted Health Medicare	$3,655.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,332.50
Rate for Payer: Hawaii Western Management Group Commercial	$7,525.00
Rate for Payer: Health Management Network Commercial	$9,137.50
Rate for Payer: Humana Medicare	$3,332.50
Rate for Payer: Kaiser Permanente Commercial	$9,675.00
Rate for Payer: Kaiser Permanente Medicaid	$5,482.50
Rate for Payer: Kaiser Permanente Medicare	$3,332.50
Rate for Payer: MDX Hawaii PPO	$10,427.50
Rate for Payer: Ohana Health Plan Medicaid	$3,332.50
Rate for Payer: Ohana Health Plan Medicare	$3,332.50
Rate for Payer: UnitedHealthcare Medicare	$3,332.50
Rate for Payer: University Health Alliance Commercial	$6,020.00

HUMERAL STEM CEMENTED DWF702B

Facility

$10,750.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,020.00
Max. Negotiated Rate	$10,427.50
Rate for Payer: Cash Price	$6,450.00
Rate for Payer: Hawaii Western Management Group Commercial	$7,525.00
Rate for Payer: Health Management Network Commercial	$9,137.50
Rate for Payer: Kaiser Permanente Commercial	$9,675.00
Rate for Payer: MDX Hawaii PPO	$10,427.50
Rate for Payer: University Health Alliance Commercial	$6,020.00

HUMERAL STEM CEMENTED X10.5-10

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 STEM CEMENTED X10.5-10

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 STEM CEMENTED X5-70

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 STEM CEMENTED X5-70

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 STEM CEMENTED X6-70

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 STEM CEMENTED X6-70

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 STEM CEMENTED X7-90

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

Know your out-of-pocket cost for care.

All Charges