Kau Hospital

All Charges

Charge

Type

Setting

Price

INSERT ADM/MDM X3 1236-2-854

Facility

$3,244.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,816.64
Max. Negotiated Rate	$3,146.68
Rate for Payer: Cash Price	$1,946.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,270.80
Rate for Payer: Health Management Network Commercial	$2,757.40
Rate for Payer: Kaiser Permanente Commercial	$2,919.60
Rate for Payer: MDX Hawaii PPO	$3,146.68
Rate for Payer: University Health Alliance Commercial	$1,816.64

INSERT BEARING 5532-G-413-E

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

INSERT BEARING 5532-G-413-E

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

INSERT CR SZ 6 6MM 1516-20-606

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

INSERT CR SZ 6 6MM 1516-20-606

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

INSERT E-VITALIZ SZ6 166-7613

Facility

$8,550.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,650.50
Max. Negotiated Rate	$8,293.50
Rate for Payer: AlohaCare Medicaid	$4,275.00
Rate for Payer: AlohaCare Medicare	$2,650.50
Rate for Payer: Cash Price	$5,130.00
Rate for Payer: Devoted Health Medicare	$2,907.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,650.50
Rate for Payer: Hawaii Western Management Group Commercial	$5,985.00
Rate for Payer: Health Management Network Commercial	$7,267.50
Rate for Payer: Humana Medicare	$2,650.50
Rate for Payer: Kaiser Permanente Commercial	$7,695.00
Rate for Payer: Kaiser Permanente Medicaid	$4,360.50
Rate for Payer: Kaiser Permanente Medicare	$2,650.50
Rate for Payer: MDX Hawaii PPO	$8,293.50
Rate for Payer: Ohana Health Plan Medicaid	$2,650.50
Rate for Payer: Ohana Health Plan Medicare	$2,650.50
Rate for Payer: UnitedHealthcare Medicare	$2,650.50
Rate for Payer: University Health Alliance Commercial	$4,788.00

INSERT E-VITALIZ SZ6 166-7613

Facility

$8,550.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,788.00
Max. Negotiated Rate	$8,293.50
Rate for Payer: Cash Price	$5,130.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,985.00
Rate for Payer: Health Management Network Commercial	$7,267.50
Rate for Payer: Kaiser Permanente Commercial	$7,695.00
Rate for Payer: MDX Hawaii PPO	$8,293.50
Rate for Payer: University Health Alliance Commercial	$4,788.00

INSERT E-VITALIZ SZ7 166-5712

Facility

$8,550.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,650.50
Max. Negotiated Rate	$8,293.50
Rate for Payer: AlohaCare Medicaid	$4,275.00
Rate for Payer: AlohaCare Medicare	$2,650.50
Rate for Payer: Cash Price	$5,130.00
Rate for Payer: Devoted Health Medicare	$2,907.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,650.50
Rate for Payer: Hawaii Western Management Group Commercial	$5,985.00
Rate for Payer: Health Management Network Commercial	$7,267.50
Rate for Payer: Humana Medicare	$2,650.50
Rate for Payer: Kaiser Permanente Commercial	$7,695.00
Rate for Payer: Kaiser Permanente Medicaid	$4,360.50
Rate for Payer: Kaiser Permanente Medicare	$2,650.50
Rate for Payer: MDX Hawaii PPO	$8,293.50
Rate for Payer: Ohana Health Plan Medicaid	$2,650.50
Rate for Payer: Ohana Health Plan Medicare	$2,650.50
Rate for Payer: UnitedHealthcare Medicare	$2,650.50
Rate for Payer: University Health Alliance Commercial	$4,788.00

INSERT E-VITALIZ SZ7 166-5712

Facility

$8,550.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,788.00
Max. Negotiated Rate	$8,293.50
Rate for Payer: Cash Price	$5,130.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,985.00
Rate for Payer: Health Management Network Commercial	$7,267.50
Rate for Payer: Kaiser Permanente Commercial	$7,695.00
Rate for Payer: MDX Hawaii PPO	$8,293.50
Rate for Payer: University Health Alliance Commercial	$4,788.00

INSERT HINGE TRIATH 5612-P-511

Facility

$5,870.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,287.20
Max. Negotiated Rate	$5,693.90
Rate for Payer: Cash Price	$3,522.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,109.00
Rate for Payer: Health Management Network Commercial	$4,989.50
Rate for Payer: Kaiser Permanente Commercial	$5,283.00
Rate for Payer: MDX Hawaii PPO	$5,693.90
Rate for Payer: University Health Alliance Commercial	$3,287.20

INSERT HINGE TRIATH 5612-P-511

Facility

$5,870.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,819.70
Max. Negotiated Rate	$5,693.90
Rate for Payer: AlohaCare Medicaid	$2,935.00
Rate for Payer: AlohaCare Medicare	$1,819.70
Rate for Payer: Cash Price	$3,522.00
Rate for Payer: Devoted Health Medicare	$1,995.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,819.70
Rate for Payer: Hawaii Western Management Group Commercial	$4,109.00
Rate for Payer: Health Management Network Commercial	$4,989.50
Rate for Payer: Humana Medicare	$1,819.70
Rate for Payer: Kaiser Permanente Commercial	$5,283.00
Rate for Payer: Kaiser Permanente Medicaid	$2,993.70
Rate for Payer: Kaiser Permanente Medicare	$1,819.70
Rate for Payer: MDX Hawaii PPO	$5,693.90
Rate for Payer: Ohana Health Plan Medicaid	$1,819.70
Rate for Payer: Ohana Health Plan Medicare	$1,819.70
Rate for Payer: UnitedHealthcare Medicare	$1,819.70
Rate for Payer: University Health Alliance Commercial	$3,287.20

INSERT HUMERAL X3 5571-C-3608

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

INSERT HUMERAL X3 5571-C-3608

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

INSERT HUMERL 32X4 5571-S-3204

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

INSERT HUMERL 32X4 5571-S-3204

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

INSERT HUM S36/+3 AR-9503S-03

Facility

$2,030.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$629.30
Max. Negotiated Rate	$1,969.10
Rate for Payer: AlohaCare Medicaid	$1,015.00
Rate for Payer: AlohaCare Medicare	$629.30
Rate for Payer: Cash Price	$1,218.00
Rate for Payer: Devoted Health Medicare	$690.20
Rate for Payer: Hawaii Medical Service Association Medicare	$629.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,421.00
Rate for Payer: Health Management Network Commercial	$1,725.50
Rate for Payer: Humana Medicare	$629.30
Rate for Payer: Kaiser Permanente Commercial	$1,827.00
Rate for Payer: Kaiser Permanente Medicaid	$1,035.30
Rate for Payer: Kaiser Permanente Medicare	$629.30
Rate for Payer: MDX Hawaii PPO	$1,969.10
Rate for Payer: Ohana Health Plan Medicaid	$629.30
Rate for Payer: Ohana Health Plan Medicare	$629.30
Rate for Payer: UnitedHealthcare Medicare	$629.30
Rate for Payer: University Health Alliance Commercial	$1,136.80

INSERT HUM S36/+3 AR-9503S-03

Facility

$2,030.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,136.80
Max. Negotiated Rate	$1,969.10
Rate for Payer: Cash Price	$1,218.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,421.00
Rate for Payer: Health Management Network Commercial	$1,725.50
Rate for Payer: Kaiser Permanente Commercial	$1,827.00
Rate for Payer: MDX Hawaii PPO	$1,969.10
Rate for Payer: University Health Alliance Commercial	$1,136.80

INSERTION KIT AR-3610PK-3

Facility

$886.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$274.66
Max. Negotiated Rate	$859.42
Rate for Payer: AlohaCare Medicaid	$443.00
Rate for Payer: AlohaCare Medicare	$274.66
Rate for Payer: Cash Price	$531.60
Rate for Payer: Devoted Health Medicare	$301.24
Rate for Payer: Hawaii Medical Service Association Medicare	$274.66
Rate for Payer: Hawaii Western Management Group Commercial	$841.70
Rate for Payer: Health Management Network Commercial	$753.10
Rate for Payer: Humana Medicare	$274.66
Rate for Payer: Kaiser Permanente Commercial	$797.40
Rate for Payer: Kaiser Permanente Medicaid	$451.86
Rate for Payer: Kaiser Permanente Medicare	$274.66
Rate for Payer: MDX Hawaii PPO	$859.42
Rate for Payer: Ohana Health Plan Medicaid	$274.66
Rate for Payer: Ohana Health Plan Medicare	$274.66
Rate for Payer: UnitedHealthcare Medicare	$274.66
Rate for Payer: University Health Alliance Commercial	$645.81

INSERTION KIT AR-3610PK-3

Facility

$886.00

Service Code	HCPCS C1713
Hospital Revenue Code	272
Min. Negotiated Rate	$753.10
Max. Negotiated Rate	$859.42
Rate for Payer: Cash Price	$531.60
Rate for Payer: Health Management Network Commercial	$753.10
Rate for Payer: Kaiser Permanente Commercial	$797.40
Rate for Payer: MDX Hawaii PPO	$859.42

INSERT JOURNEY II BSC XLPE

Facility

$4,038.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,251.78
Max. Negotiated Rate	$3,916.86
Rate for Payer: AlohaCare Medicaid	$2,019.00
Rate for Payer: AlohaCare Medicare	$1,251.78
Rate for Payer: Cash Price	$2,422.80
Rate for Payer: Devoted Health Medicare	$1,372.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,251.78
Rate for Payer: Hawaii Western Management Group Commercial	$2,826.60
Rate for Payer: Health Management Network Commercial	$3,432.30
Rate for Payer: Humana Medicare	$1,251.78
Rate for Payer: Kaiser Permanente Commercial	$3,634.20
Rate for Payer: Kaiser Permanente Medicaid	$2,059.38
Rate for Payer: Kaiser Permanente Medicare	$1,251.78
Rate for Payer: MDX Hawaii PPO	$3,916.86
Rate for Payer: Ohana Health Plan Medicaid	$1,251.78
Rate for Payer: Ohana Health Plan Medicare	$1,251.78
Rate for Payer: UnitedHealthcare Medicare	$1,251.78
Rate for Payer: University Health Alliance Commercial	$2,261.28

INSERT JOURNEY II BSC XLPE

Facility

$4,038.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,261.28
Max. Negotiated Rate	$3,916.86
Rate for Payer: Cash Price	$2,422.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,826.60
Rate for Payer: Health Management Network Commercial	$3,432.30
Rate for Payer: Kaiser Permanente Commercial	$3,634.20
Rate for Payer: MDX Hawaii PPO	$3,916.86
Rate for Payer: University Health Alliance Commercial	$2,261.28

INSERT MDM X3 1236-2-244

Facility

$3,244.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.64
Max. Negotiated Rate	$3,146.68
Rate for Payer: AlohaCare Medicaid	$1,622.00
Rate for Payer: AlohaCare Medicare	$1,005.64
Rate for Payer: Cash Price	$1,946.40
Rate for Payer: Devoted Health Medicare	$1,102.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,005.64
Rate for Payer: Hawaii Western Management Group Commercial	$2,270.80
Rate for Payer: Health Management Network Commercial	$2,757.40
Rate for Payer: Humana Medicare	$1,005.64
Rate for Payer: Kaiser Permanente Commercial	$2,919.60
Rate for Payer: Kaiser Permanente Medicaid	$1,654.44
Rate for Payer: Kaiser Permanente Medicare	$1,005.64
Rate for Payer: MDX Hawaii PPO	$3,146.68
Rate for Payer: Ohana Health Plan Medicaid	$1,005.64
Rate for Payer: Ohana Health Plan Medicare	$1,005.64
Rate for Payer: UnitedHealthcare Medicare	$1,005.64
Rate for Payer: University Health Alliance Commercial	$1,816.64

INSERT MDM X3 1236-2-244

Facility

$3,244.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,816.64
Max. Negotiated Rate	$3,146.68
Rate for Payer: Cash Price	$1,946.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,270.80
Rate for Payer: Health Management Network Commercial	$2,757.40
Rate for Payer: Kaiser Permanente Commercial	$2,919.60
Rate for Payer: MDX Hawaii PPO	$3,146.68
Rate for Payer: University Health Alliance Commercial	$1,816.64

INSERT POLYEHTYLENE 723-00-36E

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.68
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

INSERT POLYEHTYLENE 723-00-36E

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$837.93
Max. Negotiated Rate	$2,621.91
Rate for Payer: AlohaCare Medicaid	$1,351.50
Rate for Payer: AlohaCare Medicare	$837.93
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Devoted Health Medicare	$919.02
Rate for Payer: Hawaii Medical Service Association Medicare	$837.93
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Humana Medicare	$837.93
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: Kaiser Permanente Medicaid	$1,378.53
Rate for Payer: Kaiser Permanente Medicare	$837.93
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: Ohana Health Plan Medicaid	$837.93
Rate for Payer: Ohana Health Plan Medicare	$837.93
Rate for Payer: UnitedHealthcare Medicare	$837.93
Rate for Payer: University Health Alliance Commercial	$1,513.68

Know your out-of-pocket cost for care.

All Charges