Kau Hospital

All Charges

Charge

Type

Setting

Price

KNEE SYS SZ/E L 42-5380-005-01

Facility

$3,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,876.00
Max. Negotiated Rate	$3,249.50
Rate for Payer: Cash Price	$2,010.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,345.00
Rate for Payer: Health Management Network Commercial	$2,847.50
Rate for Payer: Kaiser Permanente Commercial	$3,015.00
Rate for Payer: MDX Hawaii PPO	$3,249.50
Rate for Payer: University Health Alliance Commercial	$1,876.00

KNEE SYSTEM PARTIAL RT 159532

Facility

$3,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,023.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: AlohaCare Medicaid	$1,650.00
Rate for Payer: AlohaCare Medicare	$1,023.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Devoted Health Medicare	$1,122.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,023.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Humana Medicare	$1,023.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: Kaiser Permanente Medicaid	$1,683.00
Rate for Payer: Kaiser Permanente Medicare	$1,023.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: Ohana Health Plan Medicaid	$1,023.00
Rate for Payer: Ohana Health Plan Medicare	$1,023.00
Rate for Payer: UnitedHealthcare Medicare	$1,023.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

KNEE SYSTEM PARTIAL RT 159532

Facility

$3,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,848.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

KNEE SZH 9MM 42-5182-008-09

Facility

$2,520.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,411.20
Max. Negotiated Rate	$2,444.40
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,764.00
Rate for Payer: Health Management Network Commercial	$2,142.00
Rate for Payer: Kaiser Permanente Commercial	$2,268.00
Rate for Payer: MDX Hawaii PPO	$2,444.40
Rate for Payer: University Health Alliance Commercial	$1,411.20

KNEE SZH 9MM 42-5182-008-09

Facility

$2,520.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$781.20
Max. Negotiated Rate	$2,444.40
Rate for Payer: AlohaCare Medicaid	$1,260.00
Rate for Payer: AlohaCare Medicare	$781.20
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Devoted Health Medicare	$856.80
Rate for Payer: Hawaii Medical Service Association Medicare	$781.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,764.00
Rate for Payer: Health Management Network Commercial	$2,142.00
Rate for Payer: Humana Medicare	$781.20
Rate for Payer: Kaiser Permanente Commercial	$2,268.00
Rate for Payer: Kaiser Permanente Medicaid	$1,285.20
Rate for Payer: Kaiser Permanente Medicare	$781.20
Rate for Payer: MDX Hawaii PPO	$2,444.40
Rate for Payer: Ohana Health Plan Medicaid	$781.20
Rate for Payer: Ohana Health Plan Medicare	$781.20
Rate for Payer: UnitedHealthcare Medicare	$781.20
Rate for Payer: University Health Alliance Commercial	$1,411.20

KNEE TIB SZ:3 00-5842-003-01

Facility

$2,861.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$886.91
Max. Negotiated Rate	$2,775.17
Rate for Payer: AlohaCare Medicaid	$1,430.50
Rate for Payer: AlohaCare Medicare	$886.91
Rate for Payer: Cash Price	$1,716.60
Rate for Payer: Devoted Health Medicare	$972.74
Rate for Payer: Hawaii Medical Service Association Medicare	$886.91
Rate for Payer: Hawaii Western Management Group Commercial	$2,002.70
Rate for Payer: Health Management Network Commercial	$2,431.85
Rate for Payer: Humana Medicare	$886.91
Rate for Payer: Kaiser Permanente Commercial	$2,574.90
Rate for Payer: Kaiser Permanente Medicaid	$1,459.11
Rate for Payer: Kaiser Permanente Medicare	$886.91
Rate for Payer: MDX Hawaii PPO	$2,775.17
Rate for Payer: Ohana Health Plan Medicaid	$886.91
Rate for Payer: Ohana Health Plan Medicare	$886.91
Rate for Payer: UnitedHealthcare Medicare	$886.91
Rate for Payer: University Health Alliance Commercial	$1,602.16

KNEE TIB SZ:3 00-5842-003-01

Facility

$2,861.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,602.16
Max. Negotiated Rate	$2,775.17
Rate for Payer: Cash Price	$1,716.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,002.70
Rate for Payer: Health Management Network Commercial	$2,431.85
Rate for Payer: Kaiser Permanente Commercial	$2,574.90
Rate for Payer: MDX Hawaii PPO	$2,775.17
Rate for Payer: University Health Alliance Commercial	$1,602.16

KNEE TIB SZ:5 00-5842-005-01

Facility

$4,220.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,308.20
Max. Negotiated Rate	$4,093.40
Rate for Payer: AlohaCare Medicaid	$2,110.00
Rate for Payer: AlohaCare Medicare	$1,308.20
Rate for Payer: Cash Price	$2,532.00
Rate for Payer: Devoted Health Medicare	$1,434.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,308.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,954.00
Rate for Payer: Health Management Network Commercial	$3,587.00
Rate for Payer: Humana Medicare	$1,308.20
Rate for Payer: Kaiser Permanente Commercial	$3,798.00
Rate for Payer: Kaiser Permanente Medicaid	$2,152.20
Rate for Payer: Kaiser Permanente Medicare	$1,308.20
Rate for Payer: MDX Hawaii PPO	$4,093.40
Rate for Payer: Ohana Health Plan Medicaid	$1,308.20
Rate for Payer: Ohana Health Plan Medicare	$1,308.20
Rate for Payer: UnitedHealthcare Medicare	$1,308.20
Rate for Payer: University Health Alliance Commercial	$2,363.20

KNEE TIB SZ:5 00-5842-005-01

Facility

$4,220.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,363.20
Max. Negotiated Rate	$4,093.40
Rate for Payer: Cash Price	$2,532.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,954.00
Rate for Payer: Health Management Network Commercial	$3,587.00
Rate for Payer: Kaiser Permanente Commercial	$3,798.00
Rate for Payer: MDX Hawaii PPO	$4,093.40
Rate for Payer: University Health Alliance Commercial	$2,363.20

KNE FEM SZ:D/LT 00-5956-014-01

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$1,550.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$1,700.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$1,550.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$1,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$1,550.00
Rate for Payer: Ohana Health Plan Medicare	$1,550.00
Rate for Payer: UnitedHealthcare Medicare	$1,550.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:D/LT 00-5956-014-01

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:E 00-5842-015-01

Facility

$6,976.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,162.56
Max. Negotiated Rate	$6,766.72
Rate for Payer: AlohaCare Medicaid	$3,488.00
Rate for Payer: AlohaCare Medicare	$2,162.56
Rate for Payer: Cash Price	$4,185.60
Rate for Payer: Devoted Health Medicare	$2,371.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2,162.56
Rate for Payer: Hawaii Western Management Group Commercial	$4,883.20
Rate for Payer: Health Management Network Commercial	$5,929.60
Rate for Payer: Humana Medicare	$2,162.56
Rate for Payer: Kaiser Permanente Commercial	$6,278.40
Rate for Payer: Kaiser Permanente Medicaid	$3,557.76
Rate for Payer: Kaiser Permanente Medicare	$2,162.56
Rate for Payer: MDX Hawaii PPO	$6,766.72
Rate for Payer: Ohana Health Plan Medicaid	$2,162.56
Rate for Payer: Ohana Health Plan Medicare	$2,162.56
Rate for Payer: UnitedHealthcare Medicare	$2,162.56
Rate for Payer: University Health Alliance Commercial	$3,906.56

KNE FEM SZ:E 00-5842-015-01

Facility

$6,976.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,906.56
Max. Negotiated Rate	$6,766.72
Rate for Payer: Cash Price	$4,185.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,883.20
Rate for Payer: Health Management Network Commercial	$5,929.60
Rate for Payer: Kaiser Permanente Commercial	$6,278.40
Rate for Payer: MDX Hawaii PPO	$6,766.72
Rate for Payer: University Health Alliance Commercial	$3,906.56

KNE FEM SZ:E/LT 00-5750-015-01

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$1,550.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$1,700.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$1,550.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$1,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$1,550.00
Rate for Payer: Ohana Health Plan Medicare	$1,550.00
Rate for Payer: UnitedHealthcare Medicare	$1,550.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:E/LT 00-5750-015-01

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:E/LT 00-5956-015-01

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:E/LT 00-5956-015-01

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$1,550.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$1,700.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$1,550.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$1,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$1,550.00
Rate for Payer: Ohana Health Plan Medicare	$1,550.00
Rate for Payer: UnitedHealthcare Medicare	$1,550.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:E/LT 00-5964-015-51

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$1,550.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$1,700.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$1,550.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$1,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$1,550.00
Rate for Payer: Ohana Health Plan Medicare	$1,550.00
Rate for Payer: UnitedHealthcare Medicare	$1,550.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:E/LT 00-5964-015-51

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:E/RT 00-5750-015-02

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$1,550.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$1,700.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$1,550.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$1,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$1,550.00
Rate for Payer: Ohana Health Plan Medicare	$1,550.00
Rate for Payer: UnitedHealthcare Medicare	$1,550.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:E/RT 00-5750-015-02

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:F/LT 00-5956-016-01

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$1,550.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$1,700.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$1,550.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$1,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$1,550.00
Rate for Payer: Ohana Health Plan Medicare	$1,550.00
Rate for Payer: UnitedHealthcare Medicare	$1,550.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:F/LT 00-5956-016-01

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:F/RT 00-5750-016-02

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

KNE FEM SZ:F/RT 00-5750-016-02

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$1,550.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$1,700.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$1,550.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$1,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$1,550.00
Rate for Payer: Ohana Health Plan Medicare	$1,550.00
Rate for Payer: UnitedHealthcare Medicare	$1,550.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

Know your out-of-pocket cost for care.

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