Kau Hospital

All Charges

Charge

Type

Setting

Price

LAUNCHER JR 6FX35

Facility

$225.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$69.75
Rate for Payer: Cash Price	$135.00
Rate for Payer: Devoted Health Medicare	$76.50
Rate for Payer: Hawaii Medical Service Association Medicare	$69.75
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$69.75
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$69.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$69.75
Rate for Payer: Ohana Health Plan Medicare	$69.75
Rate for Payer: UnitedHealthcare Medicare	$69.75
Rate for Payer: University Health Alliance Commercial	$164.00

LAUNCHER JR 6FX35

Facility

$225.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

LAUNCHR BU LT 5FR EBU 3.0

Facility

$225.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$69.75
Rate for Payer: Cash Price	$135.00
Rate for Payer: Devoted Health Medicare	$76.50
Rate for Payer: Hawaii Medical Service Association Medicare	$69.75
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$69.75
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$69.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$69.75
Rate for Payer: Ohana Health Plan Medicare	$69.75
Rate for Payer: UnitedHealthcare Medicare	$69.75
Rate for Payer: University Health Alliance Commercial	$164.00

LAUNCHR BU LT 5FR EBU 3.0

Facility

$225.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

LAUNCHR BU LT 5FR EBU 3.5

Facility

$225.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$69.75
Rate for Payer: Cash Price	$135.00
Rate for Payer: Devoted Health Medicare	$76.50
Rate for Payer: Hawaii Medical Service Association Medicare	$69.75
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$69.75
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$69.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$69.75
Rate for Payer: Ohana Health Plan Medicare	$69.75
Rate for Payer: UnitedHealthcare Medicare	$69.75
Rate for Payer: University Health Alliance Commercial	$164.00

LAUNCHR BU LT 5FR EBU 3.5

Facility

$225.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

LCD 2.7/3.5 2H/RT 02.117.402

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

LCD 2.7/3.5 2H/RT 02.117.402

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

LCD 2.7/3.5 2H/RT 02.117.602

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

LCD 2.7/3.5 2H/RT 02.117.602

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

LCP 3.5 MED PROX TIBIA 239.954

Facility

$3,291.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,020.21
Max. Negotiated Rate	$3,192.27
Rate for Payer: AlohaCare Medicaid	$1,645.50
Rate for Payer: AlohaCare Medicare	$1,020.21
Rate for Payer: Cash Price	$1,974.60
Rate for Payer: Devoted Health Medicare	$1,118.94
Rate for Payer: Hawaii Medical Service Association Medicare	$1,020.21
Rate for Payer: Hawaii Western Management Group Commercial	$2,303.70
Rate for Payer: Health Management Network Commercial	$2,797.35
Rate for Payer: Humana Medicare	$1,020.21
Rate for Payer: Kaiser Permanente Commercial	$2,961.90
Rate for Payer: Kaiser Permanente Medicaid	$1,678.41
Rate for Payer: Kaiser Permanente Medicare	$1,020.21
Rate for Payer: MDX Hawaii PPO	$3,192.27
Rate for Payer: Ohana Health Plan Medicaid	$1,020.21
Rate for Payer: Ohana Health Plan Medicare	$1,020.21
Rate for Payer: UnitedHealthcare Medicare	$1,020.21
Rate for Payer: University Health Alliance Commercial	$1,842.96

LCP 3.5 MED PROX TIBIA 239.954

Facility

$3,291.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,842.96
Max. Negotiated Rate	$3,192.27
Rate for Payer: Cash Price	$1,974.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,303.70
Rate for Payer: Health Management Network Commercial	$2,797.35
Rate for Payer: Kaiser Permanente Commercial	$2,961.90
Rate for Payer: MDX Hawaii PPO	$3,192.27
Rate for Payer: University Health Alliance Commercial	$1,842.96

LCP 3.5MM 3 HOLE 02.113.103

Facility

$1,926.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$597.06
Max. Negotiated Rate	$1,868.22
Rate for Payer: AlohaCare Medicaid	$963.00
Rate for Payer: AlohaCare Medicare	$597.06
Rate for Payer: Cash Price	$1,155.60
Rate for Payer: Devoted Health Medicare	$654.84
Rate for Payer: Hawaii Medical Service Association Medicare	$597.06
Rate for Payer: Hawaii Western Management Group Commercial	$1,348.20
Rate for Payer: Health Management Network Commercial	$1,637.10
Rate for Payer: Humana Medicare	$597.06
Rate for Payer: Kaiser Permanente Commercial	$1,733.40
Rate for Payer: Kaiser Permanente Medicaid	$982.26
Rate for Payer: Kaiser Permanente Medicare	$597.06
Rate for Payer: MDX Hawaii PPO	$1,868.22
Rate for Payer: Ohana Health Plan Medicaid	$597.06
Rate for Payer: Ohana Health Plan Medicare	$597.06
Rate for Payer: UnitedHealthcare Medicare	$597.06
Rate for Payer: University Health Alliance Commercial	$1,078.56

LCP 3.5MM 3 HOLE 02.113.103

Facility

$1,926.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,078.56
Max. Negotiated Rate	$1,868.22
Rate for Payer: Cash Price	$1,155.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,348.20
Rate for Payer: Health Management Network Commercial	$1,637.10
Rate for Payer: Kaiser Permanente Commercial	$1,733.40
Rate for Payer: MDX Hawaii PPO	$1,868.22
Rate for Payer: University Health Alliance Commercial	$1,078.56

LCP 4.5X336MM LF 02.124.417

Facility

$4,808.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,692.48
Max. Negotiated Rate	$4,663.76
Rate for Payer: Cash Price	$2,884.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,365.60
Rate for Payer: Health Management Network Commercial	$4,086.80
Rate for Payer: Kaiser Permanente Commercial	$4,327.20
Rate for Payer: MDX Hawaii PPO	$4,663.76
Rate for Payer: University Health Alliance Commercial	$2,692.48

LCP 4.5X336MM LF 02.124.417

Facility

$4,808.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,490.48
Max. Negotiated Rate	$4,663.76
Rate for Payer: AlohaCare Medicaid	$2,404.00
Rate for Payer: AlohaCare Medicare	$1,490.48
Rate for Payer: Cash Price	$2,884.80
Rate for Payer: Devoted Health Medicare	$1,634.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,490.48
Rate for Payer: Hawaii Western Management Group Commercial	$3,365.60
Rate for Payer: Health Management Network Commercial	$4,086.80
Rate for Payer: Humana Medicare	$1,490.48
Rate for Payer: Kaiser Permanente Commercial	$4,327.20
Rate for Payer: Kaiser Permanente Medicaid	$2,452.08
Rate for Payer: Kaiser Permanente Medicare	$1,490.48
Rate for Payer: MDX Hawaii PPO	$4,663.76
Rate for Payer: Ohana Health Plan Medicaid	$1,490.48
Rate for Payer: Ohana Health Plan Medicare	$1,490.48
Rate for Payer: UnitedHealthcare Medicare	$1,490.48
Rate for Payer: University Health Alliance Commercial	$2,692.48

LCP HUMERUS 2.7X3.5 02.117.704

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

LCP HUMERUS 2.7X3.5 02.117.704

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

LCP PLATE 2.0, 5 HOLE/38MM

Facility

$1,180.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$660.80
Max. Negotiated Rate	$1,144.60
Rate for Payer: Cash Price	$708.00
Rate for Payer: Hawaii Western Management Group Commercial	$826.00
Rate for Payer: Health Management Network Commercial	$1,003.00
Rate for Payer: Kaiser Permanente Commercial	$1,062.00
Rate for Payer: MDX Hawaii PPO	$1,144.60
Rate for Payer: University Health Alliance Commercial	$660.80

LCP PLATE 2.0, 5 HOLE/38MM

Facility

$1,180.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$365.80
Max. Negotiated Rate	$1,144.60
Rate for Payer: AlohaCare Medicaid	$590.00
Rate for Payer: AlohaCare Medicare	$365.80
Rate for Payer: Cash Price	$708.00
Rate for Payer: Devoted Health Medicare	$401.20
Rate for Payer: Hawaii Medical Service Association Medicare	$365.80
Rate for Payer: Hawaii Western Management Group Commercial	$826.00
Rate for Payer: Health Management Network Commercial	$1,003.00
Rate for Payer: Humana Medicare	$365.80
Rate for Payer: Kaiser Permanente Commercial	$1,062.00
Rate for Payer: Kaiser Permanente Medicaid	$601.80
Rate for Payer: Kaiser Permanente Medicare	$365.80
Rate for Payer: MDX Hawaii PPO	$1,144.60
Rate for Payer: Ohana Health Plan Medicaid	$365.80
Rate for Payer: Ohana Health Plan Medicare	$365.80
Rate for Payer: UnitedHealthcare Medicare	$365.80
Rate for Payer: University Health Alliance Commercial	$660.80

LCP PLATE 3H 4.5X62MM 224.531

Facility

$1,530.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$474.30
Max. Negotiated Rate	$1,484.10
Rate for Payer: AlohaCare Medicaid	$765.00
Rate for Payer: AlohaCare Medicare	$474.30
Rate for Payer: Cash Price	$918.00
Rate for Payer: Devoted Health Medicare	$520.20
Rate for Payer: Hawaii Medical Service Association Medicare	$474.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,071.00
Rate for Payer: Health Management Network Commercial	$1,300.50
Rate for Payer: Humana Medicare	$474.30
Rate for Payer: Kaiser Permanente Commercial	$1,377.00
Rate for Payer: Kaiser Permanente Medicaid	$780.30
Rate for Payer: Kaiser Permanente Medicare	$474.30
Rate for Payer: MDX Hawaii PPO	$1,484.10
Rate for Payer: Ohana Health Plan Medicaid	$474.30
Rate for Payer: Ohana Health Plan Medicare	$474.30
Rate for Payer: UnitedHealthcare Medicare	$474.30
Rate for Payer: University Health Alliance Commercial	$856.80

LCP PLATE 3H 4.5X62MM 224.531

Facility

$1,530.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$856.80
Max. Negotiated Rate	$1,484.10
Rate for Payer: Cash Price	$918.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,071.00
Rate for Payer: Health Management Network Commercial	$1,300.50
Rate for Payer: Kaiser Permanente Commercial	$1,377.00
Rate for Payer: MDX Hawaii PPO	$1,484.10
Rate for Payer: University Health Alliance Commercial	$856.80

LCP PLATE 9H RT 02.110.009S

Facility

$1,039.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$322.09
Max. Negotiated Rate	$1,007.83
Rate for Payer: AlohaCare Medicaid	$519.50
Rate for Payer: AlohaCare Medicare	$322.09
Rate for Payer: Cash Price	$623.40
Rate for Payer: Devoted Health Medicare	$353.26
Rate for Payer: Hawaii Medical Service Association Medicare	$322.09
Rate for Payer: Hawaii Western Management Group Commercial	$727.30
Rate for Payer: Health Management Network Commercial	$883.15
Rate for Payer: Humana Medicare	$322.09
Rate for Payer: Kaiser Permanente Commercial	$935.10
Rate for Payer: Kaiser Permanente Medicaid	$529.89
Rate for Payer: Kaiser Permanente Medicare	$322.09
Rate for Payer: MDX Hawaii PPO	$1,007.83
Rate for Payer: Ohana Health Plan Medicaid	$322.09
Rate for Payer: Ohana Health Plan Medicare	$322.09
Rate for Payer: UnitedHealthcare Medicare	$322.09
Rate for Payer: University Health Alliance Commercial	$581.84

LCP PLATE 9H RT 02.110.009S

Facility

$1,039.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$581.84
Max. Negotiated Rate	$1,007.83
Rate for Payer: Cash Price	$623.40
Rate for Payer: Hawaii Western Management Group Commercial	$727.30
Rate for Payer: Health Management Network Commercial	$883.15
Rate for Payer: Kaiser Permanente Commercial	$935.10
Rate for Payer: MDX Hawaii PPO	$1,007.83
Rate for Payer: University Health Alliance Commercial	$581.84

LCP PROX HUM PL 241.921

Facility

$3,834.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,188.54
Max. Negotiated Rate	$3,718.98
Rate for Payer: AlohaCare Medicaid	$1,917.00
Rate for Payer: AlohaCare Medicare	$1,188.54
Rate for Payer: Cash Price	$2,300.40
Rate for Payer: Devoted Health Medicare	$1,303.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,188.54
Rate for Payer: Hawaii Western Management Group Commercial	$2,683.80
Rate for Payer: Health Management Network Commercial	$3,258.90
Rate for Payer: Humana Medicare	$1,188.54
Rate for Payer: Kaiser Permanente Commercial	$3,450.60
Rate for Payer: Kaiser Permanente Medicaid	$1,955.34
Rate for Payer: Kaiser Permanente Medicare	$1,188.54
Rate for Payer: MDX Hawaii PPO	$3,718.98
Rate for Payer: Ohana Health Plan Medicaid	$1,188.54
Rate for Payer: Ohana Health Plan Medicare	$1,188.54
Rate for Payer: UnitedHealthcare Medicare	$1,188.54
Rate for Payer: University Health Alliance Commercial	$2,147.04

Know your out-of-pocket cost for care.

All Charges