Kau Hospital

All Charges

Charge

Type

Setting

Price

NAIL TIBIAL 12/285 04.004.637S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,966.72
Max. Negotiated Rate	$3,406.64
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 12/285 04.004.637S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,088.72
Max. Negotiated Rate	$3,406.64
Rate for Payer: AlohaCare Medicaid	$1,756.00
Rate for Payer: AlohaCare Medicare	$1,088.72
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Devoted Health Medicare	$1,194.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,088.72
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Humana Medicare	$1,088.72
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: Kaiser Permanente Medicaid	$1,791.12
Rate for Payer: Kaiser Permanente Medicare	$1,088.72
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: Ohana Health Plan Medicaid	$1,088.72
Rate for Payer: Ohana Health Plan Medicare	$1,088.72
Rate for Payer: UnitedHealthcare Medicare	$1,088.72
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 12/300 04.004.640S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,088.72
Max. Negotiated Rate	$3,406.64
Rate for Payer: AlohaCare Medicaid	$1,756.00
Rate for Payer: AlohaCare Medicare	$1,088.72
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Devoted Health Medicare	$1,194.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,088.72
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Humana Medicare	$1,088.72
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: Kaiser Permanente Medicaid	$1,791.12
Rate for Payer: Kaiser Permanente Medicare	$1,088.72
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: Ohana Health Plan Medicaid	$1,088.72
Rate for Payer: Ohana Health Plan Medicare	$1,088.72
Rate for Payer: UnitedHealthcare Medicare	$1,088.72
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 12/300 04.004.640S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,966.72
Max. Negotiated Rate	$3,406.64
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 12/315 04.004.643S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,966.72
Max. Negotiated Rate	$3,406.64
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 12/315 04.004.643S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,088.72
Max. Negotiated Rate	$3,406.64
Rate for Payer: AlohaCare Medicaid	$1,756.00
Rate for Payer: AlohaCare Medicare	$1,088.72
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Devoted Health Medicare	$1,194.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,088.72
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Humana Medicare	$1,088.72
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: Kaiser Permanente Medicaid	$1,791.12
Rate for Payer: Kaiser Permanente Medicare	$1,088.72
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: Ohana Health Plan Medicaid	$1,088.72
Rate for Payer: Ohana Health Plan Medicare	$1,088.72
Rate for Payer: UnitedHealthcare Medicare	$1,088.72
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 12/330 04.004.646S

Facility

$4,214.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,359.84
Max. Negotiated Rate	$4,087.58
Rate for Payer: Cash Price	$2,528.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,949.80
Rate for Payer: Health Management Network Commercial	$3,581.90
Rate for Payer: Kaiser Permanente Commercial	$3,792.60
Rate for Payer: MDX Hawaii PPO	$4,087.58
Rate for Payer: University Health Alliance Commercial	$2,359.84

NAIL TIBIAL 12/330 04.004.646S

Facility

$4,214.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,306.34
Max. Negotiated Rate	$4,087.58
Rate for Payer: AlohaCare Medicaid	$2,107.00
Rate for Payer: AlohaCare Medicare	$1,306.34
Rate for Payer: Cash Price	$2,528.40
Rate for Payer: Devoted Health Medicare	$1,432.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,306.34
Rate for Payer: Hawaii Western Management Group Commercial	$2,949.80
Rate for Payer: Health Management Network Commercial	$3,581.90
Rate for Payer: Humana Medicare	$1,306.34
Rate for Payer: Kaiser Permanente Commercial	$3,792.60
Rate for Payer: Kaiser Permanente Medicaid	$2,149.14
Rate for Payer: Kaiser Permanente Medicare	$1,306.34
Rate for Payer: MDX Hawaii PPO	$4,087.58
Rate for Payer: Ohana Health Plan Medicaid	$1,306.34
Rate for Payer: Ohana Health Plan Medicare	$1,306.34
Rate for Payer: UnitedHealthcare Medicare	$1,306.34
Rate for Payer: University Health Alliance Commercial	$2,359.84

NAIL TIBIAL 12/345 04.004.649S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,126.85
Max. Negotiated Rate	$3,525.95
Rate for Payer: AlohaCare Medicaid	$1,817.50
Rate for Payer: AlohaCare Medicare	$1,126.85
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Devoted Health Medicare	$1,235.90
Rate for Payer: Hawaii Medical Service Association Medicare	$1,126.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: Humana Medicare	$1,126.85
Rate for Payer: Kaiser Permanente Commercial	$3,271.50
Rate for Payer: Kaiser Permanente Medicaid	$1,853.85
Rate for Payer: Kaiser Permanente Medicare	$1,126.85
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: Ohana Health Plan Medicaid	$1,126.85
Rate for Payer: Ohana Health Plan Medicare	$1,126.85
Rate for Payer: UnitedHealthcare Medicare	$1,126.85
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL TIBIAL 12/345 04.004.649S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.60
Max. Negotiated Rate	$3,525.95
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: Kaiser Permanente Commercial	$3,271.50
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL TIBIAL 12/360 04.004.652S

Facility

$5,268.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,633.08
Max. Negotiated Rate	$5,109.96
Rate for Payer: AlohaCare Medicaid	$2,634.00
Rate for Payer: AlohaCare Medicare	$1,633.08
Rate for Payer: Cash Price	$3,160.80
Rate for Payer: Devoted Health Medicare	$1,791.12
Rate for Payer: Hawaii Medical Service Association Medicare	$1,633.08
Rate for Payer: Hawaii Western Management Group Commercial	$3,687.60
Rate for Payer: Health Management Network Commercial	$4,477.80
Rate for Payer: Humana Medicare	$1,633.08
Rate for Payer: Kaiser Permanente Commercial	$4,741.20
Rate for Payer: Kaiser Permanente Medicaid	$2,686.68
Rate for Payer: Kaiser Permanente Medicare	$1,633.08
Rate for Payer: MDX Hawaii PPO	$5,109.96
Rate for Payer: Ohana Health Plan Medicaid	$1,633.08
Rate for Payer: Ohana Health Plan Medicare	$1,633.08
Rate for Payer: UnitedHealthcare Medicare	$1,633.08
Rate for Payer: University Health Alliance Commercial	$2,950.08

NAIL TIBIAL 12/360 04.004.652S

Facility

$5,268.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,950.08
Max. Negotiated Rate	$5,109.96
Rate for Payer: Cash Price	$3,160.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,687.60
Rate for Payer: Health Management Network Commercial	$4,477.80
Rate for Payer: Kaiser Permanente Commercial	$4,741.20
Rate for Payer: MDX Hawaii PPO	$5,109.96
Rate for Payer: University Health Alliance Commercial	$2,950.08

NAIL TIBIAL 12/375 04.004.655S

Facility

$4,214.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,359.84
Max. Negotiated Rate	$4,087.58
Rate for Payer: Cash Price	$2,528.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,949.80
Rate for Payer: Health Management Network Commercial	$3,581.90
Rate for Payer: Kaiser Permanente Commercial	$3,792.60
Rate for Payer: MDX Hawaii PPO	$4,087.58
Rate for Payer: University Health Alliance Commercial	$2,359.84

NAIL TIBIAL 12/375 04.004.655S

Facility

$4,214.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,306.34
Max. Negotiated Rate	$4,087.58
Rate for Payer: AlohaCare Medicaid	$2,107.00
Rate for Payer: AlohaCare Medicare	$1,306.34
Rate for Payer: Cash Price	$2,528.40
Rate for Payer: Devoted Health Medicare	$1,432.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,306.34
Rate for Payer: Hawaii Western Management Group Commercial	$2,949.80
Rate for Payer: Health Management Network Commercial	$3,581.90
Rate for Payer: Humana Medicare	$1,306.34
Rate for Payer: Kaiser Permanente Commercial	$3,792.60
Rate for Payer: Kaiser Permanente Medicaid	$2,149.14
Rate for Payer: Kaiser Permanente Medicare	$1,306.34
Rate for Payer: MDX Hawaii PPO	$4,087.58
Rate for Payer: Ohana Health Plan Medicaid	$1,306.34
Rate for Payer: Ohana Health Plan Medicare	$1,306.34
Rate for Payer: UnitedHealthcare Medicare	$1,306.34
Rate for Payer: University Health Alliance Commercial	$2,359.84

NAIL TIBIAL 12/390 04.004.658S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,088.72
Max. Negotiated Rate	$3,406.64
Rate for Payer: AlohaCare Medicaid	$1,756.00
Rate for Payer: AlohaCare Medicare	$1,088.72
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Devoted Health Medicare	$1,194.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,088.72
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Humana Medicare	$1,088.72
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: Kaiser Permanente Medicaid	$1,791.12
Rate for Payer: Kaiser Permanente Medicare	$1,088.72
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: Ohana Health Plan Medicaid	$1,088.72
Rate for Payer: Ohana Health Plan Medicare	$1,088.72
Rate for Payer: UnitedHealthcare Medicare	$1,088.72
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 12/390 04.004.658S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,966.72
Max. Negotiated Rate	$3,406.64
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 12/405 04.004.661S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,966.72
Max. Negotiated Rate	$3,406.64
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 12/405 04.004.661S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,088.72
Max. Negotiated Rate	$3,406.64
Rate for Payer: AlohaCare Medicaid	$1,756.00
Rate for Payer: AlohaCare Medicare	$1,088.72
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Devoted Health Medicare	$1,194.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,088.72
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Humana Medicare	$1,088.72
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: Kaiser Permanente Medicaid	$1,791.12
Rate for Payer: Kaiser Permanente Medicare	$1,088.72
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: Ohana Health Plan Medicaid	$1,088.72
Rate for Payer: Ohana Health Plan Medicare	$1,088.72
Rate for Payer: UnitedHealthcare Medicare	$1,088.72
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 12/420 04.004.664S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,966.72
Max. Negotiated Rate	$3,406.64
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 12/420 04.004.664S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,088.72
Max. Negotiated Rate	$3,406.64
Rate for Payer: AlohaCare Medicaid	$1,756.00
Rate for Payer: AlohaCare Medicare	$1,088.72
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Devoted Health Medicare	$1,194.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,088.72
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Humana Medicare	$1,088.72
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: Kaiser Permanente Medicaid	$1,791.12
Rate for Payer: Kaiser Permanente Medicare	$1,088.72
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: Ohana Health Plan Medicaid	$1,088.72
Rate for Payer: Ohana Health Plan Medicare	$1,088.72
Rate for Payer: UnitedHealthcare Medicare	$1,088.72
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 2341-0931S

Facility

$4,100.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,271.00
Max. Negotiated Rate	$3,977.00
Rate for Payer: AlohaCare Medicaid	$2,050.00
Rate for Payer: AlohaCare Medicare	$1,271.00
Rate for Payer: Cash Price	$2,460.00
Rate for Payer: Devoted Health Medicare	$1,394.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,271.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,870.00
Rate for Payer: Health Management Network Commercial	$3,485.00
Rate for Payer: Humana Medicare	$1,271.00
Rate for Payer: Kaiser Permanente Commercial	$3,690.00
Rate for Payer: Kaiser Permanente Medicaid	$2,091.00
Rate for Payer: Kaiser Permanente Medicare	$1,271.00
Rate for Payer: MDX Hawaii PPO	$3,977.00
Rate for Payer: Ohana Health Plan Medicaid	$1,271.00
Rate for Payer: Ohana Health Plan Medicare	$1,271.00
Rate for Payer: UnitedHealthcare Medicare	$1,271.00
Rate for Payer: University Health Alliance Commercial	$2,296.00

NAIL TIBIAL 2341-0931S

Facility

$4,100.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,296.00
Max. Negotiated Rate	$3,977.00
Rate for Payer: Cash Price	$2,460.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,870.00
Rate for Payer: Health Management Network Commercial	$3,485.00
Rate for Payer: Kaiser Permanente Commercial	$3,690.00
Rate for Payer: MDX Hawaii PPO	$3,977.00
Rate for Payer: University Health Alliance Commercial	$2,296.00

NAIL TIBIAL 8/285 #04.004.237S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,126.85
Max. Negotiated Rate	$3,525.95
Rate for Payer: AlohaCare Medicaid	$1,817.50
Rate for Payer: AlohaCare Medicare	$1,126.85
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Devoted Health Medicare	$1,235.90
Rate for Payer: Hawaii Medical Service Association Medicare	$1,126.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: Humana Medicare	$1,126.85
Rate for Payer: Kaiser Permanente Commercial	$3,271.50
Rate for Payer: Kaiser Permanente Medicaid	$1,853.85
Rate for Payer: Kaiser Permanente Medicare	$1,126.85
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: Ohana Health Plan Medicaid	$1,126.85
Rate for Payer: Ohana Health Plan Medicare	$1,126.85
Rate for Payer: UnitedHealthcare Medicare	$1,126.85
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL TIBIAL 8/285 #04.004.237S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.60
Max. Negotiated Rate	$3,525.95
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: Kaiser Permanente Commercial	$3,271.50
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL TIBIAL 8/300 #04.004.240S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,966.72
Max. Negotiated Rate	$3,406.64
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: University Health Alliance Commercial	$1,966.72

Know your out-of-pocket cost for care.

All Charges