Kau Hospital

All Charges

Charge

Type

Setting

Price

PATELLA 36X10MM X3 5550-G-360

Facility

$3,628.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,031.68
Max. Negotiated Rate	$3,519.16
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,539.60
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: Kaiser Permanente Commercial	$3,265.20
Rate for Payer: MDX Hawaii PPO	$3,519.16
Rate for Payer: University Health Alliance Commercial	$2,031.68

PATELLA 36X10MM X3 5550-G-360

Facility

$3,628.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,124.68
Max. Negotiated Rate	$3,519.16
Rate for Payer: AlohaCare Medicaid	$1,814.00
Rate for Payer: AlohaCare Medicare	$1,124.68
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Devoted Health Medicare	$1,233.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,124.68
Rate for Payer: Hawaii Western Management Group Commercial	$2,539.60
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: Humana Medicare	$1,124.68
Rate for Payer: Kaiser Permanente Commercial	$3,265.20
Rate for Payer: Kaiser Permanente Medicaid	$1,850.28
Rate for Payer: Kaiser Permanente Medicare	$1,124.68
Rate for Payer: MDX Hawaii PPO	$3,519.16
Rate for Payer: Ohana Health Plan Medicaid	$1,124.68
Rate for Payer: Ohana Health Plan Medicare	$1,124.68
Rate for Payer: UnitedHealthcare Medicare	$1,124.68
Rate for Payer: University Health Alliance Commercial	$2,031.68

PATELLA 38X42X11MM 5551-T-381

Facility

$956.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$535.36
Max. Negotiated Rate	$927.32
Rate for Payer: Cash Price	$573.60
Rate for Payer: Hawaii Western Management Group Commercial	$669.20
Rate for Payer: Health Management Network Commercial	$812.60
Rate for Payer: Kaiser Permanente Commercial	$860.40
Rate for Payer: MDX Hawaii PPO	$927.32
Rate for Payer: University Health Alliance Commercial	$535.36

PATELLA 38X42X11MM 5551-T-381

Facility

$956.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$296.36
Max. Negotiated Rate	$927.32
Rate for Payer: AlohaCare Medicaid	$478.00
Rate for Payer: AlohaCare Medicare	$296.36
Rate for Payer: Cash Price	$573.60
Rate for Payer: Devoted Health Medicare	$325.04
Rate for Payer: Hawaii Medical Service Association Medicare	$296.36
Rate for Payer: Hawaii Western Management Group Commercial	$669.20
Rate for Payer: Health Management Network Commercial	$812.60
Rate for Payer: Humana Medicare	$296.36
Rate for Payer: Kaiser Permanente Commercial	$860.40
Rate for Payer: Kaiser Permanente Medicaid	$487.56
Rate for Payer: Kaiser Permanente Medicare	$296.36
Rate for Payer: MDX Hawaii PPO	$927.32
Rate for Payer: Ohana Health Plan Medicaid	$296.36
Rate for Payer: Ohana Health Plan Medicare	$296.36
Rate for Payer: UnitedHealthcare Medicare	$296.36
Rate for Payer: University Health Alliance Commercial	$535.36

PATELLA A32X10MM 5552-L-320

Facility

$2,317.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,297.52
Max. Negotiated Rate	$2,247.49
Rate for Payer: Cash Price	$1,390.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,621.90
Rate for Payer: Health Management Network Commercial	$1,969.45
Rate for Payer: Kaiser Permanente Commercial	$2,085.30
Rate for Payer: MDX Hawaii PPO	$2,247.49
Rate for Payer: University Health Alliance Commercial	$1,297.52

PATELLA A32X10MM 5552-L-320

Facility

$2,317.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$718.27
Max. Negotiated Rate	$2,247.49
Rate for Payer: AlohaCare Medicaid	$1,158.50
Rate for Payer: AlohaCare Medicare	$718.27
Rate for Payer: Cash Price	$1,390.20
Rate for Payer: Devoted Health Medicare	$787.78
Rate for Payer: Hawaii Medical Service Association Medicare	$718.27
Rate for Payer: Hawaii Western Management Group Commercial	$1,621.90
Rate for Payer: Health Management Network Commercial	$1,969.45
Rate for Payer: Humana Medicare	$718.27
Rate for Payer: Kaiser Permanente Commercial	$2,085.30
Rate for Payer: Kaiser Permanente Medicaid	$1,181.67
Rate for Payer: Kaiser Permanente Medicare	$718.27
Rate for Payer: MDX Hawaii PPO	$2,247.49
Rate for Payer: Ohana Health Plan Medicaid	$718.27
Rate for Payer: Ohana Health Plan Medicare	$718.27
Rate for Payer: UnitedHealthcare Medicare	$718.27
Rate for Payer: University Health Alliance Commercial	$1,297.52

PATELLA ASYMETRIC 5551-G-299-E

Facility

$2,317.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$718.27
Max. Negotiated Rate	$2,247.49
Rate for Payer: AlohaCare Medicaid	$1,158.50
Rate for Payer: AlohaCare Medicare	$718.27
Rate for Payer: Cash Price	$1,390.20
Rate for Payer: Devoted Health Medicare	$787.78
Rate for Payer: Hawaii Medical Service Association Medicare	$718.27
Rate for Payer: Hawaii Western Management Group Commercial	$1,621.90
Rate for Payer: Health Management Network Commercial	$1,969.45
Rate for Payer: Humana Medicare	$718.27
Rate for Payer: Kaiser Permanente Commercial	$2,085.30
Rate for Payer: Kaiser Permanente Medicaid	$1,181.67
Rate for Payer: Kaiser Permanente Medicare	$718.27
Rate for Payer: MDX Hawaii PPO	$2,247.49
Rate for Payer: Ohana Health Plan Medicaid	$718.27
Rate for Payer: Ohana Health Plan Medicare	$718.27
Rate for Payer: UnitedHealthcare Medicare	$718.27
Rate for Payer: University Health Alliance Commercial	$1,297.52

PATELLA ASYMETRIC 5551-G-299-E

Facility

$2,317.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,297.52
Max. Negotiated Rate	$2,247.49
Rate for Payer: Cash Price	$1,390.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,621.90
Rate for Payer: Health Management Network Commercial	$1,969.45
Rate for Payer: Kaiser Permanente Commercial	$2,085.30
Rate for Payer: MDX Hawaii PPO	$2,247.49
Rate for Payer: University Health Alliance Commercial	$1,297.52

PATELLA DOME 35MM 1518-20-035

Facility

$1,650.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$924.00
Max. Negotiated Rate	$1,600.50
Rate for Payer: Cash Price	$990.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,155.00
Rate for Payer: Health Management Network Commercial	$1,402.50
Rate for Payer: Kaiser Permanente Commercial	$1,485.00
Rate for Payer: MDX Hawaii PPO	$1,600.50
Rate for Payer: University Health Alliance Commercial	$924.00

PATELLA DOME 35MM 1518-20-035

Facility

$1,650.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$511.50
Max. Negotiated Rate	$1,600.50
Rate for Payer: AlohaCare Medicaid	$825.00
Rate for Payer: AlohaCare Medicare	$511.50
Rate for Payer: Cash Price	$990.00
Rate for Payer: Devoted Health Medicare	$561.00
Rate for Payer: Hawaii Medical Service Association Medicare	$511.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,155.00
Rate for Payer: Health Management Network Commercial	$1,402.50
Rate for Payer: Humana Medicare	$511.50
Rate for Payer: Kaiser Permanente Commercial	$1,485.00
Rate for Payer: Kaiser Permanente Medicaid	$841.50
Rate for Payer: Kaiser Permanente Medicare	$511.50
Rate for Payer: MDX Hawaii PPO	$1,600.50
Rate for Payer: Ohana Health Plan Medicaid	$511.50
Rate for Payer: Ohana Health Plan Medicare	$511.50
Rate for Payer: UnitedHealthcare Medicare	$511.50
Rate for Payer: University Health Alliance Commercial	$924.00

PATELLA DOME 41MM 1518-20-041

Facility

$1,650.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$511.50
Max. Negotiated Rate	$1,600.50
Rate for Payer: AlohaCare Medicaid	$825.00
Rate for Payer: AlohaCare Medicare	$511.50
Rate for Payer: Cash Price	$990.00
Rate for Payer: Devoted Health Medicare	$561.00
Rate for Payer: Hawaii Medical Service Association Medicare	$511.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,155.00
Rate for Payer: Health Management Network Commercial	$1,402.50
Rate for Payer: Humana Medicare	$511.50
Rate for Payer: Kaiser Permanente Commercial	$1,485.00
Rate for Payer: Kaiser Permanente Medicaid	$841.50
Rate for Payer: Kaiser Permanente Medicare	$511.50
Rate for Payer: MDX Hawaii PPO	$1,600.50
Rate for Payer: Ohana Health Plan Medicaid	$511.50
Rate for Payer: Ohana Health Plan Medicare	$511.50
Rate for Payer: UnitedHealthcare Medicare	$511.50
Rate for Payer: University Health Alliance Commercial	$924.00

PATELLA DOME 41MM 1518-20-041

Facility

$1,650.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$924.00
Max. Negotiated Rate	$1,600.50
Rate for Payer: Cash Price	$990.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,155.00
Rate for Payer: Health Management Network Commercial	$1,402.50
Rate for Payer: Kaiser Permanente Commercial	$1,485.00
Rate for Payer: MDX Hawaii PPO	$1,600.50
Rate for Payer: University Health Alliance Commercial	$924.00

PATELLA RESURFACE 02.07.0035RP

Facility

$1,575.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$488.25
Max. Negotiated Rate	$1,527.75
Rate for Payer: AlohaCare Medicaid	$787.50
Rate for Payer: AlohaCare Medicare	$488.25
Rate for Payer: Cash Price	$945.00
Rate for Payer: Devoted Health Medicare	$535.50
Rate for Payer: Hawaii Medical Service Association Medicare	$488.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,102.50
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: Humana Medicare	$488.25
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: Kaiser Permanente Medicaid	$803.25
Rate for Payer: Kaiser Permanente Medicare	$488.25
Rate for Payer: MDX Hawaii PPO	$1,527.75
Rate for Payer: Ohana Health Plan Medicaid	$488.25
Rate for Payer: Ohana Health Plan Medicare	$488.25
Rate for Payer: UnitedHealthcare Medicare	$488.25
Rate for Payer: University Health Alliance Commercial	$882.00

PATELLA RESURFACE 02.07.0035RP

Facility

$1,575.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$1,527.75
Rate for Payer: Cash Price	$945.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,102.50
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: MDX Hawaii PPO	$1,527.75
Rate for Payer: University Health Alliance Commercial	$882.00

PATELLA RESURF S2 02.07.0034RP

Facility

$1,575.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$488.25
Max. Negotiated Rate	$1,527.75
Rate for Payer: AlohaCare Medicaid	$787.50
Rate for Payer: AlohaCare Medicare	$488.25
Rate for Payer: Cash Price	$945.00
Rate for Payer: Devoted Health Medicare	$535.50
Rate for Payer: Hawaii Medical Service Association Medicare	$488.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,102.50
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: Humana Medicare	$488.25
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: Kaiser Permanente Medicaid	$803.25
Rate for Payer: Kaiser Permanente Medicare	$488.25
Rate for Payer: MDX Hawaii PPO	$1,527.75
Rate for Payer: Ohana Health Plan Medicaid	$488.25
Rate for Payer: Ohana Health Plan Medicare	$488.25
Rate for Payer: UnitedHealthcare Medicare	$488.25
Rate for Payer: University Health Alliance Commercial	$882.00

PATELLA RESURF S2 02.07.0034RP

Facility

$1,575.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$1,527.75
Rate for Payer: Cash Price	$945.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,102.50
Rate for Payer: Health Management Network Commercial	$1,338.75
Rate for Payer: Kaiser Permanente Commercial	$1,417.50
Rate for Payer: MDX Hawaii PPO	$1,527.75
Rate for Payer: University Health Alliance Commercial	$882.00

PATELLA RESURF S4 02.07.0036RP

Facility

$1,050.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$588.00
Max. Negotiated Rate	$1,018.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Hawaii Western Management Group Commercial	$735.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Kaiser Permanente Commercial	$945.00
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: University Health Alliance Commercial	$588.00

PATELLA RESURF S4 02.07.0036RP

Facility

$1,050.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$325.50
Max. Negotiated Rate	$1,018.50
Rate for Payer: AlohaCare Medicaid	$525.00
Rate for Payer: AlohaCare Medicare	$325.50
Rate for Payer: Cash Price	$630.00
Rate for Payer: Devoted Health Medicare	$357.00
Rate for Payer: Hawaii Medical Service Association Medicare	$325.50
Rate for Payer: Hawaii Western Management Group Commercial	$735.00
Rate for Payer: Health Management Network Commercial	$892.50
Rate for Payer: Humana Medicare	$325.50
Rate for Payer: Kaiser Permanente Commercial	$945.00
Rate for Payer: Kaiser Permanente Medicaid	$535.50
Rate for Payer: Kaiser Permanente Medicare	$325.50
Rate for Payer: MDX Hawaii PPO	$1,018.50
Rate for Payer: Ohana Health Plan Medicaid	$325.50
Rate for Payer: Ohana Health Plan Medicare	$325.50
Rate for Payer: UnitedHealthcare Medicare	$325.50
Rate for Payer: University Health Alliance Commercial	$588.00

PATELLA S39X11MM X3 5550-G-391

Facility

$3,628.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,124.68
Max. Negotiated Rate	$3,519.16
Rate for Payer: AlohaCare Medicaid	$1,814.00
Rate for Payer: AlohaCare Medicare	$1,124.68
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Devoted Health Medicare	$1,233.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,124.68
Rate for Payer: Hawaii Western Management Group Commercial	$2,539.60
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: Humana Medicare	$1,124.68
Rate for Payer: Kaiser Permanente Commercial	$3,265.20
Rate for Payer: Kaiser Permanente Medicaid	$1,850.28
Rate for Payer: Kaiser Permanente Medicare	$1,124.68
Rate for Payer: MDX Hawaii PPO	$3,519.16
Rate for Payer: Ohana Health Plan Medicaid	$1,124.68
Rate for Payer: Ohana Health Plan Medicare	$1,124.68
Rate for Payer: UnitedHealthcare Medicare	$1,124.68
Rate for Payer: University Health Alliance Commercial	$2,031.68

PATELLA S39X11MM X3 5550-G-391

Facility

$3,628.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,031.68
Max. Negotiated Rate	$3,519.16
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,539.60
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: Kaiser Permanente Commercial	$3,265.20
Rate for Payer: MDX Hawaii PPO	$3,519.16
Rate for Payer: University Health Alliance Commercial	$2,031.68

PATELLA SUTPLT II AR-13070M-S

Facility

$9,318.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,888.58
Max. Negotiated Rate	$9,038.46
Rate for Payer: AlohaCare Medicaid	$4,659.00
Rate for Payer: AlohaCare Medicare	$2,888.58
Rate for Payer: Cash Price	$5,590.80
Rate for Payer: Devoted Health Medicare	$3,168.12
Rate for Payer: Hawaii Medical Service Association Medicare	$2,888.58
Rate for Payer: Hawaii Western Management Group Commercial	$6,522.60
Rate for Payer: Health Management Network Commercial	$7,920.30
Rate for Payer: Humana Medicare	$2,888.58
Rate for Payer: Kaiser Permanente Commercial	$8,386.20
Rate for Payer: Kaiser Permanente Medicaid	$4,752.18
Rate for Payer: Kaiser Permanente Medicare	$2,888.58
Rate for Payer: MDX Hawaii PPO	$9,038.46
Rate for Payer: Ohana Health Plan Medicaid	$2,888.58
Rate for Payer: Ohana Health Plan Medicare	$2,888.58
Rate for Payer: UnitedHealthcare Medicare	$2,888.58
Rate for Payer: University Health Alliance Commercial	$5,218.08

PATELLA SUTPLT II AR-13070M-S

Facility

$9,318.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$5,218.08
Max. Negotiated Rate	$9,038.46
Rate for Payer: Cash Price	$5,590.80
Rate for Payer: Hawaii Western Management Group Commercial	$6,522.60
Rate for Payer: Health Management Network Commercial	$7,920.30
Rate for Payer: Kaiser Permanente Commercial	$8,386.20
Rate for Payer: MDX Hawaii PPO	$9,038.46
Rate for Payer: University Health Alliance Commercial	$5,218.08

PATELLA SUTRE AR-13070M-P-S

Facility

$7,787.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$4,360.72
Max. Negotiated Rate	$7,553.39
Rate for Payer: Cash Price	$4,672.20
Rate for Payer: Hawaii Western Management Group Commercial	$5,450.90
Rate for Payer: Health Management Network Commercial	$6,618.95
Rate for Payer: Kaiser Permanente Commercial	$7,008.30
Rate for Payer: MDX Hawaii PPO	$7,553.39
Rate for Payer: University Health Alliance Commercial	$4,360.72

PATELLA SUTRE AR-13070M-P-S

Facility

$7,787.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,413.97
Max. Negotiated Rate	$7,553.39
Rate for Payer: AlohaCare Medicaid	$3,893.50
Rate for Payer: AlohaCare Medicare	$2,413.97
Rate for Payer: Cash Price	$4,672.20
Rate for Payer: Devoted Health Medicare	$2,647.58
Rate for Payer: Hawaii Medical Service Association Medicare	$2,413.97
Rate for Payer: Hawaii Western Management Group Commercial	$5,450.90
Rate for Payer: Health Management Network Commercial	$6,618.95
Rate for Payer: Humana Medicare	$2,413.97
Rate for Payer: Kaiser Permanente Commercial	$7,008.30
Rate for Payer: Kaiser Permanente Medicaid	$3,971.37
Rate for Payer: Kaiser Permanente Medicare	$2,413.97
Rate for Payer: MDX Hawaii PPO	$7,553.39
Rate for Payer: Ohana Health Plan Medicaid	$2,413.97
Rate for Payer: Ohana Health Plan Medicare	$2,413.97
Rate for Payer: UnitedHealthcare Medicare	$2,413.97
Rate for Payer: University Health Alliance Commercial	$4,360.72

PATELLA X3 S31X9MM 5550-G-319

Facility

$3,628.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,031.68
Max. Negotiated Rate	$3,519.16
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,539.60
Rate for Payer: Health Management Network Commercial	$3,083.80
Rate for Payer: Kaiser Permanente Commercial	$3,265.20
Rate for Payer: MDX Hawaii PPO	$3,519.16
Rate for Payer: University Health Alliance Commercial	$2,031.68

Know your out-of-pocket cost for care.

All Charges