Kau Hospital

All Charges

Charge

Type

Setting

Price

PLATE 1/3 TUBULAR 83 7H 626677

Facility

$1,608.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$900.48
Max. Negotiated Rate	$1,559.76
Rate for Payer: Cash Price	$964.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,125.60
Rate for Payer: Health Management Network Commercial	$1,366.80
Rate for Payer: Kaiser Permanente Commercial	$1,447.20
Rate for Payer: MDX Hawaii PPO	$1,559.76
Rate for Payer: University Health Alliance Commercial	$900.48

PLATE 1/3 TUB W COLLAR 241.35

Facility

$805.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$249.55
Max. Negotiated Rate	$780.85
Rate for Payer: AlohaCare Medicaid	$402.50
Rate for Payer: AlohaCare Medicare	$249.55
Rate for Payer: Cash Price	$483.00
Rate for Payer: Devoted Health Medicare	$273.70
Rate for Payer: Hawaii Medical Service Association Medicare	$249.55
Rate for Payer: Hawaii Western Management Group Commercial	$563.50
Rate for Payer: Health Management Network Commercial	$684.25
Rate for Payer: Humana Medicare	$249.55
Rate for Payer: Kaiser Permanente Commercial	$724.50
Rate for Payer: Kaiser Permanente Medicaid	$410.55
Rate for Payer: Kaiser Permanente Medicare	$249.55
Rate for Payer: MDX Hawaii PPO	$780.85
Rate for Payer: Ohana Health Plan Medicaid	$249.55
Rate for Payer: Ohana Health Plan Medicare	$249.55
Rate for Payer: UnitedHealthcare Medicare	$249.55
Rate for Payer: University Health Alliance Commercial	$450.80

PLATE 1/3 TUB W COLLAR 241.35

Facility

$805.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$450.80
Max. Negotiated Rate	$780.85
Rate for Payer: Cash Price	$483.00
Rate for Payer: Hawaii Western Management Group Commercial	$563.50
Rate for Payer: Health Management Network Commercial	$684.25
Rate for Payer: Kaiser Permanente Commercial	$724.50
Rate for Payer: MDX Hawaii PPO	$780.85
Rate for Payer: University Health Alliance Commercial	$450.80

PLATE 1/3 TUB W COLLAR 241.37

Facility

$435.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$134.85
Max. Negotiated Rate	$421.95
Rate for Payer: AlohaCare Medicaid	$217.50
Rate for Payer: AlohaCare Medicare	$134.85
Rate for Payer: Cash Price	$261.00
Rate for Payer: Devoted Health Medicare	$147.90
Rate for Payer: Hawaii Medical Service Association Medicare	$134.85
Rate for Payer: Hawaii Western Management Group Commercial	$304.50
Rate for Payer: Health Management Network Commercial	$369.75
Rate for Payer: Humana Medicare	$134.85
Rate for Payer: Kaiser Permanente Commercial	$391.50
Rate for Payer: Kaiser Permanente Medicaid	$221.85
Rate for Payer: Kaiser Permanente Medicare	$134.85
Rate for Payer: MDX Hawaii PPO	$421.95
Rate for Payer: Ohana Health Plan Medicaid	$134.85
Rate for Payer: Ohana Health Plan Medicare	$134.85
Rate for Payer: UnitedHealthcare Medicare	$134.85
Rate for Payer: University Health Alliance Commercial	$243.60

PLATE 1/3 TUB W COLLAR 241.37

Facility

$435.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$243.60
Max. Negotiated Rate	$421.95
Rate for Payer: Cash Price	$261.00
Rate for Payer: Hawaii Western Management Group Commercial	$304.50
Rate for Payer: Health Management Network Commercial	$369.75
Rate for Payer: Kaiser Permanente Commercial	$391.50
Rate for Payer: MDX Hawaii PPO	$421.95
Rate for Payer: University Health Alliance Commercial	$243.60

PLATE 1.5 LCK T-SHP 131220152

Facility

$2,120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,187.20
Max. Negotiated Rate	$2,056.40
Rate for Payer: Cash Price	$1,272.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,484.00
Rate for Payer: Health Management Network Commercial	$1,802.00
Rate for Payer: Kaiser Permanente Commercial	$1,908.00
Rate for Payer: MDX Hawaii PPO	$2,056.40
Rate for Payer: University Health Alliance Commercial	$1,187.20

PLATE 1.5 LCK T-SHP 131220152

Facility

$2,120.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$657.20
Max. Negotiated Rate	$2,056.40
Rate for Payer: AlohaCare Medicaid	$1,060.00
Rate for Payer: AlohaCare Medicare	$657.20
Rate for Payer: Cash Price	$1,272.00
Rate for Payer: Devoted Health Medicare	$720.80
Rate for Payer: Hawaii Medical Service Association Medicare	$657.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,484.00
Rate for Payer: Health Management Network Commercial	$1,802.00
Rate for Payer: Humana Medicare	$657.20
Rate for Payer: Kaiser Permanente Commercial	$1,908.00
Rate for Payer: Kaiser Permanente Medicaid	$1,081.20
Rate for Payer: Kaiser Permanente Medicare	$657.20
Rate for Payer: MDX Hawaii PPO	$2,056.40
Rate for Payer: Ohana Health Plan Medicaid	$657.20
Rate for Payer: Ohana Health Plan Medicare	$657.20
Rate for Payer: UnitedHealthcare Medicare	$657.20
Rate for Payer: University Health Alliance Commercial	$1,187.20

PLATE 16 HOLE 627616

Facility

$6,753.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,781.68
Max. Negotiated Rate	$6,550.41
Rate for Payer: Cash Price	$4,051.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,727.10
Rate for Payer: Health Management Network Commercial	$5,740.05
Rate for Payer: Kaiser Permanente Commercial	$6,077.70
Rate for Payer: MDX Hawaii PPO	$6,550.41
Rate for Payer: University Health Alliance Commercial	$3,781.68

PLATE 16 HOLE 627616

Facility

$6,753.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,093.43
Max. Negotiated Rate	$6,550.41
Rate for Payer: AlohaCare Medicaid	$3,376.50
Rate for Payer: AlohaCare Medicare	$2,093.43
Rate for Payer: Cash Price	$4,051.80
Rate for Payer: Devoted Health Medicare	$2,296.02
Rate for Payer: Hawaii Medical Service Association Medicare	$2,093.43
Rate for Payer: Hawaii Western Management Group Commercial	$4,727.10
Rate for Payer: Health Management Network Commercial	$5,740.05
Rate for Payer: Humana Medicare	$2,093.43
Rate for Payer: Kaiser Permanente Commercial	$6,077.70
Rate for Payer: Kaiser Permanente Medicaid	$3,444.03
Rate for Payer: Kaiser Permanente Medicare	$2,093.43
Rate for Payer: MDX Hawaii PPO	$6,550.41
Rate for Payer: Ohana Health Plan Medicaid	$2,093.43
Rate for Payer: Ohana Health Plan Medicare	$2,093.43
Rate for Payer: UnitedHealthcare Medicare	$2,093.43
Rate for Payer: University Health Alliance Commercial	$3,781.68

PLATE 1.7MM S LCKIN Z, NARR 9H

Facility

$1,900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,064.00
Max. Negotiated Rate	$1,843.00
Rate for Payer: Cash Price	$1,140.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,330.00
Rate for Payer: Health Management Network Commercial	$1,615.00
Rate for Payer: Kaiser Permanente Commercial	$1,710.00
Rate for Payer: MDX Hawaii PPO	$1,843.00
Rate for Payer: University Health Alliance Commercial	$1,064.00

PLATE 1.7MM S LCKIN Z, NARR 9H

Facility

$1,900.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$589.00
Max. Negotiated Rate	$1,843.00
Rate for Payer: AlohaCare Medicaid	$950.00
Rate for Payer: AlohaCare Medicare	$589.00
Rate for Payer: Cash Price	$1,140.00
Rate for Payer: Devoted Health Medicare	$646.00
Rate for Payer: Hawaii Medical Service Association Medicare	$589.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,330.00
Rate for Payer: Health Management Network Commercial	$1,615.00
Rate for Payer: Humana Medicare	$589.00
Rate for Payer: Kaiser Permanente Commercial	$1,710.00
Rate for Payer: Kaiser Permanente Medicaid	$969.00
Rate for Payer: Kaiser Permanente Medicare	$589.00
Rate for Payer: MDX Hawaii PPO	$1,843.00
Rate for Payer: Ohana Health Plan Medicaid	$589.00
Rate for Payer: Ohana Health Plan Medicare	$589.00
Rate for Payer: UnitedHealthcare Medicare	$589.00
Rate for Payer: University Health Alliance Commercial	$1,064.00

PLATE 1.7 STR 16H 57-08216

Facility

$1,548.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$866.88
Max. Negotiated Rate	$1,501.56
Rate for Payer: Cash Price	$928.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,083.60
Rate for Payer: Health Management Network Commercial	$1,315.80
Rate for Payer: Kaiser Permanente Commercial	$1,393.20
Rate for Payer: MDX Hawaii PPO	$1,501.56
Rate for Payer: University Health Alliance Commercial	$866.88

PLATE 1.7 STR 16H 57-08216

Facility

$1,548.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$479.88
Max. Negotiated Rate	$1,501.56
Rate for Payer: AlohaCare Medicaid	$774.00
Rate for Payer: AlohaCare Medicare	$479.88
Rate for Payer: Cash Price	$928.80
Rate for Payer: Devoted Health Medicare	$526.32
Rate for Payer: Hawaii Medical Service Association Medicare	$479.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,083.60
Rate for Payer: Health Management Network Commercial	$1,315.80
Rate for Payer: Humana Medicare	$479.88
Rate for Payer: Kaiser Permanente Commercial	$1,393.20
Rate for Payer: Kaiser Permanente Medicaid	$789.48
Rate for Payer: Kaiser Permanente Medicare	$479.88
Rate for Payer: MDX Hawaii PPO	$1,501.56
Rate for Payer: Ohana Health Plan Medicaid	$479.88
Rate for Payer: Ohana Health Plan Medicare	$479.88
Rate for Payer: UnitedHealthcare Medicare	$479.88
Rate for Payer: University Health Alliance Commercial	$866.88

PLATE 2.0 LCP 10H/73 247.360

Facility

$1,033.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$320.23
Max. Negotiated Rate	$1,002.01
Rate for Payer: AlohaCare Medicaid	$516.50
Rate for Payer: AlohaCare Medicare	$320.23
Rate for Payer: Cash Price	$619.80
Rate for Payer: Devoted Health Medicare	$351.22
Rate for Payer: Hawaii Medical Service Association Medicare	$320.23
Rate for Payer: Hawaii Western Management Group Commercial	$723.10
Rate for Payer: Health Management Network Commercial	$878.05
Rate for Payer: Humana Medicare	$320.23
Rate for Payer: Kaiser Permanente Commercial	$929.70
Rate for Payer: Kaiser Permanente Medicaid	$526.83
Rate for Payer: Kaiser Permanente Medicare	$320.23
Rate for Payer: MDX Hawaii PPO	$1,002.01
Rate for Payer: Ohana Health Plan Medicaid	$320.23
Rate for Payer: Ohana Health Plan Medicare	$320.23
Rate for Payer: UnitedHealthcare Medicare	$320.23
Rate for Payer: University Health Alliance Commercial	$578.48

PLATE 2.0 LCP 10H/73 247.360

Facility

$1,033.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$578.48
Max. Negotiated Rate	$1,002.01
Rate for Payer: Cash Price	$619.80
Rate for Payer: Hawaii Western Management Group Commercial	$723.10
Rate for Payer: Health Management Network Commercial	$878.05
Rate for Payer: Kaiser Permanente Commercial	$929.70
Rate for Payer: MDX Hawaii PPO	$1,002.01
Rate for Payer: University Health Alliance Commercial	$578.48

PLATE 2.0 LCP 3H/7H 247.615

Facility

$1,566.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$876.96
Max. Negotiated Rate	$1,519.02
Rate for Payer: Cash Price	$939.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,096.20
Rate for Payer: Health Management Network Commercial	$1,331.10
Rate for Payer: Kaiser Permanente Commercial	$1,409.40
Rate for Payer: MDX Hawaii PPO	$1,519.02
Rate for Payer: University Health Alliance Commercial	$876.96

PLATE 2.0 LCP 3H/7H 247.615

Facility

$1,566.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$485.46
Max. Negotiated Rate	$1,519.02
Rate for Payer: AlohaCare Medicaid	$783.00
Rate for Payer: AlohaCare Medicare	$485.46
Rate for Payer: Cash Price	$939.60
Rate for Payer: Devoted Health Medicare	$532.44
Rate for Payer: Hawaii Medical Service Association Medicare	$485.46
Rate for Payer: Hawaii Western Management Group Commercial	$1,096.20
Rate for Payer: Health Management Network Commercial	$1,331.10
Rate for Payer: Humana Medicare	$485.46
Rate for Payer: Kaiser Permanente Commercial	$1,409.40
Rate for Payer: Kaiser Permanente Medicaid	$798.66
Rate for Payer: Kaiser Permanente Medicare	$485.46
Rate for Payer: MDX Hawaii PPO	$1,519.02
Rate for Payer: Ohana Health Plan Medicaid	$485.46
Rate for Payer: Ohana Health Plan Medicare	$485.46
Rate for Payer: UnitedHealthcare Medicare	$485.46
Rate for Payer: University Health Alliance Commercial	$876.96

PLATE 2.0 LCP 4H/31 247.344

Facility

$1,051.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$588.56
Max. Negotiated Rate	$1,019.47
Rate for Payer: Cash Price	$630.60
Rate for Payer: Hawaii Western Management Group Commercial	$735.70
Rate for Payer: Health Management Network Commercial	$893.35
Rate for Payer: Kaiser Permanente Commercial	$945.90
Rate for Payer: MDX Hawaii PPO	$1,019.47
Rate for Payer: University Health Alliance Commercial	$588.56

PLATE 2.0 LCP 4H/31 247.344

Facility

$1,051.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$325.81
Max. Negotiated Rate	$1,019.47
Rate for Payer: AlohaCare Medicaid	$525.50
Rate for Payer: AlohaCare Medicare	$325.81
Rate for Payer: Cash Price	$630.60
Rate for Payer: Devoted Health Medicare	$357.34
Rate for Payer: Hawaii Medical Service Association Medicare	$325.81
Rate for Payer: Hawaii Western Management Group Commercial	$735.70
Rate for Payer: Health Management Network Commercial	$893.35
Rate for Payer: Humana Medicare	$325.81
Rate for Payer: Kaiser Permanente Commercial	$945.90
Rate for Payer: Kaiser Permanente Medicaid	$536.01
Rate for Payer: Kaiser Permanente Medicare	$325.81
Rate for Payer: MDX Hawaii PPO	$1,019.47
Rate for Payer: Ohana Health Plan Medicaid	$325.81
Rate for Payer: Ohana Health Plan Medicare	$325.81
Rate for Payer: UnitedHealthcare Medicare	$325.81
Rate for Payer: University Health Alliance Commercial	$588.56

PLATE 2.0 LCP 6H/45 247.346

Facility

$1,126.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$630.56
Max. Negotiated Rate	$1,092.22
Rate for Payer: Cash Price	$675.60
Rate for Payer: Hawaii Western Management Group Commercial	$788.20
Rate for Payer: Health Management Network Commercial	$957.10
Rate for Payer: Kaiser Permanente Commercial	$1,013.40
Rate for Payer: MDX Hawaii PPO	$1,092.22
Rate for Payer: University Health Alliance Commercial	$630.56

PLATE 2.0 LCP 6H/45 247.346

Facility

$1,126.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$349.06
Max. Negotiated Rate	$1,092.22
Rate for Payer: AlohaCare Medicaid	$563.00
Rate for Payer: AlohaCare Medicare	$349.06
Rate for Payer: Cash Price	$675.60
Rate for Payer: Devoted Health Medicare	$382.84
Rate for Payer: Hawaii Medical Service Association Medicare	$349.06
Rate for Payer: Hawaii Western Management Group Commercial	$788.20
Rate for Payer: Health Management Network Commercial	$957.10
Rate for Payer: Humana Medicare	$349.06
Rate for Payer: Kaiser Permanente Commercial	$1,013.40
Rate for Payer: Kaiser Permanente Medicaid	$574.26
Rate for Payer: Kaiser Permanente Medicare	$349.06
Rate for Payer: MDX Hawaii PPO	$1,092.22
Rate for Payer: Ohana Health Plan Medicaid	$349.06
Rate for Payer: Ohana Health Plan Medicare	$349.06
Rate for Payer: UnitedHealthcare Medicare	$349.06
Rate for Payer: University Health Alliance Commercial	$630.56

PLATE 2.0 LCP 7H/52 247.347

Facility

$1,033.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$578.48
Max. Negotiated Rate	$1,002.01
Rate for Payer: Cash Price	$619.80
Rate for Payer: Hawaii Western Management Group Commercial	$723.10
Rate for Payer: Health Management Network Commercial	$878.05
Rate for Payer: Kaiser Permanente Commercial	$929.70
Rate for Payer: MDX Hawaii PPO	$1,002.01
Rate for Payer: University Health Alliance Commercial	$578.48

PLATE 2.0 LCP 7H/52 247.347

Facility

$1,033.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$320.23
Max. Negotiated Rate	$1,002.01
Rate for Payer: AlohaCare Medicaid	$516.50
Rate for Payer: AlohaCare Medicare	$320.23
Rate for Payer: Cash Price	$619.80
Rate for Payer: Devoted Health Medicare	$351.22
Rate for Payer: Hawaii Medical Service Association Medicare	$320.23
Rate for Payer: Hawaii Western Management Group Commercial	$723.10
Rate for Payer: Health Management Network Commercial	$878.05
Rate for Payer: Humana Medicare	$320.23
Rate for Payer: Kaiser Permanente Commercial	$929.70
Rate for Payer: Kaiser Permanente Medicaid	$526.83
Rate for Payer: Kaiser Permanente Medicare	$320.23
Rate for Payer: MDX Hawaii PPO	$1,002.01
Rate for Payer: Ohana Health Plan Medicaid	$320.23
Rate for Payer: Ohana Health Plan Medicare	$320.23
Rate for Payer: UnitedHealthcare Medicare	$320.23
Rate for Payer: University Health Alliance Commercial	$578.48

PLATE 2.0 LCP 8H/59 247.348

Facility

$1,033.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$320.23
Max. Negotiated Rate	$1,002.01
Rate for Payer: AlohaCare Medicaid	$516.50
Rate for Payer: AlohaCare Medicare	$320.23
Rate for Payer: Cash Price	$619.80
Rate for Payer: Devoted Health Medicare	$351.22
Rate for Payer: Hawaii Medical Service Association Medicare	$320.23
Rate for Payer: Hawaii Western Management Group Commercial	$723.10
Rate for Payer: Health Management Network Commercial	$878.05
Rate for Payer: Humana Medicare	$320.23
Rate for Payer: Kaiser Permanente Commercial	$929.70
Rate for Payer: Kaiser Permanente Medicaid	$526.83
Rate for Payer: Kaiser Permanente Medicare	$320.23
Rate for Payer: MDX Hawaii PPO	$1,002.01
Rate for Payer: Ohana Health Plan Medicaid	$320.23
Rate for Payer: Ohana Health Plan Medicare	$320.23
Rate for Payer: UnitedHealthcare Medicare	$320.23
Rate for Payer: University Health Alliance Commercial	$578.48

PLATE 2.0 LCP 8H/59 247.348

Facility

$1,033.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$578.48
Max. Negotiated Rate	$1,002.01
Rate for Payer: Cash Price	$619.80
Rate for Payer: Hawaii Western Management Group Commercial	$723.10
Rate for Payer: Health Management Network Commercial	$878.05
Rate for Payer: Kaiser Permanente Commercial	$929.70
Rate for Payer: MDX Hawaii PPO	$1,002.01
Rate for Payer: University Health Alliance Commercial	$578.48

Know your out-of-pocket cost for care.

All Charges