Kau Hospital

All Charges

Charge

Type

Setting

Price

PLATE 2.0 STRAIGHT MCS-6

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$931.28
Max. Negotiated Rate	$1,613.11
Rate for Payer: Cash Price	$997.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: University Health Alliance Commercial	$931.28

PLATE 2.0 STRAIGHT MCS-6

Facility

$1,663.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$515.53
Max. Negotiated Rate	$1,613.11
Rate for Payer: AlohaCare Medicaid	$831.50
Rate for Payer: AlohaCare Medicare	$515.53
Rate for Payer: Cash Price	$997.80
Rate for Payer: Devoted Health Medicare	$565.42
Rate for Payer: Hawaii Medical Service Association Medicare	$515.53
Rate for Payer: Hawaii Western Management Group Commercial	$1,164.10
Rate for Payer: Health Management Network Commercial	$1,413.55
Rate for Payer: Humana Medicare	$515.53
Rate for Payer: Kaiser Permanente Commercial	$1,496.70
Rate for Payer: Kaiser Permanente Medicaid	$848.13
Rate for Payer: Kaiser Permanente Medicare	$515.53
Rate for Payer: MDX Hawaii PPO	$1,613.11
Rate for Payer: Ohana Health Plan Medicaid	$515.53
Rate for Payer: Ohana Health Plan Medicare	$515.53
Rate for Payer: UnitedHealthcare Medicare	$515.53
Rate for Payer: University Health Alliance Commercial	$931.28

PLATE 2.3 L COMP 6H 57-13408

Facility

$1,272.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$394.32
Max. Negotiated Rate	$1,233.84
Rate for Payer: AlohaCare Medicaid	$636.00
Rate for Payer: AlohaCare Medicare	$394.32
Rate for Payer: Cash Price	$763.20
Rate for Payer: Devoted Health Medicare	$432.48
Rate for Payer: Hawaii Medical Service Association Medicare	$394.32
Rate for Payer: Hawaii Western Management Group Commercial	$890.40
Rate for Payer: Health Management Network Commercial	$1,081.20
Rate for Payer: Humana Medicare	$394.32
Rate for Payer: Kaiser Permanente Commercial	$1,144.80
Rate for Payer: Kaiser Permanente Medicaid	$648.72
Rate for Payer: Kaiser Permanente Medicare	$394.32
Rate for Payer: MDX Hawaii PPO	$1,233.84
Rate for Payer: Ohana Health Plan Medicaid	$394.32
Rate for Payer: Ohana Health Plan Medicare	$394.32
Rate for Payer: UnitedHealthcare Medicare	$394.32
Rate for Payer: University Health Alliance Commercial	$712.32

PLATE 2.3 L COMP 6H 57-13408

Facility

$1,272.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$712.32
Max. Negotiated Rate	$1,233.84
Rate for Payer: Cash Price	$763.20
Rate for Payer: Hawaii Western Management Group Commercial	$890.40
Rate for Payer: Health Management Network Commercial	$1,081.20
Rate for Payer: Kaiser Permanente Commercial	$1,144.80
Rate for Payer: MDX Hawaii PPO	$1,233.84
Rate for Payer: University Health Alliance Commercial	$712.32

PLATE 2.3 M LCK 13H 57-15379

Facility

$2,476.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$767.56
Max. Negotiated Rate	$2,401.72
Rate for Payer: AlohaCare Medicaid	$1,238.00
Rate for Payer: AlohaCare Medicare	$767.56
Rate for Payer: Cash Price	$1,485.60
Rate for Payer: Devoted Health Medicare	$841.84
Rate for Payer: Hawaii Medical Service Association Medicare	$767.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,733.20
Rate for Payer: Health Management Network Commercial	$2,104.60
Rate for Payer: Humana Medicare	$767.56
Rate for Payer: Kaiser Permanente Commercial	$2,228.40
Rate for Payer: Kaiser Permanente Medicaid	$1,262.76
Rate for Payer: Kaiser Permanente Medicare	$767.56
Rate for Payer: MDX Hawaii PPO	$2,401.72
Rate for Payer: Ohana Health Plan Medicaid	$767.56
Rate for Payer: Ohana Health Plan Medicare	$767.56
Rate for Payer: UnitedHealthcare Medicare	$767.56
Rate for Payer: University Health Alliance Commercial	$1,386.56

PLATE 2.3 M LCK 13H 57-15379

Facility

$2,476.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,386.56
Max. Negotiated Rate	$2,401.72
Rate for Payer: Cash Price	$1,485.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,733.20
Rate for Payer: Health Management Network Commercial	$2,104.60
Rate for Payer: Kaiser Permanente Commercial	$2,228.40
Rate for Payer: MDX Hawaii PPO	$2,401.72
Rate for Payer: University Health Alliance Commercial	$1,386.56

PLATE 2.3MM 16H STR 57-10116

Facility

$1,677.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$519.87
Max. Negotiated Rate	$1,626.69
Rate for Payer: AlohaCare Medicaid	$838.50
Rate for Payer: AlohaCare Medicare	$519.87
Rate for Payer: Cash Price	$1,006.20
Rate for Payer: Devoted Health Medicare	$570.18
Rate for Payer: Hawaii Medical Service Association Medicare	$519.87
Rate for Payer: Hawaii Western Management Group Commercial	$1,173.90
Rate for Payer: Health Management Network Commercial	$1,425.45
Rate for Payer: Humana Medicare	$519.87
Rate for Payer: Kaiser Permanente Commercial	$1,509.30
Rate for Payer: Kaiser Permanente Medicaid	$855.27
Rate for Payer: Kaiser Permanente Medicare	$519.87
Rate for Payer: MDX Hawaii PPO	$1,626.69
Rate for Payer: Ohana Health Plan Medicaid	$519.87
Rate for Payer: Ohana Health Plan Medicare	$519.87
Rate for Payer: UnitedHealthcare Medicare	$519.87
Rate for Payer: University Health Alliance Commercial	$939.12

PLATE 2.3MM 16H STR 57-10116

Facility

$1,677.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$939.12
Max. Negotiated Rate	$1,626.69
Rate for Payer: Cash Price	$1,006.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,173.90
Rate for Payer: Health Management Network Commercial	$1,425.45
Rate for Payer: Kaiser Permanente Commercial	$1,509.30
Rate for Payer: MDX Hawaii PPO	$1,626.69
Rate for Payer: University Health Alliance Commercial	$939.12

PLATE 2.3MM STR 4HOLE 57-10101

Facility

$1,277.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$715.12
Max. Negotiated Rate	$1,238.69
Rate for Payer: Cash Price	$766.20
Rate for Payer: Hawaii Western Management Group Commercial	$893.90
Rate for Payer: Health Management Network Commercial	$1,085.45
Rate for Payer: Kaiser Permanente Commercial	$1,149.30
Rate for Payer: MDX Hawaii PPO	$1,238.69
Rate for Payer: University Health Alliance Commercial	$715.12

PLATE 2.3MM STR 4HOLE 57-10101

Facility

$1,277.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$395.87
Max. Negotiated Rate	$1,238.69
Rate for Payer: AlohaCare Medicaid	$638.50
Rate for Payer: AlohaCare Medicare	$395.87
Rate for Payer: Cash Price	$766.20
Rate for Payer: Devoted Health Medicare	$434.18
Rate for Payer: Hawaii Medical Service Association Medicare	$395.87
Rate for Payer: Hawaii Western Management Group Commercial	$893.90
Rate for Payer: Health Management Network Commercial	$1,085.45
Rate for Payer: Humana Medicare	$395.87
Rate for Payer: Kaiser Permanente Commercial	$1,149.30
Rate for Payer: Kaiser Permanente Medicaid	$651.27
Rate for Payer: Kaiser Permanente Medicare	$395.87
Rate for Payer: MDX Hawaii PPO	$1,238.69
Rate for Payer: Ohana Health Plan Medicaid	$395.87
Rate for Payer: Ohana Health Plan Medicare	$395.87
Rate for Payer: UnitedHealthcare Medicare	$395.87
Rate for Payer: University Health Alliance Commercial	$715.12

PLATE 2.3 STANDARD LF 57-10121

Facility

$1,562.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$874.72
Max. Negotiated Rate	$1,515.14
Rate for Payer: Cash Price	$937.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.40
Rate for Payer: Health Management Network Commercial	$1,327.70
Rate for Payer: Kaiser Permanente Commercial	$1,405.80
Rate for Payer: MDX Hawaii PPO	$1,515.14
Rate for Payer: University Health Alliance Commercial	$874.72

PLATE 2.3 STANDARD LF 57-10121

Facility

$1,562.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$484.22
Max. Negotiated Rate	$1,515.14
Rate for Payer: AlohaCare Medicaid	$781.00
Rate for Payer: AlohaCare Medicare	$484.22
Rate for Payer: Cash Price	$937.20
Rate for Payer: Devoted Health Medicare	$531.08
Rate for Payer: Hawaii Medical Service Association Medicare	$484.22
Rate for Payer: Hawaii Western Management Group Commercial	$1,093.40
Rate for Payer: Health Management Network Commercial	$1,327.70
Rate for Payer: Humana Medicare	$484.22
Rate for Payer: Kaiser Permanente Commercial	$1,405.80
Rate for Payer: Kaiser Permanente Medicaid	$796.62
Rate for Payer: Kaiser Permanente Medicare	$484.22
Rate for Payer: MDX Hawaii PPO	$1,515.14
Rate for Payer: Ohana Health Plan Medicaid	$484.22
Rate for Payer: Ohana Health Plan Medicare	$484.22
Rate for Payer: UnitedHealthcare Medicare	$484.22
Rate for Payer: University Health Alliance Commercial	$874.72

PLATE 2.3X1.5MM 5HOLE 57-15324

Facility

$2,335.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,307.60
Max. Negotiated Rate	$2,264.95
Rate for Payer: Cash Price	$1,401.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,634.50
Rate for Payer: Health Management Network Commercial	$1,984.75
Rate for Payer: Kaiser Permanente Commercial	$2,101.50
Rate for Payer: MDX Hawaii PPO	$2,264.95
Rate for Payer: University Health Alliance Commercial	$1,307.60

PLATE 2.3X1.5MM 5HOLE 57-15324

Facility

$2,335.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$723.85
Max. Negotiated Rate	$2,264.95
Rate for Payer: AlohaCare Medicaid	$1,167.50
Rate for Payer: AlohaCare Medicare	$723.85
Rate for Payer: Cash Price	$1,401.00
Rate for Payer: Devoted Health Medicare	$793.90
Rate for Payer: Hawaii Medical Service Association Medicare	$723.85
Rate for Payer: Hawaii Western Management Group Commercial	$1,634.50
Rate for Payer: Health Management Network Commercial	$1,984.75
Rate for Payer: Humana Medicare	$723.85
Rate for Payer: Kaiser Permanente Commercial	$2,101.50
Rate for Payer: Kaiser Permanente Medicaid	$1,190.85
Rate for Payer: Kaiser Permanente Medicare	$723.85
Rate for Payer: MDX Hawaii PPO	$2,264.95
Rate for Payer: Ohana Health Plan Medicaid	$723.85
Rate for Payer: Ohana Health Plan Medicare	$723.85
Rate for Payer: UnitedHealthcare Medicare	$723.85
Rate for Payer: University Health Alliance Commercial	$1,307.60

PLATE 2.4 CONDYLAR 249.679

Facility

$2,064.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$639.84
Max. Negotiated Rate	$2,002.08
Rate for Payer: AlohaCare Medicaid	$1,032.00
Rate for Payer: AlohaCare Medicare	$639.84
Rate for Payer: Cash Price	$1,238.40
Rate for Payer: Devoted Health Medicare	$701.76
Rate for Payer: Hawaii Medical Service Association Medicare	$639.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,444.80
Rate for Payer: Health Management Network Commercial	$1,754.40
Rate for Payer: Humana Medicare	$639.84
Rate for Payer: Kaiser Permanente Commercial	$1,857.60
Rate for Payer: Kaiser Permanente Medicaid	$1,052.64
Rate for Payer: Kaiser Permanente Medicare	$639.84
Rate for Payer: MDX Hawaii PPO	$2,002.08
Rate for Payer: Ohana Health Plan Medicaid	$639.84
Rate for Payer: Ohana Health Plan Medicare	$639.84
Rate for Payer: UnitedHealthcare Medicare	$639.84
Rate for Payer: University Health Alliance Commercial	$1,155.84

PLATE 2.4 CONDYLAR 249.679

Facility

$2,064.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.84
Max. Negotiated Rate	$2,002.08
Rate for Payer: Cash Price	$1,238.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,444.80
Rate for Payer: Health Management Network Commercial	$1,754.40
Rate for Payer: Kaiser Permanente Commercial	$1,857.60
Rate for Payer: MDX Hawaii PPO	$2,002.08
Rate for Payer: University Health Alliance Commercial	$1,155.84

PLATE 2.4 LCP 10H 84MM 247.364

Facility

$1,604.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$497.24
Max. Negotiated Rate	$1,555.88
Rate for Payer: AlohaCare Medicaid	$802.00
Rate for Payer: AlohaCare Medicare	$497.24
Rate for Payer: Cash Price	$962.40
Rate for Payer: Devoted Health Medicare	$545.36
Rate for Payer: Hawaii Medical Service Association Medicare	$497.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,122.80
Rate for Payer: Health Management Network Commercial	$1,363.40
Rate for Payer: Humana Medicare	$497.24
Rate for Payer: Kaiser Permanente Commercial	$1,443.60
Rate for Payer: Kaiser Permanente Medicaid	$818.04
Rate for Payer: Kaiser Permanente Medicare	$497.24
Rate for Payer: MDX Hawaii PPO	$1,555.88
Rate for Payer: Ohana Health Plan Medicaid	$497.24
Rate for Payer: Ohana Health Plan Medicare	$497.24
Rate for Payer: UnitedHealthcare Medicare	$497.24
Rate for Payer: University Health Alliance Commercial	$898.24

PLATE 2.4 LCP 10H 84MM 247.364

Facility

$1,604.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$898.24
Max. Negotiated Rate	$1,555.88
Rate for Payer: Cash Price	$962.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,122.80
Rate for Payer: Health Management Network Commercial	$1,363.40
Rate for Payer: Kaiser Permanente Commercial	$1,443.60
Rate for Payer: MDX Hawaii PPO	$1,555.88
Rate for Payer: University Health Alliance Commercial	$898.24

PLATE 2.4 LCP 12H 88MM 247.366

Facility

$1,602.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$496.62
Max. Negotiated Rate	$1,553.94
Rate for Payer: AlohaCare Medicaid	$801.00
Rate for Payer: AlohaCare Medicare	$496.62
Rate for Payer: Cash Price	$961.20
Rate for Payer: Devoted Health Medicare	$544.68
Rate for Payer: Hawaii Medical Service Association Medicare	$496.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,121.40
Rate for Payer: Health Management Network Commercial	$1,361.70
Rate for Payer: Humana Medicare	$496.62
Rate for Payer: Kaiser Permanente Commercial	$1,441.80
Rate for Payer: Kaiser Permanente Medicaid	$817.02
Rate for Payer: Kaiser Permanente Medicare	$496.62
Rate for Payer: MDX Hawaii PPO	$1,553.94
Rate for Payer: Ohana Health Plan Medicaid	$496.62
Rate for Payer: Ohana Health Plan Medicare	$496.62
Rate for Payer: UnitedHealthcare Medicare	$496.62
Rate for Payer: University Health Alliance Commercial	$897.12

PLATE 2.4 LCP 12H 88MM 247.366

Facility

$1,602.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$897.12
Max. Negotiated Rate	$1,553.94
Rate for Payer: Cash Price	$961.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,121.40
Rate for Payer: Health Management Network Commercial	$1,361.70
Rate for Payer: Kaiser Permanente Commercial	$1,441.80
Rate for Payer: MDX Hawaii PPO	$1,553.94
Rate for Payer: University Health Alliance Commercial	$897.12

PLATE 2.4 LCP 4 HOLE 249.674

Facility

$1,604.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$898.24
Max. Negotiated Rate	$1,555.88
Rate for Payer: Cash Price	$962.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,122.80
Rate for Payer: Health Management Network Commercial	$1,363.40
Rate for Payer: Kaiser Permanente Commercial	$1,443.60
Rate for Payer: MDX Hawaii PPO	$1,555.88
Rate for Payer: University Health Alliance Commercial	$898.24

PLATE 2.4 LCP 4 HOLE 249.674

Facility

$1,604.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$497.24
Max. Negotiated Rate	$1,555.88
Rate for Payer: AlohaCare Medicaid	$802.00
Rate for Payer: AlohaCare Medicare	$497.24
Rate for Payer: Cash Price	$962.40
Rate for Payer: Devoted Health Medicare	$545.36
Rate for Payer: Hawaii Medical Service Association Medicare	$497.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,122.80
Rate for Payer: Health Management Network Commercial	$1,363.40
Rate for Payer: Humana Medicare	$497.24
Rate for Payer: Kaiser Permanente Commercial	$1,443.60
Rate for Payer: Kaiser Permanente Medicaid	$818.04
Rate for Payer: Kaiser Permanente Medicare	$497.24
Rate for Payer: MDX Hawaii PPO	$1,555.88
Rate for Payer: Ohana Health Plan Medicaid	$497.24
Rate for Payer: Ohana Health Plan Medicare	$497.24
Rate for Payer: UnitedHealthcare Medicare	$497.24
Rate for Payer: University Health Alliance Commercial	$898.24

PLATE 2.4 LCP 5H 40MM 247.375

Facility

$1,604.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$898.24
Max. Negotiated Rate	$1,555.88
Rate for Payer: Cash Price	$962.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,122.80
Rate for Payer: Health Management Network Commercial	$1,363.40
Rate for Payer: Kaiser Permanente Commercial	$1,443.60
Rate for Payer: MDX Hawaii PPO	$1,555.88
Rate for Payer: University Health Alliance Commercial	$898.24

PLATE 2.4 LCP 5H 40MM 247.375

Facility

$1,604.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$497.24
Max. Negotiated Rate	$1,555.88
Rate for Payer: AlohaCare Medicaid	$802.00
Rate for Payer: AlohaCare Medicare	$497.24
Rate for Payer: Cash Price	$962.40
Rate for Payer: Devoted Health Medicare	$545.36
Rate for Payer: Hawaii Medical Service Association Medicare	$497.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,122.80
Rate for Payer: Health Management Network Commercial	$1,363.40
Rate for Payer: Humana Medicare	$497.24
Rate for Payer: Kaiser Permanente Commercial	$1,443.60
Rate for Payer: Kaiser Permanente Medicaid	$818.04
Rate for Payer: Kaiser Permanente Medicare	$497.24
Rate for Payer: MDX Hawaii PPO	$1,555.88
Rate for Payer: Ohana Health Plan Medicaid	$497.24
Rate for Payer: Ohana Health Plan Medicare	$497.24
Rate for Payer: UnitedHealthcare Medicare	$497.24
Rate for Payer: University Health Alliance Commercial	$898.24

PLATE 2.4 LCP 6 HOLE 249.676

Facility

$1,604.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$898.24
Max. Negotiated Rate	$1,555.88
Rate for Payer: Cash Price	$962.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,122.80
Rate for Payer: Health Management Network Commercial	$1,363.40
Rate for Payer: Kaiser Permanente Commercial	$1,443.60
Rate for Payer: MDX Hawaii PPO	$1,555.88
Rate for Payer: University Health Alliance Commercial	$898.24

Know your out-of-pocket cost for care.

All Charges