Kau Hospital

All Charges

Charge

Type

Setting

Price

PLATE 2.7 VA-LCK RT 02.211.400

Facility

$2,280.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,276.80
Max. Negotiated Rate	$2,211.60
Rate for Payer: Cash Price	$1,368.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,596.00
Rate for Payer: Health Management Network Commercial	$1,938.00
Rate for Payer: Kaiser Permanente Commercial	$2,052.00
Rate for Payer: MDX Hawaii PPO	$2,211.60
Rate for Payer: University Health Alliance Commercial	$1,276.80

PLATE 2.7 VA-LCK RT 02.211.400

Facility

$2,280.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$706.80
Max. Negotiated Rate	$2,211.60
Rate for Payer: AlohaCare Medicaid	$1,140.00
Rate for Payer: AlohaCare Medicare	$706.80
Rate for Payer: Cash Price	$1,368.00
Rate for Payer: Devoted Health Medicare	$775.20
Rate for Payer: Hawaii Medical Service Association Medicare	$706.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,596.00
Rate for Payer: Health Management Network Commercial	$1,938.00
Rate for Payer: Humana Medicare	$706.80
Rate for Payer: Kaiser Permanente Commercial	$2,052.00
Rate for Payer: Kaiser Permanente Medicaid	$1,162.80
Rate for Payer: Kaiser Permanente Medicare	$706.80
Rate for Payer: MDX Hawaii PPO	$2,211.60
Rate for Payer: Ohana Health Plan Medicaid	$706.80
Rate for Payer: Ohana Health Plan Medicare	$706.80
Rate for Payer: UnitedHealthcare Medicare	$706.80
Rate for Payer: University Health Alliance Commercial	$1,276.80

PLATE 2.7X2MM STEP 336-2722

Facility

$2,667.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$826.77
Max. Negotiated Rate	$2,586.99
Rate for Payer: AlohaCare Medicaid	$1,333.50
Rate for Payer: AlohaCare Medicare	$826.77
Rate for Payer: Cash Price	$1,600.20
Rate for Payer: Devoted Health Medicare	$906.78
Rate for Payer: Hawaii Medical Service Association Medicare	$826.77
Rate for Payer: Hawaii Western Management Group Commercial	$1,866.90
Rate for Payer: Health Management Network Commercial	$2,266.95
Rate for Payer: Humana Medicare	$826.77
Rate for Payer: Kaiser Permanente Commercial	$2,400.30
Rate for Payer: Kaiser Permanente Medicaid	$1,360.17
Rate for Payer: Kaiser Permanente Medicare	$826.77
Rate for Payer: MDX Hawaii PPO	$2,586.99
Rate for Payer: Ohana Health Plan Medicaid	$826.77
Rate for Payer: Ohana Health Plan Medicare	$826.77
Rate for Payer: UnitedHealthcare Medicare	$826.77
Rate for Payer: University Health Alliance Commercial	$1,493.52

PLATE 2.7X2MM STEP 336-2722

Facility

$2,667.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,493.52
Max. Negotiated Rate	$2,586.99
Rate for Payer: Cash Price	$1,600.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,866.90
Rate for Payer: Health Management Network Commercial	$2,266.95
Rate for Payer: Kaiser Permanente Commercial	$2,400.30
Rate for Payer: MDX Hawaii PPO	$2,586.99
Rate for Payer: University Health Alliance Commercial	$1,493.52

PLATE 2H/LT/85MM 02.117.702

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

PLATE 2H/LT/85MM 02.117.702

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

PLATE 2H SYNDESMOS AR-8959-01S

Facility

$2,834.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$878.54
Max. Negotiated Rate	$2,748.98
Rate for Payer: AlohaCare Medicaid	$1,417.00
Rate for Payer: AlohaCare Medicare	$878.54
Rate for Payer: Cash Price	$1,700.40
Rate for Payer: Devoted Health Medicare	$963.56
Rate for Payer: Hawaii Medical Service Association Medicare	$878.54
Rate for Payer: Hawaii Western Management Group Commercial	$1,983.80
Rate for Payer: Health Management Network Commercial	$2,408.90
Rate for Payer: Humana Medicare	$878.54
Rate for Payer: Kaiser Permanente Commercial	$2,550.60
Rate for Payer: Kaiser Permanente Medicaid	$1,445.34
Rate for Payer: Kaiser Permanente Medicare	$878.54
Rate for Payer: MDX Hawaii PPO	$2,748.98
Rate for Payer: Ohana Health Plan Medicaid	$878.54
Rate for Payer: Ohana Health Plan Medicare	$878.54
Rate for Payer: UnitedHealthcare Medicare	$878.54
Rate for Payer: University Health Alliance Commercial	$1,587.04

PLATE 2H SYNDESMOS AR-8959-01S

Facility

$2,834.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,587.04
Max. Negotiated Rate	$2,748.98
Rate for Payer: Cash Price	$1,700.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,983.80
Rate for Payer: Health Management Network Commercial	$2,408.90
Rate for Payer: Kaiser Permanente Commercial	$2,550.60
Rate for Payer: MDX Hawaii PPO	$2,748.98
Rate for Payer: University Health Alliance Commercial	$1,587.04

PLATE 2X2 HOLES

Facility

$668.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$374.08
Max. Negotiated Rate	$647.96
Rate for Payer: Cash Price	$400.80
Rate for Payer: Hawaii Western Management Group Commercial	$467.60
Rate for Payer: Health Management Network Commercial	$567.80
Rate for Payer: Kaiser Permanente Commercial	$601.20
Rate for Payer: MDX Hawaii PPO	$647.96
Rate for Payer: University Health Alliance Commercial	$374.08

PLATE 2X2 HOLES

Facility

$668.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$207.08
Max. Negotiated Rate	$647.96
Rate for Payer: AlohaCare Medicaid	$334.00
Rate for Payer: AlohaCare Medicare	$207.08
Rate for Payer: Cash Price	$400.80
Rate for Payer: Devoted Health Medicare	$227.12
Rate for Payer: Hawaii Medical Service Association Medicare	$207.08
Rate for Payer: Hawaii Western Management Group Commercial	$467.60
Rate for Payer: Health Management Network Commercial	$567.80
Rate for Payer: Humana Medicare	$207.08
Rate for Payer: Kaiser Permanente Commercial	$601.20
Rate for Payer: Kaiser Permanente Medicaid	$340.68
Rate for Payer: Kaiser Permanente Medicare	$207.08
Rate for Payer: MDX Hawaii PPO	$647.96
Rate for Payer: Ohana Health Plan Medicaid	$207.08
Rate for Payer: Ohana Health Plan Medicare	$207.08
Rate for Payer: UnitedHealthcare Medicare	$207.08
Rate for Payer: University Health Alliance Commercial	$374.08

PLATE 3.2MM CLAV HOOK 241.073S

Facility

$2,937.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$910.47
Max. Negotiated Rate	$2,848.89
Rate for Payer: AlohaCare Medicaid	$1,468.50
Rate for Payer: AlohaCare Medicare	$910.47
Rate for Payer: Cash Price	$1,762.20
Rate for Payer: Devoted Health Medicare	$998.58
Rate for Payer: Hawaii Medical Service Association Medicare	$910.47
Rate for Payer: Hawaii Western Management Group Commercial	$2,055.90
Rate for Payer: Health Management Network Commercial	$2,496.45
Rate for Payer: Humana Medicare	$910.47
Rate for Payer: Kaiser Permanente Commercial	$2,643.30
Rate for Payer: Kaiser Permanente Medicaid	$1,497.87
Rate for Payer: Kaiser Permanente Medicare	$910.47
Rate for Payer: MDX Hawaii PPO	$2,848.89
Rate for Payer: Ohana Health Plan Medicaid	$910.47
Rate for Payer: Ohana Health Plan Medicare	$910.47
Rate for Payer: UnitedHealthcare Medicare	$910.47
Rate for Payer: University Health Alliance Commercial	$1,644.72

PLATE 3.2MM CLAV HOOK 241.073S

Facility

$2,937.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,644.72
Max. Negotiated Rate	$2,848.89
Rate for Payer: Cash Price	$1,762.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,055.90
Rate for Payer: Health Management Network Commercial	$2,496.45
Rate for Payer: Kaiser Permanente Commercial	$2,643.30
Rate for Payer: MDX Hawaii PPO	$2,848.89
Rate for Payer: University Health Alliance Commercial	$1,644.72

PLATE 3.5 4-HOLE/51MM 223.54

Facility

$1,246.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$697.76
Max. Negotiated Rate	$1,208.62
Rate for Payer: Cash Price	$747.60
Rate for Payer: Hawaii Western Management Group Commercial	$872.20
Rate for Payer: Health Management Network Commercial	$1,059.10
Rate for Payer: Kaiser Permanente Commercial	$1,121.40
Rate for Payer: MDX Hawaii PPO	$1,208.62
Rate for Payer: University Health Alliance Commercial	$697.76

PLATE 3.5 4-HOLE/51MM 223.54

Facility

$1,246.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$386.26
Max. Negotiated Rate	$1,208.62
Rate for Payer: AlohaCare Medicaid	$623.00
Rate for Payer: AlohaCare Medicare	$386.26
Rate for Payer: Cash Price	$747.60
Rate for Payer: Devoted Health Medicare	$423.64
Rate for Payer: Hawaii Medical Service Association Medicare	$386.26
Rate for Payer: Hawaii Western Management Group Commercial	$872.20
Rate for Payer: Health Management Network Commercial	$1,059.10
Rate for Payer: Humana Medicare	$386.26
Rate for Payer: Kaiser Permanente Commercial	$1,121.40
Rate for Payer: Kaiser Permanente Medicaid	$635.46
Rate for Payer: Kaiser Permanente Medicare	$386.26
Rate for Payer: MDX Hawaii PPO	$1,208.62
Rate for Payer: Ohana Health Plan Medicaid	$386.26
Rate for Payer: Ohana Health Plan Medicare	$386.26
Rate for Payer: UnitedHealthcare Medicare	$386.26
Rate for Payer: University Health Alliance Commercial	$697.76

PLATE 3.5 5-HOLE/64MM 223.55

Facility

$1,285.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$398.35
Max. Negotiated Rate	$1,246.45
Rate for Payer: AlohaCare Medicaid	$642.50
Rate for Payer: AlohaCare Medicare	$398.35
Rate for Payer: Cash Price	$771.00
Rate for Payer: Devoted Health Medicare	$436.90
Rate for Payer: Hawaii Medical Service Association Medicare	$398.35
Rate for Payer: Hawaii Western Management Group Commercial	$899.50
Rate for Payer: Health Management Network Commercial	$1,092.25
Rate for Payer: Humana Medicare	$398.35
Rate for Payer: Kaiser Permanente Commercial	$1,156.50
Rate for Payer: Kaiser Permanente Medicaid	$655.35
Rate for Payer: Kaiser Permanente Medicare	$398.35
Rate for Payer: MDX Hawaii PPO	$1,246.45
Rate for Payer: Ohana Health Plan Medicaid	$398.35
Rate for Payer: Ohana Health Plan Medicare	$398.35
Rate for Payer: UnitedHealthcare Medicare	$398.35
Rate for Payer: University Health Alliance Commercial	$719.60

PLATE 3.5 5-HOLE/64MM 223.55

Facility

$1,285.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$719.60
Max. Negotiated Rate	$1,246.45
Rate for Payer: Cash Price	$771.00
Rate for Payer: Hawaii Western Management Group Commercial	$899.50
Rate for Payer: Health Management Network Commercial	$1,092.25
Rate for Payer: Kaiser Permanente Commercial	$1,156.50
Rate for Payer: MDX Hawaii PPO	$1,246.45
Rate for Payer: University Health Alliance Commercial	$719.60

PLATE 3.5 7-HOLE/90MM 223.57

Facility

$1,422.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$440.82
Max. Negotiated Rate	$1,379.34
Rate for Payer: AlohaCare Medicaid	$711.00
Rate for Payer: AlohaCare Medicare	$440.82
Rate for Payer: Cash Price	$853.20
Rate for Payer: Devoted Health Medicare	$483.48
Rate for Payer: Hawaii Medical Service Association Medicare	$440.82
Rate for Payer: Hawaii Western Management Group Commercial	$995.40
Rate for Payer: Health Management Network Commercial	$1,208.70
Rate for Payer: Humana Medicare	$440.82
Rate for Payer: Kaiser Permanente Commercial	$1,279.80
Rate for Payer: Kaiser Permanente Medicaid	$725.22
Rate for Payer: Kaiser Permanente Medicare	$440.82
Rate for Payer: MDX Hawaii PPO	$1,379.34
Rate for Payer: Ohana Health Plan Medicaid	$440.82
Rate for Payer: Ohana Health Plan Medicare	$440.82
Rate for Payer: UnitedHealthcare Medicare	$440.82
Rate for Payer: University Health Alliance Commercial	$796.32

PLATE 3.5 7-HOLE/90MM 223.57

Facility

$1,422.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$796.32
Max. Negotiated Rate	$1,379.34
Rate for Payer: Cash Price	$853.20
Rate for Payer: Hawaii Western Management Group Commercial	$995.40
Rate for Payer: Health Management Network Commercial	$1,208.70
Rate for Payer: Kaiser Permanente Commercial	$1,279.80
Rate for Payer: MDX Hawaii PPO	$1,379.34
Rate for Payer: University Health Alliance Commercial	$796.32

PLATE 3.5 LCP 2H 02.120.702S

Facility

$2,414.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$748.34
Max. Negotiated Rate	$2,341.58
Rate for Payer: AlohaCare Medicaid	$1,207.00
Rate for Payer: AlohaCare Medicare	$748.34
Rate for Payer: Cash Price	$1,448.40
Rate for Payer: Devoted Health Medicare	$820.76
Rate for Payer: Hawaii Medical Service Association Medicare	$748.34
Rate for Payer: Hawaii Western Management Group Commercial	$1,689.80
Rate for Payer: Health Management Network Commercial	$2,051.90
Rate for Payer: Humana Medicare	$748.34
Rate for Payer: Kaiser Permanente Commercial	$2,172.60
Rate for Payer: Kaiser Permanente Medicaid	$1,231.14
Rate for Payer: Kaiser Permanente Medicare	$748.34
Rate for Payer: MDX Hawaii PPO	$2,341.58
Rate for Payer: Ohana Health Plan Medicaid	$748.34
Rate for Payer: Ohana Health Plan Medicare	$748.34
Rate for Payer: UnitedHealthcare Medicare	$748.34
Rate for Payer: University Health Alliance Commercial	$1,351.84

PLATE 3.5 LCP 2H 02.120.702S

Facility

$2,414.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.84
Max. Negotiated Rate	$2,341.58
Rate for Payer: Cash Price	$1,448.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,689.80
Rate for Payer: Health Management Network Commercial	$2,051.90
Rate for Payer: Kaiser Permanente Commercial	$2,172.60
Rate for Payer: MDX Hawaii PPO	$2,341.58
Rate for Payer: University Health Alliance Commercial	$1,351.84

PLATE 3.5 LF 4 HOLE 02.110.107

Facility

$3,709.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,077.04
Max. Negotiated Rate	$3,597.73
Rate for Payer: Cash Price	$2,225.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,596.30
Rate for Payer: Health Management Network Commercial	$3,152.65
Rate for Payer: Kaiser Permanente Commercial	$3,338.10
Rate for Payer: MDX Hawaii PPO	$3,597.73
Rate for Payer: University Health Alliance Commercial	$2,077.04

PLATE 3.5 LF 4 HOLE 02.110.107

Facility

$3,709.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,149.79
Max. Negotiated Rate	$3,597.73
Rate for Payer: AlohaCare Medicaid	$1,854.50
Rate for Payer: AlohaCare Medicare	$1,149.79
Rate for Payer: Cash Price	$2,225.40
Rate for Payer: Devoted Health Medicare	$1,261.06
Rate for Payer: Hawaii Medical Service Association Medicare	$1,149.79
Rate for Payer: Hawaii Western Management Group Commercial	$2,596.30
Rate for Payer: Health Management Network Commercial	$3,152.65
Rate for Payer: Humana Medicare	$1,149.79
Rate for Payer: Kaiser Permanente Commercial	$3,338.10
Rate for Payer: Kaiser Permanente Medicaid	$1,891.59
Rate for Payer: Kaiser Permanente Medicare	$1,149.79
Rate for Payer: MDX Hawaii PPO	$3,597.73
Rate for Payer: Ohana Health Plan Medicaid	$1,149.79
Rate for Payer: Ohana Health Plan Medicare	$1,149.79
Rate for Payer: UnitedHealthcare Medicare	$1,149.79
Rate for Payer: University Health Alliance Commercial	$2,077.04

PLATE 3.5MM 10HL/194MM 239.913

Facility

$3,066.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,716.96
Max. Negotiated Rate	$2,974.02
Rate for Payer: Cash Price	$1,839.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,146.20
Rate for Payer: Health Management Network Commercial	$2,606.10
Rate for Payer: Kaiser Permanente Commercial	$2,759.40
Rate for Payer: MDX Hawaii PPO	$2,974.02
Rate for Payer: University Health Alliance Commercial	$1,716.96

PLATE 3.5MM 10HL/194MM 239.913

Facility

$3,066.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$950.46
Max. Negotiated Rate	$2,974.02
Rate for Payer: AlohaCare Medicaid	$1,533.00
Rate for Payer: AlohaCare Medicare	$950.46
Rate for Payer: Cash Price	$1,839.60
Rate for Payer: Devoted Health Medicare	$1,042.44
Rate for Payer: Hawaii Medical Service Association Medicare	$950.46
Rate for Payer: Hawaii Western Management Group Commercial	$2,146.20
Rate for Payer: Health Management Network Commercial	$2,606.10
Rate for Payer: Humana Medicare	$950.46
Rate for Payer: Kaiser Permanente Commercial	$2,759.40
Rate for Payer: Kaiser Permanente Medicaid	$1,563.66
Rate for Payer: Kaiser Permanente Medicare	$950.46
Rate for Payer: MDX Hawaii PPO	$2,974.02
Rate for Payer: Ohana Health Plan Medicaid	$950.46
Rate for Payer: Ohana Health Plan Medicare	$950.46
Rate for Payer: UnitedHealthcare Medicare	$950.46
Rate for Payer: University Health Alliance Commercial	$1,716.96

PLATE 3.5MM 10HL/195MM 239.912

Facility

$3,066.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,716.96
Max. Negotiated Rate	$2,974.02
Rate for Payer: Cash Price	$1,839.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,146.20
Rate for Payer: Health Management Network Commercial	$2,606.10
Rate for Payer: Kaiser Permanente Commercial	$2,759.40
Rate for Payer: MDX Hawaii PPO	$2,974.02
Rate for Payer: University Health Alliance Commercial	$1,716.96

Know your out-of-pocket cost for care.

All Charges