Kau Hospital

All Charges

Charge

Type

Setting

Price

PLATE BONE LCK LF 02.117.504

Facility

$2,749.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$852.19
Max. Negotiated Rate	$2,666.53
Rate for Payer: AlohaCare Medicaid	$1,374.50
Rate for Payer: AlohaCare Medicare	$852.19
Rate for Payer: Cash Price	$1,649.40
Rate for Payer: Devoted Health Medicare	$934.66
Rate for Payer: Hawaii Medical Service Association Medicare	$852.19
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.30
Rate for Payer: Health Management Network Commercial	$2,336.65
Rate for Payer: Humana Medicare	$852.19
Rate for Payer: Kaiser Permanente Commercial	$2,474.10
Rate for Payer: Kaiser Permanente Medicaid	$1,401.99
Rate for Payer: Kaiser Permanente Medicare	$852.19
Rate for Payer: MDX Hawaii PPO	$2,666.53
Rate for Payer: Ohana Health Plan Medicaid	$852.19
Rate for Payer: Ohana Health Plan Medicare	$852.19
Rate for Payer: UnitedHealthcare Medicare	$852.19
Rate for Payer: University Health Alliance Commercial	$1,539.44

PLATE BONE LCK LF 02.117.504

Facility

$2,749.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,539.44
Max. Negotiated Rate	$2,666.53
Rate for Payer: Cash Price	$1,649.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.30
Rate for Payer: Health Management Network Commercial	$2,336.65
Rate for Payer: Kaiser Permanente Commercial	$2,474.10
Rate for Payer: MDX Hawaii PPO	$2,666.53
Rate for Payer: University Health Alliance Commercial	$1,539.44

PLATE BONE LCK RT 02.117.606

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 BONE LCK RT 02.117.606

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 BONE LCK T-SHP 247.351

Facility

$1,627.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$911.12
Max. Negotiated Rate	$1,578.19
Rate for Payer: Cash Price	$976.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,138.90
Rate for Payer: Health Management Network Commercial	$1,382.95
Rate for Payer: Kaiser Permanente Commercial	$1,464.30
Rate for Payer: MDX Hawaii PPO	$1,578.19
Rate for Payer: University Health Alliance Commercial	$911.12

PLATE BONE LCK T-SHP 247.351

Facility

$1,627.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$504.37
Max. Negotiated Rate	$1,578.19
Rate for Payer: AlohaCare Medicaid	$813.50
Rate for Payer: AlohaCare Medicare	$504.37
Rate for Payer: Cash Price	$976.20
Rate for Payer: Devoted Health Medicare	$553.18
Rate for Payer: Hawaii Medical Service Association Medicare	$504.37
Rate for Payer: Hawaii Western Management Group Commercial	$1,138.90
Rate for Payer: Health Management Network Commercial	$1,382.95
Rate for Payer: Humana Medicare	$504.37
Rate for Payer: Kaiser Permanente Commercial	$1,464.30
Rate for Payer: Kaiser Permanente Medicaid	$829.77
Rate for Payer: Kaiser Permanente Medicare	$504.37
Rate for Payer: MDX Hawaii PPO	$1,578.19
Rate for Payer: Ohana Health Plan Medicaid	$504.37
Rate for Payer: Ohana Health Plan Medicare	$504.37
Rate for Payer: UnitedHealthcare Medicare	$504.37
Rate for Payer: University Health Alliance Commercial	$911.12

PLATE BONE UNI 7HOLE 482.823

Facility

$1,611.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$499.41
Max. Negotiated Rate	$1,562.67
Rate for Payer: AlohaCare Medicaid	$805.50
Rate for Payer: AlohaCare Medicare	$499.41
Rate for Payer: Cash Price	$966.60
Rate for Payer: Devoted Health Medicare	$547.74
Rate for Payer: Hawaii Medical Service Association Medicare	$499.41
Rate for Payer: Hawaii Western Management Group Commercial	$1,127.70
Rate for Payer: Health Management Network Commercial	$1,369.35
Rate for Payer: Humana Medicare	$499.41
Rate for Payer: Kaiser Permanente Commercial	$1,449.90
Rate for Payer: Kaiser Permanente Medicaid	$821.61
Rate for Payer: Kaiser Permanente Medicare	$499.41
Rate for Payer: MDX Hawaii PPO	$1,562.67
Rate for Payer: Ohana Health Plan Medicaid	$499.41
Rate for Payer: Ohana Health Plan Medicare	$499.41
Rate for Payer: UnitedHealthcare Medicare	$499.41
Rate for Payer: University Health Alliance Commercial	$902.16

PLATE BONE UNI 7HOLE 482.823

Facility

$1,611.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$902.16
Max. Negotiated Rate	$1,562.67
Rate for Payer: Cash Price	$966.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,127.70
Rate for Payer: Health Management Network Commercial	$1,369.35
Rate for Payer: Kaiser Permanente Commercial	$1,449.90
Rate for Payer: MDX Hawaii PPO	$1,562.67
Rate for Payer: University Health Alliance Commercial	$902.16

PLATE BROAD 8H 629748

Facility

$2,446.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,369.76
Max. Negotiated Rate	$2,372.62
Rate for Payer: Cash Price	$1,467.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,712.20
Rate for Payer: Health Management Network Commercial	$2,079.10
Rate for Payer: Kaiser Permanente Commercial	$2,201.40
Rate for Payer: MDX Hawaii PPO	$2,372.62
Rate for Payer: University Health Alliance Commercial	$1,369.76

PLATE BROAD 8H 629748

Facility

$2,446.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$758.26
Max. Negotiated Rate	$2,372.62
Rate for Payer: AlohaCare Medicaid	$1,223.00
Rate for Payer: AlohaCare Medicare	$758.26
Rate for Payer: Cash Price	$1,467.60
Rate for Payer: Devoted Health Medicare	$831.64
Rate for Payer: Hawaii Medical Service Association Medicare	$758.26
Rate for Payer: Hawaii Western Management Group Commercial	$1,712.20
Rate for Payer: Health Management Network Commercial	$2,079.10
Rate for Payer: Humana Medicare	$758.26
Rate for Payer: Kaiser Permanente Commercial	$2,201.40
Rate for Payer: Kaiser Permanente Medicaid	$1,247.46
Rate for Payer: Kaiser Permanente Medicare	$758.26
Rate for Payer: MDX Hawaii PPO	$2,372.62
Rate for Payer: Ohana Health Plan Medicaid	$758.26
Rate for Payer: Ohana Health Plan Medicare	$758.26
Rate for Payer: UnitedHealthcare Medicare	$758.26
Rate for Payer: University Health Alliance Commercial	$1,369.76

PLATE BUTT-L RT 4H 86MM 240.54

Facility

$1,506.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$466.86
Max. Negotiated Rate	$1,460.82
Rate for Payer: AlohaCare Medicaid	$753.00
Rate for Payer: AlohaCare Medicare	$466.86
Rate for Payer: Cash Price	$903.60
Rate for Payer: Devoted Health Medicare	$512.04
Rate for Payer: Hawaii Medical Service Association Medicare	$466.86
Rate for Payer: Hawaii Western Management Group Commercial	$1,054.20
Rate for Payer: Health Management Network Commercial	$1,280.10
Rate for Payer: Humana Medicare	$466.86
Rate for Payer: Kaiser Permanente Commercial	$1,355.40
Rate for Payer: Kaiser Permanente Medicaid	$768.06
Rate for Payer: Kaiser Permanente Medicare	$466.86
Rate for Payer: MDX Hawaii PPO	$1,460.82
Rate for Payer: Ohana Health Plan Medicaid	$466.86
Rate for Payer: Ohana Health Plan Medicare	$466.86
Rate for Payer: UnitedHealthcare Medicare	$466.86
Rate for Payer: University Health Alliance Commercial	$843.36

PLATE BUTT-L RT 4H 86MM 240.54

Facility

$1,506.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$843.36
Max. Negotiated Rate	$1,460.82
Rate for Payer: Cash Price	$903.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,054.20
Rate for Payer: Health Management Network Commercial	$1,280.10
Rate for Payer: Kaiser Permanente Commercial	$1,355.40
Rate for Payer: MDX Hawaii PPO	$1,460.82
Rate for Payer: University Health Alliance Commercial	$843.36

PLATE BUTTRESS AR-8959TDS

Facility

$13,318.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$7,458.08
Max. Negotiated Rate	$12,918.46
Rate for Payer: Cash Price	$7,990.80
Rate for Payer: Hawaii Western Management Group Commercial	$9,322.60
Rate for Payer: Health Management Network Commercial	$11,320.30
Rate for Payer: Kaiser Permanente Commercial	$11,986.20
Rate for Payer: MDX Hawaii PPO	$12,918.46
Rate for Payer: University Health Alliance Commercial	$7,458.08

PLATE BUTTRESS AR-8959TDS

Facility

$13,318.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$4,128.58
Max. Negotiated Rate	$12,918.46
Rate for Payer: AlohaCare Medicaid	$6,659.00
Rate for Payer: AlohaCare Medicare	$4,128.58
Rate for Payer: Cash Price	$7,990.80
Rate for Payer: Devoted Health Medicare	$4,528.12
Rate for Payer: Hawaii Medical Service Association Medicare	$4,128.58
Rate for Payer: Hawaii Western Management Group Commercial	$9,322.60
Rate for Payer: Health Management Network Commercial	$11,320.30
Rate for Payer: Humana Medicare	$4,128.58
Rate for Payer: Kaiser Permanente Commercial	$11,986.20
Rate for Payer: Kaiser Permanente Medicaid	$6,792.18
Rate for Payer: Kaiser Permanente Medicare	$4,128.58
Rate for Payer: MDX Hawaii PPO	$12,918.46
Rate for Payer: Ohana Health Plan Medicaid	$4,128.58
Rate for Payer: Ohana Health Plan Medicare	$4,128.58
Rate for Payer: UnitedHealthcare Medicare	$4,128.58
Rate for Payer: University Health Alliance Commercial	$7,458.08

PLATE BUTTRES-T 4H 80MM 240.34

Facility

$2,094.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$649.14
Max. Negotiated Rate	$2,031.18
Rate for Payer: AlohaCare Medicaid	$1,047.00
Rate for Payer: AlohaCare Medicare	$649.14
Rate for Payer: Cash Price	$1,256.40
Rate for Payer: Devoted Health Medicare	$711.96
Rate for Payer: Hawaii Medical Service Association Medicare	$649.14
Rate for Payer: Hawaii Western Management Group Commercial	$1,465.80
Rate for Payer: Health Management Network Commercial	$1,779.90
Rate for Payer: Humana Medicare	$649.14
Rate for Payer: Kaiser Permanente Commercial	$1,884.60
Rate for Payer: Kaiser Permanente Medicaid	$1,067.94
Rate for Payer: Kaiser Permanente Medicare	$649.14
Rate for Payer: MDX Hawaii PPO	$2,031.18
Rate for Payer: Ohana Health Plan Medicaid	$649.14
Rate for Payer: Ohana Health Plan Medicare	$649.14
Rate for Payer: UnitedHealthcare Medicare	$649.14
Rate for Payer: University Health Alliance Commercial	$1,172.64

PLATE BUTTRES-T 4H 80MM 240.34

Facility

$2,094.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,172.64
Max. Negotiated Rate	$2,031.18
Rate for Payer: Cash Price	$1,256.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,465.80
Rate for Payer: Health Management Network Commercial	$1,779.90
Rate for Payer: Kaiser Permanente Commercial	$1,884.60
Rate for Payer: MDX Hawaii PPO	$2,031.18
Rate for Payer: University Health Alliance Commercial	$1,172.64

PLATE BUTTRES-T 5H 96MM 240.35

Facility

$2,202.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,233.12
Max. Negotiated Rate	$2,135.94
Rate for Payer: Cash Price	$1,321.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,541.40
Rate for Payer: Health Management Network Commercial	$1,871.70
Rate for Payer: Kaiser Permanente Commercial	$1,981.80
Rate for Payer: MDX Hawaii PPO	$2,135.94
Rate for Payer: University Health Alliance Commercial	$1,233.12

PLATE BUTTRES-T 5H 96MM 240.35

Facility

$2,202.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$682.62
Max. Negotiated Rate	$2,135.94
Rate for Payer: AlohaCare Medicaid	$1,101.00
Rate for Payer: AlohaCare Medicare	$682.62
Rate for Payer: Cash Price	$1,321.20
Rate for Payer: Devoted Health Medicare	$748.68
Rate for Payer: Hawaii Medical Service Association Medicare	$682.62
Rate for Payer: Hawaii Western Management Group Commercial	$1,541.40
Rate for Payer: Health Management Network Commercial	$1,871.70
Rate for Payer: Humana Medicare	$682.62
Rate for Payer: Kaiser Permanente Commercial	$1,981.80
Rate for Payer: Kaiser Permanente Medicaid	$1,123.02
Rate for Payer: Kaiser Permanente Medicare	$682.62
Rate for Payer: MDX Hawaii PPO	$2,135.94
Rate for Payer: Ohana Health Plan Medicaid	$682.62
Rate for Payer: Ohana Health Plan Medicare	$682.62
Rate for Payer: UnitedHealthcare Medicare	$682.62
Rate for Payer: University Health Alliance Commercial	$1,233.12

PLATE CALCANEAL64MM02.211.403

Facility

$2,296.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,285.76
Max. Negotiated Rate	$2,227.12
Rate for Payer: Cash Price	$1,377.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,607.20
Rate for Payer: Health Management Network Commercial	$1,951.60
Rate for Payer: Kaiser Permanente Commercial	$2,066.40
Rate for Payer: MDX Hawaii PPO	$2,227.12
Rate for Payer: University Health Alliance Commercial	$1,285.76

PLATE CALCANEAL64MM02.211.403

Facility

$2,296.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$711.76
Max. Negotiated Rate	$2,227.12
Rate for Payer: AlohaCare Medicaid	$1,148.00
Rate for Payer: AlohaCare Medicare	$711.76
Rate for Payer: Cash Price	$1,377.60
Rate for Payer: Devoted Health Medicare	$780.64
Rate for Payer: Hawaii Medical Service Association Medicare	$711.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,607.20
Rate for Payer: Health Management Network Commercial	$1,951.60
Rate for Payer: Humana Medicare	$711.76
Rate for Payer: Kaiser Permanente Commercial	$2,066.40
Rate for Payer: Kaiser Permanente Medicaid	$1,170.96
Rate for Payer: Kaiser Permanente Medicare	$711.76
Rate for Payer: MDX Hawaii PPO	$2,227.12
Rate for Payer: Ohana Health Plan Medicaid	$711.76
Rate for Payer: Ohana Health Plan Medicare	$711.76
Rate for Payer: UnitedHealthcare Medicare	$711.76
Rate for Payer: University Health Alliance Commercial	$1,285.76

PLATE CALCANEAL70MM 02.211.404

Facility

$2,313.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$717.03
Max. Negotiated Rate	$2,243.61
Rate for Payer: AlohaCare Medicaid	$1,156.50
Rate for Payer: AlohaCare Medicare	$717.03
Rate for Payer: Cash Price	$1,387.80
Rate for Payer: Devoted Health Medicare	$786.42
Rate for Payer: Hawaii Medical Service Association Medicare	$717.03
Rate for Payer: Hawaii Western Management Group Commercial	$1,619.10
Rate for Payer: Health Management Network Commercial	$1,966.05
Rate for Payer: Humana Medicare	$717.03
Rate for Payer: Kaiser Permanente Commercial	$2,081.70
Rate for Payer: Kaiser Permanente Medicaid	$1,179.63
Rate for Payer: Kaiser Permanente Medicare	$717.03
Rate for Payer: MDX Hawaii PPO	$2,243.61
Rate for Payer: Ohana Health Plan Medicaid	$717.03
Rate for Payer: Ohana Health Plan Medicare	$717.03
Rate for Payer: UnitedHealthcare Medicare	$717.03
Rate for Payer: University Health Alliance Commercial	$1,295.28

PLATE CALCANEAL70MM 02.211.404

Facility

$2,313.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,295.28
Max. Negotiated Rate	$2,243.61
Rate for Payer: Cash Price	$1,387.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,619.10
Rate for Payer: Health Management Network Commercial	$1,966.05
Rate for Payer: Kaiser Permanente Commercial	$2,081.70
Rate for Payer: MDX Hawaii PPO	$2,243.61
Rate for Payer: University Health Alliance Commercial	$1,295.28

PLATE CALC SHORT-LEFT 241.625

Facility

$2,274.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,273.44
Max. Negotiated Rate	$2,205.78
Rate for Payer: Cash Price	$1,364.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,591.80
Rate for Payer: Health Management Network Commercial	$1,932.90
Rate for Payer: Kaiser Permanente Commercial	$2,046.60
Rate for Payer: MDX Hawaii PPO	$2,205.78
Rate for Payer: University Health Alliance Commercial	$1,273.44

PLATE CALC SHORT-LEFT 241.625

Facility

$2,274.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$704.94
Max. Negotiated Rate	$2,205.78
Rate for Payer: AlohaCare Medicaid	$1,137.00
Rate for Payer: AlohaCare Medicare	$704.94
Rate for Payer: Cash Price	$1,364.40
Rate for Payer: Devoted Health Medicare	$773.16
Rate for Payer: Hawaii Medical Service Association Medicare	$704.94
Rate for Payer: Hawaii Western Management Group Commercial	$1,591.80
Rate for Payer: Health Management Network Commercial	$1,932.90
Rate for Payer: Humana Medicare	$704.94
Rate for Payer: Kaiser Permanente Commercial	$2,046.60
Rate for Payer: Kaiser Permanente Medicaid	$1,159.74
Rate for Payer: Kaiser Permanente Medicare	$704.94
Rate for Payer: MDX Hawaii PPO	$2,205.78
Rate for Payer: Ohana Health Plan Medicaid	$704.94
Rate for Payer: Ohana Health Plan Medicare	$704.94
Rate for Payer: UnitedHealthcare Medicare	$704.94
Rate for Payer: University Health Alliance Commercial	$1,273.44

PLATE CENTRAL R SM AR-2652CR

Facility

$2,678.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$830.18
Max. Negotiated Rate	$2,597.66
Rate for Payer: AlohaCare Medicaid	$1,339.00
Rate for Payer: AlohaCare Medicare	$830.18
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Devoted Health Medicare	$910.52
Rate for Payer: Hawaii Medical Service Association Medicare	$830.18
Rate for Payer: Hawaii Western Management Group Commercial	$1,874.60
Rate for Payer: Health Management Network Commercial	$2,276.30
Rate for Payer: Humana Medicare	$830.18
Rate for Payer: Kaiser Permanente Commercial	$2,410.20
Rate for Payer: Kaiser Permanente Medicaid	$1,365.78
Rate for Payer: Kaiser Permanente Medicare	$830.18
Rate for Payer: MDX Hawaii PPO	$2,597.66
Rate for Payer: Ohana Health Plan Medicaid	$830.18
Rate for Payer: Ohana Health Plan Medicare	$830.18
Rate for Payer: UnitedHealthcare Medicare	$830.18
Rate for Payer: University Health Alliance Commercial	$1,499.68

Know your out-of-pocket cost for care.

All Charges