Kau Hospital

All Charges

Charge

Type

Setting

Price

PLATE DVR LF 131821040

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.28
Max. Negotiated Rate	$2,825.61
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE DVR NARROW LF 131821050

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$903.03
Max. Negotiated Rate	$2,825.61
Rate for Payer: AlohaCare Medicaid	$1,456.50
Rate for Payer: AlohaCare Medicare	$903.03
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Devoted Health Medicare	$990.42
Rate for Payer: Hawaii Medical Service Association Medicare	$903.03
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Humana Medicare	$903.03
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: Kaiser Permanente Medicaid	$1,485.63
Rate for Payer: Kaiser Permanente Medicare	$903.03
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: Ohana Health Plan Medicaid	$903.03
Rate for Payer: Ohana Health Plan Medicare	$903.03
Rate for Payer: UnitedHealthcare Medicare	$903.03
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE DVR NARROW LF 131821050

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.28
Max. Negotiated Rate	$2,825.61
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE DVR SHORT RT DVRANSR

Facility

$2,235.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$692.85
Max. Negotiated Rate	$2,167.95
Rate for Payer: AlohaCare Medicaid	$1,117.50
Rate for Payer: AlohaCare Medicare	$692.85
Rate for Payer: Cash Price	$1,341.00
Rate for Payer: Devoted Health Medicare	$759.90
Rate for Payer: Hawaii Medical Service Association Medicare	$692.85
Rate for Payer: Hawaii Western Management Group Commercial	$1,564.50
Rate for Payer: Health Management Network Commercial	$1,899.75
Rate for Payer: Humana Medicare	$692.85
Rate for Payer: Kaiser Permanente Commercial	$2,011.50
Rate for Payer: Kaiser Permanente Medicaid	$1,139.85
Rate for Payer: Kaiser Permanente Medicare	$692.85
Rate for Payer: MDX Hawaii PPO	$2,167.95
Rate for Payer: Ohana Health Plan Medicaid	$692.85
Rate for Payer: Ohana Health Plan Medicare	$692.85
Rate for Payer: UnitedHealthcare Medicare	$692.85
Rate for Payer: University Health Alliance Commercial	$1,251.60

PLATE DVR SHORT RT DVRANSR

Facility

$2,235.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,251.60
Max. Negotiated Rate	$2,167.95
Rate for Payer: Cash Price	$1,341.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,564.50
Rate for Payer: Health Management Network Commercial	$1,899.75
Rate for Payer: Kaiser Permanente Commercial	$2,011.50
Rate for Payer: MDX Hawaii PPO	$2,167.95
Rate for Payer: University Health Alliance Commercial	$1,251.60

PLATE DVR XLCK LF 131822090

Facility

$5,160.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,599.60
Max. Negotiated Rate	$5,005.20
Rate for Payer: AlohaCare Medicaid	$2,580.00
Rate for Payer: AlohaCare Medicare	$1,599.60
Rate for Payer: Cash Price	$3,096.00
Rate for Payer: Devoted Health Medicare	$1,754.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,599.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,612.00
Rate for Payer: Health Management Network Commercial	$4,386.00
Rate for Payer: Humana Medicare	$1,599.60
Rate for Payer: Kaiser Permanente Commercial	$4,644.00
Rate for Payer: Kaiser Permanente Medicaid	$2,631.60
Rate for Payer: Kaiser Permanente Medicare	$1,599.60
Rate for Payer: MDX Hawaii PPO	$5,005.20
Rate for Payer: Ohana Health Plan Medicaid	$1,599.60
Rate for Payer: Ohana Health Plan Medicare	$1,599.60
Rate for Payer: UnitedHealthcare Medicare	$1,599.60
Rate for Payer: University Health Alliance Commercial	$2,889.60

PLATE DVR XLCK LF 131822090

Facility

$5,160.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,889.60
Max. Negotiated Rate	$5,005.20
Rate for Payer: Cash Price	$3,096.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,612.00
Rate for Payer: Health Management Network Commercial	$4,386.00
Rate for Payer: Kaiser Permanente Commercial	$4,644.00
Rate for Payer: MDX Hawaii PPO	$5,005.20
Rate for Payer: University Health Alliance Commercial	$2,889.60

PLATE DVR XLCK NARR 131811040

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$903.03
Max. Negotiated Rate	$2,825.61
Rate for Payer: AlohaCare Medicaid	$1,456.50
Rate for Payer: AlohaCare Medicare	$903.03
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Devoted Health Medicare	$990.42
Rate for Payer: Hawaii Medical Service Association Medicare	$903.03
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Humana Medicare	$903.03
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: Kaiser Permanente Medicaid	$1,485.63
Rate for Payer: Kaiser Permanente Medicare	$903.03
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: Ohana Health Plan Medicaid	$903.03
Rate for Payer: Ohana Health Plan Medicare	$903.03
Rate for Payer: UnitedHealthcare Medicare	$903.03
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE DVR XLCK NARR 131811040

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.28
Max. Negotiated Rate	$2,825.61
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE DVR XLCK RT 131812050

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.28
Max. Negotiated Rate	$2,825.61
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE DVR XLCK RT 131812050

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$903.03
Max. Negotiated Rate	$2,825.61
Rate for Payer: AlohaCare Medicaid	$1,456.50
Rate for Payer: AlohaCare Medicare	$903.03
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Devoted Health Medicare	$990.42
Rate for Payer: Hawaii Medical Service Association Medicare	$903.03
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Humana Medicare	$903.03
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: Kaiser Permanente Medicaid	$1,485.63
Rate for Payer: Kaiser Permanente Medicare	$903.03
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: Ohana Health Plan Medicaid	$903.03
Rate for Payer: Ohana Health Plan Medicare	$903.03
Rate for Payer: UnitedHealthcare Medicare	$903.03
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE FEMORAL 627618

Facility

$7,026.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,178.06
Max. Negotiated Rate	$6,815.22
Rate for Payer: AlohaCare Medicaid	$3,513.00
Rate for Payer: AlohaCare Medicare	$2,178.06
Rate for Payer: Cash Price	$4,215.60
Rate for Payer: Devoted Health Medicare	$2,388.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2,178.06
Rate for Payer: Hawaii Western Management Group Commercial	$4,918.20
Rate for Payer: Health Management Network Commercial	$5,972.10
Rate for Payer: Humana Medicare	$2,178.06
Rate for Payer: Kaiser Permanente Commercial	$6,323.40
Rate for Payer: Kaiser Permanente Medicaid	$3,583.26
Rate for Payer: Kaiser Permanente Medicare	$2,178.06
Rate for Payer: MDX Hawaii PPO	$6,815.22
Rate for Payer: Ohana Health Plan Medicaid	$2,178.06
Rate for Payer: Ohana Health Plan Medicare	$2,178.06
Rate for Payer: UnitedHealthcare Medicare	$2,178.06
Rate for Payer: University Health Alliance Commercial	$3,934.56

PLATE FEMORAL 627618

Facility

$7,026.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,934.56
Max. Negotiated Rate	$6,815.22
Rate for Payer: Cash Price	$4,215.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,918.20
Rate for Payer: Health Management Network Commercial	$5,972.10
Rate for Payer: Kaiser Permanente Commercial	$6,323.40
Rate for Payer: MDX Hawaii PPO	$6,815.22
Rate for Payer: University Health Alliance Commercial	$3,934.56

PLATE FEMORAL LF DISTAL 627604

Facility

$5,925.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,836.75
Max. Negotiated Rate	$5,747.25
Rate for Payer: AlohaCare Medicaid	$2,962.50
Rate for Payer: AlohaCare Medicare	$1,836.75
Rate for Payer: Cash Price	$3,555.00
Rate for Payer: Devoted Health Medicare	$2,014.50
Rate for Payer: Hawaii Medical Service Association Medicare	$1,836.75
Rate for Payer: Hawaii Western Management Group Commercial	$4,147.50
Rate for Payer: Health Management Network Commercial	$5,036.25
Rate for Payer: Humana Medicare	$1,836.75
Rate for Payer: Kaiser Permanente Commercial	$5,332.50
Rate for Payer: Kaiser Permanente Medicaid	$3,021.75
Rate for Payer: Kaiser Permanente Medicare	$1,836.75
Rate for Payer: MDX Hawaii PPO	$5,747.25
Rate for Payer: Ohana Health Plan Medicaid	$1,836.75
Rate for Payer: Ohana Health Plan Medicare	$1,836.75
Rate for Payer: UnitedHealthcare Medicare	$1,836.75
Rate for Payer: University Health Alliance Commercial	$3,318.00

PLATE FEMORAL LF DISTAL 627604

Facility

$5,925.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,318.00
Max. Negotiated Rate	$5,747.25
Rate for Payer: Cash Price	$3,555.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,147.50
Rate for Payer: Health Management Network Commercial	$5,036.25
Rate for Payer: Kaiser Permanente Commercial	$5,332.50
Rate for Payer: MDX Hawaii PPO	$5,747.25
Rate for Payer: University Health Alliance Commercial	$3,318.00

PLATE FEMORAL R DIS LAT 627640

Facility

$4,707.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,459.17
Max. Negotiated Rate	$4,565.79
Rate for Payer: AlohaCare Medicaid	$2,353.50
Rate for Payer: AlohaCare Medicare	$1,459.17
Rate for Payer: Cash Price	$2,824.20
Rate for Payer: Devoted Health Medicare	$1,600.38
Rate for Payer: Hawaii Medical Service Association Medicare	$1,459.17
Rate for Payer: Hawaii Western Management Group Commercial	$3,294.90
Rate for Payer: Health Management Network Commercial	$4,000.95
Rate for Payer: Humana Medicare	$1,459.17
Rate for Payer: Kaiser Permanente Commercial	$4,236.30
Rate for Payer: Kaiser Permanente Medicaid	$2,400.57
Rate for Payer: Kaiser Permanente Medicare	$1,459.17
Rate for Payer: MDX Hawaii PPO	$4,565.79
Rate for Payer: Ohana Health Plan Medicaid	$1,459.17
Rate for Payer: Ohana Health Plan Medicare	$1,459.17
Rate for Payer: UnitedHealthcare Medicare	$1,459.17
Rate for Payer: University Health Alliance Commercial	$2,635.92

PLATE FEMORAL R DIS LAT 627640

Facility

$4,707.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,635.92
Max. Negotiated Rate	$4,565.79
Rate for Payer: Cash Price	$2,824.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,294.90
Rate for Payer: Health Management Network Commercial	$4,000.95
Rate for Payer: Kaiser Permanente Commercial	$4,236.30
Rate for Payer: MDX Hawaii PPO	$4,565.79
Rate for Payer: University Health Alliance Commercial	$2,635.92

PLATE FEMORAL RT DISTAL 627634

Facility

$5,925.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,318.00
Max. Negotiated Rate	$5,747.25
Rate for Payer: Cash Price	$3,555.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,147.50
Rate for Payer: Health Management Network Commercial	$5,036.25
Rate for Payer: Kaiser Permanente Commercial	$5,332.50
Rate for Payer: MDX Hawaii PPO	$5,747.25
Rate for Payer: University Health Alliance Commercial	$3,318.00

PLATE FEMORAL RT DISTAL 627634

Facility

$5,925.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,836.75
Max. Negotiated Rate	$5,747.25
Rate for Payer: AlohaCare Medicaid	$2,962.50
Rate for Payer: AlohaCare Medicare	$1,836.75
Rate for Payer: Cash Price	$3,555.00
Rate for Payer: Devoted Health Medicare	$2,014.50
Rate for Payer: Hawaii Medical Service Association Medicare	$1,836.75
Rate for Payer: Hawaii Western Management Group Commercial	$4,147.50
Rate for Payer: Health Management Network Commercial	$5,036.25
Rate for Payer: Humana Medicare	$1,836.75
Rate for Payer: Kaiser Permanente Commercial	$5,332.50
Rate for Payer: Kaiser Permanente Medicaid	$3,021.75
Rate for Payer: Kaiser Permanente Medicare	$1,836.75
Rate for Payer: MDX Hawaii PPO	$5,747.25
Rate for Payer: Ohana Health Plan Medicaid	$1,836.75
Rate for Payer: Ohana Health Plan Medicare	$1,836.75
Rate for Payer: UnitedHealthcare Medicare	$1,836.75
Rate for Payer: University Health Alliance Commercial	$3,318.00

PLATE FEMUR 379MM 18H 627648S

Facility

$7,026.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,178.06
Max. Negotiated Rate	$6,815.22
Rate for Payer: AlohaCare Medicaid	$3,513.00
Rate for Payer: AlohaCare Medicare	$2,178.06
Rate for Payer: Cash Price	$4,215.60
Rate for Payer: Devoted Health Medicare	$2,388.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2,178.06
Rate for Payer: Hawaii Western Management Group Commercial	$4,918.20
Rate for Payer: Health Management Network Commercial	$5,972.10
Rate for Payer: Humana Medicare	$2,178.06
Rate for Payer: Kaiser Permanente Commercial	$6,323.40
Rate for Payer: Kaiser Permanente Medicaid	$3,583.26
Rate for Payer: Kaiser Permanente Medicare	$2,178.06
Rate for Payer: MDX Hawaii PPO	$6,815.22
Rate for Payer: Ohana Health Plan Medicaid	$2,178.06
Rate for Payer: Ohana Health Plan Medicare	$2,178.06
Rate for Payer: UnitedHealthcare Medicare	$2,178.06
Rate for Payer: University Health Alliance Commercial	$3,934.56

PLATE FEMUR 379MM 18H 627648S

Facility

$7,026.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,934.56
Max. Negotiated Rate	$6,815.22
Rate for Payer: Cash Price	$4,215.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,918.20
Rate for Payer: Health Management Network Commercial	$5,972.10
Rate for Payer: Kaiser Permanente Commercial	$6,323.40
Rate for Payer: MDX Hawaii PPO	$6,815.22
Rate for Payer: University Health Alliance Commercial	$3,934.56

PLATE FIB 3H RT 85MM 336-5203

Facility

$2,884.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,615.04
Max. Negotiated Rate	$2,797.48
Rate for Payer: Cash Price	$1,730.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,018.80
Rate for Payer: Health Management Network Commercial	$2,451.40
Rate for Payer: Kaiser Permanente Commercial	$2,595.60
Rate for Payer: MDX Hawaii PPO	$2,797.48
Rate for Payer: University Health Alliance Commercial	$1,615.04

PLATE FIB 3H RT 85MM 336-5203

Facility

$2,884.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$894.04
Max. Negotiated Rate	$2,797.48
Rate for Payer: AlohaCare Medicaid	$1,442.00
Rate for Payer: AlohaCare Medicare	$894.04
Rate for Payer: Cash Price	$1,730.40
Rate for Payer: Devoted Health Medicare	$980.56
Rate for Payer: Hawaii Medical Service Association Medicare	$894.04
Rate for Payer: Hawaii Western Management Group Commercial	$2,018.80
Rate for Payer: Health Management Network Commercial	$2,451.40
Rate for Payer: Humana Medicare	$894.04
Rate for Payer: Kaiser Permanente Commercial	$2,595.60
Rate for Payer: Kaiser Permanente Medicaid	$1,470.84
Rate for Payer: Kaiser Permanente Medicare	$894.04
Rate for Payer: MDX Hawaii PPO	$2,797.48
Rate for Payer: Ohana Health Plan Medicaid	$894.04
Rate for Payer: Ohana Health Plan Medicare	$894.04
Rate for Payer: UnitedHealthcare Medicare	$894.04
Rate for Payer: University Health Alliance Commercial	$1,615.04

PLATE FIBULA 40-20906

Facility

$2,237.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.72
Max. Negotiated Rate	$2,169.89
Rate for Payer: Cash Price	$1,342.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,565.90
Rate for Payer: Health Management Network Commercial	$1,901.45
Rate for Payer: Kaiser Permanente Commercial	$2,013.30
Rate for Payer: MDX Hawaii PPO	$2,169.89
Rate for Payer: University Health Alliance Commercial	$1,252.72

PLATE FIBULA 40-20906

Facility

$2,237.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$693.47
Max. Negotiated Rate	$2,169.89
Rate for Payer: AlohaCare Medicaid	$1,118.50
Rate for Payer: AlohaCare Medicare	$693.47
Rate for Payer: Cash Price	$1,342.20
Rate for Payer: Devoted Health Medicare	$760.58
Rate for Payer: Hawaii Medical Service Association Medicare	$693.47
Rate for Payer: Hawaii Western Management Group Commercial	$1,565.90
Rate for Payer: Health Management Network Commercial	$1,901.45
Rate for Payer: Humana Medicare	$693.47
Rate for Payer: Kaiser Permanente Commercial	$2,013.30
Rate for Payer: Kaiser Permanente Medicaid	$1,140.87
Rate for Payer: Kaiser Permanente Medicare	$693.47
Rate for Payer: MDX Hawaii PPO	$2,169.89
Rate for Payer: Ohana Health Plan Medicaid	$693.47
Rate for Payer: Ohana Health Plan Medicare	$693.47
Rate for Payer: UnitedHealthcare Medicare	$693.47
Rate for Payer: University Health Alliance Commercial	$1,252.72

Know your out-of-pocket cost for care.

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