Kau Hospital

All Charges

Charge

Type

Setting

Price

PLATE LCKIGN 3.5, 7 HOLE

Facility

$774.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$239.94
Max. Negotiated Rate	$750.78
Rate for Payer: AlohaCare Medicaid	$387.00
Rate for Payer: AlohaCare Medicare	$239.94
Rate for Payer: Cash Price	$464.40
Rate for Payer: Devoted Health Medicare	$263.16
Rate for Payer: Hawaii Medical Service Association Medicare	$239.94
Rate for Payer: Hawaii Western Management Group Commercial	$541.80
Rate for Payer: Health Management Network Commercial	$657.90
Rate for Payer: Humana Medicare	$239.94
Rate for Payer: Kaiser Permanente Commercial	$696.60
Rate for Payer: Kaiser Permanente Medicaid	$394.74
Rate for Payer: Kaiser Permanente Medicare	$239.94
Rate for Payer: MDX Hawaii PPO	$750.78
Rate for Payer: Ohana Health Plan Medicaid	$239.94
Rate for Payer: Ohana Health Plan Medicare	$239.94
Rate for Payer: UnitedHealthcare Medicare	$239.94
Rate for Payer: University Health Alliance Commercial	$433.44

PLATE LCKIGN 3.5, 7 HOLE

Facility

$774.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$433.44
Max. Negotiated Rate	$750.78
Rate for Payer: Cash Price	$464.40
Rate for Payer: Hawaii Western Management Group Commercial	$541.80
Rate for Payer: Health Management Network Commercial	$657.90
Rate for Payer: Kaiser Permanente Commercial	$696.60
Rate for Payer: MDX Hawaii PPO	$750.78
Rate for Payer: University Health Alliance Commercial	$433.44

PLATE LCKING COUNTOUR DUAL 3.5

Facility

$1,535.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$475.85
Max. Negotiated Rate	$1,488.95
Rate for Payer: AlohaCare Medicaid	$767.50
Rate for Payer: AlohaCare Medicare	$475.85
Rate for Payer: Cash Price	$921.00
Rate for Payer: Devoted Health Medicare	$521.90
Rate for Payer: Hawaii Medical Service Association Medicare	$475.85
Rate for Payer: Hawaii Western Management Group Commercial	$1,074.50
Rate for Payer: Health Management Network Commercial	$1,304.75
Rate for Payer: Humana Medicare	$475.85
Rate for Payer: Kaiser Permanente Commercial	$1,381.50
Rate for Payer: Kaiser Permanente Medicaid	$782.85
Rate for Payer: Kaiser Permanente Medicare	$475.85
Rate for Payer: MDX Hawaii PPO	$1,488.95
Rate for Payer: Ohana Health Plan Medicaid	$475.85
Rate for Payer: Ohana Health Plan Medicare	$475.85
Rate for Payer: UnitedHealthcare Medicare	$475.85
Rate for Payer: University Health Alliance Commercial	$859.60

PLATE LCKING COUNTOUR DUAL 3.5

Facility

$1,535.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$859.60
Max. Negotiated Rate	$1,488.95
Rate for Payer: Cash Price	$921.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,074.50
Rate for Payer: Health Management Network Commercial	$1,304.75
Rate for Payer: Kaiser Permanente Commercial	$1,381.50
Rate for Payer: MDX Hawaii PPO	$1,488.95
Rate for Payer: University Health Alliance Commercial	$859.60

PLATE LCKING DUAL COMPRESS 3.5

Facility

$1,488.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$461.28
Max. Negotiated Rate	$1,443.36
Rate for Payer: AlohaCare Medicaid	$744.00
Rate for Payer: AlohaCare Medicare	$461.28
Rate for Payer: Cash Price	$892.80
Rate for Payer: Devoted Health Medicare	$505.92
Rate for Payer: Hawaii Medical Service Association Medicare	$461.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,041.60
Rate for Payer: Health Management Network Commercial	$1,264.80
Rate for Payer: Humana Medicare	$461.28
Rate for Payer: Kaiser Permanente Commercial	$1,339.20
Rate for Payer: Kaiser Permanente Medicaid	$758.88
Rate for Payer: Kaiser Permanente Medicare	$461.28
Rate for Payer: MDX Hawaii PPO	$1,443.36
Rate for Payer: Ohana Health Plan Medicaid	$461.28
Rate for Payer: Ohana Health Plan Medicare	$461.28
Rate for Payer: UnitedHealthcare Medicare	$461.28
Rate for Payer: University Health Alliance Commercial	$833.28

PLATE LCKING DUAL COMPRESS 3.5

Facility

$1,488.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$833.28
Max. Negotiated Rate	$1,443.36
Rate for Payer: Cash Price	$892.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,041.60
Rate for Payer: Health Management Network Commercial	$1,264.80
Rate for Payer: Kaiser Permanente Commercial	$1,339.20
Rate for Payer: MDX Hawaii PPO	$1,443.36
Rate for Payer: University Health Alliance Commercial	$833.28

PLATE LCK LAT HK AR-8943TH-03

Facility

$2,205.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$683.55
Max. Negotiated Rate	$2,138.85
Rate for Payer: AlohaCare Medicaid	$1,102.50
Rate for Payer: AlohaCare Medicare	$683.55
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Devoted Health Medicare	$749.70
Rate for Payer: Hawaii Medical Service Association Medicare	$683.55
Rate for Payer: Hawaii Western Management Group Commercial	$1,543.50
Rate for Payer: Health Management Network Commercial	$1,874.25
Rate for Payer: Humana Medicare	$683.55
Rate for Payer: Kaiser Permanente Commercial	$1,984.50
Rate for Payer: Kaiser Permanente Medicaid	$1,124.55
Rate for Payer: Kaiser Permanente Medicare	$683.55
Rate for Payer: MDX Hawaii PPO	$2,138.85
Rate for Payer: Ohana Health Plan Medicaid	$683.55
Rate for Payer: Ohana Health Plan Medicare	$683.55
Rate for Payer: UnitedHealthcare Medicare	$683.55
Rate for Payer: University Health Alliance Commercial	$1,234.80

PLATE LCK LAT HK AR-8943TH-03

Facility

$2,205.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,234.80
Max. Negotiated Rate	$2,138.85
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,543.50
Rate for Payer: Health Management Network Commercial	$1,874.25
Rate for Payer: Kaiser Permanente Commercial	$1,984.50
Rate for Payer: MDX Hawaii PPO	$2,138.85
Rate for Payer: University Health Alliance Commercial	$1,234.80

PLATE LCKNG 2.3MM 3D 57-15392

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 LCKNG 2.3MM 3D 57-15392

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 LCK RT 3 HOLE 627233

Facility

$5,084.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,576.04
Max. Negotiated Rate	$4,931.48
Rate for Payer: AlohaCare Medicaid	$2,542.00
Rate for Payer: AlohaCare Medicare	$1,576.04
Rate for Payer: Cash Price	$3,050.40
Rate for Payer: Devoted Health Medicare	$1,728.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,576.04
Rate for Payer: Hawaii Western Management Group Commercial	$3,558.80
Rate for Payer: Health Management Network Commercial	$4,321.40
Rate for Payer: Humana Medicare	$1,576.04
Rate for Payer: Kaiser Permanente Commercial	$4,575.60
Rate for Payer: Kaiser Permanente Medicaid	$2,592.84
Rate for Payer: Kaiser Permanente Medicare	$1,576.04
Rate for Payer: MDX Hawaii PPO	$4,931.48
Rate for Payer: Ohana Health Plan Medicaid	$1,576.04
Rate for Payer: Ohana Health Plan Medicare	$1,576.04
Rate for Payer: UnitedHealthcare Medicare	$1,576.04
Rate for Payer: University Health Alliance Commercial	$2,847.04

PLATE LCK RT 3 HOLE 627233

Facility

$5,084.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,847.04
Max. Negotiated Rate	$4,931.48
Rate for Payer: Cash Price	$3,050.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,558.80
Rate for Payer: Health Management Network Commercial	$4,321.40
Rate for Payer: Kaiser Permanente Commercial	$4,575.60
Rate for Payer: MDX Hawaii PPO	$4,931.48
Rate for Payer: University Health Alliance Commercial	$2,847.04

PLATE LCK ST 10H AR-8943C-10

Facility

$1,874.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,049.44
Max. Negotiated Rate	$1,817.78
Rate for Payer: Cash Price	$1,124.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,311.80
Rate for Payer: Health Management Network Commercial	$1,592.90
Rate for Payer: Kaiser Permanente Commercial	$1,686.60
Rate for Payer: MDX Hawaii PPO	$1,817.78
Rate for Payer: University Health Alliance Commercial	$1,049.44

PLATE LCK ST 10H AR-8943C-10

Facility

$1,874.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$580.94
Max. Negotiated Rate	$1,817.78
Rate for Payer: AlohaCare Medicaid	$937.00
Rate for Payer: AlohaCare Medicare	$580.94
Rate for Payer: Cash Price	$1,124.40
Rate for Payer: Devoted Health Medicare	$637.16
Rate for Payer: Hawaii Medical Service Association Medicare	$580.94
Rate for Payer: Hawaii Western Management Group Commercial	$1,311.80
Rate for Payer: Health Management Network Commercial	$1,592.90
Rate for Payer: Humana Medicare	$580.94
Rate for Payer: Kaiser Permanente Commercial	$1,686.60
Rate for Payer: Kaiser Permanente Medicaid	$955.74
Rate for Payer: Kaiser Permanente Medicare	$580.94
Rate for Payer: MDX Hawaii PPO	$1,817.78
Rate for Payer: Ohana Health Plan Medicaid	$580.94
Rate for Payer: Ohana Health Plan Medicare	$580.94
Rate for Payer: UnitedHealthcare Medicare	$580.94
Rate for Payer: University Health Alliance Commercial	$1,049.44

PLATE LCK STR 7H AR-8943C-06

Facility

$1,746.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$541.26
Max. Negotiated Rate	$1,693.62
Rate for Payer: AlohaCare Medicaid	$873.00
Rate for Payer: AlohaCare Medicare	$541.26
Rate for Payer: Cash Price	$1,047.60
Rate for Payer: Devoted Health Medicare	$593.64
Rate for Payer: Hawaii Medical Service Association Medicare	$541.26
Rate for Payer: Hawaii Western Management Group Commercial	$1,222.20
Rate for Payer: Health Management Network Commercial	$1,484.10
Rate for Payer: Humana Medicare	$541.26
Rate for Payer: Kaiser Permanente Commercial	$1,571.40
Rate for Payer: Kaiser Permanente Medicaid	$890.46
Rate for Payer: Kaiser Permanente Medicare	$541.26
Rate for Payer: MDX Hawaii PPO	$1,693.62
Rate for Payer: Ohana Health Plan Medicaid	$541.26
Rate for Payer: Ohana Health Plan Medicare	$541.26
Rate for Payer: UnitedHealthcare Medicare	$541.26
Rate for Payer: University Health Alliance Commercial	$977.76

PLATE LCK STR 7H AR-8943C-06

Facility

$1,746.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$977.76
Max. Negotiated Rate	$1,693.62
Rate for Payer: Cash Price	$1,047.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,222.20
Rate for Payer: Health Management Network Commercial	$1,484.10
Rate for Payer: Kaiser Permanente Commercial	$1,571.40
Rate for Payer: MDX Hawaii PPO	$1,693.62
Rate for Payer: University Health Alliance Commercial	$977.76

PLATE LCK STR 8H AR-8943C-08

Facility

$1,650.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$511.50
Max. Negotiated Rate	$1,600.50
Rate for Payer: AlohaCare Medicaid	$825.00
Rate for Payer: AlohaCare Medicare	$511.50
Rate for Payer: Cash Price	$990.00
Rate for Payer: Devoted Health Medicare	$561.00
Rate for Payer: Hawaii Medical Service Association Medicare	$511.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,155.00
Rate for Payer: Health Management Network Commercial	$1,402.50
Rate for Payer: Humana Medicare	$511.50
Rate for Payer: Kaiser Permanente Commercial	$1,485.00
Rate for Payer: Kaiser Permanente Medicaid	$841.50
Rate for Payer: Kaiser Permanente Medicare	$511.50
Rate for Payer: MDX Hawaii PPO	$1,600.50
Rate for Payer: Ohana Health Plan Medicaid	$511.50
Rate for Payer: Ohana Health Plan Medicare	$511.50
Rate for Payer: UnitedHealthcare Medicare	$511.50
Rate for Payer: University Health Alliance Commercial	$924.00

PLATE LCK STR 8H AR-8943C-08

Facility

$1,650.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$924.00
Max. Negotiated Rate	$1,600.50
Rate for Payer: Cash Price	$990.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,155.00
Rate for Payer: Health Management Network Commercial	$1,402.50
Rate for Payer: Kaiser Permanente Commercial	$1,485.00
Rate for Payer: MDX Hawaii PPO	$1,600.50
Rate for Payer: University Health Alliance Commercial	$924.00

PLATE LCK THIRD 4H AR-8943T-04

Facility

$886.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$274.66
Max. Negotiated Rate	$859.42
Rate for Payer: AlohaCare Medicaid	$443.00
Rate for Payer: AlohaCare Medicare	$274.66
Rate for Payer: Cash Price	$531.60
Rate for Payer: Devoted Health Medicare	$301.24
Rate for Payer: Hawaii Medical Service Association Medicare	$274.66
Rate for Payer: Hawaii Western Management Group Commercial	$620.20
Rate for Payer: Health Management Network Commercial	$753.10
Rate for Payer: Humana Medicare	$274.66
Rate for Payer: Kaiser Permanente Commercial	$797.40
Rate for Payer: Kaiser Permanente Medicaid	$451.86
Rate for Payer: Kaiser Permanente Medicare	$274.66
Rate for Payer: MDX Hawaii PPO	$859.42
Rate for Payer: Ohana Health Plan Medicaid	$274.66
Rate for Payer: Ohana Health Plan Medicare	$274.66
Rate for Payer: UnitedHealthcare Medicare	$274.66
Rate for Payer: University Health Alliance Commercial	$496.16

PLATE LCK THIRD 4H AR-8943T-04

Facility

$886.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$496.16
Max. Negotiated Rate	$859.42
Rate for Payer: Cash Price	$531.60
Rate for Payer: Hawaii Western Management Group Commercial	$620.20
Rate for Payer: Health Management Network Commercial	$753.10
Rate for Payer: Kaiser Permanente Commercial	$797.40
Rate for Payer: MDX Hawaii PPO	$859.42
Rate for Payer: University Health Alliance Commercial	$496.16

PLATE LCK TIBIAL LF 5H 627705

Facility

$4,456.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,495.36
Max. Negotiated Rate	$4,322.32
Rate for Payer: Cash Price	$2,673.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,119.20
Rate for Payer: Health Management Network Commercial	$3,787.60
Rate for Payer: Kaiser Permanente Commercial	$4,010.40
Rate for Payer: MDX Hawaii PPO	$4,322.32
Rate for Payer: University Health Alliance Commercial	$2,495.36

PLATE LCK TIBIAL LF 5H 627705

Facility

$4,456.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,381.36
Max. Negotiated Rate	$4,322.32
Rate for Payer: AlohaCare Medicaid	$2,228.00
Rate for Payer: AlohaCare Medicare	$1,381.36
Rate for Payer: Cash Price	$2,673.60
Rate for Payer: Devoted Health Medicare	$1,515.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1,381.36
Rate for Payer: Hawaii Western Management Group Commercial	$3,119.20
Rate for Payer: Health Management Network Commercial	$3,787.60
Rate for Payer: Humana Medicare	$1,381.36
Rate for Payer: Kaiser Permanente Commercial	$4,010.40
Rate for Payer: Kaiser Permanente Medicaid	$2,272.56
Rate for Payer: Kaiser Permanente Medicare	$1,381.36
Rate for Payer: MDX Hawaii PPO	$4,322.32
Rate for Payer: Ohana Health Plan Medicaid	$1,381.36
Rate for Payer: Ohana Health Plan Medicare	$1,381.36
Rate for Payer: UnitedHealthcare Medicare	$1,381.36
Rate for Payer: University Health Alliance Commercial	$2,495.36

PLATE LCK TIBIAL RT 2H 627332

Facility

$4,894.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,740.64
Max. Negotiated Rate	$4,747.18
Rate for Payer: Cash Price	$2,936.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,425.80
Rate for Payer: Health Management Network Commercial	$4,159.90
Rate for Payer: Kaiser Permanente Commercial	$4,404.60
Rate for Payer: MDX Hawaii PPO	$4,747.18
Rate for Payer: University Health Alliance Commercial	$2,740.64

PLATE LCK TIBIAL RT 2H 627332

Facility

$4,894.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,517.14
Max. Negotiated Rate	$4,747.18
Rate for Payer: AlohaCare Medicaid	$2,447.00
Rate for Payer: AlohaCare Medicare	$1,517.14
Rate for Payer: Cash Price	$2,936.40
Rate for Payer: Devoted Health Medicare	$1,663.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,517.14
Rate for Payer: Hawaii Western Management Group Commercial	$3,425.80
Rate for Payer: Health Management Network Commercial	$4,159.90
Rate for Payer: Humana Medicare	$1,517.14
Rate for Payer: Kaiser Permanente Commercial	$4,404.60
Rate for Payer: Kaiser Permanente Medicaid	$2,495.94
Rate for Payer: Kaiser Permanente Medicare	$1,517.14
Rate for Payer: MDX Hawaii PPO	$4,747.18
Rate for Payer: Ohana Health Plan Medicaid	$1,517.14
Rate for Payer: Ohana Health Plan Medicare	$1,517.14
Rate for Payer: UnitedHealthcare Medicare	$1,517.14
Rate for Payer: University Health Alliance Commercial	$2,740.64

PLATE LCK TIB LT DIST 627412

Facility

$3,890.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,205.90
Max. Negotiated Rate	$3,773.30
Rate for Payer: AlohaCare Medicaid	$1,945.00
Rate for Payer: AlohaCare Medicare	$1,205.90
Rate for Payer: Cash Price	$2,334.00
Rate for Payer: Devoted Health Medicare	$1,322.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,205.90
Rate for Payer: Hawaii Western Management Group Commercial	$2,723.00
Rate for Payer: Health Management Network Commercial	$3,306.50
Rate for Payer: Humana Medicare	$1,205.90
Rate for Payer: Kaiser Permanente Commercial	$3,501.00
Rate for Payer: Kaiser Permanente Medicaid	$1,983.90
Rate for Payer: Kaiser Permanente Medicare	$1,205.90
Rate for Payer: MDX Hawaii PPO	$3,773.30
Rate for Payer: Ohana Health Plan Medicaid	$1,205.90
Rate for Payer: Ohana Health Plan Medicare	$1,205.90
Rate for Payer: UnitedHealthcare Medicare	$1,205.90
Rate for Payer: University Health Alliance Commercial	$2,178.40

Know your out-of-pocket cost for care.

All Charges