Kau Hospital

All Charges

Charge

Type

Setting

Price

PLATE LCP 8H 3.5X133MM 239.938

Facility

$4,578.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,419.18
Max. Negotiated Rate	$4,440.66
Rate for Payer: AlohaCare Medicaid	$2,289.00
Rate for Payer: AlohaCare Medicare	$1,419.18
Rate for Payer: Cash Price	$2,746.80
Rate for Payer: Devoted Health Medicare	$1,556.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,419.18
Rate for Payer: Hawaii Western Management Group Commercial	$3,204.60
Rate for Payer: Health Management Network Commercial	$3,891.30
Rate for Payer: Humana Medicare	$1,419.18
Rate for Payer: Kaiser Permanente Commercial	$4,120.20
Rate for Payer: Kaiser Permanente Medicaid	$2,334.78
Rate for Payer: Kaiser Permanente Medicare	$1,419.18
Rate for Payer: MDX Hawaii PPO	$4,440.66
Rate for Payer: Ohana Health Plan Medicaid	$1,419.18
Rate for Payer: Ohana Health Plan Medicare	$1,419.18
Rate for Payer: UnitedHealthcare Medicare	$1,419.18
Rate for Payer: University Health Alliance Commercial	$2,563.68

PLATE LCP 8H 3.5X133MM 239.938

Facility

$4,578.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,563.68
Max. Negotiated Rate	$4,440.66
Rate for Payer: Cash Price	$2,746.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,204.60
Rate for Payer: Health Management Network Commercial	$3,891.30
Rate for Payer: Kaiser Permanente Commercial	$4,120.20
Rate for Payer: MDX Hawaii PPO	$4,440.66
Rate for Payer: University Health Alliance Commercial	$2,563.68

PLATE LCP 8H 3.5X133MM 239.939

Facility

$4,989.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,546.59
Max. Negotiated Rate	$4,839.33
Rate for Payer: AlohaCare Medicaid	$2,494.50
Rate for Payer: AlohaCare Medicare	$1,546.59
Rate for Payer: Cash Price	$2,993.40
Rate for Payer: Devoted Health Medicare	$1,696.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1,546.59
Rate for Payer: Hawaii Western Management Group Commercial	$3,492.30
Rate for Payer: Health Management Network Commercial	$4,240.65
Rate for Payer: Humana Medicare	$1,546.59
Rate for Payer: Kaiser Permanente Commercial	$4,490.10
Rate for Payer: Kaiser Permanente Medicaid	$2,544.39
Rate for Payer: Kaiser Permanente Medicare	$1,546.59
Rate for Payer: MDX Hawaii PPO	$4,839.33
Rate for Payer: Ohana Health Plan Medicaid	$1,546.59
Rate for Payer: Ohana Health Plan Medicare	$1,546.59
Rate for Payer: UnitedHealthcare Medicare	$1,546.59
Rate for Payer: University Health Alliance Commercial	$2,793.84

PLATE LCP 8H 3.5X133MM 239.939

Facility

$4,989.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,793.84
Max. Negotiated Rate	$4,839.33
Rate for Payer: Cash Price	$2,993.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,492.30
Rate for Payer: Health Management Network Commercial	$4,240.65
Rate for Payer: Kaiser Permanente Commercial	$4,490.10
Rate for Payer: MDX Hawaii PPO	$4,839.33
Rate for Payer: University Health Alliance Commercial	$2,793.84

PLATE LCP 8H 4.5X152MM 224.581

Facility

$1,685.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$522.35
Max. Negotiated Rate	$1,634.45
Rate for Payer: AlohaCare Medicaid	$842.50
Rate for Payer: AlohaCare Medicare	$522.35
Rate for Payer: Cash Price	$1,011.00
Rate for Payer: Devoted Health Medicare	$572.90
Rate for Payer: Hawaii Medical Service Association Medicare	$522.35
Rate for Payer: Hawaii Western Management Group Commercial	$1,179.50
Rate for Payer: Health Management Network Commercial	$1,432.25
Rate for Payer: Humana Medicare	$522.35
Rate for Payer: Kaiser Permanente Commercial	$1,516.50
Rate for Payer: Kaiser Permanente Medicaid	$859.35
Rate for Payer: Kaiser Permanente Medicare	$522.35
Rate for Payer: MDX Hawaii PPO	$1,634.45
Rate for Payer: Ohana Health Plan Medicaid	$522.35
Rate for Payer: Ohana Health Plan Medicare	$522.35
Rate for Payer: UnitedHealthcare Medicare	$522.35
Rate for Payer: University Health Alliance Commercial	$943.60

PLATE LCP 8H 4.5X152MM 224.581

Facility

$1,685.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$943.60
Max. Negotiated Rate	$1,634.45
Rate for Payer: Cash Price	$1,011.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,179.50
Rate for Payer: Health Management Network Commercial	$1,432.25
Rate for Payer: Kaiser Permanente Commercial	$1,516.50
Rate for Payer: MDX Hawaii PPO	$1,634.45
Rate for Payer: University Health Alliance Commercial	$943.60

PLATE LCP 8H 4.5X152MM 226.581

Facility

$1,904.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$590.24
Max. Negotiated Rate	$1,846.88
Rate for Payer: AlohaCare Medicaid	$952.00
Rate for Payer: AlohaCare Medicare	$590.24
Rate for Payer: Cash Price	$1,142.40
Rate for Payer: Devoted Health Medicare	$647.36
Rate for Payer: Hawaii Medical Service Association Medicare	$590.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,332.80
Rate for Payer: Health Management Network Commercial	$1,618.40
Rate for Payer: Humana Medicare	$590.24
Rate for Payer: Kaiser Permanente Commercial	$1,713.60
Rate for Payer: Kaiser Permanente Medicaid	$971.04
Rate for Payer: Kaiser Permanente Medicare	$590.24
Rate for Payer: MDX Hawaii PPO	$1,846.88
Rate for Payer: Ohana Health Plan Medicaid	$590.24
Rate for Payer: Ohana Health Plan Medicare	$590.24
Rate for Payer: UnitedHealthcare Medicare	$590.24
Rate for Payer: University Health Alliance Commercial	$1,066.24

PLATE LCP 8H 4.5X152MM 226.581

Facility

$1,904.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,066.24
Max. Negotiated Rate	$1,846.88
Rate for Payer: Cash Price	$1,142.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,332.80
Rate for Payer: Health Management Network Commercial	$1,618.40
Rate for Payer: Kaiser Permanente Commercial	$1,713.60
Rate for Payer: MDX Hawaii PPO	$1,846.88
Rate for Payer: University Health Alliance Commercial	$1,066.24

PLATE LCP 9H 3.5X124MM 223.591

Facility

$1,454.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$814.24
Max. Negotiated Rate	$1,410.38
Rate for Payer: Cash Price	$872.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.80
Rate for Payer: Health Management Network Commercial	$1,235.90
Rate for Payer: Kaiser Permanente Commercial	$1,308.60
Rate for Payer: MDX Hawaii PPO	$1,410.38
Rate for Payer: University Health Alliance Commercial	$814.24

PLATE LCP 9H 3.5X124MM 223.591

Facility

$1,454.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$450.74
Max. Negotiated Rate	$1,410.38
Rate for Payer: AlohaCare Medicaid	$727.00
Rate for Payer: AlohaCare Medicare	$450.74
Rate for Payer: Cash Price	$872.40
Rate for Payer: Devoted Health Medicare	$494.36
Rate for Payer: Hawaii Medical Service Association Medicare	$450.74
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.80
Rate for Payer: Health Management Network Commercial	$1,235.90
Rate for Payer: Humana Medicare	$450.74
Rate for Payer: Kaiser Permanente Commercial	$1,308.60
Rate for Payer: Kaiser Permanente Medicaid	$741.54
Rate for Payer: Kaiser Permanente Medicare	$450.74
Rate for Payer: MDX Hawaii PPO	$1,410.38
Rate for Payer: Ohana Health Plan Medicaid	$450.74
Rate for Payer: Ohana Health Plan Medicare	$450.74
Rate for Payer: UnitedHealthcare Medicare	$450.74
Rate for Payer: University Health Alliance Commercial	$814.24

PLATE LCP 9H 4.5X170MM 224.591

Facility

$1,762.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$986.72
Max. Negotiated Rate	$1,709.14
Rate for Payer: Cash Price	$1,057.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,233.40
Rate for Payer: Health Management Network Commercial	$1,497.70
Rate for Payer: Kaiser Permanente Commercial	$1,585.80
Rate for Payer: MDX Hawaii PPO	$1,709.14
Rate for Payer: University Health Alliance Commercial	$986.72

PLATE LCP 9H 4.5X170MM 224.591

Facility

$1,762.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$546.22
Max. Negotiated Rate	$1,709.14
Rate for Payer: AlohaCare Medicaid	$881.00
Rate for Payer: AlohaCare Medicare	$546.22
Rate for Payer: Cash Price	$1,057.20
Rate for Payer: Devoted Health Medicare	$599.08
Rate for Payer: Hawaii Medical Service Association Medicare	$546.22
Rate for Payer: Hawaii Western Management Group Commercial	$1,233.40
Rate for Payer: Health Management Network Commercial	$1,497.70
Rate for Payer: Humana Medicare	$546.22
Rate for Payer: Kaiser Permanente Commercial	$1,585.80
Rate for Payer: Kaiser Permanente Medicaid	$898.62
Rate for Payer: Kaiser Permanente Medicare	$546.22
Rate for Payer: MDX Hawaii PPO	$1,709.14
Rate for Payer: Ohana Health Plan Medicaid	$546.22
Rate for Payer: Ohana Health Plan Medicare	$546.22
Rate for Payer: UnitedHealthcare Medicare	$546.22
Rate for Payer: University Health Alliance Commercial	$986.72

PLATE LCP FIB-L 11H 01.118.413

Facility

$3,140.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$973.40
Max. Negotiated Rate	$3,045.80
Rate for Payer: AlohaCare Medicaid	$1,570.00
Rate for Payer: AlohaCare Medicare	$973.40
Rate for Payer: Cash Price	$1,884.00
Rate for Payer: Devoted Health Medicare	$1,067.60
Rate for Payer: Hawaii Medical Service Association Medicare	$973.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,198.00
Rate for Payer: Health Management Network Commercial	$2,669.00
Rate for Payer: Humana Medicare	$973.40
Rate for Payer: Kaiser Permanente Commercial	$2,826.00
Rate for Payer: Kaiser Permanente Medicaid	$1,601.40
Rate for Payer: Kaiser Permanente Medicare	$973.40
Rate for Payer: MDX Hawaii PPO	$3,045.80
Rate for Payer: Ohana Health Plan Medicaid	$973.40
Rate for Payer: Ohana Health Plan Medicare	$973.40
Rate for Payer: UnitedHealthcare Medicare	$973.40
Rate for Payer: University Health Alliance Commercial	$1,758.40

PLATE LCP FIB-L 11H 01.118.413

Facility

$3,140.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,758.40
Max. Negotiated Rate	$3,045.80
Rate for Payer: Cash Price	$1,884.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,198.00
Rate for Payer: Health Management Network Commercial	$2,669.00
Rate for Payer: Kaiser Permanente Commercial	$2,826.00
Rate for Payer: MDX Hawaii PPO	$3,045.80
Rate for Payer: University Health Alliance Commercial	$1,758.40

PLATE LCP FIB-L 13H 02.118.415

Facility

$3,378.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,891.68
Max. Negotiated Rate	$3,276.66
Rate for Payer: Cash Price	$2,026.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,364.60
Rate for Payer: Health Management Network Commercial	$2,871.30
Rate for Payer: Kaiser Permanente Commercial	$3,040.20
Rate for Payer: MDX Hawaii PPO	$3,276.66
Rate for Payer: University Health Alliance Commercial	$1,891.68

PLATE LCP FIB-L 13H 02.118.415

Facility

$3,378.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,047.18
Max. Negotiated Rate	$3,276.66
Rate for Payer: AlohaCare Medicaid	$1,689.00
Rate for Payer: AlohaCare Medicare	$1,047.18
Rate for Payer: Cash Price	$2,026.80
Rate for Payer: Devoted Health Medicare	$1,148.52
Rate for Payer: Hawaii Medical Service Association Medicare	$1,047.18
Rate for Payer: Hawaii Western Management Group Commercial	$2,364.60
Rate for Payer: Health Management Network Commercial	$2,871.30
Rate for Payer: Humana Medicare	$1,047.18
Rate for Payer: Kaiser Permanente Commercial	$3,040.20
Rate for Payer: Kaiser Permanente Medicaid	$1,722.78
Rate for Payer: Kaiser Permanente Medicare	$1,047.18
Rate for Payer: MDX Hawaii PPO	$3,276.66
Rate for Payer: Ohana Health Plan Medicaid	$1,047.18
Rate for Payer: Ohana Health Plan Medicare	$1,047.18
Rate for Payer: UnitedHealthcare Medicare	$1,047.18
Rate for Payer: University Health Alliance Commercial	$1,891.68

PLATE LCP FIB-L 15H 02.118.417

Facility

$3,452.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,070.12
Max. Negotiated Rate	$3,348.44
Rate for Payer: AlohaCare Medicaid	$1,726.00
Rate for Payer: AlohaCare Medicare	$1,070.12
Rate for Payer: Cash Price	$2,071.20
Rate for Payer: Devoted Health Medicare	$1,173.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,070.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,416.40
Rate for Payer: Health Management Network Commercial	$2,934.20
Rate for Payer: Humana Medicare	$1,070.12
Rate for Payer: Kaiser Permanente Commercial	$3,106.80
Rate for Payer: Kaiser Permanente Medicaid	$1,760.52
Rate for Payer: Kaiser Permanente Medicare	$1,070.12
Rate for Payer: MDX Hawaii PPO	$3,348.44
Rate for Payer: Ohana Health Plan Medicaid	$1,070.12
Rate for Payer: Ohana Health Plan Medicare	$1,070.12
Rate for Payer: UnitedHealthcare Medicare	$1,070.12
Rate for Payer: University Health Alliance Commercial	$1,933.12

PLATE LCP FIB-L 15H 02.118.417

Facility

$3,452.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,933.12
Max. Negotiated Rate	$3,348.44
Rate for Payer: Cash Price	$2,071.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,416.40
Rate for Payer: Health Management Network Commercial	$2,934.20
Rate for Payer: Kaiser Permanente Commercial	$3,106.80
Rate for Payer: MDX Hawaii PPO	$3,348.44
Rate for Payer: University Health Alliance Commercial	$1,933.12

PLATE LCP FIB-L 3H 02.118.401

Facility

$2,629.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,472.24
Max. Negotiated Rate	$2,550.13
Rate for Payer: Cash Price	$1,577.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,840.30
Rate for Payer: Health Management Network Commercial	$2,234.65
Rate for Payer: Kaiser Permanente Commercial	$2,366.10
Rate for Payer: MDX Hawaii PPO	$2,550.13
Rate for Payer: University Health Alliance Commercial	$1,472.24

PLATE LCP FIB-L 3H 02.118.401

Facility

$2,629.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$814.99
Max. Negotiated Rate	$2,550.13
Rate for Payer: AlohaCare Medicaid	$1,314.50
Rate for Payer: AlohaCare Medicare	$814.99
Rate for Payer: Cash Price	$1,577.40
Rate for Payer: Devoted Health Medicare	$893.86
Rate for Payer: Hawaii Medical Service Association Medicare	$814.99
Rate for Payer: Hawaii Western Management Group Commercial	$1,840.30
Rate for Payer: Health Management Network Commercial	$2,234.65
Rate for Payer: Humana Medicare	$814.99
Rate for Payer: Kaiser Permanente Commercial	$2,366.10
Rate for Payer: Kaiser Permanente Medicaid	$1,340.79
Rate for Payer: Kaiser Permanente Medicare	$814.99
Rate for Payer: MDX Hawaii PPO	$2,550.13
Rate for Payer: Ohana Health Plan Medicaid	$814.99
Rate for Payer: Ohana Health Plan Medicare	$814.99
Rate for Payer: UnitedHealthcare Medicare	$814.99
Rate for Payer: University Health Alliance Commercial	$1,472.24

PLATE LCP FIB-L 4H 02.118.403

Facility

$2,747.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$851.57
Max. Negotiated Rate	$2,664.59
Rate for Payer: AlohaCare Medicaid	$1,373.50
Rate for Payer: AlohaCare Medicare	$851.57
Rate for Payer: Cash Price	$1,648.20
Rate for Payer: Devoted Health Medicare	$933.98
Rate for Payer: Hawaii Medical Service Association Medicare	$851.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,922.90
Rate for Payer: Health Management Network Commercial	$2,334.95
Rate for Payer: Humana Medicare	$851.57
Rate for Payer: Kaiser Permanente Commercial	$2,472.30
Rate for Payer: Kaiser Permanente Medicaid	$1,400.97
Rate for Payer: Kaiser Permanente Medicare	$851.57
Rate for Payer: MDX Hawaii PPO	$2,664.59
Rate for Payer: Ohana Health Plan Medicaid	$851.57
Rate for Payer: Ohana Health Plan Medicare	$851.57
Rate for Payer: UnitedHealthcare Medicare	$851.57
Rate for Payer: University Health Alliance Commercial	$1,538.32

PLATE LCP FIB-L 4H 02.118.403

Facility

$2,747.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,538.32
Max. Negotiated Rate	$2,664.59
Rate for Payer: Cash Price	$1,648.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,922.90
Rate for Payer: Health Management Network Commercial	$2,334.95
Rate for Payer: Kaiser Permanente Commercial	$2,472.30
Rate for Payer: MDX Hawaii PPO	$2,664.59
Rate for Payer: University Health Alliance Commercial	$1,538.32

PLATE LCP FIB-L 5H 02.118.405

Facility

$2,886.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$894.66
Max. Negotiated Rate	$2,799.42
Rate for Payer: AlohaCare Medicaid	$1,443.00
Rate for Payer: AlohaCare Medicare	$894.66
Rate for Payer: Cash Price	$1,731.60
Rate for Payer: Devoted Health Medicare	$981.24
Rate for Payer: Hawaii Medical Service Association Medicare	$894.66
Rate for Payer: Hawaii Western Management Group Commercial	$2,020.20
Rate for Payer: Health Management Network Commercial	$2,453.10
Rate for Payer: Humana Medicare	$894.66
Rate for Payer: Kaiser Permanente Commercial	$2,597.40
Rate for Payer: Kaiser Permanente Medicaid	$1,471.86
Rate for Payer: Kaiser Permanente Medicare	$894.66
Rate for Payer: MDX Hawaii PPO	$2,799.42
Rate for Payer: Ohana Health Plan Medicaid	$894.66
Rate for Payer: Ohana Health Plan Medicare	$894.66
Rate for Payer: UnitedHealthcare Medicare	$894.66
Rate for Payer: University Health Alliance Commercial	$1,616.16

PLATE LCP FIB-L 5H 02.118.405

Facility

$2,886.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,616.16
Max. Negotiated Rate	$2,799.42
Rate for Payer: Cash Price	$1,731.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,020.20
Rate for Payer: Health Management Network Commercial	$2,453.10
Rate for Payer: Kaiser Permanente Commercial	$2,597.40
Rate for Payer: MDX Hawaii PPO	$2,799.42
Rate for Payer: University Health Alliance Commercial	$1,616.16

PLATE LCP FIB-L 6H 02.118.407

Facility

$2,020.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,131.20
Max. Negotiated Rate	$1,959.40
Rate for Payer: Cash Price	$1,212.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,414.00
Rate for Payer: Health Management Network Commercial	$1,717.00
Rate for Payer: Kaiser Permanente Commercial	$1,818.00
Rate for Payer: MDX Hawaii PPO	$1,959.40
Rate for Payer: University Health Alliance Commercial	$1,131.20

Know your out-of-pocket cost for care.

All Charges