Kau Hospital

All Charges

Charge

Type

Setting

Price

PLATE MINI LF DVR 131822040

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 MINI LF DVR 131822040

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 M LCK T REG 7H 57-15360

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 M LCK T REG 7H 57-15360

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 NARR LCK 2.0

Facility

$1,907.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,067.92
Max. Negotiated Rate	$1,849.79
Rate for Payer: Cash Price	$1,144.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,334.90
Rate for Payer: Health Management Network Commercial	$1,620.95
Rate for Payer: Kaiser Permanente Commercial	$1,716.30
Rate for Payer: MDX Hawaii PPO	$1,849.79
Rate for Payer: University Health Alliance Commercial	$1,067.92

PLATE NARR LCK 2.0

Facility

$1,907.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$591.17
Max. Negotiated Rate	$1,849.79
Rate for Payer: AlohaCare Medicaid	$953.50
Rate for Payer: AlohaCare Medicare	$591.17
Rate for Payer: Cash Price	$1,144.20
Rate for Payer: Devoted Health Medicare	$648.38
Rate for Payer: Hawaii Medical Service Association Medicare	$591.17
Rate for Payer: Hawaii Western Management Group Commercial	$1,334.90
Rate for Payer: Health Management Network Commercial	$1,620.95
Rate for Payer: Humana Medicare	$591.17
Rate for Payer: Kaiser Permanente Commercial	$1,716.30
Rate for Payer: Kaiser Permanente Medicaid	$972.57
Rate for Payer: Kaiser Permanente Medicare	$591.17
Rate for Payer: MDX Hawaii PPO	$1,849.79
Rate for Payer: Ohana Health Plan Medicaid	$591.17
Rate for Payer: Ohana Health Plan Medicare	$591.17
Rate for Payer: UnitedHealthcare Medicare	$591.17
Rate for Payer: University Health Alliance Commercial	$1,067.92

PLATE NARROW LEFT DVRAN-L

Facility

$2,460.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,377.60
Max. Negotiated Rate	$2,386.20
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,722.00
Rate for Payer: Health Management Network Commercial	$2,091.00
Rate for Payer: Kaiser Permanente Commercial	$2,214.00
Rate for Payer: MDX Hawaii PPO	$2,386.20
Rate for Payer: University Health Alliance Commercial	$1,377.60

PLATE NARROW LEFT DVRAN-L

Facility

$2,460.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$762.60
Max. Negotiated Rate	$2,386.20
Rate for Payer: AlohaCare Medicaid	$1,230.00
Rate for Payer: AlohaCare Medicare	$762.60
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Devoted Health Medicare	$836.40
Rate for Payer: Hawaii Medical Service Association Medicare	$762.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,722.00
Rate for Payer: Health Management Network Commercial	$2,091.00
Rate for Payer: Humana Medicare	$762.60
Rate for Payer: Kaiser Permanente Commercial	$2,214.00
Rate for Payer: Kaiser Permanente Medicaid	$1,254.60
Rate for Payer: Kaiser Permanente Medicare	$762.60
Rate for Payer: MDX Hawaii PPO	$2,386.20
Rate for Payer: Ohana Health Plan Medicaid	$762.60
Rate for Payer: Ohana Health Plan Medicare	$762.60
Rate for Payer: UnitedHealthcare Medicare	$762.60
Rate for Payer: University Health Alliance Commercial	$1,377.60

PLATE NCB RT 12H 02.03264.012

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,640.00
Max. Negotiated Rate	$6,305.00
Rate for Payer: Cash Price	$3,900.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,550.00
Rate for Payer: Health Management Network Commercial	$5,525.00
Rate for Payer: Kaiser Permanente Commercial	$5,850.00
Rate for Payer: MDX Hawaii PPO	$6,305.00
Rate for Payer: University Health Alliance Commercial	$3,640.00

PLATE NCB RT 12H 02.03264.012

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,015.00
Max. Negotiated Rate	$6,305.00
Rate for Payer: AlohaCare Medicaid	$3,250.00
Rate for Payer: AlohaCare Medicare	$2,015.00
Rate for Payer: Cash Price	$3,900.00
Rate for Payer: Devoted Health Medicare	$2,210.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,015.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,550.00
Rate for Payer: Health Management Network Commercial	$5,525.00
Rate for Payer: Humana Medicare	$2,015.00
Rate for Payer: Kaiser Permanente Commercial	$5,850.00
Rate for Payer: Kaiser Permanente Medicaid	$3,315.00
Rate for Payer: Kaiser Permanente Medicare	$2,015.00
Rate for Payer: MDX Hawaii PPO	$6,305.00
Rate for Payer: Ohana Health Plan Medicaid	$2,015.00
Rate for Payer: Ohana Health Plan Medicare	$2,015.00
Rate for Payer: UnitedHealthcare Medicare	$2,015.00
Rate for Payer: University Health Alliance Commercial	$3,640.00

PLATE NON COMP FEM LF 627610

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 NON COMP FEM LF 627610

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 OLECRANON 12HOLE 629352S

Facility

$4,020.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,251.20
Max. Negotiated Rate	$3,899.40
Rate for Payer: Cash Price	$2,412.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,814.00
Rate for Payer: Health Management Network Commercial	$3,417.00
Rate for Payer: Kaiser Permanente Commercial	$3,618.00
Rate for Payer: MDX Hawaii PPO	$3,899.40
Rate for Payer: University Health Alliance Commercial	$2,251.20

PLATE OLECRANON 12HOLE 629352S

Facility

$4,020.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,246.20
Max. Negotiated Rate	$3,899.40
Rate for Payer: AlohaCare Medicaid	$2,010.00
Rate for Payer: AlohaCare Medicare	$1,246.20
Rate for Payer: Cash Price	$2,412.00
Rate for Payer: Devoted Health Medicare	$1,366.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,246.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,814.00
Rate for Payer: Health Management Network Commercial	$3,417.00
Rate for Payer: Humana Medicare	$1,246.20
Rate for Payer: Kaiser Permanente Commercial	$3,618.00
Rate for Payer: Kaiser Permanente Medicaid	$2,050.20
Rate for Payer: Kaiser Permanente Medicare	$1,246.20
Rate for Payer: MDX Hawaii PPO	$3,899.40
Rate for Payer: Ohana Health Plan Medicaid	$1,246.20
Rate for Payer: Ohana Health Plan Medicare	$1,246.20
Rate for Payer: UnitedHealthcare Medicare	$1,246.20
Rate for Payer: University Health Alliance Commercial	$2,251.20

PLATE OLECRANON 3H 65MM 629343

Facility

$2,193.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$679.83
Max. Negotiated Rate	$2,127.21
Rate for Payer: AlohaCare Medicaid	$1,096.50
Rate for Payer: AlohaCare Medicare	$679.83
Rate for Payer: Cash Price	$1,315.80
Rate for Payer: Devoted Health Medicare	$745.62
Rate for Payer: Hawaii Medical Service Association Medicare	$679.83
Rate for Payer: Hawaii Western Management Group Commercial	$1,535.10
Rate for Payer: Health Management Network Commercial	$1,864.05
Rate for Payer: Humana Medicare	$679.83
Rate for Payer: Kaiser Permanente Commercial	$1,973.70
Rate for Payer: Kaiser Permanente Medicaid	$1,118.43
Rate for Payer: Kaiser Permanente Medicare	$679.83
Rate for Payer: MDX Hawaii PPO	$2,127.21
Rate for Payer: Ohana Health Plan Medicaid	$679.83
Rate for Payer: Ohana Health Plan Medicare	$679.83
Rate for Payer: UnitedHealthcare Medicare	$679.83
Rate for Payer: University Health Alliance Commercial	$1,228.08

PLATE OLECRANON 3H 65MM 629343

Facility

$2,193.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,228.08
Max. Negotiated Rate	$2,127.21
Rate for Payer: Cash Price	$1,315.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,535.10
Rate for Payer: Health Management Network Commercial	$1,864.05
Rate for Payer: Kaiser Permanente Commercial	$1,973.70
Rate for Payer: MDX Hawaii PPO	$2,127.21
Rate for Payer: University Health Alliance Commercial	$1,228.08

PLATE OLECRANON LF 629344

Facility

$2,418.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$749.58
Max. Negotiated Rate	$2,345.46
Rate for Payer: AlohaCare Medicaid	$1,209.00
Rate for Payer: AlohaCare Medicare	$749.58
Rate for Payer: Cash Price	$1,450.80
Rate for Payer: Devoted Health Medicare	$822.12
Rate for Payer: Hawaii Medical Service Association Medicare	$749.58
Rate for Payer: Hawaii Western Management Group Commercial	$1,692.60
Rate for Payer: Health Management Network Commercial	$2,055.30
Rate for Payer: Humana Medicare	$749.58
Rate for Payer: Kaiser Permanente Commercial	$2,176.20
Rate for Payer: Kaiser Permanente Medicaid	$1,233.18
Rate for Payer: Kaiser Permanente Medicare	$749.58
Rate for Payer: MDX Hawaii PPO	$2,345.46
Rate for Payer: Ohana Health Plan Medicaid	$749.58
Rate for Payer: Ohana Health Plan Medicare	$749.58
Rate for Payer: UnitedHealthcare Medicare	$749.58
Rate for Payer: University Health Alliance Commercial	$1,354.08

PLATE OLECRANON LF 629344

Facility

$2,418.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,354.08
Max. Negotiated Rate	$2,345.46
Rate for Payer: Cash Price	$1,450.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,692.60
Rate for Payer: Health Management Network Commercial	$2,055.30
Rate for Payer: Kaiser Permanente Commercial	$2,176.20
Rate for Payer: MDX Hawaii PPO	$2,345.46
Rate for Payer: University Health Alliance Commercial	$1,354.08

PLATE ONE THIRD 7H 71MM 626676

Facility

$1,234.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$691.04
Max. Negotiated Rate	$1,196.98
Rate for Payer: Cash Price	$740.40
Rate for Payer: Hawaii Western Management Group Commercial	$863.80
Rate for Payer: Health Management Network Commercial	$1,048.90
Rate for Payer: Kaiser Permanente Commercial	$1,110.60
Rate for Payer: MDX Hawaii PPO	$1,196.98
Rate for Payer: University Health Alliance Commercial	$691.04

PLATE ONE THIRD 7H 71MM 626676

Facility

$1,234.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$382.54
Max. Negotiated Rate	$1,196.98
Rate for Payer: AlohaCare Medicaid	$617.00
Rate for Payer: AlohaCare Medicare	$382.54
Rate for Payer: Cash Price	$740.40
Rate for Payer: Devoted Health Medicare	$419.56
Rate for Payer: Hawaii Medical Service Association Medicare	$382.54
Rate for Payer: Hawaii Western Management Group Commercial	$863.80
Rate for Payer: Health Management Network Commercial	$1,048.90
Rate for Payer: Humana Medicare	$382.54
Rate for Payer: Kaiser Permanente Commercial	$1,110.60
Rate for Payer: Kaiser Permanente Medicaid	$629.34
Rate for Payer: Kaiser Permanente Medicare	$382.54
Rate for Payer: MDX Hawaii PPO	$1,196.98
Rate for Payer: Ohana Health Plan Medicaid	$382.54
Rate for Payer: Ohana Health Plan Medicare	$382.54
Rate for Payer: UnitedHealthcare Medicare	$382.54
Rate for Payer: University Health Alliance Commercial	$691.04

PLATE PRIMARY 6 HOLE 336-3554

Facility

$3,605.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,117.55
Max. Negotiated Rate	$3,496.85
Rate for Payer: AlohaCare Medicaid	$1,802.50
Rate for Payer: AlohaCare Medicare	$1,117.55
Rate for Payer: Cash Price	$2,163.00
Rate for Payer: Devoted Health Medicare	$1,225.70
Rate for Payer: Hawaii Medical Service Association Medicare	$1,117.55
Rate for Payer: Hawaii Western Management Group Commercial	$2,523.50
Rate for Payer: Health Management Network Commercial	$3,064.25
Rate for Payer: Humana Medicare	$1,117.55
Rate for Payer: Kaiser Permanente Commercial	$3,244.50
Rate for Payer: Kaiser Permanente Medicaid	$1,838.55
Rate for Payer: Kaiser Permanente Medicare	$1,117.55
Rate for Payer: MDX Hawaii PPO	$3,496.85
Rate for Payer: Ohana Health Plan Medicaid	$1,117.55
Rate for Payer: Ohana Health Plan Medicare	$1,117.55
Rate for Payer: UnitedHealthcare Medicare	$1,117.55
Rate for Payer: University Health Alliance Commercial	$2,018.80

PLATE PRIMARY 6 HOLE 336-3554

Facility

$3,605.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,018.80
Max. Negotiated Rate	$3,496.85
Rate for Payer: Cash Price	$2,163.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,523.50
Rate for Payer: Health Management Network Commercial	$3,064.25
Rate for Payer: Kaiser Permanente Commercial	$3,244.50
Rate for Payer: MDX Hawaii PPO	$3,496.85
Rate for Payer: University Health Alliance Commercial	$2,018.80

PLATE PRIMRY 2.7MM LT 336-2754

Facility

$3,605.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,018.80
Max. Negotiated Rate	$3,496.85
Rate for Payer: Cash Price	$2,163.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,523.50
Rate for Payer: Health Management Network Commercial	$3,064.25
Rate for Payer: Kaiser Permanente Commercial	$3,244.50
Rate for Payer: MDX Hawaii PPO	$3,496.85
Rate for Payer: University Health Alliance Commercial	$2,018.80

PLATE PRIMRY 2.7MM LT 336-2754

Facility

$3,605.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,117.55
Max. Negotiated Rate	$3,496.85
Rate for Payer: AlohaCare Medicaid	$1,802.50
Rate for Payer: AlohaCare Medicare	$1,117.55
Rate for Payer: Cash Price	$2,163.00
Rate for Payer: Devoted Health Medicare	$1,225.70
Rate for Payer: Hawaii Medical Service Association Medicare	$1,117.55
Rate for Payer: Hawaii Western Management Group Commercial	$2,523.50
Rate for Payer: Health Management Network Commercial	$3,064.25
Rate for Payer: Humana Medicare	$1,117.55
Rate for Payer: Kaiser Permanente Commercial	$3,244.50
Rate for Payer: Kaiser Permanente Medicaid	$1,838.55
Rate for Payer: Kaiser Permanente Medicare	$1,117.55
Rate for Payer: MDX Hawaii PPO	$3,496.85
Rate for Payer: Ohana Health Plan Medicaid	$1,117.55
Rate for Payer: Ohana Health Plan Medicare	$1,117.55
Rate for Payer: UnitedHealthcare Medicare	$1,117.55
Rate for Payer: University Health Alliance Commercial	$2,018.80

PLATE PRMARY 2.7MM RT 336-2759

Facility

$3,605.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,018.80
Max. Negotiated Rate	$3,496.85
Rate for Payer: Cash Price	$2,163.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,523.50
Rate for Payer: Health Management Network Commercial	$3,064.25
Rate for Payer: Kaiser Permanente Commercial	$3,244.50
Rate for Payer: MDX Hawaii PPO	$3,496.85
Rate for Payer: University Health Alliance Commercial	$2,018.80

Know your out-of-pocket cost for care.

All Charges