Kau Hospital

All Charges

Charge

Type

Setting

Price

STEINMAN PIN 3.6MM 187-05-59

Facility

$110.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$34.10
Max. Negotiated Rate	$106.70
Rate for Payer: AlohaCare Medicaid	$55.00
Rate for Payer: AlohaCare Medicare	$34.10
Rate for Payer: Cash Price	$66.00
Rate for Payer: Devoted Health Medicare	$37.40
Rate for Payer: Hawaii Medical Service Association Medicare	$34.10
Rate for Payer: Hawaii Western Management Group Commercial	$77.00
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: Humana Medicare	$34.10
Rate for Payer: Kaiser Permanente Commercial	$99.00
Rate for Payer: Kaiser Permanente Medicaid	$56.10
Rate for Payer: Kaiser Permanente Medicare	$34.10
Rate for Payer: MDX Hawaii PPO	$106.70
Rate for Payer: Ohana Health Plan Medicaid	$34.10
Rate for Payer: Ohana Health Plan Medicare	$34.10
Rate for Payer: UnitedHealthcare Medicare	$34.10
Rate for Payer: University Health Alliance Commercial	$61.60

STEINMAN PIN 4.0MM 187-06-59

Facility

$227.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$70.37
Max. Negotiated Rate	$220.19
Rate for Payer: AlohaCare Medicaid	$113.50
Rate for Payer: AlohaCare Medicare	$70.37
Rate for Payer: Cash Price	$136.20
Rate for Payer: Devoted Health Medicare	$77.18
Rate for Payer: Hawaii Medical Service Association Medicare	$70.37
Rate for Payer: Hawaii Western Management Group Commercial	$158.90
Rate for Payer: Health Management Network Commercial	$192.95
Rate for Payer: Humana Medicare	$70.37
Rate for Payer: Kaiser Permanente Commercial	$204.30
Rate for Payer: Kaiser Permanente Medicaid	$115.77
Rate for Payer: Kaiser Permanente Medicare	$70.37
Rate for Payer: MDX Hawaii PPO	$220.19
Rate for Payer: Ohana Health Plan Medicaid	$70.37
Rate for Payer: Ohana Health Plan Medicare	$70.37
Rate for Payer: UnitedHealthcare Medicare	$70.37
Rate for Payer: University Health Alliance Commercial	$127.12

STEINMAN PIN 4.0MM 187-06-59

Facility

$227.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$127.12
Max. Negotiated Rate	$220.19
Rate for Payer: Cash Price	$136.20
Rate for Payer: Hawaii Western Management Group Commercial	$158.90
Rate for Payer: Health Management Network Commercial	$192.95
Rate for Payer: Kaiser Permanente Commercial	$204.30
Rate for Payer: MDX Hawaii PPO	$220.19
Rate for Payer: University Health Alliance Commercial	$127.12

STEM 11X40MM 127° 6052-1140S

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,791.80
Max. Negotiated Rate	$5,606.60
Rate for Payer: AlohaCare Medicaid	$2,890.00
Rate for Payer: AlohaCare Medicare	$1,791.80
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Devoted Health Medicare	$1,965.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,791.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Humana Medicare	$1,791.80
Rate for Payer: Kaiser Permanente Commercial	$5,202.00
Rate for Payer: Kaiser Permanente Medicaid	$2,947.80
Rate for Payer: Kaiser Permanente Medicare	$1,791.80
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: Ohana Health Plan Medicaid	$1,791.80
Rate for Payer: Ohana Health Plan Medicare	$1,791.80
Rate for Payer: UnitedHealthcare Medicare	$1,791.80
Rate for Payer: University Health Alliance Commercial	$3,236.80

STEM 11X40MM 127° 6052-1140S

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,236.80
Max. Negotiated Rate	$5,606.60
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Kaiser Permanente Commercial	$5,202.00
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: University Health Alliance Commercial	$3,236.80

STEM ACCOLADE HIP 6057-0230D

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,733.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Kaiser Permanente Commercial	$2,786.40
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

STEM ACCOLADE HIP 6057-0230D

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$959.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: AlohaCare Medicaid	$1,548.00
Rate for Payer: AlohaCare Medicare	$959.76
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Devoted Health Medicare	$1,052.64
Rate for Payer: Hawaii Medical Service Association Medicare	$959.76
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Humana Medicare	$959.76
Rate for Payer: Kaiser Permanente Commercial	$2,786.40
Rate for Payer: Kaiser Permanente Medicaid	$1,578.96
Rate for Payer: Kaiser Permanente Medicare	$959.76
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: Ohana Health Plan Medicaid	$959.76
Rate for Payer: Ohana Health Plan Medicare	$959.76
Rate for Payer: UnitedHealthcare Medicare	$959.76
Rate for Payer: University Health Alliance Commercial	$1,733.76

STEM ACCOLADE SZ2 6721-0230

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,236.80
Max. Negotiated Rate	$5,606.60
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Kaiser Permanente Commercial	$5,202.00
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: University Health Alliance Commercial	$3,236.80

STEM ACCOLADE SZ2 6721-0230

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,791.80
Max. Negotiated Rate	$5,606.60
Rate for Payer: AlohaCare Medicaid	$2,890.00
Rate for Payer: AlohaCare Medicare	$1,791.80
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Devoted Health Medicare	$1,965.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,791.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Humana Medicare	$1,791.80
Rate for Payer: Kaiser Permanente Commercial	$5,202.00
Rate for Payer: Kaiser Permanente Medicaid	$2,947.80
Rate for Payer: Kaiser Permanente Medicare	$1,791.80
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: Ohana Health Plan Medicaid	$1,791.80
Rate for Payer: Ohana Health Plan Medicare	$1,791.80
Rate for Payer: UnitedHealthcare Medicare	$1,791.80
Rate for Payer: University Health Alliance Commercial	$3,236.80

STEM AS CEMENTD HUMERAL 12X110

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,480.00
Max. Negotiated Rate	$7,760.00
Rate for Payer: Cash Price	$4,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,600.00
Rate for Payer: Health Management Network Commercial	$6,800.00
Rate for Payer: Kaiser Permanente Commercial	$7,200.00
Rate for Payer: MDX Hawaii PPO	$7,760.00
Rate for Payer: University Health Alliance Commercial	$4,480.00

STEM AS CEMENTD HUMERAL 12X110

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,480.00
Max. Negotiated Rate	$7,760.00
Rate for Payer: AlohaCare Medicaid	$4,000.00
Rate for Payer: AlohaCare Medicare	$2,480.00
Rate for Payer: Cash Price	$4,800.00
Rate for Payer: Devoted Health Medicare	$2,720.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,480.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,600.00
Rate for Payer: Health Management Network Commercial	$6,800.00
Rate for Payer: Humana Medicare	$2,480.00
Rate for Payer: Kaiser Permanente Commercial	$7,200.00
Rate for Payer: Kaiser Permanente Medicaid	$4,080.00
Rate for Payer: Kaiser Permanente Medicare	$2,480.00
Rate for Payer: MDX Hawaii PPO	$7,760.00
Rate for Payer: Ohana Health Plan Medicaid	$2,480.00
Rate for Payer: Ohana Health Plan Medicare	$2,480.00
Rate for Payer: UnitedHealthcare Medicare	$2,480.00
Rate for Payer: University Health Alliance Commercial	$4,480.00

STEM AS CEMENTD HUMERAL 14X110

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,480.00
Max. Negotiated Rate	$7,760.00
Rate for Payer: Cash Price	$4,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,600.00
Rate for Payer: Health Management Network Commercial	$6,800.00
Rate for Payer: Kaiser Permanente Commercial	$7,200.00
Rate for Payer: MDX Hawaii PPO	$7,760.00
Rate for Payer: University Health Alliance Commercial	$4,480.00

STEM AS CEMENTD HUMERAL 14X110

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,480.00
Max. Negotiated Rate	$7,760.00
Rate for Payer: AlohaCare Medicaid	$4,000.00
Rate for Payer: AlohaCare Medicare	$2,480.00
Rate for Payer: Cash Price	$4,800.00
Rate for Payer: Devoted Health Medicare	$2,720.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,480.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,600.00
Rate for Payer: Health Management Network Commercial	$6,800.00
Rate for Payer: Humana Medicare	$2,480.00
Rate for Payer: Kaiser Permanente Commercial	$7,200.00
Rate for Payer: Kaiser Permanente Medicaid	$4,080.00
Rate for Payer: Kaiser Permanente Medicare	$2,480.00
Rate for Payer: MDX Hawaii PPO	$7,760.00
Rate for Payer: Ohana Health Plan Medicaid	$2,480.00
Rate for Payer: Ohana Health Plan Medicare	$2,480.00
Rate for Payer: UnitedHealthcare Medicare	$2,480.00
Rate for Payer: University Health Alliance Commercial	$4,480.00

STEM AS CEMENTED HUMERAL 7X100

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,480.00
Max. Negotiated Rate	$7,760.00
Rate for Payer: Cash Price	$4,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,600.00
Rate for Payer: Health Management Network Commercial	$6,800.00
Rate for Payer: Kaiser Permanente Commercial	$7,200.00
Rate for Payer: MDX Hawaii PPO	$7,760.00
Rate for Payer: University Health Alliance Commercial	$4,480.00

STEM AS CEMENTED HUMERAL 7X100

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,480.00
Max. Negotiated Rate	$7,760.00
Rate for Payer: AlohaCare Medicaid	$4,000.00
Rate for Payer: AlohaCare Medicare	$2,480.00
Rate for Payer: Cash Price	$4,800.00
Rate for Payer: Devoted Health Medicare	$2,720.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,480.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,600.00
Rate for Payer: Health Management Network Commercial	$6,800.00
Rate for Payer: Humana Medicare	$2,480.00
Rate for Payer: Kaiser Permanente Commercial	$7,200.00
Rate for Payer: Kaiser Permanente Medicaid	$4,080.00
Rate for Payer: Kaiser Permanente Medicare	$2,480.00
Rate for Payer: MDX Hawaii PPO	$7,760.00
Rate for Payer: Ohana Health Plan Medicaid	$2,480.00
Rate for Payer: Ohana Health Plan Medicare	$2,480.00
Rate for Payer: UnitedHealthcare Medicare	$2,480.00
Rate for Payer: University Health Alliance Commercial	$4,480.00

STEM AS CEMENTED HUMERAL 9X110

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,480.00
Max. Negotiated Rate	$7,760.00
Rate for Payer: AlohaCare Medicaid	$4,000.00
Rate for Payer: AlohaCare Medicare	$2,480.00
Rate for Payer: Cash Price	$4,800.00
Rate for Payer: Devoted Health Medicare	$2,720.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,480.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,600.00
Rate for Payer: Health Management Network Commercial	$6,800.00
Rate for Payer: Humana Medicare	$2,480.00
Rate for Payer: Kaiser Permanente Commercial	$7,200.00
Rate for Payer: Kaiser Permanente Medicaid	$4,080.00
Rate for Payer: Kaiser Permanente Medicare	$2,480.00
Rate for Payer: MDX Hawaii PPO	$7,760.00
Rate for Payer: Ohana Health Plan Medicaid	$2,480.00
Rate for Payer: Ohana Health Plan Medicare	$2,480.00
Rate for Payer: UnitedHealthcare Medicare	$2,480.00
Rate for Payer: University Health Alliance Commercial	$4,480.00

STEM AS CEMENTED HUMERAL 9X110

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,480.00
Max. Negotiated Rate	$7,760.00
Rate for Payer: Cash Price	$4,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,600.00
Rate for Payer: Health Management Network Commercial	$6,800.00
Rate for Payer: Kaiser Permanente Commercial	$7,200.00
Rate for Payer: MDX Hawaii PPO	$7,760.00
Rate for Payer: University Health Alliance Commercial	$4,480.00

STEM CEMENT 12X50MM 5560-S-112

Facility

$2,271.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$704.01
Max. Negotiated Rate	$2,202.87
Rate for Payer: AlohaCare Medicaid	$1,135.50
Rate for Payer: AlohaCare Medicare	$704.01
Rate for Payer: Cash Price	$1,362.60
Rate for Payer: Devoted Health Medicare	$772.14
Rate for Payer: Hawaii Medical Service Association Medicare	$704.01
Rate for Payer: Hawaii Western Management Group Commercial	$1,589.70
Rate for Payer: Health Management Network Commercial	$1,930.35
Rate for Payer: Humana Medicare	$704.01
Rate for Payer: Kaiser Permanente Commercial	$2,043.90
Rate for Payer: Kaiser Permanente Medicaid	$1,158.21
Rate for Payer: Kaiser Permanente Medicare	$704.01
Rate for Payer: MDX Hawaii PPO	$2,202.87
Rate for Payer: Ohana Health Plan Medicaid	$704.01
Rate for Payer: Ohana Health Plan Medicare	$704.01
Rate for Payer: UnitedHealthcare Medicare	$704.01
Rate for Payer: University Health Alliance Commercial	$1,271.76

STEM CEMENT 12X50MM 5560-S-112

Facility

$2,271.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,271.76
Max. Negotiated Rate	$2,202.87
Rate for Payer: Cash Price	$1,362.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,589.70
Rate for Payer: Health Management Network Commercial	$1,930.35
Rate for Payer: Kaiser Permanente Commercial	$2,043.90
Rate for Payer: MDX Hawaii PPO	$2,202.87
Rate for Payer: University Health Alliance Commercial	$1,271.76

STEM CEMENTED HIP 6057-0335D

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$959.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: AlohaCare Medicaid	$1,548.00
Rate for Payer: AlohaCare Medicare	$959.76
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Devoted Health Medicare	$1,052.64
Rate for Payer: Hawaii Medical Service Association Medicare	$959.76
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Humana Medicare	$959.76
Rate for Payer: Kaiser Permanente Commercial	$2,786.40
Rate for Payer: Kaiser Permanente Medicaid	$1,578.96
Rate for Payer: Kaiser Permanente Medicare	$959.76
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: Ohana Health Plan Medicaid	$959.76
Rate for Payer: Ohana Health Plan Medicare	$959.76
Rate for Payer: UnitedHealthcare Medicare	$959.76
Rate for Payer: University Health Alliance Commercial	$1,733.76

STEM CEMENTED HIP 6057-0335D

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,733.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Kaiser Permanente Commercial	$2,786.40
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

STEM CEMENTED HIP 6058-0335D

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$959.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: AlohaCare Medicaid	$1,548.00
Rate for Payer: AlohaCare Medicare	$959.76
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Devoted Health Medicare	$1,052.64
Rate for Payer: Hawaii Medical Service Association Medicare	$959.76
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Humana Medicare	$959.76
Rate for Payer: Kaiser Permanente Commercial	$2,786.40
Rate for Payer: Kaiser Permanente Medicaid	$1,578.96
Rate for Payer: Kaiser Permanente Medicare	$959.76
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: Ohana Health Plan Medicaid	$959.76
Rate for Payer: Ohana Health Plan Medicare	$959.76
Rate for Payer: UnitedHealthcare Medicare	$959.76
Rate for Payer: University Health Alliance Commercial	$1,733.76

STEM CEMENTED HIP 6058-0335D

Facility

$3,096.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,733.76
Max. Negotiated Rate	$3,003.12
Rate for Payer: Cash Price	$1,857.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,167.20
Rate for Payer: Health Management Network Commercial	$2,631.60
Rate for Payer: Kaiser Permanente Commercial	$2,786.40
Rate for Payer: MDX Hawaii PPO	$3,003.12
Rate for Payer: University Health Alliance Commercial	$1,733.76

STEM CEMENTED TRIAT 5560-S-115

Facility

$2,163.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$670.53
Max. Negotiated Rate	$2,098.11
Rate for Payer: AlohaCare Medicaid	$1,081.50
Rate for Payer: AlohaCare Medicare	$670.53
Rate for Payer: Cash Price	$1,297.80
Rate for Payer: Devoted Health Medicare	$735.42
Rate for Payer: Hawaii Medical Service Association Medicare	$670.53
Rate for Payer: Hawaii Western Management Group Commercial	$1,514.10
Rate for Payer: Health Management Network Commercial	$1,838.55
Rate for Payer: Humana Medicare	$670.53
Rate for Payer: Kaiser Permanente Commercial	$1,946.70
Rate for Payer: Kaiser Permanente Medicaid	$1,103.13
Rate for Payer: Kaiser Permanente Medicare	$670.53
Rate for Payer: MDX Hawaii PPO	$2,098.11
Rate for Payer: Ohana Health Plan Medicaid	$670.53
Rate for Payer: Ohana Health Plan Medicare	$670.53
Rate for Payer: UnitedHealthcare Medicare	$670.53
Rate for Payer: University Health Alliance Commercial	$1,211.28

STEM CEMENTED TRIAT 5560-S-115

Facility

$2,163.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,211.28
Max. Negotiated Rate	$2,098.11
Rate for Payer: Cash Price	$1,297.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,514.10
Rate for Payer: Health Management Network Commercial	$1,838.55
Rate for Payer: Kaiser Permanente Commercial	$1,946.70
Rate for Payer: MDX Hawaii PPO	$2,098.11
Rate for Payer: University Health Alliance Commercial	$1,211.28

Know your out-of-pocket cost for care.

All Charges