Kau Hospital

All Charges

Charge

Type

Setting

Price

STEM CEMENT HIP 6057-0740D

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 CEMENT HIP 6057-0740D

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 DISTAL P.COAT ARS980902

Facility

$11,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,608.00
Max. Negotiated Rate	$11,446.00
Rate for Payer: Cash Price	$7,080.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,260.00
Rate for Payer: Health Management Network Commercial	$10,030.00
Rate for Payer: Kaiser Permanente Commercial	$10,620.00
Rate for Payer: MDX Hawaii PPO	$11,446.00
Rate for Payer: University Health Alliance Commercial	$6,608.00

STEM DISTAL P.COAT ARS980902

Facility

$11,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,658.00
Max. Negotiated Rate	$11,446.00
Rate for Payer: AlohaCare Medicaid	$5,900.00
Rate for Payer: AlohaCare Medicare	$3,658.00
Rate for Payer: Cash Price	$7,080.00
Rate for Payer: Devoted Health Medicare	$4,012.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,658.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,260.00
Rate for Payer: Health Management Network Commercial	$10,030.00
Rate for Payer: Humana Medicare	$3,658.00
Rate for Payer: Kaiser Permanente Commercial	$10,620.00
Rate for Payer: Kaiser Permanente Medicaid	$6,018.00
Rate for Payer: Kaiser Permanente Medicare	$3,658.00
Rate for Payer: MDX Hawaii PPO	$11,446.00
Rate for Payer: Ohana Health Plan Medicaid	$3,658.00
Rate for Payer: Ohana Health Plan Medicare	$3,658.00
Rate for Payer: UnitedHealthcare Medicare	$3,658.00
Rate for Payer: University Health Alliance Commercial	$6,608.00

STEM EVOLVE PROLIN 7.5 496S075

Facility

$4,530.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,404.30
Max. Negotiated Rate	$4,394.10
Rate for Payer: AlohaCare Medicaid	$2,265.00
Rate for Payer: AlohaCare Medicare	$1,404.30
Rate for Payer: Cash Price	$2,718.00
Rate for Payer: Devoted Health Medicare	$1,540.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,404.30
Rate for Payer: Hawaii Western Management Group Commercial	$3,171.00
Rate for Payer: Health Management Network Commercial	$3,850.50
Rate for Payer: Humana Medicare	$1,404.30
Rate for Payer: Kaiser Permanente Commercial	$4,077.00
Rate for Payer: Kaiser Permanente Medicaid	$2,310.30
Rate for Payer: Kaiser Permanente Medicare	$1,404.30
Rate for Payer: MDX Hawaii PPO	$4,394.10
Rate for Payer: Ohana Health Plan Medicaid	$1,404.30
Rate for Payer: Ohana Health Plan Medicare	$1,404.30
Rate for Payer: UnitedHealthcare Medicare	$1,404.30
Rate for Payer: University Health Alliance Commercial	$2,536.80

STEM EVOLVE PROLIN 7.5 496S075

Facility

$4,530.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,536.80
Max. Negotiated Rate	$4,394.10
Rate for Payer: Cash Price	$2,718.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,171.00
Rate for Payer: Health Management Network Commercial	$3,850.50
Rate for Payer: Kaiser Permanente Commercial	$4,077.00
Rate for Payer: MDX Hawaii PPO	$4,394.10
Rate for Payer: University Health Alliance Commercial	$2,536.80

STEM EXTEND TRIATHL 5571-S-025

Facility

$2,966.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$919.46
Max. Negotiated Rate	$2,877.02
Rate for Payer: AlohaCare Medicaid	$1,483.00
Rate for Payer: AlohaCare Medicare	$919.46
Rate for Payer: Cash Price	$1,779.60
Rate for Payer: Devoted Health Medicare	$1,008.44
Rate for Payer: Hawaii Medical Service Association Medicare	$919.46
Rate for Payer: Hawaii Western Management Group Commercial	$2,076.20
Rate for Payer: Health Management Network Commercial	$2,521.10
Rate for Payer: Humana Medicare	$919.46
Rate for Payer: Kaiser Permanente Commercial	$2,669.40
Rate for Payer: Kaiser Permanente Medicaid	$1,512.66
Rate for Payer: Kaiser Permanente Medicare	$919.46
Rate for Payer: MDX Hawaii PPO	$2,877.02
Rate for Payer: Ohana Health Plan Medicaid	$919.46
Rate for Payer: Ohana Health Plan Medicare	$919.46
Rate for Payer: UnitedHealthcare Medicare	$919.46
Rate for Payer: University Health Alliance Commercial	$1,660.96

STEM EXTEND TRIATHL 5571-S-025

Facility

$2,966.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,660.96
Max. Negotiated Rate	$2,877.02
Rate for Payer: Cash Price	$1,779.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,076.20
Rate for Payer: Health Management Network Commercial	$2,521.10
Rate for Payer: Kaiser Permanente Commercial	$2,669.40
Rate for Payer: MDX Hawaii PPO	$2,877.02
Rate for Payer: University Health Alliance Commercial	$1,660.96

STEM FEMORAL HIP 6276-7-120

Facility

$6,737.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,088.47
Max. Negotiated Rate	$6,534.89
Rate for Payer: AlohaCare Medicaid	$3,368.50
Rate for Payer: AlohaCare Medicare	$2,088.47
Rate for Payer: Cash Price	$4,042.20
Rate for Payer: Devoted Health Medicare	$2,290.58
Rate for Payer: Hawaii Medical Service Association Medicare	$2,088.47
Rate for Payer: Hawaii Western Management Group Commercial	$4,715.90
Rate for Payer: Health Management Network Commercial	$5,726.45
Rate for Payer: Humana Medicare	$2,088.47
Rate for Payer: Kaiser Permanente Commercial	$6,063.30
Rate for Payer: Kaiser Permanente Medicaid	$3,435.87
Rate for Payer: Kaiser Permanente Medicare	$2,088.47
Rate for Payer: MDX Hawaii PPO	$6,534.89
Rate for Payer: Ohana Health Plan Medicaid	$2,088.47
Rate for Payer: Ohana Health Plan Medicare	$2,088.47
Rate for Payer: UnitedHealthcare Medicare	$2,088.47
Rate for Payer: University Health Alliance Commercial	$3,772.72

STEM FEMORAL HIP 6276-7-120

Facility

$6,737.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,772.72
Max. Negotiated Rate	$6,534.89
Rate for Payer: Cash Price	$4,042.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,715.90
Rate for Payer: Health Management Network Commercial	$5,726.45
Rate for Payer: Kaiser Permanente Commercial	$6,063.30
Rate for Payer: MDX Hawaii PPO	$6,534.89
Rate for Payer: University Health Alliance Commercial	$3,772.72

STEM FINGER JOINT 470-0010

Facility

$2,522.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,412.32
Max. Negotiated Rate	$2,446.34
Rate for Payer: Cash Price	$1,513.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,765.40
Rate for Payer: Health Management Network Commercial	$2,143.70
Rate for Payer: Kaiser Permanente Commercial	$2,269.80
Rate for Payer: MDX Hawaii PPO	$2,446.34
Rate for Payer: University Health Alliance Commercial	$1,412.32

STEM FINGER JOINT 470-0010

Facility

$2,522.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$781.82
Max. Negotiated Rate	$2,446.34
Rate for Payer: AlohaCare Medicaid	$1,261.00
Rate for Payer: AlohaCare Medicare	$781.82
Rate for Payer: Cash Price	$1,513.20
Rate for Payer: Devoted Health Medicare	$857.48
Rate for Payer: Hawaii Medical Service Association Medicare	$781.82
Rate for Payer: Hawaii Western Management Group Commercial	$1,765.40
Rate for Payer: Health Management Network Commercial	$2,143.70
Rate for Payer: Humana Medicare	$781.82
Rate for Payer: Kaiser Permanente Commercial	$2,269.80
Rate for Payer: Kaiser Permanente Medicaid	$1,286.22
Rate for Payer: Kaiser Permanente Medicare	$781.82
Rate for Payer: MDX Hawaii PPO	$2,446.34
Rate for Payer: Ohana Health Plan Medicaid	$781.82
Rate for Payer: Ohana Health Plan Medicare	$781.82
Rate for Payer: UnitedHealthcare Medicare	$781.82
Rate for Payer: University Health Alliance Commercial	$1,412.32

STEM-FIXED HUM 42X21X43 113034

Facility

$2,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$682.00
Max. Negotiated Rate	$2,134.00
Rate for Payer: AlohaCare Medicaid	$1,100.00
Rate for Payer: AlohaCare Medicare	$682.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Devoted Health Medicare	$748.00
Rate for Payer: Hawaii Medical Service Association Medicare	$682.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,540.00
Rate for Payer: Health Management Network Commercial	$1,870.00
Rate for Payer: Humana Medicare	$682.00
Rate for Payer: Kaiser Permanente Commercial	$1,980.00
Rate for Payer: Kaiser Permanente Medicaid	$1,122.00
Rate for Payer: Kaiser Permanente Medicare	$682.00
Rate for Payer: MDX Hawaii PPO	$2,134.00
Rate for Payer: Ohana Health Plan Medicaid	$682.00
Rate for Payer: Ohana Health Plan Medicare	$682.00
Rate for Payer: UnitedHealthcare Medicare	$682.00
Rate for Payer: University Health Alliance Commercial	$1,232.00

STEM-FIXED HUM 42X21X43 113034

Facility

$2,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,232.00
Max. Negotiated Rate	$2,134.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,540.00
Rate for Payer: Health Management Network Commercial	$1,870.00
Rate for Payer: Kaiser Permanente Commercial	$1,980.00
Rate for Payer: MDX Hawaii PPO	$2,134.00
Rate for Payer: University Health Alliance Commercial	$1,232.00

STEM FLUTED TRIATH 5565-S-021

Facility

$2,421.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,355.76
Max. Negotiated Rate	$2,348.37
Rate for Payer: Cash Price	$1,452.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,694.70
Rate for Payer: Health Management Network Commercial	$2,057.85
Rate for Payer: Kaiser Permanente Commercial	$2,178.90
Rate for Payer: MDX Hawaii PPO	$2,348.37
Rate for Payer: University Health Alliance Commercial	$1,355.76

STEM FLUTED TRIATH 5565-S-021

Facility

$2,421.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$750.51
Max. Negotiated Rate	$2,348.37
Rate for Payer: AlohaCare Medicaid	$1,210.50
Rate for Payer: AlohaCare Medicare	$750.51
Rate for Payer: Cash Price	$1,452.60
Rate for Payer: Devoted Health Medicare	$823.14
Rate for Payer: Hawaii Medical Service Association Medicare	$750.51
Rate for Payer: Hawaii Western Management Group Commercial	$1,694.70
Rate for Payer: Health Management Network Commercial	$2,057.85
Rate for Payer: Humana Medicare	$750.51
Rate for Payer: Kaiser Permanente Commercial	$2,178.90
Rate for Payer: Kaiser Permanente Medicaid	$1,234.71
Rate for Payer: Kaiser Permanente Medicare	$750.51
Rate for Payer: MDX Hawaii PPO	$2,348.37
Rate for Payer: Ohana Health Plan Medicaid	$750.51
Rate for Payer: Ohana Health Plan Medicare	$750.51
Rate for Payer: UnitedHealthcare Medicare	$750.51
Rate for Payer: University Health Alliance Commercial	$1,355.76

STEM FRACTURE STD

Facility

$14,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,576.22
Max. Negotiated Rate	$14,319.14
Rate for Payer: AlohaCare Medicaid	$7,381.00
Rate for Payer: AlohaCare Medicare	$4,576.22
Rate for Payer: Cash Price	$8,857.20
Rate for Payer: Devoted Health Medicare	$5,019.08
Rate for Payer: Hawaii Medical Service Association Medicare	$4,576.22
Rate for Payer: Hawaii Western Management Group Commercial	$10,333.40
Rate for Payer: Health Management Network Commercial	$12,547.70
Rate for Payer: Humana Medicare	$4,576.22
Rate for Payer: Kaiser Permanente Commercial	$13,285.80
Rate for Payer: Kaiser Permanente Medicaid	$7,528.62
Rate for Payer: Kaiser Permanente Medicare	$4,576.22
Rate for Payer: MDX Hawaii PPO	$14,319.14
Rate for Payer: Ohana Health Plan Medicaid	$4,576.22
Rate for Payer: Ohana Health Plan Medicare	$4,576.22
Rate for Payer: UnitedHealthcare Medicare	$4,576.22
Rate for Payer: University Health Alliance Commercial	$8,266.72

STEM FRACTURE STD

Facility

$14,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$8,266.72
Max. Negotiated Rate	$14,319.14
Rate for Payer: Cash Price	$8,857.20
Rate for Payer: Hawaii Western Management Group Commercial	$10,333.40
Rate for Payer: Health Management Network Commercial	$12,547.70
Rate for Payer: Kaiser Permanente Commercial	$13,285.80
Rate for Payer: MDX Hawaii PPO	$14,319.14
Rate for Payer: University Health Alliance Commercial	$8,266.72

STEM HIP 37X114MM 6721-0737

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 HIP 37X114MM 6721-0737

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 HIP 6051-0525S

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 HIP 6051-0525S

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 HIP ACCOLADE 6057-0537D

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 HIP ACCOLADE 6057-0537D

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 HIP OMNIFIT #6 6098-0630

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

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