Kau Hospital

All Charges

Charge

Type

Setting

Price

STEM HIP OMNIFIT #6 6098-0630

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 SECUR-FIT 6052-1035S

Facility

$5,839.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,269.84
Max. Negotiated Rate	$5,663.83
Rate for Payer: Cash Price	$3,503.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,087.30
Rate for Payer: Health Management Network Commercial	$4,963.15
Rate for Payer: Kaiser Permanente Commercial	$5,255.10
Rate for Payer: MDX Hawaii PPO	$5,663.83
Rate for Payer: University Health Alliance Commercial	$3,269.84

STEM HIP SECUR-FIT 6052-1035S

Facility

$5,839.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,810.09
Max. Negotiated Rate	$5,663.83
Rate for Payer: AlohaCare Medicaid	$2,919.50
Rate for Payer: AlohaCare Medicare	$1,810.09
Rate for Payer: Cash Price	$3,503.40
Rate for Payer: Devoted Health Medicare	$1,985.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1,810.09
Rate for Payer: Hawaii Western Management Group Commercial	$4,087.30
Rate for Payer: Health Management Network Commercial	$4,963.15
Rate for Payer: Humana Medicare	$1,810.09
Rate for Payer: Kaiser Permanente Commercial	$5,255.10
Rate for Payer: Kaiser Permanente Medicaid	$2,977.89
Rate for Payer: Kaiser Permanente Medicare	$1,810.09
Rate for Payer: MDX Hawaii PPO	$5,663.83
Rate for Payer: Ohana Health Plan Medicaid	$1,810.09
Rate for Payer: Ohana Health Plan Medicare	$1,810.09
Rate for Payer: UnitedHealthcare Medicare	$1,810.09
Rate for Payer: University Health Alliance Commercial	$3,269.84

STEM HUM 10X123MM 5569-P-2010

Facility

$9,010.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,045.60
Max. Negotiated Rate	$8,739.70
Rate for Payer: Cash Price	$5,406.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,307.00
Rate for Payer: Health Management Network Commercial	$7,658.50
Rate for Payer: Kaiser Permanente Commercial	$8,109.00
Rate for Payer: MDX Hawaii PPO	$8,739.70
Rate for Payer: University Health Alliance Commercial	$5,045.60

STEM HUM 10X123MM 5569-P-2010

Facility

$9,010.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,793.10
Max. Negotiated Rate	$8,739.70
Rate for Payer: AlohaCare Medicaid	$4,505.00
Rate for Payer: AlohaCare Medicare	$2,793.10
Rate for Payer: Cash Price	$5,406.00
Rate for Payer: Devoted Health Medicare	$3,063.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,793.10
Rate for Payer: Hawaii Western Management Group Commercial	$6,307.00
Rate for Payer: Health Management Network Commercial	$7,658.50
Rate for Payer: Humana Medicare	$2,793.10
Rate for Payer: Kaiser Permanente Commercial	$8,109.00
Rate for Payer: Kaiser Permanente Medicaid	$4,595.10
Rate for Payer: Kaiser Permanente Medicare	$2,793.10
Rate for Payer: MDX Hawaii PPO	$8,739.70
Rate for Payer: Ohana Health Plan Medicaid	$2,793.10
Rate for Payer: Ohana Health Plan Medicare	$2,793.10
Rate for Payer: UnitedHealthcare Medicare	$2,793.10
Rate for Payer: University Health Alliance Commercial	$5,045.60

STEM HUM 13 128MM 5569-P-2013

Facility

$9,010.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,045.60
Max. Negotiated Rate	$8,739.70
Rate for Payer: Cash Price	$5,406.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,307.00
Rate for Payer: Health Management Network Commercial	$7,658.50
Rate for Payer: Kaiser Permanente Commercial	$8,109.00
Rate for Payer: MDX Hawaii PPO	$8,739.70
Rate for Payer: University Health Alliance Commercial	$5,045.60

STEM HUM 13 128MM 5569-P-2013

Facility

$9,010.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,793.10
Max. Negotiated Rate	$8,739.70
Rate for Payer: AlohaCare Medicaid	$4,505.00
Rate for Payer: AlohaCare Medicare	$2,793.10
Rate for Payer: Cash Price	$5,406.00
Rate for Payer: Devoted Health Medicare	$3,063.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,793.10
Rate for Payer: Hawaii Western Management Group Commercial	$6,307.00
Rate for Payer: Health Management Network Commercial	$7,658.50
Rate for Payer: Humana Medicare	$2,793.10
Rate for Payer: Kaiser Permanente Commercial	$8,109.00
Rate for Payer: Kaiser Permanente Medicaid	$4,595.10
Rate for Payer: Kaiser Permanente Medicare	$2,793.10
Rate for Payer: MDX Hawaii PPO	$8,739.70
Rate for Payer: Ohana Health Plan Medicaid	$2,793.10
Rate for Payer: Ohana Health Plan Medicare	$2,793.10
Rate for Payer: UnitedHealthcare Medicare	$2,793.10
Rate for Payer: University Health Alliance Commercial	$5,045.60

STEM HUM 15X133MM 5569-P-2015

Facility

$9,010.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,793.10
Max. Negotiated Rate	$8,739.70
Rate for Payer: AlohaCare Medicaid	$4,505.00
Rate for Payer: AlohaCare Medicare	$2,793.10
Rate for Payer: Cash Price	$5,406.00
Rate for Payer: Devoted Health Medicare	$3,063.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,793.10
Rate for Payer: Hawaii Western Management Group Commercial	$6,307.00
Rate for Payer: Health Management Network Commercial	$7,658.50
Rate for Payer: Humana Medicare	$2,793.10
Rate for Payer: Kaiser Permanente Commercial	$8,109.00
Rate for Payer: Kaiser Permanente Medicaid	$4,595.10
Rate for Payer: Kaiser Permanente Medicare	$2,793.10
Rate for Payer: MDX Hawaii PPO	$8,739.70
Rate for Payer: Ohana Health Plan Medicaid	$2,793.10
Rate for Payer: Ohana Health Plan Medicare	$2,793.10
Rate for Payer: UnitedHealthcare Medicare	$2,793.10
Rate for Payer: University Health Alliance Commercial	$5,045.60

STEM HUM 15X133MM 5569-P-2015

Facility

$9,010.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,045.60
Max. Negotiated Rate	$8,739.70
Rate for Payer: Cash Price	$5,406.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,307.00
Rate for Payer: Health Management Network Commercial	$7,658.50
Rate for Payer: Kaiser Permanente Commercial	$8,109.00
Rate for Payer: MDX Hawaii PPO	$8,739.70
Rate for Payer: University Health Alliance Commercial	$5,045.60

STEM HUM 7X113MM RFX 5568-0007

Facility

$15,748.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,881.88
Max. Negotiated Rate	$15,275.56
Rate for Payer: AlohaCare Medicaid	$7,874.00
Rate for Payer: AlohaCare Medicare	$4,881.88
Rate for Payer: Cash Price	$9,448.80
Rate for Payer: Devoted Health Medicare	$5,354.32
Rate for Payer: Hawaii Medical Service Association Medicare	$4,881.88
Rate for Payer: Hawaii Western Management Group Commercial	$11,023.60
Rate for Payer: Health Management Network Commercial	$13,385.80
Rate for Payer: Humana Medicare	$4,881.88
Rate for Payer: Kaiser Permanente Commercial	$14,173.20
Rate for Payer: Kaiser Permanente Medicaid	$8,031.48
Rate for Payer: Kaiser Permanente Medicare	$4,881.88
Rate for Payer: MDX Hawaii PPO	$15,275.56
Rate for Payer: Ohana Health Plan Medicaid	$4,881.88
Rate for Payer: Ohana Health Plan Medicare	$4,881.88
Rate for Payer: UnitedHealthcare Medicare	$4,881.88
Rate for Payer: University Health Alliance Commercial	$8,818.88

STEM HUM 7X113MM RFX 5568-0007

Facility

$15,748.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$8,818.88
Max. Negotiated Rate	$15,275.56
Rate for Payer: Cash Price	$9,448.80
Rate for Payer: Hawaii Western Management Group Commercial	$11,023.60
Rate for Payer: Health Management Network Commercial	$13,385.80
Rate for Payer: Kaiser Permanente Commercial	$14,173.20
Rate for Payer: MDX Hawaii PPO	$15,275.56
Rate for Payer: University Health Alliance Commercial	$8,818.88

STEM HUMERAL 10X55MM 113610

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

STEM HUMERAL 10X55MM 113610

Facility

$5,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,550.00
Max. Negotiated Rate	$4,850.00
Rate for Payer: AlohaCare Medicaid	$2,500.00
Rate for Payer: AlohaCare Medicare	$1,550.00
Rate for Payer: Cash Price	$3,000.00
Rate for Payer: Devoted Health Medicare	$1,700.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,550.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,500.00
Rate for Payer: Health Management Network Commercial	$4,250.00
Rate for Payer: Humana Medicare	$1,550.00
Rate for Payer: Kaiser Permanente Commercial	$4,500.00
Rate for Payer: Kaiser Permanente Medicaid	$2,550.00
Rate for Payer: Kaiser Permanente Medicare	$1,550.00
Rate for Payer: MDX Hawaii PPO	$4,850.00
Rate for Payer: Ohana Health Plan Medicaid	$1,550.00
Rate for Payer: Ohana Health Plan Medicare	$1,550.00
Rate for Payer: UnitedHealthcare Medicare	$1,550.00
Rate for Payer: University Health Alliance Commercial	$2,800.00

STEM HUMERAL 9MM 5568-0009

Facility

$8,462.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,738.72
Max. Negotiated Rate	$8,208.14
Rate for Payer: Cash Price	$5,077.20
Rate for Payer: Hawaii Western Management Group Commercial	$5,923.40
Rate for Payer: Health Management Network Commercial	$7,192.70
Rate for Payer: Kaiser Permanente Commercial	$7,615.80
Rate for Payer: MDX Hawaii PPO	$8,208.14
Rate for Payer: University Health Alliance Commercial	$4,738.72

STEM HUMERAL 9MM 5568-0009

Facility

$8,462.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,623.22
Max. Negotiated Rate	$8,208.14
Rate for Payer: AlohaCare Medicaid	$4,231.00
Rate for Payer: AlohaCare Medicare	$2,623.22
Rate for Payer: Cash Price	$5,077.20
Rate for Payer: Devoted Health Medicare	$2,877.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,623.22
Rate for Payer: Hawaii Western Management Group Commercial	$5,923.40
Rate for Payer: Health Management Network Commercial	$7,192.70
Rate for Payer: Humana Medicare	$2,623.22
Rate for Payer: Kaiser Permanente Commercial	$7,615.80
Rate for Payer: Kaiser Permanente Medicaid	$4,315.62
Rate for Payer: Kaiser Permanente Medicare	$2,623.22
Rate for Payer: MDX Hawaii PPO	$8,208.14
Rate for Payer: Ohana Health Plan Medicaid	$2,623.22
Rate for Payer: Ohana Health Plan Medicare	$2,623.22
Rate for Payer: UnitedHealthcare Medicare	$2,623.22
Rate for Payer: University Health Alliance Commercial	$4,738.72

STEM HUMERAL 9MM AR-9100-09S

Facility

$11,930.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,680.80
Max. Negotiated Rate	$11,572.10
Rate for Payer: Cash Price	$7,158.00
Rate for Payer: Hawaii Western Management Group Commercial	$8,351.00
Rate for Payer: Health Management Network Commercial	$10,140.50
Rate for Payer: Kaiser Permanente Commercial	$10,737.00
Rate for Payer: MDX Hawaii PPO	$11,572.10
Rate for Payer: University Health Alliance Commercial	$6,680.80

STEM HUMERAL 9MM AR-9100-09S

Facility

$11,930.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,698.30
Max. Negotiated Rate	$11,572.10
Rate for Payer: AlohaCare Medicaid	$5,965.00
Rate for Payer: AlohaCare Medicare	$3,698.30
Rate for Payer: Cash Price	$7,158.00
Rate for Payer: Devoted Health Medicare	$4,056.20
Rate for Payer: Hawaii Medical Service Association Medicare	$3,698.30
Rate for Payer: Hawaii Western Management Group Commercial	$8,351.00
Rate for Payer: Health Management Network Commercial	$10,140.50
Rate for Payer: Humana Medicare	$3,698.30
Rate for Payer: Kaiser Permanente Commercial	$10,737.00
Rate for Payer: Kaiser Permanente Medicaid	$6,084.30
Rate for Payer: Kaiser Permanente Medicare	$3,698.30
Rate for Payer: MDX Hawaii PPO	$11,572.10
Rate for Payer: Ohana Health Plan Medicaid	$3,698.30
Rate for Payer: Ohana Health Plan Medicare	$3,698.30
Rate for Payer: UnitedHealthcare Medicare	$3,698.30
Rate for Payer: University Health Alliance Commercial	$6,680.80

STEM HUMERAL CEMENTED X12-100

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 HUMERAL CEMENTED X12-100

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 HUMERAL CEMENTED X14-100

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 HUMERAL CEMENTED X14-100

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 HUMERAL CEMENTED X16-120

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 HUMERAL CEMENTED X16-120

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 HUMERAL CEMENTED X18-120

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 HUMERAL CEMENTED X18-120

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

Know your out-of-pocket cost for care.

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