Kau Hospital

All Charges

Charge

Type

Setting

Price

STEM HUMERAL MODULAR 14X133MM

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 HUMERAL MODULAR 14X133MM

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 HUMERAL SMALL LEFT 72MM

Facility

$13,242.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$7,415.52
Max. Negotiated Rate	$12,844.74
Rate for Payer: Cash Price	$7,945.20
Rate for Payer: Hawaii Western Management Group Commercial	$9,269.40
Rate for Payer: Health Management Network Commercial	$11,255.70
Rate for Payer: Kaiser Permanente Commercial	$11,917.80
Rate for Payer: MDX Hawaii PPO	$12,844.74
Rate for Payer: University Health Alliance Commercial	$7,415.52

STEM HUMERAL SMALL LEFT 72MM

Facility

$13,242.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,105.02
Max. Negotiated Rate	$12,844.74
Rate for Payer: AlohaCare Medicaid	$6,621.00
Rate for Payer: AlohaCare Medicare	$4,105.02
Rate for Payer: Cash Price	$7,945.20
Rate for Payer: Devoted Health Medicare	$4,502.28
Rate for Payer: Hawaii Medical Service Association Medicare	$4,105.02
Rate for Payer: Hawaii Western Management Group Commercial	$9,269.40
Rate for Payer: Health Management Network Commercial	$11,255.70
Rate for Payer: Humana Medicare	$4,105.02
Rate for Payer: Kaiser Permanente Commercial	$11,917.80
Rate for Payer: Kaiser Permanente Medicaid	$6,753.42
Rate for Payer: Kaiser Permanente Medicare	$4,105.02
Rate for Payer: MDX Hawaii PPO	$12,844.74
Rate for Payer: Ohana Health Plan Medicaid	$4,105.02
Rate for Payer: Ohana Health Plan Medicare	$4,105.02
Rate for Payer: UnitedHealthcare Medicare	$4,105.02
Rate for Payer: University Health Alliance Commercial	$7,415.52

STEM HUMERAL SZ7 AR-9501-07P

Facility

$4,970.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,783.20
Max. Negotiated Rate	$4,820.90
Rate for Payer: Cash Price	$2,982.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,479.00
Rate for Payer: Health Management Network Commercial	$4,224.50
Rate for Payer: Kaiser Permanente Commercial	$4,473.00
Rate for Payer: MDX Hawaii PPO	$4,820.90
Rate for Payer: University Health Alliance Commercial	$2,783.20

STEM HUMERAL SZ7 AR-9501-07P

Facility

$4,970.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,540.70
Max. Negotiated Rate	$4,820.90
Rate for Payer: AlohaCare Medicaid	$2,485.00
Rate for Payer: AlohaCare Medicare	$1,540.70
Rate for Payer: Cash Price	$2,982.00
Rate for Payer: Devoted Health Medicare	$1,689.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,540.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,479.00
Rate for Payer: Health Management Network Commercial	$4,224.50
Rate for Payer: Humana Medicare	$1,540.70
Rate for Payer: Kaiser Permanente Commercial	$4,473.00
Rate for Payer: Kaiser Permanente Medicaid	$2,534.70
Rate for Payer: Kaiser Permanente Medicare	$1,540.70
Rate for Payer: MDX Hawaii PPO	$4,820.90
Rate for Payer: Ohana Health Plan Medicaid	$1,540.70
Rate for Payer: Ohana Health Plan Medicare	$1,540.70
Rate for Payer: UnitedHealthcare Medicare	$1,540.70
Rate for Payer: University Health Alliance Commercial	$2,783.20

STEM HUMERL 11X123 5569-P-2011

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 HUMERL 11X123 5569-P-2011

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 PROLINE EVOLVE 496S055

Facility

$4,532.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,537.92
Max. Negotiated Rate	$4,396.04
Rate for Payer: Cash Price	$2,719.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,172.40
Rate for Payer: Health Management Network Commercial	$3,852.20
Rate for Payer: Kaiser Permanente Commercial	$4,078.80
Rate for Payer: MDX Hawaii PPO	$4,396.04
Rate for Payer: University Health Alliance Commercial	$2,537.92

STEM PROLINE EVOLVE 496S055

Facility

$4,532.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,404.92
Max. Negotiated Rate	$4,396.04
Rate for Payer: AlohaCare Medicaid	$2,266.00
Rate for Payer: AlohaCare Medicare	$1,404.92
Rate for Payer: Cash Price	$2,719.20
Rate for Payer: Devoted Health Medicare	$1,540.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,404.92
Rate for Payer: Hawaii Western Management Group Commercial	$3,172.40
Rate for Payer: Health Management Network Commercial	$3,852.20
Rate for Payer: Humana Medicare	$1,404.92
Rate for Payer: Kaiser Permanente Commercial	$4,078.80
Rate for Payer: Kaiser Permanente Medicaid	$2,311.32
Rate for Payer: Kaiser Permanente Medicare	$1,404.92
Rate for Payer: MDX Hawaii PPO	$4,396.04
Rate for Payer: Ohana Health Plan Medicaid	$1,404.92
Rate for Payer: Ohana Health Plan Medicare	$1,404.92
Rate for Payer: UnitedHealthcare Medicare	$1,404.92
Rate for Payer: University Health Alliance Commercial	$2,537.92

STEM PTC HUMERAL DWF603B

Facility

$8,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,716.22
Max. Negotiated Rate	$8,499.14
Rate for Payer: AlohaCare Medicaid	$4,381.00
Rate for Payer: AlohaCare Medicare	$2,716.22
Rate for Payer: Cash Price	$5,257.20
Rate for Payer: Devoted Health Medicare	$2,979.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,716.22
Rate for Payer: Hawaii Western Management Group Commercial	$6,133.40
Rate for Payer: Health Management Network Commercial	$7,447.70
Rate for Payer: Humana Medicare	$2,716.22
Rate for Payer: Kaiser Permanente Commercial	$7,885.80
Rate for Payer: Kaiser Permanente Medicaid	$4,468.62
Rate for Payer: Kaiser Permanente Medicare	$2,716.22
Rate for Payer: MDX Hawaii PPO	$8,499.14
Rate for Payer: Ohana Health Plan Medicaid	$2,716.22
Rate for Payer: Ohana Health Plan Medicare	$2,716.22
Rate for Payer: UnitedHealthcare Medicare	$2,716.22
Rate for Payer: University Health Alliance Commercial	$4,906.72

STEM PTC HUMERAL DWF603B

Facility

$8,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,906.72
Max. Negotiated Rate	$8,499.14
Rate for Payer: Cash Price	$5,257.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,133.40
Rate for Payer: Health Management Network Commercial	$7,447.70
Rate for Payer: Kaiser Permanente Commercial	$7,885.80
Rate for Payer: MDX Hawaii PPO	$8,499.14
Rate for Payer: University Health Alliance Commercial	$4,906.72

STEM PTC HUMERAL DWF605B

Facility

$8,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,716.22
Max. Negotiated Rate	$8,499.14
Rate for Payer: AlohaCare Medicaid	$4,381.00
Rate for Payer: AlohaCare Medicare	$2,716.22
Rate for Payer: Cash Price	$5,257.20
Rate for Payer: Devoted Health Medicare	$2,979.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,716.22
Rate for Payer: Hawaii Western Management Group Commercial	$6,133.40
Rate for Payer: Health Management Network Commercial	$7,447.70
Rate for Payer: Humana Medicare	$2,716.22
Rate for Payer: Kaiser Permanente Commercial	$7,885.80
Rate for Payer: Kaiser Permanente Medicaid	$4,468.62
Rate for Payer: Kaiser Permanente Medicare	$2,716.22
Rate for Payer: MDX Hawaii PPO	$8,499.14
Rate for Payer: Ohana Health Plan Medicaid	$2,716.22
Rate for Payer: Ohana Health Plan Medicare	$2,716.22
Rate for Payer: UnitedHealthcare Medicare	$2,716.22
Rate for Payer: University Health Alliance Commercial	$4,906.72

STEM PTC HUMERAL DWF605B

Facility

$8,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,906.72
Max. Negotiated Rate	$8,499.14
Rate for Payer: Cash Price	$5,257.20
Rate for Payer: Hawaii Western Management Group Commercial	$6,133.40
Rate for Payer: Health Management Network Commercial	$7,447.70
Rate for Payer: Kaiser Permanente Commercial	$7,885.80
Rate for Payer: MDX Hawaii PPO	$8,499.14
Rate for Payer: University Health Alliance Commercial	$4,906.72

STEM RFX 5568-0011

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 RFX 5568-0011

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 SECUR-FIT 6051-0625S

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 SECUR-FIT 6051-0625S

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 TRIATHLON 5565-S-018

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 TRIATHLON 5565-S-018

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 ULNAR SMALL LEFT 70MM

Facility

$10,406.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.86
Max. Negotiated Rate	$10,093.82
Rate for Payer: AlohaCare Medicaid	$5,203.00
Rate for Payer: AlohaCare Medicare	$3,225.86
Rate for Payer: Cash Price	$6,243.60
Rate for Payer: Devoted Health Medicare	$3,538.04
Rate for Payer: Hawaii Medical Service Association Medicare	$3,225.86
Rate for Payer: Hawaii Western Management Group Commercial	$7,284.20
Rate for Payer: Health Management Network Commercial	$8,845.10
Rate for Payer: Humana Medicare	$3,225.86
Rate for Payer: Kaiser Permanente Commercial	$9,365.40
Rate for Payer: Kaiser Permanente Medicaid	$5,307.06
Rate for Payer: Kaiser Permanente Medicare	$3,225.86
Rate for Payer: MDX Hawaii PPO	$10,093.82
Rate for Payer: Ohana Health Plan Medicaid	$3,225.86
Rate for Payer: Ohana Health Plan Medicare	$3,225.86
Rate for Payer: UnitedHealthcare Medicare	$3,225.86
Rate for Payer: University Health Alliance Commercial	$5,827.36

STEM ULNAR SMALL LEFT 70MM

Facility

$10,406.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,827.36
Max. Negotiated Rate	$10,093.82
Rate for Payer: Cash Price	$6,243.60
Rate for Payer: Hawaii Western Management Group Commercial	$7,284.20
Rate for Payer: Health Management Network Commercial	$8,845.10
Rate for Payer: Kaiser Permanente Commercial	$9,365.40
Rate for Payer: MDX Hawaii PPO	$10,093.82
Rate for Payer: University Health Alliance Commercial	$5,827.36

STEN SYSTEM ENROUTE TRANSCAROT

Facility

$5,400.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,674.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: AlohaCare Medicaid	$2,700.00
Rate for Payer: AlohaCare Medicare	$1,674.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Devoted Health Medicare	$1,836.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,674.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Humana Medicare	$1,674.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: Kaiser Permanente Medicaid	$2,754.00
Rate for Payer: Kaiser Permanente Medicare	$1,674.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: Ohana Health Plan Medicaid	$1,674.00
Rate for Payer: Ohana Health Plan Medicare	$1,674.00
Rate for Payer: UnitedHealthcare Medicare	$1,674.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

STEN SYSTEM ENROUTE TRANSCAROT

Facility

$5,400.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$5,238.00
Rate for Payer: Cash Price	$3,240.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,780.00
Rate for Payer: Health Management Network Commercial	$4,590.00
Rate for Payer: Kaiser Permanente Commercial	$4,860.00
Rate for Payer: MDX Hawaii PPO	$5,238.00
Rate for Payer: University Health Alliance Commercial	$3,024.00

STENT 10X60 BILIARY RX BARE

Facility

$3,357.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,040.67
Max. Negotiated Rate	$3,256.29
Rate for Payer: AlohaCare Medicaid	$1,678.50
Rate for Payer: AlohaCare Medicare	$1,040.67
Rate for Payer: Cash Price	$2,014.20
Rate for Payer: Devoted Health Medicare	$1,141.38
Rate for Payer: Hawaii Medical Service Association Medicare	$1,040.67
Rate for Payer: Hawaii Western Management Group Commercial	$2,349.90
Rate for Payer: Health Management Network Commercial	$2,853.45
Rate for Payer: Humana Medicare	$1,040.67
Rate for Payer: Kaiser Permanente Commercial	$3,021.30
Rate for Payer: Kaiser Permanente Medicaid	$1,712.07
Rate for Payer: Kaiser Permanente Medicare	$1,040.67
Rate for Payer: MDX Hawaii PPO	$3,256.29
Rate for Payer: Ohana Health Plan Medicaid	$1,040.67
Rate for Payer: Ohana Health Plan Medicare	$1,040.67
Rate for Payer: UnitedHealthcare Medicare	$1,040.67
Rate for Payer: University Health Alliance Commercial	$1,879.92

Know your out-of-pocket cost for care.

All Charges