Kau Hospital

All Charges

Charge

Type

Setting

Price

TI ANCHOR 5.5MM 3910-400-050

Facility

$1,306.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$404.86
Max. Negotiated Rate	$1,266.82
Rate for Payer: AlohaCare Medicaid	$653.00
Rate for Payer: AlohaCare Medicare	$404.86
Rate for Payer: Cash Price	$783.60
Rate for Payer: Devoted Health Medicare	$444.04
Rate for Payer: Hawaii Medical Service Association Medicare	$404.86
Rate for Payer: Hawaii Western Management Group Commercial	$914.20
Rate for Payer: Health Management Network Commercial	$1,110.10
Rate for Payer: Humana Medicare	$404.86
Rate for Payer: Kaiser Permanente Commercial	$1,175.40
Rate for Payer: Kaiser Permanente Medicaid	$666.06
Rate for Payer: Kaiser Permanente Medicare	$404.86
Rate for Payer: MDX Hawaii PPO	$1,266.82
Rate for Payer: Ohana Health Plan Medicaid	$404.86
Rate for Payer: Ohana Health Plan Medicare	$404.86
Rate for Payer: UnitedHealthcare Medicare	$404.86
Rate for Payer: University Health Alliance Commercial	$731.36

TI ANCHOR 5.5MM 3910-400-050

Facility

$1,306.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$731.36
Max. Negotiated Rate	$1,266.82
Rate for Payer: Cash Price	$783.60
Rate for Payer: Hawaii Western Management Group Commercial	$914.20
Rate for Payer: Health Management Network Commercial	$1,110.10
Rate for Payer: Kaiser Permanente Commercial	$1,175.40
Rate for Payer: MDX Hawaii PPO	$1,266.82
Rate for Payer: University Health Alliance Commercial	$731.36

TIB BEARING SZ 7 #5532-G-709

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: University Health Alliance Commercial	$1,498.56

TIB BEARING SZ 7 #5532-G-709

Facility

$2,676.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$829.56
Max. Negotiated Rate	$2,595.72
Rate for Payer: AlohaCare Medicaid	$1,338.00
Rate for Payer: AlohaCare Medicare	$829.56
Rate for Payer: Cash Price	$1,605.60
Rate for Payer: Devoted Health Medicare	$909.84
Rate for Payer: Hawaii Medical Service Association Medicare	$829.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,873.20
Rate for Payer: Health Management Network Commercial	$2,274.60
Rate for Payer: Humana Medicare	$829.56
Rate for Payer: Kaiser Permanente Commercial	$2,408.40
Rate for Payer: Kaiser Permanente Medicaid	$1,364.76
Rate for Payer: Kaiser Permanente Medicare	$829.56
Rate for Payer: MDX Hawaii PPO	$2,595.72
Rate for Payer: Ohana Health Plan Medicaid	$829.56
Rate for Payer: Ohana Health Plan Medicare	$829.56
Rate for Payer: UnitedHealthcare Medicare	$829.56
Rate for Payer: University Health Alliance Commercial	$1,498.56

TIBIA CAP 11.5 10MM 2341-0010S

Facility

$1,071.00

Hospital Revenue Code	278
Min. Negotiated Rate	$599.76
Max. Negotiated Rate	$1,038.87
Rate for Payer: Cash Price	$642.60
Rate for Payer: Hawaii Western Management Group Commercial	$749.70
Rate for Payer: Health Management Network Commercial	$910.35
Rate for Payer: Kaiser Permanente Commercial	$963.90
Rate for Payer: MDX Hawaii PPO	$1,038.87
Rate for Payer: University Health Alliance Commercial	$599.76

TIBIA CAP 11.5 10MM 2341-0010S

Facility

$1,071.00

Hospital Revenue Code	278
Min. Negotiated Rate	$332.01
Max. Negotiated Rate	$1,038.87
Rate for Payer: AlohaCare Medicaid	$535.50
Rate for Payer: AlohaCare Medicare	$332.01
Rate for Payer: Cash Price	$642.60
Rate for Payer: Devoted Health Medicare	$364.14
Rate for Payer: Hawaii Medical Service Association Medicare	$332.01
Rate for Payer: Hawaii Western Management Group Commercial	$749.70
Rate for Payer: Health Management Network Commercial	$910.35
Rate for Payer: Humana Medicare	$332.01
Rate for Payer: Kaiser Permanente Commercial	$963.90
Rate for Payer: Kaiser Permanente Medicaid	$546.21
Rate for Payer: Kaiser Permanente Medicare	$332.01
Rate for Payer: MDX Hawaii PPO	$1,038.87
Rate for Payer: Ohana Health Plan Medicaid	$332.01
Rate for Payer: Ohana Health Plan Medicare	$332.01
Rate for Payer: UnitedHealthcare Medicare	$332.01
Rate for Payer: University Health Alliance Commercial	$599.76

TIBIA CAP 11.5 20MM 2341-0020S

Facility

$1,071.00

Hospital Revenue Code	278
Min. Negotiated Rate	$332.01
Max. Negotiated Rate	$1,038.87
Rate for Payer: AlohaCare Medicaid	$535.50
Rate for Payer: AlohaCare Medicare	$332.01
Rate for Payer: Cash Price	$642.60
Rate for Payer: Devoted Health Medicare	$364.14
Rate for Payer: Hawaii Medical Service Association Medicare	$332.01
Rate for Payer: Hawaii Western Management Group Commercial	$749.70
Rate for Payer: Health Management Network Commercial	$910.35
Rate for Payer: Humana Medicare	$332.01
Rate for Payer: Kaiser Permanente Commercial	$963.90
Rate for Payer: Kaiser Permanente Medicaid	$546.21
Rate for Payer: Kaiser Permanente Medicare	$332.01
Rate for Payer: MDX Hawaii PPO	$1,038.87
Rate for Payer: Ohana Health Plan Medicaid	$332.01
Rate for Payer: Ohana Health Plan Medicare	$332.01
Rate for Payer: UnitedHealthcare Medicare	$332.01
Rate for Payer: University Health Alliance Commercial	$599.76

TIBIA CAP 11.5 20MM 2341-0020S

Facility

$1,071.00

Hospital Revenue Code	278
Min. Negotiated Rate	$599.76
Max. Negotiated Rate	$1,038.87
Rate for Payer: Cash Price	$642.60
Rate for Payer: Hawaii Western Management Group Commercial	$749.70
Rate for Payer: Health Management Network Commercial	$910.35
Rate for Payer: Kaiser Permanente Commercial	$963.90
Rate for Payer: MDX Hawaii PPO	$1,038.87
Rate for Payer: University Health Alliance Commercial	$599.76

TIBIA END CAP 11.5 2341-0015S

Facility

$1,071.00

Hospital Revenue Code	278
Min. Negotiated Rate	$332.01
Max. Negotiated Rate	$1,038.87
Rate for Payer: AlohaCare Medicaid	$535.50
Rate for Payer: AlohaCare Medicare	$332.01
Rate for Payer: Cash Price	$642.60
Rate for Payer: Devoted Health Medicare	$364.14
Rate for Payer: Hawaii Medical Service Association Medicare	$332.01
Rate for Payer: Hawaii Western Management Group Commercial	$749.70
Rate for Payer: Health Management Network Commercial	$910.35
Rate for Payer: Humana Medicare	$332.01
Rate for Payer: Kaiser Permanente Commercial	$963.90
Rate for Payer: Kaiser Permanente Medicaid	$546.21
Rate for Payer: Kaiser Permanente Medicare	$332.01
Rate for Payer: MDX Hawaii PPO	$1,038.87
Rate for Payer: Ohana Health Plan Medicaid	$332.01
Rate for Payer: Ohana Health Plan Medicare	$332.01
Rate for Payer: UnitedHealthcare Medicare	$332.01
Rate for Payer: University Health Alliance Commercial	$599.76

TIBIA END CAP 11.5 2341-0015S

Facility

$1,071.00

Hospital Revenue Code	278
Min. Negotiated Rate	$599.76
Max. Negotiated Rate	$1,038.87
Rate for Payer: Cash Price	$642.60
Rate for Payer: Hawaii Western Management Group Commercial	$749.70
Rate for Payer: Health Management Network Commercial	$910.35
Rate for Payer: Kaiser Permanente Commercial	$963.90
Rate for Payer: MDX Hawaii PPO	$1,038.87
Rate for Payer: University Health Alliance Commercial	$599.76

TIBIAL 4X9MM BRNG 5531-G-409-E

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$837.93
Max. Negotiated Rate	$2,621.91
Rate for Payer: AlohaCare Medicaid	$1,351.50
Rate for Payer: AlohaCare Medicare	$837.93
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Devoted Health Medicare	$919.02
Rate for Payer: Hawaii Medical Service Association Medicare	$837.93
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Humana Medicare	$837.93
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: Kaiser Permanente Medicaid	$1,378.53
Rate for Payer: Kaiser Permanente Medicare	$837.93
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: Ohana Health Plan Medicaid	$837.93
Rate for Payer: Ohana Health Plan Medicare	$837.93
Rate for Payer: UnitedHealthcare Medicare	$837.93
Rate for Payer: University Health Alliance Commercial	$1,513.68

TIBIAL 4X9MM BRNG 5531-G-409-E

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.68
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

TIBIAL ASYMMETRICE 5549-A-241

Facility

$11,136.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,452.16
Max. Negotiated Rate	$10,801.92
Rate for Payer: AlohaCare Medicaid	$5,568.00
Rate for Payer: AlohaCare Medicare	$3,452.16
Rate for Payer: Cash Price	$6,681.60
Rate for Payer: Devoted Health Medicare	$3,786.24
Rate for Payer: Hawaii Medical Service Association Medicare	$3,452.16
Rate for Payer: Hawaii Western Management Group Commercial	$7,795.20
Rate for Payer: Health Management Network Commercial	$9,465.60
Rate for Payer: Humana Medicare	$3,452.16
Rate for Payer: Kaiser Permanente Commercial	$10,022.40
Rate for Payer: Kaiser Permanente Medicaid	$5,679.36
Rate for Payer: Kaiser Permanente Medicare	$3,452.16
Rate for Payer: MDX Hawaii PPO	$10,801.92
Rate for Payer: Ohana Health Plan Medicaid	$3,452.16
Rate for Payer: Ohana Health Plan Medicare	$3,452.16
Rate for Payer: UnitedHealthcare Medicare	$3,452.16
Rate for Payer: University Health Alliance Commercial	$6,236.16

TIBIAL ASYMMETRICE 5549-A-241

Facility

$11,136.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,236.16
Max. Negotiated Rate	$10,801.92
Rate for Payer: Cash Price	$6,681.60
Rate for Payer: Hawaii Western Management Group Commercial	$7,795.20
Rate for Payer: Health Management Network Commercial	$9,465.60
Rate for Payer: Kaiser Permanente Commercial	$10,022.40
Rate for Payer: MDX Hawaii PPO	$10,801.92
Rate for Payer: University Health Alliance Commercial	$6,236.16

TIBIAL AUGMENT 5545-A-401

Facility

$2,123.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$658.13
Max. Negotiated Rate	$2,059.31
Rate for Payer: AlohaCare Medicaid	$1,061.50
Rate for Payer: AlohaCare Medicare	$658.13
Rate for Payer: Cash Price	$1,273.80
Rate for Payer: Devoted Health Medicare	$721.82
Rate for Payer: Hawaii Medical Service Association Medicare	$658.13
Rate for Payer: Hawaii Western Management Group Commercial	$1,486.10
Rate for Payer: Health Management Network Commercial	$1,804.55
Rate for Payer: Humana Medicare	$658.13
Rate for Payer: Kaiser Permanente Commercial	$1,910.70
Rate for Payer: Kaiser Permanente Medicaid	$1,082.73
Rate for Payer: Kaiser Permanente Medicare	$658.13
Rate for Payer: MDX Hawaii PPO	$2,059.31
Rate for Payer: Ohana Health Plan Medicaid	$658.13
Rate for Payer: Ohana Health Plan Medicare	$658.13
Rate for Payer: UnitedHealthcare Medicare	$658.13
Rate for Payer: University Health Alliance Commercial	$1,188.88

TIBIAL AUGMENT 5545-A-401

Facility

$2,123.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,188.88
Max. Negotiated Rate	$2,059.31
Rate for Payer: Cash Price	$1,273.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,486.10
Rate for Payer: Health Management Network Commercial	$1,804.55
Rate for Payer: Kaiser Permanente Commercial	$1,910.70
Rate for Payer: MDX Hawaii PPO	$2,059.31
Rate for Payer: University Health Alliance Commercial	$1,188.88

TIBIAL AUGMENT 5545-A-402

Facility

$2,123.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,188.88
Max. Negotiated Rate	$2,059.31
Rate for Payer: Cash Price	$1,273.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,486.10
Rate for Payer: Health Management Network Commercial	$1,804.55
Rate for Payer: Kaiser Permanente Commercial	$1,910.70
Rate for Payer: MDX Hawaii PPO	$2,059.31
Rate for Payer: University Health Alliance Commercial	$1,188.88

TIBIAL AUGMENT 5545-A-402

Facility

$2,123.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$658.13
Max. Negotiated Rate	$2,059.31
Rate for Payer: AlohaCare Medicaid	$1,061.50
Rate for Payer: AlohaCare Medicare	$658.13
Rate for Payer: Cash Price	$1,273.80
Rate for Payer: Devoted Health Medicare	$721.82
Rate for Payer: Hawaii Medical Service Association Medicare	$658.13
Rate for Payer: Hawaii Western Management Group Commercial	$1,486.10
Rate for Payer: Health Management Network Commercial	$1,804.55
Rate for Payer: Humana Medicare	$658.13
Rate for Payer: Kaiser Permanente Commercial	$1,910.70
Rate for Payer: Kaiser Permanente Medicaid	$1,082.73
Rate for Payer: Kaiser Permanente Medicare	$658.13
Rate for Payer: MDX Hawaii PPO	$2,059.31
Rate for Payer: Ohana Health Plan Medicaid	$658.13
Rate for Payer: Ohana Health Plan Medicare	$658.13
Rate for Payer: UnitedHealthcare Medicare	$658.13
Rate for Payer: University Health Alliance Commercial	$1,188.88

TIBIAL AUGMENT 5545-A-601

Facility

$2,123.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,188.88
Max. Negotiated Rate	$2,059.31
Rate for Payer: Cash Price	$1,273.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,486.10
Rate for Payer: Health Management Network Commercial	$1,804.55
Rate for Payer: Kaiser Permanente Commercial	$1,910.70
Rate for Payer: MDX Hawaii PPO	$2,059.31
Rate for Payer: University Health Alliance Commercial	$1,188.88

TIBIAL AUGMENT 5545-A-601

Facility

$2,123.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$658.13
Max. Negotiated Rate	$2,059.31
Rate for Payer: AlohaCare Medicaid	$1,061.50
Rate for Payer: AlohaCare Medicare	$658.13
Rate for Payer: Cash Price	$1,273.80
Rate for Payer: Devoted Health Medicare	$721.82
Rate for Payer: Hawaii Medical Service Association Medicare	$658.13
Rate for Payer: Hawaii Western Management Group Commercial	$1,486.10
Rate for Payer: Health Management Network Commercial	$1,804.55
Rate for Payer: Humana Medicare	$658.13
Rate for Payer: Kaiser Permanente Commercial	$1,910.70
Rate for Payer: Kaiser Permanente Medicaid	$1,082.73
Rate for Payer: Kaiser Permanente Medicare	$658.13
Rate for Payer: MDX Hawaii PPO	$2,059.31
Rate for Payer: Ohana Health Plan Medicaid	$658.13
Rate for Payer: Ohana Health Plan Medicare	$658.13
Rate for Payer: UnitedHealthcare Medicare	$658.13
Rate for Payer: University Health Alliance Commercial	$1,188.88

TIBIAL AUGMENT 5545-A-602

Facility

$2,123.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,188.88
Max. Negotiated Rate	$2,059.31
Rate for Payer: Cash Price	$1,273.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,486.10
Rate for Payer: Health Management Network Commercial	$1,804.55
Rate for Payer: Kaiser Permanente Commercial	$1,910.70
Rate for Payer: MDX Hawaii PPO	$2,059.31
Rate for Payer: University Health Alliance Commercial	$1,188.88

TIBIAL AUGMENT 5545-A-602

Facility

$2,123.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$658.13
Max. Negotiated Rate	$2,059.31
Rate for Payer: AlohaCare Medicaid	$1,061.50
Rate for Payer: AlohaCare Medicare	$658.13
Rate for Payer: Cash Price	$1,273.80
Rate for Payer: Devoted Health Medicare	$721.82
Rate for Payer: Hawaii Medical Service Association Medicare	$658.13
Rate for Payer: Hawaii Western Management Group Commercial	$1,486.10
Rate for Payer: Health Management Network Commercial	$1,804.55
Rate for Payer: Humana Medicare	$658.13
Rate for Payer: Kaiser Permanente Commercial	$1,910.70
Rate for Payer: Kaiser Permanente Medicaid	$1,082.73
Rate for Payer: Kaiser Permanente Medicare	$658.13
Rate for Payer: MDX Hawaii PPO	$2,059.31
Rate for Payer: Ohana Health Plan Medicaid	$658.13
Rate for Payer: Ohana Health Plan Medicare	$658.13
Rate for Payer: UnitedHealthcare Medicare	$658.13
Rate for Payer: University Health Alliance Commercial	$1,188.88

TIBIAL AUGMENT #5 5546-A-502

Facility

$2,173.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,216.88
Max. Negotiated Rate	$2,107.81
Rate for Payer: Cash Price	$1,303.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,521.10
Rate for Payer: Health Management Network Commercial	$1,847.05
Rate for Payer: Kaiser Permanente Commercial	$1,955.70
Rate for Payer: MDX Hawaii PPO	$2,107.81
Rate for Payer: University Health Alliance Commercial	$1,216.88

TIBIAL AUGMENT #5 5546-A-502

Facility

$2,173.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$673.63
Max. Negotiated Rate	$2,107.81
Rate for Payer: AlohaCare Medicaid	$1,086.50
Rate for Payer: AlohaCare Medicare	$673.63
Rate for Payer: Cash Price	$1,303.80
Rate for Payer: Devoted Health Medicare	$738.82
Rate for Payer: Hawaii Medical Service Association Medicare	$673.63
Rate for Payer: Hawaii Western Management Group Commercial	$1,521.10
Rate for Payer: Health Management Network Commercial	$1,847.05
Rate for Payer: Humana Medicare	$673.63
Rate for Payer: Kaiser Permanente Commercial	$1,955.70
Rate for Payer: Kaiser Permanente Medicaid	$1,108.23
Rate for Payer: Kaiser Permanente Medicare	$673.63
Rate for Payer: MDX Hawaii PPO	$2,107.81
Rate for Payer: Ohana Health Plan Medicaid	$673.63
Rate for Payer: Ohana Health Plan Medicare	$673.63
Rate for Payer: UnitedHealthcare Medicare	$673.63
Rate for Payer: University Health Alliance Commercial	$1,216.88

TIBIAL AUGMENT HALF BLK SIZE 3

Facility

$2,229.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,248.24
Max. Negotiated Rate	$2,162.13
Rate for Payer: Cash Price	$1,337.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,560.30
Rate for Payer: Health Management Network Commercial	$1,894.65
Rate for Payer: Kaiser Permanente Commercial	$2,006.10
Rate for Payer: MDX Hawaii PPO	$2,162.13
Rate for Payer: University Health Alliance Commercial	$1,248.24

Know your out-of-pocket cost for care.

All Charges