Kau Hospital

All Charges

Charge

Type

Setting

Price

TIBIAL AUGMENT HALF BLK SIZE 3

Facility

$2,229.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$690.99
Max. Negotiated Rate	$2,162.13
Rate for Payer: AlohaCare Medicaid	$1,114.50
Rate for Payer: AlohaCare Medicare	$690.99
Rate for Payer: Cash Price	$1,337.40
Rate for Payer: Devoted Health Medicare	$757.86
Rate for Payer: Hawaii Medical Service Association Medicare	$690.99
Rate for Payer: Hawaii Western Management Group Commercial	$1,560.30
Rate for Payer: Health Management Network Commercial	$1,894.65
Rate for Payer: Humana Medicare	$690.99
Rate for Payer: Kaiser Permanente Commercial	$2,006.10
Rate for Payer: Kaiser Permanente Medicaid	$1,136.79
Rate for Payer: Kaiser Permanente Medicare	$690.99
Rate for Payer: MDX Hawaii PPO	$2,162.13
Rate for Payer: Ohana Health Plan Medicaid	$690.99
Rate for Payer: Ohana Health Plan Medicare	$690.99
Rate for Payer: UnitedHealthcare Medicare	$690.99
Rate for Payer: University Health Alliance Commercial	$1,248.24

TIBIAL BEARING 5MM 1516-40-605

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$930.00
Max. Negotiated Rate	$2,910.00
Rate for Payer: AlohaCare Medicaid	$1,500.00
Rate for Payer: AlohaCare Medicare	$930.00
Rate for Payer: Cash Price	$1,800.00
Rate for Payer: Devoted Health Medicare	$1,020.00
Rate for Payer: Hawaii Medical Service Association Medicare	$930.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,100.00
Rate for Payer: Health Management Network Commercial	$2,550.00
Rate for Payer: Humana Medicare	$930.00
Rate for Payer: Kaiser Permanente Commercial	$2,700.00
Rate for Payer: Kaiser Permanente Medicaid	$1,530.00
Rate for Payer: Kaiser Permanente Medicare	$930.00
Rate for Payer: MDX Hawaii PPO	$2,910.00
Rate for Payer: Ohana Health Plan Medicaid	$930.00
Rate for Payer: Ohana Health Plan Medicare	$930.00
Rate for Payer: UnitedHealthcare Medicare	$930.00
Rate for Payer: University Health Alliance Commercial	$1,680.00

TIBIAL BEARING 5MM 1516-40-605

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,680.00
Max. Negotiated Rate	$2,910.00
Rate for Payer: Cash Price	$1,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,100.00
Rate for Payer: Health Management Network Commercial	$2,550.00
Rate for Payer: Kaiser Permanente Commercial	$2,700.00
Rate for Payer: MDX Hawaii PPO	$2,910.00
Rate for Payer: University Health Alliance Commercial	$1,680.00

TIBIAL BEARING INS 5531-G-609

Facility

$7,716.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,320.96
Max. Negotiated Rate	$7,484.52
Rate for Payer: Cash Price	$4,629.60
Rate for Payer: Hawaii Western Management Group Commercial	$5,401.20
Rate for Payer: Health Management Network Commercial	$6,558.60
Rate for Payer: Kaiser Permanente Commercial	$6,944.40
Rate for Payer: MDX Hawaii PPO	$7,484.52
Rate for Payer: University Health Alliance Commercial	$4,320.96

TIBIAL BEARING INS 5531-G-609

Facility

$7,716.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,391.96
Max. Negotiated Rate	$7,484.52
Rate for Payer: AlohaCare Medicaid	$3,858.00
Rate for Payer: AlohaCare Medicare	$2,391.96
Rate for Payer: Cash Price	$4,629.60
Rate for Payer: Devoted Health Medicare	$2,623.44
Rate for Payer: Hawaii Medical Service Association Medicare	$2,391.96
Rate for Payer: Hawaii Western Management Group Commercial	$5,401.20
Rate for Payer: Health Management Network Commercial	$6,558.60
Rate for Payer: Humana Medicare	$2,391.96
Rate for Payer: Kaiser Permanente Commercial	$6,944.40
Rate for Payer: Kaiser Permanente Medicaid	$3,935.16
Rate for Payer: Kaiser Permanente Medicare	$2,391.96
Rate for Payer: MDX Hawaii PPO	$7,484.52
Rate for Payer: Ohana Health Plan Medicaid	$2,391.96
Rate for Payer: Ohana Health Plan Medicare	$2,391.96
Rate for Payer: UnitedHealthcare Medicare	$2,391.96
Rate for Payer: University Health Alliance Commercial	$4,320.96

TIBIAL BEARING SZ5 1506-70-005

Facility

$3,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,054.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: AlohaCare Medicaid	$1,700.00
Rate for Payer: AlohaCare Medicare	$1,054.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Devoted Health Medicare	$1,156.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,054.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,380.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Humana Medicare	$1,054.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Medicaid	$1,734.00
Rate for Payer: Kaiser Permanente Medicare	$1,054.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: Ohana Health Plan Medicaid	$1,054.00
Rate for Payer: Ohana Health Plan Medicare	$1,054.00
Rate for Payer: UnitedHealthcare Medicare	$1,054.00
Rate for Payer: University Health Alliance Commercial	$1,904.00

TIBIAL BEARING SZ5 1506-70-005

Facility

$3,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,904.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,380.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: University Health Alliance Commercial	$1,904.00

TIBIAL BEARING SZ6 1506-70-006

Facility

$3,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,054.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: AlohaCare Medicaid	$1,700.00
Rate for Payer: AlohaCare Medicare	$1,054.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Devoted Health Medicare	$1,156.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,054.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,380.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Humana Medicare	$1,054.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: Kaiser Permanente Medicaid	$1,734.00
Rate for Payer: Kaiser Permanente Medicare	$1,054.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: Ohana Health Plan Medicaid	$1,054.00
Rate for Payer: Ohana Health Plan Medicare	$1,054.00
Rate for Payer: UnitedHealthcare Medicare	$1,054.00
Rate for Payer: University Health Alliance Commercial	$1,904.00

TIBIAL BEARING SZ6 1506-70-006

Facility

$3,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,904.00
Max. Negotiated Rate	$3,298.00
Rate for Payer: Cash Price	$2,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,380.00
Rate for Payer: Health Management Network Commercial	$2,890.00
Rate for Payer: Kaiser Permanente Commercial	$3,060.00
Rate for Payer: MDX Hawaii PPO	$3,298.00
Rate for Payer: University Health Alliance Commercial	$1,904.00

TIBIAL BEARING X3 5532-G-511-E

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

TIBIAL BEARING X3 5532-G-511-E

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

TIBIAL BEARING XS 4MM L 160791

Facility

$2,850.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$883.50
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$883.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$969.00
Rate for Payer: Hawaii Medical Service Association Medicare	$883.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$883.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$883.50
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$883.50
Rate for Payer: Ohana Health Plan Medicare	$883.50
Rate for Payer: UnitedHealthcare Medicare	$883.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

TIBIAL BEARING XS 4MM L 160791

Facility

$2,850.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,596.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

TIBIAL BEARNG 10MM 1516-20-610

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,680.00
Max. Negotiated Rate	$2,910.00
Rate for Payer: Cash Price	$1,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,100.00
Rate for Payer: Health Management Network Commercial	$2,550.00
Rate for Payer: Kaiser Permanente Commercial	$2,700.00
Rate for Payer: MDX Hawaii PPO	$2,910.00
Rate for Payer: University Health Alliance Commercial	$1,680.00

TIBIAL BEARNG 10MM 1516-20-610

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$930.00
Max. Negotiated Rate	$2,910.00
Rate for Payer: AlohaCare Medicaid	$1,500.00
Rate for Payer: AlohaCare Medicare	$930.00
Rate for Payer: Cash Price	$1,800.00
Rate for Payer: Devoted Health Medicare	$1,020.00
Rate for Payer: Hawaii Medical Service Association Medicare	$930.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,100.00
Rate for Payer: Health Management Network Commercial	$2,550.00
Rate for Payer: Humana Medicare	$930.00
Rate for Payer: Kaiser Permanente Commercial	$2,700.00
Rate for Payer: Kaiser Permanente Medicaid	$1,530.00
Rate for Payer: Kaiser Permanente Medicare	$930.00
Rate for Payer: MDX Hawaii PPO	$2,910.00
Rate for Payer: Ohana Health Plan Medicaid	$930.00
Rate for Payer: Ohana Health Plan Medicare	$930.00
Rate for Payer: UnitedHealthcare Medicare	$930.00
Rate for Payer: University Health Alliance Commercial	$1,680.00

TIBIAL BEARNG SZ4 5531-G-411-E

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

TIBIAL BEARNG SZ4 5531-G-411-E

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

TIBIAL BEARNG SZ5 5531-G-509-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 BEARNG SZ5 5531-G-509-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 BEARNG SZ5 5532-G-513-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 BEARNG SZ5 5532-G-513-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 CEMENTED TRAY 154718

Facility

$3,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,848.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

TIBIAL CEMENTED TRAY 154718

Facility

$3,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,023.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: AlohaCare Medicaid	$1,650.00
Rate for Payer: AlohaCare Medicare	$1,023.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Devoted Health Medicare	$1,122.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,023.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Humana Medicare	$1,023.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: Kaiser Permanente Medicaid	$1,683.00
Rate for Payer: Kaiser Permanente Medicare	$1,023.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: Ohana Health Plan Medicaid	$1,023.00
Rate for Payer: Ohana Health Plan Medicare	$1,023.00
Rate for Payer: UnitedHealthcare Medicare	$1,023.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

TIBIAL COMP 70MM MED RKTBMD

Facility

$9,160.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,839.60
Max. Negotiated Rate	$8,885.20
Rate for Payer: AlohaCare Medicaid	$4,580.00
Rate for Payer: AlohaCare Medicare	$2,839.60
Rate for Payer: Cash Price	$5,496.00
Rate for Payer: Devoted Health Medicare	$3,114.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,839.60
Rate for Payer: Hawaii Western Management Group Commercial	$6,412.00
Rate for Payer: Health Management Network Commercial	$7,786.00
Rate for Payer: Humana Medicare	$2,839.60
Rate for Payer: Kaiser Permanente Commercial	$8,244.00
Rate for Payer: Kaiser Permanente Medicaid	$4,671.60
Rate for Payer: Kaiser Permanente Medicare	$2,839.60
Rate for Payer: MDX Hawaii PPO	$8,885.20
Rate for Payer: Ohana Health Plan Medicaid	$2,839.60
Rate for Payer: Ohana Health Plan Medicare	$2,839.60
Rate for Payer: UnitedHealthcare Medicare	$2,839.60
Rate for Payer: University Health Alliance Commercial	$5,129.60

TIBIAL COMP 70MM MED RKTBMD

Facility

$9,160.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,129.60
Max. Negotiated Rate	$8,885.20
Rate for Payer: Cash Price	$5,496.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,412.00
Rate for Payer: Health Management Network Commercial	$7,786.00
Rate for Payer: Kaiser Permanente Commercial	$8,244.00
Rate for Payer: MDX Hawaii PPO	$8,885.20
Rate for Payer: University Health Alliance Commercial	$5,129.60

Know your out-of-pocket cost for care.

All Charges