Kau Hospital

All Charges

Charge

Type

Setting

Price

TRIATHLON CR FEMUR

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Cash Price	$2,595.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,027.50
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Health Management Network Commercial	$3,676.25
Rate for Payer: Kaiser Permanente Commercial	$3,892.50
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: MDX Hawaii PPO	$4,195.25
Rate for Payer: University Health Alliance Commercial	$2,422.00
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRIATHLONCR FEMUR

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,327.42
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$1,327.42
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$1,455.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,327.42
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$1,327.42
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$1,327.42
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$1,327.42
Rate for Payer: Ohana Health Plan Medicare	$1,327.42
Rate for Payer: UnitedHealthcare Medicare	$1,327.42
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRIATHLONCR FEMUR

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRIATHLON CR FEMUR COMP

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,327.42
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$1,327.42
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$1,455.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,327.42
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$1,327.42
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$1,327.42
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$1,327.42
Rate for Payer: Ohana Health Plan Medicare	$1,327.42
Rate for Payer: UnitedHealthcare Medicare	$1,327.42
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRIATHLON CR FEMUR COMP

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRIATHLON CRUCIATE 5510-F-201

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,327.42
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$1,327.42
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$1,455.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,327.42
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$1,327.42
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$1,327.42
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$1,327.42
Rate for Payer: Ohana Health Plan Medicare	$1,327.42
Rate for Payer: UnitedHealthcare Medicare	$1,327.42
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRIATHLON CRUCIATE 5510-F-201

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRIATHLON FEM SZ2 5515-F-201

Facility

$4,325.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,422.00
Max. Negotiated Rate	$4,195.25
Rate for Payer: Cash Price	$2,595.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,027.50
Rate for Payer: Health Management Network Commercial	$3,676.25
Rate for Payer: Kaiser Permanente Commercial	$3,892.50
Rate for Payer: MDX Hawaii PPO	$4,195.25
Rate for Payer: University Health Alliance Commercial	$2,422.00

TRIATHLON FEM SZ2 5515-F-201

Facility

$4,325.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,340.75
Max. Negotiated Rate	$4,195.25
Rate for Payer: AlohaCare Medicaid	$2,162.50
Rate for Payer: AlohaCare Medicare	$1,340.75
Rate for Payer: Cash Price	$2,595.00
Rate for Payer: Devoted Health Medicare	$1,470.50
Rate for Payer: Hawaii Medical Service Association Medicare	$1,340.75
Rate for Payer: Hawaii Western Management Group Commercial	$3,027.50
Rate for Payer: Health Management Network Commercial	$3,676.25
Rate for Payer: Humana Medicare	$1,340.75
Rate for Payer: Kaiser Permanente Commercial	$3,892.50
Rate for Payer: Kaiser Permanente Medicaid	$2,205.75
Rate for Payer: Kaiser Permanente Medicare	$1,340.75
Rate for Payer: MDX Hawaii PPO	$4,195.25
Rate for Payer: Ohana Health Plan Medicaid	$1,340.75
Rate for Payer: Ohana Health Plan Medicare	$1,340.75
Rate for Payer: UnitedHealthcare Medicare	$1,340.75
Rate for Payer: University Health Alliance Commercial	$2,422.00

TRIATHLON FEM SZ#4 5515-F-402

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,327.42
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$1,327.42
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$1,455.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1,327.42
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$1,327.42
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$1,327.42
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$1,327.42
Rate for Payer: Ohana Health Plan Medicare	$1,327.42
Rate for Payer: UnitedHealthcare Medicare	$1,327.42
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRIATHLON FEM SZ#4 5515-F-402

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRIATHLON INSERT 5531-G-513-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

TRIATHLON INSERT 5531-G-513-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

TRIATHLON INSERT 5531-G-609-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

TRIATHLON INSERT 5531-G-609-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

TRIATHLON INSERT 5531-G-809-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

TRIATHLON INSERT 5531-G-809-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

TRIATHLON PATELLA 5551-G-320

Facility

$2,317.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,297.52
Max. Negotiated Rate	$2,247.49
Rate for Payer: Cash Price	$1,390.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,621.90
Rate for Payer: Health Management Network Commercial	$1,969.45
Rate for Payer: Kaiser Permanente Commercial	$2,085.30
Rate for Payer: MDX Hawaii PPO	$2,247.49
Rate for Payer: University Health Alliance Commercial	$1,297.52

TRIATHLON PATELLA 5551-G-320

Facility

$2,317.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$718.27
Max. Negotiated Rate	$2,247.49
Rate for Payer: AlohaCare Medicaid	$1,158.50
Rate for Payer: AlohaCare Medicare	$718.27
Rate for Payer: Cash Price	$1,390.20
Rate for Payer: Devoted Health Medicare	$787.78
Rate for Payer: Hawaii Medical Service Association Medicare	$718.27
Rate for Payer: Hawaii Western Management Group Commercial	$1,621.90
Rate for Payer: Health Management Network Commercial	$1,969.45
Rate for Payer: Humana Medicare	$718.27
Rate for Payer: Kaiser Permanente Commercial	$2,085.30
Rate for Payer: Kaiser Permanente Medicaid	$1,181.67
Rate for Payer: Kaiser Permanente Medicare	$718.27
Rate for Payer: MDX Hawaii PPO	$2,247.49
Rate for Payer: Ohana Health Plan Medicaid	$718.27
Rate for Payer: Ohana Health Plan Medicare	$718.27
Rate for Payer: UnitedHealthcare Medicare	$718.27
Rate for Payer: University Health Alliance Commercial	$1,297.52

TRIATHLON TIBIA #5532-G-313

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

TRIATHLON TIBIA #5532-G-313

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

TRIATHLON TIBIAL 5531-G-711-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

TRIATHLON TIBIAL 5531-G-711-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

TRIATHLON TIBIAL 5545-A-202

Facility

$2,145.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$664.95
Max. Negotiated Rate	$2,080.65
Rate for Payer: AlohaCare Medicaid	$1,072.50
Rate for Payer: AlohaCare Medicare	$664.95
Rate for Payer: Cash Price	$1,287.00
Rate for Payer: Devoted Health Medicare	$729.30
Rate for Payer: Hawaii Medical Service Association Medicare	$664.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,501.50
Rate for Payer: Health Management Network Commercial	$1,823.25
Rate for Payer: Humana Medicare	$664.95
Rate for Payer: Kaiser Permanente Commercial	$1,930.50
Rate for Payer: Kaiser Permanente Medicaid	$1,093.95
Rate for Payer: Kaiser Permanente Medicare	$664.95
Rate for Payer: MDX Hawaii PPO	$2,080.65
Rate for Payer: Ohana Health Plan Medicaid	$664.95
Rate for Payer: Ohana Health Plan Medicare	$664.95
Rate for Payer: UnitedHealthcare Medicare	$664.95
Rate for Payer: University Health Alliance Commercial	$1,201.20

TRIATHLON TIBIAL 5545-A-202

Facility

$2,145.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,201.20
Max. Negotiated Rate	$2,080.65
Rate for Payer: Cash Price	$1,287.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,501.50
Rate for Payer: Health Management Network Commercial	$1,823.25
Rate for Payer: Kaiser Permanente Commercial	$1,930.50
Rate for Payer: MDX Hawaii PPO	$2,080.65
Rate for Payer: University Health Alliance Commercial	$1,201.20

Know your out-of-pocket cost for care.

All Charges