Kau Hospital

All Charges

Charge

Type

Setting

Price

TRIATHLON TIBIAL LF 5545-A-201

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 LF 5545-A-201

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

TRIATHLON TIB SZ2 5521-B-200

Facility

$3,311.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,026.41
Max. Negotiated Rate	$3,211.67
Rate for Payer: AlohaCare Medicaid	$1,655.50
Rate for Payer: AlohaCare Medicare	$1,026.41
Rate for Payer: Cash Price	$1,986.60
Rate for Payer: Devoted Health Medicare	$1,125.74
Rate for Payer: Hawaii Medical Service Association Medicare	$1,026.41
Rate for Payer: Hawaii Western Management Group Commercial	$2,317.70
Rate for Payer: Health Management Network Commercial	$2,814.35
Rate for Payer: Humana Medicare	$1,026.41
Rate for Payer: Kaiser Permanente Commercial	$2,979.90
Rate for Payer: Kaiser Permanente Medicaid	$1,688.61
Rate for Payer: Kaiser Permanente Medicare	$1,026.41
Rate for Payer: MDX Hawaii PPO	$3,211.67
Rate for Payer: Ohana Health Plan Medicaid	$1,026.41
Rate for Payer: Ohana Health Plan Medicare	$1,026.41
Rate for Payer: UnitedHealthcare Medicare	$1,026.41
Rate for Payer: University Health Alliance Commercial	$1,854.16

TRIATHLON TIB SZ2 5521-B-200

Facility

$3,311.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,854.16
Max. Negotiated Rate	$3,211.67
Rate for Payer: Cash Price	$1,986.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,317.70
Rate for Payer: Health Management Network Commercial	$2,814.35
Rate for Payer: Kaiser Permanente Commercial	$2,979.90
Rate for Payer: MDX Hawaii PPO	$3,211.67
Rate for Payer: University Health Alliance Commercial	$1,854.16

TRIATHLON TIB SZ2 5532-G-211

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 TIB SZ2 5532-G-211

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 TK SZ4 5521-B-400

Facility

$3,311.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,854.16
Max. Negotiated Rate	$3,211.67
Rate for Payer: Cash Price	$1,986.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,317.70
Rate for Payer: Health Management Network Commercial	$2,814.35
Rate for Payer: Kaiser Permanente Commercial	$2,979.90
Rate for Payer: MDX Hawaii PPO	$3,211.67
Rate for Payer: University Health Alliance Commercial	$1,854.16

TRIATHLON TK SZ4 5521-B-400

Facility

$3,311.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,026.41
Max. Negotiated Rate	$3,211.67
Rate for Payer: AlohaCare Medicaid	$1,655.50
Rate for Payer: AlohaCare Medicare	$1,026.41
Rate for Payer: Cash Price	$1,986.60
Rate for Payer: Devoted Health Medicare	$1,125.74
Rate for Payer: Hawaii Medical Service Association Medicare	$1,026.41
Rate for Payer: Hawaii Western Management Group Commercial	$2,317.70
Rate for Payer: Health Management Network Commercial	$2,814.35
Rate for Payer: Humana Medicare	$1,026.41
Rate for Payer: Kaiser Permanente Commercial	$2,979.90
Rate for Payer: Kaiser Permanente Medicaid	$1,688.61
Rate for Payer: Kaiser Permanente Medicare	$1,026.41
Rate for Payer: MDX Hawaii PPO	$3,211.67
Rate for Payer: Ohana Health Plan Medicaid	$1,026.41
Rate for Payer: Ohana Health Plan Medicare	$1,026.41
Rate for Payer: UnitedHealthcare Medicare	$1,026.41
Rate for Payer: University Health Alliance Commercial	$1,854.16

TRIATHLON TRITANIUM 5536-B-700

Facility

$3,244.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.64
Max. Negotiated Rate	$3,146.68
Rate for Payer: AlohaCare Medicaid	$1,622.00
Rate for Payer: AlohaCare Medicare	$1,005.64
Rate for Payer: Cash Price	$1,946.40
Rate for Payer: Devoted Health Medicare	$1,102.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,005.64
Rate for Payer: Hawaii Western Management Group Commercial	$2,270.80
Rate for Payer: Health Management Network Commercial	$2,757.40
Rate for Payer: Humana Medicare	$1,005.64
Rate for Payer: Kaiser Permanente Commercial	$2,919.60
Rate for Payer: Kaiser Permanente Medicaid	$1,654.44
Rate for Payer: Kaiser Permanente Medicare	$1,005.64
Rate for Payer: MDX Hawaii PPO	$3,146.68
Rate for Payer: Ohana Health Plan Medicaid	$1,005.64
Rate for Payer: Ohana Health Plan Medicare	$1,005.64
Rate for Payer: UnitedHealthcare Medicare	$1,005.64
Rate for Payer: University Health Alliance Commercial	$1,816.64

TRIATHLON TRITANIUM 5536-B-700

Facility

$3,244.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,816.64
Max. Negotiated Rate	$3,146.68
Rate for Payer: Cash Price	$1,946.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,270.80
Rate for Payer: Health Management Network Commercial	$2,757.40
Rate for Payer: Kaiser Permanente Commercial	$2,919.60
Rate for Payer: MDX Hawaii PPO	$3,146.68
Rate for Payer: University Health Alliance Commercial	$1,816.64

TRIATHLON TRITANIUM 5552-L-350

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 TRITANIUM 5552-L-350

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 TRITANIUM 5552-L-381

Facility

$2,341.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$725.71
Max. Negotiated Rate	$2,270.77
Rate for Payer: AlohaCare Medicaid	$1,170.50
Rate for Payer: AlohaCare Medicare	$725.71
Rate for Payer: Cash Price	$1,404.60
Rate for Payer: Devoted Health Medicare	$795.94
Rate for Payer: Hawaii Medical Service Association Medicare	$725.71
Rate for Payer: Hawaii Western Management Group Commercial	$1,638.70
Rate for Payer: Health Management Network Commercial	$1,989.85
Rate for Payer: Humana Medicare	$725.71
Rate for Payer: Kaiser Permanente Commercial	$2,106.90
Rate for Payer: Kaiser Permanente Medicaid	$1,193.91
Rate for Payer: Kaiser Permanente Medicare	$725.71
Rate for Payer: MDX Hawaii PPO	$2,270.77
Rate for Payer: Ohana Health Plan Medicaid	$725.71
Rate for Payer: Ohana Health Plan Medicare	$725.71
Rate for Payer: UnitedHealthcare Medicare	$725.71
Rate for Payer: University Health Alliance Commercial	$1,310.96

TRIATHLON TRITANIUM 5552-L-381

Facility

$2,341.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,310.96
Max. Negotiated Rate	$2,270.77
Rate for Payer: Cash Price	$1,404.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,638.70
Rate for Payer: Health Management Network Commercial	$1,989.85
Rate for Payer: Kaiser Permanente Commercial	$2,106.90
Rate for Payer: MDX Hawaii PPO	$2,270.77
Rate for Payer: University Health Alliance Commercial	$1,310.96

TRIATHLON X3 5531-G-710-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 X3 5531-G-710-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 X3 5532-G-310-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 X3 5532-G-310-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 X3 PS 5532-G-312-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

TRIATHLON X3 PS 5532-G-312-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

TRIATHLON X3 TB 5531-G-312-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 X3 TB 5531-G-312-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 X3 TB 5531-G-314-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 X3 TB 5531-G-314-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 X3 TB 5531-G-510-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

Know your out-of-pocket cost for care.

All Charges