Kau Hospital

All Charges

Charge

Type

Setting

Price

TRI CR XS TIB INSRT 5530-G-409

Facility

$7,316.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,096.96
Max. Negotiated Rate	$7,096.52
Rate for Payer: Cash Price	$4,389.60
Rate for Payer: Hawaii Western Management Group Commercial	$5,121.20
Rate for Payer: Health Management Network Commercial	$6,218.60
Rate for Payer: Kaiser Permanente Commercial	$6,584.40
Rate for Payer: MDX Hawaii PPO	$7,096.52
Rate for Payer: University Health Alliance Commercial	$4,096.96

TRI CR XS TIB INSRT 5530-G-409

Facility

$7,316.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,267.96
Max. Negotiated Rate	$7,096.52
Rate for Payer: AlohaCare Medicaid	$3,658.00
Rate for Payer: AlohaCare Medicare	$2,267.96
Rate for Payer: Cash Price	$4,389.60
Rate for Payer: Devoted Health Medicare	$2,487.44
Rate for Payer: Hawaii Medical Service Association Medicare	$2,267.96
Rate for Payer: Hawaii Western Management Group Commercial	$5,121.20
Rate for Payer: Health Management Network Commercial	$6,218.60
Rate for Payer: Humana Medicare	$2,267.96
Rate for Payer: Kaiser Permanente Commercial	$6,584.40
Rate for Payer: Kaiser Permanente Medicaid	$3,731.16
Rate for Payer: Kaiser Permanente Medicare	$2,267.96
Rate for Payer: MDX Hawaii PPO	$7,096.52
Rate for Payer: Ohana Health Plan Medicaid	$2,267.96
Rate for Payer: Ohana Health Plan Medicare	$2,267.96
Rate for Payer: UnitedHealthcare Medicare	$2,267.96
Rate for Payer: University Health Alliance Commercial	$4,096.96

TRI CR XS TIB INSRT 5530-G-411

Facility

$6,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,786.72
Max. Negotiated Rate	$6,559.14
Rate for Payer: Cash Price	$4,057.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,733.40
Rate for Payer: Health Management Network Commercial	$5,747.70
Rate for Payer: Kaiser Permanente Commercial	$6,085.80
Rate for Payer: MDX Hawaii PPO	$6,559.14
Rate for Payer: University Health Alliance Commercial	$3,786.72

TRI CR XS TIB INSRT 5530-G-411

Facility

$6,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,096.22
Max. Negotiated Rate	$6,559.14
Rate for Payer: AlohaCare Medicaid	$3,381.00
Rate for Payer: AlohaCare Medicare	$2,096.22
Rate for Payer: Cash Price	$4,057.20
Rate for Payer: Devoted Health Medicare	$2,299.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,096.22
Rate for Payer: Hawaii Western Management Group Commercial	$4,733.40
Rate for Payer: Health Management Network Commercial	$5,747.70
Rate for Payer: Humana Medicare	$2,096.22
Rate for Payer: Kaiser Permanente Commercial	$6,085.80
Rate for Payer: Kaiser Permanente Medicaid	$3,448.62
Rate for Payer: Kaiser Permanente Medicare	$2,096.22
Rate for Payer: MDX Hawaii PPO	$6,559.14
Rate for Payer: Ohana Health Plan Medicaid	$2,096.22
Rate for Payer: Ohana Health Plan Medicare	$2,096.22
Rate for Payer: UnitedHealthcare Medicare	$2,096.22
Rate for Payer: University Health Alliance Commercial	$3,786.72

TRI CR XS TIB INSRT 5530-G-509

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

TRI CR XS TIB INSRT 5530-G-509

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

TRI CR XS TIB INSRT 5530-G-511

Facility

$6,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,096.22
Max. Negotiated Rate	$6,559.14
Rate for Payer: AlohaCare Medicaid	$3,381.00
Rate for Payer: AlohaCare Medicare	$2,096.22
Rate for Payer: Cash Price	$4,057.20
Rate for Payer: Devoted Health Medicare	$2,299.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,096.22
Rate for Payer: Hawaii Western Management Group Commercial	$4,733.40
Rate for Payer: Health Management Network Commercial	$5,747.70
Rate for Payer: Humana Medicare	$2,096.22
Rate for Payer: Kaiser Permanente Commercial	$6,085.80
Rate for Payer: Kaiser Permanente Medicaid	$3,448.62
Rate for Payer: Kaiser Permanente Medicare	$2,096.22
Rate for Payer: MDX Hawaii PPO	$6,559.14
Rate for Payer: Ohana Health Plan Medicaid	$2,096.22
Rate for Payer: Ohana Health Plan Medicare	$2,096.22
Rate for Payer: UnitedHealthcare Medicare	$2,096.22
Rate for Payer: University Health Alliance Commercial	$3,786.72

TRI CR XS TIB INSRT 5530-G-511

Facility

$6,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,786.72
Max. Negotiated Rate	$6,559.14
Rate for Payer: Cash Price	$4,057.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,733.40
Rate for Payer: Health Management Network Commercial	$5,747.70
Rate for Payer: Kaiser Permanente Commercial	$6,085.80
Rate for Payer: MDX Hawaii PPO	$6,559.14
Rate for Payer: University Health Alliance Commercial	$3,786.72

TRI CR XS TIB INSRT 5530-G-609

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

TRI CR XS TIB INSRT 5530-G-609

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

TRI CR XS TIB INSRT 5530-G-611

Facility

$6,964.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,899.84
Max. Negotiated Rate	$6,755.08
Rate for Payer: Cash Price	$4,178.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,874.80
Rate for Payer: Health Management Network Commercial	$5,919.40
Rate for Payer: Kaiser Permanente Commercial	$6,267.60
Rate for Payer: MDX Hawaii PPO	$6,755.08
Rate for Payer: University Health Alliance Commercial	$3,899.84

TRI CR XS TIB INSRT 5530-G-611

Facility

$6,964.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,158.84
Max. Negotiated Rate	$6,755.08
Rate for Payer: AlohaCare Medicaid	$3,482.00
Rate for Payer: AlohaCare Medicare	$2,158.84
Rate for Payer: Cash Price	$4,178.40
Rate for Payer: Devoted Health Medicare	$2,367.76
Rate for Payer: Hawaii Medical Service Association Medicare	$2,158.84
Rate for Payer: Hawaii Western Management Group Commercial	$4,874.80
Rate for Payer: Health Management Network Commercial	$5,919.40
Rate for Payer: Humana Medicare	$2,158.84
Rate for Payer: Kaiser Permanente Commercial	$6,267.60
Rate for Payer: Kaiser Permanente Medicaid	$3,551.64
Rate for Payer: Kaiser Permanente Medicare	$2,158.84
Rate for Payer: MDX Hawaii PPO	$6,755.08
Rate for Payer: Ohana Health Plan Medicaid	$2,158.84
Rate for Payer: Ohana Health Plan Medicare	$2,158.84
Rate for Payer: UnitedHealthcare Medicare	$2,158.84
Rate for Payer: University Health Alliance Commercial	$3,899.84

TRI CR XS TIB INSRT 5530-G-616

Facility

$6,616.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,704.96
Max. Negotiated Rate	$6,417.52
Rate for Payer: Cash Price	$3,969.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,631.20
Rate for Payer: Health Management Network Commercial	$5,623.60
Rate for Payer: Kaiser Permanente Commercial	$5,954.40
Rate for Payer: MDX Hawaii PPO	$6,417.52
Rate for Payer: University Health Alliance Commercial	$3,704.96

TRI CR XS TIB INSRT 5530-G-616

Facility

$6,616.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,050.96
Max. Negotiated Rate	$6,417.52
Rate for Payer: AlohaCare Medicaid	$3,308.00
Rate for Payer: AlohaCare Medicare	$2,050.96
Rate for Payer: Cash Price	$3,969.60
Rate for Payer: Devoted Health Medicare	$2,249.44
Rate for Payer: Hawaii Medical Service Association Medicare	$2,050.96
Rate for Payer: Hawaii Western Management Group Commercial	$4,631.20
Rate for Payer: Health Management Network Commercial	$5,623.60
Rate for Payer: Humana Medicare	$2,050.96
Rate for Payer: Kaiser Permanente Commercial	$5,954.40
Rate for Payer: Kaiser Permanente Medicaid	$3,374.16
Rate for Payer: Kaiser Permanente Medicare	$2,050.96
Rate for Payer: MDX Hawaii PPO	$6,417.52
Rate for Payer: Ohana Health Plan Medicaid	$2,050.96
Rate for Payer: Ohana Health Plan Medicare	$2,050.96
Rate for Payer: UnitedHealthcare Medicare	$2,050.96
Rate for Payer: University Health Alliance Commercial	$3,704.96

TRI CR XS TIB INSRT 5530-G-709

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

TRI CR XS TIB INSRT 5530-G-709

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

TRIDEN II TRITANIUM 702-04-62G

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

TRIDEN II TRITANIUM 702-04-62G

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

TRIDENT ACETABULAR 690-00-22D

Facility

$6,105.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,418.80
Max. Negotiated Rate	$5,921.85
Rate for Payer: Cash Price	$3,663.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,273.50
Rate for Payer: Health Management Network Commercial	$5,189.25
Rate for Payer: Kaiser Permanente Commercial	$5,494.50
Rate for Payer: MDX Hawaii PPO	$5,921.85
Rate for Payer: University Health Alliance Commercial	$3,418.80

TRIDENT ACETABULAR 690-00-22D

Facility

$6,105.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,892.55
Max. Negotiated Rate	$5,921.85
Rate for Payer: AlohaCare Medicaid	$3,052.50
Rate for Payer: AlohaCare Medicare	$1,892.55
Rate for Payer: Cash Price	$3,663.00
Rate for Payer: Devoted Health Medicare	$2,075.70
Rate for Payer: Hawaii Medical Service Association Medicare	$1,892.55
Rate for Payer: Hawaii Western Management Group Commercial	$4,273.50
Rate for Payer: Health Management Network Commercial	$5,189.25
Rate for Payer: Humana Medicare	$1,892.55
Rate for Payer: Kaiser Permanente Commercial	$5,494.50
Rate for Payer: Kaiser Permanente Medicaid	$3,113.55
Rate for Payer: Kaiser Permanente Medicare	$1,892.55
Rate for Payer: MDX Hawaii PPO	$5,921.85
Rate for Payer: Ohana Health Plan Medicaid	$1,892.55
Rate for Payer: Ohana Health Plan Medicare	$1,892.55
Rate for Payer: UnitedHealthcare Medicare	$1,892.55
Rate for Payer: University Health Alliance Commercial	$3,418.80

TRIDENT CUP 3/36MM 623-00-36I

Facility

$5,696.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,765.76
Max. Negotiated Rate	$5,525.12
Rate for Payer: AlohaCare Medicaid	$2,848.00
Rate for Payer: AlohaCare Medicare	$1,765.76
Rate for Payer: Cash Price	$3,417.60
Rate for Payer: Devoted Health Medicare	$1,936.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,765.76
Rate for Payer: Hawaii Western Management Group Commercial	$3,987.20
Rate for Payer: Health Management Network Commercial	$4,841.60
Rate for Payer: Humana Medicare	$1,765.76
Rate for Payer: Kaiser Permanente Commercial	$5,126.40
Rate for Payer: Kaiser Permanente Medicaid	$2,904.96
Rate for Payer: Kaiser Permanente Medicare	$1,765.76
Rate for Payer: MDX Hawaii PPO	$5,525.12
Rate for Payer: Ohana Health Plan Medicaid	$1,765.76
Rate for Payer: Ohana Health Plan Medicare	$1,765.76
Rate for Payer: UnitedHealthcare Medicare	$1,765.76
Rate for Payer: University Health Alliance Commercial	$3,189.76

TRIDENT CUP 3/36MM 623-00-36I

Facility

$5,696.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,189.76
Max. Negotiated Rate	$5,525.12
Rate for Payer: Cash Price	$3,417.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,987.20
Rate for Payer: Health Management Network Commercial	$4,841.60
Rate for Payer: Kaiser Permanente Commercial	$5,126.40
Rate for Payer: MDX Hawaii PPO	$5,525.12
Rate for Payer: University Health Alliance Commercial	$3,189.76

TRIDENT CUP 3/36MM 623-00-36J

Facility

$5,696.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,765.76
Max. Negotiated Rate	$5,525.12
Rate for Payer: AlohaCare Medicaid	$2,848.00
Rate for Payer: AlohaCare Medicare	$1,765.76
Rate for Payer: Cash Price	$3,417.60
Rate for Payer: Devoted Health Medicare	$1,936.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,765.76
Rate for Payer: Hawaii Western Management Group Commercial	$3,987.20
Rate for Payer: Health Management Network Commercial	$4,841.60
Rate for Payer: Humana Medicare	$1,765.76
Rate for Payer: Kaiser Permanente Commercial	$5,126.40
Rate for Payer: Kaiser Permanente Medicaid	$2,904.96
Rate for Payer: Kaiser Permanente Medicare	$1,765.76
Rate for Payer: MDX Hawaii PPO	$5,525.12
Rate for Payer: Ohana Health Plan Medicaid	$1,765.76
Rate for Payer: Ohana Health Plan Medicare	$1,765.76
Rate for Payer: UnitedHealthcare Medicare	$1,765.76
Rate for Payer: University Health Alliance Commercial	$3,189.76

TRIDENT CUP 3/36MM 623-00-36J

Facility

$5,696.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,189.76
Max. Negotiated Rate	$5,525.12
Rate for Payer: Cash Price	$3,417.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,987.20
Rate for Payer: Health Management Network Commercial	$4,841.60
Rate for Payer: Kaiser Permanente Commercial	$5,126.40
Rate for Payer: MDX Hawaii PPO	$5,525.12
Rate for Payer: University Health Alliance Commercial	$3,189.76

TRIDENT CUP 3/36MM 623-10-36E

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