Kau Hospital

All Charges

Charge

Type

Setting

Price

TIGHTROPE SUTURE AR-1588BTB-J

Facility

$1,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$915.60
Max. Negotiated Rate	$1,585.95
Rate for Payer: Cash Price	$981.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,144.50
Rate for Payer: Health Management Network Commercial	$1,389.75
Rate for Payer: Kaiser Permanente Commercial	$1,471.50
Rate for Payer: MDX Hawaii PPO	$1,585.95
Rate for Payer: University Health Alliance Commercial	$915.60

TIGHTROPE SYS AR-1288BTBIB-FC3

Facility

$2,384.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.04
Max. Negotiated Rate	$2,312.48
Rate for Payer: Cash Price	$1,430.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,668.80
Rate for Payer: Health Management Network Commercial	$2,026.40
Rate for Payer: Kaiser Permanente Commercial	$2,145.60
Rate for Payer: MDX Hawaii PPO	$2,312.48
Rate for Payer: University Health Alliance Commercial	$1,335.04

TIGHTROPE SYS AR-1288BTBIB-FC3

Facility

$2,384.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$739.04
Max. Negotiated Rate	$2,312.48
Rate for Payer: AlohaCare Medicaid	$1,192.00
Rate for Payer: AlohaCare Medicare	$739.04
Rate for Payer: Cash Price	$1,430.40
Rate for Payer: Devoted Health Medicare	$810.56
Rate for Payer: Hawaii Medical Service Association Medicare	$739.04
Rate for Payer: Hawaii Western Management Group Commercial	$1,668.80
Rate for Payer: Health Management Network Commercial	$2,026.40
Rate for Payer: Humana Medicare	$739.04
Rate for Payer: Kaiser Permanente Commercial	$2,145.60
Rate for Payer: Kaiser Permanente Medicaid	$1,215.84
Rate for Payer: Kaiser Permanente Medicare	$739.04
Rate for Payer: MDX Hawaii PPO	$2,312.48
Rate for Payer: Ohana Health Plan Medicaid	$739.04
Rate for Payer: Ohana Health Plan Medicare	$739.04
Rate for Payer: UnitedHealthcare Medicare	$739.04
Rate for Payer: University Health Alliance Commercial	$1,335.04

TIMOLOL MALEATE 0.25 % EYE DROPS [11561]

Facility

$53.00

Service Code	NDC 64980051305
Hospital Revenue Code	250
Min. Negotiated Rate	$45.05
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$31.80
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Kaiser Permanente Commercial	$47.70
Rate for Payer: MDX Hawaii PPO	$51.41

TIMOLOL MALEATE 0.25 % EYE DROPS [11561]

Facility

$53.00

Service Code	NDC 64980051305
Hospital Revenue Code	637
Min. Negotiated Rate	$16.43
Max. Negotiated Rate	$51.41
Rate for Payer: AlohaCare Medicaid	$26.50
Rate for Payer: AlohaCare Medicare	$16.43
Rate for Payer: Cash Price	$31.80
Rate for Payer: Devoted Health Medicare	$18.02
Rate for Payer: Hawaii Medical Service Association Medicare	$16.43
Rate for Payer: Hawaii Western Management Group Commercial	$50.35
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Humana Medicare	$16.43
Rate for Payer: Kaiser Permanente Commercial	$47.70
Rate for Payer: Kaiser Permanente Medicaid	$27.03
Rate for Payer: Kaiser Permanente Medicare	$16.43
Rate for Payer: MDX Hawaii PPO	$51.41
Rate for Payer: Ohana Health Plan Medicaid	$16.43
Rate for Payer: Ohana Health Plan Medicare	$16.43
Rate for Payer: UnitedHealthcare Medicare	$16.43
Rate for Payer: University Health Alliance Commercial	$38.63

TIMOLOL MALEATE 0.5 % EYE DROPS [11562]

Facility

$60.00

Service Code	NDC 61314022705
Hospital Revenue Code	250
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: MDX Hawaii PPO	$58.20

TIMOLOL MALEATE 0.5 % EYE DROPS [11562]

Facility

$60.00

Service Code	NDC 61314022705
Hospital Revenue Code	637
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$58.20
Rate for Payer: AlohaCare Medicaid	$30.00
Rate for Payer: AlohaCare Medicare	$18.60
Rate for Payer: Cash Price	$36.00
Rate for Payer: Devoted Health Medicare	$20.40
Rate for Payer: Hawaii Medical Service Association Medicare	$18.60
Rate for Payer: Hawaii Western Management Group Commercial	$57.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Humana Medicare	$18.60
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: Kaiser Permanente Medicaid	$30.60
Rate for Payer: Kaiser Permanente Medicare	$18.60
Rate for Payer: MDX Hawaii PPO	$58.20
Rate for Payer: Ohana Health Plan Medicaid	$18.60
Rate for Payer: Ohana Health Plan Medicare	$18.60
Rate for Payer: UnitedHealthcare Medicare	$18.60
Rate for Payer: University Health Alliance Commercial	$43.73

TI NAIL 11X380/RT 04.003.456S

Facility

$3,806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,131.36
Max. Negotiated Rate	$3,691.82
Rate for Payer: Cash Price	$2,283.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,664.20
Rate for Payer: Health Management Network Commercial	$3,235.10
Rate for Payer: Kaiser Permanente Commercial	$3,425.40
Rate for Payer: MDX Hawaii PPO	$3,691.82
Rate for Payer: University Health Alliance Commercial	$2,131.36

TI NAIL 11X380/RT 04.003.456S

Facility

$3,806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,179.86
Max. Negotiated Rate	$3,691.82
Rate for Payer: AlohaCare Medicaid	$1,903.00
Rate for Payer: AlohaCare Medicare	$1,179.86
Rate for Payer: Cash Price	$2,283.60
Rate for Payer: Devoted Health Medicare	$1,294.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1,179.86
Rate for Payer: Hawaii Western Management Group Commercial	$2,664.20
Rate for Payer: Health Management Network Commercial	$3,235.10
Rate for Payer: Humana Medicare	$1,179.86
Rate for Payer: Kaiser Permanente Commercial	$3,425.40
Rate for Payer: Kaiser Permanente Medicaid	$1,941.06
Rate for Payer: Kaiser Permanente Medicare	$1,179.86
Rate for Payer: MDX Hawaii PPO	$3,691.82
Rate for Payer: Ohana Health Plan Medicaid	$1,179.86
Rate for Payer: Ohana Health Plan Medicare	$1,179.86
Rate for Payer: UnitedHealthcare Medicare	$1,179.86
Rate for Payer: University Health Alliance Commercial	$2,131.36

TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR INHALATION [127331]

Facility

$225.00

Service Code	NDC 00597010051
Hospital Revenue Code	637
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$69.75
Rate for Payer: Cash Price	$135.00
Rate for Payer: Devoted Health Medicare	$76.50
Rate for Payer: Hawaii Medical Service Association Medicare	$69.75
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$69.75
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$69.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$69.75
Rate for Payer: Ohana Health Plan Medicare	$69.75
Rate for Payer: UnitedHealthcare Medicare	$69.75
Rate for Payer: University Health Alliance Commercial	$164.00

TIOTROPIUM BROMIDE 2.5 MCG/ACTUATION MIST FOR INHALATION [127331]

Facility

$225.00

Service Code	NDC 00597010051
Hospital Revenue Code	250
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$135.00
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

TIPS DISPOSABLE RENEW 3372

Facility

$226.00

Hospital Revenue Code	272
Min. Negotiated Rate	$70.06
Max. Negotiated Rate	$219.22
Rate for Payer: AlohaCare Medicaid	$113.00
Rate for Payer: AlohaCare Medicare	$70.06
Rate for Payer: Cash Price	$135.60
Rate for Payer: Devoted Health Medicare	$76.84
Rate for Payer: Hawaii Medical Service Association Medicare	$70.06
Rate for Payer: Hawaii Western Management Group Commercial	$214.70
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: Humana Medicare	$70.06
Rate for Payer: Kaiser Permanente Commercial	$203.40
Rate for Payer: Kaiser Permanente Medicaid	$115.26
Rate for Payer: Kaiser Permanente Medicare	$70.06
Rate for Payer: MDX Hawaii PPO	$219.22
Rate for Payer: Ohana Health Plan Medicaid	$70.06
Rate for Payer: Ohana Health Plan Medicare	$70.06
Rate for Payer: UnitedHealthcare Medicare	$70.06
Rate for Payer: University Health Alliance Commercial	$164.73

TIPS DISPOSABLE RENEW 3372

Facility

$226.00

Hospital Revenue Code	272
Min. Negotiated Rate	$192.10
Max. Negotiated Rate	$219.22
Rate for Payer: Cash Price	$135.60
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: Kaiser Permanente Commercial	$203.40
Rate for Payer: MDX Hawaii PPO	$219.22

TISOTUMAB VEDOTIN-TFTV 40 MG/4ML IV (WET SOLR VIAL) [430181289]

Facility

$9,381.00

Service Code	NDC 51144000301
Hospital Revenue Code	250
Min. Negotiated Rate	$7,973.85
Max. Negotiated Rate	$9,099.57
Rate for Payer: Cash Price	$5,628.60
Rate for Payer: Health Management Network Commercial	$7,973.85
Rate for Payer: Kaiser Permanente Commercial	$8,442.90
Rate for Payer: MDX Hawaii PPO	$9,099.57

TISOTUMAB VEDOTIN-TFTV 40 MG INTRAVENOUS SOLUTION [181289]

Facility

$19,595.00

Service Code	HCPCS J9273
Hospital Revenue Code	636
Min. Negotiated Rate	$188.65
Max. Negotiated Rate	$19,007.15
Rate for Payer: AlohaCare Medicaid	$9,797.50
Rate for Payer: AlohaCare Medicaid	$4,690.50
Rate for Payer: AlohaCare Medicare	$6,074.45
Rate for Payer: AlohaCare Medicare	$2,908.11
Rate for Payer: Cash Price	$11,757.00
Rate for Payer: Cash Price	$5,628.60
Rate for Payer: Cash Price	$5,628.60
Rate for Payer: Cash Price	$11,757.00
Rate for Payer: Devoted Health Medicare	$6,662.30
Rate for Payer: Devoted Health Medicare	$3,189.54
Rate for Payer: Hawaii Medical Service Association ABD	$188.65
Rate for Payer: Hawaii Medical Service Association ABD	$188.65
Rate for Payer: Hawaii Medical Service Association Commercial	$245.15
Rate for Payer: Hawaii Medical Service Association Commercial	$245.15
Rate for Payer: Hawaii Medical Service Association Medicare	$2,908.11
Rate for Payer: Hawaii Medical Service Association Medicare	$6,074.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$188.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$188.65
Rate for Payer: Hawaii Western Management Group Commercial	$18,615.25
Rate for Payer: Hawaii Western Management Group Commercial	$8,911.95
Rate for Payer: Health Management Network Commercial	$16,655.75
Rate for Payer: Health Management Network Commercial	$7,973.85
Rate for Payer: Humana Medicare	$2,908.11
Rate for Payer: Humana Medicare	$6,074.45
Rate for Payer: Kaiser Permanente Commercial	$17,635.50
Rate for Payer: Kaiser Permanente Commercial	$8,442.90
Rate for Payer: Kaiser Permanente Medicaid	$4,784.31
Rate for Payer: Kaiser Permanente Medicaid	$9,993.45
Rate for Payer: Kaiser Permanente Medicare	$6,074.45
Rate for Payer: Kaiser Permanente Medicare	$2,908.11
Rate for Payer: MDX Hawaii PPO	$9,099.57
Rate for Payer: MDX Hawaii PPO	$19,007.15
Rate for Payer: Ohana Health Plan Medicaid	$2,908.11
Rate for Payer: Ohana Health Plan Medicaid	$6,074.45
Rate for Payer: Ohana Health Plan Medicare	$6,074.45
Rate for Payer: Ohana Health Plan Medicare	$2,908.11
Rate for Payer: UnitedHealthcare Medicaid	$5,628.60
Rate for Payer: UnitedHealthcare Medicaid	$11,757.00
Rate for Payer: UnitedHealthcare Medicare	$6,074.45
Rate for Payer: UnitedHealthcare Medicare	$2,908.11
Rate for Payer: University Health Alliance Commercial	$14,282.80
Rate for Payer: University Health Alliance Commercial	$6,837.81

TISOTUMAB VEDOTIN-TFTV 40 MG INTRAVENOUS SOLUTION [181289]

Facility

$9,381.00

Service Code	HCPCS J9273
Hospital Revenue Code	250
Min. Negotiated Rate	$7,973.85
Max. Negotiated Rate	$9,099.57
Rate for Payer: Cash Price	$5,628.60
Rate for Payer: Cash Price	$11,757.00
Rate for Payer: Health Management Network Commercial	$7,973.85
Rate for Payer: Health Management Network Commercial	$16,655.75
Rate for Payer: Kaiser Permanente Commercial	$17,635.50
Rate for Payer: Kaiser Permanente Commercial	$8,442.90
Rate for Payer: MDX Hawaii PPO	$9,099.57
Rate for Payer: MDX Hawaii PPO	$19,007.15

TISSEEL DUPLOSPRAY 060-1130

Facility

$436.00

Hospital Revenue Code	272
Min. Negotiated Rate	$135.16
Max. Negotiated Rate	$422.92
Rate for Payer: AlohaCare Medicaid	$218.00
Rate for Payer: AlohaCare Medicare	$135.16
Rate for Payer: Cash Price	$261.60
Rate for Payer: Devoted Health Medicare	$148.24
Rate for Payer: Hawaii Medical Service Association Medicare	$135.16
Rate for Payer: Hawaii Western Management Group Commercial	$414.20
Rate for Payer: Health Management Network Commercial	$370.60
Rate for Payer: Humana Medicare	$135.16
Rate for Payer: Kaiser Permanente Commercial	$392.40
Rate for Payer: Kaiser Permanente Medicaid	$222.36
Rate for Payer: Kaiser Permanente Medicare	$135.16
Rate for Payer: MDX Hawaii PPO	$422.92
Rate for Payer: Ohana Health Plan Medicaid	$135.16
Rate for Payer: Ohana Health Plan Medicare	$135.16
Rate for Payer: UnitedHealthcare Medicare	$135.16
Rate for Payer: University Health Alliance Commercial	$317.80

TISSEEL DUPLOSPRAY 060-1130

Facility

$436.00

Hospital Revenue Code	272
Min. Negotiated Rate	$370.60
Max. Negotiated Rate	$422.92
Rate for Payer: Cash Price	$261.60
Rate for Payer: Health Management Network Commercial	$370.60
Rate for Payer: Kaiser Permanente Commercial	$392.40
Rate for Payer: MDX Hawaii PPO	$422.92

TISSEEL FROZEN 10ML KT 1506080

Facility

$2,115.00

Service Code	HCPCS C9250
Hospital Revenue Code	636
Min. Negotiated Rate	$179.62
Max. Negotiated Rate	$2,051.55
Rate for Payer: AlohaCare Medicaid	$1,057.50
Rate for Payer: AlohaCare Medicare	$655.65
Rate for Payer: Cash Price	$1,269.00
Rate for Payer: Cash Price	$1,269.00
Rate for Payer: Devoted Health Medicare	$719.10
Rate for Payer: Hawaii Medical Service Association Commercial	$179.62
Rate for Payer: Hawaii Medical Service Association Medicare	$655.65
Rate for Payer: Hawaii Western Management Group Commercial	$2,009.25
Rate for Payer: Health Management Network Commercial	$1,797.75
Rate for Payer: Humana Medicare	$655.65
Rate for Payer: Kaiser Permanente Commercial	$1,903.50
Rate for Payer: Kaiser Permanente Medicaid	$1,078.65
Rate for Payer: Kaiser Permanente Medicare	$655.65
Rate for Payer: MDX Hawaii PPO	$2,051.55
Rate for Payer: Ohana Health Plan Medicaid	$655.65
Rate for Payer: Ohana Health Plan Medicare	$655.65
Rate for Payer: UnitedHealthcare Medicaid	$1,269.00
Rate for Payer: UnitedHealthcare Medicare	$655.65
Rate for Payer: University Health Alliance Commercial	$1,541.62

TISSEEL FROZEN 10ML KT 1506080

Facility

$2,115.00

Service Code	HCPCS C9250
Hospital Revenue Code	636
Min. Negotiated Rate	$1,797.75
Max. Negotiated Rate	$2,051.55
Rate for Payer: Cash Price	$1,269.00
Rate for Payer: Health Management Network Commercial	$1,797.75
Rate for Payer: Kaiser Permanente Commercial	$1,903.50
Rate for Payer: MDX Hawaii PPO	$2,051.55

TISSEEL VHSD FROZEN 4ML KIT

Facility

$929.00

Service Code	HCPCS C9250
Hospital Revenue Code	636
Min. Negotiated Rate	$179.62
Max. Negotiated Rate	$901.13
Rate for Payer: AlohaCare Medicaid	$464.50
Rate for Payer: AlohaCare Medicare	$287.99
Rate for Payer: Cash Price	$557.40
Rate for Payer: Cash Price	$557.40
Rate for Payer: Devoted Health Medicare	$315.86
Rate for Payer: Hawaii Medical Service Association Commercial	$179.62
Rate for Payer: Hawaii Medical Service Association Medicare	$287.99
Rate for Payer: Hawaii Western Management Group Commercial	$882.55
Rate for Payer: Health Management Network Commercial	$789.65
Rate for Payer: Humana Medicare	$287.99
Rate for Payer: Kaiser Permanente Commercial	$836.10
Rate for Payer: Kaiser Permanente Medicaid	$473.79
Rate for Payer: Kaiser Permanente Medicare	$287.99
Rate for Payer: MDX Hawaii PPO	$901.13
Rate for Payer: Ohana Health Plan Medicaid	$287.99
Rate for Payer: Ohana Health Plan Medicare	$287.99
Rate for Payer: UnitedHealthcare Medicaid	$557.40
Rate for Payer: UnitedHealthcare Medicare	$287.99
Rate for Payer: University Health Alliance Commercial	$677.15

TISSEEL VHSD FROZEN 4ML KIT

Facility

$929.00

Service Code	HCPCS C9250
Hospital Revenue Code	636
Min. Negotiated Rate	$789.65
Max. Negotiated Rate	$901.13
Rate for Payer: Cash Price	$557.40
Rate for Payer: Health Management Network Commercial	$789.65
Rate for Payer: Kaiser Permanente Commercial	$836.10
Rate for Payer: MDX Hawaii PPO	$901.13

TISSUE MICROMATRIX MM1000

Facility

$5,436.00

Service Code	HCPCS Q4118
Hospital Revenue Code	636
Min. Negotiated Rate	$4,620.60
Max. Negotiated Rate	$5,272.92
Rate for Payer: Cash Price	$3,261.60
Rate for Payer: Health Management Network Commercial	$4,620.60
Rate for Payer: Kaiser Permanente Commercial	$4,892.40
Rate for Payer: MDX Hawaii PPO	$5,272.92

TISSUE MICROMATRIX MM1000

Facility

$5,436.00

Service Code	HCPCS Q4118
Hospital Revenue Code	636
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$5,272.92
Rate for Payer: AlohaCare Medicaid	$2,718.00
Rate for Payer: AlohaCare Medicare	$1,685.16
Rate for Payer: Cash Price	$3,261.60
Rate for Payer: Cash Price	$3,261.60
Rate for Payer: Devoted Health Medicare	$1,848.24
Rate for Payer: Hawaii Medical Service Association ABD	$2.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,685.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.56
Rate for Payer: Hawaii Western Management Group Commercial	$5,164.20
Rate for Payer: Health Management Network Commercial	$4,620.60
Rate for Payer: Humana Medicare	$1,685.16
Rate for Payer: Kaiser Permanente Commercial	$4,892.40
Rate for Payer: Kaiser Permanente Medicaid	$2,772.36
Rate for Payer: Kaiser Permanente Medicare	$1,685.16
Rate for Payer: MDX Hawaii PPO	$5,272.92
Rate for Payer: Ohana Health Plan Medicaid	$1,685.16
Rate for Payer: Ohana Health Plan Medicare	$1,685.16
Rate for Payer: UnitedHealthcare Medicaid	$3,261.60
Rate for Payer: UnitedHealthcare Medicare	$1,685.16
Rate for Payer: University Health Alliance Commercial	$3,962.30

TISSUE RETRIEVAL TRS-ROBO-8

Facility

$450.00

Hospital Revenue Code	272
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$270.00
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: Kaiser Permanente Commercial	$405.00
Rate for Payer: MDX Hawaii PPO	$436.50

Know your out-of-pocket cost for care.

All Charges