Kau Hospital

All Charges

Charge

Type

Setting

Price

TRABECTEDIN 1 MG/20ML IV (WET SOLR VIAL) [430129413]

Facility

$4,928.00

Service Code	HCPCS J9352
Hospital Revenue Code	250
Min. Negotiated Rate	$4,188.80
Max. Negotiated Rate	$4,780.16
Rate for Payer: Cash Price	$2,956.80
Rate for Payer: Health Management Network Commercial	$4,188.80
Rate for Payer: Kaiser Permanente Commercial	$4,435.20
Rate for Payer: MDX Hawaii PPO	$4,780.16

TRABECTEDIN 1 MG/20ML IV (WET SOLR VIAL) [430129413]

Facility

$4,928.00

Service Code	HCPCS J9352
Hospital Revenue Code	636
Min. Negotiated Rate	$383.07
Max. Negotiated Rate	$4,780.16
Rate for Payer: AlohaCare Medicaid	$2,464.00
Rate for Payer: AlohaCare Medicare	$1,527.68
Rate for Payer: Cash Price	$2,956.80
Rate for Payer: Cash Price	$2,956.80
Rate for Payer: Devoted Health Medicare	$1,675.52
Rate for Payer: Hawaii Medical Service Association ABD	$383.07
Rate for Payer: Hawaii Medical Service Association Commercial	$488.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,527.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$383.07
Rate for Payer: Hawaii Western Management Group Commercial	$4,681.60
Rate for Payer: Health Management Network Commercial	$4,188.80
Rate for Payer: Humana Medicare	$1,527.68
Rate for Payer: Kaiser Permanente Commercial	$4,435.20
Rate for Payer: Kaiser Permanente Medicaid	$2,513.28
Rate for Payer: Kaiser Permanente Medicare	$1,527.68
Rate for Payer: MDX Hawaii PPO	$4,780.16
Rate for Payer: Ohana Health Plan Medicaid	$1,527.68
Rate for Payer: Ohana Health Plan Medicare	$1,527.68
Rate for Payer: UnitedHealthcare Medicaid	$2,956.80
Rate for Payer: UnitedHealthcare Medicare	$1,527.68
Rate for Payer: University Health Alliance Commercial	$3,592.02

TRABECTEDIN 1 MG INTRAVENOUS SOLUTION [129413]

Facility

$4,928.00

Service Code	HCPCS J9352
Hospital Revenue Code	636
Min. Negotiated Rate	$383.07
Max. Negotiated Rate	$4,780.16
Rate for Payer: AlohaCare Medicaid	$2,464.00
Rate for Payer: AlohaCare Medicaid	$3,854.00
Rate for Payer: AlohaCare Medicare	$2,389.48
Rate for Payer: AlohaCare Medicare	$1,527.68
Rate for Payer: Cash Price	$2,956.80
Rate for Payer: Cash Price	$2,956.80
Rate for Payer: Cash Price	$4,624.80
Rate for Payer: Cash Price	$4,624.80
Rate for Payer: Devoted Health Medicare	$1,675.52
Rate for Payer: Devoted Health Medicare	$2,620.72
Rate for Payer: Hawaii Medical Service Association ABD	$383.07
Rate for Payer: Hawaii Medical Service Association ABD	$383.07
Rate for Payer: Hawaii Medical Service Association Commercial	$488.84
Rate for Payer: Hawaii Medical Service Association Commercial	$488.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,527.68
Rate for Payer: Hawaii Medical Service Association Medicare	$2,389.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$383.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$383.07
Rate for Payer: Hawaii Western Management Group Commercial	$4,681.60
Rate for Payer: Hawaii Western Management Group Commercial	$7,322.60
Rate for Payer: Health Management Network Commercial	$4,188.80
Rate for Payer: Health Management Network Commercial	$6,551.80
Rate for Payer: Humana Medicare	$1,527.68
Rate for Payer: Humana Medicare	$2,389.48
Rate for Payer: Kaiser Permanente Commercial	$4,435.20
Rate for Payer: Kaiser Permanente Commercial	$6,937.20
Rate for Payer: Kaiser Permanente Medicaid	$2,513.28
Rate for Payer: Kaiser Permanente Medicaid	$3,931.08
Rate for Payer: Kaiser Permanente Medicare	$1,527.68
Rate for Payer: Kaiser Permanente Medicare	$2,389.48
Rate for Payer: MDX Hawaii PPO	$4,780.16
Rate for Payer: MDX Hawaii PPO	$7,476.76
Rate for Payer: Ohana Health Plan Medicaid	$2,389.48
Rate for Payer: Ohana Health Plan Medicaid	$1,527.68
Rate for Payer: Ohana Health Plan Medicare	$1,527.68
Rate for Payer: Ohana Health Plan Medicare	$2,389.48
Rate for Payer: UnitedHealthcare Medicaid	$2,956.80
Rate for Payer: UnitedHealthcare Medicaid	$4,624.80
Rate for Payer: UnitedHealthcare Medicare	$2,389.48
Rate for Payer: UnitedHealthcare Medicare	$1,527.68
Rate for Payer: University Health Alliance Commercial	$3,592.02
Rate for Payer: University Health Alliance Commercial	$5,618.36

TRABECTEDIN 1 MG INTRAVENOUS SOLUTION [129413]

Facility

$4,928.00

Service Code	HCPCS J9352
Hospital Revenue Code	250
Min. Negotiated Rate	$4,188.80
Max. Negotiated Rate	$4,780.16
Rate for Payer: Cash Price	$2,956.80
Rate for Payer: Cash Price	$4,624.80
Rate for Payer: Health Management Network Commercial	$6,551.80
Rate for Payer: Health Management Network Commercial	$4,188.80
Rate for Payer: Kaiser Permanente Commercial	$4,435.20
Rate for Payer: Kaiser Permanente Commercial	$6,937.20
Rate for Payer: MDX Hawaii PPO	$4,780.16
Rate for Payer: MDX Hawaii PPO	$7,476.76

TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION [174502]

Facility

$85.00

Service Code	NDC 00517930525
Hospital Revenue Code	250
Min. Negotiated Rate	$72.25
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$51.00
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: Kaiser Permanente Commercial	$76.50
Rate for Payer: MDX Hawaii PPO	$82.45

TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION [174502]

Facility

$85.00

Service Code	NDC 00517930501
Hospital Revenue Code	250
Min. Negotiated Rate	$72.25
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$51.00
Rate for Payer: Health Management Network Commercial	$72.25
Rate for Payer: Kaiser Permanente Commercial	$76.50
Rate for Payer: MDX Hawaii PPO	$82.45

TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC

Facility

$83,122.91

Service Code	MSDRG 012
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$83,122.91
Rate for Payer: Hawaii Medical Service Association Commercial	$83,122.91
Rate for Payer: University Health Alliance Commercial	$10,400.00

TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC

Facility

$83,122.91

Service Code	MSDRG 011
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$83,122.91
Rate for Payer: Hawaii Medical Service Association Commercial	$83,122.91
Rate for Payer: University Health Alliance Commercial	$10,400.00

TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC

Facility

$83,122.91

Service Code	MSDRG 013
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$83,122.91
Rate for Payer: Hawaii Medical Service Association Commercial	$83,122.91
Rate for Payer: University Health Alliance Commercial	$10,400.00

TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES

Facility

$404,593.14

Service Code	MSDRG 004
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$404,593.14
Rate for Payer: Hawaii Medical Service Association Commercial	$404,593.14
Rate for Payer: University Health Alliance Commercial	$10,400.00

TRACH PERC INTROD 8.0MM

Facility

$1,560.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$483.60
Max. Negotiated Rate	$1,513.20
Rate for Payer: AlohaCare Medicaid	$780.00
Rate for Payer: AlohaCare Medicare	$483.60
Rate for Payer: Cash Price	$936.00
Rate for Payer: Devoted Health Medicare	$530.40
Rate for Payer: Hawaii Medical Service Association Medicare	$483.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,482.00
Rate for Payer: Health Management Network Commercial	$1,326.00
Rate for Payer: Humana Medicare	$483.60
Rate for Payer: Kaiser Permanente Commercial	$1,404.00
Rate for Payer: Kaiser Permanente Medicaid	$795.60
Rate for Payer: Kaiser Permanente Medicare	$483.60
Rate for Payer: MDX Hawaii PPO	$1,513.20
Rate for Payer: Ohana Health Plan Medicaid	$483.60
Rate for Payer: Ohana Health Plan Medicare	$483.60
Rate for Payer: UnitedHealthcare Medicare	$483.60
Rate for Payer: University Health Alliance Commercial	$1,137.08

TRACH PERC INTROD 8.0MM

Facility

$1,560.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$1,326.00
Max. Negotiated Rate	$1,513.20
Rate for Payer: Cash Price	$936.00
Rate for Payer: Health Management Network Commercial	$1,326.00
Rate for Payer: Kaiser Permanente Commercial	$1,404.00
Rate for Payer: MDX Hawaii PPO	$1,513.20

TRACH SHILEY 8XLT CUFF

Facility

$259.00

Hospital Revenue Code	272
Min. Negotiated Rate	$220.15
Max. Negotiated Rate	$251.23
Rate for Payer: Cash Price	$155.40
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Kaiser Permanente Commercial	$233.10
Rate for Payer: MDX Hawaii PPO	$251.23

TRACH SHILEY 8XLT CUFF

Facility

$259.00

Hospital Revenue Code	272
Min. Negotiated Rate	$80.29
Max. Negotiated Rate	$251.23
Rate for Payer: AlohaCare Medicaid	$129.50
Rate for Payer: AlohaCare Medicare	$80.29
Rate for Payer: Cash Price	$155.40
Rate for Payer: Devoted Health Medicare	$88.06
Rate for Payer: Hawaii Medical Service Association Medicare	$80.29
Rate for Payer: Hawaii Western Management Group Commercial	$246.05
Rate for Payer: Health Management Network Commercial	$220.15
Rate for Payer: Humana Medicare	$80.29
Rate for Payer: Kaiser Permanente Commercial	$233.10
Rate for Payer: Kaiser Permanente Medicaid	$132.09
Rate for Payer: Kaiser Permanente Medicare	$80.29
Rate for Payer: MDX Hawaii PPO	$251.23
Rate for Payer: Ohana Health Plan Medicaid	$80.29
Rate for Payer: Ohana Health Plan Medicare	$80.29
Rate for Payer: UnitedHealthcare Medicare	$80.29
Rate for Payer: University Health Alliance Commercial	$188.79

TRACH TUBE 6.0MM BIVONA

Facility

$735.00

Hospital Revenue Code	272
Min. Negotiated Rate	$624.75
Max. Negotiated Rate	$712.95
Rate for Payer: Cash Price	$441.00
Rate for Payer: Health Management Network Commercial	$624.75
Rate for Payer: Kaiser Permanente Commercial	$661.50
Rate for Payer: MDX Hawaii PPO	$712.95

TRACH TUBE 6.0MM BIVONA

Facility

$735.00

Hospital Revenue Code	272
Min. Negotiated Rate	$227.85
Max. Negotiated Rate	$712.95
Rate for Payer: AlohaCare Medicaid	$367.50
Rate for Payer: AlohaCare Medicare	$227.85
Rate for Payer: Cash Price	$441.00
Rate for Payer: Devoted Health Medicare	$249.90
Rate for Payer: Hawaii Medical Service Association Medicare	$227.85
Rate for Payer: Hawaii Western Management Group Commercial	$698.25
Rate for Payer: Health Management Network Commercial	$624.75
Rate for Payer: Humana Medicare	$227.85
Rate for Payer: Kaiser Permanente Commercial	$661.50
Rate for Payer: Kaiser Permanente Medicaid	$374.85
Rate for Payer: Kaiser Permanente Medicare	$227.85
Rate for Payer: MDX Hawaii PPO	$712.95
Rate for Payer: Ohana Health Plan Medicaid	$227.85
Rate for Payer: Ohana Health Plan Medicare	$227.85
Rate for Payer: UnitedHealthcare Medicare	$227.85
Rate for Payer: University Health Alliance Commercial	$535.74

TRACH TUBE 7.0MM BIVONA

Facility

$735.00

Hospital Revenue Code	272
Min. Negotiated Rate	$624.75
Max. Negotiated Rate	$712.95
Rate for Payer: Cash Price	$441.00
Rate for Payer: Health Management Network Commercial	$624.75
Rate for Payer: Kaiser Permanente Commercial	$661.50
Rate for Payer: MDX Hawaii PPO	$712.95

TRACH TUBE 7.0MM BIVONA

Facility

$735.00

Hospital Revenue Code	272
Min. Negotiated Rate	$227.85
Max. Negotiated Rate	$712.95
Rate for Payer: AlohaCare Medicaid	$367.50
Rate for Payer: AlohaCare Medicare	$227.85
Rate for Payer: Cash Price	$441.00
Rate for Payer: Devoted Health Medicare	$249.90
Rate for Payer: Hawaii Medical Service Association Medicare	$227.85
Rate for Payer: Hawaii Western Management Group Commercial	$698.25
Rate for Payer: Health Management Network Commercial	$624.75
Rate for Payer: Humana Medicare	$227.85
Rate for Payer: Kaiser Permanente Commercial	$661.50
Rate for Payer: Kaiser Permanente Medicaid	$374.85
Rate for Payer: Kaiser Permanente Medicare	$227.85
Rate for Payer: MDX Hawaii PPO	$712.95
Rate for Payer: Ohana Health Plan Medicaid	$227.85
Rate for Payer: Ohana Health Plan Medicare	$227.85
Rate for Payer: UnitedHealthcare Medicare	$227.85
Rate for Payer: University Health Alliance Commercial	$535.74

TRACH TUBE BIVONA 8 SILICONE

Facility

$713.00

Hospital Revenue Code	272
Min. Negotiated Rate	$606.05
Max. Negotiated Rate	$691.61
Rate for Payer: Cash Price	$427.80
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: Kaiser Permanente Commercial	$641.70
Rate for Payer: MDX Hawaii PPO	$691.61

TRACH TUBE BIVONA 8 SILICONE

Facility

$713.00

Hospital Revenue Code	272
Min. Negotiated Rate	$221.03
Max. Negotiated Rate	$691.61
Rate for Payer: AlohaCare Medicaid	$356.50
Rate for Payer: AlohaCare Medicare	$221.03
Rate for Payer: Cash Price	$427.80
Rate for Payer: Devoted Health Medicare	$242.42
Rate for Payer: Hawaii Medical Service Association Medicare	$221.03
Rate for Payer: Hawaii Western Management Group Commercial	$677.35
Rate for Payer: Health Management Network Commercial	$606.05
Rate for Payer: Humana Medicare	$221.03
Rate for Payer: Kaiser Permanente Commercial	$641.70
Rate for Payer: Kaiser Permanente Medicaid	$363.63
Rate for Payer: Kaiser Permanente Medicare	$221.03
Rate for Payer: MDX Hawaii PPO	$691.61
Rate for Payer: Ohana Health Plan Medicaid	$221.03
Rate for Payer: Ohana Health Plan Medicare	$221.03
Rate for Payer: UnitedHealthcare Medicare	$221.03
Rate for Payer: University Health Alliance Commercial	$519.71

TRACH TUBE CUFF 6.5

Facility

$192.00

Hospital Revenue Code	272
Min. Negotiated Rate	$59.52
Max. Negotiated Rate	$186.24
Rate for Payer: AlohaCare Medicaid	$96.00
Rate for Payer: AlohaCare Medicare	$59.52
Rate for Payer: Cash Price	$115.20
Rate for Payer: Devoted Health Medicare	$65.28
Rate for Payer: Hawaii Medical Service Association Medicare	$59.52
Rate for Payer: Hawaii Western Management Group Commercial	$182.40
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Humana Medicare	$59.52
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: Kaiser Permanente Medicaid	$97.92
Rate for Payer: Kaiser Permanente Medicare	$59.52
Rate for Payer: MDX Hawaii PPO	$186.24
Rate for Payer: Ohana Health Plan Medicaid	$59.52
Rate for Payer: Ohana Health Plan Medicare	$59.52
Rate for Payer: UnitedHealthcare Medicare	$59.52
Rate for Payer: University Health Alliance Commercial	$139.95

TRACH TUBE CUFF 6.5

Facility

$192.00

Hospital Revenue Code	272
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$186.24
Rate for Payer: Cash Price	$115.20
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: MDX Hawaii PPO	$186.24

TRACH TUBE CUFF 7.5

Facility

$192.00

Hospital Revenue Code	272
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$186.24
Rate for Payer: Cash Price	$115.20
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: MDX Hawaii PPO	$186.24

TRACH TUBE CUFF 7.5

Facility

$192.00

Hospital Revenue Code	272
Min. Negotiated Rate	$59.52
Max. Negotiated Rate	$186.24
Rate for Payer: AlohaCare Medicaid	$96.00
Rate for Payer: AlohaCare Medicare	$59.52
Rate for Payer: Cash Price	$115.20
Rate for Payer: Devoted Health Medicare	$65.28
Rate for Payer: Hawaii Medical Service Association Medicare	$59.52
Rate for Payer: Hawaii Western Management Group Commercial	$182.40
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Humana Medicare	$59.52
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: Kaiser Permanente Medicaid	$97.92
Rate for Payer: Kaiser Permanente Medicare	$59.52
Rate for Payer: MDX Hawaii PPO	$186.24
Rate for Payer: Ohana Health Plan Medicaid	$59.52
Rate for Payer: Ohana Health Plan Medicare	$59.52
Rate for Payer: UnitedHealthcare Medicare	$59.52
Rate for Payer: University Health Alliance Commercial	$139.95

TRACH TUBE CUFF 8.5

Facility

$192.00

Hospital Revenue Code	272
Min. Negotiated Rate	$59.52
Max. Negotiated Rate	$186.24
Rate for Payer: AlohaCare Medicaid	$96.00
Rate for Payer: AlohaCare Medicare	$59.52
Rate for Payer: Cash Price	$115.20
Rate for Payer: Devoted Health Medicare	$65.28
Rate for Payer: Hawaii Medical Service Association Medicare	$59.52
Rate for Payer: Hawaii Western Management Group Commercial	$182.40
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Humana Medicare	$59.52
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: Kaiser Permanente Medicaid	$97.92
Rate for Payer: Kaiser Permanente Medicare	$59.52
Rate for Payer: MDX Hawaii PPO	$186.24
Rate for Payer: Ohana Health Plan Medicaid	$59.52
Rate for Payer: Ohana Health Plan Medicare	$59.52
Rate for Payer: UnitedHealthcare Medicare	$59.52
Rate for Payer: University Health Alliance Commercial	$139.95

Know your out-of-pocket cost for care.

All Charges