Kau Hospital

All Charges

Charge

Type

Setting

Price

TRACH TUBE CUFF 8.5

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 CUFFED

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 CUFFED

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 TUBE SHHILEY 8FEN

Facility

$251.00

Hospital Revenue Code	272
Min. Negotiated Rate	$213.35
Max. Negotiated Rate	$243.47
Rate for Payer: Cash Price	$150.60
Rate for Payer: Health Management Network Commercial	$213.35
Rate for Payer: Kaiser Permanente Commercial	$225.90
Rate for Payer: MDX Hawaii PPO	$243.47

TRACH TUBE SHHILEY 8FEN

Facility

$251.00

Hospital Revenue Code	272
Min. Negotiated Rate	$77.81
Max. Negotiated Rate	$243.47
Rate for Payer: AlohaCare Medicaid	$125.50
Rate for Payer: AlohaCare Medicare	$77.81
Rate for Payer: Cash Price	$150.60
Rate for Payer: Devoted Health Medicare	$85.34
Rate for Payer: Hawaii Medical Service Association Medicare	$77.81
Rate for Payer: Hawaii Western Management Group Commercial	$238.45
Rate for Payer: Health Management Network Commercial	$213.35
Rate for Payer: Humana Medicare	$77.81
Rate for Payer: Kaiser Permanente Commercial	$225.90
Rate for Payer: Kaiser Permanente Medicaid	$128.01
Rate for Payer: Kaiser Permanente Medicare	$77.81
Rate for Payer: MDX Hawaii PPO	$243.47
Rate for Payer: Ohana Health Plan Medicaid	$77.81
Rate for Payer: Ohana Health Plan Medicare	$77.81
Rate for Payer: UnitedHealthcare Medicare	$77.81
Rate for Payer: University Health Alliance Commercial	$182.95

TRACH TUBE SHILEY 5X9.4

Facility

$236.00

Hospital Revenue Code	272
Min. Negotiated Rate	$73.16
Max. Negotiated Rate	$228.92
Rate for Payer: AlohaCare Medicaid	$118.00
Rate for Payer: AlohaCare Medicare	$73.16
Rate for Payer: Cash Price	$141.60
Rate for Payer: Devoted Health Medicare	$80.24
Rate for Payer: Hawaii Medical Service Association Medicare	$73.16
Rate for Payer: Hawaii Western Management Group Commercial	$224.20
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Humana Medicare	$73.16
Rate for Payer: Kaiser Permanente Commercial	$212.40
Rate for Payer: Kaiser Permanente Medicaid	$120.36
Rate for Payer: Kaiser Permanente Medicare	$73.16
Rate for Payer: MDX Hawaii PPO	$228.92
Rate for Payer: Ohana Health Plan Medicaid	$73.16
Rate for Payer: Ohana Health Plan Medicare	$73.16
Rate for Payer: UnitedHealthcare Medicare	$73.16
Rate for Payer: University Health Alliance Commercial	$172.02

TRACH TUBE SHILEY 5X9.4

Facility

$236.00

Hospital Revenue Code	272
Min. Negotiated Rate	$200.60
Max. Negotiated Rate	$228.92
Rate for Payer: Cash Price	$141.60
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Kaiser Permanente Commercial	$212.40
Rate for Payer: MDX Hawaii PPO	$228.92

TRACH TUBE SHILEY 5X9.4 CUFFED

Facility

$204.00

Hospital Revenue Code	272
Min. Negotiated Rate	$63.24
Max. Negotiated Rate	$197.88
Rate for Payer: AlohaCare Medicaid	$102.00
Rate for Payer: AlohaCare Medicare	$63.24
Rate for Payer: Cash Price	$122.40
Rate for Payer: Devoted Health Medicare	$69.36
Rate for Payer: Hawaii Medical Service Association Medicare	$63.24
Rate for Payer: Hawaii Western Management Group Commercial	$193.80
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Humana Medicare	$63.24
Rate for Payer: Kaiser Permanente Commercial	$183.60
Rate for Payer: Kaiser Permanente Medicaid	$104.04
Rate for Payer: Kaiser Permanente Medicare	$63.24
Rate for Payer: MDX Hawaii PPO	$197.88
Rate for Payer: Ohana Health Plan Medicaid	$63.24
Rate for Payer: Ohana Health Plan Medicare	$63.24
Rate for Payer: UnitedHealthcare Medicare	$63.24
Rate for Payer: University Health Alliance Commercial	$148.70

TRACH TUBE SHILEY 5X9.4 CUFFED

Facility

$204.00

Hospital Revenue Code	272
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$197.88
Rate for Payer: Cash Price	$122.40
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Kaiser Permanente Commercial	$183.60
Rate for Payer: MDX Hawaii PPO	$197.88

TRACH TUBE SHILEY 6DCFN

Facility

$236.00

Hospital Revenue Code	272
Min. Negotiated Rate	$200.60
Max. Negotiated Rate	$228.92
Rate for Payer: Cash Price	$141.60
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Kaiser Permanente Commercial	$212.40
Rate for Payer: MDX Hawaii PPO	$228.92

TRACH TUBE SHILEY 6DCFN

Facility

$236.00

Hospital Revenue Code	272
Min. Negotiated Rate	$73.16
Max. Negotiated Rate	$228.92
Rate for Payer: AlohaCare Medicaid	$118.00
Rate for Payer: AlohaCare Medicare	$73.16
Rate for Payer: Cash Price	$141.60
Rate for Payer: Devoted Health Medicare	$80.24
Rate for Payer: Hawaii Medical Service Association Medicare	$73.16
Rate for Payer: Hawaii Western Management Group Commercial	$224.20
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Humana Medicare	$73.16
Rate for Payer: Kaiser Permanente Commercial	$212.40
Rate for Payer: Kaiser Permanente Medicaid	$120.36
Rate for Payer: Kaiser Permanente Medicare	$73.16
Rate for Payer: MDX Hawaii PPO	$228.92
Rate for Payer: Ohana Health Plan Medicaid	$73.16
Rate for Payer: Ohana Health Plan Medicare	$73.16
Rate for Payer: UnitedHealthcare Medicare	$73.16
Rate for Payer: University Health Alliance Commercial	$172.02

TRACH TUBE SHILEY 6X10 CUFFED

Facility

$204.00

Hospital Revenue Code	272
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$197.88
Rate for Payer: Cash Price	$122.40
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Kaiser Permanente Commercial	$183.60
Rate for Payer: MDX Hawaii PPO	$197.88

TRACH TUBE SHILEY 6X10 CUFFED

Facility

$204.00

Hospital Revenue Code	272
Min. Negotiated Rate	$63.24
Max. Negotiated Rate	$197.88
Rate for Payer: AlohaCare Medicaid	$102.00
Rate for Payer: AlohaCare Medicare	$63.24
Rate for Payer: Cash Price	$122.40
Rate for Payer: Devoted Health Medicare	$69.36
Rate for Payer: Hawaii Medical Service Association Medicare	$63.24
Rate for Payer: Hawaii Western Management Group Commercial	$193.80
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Humana Medicare	$63.24
Rate for Payer: Kaiser Permanente Commercial	$183.60
Rate for Payer: Kaiser Permanente Medicaid	$104.04
Rate for Payer: Kaiser Permanente Medicare	$63.24
Rate for Payer: MDX Hawaii PPO	$197.88
Rate for Payer: Ohana Health Plan Medicaid	$63.24
Rate for Payer: Ohana Health Plan Medicare	$63.24
Rate for Payer: UnitedHealthcare Medicare	$63.24
Rate for Payer: University Health Alliance Commercial	$148.70

TRACH TUBE SHILEY 7.6X12.2

Facility

$236.00

Hospital Revenue Code	272
Min. Negotiated Rate	$200.60
Max. Negotiated Rate	$228.92
Rate for Payer: Cash Price	$141.60
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Kaiser Permanente Commercial	$212.40
Rate for Payer: MDX Hawaii PPO	$228.92

TRACH TUBE SHILEY 7.6X12.2

Facility

$236.00

Hospital Revenue Code	272
Min. Negotiated Rate	$73.16
Max. Negotiated Rate	$228.92
Rate for Payer: AlohaCare Medicaid	$118.00
Rate for Payer: AlohaCare Medicare	$73.16
Rate for Payer: Cash Price	$141.60
Rate for Payer: Devoted Health Medicare	$80.24
Rate for Payer: Hawaii Medical Service Association Medicare	$73.16
Rate for Payer: Hawaii Western Management Group Commercial	$224.20
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Humana Medicare	$73.16
Rate for Payer: Kaiser Permanente Commercial	$212.40
Rate for Payer: Kaiser Permanente Medicaid	$120.36
Rate for Payer: Kaiser Permanente Medicare	$73.16
Rate for Payer: MDX Hawaii PPO	$228.92
Rate for Payer: Ohana Health Plan Medicaid	$73.16
Rate for Payer: Ohana Health Plan Medicare	$73.16
Rate for Payer: UnitedHealthcare Medicare	$73.16
Rate for Payer: University Health Alliance Commercial	$172.02

TRACH TUBE SHILEY 7X12 CUFFED

Facility

$204.00

Hospital Revenue Code	272
Min. Negotiated Rate	$63.24
Max. Negotiated Rate	$197.88
Rate for Payer: AlohaCare Medicaid	$102.00
Rate for Payer: AlohaCare Medicare	$63.24
Rate for Payer: Cash Price	$122.40
Rate for Payer: Devoted Health Medicare	$69.36
Rate for Payer: Hawaii Medical Service Association Medicare	$63.24
Rate for Payer: Hawaii Western Management Group Commercial	$193.80
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Humana Medicare	$63.24
Rate for Payer: Kaiser Permanente Commercial	$183.60
Rate for Payer: Kaiser Permanente Medicaid	$104.04
Rate for Payer: Kaiser Permanente Medicare	$63.24
Rate for Payer: MDX Hawaii PPO	$197.88
Rate for Payer: Ohana Health Plan Medicaid	$63.24
Rate for Payer: Ohana Health Plan Medicare	$63.24
Rate for Payer: UnitedHealthcare Medicare	$63.24
Rate for Payer: University Health Alliance Commercial	$148.70

TRACH TUBE SHILEY 7X12 CUFFED

Facility

$204.00

Hospital Revenue Code	272
Min. Negotiated Rate	$173.40
Max. Negotiated Rate	$197.88
Rate for Payer: Cash Price	$122.40
Rate for Payer: Health Management Network Commercial	$173.40
Rate for Payer: Kaiser Permanente Commercial	$183.60
Rate for Payer: MDX Hawaii PPO	$197.88

TRACH TUBE UNCUFF 6.5

Facility

$215.00

Hospital Revenue Code	272
Min. Negotiated Rate	$66.65
Max. Negotiated Rate	$208.55
Rate for Payer: AlohaCare Medicaid	$107.50
Rate for Payer: AlohaCare Medicare	$66.65
Rate for Payer: Cash Price	$129.00
Rate for Payer: Devoted Health Medicare	$73.10
Rate for Payer: Hawaii Medical Service Association Medicare	$66.65
Rate for Payer: Hawaii Western Management Group Commercial	$204.25
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Humana Medicare	$66.65
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: Kaiser Permanente Medicaid	$109.65
Rate for Payer: Kaiser Permanente Medicare	$66.65
Rate for Payer: MDX Hawaii PPO	$208.55
Rate for Payer: Ohana Health Plan Medicaid	$66.65
Rate for Payer: Ohana Health Plan Medicare	$66.65
Rate for Payer: UnitedHealthcare Medicare	$66.65
Rate for Payer: University Health Alliance Commercial	$156.71

TRACH TUBE UNCUFF 6.5

Facility

$215.00

Hospital Revenue Code	272
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$129.00
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: MDX Hawaii PPO	$208.55

TRACH TUBE UNCUFF 7.5

Facility

$214.00

Hospital Revenue Code	272
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$128.40
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: MDX Hawaii PPO	$207.58

TRACH TUBE UNCUFF 7.5

Facility

$214.00

Hospital Revenue Code	272
Min. Negotiated Rate	$66.34
Max. Negotiated Rate	$207.58
Rate for Payer: AlohaCare Medicaid	$107.00
Rate for Payer: AlohaCare Medicare	$66.34
Rate for Payer: Cash Price	$128.40
Rate for Payer: Devoted Health Medicare	$72.76
Rate for Payer: Hawaii Medical Service Association Medicare	$66.34
Rate for Payer: Hawaii Western Management Group Commercial	$203.30
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Humana Medicare	$66.34
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: Kaiser Permanente Medicaid	$109.14
Rate for Payer: Kaiser Permanente Medicare	$66.34
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: Ohana Health Plan Medicaid	$66.34
Rate for Payer: Ohana Health Plan Medicare	$66.34
Rate for Payer: UnitedHealthcare Medicare	$66.34
Rate for Payer: University Health Alliance Commercial	$155.98

TRACH TUBE UNCUFF 8.5

Facility

$215.00

Hospital Revenue Code	272
Min. Negotiated Rate	$66.65
Max. Negotiated Rate	$208.55
Rate for Payer: AlohaCare Medicaid	$107.50
Rate for Payer: AlohaCare Medicare	$66.65
Rate for Payer: Cash Price	$129.00
Rate for Payer: Devoted Health Medicare	$73.10
Rate for Payer: Hawaii Medical Service Association Medicare	$66.65
Rate for Payer: Hawaii Western Management Group Commercial	$204.25
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Humana Medicare	$66.65
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: Kaiser Permanente Medicaid	$109.65
Rate for Payer: Kaiser Permanente Medicare	$66.65
Rate for Payer: MDX Hawaii PPO	$208.55
Rate for Payer: Ohana Health Plan Medicaid	$66.65
Rate for Payer: Ohana Health Plan Medicare	$66.65
Rate for Payer: UnitedHealthcare Medicare	$66.65
Rate for Payer: University Health Alliance Commercial	$156.71

TRACH TUBE UNCUFF 8.5

Facility

$215.00

Hospital Revenue Code	272
Min. Negotiated Rate	$182.75
Max. Negotiated Rate	$208.55
Rate for Payer: Cash Price	$129.00
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$193.50
Rate for Payer: MDX Hawaii PPO	$208.55

TRACH VALVE AQUA SPEAKING

Facility

$268.00

Service Code	HCPCS L8501
Hospital Revenue Code	274
Min. Negotiated Rate	$150.08
Max. Negotiated Rate	$259.96
Rate for Payer: Cash Price	$160.80
Rate for Payer: Hawaii Western Management Group Commercial	$187.60
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: Kaiser Permanente Commercial	$241.20
Rate for Payer: MDX Hawaii PPO	$259.96
Rate for Payer: University Health Alliance Commercial	$150.08

TRACH VALVE AQUA SPEAKING

Facility

$268.00

Service Code	HCPCS L8501
Hospital Revenue Code	274
Min. Negotiated Rate	$69.71
Max. Negotiated Rate	$259.96
Rate for Payer: AlohaCare Medicaid	$134.00
Rate for Payer: AlohaCare Medicare	$83.08
Rate for Payer: Cash Price	$160.80
Rate for Payer: Cash Price	$160.80
Rate for Payer: Devoted Health Medicare	$91.12
Rate for Payer: Hawaii Medical Service Association Medicare	$83.08
Rate for Payer: Hawaii Western Management Group Commercial	$187.60
Rate for Payer: Health Management Network Commercial	$227.80
Rate for Payer: Humana Medicare	$83.08
Rate for Payer: Kaiser Permanente Commercial	$241.20
Rate for Payer: Kaiser Permanente Medicaid	$136.68
Rate for Payer: Kaiser Permanente Medicare	$83.08
Rate for Payer: MDX Hawaii PPO	$259.96
Rate for Payer: Ohana Health Plan Medicaid	$83.08
Rate for Payer: Ohana Health Plan Medicare	$83.08
Rate for Payer: UnitedHealthcare Medicaid	$69.71
Rate for Payer: UnitedHealthcare Medicare	$83.08
Rate for Payer: University Health Alliance Commercial	$150.08

Know your out-of-pocket cost for care.

All Charges