Kau Hospital

All Charges

Charge

Type

Setting

Price

TRASTUZUMAB-DTTB 420 MG INTRAVENOUS SOLUTION [173239]

Facility

$4,951.00

Service Code	HCPCS Q5112
Hospital Revenue Code	250
Min. Negotiated Rate	$4,208.35
Max. Negotiated Rate	$4,802.47
Rate for Payer: Cash Price	$2,970.60
Rate for Payer: Health Management Network Commercial	$4,208.35
Rate for Payer: Kaiser Permanente Commercial	$4,455.90
Rate for Payer: MDX Hawaii PPO	$4,802.47

TRASTUZUMAB-DTTB 420 MG INTRAVENOUS SOLUTION [173239]

Facility

$4,951.00

Service Code	HCPCS Q5112
Hospital Revenue Code	636
Min. Negotiated Rate	$21.99
Max. Negotiated Rate	$4,802.47
Rate for Payer: AlohaCare Medicaid	$2,475.50
Rate for Payer: AlohaCare Medicare	$1,534.81
Rate for Payer: Cash Price	$2,970.60
Rate for Payer: Cash Price	$2,970.60
Rate for Payer: Devoted Health Medicare	$1,683.34
Rate for Payer: Hawaii Medical Service Association ABD	$21.99
Rate for Payer: Hawaii Medical Service Association Commercial	$37.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1,534.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.99
Rate for Payer: Hawaii Western Management Group Commercial	$4,703.45
Rate for Payer: Health Management Network Commercial	$4,208.35
Rate for Payer: Humana Medicare	$1,534.81
Rate for Payer: Kaiser Permanente Commercial	$4,455.90
Rate for Payer: Kaiser Permanente Medicaid	$2,525.01
Rate for Payer: Kaiser Permanente Medicare	$1,534.81
Rate for Payer: MDX Hawaii PPO	$4,802.47
Rate for Payer: Ohana Health Plan Medicaid	$1,534.81
Rate for Payer: Ohana Health Plan Medicare	$1,534.81
Rate for Payer: UnitedHealthcare Medicaid	$2,970.60
Rate for Payer: UnitedHealthcare Medicare	$1,534.81
Rate for Payer: University Health Alliance Commercial	$3,608.78

TRASTUZUMAB-PKRB 150 MG/7.15ML IV (WET SOLR VIAL) [430171650]

Facility

$1,809.00

Service Code	HCPCS Q5113
Hospital Revenue Code	250
Min. Negotiated Rate	$1,537.65
Max. Negotiated Rate	$1,754.73
Rate for Payer: Cash Price	$1,085.40
Rate for Payer: Health Management Network Commercial	$1,537.65
Rate for Payer: Kaiser Permanente Commercial	$1,628.10
Rate for Payer: MDX Hawaii PPO	$1,754.73

TRASTUZUMAB-PKRB 150 MG/7.15ML IV (WET SOLR VIAL) [430171650]

Facility

$1,809.00

Service Code	HCPCS Q5113
Hospital Revenue Code	636
Min. Negotiated Rate	$70.03
Max. Negotiated Rate	$1,754.73
Rate for Payer: AlohaCare Medicaid	$904.50
Rate for Payer: AlohaCare Medicare	$560.79
Rate for Payer: Cash Price	$1,085.40
Rate for Payer: Cash Price	$1,085.40
Rate for Payer: Devoted Health Medicare	$615.06
Rate for Payer: Hawaii Medical Service Association ABD	$77.49
Rate for Payer: Hawaii Medical Service Association Commercial	$70.03
Rate for Payer: Hawaii Medical Service Association Medicare	$560.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$77.49
Rate for Payer: Hawaii Western Management Group Commercial	$1,718.55
Rate for Payer: Health Management Network Commercial	$1,537.65
Rate for Payer: Humana Medicare	$560.79
Rate for Payer: Kaiser Permanente Commercial	$1,628.10
Rate for Payer: Kaiser Permanente Medicaid	$922.59
Rate for Payer: Kaiser Permanente Medicare	$560.79
Rate for Payer: MDX Hawaii PPO	$1,754.73
Rate for Payer: Ohana Health Plan Medicaid	$560.79
Rate for Payer: Ohana Health Plan Medicare	$560.79
Rate for Payer: UnitedHealthcare Medicaid	$1,085.40
Rate for Payer: UnitedHealthcare Medicare	$560.79
Rate for Payer: University Health Alliance Commercial	$1,318.58

TRAUMACEM V CEMENT 07.702.040S

Facility

$1,598.00

Hospital Revenue Code	278
Min. Negotiated Rate	$495.38
Max. Negotiated Rate	$1,550.06
Rate for Payer: AlohaCare Medicaid	$799.00
Rate for Payer: AlohaCare Medicare	$495.38
Rate for Payer: Cash Price	$958.80
Rate for Payer: Devoted Health Medicare	$543.32
Rate for Payer: Hawaii Medical Service Association Medicare	$495.38
Rate for Payer: Hawaii Western Management Group Commercial	$1,118.60
Rate for Payer: Health Management Network Commercial	$1,358.30
Rate for Payer: Humana Medicare	$495.38
Rate for Payer: Kaiser Permanente Commercial	$1,438.20
Rate for Payer: Kaiser Permanente Medicaid	$814.98
Rate for Payer: Kaiser Permanente Medicare	$495.38
Rate for Payer: MDX Hawaii PPO	$1,550.06
Rate for Payer: Ohana Health Plan Medicaid	$495.38
Rate for Payer: Ohana Health Plan Medicare	$495.38
Rate for Payer: UnitedHealthcare Medicare	$495.38
Rate for Payer: University Health Alliance Commercial	$894.88

TRAUMACEM V CEMENT 07.702.040S

Facility

$1,598.00

Hospital Revenue Code	278
Min. Negotiated Rate	$894.88
Max. Negotiated Rate	$1,550.06
Rate for Payer: Cash Price	$958.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,118.60
Rate for Payer: Health Management Network Commercial	$1,358.30
Rate for Payer: Kaiser Permanente Commercial	$1,438.20
Rate for Payer: MDX Hawaii PPO	$1,550.06
Rate for Payer: University Health Alliance Commercial	$894.88

TRAUMACEM V INJECT 03.702.121S

Facility

$1,684.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,431.40
Max. Negotiated Rate	$1,633.48
Rate for Payer: Cash Price	$1,010.40
Rate for Payer: Health Management Network Commercial	$1,431.40
Rate for Payer: Kaiser Permanente Commercial	$1,515.60
Rate for Payer: MDX Hawaii PPO	$1,633.48

TRAUMACEM V INJECT 03.702.121S

Facility

$1,684.00

Hospital Revenue Code	272
Min. Negotiated Rate	$522.04
Max. Negotiated Rate	$1,633.48
Rate for Payer: AlohaCare Medicaid	$842.00
Rate for Payer: AlohaCare Medicare	$522.04
Rate for Payer: Cash Price	$1,010.40
Rate for Payer: Devoted Health Medicare	$572.56
Rate for Payer: Hawaii Medical Service Association Medicare	$522.04
Rate for Payer: Hawaii Western Management Group Commercial	$1,599.80
Rate for Payer: Health Management Network Commercial	$1,431.40
Rate for Payer: Humana Medicare	$522.04
Rate for Payer: Kaiser Permanente Commercial	$1,515.60
Rate for Payer: Kaiser Permanente Medicaid	$858.84
Rate for Payer: Kaiser Permanente Medicare	$522.04
Rate for Payer: MDX Hawaii PPO	$1,633.48
Rate for Payer: Ohana Health Plan Medicaid	$522.04
Rate for Payer: Ohana Health Plan Medicare	$522.04
Rate for Payer: UnitedHealthcare Medicare	$522.04
Rate for Payer: University Health Alliance Commercial	$1,227.47

TRAUMACEM V SYRING 03.702.150S

Facility

$666.00

Hospital Revenue Code	272
Min. Negotiated Rate	$206.46
Max. Negotiated Rate	$646.02
Rate for Payer: AlohaCare Medicaid	$333.00
Rate for Payer: AlohaCare Medicare	$206.46
Rate for Payer: Cash Price	$399.60
Rate for Payer: Devoted Health Medicare	$226.44
Rate for Payer: Hawaii Medical Service Association Medicare	$206.46
Rate for Payer: Hawaii Western Management Group Commercial	$632.70
Rate for Payer: Health Management Network Commercial	$566.10
Rate for Payer: Humana Medicare	$206.46
Rate for Payer: Kaiser Permanente Commercial	$599.40
Rate for Payer: Kaiser Permanente Medicaid	$339.66
Rate for Payer: Kaiser Permanente Medicare	$206.46
Rate for Payer: MDX Hawaii PPO	$646.02
Rate for Payer: Ohana Health Plan Medicaid	$206.46
Rate for Payer: Ohana Health Plan Medicare	$206.46
Rate for Payer: UnitedHealthcare Medicare	$206.46
Rate for Payer: University Health Alliance Commercial	$485.45

TRAUMACEM V SYRING 03.702.150S

Facility

$666.00

Hospital Revenue Code	272
Min. Negotiated Rate	$566.10
Max. Negotiated Rate	$646.02
Rate for Payer: Cash Price	$399.60
Rate for Payer: Health Management Network Commercial	$566.10
Rate for Payer: Kaiser Permanente Commercial	$599.40
Rate for Payer: MDX Hawaii PPO	$646.02

TRAUMATIC INJURY WITH MCC

Facility

$14,861.15

Service Code	MSDRG 913
Min. Negotiated Rate	$14,861.15
Max. Negotiated Rate	$14,861.15
Rate for Payer: Hawaii Medical Service Association Commercial	$14,861.15

TRAUMATIC INJURY WITHOUT MCC

Facility

$14,861.15

Service Code	MSDRG 914
Min. Negotiated Rate	$14,861.15
Max. Negotiated Rate	$14,861.15
Rate for Payer: Hawaii Medical Service Association Commercial	$14,861.15

TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC

Facility

$16,709.91

Service Code	MSDRG 086
Min. Negotiated Rate	$16,709.91
Max. Negotiated Rate	$16,709.91
Rate for Payer: Hawaii Medical Service Association Commercial	$16,709.91

TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC

Facility

$37,757.29

Service Code	MSDRG 083
Min. Negotiated Rate	$37,757.29
Max. Negotiated Rate	$37,757.29
Rate for Payer: Hawaii Medical Service Association Commercial	$37,757.29

TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC

Facility

$58,235.81

Service Code	MSDRG 085
Min. Negotiated Rate	$58,235.81
Max. Negotiated Rate	$58,235.81
Rate for Payer: Hawaii Medical Service Association Commercial	$58,235.81

TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC

Facility

$37,757.29

Service Code	MSDRG 082
Min. Negotiated Rate	$37,757.29
Max. Negotiated Rate	$37,757.29
Rate for Payer: Hawaii Medical Service Association Commercial	$37,757.29

TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC

Facility

$15,216.68

Service Code	MSDRG 087
Min. Negotiated Rate	$15,216.68
Max. Negotiated Rate	$15,216.68
Rate for Payer: Hawaii Medical Service Association Commercial	$15,216.68

TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC

Facility

$37,757.29

Service Code	MSDRG 084
Min. Negotiated Rate	$37,757.29
Max. Negotiated Rate	$37,757.29
Rate for Payer: Hawaii Medical Service Association Commercial	$37,757.29

TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC

Facility

$17,918.71

Service Code	MSDRG 604
Min. Negotiated Rate	$17,918.71
Max. Negotiated Rate	$17,918.71
Rate for Payer: Hawaii Medical Service Association Commercial	$17,918.71

TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC

Facility

$14,718.94

Service Code	MSDRG 605
Min. Negotiated Rate	$14,718.94
Max. Negotiated Rate	$14,718.94
Rate for Payer: Hawaii Medical Service Association Commercial	$14,718.94

TRAY CATHETER UMBILICAL

Facility

$203.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$172.55
Max. Negotiated Rate	$196.91
Rate for Payer: Cash Price	$121.80
Rate for Payer: Health Management Network Commercial	$172.55
Rate for Payer: Kaiser Permanente Commercial	$182.70
Rate for Payer: MDX Hawaii PPO	$196.91

TRAY CATHETER UMBILICAL

Facility

$203.00

Service Code	HCPCS C1751
Hospital Revenue Code	272
Min. Negotiated Rate	$62.93
Max. Negotiated Rate	$196.91
Rate for Payer: AlohaCare Medicaid	$101.50
Rate for Payer: AlohaCare Medicare	$62.93
Rate for Payer: Cash Price	$121.80
Rate for Payer: Devoted Health Medicare	$69.02
Rate for Payer: Hawaii Medical Service Association Medicare	$62.93
Rate for Payer: Hawaii Western Management Group Commercial	$192.85
Rate for Payer: Health Management Network Commercial	$172.55
Rate for Payer: Humana Medicare	$62.93
Rate for Payer: Kaiser Permanente Commercial	$182.70
Rate for Payer: Kaiser Permanente Medicaid	$103.53
Rate for Payer: Kaiser Permanente Medicare	$62.93
Rate for Payer: MDX Hawaii PPO	$196.91
Rate for Payer: Ohana Health Plan Medicaid	$62.93
Rate for Payer: Ohana Health Plan Medicare	$62.93
Rate for Payer: UnitedHealthcare Medicare	$62.93
Rate for Payer: University Health Alliance Commercial	$147.97

TRAY CATH TEMPERATURE SENSING

Facility

$166.00

Hospital Revenue Code	272
Min. Negotiated Rate	$141.10
Max. Negotiated Rate	$161.02
Rate for Payer: Cash Price	$99.60
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Kaiser Permanente Commercial	$149.40
Rate for Payer: MDX Hawaii PPO	$161.02

TRAY CATH TEMPERATURE SENSING

Facility

$166.00

Hospital Revenue Code	272
Min. Negotiated Rate	$51.46
Max. Negotiated Rate	$161.02
Rate for Payer: AlohaCare Medicaid	$83.00
Rate for Payer: AlohaCare Medicare	$51.46
Rate for Payer: Cash Price	$99.60
Rate for Payer: Devoted Health Medicare	$56.44
Rate for Payer: Hawaii Medical Service Association Medicare	$51.46
Rate for Payer: Hawaii Western Management Group Commercial	$157.70
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Humana Medicare	$51.46
Rate for Payer: Kaiser Permanente Commercial	$149.40
Rate for Payer: Kaiser Permanente Medicaid	$84.66
Rate for Payer: Kaiser Permanente Medicare	$51.46
Rate for Payer: MDX Hawaii PPO	$161.02
Rate for Payer: Ohana Health Plan Medicaid	$51.46
Rate for Payer: Ohana Health Plan Medicare	$51.46
Rate for Payer: UnitedHealthcare Medicare	$51.46
Rate for Payer: University Health Alliance Commercial	$121.00

TRAY CHEST TUBE THALQUIK 18F

Facility

$678.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$210.18
Max. Negotiated Rate	$657.66
Rate for Payer: AlohaCare Medicaid	$339.00
Rate for Payer: AlohaCare Medicare	$210.18
Rate for Payer: Cash Price	$406.80
Rate for Payer: Devoted Health Medicare	$230.52
Rate for Payer: Hawaii Medical Service Association Medicare	$210.18
Rate for Payer: Hawaii Western Management Group Commercial	$644.10
Rate for Payer: Health Management Network Commercial	$576.30
Rate for Payer: Humana Medicare	$210.18
Rate for Payer: Kaiser Permanente Commercial	$610.20
Rate for Payer: Kaiser Permanente Medicaid	$345.78
Rate for Payer: Kaiser Permanente Medicare	$210.18
Rate for Payer: MDX Hawaii PPO	$657.66
Rate for Payer: Ohana Health Plan Medicaid	$210.18
Rate for Payer: Ohana Health Plan Medicare	$210.18
Rate for Payer: UnitedHealthcare Medicare	$210.18
Rate for Payer: University Health Alliance Commercial	$494.19

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