Kau Hospital

All Charges

Charge

Type

Setting

Price

TRIMETHOPRIM 100 MG TABLET [8182]

Facility

$9.00

Service Code	NDC 75907004301
Hospital Revenue Code	637
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$8.73
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$2.79
Rate for Payer: Cash Price	$5.40
Rate for Payer: Devoted Health Medicare	$3.06
Rate for Payer: Hawaii Medical Service Association Medicare	$2.79
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Humana Medicare	$2.79
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicare	$2.79
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$2.79
Rate for Payer: Ohana Health Plan Medicare	$2.79
Rate for Payer: UnitedHealthcare Medicare	$2.79
Rate for Payer: University Health Alliance Commercial	$6.56

TRIMETHOPRIM 100 MG TABLET [8182]

Facility

$9.00

Service Code	NDC 70954054110
Hospital Revenue Code	637
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$8.73
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$2.79
Rate for Payer: Cash Price	$5.40
Rate for Payer: Devoted Health Medicare	$3.06
Rate for Payer: Hawaii Medical Service Association Medicare	$2.79
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Humana Medicare	$2.79
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicare	$2.79
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$2.79
Rate for Payer: Ohana Health Plan Medicare	$2.79
Rate for Payer: UnitedHealthcare Medicare	$2.79
Rate for Payer: University Health Alliance Commercial	$6.56

TRIPORT CANNU 2 4X22 PAL-402LS

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: MDX Hawaii PPO	$291.00

TRIPORT CANNU 2 4X22 PAL-402LS

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$291.00
Rate for Payer: AlohaCare Medicaid	$150.00
Rate for Payer: AlohaCare Medicare	$93.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Devoted Health Medicare	$102.00
Rate for Payer: Hawaii Medical Service Association Medicare	$93.00
Rate for Payer: Hawaii Western Management Group Commercial	$285.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Humana Medicare	$93.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: Kaiser Permanente Medicaid	$153.00
Rate for Payer: Kaiser Permanente Medicare	$93.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: Ohana Health Plan Medicaid	$93.00
Rate for Payer: Ohana Health Plan Medicare	$93.00
Rate for Payer: UnitedHealthcare Medicare	$93.00
Rate for Payer: University Health Alliance Commercial	$218.67

TRIPORT HELIXED 5X22 PAL-507LS

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: MDX Hawaii PPO	$291.00

TRIPORT HELIXED 5X22 PAL-507LS

Facility

$300.00

Hospital Revenue Code	272
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$291.00
Rate for Payer: AlohaCare Medicaid	$150.00
Rate for Payer: AlohaCare Medicare	$93.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Devoted Health Medicare	$102.00
Rate for Payer: Hawaii Medical Service Association Medicare	$93.00
Rate for Payer: Hawaii Western Management Group Commercial	$285.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Humana Medicare	$93.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: Kaiser Permanente Medicaid	$153.00
Rate for Payer: Kaiser Permanente Medicare	$93.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: Ohana Health Plan Medicaid	$93.00
Rate for Payer: Ohana Health Plan Medicare	$93.00
Rate for Payer: UnitedHealthcare Medicare	$93.00
Rate for Payer: University Health Alliance Commercial	$218.67

TRITANIUM CUP 50MM 502-03-50D

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

TRITANIUM CUP 50MM 502-03-50D

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

TRITANIUM CUP 52MM 502-03-52D

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

TRITANIUM CUP 52MM 502-03-52D

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

TRITANIUM CUP 54MM 502-03-54E

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

TRITANIUM CUP 54MM 502-03-54E

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

TRITANIUM CUP 56MM 502-03-56E

Facility

$4,734.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,467.54
Max. Negotiated Rate	$4,591.98
Rate for Payer: AlohaCare Medicaid	$2,367.00
Rate for Payer: AlohaCare Medicare	$1,467.54
Rate for Payer: Cash Price	$2,840.40
Rate for Payer: Devoted Health Medicare	$1,609.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,467.54
Rate for Payer: Hawaii Western Management Group Commercial	$3,313.80
Rate for Payer: Health Management Network Commercial	$4,023.90
Rate for Payer: Humana Medicare	$1,467.54
Rate for Payer: Kaiser Permanente Commercial	$4,260.60
Rate for Payer: Kaiser Permanente Medicaid	$2,414.34
Rate for Payer: Kaiser Permanente Medicare	$1,467.54
Rate for Payer: MDX Hawaii PPO	$4,591.98
Rate for Payer: Ohana Health Plan Medicaid	$1,467.54
Rate for Payer: Ohana Health Plan Medicare	$1,467.54
Rate for Payer: UnitedHealthcare Medicare	$1,467.54
Rate for Payer: University Health Alliance Commercial	$2,651.04

TRITANIUM CUP 56MM 502-03-56E

Facility

$4,734.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,651.04
Max. Negotiated Rate	$4,591.98
Rate for Payer: Cash Price	$2,840.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,313.80
Rate for Payer: Health Management Network Commercial	$4,023.90
Rate for Payer: Kaiser Permanente Commercial	$4,260.60
Rate for Payer: MDX Hawaii PPO	$4,591.98
Rate for Payer: University Health Alliance Commercial	$2,651.04

TRITANIUM CUP 58MM 502-03-58F

Facility

$4,734.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,651.04
Max. Negotiated Rate	$4,591.98
Rate for Payer: Cash Price	$2,840.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,313.80
Rate for Payer: Health Management Network Commercial	$4,023.90
Rate for Payer: Kaiser Permanente Commercial	$4,260.60
Rate for Payer: MDX Hawaii PPO	$4,591.98
Rate for Payer: University Health Alliance Commercial	$2,651.04

TRITANIUM CUP 58MM 502-03-58F

Facility

$4,734.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,467.54
Max. Negotiated Rate	$4,591.98
Rate for Payer: AlohaCare Medicaid	$2,367.00
Rate for Payer: AlohaCare Medicare	$1,467.54
Rate for Payer: Cash Price	$2,840.40
Rate for Payer: Devoted Health Medicare	$1,609.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,467.54
Rate for Payer: Hawaii Western Management Group Commercial	$3,313.80
Rate for Payer: Health Management Network Commercial	$4,023.90
Rate for Payer: Humana Medicare	$1,467.54
Rate for Payer: Kaiser Permanente Commercial	$4,260.60
Rate for Payer: Kaiser Permanente Medicaid	$2,414.34
Rate for Payer: Kaiser Permanente Medicare	$1,467.54
Rate for Payer: MDX Hawaii PPO	$4,591.98
Rate for Payer: Ohana Health Plan Medicaid	$1,467.54
Rate for Payer: Ohana Health Plan Medicare	$1,467.54
Rate for Payer: UnitedHealthcare Medicare	$1,467.54
Rate for Payer: University Health Alliance Commercial	$2,651.04

TRI TIB BASE CEMENT 5520-B-500

Facility

$5,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,798.00
Max. Negotiated Rate	$5,626.00
Rate for Payer: AlohaCare Medicaid	$2,900.00
Rate for Payer: AlohaCare Medicare	$1,798.00
Rate for Payer: Cash Price	$3,480.00
Rate for Payer: Devoted Health Medicare	$1,972.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,798.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,060.00
Rate for Payer: Health Management Network Commercial	$4,930.00
Rate for Payer: Humana Medicare	$1,798.00
Rate for Payer: Kaiser Permanente Commercial	$5,220.00
Rate for Payer: Kaiser Permanente Medicaid	$2,958.00
Rate for Payer: Kaiser Permanente Medicare	$1,798.00
Rate for Payer: MDX Hawaii PPO	$5,626.00
Rate for Payer: Ohana Health Plan Medicaid	$1,798.00
Rate for Payer: Ohana Health Plan Medicare	$1,798.00
Rate for Payer: UnitedHealthcare Medicare	$1,798.00
Rate for Payer: University Health Alliance Commercial	$3,248.00

TRI TIB BASE CEMENT 5520-B-500

Facility

$5,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,248.00
Max. Negotiated Rate	$5,626.00
Rate for Payer: Cash Price	$3,480.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,060.00
Rate for Payer: Health Management Network Commercial	$4,930.00
Rate for Payer: Kaiser Permanente Commercial	$5,220.00
Rate for Payer: MDX Hawaii PPO	$5,626.00
Rate for Payer: University Health Alliance Commercial	$3,248.00

TRI TIB BASE CEMENT 5520-B-600

Facility

$5,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,798.00
Max. Negotiated Rate	$5,626.00
Rate for Payer: AlohaCare Medicaid	$2,900.00
Rate for Payer: AlohaCare Medicare	$1,798.00
Rate for Payer: Cash Price	$3,480.00
Rate for Payer: Devoted Health Medicare	$1,972.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,798.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,060.00
Rate for Payer: Health Management Network Commercial	$4,930.00
Rate for Payer: Humana Medicare	$1,798.00
Rate for Payer: Kaiser Permanente Commercial	$5,220.00
Rate for Payer: Kaiser Permanente Medicaid	$2,958.00
Rate for Payer: Kaiser Permanente Medicare	$1,798.00
Rate for Payer: MDX Hawaii PPO	$5,626.00
Rate for Payer: Ohana Health Plan Medicaid	$1,798.00
Rate for Payer: Ohana Health Plan Medicare	$1,798.00
Rate for Payer: UnitedHealthcare Medicare	$1,798.00
Rate for Payer: University Health Alliance Commercial	$3,248.00

TRI TIB BASE CEMENT 5520-B-600

Facility

$5,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,248.00
Max. Negotiated Rate	$5,626.00
Rate for Payer: Cash Price	$3,480.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,060.00
Rate for Payer: Health Management Network Commercial	$4,930.00
Rate for Payer: Kaiser Permanente Commercial	$5,220.00
Rate for Payer: MDX Hawaii PPO	$5,626.00
Rate for Payer: University Health Alliance Commercial	$3,248.00

TRI TIB BASE CEMENT 5520-B-700

Facility

$5,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,798.00
Max. Negotiated Rate	$5,626.00
Rate for Payer: AlohaCare Medicaid	$2,900.00
Rate for Payer: AlohaCare Medicare	$1,798.00
Rate for Payer: Cash Price	$3,480.00
Rate for Payer: Devoted Health Medicare	$1,972.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,798.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,060.00
Rate for Payer: Health Management Network Commercial	$4,930.00
Rate for Payer: Humana Medicare	$1,798.00
Rate for Payer: Kaiser Permanente Commercial	$5,220.00
Rate for Payer: Kaiser Permanente Medicaid	$2,958.00
Rate for Payer: Kaiser Permanente Medicare	$1,798.00
Rate for Payer: MDX Hawaii PPO	$5,626.00
Rate for Payer: Ohana Health Plan Medicaid	$1,798.00
Rate for Payer: Ohana Health Plan Medicare	$1,798.00
Rate for Payer: UnitedHealthcare Medicare	$1,798.00
Rate for Payer: University Health Alliance Commercial	$3,248.00

TRI TIB BASE CEMENT 5520-B-700

Facility

$5,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,248.00
Max. Negotiated Rate	$5,626.00
Rate for Payer: Cash Price	$3,480.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,060.00
Rate for Payer: Health Management Network Commercial	$4,930.00
Rate for Payer: Kaiser Permanente Commercial	$5,220.00
Rate for Payer: MDX Hawaii PPO	$5,626.00
Rate for Payer: University Health Alliance Commercial	$3,248.00

TROCAR 11.5 THORACPORT

Facility

$529.00

Hospital Revenue Code	272
Min. Negotiated Rate	$163.99
Max. Negotiated Rate	$513.13
Rate for Payer: AlohaCare Medicaid	$264.50
Rate for Payer: AlohaCare Medicare	$163.99
Rate for Payer: Cash Price	$317.40
Rate for Payer: Devoted Health Medicare	$179.86
Rate for Payer: Hawaii Medical Service Association Medicare	$163.99
Rate for Payer: Hawaii Western Management Group Commercial	$502.55
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Humana Medicare	$163.99
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: Kaiser Permanente Medicaid	$269.79
Rate for Payer: Kaiser Permanente Medicare	$163.99
Rate for Payer: MDX Hawaii PPO	$513.13
Rate for Payer: Ohana Health Plan Medicaid	$163.99
Rate for Payer: Ohana Health Plan Medicare	$163.99
Rate for Payer: UnitedHealthcare Medicare	$163.99
Rate for Payer: University Health Alliance Commercial	$385.59

TROCAR 11.5 THORACPORT

Facility

$529.00

Hospital Revenue Code	272
Min. Negotiated Rate	$449.65
Max. Negotiated Rate	$513.13
Rate for Payer: Cash Price	$317.40
Rate for Payer: Health Management Network Commercial	$449.65
Rate for Payer: Kaiser Permanente Commercial	$476.10
Rate for Payer: MDX Hawaii PPO	$513.13

TROCAR 11MM VERSAONE

Facility

$165.00

Hospital Revenue Code	272
Min. Negotiated Rate	$51.15
Max. Negotiated Rate	$160.05
Rate for Payer: AlohaCare Medicaid	$82.50
Rate for Payer: AlohaCare Medicare	$51.15
Rate for Payer: Cash Price	$99.00
Rate for Payer: Devoted Health Medicare	$56.10
Rate for Payer: Hawaii Medical Service Association Medicare	$51.15
Rate for Payer: Hawaii Western Management Group Commercial	$156.75
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: Humana Medicare	$51.15
Rate for Payer: Kaiser Permanente Commercial	$148.50
Rate for Payer: Kaiser Permanente Medicaid	$84.15
Rate for Payer: Kaiser Permanente Medicare	$51.15
Rate for Payer: MDX Hawaii PPO	$160.05
Rate for Payer: Ohana Health Plan Medicaid	$51.15
Rate for Payer: Ohana Health Plan Medicare	$51.15
Rate for Payer: UnitedHealthcare Medicare	$51.15
Rate for Payer: University Health Alliance Commercial	$120.27

Know your out-of-pocket cost for care.

All Charges