Kau Hospital

All Charges

Charge

Type

Setting

Price

TROCAR 11MM VERSAONE

Facility

$165.00

Hospital Revenue Code	272
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$160.05
Rate for Payer: Cash Price	$99.00
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: Kaiser Permanente Commercial	$148.50
Rate for Payer: MDX Hawaii PPO	$160.05

TROCAR 12MM BLUNTPORT

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

TROCAR 12MM BLUNTPORT

Facility

$165.00

Hospital Revenue Code	272
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$160.05
Rate for Payer: Cash Price	$99.00
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: Kaiser Permanente Commercial	$148.50
Rate for Payer: MDX Hawaii PPO	$160.05

TROCAR 12MM 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

TROCAR 12MM VERSAONE

Facility

$165.00

Hospital Revenue Code	272
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$160.05
Rate for Payer: Cash Price	$99.00
Rate for Payer: Health Management Network Commercial	$140.25
Rate for Payer: Kaiser Permanente Commercial	$148.50
Rate for Payer: MDX Hawaii PPO	$160.05

TROCAR 12MM W/CANNULA

Facility

$150.00

Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: MDX Hawaii PPO	$145.50

TROCAR 12MM W/CANNULA

Facility

$150.00

Hospital Revenue Code	272
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$145.50
Rate for Payer: AlohaCare Medicaid	$75.00
Rate for Payer: AlohaCare Medicare	$46.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Devoted Health Medicare	$51.00
Rate for Payer: Hawaii Medical Service Association Medicare	$46.50
Rate for Payer: Hawaii Western Management Group Commercial	$142.50
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: Humana Medicare	$46.50
Rate for Payer: Kaiser Permanente Commercial	$135.00
Rate for Payer: Kaiser Permanente Medicaid	$76.50
Rate for Payer: Kaiser Permanente Medicare	$46.50
Rate for Payer: MDX Hawaii PPO	$145.50
Rate for Payer: Ohana Health Plan Medicaid	$46.50
Rate for Payer: Ohana Health Plan Medicare	$46.50
Rate for Payer: UnitedHealthcare Medicare	$46.50
Rate for Payer: University Health Alliance Commercial	$109.33

TROCAR 24F CHEST TUBE THORACIC

Facility

$96.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$29.76
Max. Negotiated Rate	$93.12
Rate for Payer: AlohaCare Medicaid	$48.00
Rate for Payer: AlohaCare Medicare	$29.76
Rate for Payer: Cash Price	$57.60
Rate for Payer: Devoted Health Medicare	$32.64
Rate for Payer: Hawaii Medical Service Association Medicare	$29.76
Rate for Payer: Hawaii Western Management Group Commercial	$91.20
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Humana Medicare	$29.76
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: Kaiser Permanente Medicare	$29.76
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: Ohana Health Plan Medicaid	$29.76
Rate for Payer: Ohana Health Plan Medicare	$29.76
Rate for Payer: UnitedHealthcare Medicare	$29.76
Rate for Payer: University Health Alliance Commercial	$69.97

TROCAR 24F CHEST TUBE THORACIC

Facility

$96.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$57.60
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12

TROCAR 28F CHEST TUBE THORACIC

Facility

$113.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$96.05
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$67.80
Rate for Payer: Health Management Network Commercial	$96.05
Rate for Payer: Kaiser Permanente Commercial	$101.70
Rate for Payer: MDX Hawaii PPO	$109.61

TROCAR 28F CHEST TUBE THORACIC

Facility

$113.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$35.03
Max. Negotiated Rate	$109.61
Rate for Payer: AlohaCare Medicaid	$56.50
Rate for Payer: AlohaCare Medicare	$35.03
Rate for Payer: Cash Price	$67.80
Rate for Payer: Devoted Health Medicare	$38.42
Rate for Payer: Hawaii Medical Service Association Medicare	$35.03
Rate for Payer: Hawaii Western Management Group Commercial	$107.35
Rate for Payer: Health Management Network Commercial	$96.05
Rate for Payer: Humana Medicare	$35.03
Rate for Payer: Kaiser Permanente Commercial	$101.70
Rate for Payer: Kaiser Permanente Medicaid	$57.63
Rate for Payer: Kaiser Permanente Medicare	$35.03
Rate for Payer: MDX Hawaii PPO	$109.61
Rate for Payer: Ohana Health Plan Medicaid	$35.03
Rate for Payer: Ohana Health Plan Medicare	$35.03
Rate for Payer: UnitedHealthcare Medicare	$35.03
Rate for Payer: University Health Alliance Commercial	$82.37

TROCAR 32F CHEST TUBE THORACIC

Facility

$106.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$90.10
Max. Negotiated Rate	$102.82
Rate for Payer: Cash Price	$63.60
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Kaiser Permanente Commercial	$95.40
Rate for Payer: MDX Hawaii PPO	$102.82

TROCAR 32F CHEST TUBE THORACIC

Facility

$106.00

Service Code	HCPCS C1729
Hospital Revenue Code	272
Min. Negotiated Rate	$32.86
Max. Negotiated Rate	$102.82
Rate for Payer: AlohaCare Medicaid	$53.00
Rate for Payer: AlohaCare Medicare	$32.86
Rate for Payer: Cash Price	$63.60
Rate for Payer: Devoted Health Medicare	$36.04
Rate for Payer: Hawaii Medical Service Association Medicare	$32.86
Rate for Payer: Hawaii Western Management Group Commercial	$100.70
Rate for Payer: Health Management Network Commercial	$90.10
Rate for Payer: Humana Medicare	$32.86
Rate for Payer: Kaiser Permanente Commercial	$95.40
Rate for Payer: Kaiser Permanente Medicaid	$54.06
Rate for Payer: Kaiser Permanente Medicare	$32.86
Rate for Payer: MDX Hawaii PPO	$102.82
Rate for Payer: Ohana Health Plan Medicaid	$32.86
Rate for Payer: Ohana Health Plan Medicare	$32.86
Rate for Payer: UnitedHealthcare Medicare	$32.86
Rate for Payer: University Health Alliance Commercial	$77.26

TROCAR 5-11MM VISIPORT PLUS

Facility

$241.00

Hospital Revenue Code	272
Min. Negotiated Rate	$204.85
Max. Negotiated Rate	$233.77
Rate for Payer: Cash Price	$144.60
Rate for Payer: Health Management Network Commercial	$204.85
Rate for Payer: Kaiser Permanente Commercial	$216.90
Rate for Payer: MDX Hawaii PPO	$233.77

TROCAR 5-11MM VISIPORT PLUS

Facility

$241.00

Hospital Revenue Code	272
Min. Negotiated Rate	$74.71
Max. Negotiated Rate	$233.77
Rate for Payer: AlohaCare Medicaid	$120.50
Rate for Payer: AlohaCare Medicare	$74.71
Rate for Payer: Cash Price	$144.60
Rate for Payer: Devoted Health Medicare	$81.94
Rate for Payer: Hawaii Medical Service Association Medicare	$74.71
Rate for Payer: Hawaii Western Management Group Commercial	$228.95
Rate for Payer: Health Management Network Commercial	$204.85
Rate for Payer: Humana Medicare	$74.71
Rate for Payer: Kaiser Permanente Commercial	$216.90
Rate for Payer: Kaiser Permanente Medicaid	$122.91
Rate for Payer: Kaiser Permanente Medicare	$74.71
Rate for Payer: MDX Hawaii PPO	$233.77
Rate for Payer: Ohana Health Plan Medicaid	$74.71
Rate for Payer: Ohana Health Plan Medicare	$74.71
Rate for Payer: UnitedHealthcare Medicare	$74.71
Rate for Payer: University Health Alliance Commercial	$175.66

TROCAR 5-12MM VISIPORT PLUS

Facility

$241.00

Hospital Revenue Code	272
Min. Negotiated Rate	$74.71
Max. Negotiated Rate	$233.77
Rate for Payer: AlohaCare Medicaid	$120.50
Rate for Payer: AlohaCare Medicare	$74.71
Rate for Payer: Cash Price	$144.60
Rate for Payer: Devoted Health Medicare	$81.94
Rate for Payer: Hawaii Medical Service Association Medicare	$74.71
Rate for Payer: Hawaii Western Management Group Commercial	$228.95
Rate for Payer: Health Management Network Commercial	$204.85
Rate for Payer: Humana Medicare	$74.71
Rate for Payer: Kaiser Permanente Commercial	$216.90
Rate for Payer: Kaiser Permanente Medicaid	$122.91
Rate for Payer: Kaiser Permanente Medicare	$74.71
Rate for Payer: MDX Hawaii PPO	$233.77
Rate for Payer: Ohana Health Plan Medicaid	$74.71
Rate for Payer: Ohana Health Plan Medicare	$74.71
Rate for Payer: UnitedHealthcare Medicare	$74.71
Rate for Payer: University Health Alliance Commercial	$175.66

TROCAR 5-12MM VISIPORT PLUS

Facility

$241.00

Hospital Revenue Code	272
Min. Negotiated Rate	$204.85
Max. Negotiated Rate	$233.77
Rate for Payer: Cash Price	$144.60
Rate for Payer: Health Management Network Commercial	$204.85
Rate for Payer: Kaiser Permanente Commercial	$216.90
Rate for Payer: MDX Hawaii PPO	$233.77

TROCAR 5MM STEP

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

TROCAR 5MM STEP

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

TROCAR BALLOON 12X100MM CFF73

Facility

$525.00

Hospital Revenue Code	272
Min. Negotiated Rate	$162.75
Max. Negotiated Rate	$509.25
Rate for Payer: AlohaCare Medicaid	$262.50
Rate for Payer: AlohaCare Medicare	$162.75
Rate for Payer: Cash Price	$315.00
Rate for Payer: Devoted Health Medicare	$178.50
Rate for Payer: Hawaii Medical Service Association Medicare	$162.75
Rate for Payer: Hawaii Western Management Group Commercial	$498.75
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Humana Medicare	$162.75
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: Kaiser Permanente Medicaid	$267.75
Rate for Payer: Kaiser Permanente Medicare	$162.75
Rate for Payer: MDX Hawaii PPO	$509.25
Rate for Payer: Ohana Health Plan Medicaid	$162.75
Rate for Payer: Ohana Health Plan Medicare	$162.75
Rate for Payer: UnitedHealthcare Medicare	$162.75
Rate for Payer: University Health Alliance Commercial	$382.67

TROCAR BALLOON 12X100MM CFF73

Facility

$525.00

Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$509.25
Rate for Payer: Cash Price	$315.00
Rate for Payer: Health Management Network Commercial	$446.25
Rate for Payer: Kaiser Permanente Commercial	$472.50
Rate for Payer: MDX Hawaii PPO	$509.25

TROCAR BALLOON 12X150MM CFF71

Facility

$375.00

Hospital Revenue Code	272
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$363.75
Rate for Payer: AlohaCare Medicaid	$187.50
Rate for Payer: AlohaCare Medicare	$116.25
Rate for Payer: Cash Price	$225.00
Rate for Payer: Devoted Health Medicare	$127.50
Rate for Payer: Hawaii Medical Service Association Medicare	$116.25
Rate for Payer: Hawaii Western Management Group Commercial	$356.25
Rate for Payer: Health Management Network Commercial	$318.75
Rate for Payer: Humana Medicare	$116.25
Rate for Payer: Kaiser Permanente Commercial	$337.50
Rate for Payer: Kaiser Permanente Medicaid	$191.25
Rate for Payer: Kaiser Permanente Medicare	$116.25
Rate for Payer: MDX Hawaii PPO	$363.75
Rate for Payer: Ohana Health Plan Medicaid	$116.25
Rate for Payer: Ohana Health Plan Medicare	$116.25
Rate for Payer: UnitedHealthcare Medicare	$116.25
Rate for Payer: University Health Alliance Commercial	$273.34

TROCAR BALLOON 12X150MM CFF71

Facility

$375.00

Hospital Revenue Code	272
Min. Negotiated Rate	$318.75
Max. Negotiated Rate	$363.75
Rate for Payer: Cash Price	$225.00
Rate for Payer: Health Management Network Commercial	$318.75
Rate for Payer: Kaiser Permanente Commercial	$337.50
Rate for Payer: MDX Hawaii PPO	$363.75

TROCAR BALLOON OVAL

Facility

$3,258.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,769.30
Max. Negotiated Rate	$3,160.26
Rate for Payer: Cash Price	$1,954.80
Rate for Payer: Health Management Network Commercial	$2,769.30
Rate for Payer: Kaiser Permanente Commercial	$2,932.20
Rate for Payer: MDX Hawaii PPO	$3,160.26

TROCAR BALLOON OVAL

Facility

$3,258.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,009.98
Max. Negotiated Rate	$3,160.26
Rate for Payer: AlohaCare Medicaid	$1,629.00
Rate for Payer: AlohaCare Medicare	$1,009.98
Rate for Payer: Cash Price	$1,954.80
Rate for Payer: Devoted Health Medicare	$1,107.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,009.98
Rate for Payer: Hawaii Western Management Group Commercial	$3,095.10
Rate for Payer: Health Management Network Commercial	$2,769.30
Rate for Payer: Humana Medicare	$1,009.98
Rate for Payer: Kaiser Permanente Commercial	$2,932.20
Rate for Payer: Kaiser Permanente Medicaid	$1,661.58
Rate for Payer: Kaiser Permanente Medicare	$1,009.98
Rate for Payer: MDX Hawaii PPO	$3,160.26
Rate for Payer: Ohana Health Plan Medicaid	$1,009.98
Rate for Payer: Ohana Health Plan Medicare	$1,009.98
Rate for Payer: UnitedHealthcare Medicare	$1,009.98
Rate for Payer: University Health Alliance Commercial	$2,374.76

Know your out-of-pocket cost for care.

All Charges