Kau Hospital

All Charges

Charge

Type

Setting

Price

TROCAR BALLOON ROUND

Facility

$2,457.00

Hospital Revenue Code	272
Min. Negotiated Rate	$2,088.45
Max. Negotiated Rate	$2,383.29
Rate for Payer: Cash Price	$1,474.20
Rate for Payer: Health Management Network Commercial	$2,088.45
Rate for Payer: Kaiser Permanente Commercial	$2,211.30
Rate for Payer: MDX Hawaii PPO	$2,383.29

TROCAR BALLOON ROUND

Facility

$2,457.00

Hospital Revenue Code	272
Min. Negotiated Rate	$761.67
Max. Negotiated Rate	$2,383.29
Rate for Payer: AlohaCare Medicaid	$1,228.50
Rate for Payer: AlohaCare Medicare	$761.67
Rate for Payer: Cash Price	$1,474.20
Rate for Payer: Devoted Health Medicare	$835.38
Rate for Payer: Hawaii Medical Service Association Medicare	$761.67
Rate for Payer: Hawaii Western Management Group Commercial	$2,334.15
Rate for Payer: Health Management Network Commercial	$2,088.45
Rate for Payer: Humana Medicare	$761.67
Rate for Payer: Kaiser Permanente Commercial	$2,211.30
Rate for Payer: Kaiser Permanente Medicaid	$1,253.07
Rate for Payer: Kaiser Permanente Medicare	$761.67
Rate for Payer: MDX Hawaii PPO	$2,383.29
Rate for Payer: Ohana Health Plan Medicaid	$761.67
Rate for Payer: Ohana Health Plan Medicare	$761.67
Rate for Payer: UnitedHealthcare Medicare	$761.67
Rate for Payer: University Health Alliance Commercial	$1,790.91

TROCAR CLOSURE ENDOCLOSE

Facility

$141.00

Hospital Revenue Code	272
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$84.60
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Kaiser Permanente Commercial	$126.90
Rate for Payer: MDX Hawaii PPO	$136.77

TROCAR CLOSURE ENDOCLOSE

Facility

$141.00

Hospital Revenue Code	272
Min. Negotiated Rate	$43.71
Max. Negotiated Rate	$136.77
Rate for Payer: AlohaCare Medicaid	$70.50
Rate for Payer: AlohaCare Medicare	$43.71
Rate for Payer: Cash Price	$84.60
Rate for Payer: Devoted Health Medicare	$47.94
Rate for Payer: Hawaii Medical Service Association Medicare	$43.71
Rate for Payer: Hawaii Western Management Group Commercial	$133.95
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Humana Medicare	$43.71
Rate for Payer: Kaiser Permanente Commercial	$126.90
Rate for Payer: Kaiser Permanente Medicaid	$71.91
Rate for Payer: Kaiser Permanente Medicare	$43.71
Rate for Payer: MDX Hawaii PPO	$136.77
Rate for Payer: Ohana Health Plan Medicaid	$43.71
Rate for Payer: Ohana Health Plan Medicare	$43.71
Rate for Payer: UnitedHealthcare Medicare	$43.71
Rate for Payer: University Health Alliance Commercial	$102.77

TROCAR EXPAND SLV

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 EXPAND SLV

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 LAPAROSCOPIC 5MM CFF03

Facility

$360.00

Hospital Revenue Code	272
Min. Negotiated Rate	$306.00
Max. Negotiated Rate	$349.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Kaiser Permanente Commercial	$324.00
Rate for Payer: MDX Hawaii PPO	$349.20

TROCAR LAPAROSCOPIC 5MM CFF03

Facility

$360.00

Hospital Revenue Code	272
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$349.20
Rate for Payer: AlohaCare Medicaid	$180.00
Rate for Payer: AlohaCare Medicare	$111.60
Rate for Payer: Cash Price	$216.00
Rate for Payer: Devoted Health Medicare	$122.40
Rate for Payer: Hawaii Medical Service Association Medicare	$111.60
Rate for Payer: Hawaii Western Management Group Commercial	$342.00
Rate for Payer: Health Management Network Commercial	$306.00
Rate for Payer: Humana Medicare	$111.60
Rate for Payer: Kaiser Permanente Commercial	$324.00
Rate for Payer: Kaiser Permanente Medicaid	$183.60
Rate for Payer: Kaiser Permanente Medicare	$111.60
Rate for Payer: MDX Hawaii PPO	$349.20
Rate for Payer: Ohana Health Plan Medicaid	$111.60
Rate for Payer: Ohana Health Plan Medicare	$111.60
Rate for Payer: UnitedHealthcare Medicare	$111.60
Rate for Payer: University Health Alliance Commercial	$262.40

TROCAR REP 5MM

Facility

$193.00

Hospital Revenue Code	272
Min. Negotiated Rate	$164.05
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$115.80
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: MDX Hawaii PPO	$187.21

TROCAR REP 5MM

Facility

$193.00

Hospital Revenue Code	272
Min. Negotiated Rate	$59.83
Max. Negotiated Rate	$187.21
Rate for Payer: AlohaCare Medicaid	$96.50
Rate for Payer: AlohaCare Medicare	$59.83
Rate for Payer: Cash Price	$115.80
Rate for Payer: Devoted Health Medicare	$65.62
Rate for Payer: Hawaii Medical Service Association Medicare	$59.83
Rate for Payer: Hawaii Western Management Group Commercial	$183.35
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Humana Medicare	$59.83
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: Kaiser Permanente Medicare	$59.83
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: Ohana Health Plan Medicaid	$59.83
Rate for Payer: Ohana Health Plan Medicare	$59.83
Rate for Payer: UnitedHealthcare Medicare	$59.83
Rate for Payer: University Health Alliance Commercial	$140.68

TROCAR SHIELDED BLADED 11X100

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 SHIELDED BLADED 11X100

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 STEP 12MM

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

TROCAR STEP 12MM

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

TROCAR STEP 5MM SHORT

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

TROCAR STEP 5MM SHORT

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

TROPICAMIDE 0.5 % EYE DROPS [8249]

Facility

$94.00

Service Code	NDC 61314035401
Hospital Revenue Code	250
Min. Negotiated Rate	$79.90
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$56.40
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Kaiser Permanente Commercial	$84.60
Rate for Payer: MDX Hawaii PPO	$91.18

TROPICAMIDE 0.5 % EYE DROPS [8249]

Facility

$94.00

Service Code	NDC 61314035401
Hospital Revenue Code	637
Min. Negotiated Rate	$29.14
Max. Negotiated Rate	$91.18
Rate for Payer: AlohaCare Medicaid	$47.00
Rate for Payer: AlohaCare Medicare	$29.14
Rate for Payer: Cash Price	$56.40
Rate for Payer: Devoted Health Medicare	$31.96
Rate for Payer: Hawaii Medical Service Association Medicare	$29.14
Rate for Payer: Hawaii Western Management Group Commercial	$89.30
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Humana Medicare	$29.14
Rate for Payer: Kaiser Permanente Commercial	$84.60
Rate for Payer: Kaiser Permanente Medicaid	$47.94
Rate for Payer: Kaiser Permanente Medicare	$29.14
Rate for Payer: MDX Hawaii PPO	$91.18
Rate for Payer: Ohana Health Plan Medicaid	$29.14
Rate for Payer: Ohana Health Plan Medicare	$29.14
Rate for Payer: UnitedHealthcare Medicare	$29.14
Rate for Payer: University Health Alliance Commercial	$68.52

TROPICAMIDE 1 % EYE DROPS [8250]

Facility

$125.00

Service Code	NDC 70069012101
Hospital Revenue Code	250
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$75.00
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: MDX Hawaii PPO	$121.25

TROPICAMIDE 1 % EYE DROPS [8250]

Facility

$125.00

Service Code	NDC 70069012101
Hospital Revenue Code	637
Min. Negotiated Rate	$38.75
Max. Negotiated Rate	$121.25
Rate for Payer: AlohaCare Medicaid	$62.50
Rate for Payer: AlohaCare Medicare	$38.75
Rate for Payer: Cash Price	$75.00
Rate for Payer: Devoted Health Medicare	$42.50
Rate for Payer: Hawaii Medical Service Association Medicare	$38.75
Rate for Payer: Hawaii Western Management Group Commercial	$118.75
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Humana Medicare	$38.75
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: Kaiser Permanente Medicare	$38.75
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: Ohana Health Plan Medicaid	$38.75
Rate for Payer: Ohana Health Plan Medicare	$38.75
Rate for Payer: UnitedHealthcare Medicare	$38.75
Rate for Payer: University Health Alliance Commercial	$91.11

TRUSELECT STRAIGHT 021X130

Facility

$2,025.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$1,721.25
Max. Negotiated Rate	$1,964.25
Rate for Payer: Cash Price	$1,215.00
Rate for Payer: Health Management Network Commercial	$1,721.25
Rate for Payer: Kaiser Permanente Commercial	$1,822.50
Rate for Payer: MDX Hawaii PPO	$1,964.25

TRUSELECT STRAIGHT 021X130

Facility

$2,025.00

Service Code	HCPCS C1887
Hospital Revenue Code	272
Min. Negotiated Rate	$627.75
Max. Negotiated Rate	$1,964.25
Rate for Payer: AlohaCare Medicaid	$1,012.50
Rate for Payer: AlohaCare Medicare	$627.75
Rate for Payer: Cash Price	$1,215.00
Rate for Payer: Devoted Health Medicare	$688.50
Rate for Payer: Hawaii Medical Service Association Medicare	$627.75
Rate for Payer: Hawaii Western Management Group Commercial	$1,923.75
Rate for Payer: Health Management Network Commercial	$1,721.25
Rate for Payer: Humana Medicare	$627.75
Rate for Payer: Kaiser Permanente Commercial	$1,822.50
Rate for Payer: Kaiser Permanente Medicaid	$1,032.75
Rate for Payer: Kaiser Permanente Medicare	$627.75
Rate for Payer: MDX Hawaii PPO	$1,964.25
Rate for Payer: Ohana Health Plan Medicaid	$627.75
Rate for Payer: Ohana Health Plan Medicare	$627.75
Rate for Payer: UnitedHealthcare Medicare	$627.75
Rate for Payer: University Health Alliance Commercial	$1,476.02

TTKNIFE ELECTROSURGCAL KD-640L

Facility

$2,110.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,793.50
Max. Negotiated Rate	$2,046.70
Rate for Payer: Cash Price	$1,266.00
Rate for Payer: Health Management Network Commercial	$1,793.50
Rate for Payer: Kaiser Permanente Commercial	$1,899.00
Rate for Payer: MDX Hawaii PPO	$2,046.70

TTKNIFE ELECTROSURGCAL KD-640L

Facility

$2,110.00

Hospital Revenue Code	272
Min. Negotiated Rate	$654.10
Max. Negotiated Rate	$2,046.70
Rate for Payer: AlohaCare Medicaid	$1,055.00
Rate for Payer: AlohaCare Medicare	$654.10
Rate for Payer: Cash Price	$1,266.00
Rate for Payer: Devoted Health Medicare	$717.40
Rate for Payer: Hawaii Medical Service Association Medicare	$654.10
Rate for Payer: Hawaii Western Management Group Commercial	$2,004.50
Rate for Payer: Health Management Network Commercial	$1,793.50
Rate for Payer: Humana Medicare	$654.10
Rate for Payer: Kaiser Permanente Commercial	$1,899.00
Rate for Payer: Kaiser Permanente Medicaid	$1,076.10
Rate for Payer: Kaiser Permanente Medicare	$654.10
Rate for Payer: MDX Hawaii PPO	$2,046.70
Rate for Payer: Ohana Health Plan Medicaid	$654.10
Rate for Payer: Ohana Health Plan Medicare	$654.10
Rate for Payer: UnitedHealthcare Medicare	$654.10
Rate for Payer: University Health Alliance Commercial	$1,537.98

TUBE 16F ENFIT GASTRO

Facility

$140.00

Hospital Revenue Code	272
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$84.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: MDX Hawaii PPO	$135.80

Know your out-of-pocket cost for care.

All Charges