Kau Hospital

All Charges

Charge

Type

Setting

Price

VERSAJET II HANDSET 45DEG/8MM

Facility

$1,587.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,348.95
Max. Negotiated Rate	$1,539.39
Rate for Payer: Cash Price	$952.20
Rate for Payer: Health Management Network Commercial	$1,348.95
Rate for Payer: Kaiser Permanente Commercial	$1,428.30
Rate for Payer: MDX Hawaii PPO	$1,539.39

VERSAJET II HANDSET 45DEG/8MM

Facility

$1,587.00

Hospital Revenue Code	272
Min. Negotiated Rate	$491.97
Max. Negotiated Rate	$1,539.39
Rate for Payer: AlohaCare Medicaid	$793.50
Rate for Payer: AlohaCare Medicare	$491.97
Rate for Payer: Cash Price	$952.20
Rate for Payer: Devoted Health Medicare	$539.58
Rate for Payer: Hawaii Medical Service Association Medicare	$491.97
Rate for Payer: Hawaii Western Management Group Commercial	$1,507.65
Rate for Payer: Health Management Network Commercial	$1,348.95
Rate for Payer: Humana Medicare	$491.97
Rate for Payer: Kaiser Permanente Commercial	$1,428.30
Rate for Payer: Kaiser Permanente Medicaid	$809.37
Rate for Payer: Kaiser Permanente Medicare	$491.97
Rate for Payer: MDX Hawaii PPO	$1,539.39
Rate for Payer: Ohana Health Plan Medicaid	$491.97
Rate for Payer: Ohana Health Plan Medicare	$491.97
Rate for Payer: UnitedHealthcare Medicare	$491.97
Rate for Payer: University Health Alliance Commercial	$1,156.76

VERSAPORT OPT 5MM ONB5STF

Facility

$119.00

Hospital Revenue Code	272
Min. Negotiated Rate	$101.15
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$71.40
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Kaiser Permanente Commercial	$107.10
Rate for Payer: MDX Hawaii PPO	$115.43

VERSAPORT OPT 5MM ONB5STF

Facility

$119.00

Hospital Revenue Code	272
Min. Negotiated Rate	$36.89
Max. Negotiated Rate	$115.43
Rate for Payer: AlohaCare Medicaid	$59.50
Rate for Payer: AlohaCare Medicare	$36.89
Rate for Payer: Cash Price	$71.40
Rate for Payer: Devoted Health Medicare	$40.46
Rate for Payer: Hawaii Medical Service Association Medicare	$36.89
Rate for Payer: Hawaii Western Management Group Commercial	$113.05
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Humana Medicare	$36.89
Rate for Payer: Kaiser Permanente Commercial	$107.10
Rate for Payer: Kaiser Permanente Medicaid	$60.69
Rate for Payer: Kaiser Permanente Medicare	$36.89
Rate for Payer: MDX Hawaii PPO	$115.43
Rate for Payer: Ohana Health Plan Medicaid	$36.89
Rate for Payer: Ohana Health Plan Medicare	$36.89
Rate for Payer: UnitedHealthcare Medicare	$36.89
Rate for Payer: University Health Alliance Commercial	$86.74

VERSAPORT PLUS BLADELESS CANN

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

VERSAPORT PLUS BLADELESS CANN

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

VERSASTEP 12MM LONG

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

VERSASTEP 12MM LONG

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

VERSASTEP 5MM LONG

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

VERSASTEP 5MM LONG

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

VERSASTEP XTRA SLEEVE

Facility

$226.00

Hospital Revenue Code	272
Min. Negotiated Rate	$192.10
Max. Negotiated Rate	$219.22
Rate for Payer: Cash Price	$135.60
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: Kaiser Permanente Commercial	$203.40
Rate for Payer: MDX Hawaii PPO	$219.22

VERSASTEP XTRA SLEEVE

Facility

$226.00

Hospital Revenue Code	272
Min. Negotiated Rate	$70.06
Max. Negotiated Rate	$219.22
Rate for Payer: AlohaCare Medicaid	$113.00
Rate for Payer: AlohaCare Medicare	$70.06
Rate for Payer: Cash Price	$135.60
Rate for Payer: Devoted Health Medicare	$76.84
Rate for Payer: Hawaii Medical Service Association Medicare	$70.06
Rate for Payer: Hawaii Western Management Group Commercial	$214.70
Rate for Payer: Health Management Network Commercial	$192.10
Rate for Payer: Humana Medicare	$70.06
Rate for Payer: Kaiser Permanente Commercial	$203.40
Rate for Payer: Kaiser Permanente Medicaid	$115.26
Rate for Payer: Kaiser Permanente Medicare	$70.06
Rate for Payer: MDX Hawaii PPO	$219.22
Rate for Payer: Ohana Health Plan Medicaid	$70.06
Rate for Payer: Ohana Health Plan Medicare	$70.06
Rate for Payer: UnitedHealthcare Medicare	$70.06
Rate for Payer: University Health Alliance Commercial	$164.73

VERS DSTL 10MM 00-7859-010-00

Facility

$200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$194.00
Rate for Payer: AlohaCare Medicaid	$100.00
Rate for Payer: AlohaCare Medicare	$62.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Devoted Health Medicare	$68.00
Rate for Payer: Hawaii Medical Service Association Medicare	$62.00
Rate for Payer: Hawaii Western Management Group Commercial	$140.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Humana Medicare	$62.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: Kaiser Permanente Medicare	$62.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: Ohana Health Plan Medicaid	$62.00
Rate for Payer: Ohana Health Plan Medicare	$62.00
Rate for Payer: UnitedHealthcare Medicare	$62.00
Rate for Payer: University Health Alliance Commercial	$112.00

VERS DSTL 10MM 00-7859-010-00

Facility

$200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Hawaii Western Management Group Commercial	$140.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: University Health Alliance Commercial	$112.00

VERSYS CEMENTED LD/FX 14X135MM

Facility

$4,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: AlohaCare Medicaid	$2,150.00
Rate for Payer: AlohaCare Medicare	$1,333.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Devoted Health Medicare	$1,462.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,333.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Humana Medicare	$1,333.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: Kaiser Permanente Medicare	$1,333.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: Ohana Health Plan Medicaid	$1,333.00
Rate for Payer: Ohana Health Plan Medicare	$1,333.00
Rate for Payer: UnitedHealthcare Medicare	$1,333.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

VERSYS CEMENTED LD/FX 14X135MM

Facility

$4,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

VESSEL SEALER EXTENDED 480422

Facility

$1,969.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,673.65
Max. Negotiated Rate	$1,909.93
Rate for Payer: Cash Price	$1,181.40
Rate for Payer: Health Management Network Commercial	$1,673.65
Rate for Payer: Kaiser Permanente Commercial	$1,772.10
Rate for Payer: MDX Hawaii PPO	$1,909.93

VESSEL SEALER EXTENDED 480422

Facility

$1,969.00

Hospital Revenue Code	272
Min. Negotiated Rate	$610.39
Max. Negotiated Rate	$1,909.93
Rate for Payer: AlohaCare Medicaid	$984.50
Rate for Payer: AlohaCare Medicare	$610.39
Rate for Payer: Cash Price	$1,181.40
Rate for Payer: Devoted Health Medicare	$669.46
Rate for Payer: Hawaii Medical Service Association Medicare	$610.39
Rate for Payer: Hawaii Western Management Group Commercial	$1,870.55
Rate for Payer: Health Management Network Commercial	$1,673.65
Rate for Payer: Humana Medicare	$610.39
Rate for Payer: Kaiser Permanente Commercial	$1,772.10
Rate for Payer: Kaiser Permanente Medicaid	$1,004.19
Rate for Payer: Kaiser Permanente Medicare	$610.39
Rate for Payer: MDX Hawaii PPO	$1,909.93
Rate for Payer: Ohana Health Plan Medicaid	$610.39
Rate for Payer: Ohana Health Plan Medicare	$610.39
Rate for Payer: UnitedHealthcare Medicare	$610.39
Rate for Payer: University Health Alliance Commercial	$1,435.20

VIABAHN BALLOON BXB085902A

Facility

$8,106.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$2,512.86
Max. Negotiated Rate	$7,862.82
Rate for Payer: AlohaCare Medicaid	$4,053.00
Rate for Payer: AlohaCare Medicare	$2,512.86
Rate for Payer: Cash Price	$4,863.60
Rate for Payer: Devoted Health Medicare	$2,756.04
Rate for Payer: Hawaii Medical Service Association Medicare	$2,512.86
Rate for Payer: Hawaii Western Management Group Commercial	$5,674.20
Rate for Payer: Health Management Network Commercial	$6,890.10
Rate for Payer: Humana Medicare	$2,512.86
Rate for Payer: Kaiser Permanente Commercial	$7,295.40
Rate for Payer: Kaiser Permanente Medicaid	$4,134.06
Rate for Payer: Kaiser Permanente Medicare	$2,512.86
Rate for Payer: MDX Hawaii PPO	$7,862.82
Rate for Payer: Ohana Health Plan Medicaid	$2,512.86
Rate for Payer: Ohana Health Plan Medicare	$2,512.86
Rate for Payer: UnitedHealthcare Medicare	$2,512.86
Rate for Payer: University Health Alliance Commercial	$4,539.36

VIABAHN BALLOON BXB085902A

Facility

$8,106.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,539.36
Max. Negotiated Rate	$7,862.82
Rate for Payer: Cash Price	$4,863.60
Rate for Payer: Hawaii Western Management Group Commercial	$5,674.20
Rate for Payer: Health Management Network Commercial	$6,890.10
Rate for Payer: Kaiser Permanente Commercial	$7,295.40
Rate for Payer: MDX Hawaii PPO	$7,862.82
Rate for Payer: University Health Alliance Commercial	$4,539.36

VIABAHN BALLOON BXBL083902A

Facility

$8,106.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$2,512.86
Max. Negotiated Rate	$7,862.82
Rate for Payer: AlohaCare Medicaid	$4,053.00
Rate for Payer: AlohaCare Medicare	$2,512.86
Rate for Payer: Cash Price	$4,863.60
Rate for Payer: Devoted Health Medicare	$2,756.04
Rate for Payer: Hawaii Medical Service Association Medicare	$2,512.86
Rate for Payer: Hawaii Western Management Group Commercial	$5,674.20
Rate for Payer: Health Management Network Commercial	$6,890.10
Rate for Payer: Humana Medicare	$2,512.86
Rate for Payer: Kaiser Permanente Commercial	$7,295.40
Rate for Payer: Kaiser Permanente Medicaid	$4,134.06
Rate for Payer: Kaiser Permanente Medicare	$2,512.86
Rate for Payer: MDX Hawaii PPO	$7,862.82
Rate for Payer: Ohana Health Plan Medicaid	$2,512.86
Rate for Payer: Ohana Health Plan Medicare	$2,512.86
Rate for Payer: UnitedHealthcare Medicare	$2,512.86
Rate for Payer: University Health Alliance Commercial	$4,539.36

VIABAHN BALLOON BXBL083902A

Facility

$8,106.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,539.36
Max. Negotiated Rate	$7,862.82
Rate for Payer: Cash Price	$4,863.60
Rate for Payer: Hawaii Western Management Group Commercial	$5,674.20
Rate for Payer: Health Management Network Commercial	$6,890.10
Rate for Payer: Kaiser Permanente Commercial	$7,295.40
Rate for Payer: MDX Hawaii PPO	$7,862.82
Rate for Payer: University Health Alliance Commercial	$4,539.36

VIABAHN BALLOON BXBL085902A

Facility

$8,106.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$2,512.86
Max. Negotiated Rate	$7,862.82
Rate for Payer: AlohaCare Medicaid	$4,053.00
Rate for Payer: AlohaCare Medicare	$2,512.86
Rate for Payer: Cash Price	$4,863.60
Rate for Payer: Devoted Health Medicare	$2,756.04
Rate for Payer: Hawaii Medical Service Association Medicare	$2,512.86
Rate for Payer: Hawaii Western Management Group Commercial	$5,674.20
Rate for Payer: Health Management Network Commercial	$6,890.10
Rate for Payer: Humana Medicare	$2,512.86
Rate for Payer: Kaiser Permanente Commercial	$7,295.40
Rate for Payer: Kaiser Permanente Medicaid	$4,134.06
Rate for Payer: Kaiser Permanente Medicare	$2,512.86
Rate for Payer: MDX Hawaii PPO	$7,862.82
Rate for Payer: Ohana Health Plan Medicaid	$2,512.86
Rate for Payer: Ohana Health Plan Medicare	$2,512.86
Rate for Payer: UnitedHealthcare Medicare	$2,512.86
Rate for Payer: University Health Alliance Commercial	$4,539.36

VIABAHN BALLOON BXBL085902A

Facility

$8,106.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,539.36
Max. Negotiated Rate	$7,862.82
Rate for Payer: Cash Price	$4,863.60
Rate for Payer: Hawaii Western Management Group Commercial	$5,674.20
Rate for Payer: Health Management Network Commercial	$6,890.10
Rate for Payer: Kaiser Permanente Commercial	$7,295.40
Rate for Payer: MDX Hawaii PPO	$7,862.82
Rate for Payer: University Health Alliance Commercial	$4,539.36

VIABAHN BX BALLOON BXA085901A

Facility

$8,106.00

Service Code	HCPCS C1874
Hospital Revenue Code	278
Min. Negotiated Rate	$4,539.36
Max. Negotiated Rate	$7,862.82
Rate for Payer: Cash Price	$4,863.60
Rate for Payer: Hawaii Western Management Group Commercial	$5,674.20
Rate for Payer: Health Management Network Commercial	$6,890.10
Rate for Payer: Kaiser Permanente Commercial	$7,295.40
Rate for Payer: MDX Hawaii PPO	$7,862.82
Rate for Payer: University Health Alliance Commercial	$4,539.36

Know your out-of-pocket cost for care.

All Charges