Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Amylase FSI

Facility

$97.00

Service Code	HCPCS 82150
Hospital Charge Code	8117839
Hospital Revenue Code	301
Min. Negotiated Rate	$82.45
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$63.05
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Kaiser Permanente Commercial	$87.30
Rate for Payer: MDX Hawaii PPO	$94.09

ANAL AND STOMAL PROCEDURES WITH CC

Facility

$24,603.64

Service Code	MSDRG 348
Min. Negotiated Rate	$24,603.64
Max. Negotiated Rate	$24,603.64
Rate for Payer: Hawaii Medical Service Association Commercial	$24,603.64

ANAL AND STOMAL PROCEDURES WITH MCC

Facility

$30,671.69

Service Code	MSDRG 347
Min. Negotiated Rate	$30,671.69
Max. Negotiated Rate	$30,671.69
Rate for Payer: Hawaii Medical Service Association Commercial	$30,671.69

ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC

Facility

$15,272.10

Service Code	MSDRG 349
Min. Negotiated Rate	$15,272.10
Max. Negotiated Rate	$15,272.10
Rate for Payer: Hawaii Medical Service Association Commercial	$15,272.10

ANA Screen Rfx Titer FSI

Facility

$173.00

Service Code	HCPCS 86038
Hospital Charge Code	8117841
Hospital Revenue Code	302
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$167.81
Rate for Payer: AlohaCare Medicaid	$86.50
Rate for Payer: AlohaCare Medicare	$86.50
Rate for Payer: Cash Price	$112.45
Rate for Payer: Cash Price	$112.45
Rate for Payer: Devoted Health Medicare	$95.15
Rate for Payer: Hawaii Medical Service Association ABD	$16.70
Rate for Payer: Hawaii Medical Service Association Commercial	$15.11
Rate for Payer: Hawaii Medical Service Association Medicare	$86.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.54
Rate for Payer: Hawaii Western Management Group Commercial	$12.09
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Humana Medicare	$86.50
Rate for Payer: Kaiser Permanente Commercial	$155.70
Rate for Payer: Kaiser Permanente Medicaid	$88.23
Rate for Payer: Kaiser Permanente Medicare	$86.50
Rate for Payer: MDX Hawaii PPO	$167.81
Rate for Payer: Ohana Health Plan Medicaid	$86.50
Rate for Payer: Ohana Health Plan Medicare	$86.50
Rate for Payer: UnitedHealthcare Medicaid	$16.70
Rate for Payer: UnitedHealthcare Medicare	$86.50
Rate for Payer: University Health Alliance Commercial	$31.25

ANA Screen Rfx Titer FSI

Facility

$173.00

Service Code	HCPCS 86038
Hospital Charge Code	8117841
Hospital Revenue Code	302
Min. Negotiated Rate	$147.05
Max. Negotiated Rate	$167.81
Rate for Payer: Cash Price	$112.45
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Kaiser Permanente Commercial	$155.70
Rate for Payer: MDX Hawaii PPO	$167.81

ANES ARTHRS HUMERAL H/N STRNCLAV & SHOULDER NOS

Professional

Both

$191.00

Hospital Charge Code	8522126
Hospital Revenue Code	963
Min. Negotiated Rate	$162.35
Max. Negotiated Rate	$162.35
Rate for Payer: Cash Price	$124.15
Rate for Payer: Health Management Network Commercial	$162.35

ANES ENDO RETRO CHOLANGIOPANCREATOGRAPHY- 00732

Professional

Both

$400.00

Hospital Charge Code	9365277
Hospital Revenue Code	964
Min. Negotiated Rate	$340.00
Max. Negotiated Rate	$340.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Health Management Network Commercial	$340.00

ANES NERVE MUSCLE TDN FASCIA&BURSA FOREARM WRIST

Professional

Both

$191.00

Hospital Charge Code	8541860
Hospital Revenue Code	963
Min. Negotiated Rate	$162.35
Max. Negotiated Rate	$162.35
Rate for Payer: Cash Price	$124.15
Rate for Payer: Health Management Network Commercial	$162.35

ANES NERVE MUSC TENDON FASCIA&BURSA KNEE&/POPLT

Professional

Both

$191.00

Hospital Charge Code	8802598
Hospital Revenue Code	963
Min. Negotiated Rate	$162.35
Max. Negotiated Rate	$162.35
Rate for Payer: Cash Price	$124.15
Rate for Payer: Health Management Network Commercial	$162.35

Anesthesia Closed Procedures Humerus & Elbow

Professional

Both

$191.00

Hospital Charge Code	9560898
Hospital Revenue Code	963
Min. Negotiated Rate	$162.35
Max. Negotiated Rate	$162.35
Rate for Payer: Cash Price	$124.15
Rate for Payer: Health Management Network Commercial	$162.35

ANESTHESIA EXTENSIVE SPINE & SPINAL CORD

Professional

Both

$191.00

Hospital Charge Code	9536033
Hospital Revenue Code	963
Min. Negotiated Rate	$162.35
Max. Negotiated Rate	$162.35
Rate for Payer: Cash Price	$124.15
Rate for Payer: Health Management Network Commercial	$162.35

ANESTHESIA FOR ACCESS TO CENTRAL VENOUS CIRCULATION

Facility

$2,837.00

Service Code	CPT 00532
Hospital Revenue Code	360
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$22.80

ANESTHESIA FOR COMBINED UPPER AND LOWER GASTROINTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED BOTH PROXIMAL TO AND DISTAL TO THE DUODENUM

Facility

$2,837.00

Service Code	CPT 00813
Hospital Revenue Code	360
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$22.80

ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN INCLUDING LAPAROSCOPY; NOT OTHERWISE SPECIFIED

Facility

$2,837.00

Service Code	CPT 00840
Hospital Revenue Code	360
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$22.80

ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN UPPER ABDOMEN INCLUDING LAPAROSCOPY; NOT OTHERWISE SPECIFIED

Facility

$2,837.00

Service Code	CPT 00790
Hospital Revenue Code	360
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$22.80

ANESTHESIA FOR LOWER INTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED DISTAL TO DUODENUM; NOT OTHERWISE SPECIFIED

Facility

$2,837.00

Service Code	CPT 00811
Hospital Revenue Code	360
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$22.80

ANESTHESIA FOR LOWER INTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED DISTAL TO DUODENUM; SCREENING COLONOSCOPY

Facility

$2,837.00

Service Code	CPT 00812
Hospital Revenue Code	360
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$22.80

ANESTHESIA FOR PROCEDURES ON EYE; LENS SURGERY

Facility

$2,837.00

Service Code	CPT 00142
Hospital Revenue Code	360
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$22.80

ANESTHESIA FOR UPPER GASTROINTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED PROXIMAL TO DUODENUM; NOT OTHERWISE SPECIFIED

Facility

$2,837.00

Service Code	CPT 00731
Hospital Revenue Code	360
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$22.80

ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR ENDOMETRIUM); NOT OTHERWISE SPECIFIED

Facility

$2,837.00

Service Code	CPT 00940
Hospital Revenue Code	360
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$22.80

ANGINA PECTORIS

Facility

$13,665.86

Service Code	MSDRG 311
Min. Negotiated Rate	$13,665.86
Max. Negotiated Rate	$13,665.86
Rate for Payer: Hawaii Medical Service Association Commercial	$13,665.86

Angiotensin Converting Enzyme ACE FSI

Facility

$166.00

Service Code	HCPCS 82164
Hospital Charge Code	8117842
Hospital Revenue Code	301
Min. Negotiated Rate	$14.60
Max. Negotiated Rate	$161.02
Rate for Payer: AlohaCare Medicaid	$83.00
Rate for Payer: AlohaCare Medicare	$83.00
Rate for Payer: Cash Price	$107.90
Rate for Payer: Cash Price	$107.90
Rate for Payer: Devoted Health Medicare	$91.30
Rate for Payer: Hawaii Medical Service Association ABD	$20.17
Rate for Payer: Hawaii Medical Service Association Commercial	$18.25
Rate for Payer: Hawaii Medical Service Association Medicare	$83.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.18
Rate for Payer: Hawaii Western Management Group Commercial	$14.60
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Humana Medicare	$83.00
Rate for Payer: Kaiser Permanente Commercial	$149.40
Rate for Payer: Kaiser Permanente Medicaid	$84.66
Rate for Payer: Kaiser Permanente Medicare	$83.00
Rate for Payer: MDX Hawaii PPO	$161.02
Rate for Payer: Ohana Health Plan Medicaid	$83.00
Rate for Payer: Ohana Health Plan Medicare	$83.00
Rate for Payer: UnitedHealthcare Medicaid	$20.17
Rate for Payer: UnitedHealthcare Medicare	$83.00
Rate for Payer: University Health Alliance Commercial	$37.72

Angiotensin Converting Enzyme ACE FSI

Facility

$166.00

Service Code	HCPCS 82164
Hospital Charge Code	8117842
Hospital Revenue Code	301
Min. Negotiated Rate	$141.10
Max. Negotiated Rate	$161.02
Rate for Payer: Cash Price	$107.90
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

ANTEGRADE FEMORAL NAIL, LT, 10MM X 30CM

Facility

$4,610.00

Service Code	HCPCS C1713
Hospital Charge Code	12969392
Hospital Revenue Code	278
Min. Negotiated Rate	$2,581.60
Max. Negotiated Rate	$4,471.70
Rate for Payer: Cash Price	$2,996.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,227.00
Rate for Payer: Health Management Network Commercial	$3,918.50
Rate for Payer: Kaiser Permanente Commercial	$4,149.00
Rate for Payer: MDX Hawaii PPO	$4,471.70
Rate for Payer: University Health Alliance Commercial	$2,581.60

Know your out-of-pocket cost for care.

All Charges