Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Anti-Parietal Cell AB FSI

Facility

$699.00

Service Code	HCPCS 83516
Hospital Charge Code	8404549
Hospital Revenue Code	302
Min. Negotiated Rate	$594.15
Max. Negotiated Rate	$678.03
Rate for Payer: Cash Price	$454.35
Rate for Payer: Health Management Network Commercial	$594.15
Rate for Payer: Kaiser Permanente Commercial	$629.10
Rate for Payer: MDX Hawaii PPO	$678.03

Anti-Parietal Cell AB FSI

Facility

$699.00

Service Code	HCPCS 83516
Hospital Charge Code	8404549
Hospital Revenue Code	302
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$678.03
Rate for Payer: AlohaCare Medicaid	$349.50
Rate for Payer: AlohaCare Medicare	$349.50
Rate for Payer: Cash Price	$454.35
Rate for Payer: Cash Price	$454.35
Rate for Payer: Devoted Health Medicare	$384.45
Rate for Payer: Hawaii Medical Service Association ABD	$15.95
Rate for Payer: Hawaii Medical Service Association Commercial	$14.41
Rate for Payer: Hawaii Medical Service Association Medicare	$349.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.75
Rate for Payer: Hawaii Western Management Group Commercial	$11.53
Rate for Payer: Health Management Network Commercial	$594.15
Rate for Payer: Humana Medicare	$349.50
Rate for Payer: Kaiser Permanente Commercial	$629.10
Rate for Payer: Kaiser Permanente Medicaid	$356.49
Rate for Payer: Kaiser Permanente Medicare	$349.50
Rate for Payer: MDX Hawaii PPO	$678.03
Rate for Payer: Ohana Health Plan Medicaid	$349.50
Rate for Payer: Ohana Health Plan Medicare	$349.50
Rate for Payer: UnitedHealthcare Medicaid	$15.95
Rate for Payer: UnitedHealthcare Medicare	$349.50
Rate for Payer: University Health Alliance Commercial	$29.82

ANTI-ROTATION SCREW, 5.0 MM X 100 MM

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	12970885
Hospital Revenue Code	278
Min. Negotiated Rate	$896.00
Max. Negotiated Rate	$1,552.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,120.00
Rate for Payer: Health Management Network Commercial	$1,360.00
Rate for Payer: Kaiser Permanente Commercial	$1,440.00
Rate for Payer: MDX Hawaii PPO	$1,552.00
Rate for Payer: University Health Alliance Commercial	$896.00

ANTI-ROTATION SCREW, 5.0 MM X 100 MM

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	12970885
Hospital Revenue Code	278
Min. Negotiated Rate	$800.00
Max. Negotiated Rate	$1,552.00
Rate for Payer: AlohaCare Medicaid	$800.00
Rate for Payer: AlohaCare Medicare	$800.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Devoted Health Medicare	$880.00
Rate for Payer: Hawaii Medical Service Association Medicare	$800.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,120.00
Rate for Payer: Health Management Network Commercial	$1,360.00
Rate for Payer: Humana Medicare	$800.00
Rate for Payer: Kaiser Permanente Commercial	$1,440.00
Rate for Payer: Kaiser Permanente Medicaid	$816.00
Rate for Payer: Kaiser Permanente Medicare	$800.00
Rate for Payer: MDX Hawaii PPO	$1,552.00
Rate for Payer: Ohana Health Plan Medicaid	$800.00
Rate for Payer: Ohana Health Plan Medicare	$800.00
Rate for Payer: UnitedHealthcare Medicare	$800.00
Rate for Payer: University Health Alliance Commercial	$896.00

ANTI-ROTATION SCREW, 5.0 MM X 60 MM

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	12970888
Hospital Revenue Code	278
Min. Negotiated Rate	$896.00
Max. Negotiated Rate	$1,552.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,120.00
Rate for Payer: Health Management Network Commercial	$1,360.00
Rate for Payer: Kaiser Permanente Commercial	$1,440.00
Rate for Payer: MDX Hawaii PPO	$1,552.00
Rate for Payer: University Health Alliance Commercial	$896.00

ANTI-ROTATION SCREW, 5.0 MM X 60 MM

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	12970888
Hospital Revenue Code	278
Min. Negotiated Rate	$800.00
Max. Negotiated Rate	$1,552.00
Rate for Payer: AlohaCare Medicaid	$800.00
Rate for Payer: AlohaCare Medicare	$800.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Devoted Health Medicare	$880.00
Rate for Payer: Hawaii Medical Service Association Medicare	$800.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,120.00
Rate for Payer: Health Management Network Commercial	$1,360.00
Rate for Payer: Humana Medicare	$800.00
Rate for Payer: Kaiser Permanente Commercial	$1,440.00
Rate for Payer: Kaiser Permanente Medicaid	$816.00
Rate for Payer: Kaiser Permanente Medicare	$800.00
Rate for Payer: MDX Hawaii PPO	$1,552.00
Rate for Payer: Ohana Health Plan Medicaid	$800.00
Rate for Payer: Ohana Health Plan Medicare	$800.00
Rate for Payer: UnitedHealthcare Medicare	$800.00
Rate for Payer: University Health Alliance Commercial	$896.00

ANTI-ROTATION SCREW, 5.0 MM X 65 MM

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	12970886
Hospital Revenue Code	278
Min. Negotiated Rate	$896.00
Max. Negotiated Rate	$1,552.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,120.00
Rate for Payer: Health Management Network Commercial	$1,360.00
Rate for Payer: Kaiser Permanente Commercial	$1,440.00
Rate for Payer: MDX Hawaii PPO	$1,552.00
Rate for Payer: University Health Alliance Commercial	$896.00

ANTI-ROTATION SCREW, 5.0 MM X 65 MM

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	12970886
Hospital Revenue Code	278
Min. Negotiated Rate	$800.00
Max. Negotiated Rate	$1,552.00
Rate for Payer: AlohaCare Medicaid	$800.00
Rate for Payer: AlohaCare Medicare	$800.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Devoted Health Medicare	$880.00
Rate for Payer: Hawaii Medical Service Association Medicare	$800.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,120.00
Rate for Payer: Health Management Network Commercial	$1,360.00
Rate for Payer: Humana Medicare	$800.00
Rate for Payer: Kaiser Permanente Commercial	$1,440.00
Rate for Payer: Kaiser Permanente Medicaid	$816.00
Rate for Payer: Kaiser Permanente Medicare	$800.00
Rate for Payer: MDX Hawaii PPO	$1,552.00
Rate for Payer: Ohana Health Plan Medicaid	$800.00
Rate for Payer: Ohana Health Plan Medicare	$800.00
Rate for Payer: UnitedHealthcare Medicare	$800.00
Rate for Payer: University Health Alliance Commercial	$896.00

ANTI-ROTATION SCREW, 5.0 MM X 70 MM

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	12970887
Hospital Revenue Code	278
Min. Negotiated Rate	$896.00
Max. Negotiated Rate	$1,552.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,120.00
Rate for Payer: Health Management Network Commercial	$1,360.00
Rate for Payer: Kaiser Permanente Commercial	$1,440.00
Rate for Payer: MDX Hawaii PPO	$1,552.00
Rate for Payer: University Health Alliance Commercial	$896.00

ANTI-ROTATION SCREW, 5.0 MM X 70 MM

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	12970887
Hospital Revenue Code	278
Min. Negotiated Rate	$800.00
Max. Negotiated Rate	$1,552.00
Rate for Payer: AlohaCare Medicaid	$800.00
Rate for Payer: AlohaCare Medicare	$800.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Devoted Health Medicare	$880.00
Rate for Payer: Hawaii Medical Service Association Medicare	$800.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,120.00
Rate for Payer: Health Management Network Commercial	$1,360.00
Rate for Payer: Humana Medicare	$800.00
Rate for Payer: Kaiser Permanente Commercial	$1,440.00
Rate for Payer: Kaiser Permanente Medicaid	$816.00
Rate for Payer: Kaiser Permanente Medicare	$800.00
Rate for Payer: MDX Hawaii PPO	$1,552.00
Rate for Payer: Ohana Health Plan Medicaid	$800.00
Rate for Payer: Ohana Health Plan Medicare	$800.00
Rate for Payer: UnitedHealthcare Medicare	$800.00
Rate for Payer: University Health Alliance Commercial	$896.00

ANTI-ROTATION SCREW, 5.0 MM X 80 MM

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	12974039
Hospital Revenue Code	278
Min. Negotiated Rate	$896.00
Max. Negotiated Rate	$1,552.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,120.00
Rate for Payer: Health Management Network Commercial	$1,360.00
Rate for Payer: Kaiser Permanente Commercial	$1,440.00
Rate for Payer: MDX Hawaii PPO	$1,552.00
Rate for Payer: University Health Alliance Commercial	$896.00

ANTI-ROTATION SCREW, 5.0 MM X 80 MM

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	12974039
Hospital Revenue Code	278
Min. Negotiated Rate	$800.00
Max. Negotiated Rate	$1,552.00
Rate for Payer: AlohaCare Medicaid	$800.00
Rate for Payer: AlohaCare Medicare	$800.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Devoted Health Medicare	$880.00
Rate for Payer: Hawaii Medical Service Association Medicare	$800.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,120.00
Rate for Payer: Health Management Network Commercial	$1,360.00
Rate for Payer: Humana Medicare	$800.00
Rate for Payer: Kaiser Permanente Commercial	$1,440.00
Rate for Payer: Kaiser Permanente Medicaid	$816.00
Rate for Payer: Kaiser Permanente Medicare	$800.00
Rate for Payer: MDX Hawaii PPO	$1,552.00
Rate for Payer: Ohana Health Plan Medicaid	$800.00
Rate for Payer: Ohana Health Plan Medicare	$800.00
Rate for Payer: UnitedHealthcare Medicare	$800.00
Rate for Payer: University Health Alliance Commercial	$896.00

ANTI-ROTATION SCREW, 5.0 MM X 85 MM

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	12974037
Hospital Revenue Code	278
Min. Negotiated Rate	$896.00
Max. Negotiated Rate	$1,552.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,120.00
Rate for Payer: Health Management Network Commercial	$1,360.00
Rate for Payer: Kaiser Permanente Commercial	$1,440.00
Rate for Payer: MDX Hawaii PPO	$1,552.00
Rate for Payer: University Health Alliance Commercial	$896.00

ANTI-ROTATION SCREW, 5.0 MM X 85 MM

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	12974037
Hospital Revenue Code	278
Min. Negotiated Rate	$800.00
Max. Negotiated Rate	$1,552.00
Rate for Payer: AlohaCare Medicaid	$800.00
Rate for Payer: AlohaCare Medicare	$800.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Devoted Health Medicare	$880.00
Rate for Payer: Hawaii Medical Service Association Medicare	$800.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,120.00
Rate for Payer: Health Management Network Commercial	$1,360.00
Rate for Payer: Humana Medicare	$800.00
Rate for Payer: Kaiser Permanente Commercial	$1,440.00
Rate for Payer: Kaiser Permanente Medicaid	$816.00
Rate for Payer: Kaiser Permanente Medicare	$800.00
Rate for Payer: MDX Hawaii PPO	$1,552.00
Rate for Payer: Ohana Health Plan Medicaid	$800.00
Rate for Payer: Ohana Health Plan Medicare	$800.00
Rate for Payer: UnitedHealthcare Medicare	$800.00
Rate for Payer: University Health Alliance Commercial	$896.00

ANTI-ROTATION SCREW, 5.0 MM X 90 MM

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	12974038
Hospital Revenue Code	278
Min. Negotiated Rate	$800.00
Max. Negotiated Rate	$1,552.00
Rate for Payer: AlohaCare Medicaid	$800.00
Rate for Payer: AlohaCare Medicare	$800.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Devoted Health Medicare	$880.00
Rate for Payer: Hawaii Medical Service Association Medicare	$800.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,120.00
Rate for Payer: Health Management Network Commercial	$1,360.00
Rate for Payer: Humana Medicare	$800.00
Rate for Payer: Kaiser Permanente Commercial	$1,440.00
Rate for Payer: Kaiser Permanente Medicaid	$816.00
Rate for Payer: Kaiser Permanente Medicare	$800.00
Rate for Payer: MDX Hawaii PPO	$1,552.00
Rate for Payer: Ohana Health Plan Medicaid	$800.00
Rate for Payer: Ohana Health Plan Medicare	$800.00
Rate for Payer: UnitedHealthcare Medicare	$800.00
Rate for Payer: University Health Alliance Commercial	$896.00

ANTI-ROTATION SCREW, 5.0 MM X 90 MM

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	12974038
Hospital Revenue Code	278
Min. Negotiated Rate	$896.00
Max. Negotiated Rate	$1,552.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,120.00
Rate for Payer: Health Management Network Commercial	$1,360.00
Rate for Payer: Kaiser Permanente Commercial	$1,440.00
Rate for Payer: MDX Hawaii PPO	$1,552.00
Rate for Payer: University Health Alliance Commercial	$896.00

ANTI-ROTATION SCREW, 5.0 MM X 95 MM

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	12974040
Hospital Revenue Code	278
Min. Negotiated Rate	$800.00
Max. Negotiated Rate	$1,552.00
Rate for Payer: AlohaCare Medicaid	$800.00
Rate for Payer: AlohaCare Medicare	$800.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Devoted Health Medicare	$880.00
Rate for Payer: Hawaii Medical Service Association Medicare	$800.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,120.00
Rate for Payer: Health Management Network Commercial	$1,360.00
Rate for Payer: Humana Medicare	$800.00
Rate for Payer: Kaiser Permanente Commercial	$1,440.00
Rate for Payer: Kaiser Permanente Medicaid	$816.00
Rate for Payer: Kaiser Permanente Medicare	$800.00
Rate for Payer: MDX Hawaii PPO	$1,552.00
Rate for Payer: Ohana Health Plan Medicaid	$800.00
Rate for Payer: Ohana Health Plan Medicare	$800.00
Rate for Payer: UnitedHealthcare Medicare	$800.00
Rate for Payer: University Health Alliance Commercial	$896.00

ANTI-ROTATION SCREW, 5.0 MM X 95 MM

Facility

$1,600.00

Service Code	HCPCS C1713
Hospital Charge Code	12974040
Hospital Revenue Code	278
Min. Negotiated Rate	$896.00
Max. Negotiated Rate	$1,552.00
Rate for Payer: Cash Price	$1,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,120.00
Rate for Payer: Health Management Network Commercial	$1,360.00
Rate for Payer: Kaiser Permanente Commercial	$1,440.00
Rate for Payer: MDX Hawaii PPO	$1,552.00
Rate for Payer: University Health Alliance Commercial	$896.00

ANTI-ROTATION SET SCREW

Facility

$1,453.00

Service Code	HCPCS C1713
Hospital Charge Code	12974042
Hospital Revenue Code	278
Min. Negotiated Rate	$813.68
Max. Negotiated Rate	$1,409.41
Rate for Payer: Cash Price	$944.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.10
Rate for Payer: Health Management Network Commercial	$1,235.05
Rate for Payer: Kaiser Permanente Commercial	$1,307.70
Rate for Payer: MDX Hawaii PPO	$1,409.41
Rate for Payer: University Health Alliance Commercial	$813.68

ANTI-ROTATION SET SCREW

Facility

$1,453.00

Service Code	HCPCS C1713
Hospital Charge Code	12974042
Hospital Revenue Code	278
Min. Negotiated Rate	$726.50
Max. Negotiated Rate	$1,409.41
Rate for Payer: AlohaCare Medicaid	$726.50
Rate for Payer: AlohaCare Medicare	$726.50
Rate for Payer: Cash Price	$944.45
Rate for Payer: Devoted Health Medicare	$799.15
Rate for Payer: Hawaii Medical Service Association Medicare	$726.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.10
Rate for Payer: Health Management Network Commercial	$1,235.05
Rate for Payer: Humana Medicare	$726.50
Rate for Payer: Kaiser Permanente Commercial	$1,307.70
Rate for Payer: Kaiser Permanente Medicaid	$741.03
Rate for Payer: Kaiser Permanente Medicare	$726.50
Rate for Payer: MDX Hawaii PPO	$1,409.41
Rate for Payer: Ohana Health Plan Medicaid	$726.50
Rate for Payer: Ohana Health Plan Medicare	$726.50
Rate for Payer: UnitedHealthcare Medicare	$726.50
Rate for Payer: University Health Alliance Commercial	$813.68

Anti SARS CoV-2 (COVID-19) Spike FSI

Facility

$143.00

Service Code	HCPCS 86769
Hospital Charge Code	9539263
Hospital Revenue Code	302
Min. Negotiated Rate	$42.13
Max. Negotiated Rate	$138.71
Rate for Payer: AlohaCare Medicaid	$71.50
Rate for Payer: AlohaCare Medicare	$71.50
Rate for Payer: Cash Price	$92.95
Rate for Payer: Cash Price	$92.95
Rate for Payer: Devoted Health Medicare	$78.65
Rate for Payer: Hawaii Medical Service Association ABD	$42.13
Rate for Payer: Hawaii Medical Service Association Commercial	$52.66
Rate for Payer: Hawaii Medical Service Association Medicare	$71.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42.13
Rate for Payer: Hawaii Western Management Group Commercial	$42.13
Rate for Payer: Health Management Network Commercial	$121.55
Rate for Payer: Humana Medicare	$71.50
Rate for Payer: Kaiser Permanente Commercial	$128.70
Rate for Payer: Kaiser Permanente Medicaid	$72.93
Rate for Payer: Kaiser Permanente Medicare	$71.50
Rate for Payer: MDX Hawaii PPO	$138.71
Rate for Payer: Ohana Health Plan Medicaid	$71.50
Rate for Payer: Ohana Health Plan Medicare	$71.50
Rate for Payer: UnitedHealthcare Medicaid	$42.13
Rate for Payer: UnitedHealthcare Medicare	$71.50
Rate for Payer: University Health Alliance Commercial	$104.23

Anti SARS CoV-2 (COVID-19) Spike FSI

Facility

$143.00

Service Code	HCPCS 86769
Hospital Charge Code	9539263
Hospital Revenue Code	302
Min. Negotiated Rate	$121.55
Max. Negotiated Rate	$138.71
Rate for Payer: Cash Price	$92.95
Rate for Payer: Health Management Network Commercial	$121.55
Rate for Payer: Kaiser Permanente Commercial	$128.70
Rate for Payer: MDX Hawaii PPO	$138.71

Anti-Streptolysin O REF

Facility

$89.00

Service Code	HCPCS 86060
Hospital Charge Code	8159914
Hospital Revenue Code	302
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$57.85
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$86.33

Anti-Streptolysin O REF

Facility

$89.00

Service Code	HCPCS 86060
Hospital Charge Code	8159914
Hospital Revenue Code	302
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$86.33
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$44.50
Rate for Payer: Cash Price	$57.85
Rate for Payer: Cash Price	$57.85
Rate for Payer: Devoted Health Medicare	$48.95
Rate for Payer: Hawaii Medical Service Association ABD	$10.09
Rate for Payer: Hawaii Medical Service Association Commercial	$9.12
Rate for Payer: Hawaii Medical Service Association Medicare	$44.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.59
Rate for Payer: Hawaii Western Management Group Commercial	$7.30
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Humana Medicare	$44.50
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicare	$44.50
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$44.50
Rate for Payer: Ohana Health Plan Medicare	$44.50
Rate for Payer: UnitedHealthcare Medicaid	$10.09
Rate for Payer: UnitedHealthcare Medicare	$44.50
Rate for Payer: University Health Alliance Commercial	$18.87

Anti-Thyroglobulin and Anti-Thyroid Peroxidase Antibody FSI

Facility

$183.00

Service Code	HCPCS 86800
Hospital Charge Code	8117851
Hospital Revenue Code	302
Min. Negotiated Rate	$155.55
Max. Negotiated Rate	$177.51
Rate for Payer: Cash Price	$118.95
Rate for Payer: Health Management Network Commercial	$155.55
Rate for Payer: Kaiser Permanente Commercial	$164.70
Rate for Payer: MDX Hawaii PPO	$177.51

Know your out-of-pocket cost for care.

All Charges