Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Bile Acids, Fract and Total, Preg.

Facility

$355.00

Service Code	HCPCS 82542
Hospital Charge Code	12499891
Hospital Revenue Code	301
Min. Negotiated Rate	$301.75
Max. Negotiated Rate	$344.35
Rate for Payer: Cash Price	$230.75
Rate for Payer: Health Management Network Commercial	$301.75
Rate for Payer: Kaiser Permanente Commercial	$319.50
Rate for Payer: MDX Hawaii PPO	$344.35

Bile Acids, Fract and Total, Preg.

Facility

$355.00

Service Code	HCPCS 82542
Hospital Charge Code	12499891
Hospital Revenue Code	301
Min. Negotiated Rate	$24.09
Max. Negotiated Rate	$344.35
Rate for Payer: AlohaCare Medicaid	$177.50
Rate for Payer: AlohaCare Medicare	$177.50
Rate for Payer: Cash Price	$230.75
Rate for Payer: Cash Price	$230.75
Rate for Payer: Devoted Health Medicare	$195.25
Rate for Payer: Hawaii Medical Service Association ABD	$24.96
Rate for Payer: Hawaii Medical Service Association Commercial	$30.11
Rate for Payer: Hawaii Medical Service Association Medicare	$177.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.21
Rate for Payer: Hawaii Western Management Group Commercial	$24.09
Rate for Payer: Health Management Network Commercial	$301.75
Rate for Payer: Humana Medicare	$177.50
Rate for Payer: Kaiser Permanente Commercial	$319.50
Rate for Payer: Kaiser Permanente Medicaid	$181.05
Rate for Payer: Kaiser Permanente Medicare	$177.50
Rate for Payer: MDX Hawaii PPO	$344.35
Rate for Payer: Ohana Health Plan Medicaid	$177.50
Rate for Payer: Ohana Health Plan Medicare	$177.50
Rate for Payer: UnitedHealthcare Medicaid	$24.96
Rate for Payer: UnitedHealthcare Medicare	$177.50
Rate for Payer: University Health Alliance Commercial	$46.68

Bile Acids, Total FSI

Facility

$195.00

Service Code	HCPCS 82239
Hospital Charge Code	8117857
Hospital Revenue Code	301
Min. Negotiated Rate	$165.75
Max. Negotiated Rate	$189.15
Rate for Payer: Cash Price	$126.75
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: Kaiser Permanente Commercial	$175.50
Rate for Payer: MDX Hawaii PPO	$189.15

Bile Acids, Total FSI

Facility

$195.00

Service Code	HCPCS 82239
Hospital Charge Code	8117857
Hospital Revenue Code	301
Min. Negotiated Rate	$17.12
Max. Negotiated Rate	$189.15
Rate for Payer: AlohaCare Medicaid	$97.50
Rate for Payer: AlohaCare Medicare	$97.50
Rate for Payer: Cash Price	$126.75
Rate for Payer: Cash Price	$126.75
Rate for Payer: Devoted Health Medicare	$107.25
Rate for Payer: Hawaii Medical Service Association ABD	$23.67
Rate for Payer: Hawaii Medical Service Association Commercial	$21.40
Rate for Payer: Hawaii Medical Service Association Medicare	$97.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.85
Rate for Payer: Hawaii Western Management Group Commercial	$17.12
Rate for Payer: Health Management Network Commercial	$165.75
Rate for Payer: Humana Medicare	$97.50
Rate for Payer: Kaiser Permanente Commercial	$175.50
Rate for Payer: Kaiser Permanente Medicaid	$99.45
Rate for Payer: Kaiser Permanente Medicare	$97.50
Rate for Payer: MDX Hawaii PPO	$189.15
Rate for Payer: Ohana Health Plan Medicaid	$97.50
Rate for Payer: Ohana Health Plan Medicare	$97.50
Rate for Payer: UnitedHealthcare Medicaid	$23.67
Rate for Payer: UnitedHealthcare Medicare	$97.50
Rate for Payer: University Health Alliance Commercial	$44.29

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC

Facility

$49,742.70

Service Code	MSDRG 409
Min. Negotiated Rate	$49,742.70
Max. Negotiated Rate	$49,742.70
Rate for Payer: Hawaii Medical Service Association Commercial	$49,742.70

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC

Facility

$49,742.70

Service Code	MSDRG 408
Min. Negotiated Rate	$49,742.70
Max. Negotiated Rate	$49,742.70
Rate for Payer: Hawaii Medical Service Association Commercial	$49,742.70

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$48,671.86

Service Code	MSDRG 410
Min. Negotiated Rate	$48,671.86
Max. Negotiated Rate	$48,671.86
Rate for Payer: Hawaii Medical Service Association Commercial	$48,671.86

Bilirubin, Direct FSI

Facility

$71.00

Service Code	HCPCS 82248
Hospital Charge Code	8117859
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: AlohaCare Medicare	$35.50
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Devoted Health Medicare	$39.05
Rate for Payer: Hawaii Medical Service Association ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$35.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.29
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$35.50
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$35.50
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$35.50
Rate for Payer: Ohana Health Plan Medicare	$35.50
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$35.50
Rate for Payer: University Health Alliance Commercial	$12.99

Bilirubin, Direct FSI

Facility

$71.00

Service Code	HCPCS 82248
Hospital Charge Code	8117859
Hospital Revenue Code	301
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

Bilirubin, Fluid FSI

Facility

$71.00

Service Code	HCPCS 82247
Hospital Charge Code	8404521
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: AlohaCare Medicare	$35.50
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Devoted Health Medicare	$39.05
Rate for Payer: Hawaii Medical Service Association ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$35.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.29
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$35.50
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$35.50
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$35.50
Rate for Payer: Ohana Health Plan Medicare	$35.50
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$35.50
Rate for Payer: University Health Alliance Commercial	$12.99

Bilirubin, Fluid FSI

Facility

$71.00

Service Code	HCPCS 82247
Hospital Charge Code	8404521
Hospital Revenue Code	301
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

Bilirubin, Neonatal Total Biliscreen FSI

Facility

$71.00

Service Code	HCPCS 82247
Hospital Charge Code	8117860
Hospital Revenue Code	301
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

Bilirubin, Neonatal Total Biliscreen FSI

Facility

$71.00

Service Code	HCPCS 82247
Hospital Charge Code	8117860
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: AlohaCare Medicare	$35.50
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Devoted Health Medicare	$39.05
Rate for Payer: Hawaii Medical Service Association ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$35.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.29
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$35.50
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$35.50
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$35.50
Rate for Payer: Ohana Health Plan Medicare	$35.50
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$35.50
Rate for Payer: University Health Alliance Commercial	$12.99

Bilirubin Neonatal, Total/Direct FSI

Facility

$71.00

Service Code	HCPCS 82247
Hospital Charge Code	8117858
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: AlohaCare Medicare	$35.50
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Devoted Health Medicare	$39.05
Rate for Payer: Hawaii Medical Service Association ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$35.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.29
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$35.50
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$35.50
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$35.50
Rate for Payer: Ohana Health Plan Medicare	$35.50
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$35.50
Rate for Payer: University Health Alliance Commercial	$12.99

Bilirubin Neonatal, Total/Direct FSI

Facility

$71.00

Service Code	HCPCS 82247
Hospital Charge Code	8117858
Hospital Revenue Code	301
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

Bilirubin, Total/Direct FSI

Facility

$47.00

Service Code	HCPCS 82247
Hospital Charge Code	8228844
Hospital Revenue Code	300
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$45.59
Rate for Payer: AlohaCare Medicaid	$23.50
Rate for Payer: AlohaCare Medicare	$23.50
Rate for Payer: Cash Price	$30.55
Rate for Payer: Cash Price	$30.55
Rate for Payer: Devoted Health Medicare	$25.85
Rate for Payer: Hawaii Medical Service Association ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$23.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.29
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Humana Medicare	$23.50
Rate for Payer: Kaiser Permanente Commercial	$42.30
Rate for Payer: Kaiser Permanente Medicaid	$23.97
Rate for Payer: Kaiser Permanente Medicare	$23.50
Rate for Payer: MDX Hawaii PPO	$45.59
Rate for Payer: Ohana Health Plan Medicaid	$23.50
Rate for Payer: Ohana Health Plan Medicare	$23.50
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$23.50
Rate for Payer: University Health Alliance Commercial	$12.99

Bilirubin, Total/Direct FSI

Facility

$47.00

Service Code	HCPCS 82247
Hospital Charge Code	8228844
Hospital Revenue Code	300
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$30.55
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Kaiser Permanente Commercial	$42.30
Rate for Payer: MDX Hawaii PPO	$45.59

Bilirubin, Total FSI

Facility

$71.00

Service Code	HCPCS 82247
Hospital Charge Code	8117861
Hospital Revenue Code	301
Min. Negotiated Rate	$60.35
Max. Negotiated Rate	$68.87
Rate for Payer: Cash Price	$46.15
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: MDX Hawaii PPO	$68.87

Bilirubin, Total FSI

Facility

$71.00

Service Code	HCPCS 82247
Hospital Charge Code	8117861
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$68.87
Rate for Payer: AlohaCare Medicaid	$35.50
Rate for Payer: AlohaCare Medicare	$35.50
Rate for Payer: Cash Price	$46.15
Rate for Payer: Cash Price	$46.15
Rate for Payer: Devoted Health Medicare	$39.05
Rate for Payer: Hawaii Medical Service Association ABD	$6.94
Rate for Payer: Hawaii Medical Service Association Commercial	$6.28
Rate for Payer: Hawaii Medical Service Association Medicare	$35.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.29
Rate for Payer: Hawaii Western Management Group Commercial	$5.02
Rate for Payer: Health Management Network Commercial	$60.35
Rate for Payer: Humana Medicare	$35.50
Rate for Payer: Kaiser Permanente Commercial	$63.90
Rate for Payer: Kaiser Permanente Medicaid	$36.21
Rate for Payer: Kaiser Permanente Medicare	$35.50
Rate for Payer: MDX Hawaii PPO	$68.87
Rate for Payer: Ohana Health Plan Medicaid	$35.50
Rate for Payer: Ohana Health Plan Medicare	$35.50
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$35.50
Rate for Payer: University Health Alliance Commercial	$12.99

Bill DLS2ID Org ID, Ur, Presumptive, 2 Isolate

Facility

$86.00

Service Code	HCPCS 87088
Hospital Charge Code	12138782
Hospital Revenue Code	306
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$55.90
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: MDX Hawaii PPO	$83.42

Bill DLS2ID Org ID, Ur, Presumptive, 2 Isolate

Facility

$86.00

Service Code	HCPCS 87088
Hospital Charge Code	12138782
Hospital Revenue Code	306
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$43.00
Rate for Payer: AlohaCare Medicare	$43.00
Rate for Payer: Cash Price	$55.90
Rate for Payer: Cash Price	$55.90
Rate for Payer: Devoted Health Medicare	$47.30
Rate for Payer: Hawaii Medical Service Association ABD	$10.55
Rate for Payer: Hawaii Medical Service Association Commercial	$10.11
Rate for Payer: Hawaii Medical Service Association Medicare	$43.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.08
Rate for Payer: Hawaii Western Management Group Commercial	$8.09
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Humana Medicare	$43.00
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: Kaiser Permanente Medicare	$43.00
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: Ohana Health Plan Medicaid	$43.00
Rate for Payer: Ohana Health Plan Medicare	$43.00
Rate for Payer: UnitedHealthcare Medicaid	$10.55
Rate for Payer: UnitedHealthcare Medicare	$43.00
Rate for Payer: University Health Alliance Commercial	$19.74

Bill DLS3ID Org ID, Ur, Presumptive, 3 Isolate

Facility

$86.00

Service Code	HCPCS 87088
Hospital Charge Code	12147775
Hospital Revenue Code	306
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$55.90
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: MDX Hawaii PPO	$83.42

Bill DLS3ID Org ID, Ur, Presumptive, 3 Isolate

Facility

$86.00

Service Code	HCPCS 87088
Hospital Charge Code	12147775
Hospital Revenue Code	306
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$43.00
Rate for Payer: AlohaCare Medicare	$43.00
Rate for Payer: Cash Price	$55.90
Rate for Payer: Cash Price	$55.90
Rate for Payer: Devoted Health Medicare	$47.30
Rate for Payer: Hawaii Medical Service Association ABD	$10.55
Rate for Payer: Hawaii Medical Service Association Commercial	$10.11
Rate for Payer: Hawaii Medical Service Association Medicare	$43.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.08
Rate for Payer: Hawaii Western Management Group Commercial	$8.09
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Humana Medicare	$43.00
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: Kaiser Permanente Medicare	$43.00
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: Ohana Health Plan Medicaid	$43.00
Rate for Payer: Ohana Health Plan Medicare	$43.00
Rate for Payer: UnitedHealthcare Medicaid	$10.55
Rate for Payer: UnitedHealthcare Medicare	$43.00
Rate for Payer: University Health Alliance Commercial	$19.74

Bill DLS4ID Org ID, Ur, Presumptive, 4 Isolate

Facility

$86.00

Service Code	HCPCS 87088
Hospital Charge Code	12138783
Hospital Revenue Code	306
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$55.90
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: MDX Hawaii PPO	$83.42

Bill DLS4ID Org ID, Ur, Presumptive, 4 Isolate

Facility

$86.00

Service Code	HCPCS 87088
Hospital Charge Code	12138783
Hospital Revenue Code	306
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$43.00
Rate for Payer: AlohaCare Medicare	$43.00
Rate for Payer: Cash Price	$55.90
Rate for Payer: Cash Price	$55.90
Rate for Payer: Devoted Health Medicare	$47.30
Rate for Payer: Hawaii Medical Service Association ABD	$10.55
Rate for Payer: Hawaii Medical Service Association Commercial	$10.11
Rate for Payer: Hawaii Medical Service Association Medicare	$43.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.08
Rate for Payer: Hawaii Western Management Group Commercial	$8.09
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Humana Medicare	$43.00
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: Kaiser Permanente Medicare	$43.00
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: Ohana Health Plan Medicaid	$43.00
Rate for Payer: Ohana Health Plan Medicare	$43.00
Rate for Payer: UnitedHealthcare Medicaid	$10.55
Rate for Payer: UnitedHealthcare Medicare	$43.00
Rate for Payer: University Health Alliance Commercial	$19.74

Know your out-of-pocket cost for care.

All Charges