Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

BINDER PELVIC

Facility

$963.00

Hospital Charge Code	8419560
Hospital Revenue Code	270
Min. Negotiated Rate	$481.50
Max. Negotiated Rate	$934.11
Rate for Payer: AlohaCare Medicaid	$481.50
Rate for Payer: AlohaCare Medicare	$481.50
Rate for Payer: Cash Price	$625.95
Rate for Payer: Devoted Health Medicare	$529.65
Rate for Payer: Hawaii Medical Service Association Medicare	$481.50
Rate for Payer: Hawaii Western Management Group Commercial	$914.85
Rate for Payer: Health Management Network Commercial	$818.55
Rate for Payer: Humana Medicare	$481.50
Rate for Payer: Kaiser Permanente Commercial	$866.70
Rate for Payer: Kaiser Permanente Medicaid	$491.13
Rate for Payer: Kaiser Permanente Medicare	$481.50
Rate for Payer: MDX Hawaii PPO	$934.11
Rate for Payer: Ohana Health Plan Medicaid	$481.50
Rate for Payer: Ohana Health Plan Medicare	$481.50
Rate for Payer: UnitedHealthcare Medicare	$481.50
Rate for Payer: University Health Alliance Commercial	$701.93

BINDER PELVIC

Facility

$963.00

Hospital Charge Code	8419560
Hospital Revenue Code	270
Min. Negotiated Rate	$818.55
Max. Negotiated Rate	$934.11
Rate for Payer: Cash Price	$625.95
Rate for Payer: Health Management Network Commercial	$818.55
Rate for Payer: Kaiser Permanente Commercial	$866.70
Rate for Payer: MDX Hawaii PPO	$934.11

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$51,450.93

Service Code	MSDRG 478
Min. Negotiated Rate	$51,450.93
Max. Negotiated Rate	$51,450.93
Rate for Payer: Hawaii Medical Service Association Commercial	$51,450.93

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$51,450.93

Service Code	MSDRG 477
Min. Negotiated Rate	$51,450.93
Max. Negotiated Rate	$51,450.93
Rate for Payer: Hawaii Medical Service Association Commercial	$51,450.93

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$51,450.93

Service Code	MSDRG 479
Min. Negotiated Rate	$51,450.93
Max. Negotiated Rate	$51,450.93
Rate for Payer: Hawaii Medical Service Association Commercial	$51,450.93

BIOPSY OF ANORECTAL WALL, ANAL APPROACH (EG, CONGENITAL MEGACOLON)

Facility

$5,655.00

Service Code	CPT 45100
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$672.48
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03

BiPAP/ CPAP INITIAL AND SUBSEQUENT CHARGE

Facility

$1,666.00

Service Code	HCPCS 94660
Hospital Charge Code	8243036
Hospital Revenue Code	410
Min. Negotiated Rate	$39.67
Max. Negotiated Rate	$1,616.02
Rate for Payer: AlohaCare Medicaid	$833.00
Rate for Payer: AlohaCare Medicare	$833.00
Rate for Payer: Cash Price	$1,082.90
Rate for Payer: Cash Price	$1,082.90
Rate for Payer: Devoted Health Medicare	$916.30
Rate for Payer: Hawaii Medical Service Association Commercial	$279.65
Rate for Payer: Hawaii Medical Service Association Medicare	$833.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,582.70
Rate for Payer: Health Management Network Commercial	$1,416.10
Rate for Payer: Humana Medicare	$833.00
Rate for Payer: Kaiser Permanente Commercial	$1,499.40
Rate for Payer: Kaiser Permanente Medicaid	$849.66
Rate for Payer: Kaiser Permanente Medicare	$833.00
Rate for Payer: MDX Hawaii PPO	$1,616.02
Rate for Payer: Ohana Health Plan Medicaid	$833.00
Rate for Payer: Ohana Health Plan Medicare	$833.00
Rate for Payer: UnitedHealthcare Medicaid	$39.67
Rate for Payer: UnitedHealthcare Medicare	$833.00
Rate for Payer: University Health Alliance Commercial	$1,214.35

BiPAP/ CPAP INITIAL AND SUBSEQUENT CHARGE

Facility

$1,666.00

Service Code	HCPCS 94660
Hospital Charge Code	8243036
Hospital Revenue Code	410
Min. Negotiated Rate	$1,416.10
Max. Negotiated Rate	$1,616.02
Rate for Payer: Cash Price	$1,082.90
Rate for Payer: Health Management Network Commercial	$1,416.10
Rate for Payer: Kaiser Permanente Commercial	$1,499.40
Rate for Payer: MDX Hawaii PPO	$1,616.02

bisacodyl 10 mg suppository [HHSC]

Facility

$3.00

Service Code	NDC 00904505860
Hospital Charge Code	2500114
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

bisacodyl 10 mg suppository [HHSC]

Facility

$3.00

Service Code	NDC 00904505860
Hospital Charge Code	2500114
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

bisacodyl 10 mg suppository [HHSC]

Facility

$3.00

Service Code	NDC 71399846002
Hospital Charge Code	2500114
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

bisacodyl 10 mg suppository [HHSC]

Facility

$3.00

Service Code	NDC 00574705050
Hospital Charge Code	2500114
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

bisacodyl 10 mg suppository [HHSC]

Facility

$3.00

Service Code	NDC 00574705050
Hospital Charge Code	2500114
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

bisacodyl 10 mg suppository [HHSC]

Facility

$3.00

Service Code	NDC 00574705012
Hospital Charge Code	2500114
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

bisacodyl 10 mg suppository [HHSC]

Facility

$3.00

Service Code	NDC 00574705012
Hospital Charge Code	2500114
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

bisacodyl 10 mg suppository [HHSC]

Facility

$3.00

Service Code	NDC 71399846002
Hospital Charge Code	2500114
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

bisacodyl EC 5mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 00904640761
Hospital Charge Code	2500115
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

bisacodyl EC 5mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 00904640761
Hospital Charge Code	2500115
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

Bladder Scan

Facility

$356.00

Service Code	HCPCS 51798
Hospital Charge Code	649589
Hospital Revenue Code	761
Min. Negotiated Rate	$302.60
Max. Negotiated Rate	$345.32
Rate for Payer: Cash Price	$231.40
Rate for Payer: Health Management Network Commercial	$302.60
Rate for Payer: Kaiser Permanente Commercial	$320.40
Rate for Payer: MDX Hawaii PPO	$345.32

Bladder Scan

Facility

$356.00

Service Code	HCPCS 51798
Hospital Charge Code	649589
Hospital Revenue Code	761
Min. Negotiated Rate	$15.83
Max. Negotiated Rate	$2,389.00
Rate for Payer: AlohaCare Medicaid	$178.00
Rate for Payer: AlohaCare Medicare	$178.00
Rate for Payer: Cash Price	$231.40
Rate for Payer: Cash Price	$231.40
Rate for Payer: Cash Price	$231.40
Rate for Payer: Devoted Health Medicare	$195.80
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$178.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$338.20
Rate for Payer: Health Management Network Commercial	$302.60
Rate for Payer: Humana Medicare	$178.00
Rate for Payer: Kaiser Permanente Commercial	$320.40
Rate for Payer: Kaiser Permanente Medicaid	$181.56
Rate for Payer: Kaiser Permanente Medicare	$178.00
Rate for Payer: MDX Hawaii PPO	$345.32
Rate for Payer: Ohana Health Plan Medicaid	$178.00
Rate for Payer: Ohana Health Plan Medicare	$178.00
Rate for Payer: UnitedHealthcare Medicaid	$15.83
Rate for Payer: UnitedHealthcare Medicare	$178.00
Rate for Payer: University Health Alliance Commercial	$259.49

BLAKE DRAIN 15FR ROUND

Facility

$296.00

Hospital Charge Code	8479431
Hospital Revenue Code	272
Min. Negotiated Rate	$251.60
Max. Negotiated Rate	$287.12
Rate for Payer: Cash Price	$192.40
Rate for Payer: Health Management Network Commercial	$251.60
Rate for Payer: Kaiser Permanente Commercial	$266.40
Rate for Payer: MDX Hawaii PPO	$287.12

BLAKE DRAIN 15FR ROUND

Facility

$296.00

Hospital Charge Code	8479431
Hospital Revenue Code	272
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$287.12
Rate for Payer: AlohaCare Medicaid	$148.00
Rate for Payer: AlohaCare Medicare	$148.00
Rate for Payer: Cash Price	$192.40
Rate for Payer: Devoted Health Medicare	$162.80
Rate for Payer: Hawaii Medical Service Association Medicare	$148.00
Rate for Payer: Hawaii Western Management Group Commercial	$281.20
Rate for Payer: Health Management Network Commercial	$251.60
Rate for Payer: Humana Medicare	$148.00
Rate for Payer: Kaiser Permanente Commercial	$266.40
Rate for Payer: Kaiser Permanente Medicaid	$150.96
Rate for Payer: Kaiser Permanente Medicare	$148.00
Rate for Payer: MDX Hawaii PPO	$287.12
Rate for Payer: Ohana Health Plan Medicaid	$148.00
Rate for Payer: Ohana Health Plan Medicare	$148.00
Rate for Payer: UnitedHealthcare Medicare	$148.00
Rate for Payer: University Health Alliance Commercial	$215.75

BLANKET BAIR HUGGER LOWER

Facility

$40.00

Hospital Charge Code	9916480
Hospital Revenue Code	272
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$38.80
Rate for Payer: Cash Price	$26.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: MDX Hawaii PPO	$38.80

BLANKET BAIR HUGGER LOWER

Facility

$40.00

Hospital Charge Code	9916480
Hospital Revenue Code	272
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$38.80
Rate for Payer: AlohaCare Medicaid	$20.00
Rate for Payer: AlohaCare Medicare	$20.00
Rate for Payer: Cash Price	$26.00
Rate for Payer: Devoted Health Medicare	$22.00
Rate for Payer: Hawaii Medical Service Association Medicare	$20.00
Rate for Payer: Hawaii Western Management Group Commercial	$38.00
Rate for Payer: Health Management Network Commercial	$34.00
Rate for Payer: Humana Medicare	$20.00
Rate for Payer: Kaiser Permanente Commercial	$36.00
Rate for Payer: Kaiser Permanente Medicaid	$20.40
Rate for Payer: Kaiser Permanente Medicare	$20.00
Rate for Payer: MDX Hawaii PPO	$38.80
Rate for Payer: Ohana Health Plan Medicaid	$20.00
Rate for Payer: Ohana Health Plan Medicare	$20.00
Rate for Payer: UnitedHealthcare Medicare	$20.00
Rate for Payer: University Health Alliance Commercial	$29.16

BLANKET, COOLING

Facility

$63.00

Hospital Charge Code	8274470
Hospital Revenue Code	271
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$61.11
Rate for Payer: Cash Price	$40.95
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: MDX Hawaii PPO	$61.11

Know your out-of-pocket cost for care.

All Charges