Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Brain Natriuretic Peptide BNP FSI

Facility

$878.00

Service Code	HCPCS 83880
Hospital Charge Code	8117866
Hospital Revenue Code	301
Min. Negotiated Rate	$28.46
Max. Negotiated Rate	$851.66
Rate for Payer: AlohaCare Medicaid	$439.00
Rate for Payer: AlohaCare Medicare	$439.00
Rate for Payer: Cash Price	$570.70
Rate for Payer: Cash Price	$570.70
Rate for Payer: Devoted Health Medicare	$482.90
Rate for Payer: Hawaii Medical Service Association ABD	$28.46
Rate for Payer: Hawaii Medical Service Association Commercial	$49.08
Rate for Payer: Hawaii Medical Service Association Medicare	$439.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$46.89
Rate for Payer: Hawaii Western Management Group Commercial	$39.26
Rate for Payer: Health Management Network Commercial	$746.30
Rate for Payer: Humana Medicare	$439.00
Rate for Payer: Kaiser Permanente Commercial	$790.20
Rate for Payer: Kaiser Permanente Medicaid	$447.78
Rate for Payer: Kaiser Permanente Medicare	$439.00
Rate for Payer: MDX Hawaii PPO	$851.66
Rate for Payer: Ohana Health Plan Medicaid	$439.00
Rate for Payer: Ohana Health Plan Medicare	$439.00
Rate for Payer: UnitedHealthcare Medicaid	$28.46
Rate for Payer: UnitedHealthcare Medicare	$439.00
Rate for Payer: University Health Alliance Commercial	$87.75

Brain Natriuretic Peptide BNP FSI

Facility

$878.00

Service Code	HCPCS 83880
Hospital Charge Code	8117866
Hospital Revenue Code	301
Min. Negotiated Rate	$746.30
Max. Negotiated Rate	$851.66
Rate for Payer: Cash Price	$570.70
Rate for Payer: Health Management Network Commercial	$746.30
Rate for Payer: Kaiser Permanente Commercial	$790.20
Rate for Payer: MDX Hawaii PPO	$851.66

BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC

Facility

$27,076.75

Service Code	MSDRG 584
Min. Negotiated Rate	$27,076.75
Max. Negotiated Rate	$27,076.75
Rate for Payer: Hawaii Medical Service Association Commercial	$27,076.75

BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC

Facility

$26,209.89

Service Code	MSDRG 585
Min. Negotiated Rate	$26,209.89
Max. Negotiated Rate	$26,209.89
Rate for Payer: Hawaii Medical Service Association Commercial	$26,209.89

BREAST PUMP CHARGE

Facility

$181.00

Service Code	HCPCS E0604
Hospital Charge Code	8280923
Hospital Revenue Code	271
Min. Negotiated Rate	$153.85
Max. Negotiated Rate	$175.57
Rate for Payer: Cash Price	$117.65
Rate for Payer: Health Management Network Commercial	$153.85
Rate for Payer: Kaiser Permanente Commercial	$162.90
Rate for Payer: MDX Hawaii PPO	$175.57

BREAST PUMP CHARGE

Facility

$181.00

Service Code	HCPCS E0604
Hospital Charge Code	8280923
Hospital Revenue Code	271
Min. Negotiated Rate	$90.50
Max. Negotiated Rate	$175.57
Rate for Payer: AlohaCare Medicaid	$90.50
Rate for Payer: AlohaCare Medicare	$90.50
Rate for Payer: Cash Price	$117.65
Rate for Payer: Devoted Health Medicare	$99.55
Rate for Payer: Hawaii Medical Service Association Medicare	$90.50
Rate for Payer: Hawaii Western Management Group Commercial	$171.95
Rate for Payer: Health Management Network Commercial	$153.85
Rate for Payer: Humana Medicare	$90.50
Rate for Payer: Kaiser Permanente Commercial	$162.90
Rate for Payer: Kaiser Permanente Medicaid	$92.31
Rate for Payer: Kaiser Permanente Medicare	$90.50
Rate for Payer: MDX Hawaii PPO	$175.57
Rate for Payer: Ohana Health Plan Medicaid	$90.50
Rate for Payer: Ohana Health Plan Medicare	$90.50
Rate for Payer: UnitedHealthcare Medicare	$90.50
Rate for Payer: University Health Alliance Commercial	$131.93

BRIDGE PLATE, STRAIGHT, 2.0MM, 6 HOLE

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	12971938
Hospital Revenue Code	278
Min. Negotiated Rate	$731.00
Max. Negotiated Rate	$1,418.14
Rate for Payer: AlohaCare Medicaid	$731.00
Rate for Payer: AlohaCare Medicare	$731.00
Rate for Payer: Cash Price	$950.30
Rate for Payer: Devoted Health Medicare	$804.10
Rate for Payer: Hawaii Medical Service Association Medicare	$731.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Humana Medicare	$731.00
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: Kaiser Permanente Medicaid	$745.62
Rate for Payer: Kaiser Permanente Medicare	$731.00
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: Ohana Health Plan Medicaid	$731.00
Rate for Payer: Ohana Health Plan Medicare	$731.00
Rate for Payer: UnitedHealthcare Medicare	$731.00
Rate for Payer: University Health Alliance Commercial	$818.72

BRIDGE PLATE, STRAIGHT, 2.0MM, 6 HOLE

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	12971938
Hospital Revenue Code	278
Min. Negotiated Rate	$818.72
Max. Negotiated Rate	$1,418.14
Rate for Payer: Cash Price	$950.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: University Health Alliance Commercial	$818.72

BRIDGE PLATE, STRAIGHT, 2.4MM, 6 HOLE

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	12970973
Hospital Revenue Code	278
Min. Negotiated Rate	$818.72
Max. Negotiated Rate	$1,418.14
Rate for Payer: Cash Price	$950.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: University Health Alliance Commercial	$818.72

BRIDGE PLATE, STRAIGHT, 2.4MM, 6 HOLE

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	12970973
Hospital Revenue Code	278
Min. Negotiated Rate	$731.00
Max. Negotiated Rate	$1,418.14
Rate for Payer: AlohaCare Medicaid	$731.00
Rate for Payer: AlohaCare Medicare	$731.00
Rate for Payer: Cash Price	$950.30
Rate for Payer: Devoted Health Medicare	$804.10
Rate for Payer: Hawaii Medical Service Association Medicare	$731.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Humana Medicare	$731.00
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: Kaiser Permanente Medicaid	$745.62
Rate for Payer: Kaiser Permanente Medicare	$731.00
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: Ohana Health Plan Medicaid	$731.00
Rate for Payer: Ohana Health Plan Medicare	$731.00
Rate for Payer: UnitedHealthcare Medicare	$731.00
Rate for Payer: University Health Alliance Commercial	$818.72

brimonidine 0.15% ophth soln 5 mL [HHSC]

Facility

$642.61

Service Code	NDC 61314014405
Hospital Charge Code	2501083
Hospital Revenue Code	250
Min. Negotiated Rate	$546.22
Max. Negotiated Rate	$623.33
Rate for Payer: Cash Price	$417.70
Rate for Payer: Health Management Network Commercial	$546.22
Rate for Payer: Kaiser Permanente Commercial	$578.35
Rate for Payer: MDX Hawaii PPO	$623.33

brimonidine 0.15% ophth soln 5 mL [HHSC]

Facility

$642.61

Service Code	NDC 60505056401
Hospital Charge Code	2501083
Hospital Revenue Code	250
Min. Negotiated Rate	$546.22
Max. Negotiated Rate	$623.33
Rate for Payer: Cash Price	$417.70
Rate for Payer: Health Management Network Commercial	$546.22
Rate for Payer: Kaiser Permanente Commercial	$578.35
Rate for Payer: MDX Hawaii PPO	$623.33

brimonidine 0.15% ophth soln 5 mL [HHSC]

Facility

$642.61

Service Code	NDC 60505056401
Hospital Charge Code	2501083
Hospital Revenue Code	250
Min. Negotiated Rate	$321.31
Max. Negotiated Rate	$623.33
Rate for Payer: AlohaCare Medicaid	$321.31
Rate for Payer: AlohaCare Medicare	$321.31
Rate for Payer: Cash Price	$417.70
Rate for Payer: Devoted Health Medicare	$353.44
Rate for Payer: Hawaii Medical Service Association Medicare	$321.31
Rate for Payer: Hawaii Western Management Group Commercial	$610.48
Rate for Payer: Health Management Network Commercial	$546.22
Rate for Payer: Humana Medicare	$321.31
Rate for Payer: Kaiser Permanente Commercial	$578.35
Rate for Payer: Kaiser Permanente Medicaid	$327.73
Rate for Payer: Kaiser Permanente Medicare	$321.31
Rate for Payer: MDX Hawaii PPO	$623.33
Rate for Payer: Ohana Health Plan Medicaid	$321.31
Rate for Payer: Ohana Health Plan Medicare	$321.31
Rate for Payer: UnitedHealthcare Medicaid	$385.57
Rate for Payer: UnitedHealthcare Medicare	$321.31
Rate for Payer: University Health Alliance Commercial	$468.40

brimonidine 0.15% ophth soln 5 mL [HHSC]

Facility

$642.61

Service Code	NDC 61314014405
Hospital Charge Code	2501083
Hospital Revenue Code	250
Min. Negotiated Rate	$321.31
Max. Negotiated Rate	$623.33
Rate for Payer: AlohaCare Medicaid	$321.31
Rate for Payer: AlohaCare Medicare	$321.31
Rate for Payer: Cash Price	$417.70
Rate for Payer: Devoted Health Medicare	$353.44
Rate for Payer: Hawaii Medical Service Association Medicare	$321.31
Rate for Payer: Hawaii Western Management Group Commercial	$610.48
Rate for Payer: Health Management Network Commercial	$546.22
Rate for Payer: Humana Medicare	$321.31
Rate for Payer: Kaiser Permanente Commercial	$578.35
Rate for Payer: Kaiser Permanente Medicaid	$327.73
Rate for Payer: Kaiser Permanente Medicare	$321.31
Rate for Payer: MDX Hawaii PPO	$623.33
Rate for Payer: Ohana Health Plan Medicaid	$321.31
Rate for Payer: Ohana Health Plan Medicare	$321.31
Rate for Payer: UnitedHealthcare Medicaid	$385.57
Rate for Payer: UnitedHealthcare Medicare	$321.31
Rate for Payer: University Health Alliance Commercial	$468.40

BRONCHITIS AND ASTHMA WITH CC/MCC

Facility

$19,147.50

Service Code	MSDRG 202
Min. Negotiated Rate	$19,147.50
Max. Negotiated Rate	$19,147.50
Rate for Payer: Hawaii Medical Service Association Commercial	$19,147.50

BRONCHITIS AND ASTHMA WITHOUT CC/MCC

Facility

$14,558.22

Service Code	MSDRG 203
Min. Negotiated Rate	$14,558.22
Max. Negotiated Rate	$14,558.22
Rate for Payer: Hawaii Medical Service Association Commercial	$14,558.22

BRONCHOSPASM EVALUATION CHARGE

Facility

$664.00

Service Code	HCPCS 94060
Hospital Charge Code	8243039
Hospital Revenue Code	460
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$644.08
Rate for Payer: AlohaCare Medicaid	$332.00
Rate for Payer: AlohaCare Medicare	$332.00
Rate for Payer: Cash Price	$431.60
Rate for Payer: Cash Price	$431.60
Rate for Payer: Devoted Health Medicare	$365.20
Rate for Payer: Hawaii Medical Service Association ABD	$31.20
Rate for Payer: Hawaii Medical Service Association Commercial	$476.55
Rate for Payer: Hawaii Medical Service Association Medicare	$332.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$32.76
Rate for Payer: Hawaii Western Management Group Commercial	$630.80
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: Humana Medicare	$332.00
Rate for Payer: Kaiser Permanente Commercial	$597.60
Rate for Payer: Kaiser Permanente Medicaid	$338.64
Rate for Payer: Kaiser Permanente Medicare	$332.00
Rate for Payer: MDX Hawaii PPO	$644.08
Rate for Payer: Ohana Health Plan Medicaid	$332.00
Rate for Payer: Ohana Health Plan Medicare	$332.00
Rate for Payer: UnitedHealthcare Medicaid	$31.20
Rate for Payer: UnitedHealthcare Medicare	$332.00
Rate for Payer: University Health Alliance Commercial	$483.99

BRONCHOSPASM EVALUATION CHARGE

Facility

$664.00

Service Code	HCPCS 94060
Hospital Charge Code	8243039
Hospital Revenue Code	460
Min. Negotiated Rate	$564.40
Max. Negotiated Rate	$644.08
Rate for Payer: Cash Price	$431.60
Rate for Payer: Health Management Network Commercial	$564.40
Rate for Payer: Kaiser Permanente Commercial	$597.60
Rate for Payer: MDX Hawaii PPO	$644.08

BSS 500 ML Bag

Facility

$119.00

Hospital Charge Code	8527570
Hospital Revenue Code	272
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$115.43
Rate for Payer: AlohaCare Medicaid	$59.50
Rate for Payer: AlohaCare Medicare	$59.50
Rate for Payer: Cash Price	$77.35
Rate for Payer: Devoted Health Medicare	$65.45
Rate for Payer: Hawaii Medical Service Association Medicare	$59.50
Rate for Payer: Hawaii Western Management Group Commercial	$113.05
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Humana Medicare	$59.50
Rate for Payer: Kaiser Permanente Commercial	$107.10
Rate for Payer: Kaiser Permanente Medicaid	$60.69
Rate for Payer: Kaiser Permanente Medicare	$59.50
Rate for Payer: MDX Hawaii PPO	$115.43
Rate for Payer: Ohana Health Plan Medicaid	$59.50
Rate for Payer: Ohana Health Plan Medicare	$59.50
Rate for Payer: UnitedHealthcare Medicare	$59.50
Rate for Payer: University Health Alliance Commercial	$86.74

BSS 500 ML Bag

Facility

$119.00

Hospital Charge Code	8527570
Hospital Revenue Code	272
Min. Negotiated Rate	$101.15
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$77.35
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

BSS eye solution 15ml [HHSC]

Facility

$51.93

Service Code	NDC 00065079515
Hospital Charge Code	2500615
Hospital Revenue Code	250
Min. Negotiated Rate	$25.96
Max. Negotiated Rate	$50.37
Rate for Payer: AlohaCare Medicaid	$25.96
Rate for Payer: AlohaCare Medicare	$25.96
Rate for Payer: Cash Price	$33.75
Rate for Payer: Devoted Health Medicare	$28.56
Rate for Payer: Hawaii Medical Service Association Medicare	$25.96
Rate for Payer: Hawaii Western Management Group Commercial	$49.33
Rate for Payer: Health Management Network Commercial	$44.14
Rate for Payer: Humana Medicare	$25.96
Rate for Payer: Kaiser Permanente Commercial	$46.74
Rate for Payer: Kaiser Permanente Medicaid	$26.48
Rate for Payer: Kaiser Permanente Medicare	$25.96
Rate for Payer: MDX Hawaii PPO	$50.37
Rate for Payer: Ohana Health Plan Medicaid	$25.96
Rate for Payer: Ohana Health Plan Medicare	$25.96
Rate for Payer: UnitedHealthcare Medicaid	$31.16
Rate for Payer: UnitedHealthcare Medicare	$25.96
Rate for Payer: University Health Alliance Commercial	$37.85

BSS eye solution 15ml [HHSC]

Facility

$51.93

Service Code	NDC 00065079515
Hospital Charge Code	2500615
Hospital Revenue Code	250
Min. Negotiated Rate	$44.14
Max. Negotiated Rate	$50.37
Rate for Payer: Cash Price	$33.75
Rate for Payer: Health Management Network Commercial	$44.14
Rate for Payer: Kaiser Permanente Commercial	$46.74
Rate for Payer: MDX Hawaii PPO	$50.37

BUCKET CAST PLASTIC EA

Facility

$43.00

Hospital Charge Code	12954881
Hospital Revenue Code	272
Min. Negotiated Rate	$21.50
Max. Negotiated Rate	$41.71
Rate for Payer: AlohaCare Medicaid	$21.50
Rate for Payer: AlohaCare Medicare	$21.50
Rate for Payer: Cash Price	$27.95
Rate for Payer: Devoted Health Medicare	$23.65
Rate for Payer: Hawaii Medical Service Association Medicare	$21.50
Rate for Payer: Hawaii Western Management Group Commercial	$40.85
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Humana Medicare	$21.50
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: Kaiser Permanente Medicaid	$21.93
Rate for Payer: Kaiser Permanente Medicare	$21.50
Rate for Payer: MDX Hawaii PPO	$41.71
Rate for Payer: Ohana Health Plan Medicaid	$21.50
Rate for Payer: Ohana Health Plan Medicare	$21.50
Rate for Payer: UnitedHealthcare Medicare	$21.50
Rate for Payer: University Health Alliance Commercial	$31.34

BUCKET CAST PLASTIC EA

Facility

$43.00

Hospital Charge Code	12954881
Hospital Revenue Code	272
Min. Negotiated Rate	$36.55
Max. Negotiated Rate	$41.71
Rate for Payer: Cash Price	$27.95
Rate for Payer: Health Management Network Commercial	$36.55
Rate for Payer: Kaiser Permanente Commercial	$38.70
Rate for Payer: MDX Hawaii PPO	$41.71

budesonide 0.5 mg/2 mL neb susp [HHSC]

Facility

$64.46

Service Code	HCPCS J7626
Hospital Charge Code	2500117
Hospital Revenue Code	636
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$62.53
Rate for Payer: AlohaCare Medicaid	$32.23
Rate for Payer: AlohaCare Medicaid	$32.48
Rate for Payer: AlohaCare Medicaid	$32.41
Rate for Payer: AlohaCare Medicare	$32.41
Rate for Payer: AlohaCare Medicare	$32.23
Rate for Payer: AlohaCare Medicare	$32.48
Rate for Payer: Cash Price	$42.13
Rate for Payer: Cash Price	$42.23
Rate for Payer: Cash Price	$42.13
Rate for Payer: Cash Price	$41.90
Rate for Payer: Cash Price	$41.90
Rate for Payer: Cash Price	$42.23
Rate for Payer: Devoted Health Medicare	$35.45
Rate for Payer: Devoted Health Medicare	$35.73
Rate for Payer: Devoted Health Medicare	$35.65
Rate for Payer: Hawaii Medical Service Association ABD	$1.28
Rate for Payer: Hawaii Medical Service Association ABD	$1.28
Rate for Payer: Hawaii Medical Service Association ABD	$1.28
Rate for Payer: Hawaii Medical Service Association Medicare	$32.23
Rate for Payer: Hawaii Medical Service Association Medicare	$32.48
Rate for Payer: Hawaii Medical Service Association Medicare	$32.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.28
Rate for Payer: Hawaii Western Management Group Commercial	$61.58
Rate for Payer: Hawaii Western Management Group Commercial	$61.24
Rate for Payer: Hawaii Western Management Group Commercial	$61.72
Rate for Payer: Health Management Network Commercial	$55.22
Rate for Payer: Health Management Network Commercial	$54.79
Rate for Payer: Health Management Network Commercial	$55.10
Rate for Payer: Humana Medicare	$32.23
Rate for Payer: Humana Medicare	$32.41
Rate for Payer: Humana Medicare	$32.48
Rate for Payer: Kaiser Permanente Commercial	$58.01
Rate for Payer: Kaiser Permanente Commercial	$58.34
Rate for Payer: Kaiser Permanente Commercial	$58.47
Rate for Payer: Kaiser Permanente Medicaid	$33.13
Rate for Payer: Kaiser Permanente Medicaid	$33.06
Rate for Payer: Kaiser Permanente Medicaid	$32.87
Rate for Payer: Kaiser Permanente Medicare	$32.23
Rate for Payer: Kaiser Permanente Medicare	$32.41
Rate for Payer: Kaiser Permanente Medicare	$32.48
Rate for Payer: MDX Hawaii PPO	$63.02
Rate for Payer: MDX Hawaii PPO	$62.88
Rate for Payer: MDX Hawaii PPO	$62.53
Rate for Payer: Ohana Health Plan Medicaid	$32.41
Rate for Payer: Ohana Health Plan Medicaid	$32.23
Rate for Payer: Ohana Health Plan Medicaid	$32.48
Rate for Payer: Ohana Health Plan Medicare	$32.41
Rate for Payer: Ohana Health Plan Medicare	$32.23
Rate for Payer: Ohana Health Plan Medicare	$32.48
Rate for Payer: UnitedHealthcare Medicaid	$38.89
Rate for Payer: UnitedHealthcare Medicaid	$38.68
Rate for Payer: UnitedHealthcare Medicaid	$38.98
Rate for Payer: UnitedHealthcare Medicare	$32.41
Rate for Payer: UnitedHealthcare Medicare	$32.23
Rate for Payer: UnitedHealthcare Medicare	$32.48
Rate for Payer: University Health Alliance Commercial	$46.98
Rate for Payer: University Health Alliance Commercial	$47.25
Rate for Payer: University Health Alliance Commercial	$47.36

Know your out-of-pocket cost for care.

All Charges