Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Cardiac Risk Panel FSI

Facility

$120.00

Service Code	HCPCS 83718
Hospital Charge Code	8404415
Hospital Revenue Code	301
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$116.40
Rate for Payer: AlohaCare Medicaid	$60.00
Rate for Payer: AlohaCare Medicare	$60.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Cash Price	$78.00
Rate for Payer: Devoted Health Medicare	$66.00
Rate for Payer: Hawaii Medical Service Association ABD	$11.31
Rate for Payer: Hawaii Medical Service Association Commercial	$10.24
Rate for Payer: Hawaii Medical Service Association Medicare	$60.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.88
Rate for Payer: Hawaii Western Management Group Commercial	$8.19
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Humana Medicare	$60.00
Rate for Payer: Kaiser Permanente Commercial	$108.00
Rate for Payer: Kaiser Permanente Medicaid	$61.20
Rate for Payer: Kaiser Permanente Medicare	$60.00
Rate for Payer: MDX Hawaii PPO	$116.40
Rate for Payer: Ohana Health Plan Medicaid	$60.00
Rate for Payer: Ohana Health Plan Medicare	$60.00
Rate for Payer: UnitedHealthcare Medicaid	$11.31
Rate for Payer: UnitedHealthcare Medicare	$60.00
Rate for Payer: University Health Alliance Commercial	$21.16

Cardiac Risk Panel FSI

Facility

$120.00

Service Code	HCPCS 83718
Hospital Charge Code	8404415
Hospital Revenue Code	301
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$116.40
Rate for Payer: Cash Price	$78.00
Rate for Payer: Health Management Network Commercial	$102.00
Rate for Payer: Kaiser Permanente Commercial	$108.00
Rate for Payer: MDX Hawaii PPO	$116.40

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC

Facility

$207,996.37

Service Code	MSDRG 217
Min. Negotiated Rate	$207,996.37
Max. Negotiated Rate	$207,996.37
Rate for Payer: Hawaii Medical Service Association Commercial	$207,996.37

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$207,996.37

Service Code	MSDRG 216
Min. Negotiated Rate	$207,996.37
Max. Negotiated Rate	$207,996.37
Rate for Payer: Hawaii Medical Service Association Commercial	$207,996.37

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$207,996.37

Service Code	MSDRG 218
Min. Negotiated Rate	$207,996.37
Max. Negotiated Rate	$207,996.37
Rate for Payer: Hawaii Medical Service Association Commercial	$207,996.37

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC

Facility

$135,281.78

Service Code	MSDRG 220
Min. Negotiated Rate	$135,281.78
Max. Negotiated Rate	$135,281.78
Rate for Payer: Hawaii Medical Service Association Commercial	$135,281.78

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC

Facility

$135,281.78

Service Code	MSDRG 219
Min. Negotiated Rate	$135,281.78
Max. Negotiated Rate	$135,281.78
Rate for Payer: Hawaii Medical Service Association Commercial	$135,281.78

CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC

Facility

$135,281.78

Service Code	MSDRG 221
Min. Negotiated Rate	$135,281.78
Max. Negotiated Rate	$135,281.78
Rate for Payer: Hawaii Medical Service Association Commercial	$135,281.78

Cardiolipin Ab, IgA FSI

Facility

$174.00

Service Code	HCPCS 86147
Hospital Charge Code	12386986
Hospital Revenue Code	302
Min. Negotiated Rate	$147.90
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$113.10
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: MDX Hawaii PPO	$168.78

Cardiolipin Ab, IgA FSI

Facility

$174.00

Service Code	HCPCS 86147
Hospital Charge Code	12386986
Hospital Revenue Code	302
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$168.78
Rate for Payer: AlohaCare Medicaid	$87.00
Rate for Payer: AlohaCare Medicare	$87.00
Rate for Payer: Cash Price	$113.10
Rate for Payer: Cash Price	$113.10
Rate for Payer: Devoted Health Medicare	$95.70
Rate for Payer: Hawaii Medical Service Association ABD	$35.16
Rate for Payer: Hawaii Medical Service Association Commercial	$31.81
Rate for Payer: Hawaii Medical Service Association Medicare	$87.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.92
Rate for Payer: Hawaii Western Management Group Commercial	$25.45
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Humana Medicare	$87.00
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: Kaiser Permanente Medicaid	$88.74
Rate for Payer: Kaiser Permanente Medicare	$87.00
Rate for Payer: MDX Hawaii PPO	$168.78
Rate for Payer: Ohana Health Plan Medicaid	$87.00
Rate for Payer: Ohana Health Plan Medicare	$87.00
Rate for Payer: UnitedHealthcare Medicaid	$35.16
Rate for Payer: UnitedHealthcare Medicare	$87.00
Rate for Payer: University Health Alliance Commercial	$65.75

Cardiolipin Ab, IgG

Facility

$142.00

Service Code	HCPCS 86147
Hospital Charge Code	12528226
Hospital Revenue Code	302
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$92.30
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: MDX Hawaii PPO	$137.74

Cardiolipin Ab, IgG

Facility

$142.00

Service Code	HCPCS 86147
Hospital Charge Code	12528226
Hospital Revenue Code	302
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$71.00
Rate for Payer: AlohaCare Medicare	$71.00
Rate for Payer: Cash Price	$92.30
Rate for Payer: Cash Price	$92.30
Rate for Payer: Devoted Health Medicare	$78.10
Rate for Payer: Hawaii Medical Service Association ABD	$35.16
Rate for Payer: Hawaii Medical Service Association Commercial	$31.81
Rate for Payer: Hawaii Medical Service Association Medicare	$71.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.92
Rate for Payer: Hawaii Western Management Group Commercial	$25.45
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$71.00
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$71.00
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$71.00
Rate for Payer: Ohana Health Plan Medicare	$71.00
Rate for Payer: UnitedHealthcare Medicaid	$35.16
Rate for Payer: UnitedHealthcare Medicare	$71.00
Rate for Payer: University Health Alliance Commercial	$65.75

Cardiolipin Ab, IgG FSI

Facility

$174.00

Service Code	HCPCS 86147
Hospital Charge Code	12333004
Hospital Revenue Code	302
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$168.78
Rate for Payer: AlohaCare Medicaid	$87.00
Rate for Payer: AlohaCare Medicare	$87.00
Rate for Payer: Cash Price	$113.10
Rate for Payer: Cash Price	$113.10
Rate for Payer: Devoted Health Medicare	$95.70
Rate for Payer: Hawaii Medical Service Association ABD	$35.16
Rate for Payer: Hawaii Medical Service Association Commercial	$31.81
Rate for Payer: Hawaii Medical Service Association Medicare	$87.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.92
Rate for Payer: Hawaii Western Management Group Commercial	$25.45
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Humana Medicare	$87.00
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: Kaiser Permanente Medicaid	$88.74
Rate for Payer: Kaiser Permanente Medicare	$87.00
Rate for Payer: MDX Hawaii PPO	$168.78
Rate for Payer: Ohana Health Plan Medicaid	$87.00
Rate for Payer: Ohana Health Plan Medicare	$87.00
Rate for Payer: UnitedHealthcare Medicaid	$35.16
Rate for Payer: UnitedHealthcare Medicare	$87.00
Rate for Payer: University Health Alliance Commercial	$65.75

Cardiolipin Ab, IgG FSI

Facility

$174.00

Service Code	HCPCS 86147
Hospital Charge Code	12333004
Hospital Revenue Code	302
Min. Negotiated Rate	$147.90
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$113.10
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: MDX Hawaii PPO	$168.78

Cardiolipin Ab, IgM

Facility

$142.00

Service Code	HCPCS 86147
Hospital Charge Code	12516676
Hospital Revenue Code	302
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$92.30
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: MDX Hawaii PPO	$137.74

Cardiolipin Ab, IgM

Facility

$142.00

Service Code	HCPCS 86147
Hospital Charge Code	12516676
Hospital Revenue Code	302
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$71.00
Rate for Payer: AlohaCare Medicare	$71.00
Rate for Payer: Cash Price	$92.30
Rate for Payer: Cash Price	$92.30
Rate for Payer: Devoted Health Medicare	$78.10
Rate for Payer: Hawaii Medical Service Association ABD	$35.16
Rate for Payer: Hawaii Medical Service Association Commercial	$31.81
Rate for Payer: Hawaii Medical Service Association Medicare	$71.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.92
Rate for Payer: Hawaii Western Management Group Commercial	$25.45
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$71.00
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$71.00
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$71.00
Rate for Payer: Ohana Health Plan Medicare	$71.00
Rate for Payer: UnitedHealthcare Medicaid	$35.16
Rate for Payer: UnitedHealthcare Medicare	$71.00
Rate for Payer: University Health Alliance Commercial	$65.75

Cardiolipin Ab, IgM FSI

Facility

$142.00

Service Code	HCPCS 86147
Hospital Charge Code	12478234
Hospital Revenue Code	302
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$137.74
Rate for Payer: Cash Price	$92.30
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: MDX Hawaii PPO	$137.74

Cardiolipin Ab, IgM FSI

Facility

$142.00

Service Code	HCPCS 86147
Hospital Charge Code	12478234
Hospital Revenue Code	302
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$137.74
Rate for Payer: AlohaCare Medicaid	$71.00
Rate for Payer: AlohaCare Medicare	$71.00
Rate for Payer: Cash Price	$92.30
Rate for Payer: Cash Price	$92.30
Rate for Payer: Devoted Health Medicare	$78.10
Rate for Payer: Hawaii Medical Service Association ABD	$35.16
Rate for Payer: Hawaii Medical Service Association Commercial	$31.81
Rate for Payer: Hawaii Medical Service Association Medicare	$71.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.92
Rate for Payer: Hawaii Western Management Group Commercial	$25.45
Rate for Payer: Health Management Network Commercial	$120.70
Rate for Payer: Humana Medicare	$71.00
Rate for Payer: Kaiser Permanente Commercial	$127.80
Rate for Payer: Kaiser Permanente Medicaid	$72.42
Rate for Payer: Kaiser Permanente Medicare	$71.00
Rate for Payer: MDX Hawaii PPO	$137.74
Rate for Payer: Ohana Health Plan Medicaid	$71.00
Rate for Payer: Ohana Health Plan Medicare	$71.00
Rate for Payer: UnitedHealthcare Medicaid	$35.16
Rate for Payer: UnitedHealthcare Medicare	$71.00
Rate for Payer: University Health Alliance Commercial	$65.75

Cardiopulmonary Exercise Test

Facility

$188.00

Service Code	HCPCS 94621
Hospital Charge Code	10856784
Hospital Revenue Code	976
Min. Negotiated Rate	$159.80
Max. Negotiated Rate	$182.36
Rate for Payer: Cash Price	$122.20
Rate for Payer: Health Management Network Commercial	$159.80
Rate for Payer: Kaiser Permanente Commercial	$169.20
Rate for Payer: MDX Hawaii PPO	$182.36

Cardiopulmonary Exercise Test

Facility

$188.00

Service Code	HCPCS 94621
Hospital Charge Code	10856784
Hospital Revenue Code	976
Min. Negotiated Rate	$46.54
Max. Negotiated Rate	$476.55
Rate for Payer: AlohaCare Medicaid	$94.00
Rate for Payer: AlohaCare Medicare	$94.00
Rate for Payer: Cash Price	$122.20
Rate for Payer: Cash Price	$122.20
Rate for Payer: Devoted Health Medicare	$103.40
Rate for Payer: Hawaii Medical Service Association ABD	$46.54
Rate for Payer: Hawaii Medical Service Association Commercial	$476.55
Rate for Payer: Hawaii Medical Service Association Medicare	$94.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$55.57
Rate for Payer: Hawaii Western Management Group Commercial	$178.60
Rate for Payer: Health Management Network Commercial	$159.80
Rate for Payer: Humana Medicare	$94.00
Rate for Payer: Kaiser Permanente Commercial	$169.20
Rate for Payer: Kaiser Permanente Medicaid	$95.88
Rate for Payer: Kaiser Permanente Medicare	$94.00
Rate for Payer: MDX Hawaii PPO	$182.36
Rate for Payer: Ohana Health Plan Medicaid	$94.00
Rate for Payer: Ohana Health Plan Medicare	$94.00
Rate for Payer: UnitedHealthcare Medicaid	$46.54
Rate for Payer: UnitedHealthcare Medicare	$94.00
Rate for Payer: University Health Alliance Commercial	$137.03

CARDIOVASCULAR STRESS TEST CHARGE

Facility

$1,329.00

Service Code	HCPCS 93017
Hospital Charge Code	8282438
Hospital Revenue Code	482
Min. Negotiated Rate	$55.90
Max. Negotiated Rate	$1,289.13
Rate for Payer: AlohaCare Medicaid	$664.50
Rate for Payer: AlohaCare Medicare	$664.50
Rate for Payer: Cash Price	$863.85
Rate for Payer: Cash Price	$863.85
Rate for Payer: Devoted Health Medicare	$730.95
Rate for Payer: Hawaii Medical Service Association Commercial	$275.75
Rate for Payer: Hawaii Medical Service Association Medicare	$664.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,262.55
Rate for Payer: Health Management Network Commercial	$1,129.65
Rate for Payer: Humana Medicare	$664.50
Rate for Payer: Kaiser Permanente Commercial	$1,196.10
Rate for Payer: Kaiser Permanente Medicaid	$677.79
Rate for Payer: Kaiser Permanente Medicare	$664.50
Rate for Payer: MDX Hawaii PPO	$1,289.13
Rate for Payer: Ohana Health Plan Medicaid	$664.50
Rate for Payer: Ohana Health Plan Medicare	$664.50
Rate for Payer: UnitedHealthcare Medicaid	$55.90
Rate for Payer: UnitedHealthcare Medicare	$664.50
Rate for Payer: University Health Alliance Commercial	$968.71

CARDIOVASCULAR STRESS TEST CHARGE

Facility

$1,329.00

Service Code	HCPCS 93017
Hospital Charge Code	8282438
Hospital Revenue Code	482
Min. Negotiated Rate	$1,129.65
Max. Negotiated Rate	$1,289.13
Rate for Payer: Cash Price	$863.85
Rate for Payer: Health Management Network Commercial	$1,129.65
Rate for Payer: Kaiser Permanente Commercial	$1,196.10
Rate for Payer: MDX Hawaii PPO	$1,289.13

carmex lip balm 10gm [HHSC]

Facility

$4.11

Service Code	NDC 83078011214
Hospital Charge Code	2500283
Hospital Revenue Code	250
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$3.99
Rate for Payer: AlohaCare Medicaid	$2.06
Rate for Payer: AlohaCare Medicare	$2.06
Rate for Payer: Cash Price	$2.67
Rate for Payer: Devoted Health Medicare	$2.26
Rate for Payer: Hawaii Medical Service Association Medicare	$2.06
Rate for Payer: Hawaii Western Management Group Commercial	$3.90
Rate for Payer: Health Management Network Commercial	$3.49
Rate for Payer: Humana Medicare	$2.06
Rate for Payer: Kaiser Permanente Commercial	$3.70
Rate for Payer: Kaiser Permanente Medicaid	$2.10
Rate for Payer: Kaiser Permanente Medicare	$2.06
Rate for Payer: MDX Hawaii PPO	$3.99
Rate for Payer: Ohana Health Plan Medicaid	$2.06
Rate for Payer: Ohana Health Plan Medicare	$2.06
Rate for Payer: UnitedHealthcare Medicaid	$2.47
Rate for Payer: UnitedHealthcare Medicare	$2.06
Rate for Payer: University Health Alliance Commercial	$3.00

carmex lip balm 10gm [HHSC]

Facility

$4.11

Service Code	NDC 83078011214
Hospital Charge Code	2500283
Hospital Revenue Code	250
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$3.99
Rate for Payer: Cash Price	$2.67
Rate for Payer: Health Management Network Commercial	$3.49
Rate for Payer: Kaiser Permanente Commercial	$3.70
Rate for Payer: MDX Hawaii PPO	$3.99

CAROTID ARTERY STENT PROCEDURES WITH CC

Facility

$10,400.00

Service Code	MSDRG 035
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$10,400.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

Know your out-of-pocket cost for care.

All Charges