Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Catecholamines Urine 24 Hour FSI

Facility

$287.00

Service Code	HCPCS 82384
Hospital Charge Code	8117874
Hospital Revenue Code	301
Min. Negotiated Rate	$243.95
Max. Negotiated Rate	$278.39
Rate for Payer: Cash Price	$186.55
Rate for Payer: Health Management Network Commercial	$243.95
Rate for Payer: Kaiser Permanente Commercial	$258.30
Rate for Payer: MDX Hawaii PPO	$278.39

Catecholamines Urine 24 Hour FSI

Facility

$287.00

Service Code	HCPCS 82384
Hospital Charge Code	8117874
Hospital Revenue Code	301
Min. Negotiated Rate	$25.25
Max. Negotiated Rate	$278.39
Rate for Payer: AlohaCare Medicaid	$143.50
Rate for Payer: AlohaCare Medicare	$143.50
Rate for Payer: Cash Price	$186.55
Rate for Payer: Cash Price	$186.55
Rate for Payer: Devoted Health Medicare	$157.85
Rate for Payer: Hawaii Medical Service Association ABD	$34.90
Rate for Payer: Hawaii Medical Service Association Commercial	$31.56
Rate for Payer: Hawaii Medical Service Association Medicare	$143.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$36.65
Rate for Payer: Hawaii Western Management Group Commercial	$25.25
Rate for Payer: Health Management Network Commercial	$243.95
Rate for Payer: Humana Medicare	$143.50
Rate for Payer: Kaiser Permanente Commercial	$258.30
Rate for Payer: Kaiser Permanente Medicaid	$146.37
Rate for Payer: Kaiser Permanente Medicare	$143.50
Rate for Payer: MDX Hawaii PPO	$278.39
Rate for Payer: Ohana Health Plan Medicaid	$143.50
Rate for Payer: Ohana Health Plan Medicare	$143.50
Rate for Payer: UnitedHealthcare Medicaid	$34.90
Rate for Payer: UnitedHealthcare Medicare	$143.50
Rate for Payer: University Health Alliance Commercial	$65.27

Catherization for Urine Sample Charge

Facility

$46.00

Service Code	HCPCS P9612
Hospital Charge Code	8422801
Hospital Revenue Code	300
Min. Negotiated Rate	$39.10
Max. Negotiated Rate	$44.62
Rate for Payer: Cash Price	$29.90
Rate for Payer: Health Management Network Commercial	$39.10
Rate for Payer: Kaiser Permanente Commercial	$41.40
Rate for Payer: MDX Hawaii PPO	$44.62

Catherization for Urine Sample Charge

Facility

$46.00

Service Code	HCPCS P9612
Hospital Charge Code	8422801
Hospital Revenue Code	300
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$44.62
Rate for Payer: AlohaCare Medicaid	$23.00
Rate for Payer: AlohaCare Medicare	$23.00
Rate for Payer: Cash Price	$29.90
Rate for Payer: Cash Price	$29.90
Rate for Payer: Devoted Health Medicare	$25.30
Rate for Payer: Hawaii Medical Service Association ABD	$3.00
Rate for Payer: Hawaii Medical Service Association Commercial	$11.68
Rate for Payer: Hawaii Medical Service Association Medicare	$23.00
Rate for Payer: Hawaii Western Management Group Commercial	$43.70
Rate for Payer: Health Management Network Commercial	$39.10
Rate for Payer: Humana Medicare	$23.00
Rate for Payer: Kaiser Permanente Commercial	$41.40
Rate for Payer: Kaiser Permanente Medicaid	$23.46
Rate for Payer: Kaiser Permanente Medicare	$23.00
Rate for Payer: MDX Hawaii PPO	$44.62
Rate for Payer: Ohana Health Plan Medicaid	$23.00
Rate for Payer: Ohana Health Plan Medicare	$23.00
Rate for Payer: UnitedHealthcare Medicaid	$3.00
Rate for Payer: UnitedHealthcare Medicare	$23.00
Rate for Payer: University Health Alliance Commercial	$33.53

Catherization for Urine Sample Charge [HHSC]

Facility

$46.00

Service Code	HCPCS P9612
Hospital Charge Code	13357626
Hospital Revenue Code	380
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$44.62
Rate for Payer: AlohaCare Medicaid	$23.00
Rate for Payer: AlohaCare Medicare	$23.00
Rate for Payer: Cash Price	$29.90
Rate for Payer: Cash Price	$29.90
Rate for Payer: Devoted Health Medicare	$25.30
Rate for Payer: Hawaii Medical Service Association ABD	$3.00
Rate for Payer: Hawaii Medical Service Association Commercial	$11.68
Rate for Payer: Hawaii Medical Service Association Medicare	$23.00
Rate for Payer: Hawaii Western Management Group Commercial	$43.70
Rate for Payer: Health Management Network Commercial	$39.10
Rate for Payer: Humana Medicare	$23.00
Rate for Payer: Kaiser Permanente Commercial	$41.40
Rate for Payer: Kaiser Permanente Medicaid	$23.46
Rate for Payer: Kaiser Permanente Medicare	$23.00
Rate for Payer: MDX Hawaii PPO	$44.62
Rate for Payer: Ohana Health Plan Medicaid	$23.00
Rate for Payer: Ohana Health Plan Medicare	$23.00
Rate for Payer: UnitedHealthcare Medicaid	$3.00
Rate for Payer: UnitedHealthcare Medicare	$23.00
Rate for Payer: University Health Alliance Commercial	$33.53

Catherization for Urine Sample Charge [HHSC]

Facility

$46.00

Service Code	HCPCS P9612
Hospital Charge Code	13357626
Hospital Revenue Code	380
Min. Negotiated Rate	$39.10
Max. Negotiated Rate	$44.62
Rate for Payer: Kaiser Permanente Commercial	$41.40
Rate for Payer: Cash Price	$29.90
Rate for Payer: Health Management Network Commercial	$39.10
Rate for Payer: MDX Hawaii PPO	$44.62

CATHERIZATION TRAY UMBILICAL

Facility

$250.00

Hospital Charge Code	8274483
Hospital Revenue Code	272
Min. Negotiated Rate	$125.00
Max. Negotiated Rate	$242.50
Rate for Payer: AlohaCare Medicaid	$125.00
Rate for Payer: AlohaCare Medicare	$125.00
Rate for Payer: Cash Price	$162.50
Rate for Payer: Devoted Health Medicare	$137.50
Rate for Payer: Hawaii Medical Service Association Medicare	$125.00
Rate for Payer: Hawaii Western Management Group Commercial	$237.50
Rate for Payer: Health Management Network Commercial	$212.50
Rate for Payer: Humana Medicare	$125.00
Rate for Payer: Kaiser Permanente Commercial	$225.00
Rate for Payer: Kaiser Permanente Medicaid	$127.50
Rate for Payer: Kaiser Permanente Medicare	$125.00
Rate for Payer: MDX Hawaii PPO	$242.50
Rate for Payer: Ohana Health Plan Medicaid	$125.00
Rate for Payer: Ohana Health Plan Medicare	$125.00
Rate for Payer: UnitedHealthcare Medicare	$125.00
Rate for Payer: University Health Alliance Commercial	$182.22

CATHERIZATION TRAY UMBILICAL

Facility

$250.00

Hospital Charge Code	8274483
Hospital Revenue Code	272
Min. Negotiated Rate	$212.50
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Health Management Network Commercial	$212.50
Rate for Payer: Kaiser Permanente Commercial	$225.00
Rate for Payer: MDX Hawaii PPO	$242.50

CATHETER 3.5F SINGLE LUMEN UMBILICAL

Facility

$91.00

Service Code	HCPCS C1887
Hospital Charge Code	8891287
Hospital Revenue Code	272
Min. Negotiated Rate	$77.35
Max. Negotiated Rate	$88.27
Rate for Payer: Cash Price	$59.15
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Kaiser Permanente Commercial	$81.90
Rate for Payer: MDX Hawaii PPO	$88.27

CATHETER 3.5F SINGLE LUMEN UMBILICAL

Facility

$91.00

Service Code	HCPCS C1887
Hospital Charge Code	8891287
Hospital Revenue Code	272
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$88.27
Rate for Payer: AlohaCare Medicaid	$45.50
Rate for Payer: AlohaCare Medicare	$45.50
Rate for Payer: Cash Price	$59.15
Rate for Payer: Devoted Health Medicare	$50.05
Rate for Payer: Hawaii Medical Service Association Medicare	$45.50
Rate for Payer: Hawaii Western Management Group Commercial	$86.45
Rate for Payer: Health Management Network Commercial	$77.35
Rate for Payer: Humana Medicare	$45.50
Rate for Payer: Kaiser Permanente Commercial	$81.90
Rate for Payer: Kaiser Permanente Medicaid	$46.41
Rate for Payer: Kaiser Permanente Medicare	$45.50
Rate for Payer: MDX Hawaii PPO	$88.27
Rate for Payer: Ohana Health Plan Medicaid	$45.50
Rate for Payer: Ohana Health Plan Medicare	$45.50
Rate for Payer: UnitedHealthcare Medicare	$45.50
Rate for Payer: University Health Alliance Commercial	$66.33

CATHETER ANGIOCATH 14G X 3.25 IN PERIPHERAL VENOUS

Facility

$131.00

Service Code	HCPCS C1751
Hospital Charge Code	9526197
Hospital Revenue Code	272
Min. Negotiated Rate	$111.35
Max. Negotiated Rate	$127.07
Rate for Payer: Cash Price	$85.15
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: MDX Hawaii PPO	$127.07

CATHETER ANGIOCATH 14G X 3.25 IN PERIPHERAL VENOUS

Facility

$131.00

Service Code	HCPCS C1751
Hospital Charge Code	9526197
Hospital Revenue Code	272
Min. Negotiated Rate	$65.50
Max. Negotiated Rate	$127.07
Rate for Payer: AlohaCare Medicaid	$65.50
Rate for Payer: AlohaCare Medicare	$65.50
Rate for Payer: Cash Price	$85.15
Rate for Payer: Devoted Health Medicare	$72.05
Rate for Payer: Hawaii Medical Service Association Medicare	$65.50
Rate for Payer: Hawaii Western Management Group Commercial	$124.45
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Humana Medicare	$65.50
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: Kaiser Permanente Medicaid	$66.81
Rate for Payer: Kaiser Permanente Medicare	$65.50
Rate for Payer: MDX Hawaii PPO	$127.07
Rate for Payer: Ohana Health Plan Medicaid	$65.50
Rate for Payer: Ohana Health Plan Medicare	$65.50
Rate for Payer: UnitedHealthcare Medicare	$65.50
Rate for Payer: University Health Alliance Commercial	$95.49

CATHETER ANGIOCATH 16G X 3.25 IN PERIPHERAL VENOUS

Facility

$177.00

Service Code	HCPCS C1751
Hospital Charge Code	9526198
Hospital Revenue Code	272
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$115.05
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Kaiser Permanente Commercial	$159.30
Rate for Payer: MDX Hawaii PPO	$171.69

CATHETER ANGIOCATH 16G X 3.25 IN PERIPHERAL VENOUS

Facility

$177.00

Service Code	HCPCS C1751
Hospital Charge Code	9526198
Hospital Revenue Code	272
Min. Negotiated Rate	$88.50
Max. Negotiated Rate	$171.69
Rate for Payer: AlohaCare Medicaid	$88.50
Rate for Payer: AlohaCare Medicare	$88.50
Rate for Payer: Cash Price	$115.05
Rate for Payer: Devoted Health Medicare	$97.35
Rate for Payer: Hawaii Medical Service Association Medicare	$88.50
Rate for Payer: Hawaii Western Management Group Commercial	$168.15
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Humana Medicare	$88.50
Rate for Payer: Kaiser Permanente Commercial	$159.30
Rate for Payer: Kaiser Permanente Medicaid	$90.27
Rate for Payer: Kaiser Permanente Medicare	$88.50
Rate for Payer: MDX Hawaii PPO	$171.69
Rate for Payer: Ohana Health Plan Medicaid	$88.50
Rate for Payer: Ohana Health Plan Medicare	$88.50
Rate for Payer: UnitedHealthcare Medicare	$88.50
Rate for Payer: University Health Alliance Commercial	$129.02

CATHETER ANGIOCATH 18G X 1.88 IN IV STRAIGHT HUB

Facility

$83.00

Service Code	HCPCS C1751
Hospital Charge Code	9526199
Hospital Revenue Code	272
Min. Negotiated Rate	$41.50
Max. Negotiated Rate	$80.51
Rate for Payer: AlohaCare Medicaid	$41.50
Rate for Payer: AlohaCare Medicare	$41.50
Rate for Payer: Cash Price	$53.95
Rate for Payer: Devoted Health Medicare	$45.65
Rate for Payer: Hawaii Medical Service Association Medicare	$41.50
Rate for Payer: Hawaii Western Management Group Commercial	$78.85
Rate for Payer: Health Management Network Commercial	$70.55
Rate for Payer: Humana Medicare	$41.50
Rate for Payer: Kaiser Permanente Commercial	$74.70
Rate for Payer: Kaiser Permanente Medicaid	$42.33
Rate for Payer: Kaiser Permanente Medicare	$41.50
Rate for Payer: MDX Hawaii PPO	$80.51
Rate for Payer: Ohana Health Plan Medicaid	$41.50
Rate for Payer: Ohana Health Plan Medicare	$41.50
Rate for Payer: UnitedHealthcare Medicare	$41.50
Rate for Payer: University Health Alliance Commercial	$60.50

CATHETER ANGIOCATH 18G X 1.88 IN IV STRAIGHT HUB

Facility

$83.00

Service Code	HCPCS C1751
Hospital Charge Code	9526199
Hospital Revenue Code	272
Min. Negotiated Rate	$70.55
Max. Negotiated Rate	$80.51
Rate for Payer: Cash Price	$53.95
Rate for Payer: Health Management Network Commercial	$70.55
Rate for Payer: Kaiser Permanente Commercial	$74.70
Rate for Payer: MDX Hawaii PPO	$80.51

CATHETER DRAINAGE (CT)

Facility

$400.00

Service Code	HCPCS C1729
Hospital Charge Code	8890008
Hospital Revenue Code	272
Min. Negotiated Rate	$340.00
Max. Negotiated Rate	$388.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Kaiser Permanente Commercial	$360.00
Rate for Payer: MDX Hawaii PPO	$388.00

CATHETER DRAINAGE (CT)

Facility

$400.00

Service Code	HCPCS C1729
Hospital Charge Code	8890008
Hospital Revenue Code	272
Min. Negotiated Rate	$200.00
Max. Negotiated Rate	$388.00
Rate for Payer: AlohaCare Medicaid	$200.00
Rate for Payer: AlohaCare Medicare	$200.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Devoted Health Medicare	$220.00
Rate for Payer: Hawaii Medical Service Association Medicare	$200.00
Rate for Payer: Hawaii Western Management Group Commercial	$380.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Humana Medicare	$200.00
Rate for Payer: Kaiser Permanente Commercial	$360.00
Rate for Payer: Kaiser Permanente Medicaid	$204.00
Rate for Payer: Kaiser Permanente Medicare	$200.00
Rate for Payer: MDX Hawaii PPO	$388.00
Rate for Payer: Ohana Health Plan Medicaid	$200.00
Rate for Payer: Ohana Health Plan Medicare	$200.00
Rate for Payer: UnitedHealthcare Medicare	$200.00
Rate for Payer: University Health Alliance Commercial	$291.56

CATHETER DRAINAGE (US)

Facility

$453.00

Service Code	HCPCS C1729
Hospital Charge Code	8890007
Hospital Revenue Code	272
Min. Negotiated Rate	$385.05
Max. Negotiated Rate	$439.41
Rate for Payer: Cash Price	$294.45
Rate for Payer: Health Management Network Commercial	$385.05
Rate for Payer: Kaiser Permanente Commercial	$407.70
Rate for Payer: MDX Hawaii PPO	$439.41

CATHETER DRAINAGE (US)

Facility

$453.00

Service Code	HCPCS C1729
Hospital Charge Code	8890007
Hospital Revenue Code	272
Min. Negotiated Rate	$226.50
Max. Negotiated Rate	$439.41
Rate for Payer: AlohaCare Medicaid	$226.50
Rate for Payer: AlohaCare Medicare	$226.50
Rate for Payer: Cash Price	$294.45
Rate for Payer: Devoted Health Medicare	$249.15
Rate for Payer: Hawaii Medical Service Association Medicare	$226.50
Rate for Payer: Hawaii Western Management Group Commercial	$430.35
Rate for Payer: Health Management Network Commercial	$385.05
Rate for Payer: Humana Medicare	$226.50
Rate for Payer: Kaiser Permanente Commercial	$407.70
Rate for Payer: Kaiser Permanente Medicaid	$231.03
Rate for Payer: Kaiser Permanente Medicare	$226.50
Rate for Payer: MDX Hawaii PPO	$439.41
Rate for Payer: Ohana Health Plan Medicaid	$226.50
Rate for Payer: Ohana Health Plan Medicare	$226.50
Rate for Payer: UnitedHealthcare Medicare	$226.50
Rate for Payer: University Health Alliance Commercial	$330.19

CATHETER DRAINAGE (XR/MAMMO)

Facility

$400.00

Service Code	HCPCS C1729
Hospital Charge Code	8890078
Hospital Revenue Code	272
Min. Negotiated Rate	$340.00
Max. Negotiated Rate	$388.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Kaiser Permanente Commercial	$360.00
Rate for Payer: MDX Hawaii PPO	$388.00

CATHETER DRAINAGE (XR/MAMMO)

Facility

$400.00

Service Code	HCPCS C1729
Hospital Charge Code	8890078
Hospital Revenue Code	272
Min. Negotiated Rate	$200.00
Max. Negotiated Rate	$388.00
Rate for Payer: AlohaCare Medicaid	$200.00
Rate for Payer: AlohaCare Medicare	$200.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Devoted Health Medicare	$220.00
Rate for Payer: Hawaii Medical Service Association Medicare	$200.00
Rate for Payer: Hawaii Western Management Group Commercial	$380.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Humana Medicare	$200.00
Rate for Payer: Kaiser Permanente Commercial	$360.00
Rate for Payer: Kaiser Permanente Medicaid	$204.00
Rate for Payer: Kaiser Permanente Medicare	$200.00
Rate for Payer: MDX Hawaii PPO	$388.00
Rate for Payer: Ohana Health Plan Medicaid	$200.00
Rate for Payer: Ohana Health Plan Medicare	$200.00
Rate for Payer: UnitedHealthcare Medicare	$200.00
Rate for Payer: University Health Alliance Commercial	$291.56

CATHETER EXTERNAL MALE LARGE

Facility

$7.00

Service Code	HCPCS C1758
Hospital Charge Code	8266863
Hospital Revenue Code	270
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.55
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$6.79

CATHETER EXTERNAL MALE LARGE

Facility

$7.00

Service Code	HCPCS C1758
Hospital Charge Code	8266863
Hospital Revenue Code	270
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$6.79
Rate for Payer: AlohaCare Medicaid	$3.50
Rate for Payer: AlohaCare Medicare	$3.50
Rate for Payer: Cash Price	$4.55
Rate for Payer: Devoted Health Medicare	$3.85
Rate for Payer: Hawaii Medical Service Association Medicare	$3.50
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Humana Medicare	$3.50
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: Kaiser Permanente Medicare	$3.50
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: Ohana Health Plan Medicaid	$3.50
Rate for Payer: Ohana Health Plan Medicare	$3.50
Rate for Payer: UnitedHealthcare Medicare	$3.50
Rate for Payer: University Health Alliance Commercial	$5.10

CATHETER FOLEY 10FR 3CC 2 WAY

Facility

$24.00

Service Code	HCPCS A4311
Hospital Charge Code	8266305
Hospital Revenue Code	272
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$23.28
Rate for Payer: AlohaCare Medicaid	$12.00
Rate for Payer: AlohaCare Medicare	$12.00
Rate for Payer: Cash Price	$15.60
Rate for Payer: Cash Price	$15.60
Rate for Payer: Devoted Health Medicare	$13.20
Rate for Payer: Hawaii Medical Service Association Medicare	$12.00
Rate for Payer: Hawaii Western Management Group Commercial	$22.80
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Humana Medicare	$12.00
Rate for Payer: Kaiser Permanente Commercial	$21.60
Rate for Payer: Kaiser Permanente Medicaid	$12.24
Rate for Payer: Kaiser Permanente Medicare	$12.00
Rate for Payer: MDX Hawaii PPO	$23.28
Rate for Payer: Ohana Health Plan Medicaid	$12.00
Rate for Payer: Ohana Health Plan Medicare	$12.00
Rate for Payer: UnitedHealthcare Medicaid	$14.13
Rate for Payer: UnitedHealthcare Medicare	$12.00
Rate for Payer: University Health Alliance Commercial	$17.49

Know your out-of-pocket cost for care.

All Charges