Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

CATHETER FOLEY 24FR 30CC 3 WAY

Facility

$86.00

Service Code	HCPCS A4313
Hospital Charge Code	8266956
Hospital Revenue Code	272
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

CATHETER FOLEY 24FR 30CC 3 WAY

Facility

$86.00

Service Code	HCPCS A4313
Hospital Charge Code	8266956
Hospital Revenue Code	272
Min. Negotiated Rate	$17.05
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 Medicare	$43.00
Rate for Payer: Hawaii Western Management Group Commercial	$81.70
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	$17.05
Rate for Payer: UnitedHealthcare Medicare	$43.00
Rate for Payer: University Health Alliance Commercial	$62.69

CATHETER FOLEY 24FR 5CC 2 WAY

Facility

$9.00

Service Code	HCPCS A4311
Hospital Charge Code	8266879
Hospital Revenue Code	272
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$8.73
Rate for Payer: Cash Price	$5.85
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: MDX Hawaii PPO	$8.73

CATHETER FOLEY 24FR 5CC 2 WAY

Facility

$9.00

Service Code	HCPCS A4311
Hospital Charge Code	8266879
Hospital Revenue Code	272
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$14.13
Rate for Payer: AlohaCare Medicaid	$4.50
Rate for Payer: AlohaCare Medicare	$4.50
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cash Price	$5.85
Rate for Payer: Devoted Health Medicare	$4.95
Rate for Payer: Hawaii Medical Service Association Medicare	$4.50
Rate for Payer: Hawaii Western Management Group Commercial	$8.55
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Humana Medicare	$4.50
Rate for Payer: Kaiser Permanente Commercial	$8.10
Rate for Payer: Kaiser Permanente Medicaid	$4.59
Rate for Payer: Kaiser Permanente Medicare	$4.50
Rate for Payer: MDX Hawaii PPO	$8.73
Rate for Payer: Ohana Health Plan Medicaid	$4.50
Rate for Payer: Ohana Health Plan Medicare	$4.50
Rate for Payer: UnitedHealthcare Medicaid	$14.13
Rate for Payer: UnitedHealthcare Medicare	$4.50
Rate for Payer: University Health Alliance Commercial	$6.56

CATHETER FOLEY 8FR 3CC 2WAY

Facility

$48.00

Service Code	HCPCS A4311
Hospital Charge Code	8266292
Hospital Revenue Code	272
Min. Negotiated Rate	$14.13
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$31.20
Rate for Payer: AlohaCare Medicaid	$24.00
Rate for Payer: AlohaCare Medicare	$24.00
Rate for Payer: Cash Price	$31.20
Rate for Payer: Devoted Health Medicare	$26.40
Rate for Payer: Hawaii Medical Service Association Medicare	$24.00
Rate for Payer: Hawaii Western Management Group Commercial	$45.60
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Humana Medicare	$24.00
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: Kaiser Permanente Medicaid	$24.48
Rate for Payer: Kaiser Permanente Medicare	$24.00
Rate for Payer: MDX Hawaii PPO	$46.56
Rate for Payer: Ohana Health Plan Medicaid	$24.00
Rate for Payer: Ohana Health Plan Medicare	$24.00
Rate for Payer: UnitedHealthcare Medicaid	$14.13
Rate for Payer: UnitedHealthcare Medicare	$24.00
Rate for Payer: University Health Alliance Commercial	$34.99

CATHETER FOLEY 8FR 3CC 2WAY

Facility

$48.00

Service Code	HCPCS A4311
Hospital Charge Code	8266292
Hospital Revenue Code	272
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$46.56
Rate for Payer: Cash Price	$31.20
Rate for Payer: Health Management Network Commercial	$40.80
Rate for Payer: Kaiser Permanente Commercial	$43.20
Rate for Payer: MDX Hawaii PPO	$46.56

CATHETER FOLEY COUDE 14FR 5CC 2-WAY

Facility

$55.00

Service Code	HCPCS A4311
Hospital Charge Code	8266295
Hospital Revenue Code	272
Min. Negotiated Rate	$14.13
Max. Negotiated Rate	$53.35
Rate for Payer: AlohaCare Medicaid	$27.50
Rate for Payer: AlohaCare Medicare	$27.50
Rate for Payer: Cash Price	$35.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Devoted Health Medicare	$30.25
Rate for Payer: Hawaii Medical Service Association Medicare	$27.50
Rate for Payer: Hawaii Western Management Group Commercial	$52.25
Rate for Payer: Health Management Network Commercial	$46.75
Rate for Payer: Humana Medicare	$27.50
Rate for Payer: Kaiser Permanente Commercial	$49.50
Rate for Payer: Kaiser Permanente Medicaid	$28.05
Rate for Payer: Kaiser Permanente Medicare	$27.50
Rate for Payer: MDX Hawaii PPO	$53.35
Rate for Payer: Ohana Health Plan Medicaid	$27.50
Rate for Payer: Ohana Health Plan Medicare	$27.50
Rate for Payer: UnitedHealthcare Medicaid	$14.13
Rate for Payer: UnitedHealthcare Medicare	$27.50
Rate for Payer: University Health Alliance Commercial	$40.09

CATHETER FOLEY COUDE 14FR 5CC 2-WAY

Facility

$55.00

Service Code	HCPCS A4311
Hospital Charge Code	8266295
Hospital Revenue Code	272
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$35.75
Rate for Payer: Health Management Network Commercial	$46.75
Rate for Payer: Kaiser Permanente Commercial	$49.50
Rate for Payer: MDX Hawaii PPO	$53.35

CATHETER FOLEY COUDE 16FR 5CC 2-WAY

Facility

$65.00

Service Code	HCPCS A4311
Hospital Charge Code	8266296
Hospital Revenue Code	272
Min. Negotiated Rate	$14.13
Max. Negotiated Rate	$63.05
Rate for Payer: AlohaCare Medicaid	$32.50
Rate for Payer: AlohaCare Medicare	$32.50
Rate for Payer: Cash Price	$42.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Devoted Health Medicare	$35.75
Rate for Payer: Hawaii Medical Service Association Medicare	$32.50
Rate for Payer: Hawaii Western Management Group Commercial	$61.75
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Humana Medicare	$32.50
Rate for Payer: Kaiser Permanente Commercial	$58.50
Rate for Payer: Kaiser Permanente Medicaid	$33.15
Rate for Payer: Kaiser Permanente Medicare	$32.50
Rate for Payer: MDX Hawaii PPO	$63.05
Rate for Payer: Ohana Health Plan Medicaid	$32.50
Rate for Payer: Ohana Health Plan Medicare	$32.50
Rate for Payer: UnitedHealthcare Medicaid	$14.13
Rate for Payer: UnitedHealthcare Medicare	$32.50
Rate for Payer: University Health Alliance Commercial	$47.38

CATHETER FOLEY COUDE 16FR 5CC 2-WAY

Facility

$65.00

Service Code	HCPCS A4311
Hospital Charge Code	8266296
Hospital Revenue Code	272
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$42.25
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Kaiser Permanente Commercial	$58.50
Rate for Payer: MDX Hawaii PPO	$63.05

CATHETER, GROSHONG 8.0 FR.

Facility

$2,226.00

Service Code	HCPCS C1751
Hospital Charge Code	8274149
Hospital Revenue Code	272
Min. Negotiated Rate	$1,113.00
Max. Negotiated Rate	$2,159.22
Rate for Payer: AlohaCare Medicaid	$1,113.00
Rate for Payer: AlohaCare Medicare	$1,113.00
Rate for Payer: Cash Price	$1,446.90
Rate for Payer: Devoted Health Medicare	$1,224.30
Rate for Payer: Hawaii Medical Service Association Medicare	$1,113.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,114.70
Rate for Payer: Health Management Network Commercial	$1,892.10
Rate for Payer: Humana Medicare	$1,113.00
Rate for Payer: Kaiser Permanente Commercial	$2,003.40
Rate for Payer: Kaiser Permanente Medicaid	$1,135.26
Rate for Payer: Kaiser Permanente Medicare	$1,113.00
Rate for Payer: MDX Hawaii PPO	$2,159.22
Rate for Payer: Ohana Health Plan Medicaid	$1,113.00
Rate for Payer: Ohana Health Plan Medicare	$1,113.00
Rate for Payer: UnitedHealthcare Medicare	$1,113.00
Rate for Payer: University Health Alliance Commercial	$1,622.53

CATHETER, GROSHONG 8.0 FR.

Facility

$2,226.00

Service Code	HCPCS C1751
Hospital Charge Code	8274149
Hospital Revenue Code	272
Min. Negotiated Rate	$1,892.10
Max. Negotiated Rate	$2,159.22
Rate for Payer: Cash Price	$1,446.90
Rate for Payer: Health Management Network Commercial	$1,892.10
Rate for Payer: Kaiser Permanente Commercial	$2,003.40
Rate for Payer: MDX Hawaii PPO	$2,159.22

CATHETER, GROSHONG 9.5 DUAL LUMEN

Facility

$1,805.00

Service Code	HCPCS C1751
Hospital Charge Code	8274150
Hospital Revenue Code	272
Min. Negotiated Rate	$1,534.25
Max. Negotiated Rate	$1,750.85
Rate for Payer: Cash Price	$1,173.25
Rate for Payer: Health Management Network Commercial	$1,534.25
Rate for Payer: Kaiser Permanente Commercial	$1,624.50
Rate for Payer: MDX Hawaii PPO	$1,750.85

CATHETER, GROSHONG 9.5 DUAL LUMEN

Facility

$1,805.00

Service Code	HCPCS C1751
Hospital Charge Code	8274150
Hospital Revenue Code	272
Min. Negotiated Rate	$902.50
Max. Negotiated Rate	$1,750.85
Rate for Payer: AlohaCare Medicaid	$902.50
Rate for Payer: AlohaCare Medicare	$902.50
Rate for Payer: Cash Price	$1,173.25
Rate for Payer: Devoted Health Medicare	$992.75
Rate for Payer: Hawaii Medical Service Association Medicare	$902.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,714.75
Rate for Payer: Health Management Network Commercial	$1,534.25
Rate for Payer: Humana Medicare	$902.50
Rate for Payer: Kaiser Permanente Commercial	$1,624.50
Rate for Payer: Kaiser Permanente Medicaid	$920.55
Rate for Payer: Kaiser Permanente Medicare	$902.50
Rate for Payer: MDX Hawaii PPO	$1,750.85
Rate for Payer: Ohana Health Plan Medicaid	$902.50
Rate for Payer: Ohana Health Plan Medicare	$902.50
Rate for Payer: UnitedHealthcare Medicare	$902.50
Rate for Payer: University Health Alliance Commercial	$1,315.66

CATHETER HICKMAN 9.6 FR

Facility

$390.00

Service Code	HCPCS C1750
Hospital Charge Code	8348094
Hospital Revenue Code	272
Min. Negotiated Rate	$331.50
Max. Negotiated Rate	$378.30
Rate for Payer: Cash Price	$253.50
Rate for Payer: Health Management Network Commercial	$331.50
Rate for Payer: Kaiser Permanente Commercial	$351.00
Rate for Payer: MDX Hawaii PPO	$378.30

CATHETER HICKMAN 9.6 FR

Facility

$390.00

Service Code	HCPCS C1750
Hospital Charge Code	8348094
Hospital Revenue Code	272
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$378.30
Rate for Payer: AlohaCare Medicaid	$195.00
Rate for Payer: AlohaCare Medicare	$195.00
Rate for Payer: Cash Price	$253.50
Rate for Payer: Devoted Health Medicare	$214.50
Rate for Payer: Hawaii Medical Service Association Medicare	$195.00
Rate for Payer: Hawaii Western Management Group Commercial	$370.50
Rate for Payer: Health Management Network Commercial	$331.50
Rate for Payer: Humana Medicare	$195.00
Rate for Payer: Kaiser Permanente Commercial	$351.00
Rate for Payer: Kaiser Permanente Medicaid	$198.90
Rate for Payer: Kaiser Permanente Medicare	$195.00
Rate for Payer: MDX Hawaii PPO	$378.30
Rate for Payer: Ohana Health Plan Medicaid	$195.00
Rate for Payer: Ohana Health Plan Medicare	$195.00
Rate for Payer: UnitedHealthcare Medicare	$195.00
Rate for Payer: University Health Alliance Commercial	$284.27

CATHETERIZATION TRAY

Facility

$245.00

Hospital Charge Code	9589765
Hospital Revenue Code	272
Min. Negotiated Rate	$208.25
Max. Negotiated Rate	$237.65
Rate for Payer: Cash Price	$159.25
Rate for Payer: Health Management Network Commercial	$208.25
Rate for Payer: Kaiser Permanente Commercial	$220.50
Rate for Payer: MDX Hawaii PPO	$237.65

CATHETERIZATION TRAY

Facility

$245.00

Hospital Charge Code	9589765
Hospital Revenue Code	272
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$237.65
Rate for Payer: AlohaCare Medicaid	$122.50
Rate for Payer: AlohaCare Medicare	$122.50
Rate for Payer: Cash Price	$159.25
Rate for Payer: Devoted Health Medicare	$134.75
Rate for Payer: Hawaii Medical Service Association Medicare	$122.50
Rate for Payer: Hawaii Western Management Group Commercial	$232.75
Rate for Payer: Health Management Network Commercial	$208.25
Rate for Payer: Humana Medicare	$122.50
Rate for Payer: Kaiser Permanente Commercial	$220.50
Rate for Payer: Kaiser Permanente Medicaid	$124.95
Rate for Payer: Kaiser Permanente Medicare	$122.50
Rate for Payer: MDX Hawaii PPO	$237.65
Rate for Payer: Ohana Health Plan Medicaid	$122.50
Rate for Payer: Ohana Health Plan Medicare	$122.50
Rate for Payer: UnitedHealthcare Medicare	$122.50
Rate for Payer: University Health Alliance Commercial	$178.58

CATHETER POWERPORT 8FR IMPLANTABLE PORT

Facility

$1,015.00

Service Code	HCPCS C1788
Hospital Charge Code	9089383
Hospital Revenue Code	278
Min. Negotiated Rate	$568.40
Max. Negotiated Rate	$984.55
Rate for Payer: Cash Price	$659.75
Rate for Payer: Hawaii Western Management Group Commercial	$710.50
Rate for Payer: Health Management Network Commercial	$862.75
Rate for Payer: Kaiser Permanente Commercial	$913.50
Rate for Payer: MDX Hawaii PPO	$984.55
Rate for Payer: University Health Alliance Commercial	$568.40

CATHETER POWERPORT 8FR IMPLANTABLE PORT

Facility

$1,015.00

Service Code	HCPCS C1788
Hospital Charge Code	9089383
Hospital Revenue Code	278
Min. Negotiated Rate	$507.50
Max. Negotiated Rate	$984.55
Rate for Payer: AlohaCare Medicaid	$507.50
Rate for Payer: AlohaCare Medicare	$507.50
Rate for Payer: Cash Price	$659.75
Rate for Payer: Devoted Health Medicare	$558.25
Rate for Payer: Hawaii Medical Service Association Medicare	$507.50
Rate for Payer: Hawaii Western Management Group Commercial	$710.50
Rate for Payer: Health Management Network Commercial	$862.75
Rate for Payer: Humana Medicare	$507.50
Rate for Payer: Kaiser Permanente Commercial	$913.50
Rate for Payer: Kaiser Permanente Medicaid	$517.65
Rate for Payer: Kaiser Permanente Medicare	$507.50
Rate for Payer: MDX Hawaii PPO	$984.55
Rate for Payer: Ohana Health Plan Medicaid	$507.50
Rate for Payer: Ohana Health Plan Medicare	$507.50
Rate for Payer: UnitedHealthcare Medicare	$507.50
Rate for Payer: University Health Alliance Commercial	$568.40

CATHETER PUREWICK FEMALE EXTERNAL

Facility

$72.00

Hospital Charge Code	9250726
Hospital Revenue Code	272
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$69.84
Rate for Payer: Cash Price	$46.80
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: MDX Hawaii PPO	$69.84

CATHETER PUREWICK FEMALE EXTERNAL

Facility

$72.00

Hospital Charge Code	9250726
Hospital Revenue Code	272
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$69.84
Rate for Payer: AlohaCare Medicaid	$36.00
Rate for Payer: AlohaCare Medicare	$36.00
Rate for Payer: Cash Price	$46.80
Rate for Payer: Devoted Health Medicare	$39.60
Rate for Payer: Hawaii Medical Service Association Medicare	$36.00
Rate for Payer: Hawaii Western Management Group Commercial	$68.40
Rate for Payer: Health Management Network Commercial	$61.20
Rate for Payer: Humana Medicare	$36.00
Rate for Payer: Kaiser Permanente Commercial	$64.80
Rate for Payer: Kaiser Permanente Medicaid	$36.72
Rate for Payer: Kaiser Permanente Medicare	$36.00
Rate for Payer: MDX Hawaii PPO	$69.84
Rate for Payer: Ohana Health Plan Medicaid	$36.00
Rate for Payer: Ohana Health Plan Medicare	$36.00
Rate for Payer: UnitedHealthcare Medicare	$36.00
Rate for Payer: University Health Alliance Commercial	$52.48

CATHETER RABINOV SIALOGRAPHY 0.016IN (CT)

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	8886991
Hospital Revenue Code	272
Min. Negotiated Rate	$192.95
Max. Negotiated Rate	$220.19
Rate for Payer: Cash Price	$147.55
Rate for Payer: Health Management Network Commercial	$192.95
Rate for Payer: Kaiser Permanente Commercial	$204.30
Rate for Payer: MDX Hawaii PPO	$220.19

CATHETER RABINOV SIALOGRAPHY 0.016IN (CT)

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	8886991
Hospital Revenue Code	272
Min. Negotiated Rate	$113.50
Max. Negotiated Rate	$220.19
Rate for Payer: AlohaCare Medicaid	$113.50
Rate for Payer: AlohaCare Medicare	$113.50
Rate for Payer: Cash Price	$147.55
Rate for Payer: Devoted Health Medicare	$124.85
Rate for Payer: Hawaii Medical Service Association Medicare	$113.50
Rate for Payer: Hawaii Western Management Group Commercial	$215.65
Rate for Payer: Health Management Network Commercial	$192.95
Rate for Payer: Humana Medicare	$113.50
Rate for Payer: Kaiser Permanente Commercial	$204.30
Rate for Payer: Kaiser Permanente Medicaid	$115.77
Rate for Payer: Kaiser Permanente Medicare	$113.50
Rate for Payer: MDX Hawaii PPO	$220.19
Rate for Payer: Ohana Health Plan Medicaid	$113.50
Rate for Payer: Ohana Health Plan Medicare	$113.50
Rate for Payer: UnitedHealthcare Medicare	$113.50
Rate for Payer: University Health Alliance Commercial	$165.46

CATHETER RABINOV SIALOGRAPHY 0.016IN (US)

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	8886990
Hospital Revenue Code	272
Min. Negotiated Rate	$192.95
Max. Negotiated Rate	$220.19
Rate for Payer: Cash Price	$147.55
Rate for Payer: Health Management Network Commercial	$192.95
Rate for Payer: Kaiser Permanente Commercial	$204.30
Rate for Payer: MDX Hawaii PPO	$220.19

Know your out-of-pocket cost for care.

All Charges