Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

20600 Drain Inject Joint Bursa LT Charges

Facility

$1,180.00

Service Code	HCPCS 20600 LT
Hospital Charge Code	8221496
Hospital Revenue Code	761
Min. Negotiated Rate	$40.93
Max. Negotiated Rate	$1,144.60
Rate for Payer: AlohaCare Medicaid	$590.00
Rate for Payer: AlohaCare Medicare	$590.00
Rate for Payer: Cash Price	$767.00
Rate for Payer: Cash Price	$767.00
Rate for Payer: Devoted Health Medicare	$649.00
Rate for Payer: Hawaii Medical Service Association Medicare	$590.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,121.00
Rate for Payer: Health Management Network Commercial	$1,003.00
Rate for Payer: Humana Medicare	$590.00
Rate for Payer: Kaiser Permanente Commercial	$1,062.00
Rate for Payer: Kaiser Permanente Medicaid	$601.80
Rate for Payer: Kaiser Permanente Medicare	$590.00
Rate for Payer: MDX Hawaii PPO	$1,144.60
Rate for Payer: Ohana Health Plan Medicaid	$590.00
Rate for Payer: Ohana Health Plan Medicare	$590.00
Rate for Payer: UnitedHealthcare Medicaid	$40.93
Rate for Payer: UnitedHealthcare Medicare	$590.00
Rate for Payer: University Health Alliance Commercial	$860.10

20600 Drain Inject Joint Bursa LT Charges

Facility

$1,180.00

Service Code	HCPCS 20600 LT
Hospital Charge Code	8221496
Hospital Revenue Code	761
Min. Negotiated Rate	$1,003.00
Max. Negotiated Rate	$1,144.60
Rate for Payer: Cash Price	$767.00
Rate for Payer: Health Management Network Commercial	$1,003.00
Rate for Payer: Kaiser Permanente Commercial	$1,062.00
Rate for Payer: MDX Hawaii PPO	$1,144.60

20600 Drain Inject Joint Bursa RT Charges

Facility

$1,180.00

Service Code	HCPCS 20600 RT
Hospital Charge Code	8221497
Hospital Revenue Code	761
Min. Negotiated Rate	$1,003.00
Max. Negotiated Rate	$1,144.60
Rate for Payer: Cash Price	$767.00
Rate for Payer: Health Management Network Commercial	$1,003.00
Rate for Payer: Kaiser Permanente Commercial	$1,062.00
Rate for Payer: MDX Hawaii PPO	$1,144.60

20600 Drain Inject Joint Bursa RT Charges

Facility

$1,180.00

Service Code	HCPCS 20600 RT
Hospital Charge Code	8221497
Hospital Revenue Code	761
Min. Negotiated Rate	$40.93
Max. Negotiated Rate	$1,144.60
Rate for Payer: AlohaCare Medicaid	$590.00
Rate for Payer: AlohaCare Medicare	$590.00
Rate for Payer: Cash Price	$767.00
Rate for Payer: Cash Price	$767.00
Rate for Payer: Devoted Health Medicare	$649.00
Rate for Payer: Hawaii Medical Service Association Medicare	$590.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,121.00
Rate for Payer: Health Management Network Commercial	$1,003.00
Rate for Payer: Humana Medicare	$590.00
Rate for Payer: Kaiser Permanente Commercial	$1,062.00
Rate for Payer: Kaiser Permanente Medicaid	$601.80
Rate for Payer: Kaiser Permanente Medicare	$590.00
Rate for Payer: MDX Hawaii PPO	$1,144.60
Rate for Payer: Ohana Health Plan Medicaid	$590.00
Rate for Payer: Ohana Health Plan Medicare	$590.00
Rate for Payer: UnitedHealthcare Medicaid	$40.93
Rate for Payer: UnitedHealthcare Medicare	$590.00
Rate for Payer: University Health Alliance Commercial	$860.10

20600-Small Joint Aspirate/Inject w/o US

Facility

$1,100.00

Service Code	HCPCS 20600
Hospital Charge Code	8080227
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$550.00
Rate for Payer: Cash Price	$715.00
Rate for Payer: Cash Price	$715.00
Rate for Payer: Cash Price	$715.00
Rate for Payer: Devoted Health Medicare	$605.00
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$550.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,045.00
Rate for Payer: Health Management Network Commercial	$935.00
Rate for Payer: Humana Medicare	$550.00
Rate for Payer: Kaiser Permanente Commercial	$990.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$550.00
Rate for Payer: MDX Hawaii PPO	$1,067.00
Rate for Payer: Ohana Health Plan Medicaid	$550.00
Rate for Payer: Ohana Health Plan Medicare	$550.00
Rate for Payer: UnitedHealthcare Medicare	$550.00
Rate for Payer: University Health Alliance Commercial	$801.79

20600-Small Joint Aspirate/Inject w/o US

Facility

$1,100.00

Service Code	HCPCS 20600
Hospital Charge Code	8080227
Hospital Revenue Code	450
Min. Negotiated Rate	$935.00
Max. Negotiated Rate	$1,067.00
Rate for Payer: Cash Price	$715.00
Rate for Payer: Health Management Network Commercial	$935.00
Rate for Payer: Kaiser Permanente Commercial	$990.00
Rate for Payer: MDX Hawaii PPO	$1,067.00

20605 CT Aspiration Bursa Med Joint Charges

Facility

$805.00

Service Code	HCPCS 20605
Hospital Charge Code	8221485
Hospital Revenue Code	761
Min. Negotiated Rate	$42.08
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$402.50
Rate for Payer: AlohaCare Medicare	$402.50
Rate for Payer: Cash Price	$523.25
Rate for Payer: Cash Price	$523.25
Rate for Payer: Cash Price	$523.25
Rate for Payer: Devoted Health Medicare	$442.75
Rate for Payer: Hawaii Medical Service Association Commercial	$392.00
Rate for Payer: Hawaii Medical Service Association Medicare	$402.50
Rate for Payer: Hawaii Western Management Group Commercial	$764.75
Rate for Payer: Health Management Network Commercial	$684.25
Rate for Payer: Humana Medicare	$402.50
Rate for Payer: Kaiser Permanente Commercial	$724.50
Rate for Payer: Kaiser Permanente Medicaid	$410.55
Rate for Payer: Kaiser Permanente Medicare	$402.50
Rate for Payer: MDX Hawaii PPO	$780.85
Rate for Payer: Ohana Health Plan Medicaid	$402.50
Rate for Payer: Ohana Health Plan Medicare	$402.50
Rate for Payer: UnitedHealthcare Medicaid	$42.08
Rate for Payer: UnitedHealthcare Medicare	$402.50
Rate for Payer: University Health Alliance Commercial	$4,035.20

20605 CT Aspiration Bursa Med Joint Charges

Facility

$805.00

Service Code	HCPCS 20605
Hospital Charge Code	8221485
Hospital Revenue Code	761
Min. Negotiated Rate	$684.25
Max. Negotiated Rate	$780.85
Rate for Payer: Cash Price	$523.25
Rate for Payer: Health Management Network Commercial	$684.25
Rate for Payer: Kaiser Permanente Commercial	$724.50
Rate for Payer: MDX Hawaii PPO	$780.85

20605 Drain Inj Interm JT Bursa Bil Charges

Facility

$805.00

Service Code	HCPCS 20605 50
Hospital Charge Code	8221489
Hospital Revenue Code	761
Min. Negotiated Rate	$684.25
Max. Negotiated Rate	$780.85
Rate for Payer: Cash Price	$523.25
Rate for Payer: Health Management Network Commercial	$684.25
Rate for Payer: Kaiser Permanente Commercial	$724.50
Rate for Payer: MDX Hawaii PPO	$780.85

20605 Drain Inj Interm JT Bursa Bil Charges

Facility

$805.00

Service Code	HCPCS 20605 50
Hospital Charge Code	8221489
Hospital Revenue Code	761
Min. Negotiated Rate	$42.08
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$402.50
Rate for Payer: AlohaCare Medicare	$402.50
Rate for Payer: Cash Price	$523.25
Rate for Payer: Cash Price	$523.25
Rate for Payer: Cash Price	$523.25
Rate for Payer: Devoted Health Medicare	$442.75
Rate for Payer: Hawaii Medical Service Association Medicare	$402.50
Rate for Payer: Hawaii Western Management Group Commercial	$764.75
Rate for Payer: Health Management Network Commercial	$684.25
Rate for Payer: Humana Medicare	$402.50
Rate for Payer: Kaiser Permanente Commercial	$724.50
Rate for Payer: Kaiser Permanente Medicaid	$410.55
Rate for Payer: Kaiser Permanente Medicare	$402.50
Rate for Payer: MDX Hawaii PPO	$780.85
Rate for Payer: Ohana Health Plan Medicaid	$402.50
Rate for Payer: Ohana Health Plan Medicare	$402.50
Rate for Payer: UnitedHealthcare Medicaid	$42.08
Rate for Payer: UnitedHealthcare Medicare	$402.50
Rate for Payer: University Health Alliance Commercial	$4,035.20

20605 Drain Inj Interm JT Bursa LT Charges

Facility

$805.00

Service Code	HCPCS 20605 LT
Hospital Charge Code	8221490
Hospital Revenue Code	761
Min. Negotiated Rate	$42.08
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$402.50
Rate for Payer: AlohaCare Medicare	$402.50
Rate for Payer: Cash Price	$523.25
Rate for Payer: Cash Price	$523.25
Rate for Payer: Cash Price	$523.25
Rate for Payer: Devoted Health Medicare	$442.75
Rate for Payer: Hawaii Medical Service Association Medicare	$402.50
Rate for Payer: Hawaii Western Management Group Commercial	$764.75
Rate for Payer: Health Management Network Commercial	$684.25
Rate for Payer: Humana Medicare	$402.50
Rate for Payer: Kaiser Permanente Commercial	$724.50
Rate for Payer: Kaiser Permanente Medicaid	$410.55
Rate for Payer: Kaiser Permanente Medicare	$402.50
Rate for Payer: MDX Hawaii PPO	$780.85
Rate for Payer: Ohana Health Plan Medicaid	$402.50
Rate for Payer: Ohana Health Plan Medicare	$402.50
Rate for Payer: UnitedHealthcare Medicaid	$42.08
Rate for Payer: UnitedHealthcare Medicare	$402.50
Rate for Payer: University Health Alliance Commercial	$4,035.20

20605 Drain Inj Interm JT Bursa LT Charges

Facility

$805.00

Service Code	HCPCS 20605 LT
Hospital Charge Code	8221490
Hospital Revenue Code	761
Min. Negotiated Rate	$684.25
Max. Negotiated Rate	$780.85
Rate for Payer: Cash Price	$523.25
Rate for Payer: Health Management Network Commercial	$684.25
Rate for Payer: Kaiser Permanente Commercial	$724.50
Rate for Payer: MDX Hawaii PPO	$780.85

20605 Drain Inj Interm JT Bursa RT Charges

Facility

$805.00

Service Code	HCPCS 20605 RT
Hospital Charge Code	8221491
Hospital Revenue Code	761
Min. Negotiated Rate	$684.25
Max. Negotiated Rate	$780.85
Rate for Payer: Cash Price	$523.25
Rate for Payer: Health Management Network Commercial	$684.25
Rate for Payer: Kaiser Permanente Commercial	$724.50
Rate for Payer: MDX Hawaii PPO	$780.85

20605 Drain Inj Interm JT Bursa RT Charges

Facility

$805.00

Service Code	HCPCS 20605 RT
Hospital Charge Code	8221491
Hospital Revenue Code	761
Min. Negotiated Rate	$42.08
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$402.50
Rate for Payer: AlohaCare Medicare	$402.50
Rate for Payer: Cash Price	$523.25
Rate for Payer: Cash Price	$523.25
Rate for Payer: Cash Price	$523.25
Rate for Payer: Devoted Health Medicare	$442.75
Rate for Payer: Hawaii Medical Service Association Medicare	$402.50
Rate for Payer: Hawaii Western Management Group Commercial	$764.75
Rate for Payer: Health Management Network Commercial	$684.25
Rate for Payer: Humana Medicare	$402.50
Rate for Payer: Kaiser Permanente Commercial	$724.50
Rate for Payer: Kaiser Permanente Medicaid	$410.55
Rate for Payer: Kaiser Permanente Medicare	$402.50
Rate for Payer: MDX Hawaii PPO	$780.85
Rate for Payer: Ohana Health Plan Medicaid	$402.50
Rate for Payer: Ohana Health Plan Medicare	$402.50
Rate for Payer: UnitedHealthcare Medicaid	$42.08
Rate for Payer: UnitedHealthcare Medicare	$402.50
Rate for Payer: University Health Alliance Commercial	$4,035.20

20605-Intermediate Aspiration/Inj w/o US

Facility

$805.00

Service Code	HCPCS 20605
Hospital Charge Code	8080229
Hospital Revenue Code	450
Min. Negotiated Rate	$684.25
Max. Negotiated Rate	$780.85
Rate for Payer: Cash Price	$523.25
Rate for Payer: Health Management Network Commercial	$684.25
Rate for Payer: Kaiser Permanente Commercial	$724.50
Rate for Payer: MDX Hawaii PPO	$780.85

20605-Intermediate Aspiration/Inj w/o US

Facility

$805.00

Service Code	HCPCS 20605
Hospital Charge Code	8080229
Hospital Revenue Code	450
Min. Negotiated Rate	$402.50
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$402.50
Rate for Payer: Cash Price	$523.25
Rate for Payer: Cash Price	$523.25
Rate for Payer: Cash Price	$523.25
Rate for Payer: Devoted Health Medicare	$442.75
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$402.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$764.75
Rate for Payer: Health Management Network Commercial	$684.25
Rate for Payer: Humana Medicare	$402.50
Rate for Payer: Kaiser Permanente Commercial	$724.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$402.50
Rate for Payer: MDX Hawaii PPO	$780.85
Rate for Payer: Ohana Health Plan Medicaid	$402.50
Rate for Payer: Ohana Health Plan Medicare	$402.50
Rate for Payer: UnitedHealthcare Medicare	$402.50
Rate for Payer: University Health Alliance Commercial	$4,035.20

20605 US Aspiration Bursa Med Joint Charges

Facility

$805.00

Service Code	HCPCS 20605
Hospital Charge Code	8221513
Hospital Revenue Code	761
Min. Negotiated Rate	$42.08
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$402.50
Rate for Payer: AlohaCare Medicare	$402.50
Rate for Payer: Cash Price	$523.25
Rate for Payer: Cash Price	$523.25
Rate for Payer: Cash Price	$523.25
Rate for Payer: Devoted Health Medicare	$442.75
Rate for Payer: Hawaii Medical Service Association Commercial	$392.00
Rate for Payer: Hawaii Medical Service Association Medicare	$402.50
Rate for Payer: Hawaii Western Management Group Commercial	$764.75
Rate for Payer: Health Management Network Commercial	$684.25
Rate for Payer: Humana Medicare	$402.50
Rate for Payer: Kaiser Permanente Commercial	$724.50
Rate for Payer: Kaiser Permanente Medicaid	$410.55
Rate for Payer: Kaiser Permanente Medicare	$402.50
Rate for Payer: MDX Hawaii PPO	$780.85
Rate for Payer: Ohana Health Plan Medicaid	$402.50
Rate for Payer: Ohana Health Plan Medicare	$402.50
Rate for Payer: UnitedHealthcare Medicaid	$42.08
Rate for Payer: UnitedHealthcare Medicare	$402.50
Rate for Payer: University Health Alliance Commercial	$4,035.20

20605 US Aspiration Bursa Med Joint Charges

Facility

$805.00

Service Code	HCPCS 20605
Hospital Charge Code	8221513
Hospital Revenue Code	761
Min. Negotiated Rate	$684.25
Max. Negotiated Rate	$780.85
Rate for Payer: Cash Price	$523.25
Rate for Payer: Health Management Network Commercial	$684.25
Rate for Payer: Kaiser Permanente Commercial	$724.50
Rate for Payer: MDX Hawaii PPO	$780.85

20606 ARTHROCENTESIS W US GUIDANCE

Facility

$1,342.00

Service Code	HCPCS 20606
Hospital Charge Code	9338524
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$671.00
Rate for Payer: AlohaCare Medicare	$671.00
Rate for Payer: Cash Price	$872.30
Rate for Payer: Cash Price	$872.30
Rate for Payer: Devoted Health Medicare	$738.10
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	$671.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$1,140.70
Rate for Payer: Humana Medicare	$671.00
Rate for Payer: Kaiser Permanente Commercial	$1,207.80
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$671.00
Rate for Payer: MDX Hawaii PPO	$1,301.74
Rate for Payer: Ohana Health Plan Medicaid	$671.00
Rate for Payer: Ohana Health Plan Medicare	$671.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$671.00
Rate for Payer: University Health Alliance Commercial	$978.18

20606 ARTHROCENTESIS W US GUIDANCE

Facility

$1,342.00

Service Code	HCPCS 20606
Hospital Charge Code	9338524
Hospital Revenue Code	361
Min. Negotiated Rate	$1,140.70
Max. Negotiated Rate	$1,301.74
Rate for Payer: Cash Price	$872.30
Rate for Payer: Health Management Network Commercial	$1,140.70
Rate for Payer: Kaiser Permanente Commercial	$1,207.80
Rate for Payer: MDX Hawaii PPO	$1,301.74

20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US TechFee

Facility

$747.00

Service Code	HCPCS 20610
Hospital Charge Code	8022756
Hospital Revenue Code	450
Min. Negotiated Rate	$373.50
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$373.50
Rate for Payer: Cash Price	$485.55
Rate for Payer: Cash Price	$485.55
Rate for Payer: Cash Price	$485.55
Rate for Payer: Devoted Health Medicare	$410.85
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	$373.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$709.65
Rate for Payer: Health Management Network Commercial	$634.95
Rate for Payer: Humana Medicare	$373.50
Rate for Payer: Kaiser Permanente Commercial	$672.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$373.50
Rate for Payer: MDX Hawaii PPO	$724.59
Rate for Payer: Ohana Health Plan Medicaid	$373.50
Rate for Payer: Ohana Health Plan Medicare	$373.50
Rate for Payer: UnitedHealthcare Medicare	$373.50
Rate for Payer: University Health Alliance Commercial	$4,035.20

20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US TechFee

Facility

$747.00

Service Code	HCPCS 20610
Hospital Charge Code	8022756
Hospital Revenue Code	450
Min. Negotiated Rate	$634.95
Max. Negotiated Rate	$724.59
Rate for Payer: Cash Price	$485.55
Rate for Payer: Health Management Network Commercial	$634.95
Rate for Payer: Kaiser Permanente Commercial	$672.30
Rate for Payer: MDX Hawaii PPO	$724.59

20610 Drain Inj Major JT Bursa Bil Charges

Facility

$747.00

Service Code	HCPCS 20610 50
Hospital Charge Code	8221492
Hospital Revenue Code	761
Min. Negotiated Rate	$48.79
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$373.50
Rate for Payer: AlohaCare Medicare	$373.50
Rate for Payer: Cash Price	$485.55
Rate for Payer: Cash Price	$485.55
Rate for Payer: Cash Price	$485.55
Rate for Payer: Devoted Health Medicare	$410.85
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	$373.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$709.65
Rate for Payer: Health Management Network Commercial	$634.95
Rate for Payer: Humana Medicare	$373.50
Rate for Payer: Kaiser Permanente Commercial	$672.30
Rate for Payer: Kaiser Permanente Medicaid	$380.97
Rate for Payer: Kaiser Permanente Medicare	$373.50
Rate for Payer: MDX Hawaii PPO	$724.59
Rate for Payer: Ohana Health Plan Medicaid	$373.50
Rate for Payer: Ohana Health Plan Medicare	$373.50
Rate for Payer: UnitedHealthcare Medicaid	$48.79
Rate for Payer: UnitedHealthcare Medicare	$373.50
Rate for Payer: University Health Alliance Commercial	$4,035.20

20610 Drain Inj Major JT Bursa Bil Charges

Facility

$747.00

Service Code	HCPCS 20610 50
Hospital Charge Code	8221492
Hospital Revenue Code	761
Min. Negotiated Rate	$634.95
Max. Negotiated Rate	$724.59
Rate for Payer: Cash Price	$485.55
Rate for Payer: Health Management Network Commercial	$634.95
Rate for Payer: Kaiser Permanente Commercial	$672.30
Rate for Payer: MDX Hawaii PPO	$724.59

20610 Drain Inj Major JT Bursa LT Charges

Facility

$747.00

Service Code	HCPCS 20610 LT
Hospital Charge Code	8221493
Hospital Revenue Code	761
Min. Negotiated Rate	$634.95
Max. Negotiated Rate	$724.59
Rate for Payer: Cash Price	$485.55
Rate for Payer: Health Management Network Commercial	$634.95
Rate for Payer: Kaiser Permanente Commercial	$672.30
Rate for Payer: MDX Hawaii PPO	$724.59

Know your out-of-pocket cost for care.

All Charges