Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

CATHETER THORACIC 40FR STRAIGHT

Facility

$47.00

Service Code	HCPCS C1725
Hospital Charge Code	8266701
Hospital Revenue Code	272
Min. Negotiated Rate	$39.95
Max. Negotiated Rate	$45.59
Rate for Payer: Cash Price	$30.55
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Kaiser Permanente Commercial	$42.30
Rate for Payer: MDX Hawaii PPO	$45.59

CATHETER THORACIC 40FR STRAIGHT

Facility

$47.00

Service Code	HCPCS C1725
Hospital Charge Code	8266701
Hospital Revenue Code	272
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$45.59
Rate for Payer: AlohaCare Medicaid	$23.50
Rate for Payer: AlohaCare Medicare	$23.50
Rate for Payer: Cash Price	$30.55
Rate for Payer: Devoted Health Medicare	$25.85
Rate for Payer: Hawaii Medical Service Association Medicare	$23.50
Rate for Payer: Hawaii Western Management Group Commercial	$44.65
Rate for Payer: Health Management Network Commercial	$39.95
Rate for Payer: Humana Medicare	$23.50
Rate for Payer: Kaiser Permanente Commercial	$42.30
Rate for Payer: Kaiser Permanente Medicaid	$23.97
Rate for Payer: Kaiser Permanente Medicare	$23.50
Rate for Payer: MDX Hawaii PPO	$45.59
Rate for Payer: Ohana Health Plan Medicaid	$23.50
Rate for Payer: Ohana Health Plan Medicare	$23.50
Rate for Payer: UnitedHealthcare Medicare	$23.50
Rate for Payer: University Health Alliance Commercial	$34.26

Cath Urine Culture

Facility

$82.00

Service Code	HCPCS 87086
Hospital Charge Code	12514768
Hospital Revenue Code	306
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$79.54
Rate for Payer: Cash Price	$53.30
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: MDX Hawaii PPO	$79.54

Cath Urine Culture

Facility

$82.00

Service Code	HCPCS 87086
Hospital Charge Code	12514768
Hospital Revenue Code	306
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$79.54
Rate for Payer: AlohaCare Medicaid	$41.00
Rate for Payer: AlohaCare Medicare	$41.00
Rate for Payer: Cash Price	$53.30
Rate for Payer: Cash Price	$53.30
Rate for Payer: Devoted Health Medicare	$45.10
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.09
Rate for Payer: Hawaii Medical Service Association Medicare	$41.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.72
Rate for Payer: Hawaii Western Management Group Commercial	$8.07
Rate for Payer: Health Management Network Commercial	$69.70
Rate for Payer: Humana Medicare	$41.00
Rate for Payer: Kaiser Permanente Commercial	$73.80
Rate for Payer: Kaiser Permanente Medicaid	$41.82
Rate for Payer: Kaiser Permanente Medicare	$41.00
Rate for Payer: MDX Hawaii PPO	$79.54
Rate for Payer: Ohana Health Plan Medicaid	$41.00
Rate for Payer: Ohana Health Plan Medicare	$41.00
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$41.00
Rate for Payer: University Health Alliance Commercial	$20.87

Cat Scratch Fever Antibody

Facility

$113.00

Service Code	HCPCS 86611
Hospital Charge Code	10597302
Hospital Revenue Code	302
Min. Negotiated Rate	$96.05
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$73.45
Rate for Payer: Health Management Network Commercial	$96.05
Rate for Payer: Kaiser Permanente Commercial	$101.70
Rate for Payer: MDX Hawaii PPO	$109.61

Cat Scratch Fever Antibody

Facility

$113.00

Service Code	HCPCS 86611
Hospital Charge Code	10597302
Hospital Revenue Code	302
Min. Negotiated Rate	$10.18
Max. Negotiated Rate	$109.61
Rate for Payer: AlohaCare Medicaid	$56.50
Rate for Payer: AlohaCare Medicare	$56.50
Rate for Payer: Cash Price	$73.45
Rate for Payer: Cash Price	$73.45
Rate for Payer: Devoted Health Medicare	$62.15
Rate for Payer: Hawaii Medical Service Association ABD	$14.22
Rate for Payer: Hawaii Medical Service Association Commercial	$12.72
Rate for Payer: Hawaii Medical Service Association Medicare	$56.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.93
Rate for Payer: Hawaii Western Management Group Commercial	$10.18
Rate for Payer: Health Management Network Commercial	$96.05
Rate for Payer: Humana Medicare	$56.50
Rate for Payer: Kaiser Permanente Commercial	$101.70
Rate for Payer: Kaiser Permanente Medicaid	$57.63
Rate for Payer: Kaiser Permanente Medicare	$56.50
Rate for Payer: MDX Hawaii PPO	$109.61
Rate for Payer: Ohana Health Plan Medicaid	$56.50
Rate for Payer: Ohana Health Plan Medicare	$56.50
Rate for Payer: UnitedHealthcare Medicaid	$14.22
Rate for Payer: UnitedHealthcare Medicare	$56.50
Rate for Payer: University Health Alliance Commercial	$26.31

Cat Scratch Fever Antibody FSI

Facility

$118.00

Service Code	HCPCS 86611
Hospital Charge Code	10594218
Hospital Revenue Code	302
Min. Negotiated Rate	$100.30
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$76.70
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: MDX Hawaii PPO	$114.46

Cat Scratch Fever Antibody FSI

Facility

$118.00

Service Code	HCPCS 86611
Hospital Charge Code	10594218
Hospital Revenue Code	302
Min. Negotiated Rate	$10.18
Max. Negotiated Rate	$114.46
Rate for Payer: AlohaCare Medicaid	$59.00
Rate for Payer: AlohaCare Medicare	$59.00
Rate for Payer: Cash Price	$76.70
Rate for Payer: Cash Price	$76.70
Rate for Payer: Devoted Health Medicare	$64.90
Rate for Payer: Hawaii Medical Service Association ABD	$14.22
Rate for Payer: Hawaii Medical Service Association Commercial	$12.72
Rate for Payer: Hawaii Medical Service Association Medicare	$59.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.93
Rate for Payer: Hawaii Western Management Group Commercial	$10.18
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Humana Medicare	$59.00
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: Kaiser Permanente Medicaid	$60.18
Rate for Payer: Kaiser Permanente Medicare	$59.00
Rate for Payer: MDX Hawaii PPO	$114.46
Rate for Payer: Ohana Health Plan Medicaid	$59.00
Rate for Payer: Ohana Health Plan Medicare	$59.00
Rate for Payer: UnitedHealthcare Medicaid	$14.22
Rate for Payer: UnitedHealthcare Medicare	$59.00
Rate for Payer: University Health Alliance Commercial	$26.31

CAUTERY EDGE BLADE ELECTRODE 6.5 INCH 16.51 CM

Facility

$28.00

Hospital Charge Code	8274367
Hospital Revenue Code	272
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$27.16
Rate for Payer: AlohaCare Medicaid	$14.00
Rate for Payer: AlohaCare Medicare	$14.00
Rate for Payer: Cash Price	$18.20
Rate for Payer: Devoted Health Medicare	$15.40
Rate for Payer: Hawaii Medical Service Association Medicare	$14.00
Rate for Payer: Hawaii Western Management Group Commercial	$26.60
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Humana Medicare	$14.00
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Medicaid	$14.28
Rate for Payer: Kaiser Permanente Medicare	$14.00
Rate for Payer: MDX Hawaii PPO	$27.16
Rate for Payer: Ohana Health Plan Medicaid	$14.00
Rate for Payer: Ohana Health Plan Medicare	$14.00
Rate for Payer: UnitedHealthcare Medicare	$14.00
Rate for Payer: University Health Alliance Commercial	$20.41

CAUTERY EDGE BLADE ELECTRODE 6.5 INCH 16.51 CM

Facility

$28.00

Hospital Charge Code	8274367
Hospital Revenue Code	272
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$18.20
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: MDX Hawaii PPO	$27.16

CAUTERY EDGE INSULATED BLADE ELECTRODE 4 INCH 10CM

Facility

$34.00

Hospital Charge Code	9655313
Hospital Revenue Code	272
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$32.98
Rate for Payer: AlohaCare Medicaid	$17.00
Rate for Payer: AlohaCare Medicare	$17.00
Rate for Payer: Cash Price	$22.10
Rate for Payer: Devoted Health Medicare	$18.70
Rate for Payer: Hawaii Medical Service Association Medicare	$17.00
Rate for Payer: Hawaii Western Management Group Commercial	$32.30
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Humana Medicare	$17.00
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: Kaiser Permanente Medicaid	$17.34
Rate for Payer: Kaiser Permanente Medicare	$17.00
Rate for Payer: MDX Hawaii PPO	$32.98
Rate for Payer: Ohana Health Plan Medicaid	$17.00
Rate for Payer: Ohana Health Plan Medicare	$17.00
Rate for Payer: UnitedHealthcare Medicare	$17.00
Rate for Payer: University Health Alliance Commercial	$24.78

CAUTERY EDGE INSULATED BLADE ELECTRODE 4 INCH 10CM

Facility

$34.00

Hospital Charge Code	9655313
Hospital Revenue Code	272
Min. Negotiated Rate	$28.90
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$22.10
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$32.98

CAUTERY, ELECTRODE HOOK

Facility

$182.00

Hospital Charge Code	8274260
Hospital Revenue Code	272
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$176.54
Rate for Payer: AlohaCare Medicaid	$91.00
Rate for Payer: AlohaCare Medicare	$91.00
Rate for Payer: Cash Price	$118.30
Rate for Payer: Devoted Health Medicare	$100.10
Rate for Payer: Hawaii Medical Service Association Medicare	$91.00
Rate for Payer: Hawaii Western Management Group Commercial	$172.90
Rate for Payer: Health Management Network Commercial	$154.70
Rate for Payer: Humana Medicare	$91.00
Rate for Payer: Kaiser Permanente Commercial	$163.80
Rate for Payer: Kaiser Permanente Medicaid	$92.82
Rate for Payer: Kaiser Permanente Medicare	$91.00
Rate for Payer: MDX Hawaii PPO	$176.54
Rate for Payer: Ohana Health Plan Medicaid	$91.00
Rate for Payer: Ohana Health Plan Medicare	$91.00
Rate for Payer: UnitedHealthcare Medicare	$91.00
Rate for Payer: University Health Alliance Commercial	$132.66

CAUTERY, ELECTRODE HOOK

Facility

$182.00

Hospital Charge Code	8274260
Hospital Revenue Code	272
Min. Negotiated Rate	$154.70
Max. Negotiated Rate	$176.54
Rate for Payer: Cash Price	$118.30
Rate for Payer: Health Management Network Commercial	$154.70
Rate for Payer: Kaiser Permanente Commercial	$163.80
Rate for Payer: MDX Hawaii PPO	$176.54

CAUTERY, ELECTRODES E1564 LLETZ TUNGSTEN 5MM BALL

Facility

$76.00

Hospital Charge Code	8274264
Hospital Revenue Code	272
Min. Negotiated Rate	$38.00
Max. Negotiated Rate	$73.72
Rate for Payer: AlohaCare Medicaid	$38.00
Rate for Payer: AlohaCare Medicare	$38.00
Rate for Payer: Cash Price	$49.40
Rate for Payer: Devoted Health Medicare	$41.80
Rate for Payer: Hawaii Medical Service Association Medicare	$38.00
Rate for Payer: Hawaii Western Management Group Commercial	$72.20
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Humana Medicare	$38.00
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: Kaiser Permanente Medicaid	$38.76
Rate for Payer: Kaiser Permanente Medicare	$38.00
Rate for Payer: MDX Hawaii PPO	$73.72
Rate for Payer: Ohana Health Plan Medicaid	$38.00
Rate for Payer: Ohana Health Plan Medicare	$38.00
Rate for Payer: UnitedHealthcare Medicare	$38.00
Rate for Payer: University Health Alliance Commercial	$55.40

CAUTERY, ELECTRODES E1564 LLETZ TUNGSTEN 5MM BALL

Facility

$76.00

Hospital Charge Code	8274264
Hospital Revenue Code	272
Min. Negotiated Rate	$64.60
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$49.40
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: MDX Hawaii PPO	$73.72

CAUTERY, ELECTRODES LEEP 15MM X 12MM LOOP

Facility

$76.00

Hospital Charge Code	8274265
Hospital Revenue Code	272
Min. Negotiated Rate	$38.00
Max. Negotiated Rate	$73.72
Rate for Payer: AlohaCare Medicaid	$38.00
Rate for Payer: AlohaCare Medicare	$38.00
Rate for Payer: Cash Price	$49.40
Rate for Payer: Devoted Health Medicare	$41.80
Rate for Payer: Hawaii Medical Service Association Medicare	$38.00
Rate for Payer: Hawaii Western Management Group Commercial	$72.20
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Humana Medicare	$38.00
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: Kaiser Permanente Medicaid	$38.76
Rate for Payer: Kaiser Permanente Medicare	$38.00
Rate for Payer: MDX Hawaii PPO	$73.72
Rate for Payer: Ohana Health Plan Medicaid	$38.00
Rate for Payer: Ohana Health Plan Medicare	$38.00
Rate for Payer: UnitedHealthcare Medicare	$38.00
Rate for Payer: University Health Alliance Commercial	$55.40

CAUTERY, ELECTRODES LEEP 15MM X 12MM LOOP

Facility

$76.00

Hospital Charge Code	8274265
Hospital Revenue Code	272
Min. Negotiated Rate	$64.60
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$49.40
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: MDX Hawaii PPO	$73.72

CAUTERY, ELECTRODES LEEP 20MM X 12MM LOOP

Facility

$95.00

Hospital Charge Code	8274261
Hospital Revenue Code	272
Min. Negotiated Rate	$47.50
Max. Negotiated Rate	$92.15
Rate for Payer: AlohaCare Medicaid	$47.50
Rate for Payer: AlohaCare Medicare	$47.50
Rate for Payer: Cash Price	$61.75
Rate for Payer: Devoted Health Medicare	$52.25
Rate for Payer: Hawaii Medical Service Association Medicare	$47.50
Rate for Payer: Hawaii Western Management Group Commercial	$90.25
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Humana Medicare	$47.50
Rate for Payer: Kaiser Permanente Commercial	$85.50
Rate for Payer: Kaiser Permanente Medicaid	$48.45
Rate for Payer: Kaiser Permanente Medicare	$47.50
Rate for Payer: MDX Hawaii PPO	$92.15
Rate for Payer: Ohana Health Plan Medicaid	$47.50
Rate for Payer: Ohana Health Plan Medicare	$47.50
Rate for Payer: UnitedHealthcare Medicare	$47.50
Rate for Payer: University Health Alliance Commercial	$69.25

CAUTERY, ELECTRODES LEEP 20MM X 12MM LOOP

Facility

$95.00

Hospital Charge Code	8274261
Hospital Revenue Code	272
Min. Negotiated Rate	$80.75
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$61.75
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Kaiser Permanente Commercial	$85.50
Rate for Payer: MDX Hawaii PPO	$92.15

CAUTERY, ELECTRODES LEEP 20MMX15MM LOOP

Facility

$76.00

Hospital Charge Code	8274262
Hospital Revenue Code	272
Min. Negotiated Rate	$38.00
Max. Negotiated Rate	$73.72
Rate for Payer: AlohaCare Medicaid	$38.00
Rate for Payer: AlohaCare Medicare	$38.00
Rate for Payer: Cash Price	$49.40
Rate for Payer: Devoted Health Medicare	$41.80
Rate for Payer: Hawaii Medical Service Association Medicare	$38.00
Rate for Payer: Hawaii Western Management Group Commercial	$72.20
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Humana Medicare	$38.00
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: Kaiser Permanente Medicaid	$38.76
Rate for Payer: Kaiser Permanente Medicare	$38.00
Rate for Payer: MDX Hawaii PPO	$73.72
Rate for Payer: Ohana Health Plan Medicaid	$38.00
Rate for Payer: Ohana Health Plan Medicare	$38.00
Rate for Payer: UnitedHealthcare Medicare	$38.00
Rate for Payer: University Health Alliance Commercial	$55.40

CAUTERY, ELECTRODES LEEP 20MMX15MM LOOP

Facility

$76.00

Hospital Charge Code	8274262
Hospital Revenue Code	272
Min. Negotiated Rate	$64.60
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$49.40
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: MDX Hawaii PPO	$73.72

CAUTERY, ELECTRODES LEEP 3MM BALL

Facility

$76.00

Hospital Charge Code	8274263
Hospital Revenue Code	272
Min. Negotiated Rate	$64.60
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$49.40
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: MDX Hawaii PPO	$73.72

CAUTERY, ELECTRODES LEEP 3MM BALL

Facility

$76.00

Hospital Charge Code	8274263
Hospital Revenue Code	272
Min. Negotiated Rate	$38.00
Max. Negotiated Rate	$73.72
Rate for Payer: AlohaCare Medicaid	$38.00
Rate for Payer: AlohaCare Medicare	$38.00
Rate for Payer: Cash Price	$49.40
Rate for Payer: Devoted Health Medicare	$41.80
Rate for Payer: Hawaii Medical Service Association Medicare	$38.00
Rate for Payer: Hawaii Western Management Group Commercial	$72.20
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Humana Medicare	$38.00
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: Kaiser Permanente Medicaid	$38.76
Rate for Payer: Kaiser Permanente Medicare	$38.00
Rate for Payer: MDX Hawaii PPO	$73.72
Rate for Payer: Ohana Health Plan Medicaid	$38.00
Rate for Payer: Ohana Health Plan Medicare	$38.00
Rate for Payer: UnitedHealthcare Medicare	$38.00
Rate for Payer: University Health Alliance Commercial	$55.40

CAUTERY, HANDSWITCHING PENCIL

Facility

$36.00

Hospital Charge Code	8274434
Hospital Revenue Code	270
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$34.92
Rate for Payer: AlohaCare Medicaid	$18.00
Rate for Payer: AlohaCare Medicare	$18.00
Rate for Payer: Cash Price	$23.40
Rate for Payer: Devoted Health Medicare	$19.80
Rate for Payer: Hawaii Medical Service Association Medicare	$18.00
Rate for Payer: Hawaii Western Management Group Commercial	$34.20
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Humana Medicare	$18.00
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: Kaiser Permanente Medicare	$18.00
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: Ohana Health Plan Medicaid	$18.00
Rate for Payer: Ohana Health Plan Medicare	$18.00
Rate for Payer: UnitedHealthcare Medicare	$18.00
Rate for Payer: University Health Alliance Commercial	$26.24

Know your out-of-pocket cost for care.

All Charges