Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

CESAREAN SECTION WITH STERILIZATION WITH CC

Facility

$20,549.78

Service Code	MSDRG 784
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$20,549.78
Rate for Payer: Hawaii Medical Service Association Commercial	$20,549.78
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION WITH STERILIZATION WITH MCC

Facility

$20,549.78

Service Code	MSDRG 783
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$20,549.78
Rate for Payer: Hawaii Medical Service Association Commercial	$20,549.78
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: University Health Alliance Commercial	$9,950.00

CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC

Facility

$18,204.14

Service Code	MSDRG 785
Min. Negotiated Rate	$7,800.00
Max. Negotiated Rate	$18,204.14
Rate for Payer: Hawaii Medical Service Association Commercial	$18,204.14
Rate for Payer: Hawaii Western Management Group Commercial	$7,800.00
Rate for Payer: University Health Alliance Commercial	$9,950.00

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC

Facility

$62,363.22

Service Code	MSDRG 837
Min. Negotiated Rate	$62,363.22
Max. Negotiated Rate	$62,363.22
Rate for Payer: Hawaii Medical Service Association Commercial	$62,363.22

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT

Facility

$62,363.22

Service Code	MSDRG 838
Min. Negotiated Rate	$62,363.22
Max. Negotiated Rate	$62,363.22
Rate for Payer: Hawaii Medical Service Association Commercial	$62,363.22

CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$62,363.22

Service Code	MSDRG 839
Min. Negotiated Rate	$62,363.22
Max. Negotiated Rate	$62,363.22
Rate for Payer: Hawaii Medical Service Association Commercial	$62,363.22

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC

Facility

$19,912.38

Service Code	MSDRG 847
Min. Negotiated Rate	$19,912.38
Max. Negotiated Rate	$19,912.38
Rate for Payer: Hawaii Medical Service Association Commercial	$19,912.38

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC

Facility

$19,912.38

Service Code	MSDRG 846
Min. Negotiated Rate	$19,912.38
Max. Negotiated Rate	$19,912.38
Rate for Payer: Hawaii Medical Service Association Commercial	$19,912.38

CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC

Facility

$19,912.38

Service Code	MSDRG 848
Min. Negotiated Rate	$19,912.38
Max. Negotiated Rate	$19,912.38
Rate for Payer: Hawaii Medical Service Association Commercial	$19,912.38

CHEST PAIN

Facility

$12,314.57

Service Code	MSDRG 313
Min. Negotiated Rate	$12,314.57
Max. Negotiated Rate	$12,314.57
Rate for Payer: Hawaii Medical Service Association Commercial	$12,314.57

Chest Tube Insertion..

Facility

$3,290.00

Service Code	HCPCS 32551
Hospital Charge Code	7998888
Hospital Revenue Code	761
Min. Negotiated Rate	$2,796.50
Max. Negotiated Rate	$3,191.30
Rate for Payer: Cash Price	$2,138.50
Rate for Payer: Health Management Network Commercial	$2,796.50
Rate for Payer: Kaiser Permanente Commercial	$2,961.00
Rate for Payer: MDX Hawaii PPO	$3,191.30

Chest Tube Insertion..

Facility

$3,290.00

Service Code	HCPCS 32551
Hospital Charge Code	7998888
Hospital Revenue Code	761
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,191.30
Rate for Payer: AlohaCare Medicaid	$1,645.00
Rate for Payer: AlohaCare Medicare	$1,645.00
Rate for Payer: Cash Price	$2,138.50
Rate for Payer: Cash Price	$2,138.50
Rate for Payer: Devoted Health Medicare	$1,809.50
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	$1,645.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,125.50
Rate for Payer: Health Management Network Commercial	$2,796.50
Rate for Payer: Humana Medicare	$1,645.00
Rate for Payer: Kaiser Permanente Commercial	$2,961.00
Rate for Payer: Kaiser Permanente Medicaid	$1,677.90
Rate for Payer: Kaiser Permanente Medicare	$1,645.00
Rate for Payer: MDX Hawaii PPO	$3,191.30
Rate for Payer: Ohana Health Plan Medicaid	$1,645.00
Rate for Payer: Ohana Health Plan Medicare	$1,645.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,645.00
Rate for Payer: University Health Alliance Commercial	$2,398.08

CHEST WALL MANIPULATION INITITAL CHARGE

Facility

$350.00

Service Code	HCPCS 94667
Hospital Charge Code	8243384
Hospital Revenue Code	410
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$339.50
Rate for Payer: Cash Price	$227.50
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: MDX Hawaii PPO	$339.50

CHEST WALL MANIPULATION INITITAL CHARGE

Facility

$350.00

Service Code	HCPCS 94667
Hospital Charge Code	8243384
Hospital Revenue Code	410
Min. Negotiated Rate	$20.34
Max. Negotiated Rate	$339.50
Rate for Payer: AlohaCare Medicaid	$175.00
Rate for Payer: AlohaCare Medicare	$175.00
Rate for Payer: Cash Price	$227.50
Rate for Payer: Cash Price	$227.50
Rate for Payer: Devoted Health Medicare	$192.50
Rate for Payer: Hawaii Medical Service Association Commercial	$169.91
Rate for Payer: Hawaii Medical Service Association Medicare	$175.00
Rate for Payer: Hawaii Western Management Group Commercial	$332.50
Rate for Payer: Health Management Network Commercial	$297.50
Rate for Payer: Humana Medicare	$175.00
Rate for Payer: Kaiser Permanente Commercial	$315.00
Rate for Payer: Kaiser Permanente Medicaid	$178.50
Rate for Payer: Kaiser Permanente Medicare	$175.00
Rate for Payer: MDX Hawaii PPO	$339.50
Rate for Payer: Ohana Health Plan Medicaid	$175.00
Rate for Payer: Ohana Health Plan Medicare	$175.00
Rate for Payer: UnitedHealthcare Medicaid	$20.34
Rate for Payer: UnitedHealthcare Medicare	$175.00
Rate for Payer: University Health Alliance Commercial	$255.12

CHEST WALL MANIPULATION SUBSEQUENT CHARGE

Facility

$255.00

Service Code	HCPCS 94668
Hospital Charge Code	8243386
Hospital Revenue Code	410
Min. Negotiated Rate	$216.75
Max. Negotiated Rate	$247.35
Rate for Payer: Cash Price	$165.75
Rate for Payer: Health Management Network Commercial	$216.75
Rate for Payer: Kaiser Permanente Commercial	$229.50
Rate for Payer: MDX Hawaii PPO	$247.35

CHEST WALL MANIPULATION SUBSEQUENT CHARGE

Facility

$255.00

Service Code	HCPCS 94668
Hospital Charge Code	8243386
Hospital Revenue Code	410
Min. Negotiated Rate	$16.41
Max. Negotiated Rate	$247.35
Rate for Payer: AlohaCare Medicaid	$127.50
Rate for Payer: AlohaCare Medicare	$127.50
Rate for Payer: Cash Price	$165.75
Rate for Payer: Cash Price	$165.75
Rate for Payer: Devoted Health Medicare	$140.25
Rate for Payer: Hawaii Medical Service Association Commercial	$169.91
Rate for Payer: Hawaii Medical Service Association Medicare	$127.50
Rate for Payer: Hawaii Western Management Group Commercial	$242.25
Rate for Payer: Health Management Network Commercial	$216.75
Rate for Payer: Humana Medicare	$127.50
Rate for Payer: Kaiser Permanente Commercial	$229.50
Rate for Payer: Kaiser Permanente Medicaid	$130.05
Rate for Payer: Kaiser Permanente Medicare	$127.50
Rate for Payer: MDX Hawaii PPO	$247.35
Rate for Payer: Ohana Health Plan Medicaid	$127.50
Rate for Payer: Ohana Health Plan Medicare	$127.50
Rate for Payer: UnitedHealthcare Medicaid	$16.41
Rate for Payer: UnitedHealthcare Medicare	$127.50
Rate for Payer: University Health Alliance Commercial	$185.87

Chlamydia Culture FSI

Facility

$224.00

Service Code	HCPCS 87110
Hospital Charge Code	9700505
Hospital Revenue Code	306
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$217.28
Rate for Payer: AlohaCare Medicaid	$112.00
Rate for Payer: AlohaCare Medicare	$112.00
Rate for Payer: Cash Price	$145.60
Rate for Payer: Cash Price	$145.60
Rate for Payer: Devoted Health Medicare	$123.20
Rate for Payer: Hawaii Medical Service Association ABD	$27.08
Rate for Payer: Hawaii Medical Service Association Commercial	$24.50
Rate for Payer: Hawaii Medical Service Association Medicare	$112.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.43
Rate for Payer: Hawaii Western Management Group Commercial	$19.60
Rate for Payer: Health Management Network Commercial	$190.40
Rate for Payer: Humana Medicare	$112.00
Rate for Payer: Kaiser Permanente Commercial	$201.60
Rate for Payer: Kaiser Permanente Medicaid	$114.24
Rate for Payer: Kaiser Permanente Medicare	$112.00
Rate for Payer: MDX Hawaii PPO	$217.28
Rate for Payer: Ohana Health Plan Medicaid	$112.00
Rate for Payer: Ohana Health Plan Medicare	$112.00
Rate for Payer: UnitedHealthcare Medicaid	$27.08
Rate for Payer: UnitedHealthcare Medicare	$112.00
Rate for Payer: University Health Alliance Commercial	$50.63

Chlamydia Culture FSI

Facility

$224.00

Service Code	HCPCS 87110
Hospital Charge Code	9700505
Hospital Revenue Code	306
Min. Negotiated Rate	$190.40
Max. Negotiated Rate	$217.28
Rate for Payer: Cash Price	$145.60
Rate for Payer: Health Management Network Commercial	$190.40
Rate for Payer: Kaiser Permanente Commercial	$201.60
Rate for Payer: MDX Hawaii PPO	$217.28

Chlamydia Trachomatis and Neisseria Gonorrheae Nucleic Acid Amplification TMA Method FSI

Facility

$365.00

Service Code	HCPCS 87491
Hospital Charge Code	8117880
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$354.05
Rate for Payer: AlohaCare Medicaid	$182.50
Rate for Payer: AlohaCare Medicare	$182.50
Rate for Payer: Cash Price	$237.25
Rate for Payer: Cash Price	$237.25
Rate for Payer: Devoted Health Medicare	$200.75
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$182.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$310.25
Rate for Payer: Humana Medicare	$182.50
Rate for Payer: Kaiser Permanente Commercial	$328.50
Rate for Payer: Kaiser Permanente Medicaid	$186.15
Rate for Payer: Kaiser Permanente Medicare	$182.50
Rate for Payer: MDX Hawaii PPO	$354.05
Rate for Payer: Ohana Health Plan Medicaid	$182.50
Rate for Payer: Ohana Health Plan Medicare	$182.50
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$182.50
Rate for Payer: University Health Alliance Commercial	$90.72

Chlamydia Trachomatis and Neisseria Gonorrheae Nucleic Acid Amplification TMA Method FSI

Facility

$365.00

Service Code	HCPCS 87491
Hospital Charge Code	8117880
Hospital Revenue Code	306
Min. Negotiated Rate	$310.25
Max. Negotiated Rate	$354.05
Rate for Payer: Cash Price	$237.25
Rate for Payer: Health Management Network Commercial	$310.25
Rate for Payer: Kaiser Permanente Commercial	$328.50
Rate for Payer: MDX Hawaii PPO	$354.05

Chlamydia trachomatis Nucleic Acid Amplication Testing TMA FSI

Facility

$365.00

Service Code	HCPCS 87491
Hospital Charge Code	8117881
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$354.05
Rate for Payer: AlohaCare Medicaid	$182.50
Rate for Payer: AlohaCare Medicare	$182.50
Rate for Payer: Cash Price	$237.25
Rate for Payer: Cash Price	$237.25
Rate for Payer: Devoted Health Medicare	$200.75
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$182.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$310.25
Rate for Payer: Humana Medicare	$182.50
Rate for Payer: Kaiser Permanente Commercial	$328.50
Rate for Payer: Kaiser Permanente Medicaid	$186.15
Rate for Payer: Kaiser Permanente Medicare	$182.50
Rate for Payer: MDX Hawaii PPO	$354.05
Rate for Payer: Ohana Health Plan Medicaid	$182.50
Rate for Payer: Ohana Health Plan Medicare	$182.50
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$182.50
Rate for Payer: University Health Alliance Commercial	$90.72

Chlamydia trachomatis Nucleic Acid Amplication Testing TMA FSI

Facility

$365.00

Service Code	HCPCS 87491
Hospital Charge Code	8117881
Hospital Revenue Code	306
Min. Negotiated Rate	$310.25
Max. Negotiated Rate	$354.05
Rate for Payer: Cash Price	$237.25
Rate for Payer: Health Management Network Commercial	$310.25
Rate for Payer: Kaiser Permanente Commercial	$328.50
Rate for Payer: MDX Hawaii PPO	$354.05

chlordiazePOXIDE 25 mg capsule [HHSC]

Facility

$3.72

Service Code	NDC 51079014120
Hospital Charge Code	2500172
Hospital Revenue Code	250
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$3.61
Rate for Payer: Cash Price	$2.42
Rate for Payer: Health Management Network Commercial	$3.16
Rate for Payer: Kaiser Permanente Commercial	$3.35
Rate for Payer: MDX Hawaii PPO	$3.61

chlordiazePOXIDE 25 mg capsule [HHSC]

Facility

$4.42

Service Code	NDC 60687080701
Hospital Charge Code	2500172
Hospital Revenue Code	250
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$4.29
Rate for Payer: AlohaCare Medicaid	$2.21
Rate for Payer: AlohaCare Medicare	$2.21
Rate for Payer: Cash Price	$2.87
Rate for Payer: Devoted Health Medicare	$2.43
Rate for Payer: Hawaii Medical Service Association Medicare	$2.21
Rate for Payer: Hawaii Western Management Group Commercial	$4.20
Rate for Payer: Health Management Network Commercial	$3.76
Rate for Payer: Humana Medicare	$2.21
Rate for Payer: Kaiser Permanente Commercial	$3.98
Rate for Payer: Kaiser Permanente Medicaid	$2.25
Rate for Payer: Kaiser Permanente Medicare	$2.21
Rate for Payer: MDX Hawaii PPO	$4.29
Rate for Payer: Ohana Health Plan Medicaid	$2.21
Rate for Payer: Ohana Health Plan Medicare	$2.21
Rate for Payer: UnitedHealthcare Medicaid	$2.65
Rate for Payer: UnitedHealthcare Medicare	$2.21
Rate for Payer: University Health Alliance Commercial	$3.22

chlordiazePOXIDE 25 mg capsule [HHSC]

Facility

$3.72

Service Code	NDC 51079014120
Hospital Charge Code	2500172
Hospital Revenue Code	250
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$3.61
Rate for Payer: UnitedHealthcare Medicaid	$2.23
Rate for Payer: AlohaCare Medicaid	$1.86
Rate for Payer: AlohaCare Medicare	$1.86
Rate for Payer: Cash Price	$2.42
Rate for Payer: Devoted Health Medicare	$2.05
Rate for Payer: Hawaii Medical Service Association Medicare	$1.86
Rate for Payer: Hawaii Western Management Group Commercial	$3.53
Rate for Payer: Health Management Network Commercial	$3.16
Rate for Payer: Humana Medicare	$1.86
Rate for Payer: Kaiser Permanente Commercial	$3.35
Rate for Payer: Kaiser Permanente Medicaid	$1.90
Rate for Payer: Kaiser Permanente Medicare	$1.86
Rate for Payer: MDX Hawaii PPO	$3.61
Rate for Payer: Ohana Health Plan Medicaid	$1.86
Rate for Payer: Ohana Health Plan Medicare	$1.86
Rate for Payer: UnitedHealthcare Medicare	$1.86
Rate for Payer: University Health Alliance Commercial	$2.71

Know your out-of-pocket cost for care.

All Charges