Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

COLLAR EXTRICATION REGULAR

Facility

$87.00

Hospital Charge Code	8266522
Hospital Revenue Code	274
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$84.39
Rate for Payer: AlohaCare Medicaid	$43.50
Rate for Payer: AlohaCare Medicare	$43.50
Rate for Payer: Cash Price	$56.55
Rate for Payer: Devoted Health Medicare	$47.85
Rate for Payer: Hawaii Medical Service Association Medicare	$43.50
Rate for Payer: Hawaii Western Management Group Commercial	$60.90
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$43.50
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$43.50
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$43.50
Rate for Payer: Ohana Health Plan Medicare	$43.50
Rate for Payer: UnitedHealthcare Medicare	$43.50
Rate for Payer: University Health Alliance Commercial	$48.72

COLLAR EXTRICATION REGULAR

Facility

$87.00

Hospital Charge Code	8266522
Hospital Revenue Code	274
Min. Negotiated Rate	$48.72
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$56.55
Rate for Payer: Hawaii Western Management Group Commercial	$60.90
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: University Health Alliance Commercial	$48.72

COLLAR EXTRICATION TALL

Facility

$61.00

Hospital Charge Code	8266523
Hospital Revenue Code	274
Min. Negotiated Rate	$34.16
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$39.65
Rate for Payer: Hawaii Western Management Group Commercial	$42.70
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: MDX Hawaii PPO	$59.17
Rate for Payer: University Health Alliance Commercial	$34.16

COLLAR EXTRICATION TALL

Facility

$61.00

Hospital Charge Code	8266523
Hospital Revenue Code	274
Min. Negotiated Rate	$30.50
Max. Negotiated Rate	$59.17
Rate for Payer: AlohaCare Medicaid	$30.50
Rate for Payer: AlohaCare Medicare	$30.50
Rate for Payer: Cash Price	$39.65
Rate for Payer: Devoted Health Medicare	$33.55
Rate for Payer: Hawaii Medical Service Association Medicare	$30.50
Rate for Payer: Hawaii Western Management Group Commercial	$42.70
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Humana Medicare	$30.50
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: Kaiser Permanente Medicaid	$31.11
Rate for Payer: Kaiser Permanente Medicare	$30.50
Rate for Payer: MDX Hawaii PPO	$59.17
Rate for Payer: Ohana Health Plan Medicaid	$30.50
Rate for Payer: Ohana Health Plan Medicare	$30.50
Rate for Payer: UnitedHealthcare Medicare	$30.50
Rate for Payer: University Health Alliance Commercial	$34.16

COLLAR MIAMI J PED 0-6 MO

Facility

$386.00

Service Code	HCPCS L0174
Hospital Charge Code	8500829
Hospital Revenue Code	274
Min. Negotiated Rate	$216.16
Max. Negotiated Rate	$374.42
Rate for Payer: Cash Price	$250.90
Rate for Payer: Hawaii Western Management Group Commercial	$270.20
Rate for Payer: Health Management Network Commercial	$328.10
Rate for Payer: Kaiser Permanente Commercial	$347.40
Rate for Payer: MDX Hawaii PPO	$374.42
Rate for Payer: University Health Alliance Commercial	$216.16

COLLAR MIAMI J PED 0-6 MO

Facility

$386.00

Service Code	HCPCS L0174
Hospital Charge Code	8500829
Hospital Revenue Code	274
Min. Negotiated Rate	$193.00
Max. Negotiated Rate	$374.42
Rate for Payer: AlohaCare Medicaid	$193.00
Rate for Payer: AlohaCare Medicare	$193.00
Rate for Payer: Cash Price	$250.90
Rate for Payer: Cash Price	$250.90
Rate for Payer: Devoted Health Medicare	$212.30
Rate for Payer: Hawaii Medical Service Association Medicare	$193.00
Rate for Payer: Hawaii Western Management Group Commercial	$270.20
Rate for Payer: Health Management Network Commercial	$328.10
Rate for Payer: Humana Medicare	$193.00
Rate for Payer: Kaiser Permanente Commercial	$347.40
Rate for Payer: Kaiser Permanente Medicaid	$196.86
Rate for Payer: Kaiser Permanente Medicare	$193.00
Rate for Payer: MDX Hawaii PPO	$374.42
Rate for Payer: Ohana Health Plan Medicaid	$193.00
Rate for Payer: Ohana Health Plan Medicare	$193.00
Rate for Payer: UnitedHealthcare Medicaid	$211.18
Rate for Payer: UnitedHealthcare Medicare	$193.00
Rate for Payer: University Health Alliance Commercial	$216.16

COLLAR MIAMI J PED 2YR-6YR

Facility

$386.00

Service Code	HCPCS L0174
Hospital Charge Code	8500830
Hospital Revenue Code	274
Min. Negotiated Rate	$193.00
Max. Negotiated Rate	$374.42
Rate for Payer: AlohaCare Medicaid	$193.00
Rate for Payer: AlohaCare Medicare	$193.00
Rate for Payer: Cash Price	$250.90
Rate for Payer: Cash Price	$250.90
Rate for Payer: Devoted Health Medicare	$212.30
Rate for Payer: Hawaii Medical Service Association Medicare	$193.00
Rate for Payer: Hawaii Western Management Group Commercial	$270.20
Rate for Payer: Health Management Network Commercial	$328.10
Rate for Payer: Humana Medicare	$193.00
Rate for Payer: Kaiser Permanente Commercial	$347.40
Rate for Payer: Kaiser Permanente Medicaid	$196.86
Rate for Payer: Kaiser Permanente Medicare	$193.00
Rate for Payer: MDX Hawaii PPO	$374.42
Rate for Payer: Ohana Health Plan Medicaid	$193.00
Rate for Payer: Ohana Health Plan Medicare	$193.00
Rate for Payer: UnitedHealthcare Medicaid	$211.18
Rate for Payer: UnitedHealthcare Medicare	$193.00
Rate for Payer: University Health Alliance Commercial	$216.16

COLLAR MIAMI J PED 2YR-6YR

Facility

$386.00

Service Code	HCPCS L0174
Hospital Charge Code	8500830
Hospital Revenue Code	274
Min. Negotiated Rate	$216.16
Max. Negotiated Rate	$374.42
Rate for Payer: Cash Price	$250.90
Rate for Payer: Hawaii Western Management Group Commercial	$270.20
Rate for Payer: Health Management Network Commercial	$328.10
Rate for Payer: Kaiser Permanente Commercial	$347.40
Rate for Payer: MDX Hawaii PPO	$374.42
Rate for Payer: University Health Alliance Commercial	$216.16

COLLAR MIAMI J PED 6MO-2YR

Facility

$386.00

Service Code	HCPCS L0174
Hospital Charge Code	8500831
Hospital Revenue Code	274
Min. Negotiated Rate	$193.00
Max. Negotiated Rate	$374.42
Rate for Payer: AlohaCare Medicaid	$193.00
Rate for Payer: AlohaCare Medicare	$193.00
Rate for Payer: Cash Price	$250.90
Rate for Payer: Cash Price	$250.90
Rate for Payer: Devoted Health Medicare	$212.30
Rate for Payer: Hawaii Medical Service Association Medicare	$193.00
Rate for Payer: Hawaii Western Management Group Commercial	$270.20
Rate for Payer: Health Management Network Commercial	$328.10
Rate for Payer: Humana Medicare	$193.00
Rate for Payer: Kaiser Permanente Commercial	$347.40
Rate for Payer: Kaiser Permanente Medicaid	$196.86
Rate for Payer: Kaiser Permanente Medicare	$193.00
Rate for Payer: MDX Hawaii PPO	$374.42
Rate for Payer: Ohana Health Plan Medicaid	$193.00
Rate for Payer: Ohana Health Plan Medicare	$193.00
Rate for Payer: UnitedHealthcare Medicaid	$211.18
Rate for Payer: UnitedHealthcare Medicare	$193.00
Rate for Payer: University Health Alliance Commercial	$216.16

COLLAR MIAMI J PED 6MO-2YR

Facility

$386.00

Service Code	HCPCS L0174
Hospital Charge Code	8500831
Hospital Revenue Code	274
Min. Negotiated Rate	$216.16
Max. Negotiated Rate	$374.42
Rate for Payer: Cash Price	$250.90
Rate for Payer: Hawaii Western Management Group Commercial	$270.20
Rate for Payer: Health Management Network Commercial	$328.10
Rate for Payer: Kaiser Permanente Commercial	$347.40
Rate for Payer: MDX Hawaii PPO	$374.42
Rate for Payer: University Health Alliance Commercial	$216.16

COLLAR MIAMI J PED 6YR-12YR

Facility

$386.00

Service Code	HCPCS L0174
Hospital Charge Code	8500832
Hospital Revenue Code	274
Min. Negotiated Rate	$216.16
Max. Negotiated Rate	$374.42
Rate for Payer: Cash Price	$250.90
Rate for Payer: Hawaii Western Management Group Commercial	$270.20
Rate for Payer: Health Management Network Commercial	$328.10
Rate for Payer: Kaiser Permanente Commercial	$347.40
Rate for Payer: MDX Hawaii PPO	$374.42
Rate for Payer: University Health Alliance Commercial	$216.16

COLLAR MIAMI J PED 6YR-12YR

Facility

$386.00

Service Code	HCPCS L0174
Hospital Charge Code	8500832
Hospital Revenue Code	274
Min. Negotiated Rate	$193.00
Max. Negotiated Rate	$374.42
Rate for Payer: AlohaCare Medicaid	$193.00
Rate for Payer: AlohaCare Medicare	$193.00
Rate for Payer: Cash Price	$250.90
Rate for Payer: Cash Price	$250.90
Rate for Payer: Devoted Health Medicare	$212.30
Rate for Payer: Hawaii Medical Service Association Medicare	$193.00
Rate for Payer: Hawaii Western Management Group Commercial	$270.20
Rate for Payer: Health Management Network Commercial	$328.10
Rate for Payer: Humana Medicare	$193.00
Rate for Payer: Kaiser Permanente Commercial	$347.40
Rate for Payer: Kaiser Permanente Medicaid	$196.86
Rate for Payer: Kaiser Permanente Medicare	$193.00
Rate for Payer: MDX Hawaii PPO	$374.42
Rate for Payer: Ohana Health Plan Medicaid	$193.00
Rate for Payer: Ohana Health Plan Medicare	$193.00
Rate for Payer: UnitedHealthcare Medicaid	$211.18
Rate for Payer: UnitedHealthcare Medicare	$193.00
Rate for Payer: University Health Alliance Commercial	$216.16

COLLAR PHILADELPHIA NO NECK EXTRICATION DEROYAL

Facility

$133.00

Hospital Charge Code	8266932
Hospital Revenue Code	274
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$129.01
Rate for Payer: AlohaCare Medicaid	$66.50
Rate for Payer: AlohaCare Medicare	$66.50
Rate for Payer: Cash Price	$86.45
Rate for Payer: Devoted Health Medicare	$73.15
Rate for Payer: Hawaii Medical Service Association Medicare	$66.50
Rate for Payer: Hawaii Western Management Group Commercial	$93.10
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Humana Medicare	$66.50
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: Kaiser Permanente Medicare	$66.50
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: Ohana Health Plan Medicaid	$66.50
Rate for Payer: Ohana Health Plan Medicare	$66.50
Rate for Payer: UnitedHealthcare Medicare	$66.50
Rate for Payer: University Health Alliance Commercial	$74.48

COLLAR PHILADELPHIA NO NECK EXTRICATION DEROYAL

Facility

$133.00

Hospital Charge Code	8266932
Hospital Revenue Code	274
Min. Negotiated Rate	$74.48
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$86.45
Rate for Payer: Hawaii Western Management Group Commercial	$93.10
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: University Health Alliance Commercial	$74.48

COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)

Facility

$5,655.00

Service Code	CPT 45378
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$901.48
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: University Health Alliance Commercial	$5,160.40

COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE

Facility

$5,655.00

Service Code	CPT 45380
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$901.48
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: University Health Alliance Commercial	$5,160.40

COLONOSCOPY, FLEXIBLE; WITH DECOMPRESSION (FOR PATHOLOGIC DISTENTION) (EG, VOLVULUS, MEGACOLON), INCLUDING PLACEMENT OF DECOMPRESSION TUBE, WHEN PERFORMED

Facility

$5,655.00

Service Code	CPT 45393
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,655.00
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03

COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE

Facility

$5,655.00

Service Code	CPT 45385
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$901.48
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: University Health Alliance Commercial	$5,160.40

COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK

Facility

$5,655.00

Service Code	CPT G0105
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$901.48
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: University Health Alliance Commercial	$5,160.40

COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK

Facility

$5,655.00

Service Code	CPT G0121
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$901.48
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: University Health Alliance Commercial	$5,160.40

COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY

Facility

$2,837.00

Service Code	CPT G0104
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,187.62
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18

COLOSTOMY POUCH

Facility

$4.00

Hospital Charge Code	8266303
Hospital Revenue Code	271
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$2.00
Rate for Payer: Cash Price	$2.60
Rate for Payer: Devoted Health Medicare	$2.20
Rate for Payer: Hawaii Medical Service Association Medicare	$2.00
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$2.00
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$2.00
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$2.00
Rate for Payer: Ohana Health Plan Medicare	$2.00
Rate for Payer: UnitedHealthcare Medicare	$2.00
Rate for Payer: University Health Alliance Commercial	$2.92

COLOSTOMY POUCH

Facility

$4.00

Hospital Charge Code	8266303
Hospital Revenue Code	271
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.60
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: MDX Hawaii PPO	$3.88

COLOSTOMY WAFER 2.75 INCH

Facility

$15.00

Hospital Charge Code	12748938
Hospital Revenue Code	272
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.75
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

COLOSTOMY WAFER 2.75 INCH

Facility

$15.00

Hospital Charge Code	12748938
Hospital Revenue Code	272
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$7.50
Rate for Payer: Cash Price	$9.75
Rate for Payer: Devoted Health Medicare	$8.25
Rate for Payer: Hawaii Medical Service Association Medicare	$7.50
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$7.50
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$7.50
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$7.50
Rate for Payer: Ohana Health Plan Medicare	$7.50
Rate for Payer: UnitedHealthcare Medicare	$7.50
Rate for Payer: University Health Alliance Commercial	$10.93

Know your out-of-pocket cost for care.

All Charges