Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC

Facility

$124,343.99

Service Code	MSDRG 429
Min. Negotiated Rate	$124,343.99
Max. Negotiated Rate	$124,343.99
Rate for Payer: Hawaii Medical Service Association Commercial	$124,343.99

COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC

Facility

$124,343.99

Service Code	MSDRG 430
Min. Negotiated Rate	$124,343.99
Max. Negotiated Rate	$124,343.99
Rate for Payer: Hawaii Medical Service Association Commercial	$124,343.99

Community/Work Reintegration Charges

Facility

$251.00

Service Code	HCPCS 97537 GP,CQ
Hospital Charge Code	8123837
Hospital Revenue Code	430
Min. Negotiated Rate	$18.95
Max. Negotiated Rate	$243.47
Rate for Payer: AlohaCare Medicaid	$125.50
Rate for Payer: AlohaCare Medicare	$125.50
Rate for Payer: Cash Price	$163.15
Rate for Payer: Cash Price	$163.15
Rate for Payer: Devoted Health Medicare	$138.05
Rate for Payer: Hawaii Medical Service Association Medicare	$125.50
Rate for Payer: Hawaii Western Management Group Commercial	$238.45
Rate for Payer: Health Management Network Commercial	$213.35
Rate for Payer: Humana Medicare	$125.50
Rate for Payer: Kaiser Permanente Commercial	$225.90
Rate for Payer: Kaiser Permanente Medicaid	$128.01
Rate for Payer: Kaiser Permanente Medicare	$125.50
Rate for Payer: MDX Hawaii PPO	$243.47
Rate for Payer: Ohana Health Plan Medicaid	$125.50
Rate for Payer: Ohana Health Plan Medicare	$125.50
Rate for Payer: UnitedHealthcare Medicaid	$18.95
Rate for Payer: UnitedHealthcare Medicare	$125.50
Rate for Payer: University Health Alliance Commercial	$182.95

Community/Work Reintegration Charges

Facility

$251.00

Service Code	HCPCS 97537 GP,CQ
Hospital Charge Code	8123837
Hospital Revenue Code	430
Min. Negotiated Rate	$213.35
Max. Negotiated Rate	$243.47
Rate for Payer: Cash Price	$163.15
Rate for Payer: Health Management Network Commercial	$213.35
Rate for Payer: Kaiser Permanente Commercial	$225.90
Rate for Payer: MDX Hawaii PPO	$243.47

Compatib AHG

Facility

$339.00

Service Code	HCPCS 86922
Hospital Charge Code	8502935
Hospital Revenue Code	300
Min. Negotiated Rate	$288.15
Max. Negotiated Rate	$328.83
Rate for Payer: Cash Price	$220.35
Rate for Payer: Health Management Network Commercial	$288.15
Rate for Payer: Kaiser Permanente Commercial	$305.10
Rate for Payer: MDX Hawaii PPO	$328.83

Compatib AHG

Facility

$339.00

Service Code	HCPCS 86922
Hospital Charge Code	8502935
Hospital Revenue Code	300
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$328.83
Rate for Payer: AlohaCare Medicaid	$169.50
Rate for Payer: AlohaCare Medicare	$169.50
Rate for Payer: Cash Price	$220.35
Rate for Payer: Cash Price	$220.35
Rate for Payer: Devoted Health Medicare	$186.45
Rate for Payer: Hawaii Medical Service Association ABD	$20.80
Rate for Payer: Hawaii Medical Service Association Commercial	$217.57
Rate for Payer: Hawaii Medical Service Association Medicare	$169.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.97
Rate for Payer: Hawaii Western Management Group Commercial	$174.06
Rate for Payer: Health Management Network Commercial	$288.15
Rate for Payer: Humana Medicare	$169.50
Rate for Payer: Kaiser Permanente Commercial	$305.10
Rate for Payer: Kaiser Permanente Medicaid	$172.89
Rate for Payer: Kaiser Permanente Medicare	$169.50
Rate for Payer: MDX Hawaii PPO	$328.83
Rate for Payer: Ohana Health Plan Medicaid	$169.50
Rate for Payer: Ohana Health Plan Medicare	$169.50
Rate for Payer: UnitedHealthcare Medicaid	$20.80
Rate for Payer: UnitedHealthcare Medicare	$169.50
Rate for Payer: University Health Alliance Commercial	$247.10

Compatib Immed Spin Ea

Facility

$339.00

Service Code	HCPCS 86920
Hospital Charge Code	8502936
Hospital Revenue Code	300
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$328.83
Rate for Payer: AlohaCare Medicaid	$169.50
Rate for Payer: AlohaCare Medicare	$169.50
Rate for Payer: Cash Price	$220.35
Rate for Payer: Cash Price	$220.35
Rate for Payer: Devoted Health Medicare	$186.45
Rate for Payer: Hawaii Medical Service Association ABD	$20.80
Rate for Payer: Hawaii Medical Service Association Commercial	$217.57
Rate for Payer: Hawaii Medical Service Association Medicare	$169.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.97
Rate for Payer: Hawaii Western Management Group Commercial	$174.06
Rate for Payer: Health Management Network Commercial	$288.15
Rate for Payer: Humana Medicare	$169.50
Rate for Payer: Kaiser Permanente Commercial	$305.10
Rate for Payer: Kaiser Permanente Medicaid	$172.89
Rate for Payer: Kaiser Permanente Medicare	$169.50
Rate for Payer: MDX Hawaii PPO	$328.83
Rate for Payer: Ohana Health Plan Medicaid	$169.50
Rate for Payer: Ohana Health Plan Medicare	$169.50
Rate for Payer: UnitedHealthcare Medicaid	$20.80
Rate for Payer: UnitedHealthcare Medicare	$169.50
Rate for Payer: University Health Alliance Commercial	$42.35

Compatib Immed Spin Ea

Facility

$339.00

Service Code	HCPCS 86920
Hospital Charge Code	8502936
Hospital Revenue Code	300
Min. Negotiated Rate	$288.15
Max. Negotiated Rate	$328.83
Rate for Payer: Cash Price	$220.35
Rate for Payer: Health Management Network Commercial	$288.15
Rate for Payer: Kaiser Permanente Commercial	$305.10
Rate for Payer: MDX Hawaii PPO	$328.83

Comp Blood Drug Scrn FSI

Facility

$1,384.00

Service Code	HCPCS 80307
Hospital Charge Code	8228859
Hospital Revenue Code	301
Min. Negotiated Rate	$1,176.40
Max. Negotiated Rate	$1,342.48
Rate for Payer: Cash Price	$899.60
Rate for Payer: Health Management Network Commercial	$1,176.40
Rate for Payer: Kaiser Permanente Commercial	$1,245.60
Rate for Payer: MDX Hawaii PPO	$1,342.48

Comp Blood Drug Scrn FSI

Facility

$1,384.00

Service Code	HCPCS 80307
Hospital Charge Code	8228859
Hospital Revenue Code	301
Min. Negotiated Rate	$47.89
Max. Negotiated Rate	$1,342.48
Rate for Payer: AlohaCare Medicaid	$692.00
Rate for Payer: AlohaCare Medicare	$692.00
Rate for Payer: Cash Price	$899.60
Rate for Payer: Cash Price	$899.60
Rate for Payer: Devoted Health Medicare	$761.20
Rate for Payer: Hawaii Medical Service Association ABD	$59.38
Rate for Payer: Hawaii Medical Service Association Commercial	$77.67
Rate for Payer: Hawaii Medical Service Association Medicare	$692.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.38
Rate for Payer: Hawaii Western Management Group Commercial	$62.14
Rate for Payer: Health Management Network Commercial	$1,176.40
Rate for Payer: Humana Medicare	$692.00
Rate for Payer: Kaiser Permanente Commercial	$1,245.60
Rate for Payer: Kaiser Permanente Medicaid	$705.84
Rate for Payer: Kaiser Permanente Medicare	$692.00
Rate for Payer: MDX Hawaii PPO	$1,342.48
Rate for Payer: Ohana Health Plan Medicaid	$692.00
Rate for Payer: Ohana Health Plan Medicare	$692.00
Rate for Payer: UnitedHealthcare Medicaid	$47.89
Rate for Payer: UnitedHealthcare Medicare	$692.00
Rate for Payer: University Health Alliance Commercial	$147.65

Complement Activity Total FSI

Facility

$231.00

Service Code	HCPCS 86162
Hospital Charge Code	8902883
Hospital Revenue Code	302
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$224.07
Rate for Payer: AlohaCare Medicaid	$115.50
Rate for Payer: AlohaCare Medicare	$115.50
Rate for Payer: Cash Price	$150.15
Rate for Payer: Cash Price	$150.15
Rate for Payer: Devoted Health Medicare	$127.05
Rate for Payer: Hawaii Medical Service Association ABD	$28.08
Rate for Payer: Hawaii Medical Service Association Commercial	$25.40
Rate for Payer: Hawaii Medical Service Association Medicare	$115.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$29.48
Rate for Payer: Hawaii Western Management Group Commercial	$20.32
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Humana Medicare	$115.50
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: Kaiser Permanente Medicaid	$117.81
Rate for Payer: Kaiser Permanente Medicare	$115.50
Rate for Payer: MDX Hawaii PPO	$224.07
Rate for Payer: Ohana Health Plan Medicaid	$115.50
Rate for Payer: Ohana Health Plan Medicare	$115.50
Rate for Payer: UnitedHealthcare Medicaid	$28.08
Rate for Payer: UnitedHealthcare Medicare	$115.50
Rate for Payer: University Health Alliance Commercial	$52.52

Complement Activity Total FSI

Facility

$231.00

Service Code	HCPCS 86162
Hospital Charge Code	8902883
Hospital Revenue Code	302
Min. Negotiated Rate	$196.35
Max. Negotiated Rate	$224.07
Rate for Payer: Cash Price	$150.15
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: MDX Hawaii PPO	$224.07

Complement C3 FSI

Facility

$276.00

Service Code	HCPCS 86160
Hospital Charge Code	8117886
Hospital Revenue Code	302
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$267.72
Rate for Payer: AlohaCare Medicaid	$138.00
Rate for Payer: AlohaCare Medicare	$138.00
Rate for Payer: Cash Price	$179.40
Rate for Payer: Cash Price	$179.40
Rate for Payer: Devoted Health Medicare	$151.80
Rate for Payer: Hawaii Medical Service Association ABD	$16.59
Rate for Payer: Hawaii Medical Service Association Commercial	$15.00
Rate for Payer: Hawaii Medical Service Association Medicare	$138.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.42
Rate for Payer: Hawaii Western Management Group Commercial	$12.00
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Humana Medicare	$138.00
Rate for Payer: Kaiser Permanente Commercial	$248.40
Rate for Payer: Kaiser Permanente Medicaid	$140.76
Rate for Payer: Kaiser Permanente Medicare	$138.00
Rate for Payer: MDX Hawaii PPO	$267.72
Rate for Payer: Ohana Health Plan Medicaid	$138.00
Rate for Payer: Ohana Health Plan Medicare	$138.00
Rate for Payer: UnitedHealthcare Medicaid	$16.59
Rate for Payer: UnitedHealthcare Medicare	$138.00
Rate for Payer: University Health Alliance Commercial	$31.04

Complement C3 FSI

Facility

$276.00

Service Code	HCPCS 86160
Hospital Charge Code	8117886
Hospital Revenue Code	302
Min. Negotiated Rate	$234.60
Max. Negotiated Rate	$267.72
Rate for Payer: Cash Price	$179.40
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Kaiser Permanente Commercial	$248.40
Rate for Payer: MDX Hawaii PPO	$267.72

Complement C4 FSI

Facility

$172.00

Service Code	HCPCS 82533
Hospital Charge Code	8117887
Hospital Revenue Code	302
Min. Negotiated Rate	$146.20
Max. Negotiated Rate	$166.84
Rate for Payer: Cash Price	$111.80
Rate for Payer: Health Management Network Commercial	$146.20
Rate for Payer: Kaiser Permanente Commercial	$154.80
Rate for Payer: MDX Hawaii PPO	$166.84

Complement C4 FSI

Facility

$172.00

Service Code	HCPCS 82533
Hospital Charge Code	8117887
Hospital Revenue Code	302
Min. Negotiated Rate	$16.30
Max. Negotiated Rate	$166.84
Rate for Payer: AlohaCare Medicaid	$86.00
Rate for Payer: AlohaCare Medicare	$86.00
Rate for Payer: Cash Price	$111.80
Rate for Payer: Cash Price	$111.80
Rate for Payer: Devoted Health Medicare	$94.60
Rate for Payer: Hawaii Medical Service Association ABD	$22.53
Rate for Payer: Hawaii Medical Service Association Commercial	$20.38
Rate for Payer: Hawaii Medical Service Association Medicare	$86.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.66
Rate for Payer: Hawaii Western Management Group Commercial	$16.30
Rate for Payer: Health Management Network Commercial	$146.20
Rate for Payer: Humana Medicare	$86.00
Rate for Payer: Kaiser Permanente Commercial	$154.80
Rate for Payer: Kaiser Permanente Medicaid	$87.72
Rate for Payer: Kaiser Permanente Medicare	$86.00
Rate for Payer: MDX Hawaii PPO	$166.84
Rate for Payer: Ohana Health Plan Medicaid	$86.00
Rate for Payer: Ohana Health Plan Medicare	$86.00
Rate for Payer: UnitedHealthcare Medicaid	$22.53
Rate for Payer: UnitedHealthcare Medicare	$86.00
Rate for Payer: University Health Alliance Commercial	$42.14

Complement Total CH50 FSI

Facility

$231.00

Service Code	HCPCS 86162
Hospital Charge Code	8117888
Hospital Revenue Code	302
Min. Negotiated Rate	$196.35
Max. Negotiated Rate	$224.07
Rate for Payer: Cash Price	$150.15
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: MDX Hawaii PPO	$224.07

Complement Total CH50 FSI

Facility

$231.00

Service Code	HCPCS 86162
Hospital Charge Code	8117888
Hospital Revenue Code	302
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$224.07
Rate for Payer: AlohaCare Medicaid	$115.50
Rate for Payer: AlohaCare Medicare	$115.50
Rate for Payer: Cash Price	$150.15
Rate for Payer: Cash Price	$150.15
Rate for Payer: Devoted Health Medicare	$127.05
Rate for Payer: Hawaii Medical Service Association ABD	$28.08
Rate for Payer: Hawaii Medical Service Association Commercial	$25.40
Rate for Payer: Hawaii Medical Service Association Medicare	$115.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$29.48
Rate for Payer: Hawaii Western Management Group Commercial	$20.32
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Humana Medicare	$115.50
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: Kaiser Permanente Medicaid	$117.81
Rate for Payer: Kaiser Permanente Medicare	$115.50
Rate for Payer: MDX Hawaii PPO	$224.07
Rate for Payer: Ohana Health Plan Medicaid	$115.50
Rate for Payer: Ohana Health Plan Medicare	$115.50
Rate for Payer: UnitedHealthcare Medicaid	$28.08
Rate for Payer: UnitedHealthcare Medicare	$115.50
Rate for Payer: University Health Alliance Commercial	$52.52

COMPLEX AORTIC ARCH PROCEDURES

Facility

$207,996.37

Service Code	MSDRG 209
Min. Negotiated Rate	$207,996.37
Max. Negotiated Rate	$207,996.37
Rate for Payer: Hawaii Medical Service Association Commercial	$207,996.37

COMPLICATED PEPTIC ULCER WITH CC

Facility

$25,597.98

Service Code	MSDRG 381
Min. Negotiated Rate	$25,597.98
Max. Negotiated Rate	$25,597.98
Rate for Payer: Hawaii Medical Service Association Commercial	$25,597.98

COMPLICATED PEPTIC ULCER WITH MCC

Facility

$25,597.98

Service Code	MSDRG 380
Min. Negotiated Rate	$25,597.98
Max. Negotiated Rate	$25,597.98
Rate for Payer: Hawaii Medical Service Association Commercial	$25,597.98

COMPLICATED PEPTIC ULCER WITHOUT CC/MCC

Facility

$25,597.98

Service Code	MSDRG 382
Min. Negotiated Rate	$25,597.98
Max. Negotiated Rate	$25,597.98
Rate for Payer: Hawaii Medical Service Association Commercial	$25,597.98

COMPLICATIONS OF TREATMENT WITH CC

Facility

$29,932.30

Service Code	MSDRG 920
Min. Negotiated Rate	$29,932.30
Max. Negotiated Rate	$29,932.30
Rate for Payer: Hawaii Medical Service Association Commercial	$29,932.30

COMPLICATIONS OF TREATMENT WITH MCC

Facility

$29,932.30

Service Code	MSDRG 919
Min. Negotiated Rate	$29,932.30
Max. Negotiated Rate	$29,932.30
Rate for Payer: Hawaii Medical Service Association Commercial	$29,932.30

COMPLICATIONS OF TREATMENT WITHOUT CC/MCC

Facility

$16,954.84

Service Code	MSDRG 921
Min. Negotiated Rate	$16,954.84
Max. Negotiated Rate	$16,954.84
Rate for Payer: Hawaii Medical Service Association Commercial	$16,954.84

Know your out-of-pocket cost for care.

All Charges