Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Covid, Flu AB by PCR (Cepheid) FSI

Facility

$561.00

Service Code	HCPCS 87636 QW
Hospital Charge Code	12862434
Hospital Revenue Code	306
Min. Negotiated Rate	$476.85
Max. Negotiated Rate	$544.17
Rate for Payer: Cash Price	$364.65
Rate for Payer: Health Management Network Commercial	$476.85
Rate for Payer: Kaiser Permanente Commercial	$504.90
Rate for Payer: MDX Hawaii PPO	$544.17

Covid, Flu AB, & RSV by PCR (Cepheid) FSI

Facility

$710.00

Service Code	HCPCS 87631
Hospital Charge Code	12930972
Hospital Revenue Code	306
Min. Negotiated Rate	$603.50
Max. Negotiated Rate	$688.70
Rate for Payer: Cash Price	$461.50
Rate for Payer: Health Management Network Commercial	$603.50
Rate for Payer: Kaiser Permanente Commercial	$639.00
Rate for Payer: MDX Hawaii PPO	$688.70

Covid, Flu AB, & RSV by PCR (Cepheid) FSI

Facility

$710.00

Service Code	HCPCS 87631
Hospital Charge Code	12930972
Hospital Revenue Code	306
Min. Negotiated Rate	$105.80
Max. Negotiated Rate	$688.70
Rate for Payer: AlohaCare Medicaid	$355.00
Rate for Payer: AlohaCare Medicare	$355.00
Rate for Payer: Cash Price	$461.50
Rate for Payer: Cash Price	$461.50
Rate for Payer: Devoted Health Medicare	$390.50
Rate for Payer: Hawaii Medical Service Association ABD	$174.58
Rate for Payer: Hawaii Medical Service Association Commercial	$178.29
Rate for Payer: Hawaii Medical Service Association Medicare	$355.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$177.84
Rate for Payer: Hawaii Western Management Group Commercial	$142.63
Rate for Payer: Health Management Network Commercial	$603.50
Rate for Payer: Humana Medicare	$355.00
Rate for Payer: Kaiser Permanente Commercial	$639.00
Rate for Payer: Kaiser Permanente Medicaid	$362.10
Rate for Payer: Kaiser Permanente Medicare	$355.00
Rate for Payer: MDX Hawaii PPO	$688.70
Rate for Payer: Ohana Health Plan Medicaid	$355.00
Rate for Payer: Ohana Health Plan Medicare	$355.00
Rate for Payer: UnitedHealthcare Medicaid	$105.80
Rate for Payer: UnitedHealthcare Medicare	$355.00
Rate for Payer: University Health Alliance Commercial	$517.52

CPAP/BIPAP FULL MASK CHARGE

Facility

$145.00

Hospital Charge Code	8282440
Hospital Revenue Code	271
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$94.25
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: MDX Hawaii PPO	$140.65

CPAP/BIPAP FULL MASK CHARGE

Facility

$145.00

Hospital Charge Code	8282440
Hospital Revenue Code	271
Min. Negotiated Rate	$72.50
Max. Negotiated Rate	$140.65
Rate for Payer: AlohaCare Medicaid	$72.50
Rate for Payer: AlohaCare Medicare	$72.50
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$79.75
Rate for Payer: Hawaii Medical Service Association Medicare	$72.50
Rate for Payer: Hawaii Western Management Group Commercial	$137.75
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$72.50
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicare	$72.50
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$72.50
Rate for Payer: Ohana Health Plan Medicare	$72.50
Rate for Payer: UnitedHealthcare Medicare	$72.50
Rate for Payer: University Health Alliance Commercial	$105.69

CPAP/BIPAP NASAL MASK CHARGE

Facility

$87.00

Hospital Charge Code	8284767
Hospital Revenue Code	271
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$56.55
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

CPAP/BIPAP NASAL MASK CHARGE

Facility

$87.00

Hospital Charge Code	8284767
Hospital Revenue Code	271
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	$82.65
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	$63.41

CPAP GENERATOR KIT CHARGE

Facility

$200.00

Hospital Charge Code	8282437
Hospital Revenue Code	272
Min. Negotiated Rate	$170.00
Max. Negotiated Rate	$194.00
Rate for Payer: Cash Price	$130.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: MDX Hawaii PPO	$194.00

CPAP GENERATOR KIT CHARGE

Facility

$200.00

Hospital Charge Code	8282437
Hospital Revenue Code	272
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$194.00
Rate for Payer: AlohaCare Medicaid	$100.00
Rate for Payer: AlohaCare Medicare	$100.00
Rate for Payer: Cash Price	$130.00
Rate for Payer: Devoted Health Medicare	$110.00
Rate for Payer: Hawaii Medical Service Association Medicare	$100.00
Rate for Payer: Hawaii Western Management Group Commercial	$190.00
Rate for Payer: Health Management Network Commercial	$170.00
Rate for Payer: Humana Medicare	$100.00
Rate for Payer: Kaiser Permanente Commercial	$180.00
Rate for Payer: Kaiser Permanente Medicaid	$102.00
Rate for Payer: Kaiser Permanente Medicare	$100.00
Rate for Payer: MDX Hawaii PPO	$194.00
Rate for Payer: Ohana Health Plan Medicaid	$100.00
Rate for Payer: Ohana Health Plan Medicare	$100.00
Rate for Payer: UnitedHealthcare Medicare	$100.00
Rate for Payer: University Health Alliance Commercial	$145.78

C-Peptide FSI

Facility

$96.00

Service Code	HCPCS 82340
Hospital Charge Code	8117894
Hospital Revenue Code	301
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$93.12
Rate for Payer: AlohaCare Medicaid	$48.00
Rate for Payer: AlohaCare Medicare	$48.00
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Devoted Health Medicare	$52.80
Rate for Payer: Hawaii Medical Service Association ABD	$8.34
Rate for Payer: Hawaii Medical Service Association Commercial	$7.54
Rate for Payer: Hawaii Medical Service Association Medicare	$48.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8.76
Rate for Payer: Hawaii Western Management Group Commercial	$6.03
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Humana Medicare	$48.00
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: Kaiser Permanente Medicare	$48.00
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: Ohana Health Plan Medicaid	$48.00
Rate for Payer: Ohana Health Plan Medicare	$48.00
Rate for Payer: UnitedHealthcare Medicaid	$8.34
Rate for Payer: UnitedHealthcare Medicare	$48.00
Rate for Payer: University Health Alliance Commercial	$15.60

C-Peptide FSI

Facility

$96.00

Service Code	HCPCS 82340
Hospital Charge Code	8117894
Hospital Revenue Code	301
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$62.40
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12

CPR CODE BLUE CHARGE

Facility

$1,249.00

Service Code	HCPCS 92950
Hospital Charge Code	8243408
Hospital Revenue Code	480
Min. Negotiated Rate	$168.25
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$624.50
Rate for Payer: AlohaCare Medicare	$624.50
Rate for Payer: Cash Price	$811.85
Rate for Payer: Cash Price	$811.85
Rate for Payer: Cash Price	$811.85
Rate for Payer: Devoted Health Medicare	$686.95
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 Medicare	$624.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,186.55
Rate for Payer: Health Management Network Commercial	$1,061.65
Rate for Payer: Humana Medicare	$624.50
Rate for Payer: Kaiser Permanente Commercial	$1,124.10
Rate for Payer: Kaiser Permanente Medicaid	$636.99
Rate for Payer: Kaiser Permanente Medicare	$624.50
Rate for Payer: MDX Hawaii PPO	$1,211.53
Rate for Payer: Ohana Health Plan Medicaid	$624.50
Rate for Payer: Ohana Health Plan Medicare	$624.50
Rate for Payer: UnitedHealthcare Medicaid	$168.25
Rate for Payer: UnitedHealthcare Medicare	$624.50
Rate for Payer: University Health Alliance Commercial	$910.40

CPR CODE BLUE CHARGE

Facility

$1,249.00

Service Code	HCPCS 92950
Hospital Charge Code	8243408
Hospital Revenue Code	480
Min. Negotiated Rate	$1,061.65
Max. Negotiated Rate	$1,211.53
Rate for Payer: Cash Price	$811.85
Rate for Payer: Health Management Network Commercial	$1,061.65
Rate for Payer: Kaiser Permanente Commercial	$1,124.10
Rate for Payer: MDX Hawaii PPO	$1,211.53

CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC

Facility

$26,362.86

Service Code	MSDRG 073
Min. Negotiated Rate	$26,362.86
Max. Negotiated Rate	$26,362.86
Rate for Payer: Hawaii Medical Service Association Commercial	$26,362.86

CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC

Facility

$24,017.23

Service Code	MSDRG 074
Min. Negotiated Rate	$24,017.23
Max. Negotiated Rate	$24,017.23
Rate for Payer: Hawaii Medical Service Association Commercial	$24,017.23

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC

Facility

$95,839.46

Service Code	MSDRG 026
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$95,839.46
Rate for Payer: Hawaii Medical Service Association Commercial	$95,839.46
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC

Facility

$95,839.46

Service Code	MSDRG 025
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$95,839.46
Rate for Payer: Hawaii Medical Service Association Commercial	$95,839.46
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$82,454.06

Service Code	MSDRG 027
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$82,454.06
Rate for Payer: Hawaii Medical Service Association Commercial	$82,454.06
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$241,880.55

Service Code	MSDRG 955
Min. Negotiated Rate	$241,880.55
Max. Negotiated Rate	$241,880.55
Rate for Payer: Hawaii Medical Service Association Commercial	$241,880.55

CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR ANTINEOPLASTIC IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR

Facility

$112,794.30

Service Code	MSDRG 023
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$112,794.30
Rate for Payer: Hawaii Medical Service Association Commercial	$112,794.30
Rate for Payer: University Health Alliance Commercial	$10,400.00

CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC

Facility

$107,491.14

Service Code	MSDRG 024
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$107,491.14
Rate for Payer: Hawaii Medical Service Association Commercial	$107,491.14
Rate for Payer: University Health Alliance Commercial	$10,400.00

C-Reactive Protein

Facility

$86.00

Service Code	HCPCS 86140
Hospital Charge Code	1628890
Hospital Revenue Code	300
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$43.00
Rate for Payer: AlohaCare Medicare	$43.00
Rate for Payer: Cash Price	$55.90
Rate for Payer: Cash Price	$55.90
Rate for Payer: Devoted Health Medicare	$47.30
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$43.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Humana Medicare	$43.00
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: Kaiser Permanente Medicare	$43.00
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: Ohana Health Plan Medicaid	$43.00
Rate for Payer: Ohana Health Plan Medicare	$43.00
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$43.00
Rate for Payer: University Health Alliance Commercial	$13.38

C-Reactive Protein

Facility

$86.00

Service Code	HCPCS 86140
Hospital Charge Code	1628890
Hospital Revenue Code	300
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$55.90
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: MDX Hawaii PPO	$83.42

C Reactive Protein CRP FSI

Facility

$86.00

Service Code	HCPCS 86140
Hospital Charge Code	8117868
Hospital Revenue Code	302
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$43.00
Rate for Payer: AlohaCare Medicare	$43.00
Rate for Payer: Cash Price	$55.90
Rate for Payer: Cash Price	$55.90
Rate for Payer: Devoted Health Medicare	$47.30
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$43.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Humana Medicare	$43.00
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: Kaiser Permanente Medicare	$43.00
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: Ohana Health Plan Medicaid	$43.00
Rate for Payer: Ohana Health Plan Medicare	$43.00
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$43.00
Rate for Payer: University Health Alliance Commercial	$13.38

C Reactive Protein CRP FSI

Facility

$86.00

Service Code	HCPCS 86140
Hospital Charge Code	8117868
Hospital Revenue Code	302
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$55.90
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: MDX Hawaii PPO	$83.42

Know your out-of-pocket cost for care.

All Charges