Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

DRESSING LARGE

Facility

$74.00

Hospital Charge Code	13034587
Hospital Revenue Code	272
Min. Negotiated Rate	$62.90
Max. Negotiated Rate	$71.78
Rate for Payer: Cash Price	$48.10
Rate for Payer: Health Management Network Commercial	$62.90
Rate for Payer: Kaiser Permanente Commercial	$66.60
Rate for Payer: MDX Hawaii PPO	$71.78

DRESSING NASAL TAMPON 8 CM

Facility

$55.00

Hospital Charge Code	8266699
Hospital Revenue Code	272
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$53.35
Rate for Payer: AlohaCare Medicaid	$27.50
Rate for Payer: AlohaCare Medicare	$27.50
Rate for Payer: Cash Price	$35.75
Rate for Payer: Devoted Health Medicare	$30.25
Rate for Payer: Hawaii Medical Service Association Medicare	$27.50
Rate for Payer: Hawaii Western Management Group Commercial	$52.25
Rate for Payer: Health Management Network Commercial	$46.75
Rate for Payer: Humana Medicare	$27.50
Rate for Payer: Kaiser Permanente Commercial	$49.50
Rate for Payer: Kaiser Permanente Medicaid	$28.05
Rate for Payer: Kaiser Permanente Medicare	$27.50
Rate for Payer: MDX Hawaii PPO	$53.35
Rate for Payer: Ohana Health Plan Medicaid	$27.50
Rate for Payer: Ohana Health Plan Medicare	$27.50
Rate for Payer: UnitedHealthcare Medicare	$27.50
Rate for Payer: University Health Alliance Commercial	$40.09

DRESSING NASAL TAMPON 8 CM

Facility

$55.00

Hospital Charge Code	8266699
Hospital Revenue Code	272
Min. Negotiated Rate	$46.75
Max. Negotiated Rate	$53.35
Rate for Payer: Cash Price	$35.75
Rate for Payer: Health Management Network Commercial	$46.75
Rate for Payer: Kaiser Permanente Commercial	$49.50
Rate for Payer: MDX Hawaii PPO	$53.35

DRESSING OIL EMULSION DRESSING 3 X 3

Facility

$3.00

Hospital Charge Code	8266998
Hospital Revenue Code	272
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

DRESSING OIL EMULSION DRESSING 3 X 3

Facility

$3.00

Hospital Charge Code	8266998
Hospital Revenue Code	272
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

DRESSING OIL EMULSION DRESSING 3 X 8

Facility

$7.00

Hospital Charge Code	8266337
Hospital Revenue Code	272
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$6.79
Rate for Payer: AlohaCare Medicaid	$3.50
Rate for Payer: AlohaCare Medicare	$3.50
Rate for Payer: Cash Price	$4.55
Rate for Payer: Devoted Health Medicare	$3.85
Rate for Payer: Hawaii Medical Service Association Medicare	$3.50
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Humana Medicare	$3.50
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: Kaiser Permanente Medicare	$3.50
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: Ohana Health Plan Medicaid	$3.50
Rate for Payer: Ohana Health Plan Medicare	$3.50
Rate for Payer: UnitedHealthcare Medicare	$3.50
Rate for Payer: University Health Alliance Commercial	$5.10

DRESSING OIL EMULSION DRESSING 3 X 8

Facility

$7.00

Hospital Charge Code	8266337
Hospital Revenue Code	272
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$6.79
Rate for Payer: Cash Price	$4.55
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: MDX Hawaii PPO	$6.79

DRESSING OPSITE ADHESIVE WOUND 11 X 6

Facility

$23.00

Hospital Charge Code	8266881
Hospital Revenue Code	272
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$22.31
Rate for Payer: AlohaCare Medicaid	$11.50
Rate for Payer: AlohaCare Medicare	$11.50
Rate for Payer: Cash Price	$14.95
Rate for Payer: Devoted Health Medicare	$12.65
Rate for Payer: Hawaii Medical Service Association Medicare	$11.50
Rate for Payer: Hawaii Western Management Group Commercial	$21.85
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Humana Medicare	$11.50
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: Kaiser Permanente Medicaid	$11.73
Rate for Payer: Kaiser Permanente Medicare	$11.50
Rate for Payer: MDX Hawaii PPO	$22.31
Rate for Payer: Ohana Health Plan Medicaid	$11.50
Rate for Payer: Ohana Health Plan Medicare	$11.50
Rate for Payer: UnitedHealthcare Medicare	$11.50
Rate for Payer: University Health Alliance Commercial	$16.76

DRESSING OPSITE ADHESIVE WOUND 11 X 6

Facility

$23.00

Hospital Charge Code	8266881
Hospital Revenue Code	272
Min. Negotiated Rate	$19.55
Max. Negotiated Rate	$22.31
Rate for Payer: Cash Price	$14.95
Rate for Payer: Health Management Network Commercial	$19.55
Rate for Payer: Kaiser Permanente Commercial	$20.70
Rate for Payer: MDX Hawaii PPO	$22.31

DRESSING OPTIFOAM 3.5 X 10 GENTLE AG+ POST-OP STRIP

Facility

$147.00

Hospital Charge Code	8274273
Hospital Revenue Code	272
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$73.50
Rate for Payer: Cash Price	$95.55
Rate for Payer: Devoted Health Medicare	$80.85
Rate for Payer: Hawaii Medical Service Association Medicare	$73.50
Rate for Payer: Hawaii Western Management Group Commercial	$139.65
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$73.50
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$73.50
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$73.50
Rate for Payer: Ohana Health Plan Medicare	$73.50
Rate for Payer: UnitedHealthcare Medicare	$73.50
Rate for Payer: University Health Alliance Commercial	$107.15

DRESSING OPTIFOAM 3.5 X 10 GENTLE AG+ POST-OP STRIP

Facility

$147.00

Hospital Charge Code	8274273
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$95.55
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59

DRESSING PETROLATUM GAUZE 3 X 18

Facility

$5.00

Hospital Charge Code	8266739
Hospital Revenue Code	272
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$2.50
Rate for Payer: Cash Price	$3.25
Rate for Payer: Devoted Health Medicare	$2.75
Rate for Payer: Hawaii Medical Service Association Medicare	$2.50
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$2.50
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$2.50
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$2.50
Rate for Payer: Ohana Health Plan Medicare	$2.50
Rate for Payer: UnitedHealthcare Medicare	$2.50
Rate for Payer: University Health Alliance Commercial	$3.64

DRESSING PETROLATUM GAUZE 3 X 18

Facility

$5.00

Hospital Charge Code	8266739
Hospital Revenue Code	272
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.25
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

DRESSING WHITEFOAM KCI

Facility

$34.00

Service Code	HCPCS A6550
Hospital Charge Code	8528315
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: 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 Medicaid	$24.82
Rate for Payer: UnitedHealthcare Medicare	$17.00
Rate for Payer: University Health Alliance Commercial	$24.78

DRESSING WHITEFOAM KCI

Facility

$34.00

Service Code	HCPCS A6550
Hospital Charge Code	8528315
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

DRILL, A-O STYLE, 4.0MM X 165MM

Facility

$386.00

Hospital Charge Code	12985795
Hospital Revenue Code	272
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: Devoted Health Medicare	$212.30
Rate for Payer: Hawaii Medical Service Association Medicare	$193.00
Rate for Payer: Hawaii Western Management Group Commercial	$366.70
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 Medicare	$193.00
Rate for Payer: University Health Alliance Commercial	$281.36

DRILL, A-O STYLE, 4.0MM X 165MM

Facility

$386.00

Hospital Charge Code	12985795
Hospital Revenue Code	272
Min. Negotiated Rate	$328.10
Max. Negotiated Rate	$374.42
Rate for Payer: Cash Price	$250.90
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

DRILL BIT, .059 (1.5MM), AO

Facility

$368.00

Hospital Charge Code	12985759
Hospital Revenue Code	272
Min. Negotiated Rate	$312.80
Max. Negotiated Rate	$356.96
Rate for Payer: Cash Price	$239.20
Rate for Payer: Health Management Network Commercial	$312.80
Rate for Payer: Kaiser Permanente Commercial	$331.20
Rate for Payer: MDX Hawaii PPO	$356.96

DRILL BIT, .059 (1.5MM), AO

Facility

$368.00

Hospital Charge Code	12985759
Hospital Revenue Code	272
Min. Negotiated Rate	$184.00
Max. Negotiated Rate	$356.96
Rate for Payer: AlohaCare Medicaid	$184.00
Rate for Payer: AlohaCare Medicare	$184.00
Rate for Payer: Cash Price	$239.20
Rate for Payer: Devoted Health Medicare	$202.40
Rate for Payer: Hawaii Medical Service Association Medicare	$184.00
Rate for Payer: Hawaii Western Management Group Commercial	$349.60
Rate for Payer: Health Management Network Commercial	$312.80
Rate for Payer: Humana Medicare	$184.00
Rate for Payer: Kaiser Permanente Commercial	$331.20
Rate for Payer: Kaiser Permanente Medicaid	$187.68
Rate for Payer: Kaiser Permanente Medicare	$184.00
Rate for Payer: MDX Hawaii PPO	$356.96
Rate for Payer: Ohana Health Plan Medicaid	$184.00
Rate for Payer: Ohana Health Plan Medicare	$184.00
Rate for Payer: UnitedHealthcare Medicare	$184.00
Rate for Payer: University Health Alliance Commercial	$268.24

DRILL BIT, 1.7MM

Facility

$394.00

Hospital Charge Code	12985794
Hospital Revenue Code	272
Min. Negotiated Rate	$334.90
Max. Negotiated Rate	$382.18
Rate for Payer: Cash Price	$256.10
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Kaiser Permanente Commercial	$354.60
Rate for Payer: MDX Hawaii PPO	$382.18

DRILL BIT, 1.7MM

Facility

$394.00

Hospital Charge Code	12985794
Hospital Revenue Code	272
Min. Negotiated Rate	$197.00
Max. Negotiated Rate	$382.18
Rate for Payer: AlohaCare Medicaid	$197.00
Rate for Payer: AlohaCare Medicare	$197.00
Rate for Payer: Cash Price	$256.10
Rate for Payer: Devoted Health Medicare	$216.70
Rate for Payer: Hawaii Medical Service Association Medicare	$197.00
Rate for Payer: Hawaii Western Management Group Commercial	$374.30
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Humana Medicare	$197.00
Rate for Payer: Kaiser Permanente Commercial	$354.60
Rate for Payer: Kaiser Permanente Medicaid	$200.94
Rate for Payer: Kaiser Permanente Medicare	$197.00
Rate for Payer: MDX Hawaii PPO	$382.18
Rate for Payer: Ohana Health Plan Medicaid	$197.00
Rate for Payer: Ohana Health Plan Medicare	$197.00
Rate for Payer: UnitedHealthcare Medicare	$197.00
Rate for Payer: University Health Alliance Commercial	$287.19

DRILL BIT, 1.7MM, LONG

Facility

$394.00

Hospital Charge Code	12985793
Hospital Revenue Code	272
Min. Negotiated Rate	$197.00
Max. Negotiated Rate	$382.18
Rate for Payer: AlohaCare Medicaid	$197.00
Rate for Payer: AlohaCare Medicare	$197.00
Rate for Payer: Cash Price	$256.10
Rate for Payer: Devoted Health Medicare	$216.70
Rate for Payer: Hawaii Medical Service Association Medicare	$197.00
Rate for Payer: Hawaii Western Management Group Commercial	$374.30
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Humana Medicare	$197.00
Rate for Payer: Kaiser Permanente Commercial	$354.60
Rate for Payer: Kaiser Permanente Medicaid	$200.94
Rate for Payer: Kaiser Permanente Medicare	$197.00
Rate for Payer: MDX Hawaii PPO	$382.18
Rate for Payer: Ohana Health Plan Medicaid	$197.00
Rate for Payer: Ohana Health Plan Medicare	$197.00
Rate for Payer: UnitedHealthcare Medicare	$197.00
Rate for Payer: University Health Alliance Commercial	$287.19

DRILL BIT, 1.7MM, LONG

Facility

$394.00

Hospital Charge Code	12985793
Hospital Revenue Code	272
Min. Negotiated Rate	$334.90
Max. Negotiated Rate	$382.18
Rate for Payer: Cash Price	$256.10
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Kaiser Permanente Commercial	$354.60
Rate for Payer: MDX Hawaii PPO	$382.18

DRILL BIT, 2.0MM, LONG (AO)

Facility

$394.00

Hospital Charge Code	12985796
Hospital Revenue Code	272
Min. Negotiated Rate	$197.00
Max. Negotiated Rate	$382.18
Rate for Payer: AlohaCare Medicaid	$197.00
Rate for Payer: AlohaCare Medicare	$197.00
Rate for Payer: Cash Price	$256.10
Rate for Payer: Devoted Health Medicare	$216.70
Rate for Payer: Hawaii Medical Service Association Medicare	$197.00
Rate for Payer: Hawaii Western Management Group Commercial	$374.30
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Humana Medicare	$197.00
Rate for Payer: Kaiser Permanente Commercial	$354.60
Rate for Payer: Kaiser Permanente Medicaid	$200.94
Rate for Payer: Kaiser Permanente Medicare	$197.00
Rate for Payer: MDX Hawaii PPO	$382.18
Rate for Payer: Ohana Health Plan Medicaid	$197.00
Rate for Payer: Ohana Health Plan Medicare	$197.00
Rate for Payer: UnitedHealthcare Medicare	$197.00
Rate for Payer: University Health Alliance Commercial	$287.19

DRILL BIT, 2.0MM, LONG (AO)

Facility

$394.00

Hospital Charge Code	12985796
Hospital Revenue Code	272
Min. Negotiated Rate	$334.90
Max. Negotiated Rate	$382.18
Rate for Payer: Cash Price	$256.10
Rate for Payer: Health Management Network Commercial	$334.90
Rate for Payer: Kaiser Permanente Commercial	$354.60
Rate for Payer: MDX Hawaii PPO	$382.18

Know your out-of-pocket cost for care.

All Charges