Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

DRILL BIT, 2.0MM, SHORT (AO)

Facility

$336.00

Hospital Charge Code	12985797
Hospital Revenue Code	272
Min. Negotiated Rate	$285.60
Max. Negotiated Rate	$325.92
Rate for Payer: Cash Price	$218.40
Rate for Payer: Health Management Network Commercial	$285.60
Rate for Payer: Kaiser Permanente Commercial	$302.40
Rate for Payer: MDX Hawaii PPO	$325.92

DRILL BIT, 2.0MM, SHORT (AO)

Facility

$336.00

Hospital Charge Code	12985797
Hospital Revenue Code	272
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$325.92
Rate for Payer: AlohaCare Medicaid	$168.00
Rate for Payer: AlohaCare Medicare	$168.00
Rate for Payer: Cash Price	$218.40
Rate for Payer: Devoted Health Medicare	$184.80
Rate for Payer: Hawaii Medical Service Association Medicare	$168.00
Rate for Payer: Hawaii Western Management Group Commercial	$319.20
Rate for Payer: Health Management Network Commercial	$285.60
Rate for Payer: Humana Medicare	$168.00
Rate for Payer: Kaiser Permanente Commercial	$302.40
Rate for Payer: Kaiser Permanente Medicaid	$171.36
Rate for Payer: Kaiser Permanente Medicare	$168.00
Rate for Payer: MDX Hawaii PPO	$325.92
Rate for Payer: Ohana Health Plan Medicaid	$168.00
Rate for Payer: Ohana Health Plan Medicare	$168.00
Rate for Payer: UnitedHealthcare Medicare	$168.00
Rate for Payer: University Health Alliance Commercial	$244.91

DRILL BIT, 2.4 MM

Facility

$550.00

Hospital Charge Code	12985798
Hospital Revenue Code	272
Min. Negotiated Rate	$275.00
Max. Negotiated Rate	$533.50
Rate for Payer: AlohaCare Medicaid	$275.00
Rate for Payer: AlohaCare Medicare	$275.00
Rate for Payer: Cash Price	$357.50
Rate for Payer: Devoted Health Medicare	$302.50
Rate for Payer: Hawaii Medical Service Association Medicare	$275.00
Rate for Payer: Hawaii Western Management Group Commercial	$522.50
Rate for Payer: Health Management Network Commercial	$467.50
Rate for Payer: Humana Medicare	$275.00
Rate for Payer: Kaiser Permanente Commercial	$495.00
Rate for Payer: Kaiser Permanente Medicaid	$280.50
Rate for Payer: Kaiser Permanente Medicare	$275.00
Rate for Payer: MDX Hawaii PPO	$533.50
Rate for Payer: Ohana Health Plan Medicaid	$275.00
Rate for Payer: Ohana Health Plan Medicare	$275.00
Rate for Payer: UnitedHealthcare Medicare	$275.00
Rate for Payer: University Health Alliance Commercial	$400.89

DRILL BIT, 2.4 MM

Facility

$550.00

Hospital Charge Code	12985798
Hospital Revenue Code	272
Min. Negotiated Rate	$467.50
Max. Negotiated Rate	$533.50
Rate for Payer: Cash Price	$357.50
Rate for Payer: Health Management Network Commercial	$467.50
Rate for Payer: Kaiser Permanente Commercial	$495.00
Rate for Payer: MDX Hawaii PPO	$533.50

DRILL BIT, 2.7MM, (AO)

Facility

$336.00

Hospital Charge Code	12985799
Hospital Revenue Code	272
Min. Negotiated Rate	$285.60
Max. Negotiated Rate	$325.92
Rate for Payer: Cash Price	$218.40
Rate for Payer: Health Management Network Commercial	$285.60
Rate for Payer: Kaiser Permanente Commercial	$302.40
Rate for Payer: MDX Hawaii PPO	$325.92

DRILL BIT, 2.7MM, (AO)

Facility

$336.00

Hospital Charge Code	12985799
Hospital Revenue Code	272
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$325.92
Rate for Payer: AlohaCare Medicaid	$168.00
Rate for Payer: AlohaCare Medicare	$168.00
Rate for Payer: Cash Price	$218.40
Rate for Payer: Devoted Health Medicare	$184.80
Rate for Payer: Hawaii Medical Service Association Medicare	$168.00
Rate for Payer: Hawaii Western Management Group Commercial	$319.20
Rate for Payer: Health Management Network Commercial	$285.60
Rate for Payer: Humana Medicare	$168.00
Rate for Payer: Kaiser Permanente Commercial	$302.40
Rate for Payer: Kaiser Permanente Medicaid	$171.36
Rate for Payer: Kaiser Permanente Medicare	$168.00
Rate for Payer: MDX Hawaii PPO	$325.92
Rate for Payer: Ohana Health Plan Medicaid	$168.00
Rate for Payer: Ohana Health Plan Medicare	$168.00
Rate for Payer: UnitedHealthcare Medicare	$168.00
Rate for Payer: University Health Alliance Commercial	$244.91

DRILL BIT 3.0MM CANNULATED

Facility

$1,544.00

Hospital Charge Code	10600423
Hospital Revenue Code	272
Min. Negotiated Rate	$772.00
Max. Negotiated Rate	$1,497.68
Rate for Payer: AlohaCare Medicaid	$772.00
Rate for Payer: AlohaCare Medicare	$772.00
Rate for Payer: Cash Price	$1,003.60
Rate for Payer: Devoted Health Medicare	$849.20
Rate for Payer: Hawaii Medical Service Association Medicare	$772.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,466.80
Rate for Payer: Health Management Network Commercial	$1,312.40
Rate for Payer: Humana Medicare	$772.00
Rate for Payer: Kaiser Permanente Commercial	$1,389.60
Rate for Payer: Kaiser Permanente Medicaid	$787.44
Rate for Payer: Kaiser Permanente Medicare	$772.00
Rate for Payer: MDX Hawaii PPO	$1,497.68
Rate for Payer: Ohana Health Plan Medicaid	$772.00
Rate for Payer: Ohana Health Plan Medicare	$772.00
Rate for Payer: UnitedHealthcare Medicare	$772.00
Rate for Payer: University Health Alliance Commercial	$1,125.42

DRILL BIT 3.0MM CANNULATED

Facility

$1,544.00

Hospital Charge Code	10600423
Hospital Revenue Code	272
Min. Negotiated Rate	$1,312.40
Max. Negotiated Rate	$1,497.68
Rate for Payer: Cash Price	$1,003.60
Rate for Payer: Health Management Network Commercial	$1,312.40
Rate for Payer: Kaiser Permanente Commercial	$1,389.60
Rate for Payer: MDX Hawaii PPO	$1,497.68

DRILL BIT, CANNULATED, 2.6MM

Facility

$368.00

Hospital Charge Code	12944056
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, CANNULATED, 2.6MM

Facility

$368.00

Hospital Charge Code	12944056
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, CANNULATED, SMALL HUDSON, 5.0MM

Facility

$1,038.00

Hospital Charge Code	12985800
Hospital Revenue Code	272
Min. Negotiated Rate	$519.00
Max. Negotiated Rate	$1,006.86
Rate for Payer: AlohaCare Medicaid	$519.00
Rate for Payer: AlohaCare Medicare	$519.00
Rate for Payer: Cash Price	$674.70
Rate for Payer: Devoted Health Medicare	$570.90
Rate for Payer: Hawaii Medical Service Association Medicare	$519.00
Rate for Payer: Hawaii Western Management Group Commercial	$986.10
Rate for Payer: Health Management Network Commercial	$882.30
Rate for Payer: Humana Medicare	$519.00
Rate for Payer: Kaiser Permanente Commercial	$934.20
Rate for Payer: Kaiser Permanente Medicaid	$529.38
Rate for Payer: Kaiser Permanente Medicare	$519.00
Rate for Payer: MDX Hawaii PPO	$1,006.86
Rate for Payer: Ohana Health Plan Medicaid	$519.00
Rate for Payer: Ohana Health Plan Medicare	$519.00
Rate for Payer: UnitedHealthcare Medicare	$519.00
Rate for Payer: University Health Alliance Commercial	$756.60

DRILL, CANNULATED, SMALL HUDSON, 5.0MM

Facility

$1,038.00

Hospital Charge Code	12985800
Hospital Revenue Code	272
Min. Negotiated Rate	$882.30
Max. Negotiated Rate	$1,006.86
Rate for Payer: Cash Price	$674.70
Rate for Payer: Health Management Network Commercial	$882.30
Rate for Payer: Kaiser Permanente Commercial	$934.20
Rate for Payer: MDX Hawaii PPO	$1,006.86

DRILL, LARGE HUDSON,CANNULATED, 5.5MM

Facility

$650.00

Hospital Charge Code	12985801
Hospital Revenue Code	272
Min. Negotiated Rate	$552.50
Max. Negotiated Rate	$630.50
Rate for Payer: Cash Price	$422.50
Rate for Payer: Health Management Network Commercial	$552.50
Rate for Payer: Kaiser Permanente Commercial	$585.00
Rate for Payer: MDX Hawaii PPO	$630.50

DRILL, LARGE HUDSON,CANNULATED, 5.5MM

Facility

$650.00

Hospital Charge Code	12985801
Hospital Revenue Code	272
Min. Negotiated Rate	$325.00
Max. Negotiated Rate	$630.50
Rate for Payer: AlohaCare Medicaid	$325.00
Rate for Payer: AlohaCare Medicare	$325.00
Rate for Payer: Cash Price	$422.50
Rate for Payer: Devoted Health Medicare	$357.50
Rate for Payer: Hawaii Medical Service Association Medicare	$325.00
Rate for Payer: Hawaii Western Management Group Commercial	$617.50
Rate for Payer: Health Management Network Commercial	$552.50
Rate for Payer: Humana Medicare	$325.00
Rate for Payer: Kaiser Permanente Commercial	$585.00
Rate for Payer: Kaiser Permanente Medicaid	$331.50
Rate for Payer: Kaiser Permanente Medicare	$325.00
Rate for Payer: MDX Hawaii PPO	$630.50
Rate for Payer: Ohana Health Plan Medicaid	$325.00
Rate for Payer: Ohana Health Plan Medicare	$325.00
Rate for Payer: UnitedHealthcare Medicare	$325.00
Rate for Payer: University Health Alliance Commercial	$473.79

droperidol 5 mg/2 mL vial [HHSC]

Facility

$60.00

Service Code	HCPCS J1790
Hospital Charge Code	2501087
Hospital Revenue Code	636
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$58.20
Rate for Payer: AlohaCare Medicaid	$30.00
Rate for Payer: AlohaCare Medicare	$30.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Cash Price	$39.00
Rate for Payer: Devoted Health Medicare	$33.00
Rate for Payer: Hawaii Medical Service Association ABD	$5.36
Rate for Payer: Hawaii Medical Service Association Medicare	$30.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.36
Rate for Payer: Hawaii Western Management Group Commercial	$57.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Humana Medicare	$30.00
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: Kaiser Permanente Medicaid	$30.60
Rate for Payer: Kaiser Permanente Medicare	$30.00
Rate for Payer: MDX Hawaii PPO	$58.20
Rate for Payer: Ohana Health Plan Medicaid	$30.00
Rate for Payer: Ohana Health Plan Medicare	$30.00
Rate for Payer: UnitedHealthcare Medicaid	$36.00
Rate for Payer: UnitedHealthcare Medicare	$30.00
Rate for Payer: University Health Alliance Commercial	$43.73

droperidol 5 mg/2 mL vial [HHSC]

Facility

$60.00

Service Code	HCPCS J1790
Hospital Charge Code	2501087
Hospital Revenue Code	250
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$58.20
Rate for Payer: Cash Price	$39.00
Rate for Payer: Health Management Network Commercial	$51.00
Rate for Payer: Kaiser Permanente Commercial	$54.00
Rate for Payer: MDX Hawaii PPO	$58.20

Drug Detection Panel, Meconium, Qualitative FSI

Facility

$1,118.00

Service Code	HCPCS G0481
Hospital Charge Code	10654595
Hospital Revenue Code	300
Min. Negotiated Rate	$73.79
Max. Negotiated Rate	$1,084.46
Rate for Payer: AlohaCare Medicaid	$559.00
Rate for Payer: AlohaCare Medicare	$559.00
Rate for Payer: Cash Price	$726.70
Rate for Payer: Cash Price	$726.70
Rate for Payer: Devoted Health Medicare	$614.90
Rate for Payer: Hawaii Medical Service Association Commercial	$195.74
Rate for Payer: Hawaii Medical Service Association Medicare	$559.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,062.10
Rate for Payer: Health Management Network Commercial	$950.30
Rate for Payer: Humana Medicare	$559.00
Rate for Payer: Kaiser Permanente Commercial	$1,006.20
Rate for Payer: Kaiser Permanente Medicaid	$570.18
Rate for Payer: Kaiser Permanente Medicare	$559.00
Rate for Payer: MDX Hawaii PPO	$1,084.46
Rate for Payer: Ohana Health Plan Medicaid	$559.00
Rate for Payer: Ohana Health Plan Medicare	$559.00
Rate for Payer: UnitedHealthcare Medicaid	$73.79
Rate for Payer: UnitedHealthcare Medicare	$559.00
Rate for Payer: University Health Alliance Commercial	$814.91

Drug Detection Panel, Meconium, Qualitative FSI

Facility

$1,118.00

Service Code	HCPCS G0481
Hospital Charge Code	10654595
Hospital Revenue Code	300
Min. Negotiated Rate	$950.30
Max. Negotiated Rate	$1,084.46
Rate for Payer: Cash Price	$726.70
Rate for Payer: Health Management Network Commercial	$950.30
Rate for Payer: Kaiser Permanente Commercial	$1,006.20
Rate for Payer: MDX Hawaii PPO	$1,084.46

Drug Detection Panel, Meconium, Qualitative FSI 3000326

Facility

$408.00

Service Code	HCPCS 80326
Hospital Charge Code	10845693
Hospital Revenue Code	300
Min. Negotiated Rate	$21.48
Max. Negotiated Rate	$395.76
Rate for Payer: AlohaCare Medicaid	$204.00
Rate for Payer: AlohaCare Medicare	$204.00
Rate for Payer: Cash Price	$265.20
Rate for Payer: Cash Price	$265.20
Rate for Payer: Devoted Health Medicare	$224.40
Rate for Payer: Hawaii Medical Service Association ABD	$21.48
Rate for Payer: Hawaii Medical Service Association Medicare	$204.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.55
Rate for Payer: Hawaii Western Management Group Commercial	$387.60
Rate for Payer: Health Management Network Commercial	$346.80
Rate for Payer: Humana Medicare	$204.00
Rate for Payer: Kaiser Permanente Commercial	$367.20
Rate for Payer: Kaiser Permanente Medicaid	$208.08
Rate for Payer: Kaiser Permanente Medicare	$204.00
Rate for Payer: MDX Hawaii PPO	$395.76
Rate for Payer: Ohana Health Plan Medicaid	$204.00
Rate for Payer: Ohana Health Plan Medicare	$204.00
Rate for Payer: UnitedHealthcare Medicare	$204.00
Rate for Payer: University Health Alliance Commercial	$297.39

Drug Detection Panel, Meconium, Qualitative FSI 3000326

Facility

$408.00

Service Code	HCPCS 80326
Hospital Charge Code	10845693
Hospital Revenue Code	300
Min. Negotiated Rate	$346.80
Max. Negotiated Rate	$395.76
Rate for Payer: Cash Price	$265.20
Rate for Payer: Health Management Network Commercial	$346.80
Rate for Payer: Kaiser Permanente Commercial	$367.20
Rate for Payer: MDX Hawaii PPO	$395.76

Drug Detection Panel, Meconium, Qualitative FSI 3000347

Facility

$408.00

Service Code	HCPCS 80347
Hospital Charge Code	10654743
Hospital Revenue Code	300
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$395.76
Rate for Payer: AlohaCare Medicaid	$204.00
Rate for Payer: AlohaCare Medicare	$204.00
Rate for Payer: Cash Price	$265.20
Rate for Payer: Cash Price	$265.20
Rate for Payer: Devoted Health Medicare	$224.40
Rate for Payer: Hawaii Medical Service Association ABD	$25.56
Rate for Payer: Hawaii Medical Service Association Medicare	$204.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.84
Rate for Payer: Hawaii Western Management Group Commercial	$387.60
Rate for Payer: Health Management Network Commercial	$346.80
Rate for Payer: Humana Medicare	$204.00
Rate for Payer: Kaiser Permanente Commercial	$367.20
Rate for Payer: Kaiser Permanente Medicaid	$208.08
Rate for Payer: Kaiser Permanente Medicare	$204.00
Rate for Payer: MDX Hawaii PPO	$395.76
Rate for Payer: Ohana Health Plan Medicaid	$204.00
Rate for Payer: Ohana Health Plan Medicare	$204.00
Rate for Payer: UnitedHealthcare Medicare	$204.00
Rate for Payer: University Health Alliance Commercial	$297.39

Drug Detection Panel, Meconium, Qualitative FSI 3000347

Facility

$408.00

Service Code	HCPCS 80347
Hospital Charge Code	10654743
Hospital Revenue Code	300
Min. Negotiated Rate	$346.80
Max. Negotiated Rate	$395.76
Rate for Payer: Cash Price	$265.20
Rate for Payer: Health Management Network Commercial	$346.80
Rate for Payer: Kaiser Permanente Commercial	$367.20
Rate for Payer: MDX Hawaii PPO	$395.76

Drug Detection Panel, Meconium, Qualitative FSI 3000356

Facility

$408.00

Service Code	HCPCS 80355
Hospital Charge Code	10655265
Hospital Revenue Code	300
Min. Negotiated Rate	$18.31
Max. Negotiated Rate	$395.76
Rate for Payer: AlohaCare Medicaid	$204.00
Rate for Payer: AlohaCare Medicare	$204.00
Rate for Payer: Cash Price	$265.20
Rate for Payer: Cash Price	$265.20
Rate for Payer: Devoted Health Medicare	$224.40
Rate for Payer: Hawaii Medical Service Association ABD	$18.31
Rate for Payer: Hawaii Medical Service Association Medicare	$204.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.23
Rate for Payer: Hawaii Western Management Group Commercial	$387.60
Rate for Payer: Health Management Network Commercial	$346.80
Rate for Payer: Humana Medicare	$204.00
Rate for Payer: Kaiser Permanente Commercial	$367.20
Rate for Payer: Kaiser Permanente Medicaid	$208.08
Rate for Payer: Kaiser Permanente Medicare	$204.00
Rate for Payer: MDX Hawaii PPO	$395.76
Rate for Payer: Ohana Health Plan Medicaid	$204.00
Rate for Payer: Ohana Health Plan Medicare	$204.00
Rate for Payer: UnitedHealthcare Medicare	$204.00
Rate for Payer: University Health Alliance Commercial	$297.39

Drug Detection Panel, Meconium, Qualitative FSI 3000356

Facility

$408.00

Service Code	HCPCS 80355
Hospital Charge Code	10655265
Hospital Revenue Code	300
Min. Negotiated Rate	$346.80
Max. Negotiated Rate	$395.76
Rate for Payer: Cash Price	$265.20
Rate for Payer: Health Management Network Commercial	$346.80
Rate for Payer: Kaiser Permanente Commercial	$367.20
Rate for Payer: MDX Hawaii PPO	$395.76

Drug Detection Panel, Meconium, Qualitative FSI 3000364

Facility

$408.00

Service Code	HCPCS 80364
Hospital Charge Code	10654747
Hospital Revenue Code	300
Min. Negotiated Rate	$26.89
Max. Negotiated Rate	$395.76
Rate for Payer: AlohaCare Medicaid	$204.00
Rate for Payer: AlohaCare Medicare	$204.00
Rate for Payer: Cash Price	$265.20
Rate for Payer: Cash Price	$265.20
Rate for Payer: Devoted Health Medicare	$224.40
Rate for Payer: Hawaii Medical Service Association ABD	$26.89
Rate for Payer: Hawaii Medical Service Association Medicare	$204.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.23
Rate for Payer: Hawaii Western Management Group Commercial	$387.60
Rate for Payer: Health Management Network Commercial	$346.80
Rate for Payer: Humana Medicare	$204.00
Rate for Payer: Kaiser Permanente Commercial	$367.20
Rate for Payer: Kaiser Permanente Medicaid	$208.08
Rate for Payer: Kaiser Permanente Medicare	$204.00
Rate for Payer: MDX Hawaii PPO	$395.76
Rate for Payer: Ohana Health Plan Medicaid	$204.00
Rate for Payer: Ohana Health Plan Medicare	$204.00
Rate for Payer: UnitedHealthcare Medicare	$204.00
Rate for Payer: University Health Alliance Commercial	$297.39

Know your out-of-pocket cost for care.

All Charges