Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

END CAP, CAPTURED, BULLET TIP, 10 MM

Facility

$1,453.00

Hospital Charge Code	12987412
Hospital Revenue Code	278
Min. Negotiated Rate	$726.50
Max. Negotiated Rate	$1,409.41
Rate for Payer: AlohaCare Medicaid	$726.50
Rate for Payer: AlohaCare Medicare	$726.50
Rate for Payer: Cash Price	$944.45
Rate for Payer: Devoted Health Medicare	$799.15
Rate for Payer: Hawaii Medical Service Association Medicare	$726.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.10
Rate for Payer: Health Management Network Commercial	$1,235.05
Rate for Payer: Humana Medicare	$726.50
Rate for Payer: Kaiser Permanente Commercial	$1,307.70
Rate for Payer: Kaiser Permanente Medicaid	$741.03
Rate for Payer: Kaiser Permanente Medicare	$726.50
Rate for Payer: MDX Hawaii PPO	$1,409.41
Rate for Payer: Ohana Health Plan Medicaid	$726.50
Rate for Payer: Ohana Health Plan Medicare	$726.50
Rate for Payer: UnitedHealthcare Medicare	$726.50
Rate for Payer: University Health Alliance Commercial	$813.68

END CAP, CAPTURED, BULLET TIP, 10 MM

Facility

$1,453.00

Hospital Charge Code	12987412
Hospital Revenue Code	278
Min. Negotiated Rate	$813.68
Max. Negotiated Rate	$1,409.41
Rate for Payer: Cash Price	$944.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.10
Rate for Payer: Health Management Network Commercial	$1,235.05
Rate for Payer: Kaiser Permanente Commercial	$1,307.70
Rate for Payer: MDX Hawaii PPO	$1,409.41
Rate for Payer: University Health Alliance Commercial	$813.68

END CAP, CAPTURED, BULLET TIP, 1 MM

Facility

$779.00

Hospital Charge Code	12987411
Hospital Revenue Code	278
Min. Negotiated Rate	$389.50
Max. Negotiated Rate	$755.63
Rate for Payer: AlohaCare Medicaid	$389.50
Rate for Payer: AlohaCare Medicare	$389.50
Rate for Payer: Cash Price	$506.35
Rate for Payer: Devoted Health Medicare	$428.45
Rate for Payer: Hawaii Medical Service Association Medicare	$389.50
Rate for Payer: Hawaii Western Management Group Commercial	$545.30
Rate for Payer: Health Management Network Commercial	$662.15
Rate for Payer: Humana Medicare	$389.50
Rate for Payer: Kaiser Permanente Commercial	$701.10
Rate for Payer: Kaiser Permanente Medicaid	$397.29
Rate for Payer: Kaiser Permanente Medicare	$389.50
Rate for Payer: MDX Hawaii PPO	$755.63
Rate for Payer: Ohana Health Plan Medicaid	$389.50
Rate for Payer: Ohana Health Plan Medicare	$389.50
Rate for Payer: UnitedHealthcare Medicare	$389.50
Rate for Payer: University Health Alliance Commercial	$436.24

END CAP, CAPTURED, BULLET TIP, 1 MM

Facility

$779.00

Hospital Charge Code	12987411
Hospital Revenue Code	278
Min. Negotiated Rate	$436.24
Max. Negotiated Rate	$755.63
Rate for Payer: Cash Price	$506.35
Rate for Payer: Hawaii Western Management Group Commercial	$545.30
Rate for Payer: Health Management Network Commercial	$662.15
Rate for Payer: Kaiser Permanente Commercial	$701.10
Rate for Payer: MDX Hawaii PPO	$755.63
Rate for Payer: University Health Alliance Commercial	$436.24

END CAP, CAPTURED, BULLET TIP, 5 MM

Facility

$1,453.00

Hospital Charge Code	12987413
Hospital Revenue Code	278
Min. Negotiated Rate	$726.50
Max. Negotiated Rate	$1,409.41
Rate for Payer: AlohaCare Medicaid	$726.50
Rate for Payer: AlohaCare Medicare	$726.50
Rate for Payer: Cash Price	$944.45
Rate for Payer: Devoted Health Medicare	$799.15
Rate for Payer: Hawaii Medical Service Association Medicare	$726.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.10
Rate for Payer: Health Management Network Commercial	$1,235.05
Rate for Payer: Humana Medicare	$726.50
Rate for Payer: Kaiser Permanente Commercial	$1,307.70
Rate for Payer: Kaiser Permanente Medicaid	$741.03
Rate for Payer: Kaiser Permanente Medicare	$726.50
Rate for Payer: MDX Hawaii PPO	$1,409.41
Rate for Payer: Ohana Health Plan Medicaid	$726.50
Rate for Payer: Ohana Health Plan Medicare	$726.50
Rate for Payer: UnitedHealthcare Medicare	$726.50
Rate for Payer: University Health Alliance Commercial	$813.68

END CAP, CAPTURED, BULLET TIP, 5 MM

Facility

$1,453.00

Hospital Charge Code	12987413
Hospital Revenue Code	278
Min. Negotiated Rate	$813.68
Max. Negotiated Rate	$1,409.41
Rate for Payer: Cash Price	$944.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.10
Rate for Payer: Health Management Network Commercial	$1,235.05
Rate for Payer: Kaiser Permanente Commercial	$1,307.70
Rate for Payer: MDX Hawaii PPO	$1,409.41
Rate for Payer: University Health Alliance Commercial	$813.68

END CAP, RETROGRADE FEMORAL NAIL, 1 MM

Facility

$1,453.00

Service Code	HCPCS C1713
Hospital Charge Code	12987409
Hospital Revenue Code	278
Min. Negotiated Rate	$813.68
Max. Negotiated Rate	$1,409.41
Rate for Payer: Cash Price	$944.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.10
Rate for Payer: Health Management Network Commercial	$1,235.05
Rate for Payer: Kaiser Permanente Commercial	$1,307.70
Rate for Payer: MDX Hawaii PPO	$1,409.41
Rate for Payer: University Health Alliance Commercial	$813.68

END CAP, RETROGRADE FEMORAL NAIL, 1 MM

Facility

$1,453.00

Service Code	HCPCS C1713
Hospital Charge Code	12987409
Hospital Revenue Code	278
Min. Negotiated Rate	$726.50
Max. Negotiated Rate	$1,409.41
Rate for Payer: AlohaCare Medicaid	$726.50
Rate for Payer: AlohaCare Medicare	$726.50
Rate for Payer: Cash Price	$944.45
Rate for Payer: Devoted Health Medicare	$799.15
Rate for Payer: Hawaii Medical Service Association Medicare	$726.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.10
Rate for Payer: Health Management Network Commercial	$1,235.05
Rate for Payer: Humana Medicare	$726.50
Rate for Payer: Kaiser Permanente Commercial	$1,307.70
Rate for Payer: Kaiser Permanente Medicaid	$741.03
Rate for Payer: Kaiser Permanente Medicare	$726.50
Rate for Payer: MDX Hawaii PPO	$1,409.41
Rate for Payer: Ohana Health Plan Medicaid	$726.50
Rate for Payer: Ohana Health Plan Medicare	$726.50
Rate for Payer: UnitedHealthcare Medicare	$726.50
Rate for Payer: University Health Alliance Commercial	$813.68

END CAP, RETROGRADE FEMORAL NAIL, 5 MM

Facility

$1,453.00

Service Code	HCPCS C1713
Hospital Charge Code	12985819
Hospital Revenue Code	278
Min. Negotiated Rate	$726.50
Max. Negotiated Rate	$1,409.41
Rate for Payer: AlohaCare Medicaid	$726.50
Rate for Payer: AlohaCare Medicare	$726.50
Rate for Payer: Cash Price	$944.45
Rate for Payer: Devoted Health Medicare	$799.15
Rate for Payer: Hawaii Medical Service Association Medicare	$726.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.10
Rate for Payer: Health Management Network Commercial	$1,235.05
Rate for Payer: Humana Medicare	$726.50
Rate for Payer: Kaiser Permanente Commercial	$1,307.70
Rate for Payer: Kaiser Permanente Medicaid	$741.03
Rate for Payer: Kaiser Permanente Medicare	$726.50
Rate for Payer: MDX Hawaii PPO	$1,409.41
Rate for Payer: Ohana Health Plan Medicaid	$726.50
Rate for Payer: Ohana Health Plan Medicare	$726.50
Rate for Payer: UnitedHealthcare Medicare	$726.50
Rate for Payer: University Health Alliance Commercial	$813.68

END CAP, RETROGRADE FEMORAL NAIL, 5 MM

Facility

$1,453.00

Service Code	HCPCS C1713
Hospital Charge Code	12985819
Hospital Revenue Code	278
Min. Negotiated Rate	$813.68
Max. Negotiated Rate	$1,409.41
Rate for Payer: Cash Price	$944.45
Rate for Payer: Hawaii Western Management Group Commercial	$1,017.10
Rate for Payer: Health Management Network Commercial	$1,235.05
Rate for Payer: Kaiser Permanente Commercial	$1,307.70
Rate for Payer: MDX Hawaii PPO	$1,409.41
Rate for Payer: University Health Alliance Commercial	$813.68

ENDO CATCH 10MM

Facility

$201.00

Hospital Charge Code	8274226
Hospital Revenue Code	272
Min. Negotiated Rate	$170.85
Max. Negotiated Rate	$194.97
Rate for Payer: Cash Price	$130.65
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: MDX Hawaii PPO	$194.97

ENDO CATCH 10MM

Facility

$201.00

Hospital Charge Code	8274226
Hospital Revenue Code	272
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$194.97
Rate for Payer: AlohaCare Medicaid	$100.50
Rate for Payer: AlohaCare Medicare	$100.50
Rate for Payer: Cash Price	$130.65
Rate for Payer: Devoted Health Medicare	$110.55
Rate for Payer: Hawaii Medical Service Association Medicare	$100.50
Rate for Payer: Hawaii Western Management Group Commercial	$190.95
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Humana Medicare	$100.50
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: Kaiser Permanente Medicaid	$102.51
Rate for Payer: Kaiser Permanente Medicare	$100.50
Rate for Payer: MDX Hawaii PPO	$194.97
Rate for Payer: Ohana Health Plan Medicaid	$100.50
Rate for Payer: Ohana Health Plan Medicare	$100.50
Rate for Payer: UnitedHealthcare Medicare	$100.50
Rate for Payer: University Health Alliance Commercial	$146.51

ENDO CLIP, LAPAROSCOPIC 5MM

Facility

$1,117.00

Hospital Charge Code	8274208
Hospital Revenue Code	272
Min. Negotiated Rate	$949.45
Max. Negotiated Rate	$1,083.49
Rate for Payer: Cash Price	$726.05
Rate for Payer: Health Management Network Commercial	$949.45
Rate for Payer: Kaiser Permanente Commercial	$1,005.30
Rate for Payer: MDX Hawaii PPO	$1,083.49

ENDO CLIP, LAPAROSCOPIC 5MM

Facility

$1,117.00

Hospital Charge Code	8274208
Hospital Revenue Code	272
Min. Negotiated Rate	$558.50
Max. Negotiated Rate	$1,083.49
Rate for Payer: AlohaCare Medicaid	$558.50
Rate for Payer: AlohaCare Medicare	$558.50
Rate for Payer: Cash Price	$726.05
Rate for Payer: Devoted Health Medicare	$614.35
Rate for Payer: Hawaii Medical Service Association Medicare	$558.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,061.15
Rate for Payer: Health Management Network Commercial	$949.45
Rate for Payer: Humana Medicare	$558.50
Rate for Payer: Kaiser Permanente Commercial	$1,005.30
Rate for Payer: Kaiser Permanente Medicaid	$569.67
Rate for Payer: Kaiser Permanente Medicare	$558.50
Rate for Payer: MDX Hawaii PPO	$1,083.49
Rate for Payer: Ohana Health Plan Medicaid	$558.50
Rate for Payer: Ohana Health Plan Medicare	$558.50
Rate for Payer: UnitedHealthcare Medicare	$558.50
Rate for Payer: University Health Alliance Commercial	$814.18

ENDOCRINE DISORDERS WITH CC

Facility

$20,855.73

Service Code	MSDRG 644
Min. Negotiated Rate	$20,855.73
Max. Negotiated Rate	$20,855.73
Rate for Payer: Hawaii Medical Service Association Commercial	$20,855.73

ENDOCRINE DISORDERS WITH MCC

Facility

$20,855.73

Service Code	MSDRG 643
Min. Negotiated Rate	$20,855.73
Max. Negotiated Rate	$20,855.73
Rate for Payer: Hawaii Medical Service Association Commercial	$20,855.73

ENDOCRINE DISORDERS WITHOUT CC/MCC

Facility

$18,051.17

Service Code	MSDRG 645
Min. Negotiated Rate	$18,051.17
Max. Negotiated Rate	$18,051.17
Rate for Payer: Hawaii Medical Service Association Commercial	$18,051.17

ENDO CUTTER LINEAR, 45MM ARTICULATING (ETHICON)

Facility

$3,121.00

Hospital Charge Code	8274209
Hospital Revenue Code	272
Min. Negotiated Rate	$1,560.50
Max. Negotiated Rate	$3,027.37
Rate for Payer: AlohaCare Medicaid	$1,560.50
Rate for Payer: AlohaCare Medicare	$1,560.50
Rate for Payer: Cash Price	$2,028.65
Rate for Payer: Devoted Health Medicare	$1,716.55
Rate for Payer: Hawaii Medical Service Association Medicare	$1,560.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,964.95
Rate for Payer: Health Management Network Commercial	$2,652.85
Rate for Payer: Humana Medicare	$1,560.50
Rate for Payer: Kaiser Permanente Commercial	$2,808.90
Rate for Payer: Kaiser Permanente Medicaid	$1,591.71
Rate for Payer: Kaiser Permanente Medicare	$1,560.50
Rate for Payer: MDX Hawaii PPO	$3,027.37
Rate for Payer: Ohana Health Plan Medicaid	$1,560.50
Rate for Payer: Ohana Health Plan Medicare	$1,560.50
Rate for Payer: UnitedHealthcare Medicare	$1,560.50
Rate for Payer: University Health Alliance Commercial	$2,274.90

ENDO CUTTER LINEAR, 45MM ARTICULATING (ETHICON)

Facility

$3,121.00

Hospital Charge Code	8274209
Hospital Revenue Code	272
Min. Negotiated Rate	$2,652.85
Max. Negotiated Rate	$3,027.37
Rate for Payer: Cash Price	$2,028.65
Rate for Payer: Health Management Network Commercial	$2,652.85
Rate for Payer: Kaiser Permanente Commercial	$2,808.90
Rate for Payer: MDX Hawaii PPO	$3,027.37

ENDO GIA ROTICULATOR 30/2.0

Facility

$551.00

Hospital Charge Code	8274227
Hospital Revenue Code	272
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$534.47
Rate for Payer: AlohaCare Medicaid	$275.50
Rate for Payer: AlohaCare Medicare	$275.50
Rate for Payer: Cash Price	$358.15
Rate for Payer: Devoted Health Medicare	$303.05
Rate for Payer: Hawaii Medical Service Association Medicare	$275.50
Rate for Payer: Hawaii Western Management Group Commercial	$523.45
Rate for Payer: Health Management Network Commercial	$468.35
Rate for Payer: Humana Medicare	$275.50
Rate for Payer: Kaiser Permanente Commercial	$495.90
Rate for Payer: Kaiser Permanente Medicaid	$281.01
Rate for Payer: Kaiser Permanente Medicare	$275.50
Rate for Payer: MDX Hawaii PPO	$534.47
Rate for Payer: Ohana Health Plan Medicaid	$275.50
Rate for Payer: Ohana Health Plan Medicare	$275.50
Rate for Payer: UnitedHealthcare Medicare	$275.50
Rate for Payer: University Health Alliance Commercial	$401.62

ENDO GIA ROTICULATOR 30/2.0

Facility

$551.00

Hospital Charge Code	8274227
Hospital Revenue Code	272
Min. Negotiated Rate	$468.35
Max. Negotiated Rate	$534.47
Rate for Payer: Cash Price	$358.15
Rate for Payer: Health Management Network Commercial	$468.35
Rate for Payer: Kaiser Permanente Commercial	$495.90
Rate for Payer: MDX Hawaii PPO	$534.47

ENDO GIA ROTICULATOR 45/2.0

Facility

$753.00

Hospital Charge Code	8274228
Hospital Revenue Code	272
Min. Negotiated Rate	$640.05
Max. Negotiated Rate	$730.41
Rate for Payer: Cash Price	$489.45
Rate for Payer: Health Management Network Commercial	$640.05
Rate for Payer: Kaiser Permanente Commercial	$677.70
Rate for Payer: MDX Hawaii PPO	$730.41

ENDO GIA ROTICULATOR 45/2.0

Facility

$753.00

Hospital Charge Code	8274228
Hospital Revenue Code	272
Min. Negotiated Rate	$376.50
Max. Negotiated Rate	$730.41
Rate for Payer: AlohaCare Medicaid	$376.50
Rate for Payer: AlohaCare Medicare	$376.50
Rate for Payer: Cash Price	$489.45
Rate for Payer: Devoted Health Medicare	$414.15
Rate for Payer: Hawaii Medical Service Association Medicare	$376.50
Rate for Payer: Hawaii Western Management Group Commercial	$715.35
Rate for Payer: Health Management Network Commercial	$640.05
Rate for Payer: Humana Medicare	$376.50
Rate for Payer: Kaiser Permanente Commercial	$677.70
Rate for Payer: Kaiser Permanente Medicaid	$384.03
Rate for Payer: Kaiser Permanente Medicare	$376.50
Rate for Payer: MDX Hawaii PPO	$730.41
Rate for Payer: Ohana Health Plan Medicaid	$376.50
Rate for Payer: Ohana Health Plan Medicare	$376.50
Rate for Payer: UnitedHealthcare Medicare	$376.50
Rate for Payer: University Health Alliance Commercial	$548.86

ENDO GIA ROTICULATOR 45/2.5 VASCULAR

Facility

$602.00

Hospital Charge Code	8274229
Hospital Revenue Code	272
Min. Negotiated Rate	$511.70
Max. Negotiated Rate	$583.94
Rate for Payer: Cash Price	$391.30
Rate for Payer: Health Management Network Commercial	$511.70
Rate for Payer: Kaiser Permanente Commercial	$541.80
Rate for Payer: MDX Hawaii PPO	$583.94

ENDO GIA ROTICULATOR 45/2.5 VASCULAR

Facility

$602.00

Hospital Charge Code	8274229
Hospital Revenue Code	272
Min. Negotiated Rate	$301.00
Max. Negotiated Rate	$583.94
Rate for Payer: AlohaCare Medicaid	$301.00
Rate for Payer: AlohaCare Medicare	$301.00
Rate for Payer: Cash Price	$391.30
Rate for Payer: Devoted Health Medicare	$331.10
Rate for Payer: Hawaii Medical Service Association Medicare	$301.00
Rate for Payer: Hawaii Western Management Group Commercial	$571.90
Rate for Payer: Health Management Network Commercial	$511.70
Rate for Payer: Humana Medicare	$301.00
Rate for Payer: Kaiser Permanente Commercial	$541.80
Rate for Payer: Kaiser Permanente Medicaid	$307.02
Rate for Payer: Kaiser Permanente Medicare	$301.00
Rate for Payer: MDX Hawaii PPO	$583.94
Rate for Payer: Ohana Health Plan Medicaid	$301.00
Rate for Payer: Ohana Health Plan Medicare	$301.00
Rate for Payer: UnitedHealthcare Medicare	$301.00
Rate for Payer: University Health Alliance Commercial	$438.80

Know your out-of-pocket cost for care.

All Charges