Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Hepatitis C HCV RNA PCR Quantitative FSI

Facility

$478.00

Service Code	HCPCS 87522
Hospital Charge Code	8117952
Hospital Revenue Code	306
Min. Negotiated Rate	$406.30
Max. Negotiated Rate	$463.66
Rate for Payer: Cash Price	$310.70
Rate for Payer: Health Management Network Commercial	$406.30
Rate for Payer: Kaiser Permanente Commercial	$430.20
Rate for Payer: MDX Hawaii PPO	$463.66

Hepatitis C HCV RNA PCR Quantitative FSI

Facility

$478.00

Service Code	HCPCS 87522
Hospital Charge Code	8117952
Hospital Revenue Code	306
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$463.66
Rate for Payer: AlohaCare Medicaid	$239.00
Rate for Payer: AlohaCare Medicare	$239.00
Rate for Payer: Cash Price	$310.70
Rate for Payer: Cash Price	$310.70
Rate for Payer: Devoted Health Medicare	$262.90
Rate for Payer: Hawaii Medical Service Association ABD	$59.20
Rate for Payer: Hawaii Medical Service Association Commercial	$53.55
Rate for Payer: Hawaii Medical Service Association Medicare	$239.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$62.16
Rate for Payer: Hawaii Western Management Group Commercial	$42.84
Rate for Payer: Health Management Network Commercial	$406.30
Rate for Payer: Humana Medicare	$239.00
Rate for Payer: Kaiser Permanente Commercial	$430.20
Rate for Payer: Kaiser Permanente Medicaid	$243.78
Rate for Payer: Kaiser Permanente Medicare	$239.00
Rate for Payer: MDX Hawaii PPO	$463.66
Rate for Payer: Ohana Health Plan Medicaid	$239.00
Rate for Payer: Ohana Health Plan Medicare	$239.00
Rate for Payer: UnitedHealthcare Medicaid	$59.20
Rate for Payer: UnitedHealthcare Medicare	$239.00
Rate for Payer: University Health Alliance Commercial	$110.72

Hepatitis C Virus Genotype FSI

Facility

$2,876.00

Service Code	HCPCS 87902
Hospital Charge Code	8117953
Hospital Revenue Code	306
Min. Negotiated Rate	$2,444.60
Max. Negotiated Rate	$2,789.72
Rate for Payer: Cash Price	$1,869.40
Rate for Payer: Health Management Network Commercial	$2,444.60
Rate for Payer: Kaiser Permanente Commercial	$2,588.40
Rate for Payer: MDX Hawaii PPO	$2,789.72

Hepatitis C Virus Genotype FSI

Facility

$2,876.00

Service Code	HCPCS 87902
Hospital Charge Code	8117953
Hospital Revenue Code	306
Min. Negotiated Rate	$256.16
Max. Negotiated Rate	$2,789.72
Rate for Payer: AlohaCare Medicaid	$1,438.00
Rate for Payer: AlohaCare Medicare	$1,438.00
Rate for Payer: Cash Price	$1,869.40
Rate for Payer: Cash Price	$1,869.40
Rate for Payer: Devoted Health Medicare	$1,581.80
Rate for Payer: Hawaii Medical Service Association ABD	$256.16
Rate for Payer: Hawaii Medical Service Association Commercial	$321.81
Rate for Payer: Hawaii Medical Service Association Medicare	$1,438.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$355.58
Rate for Payer: Hawaii Western Management Group Commercial	$257.45
Rate for Payer: Health Management Network Commercial	$2,444.60
Rate for Payer: Humana Medicare	$1,438.00
Rate for Payer: Kaiser Permanente Commercial	$2,588.40
Rate for Payer: Kaiser Permanente Medicaid	$1,466.76
Rate for Payer: Kaiser Permanente Medicare	$1,438.00
Rate for Payer: MDX Hawaii PPO	$2,789.72
Rate for Payer: Ohana Health Plan Medicaid	$1,438.00
Rate for Payer: Ohana Health Plan Medicare	$1,438.00
Rate for Payer: UnitedHealthcare Medicaid	$256.16
Rate for Payer: UnitedHealthcare Medicare	$1,438.00
Rate for Payer: University Health Alliance Commercial	$665.43

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC

Facility

$70,419.95

Service Code	MSDRG 421
Min. Negotiated Rate	$70,419.95
Max. Negotiated Rate	$70,419.95
Rate for Payer: Hawaii Medical Service Association Commercial	$70,419.95

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC

Facility

$70,419.95

Service Code	MSDRG 420
Min. Negotiated Rate	$70,419.95
Max. Negotiated Rate	$70,419.95
Rate for Payer: Hawaii Medical Service Association Commercial	$70,419.95

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC

Facility

$62,490.70

Service Code	MSDRG 422
Min. Negotiated Rate	$62,490.70
Max. Negotiated Rate	$62,490.70
Rate for Payer: Hawaii Medical Service Association Commercial	$62,490.70

Hep C Ab Rfx Quant FSI

Facility

$163.00

Service Code	HCPCS 86803
Hospital Charge Code	8228880
Hospital Revenue Code	302
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$158.11
Rate for Payer: AlohaCare Medicaid	$81.50
Rate for Payer: AlohaCare Medicare	$81.50
Rate for Payer: Cash Price	$105.95
Rate for Payer: Cash Price	$105.95
Rate for Payer: Devoted Health Medicare	$89.65
Rate for Payer: Hawaii Medical Service Association ABD	$19.73
Rate for Payer: Hawaii Medical Service Association Commercial	$17.84
Rate for Payer: Hawaii Medical Service Association Medicare	$81.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.72
Rate for Payer: Hawaii Western Management Group Commercial	$14.27
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Humana Medicare	$81.50
Rate for Payer: Kaiser Permanente Commercial	$146.70
Rate for Payer: Kaiser Permanente Medicaid	$83.13
Rate for Payer: Kaiser Permanente Medicare	$81.50
Rate for Payer: MDX Hawaii PPO	$158.11
Rate for Payer: Ohana Health Plan Medicaid	$81.50
Rate for Payer: Ohana Health Plan Medicare	$81.50
Rate for Payer: UnitedHealthcare Medicaid	$19.73
Rate for Payer: UnitedHealthcare Medicare	$81.50
Rate for Payer: University Health Alliance Commercial	$36.89

Hep C Ab Rfx Quant FSI

Facility

$163.00

Service Code	HCPCS 86803
Hospital Charge Code	8228880
Hospital Revenue Code	302
Min. Negotiated Rate	$138.55
Max. Negotiated Rate	$158.11
Rate for Payer: Cash Price	$105.95
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Kaiser Permanente Commercial	$146.70
Rate for Payer: MDX Hawaii PPO	$158.11

Hep C Ab Rfx Quant, Rfx Genotype FSI

Facility

$163.00

Service Code	HCPCS 86803
Hospital Charge Code	8228881
Hospital Revenue Code	302
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$158.11
Rate for Payer: AlohaCare Medicaid	$81.50
Rate for Payer: AlohaCare Medicare	$81.50
Rate for Payer: Cash Price	$105.95
Rate for Payer: Cash Price	$105.95
Rate for Payer: Devoted Health Medicare	$89.65
Rate for Payer: Hawaii Medical Service Association ABD	$19.73
Rate for Payer: Hawaii Medical Service Association Commercial	$17.84
Rate for Payer: Hawaii Medical Service Association Medicare	$81.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.72
Rate for Payer: Hawaii Western Management Group Commercial	$14.27
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Humana Medicare	$81.50
Rate for Payer: Kaiser Permanente Commercial	$146.70
Rate for Payer: Kaiser Permanente Medicaid	$83.13
Rate for Payer: Kaiser Permanente Medicare	$81.50
Rate for Payer: MDX Hawaii PPO	$158.11
Rate for Payer: Ohana Health Plan Medicaid	$81.50
Rate for Payer: Ohana Health Plan Medicare	$81.50
Rate for Payer: UnitedHealthcare Medicaid	$19.73
Rate for Payer: UnitedHealthcare Medicare	$81.50
Rate for Payer: University Health Alliance Commercial	$36.89

Hep C Ab Rfx Quant, Rfx Genotype FSI

Facility

$163.00

Service Code	HCPCS 86803
Hospital Charge Code	8228881
Hospital Revenue Code	302
Min. Negotiated Rate	$138.55
Max. Negotiated Rate	$158.11
Rate for Payer: Cash Price	$105.95
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Kaiser Permanente Commercial	$146.70
Rate for Payer: MDX Hawaii PPO	$158.11

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC

Facility

$34,368.61

Service Code	MSDRG 354
Min. Negotiated Rate	$34,368.61
Max. Negotiated Rate	$34,368.61
Rate for Payer: Hawaii Medical Service Association Commercial	$34,368.61

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC

Facility

$44,541.51

Service Code	MSDRG 353
Min. Negotiated Rate	$44,541.51
Max. Negotiated Rate	$44,541.51
Rate for Payer: Hawaii Medical Service Association Commercial	$44,541.51

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC

Facility

$25,394.02

Service Code	MSDRG 355
Min. Negotiated Rate	$25,394.02
Max. Negotiated Rate	$25,394.02
Rate for Payer: Hawaii Medical Service Association Commercial	$25,394.02

Herpes Simplex HSV 1,2 DNA by PCR FSI

Facility

$392.00

Service Code	HCPCS 87529
Hospital Charge Code	8117954
Hospital Revenue Code	306
Min. Negotiated Rate	$333.20
Max. Negotiated Rate	$380.24
Rate for Payer: Cash Price	$254.80
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: MDX Hawaii PPO	$380.24

Herpes Simplex HSV 1,2 DNA by PCR FSI

Facility

$392.00

Service Code	HCPCS 87529
Hospital Charge Code	8117954
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$380.24
Rate for Payer: AlohaCare Medicaid	$196.00
Rate for Payer: AlohaCare Medicare	$196.00
Rate for Payer: Cash Price	$254.80
Rate for Payer: Cash Price	$254.80
Rate for Payer: Devoted Health Medicare	$215.60
Rate for Payer: Hawaii Medical Service Association ABD	$46.44
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$196.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$48.76
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Humana Medicare	$196.00
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: Kaiser Permanente Medicaid	$199.92
Rate for Payer: Kaiser Permanente Medicare	$196.00
Rate for Payer: MDX Hawaii PPO	$380.24
Rate for Payer: Ohana Health Plan Medicaid	$196.00
Rate for Payer: Ohana Health Plan Medicare	$196.00
Rate for Payer: UnitedHealthcare Medicaid	$46.44
Rate for Payer: UnitedHealthcare Medicare	$196.00
Rate for Payer: University Health Alliance Commercial	$90.72

Herpes Simplex HSV 1,2 IgG FSI

Facility

$139.00

Service Code	HCPCS 86695
Hospital Charge Code	8117955
Hospital Revenue Code	300
Min. Negotiated Rate	$13.19
Max. Negotiated Rate	$134.83
Rate for Payer: AlohaCare Medicaid	$69.50
Rate for Payer: AlohaCare Medicare	$69.50
Rate for Payer: Cash Price	$90.35
Rate for Payer: Cash Price	$90.35
Rate for Payer: Devoted Health Medicare	$76.45
Rate for Payer: Hawaii Medical Service Association ABD	$18.23
Rate for Payer: Hawaii Medical Service Association Commercial	$16.49
Rate for Payer: Hawaii Medical Service Association Medicare	$69.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.14
Rate for Payer: Hawaii Western Management Group Commercial	$13.19
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Humana Medicare	$69.50
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: Kaiser Permanente Medicaid	$70.89
Rate for Payer: Kaiser Permanente Medicare	$69.50
Rate for Payer: MDX Hawaii PPO	$134.83
Rate for Payer: Ohana Health Plan Medicaid	$69.50
Rate for Payer: Ohana Health Plan Medicare	$69.50
Rate for Payer: UnitedHealthcare Medicaid	$18.23
Rate for Payer: UnitedHealthcare Medicare	$69.50
Rate for Payer: University Health Alliance Commercial	$34.10

Herpes Simplex HSV 1,2 IgG FSI

Facility

$139.00

Service Code	HCPCS 86695
Hospital Charge Code	8117955
Hospital Revenue Code	300
Min. Negotiated Rate	$118.15
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$90.35
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: MDX Hawaii PPO	$134.83

Herpes Simplex HSV 2 IgG FSI

Facility

$138.00

Service Code	HCPCS 86696
Hospital Charge Code	8117957
Hospital Revenue Code	300
Min. Negotiated Rate	$117.30
Max. Negotiated Rate	$133.86
Rate for Payer: Cash Price	$89.70
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: MDX Hawaii PPO	$133.86

Herpes Simplex HSV 2 IgG FSI

Facility

$138.00

Service Code	HCPCS 86696
Hospital Charge Code	8117957
Hospital Revenue Code	300
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$133.86
Rate for Payer: AlohaCare Medicaid	$69.00
Rate for Payer: AlohaCare Medicare	$69.00
Rate for Payer: Cash Price	$89.70
Rate for Payer: Cash Price	$89.70
Rate for Payer: Devoted Health Medicare	$75.90
Rate for Payer: Hawaii Medical Service Association ABD	$27.05
Rate for Payer: Hawaii Medical Service Association Commercial	$24.19
Rate for Payer: Hawaii Medical Service Association Medicare	$69.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.40
Rate for Payer: Hawaii Western Management Group Commercial	$19.35
Rate for Payer: Health Management Network Commercial	$117.30
Rate for Payer: Humana Medicare	$69.00
Rate for Payer: Kaiser Permanente Commercial	$124.20
Rate for Payer: Kaiser Permanente Medicaid	$70.38
Rate for Payer: Kaiser Permanente Medicare	$69.00
Rate for Payer: MDX Hawaii PPO	$133.86
Rate for Payer: Ohana Health Plan Medicaid	$69.00
Rate for Payer: Ohana Health Plan Medicare	$69.00
Rate for Payer: UnitedHealthcare Medicaid	$27.05
Rate for Payer: UnitedHealthcare Medicare	$69.00
Rate for Payer: University Health Alliance Commercial	$50.04

Herpes Simplex PCR Reflex to Subtype 1, 2 (Blood and Fluid other than CSF) FSI

Facility

$392.00

Service Code	HCPCS 87529
Hospital Charge Code	8117959
Hospital Revenue Code	306
Min. Negotiated Rate	$333.20
Max. Negotiated Rate	$380.24
Rate for Payer: Cash Price	$254.80
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: MDX Hawaii PPO	$380.24

Herpes Simplex PCR Reflex to Subtype 1, 2 (Blood and Fluid other than CSF) FSI

Facility

$392.00

Service Code	HCPCS 87529
Hospital Charge Code	8117959
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$380.24
Rate for Payer: AlohaCare Medicaid	$196.00
Rate for Payer: AlohaCare Medicare	$196.00
Rate for Payer: Cash Price	$254.80
Rate for Payer: Cash Price	$254.80
Rate for Payer: Devoted Health Medicare	$215.60
Rate for Payer: Hawaii Medical Service Association ABD	$46.44
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$196.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$48.76
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Humana Medicare	$196.00
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: Kaiser Permanente Medicaid	$199.92
Rate for Payer: Kaiser Permanente Medicare	$196.00
Rate for Payer: MDX Hawaii PPO	$380.24
Rate for Payer: Ohana Health Plan Medicaid	$196.00
Rate for Payer: Ohana Health Plan Medicare	$196.00
Rate for Payer: UnitedHealthcare Medicaid	$46.44
Rate for Payer: UnitedHealthcare Medicare	$196.00
Rate for Payer: University Health Alliance Commercial	$90.72

hetastarch-ns 6% 500ml [HHSC]

Facility

$86.16

Service Code	NDC 00264196510
Hospital Charge Code	2500384
Hospital Revenue Code	250
Min. Negotiated Rate	$43.08
Max. Negotiated Rate	$83.58
Rate for Payer: AlohaCare Medicaid	$43.08
Rate for Payer: AlohaCare Medicare	$43.08
Rate for Payer: Cash Price	$56.00
Rate for Payer: Devoted Health Medicare	$47.39
Rate for Payer: Hawaii Medical Service Association Medicare	$43.08
Rate for Payer: Hawaii Western Management Group Commercial	$81.85
Rate for Payer: Health Management Network Commercial	$73.24
Rate for Payer: Humana Medicare	$43.08
Rate for Payer: Kaiser Permanente Commercial	$77.54
Rate for Payer: Kaiser Permanente Medicaid	$43.94
Rate for Payer: Kaiser Permanente Medicare	$43.08
Rate for Payer: MDX Hawaii PPO	$83.58
Rate for Payer: Ohana Health Plan Medicaid	$43.08
Rate for Payer: Ohana Health Plan Medicare	$43.08
Rate for Payer: UnitedHealthcare Medicaid	$51.70
Rate for Payer: UnitedHealthcare Medicare	$43.08
Rate for Payer: University Health Alliance Commercial	$62.80

hetastarch-ns 6% 500ml [HHSC]

Facility

$94.58

Service Code	NDC 00409724803
Hospital Charge Code	2500384
Hospital Revenue Code	250
Min. Negotiated Rate	$47.29
Max. Negotiated Rate	$91.74
Rate for Payer: AlohaCare Medicaid	$47.29
Rate for Payer: AlohaCare Medicare	$47.29
Rate for Payer: Cash Price	$61.48
Rate for Payer: Devoted Health Medicare	$52.02
Rate for Payer: Hawaii Medical Service Association Medicare	$47.29
Rate for Payer: Hawaii Western Management Group Commercial	$89.85
Rate for Payer: Health Management Network Commercial	$80.39
Rate for Payer: Humana Medicare	$47.29
Rate for Payer: Kaiser Permanente Commercial	$85.12
Rate for Payer: Kaiser Permanente Medicaid	$48.24
Rate for Payer: Kaiser Permanente Medicare	$47.29
Rate for Payer: MDX Hawaii PPO	$91.74
Rate for Payer: Ohana Health Plan Medicaid	$47.29
Rate for Payer: Ohana Health Plan Medicare	$47.29
Rate for Payer: UnitedHealthcare Medicaid	$56.75
Rate for Payer: UnitedHealthcare Medicare	$47.29
Rate for Payer: University Health Alliance Commercial	$68.94

hetastarch-ns 6% 500ml [HHSC]

Facility

$86.16

Service Code	NDC 00264196510
Hospital Charge Code	2500384
Hospital Revenue Code	250
Min. Negotiated Rate	$73.24
Max. Negotiated Rate	$83.58
Rate for Payer: Cash Price	$56.00
Rate for Payer: Health Management Network Commercial	$73.24
Rate for Payer: Kaiser Permanente Commercial	$77.54
Rate for Payer: MDX Hawaii PPO	$83.58

Know your out-of-pocket cost for care.

All Charges