Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

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

Hgb/Hct iSTAT

Facility

$97.00

Service Code	HCPCS 85014 QW
Hospital Charge Code	8293266
Hospital Revenue Code	305
Min. Negotiated Rate	$82.45
Max. Negotiated Rate	$94.09
Rate for Payer: Cash Price	$63.05
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Kaiser Permanente Commercial	$87.30
Rate for Payer: MDX Hawaii PPO	$94.09

Hgb/Hct iSTAT

Facility

$97.00

Service Code	HCPCS 85014 QW
Hospital Charge Code	8293266
Hospital Revenue Code	305
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$94.09
Rate for Payer: AlohaCare Medicaid	$48.50
Rate for Payer: AlohaCare Medicare	$48.50
Rate for Payer: Cash Price	$63.05
Rate for Payer: Cash Price	$63.05
Rate for Payer: Devoted Health Medicare	$53.35
Rate for Payer: Hawaii Medical Service Association ABD	$3.27
Rate for Payer: Hawaii Medical Service Association Commercial	$2.96
Rate for Payer: Hawaii Medical Service Association Medicare	$48.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.43
Rate for Payer: Hawaii Western Management Group Commercial	$2.37
Rate for Payer: Health Management Network Commercial	$82.45
Rate for Payer: Humana Medicare	$48.50
Rate for Payer: Kaiser Permanente Commercial	$87.30
Rate for Payer: Kaiser Permanente Medicaid	$49.47
Rate for Payer: Kaiser Permanente Medicare	$48.50
Rate for Payer: MDX Hawaii PPO	$94.09
Rate for Payer: Ohana Health Plan Medicaid	$48.50
Rate for Payer: Ohana Health Plan Medicare	$48.50
Rate for Payer: UnitedHealthcare Medicaid	$3.27
Rate for Payer: UnitedHealthcare Medicare	$48.50
Rate for Payer: University Health Alliance Commercial	$6.12

HHSC AMNIOCENTESIS TRAYS

Facility

$109.00

Hospital Charge Code	8223464
Hospital Revenue Code	272
Min. Negotiated Rate	$92.65
Max. Negotiated Rate	$105.73
Rate for Payer: Cash Price	$70.85
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: Kaiser Permanente Commercial	$98.10
Rate for Payer: MDX Hawaii PPO	$105.73

HHSC AMNIOCENTESIS TRAYS

Facility

$109.00

Hospital Charge Code	8223464
Hospital Revenue Code	272
Min. Negotiated Rate	$54.50
Max. Negotiated Rate	$105.73
Rate for Payer: AlohaCare Medicaid	$54.50
Rate for Payer: AlohaCare Medicare	$54.50
Rate for Payer: Cash Price	$70.85
Rate for Payer: Devoted Health Medicare	$59.95
Rate for Payer: Hawaii Medical Service Association Medicare	$54.50
Rate for Payer: Hawaii Western Management Group Commercial	$103.55
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: Humana Medicare	$54.50
Rate for Payer: Kaiser Permanente Commercial	$98.10
Rate for Payer: Kaiser Permanente Medicaid	$55.59
Rate for Payer: Kaiser Permanente Medicare	$54.50
Rate for Payer: MDX Hawaii PPO	$105.73
Rate for Payer: Ohana Health Plan Medicaid	$54.50
Rate for Payer: Ohana Health Plan Medicare	$54.50
Rate for Payer: UnitedHealthcare Medicare	$54.50
Rate for Payer: University Health Alliance Commercial	$79.45

HHSC AT0912-12 9X12,12MM HP HOLO BRST BX

Facility

$155.00

Hospital Charge Code	8223446
Hospital Revenue Code	272
Min. Negotiated Rate	$77.50
Max. Negotiated Rate	$150.35
Rate for Payer: AlohaCare Medicaid	$77.50
Rate for Payer: AlohaCare Medicare	$77.50
Rate for Payer: Cash Price	$100.75
Rate for Payer: Devoted Health Medicare	$85.25
Rate for Payer: Hawaii Medical Service Association Medicare	$77.50
Rate for Payer: Hawaii Western Management Group Commercial	$147.25
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Humana Medicare	$77.50
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: Kaiser Permanente Medicare	$77.50
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: Ohana Health Plan Medicaid	$77.50
Rate for Payer: Ohana Health Plan Medicare	$77.50
Rate for Payer: UnitedHealthcare Medicare	$77.50
Rate for Payer: University Health Alliance Commercial	$112.98

HHSC AT0912-12 9X12,12MM HP HOLO BRST BX

Facility

$155.00

Hospital Charge Code	8223446
Hospital Revenue Code	272
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$100.75
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: MDX Hawaii PPO	$150.35

HHSC AT0912-20 9X12,20MM HP HOLO BRST BX

Facility

$110.00

Hospital Charge Code	8223448
Hospital Revenue Code	272
Min. Negotiated Rate	$93.50
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$71.50
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: Kaiser Permanente Commercial	$99.00
Rate for Payer: MDX Hawaii PPO	$106.70

HHSC AT0912-20 9X12,20MM HP HOLO BRST BX

Facility

$110.00

Hospital Charge Code	8223448
Hospital Revenue Code	272
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$106.70
Rate for Payer: AlohaCare Medicaid	$55.00
Rate for Payer: AlohaCare Medicare	$55.00
Rate for Payer: Cash Price	$71.50
Rate for Payer: Devoted Health Medicare	$60.50
Rate for Payer: Hawaii Medical Service Association Medicare	$55.00
Rate for Payer: Hawaii Western Management Group Commercial	$104.50
Rate for Payer: Health Management Network Commercial	$93.50
Rate for Payer: Humana Medicare	$55.00
Rate for Payer: Kaiser Permanente Commercial	$99.00
Rate for Payer: Kaiser Permanente Medicaid	$56.10
Rate for Payer: Kaiser Permanente Medicare	$55.00
Rate for Payer: MDX Hawaii PPO	$106.70
Rate for Payer: Ohana Health Plan Medicaid	$55.00
Rate for Payer: Ohana Health Plan Medicare	$55.00
Rate for Payer: UnitedHealthcare Medicare	$55.00
Rate for Payer: University Health Alliance Commercial	$80.18

HHSC AUTOMATIC BX NEEDLE 18GX15CM

Facility

$76.00

Hospital Charge Code	8223444
Hospital Revenue Code	272
Min. Negotiated Rate	$64.60
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$49.40
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: MDX Hawaii PPO	$73.72

HHSC AUTOMATIC BX NEEDLE 18GX15CM

Facility

$76.00

Hospital Charge Code	8223444
Hospital Revenue Code	272
Min. Negotiated Rate	$38.00
Max. Negotiated Rate	$73.72
Rate for Payer: AlohaCare Medicaid	$38.00
Rate for Payer: AlohaCare Medicare	$38.00
Rate for Payer: Cash Price	$49.40
Rate for Payer: Devoted Health Medicare	$41.80
Rate for Payer: Hawaii Medical Service Association Medicare	$38.00
Rate for Payer: Hawaii Western Management Group Commercial	$72.20
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Humana Medicare	$38.00
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: Kaiser Permanente Medicaid	$38.76
Rate for Payer: Kaiser Permanente Medicare	$38.00
Rate for Payer: MDX Hawaii PPO	$73.72
Rate for Payer: Ohana Health Plan Medicaid	$38.00
Rate for Payer: Ohana Health Plan Medicare	$38.00
Rate for Payer: UnitedHealthcare Medicare	$38.00
Rate for Payer: University Health Alliance Commercial	$55.40

HHSC BCE 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa; without ultrasound

Facility

$717.00

Service Code	HCPCS 20610
Hospital Charge Code	8529434
Hospital Revenue Code	450
Min. Negotiated Rate	$358.50
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$358.50
Rate for Payer: Cash Price	$466.05
Rate for Payer: Cash Price	$466.05
Rate for Payer: Cash Price	$466.05
Rate for Payer: Devoted Health Medicare	$394.35
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$358.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$681.15
Rate for Payer: Health Management Network Commercial	$609.45
Rate for Payer: Humana Medicare	$358.50
Rate for Payer: Kaiser Permanente Commercial	$645.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$358.50
Rate for Payer: MDX Hawaii PPO	$695.49
Rate for Payer: Ohana Health Plan Medicaid	$358.50
Rate for Payer: Ohana Health Plan Medicare	$358.50
Rate for Payer: UnitedHealthcare Medicare	$358.50
Rate for Payer: University Health Alliance Commercial	$4,035.20

HHSC BCE 20610 Arthrocentesis, aspiration and/or injection, major joint or bursa; without ultrasound

Facility

$717.00

Service Code	HCPCS 20610
Hospital Charge Code	8529434
Hospital Revenue Code	450
Min. Negotiated Rate	$609.45
Max. Negotiated Rate	$695.49
Rate for Payer: Cash Price	$466.05
Rate for Payer: Health Management Network Commercial	$609.45
Rate for Payer: Kaiser Permanente Commercial	$645.30
Rate for Payer: MDX Hawaii PPO	$695.49

HHSC BIOPSY TRAYS

Facility

$131.00

Hospital Charge Code	8223462
Hospital Revenue Code	272
Min. Negotiated Rate	$111.35
Max. Negotiated Rate	$127.07
Rate for Payer: Cash Price	$85.15
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: MDX Hawaii PPO	$127.07

HHSC BIOPSY TRAYS

Facility

$131.00

Hospital Charge Code	8223462
Hospital Revenue Code	272
Min. Negotiated Rate	$65.50
Max. Negotiated Rate	$127.07
Rate for Payer: AlohaCare Medicaid	$65.50
Rate for Payer: AlohaCare Medicare	$65.50
Rate for Payer: Cash Price	$85.15
Rate for Payer: Devoted Health Medicare	$72.05
Rate for Payer: Hawaii Medical Service Association Medicare	$65.50
Rate for Payer: Hawaii Western Management Group Commercial	$124.45
Rate for Payer: Health Management Network Commercial	$111.35
Rate for Payer: Humana Medicare	$65.50
Rate for Payer: Kaiser Permanente Commercial	$117.90
Rate for Payer: Kaiser Permanente Medicaid	$66.81
Rate for Payer: Kaiser Permanente Medicare	$65.50
Rate for Payer: MDX Hawaii PPO	$127.07
Rate for Payer: Ohana Health Plan Medicaid	$65.50
Rate for Payer: Ohana Health Plan Medicare	$65.50
Rate for Payer: UnitedHealthcare Medicare	$65.50
Rate for Payer: University Health Alliance Commercial	$95.49

HHSC BREAST WIRE LOCAL 20G X 5.7CM NDL

Facility

$239.00

Hospital Charge Code	8223456
Hospital Revenue Code	272
Min. Negotiated Rate	$119.50
Max. Negotiated Rate	$231.83
Rate for Payer: AlohaCare Medicaid	$119.50
Rate for Payer: AlohaCare Medicare	$119.50
Rate for Payer: Cash Price	$155.35
Rate for Payer: Devoted Health Medicare	$131.45
Rate for Payer: Hawaii Medical Service Association Medicare	$119.50
Rate for Payer: Hawaii Western Management Group Commercial	$227.05
Rate for Payer: Health Management Network Commercial	$203.15
Rate for Payer: Humana Medicare	$119.50
Rate for Payer: Kaiser Permanente Commercial	$215.10
Rate for Payer: Kaiser Permanente Medicaid	$121.89
Rate for Payer: Kaiser Permanente Medicare	$119.50
Rate for Payer: MDX Hawaii PPO	$231.83
Rate for Payer: Ohana Health Plan Medicaid	$119.50
Rate for Payer: Ohana Health Plan Medicare	$119.50
Rate for Payer: UnitedHealthcare Medicare	$119.50
Rate for Payer: University Health Alliance Commercial	$174.21

HHSC BREAST WIRE LOCAL 20G X 5.7CM NDL

Facility

$239.00

Hospital Charge Code	8223456
Hospital Revenue Code	272
Min. Negotiated Rate	$203.15
Max. Negotiated Rate	$231.83
Rate for Payer: Cash Price	$155.35
Rate for Payer: Health Management Network Commercial	$203.15
Rate for Payer: Kaiser Permanente Commercial	$215.10
Rate for Payer: MDX Hawaii PPO	$231.83

HHSC CATHETER DRAINAGE (CT)

Facility

$453.00

Service Code	HCPCS C1729
Hospital Charge Code	9469115
Hospital Revenue Code	272
Min. Negotiated Rate	$226.50
Max. Negotiated Rate	$439.41
Rate for Payer: AlohaCare Medicaid	$226.50
Rate for Payer: AlohaCare Medicare	$226.50
Rate for Payer: Cash Price	$294.45
Rate for Payer: Devoted Health Medicare	$249.15
Rate for Payer: Hawaii Medical Service Association Medicare	$226.50
Rate for Payer: Hawaii Western Management Group Commercial	$430.35
Rate for Payer: Health Management Network Commercial	$385.05
Rate for Payer: Humana Medicare	$226.50
Rate for Payer: Kaiser Permanente Commercial	$407.70
Rate for Payer: Kaiser Permanente Medicaid	$231.03
Rate for Payer: Kaiser Permanente Medicare	$226.50
Rate for Payer: MDX Hawaii PPO	$439.41
Rate for Payer: Ohana Health Plan Medicaid	$226.50
Rate for Payer: Ohana Health Plan Medicare	$226.50
Rate for Payer: UnitedHealthcare Medicare	$226.50
Rate for Payer: University Health Alliance Commercial	$330.19

HHSC CATHETER DRAINAGE (CT)

Facility

$453.00

Service Code	HCPCS C1729
Hospital Charge Code	9469115
Hospital Revenue Code	272
Min. Negotiated Rate	$385.05
Max. Negotiated Rate	$439.41
Rate for Payer: Cash Price	$294.45
Rate for Payer: Health Management Network Commercial	$385.05
Rate for Payer: Kaiser Permanente Commercial	$407.70
Rate for Payer: MDX Hawaii PPO	$439.41

HHSC CATHETER DRAINAGE (US)

Facility

$453.00

Service Code	HCPCS C1729
Hospital Charge Code	9469343
Hospital Revenue Code	272
Min. Negotiated Rate	$226.50
Max. Negotiated Rate	$439.41
Rate for Payer: AlohaCare Medicaid	$226.50
Rate for Payer: AlohaCare Medicare	$226.50
Rate for Payer: Cash Price	$294.45
Rate for Payer: Devoted Health Medicare	$249.15
Rate for Payer: Hawaii Medical Service Association Medicare	$226.50
Rate for Payer: Hawaii Western Management Group Commercial	$430.35
Rate for Payer: Health Management Network Commercial	$385.05
Rate for Payer: Humana Medicare	$226.50
Rate for Payer: Kaiser Permanente Commercial	$407.70
Rate for Payer: Kaiser Permanente Medicaid	$231.03
Rate for Payer: Kaiser Permanente Medicare	$226.50
Rate for Payer: MDX Hawaii PPO	$439.41
Rate for Payer: Ohana Health Plan Medicaid	$226.50
Rate for Payer: Ohana Health Plan Medicare	$226.50
Rate for Payer: UnitedHealthcare Medicare	$226.50
Rate for Payer: University Health Alliance Commercial	$330.19

HHSC CATHETER DRAINAGE (US)

Facility

$453.00

Service Code	HCPCS C1729
Hospital Charge Code	9469343
Hospital Revenue Code	272
Min. Negotiated Rate	$385.05
Max. Negotiated Rate	$439.41
Rate for Payer: Cash Price	$294.45
Rate for Payer: Health Management Network Commercial	$385.05
Rate for Payer: Kaiser Permanente Commercial	$407.70
Rate for Payer: MDX Hawaii PPO	$439.41

HHSC CATHETER DRAINAGE (XR/MAMMO)

Facility

$400.00

Service Code	HCPCS C1729
Hospital Charge Code	9469079
Hospital Revenue Code	272
Min. Negotiated Rate	$200.00
Max. Negotiated Rate	$388.00
Rate for Payer: AlohaCare Medicaid	$200.00
Rate for Payer: AlohaCare Medicare	$200.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Devoted Health Medicare	$220.00
Rate for Payer: Hawaii Medical Service Association Medicare	$200.00
Rate for Payer: Hawaii Western Management Group Commercial	$380.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Humana Medicare	$200.00
Rate for Payer: Kaiser Permanente Commercial	$360.00
Rate for Payer: Kaiser Permanente Medicaid	$204.00
Rate for Payer: Kaiser Permanente Medicare	$200.00
Rate for Payer: MDX Hawaii PPO	$388.00
Rate for Payer: Ohana Health Plan Medicaid	$200.00
Rate for Payer: Ohana Health Plan Medicare	$200.00
Rate for Payer: UnitedHealthcare Medicare	$200.00
Rate for Payer: University Health Alliance Commercial	$291.56

HHSC CATHETER DRAINAGE (XR/MAMMO)

Facility

$400.00

Service Code	HCPCS C1729
Hospital Charge Code	9469079
Hospital Revenue Code	272
Min. Negotiated Rate	$340.00
Max. Negotiated Rate	$388.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Kaiser Permanente Commercial	$360.00
Rate for Payer: MDX Hawaii PPO	$388.00

HHSC CATH RABINOV 0.016IN(CT)

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	9469101
Hospital Revenue Code	272
Min. Negotiated Rate	$113.50
Max. Negotiated Rate	$220.19
Rate for Payer: AlohaCare Medicaid	$113.50
Rate for Payer: AlohaCare Medicare	$113.50
Rate for Payer: Cash Price	$147.55
Rate for Payer: Devoted Health Medicare	$124.85
Rate for Payer: Hawaii Medical Service Association Medicare	$113.50
Rate for Payer: Hawaii Western Management Group Commercial	$215.65
Rate for Payer: Health Management Network Commercial	$192.95
Rate for Payer: Humana Medicare	$113.50
Rate for Payer: Kaiser Permanente Commercial	$204.30
Rate for Payer: Kaiser Permanente Medicaid	$115.77
Rate for Payer: Kaiser Permanente Medicare	$113.50
Rate for Payer: MDX Hawaii PPO	$220.19
Rate for Payer: Ohana Health Plan Medicaid	$113.50
Rate for Payer: Ohana Health Plan Medicare	$113.50
Rate for Payer: UnitedHealthcare Medicare	$113.50
Rate for Payer: University Health Alliance Commercial	$165.46

HHSC CATH RABINOV 0.016IN(CT)

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	9469101
Hospital Revenue Code	272
Min. Negotiated Rate	$192.95
Max. Negotiated Rate	$220.19
Rate for Payer: Cash Price	$147.55
Rate for Payer: Health Management Network Commercial	$192.95
Rate for Payer: Kaiser Permanente Commercial	$204.30
Rate for Payer: MDX Hawaii PPO	$220.19

Know your out-of-pocket cost for care.

All Charges