Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

HHSC CATH RABINOV 0.016IN (US)

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	9469333
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 (US)

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	9469333
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

HHSC CATH RABINOV 0.016IN(XR/MAMMO)

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	9469006
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(XR/MAMMO)

Facility

$227.00

Service Code	HCPCS C1887
Hospital Charge Code	9469006
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

HHSC CEL12 SP LOAD CORE BX DEV US GID BX

Facility

$919.00

Service Code	HCPCS C1769
Hospital Charge Code	8223442
Hospital Revenue Code	272
Min. Negotiated Rate	$459.50
Max. Negotiated Rate	$891.43
Rate for Payer: AlohaCare Medicaid	$459.50
Rate for Payer: AlohaCare Medicare	$459.50
Rate for Payer: Cash Price	$597.35
Rate for Payer: Devoted Health Medicare	$505.45
Rate for Payer: Hawaii Medical Service Association Medicare	$459.50
Rate for Payer: Hawaii Western Management Group Commercial	$873.05
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Humana Medicare	$459.50
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: Kaiser Permanente Medicaid	$468.69
Rate for Payer: Kaiser Permanente Medicare	$459.50
Rate for Payer: MDX Hawaii PPO	$891.43
Rate for Payer: Ohana Health Plan Medicaid	$459.50
Rate for Payer: Ohana Health Plan Medicare	$459.50
Rate for Payer: UnitedHealthcare Medicare	$459.50
Rate for Payer: University Health Alliance Commercial	$669.86

HHSC CEL12 SP LOAD CORE BX DEV US GID BX

Facility

$919.00

Service Code	HCPCS C1769
Hospital Charge Code	8223442
Hospital Revenue Code	272
Min. Negotiated Rate	$781.15
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$597.35
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: MDX Hawaii PPO	$891.43

HHSC CELERO 12 SPRING LOADED CORE BX(US)

Facility

$919.00

Hospital Charge Code	9469347
Hospital Revenue Code	272
Min. Negotiated Rate	$781.15
Max. Negotiated Rate	$891.43
Rate for Payer: Cash Price	$597.35
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: MDX Hawaii PPO	$891.43

HHSC CELERO 12 SPRING LOADED CORE BX(US)

Facility

$919.00

Hospital Charge Code	9469347
Hospital Revenue Code	272
Min. Negotiated Rate	$459.50
Max. Negotiated Rate	$891.43
Rate for Payer: AlohaCare Medicaid	$459.50
Rate for Payer: AlohaCare Medicare	$459.50
Rate for Payer: Cash Price	$597.35
Rate for Payer: Devoted Health Medicare	$505.45
Rate for Payer: Hawaii Medical Service Association Medicare	$459.50
Rate for Payer: Hawaii Western Management Group Commercial	$873.05
Rate for Payer: Health Management Network Commercial	$781.15
Rate for Payer: Humana Medicare	$459.50
Rate for Payer: Kaiser Permanente Commercial	$827.10
Rate for Payer: Kaiser Permanente Medicaid	$468.69
Rate for Payer: Kaiser Permanente Medicare	$459.50
Rate for Payer: MDX Hawaii PPO	$891.43
Rate for Payer: Ohana Health Plan Medicaid	$459.50
Rate for Payer: Ohana Health Plan Medicare	$459.50
Rate for Payer: UnitedHealthcare Medicare	$459.50
Rate for Payer: University Health Alliance Commercial	$669.86

HHSC CK8.5F MPDRNCATHSTCLM-8.5RH-NPAS-NT

Facility

$262.00

Hospital Charge Code	8223450
Hospital Revenue Code	272
Min. Negotiated Rate	$131.00
Max. Negotiated Rate	$254.14
Rate for Payer: AlohaCare Medicaid	$131.00
Rate for Payer: AlohaCare Medicare	$131.00
Rate for Payer: Cash Price	$170.30
Rate for Payer: Devoted Health Medicare	$144.10
Rate for Payer: Hawaii Medical Service Association Medicare	$131.00
Rate for Payer: Hawaii Western Management Group Commercial	$248.90
Rate for Payer: Health Management Network Commercial	$222.70
Rate for Payer: Humana Medicare	$131.00
Rate for Payer: Kaiser Permanente Commercial	$235.80
Rate for Payer: Kaiser Permanente Medicaid	$133.62
Rate for Payer: Kaiser Permanente Medicare	$131.00
Rate for Payer: MDX Hawaii PPO	$254.14
Rate for Payer: Ohana Health Plan Medicaid	$131.00
Rate for Payer: Ohana Health Plan Medicare	$131.00
Rate for Payer: UnitedHealthcare Medicare	$131.00
Rate for Payer: University Health Alliance Commercial	$190.97

HHSC CK8.5F MPDRNCATHSTCLM-8.5RH-NPAS-NT

Facility

$262.00

Hospital Charge Code	8223450
Hospital Revenue Code	272
Min. Negotiated Rate	$222.70
Max. Negotiated Rate	$254.14
Rate for Payer: Cash Price	$170.30
Rate for Payer: Health Management Network Commercial	$222.70
Rate for Payer: Kaiser Permanente Commercial	$235.80
Rate for Payer: MDX Hawaii PPO	$254.14

HHSC COAXIAL TEMNO BIOPSY SYST 18Gx15CM

Facility

$731.00

Service Code	HCPCS C1729
Hospital Charge Code	8223440
Hospital Revenue Code	272
Min. Negotiated Rate	$365.50
Max. Negotiated Rate	$709.07
Rate for Payer: AlohaCare Medicaid	$365.50
Rate for Payer: AlohaCare Medicare	$365.50
Rate for Payer: Cash Price	$475.15
Rate for Payer: Devoted Health Medicare	$402.05
Rate for Payer: Hawaii Medical Service Association Medicare	$365.50
Rate for Payer: Hawaii Western Management Group Commercial	$694.45
Rate for Payer: Health Management Network Commercial	$621.35
Rate for Payer: Humana Medicare	$365.50
Rate for Payer: Kaiser Permanente Commercial	$657.90
Rate for Payer: Kaiser Permanente Medicaid	$372.81
Rate for Payer: Kaiser Permanente Medicare	$365.50
Rate for Payer: MDX Hawaii PPO	$709.07
Rate for Payer: Ohana Health Plan Medicaid	$365.50
Rate for Payer: Ohana Health Plan Medicare	$365.50
Rate for Payer: UnitedHealthcare Medicare	$365.50
Rate for Payer: University Health Alliance Commercial	$532.83

HHSC COAXIAL TEMNO BIOPSY SYST 18Gx15CM

Facility

$731.00

Service Code	HCPCS C1729
Hospital Charge Code	8223440
Hospital Revenue Code	272
Min. Negotiated Rate	$621.35
Max. Negotiated Rate	$709.07
Rate for Payer: Cash Price	$475.15
Rate for Payer: Health Management Network Commercial	$621.35
Rate for Payer: Kaiser Permanente Commercial	$657.90
Rate for Payer: MDX Hawaii PPO	$709.07

HHSC CONNECT TUBE WITH DRAIN BAG CONNECT

Facility

$90.00

Hospital Charge Code	8223460
Hospital Revenue Code	272
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$58.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: MDX Hawaii PPO	$87.30

HHSC CONNECT TUBE WITH DRAIN BAG CONNECT

Facility

$90.00

Hospital Charge Code	8223460
Hospital Revenue Code	272
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$87.30
Rate for Payer: AlohaCare Medicaid	$45.00
Rate for Payer: AlohaCare Medicare	$45.00
Rate for Payer: Cash Price	$58.50
Rate for Payer: Devoted Health Medicare	$49.50
Rate for Payer: Hawaii Medical Service Association Medicare	$45.00
Rate for Payer: Hawaii Western Management Group Commercial	$85.50
Rate for Payer: Health Management Network Commercial	$76.50
Rate for Payer: Humana Medicare	$45.00
Rate for Payer: Kaiser Permanente Commercial	$81.00
Rate for Payer: Kaiser Permanente Medicaid	$45.90
Rate for Payer: Kaiser Permanente Medicare	$45.00
Rate for Payer: MDX Hawaii PPO	$87.30
Rate for Payer: Ohana Health Plan Medicaid	$45.00
Rate for Payer: Ohana Health Plan Medicare	$45.00
Rate for Payer: UnitedHealthcare Medicare	$45.00
Rate for Payer: University Health Alliance Commercial	$65.60

HHSC CT 3D Rendering w/o Postprocess

Facility

$243.00

Service Code	HCPCS 76376
Hospital Charge Code	8223470
Hospital Revenue Code	350
Min. Negotiated Rate	$40.37
Max. Negotiated Rate	$235.71
Rate for Payer: Ohana Health Plan Medicaid	$121.50
Rate for Payer: AlohaCare Medicaid	$121.50
Rate for Payer: AlohaCare Medicare	$121.50
Rate for Payer: Cash Price	$157.95
Rate for Payer: Cash Price	$157.95
Rate for Payer: Devoted Health Medicare	$133.65
Rate for Payer: Hawaii Medical Service Association ABD	$98.13
Rate for Payer: Hawaii Medical Service Association Medicare	$121.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$40.37
Rate for Payer: Hawaii Western Management Group Commercial	$230.85
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Humana Medicare	$121.50
Rate for Payer: Kaiser Permanente Commercial	$218.70
Rate for Payer: Kaiser Permanente Medicaid	$123.93
Rate for Payer: Kaiser Permanente Medicare	$121.50
Rate for Payer: MDX Hawaii PPO	$235.71
Rate for Payer: Ohana Health Plan Medicare	$121.50
Rate for Payer: UnitedHealthcare Medicaid	$98.13
Rate for Payer: UnitedHealthcare Medicare	$121.50
Rate for Payer: University Health Alliance Commercial	$214.08

HHSC CT 3D Rendering w/o Postprocess

Facility

$243.00

Service Code	HCPCS 76376
Hospital Charge Code	8223470
Hospital Revenue Code	350
Min. Negotiated Rate	$206.55
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$157.95
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Kaiser Permanente Commercial	$218.70
Rate for Payer: MDX Hawaii PPO	$235.71

HHSC CT 3D Rendering w/ Postprocess

Facility

$436.00

Service Code	HCPCS 76377
Hospital Charge Code	8223468
Hospital Revenue Code	350
Min. Negotiated Rate	$38.91
Max. Negotiated Rate	$422.92
Rate for Payer: AlohaCare Medicaid	$218.00
Rate for Payer: AlohaCare Medicare	$218.00
Rate for Payer: Cash Price	$283.40
Rate for Payer: Cash Price	$283.40
Rate for Payer: Devoted Health Medicare	$239.80
Rate for Payer: Hawaii Medical Service Association ABD	$102.78
Rate for Payer: Hawaii Medical Service Association Medicare	$218.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$38.91
Rate for Payer: Hawaii Western Management Group Commercial	$414.20
Rate for Payer: Health Management Network Commercial	$370.60
Rate for Payer: Humana Medicare	$218.00
Rate for Payer: Kaiser Permanente Commercial	$392.40
Rate for Payer: Kaiser Permanente Medicaid	$222.36
Rate for Payer: Kaiser Permanente Medicare	$218.00
Rate for Payer: MDX Hawaii PPO	$422.92
Rate for Payer: Ohana Health Plan Medicaid	$218.00
Rate for Payer: Ohana Health Plan Medicare	$218.00
Rate for Payer: UnitedHealthcare Medicaid	$102.78
Rate for Payer: UnitedHealthcare Medicare	$218.00
Rate for Payer: University Health Alliance Commercial	$272.82

HHSC CT 3D Rendering w/ Postprocess

Facility

$436.00

Service Code	HCPCS 76377
Hospital Charge Code	8223468
Hospital Revenue Code	350
Min. Negotiated Rate	$370.60
Max. Negotiated Rate	$422.92
Rate for Payer: Cash Price	$283.40
Rate for Payer: Health Management Network Commercial	$370.60
Rate for Payer: Kaiser Permanente Commercial	$392.40
Rate for Payer: MDX Hawaii PPO	$422.92

HHSC CT Guided FNA Addl

Facility

$1,331.00

Service Code	HCPCS 10010
Hospital Charge Code	8223488
Hospital Revenue Code	361
Min. Negotiated Rate	$1,131.35
Max. Negotiated Rate	$1,291.07
Rate for Payer: Cash Price	$865.15
Rate for Payer: Health Management Network Commercial	$1,131.35
Rate for Payer: Kaiser Permanente Commercial	$1,197.90
Rate for Payer: MDX Hawaii PPO	$1,291.07

HHSC CT Guided FNA Addl

Facility

$1,331.00

Service Code	HCPCS 10010
Hospital Charge Code	8223488
Hospital Revenue Code	361
Min. Negotiated Rate	$69.17
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$665.50
Rate for Payer: AlohaCare Medicare	$665.50
Rate for Payer: Cash Price	$865.15
Rate for Payer: Cash Price	$865.15
Rate for Payer: Cash Price	$865.15
Rate for Payer: Devoted Health Medicare	$732.05
Rate for Payer: Hawaii Medical Service Association Medicare	$665.50
Rate for Payer: Health Management Network Commercial	$1,131.35
Rate for Payer: Humana Medicare	$665.50
Rate for Payer: Kaiser Permanente Commercial	$1,197.90
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$665.50
Rate for Payer: MDX Hawaii PPO	$1,291.07
Rate for Payer: Ohana Health Plan Medicaid	$665.50
Rate for Payer: Ohana Health Plan Medicare	$665.50
Rate for Payer: UnitedHealthcare Medicaid	$69.17
Rate for Payer: UnitedHealthcare Medicare	$665.50
Rate for Payer: University Health Alliance Commercial	$970.17

HHSC Doppler Color Flow Addon

Facility

$511.00

Service Code	HCPCS 93325
Hospital Charge Code	8223480
Hospital Revenue Code	483
Min. Negotiated Rate	$434.35
Max. Negotiated Rate	$495.67
Rate for Payer: Cash Price	$332.15
Rate for Payer: Health Management Network Commercial	$434.35
Rate for Payer: Kaiser Permanente Commercial	$459.90
Rate for Payer: MDX Hawaii PPO	$495.67

HHSC Doppler Color Flow Addon

Facility

$511.00

Service Code	HCPCS 93325
Hospital Charge Code	8223480
Hospital Revenue Code	483
Min. Negotiated Rate	$40.70
Max. Negotiated Rate	$495.67
Rate for Payer: AlohaCare Medicaid	$255.50
Rate for Payer: AlohaCare Medicare	$255.50
Rate for Payer: Cash Price	$332.15
Rate for Payer: Cash Price	$332.15
Rate for Payer: Devoted Health Medicare	$281.05
Rate for Payer: Hawaii Medical Service Association ABD	$96.84
Rate for Payer: Hawaii Medical Service Association Medicare	$255.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$40.70
Rate for Payer: Hawaii Western Management Group Commercial	$485.45
Rate for Payer: Health Management Network Commercial	$434.35
Rate for Payer: Humana Medicare	$255.50
Rate for Payer: Kaiser Permanente Commercial	$459.90
Rate for Payer: Kaiser Permanente Medicaid	$260.61
Rate for Payer: Kaiser Permanente Medicare	$255.50
Rate for Payer: MDX Hawaii PPO	$495.67
Rate for Payer: Ohana Health Plan Medicaid	$255.50
Rate for Payer: Ohana Health Plan Medicare	$255.50
Rate for Payer: UnitedHealthcare Medicaid	$96.84
Rate for Payer: UnitedHealthcare Medicare	$255.50
Rate for Payer: University Health Alliance Commercial	$372.47

HHSC Doppler Echo Exam Heart

Facility

$597.00

Service Code	HCPCS 93320
Hospital Charge Code	8223484
Hospital Revenue Code	483
Min. Negotiated Rate	$57.09
Max. Negotiated Rate	$579.09
Rate for Payer: AlohaCare Medicaid	$298.50
Rate for Payer: AlohaCare Medicare	$298.50
Rate for Payer: Cash Price	$388.05
Rate for Payer: Cash Price	$388.05
Rate for Payer: Devoted Health Medicare	$328.35
Rate for Payer: Hawaii Medical Service Association ABD	$57.09
Rate for Payer: Hawaii Medical Service Association Medicare	$298.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.94
Rate for Payer: Hawaii Western Management Group Commercial	$567.15
Rate for Payer: Health Management Network Commercial	$507.45
Rate for Payer: Humana Medicare	$298.50
Rate for Payer: Kaiser Permanente Commercial	$537.30
Rate for Payer: Kaiser Permanente Medicaid	$304.47
Rate for Payer: Kaiser Permanente Medicare	$298.50
Rate for Payer: MDX Hawaii PPO	$579.09
Rate for Payer: Ohana Health Plan Medicaid	$298.50
Rate for Payer: Ohana Health Plan Medicare	$298.50
Rate for Payer: UnitedHealthcare Medicaid	$57.09
Rate for Payer: UnitedHealthcare Medicare	$298.50
Rate for Payer: University Health Alliance Commercial	$435.15

HHSC Doppler Echo Exam Heart

Facility

$597.00

Service Code	HCPCS 93320
Hospital Charge Code	8223484
Hospital Revenue Code	483
Min. Negotiated Rate	$507.45
Max. Negotiated Rate	$579.09
Rate for Payer: Cash Price	$388.05
Rate for Payer: Health Management Network Commercial	$507.45
Rate for Payer: Kaiser Permanente Commercial	$537.30
Rate for Payer: MDX Hawaii PPO	$579.09

HHSC Doppler Echo Exam Heart Ltd

Facility

$439.00

Service Code	HCPCS 93321
Hospital Charge Code	8223482
Hospital Revenue Code	483
Min. Negotiated Rate	$373.15
Max. Negotiated Rate	$425.83
Rate for Payer: Cash Price	$285.35
Rate for Payer: Health Management Network Commercial	$373.15
Rate for Payer: Kaiser Permanente Commercial	$395.10
Rate for Payer: MDX Hawaii PPO	$425.83

Know your out-of-pocket cost for care.

All Charges