Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

HHSC Doppler Echo Exam Heart Ltd

Facility

$439.00

Service Code	HCPCS 93321
Hospital Charge Code	8223482
Hospital Revenue Code	483
Min. Negotiated Rate	$37.31
Max. Negotiated Rate	$425.83
Rate for Payer: AlohaCare Medicaid	$219.50
Rate for Payer: AlohaCare Medicare	$219.50
Rate for Payer: Cash Price	$285.35
Rate for Payer: Cash Price	$285.35
Rate for Payer: Devoted Health Medicare	$241.45
Rate for Payer: Hawaii Medical Service Association ABD	$37.31
Rate for Payer: Hawaii Medical Service Association Medicare	$219.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$39.18
Rate for Payer: Hawaii Western Management Group Commercial	$417.05
Rate for Payer: Health Management Network Commercial	$373.15
Rate for Payer: Humana Medicare	$219.50
Rate for Payer: Kaiser Permanente Commercial	$395.10
Rate for Payer: Kaiser Permanente Medicaid	$223.89
Rate for Payer: Kaiser Permanente Medicare	$219.50
Rate for Payer: MDX Hawaii PPO	$425.83
Rate for Payer: Ohana Health Plan Medicaid	$219.50
Rate for Payer: Ohana Health Plan Medicare	$219.50
Rate for Payer: UnitedHealthcare Medicaid	$37.31
Rate for Payer: UnitedHealthcare Medicare	$219.50
Rate for Payer: University Health Alliance Commercial	$319.99

HHSC EVIVA BREAST BX NEEDLE, PETITE 9GX10CM

Facility

$1,078.00

Hospital Charge Code	13019998
Hospital Revenue Code	272
Min. Negotiated Rate	$539.00
Max. Negotiated Rate	$1,045.66
Rate for Payer: AlohaCare Medicaid	$539.00
Rate for Payer: AlohaCare Medicare	$539.00
Rate for Payer: Cash Price	$700.70
Rate for Payer: Devoted Health Medicare	$592.90
Rate for Payer: Hawaii Medical Service Association Medicare	$539.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,024.10
Rate for Payer: Health Management Network Commercial	$916.30
Rate for Payer: Humana Medicare	$539.00
Rate for Payer: Kaiser Permanente Commercial	$970.20
Rate for Payer: Kaiser Permanente Medicaid	$549.78
Rate for Payer: Kaiser Permanente Medicare	$539.00
Rate for Payer: MDX Hawaii PPO	$1,045.66
Rate for Payer: Ohana Health Plan Medicaid	$539.00
Rate for Payer: Ohana Health Plan Medicare	$539.00
Rate for Payer: UnitedHealthcare Medicare	$539.00
Rate for Payer: University Health Alliance Commercial	$785.75

HHSC EVIVA BREAST BX NEEDLE, PETITE 9GX10CM

Facility

$1,078.00

Hospital Charge Code	13019998
Hospital Revenue Code	272
Min. Negotiated Rate	$916.30
Max. Negotiated Rate	$1,045.66
Rate for Payer: Cash Price	$700.70
Rate for Payer: Health Management Network Commercial	$916.30
Rate for Payer: Kaiser Permanente Commercial	$970.20
Rate for Payer: MDX Hawaii PPO	$1,045.66

HHSC EVIVA BREAST BX NEEDLE, STANDARD 9GX13CM

Facility

$1,078.00

Hospital Charge Code	13031469
Hospital Revenue Code	272
Min. Negotiated Rate	$916.30
Max. Negotiated Rate	$1,045.66
Rate for Payer: Cash Price	$700.70
Rate for Payer: Health Management Network Commercial	$916.30
Rate for Payer: Kaiser Permanente Commercial	$970.20
Rate for Payer: MDX Hawaii PPO	$1,045.66

HHSC EVIVA BREAST BX NEEDLE, STANDARD 9GX13CM

Facility

$1,078.00

Hospital Charge Code	13031469
Hospital Revenue Code	272
Min. Negotiated Rate	$539.00
Max. Negotiated Rate	$1,045.66
Rate for Payer: AlohaCare Medicaid	$539.00
Rate for Payer: AlohaCare Medicare	$539.00
Rate for Payer: Cash Price	$700.70
Rate for Payer: Devoted Health Medicare	$592.90
Rate for Payer: Hawaii Medical Service Association Medicare	$539.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,024.10
Rate for Payer: Health Management Network Commercial	$916.30
Rate for Payer: Humana Medicare	$539.00
Rate for Payer: Kaiser Permanente Commercial	$970.20
Rate for Payer: Kaiser Permanente Medicaid	$549.78
Rate for Payer: Kaiser Permanente Medicare	$539.00
Rate for Payer: MDX Hawaii PPO	$1,045.66
Rate for Payer: Ohana Health Plan Medicaid	$539.00
Rate for Payer: Ohana Health Plan Medicare	$539.00
Rate for Payer: UnitedHealthcare Medicare	$539.00
Rate for Payer: University Health Alliance Commercial	$785.75

HHSC FIXED CORE WIRE GUIDE SAFE TJ CURVE

Facility

$138.00

Hospital Charge Code	8223458
Hospital Revenue Code	272
Min. Negotiated Rate	$69.00
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: Devoted Health Medicare	$75.90
Rate for Payer: Hawaii Medical Service Association Medicare	$69.00
Rate for Payer: Hawaii Western Management Group Commercial	$131.10
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 Medicare	$69.00
Rate for Payer: University Health Alliance Commercial	$100.59

HHSC FIXED CORE WIRE GUIDE SAFE TJ CURVE

Facility

$138.00

Hospital Charge Code	8223458
Hospital Revenue Code	272
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

HHSC FRANSN LNG BX NDL-22-5.0-U 22G/5CM

Facility

$160.00

Hospital Charge Code	8223452
Hospital Revenue Code	272
Min. Negotiated Rate	$80.00
Max. Negotiated Rate	$155.20
Rate for Payer: AlohaCare Medicaid	$80.00
Rate for Payer: AlohaCare Medicare	$80.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Devoted Health Medicare	$88.00
Rate for Payer: Hawaii Medical Service Association Medicare	$80.00
Rate for Payer: Hawaii Western Management Group Commercial	$152.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Humana Medicare	$80.00
Rate for Payer: Kaiser Permanente Commercial	$144.00
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: Kaiser Permanente Medicare	$80.00
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: Ohana Health Plan Medicaid	$80.00
Rate for Payer: Ohana Health Plan Medicare	$80.00
Rate for Payer: UnitedHealthcare Medicare	$80.00
Rate for Payer: University Health Alliance Commercial	$116.62

HHSC FRANSN LNG BX NDL-22-5.0-U 22G/5CM

Facility

$160.00

Hospital Charge Code	8223452
Hospital Revenue Code	272
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$104.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Kaiser Permanente Commercial	$144.00
Rate for Payer: MDX Hawaii PPO	$155.20

HHSC G/W FIXED CORE SAFE TJ CURVE (CT)

Facility

$84.00

Service Code	HCPCS C1769
Hospital Charge Code	9469095
Hospital Revenue Code	272
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$81.48
Rate for Payer: AlohaCare Medicaid	$42.00
Rate for Payer: AlohaCare Medicare	$42.00
Rate for Payer: Cash Price	$54.60
Rate for Payer: Devoted Health Medicare	$46.20
Rate for Payer: Hawaii Medical Service Association Medicare	$42.00
Rate for Payer: Hawaii Western Management Group Commercial	$79.80
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Humana Medicare	$42.00
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: Kaiser Permanente Medicaid	$42.84
Rate for Payer: Kaiser Permanente Medicare	$42.00
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: Ohana Health Plan Medicaid	$42.00
Rate for Payer: Ohana Health Plan Medicare	$42.00
Rate for Payer: UnitedHealthcare Medicare	$42.00
Rate for Payer: University Health Alliance Commercial	$61.23

HHSC G/W FIXED CORE SAFE TJ CURVE (CT)

Facility

$84.00

Service Code	HCPCS C1769
Hospital Charge Code	9469095
Hospital Revenue Code	272
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$54.60
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: MDX Hawaii PPO	$81.48

HHSC GWIRE FXD CORE TJ CURVE(US)

Facility

$84.00

Service Code	HCPCS C1769
Hospital Charge Code	9469323
Hospital Revenue Code	272
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$81.48
Rate for Payer: AlohaCare Medicaid	$42.00
Rate for Payer: AlohaCare Medicare	$42.00
Rate for Payer: Cash Price	$54.60
Rate for Payer: Devoted Health Medicare	$46.20
Rate for Payer: Hawaii Medical Service Association Medicare	$42.00
Rate for Payer: Hawaii Western Management Group Commercial	$79.80
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Humana Medicare	$42.00
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: Kaiser Permanente Medicaid	$42.84
Rate for Payer: Kaiser Permanente Medicare	$42.00
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: Ohana Health Plan Medicaid	$42.00
Rate for Payer: Ohana Health Plan Medicare	$42.00
Rate for Payer: UnitedHealthcare Medicare	$42.00
Rate for Payer: University Health Alliance Commercial	$61.23

HHSC GWIRE FXD CORE TJ CURVE(US)

Facility

$84.00

Service Code	HCPCS C1769
Hospital Charge Code	9469323
Hospital Revenue Code	272
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$54.60
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: MDX Hawaii PPO	$81.48

HHSC GWIRE FXD CORE TJ CURVE(XR/MAMMO)

Facility

$84.00

Service Code	HCPCS C1769
Hospital Charge Code	9468999
Hospital Revenue Code	272
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$54.60
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: MDX Hawaii PPO	$81.48

HHSC GWIRE FXD CORE TJ CURVE(XR/MAMMO)

Facility

$84.00

Service Code	HCPCS C1769
Hospital Charge Code	9468999
Hospital Revenue Code	272
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$81.48
Rate for Payer: AlohaCare Medicaid	$42.00
Rate for Payer: AlohaCare Medicare	$42.00
Rate for Payer: Cash Price	$54.60
Rate for Payer: Devoted Health Medicare	$46.20
Rate for Payer: Hawaii Medical Service Association Medicare	$42.00
Rate for Payer: Hawaii Western Management Group Commercial	$79.80
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Humana Medicare	$42.00
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: Kaiser Permanente Medicaid	$42.84
Rate for Payer: Kaiser Permanente Medicare	$42.00
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: Ohana Health Plan Medicaid	$42.00
Rate for Payer: Ohana Health Plan Medicare	$42.00
Rate for Payer: UnitedHealthcare Medicare	$42.00
Rate for Payer: University Health Alliance Commercial	$61.23

HHSC HSG CATHETER SET 5F

Facility

$235.00

Service Code	HCPCS C1887
Hospital Charge Code	8223454
Hospital Revenue Code	272
Min. Negotiated Rate	$117.50
Max. Negotiated Rate	$227.95
Rate for Payer: AlohaCare Medicaid	$117.50
Rate for Payer: AlohaCare Medicare	$117.50
Rate for Payer: Cash Price	$152.75
Rate for Payer: Devoted Health Medicare	$129.25
Rate for Payer: Hawaii Medical Service Association Medicare	$117.50
Rate for Payer: Hawaii Western Management Group Commercial	$223.25
Rate for Payer: Health Management Network Commercial	$199.75
Rate for Payer: Humana Medicare	$117.50
Rate for Payer: Kaiser Permanente Commercial	$211.50
Rate for Payer: Kaiser Permanente Medicaid	$119.85
Rate for Payer: Kaiser Permanente Medicare	$117.50
Rate for Payer: MDX Hawaii PPO	$227.95
Rate for Payer: Ohana Health Plan Medicaid	$117.50
Rate for Payer: Ohana Health Plan Medicare	$117.50
Rate for Payer: UnitedHealthcare Medicare	$117.50
Rate for Payer: University Health Alliance Commercial	$171.29

HHSC HSG CATHETER SET 5F

Facility

$235.00

Service Code	HCPCS C1887
Hospital Charge Code	8223454
Hospital Revenue Code	272
Min. Negotiated Rate	$199.75
Max. Negotiated Rate	$227.95
Rate for Payer: Cash Price	$152.75
Rate for Payer: Health Management Network Commercial	$199.75
Rate for Payer: Kaiser Permanente Commercial	$211.50
Rate for Payer: MDX Hawaii PPO	$227.95

HHSC INTRO TIP PNEUMOTHORAX SET

Facility

$523.00

Hospital Charge Code	8223466
Hospital Revenue Code	272
Min. Negotiated Rate	$261.50
Max. Negotiated Rate	$507.31
Rate for Payer: AlohaCare Medicaid	$261.50
Rate for Payer: AlohaCare Medicare	$261.50
Rate for Payer: Cash Price	$339.95
Rate for Payer: Devoted Health Medicare	$287.65
Rate for Payer: Hawaii Medical Service Association Medicare	$261.50
Rate for Payer: Hawaii Western Management Group Commercial	$496.85
Rate for Payer: Health Management Network Commercial	$444.55
Rate for Payer: Humana Medicare	$261.50
Rate for Payer: Kaiser Permanente Commercial	$470.70
Rate for Payer: Kaiser Permanente Medicaid	$266.73
Rate for Payer: Kaiser Permanente Medicare	$261.50
Rate for Payer: MDX Hawaii PPO	$507.31
Rate for Payer: Ohana Health Plan Medicaid	$261.50
Rate for Payer: Ohana Health Plan Medicare	$261.50
Rate for Payer: UnitedHealthcare Medicare	$261.50
Rate for Payer: University Health Alliance Commercial	$381.21

HHSC INTRO TIP PNEUMOTHORAX SET

Facility

$523.00

Hospital Charge Code	8223466
Hospital Revenue Code	272
Min. Negotiated Rate	$444.55
Max. Negotiated Rate	$507.31
Rate for Payer: Cash Price	$339.95
Rate for Payer: Health Management Network Commercial	$444.55
Rate for Payer: Kaiser Permanente Commercial	$470.70
Rate for Payer: MDX Hawaii PPO	$507.31

HHSC MARKER BREAST BIOPSY TUMARK VISION 10CM

Facility

$480.00

Hospital Charge Code	11579936
Hospital Revenue Code	272
Min. Negotiated Rate	$408.00
Max. Negotiated Rate	$465.60
Rate for Payer: Cash Price	$312.00
Rate for Payer: Health Management Network Commercial	$408.00
Rate for Payer: Kaiser Permanente Commercial	$432.00
Rate for Payer: MDX Hawaii PPO	$465.60

HHSC MARKER BREAST BIOPSY TUMARK VISION 10CM

Facility

$480.00

Hospital Charge Code	11579936
Hospital Revenue Code	272
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$465.60
Rate for Payer: AlohaCare Medicaid	$240.00
Rate for Payer: AlohaCare Medicare	$240.00
Rate for Payer: Cash Price	$312.00
Rate for Payer: Devoted Health Medicare	$264.00
Rate for Payer: Hawaii Medical Service Association Medicare	$240.00
Rate for Payer: Hawaii Western Management Group Commercial	$456.00
Rate for Payer: Health Management Network Commercial	$408.00
Rate for Payer: Humana Medicare	$240.00
Rate for Payer: Kaiser Permanente Commercial	$432.00
Rate for Payer: Kaiser Permanente Medicaid	$244.80
Rate for Payer: Kaiser Permanente Medicare	$240.00
Rate for Payer: MDX Hawaii PPO	$465.60
Rate for Payer: Ohana Health Plan Medicaid	$240.00
Rate for Payer: Ohana Health Plan Medicare	$240.00
Rate for Payer: UnitedHealthcare Medicare	$240.00
Rate for Payer: University Health Alliance Commercial	$349.87

HHSC MG Bx Breast Add Lesion Strtctc LT

Facility

$719.00

Service Code	HCPCS 19082
Hospital Charge Code	8223498
Hospital Revenue Code	361
Min. Negotiated Rate	$611.15
Max. Negotiated Rate	$697.43
Rate for Payer: Cash Price	$467.35
Rate for Payer: Health Management Network Commercial	$611.15
Rate for Payer: Kaiser Permanente Commercial	$647.10
Rate for Payer: MDX Hawaii PPO	$697.43

HHSC MG Bx Breast Add Lesion Strtctc LT

Facility

$719.00

Service Code	HCPCS 19082
Hospital Charge Code	8223498
Hospital Revenue Code	361
Min. Negotiated Rate	$80.28
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$359.50
Rate for Payer: AlohaCare Medicare	$359.50
Rate for Payer: Cash Price	$467.35
Rate for Payer: Cash Price	$467.35
Rate for Payer: Cash Price	$467.35
Rate for Payer: Devoted Health Medicare	$395.45
Rate for Payer: Hawaii Medical Service Association Medicare	$359.50
Rate for Payer: Health Management Network Commercial	$611.15
Rate for Payer: Humana Medicare	$359.50
Rate for Payer: Kaiser Permanente Commercial	$647.10
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$359.50
Rate for Payer: MDX Hawaii PPO	$697.43
Rate for Payer: Ohana Health Plan Medicaid	$359.50
Rate for Payer: Ohana Health Plan Medicare	$359.50
Rate for Payer: UnitedHealthcare Medicaid	$80.28
Rate for Payer: UnitedHealthcare Medicare	$359.50
Rate for Payer: University Health Alliance Commercial	$524.08

HHSC MG Bx Breast Add Lesion Strtctc RT

Facility

$719.00

Service Code	HCPCS 19082
Hospital Charge Code	8223500
Hospital Revenue Code	361
Min. Negotiated Rate	$80.28
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$359.50
Rate for Payer: AlohaCare Medicare	$359.50
Rate for Payer: Cash Price	$467.35
Rate for Payer: Cash Price	$467.35
Rate for Payer: Cash Price	$467.35
Rate for Payer: Devoted Health Medicare	$395.45
Rate for Payer: Hawaii Medical Service Association Medicare	$359.50
Rate for Payer: Health Management Network Commercial	$611.15
Rate for Payer: Humana Medicare	$359.50
Rate for Payer: Kaiser Permanente Commercial	$647.10
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$359.50
Rate for Payer: MDX Hawaii PPO	$697.43
Rate for Payer: Ohana Health Plan Medicaid	$359.50
Rate for Payer: Ohana Health Plan Medicare	$359.50
Rate for Payer: UnitedHealthcare Medicaid	$80.28
Rate for Payer: UnitedHealthcare Medicare	$359.50
Rate for Payer: University Health Alliance Commercial	$524.08

HHSC MG Bx Breast Add Lesion Strtctc RT

Facility

$719.00

Service Code	HCPCS 19082
Hospital Charge Code	8223500
Hospital Revenue Code	361
Min. Negotiated Rate	$611.15
Max. Negotiated Rate	$697.43
Rate for Payer: Cash Price	$467.35
Rate for Payer: Health Management Network Commercial	$611.15
Rate for Payer: Kaiser Permanente Commercial	$647.10
Rate for Payer: MDX Hawaii PPO	$697.43

Know your out-of-pocket cost for care.

All Charges