Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

HHSC NDL YUEH 5FR/7CM (US)

Facility

$133.00

Hospital Charge Code	9469337
Hospital Revenue Code	272
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$129.01
Rate for Payer: AlohaCare Medicaid	$66.50
Rate for Payer: AlohaCare Medicare	$66.50
Rate for Payer: Cash Price	$86.45
Rate for Payer: Devoted Health Medicare	$73.15
Rate for Payer: Hawaii Medical Service Association Medicare	$66.50
Rate for Payer: Hawaii Western Management Group Commercial	$126.35
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Humana Medicare	$66.50
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: Kaiser Permanente Medicare	$66.50
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: Ohana Health Plan Medicaid	$66.50
Rate for Payer: Ohana Health Plan Medicare	$66.50
Rate for Payer: UnitedHealthcare Medicare	$66.50
Rate for Payer: University Health Alliance Commercial	$96.94

HHSC NDL YUEH 5FR/7CM (XR/MAMMO)

Facility

$133.00

Hospital Charge Code	9469070
Hospital Revenue Code	272
Min. Negotiated Rate	$113.05
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$86.45
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: MDX Hawaii PPO	$129.01

HHSC NDL YUEH 5FR/7CM (XR/MAMMO)

Facility

$133.00

Hospital Charge Code	9469070
Hospital Revenue Code	272
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$129.01
Rate for Payer: AlohaCare Medicaid	$66.50
Rate for Payer: AlohaCare Medicare	$66.50
Rate for Payer: Cash Price	$86.45
Rate for Payer: Devoted Health Medicare	$73.15
Rate for Payer: Hawaii Medical Service Association Medicare	$66.50
Rate for Payer: Hawaii Western Management Group Commercial	$126.35
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Humana Medicare	$66.50
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: Kaiser Permanente Medicare	$66.50
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: Ohana Health Plan Medicaid	$66.50
Rate for Payer: Ohana Health Plan Medicare	$66.50
Rate for Payer: UnitedHealthcare Medicare	$66.50
Rate for Payer: University Health Alliance Commercial	$96.94

HHSC NDL YUEH CATH 5FR/10CM (CT)

Facility

$133.00

Service Code	HCPCS C1887
Hospital Charge Code	9469103
Hospital Revenue Code	272
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$129.01
Rate for Payer: AlohaCare Medicaid	$66.50
Rate for Payer: AlohaCare Medicare	$66.50
Rate for Payer: Cash Price	$86.45
Rate for Payer: Devoted Health Medicare	$73.15
Rate for Payer: Hawaii Medical Service Association Medicare	$66.50
Rate for Payer: Hawaii Western Management Group Commercial	$126.35
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Humana Medicare	$66.50
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: Kaiser Permanente Medicare	$66.50
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: Ohana Health Plan Medicaid	$66.50
Rate for Payer: Ohana Health Plan Medicare	$66.50
Rate for Payer: UnitedHealthcare Medicare	$66.50
Rate for Payer: University Health Alliance Commercial	$96.94

HHSC NDL YUEH CATH 5FR/10CM (CT)

Facility

$133.00

Service Code	HCPCS C1887
Hospital Charge Code	9469103
Hospital Revenue Code	272
Min. Negotiated Rate	$113.05
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$86.45
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: MDX Hawaii PPO	$129.01

HHSC NDL YUEH CATH 5FR/10CM (US)

Facility

$127.00

Service Code	HCPCS C1887
Hospital Charge Code	9469335
Hospital Revenue Code	272
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$82.55
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: MDX Hawaii PPO	$123.19

HHSC NDL YUEH CATH 5FR/10CM (US)

Facility

$127.00

Service Code	HCPCS C1887
Hospital Charge Code	9469335
Hospital Revenue Code	272
Min. Negotiated Rate	$63.50
Max. Negotiated Rate	$123.19
Rate for Payer: AlohaCare Medicaid	$63.50
Rate for Payer: AlohaCare Medicare	$63.50
Rate for Payer: Cash Price	$82.55
Rate for Payer: Devoted Health Medicare	$69.85
Rate for Payer: Hawaii Medical Service Association Medicare	$63.50
Rate for Payer: Hawaii Western Management Group Commercial	$120.65
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Humana Medicare	$63.50
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: Kaiser Permanente Medicaid	$64.77
Rate for Payer: Kaiser Permanente Medicare	$63.50
Rate for Payer: MDX Hawaii PPO	$123.19
Rate for Payer: Ohana Health Plan Medicaid	$63.50
Rate for Payer: Ohana Health Plan Medicare	$63.50
Rate for Payer: UnitedHealthcare Medicare	$63.50
Rate for Payer: University Health Alliance Commercial	$92.57

HHSC NDL YUEH CATH 5FR/10CM (XR/MAMMO)

Facility

$133.00

Service Code	HCPCS C1887
Hospital Charge Code	9469068
Hospital Revenue Code	272
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$129.01
Rate for Payer: AlohaCare Medicaid	$66.50
Rate for Payer: AlohaCare Medicare	$66.50
Rate for Payer: Cash Price	$86.45
Rate for Payer: Devoted Health Medicare	$73.15
Rate for Payer: Hawaii Medical Service Association Medicare	$66.50
Rate for Payer: Hawaii Western Management Group Commercial	$126.35
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Humana Medicare	$66.50
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: Kaiser Permanente Medicare	$66.50
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: Ohana Health Plan Medicaid	$66.50
Rate for Payer: Ohana Health Plan Medicare	$66.50
Rate for Payer: UnitedHealthcare Medicare	$66.50
Rate for Payer: University Health Alliance Commercial	$96.94

HHSC NDL YUEH CATH 5FR/10CM (XR/MAMMO)

Facility

$133.00

Service Code	HCPCS C1887
Hospital Charge Code	9469068
Hospital Revenue Code	272
Min. Negotiated Rate	$113.05
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$86.45
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: MDX Hawaii PPO	$129.01

HHSC NEEDLE 13G X 10CM OSTEO-SITE BONE BIOPSY SET

Facility

$788.00

Hospital Charge Code	11579938
Hospital Revenue Code	272
Min. Negotiated Rate	$394.00
Max. Negotiated Rate	$764.36
Rate for Payer: AlohaCare Medicaid	$394.00
Rate for Payer: AlohaCare Medicare	$394.00
Rate for Payer: Cash Price	$512.20
Rate for Payer: Devoted Health Medicare	$433.40
Rate for Payer: Hawaii Medical Service Association Medicare	$394.00
Rate for Payer: Hawaii Western Management Group Commercial	$748.60
Rate for Payer: Health Management Network Commercial	$669.80
Rate for Payer: Humana Medicare	$394.00
Rate for Payer: Kaiser Permanente Commercial	$709.20
Rate for Payer: Kaiser Permanente Medicaid	$401.88
Rate for Payer: Kaiser Permanente Medicare	$394.00
Rate for Payer: MDX Hawaii PPO	$764.36
Rate for Payer: Ohana Health Plan Medicaid	$394.00
Rate for Payer: Ohana Health Plan Medicare	$394.00
Rate for Payer: UnitedHealthcare Medicare	$394.00
Rate for Payer: University Health Alliance Commercial	$574.37

HHSC NEEDLE 13G X 10CM OSTEO-SITE BONE BIOPSY SET

Facility

$788.00

Hospital Charge Code	11579938
Hospital Revenue Code	272
Min. Negotiated Rate	$669.80
Max. Negotiated Rate	$764.36
Rate for Payer: Cash Price	$512.20
Rate for Payer: Health Management Network Commercial	$669.80
Rate for Payer: Kaiser Permanente Commercial	$709.20
Rate for Payer: MDX Hawaii PPO	$764.36

HHSC NEEDLE BIOPINCE BIOPSY 16G X 10CM

Facility

$240.00

Hospital Charge Code	11576614
Hospital Revenue Code	272
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$232.80
Rate for Payer: Cash Price	$156.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Kaiser Permanente Commercial	$216.00
Rate for Payer: MDX Hawaii PPO	$232.80

HHSC NEEDLE BIOPINCE BIOPSY 16G X 10CM

Facility

$240.00

Hospital Charge Code	11576614
Hospital Revenue Code	272
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$232.80
Rate for Payer: AlohaCare Medicaid	$120.00
Rate for Payer: AlohaCare Medicare	$120.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Devoted Health Medicare	$132.00
Rate for Payer: Hawaii Medical Service Association Medicare	$120.00
Rate for Payer: Hawaii Western Management Group Commercial	$228.00
Rate for Payer: Health Management Network Commercial	$204.00
Rate for Payer: Humana Medicare	$120.00
Rate for Payer: Kaiser Permanente Commercial	$216.00
Rate for Payer: Kaiser Permanente Medicaid	$122.40
Rate for Payer: Kaiser Permanente Medicare	$120.00
Rate for Payer: MDX Hawaii PPO	$232.80
Rate for Payer: Ohana Health Plan Medicaid	$120.00
Rate for Payer: Ohana Health Plan Medicare	$120.00
Rate for Payer: UnitedHealthcare Medicare	$120.00
Rate for Payer: University Health Alliance Commercial	$174.94

HHSC NEEDLE BIOPINCE BIOPSY 16G X 10CM W/COAX

Facility

$372.00

Hospital Charge Code	11576616
Hospital Revenue Code	272
Min. Negotiated Rate	$186.00
Max. Negotiated Rate	$360.84
Rate for Payer: AlohaCare Medicaid	$186.00
Rate for Payer: AlohaCare Medicare	$186.00
Rate for Payer: Cash Price	$241.80
Rate for Payer: Devoted Health Medicare	$204.60
Rate for Payer: Hawaii Medical Service Association Medicare	$186.00
Rate for Payer: Hawaii Western Management Group Commercial	$353.40
Rate for Payer: Health Management Network Commercial	$316.20
Rate for Payer: Humana Medicare	$186.00
Rate for Payer: Kaiser Permanente Commercial	$334.80
Rate for Payer: Kaiser Permanente Medicaid	$189.72
Rate for Payer: Kaiser Permanente Medicare	$186.00
Rate for Payer: MDX Hawaii PPO	$360.84
Rate for Payer: Ohana Health Plan Medicaid	$186.00
Rate for Payer: Ohana Health Plan Medicare	$186.00
Rate for Payer: UnitedHealthcare Medicare	$186.00
Rate for Payer: University Health Alliance Commercial	$271.15

HHSC NEEDLE BIOPINCE BIOPSY 16G X 10CM W/COAX

Facility

$372.00

Hospital Charge Code	11576616
Hospital Revenue Code	272
Min. Negotiated Rate	$316.20
Max. Negotiated Rate	$360.84
Rate for Payer: Cash Price	$241.80
Rate for Payer: Health Management Network Commercial	$316.20
Rate for Payer: Kaiser Permanente Commercial	$334.80
Rate for Payer: MDX Hawaii PPO	$360.84

HHSC NEEDLE BIOPINCE BIOPSY 18G X 10CM W/COAX

Facility

$372.00

Hospital Charge Code	11579940
Hospital Revenue Code	272
Min. Negotiated Rate	$186.00
Max. Negotiated Rate	$360.84
Rate for Payer: AlohaCare Medicaid	$186.00
Rate for Payer: AlohaCare Medicare	$186.00
Rate for Payer: Cash Price	$241.80
Rate for Payer: Devoted Health Medicare	$204.60
Rate for Payer: Hawaii Medical Service Association Medicare	$186.00
Rate for Payer: Hawaii Western Management Group Commercial	$353.40
Rate for Payer: Health Management Network Commercial	$316.20
Rate for Payer: Humana Medicare	$186.00
Rate for Payer: Kaiser Permanente Commercial	$334.80
Rate for Payer: Kaiser Permanente Medicaid	$189.72
Rate for Payer: Kaiser Permanente Medicare	$186.00
Rate for Payer: MDX Hawaii PPO	$360.84
Rate for Payer: Ohana Health Plan Medicaid	$186.00
Rate for Payer: Ohana Health Plan Medicare	$186.00
Rate for Payer: UnitedHealthcare Medicare	$186.00
Rate for Payer: University Health Alliance Commercial	$271.15

HHSC NEEDLE BIOPINCE BIOPSY 18G X 10CM W/COAX

Facility

$372.00

Hospital Charge Code	11579940
Hospital Revenue Code	272
Min. Negotiated Rate	$316.20
Max. Negotiated Rate	$360.84
Rate for Payer: Cash Price	$241.80
Rate for Payer: Health Management Network Commercial	$316.20
Rate for Payer: Kaiser Permanente Commercial	$334.80
Rate for Payer: MDX Hawaii PPO	$360.84

HHSC NEEDLE GUIDES FOR EVIVA 9G

Facility

$73.00

Hospital Charge Code	13021601
Hospital Revenue Code	272
Min. Negotiated Rate	$36.50
Max. Negotiated Rate	$70.81
Rate for Payer: AlohaCare Medicaid	$36.50
Rate for Payer: AlohaCare Medicare	$36.50
Rate for Payer: Cash Price	$47.45
Rate for Payer: Devoted Health Medicare	$40.15
Rate for Payer: Hawaii Medical Service Association Medicare	$36.50
Rate for Payer: Hawaii Western Management Group Commercial	$69.35
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Humana Medicare	$36.50
Rate for Payer: Kaiser Permanente Commercial	$65.70
Rate for Payer: Kaiser Permanente Medicaid	$37.23
Rate for Payer: Kaiser Permanente Medicare	$36.50
Rate for Payer: MDX Hawaii PPO	$70.81
Rate for Payer: Ohana Health Plan Medicaid	$36.50
Rate for Payer: Ohana Health Plan Medicare	$36.50
Rate for Payer: UnitedHealthcare Medicare	$36.50
Rate for Payer: University Health Alliance Commercial	$53.21

HHSC NEEDLE GUIDES FOR EVIVA 9G

Facility

$73.00

Hospital Charge Code	13021601
Hospital Revenue Code	272
Min. Negotiated Rate	$62.05
Max. Negotiated Rate	$70.81
Rate for Payer: Cash Price	$47.45
Rate for Payer: Health Management Network Commercial	$62.05
Rate for Payer: Kaiser Permanente Commercial	$65.70
Rate for Payer: MDX Hawaii PPO	$70.81

HHSC NEEDLE KOPANS MODIFIED BREAST LOCALIZATION

Facility

$210.00

Hospital Charge Code	11583904
Hospital Revenue Code	272
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$203.70
Rate for Payer: AlohaCare Medicaid	$105.00
Rate for Payer: AlohaCare Medicare	$105.00
Rate for Payer: Cash Price	$136.50
Rate for Payer: Devoted Health Medicare	$115.50
Rate for Payer: Hawaii Medical Service Association Medicare	$105.00
Rate for Payer: Hawaii Western Management Group Commercial	$199.50
Rate for Payer: Health Management Network Commercial	$178.50
Rate for Payer: Humana Medicare	$105.00
Rate for Payer: Kaiser Permanente Commercial	$189.00
Rate for Payer: Kaiser Permanente Medicaid	$107.10
Rate for Payer: Kaiser Permanente Medicare	$105.00
Rate for Payer: MDX Hawaii PPO	$203.70
Rate for Payer: Ohana Health Plan Medicaid	$105.00
Rate for Payer: Ohana Health Plan Medicare	$105.00
Rate for Payer: UnitedHealthcare Medicare	$105.00
Rate for Payer: University Health Alliance Commercial	$153.07

HHSC NEEDLE KOPANS MODIFIED BREAST LOCALIZATION

Facility

$210.00

Hospital Charge Code	11583904
Hospital Revenue Code	272
Min. Negotiated Rate	$178.50
Max. Negotiated Rate	$203.70
Rate for Payer: Cash Price	$136.50
Rate for Payer: Health Management Network Commercial	$178.50
Rate for Payer: Kaiser Permanente Commercial	$189.00
Rate for Payer: MDX Hawaii PPO	$203.70

HHSC NEEDLE MONOPTY BIOPSY 16G X 9CM

Facility

$34.00

Service Code	HCPCS C1819
Hospital Charge Code	11170699
Hospital Revenue Code	278
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$32.98
Rate for Payer: AlohaCare Medicaid	$17.00
Rate for Payer: AlohaCare Medicare	$17.00
Rate for Payer: Cash Price	$22.10
Rate for Payer: Devoted Health Medicare	$18.70
Rate for Payer: Hawaii Medical Service Association Medicare	$17.00
Rate for Payer: Hawaii Western Management Group Commercial	$23.80
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Humana Medicare	$17.00
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: Kaiser Permanente Medicaid	$17.34
Rate for Payer: Kaiser Permanente Medicare	$17.00
Rate for Payer: MDX Hawaii PPO	$32.98
Rate for Payer: Ohana Health Plan Medicaid	$17.00
Rate for Payer: Ohana Health Plan Medicare	$17.00
Rate for Payer: UnitedHealthcare Medicare	$17.00
Rate for Payer: University Health Alliance Commercial	$19.04

HHSC NEEDLE MONOPTY BIOPSY 16G X 9CM

Facility

$34.00

Service Code	HCPCS C1819
Hospital Charge Code	11170699
Hospital Revenue Code	278
Min. Negotiated Rate	$19.04
Max. Negotiated Rate	$32.98
Rate for Payer: Cash Price	$22.10
Rate for Payer: Hawaii Western Management Group Commercial	$23.80
Rate for Payer: Health Management Network Commercial	$28.90
Rate for Payer: Kaiser Permanente Commercial	$30.60
Rate for Payer: MDX Hawaii PPO	$32.98
Rate for Payer: University Health Alliance Commercial	$19.04

HHSC NEEDLE MONOPTY BIOPSY 18G X 9CM

Facility

$28.00

Service Code	HCPCS C1819
Hospital Charge Code	11178177
Hospital Revenue Code	278
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$27.16
Rate for Payer: AlohaCare Medicaid	$14.00
Rate for Payer: AlohaCare Medicare	$14.00
Rate for Payer: Cash Price	$18.20
Rate for Payer: Devoted Health Medicare	$15.40
Rate for Payer: Hawaii Medical Service Association Medicare	$14.00
Rate for Payer: Hawaii Western Management Group Commercial	$19.60
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Humana Medicare	$14.00
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Medicaid	$14.28
Rate for Payer: Kaiser Permanente Medicare	$14.00
Rate for Payer: MDX Hawaii PPO	$27.16
Rate for Payer: Ohana Health Plan Medicaid	$14.00
Rate for Payer: Ohana Health Plan Medicare	$14.00
Rate for Payer: UnitedHealthcare Medicare	$14.00
Rate for Payer: University Health Alliance Commercial	$15.68

HHSC NEEDLE MONOPTY BIOPSY 18G X 9CM

Facility

$28.00

Service Code	HCPCS C1819
Hospital Charge Code	11178177
Hospital Revenue Code	278
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$18.20
Rate for Payer: Hawaii Western Management Group Commercial	$19.60
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: MDX Hawaii PPO	$27.16
Rate for Payer: University Health Alliance Commercial	$15.68

Know your out-of-pocket cost for care.

All Charges