Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

HHSC SET UNI CURVED DRNGE CATH (US)

Facility

$354.00

Hospital Charge Code	9469341
Hospital Revenue Code	272
Min. Negotiated Rate	$177.00
Max. Negotiated Rate	$343.38
Rate for Payer: AlohaCare Medicaid	$177.00
Rate for Payer: AlohaCare Medicare	$177.00
Rate for Payer: Cash Price	$230.10
Rate for Payer: Devoted Health Medicare	$194.70
Rate for Payer: Hawaii Medical Service Association Medicare	$177.00
Rate for Payer: Hawaii Western Management Group Commercial	$336.30
Rate for Payer: Health Management Network Commercial	$300.90
Rate for Payer: Humana Medicare	$177.00
Rate for Payer: Kaiser Permanente Commercial	$318.60
Rate for Payer: Kaiser Permanente Medicaid	$180.54
Rate for Payer: Kaiser Permanente Medicare	$177.00
Rate for Payer: MDX Hawaii PPO	$343.38
Rate for Payer: Ohana Health Plan Medicaid	$177.00
Rate for Payer: Ohana Health Plan Medicare	$177.00
Rate for Payer: UnitedHealthcare Medicare	$177.00
Rate for Payer: University Health Alliance Commercial	$258.03

HHSC SET UNI CURVED DRNGE CATH (US)

Facility

$354.00

Hospital Charge Code	9469341
Hospital Revenue Code	272
Min. Negotiated Rate	$300.90
Max. Negotiated Rate	$343.38
Rate for Payer: Cash Price	$230.10
Rate for Payer: Health Management Network Commercial	$300.90
Rate for Payer: Kaiser Permanente Commercial	$318.60
Rate for Payer: MDX Hawaii PPO	$343.38

HHSC SET UNI CURVED DRNGE CATH(XR/MAMMO)

Facility

$301.00

Hospital Charge Code	9469077
Hospital Revenue Code	272
Min. Negotiated Rate	$255.85
Max. Negotiated Rate	$291.97
Rate for Payer: Cash Price	$195.65
Rate for Payer: Health Management Network Commercial	$255.85
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: MDX Hawaii PPO	$291.97

HHSC SET UNI CURVED DRNGE CATH(XR/MAMMO)

Facility

$301.00

Hospital Charge Code	9469077
Hospital Revenue Code	272
Min. Negotiated Rate	$150.50
Max. Negotiated Rate	$291.97
Rate for Payer: AlohaCare Medicaid	$150.50
Rate for Payer: AlohaCare Medicare	$150.50
Rate for Payer: Cash Price	$195.65
Rate for Payer: Devoted Health Medicare	$165.55
Rate for Payer: Hawaii Medical Service Association Medicare	$150.50
Rate for Payer: Hawaii Western Management Group Commercial	$285.95
Rate for Payer: Health Management Network Commercial	$255.85
Rate for Payer: Humana Medicare	$150.50
Rate for Payer: Kaiser Permanente Commercial	$270.90
Rate for Payer: Kaiser Permanente Medicaid	$153.51
Rate for Payer: Kaiser Permanente Medicare	$150.50
Rate for Payer: MDX Hawaii PPO	$291.97
Rate for Payer: Ohana Health Plan Medicaid	$150.50
Rate for Payer: Ohana Health Plan Medicare	$150.50
Rate for Payer: UnitedHealthcare Medicare	$150.50
Rate for Payer: University Health Alliance Commercial	$219.40

HHSC STEREO BIOPSY MARKER TUMARK Q

Facility

$315.00

Service Code	HCPCS A4648
Hospital Charge Code	13157519
Hospital Revenue Code	278
Min. Negotiated Rate	$176.40
Max. Negotiated Rate	$305.55
Rate for Payer: Cash Price	$204.75
Rate for Payer: Hawaii Western Management Group Commercial	$220.50
Rate for Payer: Health Management Network Commercial	$267.75
Rate for Payer: Kaiser Permanente Commercial	$283.50
Rate for Payer: MDX Hawaii PPO	$305.55
Rate for Payer: University Health Alliance Commercial	$176.40

HHSC STEREO BIOPSY MARKER TUMARK Q

Facility

$315.00

Service Code	HCPCS A4648
Hospital Charge Code	13157519
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$305.55
Rate for Payer: AlohaCare Medicaid	$157.50
Rate for Payer: AlohaCare Medicare	$157.50
Rate for Payer: Cash Price	$204.75
Rate for Payer: Devoted Health Medicare	$173.25
Rate for Payer: Hawaii Medical Service Association Medicare	$157.50
Rate for Payer: Hawaii Western Management Group Commercial	$220.50
Rate for Payer: Health Management Network Commercial	$267.75
Rate for Payer: Humana Medicare	$157.50
Rate for Payer: Kaiser Permanente Commercial	$283.50
Rate for Payer: Kaiser Permanente Medicaid	$160.65
Rate for Payer: Kaiser Permanente Medicare	$157.50
Rate for Payer: MDX Hawaii PPO	$305.55
Rate for Payer: Ohana Health Plan Medicaid	$157.50
Rate for Payer: Ohana Health Plan Medicare	$157.50
Rate for Payer: UnitedHealthcare Medicare	$157.50
Rate for Payer: University Health Alliance Commercial	$176.40

HHSC STEREO BIOPSY MARKER TUMARK VISION

Facility

$413.00

Service Code	HCPCS A4648
Hospital Charge Code	13157517
Hospital Revenue Code	278
Min. Negotiated Rate	$206.50
Max. Negotiated Rate	$400.61
Rate for Payer: AlohaCare Medicaid	$206.50
Rate for Payer: AlohaCare Medicare	$206.50
Rate for Payer: Cash Price	$268.45
Rate for Payer: Devoted Health Medicare	$227.15
Rate for Payer: Hawaii Medical Service Association Medicare	$206.50
Rate for Payer: Hawaii Western Management Group Commercial	$289.10
Rate for Payer: Health Management Network Commercial	$351.05
Rate for Payer: Humana Medicare	$206.50
Rate for Payer: Kaiser Permanente Commercial	$371.70
Rate for Payer: Kaiser Permanente Medicaid	$210.63
Rate for Payer: Kaiser Permanente Medicare	$206.50
Rate for Payer: MDX Hawaii PPO	$400.61
Rate for Payer: Ohana Health Plan Medicaid	$206.50
Rate for Payer: Ohana Health Plan Medicare	$206.50
Rate for Payer: UnitedHealthcare Medicare	$206.50
Rate for Payer: University Health Alliance Commercial	$231.28

HHSC STEREO BIOPSY MARKER TUMARK VISION

Facility

$413.00

Service Code	HCPCS A4648
Hospital Charge Code	13157517
Hospital Revenue Code	278
Min. Negotiated Rate	$231.28
Max. Negotiated Rate	$400.61
Rate for Payer: Cash Price	$268.45
Rate for Payer: Hawaii Western Management Group Commercial	$289.10
Rate for Payer: Health Management Network Commercial	$351.05
Rate for Payer: Kaiser Permanente Commercial	$371.70
Rate for Payer: MDX Hawaii PPO	$400.61
Rate for Payer: University Health Alliance Commercial	$231.28

HHSC TEMNO CHIBA FINE NDL ASP 22GX15CM

Facility

$95.00

Service Code	HCPCS C1729
Hospital Charge Code	8223434
Hospital Revenue Code	272
Min. Negotiated Rate	$80.75
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$61.75
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Kaiser Permanente Commercial	$85.50
Rate for Payer: MDX Hawaii PPO	$92.15

HHSC TEMNO CHIBA FINE NDL ASP 22GX15CM

Facility

$95.00

Service Code	HCPCS C1729
Hospital Charge Code	8223434
Hospital Revenue Code	272
Min. Negotiated Rate	$47.50
Max. Negotiated Rate	$92.15
Rate for Payer: AlohaCare Medicaid	$47.50
Rate for Payer: AlohaCare Medicare	$47.50
Rate for Payer: Cash Price	$61.75
Rate for Payer: Devoted Health Medicare	$52.25
Rate for Payer: Hawaii Medical Service Association Medicare	$47.50
Rate for Payer: Hawaii Western Management Group Commercial	$90.25
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Humana Medicare	$47.50
Rate for Payer: Kaiser Permanente Commercial	$85.50
Rate for Payer: Kaiser Permanente Medicaid	$48.45
Rate for Payer: Kaiser Permanente Medicare	$47.50
Rate for Payer: MDX Hawaii PPO	$92.15
Rate for Payer: Ohana Health Plan Medicaid	$47.50
Rate for Payer: Ohana Health Plan Medicare	$47.50
Rate for Payer: UnitedHealthcare Medicare	$47.50
Rate for Payer: University Health Alliance Commercial	$69.25

HHSC TENMO EVOLUTION 18GX15CM (CT)

Facility

$220.00

Hospital Charge Code	9469091
Hospital Revenue Code	272
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$213.40
Rate for Payer: AlohaCare Medicaid	$110.00
Rate for Payer: AlohaCare Medicare	$110.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Devoted Health Medicare	$121.00
Rate for Payer: Hawaii Medical Service Association Medicare	$110.00
Rate for Payer: Hawaii Western Management Group Commercial	$209.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Humana Medicare	$110.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: Kaiser Permanente Medicaid	$112.20
Rate for Payer: Kaiser Permanente Medicare	$110.00
Rate for Payer: MDX Hawaii PPO	$213.40
Rate for Payer: Ohana Health Plan Medicaid	$110.00
Rate for Payer: Ohana Health Plan Medicare	$110.00
Rate for Payer: UnitedHealthcare Medicare	$110.00
Rate for Payer: University Health Alliance Commercial	$160.36

HHSC TENMO EVOLUTION 18GX15CM (CT)

Facility

$220.00

Hospital Charge Code	9469091
Hospital Revenue Code	272
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$143.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: MDX Hawaii PPO	$213.40

HHSC TENMO EVOLUTION 18GX15CM (US)

Facility

$220.00

Hospital Charge Code	9469310
Hospital Revenue Code	272
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$213.40
Rate for Payer: AlohaCare Medicaid	$110.00
Rate for Payer: AlohaCare Medicare	$110.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Devoted Health Medicare	$121.00
Rate for Payer: Hawaii Medical Service Association Medicare	$110.00
Rate for Payer: Hawaii Western Management Group Commercial	$209.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Humana Medicare	$110.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: Kaiser Permanente Medicaid	$112.20
Rate for Payer: Kaiser Permanente Medicare	$110.00
Rate for Payer: MDX Hawaii PPO	$213.40
Rate for Payer: Ohana Health Plan Medicaid	$110.00
Rate for Payer: Ohana Health Plan Medicare	$110.00
Rate for Payer: UnitedHealthcare Medicare	$110.00
Rate for Payer: University Health Alliance Commercial	$160.36

HHSC TENMO EVOLUTION 18GX15CM (US)

Facility

$220.00

Hospital Charge Code	9469310
Hospital Revenue Code	272
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$143.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: MDX Hawaii PPO	$213.40

HHSC TENMO EVOLUTION 18GX15CM (XR/MAMMO)

Facility

$220.00

Hospital Charge Code	9468984
Hospital Revenue Code	272
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$213.40
Rate for Payer: AlohaCare Medicaid	$110.00
Rate for Payer: AlohaCare Medicare	$110.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Devoted Health Medicare	$121.00
Rate for Payer: Hawaii Medical Service Association Medicare	$110.00
Rate for Payer: Hawaii Western Management Group Commercial	$209.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Humana Medicare	$110.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: Kaiser Permanente Medicaid	$112.20
Rate for Payer: Kaiser Permanente Medicare	$110.00
Rate for Payer: MDX Hawaii PPO	$213.40
Rate for Payer: Ohana Health Plan Medicaid	$110.00
Rate for Payer: Ohana Health Plan Medicare	$110.00
Rate for Payer: UnitedHealthcare Medicare	$110.00
Rate for Payer: University Health Alliance Commercial	$160.36

HHSC TENMO EVOLUTION 18GX15CM (XR/MAMMO)

Facility

$220.00

Hospital Charge Code	9468984
Hospital Revenue Code	272
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$143.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: MDX Hawaii PPO	$213.40

HHSC TENMO EVOLUTION 18GX6CM (CT)

Facility

$291.00

Hospital Charge Code	9469089
Hospital Revenue Code	272
Min. Negotiated Rate	$247.35
Max. Negotiated Rate	$282.27
Rate for Payer: Cash Price	$189.15
Rate for Payer: Health Management Network Commercial	$247.35
Rate for Payer: Kaiser Permanente Commercial	$261.90
Rate for Payer: MDX Hawaii PPO	$282.27

HHSC TENMO EVOLUTION 18GX6CM (CT)

Facility

$291.00

Hospital Charge Code	9469089
Hospital Revenue Code	272
Min. Negotiated Rate	$145.50
Max. Negotiated Rate	$282.27
Rate for Payer: AlohaCare Medicaid	$145.50
Rate for Payer: AlohaCare Medicare	$145.50
Rate for Payer: Cash Price	$189.15
Rate for Payer: Devoted Health Medicare	$160.05
Rate for Payer: Hawaii Medical Service Association Medicare	$145.50
Rate for Payer: Hawaii Western Management Group Commercial	$276.45
Rate for Payer: Health Management Network Commercial	$247.35
Rate for Payer: Humana Medicare	$145.50
Rate for Payer: Kaiser Permanente Commercial	$261.90
Rate for Payer: Kaiser Permanente Medicaid	$148.41
Rate for Payer: Kaiser Permanente Medicare	$145.50
Rate for Payer: MDX Hawaii PPO	$282.27
Rate for Payer: Ohana Health Plan Medicaid	$145.50
Rate for Payer: Ohana Health Plan Medicare	$145.50
Rate for Payer: UnitedHealthcare Medicare	$145.50
Rate for Payer: University Health Alliance Commercial	$212.11

HHSC TENMO EVOLUTION 18GX6CM (US)

Facility

$291.00

Hospital Charge Code	9469129
Hospital Revenue Code	272
Min. Negotiated Rate	$145.50
Max. Negotiated Rate	$282.27
Rate for Payer: AlohaCare Medicaid	$145.50
Rate for Payer: AlohaCare Medicare	$145.50
Rate for Payer: Cash Price	$189.15
Rate for Payer: Devoted Health Medicare	$160.05
Rate for Payer: Hawaii Medical Service Association Medicare	$145.50
Rate for Payer: Hawaii Western Management Group Commercial	$276.45
Rate for Payer: Health Management Network Commercial	$247.35
Rate for Payer: Humana Medicare	$145.50
Rate for Payer: Kaiser Permanente Commercial	$261.90
Rate for Payer: Kaiser Permanente Medicaid	$148.41
Rate for Payer: Kaiser Permanente Medicare	$145.50
Rate for Payer: MDX Hawaii PPO	$282.27
Rate for Payer: Ohana Health Plan Medicaid	$145.50
Rate for Payer: Ohana Health Plan Medicare	$145.50
Rate for Payer: UnitedHealthcare Medicare	$145.50
Rate for Payer: University Health Alliance Commercial	$212.11

HHSC TENMO EVOLUTION 18GX6CM (US)

Facility

$291.00

Hospital Charge Code	9469129
Hospital Revenue Code	272
Min. Negotiated Rate	$247.35
Max. Negotiated Rate	$282.27
Rate for Payer: Cash Price	$189.15
Rate for Payer: Health Management Network Commercial	$247.35
Rate for Payer: Kaiser Permanente Commercial	$261.90
Rate for Payer: MDX Hawaii PPO	$282.27

HHSC TENMO EVOLUTION 18GX6CM (XR/MAMMO)

Facility

$291.00

Hospital Charge Code	9468982
Hospital Revenue Code	272
Min. Negotiated Rate	$145.50
Max. Negotiated Rate	$282.27
Rate for Payer: AlohaCare Medicaid	$145.50
Rate for Payer: AlohaCare Medicare	$145.50
Rate for Payer: Cash Price	$189.15
Rate for Payer: Devoted Health Medicare	$160.05
Rate for Payer: Hawaii Medical Service Association Medicare	$145.50
Rate for Payer: Hawaii Western Management Group Commercial	$276.45
Rate for Payer: Health Management Network Commercial	$247.35
Rate for Payer: Humana Medicare	$145.50
Rate for Payer: Kaiser Permanente Commercial	$261.90
Rate for Payer: Kaiser Permanente Medicaid	$148.41
Rate for Payer: Kaiser Permanente Medicare	$145.50
Rate for Payer: MDX Hawaii PPO	$282.27
Rate for Payer: Ohana Health Plan Medicaid	$145.50
Rate for Payer: Ohana Health Plan Medicare	$145.50
Rate for Payer: UnitedHealthcare Medicare	$145.50
Rate for Payer: University Health Alliance Commercial	$212.11

HHSC TENMO EVOLUTION 18GX6CM (XR/MAMMO)

Facility

$291.00

Hospital Charge Code	9468982
Hospital Revenue Code	272
Min. Negotiated Rate	$247.35
Max. Negotiated Rate	$282.27
Rate for Payer: Cash Price	$189.15
Rate for Payer: Health Management Network Commercial	$247.35
Rate for Payer: Kaiser Permanente Commercial	$261.90
Rate for Payer: MDX Hawaii PPO	$282.27

HHSC TENMO EVOLUTION 20GX15CM (CT)

Facility

$220.00

Hospital Charge Code	9469087
Hospital Revenue Code	272
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$213.40
Rate for Payer: AlohaCare Medicaid	$110.00
Rate for Payer: AlohaCare Medicare	$110.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Devoted Health Medicare	$121.00
Rate for Payer: Hawaii Medical Service Association Medicare	$110.00
Rate for Payer: Hawaii Western Management Group Commercial	$209.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Humana Medicare	$110.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: Kaiser Permanente Medicaid	$112.20
Rate for Payer: Kaiser Permanente Medicare	$110.00
Rate for Payer: MDX Hawaii PPO	$213.40
Rate for Payer: Ohana Health Plan Medicaid	$110.00
Rate for Payer: Ohana Health Plan Medicare	$110.00
Rate for Payer: UnitedHealthcare Medicare	$110.00
Rate for Payer: University Health Alliance Commercial	$160.36

HHSC TENMO EVOLUTION 20GX15CM (CT)

Facility

$220.00

Hospital Charge Code	9469087
Hospital Revenue Code	272
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$143.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: MDX Hawaii PPO	$213.40

HHSC TENMO EVOLUTION 20GX15CM (US)

Facility

$220.00

Hospital Charge Code	9469125
Hospital Revenue Code	272
Min. Negotiated Rate	$110.00
Max. Negotiated Rate	$213.40
Rate for Payer: AlohaCare Medicaid	$110.00
Rate for Payer: AlohaCare Medicare	$110.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Devoted Health Medicare	$121.00
Rate for Payer: Hawaii Medical Service Association Medicare	$110.00
Rate for Payer: Hawaii Western Management Group Commercial	$209.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Humana Medicare	$110.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: Kaiser Permanente Medicaid	$112.20
Rate for Payer: Kaiser Permanente Medicare	$110.00
Rate for Payer: MDX Hawaii PPO	$213.40
Rate for Payer: Ohana Health Plan Medicaid	$110.00
Rate for Payer: Ohana Health Plan Medicare	$110.00
Rate for Payer: UnitedHealthcare Medicare	$110.00
Rate for Payer: University Health Alliance Commercial	$160.36

Know your out-of-pocket cost for care.

All Charges