Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

HHSC US Vac Assisted Biopsy Probe

Facility

$928.00

Service Code	HCPCS A4215
Hospital Charge Code	8223476
Hospital Revenue Code	272
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$900.16
Rate for Payer: AlohaCare Medicaid	$464.00
Rate for Payer: AlohaCare Medicare	$464.00
Rate for Payer: Cash Price	$603.20
Rate for Payer: Cash Price	$603.20
Rate for Payer: Devoted Health Medicare	$510.40
Rate for Payer: Hawaii Medical Service Association Medicare	$464.00
Rate for Payer: Hawaii Western Management Group Commercial	$881.60
Rate for Payer: Health Management Network Commercial	$788.80
Rate for Payer: Humana Medicare	$464.00
Rate for Payer: Kaiser Permanente Commercial	$835.20
Rate for Payer: Kaiser Permanente Medicaid	$473.28
Rate for Payer: Kaiser Permanente Medicare	$464.00
Rate for Payer: MDX Hawaii PPO	$900.16
Rate for Payer: Ohana Health Plan Medicaid	$464.00
Rate for Payer: Ohana Health Plan Medicare	$464.00
Rate for Payer: UnitedHealthcare Medicaid	$0.10
Rate for Payer: UnitedHealthcare Medicare	$464.00
Rate for Payer: University Health Alliance Commercial	$676.42

HHSC US Vac Assisted Biopsy Probe

Facility

$928.00

Service Code	HCPCS A4215
Hospital Charge Code	8223476
Hospital Revenue Code	272
Min. Negotiated Rate	$788.80
Max. Negotiated Rate	$900.16
Rate for Payer: Cash Price	$603.20
Rate for Payer: Health Management Network Commercial	$788.80
Rate for Payer: Kaiser Permanente Commercial	$835.20
Rate for Payer: MDX Hawaii PPO	$900.16

HHSC Vac Assisted Biopsy Probe

Facility

$928.00

Service Code	HCPCS A4215
Hospital Charge Code	8223472
Hospital Revenue Code	272
Min. Negotiated Rate	$788.80
Max. Negotiated Rate	$900.16
Rate for Payer: Cash Price	$603.20
Rate for Payer: Health Management Network Commercial	$788.80
Rate for Payer: Kaiser Permanente Commercial	$835.20
Rate for Payer: MDX Hawaii PPO	$900.16

HHSC Vac Assisted Biopsy Probe

Facility

$928.00

Service Code	HCPCS A4215
Hospital Charge Code	8223472
Hospital Revenue Code	272
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$900.16
Rate for Payer: AlohaCare Medicaid	$464.00
Rate for Payer: AlohaCare Medicare	$464.00
Rate for Payer: Cash Price	$603.20
Rate for Payer: Cash Price	$603.20
Rate for Payer: Devoted Health Medicare	$510.40
Rate for Payer: Hawaii Medical Service Association Medicare	$464.00
Rate for Payer: Hawaii Western Management Group Commercial	$881.60
Rate for Payer: Health Management Network Commercial	$788.80
Rate for Payer: Humana Medicare	$464.00
Rate for Payer: Kaiser Permanente Commercial	$835.20
Rate for Payer: Kaiser Permanente Medicaid	$473.28
Rate for Payer: Kaiser Permanente Medicare	$464.00
Rate for Payer: MDX Hawaii PPO	$900.16
Rate for Payer: Ohana Health Plan Medicaid	$464.00
Rate for Payer: Ohana Health Plan Medicare	$464.00
Rate for Payer: UnitedHealthcare Medicaid	$0.10
Rate for Payer: UnitedHealthcare Medicare	$464.00
Rate for Payer: University Health Alliance Commercial	$676.42

HHSC Xrays at Surgery Addon

Facility

$494.00

Service Code	HCPCS 74301
Hospital Charge Code	8223478
Hospital Revenue Code	320
Min. Negotiated Rate	$419.90
Max. Negotiated Rate	$479.18
Rate for Payer: Cash Price	$321.10
Rate for Payer: Health Management Network Commercial	$419.90
Rate for Payer: Kaiser Permanente Commercial	$444.60
Rate for Payer: MDX Hawaii PPO	$479.18

HHSC Xrays at Surgery Addon

Facility

$494.00

Service Code	HCPCS 74301
Hospital Charge Code	8223478
Hospital Revenue Code	320
Min. Negotiated Rate	$247.00
Max. Negotiated Rate	$479.18
Rate for Payer: AlohaCare Medicaid	$247.00
Rate for Payer: AlohaCare Medicare	$247.00
Rate for Payer: Cash Price	$321.10
Rate for Payer: Devoted Health Medicare	$271.70
Rate for Payer: Hawaii Medical Service Association Medicare	$247.00
Rate for Payer: Hawaii Western Management Group Commercial	$469.30
Rate for Payer: Health Management Network Commercial	$419.90
Rate for Payer: Humana Medicare	$247.00
Rate for Payer: Kaiser Permanente Commercial	$444.60
Rate for Payer: Kaiser Permanente Medicaid	$251.94
Rate for Payer: Kaiser Permanente Medicare	$247.00
Rate for Payer: MDX Hawaii PPO	$479.18
Rate for Payer: Ohana Health Plan Medicaid	$247.00
Rate for Payer: Ohana Health Plan Medicare	$247.00
Rate for Payer: UnitedHealthcare Medicare	$247.00
Rate for Payer: University Health Alliance Commercial	$360.08

HHSC XR Guided FNA Addl

Facility

$1,331.00

Service Code	HCPCS 10008
Hospital Charge Code	8223494
Hospital Revenue Code	361
Min. Negotiated Rate	$49.35
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	$49.35
Rate for Payer: UnitedHealthcare Medicare	$665.50
Rate for Payer: University Health Alliance Commercial	$970.17

HHSC XR Guided FNA Addl

Facility

$1,331.00

Service Code	HCPCS 10008
Hospital Charge Code	8223494
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 XR Inj Ankle Arthro

Facility

$214.00

Service Code	HCPCS 27648
Hospital Charge Code	8224268
Hospital Revenue Code	361
Min. Negotiated Rate	$39.92
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$107.00
Rate for Payer: AlohaCare Medicare	$107.00
Rate for Payer: Cash Price	$139.10
Rate for Payer: Cash Price	$139.10
Rate for Payer: Cash Price	$139.10
Rate for Payer: Devoted Health Medicare	$117.70
Rate for Payer: Hawaii Medical Service Association Medicare	$107.00
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Humana Medicare	$107.00
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$107.00
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: Ohana Health Plan Medicaid	$107.00
Rate for Payer: Ohana Health Plan Medicare	$107.00
Rate for Payer: UnitedHealthcare Medicaid	$39.92
Rate for Payer: UnitedHealthcare Medicare	$107.00
Rate for Payer: University Health Alliance Commercial	$155.98

HHSC XR Inj Ankle Arthro

Facility

$214.00

Service Code	HCPCS 27648
Hospital Charge Code	8224268
Hospital Revenue Code	361
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$139.10
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: MDX Hawaii PPO	$207.58

HHSC XR Inj Hysterosalpingogram

Facility

$442.00

Service Code	HCPCS 58340
Hospital Charge Code	8224266
Hospital Revenue Code	361
Min. Negotiated Rate	$38.69
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$221.00
Rate for Payer: AlohaCare Medicare	$221.00
Rate for Payer: Cash Price	$287.30
Rate for Payer: Cash Price	$287.30
Rate for Payer: Cash Price	$287.30
Rate for Payer: Devoted Health Medicare	$243.10
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	$221.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$375.70
Rate for Payer: Humana Medicare	$221.00
Rate for Payer: Kaiser Permanente Commercial	$397.80
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$221.00
Rate for Payer: MDX Hawaii PPO	$428.74
Rate for Payer: Ohana Health Plan Medicaid	$221.00
Rate for Payer: Ohana Health Plan Medicare	$221.00
Rate for Payer: UnitedHealthcare Medicaid	$38.69
Rate for Payer: UnitedHealthcare Medicare	$221.00
Rate for Payer: University Health Alliance Commercial	$322.17

HHSC XR Inj Hysterosalpingogram

Facility

$442.00

Service Code	HCPCS 58340
Hospital Charge Code	8224266
Hospital Revenue Code	361
Min. Negotiated Rate	$375.70
Max. Negotiated Rate	$428.74
Rate for Payer: Cash Price	$287.30
Rate for Payer: Health Management Network Commercial	$375.70
Rate for Payer: Kaiser Permanente Commercial	$397.80
Rate for Payer: MDX Hawaii PPO	$428.74

HHSC XR Inj Knee Arthro

Facility

$214.00

Service Code	HCPCS 27370
Hospital Charge Code	8224260
Hospital Revenue Code	361
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$139.10
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: MDX Hawaii PPO	$207.58

HHSC XR Inj Knee Arthro

Facility

$214.00

Service Code	HCPCS 27370
Hospital Charge Code	8224260
Hospital Revenue Code	361
Min. Negotiated Rate	$107.00
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$107.00
Rate for Payer: AlohaCare Medicare	$107.00
Rate for Payer: Cash Price	$139.10
Rate for Payer: Cash Price	$139.10
Rate for Payer: Devoted Health Medicare	$117.70
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	$107.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Humana Medicare	$107.00
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$107.00
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: Ohana Health Plan Medicaid	$107.00
Rate for Payer: Ohana Health Plan Medicare	$107.00
Rate for Payer: UnitedHealthcare Medicare	$107.00
Rate for Payer: University Health Alliance Commercial	$155.98

HHSC XR Inj Mamm Duct Galact

Facility

$214.00

Service Code	HCPCS 19030
Hospital Charge Code	8224256
Hospital Revenue Code	361
Min. Negotiated Rate	$56.73
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$107.00
Rate for Payer: AlohaCare Medicare	$107.00
Rate for Payer: Cash Price	$139.10
Rate for Payer: Cash Price	$139.10
Rate for Payer: Cash Price	$139.10
Rate for Payer: Devoted Health Medicare	$117.70
Rate for Payer: Hawaii Medical Service Association Medicare	$107.00
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Humana Medicare	$107.00
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$107.00
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: Ohana Health Plan Medicaid	$107.00
Rate for Payer: Ohana Health Plan Medicare	$107.00
Rate for Payer: UnitedHealthcare Medicaid	$56.73
Rate for Payer: UnitedHealthcare Medicare	$107.00
Rate for Payer: University Health Alliance Commercial	$155.98

HHSC XR Inj Mamm Duct Galact

Facility

$214.00

Service Code	HCPCS 19030
Hospital Charge Code	8224256
Hospital Revenue Code	361
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$139.10
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: MDX Hawaii PPO	$207.58

HHSC XR Inj Shoulder Arthro

Facility

$351.00

Service Code	HCPCS 23350
Hospital Charge Code	8224262
Hospital Revenue Code	361
Min. Negotiated Rate	$40.41
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$175.50
Rate for Payer: AlohaCare Medicare	$175.50
Rate for Payer: Cash Price	$228.15
Rate for Payer: Cash Price	$228.15
Rate for Payer: Cash Price	$228.15
Rate for Payer: Devoted Health Medicare	$193.05
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	$175.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$298.35
Rate for Payer: Humana Medicare	$175.50
Rate for Payer: Kaiser Permanente Commercial	$315.90
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$175.50
Rate for Payer: MDX Hawaii PPO	$340.47
Rate for Payer: Ohana Health Plan Medicaid	$175.50
Rate for Payer: Ohana Health Plan Medicare	$175.50
Rate for Payer: UnitedHealthcare Medicaid	$40.41
Rate for Payer: UnitedHealthcare Medicare	$175.50
Rate for Payer: University Health Alliance Commercial	$255.84

HHSC XR Inj Shoulder Arthro

Facility

$351.00

Service Code	HCPCS 23350
Hospital Charge Code	8224262
Hospital Revenue Code	361
Min. Negotiated Rate	$298.35
Max. Negotiated Rate	$340.47
Rate for Payer: Cash Price	$228.15
Rate for Payer: Health Management Network Commercial	$298.35
Rate for Payer: Kaiser Permanente Commercial	$315.90
Rate for Payer: MDX Hawaii PPO	$340.47

HHSC XR Inj Wrist Arthro

Facility

$214.00

Service Code	HCPCS 25246
Hospital Charge Code	8224264
Hospital Revenue Code	361
Min. Negotiated Rate	$181.90
Max. Negotiated Rate	$207.58
Rate for Payer: Cash Price	$139.10
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: MDX Hawaii PPO	$207.58

HHSC XR Inj Wrist Arthro

Facility

$214.00

Service Code	HCPCS 25246
Hospital Charge Code	8224264
Hospital Revenue Code	361
Min. Negotiated Rate	$54.32
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$107.00
Rate for Payer: AlohaCare Medicare	$107.00
Rate for Payer: Cash Price	$139.10
Rate for Payer: Cash Price	$139.10
Rate for Payer: Cash Price	$139.10
Rate for Payer: Devoted Health Medicare	$117.70
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	$107.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$181.90
Rate for Payer: Humana Medicare	$107.00
Rate for Payer: Kaiser Permanente Commercial	$192.60
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$107.00
Rate for Payer: MDX Hawaii PPO	$207.58
Rate for Payer: Ohana Health Plan Medicaid	$107.00
Rate for Payer: Ohana Health Plan Medicare	$107.00
Rate for Payer: UnitedHealthcare Medicaid	$54.32
Rate for Payer: UnitedHealthcare Medicare	$107.00
Rate for Payer: University Health Alliance Commercial	$155.98

HHSC XR Small Bowel

Facility

$647.00

Service Code	HCPCS 74248
Hospital Charge Code	9218290
Hospital Revenue Code	320
Min. Negotiated Rate	$43.61
Max. Negotiated Rate	$627.59
Rate for Payer: AlohaCare Medicaid	$323.50
Rate for Payer: AlohaCare Medicare	$323.50
Rate for Payer: Cash Price	$420.55
Rate for Payer: Cash Price	$420.55
Rate for Payer: Devoted Health Medicare	$355.85
Rate for Payer: Hawaii Medical Service Association ABD	$65.90
Rate for Payer: Hawaii Medical Service Association Medicare	$323.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$43.61
Rate for Payer: Hawaii Western Management Group Commercial	$614.65
Rate for Payer: Health Management Network Commercial	$549.95
Rate for Payer: Humana Medicare	$323.50
Rate for Payer: Kaiser Permanente Commercial	$582.30
Rate for Payer: Kaiser Permanente Medicaid	$329.97
Rate for Payer: Kaiser Permanente Medicare	$323.50
Rate for Payer: MDX Hawaii PPO	$627.59
Rate for Payer: Ohana Health Plan Medicaid	$323.50
Rate for Payer: Ohana Health Plan Medicare	$323.50
Rate for Payer: UnitedHealthcare Medicaid	$54.01
Rate for Payer: UnitedHealthcare Medicare	$323.50
Rate for Payer: University Health Alliance Commercial	$176.51

HHSC XR Small Bowel

Facility

$647.00

Service Code	HCPCS 74248
Hospital Charge Code	9218290
Hospital Revenue Code	320
Min. Negotiated Rate	$549.95
Max. Negotiated Rate	$627.59
Rate for Payer: Cash Price	$420.55
Rate for Payer: Health Management Network Commercial	$549.95
Rate for Payer: Kaiser Permanente Commercial	$582.30
Rate for Payer: MDX Hawaii PPO	$627.59

HHSC XR Small Bowel ProFee

Professional

Both

$111.00

Service Code	HCPCS 74248 26
Hospital Charge Code	9218291
Hospital Revenue Code	972
Min. Negotiated Rate	$32.60
Max. Negotiated Rate	$94.35
Rate for Payer: AlohaCare Medicaid	$54.01
Rate for Payer: AlohaCare Medicare	$32.60
Rate for Payer: Cash Price	$72.15
Rate for Payer: Cash Price	$72.15
Rate for Payer: Devoted Health Medicare	$35.86
Rate for Payer: Hawaii Medical Service Association Medicare	$32.60
Rate for Payer: Hawaii Western Management Group Commercial	$91.74
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Kaiser Permanente Commercial	$35.86
Rate for Payer: Kaiser Permanente Medicaid	$35.86
Rate for Payer: Kaiser Permanente Medicare	$35.86
Rate for Payer: Ohana Health Plan Medicaid	$54.01
Rate for Payer: Ohana Health Plan Medicare	$32.60
Rate for Payer: UnitedHealthcare Medicaid	$54.01
Rate for Payer: UnitedHealthcare Medicare	$32.60

HHSC YUEH CENT DISP CATH NDL 5 FR/10CM

Facility

$95.00

Service Code	HCPCS A4648
Hospital Charge Code	8223432
Hospital Revenue Code	278
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	$66.50
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	$53.20

HHSC YUEH CENT DISP CATH NDL 5 FR/10CM

Facility

$95.00

Service Code	HCPCS A4648
Hospital Charge Code	8223432
Hospital Revenue Code	278
Min. Negotiated Rate	$53.20
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$61.75
Rate for Payer: Hawaii Western Management Group Commercial	$66.50
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
Rate for Payer: University Health Alliance Commercial	$53.20

Know your out-of-pocket cost for care.

All Charges