Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

HHSC YUEH CENT DISP CATH NDL 5 FR/7CM

Facility

$95.00

Service Code	HCPCS A4648
Hospital Charge Code	8223430
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 YUEH CENT DISP CATH NDL 5 FR/7CM

Facility

$95.00

Service Code	HCPCS A4648
Hospital Charge Code	8223430
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 YUEH CENT DISP CATH NDL 5 FR/9CM

Facility

$95.00

Service Code	HCPCS A4648
Hospital Charge Code	8223428
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/9CM

Facility

$95.00

Service Code	HCPCS A4648
Hospital Charge Code	8223428
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

High Sensitivity Troponin iSTAT POCT

Facility

$125.00

Service Code	HCPCS 84484 QW
Hospital Charge Code	13230888
Hospital Revenue Code	301
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$121.25
Rate for Payer: AlohaCare Medicaid	$62.50
Rate for Payer: AlohaCare Medicare	$62.50
Rate for Payer: Cash Price	$81.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Devoted Health Medicare	$68.75
Rate for Payer: Hawaii Medical Service Association ABD	$13.60
Rate for Payer: Hawaii Medical Service Association Medicare	$62.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14.28
Rate for Payer: Hawaii Western Management Group Commercial	$118.75
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Humana Medicare	$62.50
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: Kaiser Permanente Medicaid	$63.75
Rate for Payer: Kaiser Permanente Medicare	$62.50
Rate for Payer: MDX Hawaii PPO	$121.25
Rate for Payer: Ohana Health Plan Medicaid	$62.50
Rate for Payer: Ohana Health Plan Medicare	$62.50
Rate for Payer: UnitedHealthcare Medicaid	$13.60
Rate for Payer: UnitedHealthcare Medicare	$62.50
Rate for Payer: University Health Alliance Commercial	$25.44

High Sensitivity Troponin iSTAT POCT

Facility

$125.00

Service Code	HCPCS 84484 QW
Hospital Charge Code	13230888
Hospital Revenue Code	301
Min. Negotiated Rate	$106.25
Max. Negotiated Rate	$121.25
Rate for Payer: Cash Price	$81.25
Rate for Payer: Health Management Network Commercial	$106.25
Rate for Payer: Kaiser Permanente Commercial	$112.50
Rate for Payer: MDX Hawaii PPO	$121.25

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC

Facility

$52,190.31

Service Code	MSDRG 481
Min. Negotiated Rate	$52,190.31
Max. Negotiated Rate	$52,190.31
Rate for Payer: Hawaii Medical Service Association Commercial	$52,190.31

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC

Facility

$53,516.10

Service Code	MSDRG 480
Min. Negotiated Rate	$53,516.10
Max. Negotiated Rate	$53,516.10
Rate for Payer: Hawaii Medical Service Association Commercial	$53,516.10

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC

Facility

$37,606.60

Service Code	MSDRG 482
Min. Negotiated Rate	$37,606.60
Max. Negotiated Rate	$37,606.60
Rate for Payer: Hawaii Medical Service Association Commercial	$37,606.60

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC

Facility

$54,408.46

Service Code	MSDRG 521
Min. Negotiated Rate	$54,408.46
Max. Negotiated Rate	$54,408.46
Rate for Payer: Hawaii Medical Service Association Commercial	$54,408.46

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC

Facility

$39,671.78

Service Code	MSDRG 522
Min. Negotiated Rate	$39,671.78
Max. Negotiated Rate	$39,671.78
Rate for Payer: Hawaii Medical Service Association Commercial	$39,671.78

Histone Antibody, IgG FSI

Facility

$699.00

Service Code	HCPCS 83516
Hospital Charge Code	8117960
Hospital Revenue Code	301
Min. Negotiated Rate	$594.15
Max. Negotiated Rate	$678.03
Rate for Payer: Cash Price	$454.35
Rate for Payer: Health Management Network Commercial	$594.15
Rate for Payer: Kaiser Permanente Commercial	$629.10
Rate for Payer: MDX Hawaii PPO	$678.03

Histone Antibody, IgG FSI

Facility

$699.00

Service Code	HCPCS 83516
Hospital Charge Code	8117960
Hospital Revenue Code	301
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$678.03
Rate for Payer: AlohaCare Medicaid	$349.50
Rate for Payer: AlohaCare Medicare	$349.50
Rate for Payer: Cash Price	$454.35
Rate for Payer: Cash Price	$454.35
Rate for Payer: Devoted Health Medicare	$384.45
Rate for Payer: Hawaii Medical Service Association ABD	$15.95
Rate for Payer: Hawaii Medical Service Association Commercial	$14.41
Rate for Payer: Hawaii Medical Service Association Medicare	$349.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.75
Rate for Payer: Hawaii Western Management Group Commercial	$11.53
Rate for Payer: Health Management Network Commercial	$594.15
Rate for Payer: Humana Medicare	$349.50
Rate for Payer: Kaiser Permanente Commercial	$629.10
Rate for Payer: Kaiser Permanente Medicaid	$356.49
Rate for Payer: Kaiser Permanente Medicare	$349.50
Rate for Payer: MDX Hawaii PPO	$678.03
Rate for Payer: Ohana Health Plan Medicaid	$349.50
Rate for Payer: Ohana Health Plan Medicare	$349.50
Rate for Payer: UnitedHealthcare Medicaid	$15.95
Rate for Payer: UnitedHealthcare Medicare	$349.50
Rate for Payer: University Health Alliance Commercial	$29.82

Histoplasma Antibody FSI

Facility

$490.00

Service Code	HCPCS 86698
Hospital Charge Code	10592882
Hospital Revenue Code	306
Min. Negotiated Rate	$10.48
Max. Negotiated Rate	$475.30
Rate for Payer: AlohaCare Medicaid	$245.00
Rate for Payer: AlohaCare Medicare	$245.00
Rate for Payer: Cash Price	$318.50
Rate for Payer: Cash Price	$318.50
Rate for Payer: Devoted Health Medicare	$269.50
Rate for Payer: Hawaii Medical Service Association ABD	$10.48
Rate for Payer: Hawaii Medical Service Association Commercial	$17.24
Rate for Payer: Hawaii Medical Service Association Medicare	$245.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.26
Rate for Payer: Hawaii Western Management Group Commercial	$13.79
Rate for Payer: Health Management Network Commercial	$416.50
Rate for Payer: Humana Medicare	$245.00
Rate for Payer: Kaiser Permanente Commercial	$441.00
Rate for Payer: Kaiser Permanente Medicaid	$249.90
Rate for Payer: Kaiser Permanente Medicare	$245.00
Rate for Payer: MDX Hawaii PPO	$475.30
Rate for Payer: Ohana Health Plan Medicaid	$245.00
Rate for Payer: Ohana Health Plan Medicare	$245.00
Rate for Payer: UnitedHealthcare Medicaid	$10.48
Rate for Payer: UnitedHealthcare Medicare	$245.00
Rate for Payer: University Health Alliance Commercial	$32.30

Histoplasma Antibody FSI

Facility

$490.00

Service Code	HCPCS 86698
Hospital Charge Code	10592882
Hospital Revenue Code	306
Min. Negotiated Rate	$416.50
Max. Negotiated Rate	$475.30
Rate for Payer: Cash Price	$318.50
Rate for Payer: Health Management Network Commercial	$416.50
Rate for Payer: Kaiser Permanente Commercial	$441.00
Rate for Payer: MDX Hawaii PPO	$475.30

HIV 1, 2 Antigen/Antibody FSI

Facility

$287.00

Service Code	HCPCS 87389
Hospital Charge Code	8117963
Hospital Revenue Code	306
Min. Negotiated Rate	$24.08
Max. Negotiated Rate	$278.39
Rate for Payer: AlohaCare Medicaid	$143.50
Rate for Payer: AlohaCare Medicare	$143.50
Rate for Payer: Cash Price	$186.55
Rate for Payer: Cash Price	$186.55
Rate for Payer: Devoted Health Medicare	$157.85
Rate for Payer: Hawaii Medical Service Association ABD	$34.12
Rate for Payer: Hawaii Medical Service Association Commercial	$30.10
Rate for Payer: Hawaii Medical Service Association Medicare	$143.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.90
Rate for Payer: Hawaii Western Management Group Commercial	$24.08
Rate for Payer: Health Management Network Commercial	$243.95
Rate for Payer: Humana Medicare	$143.50
Rate for Payer: Kaiser Permanente Commercial	$258.30
Rate for Payer: Kaiser Permanente Medicaid	$146.37
Rate for Payer: Kaiser Permanente Medicare	$143.50
Rate for Payer: MDX Hawaii PPO	$278.39
Rate for Payer: Ohana Health Plan Medicaid	$143.50
Rate for Payer: Ohana Health Plan Medicare	$143.50
Rate for Payer: UnitedHealthcare Medicaid	$34.12
Rate for Payer: UnitedHealthcare Medicare	$143.50
Rate for Payer: University Health Alliance Commercial	$63.12

HIV 1, 2 Antigen/Antibody FSI

Facility

$287.00

Service Code	HCPCS 87389
Hospital Charge Code	8117963
Hospital Revenue Code	306
Min. Negotiated Rate	$243.95
Max. Negotiated Rate	$278.39
Rate for Payer: Cash Price	$186.55
Rate for Payer: Health Management Network Commercial	$243.95
Rate for Payer: Kaiser Permanente Commercial	$258.30
Rate for Payer: MDX Hawaii PPO	$278.39

HIV 1, 2 Antigen/Antibody Prenatal FSI

Facility

$287.00

Service Code	HCPCS 87389
Hospital Charge Code	8117964
Hospital Revenue Code	306
Min. Negotiated Rate	$24.08
Max. Negotiated Rate	$278.39
Rate for Payer: AlohaCare Medicaid	$143.50
Rate for Payer: AlohaCare Medicare	$143.50
Rate for Payer: Cash Price	$186.55
Rate for Payer: Cash Price	$186.55
Rate for Payer: Devoted Health Medicare	$157.85
Rate for Payer: Hawaii Medical Service Association ABD	$34.12
Rate for Payer: Hawaii Medical Service Association Commercial	$30.10
Rate for Payer: Hawaii Medical Service Association Medicare	$143.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.90
Rate for Payer: Hawaii Western Management Group Commercial	$24.08
Rate for Payer: Health Management Network Commercial	$243.95
Rate for Payer: Humana Medicare	$143.50
Rate for Payer: Kaiser Permanente Commercial	$258.30
Rate for Payer: Kaiser Permanente Medicaid	$146.37
Rate for Payer: Kaiser Permanente Medicare	$143.50
Rate for Payer: MDX Hawaii PPO	$278.39
Rate for Payer: Ohana Health Plan Medicaid	$143.50
Rate for Payer: Ohana Health Plan Medicare	$143.50
Rate for Payer: UnitedHealthcare Medicaid	$34.12
Rate for Payer: UnitedHealthcare Medicare	$143.50
Rate for Payer: University Health Alliance Commercial	$63.12

HIV 1, 2 Antigen/Antibody Prenatal FSI

Facility

$287.00

Service Code	HCPCS 87389
Hospital Charge Code	8117964
Hospital Revenue Code	306
Min. Negotiated Rate	$243.95
Max. Negotiated Rate	$278.39
Rate for Payer: Cash Price	$186.55
Rate for Payer: Health Management Network Commercial	$243.95
Rate for Payer: Kaiser Permanente Commercial	$258.30
Rate for Payer: MDX Hawaii PPO	$278.39

HIV 1, 2 Antigen/Antibody Reflex Western Blot FSI

Facility

$28.00

Service Code	HCPCS 87389
Hospital Charge Code	8117965
Hospital Revenue Code	306
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$18.20
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

HIV 1, 2 Antigen/Antibody Reflex Western Blot FSI

Facility

$28.00

Service Code	HCPCS 87389
Hospital Charge Code	8117965
Hospital Revenue Code	306
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$63.12
Rate for Payer: AlohaCare Medicaid	$14.00
Rate for Payer: AlohaCare Medicare	$14.00
Rate for Payer: Cash Price	$18.20
Rate for Payer: Cash Price	$18.20
Rate for Payer: Devoted Health Medicare	$15.40
Rate for Payer: Hawaii Medical Service Association ABD	$34.12
Rate for Payer: Hawaii Medical Service Association Commercial	$30.10
Rate for Payer: Hawaii Medical Service Association Medicare	$14.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.90
Rate for Payer: Hawaii Western Management Group Commercial	$24.08
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 Medicaid	$34.12
Rate for Payer: UnitedHealthcare Medicare	$14.00
Rate for Payer: University Health Alliance Commercial	$63.12

HIV 1 Genotype Drug Resistance FSI

Facility

$2,876.00

Service Code	HCPCS 87901
Hospital Charge Code	8228883
Hospital Revenue Code	306
Min. Negotiated Rate	$257.45
Max. Negotiated Rate	$2,789.72
Rate for Payer: AlohaCare Medicaid	$1,438.00
Rate for Payer: AlohaCare Medicare	$1,438.00
Rate for Payer: Cash Price	$1,869.40
Rate for Payer: Cash Price	$1,869.40
Rate for Payer: Devoted Health Medicare	$1,581.80
Rate for Payer: Hawaii Medical Service Association ABD	$355.78
Rate for Payer: Hawaii Medical Service Association Commercial	$321.81
Rate for Payer: Hawaii Medical Service Association Medicare	$1,438.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$373.57
Rate for Payer: Hawaii Western Management Group Commercial	$257.45
Rate for Payer: Health Management Network Commercial	$2,444.60
Rate for Payer: Humana Medicare	$1,438.00
Rate for Payer: Kaiser Permanente Commercial	$2,588.40
Rate for Payer: Kaiser Permanente Medicaid	$1,466.76
Rate for Payer: Kaiser Permanente Medicare	$1,438.00
Rate for Payer: MDX Hawaii PPO	$2,789.72
Rate for Payer: Ohana Health Plan Medicaid	$1,438.00
Rate for Payer: Ohana Health Plan Medicare	$1,438.00
Rate for Payer: UnitedHealthcare Medicaid	$355.78
Rate for Payer: UnitedHealthcare Medicare	$1,438.00
Rate for Payer: University Health Alliance Commercial	$665.43

HIV 1 Genotype Drug Resistance FSI

Facility

$2,876.00

Service Code	HCPCS 87901
Hospital Charge Code	8228883
Hospital Revenue Code	306
Min. Negotiated Rate	$2,444.60
Max. Negotiated Rate	$2,789.72
Rate for Payer: Cash Price	$1,869.40
Rate for Payer: Health Management Network Commercial	$2,444.60
Rate for Payer: Kaiser Permanente Commercial	$2,588.40
Rate for Payer: MDX Hawaii PPO	$2,789.72

HIV 1 Quantitative PCR FSI

Facility

$950.00

Service Code	HCPCS 87536
Hospital Charge Code	8117961
Hospital Revenue Code	306
Min. Negotiated Rate	$85.10
Max. Negotiated Rate	$921.50
Rate for Payer: AlohaCare Medicaid	$475.00
Rate for Payer: AlohaCare Medicare	$475.00
Rate for Payer: Cash Price	$617.50
Rate for Payer: Cash Price	$617.50
Rate for Payer: Devoted Health Medicare	$522.50
Rate for Payer: Hawaii Medical Service Association ABD	$117.59
Rate for Payer: Hawaii Medical Service Association Commercial	$106.38
Rate for Payer: Hawaii Medical Service Association Medicare	$475.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$123.47
Rate for Payer: Hawaii Western Management Group Commercial	$85.10
Rate for Payer: Health Management Network Commercial	$807.50
Rate for Payer: Humana Medicare	$475.00
Rate for Payer: Kaiser Permanente Commercial	$855.00
Rate for Payer: Kaiser Permanente Medicaid	$484.50
Rate for Payer: Kaiser Permanente Medicare	$475.00
Rate for Payer: MDX Hawaii PPO	$921.50
Rate for Payer: Ohana Health Plan Medicaid	$475.00
Rate for Payer: Ohana Health Plan Medicare	$475.00
Rate for Payer: UnitedHealthcare Medicaid	$117.59
Rate for Payer: UnitedHealthcare Medicare	$475.00
Rate for Payer: University Health Alliance Commercial	$219.95

HIV 1 Quantitative PCR FSI

Facility

$950.00

Service Code	HCPCS 87536
Hospital Charge Code	8117961
Hospital Revenue Code	306
Min. Negotiated Rate	$807.50
Max. Negotiated Rate	$921.50
Rate for Payer: Cash Price	$617.50
Rate for Payer: Health Management Network Commercial	$807.50
Rate for Payer: Kaiser Permanente Commercial	$855.00
Rate for Payer: MDX Hawaii PPO	$921.50

Know your out-of-pocket cost for care.

All Charges