Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC

Facility

$106,573.28

Service Code	MSDRG 969
Min. Negotiated Rate	$106,573.28
Max. Negotiated Rate	$106,573.28
Rate for Payer: Hawaii Medical Service Association Commercial	$106,573.28

HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC

Facility

$106,573.28

Service Code	MSDRG 970
Min. Negotiated Rate	$106,573.28
Max. Negotiated Rate	$106,573.28
Rate for Payer: Hawaii Medical Service Association Commercial	$106,573.28

HIV WITH MAJOR RELATED CONDITION WITH CC

Facility

$62,006.27

Service Code	MSDRG 975
Min. Negotiated Rate	$62,006.27
Max. Negotiated Rate	$62,006.27
Rate for Payer: Hawaii Medical Service Association Commercial	$62,006.27

HIV WITH MAJOR RELATED CONDITION WITH MCC

Facility

$62,006.27

Service Code	MSDRG 974
Min. Negotiated Rate	$62,006.27
Max. Negotiated Rate	$62,006.27
Rate for Payer: Hawaii Medical Service Association Commercial	$62,006.27

HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC

Facility

$62,006.27

Service Code	MSDRG 976
Min. Negotiated Rate	$62,006.27
Max. Negotiated Rate	$62,006.27
Rate for Payer: Hawaii Medical Service Association Commercial	$62,006.27

HIV WITH OR WITHOUT OTHER RELATED CONDITION

Facility

$44,567.01

Service Code	MSDRG 977
Min. Negotiated Rate	$44,567.01
Max. Negotiated Rate	$44,567.01
Rate for Payer: Hawaii Medical Service Association Commercial	$44,567.01

HMGCR Antibody IgG

Facility

$530.00

Service Code	HCPCS 82397
Hospital Charge Code	12514764
Hospital Revenue Code	301
Min. Negotiated Rate	$450.50
Max. Negotiated Rate	$514.10
Rate for Payer: Cash Price	$344.50
Rate for Payer: Health Management Network Commercial	$450.50
Rate for Payer: Kaiser Permanente Commercial	$477.00
Rate for Payer: MDX Hawaii PPO	$514.10

HMGCR Antibody IgG

Facility

$530.00

Service Code	HCPCS 82397
Hospital Charge Code	12514764
Hospital Revenue Code	301
Min. Negotiated Rate	$11.84
Max. Negotiated Rate	$514.10
Rate for Payer: AlohaCare Medicaid	$265.00
Rate for Payer: AlohaCare Medicare	$265.00
Rate for Payer: Cash Price	$344.50
Rate for Payer: Cash Price	$344.50
Rate for Payer: Devoted Health Medicare	$291.50
Rate for Payer: Hawaii Medical Service Association ABD	$11.84
Rate for Payer: Hawaii Medical Service Association Commercial	$17.65
Rate for Payer: Hawaii Medical Service Association Medicare	$265.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.51
Rate for Payer: Hawaii Western Management Group Commercial	$14.12
Rate for Payer: Health Management Network Commercial	$450.50
Rate for Payer: Humana Medicare	$265.00
Rate for Payer: Kaiser Permanente Commercial	$477.00
Rate for Payer: Kaiser Permanente Medicaid	$270.30
Rate for Payer: Kaiser Permanente Medicare	$265.00
Rate for Payer: MDX Hawaii PPO	$514.10
Rate for Payer: Ohana Health Plan Medicaid	$265.00
Rate for Payer: Ohana Health Plan Medicare	$265.00
Rate for Payer: UnitedHealthcare Medicaid	$11.84
Rate for Payer: UnitedHealthcare Medicare	$265.00
Rate for Payer: University Health Alliance Commercial	$36.52

HMGCR Antibody IgG FSI

Facility

$557.00

Service Code	HCPCS 82397
Hospital Charge Code	12332995
Hospital Revenue Code	300
Min. Negotiated Rate	$11.84
Max. Negotiated Rate	$540.29
Rate for Payer: AlohaCare Medicaid	$278.50
Rate for Payer: AlohaCare Medicare	$278.50
Rate for Payer: Cash Price	$362.05
Rate for Payer: Cash Price	$362.05
Rate for Payer: Devoted Health Medicare	$306.35
Rate for Payer: Hawaii Medical Service Association ABD	$11.84
Rate for Payer: Hawaii Medical Service Association Commercial	$17.65
Rate for Payer: Hawaii Medical Service Association Medicare	$278.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.51
Rate for Payer: Hawaii Western Management Group Commercial	$14.12
Rate for Payer: Health Management Network Commercial	$473.45
Rate for Payer: Humana Medicare	$278.50
Rate for Payer: Kaiser Permanente Commercial	$501.30
Rate for Payer: Kaiser Permanente Medicaid	$284.07
Rate for Payer: Kaiser Permanente Medicare	$278.50
Rate for Payer: MDX Hawaii PPO	$540.29
Rate for Payer: Ohana Health Plan Medicaid	$278.50
Rate for Payer: Ohana Health Plan Medicare	$278.50
Rate for Payer: UnitedHealthcare Medicaid	$11.84
Rate for Payer: UnitedHealthcare Medicare	$278.50
Rate for Payer: University Health Alliance Commercial	$36.52

HMGCR Antibody IgG FSI

Facility

$557.00

Service Code	HCPCS 82397
Hospital Charge Code	12332995
Hospital Revenue Code	300
Min. Negotiated Rate	$473.45
Max. Negotiated Rate	$540.29
Rate for Payer: Cash Price	$362.05
Rate for Payer: Health Management Network Commercial	$473.45
Rate for Payer: Kaiser Permanente Commercial	$501.30
Rate for Payer: MDX Hawaii PPO	$540.29

Homocysteine, Total FSI

Facility

$264.00

Service Code	HCPCS 83090
Hospital Charge Code	8117966
Hospital Revenue Code	301
Min. Negotiated Rate	$224.40
Max. Negotiated Rate	$256.08
Rate for Payer: Cash Price	$171.60
Rate for Payer: Health Management Network Commercial	$224.40
Rate for Payer: Kaiser Permanente Commercial	$237.60
Rate for Payer: MDX Hawaii PPO	$256.08

Homocysteine, Total FSI

Facility

$264.00

Service Code	HCPCS 83090
Hospital Charge Code	8117966
Hospital Revenue Code	301
Min. Negotiated Rate	$17.92
Max. Negotiated Rate	$256.08
Rate for Payer: AlohaCare Medicaid	$132.00
Rate for Payer: AlohaCare Medicare	$132.00
Rate for Payer: Cash Price	$171.60
Rate for Payer: Cash Price	$171.60
Rate for Payer: Devoted Health Medicare	$145.20
Rate for Payer: Hawaii Medical Service Association ABD	$23.31
Rate for Payer: Hawaii Medical Service Association Commercial	$22.40
Rate for Payer: Hawaii Medical Service Association Medicare	$132.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.48
Rate for Payer: Hawaii Western Management Group Commercial	$17.92
Rate for Payer: Health Management Network Commercial	$224.40
Rate for Payer: Humana Medicare	$132.00
Rate for Payer: Kaiser Permanente Commercial	$237.60
Rate for Payer: Kaiser Permanente Medicaid	$134.64
Rate for Payer: Kaiser Permanente Medicare	$132.00
Rate for Payer: MDX Hawaii PPO	$256.08
Rate for Payer: Ohana Health Plan Medicaid	$132.00
Rate for Payer: Ohana Health Plan Medicare	$132.00
Rate for Payer: UnitedHealthcare Medicaid	$23.31
Rate for Payer: UnitedHealthcare Medicare	$132.00
Rate for Payer: University Health Alliance Commercial	$43.60

Hot/Cold Pack Application Charge

Facility

$95.00

Service Code	HCPCS 97010 GP,CQ
Hospital Charge Code	8123894
Hospital Revenue Code	430
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

Hot/Cold Pack Application Charge

Facility

$95.00

Service Code	HCPCS 97010 GP,CQ
Hospital Charge Code	8123894
Hospital Revenue Code	430
Min. Negotiated Rate	$10.08
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: 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 Medicaid	$10.08
Rate for Payer: UnitedHealthcare Medicare	$47.50
Rate for Payer: University Health Alliance Commercial	$69.25

.HPV Genotype 16, 18/45 FSI

Facility

$276.00

Service Code	HCPCS 87625
Hospital Charge Code	8727819
Hospital Revenue Code	306
Min. Negotiated Rate	$28.68
Max. Negotiated Rate	$267.72
Rate for Payer: AlohaCare Medicaid	$138.00
Rate for Payer: AlohaCare Medicare	$138.00
Rate for Payer: Cash Price	$179.40
Rate for Payer: Cash Price	$179.40
Rate for Payer: Devoted Health Medicare	$151.80
Rate for Payer: Hawaii Medical Service Association ABD	$48.29
Rate for Payer: Hawaii Medical Service Association Commercial	$50.69
Rate for Payer: Hawaii Medical Service Association Medicare	$138.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.70
Rate for Payer: Hawaii Western Management Group Commercial	$40.55
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Humana Medicare	$138.00
Rate for Payer: Kaiser Permanente Commercial	$248.40
Rate for Payer: Kaiser Permanente Medicaid	$140.76
Rate for Payer: Kaiser Permanente Medicare	$138.00
Rate for Payer: MDX Hawaii PPO	$267.72
Rate for Payer: Ohana Health Plan Medicaid	$138.00
Rate for Payer: Ohana Health Plan Medicare	$138.00
Rate for Payer: UnitedHealthcare Medicaid	$28.68
Rate for Payer: UnitedHealthcare Medicare	$138.00
Rate for Payer: University Health Alliance Commercial	$88.36

.HPV Genotype 16, 18/45 FSI

Facility

$276.00

Service Code	HCPCS 87625
Hospital Charge Code	8727819
Hospital Revenue Code	306
Min. Negotiated Rate	$234.60
Max. Negotiated Rate	$267.72
Rate for Payer: Cash Price	$179.40
Rate for Payer: Health Management Network Commercial	$234.60
Rate for Payer: Kaiser Permanente Commercial	$248.40
Rate for Payer: MDX Hawaii PPO	$267.72

HPV High Risk, Cervical FSI

Facility

$392.00

Service Code	HCPCS 87624
Hospital Charge Code	11545252
Hospital Revenue Code	306
Min. Negotiated Rate	$333.20
Max. Negotiated Rate	$380.24
Rate for Payer: Cash Price	$254.80
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: MDX Hawaii PPO	$380.24

HPV High Risk, Cervical FSI

Facility

$392.00

Service Code	HCPCS 87624
Hospital Charge Code	11545252
Hospital Revenue Code	306
Min. Negotiated Rate	$28.68
Max. Negotiated Rate	$380.24
Rate for Payer: AlohaCare Medicaid	$196.00
Rate for Payer: AlohaCare Medicare	$196.00
Rate for Payer: Cash Price	$254.80
Rate for Payer: Cash Price	$254.80
Rate for Payer: Devoted Health Medicare	$215.60
Rate for Payer: Hawaii Medical Service Association ABD	$48.29
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$196.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.70
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Humana Medicare	$196.00
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: Kaiser Permanente Medicaid	$199.92
Rate for Payer: Kaiser Permanente Medicare	$196.00
Rate for Payer: MDX Hawaii PPO	$380.24
Rate for Payer: Ohana Health Plan Medicaid	$196.00
Rate for Payer: Ohana Health Plan Medicare	$196.00
Rate for Payer: UnitedHealthcare Medicaid	$28.68
Rate for Payer: UnitedHealthcare Medicare	$196.00
Rate for Payer: University Health Alliance Commercial	$88.36

HPV†High†Risk†Screen, Cervical FSI

Facility

$392.00

Service Code	HCPCS 87624
Hospital Charge Code	8727825
Hospital Revenue Code	306
Min. Negotiated Rate	$333.20
Max. Negotiated Rate	$380.24
Rate for Payer: Cash Price	$254.80
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: MDX Hawaii PPO	$380.24

HPV†High†Risk†Screen, Cervical FSI

Facility

$392.00

Service Code	HCPCS 87624
Hospital Charge Code	8727825
Hospital Revenue Code	306
Min. Negotiated Rate	$28.68
Max. Negotiated Rate	$380.24
Rate for Payer: AlohaCare Medicaid	$196.00
Rate for Payer: AlohaCare Medicare	$196.00
Rate for Payer: Cash Price	$254.80
Rate for Payer: Cash Price	$254.80
Rate for Payer: Devoted Health Medicare	$215.60
Rate for Payer: Hawaii Medical Service Association ABD	$48.29
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$196.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.70
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Humana Medicare	$196.00
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: Kaiser Permanente Medicaid	$199.92
Rate for Payer: Kaiser Permanente Medicare	$196.00
Rate for Payer: MDX Hawaii PPO	$380.24
Rate for Payer: Ohana Health Plan Medicaid	$196.00
Rate for Payer: Ohana Health Plan Medicare	$196.00
Rate for Payer: UnitedHealthcare Medicaid	$28.68
Rate for Payer: UnitedHealthcare Medicare	$196.00
Rate for Payer: University Health Alliance Commercial	$88.36

HSV Subtype by PCR FSI

Facility

$392.00

Service Code	HCPCS 87529
Hospital Charge Code	8191170
Hospital Revenue Code	306
Min. Negotiated Rate	$333.20
Max. Negotiated Rate	$380.24
Rate for Payer: Cash Price	$254.80
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: MDX Hawaii PPO	$380.24

HSV Subtype by PCR FSI

Facility

$392.00

Service Code	HCPCS 87529
Hospital Charge Code	8191170
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$380.24
Rate for Payer: AlohaCare Medicaid	$196.00
Rate for Payer: AlohaCare Medicare	$196.00
Rate for Payer: Cash Price	$254.80
Rate for Payer: Cash Price	$254.80
Rate for Payer: Devoted Health Medicare	$215.60
Rate for Payer: Hawaii Medical Service Association ABD	$46.44
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$196.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$48.76
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Humana Medicare	$196.00
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: Kaiser Permanente Medicaid	$199.92
Rate for Payer: Kaiser Permanente Medicare	$196.00
Rate for Payer: MDX Hawaii PPO	$380.24
Rate for Payer: Ohana Health Plan Medicaid	$196.00
Rate for Payer: Ohana Health Plan Medicare	$196.00
Rate for Payer: UnitedHealthcare Medicaid	$46.44
Rate for Payer: UnitedHealthcare Medicare	$196.00
Rate for Payer: University Health Alliance Commercial	$90.72

Human Growth Hormone FSI

Facility

$191.00

Service Code	HCPCS 83003
Hospital Charge Code	11447067
Hospital Revenue Code	301
Min. Negotiated Rate	$16.67
Max. Negotiated Rate	$185.27
Rate for Payer: AlohaCare Medicaid	$95.50
Rate for Payer: AlohaCare Medicare	$95.50
Rate for Payer: Cash Price	$124.15
Rate for Payer: Cash Price	$124.15
Rate for Payer: Devoted Health Medicare	$105.05
Rate for Payer: Hawaii Medical Service Association ABD	$23.04
Rate for Payer: Hawaii Medical Service Association Commercial	$20.84
Rate for Payer: Hawaii Medical Service Association Medicare	$95.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.19
Rate for Payer: Hawaii Western Management Group Commercial	$16.67
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: Humana Medicare	$95.50
Rate for Payer: Kaiser Permanente Commercial	$171.90
Rate for Payer: Kaiser Permanente Medicaid	$97.41
Rate for Payer: Kaiser Permanente Medicare	$95.50
Rate for Payer: MDX Hawaii PPO	$185.27
Rate for Payer: Ohana Health Plan Medicaid	$95.50
Rate for Payer: Ohana Health Plan Medicare	$95.50
Rate for Payer: UnitedHealthcare Medicaid	$23.04
Rate for Payer: UnitedHealthcare Medicare	$95.50
Rate for Payer: University Health Alliance Commercial	$43.09

Human Growth Hormone FSI

Facility

$191.00

Service Code	HCPCS 83003
Hospital Charge Code	11447067
Hospital Revenue Code	301
Min. Negotiated Rate	$162.35
Max. Negotiated Rate	$185.27
Rate for Payer: Cash Price	$124.15
Rate for Payer: Health Management Network Commercial	$162.35
Rate for Payer: Kaiser Permanente Commercial	$171.90
Rate for Payer: MDX Hawaii PPO	$185.27

hydrALAZINE 20 mg/1ml vial [HHSC]

Facility

$23.35

Service Code	HCPCS J0360
Hospital Charge Code	2500385
Hospital Revenue Code	636
Min. Negotiated Rate	$5.19
Max. Negotiated Rate	$22.65
Rate for Payer: AlohaCare Medicaid	$11.68
Rate for Payer: AlohaCare Medicaid	$39.17
Rate for Payer: AlohaCare Medicare	$39.17
Rate for Payer: AlohaCare Medicare	$11.68
Rate for Payer: Cash Price	$50.92
Rate for Payer: Cash Price	$15.18
Rate for Payer: Cash Price	$15.18
Rate for Payer: Cash Price	$50.92
Rate for Payer: Devoted Health Medicare	$12.84
Rate for Payer: Devoted Health Medicare	$43.09
Rate for Payer: Hawaii Medical Service Association ABD	$5.19
Rate for Payer: Hawaii Medical Service Association ABD	$5.19
Rate for Payer: Hawaii Medical Service Association Medicare	$39.17
Rate for Payer: Hawaii Medical Service Association Medicare	$11.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.19
Rate for Payer: Hawaii Western Management Group Commercial	$22.18
Rate for Payer: Hawaii Western Management Group Commercial	$74.42
Rate for Payer: Health Management Network Commercial	$66.59
Rate for Payer: Health Management Network Commercial	$19.85
Rate for Payer: Humana Medicare	$11.68
Rate for Payer: Humana Medicare	$39.17
Rate for Payer: Kaiser Permanente Commercial	$21.02
Rate for Payer: Kaiser Permanente Commercial	$70.51
Rate for Payer: Kaiser Permanente Medicaid	$39.95
Rate for Payer: Kaiser Permanente Medicaid	$11.91
Rate for Payer: Kaiser Permanente Medicare	$11.68
Rate for Payer: Kaiser Permanente Medicare	$39.17
Rate for Payer: MDX Hawaii PPO	$22.65
Rate for Payer: MDX Hawaii PPO	$75.99
Rate for Payer: Ohana Health Plan Medicaid	$39.17
Rate for Payer: Ohana Health Plan Medicaid	$11.68
Rate for Payer: Ohana Health Plan Medicare	$11.68
Rate for Payer: Ohana Health Plan Medicare	$39.17
Rate for Payer: UnitedHealthcare Medicaid	$47.00
Rate for Payer: UnitedHealthcare Medicaid	$14.01
Rate for Payer: UnitedHealthcare Medicare	$11.68
Rate for Payer: UnitedHealthcare Medicare	$39.17
Rate for Payer: University Health Alliance Commercial	$17.02
Rate for Payer: University Health Alliance Commercial	$57.10

Know your out-of-pocket cost for care.

All Charges