Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

29130-Finger

Facility

$533.00

Service Code	HCPCS 29130
Hospital Charge Code	8080073
Hospital Revenue Code	450
Min. Negotiated Rate	$266.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$266.50
Rate for Payer: Cash Price	$346.45
Rate for Payer: Cash Price	$346.45
Rate for Payer: Cash Price	$346.45
Rate for Payer: Devoted Health Medicare	$293.15
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$266.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$506.35
Rate for Payer: Health Management Network Commercial	$453.05
Rate for Payer: Humana Medicare	$266.50
Rate for Payer: Kaiser Permanente Commercial	$479.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$266.50
Rate for Payer: MDX Hawaii PPO	$517.01
Rate for Payer: Ohana Health Plan Medicaid	$266.50
Rate for Payer: Ohana Health Plan Medicare	$266.50
Rate for Payer: UnitedHealthcare Medicare	$266.50
Rate for Payer: University Health Alliance Commercial	$388.50

29130-Finger

Facility

$533.00

Service Code	HCPCS 29130
Hospital Charge Code	8080073
Hospital Revenue Code	450
Min. Negotiated Rate	$453.05
Max. Negotiated Rate	$517.01
Rate for Payer: Cash Price	$346.45
Rate for Payer: Health Management Network Commercial	$453.05
Rate for Payer: Kaiser Permanente Commercial	$479.70
Rate for Payer: MDX Hawaii PPO	$517.01

29131 Appl Finger Splint Dynamic Bil

Facility

$457.00

Service Code	HCPCS 29131 50
Hospital Charge Code	8223394
Hospital Revenue Code	430
Min. Negotiated Rate	$22.28
Max. Negotiated Rate	$443.29
Rate for Payer: AlohaCare Medicaid	$228.50
Rate for Payer: AlohaCare Medicare	$228.50
Rate for Payer: Cash Price	$297.05
Rate for Payer: Cash Price	$297.05
Rate for Payer: Devoted Health Medicare	$251.35
Rate for Payer: Hawaii Medical Service Association Medicare	$228.50
Rate for Payer: Hawaii Western Management Group Commercial	$434.15
Rate for Payer: Health Management Network Commercial	$388.45
Rate for Payer: Humana Medicare	$228.50
Rate for Payer: Kaiser Permanente Commercial	$411.30
Rate for Payer: Kaiser Permanente Medicaid	$233.07
Rate for Payer: Kaiser Permanente Medicare	$228.50
Rate for Payer: MDX Hawaii PPO	$443.29
Rate for Payer: Ohana Health Plan Medicaid	$228.50
Rate for Payer: Ohana Health Plan Medicare	$228.50
Rate for Payer: UnitedHealthcare Medicaid	$22.28
Rate for Payer: UnitedHealthcare Medicare	$228.50
Rate for Payer: University Health Alliance Commercial	$333.11

29131 Appl Finger Splint Dynamic Bil

Facility

$457.00

Service Code	HCPCS 29131 50
Hospital Charge Code	8223394
Hospital Revenue Code	430
Min. Negotiated Rate	$388.45
Max. Negotiated Rate	$443.29
Rate for Payer: Cash Price	$297.05
Rate for Payer: Health Management Network Commercial	$388.45
Rate for Payer: Kaiser Permanente Commercial	$411.30
Rate for Payer: MDX Hawaii PPO	$443.29

29131 Appl Finger Splint Dynamic LT

Facility

$457.00

Service Code	HCPCS 29131 LT
Hospital Charge Code	8222612
Hospital Revenue Code	430
Min. Negotiated Rate	$22.28
Max. Negotiated Rate	$443.29
Rate for Payer: AlohaCare Medicaid	$228.50
Rate for Payer: AlohaCare Medicare	$228.50
Rate for Payer: Cash Price	$297.05
Rate for Payer: Cash Price	$297.05
Rate for Payer: Devoted Health Medicare	$251.35
Rate for Payer: Hawaii Medical Service Association Medicare	$228.50
Rate for Payer: Hawaii Western Management Group Commercial	$434.15
Rate for Payer: Health Management Network Commercial	$388.45
Rate for Payer: Humana Medicare	$228.50
Rate for Payer: Kaiser Permanente Commercial	$411.30
Rate for Payer: Kaiser Permanente Medicaid	$233.07
Rate for Payer: Kaiser Permanente Medicare	$228.50
Rate for Payer: MDX Hawaii PPO	$443.29
Rate for Payer: Ohana Health Plan Medicaid	$228.50
Rate for Payer: Ohana Health Plan Medicare	$228.50
Rate for Payer: UnitedHealthcare Medicaid	$22.28
Rate for Payer: UnitedHealthcare Medicare	$228.50
Rate for Payer: University Health Alliance Commercial	$333.11

29131 Appl Finger Splint Dynamic LT

Facility

$457.00

Service Code	HCPCS 29131 LT
Hospital Charge Code	8222612
Hospital Revenue Code	430
Min. Negotiated Rate	$388.45
Max. Negotiated Rate	$443.29
Rate for Payer: Cash Price	$297.05
Rate for Payer: Health Management Network Commercial	$388.45
Rate for Payer: Kaiser Permanente Commercial	$411.30
Rate for Payer: MDX Hawaii PPO	$443.29

29131 Appl Finger Splint Dynamic RT

Facility

$457.00

Service Code	HCPCS 29131 RT
Hospital Charge Code	8222626
Hospital Revenue Code	430
Min. Negotiated Rate	$388.45
Max. Negotiated Rate	$443.29
Rate for Payer: Cash Price	$297.05
Rate for Payer: Health Management Network Commercial	$388.45
Rate for Payer: Kaiser Permanente Commercial	$411.30
Rate for Payer: MDX Hawaii PPO	$443.29

29131 Appl Finger Splint Dynamic RT

Facility

$457.00

Service Code	HCPCS 29131 RT
Hospital Charge Code	8222626
Hospital Revenue Code	430
Min. Negotiated Rate	$22.28
Max. Negotiated Rate	$443.29
Rate for Payer: AlohaCare Medicaid	$228.50
Rate for Payer: AlohaCare Medicare	$228.50
Rate for Payer: Cash Price	$297.05
Rate for Payer: Cash Price	$297.05
Rate for Payer: Devoted Health Medicare	$251.35
Rate for Payer: Hawaii Medical Service Association Medicare	$228.50
Rate for Payer: Hawaii Western Management Group Commercial	$434.15
Rate for Payer: Health Management Network Commercial	$388.45
Rate for Payer: Humana Medicare	$228.50
Rate for Payer: Kaiser Permanente Commercial	$411.30
Rate for Payer: Kaiser Permanente Medicaid	$233.07
Rate for Payer: Kaiser Permanente Medicare	$228.50
Rate for Payer: MDX Hawaii PPO	$443.29
Rate for Payer: Ohana Health Plan Medicaid	$228.50
Rate for Payer: Ohana Health Plan Medicare	$228.50
Rate for Payer: UnitedHealthcare Medicaid	$22.28
Rate for Payer: UnitedHealthcare Medicare	$228.50
Rate for Payer: University Health Alliance Commercial	$333.11

29200 STRAPPING; THORAX TechFee

Facility

$359.00

Service Code	HCPCS 29200
Hospital Charge Code	8023341
Hospital Revenue Code	450
Min. Negotiated Rate	$179.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$179.50
Rate for Payer: Cash Price	$233.35
Rate for Payer: Cash Price	$233.35
Rate for Payer: Cash Price	$233.35
Rate for Payer: Devoted Health Medicare	$197.45
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$179.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$341.05
Rate for Payer: Health Management Network Commercial	$305.15
Rate for Payer: Humana Medicare	$179.50
Rate for Payer: Kaiser Permanente Commercial	$323.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$179.50
Rate for Payer: MDX Hawaii PPO	$348.23
Rate for Payer: Ohana Health Plan Medicaid	$179.50
Rate for Payer: Ohana Health Plan Medicare	$179.50
Rate for Payer: UnitedHealthcare Medicare	$179.50
Rate for Payer: University Health Alliance Commercial	$261.68

29200 STRAPPING; THORAX TechFee

Facility

$359.00

Service Code	HCPCS 29200
Hospital Charge Code	8023341
Hospital Revenue Code	450
Min. Negotiated Rate	$305.15
Max. Negotiated Rate	$348.23
Rate for Payer: Cash Price	$233.35
Rate for Payer: Health Management Network Commercial	$305.15
Rate for Payer: Kaiser Permanente Commercial	$323.10
Rate for Payer: MDX Hawaii PPO	$348.23

29240 Strapping of Shoulder

Facility

$451.00

Service Code	HCPCS 29240
Hospital Charge Code	8222673
Hospital Revenue Code	430
Min. Negotiated Rate	$383.35
Max. Negotiated Rate	$437.47
Rate for Payer: Cash Price	$293.15
Rate for Payer: Health Management Network Commercial	$383.35
Rate for Payer: Kaiser Permanente Commercial	$405.90
Rate for Payer: MDX Hawaii PPO	$437.47

29240 Strapping of Shoulder

Facility

$451.00

Service Code	HCPCS 29240
Hospital Charge Code	8222673
Hospital Revenue Code	430
Min. Negotiated Rate	$27.92
Max. Negotiated Rate	$437.47
Rate for Payer: AlohaCare Medicaid	$225.50
Rate for Payer: AlohaCare Medicare	$225.50
Rate for Payer: Cash Price	$293.15
Rate for Payer: Cash Price	$293.15
Rate for Payer: Devoted Health Medicare	$248.05
Rate for Payer: Hawaii Medical Service Association Commercial	$169.91
Rate for Payer: Hawaii Medical Service Association Medicare	$225.50
Rate for Payer: Hawaii Western Management Group Commercial	$428.45
Rate for Payer: Health Management Network Commercial	$383.35
Rate for Payer: Humana Medicare	$225.50
Rate for Payer: Kaiser Permanente Commercial	$405.90
Rate for Payer: Kaiser Permanente Medicaid	$230.01
Rate for Payer: Kaiser Permanente Medicare	$225.50
Rate for Payer: MDX Hawaii PPO	$437.47
Rate for Payer: Ohana Health Plan Medicaid	$225.50
Rate for Payer: Ohana Health Plan Medicare	$225.50
Rate for Payer: UnitedHealthcare Medicaid	$27.92
Rate for Payer: UnitedHealthcare Medicare	$225.50
Rate for Payer: University Health Alliance Commercial	$328.73

29260 Strapping Elbow or Wrist Bilat

Facility

$428.00

Service Code	HCPCS 29260 50
Hospital Charge Code	8222669
Hospital Revenue Code	430
Min. Negotiated Rate	$363.80
Max. Negotiated Rate	$415.16
Rate for Payer: Cash Price	$278.20
Rate for Payer: Health Management Network Commercial	$363.80
Rate for Payer: Kaiser Permanente Commercial	$385.20
Rate for Payer: MDX Hawaii PPO	$415.16

29260 Strapping Elbow or Wrist Bilat

Facility

$428.00

Service Code	HCPCS 29260 50
Hospital Charge Code	8222669
Hospital Revenue Code	430
Min. Negotiated Rate	$21.56
Max. Negotiated Rate	$415.16
Rate for Payer: AlohaCare Medicaid	$214.00
Rate for Payer: AlohaCare Medicare	$214.00
Rate for Payer: Cash Price	$278.20
Rate for Payer: Cash Price	$278.20
Rate for Payer: Devoted Health Medicare	$235.40
Rate for Payer: Hawaii Medical Service Association Medicare	$214.00
Rate for Payer: Hawaii Western Management Group Commercial	$406.60
Rate for Payer: Health Management Network Commercial	$363.80
Rate for Payer: Humana Medicare	$214.00
Rate for Payer: Kaiser Permanente Commercial	$385.20
Rate for Payer: Kaiser Permanente Medicaid	$218.28
Rate for Payer: Kaiser Permanente Medicare	$214.00
Rate for Payer: MDX Hawaii PPO	$415.16
Rate for Payer: Ohana Health Plan Medicaid	$214.00
Rate for Payer: Ohana Health Plan Medicare	$214.00
Rate for Payer: UnitedHealthcare Medicaid	$21.56
Rate for Payer: UnitedHealthcare Medicare	$214.00
Rate for Payer: University Health Alliance Commercial	$311.97

29260 STRAPPING ELBOW/WRIST TechFee

Facility

$276.00

Service Code	HCPCS 29260
Hospital Charge Code	8023343
Hospital Revenue Code	450
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

29260 STRAPPING ELBOW/WRIST TechFee

Facility

$276.00

Service Code	HCPCS 29260
Hospital Charge Code	8023343
Hospital Revenue Code	450
Min. Negotiated Rate	$138.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$138.00
Rate for Payer: Cash Price	$179.40
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	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$138.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$262.20
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	$937.50
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 Medicare	$138.00
Rate for Payer: University Health Alliance Commercial	$201.18

29260 Strapping of Elbow or Wrist LT

Facility

$428.00

Service Code	HCPCS 29260 LT
Hospital Charge Code	8222670
Hospital Revenue Code	430
Min. Negotiated Rate	$363.80
Max. Negotiated Rate	$415.16
Rate for Payer: Cash Price	$278.20
Rate for Payer: Health Management Network Commercial	$363.80
Rate for Payer: Kaiser Permanente Commercial	$385.20
Rate for Payer: MDX Hawaii PPO	$415.16

29260 Strapping of Elbow or Wrist LT

Facility

$428.00

Service Code	HCPCS 29260 LT
Hospital Charge Code	8222670
Hospital Revenue Code	430
Min. Negotiated Rate	$21.56
Max. Negotiated Rate	$415.16
Rate for Payer: AlohaCare Medicaid	$214.00
Rate for Payer: AlohaCare Medicare	$214.00
Rate for Payer: Cash Price	$278.20
Rate for Payer: Cash Price	$278.20
Rate for Payer: Devoted Health Medicare	$235.40
Rate for Payer: Hawaii Medical Service Association Medicare	$214.00
Rate for Payer: Hawaii Western Management Group Commercial	$406.60
Rate for Payer: Health Management Network Commercial	$363.80
Rate for Payer: Humana Medicare	$214.00
Rate for Payer: Kaiser Permanente Commercial	$385.20
Rate for Payer: Kaiser Permanente Medicaid	$218.28
Rate for Payer: Kaiser Permanente Medicare	$214.00
Rate for Payer: MDX Hawaii PPO	$415.16
Rate for Payer: Ohana Health Plan Medicaid	$214.00
Rate for Payer: Ohana Health Plan Medicare	$214.00
Rate for Payer: UnitedHealthcare Medicaid	$21.56
Rate for Payer: UnitedHealthcare Medicare	$214.00
Rate for Payer: University Health Alliance Commercial	$311.97

29260 Strapping of Elbow or Wrist RT

Facility

$428.00

Service Code	HCPCS 29260 RT
Hospital Charge Code	8222672
Hospital Revenue Code	430
Min. Negotiated Rate	$363.80
Max. Negotiated Rate	$415.16
Rate for Payer: Cash Price	$278.20
Rate for Payer: Health Management Network Commercial	$363.80
Rate for Payer: Kaiser Permanente Commercial	$385.20
Rate for Payer: MDX Hawaii PPO	$415.16

29260 Strapping of Elbow or Wrist RT

Facility

$428.00

Service Code	HCPCS 29260 RT
Hospital Charge Code	8222672
Hospital Revenue Code	430
Min. Negotiated Rate	$21.56
Max. Negotiated Rate	$415.16
Rate for Payer: AlohaCare Medicaid	$214.00
Rate for Payer: AlohaCare Medicare	$214.00
Rate for Payer: Cash Price	$278.20
Rate for Payer: Cash Price	$278.20
Rate for Payer: Devoted Health Medicare	$235.40
Rate for Payer: Hawaii Medical Service Association Medicare	$214.00
Rate for Payer: Hawaii Western Management Group Commercial	$406.60
Rate for Payer: Health Management Network Commercial	$363.80
Rate for Payer: Humana Medicare	$214.00
Rate for Payer: Kaiser Permanente Commercial	$385.20
Rate for Payer: Kaiser Permanente Medicaid	$218.28
Rate for Payer: Kaiser Permanente Medicare	$214.00
Rate for Payer: MDX Hawaii PPO	$415.16
Rate for Payer: Ohana Health Plan Medicaid	$214.00
Rate for Payer: Ohana Health Plan Medicare	$214.00
Rate for Payer: UnitedHealthcare Medicaid	$21.56
Rate for Payer: UnitedHealthcare Medicare	$214.00
Rate for Payer: University Health Alliance Commercial	$311.97

29280 STRAPPING HAND/FINGER TechFee

Facility

$528.00

Service Code	HCPCS 29280
Hospital Charge Code	8023344
Hospital Revenue Code	450
Min. Negotiated Rate	$264.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$264.00
Rate for Payer: Cash Price	$343.20
Rate for Payer: Cash Price	$343.20
Rate for Payer: Cash Price	$343.20
Rate for Payer: Devoted Health Medicare	$290.40
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$264.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$501.60
Rate for Payer: Health Management Network Commercial	$448.80
Rate for Payer: Humana Medicare	$264.00
Rate for Payer: Kaiser Permanente Commercial	$475.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$264.00
Rate for Payer: MDX Hawaii PPO	$512.16
Rate for Payer: Ohana Health Plan Medicaid	$264.00
Rate for Payer: Ohana Health Plan Medicare	$264.00
Rate for Payer: UnitedHealthcare Medicare	$264.00
Rate for Payer: University Health Alliance Commercial	$384.86

29280 STRAPPING HAND/FINGER TechFee

Facility

$528.00

Service Code	HCPCS 29280
Hospital Charge Code	8023344
Hospital Revenue Code	450
Min. Negotiated Rate	$448.80
Max. Negotiated Rate	$512.16
Rate for Payer: Cash Price	$343.20
Rate for Payer: Health Management Network Commercial	$448.80
Rate for Payer: Kaiser Permanente Commercial	$475.20
Rate for Payer: MDX Hawaii PPO	$512.16

29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE TechFee

Facility

$1,058.00

Service Code	HCPCS 29405
Hospital Charge Code	8023348
Hospital Revenue Code	450
Min. Negotiated Rate	$899.30
Max. Negotiated Rate	$1,026.26
Rate for Payer: Cash Price	$687.70
Rate for Payer: Health Management Network Commercial	$899.30
Rate for Payer: Kaiser Permanente Commercial	$952.20
Rate for Payer: MDX Hawaii PPO	$1,026.26

29405 APPLICATION SHORT LEG CAST BELOW KNEE-TOE TechFee

Facility

$1,058.00

Service Code	HCPCS 29405
Hospital Charge Code	8023348
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$529.00
Rate for Payer: Cash Price	$687.70
Rate for Payer: Cash Price	$687.70
Rate for Payer: Cash Price	$687.70
Rate for Payer: Devoted Health Medicare	$581.90
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$529.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,005.10
Rate for Payer: Health Management Network Commercial	$899.30
Rate for Payer: Humana Medicare	$529.00
Rate for Payer: Kaiser Permanente Commercial	$952.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$529.00
Rate for Payer: MDX Hawaii PPO	$1,026.26
Rate for Payer: Ohana Health Plan Medicaid	$529.00
Rate for Payer: Ohana Health Plan Medicare	$529.00
Rate for Payer: UnitedHealthcare Medicare	$529.00
Rate for Payer: University Health Alliance Commercial	$771.18

29505 APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES TechFee

Facility

$613.00

Service Code	HCPCS 29505
Hospital Charge Code	8023349
Hospital Revenue Code	450
Min. Negotiated Rate	$521.05
Max. Negotiated Rate	$594.61
Rate for Payer: Cash Price	$398.45
Rate for Payer: Health Management Network Commercial	$521.05
Rate for Payer: Kaiser Permanente Commercial	$551.70
Rate for Payer: MDX Hawaii PPO	$594.61

Know your out-of-pocket cost for care.

All Charges