Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC

Facility

$165,698.50

Service Code	MSDRG 853
Min. Negotiated Rate	$165,698.50
Max. Negotiated Rate	$165,698.50
Rate for Payer: Hawaii Medical Service Association Commercial	$165,698.50

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$165,698.50

Service Code	MSDRG 855
Min. Negotiated Rate	$165,698.50
Max. Negotiated Rate	$165,698.50
Rate for Payer: Hawaii Medical Service Association Commercial	$165,698.50

Infectious Mono Test FSI

Facility

$92.00

Service Code	HCPCS 86308
Hospital Charge Code	8117971
Hospital Revenue Code	302
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$89.24
Rate for Payer: AlohaCare Medicaid	$46.00
Rate for Payer: AlohaCare Medicare	$46.00
Rate for Payer: Cash Price	$59.80
Rate for Payer: Cash Price	$59.80
Rate for Payer: Devoted Health Medicare	$50.60
Rate for Payer: Hawaii Medical Service Association ABD	$7.15
Rate for Payer: Hawaii Medical Service Association Commercial	$6.47
Rate for Payer: Hawaii Medical Service Association Medicare	$46.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.18
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Humana Medicare	$46.00
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: Kaiser Permanente Medicaid	$46.92
Rate for Payer: Kaiser Permanente Medicare	$46.00
Rate for Payer: MDX Hawaii PPO	$89.24
Rate for Payer: Ohana Health Plan Medicaid	$46.00
Rate for Payer: Ohana Health Plan Medicare	$46.00
Rate for Payer: UnitedHealthcare Medicaid	$7.15
Rate for Payer: UnitedHealthcare Medicare	$46.00
Rate for Payer: University Health Alliance Commercial	$13.38

Infectious Mono Test FSI

Facility

$92.00

Service Code	HCPCS 86308
Hospital Charge Code	8117971
Hospital Revenue Code	302
Min. Negotiated Rate	$78.20
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$59.80
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: MDX Hawaii PPO	$89.24

INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$14,175.78

Service Code	MSDRG 727
Min. Negotiated Rate	$14,175.78
Max. Negotiated Rate	$14,175.78
Rate for Payer: Hawaii Medical Service Association Commercial	$14,175.78

INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC

Facility

$14,175.78

Service Code	MSDRG 728
Min. Negotiated Rate	$14,175.78
Max. Negotiated Rate	$14,175.78
Rate for Payer: Hawaii Medical Service Association Commercial	$14,175.78

INFLAMMATORY BOWEL DISEASE WITH CC

Facility

$20,906.72

Service Code	MSDRG 386
Min. Negotiated Rate	$20,906.72
Max. Negotiated Rate	$20,906.72
Rate for Payer: Hawaii Medical Service Association Commercial	$20,906.72

INFLAMMATORY BOWEL DISEASE WITH MCC

Facility

$20,906.72

Service Code	MSDRG 385
Min. Negotiated Rate	$20,906.72
Max. Negotiated Rate	$20,906.72
Rate for Payer: Hawaii Medical Service Association Commercial	$20,906.72

INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC

Facility

$20,906.72

Service Code	MSDRG 387
Min. Negotiated Rate	$20,906.72
Max. Negotiated Rate	$20,906.72
Rate for Payer: Hawaii Medical Service Association Commercial	$20,906.72

INFLATION DEVICE DISPOSABLE FOR EBD

Facility

$228.00

Hospital Charge Code	9552699
Hospital Revenue Code	272
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$221.16
Rate for Payer: AlohaCare Medicaid	$114.00
Rate for Payer: AlohaCare Medicare	$114.00
Rate for Payer: Cash Price	$148.20
Rate for Payer: Devoted Health Medicare	$125.40
Rate for Payer: Hawaii Medical Service Association Medicare	$114.00
Rate for Payer: Hawaii Western Management Group Commercial	$216.60
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: Humana Medicare	$114.00
Rate for Payer: Kaiser Permanente Commercial	$205.20
Rate for Payer: Kaiser Permanente Medicaid	$116.28
Rate for Payer: Kaiser Permanente Medicare	$114.00
Rate for Payer: MDX Hawaii PPO	$221.16
Rate for Payer: Ohana Health Plan Medicaid	$114.00
Rate for Payer: Ohana Health Plan Medicare	$114.00
Rate for Payer: UnitedHealthcare Medicare	$114.00
Rate for Payer: University Health Alliance Commercial	$166.19

INFLATION DEVICE DISPOSABLE FOR EBD

Facility

$228.00

Hospital Charge Code	9552699
Hospital Revenue Code	272
Min. Negotiated Rate	$193.80
Max. Negotiated Rate	$221.16
Rate for Payer: Cash Price	$148.20
Rate for Payer: Health Management Network Commercial	$193.80
Rate for Payer: Kaiser Permanente Commercial	$205.20
Rate for Payer: MDX Hawaii PPO	$221.16

inFLIXimab 100 mg vial [HHSC]

Facility

$1,433.30

Service Code	HCPCS J1745
Hospital Charge Code	2501204
Hospital Revenue Code	636
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$1,390.30
Rate for Payer: AlohaCare Medicaid	$716.65
Rate for Payer: AlohaCare Medicare	$716.65
Rate for Payer: Cash Price	$931.64
Rate for Payer: Cash Price	$931.64
Rate for Payer: Devoted Health Medicare	$788.32
Rate for Payer: Hawaii Medical Service Association ABD	$109.98
Rate for Payer: Hawaii Medical Service Association Commercial	$38.80
Rate for Payer: Hawaii Medical Service Association Medicare	$716.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$109.98
Rate for Payer: Hawaii Western Management Group Commercial	$1,361.63
Rate for Payer: Health Management Network Commercial	$1,218.31
Rate for Payer: Humana Medicare	$716.65
Rate for Payer: Kaiser Permanente Commercial	$1,289.97
Rate for Payer: Kaiser Permanente Medicaid	$730.98
Rate for Payer: Kaiser Permanente Medicare	$716.65
Rate for Payer: MDX Hawaii PPO	$1,390.30
Rate for Payer: Ohana Health Plan Medicaid	$716.65
Rate for Payer: Ohana Health Plan Medicare	$716.65
Rate for Payer: UnitedHealthcare Medicaid	$859.98
Rate for Payer: UnitedHealthcare Medicare	$716.65
Rate for Payer: University Health Alliance Commercial	$1,044.73

inFLIXimab 100 mg vial [HHSC]

Facility

$1,433.30

Service Code	HCPCS J1745
Hospital Charge Code	2501204
Hospital Revenue Code	250
Min. Negotiated Rate	$1,218.31
Max. Negotiated Rate	$1,390.30
Rate for Payer: Cash Price	$931.64
Rate for Payer: Health Management Network Commercial	$1,218.31
Rate for Payer: Kaiser Permanente Commercial	$1,289.97
Rate for Payer: MDX Hawaii PPO	$1,390.30

Influenza A/B POC.

Facility

$76.00

Service Code	HCPCS 87804 QW
Hospital Charge Code	8041486
Hospital Revenue Code	306
Min. Negotiated Rate	$16.55
Max. Negotiated Rate	$73.72
Rate for Payer: AlohaCare Medicaid	$38.00
Rate for Payer: AlohaCare Medicare	$38.00
Rate for Payer: Cash Price	$49.40
Rate for Payer: Cash Price	$49.40
Rate for Payer: Devoted Health Medicare	$41.80
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$20.69
Rate for Payer: Hawaii Medical Service Association Medicare	$38.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$16.55
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Humana Medicare	$38.00
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: Kaiser Permanente Medicaid	$38.76
Rate for Payer: Kaiser Permanente Medicare	$38.00
Rate for Payer: MDX Hawaii PPO	$73.72
Rate for Payer: Ohana Health Plan Medicaid	$38.00
Rate for Payer: Ohana Health Plan Medicare	$38.00
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$38.00
Rate for Payer: University Health Alliance Commercial	$31.01

Influenza A/B POC.

Facility

$76.00

Service Code	HCPCS 87804 QW
Hospital Charge Code	8041486
Hospital Revenue Code	306
Min. Negotiated Rate	$64.60
Max. Negotiated Rate	$73.72
Rate for Payer: Cash Price	$49.40
Rate for Payer: Health Management Network Commercial	$64.60
Rate for Payer: Kaiser Permanente Commercial	$68.40
Rate for Payer: MDX Hawaii PPO	$73.72

Influenza A/B POCT

Facility

$61.00

Service Code	HCPCS 87084
Hospital Charge Code	9578814
Hospital Revenue Code	306
Min. Negotiated Rate	$51.85
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$39.65
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: MDX Hawaii PPO	$59.17

Influenza A/B POCT

Facility

$61.00

Service Code	HCPCS 87084
Hospital Charge Code	9578814
Hospital Revenue Code	306
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$59.17
Rate for Payer: AlohaCare Medicaid	$30.50
Rate for Payer: AlohaCare Medicare	$30.50
Rate for Payer: Cash Price	$39.65
Rate for Payer: Cash Price	$39.65
Rate for Payer: Devoted Health Medicare	$33.55
Rate for Payer: Hawaii Medical Service Association ABD	$11.90
Rate for Payer: Hawaii Medical Service Association Commercial	$33.84
Rate for Payer: Hawaii Medical Service Association Medicare	$30.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.50
Rate for Payer: Hawaii Western Management Group Commercial	$27.07
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Humana Medicare	$30.50
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: Kaiser Permanente Medicaid	$31.11
Rate for Payer: Kaiser Permanente Medicare	$30.50
Rate for Payer: MDX Hawaii PPO	$59.17
Rate for Payer: Ohana Health Plan Medicaid	$30.50
Rate for Payer: Ohana Health Plan Medicare	$30.50
Rate for Payer: UnitedHealthcare Medicaid	$11.90
Rate for Payer: UnitedHealthcare Medicare	$30.50
Rate for Payer: University Health Alliance Commercial	$22.26

Influenza Testing to DOH FSI

Facility

$139.00

Service Code	HCPCS 87804 QW
Hospital Charge Code	8228884
Hospital Revenue Code	306
Min. Negotiated Rate	$118.15
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$90.35
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: MDX Hawaii PPO	$134.83

Influenza Testing to DOH FSI

Facility

$139.00

Service Code	HCPCS 87804 QW
Hospital Charge Code	8228884
Hospital Revenue Code	306
Min. Negotiated Rate	$16.55
Max. Negotiated Rate	$134.83
Rate for Payer: AlohaCare Medicaid	$69.50
Rate for Payer: AlohaCare Medicare	$69.50
Rate for Payer: Cash Price	$90.35
Rate for Payer: Cash Price	$90.35
Rate for Payer: Devoted Health Medicare	$76.45
Rate for Payer: Hawaii Medical Service Association ABD	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$20.69
Rate for Payer: Hawaii Medical Service Association Medicare	$69.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$16.55
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Humana Medicare	$69.50
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: Kaiser Permanente Medicaid	$70.89
Rate for Payer: Kaiser Permanente Medicare	$69.50
Rate for Payer: MDX Hawaii PPO	$134.83
Rate for Payer: Ohana Health Plan Medicaid	$69.50
Rate for Payer: Ohana Health Plan Medicare	$69.50
Rate for Payer: UnitedHealthcare Medicaid	$16.58
Rate for Payer: UnitedHealthcare Medicare	$69.50
Rate for Payer: University Health Alliance Commercial	$31.01

Influenza Virus Flu A/B PCR FSI

Facility

$947.00

Service Code	HCPCS 87502
Hospital Charge Code	8228885
Hospital Revenue Code	306
Min. Negotiated Rate	$804.95
Max. Negotiated Rate	$918.59
Rate for Payer: Cash Price	$615.55
Rate for Payer: Health Management Network Commercial	$804.95
Rate for Payer: Kaiser Permanente Commercial	$852.30
Rate for Payer: MDX Hawaii PPO	$918.59

Influenza Virus Flu A/B PCR FSI

Facility

$947.00

Service Code	HCPCS 87502
Hospital Charge Code	8228885
Hospital Revenue Code	306
Min. Negotiated Rate	$95.80
Max. Negotiated Rate	$918.59
Rate for Payer: AlohaCare Medicaid	$473.50
Rate for Payer: AlohaCare Medicare	$473.50
Rate for Payer: Cash Price	$615.55
Rate for Payer: Cash Price	$615.55
Rate for Payer: Devoted Health Medicare	$520.85
Rate for Payer: Hawaii Medical Service Association ABD	$119.75
Rate for Payer: Hawaii Medical Service Association Commercial	$119.75
Rate for Payer: Hawaii Medical Service Association Medicare	$473.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$117.54
Rate for Payer: Hawaii Western Management Group Commercial	$95.80
Rate for Payer: Health Management Network Commercial	$804.95
Rate for Payer: Humana Medicare	$473.50
Rate for Payer: Kaiser Permanente Commercial	$852.30
Rate for Payer: Kaiser Permanente Medicaid	$482.97
Rate for Payer: Kaiser Permanente Medicare	$473.50
Rate for Payer: MDX Hawaii PPO	$918.59
Rate for Payer: Ohana Health Plan Medicaid	$473.50
Rate for Payer: Ohana Health Plan Medicare	$473.50
Rate for Payer: UnitedHealthcare Medicaid	$119.75
Rate for Payer: UnitedHealthcare Medicare	$473.50
Rate for Payer: University Health Alliance Commercial	$221.54

Infrared-Light Therapy Charge

Facility

$45.00

Service Code	HCPCS 97026 GP,CQ
Hospital Charge Code	8111743
Hospital Revenue Code	420
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$29.25
Rate for Payer: Health Management Network Commercial	$38.25
Rate for Payer: Kaiser Permanente Commercial	$40.50
Rate for Payer: MDX Hawaii PPO	$43.65

Infrared-Light Therapy Charge

Facility

$45.00

Service Code	HCPCS 97026 GP,CQ
Hospital Charge Code	8111743
Hospital Revenue Code	420
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$43.65
Rate for Payer: AlohaCare Medicaid	$22.50
Rate for Payer: AlohaCare Medicare	$22.50
Rate for Payer: Cash Price	$29.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Devoted Health Medicare	$24.75
Rate for Payer: Hawaii Medical Service Association Medicare	$22.50
Rate for Payer: Hawaii Western Management Group Commercial	$42.75
Rate for Payer: Health Management Network Commercial	$38.25
Rate for Payer: Humana Medicare	$22.50
Rate for Payer: Kaiser Permanente Commercial	$40.50
Rate for Payer: Kaiser Permanente Medicaid	$22.95
Rate for Payer: Kaiser Permanente Medicare	$22.50
Rate for Payer: MDX Hawaii PPO	$43.65
Rate for Payer: Ohana Health Plan Medicaid	$22.50
Rate for Payer: Ohana Health Plan Medicare	$22.50
Rate for Payer: UnitedHealthcare Medicaid	$4.50
Rate for Payer: UnitedHealthcare Medicare	$22.50
Rate for Payer: University Health Alliance Commercial	$32.80

Infusion, normal saline solution 1,000 cc

Facility

$10.00

Service Code	HCPCS J7030
Hospital Charge Code	8764248
Hospital Revenue Code	636
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$9.70
Rate for Payer: AlohaCare Medicaid	$5.00
Rate for Payer: AlohaCare Medicare	$5.00
Rate for Payer: Cash Price	$6.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Devoted Health Medicare	$5.50
Rate for Payer: Hawaii Medical Service Association ABD	$2.28
Rate for Payer: Hawaii Medical Service Association Medicare	$5.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$9.50
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Humana Medicare	$5.00
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: Kaiser Permanente Medicaid	$5.10
Rate for Payer: Kaiser Permanente Medicare	$5.00
Rate for Payer: MDX Hawaii PPO	$9.70
Rate for Payer: Ohana Health Plan Medicaid	$5.00
Rate for Payer: Ohana Health Plan Medicare	$5.00
Rate for Payer: UnitedHealthcare Medicaid	$6.00
Rate for Payer: UnitedHealthcare Medicare	$5.00
Rate for Payer: University Health Alliance Commercial	$7.29

Infusion, normal saline solution 1,000 cc

Facility

$10.00

Service Code	HCPCS J7030
Hospital Charge Code	8764248
Hospital Revenue Code	636
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.50
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: MDX Hawaii PPO	$9.70

Know your out-of-pocket cost for care.

All Charges