Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC

Facility

$32,150.46

Service Code	MSDRG 351
Min. Negotiated Rate	$32,150.46
Max. Negotiated Rate	$32,150.46
Rate for Payer: Hawaii Medical Service Association Commercial	$32,150.46

INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC

Facility

$39,926.74

Service Code	MSDRG 350
Min. Negotiated Rate	$39,926.74
Max. Negotiated Rate	$39,926.74
Rate for Payer: Hawaii Medical Service Association Commercial	$39,926.74

INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC

Facility

$16,623.39

Service Code	MSDRG 352
Min. Negotiated Rate	$16,623.39
Max. Negotiated Rate	$16,623.39
Rate for Payer: Hawaii Medical Service Association Commercial	$16,623.39

Insert Coude Catheter

Facility

$633.00

Service Code	HCPCS 51703
Hospital Charge Code	9259112
Hospital Revenue Code	450
Min. Negotiated Rate	$538.05
Max. Negotiated Rate	$614.01
Rate for Payer: Cash Price	$411.45
Rate for Payer: Health Management Network Commercial	$538.05
Rate for Payer: Kaiser Permanente Commercial	$569.70
Rate for Payer: MDX Hawaii PPO	$614.01

Insert Coude Catheter

Facility

$633.00

Service Code	HCPCS 51703
Hospital Charge Code	9259112
Hospital Revenue Code	450
Min. Negotiated Rate	$316.50
Max. Negotiated Rate	$2,389.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$316.50
Rate for Payer: Cash Price	$411.45
Rate for Payer: Cash Price	$411.45
Rate for Payer: Cash Price	$411.45
Rate for Payer: Devoted Health Medicare	$348.15
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	$316.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$601.35
Rate for Payer: Health Management Network Commercial	$538.05
Rate for Payer: Humana Medicare	$316.50
Rate for Payer: Kaiser Permanente Commercial	$569.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$316.50
Rate for Payer: MDX Hawaii PPO	$614.01
Rate for Payer: Ohana Health Plan Medicaid	$316.50
Rate for Payer: Ohana Health Plan Medicare	$316.50
Rate for Payer: UnitedHealthcare Medicare	$316.50
Rate for Payer: University Health Alliance Commercial	$461.39

Insert Coude or Complicated Foley Insertion Charge

Facility

$631.00

Service Code	HCPCS 51703
Hospital Charge Code	8422800
Hospital Revenue Code	450
Min. Negotiated Rate	$536.35
Max. Negotiated Rate	$612.07
Rate for Payer: Cash Price	$410.15
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: Kaiser Permanente Commercial	$567.90
Rate for Payer: MDX Hawaii PPO	$612.07

Insert Coude or Complicated Foley Insertion Charge

Facility

$631.00

Service Code	HCPCS 51703
Hospital Charge Code	8422800
Hospital Revenue Code	450
Min. Negotiated Rate	$315.50
Max. Negotiated Rate	$2,389.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$315.50
Rate for Payer: Cash Price	$410.15
Rate for Payer: Cash Price	$410.15
Rate for Payer: Cash Price	$410.15
Rate for Payer: Devoted Health Medicare	$347.05
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	$315.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$599.45
Rate for Payer: Health Management Network Commercial	$536.35
Rate for Payer: Humana Medicare	$315.50
Rate for Payer: Kaiser Permanente Commercial	$567.90
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$315.50
Rate for Payer: MDX Hawaii PPO	$612.07
Rate for Payer: Ohana Health Plan Medicaid	$315.50
Rate for Payer: Ohana Health Plan Medicare	$315.50
Rate for Payer: UnitedHealthcare Medicare	$315.50
Rate for Payer: University Health Alliance Commercial	$459.94

Insert Foley Catheter Charge

Facility

$451.00

Service Code	HCPCS 51702
Hospital Charge Code	8422799
Hospital Revenue Code	450
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

Insert Foley Catheter Charge

Facility

$451.00

Service Code	HCPCS 51702
Hospital Charge Code	8422799
Hospital Revenue Code	450
Min. Negotiated Rate	$225.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$225.50
Rate for Payer: Cash Price	$293.15
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 ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$225.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
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	$937.50
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 Medicare	$225.50
Rate for Payer: University Health Alliance Commercial	$328.73

Insertion of cervical dilator 59200

Professional

Both

$601.00

Service Code	HCPCS 59200
Hospital Charge Code	5544179
Hospital Revenue Code	720
Min. Negotiated Rate	$42.45
Max. Negotiated Rate	$510.85
Rate for Payer: AlohaCare Medicaid	$42.45
Rate for Payer: AlohaCare Medicare	$55.92
Rate for Payer: Cash Price	$390.65
Rate for Payer: Cash Price	$390.65
Rate for Payer: Devoted Health Medicare	$61.51
Rate for Payer: Hawaii Medical Service Association ABD	$42.45
Rate for Payer: Hawaii Medical Service Association Commercial	$70.14
Rate for Payer: Hawaii Medical Service Association Medicare	$55.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42.45
Rate for Payer: Hawaii Western Management Group Commercial	$59.02
Rate for Payer: Health Management Network Commercial	$510.85
Rate for Payer: Kaiser Permanente Commercial	$61.51
Rate for Payer: Kaiser Permanente Medicaid	$61.51
Rate for Payer: Kaiser Permanente Medicare	$61.51
Rate for Payer: Ohana Health Plan Medicaid	$42.45
Rate for Payer: Ohana Health Plan Medicare	$55.92
Rate for Payer: UnitedHealthcare Medicaid	$42.45
Rate for Payer: UnitedHealthcare Medicare	$55.92
Rate for Payer: University Health Alliance Commercial	$79.55

INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARS OR OLDER

Facility

$7,085.00

Service Code	CPT 36561
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,085.00
Rate for Payer: AlohaCare Medicaid	$1,030.55
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$7,085.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: University Health Alliance Commercial	$6,743.44

INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, REQUIRING POCKET CREATION AND CONNECTION BETWEEN ELECTRODE ARRAY AND PULSE GENERATOR OR RECEIVER

Facility

$5,655.00

Service Code	CPT 63685
Hospital Revenue Code	360
Min. Negotiated Rate	$395.96
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$901.48
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$395.96
Rate for Payer: University Health Alliance Commercial	$5,160.40

Insert Midcath > 3 years of age Charge

Facility

$449.00

Service Code	HCPCS 36410
Hospital Charge Code	8386869
Hospital Revenue Code	450
Min. Negotiated Rate	$381.65
Max. Negotiated Rate	$435.53
Rate for Payer: Cash Price	$291.85
Rate for Payer: Health Management Network Commercial	$381.65
Rate for Payer: Kaiser Permanente Commercial	$404.10
Rate for Payer: MDX Hawaii PPO	$435.53

Insert Midcath > 3 years of age Charge

Facility

$449.00

Service Code	HCPCS 36410
Hospital Charge Code	8386869
Hospital Revenue Code	450
Min. Negotiated Rate	$224.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$224.50
Rate for Payer: Cash Price	$291.85
Rate for Payer: Cash Price	$291.85
Rate for Payer: Cash Price	$291.85
Rate for Payer: Devoted Health Medicare	$246.95
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	$224.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$426.55
Rate for Payer: Health Management Network Commercial	$381.65
Rate for Payer: Humana Medicare	$224.50
Rate for Payer: Kaiser Permanente Commercial	$404.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$224.50
Rate for Payer: MDX Hawaii PPO	$435.53
Rate for Payer: Ohana Health Plan Medicaid	$224.50
Rate for Payer: Ohana Health Plan Medicare	$224.50
Rate for Payer: UnitedHealthcare Medicare	$224.50
Rate for Payer: University Health Alliance Commercial	$327.28

Insert new site - Arterial Line Activity:

Facility

$273.00

Service Code	HCPCS 36620
Hospital Charge Code	8253453
Hospital Revenue Code	761
Min. Negotiated Rate	$232.05
Max. Negotiated Rate	$264.81
Rate for Payer: Cash Price	$177.45
Rate for Payer: Health Management Network Commercial	$232.05
Rate for Payer: Kaiser Permanente Commercial	$245.70
Rate for Payer: MDX Hawaii PPO	$264.81

Insert new site - Arterial Line Activity:

Facility

$273.00

Service Code	HCPCS 36620
Hospital Charge Code	8253453
Hospital Revenue Code	761
Min. Negotiated Rate	$47.24
Max. Negotiated Rate	$2,389.00
Rate for Payer: AlohaCare Medicaid	$136.50
Rate for Payer: AlohaCare Medicare	$136.50
Rate for Payer: Cash Price	$177.45
Rate for Payer: Cash Price	$177.45
Rate for Payer: Cash Price	$177.45
Rate for Payer: Devoted Health Medicare	$150.15
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	$136.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$259.35
Rate for Payer: Health Management Network Commercial	$232.05
Rate for Payer: Humana Medicare	$136.50
Rate for Payer: Kaiser Permanente Commercial	$245.70
Rate for Payer: Kaiser Permanente Medicaid	$139.23
Rate for Payer: Kaiser Permanente Medicare	$136.50
Rate for Payer: MDX Hawaii PPO	$264.81
Rate for Payer: Ohana Health Plan Medicaid	$136.50
Rate for Payer: Ohana Health Plan Medicare	$136.50
Rate for Payer: UnitedHealthcare Medicaid	$47.24
Rate for Payer: UnitedHealthcare Medicare	$136.50
Rate for Payer: University Health Alliance Commercial	$198.99

Insert PICC Cath 5 yrs/> Charge w/out imaging Charge

Facility

$4,007.00

Service Code	HCPCS 36569
Hospital Charge Code	8422798
Hospital Revenue Code	450
Min. Negotiated Rate	$3,405.95
Max. Negotiated Rate	$3,886.79
Rate for Payer: Cash Price	$2,604.55
Rate for Payer: Health Management Network Commercial	$3,405.95
Rate for Payer: Kaiser Permanente Commercial	$3,606.30
Rate for Payer: MDX Hawaii PPO	$3,886.79

Insert PICC Cath 5 yrs/> Charge w/out imaging Charge

Facility

$4,007.00

Service Code	HCPCS 36569
Hospital Charge Code	8422798
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,886.79
Rate for Payer: AlohaCare Medicaid	$672.48
Rate for Payer: AlohaCare Medicare	$2,003.50
Rate for Payer: Cash Price	$2,604.55
Rate for Payer: Cash Price	$2,604.55
Rate for Payer: Devoted Health Medicare	$2,203.85
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	$2,003.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,806.65
Rate for Payer: Health Management Network Commercial	$3,405.95
Rate for Payer: Humana Medicare	$2,003.50
Rate for Payer: Kaiser Permanente Commercial	$3,606.30
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,003.50
Rate for Payer: MDX Hawaii PPO	$3,886.79
Rate for Payer: Ohana Health Plan Medicaid	$2,003.50
Rate for Payer: Ohana Health Plan Medicare	$2,003.50
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$2,003.50
Rate for Payer: University Health Alliance Commercial	$2,920.70

Insulin, Fasting FSI

Facility

$133.00

Service Code	HCPCS 83525
Hospital Charge Code	8117973
Hospital Revenue Code	301
Min. Negotiated Rate	$113.05
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$86.45
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: MDX Hawaii PPO	$129.01

Insulin, Fasting FSI

Facility

$133.00

Service Code	HCPCS 83525
Hospital Charge Code	8117973
Hospital Revenue Code	301
Min. Negotiated Rate	$11.43
Max. Negotiated Rate	$129.01
Rate for Payer: AlohaCare Medicaid	$66.50
Rate for Payer: AlohaCare Medicare	$66.50
Rate for Payer: Cash Price	$86.45
Rate for Payer: Cash Price	$86.45
Rate for Payer: Devoted Health Medicare	$73.15
Rate for Payer: Hawaii Medical Service Association ABD	$15.81
Rate for Payer: Hawaii Medical Service Association Commercial	$14.29
Rate for Payer: Hawaii Medical Service Association Medicare	$66.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.60
Rate for Payer: Hawaii Western Management Group Commercial	$11.43
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Humana Medicare	$66.50
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: Kaiser Permanente Medicare	$66.50
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: Ohana Health Plan Medicaid	$66.50
Rate for Payer: Ohana Health Plan Medicare	$66.50
Rate for Payer: UnitedHealthcare Medicaid	$15.81
Rate for Payer: UnitedHealthcare Medicare	$66.50
Rate for Payer: University Health Alliance Commercial	$29.56

Insulin, Free w/ Total FSI

Facility

$148.00

Service Code	HCPCS 83527
Hospital Charge Code	8228886
Hospital Revenue Code	301
Min. Negotiated Rate	$125.80
Max. Negotiated Rate	$143.56
Rate for Payer: Cash Price	$96.20
Rate for Payer: Health Management Network Commercial	$125.80
Rate for Payer: Kaiser Permanente Commercial	$133.20
Rate for Payer: MDX Hawaii PPO	$143.56

Insulin, Free w/ Total FSI

Facility

$148.00

Service Code	HCPCS 83527
Hospital Charge Code	8228886
Hospital Revenue Code	301
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$143.56
Rate for Payer: AlohaCare Medicaid	$74.00
Rate for Payer: AlohaCare Medicare	$74.00
Rate for Payer: Cash Price	$96.20
Rate for Payer: Cash Price	$96.20
Rate for Payer: Devoted Health Medicare	$81.40
Rate for Payer: Hawaii Medical Service Association ABD	$10.85
Rate for Payer: Hawaii Medical Service Association Commercial	$16.19
Rate for Payer: Hawaii Medical Service Association Medicare	$74.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.88
Rate for Payer: Hawaii Western Management Group Commercial	$12.95
Rate for Payer: Health Management Network Commercial	$125.80
Rate for Payer: Humana Medicare	$74.00
Rate for Payer: Kaiser Permanente Commercial	$133.20
Rate for Payer: Kaiser Permanente Medicaid	$75.48
Rate for Payer: Kaiser Permanente Medicare	$74.00
Rate for Payer: MDX Hawaii PPO	$143.56
Rate for Payer: Ohana Health Plan Medicaid	$74.00
Rate for Payer: Ohana Health Plan Medicare	$74.00
Rate for Payer: UnitedHealthcare Medicaid	$10.85
Rate for Payer: UnitedHealthcare Medicare	$74.00
Rate for Payer: University Health Alliance Commercial	$33.47

insulin glargine 100 units/mL 3 mL pen [HHSC]

Facility

$114.84

Service Code	NDC 00088221905
Hospital Charge Code	2501158
Hospital Revenue Code	250
Min. Negotiated Rate	$97.61
Max. Negotiated Rate	$111.39
Rate for Payer: Cash Price	$74.65
Rate for Payer: Health Management Network Commercial	$97.61
Rate for Payer: Kaiser Permanente Commercial	$103.36
Rate for Payer: MDX Hawaii PPO	$111.39

insulin glargine 100 units/mL 3 mL pen [HHSC]

Facility

$114.84

Service Code	NDC 00088221905
Hospital Charge Code	2501158
Hospital Revenue Code	250
Min. Negotiated Rate	$57.42
Max. Negotiated Rate	$111.39
Rate for Payer: AlohaCare Medicaid	$57.42
Rate for Payer: AlohaCare Medicare	$57.42
Rate for Payer: Cash Price	$74.65
Rate for Payer: Devoted Health Medicare	$63.16
Rate for Payer: Hawaii Medical Service Association Medicare	$57.42
Rate for Payer: Hawaii Western Management Group Commercial	$109.10
Rate for Payer: Health Management Network Commercial	$97.61
Rate for Payer: Humana Medicare	$57.42
Rate for Payer: Kaiser Permanente Commercial	$103.36
Rate for Payer: Kaiser Permanente Medicaid	$58.57
Rate for Payer: Kaiser Permanente Medicare	$57.42
Rate for Payer: MDX Hawaii PPO	$111.39
Rate for Payer: Ohana Health Plan Medicaid	$57.42
Rate for Payer: Ohana Health Plan Medicare	$57.42
Rate for Payer: UnitedHealthcare Medicaid	$68.90
Rate for Payer: UnitedHealthcare Medicare	$57.42
Rate for Payer: University Health Alliance Commercial	$83.71

insulin NPH 100 units/1mL 10 mL vial [HHSC]

Facility

$301.71

Service Code	HCPCS J1815
Hospital Charge Code	2500420
Hospital Revenue Code	250
Min. Negotiated Rate	$256.45
Max. Negotiated Rate	$292.66
Rate for Payer: Cash Price	$196.11
Rate for Payer: Cash Price	$186.36
Rate for Payer: Cash Price	$376.56
Rate for Payer: Health Management Network Commercial	$492.43
Rate for Payer: Health Management Network Commercial	$243.70
Rate for Payer: Health Management Network Commercial	$256.45
Rate for Payer: Kaiser Permanente Commercial	$521.40
Rate for Payer: Kaiser Permanente Commercial	$258.04
Rate for Payer: Kaiser Permanente Commercial	$271.54
Rate for Payer: MDX Hawaii PPO	$292.66
Rate for Payer: MDX Hawaii PPO	$278.11
Rate for Payer: MDX Hawaii PPO	$561.95

Know your out-of-pocket cost for care.

All Charges