Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

KIT EZ-IO 45MM NEEDLE+STABILIZER

Facility

$535.00

Hospital Charge Code	8500828
Hospital Revenue Code	272
Min. Negotiated Rate	$454.75
Max. Negotiated Rate	$518.95
Rate for Payer: Cash Price	$347.75
Rate for Payer: Health Management Network Commercial	$454.75
Rate for Payer: Kaiser Permanente Commercial	$481.50
Rate for Payer: MDX Hawaii PPO	$518.95

KIT GASTRIC LAVAGE E VAC 34F

Facility

$243.00

Hospital Charge Code	8266637
Hospital Revenue Code	272
Min. Negotiated Rate	$206.55
Max. Negotiated Rate	$235.71
Rate for Payer: Cash Price	$157.95
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Kaiser Permanente Commercial	$218.70
Rate for Payer: MDX Hawaii PPO	$235.71

KIT GASTRIC LAVAGE E VAC 34F

Facility

$243.00

Hospital Charge Code	8266637
Hospital Revenue Code	272
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$235.71
Rate for Payer: AlohaCare Medicaid	$121.50
Rate for Payer: AlohaCare Medicare	$121.50
Rate for Payer: Cash Price	$157.95
Rate for Payer: Devoted Health Medicare	$133.65
Rate for Payer: Hawaii Medical Service Association Medicare	$121.50
Rate for Payer: Hawaii Western Management Group Commercial	$230.85
Rate for Payer: Health Management Network Commercial	$206.55
Rate for Payer: Humana Medicare	$121.50
Rate for Payer: Kaiser Permanente Commercial	$218.70
Rate for Payer: Kaiser Permanente Medicaid	$123.93
Rate for Payer: Kaiser Permanente Medicare	$121.50
Rate for Payer: MDX Hawaii PPO	$235.71
Rate for Payer: Ohana Health Plan Medicaid	$121.50
Rate for Payer: Ohana Health Plan Medicare	$121.50
Rate for Payer: UnitedHealthcare Medicare	$121.50
Rate for Payer: University Health Alliance Commercial	$177.12

KIT MICROINTRODUCER 5FR

Facility

$174.00

Hospital Charge Code	8266279
Hospital Revenue Code	272
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$168.78
Rate for Payer: AlohaCare Medicaid	$87.00
Rate for Payer: AlohaCare Medicare	$87.00
Rate for Payer: Cash Price	$113.10
Rate for Payer: Devoted Health Medicare	$95.70
Rate for Payer: Hawaii Medical Service Association Medicare	$87.00
Rate for Payer: Hawaii Western Management Group Commercial	$165.30
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Humana Medicare	$87.00
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: Kaiser Permanente Medicaid	$88.74
Rate for Payer: Kaiser Permanente Medicare	$87.00
Rate for Payer: MDX Hawaii PPO	$168.78
Rate for Payer: Ohana Health Plan Medicaid	$87.00
Rate for Payer: Ohana Health Plan Medicare	$87.00
Rate for Payer: UnitedHealthcare Medicare	$87.00
Rate for Payer: University Health Alliance Commercial	$126.83

KIT MICROINTRODUCER 5FR

Facility

$174.00

Hospital Charge Code	8266279
Hospital Revenue Code	272
Min. Negotiated Rate	$147.90
Max. Negotiated Rate	$168.78
Rate for Payer: Cash Price	$113.10
Rate for Payer: Health Management Network Commercial	$147.90
Rate for Payer: Kaiser Permanente Commercial	$156.60
Rate for Payer: MDX Hawaii PPO	$168.78

KIT MULTI LUMEN CVC 7FR

Facility

$459.00

Hospital Charge Code	8266492
Hospital Revenue Code	272
Min. Negotiated Rate	$390.15
Max. Negotiated Rate	$445.23
Rate for Payer: Cash Price	$298.35
Rate for Payer: Health Management Network Commercial	$390.15
Rate for Payer: Kaiser Permanente Commercial	$413.10
Rate for Payer: MDX Hawaii PPO	$445.23

KIT MULTI LUMEN CVC 7FR

Facility

$459.00

Hospital Charge Code	8266492
Hospital Revenue Code	272
Min. Negotiated Rate	$229.50
Max. Negotiated Rate	$445.23
Rate for Payer: AlohaCare Medicaid	$229.50
Rate for Payer: AlohaCare Medicare	$229.50
Rate for Payer: Cash Price	$298.35
Rate for Payer: Devoted Health Medicare	$252.45
Rate for Payer: Hawaii Medical Service Association Medicare	$229.50
Rate for Payer: Hawaii Western Management Group Commercial	$436.05
Rate for Payer: Health Management Network Commercial	$390.15
Rate for Payer: Humana Medicare	$229.50
Rate for Payer: Kaiser Permanente Commercial	$413.10
Rate for Payer: Kaiser Permanente Medicaid	$234.09
Rate for Payer: Kaiser Permanente Medicare	$229.50
Rate for Payer: MDX Hawaii PPO	$445.23
Rate for Payer: Ohana Health Plan Medicaid	$229.50
Rate for Payer: Ohana Health Plan Medicare	$229.50
Rate for Payer: UnitedHealthcare Medicare	$229.50
Rate for Payer: University Health Alliance Commercial	$334.57

KIT PICC DUAL LUMEN 5FR

Facility

$878.00

Service Code	HCPCS C1751
Hospital Charge Code	8266277
Hospital Revenue Code	272
Min. Negotiated Rate	$439.00
Max. Negotiated Rate	$851.66
Rate for Payer: AlohaCare Medicaid	$439.00
Rate for Payer: AlohaCare Medicare	$439.00
Rate for Payer: Cash Price	$570.70
Rate for Payer: Devoted Health Medicare	$482.90
Rate for Payer: Hawaii Medical Service Association Medicare	$439.00
Rate for Payer: Hawaii Western Management Group Commercial	$834.10
Rate for Payer: Health Management Network Commercial	$746.30
Rate for Payer: Humana Medicare	$439.00
Rate for Payer: Kaiser Permanente Commercial	$790.20
Rate for Payer: Kaiser Permanente Medicaid	$447.78
Rate for Payer: Kaiser Permanente Medicare	$439.00
Rate for Payer: MDX Hawaii PPO	$851.66
Rate for Payer: Ohana Health Plan Medicaid	$439.00
Rate for Payer: Ohana Health Plan Medicare	$439.00
Rate for Payer: UnitedHealthcare Medicare	$439.00
Rate for Payer: University Health Alliance Commercial	$639.97

KIT PICC DUAL LUMEN 5FR

Facility

$878.00

Service Code	HCPCS C1751
Hospital Charge Code	8266277
Hospital Revenue Code	272
Min. Negotiated Rate	$746.30
Max. Negotiated Rate	$851.66
Rate for Payer: Cash Price	$570.70
Rate for Payer: Health Management Network Commercial	$746.30
Rate for Payer: Kaiser Permanente Commercial	$790.20
Rate for Payer: MDX Hawaii PPO	$851.66

KIT PICC SINGLE LUMEN 4FR

Facility

$834.00

Service Code	HCPCS C1751
Hospital Charge Code	8266276
Hospital Revenue Code	272
Min. Negotiated Rate	$708.90
Max. Negotiated Rate	$808.98
Rate for Payer: Cash Price	$542.10
Rate for Payer: Health Management Network Commercial	$708.90
Rate for Payer: Kaiser Permanente Commercial	$750.60
Rate for Payer: MDX Hawaii PPO	$808.98

KIT PICC SINGLE LUMEN 4FR

Facility

$834.00

Service Code	HCPCS C1751
Hospital Charge Code	8266276
Hospital Revenue Code	272
Min. Negotiated Rate	$417.00
Max. Negotiated Rate	$808.98
Rate for Payer: AlohaCare Medicaid	$417.00
Rate for Payer: AlohaCare Medicare	$417.00
Rate for Payer: Cash Price	$542.10
Rate for Payer: Devoted Health Medicare	$458.70
Rate for Payer: Hawaii Medical Service Association Medicare	$417.00
Rate for Payer: Hawaii Western Management Group Commercial	$792.30
Rate for Payer: Health Management Network Commercial	$708.90
Rate for Payer: Humana Medicare	$417.00
Rate for Payer: Kaiser Permanente Commercial	$750.60
Rate for Payer: Kaiser Permanente Medicaid	$425.34
Rate for Payer: Kaiser Permanente Medicare	$417.00
Rate for Payer: MDX Hawaii PPO	$808.98
Rate for Payer: Ohana Health Plan Medicaid	$417.00
Rate for Payer: Ohana Health Plan Medicare	$417.00
Rate for Payer: UnitedHealthcare Medicare	$417.00
Rate for Payer: University Health Alliance Commercial	$607.90

KIT TRIMANO BEACH CHAIR

Facility

$300.00

Hospital Charge Code	9080354
Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$291.00
Rate for Payer: Devoted Health Medicare	$165.00
Rate for Payer: AlohaCare Medicaid	$150.00
Rate for Payer: AlohaCare Medicare	$150.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Hawaii Medical Service Association Medicare	$150.00
Rate for Payer: Hawaii Western Management Group Commercial	$285.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Humana Medicare	$150.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: Kaiser Permanente Medicaid	$153.00
Rate for Payer: Kaiser Permanente Medicare	$150.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: Ohana Health Plan Medicaid	$150.00
Rate for Payer: Ohana Health Plan Medicare	$150.00
Rate for Payer: UnitedHealthcare Medicare	$150.00
Rate for Payer: University Health Alliance Commercial	$218.67

KIT TRIMANO BEACH CHAIR

Facility

$300.00

Hospital Charge Code	9080354
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: MDX Hawaii PPO	$291.00

KIT TRIMANO ELBOW

Facility

$300.00

Hospital Charge Code	9080355
Hospital Revenue Code	272
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$291.00
Rate for Payer: AlohaCare Medicaid	$150.00
Rate for Payer: AlohaCare Medicare	$150.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Devoted Health Medicare	$165.00
Rate for Payer: Hawaii Medical Service Association Medicare	$150.00
Rate for Payer: Hawaii Western Management Group Commercial	$285.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Humana Medicare	$150.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: Kaiser Permanente Medicaid	$153.00
Rate for Payer: Kaiser Permanente Medicare	$150.00
Rate for Payer: MDX Hawaii PPO	$291.00
Rate for Payer: Ohana Health Plan Medicaid	$150.00
Rate for Payer: Ohana Health Plan Medicare	$150.00
Rate for Payer: UnitedHealthcare Medicare	$150.00
Rate for Payer: University Health Alliance Commercial	$218.67

KIT TRIMANO ELBOW

Facility

$300.00

Hospital Charge Code	9080355
Hospital Revenue Code	272
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$291.00
Rate for Payer: Cash Price	$195.00
Rate for Payer: Health Management Network Commercial	$255.00
Rate for Payer: Kaiser Permanente Commercial	$270.00
Rate for Payer: MDX Hawaii PPO	$291.00

KIT TROCAR CATHETER 20FR

Facility

$145.00

Hospital Charge Code	8266641
Hospital Revenue Code	272
Min. Negotiated Rate	$72.50
Max. Negotiated Rate	$140.65
Rate for Payer: AlohaCare Medicaid	$72.50
Rate for Payer: AlohaCare Medicare	$72.50
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$79.75
Rate for Payer: Hawaii Medical Service Association Medicare	$72.50
Rate for Payer: Hawaii Western Management Group Commercial	$137.75
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Humana Medicare	$72.50
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: Kaiser Permanente Medicaid	$73.95
Rate for Payer: Kaiser Permanente Medicare	$72.50
Rate for Payer: MDX Hawaii PPO	$140.65
Rate for Payer: Ohana Health Plan Medicaid	$72.50
Rate for Payer: Ohana Health Plan Medicare	$72.50
Rate for Payer: UnitedHealthcare Medicare	$72.50
Rate for Payer: University Health Alliance Commercial	$105.69

KIT TROCAR CATHETER 20FR

Facility

$145.00

Hospital Charge Code	8266641
Hospital Revenue Code	272
Min. Negotiated Rate	$123.25
Max. Negotiated Rate	$140.65
Rate for Payer: Cash Price	$94.25
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$130.50
Rate for Payer: MDX Hawaii PPO	$140.65

KIWI OMNI CUP

Facility

$176.00

Hospital Charge Code	8274464
Hospital Revenue Code	272
Min. Negotiated Rate	$149.60
Max. Negotiated Rate	$170.72
Rate for Payer: Cash Price	$114.40
Rate for Payer: Health Management Network Commercial	$149.60
Rate for Payer: Kaiser Permanente Commercial	$158.40
Rate for Payer: MDX Hawaii PPO	$170.72

KIWI OMNI CUP

Facility

$176.00

Hospital Charge Code	8274464
Hospital Revenue Code	272
Min. Negotiated Rate	$88.00
Max. Negotiated Rate	$170.72
Rate for Payer: AlohaCare Medicaid	$88.00
Rate for Payer: AlohaCare Medicare	$88.00
Rate for Payer: Cash Price	$114.40
Rate for Payer: Devoted Health Medicare	$96.80
Rate for Payer: Hawaii Medical Service Association Medicare	$88.00
Rate for Payer: Hawaii Western Management Group Commercial	$167.20
Rate for Payer: Health Management Network Commercial	$149.60
Rate for Payer: Humana Medicare	$88.00
Rate for Payer: Kaiser Permanente Commercial	$158.40
Rate for Payer: Kaiser Permanente Medicaid	$89.76
Rate for Payer: Kaiser Permanente Medicare	$88.00
Rate for Payer: MDX Hawaii PPO	$170.72
Rate for Payer: Ohana Health Plan Medicaid	$88.00
Rate for Payer: Ohana Health Plan Medicare	$88.00
Rate for Payer: UnitedHealthcare Medicare	$88.00
Rate for Payer: University Health Alliance Commercial	$128.29

KIWI PROCUP COMPLETE VACUUM DELIVERY SYSTEM

Facility

$163.00

Hospital Charge Code	9297535
Hospital Revenue Code	272
Min. Negotiated Rate	$138.55
Max. Negotiated Rate	$158.11
Rate for Payer: Cash Price	$105.95
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Kaiser Permanente Commercial	$146.70
Rate for Payer: MDX Hawaii PPO	$158.11

KIWI PROCUP COMPLETE VACUUM DELIVERY SYSTEM

Facility

$163.00

Hospital Charge Code	9297535
Hospital Revenue Code	272
Min. Negotiated Rate	$81.50
Max. Negotiated Rate	$158.11
Rate for Payer: AlohaCare Medicaid	$81.50
Rate for Payer: AlohaCare Medicare	$81.50
Rate for Payer: Cash Price	$105.95
Rate for Payer: Devoted Health Medicare	$89.65
Rate for Payer: Hawaii Medical Service Association Medicare	$81.50
Rate for Payer: Hawaii Western Management Group Commercial	$154.85
Rate for Payer: Health Management Network Commercial	$138.55
Rate for Payer: Humana Medicare	$81.50
Rate for Payer: Kaiser Permanente Commercial	$146.70
Rate for Payer: Kaiser Permanente Medicaid	$83.13
Rate for Payer: Kaiser Permanente Medicare	$81.50
Rate for Payer: MDX Hawaii PPO	$158.11
Rate for Payer: Ohana Health Plan Medicaid	$81.50
Rate for Payer: Ohana Health Plan Medicare	$81.50
Rate for Payer: UnitedHealthcare Medicare	$81.50
Rate for Payer: University Health Alliance Commercial	$118.81

Kleihauer-Betke (Fetal Cell Screen) FSI

Facility

$93.00

Service Code	HCPCS 85460
Hospital Charge Code	12231266
Hospital Revenue Code	305
Min. Negotiated Rate	$7.73
Max. Negotiated Rate	$90.21
Rate for Payer: AlohaCare Medicaid	$46.50
Rate for Payer: AlohaCare Medicare	$46.50
Rate for Payer: Cash Price	$60.45
Rate for Payer: Cash Price	$60.45
Rate for Payer: Devoted Health Medicare	$51.15
Rate for Payer: Hawaii Medical Service Association ABD	$10.69
Rate for Payer: Hawaii Medical Service Association Commercial	$9.66
Rate for Payer: Hawaii Medical Service Association Medicare	$46.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.22
Rate for Payer: Hawaii Western Management Group Commercial	$7.73
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Humana Medicare	$46.50
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: Kaiser Permanente Medicare	$46.50
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: Ohana Health Plan Medicaid	$46.50
Rate for Payer: Ohana Health Plan Medicare	$46.50
Rate for Payer: UnitedHealthcare Medicaid	$10.69
Rate for Payer: UnitedHealthcare Medicare	$46.50
Rate for Payer: University Health Alliance Commercial	$20.00

Kleihauer-Betke (Fetal Cell Screen) FSI

Facility

$93.00

Service Code	HCPCS 85460
Hospital Charge Code	12231266
Hospital Revenue Code	305
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$60.45
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: MDX Hawaii PPO	$90.21

KNEE BRACE REDDIE MEDIUM

Facility

$222.00

Service Code	HCPCS L1820
Hospital Charge Code	9361881
Hospital Revenue Code	274
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$215.34
Rate for Payer: Cash Price	$144.30
Rate for Payer: Hawaii Western Management Group Commercial	$155.40
Rate for Payer: Health Management Network Commercial	$188.70
Rate for Payer: Kaiser Permanente Commercial	$199.80
Rate for Payer: MDX Hawaii PPO	$215.34
Rate for Payer: University Health Alliance Commercial	$124.32

KNEE BRACE REDDIE MEDIUM

Facility

$222.00

Service Code	HCPCS L1820
Hospital Charge Code	9361881
Hospital Revenue Code	274
Min. Negotiated Rate	$76.34
Max. Negotiated Rate	$215.34
Rate for Payer: AlohaCare Medicaid	$111.00
Rate for Payer: AlohaCare Medicare	$111.00
Rate for Payer: Cash Price	$144.30
Rate for Payer: Cash Price	$144.30
Rate for Payer: Devoted Health Medicare	$122.10
Rate for Payer: Hawaii Medical Service Association Medicare	$111.00
Rate for Payer: Hawaii Western Management Group Commercial	$155.40
Rate for Payer: Health Management Network Commercial	$188.70
Rate for Payer: Humana Medicare	$111.00
Rate for Payer: Kaiser Permanente Commercial	$199.80
Rate for Payer: Kaiser Permanente Medicaid	$113.22
Rate for Payer: Kaiser Permanente Medicare	$111.00
Rate for Payer: MDX Hawaii PPO	$215.34
Rate for Payer: Ohana Health Plan Medicaid	$111.00
Rate for Payer: Ohana Health Plan Medicare	$111.00
Rate for Payer: UnitedHealthcare Medicaid	$76.34
Rate for Payer: UnitedHealthcare Medicare	$111.00
Rate for Payer: University Health Alliance Commercial	$124.32

Know your out-of-pocket cost for care.

All Charges