Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC

Facility

$26,821.79

Service Code	MSDRG 488
Min. Negotiated Rate	$26,821.79
Max. Negotiated Rate	$26,821.79
Rate for Payer: Hawaii Medical Service Association Commercial	$26,821.79

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$26,821.79

Service Code	MSDRG 489
Min. Negotiated Rate	$26,821.79
Max. Negotiated Rate	$26,821.79
Rate for Payer: Hawaii Medical Service Association Commercial	$26,821.79

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC

Facility

$47,499.05

Service Code	MSDRG 486
Min. Negotiated Rate	$47,499.05
Max. Negotiated Rate	$47,499.05
Rate for Payer: Hawaii Medical Service Association Commercial	$47,499.05

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC

Facility

$47,499.05

Service Code	MSDRG 485
Min. Negotiated Rate	$47,499.05
Max. Negotiated Rate	$47,499.05
Rate for Payer: Hawaii Medical Service Association Commercial	$47,499.05

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$33,935.18

Service Code	MSDRG 487
Min. Negotiated Rate	$33,935.18
Max. Negotiated Rate	$33,935.18
Rate for Payer: Hawaii Medical Service Association Commercial	$33,935.18

KOALA INTRAUTERINE PRESSURE MONITORING

Facility

$141.00

Hospital Charge Code	9002340
Hospital Revenue Code	272
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$136.77
Rate for Payer: AlohaCare Medicaid	$70.50
Rate for Payer: AlohaCare Medicare	$70.50
Rate for Payer: Cash Price	$91.65
Rate for Payer: Devoted Health Medicare	$77.55
Rate for Payer: Hawaii Medical Service Association Medicare	$70.50
Rate for Payer: Hawaii Western Management Group Commercial	$133.95
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Humana Medicare	$70.50
Rate for Payer: Kaiser Permanente Commercial	$126.90
Rate for Payer: Kaiser Permanente Medicaid	$71.91
Rate for Payer: Kaiser Permanente Medicare	$70.50
Rate for Payer: MDX Hawaii PPO	$136.77
Rate for Payer: Ohana Health Plan Medicaid	$70.50
Rate for Payer: Ohana Health Plan Medicare	$70.50
Rate for Payer: UnitedHealthcare Medicare	$70.50
Rate for Payer: University Health Alliance Commercial	$102.77

KOALA INTRAUTERINE PRESSURE MONITORING

Facility

$141.00

Hospital Charge Code	9002340
Hospital Revenue Code	272
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$91.65
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Kaiser Permanente Commercial	$126.90
Rate for Payer: MDX Hawaii PPO	$136.77

KOH EFFICIENT RUMI 2.5 CM FOR ELECTROSURGERY

Facility

$502.00

Hospital Charge Code	9716475
Hospital Revenue Code	272
Min. Negotiated Rate	$251.00
Max. Negotiated Rate	$486.94
Rate for Payer: AlohaCare Medicaid	$251.00
Rate for Payer: AlohaCare Medicare	$251.00
Rate for Payer: Cash Price	$326.30
Rate for Payer: Devoted Health Medicare	$276.10
Rate for Payer: Hawaii Medical Service Association Medicare	$251.00
Rate for Payer: Hawaii Western Management Group Commercial	$476.90
Rate for Payer: Health Management Network Commercial	$426.70
Rate for Payer: Humana Medicare	$251.00
Rate for Payer: Kaiser Permanente Commercial	$451.80
Rate for Payer: Kaiser Permanente Medicaid	$256.02
Rate for Payer: Kaiser Permanente Medicare	$251.00
Rate for Payer: MDX Hawaii PPO	$486.94
Rate for Payer: Ohana Health Plan Medicaid	$251.00
Rate for Payer: Ohana Health Plan Medicare	$251.00
Rate for Payer: UnitedHealthcare Medicare	$251.00
Rate for Payer: University Health Alliance Commercial	$365.91

KOH EFFICIENT RUMI 2.5 CM FOR ELECTROSURGERY

Facility

$502.00

Hospital Charge Code	9716475
Hospital Revenue Code	272
Min. Negotiated Rate	$426.70
Max. Negotiated Rate	$486.94
Rate for Payer: Cash Price	$326.30
Rate for Payer: Health Management Network Commercial	$426.70
Rate for Payer: Kaiser Permanente Commercial	$451.80
Rate for Payer: MDX Hawaii PPO	$486.94

KOH-EFFICIENT RUMI 3.0 CM FOR ELECTROSURGERY

Facility

$739.00

Hospital Charge Code	9723653
Hospital Revenue Code	272
Min. Negotiated Rate	$628.15
Max. Negotiated Rate	$716.83
Rate for Payer: Cash Price	$480.35
Rate for Payer: Health Management Network Commercial	$628.15
Rate for Payer: Kaiser Permanente Commercial	$665.10
Rate for Payer: MDX Hawaii PPO	$716.83

KOH-EFFICIENT RUMI 3.0 CM FOR ELECTROSURGERY

Facility

$739.00

Hospital Charge Code	9723653
Hospital Revenue Code	272
Min. Negotiated Rate	$369.50
Max. Negotiated Rate	$716.83
Rate for Payer: AlohaCare Medicaid	$369.50
Rate for Payer: AlohaCare Medicare	$369.50
Rate for Payer: Cash Price	$480.35
Rate for Payer: Devoted Health Medicare	$406.45
Rate for Payer: Hawaii Medical Service Association Medicare	$369.50
Rate for Payer: Hawaii Western Management Group Commercial	$702.05
Rate for Payer: Health Management Network Commercial	$628.15
Rate for Payer: Humana Medicare	$369.50
Rate for Payer: Kaiser Permanente Commercial	$665.10
Rate for Payer: Kaiser Permanente Medicaid	$376.89
Rate for Payer: Kaiser Permanente Medicare	$369.50
Rate for Payer: MDX Hawaii PPO	$716.83
Rate for Payer: Ohana Health Plan Medicaid	$369.50
Rate for Payer: Ohana Health Plan Medicare	$369.50
Rate for Payer: UnitedHealthcare Medicare	$369.50
Rate for Payer: University Health Alliance Commercial	$538.66

KOH-EFFICIENT RUMI 3.5 CM FOR ELECTROSURGERY

Facility

$595.00

Hospital Charge Code	9723654
Hospital Revenue Code	272
Min. Negotiated Rate	$505.75
Max. Negotiated Rate	$577.15
Rate for Payer: Cash Price	$386.75
Rate for Payer: Health Management Network Commercial	$505.75
Rate for Payer: Kaiser Permanente Commercial	$535.50
Rate for Payer: MDX Hawaii PPO	$577.15

KOH-EFFICIENT RUMI 3.5 CM FOR ELECTROSURGERY

Facility

$595.00

Hospital Charge Code	9723654
Hospital Revenue Code	272
Min. Negotiated Rate	$297.50
Max. Negotiated Rate	$577.15
Rate for Payer: AlohaCare Medicaid	$297.50
Rate for Payer: AlohaCare Medicare	$297.50
Rate for Payer: Cash Price	$386.75
Rate for Payer: Devoted Health Medicare	$327.25
Rate for Payer: Hawaii Medical Service Association Medicare	$297.50
Rate for Payer: Hawaii Western Management Group Commercial	$565.25
Rate for Payer: Health Management Network Commercial	$505.75
Rate for Payer: Humana Medicare	$297.50
Rate for Payer: Kaiser Permanente Commercial	$535.50
Rate for Payer: Kaiser Permanente Medicaid	$303.45
Rate for Payer: Kaiser Permanente Medicare	$297.50
Rate for Payer: MDX Hawaii PPO	$577.15
Rate for Payer: Ohana Health Plan Medicaid	$297.50
Rate for Payer: Ohana Health Plan Medicare	$297.50
Rate for Payer: UnitedHealthcare Medicare	$297.50
Rate for Payer: University Health Alliance Commercial	$433.70

KOH-EFFICIENT RUMI 4.0 CM FOR ELECTROSURGERY

Facility

$502.00

Hospital Charge Code	9723655
Hospital Revenue Code	272
Min. Negotiated Rate	$251.00
Max. Negotiated Rate	$486.94
Rate for Payer: AlohaCare Medicaid	$251.00
Rate for Payer: AlohaCare Medicare	$251.00
Rate for Payer: Cash Price	$326.30
Rate for Payer: Devoted Health Medicare	$276.10
Rate for Payer: Hawaii Medical Service Association Medicare	$251.00
Rate for Payer: Hawaii Western Management Group Commercial	$476.90
Rate for Payer: Health Management Network Commercial	$426.70
Rate for Payer: Humana Medicare	$251.00
Rate for Payer: Kaiser Permanente Commercial	$451.80
Rate for Payer: Kaiser Permanente Medicaid	$256.02
Rate for Payer: Kaiser Permanente Medicare	$251.00
Rate for Payer: MDX Hawaii PPO	$486.94
Rate for Payer: Ohana Health Plan Medicaid	$251.00
Rate for Payer: Ohana Health Plan Medicare	$251.00
Rate for Payer: UnitedHealthcare Medicare	$251.00
Rate for Payer: University Health Alliance Commercial	$365.91

KOH-EFFICIENT RUMI 4.0 CM FOR ELECTROSURGERY

Facility

$502.00

Hospital Charge Code	9723655
Hospital Revenue Code	272
Min. Negotiated Rate	$426.70
Max. Negotiated Rate	$486.94
Rate for Payer: Cash Price	$326.30
Rate for Payer: Health Management Network Commercial	$426.70
Rate for Payer: Kaiser Permanente Commercial	$451.80
Rate for Payer: MDX Hawaii PPO	$486.94

KOH Preparation FSI

Facility

$65.00

Service Code	HCPCS 87220
Hospital Charge Code	8228887
Hospital Revenue Code	306
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$63.05
Rate for Payer: AlohaCare Medicaid	$32.50
Rate for Payer: AlohaCare Medicare	$32.50
Rate for Payer: Cash Price	$42.25
Rate for Payer: Cash Price	$42.25
Rate for Payer: Devoted Health Medicare	$35.75
Rate for Payer: Hawaii Medical Service Association ABD	$5.90
Rate for Payer: Hawaii Medical Service Association Commercial	$5.34
Rate for Payer: Hawaii Medical Service Association Medicare	$32.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.20
Rate for Payer: Hawaii Western Management Group Commercial	$4.27
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Humana Medicare	$32.50
Rate for Payer: Kaiser Permanente Commercial	$58.50
Rate for Payer: Kaiser Permanente Medicaid	$33.15
Rate for Payer: Kaiser Permanente Medicare	$32.50
Rate for Payer: MDX Hawaii PPO	$63.05
Rate for Payer: Ohana Health Plan Medicaid	$32.50
Rate for Payer: Ohana Health Plan Medicare	$32.50
Rate for Payer: UnitedHealthcare Medicaid	$5.90
Rate for Payer: UnitedHealthcare Medicare	$32.50
Rate for Payer: University Health Alliance Commercial	$11.03

KOH Preparation FSI

Facility

$65.00

Service Code	HCPCS 87220
Hospital Charge Code	8228887
Hospital Revenue Code	306
Min. Negotiated Rate	$55.25
Max. Negotiated Rate	$63.05
Rate for Payer: Cash Price	$42.25
Rate for Payer: Health Management Network Commercial	$55.25
Rate for Payer: Kaiser Permanente Commercial	$58.50
Rate for Payer: MDX Hawaii PPO	$63.05

KOOL KIT WRAPS

Facility

$846.00

Hospital Charge Code	8274457
Hospital Revenue Code	272
Min. Negotiated Rate	$423.00
Max. Negotiated Rate	$820.62
Rate for Payer: AlohaCare Medicaid	$423.00
Rate for Payer: AlohaCare Medicare	$423.00
Rate for Payer: Cash Price	$549.90
Rate for Payer: Devoted Health Medicare	$465.30
Rate for Payer: Hawaii Medical Service Association Medicare	$423.00
Rate for Payer: Hawaii Western Management Group Commercial	$803.70
Rate for Payer: Health Management Network Commercial	$719.10
Rate for Payer: Humana Medicare	$423.00
Rate for Payer: Kaiser Permanente Commercial	$761.40
Rate for Payer: Kaiser Permanente Medicaid	$431.46
Rate for Payer: Kaiser Permanente Medicare	$423.00
Rate for Payer: MDX Hawaii PPO	$820.62
Rate for Payer: Ohana Health Plan Medicaid	$423.00
Rate for Payer: Ohana Health Plan Medicare	$423.00
Rate for Payer: UnitedHealthcare Medicare	$423.00
Rate for Payer: University Health Alliance Commercial	$616.65

KOOL KIT WRAPS

Facility

$846.00

Hospital Charge Code	8274457
Hospital Revenue Code	272
Min. Negotiated Rate	$719.10
Max. Negotiated Rate	$820.62
Rate for Payer: Cash Price	$549.90
Rate for Payer: Health Management Network Commercial	$719.10
Rate for Payer: Kaiser Permanente Commercial	$761.40
Rate for Payer: MDX Hawaii PPO	$820.62

K-WIRE 0.9 X150MM BLUNT/TROCAR

Facility

$256.00

Hospital Charge Code	10600424
Hospital Revenue Code	272
Min. Negotiated Rate	$217.60
Max. Negotiated Rate	$248.32
Rate for Payer: Cash Price	$166.40
Rate for Payer: Health Management Network Commercial	$217.60
Rate for Payer: Kaiser Permanente Commercial	$230.40
Rate for Payer: MDX Hawaii PPO	$248.32

K-WIRE 0.9 X150MM BLUNT/TROCAR

Facility

$256.00

Hospital Charge Code	10600424
Hospital Revenue Code	272
Min. Negotiated Rate	$128.00
Max. Negotiated Rate	$248.32
Rate for Payer: AlohaCare Medicaid	$128.00
Rate for Payer: AlohaCare Medicare	$128.00
Rate for Payer: Cash Price	$166.40
Rate for Payer: Devoted Health Medicare	$140.80
Rate for Payer: Hawaii Medical Service Association Medicare	$128.00
Rate for Payer: Hawaii Western Management Group Commercial	$243.20
Rate for Payer: Health Management Network Commercial	$217.60
Rate for Payer: Humana Medicare	$128.00
Rate for Payer: Kaiser Permanente Commercial	$230.40
Rate for Payer: Kaiser Permanente Medicaid	$130.56
Rate for Payer: Kaiser Permanente Medicare	$128.00
Rate for Payer: MDX Hawaii PPO	$248.32
Rate for Payer: Ohana Health Plan Medicaid	$128.00
Rate for Payer: Ohana Health Plan Medicare	$128.00
Rate for Payer: UnitedHealthcare Medicare	$128.00
Rate for Payer: University Health Alliance Commercial	$186.60

K-WIRE 1.1 X150MM BLUNT/TROCAR

Facility

$236.00

Service Code	HCPCS C1713
Hospital Charge Code	10600438
Hospital Revenue Code	278
Min. Negotiated Rate	$118.00
Max. Negotiated Rate	$228.92
Rate for Payer: AlohaCare Medicaid	$118.00
Rate for Payer: AlohaCare Medicare	$118.00
Rate for Payer: Cash Price	$153.40
Rate for Payer: Devoted Health Medicare	$129.80
Rate for Payer: Hawaii Medical Service Association Medicare	$118.00
Rate for Payer: Hawaii Western Management Group Commercial	$165.20
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Humana Medicare	$118.00
Rate for Payer: Kaiser Permanente Commercial	$212.40
Rate for Payer: Kaiser Permanente Medicaid	$120.36
Rate for Payer: Kaiser Permanente Medicare	$118.00
Rate for Payer: MDX Hawaii PPO	$228.92
Rate for Payer: Ohana Health Plan Medicaid	$118.00
Rate for Payer: Ohana Health Plan Medicare	$118.00
Rate for Payer: UnitedHealthcare Medicare	$118.00
Rate for Payer: University Health Alliance Commercial	$132.16

K-WIRE 1.1 X150MM BLUNT/TROCAR

Facility

$236.00

Service Code	HCPCS C1713
Hospital Charge Code	10600438
Hospital Revenue Code	278
Min. Negotiated Rate	$132.16
Max. Negotiated Rate	$228.92
Rate for Payer: Cash Price	$153.40
Rate for Payer: Hawaii Western Management Group Commercial	$165.20
Rate for Payer: Health Management Network Commercial	$200.60
Rate for Payer: Kaiser Permanente Commercial	$212.40
Rate for Payer: MDX Hawaii PPO	$228.92
Rate for Payer: University Health Alliance Commercial	$132.16

L0625 - Brace Back Sup Corfit Sys

Facility

$186.00

Service Code	HCPCS L0625
Hospital Charge Code	8409626
Hospital Revenue Code	274
Min. Negotiated Rate	$43.27
Max. Negotiated Rate	$180.42
Rate for Payer: AlohaCare Medicaid	$93.00
Rate for Payer: AlohaCare Medicare	$93.00
Rate for Payer: Cash Price	$120.90
Rate for Payer: Cash Price	$120.90
Rate for Payer: Devoted Health Medicare	$102.30
Rate for Payer: Hawaii Medical Service Association Medicare	$93.00
Rate for Payer: Hawaii Western Management Group Commercial	$130.20
Rate for Payer: Health Management Network Commercial	$158.10
Rate for Payer: Humana Medicare	$93.00
Rate for Payer: Kaiser Permanente Commercial	$167.40
Rate for Payer: Kaiser Permanente Medicaid	$94.86
Rate for Payer: Kaiser Permanente Medicare	$93.00
Rate for Payer: MDX Hawaii PPO	$180.42
Rate for Payer: Ohana Health Plan Medicaid	$93.00
Rate for Payer: Ohana Health Plan Medicare	$93.00
Rate for Payer: UnitedHealthcare Medicaid	$43.27
Rate for Payer: UnitedHealthcare Medicare	$93.00
Rate for Payer: University Health Alliance Commercial	$104.16

L0625 - Brace Back Sup Corfit Sys

Facility

$186.00

Service Code	HCPCS L0625
Hospital Charge Code	8409626
Hospital Revenue Code	274
Min. Negotiated Rate	$104.16
Max. Negotiated Rate	$180.42
Rate for Payer: Cash Price	$120.90
Rate for Payer: Hawaii Western Management Group Commercial	$130.20
Rate for Payer: Health Management Network Commercial	$158.10
Rate for Payer: Kaiser Permanente Commercial	$167.40
Rate for Payer: MDX Hawaii PPO	$180.42
Rate for Payer: University Health Alliance Commercial	$104.16

Know your out-of-pocket cost for care.

All Charges