Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

LAPAROSCOPIC, CHOLANGIOGRAM 5MM CATHETER

Facility

$392.00

Hospital Charge Code	8274302
Hospital Revenue Code	272
Min. Negotiated Rate	$196.00
Max. Negotiated Rate	$380.24
Rate for Payer: AlohaCare Medicaid	$196.00
Rate for Payer: AlohaCare Medicare	$196.00
Rate for Payer: Cash Price	$254.80
Rate for Payer: Devoted Health Medicare	$215.60
Rate for Payer: Hawaii Medical Service Association Medicare	$196.00
Rate for Payer: Hawaii Western Management Group Commercial	$372.40
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Humana Medicare	$196.00
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: Kaiser Permanente Medicaid	$199.92
Rate for Payer: Kaiser Permanente Medicare	$196.00
Rate for Payer: MDX Hawaii PPO	$380.24
Rate for Payer: Ohana Health Plan Medicaid	$196.00
Rate for Payer: Ohana Health Plan Medicare	$196.00
Rate for Payer: UnitedHealthcare Medicare	$196.00
Rate for Payer: University Health Alliance Commercial	$285.73

LAPAROSCOPIC, CHOLANGIOGRAM 5MM CATHETER

Facility

$392.00

Hospital Charge Code	8274302
Hospital Revenue Code	272
Min. Negotiated Rate	$333.20
Max. Negotiated Rate	$380.24
Rate for Payer: Cash Price	$254.80
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: MDX Hawaii PPO	$380.24

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC

Facility

$29,039.94

Service Code	MSDRG 418
Min. Negotiated Rate	$29,039.94
Max. Negotiated Rate	$29,039.94
Rate for Payer: Hawaii Medical Service Association Commercial	$29,039.94

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC

Facility

$31,844.50

Service Code	MSDRG 417
Min. Negotiated Rate	$31,844.50
Max. Negotiated Rate	$31,844.50
Rate for Payer: Hawaii Medical Service Association Commercial	$31,844.50

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$18,790.55

Service Code	MSDRG 419
Min. Negotiated Rate	$18,790.55
Max. Negotiated Rate	$18,790.55
Rate for Payer: Hawaii Medical Service Association Commercial	$18,790.55

LAPAROSCOPIC, ECHELON 45, LINEAR CUTTER STRAIGHT

Facility

$2,540.00

Hospital Charge Code	8274213
Hospital Revenue Code	272
Min. Negotiated Rate	$1,270.00
Max. Negotiated Rate	$2,463.80
Rate for Payer: AlohaCare Medicaid	$1,270.00
Rate for Payer: AlohaCare Medicare	$1,270.00
Rate for Payer: Cash Price	$1,651.00
Rate for Payer: Devoted Health Medicare	$1,397.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,270.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,413.00
Rate for Payer: Health Management Network Commercial	$2,159.00
Rate for Payer: Humana Medicare	$1,270.00
Rate for Payer: Kaiser Permanente Commercial	$2,286.00
Rate for Payer: Kaiser Permanente Medicaid	$1,295.40
Rate for Payer: Kaiser Permanente Medicare	$1,270.00
Rate for Payer: MDX Hawaii PPO	$2,463.80
Rate for Payer: Ohana Health Plan Medicaid	$1,270.00
Rate for Payer: Ohana Health Plan Medicare	$1,270.00
Rate for Payer: UnitedHealthcare Medicare	$1,270.00
Rate for Payer: University Health Alliance Commercial	$1,851.41

LAPAROSCOPIC, ECHELON 45, LINEAR CUTTER STRAIGHT

Facility

$2,540.00

Hospital Charge Code	8274213
Hospital Revenue Code	272
Min. Negotiated Rate	$2,159.00
Max. Negotiated Rate	$2,463.80
Rate for Payer: Cash Price	$1,651.00
Rate for Payer: Health Management Network Commercial	$2,159.00
Rate for Payer: Kaiser Permanente Commercial	$2,286.00
Rate for Payer: MDX Hawaii PPO	$2,463.80

LAPAROSCOPIC ECHELON LINEAR CUTTER RELOADS

Facility

$2,313.00

Hospital Charge Code	8348079
Hospital Revenue Code	272
Min. Negotiated Rate	$1,966.05
Max. Negotiated Rate	$2,243.61
Rate for Payer: Cash Price	$1,503.45
Rate for Payer: Health Management Network Commercial	$1,966.05
Rate for Payer: Kaiser Permanente Commercial	$2,081.70
Rate for Payer: MDX Hawaii PPO	$2,243.61

LAPAROSCOPIC ECHELON LINEAR CUTTER RELOADS

Facility

$2,313.00

Hospital Charge Code	8348079
Hospital Revenue Code	272
Min. Negotiated Rate	$1,156.50
Max. Negotiated Rate	$2,243.61
Rate for Payer: AlohaCare Medicaid	$1,156.50
Rate for Payer: AlohaCare Medicare	$1,156.50
Rate for Payer: Cash Price	$1,503.45
Rate for Payer: Devoted Health Medicare	$1,272.15
Rate for Payer: Hawaii Medical Service Association Medicare	$1,156.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,197.35
Rate for Payer: Health Management Network Commercial	$1,966.05
Rate for Payer: Humana Medicare	$1,156.50
Rate for Payer: Kaiser Permanente Commercial	$2,081.70
Rate for Payer: Kaiser Permanente Medicaid	$1,179.63
Rate for Payer: Kaiser Permanente Medicare	$1,156.50
Rate for Payer: MDX Hawaii PPO	$2,243.61
Rate for Payer: Ohana Health Plan Medicaid	$1,156.50
Rate for Payer: Ohana Health Plan Medicare	$1,156.50
Rate for Payer: UnitedHealthcare Medicare	$1,156.50
Rate for Payer: University Health Alliance Commercial	$1,685.95

LAPAROSCOPIC ECHELON LINEAR CUTTER RELOADS 2.5MM

Facility

$2,575.00

Hospital Charge Code	8879041
Hospital Revenue Code	272
Min. Negotiated Rate	$1,287.50
Max. Negotiated Rate	$2,497.75
Rate for Payer: AlohaCare Medicaid	$1,287.50
Rate for Payer: AlohaCare Medicare	$1,287.50
Rate for Payer: Cash Price	$1,673.75
Rate for Payer: Devoted Health Medicare	$1,416.25
Rate for Payer: Hawaii Medical Service Association Medicare	$1,287.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,446.25
Rate for Payer: Health Management Network Commercial	$2,188.75
Rate for Payer: Humana Medicare	$1,287.50
Rate for Payer: Kaiser Permanente Commercial	$2,317.50
Rate for Payer: Kaiser Permanente Medicaid	$1,313.25
Rate for Payer: Kaiser Permanente Medicare	$1,287.50
Rate for Payer: MDX Hawaii PPO	$2,497.75
Rate for Payer: Ohana Health Plan Medicaid	$1,287.50
Rate for Payer: Ohana Health Plan Medicare	$1,287.50
Rate for Payer: UnitedHealthcare Medicare	$1,287.50
Rate for Payer: University Health Alliance Commercial	$1,876.92

LAPAROSCOPIC ECHELON LINEAR CUTTER RELOADS 2.5MM

Facility

$2,575.00

Hospital Charge Code	8879041
Hospital Revenue Code	272
Min. Negotiated Rate	$2,188.75
Max. Negotiated Rate	$2,497.75
Rate for Payer: Cash Price	$1,673.75
Rate for Payer: Health Management Network Commercial	$2,188.75
Rate for Payer: Kaiser Permanente Commercial	$2,317.50
Rate for Payer: MDX Hawaii PPO	$2,497.75

LAPAROSCOPIC ENDO CLIP II 10 MM

Facility

$283.00

Hospital Charge Code	8274231
Hospital Revenue Code	272
Min. Negotiated Rate	$141.50
Max. Negotiated Rate	$274.51
Rate for Payer: AlohaCare Medicaid	$141.50
Rate for Payer: AlohaCare Medicare	$141.50
Rate for Payer: Cash Price	$183.95
Rate for Payer: Devoted Health Medicare	$155.65
Rate for Payer: Hawaii Medical Service Association Medicare	$141.50
Rate for Payer: Hawaii Western Management Group Commercial	$268.85
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Humana Medicare	$141.50
Rate for Payer: Kaiser Permanente Commercial	$254.70
Rate for Payer: Kaiser Permanente Medicaid	$144.33
Rate for Payer: Kaiser Permanente Medicare	$141.50
Rate for Payer: MDX Hawaii PPO	$274.51
Rate for Payer: Ohana Health Plan Medicaid	$141.50
Rate for Payer: Ohana Health Plan Medicare	$141.50
Rate for Payer: UnitedHealthcare Medicare	$141.50
Rate for Payer: University Health Alliance Commercial	$206.28

LAPAROSCOPIC ENDO CLIP II 10 MM

Facility

$283.00

Hospital Charge Code	8274231
Hospital Revenue Code	272
Min. Negotiated Rate	$240.55
Max. Negotiated Rate	$274.51
Rate for Payer: Cash Price	$183.95
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Kaiser Permanente Commercial	$254.70
Rate for Payer: MDX Hawaii PPO	$274.51

LAPAROSCOPIC, KITTNER 5MM

Facility

$134.00

Hospital Charge Code	8274232
Hospital Revenue Code	272
Min. Negotiated Rate	$67.00
Max. Negotiated Rate	$129.98
Rate for Payer: AlohaCare Medicaid	$67.00
Rate for Payer: AlohaCare Medicare	$67.00
Rate for Payer: Cash Price	$87.10
Rate for Payer: Devoted Health Medicare	$73.70
Rate for Payer: Hawaii Medical Service Association Medicare	$67.00
Rate for Payer: Hawaii Western Management Group Commercial	$127.30
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Humana Medicare	$67.00
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: Kaiser Permanente Medicaid	$68.34
Rate for Payer: Kaiser Permanente Medicare	$67.00
Rate for Payer: MDX Hawaii PPO	$129.98
Rate for Payer: Ohana Health Plan Medicaid	$67.00
Rate for Payer: Ohana Health Plan Medicare	$67.00
Rate for Payer: UnitedHealthcare Medicare	$67.00
Rate for Payer: University Health Alliance Commercial	$97.67

LAPAROSCOPIC, KITTNER 5MM

Facility

$134.00

Hospital Charge Code	8274232
Hospital Revenue Code	272
Min. Negotiated Rate	$113.90
Max. Negotiated Rate	$129.98
Rate for Payer: Cash Price	$87.10
Rate for Payer: Health Management Network Commercial	$113.90
Rate for Payer: Kaiser Permanente Commercial	$120.60
Rate for Payer: MDX Hawaii PPO	$129.98

LAPAROSCOPIC, KUMAR CATHETER

Facility

$175.00

Hospital Charge Code	8274347
Hospital Revenue Code	272
Min. Negotiated Rate	$148.75
Max. Negotiated Rate	$169.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: Kaiser Permanente Commercial	$157.50
Rate for Payer: MDX Hawaii PPO	$169.75

LAPAROSCOPIC, KUMAR CATHETER

Facility

$175.00

Hospital Charge Code	8274347
Hospital Revenue Code	272
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$169.75
Rate for Payer: AlohaCare Medicaid	$87.50
Rate for Payer: AlohaCare Medicare	$87.50
Rate for Payer: Cash Price	$113.75
Rate for Payer: Devoted Health Medicare	$96.25
Rate for Payer: Hawaii Medical Service Association Medicare	$87.50
Rate for Payer: Hawaii Western Management Group Commercial	$166.25
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: Humana Medicare	$87.50
Rate for Payer: Kaiser Permanente Commercial	$157.50
Rate for Payer: Kaiser Permanente Medicaid	$89.25
Rate for Payer: Kaiser Permanente Medicare	$87.50
Rate for Payer: MDX Hawaii PPO	$169.75
Rate for Payer: Ohana Health Plan Medicaid	$87.50
Rate for Payer: Ohana Health Plan Medicare	$87.50
Rate for Payer: UnitedHealthcare Medicare	$87.50
Rate for Payer: University Health Alliance Commercial	$127.56

LAPAROSCOPIC, L-HOOK CAUTERY, GEN NEZHAT-DORSEY

Facility

$179.00

Hospital Charge Code	8274275
Hospital Revenue Code	272
Min. Negotiated Rate	$89.50
Max. Negotiated Rate	$173.63
Rate for Payer: AlohaCare Medicaid	$89.50
Rate for Payer: AlohaCare Medicare	$89.50
Rate for Payer: Cash Price	$116.35
Rate for Payer: Devoted Health Medicare	$98.45
Rate for Payer: Hawaii Medical Service Association Medicare	$89.50
Rate for Payer: Hawaii Western Management Group Commercial	$170.05
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Humana Medicare	$89.50
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: Kaiser Permanente Medicaid	$91.29
Rate for Payer: Kaiser Permanente Medicare	$89.50
Rate for Payer: MDX Hawaii PPO	$173.63
Rate for Payer: Ohana Health Plan Medicaid	$89.50
Rate for Payer: Ohana Health Plan Medicare	$89.50
Rate for Payer: UnitedHealthcare Medicare	$89.50
Rate for Payer: University Health Alliance Commercial	$130.47

LAPAROSCOPIC, L-HOOK CAUTERY, GEN NEZHAT-DORSEY

Facility

$179.00

Hospital Charge Code	8274275
Hospital Revenue Code	272
Min. Negotiated Rate	$152.15
Max. Negotiated Rate	$173.63
Rate for Payer: Cash Price	$116.35
Rate for Payer: Health Management Network Commercial	$152.15
Rate for Payer: Kaiser Permanente Commercial	$161.10
Rate for Payer: MDX Hawaii PPO	$173.63

LAPAROSCOPIC SMOKE EVACUATOR AC/PA

Facility

$206.00

Hospital Charge Code	9656067
Hospital Revenue Code	272
Min. Negotiated Rate	$103.00
Max. Negotiated Rate	$199.82
Rate for Payer: AlohaCare Medicaid	$103.00
Rate for Payer: AlohaCare Medicare	$103.00
Rate for Payer: Cash Price	$133.90
Rate for Payer: Devoted Health Medicare	$113.30
Rate for Payer: Hawaii Medical Service Association Medicare	$103.00
Rate for Payer: Hawaii Western Management Group Commercial	$195.70
Rate for Payer: Health Management Network Commercial	$175.10
Rate for Payer: Humana Medicare	$103.00
Rate for Payer: Kaiser Permanente Commercial	$185.40
Rate for Payer: Kaiser Permanente Medicaid	$105.06
Rate for Payer: Kaiser Permanente Medicare	$103.00
Rate for Payer: MDX Hawaii PPO	$199.82
Rate for Payer: Ohana Health Plan Medicaid	$103.00
Rate for Payer: Ohana Health Plan Medicare	$103.00
Rate for Payer: UnitedHealthcare Medicare	$103.00
Rate for Payer: University Health Alliance Commercial	$150.15

LAPAROSCOPIC SMOKE EVACUATOR AC/PA

Facility

$206.00

Hospital Charge Code	9656067
Hospital Revenue Code	272
Min. Negotiated Rate	$175.10
Max. Negotiated Rate	$199.82
Rate for Payer: Cash Price	$133.90
Rate for Payer: Health Management Network Commercial	$175.10
Rate for Payer: Kaiser Permanente Commercial	$185.40
Rate for Payer: MDX Hawaii PPO	$199.82

LAPAROSCOPIC TROCAR BLADELESS 11MM XCEL 100MM DISPOSABLE STERILE

Facility

$782.00

Hospital Charge Code	8274238
Hospital Revenue Code	272
Min. Negotiated Rate	$391.00
Max. Negotiated Rate	$758.54
Rate for Payer: AlohaCare Medicaid	$391.00
Rate for Payer: AlohaCare Medicare	$391.00
Rate for Payer: Cash Price	$508.30
Rate for Payer: Devoted Health Medicare	$430.10
Rate for Payer: Hawaii Medical Service Association Medicare	$391.00
Rate for Payer: Hawaii Western Management Group Commercial	$742.90
Rate for Payer: Health Management Network Commercial	$664.70
Rate for Payer: Humana Medicare	$391.00
Rate for Payer: Kaiser Permanente Commercial	$703.80
Rate for Payer: Kaiser Permanente Medicaid	$398.82
Rate for Payer: Kaiser Permanente Medicare	$391.00
Rate for Payer: MDX Hawaii PPO	$758.54
Rate for Payer: Ohana Health Plan Medicaid	$391.00
Rate for Payer: Ohana Health Plan Medicare	$391.00
Rate for Payer: UnitedHealthcare Medicare	$391.00
Rate for Payer: University Health Alliance Commercial	$570.00

LAPAROSCOPIC TROCAR BLADELESS 11MM XCEL 100MM DISPOSABLE STERILE

Facility

$782.00

Hospital Charge Code	8274238
Hospital Revenue Code	272
Min. Negotiated Rate	$664.70
Max. Negotiated Rate	$758.54
Rate for Payer: Cash Price	$508.30
Rate for Payer: Health Management Network Commercial	$664.70
Rate for Payer: Kaiser Permanente Commercial	$703.80
Rate for Payer: MDX Hawaii PPO	$758.54

LAPAROSCOPIC TROCAR BLADELESS 5MM XCEL100MM LENGTH

Facility

$609.00

Hospital Charge Code	8274239
Hospital Revenue Code	272
Min. Negotiated Rate	$304.50
Max. Negotiated Rate	$590.73
Rate for Payer: AlohaCare Medicaid	$304.50
Rate for Payer: AlohaCare Medicare	$304.50
Rate for Payer: Cash Price	$395.85
Rate for Payer: Devoted Health Medicare	$334.95
Rate for Payer: Hawaii Medical Service Association Medicare	$304.50
Rate for Payer: Hawaii Western Management Group Commercial	$578.55
Rate for Payer: Health Management Network Commercial	$517.65
Rate for Payer: Humana Medicare	$304.50
Rate for Payer: Kaiser Permanente Commercial	$548.10
Rate for Payer: Kaiser Permanente Medicaid	$310.59
Rate for Payer: Kaiser Permanente Medicare	$304.50
Rate for Payer: MDX Hawaii PPO	$590.73
Rate for Payer: Ohana Health Plan Medicaid	$304.50
Rate for Payer: Ohana Health Plan Medicare	$304.50
Rate for Payer: UnitedHealthcare Medicare	$304.50
Rate for Payer: University Health Alliance Commercial	$443.90

LAPAROSCOPIC TROCAR BLADELESS 5MM XCEL100MM LENGTH

Facility

$609.00

Hospital Charge Code	8274239
Hospital Revenue Code	272
Min. Negotiated Rate	$517.65
Max. Negotiated Rate	$590.73
Rate for Payer: Cash Price	$395.85
Rate for Payer: Health Management Network Commercial	$517.65
Rate for Payer: Kaiser Permanente Commercial	$548.10
Rate for Payer: MDX Hawaii PPO	$590.73

Know your out-of-pocket cost for care.

All Charges