Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Lumbar Tray at Bedside

Facility

$1,136.00

Service Code	HCPCS 62270
Hospital Charge Code	1909307
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$568.00
Rate for Payer: AlohaCare Medicare	$568.00
Rate for Payer: Cash Price	$738.40
Rate for Payer: Cash Price	$738.40
Rate for Payer: Devoted Health Medicare	$624.80
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	$568.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Health Management Network Commercial	$965.60
Rate for Payer: Humana Medicare	$568.00
Rate for Payer: Kaiser Permanente Commercial	$1,022.40
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$568.00
Rate for Payer: MDX Hawaii PPO	$1,101.92
Rate for Payer: Ohana Health Plan Medicaid	$568.00
Rate for Payer: Ohana Health Plan Medicare	$568.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$568.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

LUNG TRANSPLANT

Facility

$10,400.00

Service Code	MSDRG 007
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$10,400.00
Rate for Payer: University Health Alliance Commercial	$10,400.00

Luteinizing Hormone (LH) FSI

Facility

$212.00

Service Code	HCPCS 83002
Hospital Charge Code	8117986
Hospital Revenue Code	301
Min. Negotiated Rate	$18.52
Max. Negotiated Rate	$205.64
Rate for Payer: AlohaCare Medicaid	$106.00
Rate for Payer: AlohaCare Medicare	$106.00
Rate for Payer: Cash Price	$137.80
Rate for Payer: Cash Price	$137.80
Rate for Payer: Devoted Health Medicare	$116.60
Rate for Payer: Hawaii Medical Service Association ABD	$25.60
Rate for Payer: Hawaii Medical Service Association Commercial	$23.15
Rate for Payer: Hawaii Medical Service Association Medicare	$106.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.88
Rate for Payer: Hawaii Western Management Group Commercial	$18.52
Rate for Payer: Health Management Network Commercial	$180.20
Rate for Payer: Humana Medicare	$106.00
Rate for Payer: Kaiser Permanente Commercial	$190.80
Rate for Payer: Kaiser Permanente Medicaid	$108.12
Rate for Payer: Kaiser Permanente Medicare	$106.00
Rate for Payer: MDX Hawaii PPO	$205.64
Rate for Payer: Ohana Health Plan Medicaid	$106.00
Rate for Payer: Ohana Health Plan Medicare	$106.00
Rate for Payer: UnitedHealthcare Medicaid	$25.60
Rate for Payer: UnitedHealthcare Medicare	$106.00
Rate for Payer: University Health Alliance Commercial	$47.88

Luteinizing Hormone (LH) FSI

Facility

$212.00

Service Code	HCPCS 83002
Hospital Charge Code	8117986
Hospital Revenue Code	301
Min. Negotiated Rate	$180.20
Max. Negotiated Rate	$205.64
Rate for Payer: Cash Price	$137.80
Rate for Payer: Health Management Network Commercial	$180.20
Rate for Payer: Kaiser Permanente Commercial	$190.80
Rate for Payer: MDX Hawaii PPO	$205.64

Lyme AB Total Rfx IgG, IgM IB FSI

Facility

$243.00

Service Code	HCPCS 86618
Hospital Charge Code	11240929
Hospital Revenue Code	302
Min. Negotiated Rate	$17.03
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: Cash Price	$157.95
Rate for Payer: Devoted Health Medicare	$133.65
Rate for Payer: Hawaii Medical Service Association ABD	$23.54
Rate for Payer: Hawaii Medical Service Association Commercial	$21.29
Rate for Payer: Hawaii Medical Service Association Medicare	$121.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.72
Rate for Payer: Hawaii Western Management Group Commercial	$17.03
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 Medicaid	$23.54
Rate for Payer: UnitedHealthcare Medicare	$121.50
Rate for Payer: University Health Alliance Commercial	$44.03

Lyme AB Total Rfx IgG, IgM IB FSI

Facility

$243.00

Service Code	HCPCS 86618
Hospital Charge Code	11240929
Hospital Revenue Code	302
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

Lyme Disease Antibody , Rfx Immunoglot FSI

Facility

$243.00

Service Code	HCPCS 86618
Hospital Charge Code	10383593
Hospital Revenue Code	302
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

Lyme Disease Antibody , Rfx Immunoglot FSI

Facility

$243.00

Service Code	HCPCS 86618
Hospital Charge Code	10383593
Hospital Revenue Code	302
Min. Negotiated Rate	$17.03
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: Cash Price	$157.95
Rate for Payer: Devoted Health Medicare	$133.65
Rate for Payer: Hawaii Medical Service Association ABD	$23.54
Rate for Payer: Hawaii Medical Service Association Commercial	$21.29
Rate for Payer: Hawaii Medical Service Association Medicare	$121.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.72
Rate for Payer: Hawaii Western Management Group Commercial	$17.03
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 Medicaid	$23.54
Rate for Payer: UnitedHealthcare Medicare	$121.50
Rate for Payer: University Health Alliance Commercial	$44.03

Lyme Disease Borrelia burgdorferi, IgG IgM by Western Blot FSI

Facility

$177.00

Service Code	HCPCS 86617
Hospital Charge Code	8117987
Hospital Revenue Code	302
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$115.05
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Kaiser Permanente Commercial	$159.30
Rate for Payer: MDX Hawaii PPO	$171.69

Lyme Disease Borrelia burgdorferi, IgG IgM by Western Blot FSI

Facility

$177.00

Service Code	HCPCS 86617
Hospital Charge Code	8117987
Hospital Revenue Code	302
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$171.69
Rate for Payer: AlohaCare Medicaid	$88.50
Rate for Payer: AlohaCare Medicare	$88.50
Rate for Payer: Cash Price	$115.05
Rate for Payer: Cash Price	$115.05
Rate for Payer: Devoted Health Medicare	$97.35
Rate for Payer: Hawaii Medical Service Association ABD	$21.40
Rate for Payer: Hawaii Medical Service Association Commercial	$19.36
Rate for Payer: Hawaii Medical Service Association Medicare	$88.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.47
Rate for Payer: Hawaii Western Management Group Commercial	$15.49
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Humana Medicare	$88.50
Rate for Payer: Kaiser Permanente Commercial	$159.30
Rate for Payer: Kaiser Permanente Medicaid	$90.27
Rate for Payer: Kaiser Permanente Medicare	$88.50
Rate for Payer: MDX Hawaii PPO	$171.69
Rate for Payer: Ohana Health Plan Medicaid	$88.50
Rate for Payer: Ohana Health Plan Medicare	$88.50
Rate for Payer: UnitedHealthcare Medicaid	$21.40
Rate for Payer: UnitedHealthcare Medicare	$88.50
Rate for Payer: University Health Alliance Commercial	$40.03

Lyme Immunoblot IgG FSI

Facility

$177.00

Service Code	HCPCS 86617
Hospital Charge Code	11240962
Hospital Revenue Code	302
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$115.05
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Kaiser Permanente Commercial	$159.30
Rate for Payer: MDX Hawaii PPO	$171.69

Lyme Immunoblot IgG FSI

Facility

$177.00

Service Code	HCPCS 86617
Hospital Charge Code	11240962
Hospital Revenue Code	302
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$171.69
Rate for Payer: AlohaCare Medicaid	$88.50
Rate for Payer: AlohaCare Medicare	$88.50
Rate for Payer: Cash Price	$115.05
Rate for Payer: Cash Price	$115.05
Rate for Payer: Devoted Health Medicare	$97.35
Rate for Payer: Hawaii Medical Service Association ABD	$21.40
Rate for Payer: Hawaii Medical Service Association Commercial	$19.36
Rate for Payer: Hawaii Medical Service Association Medicare	$88.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.47
Rate for Payer: Hawaii Western Management Group Commercial	$15.49
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Humana Medicare	$88.50
Rate for Payer: Kaiser Permanente Commercial	$159.30
Rate for Payer: Kaiser Permanente Medicaid	$90.27
Rate for Payer: Kaiser Permanente Medicare	$88.50
Rate for Payer: MDX Hawaii PPO	$171.69
Rate for Payer: Ohana Health Plan Medicaid	$88.50
Rate for Payer: Ohana Health Plan Medicare	$88.50
Rate for Payer: UnitedHealthcare Medicaid	$21.40
Rate for Payer: UnitedHealthcare Medicare	$88.50
Rate for Payer: University Health Alliance Commercial	$40.03

Lyme Immunoblot IgM FSI

Facility

$177.00

Service Code	HCPCS 86617
Hospital Charge Code	11240951
Hospital Revenue Code	302
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$171.69
Rate for Payer: Cash Price	$115.05
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Kaiser Permanente Commercial	$159.30
Rate for Payer: MDX Hawaii PPO	$171.69

Lyme Immunoblot IgM FSI

Facility

$177.00

Service Code	HCPCS 86617
Hospital Charge Code	11240951
Hospital Revenue Code	302
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$171.69
Rate for Payer: AlohaCare Medicaid	$88.50
Rate for Payer: AlohaCare Medicare	$88.50
Rate for Payer: Cash Price	$115.05
Rate for Payer: Cash Price	$115.05
Rate for Payer: Devoted Health Medicare	$97.35
Rate for Payer: Hawaii Medical Service Association ABD	$21.40
Rate for Payer: Hawaii Medical Service Association Commercial	$19.36
Rate for Payer: Hawaii Medical Service Association Medicare	$88.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.47
Rate for Payer: Hawaii Western Management Group Commercial	$15.49
Rate for Payer: Health Management Network Commercial	$150.45
Rate for Payer: Humana Medicare	$88.50
Rate for Payer: Kaiser Permanente Commercial	$159.30
Rate for Payer: Kaiser Permanente Medicaid	$90.27
Rate for Payer: Kaiser Permanente Medicare	$88.50
Rate for Payer: MDX Hawaii PPO	$171.69
Rate for Payer: Ohana Health Plan Medicaid	$88.50
Rate for Payer: Ohana Health Plan Medicare	$88.50
Rate for Payer: UnitedHealthcare Medicaid	$21.40
Rate for Payer: UnitedHealthcare Medicare	$88.50
Rate for Payer: University Health Alliance Commercial	$40.03

Lymphocyte Subset Panel 3 (CD4,CD3,CD8) FSI

Facility

$353.00

Service Code	HCPCS 86359
Hospital Charge Code	8228891
Hospital Revenue Code	302
Min. Negotiated Rate	$300.05
Max. Negotiated Rate	$342.41
Rate for Payer: Cash Price	$229.45
Rate for Payer: Health Management Network Commercial	$300.05
Rate for Payer: Kaiser Permanente Commercial	$317.70
Rate for Payer: MDX Hawaii PPO	$342.41

Lymphocyte Subset Panel 3 (CD4,CD3,CD8) FSI

Facility

$353.00

Service Code	HCPCS 86359
Hospital Charge Code	8228891
Hospital Revenue Code	302
Min. Negotiated Rate	$37.73
Max. Negotiated Rate	$342.41
Rate for Payer: AlohaCare Medicaid	$176.50
Rate for Payer: AlohaCare Medicare	$176.50
Rate for Payer: Cash Price	$229.45
Rate for Payer: Cash Price	$229.45
Rate for Payer: Devoted Health Medicare	$194.15
Rate for Payer: Hawaii Medical Service Association ABD	$52.13
Rate for Payer: Hawaii Medical Service Association Commercial	$47.16
Rate for Payer: Hawaii Medical Service Association Medicare	$176.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$54.74
Rate for Payer: Hawaii Western Management Group Commercial	$37.73
Rate for Payer: Health Management Network Commercial	$300.05
Rate for Payer: Humana Medicare	$176.50
Rate for Payer: Kaiser Permanente Commercial	$317.70
Rate for Payer: Kaiser Permanente Medicaid	$180.03
Rate for Payer: Kaiser Permanente Medicare	$176.50
Rate for Payer: MDX Hawaii PPO	$342.41
Rate for Payer: Ohana Health Plan Medicaid	$176.50
Rate for Payer: Ohana Health Plan Medicare	$176.50
Rate for Payer: UnitedHealthcare Medicaid	$52.13
Rate for Payer: UnitedHealthcare Medicare	$176.50
Rate for Payer: University Health Alliance Commercial	$97.50

Lymphocyte Subset Panel (CD3, CD4, CD8, CD19) FSI

Facility

$753.00

Service Code	HCPCS 86355
Hospital Charge Code	12409515
Hospital Revenue Code	302
Min. Negotiated Rate	$640.05
Max. Negotiated Rate	$730.41
Rate for Payer: Cash Price	$489.45
Rate for Payer: Health Management Network Commercial	$640.05
Rate for Payer: Kaiser Permanente Commercial	$677.70
Rate for Payer: MDX Hawaii PPO	$730.41

Lymphocyte Subset Panel (CD3, CD4, CD8, CD19) FSI

Facility

$753.00

Service Code	HCPCS 86355
Hospital Charge Code	12409515
Hospital Revenue Code	302
Min. Negotiated Rate	$36.89
Max. Negotiated Rate	$730.41
Rate for Payer: AlohaCare Medicaid	$376.50
Rate for Payer: AlohaCare Medicare	$376.50
Rate for Payer: Cash Price	$489.45
Rate for Payer: Cash Price	$489.45
Rate for Payer: Devoted Health Medicare	$414.15
Rate for Payer: Hawaii Medical Service Association ABD	$36.89
Rate for Payer: Hawaii Medical Service Association Commercial	$47.16
Rate for Payer: Hawaii Medical Service Association Medicare	$376.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$52.10
Rate for Payer: Hawaii Western Management Group Commercial	$37.73
Rate for Payer: Health Management Network Commercial	$640.05
Rate for Payer: Humana Medicare	$376.50
Rate for Payer: Kaiser Permanente Commercial	$677.70
Rate for Payer: Kaiser Permanente Medicaid	$384.03
Rate for Payer: Kaiser Permanente Medicare	$376.50
Rate for Payer: MDX Hawaii PPO	$730.41
Rate for Payer: Ohana Health Plan Medicaid	$376.50
Rate for Payer: Ohana Health Plan Medicare	$376.50
Rate for Payer: UnitedHealthcare Medicaid	$36.89
Rate for Payer: UnitedHealthcare Medicare	$376.50
Rate for Payer: University Health Alliance Commercial	$97.50

LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC

Facility

$82,301.09

Service Code	MSDRG 821
Min. Negotiated Rate	$82,301.09
Max. Negotiated Rate	$82,301.09
Rate for Payer: Hawaii Medical Service Association Commercial	$82,301.09

LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC

Facility

$82,301.09

Service Code	MSDRG 820
Min. Negotiated Rate	$82,301.09
Max. Negotiated Rate	$82,301.09
Rate for Payer: Hawaii Medical Service Association Commercial	$82,301.09

LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$32,966.33

Service Code	MSDRG 822
Min. Negotiated Rate	$32,966.33
Max. Negotiated Rate	$32,966.33
Rate for Payer: Hawaii Medical Service Association Commercial	$32,966.33

LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC

Facility

$83,601.38

Service Code	MSDRG 841
Min. Negotiated Rate	$83,601.38
Max. Negotiated Rate	$83,601.38
Rate for Payer: Hawaii Medical Service Association Commercial	$83,601.38

LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC

Facility

$88,522.11

Service Code	MSDRG 840
Min. Negotiated Rate	$88,522.11
Max. Negotiated Rate	$88,522.11
Rate for Payer: Hawaii Medical Service Association Commercial	$88,522.11

LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC

Facility

$99,536.38

Service Code	MSDRG 824
Min. Negotiated Rate	$99,536.38
Max. Negotiated Rate	$99,536.38
Rate for Payer: Hawaii Medical Service Association Commercial	$99,536.38

LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC

Facility

$99,536.38

Service Code	MSDRG 823
Min. Negotiated Rate	$99,536.38
Max. Negotiated Rate	$99,536.38
Rate for Payer: Hawaii Medical Service Association Commercial	$99,536.38

Know your out-of-pocket cost for care.

All Charges