Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Magnesium Urine Timed FSI

Facility

$94.00

Service Code	HCPCS 83735
Hospital Charge Code	8228892
Hospital Revenue Code	301
Min. Negotiated Rate	$79.90
Max. Negotiated Rate	$91.18
Rate for Payer: Cash Price	$61.10
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Kaiser Permanente Commercial	$84.60
Rate for Payer: MDX Hawaii PPO	$91.18

Magnesium Urine Timed FSI

Facility

$94.00

Service Code	HCPCS 83735
Hospital Charge Code	8228892
Hospital Revenue Code	301
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$91.18
Rate for Payer: AlohaCare Medicaid	$47.00
Rate for Payer: AlohaCare Medicare	$47.00
Rate for Payer: Cash Price	$61.10
Rate for Payer: Cash Price	$61.10
Rate for Payer: Devoted Health Medicare	$51.70
Rate for Payer: Hawaii Medical Service Association ABD	$9.26
Rate for Payer: Hawaii Medical Service Association Commercial	$8.38
Rate for Payer: Hawaii Medical Service Association Medicare	$47.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.72
Rate for Payer: Hawaii Western Management Group Commercial	$6.70
Rate for Payer: Health Management Network Commercial	$79.90
Rate for Payer: Humana Medicare	$47.00
Rate for Payer: Kaiser Permanente Commercial	$84.60
Rate for Payer: Kaiser Permanente Medicaid	$47.94
Rate for Payer: Kaiser Permanente Medicare	$47.00
Rate for Payer: MDX Hawaii PPO	$91.18
Rate for Payer: Ohana Health Plan Medicaid	$47.00
Rate for Payer: Ohana Health Plan Medicare	$47.00
Rate for Payer: UnitedHealthcare Medicaid	$9.26
Rate for Payer: UnitedHealthcare Medicare	$47.00
Rate for Payer: University Health Alliance Commercial	$17.32

MAJOR BLADDER PROCEDURES WITH CC

Facility

$49,258.27

Service Code	MSDRG 654
Min. Negotiated Rate	$49,258.27
Max. Negotiated Rate	$49,258.27
Rate for Payer: Hawaii Medical Service Association Commercial	$49,258.27

MAJOR BLADDER PROCEDURES WITH MCC

Facility

$49,258.27

Service Code	MSDRG 653
Min. Negotiated Rate	$49,258.27
Max. Negotiated Rate	$49,258.27
Rate for Payer: Hawaii Medical Service Association Commercial	$49,258.27

MAJOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$49,258.27

Service Code	MSDRG 655
Min. Negotiated Rate	$49,258.27
Max. Negotiated Rate	$49,258.27
Rate for Payer: Hawaii Medical Service Association Commercial	$49,258.27

MAJOR CHEST PROCEDURES WITH CC

Facility

$67,997.83

Service Code	MSDRG 164
Min. Negotiated Rate	$67,997.83
Max. Negotiated Rate	$67,997.83
Rate for Payer: Hawaii Medical Service Association Commercial	$67,997.83

MAJOR CHEST PROCEDURES WITH MCC

Facility

$68,252.79

Service Code	MSDRG 163
Min. Negotiated Rate	$68,252.79
Max. Negotiated Rate	$68,252.79
Rate for Payer: Hawaii Medical Service Association Commercial	$68,252.79

MAJOR CHEST PROCEDURES WITHOUT CC/MCC

Facility

$48,875.83

Service Code	MSDRG 165
Min. Negotiated Rate	$48,875.83
Max. Negotiated Rate	$48,875.83
Rate for Payer: Hawaii Medical Service Association Commercial	$48,875.83

MAJOR CHEST TRAUMA WITH CC

Facility

$21,263.66

Service Code	MSDRG 184
Min. Negotiated Rate	$21,263.66
Max. Negotiated Rate	$21,263.66
Rate for Payer: Hawaii Medical Service Association Commercial	$21,263.66

MAJOR CHEST TRAUMA WITH MCC

Facility

$23,150.37

Service Code	MSDRG 183
Min. Negotiated Rate	$23,150.37
Max. Negotiated Rate	$23,150.37
Rate for Payer: Hawaii Medical Service Association Commercial	$23,150.37

MAJOR CHEST TRAUMA WITHOUT CC/MCC

Facility

$20,320.31

Service Code	MSDRG 185
Min. Negotiated Rate	$20,320.31
Max. Negotiated Rate	$20,320.31
Rate for Payer: Hawaii Medical Service Association Commercial	$20,320.31

MAJOR ESOPHAGEAL DISORDERS WITH CC

Facility

$20,804.74

Service Code	MSDRG 369
Min. Negotiated Rate	$20,804.74
Max. Negotiated Rate	$20,804.74
Rate for Payer: Hawaii Medical Service Association Commercial	$20,804.74

MAJOR ESOPHAGEAL DISORDERS WITH MCC

Facility

$20,804.74

Service Code	MSDRG 368
Min. Negotiated Rate	$20,804.74
Max. Negotiated Rate	$20,804.74
Rate for Payer: Hawaii Medical Service Association Commercial	$20,804.74

MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC

Facility

$20,804.74

Service Code	MSDRG 370
Min. Negotiated Rate	$20,804.74
Max. Negotiated Rate	$20,804.74
Rate for Payer: Hawaii Medical Service Association Commercial	$20,804.74

MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC

Facility

$23,660.29

Service Code	MSDRG 372
Min. Negotiated Rate	$23,660.29
Max. Negotiated Rate	$23,660.29
Rate for Payer: Hawaii Medical Service Association Commercial	$23,660.29

MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC

Facility

$23,660.29

Service Code	MSDRG 371
Min. Negotiated Rate	$23,660.29
Max. Negotiated Rate	$23,660.29
Rate for Payer: Hawaii Medical Service Association Commercial	$23,660.29

MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC

Facility

$23,660.29

Service Code	MSDRG 373
Min. Negotiated Rate	$23,660.29
Max. Negotiated Rate	$23,660.29
Rate for Payer: Hawaii Medical Service Association Commercial	$23,660.29

MAJOR HEAD AND NECK PROCEDURES WITH CC

Facility

$54,204.50

Service Code	MSDRG 141
Min. Negotiated Rate	$54,204.50
Max. Negotiated Rate	$54,204.50
Rate for Payer: Hawaii Medical Service Association Commercial	$54,204.50

MAJOR HEAD AND NECK PROCEDURES WITH MCC

Facility

$65,983.65

Service Code	MSDRG 140
Min. Negotiated Rate	$65,983.65
Max. Negotiated Rate	$65,983.65
Rate for Payer: Hawaii Medical Service Association Commercial	$65,983.65

MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC

Facility

$30,212.76

Service Code	MSDRG 142
Min. Negotiated Rate	$30,212.76
Max. Negotiated Rate	$30,212.76
Rate for Payer: Hawaii Medical Service Association Commercial	$30,212.76

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC

Facility

$37,555.61

Service Code	MSDRG 809
Min. Negotiated Rate	$37,555.61
Max. Negotiated Rate	$37,555.61
Rate for Payer: Hawaii Medical Service Association Commercial	$37,555.61

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC

Facility

$37,555.61

Service Code	MSDRG 808
Min. Negotiated Rate	$37,555.61
Max. Negotiated Rate	$37,555.61
Rate for Payer: Hawaii Medical Service Association Commercial	$37,555.61

MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC

Facility

$37,555.61

Service Code	MSDRG 810
Min. Negotiated Rate	$37,555.61
Max. Negotiated Rate	$37,555.61
Rate for Payer: Hawaii Medical Service Association Commercial	$37,555.61

MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT

Facility

$44,057.09

Service Code	MSDRG 469
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$44,057.09
Rate for Payer: Hawaii Medical Service Association Commercial	$44,057.09
Rate for Payer: University Health Alliance Commercial	$10,400.00

MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC

Facility

$29,906.81

Service Code	MSDRG 470
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$29,906.81
Rate for Payer: Hawaii Medical Service Association Commercial	$29,906.81
Rate for Payer: University Health Alliance Commercial	$10,400.00

Know your out-of-pocket cost for care.

All Charges