Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

32555 Thoracentesis w/ Imaging

Facility

$2,140.00

Service Code	HCPCS 32555
Hospital Charge Code	8705582
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$1,070.00
Rate for Payer: Cash Price	$1,391.00
Rate for Payer: Cash Price	$1,391.00
Rate for Payer: Cash Price	$1,391.00
Rate for Payer: Devoted Health Medicare	$1,177.00
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	$1,070.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,033.00
Rate for Payer: Health Management Network Commercial	$1,819.00
Rate for Payer: Humana Medicare	$1,070.00
Rate for Payer: Kaiser Permanente Commercial	$1,926.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,070.00
Rate for Payer: MDX Hawaii PPO	$2,075.80
Rate for Payer: Ohana Health Plan Medicaid	$1,070.00
Rate for Payer: Ohana Health Plan Medicare	$1,070.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,070.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

32555-Thoracentesis w/ Imaging Guidance

Facility

$1,832.00

Service Code	HCPCS 32555
Hospital Charge Code	8080189
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$916.00
Rate for Payer: Cash Price	$1,190.80
Rate for Payer: Cash Price	$1,190.80
Rate for Payer: Cash Price	$1,190.80
Rate for Payer: Devoted Health Medicare	$1,007.60
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	$916.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,740.40
Rate for Payer: Health Management Network Commercial	$1,557.20
Rate for Payer: Humana Medicare	$916.00
Rate for Payer: Kaiser Permanente Commercial	$1,648.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$916.00
Rate for Payer: MDX Hawaii PPO	$1,777.04
Rate for Payer: Ohana Health Plan Medicaid	$916.00
Rate for Payer: Ohana Health Plan Medicare	$916.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$916.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

32555-Thoracentesis w/ Imaging Guidance

Facility

$1,832.00

Service Code	HCPCS 32555
Hospital Charge Code	8080189
Hospital Revenue Code	450
Min. Negotiated Rate	$1,557.20
Max. Negotiated Rate	$1,777.04
Rate for Payer: Cash Price	$1,190.80
Rate for Payer: Health Management Network Commercial	$1,557.20
Rate for Payer: Kaiser Permanente Commercial	$1,648.80
Rate for Payer: MDX Hawaii PPO	$1,777.04

32555 Thoracentesis with Imaging LT Charges

Facility

$1,832.00

Service Code	HCPCS 32555 LT
Hospital Charge Code	8221533
Hospital Revenue Code	761
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,035.20
Rate for Payer: AlohaCare Medicaid	$916.00
Rate for Payer: AlohaCare Medicare	$916.00
Rate for Payer: Cash Price	$1,190.80
Rate for Payer: Cash Price	$1,190.80
Rate for Payer: Devoted Health Medicare	$1,007.60
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	$916.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,740.40
Rate for Payer: Health Management Network Commercial	$1,557.20
Rate for Payer: Humana Medicare	$916.00
Rate for Payer: Kaiser Permanente Commercial	$1,648.80
Rate for Payer: Kaiser Permanente Medicaid	$934.32
Rate for Payer: Kaiser Permanente Medicare	$916.00
Rate for Payer: MDX Hawaii PPO	$1,777.04
Rate for Payer: Ohana Health Plan Medicaid	$916.00
Rate for Payer: Ohana Health Plan Medicare	$916.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$916.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

32555 Thoracentesis with Imaging LT Charges

Facility

$1,832.00

Service Code	HCPCS 32555 LT
Hospital Charge Code	8221533
Hospital Revenue Code	761
Min. Negotiated Rate	$1,557.20
Max. Negotiated Rate	$1,777.04
Rate for Payer: Cash Price	$1,190.80
Rate for Payer: Health Management Network Commercial	$1,557.20
Rate for Payer: Kaiser Permanente Commercial	$1,648.80
Rate for Payer: MDX Hawaii PPO	$1,777.04

32556 - Drainage, percutaneous w/o guidance

Facility

$3,408.00

Service Code	HCPCS 32556
Hospital Charge Code	10498927
Hospital Revenue Code	450
Min. Negotiated Rate	$2,896.80
Max. Negotiated Rate	$3,305.76
Rate for Payer: Cash Price	$2,215.20
Rate for Payer: Health Management Network Commercial	$2,896.80
Rate for Payer: Kaiser Permanente Commercial	$3,067.20
Rate for Payer: MDX Hawaii PPO	$3,305.76

32556 - Drainage, percutaneous w/o guidance

Facility

$3,408.00

Service Code	HCPCS 32556
Hospital Charge Code	10498927
Hospital Revenue Code	450
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$3,305.76
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$1,704.00
Rate for Payer: Cash Price	$2,215.20
Rate for Payer: Cash Price	$2,215.20
Rate for Payer: Cash Price	$2,215.20
Rate for Payer: Devoted Health Medicare	$1,874.40
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,704.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,237.60
Rate for Payer: Health Management Network Commercial	$2,896.80
Rate for Payer: Humana Medicare	$1,704.00
Rate for Payer: Kaiser Permanente Commercial	$3,067.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,704.00
Rate for Payer: MDX Hawaii PPO	$3,305.76
Rate for Payer: Ohana Health Plan Medicaid	$1,704.00
Rate for Payer: Ohana Health Plan Medicare	$1,704.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,704.00
Rate for Payer: University Health Alliance Commercial	$2,484.09

32556 PLEURAL DRAINAGE, PERCUTANEOUS, WITH INSERTION OF INDWELLING CATHETER; WITHOUT IMAGING ProFee

Professional

Both

$2,671.00

Service Code	HCPCS 32556
Hospital Charge Code	8018686
Hospital Revenue Code	987
Min. Negotiated Rate	$109.16
Max. Negotiated Rate	$2,270.35
Rate for Payer: AlohaCare Medicaid	$120.34
Rate for Payer: AlohaCare Medicare	$109.16
Rate for Payer: Cash Price	$1,736.15
Rate for Payer: Cash Price	$1,736.15
Rate for Payer: Devoted Health Medicare	$120.08
Rate for Payer: Hawaii Medical Service Association ABD	$120.34
Rate for Payer: Hawaii Medical Service Association Commercial	$204.63
Rate for Payer: Hawaii Medical Service Association Medicare	$109.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$120.34
Rate for Payer: Hawaii Western Management Group Commercial	$609.44
Rate for Payer: Health Management Network Commercial	$2,270.35
Rate for Payer: Kaiser Permanente Commercial	$120.08
Rate for Payer: Kaiser Permanente Medicaid	$120.08
Rate for Payer: Kaiser Permanente Medicare	$120.08
Rate for Payer: Ohana Health Plan Medicaid	$120.34
Rate for Payer: Ohana Health Plan Medicare	$109.16
Rate for Payer: UnitedHealthcare Medicaid	$120.34
Rate for Payer: UnitedHealthcare Medicare	$109.16
Rate for Payer: University Health Alliance Commercial	$164.44

33016 Pericardiocentesis W/Imaging

Professional

Both

$2,191.00

Service Code	HCPCS 33016
Hospital Charge Code	8881992
Hospital Revenue Code	975
Min. Negotiated Rate	$193.96
Max. Negotiated Rate	$1,862.35
Rate for Payer: AlohaCare Medicaid	$221.95
Rate for Payer: AlohaCare Medicare	$193.96
Rate for Payer: Cash Price	$1,424.15
Rate for Payer: Cash Price	$1,424.15
Rate for Payer: Devoted Health Medicare	$213.36
Rate for Payer: Hawaii Medical Service Association Medicare	$193.96
Rate for Payer: Health Management Network Commercial	$1,862.35
Rate for Payer: Kaiser Permanente Commercial	$213.36
Rate for Payer: Kaiser Permanente Medicaid	$213.36
Rate for Payer: Kaiser Permanente Medicare	$213.36
Rate for Payer: Ohana Health Plan Medicaid	$221.95
Rate for Payer: Ohana Health Plan Medicare	$193.96
Rate for Payer: UnitedHealthcare Medicaid	$221.95
Rate for Payer: UnitedHealthcare Medicare	$193.96

33016 Pericardiocentesis W/Imaging ED Tech

Facility

$7,342.00

Service Code	HCPCS 33016
Hospital Charge Code	8882006
Hospital Revenue Code	450
Min. Negotiated Rate	$6,240.70
Max. Negotiated Rate	$7,121.74
Rate for Payer: Cash Price	$4,772.30
Rate for Payer: Health Management Network Commercial	$6,240.70
Rate for Payer: Kaiser Permanente Commercial	$6,607.80
Rate for Payer: MDX Hawaii PPO	$7,121.74

33016 Pericardiocentesis W/Imaging ED Tech

Facility

$7,342.00

Service Code	HCPCS 33016
Hospital Charge Code	8882006
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$7,121.74
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$3,671.00
Rate for Payer: Cash Price	$4,772.30
Rate for Payer: Cash Price	$4,772.30
Rate for Payer: Cash Price	$4,772.30
Rate for Payer: Devoted Health Medicare	$4,038.10
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,671.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,974.90
Rate for Payer: Health Management Network Commercial	$6,240.70
Rate for Payer: Humana Medicare	$3,671.00
Rate for Payer: Kaiser Permanente Commercial	$6,607.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,671.00
Rate for Payer: MDX Hawaii PPO	$7,121.74
Rate for Payer: Ohana Health Plan Medicaid	$3,671.00
Rate for Payer: Ohana Health Plan Medicare	$3,671.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$3,671.00
Rate for Payer: University Health Alliance Commercial	$5,351.58

33016 Pericardiocentesis W/Imaging Rad ProFee

Professional

Both

$2,191.00

Service Code	HCPCS 33016
Hospital Charge Code	8882002
Hospital Revenue Code	972
Min. Negotiated Rate	$193.96
Max. Negotiated Rate	$1,862.35
Rate for Payer: AlohaCare Medicaid	$221.95
Rate for Payer: AlohaCare Medicare	$193.96
Rate for Payer: Cash Price	$1,424.15
Rate for Payer: Cash Price	$1,424.15
Rate for Payer: Devoted Health Medicare	$213.36
Rate for Payer: Hawaii Medical Service Association Medicare	$193.96
Rate for Payer: Health Management Network Commercial	$1,862.35
Rate for Payer: Kaiser Permanente Commercial	$213.36
Rate for Payer: Kaiser Permanente Medicaid	$213.36
Rate for Payer: Kaiser Permanente Medicare	$213.36
Rate for Payer: Ohana Health Plan Medicaid	$221.95
Rate for Payer: Ohana Health Plan Medicare	$193.96
Rate for Payer: UnitedHealthcare Medicaid	$221.95
Rate for Payer: UnitedHealthcare Medicare	$193.96

33017 Prcrd Drg 6Yr+ W/O Cgen Car

Professional

Both

$476.00

Service Code	HCPCS 33017
Hospital Charge Code	8881991
Hospital Revenue Code	975
Min. Negotiated Rate	$203.46
Max. Negotiated Rate	$404.60
Rate for Payer: AlohaCare Medicaid	$234.02
Rate for Payer: AlohaCare Medicare	$203.46
Rate for Payer: Cash Price	$309.40
Rate for Payer: Cash Price	$309.40
Rate for Payer: Devoted Health Medicare	$223.81
Rate for Payer: Hawaii Medical Service Association Medicare	$203.46
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: Kaiser Permanente Commercial	$223.81
Rate for Payer: Kaiser Permanente Medicaid	$223.81
Rate for Payer: Kaiser Permanente Medicare	$223.81
Rate for Payer: Ohana Health Plan Medicaid	$234.02
Rate for Payer: Ohana Health Plan Medicare	$203.46
Rate for Payer: UnitedHealthcare Medicaid	$234.02
Rate for Payer: UnitedHealthcare Medicare	$203.46

33017 Prcrd Drg 6Yr+ W/O Cgen Car ED Tech

Facility

$4,910.00

Service Code	HCPCS 33017
Hospital Charge Code	8882005
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$4,762.70
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$2,455.00
Rate for Payer: Cash Price	$3,191.50
Rate for Payer: Cash Price	$3,191.50
Rate for Payer: Cash Price	$3,191.50
Rate for Payer: Devoted Health Medicare	$2,700.50
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,455.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,664.50
Rate for Payer: Health Management Network Commercial	$4,173.50
Rate for Payer: Humana Medicare	$2,455.00
Rate for Payer: Kaiser Permanente Commercial	$4,419.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,455.00
Rate for Payer: MDX Hawaii PPO	$4,762.70
Rate for Payer: Ohana Health Plan Medicaid	$2,455.00
Rate for Payer: Ohana Health Plan Medicare	$2,455.00
Rate for Payer: UnitedHealthcare Medicare	$2,455.00
Rate for Payer: University Health Alliance Commercial	$3,578.90

33017 Prcrd Drg 6Yr+ W/O Cgen Car ED Tech

Facility

$4,910.00

Service Code	HCPCS 33017
Hospital Charge Code	8882005
Hospital Revenue Code	450
Min. Negotiated Rate	$4,173.50
Max. Negotiated Rate	$4,762.70
Rate for Payer: Cash Price	$3,191.50
Rate for Payer: Health Management Network Commercial	$4,173.50
Rate for Payer: Kaiser Permanente Commercial	$4,419.00
Rate for Payer: MDX Hawaii PPO	$4,762.70

33017 Prcrd Drg 6Yr+ W/O Cgen Car Rad ProFee

Professional

Both

$476.00

Service Code	HCPCS 33017
Hospital Charge Code	8882001
Hospital Revenue Code	972
Min. Negotiated Rate	$203.46
Max. Negotiated Rate	$404.60
Rate for Payer: AlohaCare Medicaid	$234.02
Rate for Payer: AlohaCare Medicare	$203.46
Rate for Payer: Cash Price	$309.40
Rate for Payer: Cash Price	$309.40
Rate for Payer: Devoted Health Medicare	$223.81
Rate for Payer: Hawaii Medical Service Association Medicare	$203.46
Rate for Payer: Health Management Network Commercial	$404.60
Rate for Payer: Kaiser Permanente Commercial	$223.81
Rate for Payer: Kaiser Permanente Medicaid	$223.81
Rate for Payer: Kaiser Permanente Medicare	$223.81
Rate for Payer: Ohana Health Plan Medicaid	$234.02
Rate for Payer: Ohana Health Plan Medicare	$203.46
Rate for Payer: UnitedHealthcare Medicaid	$234.02
Rate for Payer: UnitedHealthcare Medicare	$203.46

33018 Prcrd Drg 0-5Yr Or W/Anomly

Professional

Both

$545.00

Service Code	HCPCS 33018
Hospital Charge Code	8881994
Hospital Revenue Code	975
Min. Negotiated Rate	$238.18
Max. Negotiated Rate	$463.25
Rate for Payer: AlohaCare Medicaid	$272.90
Rate for Payer: AlohaCare Medicare	$238.18
Rate for Payer: Cash Price	$354.25
Rate for Payer: Cash Price	$354.25
Rate for Payer: Devoted Health Medicare	$262.00
Rate for Payer: Hawaii Medical Service Association Medicare	$238.18
Rate for Payer: Health Management Network Commercial	$463.25
Rate for Payer: Kaiser Permanente Commercial	$262.00
Rate for Payer: Kaiser Permanente Medicaid	$262.00
Rate for Payer: Kaiser Permanente Medicare	$262.00
Rate for Payer: Ohana Health Plan Medicaid	$272.90
Rate for Payer: Ohana Health Plan Medicare	$238.18
Rate for Payer: UnitedHealthcare Medicaid	$272.90
Rate for Payer: UnitedHealthcare Medicare	$238.18

33018 Prcrd Drg 0-5Yr Or W/Anomly ED Tech

Facility

$4,910.00

Service Code	HCPCS 33018
Hospital Charge Code	8882008
Hospital Revenue Code	450
Min. Negotiated Rate	$4,173.50
Max. Negotiated Rate	$4,762.70
Rate for Payer: Cash Price	$3,191.50
Rate for Payer: Health Management Network Commercial	$4,173.50
Rate for Payer: Kaiser Permanente Commercial	$4,419.00
Rate for Payer: MDX Hawaii PPO	$4,762.70

33018 Prcrd Drg 0-5Yr Or W/Anomly ED Tech

Facility

$4,910.00

Service Code	HCPCS 33018
Hospital Charge Code	8882008
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$4,762.70
Rate for Payer: Devoted Health Medicare	$2,700.50
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$2,455.00
Rate for Payer: Cash Price	$3,191.50
Rate for Payer: Cash Price	$3,191.50
Rate for Payer: Cash Price	$3,191.50
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,455.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,664.50
Rate for Payer: Health Management Network Commercial	$4,173.50
Rate for Payer: Humana Medicare	$2,455.00
Rate for Payer: Kaiser Permanente Commercial	$4,419.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,455.00
Rate for Payer: MDX Hawaii PPO	$4,762.70
Rate for Payer: Ohana Health Plan Medicaid	$2,455.00
Rate for Payer: Ohana Health Plan Medicare	$2,455.00
Rate for Payer: UnitedHealthcare Medicare	$2,455.00
Rate for Payer: University Health Alliance Commercial	$3,578.90

33018 Prcrd Drg 0-5Yr Or W/Anomly Rad ProFee

Professional

Both

$545.00

Service Code	HCPCS 33018
Hospital Charge Code	8882003
Hospital Revenue Code	972
Min. Negotiated Rate	$238.18
Max. Negotiated Rate	$463.25
Rate for Payer: AlohaCare Medicaid	$272.90
Rate for Payer: AlohaCare Medicare	$238.18
Rate for Payer: Cash Price	$354.25
Rate for Payer: Cash Price	$354.25
Rate for Payer: Devoted Health Medicare	$262.00
Rate for Payer: Hawaii Medical Service Association Medicare	$238.18
Rate for Payer: Health Management Network Commercial	$463.25
Rate for Payer: Kaiser Permanente Commercial	$262.00
Rate for Payer: Kaiser Permanente Medicaid	$262.00
Rate for Payer: Kaiser Permanente Medicare	$262.00
Rate for Payer: Ohana Health Plan Medicaid	$272.90
Rate for Payer: Ohana Health Plan Medicare	$238.18
Rate for Payer: UnitedHealthcare Medicaid	$272.90
Rate for Payer: UnitedHealthcare Medicare	$238.18

33019 Perq Prcrd Drg Insj Cath Ct

Professional

Both

$293.00

Service Code	HCPCS 33019
Hospital Charge Code	8881993
Hospital Revenue Code	975
Min. Negotiated Rate	$175.30
Max. Negotiated Rate	$249.05
Rate for Payer: AlohaCare Medicaid	$203.77
Rate for Payer: AlohaCare Medicare	$175.30
Rate for Payer: Cash Price	$190.45
Rate for Payer: Cash Price	$190.45
Rate for Payer: Devoted Health Medicare	$192.83
Rate for Payer: Hawaii Medical Service Association Medicare	$175.30
Rate for Payer: Health Management Network Commercial	$249.05
Rate for Payer: Kaiser Permanente Commercial	$192.83
Rate for Payer: Kaiser Permanente Medicaid	$192.83
Rate for Payer: Kaiser Permanente Medicare	$192.83
Rate for Payer: Ohana Health Plan Medicaid	$203.77
Rate for Payer: Ohana Health Plan Medicare	$175.30
Rate for Payer: UnitedHealthcare Medicaid	$203.77
Rate for Payer: UnitedHealthcare Medicare	$175.30

33019 Perq Prcrd Drg Insj Cath Ct ED Tech

Professional

Both

$4,676.00

Service Code	HCPCS 33019
Hospital Charge Code	8882007
Hospital Revenue Code	975
Min. Negotiated Rate	$175.30
Max. Negotiated Rate	$3,974.60
Rate for Payer: AlohaCare Medicaid	$203.77
Rate for Payer: AlohaCare Medicare	$175.30
Rate for Payer: Cash Price	$3,039.40
Rate for Payer: Cash Price	$3,039.40
Rate for Payer: Devoted Health Medicare	$192.83
Rate for Payer: Hawaii Medical Service Association Medicare	$175.30
Rate for Payer: Health Management Network Commercial	$3,974.60
Rate for Payer: Kaiser Permanente Commercial	$192.83
Rate for Payer: Kaiser Permanente Medicaid	$192.83
Rate for Payer: Kaiser Permanente Medicare	$192.83
Rate for Payer: Ohana Health Plan Medicaid	$203.77
Rate for Payer: Ohana Health Plan Medicare	$175.30
Rate for Payer: UnitedHealthcare Medicaid	$203.77
Rate for Payer: UnitedHealthcare Medicare	$175.30

33858 As-Aort Grf F/Aortic Dsj

Professional

Both

$6,546.00

Service Code	HCPCS 33858
Hospital Charge Code	8881995
Hospital Revenue Code	975
Min. Negotiated Rate	$2,994.76
Max. Negotiated Rate	$5,564.10
Rate for Payer: AlohaCare Medicaid	$3,191.54
Rate for Payer: AlohaCare Medicare	$2,994.76
Rate for Payer: Cash Price	$4,254.90
Rate for Payer: Cash Price	$4,254.90
Rate for Payer: Devoted Health Medicare	$3,294.24
Rate for Payer: Hawaii Medical Service Association Medicare	$2,994.76
Rate for Payer: Health Management Network Commercial	$5,564.10
Rate for Payer: Kaiser Permanente Commercial	$3,294.24
Rate for Payer: Kaiser Permanente Medicaid	$3,294.24
Rate for Payer: Kaiser Permanente Medicare	$3,294.24
Rate for Payer: Ohana Health Plan Medicaid	$3,191.54
Rate for Payer: Ohana Health Plan Medicare	$2,994.76
Rate for Payer: UnitedHealthcare Medicaid	$3,191.54
Rate for Payer: UnitedHealthcare Medicare	$2,994.76

33859 As-Aort Grf F/Ds Oth/Thn Dsj

Professional

Both

$4,708.00

Service Code	HCPCS 33859
Hospital Charge Code	8881996
Hospital Revenue Code	975
Min. Negotiated Rate	$2,168.04
Max. Negotiated Rate	$4,001.80
Rate for Payer: AlohaCare Medicaid	$2,299.08
Rate for Payer: AlohaCare Medicare	$2,168.04
Rate for Payer: Cash Price	$3,060.20
Rate for Payer: Cash Price	$3,060.20
Rate for Payer: Devoted Health Medicare	$2,384.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2,168.04
Rate for Payer: Health Management Network Commercial	$4,001.80
Rate for Payer: Kaiser Permanente Commercial	$2,384.84
Rate for Payer: Kaiser Permanente Medicaid	$2,384.84
Rate for Payer: Kaiser Permanente Medicare	$2,384.84
Rate for Payer: Ohana Health Plan Medicaid	$2,299.08
Rate for Payer: Ohana Health Plan Medicare	$2,168.04
Rate for Payer: UnitedHealthcare Medicaid	$2,299.08
Rate for Payer: UnitedHealthcare Medicare	$2,168.04

34502 RECONSTRUCTION OF VENA CAVA, ANY METHOD ProFee

Professional

Both

$2,534.00

Service Code	HCPCS 34502
Hospital Charge Code	8019052
Hospital Revenue Code	975
Min. Negotiated Rate	$1,329.64
Max. Negotiated Rate	$2,153.90
Rate for Payer: AlohaCare Medicaid	$1,476.67
Rate for Payer: AlohaCare Medicare	$1,365.70
Rate for Payer: Cash Price	$1,647.10
Rate for Payer: Cash Price	$1,647.10
Rate for Payer: Devoted Health Medicare	$1,502.27
Rate for Payer: Hawaii Medical Service Association Medicare	$1,365.70
Rate for Payer: Hawaii Western Management Group Commercial	$1,329.64
Rate for Payer: Health Management Network Commercial	$2,153.90
Rate for Payer: Kaiser Permanente Commercial	$1,502.27
Rate for Payer: Kaiser Permanente Medicaid	$1,502.27
Rate for Payer: Kaiser Permanente Medicare	$1,502.27
Rate for Payer: Ohana Health Plan Medicaid	$1,476.67
Rate for Payer: Ohana Health Plan Medicare	$1,365.70
Rate for Payer: UnitedHealthcare Medicaid	$1,476.67
Rate for Payer: UnitedHealthcare Medicare	$1,365.70

Know your out-of-pocket cost for care.

All Charges