Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

36000-Introduction Needle/Intracath Vein

Facility

$153.00

Service Code	HCPCS 36000
Hospital Charge Code	8080193
Hospital Revenue Code	450
Min. Negotiated Rate	$76.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$76.50
Rate for Payer: Cash Price	$99.45
Rate for Payer: Cash Price	$99.45
Rate for Payer: Cash Price	$99.45
Rate for Payer: Devoted Health Medicare	$84.15
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	$76.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$145.35
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Humana Medicare	$76.50
Rate for Payer: Kaiser Permanente Commercial	$137.70
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$76.50
Rate for Payer: MDX Hawaii PPO	$148.41
Rate for Payer: Ohana Health Plan Medicaid	$76.50
Rate for Payer: Ohana Health Plan Medicare	$76.50
Rate for Payer: UnitedHealthcare Medicare	$76.50
Rate for Payer: University Health Alliance Commercial	$111.52

36000-Introduction Needle/Intracath Vein

Facility

$153.00

Service Code	HCPCS 36000
Hospital Charge Code	8080193
Hospital Revenue Code	450
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$99.45
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Kaiser Permanente Commercial	$137.70
Rate for Payer: MDX Hawaii PPO	$148.41

36000 Place Needle In Vein Bilat Charges

Facility

$153.00

Service Code	HCPCS 36000 50
Hospital Charge Code	8221529
Hospital Revenue Code	761
Min. Negotiated Rate	$7.48
Max. Negotiated Rate	$148.41
Rate for Payer: AlohaCare Medicaid	$76.50
Rate for Payer: AlohaCare Medicare	$76.50
Rate for Payer: Cash Price	$99.45
Rate for Payer: Cash Price	$99.45
Rate for Payer: Devoted Health Medicare	$84.15
Rate for Payer: Hawaii Medical Service Association Medicare	$76.50
Rate for Payer: Hawaii Western Management Group Commercial	$145.35
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Humana Medicare	$76.50
Rate for Payer: Kaiser Permanente Commercial	$137.70
Rate for Payer: Kaiser Permanente Medicaid	$78.03
Rate for Payer: Kaiser Permanente Medicare	$76.50
Rate for Payer: MDX Hawaii PPO	$148.41
Rate for Payer: Ohana Health Plan Medicaid	$76.50
Rate for Payer: Ohana Health Plan Medicare	$76.50
Rate for Payer: UnitedHealthcare Medicaid	$7.48
Rate for Payer: UnitedHealthcare Medicare	$76.50
Rate for Payer: University Health Alliance Commercial	$111.52

36000 Place Needle In Vein Bilat Charges

Facility

$153.00

Service Code	HCPCS 36000 50
Hospital Charge Code	8221529
Hospital Revenue Code	761
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$99.45
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Kaiser Permanente Commercial	$137.70
Rate for Payer: MDX Hawaii PPO	$148.41

36000 Place Needle In Vein LT Charges

Facility

$153.00

Service Code	HCPCS 36000 LT
Hospital Charge Code	8221530
Hospital Revenue Code	761
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$99.45
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Kaiser Permanente Commercial	$137.70
Rate for Payer: MDX Hawaii PPO	$148.41

36000 Place Needle In Vein LT Charges

Facility

$153.00

Service Code	HCPCS 36000 LT
Hospital Charge Code	8221530
Hospital Revenue Code	761
Min. Negotiated Rate	$7.48
Max. Negotiated Rate	$148.41
Rate for Payer: AlohaCare Medicaid	$76.50
Rate for Payer: AlohaCare Medicare	$76.50
Rate for Payer: Cash Price	$99.45
Rate for Payer: Cash Price	$99.45
Rate for Payer: Devoted Health Medicare	$84.15
Rate for Payer: Hawaii Medical Service Association Medicare	$76.50
Rate for Payer: Hawaii Western Management Group Commercial	$145.35
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Humana Medicare	$76.50
Rate for Payer: Kaiser Permanente Commercial	$137.70
Rate for Payer: Kaiser Permanente Medicaid	$78.03
Rate for Payer: Kaiser Permanente Medicare	$76.50
Rate for Payer: MDX Hawaii PPO	$148.41
Rate for Payer: Ohana Health Plan Medicaid	$76.50
Rate for Payer: Ohana Health Plan Medicare	$76.50
Rate for Payer: UnitedHealthcare Medicaid	$7.48
Rate for Payer: UnitedHealthcare Medicare	$76.50
Rate for Payer: University Health Alliance Commercial	$111.52

36000 Place Needle In Vein RT Charges

Facility

$153.00

Service Code	HCPCS 36000 RT
Hospital Charge Code	8221531
Hospital Revenue Code	761
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$99.45
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Kaiser Permanente Commercial	$137.70
Rate for Payer: MDX Hawaii PPO	$148.41

36000 Place Needle In Vein RT Charges

Facility

$153.00

Service Code	HCPCS 36000 RT
Hospital Charge Code	8221531
Hospital Revenue Code	761
Min. Negotiated Rate	$7.48
Max. Negotiated Rate	$148.41
Rate for Payer: AlohaCare Medicaid	$76.50
Rate for Payer: AlohaCare Medicare	$76.50
Rate for Payer: Cash Price	$99.45
Rate for Payer: Cash Price	$99.45
Rate for Payer: Devoted Health Medicare	$84.15
Rate for Payer: Hawaii Medical Service Association Medicare	$76.50
Rate for Payer: Hawaii Western Management Group Commercial	$145.35
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Humana Medicare	$76.50
Rate for Payer: Kaiser Permanente Commercial	$137.70
Rate for Payer: Kaiser Permanente Medicaid	$78.03
Rate for Payer: Kaiser Permanente Medicare	$76.50
Rate for Payer: MDX Hawaii PPO	$148.41
Rate for Payer: Ohana Health Plan Medicaid	$76.50
Rate for Payer: Ohana Health Plan Medicare	$76.50
Rate for Payer: UnitedHealthcare Medicaid	$7.48
Rate for Payer: UnitedHealthcare Medicare	$76.50
Rate for Payer: University Health Alliance Commercial	$111.52

36010 Intro Sup Inf Venacav Cath Charges

Facility

$585.00

Service Code	HCPCS 36010
Hospital Charge Code	8221528
Hospital Revenue Code	761
Min. Negotiated Rate	$115.98
Max. Negotiated Rate	$7,085.00
Rate for Payer: AlohaCare Medicaid	$292.50
Rate for Payer: AlohaCare Medicare	$292.50
Rate for Payer: Cash Price	$380.25
Rate for Payer: Cash Price	$380.25
Rate for Payer: Cash Price	$380.25
Rate for Payer: Devoted Health Medicare	$321.75
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$7,085.00
Rate for Payer: Hawaii Medical Service Association Medicare	$292.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Hawaii Western Management Group Commercial	$555.75
Rate for Payer: Health Management Network Commercial	$497.25
Rate for Payer: Humana Medicare	$292.50
Rate for Payer: Kaiser Permanente Commercial	$526.50
Rate for Payer: Kaiser Permanente Medicaid	$298.35
Rate for Payer: Kaiser Permanente Medicare	$292.50
Rate for Payer: MDX Hawaii PPO	$567.45
Rate for Payer: Ohana Health Plan Medicaid	$292.50
Rate for Payer: Ohana Health Plan Medicare	$292.50
Rate for Payer: UnitedHealthcare Medicaid	$115.98
Rate for Payer: UnitedHealthcare Medicare	$292.50
Rate for Payer: University Health Alliance Commercial	$426.41

36010 Intro Sup Inf Venacav Cath Charges

Facility

$585.00

Service Code	HCPCS 36010
Hospital Charge Code	8221528
Hospital Revenue Code	761
Min. Negotiated Rate	$497.25
Max. Negotiated Rate	$567.45
Rate for Payer: Cash Price	$380.25
Rate for Payer: Health Management Network Commercial	$497.25
Rate for Payer: Kaiser Permanente Commercial	$526.50
Rate for Payer: MDX Hawaii PPO	$567.45

36400 VNPNXR <3 YEARS PHY/QHP SKILL FEMRAL/JUGLAR VEIN TechFee

Facility

$78.00

Service Code	HCPCS 36400
Hospital Charge Code	8218192
Hospital Revenue Code	450
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$39.00
Rate for Payer: Cash Price	$50.70
Rate for Payer: Cash Price	$50.70
Rate for Payer: Cash Price	$50.70
Rate for Payer: Devoted Health Medicare	$42.90
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	$39.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$74.10
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Humana Medicare	$39.00
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$39.00
Rate for Payer: MDX Hawaii PPO	$75.66
Rate for Payer: Ohana Health Plan Medicaid	$39.00
Rate for Payer: Ohana Health Plan Medicare	$39.00
Rate for Payer: UnitedHealthcare Medicare	$39.00
Rate for Payer: University Health Alliance Commercial	$56.85

36400 VNPNXR <3 YEARS PHY/QHP SKILL FEMRAL/JUGLAR VEIN TechFee

Facility

$78.00

Service Code	HCPCS 36400
Hospital Charge Code	8218192
Hospital Revenue Code	450
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$75.66
Rate for Payer: Cash Price	$50.70
Rate for Payer: Health Management Network Commercial	$66.30
Rate for Payer: Kaiser Permanente Commercial	$70.20
Rate for Payer: MDX Hawaii PPO	$75.66

36406 Bl Draw < 3 Yrs Other Vein TechFee

Facility

$80.00

Service Code	HCPCS 36406
Hospital Charge Code	8343973
Hospital Revenue Code	450
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$77.60
Rate for Payer: Cash Price	$52.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: MDX Hawaii PPO	$77.60

36406 Bl Draw < 3 Yrs Other Vein TechFee

Facility

$80.00

Service Code	HCPCS 36406
Hospital Charge Code	8343973
Hospital Revenue Code	450
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$40.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Devoted Health Medicare	$44.00
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	$40.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$76.00
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Humana Medicare	$40.00
Rate for Payer: Kaiser Permanente Commercial	$72.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$40.00
Rate for Payer: MDX Hawaii PPO	$77.60
Rate for Payer: Ohana Health Plan Medicaid	$40.00
Rate for Payer: Ohana Health Plan Medicare	$40.00
Rate for Payer: UnitedHealthcare Medicare	$40.00
Rate for Payer: University Health Alliance Commercial	$58.31

36410 Venipuncture, age 3+ by a physician, for diagnostic/therapeutic purposes

Professional

Both

$55.00

Service Code	HCPCS 36410
Hospital Charge Code	8038946
Hospital Revenue Code	975
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$50.00
Rate for Payer: AlohaCare Medicaid	$9.04
Rate for Payer: AlohaCare Medicare	$7.92
Rate for Payer: Cash Price	$35.75
Rate for Payer: Cash Price	$35.75
Rate for Payer: Devoted Health Medicare	$8.71
Rate for Payer: Hawaii Medical Service Association ABD	$9.04
Rate for Payer: Hawaii Medical Service Association Commercial	$15.37
Rate for Payer: Hawaii Medical Service Association Medicare	$7.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.04
Rate for Payer: Hawaii Western Management Group Commercial	$16.38
Rate for Payer: Health Management Network Commercial	$46.75
Rate for Payer: Kaiser Permanente Commercial	$8.71
Rate for Payer: Kaiser Permanente Medicaid	$8.71
Rate for Payer: Kaiser Permanente Medicare	$8.71
Rate for Payer: Ohana Health Plan Medicaid	$9.04
Rate for Payer: Ohana Health Plan Medicare	$7.92
Rate for Payer: UnitedHealthcare Medicaid	$9.04
Rate for Payer: UnitedHealthcare Medicare	$7.92
Rate for Payer: University Health Alliance Commercial	$50.00

36410-Venipuncture Requires Greater Than/Equal to 3 Year MD

Facility

$349.00

Service Code	HCPCS 36410
Hospital Charge Code	8080195
Hospital Revenue Code	450
Min. Negotiated Rate	$296.65
Max. Negotiated Rate	$338.53
Rate for Payer: Cash Price	$226.85
Rate for Payer: Health Management Network Commercial	$296.65
Rate for Payer: Kaiser Permanente Commercial	$314.10
Rate for Payer: MDX Hawaii PPO	$338.53

36410-Venipuncture Requires Greater Than/Equal to 3 Year MD

Facility

$349.00

Service Code	HCPCS 36410
Hospital Charge Code	8080195
Hospital Revenue Code	450
Min. Negotiated Rate	$174.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$174.50
Rate for Payer: Cash Price	$226.85
Rate for Payer: Cash Price	$226.85
Rate for Payer: Cash Price	$226.85
Rate for Payer: Devoted Health Medicare	$191.95
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	$174.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$331.55
Rate for Payer: Health Management Network Commercial	$296.65
Rate for Payer: Humana Medicare	$174.50
Rate for Payer: Kaiser Permanente Commercial	$314.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$174.50
Rate for Payer: MDX Hawaii PPO	$338.53
Rate for Payer: Ohana Health Plan Medicaid	$174.50
Rate for Payer: Ohana Health Plan Medicare	$174.50
Rate for Payer: UnitedHealthcare Medicare	$174.50
Rate for Payer: University Health Alliance Commercial	$254.39

36416 Venipuncture (Up to 2 per day) per RN

Facility

$12.00

Service Code	HCPCS 36416
Hospital Charge Code	8743027
Hospital Revenue Code	300
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$11.64
Rate for Payer: AlohaCare Medicaid	$6.00
Rate for Payer: AlohaCare Medicare	$6.00
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$6.60
Rate for Payer: Hawaii Medical Service Association Medicare	$6.00
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Humana Medicare	$6.00
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicare	$6.00
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: Ohana Health Plan Medicaid	$6.00
Rate for Payer: Ohana Health Plan Medicare	$6.00
Rate for Payer: UnitedHealthcare Medicare	$6.00
Rate for Payer: University Health Alliance Commercial	$8.75

36416 Venipuncture (Up to 2 per day) per RN

Facility

$12.00

Service Code	HCPCS 36416
Hospital Charge Code	8743027
Hospital Revenue Code	300
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: MDX Hawaii PPO	$11.64

36500 VENOUS CATHETERIZATION FOR SELECTIVE ORGAN BLOOD SAMPLING ProFee

Professional

Both

$255.00

Service Code	HCPCS 36500
Hospital Charge Code	8019307
Hospital Revenue Code	960
Min. Negotiated Rate	$107.12
Max. Negotiated Rate	$216.75
Rate for Payer: AlohaCare Medicaid	$173.34
Rate for Payer: AlohaCare Medicare	$154.15
Rate for Payer: Cash Price	$165.75
Rate for Payer: Cash Price	$165.75
Rate for Payer: Devoted Health Medicare	$169.56
Rate for Payer: Hawaii Medical Service Association Medicare	$154.15
Rate for Payer: Hawaii Western Management Group Commercial	$107.12
Rate for Payer: Health Management Network Commercial	$216.75
Rate for Payer: Kaiser Permanente Commercial	$169.56
Rate for Payer: Kaiser Permanente Medicaid	$169.56
Rate for Payer: Kaiser Permanente Medicare	$169.56
Rate for Payer: Ohana Health Plan Medicaid	$173.34
Rate for Payer: Ohana Health Plan Medicare	$154.15
Rate for Payer: UnitedHealthcare Medicaid	$173.34
Rate for Payer: UnitedHealthcare Medicare	$154.15

36510 NEWBORN UMBILICAL VEIN CATH CHARGE

Facility

$577.00

Service Code	HCPCS 36510
Hospital Charge Code	8019308
Hospital Revenue Code	761
Min. Negotiated Rate	$490.45
Max. Negotiated Rate	$559.69
Rate for Payer: Cash Price	$375.05
Rate for Payer: Health Management Network Commercial	$490.45
Rate for Payer: Kaiser Permanente Commercial	$519.30
Rate for Payer: MDX Hawaii PPO	$559.69

36510 NEWBORN UMBILICAL VEIN CATH CHARGE

Facility

$577.00

Service Code	HCPCS 36510
Hospital Charge Code	8019308
Hospital Revenue Code	761
Min. Negotiated Rate	$42.29
Max. Negotiated Rate	$559.69
Rate for Payer: AlohaCare Medicaid	$288.50
Rate for Payer: AlohaCare Medicare	$288.50
Rate for Payer: Cash Price	$375.05
Rate for Payer: Cash Price	$375.05
Rate for Payer: Devoted Health Medicare	$317.35
Rate for Payer: Hawaii Medical Service Association Medicare	$288.50
Rate for Payer: Hawaii Western Management Group Commercial	$548.15
Rate for Payer: Health Management Network Commercial	$490.45
Rate for Payer: Humana Medicare	$288.50
Rate for Payer: Kaiser Permanente Commercial	$519.30
Rate for Payer: Kaiser Permanente Medicaid	$294.27
Rate for Payer: Kaiser Permanente Medicare	$288.50
Rate for Payer: MDX Hawaii PPO	$559.69
Rate for Payer: Ohana Health Plan Medicaid	$288.50
Rate for Payer: Ohana Health Plan Medicare	$288.50
Rate for Payer: UnitedHealthcare Medicaid	$42.29
Rate for Payer: UnitedHealthcare Medicare	$288.50
Rate for Payer: University Health Alliance Commercial	$420.58

36556-Central Line Greater Than/Equal to 5 Years

Facility

$6,275.00

Service Code	HCPCS 36556
Hospital Charge Code	8080172
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$6,086.75
Rate for Payer: AlohaCare Medicaid	$672.48
Rate for Payer: AlohaCare Medicare	$3,137.50
Rate for Payer: Cash Price	$4,078.75
Rate for Payer: Cash Price	$4,078.75
Rate for Payer: Devoted Health Medicare	$3,451.25
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	$3,137.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$5,961.25
Rate for Payer: Health Management Network Commercial	$5,333.75
Rate for Payer: Humana Medicare	$3,137.50
Rate for Payer: Kaiser Permanente Commercial	$5,647.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$3,137.50
Rate for Payer: MDX Hawaii PPO	$6,086.75
Rate for Payer: Ohana Health Plan Medicaid	$3,137.50
Rate for Payer: Ohana Health Plan Medicare	$3,137.50
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$3,137.50
Rate for Payer: University Health Alliance Commercial	$4,573.85

36556-Central Line Greater Than/Equal to 5 Years

Facility

$6,275.00

Service Code	HCPCS 36556
Hospital Charge Code	8080172
Hospital Revenue Code	450
Min. Negotiated Rate	$5,333.75
Max. Negotiated Rate	$6,086.75
Rate for Payer: Cash Price	$4,078.75
Rate for Payer: Health Management Network Commercial	$5,333.75
Rate for Payer: Kaiser Permanente Commercial	$5,647.50
Rate for Payer: MDX Hawaii PPO	$6,086.75

36556 CENTRAL VENOUS CATHETER PLACE>2YR HOSP P

Facility

$5,300.00

Service Code	HCPCS 36556
Hospital Charge Code	8051032
Hospital Revenue Code	761
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$5,141.00
Rate for Payer: AlohaCare Medicaid	$672.48
Rate for Payer: AlohaCare Medicare	$2,650.00
Rate for Payer: Cash Price	$3,445.00
Rate for Payer: Cash Price	$3,445.00
Rate for Payer: Devoted Health Medicare	$2,915.00
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	$2,650.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$5,035.00
Rate for Payer: Health Management Network Commercial	$4,505.00
Rate for Payer: Humana Medicare	$2,650.00
Rate for Payer: Kaiser Permanente Commercial	$4,770.00
Rate for Payer: Kaiser Permanente Medicaid	$2,703.00
Rate for Payer: Kaiser Permanente Medicare	$2,650.00
Rate for Payer: MDX Hawaii PPO	$5,141.00
Rate for Payer: Ohana Health Plan Medicaid	$2,650.00
Rate for Payer: Ohana Health Plan Medicare	$2,650.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$2,650.00
Rate for Payer: University Health Alliance Commercial	$3,863.17

Know your out-of-pocket cost for care.

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