Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

NEEDLE VERES 120MM DS SURGINEEDLE

Facility

$59.00

Hospital Charge Code	8274303
Hospital Revenue Code	272
Min. Negotiated Rate	$50.15
Max. Negotiated Rate	$57.23
Rate for Payer: Cash Price	$38.35
Rate for Payer: Health Management Network Commercial	$50.15
Rate for Payer: Kaiser Permanente Commercial	$53.10
Rate for Payer: MDX Hawaii PPO	$57.23

NEEDLE YUEH CENTESIS DISP 5FR/7CM (CT)

Facility

$137.00

Hospital Charge Code	8889999
Hospital Revenue Code	272
Min. Negotiated Rate	$68.50
Max. Negotiated Rate	$132.89
Rate for Payer: AlohaCare Medicaid	$68.50
Rate for Payer: AlohaCare Medicare	$68.50
Rate for Payer: Cash Price	$89.05
Rate for Payer: Devoted Health Medicare	$75.35
Rate for Payer: Hawaii Medical Service Association Medicare	$68.50
Rate for Payer: Hawaii Western Management Group Commercial	$130.15
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: Humana Medicare	$68.50
Rate for Payer: Kaiser Permanente Commercial	$123.30
Rate for Payer: Kaiser Permanente Medicaid	$69.87
Rate for Payer: Kaiser Permanente Medicare	$68.50
Rate for Payer: MDX Hawaii PPO	$132.89
Rate for Payer: Ohana Health Plan Medicaid	$68.50
Rate for Payer: Ohana Health Plan Medicare	$68.50
Rate for Payer: UnitedHealthcare Medicare	$68.50
Rate for Payer: University Health Alliance Commercial	$99.86

NEEDLE YUEH CENTESIS DISP 5FR/7CM (CT)

Facility

$137.00

Hospital Charge Code	8889999
Hospital Revenue Code	272
Min. Negotiated Rate	$116.45
Max. Negotiated Rate	$132.89
Rate for Payer: Cash Price	$89.05
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: Kaiser Permanente Commercial	$123.30
Rate for Payer: MDX Hawaii PPO	$132.89

NEEDLE YUEH CENTESIS DISP 5FR/7CM (US)

Facility

$133.00

Hospital Charge Code	8889998
Hospital Revenue Code	272
Min. Negotiated Rate	$113.05
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$86.45
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: MDX Hawaii PPO	$129.01

NEEDLE YUEH CENTESIS DISP 5FR/7CM (US)

Facility

$133.00

Hospital Charge Code	8889998
Hospital Revenue Code	272
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$129.01
Rate for Payer: AlohaCare Medicaid	$66.50
Rate for Payer: AlohaCare Medicare	$66.50
Rate for Payer: Cash Price	$86.45
Rate for Payer: Devoted Health Medicare	$73.15
Rate for Payer: Hawaii Medical Service Association Medicare	$66.50
Rate for Payer: Hawaii Western Management Group Commercial	$126.35
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Humana Medicare	$66.50
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: Kaiser Permanente Medicare	$66.50
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: Ohana Health Plan Medicaid	$66.50
Rate for Payer: Ohana Health Plan Medicare	$66.50
Rate for Payer: UnitedHealthcare Medicare	$66.50
Rate for Payer: University Health Alliance Commercial	$96.94

NEEDLE YUEH CENTESIS DISP 5FR/7CM (XR/MAMMO)

Facility

$133.00

Hospital Charge Code	8890000
Hospital Revenue Code	272
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$129.01
Rate for Payer: AlohaCare Medicaid	$66.50
Rate for Payer: AlohaCare Medicare	$66.50
Rate for Payer: Cash Price	$86.45
Rate for Payer: Devoted Health Medicare	$73.15
Rate for Payer: Hawaii Medical Service Association Medicare	$66.50
Rate for Payer: Hawaii Western Management Group Commercial	$126.35
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Humana Medicare	$66.50
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: Kaiser Permanente Medicare	$66.50
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: Ohana Health Plan Medicaid	$66.50
Rate for Payer: Ohana Health Plan Medicare	$66.50
Rate for Payer: UnitedHealthcare Medicare	$66.50
Rate for Payer: University Health Alliance Commercial	$96.94

NEEDLE YUEH CENTESIS DISP 5FR/7CM (XR/MAMMO)

Facility

$133.00

Hospital Charge Code	8890000
Hospital Revenue Code	272
Min. Negotiated Rate	$113.05
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$86.45
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: MDX Hawaii PPO	$129.01

NEEDLE YUEH CENTESIS DISP CATH 5FR/10CM (CT)

Facility

$133.00

Hospital Charge Code	8889567
Hospital Revenue Code	272
Min. Negotiated Rate	$113.05
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$86.45
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: MDX Hawaii PPO	$129.01

NEEDLE YUEH CENTESIS DISP CATH 5FR/10CM (CT)

Facility

$133.00

Hospital Charge Code	8889567
Hospital Revenue Code	272
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$129.01
Rate for Payer: AlohaCare Medicaid	$66.50
Rate for Payer: AlohaCare Medicare	$66.50
Rate for Payer: Cash Price	$86.45
Rate for Payer: Devoted Health Medicare	$73.15
Rate for Payer: Hawaii Medical Service Association Medicare	$66.50
Rate for Payer: Hawaii Western Management Group Commercial	$126.35
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Humana Medicare	$66.50
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: Kaiser Permanente Medicare	$66.50
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: Ohana Health Plan Medicaid	$66.50
Rate for Payer: Ohana Health Plan Medicare	$66.50
Rate for Payer: UnitedHealthcare Medicare	$66.50
Rate for Payer: University Health Alliance Commercial	$96.94

NEEDLE YUEH CENTESIS DISP CATH 5FR/10CM (US)

Facility

$137.00

Hospital Charge Code	8889566
Hospital Revenue Code	272
Min. Negotiated Rate	$116.45
Max. Negotiated Rate	$132.89
Rate for Payer: Cash Price	$89.05
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: Kaiser Permanente Commercial	$123.30
Rate for Payer: MDX Hawaii PPO	$132.89

NEEDLE YUEH CENTESIS DISP CATH 5FR/10CM (US)

Facility

$137.00

Hospital Charge Code	8889566
Hospital Revenue Code	272
Min. Negotiated Rate	$68.50
Max. Negotiated Rate	$132.89
Rate for Payer: AlohaCare Medicaid	$68.50
Rate for Payer: AlohaCare Medicare	$68.50
Rate for Payer: Cash Price	$89.05
Rate for Payer: Devoted Health Medicare	$75.35
Rate for Payer: Hawaii Medical Service Association Medicare	$68.50
Rate for Payer: Hawaii Western Management Group Commercial	$130.15
Rate for Payer: Health Management Network Commercial	$116.45
Rate for Payer: Humana Medicare	$68.50
Rate for Payer: Kaiser Permanente Commercial	$123.30
Rate for Payer: Kaiser Permanente Medicaid	$69.87
Rate for Payer: Kaiser Permanente Medicare	$68.50
Rate for Payer: MDX Hawaii PPO	$132.89
Rate for Payer: Ohana Health Plan Medicaid	$68.50
Rate for Payer: Ohana Health Plan Medicare	$68.50
Rate for Payer: UnitedHealthcare Medicare	$68.50
Rate for Payer: University Health Alliance Commercial	$99.86

NEEDLE YUEH CENTESIS DISP CATH 5FR/10CM (XR/MAMMO)

Facility

$133.00

Hospital Charge Code	8889997
Hospital Revenue Code	272
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$129.01
Rate for Payer: AlohaCare Medicaid	$66.50
Rate for Payer: AlohaCare Medicare	$66.50
Rate for Payer: Cash Price	$86.45
Rate for Payer: Devoted Health Medicare	$73.15
Rate for Payer: Hawaii Medical Service Association Medicare	$66.50
Rate for Payer: Hawaii Western Management Group Commercial	$126.35
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Humana Medicare	$66.50
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: Kaiser Permanente Medicare	$66.50
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: Ohana Health Plan Medicaid	$66.50
Rate for Payer: Ohana Health Plan Medicare	$66.50
Rate for Payer: UnitedHealthcare Medicare	$66.50
Rate for Payer: University Health Alliance Commercial	$96.94

NEEDLE YUEH CENTESIS DISP CATH 5FR/10CM (XR/MAMMO)

Facility

$133.00

Hospital Charge Code	8889997
Hospital Revenue Code	272
Min. Negotiated Rate	$113.05
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$86.45
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: MDX Hawaii PPO	$129.01

Negative Pressure Wound Tx < 50 cm

Facility

$396.00

Service Code	HCPCS 97605
Hospital Charge Code	12725160
Hospital Revenue Code	761
Min. Negotiated Rate	$336.60
Max. Negotiated Rate	$384.12
Rate for Payer: Cash Price	$257.40
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: Kaiser Permanente Commercial	$356.40
Rate for Payer: MDX Hawaii PPO	$384.12

Negative Pressure Wound Tx < 50 cm

Facility

$396.00

Service Code	HCPCS 97605
Hospital Charge Code	12725160
Hospital Revenue Code	761
Min. Negotiated Rate	$18.49
Max. Negotiated Rate	$384.12
Rate for Payer: AlohaCare Medicaid	$198.00
Rate for Payer: AlohaCare Medicare	$198.00
Rate for Payer: Cash Price	$257.40
Rate for Payer: Cash Price	$257.40
Rate for Payer: Devoted Health Medicare	$217.80
Rate for Payer: Hawaii Medical Service Association Commercial	$256.23
Rate for Payer: Hawaii Medical Service Association Medicare	$198.00
Rate for Payer: Hawaii Western Management Group Commercial	$376.20
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: Humana Medicare	$198.00
Rate for Payer: Kaiser Permanente Commercial	$356.40
Rate for Payer: Kaiser Permanente Medicaid	$201.96
Rate for Payer: Kaiser Permanente Medicare	$198.00
Rate for Payer: MDX Hawaii PPO	$384.12
Rate for Payer: Ohana Health Plan Medicaid	$198.00
Rate for Payer: Ohana Health Plan Medicare	$198.00
Rate for Payer: UnitedHealthcare Medicaid	$18.49
Rate for Payer: UnitedHealthcare Medicare	$198.00
Rate for Payer: University Health Alliance Commercial	$288.64

Negative Pressure Wound Tx > 50cm

Facility

$815.00

Service Code	HCPCS 97606
Hospital Charge Code	12740385
Hospital Revenue Code	761
Min. Negotiated Rate	$692.75
Max. Negotiated Rate	$790.55
Rate for Payer: Cash Price	$529.75
Rate for Payer: Health Management Network Commercial	$692.75
Rate for Payer: Kaiser Permanente Commercial	$733.50
Rate for Payer: MDX Hawaii PPO	$790.55

Negative Pressure Wound Tx > 50cm

Facility

$815.00

Service Code	HCPCS 97606
Hospital Charge Code	12740385
Hospital Revenue Code	761
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$790.55
Rate for Payer: AlohaCare Medicaid	$407.50
Rate for Payer: AlohaCare Medicare	$407.50
Rate for Payer: Cash Price	$529.75
Rate for Payer: Cash Price	$529.75
Rate for Payer: Devoted Health Medicare	$448.25
Rate for Payer: Hawaii Medical Service Association Commercial	$519.15
Rate for Payer: Hawaii Medical Service Association Medicare	$407.50
Rate for Payer: Hawaii Western Management Group Commercial	$774.25
Rate for Payer: Health Management Network Commercial	$692.75
Rate for Payer: Humana Medicare	$407.50
Rate for Payer: Kaiser Permanente Commercial	$733.50
Rate for Payer: Kaiser Permanente Medicaid	$415.65
Rate for Payer: Kaiser Permanente Medicare	$407.50
Rate for Payer: MDX Hawaii PPO	$790.55
Rate for Payer: Ohana Health Plan Medicaid	$407.50
Rate for Payer: Ohana Health Plan Medicare	$407.50
Rate for Payer: UnitedHealthcare Medicaid	$20.32
Rate for Payer: UnitedHealthcare Medicare	$407.50
Rate for Payer: University Health Alliance Commercial	$594.05

Neisseria gonorrheae RNA NAT Amp FSI

Facility

$490.00

Service Code	HCPCS 87591
Hospital Charge Code	8118003
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$475.30
Rate for Payer: AlohaCare Medicaid	$245.00
Rate for Payer: AlohaCare Medicare	$245.00
Rate for Payer: Cash Price	$318.50
Rate for Payer: Cash Price	$318.50
Rate for Payer: Devoted Health Medicare	$269.50
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$245.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$416.50
Rate for Payer: Humana Medicare	$245.00
Rate for Payer: Kaiser Permanente Commercial	$441.00
Rate for Payer: Kaiser Permanente Medicaid	$249.90
Rate for Payer: Kaiser Permanente Medicare	$245.00
Rate for Payer: MDX Hawaii PPO	$475.30
Rate for Payer: Ohana Health Plan Medicaid	$245.00
Rate for Payer: Ohana Health Plan Medicare	$245.00
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$245.00
Rate for Payer: University Health Alliance Commercial	$90.72

Neisseria gonorrheae RNA NAT Amp FSI

Facility

$490.00

Service Code	HCPCS 87591
Hospital Charge Code	8118003
Hospital Revenue Code	306
Min. Negotiated Rate	$416.50
Max. Negotiated Rate	$475.30
Rate for Payer: Cash Price	$318.50
Rate for Payer: Health Management Network Commercial	$416.50
Rate for Payer: Kaiser Permanente Commercial	$441.00
Rate for Payer: MDX Hawaii PPO	$475.30

Neisseria gonorrhoeae

Facility

$167.00

Service Code	HCPCS 87591
Hospital Charge Code	12516221
Hospital Revenue Code	306
Min. Negotiated Rate	$141.95
Max. Negotiated Rate	$161.99
Rate for Payer: Cash Price	$108.55
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: Kaiser Permanente Commercial	$150.30
Rate for Payer: MDX Hawaii PPO	$161.99

Neisseria gonorrhoeae

Facility

$167.00

Service Code	HCPCS 87591
Hospital Charge Code	12516221
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$161.99
Rate for Payer: Kaiser Permanente Medicaid	$85.17
Rate for Payer: AlohaCare Medicaid	$83.50
Rate for Payer: AlohaCare Medicare	$83.50
Rate for Payer: Cash Price	$108.55
Rate for Payer: Cash Price	$108.55
Rate for Payer: Devoted Health Medicare	$91.85
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$83.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$141.95
Rate for Payer: Humana Medicare	$83.50
Rate for Payer: Kaiser Permanente Commercial	$150.30
Rate for Payer: Kaiser Permanente Medicare	$83.50
Rate for Payer: MDX Hawaii PPO	$161.99
Rate for Payer: Ohana Health Plan Medicaid	$83.50
Rate for Payer: Ohana Health Plan Medicare	$83.50
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$83.50
Rate for Payer: University Health Alliance Commercial	$90.72

neomyc-bacitrac-polymyx 3.5gm ophth oint [HHSC]

Facility

$298.62

Service Code	NDC 24208078055
Hospital Charge Code	2500097
Hospital Revenue Code	250
Min. Negotiated Rate	$253.83
Max. Negotiated Rate	$289.66
Rate for Payer: Cash Price	$194.10
Rate for Payer: Health Management Network Commercial	$253.83
Rate for Payer: Kaiser Permanente Commercial	$268.76
Rate for Payer: MDX Hawaii PPO	$289.66

neomyc-bacitrac-polymyx 3.5gm ophth oint [HHSC]

Facility

$298.62

Service Code	NDC 24208078055
Hospital Charge Code	2500097
Hospital Revenue Code	250
Min. Negotiated Rate	$149.31
Max. Negotiated Rate	$289.66
Rate for Payer: AlohaCare Medicaid	$149.31
Rate for Payer: AlohaCare Medicare	$149.31
Rate for Payer: Cash Price	$194.10
Rate for Payer: Devoted Health Medicare	$164.24
Rate for Payer: Hawaii Medical Service Association Medicare	$149.31
Rate for Payer: Hawaii Western Management Group Commercial	$283.69
Rate for Payer: Health Management Network Commercial	$253.83
Rate for Payer: Humana Medicare	$149.31
Rate for Payer: Kaiser Permanente Commercial	$268.76
Rate for Payer: Kaiser Permanente Medicaid	$152.30
Rate for Payer: Kaiser Permanente Medicare	$149.31
Rate for Payer: MDX Hawaii PPO	$289.66
Rate for Payer: Ohana Health Plan Medicaid	$149.31
Rate for Payer: Ohana Health Plan Medicare	$149.31
Rate for Payer: UnitedHealthcare Medicaid	$179.17
Rate for Payer: UnitedHealthcare Medicare	$149.31
Rate for Payer: University Health Alliance Commercial	$217.66

neomyc-bacitrac-polymyx ointment 28gm [HHSC]

Facility

$19.63

Service Code	NDC 00713026831
Hospital Charge Code	2500099
Hospital Revenue Code	250
Min. Negotiated Rate	$9.81
Max. Negotiated Rate	$19.04
Rate for Payer: AlohaCare Medicaid	$9.81
Rate for Payer: AlohaCare Medicare	$9.81
Rate for Payer: Cash Price	$12.76
Rate for Payer: Devoted Health Medicare	$10.80
Rate for Payer: Hawaii Medical Service Association Medicare	$9.81
Rate for Payer: Hawaii Western Management Group Commercial	$18.65
Rate for Payer: Health Management Network Commercial	$16.69
Rate for Payer: Humana Medicare	$9.81
Rate for Payer: Kaiser Permanente Commercial	$17.67
Rate for Payer: Kaiser Permanente Medicaid	$10.01
Rate for Payer: Kaiser Permanente Medicare	$9.81
Rate for Payer: MDX Hawaii PPO	$19.04
Rate for Payer: Ohana Health Plan Medicaid	$9.81
Rate for Payer: Ohana Health Plan Medicare	$9.81
Rate for Payer: UnitedHealthcare Medicaid	$11.78
Rate for Payer: UnitedHealthcare Medicare	$9.81
Rate for Payer: University Health Alliance Commercial	$14.31

neomyc-bacitrac-polymyx ointment 28gm [HHSC]

Facility

$19.63

Service Code	NDC 00713026831
Hospital Charge Code	2500099
Hospital Revenue Code	250
Min. Negotiated Rate	$16.69
Max. Negotiated Rate	$19.04
Rate for Payer: Cash Price	$12.76
Rate for Payer: Health Management Network Commercial	$16.69
Rate for Payer: Kaiser Permanente Commercial	$17.67
Rate for Payer: MDX Hawaii PPO	$19.04

Know your out-of-pocket cost for care.

All Charges