Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Neuromuscular Reeducation Charges

Facility

$266.00

Service Code	HCPCS 97112 GP,CQ
Hospital Charge Code	8111697
Hospital Revenue Code	420
Min. Negotiated Rate	$226.10
Max. Negotiated Rate	$258.02
Rate for Payer: Cash Price	$172.90
Rate for Payer: Health Management Network Commercial	$226.10
Rate for Payer: Kaiser Permanente Commercial	$239.40
Rate for Payer: MDX Hawaii PPO	$258.02

Neuromuscular Reeducation Charges

Facility

$266.00

Service Code	HCPCS 97112 GP,CQ
Hospital Charge Code	8123830
Hospital Revenue Code	430
Min. Negotiated Rate	$18.58
Max. Negotiated Rate	$258.02
Rate for Payer: AlohaCare Medicaid	$133.00
Rate for Payer: AlohaCare Medicare	$133.00
Rate for Payer: Cash Price	$172.90
Rate for Payer: Cash Price	$172.90
Rate for Payer: Devoted Health Medicare	$146.30
Rate for Payer: Hawaii Medical Service Association Medicare	$133.00
Rate for Payer: Hawaii Western Management Group Commercial	$252.70
Rate for Payer: Health Management Network Commercial	$226.10
Rate for Payer: Humana Medicare	$133.00
Rate for Payer: Kaiser Permanente Commercial	$239.40
Rate for Payer: Kaiser Permanente Medicaid	$135.66
Rate for Payer: Kaiser Permanente Medicare	$133.00
Rate for Payer: MDX Hawaii PPO	$258.02
Rate for Payer: Ohana Health Plan Medicaid	$133.00
Rate for Payer: Ohana Health Plan Medicare	$133.00
Rate for Payer: UnitedHealthcare Medicaid	$18.58
Rate for Payer: UnitedHealthcare Medicare	$133.00
Rate for Payer: University Health Alliance Commercial	$193.89

Neuromuscular Reeducation Charges

Facility

$266.00

Service Code	HCPCS 97112 GP,CQ
Hospital Charge Code	8123830
Hospital Revenue Code	430
Min. Negotiated Rate	$226.10
Max. Negotiated Rate	$258.02
Rate for Payer: Cash Price	$172.90
Rate for Payer: Health Management Network Commercial	$226.10
Rate for Payer: Kaiser Permanente Commercial	$239.40
Rate for Payer: MDX Hawaii PPO	$258.02

Neuromuscular Reeducation Charges

Facility

$266.00

Service Code	HCPCS 97112 GP,CQ
Hospital Charge Code	8111697
Hospital Revenue Code	420
Min. Negotiated Rate	$18.58
Max. Negotiated Rate	$258.02
Rate for Payer: AlohaCare Medicaid	$133.00
Rate for Payer: AlohaCare Medicare	$133.00
Rate for Payer: Cash Price	$172.90
Rate for Payer: Cash Price	$172.90
Rate for Payer: Devoted Health Medicare	$146.30
Rate for Payer: Hawaii Medical Service Association Medicare	$133.00
Rate for Payer: Hawaii Western Management Group Commercial	$252.70
Rate for Payer: Health Management Network Commercial	$226.10
Rate for Payer: Humana Medicare	$133.00
Rate for Payer: Kaiser Permanente Commercial	$239.40
Rate for Payer: Kaiser Permanente Medicaid	$135.66
Rate for Payer: Kaiser Permanente Medicare	$133.00
Rate for Payer: MDX Hawaii PPO	$258.02
Rate for Payer: Ohana Health Plan Medicaid	$133.00
Rate for Payer: Ohana Health Plan Medicare	$133.00
Rate for Payer: UnitedHealthcare Medicaid	$18.58
Rate for Payer: UnitedHealthcare Medicare	$133.00
Rate for Payer: University Health Alliance Commercial	$193.89

Neuron Specific Enolase FSI

Facility

$158.00

Service Code	HCPCS 86316
Hospital Charge Code	9904291
Hospital Revenue Code	302
Min. Negotiated Rate	$134.30
Max. Negotiated Rate	$153.26
Rate for Payer: Cash Price	$102.70
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: MDX Hawaii PPO	$153.26

Neuron Specific Enolase FSI

Facility

$158.00

Service Code	HCPCS 86316
Hospital Charge Code	9904291
Hospital Revenue Code	302
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$153.26
Rate for Payer: AlohaCare Medicaid	$79.00
Rate for Payer: AlohaCare Medicare	$79.00
Rate for Payer: Cash Price	$102.70
Rate for Payer: Cash Price	$102.70
Rate for Payer: Devoted Health Medicare	$86.90
Rate for Payer: Hawaii Medical Service Association ABD	$28.76
Rate for Payer: Hawaii Medical Service Association Commercial	$26.01
Rate for Payer: Hawaii Medical Service Association Medicare	$79.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.20
Rate for Payer: Hawaii Western Management Group Commercial	$20.81
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Humana Medicare	$79.00
Rate for Payer: Kaiser Permanente Commercial	$142.20
Rate for Payer: Kaiser Permanente Medicaid	$80.58
Rate for Payer: Kaiser Permanente Medicare	$79.00
Rate for Payer: MDX Hawaii PPO	$153.26
Rate for Payer: Ohana Health Plan Medicaid	$79.00
Rate for Payer: Ohana Health Plan Medicare	$79.00
Rate for Payer: UnitedHealthcare Medicaid	$28.76
Rate for Payer: UnitedHealthcare Medicare	$79.00
Rate for Payer: University Health Alliance Commercial	$53.78

NEUROSES EXCEPT DEPRESSIVE

Facility

$10,249.39

Service Code	MSDRG 882
Min. Negotiated Rate	$10,249.39
Max. Negotiated Rate	$10,249.39
Rate for Payer: Hawaii Medical Service Association Commercial	$10,249.39

neutra phos 250-280-160 mg powder [HHSC]

Facility

$3.00

Service Code	NDC 80681017200
Hospital Charge Code	2500683
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

neutra phos 250-280-160 mg powder [HHSC]

Facility

$3.00

Service Code	NDC 60258000601
Hospital Charge Code	2500683
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

neutra phos 250-280-160 mg powder [HHSC]

Facility

$3.00

Service Code	NDC 60258000601
Hospital Charge Code	2500683
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

neutra phos 250-280-160 mg powder [HHSC]

Facility

$3.00

Service Code	NDC 80681017200
Hospital Charge Code	2500683
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

neutra phos 250-280-160 mg powder [HHSC]

Facility

$3.00

Service Code	NDC 71351001001
Hospital Charge Code	2500683
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

neutra phos 250-280-160 mg powder [HHSC]

Facility

$3.00

Service Code	NDC 71351001001
Hospital Charge Code	2500683
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

Newborn Discharge Checklist

Facility

$400.00

Service Code	HCPCS 54150
Hospital Charge Code	1666881
Hospital Revenue Code	761
Min. Negotiated Rate	$200.00
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$672.48
Rate for Payer: AlohaCare Medicare	$200.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Devoted Health Medicare	$220.00
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$5,655.00
Rate for Payer: Hawaii Medical Service Association Medicare	$200.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Hawaii Western Management Group Commercial	$380.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Humana Medicare	$200.00
Rate for Payer: Kaiser Permanente Commercial	$360.00
Rate for Payer: Kaiser Permanente Medicaid	$204.00
Rate for Payer: Kaiser Permanente Medicare	$200.00
Rate for Payer: MDX Hawaii PPO	$388.00
Rate for Payer: Ohana Health Plan Medicaid	$200.00
Rate for Payer: Ohana Health Plan Medicare	$200.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$200.00
Rate for Payer: University Health Alliance Commercial	$4,035.20

Newborn Discharge Checklist

Facility

$400.00

Service Code	HCPCS 54150
Hospital Charge Code	1666881
Hospital Revenue Code	761
Min. Negotiated Rate	$340.00
Max. Negotiated Rate	$388.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Health Management Network Commercial	$340.00
Rate for Payer: Kaiser Permanente Commercial	$360.00
Rate for Payer: MDX Hawaii PPO	$388.00

Newborn Hearing Screening ABR

Facility

$767.00

Service Code	HCPCS 92651
Hospital Charge Code	11437355
Hospital Revenue Code	471
Min. Negotiated Rate	$88.91
Max. Negotiated Rate	$743.99
Rate for Payer: AlohaCare Medicaid	$383.50
Rate for Payer: AlohaCare Medicare	$383.50
Rate for Payer: Cash Price	$498.55
Rate for Payer: Cash Price	$498.55
Rate for Payer: Devoted Health Medicare	$421.85
Rate for Payer: Hawaii Medical Service Association Commercial	$275.75
Rate for Payer: Hawaii Medical Service Association Medicare	$383.50
Rate for Payer: Hawaii Western Management Group Commercial	$728.65
Rate for Payer: Health Management Network Commercial	$651.95
Rate for Payer: Humana Medicare	$383.50
Rate for Payer: Kaiser Permanente Commercial	$690.30
Rate for Payer: Kaiser Permanente Medicaid	$391.17
Rate for Payer: Kaiser Permanente Medicare	$383.50
Rate for Payer: MDX Hawaii PPO	$743.99
Rate for Payer: Ohana Health Plan Medicaid	$383.50
Rate for Payer: Ohana Health Plan Medicare	$383.50
Rate for Payer: UnitedHealthcare Medicaid	$88.91
Rate for Payer: UnitedHealthcare Medicare	$383.50
Rate for Payer: University Health Alliance Commercial	$559.07

Newborn Hearing Screening ABR

Facility

$767.00

Service Code	HCPCS 92651
Hospital Charge Code	11437355
Hospital Revenue Code	471
Min. Negotiated Rate	$651.95
Max. Negotiated Rate	$743.99
Rate for Payer: Cash Price	$498.55
Rate for Payer: Health Management Network Commercial	$651.95
Rate for Payer: Kaiser Permanente Commercial	$690.30
Rate for Payer: MDX Hawaii PPO	$743.99

Newborn Hearing Screening OAE

Facility

$767.00

Service Code	HCPCS 92587
Hospital Charge Code	11435594
Hospital Revenue Code	471
Min. Negotiated Rate	$43.74
Max. Negotiated Rate	$743.99
Rate for Payer: AlohaCare Medicaid	$383.50
Rate for Payer: AlohaCare Medicare	$383.50
Rate for Payer: Cash Price	$498.55
Rate for Payer: Cash Price	$498.55
Rate for Payer: Devoted Health Medicare	$421.85
Rate for Payer: Hawaii Medical Service Association ABD	$43.74
Rate for Payer: Hawaii Medical Service Association Commercial	$275.75
Rate for Payer: Hawaii Medical Service Association Medicare	$383.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$47.25
Rate for Payer: Hawaii Western Management Group Commercial	$728.65
Rate for Payer: Health Management Network Commercial	$651.95
Rate for Payer: Humana Medicare	$383.50
Rate for Payer: Kaiser Permanente Commercial	$690.30
Rate for Payer: Kaiser Permanente Medicaid	$391.17
Rate for Payer: Kaiser Permanente Medicare	$383.50
Rate for Payer: MDX Hawaii PPO	$743.99
Rate for Payer: Ohana Health Plan Medicaid	$383.50
Rate for Payer: Ohana Health Plan Medicare	$383.50
Rate for Payer: UnitedHealthcare Medicaid	$43.74
Rate for Payer: UnitedHealthcare Medicare	$383.50
Rate for Payer: University Health Alliance Commercial	$559.07

Newborn Hearing Screening OAE

Facility

$767.00

Service Code	HCPCS 92587
Hospital Charge Code	11435594
Hospital Revenue Code	471
Min. Negotiated Rate	$651.95
Max. Negotiated Rate	$743.99
Rate for Payer: Cash Price	$498.55
Rate for Payer: Health Management Network Commercial	$651.95
Rate for Payer: Kaiser Permanente Commercial	$690.30
Rate for Payer: MDX Hawaii PPO	$743.99

Newborn Metabolic Screen

Facility

$396.00

Hospital Charge Code	8069132
Hospital Revenue Code	272
Min. Negotiated Rate	$198.00
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: Devoted Health Medicare	$217.80
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 Medicare	$198.00
Rate for Payer: University Health Alliance Commercial	$288.64

Newborn Metabolic Screen

Facility

$396.00

Hospital Charge Code	8069132
Hospital Revenue Code	272
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

Newborn Resuscitation Charge

Facility

$1,373.00

Service Code	HCPCS 99465
Hospital Charge Code	8268528
Hospital Revenue Code	480
Min. Negotiated Rate	$1,167.05
Max. Negotiated Rate	$1,331.81
Rate for Payer: Cash Price	$892.45
Rate for Payer: Health Management Network Commercial	$1,167.05
Rate for Payer: Kaiser Permanente Commercial	$1,235.70
Rate for Payer: MDX Hawaii PPO	$1,331.81

Newborn Resuscitation Charge

Facility

$1,373.00

Service Code	HCPCS 99465
Hospital Charge Code	8268528
Hospital Revenue Code	480
Min. Negotiated Rate	$122.74
Max. Negotiated Rate	$1,331.81
Rate for Payer: AlohaCare Medicaid	$686.50
Rate for Payer: AlohaCare Medicare	$686.50
Rate for Payer: Cash Price	$892.45
Rate for Payer: Cash Price	$892.45
Rate for Payer: Devoted Health Medicare	$755.15
Rate for Payer: Hawaii Medical Service Association Commercial	$844.08
Rate for Payer: Hawaii Medical Service Association Medicare	$686.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,304.35
Rate for Payer: Health Management Network Commercial	$1,167.05
Rate for Payer: Humana Medicare	$686.50
Rate for Payer: Kaiser Permanente Commercial	$1,235.70
Rate for Payer: Kaiser Permanente Medicaid	$700.23
Rate for Payer: Kaiser Permanente Medicare	$686.50
Rate for Payer: MDX Hawaii PPO	$1,331.81
Rate for Payer: Ohana Health Plan Medicaid	$686.50
Rate for Payer: Ohana Health Plan Medicare	$686.50
Rate for Payer: UnitedHealthcare Medicaid	$122.74
Rate for Payer: UnitedHealthcare Medicare	$686.50
Rate for Payer: University Health Alliance Commercial	$1,000.78

NEWBORN SCREENING PKU KIT CHARGE

Facility

$416.00

Hospital Charge Code	8280924
Hospital Revenue Code	272
Min. Negotiated Rate	$208.00
Max. Negotiated Rate	$403.52
Rate for Payer: AlohaCare Medicaid	$208.00
Rate for Payer: AlohaCare Medicare	$208.00
Rate for Payer: Cash Price	$270.40
Rate for Payer: Devoted Health Medicare	$228.80
Rate for Payer: Hawaii Medical Service Association Medicare	$208.00
Rate for Payer: Hawaii Western Management Group Commercial	$395.20
Rate for Payer: Health Management Network Commercial	$353.60
Rate for Payer: Humana Medicare	$208.00
Rate for Payer: Kaiser Permanente Commercial	$374.40
Rate for Payer: Kaiser Permanente Medicaid	$212.16
Rate for Payer: Kaiser Permanente Medicare	$208.00
Rate for Payer: MDX Hawaii PPO	$403.52
Rate for Payer: Ohana Health Plan Medicaid	$208.00
Rate for Payer: Ohana Health Plan Medicare	$208.00
Rate for Payer: UnitedHealthcare Medicare	$208.00
Rate for Payer: University Health Alliance Commercial	$303.22

NEWBORN SCREENING PKU KIT CHARGE

Facility

$416.00

Hospital Charge Code	8280924
Hospital Revenue Code	272
Min. Negotiated Rate	$353.60
Max. Negotiated Rate	$403.52
Rate for Payer: Cash Price	$270.40
Rate for Payer: Health Management Network Commercial	$353.60
Rate for Payer: Kaiser Permanente Commercial	$374.40
Rate for Payer: MDX Hawaii PPO	$403.52

Know your out-of-pocket cost for care.

All Charges