Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

OPTH RETRACTOR IRIS FLEXIBLE

Facility

$164.00

Hospital Charge Code	8348103
Hospital Revenue Code	272
Min. Negotiated Rate	$139.40
Max. Negotiated Rate	$159.08
Rate for Payer: Cash Price	$106.60
Rate for Payer: Health Management Network Commercial	$139.40
Rate for Payer: Kaiser Permanente Commercial	$147.60
Rate for Payer: MDX Hawaii PPO	$159.08

OPTH:RETROBULBAR NEEDLE 25G 1 1/2

Facility

$57.00

Hospital Charge Code	8274286
Hospital Revenue Code	272
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$37.05
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Kaiser Permanente Commercial	$51.30
Rate for Payer: MDX Hawaii PPO	$55.29

OPTH:RETROBULBAR NEEDLE 25G 1 1/2

Facility

$57.00

Hospital Charge Code	8274286
Hospital Revenue Code	272
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$55.29
Rate for Payer: AlohaCare Medicaid	$28.50
Rate for Payer: AlohaCare Medicare	$28.50
Rate for Payer: Cash Price	$37.05
Rate for Payer: Devoted Health Medicare	$31.35
Rate for Payer: Hawaii Medical Service Association Medicare	$28.50
Rate for Payer: Hawaii Western Management Group Commercial	$54.15
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Humana Medicare	$28.50
Rate for Payer: Kaiser Permanente Commercial	$51.30
Rate for Payer: Kaiser Permanente Medicaid	$29.07
Rate for Payer: Kaiser Permanente Medicare	$28.50
Rate for Payer: MDX Hawaii PPO	$55.29
Rate for Payer: Ohana Health Plan Medicaid	$28.50
Rate for Payer: Ohana Health Plan Medicare	$28.50
Rate for Payer: UnitedHealthcare Medicare	$28.50
Rate for Payer: University Health Alliance Commercial	$41.55

OPTH:SUTURE 6-0 PROLENE BLUE 1X18 P-1

Facility

$53.00

Hospital Charge Code	8550249
Hospital Revenue Code	272
Min. Negotiated Rate	$26.50
Max. Negotiated Rate	$51.41
Rate for Payer: AlohaCare Medicaid	$26.50
Rate for Payer: AlohaCare Medicare	$26.50
Rate for Payer: Cash Price	$34.45
Rate for Payer: Devoted Health Medicare	$29.15
Rate for Payer: Hawaii Medical Service Association Medicare	$26.50
Rate for Payer: Hawaii Western Management Group Commercial	$50.35
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Humana Medicare	$26.50
Rate for Payer: Kaiser Permanente Commercial	$47.70
Rate for Payer: Kaiser Permanente Medicaid	$27.03
Rate for Payer: Kaiser Permanente Medicare	$26.50
Rate for Payer: MDX Hawaii PPO	$51.41
Rate for Payer: Ohana Health Plan Medicaid	$26.50
Rate for Payer: Ohana Health Plan Medicare	$26.50
Rate for Payer: UnitedHealthcare Medicare	$26.50
Rate for Payer: University Health Alliance Commercial	$38.63

OPTH:SUTURE 6-0 PROLENE BLUE 1X18 P-1

Facility

$53.00

Hospital Charge Code	8550249
Hospital Revenue Code	272
Min. Negotiated Rate	$45.05
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$34.45
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Kaiser Permanente Commercial	$47.70
Rate for Payer: MDX Hawaii PPO	$51.41

OPTH:SUTURE CHROMIC 4-0 S-2

Facility

$136.00

Hospital Charge Code	8274305
Hospital Revenue Code	272
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$131.92
Rate for Payer: AlohaCare Medicaid	$68.00
Rate for Payer: AlohaCare Medicare	$68.00
Rate for Payer: Cash Price	$88.40
Rate for Payer: Devoted Health Medicare	$74.80
Rate for Payer: Hawaii Medical Service Association Medicare	$68.00
Rate for Payer: Hawaii Western Management Group Commercial	$129.20
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Humana Medicare	$68.00
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: Kaiser Permanente Medicaid	$69.36
Rate for Payer: Kaiser Permanente Medicare	$68.00
Rate for Payer: MDX Hawaii PPO	$131.92
Rate for Payer: Ohana Health Plan Medicaid	$68.00
Rate for Payer: Ohana Health Plan Medicare	$68.00
Rate for Payer: UnitedHealthcare Medicare	$68.00
Rate for Payer: University Health Alliance Commercial	$99.13

OPTH:SUTURE CHROMIC 4-0 S-2

Facility

$136.00

Hospital Charge Code	8274305
Hospital Revenue Code	272
Min. Negotiated Rate	$115.60
Max. Negotiated Rate	$131.92
Rate for Payer: Cash Price	$88.40
Rate for Payer: Health Management Network Commercial	$115.60
Rate for Payer: Kaiser Permanente Commercial	$122.40
Rate for Payer: MDX Hawaii PPO	$131.92

OPTH SUTURE CHROMIC 5-0 G1766K

Facility

$78.00

Hospital Charge Code	8348104
Hospital Revenue Code	272
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$75.66
Rate for Payer: AlohaCare Medicaid	$39.00
Rate for Payer: AlohaCare Medicare	$39.00
Rate for Payer: Cash Price	$50.70
Rate for Payer: Devoted Health Medicare	$42.90
Rate for Payer: Hawaii Medical Service Association Medicare	$39.00
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	$39.78
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

OPTH SUTURE CHROMIC 5-0 G1766K

Facility

$78.00

Hospital Charge Code	8348104
Hospital Revenue Code	272
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

OPTH:SUTURE CHROMIC 5-0 P-13

Facility

$28.00

Hospital Charge Code	8274306
Hospital Revenue Code	272
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$27.16
Rate for Payer: AlohaCare Medicaid	$14.00
Rate for Payer: AlohaCare Medicare	$14.00
Rate for Payer: Cash Price	$18.20
Rate for Payer: Devoted Health Medicare	$15.40
Rate for Payer: Hawaii Medical Service Association Medicare	$14.00
Rate for Payer: Hawaii Western Management Group Commercial	$26.60
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Humana Medicare	$14.00
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: Kaiser Permanente Medicaid	$14.28
Rate for Payer: Kaiser Permanente Medicare	$14.00
Rate for Payer: MDX Hawaii PPO	$27.16
Rate for Payer: Ohana Health Plan Medicaid	$14.00
Rate for Payer: Ohana Health Plan Medicare	$14.00
Rate for Payer: UnitedHealthcare Medicare	$14.00
Rate for Payer: University Health Alliance Commercial	$20.41

OPTH:SUTURE CHROMIC 5-0 P-13

Facility

$28.00

Hospital Charge Code	8274306
Hospital Revenue Code	272
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$27.16
Rate for Payer: Cash Price	$18.20
Rate for Payer: Health Management Network Commercial	$23.80
Rate for Payer: Kaiser Permanente Commercial	$25.20
Rate for Payer: MDX Hawaii PPO	$27.16

OPTH:SUTURE CHROMIC GUT 4-0

Facility

$118.00

Hospital Charge Code	8274307
Hospital Revenue Code	272
Min. Negotiated Rate	$100.30
Max. Negotiated Rate	$114.46
Rate for Payer: Cash Price	$76.70
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: MDX Hawaii PPO	$114.46

OPTH:SUTURE CHROMIC GUT 4-0

Facility

$118.00

Hospital Charge Code	8274307
Hospital Revenue Code	272
Min. Negotiated Rate	$59.00
Max. Negotiated Rate	$114.46
Rate for Payer: AlohaCare Medicaid	$59.00
Rate for Payer: AlohaCare Medicare	$59.00
Rate for Payer: Cash Price	$76.70
Rate for Payer: Devoted Health Medicare	$64.90
Rate for Payer: Hawaii Medical Service Association Medicare	$59.00
Rate for Payer: Hawaii Western Management Group Commercial	$112.10
Rate for Payer: Health Management Network Commercial	$100.30
Rate for Payer: Humana Medicare	$59.00
Rate for Payer: Kaiser Permanente Commercial	$106.20
Rate for Payer: Kaiser Permanente Medicaid	$60.18
Rate for Payer: Kaiser Permanente Medicare	$59.00
Rate for Payer: MDX Hawaii PPO	$114.46
Rate for Payer: Ohana Health Plan Medicaid	$59.00
Rate for Payer: Ohana Health Plan Medicare	$59.00
Rate for Payer: UnitedHealthcare Medicare	$59.00
Rate for Payer: University Health Alliance Commercial	$86.01

OPTH:SUTURE CHROMIC GUT 4-0, , M-2

Facility

$29.00

Hospital Charge Code	8274308
Hospital Revenue Code	272
Min. Negotiated Rate	$24.65
Max. Negotiated Rate	$28.13
Rate for Payer: Cash Price	$18.85
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Kaiser Permanente Commercial	$26.10
Rate for Payer: MDX Hawaii PPO	$28.13

OPTH:SUTURE CHROMIC GUT 4-0, , M-2

Facility

$29.00

Hospital Charge Code	8274308
Hospital Revenue Code	272
Min. Negotiated Rate	$14.50
Max. Negotiated Rate	$28.13
Rate for Payer: AlohaCare Medicaid	$14.50
Rate for Payer: AlohaCare Medicare	$14.50
Rate for Payer: Cash Price	$18.85
Rate for Payer: Devoted Health Medicare	$15.95
Rate for Payer: Hawaii Medical Service Association Medicare	$14.50
Rate for Payer: Hawaii Western Management Group Commercial	$27.55
Rate for Payer: Health Management Network Commercial	$24.65
Rate for Payer: Humana Medicare	$14.50
Rate for Payer: Kaiser Permanente Commercial	$26.10
Rate for Payer: Kaiser Permanente Medicaid	$14.79
Rate for Payer: Kaiser Permanente Medicare	$14.50
Rate for Payer: MDX Hawaii PPO	$28.13
Rate for Payer: Ohana Health Plan Medicaid	$14.50
Rate for Payer: Ohana Health Plan Medicare	$14.50
Rate for Payer: UnitedHealthcare Medicare	$14.50
Rate for Payer: University Health Alliance Commercial	$21.14

OPTH:SUTURE CHROMIC GUT 5-0

Facility

$64.00

Hospital Charge Code	8274309
Hospital Revenue Code	272
Min. Negotiated Rate	$54.40
Max. Negotiated Rate	$62.08
Rate for Payer: Cash Price	$41.60
Rate for Payer: Health Management Network Commercial	$54.40
Rate for Payer: Kaiser Permanente Commercial	$57.60
Rate for Payer: MDX Hawaii PPO	$62.08

OPTH:SUTURE CHROMIC GUT 5-0

Facility

$64.00

Hospital Charge Code	8274309
Hospital Revenue Code	272
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$62.08
Rate for Payer: AlohaCare Medicaid	$32.00
Rate for Payer: AlohaCare Medicare	$32.00
Rate for Payer: Cash Price	$41.60
Rate for Payer: Devoted Health Medicare	$35.20
Rate for Payer: Hawaii Medical Service Association Medicare	$32.00
Rate for Payer: Hawaii Western Management Group Commercial	$60.80
Rate for Payer: Health Management Network Commercial	$54.40
Rate for Payer: Humana Medicare	$32.00
Rate for Payer: Kaiser Permanente Commercial	$57.60
Rate for Payer: Kaiser Permanente Medicaid	$32.64
Rate for Payer: Kaiser Permanente Medicare	$32.00
Rate for Payer: MDX Hawaii PPO	$62.08
Rate for Payer: Ohana Health Plan Medicaid	$32.00
Rate for Payer: Ohana Health Plan Medicare	$32.00
Rate for Payer: UnitedHealthcare Medicare	$32.00
Rate for Payer: University Health Alliance Commercial	$46.65

OPTH:SUTURE CHROMIC GUT 5-0 HE-3

Facility

$87.00

Hospital Charge Code	8806355
Hospital Revenue Code	272
Min. Negotiated Rate	$73.95
Max. Negotiated Rate	$84.39
Rate for Payer: Cash Price	$56.55
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: MDX Hawaii PPO	$84.39

OPTH:SUTURE CHROMIC GUT 5-0 HE-3

Facility

$87.00

Hospital Charge Code	8806355
Hospital Revenue Code	272
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$84.39
Rate for Payer: AlohaCare Medicaid	$43.50
Rate for Payer: AlohaCare Medicare	$43.50
Rate for Payer: Cash Price	$56.55
Rate for Payer: Devoted Health Medicare	$47.85
Rate for Payer: Hawaii Medical Service Association Medicare	$43.50
Rate for Payer: Hawaii Western Management Group Commercial	$82.65
Rate for Payer: Health Management Network Commercial	$73.95
Rate for Payer: Humana Medicare	$43.50
Rate for Payer: Kaiser Permanente Commercial	$78.30
Rate for Payer: Kaiser Permanente Medicaid	$44.37
Rate for Payer: Kaiser Permanente Medicare	$43.50
Rate for Payer: MDX Hawaii PPO	$84.39
Rate for Payer: Ohana Health Plan Medicaid	$43.50
Rate for Payer: Ohana Health Plan Medicare	$43.50
Rate for Payer: UnitedHealthcare Medicare	$43.50
Rate for Payer: University Health Alliance Commercial	$63.41

OPTH:SUTURE CHROMIC GUT 7-0, G2745K

Facility

$111.00

Hospital Charge Code	8274310
Hospital Revenue Code	272
Min. Negotiated Rate	$94.35
Max. Negotiated Rate	$107.67
Rate for Payer: Cash Price	$72.15
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Kaiser Permanente Commercial	$99.90
Rate for Payer: MDX Hawaii PPO	$107.67

OPTH:SUTURE CHROMIC GUT 7-0, G2745K

Facility

$111.00

Hospital Charge Code	8274310
Hospital Revenue Code	272
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$107.67
Rate for Payer: AlohaCare Medicaid	$55.50
Rate for Payer: AlohaCare Medicare	$55.50
Rate for Payer: Cash Price	$72.15
Rate for Payer: Devoted Health Medicare	$61.05
Rate for Payer: Hawaii Medical Service Association Medicare	$55.50
Rate for Payer: Hawaii Western Management Group Commercial	$105.45
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Humana Medicare	$55.50
Rate for Payer: Kaiser Permanente Commercial	$99.90
Rate for Payer: Kaiser Permanente Medicaid	$56.61
Rate for Payer: Kaiser Permanente Medicare	$55.50
Rate for Payer: MDX Hawaii PPO	$107.67
Rate for Payer: Ohana Health Plan Medicaid	$55.50
Rate for Payer: Ohana Health Plan Medicare	$55.50
Rate for Payer: UnitedHealthcare Medicare	$55.50
Rate for Payer: University Health Alliance Commercial	$80.91

OPTH SUTURE ETHICON 6-0 NYLON C-2

Facility

$16.00

Hospital Charge Code	8998364
Hospital Revenue Code	272
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$10.40
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

OPTH SUTURE ETHICON 6-0 NYLON C-2

Facility

$16.00

Hospital Charge Code	8998364
Hospital Revenue Code	272
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$15.52
Rate for Payer: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$8.00
Rate for Payer: Cash Price	$10.40
Rate for Payer: Devoted Health Medicare	$8.80
Rate for Payer: Hawaii Medical Service Association Medicare	$8.00
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Humana Medicare	$8.00
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicare	$8.00
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: Ohana Health Plan Medicaid	$8.00
Rate for Payer: Ohana Health Plan Medicare	$8.00
Rate for Payer: UnitedHealthcare Medicare	$8.00
Rate for Payer: University Health Alliance Commercial	$11.66

OPTH SUTURE ETHICON 6-0 P-1

Facility

$36.00

Hospital Charge Code	8998365
Hospital Revenue Code	272
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$34.92
Rate for Payer: AlohaCare Medicaid	$18.00
Rate for Payer: AlohaCare Medicare	$18.00
Rate for Payer: Cash Price	$23.40
Rate for Payer: Devoted Health Medicare	$19.80
Rate for Payer: Hawaii Medical Service Association Medicare	$18.00
Rate for Payer: Hawaii Western Management Group Commercial	$34.20
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Humana Medicare	$18.00
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: Kaiser Permanente Medicaid	$18.36
Rate for Payer: Kaiser Permanente Medicare	$18.00
Rate for Payer: MDX Hawaii PPO	$34.92
Rate for Payer: Ohana Health Plan Medicaid	$18.00
Rate for Payer: Ohana Health Plan Medicare	$18.00
Rate for Payer: UnitedHealthcare Medicare	$18.00
Rate for Payer: University Health Alliance Commercial	$26.24

OPTH SUTURE ETHICON 6-0 P-1

Facility

$36.00

Hospital Charge Code	8998365
Hospital Revenue Code	272
Min. Negotiated Rate	$30.60
Max. Negotiated Rate	$34.92
Rate for Payer: Cash Price	$23.40
Rate for Payer: Health Management Network Commercial	$30.60
Rate for Payer: Kaiser Permanente Commercial	$32.40
Rate for Payer: MDX Hawaii PPO	$34.92

Know your out-of-pocket cost for care.

All Charges