Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

oseltamivir 75 mg capsule [HHSC]

Facility

$82.76

Service Code	NDC 70710101002
Hospital Charge Code	2500619
Hospital Revenue Code	250
Min. Negotiated Rate	$41.38
Max. Negotiated Rate	$80.28
Rate for Payer: AlohaCare Medicaid	$41.38
Rate for Payer: AlohaCare Medicare	$41.38
Rate for Payer: Cash Price	$53.79
Rate for Payer: Devoted Health Medicare	$45.52
Rate for Payer: Hawaii Medical Service Association Medicare	$41.38
Rate for Payer: Hawaii Western Management Group Commercial	$78.62
Rate for Payer: Health Management Network Commercial	$70.35
Rate for Payer: Humana Medicare	$41.38
Rate for Payer: Kaiser Permanente Commercial	$74.48
Rate for Payer: Kaiser Permanente Medicaid	$42.21
Rate for Payer: Kaiser Permanente Medicare	$41.38
Rate for Payer: MDX Hawaii PPO	$80.28
Rate for Payer: Ohana Health Plan Medicaid	$41.38
Rate for Payer: Ohana Health Plan Medicare	$41.38
Rate for Payer: UnitedHealthcare Medicaid	$49.66
Rate for Payer: UnitedHealthcare Medicare	$41.38
Rate for Payer: University Health Alliance Commercial	$60.32

oseltamivir 75 mg capsule [HHSC]

Facility

$82.76

Service Code	NDC 70710101002
Hospital Charge Code	2500619
Hospital Revenue Code	250
Min. Negotiated Rate	$70.35
Max. Negotiated Rate	$80.28
Rate for Payer: Cash Price	$53.79
Rate for Payer: Health Management Network Commercial	$70.35
Rate for Payer: Kaiser Permanente Commercial	$74.48
Rate for Payer: MDX Hawaii PPO	$80.28

oseltamivir 75 mg capsule [HHSC]

Facility

$94.33

Service Code	NDC 00004080085
Hospital Charge Code	2500619
Hospital Revenue Code	250
Min. Negotiated Rate	$47.16
Max. Negotiated Rate	$91.50
Rate for Payer: AlohaCare Medicaid	$47.16
Rate for Payer: AlohaCare Medicare	$47.16
Rate for Payer: Cash Price	$61.31
Rate for Payer: Devoted Health Medicare	$51.88
Rate for Payer: Hawaii Medical Service Association Medicare	$47.16
Rate for Payer: Hawaii Western Management Group Commercial	$89.61
Rate for Payer: Health Management Network Commercial	$80.18
Rate for Payer: Humana Medicare	$47.16
Rate for Payer: Kaiser Permanente Commercial	$84.90
Rate for Payer: Kaiser Permanente Medicaid	$48.11
Rate for Payer: Kaiser Permanente Medicare	$47.16
Rate for Payer: MDX Hawaii PPO	$91.50
Rate for Payer: Ohana Health Plan Medicaid	$47.16
Rate for Payer: Ohana Health Plan Medicare	$47.16
Rate for Payer: UnitedHealthcare Medicaid	$56.60
Rate for Payer: UnitedHealthcare Medicare	$47.16
Rate for Payer: University Health Alliance Commercial	$68.76

Osmolality, Serum FSI

Facility

$100.00

Service Code	HCPCS 83930
Hospital Charge Code	8118006
Hospital Revenue Code	301
Min. Negotiated Rate	$6.61
Max. Negotiated Rate	$97.00
Rate for Payer: AlohaCare Medicaid	$50.00
Rate for Payer: AlohaCare Medicare	$50.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Devoted Health Medicare	$55.00
Rate for Payer: Hawaii Medical Service Association ABD	$9.13
Rate for Payer: Hawaii Medical Service Association Commercial	$8.26
Rate for Payer: Hawaii Medical Service Association Medicare	$50.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.59
Rate for Payer: Hawaii Western Management Group Commercial	$6.61
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: Humana Medicare	$50.00
Rate for Payer: Kaiser Permanente Commercial	$90.00
Rate for Payer: Kaiser Permanente Medicaid	$51.00
Rate for Payer: Kaiser Permanente Medicare	$50.00
Rate for Payer: MDX Hawaii PPO	$97.00
Rate for Payer: Ohana Health Plan Medicaid	$50.00
Rate for Payer: Ohana Health Plan Medicare	$50.00
Rate for Payer: UnitedHealthcare Medicaid	$9.13
Rate for Payer: UnitedHealthcare Medicare	$50.00
Rate for Payer: University Health Alliance Commercial	$17.09

Osmolality, Serum FSI

Facility

$100.00

Service Code	HCPCS 83930
Hospital Charge Code	8118006
Hospital Revenue Code	301
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: Kaiser Permanente Commercial	$90.00
Rate for Payer: MDX Hawaii PPO	$97.00

Osmolality (Ur) REF

Facility

$96.00

Service Code	HCPCS 83935
Hospital Charge Code	8159981
Hospital Revenue Code	301
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$93.12
Rate for Payer: AlohaCare Medicaid	$48.00
Rate for Payer: AlohaCare Medicare	$48.00
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Devoted Health Medicare	$52.80
Rate for Payer: Hawaii Medical Service Association ABD	$9.42
Rate for Payer: Hawaii Medical Service Association Commercial	$8.53
Rate for Payer: Hawaii Medical Service Association Medicare	$48.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.89
Rate for Payer: Hawaii Western Management Group Commercial	$6.82
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Humana Medicare	$48.00
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: Kaiser Permanente Medicare	$48.00
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: Ohana Health Plan Medicaid	$48.00
Rate for Payer: Ohana Health Plan Medicare	$48.00
Rate for Payer: UnitedHealthcare Medicaid	$9.42
Rate for Payer: UnitedHealthcare Medicare	$48.00
Rate for Payer: University Health Alliance Commercial	$17.61

Osmolality (Ur) REF

Facility

$96.00

Service Code	HCPCS 83935
Hospital Charge Code	8159981
Hospital Revenue Code	301
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$62.40
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$86.40
Rate for Payer: MDX Hawaii PPO	$93.12

OSTECTOMY, CALCANEUS;

Facility

$10,679.55

Service Code	CPT 28118
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$10,679.55
Rate for Payer: AlohaCare Medicaid	$1,379.34
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 Non-ABD	$700.72
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: University Health Alliance Commercial	$10,679.55

OSTECTOMY, PARTIAL, EXOSTECTOMY OR CONDYLECTOMY, METATARSAL HEAD, EACH METATARSAL HEAD

Facility

$6,743.44

Service Code	CPT 28288
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,743.44
Rate for Payer: AlohaCare Medicaid	$1,030.55
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 Non-ABD	$700.72
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: University Health Alliance Commercial	$6,743.44

OSTEOMYELITIS WITH CC

Facility

$41,966.42

Service Code	MSDRG 540
Min. Negotiated Rate	$41,966.42
Max. Negotiated Rate	$41,966.42
Rate for Payer: Hawaii Medical Service Association Commercial	$41,966.42

OSTEOMYELITIS WITH MCC

Facility

$41,966.42

Service Code	MSDRG 539
Min. Negotiated Rate	$41,966.42
Max. Negotiated Rate	$41,966.42
Rate for Payer: Hawaii Medical Service Association Commercial	$41,966.42

OSTEOMYELITIS WITHOUT CC/MCC

Facility

$41,966.42

Service Code	MSDRG 541
Min. Negotiated Rate	$41,966.42
Max. Negotiated Rate	$41,966.42
Rate for Payer: Hawaii Medical Service Association Commercial	$41,966.42

OT ADL Training Assist Units

Facility

$220.00

Service Code	HCPCS 97535 GO,CO
Hospital Charge Code	8743910
Hospital Revenue Code	430
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$213.40
Rate for Payer: AlohaCare Medicaid	$110.00
Rate for Payer: AlohaCare Medicare	$110.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Devoted Health Medicare	$121.00
Rate for Payer: Hawaii Medical Service Association Medicare	$110.00
Rate for Payer: Hawaii Western Management Group Commercial	$209.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Humana Medicare	$110.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: Kaiser Permanente Medicaid	$112.20
Rate for Payer: Kaiser Permanente Medicare	$110.00
Rate for Payer: MDX Hawaii PPO	$213.40
Rate for Payer: Ohana Health Plan Medicaid	$110.00
Rate for Payer: Ohana Health Plan Medicare	$110.00
Rate for Payer: UnitedHealthcare Medicaid	$19.20
Rate for Payer: UnitedHealthcare Medicare	$110.00
Rate for Payer: University Health Alliance Commercial	$160.36

OT ADL Training Assist Units

Facility

$220.00

Service Code	HCPCS 97535 GO,CO
Hospital Charge Code	8743910
Hospital Revenue Code	430
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$143.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: MDX Hawaii PPO	$213.40

OT ADL Training Charges

Facility

$220.00

Service Code	HCPCS 97535 GP,CQ
Hospital Charge Code	1366372
Hospital Revenue Code	430
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$213.40
Rate for Payer: AlohaCare Medicaid	$110.00
Rate for Payer: AlohaCare Medicare	$110.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Devoted Health Medicare	$121.00
Rate for Payer: Hawaii Medical Service Association Medicare	$110.00
Rate for Payer: Hawaii Western Management Group Commercial	$209.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Humana Medicare	$110.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: Kaiser Permanente Medicaid	$112.20
Rate for Payer: Kaiser Permanente Medicare	$110.00
Rate for Payer: MDX Hawaii PPO	$213.40
Rate for Payer: Ohana Health Plan Medicaid	$110.00
Rate for Payer: Ohana Health Plan Medicare	$110.00
Rate for Payer: UnitedHealthcare Medicaid	$19.20
Rate for Payer: UnitedHealthcare Medicare	$110.00
Rate for Payer: University Health Alliance Commercial	$160.36

OT ADL Training Charges

Facility

$220.00

Service Code	HCPCS 97535 GP,CQ
Hospital Charge Code	1366372
Hospital Revenue Code	430
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$143.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: MDX Hawaii PPO	$213.40

OT Attended E-Stim Assistant Units

Facility

$112.00

Service Code	HCPCS 97032 GO,CO
Hospital Charge Code	8720925
Hospital Revenue Code	430
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$108.64
Rate for Payer: Cash Price	$72.80
Rate for Payer: Health Management Network Commercial	$95.20
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: MDX Hawaii PPO	$108.64

OT Attended E-Stim Assistant Units

Facility

$112.00

Service Code	HCPCS 97032 GO,CO
Hospital Charge Code	8720925
Hospital Revenue Code	430
Min. Negotiated Rate	$13.64
Max. Negotiated Rate	$108.64
Rate for Payer: AlohaCare Medicaid	$56.00
Rate for Payer: AlohaCare Medicare	$56.00
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cash Price	$72.80
Rate for Payer: Devoted Health Medicare	$61.60
Rate for Payer: Hawaii Medical Service Association Medicare	$56.00
Rate for Payer: Hawaii Western Management Group Commercial	$106.40
Rate for Payer: Health Management Network Commercial	$95.20
Rate for Payer: Humana Medicare	$56.00
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: Kaiser Permanente Medicaid	$57.12
Rate for Payer: Kaiser Permanente Medicare	$56.00
Rate for Payer: MDX Hawaii PPO	$108.64
Rate for Payer: Ohana Health Plan Medicaid	$56.00
Rate for Payer: Ohana Health Plan Medicare	$56.00
Rate for Payer: UnitedHealthcare Medicaid	$13.64
Rate for Payer: UnitedHealthcare Medicare	$56.00
Rate for Payer: University Health Alliance Commercial	$81.64

OT Cognitive Function Charge

Facility

$155.00

Service Code	HCPCS 97129 LT,26
Hospital Charge Code	8123921
Hospital Revenue Code	430
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$100.75
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: MDX Hawaii PPO	$150.35

OT Cognitive Function Charge

Facility

$155.00

Service Code	HCPCS 97129 LT,26
Hospital Charge Code	8123921
Hospital Revenue Code	430
Min. Negotiated Rate	$22.57
Max. Negotiated Rate	$150.35
Rate for Payer: AlohaCare Medicaid	$77.50
Rate for Payer: AlohaCare Medicare	$77.50
Rate for Payer: Cash Price	$100.75
Rate for Payer: Cash Price	$100.75
Rate for Payer: Devoted Health Medicare	$85.25
Rate for Payer: Hawaii Medical Service Association Medicare	$77.50
Rate for Payer: Hawaii Western Management Group Commercial	$147.25
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Humana Medicare	$77.50
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: Kaiser Permanente Medicare	$77.50
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: Ohana Health Plan Medicaid	$77.50
Rate for Payer: Ohana Health Plan Medicare	$77.50
Rate for Payer: UnitedHealthcare Medicaid	$22.57
Rate for Payer: UnitedHealthcare Medicare	$77.50
Rate for Payer: University Health Alliance Commercial	$112.98

OT Cognitive Skills Development Units

Facility

$155.00

Service Code	HCPCS 97129 LT,26
Hospital Charge Code	1373452
Hospital Revenue Code	430
Min. Negotiated Rate	$22.57
Max. Negotiated Rate	$150.35
Rate for Payer: AlohaCare Medicaid	$77.50
Rate for Payer: AlohaCare Medicare	$77.50
Rate for Payer: Cash Price	$100.75
Rate for Payer: Cash Price	$100.75
Rate for Payer: Devoted Health Medicare	$85.25
Rate for Payer: Hawaii Medical Service Association Medicare	$77.50
Rate for Payer: Hawaii Western Management Group Commercial	$147.25
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Humana Medicare	$77.50
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: Kaiser Permanente Medicaid	$79.05
Rate for Payer: Kaiser Permanente Medicare	$77.50
Rate for Payer: MDX Hawaii PPO	$150.35
Rate for Payer: Ohana Health Plan Medicaid	$77.50
Rate for Payer: Ohana Health Plan Medicare	$77.50
Rate for Payer: UnitedHealthcare Medicaid	$22.57
Rate for Payer: UnitedHealthcare Medicare	$77.50
Rate for Payer: University Health Alliance Commercial	$112.98

OT Cognitive Skills Development Units

Facility

$155.00

Service Code	HCPCS 97129 LT,26
Hospital Charge Code	1373452
Hospital Revenue Code	430
Min. Negotiated Rate	$131.75
Max. Negotiated Rate	$150.35
Rate for Payer: Cash Price	$100.75
Rate for Payer: Health Management Network Commercial	$131.75
Rate for Payer: Kaiser Permanente Commercial	$139.50
Rate for Payer: MDX Hawaii PPO	$150.35

OT Cog Ther Intervent, Addl 15 Min Asst

Facility

$149.00

Service Code	HCPCS 97130 GO,CO
Hospital Charge Code	8740073
Hospital Revenue Code	430
Min. Negotiated Rate	$126.65
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$96.85
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Kaiser Permanente Commercial	$134.10
Rate for Payer: MDX Hawaii PPO	$144.53

OT Cog Ther Intervent, Addl 15 Min Asst

Facility

$149.00

Service Code	HCPCS 97130 GO,CO
Hospital Charge Code	8740074
Hospital Revenue Code	430
Min. Negotiated Rate	$21.52
Max. Negotiated Rate	$144.53
Rate for Payer: AlohaCare Medicaid	$74.50
Rate for Payer: AlohaCare Medicare	$74.50
Rate for Payer: Cash Price	$96.85
Rate for Payer: Cash Price	$96.85
Rate for Payer: Devoted Health Medicare	$81.95
Rate for Payer: Hawaii Medical Service Association Medicare	$74.50
Rate for Payer: Hawaii Western Management Group Commercial	$141.55
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Humana Medicare	$74.50
Rate for Payer: Kaiser Permanente Commercial	$134.10
Rate for Payer: Kaiser Permanente Medicaid	$75.99
Rate for Payer: Kaiser Permanente Medicare	$74.50
Rate for Payer: MDX Hawaii PPO	$144.53
Rate for Payer: Ohana Health Plan Medicaid	$74.50
Rate for Payer: Ohana Health Plan Medicare	$74.50
Rate for Payer: UnitedHealthcare Medicaid	$21.52
Rate for Payer: UnitedHealthcare Medicare	$74.50
Rate for Payer: University Health Alliance Commercial	$108.61

OT Cog Ther Intervent, Addl 15 Min Asst

Facility

$149.00

Service Code	HCPCS 97130 GO,CO
Hospital Charge Code	8740073
Hospital Revenue Code	430
Min. Negotiated Rate	$21.52
Max. Negotiated Rate	$144.53
Rate for Payer: AlohaCare Medicaid	$74.50
Rate for Payer: AlohaCare Medicare	$74.50
Rate for Payer: Cash Price	$96.85
Rate for Payer: Cash Price	$96.85
Rate for Payer: Devoted Health Medicare	$81.95
Rate for Payer: Hawaii Medical Service Association Medicare	$74.50
Rate for Payer: Hawaii Western Management Group Commercial	$141.55
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Humana Medicare	$74.50
Rate for Payer: Kaiser Permanente Commercial	$134.10
Rate for Payer: Kaiser Permanente Medicaid	$75.99
Rate for Payer: Kaiser Permanente Medicare	$74.50
Rate for Payer: MDX Hawaii PPO	$144.53
Rate for Payer: Ohana Health Plan Medicaid	$74.50
Rate for Payer: Ohana Health Plan Medicare	$74.50
Rate for Payer: UnitedHealthcare Medicaid	$21.52
Rate for Payer: UnitedHealthcare Medicare	$74.50
Rate for Payer: University Health Alliance Commercial	$108.61

Know your out-of-pocket cost for care.

All Charges