Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

OTHER O.R. PROCEDURES FOR INJURIES WITH CC

Facility

$47,728.51

Service Code	MSDRG 908
Min. Negotiated Rate	$47,728.51
Max. Negotiated Rate	$47,728.51
Rate for Payer: Hawaii Medical Service Association Commercial	$47,728.51

OTHER O.R. PROCEDURES FOR INJURIES WITH MCC

Facility

$51,068.49

Service Code	MSDRG 907
Min. Negotiated Rate	$51,068.49
Max. Negotiated Rate	$51,068.49
Rate for Payer: Hawaii Medical Service Association Commercial	$51,068.49

OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC

Facility

$24,731.12

Service Code	MSDRG 909
Min. Negotiated Rate	$24,731.12
Max. Negotiated Rate	$24,731.12
Rate for Payer: Hawaii Medical Service Association Commercial	$24,731.12

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC

Facility

$164,321.72

Service Code	MSDRG 958
Min. Negotiated Rate	$164,321.72
Max. Negotiated Rate	$164,321.72
Rate for Payer: Hawaii Medical Service Association Commercial	$164,321.72

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC

Facility

$164,321.72

Service Code	MSDRG 957
Min. Negotiated Rate	$164,321.72
Max. Negotiated Rate	$164,321.72
Rate for Payer: Hawaii Medical Service Association Commercial	$164,321.72

OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC

Facility

$164,321.72

Service Code	MSDRG 959
Min. Negotiated Rate	$164,321.72
Max. Negotiated Rate	$164,321.72
Rate for Payer: Hawaii Medical Service Association Commercial	$164,321.72

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC

Facility

$45,459.37

Service Code	MSDRG 803
Min. Negotiated Rate	$45,459.37
Max. Negotiated Rate	$45,459.37
Rate for Payer: Hawaii Medical Service Association Commercial	$45,459.37

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC

Facility

$45,459.37

Service Code	MSDRG 802
Min. Negotiated Rate	$45,459.37
Max. Negotiated Rate	$45,459.37
Rate for Payer: Hawaii Medical Service Association Commercial	$45,459.37

OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC

Facility

$45,459.37

Service Code	MSDRG 804
Min. Negotiated Rate	$45,459.37
Max. Negotiated Rate	$45,459.37
Rate for Payer: Hawaii Medical Service Association Commercial	$45,459.37

OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC

Facility

$22,003.05

Service Code	MSDRG 205
Min. Negotiated Rate	$22,003.05
Max. Negotiated Rate	$22,003.05
Rate for Payer: Hawaii Medical Service Association Commercial	$22,003.05

OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC

Facility

$18,969.02

Service Code	MSDRG 206
Min. Negotiated Rate	$18,969.02
Max. Negotiated Rate	$18,969.02
Rate for Payer: Hawaii Medical Service Association Commercial	$18,969.02

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC

Facility

$65,091.29

Service Code	MSDRG 167
Min. Negotiated Rate	$65,091.29
Max. Negotiated Rate	$65,091.29
Rate for Payer: Hawaii Medical Service Association Commercial	$65,091.29

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC

Facility

$68,303.78

Service Code	MSDRG 166
Min. Negotiated Rate	$68,303.78
Max. Negotiated Rate	$68,303.78
Rate for Payer: Hawaii Medical Service Association Commercial	$68,303.78

OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$46,504.70

Service Code	MSDRG 168
Min. Negotiated Rate	$46,504.70
Max. Negotiated Rate	$46,504.70
Rate for Payer: Hawaii Medical Service Association Commercial	$46,504.70

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC

Facility

$31,513.06

Service Code	MSDRG 580
Min. Negotiated Rate	$31,513.06
Max. Negotiated Rate	$31,513.06
Rate for Payer: Hawaii Medical Service Association Commercial	$31,513.06

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC

Facility

$50,354.60

Service Code	MSDRG 579
Min. Negotiated Rate	$50,354.60
Max. Negotiated Rate	$50,354.60
Rate for Payer: Hawaii Medical Service Association Commercial	$50,354.60

OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC

Facility

$25,878.44

Service Code	MSDRG 581
Min. Negotiated Rate	$25,878.44
Max. Negotiated Rate	$25,878.44
Rate for Payer: Hawaii Medical Service Association Commercial	$25,878.44

Other Thermal Charge

Facility

$95.00

Service Code	HCPCS 97010 GP,CQ
Hospital Charge Code	8111704
Hospital Revenue Code	420
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$92.15
Rate for Payer: AlohaCare Medicaid	$47.50
Rate for Payer: AlohaCare Medicare	$47.50
Rate for Payer: Cash Price	$61.75
Rate for Payer: Cash Price	$61.75
Rate for Payer: Devoted Health Medicare	$52.25
Rate for Payer: Hawaii Medical Service Association Medicare	$47.50
Rate for Payer: Hawaii Western Management Group Commercial	$90.25
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Humana Medicare	$47.50
Rate for Payer: Kaiser Permanente Commercial	$85.50
Rate for Payer: Kaiser Permanente Medicaid	$48.45
Rate for Payer: Kaiser Permanente Medicare	$47.50
Rate for Payer: MDX Hawaii PPO	$92.15
Rate for Payer: Ohana Health Plan Medicaid	$47.50
Rate for Payer: Ohana Health Plan Medicare	$47.50
Rate for Payer: UnitedHealthcare Medicaid	$10.08
Rate for Payer: UnitedHealthcare Medicare	$47.50
Rate for Payer: University Health Alliance Commercial	$69.25

Other Thermal Charge

Facility

$95.00

Service Code	HCPCS 97010 GP,CQ
Hospital Charge Code	8111704
Hospital Revenue Code	420
Min. Negotiated Rate	$80.75
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$61.75
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Kaiser Permanente Commercial	$85.50
Rate for Payer: MDX Hawaii PPO	$92.15

OTHER VASCULAR PROCEDURES WITH CC

Facility

$72,663.60

Service Code	MSDRG 253
Min. Negotiated Rate	$72,663.60
Max. Negotiated Rate	$72,663.60
Rate for Payer: Hawaii Medical Service Association Commercial	$72,663.60

OTHER VASCULAR PROCEDURES WITH MCC

Facility

$77,354.86

Service Code	MSDRG 252
Min. Negotiated Rate	$77,354.86
Max. Negotiated Rate	$77,354.86
Rate for Payer: Hawaii Medical Service Association Commercial	$77,354.86

OTHER VASCULAR PROCEDURES WITHOUT CC/MCC

Facility

$52,521.76

Service Code	MSDRG 254
Min. Negotiated Rate	$52,521.76
Max. Negotiated Rate	$52,521.76
Rate for Payer: Hawaii Medical Service Association Commercial	$52,521.76

OT High Complex Units

Facility

$604.00

Service Code	HCPCS 97167 RT,52
Hospital Charge Code	8123907
Hospital Revenue Code	434
Min. Negotiated Rate	$513.40
Max. Negotiated Rate	$585.88
Rate for Payer: Cash Price	$392.60
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Kaiser Permanente Commercial	$543.60
Rate for Payer: MDX Hawaii PPO	$585.88

OT High Complex Units

Facility

$604.00

Service Code	HCPCS 97167 RT,52
Hospital Charge Code	8123907
Hospital Revenue Code	434
Min. Negotiated Rate	$107.85
Max. Negotiated Rate	$585.88
Rate for Payer: AlohaCare Medicaid	$302.00
Rate for Payer: AlohaCare Medicare	$302.00
Rate for Payer: Cash Price	$392.60
Rate for Payer: Cash Price	$392.60
Rate for Payer: Devoted Health Medicare	$332.20
Rate for Payer: Hawaii Medical Service Association Medicare	$302.00
Rate for Payer: Hawaii Western Management Group Commercial	$573.80
Rate for Payer: Health Management Network Commercial	$513.40
Rate for Payer: Humana Medicare	$302.00
Rate for Payer: Kaiser Permanente Commercial	$543.60
Rate for Payer: Kaiser Permanente Medicaid	$308.04
Rate for Payer: Kaiser Permanente Medicare	$302.00
Rate for Payer: MDX Hawaii PPO	$585.88
Rate for Payer: Ohana Health Plan Medicaid	$302.00
Rate for Payer: Ohana Health Plan Medicare	$302.00
Rate for Payer: UnitedHealthcare Medicaid	$107.85
Rate for Payer: UnitedHealthcare Medicare	$302.00
Rate for Payer: University Health Alliance Commercial	$440.26

OT Hot, Cold Pack Assistant units

Facility

$95.00

Service Code	HCPCS 97010 GO,CO
Hospital Charge Code	8720886
Hospital Revenue Code	430
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$92.15
Rate for Payer: AlohaCare Medicaid	$47.50
Rate for Payer: AlohaCare Medicare	$47.50
Rate for Payer: Cash Price	$61.75
Rate for Payer: Cash Price	$61.75
Rate for Payer: Devoted Health Medicare	$52.25
Rate for Payer: Hawaii Medical Service Association Medicare	$47.50
Rate for Payer: Hawaii Western Management Group Commercial	$90.25
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Humana Medicare	$47.50
Rate for Payer: Kaiser Permanente Commercial	$85.50
Rate for Payer: Kaiser Permanente Medicaid	$48.45
Rate for Payer: Kaiser Permanente Medicare	$47.50
Rate for Payer: MDX Hawaii PPO	$92.15
Rate for Payer: Ohana Health Plan Medicaid	$47.50
Rate for Payer: Ohana Health Plan Medicare	$47.50
Rate for Payer: UnitedHealthcare Medicaid	$10.08
Rate for Payer: UnitedHealthcare Medicare	$47.50
Rate for Payer: University Health Alliance Commercial	$69.25

Know your out-of-pocket cost for care.

All Charges