Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

penicillin VK 500 mg tablet [HHSC]

Facility

$4.32

Service Code	NDC 57237004101
Hospital Charge Code	2500641
Hospital Revenue Code	250
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$4.19
Rate for Payer: Cash Price	$2.81
Rate for Payer: Health Management Network Commercial	$3.67
Rate for Payer: Kaiser Permanente Commercial	$3.89
Rate for Payer: MDX Hawaii PPO	$4.19

penicillin VK 500 mg tablet [HHSC]

Facility

$6.49

Service Code	NDC 00781165501
Hospital Charge Code	2500641
Hospital Revenue Code	250
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$6.30
Rate for Payer: AlohaCare Medicaid	$3.25
Rate for Payer: AlohaCare Medicare	$3.25
Rate for Payer: Cash Price	$4.22
Rate for Payer: Devoted Health Medicare	$3.57
Rate for Payer: Hawaii Medical Service Association Medicare	$3.25
Rate for Payer: Hawaii Western Management Group Commercial	$6.17
Rate for Payer: Health Management Network Commercial	$5.52
Rate for Payer: Humana Medicare	$3.25
Rate for Payer: Kaiser Permanente Commercial	$5.84
Rate for Payer: Kaiser Permanente Medicaid	$3.31
Rate for Payer: Kaiser Permanente Medicare	$3.25
Rate for Payer: MDX Hawaii PPO	$6.30
Rate for Payer: Ohana Health Plan Medicaid	$3.25
Rate for Payer: Ohana Health Plan Medicare	$3.25
Rate for Payer: UnitedHealthcare Medicaid	$3.89
Rate for Payer: UnitedHealthcare Medicare	$3.25
Rate for Payer: University Health Alliance Commercial	$4.73

penicillin VK 500 mg tablet [HHSC]

Facility

$6.49

Service Code	NDC 00781165501
Hospital Charge Code	2500641
Hospital Revenue Code	250
Min. Negotiated Rate	$5.52
Max. Negotiated Rate	$6.30
Rate for Payer: Cash Price	$4.22
Rate for Payer: Health Management Network Commercial	$5.52
Rate for Payer: Kaiser Permanente Commercial	$5.84
Rate for Payer: MDX Hawaii PPO	$6.30

PENIS PROCEDURES WITH CC/MCC

Facility

$26,847.29

Service Code	MSDRG 709
Min. Negotiated Rate	$26,847.29
Max. Negotiated Rate	$26,847.29
Rate for Payer: Hawaii Medical Service Association Commercial	$26,847.29

PENIS PROCEDURES WITHOUT CC/MCC

Facility

$26,847.29

Service Code	MSDRG 710
Min. Negotiated Rate	$26,847.29
Max. Negotiated Rate	$26,847.29
Rate for Payer: Hawaii Medical Service Association Commercial	$26,847.29

PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC

Facility

$57,442.49

Service Code	MSDRG 273
Min. Negotiated Rate	$57,442.49
Max. Negotiated Rate	$57,442.49
Rate for Payer: Hawaii Medical Service Association Commercial	$57,442.49

PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC

Facility

$40,436.66

Service Code	MSDRG 274
Min. Negotiated Rate	$40,436.66
Max. Negotiated Rate	$40,436.66
Rate for Payer: Hawaii Medical Service Association Commercial	$40,436.66

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES

Facility

$61,368.87

Service Code	MSDRG 321
Min. Negotiated Rate	$61,368.87
Max. Negotiated Rate	$61,368.87
Rate for Payer: Hawaii Medical Service Association Commercial	$61,368.87

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$43,547.17

Service Code	MSDRG 322
Min. Negotiated Rate	$43,547.17
Max. Negotiated Rate	$43,547.17
Rate for Payer: Hawaii Medical Service Association Commercial	$43,547.17

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC

Facility

$51,629.40

Service Code	MSDRG 250
Min. Negotiated Rate	$51,629.40
Max. Negotiated Rate	$51,629.40
Rate for Payer: Hawaii Medical Service Association Commercial	$51,629.40

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC

Facility

$38,447.97

Service Code	MSDRG 251
Min. Negotiated Rate	$38,447.97
Max. Negotiated Rate	$38,447.97
Rate for Payer: Hawaii Medical Service Association Commercial	$38,447.97

PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC

Facility

$61,368.87

Service Code	MSDRG 359
Min. Negotiated Rate	$61,368.87
Max. Negotiated Rate	$61,368.87
Rate for Payer: Hawaii Medical Service Association Commercial	$61,368.87

PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$43,547.17

Service Code	MSDRG 360
Min. Negotiated Rate	$43,547.17
Max. Negotiated Rate	$43,547.17
Rate for Payer: Hawaii Medical Service Association Commercial	$43,547.17

PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE

Facility

$51,629.40

Service Code	MSDRG 318
Min. Negotiated Rate	$51,629.40
Max. Negotiated Rate	$51,629.40
Rate for Payer: Hawaii Medical Service Association Commercial	$51,629.40

PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL

Facility

$5,655.00

Service Code	CPT 63650
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$5,655.00
Rate for Payer: AlohaCare Medicaid	$901.48
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	$521.33
Rate for Payer: University Health Alliance Commercial	$5,160.40

PERCUTANEOUS LIVER BIOPSY† - 00702

Professional

Both

$191.00

Hospital Charge Code	8970940
Hospital Revenue Code	963
Min. Negotiated Rate	$162.35
Max. Negotiated Rate	$162.35
Rate for Payer: Cash Price	$124.15
Rate for Payer: Health Management Network Commercial	$162.35

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR

Facility

$62,490.70

Service Code	MSDRG 041
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$62,490.70
Rate for Payer: Hawaii Medical Service Association Commercial	$62,490.70
Rate for Payer: University Health Alliance Commercial	$10,400.00

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC

Facility

$71,057.35

Service Code	MSDRG 040
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$71,057.35
Rate for Payer: Hawaii Medical Service Association Commercial	$71,057.35
Rate for Payer: University Health Alliance Commercial	$10,400.00

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC

Facility

$53,898.54

Service Code	MSDRG 042
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$53,898.54
Rate for Payer: Hawaii Medical Service Association Commercial	$53,898.54
Rate for Payer: University Health Alliance Commercial	$10,400.00

Peripherally Inserted Central Catheter Insertion

Facility

$3,286.00

Service Code	HCPCS 36569
Hospital Charge Code	607646
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$3,187.42
Rate for Payer: AlohaCare Medicaid	$672.48
Rate for Payer: AlohaCare Medicare	$1,643.00
Rate for Payer: Cash Price	$2,135.90
Rate for Payer: Cash Price	$2,135.90
Rate for Payer: Devoted Health Medicare	$1,807.30
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,643.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,121.70
Rate for Payer: Health Management Network Commercial	$2,793.10
Rate for Payer: Humana Medicare	$1,643.00
Rate for Payer: Kaiser Permanente Commercial	$2,957.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,643.00
Rate for Payer: MDX Hawaii PPO	$3,187.42
Rate for Payer: Ohana Health Plan Medicaid	$1,643.00
Rate for Payer: Ohana Health Plan Medicare	$1,643.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,643.00
Rate for Payer: University Health Alliance Commercial	$2,395.17

Peripherally Inserted Central Catheter Insertion

Facility

$3,286.00

Service Code	HCPCS 36569
Hospital Charge Code	607646
Hospital Revenue Code	450
Min. Negotiated Rate	$2,793.10
Max. Negotiated Rate	$3,187.42
Rate for Payer: Cash Price	$2,135.90
Rate for Payer: Health Management Network Commercial	$2,793.10
Rate for Payer: Kaiser Permanente Commercial	$2,957.40
Rate for Payer: MDX Hawaii PPO	$3,187.42

PERIPHERAL VASCULAR DISORDERS WITH CC

Facility

$26,388.36

Service Code	MSDRG 300
Min. Negotiated Rate	$26,388.36
Max. Negotiated Rate	$26,388.36
Rate for Payer: Hawaii Medical Service Association Commercial	$26,388.36

PERIPHERAL VASCULAR DISORDERS WITH MCC

Facility

$27,994.61

Service Code	MSDRG 299
Min. Negotiated Rate	$27,994.61
Max. Negotiated Rate	$27,994.61
Rate for Payer: Hawaii Medical Service Association Commercial	$27,994.61

PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC

Facility

$19,427.95

Service Code	MSDRG 301
Min. Negotiated Rate	$19,427.95
Max. Negotiated Rate	$19,427.95
Rate for Payer: Hawaii Medical Service Association Commercial	$19,427.95

PERITONEAL ADHESIOLYSIS WITH CC

Facility

$57,442.49

Service Code	MSDRG 336
Min. Negotiated Rate	$57,442.49
Max. Negotiated Rate	$57,442.49
Rate for Payer: Hawaii Medical Service Association Commercial	$57,442.49

Know your out-of-pocket cost for care.

All Charges