Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

PT Gait Training Assistant Units

Facility

$238.00

Service Code	HCPCS 97116 GP,CQ
Hospital Charge Code	8720438
Hospital Revenue Code	420
Min. Negotiated Rate	$202.30
Max. Negotiated Rate	$230.86
Rate for Payer: Cash Price	$154.70
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Kaiser Permanente Commercial	$214.20
Rate for Payer: MDX Hawaii PPO	$230.86

PT Gait Training Assistant Units

Facility

$238.00

Service Code	HCPCS 97116 GP,CQ
Hospital Charge Code	8720438
Hospital Revenue Code	420
Min. Negotiated Rate	$16.70
Max. Negotiated Rate	$230.86
Rate for Payer: AlohaCare Medicaid	$119.00
Rate for Payer: AlohaCare Medicare	$119.00
Rate for Payer: Cash Price	$154.70
Rate for Payer: Cash Price	$154.70
Rate for Payer: Devoted Health Medicare	$130.90
Rate for Payer: Hawaii Medical Service Association Medicare	$119.00
Rate for Payer: Hawaii Western Management Group Commercial	$226.10
Rate for Payer: Health Management Network Commercial	$202.30
Rate for Payer: Humana Medicare	$119.00
Rate for Payer: Kaiser Permanente Commercial	$214.20
Rate for Payer: Kaiser Permanente Medicaid	$121.38
Rate for Payer: Kaiser Permanente Medicare	$119.00
Rate for Payer: MDX Hawaii PPO	$230.86
Rate for Payer: Ohana Health Plan Medicaid	$119.00
Rate for Payer: Ohana Health Plan Medicare	$119.00
Rate for Payer: UnitedHealthcare Medicaid	$16.70
Rate for Payer: UnitedHealthcare Medicare	$119.00
Rate for Payer: University Health Alliance Commercial	$173.48

PT Group Therapy Assitant Units

Facility

$132.00

Service Code	HCPCS 97150 GP,CQ
Hospital Charge Code	8720418
Hospital Revenue Code	420
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$128.04
Rate for Payer: Cash Price	$85.80
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: Kaiser Permanente Commercial	$118.80
Rate for Payer: MDX Hawaii PPO	$128.04

PT Group Therapy Assitant Units

Facility

$132.00

Service Code	HCPCS 97150 GP,CQ
Hospital Charge Code	8720418
Hospital Revenue Code	420
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$128.04
Rate for Payer: AlohaCare Medicaid	$66.00
Rate for Payer: AlohaCare Medicare	$66.00
Rate for Payer: Cash Price	$85.80
Rate for Payer: Cash Price	$85.80
Rate for Payer: Devoted Health Medicare	$72.60
Rate for Payer: Hawaii Medical Service Association Medicare	$66.00
Rate for Payer: Hawaii Western Management Group Commercial	$125.40
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: Humana Medicare	$66.00
Rate for Payer: Kaiser Permanente Commercial	$118.80
Rate for Payer: Kaiser Permanente Medicaid	$67.32
Rate for Payer: Kaiser Permanente Medicare	$66.00
Rate for Payer: MDX Hawaii PPO	$128.04
Rate for Payer: Ohana Health Plan Medicaid	$66.00
Rate for Payer: Ohana Health Plan Medicare	$66.00
Rate for Payer: UnitedHealthcare Medicaid	$14.78
Rate for Payer: UnitedHealthcare Medicare	$66.00
Rate for Payer: University Health Alliance Commercial	$96.21

PT High Complex Units

Facility

$583.00

Service Code	HCPCS 97163 GP,CQ
Hospital Charge Code	8111852
Hospital Revenue Code	424
Min. Negotiated Rate	$106.70
Max. Negotiated Rate	$565.51
Rate for Payer: AlohaCare Medicaid	$291.50
Rate for Payer: AlohaCare Medicare	$291.50
Rate for Payer: Cash Price	$378.95
Rate for Payer: Cash Price	$378.95
Rate for Payer: Devoted Health Medicare	$320.65
Rate for Payer: Hawaii Medical Service Association Medicare	$291.50
Rate for Payer: Hawaii Western Management Group Commercial	$553.85
Rate for Payer: Health Management Network Commercial	$495.55
Rate for Payer: Humana Medicare	$291.50
Rate for Payer: Kaiser Permanente Commercial	$524.70
Rate for Payer: Kaiser Permanente Medicaid	$297.33
Rate for Payer: Kaiser Permanente Medicare	$291.50
Rate for Payer: MDX Hawaii PPO	$565.51
Rate for Payer: Ohana Health Plan Medicaid	$291.50
Rate for Payer: Ohana Health Plan Medicare	$291.50
Rate for Payer: UnitedHealthcare Medicaid	$106.70
Rate for Payer: UnitedHealthcare Medicare	$291.50
Rate for Payer: University Health Alliance Commercial	$424.95

PT High Complex Units

Facility

$583.00

Service Code	HCPCS 97163 GP,CQ
Hospital Charge Code	8111852
Hospital Revenue Code	424
Min. Negotiated Rate	$495.55
Max. Negotiated Rate	$565.51
Rate for Payer: Cash Price	$378.95
Rate for Payer: Health Management Network Commercial	$495.55
Rate for Payer: Kaiser Permanente Commercial	$524.70
Rate for Payer: MDX Hawaii PPO	$565.51

PT Hot, Cold Pack Units

Facility

$95.00

Service Code	HCPCS 97010 GP,CQ
Hospital Charge Code	1374111
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

PT Hot, Cold Pack Units

Facility

$95.00

Service Code	HCPCS 97010 GP,CQ
Hospital Charge Code	1374111
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

PT Infrared-Light Assistant Units

Facility

$45.00

Service Code	HCPCS 97026 GP,CQ
Hospital Charge Code	8735291
Hospital Revenue Code	420
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$29.25
Rate for Payer: Health Management Network Commercial	$38.25
Rate for Payer: Kaiser Permanente Commercial	$40.50
Rate for Payer: MDX Hawaii PPO	$43.65

PT Infrared-Light Assistant Units

Facility

$45.00

Service Code	HCPCS 97026 GP,CQ
Hospital Charge Code	8735291
Hospital Revenue Code	420
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$43.65
Rate for Payer: AlohaCare Medicaid	$22.50
Rate for Payer: AlohaCare Medicare	$22.50
Rate for Payer: Cash Price	$29.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Devoted Health Medicare	$24.75
Rate for Payer: Hawaii Medical Service Association Medicare	$22.50
Rate for Payer: Hawaii Western Management Group Commercial	$42.75
Rate for Payer: Health Management Network Commercial	$38.25
Rate for Payer: Humana Medicare	$22.50
Rate for Payer: Kaiser Permanente Commercial	$40.50
Rate for Payer: Kaiser Permanente Medicaid	$22.95
Rate for Payer: Kaiser Permanente Medicare	$22.50
Rate for Payer: MDX Hawaii PPO	$43.65
Rate for Payer: Ohana Health Plan Medicaid	$22.50
Rate for Payer: Ohana Health Plan Medicare	$22.50
Rate for Payer: UnitedHealthcare Medicaid	$4.50
Rate for Payer: UnitedHealthcare Medicare	$22.50
Rate for Payer: University Health Alliance Commercial	$32.80

PT Infrared Units

Facility

$45.00

Service Code	HCPCS 97026 GP,CQ
Hospital Charge Code	3470358
Hospital Revenue Code	420
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$29.25
Rate for Payer: Health Management Network Commercial	$38.25
Rate for Payer: Kaiser Permanente Commercial	$40.50
Rate for Payer: MDX Hawaii PPO	$43.65

PT Infrared Units

Facility

$45.00

Service Code	HCPCS 97026 GP,CQ
Hospital Charge Code	3470358
Hospital Revenue Code	420
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$43.65
Rate for Payer: AlohaCare Medicaid	$22.50
Rate for Payer: AlohaCare Medicare	$22.50
Rate for Payer: Cash Price	$29.25
Rate for Payer: Cash Price	$29.25
Rate for Payer: Devoted Health Medicare	$24.75
Rate for Payer: Hawaii Medical Service Association Medicare	$22.50
Rate for Payer: Hawaii Western Management Group Commercial	$42.75
Rate for Payer: Health Management Network Commercial	$38.25
Rate for Payer: Humana Medicare	$22.50
Rate for Payer: Kaiser Permanente Commercial	$40.50
Rate for Payer: Kaiser Permanente Medicaid	$22.95
Rate for Payer: Kaiser Permanente Medicare	$22.50
Rate for Payer: MDX Hawaii PPO	$43.65
Rate for Payer: Ohana Health Plan Medicaid	$22.50
Rate for Payer: Ohana Health Plan Medicare	$22.50
Rate for Payer: UnitedHealthcare Medicaid	$4.50
Rate for Payer: UnitedHealthcare Medicare	$22.50
Rate for Payer: University Health Alliance Commercial	$32.80

PT Iontophhoresis Assistant Units

Facility

$141.00

Service Code	HCPCS 97033 GP,CQ
Hospital Charge Code	8720424
Hospital Revenue Code	420
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$91.65
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Kaiser Permanente Commercial	$126.90
Rate for Payer: MDX Hawaii PPO	$136.77

PT Iontophhoresis Assistant Units

Facility

$141.00

Service Code	HCPCS 97033 GP,CQ
Hospital Charge Code	8720424
Hospital Revenue Code	420
Min. Negotiated Rate	$13.64
Max. Negotiated Rate	$136.77
Rate for Payer: AlohaCare Medicaid	$70.50
Rate for Payer: AlohaCare Medicare	$70.50
Rate for Payer: Cash Price	$91.65
Rate for Payer: Cash Price	$91.65
Rate for Payer: Devoted Health Medicare	$77.55
Rate for Payer: Hawaii Medical Service Association Medicare	$70.50
Rate for Payer: Hawaii Western Management Group Commercial	$133.95
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Humana Medicare	$70.50
Rate for Payer: Kaiser Permanente Commercial	$126.90
Rate for Payer: Kaiser Permanente Medicaid	$71.91
Rate for Payer: Kaiser Permanente Medicare	$70.50
Rate for Payer: MDX Hawaii PPO	$136.77
Rate for Payer: Ohana Health Plan Medicaid	$70.50
Rate for Payer: Ohana Health Plan Medicare	$70.50
Rate for Payer: UnitedHealthcare Medicaid	$13.64
Rate for Payer: UnitedHealthcare Medicare	$70.50
Rate for Payer: University Health Alliance Commercial	$102.77

PT Low Complex Units

Facility

$710.00

Service Code	HCPCS 97161 GP,CQ
Hospital Charge Code	8111848
Hospital Revenue Code	424
Min. Negotiated Rate	$106.70
Max. Negotiated Rate	$688.70
Rate for Payer: AlohaCare Medicaid	$355.00
Rate for Payer: AlohaCare Medicare	$355.00
Rate for Payer: Cash Price	$461.50
Rate for Payer: Cash Price	$461.50
Rate for Payer: Devoted Health Medicare	$390.50
Rate for Payer: Hawaii Medical Service Association Medicare	$355.00
Rate for Payer: Hawaii Western Management Group Commercial	$674.50
Rate for Payer: Health Management Network Commercial	$603.50
Rate for Payer: Humana Medicare	$355.00
Rate for Payer: Kaiser Permanente Commercial	$639.00
Rate for Payer: Kaiser Permanente Medicaid	$362.10
Rate for Payer: Kaiser Permanente Medicare	$355.00
Rate for Payer: MDX Hawaii PPO	$688.70
Rate for Payer: Ohana Health Plan Medicaid	$355.00
Rate for Payer: Ohana Health Plan Medicare	$355.00
Rate for Payer: UnitedHealthcare Medicaid	$106.70
Rate for Payer: UnitedHealthcare Medicare	$355.00
Rate for Payer: University Health Alliance Commercial	$517.52

PT Low Complex Units

Facility

$710.00

Service Code	HCPCS 97161 GP,CQ
Hospital Charge Code	8111848
Hospital Revenue Code	424
Min. Negotiated Rate	$603.50
Max. Negotiated Rate	$688.70
Rate for Payer: Cash Price	$461.50
Rate for Payer: Health Management Network Commercial	$603.50
Rate for Payer: Kaiser Permanente Commercial	$639.00
Rate for Payer: MDX Hawaii PPO	$688.70

PT Manual Therapy Assistant Units

Facility

$231.00

Service Code	HCPCS 97140 GP,CQ
Hospital Charge Code	8720442
Hospital Revenue Code	420
Min. Negotiated Rate	$20.55
Max. Negotiated Rate	$224.07
Rate for Payer: AlohaCare Medicaid	$115.50
Rate for Payer: AlohaCare Medicare	$115.50
Rate for Payer: Cash Price	$150.15
Rate for Payer: Cash Price	$150.15
Rate for Payer: Devoted Health Medicare	$127.05
Rate for Payer: Hawaii Medical Service Association Medicare	$115.50
Rate for Payer: Hawaii Western Management Group Commercial	$219.45
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Humana Medicare	$115.50
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: Kaiser Permanente Medicaid	$117.81
Rate for Payer: Kaiser Permanente Medicare	$115.50
Rate for Payer: MDX Hawaii PPO	$224.07
Rate for Payer: Ohana Health Plan Medicaid	$115.50
Rate for Payer: Ohana Health Plan Medicare	$115.50
Rate for Payer: UnitedHealthcare Medicaid	$20.55
Rate for Payer: UnitedHealthcare Medicare	$115.50
Rate for Payer: University Health Alliance Commercial	$168.38

PT Manual Therapy Assistant Units

Facility

$231.00

Service Code	HCPCS 97140 GP,CQ
Hospital Charge Code	8720442
Hospital Revenue Code	420
Min. Negotiated Rate	$196.35
Max. Negotiated Rate	$224.07
Rate for Payer: Cash Price	$150.15
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: MDX Hawaii PPO	$224.07

PT Massage Assistant Units

Facility

$207.00

Service Code	HCPCS 97124 GP,CQ
Hospital Charge Code	8720440
Hospital Revenue Code	420
Min. Negotiated Rate	$15.39
Max. Negotiated Rate	$200.79
Rate for Payer: AlohaCare Medicaid	$103.50
Rate for Payer: AlohaCare Medicare	$103.50
Rate for Payer: Cash Price	$134.55
Rate for Payer: Cash Price	$134.55
Rate for Payer: Devoted Health Medicare	$113.85
Rate for Payer: Hawaii Medical Service Association Medicare	$103.50
Rate for Payer: Hawaii Western Management Group Commercial	$196.65
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: Humana Medicare	$103.50
Rate for Payer: Kaiser Permanente Commercial	$186.30
Rate for Payer: Kaiser Permanente Medicaid	$105.57
Rate for Payer: Kaiser Permanente Medicare	$103.50
Rate for Payer: MDX Hawaii PPO	$200.79
Rate for Payer: Ohana Health Plan Medicaid	$103.50
Rate for Payer: Ohana Health Plan Medicare	$103.50
Rate for Payer: UnitedHealthcare Medicaid	$15.39
Rate for Payer: UnitedHealthcare Medicare	$103.50
Rate for Payer: University Health Alliance Commercial	$150.88

PT Massage Assistant Units

Facility

$207.00

Service Code	HCPCS 97124 GP,CQ
Hospital Charge Code	8720440
Hospital Revenue Code	420
Min. Negotiated Rate	$175.95
Max. Negotiated Rate	$200.79
Rate for Payer: Cash Price	$134.55
Rate for Payer: Health Management Network Commercial	$175.95
Rate for Payer: Kaiser Permanente Commercial	$186.30
Rate for Payer: MDX Hawaii PPO	$200.79

PT Mechanical Traction Assistant Units

Facility

$127.00

Service Code	HCPCS 97012 GP,CQ
Hospital Charge Code	8720392
Hospital Revenue Code	420
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$82.55
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: MDX Hawaii PPO	$123.19

PT Mechanical Traction Assistant Units

Facility

$127.00

Service Code	HCPCS 97012 GP,CQ
Hospital Charge Code	8720392
Hospital Revenue Code	420
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$123.19
Rate for Payer: AlohaCare Medicaid	$63.50
Rate for Payer: AlohaCare Medicare	$63.50
Rate for Payer: Cash Price	$82.55
Rate for Payer: Cash Price	$82.55
Rate for Payer: Devoted Health Medicare	$69.85
Rate for Payer: Hawaii Medical Service Association Medicare	$63.50
Rate for Payer: Hawaii Western Management Group Commercial	$120.65
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Humana Medicare	$63.50
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: Kaiser Permanente Medicaid	$64.77
Rate for Payer: Kaiser Permanente Medicare	$63.50
Rate for Payer: MDX Hawaii PPO	$123.19
Rate for Payer: Ohana Health Plan Medicaid	$63.50
Rate for Payer: Ohana Health Plan Medicare	$63.50
Rate for Payer: UnitedHealthcare Medicaid	$13.69
Rate for Payer: UnitedHealthcare Medicare	$63.50
Rate for Payer: University Health Alliance Commercial	$92.57

PT Mechanical Traction Units

Facility

$127.00

Service Code	HCPCS 97012 GP,CQ
Hospital Charge Code	1373912
Hospital Revenue Code	420
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$123.19
Rate for Payer: Cash Price	$82.55
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: MDX Hawaii PPO	$123.19

PT Mechanical Traction Units

Facility

$127.00

Service Code	HCPCS 97012 GP,CQ
Hospital Charge Code	1373912
Hospital Revenue Code	420
Min. Negotiated Rate	$13.69
Max. Negotiated Rate	$123.19
Rate for Payer: AlohaCare Medicaid	$63.50
Rate for Payer: AlohaCare Medicare	$63.50
Rate for Payer: Cash Price	$82.55
Rate for Payer: Cash Price	$82.55
Rate for Payer: Devoted Health Medicare	$69.85
Rate for Payer: Hawaii Medical Service Association Medicare	$63.50
Rate for Payer: Hawaii Western Management Group Commercial	$120.65
Rate for Payer: Health Management Network Commercial	$107.95
Rate for Payer: Humana Medicare	$63.50
Rate for Payer: Kaiser Permanente Commercial	$114.30
Rate for Payer: Kaiser Permanente Medicaid	$64.77
Rate for Payer: Kaiser Permanente Medicare	$63.50
Rate for Payer: MDX Hawaii PPO	$123.19
Rate for Payer: Ohana Health Plan Medicaid	$63.50
Rate for Payer: Ohana Health Plan Medicare	$63.50
Rate for Payer: UnitedHealthcare Medicaid	$13.69
Rate for Payer: UnitedHealthcare Medicare	$63.50
Rate for Payer: University Health Alliance Commercial	$92.57

PT Moderate Complex Units

Facility

$583.00

Service Code	HCPCS 97162 GP,CQ
Hospital Charge Code	8111850
Hospital Revenue Code	424
Min. Negotiated Rate	$106.70
Max. Negotiated Rate	$565.51
Rate for Payer: AlohaCare Medicaid	$291.50
Rate for Payer: AlohaCare Medicare	$291.50
Rate for Payer: Cash Price	$378.95
Rate for Payer: Cash Price	$378.95
Rate for Payer: Devoted Health Medicare	$320.65
Rate for Payer: Hawaii Medical Service Association Medicare	$291.50
Rate for Payer: Hawaii Western Management Group Commercial	$553.85
Rate for Payer: Health Management Network Commercial	$495.55
Rate for Payer: Humana Medicare	$291.50
Rate for Payer: Kaiser Permanente Commercial	$524.70
Rate for Payer: Kaiser Permanente Medicaid	$297.33
Rate for Payer: Kaiser Permanente Medicare	$291.50
Rate for Payer: MDX Hawaii PPO	$565.51
Rate for Payer: Ohana Health Plan Medicaid	$291.50
Rate for Payer: Ohana Health Plan Medicare	$291.50
Rate for Payer: UnitedHealthcare Medicaid	$106.70
Rate for Payer: UnitedHealthcare Medicare	$291.50
Rate for Payer: University Health Alliance Commercial	$424.95

Know your out-of-pocket cost for care.

All Charges