Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

RBC 2 Units FSI

Facility

$339.00

Service Code	HCPCS 86920
Hospital Charge Code	11641969
Hospital Revenue Code	305
Min. Negotiated Rate	$288.15
Max. Negotiated Rate	$328.83
Rate for Payer: Cash Price	$220.35
Rate for Payer: Health Management Network Commercial	$288.15
Rate for Payer: Kaiser Permanente Commercial	$305.10
Rate for Payer: MDX Hawaii PPO	$328.83

RBC Antigens 1

Facility

$24.00

Service Code	HCPCS 86905
Hospital Charge Code	12539056
Hospital Revenue Code	302
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$15.60
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Kaiser Permanente Commercial	$21.60
Rate for Payer: MDX Hawaii PPO	$23.28

RBC Antigens 1

Facility

$24.00

Service Code	HCPCS 86905
Hospital Charge Code	12539056
Hospital Revenue Code	302
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$23.28
Rate for Payer: AlohaCare Medicaid	$12.00
Rate for Payer: AlohaCare Medicare	$12.00
Rate for Payer: Cash Price	$15.60
Rate for Payer: Cash Price	$15.60
Rate for Payer: Devoted Health Medicare	$13.20
Rate for Payer: Hawaii Medical Service Association ABD	$5.28
Rate for Payer: Hawaii Medical Service Association Commercial	$4.79
Rate for Payer: Hawaii Medical Service Association Medicare	$12.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.54
Rate for Payer: Hawaii Western Management Group Commercial	$3.83
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Humana Medicare	$12.00
Rate for Payer: Kaiser Permanente Commercial	$21.60
Rate for Payer: Kaiser Permanente Medicaid	$12.24
Rate for Payer: Kaiser Permanente Medicare	$12.00
Rate for Payer: MDX Hawaii PPO	$23.28
Rate for Payer: Ohana Health Plan Medicaid	$12.00
Rate for Payer: Ohana Health Plan Medicare	$12.00
Rate for Payer: UnitedHealthcare Medicaid	$5.28
Rate for Payer: UnitedHealthcare Medicare	$12.00
Rate for Payer: University Health Alliance Commercial	$9.88

RBC Antigens 2

Facility

$53.00

Service Code	HCPCS 86905
Hospital Charge Code	12517897
Hospital Revenue Code	302
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

RBC Antigens 2

Facility

$53.00

Service Code	HCPCS 86905
Hospital Charge Code	12517897
Hospital Revenue Code	302
Min. Negotiated Rate	$3.83
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: Cash Price	$34.45
Rate for Payer: Devoted Health Medicare	$29.15
Rate for Payer: Hawaii Medical Service Association ABD	$5.28
Rate for Payer: Hawaii Medical Service Association Commercial	$4.79
Rate for Payer: Hawaii Medical Service Association Medicare	$26.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.54
Rate for Payer: Hawaii Western Management Group Commercial	$3.83
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 Medicaid	$5.28
Rate for Payer: UnitedHealthcare Medicare	$26.50
Rate for Payer: University Health Alliance Commercial	$9.88

RBC Antigens 3

Facility

$69.00

Service Code	HCPCS 86905
Hospital Charge Code	12517899
Hospital Revenue Code	302
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$66.93
Rate for Payer: AlohaCare Medicaid	$34.50
Rate for Payer: AlohaCare Medicare	$34.50
Rate for Payer: Cash Price	$44.85
Rate for Payer: Cash Price	$44.85
Rate for Payer: Devoted Health Medicare	$37.95
Rate for Payer: Hawaii Medical Service Association ABD	$5.28
Rate for Payer: Hawaii Medical Service Association Commercial	$4.79
Rate for Payer: Hawaii Medical Service Association Medicare	$34.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.54
Rate for Payer: Hawaii Western Management Group Commercial	$3.83
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Humana Medicare	$34.50
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: Kaiser Permanente Medicaid	$35.19
Rate for Payer: Kaiser Permanente Medicare	$34.50
Rate for Payer: MDX Hawaii PPO	$66.93
Rate for Payer: Ohana Health Plan Medicaid	$34.50
Rate for Payer: Ohana Health Plan Medicare	$34.50
Rate for Payer: UnitedHealthcare Medicaid	$5.28
Rate for Payer: UnitedHealthcare Medicare	$34.50
Rate for Payer: University Health Alliance Commercial	$9.88

RBC Antigens 3

Facility

$69.00

Service Code	HCPCS 86905
Hospital Charge Code	12517899
Hospital Revenue Code	302
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$66.93
Rate for Payer: Cash Price	$44.85
Rate for Payer: Health Management Network Commercial	$58.65
Rate for Payer: Kaiser Permanente Commercial	$62.10
Rate for Payer: MDX Hawaii PPO	$66.93

RBC Antigens 4

Facility

$93.00

Service Code	HCPCS 86905
Hospital Charge Code	12540273
Hospital Revenue Code	302
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$60.45
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: MDX Hawaii PPO	$90.21

RBC Antigens 4

Facility

$93.00

Service Code	HCPCS 86905
Hospital Charge Code	12540273
Hospital Revenue Code	302
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$90.21
Rate for Payer: AlohaCare Medicaid	$46.50
Rate for Payer: AlohaCare Medicare	$46.50
Rate for Payer: Cash Price	$60.45
Rate for Payer: Cash Price	$60.45
Rate for Payer: Devoted Health Medicare	$51.15
Rate for Payer: Hawaii Medical Service Association ABD	$5.28
Rate for Payer: Hawaii Medical Service Association Commercial	$4.79
Rate for Payer: Hawaii Medical Service Association Medicare	$46.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.54
Rate for Payer: Hawaii Western Management Group Commercial	$3.83
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Humana Medicare	$46.50
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: Kaiser Permanente Medicare	$46.50
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: Ohana Health Plan Medicaid	$46.50
Rate for Payer: Ohana Health Plan Medicare	$46.50
Rate for Payer: UnitedHealthcare Medicaid	$5.28
Rate for Payer: UnitedHealthcare Medicare	$46.50
Rate for Payer: University Health Alliance Commercial	$9.88

RBC Antigens 5

Facility

$112.00

Service Code	HCPCS 86905
Hospital Charge Code	12539055
Hospital Revenue Code	302
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

RBC Antigens 5

Facility

$112.00

Service Code	HCPCS 86905
Hospital Charge Code	12539055
Hospital Revenue Code	302
Min. Negotiated Rate	$3.83
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 ABD	$5.28
Rate for Payer: Hawaii Medical Service Association Commercial	$4.79
Rate for Payer: Hawaii Medical Service Association Medicare	$56.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.54
Rate for Payer: Hawaii Western Management Group Commercial	$3.83
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	$5.28
Rate for Payer: UnitedHealthcare Medicare	$56.00
Rate for Payer: University Health Alliance Commercial	$9.88

RBC Antigens 6

Facility

$133.00

Service Code	HCPCS 86905
Hospital Charge Code	12517900
Hospital Revenue Code	302
Min. Negotiated Rate	$113.05
Max. Negotiated Rate	$129.01
Rate for Payer: Cash Price	$86.45
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: MDX Hawaii PPO	$129.01

RBC Antigens 6

Facility

$133.00

Service Code	HCPCS 86905
Hospital Charge Code	12517900
Hospital Revenue Code	302
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$129.01
Rate for Payer: AlohaCare Medicaid	$66.50
Rate for Payer: AlohaCare Medicare	$66.50
Rate for Payer: Cash Price	$86.45
Rate for Payer: Cash Price	$86.45
Rate for Payer: Devoted Health Medicare	$73.15
Rate for Payer: Hawaii Medical Service Association ABD	$5.28
Rate for Payer: Hawaii Medical Service Association Commercial	$4.79
Rate for Payer: Hawaii Medical Service Association Medicare	$66.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.54
Rate for Payer: Hawaii Western Management Group Commercial	$3.83
Rate for Payer: Health Management Network Commercial	$113.05
Rate for Payer: Humana Medicare	$66.50
Rate for Payer: Kaiser Permanente Commercial	$119.70
Rate for Payer: Kaiser Permanente Medicaid	$67.83
Rate for Payer: Kaiser Permanente Medicare	$66.50
Rate for Payer: MDX Hawaii PPO	$129.01
Rate for Payer: Ohana Health Plan Medicaid	$66.50
Rate for Payer: Ohana Health Plan Medicare	$66.50
Rate for Payer: UnitedHealthcare Medicaid	$5.28
Rate for Payer: UnitedHealthcare Medicare	$66.50
Rate for Payer: University Health Alliance Commercial	$9.88

RBC Antigens 7

Facility

$154.00

Service Code	HCPCS 86905
Hospital Charge Code	12517901
Hospital Revenue Code	302
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$149.38
Rate for Payer: AlohaCare Medicaid	$77.00
Rate for Payer: AlohaCare Medicare	$77.00
Rate for Payer: Cash Price	$100.10
Rate for Payer: Cash Price	$100.10
Rate for Payer: Devoted Health Medicare	$84.70
Rate for Payer: Hawaii Medical Service Association ABD	$5.28
Rate for Payer: Hawaii Medical Service Association Commercial	$4.79
Rate for Payer: Hawaii Medical Service Association Medicare	$77.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.54
Rate for Payer: Hawaii Western Management Group Commercial	$3.83
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Humana Medicare	$77.00
Rate for Payer: Kaiser Permanente Commercial	$138.60
Rate for Payer: Kaiser Permanente Medicaid	$78.54
Rate for Payer: Kaiser Permanente Medicare	$77.00
Rate for Payer: MDX Hawaii PPO	$149.38
Rate for Payer: Ohana Health Plan Medicaid	$77.00
Rate for Payer: Ohana Health Plan Medicare	$77.00
Rate for Payer: UnitedHealthcare Medicaid	$5.28
Rate for Payer: UnitedHealthcare Medicare	$77.00
Rate for Payer: University Health Alliance Commercial	$9.88

RBC Antigens 7

Facility

$154.00

Service Code	HCPCS 86905
Hospital Charge Code	12517901
Hospital Revenue Code	302
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$149.38
Rate for Payer: Cash Price	$100.10
Rate for Payer: Health Management Network Commercial	$130.90
Rate for Payer: Kaiser Permanente Commercial	$138.60
Rate for Payer: MDX Hawaii PPO	$149.38

RBC Antigens 8

Facility

$175.00

Service Code	HCPCS 86905
Hospital Charge Code	12540274
Hospital Revenue Code	302
Min. Negotiated Rate	$148.75
Max. Negotiated Rate	$169.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: Kaiser Permanente Commercial	$157.50
Rate for Payer: MDX Hawaii PPO	$169.75

RBC Antigens 8

Facility

$175.00

Service Code	HCPCS 86905
Hospital Charge Code	12540274
Hospital Revenue Code	302
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$169.75
Rate for Payer: AlohaCare Medicaid	$87.50
Rate for Payer: AlohaCare Medicare	$87.50
Rate for Payer: Cash Price	$113.75
Rate for Payer: Cash Price	$113.75
Rate for Payer: Devoted Health Medicare	$96.25
Rate for Payer: Hawaii Medical Service Association ABD	$5.28
Rate for Payer: Hawaii Medical Service Association Commercial	$4.79
Rate for Payer: Hawaii Medical Service Association Medicare	$87.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.54
Rate for Payer: Hawaii Western Management Group Commercial	$3.83
Rate for Payer: Health Management Network Commercial	$148.75
Rate for Payer: Humana Medicare	$87.50
Rate for Payer: Kaiser Permanente Commercial	$157.50
Rate for Payer: Kaiser Permanente Medicaid	$89.25
Rate for Payer: Kaiser Permanente Medicare	$87.50
Rate for Payer: MDX Hawaii PPO	$169.75
Rate for Payer: Ohana Health Plan Medicaid	$87.50
Rate for Payer: Ohana Health Plan Medicare	$87.50
Rate for Payer: UnitedHealthcare Medicaid	$5.28
Rate for Payer: UnitedHealthcare Medicare	$87.50
Rate for Payer: University Health Alliance Commercial	$9.88

RECTAL RESECTION WITH CC

Facility

$76,615.48

Service Code	MSDRG 333
Min. Negotiated Rate	$76,615.48
Max. Negotiated Rate	$76,615.48
Rate for Payer: Hawaii Medical Service Association Commercial	$76,615.48

RECTAL RESECTION WITH MCC

Facility

$76,615.48

Service Code	MSDRG 332
Min. Negotiated Rate	$76,615.48
Max. Negotiated Rate	$76,615.48
Rate for Payer: Hawaii Medical Service Association Commercial	$76,615.48

RECTAL RESECTION WITHOUT CC/MCC

Facility

$36,663.25

Service Code	MSDRG 334
Min. Negotiated Rate	$36,663.25
Max. Negotiated Rate	$36,663.25
Rate for Payer: Hawaii Medical Service Association Commercial	$36,663.25

RED BLOOD CELL DISORDERS WITH MCC

Facility

$33,399.76

Service Code	MSDRG 811
Min. Negotiated Rate	$33,399.76
Max. Negotiated Rate	$33,399.76
Rate for Payer: Hawaii Medical Service Association Commercial	$33,399.76

RED BLOOD CELL DISORDERS WITHOUT MCC

Facility

$17,898.19

Service Code	MSDRG 812
Min. Negotiated Rate	$17,898.19
Max. Negotiated Rate	$17,898.19
Rate for Payer: Hawaii Medical Service Association Commercial	$17,898.19

REHABILITATION WITH CC/MCC

Facility

$10,504.35

Service Code	MSDRG 945
Min. Negotiated Rate	$10,504.35
Max. Negotiated Rate	$10,504.35
Rate for Payer: Hawaii Medical Service Association Commercial	$10,504.35

REHABILITATION WITHOUT CC/MCC

Facility

$10,504.35

Service Code	MSDRG 946
Min. Negotiated Rate	$10,504.35
Max. Negotiated Rate	$10,504.35
Rate for Payer: Hawaii Medical Service Association Commercial	$10,504.35

remdesivir 100 mg vial [HHSC]

Facility

$1,546.16

Service Code	NDC 61958290102
Hospital Charge Code	2501021
Hospital Revenue Code	250
Min. Negotiated Rate	$773.08
Max. Negotiated Rate	$1,499.78
Rate for Payer: AlohaCare Medicaid	$773.08
Rate for Payer: AlohaCare Medicare	$773.08
Rate for Payer: Cash Price	$1,005.00
Rate for Payer: Devoted Health Medicare	$850.39
Rate for Payer: Hawaii Medical Service Association Medicare	$773.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,468.85
Rate for Payer: Health Management Network Commercial	$1,314.24
Rate for Payer: Humana Medicare	$773.08
Rate for Payer: Kaiser Permanente Commercial	$1,391.54
Rate for Payer: Kaiser Permanente Medicaid	$788.54
Rate for Payer: Kaiser Permanente Medicare	$773.08
Rate for Payer: MDX Hawaii PPO	$1,499.78
Rate for Payer: Ohana Health Plan Medicaid	$773.08
Rate for Payer: Ohana Health Plan Medicare	$773.08
Rate for Payer: UnitedHealthcare Medicaid	$927.70
Rate for Payer: UnitedHealthcare Medicare	$773.08
Rate for Payer: University Health Alliance Commercial	$1,127.00

Know your out-of-pocket cost for care.

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