Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

remdesivir 100 mg vial [HHSC]

Facility

$1,546.16

Service Code	NDC 61958290101
Hospital Charge Code	2501021
Hospital Revenue Code	250
Min. Negotiated Rate	$1,314.24
Max. Negotiated Rate	$1,499.78
Rate for Payer: Cash Price	$1,005.00
Rate for Payer: Health Management Network Commercial	$1,314.24
Rate for Payer: Kaiser Permanente Commercial	$1,391.54
Rate for Payer: MDX Hawaii PPO	$1,499.78

remdesivir 100 mg vial [HHSC]

Facility

$1,546.16

Service Code	NDC 61958290102
Hospital Charge Code	2501021
Hospital Revenue Code	250
Min. Negotiated Rate	$1,314.24
Max. Negotiated Rate	$1,499.78
Rate for Payer: Cash Price	$1,005.00
Rate for Payer: Health Management Network Commercial	$1,314.24
Rate for Payer: Kaiser Permanente Commercial	$1,391.54
Rate for Payer: MDX Hawaii PPO	$1,499.78

remdesivir 100 mg vial [HHSC]

Facility

$1,546.16

Service Code	NDC 61958290101
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

REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT; INTRAOCULAR

Facility

$5,655.00

Service Code	CPT 67121
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
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	$456.03
Rate for Payer: University Health Alliance Commercial	$5,160.40

REMOVAL OF INTRAUTERINE DEVICE (IUD)

Facility

$4,035.20

Service Code	CPT 58301
Hospital Revenue Code	360
Min. Negotiated Rate	$47.15
Max. Negotiated Rate	$4,035.20
Rate for Payer: Hawaii Medical Service Association Commercial	$389.16
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$47.15
Rate for Payer: University Health Alliance Commercial	$4,035.20

REMOVAL OF LENS MATERIAL; PHACOFRAGMENTATION TECHNIQUE (MECHANICAL OR ULTRASONIC) (EG, PHACOEMULSIFICATION), WITH ASPIRATION

Facility

$16,700.00

Service Code	CPT 66850
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$16,700.00
Rate for Payer: AlohaCare Medicaid	$2,177.19
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	$16,700.00

REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS

Facility

$2,837.00

Service Code	CPT 11200
Hospital Revenue Code	360
Min. Negotiated Rate	$37.52
Max. Negotiated Rate	$2,837.00
Rate for Payer: Hawaii Medical Service Association Commercial	$256.23
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$37.52

Removal of sutures and staples w/o anesthesia

Facility

$17.00

Service Code	HCPCS 15853
Hospital Charge Code	8762515
Hospital Revenue Code	999
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$11.05
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: MDX Hawaii PPO	$16.49

Removal of sutures and staples w/o anesthesia

Facility

$17.00

Service Code	HCPCS 15853
Hospital Charge Code	8762515
Hospital Revenue Code	999
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$16.49
Rate for Payer: AlohaCare Medicaid	$8.50
Rate for Payer: AlohaCare Medicare	$8.50
Rate for Payer: Cash Price	$11.05
Rate for Payer: Cash Price	$11.05
Rate for Payer: Devoted Health Medicare	$9.35
Rate for Payer: Hawaii Medical Service Association Medicare	$8.50
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Humana Medicare	$8.50
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: Kaiser Permanente Medicare	$8.50
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: Ohana Health Plan Medicaid	$8.50
Rate for Payer: Ohana Health Plan Medicare	$8.50
Rate for Payer: UnitedHealthcare Medicaid	$13.19
Rate for Payer: UnitedHealthcare Medicare	$8.50
Rate for Payer: University Health Alliance Commercial	$12.39

REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); PARTIAL REMOVAL

Facility

$10,679.55

Service Code	CPT 67005
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	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$7,085.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
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

RENAL FAILURE WITH CC

Facility

$32,277.94

Service Code	MSDRG 683
Min. Negotiated Rate	$32,277.94
Max. Negotiated Rate	$32,277.94
Rate for Payer: Hawaii Medical Service Association Commercial	$32,277.94

RENAL FAILURE WITH MCC

Facility

$32,277.94

Service Code	MSDRG 682
Min. Negotiated Rate	$32,277.94
Max. Negotiated Rate	$32,277.94
Rate for Payer: Hawaii Medical Service Association Commercial	$32,277.94

RENAL FAILURE WITHOUT CC/MCC

Facility

$32,277.94

Service Code	MSDRG 684
Min. Negotiated Rate	$32,277.94
Max. Negotiated Rate	$32,277.94
Rate for Payer: Hawaii Medical Service Association Commercial	$32,277.94

Renal Function Panel FSI

Facility

$113.00

Service Code	HCPCS 80069
Hospital Charge Code	8118031
Hospital Revenue Code	301
Min. Negotiated Rate	$96.05
Max. Negotiated Rate	$109.61
Rate for Payer: Cash Price	$73.45
Rate for Payer: Health Management Network Commercial	$96.05
Rate for Payer: Kaiser Permanente Commercial	$101.70
Rate for Payer: MDX Hawaii PPO	$109.61

Renal Function Panel FSI

Facility

$113.00

Service Code	HCPCS 80069
Hospital Charge Code	8118031
Hospital Revenue Code	301
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$109.61
Rate for Payer: AlohaCare Medicaid	$56.50
Rate for Payer: AlohaCare Medicare	$56.50
Rate for Payer: Cash Price	$73.45
Rate for Payer: Cash Price	$73.45
Rate for Payer: Devoted Health Medicare	$62.15
Rate for Payer: Hawaii Medical Service Association ABD	$12.00
Rate for Payer: Hawaii Medical Service Association Commercial	$10.85
Rate for Payer: Hawaii Medical Service Association Medicare	$56.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.60
Rate for Payer: Hawaii Western Management Group Commercial	$8.68
Rate for Payer: Health Management Network Commercial	$96.05
Rate for Payer: Humana Medicare	$56.50
Rate for Payer: Kaiser Permanente Commercial	$101.70
Rate for Payer: Kaiser Permanente Medicaid	$57.63
Rate for Payer: Kaiser Permanente Medicare	$56.50
Rate for Payer: MDX Hawaii PPO	$109.61
Rate for Payer: Ohana Health Plan Medicaid	$56.50
Rate for Payer: Ohana Health Plan Medicare	$56.50
Rate for Payer: UnitedHealthcare Medicaid	$12.00
Rate for Payer: UnitedHealthcare Medicare	$56.50
Rate for Payer: University Health Alliance Commercial	$22.44

REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE

Facility

$10,679.55

Service Code	CPT 49505
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$10,679.55
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: AlohaCare Medicaid	$1,379.34
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$7,085.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: University Health Alliance Commercial	$10,679.55

REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.5 CM OR LESS

Facility

$2,837.00

Service Code	CPT 12041
Hospital Revenue Code	360
Min. Negotiated Rate	$92.51
Max. Negotiated Rate	$2,837.00
Rate for Payer: Hawaii Medical Service Association Commercial	$519.15
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$92.51

REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.6 CM TO 7.5 CM

Facility

$2,837.00

Service Code	CPT 12042
Hospital Revenue Code	360
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$2,837.00
Rate for Payer: Hawaii Medical Service Association Commercial	$519.15
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$107.80

REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM

Facility

$4,035.20

Service Code	CPT 12032
Hospital Revenue Code	360
Min. Negotiated Rate	$104.83
Max. Negotiated Rate	$4,035.20
Rate for Payer: Hawaii Medical Service Association Commercial	$519.15
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$104.83
Rate for Payer: University Health Alliance Commercial	$4,035.20

REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); GREATER THAN 10 CM, REDUCIBLE

Facility

$11,157.19

Service Code	CPT 49595
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,157.19
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$11,119.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,154.45
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: University Health Alliance Commercial	$11,157.19

Facility

$11,119.00

Service Code	CPT 49592
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$11,119.00
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$11,119.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,154.45
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: University Health Alliance Commercial	$6,743.44

Facility

$7,085.00

Service Code	CPT 49591
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$7,085.00
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$7,085.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
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

REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; REDUCIBLE

Facility

$16,700.00

Service Code	CPT 49520
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$16,700.00
Rate for Payer: AlohaCare Medicaid	$2,177.19
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$7,085.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: University Health Alliance Commercial	$16,700.00

Replace G-tube per RN Charge

Facility

$1,722.00

Service Code	HCPCS 43762
Hospital Charge Code	8386886
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$1,670.34
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$861.00
Rate for Payer: Cash Price	$1,119.30
Rate for Payer: Cash Price	$1,119.30
Rate for Payer: Cash Price	$1,119.30
Rate for Payer: Devoted Health Medicare	$947.10
Rate for Payer: Hawaii Medical Service Association ABD	$588.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$861.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,635.90
Rate for Payer: Health Management Network Commercial	$1,463.70
Rate for Payer: Humana Medicare	$861.00
Rate for Payer: Kaiser Permanente Commercial	$1,549.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$861.00
Rate for Payer: MDX Hawaii PPO	$1,670.34
Rate for Payer: Ohana Health Plan Medicaid	$861.00
Rate for Payer: Ohana Health Plan Medicare	$861.00
Rate for Payer: UnitedHealthcare Medicare	$861.00
Rate for Payer: University Health Alliance Commercial	$1,255.17

Replace G-tube per RN Charge

Facility

$1,722.00

Service Code	HCPCS 43762
Hospital Charge Code	8386886
Hospital Revenue Code	450
Min. Negotiated Rate	$1,463.70
Max. Negotiated Rate	$1,670.34
Rate for Payer: Cash Price	$1,119.30
Rate for Payer: Health Management Network Commercial	$1,463.70
Rate for Payer: Kaiser Permanente Commercial	$1,549.80
Rate for Payer: MDX Hawaii PPO	$1,670.34

Know your out-of-pocket cost for care.

All Charges