Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT

Facility

$749,607.90

Service Code	MSDRG 008
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$749,607.90
Rate for Payer: Hawaii Medical Service Association Commercial	$749,607.90
Rate for Payer: University Health Alliance Commercial	$10,400.00

SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL

Facility

$124,343.99

Service Code	MSDRG 402
Min. Negotiated Rate	$124,343.99
Max. Negotiated Rate	$124,343.99
Rate for Payer: Hawaii Medical Service Association Commercial	$124,343.99

SINGLE TROCAR WIRE 1.6X150MM

Facility

$248.00

Service Code	HCPCS C1713
Hospital Charge Code	10613400
Hospital Revenue Code	278
Min. Negotiated Rate	$138.88
Max. Negotiated Rate	$240.56
Rate for Payer: Cash Price	$161.20
Rate for Payer: Hawaii Western Management Group Commercial	$173.60
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Kaiser Permanente Commercial	$223.20
Rate for Payer: MDX Hawaii PPO	$240.56
Rate for Payer: University Health Alliance Commercial	$138.88

SINGLE TROCAR WIRE 1.6X150MM

Facility

$248.00

Service Code	HCPCS C1713
Hospital Charge Code	10613400
Hospital Revenue Code	278
Min. Negotiated Rate	$124.00
Max. Negotiated Rate	$240.56
Rate for Payer: AlohaCare Medicaid	$124.00
Rate for Payer: AlohaCare Medicare	$124.00
Rate for Payer: Cash Price	$161.20
Rate for Payer: Devoted Health Medicare	$136.40
Rate for Payer: Hawaii Medical Service Association Medicare	$124.00
Rate for Payer: Hawaii Western Management Group Commercial	$173.60
Rate for Payer: Health Management Network Commercial	$210.80
Rate for Payer: Humana Medicare	$124.00
Rate for Payer: Kaiser Permanente Commercial	$223.20
Rate for Payer: Kaiser Permanente Medicaid	$126.48
Rate for Payer: Kaiser Permanente Medicare	$124.00
Rate for Payer: MDX Hawaii PPO	$240.56
Rate for Payer: Ohana Health Plan Medicaid	$124.00
Rate for Payer: Ohana Health Plan Medicare	$124.00
Rate for Payer: UnitedHealthcare Medicare	$124.00
Rate for Payer: University Health Alliance Commercial	$138.88

SINUS AND MASTOID PROCEDURES WITH CC/MCC

Facility

$27,841.63

Service Code	MSDRG 135
Min. Negotiated Rate	$27,841.63
Max. Negotiated Rate	$27,841.63
Rate for Payer: Hawaii Medical Service Association Commercial	$27,841.63

SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC

Facility

$27,841.63

Service Code	MSDRG 136
Min. Negotiated Rate	$27,841.63
Max. Negotiated Rate	$27,841.63
Rate for Payer: Hawaii Medical Service Association Commercial	$27,841.63

Sjogren's Antibody FSI

Facility

$205.00

Service Code	HCPCS 86235
Hospital Charge Code	8118046
Hospital Revenue Code	302
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$198.85
Rate for Payer: AlohaCare Medicaid	$102.50
Rate for Payer: AlohaCare Medicare	$102.50
Rate for Payer: Cash Price	$133.25
Rate for Payer: Cash Price	$133.25
Rate for Payer: Devoted Health Medicare	$112.75
Rate for Payer: Hawaii Medical Service Association ABD	$24.78
Rate for Payer: Hawaii Medical Service Association Commercial	$22.41
Rate for Payer: Hawaii Medical Service Association Medicare	$102.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26.02
Rate for Payer: Hawaii Western Management Group Commercial	$17.93
Rate for Payer: Health Management Network Commercial	$174.25
Rate for Payer: Humana Medicare	$102.50
Rate for Payer: Kaiser Permanente Commercial	$184.50
Rate for Payer: Kaiser Permanente Medicaid	$104.55
Rate for Payer: Kaiser Permanente Medicare	$102.50
Rate for Payer: MDX Hawaii PPO	$198.85
Rate for Payer: Ohana Health Plan Medicaid	$102.50
Rate for Payer: Ohana Health Plan Medicare	$102.50
Rate for Payer: UnitedHealthcare Medicaid	$24.78
Rate for Payer: UnitedHealthcare Medicare	$102.50
Rate for Payer: University Health Alliance Commercial	$46.36

Sjogren's Antibody FSI

Facility

$205.00

Service Code	HCPCS 86235
Hospital Charge Code	8118046
Hospital Revenue Code	302
Min. Negotiated Rate	$174.25
Max. Negotiated Rate	$198.85
Rate for Payer: Cash Price	$133.25
Rate for Payer: Health Management Network Commercial	$174.25
Rate for Payer: Kaiser Permanente Commercial	$184.50
Rate for Payer: MDX Hawaii PPO	$198.85

SKIN DEBRIDEMENT WITH CC

Facility

$62,337.72

Service Code	MSDRG 571
Min. Negotiated Rate	$62,337.72
Max. Negotiated Rate	$62,337.72
Rate for Payer: Hawaii Medical Service Association Commercial	$62,337.72

SKIN DEBRIDEMENT WITH MCC

Facility

$65,397.24

Service Code	MSDRG 570
Min. Negotiated Rate	$65,397.24
Max. Negotiated Rate	$65,397.24
Rate for Payer: Hawaii Medical Service Association Commercial	$65,397.24

SKIN DEBRIDEMENT WITHOUT CC/MCC

Facility

$32,252.44

Service Code	MSDRG 572
Min. Negotiated Rate	$32,252.44
Max. Negotiated Rate	$32,252.44
Rate for Payer: Hawaii Medical Service Association Commercial	$32,252.44

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$64,428.39

Service Code	MSDRG 577
Min. Negotiated Rate	$64,428.39
Max. Negotiated Rate	$64,428.39
Rate for Payer: Hawaii Medical Service Association Commercial	$64,428.39

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$64,428.39

Service Code	MSDRG 576
Min. Negotiated Rate	$64,428.39
Max. Negotiated Rate	$64,428.39
Rate for Payer: Hawaii Medical Service Association Commercial	$64,428.39

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$15,221.11

Service Code	MSDRG 578
Min. Negotiated Rate	$15,221.11
Max. Negotiated Rate	$15,221.11
Rate for Payer: Hawaii Medical Service Association Commercial	$15,221.11

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$62,108.26

Service Code	MSDRG 574
Min. Negotiated Rate	$62,108.26
Max. Negotiated Rate	$62,108.26
Rate for Payer: Hawaii Medical Service Association Commercial	$62,108.26

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$65,499.22

Service Code	MSDRG 573
Min. Negotiated Rate	$65,499.22
Max. Negotiated Rate	$65,499.22
Rate for Payer: Hawaii Medical Service Association Commercial	$65,499.22

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$37,632.10

Service Code	MSDRG 575
Min. Negotiated Rate	$37,632.10
Max. Negotiated Rate	$37,632.10
Rate for Payer: Hawaii Medical Service Association Commercial	$37,632.10

Skin Graft Full Thickness

Professional

Both

$2,872.00

Service Code	HCPCS 15240
Hospital Charge Code	8300897
Hospital Revenue Code	975
Min. Negotiated Rate	$606.84
Max. Negotiated Rate	$2,441.20
Rate for Payer: AlohaCare Medicaid	$835.06
Rate for Payer: AlohaCare Medicare	$722.48
Rate for Payer: Cash Price	$1,866.80
Rate for Payer: Cash Price	$1,866.80
Rate for Payer: Devoted Health Medicare	$794.73
Rate for Payer: Hawaii Medical Service Association ABD	$835.06
Rate for Payer: Hawaii Medical Service Association Commercial	$1,369.00
Rate for Payer: Hawaii Medical Service Association Medicare	$722.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$835.06
Rate for Payer: Hawaii Western Management Group Commercial	$606.84
Rate for Payer: Health Management Network Commercial	$2,441.20
Rate for Payer: Kaiser Permanente Commercial	$794.73
Rate for Payer: Kaiser Permanente Medicaid	$794.73
Rate for Payer: Kaiser Permanente Medicare	$794.73
Rate for Payer: Ohana Health Plan Medicaid	$835.06
Rate for Payer: Ohana Health Plan Medicare	$722.48
Rate for Payer: UnitedHealthcare Medicaid	$835.06
Rate for Payer: UnitedHealthcare Medicare	$722.48
Rate for Payer: University Health Alliance Commercial	$942.38

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

$49,564.22

Service Code	MSDRG 623
Min. Negotiated Rate	$49,564.22
Max. Negotiated Rate	$49,564.22
Rate for Payer: Hawaii Medical Service Association Commercial	$49,564.22

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

$49,564.22

Service Code	MSDRG 622
Min. Negotiated Rate	$49,564.22
Max. Negotiated Rate	$49,564.22
Rate for Payer: Hawaii Medical Service Association Commercial	$49,564.22

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

$49,564.22

Service Code	MSDRG 624
Min. Negotiated Rate	$49,564.22
Max. Negotiated Rate	$49,564.22
Rate for Payer: Hawaii Medical Service Association Commercial	$49,564.22

SKIN GRAFTS FOR INJURIES WITH CC/MCC

Facility

$69,986.52

Service Code	MSDRG 904
Min. Negotiated Rate	$69,986.52
Max. Negotiated Rate	$69,986.52
Rate for Payer: Hawaii Medical Service Association Commercial	$69,986.52

SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC

Facility

$69,986.52

Service Code	MSDRG 905
Min. Negotiated Rate	$69,986.52
Max. Negotiated Rate	$69,986.52
Rate for Payer: Hawaii Medical Service Association Commercial	$69,986.52

SKIN ULCERS WITH CC

Facility

$24,782.11

Service Code	MSDRG 593
Min. Negotiated Rate	$24,782.11
Max. Negotiated Rate	$24,782.11
Rate for Payer: Hawaii Medical Service Association Commercial	$24,782.11

SKIN ULCERS WITH MCC

Facility

$24,782.11

Service Code	MSDRG 592
Min. Negotiated Rate	$24,782.11
Max. Negotiated Rate	$24,782.11
Rate for Payer: Hawaii Medical Service Association Commercial	$24,782.11

Know your out-of-pocket cost for care.

All Charges