Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

SUTURE VICRYL 2-0 COATED PLUS UNDYED TAPERPOINT SH 26MM 1 X 27IN/70CM

Facility

$16.00

Hospital Charge Code	8551047
Hospital Revenue Code	270
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$15.52
Rate for Payer: Cash Price	$10.40
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: MDX Hawaii PPO	$15.52

SUTURE VICRYL 2-0 COATED PLUS UNDYED TAPERPOINT SH 26MM 1 X 27IN/70CM

Facility

$16.00

Hospital Charge Code	8551047
Hospital Revenue Code	270
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$15.52
Rate for Payer: AlohaCare Medicaid	$8.00
Rate for Payer: AlohaCare Medicare	$8.00
Rate for Payer: Cash Price	$10.40
Rate for Payer: Devoted Health Medicare	$8.80
Rate for Payer: Hawaii Medical Service Association Medicare	$8.00
Rate for Payer: Hawaii Western Management Group Commercial	$15.20
Rate for Payer: Health Management Network Commercial	$13.60
Rate for Payer: Humana Medicare	$8.00
Rate for Payer: Kaiser Permanente Commercial	$14.40
Rate for Payer: Kaiser Permanente Medicaid	$8.16
Rate for Payer: Kaiser Permanente Medicare	$8.00
Rate for Payer: MDX Hawaii PPO	$15.52
Rate for Payer: Ohana Health Plan Medicaid	$8.00
Rate for Payer: Ohana Health Plan Medicare	$8.00
Rate for Payer: UnitedHealthcare Medicare	$8.00
Rate for Payer: University Health Alliance Commercial	$11.66

SUTURE, V-LOC 180 0 GREEN 23CM GS-21

Facility

$149.00

Hospital Charge Code	9590126
Hospital Revenue Code	272
Min. Negotiated Rate	$126.65
Max. Negotiated Rate	$144.53
Rate for Payer: Cash Price	$96.85
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Kaiser Permanente Commercial	$134.10
Rate for Payer: MDX Hawaii PPO	$144.53

SUTURE, V-LOC 180 0 GREEN 23CM GS-21

Facility

$149.00

Hospital Charge Code	9590126
Hospital Revenue Code	272
Min. Negotiated Rate	$74.50
Max. Negotiated Rate	$144.53
Rate for Payer: AlohaCare Medicaid	$74.50
Rate for Payer: AlohaCare Medicare	$74.50
Rate for Payer: Cash Price	$96.85
Rate for Payer: Devoted Health Medicare	$81.95
Rate for Payer: Hawaii Medical Service Association Medicare	$74.50
Rate for Payer: Hawaii Western Management Group Commercial	$141.55
Rate for Payer: Health Management Network Commercial	$126.65
Rate for Payer: Humana Medicare	$74.50
Rate for Payer: Kaiser Permanente Commercial	$134.10
Rate for Payer: Kaiser Permanente Medicaid	$75.99
Rate for Payer: Kaiser Permanente Medicare	$74.50
Rate for Payer: MDX Hawaii PPO	$144.53
Rate for Payer: Ohana Health Plan Medicaid	$74.50
Rate for Payer: Ohana Health Plan Medicare	$74.50
Rate for Payer: UnitedHealthcare Medicare	$74.50
Rate for Payer: University Health Alliance Commercial	$108.61

Swallow Evaluation

Facility

$521.00

Service Code	HCPCS 92610 GP,CQ
Hospital Charge Code	8102563
Hospital Revenue Code	444
Min. Negotiated Rate	$88.36
Max. Negotiated Rate	$505.37
Rate for Payer: AlohaCare Medicaid	$260.50
Rate for Payer: AlohaCare Medicare	$260.50
Rate for Payer: Cash Price	$338.65
Rate for Payer: Cash Price	$338.65
Rate for Payer: Devoted Health Medicare	$286.55
Rate for Payer: Hawaii Medical Service Association Medicare	$260.50
Rate for Payer: Hawaii Western Management Group Commercial	$494.95
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Humana Medicare	$260.50
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: Kaiser Permanente Medicaid	$265.71
Rate for Payer: Kaiser Permanente Medicare	$260.50
Rate for Payer: MDX Hawaii PPO	$505.37
Rate for Payer: Ohana Health Plan Medicaid	$260.50
Rate for Payer: Ohana Health Plan Medicare	$260.50
Rate for Payer: UnitedHealthcare Medicaid	$88.36
Rate for Payer: UnitedHealthcare Medicare	$260.50
Rate for Payer: University Health Alliance Commercial	$379.76

Swallow Evaluation

Facility

$521.00

Service Code	HCPCS 92610 GP
Hospital Charge Code	8102562
Hospital Revenue Code	424
Min. Negotiated Rate	$442.85
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$338.65
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: MDX Hawaii PPO	$505.37

Swallow Evaluation

Facility

$521.00

Service Code	HCPCS 92610 GP
Hospital Charge Code	8102562
Hospital Revenue Code	424
Min. Negotiated Rate	$88.36
Max. Negotiated Rate	$505.37
Rate for Payer: AlohaCare Medicaid	$260.50
Rate for Payer: AlohaCare Medicare	$260.50
Rate for Payer: Cash Price	$338.65
Rate for Payer: Cash Price	$338.65
Rate for Payer: Devoted Health Medicare	$286.55
Rate for Payer: Hawaii Medical Service Association Medicare	$260.50
Rate for Payer: Hawaii Western Management Group Commercial	$494.95
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Humana Medicare	$260.50
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: Kaiser Permanente Medicaid	$265.71
Rate for Payer: Kaiser Permanente Medicare	$260.50
Rate for Payer: MDX Hawaii PPO	$505.37
Rate for Payer: Ohana Health Plan Medicaid	$260.50
Rate for Payer: Ohana Health Plan Medicare	$260.50
Rate for Payer: UnitedHealthcare Medicaid	$88.36
Rate for Payer: UnitedHealthcare Medicare	$260.50
Rate for Payer: University Health Alliance Commercial	$379.76

Swallow Evaluation

Facility

$521.00

Service Code	HCPCS 92610 GP,CQ
Hospital Charge Code	8102563
Hospital Revenue Code	444
Min. Negotiated Rate	$442.85
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$338.65
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: MDX Hawaii PPO	$505.37

SWEETUMS 2ML PERSERVATIVE FREE

Facility

$5.00

Hospital Charge Code	10461757
Hospital Revenue Code	270
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$4.85
Rate for Payer: AlohaCare Medicaid	$2.50
Rate for Payer: AlohaCare Medicare	$2.50
Rate for Payer: Cash Price	$3.25
Rate for Payer: Devoted Health Medicare	$2.75
Rate for Payer: Hawaii Medical Service Association Medicare	$2.50
Rate for Payer: Hawaii Western Management Group Commercial	$4.75
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Humana Medicare	$2.50
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: Kaiser Permanente Medicaid	$2.55
Rate for Payer: Kaiser Permanente Medicare	$2.50
Rate for Payer: MDX Hawaii PPO	$4.85
Rate for Payer: Ohana Health Plan Medicaid	$2.50
Rate for Payer: Ohana Health Plan Medicare	$2.50
Rate for Payer: UnitedHealthcare Medicare	$2.50
Rate for Payer: University Health Alliance Commercial	$3.64

SWEETUMS 2ML PERSERVATIVE FREE

Facility

$5.00

Hospital Charge Code	10461757
Hospital Revenue Code	270
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.85
Rate for Payer: Cash Price	$3.25
Rate for Payer: Health Management Network Commercial	$4.25
Rate for Payer: Kaiser Permanente Commercial	$4.50
Rate for Payer: MDX Hawaii PPO	$4.85

SYMBOTEX COMPOSITE MESH 15CM x 10CM

Facility

$1,625.00

Hospital Charge Code	10109434
Hospital Revenue Code	272
Min. Negotiated Rate	$1,381.25
Max. Negotiated Rate	$1,576.25
Rate for Payer: Cash Price	$1,056.25
Rate for Payer: Health Management Network Commercial	$1,381.25
Rate for Payer: Kaiser Permanente Commercial	$1,462.50
Rate for Payer: MDX Hawaii PPO	$1,576.25

SYMBOTEX COMPOSITE MESH 15CM x 10CM

Facility

$1,625.00

Hospital Charge Code	10109434
Hospital Revenue Code	272
Min. Negotiated Rate	$812.50
Max. Negotiated Rate	$1,576.25
Rate for Payer: AlohaCare Medicaid	$812.50
Rate for Payer: AlohaCare Medicare	$812.50
Rate for Payer: Cash Price	$1,056.25
Rate for Payer: Devoted Health Medicare	$893.75
Rate for Payer: Hawaii Medical Service Association Medicare	$812.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,543.75
Rate for Payer: Health Management Network Commercial	$1,381.25
Rate for Payer: Humana Medicare	$812.50
Rate for Payer: Kaiser Permanente Commercial	$1,462.50
Rate for Payer: Kaiser Permanente Medicaid	$828.75
Rate for Payer: Kaiser Permanente Medicare	$812.50
Rate for Payer: MDX Hawaii PPO	$1,576.25
Rate for Payer: Ohana Health Plan Medicaid	$812.50
Rate for Payer: Ohana Health Plan Medicare	$812.50
Rate for Payer: UnitedHealthcare Medicare	$812.50
Rate for Payer: University Health Alliance Commercial	$1,184.46

SYMBOTEX COMPOSITE MESH 20CM x 15CM

Facility

$2,235.00

Hospital Charge Code	10109435
Hospital Revenue Code	272
Min. Negotiated Rate	$1,899.75
Max. Negotiated Rate	$2,167.95
Rate for Payer: Cash Price	$1,452.75
Rate for Payer: Health Management Network Commercial	$1,899.75
Rate for Payer: Kaiser Permanente Commercial	$2,011.50
Rate for Payer: MDX Hawaii PPO	$2,167.95

SYMBOTEX COMPOSITE MESH 20CM x 15CM

Facility

$2,235.00

Hospital Charge Code	10109435
Hospital Revenue Code	272
Min. Negotiated Rate	$1,117.50
Max. Negotiated Rate	$2,167.95
Rate for Payer: AlohaCare Medicaid	$1,117.50
Rate for Payer: AlohaCare Medicare	$1,117.50
Rate for Payer: Cash Price	$1,452.75
Rate for Payer: Devoted Health Medicare	$1,229.25
Rate for Payer: Hawaii Medical Service Association Medicare	$1,117.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,123.25
Rate for Payer: Health Management Network Commercial	$1,899.75
Rate for Payer: Humana Medicare	$1,117.50
Rate for Payer: Kaiser Permanente Commercial	$2,011.50
Rate for Payer: Kaiser Permanente Medicaid	$1,139.85
Rate for Payer: Kaiser Permanente Medicare	$1,117.50
Rate for Payer: MDX Hawaii PPO	$2,167.95
Rate for Payer: Ohana Health Plan Medicaid	$1,117.50
Rate for Payer: Ohana Health Plan Medicare	$1,117.50
Rate for Payer: UnitedHealthcare Medicare	$1,117.50
Rate for Payer: University Health Alliance Commercial	$1,629.09

SYNCOPE AND COLLAPSE

Facility

$15,068.14

Service Code	MSDRG 312
Min. Negotiated Rate	$15,068.14
Max. Negotiated Rate	$15,068.14
Rate for Payer: Hawaii Medical Service Association Commercial	$15,068.14

T3, Free FSI

Facility

$194.00

Service Code	HCPCS 84481
Hospital Charge Code	8118053
Hospital Revenue Code	301
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$188.18
Rate for Payer: AlohaCare Medicaid	$97.00
Rate for Payer: AlohaCare Medicare	$97.00
Rate for Payer: Cash Price	$126.10
Rate for Payer: Cash Price	$126.10
Rate for Payer: Devoted Health Medicare	$106.70
Rate for Payer: Hawaii Medical Service Association ABD	$23.41
Rate for Payer: Hawaii Medical Service Association Commercial	$21.18
Rate for Payer: Hawaii Medical Service Association Medicare	$97.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.58
Rate for Payer: Hawaii Western Management Group Commercial	$16.94
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: Humana Medicare	$97.00
Rate for Payer: Kaiser Permanente Commercial	$174.60
Rate for Payer: Kaiser Permanente Medicaid	$98.94
Rate for Payer: Kaiser Permanente Medicare	$97.00
Rate for Payer: MDX Hawaii PPO	$188.18
Rate for Payer: Ohana Health Plan Medicaid	$97.00
Rate for Payer: Ohana Health Plan Medicare	$97.00
Rate for Payer: UnitedHealthcare Medicaid	$23.41
Rate for Payer: UnitedHealthcare Medicare	$97.00
Rate for Payer: University Health Alliance Commercial	$43.79

T3, Free FSI

Facility

$194.00

Service Code	HCPCS 84481
Hospital Charge Code	8118053
Hospital Revenue Code	301
Min. Negotiated Rate	$164.90
Max. Negotiated Rate	$188.18
Rate for Payer: Cash Price	$126.10
Rate for Payer: Health Management Network Commercial	$164.90
Rate for Payer: Kaiser Permanente Commercial	$174.60
Rate for Payer: MDX Hawaii PPO	$188.18

T3, Total FSI

Facility

$201.00

Service Code	HCPCS 84480
Hospital Charge Code	8118054
Hospital Revenue Code	301
Min. Negotiated Rate	$14.18
Max. Negotiated Rate	$194.97
Rate for Payer: AlohaCare Medicaid	$100.50
Rate for Payer: AlohaCare Medicare	$100.50
Rate for Payer: Cash Price	$130.65
Rate for Payer: Cash Price	$130.65
Rate for Payer: Devoted Health Medicare	$110.55
Rate for Payer: Hawaii Medical Service Association ABD	$19.60
Rate for Payer: Hawaii Medical Service Association Commercial	$17.73
Rate for Payer: Hawaii Medical Service Association Medicare	$100.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.58
Rate for Payer: Hawaii Western Management Group Commercial	$14.18
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Humana Medicare	$100.50
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: Kaiser Permanente Medicaid	$102.51
Rate for Payer: Kaiser Permanente Medicare	$100.50
Rate for Payer: MDX Hawaii PPO	$194.97
Rate for Payer: Ohana Health Plan Medicaid	$100.50
Rate for Payer: Ohana Health Plan Medicare	$100.50
Rate for Payer: UnitedHealthcare Medicaid	$19.60
Rate for Payer: UnitedHealthcare Medicare	$100.50
Rate for Payer: University Health Alliance Commercial	$36.65

T3, Total FSI

Facility

$201.00

Service Code	HCPCS 84480
Hospital Charge Code	8118054
Hospital Revenue Code	301
Min. Negotiated Rate	$170.85
Max. Negotiated Rate	$194.97
Rate for Payer: Cash Price	$130.65
Rate for Payer: Health Management Network Commercial	$170.85
Rate for Payer: Kaiser Permanente Commercial	$180.90
Rate for Payer: MDX Hawaii PPO	$194.97

T4, Total FSI

Facility

$104.00

Service Code	HCPCS 84436
Hospital Charge Code	8118055
Hospital Revenue Code	301
Min. Negotiated Rate	$88.40
Max. Negotiated Rate	$100.88
Rate for Payer: Cash Price	$67.60
Rate for Payer: Health Management Network Commercial	$88.40
Rate for Payer: Kaiser Permanente Commercial	$93.60
Rate for Payer: MDX Hawaii PPO	$100.88

T4, Total FSI

Facility

$104.00

Service Code	HCPCS 84436
Hospital Charge Code	8118055
Hospital Revenue Code	301
Min. Negotiated Rate	$6.87
Max. Negotiated Rate	$100.88
Rate for Payer: AlohaCare Medicaid	$52.00
Rate for Payer: AlohaCare Medicare	$52.00
Rate for Payer: Cash Price	$67.60
Rate for Payer: Cash Price	$67.60
Rate for Payer: Devoted Health Medicare	$57.20
Rate for Payer: Hawaii Medical Service Association ABD	$9.50
Rate for Payer: Hawaii Medical Service Association Commercial	$8.59
Rate for Payer: Hawaii Medical Service Association Medicare	$52.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9.98
Rate for Payer: Hawaii Western Management Group Commercial	$6.87
Rate for Payer: Health Management Network Commercial	$88.40
Rate for Payer: Humana Medicare	$52.00
Rate for Payer: Kaiser Permanente Commercial	$93.60
Rate for Payer: Kaiser Permanente Medicaid	$53.04
Rate for Payer: Kaiser Permanente Medicare	$52.00
Rate for Payer: MDX Hawaii PPO	$100.88
Rate for Payer: Ohana Health Plan Medicaid	$52.00
Rate for Payer: Ohana Health Plan Medicare	$52.00
Rate for Payer: UnitedHealthcare Medicaid	$9.50
Rate for Payer: UnitedHealthcare Medicare	$52.00
Rate for Payer: University Health Alliance Commercial	$17.78

tamsulosin 0.4 mg capsule [HHSC]

Facility

$23.43

Service Code	NDC 68382013201
Hospital Charge Code	2500806
Hospital Revenue Code	250
Min. Negotiated Rate	$19.92
Max. Negotiated Rate	$22.73
Rate for Payer: Cash Price	$15.23
Rate for Payer: Health Management Network Commercial	$19.92
Rate for Payer: Kaiser Permanente Commercial	$21.09
Rate for Payer: MDX Hawaii PPO	$22.73

tamsulosin 0.4 mg capsule [HHSC]

Facility

$23.43

Service Code	NDC 68382013201
Hospital Charge Code	2500806
Hospital Revenue Code	250
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$22.73
Rate for Payer: AlohaCare Medicaid	$11.71
Rate for Payer: AlohaCare Medicare	$11.71
Rate for Payer: Cash Price	$15.23
Rate for Payer: Devoted Health Medicare	$12.89
Rate for Payer: Hawaii Medical Service Association Medicare	$11.71
Rate for Payer: Hawaii Western Management Group Commercial	$22.26
Rate for Payer: Health Management Network Commercial	$19.92
Rate for Payer: Humana Medicare	$11.71
Rate for Payer: Kaiser Permanente Commercial	$21.09
Rate for Payer: Kaiser Permanente Medicaid	$11.95
Rate for Payer: Kaiser Permanente Medicare	$11.71
Rate for Payer: MDX Hawaii PPO	$22.73
Rate for Payer: Ohana Health Plan Medicaid	$11.71
Rate for Payer: Ohana Health Plan Medicare	$11.71
Rate for Payer: UnitedHealthcare Medicaid	$14.06
Rate for Payer: UnitedHealthcare Medicare	$11.71
Rate for Payer: University Health Alliance Commercial	$17.08

tamsulosin 0.4 mg capsule [HHSC]

Facility

$23.43

Service Code	NDC 68084029901
Hospital Charge Code	2500806
Hospital Revenue Code	250
Min. Negotiated Rate	$11.71
Max. Negotiated Rate	$22.73
Rate for Payer: AlohaCare Medicaid	$11.71
Rate for Payer: AlohaCare Medicare	$11.71
Rate for Payer: Cash Price	$15.23
Rate for Payer: Devoted Health Medicare	$12.89
Rate for Payer: Hawaii Medical Service Association Medicare	$11.71
Rate for Payer: Hawaii Western Management Group Commercial	$22.26
Rate for Payer: Health Management Network Commercial	$19.92
Rate for Payer: Humana Medicare	$11.71
Rate for Payer: Kaiser Permanente Commercial	$21.09
Rate for Payer: Kaiser Permanente Medicaid	$11.95
Rate for Payer: Kaiser Permanente Medicare	$11.71
Rate for Payer: MDX Hawaii PPO	$22.73
Rate for Payer: Ohana Health Plan Medicaid	$11.71
Rate for Payer: Ohana Health Plan Medicare	$11.71
Rate for Payer: UnitedHealthcare Medicaid	$14.06
Rate for Payer: UnitedHealthcare Medicare	$11.71
Rate for Payer: University Health Alliance Commercial	$17.08

tamsulosin 0.4 mg capsule [HHSC]

Facility

$23.43

Service Code	NDC 68084029901
Hospital Charge Code	2500806
Hospital Revenue Code	250
Min. Negotiated Rate	$19.92
Max. Negotiated Rate	$22.73
Rate for Payer: Cash Price	$15.23
Rate for Payer: Health Management Network Commercial	$19.92
Rate for Payer: Kaiser Permanente Commercial	$21.09
Rate for Payer: MDX Hawaii PPO	$22.73

Know your out-of-pocket cost for care.

All Charges