Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Thyroglobulin and Thyroglobulin Antibody FSI

Facility

$230.00

Service Code	HCPCS 84432
Hospital Charge Code	8118058
Hospital Revenue Code	301
Min. Negotiated Rate	$16.06
Max. Negotiated Rate	$223.10
Rate for Payer: AlohaCare Medicaid	$115.00
Rate for Payer: AlohaCare Medicare	$115.00
Rate for Payer: Cash Price	$149.50
Rate for Payer: Cash Price	$149.50
Rate for Payer: Devoted Health Medicare	$126.50
Rate for Payer: Hawaii Medical Service Association ABD	$22.20
Rate for Payer: Hawaii Medical Service Association Commercial	$20.07
Rate for Payer: Hawaii Medical Service Association Medicare	$115.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$23.31
Rate for Payer: Hawaii Western Management Group Commercial	$16.06
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Humana Medicare	$115.00
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: Kaiser Permanente Medicaid	$117.30
Rate for Payer: Kaiser Permanente Medicare	$115.00
Rate for Payer: MDX Hawaii PPO	$223.10
Rate for Payer: Ohana Health Plan Medicaid	$115.00
Rate for Payer: Ohana Health Plan Medicare	$115.00
Rate for Payer: UnitedHealthcare Medicaid	$22.20
Rate for Payer: UnitedHealthcare Medicare	$115.00
Rate for Payer: University Health Alliance Commercial	$41.51

Thyroglobulin and Thyroglobulin Antibody FSI

Facility

$230.00

Service Code	HCPCS 84432
Hospital Charge Code	8118058
Hospital Revenue Code	301
Min. Negotiated Rate	$195.50
Max. Negotiated Rate	$223.10
Rate for Payer: Cash Price	$149.50
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: MDX Hawaii PPO	$223.10

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC

Facility

$22,640.45

Service Code	MSDRG 626
Min. Negotiated Rate	$22,640.45
Max. Negotiated Rate	$22,640.45
Rate for Payer: Hawaii Medical Service Association Commercial	$22,640.45

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC

Facility

$22,640.45

Service Code	MSDRG 625
Min. Negotiated Rate	$22,640.45
Max. Negotiated Rate	$22,640.45
Rate for Payer: Hawaii Medical Service Association Commercial	$22,640.45

THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC

Facility

$22,640.45

Service Code	MSDRG 627
Min. Negotiated Rate	$22,640.45
Max. Negotiated Rate	$22,640.45
Rate for Payer: Hawaii Medical Service Association Commercial	$22,640.45

Thyroid Peroxidase Antibody FSI

Facility

$166.00

Service Code	HCPCS 86376
Hospital Charge Code	8118059
Hospital Revenue Code	302
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$161.02
Rate for Payer: AlohaCare Medicaid	$83.00
Rate for Payer: AlohaCare Medicare	$83.00
Rate for Payer: Cash Price	$107.90
Rate for Payer: Cash Price	$107.90
Rate for Payer: Devoted Health Medicare	$91.30
Rate for Payer: Hawaii Medical Service Association ABD	$20.11
Rate for Payer: Hawaii Medical Service Association Commercial	$18.19
Rate for Payer: Hawaii Medical Service Association Medicare	$83.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.12
Rate for Payer: Hawaii Western Management Group Commercial	$14.55
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Humana Medicare	$83.00
Rate for Payer: Kaiser Permanente Commercial	$149.40
Rate for Payer: Kaiser Permanente Medicaid	$84.66
Rate for Payer: Kaiser Permanente Medicare	$83.00
Rate for Payer: MDX Hawaii PPO	$161.02
Rate for Payer: Ohana Health Plan Medicaid	$83.00
Rate for Payer: Ohana Health Plan Medicare	$83.00
Rate for Payer: UnitedHealthcare Medicaid	$20.11
Rate for Payer: UnitedHealthcare Medicare	$83.00
Rate for Payer: University Health Alliance Commercial	$37.61

Thyroid Peroxidase Antibody FSI

Facility

$166.00

Service Code	HCPCS 86376
Hospital Charge Code	8118059
Hospital Revenue Code	302
Min. Negotiated Rate	$141.10
Max. Negotiated Rate	$161.02
Rate for Payer: Cash Price	$107.90
Rate for Payer: Health Management Network Commercial	$141.10
Rate for Payer: Kaiser Permanente Commercial	$149.40
Rate for Payer: MDX Hawaii PPO	$161.02

Thyroid Stimulating Immunoglobulin FSI

Facility

$338.00

Service Code	HCPCS 84445
Hospital Charge Code	10588462
Hospital Revenue Code	301
Min. Negotiated Rate	$287.30
Max. Negotiated Rate	$327.86
Rate for Payer: Cash Price	$219.70
Rate for Payer: Health Management Network Commercial	$287.30
Rate for Payer: Kaiser Permanente Commercial	$304.20
Rate for Payer: MDX Hawaii PPO	$327.86

Thyroid Stimulating Immunoglobulin FSI

Facility

$338.00

Service Code	HCPCS 84445
Hospital Charge Code	10588462
Hospital Revenue Code	301
Min. Negotiated Rate	$32.92
Max. Negotiated Rate	$327.86
Rate for Payer: AlohaCare Medicaid	$169.00
Rate for Payer: AlohaCare Medicare	$169.00
Rate for Payer: Cash Price	$219.70
Rate for Payer: Cash Price	$219.70
Rate for Payer: Devoted Health Medicare	$185.90
Rate for Payer: Hawaii Medical Service Association ABD	$32.92
Rate for Payer: Hawaii Medical Service Association Commercial	$63.58
Rate for Payer: Hawaii Medical Service Association Medicare	$169.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$34.57
Rate for Payer: Hawaii Western Management Group Commercial	$50.86
Rate for Payer: Health Management Network Commercial	$287.30
Rate for Payer: Humana Medicare	$169.00
Rate for Payer: Kaiser Permanente Commercial	$304.20
Rate for Payer: Kaiser Permanente Medicaid	$172.38
Rate for Payer: Kaiser Permanente Medicare	$169.00
Rate for Payer: MDX Hawaii PPO	$327.86
Rate for Payer: Ohana Health Plan Medicaid	$169.00
Rate for Payer: Ohana Health Plan Medicare	$169.00
Rate for Payer: UnitedHealthcare Medicaid	$32.92
Rate for Payer: UnitedHealthcare Medicare	$169.00
Rate for Payer: University Health Alliance Commercial	$61.57

ticagrelor 60 mg tablet [HHSC]

Facility

$53.63

Service Code	NDC 00186077660
Hospital Charge Code	2501161
Hospital Revenue Code	250
Min. Negotiated Rate	$26.82
Max. Negotiated Rate	$52.02
Rate for Payer: AlohaCare Medicaid	$26.82
Rate for Payer: AlohaCare Medicare	$26.82
Rate for Payer: Cash Price	$34.86
Rate for Payer: Devoted Health Medicare	$29.50
Rate for Payer: Hawaii Medical Service Association Medicare	$26.82
Rate for Payer: Hawaii Western Management Group Commercial	$50.95
Rate for Payer: Health Management Network Commercial	$45.59
Rate for Payer: Humana Medicare	$26.82
Rate for Payer: Kaiser Permanente Commercial	$48.27
Rate for Payer: Kaiser Permanente Medicaid	$27.35
Rate for Payer: Kaiser Permanente Medicare	$26.82
Rate for Payer: MDX Hawaii PPO	$52.02
Rate for Payer: Ohana Health Plan Medicaid	$26.82
Rate for Payer: Ohana Health Plan Medicare	$26.82
Rate for Payer: UnitedHealthcare Medicaid	$32.18
Rate for Payer: UnitedHealthcare Medicare	$26.82
Rate for Payer: University Health Alliance Commercial	$39.09

ticagrelor 60 mg tablet [HHSC]

Facility

$53.63

Service Code	NDC 00186077660
Hospital Charge Code	2501161
Hospital Revenue Code	250
Min. Negotiated Rate	$45.59
Max. Negotiated Rate	$52.02
Rate for Payer: Cash Price	$34.86
Rate for Payer: Health Management Network Commercial	$45.59
Rate for Payer: Kaiser Permanente Commercial	$48.27
Rate for Payer: MDX Hawaii PPO	$52.02

ticagrelor 90 mg tablet [HHSC]

Facility

$54.95

Service Code	NDC 00186077760
Hospital Charge Code	2501202
Hospital Revenue Code	250
Min. Negotiated Rate	$46.71
Max. Negotiated Rate	$53.30
Rate for Payer: Cash Price	$35.72
Rate for Payer: Health Management Network Commercial	$46.71
Rate for Payer: Kaiser Permanente Commercial	$49.45
Rate for Payer: MDX Hawaii PPO	$53.30

ticagrelor 90 mg tablet [HHSC]

Facility

$54.95

Service Code	NDC 00186077760
Hospital Charge Code	2501202
Hospital Revenue Code	250
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$53.30
Rate for Payer: AlohaCare Medicaid	$27.48
Rate for Payer: AlohaCare Medicare	$27.48
Rate for Payer: Cash Price	$35.72
Rate for Payer: Devoted Health Medicare	$30.22
Rate for Payer: Hawaii Medical Service Association Medicare	$27.48
Rate for Payer: Hawaii Western Management Group Commercial	$52.20
Rate for Payer: Health Management Network Commercial	$46.71
Rate for Payer: Humana Medicare	$27.48
Rate for Payer: Kaiser Permanente Commercial	$49.45
Rate for Payer: Kaiser Permanente Medicaid	$28.02
Rate for Payer: Kaiser Permanente Medicare	$27.48
Rate for Payer: MDX Hawaii PPO	$53.30
Rate for Payer: Ohana Health Plan Medicaid	$27.48
Rate for Payer: Ohana Health Plan Medicare	$27.48
Rate for Payer: UnitedHealthcare Medicaid	$32.97
Rate for Payer: UnitedHealthcare Medicare	$27.48
Rate for Payer: University Health Alliance Commercial	$40.05

ticagrelor 90 mg tablet [HHSC]

Facility

$50.28

Service Code	NDC 67877049160
Hospital Charge Code	2501202
Hospital Revenue Code	250
Min. Negotiated Rate	$42.74
Max. Negotiated Rate	$48.77
Rate for Payer: Cash Price	$32.68
Rate for Payer: Health Management Network Commercial	$42.74
Rate for Payer: Kaiser Permanente Commercial	$45.25
Rate for Payer: MDX Hawaii PPO	$48.77

ticagrelor 90 mg tablet [HHSC]

Facility

$50.28

Service Code	NDC 67877049160
Hospital Charge Code	2501202
Hospital Revenue Code	250
Min. Negotiated Rate	$25.14
Max. Negotiated Rate	$48.77
Rate for Payer: AlohaCare Medicaid	$25.14
Rate for Payer: AlohaCare Medicare	$25.14
Rate for Payer: Cash Price	$32.68
Rate for Payer: Devoted Health Medicare	$27.65
Rate for Payer: Hawaii Medical Service Association Medicare	$25.14
Rate for Payer: Hawaii Western Management Group Commercial	$47.77
Rate for Payer: Health Management Network Commercial	$42.74
Rate for Payer: Humana Medicare	$25.14
Rate for Payer: Kaiser Permanente Commercial	$45.25
Rate for Payer: Kaiser Permanente Medicaid	$25.64
Rate for Payer: Kaiser Permanente Medicare	$25.14
Rate for Payer: MDX Hawaii PPO	$48.77
Rate for Payer: Ohana Health Plan Medicaid	$25.14
Rate for Payer: Ohana Health Plan Medicare	$25.14
Rate for Payer: UnitedHealthcare Medicaid	$30.17
Rate for Payer: UnitedHealthcare Medicare	$25.14
Rate for Payer: University Health Alliance Commercial	$36.65

timolol maleate 0.5% ophth drop 5mL [HHSC]

Facility

$89.21

Service Code	NDC 64980051405
Hospital Charge Code	2500824
Hospital Revenue Code	250
Min. Negotiated Rate	$44.60
Max. Negotiated Rate	$86.53
Rate for Payer: AlohaCare Medicaid	$44.60
Rate for Payer: AlohaCare Medicare	$44.60
Rate for Payer: Cash Price	$57.99
Rate for Payer: Devoted Health Medicare	$49.07
Rate for Payer: Hawaii Medical Service Association Medicare	$44.60
Rate for Payer: Hawaii Western Management Group Commercial	$84.75
Rate for Payer: Health Management Network Commercial	$75.83
Rate for Payer: Humana Medicare	$44.60
Rate for Payer: Kaiser Permanente Commercial	$80.29
Rate for Payer: Kaiser Permanente Medicaid	$45.50
Rate for Payer: Kaiser Permanente Medicare	$44.60
Rate for Payer: MDX Hawaii PPO	$86.53
Rate for Payer: Ohana Health Plan Medicaid	$44.60
Rate for Payer: Ohana Health Plan Medicare	$44.60
Rate for Payer: UnitedHealthcare Medicaid	$53.53
Rate for Payer: UnitedHealthcare Medicare	$44.60
Rate for Payer: University Health Alliance Commercial	$65.03

timolol maleate 0.5% ophth drop 5mL [HHSC]

Facility

$41.63

Service Code	NDC 60758080105
Hospital Charge Code	2500824
Hospital Revenue Code	250
Min. Negotiated Rate	$20.82
Max. Negotiated Rate	$40.38
Rate for Payer: AlohaCare Medicaid	$20.82
Rate for Payer: AlohaCare Medicare	$20.82
Rate for Payer: Cash Price	$27.06
Rate for Payer: Devoted Health Medicare	$22.90
Rate for Payer: Hawaii Medical Service Association Medicare	$20.82
Rate for Payer: Hawaii Western Management Group Commercial	$39.55
Rate for Payer: Health Management Network Commercial	$35.39
Rate for Payer: Humana Medicare	$20.82
Rate for Payer: Kaiser Permanente Commercial	$37.47
Rate for Payer: Kaiser Permanente Medicaid	$21.23
Rate for Payer: Kaiser Permanente Medicare	$20.82
Rate for Payer: MDX Hawaii PPO	$40.38
Rate for Payer: Ohana Health Plan Medicaid	$20.82
Rate for Payer: Ohana Health Plan Medicare	$20.82
Rate for Payer: UnitedHealthcare Medicaid	$24.98
Rate for Payer: UnitedHealthcare Medicare	$20.82
Rate for Payer: University Health Alliance Commercial	$30.34

timolol maleate 0.5% ophth drop 5mL [HHSC]

Facility

$41.63

Service Code	NDC 60758080105
Hospital Charge Code	2500824
Hospital Revenue Code	250
Min. Negotiated Rate	$35.39
Max. Negotiated Rate	$40.38
Rate for Payer: Cash Price	$27.06
Rate for Payer: Health Management Network Commercial	$35.39
Rate for Payer: Kaiser Permanente Commercial	$37.47
Rate for Payer: MDX Hawaii PPO	$40.38

timolol maleate 0.5% ophth drop 5mL [HHSC]

Facility

$89.21

Service Code	NDC 64980051405
Hospital Charge Code	2500824
Hospital Revenue Code	250
Min. Negotiated Rate	$75.83
Max. Negotiated Rate	$86.53
Rate for Payer: Cash Price	$57.99
Rate for Payer: Health Management Network Commercial	$75.83
Rate for Payer: Kaiser Permanente Commercial	$80.29
Rate for Payer: MDX Hawaii PPO	$86.53

timolol maleate 0.5% ophth drop 5mL [HHSC]

Facility

$89.21

Service Code	NDC 61314022705
Hospital Charge Code	2500824
Hospital Revenue Code	250
Min. Negotiated Rate	$44.60
Max. Negotiated Rate	$86.53
Rate for Payer: AlohaCare Medicaid	$44.60
Rate for Payer: AlohaCare Medicare	$44.60
Rate for Payer: Cash Price	$57.99
Rate for Payer: Devoted Health Medicare	$49.07
Rate for Payer: Hawaii Medical Service Association Medicare	$44.60
Rate for Payer: Hawaii Western Management Group Commercial	$84.75
Rate for Payer: Health Management Network Commercial	$75.83
Rate for Payer: Humana Medicare	$44.60
Rate for Payer: Kaiser Permanente Commercial	$80.29
Rate for Payer: Kaiser Permanente Medicaid	$45.50
Rate for Payer: Kaiser Permanente Medicare	$44.60
Rate for Payer: MDX Hawaii PPO	$86.53
Rate for Payer: Ohana Health Plan Medicaid	$44.60
Rate for Payer: Ohana Health Plan Medicare	$44.60
Rate for Payer: UnitedHealthcare Medicaid	$53.53
Rate for Payer: UnitedHealthcare Medicare	$44.60
Rate for Payer: University Health Alliance Commercial	$65.03

timolol maleate 0.5% ophth drop 5mL [HHSC]

Facility

$89.21

Service Code	NDC 17478028810
Hospital Charge Code	2500824
Hospital Revenue Code	250
Min. Negotiated Rate	$44.60
Max. Negotiated Rate	$86.53
Rate for Payer: AlohaCare Medicaid	$44.60
Rate for Payer: AlohaCare Medicare	$44.60
Rate for Payer: Cash Price	$57.99
Rate for Payer: Devoted Health Medicare	$49.07
Rate for Payer: Hawaii Medical Service Association Medicare	$44.60
Rate for Payer: Hawaii Western Management Group Commercial	$84.75
Rate for Payer: Health Management Network Commercial	$75.83
Rate for Payer: Humana Medicare	$44.60
Rate for Payer: Kaiser Permanente Commercial	$80.29
Rate for Payer: Kaiser Permanente Medicaid	$45.50
Rate for Payer: Kaiser Permanente Medicare	$44.60
Rate for Payer: MDX Hawaii PPO	$86.53
Rate for Payer: Ohana Health Plan Medicaid	$44.60
Rate for Payer: Ohana Health Plan Medicare	$44.60
Rate for Payer: UnitedHealthcare Medicaid	$53.53
Rate for Payer: UnitedHealthcare Medicare	$44.60
Rate for Payer: University Health Alliance Commercial	$65.03

timolol maleate 0.5% ophth drop 5mL [HHSC]

Facility

$89.21

Service Code	NDC 61314022705
Hospital Charge Code	2500824
Hospital Revenue Code	250
Min. Negotiated Rate	$75.83
Max. Negotiated Rate	$86.53
Rate for Payer: Cash Price	$57.99
Rate for Payer: Health Management Network Commercial	$75.83
Rate for Payer: Kaiser Permanente Commercial	$80.29
Rate for Payer: MDX Hawaii PPO	$86.53

timolol maleate 0.5% ophth drop 5mL [HHSC]

Facility

$89.21

Service Code	NDC 17478028810
Hospital Charge Code	2500824
Hospital Revenue Code	250
Min. Negotiated Rate	$75.83
Max. Negotiated Rate	$86.53
Rate for Payer: Cash Price	$57.99
Rate for Payer: Health Management Network Commercial	$75.83
Rate for Payer: Kaiser Permanente Commercial	$80.29
Rate for Payer: MDX Hawaii PPO	$86.53

TINE PLATE, 2.7MM, 10 HOLE

Facility

$1,883.00

Service Code	HCPCS C1713
Hospital Charge Code	13001561
Hospital Revenue Code	278
Min. Negotiated Rate	$941.50
Max. Negotiated Rate	$1,826.51
Rate for Payer: AlohaCare Medicaid	$941.50
Rate for Payer: AlohaCare Medicare	$941.50
Rate for Payer: Cash Price	$1,223.95
Rate for Payer: Devoted Health Medicare	$1,035.65
Rate for Payer: Hawaii Medical Service Association Medicare	$941.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,318.10
Rate for Payer: Health Management Network Commercial	$1,600.55
Rate for Payer: Humana Medicare	$941.50
Rate for Payer: Kaiser Permanente Commercial	$1,694.70
Rate for Payer: Kaiser Permanente Medicaid	$960.33
Rate for Payer: Kaiser Permanente Medicare	$941.50
Rate for Payer: MDX Hawaii PPO	$1,826.51
Rate for Payer: Ohana Health Plan Medicaid	$941.50
Rate for Payer: Ohana Health Plan Medicare	$941.50
Rate for Payer: UnitedHealthcare Medicare	$941.50
Rate for Payer: University Health Alliance Commercial	$1,054.48

TINE PLATE, 2.7MM, 10 HOLE

Facility

$1,883.00

Service Code	HCPCS C1713
Hospital Charge Code	13001561
Hospital Revenue Code	278
Min. Negotiated Rate	$1,054.48
Max. Negotiated Rate	$1,826.51
Rate for Payer: Cash Price	$1,223.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,318.10
Rate for Payer: Health Management Network Commercial	$1,600.55
Rate for Payer: Kaiser Permanente Commercial	$1,694.70
Rate for Payer: MDX Hawaii PPO	$1,826.51
Rate for Payer: University Health Alliance Commercial	$1,054.48

Know your out-of-pocket cost for care.

All Charges