Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Transfuse Red Blood Cells Leukoreduced

Facility

$2,059.00

Service Code	HCPCS 36430
Hospital Charge Code	7894724
Hospital Revenue Code	391
Min. Negotiated Rate	$33.38
Max. Negotiated Rate	$2,389.00
Rate for Payer: AlohaCare Medicaid	$1,029.50
Rate for Payer: AlohaCare Medicare	$1,029.50
Rate for Payer: Cash Price	$1,338.35
Rate for Payer: Cash Price	$1,338.35
Rate for Payer: Cash Price	$1,338.35
Rate for Payer: Devoted Health Medicare	$1,132.45
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,389.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,029.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Hawaii Western Management Group Commercial	$1,956.05
Rate for Payer: Health Management Network Commercial	$1,750.15
Rate for Payer: Humana Medicare	$1,029.50
Rate for Payer: Kaiser Permanente Commercial	$1,853.10
Rate for Payer: Kaiser Permanente Medicaid	$1,050.09
Rate for Payer: Kaiser Permanente Medicare	$1,029.50
Rate for Payer: MDX Hawaii PPO	$1,997.23
Rate for Payer: Ohana Health Plan Medicaid	$1,029.50
Rate for Payer: Ohana Health Plan Medicare	$1,029.50
Rate for Payer: UnitedHealthcare Medicaid	$33.38
Rate for Payer: UnitedHealthcare Medicare	$1,029.50
Rate for Payer: University Health Alliance Commercial	$1,500.81

Transfuse Red Blood Cells Leukoreduced

Facility

$2,059.00

Service Code	HCPCS 36430
Hospital Charge Code	7894720
Hospital Revenue Code	391
Min. Negotiated Rate	$1,750.15
Max. Negotiated Rate	$1,997.23
Rate for Payer: Cash Price	$1,338.35
Rate for Payer: Health Management Network Commercial	$1,750.15
Rate for Payer: Kaiser Permanente Commercial	$1,853.10
Rate for Payer: MDX Hawaii PPO	$1,997.23

Transfuse Red Blood Cells Leukoreduced

Facility

$2,059.00

Service Code	HCPCS 36430
Hospital Charge Code	7894724
Hospital Revenue Code	391
Min. Negotiated Rate	$1,750.15
Max. Negotiated Rate	$1,997.23
Rate for Payer: Cash Price	$1,338.35
Rate for Payer: Health Management Network Commercial	$1,750.15
Rate for Payer: Kaiser Permanente Commercial	$1,853.10
Rate for Payer: MDX Hawaii PPO	$1,997.23

TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC

Facility

$18,790.55

Service Code	MSDRG 069
Min. Negotiated Rate	$18,790.55
Max. Negotiated Rate	$18,790.55
Rate for Payer: Hawaii Medical Service Association Commercial	$18,790.55

TRANSLUMINAL DILATION OF AQUEOUS OUTFLOW CANAL (EG, CANALOPLASTY); WITHOUT RETENTION OF DEVICE OR STENT

Facility

$11,119.00

Service Code	CPT 66174
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	$5,160.40

TRANSURETHRAL PROCEDURES WITH CC

Facility

$22,767.93

Service Code	MSDRG 669
Min. Negotiated Rate	$22,767.93
Max. Negotiated Rate	$22,767.93
Rate for Payer: Hawaii Medical Service Association Commercial	$22,767.93

TRANSURETHRAL PROCEDURES WITH MCC

Facility

$22,767.93

Service Code	MSDRG 668
Min. Negotiated Rate	$22,767.93
Max. Negotiated Rate	$22,767.93
Rate for Payer: Hawaii Medical Service Association Commercial	$22,767.93

TRANSURETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$20,192.83

Service Code	MSDRG 670
Min. Negotiated Rate	$20,192.83
Max. Negotiated Rate	$20,192.83
Rate for Payer: Hawaii Medical Service Association Commercial	$20,192.83

TRANSURETHRAL PROSTATECTOMY WITH CC/MCC

Facility

$19,020.02

Service Code	MSDRG 713
Min. Negotiated Rate	$19,020.02
Max. Negotiated Rate	$19,020.02
Rate for Payer: Hawaii Medical Service Association Commercial	$19,020.02

TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC

Facility

$15,068.14

Service Code	MSDRG 714
Min. Negotiated Rate	$15,068.14
Max. Negotiated Rate	$15,068.14
Rate for Payer: Hawaii Medical Service Association Commercial	$15,068.14

TRAUMATIC INJURY WITH MCC

Facility

$15,985.99

Service Code	MSDRG 913
Min. Negotiated Rate	$15,985.99
Max. Negotiated Rate	$15,985.99
Rate for Payer: Hawaii Medical Service Association Commercial	$15,985.99

TRAUMATIC INJURY WITHOUT MCC

Facility

$15,985.99

Service Code	MSDRG 914
Min. Negotiated Rate	$15,985.99
Max. Negotiated Rate	$15,985.99
Rate for Payer: Hawaii Medical Service Association Commercial	$15,985.99

TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC

Facility

$17,974.68

Service Code	MSDRG 086
Min. Negotiated Rate	$17,974.68
Max. Negotiated Rate	$17,974.68
Rate for Payer: Hawaii Medical Service Association Commercial	$17,974.68

TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC

Facility

$40,615.13

Service Code	MSDRG 083
Min. Negotiated Rate	$40,615.13
Max. Negotiated Rate	$40,615.13
Rate for Payer: Hawaii Medical Service Association Commercial	$40,615.13

TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC

Facility

$62,643.67

Service Code	MSDRG 085
Min. Negotiated Rate	$62,643.67
Max. Negotiated Rate	$62,643.67
Rate for Payer: Hawaii Medical Service Association Commercial	$62,643.67

TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC

Facility

$40,615.13

Service Code	MSDRG 082
Min. Negotiated Rate	$40,615.13
Max. Negotiated Rate	$40,615.13
Rate for Payer: Hawaii Medical Service Association Commercial	$40,615.13

TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC

Facility

$16,368.43

Service Code	MSDRG 087
Min. Negotiated Rate	$16,368.43
Max. Negotiated Rate	$16,368.43
Rate for Payer: Hawaii Medical Service Association Commercial	$16,368.43

TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC

Facility

$40,615.13

Service Code	MSDRG 084
Min. Negotiated Rate	$40,615.13
Max. Negotiated Rate	$40,615.13
Rate for Payer: Hawaii Medical Service Association Commercial	$40,615.13

TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC

Facility

$19,274.98

Service Code	MSDRG 604
Min. Negotiated Rate	$19,274.98
Max. Negotiated Rate	$19,274.98
Rate for Payer: Hawaii Medical Service Association Commercial	$19,274.98

TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC

Facility

$15,833.02

Service Code	MSDRG 605
Min. Negotiated Rate	$15,833.02
Max. Negotiated Rate	$15,833.02
Rate for Payer: Hawaii Medical Service Association Commercial	$15,833.02

TRAY 20G 10CM POWERGLIDE

Facility

$424.00

Service Code	HCPCS C1751
Hospital Charge Code	8266278
Hospital Revenue Code	272
Min. Negotiated Rate	$212.00
Max. Negotiated Rate	$411.28
Rate for Payer: AlohaCare Medicaid	$212.00
Rate for Payer: AlohaCare Medicare	$212.00
Rate for Payer: Cash Price	$275.60
Rate for Payer: Devoted Health Medicare	$233.20
Rate for Payer: Hawaii Medical Service Association Medicare	$212.00
Rate for Payer: Hawaii Western Management Group Commercial	$402.80
Rate for Payer: Health Management Network Commercial	$360.40
Rate for Payer: Humana Medicare	$212.00
Rate for Payer: Kaiser Permanente Commercial	$381.60
Rate for Payer: Kaiser Permanente Medicaid	$216.24
Rate for Payer: Kaiser Permanente Medicare	$212.00
Rate for Payer: MDX Hawaii PPO	$411.28
Rate for Payer: Ohana Health Plan Medicaid	$212.00
Rate for Payer: Ohana Health Plan Medicare	$212.00
Rate for Payer: UnitedHealthcare Medicare	$212.00
Rate for Payer: University Health Alliance Commercial	$309.05

TRAY 20G 10CM POWERGLIDE

Facility

$424.00

Service Code	HCPCS C1751
Hospital Charge Code	8266278
Hospital Revenue Code	272
Min. Negotiated Rate	$360.40
Max. Negotiated Rate	$411.28
Rate for Payer: Cash Price	$275.60
Rate for Payer: Health Management Network Commercial	$360.40
Rate for Payer: Kaiser Permanente Commercial	$381.60
Rate for Payer: MDX Hawaii PPO	$411.28

TRAY CATHETER FOLEY 14FR

Facility

$98.00

Hospital Charge Code	8266282
Hospital Revenue Code	272
Min. Negotiated Rate	$83.30
Max. Negotiated Rate	$95.06
Rate for Payer: Cash Price	$63.70
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: MDX Hawaii PPO	$95.06

TRAY CATHETER FOLEY 14FR

Facility

$98.00

Hospital Charge Code	8266282
Hospital Revenue Code	272
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$95.06
Rate for Payer: AlohaCare Medicaid	$49.00
Rate for Payer: AlohaCare Medicare	$49.00
Rate for Payer: Cash Price	$63.70
Rate for Payer: Devoted Health Medicare	$53.90
Rate for Payer: Hawaii Medical Service Association Medicare	$49.00
Rate for Payer: Hawaii Western Management Group Commercial	$93.10
Rate for Payer: Health Management Network Commercial	$83.30
Rate for Payer: Humana Medicare	$49.00
Rate for Payer: Kaiser Permanente Commercial	$88.20
Rate for Payer: Kaiser Permanente Medicaid	$49.98
Rate for Payer: Kaiser Permanente Medicare	$49.00
Rate for Payer: MDX Hawaii PPO	$95.06
Rate for Payer: Ohana Health Plan Medicaid	$49.00
Rate for Payer: Ohana Health Plan Medicare	$49.00
Rate for Payer: UnitedHealthcare Medicare	$49.00
Rate for Payer: University Health Alliance Commercial	$71.43

TRAY CATHETER FOLEY 16FR

Facility

$128.00

Hospital Charge Code	8266283
Hospital Revenue Code	272
Min. Negotiated Rate	$64.00
Max. Negotiated Rate	$124.16
Rate for Payer: AlohaCare Medicaid	$64.00
Rate for Payer: AlohaCare Medicare	$64.00
Rate for Payer: Cash Price	$83.20
Rate for Payer: Devoted Health Medicare	$70.40
Rate for Payer: Hawaii Medical Service Association Medicare	$64.00
Rate for Payer: Hawaii Western Management Group Commercial	$121.60
Rate for Payer: Health Management Network Commercial	$108.80
Rate for Payer: Humana Medicare	$64.00
Rate for Payer: Kaiser Permanente Commercial	$115.20
Rate for Payer: Kaiser Permanente Medicaid	$65.28
Rate for Payer: Kaiser Permanente Medicare	$64.00
Rate for Payer: MDX Hawaii PPO	$124.16
Rate for Payer: Ohana Health Plan Medicaid	$64.00
Rate for Payer: Ohana Health Plan Medicare	$64.00
Rate for Payer: UnitedHealthcare Medicare	$64.00
Rate for Payer: University Health Alliance Commercial	$93.30

Know your out-of-pocket cost for care.

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