Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Typhus Fever, IgG, IgM FSI

Facility

$218.00

Service Code	HCPCS 86757
Hospital Charge Code	8228933
Hospital Revenue Code	302
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$211.46
Rate for Payer: AlohaCare Medicaid	$109.00
Rate for Payer: AlohaCare Medicare	$109.00
Rate for Payer: Cash Price	$141.70
Rate for Payer: Cash Price	$141.70
Rate for Payer: Devoted Health Medicare	$119.90
Rate for Payer: Hawaii Medical Service Association ABD	$26.75
Rate for Payer: Hawaii Medical Service Association Commercial	$24.19
Rate for Payer: Hawaii Medical Service Association Medicare	$109.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.09
Rate for Payer: Hawaii Western Management Group Commercial	$19.35
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Humana Medicare	$109.00
Rate for Payer: Kaiser Permanente Commercial	$196.20
Rate for Payer: Kaiser Permanente Medicaid	$111.18
Rate for Payer: Kaiser Permanente Medicare	$109.00
Rate for Payer: MDX Hawaii PPO	$211.46
Rate for Payer: Ohana Health Plan Medicaid	$109.00
Rate for Payer: Ohana Health Plan Medicare	$109.00
Rate for Payer: UnitedHealthcare Medicaid	$26.75
Rate for Payer: UnitedHealthcare Medicare	$109.00
Rate for Payer: University Health Alliance Commercial	$50.04

Typhus Fever, IgG, IgM FSI

Facility

$218.00

Service Code	HCPCS 86757
Hospital Charge Code	8228933
Hospital Revenue Code	302
Min. Negotiated Rate	$185.30
Max. Negotiated Rate	$211.46
Rate for Payer: Cash Price	$141.70
Rate for Payer: Health Management Network Commercial	$185.30
Rate for Payer: Kaiser Permanente Commercial	$196.20
Rate for Payer: MDX Hawaii PPO	$211.46

UA Microscopic REF

Facility

$26.00

Service Code	HCPCS 81015
Hospital Charge Code	8191172
Hospital Revenue Code	300
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$16.90
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Kaiser Permanente Commercial	$23.40
Rate for Payer: MDX Hawaii PPO	$25.22

UA Microscopic REF

Facility

$26.00

Service Code	HCPCS 81015
Hospital Charge Code	8191172
Hospital Revenue Code	300
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$25.22
Rate for Payer: AlohaCare Medicaid	$13.00
Rate for Payer: AlohaCare Medicare	$13.00
Rate for Payer: Cash Price	$16.90
Rate for Payer: Cash Price	$16.90
Rate for Payer: Devoted Health Medicare	$14.30
Rate for Payer: Hawaii Medical Service Association ABD	$4.20
Rate for Payer: Hawaii Medical Service Association Commercial	$3.81
Rate for Payer: Hawaii Medical Service Association Medicare	$13.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.41
Rate for Payer: Hawaii Western Management Group Commercial	$3.05
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Humana Medicare	$13.00
Rate for Payer: Kaiser Permanente Commercial	$23.40
Rate for Payer: Kaiser Permanente Medicaid	$13.26
Rate for Payer: Kaiser Permanente Medicare	$13.00
Rate for Payer: MDX Hawaii PPO	$25.22
Rate for Payer: Ohana Health Plan Medicaid	$13.00
Rate for Payer: Ohana Health Plan Medicare	$13.00
Rate for Payer: UnitedHealthcare Medicaid	$4.20
Rate for Payer: UnitedHealthcare Medicare	$13.00
Rate for Payer: University Health Alliance Commercial	$7.84

UA Micro w Rfx Culture REF

Facility

$56.00

Service Code	HCPCS 81001
Hospital Charge Code	8191173
Hospital Revenue Code	307
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$54.32
Rate for Payer: Cash Price	$36.40
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Kaiser Permanente Commercial	$50.40
Rate for Payer: MDX Hawaii PPO	$54.32

UA Micro w Rfx Culture REF

Facility

$56.00

Service Code	HCPCS 81001
Hospital Charge Code	8191173
Hospital Revenue Code	307
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$54.32
Rate for Payer: AlohaCare Medicaid	$28.00
Rate for Payer: AlohaCare Medicare	$28.00
Rate for Payer: Cash Price	$36.40
Rate for Payer: Cash Price	$36.40
Rate for Payer: Devoted Health Medicare	$30.80
Rate for Payer: Hawaii Medical Service Association ABD	$4.37
Rate for Payer: Hawaii Medical Service Association Commercial	$3.96
Rate for Payer: Hawaii Medical Service Association Medicare	$28.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.59
Rate for Payer: Hawaii Western Management Group Commercial	$3.17
Rate for Payer: Health Management Network Commercial	$47.60
Rate for Payer: Humana Medicare	$28.00
Rate for Payer: Kaiser Permanente Commercial	$50.40
Rate for Payer: Kaiser Permanente Medicaid	$28.56
Rate for Payer: Kaiser Permanente Medicare	$28.00
Rate for Payer: MDX Hawaii PPO	$54.32
Rate for Payer: Ohana Health Plan Medicaid	$28.00
Rate for Payer: Ohana Health Plan Medicare	$28.00
Rate for Payer: UnitedHealthcare Medicaid	$4.37
Rate for Payer: UnitedHealthcare Medicare	$28.00
Rate for Payer: University Health Alliance Commercial	$8.20

ULNAR NERVE CUSHION

Facility

$25.00

Service Code	HCPCS E0190
Hospital Charge Code	11511782
Hospital Revenue Code	272
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$24.25
Rate for Payer: AlohaCare Medicaid	$12.50
Rate for Payer: AlohaCare Medicare	$12.50
Rate for Payer: Cash Price	$16.25
Rate for Payer: Devoted Health Medicare	$13.75
Rate for Payer: Hawaii Medical Service Association Medicare	$12.50
Rate for Payer: Hawaii Western Management Group Commercial	$23.75
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Humana Medicare	$12.50
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: Kaiser Permanente Medicaid	$12.75
Rate for Payer: Kaiser Permanente Medicare	$12.50
Rate for Payer: MDX Hawaii PPO	$24.25
Rate for Payer: Ohana Health Plan Medicaid	$12.50
Rate for Payer: Ohana Health Plan Medicare	$12.50
Rate for Payer: UnitedHealthcare Medicare	$12.50
Rate for Payer: University Health Alliance Commercial	$18.22

ULNAR NERVE CUSHION

Facility

$25.00

Service Code	HCPCS E0190
Hospital Charge Code	11511782
Hospital Revenue Code	272
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: MDX Hawaii PPO	$24.25

ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC

Facility

$77,354.86

Service Code	MSDRG 278
Min. Negotiated Rate	$77,354.86
Max. Negotiated Rate	$77,354.86
Rate for Payer: Hawaii Medical Service Association Commercial	$77,354.86

ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC

Facility

$77,354.86

Service Code	MSDRG 279
Min. Negotiated Rate	$77,354.86
Max. Negotiated Rate	$77,354.86
Rate for Payer: Hawaii Medical Service Association Commercial	$77,354.86

Ultrasound Charges

Facility

$104.00

Service Code	HCPCS 97035 GP
Hospital Charge Code	8111698
Hospital Revenue Code	420
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

Ultrasound Charges

Facility

$104.00

Service Code	HCPCS 97035 GP
Hospital Charge Code	8111698
Hospital Revenue Code	420
Min. Negotiated Rate	$9.52
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 Medicare	$52.00
Rate for Payer: Hawaii Western Management Group Commercial	$98.80
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	$9.52
Rate for Payer: UnitedHealthcare Medicare	$52.00
Rate for Payer: University Health Alliance Commercial	$75.81

Ultrasound Charges

Facility

$104.00

Service Code	HCPCS 97035 GO
Hospital Charge Code	8123832
Hospital Revenue Code	430
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

Ultrasound Charges

Facility

$104.00

Service Code	HCPCS 97035 GO
Hospital Charge Code	8123832
Hospital Revenue Code	430
Min. Negotiated Rate	$9.52
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 Medicare	$52.00
Rate for Payer: Hawaii Western Management Group Commercial	$98.80
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	$9.52
Rate for Payer: UnitedHealthcare Medicare	$52.00
Rate for Payer: University Health Alliance Commercial	$75.81

UNCOMPLICATED PEPTIC ULCER WITH MCC

Facility

$21,110.69

Service Code	MSDRG 383
Min. Negotiated Rate	$21,110.69
Max. Negotiated Rate	$21,110.69
Rate for Payer: Hawaii Medical Service Association Commercial	$21,110.69

UNCOMPLICATED PEPTIC ULCER WITHOUT MCC

Facility

$21,110.69

Service Code	MSDRG 384
Min. Negotiated Rate	$21,110.69
Max. Negotiated Rate	$21,110.69
Rate for Payer: Hawaii Medical Service Association Commercial	$21,110.69

UNIVERSAL HOOK PLATE

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Charge Code	13005600
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.28
Max. Negotiated Rate	$2,825.61
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: Cash Price	$1,893.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: University Health Alliance Commercial	$1,631.28

UNIVERSAL HOOK PLATE

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Charge Code	13005600
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.50
Max. Negotiated Rate	$2,825.61
Rate for Payer: AlohaCare Medicaid	$1,456.50
Rate for Payer: AlohaCare Medicare	$1,456.50
Rate for Payer: Cash Price	$1,893.45
Rate for Payer: Devoted Health Medicare	$1,602.15
Rate for Payer: Hawaii Medical Service Association Medicare	$1,456.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Humana Medicare	$1,456.50
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: Kaiser Permanente Medicaid	$1,485.63
Rate for Payer: Kaiser Permanente Medicare	$1,456.50
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: Ohana Health Plan Medicaid	$1,456.50
Rate for Payer: Ohana Health Plan Medicare	$1,456.50
Rate for Payer: UnitedHealthcare Medicare	$1,456.50
Rate for Payer: University Health Alliance Commercial	$1,631.28

Unlisted Laparoscopic PX Abd Pertoneum & Omentum

Professional

Both

$898.00

Service Code	HCPCS 49329
Hospital Charge Code	9589980
Hospital Revenue Code	975
Min. Negotiated Rate	$548.58
Max. Negotiated Rate	$763.30
Rate for Payer: AlohaCare Medicaid	$548.58
Rate for Payer: Cash Price	$583.70
Rate for Payer: Cash Price	$583.70
Rate for Payer: Health Management Network Commercial	$763.30
Rate for Payer: Ohana Health Plan Medicaid	$548.58
Rate for Payer: UnitedHealthcare Medicaid	$548.58

UNLISTED LAPAROSCOPY PROCEDURE, SPERMATIC CORD

Facility

$7,720.59

Service Code	CPT 55559
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$7,720.59
Rate for Payer: Hawaii Medical Service Association Commercial	$7,720.59
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$521.33

Unlisted Physical Medicine/Rehab Service Charge

Facility

$114.00

Service Code	HCPCS 97799 GP
Hospital Charge Code	8111829
Hospital Revenue Code	420
Min. Negotiated Rate	$57.00
Max. Negotiated Rate	$110.58
Rate for Payer: AlohaCare Medicaid	$57.00
Rate for Payer: AlohaCare Medicare	$57.00
Rate for Payer: Cash Price	$74.10
Rate for Payer: Devoted Health Medicare	$62.70
Rate for Payer: Hawaii Medical Service Association Medicare	$57.00
Rate for Payer: Hawaii Western Management Group Commercial	$108.30
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Humana Medicare	$57.00
Rate for Payer: Kaiser Permanente Commercial	$102.60
Rate for Payer: Kaiser Permanente Medicaid	$58.14
Rate for Payer: Kaiser Permanente Medicare	$57.00
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: Ohana Health Plan Medicaid	$57.00
Rate for Payer: Ohana Health Plan Medicare	$57.00
Rate for Payer: UnitedHealthcare Medicare	$57.00
Rate for Payer: University Health Alliance Commercial	$83.09

Unlisted Physical Medicine/Rehab Service Charge

Facility

$114.00

Service Code	HCPCS 97799 GP
Hospital Charge Code	8111829
Hospital Revenue Code	420
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$74.10
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Kaiser Permanente Commercial	$102.60
Rate for Payer: MDX Hawaii PPO	$110.58

Unlisted Procedure, Vascular Surgery 37799

Facility

$4,140.00

Service Code	HCPCS 37799
Hospital Charge Code	8749388
Hospital Revenue Code	450
Min. Negotiated Rate	$3,519.00
Max. Negotiated Rate	$4,015.80
Rate for Payer: Cash Price	$2,691.00
Rate for Payer: Health Management Network Commercial	$3,519.00
Rate for Payer: Kaiser Permanente Commercial	$3,726.00
Rate for Payer: MDX Hawaii PPO	$4,015.80

Unlisted Procedure, Vascular Surgery 37799

Facility

$4,140.00

Service Code	HCPCS 37799
Hospital Charge Code	8749388
Hospital Revenue Code	450
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$4,015.80
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$2,070.00
Rate for Payer: Cash Price	$2,691.00
Rate for Payer: Cash Price	$2,691.00
Rate for Payer: Cash Price	$2,691.00
Rate for Payer: Devoted Health Medicare	$2,277.00
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	$2,070.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,933.00
Rate for Payer: Health Management Network Commercial	$3,519.00
Rate for Payer: Humana Medicare	$2,070.00
Rate for Payer: Kaiser Permanente Commercial	$3,726.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,070.00
Rate for Payer: MDX Hawaii PPO	$4,015.80
Rate for Payer: Ohana Health Plan Medicaid	$2,070.00
Rate for Payer: Ohana Health Plan Medicare	$2,070.00
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$2,070.00
Rate for Payer: University Health Alliance Commercial	$3,017.65

U Parvum Amp Probe

Facility

$365.00

Service Code	HCPCS 87798
Hospital Charge Code	10023503
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$354.05
Rate for Payer: AlohaCare Medicaid	$182.50
Rate for Payer: AlohaCare Medicare	$182.50
Rate for Payer: Cash Price	$237.25
Rate for Payer: Cash Price	$237.25
Rate for Payer: Devoted Health Medicare	$200.75
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$182.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$310.25
Rate for Payer: Humana Medicare	$182.50
Rate for Payer: Kaiser Permanente Commercial	$328.50
Rate for Payer: Kaiser Permanente Medicaid	$186.15
Rate for Payer: Kaiser Permanente Medicare	$182.50
Rate for Payer: MDX Hawaii PPO	$354.05
Rate for Payer: Ohana Health Plan Medicaid	$182.50
Rate for Payer: Ohana Health Plan Medicare	$182.50
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$182.50
Rate for Payer: University Health Alliance Commercial	$90.72

Know your out-of-pocket cost for care.

All Charges