Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

UROLOGY - EVACUATOR UROVAC BLADDER

Facility

$117.00

Hospital Charge Code	9740163
Hospital Revenue Code	272
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$113.49
Rate for Payer: Cash Price	$76.05
Rate for Payer: Health Management Network Commercial	$99.45
Rate for Payer: Kaiser Permanente Commercial	$105.30
Rate for Payer: MDX Hawaii PPO	$113.49

UROLOGY: EXTRACTOR 8MM OPEN TIP, 1.5FR X 120CM

Facility

$722.00

Hospital Charge Code	10048444
Hospital Revenue Code	272
Min. Negotiated Rate	$613.70
Max. Negotiated Rate	$700.34
Rate for Payer: Cash Price	$469.30
Rate for Payer: Health Management Network Commercial	$613.70
Rate for Payer: Kaiser Permanente Commercial	$649.80
Rate for Payer: MDX Hawaii PPO	$700.34

UROLOGY: EXTRACTOR 8MM OPEN TIP, 1.5FR X 120CM

Facility

$722.00

Hospital Charge Code	10048444
Hospital Revenue Code	272
Min. Negotiated Rate	$361.00
Max. Negotiated Rate	$700.34
Rate for Payer: AlohaCare Medicaid	$361.00
Rate for Payer: AlohaCare Medicare	$361.00
Rate for Payer: Cash Price	$469.30
Rate for Payer: Devoted Health Medicare	$397.10
Rate for Payer: Hawaii Medical Service Association Medicare	$361.00
Rate for Payer: Hawaii Western Management Group Commercial	$685.90
Rate for Payer: Health Management Network Commercial	$613.70
Rate for Payer: Humana Medicare	$361.00
Rate for Payer: Kaiser Permanente Commercial	$649.80
Rate for Payer: Kaiser Permanente Medicaid	$368.22
Rate for Payer: Kaiser Permanente Medicare	$361.00
Rate for Payer: MDX Hawaii PPO	$700.34
Rate for Payer: Ohana Health Plan Medicaid	$361.00
Rate for Payer: Ohana Health Plan Medicare	$361.00
Rate for Payer: UnitedHealthcare Medicare	$361.00
Rate for Payer: University Health Alliance Commercial	$526.27

UROLOGY: MAGELLAN SHEATH, 10/12FR X 35CM

Facility

$384.00

Hospital Charge Code	10048404
Hospital Revenue Code	272
Min. Negotiated Rate	$192.00
Max. Negotiated Rate	$372.48
Rate for Payer: AlohaCare Medicaid	$192.00
Rate for Payer: AlohaCare Medicare	$192.00
Rate for Payer: Cash Price	$249.60
Rate for Payer: Devoted Health Medicare	$211.20
Rate for Payer: Hawaii Medical Service Association Medicare	$192.00
Rate for Payer: Hawaii Western Management Group Commercial	$364.80
Rate for Payer: Health Management Network Commercial	$326.40
Rate for Payer: Humana Medicare	$192.00
Rate for Payer: Kaiser Permanente Commercial	$345.60
Rate for Payer: Kaiser Permanente Medicaid	$195.84
Rate for Payer: Kaiser Permanente Medicare	$192.00
Rate for Payer: MDX Hawaii PPO	$372.48
Rate for Payer: Ohana Health Plan Medicaid	$192.00
Rate for Payer: Ohana Health Plan Medicare	$192.00
Rate for Payer: UnitedHealthcare Medicare	$192.00
Rate for Payer: University Health Alliance Commercial	$279.90

UROLOGY: MAGELLAN SHEATH, 10/12FR X 35CM

Facility

$384.00

Hospital Charge Code	10048404
Hospital Revenue Code	272
Min. Negotiated Rate	$326.40
Max. Negotiated Rate	$372.48
Rate for Payer: Cash Price	$249.60
Rate for Payer: Health Management Network Commercial	$326.40
Rate for Payer: Kaiser Permanente Commercial	$345.60
Rate for Payer: MDX Hawaii PPO	$372.48

UROLOGY MAGELLAN SHEATH 10/12FR X 45CM

Facility

$464.00

Hospital Charge Code	10260868
Hospital Revenue Code	272
Min. Negotiated Rate	$394.40
Max. Negotiated Rate	$450.08
Rate for Payer: Cash Price	$301.60
Rate for Payer: Health Management Network Commercial	$394.40
Rate for Payer: Kaiser Permanente Commercial	$417.60
Rate for Payer: MDX Hawaii PPO	$450.08

UROLOGY MAGELLAN SHEATH 10/12FR X 45CM

Facility

$464.00

Hospital Charge Code	10260868
Hospital Revenue Code	272
Min. Negotiated Rate	$232.00
Max. Negotiated Rate	$450.08
Rate for Payer: AlohaCare Medicaid	$232.00
Rate for Payer: AlohaCare Medicare	$232.00
Rate for Payer: Cash Price	$301.60
Rate for Payer: Devoted Health Medicare	$255.20
Rate for Payer: Hawaii Medical Service Association Medicare	$232.00
Rate for Payer: Hawaii Western Management Group Commercial	$440.80
Rate for Payer: Health Management Network Commercial	$394.40
Rate for Payer: Humana Medicare	$232.00
Rate for Payer: Kaiser Permanente Commercial	$417.60
Rate for Payer: Kaiser Permanente Medicaid	$236.64
Rate for Payer: Kaiser Permanente Medicare	$232.00
Rate for Payer: MDX Hawaii PPO	$450.08
Rate for Payer: Ohana Health Plan Medicaid	$232.00
Rate for Payer: Ohana Health Plan Medicare	$232.00
Rate for Payer: UnitedHealthcare Medicare	$232.00
Rate for Payer: University Health Alliance Commercial	$338.21

UROLOGY: MAGELLAN SHEATH, 12/14FR X 35CM

Facility

$384.00

Service Code	HCPCS C1766
Hospital Charge Code	10048405
Hospital Revenue Code	272
Min. Negotiated Rate	$326.40
Max. Negotiated Rate	$372.48
Rate for Payer: Cash Price	$249.60
Rate for Payer: Health Management Network Commercial	$326.40
Rate for Payer: Kaiser Permanente Commercial	$345.60
Rate for Payer: MDX Hawaii PPO	$372.48

UROLOGY: MAGELLAN SHEATH, 12/14FR X 35CM

Facility

$384.00

Service Code	HCPCS C1766
Hospital Charge Code	10048405
Hospital Revenue Code	272
Min. Negotiated Rate	$192.00
Max. Negotiated Rate	$372.48
Rate for Payer: AlohaCare Medicaid	$192.00
Rate for Payer: AlohaCare Medicare	$192.00
Rate for Payer: Cash Price	$249.60
Rate for Payer: Devoted Health Medicare	$211.20
Rate for Payer: Hawaii Medical Service Association Medicare	$192.00
Rate for Payer: Hawaii Western Management Group Commercial	$364.80
Rate for Payer: Health Management Network Commercial	$326.40
Rate for Payer: Humana Medicare	$192.00
Rate for Payer: Kaiser Permanente Commercial	$345.60
Rate for Payer: Kaiser Permanente Medicaid	$195.84
Rate for Payer: Kaiser Permanente Medicare	$192.00
Rate for Payer: MDX Hawaii PPO	$372.48
Rate for Payer: Ohana Health Plan Medicaid	$192.00
Rate for Payer: Ohana Health Plan Medicare	$192.00
Rate for Payer: UnitedHealthcare Medicare	$192.00
Rate for Payer: University Health Alliance Commercial	$279.90

UROLOGY MAGELLAN SHEATH 12/14FR X 45CM

Facility

$646.00

Hospital Charge Code	10260869
Hospital Revenue Code	272
Min. Negotiated Rate	$323.00
Max. Negotiated Rate	$626.62
Rate for Payer: AlohaCare Medicaid	$323.00
Rate for Payer: AlohaCare Medicare	$323.00
Rate for Payer: Cash Price	$419.90
Rate for Payer: Devoted Health Medicare	$355.30
Rate for Payer: Hawaii Medical Service Association Medicare	$323.00
Rate for Payer: Hawaii Western Management Group Commercial	$613.70
Rate for Payer: Health Management Network Commercial	$549.10
Rate for Payer: Humana Medicare	$323.00
Rate for Payer: Kaiser Permanente Commercial	$581.40
Rate for Payer: Kaiser Permanente Medicaid	$329.46
Rate for Payer: Kaiser Permanente Medicare	$323.00
Rate for Payer: MDX Hawaii PPO	$626.62
Rate for Payer: Ohana Health Plan Medicaid	$323.00
Rate for Payer: Ohana Health Plan Medicare	$323.00
Rate for Payer: UnitedHealthcare Medicare	$323.00
Rate for Payer: University Health Alliance Commercial	$470.87

UROLOGY MAGELLAN SHEATH 12/14FR X 45CM

Facility

$646.00

Hospital Charge Code	10260869
Hospital Revenue Code	272
Min. Negotiated Rate	$549.10
Max. Negotiated Rate	$626.62
Rate for Payer: Cash Price	$419.90
Rate for Payer: Health Management Network Commercial	$549.10
Rate for Payer: Kaiser Permanente Commercial	$581.40
Rate for Payer: MDX Hawaii PPO	$626.62

UROLOGY: MERDIAN PTFE/NITINOL GUIDE WIRE, ANGLE, DUAL FLEX HYDROPHILIC TIP, STIFF, 0.035IN X 150CM

Facility

$176.00

Service Code	HCPCS C1769
Hospital Charge Code	10048419
Hospital Revenue Code	272
Min. Negotiated Rate	$149.60
Max. Negotiated Rate	$170.72
Rate for Payer: Cash Price	$114.40
Rate for Payer: Health Management Network Commercial	$149.60
Rate for Payer: Kaiser Permanente Commercial	$158.40
Rate for Payer: MDX Hawaii PPO	$170.72

UROLOGY: MERDIAN PTFE/NITINOL GUIDE WIRE, ANGLE, DUAL FLEX HYDROPHILIC TIP, STIFF, 0.035IN X 150CM

Facility

$176.00

Service Code	HCPCS C1769
Hospital Charge Code	10048419
Hospital Revenue Code	272
Min. Negotiated Rate	$88.00
Max. Negotiated Rate	$170.72
Rate for Payer: AlohaCare Medicaid	$88.00
Rate for Payer: AlohaCare Medicare	$88.00
Rate for Payer: Cash Price	$114.40
Rate for Payer: Devoted Health Medicare	$96.80
Rate for Payer: Hawaii Medical Service Association Medicare	$88.00
Rate for Payer: Hawaii Western Management Group Commercial	$167.20
Rate for Payer: Health Management Network Commercial	$149.60
Rate for Payer: Humana Medicare	$88.00
Rate for Payer: Kaiser Permanente Commercial	$158.40
Rate for Payer: Kaiser Permanente Medicaid	$89.76
Rate for Payer: Kaiser Permanente Medicare	$88.00
Rate for Payer: MDX Hawaii PPO	$170.72
Rate for Payer: Ohana Health Plan Medicaid	$88.00
Rate for Payer: Ohana Health Plan Medicare	$88.00
Rate for Payer: UnitedHealthcare Medicare	$88.00
Rate for Payer: University Health Alliance Commercial	$128.29

UROLOGY: MERDIAN PTFE/NITINOL GUIDE WIRE, STRAIGHT, DUAL FLEX HYDROPHILIC TIP, STIFF, 0.035IN X 150C

Facility

$176.00

Hospital Charge Code	10048420
Hospital Revenue Code	272
Min. Negotiated Rate	$149.60
Max. Negotiated Rate	$170.72
Rate for Payer: Cash Price	$114.40
Rate for Payer: Health Management Network Commercial	$149.60
Rate for Payer: Kaiser Permanente Commercial	$158.40
Rate for Payer: MDX Hawaii PPO	$170.72

UROLOGY: MERDIAN PTFE/NITINOL GUIDE WIRE, STRAIGHT, DUAL FLEX HYDROPHILIC TIP, STIFF, 0.035IN X 150C

Facility

$176.00

Hospital Charge Code	10048420
Hospital Revenue Code	272
Min. Negotiated Rate	$88.00
Max. Negotiated Rate	$170.72
Rate for Payer: AlohaCare Medicaid	$88.00
Rate for Payer: AlohaCare Medicare	$88.00
Rate for Payer: Cash Price	$114.40
Rate for Payer: Devoted Health Medicare	$96.80
Rate for Payer: Hawaii Medical Service Association Medicare	$88.00
Rate for Payer: Hawaii Western Management Group Commercial	$167.20
Rate for Payer: Health Management Network Commercial	$149.60
Rate for Payer: Humana Medicare	$88.00
Rate for Payer: Kaiser Permanente Commercial	$158.40
Rate for Payer: Kaiser Permanente Medicaid	$89.76
Rate for Payer: Kaiser Permanente Medicare	$88.00
Rate for Payer: MDX Hawaii PPO	$170.72
Rate for Payer: Ohana Health Plan Medicaid	$88.00
Rate for Payer: Ohana Health Plan Medicare	$88.00
Rate for Payer: UnitedHealthcare Medicare	$88.00
Rate for Payer: University Health Alliance Commercial	$128.29

UROLOGY: MINNOW URETERAL CATHETER, 5 FR X 70CM OPEN TIP-RIGHT

Facility

$68.00

Hospital Charge Code	10048421
Hospital Revenue Code	272
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$44.20
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Kaiser Permanente Commercial	$61.20
Rate for Payer: MDX Hawaii PPO	$65.96

UROLOGY: MINNOW URETERAL CATHETER, 5 FR X 70CM OPEN TIP-RIGHT

Facility

$68.00

Hospital Charge Code	10048421
Hospital Revenue Code	272
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$65.96
Rate for Payer: AlohaCare Medicaid	$34.00
Rate for Payer: AlohaCare Medicare	$34.00
Rate for Payer: Cash Price	$44.20
Rate for Payer: Devoted Health Medicare	$37.40
Rate for Payer: Hawaii Medical Service Association Medicare	$34.00
Rate for Payer: Hawaii Western Management Group Commercial	$64.60
Rate for Payer: Health Management Network Commercial	$57.80
Rate for Payer: Humana Medicare	$34.00
Rate for Payer: Kaiser Permanente Commercial	$61.20
Rate for Payer: Kaiser Permanente Medicaid	$34.68
Rate for Payer: Kaiser Permanente Medicare	$34.00
Rate for Payer: MDX Hawaii PPO	$65.96
Rate for Payer: Ohana Health Plan Medicaid	$34.00
Rate for Payer: Ohana Health Plan Medicare	$34.00
Rate for Payer: UnitedHealthcare Medicare	$34.00
Rate for Payer: University Health Alliance Commercial	$49.57

UROLOGY - NAVIGATOR HD ACCESS SEATH 11/13 FR X 36 CM

Facility

$451.00

Hospital Charge Code	9816307
Hospital Revenue Code	272
Min. Negotiated Rate	$225.50
Max. Negotiated Rate	$437.47
Rate for Payer: AlohaCare Medicaid	$225.50
Rate for Payer: AlohaCare Medicare	$225.50
Rate for Payer: Cash Price	$293.15
Rate for Payer: Devoted Health Medicare	$248.05
Rate for Payer: Hawaii Medical Service Association Medicare	$225.50
Rate for Payer: Hawaii Western Management Group Commercial	$428.45
Rate for Payer: Health Management Network Commercial	$383.35
Rate for Payer: Humana Medicare	$225.50
Rate for Payer: Kaiser Permanente Commercial	$405.90
Rate for Payer: Kaiser Permanente Medicaid	$230.01
Rate for Payer: Kaiser Permanente Medicare	$225.50
Rate for Payer: MDX Hawaii PPO	$437.47
Rate for Payer: Ohana Health Plan Medicaid	$225.50
Rate for Payer: Ohana Health Plan Medicare	$225.50
Rate for Payer: UnitedHealthcare Medicare	$225.50
Rate for Payer: University Health Alliance Commercial	$328.73

UROLOGY - NAVIGATOR HD ACCESS SEATH 11/13 FR X 36 CM

Facility

$451.00

Hospital Charge Code	9816307
Hospital Revenue Code	272
Min. Negotiated Rate	$383.35
Max. Negotiated Rate	$437.47
Rate for Payer: Cash Price	$293.15
Rate for Payer: Health Management Network Commercial	$383.35
Rate for Payer: Kaiser Permanente Commercial	$405.90
Rate for Payer: MDX Hawaii PPO	$437.47

UROLOGY:PATHFINDER PLUS (DISP)

Facility

$193.00

Hospital Charge Code	10171261
Hospital Revenue Code	270
Min. Negotiated Rate	$96.50
Max. Negotiated Rate	$187.21
Rate for Payer: AlohaCare Medicaid	$96.50
Rate for Payer: AlohaCare Medicare	$96.50
Rate for Payer: Cash Price	$125.45
Rate for Payer: Devoted Health Medicare	$106.15
Rate for Payer: Hawaii Medical Service Association Medicare	$96.50
Rate for Payer: Hawaii Western Management Group Commercial	$183.35
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Humana Medicare	$96.50
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: Kaiser Permanente Medicare	$96.50
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: Ohana Health Plan Medicaid	$96.50
Rate for Payer: Ohana Health Plan Medicare	$96.50
Rate for Payer: UnitedHealthcare Medicare	$96.50
Rate for Payer: University Health Alliance Commercial	$140.68

UROLOGY:PATHFINDER PLUS (DISP)

Facility

$193.00

Hospital Charge Code	10171261
Hospital Revenue Code	270
Min. Negotiated Rate	$164.05
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$125.45
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: MDX Hawaii PPO	$187.21

UROLOGY - PIRANHA 3 FR URETERSCOPIC BIOPSY FORCEPS

Facility

$1,100.00

Hospital Charge Code	9816310
Hospital Revenue Code	272
Min. Negotiated Rate	$550.00
Max. Negotiated Rate	$1,067.00
Rate for Payer: AlohaCare Medicaid	$550.00
Rate for Payer: AlohaCare Medicare	$550.00
Rate for Payer: Cash Price	$715.00
Rate for Payer: Devoted Health Medicare	$605.00
Rate for Payer: Hawaii Medical Service Association Medicare	$550.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,045.00
Rate for Payer: Health Management Network Commercial	$935.00
Rate for Payer: Humana Medicare	$550.00
Rate for Payer: Kaiser Permanente Commercial	$990.00
Rate for Payer: Kaiser Permanente Medicaid	$561.00
Rate for Payer: Kaiser Permanente Medicare	$550.00
Rate for Payer: MDX Hawaii PPO	$1,067.00
Rate for Payer: Ohana Health Plan Medicaid	$550.00
Rate for Payer: Ohana Health Plan Medicare	$550.00
Rate for Payer: UnitedHealthcare Medicare	$550.00
Rate for Payer: University Health Alliance Commercial	$801.79

UROLOGY - PIRANHA 3 FR URETERSCOPIC BIOPSY FORCEPS

Facility

$1,100.00

Hospital Charge Code	9816310
Hospital Revenue Code	272
Min. Negotiated Rate	$935.00
Max. Negotiated Rate	$1,067.00
Rate for Payer: Cash Price	$715.00
Rate for Payer: Health Management Network Commercial	$935.00
Rate for Payer: Kaiser Permanente Commercial	$990.00
Rate for Payer: MDX Hawaii PPO	$1,067.00

UROLOGY - SAPS - SINGLE ACTION PUMP LIKE PATHFINDER

Facility

$223.00

Hospital Charge Code	9816309
Hospital Revenue Code	272
Min. Negotiated Rate	$111.50
Max. Negotiated Rate	$216.31
Rate for Payer: AlohaCare Medicaid	$111.50
Rate for Payer: AlohaCare Medicare	$111.50
Rate for Payer: Cash Price	$144.95
Rate for Payer: Devoted Health Medicare	$122.65
Rate for Payer: Hawaii Medical Service Association Medicare	$111.50
Rate for Payer: Hawaii Western Management Group Commercial	$211.85
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: Humana Medicare	$111.50
Rate for Payer: Kaiser Permanente Commercial	$200.70
Rate for Payer: Kaiser Permanente Medicaid	$113.73
Rate for Payer: Kaiser Permanente Medicare	$111.50
Rate for Payer: MDX Hawaii PPO	$216.31
Rate for Payer: Ohana Health Plan Medicaid	$111.50
Rate for Payer: Ohana Health Plan Medicare	$111.50
Rate for Payer: UnitedHealthcare Medicare	$111.50
Rate for Payer: University Health Alliance Commercial	$162.54

UROLOGY - SAPS - SINGLE ACTION PUMP LIKE PATHFINDER

Facility

$223.00

Hospital Charge Code	9816309
Hospital Revenue Code	272
Min. Negotiated Rate	$189.55
Max. Negotiated Rate	$216.31
Rate for Payer: Cash Price	$144.95
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: Kaiser Permanente Commercial	$200.70
Rate for Payer: MDX Hawaii PPO	$216.31

Know your out-of-pocket cost for care.

All Charges