Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

UROLOGY - SENSOR 0.35 DUALFLEX STRAIGHT

Facility

$211.00

Hospital Charge Code	9816285
Hospital Revenue Code	272
Min. Negotiated Rate	$179.35
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$137.15
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: MDX Hawaii PPO	$204.67

UROLOGY - SENSOR 0.35 DUALFLEX STRAIGHT

Facility

$211.00

Hospital Charge Code	9816285
Hospital Revenue Code	272
Min. Negotiated Rate	$105.50
Max. Negotiated Rate	$204.67
Rate for Payer: AlohaCare Medicaid	$105.50
Rate for Payer: AlohaCare Medicare	$105.50
Rate for Payer: Cash Price	$137.15
Rate for Payer: Devoted Health Medicare	$116.05
Rate for Payer: Hawaii Medical Service Association Medicare	$105.50
Rate for Payer: Hawaii Western Management Group Commercial	$200.45
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Humana Medicare	$105.50
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: Kaiser Permanente Medicaid	$107.61
Rate for Payer: Kaiser Permanente Medicare	$105.50
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: Ohana Health Plan Medicaid	$105.50
Rate for Payer: Ohana Health Plan Medicare	$105.50
Rate for Payer: UnitedHealthcare Medicare	$105.50
Rate for Payer: University Health Alliance Commercial	$153.80

UROLOGY - SENSOR 0.35 SENSOR ANGLED-NEED

Facility

$203.00

Hospital Charge Code	9816286
Hospital Revenue Code	272
Min. Negotiated Rate	$101.50
Max. Negotiated Rate	$196.91
Rate for Payer: AlohaCare Medicaid	$101.50
Rate for Payer: AlohaCare Medicare	$101.50
Rate for Payer: Cash Price	$131.95
Rate for Payer: Devoted Health Medicare	$111.65
Rate for Payer: Hawaii Medical Service Association Medicare	$101.50
Rate for Payer: Hawaii Western Management Group Commercial	$192.85
Rate for Payer: Health Management Network Commercial	$172.55
Rate for Payer: Humana Medicare	$101.50
Rate for Payer: Kaiser Permanente Commercial	$182.70
Rate for Payer: Kaiser Permanente Medicaid	$103.53
Rate for Payer: Kaiser Permanente Medicare	$101.50
Rate for Payer: MDX Hawaii PPO	$196.91
Rate for Payer: Ohana Health Plan Medicaid	$101.50
Rate for Payer: Ohana Health Plan Medicare	$101.50
Rate for Payer: UnitedHealthcare Medicare	$101.50
Rate for Payer: University Health Alliance Commercial	$147.97

UROLOGY - SENSOR 0.35 SENSOR ANGLED-NEED

Facility

$203.00

Hospital Charge Code	9816286
Hospital Revenue Code	272
Min. Negotiated Rate	$172.55
Max. Negotiated Rate	$196.91
Rate for Payer: Cash Price	$131.95
Rate for Payer: Health Management Network Commercial	$172.55
Rate for Payer: Kaiser Permanente Commercial	$182.70
Rate for Payer: MDX Hawaii PPO	$196.91

UROLOGY: SLIP NITINOL HYDOPHILIC GUIDE WIRE, STRAIGHT, FLEXIBLE TIP, REGULAR STIFFNESS, 0.025IN X 15

Facility

$141.00

Hospital Charge Code	10048443
Hospital Revenue Code	272
Min. Negotiated Rate	$119.85
Max. Negotiated Rate	$136.77
Rate for Payer: Cash Price	$91.65
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Kaiser Permanente Commercial	$126.90
Rate for Payer: MDX Hawaii PPO	$136.77

UROLOGY: SLIP NITINOL HYDOPHILIC GUIDE WIRE, STRAIGHT, FLEXIBLE TIP, REGULAR STIFFNESS, 0.025IN X 15

Facility

$141.00

Hospital Charge Code	10048443
Hospital Revenue Code	272
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$136.77
Rate for Payer: AlohaCare Medicaid	$70.50
Rate for Payer: AlohaCare Medicare	$70.50
Rate for Payer: Cash Price	$91.65
Rate for Payer: Devoted Health Medicare	$77.55
Rate for Payer: Hawaii Medical Service Association Medicare	$70.50
Rate for Payer: Hawaii Western Management Group Commercial	$133.95
Rate for Payer: Health Management Network Commercial	$119.85
Rate for Payer: Humana Medicare	$70.50
Rate for Payer: Kaiser Permanente Commercial	$126.90
Rate for Payer: Kaiser Permanente Medicaid	$71.91
Rate for Payer: Kaiser Permanente Medicare	$70.50
Rate for Payer: MDX Hawaii PPO	$136.77
Rate for Payer: Ohana Health Plan Medicaid	$70.50
Rate for Payer: Ohana Health Plan Medicare	$70.50
Rate for Payer: UnitedHealthcare Medicare	$70.50
Rate for Payer: University Health Alliance Commercial	$102.77

UROLOGY - ZERO TIP 1.9 FR BASKET

Facility

$746.00

Hospital Charge Code	9816311
Hospital Revenue Code	272
Min. Negotiated Rate	$373.00
Max. Negotiated Rate	$723.62
Rate for Payer: AlohaCare Medicaid	$373.00
Rate for Payer: AlohaCare Medicare	$373.00
Rate for Payer: Cash Price	$484.90
Rate for Payer: Devoted Health Medicare	$410.30
Rate for Payer: Hawaii Medical Service Association Medicare	$373.00
Rate for Payer: Hawaii Western Management Group Commercial	$708.70
Rate for Payer: Health Management Network Commercial	$634.10
Rate for Payer: Humana Medicare	$373.00
Rate for Payer: Kaiser Permanente Commercial	$671.40
Rate for Payer: Kaiser Permanente Medicaid	$380.46
Rate for Payer: Kaiser Permanente Medicare	$373.00
Rate for Payer: MDX Hawaii PPO	$723.62
Rate for Payer: Ohana Health Plan Medicaid	$373.00
Rate for Payer: Ohana Health Plan Medicare	$373.00
Rate for Payer: UnitedHealthcare Medicare	$373.00
Rate for Payer: University Health Alliance Commercial	$543.76

UROLOGY - ZERO TIP 1.9 FR BASKET

Facility

$746.00

Hospital Charge Code	9816311
Hospital Revenue Code	272
Min. Negotiated Rate	$634.10
Max. Negotiated Rate	$723.62
Rate for Payer: Cash Price	$484.90
Rate for Payer: Health Management Network Commercial	$634.10
Rate for Payer: Kaiser Permanente Commercial	$671.40
Rate for Payer: MDX Hawaii PPO	$723.62

UROLOGY: ZIPWIRE .018 STRAIGHT

Facility

$211.00

Hospital Charge Code	9882798
Hospital Revenue Code	270
Min. Negotiated Rate	$105.50
Max. Negotiated Rate	$204.67
Rate for Payer: AlohaCare Medicaid	$105.50
Rate for Payer: AlohaCare Medicare	$105.50
Rate for Payer: Cash Price	$137.15
Rate for Payer: Devoted Health Medicare	$116.05
Rate for Payer: Hawaii Medical Service Association Medicare	$105.50
Rate for Payer: Hawaii Western Management Group Commercial	$200.45
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Humana Medicare	$105.50
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: Kaiser Permanente Medicaid	$107.61
Rate for Payer: Kaiser Permanente Medicare	$105.50
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: Ohana Health Plan Medicaid	$105.50
Rate for Payer: Ohana Health Plan Medicare	$105.50
Rate for Payer: UnitedHealthcare Medicare	$105.50
Rate for Payer: University Health Alliance Commercial	$153.80

UROLOGY: ZIPWIRE .018 STRAIGHT

Facility

$211.00

Hospital Charge Code	9882798
Hospital Revenue Code	270
Min. Negotiated Rate	$179.35
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$137.15
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: MDX Hawaii PPO	$204.67

UROLOGY: ZIPWIRE .035 ANGLED

Facility

$183.00

Hospital Charge Code	9882800
Hospital Revenue Code	270
Min. Negotiated Rate	$155.55
Max. Negotiated Rate	$177.51
Rate for Payer: Cash Price	$118.95
Rate for Payer: Health Management Network Commercial	$155.55
Rate for Payer: Kaiser Permanente Commercial	$164.70
Rate for Payer: MDX Hawaii PPO	$177.51

UROLOGY: ZIPWIRE .035 ANGLED

Facility

$183.00

Hospital Charge Code	9882800
Hospital Revenue Code	270
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$177.51
Rate for Payer: AlohaCare Medicaid	$91.50
Rate for Payer: AlohaCare Medicare	$91.50
Rate for Payer: Cash Price	$118.95
Rate for Payer: Devoted Health Medicare	$100.65
Rate for Payer: Hawaii Medical Service Association Medicare	$91.50
Rate for Payer: Hawaii Western Management Group Commercial	$173.85
Rate for Payer: Health Management Network Commercial	$155.55
Rate for Payer: Humana Medicare	$91.50
Rate for Payer: Kaiser Permanente Commercial	$164.70
Rate for Payer: Kaiser Permanente Medicaid	$93.33
Rate for Payer: Kaiser Permanente Medicare	$91.50
Rate for Payer: MDX Hawaii PPO	$177.51
Rate for Payer: Ohana Health Plan Medicaid	$91.50
Rate for Payer: Ohana Health Plan Medicare	$91.50
Rate for Payer: UnitedHealthcare Medicare	$91.50
Rate for Payer: University Health Alliance Commercial	$133.39

UROLOGY: ZIPWIRE .035 STRAIGHT

Facility

$183.00

Hospital Charge Code	9882799
Hospital Revenue Code	270
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$177.51
Rate for Payer: AlohaCare Medicaid	$91.50
Rate for Payer: AlohaCare Medicare	$91.50
Rate for Payer: Cash Price	$118.95
Rate for Payer: Devoted Health Medicare	$100.65
Rate for Payer: Hawaii Medical Service Association Medicare	$91.50
Rate for Payer: Hawaii Western Management Group Commercial	$173.85
Rate for Payer: Health Management Network Commercial	$155.55
Rate for Payer: Humana Medicare	$91.50
Rate for Payer: Kaiser Permanente Commercial	$164.70
Rate for Payer: Kaiser Permanente Medicaid	$93.33
Rate for Payer: Kaiser Permanente Medicare	$91.50
Rate for Payer: MDX Hawaii PPO	$177.51
Rate for Payer: Ohana Health Plan Medicaid	$91.50
Rate for Payer: Ohana Health Plan Medicare	$91.50
Rate for Payer: UnitedHealthcare Medicare	$91.50
Rate for Payer: University Health Alliance Commercial	$133.39

UROLOGY: ZIPWIRE .035 STRAIGHT

Facility

$183.00

Hospital Charge Code	9882799
Hospital Revenue Code	270
Min. Negotiated Rate	$155.55
Max. Negotiated Rate	$177.51
Rate for Payer: Cash Price	$118.95
Rate for Payer: Health Management Network Commercial	$155.55
Rate for Payer: Kaiser Permanente Commercial	$164.70
Rate for Payer: MDX Hawaii PPO	$177.51

US AAA Screening

Facility

$283.00

Service Code	HCPCS 76706
Hospital Charge Code	8111052
Hospital Revenue Code	402
Min. Negotiated Rate	$240.55
Max. Negotiated Rate	$274.51
Rate for Payer: Cash Price	$183.95
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Kaiser Permanente Commercial	$254.70
Rate for Payer: MDX Hawaii PPO	$274.51

US AAA Screening

Facility

$283.00

Service Code	HCPCS 76706
Hospital Charge Code	8111052
Hospital Revenue Code	402
Min. Negotiated Rate	$46.35
Max. Negotiated Rate	$274.51
Rate for Payer: AlohaCare Medicaid	$141.50
Rate for Payer: AlohaCare Medicare	$141.50
Rate for Payer: Cash Price	$183.95
Rate for Payer: Cash Price	$183.95
Rate for Payer: Devoted Health Medicare	$155.65
Rate for Payer: Hawaii Medical Service Association ABD	$46.35
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$141.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$63.32
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Humana Medicare	$141.50
Rate for Payer: Kaiser Permanente Commercial	$254.70
Rate for Payer: Kaiser Permanente Medicaid	$144.33
Rate for Payer: Kaiser Permanente Medicare	$141.50
Rate for Payer: MDX Hawaii PPO	$274.51
Rate for Payer: Ohana Health Plan Medicaid	$141.50
Rate for Payer: Ohana Health Plan Medicare	$141.50
Rate for Payer: UnitedHealthcare Medicaid	$71.33
Rate for Payer: UnitedHealthcare Medicare	$141.50
Rate for Payer: University Health Alliance Commercial	$196.82

US AAA Screening Medicare

Facility

$283.00

Service Code	HCPCS 76706
Hospital Charge Code	2425290
Hospital Revenue Code	402
Min. Negotiated Rate	$46.35
Max. Negotiated Rate	$274.51
Rate for Payer: AlohaCare Medicaid	$141.50
Rate for Payer: AlohaCare Medicare	$141.50
Rate for Payer: Cash Price	$183.95
Rate for Payer: Cash Price	$183.95
Rate for Payer: Devoted Health Medicare	$155.65
Rate for Payer: Hawaii Medical Service Association ABD	$46.35
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$141.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$63.32
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Humana Medicare	$141.50
Rate for Payer: Kaiser Permanente Commercial	$254.70
Rate for Payer: Kaiser Permanente Medicaid	$144.33
Rate for Payer: Kaiser Permanente Medicare	$141.50
Rate for Payer: MDX Hawaii PPO	$274.51
Rate for Payer: Ohana Health Plan Medicaid	$141.50
Rate for Payer: Ohana Health Plan Medicare	$141.50
Rate for Payer: UnitedHealthcare Medicaid	$71.33
Rate for Payer: UnitedHealthcare Medicare	$141.50
Rate for Payer: University Health Alliance Commercial	$196.82

US AAA Screening Medicare

Facility

$283.00

Service Code	HCPCS 76706
Hospital Charge Code	2425290
Hospital Revenue Code	402
Min. Negotiated Rate	$240.55
Max. Negotiated Rate	$274.51
Rate for Payer: Cash Price	$183.95
Rate for Payer: Health Management Network Commercial	$240.55
Rate for Payer: Kaiser Permanente Commercial	$254.70
Rate for Payer: MDX Hawaii PPO	$274.51

US AAA Screening Medicare - Report

Professional

Both

$145.00

Service Code	HCPCS 76706 26
Hospital Charge Code	2425292
Hospital Revenue Code	972
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$123.25
Rate for Payer: AlohaCare Medicaid	$71.33
Rate for Payer: AlohaCare Medicare	$26.03
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$28.63
Rate for Payer: Hawaii Medical Service Association Medicare	$26.03
Rate for Payer: Hawaii Western Management Group Commercial	$106.39
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$28.63
Rate for Payer: Kaiser Permanente Medicaid	$28.63
Rate for Payer: Kaiser Permanente Medicare	$28.63
Rate for Payer: Ohana Health Plan Medicaid	$71.33
Rate for Payer: Ohana Health Plan Medicare	$26.03
Rate for Payer: UnitedHealthcare Medicaid	$71.33
Rate for Payer: UnitedHealthcare Medicare	$26.03

US AAA Screening - Report

Professional

Both

$178.00

Service Code	HCPCS 76706 26
Hospital Charge Code	8111054
Hospital Revenue Code	972
Min. Negotiated Rate	$26.03
Max. Negotiated Rate	$151.30
Rate for Payer: AlohaCare Medicaid	$71.33
Rate for Payer: AlohaCare Medicare	$26.03
Rate for Payer: Cash Price	$115.70
Rate for Payer: Cash Price	$115.70
Rate for Payer: Devoted Health Medicare	$28.63
Rate for Payer: Hawaii Medical Service Association Medicare	$26.03
Rate for Payer: Hawaii Western Management Group Commercial	$106.39
Rate for Payer: Health Management Network Commercial	$151.30
Rate for Payer: Kaiser Permanente Commercial	$28.63
Rate for Payer: Kaiser Permanente Medicaid	$28.63
Rate for Payer: Kaiser Permanente Medicare	$28.63
Rate for Payer: Ohana Health Plan Medicaid	$71.33
Rate for Payer: Ohana Health Plan Medicare	$26.03
Rate for Payer: UnitedHealthcare Medicaid	$71.33
Rate for Payer: UnitedHealthcare Medicare	$26.03

US Abdomen Complete

Facility

$758.00

Service Code	HCPCS 76700
Hospital Charge Code	1169567
Hospital Revenue Code	402
Min. Negotiated Rate	$64.94
Max. Negotiated Rate	$735.26
Rate for Payer: AlohaCare Medicaid	$379.00
Rate for Payer: AlohaCare Medicare	$379.00
Rate for Payer: Cash Price	$492.70
Rate for Payer: Cash Price	$492.70
Rate for Payer: Devoted Health Medicare	$416.90
Rate for Payer: Hawaii Medical Service Association ABD	$64.94
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$379.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$70.56
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: Humana Medicare	$379.00
Rate for Payer: Kaiser Permanente Commercial	$682.20
Rate for Payer: Kaiser Permanente Medicaid	$386.58
Rate for Payer: Kaiser Permanente Medicare	$379.00
Rate for Payer: MDX Hawaii PPO	$735.26
Rate for Payer: Ohana Health Plan Medicaid	$379.00
Rate for Payer: Ohana Health Plan Medicare	$379.00
Rate for Payer: UnitedHealthcare Medicaid	$64.94
Rate for Payer: UnitedHealthcare Medicare	$379.00
Rate for Payer: University Health Alliance Commercial	$268.45

US Abdomen Complete

Facility

$758.00

Service Code	HCPCS 76700
Hospital Charge Code	1169567
Hospital Revenue Code	402
Min. Negotiated Rate	$644.30
Max. Negotiated Rate	$735.26
Rate for Payer: Cash Price	$492.70
Rate for Payer: Health Management Network Commercial	$644.30
Rate for Payer: Kaiser Permanente Commercial	$682.20
Rate for Payer: MDX Hawaii PPO	$735.26

US Abdomen Complete - Report

Professional

Both

$146.00

Service Code	HCPCS 76700 26
Hospital Charge Code	625609
Hospital Revenue Code	972
Min. Negotiated Rate	$38.17
Max. Negotiated Rate	$130.90
Rate for Payer: AlohaCare Medicaid	$76.97
Rate for Payer: AlohaCare Medicare	$38.17
Rate for Payer: Cash Price	$94.90
Rate for Payer: Cash Price	$94.90
Rate for Payer: Devoted Health Medicare	$41.99
Rate for Payer: Hawaii Medical Service Association Medicare	$38.17
Rate for Payer: Hawaii Western Management Group Commercial	$130.90
Rate for Payer: Health Management Network Commercial	$124.10
Rate for Payer: Kaiser Permanente Commercial	$41.99
Rate for Payer: Kaiser Permanente Medicaid	$41.99
Rate for Payer: Kaiser Permanente Medicare	$41.99
Rate for Payer: Ohana Health Plan Medicaid	$76.97
Rate for Payer: Ohana Health Plan Medicare	$38.17
Rate for Payer: UnitedHealthcare Medicaid	$76.97
Rate for Payer: UnitedHealthcare Medicare	$38.17

US Abdomen Doppler Complete

Facility

$2,788.00

Service Code	HCPCS 93975
Hospital Charge Code	9042542
Hospital Revenue Code	402
Min. Negotiated Rate	$185.92
Max. Negotiated Rate	$2,704.36
Rate for Payer: AlohaCare Medicaid	$1,394.00
Rate for Payer: AlohaCare Medicare	$1,394.00
Rate for Payer: Cash Price	$1,812.20
Rate for Payer: Cash Price	$1,812.20
Rate for Payer: Devoted Health Medicare	$1,533.40
Rate for Payer: Hawaii Medical Service Association ABD	$185.92
Rate for Payer: Hawaii Medical Service Association Commercial	$304.71
Rate for Payer: Hawaii Medical Service Association Medicare	$1,394.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$222.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,648.60
Rate for Payer: Health Management Network Commercial	$2,369.80
Rate for Payer: Humana Medicare	$1,394.00
Rate for Payer: Kaiser Permanente Commercial	$2,509.20
Rate for Payer: Kaiser Permanente Medicaid	$1,421.88
Rate for Payer: Kaiser Permanente Medicare	$1,394.00
Rate for Payer: MDX Hawaii PPO	$2,704.36
Rate for Payer: Ohana Health Plan Medicaid	$1,394.00
Rate for Payer: Ohana Health Plan Medicare	$1,394.00
Rate for Payer: UnitedHealthcare Medicaid	$185.92
Rate for Payer: UnitedHealthcare Medicare	$1,394.00
Rate for Payer: University Health Alliance Commercial	$2,032.17

US Abdomen Doppler Complete

Facility

$2,788.00

Service Code	HCPCS 93975
Hospital Charge Code	9042542
Hospital Revenue Code	402
Min. Negotiated Rate	$2,369.80
Max. Negotiated Rate	$2,704.36
Rate for Payer: Cash Price	$1,812.20
Rate for Payer: Health Management Network Commercial	$2,369.80
Rate for Payer: Kaiser Permanente Commercial	$2,509.20
Rate for Payer: MDX Hawaii PPO	$2,704.36

Know your out-of-pocket cost for care.

All Charges