Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Yes - OT Paraffin Bath Charge

Facility

$42.00

Service Code	HCPCS 97018 GO
Hospital Charge Code	8372814
Hospital Revenue Code	430
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$40.74
Rate for Payer: Cash Price	$27.30
Rate for Payer: Health Management Network Commercial	$35.70
Rate for Payer: Kaiser Permanente Commercial	$37.80
Rate for Payer: MDX Hawaii PPO	$40.74

Yes - OT Swallow Eval Charge

Facility

$521.00

Service Code	HCPCS 92610 GO
Hospital Charge Code	8450059
Hospital Revenue Code	434
Min. Negotiated Rate	$88.36
Max. Negotiated Rate	$505.37
Rate for Payer: AlohaCare Medicaid	$260.50
Rate for Payer: AlohaCare Medicare	$260.50
Rate for Payer: Cash Price	$338.65
Rate for Payer: Cash Price	$338.65
Rate for Payer: Devoted Health Medicare	$286.55
Rate for Payer: Hawaii Medical Service Association Medicare	$260.50
Rate for Payer: Hawaii Western Management Group Commercial	$494.95
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Humana Medicare	$260.50
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: Kaiser Permanente Medicaid	$265.71
Rate for Payer: Kaiser Permanente Medicare	$260.50
Rate for Payer: MDX Hawaii PPO	$505.37
Rate for Payer: Ohana Health Plan Medicaid	$260.50
Rate for Payer: Ohana Health Plan Medicare	$260.50
Rate for Payer: UnitedHealthcare Medicaid	$88.36
Rate for Payer: UnitedHealthcare Medicare	$260.50
Rate for Payer: University Health Alliance Commercial	$379.76

Yes - OT Swallow Eval Charge

Facility

$521.00

Service Code	HCPCS 92610 GO
Hospital Charge Code	8450059
Hospital Revenue Code	434
Min. Negotiated Rate	$442.85
Max. Negotiated Rate	$505.37
Rate for Payer: Cash Price	$338.65
Rate for Payer: Health Management Network Commercial	$442.85
Rate for Payer: Kaiser Permanente Commercial	$468.90
Rate for Payer: MDX Hawaii PPO	$505.37

Yes - Unattended Electrical Therapy Charge

Facility

$100.00

Service Code	HCPCS 97014 GP
Hospital Charge Code	8416253
Hospital Revenue Code	420
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: Kaiser Permanente Commercial	$90.00
Rate for Payer: MDX Hawaii PPO	$97.00

Yes - Unattended Electrical Therapy Charge

Facility

$100.00

Service Code	HCPCS 97014 GO
Hospital Charge Code	8246631
Hospital Revenue Code	430
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: Kaiser Permanente Commercial	$90.00
Rate for Payer: MDX Hawaii PPO	$97.00

Yes - Unattended Electrical Therapy Charge

Facility

$100.00

Service Code	HCPCS 97014 GP
Hospital Charge Code	8416253
Hospital Revenue Code	420
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$97.00
Rate for Payer: AlohaCare Medicaid	$50.00
Rate for Payer: AlohaCare Medicare	$50.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Devoted Health Medicare	$55.00
Rate for Payer: Hawaii Medical Service Association Medicare	$50.00
Rate for Payer: Hawaii Western Management Group Commercial	$95.00
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: Humana Medicare	$50.00
Rate for Payer: Kaiser Permanente Commercial	$90.00
Rate for Payer: Kaiser Permanente Medicaid	$51.00
Rate for Payer: Kaiser Permanente Medicare	$50.00
Rate for Payer: MDX Hawaii PPO	$97.00
Rate for Payer: Ohana Health Plan Medicaid	$50.00
Rate for Payer: Ohana Health Plan Medicare	$50.00
Rate for Payer: UnitedHealthcare Medicaid	$11.85
Rate for Payer: UnitedHealthcare Medicare	$50.00
Rate for Payer: University Health Alliance Commercial	$72.89

Yes - Unattended Electrical Therapy Charge

Facility

$100.00

Service Code	HCPCS 97014 GP,CQ
Hospital Charge Code	8246629
Hospital Revenue Code	430
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$97.00
Rate for Payer: AlohaCare Medicaid	$50.00
Rate for Payer: AlohaCare Medicare	$50.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Devoted Health Medicare	$55.00
Rate for Payer: Hawaii Medical Service Association Medicare	$50.00
Rate for Payer: Hawaii Western Management Group Commercial	$95.00
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: Humana Medicare	$50.00
Rate for Payer: Kaiser Permanente Commercial	$90.00
Rate for Payer: Kaiser Permanente Medicaid	$51.00
Rate for Payer: Kaiser Permanente Medicare	$50.00
Rate for Payer: MDX Hawaii PPO	$97.00
Rate for Payer: Ohana Health Plan Medicaid	$50.00
Rate for Payer: Ohana Health Plan Medicare	$50.00
Rate for Payer: UnitedHealthcare Medicaid	$11.85
Rate for Payer: UnitedHealthcare Medicare	$50.00
Rate for Payer: University Health Alliance Commercial	$72.89

Yes - Unattended Electrical Therapy Charge

Facility

$100.00

Service Code	HCPCS 97014 GO
Hospital Charge Code	8246631
Hospital Revenue Code	430
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$97.00
Rate for Payer: AlohaCare Medicaid	$50.00
Rate for Payer: AlohaCare Medicare	$50.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Devoted Health Medicare	$55.00
Rate for Payer: Hawaii Medical Service Association Medicare	$50.00
Rate for Payer: Hawaii Western Management Group Commercial	$95.00
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: Humana Medicare	$50.00
Rate for Payer: Kaiser Permanente Commercial	$90.00
Rate for Payer: Kaiser Permanente Medicaid	$51.00
Rate for Payer: Kaiser Permanente Medicare	$50.00
Rate for Payer: MDX Hawaii PPO	$97.00
Rate for Payer: Ohana Health Plan Medicaid	$50.00
Rate for Payer: Ohana Health Plan Medicare	$50.00
Rate for Payer: UnitedHealthcare Medicaid	$11.85
Rate for Payer: UnitedHealthcare Medicare	$50.00
Rate for Payer: University Health Alliance Commercial	$72.89

Yes - Unattended Electrical Therapy Charge

Facility

$100.00

Service Code	HCPCS 97014 GP,CQ
Hospital Charge Code	8246629
Hospital Revenue Code	430
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$97.00
Rate for Payer: Cash Price	$65.00
Rate for Payer: Health Management Network Commercial	$85.00
Rate for Payer: Kaiser Permanente Commercial	$90.00
Rate for Payer: MDX Hawaii PPO	$97.00

Y-PLATE, 2.0MM, 6 HOLE

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13006756
Hospital Revenue Code	278
Min. Negotiated Rate	$818.72
Max. Negotiated Rate	$1,418.14
Rate for Payer: Cash Price	$950.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: University Health Alliance Commercial	$818.72

Y-PLATE, 2.0MM, 6 HOLE

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13006756
Hospital Revenue Code	278
Min. Negotiated Rate	$731.00
Max. Negotiated Rate	$1,418.14
Rate for Payer: AlohaCare Medicaid	$731.00
Rate for Payer: AlohaCare Medicare	$731.00
Rate for Payer: Cash Price	$950.30
Rate for Payer: Devoted Health Medicare	$804.10
Rate for Payer: Hawaii Medical Service Association Medicare	$731.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Humana Medicare	$731.00
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: Kaiser Permanente Medicaid	$745.62
Rate for Payer: Kaiser Permanente Medicare	$731.00
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: Ohana Health Plan Medicaid	$731.00
Rate for Payer: Ohana Health Plan Medicare	$731.00
Rate for Payer: UnitedHealthcare Medicare	$731.00
Rate for Payer: University Health Alliance Commercial	$818.72

zinc oxide 40% ointment topical [HHSC]

Facility

$17.85

Service Code	NDC 69968006102
Hospital Charge Code	2500866
Hospital Revenue Code	250
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$17.31
Rate for Payer: AlohaCare Medicaid	$8.93
Rate for Payer: AlohaCare Medicare	$8.93
Rate for Payer: Cash Price	$11.60
Rate for Payer: Devoted Health Medicare	$9.82
Rate for Payer: Hawaii Medical Service Association Medicare	$8.93
Rate for Payer: Hawaii Western Management Group Commercial	$16.96
Rate for Payer: Health Management Network Commercial	$15.17
Rate for Payer: Humana Medicare	$8.93
Rate for Payer: Kaiser Permanente Commercial	$16.07
Rate for Payer: Kaiser Permanente Medicaid	$9.10
Rate for Payer: Kaiser Permanente Medicare	$8.93
Rate for Payer: MDX Hawaii PPO	$17.31
Rate for Payer: Ohana Health Plan Medicaid	$8.93
Rate for Payer: Ohana Health Plan Medicare	$8.93
Rate for Payer: UnitedHealthcare Medicaid	$10.71
Rate for Payer: UnitedHealthcare Medicare	$8.93
Rate for Payer: University Health Alliance Commercial	$13.01

zinc oxide 40% ointment topical [HHSC]

Facility

$17.85

Service Code	NDC 00501340002
Hospital Charge Code	2500866
Hospital Revenue Code	250
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$17.31
Rate for Payer: AlohaCare Medicaid	$8.93
Rate for Payer: AlohaCare Medicare	$8.93
Rate for Payer: Cash Price	$11.60
Rate for Payer: Devoted Health Medicare	$9.82
Rate for Payer: Hawaii Medical Service Association Medicare	$8.93
Rate for Payer: Hawaii Western Management Group Commercial	$16.96
Rate for Payer: Health Management Network Commercial	$15.17
Rate for Payer: Humana Medicare	$8.93
Rate for Payer: Kaiser Permanente Commercial	$16.07
Rate for Payer: Kaiser Permanente Medicaid	$9.10
Rate for Payer: Kaiser Permanente Medicare	$8.93
Rate for Payer: MDX Hawaii PPO	$17.31
Rate for Payer: Ohana Health Plan Medicaid	$8.93
Rate for Payer: Ohana Health Plan Medicare	$8.93
Rate for Payer: UnitedHealthcare Medicaid	$10.71
Rate for Payer: UnitedHealthcare Medicare	$8.93
Rate for Payer: University Health Alliance Commercial	$13.01

zinc oxide 40% ointment topical [HHSC]

Facility

$17.85

Service Code	NDC 00501340002
Hospital Charge Code	2500866
Hospital Revenue Code	250
Min. Negotiated Rate	$15.17
Max. Negotiated Rate	$17.31
Rate for Payer: Cash Price	$11.60
Rate for Payer: Health Management Network Commercial	$15.17
Rate for Payer: Kaiser Permanente Commercial	$16.07
Rate for Payer: MDX Hawaii PPO	$17.31

zinc oxide 40% ointment topical [HHSC]

Facility

$13.68

Service Code	NDC 74300000700
Hospital Charge Code	2500866
Hospital Revenue Code	250
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$13.27
Rate for Payer: AlohaCare Medicaid	$6.84
Rate for Payer: AlohaCare Medicare	$6.84
Rate for Payer: Cash Price	$8.89
Rate for Payer: Devoted Health Medicare	$7.52
Rate for Payer: Hawaii Medical Service Association Medicare	$6.84
Rate for Payer: Hawaii Western Management Group Commercial	$13.00
Rate for Payer: Health Management Network Commercial	$11.63
Rate for Payer: Humana Medicare	$6.84
Rate for Payer: Kaiser Permanente Commercial	$12.31
Rate for Payer: Kaiser Permanente Medicaid	$6.98
Rate for Payer: Kaiser Permanente Medicare	$6.84
Rate for Payer: MDX Hawaii PPO	$13.27
Rate for Payer: Ohana Health Plan Medicaid	$6.84
Rate for Payer: Ohana Health Plan Medicare	$6.84
Rate for Payer: UnitedHealthcare Medicaid	$8.21
Rate for Payer: UnitedHealthcare Medicare	$6.84
Rate for Payer: University Health Alliance Commercial	$9.97

zinc oxide 40% ointment topical [HHSC]

Facility

$13.68

Service Code	NDC 74300000700
Hospital Charge Code	2500866
Hospital Revenue Code	250
Min. Negotiated Rate	$11.63
Max. Negotiated Rate	$13.27
Rate for Payer: Cash Price	$8.89
Rate for Payer: Health Management Network Commercial	$11.63
Rate for Payer: Kaiser Permanente Commercial	$12.31
Rate for Payer: MDX Hawaii PPO	$13.27

zinc oxide 40% ointment topical [HHSC]

Facility

$17.85

Service Code	NDC 69968006102
Hospital Charge Code	2500866
Hospital Revenue Code	250
Min. Negotiated Rate	$15.17
Max. Negotiated Rate	$17.31
Rate for Payer: Cash Price	$11.60
Rate for Payer: Health Management Network Commercial	$15.17
Rate for Payer: Kaiser Permanente Commercial	$16.07
Rate for Payer: MDX Hawaii PPO	$17.31

Zinc, Serum FSI

Facility

$132.00

Service Code	HCPCS 84630
Hospital Charge Code	8118089
Hospital Revenue Code	301
Min. Negotiated Rate	$11.39
Max. Negotiated Rate	$128.04
Rate for Payer: AlohaCare Medicaid	$66.00
Rate for Payer: AlohaCare Medicare	$66.00
Rate for Payer: Cash Price	$85.80
Rate for Payer: Cash Price	$85.80
Rate for Payer: Devoted Health Medicare	$72.60
Rate for Payer: Hawaii Medical Service Association ABD	$15.74
Rate for Payer: Hawaii Medical Service Association Commercial	$14.24
Rate for Payer: Hawaii Medical Service Association Medicare	$66.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.53
Rate for Payer: Hawaii Western Management Group Commercial	$11.39
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: Humana Medicare	$66.00
Rate for Payer: Kaiser Permanente Commercial	$118.80
Rate for Payer: Kaiser Permanente Medicaid	$67.32
Rate for Payer: Kaiser Permanente Medicare	$66.00
Rate for Payer: MDX Hawaii PPO	$128.04
Rate for Payer: Ohana Health Plan Medicaid	$66.00
Rate for Payer: Ohana Health Plan Medicare	$66.00
Rate for Payer: UnitedHealthcare Medicaid	$15.74
Rate for Payer: UnitedHealthcare Medicare	$66.00
Rate for Payer: University Health Alliance Commercial	$29.43

Zinc, Serum FSI

Facility

$132.00

Service Code	HCPCS 84630
Hospital Charge Code	8118089
Hospital Revenue Code	301
Min. Negotiated Rate	$112.20
Max. Negotiated Rate	$128.04
Rate for Payer: Cash Price	$85.80
Rate for Payer: Health Management Network Commercial	$112.20
Rate for Payer: Kaiser Permanente Commercial	$118.80
Rate for Payer: MDX Hawaii PPO	$128.04

zinc sulfate 220 mg capsule [HHSC]

Facility

$3.00

Service Code	NDC 68585000801
Hospital Charge Code	2500867
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

zinc sulfate 220 mg capsule [HHSC]

Facility

$3.00

Service Code	NDC 20555004000
Hospital Charge Code	2500867
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

zinc sulfate 220 mg capsule [HHSC]

Facility

$3.00

Service Code	NDC 77333098310
Hospital Charge Code	2500867
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

zinc sulfate 220 mg capsule [HHSC]

Facility

$3.00

Service Code	NDC 77333098310
Hospital Charge Code	2500867
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

zinc sulfate 220 mg capsule [HHSC]

Facility

$3.00

Service Code	NDC 20555004000
Hospital Charge Code	2500867
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

zinc sulfate 220 mg capsule [HHSC]

Facility

$3.00

Service Code	NDC 00904533260
Hospital Charge Code	2500867
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

Know your out-of-pocket cost for care.

All Charges