Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

76882 US Lwr Extrem Non Vasc Ltd RT

Facility

$858.00

Service Code	HCPCS 76882
Hospital Charge Code	8280917
Hospital Revenue Code	320
Min. Negotiated Rate	$729.30
Max. Negotiated Rate	$832.26
Rate for Payer: Cash Price	$557.70
Rate for Payer: Health Management Network Commercial	$729.30
Rate for Payer: Kaiser Permanente Commercial	$772.20
Rate for Payer: MDX Hawaii PPO	$832.26

76882 US Up Extrem Non Vasc Ltd LT

Facility

$858.00

Service Code	HCPCS 76882
Hospital Charge Code	8280918
Hospital Revenue Code	320
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$832.26
Rate for Payer: AlohaCare Medicaid	$429.00
Rate for Payer: AlohaCare Medicare	$429.00
Rate for Payer: Cash Price	$557.70
Rate for Payer: Cash Price	$557.70
Rate for Payer: Devoted Health Medicare	$471.90
Rate for Payer: Hawaii Medical Service Association ABD	$7.22
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$429.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.72
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$729.30
Rate for Payer: Humana Medicare	$429.00
Rate for Payer: Kaiser Permanente Commercial	$772.20
Rate for Payer: Kaiser Permanente Medicaid	$437.58
Rate for Payer: Kaiser Permanente Medicare	$429.00
Rate for Payer: MDX Hawaii PPO	$832.26
Rate for Payer: Ohana Health Plan Medicaid	$429.00
Rate for Payer: Ohana Health Plan Medicare	$429.00
Rate for Payer: UnitedHealthcare Medicaid	$7.22
Rate for Payer: UnitedHealthcare Medicare	$429.00
Rate for Payer: University Health Alliance Commercial	$60.62

76882 US Up Extrem Non Vasc Ltd LT

Facility

$858.00

Service Code	HCPCS 76882
Hospital Charge Code	8280918
Hospital Revenue Code	320
Min. Negotiated Rate	$729.30
Max. Negotiated Rate	$832.26
Rate for Payer: Cash Price	$557.70
Rate for Payer: Health Management Network Commercial	$729.30
Rate for Payer: Kaiser Permanente Commercial	$772.20
Rate for Payer: MDX Hawaii PPO	$832.26

76882 US Up Extrem Non Vasc Ltd RT

Facility

$858.00

Service Code	HCPCS 76882
Hospital Charge Code	8280919
Hospital Revenue Code	320
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$832.26
Rate for Payer: AlohaCare Medicaid	$429.00
Rate for Payer: AlohaCare Medicare	$429.00
Rate for Payer: Cash Price	$557.70
Rate for Payer: Cash Price	$557.70
Rate for Payer: Devoted Health Medicare	$471.90
Rate for Payer: Hawaii Medical Service Association ABD	$7.22
Rate for Payer: Hawaii Medical Service Association Commercial	$133.51
Rate for Payer: Hawaii Medical Service Association Medicare	$429.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10.72
Rate for Payer: Hawaii Western Management Group Commercial	$106.81
Rate for Payer: Health Management Network Commercial	$729.30
Rate for Payer: Humana Medicare	$429.00
Rate for Payer: Kaiser Permanente Commercial	$772.20
Rate for Payer: Kaiser Permanente Medicaid	$437.58
Rate for Payer: Kaiser Permanente Medicare	$429.00
Rate for Payer: MDX Hawaii PPO	$832.26
Rate for Payer: Ohana Health Plan Medicaid	$429.00
Rate for Payer: Ohana Health Plan Medicare	$429.00
Rate for Payer: UnitedHealthcare Medicaid	$7.22
Rate for Payer: UnitedHealthcare Medicare	$429.00
Rate for Payer: University Health Alliance Commercial	$60.62

76882 US Up Extrem Non Vasc Ltd RT

Facility

$858.00

Service Code	HCPCS 76882
Hospital Charge Code	8280919
Hospital Revenue Code	320
Min. Negotiated Rate	$729.30
Max. Negotiated Rate	$832.26
Rate for Payer: Cash Price	$557.70
Rate for Payer: Health Management Network Commercial	$729.30
Rate for Payer: Kaiser Permanente Commercial	$772.20
Rate for Payer: MDX Hawaii PPO	$832.26

76937 Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access si

Facility

$515.00

Service Code	HCPCS 76937
Hospital Charge Code	8040548
Hospital Revenue Code	402
Min. Negotiated Rate	$437.75
Max. Negotiated Rate	$499.55
Rate for Payer: Cash Price	$334.75
Rate for Payer: Health Management Network Commercial	$437.75
Rate for Payer: Kaiser Permanente Commercial	$463.50
Rate for Payer: MDX Hawaii PPO	$499.55

76937 Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access si

Facility

$515.00

Service Code	HCPCS 76937
Hospital Charge Code	8040548
Hospital Revenue Code	402
Min. Negotiated Rate	$13.38
Max. Negotiated Rate	$499.55
Rate for Payer: AlohaCare Medicaid	$257.50
Rate for Payer: AlohaCare Medicare	$257.50
Rate for Payer: Cash Price	$334.75
Rate for Payer: Cash Price	$334.75
Rate for Payer: Devoted Health Medicare	$283.25
Rate for Payer: Hawaii Medical Service Association ABD	$13.38
Rate for Payer: Hawaii Medical Service Association Medicare	$257.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.63
Rate for Payer: Hawaii Western Management Group Commercial	$489.25
Rate for Payer: Health Management Network Commercial	$437.75
Rate for Payer: Humana Medicare	$257.50
Rate for Payer: Kaiser Permanente Commercial	$463.50
Rate for Payer: Kaiser Permanente Medicaid	$262.65
Rate for Payer: Kaiser Permanente Medicare	$257.50
Rate for Payer: MDX Hawaii PPO	$499.55
Rate for Payer: Ohana Health Plan Medicaid	$257.50
Rate for Payer: Ohana Health Plan Medicare	$257.50
Rate for Payer: UnitedHealthcare Medicaid	$13.38
Rate for Payer: UnitedHealthcare Medicare	$257.50
Rate for Payer: University Health Alliance Commercial	$69.04

76937 US Guide Vascular Access

Facility

$615.00

Service Code	HCPCS 76937
Hospital Charge Code	8280908
Hospital Revenue Code	402
Min. Negotiated Rate	$522.75
Max. Negotiated Rate	$596.55
Rate for Payer: Cash Price	$399.75
Rate for Payer: Health Management Network Commercial	$522.75
Rate for Payer: Kaiser Permanente Commercial	$553.50
Rate for Payer: MDX Hawaii PPO	$596.55

76937 US Guide Vascular Access

Facility

$615.00

Service Code	HCPCS 76937
Hospital Charge Code	8280908
Hospital Revenue Code	402
Min. Negotiated Rate	$13.38
Max. Negotiated Rate	$596.55
Rate for Payer: AlohaCare Medicaid	$307.50
Rate for Payer: AlohaCare Medicare	$307.50
Rate for Payer: Cash Price	$399.75
Rate for Payer: Cash Price	$399.75
Rate for Payer: Devoted Health Medicare	$338.25
Rate for Payer: Hawaii Medical Service Association ABD	$13.38
Rate for Payer: Hawaii Medical Service Association Medicare	$307.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.63
Rate for Payer: Hawaii Western Management Group Commercial	$584.25
Rate for Payer: Health Management Network Commercial	$522.75
Rate for Payer: Humana Medicare	$307.50
Rate for Payer: Kaiser Permanente Commercial	$553.50
Rate for Payer: Kaiser Permanente Medicaid	$313.65
Rate for Payer: Kaiser Permanente Medicare	$307.50
Rate for Payer: MDX Hawaii PPO	$596.55
Rate for Payer: Ohana Health Plan Medicaid	$307.50
Rate for Payer: Ohana Health Plan Medicare	$307.50
Rate for Payer: UnitedHealthcare Medicaid	$13.38
Rate for Payer: UnitedHealthcare Medicare	$307.50
Rate for Payer: University Health Alliance Commercial	$69.04

76942 US Guidance Ndl Placement

Facility

$659.00

Service Code	HCPCS 76942
Hospital Charge Code	8280909
Hospital Revenue Code	320
Min. Negotiated Rate	$73.06
Max. Negotiated Rate	$639.23
Rate for Payer: AlohaCare Medicaid	$329.50
Rate for Payer: AlohaCare Medicare	$329.50
Rate for Payer: Cash Price	$428.35
Rate for Payer: Cash Price	$428.35
Rate for Payer: Devoted Health Medicare	$362.45
Rate for Payer: Hawaii Medical Service Association ABD	$73.06
Rate for Payer: Hawaii Medical Service Association Medicare	$329.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$104.75
Rate for Payer: Hawaii Western Management Group Commercial	$626.05
Rate for Payer: Health Management Network Commercial	$560.15
Rate for Payer: Humana Medicare	$329.50
Rate for Payer: Kaiser Permanente Commercial	$593.10
Rate for Payer: Kaiser Permanente Medicaid	$336.09
Rate for Payer: Kaiser Permanente Medicare	$329.50
Rate for Payer: MDX Hawaii PPO	$639.23
Rate for Payer: Ohana Health Plan Medicaid	$329.50
Rate for Payer: Ohana Health Plan Medicare	$329.50
Rate for Payer: UnitedHealthcare Medicaid	$73.06
Rate for Payer: UnitedHealthcare Medicare	$329.50
Rate for Payer: University Health Alliance Commercial	$361.51

76942 US Guidance Ndl Placement

Facility

$659.00

Service Code	HCPCS 76942
Hospital Charge Code	8280909
Hospital Revenue Code	320
Min. Negotiated Rate	$560.15
Max. Negotiated Rate	$639.23
Rate for Payer: Cash Price	$428.35
Rate for Payer: Health Management Network Commercial	$560.15
Rate for Payer: Kaiser Permanente Commercial	$593.10
Rate for Payer: MDX Hawaii PPO	$639.23

76942 US GUIDED NEEDLE PLACMENT ProFee

Professional

Both

$77.00

Service Code	HCPCS 76942
Hospital Charge Code	8022171
Hospital Revenue Code	972
Min. Negotiated Rate	$37.47
Max. Negotiated Rate	$104.35
Rate for Payer: AlohaCare Medicaid	$37.47
Rate for Payer: AlohaCare Medicare	$69.20
Rate for Payer: Cash Price	$50.05
Rate for Payer: Cash Price	$50.05
Rate for Payer: Devoted Health Medicare	$76.12
Rate for Payer: Hawaii Medical Service Association Medicare	$69.20
Rate for Payer: Hawaii Western Management Group Commercial	$104.35
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$76.12
Rate for Payer: Kaiser Permanente Medicaid	$76.12
Rate for Payer: Kaiser Permanente Medicare	$76.12
Rate for Payer: Ohana Health Plan Medicaid	$37.47
Rate for Payer: Ohana Health Plan Medicare	$69.20
Rate for Payer: UnitedHealthcare Medicaid	$37.47
Rate for Payer: UnitedHealthcare Medicare	$69.20

77001 FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT ProFee

Professional

Both

$215.00

Service Code	HCPCS 77001
Hospital Charge Code	8523147
Hospital Revenue Code	972
Min. Negotiated Rate	$66.21
Max. Negotiated Rate	$182.75
Rate for Payer: AlohaCare Medicaid	$66.21
Rate for Payer: AlohaCare Medicare	$109.41
Rate for Payer: Cash Price	$139.75
Rate for Payer: Cash Price	$139.75
Rate for Payer: Devoted Health Medicare	$120.35
Rate for Payer: Hawaii Medical Service Association Medicare	$109.41
Rate for Payer: Hawaii Western Management Group Commercial	$89.19
Rate for Payer: Health Management Network Commercial	$182.75
Rate for Payer: Kaiser Permanente Commercial	$120.35
Rate for Payer: Kaiser Permanente Medicaid	$120.35
Rate for Payer: Kaiser Permanente Medicare	$120.35
Rate for Payer: Ohana Health Plan Medicaid	$66.21
Rate for Payer: Ohana Health Plan Medicare	$109.41
Rate for Payer: UnitedHealthcare Medicaid	$66.21
Rate for Payer: UnitedHealthcare Medicare	$109.41

77003 FLUOR GID & LOCLZJ NDL/CATH SPI DX/THER NJX ProFee

Professional

Both

$144.00

Service Code	HCPCS 77003 26
Hospital Charge Code	8103018
Hospital Revenue Code	972
Min. Negotiated Rate	$28.83
Max. Negotiated Rate	$122.40
Rate for Payer: AlohaCare Medicaid	$70.14
Rate for Payer: AlohaCare Medicare	$28.83
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Devoted Health Medicare	$31.71
Rate for Payer: Hawaii Medical Service Association Medicare	$28.83
Rate for Payer: Hawaii Western Management Group Commercial	$77.55
Rate for Payer: Health Management Network Commercial	$122.40
Rate for Payer: Kaiser Permanente Commercial	$31.71
Rate for Payer: Kaiser Permanente Medicaid	$31.71
Rate for Payer: Kaiser Permanente Medicare	$31.71
Rate for Payer: Ohana Health Plan Medicaid	$70.14
Rate for Payer: Ohana Health Plan Medicare	$28.83
Rate for Payer: UnitedHealthcare Medicaid	$70.14
Rate for Payer: UnitedHealthcare Medicare	$28.83

77061 MG Mammo Diagnostic Left w/ Tomo Pro

Professional

Both

$68.00

Service Code	HCPCS 77061 26,LT
Hospital Charge Code	11858274
Hospital Revenue Code	972
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$206.71
Rate for Payer: Cash Price	$44.20
Rate for Payer: Cash Price	$44.20
Rate for Payer: Hawaii Western Management Group Commercial	$206.71
Rate for Payer: Health Management Network Commercial	$57.80

77061 MG Mammo Diagnostic Left w/ Tomo. Pro

Professional

Both

$68.00

Service Code	HCPCS 77061 LT
Hospital Charge Code	12125585
Hospital Revenue Code	972
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$206.71
Rate for Payer: Cash Price	$44.20
Rate for Payer: Cash Price	$44.20
Rate for Payer: Hawaii Western Management Group Commercial	$206.71
Rate for Payer: Health Management Network Commercial	$57.80

77061 MG Mammo Diagnostic Left w/ Tomo Tech

Facility

$351.00

Service Code	HCPCS 77061 LT
Hospital Charge Code	11848525
Hospital Revenue Code	401
Min. Negotiated Rate	$175.50
Max. Negotiated Rate	$340.47
Rate for Payer: AlohaCare Medicaid	$175.50
Rate for Payer: AlohaCare Medicare	$175.50
Rate for Payer: Cash Price	$228.15
Rate for Payer: Devoted Health Medicare	$193.05
Rate for Payer: Hawaii Medical Service Association Medicare	$175.50
Rate for Payer: Hawaii Western Management Group Commercial	$333.45
Rate for Payer: Health Management Network Commercial	$298.35
Rate for Payer: Humana Medicare	$175.50
Rate for Payer: Kaiser Permanente Commercial	$315.90
Rate for Payer: Kaiser Permanente Medicaid	$179.01
Rate for Payer: Kaiser Permanente Medicare	$175.50
Rate for Payer: MDX Hawaii PPO	$340.47
Rate for Payer: Ohana Health Plan Medicaid	$175.50
Rate for Payer: Ohana Health Plan Medicare	$175.50
Rate for Payer: UnitedHealthcare Medicare	$175.50

77061 MG Mammo Diagnostic Left w/ Tomo Tech

Facility

$351.00

Service Code	HCPCS 77061 LT
Hospital Charge Code	11848525
Hospital Revenue Code	401
Min. Negotiated Rate	$298.35
Max. Negotiated Rate	$340.47
Rate for Payer: Cash Price	$228.15
Rate for Payer: Health Management Network Commercial	$298.35
Rate for Payer: Kaiser Permanente Commercial	$315.90
Rate for Payer: MDX Hawaii PPO	$340.47

77061 MG Mammo Diagnostic Left w/ Tomo. Tech

Facility

$351.00

Service Code	HCPCS 77061 LT
Hospital Charge Code	12133861
Hospital Revenue Code	401
Min. Negotiated Rate	$175.50
Max. Negotiated Rate	$340.47
Rate for Payer: AlohaCare Medicaid	$175.50
Rate for Payer: AlohaCare Medicare	$175.50
Rate for Payer: Cash Price	$228.15
Rate for Payer: Devoted Health Medicare	$193.05
Rate for Payer: Hawaii Medical Service Association Medicare	$175.50
Rate for Payer: Hawaii Western Management Group Commercial	$333.45
Rate for Payer: Health Management Network Commercial	$298.35
Rate for Payer: Humana Medicare	$175.50
Rate for Payer: Kaiser Permanente Commercial	$315.90
Rate for Payer: Kaiser Permanente Medicaid	$179.01
Rate for Payer: Kaiser Permanente Medicare	$175.50
Rate for Payer: MDX Hawaii PPO	$340.47
Rate for Payer: Ohana Health Plan Medicaid	$175.50
Rate for Payer: Ohana Health Plan Medicare	$175.50
Rate for Payer: UnitedHealthcare Medicare	$175.50

77061 MG Mammo Diagnostic Left w/ Tomo. Tech

Facility

$351.00

Service Code	HCPCS 77061 LT
Hospital Charge Code	12133861
Hospital Revenue Code	401
Min. Negotiated Rate	$298.35
Max. Negotiated Rate	$340.47
Rate for Payer: Cash Price	$228.15
Rate for Payer: Health Management Network Commercial	$298.35
Rate for Payer: Kaiser Permanente Commercial	$315.90
Rate for Payer: MDX Hawaii PPO	$340.47

77061 MG Mammo Diagnostic Right w/ Tomo Pro

Professional

Both

$68.00

Service Code	HCPCS 77061 RT
Hospital Charge Code	11858275
Hospital Revenue Code	972
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$206.71
Rate for Payer: Cash Price	$44.20
Rate for Payer: Cash Price	$44.20
Rate for Payer: Hawaii Western Management Group Commercial	$206.71
Rate for Payer: Health Management Network Commercial	$57.80

77061 MG Mammo Diagnostic Right w/ Tomo. Pro

Professional

Both

$68.00

Service Code	HCPCS 77061 RT
Hospital Charge Code	12125586
Hospital Revenue Code	972
Min. Negotiated Rate	$57.80
Max. Negotiated Rate	$206.71
Rate for Payer: Cash Price	$44.20
Rate for Payer: Cash Price	$44.20
Rate for Payer: Hawaii Western Management Group Commercial	$206.71
Rate for Payer: Health Management Network Commercial	$57.80

77061 MG Mammo Diagnostic Right w/ Tomo Tech

Facility

$351.00

Service Code	HCPCS 77061 RT
Hospital Charge Code	11848526
Hospital Revenue Code	401
Min. Negotiated Rate	$298.35
Max. Negotiated Rate	$340.47
Rate for Payer: Cash Price	$228.15
Rate for Payer: Health Management Network Commercial	$298.35
Rate for Payer: Kaiser Permanente Commercial	$315.90
Rate for Payer: MDX Hawaii PPO	$340.47

77061 MG Mammo Diagnostic Right w/ Tomo Tech

Facility

$351.00

Service Code	HCPCS 77061 RT
Hospital Charge Code	11848526
Hospital Revenue Code	401
Min. Negotiated Rate	$175.50
Max. Negotiated Rate	$340.47
Rate for Payer: AlohaCare Medicaid	$175.50
Rate for Payer: AlohaCare Medicare	$175.50
Rate for Payer: Cash Price	$228.15
Rate for Payer: Devoted Health Medicare	$193.05
Rate for Payer: Hawaii Medical Service Association Medicare	$175.50
Rate for Payer: Hawaii Western Management Group Commercial	$333.45
Rate for Payer: Health Management Network Commercial	$298.35
Rate for Payer: Humana Medicare	$175.50
Rate for Payer: Kaiser Permanente Commercial	$315.90
Rate for Payer: Kaiser Permanente Medicaid	$179.01
Rate for Payer: Kaiser Permanente Medicare	$175.50
Rate for Payer: MDX Hawaii PPO	$340.47
Rate for Payer: Ohana Health Plan Medicaid	$175.50
Rate for Payer: Ohana Health Plan Medicare	$175.50
Rate for Payer: UnitedHealthcare Medicare	$175.50

77061 MG Mammo Diagnostic Right w/ Tomo. Tech

Facility

$351.00

Service Code	HCPCS 77061 RT
Hospital Charge Code	12135853
Hospital Revenue Code	401
Min. Negotiated Rate	$298.35
Max. Negotiated Rate	$340.47
Rate for Payer: Cash Price	$228.15
Rate for Payer: Health Management Network Commercial	$298.35
Rate for Payer: Kaiser Permanente Commercial	$315.90
Rate for Payer: MDX Hawaii PPO	$340.47

Know your out-of-pocket cost for care.

All Charges