Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

97605 Neg Press Wound Tx < 50 CM Charges

Facility

$396.00

Service Code	HCPCS 97605
Hospital Charge Code	8221507
Hospital Revenue Code	761
Min. Negotiated Rate	$336.60
Max. Negotiated Rate	$384.12
Rate for Payer: Cash Price	$257.40
Rate for Payer: Health Management Network Commercial	$336.60
Rate for Payer: Kaiser Permanente Commercial	$356.40
Rate for Payer: MDX Hawaii PPO	$384.12

97606 Negative pressure wound therapy; total wound(s) surface area greater than 50 sq cm

Professional

Both

$566.00

Service Code	HCPCS 97606
Hospital Charge Code	8040898
Hospital Revenue Code	975
Min. Negotiated Rate	$23.32
Max. Negotiated Rate	$481.10
Rate for Payer: AlohaCare Medicaid	$27.04
Rate for Payer: AlohaCare Medicare	$23.32
Rate for Payer: Cash Price	$367.90
Rate for Payer: Cash Price	$367.90
Rate for Payer: Devoted Health Medicare	$25.65
Rate for Payer: Hawaii Medical Service Association ABD	$27.04
Rate for Payer: Hawaii Medical Service Association Medicare	$23.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.04
Rate for Payer: Hawaii Western Management Group Commercial	$35.63
Rate for Payer: Health Management Network Commercial	$481.10
Rate for Payer: Kaiser Permanente Commercial	$25.65
Rate for Payer: Kaiser Permanente Medicaid	$25.65
Rate for Payer: Kaiser Permanente Medicare	$25.65
Rate for Payer: Ohana Health Plan Medicaid	$27.04
Rate for Payer: Ohana Health Plan Medicare	$23.32
Rate for Payer: UnitedHealthcare Medicaid	$27.04
Rate for Payer: UnitedHealthcare Medicare	$23.32
Rate for Payer: University Health Alliance Commercial	$33.42

97606 Neg Press Wound Tx > 50 CM Charges

Facility

$815.00

Service Code	HCPCS 97606
Hospital Charge Code	8221532
Hospital Revenue Code	761
Min. Negotiated Rate	$692.75
Max. Negotiated Rate	$790.55
Rate for Payer: Cash Price	$529.75
Rate for Payer: Health Management Network Commercial	$692.75
Rate for Payer: Kaiser Permanente Commercial	$733.50
Rate for Payer: MDX Hawaii PPO	$790.55

97606 Neg Press Wound Tx > 50 CM Charges

Facility

$815.00

Service Code	HCPCS 97606
Hospital Charge Code	8221532
Hospital Revenue Code	761
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$790.55
Rate for Payer: AlohaCare Medicaid	$407.50
Rate for Payer: AlohaCare Medicare	$407.50
Rate for Payer: Cash Price	$529.75
Rate for Payer: Cash Price	$529.75
Rate for Payer: Devoted Health Medicare	$448.25
Rate for Payer: Hawaii Medical Service Association Commercial	$519.15
Rate for Payer: Hawaii Medical Service Association Medicare	$407.50
Rate for Payer: Hawaii Western Management Group Commercial	$774.25
Rate for Payer: Health Management Network Commercial	$692.75
Rate for Payer: Humana Medicare	$407.50
Rate for Payer: Kaiser Permanente Commercial	$733.50
Rate for Payer: Kaiser Permanente Medicaid	$415.65
Rate for Payer: Kaiser Permanente Medicare	$407.50
Rate for Payer: MDX Hawaii PPO	$790.55
Rate for Payer: Ohana Health Plan Medicaid	$407.50
Rate for Payer: Ohana Health Plan Medicare	$407.50
Rate for Payer: UnitedHealthcare Medicaid	$20.32
Rate for Payer: UnitedHealthcare Medicare	$407.50
Rate for Payer: University Health Alliance Commercial	$594.05

97607 NEG PRESS WND TX <=50 SQ CM W/VIA ProFee

Professional

Both

$566.00

Service Code	HCPCS 97607
Hospital Charge Code	8022381
Hospital Revenue Code	975
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$481.10
Rate for Payer: AlohaCare Medicaid	$20.89
Rate for Payer: AlohaCare Medicare	$18.32
Rate for Payer: Cash Price	$367.90
Rate for Payer: Cash Price	$367.90
Rate for Payer: Devoted Health Medicare	$20.15
Rate for Payer: Hawaii Medical Service Association ABD	$20.89
Rate for Payer: Hawaii Medical Service Association Commercial	$35.68
Rate for Payer: Hawaii Medical Service Association Medicare	$18.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.89
Rate for Payer: Hawaii Western Management Group Commercial	$45.19
Rate for Payer: Health Management Network Commercial	$481.10
Rate for Payer: Kaiser Permanente Commercial	$20.15
Rate for Payer: Kaiser Permanente Medicaid	$20.15
Rate for Payer: Kaiser Permanente Medicare	$20.15
Rate for Payer: Ohana Health Plan Medicaid	$20.89
Rate for Payer: Ohana Health Plan Medicare	$18.32
Rate for Payer: UnitedHealthcare Medicaid	$20.89
Rate for Payer: UnitedHealthcare Medicare	$18.32
Rate for Payer: University Health Alliance Commercial	$23.97

97607 Neg Pre Wound <50 Sq Cm

Facility

$1,541.00

Service Code	HCPCS 97607 GP,CQ
Hospital Charge Code	8222662
Hospital Revenue Code	430
Min. Negotiated Rate	$1,309.85
Max. Negotiated Rate	$1,494.77
Rate for Payer: Cash Price	$1,001.65
Rate for Payer: Health Management Network Commercial	$1,309.85
Rate for Payer: Kaiser Permanente Commercial	$1,386.90
Rate for Payer: MDX Hawaii PPO	$1,494.77

97607 Neg Pre Wound <50 Sq Cm

Professional

Both

$566.00

Service Code	HCPCS 97607 GP,CQ
Hospital Charge Code	8222662
Hospital Revenue Code	960
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$481.10
Rate for Payer: AlohaCare Medicaid	$20.89
Rate for Payer: Cash Price	$367.90
Rate for Payer: Cash Price	$367.90
Rate for Payer: Hawaii Medical Service Association ABD	$20.89
Rate for Payer: Hawaii Medical Service Association Commercial	$35.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.89
Rate for Payer: Hawaii Western Management Group Commercial	$45.19
Rate for Payer: Health Management Network Commercial	$481.10
Rate for Payer: Ohana Health Plan Medicaid	$20.89
Rate for Payer: UnitedHealthcare Medicaid	$20.89
Rate for Payer: University Health Alliance Commercial	$23.97

97607 Neg Pre Wound <50 Sq Cm

Facility

$1,541.00

Service Code	HCPCS 97607 GP,CQ
Hospital Charge Code	8222662
Hospital Revenue Code	430
Min. Negotiated Rate	$20.89
Max. Negotiated Rate	$1,494.77
Rate for Payer: AlohaCare Medicaid	$770.50
Rate for Payer: AlohaCare Medicare	$770.50
Rate for Payer: Cash Price	$1,001.65
Rate for Payer: Cash Price	$1,001.65
Rate for Payer: Devoted Health Medicare	$847.55
Rate for Payer: Hawaii Medical Service Association Medicare	$770.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,463.95
Rate for Payer: Health Management Network Commercial	$1,309.85
Rate for Payer: Humana Medicare	$770.50
Rate for Payer: Kaiser Permanente Commercial	$1,386.90
Rate for Payer: Kaiser Permanente Medicaid	$785.91
Rate for Payer: Kaiser Permanente Medicare	$770.50
Rate for Payer: MDX Hawaii PPO	$1,494.77
Rate for Payer: Ohana Health Plan Medicaid	$770.50
Rate for Payer: Ohana Health Plan Medicare	$770.50
Rate for Payer: UnitedHealthcare Medicaid	$20.89
Rate for Payer: UnitedHealthcare Medicare	$770.50
Rate for Payer: University Health Alliance Commercial	$1,123.23

97608 Neg Pres Wound >50 Sq Cm

Facility

$1,541.00

Service Code	HCPCS 97608 GP,CQ
Hospital Charge Code	8222665
Hospital Revenue Code	430
Min. Negotiated Rate	$24.26
Max. Negotiated Rate	$1,494.77
Rate for Payer: AlohaCare Medicaid	$770.50
Rate for Payer: AlohaCare Medicare	$770.50
Rate for Payer: Cash Price	$1,001.65
Rate for Payer: Cash Price	$1,001.65
Rate for Payer: Devoted Health Medicare	$847.55
Rate for Payer: Hawaii Medical Service Association Medicare	$770.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,463.95
Rate for Payer: Health Management Network Commercial	$1,309.85
Rate for Payer: Humana Medicare	$770.50
Rate for Payer: Kaiser Permanente Commercial	$1,386.90
Rate for Payer: Kaiser Permanente Medicaid	$785.91
Rate for Payer: Kaiser Permanente Medicare	$770.50
Rate for Payer: MDX Hawaii PPO	$1,494.77
Rate for Payer: Ohana Health Plan Medicaid	$770.50
Rate for Payer: Ohana Health Plan Medicare	$770.50
Rate for Payer: UnitedHealthcare Medicaid	$24.26
Rate for Payer: UnitedHealthcare Medicare	$770.50
Rate for Payer: University Health Alliance Commercial	$1,123.23

97608 Neg Pres Wound >50 Sq Cm

Facility

$1,541.00

Service Code	HCPCS 97608 GP,CQ
Hospital Charge Code	8222665
Hospital Revenue Code	430
Min. Negotiated Rate	$1,309.85
Max. Negotiated Rate	$1,494.77
Rate for Payer: Cash Price	$1,001.65
Rate for Payer: Health Management Network Commercial	$1,309.85
Rate for Payer: Kaiser Permanente Commercial	$1,386.90
Rate for Payer: MDX Hawaii PPO	$1,494.77

97760 Physical Therapy Tx/Procedures

Facility

$246.00

Service Code	HCPCS 97530 GP,59
Hospital Charge Code	9700045
Hospital Revenue Code	420
Min. Negotiated Rate	$209.10
Max. Negotiated Rate	$238.62
Rate for Payer: Cash Price	$159.90
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: Kaiser Permanente Commercial	$221.40
Rate for Payer: MDX Hawaii PPO	$238.62

97760 Physical Therapy Tx/Procedures

Facility

$246.00

Service Code	HCPCS 97530 GP,59
Hospital Charge Code	9700045
Hospital Revenue Code	420
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$238.62
Rate for Payer: AlohaCare Medicaid	$123.00
Rate for Payer: AlohaCare Medicare	$123.00
Rate for Payer: Cash Price	$159.90
Rate for Payer: Cash Price	$159.90
Rate for Payer: Devoted Health Medicare	$135.30
Rate for Payer: Hawaii Medical Service Association Medicare	$123.00
Rate for Payer: Hawaii Western Management Group Commercial	$233.70
Rate for Payer: Health Management Network Commercial	$209.10
Rate for Payer: Humana Medicare	$123.00
Rate for Payer: Kaiser Permanente Commercial	$221.40
Rate for Payer: Kaiser Permanente Medicaid	$125.46
Rate for Payer: Kaiser Permanente Medicare	$123.00
Rate for Payer: MDX Hawaii PPO	$238.62
Rate for Payer: Ohana Health Plan Medicaid	$123.00
Rate for Payer: Ohana Health Plan Medicare	$123.00
Rate for Payer: UnitedHealthcare Medicaid	$18.32
Rate for Payer: UnitedHealthcare Medicare	$123.00
Rate for Payer: University Health Alliance Commercial	$179.31

99100 ANES PRO Age <1 or >70

Professional

Both

$346.00

Service Code	HCPCS 99100
Hospital Charge Code	8952659
Hospital Revenue Code	975
Min. Negotiated Rate	$27.33
Max. Negotiated Rate	$294.10
Rate for Payer: Cash Price	$224.90
Rate for Payer: Cash Price	$224.90
Rate for Payer: Hawaii Western Management Group Commercial	$27.33
Rate for Payer: Health Management Network Commercial	$294.10

99140 EMERGENCY CONDITIONS ProFee

Professional

Both

$96.00

Service Code	HCPCS 99140
Hospital Charge Code	8022391
Hospital Revenue Code	963
Min. Negotiated Rate	$50.10
Max. Negotiated Rate	$81.60
Rate for Payer: Cash Price	$62.40
Rate for Payer: Cash Price	$62.40
Rate for Payer: Hawaii Western Management Group Commercial	$50.10
Rate for Payer: Health Management Network Commercial	$81.60

99151-Same MD First 15 mins Less Than 5 yrs

Facility

$153.00

Service Code	HCPCS 99151
Hospital Charge Code	8080164
Hospital Revenue Code	370
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$99.45
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Kaiser Permanente Commercial	$137.70
Rate for Payer: MDX Hawaii PPO	$148.41

99151-Same MD First 15 mins Less Than 5 yrs

Facility

$153.00

Service Code	HCPCS 99151
Hospital Charge Code	8080164
Hospital Revenue Code	370
Min. Negotiated Rate	$17.23
Max. Negotiated Rate	$148.41
Rate for Payer: AlohaCare Medicaid	$76.50
Rate for Payer: AlohaCare Medicare	$76.50
Rate for Payer: Cash Price	$99.45
Rate for Payer: Cash Price	$99.45
Rate for Payer: Devoted Health Medicare	$84.15
Rate for Payer: Hawaii Medical Service Association Medicare	$76.50
Rate for Payer: Hawaii Western Management Group Commercial	$145.35
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Humana Medicare	$76.50
Rate for Payer: Kaiser Permanente Commercial	$137.70
Rate for Payer: Kaiser Permanente Medicaid	$78.03
Rate for Payer: Kaiser Permanente Medicare	$76.50
Rate for Payer: MDX Hawaii PPO	$148.41
Rate for Payer: Ohana Health Plan Medicaid	$76.50
Rate for Payer: Ohana Health Plan Medicare	$76.50
Rate for Payer: UnitedHealthcare Medicaid	$17.23
Rate for Payer: UnitedHealthcare Medicare	$76.50
Rate for Payer: University Health Alliance Commercial	$111.52

99152-Same MD First 15 mins Greater Than/Equal to 5 yrs

Facility

$202.00

Service Code	HCPCS 99152
Hospital Charge Code	8080165
Hospital Revenue Code	370
Min. Negotiated Rate	$11.94
Max. Negotiated Rate	$195.94
Rate for Payer: AlohaCare Medicaid	$101.00
Rate for Payer: AlohaCare Medicare	$101.00
Rate for Payer: Cash Price	$131.30
Rate for Payer: Cash Price	$131.30
Rate for Payer: Devoted Health Medicare	$111.10
Rate for Payer: Hawaii Medical Service Association Medicare	$101.00
Rate for Payer: Hawaii Western Management Group Commercial	$191.90
Rate for Payer: Health Management Network Commercial	$171.70
Rate for Payer: Humana Medicare	$101.00
Rate for Payer: Kaiser Permanente Commercial	$181.80
Rate for Payer: Kaiser Permanente Medicaid	$103.02
Rate for Payer: Kaiser Permanente Medicare	$101.00
Rate for Payer: MDX Hawaii PPO	$195.94
Rate for Payer: Ohana Health Plan Medicaid	$101.00
Rate for Payer: Ohana Health Plan Medicare	$101.00
Rate for Payer: UnitedHealthcare Medicaid	$11.94
Rate for Payer: UnitedHealthcare Medicare	$101.00
Rate for Payer: University Health Alliance Commercial	$147.24

99152-Same MD First 15 mins Greater Than/Equal to 5 yrs

Facility

$202.00

Service Code	HCPCS 99152
Hospital Charge Code	8080165
Hospital Revenue Code	370
Min. Negotiated Rate	$171.70
Max. Negotiated Rate	$195.94
Rate for Payer: Cash Price	$131.30
Rate for Payer: Health Management Network Commercial	$171.70
Rate for Payer: Kaiser Permanente Commercial	$181.80
Rate for Payer: MDX Hawaii PPO	$195.94

99153-Same MD Each Additional 15 mins

Facility

$119.00

Service Code	HCPCS 99153
Hospital Charge Code	8080166
Hospital Revenue Code	450
Min. Negotiated Rate	$101.15
Max. Negotiated Rate	$115.43
Rate for Payer: Cash Price	$77.35
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Kaiser Permanente Commercial	$107.10
Rate for Payer: MDX Hawaii PPO	$115.43

99153-Same MD Each Additional 15 mins

Facility

$119.00

Service Code	HCPCS 99153
Hospital Charge Code	8080166
Hospital Revenue Code	450
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$59.50
Rate for Payer: Cash Price	$77.35
Rate for Payer: Cash Price	$77.35
Rate for Payer: Cash Price	$77.35
Rate for Payer: Devoted Health Medicare	$65.45
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	$59.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$113.05
Rate for Payer: Health Management Network Commercial	$101.15
Rate for Payer: Humana Medicare	$59.50
Rate for Payer: Kaiser Permanente Commercial	$107.10
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$59.50
Rate for Payer: MDX Hawaii PPO	$115.43
Rate for Payer: Ohana Health Plan Medicaid	$59.50
Rate for Payer: Ohana Health Plan Medicare	$59.50
Rate for Payer: UnitedHealthcare Medicare	$59.50
Rate for Payer: University Health Alliance Commercial	$86.74

99155-Different MD First 15 mins Less Than 5 yrs

Facility

$153.00

Service Code	HCPCS 99155
Hospital Charge Code	8080167
Hospital Revenue Code	370
Min. Negotiated Rate	$130.05
Max. Negotiated Rate	$148.41
Rate for Payer: Cash Price	$99.45
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Kaiser Permanente Commercial	$137.70
Rate for Payer: MDX Hawaii PPO	$148.41

99155-Different MD First 15 mins Less Than 5 yrs

Facility

$153.00

Service Code	HCPCS 99155
Hospital Charge Code	8080167
Hospital Revenue Code	370
Min. Negotiated Rate	$59.68
Max. Negotiated Rate	$148.41
Rate for Payer: AlohaCare Medicaid	$76.50
Rate for Payer: AlohaCare Medicare	$76.50
Rate for Payer: Cash Price	$99.45
Rate for Payer: Cash Price	$99.45
Rate for Payer: Devoted Health Medicare	$84.15
Rate for Payer: Hawaii Medical Service Association Medicare	$76.50
Rate for Payer: Hawaii Western Management Group Commercial	$145.35
Rate for Payer: Health Management Network Commercial	$130.05
Rate for Payer: Humana Medicare	$76.50
Rate for Payer: Kaiser Permanente Commercial	$137.70
Rate for Payer: Kaiser Permanente Medicaid	$78.03
Rate for Payer: Kaiser Permanente Medicare	$76.50
Rate for Payer: MDX Hawaii PPO	$148.41
Rate for Payer: Ohana Health Plan Medicaid	$76.50
Rate for Payer: Ohana Health Plan Medicare	$76.50
Rate for Payer: UnitedHealthcare Medicaid	$59.68
Rate for Payer: UnitedHealthcare Medicare	$76.50
Rate for Payer: University Health Alliance Commercial	$111.52

99156 CONS SEDATE >5Y 1ST 15MIN DIFF PROV ProFee

Professional

Both

$158.00

Service Code	HCPCS 99156
Hospital Charge Code	8022400
Hospital Revenue Code	963
Min. Negotiated Rate	$69.80
Max. Negotiated Rate	$134.30
Rate for Payer: AlohaCare Medicaid	$73.40
Rate for Payer: AlohaCare Medicare	$69.80
Rate for Payer: Cash Price	$102.70
Rate for Payer: Cash Price	$102.70
Rate for Payer: Devoted Health Medicare	$76.78
Rate for Payer: Hawaii Medical Service Association Medicare	$69.80
Rate for Payer: Hawaii Western Management Group Commercial	$77.15
Rate for Payer: Health Management Network Commercial	$134.30
Rate for Payer: Kaiser Permanente Commercial	$76.78
Rate for Payer: Kaiser Permanente Medicaid	$76.78
Rate for Payer: Kaiser Permanente Medicare	$76.78
Rate for Payer: Ohana Health Plan Medicaid	$73.40
Rate for Payer: Ohana Health Plan Medicare	$69.80
Rate for Payer: UnitedHealthcare Medicaid	$73.40
Rate for Payer: UnitedHealthcare Medicare	$69.80

99156-Different MD First 15 mins Greater Than/Equal to 5 yrs

Facility

$139.00

Service Code	HCPCS 99156
Hospital Charge Code	8080168
Hospital Revenue Code	370
Min. Negotiated Rate	$53.37
Max. Negotiated Rate	$134.83
Rate for Payer: AlohaCare Medicaid	$69.50
Rate for Payer: AlohaCare Medicare	$69.50
Rate for Payer: Cash Price	$90.35
Rate for Payer: Cash Price	$90.35
Rate for Payer: Devoted Health Medicare	$76.45
Rate for Payer: Hawaii Medical Service Association Medicare	$69.50
Rate for Payer: Hawaii Western Management Group Commercial	$132.05
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Humana Medicare	$69.50
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: Kaiser Permanente Medicaid	$70.89
Rate for Payer: Kaiser Permanente Medicare	$69.50
Rate for Payer: MDX Hawaii PPO	$134.83
Rate for Payer: Ohana Health Plan Medicaid	$69.50
Rate for Payer: Ohana Health Plan Medicare	$69.50
Rate for Payer: UnitedHealthcare Medicaid	$53.37
Rate for Payer: UnitedHealthcare Medicare	$69.50
Rate for Payer: University Health Alliance Commercial	$101.32

99156-Different MD First 15 mins Greater Than/Equal to 5 yrs

Facility

$139.00

Service Code	HCPCS 99156
Hospital Charge Code	8080168
Hospital Revenue Code	370
Min. Negotiated Rate	$118.15
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$90.35
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: MDX Hawaii PPO	$134.83

Know your out-of-pocket cost for care.

All Charges