Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

99236 Same Day Admit/Discharge, High

Professional

Both

$679.00

Service Code	HCPCS 99236
Hospital Charge Code	8041037
Hospital Revenue Code	975
Min. Negotiated Rate	$164.50
Max. Negotiated Rate	$577.15
Rate for Payer: AlohaCare Medicaid	$208.78
Rate for Payer: AlohaCare Medicare	$189.32
Rate for Payer: Cash Price	$441.35
Rate for Payer: Cash Price	$441.35
Rate for Payer: Devoted Health Medicare	$208.25
Rate for Payer: Hawaii Medical Service Association Medicare	$189.32
Rate for Payer: Hawaii Western Management Group Commercial	$164.50
Rate for Payer: Health Management Network Commercial	$577.15
Rate for Payer: Kaiser Permanente Commercial	$208.25
Rate for Payer: Kaiser Permanente Medicaid	$208.25
Rate for Payer: Kaiser Permanente Medicare	$208.25
Rate for Payer: Ohana Health Plan Medicaid	$208.78
Rate for Payer: Ohana Health Plan Medicare	$189.32
Rate for Payer: UnitedHealthcare Medicaid	$208.78
Rate for Payer: UnitedHealthcare Medicare	$189.32

99238 Hospital Discharge Day, <30 Minutes

Professional

Both

$254.00

Service Code	HCPCS 99238
Hospital Charge Code	8041038
Hospital Revenue Code	975
Min. Negotiated Rate	$64.63
Max. Negotiated Rate	$215.90
Rate for Payer: AlohaCare Medicaid	$82.58
Rate for Payer: AlohaCare Medicare	$75.97
Rate for Payer: Cash Price	$165.10
Rate for Payer: Cash Price	$165.10
Rate for Payer: Devoted Health Medicare	$83.57
Rate for Payer: Hawaii Medical Service Association Medicare	$75.97
Rate for Payer: Hawaii Western Management Group Commercial	$64.63
Rate for Payer: Health Management Network Commercial	$215.90
Rate for Payer: Kaiser Permanente Commercial	$83.57
Rate for Payer: Kaiser Permanente Medicaid	$83.57
Rate for Payer: Kaiser Permanente Medicare	$83.57
Rate for Payer: Ohana Health Plan Medicaid	$82.58
Rate for Payer: Ohana Health Plan Medicare	$75.97
Rate for Payer: UnitedHealthcare Medicaid	$82.58
Rate for Payer: UnitedHealthcare Medicare	$75.97

99239 Hospital Discharge Day, > 30 Min

Professional

Both

$373.00

Service Code	HCPCS 99239
Hospital Charge Code	8041039
Hospital Revenue Code	975
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$317.05
Rate for Payer: AlohaCare Medicaid	$116.44
Rate for Payer: AlohaCare Medicare	$108.33
Rate for Payer: Cash Price	$242.45
Rate for Payer: Cash Price	$242.45
Rate for Payer: Devoted Health Medicare	$119.16
Rate for Payer: Hawaii Medical Service Association Medicare	$108.33
Rate for Payer: Hawaii Western Management Group Commercial	$78.33
Rate for Payer: Health Management Network Commercial	$317.05
Rate for Payer: Kaiser Permanente Commercial	$119.16
Rate for Payer: Kaiser Permanente Medicaid	$119.16
Rate for Payer: Kaiser Permanente Medicare	$119.16
Rate for Payer: Ohana Health Plan Medicaid	$116.44
Rate for Payer: Ohana Health Plan Medicare	$108.33
Rate for Payer: UnitedHealthcare Medicaid	$116.44
Rate for Payer: UnitedHealthcare Medicare	$108.33

99241 Office Consultation, Level 1

Professional

Both

$53.00

Hospital Charge Code	8041041
Hospital Revenue Code	982
Min. Negotiated Rate	$45.05
Max. Negotiated Rate	$45.05
Rate for Payer: Cash Price	$34.45
Rate for Payer: Health Management Network Commercial	$45.05

99242 Office Consultation, Level 2

Professional

Both

$126.00

Service Code	HCPCS 99242
Hospital Charge Code	8041042
Hospital Revenue Code	975
Min. Negotiated Rate	$56.76
Max. Negotiated Rate	$107.10
Rate for Payer: Cash Price	$81.90
Rate for Payer: Cash Price	$81.90
Rate for Payer: Hawaii Medical Service Association ABD	$56.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$56.76
Rate for Payer: Hawaii Western Management Group Commercial	$82.11
Rate for Payer: Health Management Network Commercial	$107.10

99243 Office Consultation, Level 3

Professional

Both

$423.00

Service Code	HCPCS 99243
Hospital Charge Code	8041043
Hospital Revenue Code	960
Min. Negotiated Rate	$89.13
Max. Negotiated Rate	$359.55
Rate for Payer: Cash Price	$274.95
Rate for Payer: Cash Price	$274.95
Rate for Payer: Hawaii Medical Service Association ABD	$89.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$89.13
Rate for Payer: Hawaii Western Management Group Commercial	$105.54
Rate for Payer: Health Management Network Commercial	$359.55

99244 Office Consultation, Level 4

Professional

Both

$170.00

Service Code	HCPCS 99244
Hospital Charge Code	8041044
Hospital Revenue Code	982
Min. Negotiated Rate	$136.13
Max. Negotiated Rate	$144.50
Rate for Payer: Cash Price	$110.50
Rate for Payer: Cash Price	$110.50
Rate for Payer: Hawaii Medical Service Association ABD	$136.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$136.13
Rate for Payer: Hawaii Western Management Group Commercial	$139.47
Rate for Payer: Health Management Network Commercial	$144.50

99245 Office Consultation, Level 5

Professional

Both

$410.00

Service Code	HCPCS 99245
Hospital Charge Code	8041045
Hospital Revenue Code	975
Min. Negotiated Rate	$150.80
Max. Negotiated Rate	$348.50
Rate for Payer: Cash Price	$266.50
Rate for Payer: Cash Price	$266.50
Rate for Payer: Hawaii Medical Service Association ABD	$181.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$181.90
Rate for Payer: Hawaii Western Management Group Commercial	$150.80
Rate for Payer: Health Management Network Commercial	$348.50

99251 Inpatient Consultation, Level 1

Professional

Both

$246.00

Service Code	HCPCS 99251
Hospital Charge Code	8041046
Hospital Revenue Code	987
Min. Negotiated Rate	$49.51
Max. Negotiated Rate	$209.10
Rate for Payer: Cash Price	$159.90
Rate for Payer: Cash Price	$159.90
Rate for Payer: Hawaii Western Management Group Commercial	$49.51
Rate for Payer: Health Management Network Commercial	$209.10

99252 Inpatient Consultation, Level 2

Professional

Both

$305.00

Service Code	HCPCS 99252
Hospital Charge Code	8041047
Hospital Revenue Code	987
Min. Negotiated Rate	$77.22
Max. Negotiated Rate	$259.25
Rate for Payer: Cash Price	$198.25
Rate for Payer: Cash Price	$198.25
Rate for Payer: Hawaii Western Management Group Commercial	$77.22
Rate for Payer: Health Management Network Commercial	$259.25

99253 Inpatient Consultation, Level 3

Professional

Both

$431.00

Service Code	HCPCS 99253
Hospital Charge Code	8041048
Hospital Revenue Code	987
Min. Negotiated Rate	$102.55
Max. Negotiated Rate	$366.35
Rate for Payer: Cash Price	$280.15
Rate for Payer: Cash Price	$280.15
Rate for Payer: Hawaii Western Management Group Commercial	$102.55
Rate for Payer: Health Management Network Commercial	$366.35

99254 Inpatient Consultation, Level 4

Professional

Both

$585.00

Service Code	HCPCS 99254
Hospital Charge Code	8041049
Hospital Revenue Code	983
Min. Negotiated Rate	$141.07
Max. Negotiated Rate	$497.25
Rate for Payer: Cash Price	$380.25
Rate for Payer: Cash Price	$380.25
Rate for Payer: Hawaii Western Management Group Commercial	$141.07
Rate for Payer: Health Management Network Commercial	$497.25

99255 Inpatient Consultation, Level 5

Professional

Both

$626.00

Service Code	HCPCS 99255
Hospital Charge Code	8041050
Hospital Revenue Code	987
Min. Negotiated Rate	$190.80
Max. Negotiated Rate	$532.10
Rate for Payer: Cash Price	$406.90
Rate for Payer: Cash Price	$406.90
Rate for Payer: Hawaii Western Management Group Commercial	$190.80
Rate for Payer: Health Management Network Commercial	$532.10

99281 ED VISIT FOR E&M PATIENT, LEV 1, MAY NOT REQ PRESENCE OF PHYSICIAN OR OTHER, CC

Facility

$728.00

Service Code	HCPCS 99281
Hospital Charge Code	2644297
Hospital Revenue Code	450
Min. Negotiated Rate	$364.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$364.00
Rate for Payer: Cash Price	$473.20
Rate for Payer: Cash Price	$473.20
Rate for Payer: Cash Price	$473.20
Rate for Payer: Devoted Health Medicare	$400.40
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	$364.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$691.60
Rate for Payer: Health Management Network Commercial	$618.80
Rate for Payer: Humana Medicare	$364.00
Rate for Payer: Kaiser Permanente Commercial	$655.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$364.00
Rate for Payer: MDX Hawaii PPO	$706.16
Rate for Payer: Ohana Health Plan Medicaid	$364.00
Rate for Payer: Ohana Health Plan Medicare	$364.00
Rate for Payer: UnitedHealthcare Medicare	$364.00
Rate for Payer: University Health Alliance Commercial	$530.64

99281 ED VISIT FOR E&M PATIENT, LEV 1, MAY NOT REQ PRESENCE OF PHYSICIAN OR OTHER, CC

Facility

$728.00

Service Code	HCPCS 99281
Hospital Charge Code	2644297
Hospital Revenue Code	450
Min. Negotiated Rate	$618.80
Max. Negotiated Rate	$706.16
Rate for Payer: Cash Price	$473.20
Rate for Payer: Health Management Network Commercial	$618.80
Rate for Payer: Kaiser Permanente Commercial	$655.20
Rate for Payer: MDX Hawaii PPO	$706.16

99282 ED VISIT E&M PATIENT, LEV 2, REQ MED APPROP HSTRY/EXAM/MDM, CC

Facility

$1,255.00

Service Code	HCPCS 99282
Hospital Charge Code	2644298
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$627.50
Rate for Payer: Cash Price	$815.75
Rate for Payer: Cash Price	$815.75
Rate for Payer: Cash Price	$815.75
Rate for Payer: Devoted Health Medicare	$690.25
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	$627.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,192.25
Rate for Payer: Health Management Network Commercial	$1,066.75
Rate for Payer: Humana Medicare	$627.50
Rate for Payer: Kaiser Permanente Commercial	$1,129.50
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$627.50
Rate for Payer: MDX Hawaii PPO	$1,217.35
Rate for Payer: Ohana Health Plan Medicaid	$627.50
Rate for Payer: Ohana Health Plan Medicare	$627.50
Rate for Payer: UnitedHealthcare Medicare	$627.50
Rate for Payer: University Health Alliance Commercial	$914.77

99282 ED VISIT E&M PATIENT, LEV 2, REQ MED APPROP HSTRY/EXAM/MDM, CC

Facility

$1,255.00

Service Code	HCPCS 99282
Hospital Charge Code	2644298
Hospital Revenue Code	450
Min. Negotiated Rate	$1,066.75
Max. Negotiated Rate	$1,217.35
Rate for Payer: Cash Price	$815.75
Rate for Payer: Health Management Network Commercial	$1,066.75
Rate for Payer: Kaiser Permanente Commercial	$1,129.50
Rate for Payer: MDX Hawaii PPO	$1,217.35

99283 ED VISIT E&M PATIENT, LEV 3, REQ MED APPROP HSTRY/EXAM/LOW MDM, CC

Facility

$1,678.00

Service Code	HCPCS 99283
Hospital Charge Code	2644299
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$1,627.66
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$839.00
Rate for Payer: Cash Price	$1,090.70
Rate for Payer: Cash Price	$1,090.70
Rate for Payer: Cash Price	$1,090.70
Rate for Payer: Devoted Health Medicare	$922.90
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	$839.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,594.10
Rate for Payer: Health Management Network Commercial	$1,426.30
Rate for Payer: Humana Medicare	$839.00
Rate for Payer: Kaiser Permanente Commercial	$1,510.20
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$839.00
Rate for Payer: MDX Hawaii PPO	$1,627.66
Rate for Payer: Ohana Health Plan Medicaid	$839.00
Rate for Payer: Ohana Health Plan Medicare	$839.00
Rate for Payer: UnitedHealthcare Medicare	$839.00
Rate for Payer: University Health Alliance Commercial	$1,223.09

99283 ED VISIT E&M PATIENT, LEV 3, REQ MED APPROP HSTRY/EXAM/LOW MDM, CC

Facility

$1,678.00

Service Code	HCPCS 99283
Hospital Charge Code	2644299
Hospital Revenue Code	450
Min. Negotiated Rate	$1,426.30
Max. Negotiated Rate	$1,627.66
Rate for Payer: Cash Price	$1,090.70
Rate for Payer: Health Management Network Commercial	$1,426.30
Rate for Payer: Kaiser Permanente Commercial	$1,510.20
Rate for Payer: MDX Hawaii PPO	$1,627.66

99284 ED VISIT E&M PATIENT, LEV 4, REQ MED APPROP HSTRY/EXAM/MODERATE MDM, CC

Facility

$3,010.00

Service Code	HCPCS 99284
Hospital Charge Code	2644300
Hospital Revenue Code	450
Min. Negotiated Rate	$2,558.50
Max. Negotiated Rate	$2,919.70
Rate for Payer: Cash Price	$1,956.50
Rate for Payer: Health Management Network Commercial	$2,558.50
Rate for Payer: Kaiser Permanente Commercial	$2,709.00
Rate for Payer: MDX Hawaii PPO	$2,919.70

99284 ED VISIT E&M PATIENT, LEV 4, REQ MED APPROP HSTRY/EXAM/MODERATE MDM, CC

Facility

$3,010.00

Service Code	HCPCS 99284
Hospital Charge Code	2644300
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$2,919.70
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$1,505.00
Rate for Payer: Cash Price	$1,956.50
Rate for Payer: Cash Price	$1,956.50
Rate for Payer: Cash Price	$1,956.50
Rate for Payer: Devoted Health Medicare	$1,655.50
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	$1,505.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,859.50
Rate for Payer: Health Management Network Commercial	$2,558.50
Rate for Payer: Humana Medicare	$1,505.00
Rate for Payer: Kaiser Permanente Commercial	$2,709.00
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$1,505.00
Rate for Payer: MDX Hawaii PPO	$2,919.70
Rate for Payer: Ohana Health Plan Medicaid	$1,505.00
Rate for Payer: Ohana Health Plan Medicare	$1,505.00
Rate for Payer: UnitedHealthcare Medicare	$1,505.00
Rate for Payer: University Health Alliance Commercial	$2,193.99

99285 ED VISIT E M PATIENT, LEV 5, REQ MED APPROP HSTRY/EXAM/HIGH MDM, CC

Facility

$4,646.00

Service Code	HCPCS 99285
Hospital Charge Code	2644301
Hospital Revenue Code	450
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$4,506.62
Rate for Payer: AlohaCare Medicaid	$525.09
Rate for Payer: AlohaCare Medicare	$2,323.00
Rate for Payer: Cash Price	$3,019.90
Rate for Payer: Cash Price	$3,019.90
Rate for Payer: Cash Price	$3,019.90
Rate for Payer: Devoted Health Medicare	$2,555.30
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	$2,323.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$520.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,413.70
Rate for Payer: Health Management Network Commercial	$3,949.10
Rate for Payer: Humana Medicare	$2,323.00
Rate for Payer: Kaiser Permanente Commercial	$4,181.40
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$2,323.00
Rate for Payer: MDX Hawaii PPO	$4,506.62
Rate for Payer: Ohana Health Plan Medicaid	$2,323.00
Rate for Payer: Ohana Health Plan Medicare	$2,323.00
Rate for Payer: UnitedHealthcare Medicare	$2,323.00
Rate for Payer: University Health Alliance Commercial	$3,386.47

99285 ED VISIT E M PATIENT, LEV 5, REQ MED APPROP HSTRY/EXAM/HIGH MDM, CC

Facility

$4,646.00

Service Code	HCPCS 99285
Hospital Charge Code	2644301
Hospital Revenue Code	450
Min. Negotiated Rate	$3,949.10
Max. Negotiated Rate	$4,506.62
Rate for Payer: Cash Price	$3,019.90
Rate for Payer: Health Management Network Commercial	$3,949.10
Rate for Payer: Kaiser Permanente Commercial	$4,181.40
Rate for Payer: MDX Hawaii PPO	$4,506.62

99291 Critical Care, First 30-74 Min

Professional

Both

$1,150.00

Service Code	HCPCS 99291
Hospital Charge Code	8041056
Hospital Revenue Code	975
Min. Negotiated Rate	$197.18
Max. Negotiated Rate	$977.50
Rate for Payer: AlohaCare Medicaid	$210.80
Rate for Payer: AlohaCare Medicare	$197.18
Rate for Payer: Cash Price	$747.50
Rate for Payer: Cash Price	$747.50
Rate for Payer: Devoted Health Medicare	$216.90
Rate for Payer: Hawaii Medical Service Association ABD	$210.80
Rate for Payer: Hawaii Medical Service Association Medicare	$197.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$210.80
Rate for Payer: Hawaii Western Management Group Commercial	$251.64
Rate for Payer: Health Management Network Commercial	$977.50
Rate for Payer: Kaiser Permanente Commercial	$216.90
Rate for Payer: Kaiser Permanente Medicaid	$216.90
Rate for Payer: Kaiser Permanente Medicare	$216.90
Rate for Payer: Ohana Health Plan Medicaid	$210.80
Rate for Payer: Ohana Health Plan Medicare	$197.18
Rate for Payer: UnitedHealthcare Medicaid	$210.80
Rate for Payer: UnitedHealthcare Medicare	$197.18

99291 CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN ProFee

Professional

Both

$553.00

Service Code	HCPCS 99291
Hospital Charge Code	8218186
Hospital Revenue Code	981
Min. Negotiated Rate	$197.18
Max. Negotiated Rate	$470.05
Rate for Payer: AlohaCare Medicaid	$210.80
Rate for Payer: AlohaCare Medicare	$197.18
Rate for Payer: Cash Price	$359.45
Rate for Payer: Cash Price	$359.45
Rate for Payer: Devoted Health Medicare	$216.90
Rate for Payer: Hawaii Medical Service Association ABD	$210.80
Rate for Payer: Hawaii Medical Service Association Medicare	$197.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$210.80
Rate for Payer: Hawaii Western Management Group Commercial	$251.64
Rate for Payer: Health Management Network Commercial	$470.05
Rate for Payer: Kaiser Permanente Commercial	$216.90
Rate for Payer: Kaiser Permanente Medicaid	$216.90
Rate for Payer: Kaiser Permanente Medicare	$216.90
Rate for Payer: Ohana Health Plan Medicaid	$210.80
Rate for Payer: Ohana Health Plan Medicare	$197.18
Rate for Payer: UnitedHealthcare Medicaid	$210.80
Rate for Payer: UnitedHealthcare Medicare	$197.18

Know your out-of-pocket cost for care.

All Charges