Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

ADL Training Charge

Facility

$220.00

Service Code	HCPCS 97535 GP,CQ
Hospital Charge Code	8111715
Hospital Revenue Code	420
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$143.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: MDX Hawaii PPO	$213.40

ADL Training Charges

Facility

$220.00

Service Code	HCPCS 97535 GP,CQ
Hospital Charge Code	8123821
Hospital Revenue Code	430
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$143.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: MDX Hawaii PPO	$213.40

ADL Training Charges

Facility

$220.00

Service Code	HCPCS 97535 GP,CQ
Hospital Charge Code	8123821
Hospital Revenue Code	430
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$213.40
Rate for Payer: AlohaCare Medicaid	$110.00
Rate for Payer: AlohaCare Medicare	$110.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Devoted Health Medicare	$121.00
Rate for Payer: Hawaii Medical Service Association Medicare	$110.00
Rate for Payer: Hawaii Western Management Group Commercial	$209.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Humana Medicare	$110.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: Kaiser Permanente Medicaid	$112.20
Rate for Payer: Kaiser Permanente Medicare	$110.00
Rate for Payer: MDX Hawaii PPO	$213.40
Rate for Payer: Ohana Health Plan Medicaid	$110.00
Rate for Payer: Ohana Health Plan Medicare	$110.00
Rate for Payer: UnitedHealthcare Medicaid	$19.20
Rate for Payer: UnitedHealthcare Medicare	$110.00
Rate for Payer: University Health Alliance Commercial	$160.36

ADNA w/ IFA Titer FSI

Facility

$157.00

Service Code	HCPCS 86225
Hospital Charge Code	8117763
Hospital Revenue Code	302
Min. Negotiated Rate	$133.45
Max. Negotiated Rate	$152.29
Rate for Payer: Cash Price	$102.05
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: Kaiser Permanente Commercial	$141.30
Rate for Payer: MDX Hawaii PPO	$152.29

ADNA w/ IFA Titer FSI

Facility

$157.00

Service Code	HCPCS 86225
Hospital Charge Code	8117763
Hospital Revenue Code	302
Min. Negotiated Rate	$13.74
Max. Negotiated Rate	$152.29
Rate for Payer: AlohaCare Medicaid	$78.50
Rate for Payer: AlohaCare Medicare	$78.50
Rate for Payer: Cash Price	$102.05
Rate for Payer: Cash Price	$102.05
Rate for Payer: Devoted Health Medicare	$86.35
Rate for Payer: Hawaii Medical Service Association ABD	$18.99
Rate for Payer: Hawaii Medical Service Association Commercial	$17.18
Rate for Payer: Hawaii Medical Service Association Medicare	$78.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.94
Rate for Payer: Hawaii Western Management Group Commercial	$13.74
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: Humana Medicare	$78.50
Rate for Payer: Kaiser Permanente Commercial	$141.30
Rate for Payer: Kaiser Permanente Medicaid	$80.07
Rate for Payer: Kaiser Permanente Medicare	$78.50
Rate for Payer: MDX Hawaii PPO	$152.29
Rate for Payer: Ohana Health Plan Medicaid	$78.50
Rate for Payer: Ohana Health Plan Medicare	$78.50
Rate for Payer: UnitedHealthcare Medicaid	$18.99
Rate for Payer: UnitedHealthcare Medicare	$78.50
Rate for Payer: University Health Alliance Commercial	$35.52

ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC

Facility

$61,368.87

Service Code	MSDRG 614
Min. Negotiated Rate	$61,368.87
Max. Negotiated Rate	$61,368.87
Rate for Payer: Hawaii Medical Service Association Commercial	$61,368.87

ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC

Facility

$61,368.87

Service Code	MSDRG 615
Min. Negotiated Rate	$61,368.87
Max. Negotiated Rate	$61,368.87
Rate for Payer: Hawaii Medical Service Association Commercial	$61,368.87

Adrenocorticotropic Hormone ACTH FSI

Facility

$217.00

Service Code	HCPCS 82024
Hospital Charge Code	8117764
Hospital Revenue Code	301
Min. Negotiated Rate	$184.45
Max. Negotiated Rate	$210.49
Rate for Payer: Cash Price	$141.05
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: Kaiser Permanente Commercial	$195.30
Rate for Payer: MDX Hawaii PPO	$210.49

Adrenocorticotropic Hormone ACTH FSI

Facility

$217.00

Service Code	HCPCS 82024
Hospital Charge Code	8117764
Hospital Revenue Code	301
Min. Negotiated Rate	$38.62
Max. Negotiated Rate	$210.49
Rate for Payer: AlohaCare Medicaid	$108.50
Rate for Payer: AlohaCare Medicare	$108.50
Rate for Payer: Cash Price	$141.05
Rate for Payer: Cash Price	$141.05
Rate for Payer: Devoted Health Medicare	$119.35
Rate for Payer: Hawaii Medical Service Association ABD	$53.38
Rate for Payer: Hawaii Medical Service Association Commercial	$48.27
Rate for Payer: Hawaii Medical Service Association Medicare	$108.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$56.05
Rate for Payer: Hawaii Western Management Group Commercial	$38.62
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: Humana Medicare	$108.50
Rate for Payer: Kaiser Permanente Commercial	$195.30
Rate for Payer: Kaiser Permanente Medicaid	$110.67
Rate for Payer: Kaiser Permanente Medicare	$108.50
Rate for Payer: MDX Hawaii PPO	$210.49
Rate for Payer: Ohana Health Plan Medicaid	$108.50
Rate for Payer: Ohana Health Plan Medicare	$108.50
Rate for Payer: UnitedHealthcare Medicaid	$53.38
Rate for Payer: UnitedHealthcare Medicare	$108.50
Rate for Payer: University Health Alliance Commercial	$99.84

AEROSOL INHALATION TREATMENT CHARGE

Facility

$610.00

Service Code	HCPCS 94642
Hospital Charge Code	8243038
Hospital Revenue Code	412
Min. Negotiated Rate	$518.50
Max. Negotiated Rate	$591.70
Rate for Payer: Cash Price	$396.50
Rate for Payer: Health Management Network Commercial	$518.50
Rate for Payer: Kaiser Permanente Commercial	$549.00
Rate for Payer: MDX Hawaii PPO	$591.70

AEROSOL INHALATION TREATMENT CHARGE

Facility

$610.00

Service Code	HCPCS 94642
Hospital Charge Code	8243038
Hospital Revenue Code	412
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$591.70
Rate for Payer: AlohaCare Medicaid	$305.00
Rate for Payer: AlohaCare Medicare	$305.00
Rate for Payer: Cash Price	$396.50
Rate for Payer: Cash Price	$396.50
Rate for Payer: Devoted Health Medicare	$335.50
Rate for Payer: Hawaii Medical Service Association Commercial	$279.65
Rate for Payer: Hawaii Medical Service Association Medicare	$305.00
Rate for Payer: Hawaii Western Management Group Commercial	$579.50
Rate for Payer: Health Management Network Commercial	$518.50
Rate for Payer: Humana Medicare	$305.00
Rate for Payer: Kaiser Permanente Commercial	$549.00
Rate for Payer: Kaiser Permanente Medicaid	$311.10
Rate for Payer: Kaiser Permanente Medicare	$305.00
Rate for Payer: MDX Hawaii PPO	$591.70
Rate for Payer: Ohana Health Plan Medicaid	$305.00
Rate for Payer: Ohana Health Plan Medicare	$305.00
Rate for Payer: UnitedHealthcare Medicaid	$5.50
Rate for Payer: UnitedHealthcare Medicare	$305.00
Rate for Payer: University Health Alliance Commercial	$444.63

AFB Each Isolate

Facility

$111.00

Service Code	HCPCS 87118
Hospital Charge Code	8879045
Hospital Revenue Code	306
Min. Negotiated Rate	$14.61
Max. Negotiated Rate	$107.67
Rate for Payer: AlohaCare Medicaid	$55.50
Rate for Payer: AlohaCare Medicare	$55.50
Rate for Payer: Cash Price	$72.15
Rate for Payer: Cash Price	$72.15
Rate for Payer: Devoted Health Medicare	$61.05
Rate for Payer: Hawaii Medical Service Association ABD	$15.13
Rate for Payer: Hawaii Medical Service Association Commercial	$18.26
Rate for Payer: Hawaii Medical Service Association Medicare	$55.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15.89
Rate for Payer: Hawaii Western Management Group Commercial	$14.61
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Humana Medicare	$55.50
Rate for Payer: Kaiser Permanente Commercial	$99.90
Rate for Payer: Kaiser Permanente Medicaid	$56.61
Rate for Payer: Kaiser Permanente Medicare	$55.50
Rate for Payer: MDX Hawaii PPO	$107.67
Rate for Payer: Ohana Health Plan Medicaid	$55.50
Rate for Payer: Ohana Health Plan Medicare	$55.50
Rate for Payer: UnitedHealthcare Medicaid	$15.13
Rate for Payer: UnitedHealthcare Medicare	$55.50
Rate for Payer: University Health Alliance Commercial	$28.29

AFB Each Isolate

Facility

$111.00

Service Code	HCPCS 87118
Hospital Charge Code	8879045
Hospital Revenue Code	306
Min. Negotiated Rate	$94.35
Max. Negotiated Rate	$107.67
Rate for Payer: Cash Price	$72.15
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Kaiser Permanente Commercial	$99.90
Rate for Payer: MDX Hawaii PPO	$107.67

AFB (MTB) PCR FSI

Facility

$466.00

Service Code	HCPCS 87556
Hospital Charge Code	8669304
Hospital Revenue Code	300
Min. Negotiated Rate	$396.10
Max. Negotiated Rate	$452.02
Rate for Payer: Cash Price	$302.90
Rate for Payer: Health Management Network Commercial	$396.10
Rate for Payer: Kaiser Permanente Commercial	$419.40
Rate for Payer: MDX Hawaii PPO	$452.02

AFB (MTB) PCR FSI

Facility

$466.00

Service Code	HCPCS 87556
Hospital Charge Code	8669304
Hospital Revenue Code	300
Min. Negotiated Rate	$41.68
Max. Negotiated Rate	$452.02
Rate for Payer: AlohaCare Medicaid	$233.00
Rate for Payer: AlohaCare Medicare	$233.00
Rate for Payer: Cash Price	$302.90
Rate for Payer: Cash Price	$302.90
Rate for Payer: Devoted Health Medicare	$256.30
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$52.10
Rate for Payer: Hawaii Medical Service Association Medicare	$233.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$41.68
Rate for Payer: Health Management Network Commercial	$396.10
Rate for Payer: Humana Medicare	$233.00
Rate for Payer: Kaiser Permanente Commercial	$419.40
Rate for Payer: Kaiser Permanente Medicaid	$237.66
Rate for Payer: Kaiser Permanente Medicare	$233.00
Rate for Payer: MDX Hawaii PPO	$452.02
Rate for Payer: Ohana Health Plan Medicaid	$233.00
Rate for Payer: Ohana Health Plan Medicare	$233.00
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$233.00
Rate for Payer: University Health Alliance Commercial	$90.72

AFB Smear FSI

Facility

$365.00

Service Code	HCPCS 87150
Hospital Charge Code	8228832
Hospital Revenue Code	306
Min. Negotiated Rate	$310.25
Max. Negotiated Rate	$354.05
Rate for Payer: Cash Price	$237.25
Rate for Payer: Health Management Network Commercial	$310.25
Rate for Payer: Kaiser Permanente Commercial	$328.50
Rate for Payer: MDX Hawaii PPO	$354.05

AFB Smear FSI

Facility

$365.00

Service Code	HCPCS 87150
Hospital Charge Code	8228832
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$354.05
Rate for Payer: AlohaCare Medicaid	$182.50
Rate for Payer: AlohaCare Medicare	$182.50
Rate for Payer: Cash Price	$237.25
Rate for Payer: Cash Price	$237.25
Rate for Payer: Devoted Health Medicare	$200.75
Rate for Payer: Hawaii Medical Service Association ABD	$50.27
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$182.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$310.25
Rate for Payer: Humana Medicare	$182.50
Rate for Payer: Kaiser Permanente Commercial	$328.50
Rate for Payer: Kaiser Permanente Medicaid	$186.15
Rate for Payer: Kaiser Permanente Medicare	$182.50
Rate for Payer: MDX Hawaii PPO	$354.05
Rate for Payer: Ohana Health Plan Medicaid	$182.50
Rate for Payer: Ohana Health Plan Medicare	$182.50
Rate for Payer: UnitedHealthcare Medicaid	$50.27
Rate for Payer: UnitedHealthcare Medicare	$182.50
Rate for Payer: University Health Alliance Commercial	$91.37

AFP4, Quad Screen FSI

Facility

$403.00

Service Code	HCPCS 82105
Hospital Charge Code	8117767
Hospital Revenue Code	300
Min. Negotiated Rate	$16.77
Max. Negotiated Rate	$390.91
Rate for Payer: AlohaCare Medicaid	$201.50
Rate for Payer: AlohaCare Medicare	$201.50
Rate for Payer: Cash Price	$261.95
Rate for Payer: Cash Price	$261.95
Rate for Payer: Devoted Health Medicare	$221.65
Rate for Payer: Hawaii Medical Service Association ABD	$23.18
Rate for Payer: Hawaii Medical Service Association Commercial	$20.96
Rate for Payer: Hawaii Medical Service Association Medicare	$201.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.34
Rate for Payer: Hawaii Western Management Group Commercial	$16.77
Rate for Payer: Health Management Network Commercial	$342.55
Rate for Payer: Humana Medicare	$201.50
Rate for Payer: Kaiser Permanente Commercial	$362.70
Rate for Payer: Kaiser Permanente Medicaid	$205.53
Rate for Payer: Kaiser Permanente Medicare	$201.50
Rate for Payer: MDX Hawaii PPO	$390.91
Rate for Payer: Ohana Health Plan Medicaid	$201.50
Rate for Payer: Ohana Health Plan Medicare	$201.50
Rate for Payer: UnitedHealthcare Medicaid	$23.18
Rate for Payer: UnitedHealthcare Medicare	$201.50
Rate for Payer: University Health Alliance Commercial	$43.36

AFP4, Quad Screen FSI

Facility

$403.00

Service Code	HCPCS 82105
Hospital Charge Code	8117767
Hospital Revenue Code	300
Min. Negotiated Rate	$342.55
Max. Negotiated Rate	$390.91
Rate for Payer: Cash Price	$261.95
Rate for Payer: Health Management Network Commercial	$342.55
Rate for Payer: Kaiser Permanente Commercial	$362.70
Rate for Payer: MDX Hawaii PPO	$390.91

AFP (Alpha Fetoprotein) Maternal Serum FSI

Facility

$192.00

Service Code	HCPCS 82105
Hospital Charge Code	8117765
Hospital Revenue Code	301
Min. Negotiated Rate	$16.77
Max. Negotiated Rate	$186.24
Rate for Payer: AlohaCare Medicaid	$96.00
Rate for Payer: AlohaCare Medicare	$96.00
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cash Price	$124.80
Rate for Payer: Devoted Health Medicare	$105.60
Rate for Payer: Hawaii Medical Service Association ABD	$23.18
Rate for Payer: Hawaii Medical Service Association Commercial	$20.96
Rate for Payer: Hawaii Medical Service Association Medicare	$96.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.34
Rate for Payer: Hawaii Western Management Group Commercial	$16.77
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Humana Medicare	$96.00
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: Kaiser Permanente Medicaid	$97.92
Rate for Payer: Kaiser Permanente Medicare	$96.00
Rate for Payer: MDX Hawaii PPO	$186.24
Rate for Payer: Ohana Health Plan Medicaid	$96.00
Rate for Payer: Ohana Health Plan Medicare	$96.00
Rate for Payer: UnitedHealthcare Medicaid	$23.18
Rate for Payer: UnitedHealthcare Medicare	$96.00
Rate for Payer: University Health Alliance Commercial	$43.36

AFP (Alpha Fetoprotein) Maternal Serum FSI

Facility

$192.00

Service Code	HCPCS 82105
Hospital Charge Code	8117765
Hospital Revenue Code	301
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$186.24
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: MDX Hawaii PPO	$186.24

AFP, Alphafetoprotein NTD Only FSI

Facility

$192.00

Service Code	HCPCS 82105
Hospital Charge Code	12426505
Hospital Revenue Code	301
Min. Negotiated Rate	$16.77
Max. Negotiated Rate	$186.24
Rate for Payer: AlohaCare Medicaid	$96.00
Rate for Payer: AlohaCare Medicare	$96.00
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cash Price	$124.80
Rate for Payer: Devoted Health Medicare	$105.60
Rate for Payer: Hawaii Medical Service Association ABD	$23.18
Rate for Payer: Hawaii Medical Service Association Commercial	$20.96
Rate for Payer: Hawaii Medical Service Association Medicare	$96.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.34
Rate for Payer: Hawaii Western Management Group Commercial	$16.77
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Humana Medicare	$96.00
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: Kaiser Permanente Medicaid	$97.92
Rate for Payer: Kaiser Permanente Medicare	$96.00
Rate for Payer: MDX Hawaii PPO	$186.24
Rate for Payer: Ohana Health Plan Medicaid	$96.00
Rate for Payer: Ohana Health Plan Medicare	$96.00
Rate for Payer: UnitedHealthcare Medicaid	$23.18
Rate for Payer: UnitedHealthcare Medicare	$96.00
Rate for Payer: University Health Alliance Commercial	$43.36

AFP, Alphafetoprotein NTD Only FSI

Facility

$192.00

Service Code	HCPCS 82105
Hospital Charge Code	12426505
Hospital Revenue Code	301
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$186.24
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: MDX Hawaii PPO	$186.24

AFP Alphafetoprotein Tumor Marker FSI

Facility

$192.00

Service Code	HCPCS 82105
Hospital Charge Code	8117766
Hospital Revenue Code	301
Min. Negotiated Rate	$16.77
Max. Negotiated Rate	$186.24
Rate for Payer: AlohaCare Medicaid	$96.00
Rate for Payer: AlohaCare Medicare	$96.00
Rate for Payer: Cash Price	$124.80
Rate for Payer: Cash Price	$124.80
Rate for Payer: Devoted Health Medicare	$105.60
Rate for Payer: Hawaii Medical Service Association ABD	$23.18
Rate for Payer: Hawaii Medical Service Association Commercial	$20.96
Rate for Payer: Hawaii Medical Service Association Medicare	$96.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24.34
Rate for Payer: Hawaii Western Management Group Commercial	$16.77
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Humana Medicare	$96.00
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: Kaiser Permanente Medicaid	$97.92
Rate for Payer: Kaiser Permanente Medicare	$96.00
Rate for Payer: MDX Hawaii PPO	$186.24
Rate for Payer: Ohana Health Plan Medicaid	$96.00
Rate for Payer: Ohana Health Plan Medicare	$96.00
Rate for Payer: UnitedHealthcare Medicaid	$23.18
Rate for Payer: UnitedHealthcare Medicare	$96.00
Rate for Payer: University Health Alliance Commercial	$43.36

AFP Alphafetoprotein Tumor Marker FSI

Facility

$192.00

Service Code	HCPCS 82105
Hospital Charge Code	8117766
Hospital Revenue Code	301
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$186.24
Rate for Payer: Cash Price	$124.80
Rate for Payer: Health Management Network Commercial	$163.20
Rate for Payer: Kaiser Permanente Commercial	$172.80
Rate for Payer: MDX Hawaii PPO	$186.24

Know your out-of-pocket cost for care.

All Charges