Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

calcium acetate 667 mg capsule [HHSC]

Facility

$8.06

Service Code	NDC 68084047901
Hospital Charge Code	2500134
Hospital Revenue Code	250
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$7.82
Rate for Payer: AlohaCare Medicaid	$4.03
Rate for Payer: AlohaCare Medicare	$4.03
Rate for Payer: Cash Price	$5.24
Rate for Payer: Devoted Health Medicare	$4.43
Rate for Payer: Hawaii Medical Service Association Medicare	$4.03
Rate for Payer: Hawaii Western Management Group Commercial	$7.66
Rate for Payer: Health Management Network Commercial	$6.85
Rate for Payer: Humana Medicare	$4.03
Rate for Payer: Kaiser Permanente Commercial	$7.25
Rate for Payer: Kaiser Permanente Medicaid	$4.11
Rate for Payer: Kaiser Permanente Medicare	$4.03
Rate for Payer: MDX Hawaii PPO	$7.82
Rate for Payer: Ohana Health Plan Medicaid	$4.03
Rate for Payer: Ohana Health Plan Medicare	$4.03
Rate for Payer: UnitedHealthcare Medicaid	$4.84
Rate for Payer: UnitedHealthcare Medicare	$4.03
Rate for Payer: University Health Alliance Commercial	$5.87

calcium acetate 667 mg capsule [HHSC]

Facility

$4.00

Service Code	NDC 69097086283
Hospital Charge Code	2500134
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.88
Rate for Payer: AlohaCare Medicaid	$2.00
Rate for Payer: AlohaCare Medicare	$2.00
Rate for Payer: Cash Price	$2.60
Rate for Payer: Devoted Health Medicare	$2.20
Rate for Payer: Hawaii Medical Service Association Medicare	$2.00
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Humana Medicare	$2.00
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: Kaiser Permanente Medicare	$2.00
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: Ohana Health Plan Medicaid	$2.00
Rate for Payer: Ohana Health Plan Medicare	$2.00
Rate for Payer: UnitedHealthcare Medicaid	$2.40
Rate for Payer: UnitedHealthcare Medicare	$2.00
Rate for Payer: University Health Alliance Commercial	$2.92

calcium acetate 667 mg capsule [HHSC]

Facility

$5.71

Service Code	NDC 65162059020
Hospital Charge Code	2500134
Hospital Revenue Code	250
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$5.54
Rate for Payer: Cash Price	$3.71
Rate for Payer: Health Management Network Commercial	$4.85
Rate for Payer: Kaiser Permanente Commercial	$5.14
Rate for Payer: MDX Hawaii PPO	$5.54

calcium acetate 667 mg capsule [HHSC]

Facility

$5.71

Service Code	NDC 65162059020
Hospital Charge Code	2500134
Hospital Revenue Code	250
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$5.54
Rate for Payer: AlohaCare Medicaid	$2.85
Rate for Payer: AlohaCare Medicare	$2.85
Rate for Payer: Cash Price	$3.71
Rate for Payer: Devoted Health Medicare	$3.14
Rate for Payer: Hawaii Medical Service Association Medicare	$2.85
Rate for Payer: Hawaii Western Management Group Commercial	$5.42
Rate for Payer: Health Management Network Commercial	$4.85
Rate for Payer: Humana Medicare	$2.85
Rate for Payer: Kaiser Permanente Commercial	$5.14
Rate for Payer: Kaiser Permanente Medicaid	$2.91
Rate for Payer: Kaiser Permanente Medicare	$2.85
Rate for Payer: MDX Hawaii PPO	$5.54
Rate for Payer: Ohana Health Plan Medicaid	$2.85
Rate for Payer: Ohana Health Plan Medicare	$2.85
Rate for Payer: UnitedHealthcare Medicaid	$3.43
Rate for Payer: UnitedHealthcare Medicare	$2.85
Rate for Payer: University Health Alliance Commercial	$4.16

calcium carbonate 500 mg chew tab [HHSC]

Facility

$3.00

Service Code	NDC 00904641292
Hospital Charge Code	2501139
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

calcium carbonate 500 mg chew tab [HHSC]

Facility

$3.00

Service Code	NDC 00904641292
Hospital Charge Code	2501139
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

calcium chloride 1gm/10ml syringe [HHSC]

Facility

$70.82

Service Code	HCPCS J0618
Hospital Charge Code	2500136
Hospital Revenue Code	636
Min. Negotiated Rate	$35.41
Max. Negotiated Rate	$68.70
Rate for Payer: AlohaCare Medicaid	$35.41
Rate for Payer: AlohaCare Medicaid	$29.77
Rate for Payer: AlohaCare Medicare	$29.77
Rate for Payer: AlohaCare Medicare	$35.41
Rate for Payer: Cash Price	$38.69
Rate for Payer: Cash Price	$46.03
Rate for Payer: Devoted Health Medicare	$38.95
Rate for Payer: Devoted Health Medicare	$32.74
Rate for Payer: Hawaii Medical Service Association Medicare	$29.77
Rate for Payer: Hawaii Medical Service Association Medicare	$35.41
Rate for Payer: Hawaii Western Management Group Commercial	$56.55
Rate for Payer: Hawaii Western Management Group Commercial	$67.28
Rate for Payer: Health Management Network Commercial	$60.20
Rate for Payer: Health Management Network Commercial	$50.60
Rate for Payer: Humana Medicare	$29.77
Rate for Payer: Humana Medicare	$35.41
Rate for Payer: Kaiser Permanente Commercial	$53.58
Rate for Payer: Kaiser Permanente Commercial	$63.74
Rate for Payer: Kaiser Permanente Medicaid	$30.36
Rate for Payer: Kaiser Permanente Medicaid	$36.12
Rate for Payer: Kaiser Permanente Medicare	$35.41
Rate for Payer: Kaiser Permanente Medicare	$29.77
Rate for Payer: MDX Hawaii PPO	$57.74
Rate for Payer: MDX Hawaii PPO	$68.70
Rate for Payer: Ohana Health Plan Medicaid	$29.77
Rate for Payer: Ohana Health Plan Medicaid	$35.41
Rate for Payer: Ohana Health Plan Medicare	$35.41
Rate for Payer: Ohana Health Plan Medicare	$29.77
Rate for Payer: UnitedHealthcare Medicaid	$42.49
Rate for Payer: UnitedHealthcare Medicaid	$35.72
Rate for Payer: UnitedHealthcare Medicare	$29.77
Rate for Payer: UnitedHealthcare Medicare	$35.41
Rate for Payer: University Health Alliance Commercial	$51.62
Rate for Payer: University Health Alliance Commercial	$43.39

calcium chloride 1gm/10ml syringe [HHSC]

Facility

$59.53

Service Code	HCPCS J0618
Hospital Charge Code	2500136
Hospital Revenue Code	250
Min. Negotiated Rate	$50.60
Max. Negotiated Rate	$57.74
Rate for Payer: Cash Price	$38.69
Rate for Payer: Cash Price	$46.03
Rate for Payer: Health Management Network Commercial	$50.60
Rate for Payer: Health Management Network Commercial	$60.20
Rate for Payer: Kaiser Permanente Commercial	$53.58
Rate for Payer: Kaiser Permanente Commercial	$63.74
Rate for Payer: MDX Hawaii PPO	$68.70
Rate for Payer: MDX Hawaii PPO	$57.74

Calcium FSI

Facility

$77.00

Service Code	HCPCS 82310
Hospital Charge Code	8117870
Hospital Revenue Code	301
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$74.69
Rate for Payer: AlohaCare Medicaid	$38.50
Rate for Payer: AlohaCare Medicare	$38.50
Rate for Payer: Cash Price	$50.05
Rate for Payer: Cash Price	$50.05
Rate for Payer: Devoted Health Medicare	$42.35
Rate for Payer: Hawaii Medical Service Association ABD	$7.12
Rate for Payer: Hawaii Medical Service Association Commercial	$6.45
Rate for Payer: Hawaii Medical Service Association Medicare	$38.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7.48
Rate for Payer: Hawaii Western Management Group Commercial	$5.16
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Humana Medicare	$38.50
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: Kaiser Permanente Medicaid	$39.27
Rate for Payer: Kaiser Permanente Medicare	$38.50
Rate for Payer: MDX Hawaii PPO	$74.69
Rate for Payer: Ohana Health Plan Medicaid	$38.50
Rate for Payer: Ohana Health Plan Medicare	$38.50
Rate for Payer: UnitedHealthcare Medicaid	$7.12
Rate for Payer: UnitedHealthcare Medicare	$38.50
Rate for Payer: University Health Alliance Commercial	$13.32

Calcium FSI

Facility

$77.00

Service Code	HCPCS 82310
Hospital Charge Code	8117870
Hospital Revenue Code	301
Min. Negotiated Rate	$65.45
Max. Negotiated Rate	$74.69
Rate for Payer: Cash Price	$50.05
Rate for Payer: Health Management Network Commercial	$65.45
Rate for Payer: Kaiser Permanente Commercial	$69.30
Rate for Payer: MDX Hawaii PPO	$74.69

calcium gluconate 1gm/10ml vial [HHSC]

Facility

$63.15

Service Code	HCPCS J0612
Hospital Charge Code	2500137
Hospital Revenue Code	636
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$61.26
Rate for Payer: AlohaCare Medicaid	$31.57
Rate for Payer: AlohaCare Medicare	$31.57
Rate for Payer: Cash Price	$41.05
Rate for Payer: Cash Price	$41.05
Rate for Payer: Devoted Health Medicare	$34.73
Rate for Payer: Hawaii Medical Service Association ABD	$0.04
Rate for Payer: Hawaii Medical Service Association Medicare	$31.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.04
Rate for Payer: Hawaii Western Management Group Commercial	$59.99
Rate for Payer: Health Management Network Commercial	$53.68
Rate for Payer: Humana Medicare	$31.57
Rate for Payer: Kaiser Permanente Commercial	$56.84
Rate for Payer: Kaiser Permanente Medicaid	$32.21
Rate for Payer: Kaiser Permanente Medicare	$31.57
Rate for Payer: MDX Hawaii PPO	$61.26
Rate for Payer: Ohana Health Plan Medicaid	$31.57
Rate for Payer: Ohana Health Plan Medicare	$31.57
Rate for Payer: UnitedHealthcare Medicaid	$37.89
Rate for Payer: UnitedHealthcare Medicare	$31.57
Rate for Payer: University Health Alliance Commercial	$46.03

calcium gluconate 1gm/10ml vial [HHSC]

Facility

$63.15

Service Code	HCPCS J0612
Hospital Charge Code	2500137
Hospital Revenue Code	250
Min. Negotiated Rate	$53.68
Max. Negotiated Rate	$61.26
Rate for Payer: Cash Price	$41.05
Rate for Payer: Health Management Network Commercial	$53.68
Rate for Payer: Kaiser Permanente Commercial	$56.84
Rate for Payer: MDX Hawaii PPO	$61.26

calcium gluconate 2 g/100 mL premix [HHSC]

Facility

$216.28

Service Code	HCPCS J0613
Hospital Charge Code	2501132
Hospital Revenue Code	250
Min. Negotiated Rate	$183.84
Max. Negotiated Rate	$209.79
Rate for Payer: Cash Price	$140.58
Rate for Payer: Health Management Network Commercial	$183.84
Rate for Payer: Kaiser Permanente Commercial	$194.65
Rate for Payer: MDX Hawaii PPO	$209.79

calcium gluconate 2 g/100 mL premix [HHSC]

Facility

$216.28

Service Code	HCPCS J0613
Hospital Charge Code	2501132
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$209.79
Rate for Payer: AlohaCare Medicaid	$108.14
Rate for Payer: AlohaCare Medicare	$108.14
Rate for Payer: Cash Price	$140.58
Rate for Payer: Cash Price	$140.58
Rate for Payer: Devoted Health Medicare	$118.95
Rate for Payer: Hawaii Medical Service Association ABD	$0.08
Rate for Payer: Hawaii Medical Service Association Medicare	$108.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.08
Rate for Payer: Hawaii Western Management Group Commercial	$205.47
Rate for Payer: Health Management Network Commercial	$183.84
Rate for Payer: Humana Medicare	$108.14
Rate for Payer: Kaiser Permanente Commercial	$194.65
Rate for Payer: Kaiser Permanente Medicaid	$110.30
Rate for Payer: Kaiser Permanente Medicare	$108.14
Rate for Payer: MDX Hawaii PPO	$209.79
Rate for Payer: Ohana Health Plan Medicaid	$108.14
Rate for Payer: Ohana Health Plan Medicare	$108.14
Rate for Payer: UnitedHealthcare Medicaid	$129.77
Rate for Payer: UnitedHealthcare Medicare	$108.14
Rate for Payer: University Health Alliance Commercial	$157.65

Calcium, Ionized FSI

Facility

$95.00

Service Code	HCPCS 82330
Hospital Charge Code	10352343
Hospital Revenue Code	301
Min. Negotiated Rate	$80.75
Max. Negotiated Rate	$92.15
Rate for Payer: Cash Price	$61.75
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Kaiser Permanente Commercial	$85.50
Rate for Payer: MDX Hawaii PPO	$92.15

Calcium, Ionized FSI

Facility

$95.00

Service Code	HCPCS 82330
Hospital Charge Code	10352343
Hospital Revenue Code	301
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$92.15
Rate for Payer: AlohaCare Medicaid	$47.50
Rate for Payer: AlohaCare Medicare	$47.50
Rate for Payer: Cash Price	$61.75
Rate for Payer: Cash Price	$61.75
Rate for Payer: Devoted Health Medicare	$52.25
Rate for Payer: Hawaii Medical Service Association ABD	$18.88
Rate for Payer: Hawaii Medical Service Association Commercial	$17.10
Rate for Payer: Hawaii Medical Service Association Medicare	$47.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.82
Rate for Payer: Hawaii Western Management Group Commercial	$13.68
Rate for Payer: Health Management Network Commercial	$80.75
Rate for Payer: Humana Medicare	$47.50
Rate for Payer: Kaiser Permanente Commercial	$85.50
Rate for Payer: Kaiser Permanente Medicaid	$48.45
Rate for Payer: Kaiser Permanente Medicare	$47.50
Rate for Payer: MDX Hawaii PPO	$92.15
Rate for Payer: Ohana Health Plan Medicaid	$47.50
Rate for Payer: Ohana Health Plan Medicare	$47.50
Rate for Payer: UnitedHealthcare Medicaid	$18.88
Rate for Payer: UnitedHealthcare Medicare	$47.50
Rate for Payer: University Health Alliance Commercial	$35.32

Calcium iSTAT

Facility

$153.00

Service Code	HCPCS 82330 QW
Hospital Charge Code	8293264
Hospital Revenue Code	301
Min. Negotiated Rate	$13.68
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 ABD	$18.88
Rate for Payer: Hawaii Medical Service Association Commercial	$17.10
Rate for Payer: Hawaii Medical Service Association Medicare	$76.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.82
Rate for Payer: Hawaii Western Management Group Commercial	$13.68
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	$18.88
Rate for Payer: UnitedHealthcare Medicare	$76.50
Rate for Payer: University Health Alliance Commercial	$35.32

Calcium iSTAT

Facility

$153.00

Service Code	HCPCS 82330 QW
Hospital Charge Code	8293264
Hospital Revenue Code	301
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

Calcium, Urine Timed FSI

Facility

$140.00

Service Code	HCPCS 86304
Hospital Charge Code	8228846
Hospital Revenue Code	301
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$135.80
Rate for Payer: AlohaCare Medicaid	$70.00
Rate for Payer: AlohaCare Medicare	$70.00
Rate for Payer: Cash Price	$91.00
Rate for Payer: Cash Price	$91.00
Rate for Payer: Devoted Health Medicare	$77.00
Rate for Payer: Hawaii Medical Service Association ABD	$28.76
Rate for Payer: Hawaii Medical Service Association Commercial	$26.01
Rate for Payer: Hawaii Medical Service Association Medicare	$70.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.20
Rate for Payer: Hawaii Western Management Group Commercial	$20.81
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Humana Medicare	$70.00
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: Kaiser Permanente Medicaid	$71.40
Rate for Payer: Kaiser Permanente Medicare	$70.00
Rate for Payer: MDX Hawaii PPO	$135.80
Rate for Payer: Ohana Health Plan Medicaid	$70.00
Rate for Payer: Ohana Health Plan Medicare	$70.00
Rate for Payer: UnitedHealthcare Medicaid	$28.76
Rate for Payer: UnitedHealthcare Medicare	$70.00
Rate for Payer: University Health Alliance Commercial	$53.78

Calcium, Urine Timed FSI

Facility

$140.00

Service Code	HCPCS 86304
Hospital Charge Code	8228846
Hospital Revenue Code	301
Min. Negotiated Rate	$119.00
Max. Negotiated Rate	$135.80
Rate for Payer: Cash Price	$91.00
Rate for Payer: Health Management Network Commercial	$119.00
Rate for Payer: Kaiser Permanente Commercial	$126.00
Rate for Payer: MDX Hawaii PPO	$135.80

calcium-vit D 600mg-400 unit tablet [HHSC]

Facility

$3.00

Service Code	NDC 00904323352
Hospital Charge Code	2500138
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

calcium-vit D 600mg-400 unit tablet [HHSC]

Facility

$3.00

Service Code	NDC 20555001700
Hospital Charge Code	2500138
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: Ohana Health Plan Medicare	$1.50
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: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

calcium-vit D 600mg-400 unit tablet [HHSC]

Facility

$3.72

Service Code	NDC 50268015015
Hospital Charge Code	2500138
Hospital Revenue Code	250
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$3.61
Rate for Payer: Cash Price	$2.42
Rate for Payer: Health Management Network Commercial	$3.16
Rate for Payer: Kaiser Permanente Commercial	$3.35
Rate for Payer: MDX Hawaii PPO	$3.61

calcium-vit D 600mg-400 unit tablet [HHSC]

Facility

$3.72

Service Code	NDC 50268015015
Hospital Charge Code	2500138
Hospital Revenue Code	250
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$3.61
Rate for Payer: AlohaCare Medicaid	$1.86
Rate for Payer: AlohaCare Medicare	$1.86
Rate for Payer: Cash Price	$2.42
Rate for Payer: Devoted Health Medicare	$2.05
Rate for Payer: Hawaii Medical Service Association Medicare	$1.86
Rate for Payer: Hawaii Western Management Group Commercial	$3.53
Rate for Payer: Health Management Network Commercial	$3.16
Rate for Payer: Humana Medicare	$1.86
Rate for Payer: Kaiser Permanente Commercial	$3.35
Rate for Payer: Kaiser Permanente Medicaid	$1.90
Rate for Payer: Kaiser Permanente Medicare	$1.86
Rate for Payer: MDX Hawaii PPO	$3.61
Rate for Payer: Ohana Health Plan Medicaid	$1.86
Rate for Payer: Ohana Health Plan Medicare	$1.86
Rate for Payer: UnitedHealthcare Medicaid	$2.23
Rate for Payer: UnitedHealthcare Medicare	$1.86
Rate for Payer: University Health Alliance Commercial	$2.71

calcium-vit D 600mg-400 unit tablet [HHSC]

Facility

$3.00

Service Code	NDC 80681013900
Hospital Charge Code	2500138
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

Know your out-of-pocket cost for care.

All Charges