Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

carboprost 250 mcg/1ml ampule [HHSC]

Facility

$1,042.03

Service Code	NDC 71839013710
Hospital Charge Code	2500146
Hospital Revenue Code	250
Min. Negotiated Rate	$521.01
Max. Negotiated Rate	$1,010.77
Rate for Payer: AlohaCare Medicaid	$521.01
Rate for Payer: AlohaCare Medicare	$521.01
Rate for Payer: Cash Price	$677.32
Rate for Payer: Devoted Health Medicare	$573.12
Rate for Payer: Hawaii Medical Service Association Medicare	$521.01
Rate for Payer: Hawaii Western Management Group Commercial	$989.93
Rate for Payer: Health Management Network Commercial	$885.73
Rate for Payer: Humana Medicare	$521.01
Rate for Payer: Kaiser Permanente Commercial	$937.83
Rate for Payer: Kaiser Permanente Medicaid	$531.44
Rate for Payer: Kaiser Permanente Medicare	$521.01
Rate for Payer: MDX Hawaii PPO	$1,010.77
Rate for Payer: Ohana Health Plan Medicaid	$521.01
Rate for Payer: Ohana Health Plan Medicare	$521.01
Rate for Payer: UnitedHealthcare Medicaid	$625.22
Rate for Payer: UnitedHealthcare Medicare	$521.01
Rate for Payer: University Health Alliance Commercial	$759.54

carboprost 250 mcg/1ml ampule [HHSC]

Facility

$613.18

Service Code	NDC 81298501005
Hospital Charge Code	2500146
Hospital Revenue Code	250
Min. Negotiated Rate	$521.20
Max. Negotiated Rate	$594.78
Rate for Payer: Cash Price	$398.57
Rate for Payer: Health Management Network Commercial	$521.20
Rate for Payer: Kaiser Permanente Commercial	$551.86
Rate for Payer: MDX Hawaii PPO	$594.78

carboprost 250 mcg/1ml ampule [HHSC]

Facility

$1,042.03

Service Code	NDC 43598069858
Hospital Charge Code	2500146
Hospital Revenue Code	250
Min. Negotiated Rate	$885.73
Max. Negotiated Rate	$1,010.77
Rate for Payer: Cash Price	$677.32
Rate for Payer: Health Management Network Commercial	$885.73
Rate for Payer: Kaiser Permanente Commercial	$937.83
Rate for Payer: MDX Hawaii PPO	$1,010.77

carboprost 250 mcg/1ml ampule [HHSC]

Facility

$1,130.92

Service Code	NDC 00009085608
Hospital Charge Code	2500146
Hospital Revenue Code	250
Min. Negotiated Rate	$565.46
Max. Negotiated Rate	$1,096.99
Rate for Payer: AlohaCare Medicaid	$565.46
Rate for Payer: AlohaCare Medicare	$565.46
Rate for Payer: Cash Price	$735.10
Rate for Payer: Devoted Health Medicare	$622.01
Rate for Payer: Hawaii Medical Service Association Medicare	$565.46
Rate for Payer: Hawaii Western Management Group Commercial	$1,074.37
Rate for Payer: Health Management Network Commercial	$961.28
Rate for Payer: Humana Medicare	$565.46
Rate for Payer: Kaiser Permanente Commercial	$1,017.83
Rate for Payer: Kaiser Permanente Medicaid	$576.77
Rate for Payer: Kaiser Permanente Medicare	$565.46
Rate for Payer: MDX Hawaii PPO	$1,096.99
Rate for Payer: Ohana Health Plan Medicaid	$565.46
Rate for Payer: Ohana Health Plan Medicare	$565.46
Rate for Payer: UnitedHealthcare Medicaid	$678.55
Rate for Payer: UnitedHealthcare Medicare	$565.46
Rate for Payer: University Health Alliance Commercial	$824.33

carboprost 250 mcg/1ml ampule [HHSC]

Facility

$1,130.92

Service Code	NDC 00009085608
Hospital Charge Code	2500146
Hospital Revenue Code	250
Min. Negotiated Rate	$961.28
Max. Negotiated Rate	$1,096.99
Rate for Payer: Cash Price	$735.10
Rate for Payer: Health Management Network Commercial	$961.28
Rate for Payer: Kaiser Permanente Commercial	$1,017.83
Rate for Payer: MDX Hawaii PPO	$1,096.99

carboxymethylcellulos 0.5% ophth 15 mL [HHSC]

Facility

$55.80

Service Code	NDC 00023079815
Hospital Charge Code	2500603
Hospital Revenue Code	250
Min. Negotiated Rate	$47.43
Max. Negotiated Rate	$54.13
Rate for Payer: Cash Price	$36.27
Rate for Payer: Health Management Network Commercial	$47.43
Rate for Payer: Kaiser Permanente Commercial	$50.22
Rate for Payer: MDX Hawaii PPO	$54.13

carboxymethylcellulos 0.5% ophth 15 mL [HHSC]

Facility

$55.80

Service Code	NDC 50268006815
Hospital Charge Code	2500603
Hospital Revenue Code	250
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$54.13
Rate for Payer: AlohaCare Medicaid	$27.90
Rate for Payer: AlohaCare Medicare	$27.90
Rate for Payer: Cash Price	$36.27
Rate for Payer: Devoted Health Medicare	$30.69
Rate for Payer: Hawaii Medical Service Association Medicare	$27.90
Rate for Payer: Hawaii Western Management Group Commercial	$53.01
Rate for Payer: Health Management Network Commercial	$47.43
Rate for Payer: Humana Medicare	$27.90
Rate for Payer: Kaiser Permanente Commercial	$50.22
Rate for Payer: Kaiser Permanente Medicaid	$28.46
Rate for Payer: Kaiser Permanente Medicare	$27.90
Rate for Payer: MDX Hawaii PPO	$54.13
Rate for Payer: Ohana Health Plan Medicaid	$27.90
Rate for Payer: Ohana Health Plan Medicare	$27.90
Rate for Payer: UnitedHealthcare Medicaid	$33.48
Rate for Payer: UnitedHealthcare Medicare	$27.90
Rate for Payer: University Health Alliance Commercial	$40.67

carboxymethylcellulos 0.5% ophth 15 mL [HHSC]

Facility

$55.80

Service Code	NDC 00023079815
Hospital Charge Code	2500603
Hospital Revenue Code	250
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$54.13
Rate for Payer: AlohaCare Medicaid	$27.90
Rate for Payer: AlohaCare Medicare	$27.90
Rate for Payer: Cash Price	$36.27
Rate for Payer: Devoted Health Medicare	$30.69
Rate for Payer: Hawaii Medical Service Association Medicare	$27.90
Rate for Payer: Hawaii Western Management Group Commercial	$53.01
Rate for Payer: Health Management Network Commercial	$47.43
Rate for Payer: Humana Medicare	$27.90
Rate for Payer: Kaiser Permanente Commercial	$50.22
Rate for Payer: Kaiser Permanente Medicaid	$28.46
Rate for Payer: Kaiser Permanente Medicare	$27.90
Rate for Payer: MDX Hawaii PPO	$54.13
Rate for Payer: Ohana Health Plan Medicaid	$27.90
Rate for Payer: Ohana Health Plan Medicare	$27.90
Rate for Payer: UnitedHealthcare Medicaid	$33.48
Rate for Payer: UnitedHealthcare Medicare	$27.90
Rate for Payer: University Health Alliance Commercial	$40.67

carboxymethylcellulos 0.5% ophth 15 mL [HHSC]

Facility

$55.80

Service Code	NDC 50268006815
Hospital Charge Code	2500603
Hospital Revenue Code	250
Min. Negotiated Rate	$47.43
Max. Negotiated Rate	$54.13
Rate for Payer: Cash Price	$36.27
Rate for Payer: Health Management Network Commercial	$47.43
Rate for Payer: Kaiser Permanente Commercial	$50.22
Rate for Payer: MDX Hawaii PPO	$54.13

CARDIAC ARREST, UNEXPLAINED WITH CC

Facility

$48,059.96

Service Code	MSDRG 297
Min. Negotiated Rate	$48,059.96
Max. Negotiated Rate	$48,059.96
Rate for Payer: Hawaii Medical Service Association Commercial	$48,059.96

CARDIAC ARREST, UNEXPLAINED WITH MCC

Facility

$48,059.96

Service Code	MSDRG 296
Min. Negotiated Rate	$48,059.96
Max. Negotiated Rate	$48,059.96
Rate for Payer: Hawaii Medical Service Association Commercial	$48,059.96

CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC

Facility

$48,059.96

Service Code	MSDRG 298
Min. Negotiated Rate	$48,059.96
Max. Negotiated Rate	$48,059.96
Rate for Payer: Hawaii Medical Service Association Commercial	$48,059.96

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC

Facility

$21,314.66

Service Code	MSDRG 309
Min. Negotiated Rate	$21,314.66
Max. Negotiated Rate	$21,314.66
Rate for Payer: Hawaii Medical Service Association Commercial	$21,314.66

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC

Facility

$22,716.94

Service Code	MSDRG 308
Min. Negotiated Rate	$22,716.94
Max. Negotiated Rate	$22,716.94
Rate for Payer: Hawaii Medical Service Association Commercial	$22,716.94

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC

Facility

$16,342.94

Service Code	MSDRG 310
Min. Negotiated Rate	$16,342.94
Max. Negotiated Rate	$16,342.94
Rate for Payer: Hawaii Medical Service Association Commercial	$16,342.94

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC

Facility

$15,017.14

Service Code	MSDRG 306
Min. Negotiated Rate	$15,017.14
Max. Negotiated Rate	$15,017.14
Rate for Payer: Hawaii Medical Service Association Commercial	$15,017.14

CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC

Facility

$13,869.82

Service Code	MSDRG 307
Min. Negotiated Rate	$13,869.82
Max. Negotiated Rate	$13,869.82
Rate for Payer: Hawaii Medical Service Association Commercial	$13,869.82

CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC

Facility

$172,148.99

Service Code	MSDRG 275
Min. Negotiated Rate	$172,148.99
Max. Negotiated Rate	$172,148.99
Rate for Payer: Hawaii Medical Service Association Commercial	$172,148.99

CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR

Facility

$110,805.62

Service Code	MSDRG 276
Min. Negotiated Rate	$110,805.62
Max. Negotiated Rate	$110,805.62
Rate for Payer: Hawaii Medical Service Association Commercial	$110,805.62

CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC

Facility

$110,805.62

Service Code	MSDRG 277
Min. Negotiated Rate	$110,805.62
Max. Negotiated Rate	$110,805.62
Rate for Payer: Hawaii Medical Service Association Commercial	$110,805.62

CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC

Facility

$24,833.10

Service Code	MSDRG 258
Min. Negotiated Rate	$24,833.10
Max. Negotiated Rate	$24,833.10
Rate for Payer: Hawaii Medical Service Association Commercial	$24,833.10

CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC

Facility

$24,833.10

Service Code	MSDRG 259
Min. Negotiated Rate	$24,833.10
Max. Negotiated Rate	$24,833.10
Rate for Payer: Hawaii Medical Service Association Commercial	$24,833.10

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC

Facility

$33,527.24

Service Code	MSDRG 261
Min. Negotiated Rate	$33,527.24
Max. Negotiated Rate	$33,527.24
Rate for Payer: Hawaii Medical Service Association Commercial	$33,527.24

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC

Facility

$33,527.24

Service Code	MSDRG 260
Min. Negotiated Rate	$33,527.24
Max. Negotiated Rate	$33,527.24
Rate for Payer: Hawaii Medical Service Association Commercial	$33,527.24

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC

Facility

$33,527.24

Service Code	MSDRG 262
Min. Negotiated Rate	$33,527.24
Max. Negotiated Rate	$33,527.24
Rate for Payer: Hawaii Medical Service Association Commercial	$33,527.24

Know your out-of-pocket cost for care.

All Charges