Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

carvedilol 12.5 mg tablet [HHSC]

Facility

$11.87

Service Code	NDC 51079093120
Hospital Charge Code	2500147
Hospital Revenue Code	250
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$11.51
Rate for Payer: Cash Price	$7.72
Rate for Payer: Health Management Network Commercial	$10.09
Rate for Payer: Kaiser Permanente Commercial	$10.68
Rate for Payer: MDX Hawaii PPO	$11.51

carvedilol 25 mg tablet [HHSC]

Facility

$11.68

Service Code	NDC 00904630361
Hospital Charge Code	2500148
Hospital Revenue Code	250
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$11.33
Rate for Payer: AlohaCare Medicaid	$5.84
Rate for Payer: AlohaCare Medicare	$5.84
Rate for Payer: Cash Price	$7.59
Rate for Payer: Devoted Health Medicare	$6.42
Rate for Payer: Hawaii Medical Service Association Medicare	$5.84
Rate for Payer: Hawaii Western Management Group Commercial	$11.10
Rate for Payer: Health Management Network Commercial	$9.93
Rate for Payer: Humana Medicare	$5.84
Rate for Payer: Kaiser Permanente Commercial	$10.51
Rate for Payer: Kaiser Permanente Medicaid	$5.96
Rate for Payer: Kaiser Permanente Medicare	$5.84
Rate for Payer: MDX Hawaii PPO	$11.33
Rate for Payer: Ohana Health Plan Medicaid	$5.84
Rate for Payer: Ohana Health Plan Medicare	$5.84
Rate for Payer: UnitedHealthcare Medicaid	$7.01
Rate for Payer: UnitedHealthcare Medicare	$5.84
Rate for Payer: University Health Alliance Commercial	$8.51

carvedilol 25 mg tablet [HHSC]

Facility

$11.68

Service Code	NDC 00904630361
Hospital Charge Code	2500148
Hospital Revenue Code	250
Min. Negotiated Rate	$9.93
Max. Negotiated Rate	$11.33
Rate for Payer: Cash Price	$7.59
Rate for Payer: Health Management Network Commercial	$9.93
Rate for Payer: Kaiser Permanente Commercial	$10.51
Rate for Payer: MDX Hawaii PPO	$11.33

carvedilol 25 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 00904730861
Hospital Charge Code	2500148
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

carvedilol 25 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 00904730861
Hospital Charge Code	2500148
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

carvedilol 25 mg tablet [HHSC]

Facility

$10.84

Service Code	NDC 68084087601
Hospital Charge Code	2500148
Hospital Revenue Code	250
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$10.51
Rate for Payer: AlohaCare Medicaid	$5.42
Rate for Payer: AlohaCare Medicare	$5.42
Rate for Payer: Cash Price	$7.05
Rate for Payer: Devoted Health Medicare	$5.96
Rate for Payer: Hawaii Medical Service Association Medicare	$5.42
Rate for Payer: Hawaii Western Management Group Commercial	$10.30
Rate for Payer: Health Management Network Commercial	$9.21
Rate for Payer: Humana Medicare	$5.42
Rate for Payer: Kaiser Permanente Commercial	$9.76
Rate for Payer: Kaiser Permanente Medicaid	$5.53
Rate for Payer: Kaiser Permanente Medicare	$5.42
Rate for Payer: MDX Hawaii PPO	$10.51
Rate for Payer: Ohana Health Plan Medicaid	$5.42
Rate for Payer: Ohana Health Plan Medicare	$5.42
Rate for Payer: UnitedHealthcare Medicaid	$6.50
Rate for Payer: UnitedHealthcare Medicare	$5.42
Rate for Payer: University Health Alliance Commercial	$7.90

carvedilol 25 mg tablet [HHSC]

Facility

$11.87

Service Code	NDC 51079093220
Hospital Charge Code	2500148
Hospital Revenue Code	250
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$11.51
Rate for Payer: AlohaCare Medicaid	$5.93
Rate for Payer: AlohaCare Medicare	$5.93
Rate for Payer: Cash Price	$7.72
Rate for Payer: Devoted Health Medicare	$6.53
Rate for Payer: Hawaii Medical Service Association Medicare	$5.93
Rate for Payer: Hawaii Western Management Group Commercial	$11.28
Rate for Payer: Health Management Network Commercial	$10.09
Rate for Payer: Humana Medicare	$5.93
Rate for Payer: Kaiser Permanente Commercial	$10.68
Rate for Payer: Kaiser Permanente Medicaid	$6.05
Rate for Payer: Kaiser Permanente Medicare	$5.93
Rate for Payer: MDX Hawaii PPO	$11.51
Rate for Payer: Ohana Health Plan Medicaid	$5.93
Rate for Payer: Ohana Health Plan Medicare	$5.93
Rate for Payer: UnitedHealthcare Medicaid	$7.12
Rate for Payer: UnitedHealthcare Medicare	$5.93
Rate for Payer: University Health Alliance Commercial	$8.65

carvedilol 25 mg tablet [HHSC]

Facility

$10.84

Service Code	NDC 68084087601
Hospital Charge Code	2500148
Hospital Revenue Code	250
Min. Negotiated Rate	$9.21
Max. Negotiated Rate	$10.51
Rate for Payer: Cash Price	$7.05
Rate for Payer: Health Management Network Commercial	$9.21
Rate for Payer: Kaiser Permanente Commercial	$9.76
Rate for Payer: MDX Hawaii PPO	$10.51

carvedilol 25 mg tablet [HHSC]

Facility

$11.87

Service Code	NDC 51079093220
Hospital Charge Code	2500148
Hospital Revenue Code	250
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$11.51
Rate for Payer: Cash Price	$7.72
Rate for Payer: Health Management Network Commercial	$10.09
Rate for Payer: Kaiser Permanente Commercial	$10.68
Rate for Payer: MDX Hawaii PPO	$11.51

carvedilol 3.125 mg tablet [HHSC]

Facility

$11.68

Service Code	NDC 00904630061
Hospital Charge Code	2500149
Hospital Revenue Code	250
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$11.33
Rate for Payer: AlohaCare Medicaid	$5.84
Rate for Payer: AlohaCare Medicare	$5.84
Rate for Payer: Cash Price	$7.59
Rate for Payer: Devoted Health Medicare	$6.42
Rate for Payer: Hawaii Medical Service Association Medicare	$5.84
Rate for Payer: Hawaii Western Management Group Commercial	$11.10
Rate for Payer: Health Management Network Commercial	$9.93
Rate for Payer: Humana Medicare	$5.84
Rate for Payer: Kaiser Permanente Commercial	$10.51
Rate for Payer: Kaiser Permanente Medicaid	$5.96
Rate for Payer: Kaiser Permanente Medicare	$5.84
Rate for Payer: MDX Hawaii PPO	$11.33
Rate for Payer: Ohana Health Plan Medicaid	$5.84
Rate for Payer: Ohana Health Plan Medicare	$5.84
Rate for Payer: UnitedHealthcare Medicaid	$7.01
Rate for Payer: UnitedHealthcare Medicare	$5.84
Rate for Payer: University Health Alliance Commercial	$8.51

carvedilol 3.125 mg tablet [HHSC]

Facility

$11.68

Service Code	NDC 00904630061
Hospital Charge Code	2500149
Hospital Revenue Code	250
Min. Negotiated Rate	$9.93
Max. Negotiated Rate	$11.33
Rate for Payer: Cash Price	$7.59
Rate for Payer: Health Management Network Commercial	$9.93
Rate for Payer: Kaiser Permanente Commercial	$10.51
Rate for Payer: MDX Hawaii PPO	$11.33

carvedilol 3.125 mg tablet [HHSC]

Facility

$10.84

Service Code	NDC 68084084301
Hospital Charge Code	2500149
Hospital Revenue Code	250
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$10.51
Rate for Payer: AlohaCare Medicaid	$5.42
Rate for Payer: AlohaCare Medicare	$5.42
Rate for Payer: Cash Price	$7.05
Rate for Payer: Devoted Health Medicare	$5.96
Rate for Payer: Hawaii Medical Service Association Medicare	$5.42
Rate for Payer: Hawaii Western Management Group Commercial	$10.30
Rate for Payer: Health Management Network Commercial	$9.21
Rate for Payer: Humana Medicare	$5.42
Rate for Payer: Kaiser Permanente Commercial	$9.76
Rate for Payer: Kaiser Permanente Medicaid	$5.53
Rate for Payer: Kaiser Permanente Medicare	$5.42
Rate for Payer: MDX Hawaii PPO	$10.51
Rate for Payer: Ohana Health Plan Medicaid	$5.42
Rate for Payer: Ohana Health Plan Medicare	$5.42
Rate for Payer: UnitedHealthcare Medicaid	$6.50
Rate for Payer: UnitedHealthcare Medicare	$5.42
Rate for Payer: University Health Alliance Commercial	$7.90

carvedilol 3.125 mg tablet [HHSC]

Facility

$10.84

Service Code	NDC 68084084301
Hospital Charge Code	2500149
Hospital Revenue Code	250
Min. Negotiated Rate	$9.21
Max. Negotiated Rate	$10.51
Rate for Payer: Cash Price	$7.05
Rate for Payer: Health Management Network Commercial	$9.21
Rate for Payer: Kaiser Permanente Commercial	$9.76
Rate for Payer: MDX Hawaii PPO	$10.51

carvedilol 3.125 mg tablet [HHSC]

Facility

$11.88

Service Code	NDC 68001015300
Hospital Charge Code	2500149
Hospital Revenue Code	250
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$11.52
Rate for Payer: AlohaCare Medicaid	$5.94
Rate for Payer: AlohaCare Medicare	$5.94
Rate for Payer: Cash Price	$7.72
Rate for Payer: Devoted Health Medicare	$6.53
Rate for Payer: Hawaii Medical Service Association Medicare	$5.94
Rate for Payer: Hawaii Western Management Group Commercial	$11.29
Rate for Payer: Health Management Network Commercial	$10.10
Rate for Payer: Humana Medicare	$5.94
Rate for Payer: Kaiser Permanente Commercial	$10.69
Rate for Payer: Kaiser Permanente Medicaid	$6.06
Rate for Payer: Kaiser Permanente Medicare	$5.94
Rate for Payer: MDX Hawaii PPO	$11.52
Rate for Payer: Ohana Health Plan Medicaid	$5.94
Rate for Payer: Ohana Health Plan Medicare	$5.94
Rate for Payer: UnitedHealthcare Medicaid	$7.13
Rate for Payer: UnitedHealthcare Medicare	$5.94
Rate for Payer: University Health Alliance Commercial	$8.66

carvedilol 3.125 mg tablet [HHSC]

Facility

$11.88

Service Code	NDC 68001015300
Hospital Charge Code	2500149
Hospital Revenue Code	250
Min. Negotiated Rate	$10.10
Max. Negotiated Rate	$11.52
Rate for Payer: Cash Price	$7.72
Rate for Payer: Health Management Network Commercial	$10.10
Rate for Payer: Kaiser Permanente Commercial	$10.69
Rate for Payer: MDX Hawaii PPO	$11.52

carvedilol 3.125 mg tablet [HHSC]

Facility

$11.87

Service Code	NDC 51079077120
Hospital Charge Code	2500149
Hospital Revenue Code	250
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$11.51
Rate for Payer: AlohaCare Medicaid	$5.93
Rate for Payer: AlohaCare Medicare	$5.93
Rate for Payer: Cash Price	$7.72
Rate for Payer: Devoted Health Medicare	$6.53
Rate for Payer: Hawaii Medical Service Association Medicare	$5.93
Rate for Payer: Hawaii Western Management Group Commercial	$11.28
Rate for Payer: Health Management Network Commercial	$10.09
Rate for Payer: Humana Medicare	$5.93
Rate for Payer: Kaiser Permanente Commercial	$10.68
Rate for Payer: Kaiser Permanente Medicaid	$6.05
Rate for Payer: Kaiser Permanente Medicare	$5.93
Rate for Payer: MDX Hawaii PPO	$11.51
Rate for Payer: Ohana Health Plan Medicaid	$5.93
Rate for Payer: Ohana Health Plan Medicare	$5.93
Rate for Payer: UnitedHealthcare Medicaid	$7.12
Rate for Payer: UnitedHealthcare Medicare	$5.93
Rate for Payer: University Health Alliance Commercial	$8.65

carvedilol 3.125 mg tablet [HHSC]

Facility

$11.87

Service Code	NDC 51079077120
Hospital Charge Code	2500149
Hospital Revenue Code	250
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$11.51
Rate for Payer: Cash Price	$7.72
Rate for Payer: Health Management Network Commercial	$10.09
Rate for Payer: Kaiser Permanente Commercial	$10.68
Rate for Payer: MDX Hawaii PPO	$11.51

CAST SCOTCHCAST 2 IN

Facility

$15.00

Hospital Charge Code	8266611
Hospital Revenue Code	270
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.75
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

CAST SCOTCHCAST 2 IN

Facility

$15.00

Hospital Charge Code	8266611
Hospital Revenue Code	270
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$7.50
Rate for Payer: Cash Price	$9.75
Rate for Payer: Devoted Health Medicare	$8.25
Rate for Payer: Hawaii Medical Service Association Medicare	$7.50
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$7.50
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$7.50
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$7.50
Rate for Payer: Ohana Health Plan Medicare	$7.50
Rate for Payer: UnitedHealthcare Medicare	$7.50
Rate for Payer: University Health Alliance Commercial	$10.93

CAST SCOTCHCAST 3 IN

Facility

$17.00

Hospital Charge Code	8266612
Hospital Revenue Code	270
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$11.05
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: MDX Hawaii PPO	$16.49

CAST SCOTCHCAST 3 IN

Facility

$17.00

Hospital Charge Code	8266612
Hospital Revenue Code	270
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$16.49
Rate for Payer: AlohaCare Medicaid	$8.50
Rate for Payer: AlohaCare Medicare	$8.50
Rate for Payer: Cash Price	$11.05
Rate for Payer: Devoted Health Medicare	$9.35
Rate for Payer: Hawaii Medical Service Association Medicare	$8.50
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Humana Medicare	$8.50
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: Kaiser Permanente Medicare	$8.50
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: Ohana Health Plan Medicaid	$8.50
Rate for Payer: Ohana Health Plan Medicare	$8.50
Rate for Payer: UnitedHealthcare Medicare	$8.50
Rate for Payer: University Health Alliance Commercial	$12.39

CAST SCOTCHCAST 4 IN

Facility

$22.00

Hospital Charge Code	8266613
Hospital Revenue Code	270
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$21.34
Rate for Payer: AlohaCare Medicaid	$11.00
Rate for Payer: AlohaCare Medicare	$11.00
Rate for Payer: Cash Price	$14.30
Rate for Payer: Devoted Health Medicare	$12.10
Rate for Payer: Hawaii Medical Service Association Medicare	$11.00
Rate for Payer: Hawaii Western Management Group Commercial	$20.90
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Humana Medicare	$11.00
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: Kaiser Permanente Medicaid	$11.22
Rate for Payer: Kaiser Permanente Medicare	$11.00
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: Ohana Health Plan Medicaid	$11.00
Rate for Payer: Ohana Health Plan Medicare	$11.00
Rate for Payer: UnitedHealthcare Medicare	$11.00
Rate for Payer: University Health Alliance Commercial	$16.04

CAST SCOTCHCAST 4 IN

Facility

$22.00

Hospital Charge Code	8266613
Hospital Revenue Code	270
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$21.34
Rate for Payer: Cash Price	$14.30
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Kaiser Permanente Commercial	$19.80
Rate for Payer: MDX Hawaii PPO	$21.34

CAST SCOTCHCAST 5 IN

Facility

$93.00

Hospital Charge Code	8266736
Hospital Revenue Code	270
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$90.21
Rate for Payer: AlohaCare Medicaid	$46.50
Rate for Payer: AlohaCare Medicare	$46.50
Rate for Payer: Cash Price	$60.45
Rate for Payer: Devoted Health Medicare	$51.15
Rate for Payer: Hawaii Medical Service Association Medicare	$46.50
Rate for Payer: Hawaii Western Management Group Commercial	$88.35
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Humana Medicare	$46.50
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: Kaiser Permanente Medicaid	$47.43
Rate for Payer: Kaiser Permanente Medicare	$46.50
Rate for Payer: MDX Hawaii PPO	$90.21
Rate for Payer: Ohana Health Plan Medicaid	$46.50
Rate for Payer: Ohana Health Plan Medicare	$46.50
Rate for Payer: UnitedHealthcare Medicare	$46.50
Rate for Payer: University Health Alliance Commercial	$67.79

CAST SCOTCHCAST 5 IN

Facility

$93.00

Hospital Charge Code	8266736
Hospital Revenue Code	270
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$90.21
Rate for Payer: Cash Price	$60.45
Rate for Payer: Health Management Network Commercial	$79.05
Rate for Payer: Kaiser Permanente Commercial	$83.70
Rate for Payer: MDX Hawaii PPO	$90.21

Know your out-of-pocket cost for care.

All Charges