Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Chloride (Venous) POCT

Facility

$63.00

Service Code	HCPCS 82435
Hospital Charge Code	9364730
Hospital Revenue Code	301
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$61.11
Rate for Payer: AlohaCare Medicaid	$31.50
Rate for Payer: AlohaCare Medicare	$31.50
Rate for Payer: Cash Price	$40.95
Rate for Payer: Cash Price	$40.95
Rate for Payer: Devoted Health Medicare	$34.65
Rate for Payer: Hawaii Medical Service Association ABD	$6.35
Rate for Payer: Hawaii Medical Service Association Commercial	$5.75
Rate for Payer: Hawaii Medical Service Association Medicare	$31.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.67
Rate for Payer: Hawaii Western Management Group Commercial	$4.60
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Humana Medicare	$31.50
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: Kaiser Permanente Medicaid	$32.13
Rate for Payer: Kaiser Permanente Medicare	$31.50
Rate for Payer: MDX Hawaii PPO	$61.11
Rate for Payer: Ohana Health Plan Medicaid	$31.50
Rate for Payer: Ohana Health Plan Medicare	$31.50
Rate for Payer: UnitedHealthcare Medicaid	$6.35
Rate for Payer: UnitedHealthcare Medicare	$31.50
Rate for Payer: University Health Alliance Commercial	$11.88

Chloride (Venous) POCT

Facility

$63.00

Service Code	HCPCS 82435
Hospital Charge Code	9364730
Hospital Revenue Code	301
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$61.11
Rate for Payer: Cash Price	$40.95
Rate for Payer: Health Management Network Commercial	$53.55
Rate for Payer: Kaiser Permanente Commercial	$56.70
Rate for Payer: MDX Hawaii PPO	$61.11

chlorproMAZINE 25 mg tablet [HHSC]

Facility

$15.11

Service Code	HCPCS J8597
Hospital Charge Code	2501061
Hospital Revenue Code	636
Min. Negotiated Rate	$7.55
Max. Negotiated Rate	$14.66
Rate for Payer: AlohaCare Medicaid	$7.55
Rate for Payer: AlohaCare Medicaid	$23.45
Rate for Payer: AlohaCare Medicare	$7.55
Rate for Payer: AlohaCare Medicare	$23.45
Rate for Payer: Cash Price	$9.82
Rate for Payer: Cash Price	$30.48
Rate for Payer: Devoted Health Medicare	$8.31
Rate for Payer: Devoted Health Medicare	$25.79
Rate for Payer: Hawaii Medical Service Association Medicare	$23.45
Rate for Payer: Hawaii Medical Service Association Medicare	$7.55
Rate for Payer: Hawaii Western Management Group Commercial	$44.55
Rate for Payer: Hawaii Western Management Group Commercial	$14.35
Rate for Payer: Health Management Network Commercial	$12.84
Rate for Payer: Health Management Network Commercial	$39.86
Rate for Payer: Humana Medicare	$7.55
Rate for Payer: Humana Medicare	$23.45
Rate for Payer: Kaiser Permanente Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$42.20
Rate for Payer: Kaiser Permanente Medicaid	$7.71
Rate for Payer: Kaiser Permanente Medicaid	$23.91
Rate for Payer: Kaiser Permanente Medicare	$7.55
Rate for Payer: Kaiser Permanente Medicare	$23.45
Rate for Payer: MDX Hawaii PPO	$45.48
Rate for Payer: MDX Hawaii PPO	$14.66
Rate for Payer: Ohana Health Plan Medicaid	$23.45
Rate for Payer: Ohana Health Plan Medicaid	$7.55
Rate for Payer: Ohana Health Plan Medicare	$7.55
Rate for Payer: Ohana Health Plan Medicare	$23.45
Rate for Payer: UnitedHealthcare Medicaid	$9.07
Rate for Payer: UnitedHealthcare Medicaid	$28.13
Rate for Payer: UnitedHealthcare Medicare	$7.55
Rate for Payer: UnitedHealthcare Medicare	$23.45
Rate for Payer: University Health Alliance Commercial	$11.01
Rate for Payer: University Health Alliance Commercial	$34.18

chlorproMAZINE 25 mg tablet [HHSC]

Facility

$15.11

Service Code	HCPCS J8597
Hospital Charge Code	2501061
Hospital Revenue Code	250
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$14.66
Rate for Payer: Cash Price	$9.82
Rate for Payer: Cash Price	$30.48
Rate for Payer: Health Management Network Commercial	$39.86
Rate for Payer: Health Management Network Commercial	$12.84
Rate for Payer: Kaiser Permanente Commercial	$13.60
Rate for Payer: Kaiser Permanente Commercial	$42.20
Rate for Payer: MDX Hawaii PPO	$14.66
Rate for Payer: MDX Hawaii PPO	$45.48

cholecalciferol 1000 IntlUnit tablet [HHSC]

Facility

$3.00

Service Code	NDC 00904582461
Hospital Charge Code	2500175
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

cholecalciferol 1000 IntlUnit tablet [HHSC]

Facility

$3.00

Service Code	NDC 20555003300
Hospital Charge Code	2500175
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

cholecalciferol 1000 IntlUnit tablet [HHSC]

Facility

$3.00

Service Code	NDC 10006070033
Hospital Charge Code	2500175
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

cholecalciferol 1000 IntlUnit tablet [HHSC]

Facility

$3.00

Service Code	NDC 80681016900
Hospital Charge Code	2500175
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

cholecalciferol 1000 IntlUnit tablet [HHSC]

Facility

$3.00

Service Code	NDC 87701040750
Hospital Charge Code	2500175
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

cholecalciferol 1000 IntlUnit tablet [HHSC]

Facility

$3.00

Service Code	NDC 10006070033
Hospital Charge Code	2500175
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

cholecalciferol 1000 IntlUnit tablet [HHSC]

Facility

$3.00

Service Code	NDC 87701040750
Hospital Charge Code	2500175
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

cholecalciferol 1000 IntlUnit tablet [HHSC]

Facility

$3.00

Service Code	NDC 00904582460
Hospital Charge Code	2500175
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

cholecalciferol 1000 IntlUnit tablet [HHSC]

Facility

$3.00

Service Code	NDC 00904582461
Hospital Charge Code	2500175
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

cholecalciferol 1000 IntlUnit tablet [HHSC]

Facility

$3.00

Service Code	NDC 00904582460
Hospital Charge Code	2500175
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

cholecalciferol 1000 IntlUnit tablet [HHSC]

Facility

$3.00

Service Code	NDC 20555003300
Hospital Charge Code	2500175
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

cholecalciferol 1000 IntlUnit tablet [HHSC]

Facility

$3.00

Service Code	NDC 80681016900
Hospital Charge Code	2500175
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

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC

Facility

$41,481.99

Service Code	MSDRG 415
Min. Negotiated Rate	$41,481.99
Max. Negotiated Rate	$41,481.99
Rate for Payer: Hawaii Medical Service Association Commercial	$41,481.99

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC

Facility

$44,567.01

Service Code	MSDRG 414
Min. Negotiated Rate	$44,567.01
Max. Negotiated Rate	$44,567.01
Rate for Payer: Hawaii Medical Service Association Commercial	$44,567.01

CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$28,810.48

Service Code	MSDRG 416
Min. Negotiated Rate	$28,810.48
Max. Negotiated Rate	$28,810.48
Rate for Payer: Hawaii Medical Service Association Commercial	$28,810.48

CHOLECYSTECTOMY WITH C.D.E. WITH CC

Facility

$45,051.43

Service Code	MSDRG 412
Min. Negotiated Rate	$45,051.43
Max. Negotiated Rate	$45,051.43
Rate for Payer: Hawaii Medical Service Association Commercial	$45,051.43

CHOLECYSTECTOMY WITH C.D.E. WITH MCC

Facility

$53,873.05

Service Code	MSDRG 411
Min. Negotiated Rate	$53,873.05
Max. Negotiated Rate	$53,873.05
Rate for Payer: Hawaii Medical Service Association Commercial	$53,873.05

CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC

Facility

$36,255.31

Service Code	MSDRG 413
Min. Negotiated Rate	$36,255.31
Max. Negotiated Rate	$36,255.31
Rate for Payer: Hawaii Medical Service Association Commercial	$36,255.31

Cholesterol, Body Fluid FSI

Facility

$61.00

Service Code	HCPCS 82465
Hospital Charge Code	8228852
Hospital Revenue Code	301
Min. Negotiated Rate	$51.85
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$39.65
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: MDX Hawaii PPO	$59.17

Cholesterol, Body Fluid FSI

Facility

$61.00

Service Code	HCPCS 82465
Hospital Charge Code	8228852
Hospital Revenue Code	301
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$59.17
Rate for Payer: AlohaCare Medicaid	$30.50
Rate for Payer: AlohaCare Medicare	$30.50
Rate for Payer: Cash Price	$39.65
Rate for Payer: Cash Price	$39.65
Rate for Payer: Devoted Health Medicare	$33.55
Rate for Payer: Hawaii Medical Service Association ABD	$6.02
Rate for Payer: Hawaii Medical Service Association Commercial	$5.44
Rate for Payer: Hawaii Medical Service Association Medicare	$30.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.32
Rate for Payer: Hawaii Western Management Group Commercial	$4.35
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Humana Medicare	$30.50
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: Kaiser Permanente Medicaid	$31.11
Rate for Payer: Kaiser Permanente Medicare	$30.50
Rate for Payer: MDX Hawaii PPO	$59.17
Rate for Payer: Ohana Health Plan Medicaid	$30.50
Rate for Payer: Ohana Health Plan Medicare	$30.50
Rate for Payer: UnitedHealthcare Medicaid	$6.02
Rate for Payer: UnitedHealthcare Medicare	$30.50
Rate for Payer: University Health Alliance Commercial	$11.25

Cholesterol FSI

Facility

$61.00

Service Code	HCPCS 82465
Hospital Charge Code	8117882
Hospital Revenue Code	301
Min. Negotiated Rate	$51.85
Max. Negotiated Rate	$59.17
Rate for Payer: Cash Price	$39.65
Rate for Payer: Health Management Network Commercial	$51.85
Rate for Payer: Kaiser Permanente Commercial	$54.90
Rate for Payer: MDX Hawaii PPO	$59.17

Know your out-of-pocket cost for care.

All Charges