Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

DIGESTIVE MALIGNANCY WITHOUT CC/MCC

Facility

$30,646.19

Service Code	MSDRG 376
Min. Negotiated Rate	$30,646.19
Max. Negotiated Rate	$30,646.19
Rate for Payer: Hawaii Medical Service Association Commercial	$30,646.19

digoxin 125 mcg tablet [HHSC]

Facility

$7.72

Service Code	NDC 60687054001
Hospital Charge Code	2500247
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$7.49
Rate for Payer: Cash Price	$5.02
Rate for Payer: Health Management Network Commercial	$6.56
Rate for Payer: Kaiser Permanente Commercial	$6.95
Rate for Payer: MDX Hawaii PPO	$7.49

digoxin 125 mcg tablet [HHSC]

Facility

$9.37

Service Code	NDC 00904592161
Hospital Charge Code	2500247
Hospital Revenue Code	250
Min. Negotiated Rate	$7.96
Max. Negotiated Rate	$9.09
Rate for Payer: Cash Price	$6.09
Rate for Payer: Health Management Network Commercial	$7.96
Rate for Payer: Kaiser Permanente Commercial	$8.43
Rate for Payer: MDX Hawaii PPO	$9.09

digoxin 125 mcg tablet [HHSC]

Facility

$12.79

Service Code	NDC 00143124001
Hospital Charge Code	2500247
Hospital Revenue Code	250
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$12.41
Rate for Payer: AlohaCare Medicaid	$6.39
Rate for Payer: AlohaCare Medicare	$6.39
Rate for Payer: Cash Price	$8.31
Rate for Payer: Devoted Health Medicare	$7.03
Rate for Payer: Hawaii Medical Service Association Medicare	$6.39
Rate for Payer: Hawaii Western Management Group Commercial	$12.15
Rate for Payer: Health Management Network Commercial	$10.87
Rate for Payer: Humana Medicare	$6.39
Rate for Payer: Kaiser Permanente Commercial	$11.51
Rate for Payer: Kaiser Permanente Medicaid	$6.52
Rate for Payer: Kaiser Permanente Medicare	$6.39
Rate for Payer: MDX Hawaii PPO	$12.41
Rate for Payer: Ohana Health Plan Medicaid	$6.39
Rate for Payer: Ohana Health Plan Medicare	$6.39
Rate for Payer: UnitedHealthcare Medicaid	$7.67
Rate for Payer: UnitedHealthcare Medicare	$6.39
Rate for Payer: University Health Alliance Commercial	$9.32

digoxin 125 mcg tablet [HHSC]

Facility

$8.11

Service Code	NDC 60687085801
Hospital Charge Code	2500247
Hospital Revenue Code	250
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$7.87
Rate for Payer: AlohaCare Medicaid	$4.05
Rate for Payer: AlohaCare Medicare	$4.05
Rate for Payer: Cash Price	$5.27
Rate for Payer: Devoted Health Medicare	$4.46
Rate for Payer: Hawaii Medical Service Association Medicare	$4.05
Rate for Payer: Hawaii Western Management Group Commercial	$7.70
Rate for Payer: Health Management Network Commercial	$6.89
Rate for Payer: Humana Medicare	$4.05
Rate for Payer: Kaiser Permanente Commercial	$7.30
Rate for Payer: Kaiser Permanente Medicaid	$4.14
Rate for Payer: Kaiser Permanente Medicare	$4.05
Rate for Payer: MDX Hawaii PPO	$7.87
Rate for Payer: Ohana Health Plan Medicaid	$4.05
Rate for Payer: Ohana Health Plan Medicare	$4.05
Rate for Payer: UnitedHealthcare Medicaid	$4.87
Rate for Payer: UnitedHealthcare Medicare	$4.05
Rate for Payer: University Health Alliance Commercial	$5.91

digoxin 125 mcg tablet [HHSC]

Facility

$8.11

Service Code	NDC 60687085801
Hospital Charge Code	2500247
Hospital Revenue Code	250
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$7.87
Rate for Payer: Cash Price	$5.27
Rate for Payer: Health Management Network Commercial	$6.89
Rate for Payer: Kaiser Permanente Commercial	$7.30
Rate for Payer: MDX Hawaii PPO	$7.87

digoxin 125 mcg tablet [HHSC]

Facility

$7.72

Service Code	NDC 60687054001
Hospital Charge Code	2500247
Hospital Revenue Code	250
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$7.49
Rate for Payer: AlohaCare Medicaid	$3.86
Rate for Payer: AlohaCare Medicare	$3.86
Rate for Payer: Cash Price	$5.02
Rate for Payer: Devoted Health Medicare	$4.25
Rate for Payer: Hawaii Medical Service Association Medicare	$3.86
Rate for Payer: Hawaii Western Management Group Commercial	$7.33
Rate for Payer: Health Management Network Commercial	$6.56
Rate for Payer: Humana Medicare	$3.86
Rate for Payer: Kaiser Permanente Commercial	$6.95
Rate for Payer: Kaiser Permanente Medicaid	$3.94
Rate for Payer: Kaiser Permanente Medicare	$3.86
Rate for Payer: MDX Hawaii PPO	$7.49
Rate for Payer: Ohana Health Plan Medicaid	$3.86
Rate for Payer: Ohana Health Plan Medicare	$3.86
Rate for Payer: UnitedHealthcare Medicaid	$4.63
Rate for Payer: UnitedHealthcare Medicare	$3.86
Rate for Payer: University Health Alliance Commercial	$5.63

digoxin 125 mcg tablet [HHSC]

Facility

$12.79

Service Code	NDC 00143124001
Hospital Charge Code	2500247
Hospital Revenue Code	250
Min. Negotiated Rate	$10.87
Max. Negotiated Rate	$12.41
Rate for Payer: Cash Price	$8.31
Rate for Payer: Health Management Network Commercial	$10.87
Rate for Payer: Kaiser Permanente Commercial	$11.51
Rate for Payer: MDX Hawaii PPO	$12.41

digoxin 125 mcg tablet [HHSC]

Facility

$14.23

Service Code	NDC 68084036601
Hospital Charge Code	2500247
Hospital Revenue Code	250
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$13.80
Rate for Payer: Cash Price	$9.25
Rate for Payer: Health Management Network Commercial	$12.10
Rate for Payer: Kaiser Permanente Commercial	$12.81
Rate for Payer: MDX Hawaii PPO	$13.80

digoxin 125 mcg tablet [HHSC]

Facility

$14.23

Service Code	NDC 68084036601
Hospital Charge Code	2500247
Hospital Revenue Code	250
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$13.80
Rate for Payer: AlohaCare Medicaid	$7.12
Rate for Payer: AlohaCare Medicare	$7.12
Rate for Payer: Cash Price	$9.25
Rate for Payer: Devoted Health Medicare	$7.83
Rate for Payer: Hawaii Medical Service Association Medicare	$7.12
Rate for Payer: Hawaii Western Management Group Commercial	$13.52
Rate for Payer: Health Management Network Commercial	$12.10
Rate for Payer: Humana Medicare	$7.12
Rate for Payer: Kaiser Permanente Commercial	$12.81
Rate for Payer: Kaiser Permanente Medicaid	$7.26
Rate for Payer: Kaiser Permanente Medicare	$7.12
Rate for Payer: MDX Hawaii PPO	$13.80
Rate for Payer: Ohana Health Plan Medicaid	$7.12
Rate for Payer: Ohana Health Plan Medicare	$7.12
Rate for Payer: UnitedHealthcare Medicaid	$8.54
Rate for Payer: UnitedHealthcare Medicare	$7.12
Rate for Payer: University Health Alliance Commercial	$10.37

digoxin 125 mcg tablet [HHSC]

Facility

$12.79

Service Code	NDC 69238199101
Hospital Charge Code	2500247
Hospital Revenue Code	250
Min. Negotiated Rate	$10.87
Max. Negotiated Rate	$12.41
Rate for Payer: Cash Price	$8.31
Rate for Payer: Health Management Network Commercial	$10.87
Rate for Payer: Kaiser Permanente Commercial	$11.51
Rate for Payer: MDX Hawaii PPO	$12.41

digoxin 125 mcg tablet [HHSC]

Facility

$12.79

Service Code	NDC 69238199101
Hospital Charge Code	2500247
Hospital Revenue Code	250
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$12.41
Rate for Payer: AlohaCare Medicaid	$6.39
Rate for Payer: AlohaCare Medicare	$6.39
Rate for Payer: Cash Price	$8.31
Rate for Payer: Devoted Health Medicare	$7.03
Rate for Payer: Hawaii Medical Service Association Medicare	$6.39
Rate for Payer: Hawaii Western Management Group Commercial	$12.15
Rate for Payer: Health Management Network Commercial	$10.87
Rate for Payer: Humana Medicare	$6.39
Rate for Payer: Kaiser Permanente Commercial	$11.51
Rate for Payer: Kaiser Permanente Medicaid	$6.52
Rate for Payer: Kaiser Permanente Medicare	$6.39
Rate for Payer: MDX Hawaii PPO	$12.41
Rate for Payer: Ohana Health Plan Medicaid	$6.39
Rate for Payer: Ohana Health Plan Medicare	$6.39
Rate for Payer: UnitedHealthcare Medicaid	$7.67
Rate for Payer: UnitedHealthcare Medicare	$6.39
Rate for Payer: University Health Alliance Commercial	$9.32

digoxin 125 mcg tablet [HHSC]

Facility

$9.37

Service Code	NDC 00904592161
Hospital Charge Code	2500247
Hospital Revenue Code	250
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.09
Rate for Payer: AlohaCare Medicaid	$4.68
Rate for Payer: AlohaCare Medicare	$4.68
Rate for Payer: Cash Price	$6.09
Rate for Payer: Devoted Health Medicare	$5.15
Rate for Payer: Hawaii Medical Service Association Medicare	$4.68
Rate for Payer: Hawaii Western Management Group Commercial	$8.90
Rate for Payer: Health Management Network Commercial	$7.96
Rate for Payer: Humana Medicare	$4.68
Rate for Payer: Kaiser Permanente Commercial	$8.43
Rate for Payer: Kaiser Permanente Medicaid	$4.78
Rate for Payer: Kaiser Permanente Medicare	$4.68
Rate for Payer: MDX Hawaii PPO	$9.09
Rate for Payer: Ohana Health Plan Medicaid	$4.68
Rate for Payer: Ohana Health Plan Medicare	$4.68
Rate for Payer: UnitedHealthcare Medicaid	$5.62
Rate for Payer: UnitedHealthcare Medicare	$4.68
Rate for Payer: University Health Alliance Commercial	$6.83

digoxin 250 mcg tablet [HHSC]

Facility

$14.23

Service Code	NDC 68084068001
Hospital Charge Code	2500248
Hospital Revenue Code	250
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$13.80
Rate for Payer: Cash Price	$9.25
Rate for Payer: Health Management Network Commercial	$12.10
Rate for Payer: Kaiser Permanente Commercial	$12.81
Rate for Payer: MDX Hawaii PPO	$13.80

digoxin 250 mcg tablet [HHSC]

Facility

$14.23

Service Code	NDC 68084068001
Hospital Charge Code	2500248
Hospital Revenue Code	250
Min. Negotiated Rate	$7.12
Max. Negotiated Rate	$13.80
Rate for Payer: AlohaCare Medicaid	$7.12
Rate for Payer: AlohaCare Medicare	$7.12
Rate for Payer: Cash Price	$9.25
Rate for Payer: Devoted Health Medicare	$7.83
Rate for Payer: Hawaii Medical Service Association Medicare	$7.12
Rate for Payer: Hawaii Western Management Group Commercial	$13.52
Rate for Payer: Health Management Network Commercial	$12.10
Rate for Payer: Humana Medicare	$7.12
Rate for Payer: Kaiser Permanente Commercial	$12.81
Rate for Payer: Kaiser Permanente Medicaid	$7.26
Rate for Payer: Kaiser Permanente Medicare	$7.12
Rate for Payer: MDX Hawaii PPO	$13.80
Rate for Payer: Ohana Health Plan Medicaid	$7.12
Rate for Payer: Ohana Health Plan Medicare	$7.12
Rate for Payer: UnitedHealthcare Medicaid	$8.54
Rate for Payer: UnitedHealthcare Medicare	$7.12
Rate for Payer: University Health Alliance Commercial	$10.37

digoxin 250 mcg tablet [HHSC]

Facility

$12.79

Service Code	NDC 00143124101
Hospital Charge Code	2500248
Hospital Revenue Code	250
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$12.41
Rate for Payer: AlohaCare Medicaid	$6.39
Rate for Payer: AlohaCare Medicare	$6.39
Rate for Payer: Cash Price	$8.31
Rate for Payer: Devoted Health Medicare	$7.03
Rate for Payer: Hawaii Medical Service Association Medicare	$6.39
Rate for Payer: Hawaii Western Management Group Commercial	$12.15
Rate for Payer: Health Management Network Commercial	$10.87
Rate for Payer: Humana Medicare	$6.39
Rate for Payer: Kaiser Permanente Commercial	$11.51
Rate for Payer: Kaiser Permanente Medicaid	$6.52
Rate for Payer: Kaiser Permanente Medicare	$6.39
Rate for Payer: MDX Hawaii PPO	$12.41
Rate for Payer: Ohana Health Plan Medicaid	$6.39
Rate for Payer: Ohana Health Plan Medicare	$6.39
Rate for Payer: UnitedHealthcare Medicaid	$7.67
Rate for Payer: UnitedHealthcare Medicare	$6.39
Rate for Payer: University Health Alliance Commercial	$9.32

digoxin 250 mcg tablet [HHSC]

Facility

$7.72

Service Code	NDC 60687055101
Hospital Charge Code	2500248
Hospital Revenue Code	250
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$7.49
Rate for Payer: Cash Price	$5.02
Rate for Payer: Health Management Network Commercial	$6.56
Rate for Payer: Kaiser Permanente Commercial	$6.95
Rate for Payer: MDX Hawaii PPO	$7.49

digoxin 250 mcg tablet [HHSC]

Facility

$7.72

Service Code	NDC 60687055101
Hospital Charge Code	2500248
Hospital Revenue Code	250
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$7.49
Rate for Payer: AlohaCare Medicaid	$3.86
Rate for Payer: AlohaCare Medicare	$3.86
Rate for Payer: Cash Price	$5.02
Rate for Payer: Devoted Health Medicare	$4.25
Rate for Payer: Hawaii Medical Service Association Medicare	$3.86
Rate for Payer: Hawaii Western Management Group Commercial	$7.33
Rate for Payer: Health Management Network Commercial	$6.56
Rate for Payer: Humana Medicare	$3.86
Rate for Payer: Kaiser Permanente Commercial	$6.95
Rate for Payer: Kaiser Permanente Medicaid	$3.94
Rate for Payer: Kaiser Permanente Medicare	$3.86
Rate for Payer: MDX Hawaii PPO	$7.49
Rate for Payer: Ohana Health Plan Medicaid	$3.86
Rate for Payer: Ohana Health Plan Medicare	$3.86
Rate for Payer: UnitedHealthcare Medicaid	$4.63
Rate for Payer: UnitedHealthcare Medicare	$3.86
Rate for Payer: University Health Alliance Commercial	$5.63

digoxin 250 mcg tablet [HHSC]

Facility

$12.79

Service Code	NDC 59651043801
Hospital Charge Code	2500248
Hospital Revenue Code	250
Min. Negotiated Rate	$10.87
Max. Negotiated Rate	$12.41
Rate for Payer: Cash Price	$8.31
Rate for Payer: Health Management Network Commercial	$10.87
Rate for Payer: Kaiser Permanente Commercial	$11.51
Rate for Payer: MDX Hawaii PPO	$12.41

digoxin 250 mcg tablet [HHSC]

Facility

$12.79

Service Code	NDC 59651043801
Hospital Charge Code	2500248
Hospital Revenue Code	250
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$12.41
Rate for Payer: AlohaCare Medicaid	$6.39
Rate for Payer: AlohaCare Medicare	$6.39
Rate for Payer: Cash Price	$8.31
Rate for Payer: Devoted Health Medicare	$7.03
Rate for Payer: Hawaii Medical Service Association Medicare	$6.39
Rate for Payer: Hawaii Western Management Group Commercial	$12.15
Rate for Payer: Health Management Network Commercial	$10.87
Rate for Payer: Humana Medicare	$6.39
Rate for Payer: Kaiser Permanente Commercial	$11.51
Rate for Payer: Kaiser Permanente Medicaid	$6.52
Rate for Payer: Kaiser Permanente Medicare	$6.39
Rate for Payer: MDX Hawaii PPO	$12.41
Rate for Payer: Ohana Health Plan Medicaid	$6.39
Rate for Payer: Ohana Health Plan Medicare	$6.39
Rate for Payer: UnitedHealthcare Medicaid	$7.67
Rate for Payer: UnitedHealthcare Medicare	$6.39
Rate for Payer: University Health Alliance Commercial	$9.32

digoxin 250 mcg tablet [HHSC]

Facility

$12.79

Service Code	NDC 00143124101
Hospital Charge Code	2500248
Hospital Revenue Code	250
Min. Negotiated Rate	$10.87
Max. Negotiated Rate	$12.41
Rate for Payer: Cash Price	$8.31
Rate for Payer: Health Management Network Commercial	$10.87
Rate for Payer: Kaiser Permanente Commercial	$11.51
Rate for Payer: MDX Hawaii PPO	$12.41

digoxin 500 mcg/2 mL ampule [HHSC]

Facility

$41.82

Service Code	HCPCS J1160
Hospital Charge Code	2500249
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$40.57
Rate for Payer: AlohaCare Medicaid	$20.91
Rate for Payer: AlohaCare Medicare	$20.91
Rate for Payer: Cash Price	$27.18
Rate for Payer: Cash Price	$27.18
Rate for Payer: Devoted Health Medicare	$23.00
Rate for Payer: Hawaii Medical Service Association ABD	$4.00
Rate for Payer: Hawaii Medical Service Association Medicare	$20.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4.00
Rate for Payer: Hawaii Western Management Group Commercial	$39.73
Rate for Payer: Health Management Network Commercial	$35.55
Rate for Payer: Humana Medicare	$20.91
Rate for Payer: Kaiser Permanente Commercial	$37.64
Rate for Payer: Kaiser Permanente Medicaid	$21.33
Rate for Payer: Kaiser Permanente Medicare	$20.91
Rate for Payer: MDX Hawaii PPO	$40.57
Rate for Payer: Ohana Health Plan Medicaid	$20.91
Rate for Payer: Ohana Health Plan Medicare	$20.91
Rate for Payer: UnitedHealthcare Medicaid	$25.09
Rate for Payer: UnitedHealthcare Medicare	$20.91
Rate for Payer: University Health Alliance Commercial	$30.48

digoxin 500 mcg/2 mL ampule [HHSC]

Facility

$41.82

Service Code	HCPCS J1160
Hospital Charge Code	2500249
Hospital Revenue Code	250
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$40.57
Rate for Payer: Cash Price	$27.18
Rate for Payer: Health Management Network Commercial	$35.55
Rate for Payer: Kaiser Permanente Commercial	$37.64
Rate for Payer: MDX Hawaii PPO	$40.57

Digoxin Level FSI

Facility

$153.00

Service Code	HCPCS 80162
Hospital Charge Code	8128121
Hospital Revenue Code	301
Min. Negotiated Rate	$13.28
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	$18.35
Rate for Payer: Hawaii Medical Service Association Commercial	$16.60
Rate for Payer: Hawaii Medical Service Association Medicare	$76.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.27
Rate for Payer: Hawaii Western Management Group Commercial	$13.28
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	$18.35
Rate for Payer: UnitedHealthcare Medicare	$76.50
Rate for Payer: University Health Alliance Commercial	$34.32

Digoxin Level FSI

Facility

$153.00

Service Code	HCPCS 80162
Hospital Charge Code	8128121
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

Know your out-of-pocket cost for care.

All Charges