Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

guaiFENesin 100 mg/5 mL 118ml [HHSC]

Facility

$11.99

Service Code	NDC 00536118297
Hospital Charge Code	2500368
Hospital Revenue Code	250
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$11.63
Rate for Payer: AlohaCare Medicaid	$6.00
Rate for Payer: AlohaCare Medicare	$6.00
Rate for Payer: Cash Price	$7.79
Rate for Payer: Devoted Health Medicare	$6.59
Rate for Payer: Hawaii Medical Service Association Medicare	$6.00
Rate for Payer: Hawaii Western Management Group Commercial	$11.39
Rate for Payer: Health Management Network Commercial	$10.19
Rate for Payer: Humana Medicare	$6.00
Rate for Payer: Kaiser Permanente Commercial	$10.79
Rate for Payer: Kaiser Permanente Medicaid	$6.11
Rate for Payer: Kaiser Permanente Medicare	$6.00
Rate for Payer: MDX Hawaii PPO	$11.63
Rate for Payer: Ohana Health Plan Medicaid	$6.00
Rate for Payer: Ohana Health Plan Medicare	$6.00
Rate for Payer: UnitedHealthcare Medicaid	$7.19
Rate for Payer: UnitedHealthcare Medicare	$6.00
Rate for Payer: University Health Alliance Commercial	$8.74

guaiFENesin 100 mg/5 mL 118ml [HHSC]

Facility

$40.34

Service Code	NDC 46122029926
Hospital Charge Code	2500368
Hospital Revenue Code	250
Min. Negotiated Rate	$20.17
Max. Negotiated Rate	$39.13
Rate for Payer: AlohaCare Medicaid	$20.17
Rate for Payer: AlohaCare Medicare	$20.17
Rate for Payer: Cash Price	$26.22
Rate for Payer: Devoted Health Medicare	$22.19
Rate for Payer: Hawaii Medical Service Association Medicare	$20.17
Rate for Payer: Hawaii Western Management Group Commercial	$38.32
Rate for Payer: Health Management Network Commercial	$34.29
Rate for Payer: Humana Medicare	$20.17
Rate for Payer: Kaiser Permanente Commercial	$36.31
Rate for Payer: Kaiser Permanente Medicaid	$20.57
Rate for Payer: Kaiser Permanente Medicare	$20.17
Rate for Payer: MDX Hawaii PPO	$39.13
Rate for Payer: Ohana Health Plan Medicaid	$20.17
Rate for Payer: Ohana Health Plan Medicare	$20.17
Rate for Payer: UnitedHealthcare Medicaid	$24.20
Rate for Payer: UnitedHealthcare Medicare	$20.17
Rate for Payer: University Health Alliance Commercial	$29.40

guaiFENesin 100 mg/5 mL 118ml [HHSC]

Facility

$40.34

Service Code	NDC 46122029926
Hospital Charge Code	2500368
Hospital Revenue Code	250
Min. Negotiated Rate	$34.29
Max. Negotiated Rate	$39.13
Rate for Payer: Cash Price	$26.22
Rate for Payer: Health Management Network Commercial	$34.29
Rate for Payer: Kaiser Permanente Commercial	$36.31
Rate for Payer: MDX Hawaii PPO	$39.13

guaiFENesin 100 mg/5 mL 118ml [HHSC]

Facility

$14.08

Service Code	NDC 54838011740
Hospital Charge Code	2500368
Hospital Revenue Code	250
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$13.66
Rate for Payer: AlohaCare Medicaid	$7.04
Rate for Payer: AlohaCare Medicare	$7.04
Rate for Payer: Cash Price	$9.15
Rate for Payer: Devoted Health Medicare	$7.74
Rate for Payer: Hawaii Medical Service Association Medicare	$7.04
Rate for Payer: Hawaii Western Management Group Commercial	$13.38
Rate for Payer: Health Management Network Commercial	$11.97
Rate for Payer: Humana Medicare	$7.04
Rate for Payer: Kaiser Permanente Commercial	$12.67
Rate for Payer: Kaiser Permanente Medicaid	$7.18
Rate for Payer: Kaiser Permanente Medicare	$7.04
Rate for Payer: MDX Hawaii PPO	$13.66
Rate for Payer: Ohana Health Plan Medicaid	$7.04
Rate for Payer: Ohana Health Plan Medicare	$7.04
Rate for Payer: UnitedHealthcare Medicaid	$8.45
Rate for Payer: UnitedHealthcare Medicare	$7.04
Rate for Payer: University Health Alliance Commercial	$10.26

guaiFENesin 100 mg/5 mL 5 mL U/D [HHSC]

Facility

$10.63

Service Code	NDC 00121174400
Hospital Charge Code	2501148
Hospital Revenue Code	250
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$10.31
Rate for Payer: AlohaCare Medicaid	$5.32
Rate for Payer: AlohaCare Medicare	$5.32
Rate for Payer: Cash Price	$6.91
Rate for Payer: Devoted Health Medicare	$5.85
Rate for Payer: Hawaii Medical Service Association Medicare	$5.32
Rate for Payer: Hawaii Western Management Group Commercial	$10.10
Rate for Payer: Health Management Network Commercial	$9.04
Rate for Payer: Humana Medicare	$5.32
Rate for Payer: Kaiser Permanente Commercial	$9.57
Rate for Payer: Kaiser Permanente Medicaid	$5.42
Rate for Payer: Kaiser Permanente Medicare	$5.32
Rate for Payer: MDX Hawaii PPO	$10.31
Rate for Payer: Ohana Health Plan Medicaid	$5.32
Rate for Payer: Ohana Health Plan Medicare	$5.32
Rate for Payer: UnitedHealthcare Medicaid	$6.38
Rate for Payer: UnitedHealthcare Medicare	$5.32
Rate for Payer: University Health Alliance Commercial	$7.75

guaiFENesin 100 mg/5 mL 5 mL U/D [HHSC]

Facility

$10.63

Service Code	NDC 00121174400
Hospital Charge Code	2501148
Hospital Revenue Code	250
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$10.31
Rate for Payer: Cash Price	$6.91
Rate for Payer: Health Management Network Commercial	$9.04
Rate for Payer: Kaiser Permanente Commercial	$9.57
Rate for Payer: MDX Hawaii PPO	$10.31

guaiFENesin ER 600 mg tablet [HHSC]

Facility

$5.57

Service Code	NDC 68084057201
Hospital Charge Code	2500369
Hospital Revenue Code	250
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$5.40
Rate for Payer: AlohaCare Medicaid	$2.79
Rate for Payer: AlohaCare Medicare	$2.79
Rate for Payer: Cash Price	$3.62
Rate for Payer: Devoted Health Medicare	$3.06
Rate for Payer: Hawaii Medical Service Association Medicare	$2.79
Rate for Payer: Hawaii Western Management Group Commercial	$5.29
Rate for Payer: Health Management Network Commercial	$4.73
Rate for Payer: Humana Medicare	$2.79
Rate for Payer: Kaiser Permanente Commercial	$5.01
Rate for Payer: Kaiser Permanente Medicaid	$2.84
Rate for Payer: Kaiser Permanente Medicare	$2.79
Rate for Payer: MDX Hawaii PPO	$5.40
Rate for Payer: Ohana Health Plan Medicaid	$2.79
Rate for Payer: Ohana Health Plan Medicare	$2.79
Rate for Payer: UnitedHealthcare Medicaid	$3.34
Rate for Payer: UnitedHealthcare Medicare	$2.79
Rate for Payer: University Health Alliance Commercial	$4.06

guaiFENesin ER 600 mg tablet [HHSC]

Facility

$5.57

Service Code	NDC 68084057201
Hospital Charge Code	2500369
Hospital Revenue Code	250
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$5.40
Rate for Payer: Cash Price	$3.62
Rate for Payer: Health Management Network Commercial	$4.73
Rate for Payer: Kaiser Permanente Commercial	$5.01
Rate for Payer: MDX Hawaii PPO	$5.40

GUIDE PIN, 3.2MM X 330MM

Facility

$245.00

Hospital Charge Code	12984241
Hospital Revenue Code	272
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$237.65
Rate for Payer: AlohaCare Medicaid	$122.50
Rate for Payer: AlohaCare Medicare	$122.50
Rate for Payer: Cash Price	$159.25
Rate for Payer: Devoted Health Medicare	$134.75
Rate for Payer: Hawaii Medical Service Association Medicare	$122.50
Rate for Payer: Hawaii Western Management Group Commercial	$232.75
Rate for Payer: Health Management Network Commercial	$208.25
Rate for Payer: Humana Medicare	$122.50
Rate for Payer: Kaiser Permanente Commercial	$220.50
Rate for Payer: Kaiser Permanente Medicaid	$124.95
Rate for Payer: Kaiser Permanente Medicare	$122.50
Rate for Payer: MDX Hawaii PPO	$237.65
Rate for Payer: Ohana Health Plan Medicaid	$122.50
Rate for Payer: Ohana Health Plan Medicare	$122.50
Rate for Payer: UnitedHealthcare Medicare	$122.50
Rate for Payer: University Health Alliance Commercial	$178.58

GUIDE PIN, 3.2MM X 330MM

Facility

$245.00

Hospital Charge Code	12984241
Hospital Revenue Code	272
Min. Negotiated Rate	$208.25
Max. Negotiated Rate	$237.65
Rate for Payer: Cash Price	$159.25
Rate for Payer: Health Management Network Commercial	$208.25
Rate for Payer: Kaiser Permanente Commercial	$220.50
Rate for Payer: MDX Hawaii PPO	$237.65

GUIDE PIN, 3.2MM X 381MM

Facility

$231.00

Hospital Charge Code	12984236
Hospital Revenue Code	272
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$224.07
Rate for Payer: AlohaCare Medicaid	$115.50
Rate for Payer: AlohaCare Medicare	$115.50
Rate for Payer: Cash Price	$150.15
Rate for Payer: Devoted Health Medicare	$127.05
Rate for Payer: Hawaii Medical Service Association Medicare	$115.50
Rate for Payer: Hawaii Western Management Group Commercial	$219.45
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Humana Medicare	$115.50
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: Kaiser Permanente Medicaid	$117.81
Rate for Payer: Kaiser Permanente Medicare	$115.50
Rate for Payer: MDX Hawaii PPO	$224.07
Rate for Payer: Ohana Health Plan Medicaid	$115.50
Rate for Payer: Ohana Health Plan Medicare	$115.50
Rate for Payer: UnitedHealthcare Medicare	$115.50
Rate for Payer: University Health Alliance Commercial	$168.38

GUIDE PIN, 3.2MM X 381MM

Facility

$231.00

Hospital Charge Code	12984236
Hospital Revenue Code	272
Min. Negotiated Rate	$196.35
Max. Negotiated Rate	$224.07
Rate for Payer: Cash Price	$150.15
Rate for Payer: Health Management Network Commercial	$196.35
Rate for Payer: Kaiser Permanente Commercial	$207.90
Rate for Payer: MDX Hawaii PPO	$224.07

GUIDEWIRE, DRILL TIP, 1.25MM

Facility

$86.00

Hospital Charge Code	12984242
Hospital Revenue Code	272
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$55.90
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: MDX Hawaii PPO	$83.42

GUIDEWIRE, DRILL TIP, 1.25MM

Facility

$86.00

Hospital Charge Code	12984242
Hospital Revenue Code	272
Min. Negotiated Rate	$43.00
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$43.00
Rate for Payer: AlohaCare Medicare	$43.00
Rate for Payer: Cash Price	$55.90
Rate for Payer: Devoted Health Medicare	$47.30
Rate for Payer: Hawaii Medical Service Association Medicare	$43.00
Rate for Payer: Hawaii Western Management Group Commercial	$81.70
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Humana Medicare	$43.00
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: Kaiser Permanente Medicare	$43.00
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: Ohana Health Plan Medicaid	$43.00
Rate for Payer: Ohana Health Plan Medicare	$43.00
Rate for Payer: UnitedHealthcare Medicare	$43.00
Rate for Payer: University Health Alliance Commercial	$62.69

GUIDEWIRE, DRILL TIP, 1.6MM

Facility

$86.00

Hospital Charge Code	12984237
Hospital Revenue Code	272
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$55.90
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: MDX Hawaii PPO	$83.42

GUIDEWIRE, DRILL TIP, 1.6MM

Facility

$86.00

Hospital Charge Code	12984237
Hospital Revenue Code	272
Min. Negotiated Rate	$43.00
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$43.00
Rate for Payer: AlohaCare Medicare	$43.00
Rate for Payer: Cash Price	$55.90
Rate for Payer: Devoted Health Medicare	$47.30
Rate for Payer: Hawaii Medical Service Association Medicare	$43.00
Rate for Payer: Hawaii Western Management Group Commercial	$81.70
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Humana Medicare	$43.00
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: Kaiser Permanente Medicare	$43.00
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: Ohana Health Plan Medicaid	$43.00
Rate for Payer: Ohana Health Plan Medicare	$43.00
Rate for Payer: UnitedHealthcare Medicare	$43.00
Rate for Payer: University Health Alliance Commercial	$62.69

GUIDEWIRE, DRILL TIP, 2.0MM

Facility

$86.00

Hospital Charge Code	12984243
Hospital Revenue Code	272
Min. Negotiated Rate	$43.00
Max. Negotiated Rate	$83.42
Rate for Payer: AlohaCare Medicaid	$43.00
Rate for Payer: AlohaCare Medicare	$43.00
Rate for Payer: Cash Price	$55.90
Rate for Payer: Devoted Health Medicare	$47.30
Rate for Payer: Hawaii Medical Service Association Medicare	$43.00
Rate for Payer: Hawaii Western Management Group Commercial	$81.70
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Humana Medicare	$43.00
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: Kaiser Permanente Medicaid	$43.86
Rate for Payer: Kaiser Permanente Medicare	$43.00
Rate for Payer: MDX Hawaii PPO	$83.42
Rate for Payer: Ohana Health Plan Medicaid	$43.00
Rate for Payer: Ohana Health Plan Medicare	$43.00
Rate for Payer: UnitedHealthcare Medicare	$43.00
Rate for Payer: University Health Alliance Commercial	$62.69

GUIDEWIRE, DRILL TIP, 2.0MM

Facility

$86.00

Hospital Charge Code	12984243
Hospital Revenue Code	272
Min. Negotiated Rate	$73.10
Max. Negotiated Rate	$83.42
Rate for Payer: Cash Price	$55.90
Rate for Payer: Health Management Network Commercial	$73.10
Rate for Payer: Kaiser Permanente Commercial	$77.40
Rate for Payer: MDX Hawaii PPO	$83.42

GUIDE WIRE FIXED CORE SAFE TJ CURVE (CT)

Facility

$84.00

Service Code	HCPCS C1769
Hospital Charge Code	8886982
Hospital Revenue Code	272
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$54.60
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: MDX Hawaii PPO	$81.48

GUIDE WIRE FIXED CORE SAFE TJ CURVE (CT)

Facility

$84.00

Service Code	HCPCS C1769
Hospital Charge Code	8886982
Hospital Revenue Code	272
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$81.48
Rate for Payer: AlohaCare Medicaid	$42.00
Rate for Payer: AlohaCare Medicare	$42.00
Rate for Payer: Cash Price	$54.60
Rate for Payer: Devoted Health Medicare	$46.20
Rate for Payer: Hawaii Medical Service Association Medicare	$42.00
Rate for Payer: Hawaii Western Management Group Commercial	$79.80
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Humana Medicare	$42.00
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: Kaiser Permanente Medicaid	$42.84
Rate for Payer: Kaiser Permanente Medicare	$42.00
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: Ohana Health Plan Medicaid	$42.00
Rate for Payer: Ohana Health Plan Medicare	$42.00
Rate for Payer: UnitedHealthcare Medicare	$42.00
Rate for Payer: University Health Alliance Commercial	$61.23

GUIDE WIRE FIXED CORE SAFE TJ CURVE (US)

Facility

$84.00

Service Code	HCPCS C1769
Hospital Charge Code	8886981
Hospital Revenue Code	272
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$81.48
Rate for Payer: AlohaCare Medicaid	$42.00
Rate for Payer: AlohaCare Medicare	$42.00
Rate for Payer: Cash Price	$54.60
Rate for Payer: Devoted Health Medicare	$46.20
Rate for Payer: Hawaii Medical Service Association Medicare	$42.00
Rate for Payer: Hawaii Western Management Group Commercial	$79.80
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Humana Medicare	$42.00
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: Kaiser Permanente Medicaid	$42.84
Rate for Payer: Kaiser Permanente Medicare	$42.00
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: Ohana Health Plan Medicaid	$42.00
Rate for Payer: Ohana Health Plan Medicare	$42.00
Rate for Payer: UnitedHealthcare Medicare	$42.00
Rate for Payer: University Health Alliance Commercial	$61.23

GUIDE WIRE FIXED CORE SAFE TJ CURVE (US)

Facility

$84.00

Service Code	HCPCS C1769
Hospital Charge Code	8886981
Hospital Revenue Code	272
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$54.60
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: MDX Hawaii PPO	$81.48

GUIDE WIRE FIXED CORE SAFE TJ CURVE (XR/MAMMO)

Facility

$84.00

Service Code	HCPCS C1769
Hospital Charge Code	8886983
Hospital Revenue Code	272
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$81.48
Rate for Payer: AlohaCare Medicaid	$42.00
Rate for Payer: AlohaCare Medicare	$42.00
Rate for Payer: Cash Price	$54.60
Rate for Payer: Devoted Health Medicare	$46.20
Rate for Payer: Hawaii Medical Service Association Medicare	$42.00
Rate for Payer: Hawaii Western Management Group Commercial	$79.80
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Humana Medicare	$42.00
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: Kaiser Permanente Medicaid	$42.84
Rate for Payer: Kaiser Permanente Medicare	$42.00
Rate for Payer: MDX Hawaii PPO	$81.48
Rate for Payer: Ohana Health Plan Medicaid	$42.00
Rate for Payer: Ohana Health Plan Medicare	$42.00
Rate for Payer: UnitedHealthcare Medicare	$42.00
Rate for Payer: University Health Alliance Commercial	$61.23

GUIDE WIRE FIXED CORE SAFE TJ CURVE (XR/MAMMO)

Facility

$84.00

Service Code	HCPCS C1769
Hospital Charge Code	8886983
Hospital Revenue Code	272
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$81.48
Rate for Payer: Cash Price	$54.60
Rate for Payer: Health Management Network Commercial	$71.40
Rate for Payer: Kaiser Permanente Commercial	$75.60
Rate for Payer: MDX Hawaii PPO	$81.48

GUIDE WIRE, TROCAR TIP, 1.35 MM

Facility

$25.00

Service Code	HCPCS C1769
Hospital Charge Code	12944032
Hospital Revenue Code	272
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$24.25
Rate for Payer: AlohaCare Medicaid	$12.50
Rate for Payer: AlohaCare Medicare	$12.50
Rate for Payer: Cash Price	$16.25
Rate for Payer: Devoted Health Medicare	$13.75
Rate for Payer: Hawaii Medical Service Association Medicare	$12.50
Rate for Payer: Hawaii Western Management Group Commercial	$23.75
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Humana Medicare	$12.50
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: Kaiser Permanente Medicaid	$12.75
Rate for Payer: Kaiser Permanente Medicare	$12.50
Rate for Payer: MDX Hawaii PPO	$24.25
Rate for Payer: Ohana Health Plan Medicaid	$12.50
Rate for Payer: Ohana Health Plan Medicare	$12.50
Rate for Payer: UnitedHealthcare Medicare	$12.50
Rate for Payer: University Health Alliance Commercial	$18.22

Know your out-of-pocket cost for care.

All Charges