Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

HYDROcodone-APAP 5-325 mg tablet [HHSC]

Facility

$4.42

Service Code	NDC 00406012362
Hospital Charge Code	2500011
Hospital Revenue Code	250
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$4.29
Rate for Payer: AlohaCare Medicaid	$2.21
Rate for Payer: AlohaCare Medicare	$2.21
Rate for Payer: Cash Price	$2.87
Rate for Payer: Devoted Health Medicare	$2.43
Rate for Payer: Hawaii Medical Service Association Medicare	$2.21
Rate for Payer: Hawaii Western Management Group Commercial	$4.20
Rate for Payer: Health Management Network Commercial	$3.76
Rate for Payer: Humana Medicare	$2.21
Rate for Payer: Kaiser Permanente Commercial	$3.98
Rate for Payer: Kaiser Permanente Medicaid	$2.25
Rate for Payer: Kaiser Permanente Medicare	$2.21
Rate for Payer: MDX Hawaii PPO	$4.29
Rate for Payer: Ohana Health Plan Medicaid	$2.21
Rate for Payer: Ohana Health Plan Medicare	$2.21
Rate for Payer: UnitedHealthcare Medicaid	$2.65
Rate for Payer: UnitedHealthcare Medicare	$2.21
Rate for Payer: University Health Alliance Commercial	$3.22

HYDROcodone-APAP 5-325 mg tablet [HHSC]

Facility

$3.47

Service Code	NDC 60687039601
Hospital Charge Code	2500011
Hospital Revenue Code	250
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$3.37
Rate for Payer: AlohaCare Medicaid	$1.74
Rate for Payer: AlohaCare Medicare	$1.74
Rate for Payer: Cash Price	$2.26
Rate for Payer: Devoted Health Medicare	$1.91
Rate for Payer: Hawaii Medical Service Association Medicare	$1.74
Rate for Payer: Hawaii Western Management Group Commercial	$3.30
Rate for Payer: Health Management Network Commercial	$2.95
Rate for Payer: Humana Medicare	$1.74
Rate for Payer: Kaiser Permanente Commercial	$3.12
Rate for Payer: Kaiser Permanente Medicaid	$1.77
Rate for Payer: Kaiser Permanente Medicare	$1.74
Rate for Payer: MDX Hawaii PPO	$3.37
Rate for Payer: Ohana Health Plan Medicaid	$1.74
Rate for Payer: Ohana Health Plan Medicare	$1.74
Rate for Payer: UnitedHealthcare Medicaid	$2.08
Rate for Payer: UnitedHealthcare Medicare	$1.74
Rate for Payer: University Health Alliance Commercial	$2.53

hydrocortisone 10 mg tablet [HHSC]

Facility

$11.13

Service Code	NDC 60687058201
Hospital Charge Code	2500390
Hospital Revenue Code	250
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$10.80
Rate for Payer: AlohaCare Medicaid	$5.57
Rate for Payer: AlohaCare Medicare	$5.57
Rate for Payer: Cash Price	$7.23
Rate for Payer: Devoted Health Medicare	$6.12
Rate for Payer: Hawaii Medical Service Association Medicare	$5.57
Rate for Payer: Hawaii Western Management Group Commercial	$10.57
Rate for Payer: Health Management Network Commercial	$9.46
Rate for Payer: Humana Medicare	$5.57
Rate for Payer: Kaiser Permanente Commercial	$10.02
Rate for Payer: Kaiser Permanente Medicaid	$5.68
Rate for Payer: Kaiser Permanente Medicare	$5.57
Rate for Payer: MDX Hawaii PPO	$10.80
Rate for Payer: Ohana Health Plan Medicaid	$5.57
Rate for Payer: Ohana Health Plan Medicare	$5.57
Rate for Payer: UnitedHealthcare Medicaid	$6.68
Rate for Payer: UnitedHealthcare Medicare	$5.57
Rate for Payer: University Health Alliance Commercial	$8.11

hydrocortisone 10 mg tablet [HHSC]

Facility

$3.19

Service Code	NDC 59651041401
Hospital Charge Code	2500390
Hospital Revenue Code	250
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$3.09
Rate for Payer: Cash Price	$2.07
Rate for Payer: Health Management Network Commercial	$2.71
Rate for Payer: Kaiser Permanente Commercial	$2.87
Rate for Payer: MDX Hawaii PPO	$3.09

hydrocortisone 10 mg tablet [HHSC]

Facility

$11.13

Service Code	NDC 60687058201
Hospital Charge Code	2500390
Hospital Revenue Code	250
Min. Negotiated Rate	$9.46
Max. Negotiated Rate	$10.80
Rate for Payer: Cash Price	$7.23
Rate for Payer: Health Management Network Commercial	$9.46
Rate for Payer: Kaiser Permanente Commercial	$10.02
Rate for Payer: MDX Hawaii PPO	$10.80

hydrocortisone 10 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 59762007401
Hospital Charge Code	2500390
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

hydrocortisone 10 mg tablet [HHSC]

Facility

$3.19

Service Code	NDC 59651041401
Hospital Charge Code	2500390
Hospital Revenue Code	250
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$3.09
Rate for Payer: AlohaCare Medicaid	$1.59
Rate for Payer: AlohaCare Medicare	$1.59
Rate for Payer: Cash Price	$2.07
Rate for Payer: Devoted Health Medicare	$1.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1.59
Rate for Payer: Hawaii Western Management Group Commercial	$3.03
Rate for Payer: Health Management Network Commercial	$2.71
Rate for Payer: Humana Medicare	$1.59
Rate for Payer: Kaiser Permanente Commercial	$2.87
Rate for Payer: Kaiser Permanente Medicaid	$1.63
Rate for Payer: Kaiser Permanente Medicare	$1.59
Rate for Payer: MDX Hawaii PPO	$3.09
Rate for Payer: Ohana Health Plan Medicaid	$1.59
Rate for Payer: Ohana Health Plan Medicare	$1.59
Rate for Payer: UnitedHealthcare Medicaid	$1.91
Rate for Payer: UnitedHealthcare Medicare	$1.59
Rate for Payer: University Health Alliance Commercial	$2.33

hydrocortisone 10 mg tablet [HHSC]

Facility

$3.19

Service Code	NDC 42543014101
Hospital Charge Code	2500390
Hospital Revenue Code	250
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$3.09
Rate for Payer: AlohaCare Medicaid	$1.59
Rate for Payer: AlohaCare Medicare	$1.59
Rate for Payer: Cash Price	$2.07
Rate for Payer: Devoted Health Medicare	$1.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1.59
Rate for Payer: Hawaii Western Management Group Commercial	$3.03
Rate for Payer: Health Management Network Commercial	$2.71
Rate for Payer: Humana Medicare	$1.59
Rate for Payer: Kaiser Permanente Commercial	$2.87
Rate for Payer: Kaiser Permanente Medicaid	$1.63
Rate for Payer: Kaiser Permanente Medicare	$1.59
Rate for Payer: MDX Hawaii PPO	$3.09
Rate for Payer: Ohana Health Plan Medicaid	$1.59
Rate for Payer: Ohana Health Plan Medicare	$1.59
Rate for Payer: UnitedHealthcare Medicaid	$1.91
Rate for Payer: UnitedHealthcare Medicare	$1.59
Rate for Payer: University Health Alliance Commercial	$2.33

hydrocortisone 10 mg tablet [HHSC]

Facility

$3.19

Service Code	NDC 42543014101
Hospital Charge Code	2500390
Hospital Revenue Code	250
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$3.09
Rate for Payer: Cash Price	$2.07
Rate for Payer: Health Management Network Commercial	$2.71
Rate for Payer: Kaiser Permanente Commercial	$2.87
Rate for Payer: MDX Hawaii PPO	$3.09

hydrocortisone 10 mg tablet [HHSC]

Facility

$3.22

Service Code	NDC 00603390021
Hospital Charge Code	2500390
Hospital Revenue Code	250
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$3.12
Rate for Payer: Cash Price	$2.09
Rate for Payer: Health Management Network Commercial	$2.74
Rate for Payer: Kaiser Permanente Commercial	$2.90
Rate for Payer: MDX Hawaii PPO	$3.12

hydrocortisone 10 mg tablet [HHSC]

Facility

$3.22

Service Code	NDC 00603390021
Hospital Charge Code	2500390
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$3.12
Rate for Payer: AlohaCare Medicaid	$1.61
Rate for Payer: AlohaCare Medicare	$1.61
Rate for Payer: Cash Price	$2.09
Rate for Payer: Devoted Health Medicare	$1.77
Rate for Payer: Hawaii Medical Service Association Medicare	$1.61
Rate for Payer: Hawaii Western Management Group Commercial	$3.06
Rate for Payer: Health Management Network Commercial	$2.74
Rate for Payer: Humana Medicare	$1.61
Rate for Payer: Kaiser Permanente Commercial	$2.90
Rate for Payer: Kaiser Permanente Medicaid	$1.64
Rate for Payer: Kaiser Permanente Medicare	$1.61
Rate for Payer: MDX Hawaii PPO	$3.12
Rate for Payer: Ohana Health Plan Medicaid	$1.61
Rate for Payer: Ohana Health Plan Medicare	$1.61
Rate for Payer: UnitedHealthcare Medicaid	$1.93
Rate for Payer: UnitedHealthcare Medicare	$1.61
Rate for Payer: University Health Alliance Commercial	$2.35

hydrocortisone 10 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 59762007401
Hospital Charge Code	2500390
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

hydrocortisone 1% cream topical 28.35gm [HHSC]

Facility

$22.18

Service Code	NDC 45802043803
Hospital Charge Code	2500395
Hospital Revenue Code	250
Min. Negotiated Rate	$18.85
Max. Negotiated Rate	$21.51
Rate for Payer: Cash Price	$14.42
Rate for Payer: Health Management Network Commercial	$18.85
Rate for Payer: Kaiser Permanente Commercial	$19.96
Rate for Payer: MDX Hawaii PPO	$21.51

hydrocortisone 1% cream topical 28.35gm [HHSC]

Facility

$26.36

Service Code	NDC 00168015431
Hospital Charge Code	2500395
Hospital Revenue Code	250
Min. Negotiated Rate	$13.18
Max. Negotiated Rate	$25.57
Rate for Payer: AlohaCare Medicaid	$13.18
Rate for Payer: AlohaCare Medicare	$13.18
Rate for Payer: Cash Price	$17.13
Rate for Payer: Devoted Health Medicare	$14.50
Rate for Payer: Hawaii Medical Service Association Medicare	$13.18
Rate for Payer: Hawaii Western Management Group Commercial	$25.04
Rate for Payer: Health Management Network Commercial	$22.41
Rate for Payer: Humana Medicare	$13.18
Rate for Payer: Kaiser Permanente Commercial	$23.72
Rate for Payer: Kaiser Permanente Medicaid	$13.44
Rate for Payer: Kaiser Permanente Medicare	$13.18
Rate for Payer: MDX Hawaii PPO	$25.57
Rate for Payer: Ohana Health Plan Medicaid	$13.18
Rate for Payer: Ohana Health Plan Medicare	$13.18
Rate for Payer: UnitedHealthcare Medicaid	$15.82
Rate for Payer: UnitedHealthcare Medicare	$13.18
Rate for Payer: University Health Alliance Commercial	$19.21

hydrocortisone 1% cream topical 28.35gm [HHSC]

Facility

$22.18

Service Code	NDC 45802043803
Hospital Charge Code	2500395
Hospital Revenue Code	250
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$21.51
Rate for Payer: AlohaCare Medicaid	$11.09
Rate for Payer: AlohaCare Medicare	$11.09
Rate for Payer: Cash Price	$14.42
Rate for Payer: Devoted Health Medicare	$12.20
Rate for Payer: Hawaii Medical Service Association Medicare	$11.09
Rate for Payer: Hawaii Western Management Group Commercial	$21.07
Rate for Payer: Health Management Network Commercial	$18.85
Rate for Payer: Humana Medicare	$11.09
Rate for Payer: Kaiser Permanente Commercial	$19.96
Rate for Payer: Kaiser Permanente Medicaid	$11.31
Rate for Payer: Kaiser Permanente Medicare	$11.09
Rate for Payer: MDX Hawaii PPO	$21.51
Rate for Payer: Ohana Health Plan Medicaid	$11.09
Rate for Payer: Ohana Health Plan Medicare	$11.09
Rate for Payer: UnitedHealthcare Medicaid	$13.31
Rate for Payer: UnitedHealthcare Medicare	$11.09
Rate for Payer: University Health Alliance Commercial	$16.17

hydrocortisone 1% cream topical 28.35gm [HHSC]

Facility

$26.36

Service Code	NDC 00168015431
Hospital Charge Code	2500395
Hospital Revenue Code	250
Min. Negotiated Rate	$22.41
Max. Negotiated Rate	$25.57
Rate for Payer: Cash Price	$17.13
Rate for Payer: Health Management Network Commercial	$22.41
Rate for Payer: Kaiser Permanente Commercial	$23.72
Rate for Payer: MDX Hawaii PPO	$25.57

hydrocortisone 1% cream topical 28.35gm [HHSC]

Facility

$28.54

Service Code	NDC 51672206902
Hospital Charge Code	2500395
Hospital Revenue Code	250
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$27.68
Rate for Payer: AlohaCare Medicaid	$14.27
Rate for Payer: AlohaCare Medicare	$14.27
Rate for Payer: Cash Price	$18.55
Rate for Payer: Devoted Health Medicare	$15.70
Rate for Payer: Hawaii Medical Service Association Medicare	$14.27
Rate for Payer: Hawaii Western Management Group Commercial	$27.11
Rate for Payer: Health Management Network Commercial	$24.26
Rate for Payer: Humana Medicare	$14.27
Rate for Payer: Kaiser Permanente Commercial	$25.69
Rate for Payer: Kaiser Permanente Medicaid	$14.56
Rate for Payer: Kaiser Permanente Medicare	$14.27
Rate for Payer: MDX Hawaii PPO	$27.68
Rate for Payer: Ohana Health Plan Medicaid	$14.27
Rate for Payer: Ohana Health Plan Medicare	$14.27
Rate for Payer: UnitedHealthcare Medicaid	$17.12
Rate for Payer: UnitedHealthcare Medicare	$14.27
Rate for Payer: University Health Alliance Commercial	$20.80

hydrocortisone 1% cream topical 28.35gm [HHSC]

Facility

$28.54

Service Code	NDC 51672206902
Hospital Charge Code	2500395
Hospital Revenue Code	250
Min. Negotiated Rate	$24.26
Max. Negotiated Rate	$27.68
Rate for Payer: Cash Price	$18.55
Rate for Payer: Health Management Network Commercial	$24.26
Rate for Payer: Kaiser Permanente Commercial	$25.69
Rate for Payer: MDX Hawaii PPO	$27.68

hydrocortisone 2.5% cream rectal [HHSC]

Facility

$404.34

Service Code	NDC 64980032430
Hospital Charge Code	2500392
Hospital Revenue Code	250
Min. Negotiated Rate	$202.17
Max. Negotiated Rate	$392.21
Rate for Payer: AlohaCare Medicaid	$202.17
Rate for Payer: AlohaCare Medicare	$202.17
Rate for Payer: Cash Price	$262.82
Rate for Payer: Devoted Health Medicare	$222.39
Rate for Payer: Hawaii Medical Service Association Medicare	$202.17
Rate for Payer: Hawaii Western Management Group Commercial	$384.12
Rate for Payer: Health Management Network Commercial	$343.69
Rate for Payer: Humana Medicare	$202.17
Rate for Payer: Kaiser Permanente Commercial	$363.91
Rate for Payer: Kaiser Permanente Medicaid	$206.21
Rate for Payer: Kaiser Permanente Medicare	$202.17
Rate for Payer: MDX Hawaii PPO	$392.21
Rate for Payer: Ohana Health Plan Medicaid	$202.17
Rate for Payer: Ohana Health Plan Medicare	$202.17
Rate for Payer: UnitedHealthcare Medicaid	$242.60
Rate for Payer: UnitedHealthcare Medicare	$202.17
Rate for Payer: University Health Alliance Commercial	$294.72

hydrocortisone 2.5% cream rectal [HHSC]

Facility

$389.83

Service Code	NDC 62559043130
Hospital Charge Code	2500392
Hospital Revenue Code	250
Min. Negotiated Rate	$331.36
Max. Negotiated Rate	$378.14
Rate for Payer: Cash Price	$253.39
Rate for Payer: Health Management Network Commercial	$331.36
Rate for Payer: Kaiser Permanente Commercial	$350.85
Rate for Payer: MDX Hawaii PPO	$378.14

hydrocortisone 2.5% cream rectal [HHSC]

Facility

$389.83

Service Code	NDC 62559043130
Hospital Charge Code	2500392
Hospital Revenue Code	250
Min. Negotiated Rate	$194.91
Max. Negotiated Rate	$378.14
Rate for Payer: AlohaCare Medicaid	$194.91
Rate for Payer: AlohaCare Medicare	$194.91
Rate for Payer: Cash Price	$253.39
Rate for Payer: Devoted Health Medicare	$214.41
Rate for Payer: Hawaii Medical Service Association Medicare	$194.91
Rate for Payer: Hawaii Western Management Group Commercial	$370.34
Rate for Payer: Health Management Network Commercial	$331.36
Rate for Payer: Humana Medicare	$194.91
Rate for Payer: Kaiser Permanente Commercial	$350.85
Rate for Payer: Kaiser Permanente Medicaid	$198.81
Rate for Payer: Kaiser Permanente Medicare	$194.91
Rate for Payer: MDX Hawaii PPO	$378.14
Rate for Payer: Ohana Health Plan Medicaid	$194.91
Rate for Payer: Ohana Health Plan Medicare	$194.91
Rate for Payer: UnitedHealthcare Medicaid	$233.90
Rate for Payer: UnitedHealthcare Medicare	$194.91
Rate for Payer: University Health Alliance Commercial	$284.15

hydrocortisone 2.5% cream rectal [HHSC]

Facility

$404.34

Service Code	NDC 64980032430
Hospital Charge Code	2500392
Hospital Revenue Code	250
Min. Negotiated Rate	$343.69
Max. Negotiated Rate	$392.21
Rate for Payer: Cash Price	$262.82
Rate for Payer: Health Management Network Commercial	$343.69
Rate for Payer: Kaiser Permanente Commercial	$363.91
Rate for Payer: MDX Hawaii PPO	$392.21

hydrocortisone 25 mg suppository [HHSC]

Facility

$91.95

Service Code	NDC 00574709012
Hospital Charge Code	2500394
Hospital Revenue Code	250
Min. Negotiated Rate	$45.98
Max. Negotiated Rate	$89.19
Rate for Payer: AlohaCare Medicaid	$45.98
Rate for Payer: AlohaCare Medicare	$45.98
Rate for Payer: Cash Price	$59.77
Rate for Payer: Devoted Health Medicare	$50.57
Rate for Payer: Hawaii Medical Service Association Medicare	$45.98
Rate for Payer: Hawaii Western Management Group Commercial	$87.35
Rate for Payer: Health Management Network Commercial	$78.16
Rate for Payer: Humana Medicare	$45.98
Rate for Payer: Kaiser Permanente Commercial	$82.75
Rate for Payer: Kaiser Permanente Medicaid	$46.89
Rate for Payer: Kaiser Permanente Medicare	$45.98
Rate for Payer: MDX Hawaii PPO	$89.19
Rate for Payer: Ohana Health Plan Medicaid	$45.98
Rate for Payer: Ohana Health Plan Medicare	$45.98
Rate for Payer: UnitedHealthcare Medicaid	$55.17
Rate for Payer: UnitedHealthcare Medicare	$45.98
Rate for Payer: University Health Alliance Commercial	$67.02

hydrocortisone 25 mg suppository [HHSC]

Facility

$112.81

Service Code	NDC 00713050312
Hospital Charge Code	2500394
Hospital Revenue Code	250
Min. Negotiated Rate	$95.89
Max. Negotiated Rate	$109.43
Rate for Payer: Cash Price	$73.33
Rate for Payer: Health Management Network Commercial	$95.89
Rate for Payer: Kaiser Permanente Commercial	$101.53
Rate for Payer: MDX Hawaii PPO	$109.43

hydrocortisone 25 mg suppository [HHSC]

Facility

$112.81

Service Code	NDC 00713050312
Hospital Charge Code	2500394
Hospital Revenue Code	250
Min. Negotiated Rate	$56.41
Max. Negotiated Rate	$109.43
Rate for Payer: AlohaCare Medicaid	$56.41
Rate for Payer: AlohaCare Medicare	$56.41
Rate for Payer: Cash Price	$73.33
Rate for Payer: Devoted Health Medicare	$62.05
Rate for Payer: Hawaii Medical Service Association Medicare	$56.41
Rate for Payer: Hawaii Western Management Group Commercial	$107.17
Rate for Payer: Health Management Network Commercial	$95.89
Rate for Payer: Humana Medicare	$56.41
Rate for Payer: Kaiser Permanente Commercial	$101.53
Rate for Payer: Kaiser Permanente Medicaid	$57.53
Rate for Payer: Kaiser Permanente Medicare	$56.41
Rate for Payer: MDX Hawaii PPO	$109.43
Rate for Payer: Ohana Health Plan Medicaid	$56.41
Rate for Payer: Ohana Health Plan Medicare	$56.41
Rate for Payer: UnitedHealthcare Medicaid	$67.69
Rate for Payer: UnitedHealthcare Medicare	$56.41
Rate for Payer: University Health Alliance Commercial	$82.23

Know your out-of-pocket cost for care.

All Charges