Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

ibuprofen 600 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 63739068410
Hospital Charge Code	2500410
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

ibuprofen 600 mg tablet [HHSC]

Facility

$3.04

Service Code	NDC 53746046501
Hospital Charge Code	2500410
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$2.95
Rate for Payer: Cash Price	$1.98
Rate for Payer: Health Management Network Commercial	$2.58
Rate for Payer: Kaiser Permanente Commercial	$2.74
Rate for Payer: MDX Hawaii PPO	$2.95

ibuprofen 600 mg tablet [HHSC]

Facility

$3.24

Service Code	NDC 64380080806
Hospital Charge Code	2500410
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$3.14
Rate for Payer: Cash Price	$2.11
Rate for Payer: Health Management Network Commercial	$2.75
Rate for Payer: Kaiser Permanente Commercial	$2.92
Rate for Payer: MDX Hawaii PPO	$3.14

ibuprofen 600 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 67877032001
Hospital Charge Code	2500410
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

ibuprofen 600 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 68084070301
Hospital Charge Code	2500410
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

ibuprofen 600 mg tablet [HHSC]

Facility

$3.04

Service Code	NDC 53746046501
Hospital Charge Code	2500410
Hospital Revenue Code	250
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$2.95
Rate for Payer: AlohaCare Medicaid	$1.52
Rate for Payer: AlohaCare Medicare	$1.52
Rate for Payer: Cash Price	$1.98
Rate for Payer: Devoted Health Medicare	$1.67
Rate for Payer: Hawaii Medical Service Association Medicare	$1.52
Rate for Payer: Hawaii Western Management Group Commercial	$2.89
Rate for Payer: Health Management Network Commercial	$2.58
Rate for Payer: Humana Medicare	$1.52
Rate for Payer: Kaiser Permanente Commercial	$2.74
Rate for Payer: Kaiser Permanente Medicaid	$1.55
Rate for Payer: Kaiser Permanente Medicare	$1.52
Rate for Payer: MDX Hawaii PPO	$2.95
Rate for Payer: Ohana Health Plan Medicaid	$1.52
Rate for Payer: Ohana Health Plan Medicare	$1.52
Rate for Payer: UnitedHealthcare Medicaid	$1.82
Rate for Payer: UnitedHealthcare Medicare	$1.52
Rate for Payer: University Health Alliance Commercial	$2.22

ibuprofen 600 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 60687045701
Hospital Charge Code	2500410
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

ibuprofen 600 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 11788000901
Hospital Charge Code	2500410
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

ibuprofen 600 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 68084070301
Hospital Charge Code	2500410
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

ibuprofen 600 mg tablet [HHSC]

Facility

$3.24

Service Code	NDC 64380080806
Hospital Charge Code	2500410
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$3.14
Rate for Payer: UnitedHealthcare Medicaid	$1.94
Rate for Payer: AlohaCare Medicaid	$1.62
Rate for Payer: AlohaCare Medicare	$1.62
Rate for Payer: Cash Price	$2.11
Rate for Payer: Devoted Health Medicare	$1.78
Rate for Payer: Hawaii Medical Service Association Medicare	$1.62
Rate for Payer: Hawaii Western Management Group Commercial	$3.08
Rate for Payer: Health Management Network Commercial	$2.75
Rate for Payer: Humana Medicare	$1.62
Rate for Payer: Kaiser Permanente Commercial	$2.92
Rate for Payer: Kaiser Permanente Medicaid	$1.65
Rate for Payer: Kaiser Permanente Medicare	$1.62
Rate for Payer: MDX Hawaii PPO	$3.14
Rate for Payer: Ohana Health Plan Medicaid	$1.62
Rate for Payer: Ohana Health Plan Medicare	$1.62
Rate for Payer: UnitedHealthcare Medicare	$1.62
Rate for Payer: University Health Alliance Commercial	$2.36

ibuprofen 600 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 00904585461
Hospital Charge Code	2500410
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

ibuprofen 600 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 00904585461
Hospital Charge Code	2500410
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

ibuprofen 600 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 63739068410
Hospital Charge Code	2500410
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

ibuprofen 600 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 60687045701
Hospital Charge Code	2500410
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

Ibuprofen FSI

Facility

$157.00

Service Code	HCPCS 80299
Hospital Charge Code	8117967
Hospital Revenue Code	301
Min. Negotiated Rate	$133.45
Max. Negotiated Rate	$152.29
Rate for Payer: Cash Price	$102.05
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: Kaiser Permanente Commercial	$141.30
Rate for Payer: MDX Hawaii PPO	$152.29

Ibuprofen FSI

Facility

$157.00

Service Code	HCPCS 80299
Hospital Charge Code	8117967
Hospital Revenue Code	301
Min. Negotiated Rate	$18.64
Max. Negotiated Rate	$152.29
Rate for Payer: AlohaCare Medicaid	$78.50
Rate for Payer: AlohaCare Medicare	$78.50
Rate for Payer: Cash Price	$102.05
Rate for Payer: Cash Price	$102.05
Rate for Payer: Devoted Health Medicare	$86.35
Rate for Payer: Hawaii Medical Service Association ABD	$18.92
Rate for Payer: Hawaii Medical Service Association Commercial	$23.30
Rate for Payer: Hawaii Medical Service Association Medicare	$78.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.87
Rate for Payer: Hawaii Western Management Group Commercial	$18.64
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: Humana Medicare	$78.50
Rate for Payer: Kaiser Permanente Commercial	$141.30
Rate for Payer: Kaiser Permanente Medicaid	$80.07
Rate for Payer: Kaiser Permanente Medicare	$78.50
Rate for Payer: MDX Hawaii PPO	$152.29
Rate for Payer: Ohana Health Plan Medicaid	$78.50
Rate for Payer: Ohana Health Plan Medicare	$78.50
Rate for Payer: UnitedHealthcare Medicaid	$18.92
Rate for Payer: UnitedHealthcare Medicare	$78.50
Rate for Payer: University Health Alliance Commercial	$35.39

ICU:FECAL MANAGEMENT SYSTEM KIT FLEXI-SEAL SIGNAL

Facility

$1,159.00

Hospital Charge Code	12669425
Hospital Revenue Code	272
Min. Negotiated Rate	$985.15
Max. Negotiated Rate	$1,124.23
Rate for Payer: Cash Price	$753.35
Rate for Payer: Health Management Network Commercial	$985.15
Rate for Payer: Kaiser Permanente Commercial	$1,043.10
Rate for Payer: MDX Hawaii PPO	$1,124.23

ICU:FECAL MANAGEMENT SYSTEM KIT FLEXI-SEAL SIGNAL

Facility

$1,159.00

Hospital Charge Code	12669425
Hospital Revenue Code	272
Min. Negotiated Rate	$579.50
Max. Negotiated Rate	$1,124.23
Rate for Payer: AlohaCare Medicaid	$579.50
Rate for Payer: AlohaCare Medicare	$579.50
Rate for Payer: Cash Price	$753.35
Rate for Payer: Devoted Health Medicare	$637.45
Rate for Payer: Hawaii Medical Service Association Medicare	$579.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,101.05
Rate for Payer: Health Management Network Commercial	$985.15
Rate for Payer: Humana Medicare	$579.50
Rate for Payer: Kaiser Permanente Commercial	$1,043.10
Rate for Payer: Kaiser Permanente Medicaid	$591.09
Rate for Payer: Kaiser Permanente Medicare	$579.50
Rate for Payer: MDX Hawaii PPO	$1,124.23
Rate for Payer: Ohana Health Plan Medicaid	$579.50
Rate for Payer: Ohana Health Plan Medicare	$579.50
Rate for Payer: UnitedHealthcare Medicare	$579.50
Rate for Payer: University Health Alliance Commercial	$844.80

Ident, Aerobic Isol, 4

Facility

$159.00

Service Code	HCPCS 87077
Hospital Charge Code	12499189
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$154.23
Rate for Payer: AlohaCare Medicaid	$79.50
Rate for Payer: AlohaCare Medicare	$79.50
Rate for Payer: Cash Price	$103.35
Rate for Payer: Cash Price	$103.35
Rate for Payer: Devoted Health Medicare	$87.45
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.10
Rate for Payer: Hawaii Medical Service Association Medicare	$79.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.72
Rate for Payer: Hawaii Western Management Group Commercial	$8.08
Rate for Payer: Health Management Network Commercial	$135.15
Rate for Payer: Humana Medicare	$79.50
Rate for Payer: Kaiser Permanente Commercial	$143.10
Rate for Payer: Kaiser Permanente Medicaid	$81.09
Rate for Payer: Kaiser Permanente Medicare	$79.50
Rate for Payer: MDX Hawaii PPO	$154.23
Rate for Payer: Ohana Health Plan Medicaid	$79.50
Rate for Payer: Ohana Health Plan Medicare	$79.50
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$79.50
Rate for Payer: University Health Alliance Commercial	$20.89

Ident, Aerobic Isol, 4

Facility

$159.00

Service Code	HCPCS 87077
Hospital Charge Code	12499189
Hospital Revenue Code	306
Min. Negotiated Rate	$135.15
Max. Negotiated Rate	$154.23
Rate for Payer: Cash Price	$103.35
Rate for Payer: Health Management Network Commercial	$135.15
Rate for Payer: Kaiser Permanente Commercial	$143.10
Rate for Payer: MDX Hawaii PPO	$154.23

Ident, Aerobic Isol, 5

Facility

$197.00

Service Code	HCPCS 87077
Hospital Charge Code	12514788
Hospital Revenue Code	306
Min. Negotiated Rate	$167.45
Max. Negotiated Rate	$191.09
Rate for Payer: Cash Price	$128.05
Rate for Payer: Health Management Network Commercial	$167.45
Rate for Payer: Kaiser Permanente Commercial	$177.30
Rate for Payer: MDX Hawaii PPO	$191.09

Ident, Aerobic Isol, 5

Facility

$197.00

Service Code	HCPCS 87077
Hospital Charge Code	12514788
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$191.09
Rate for Payer: AlohaCare Medicaid	$98.50
Rate for Payer: AlohaCare Medicare	$98.50
Rate for Payer: Cash Price	$128.05
Rate for Payer: Cash Price	$128.05
Rate for Payer: Devoted Health Medicare	$108.35
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.10
Rate for Payer: Hawaii Medical Service Association Medicare	$98.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.72
Rate for Payer: Hawaii Western Management Group Commercial	$8.08
Rate for Payer: Health Management Network Commercial	$167.45
Rate for Payer: Humana Medicare	$98.50
Rate for Payer: Kaiser Permanente Commercial	$177.30
Rate for Payer: Kaiser Permanente Medicaid	$100.47
Rate for Payer: Kaiser Permanente Medicare	$98.50
Rate for Payer: MDX Hawaii PPO	$191.09
Rate for Payer: Ohana Health Plan Medicaid	$98.50
Rate for Payer: Ohana Health Plan Medicare	$98.50
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$98.50
Rate for Payer: University Health Alliance Commercial	$20.89

Ident, Aerobic Isol, 6

Facility

$122.00

Service Code	HCPCS 87077
Hospital Charge Code	12528439
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$118.34
Rate for Payer: AlohaCare Medicaid	$61.00
Rate for Payer: AlohaCare Medicare	$61.00
Rate for Payer: Cash Price	$79.30
Rate for Payer: Cash Price	$79.30
Rate for Payer: Devoted Health Medicare	$67.10
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.10
Rate for Payer: Hawaii Medical Service Association Medicare	$61.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11.72
Rate for Payer: Hawaii Western Management Group Commercial	$8.08
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Humana Medicare	$61.00
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Medicaid	$62.22
Rate for Payer: Kaiser Permanente Medicare	$61.00
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: Ohana Health Plan Medicaid	$61.00
Rate for Payer: Ohana Health Plan Medicare	$61.00
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$61.00
Rate for Payer: University Health Alliance Commercial	$20.89

Ident, Aerobic Isol, 6

Facility

$122.00

Service Code	HCPCS 87077
Hospital Charge Code	12528439
Hospital Revenue Code	306
Min. Negotiated Rate	$103.70
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$79.30
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: MDX Hawaii PPO	$118.34

Ident, Anaerobic Isol, 4

Facility

$213.00

Service Code	HCPCS 87076
Hospital Charge Code	12540203
Hospital Revenue Code	306
Min. Negotiated Rate	$8.08
Max. Negotiated Rate	$206.61
Rate for Payer: AlohaCare Medicaid	$106.50
Rate for Payer: AlohaCare Medicare	$106.50
Rate for Payer: Cash Price	$138.45
Rate for Payer: Cash Price	$138.45
Rate for Payer: Devoted Health Medicare	$117.15
Rate for Payer: Hawaii Medical Service Association ABD	$11.16
Rate for Payer: Hawaii Medical Service Association Commercial	$10.10
Rate for Payer: Hawaii Medical Service Association Medicare	$106.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13.95
Rate for Payer: Hawaii Western Management Group Commercial	$8.08
Rate for Payer: Health Management Network Commercial	$181.05
Rate for Payer: Humana Medicare	$106.50
Rate for Payer: Kaiser Permanente Commercial	$191.70
Rate for Payer: Kaiser Permanente Medicaid	$108.63
Rate for Payer: Kaiser Permanente Medicare	$106.50
Rate for Payer: MDX Hawaii PPO	$206.61
Rate for Payer: Ohana Health Plan Medicaid	$106.50
Rate for Payer: Ohana Health Plan Medicare	$106.50
Rate for Payer: UnitedHealthcare Medicaid	$11.16
Rate for Payer: UnitedHealthcare Medicare	$106.50
Rate for Payer: University Health Alliance Commercial	$20.89

Know your out-of-pocket cost for care.

All Charges