Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

IRRIGATION .9% NACL 2000ML

Facility

$17.00

Hospital Charge Code	8266622
Hospital Revenue Code	270
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$16.49
Rate for Payer: AlohaCare Medicaid	$8.50
Rate for Payer: AlohaCare Medicare	$8.50
Rate for Payer: Cash Price	$11.05
Rate for Payer: Devoted Health Medicare	$9.35
Rate for Payer: Hawaii Medical Service Association Medicare	$8.50
Rate for Payer: Hawaii Western Management Group Commercial	$16.15
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Humana Medicare	$8.50
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: Kaiser Permanente Medicaid	$8.67
Rate for Payer: Kaiser Permanente Medicare	$8.50
Rate for Payer: MDX Hawaii PPO	$16.49
Rate for Payer: Ohana Health Plan Medicaid	$8.50
Rate for Payer: Ohana Health Plan Medicare	$8.50
Rate for Payer: UnitedHealthcare Medicare	$8.50
Rate for Payer: University Health Alliance Commercial	$12.39

IRRIGATION .9% NACL 2000ML

Facility

$17.00

Hospital Charge Code	8266622
Hospital Revenue Code	270
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$11.05
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: MDX Hawaii PPO	$16.49

IRRIGATION .9% NACL 3000ML BAG

Facility

$66.00

Hospital Charge Code	8266581
Hospital Revenue Code	270
Min. Negotiated Rate	$56.10
Max. Negotiated Rate	$64.02
Rate for Payer: Cash Price	$42.90
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: MDX Hawaii PPO	$64.02

IRRIGATION .9% NACL 3000ML BAG

Facility

$66.00

Hospital Charge Code	8266581
Hospital Revenue Code	270
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$64.02
Rate for Payer: AlohaCare Medicaid	$33.00
Rate for Payer: AlohaCare Medicare	$33.00
Rate for Payer: Cash Price	$42.90
Rate for Payer: Devoted Health Medicare	$36.30
Rate for Payer: Hawaii Medical Service Association Medicare	$33.00
Rate for Payer: Hawaii Western Management Group Commercial	$62.70
Rate for Payer: Health Management Network Commercial	$56.10
Rate for Payer: Humana Medicare	$33.00
Rate for Payer: Kaiser Permanente Commercial	$59.40
Rate for Payer: Kaiser Permanente Medicaid	$33.66
Rate for Payer: Kaiser Permanente Medicare	$33.00
Rate for Payer: MDX Hawaii PPO	$64.02
Rate for Payer: Ohana Health Plan Medicaid	$33.00
Rate for Payer: Ohana Health Plan Medicare	$33.00
Rate for Payer: UnitedHealthcare Medicare	$33.00
Rate for Payer: University Health Alliance Commercial	$48.11

IRRIGATION .9% NACL 500ML CONTAINER

Facility

$12.00

Hospital Charge Code	8266421
Hospital Revenue Code	272
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$11.64
Rate for Payer: Cash Price	$7.80
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: MDX Hawaii PPO	$11.64

IRRIGATION .9% NACL 500ML CONTAINER

Facility

$12.00

Hospital Charge Code	8266421
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$11.64
Rate for Payer: AlohaCare Medicaid	$6.00
Rate for Payer: AlohaCare Medicare	$6.00
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$6.60
Rate for Payer: Hawaii Medical Service Association Medicare	$6.00
Rate for Payer: Hawaii Western Management Group Commercial	$11.40
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Humana Medicare	$6.00
Rate for Payer: Kaiser Permanente Commercial	$10.80
Rate for Payer: Kaiser Permanente Medicaid	$6.12
Rate for Payer: Kaiser Permanente Medicare	$6.00
Rate for Payer: MDX Hawaii PPO	$11.64
Rate for Payer: Ohana Health Plan Medicaid	$6.00
Rate for Payer: Ohana Health Plan Medicare	$6.00
Rate for Payer: UnitedHealthcare Medicare	$6.00
Rate for Payer: University Health Alliance Commercial	$8.75

IRRIGATION STERILE WATER 1000ML

Facility

$24.00

Hospital Charge Code	8266619
Hospital Revenue Code	270
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$23.28
Rate for Payer: Cash Price	$15.60
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Kaiser Permanente Commercial	$21.60
Rate for Payer: MDX Hawaii PPO	$23.28

IRRIGATION STERILE WATER 1000ML

Facility

$24.00

Hospital Charge Code	8266619
Hospital Revenue Code	270
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$23.28
Rate for Payer: AlohaCare Medicaid	$12.00
Rate for Payer: AlohaCare Medicare	$12.00
Rate for Payer: Cash Price	$15.60
Rate for Payer: Devoted Health Medicare	$13.20
Rate for Payer: Hawaii Medical Service Association Medicare	$12.00
Rate for Payer: Hawaii Western Management Group Commercial	$22.80
Rate for Payer: Health Management Network Commercial	$20.40
Rate for Payer: Humana Medicare	$12.00
Rate for Payer: Kaiser Permanente Commercial	$21.60
Rate for Payer: Kaiser Permanente Medicaid	$12.24
Rate for Payer: Kaiser Permanente Medicare	$12.00
Rate for Payer: MDX Hawaii PPO	$23.28
Rate for Payer: Ohana Health Plan Medicaid	$12.00
Rate for Payer: Ohana Health Plan Medicare	$12.00
Rate for Payer: UnitedHealthcare Medicare	$12.00
Rate for Payer: University Health Alliance Commercial	$17.49

IRRIGATION STERILE WATER 2000ML (PLEASE ORDER CDM 670 - 2000ML IRRIGATION BAG)

Facility

$13.00

Hospital Charge Code	8266620
Hospital Revenue Code	270
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$8.45
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: MDX Hawaii PPO	$12.61

IRRIGATION STERILE WATER 2000ML (PLEASE ORDER CDM 670 - 2000ML IRRIGATION BAG)

Facility

$13.00

Hospital Charge Code	8266620
Hospital Revenue Code	270
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$12.61
Rate for Payer: AlohaCare Medicaid	$6.50
Rate for Payer: AlohaCare Medicare	$6.50
Rate for Payer: Cash Price	$8.45
Rate for Payer: Devoted Health Medicare	$7.15
Rate for Payer: Hawaii Medical Service Association Medicare	$6.50
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Humana Medicare	$6.50
Rate for Payer: Kaiser Permanente Commercial	$11.70
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: Kaiser Permanente Medicare	$6.50
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: Ohana Health Plan Medicaid	$6.50
Rate for Payer: Ohana Health Plan Medicare	$6.50
Rate for Payer: UnitedHealthcare Medicare	$6.50
Rate for Payer: University Health Alliance Commercial	$9.48

IRRIGATION STERILE WATER 500ML CONTAINER

Facility

$20.00

Hospital Charge Code	8266401
Hospital Revenue Code	270
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$13.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: MDX Hawaii PPO	$19.40

IRRIGATION STERILE WATER 500ML CONTAINER

Facility

$20.00

Hospital Charge Code	8266401
Hospital Revenue Code	270
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$19.40
Rate for Payer: AlohaCare Medicaid	$10.00
Rate for Payer: AlohaCare Medicare	$10.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Devoted Health Medicare	$11.00
Rate for Payer: Hawaii Medical Service Association Medicare	$10.00
Rate for Payer: Hawaii Western Management Group Commercial	$19.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Humana Medicare	$10.00
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: Kaiser Permanente Medicaid	$10.20
Rate for Payer: Kaiser Permanente Medicare	$10.00
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: Ohana Health Plan Medicaid	$10.00
Rate for Payer: Ohana Health Plan Medicare	$10.00
Rate for Payer: UnitedHealthcare Medicare	$10.00
Rate for Payer: University Health Alliance Commercial	$14.58

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC

Facility

$54,663.42

Service Code	MSDRG 062
Min. Negotiated Rate	$54,663.42
Max. Negotiated Rate	$54,663.42
Rate for Payer: Hawaii Medical Service Association Commercial	$54,663.42

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC

Facility

$54,663.42

Service Code	MSDRG 061
Min. Negotiated Rate	$54,663.42
Max. Negotiated Rate	$54,663.42
Rate for Payer: Hawaii Medical Service Association Commercial	$54,663.42

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC

Facility

$54,663.42

Service Code	MSDRG 063
Min. Negotiated Rate	$54,663.42
Max. Negotiated Rate	$54,663.42
Rate for Payer: Hawaii Medical Service Association Commercial	$54,663.42

isoflurane 100% inhalation gas [HHSC]

Facility

$26.06

Service Code	NDC 66794001710
Hospital Charge Code	2500428
Hospital Revenue Code	250
Min. Negotiated Rate	$13.03
Max. Negotiated Rate	$25.28
Rate for Payer: AlohaCare Medicaid	$13.03
Rate for Payer: AlohaCare Medicare	$13.03
Rate for Payer: Cash Price	$16.94
Rate for Payer: Devoted Health Medicare	$14.33
Rate for Payer: Hawaii Medical Service Association Medicare	$13.03
Rate for Payer: Hawaii Western Management Group Commercial	$24.76
Rate for Payer: Health Management Network Commercial	$22.15
Rate for Payer: Humana Medicare	$13.03
Rate for Payer: Kaiser Permanente Commercial	$23.45
Rate for Payer: Kaiser Permanente Medicaid	$13.29
Rate for Payer: Kaiser Permanente Medicare	$13.03
Rate for Payer: MDX Hawaii PPO	$25.28
Rate for Payer: Ohana Health Plan Medicaid	$13.03
Rate for Payer: Ohana Health Plan Medicare	$13.03
Rate for Payer: UnitedHealthcare Medicaid	$15.64
Rate for Payer: UnitedHealthcare Medicare	$13.03
Rate for Payer: University Health Alliance Commercial	$19.00

isoflurane 100% inhalation gas [HHSC]

Facility

$20.85

Service Code	NDC 66794001910
Hospital Charge Code	2500428
Hospital Revenue Code	250
Min. Negotiated Rate	$10.43
Max. Negotiated Rate	$20.22
Rate for Payer: AlohaCare Medicaid	$10.43
Rate for Payer: AlohaCare Medicare	$10.43
Rate for Payer: Cash Price	$13.55
Rate for Payer: Devoted Health Medicare	$11.47
Rate for Payer: Hawaii Medical Service Association Medicare	$10.43
Rate for Payer: Hawaii Western Management Group Commercial	$19.81
Rate for Payer: Health Management Network Commercial	$17.72
Rate for Payer: Humana Medicare	$10.43
Rate for Payer: Kaiser Permanente Commercial	$18.77
Rate for Payer: Kaiser Permanente Medicaid	$10.63
Rate for Payer: Kaiser Permanente Medicare	$10.43
Rate for Payer: MDX Hawaii PPO	$20.22
Rate for Payer: Ohana Health Plan Medicaid	$10.43
Rate for Payer: Ohana Health Plan Medicare	$10.43
Rate for Payer: UnitedHealthcare Medicaid	$12.51
Rate for Payer: UnitedHealthcare Medicare	$10.43
Rate for Payer: University Health Alliance Commercial	$15.20

isoflurane 100% inhalation gas [HHSC]

Facility

$20.85

Service Code	NDC 66794001910
Hospital Charge Code	2500428
Hospital Revenue Code	250
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$20.22
Rate for Payer: Cash Price	$13.55
Rate for Payer: Health Management Network Commercial	$17.72
Rate for Payer: Kaiser Permanente Commercial	$18.77
Rate for Payer: MDX Hawaii PPO	$20.22

isoflurane 100% inhalation gas [HHSC]

Facility

$26.06

Service Code	NDC 66794001710
Hospital Charge Code	2500428
Hospital Revenue Code	250
Min. Negotiated Rate	$22.15
Max. Negotiated Rate	$25.28
Rate for Payer: Cash Price	$16.94
Rate for Payer: Health Management Network Commercial	$22.15
Rate for Payer: Kaiser Permanente Commercial	$23.45
Rate for Payer: MDX Hawaii PPO	$25.28

isoniazid 300 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 00555007102
Hospital Charge Code	2500429
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

isoniazid 300 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 00555007102
Hospital Charge Code	2500429
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

isoniazid 300 mg tablet [HHSC]

Facility

$26.02

Service Code	NDC 81665010830
Hospital Charge Code	2500429
Hospital Revenue Code	250
Min. Negotiated Rate	$13.01
Max. Negotiated Rate	$25.24
Rate for Payer: AlohaCare Medicaid	$13.01
Rate for Payer: AlohaCare Medicare	$13.01
Rate for Payer: Cash Price	$16.91
Rate for Payer: Devoted Health Medicare	$14.31
Rate for Payer: Hawaii Medical Service Association Medicare	$13.01
Rate for Payer: Hawaii Western Management Group Commercial	$24.72
Rate for Payer: Health Management Network Commercial	$22.12
Rate for Payer: Humana Medicare	$13.01
Rate for Payer: Kaiser Permanente Commercial	$23.42
Rate for Payer: Kaiser Permanente Medicaid	$13.27
Rate for Payer: Kaiser Permanente Medicare	$13.01
Rate for Payer: MDX Hawaii PPO	$25.24
Rate for Payer: Ohana Health Plan Medicaid	$13.01
Rate for Payer: Ohana Health Plan Medicare	$13.01
Rate for Payer: UnitedHealthcare Medicaid	$15.61
Rate for Payer: UnitedHealthcare Medicare	$13.01
Rate for Payer: University Health Alliance Commercial	$18.97

isoniazid 300 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 00555007101
Hospital Charge Code	2500429
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

isoniazid 300 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 00555007101
Hospital Charge Code	2500429
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

isoniazid 300 mg tablet [HHSC]

Facility

$26.02

Service Code	NDC 81665010830
Hospital Charge Code	2500429
Hospital Revenue Code	250
Min. Negotiated Rate	$22.12
Max. Negotiated Rate	$25.24
Rate for Payer: Cash Price	$16.91
Rate for Payer: Health Management Network Commercial	$22.12
Rate for Payer: Kaiser Permanente Commercial	$23.42
Rate for Payer: MDX Hawaii PPO	$25.24

Know your out-of-pocket cost for care.

All Charges