Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

nitroprusside 50 mg/2 ml vial [HHSC]

Facility

$118.47

Service Code	NDC 43598058723
Hospital Charge Code	2500592
Hospital Revenue Code	250
Min. Negotiated Rate	$59.23
Max. Negotiated Rate	$114.92
Rate for Payer: AlohaCare Medicaid	$59.23
Rate for Payer: AlohaCare Medicare	$59.23
Rate for Payer: Cash Price	$77.01
Rate for Payer: Devoted Health Medicare	$65.16
Rate for Payer: Hawaii Medical Service Association Medicare	$59.23
Rate for Payer: Hawaii Western Management Group Commercial	$112.55
Rate for Payer: Health Management Network Commercial	$100.70
Rate for Payer: Humana Medicare	$59.23
Rate for Payer: Kaiser Permanente Commercial	$106.62
Rate for Payer: Kaiser Permanente Medicaid	$60.42
Rate for Payer: Kaiser Permanente Medicare	$59.23
Rate for Payer: MDX Hawaii PPO	$114.92
Rate for Payer: Ohana Health Plan Medicaid	$59.23
Rate for Payer: Ohana Health Plan Medicare	$59.23
Rate for Payer: UnitedHealthcare Medicaid	$71.08
Rate for Payer: UnitedHealthcare Medicare	$59.23
Rate for Payer: University Health Alliance Commercial	$86.35

nitroprusside 50 mg/2 ml vial [HHSC]

Facility

$188.19

Service Code	NDC 72485010501
Hospital Charge Code	2500592
Hospital Revenue Code	250
Min. Negotiated Rate	$94.09
Max. Negotiated Rate	$182.54
Rate for Payer: AlohaCare Medicaid	$94.09
Rate for Payer: AlohaCare Medicare	$94.09
Rate for Payer: Cash Price	$122.32
Rate for Payer: Devoted Health Medicare	$103.50
Rate for Payer: Hawaii Medical Service Association Medicare	$94.09
Rate for Payer: Hawaii Western Management Group Commercial	$178.78
Rate for Payer: Health Management Network Commercial	$159.96
Rate for Payer: Humana Medicare	$94.09
Rate for Payer: Kaiser Permanente Commercial	$169.37
Rate for Payer: Kaiser Permanente Medicaid	$95.98
Rate for Payer: Kaiser Permanente Medicare	$94.09
Rate for Payer: MDX Hawaii PPO	$182.54
Rate for Payer: Ohana Health Plan Medicaid	$94.09
Rate for Payer: Ohana Health Plan Medicare	$94.09
Rate for Payer: UnitedHealthcare Medicaid	$112.91
Rate for Payer: UnitedHealthcare Medicare	$94.09
Rate for Payer: University Health Alliance Commercial	$137.17

nitroprusside 50 mg/2 ml vial [HHSC]

Facility

$477.12

Service Code	NDC 42571026575
Hospital Charge Code	2500592
Hospital Revenue Code	250
Min. Negotiated Rate	$238.56
Max. Negotiated Rate	$462.81
Rate for Payer: AlohaCare Medicaid	$238.56
Rate for Payer: AlohaCare Medicare	$238.56
Rate for Payer: Cash Price	$310.13
Rate for Payer: Devoted Health Medicare	$262.42
Rate for Payer: Hawaii Medical Service Association Medicare	$238.56
Rate for Payer: Hawaii Western Management Group Commercial	$453.26
Rate for Payer: Health Management Network Commercial	$405.55
Rate for Payer: Humana Medicare	$238.56
Rate for Payer: Kaiser Permanente Commercial	$429.41
Rate for Payer: Kaiser Permanente Medicaid	$243.33
Rate for Payer: Kaiser Permanente Medicare	$238.56
Rate for Payer: MDX Hawaii PPO	$462.81
Rate for Payer: Ohana Health Plan Medicaid	$238.56
Rate for Payer: Ohana Health Plan Medicare	$238.56
Rate for Payer: UnitedHealthcare Medicaid	$286.27
Rate for Payer: UnitedHealthcare Medicare	$238.56
Rate for Payer: University Health Alliance Commercial	$347.77

nitroprusside 50 mg/2 ml vial [HHSC]

Facility

$477.12

Service Code	NDC 42571026575
Hospital Charge Code	2500592
Hospital Revenue Code	250
Min. Negotiated Rate	$405.55
Max. Negotiated Rate	$462.81
Rate for Payer: Cash Price	$310.13
Rate for Payer: Health Management Network Commercial	$405.55
Rate for Payer: Kaiser Permanente Commercial	$429.41
Rate for Payer: MDX Hawaii PPO	$462.81

nitroprusside 50 mg/2 ml vial [HHSC]

Facility

$447.59

Service Code	NDC 25021031066
Hospital Charge Code	2500592
Hospital Revenue Code	250
Min. Negotiated Rate	$223.79
Max. Negotiated Rate	$434.16
Rate for Payer: AlohaCare Medicaid	$223.79
Rate for Payer: AlohaCare Medicare	$223.79
Rate for Payer: Cash Price	$290.93
Rate for Payer: Devoted Health Medicare	$246.17
Rate for Payer: Hawaii Medical Service Association Medicare	$223.79
Rate for Payer: Hawaii Western Management Group Commercial	$425.21
Rate for Payer: Health Management Network Commercial	$380.45
Rate for Payer: Humana Medicare	$223.79
Rate for Payer: Kaiser Permanente Commercial	$402.83
Rate for Payer: Kaiser Permanente Medicaid	$228.27
Rate for Payer: Kaiser Permanente Medicare	$223.79
Rate for Payer: MDX Hawaii PPO	$434.16
Rate for Payer: Ohana Health Plan Medicaid	$223.79
Rate for Payer: Ohana Health Plan Medicare	$223.79
Rate for Payer: UnitedHealthcare Medicaid	$268.55
Rate for Payer: UnitedHealthcare Medicare	$223.79
Rate for Payer: University Health Alliance Commercial	$326.25

nitroprusside 50 mg/2 ml vial [HHSC]

Facility

$122.65

Service Code	NDC 70069026101
Hospital Charge Code	2500592
Hospital Revenue Code	250
Min. Negotiated Rate	$61.33
Max. Negotiated Rate	$118.97
Rate for Payer: AlohaCare Medicaid	$61.33
Rate for Payer: AlohaCare Medicare	$61.33
Rate for Payer: Cash Price	$79.72
Rate for Payer: Devoted Health Medicare	$67.46
Rate for Payer: Hawaii Medical Service Association Medicare	$61.33
Rate for Payer: Hawaii Western Management Group Commercial	$116.52
Rate for Payer: Health Management Network Commercial	$104.25
Rate for Payer: Humana Medicare	$61.33
Rate for Payer: Kaiser Permanente Commercial	$110.39
Rate for Payer: Kaiser Permanente Medicaid	$62.55
Rate for Payer: Kaiser Permanente Medicare	$61.33
Rate for Payer: MDX Hawaii PPO	$118.97
Rate for Payer: Ohana Health Plan Medicaid	$61.33
Rate for Payer: Ohana Health Plan Medicare	$61.33
Rate for Payer: UnitedHealthcare Medicaid	$73.59
Rate for Payer: UnitedHealthcare Medicare	$61.33
Rate for Payer: University Health Alliance Commercial	$89.40

nitroprusside 50 mg/2 ml vial [HHSC]

Facility

$122.65

Service Code	NDC 70069026101
Hospital Charge Code	2500592
Hospital Revenue Code	250
Min. Negotiated Rate	$104.25
Max. Negotiated Rate	$118.97
Rate for Payer: Cash Price	$79.72
Rate for Payer: Health Management Network Commercial	$104.25
Rate for Payer: Kaiser Permanente Commercial	$110.39
Rate for Payer: MDX Hawaii PPO	$118.97

nitroprusside 50 mg/2 ml vial [HHSC]

Facility

$568.04

Service Code	NDC 25021031002
Hospital Charge Code	2500592
Hospital Revenue Code	250
Min. Negotiated Rate	$482.83
Max. Negotiated Rate	$551.00
Rate for Payer: Cash Price	$369.23
Rate for Payer: Health Management Network Commercial	$482.83
Rate for Payer: Kaiser Permanente Commercial	$511.24
Rate for Payer: MDX Hawaii PPO	$551.00

nitroprusside 50 mg/2 ml vial [HHSC]

Facility

$568.04

Service Code	NDC 25021031002
Hospital Charge Code	2500592
Hospital Revenue Code	250
Min. Negotiated Rate	$284.02
Max. Negotiated Rate	$551.00
Rate for Payer: AlohaCare Medicaid	$284.02
Rate for Payer: AlohaCare Medicare	$284.02
Rate for Payer: Cash Price	$369.23
Rate for Payer: Devoted Health Medicare	$312.42
Rate for Payer: Hawaii Medical Service Association Medicare	$284.02
Rate for Payer: Hawaii Western Management Group Commercial	$539.64
Rate for Payer: Health Management Network Commercial	$482.83
Rate for Payer: Humana Medicare	$284.02
Rate for Payer: Kaiser Permanente Commercial	$511.24
Rate for Payer: Kaiser Permanente Medicaid	$289.70
Rate for Payer: Kaiser Permanente Medicare	$284.02
Rate for Payer: MDX Hawaii PPO	$551.00
Rate for Payer: Ohana Health Plan Medicaid	$284.02
Rate for Payer: Ohana Health Plan Medicare	$284.02
Rate for Payer: UnitedHealthcare Medicaid	$340.82
Rate for Payer: UnitedHealthcare Medicare	$284.02
Rate for Payer: University Health Alliance Commercial	$414.04

nitroprusside 50 mg/2 ml vial [HHSC]

Facility

$118.47

Service Code	NDC 43598058723
Hospital Charge Code	2500592
Hospital Revenue Code	250
Min. Negotiated Rate	$100.70
Max. Negotiated Rate	$114.92
Rate for Payer: Cash Price	$77.01
Rate for Payer: Health Management Network Commercial	$100.70
Rate for Payer: Kaiser Permanente Commercial	$106.62
Rate for Payer: MDX Hawaii PPO	$114.92

nitroprusside 50 mg/2 ml vial [HHSC]

Facility

$188.19

Service Code	NDC 72485010501
Hospital Charge Code	2500592
Hospital Revenue Code	250
Min. Negotiated Rate	$159.96
Max. Negotiated Rate	$182.54
Rate for Payer: Cash Price	$122.32
Rate for Payer: Health Management Network Commercial	$159.96
Rate for Payer: Kaiser Permanente Commercial	$169.37
Rate for Payer: MDX Hawaii PPO	$182.54

Nitrous Oxide Gas Charge Per Hour

Facility

$25.00

Hospital Charge Code	9864762
Hospital Revenue Code	270
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: MDX Hawaii PPO	$24.25

Nitrous Oxide Gas Charge Per Hour

Facility

$25.00

Hospital Charge Code	9864762
Hospital Revenue Code	270
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

Nitrous Oxide-OB

Facility

$20.00

Hospital Charge Code	9752159
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

Nitrous Oxide-OB

Facility

$20.00

Hospital Charge Code	9752159
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

NMDA IgG Receptor Ab Rfx Titer, CSF FSI

Facility

$139.00

Service Code	HCPCS 86255
Hospital Charge Code	8228902
Hospital Revenue Code	302
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$134.83
Rate for Payer: AlohaCare Medicaid	$69.50
Rate for Payer: AlohaCare Medicare	$69.50
Rate for Payer: Cash Price	$90.35
Rate for Payer: Cash Price	$90.35
Rate for Payer: Devoted Health Medicare	$76.45
Rate for Payer: Hawaii Medical Service Association ABD	$16.66
Rate for Payer: Hawaii Medical Service Association Commercial	$15.06
Rate for Payer: Hawaii Medical Service Association Medicare	$69.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.49
Rate for Payer: Hawaii Western Management Group Commercial	$12.05
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Humana Medicare	$69.50
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: Kaiser Permanente Medicaid	$70.89
Rate for Payer: Kaiser Permanente Medicare	$69.50
Rate for Payer: MDX Hawaii PPO	$134.83
Rate for Payer: Ohana Health Plan Medicaid	$69.50
Rate for Payer: Ohana Health Plan Medicare	$69.50
Rate for Payer: UnitedHealthcare Medicaid	$16.66
Rate for Payer: UnitedHealthcare Medicare	$69.50
Rate for Payer: University Health Alliance Commercial	$31.15

NMDA IgG Receptor Ab Rfx Titer, CSF FSI

Facility

$139.00

Service Code	HCPCS 86255
Hospital Charge Code	8228902
Hospital Revenue Code	302
Min. Negotiated Rate	$118.15
Max. Negotiated Rate	$134.83
Rate for Payer: Cash Price	$90.35
Rate for Payer: Health Management Network Commercial	$118.15
Rate for Payer: Kaiser Permanente Commercial	$125.10
Rate for Payer: MDX Hawaii PPO	$134.83

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC

Facility

$40,385.66

Service Code	MSDRG 098
Min. Negotiated Rate	$40,385.66
Max. Negotiated Rate	$40,385.66
Rate for Payer: Hawaii Medical Service Association Commercial	$40,385.66

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC

Facility

$40,385.66

Service Code	MSDRG 097
Min. Negotiated Rate	$40,385.66
Max. Negotiated Rate	$40,385.66
Rate for Payer: Hawaii Medical Service Association Commercial	$40,385.66

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$40,385.66

Service Code	MSDRG 099
Min. Negotiated Rate	$40,385.66
Max. Negotiated Rate	$40,385.66
Rate for Payer: Hawaii Medical Service Association Commercial	$40,385.66

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$40,895.58

Service Code	MSDRG 988
Min. Negotiated Rate	$40,895.58
Max. Negotiated Rate	$40,895.58
Rate for Payer: Hawaii Medical Service Association Commercial	$40,895.58

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$40,895.58

Service Code	MSDRG 987
Min. Negotiated Rate	$40,895.58
Max. Negotiated Rate	$40,895.58
Rate for Payer: Hawaii Medical Service Association Commercial	$40,895.58

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$40,895.58

Service Code	MSDRG 989
Min. Negotiated Rate	$40,895.58
Max. Negotiated Rate	$40,895.58
Rate for Payer: Hawaii Medical Service Association Commercial	$40,895.58

NON-MALIGNANT BREAST DISORDERS WITH CC/MCC

Facility

$17,209.80

Service Code	MSDRG 600
Min. Negotiated Rate	$17,209.80
Max. Negotiated Rate	$17,209.80
Rate for Payer: Hawaii Medical Service Association Commercial	$17,209.80

NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$17,209.80

Service Code	MSDRG 601
Min. Negotiated Rate	$17,209.80
Max. Negotiated Rate	$17,209.80
Rate for Payer: Hawaii Medical Service Association Commercial	$17,209.80

Know your out-of-pocket cost for care.

All Charges