Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

ORTHO ULTRA SLING SHOULDER BRACE MEDIUM

Facility

$223.00

Service Code	HCPCS A4565
Hospital Charge Code	9218920
Hospital Revenue Code	271
Min. Negotiated Rate	$189.55
Max. Negotiated Rate	$216.31
Rate for Payer: Cash Price	$144.95
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: Kaiser Permanente Commercial	$200.70
Rate for Payer: MDX Hawaii PPO	$216.31

ORTHO ULTRA SLING SHOULDER BRACE MEDIUM

Facility

$223.00

Service Code	HCPCS A4565
Hospital Charge Code	9218920
Hospital Revenue Code	271
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$216.31
Rate for Payer: AlohaCare Medicaid	$111.50
Rate for Payer: AlohaCare Medicare	$111.50
Rate for Payer: Cash Price	$144.95
Rate for Payer: Cash Price	$144.95
Rate for Payer: Devoted Health Medicare	$122.65
Rate for Payer: Hawaii Medical Service Association Medicare	$111.50
Rate for Payer: Hawaii Western Management Group Commercial	$211.85
Rate for Payer: Health Management Network Commercial	$189.55
Rate for Payer: Humana Medicare	$111.50
Rate for Payer: Kaiser Permanente Commercial	$200.70
Rate for Payer: Kaiser Permanente Medicaid	$113.73
Rate for Payer: Kaiser Permanente Medicare	$111.50
Rate for Payer: MDX Hawaii PPO	$216.31
Rate for Payer: Ohana Health Plan Medicaid	$111.50
Rate for Payer: Ohana Health Plan Medicare	$111.50
Rate for Payer: UnitedHealthcare Medicaid	$10.40
Rate for Payer: UnitedHealthcare Medicare	$111.50
Rate for Payer: University Health Alliance Commercial	$162.54

oseltamivir 30 mg capsule [HHSC]

Facility

$77.42

Service Code	NDC 70710100802
Hospital Charge Code	2500617
Hospital Revenue Code	250
Min. Negotiated Rate	$38.71
Max. Negotiated Rate	$75.10
Rate for Payer: AlohaCare Medicaid	$38.71
Rate for Payer: AlohaCare Medicare	$38.71
Rate for Payer: Cash Price	$50.32
Rate for Payer: Devoted Health Medicare	$42.58
Rate for Payer: Hawaii Medical Service Association Medicare	$38.71
Rate for Payer: Hawaii Western Management Group Commercial	$73.55
Rate for Payer: Health Management Network Commercial	$65.81
Rate for Payer: Humana Medicare	$38.71
Rate for Payer: Kaiser Permanente Commercial	$69.68
Rate for Payer: Kaiser Permanente Medicaid	$39.48
Rate for Payer: Kaiser Permanente Medicare	$38.71
Rate for Payer: MDX Hawaii PPO	$75.10
Rate for Payer: Ohana Health Plan Medicaid	$38.71
Rate for Payer: Ohana Health Plan Medicare	$38.71
Rate for Payer: UnitedHealthcare Medicaid	$46.45
Rate for Payer: UnitedHealthcare Medicare	$38.71
Rate for Payer: University Health Alliance Commercial	$56.43

oseltamivir 30 mg capsule [HHSC]

Facility

$77.42

Service Code	NDC 70710100802
Hospital Charge Code	2500617
Hospital Revenue Code	250
Min. Negotiated Rate	$65.81
Max. Negotiated Rate	$75.10
Rate for Payer: Cash Price	$50.32
Rate for Payer: Health Management Network Commercial	$65.81
Rate for Payer: Kaiser Permanente Commercial	$69.68
Rate for Payer: MDX Hawaii PPO	$75.10

oseltamivir 30 mg capsule [HHSC]

Facility

$77.43

Service Code	NDC 69238126401
Hospital Charge Code	2500617
Hospital Revenue Code	250
Min. Negotiated Rate	$38.72
Max. Negotiated Rate	$75.11
Rate for Payer: AlohaCare Medicaid	$38.72
Rate for Payer: AlohaCare Medicare	$38.72
Rate for Payer: Cash Price	$50.33
Rate for Payer: Devoted Health Medicare	$42.59
Rate for Payer: Hawaii Medical Service Association Medicare	$38.72
Rate for Payer: Hawaii Western Management Group Commercial	$73.56
Rate for Payer: Health Management Network Commercial	$65.82
Rate for Payer: Humana Medicare	$38.72
Rate for Payer: Kaiser Permanente Commercial	$69.69
Rate for Payer: Kaiser Permanente Medicaid	$39.49
Rate for Payer: Kaiser Permanente Medicare	$38.72
Rate for Payer: MDX Hawaii PPO	$75.11
Rate for Payer: Ohana Health Plan Medicaid	$38.72
Rate for Payer: Ohana Health Plan Medicare	$38.72
Rate for Payer: UnitedHealthcare Medicaid	$46.46
Rate for Payer: UnitedHealthcare Medicare	$38.72
Rate for Payer: University Health Alliance Commercial	$56.44

oseltamivir 30 mg capsule [HHSC]

Facility

$77.42

Service Code	NDC 68180067511
Hospital Charge Code	2500617
Hospital Revenue Code	250
Min. Negotiated Rate	$38.71
Max. Negotiated Rate	$75.10
Rate for Payer: AlohaCare Medicaid	$38.71
Rate for Payer: AlohaCare Medicare	$38.71
Rate for Payer: Cash Price	$50.32
Rate for Payer: Devoted Health Medicare	$42.58
Rate for Payer: Hawaii Medical Service Association Medicare	$38.71
Rate for Payer: Hawaii Western Management Group Commercial	$73.55
Rate for Payer: Health Management Network Commercial	$65.81
Rate for Payer: Humana Medicare	$38.71
Rate for Payer: Kaiser Permanente Commercial	$69.68
Rate for Payer: Kaiser Permanente Medicaid	$39.48
Rate for Payer: Kaiser Permanente Medicare	$38.71
Rate for Payer: MDX Hawaii PPO	$75.10
Rate for Payer: Ohana Health Plan Medicaid	$38.71
Rate for Payer: Ohana Health Plan Medicare	$38.71
Rate for Payer: UnitedHealthcare Medicaid	$46.45
Rate for Payer: UnitedHealthcare Medicare	$38.71
Rate for Payer: University Health Alliance Commercial	$56.43

oseltamivir 30 mg capsule [HHSC]

Facility

$77.42

Service Code	NDC 68180067511
Hospital Charge Code	2500617
Hospital Revenue Code	250
Min. Negotiated Rate	$65.81
Max. Negotiated Rate	$75.10
Rate for Payer: Cash Price	$50.32
Rate for Payer: Health Management Network Commercial	$65.81
Rate for Payer: Kaiser Permanente Commercial	$69.68
Rate for Payer: MDX Hawaii PPO	$75.10

oseltamivir 30 mg capsule [HHSC]

Facility

$77.43

Service Code	NDC 69238126401
Hospital Charge Code	2500617
Hospital Revenue Code	250
Min. Negotiated Rate	$65.82
Max. Negotiated Rate	$75.11
Rate for Payer: Cash Price	$50.33
Rate for Payer: Health Management Network Commercial	$65.82
Rate for Payer: Kaiser Permanente Commercial	$69.69
Rate for Payer: MDX Hawaii PPO	$75.11

oseltamivir 6 mg/1ml 60ml [HHSC]

Facility

$584.22

Service Code	NDC 68180067801
Hospital Charge Code	2500618
Hospital Revenue Code	250
Min. Negotiated Rate	$292.11
Max. Negotiated Rate	$566.69
Rate for Payer: AlohaCare Medicaid	$292.11
Rate for Payer: AlohaCare Medicare	$292.11
Rate for Payer: Cash Price	$379.74
Rate for Payer: Devoted Health Medicare	$321.32
Rate for Payer: Hawaii Medical Service Association Medicare	$292.11
Rate for Payer: Hawaii Western Management Group Commercial	$555.01
Rate for Payer: Health Management Network Commercial	$496.59
Rate for Payer: Humana Medicare	$292.11
Rate for Payer: Kaiser Permanente Commercial	$525.80
Rate for Payer: Kaiser Permanente Medicaid	$297.95
Rate for Payer: Kaiser Permanente Medicare	$292.11
Rate for Payer: MDX Hawaii PPO	$566.69
Rate for Payer: Ohana Health Plan Medicaid	$292.11
Rate for Payer: Ohana Health Plan Medicare	$292.11
Rate for Payer: UnitedHealthcare Medicaid	$350.53
Rate for Payer: UnitedHealthcare Medicare	$292.11
Rate for Payer: University Health Alliance Commercial	$425.84

oseltamivir 6 mg/1ml 60ml [HHSC]

Facility

$584.82

Service Code	NDC 27241013909
Hospital Charge Code	2500618
Hospital Revenue Code	250
Min. Negotiated Rate	$292.41
Max. Negotiated Rate	$567.28
Rate for Payer: AlohaCare Medicaid	$292.41
Rate for Payer: AlohaCare Medicare	$292.41
Rate for Payer: Cash Price	$380.13
Rate for Payer: Devoted Health Medicare	$321.65
Rate for Payer: Hawaii Medical Service Association Medicare	$292.41
Rate for Payer: Hawaii Western Management Group Commercial	$555.58
Rate for Payer: Health Management Network Commercial	$497.10
Rate for Payer: Humana Medicare	$292.41
Rate for Payer: Kaiser Permanente Commercial	$526.34
Rate for Payer: Kaiser Permanente Medicaid	$298.26
Rate for Payer: Kaiser Permanente Medicare	$292.41
Rate for Payer: MDX Hawaii PPO	$567.28
Rate for Payer: Ohana Health Plan Medicaid	$292.41
Rate for Payer: Ohana Health Plan Medicare	$292.41
Rate for Payer: UnitedHealthcare Medicaid	$350.89
Rate for Payer: UnitedHealthcare Medicare	$292.41
Rate for Payer: University Health Alliance Commercial	$426.28

oseltamivir 6 mg/1ml 60ml [HHSC]

Facility

$584.82

Service Code	NDC 27241013909
Hospital Charge Code	2500618
Hospital Revenue Code	250
Min. Negotiated Rate	$497.10
Max. Negotiated Rate	$567.28
Rate for Payer: Cash Price	$380.13
Rate for Payer: Health Management Network Commercial	$497.10
Rate for Payer: Kaiser Permanente Commercial	$526.34
Rate for Payer: MDX Hawaii PPO	$567.28

oseltamivir 6 mg/1ml 60ml [HHSC]

Facility

$568.68

Service Code	NDC 00004082205
Hospital Charge Code	2500618
Hospital Revenue Code	250
Min. Negotiated Rate	$483.38
Max. Negotiated Rate	$551.62
Rate for Payer: Cash Price	$369.64
Rate for Payer: Health Management Network Commercial	$483.38
Rate for Payer: Kaiser Permanente Commercial	$511.81
Rate for Payer: MDX Hawaii PPO	$551.62

oseltamivir 6 mg/1ml 60ml [HHSC]

Facility

$584.82

Service Code	NDC 70710116506
Hospital Charge Code	2500618
Hospital Revenue Code	250
Min. Negotiated Rate	$292.41
Max. Negotiated Rate	$567.28
Rate for Payer: AlohaCare Medicaid	$292.41
Rate for Payer: AlohaCare Medicare	$292.41
Rate for Payer: Cash Price	$380.13
Rate for Payer: Devoted Health Medicare	$321.65
Rate for Payer: Hawaii Medical Service Association Medicare	$292.41
Rate for Payer: Hawaii Western Management Group Commercial	$555.58
Rate for Payer: Health Management Network Commercial	$497.10
Rate for Payer: Humana Medicare	$292.41
Rate for Payer: Kaiser Permanente Commercial	$526.34
Rate for Payer: Kaiser Permanente Medicaid	$298.26
Rate for Payer: Kaiser Permanente Medicare	$292.41
Rate for Payer: MDX Hawaii PPO	$567.28
Rate for Payer: Ohana Health Plan Medicaid	$292.41
Rate for Payer: Ohana Health Plan Medicare	$292.41
Rate for Payer: UnitedHealthcare Medicaid	$350.89
Rate for Payer: UnitedHealthcare Medicare	$292.41
Rate for Payer: University Health Alliance Commercial	$426.28

oseltamivir 6 mg/1ml 60ml [HHSC]

Facility

$568.68

Service Code	NDC 00004082205
Hospital Charge Code	2500618
Hospital Revenue Code	250
Min. Negotiated Rate	$284.34
Max. Negotiated Rate	$551.62
Rate for Payer: AlohaCare Medicaid	$284.34
Rate for Payer: AlohaCare Medicare	$284.34
Rate for Payer: Cash Price	$369.64
Rate for Payer: Devoted Health Medicare	$312.77
Rate for Payer: Hawaii Medical Service Association Medicare	$284.34
Rate for Payer: Hawaii Western Management Group Commercial	$540.25
Rate for Payer: Health Management Network Commercial	$483.38
Rate for Payer: Humana Medicare	$284.34
Rate for Payer: Kaiser Permanente Commercial	$511.81
Rate for Payer: Kaiser Permanente Medicaid	$290.03
Rate for Payer: Kaiser Permanente Medicare	$284.34
Rate for Payer: MDX Hawaii PPO	$551.62
Rate for Payer: Ohana Health Plan Medicaid	$284.34
Rate for Payer: Ohana Health Plan Medicare	$284.34
Rate for Payer: UnitedHealthcare Medicaid	$341.21
Rate for Payer: UnitedHealthcare Medicare	$284.34
Rate for Payer: University Health Alliance Commercial	$414.51

oseltamivir 6 mg/1ml 60ml [HHSC]

Facility

$584.82

Service Code	NDC 70710116506
Hospital Charge Code	2500618
Hospital Revenue Code	250
Min. Negotiated Rate	$497.10
Max. Negotiated Rate	$567.28
Rate for Payer: Cash Price	$380.13
Rate for Payer: Health Management Network Commercial	$497.10
Rate for Payer: Kaiser Permanente Commercial	$526.34
Rate for Payer: MDX Hawaii PPO	$567.28

oseltamivir 6 mg/1ml 60ml [HHSC]

Facility

$584.22

Service Code	NDC 68180067801
Hospital Charge Code	2500618
Hospital Revenue Code	250
Min. Negotiated Rate	$496.59
Max. Negotiated Rate	$566.69
Rate for Payer: Cash Price	$379.74
Rate for Payer: Health Management Network Commercial	$496.59
Rate for Payer: Kaiser Permanente Commercial	$525.80
Rate for Payer: MDX Hawaii PPO	$566.69

oseltamivir 75 mg capsule [HHSC]

Facility

$82.76

Service Code	NDC 69238126601
Hospital Charge Code	2500619
Hospital Revenue Code	250
Min. Negotiated Rate	$70.35
Max. Negotiated Rate	$80.28
Rate for Payer: Cash Price	$53.79
Rate for Payer: Health Management Network Commercial	$70.35
Rate for Payer: Kaiser Permanente Commercial	$74.48
Rate for Payer: MDX Hawaii PPO	$80.28

oseltamivir 75 mg capsule [HHSC]

Facility

$82.76

Service Code	NDC 47781047013
Hospital Charge Code	2500619
Hospital Revenue Code	250
Min. Negotiated Rate	$70.35
Max. Negotiated Rate	$80.28
Rate for Payer: Cash Price	$53.79
Rate for Payer: Health Management Network Commercial	$70.35
Rate for Payer: Kaiser Permanente Commercial	$74.48
Rate for Payer: MDX Hawaii PPO	$80.28

oseltamivir 75 mg capsule [HHSC]

Facility

$82.76

Service Code	NDC 68180067711
Hospital Charge Code	2500619
Hospital Revenue Code	250
Min. Negotiated Rate	$41.38
Max. Negotiated Rate	$80.28
Rate for Payer: AlohaCare Medicaid	$41.38
Rate for Payer: AlohaCare Medicare	$41.38
Rate for Payer: Cash Price	$53.79
Rate for Payer: Devoted Health Medicare	$45.52
Rate for Payer: Hawaii Medical Service Association Medicare	$41.38
Rate for Payer: Hawaii Western Management Group Commercial	$78.62
Rate for Payer: Health Management Network Commercial	$70.35
Rate for Payer: Humana Medicare	$41.38
Rate for Payer: Kaiser Permanente Commercial	$74.48
Rate for Payer: Kaiser Permanente Medicaid	$42.21
Rate for Payer: Kaiser Permanente Medicare	$41.38
Rate for Payer: MDX Hawaii PPO	$80.28
Rate for Payer: Ohana Health Plan Medicaid	$41.38
Rate for Payer: Ohana Health Plan Medicare	$41.38
Rate for Payer: UnitedHealthcare Medicaid	$49.66
Rate for Payer: UnitedHealthcare Medicare	$41.38
Rate for Payer: University Health Alliance Commercial	$60.32

oseltamivir 75 mg capsule [HHSC]

Facility

$82.76

Service Code	NDC 68180067711
Hospital Charge Code	2500619
Hospital Revenue Code	250
Min. Negotiated Rate	$70.35
Max. Negotiated Rate	$80.28
Rate for Payer: Cash Price	$53.79
Rate for Payer: Health Management Network Commercial	$70.35
Rate for Payer: Kaiser Permanente Commercial	$74.48
Rate for Payer: MDX Hawaii PPO	$80.28

oseltamivir 75 mg capsule [HHSC]

Facility

$82.76

Service Code	NDC 31722063231
Hospital Charge Code	2500619
Hospital Revenue Code	250
Min. Negotiated Rate	$41.38
Max. Negotiated Rate	$80.28
Rate for Payer: AlohaCare Medicaid	$41.38
Rate for Payer: AlohaCare Medicare	$41.38
Rate for Payer: Cash Price	$53.79
Rate for Payer: Devoted Health Medicare	$45.52
Rate for Payer: Hawaii Medical Service Association Medicare	$41.38
Rate for Payer: Hawaii Western Management Group Commercial	$78.62
Rate for Payer: Health Management Network Commercial	$70.35
Rate for Payer: Humana Medicare	$41.38
Rate for Payer: Kaiser Permanente Commercial	$74.48
Rate for Payer: Kaiser Permanente Medicaid	$42.21
Rate for Payer: Kaiser Permanente Medicare	$41.38
Rate for Payer: MDX Hawaii PPO	$80.28
Rate for Payer: Ohana Health Plan Medicaid	$41.38
Rate for Payer: Ohana Health Plan Medicare	$41.38
Rate for Payer: UnitedHealthcare Medicaid	$49.66
Rate for Payer: UnitedHealthcare Medicare	$41.38
Rate for Payer: University Health Alliance Commercial	$60.32

oseltamivir 75 mg capsule [HHSC]

Facility

$82.76

Service Code	NDC 69238126601
Hospital Charge Code	2500619
Hospital Revenue Code	250
Min. Negotiated Rate	$41.38
Max. Negotiated Rate	$80.28
Rate for Payer: AlohaCare Medicaid	$41.38
Rate for Payer: AlohaCare Medicare	$41.38
Rate for Payer: Cash Price	$53.79
Rate for Payer: Devoted Health Medicare	$45.52
Rate for Payer: Hawaii Medical Service Association Medicare	$41.38
Rate for Payer: Hawaii Western Management Group Commercial	$78.62
Rate for Payer: Health Management Network Commercial	$70.35
Rate for Payer: Humana Medicare	$41.38
Rate for Payer: Kaiser Permanente Commercial	$74.48
Rate for Payer: Kaiser Permanente Medicaid	$42.21
Rate for Payer: Kaiser Permanente Medicare	$41.38
Rate for Payer: MDX Hawaii PPO	$80.28
Rate for Payer: Ohana Health Plan Medicaid	$41.38
Rate for Payer: Ohana Health Plan Medicare	$41.38
Rate for Payer: UnitedHealthcare Medicaid	$49.66
Rate for Payer: UnitedHealthcare Medicare	$41.38
Rate for Payer: University Health Alliance Commercial	$60.32

oseltamivir 75 mg capsule [HHSC]

Facility

$82.76

Service Code	NDC 31722063231
Hospital Charge Code	2500619
Hospital Revenue Code	250
Min. Negotiated Rate	$70.35
Max. Negotiated Rate	$80.28
Rate for Payer: Cash Price	$53.79
Rate for Payer: Health Management Network Commercial	$70.35
Rate for Payer: Kaiser Permanente Commercial	$74.48
Rate for Payer: MDX Hawaii PPO	$80.28

oseltamivir 75 mg capsule [HHSC]

Facility

$82.76

Service Code	NDC 47781047013
Hospital Charge Code	2500619
Hospital Revenue Code	250
Min. Negotiated Rate	$41.38
Max. Negotiated Rate	$80.28
Rate for Payer: AlohaCare Medicaid	$41.38
Rate for Payer: AlohaCare Medicare	$41.38
Rate for Payer: Cash Price	$53.79
Rate for Payer: Devoted Health Medicare	$45.52
Rate for Payer: Hawaii Medical Service Association Medicare	$41.38
Rate for Payer: Hawaii Western Management Group Commercial	$78.62
Rate for Payer: Health Management Network Commercial	$70.35
Rate for Payer: Humana Medicare	$41.38
Rate for Payer: Kaiser Permanente Commercial	$74.48
Rate for Payer: Kaiser Permanente Medicaid	$42.21
Rate for Payer: Kaiser Permanente Medicare	$41.38
Rate for Payer: MDX Hawaii PPO	$80.28
Rate for Payer: Ohana Health Plan Medicaid	$41.38
Rate for Payer: Ohana Health Plan Medicare	$41.38
Rate for Payer: UnitedHealthcare Medicaid	$49.66
Rate for Payer: UnitedHealthcare Medicare	$41.38
Rate for Payer: University Health Alliance Commercial	$60.32

oseltamivir 75 mg capsule [HHSC]

Facility

$94.33

Service Code	NDC 00004080085
Hospital Charge Code	2500619
Hospital Revenue Code	250
Min. Negotiated Rate	$80.18
Max. Negotiated Rate	$91.50
Rate for Payer: Cash Price	$61.31
Rate for Payer: Health Management Network Commercial	$80.18
Rate for Payer: Kaiser Permanente Commercial	$84.90
Rate for Payer: MDX Hawaii PPO	$91.50

Know your out-of-pocket cost for care.

All Charges