Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

potassium chlor 20 mEq packet [HHSC]

Facility

$61.98

Service Code	NDC 69543037930
Hospital Charge Code	2500678
Hospital Revenue Code	250
Min. Negotiated Rate	$30.99
Max. Negotiated Rate	$60.12
Rate for Payer: AlohaCare Medicaid	$30.99
Rate for Payer: AlohaCare Medicare	$30.99
Rate for Payer: Cash Price	$40.29
Rate for Payer: Devoted Health Medicare	$34.09
Rate for Payer: Hawaii Medical Service Association Medicare	$30.99
Rate for Payer: Hawaii Western Management Group Commercial	$58.88
Rate for Payer: Health Management Network Commercial	$52.68
Rate for Payer: Humana Medicare	$30.99
Rate for Payer: Kaiser Permanente Commercial	$55.78
Rate for Payer: Kaiser Permanente Medicaid	$31.61
Rate for Payer: Kaiser Permanente Medicare	$30.99
Rate for Payer: MDX Hawaii PPO	$60.12
Rate for Payer: Ohana Health Plan Medicaid	$30.99
Rate for Payer: Ohana Health Plan Medicare	$30.99
Rate for Payer: UnitedHealthcare Medicaid	$37.19
Rate for Payer: UnitedHealthcare Medicare	$30.99
Rate for Payer: University Health Alliance Commercial	$45.18

potassium chlor 20 mEq packet [HHSC]

Facility

$61.98

Service Code	NDC 69543045130
Hospital Charge Code	2500678
Hospital Revenue Code	250
Min. Negotiated Rate	$52.68
Max. Negotiated Rate	$60.12
Rate for Payer: Cash Price	$40.29
Rate for Payer: Health Management Network Commercial	$52.68
Rate for Payer: Kaiser Permanente Commercial	$55.78
Rate for Payer: MDX Hawaii PPO	$60.12

potassium chlor ER 10 mEq tablet [HHSC]

Facility

$3.40

Service Code	NDC 68084052401
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$3.30
Rate for Payer: Cash Price	$2.21
Rate for Payer: Health Management Network Commercial	$2.89
Rate for Payer: Kaiser Permanente Commercial	$3.06
Rate for Payer: MDX Hawaii PPO	$3.30

potassium chlor ER 10 mEq tablet [HHSC]

Facility

$3.14

Service Code	NDC 00245531611
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$3.05
Rate for Payer: Cash Price	$2.04
Rate for Payer: Health Management Network Commercial	$2.67
Rate for Payer: Kaiser Permanente Commercial	$2.83
Rate for Payer: MDX Hawaii PPO	$3.05

potassium chlor ER 10 mEq tablet [HHSC]

Facility

$3.62

Service Code	NDC 00245531601
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$3.51
Rate for Payer: AlohaCare Medicaid	$1.81
Rate for Payer: AlohaCare Medicare	$1.81
Rate for Payer: Cash Price	$2.35
Rate for Payer: Devoted Health Medicare	$1.99
Rate for Payer: Hawaii Medical Service Association Medicare	$1.81
Rate for Payer: Hawaii Western Management Group Commercial	$3.44
Rate for Payer: Health Management Network Commercial	$3.08
Rate for Payer: Humana Medicare	$1.81
Rate for Payer: Kaiser Permanente Commercial	$3.26
Rate for Payer: Kaiser Permanente Medicaid	$1.85
Rate for Payer: Kaiser Permanente Medicare	$1.81
Rate for Payer: MDX Hawaii PPO	$3.51
Rate for Payer: Ohana Health Plan Medicaid	$1.81
Rate for Payer: Ohana Health Plan Medicare	$1.81
Rate for Payer: UnitedHealthcare Medicaid	$2.17
Rate for Payer: UnitedHealthcare Medicare	$1.81
Rate for Payer: University Health Alliance Commercial	$2.64

potassium chlor ER 10 mEq tablet [HHSC]

Facility

$3.14

Service Code	NDC 65862098701
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$3.05
Rate for Payer: Cash Price	$2.04
Rate for Payer: Health Management Network Commercial	$2.67
Rate for Payer: Kaiser Permanente Commercial	$2.83
Rate for Payer: MDX Hawaii PPO	$3.05

potassium chlor ER 10 mEq tablet [HHSC]

Facility

$3.62

Service Code	NDC 00245531601
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$3.51
Rate for Payer: Cash Price	$2.35
Rate for Payer: Health Management Network Commercial	$3.08
Rate for Payer: Kaiser Permanente Commercial	$3.26
Rate for Payer: MDX Hawaii PPO	$3.51

potassium chlor ER 10 mEq tablet [HHSC]

Facility

$3.40

Service Code	NDC 68084052401
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$3.30
Rate for Payer: AlohaCare Medicaid	$1.70
Rate for Payer: AlohaCare Medicare	$1.70
Rate for Payer: Cash Price	$2.21
Rate for Payer: Devoted Health Medicare	$1.87
Rate for Payer: Hawaii Medical Service Association Medicare	$1.70
Rate for Payer: Hawaii Western Management Group Commercial	$3.23
Rate for Payer: Health Management Network Commercial	$2.89
Rate for Payer: Humana Medicare	$1.70
Rate for Payer: Kaiser Permanente Commercial	$3.06
Rate for Payer: Kaiser Permanente Medicaid	$1.73
Rate for Payer: Kaiser Permanente Medicare	$1.70
Rate for Payer: MDX Hawaii PPO	$3.30
Rate for Payer: Ohana Health Plan Medicaid	$1.70
Rate for Payer: Ohana Health Plan Medicare	$1.70
Rate for Payer: UnitedHealthcare Medicaid	$2.04
Rate for Payer: UnitedHealthcare Medicare	$1.70
Rate for Payer: University Health Alliance Commercial	$2.48

potassium chlor ER 10 mEq tablet [HHSC]

Facility

$3.40

Service Code	NDC 60687046601
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$3.30
Rate for Payer: Cash Price	$2.21
Rate for Payer: Health Management Network Commercial	$2.89
Rate for Payer: Kaiser Permanente Commercial	$3.06
Rate for Payer: MDX Hawaii PPO	$3.30

potassium chlor ER 10 mEq tablet [HHSC]

Facility

$3.40

Service Code	NDC 60687046601
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$3.30
Rate for Payer: AlohaCare Medicaid	$1.70
Rate for Payer: AlohaCare Medicare	$1.70
Rate for Payer: Cash Price	$2.21
Rate for Payer: Devoted Health Medicare	$1.87
Rate for Payer: Hawaii Medical Service Association Medicare	$1.70
Rate for Payer: Hawaii Western Management Group Commercial	$3.23
Rate for Payer: Health Management Network Commercial	$2.89
Rate for Payer: Humana Medicare	$1.70
Rate for Payer: Kaiser Permanente Commercial	$3.06
Rate for Payer: Kaiser Permanente Medicaid	$1.73
Rate for Payer: Kaiser Permanente Medicare	$1.70
Rate for Payer: MDX Hawaii PPO	$3.30
Rate for Payer: Ohana Health Plan Medicaid	$1.70
Rate for Payer: Ohana Health Plan Medicare	$1.70
Rate for Payer: UnitedHealthcare Medicaid	$2.04
Rate for Payer: UnitedHealthcare Medicare	$1.70
Rate for Payer: University Health Alliance Commercial	$2.48

potassium chlor ER 10 mEq tablet [HHSC]

Facility

$3.00

Service Code	NDC 60687081009
Hospital Charge Code	2500673
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

potassium chlor ER 10 mEq tablet [HHSC]

Facility

$3.14

Service Code	NDC 68001051800
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$3.05
Rate for Payer: AlohaCare Medicaid	$1.57
Rate for Payer: AlohaCare Medicare	$1.57
Rate for Payer: Cash Price	$2.04
Rate for Payer: Devoted Health Medicare	$1.73
Rate for Payer: Hawaii Medical Service Association Medicare	$1.57
Rate for Payer: Hawaii Western Management Group Commercial	$2.98
Rate for Payer: Health Management Network Commercial	$2.67
Rate for Payer: Humana Medicare	$1.57
Rate for Payer: Kaiser Permanente Commercial	$2.83
Rate for Payer: Kaiser Permanente Medicaid	$1.60
Rate for Payer: Kaiser Permanente Medicare	$1.57
Rate for Payer: MDX Hawaii PPO	$3.05
Rate for Payer: Ohana Health Plan Medicaid	$1.57
Rate for Payer: Ohana Health Plan Medicare	$1.57
Rate for Payer: UnitedHealthcare Medicaid	$1.88
Rate for Payer: UnitedHealthcare Medicare	$1.57
Rate for Payer: University Health Alliance Commercial	$2.29

potassium chlor ER 10 mEq tablet [HHSC]

Facility

$3.43

Service Code	NDC 00245531701
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$3.33
Rate for Payer: AlohaCare Medicaid	$1.72
Rate for Payer: AlohaCare Medicare	$1.72
Rate for Payer: Cash Price	$2.23
Rate for Payer: Devoted Health Medicare	$1.89
Rate for Payer: Hawaii Medical Service Association Medicare	$1.72
Rate for Payer: Hawaii Western Management Group Commercial	$3.26
Rate for Payer: Health Management Network Commercial	$2.92
Rate for Payer: Humana Medicare	$1.72
Rate for Payer: Kaiser Permanente Commercial	$3.09
Rate for Payer: Kaiser Permanente Medicaid	$1.75
Rate for Payer: Kaiser Permanente Medicare	$1.72
Rate for Payer: MDX Hawaii PPO	$3.33
Rate for Payer: Ohana Health Plan Medicaid	$1.72
Rate for Payer: Ohana Health Plan Medicare	$1.72
Rate for Payer: UnitedHealthcare Medicaid	$2.06
Rate for Payer: UnitedHealthcare Medicare	$1.72
Rate for Payer: University Health Alliance Commercial	$2.50

potassium chlor ER 10 mEq tablet [HHSC]

Facility

$3.43

Service Code	NDC 00245531701
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$3.33
Rate for Payer: Cash Price	$2.23
Rate for Payer: Health Management Network Commercial	$2.92
Rate for Payer: Kaiser Permanente Commercial	$3.09
Rate for Payer: MDX Hawaii PPO	$3.33

potassium chlor ER 10 mEq tablet [HHSC]

Facility

$3.00

Service Code	NDC 60687081009
Hospital Charge Code	2500673
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

potassium chlor ER 10 mEq tablet [HHSC]

Facility

$3.14

Service Code	NDC 65862098701
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$3.05
Rate for Payer: AlohaCare Medicaid	$1.57
Rate for Payer: AlohaCare Medicare	$1.57
Rate for Payer: Cash Price	$2.04
Rate for Payer: Devoted Health Medicare	$1.73
Rate for Payer: Hawaii Medical Service Association Medicare	$1.57
Rate for Payer: Hawaii Western Management Group Commercial	$2.98
Rate for Payer: Health Management Network Commercial	$2.67
Rate for Payer: Humana Medicare	$1.57
Rate for Payer: Kaiser Permanente Commercial	$2.83
Rate for Payer: Kaiser Permanente Medicaid	$1.60
Rate for Payer: Kaiser Permanente Medicare	$1.57
Rate for Payer: MDX Hawaii PPO	$3.05
Rate for Payer: Ohana Health Plan Medicaid	$1.57
Rate for Payer: Ohana Health Plan Medicare	$1.57
Rate for Payer: UnitedHealthcare Medicaid	$1.88
Rate for Payer: UnitedHealthcare Medicare	$1.57
Rate for Payer: University Health Alliance Commercial	$2.29

potassium chlor ER 10 mEq tablet [HHSC]

Facility

$3.14

Service Code	NDC 00245531611
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$3.05
Rate for Payer: AlohaCare Medicaid	$1.57
Rate for Payer: AlohaCare Medicare	$1.57
Rate for Payer: Cash Price	$2.04
Rate for Payer: Devoted Health Medicare	$1.73
Rate for Payer: Hawaii Medical Service Association Medicare	$1.57
Rate for Payer: Hawaii Western Management Group Commercial	$2.98
Rate for Payer: Health Management Network Commercial	$2.67
Rate for Payer: Humana Medicare	$1.57
Rate for Payer: Kaiser Permanente Commercial	$2.83
Rate for Payer: Kaiser Permanente Medicaid	$1.60
Rate for Payer: Kaiser Permanente Medicare	$1.57
Rate for Payer: MDX Hawaii PPO	$3.05
Rate for Payer: Ohana Health Plan Medicaid	$1.57
Rate for Payer: Ohana Health Plan Medicare	$1.57
Rate for Payer: UnitedHealthcare Medicaid	$1.88
Rate for Payer: UnitedHealthcare Medicare	$1.57
Rate for Payer: University Health Alliance Commercial	$2.29

potassium chlor ER 10 mEq tablet [HHSC]

Facility

$3.62

Service Code	NDC 66758016013
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$3.51
Rate for Payer: Cash Price	$2.35
Rate for Payer: AlohaCare Medicaid	$1.81
Rate for Payer: AlohaCare Medicare	$1.81
Rate for Payer: Devoted Health Medicare	$1.99
Rate for Payer: Hawaii Medical Service Association Medicare	$1.81
Rate for Payer: Hawaii Western Management Group Commercial	$3.44
Rate for Payer: Health Management Network Commercial	$3.08
Rate for Payer: Humana Medicare	$1.81
Rate for Payer: Kaiser Permanente Commercial	$3.26
Rate for Payer: Kaiser Permanente Medicaid	$1.85
Rate for Payer: Kaiser Permanente Medicare	$1.81
Rate for Payer: MDX Hawaii PPO	$3.51
Rate for Payer: Ohana Health Plan Medicaid	$1.81
Rate for Payer: Ohana Health Plan Medicare	$1.81
Rate for Payer: UnitedHealthcare Medicaid	$2.17
Rate for Payer: UnitedHealthcare Medicare	$1.81
Rate for Payer: University Health Alliance Commercial	$2.64

potassium chlor ER 10 mEq tablet [HHSC]

Facility

$3.14

Service Code	NDC 68001051800
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$3.05
Rate for Payer: Cash Price	$2.04
Rate for Payer: Health Management Network Commercial	$2.67
Rate for Payer: Kaiser Permanente Commercial	$2.83
Rate for Payer: MDX Hawaii PPO	$3.05

potassium chlor ER 10 mEq tablet [HHSC]

Facility

$3.62

Service Code	NDC 66758016013
Hospital Charge Code	2500673
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$3.51
Rate for Payer: Cash Price	$2.35
Rate for Payer: Health Management Network Commercial	$3.08
Rate for Payer: Kaiser Permanente Commercial	$3.26
Rate for Payer: MDX Hawaii PPO	$3.51

potassium chlor ER 20 mEq tablet [HHSC]

Facility

$3.78

Service Code	NDC 00245531901
Hospital Charge Code	2500677
Hospital Revenue Code	250
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$3.67
Rate for Payer: Cash Price	$2.46
Rate for Payer: Health Management Network Commercial	$3.21
Rate for Payer: Kaiser Permanente Commercial	$3.40
Rate for Payer: MDX Hawaii PPO	$3.67

potassium chlor ER 20 mEq tablet [HHSC]

Facility

$3.78

Service Code	NDC 00245531901
Hospital Charge Code	2500677
Hospital Revenue Code	250
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$3.67
Rate for Payer: AlohaCare Medicaid	$1.89
Rate for Payer: AlohaCare Medicare	$1.89
Rate for Payer: Cash Price	$2.46
Rate for Payer: Devoted Health Medicare	$2.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1.89
Rate for Payer: Hawaii Western Management Group Commercial	$3.59
Rate for Payer: Health Management Network Commercial	$3.21
Rate for Payer: Humana Medicare	$1.89
Rate for Payer: Kaiser Permanente Commercial	$3.40
Rate for Payer: Kaiser Permanente Medicaid	$1.93
Rate for Payer: Kaiser Permanente Medicare	$1.89
Rate for Payer: MDX Hawaii PPO	$3.67
Rate for Payer: Ohana Health Plan Medicaid	$1.89
Rate for Payer: Ohana Health Plan Medicare	$1.89
Rate for Payer: UnitedHealthcare Medicaid	$2.27
Rate for Payer: UnitedHealthcare Medicare	$1.89
Rate for Payer: University Health Alliance Commercial	$2.76

potassium chlor ER 20 mEq tablet [HHSC]

Facility

$5.17

Service Code	NDC 63739044710
Hospital Charge Code	2500677
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$5.01
Rate for Payer: AlohaCare Medicaid	$2.58
Rate for Payer: AlohaCare Medicare	$2.58
Rate for Payer: Cash Price	$3.36
Rate for Payer: Devoted Health Medicare	$2.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2.58
Rate for Payer: Hawaii Western Management Group Commercial	$4.91
Rate for Payer: Health Management Network Commercial	$4.39
Rate for Payer: Humana Medicare	$2.58
Rate for Payer: Kaiser Permanente Commercial	$4.65
Rate for Payer: Kaiser Permanente Medicaid	$2.64
Rate for Payer: Kaiser Permanente Medicare	$2.58
Rate for Payer: MDX Hawaii PPO	$5.01
Rate for Payer: Ohana Health Plan Medicaid	$2.58
Rate for Payer: Ohana Health Plan Medicare	$2.58
Rate for Payer: UnitedHealthcare Medicaid	$3.10
Rate for Payer: UnitedHealthcare Medicare	$2.58
Rate for Payer: University Health Alliance Commercial	$3.77

potassium chlor ER 20 mEq tablet [HHSC]

Facility

$4.44

Service Code	NDC 68084036009
Hospital Charge Code	2500677
Hospital Revenue Code	250
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$4.31
Rate for Payer: Cash Price	$2.89
Rate for Payer: Health Management Network Commercial	$3.77
Rate for Payer: Kaiser Permanente Commercial	$4.00
Rate for Payer: MDX Hawaii PPO	$4.31

potassium chlor ER 20 mEq tablet [HHSC]

Facility

$4.44

Service Code	NDC 68084036009
Hospital Charge Code	2500677
Hospital Revenue Code	250
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$4.31
Rate for Payer: AlohaCare Medicaid	$2.22
Rate for Payer: AlohaCare Medicare	$2.22
Rate for Payer: Cash Price	$2.89
Rate for Payer: Devoted Health Medicare	$2.44
Rate for Payer: Hawaii Medical Service Association Medicare	$2.22
Rate for Payer: Hawaii Western Management Group Commercial	$4.22
Rate for Payer: Health Management Network Commercial	$3.77
Rate for Payer: Humana Medicare	$2.22
Rate for Payer: Kaiser Permanente Commercial	$4.00
Rate for Payer: Kaiser Permanente Medicaid	$2.26
Rate for Payer: Kaiser Permanente Medicare	$2.22
Rate for Payer: MDX Hawaii PPO	$4.31
Rate for Payer: Ohana Health Plan Medicaid	$2.22
Rate for Payer: Ohana Health Plan Medicare	$2.22
Rate for Payer: UnitedHealthcare Medicaid	$2.66
Rate for Payer: UnitedHealthcare Medicare	$2.22
Rate for Payer: University Health Alliance Commercial	$3.24

Know your out-of-pocket cost for care.

All Charges