Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

potassium chlor ER 20 mEq tablet [HHSC]

Facility

$3.78

Service Code	NDC 66758019013
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

$3.49

Service Code	NDC 68001056700
Hospital Charge Code	2500677
Hospital Revenue Code	250
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$3.39
Rate for Payer: Cash Price	$2.27
Rate for Payer: Health Management Network Commercial	$2.97
Rate for Payer: Kaiser Permanente Commercial	$3.14
Rate for Payer: MDX Hawaii PPO	$3.39

potassium chlor ER 20 mEq tablet [HHSC]

Facility

$3.49

Service Code	NDC 68001056700
Hospital Charge Code	2500677
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$3.39
Rate for Payer: AlohaCare Medicaid	$1.75
Rate for Payer: AlohaCare Medicare	$1.75
Rate for Payer: Cash Price	$2.27
Rate for Payer: Devoted Health Medicare	$1.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1.75
Rate for Payer: Hawaii Western Management Group Commercial	$3.32
Rate for Payer: Health Management Network Commercial	$2.97
Rate for Payer: Humana Medicare	$1.75
Rate for Payer: Kaiser Permanente Commercial	$3.14
Rate for Payer: Kaiser Permanente Medicaid	$1.78
Rate for Payer: Kaiser Permanente Medicare	$1.75
Rate for Payer: MDX Hawaii PPO	$3.39
Rate for Payer: Ohana Health Plan Medicaid	$1.75
Rate for Payer: Ohana Health Plan Medicare	$1.75
Rate for Payer: UnitedHealthcare Medicaid	$2.09
Rate for Payer: UnitedHealthcare Medicare	$1.75
Rate for Payer: University Health Alliance Commercial	$2.54

potassium chlor ER 20 mEq tablet [HHSC]

Facility

$3.78

Service Code	NDC 66758019013
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	$4.39
Max. Negotiated Rate	$5.01
Rate for Payer: Cash Price	$3.36
Rate for Payer: Health Management Network Commercial	$4.39
Rate for Payer: Kaiser Permanente Commercial	$4.65
Rate for Payer: MDX Hawaii PPO	$5.01

Potassium FSI

Facility

$225.00

Service Code	HCPCS 84132
Hospital Charge Code	8118016
Hospital Revenue Code	301
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

Potassium FSI

Facility

$225.00

Service Code	HCPCS 84132
Hospital Charge Code	8118016
Hospital Revenue Code	301
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$112.50
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Devoted Health Medicare	$123.75
Rate for Payer: Hawaii Medical Service Association ABD	$6.35
Rate for Payer: Hawaii Medical Service Association Commercial	$5.95
Rate for Payer: Hawaii Medical Service Association Medicare	$112.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.67
Rate for Payer: Hawaii Western Management Group Commercial	$4.76
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$112.50
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$112.50
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$112.50
Rate for Payer: Ohana Health Plan Medicare	$112.50
Rate for Payer: UnitedHealthcare Medicaid	$6.35
Rate for Payer: UnitedHealthcare Medicare	$112.50
Rate for Payer: University Health Alliance Commercial	$11.88

potassium iodide 1000mg/mL 30 mL oral soln [HHSC]

Facility

$981.86

Service Code	NDC 71740011230
Hospital Charge Code	2501028
Hospital Revenue Code	250
Min. Negotiated Rate	$490.93
Max. Negotiated Rate	$952.40
Rate for Payer: AlohaCare Medicaid	$490.93
Rate for Payer: AlohaCare Medicare	$490.93
Rate for Payer: Cash Price	$638.21
Rate for Payer: Devoted Health Medicare	$540.02
Rate for Payer: Hawaii Medical Service Association Medicare	$490.93
Rate for Payer: Hawaii Western Management Group Commercial	$932.77
Rate for Payer: Health Management Network Commercial	$834.58
Rate for Payer: Humana Medicare	$490.93
Rate for Payer: Kaiser Permanente Commercial	$883.67
Rate for Payer: Kaiser Permanente Medicaid	$500.75
Rate for Payer: Kaiser Permanente Medicare	$490.93
Rate for Payer: MDX Hawaii PPO	$952.40
Rate for Payer: Ohana Health Plan Medicaid	$490.93
Rate for Payer: Ohana Health Plan Medicare	$490.93
Rate for Payer: UnitedHealthcare Medicaid	$589.12
Rate for Payer: UnitedHealthcare Medicare	$490.93
Rate for Payer: University Health Alliance Commercial	$715.68

potassium iodide 1000mg/mL 30 mL oral soln [HHSC]

Facility

$981.86

Service Code	NDC 71740011230
Hospital Charge Code	2501028
Hospital Revenue Code	250
Min. Negotiated Rate	$834.58
Max. Negotiated Rate	$952.40
Rate for Payer: Cash Price	$638.21
Rate for Payer: Health Management Network Commercial	$834.58
Rate for Payer: Kaiser Permanente Commercial	$883.67
Rate for Payer: MDX Hawaii PPO	$952.40

Potassium iSTAT

Facility

$220.00

Service Code	HCPCS 84132 QW
Hospital Charge Code	8293267
Hospital Revenue Code	301
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$213.40
Rate for Payer: AlohaCare Medicaid	$110.00
Rate for Payer: AlohaCare Medicare	$110.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Cash Price	$143.00
Rate for Payer: Devoted Health Medicare	$121.00
Rate for Payer: Hawaii Medical Service Association ABD	$6.35
Rate for Payer: Hawaii Medical Service Association Commercial	$5.95
Rate for Payer: Hawaii Medical Service Association Medicare	$110.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.67
Rate for Payer: Hawaii Western Management Group Commercial	$4.76
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Humana Medicare	$110.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: Kaiser Permanente Medicaid	$112.20
Rate for Payer: Kaiser Permanente Medicare	$110.00
Rate for Payer: MDX Hawaii PPO	$213.40
Rate for Payer: Ohana Health Plan Medicaid	$110.00
Rate for Payer: Ohana Health Plan Medicare	$110.00
Rate for Payer: UnitedHealthcare Medicaid	$6.35
Rate for Payer: UnitedHealthcare Medicare	$110.00
Rate for Payer: University Health Alliance Commercial	$11.88

Potassium iSTAT

Facility

$220.00

Service Code	HCPCS 84132 QW
Hospital Charge Code	8293267
Hospital Revenue Code	301
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$213.40
Rate for Payer: Cash Price	$143.00
Rate for Payer: Health Management Network Commercial	$187.00
Rate for Payer: Kaiser Permanente Commercial	$198.00
Rate for Payer: MDX Hawaii PPO	$213.40

potassium phos 45 mmol/15 ml vial [HHSC]

Facility

$300.71

Service Code	NDC 65219005429
Hospital Charge Code	2501059
Hospital Revenue Code	250
Min. Negotiated Rate	$150.35
Max. Negotiated Rate	$291.69
Rate for Payer: AlohaCare Medicaid	$150.35
Rate for Payer: AlohaCare Medicare	$150.35
Rate for Payer: Cash Price	$195.46
Rate for Payer: Devoted Health Medicare	$165.39
Rate for Payer: Hawaii Medical Service Association Medicare	$150.35
Rate for Payer: Hawaii Western Management Group Commercial	$285.67
Rate for Payer: Health Management Network Commercial	$255.60
Rate for Payer: Humana Medicare	$150.35
Rate for Payer: Kaiser Permanente Commercial	$270.64
Rate for Payer: Kaiser Permanente Medicaid	$153.36
Rate for Payer: Kaiser Permanente Medicare	$150.35
Rate for Payer: MDX Hawaii PPO	$291.69
Rate for Payer: Ohana Health Plan Medicaid	$150.35
Rate for Payer: Ohana Health Plan Medicare	$150.35
Rate for Payer: UnitedHealthcare Medicaid	$180.43
Rate for Payer: UnitedHealthcare Medicare	$150.35
Rate for Payer: University Health Alliance Commercial	$219.19

potassium phos 45 mmol/15 ml vial [HHSC]

Facility

$288.35

Service Code	NDC 80830169102
Hospital Charge Code	2501059
Hospital Revenue Code	250
Min. Negotiated Rate	$144.18
Max. Negotiated Rate	$279.70
Rate for Payer: AlohaCare Medicaid	$144.18
Rate for Payer: AlohaCare Medicare	$144.18
Rate for Payer: Cash Price	$187.43
Rate for Payer: Devoted Health Medicare	$158.59
Rate for Payer: Hawaii Medical Service Association Medicare	$144.18
Rate for Payer: Hawaii Western Management Group Commercial	$273.93
Rate for Payer: Health Management Network Commercial	$245.10
Rate for Payer: Humana Medicare	$144.18
Rate for Payer: Kaiser Permanente Commercial	$259.51
Rate for Payer: Kaiser Permanente Medicaid	$147.06
Rate for Payer: Kaiser Permanente Medicare	$144.18
Rate for Payer: MDX Hawaii PPO	$279.70
Rate for Payer: Ohana Health Plan Medicaid	$144.18
Rate for Payer: Ohana Health Plan Medicare	$144.18
Rate for Payer: UnitedHealthcare Medicaid	$173.01
Rate for Payer: UnitedHealthcare Medicare	$144.18
Rate for Payer: University Health Alliance Commercial	$210.18

potassium phos 45 mmol/15 ml vial [HHSC]

Facility

$88.21

Service Code	NDC 00409729501
Hospital Charge Code	2501059
Hospital Revenue Code	250
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$85.56
Rate for Payer: AlohaCare Medicaid	$44.10
Rate for Payer: AlohaCare Medicare	$44.10
Rate for Payer: Cash Price	$57.34
Rate for Payer: Devoted Health Medicare	$48.52
Rate for Payer: Hawaii Medical Service Association Medicare	$44.10
Rate for Payer: Hawaii Western Management Group Commercial	$83.80
Rate for Payer: Health Management Network Commercial	$74.98
Rate for Payer: Humana Medicare	$44.10
Rate for Payer: Kaiser Permanente Commercial	$79.39
Rate for Payer: Kaiser Permanente Medicaid	$44.99
Rate for Payer: Kaiser Permanente Medicare	$44.10
Rate for Payer: MDX Hawaii PPO	$85.56
Rate for Payer: Ohana Health Plan Medicaid	$44.10
Rate for Payer: Ohana Health Plan Medicare	$44.10
Rate for Payer: UnitedHealthcare Medicaid	$52.93
Rate for Payer: UnitedHealthcare Medicare	$44.10
Rate for Payer: University Health Alliance Commercial	$64.30

potassium phos 45 mmol/15 ml vial [HHSC]

Facility

$300.71

Service Code	NDC 65219005429
Hospital Charge Code	2501059
Hospital Revenue Code	250
Min. Negotiated Rate	$255.60
Max. Negotiated Rate	$291.69
Rate for Payer: Cash Price	$195.46
Rate for Payer: Health Management Network Commercial	$255.60
Rate for Payer: Kaiser Permanente Commercial	$270.64
Rate for Payer: MDX Hawaii PPO	$291.69

potassium phos 45 mmol/15 ml vial [HHSC]

Facility

$300.67

Service Code	NDC 00517210225
Hospital Charge Code	2501059
Hospital Revenue Code	250
Min. Negotiated Rate	$150.34
Max. Negotiated Rate	$291.65
Rate for Payer: AlohaCare Medicaid	$150.34
Rate for Payer: AlohaCare Medicare	$150.34
Rate for Payer: Cash Price	$195.44
Rate for Payer: Devoted Health Medicare	$165.37
Rate for Payer: Hawaii Medical Service Association Medicare	$150.34
Rate for Payer: Hawaii Western Management Group Commercial	$285.64
Rate for Payer: Health Management Network Commercial	$255.57
Rate for Payer: Humana Medicare	$150.34
Rate for Payer: Kaiser Permanente Commercial	$270.60
Rate for Payer: Kaiser Permanente Medicaid	$153.34
Rate for Payer: Kaiser Permanente Medicare	$150.34
Rate for Payer: MDX Hawaii PPO	$291.65
Rate for Payer: Ohana Health Plan Medicaid	$150.34
Rate for Payer: Ohana Health Plan Medicare	$150.34
Rate for Payer: UnitedHealthcare Medicaid	$180.40
Rate for Payer: UnitedHealthcare Medicare	$150.34
Rate for Payer: University Health Alliance Commercial	$219.16

potassium phos 45 mmol/15 ml vial [HHSC]

Facility

$300.67

Service Code	NDC 00517210225
Hospital Charge Code	2501059
Hospital Revenue Code	250
Min. Negotiated Rate	$255.57
Max. Negotiated Rate	$291.65
Rate for Payer: Cash Price	$195.44
Rate for Payer: Health Management Network Commercial	$255.57
Rate for Payer: Kaiser Permanente Commercial	$270.60
Rate for Payer: MDX Hawaii PPO	$291.65

potassium phos 45 mmol/15 ml vial [HHSC]

Facility

$288.35

Service Code	NDC 80830169102
Hospital Charge Code	2501059
Hospital Revenue Code	250
Min. Negotiated Rate	$245.10
Max. Negotiated Rate	$279.70
Rate for Payer: Cash Price	$187.43
Rate for Payer: Health Management Network Commercial	$245.10
Rate for Payer: Kaiser Permanente Commercial	$259.51
Rate for Payer: MDX Hawaii PPO	$279.70

potassium phos 45 mmol/15 ml vial [HHSC]

Facility

$88.21

Service Code	NDC 00409729501
Hospital Charge Code	2501059
Hospital Revenue Code	250
Min. Negotiated Rate	$74.98
Max. Negotiated Rate	$85.56
Rate for Payer: Cash Price	$57.34
Rate for Payer: Health Management Network Commercial	$74.98
Rate for Payer: Kaiser Permanente Commercial	$79.39
Rate for Payer: MDX Hawaii PPO	$85.56

Potassium Urine Random FSI

Facility

$53.00

Service Code	HCPCS 84133
Hospital Charge Code	8228910
Hospital Revenue Code	301
Min. Negotiated Rate	$45.05
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$34.45
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Kaiser Permanente Commercial	$47.70
Rate for Payer: MDX Hawaii PPO	$51.41

Potassium Urine Random FSI

Facility

$53.00

Service Code	HCPCS 84133
Hospital Charge Code	8228910
Hospital Revenue Code	301
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$51.41
Rate for Payer: AlohaCare Medicaid	$26.50
Rate for Payer: AlohaCare Medicare	$26.50
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Devoted Health Medicare	$29.15
Rate for Payer: Hawaii Medical Service Association ABD	$5.94
Rate for Payer: Hawaii Medical Service Association Commercial	$5.91
Rate for Payer: Hawaii Medical Service Association Medicare	$26.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.24
Rate for Payer: Hawaii Western Management Group Commercial	$4.73
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Humana Medicare	$26.50
Rate for Payer: Kaiser Permanente Commercial	$47.70
Rate for Payer: Kaiser Permanente Medicaid	$27.03
Rate for Payer: Kaiser Permanente Medicare	$26.50
Rate for Payer: MDX Hawaii PPO	$51.41
Rate for Payer: Ohana Health Plan Medicaid	$26.50
Rate for Payer: Ohana Health Plan Medicare	$26.50
Rate for Payer: UnitedHealthcare Medicaid	$5.94
Rate for Payer: UnitedHealthcare Medicare	$26.50
Rate for Payer: University Health Alliance Commercial	$11.12

Potassium Urine Timed FSI

Facility

$53.00

Service Code	HCPCS 84133
Hospital Charge Code	8228911
Hospital Revenue Code	301
Min. Negotiated Rate	$45.05
Max. Negotiated Rate	$51.41
Rate for Payer: Cash Price	$34.45
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Kaiser Permanente Commercial	$47.70
Rate for Payer: MDX Hawaii PPO	$51.41

Potassium Urine Timed FSI

Facility

$53.00

Service Code	HCPCS 84133
Hospital Charge Code	8228911
Hospital Revenue Code	301
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$51.41
Rate for Payer: AlohaCare Medicaid	$26.50
Rate for Payer: AlohaCare Medicare	$26.50
Rate for Payer: Cash Price	$34.45
Rate for Payer: Cash Price	$34.45
Rate for Payer: Devoted Health Medicare	$29.15
Rate for Payer: Hawaii Medical Service Association ABD	$5.94
Rate for Payer: Hawaii Medical Service Association Commercial	$5.91
Rate for Payer: Hawaii Medical Service Association Medicare	$26.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.24
Rate for Payer: Hawaii Western Management Group Commercial	$4.73
Rate for Payer: Health Management Network Commercial	$45.05
Rate for Payer: Humana Medicare	$26.50
Rate for Payer: Kaiser Permanente Commercial	$47.70
Rate for Payer: Kaiser Permanente Medicaid	$27.03
Rate for Payer: Kaiser Permanente Medicare	$26.50
Rate for Payer: MDX Hawaii PPO	$51.41
Rate for Payer: Ohana Health Plan Medicaid	$26.50
Rate for Payer: Ohana Health Plan Medicare	$26.50
Rate for Payer: UnitedHealthcare Medicaid	$5.94
Rate for Payer: UnitedHealthcare Medicare	$26.50
Rate for Payer: University Health Alliance Commercial	$11.12

Potassium (Venous) POCT

Facility

$225.00

Service Code	HCPCS 84132
Hospital Charge Code	9364729
Hospital Revenue Code	301
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: MDX Hawaii PPO	$218.25

Potassium (Venous) POCT

Facility

$225.00

Service Code	HCPCS 84132
Hospital Charge Code	9364729
Hospital Revenue Code	301
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$218.25
Rate for Payer: AlohaCare Medicaid	$112.50
Rate for Payer: AlohaCare Medicare	$112.50
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Devoted Health Medicare	$123.75
Rate for Payer: Hawaii Medical Service Association ABD	$6.35
Rate for Payer: Hawaii Medical Service Association Commercial	$5.95
Rate for Payer: Hawaii Medical Service Association Medicare	$112.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.67
Rate for Payer: Hawaii Western Management Group Commercial	$4.76
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Humana Medicare	$112.50
Rate for Payer: Kaiser Permanente Commercial	$202.50
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicare	$112.50
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: Ohana Health Plan Medicaid	$112.50
Rate for Payer: Ohana Health Plan Medicare	$112.50
Rate for Payer: UnitedHealthcare Medicaid	$6.35
Rate for Payer: UnitedHealthcare Medicare	$112.50
Rate for Payer: University Health Alliance Commercial	$11.88

Know your out-of-pocket cost for care.

All Charges