Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

QCKFIX SCRW,TI,CANN ST,CANC.,4.0X 50MM

Facility

$346.00

Service Code	HCPCS C1713
Hospital Charge Code	12953319
Hospital Revenue Code	278
Min. Negotiated Rate	$193.76
Max. Negotiated Rate	$335.62
Rate for Payer: Cash Price	$224.90
Rate for Payer: Hawaii Western Management Group Commercial	$242.20
Rate for Payer: Health Management Network Commercial	$294.10
Rate for Payer: Kaiser Permanente Commercial	$311.40
Rate for Payer: MDX Hawaii PPO	$335.62
Rate for Payer: University Health Alliance Commercial	$193.76

QuantF TB Gold Plus FSI

Facility

$392.00

Service Code	HCPCS 86480
Hospital Charge Code	8225274
Hospital Revenue Code	300
Min. Negotiated Rate	$333.20
Max. Negotiated Rate	$380.24
Rate for Payer: Cash Price	$254.80
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: MDX Hawaii PPO	$380.24

QuantF TB Gold Plus FSI

Facility

$392.00

Service Code	HCPCS 86480
Hospital Charge Code	8225274
Hospital Revenue Code	300
Min. Negotiated Rate	$51.95
Max. Negotiated Rate	$380.24
Rate for Payer: AlohaCare Medicaid	$196.00
Rate for Payer: AlohaCare Medicare	$196.00
Rate for Payer: Cash Price	$254.80
Rate for Payer: Cash Price	$254.80
Rate for Payer: Devoted Health Medicare	$215.60
Rate for Payer: Hawaii Medical Service Association ABD	$51.95
Rate for Payer: Hawaii Medical Service Association Commercial	$77.47
Rate for Payer: Hawaii Medical Service Association Medicare	$196.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$68.87
Rate for Payer: Hawaii Western Management Group Commercial	$61.98
Rate for Payer: Health Management Network Commercial	$333.20
Rate for Payer: Humana Medicare	$196.00
Rate for Payer: Kaiser Permanente Commercial	$352.80
Rate for Payer: Kaiser Permanente Medicaid	$199.92
Rate for Payer: Kaiser Permanente Medicare	$196.00
Rate for Payer: MDX Hawaii PPO	$380.24
Rate for Payer: Ohana Health Plan Medicaid	$196.00
Rate for Payer: Ohana Health Plan Medicare	$196.00
Rate for Payer: UnitedHealthcare Medicaid	$51.95
Rate for Payer: UnitedHealthcare Medicare	$196.00
Rate for Payer: University Health Alliance Commercial	$160.19

QUEtiapine 100 mg tablet [HHSC]

Facility

$41.22

Service Code	NDC 68084053201
Hospital Charge Code	2500716
Hospital Revenue Code	250
Min. Negotiated Rate	$20.61
Max. Negotiated Rate	$39.98
Rate for Payer: AlohaCare Medicaid	$20.61
Rate for Payer: AlohaCare Medicare	$20.61
Rate for Payer: Cash Price	$26.79
Rate for Payer: Devoted Health Medicare	$22.67
Rate for Payer: Hawaii Medical Service Association Medicare	$20.61
Rate for Payer: Hawaii Western Management Group Commercial	$39.16
Rate for Payer: Health Management Network Commercial	$35.04
Rate for Payer: Humana Medicare	$20.61
Rate for Payer: Kaiser Permanente Commercial	$37.10
Rate for Payer: Kaiser Permanente Medicaid	$21.02
Rate for Payer: Kaiser Permanente Medicare	$20.61
Rate for Payer: MDX Hawaii PPO	$39.98
Rate for Payer: Ohana Health Plan Medicaid	$20.61
Rate for Payer: Ohana Health Plan Medicare	$20.61
Rate for Payer: UnitedHealthcare Medicaid	$24.73
Rate for Payer: UnitedHealthcare Medicare	$20.61
Rate for Payer: University Health Alliance Commercial	$30.05

QUEtiapine 100 mg tablet [HHSC]

Facility

$41.22

Service Code	NDC 60687034901
Hospital Charge Code	2500716
Hospital Revenue Code	250
Min. Negotiated Rate	$35.04
Max. Negotiated Rate	$39.98
Rate for Payer: Cash Price	$26.79
Rate for Payer: Health Management Network Commercial	$35.04
Rate for Payer: Kaiser Permanente Commercial	$37.10
Rate for Payer: MDX Hawaii PPO	$39.98

QUEtiapine 100 mg tablet [HHSC]

Facility

$41.22

Service Code	NDC 60687034901
Hospital Charge Code	2500716
Hospital Revenue Code	250
Min. Negotiated Rate	$20.61
Max. Negotiated Rate	$39.98
Rate for Payer: AlohaCare Medicaid	$20.61
Rate for Payer: AlohaCare Medicare	$20.61
Rate for Payer: Cash Price	$26.79
Rate for Payer: Devoted Health Medicare	$22.67
Rate for Payer: Hawaii Medical Service Association Medicare	$20.61
Rate for Payer: Hawaii Western Management Group Commercial	$39.16
Rate for Payer: Health Management Network Commercial	$35.04
Rate for Payer: Humana Medicare	$20.61
Rate for Payer: Kaiser Permanente Commercial	$37.10
Rate for Payer: Kaiser Permanente Medicaid	$21.02
Rate for Payer: Kaiser Permanente Medicare	$20.61
Rate for Payer: MDX Hawaii PPO	$39.98
Rate for Payer: Ohana Health Plan Medicaid	$20.61
Rate for Payer: Ohana Health Plan Medicare	$20.61
Rate for Payer: UnitedHealthcare Medicaid	$24.73
Rate for Payer: UnitedHealthcare Medicare	$20.61
Rate for Payer: University Health Alliance Commercial	$30.05

QUEtiapine 100 mg tablet [HHSC]

Facility

$41.22

Service Code	NDC 68084053201
Hospital Charge Code	2500716
Hospital Revenue Code	250
Min. Negotiated Rate	$35.04
Max. Negotiated Rate	$39.98
Rate for Payer: Cash Price	$26.79
Rate for Payer: Health Management Network Commercial	$35.04
Rate for Payer: Kaiser Permanente Commercial	$37.10
Rate for Payer: MDX Hawaii PPO	$39.98

QUEtiapine 25 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 00904663861
Hospital Charge Code	2500719
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

QUEtiapine 25 mg tablet [HHSC]

Facility

$21.00

Service Code	NDC 60687032701
Hospital Charge Code	2500719
Hospital Revenue Code	250
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$20.37
Rate for Payer: AlohaCare Medicaid	$10.50
Rate for Payer: AlohaCare Medicare	$10.50
Rate for Payer: Cash Price	$13.65
Rate for Payer: Devoted Health Medicare	$11.55
Rate for Payer: Hawaii Medical Service Association Medicare	$10.50
Rate for Payer: Hawaii Western Management Group Commercial	$19.95
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Humana Medicare	$10.50
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: Kaiser Permanente Medicaid	$10.71
Rate for Payer: Kaiser Permanente Medicare	$10.50
Rate for Payer: MDX Hawaii PPO	$20.37
Rate for Payer: Ohana Health Plan Medicaid	$10.50
Rate for Payer: Ohana Health Plan Medicare	$10.50
Rate for Payer: UnitedHealthcare Medicaid	$12.60
Rate for Payer: UnitedHealthcare Medicare	$10.50
Rate for Payer: University Health Alliance Commercial	$15.31

QUEtiapine 25 mg tablet [HHSC]

Facility

$3.00

Service Code	NDC 00904663861
Hospital Charge Code	2500719
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

QUEtiapine 25 mg tablet [HHSC]

Facility

$22.24

Service Code	NDC 67877024201
Hospital Charge Code	2500719
Hospital Revenue Code	250
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$21.57
Rate for Payer: Cash Price	$14.46
Rate for Payer: Health Management Network Commercial	$18.90
Rate for Payer: Kaiser Permanente Commercial	$20.02
Rate for Payer: MDX Hawaii PPO	$21.57

QUEtiapine 25 mg tablet [HHSC]

Facility

$22.24

Service Code	NDC 67877024201
Hospital Charge Code	2500719
Hospital Revenue Code	250
Min. Negotiated Rate	$11.12
Max. Negotiated Rate	$21.57
Rate for Payer: AlohaCare Medicaid	$11.12
Rate for Payer: AlohaCare Medicare	$11.12
Rate for Payer: Cash Price	$14.46
Rate for Payer: Devoted Health Medicare	$12.23
Rate for Payer: Hawaii Medical Service Association Medicare	$11.12
Rate for Payer: Hawaii Western Management Group Commercial	$21.13
Rate for Payer: Health Management Network Commercial	$18.90
Rate for Payer: Humana Medicare	$11.12
Rate for Payer: Kaiser Permanente Commercial	$20.02
Rate for Payer: Kaiser Permanente Medicaid	$11.34
Rate for Payer: Kaiser Permanente Medicare	$11.12
Rate for Payer: MDX Hawaii PPO	$21.57
Rate for Payer: Ohana Health Plan Medicaid	$11.12
Rate for Payer: Ohana Health Plan Medicare	$11.12
Rate for Payer: UnitedHealthcare Medicaid	$13.34
Rate for Payer: UnitedHealthcare Medicare	$11.12
Rate for Payer: University Health Alliance Commercial	$16.21

QUEtiapine 25 mg tablet [HHSC]

Facility

$21.00

Service Code	NDC 60687032701
Hospital Charge Code	2500719
Hospital Revenue Code	250
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$20.37
Rate for Payer: Cash Price	$13.65
Rate for Payer: Health Management Network Commercial	$17.85
Rate for Payer: Kaiser Permanente Commercial	$18.90
Rate for Payer: MDX Hawaii PPO	$20.37

racepinephrine 2.25% neb soln [HHSC]

Facility

$5.56

Service Code	NDC 00487278401
Hospital Charge Code	2500723
Hospital Revenue Code	250
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$5.39
Rate for Payer: Cash Price	$3.61
Rate for Payer: Health Management Network Commercial	$4.73
Rate for Payer: Kaiser Permanente Commercial	$5.00
Rate for Payer: MDX Hawaii PPO	$5.39

racepinephrine 2.25% neb soln [HHSC]

Facility

$10.42

Service Code	NDC 00487590199
Hospital Charge Code	2500723
Hospital Revenue Code	250
Min. Negotiated Rate	$8.86
Max. Negotiated Rate	$10.11
Rate for Payer: Cash Price	$6.77
Rate for Payer: Health Management Network Commercial	$8.86
Rate for Payer: Kaiser Permanente Commercial	$9.38
Rate for Payer: MDX Hawaii PPO	$10.11

racepinephrine 2.25% neb soln [HHSC]

Facility

$10.42

Service Code	NDC 00487590199
Hospital Charge Code	2500723
Hospital Revenue Code	250
Min. Negotiated Rate	$5.21
Max. Negotiated Rate	$10.11
Rate for Payer: AlohaCare Medicaid	$5.21
Rate for Payer: AlohaCare Medicare	$5.21
Rate for Payer: Cash Price	$6.77
Rate for Payer: Devoted Health Medicare	$5.73
Rate for Payer: Hawaii Medical Service Association Medicare	$5.21
Rate for Payer: Hawaii Western Management Group Commercial	$9.90
Rate for Payer: Health Management Network Commercial	$8.86
Rate for Payer: Humana Medicare	$5.21
Rate for Payer: Kaiser Permanente Commercial	$9.38
Rate for Payer: Kaiser Permanente Medicaid	$5.31
Rate for Payer: Kaiser Permanente Medicare	$5.21
Rate for Payer: MDX Hawaii PPO	$10.11
Rate for Payer: Ohana Health Plan Medicaid	$5.21
Rate for Payer: Ohana Health Plan Medicare	$5.21
Rate for Payer: UnitedHealthcare Medicaid	$6.25
Rate for Payer: UnitedHealthcare Medicare	$5.21
Rate for Payer: University Health Alliance Commercial	$7.60

racepinephrine 2.25% neb soln [HHSC]

Facility

$5.56

Service Code	NDC 00487278401
Hospital Charge Code	2500723
Hospital Revenue Code	250
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$5.39
Rate for Payer: AlohaCare Medicaid	$2.78
Rate for Payer: AlohaCare Medicare	$2.78
Rate for Payer: Cash Price	$3.61
Rate for Payer: Devoted Health Medicare	$3.06
Rate for Payer: Hawaii Medical Service Association Medicare	$2.78
Rate for Payer: Hawaii Western Management Group Commercial	$5.28
Rate for Payer: Health Management Network Commercial	$4.73
Rate for Payer: Humana Medicare	$2.78
Rate for Payer: Kaiser Permanente Commercial	$5.00
Rate for Payer: Kaiser Permanente Medicaid	$2.84
Rate for Payer: Kaiser Permanente Medicare	$2.78
Rate for Payer: MDX Hawaii PPO	$5.39
Rate for Payer: Ohana Health Plan Medicaid	$2.78
Rate for Payer: Ohana Health Plan Medicare	$2.78
Rate for Payer: UnitedHealthcare Medicaid	$3.34
Rate for Payer: UnitedHealthcare Medicare	$2.78
Rate for Payer: University Health Alliance Commercial	$4.05

RADIOTHERAPY

Facility

$18,688.57

Service Code	MSDRG 849
Min. Negotiated Rate	$18,688.57
Max. Negotiated Rate	$18,688.57
Rate for Payer: Hawaii Medical Service Association Commercial	$18,688.57

raltegravir 400 mg tablet [HHSC]

Facility

$185.08

Service Code	HCPCS J8499
Hospital Charge Code	2501070
Hospital Revenue Code	250
Min. Negotiated Rate	$157.32
Max. Negotiated Rate	$179.53
Rate for Payer: Cash Price	$120.30
Rate for Payer: Health Management Network Commercial	$157.32
Rate for Payer: Kaiser Permanente Commercial	$166.57
Rate for Payer: MDX Hawaii PPO	$179.53

raltegravir 400 mg tablet [HHSC]

Facility

$185.08

Service Code	HCPCS J8499
Hospital Charge Code	2501070
Hospital Revenue Code	636
Min. Negotiated Rate	$92.54
Max. Negotiated Rate	$179.53
Rate for Payer: AlohaCare Medicaid	$92.54
Rate for Payer: AlohaCare Medicare	$92.54
Rate for Payer: Cash Price	$120.30
Rate for Payer: Devoted Health Medicare	$101.79
Rate for Payer: Hawaii Medical Service Association Medicare	$92.54
Rate for Payer: Hawaii Western Management Group Commercial	$175.83
Rate for Payer: Health Management Network Commercial	$157.32
Rate for Payer: Humana Medicare	$92.54
Rate for Payer: Kaiser Permanente Commercial	$166.57
Rate for Payer: Kaiser Permanente Medicaid	$94.39
Rate for Payer: Kaiser Permanente Medicare	$92.54
Rate for Payer: MDX Hawaii PPO	$179.53
Rate for Payer: Ohana Health Plan Medicaid	$92.54
Rate for Payer: Ohana Health Plan Medicare	$92.54
Rate for Payer: UnitedHealthcare Medicaid	$111.05
Rate for Payer: UnitedHealthcare Medicare	$92.54
Rate for Payer: University Health Alliance Commercial	$134.90

Rapid EEG - ED Ceribell

Facility

$1,537.00

Service Code	HCPCS 95816
Hospital Charge Code	10095506
Hospital Revenue Code	740
Min. Negotiated Rate	$1,306.45
Max. Negotiated Rate	$1,490.89
Rate for Payer: Cash Price	$999.05
Rate for Payer: Health Management Network Commercial	$1,306.45
Rate for Payer: Kaiser Permanente Commercial	$1,383.30
Rate for Payer: MDX Hawaii PPO	$1,490.89

Rapid EEG - ED Ceribell

Professional

Both

$751.00

Service Code	HCPCS 95816
Hospital Charge Code	10095506
Hospital Revenue Code	981
Min. Negotiated Rate	$105.68
Max. Negotiated Rate	$638.35
Rate for Payer: AlohaCare Medicaid	$445.92
Rate for Payer: AlohaCare Medicare	$463.48
Rate for Payer: Cash Price	$488.15
Rate for Payer: Cash Price	$488.15
Rate for Payer: Devoted Health Medicare	$509.83
Rate for Payer: Hawaii Medical Service Association Medicare	$463.48
Rate for Payer: Hawaii Western Management Group Commercial	$105.68
Rate for Payer: Health Management Network Commercial	$638.35
Rate for Payer: Kaiser Permanente Commercial	$509.83
Rate for Payer: Kaiser Permanente Medicaid	$509.83
Rate for Payer: Kaiser Permanente Medicare	$509.83
Rate for Payer: Ohana Health Plan Medicaid	$445.92
Rate for Payer: Ohana Health Plan Medicare	$463.48
Rate for Payer: UnitedHealthcare Medicaid	$445.92
Rate for Payer: UnitedHealthcare Medicare	$463.48

Rapid EEG - ED Ceribell

Facility

$1,537.00

Service Code	HCPCS 95816
Hospital Charge Code	10095506
Hospital Revenue Code	740
Min. Negotiated Rate	$84.17
Max. Negotiated Rate	$1,490.89
Rate for Payer: AlohaCare Medicaid	$768.50
Rate for Payer: AlohaCare Medicare	$768.50
Rate for Payer: Cash Price	$999.05
Rate for Payer: Cash Price	$999.05
Rate for Payer: Devoted Health Medicare	$845.35
Rate for Payer: Hawaii Medical Service Association ABD	$84.17
Rate for Payer: Hawaii Medical Service Association Commercial	$275.75
Rate for Payer: Hawaii Medical Service Association Medicare	$768.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$145.63
Rate for Payer: Hawaii Western Management Group Commercial	$1,460.15
Rate for Payer: Health Management Network Commercial	$1,306.45
Rate for Payer: Humana Medicare	$768.50
Rate for Payer: Kaiser Permanente Commercial	$1,383.30
Rate for Payer: Kaiser Permanente Medicaid	$783.87
Rate for Payer: Kaiser Permanente Medicare	$768.50
Rate for Payer: MDX Hawaii PPO	$1,490.89
Rate for Payer: Ohana Health Plan Medicaid	$768.50
Rate for Payer: Ohana Health Plan Medicare	$768.50
Rate for Payer: UnitedHealthcare Medicaid	$84.17
Rate for Payer: UnitedHealthcare Medicare	$768.50
Rate for Payer: University Health Alliance Commercial	$1,120.32

Rapid Flu A/B Antigen FSI

Facility

$139.00

Service Code	HCPCS 87804 QW
Hospital Charge Code	8225272
Hospital Revenue Code	306
Min. Negotiated Rate	$16.55
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	$16.58
Rate for Payer: Hawaii Medical Service Association Commercial	$20.69
Rate for Payer: Hawaii Medical Service Association Medicare	$69.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17.41
Rate for Payer: Hawaii Western Management Group Commercial	$16.55
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	$16.58
Rate for Payer: UnitedHealthcare Medicare	$69.50
Rate for Payer: University Health Alliance Commercial	$31.01

Rapid Flu A/B Antigen FSI

Facility

$139.00

Service Code	HCPCS 87804 QW
Hospital Charge Code	8225272
Hospital Revenue Code	306
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

Know your out-of-pocket cost for care.

All Charges