Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

warfarin 1 mg tablet [HHSC]

Facility

$13.76

Service Code	NDC 00056016975
Hospital Charge Code	2500858
Hospital Revenue Code	250
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$13.35
Rate for Payer: Cash Price	$8.94
Rate for Payer: Health Management Network Commercial	$11.70
Rate for Payer: Kaiser Permanente Commercial	$12.38
Rate for Payer: MDX Hawaii PPO	$13.35

warfarin 1 mg tablet [HHSC]

Facility

$3.42

Service Code	NDC 00832121101
Hospital Charge Code	2500858
Hospital Revenue Code	250
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$3.32
Rate for Payer: Cash Price	$2.22
Rate for Payer: Health Management Network Commercial	$2.91
Rate for Payer: Kaiser Permanente Commercial	$3.08
Rate for Payer: MDX Hawaii PPO	$3.32

warfarin 1 mg tablet [HHSC]

Facility

$3.42

Service Code	NDC 00832121100
Hospital Charge Code	2500858
Hospital Revenue Code	250
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$3.32
Rate for Payer: Cash Price	$2.22
Rate for Payer: Health Management Network Commercial	$2.91
Rate for Payer: Kaiser Permanente Commercial	$3.08
Rate for Payer: MDX Hawaii PPO	$3.32

warfarin 1 mg tablet [HHSC]

Facility

$13.76

Service Code	NDC 00056016975
Hospital Charge Code	2500858
Hospital Revenue Code	250
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$13.35
Rate for Payer: AlohaCare Medicaid	$6.88
Rate for Payer: AlohaCare Medicare	$6.88
Rate for Payer: Cash Price	$8.94
Rate for Payer: Devoted Health Medicare	$7.57
Rate for Payer: Hawaii Medical Service Association Medicare	$6.88
Rate for Payer: Hawaii Western Management Group Commercial	$13.07
Rate for Payer: Health Management Network Commercial	$11.70
Rate for Payer: Humana Medicare	$6.88
Rate for Payer: Kaiser Permanente Commercial	$12.38
Rate for Payer: Kaiser Permanente Medicaid	$7.02
Rate for Payer: Kaiser Permanente Medicare	$6.88
Rate for Payer: MDX Hawaii PPO	$13.35
Rate for Payer: Ohana Health Plan Medicaid	$6.88
Rate for Payer: Ohana Health Plan Medicare	$6.88
Rate for Payer: UnitedHealthcare Medicaid	$8.26
Rate for Payer: UnitedHealthcare Medicare	$6.88
Rate for Payer: University Health Alliance Commercial	$10.03

warfarin 1 mg tablet [HHSC]

Facility

$3.42

Service Code	NDC 00832121101
Hospital Charge Code	2500858
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$3.32
Rate for Payer: AlohaCare Medicaid	$1.71
Rate for Payer: AlohaCare Medicare	$1.71
Rate for Payer: Cash Price	$2.22
Rate for Payer: Devoted Health Medicare	$1.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1.71
Rate for Payer: Hawaii Western Management Group Commercial	$3.25
Rate for Payer: Health Management Network Commercial	$2.91
Rate for Payer: Humana Medicare	$1.71
Rate for Payer: Kaiser Permanente Commercial	$3.08
Rate for Payer: Kaiser Permanente Medicaid	$1.74
Rate for Payer: Kaiser Permanente Medicare	$1.71
Rate for Payer: MDX Hawaii PPO	$3.32
Rate for Payer: Ohana Health Plan Medicaid	$1.71
Rate for Payer: Ohana Health Plan Medicare	$1.71
Rate for Payer: UnitedHealthcare Medicaid	$2.05
Rate for Payer: UnitedHealthcare Medicare	$1.71
Rate for Payer: University Health Alliance Commercial	$2.49

warfarin 2.5 mg tablet [HHSC]

Facility

$3.67

Service Code	NDC 00832121301
Hospital Charge Code	2500860
Hospital Revenue Code	250
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.56
Rate for Payer: Cash Price	$2.39
Rate for Payer: Health Management Network Commercial	$3.12
Rate for Payer: Kaiser Permanente Commercial	$3.30
Rate for Payer: MDX Hawaii PPO	$3.56

warfarin 2.5 mg tablet [HHSC]

Facility

$3.49

Service Code	NDC 65162076310
Hospital Charge Code	2500860
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

warfarin 2.5 mg tablet [HHSC]

Facility

$3.53

Service Code	NDC 68084002701
Hospital Charge Code	2500860
Hospital Revenue Code	250
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.42
Rate for Payer: Cash Price	$2.29
Rate for Payer: Health Management Network Commercial	$3.00
Rate for Payer: Kaiser Permanente Commercial	$3.18
Rate for Payer: MDX Hawaii PPO	$3.42

warfarin 2.5 mg tablet [HHSC]

Facility

$3.53

Service Code	NDC 68084002701
Hospital Charge Code	2500860
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$3.42
Rate for Payer: AlohaCare Medicaid	$1.76
Rate for Payer: AlohaCare Medicare	$1.76
Rate for Payer: Cash Price	$2.29
Rate for Payer: Devoted Health Medicare	$1.94
Rate for Payer: Hawaii Medical Service Association Medicare	$1.76
Rate for Payer: Hawaii Western Management Group Commercial	$3.35
Rate for Payer: Health Management Network Commercial	$3.00
Rate for Payer: Humana Medicare	$1.76
Rate for Payer: Kaiser Permanente Commercial	$3.18
Rate for Payer: Kaiser Permanente Medicaid	$1.80
Rate for Payer: Kaiser Permanente Medicare	$1.76
Rate for Payer: MDX Hawaii PPO	$3.42
Rate for Payer: Ohana Health Plan Medicaid	$1.76
Rate for Payer: Ohana Health Plan Medicare	$1.76
Rate for Payer: UnitedHealthcare Medicaid	$2.12
Rate for Payer: UnitedHealthcare Medicare	$1.76
Rate for Payer: University Health Alliance Commercial	$2.57

warfarin 2.5 mg tablet [HHSC]

Facility

$3.67

Service Code	NDC 00832121301
Hospital Charge Code	2500860
Hospital Revenue Code	250
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$3.56
Rate for Payer: AlohaCare Medicaid	$1.83
Rate for Payer: AlohaCare Medicare	$1.83
Rate for Payer: Cash Price	$2.39
Rate for Payer: Devoted Health Medicare	$2.02
Rate for Payer: Hawaii Medical Service Association Medicare	$1.83
Rate for Payer: Hawaii Western Management Group Commercial	$3.49
Rate for Payer: Health Management Network Commercial	$3.12
Rate for Payer: Humana Medicare	$1.83
Rate for Payer: Kaiser Permanente Commercial	$3.30
Rate for Payer: Kaiser Permanente Medicaid	$1.87
Rate for Payer: Kaiser Permanente Medicare	$1.83
Rate for Payer: MDX Hawaii PPO	$3.56
Rate for Payer: Ohana Health Plan Medicaid	$1.83
Rate for Payer: Ohana Health Plan Medicare	$1.83
Rate for Payer: UnitedHealthcare Medicaid	$2.20
Rate for Payer: UnitedHealthcare Medicare	$1.83
Rate for Payer: University Health Alliance Commercial	$2.68

warfarin 2.5 mg tablet [HHSC]

Facility

$3.49

Service Code	NDC 65162076310
Hospital Charge Code	2500860
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

warfarin 2.5 mg tablet [HHSC]

Facility

$14.81

Service Code	NDC 00056017675
Hospital Charge Code	2500860
Hospital Revenue Code	250
Min. Negotiated Rate	$7.41
Max. Negotiated Rate	$14.37
Rate for Payer: AlohaCare Medicaid	$7.41
Rate for Payer: AlohaCare Medicare	$7.41
Rate for Payer: Cash Price	$9.63
Rate for Payer: Devoted Health Medicare	$8.15
Rate for Payer: Hawaii Medical Service Association Medicare	$7.41
Rate for Payer: Hawaii Western Management Group Commercial	$14.07
Rate for Payer: Health Management Network Commercial	$12.59
Rate for Payer: Humana Medicare	$7.41
Rate for Payer: Kaiser Permanente Commercial	$13.33
Rate for Payer: Kaiser Permanente Medicaid	$7.55
Rate for Payer: Kaiser Permanente Medicare	$7.41
Rate for Payer: MDX Hawaii PPO	$14.37
Rate for Payer: Ohana Health Plan Medicaid	$7.41
Rate for Payer: Ohana Health Plan Medicare	$7.41
Rate for Payer: UnitedHealthcare Medicaid	$8.89
Rate for Payer: UnitedHealthcare Medicare	$7.41
Rate for Payer: University Health Alliance Commercial	$10.80

warfarin 2.5 mg tablet [HHSC]

Facility

$14.81

Service Code	NDC 00056017675
Hospital Charge Code	2500860
Hospital Revenue Code	250
Min. Negotiated Rate	$12.59
Max. Negotiated Rate	$14.37
Rate for Payer: Cash Price	$9.63
Rate for Payer: Health Management Network Commercial	$12.59
Rate for Payer: Kaiser Permanente Commercial	$13.33
Rate for Payer: MDX Hawaii PPO	$14.37

warfarin 2 mg tablet [HHSC]

Facility

$3.53

Service Code	NDC 65162076210
Hospital Charge Code	2500859
Hospital Revenue Code	250
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.42
Rate for Payer: Cash Price	$2.29
Rate for Payer: Health Management Network Commercial	$3.00
Rate for Payer: Kaiser Permanente Commercial	$3.18
Rate for Payer: MDX Hawaii PPO	$3.42

warfarin 2 mg tablet [HHSC]

Facility

$14.35

Service Code	NDC 00056017075
Hospital Charge Code	2500859
Hospital Revenue Code	250
Min. Negotiated Rate	$7.17
Max. Negotiated Rate	$13.92
Rate for Payer: AlohaCare Medicaid	$7.17
Rate for Payer: AlohaCare Medicare	$7.17
Rate for Payer: Cash Price	$9.33
Rate for Payer: Devoted Health Medicare	$7.89
Rate for Payer: Hawaii Medical Service Association Medicare	$7.17
Rate for Payer: Hawaii Western Management Group Commercial	$13.63
Rate for Payer: Health Management Network Commercial	$12.20
Rate for Payer: Humana Medicare	$7.17
Rate for Payer: Kaiser Permanente Commercial	$12.91
Rate for Payer: Kaiser Permanente Medicaid	$7.32
Rate for Payer: Kaiser Permanente Medicare	$7.17
Rate for Payer: MDX Hawaii PPO	$13.92
Rate for Payer: Ohana Health Plan Medicaid	$7.17
Rate for Payer: Ohana Health Plan Medicare	$7.17
Rate for Payer: UnitedHealthcare Medicaid	$8.61
Rate for Payer: UnitedHealthcare Medicare	$7.17
Rate for Payer: University Health Alliance Commercial	$10.46

warfarin 2 mg tablet [HHSC]

Facility

$3.57

Service Code	NDC 00832121201
Hospital Charge Code	2500859
Hospital Revenue Code	250
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$3.46
Rate for Payer: AlohaCare Medicaid	$1.78
Rate for Payer: AlohaCare Medicare	$1.78
Rate for Payer: Cash Price	$2.32
Rate for Payer: Devoted Health Medicare	$1.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1.78
Rate for Payer: Hawaii Western Management Group Commercial	$3.39
Rate for Payer: Health Management Network Commercial	$3.03
Rate for Payer: Humana Medicare	$1.78
Rate for Payer: Kaiser Permanente Commercial	$3.21
Rate for Payer: Kaiser Permanente Medicaid	$1.82
Rate for Payer: Kaiser Permanente Medicare	$1.78
Rate for Payer: MDX Hawaii PPO	$3.46
Rate for Payer: Ohana Health Plan Medicaid	$1.78
Rate for Payer: Ohana Health Plan Medicare	$1.78
Rate for Payer: UnitedHealthcare Medicaid	$2.14
Rate for Payer: UnitedHealthcare Medicare	$1.78
Rate for Payer: University Health Alliance Commercial	$2.60

warfarin 2 mg tablet [HHSC]

Facility

$3.42

Service Code	NDC 62584098401
Hospital Charge Code	2500859
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$3.32
Rate for Payer: AlohaCare Medicaid	$1.71
Rate for Payer: AlohaCare Medicare	$1.71
Rate for Payer: Cash Price	$2.22
Rate for Payer: Devoted Health Medicare	$1.88
Rate for Payer: Hawaii Medical Service Association Medicare	$1.71
Rate for Payer: Hawaii Western Management Group Commercial	$3.25
Rate for Payer: Health Management Network Commercial	$2.91
Rate for Payer: Humana Medicare	$1.71
Rate for Payer: Kaiser Permanente Commercial	$3.08
Rate for Payer: Kaiser Permanente Medicaid	$1.74
Rate for Payer: Kaiser Permanente Medicare	$1.71
Rate for Payer: MDX Hawaii PPO	$3.32
Rate for Payer: Ohana Health Plan Medicaid	$1.71
Rate for Payer: Ohana Health Plan Medicare	$1.71
Rate for Payer: UnitedHealthcare Medicaid	$2.05
Rate for Payer: UnitedHealthcare Medicare	$1.71
Rate for Payer: University Health Alliance Commercial	$2.49

warfarin 2 mg tablet [HHSC]

Facility

$14.35

Service Code	NDC 00056017075
Hospital Charge Code	2500859
Hospital Revenue Code	250
Min. Negotiated Rate	$12.20
Max. Negotiated Rate	$13.92
Rate for Payer: Cash Price	$9.33
Rate for Payer: Health Management Network Commercial	$12.20
Rate for Payer: Kaiser Permanente Commercial	$12.91
Rate for Payer: MDX Hawaii PPO	$13.92

warfarin 2 mg tablet [HHSC]

Facility

$3.42

Service Code	NDC 62584098401
Hospital Charge Code	2500859
Hospital Revenue Code	250
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$3.32
Rate for Payer: Cash Price	$2.22
Rate for Payer: Health Management Network Commercial	$2.91
Rate for Payer: Kaiser Permanente Commercial	$3.08
Rate for Payer: MDX Hawaii PPO	$3.32

warfarin 2 mg tablet [HHSC]

Facility

$3.57

Service Code	NDC 00832121201
Hospital Charge Code	2500859
Hospital Revenue Code	250
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$3.46
Rate for Payer: Cash Price	$2.32
Rate for Payer: Health Management Network Commercial	$3.03
Rate for Payer: Kaiser Permanente Commercial	$3.21
Rate for Payer: MDX Hawaii PPO	$3.46

warfarin 2 mg tablet [HHSC]

Facility

$3.53

Service Code	NDC 65162076210
Hospital Charge Code	2500859
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$3.42
Rate for Payer: AlohaCare Medicaid	$1.76
Rate for Payer: AlohaCare Medicare	$1.76
Rate for Payer: Cash Price	$2.29
Rate for Payer: Devoted Health Medicare	$1.94
Rate for Payer: Hawaii Medical Service Association Medicare	$1.76
Rate for Payer: Hawaii Western Management Group Commercial	$3.35
Rate for Payer: Health Management Network Commercial	$3.00
Rate for Payer: Humana Medicare	$1.76
Rate for Payer: Kaiser Permanente Commercial	$3.18
Rate for Payer: Kaiser Permanente Medicaid	$1.80
Rate for Payer: Kaiser Permanente Medicare	$1.76
Rate for Payer: MDX Hawaii PPO	$3.42
Rate for Payer: Ohana Health Plan Medicaid	$1.76
Rate for Payer: Ohana Health Plan Medicare	$1.76
Rate for Payer: UnitedHealthcare Medicaid	$2.12
Rate for Payer: UnitedHealthcare Medicare	$1.76
Rate for Payer: University Health Alliance Commercial	$2.57

warfarin 3 mg tablet [HHSC]

Facility

$3.67

Service Code	NDC 00832121401
Hospital Charge Code	2500861
Hospital Revenue Code	250
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$3.56
Rate for Payer: AlohaCare Medicaid	$1.83
Rate for Payer: AlohaCare Medicare	$1.83
Rate for Payer: Cash Price	$2.39
Rate for Payer: Devoted Health Medicare	$2.02
Rate for Payer: Hawaii Medical Service Association Medicare	$1.83
Rate for Payer: Hawaii Western Management Group Commercial	$3.49
Rate for Payer: Health Management Network Commercial	$3.12
Rate for Payer: Humana Medicare	$1.83
Rate for Payer: Kaiser Permanente Commercial	$3.30
Rate for Payer: Kaiser Permanente Medicaid	$1.87
Rate for Payer: Kaiser Permanente Medicare	$1.83
Rate for Payer: MDX Hawaii PPO	$3.56
Rate for Payer: Ohana Health Plan Medicaid	$1.83
Rate for Payer: Ohana Health Plan Medicare	$1.83
Rate for Payer: UnitedHealthcare Medicaid	$2.20
Rate for Payer: UnitedHealthcare Medicare	$1.83
Rate for Payer: University Health Alliance Commercial	$2.68

warfarin 3 mg tablet [HHSC]

Facility

$3.65

Service Code	NDC 65162076410
Hospital Charge Code	2500861
Hospital Revenue Code	250
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$3.54
Rate for Payer: AlohaCare Medicaid	$1.82
Rate for Payer: AlohaCare Medicare	$1.82
Rate for Payer: Cash Price	$2.37
Rate for Payer: Devoted Health Medicare	$2.01
Rate for Payer: Hawaii Medical Service Association Medicare	$1.82
Rate for Payer: Hawaii Western Management Group Commercial	$3.47
Rate for Payer: Health Management Network Commercial	$3.10
Rate for Payer: Humana Medicare	$1.82
Rate for Payer: Kaiser Permanente Commercial	$3.29
Rate for Payer: Kaiser Permanente Medicaid	$1.86
Rate for Payer: Kaiser Permanente Medicare	$1.82
Rate for Payer: MDX Hawaii PPO	$3.54
Rate for Payer: Ohana Health Plan Medicaid	$1.82
Rate for Payer: Ohana Health Plan Medicare	$1.82
Rate for Payer: UnitedHealthcare Medicaid	$2.19
Rate for Payer: UnitedHealthcare Medicare	$1.82
Rate for Payer: University Health Alliance Commercial	$2.66

warfarin 3 mg tablet [HHSC]

Facility

$3.65

Service Code	NDC 65162076410
Hospital Charge Code	2500861
Hospital Revenue Code	250
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$3.54
Rate for Payer: Cash Price	$2.37
Rate for Payer: Health Management Network Commercial	$3.10
Rate for Payer: Kaiser Permanente Commercial	$3.29
Rate for Payer: MDX Hawaii PPO	$3.54

warfarin 3 mg tablet [HHSC]

Facility

$3.67

Service Code	NDC 00832121401
Hospital Charge Code	2500861
Hospital Revenue Code	250
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.56
Rate for Payer: Cash Price	$2.39
Rate for Payer: Health Management Network Commercial	$3.12
Rate for Payer: Kaiser Permanente Commercial	$3.30
Rate for Payer: MDX Hawaii PPO	$3.56

Know your out-of-pocket cost for care.

All Charges