Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

albuterol HFA 90mcg 18gm inhaler [HHSC]

Facility

$338.53

Service Code	HCPCS J3535
Hospital Charge Code	2501054
Hospital Revenue Code	250
Min. Negotiated Rate	$287.75
Max. Negotiated Rate	$328.37
Rate for Payer: Cash Price	$220.04
Rate for Payer: Health Management Network Commercial	$287.75
Rate for Payer: Kaiser Permanente Commercial	$304.68
Rate for Payer: MDX Hawaii PPO	$328.37

albuterol HFA 90mcg 18gm inhaler [HHSC]

Facility

$338.53

Service Code	HCPCS J3535
Hospital Charge Code	2501054
Hospital Revenue Code	636
Min. Negotiated Rate	$169.26
Max. Negotiated Rate	$328.37
Rate for Payer: AlohaCare Medicaid	$169.26
Rate for Payer: AlohaCare Medicare	$169.26
Rate for Payer: Cash Price	$220.04
Rate for Payer: Devoted Health Medicare	$186.19
Rate for Payer: Hawaii Medical Service Association Medicare	$169.26
Rate for Payer: Hawaii Western Management Group Commercial	$321.60
Rate for Payer: Health Management Network Commercial	$287.75
Rate for Payer: Humana Medicare	$169.26
Rate for Payer: Kaiser Permanente Commercial	$304.68
Rate for Payer: Kaiser Permanente Medicaid	$172.65
Rate for Payer: Kaiser Permanente Medicare	$169.26
Rate for Payer: MDX Hawaii PPO	$328.37
Rate for Payer: Ohana Health Plan Medicaid	$169.26
Rate for Payer: Ohana Health Plan Medicare	$169.26
Rate for Payer: UnitedHealthcare Medicaid	$203.12
Rate for Payer: UnitedHealthcare Medicare	$169.26
Rate for Payer: University Health Alliance Commercial	$246.75

albuterol HFA 90mcg 8gm inhaler [HHSC]

Facility

$304.94

Service Code	NDC 45802008801
Hospital Charge Code	2500032
Hospital Revenue Code	250
Min. Negotiated Rate	$152.47
Max. Negotiated Rate	$295.79
Rate for Payer: AlohaCare Medicaid	$152.47
Rate for Payer: AlohaCare Medicare	$152.47
Rate for Payer: Cash Price	$198.21
Rate for Payer: Devoted Health Medicare	$167.72
Rate for Payer: Hawaii Medical Service Association Medicare	$152.47
Rate for Payer: Hawaii Western Management Group Commercial	$289.69
Rate for Payer: Health Management Network Commercial	$259.20
Rate for Payer: Humana Medicare	$152.47
Rate for Payer: Kaiser Permanente Commercial	$274.45
Rate for Payer: Kaiser Permanente Medicaid	$155.52
Rate for Payer: Kaiser Permanente Medicare	$152.47
Rate for Payer: MDX Hawaii PPO	$295.79
Rate for Payer: Ohana Health Plan Medicaid	$152.47
Rate for Payer: Ohana Health Plan Medicare	$152.47
Rate for Payer: UnitedHealthcare Medicaid	$182.96
Rate for Payer: UnitedHealthcare Medicare	$152.47
Rate for Payer: University Health Alliance Commercial	$222.27

albuterol HFA 90mcg 8gm inhaler [HHSC]

Facility

$304.94

Service Code	NDC 45802008801
Hospital Charge Code	2500032
Hospital Revenue Code	250
Min. Negotiated Rate	$259.20
Max. Negotiated Rate	$295.79
Rate for Payer: Cash Price	$198.21
Rate for Payer: Health Management Network Commercial	$259.20
Rate for Payer: Kaiser Permanente Commercial	$274.45
Rate for Payer: MDX Hawaii PPO	$295.79

albuterol HFA 90mcg 8gm inhaler [HHSC]

Facility

$132.10

Service Code	NDC 00173068224
Hospital Charge Code	2500032
Hospital Revenue Code	250
Min. Negotiated Rate	$66.05
Max. Negotiated Rate	$128.14
Rate for Payer: AlohaCare Medicaid	$66.05
Rate for Payer: AlohaCare Medicare	$66.05
Rate for Payer: Cash Price	$85.86
Rate for Payer: Devoted Health Medicare	$72.66
Rate for Payer: Hawaii Medical Service Association Medicare	$66.05
Rate for Payer: Hawaii Western Management Group Commercial	$125.50
Rate for Payer: Health Management Network Commercial	$112.28
Rate for Payer: Humana Medicare	$66.05
Rate for Payer: Kaiser Permanente Commercial	$118.89
Rate for Payer: Kaiser Permanente Medicaid	$67.37
Rate for Payer: Kaiser Permanente Medicare	$66.05
Rate for Payer: MDX Hawaii PPO	$128.14
Rate for Payer: Ohana Health Plan Medicaid	$66.05
Rate for Payer: Ohana Health Plan Medicare	$66.05
Rate for Payer: UnitedHealthcare Medicaid	$79.26
Rate for Payer: UnitedHealthcare Medicare	$66.05
Rate for Payer: University Health Alliance Commercial	$96.29

albuterol HFA 90mcg 8gm inhaler [HHSC]

Facility

$132.10

Service Code	NDC 00173068224
Hospital Charge Code	2500032
Hospital Revenue Code	250
Min. Negotiated Rate	$112.28
Max. Negotiated Rate	$128.14
Rate for Payer: Cash Price	$85.86
Rate for Payer: Health Management Network Commercial	$112.28
Rate for Payer: Kaiser Permanente Commercial	$118.89
Rate for Payer: MDX Hawaii PPO	$128.14

albuterol-ipratropium 2.5-0.5 mg/3ml neb soln [HHSC]

Facility

$12.80

Service Code	HCPCS J7620
Hospital Charge Code	2500033
Hospital Revenue Code	636
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$12.42
Rate for Payer: AlohaCare Medicaid	$6.40
Rate for Payer: AlohaCare Medicaid	$1.73
Rate for Payer: AlohaCare Medicaid	$6.14
Rate for Payer: AlohaCare Medicare	$1.73
Rate for Payer: AlohaCare Medicare	$6.14
Rate for Payer: AlohaCare Medicare	$6.40
Rate for Payer: Cash Price	$7.99
Rate for Payer: Cash Price	$2.24
Rate for Payer: Cash Price	$7.99
Rate for Payer: Cash Price	$2.24
Rate for Payer: Cash Price	$8.32
Rate for Payer: Cash Price	$8.32
Rate for Payer: Devoted Health Medicare	$1.90
Rate for Payer: Devoted Health Medicare	$7.04
Rate for Payer: Devoted Health Medicare	$6.76
Rate for Payer: Hawaii Medical Service Association ABD	$0.20
Rate for Payer: Hawaii Medical Service Association ABD	$0.20
Rate for Payer: Hawaii Medical Service Association ABD	$0.20
Rate for Payer: Hawaii Medical Service Association Medicare	$6.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1.73
Rate for Payer: Hawaii Medical Service Association Medicare	$6.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.20
Rate for Payer: Hawaii Western Management Group Commercial	$3.28
Rate for Payer: Hawaii Western Management Group Commercial	$11.68
Rate for Payer: Hawaii Western Management Group Commercial	$12.16
Rate for Payer: Health Management Network Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$10.88
Rate for Payer: Health Management Network Commercial	$2.93
Rate for Payer: Humana Medicare	$6.40
Rate for Payer: Humana Medicare	$6.14
Rate for Payer: Humana Medicare	$1.73
Rate for Payer: Kaiser Permanente Commercial	$11.52
Rate for Payer: Kaiser Permanente Commercial	$3.10
Rate for Payer: Kaiser Permanente Commercial	$11.06
Rate for Payer: Kaiser Permanente Medicaid	$6.53
Rate for Payer: Kaiser Permanente Medicaid	$1.76
Rate for Payer: Kaiser Permanente Medicaid	$6.27
Rate for Payer: Kaiser Permanente Medicare	$6.40
Rate for Payer: Kaiser Permanente Medicare	$6.14
Rate for Payer: Kaiser Permanente Medicare	$1.73
Rate for Payer: MDX Hawaii PPO	$3.35
Rate for Payer: MDX Hawaii PPO	$11.92
Rate for Payer: MDX Hawaii PPO	$12.42
Rate for Payer: Ohana Health Plan Medicaid	$6.40
Rate for Payer: Ohana Health Plan Medicaid	$1.73
Rate for Payer: Ohana Health Plan Medicaid	$6.14
Rate for Payer: Ohana Health Plan Medicare	$1.73
Rate for Payer: Ohana Health Plan Medicare	$6.14
Rate for Payer: Ohana Health Plan Medicare	$6.40
Rate for Payer: UnitedHealthcare Medicaid	$7.37
Rate for Payer: UnitedHealthcare Medicaid	$7.68
Rate for Payer: UnitedHealthcare Medicaid	$2.07
Rate for Payer: UnitedHealthcare Medicare	$6.14
Rate for Payer: UnitedHealthcare Medicare	$1.73
Rate for Payer: UnitedHealthcare Medicare	$6.40
Rate for Payer: University Health Alliance Commercial	$2.51
Rate for Payer: University Health Alliance Commercial	$9.33
Rate for Payer: University Health Alliance Commercial	$8.96

albuterol-ipratropium 2.5-0.5 mg/3ml neb soln [HHSC]

Facility

$12.80

Service Code	HCPCS J7620
Hospital Charge Code	2500033
Hospital Revenue Code	250
Min. Negotiated Rate	$10.88
Max. Negotiated Rate	$12.42
Rate for Payer: Cash Price	$8.32
Rate for Payer: Cash Price	$7.99
Rate for Payer: Cash Price	$2.24
Rate for Payer: Health Management Network Commercial	$2.93
Rate for Payer: Health Management Network Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$10.88
Rate for Payer: Kaiser Permanente Commercial	$3.10
Rate for Payer: Kaiser Permanente Commercial	$11.06
Rate for Payer: Kaiser Permanente Commercial	$11.52
Rate for Payer: MDX Hawaii PPO	$12.42
Rate for Payer: MDX Hawaii PPO	$11.92
Rate for Payer: MDX Hawaii PPO	$3.35

ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA

Facility

$9,102.07

Service Code	MSDRG 894
Min. Negotiated Rate	$9,102.07
Max. Negotiated Rate	$9,102.07
Rate for Payer: Hawaii Medical Service Association Commercial	$9,102.07

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC

Facility

$24,297.69

Service Code	MSDRG 896
Min. Negotiated Rate	$24,297.69
Max. Negotiated Rate	$24,297.69
Rate for Payer: Hawaii Medical Service Association Commercial	$24,297.69

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC

Facility

$15,501.57

Service Code	MSDRG 897
Min. Negotiated Rate	$15,501.57
Max. Negotiated Rate	$15,501.57
Rate for Payer: Hawaii Medical Service Association Commercial	$15,501.57

ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY

Facility

$24,297.69

Service Code	MSDRG 895
Min. Negotiated Rate	$24,297.69
Max. Negotiated Rate	$24,297.69
Rate for Payer: Hawaii Medical Service Association Commercial	$24,297.69

Alcohol Level FSI

Facility

$1,384.00

Service Code	HCPCS 82077
Hospital Charge Code	8228834
Hospital Revenue Code	301
Min. Negotiated Rate	$1,176.40
Max. Negotiated Rate	$1,342.48
Rate for Payer: Cash Price	$899.60
Rate for Payer: Health Management Network Commercial	$1,176.40
Rate for Payer: Kaiser Permanente Commercial	$1,245.60
Rate for Payer: MDX Hawaii PPO	$1,342.48

Alcohol Level FSI

Facility

$1,384.00

Service Code	HCPCS 82077
Hospital Charge Code	8228834
Hospital Revenue Code	301
Min. Negotiated Rate	$10.36
Max. Negotiated Rate	$1,342.48
Rate for Payer: AlohaCare Medicaid	$692.00
Rate for Payer: AlohaCare Medicare	$692.00
Rate for Payer: Cash Price	$899.60
Rate for Payer: Cash Price	$899.60
Rate for Payer: Devoted Health Medicare	$761.20
Rate for Payer: Hawaii Medical Service Association ABD	$17.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21.59
Rate for Payer: Hawaii Medical Service Association Medicare	$692.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.78
Rate for Payer: Hawaii Western Management Group Commercial	$17.27
Rate for Payer: Health Management Network Commercial	$1,176.40
Rate for Payer: Humana Medicare	$692.00
Rate for Payer: Kaiser Permanente Commercial	$1,245.60
Rate for Payer: Kaiser Permanente Medicaid	$705.84
Rate for Payer: Kaiser Permanente Medicare	$692.00
Rate for Payer: MDX Hawaii PPO	$1,342.48
Rate for Payer: Ohana Health Plan Medicaid	$692.00
Rate for Payer: Ohana Health Plan Medicare	$692.00
Rate for Payer: UnitedHealthcare Medicaid	$10.36
Rate for Payer: UnitedHealthcare Medicare	$692.00
Rate for Payer: University Health Alliance Commercial	$1,008.80

Aldosterone/Renin Activity Ratio FSI

Facility

$230.00

Service Code	HCPCS 82088
Hospital Charge Code	8117770
Hospital Revenue Code	300
Min. Negotiated Rate	$40.75
Max. Negotiated Rate	$223.10
Rate for Payer: AlohaCare Medicaid	$115.00
Rate for Payer: AlohaCare Medicare	$115.00
Rate for Payer: Cash Price	$149.50
Rate for Payer: Cash Price	$149.50
Rate for Payer: Devoted Health Medicare	$126.50
Rate for Payer: Hawaii Medical Service Association ABD	$56.32
Rate for Payer: Hawaii Medical Service Association Commercial	$50.94
Rate for Payer: Hawaii Medical Service Association Medicare	$115.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$59.14
Rate for Payer: Hawaii Western Management Group Commercial	$40.75
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Humana Medicare	$115.00
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: Kaiser Permanente Medicaid	$117.30
Rate for Payer: Kaiser Permanente Medicare	$115.00
Rate for Payer: MDX Hawaii PPO	$223.10
Rate for Payer: Ohana Health Plan Medicaid	$115.00
Rate for Payer: Ohana Health Plan Medicare	$115.00
Rate for Payer: UnitedHealthcare Medicaid	$56.32
Rate for Payer: UnitedHealthcare Medicare	$115.00
Rate for Payer: University Health Alliance Commercial	$105.34

Aldosterone/Renin Activity Ratio FSI

Facility

$230.00

Service Code	HCPCS 82088
Hospital Charge Code	8117770
Hospital Revenue Code	300
Min. Negotiated Rate	$195.50
Max. Negotiated Rate	$223.10
Rate for Payer: Cash Price	$149.50
Rate for Payer: Health Management Network Commercial	$195.50
Rate for Payer: Kaiser Permanente Commercial	$207.00
Rate for Payer: MDX Hawaii PPO	$223.10

alendronate 70 mg tablet [HHSC]

Facility

$103.32

Service Code	NDC 16252060102
Hospital Charge Code	2500034
Hospital Revenue Code	250
Min. Negotiated Rate	$87.82
Max. Negotiated Rate	$100.22
Rate for Payer: Cash Price	$67.16
Rate for Payer: Health Management Network Commercial	$87.82
Rate for Payer: Kaiser Permanente Commercial	$92.99
Rate for Payer: MDX Hawaii PPO	$100.22

alendronate 70 mg tablet [HHSC]

Facility

$103.77

Service Code	NDC 64980034214
Hospital Charge Code	2500034
Hospital Revenue Code	250
Min. Negotiated Rate	$51.88
Max. Negotiated Rate	$100.66
Rate for Payer: AlohaCare Medicaid	$51.88
Rate for Payer: AlohaCare Medicare	$51.88
Rate for Payer: Cash Price	$67.45
Rate for Payer: Devoted Health Medicare	$57.07
Rate for Payer: Hawaii Medical Service Association Medicare	$51.88
Rate for Payer: Hawaii Western Management Group Commercial	$98.58
Rate for Payer: Health Management Network Commercial	$88.20
Rate for Payer: Humana Medicare	$51.88
Rate for Payer: Kaiser Permanente Commercial	$93.39
Rate for Payer: Kaiser Permanente Medicaid	$52.92
Rate for Payer: Kaiser Permanente Medicare	$51.88
Rate for Payer: MDX Hawaii PPO	$100.66
Rate for Payer: Ohana Health Plan Medicaid	$51.88
Rate for Payer: Ohana Health Plan Medicare	$51.88
Rate for Payer: UnitedHealthcare Medicaid	$62.26
Rate for Payer: UnitedHealthcare Medicare	$51.88
Rate for Payer: University Health Alliance Commercial	$75.64

alendronate 70 mg tablet [HHSC]

Facility

$103.79

Service Code	NDC 65862032904
Hospital Charge Code	2500034
Hospital Revenue Code	250
Min. Negotiated Rate	$51.90
Max. Negotiated Rate	$100.68
Rate for Payer: AlohaCare Medicaid	$51.90
Rate for Payer: AlohaCare Medicare	$51.90
Rate for Payer: Cash Price	$67.46
Rate for Payer: Devoted Health Medicare	$57.08
Rate for Payer: Hawaii Medical Service Association Medicare	$51.90
Rate for Payer: Hawaii Western Management Group Commercial	$98.60
Rate for Payer: Health Management Network Commercial	$88.22
Rate for Payer: Humana Medicare	$51.90
Rate for Payer: Kaiser Permanente Commercial	$93.41
Rate for Payer: Kaiser Permanente Medicaid	$52.93
Rate for Payer: Kaiser Permanente Medicare	$51.90
Rate for Payer: MDX Hawaii PPO	$100.68
Rate for Payer: Ohana Health Plan Medicaid	$51.90
Rate for Payer: Ohana Health Plan Medicare	$51.90
Rate for Payer: UnitedHealthcare Medicaid	$62.27
Rate for Payer: UnitedHealthcare Medicare	$51.90
Rate for Payer: University Health Alliance Commercial	$75.65

alendronate 70 mg tablet [HHSC]

Facility

$103.77

Service Code	NDC 64980034214
Hospital Charge Code	2500034
Hospital Revenue Code	250
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$100.66
Rate for Payer: Cash Price	$67.45
Rate for Payer: Health Management Network Commercial	$88.20
Rate for Payer: Kaiser Permanente Commercial	$93.39
Rate for Payer: MDX Hawaii PPO	$100.66

alendronate 70 mg tablet [HHSC]

Facility

$103.32

Service Code	NDC 16252060102
Hospital Charge Code	2500034
Hospital Revenue Code	250
Min. Negotiated Rate	$51.66
Max. Negotiated Rate	$100.22
Rate for Payer: AlohaCare Medicaid	$51.66
Rate for Payer: AlohaCare Medicare	$51.66
Rate for Payer: Cash Price	$67.16
Rate for Payer: Devoted Health Medicare	$56.83
Rate for Payer: Hawaii Medical Service Association Medicare	$51.66
Rate for Payer: Hawaii Western Management Group Commercial	$98.15
Rate for Payer: Health Management Network Commercial	$87.82
Rate for Payer: Humana Medicare	$51.66
Rate for Payer: Kaiser Permanente Commercial	$92.99
Rate for Payer: Kaiser Permanente Medicaid	$52.69
Rate for Payer: Kaiser Permanente Medicare	$51.66
Rate for Payer: MDX Hawaii PPO	$100.22
Rate for Payer: Ohana Health Plan Medicaid	$51.66
Rate for Payer: Ohana Health Plan Medicare	$51.66
Rate for Payer: UnitedHealthcare Medicaid	$61.99
Rate for Payer: UnitedHealthcare Medicare	$51.66
Rate for Payer: University Health Alliance Commercial	$75.31

alendronate 70 mg tablet [HHSC]

Facility

$103.79

Service Code	NDC 65862032904
Hospital Charge Code	2500034
Hospital Revenue Code	250
Min. Negotiated Rate	$88.22
Max. Negotiated Rate	$100.68
Rate for Payer: Cash Price	$67.46
Rate for Payer: Health Management Network Commercial	$88.22
Rate for Payer: Kaiser Permanente Commercial	$93.41
Rate for Payer: MDX Hawaii PPO	$100.68

Alkaline Phosphatase Fractionation FSI

Facility

$211.00

Service Code	HCPCS 84080
Hospital Charge Code	8404555
Hospital Revenue Code	301
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$204.67
Rate for Payer: AlohaCare Medicaid	$105.50
Rate for Payer: AlohaCare Medicare	$105.50
Rate for Payer: Cash Price	$137.15
Rate for Payer: Cash Price	$137.15
Rate for Payer: Devoted Health Medicare	$116.05
Rate for Payer: Hawaii Medical Service Association ABD	$20.44
Rate for Payer: Hawaii Medical Service Association Commercial	$18.48
Rate for Payer: Hawaii Medical Service Association Medicare	$105.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.46
Rate for Payer: Hawaii Western Management Group Commercial	$14.78
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Humana Medicare	$105.50
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: Kaiser Permanente Medicaid	$107.61
Rate for Payer: Kaiser Permanente Medicare	$105.50
Rate for Payer: MDX Hawaii PPO	$204.67
Rate for Payer: Ohana Health Plan Medicaid	$105.50
Rate for Payer: Ohana Health Plan Medicare	$105.50
Rate for Payer: UnitedHealthcare Medicaid	$20.44
Rate for Payer: UnitedHealthcare Medicare	$105.50
Rate for Payer: University Health Alliance Commercial	$38.22

Alkaline Phosphatase Fractionation FSI

Facility

$211.00

Service Code	HCPCS 84080
Hospital Charge Code	8404555
Hospital Revenue Code	301
Min. Negotiated Rate	$179.35
Max. Negotiated Rate	$204.67
Rate for Payer: Cash Price	$137.15
Rate for Payer: Health Management Network Commercial	$179.35
Rate for Payer: Kaiser Permanente Commercial	$189.90
Rate for Payer: MDX Hawaii PPO	$204.67

Alkaline Phosphatase FSI

Facility

$92.00

Service Code	HCPCS 84075
Hospital Charge Code	8117771
Hospital Revenue Code	301
Min. Negotiated Rate	$78.20
Max. Negotiated Rate	$89.24
Rate for Payer: Cash Price	$59.80
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: MDX Hawaii PPO	$89.24

Know your out-of-pocket cost for care.

All Charges