Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

VENOVO VENOUS STENT 16X120

Facility

$7,000.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$3,500.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: AlohaCare Medicaid	$3,500.00
Rate for Payer: AlohaCare Medicare	$5,320.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Devoted Health Medicare	$5,880.00
Rate for Payer: Hawaii Medical Service Association Medicare	$5,320.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,900.00
Rate for Payer: Health Management Network Commercial	$5,950.00
Rate for Payer: Humana Medicare	$5,320.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: Kaiser Permanente Medicaid	$3,570.00
Rate for Payer: Kaiser Permanente Medicare	$5,320.00
Rate for Payer: MDX Hawaii PPO	$6,790.00
Rate for Payer: Ohana Health Plan Medicaid	$5,320.00
Rate for Payer: Ohana Health Plan Medicare	$5,320.00
Rate for Payer: UnitedHealthcare Medicare	$5,320.00
Rate for Payer: University Health Alliance Commercial	$3,920.00

VENOVO VENOUS STENT 16X40

Facility

$7,000.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$3,500.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: AlohaCare Medicaid	$3,500.00
Rate for Payer: AlohaCare Medicare	$5,320.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Devoted Health Medicare	$5,880.00
Rate for Payer: Hawaii Medical Service Association Medicare	$5,320.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,900.00
Rate for Payer: Health Management Network Commercial	$5,950.00
Rate for Payer: Humana Medicare	$5,320.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: Kaiser Permanente Medicaid	$3,570.00
Rate for Payer: Kaiser Permanente Medicare	$5,320.00
Rate for Payer: MDX Hawaii PPO	$6,790.00
Rate for Payer: Ohana Health Plan Medicaid	$5,320.00
Rate for Payer: Ohana Health Plan Medicare	$5,320.00
Rate for Payer: UnitedHealthcare Medicare	$5,320.00
Rate for Payer: University Health Alliance Commercial	$3,920.00

VENOVO VENOUS STENT 16X40

Facility

$7,000.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$3,920.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,900.00
Rate for Payer: Health Management Network Commercial	$5,950.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: MDX Hawaii PPO	$6,790.00
Rate for Payer: University Health Alliance Commercial	$3,920.00

VENOVO VENOUS STENT 20X60

Facility

$7,000.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$3,500.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: AlohaCare Medicaid	$3,500.00
Rate for Payer: AlohaCare Medicare	$5,320.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Devoted Health Medicare	$5,880.00
Rate for Payer: Hawaii Medical Service Association Medicare	$5,320.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,900.00
Rate for Payer: Health Management Network Commercial	$5,950.00
Rate for Payer: Humana Medicare	$5,320.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: Kaiser Permanente Medicaid	$3,570.00
Rate for Payer: Kaiser Permanente Medicare	$5,320.00
Rate for Payer: MDX Hawaii PPO	$6,790.00
Rate for Payer: Ohana Health Plan Medicaid	$5,320.00
Rate for Payer: Ohana Health Plan Medicare	$5,320.00
Rate for Payer: UnitedHealthcare Medicare	$5,320.00
Rate for Payer: University Health Alliance Commercial	$3,920.00

VENOVO VENOUS STENT 20X60

Facility

$7,000.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$3,920.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,900.00
Rate for Payer: Health Management Network Commercial	$5,950.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: MDX Hawaii PPO	$6,790.00
Rate for Payer: University Health Alliance Commercial	$3,920.00

VENTRALIGHT MESH 4.5" 5990011

Facility

$2,580.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,290.00
Max. Negotiated Rate	$2,502.60
Rate for Payer: AlohaCare Medicaid	$1,290.00
Rate for Payer: AlohaCare Medicare	$1,960.80
Rate for Payer: Cash Price	$1,548.00
Rate for Payer: Devoted Health Medicare	$2,167.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,960.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,806.00
Rate for Payer: Health Management Network Commercial	$2,193.00
Rate for Payer: Humana Medicare	$1,960.80
Rate for Payer: Kaiser Permanente Commercial	$2,322.00
Rate for Payer: Kaiser Permanente Medicaid	$1,315.80
Rate for Payer: Kaiser Permanente Medicare	$1,960.80
Rate for Payer: MDX Hawaii PPO	$2,502.60
Rate for Payer: Ohana Health Plan Medicaid	$1,960.80
Rate for Payer: Ohana Health Plan Medicare	$1,960.80
Rate for Payer: UnitedHealthcare Medicare	$1,960.80
Rate for Payer: University Health Alliance Commercial	$1,444.80

VENTRALIGHT MESH 4.5" 5990011

Facility

$2,580.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,444.80
Max. Negotiated Rate	$2,502.60
Rate for Payer: Cash Price	$1,548.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,806.00
Rate for Payer: Health Management Network Commercial	$2,193.00
Rate for Payer: Kaiser Permanente Commercial	$2,322.00
Rate for Payer: MDX Hawaii PPO	$2,502.60
Rate for Payer: University Health Alliance Commercial	$1,444.80

VENTRALIGHT MESH 4X6 5991015

Facility

$2,086.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,043.00
Max. Negotiated Rate	$2,023.42
Rate for Payer: AlohaCare Medicaid	$1,043.00
Rate for Payer: AlohaCare Medicare	$1,585.36
Rate for Payer: Cash Price	$1,251.60
Rate for Payer: Devoted Health Medicare	$1,752.24
Rate for Payer: Hawaii Medical Service Association Medicare	$1,585.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,460.20
Rate for Payer: Health Management Network Commercial	$1,773.10
Rate for Payer: Humana Medicare	$1,585.36
Rate for Payer: Kaiser Permanente Commercial	$1,877.40
Rate for Payer: Kaiser Permanente Medicaid	$1,063.86
Rate for Payer: Kaiser Permanente Medicare	$1,585.36
Rate for Payer: MDX Hawaii PPO	$2,023.42
Rate for Payer: Ohana Health Plan Medicaid	$1,585.36
Rate for Payer: Ohana Health Plan Medicare	$1,585.36
Rate for Payer: UnitedHealthcare Medicare	$1,585.36
Rate for Payer: University Health Alliance Commercial	$1,168.16

VENTRALIGHT MESH 4X6 5991015

Facility

$2,086.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,168.16
Max. Negotiated Rate	$2,023.42
Rate for Payer: Cash Price	$1,251.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,460.20
Rate for Payer: Health Management Network Commercial	$1,773.10
Rate for Payer: Kaiser Permanente Commercial	$1,877.40
Rate for Payer: MDX Hawaii PPO	$2,023.42
Rate for Payer: University Health Alliance Commercial	$1,168.16

VENTRALIGHT MESH 6" 5990020

Facility

$5,268.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$2,634.00
Max. Negotiated Rate	$5,109.96
Rate for Payer: AlohaCare Medicaid	$2,634.00
Rate for Payer: AlohaCare Medicare	$4,003.68
Rate for Payer: Cash Price	$3,160.80
Rate for Payer: Devoted Health Medicare	$4,425.12
Rate for Payer: Hawaii Medical Service Association Medicare	$4,003.68
Rate for Payer: Hawaii Western Management Group Commercial	$3,687.60
Rate for Payer: Health Management Network Commercial	$4,477.80
Rate for Payer: Humana Medicare	$4,003.68
Rate for Payer: Kaiser Permanente Commercial	$4,741.20
Rate for Payer: Kaiser Permanente Medicaid	$2,686.68
Rate for Payer: Kaiser Permanente Medicare	$4,003.68
Rate for Payer: MDX Hawaii PPO	$5,109.96
Rate for Payer: Ohana Health Plan Medicaid	$4,003.68
Rate for Payer: Ohana Health Plan Medicare	$4,003.68
Rate for Payer: UnitedHealthcare Medicare	$4,003.68
Rate for Payer: University Health Alliance Commercial	$2,950.08

VENTRALIGHT MESH 6" 5990020

Facility

$5,268.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$2,950.08
Max. Negotiated Rate	$5,109.96
Rate for Payer: Cash Price	$3,160.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,687.60
Rate for Payer: Health Management Network Commercial	$4,477.80
Rate for Payer: Kaiser Permanente Commercial	$4,741.20
Rate for Payer: MDX Hawaii PPO	$5,109.96
Rate for Payer: University Health Alliance Commercial	$2,950.08

VENTRALIGHT MESH 7X9 5991525

Facility

$4,580.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$2,564.80
Max. Negotiated Rate	$4,442.60
Rate for Payer: Cash Price	$2,748.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,206.00
Rate for Payer: Health Management Network Commercial	$3,893.00
Rate for Payer: Kaiser Permanente Commercial	$4,122.00
Rate for Payer: MDX Hawaii PPO	$4,442.60
Rate for Payer: University Health Alliance Commercial	$2,564.80

VENTRALIGHT MESH 7X9 5991525

Facility

$4,580.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$2,290.00
Max. Negotiated Rate	$4,442.60
Rate for Payer: AlohaCare Medicaid	$2,290.00
Rate for Payer: AlohaCare Medicare	$3,480.80
Rate for Payer: Cash Price	$2,748.00
Rate for Payer: Devoted Health Medicare	$3,847.20
Rate for Payer: Hawaii Medical Service Association Medicare	$3,480.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,206.00
Rate for Payer: Health Management Network Commercial	$3,893.00
Rate for Payer: Humana Medicare	$3,480.80
Rate for Payer: Kaiser Permanente Commercial	$4,122.00
Rate for Payer: Kaiser Permanente Medicaid	$2,335.80
Rate for Payer: Kaiser Permanente Medicare	$3,480.80
Rate for Payer: MDX Hawaii PPO	$4,442.60
Rate for Payer: Ohana Health Plan Medicaid	$3,480.80
Rate for Payer: Ohana Health Plan Medicare	$3,480.80
Rate for Payer: UnitedHealthcare Medicare	$3,480.80
Rate for Payer: University Health Alliance Commercial	$2,564.80

VENTRICULAR SHUNT PROCEDURES WITH CC

Facility

$53,827.24

Service Code	MSDRG 032
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$53,827.24
Rate for Payer: Hawaii Medical Service Association Commercial	$53,827.24
Rate for Payer: University Health Alliance Commercial	$10,400.00

VENTRICULAR SHUNT PROCEDURES WITH MCC

Facility

$53,827.24

Service Code	MSDRG 031
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$53,827.24
Rate for Payer: Hawaii Medical Service Association Commercial	$53,827.24
Rate for Payer: University Health Alliance Commercial	$10,400.00

VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC

Facility

$37,401.76

Service Code	MSDRG 033
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$37,401.76
Rate for Payer: Hawaii Medical Service Association Commercial	$37,401.76
Rate for Payer: University Health Alliance Commercial	$10,400.00

VENTRIO ST HERNIA PATCH OVAL

Facility

$3,260.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,825.60
Max. Negotiated Rate	$3,162.20
Rate for Payer: Cash Price	$1,956.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,282.00
Rate for Payer: Health Management Network Commercial	$2,771.00
Rate for Payer: Kaiser Permanente Commercial	$2,934.00
Rate for Payer: MDX Hawaii PPO	$3,162.20
Rate for Payer: University Health Alliance Commercial	$1,825.60

VENTRIO ST HERNIA PATCH OVAL

Facility

$3,260.00

Service Code	HCPCS C1781
Hospital Revenue Code	278
Min. Negotiated Rate	$1,630.00
Max. Negotiated Rate	$3,162.20
Rate for Payer: AlohaCare Medicaid	$1,630.00
Rate for Payer: AlohaCare Medicare	$2,477.60
Rate for Payer: Cash Price	$1,956.00
Rate for Payer: Devoted Health Medicare	$2,738.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,477.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,282.00
Rate for Payer: Health Management Network Commercial	$2,771.00
Rate for Payer: Humana Medicare	$2,477.60
Rate for Payer: Kaiser Permanente Commercial	$2,934.00
Rate for Payer: Kaiser Permanente Medicaid	$1,662.60
Rate for Payer: Kaiser Permanente Medicare	$2,477.60
Rate for Payer: MDX Hawaii PPO	$3,162.20
Rate for Payer: Ohana Health Plan Medicaid	$2,477.60
Rate for Payer: Ohana Health Plan Medicare	$2,477.60
Rate for Payer: UnitedHealthcare Medicare	$2,477.60
Rate for Payer: University Health Alliance Commercial	$1,825.60

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

$38.00

Service Code	NDC 70710164307
Hospital Revenue Code	250
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Kaiser Permanente Commercial	$34.20
Rate for Payer: MDX Hawaii PPO	$36.86

VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION [8527]

Facility

$38.00

Service Code	NDC 70710164301
Hospital Revenue Code	250
Min. Negotiated Rate	$32.30
Max. Negotiated Rate	$36.86
Rate for Payer: Cash Price	$22.80
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Kaiser Permanente Commercial	$34.20
Rate for Payer: MDX Hawaii PPO	$36.86

VERAPAMIL 40 MG TABLET [8529]

Facility

$1.00

Service Code	NDC 00591040401
Hospital Revenue Code	637
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.97
Rate for Payer: AlohaCare Medicaid	$0.50
Rate for Payer: AlohaCare Medicare	$0.76
Rate for Payer: Cash Price	$0.60
Rate for Payer: Devoted Health Medicare	$0.84
Rate for Payer: Hawaii Medical Service Association Medicare	$0.76
Rate for Payer: Hawaii Western Management Group Commercial	$0.95
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Humana Medicare	$0.76
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.51
Rate for Payer: Kaiser Permanente Medicare	$0.76
Rate for Payer: MDX Hawaii PPO	$0.97
Rate for Payer: Ohana Health Plan Medicaid	$0.76
Rate for Payer: Ohana Health Plan Medicare	$0.76
Rate for Payer: UnitedHealthcare Medicare	$0.76
Rate for Payer: University Health Alliance Commercial	$0.73

VERAPAMIL 40 MG TABLET [8529]

Facility

$1.00

Service Code	NDC 00591040401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.97
Rate for Payer: Cash Price	$0.60
Rate for Payer: Health Management Network Commercial	$0.85
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: MDX Hawaii PPO	$0.97

VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE [14626]

Facility

$7.00

Service Code	NDC 60687050401
Hospital Revenue Code	637
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$6.79
Rate for Payer: AlohaCare Medicaid	$3.50
Rate for Payer: AlohaCare Medicare	$5.32
Rate for Payer: Cash Price	$4.20
Rate for Payer: Devoted Health Medicare	$5.88
Rate for Payer: Hawaii Medical Service Association Medicare	$5.32
Rate for Payer: Hawaii Western Management Group Commercial	$6.65
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Humana Medicare	$5.32
Rate for Payer: Kaiser Permanente Commercial	$6.30
Rate for Payer: Kaiser Permanente Medicaid	$3.57
Rate for Payer: Kaiser Permanente Medicare	$5.32
Rate for Payer: MDX Hawaii PPO	$6.79
Rate for Payer: Ohana Health Plan Medicaid	$5.32
Rate for Payer: Ohana Health Plan Medicare	$5.32
Rate for Payer: UnitedHealthcare Medicare	$5.32
Rate for Payer: University Health Alliance Commercial	$5.10

VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE [14626]

Facility

$6.00

Service Code	NDC 75834015801
Hospital Revenue Code	250
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$3.60
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: MDX Hawaii PPO	$5.82

VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE [14626]

Facility

$6.00

Service Code	NDC 75834015801
Hospital Revenue Code	637
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$5.82
Rate for Payer: AlohaCare Medicaid	$3.00
Rate for Payer: AlohaCare Medicare	$4.56
Rate for Payer: Cash Price	$3.60
Rate for Payer: Devoted Health Medicare	$5.04
Rate for Payer: Hawaii Medical Service Association Medicare	$4.56
Rate for Payer: Hawaii Western Management Group Commercial	$5.70
Rate for Payer: Health Management Network Commercial	$5.10
Rate for Payer: Humana Medicare	$4.56
Rate for Payer: Kaiser Permanente Commercial	$5.40
Rate for Payer: Kaiser Permanente Medicaid	$3.06
Rate for Payer: Kaiser Permanente Medicare	$4.56
Rate for Payer: MDX Hawaii PPO	$5.82
Rate for Payer: Ohana Health Plan Medicaid	$4.56
Rate for Payer: Ohana Health Plan Medicare	$4.56
Rate for Payer: UnitedHealthcare Medicare	$4.56
Rate for Payer: University Health Alliance Commercial	$4.37

Know your out-of-pocket cost for care.

All Charges