Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

varenicline 0.5 mg Tab [KMC]

Facility

$24.75

Service Code	NDC 00069046856
Hospital Revenue Code	250
Min. Negotiated Rate	$21.04
Max. Negotiated Rate	$24.01
Rate for Payer: Cash Price	$16.09
Rate for Payer: Health Management Network Commercial	$21.04
Rate for Payer: Kaiser Permanente Commercial	$22.27
Rate for Payer: MDX Hawaii PPO	$24.01

varenicline 0.5 mg Tab [KMC]

Facility

$24.75

Service Code	NDC 00069046856
Hospital Revenue Code	250
Min. Negotiated Rate	$10.39
Max. Negotiated Rate	$24.01
Rate for Payer: AlohaCare Medicaid	$12.38
Rate for Payer: AlohaCare Medicare	$10.39
Rate for Payer: Cash Price	$16.09
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$22.77
Rate for Payer: Devoted Health Medicare	$10.39
Rate for Payer: Hawaii Medical Service Association Medicare	$10.39
Rate for Payer: Hawaii Western Management Group Commercial	$23.51
Rate for Payer: Health Management Network Commercial	$21.04
Rate for Payer: Humana Medicare	$10.39
Rate for Payer: Kaiser Permanente Commercial	$22.27
Rate for Payer: Kaiser Permanente Medicaid	$12.62
Rate for Payer: Kaiser Permanente Medicare	$10.39
Rate for Payer: MDX Hawaii PPO	$24.01
Rate for Payer: Ohana Health Plan Medicaid	$10.39
Rate for Payer: Ohana Health Plan Medicare	$10.39
Rate for Payer: UnitedHealthcare Medicaid	$14.85
Rate for Payer: UnitedHealthcare Medicare	$10.39
Rate for Payer: University Health Alliance Commercial	$18.04

varenicline 1 mg Tab [KMC]

Facility

$35.15

Service Code	NDC 49884015676
Hospital Revenue Code	250
Min. Negotiated Rate	$29.88
Max. Negotiated Rate	$34.10
Rate for Payer: Cash Price	$22.85
Rate for Payer: Health Management Network Commercial	$29.88
Rate for Payer: Kaiser Permanente Commercial	$31.64
Rate for Payer: MDX Hawaii PPO	$34.10

varenicline 1 mg Tab [KMC]

Facility

$35.15

Service Code	NDC 49884015676
Hospital Revenue Code	250
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$34.10
Rate for Payer: AlohaCare Medicaid	$17.57
Rate for Payer: AlohaCare Medicare	$14.76
Rate for Payer: Cash Price	$22.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$32.34
Rate for Payer: Devoted Health Medicare	$14.76
Rate for Payer: Hawaii Medical Service Association Medicare	$14.76
Rate for Payer: Hawaii Western Management Group Commercial	$33.39
Rate for Payer: Health Management Network Commercial	$29.88
Rate for Payer: Humana Medicare	$14.76
Rate for Payer: Kaiser Permanente Commercial	$31.64
Rate for Payer: Kaiser Permanente Medicaid	$17.93
Rate for Payer: Kaiser Permanente Medicare	$14.76
Rate for Payer: MDX Hawaii PPO	$34.10
Rate for Payer: Ohana Health Plan Medicaid	$14.76
Rate for Payer: Ohana Health Plan Medicare	$14.76
Rate for Payer: UnitedHealthcare Medicaid	$21.09
Rate for Payer: UnitedHealthcare Medicare	$14.76
Rate for Payer: University Health Alliance Commercial	$25.62

varenicline Starter Pack (0.5mg & 1mg tabs) [KMC]

Facility

$38.16

Service Code	NDC 00069047103
Hospital Revenue Code	250
Min. Negotiated Rate	$32.44
Max. Negotiated Rate	$37.02
Rate for Payer: Cash Price	$24.80
Rate for Payer: Health Management Network Commercial	$32.44
Rate for Payer: Kaiser Permanente Commercial	$34.34
Rate for Payer: MDX Hawaii PPO	$37.02

varenicline Starter Pack (0.5mg & 1mg tabs) [KMC]

Facility

$38.16

Service Code	NDC 00069047103
Hospital Revenue Code	250
Min. Negotiated Rate	$16.03
Max. Negotiated Rate	$37.02
Rate for Payer: AlohaCare Medicaid	$19.08
Rate for Payer: AlohaCare Medicare	$16.03
Rate for Payer: Cash Price	$24.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$35.11
Rate for Payer: Devoted Health Medicare	$16.03
Rate for Payer: Hawaii Medical Service Association Medicare	$16.03
Rate for Payer: Hawaii Western Management Group Commercial	$36.25
Rate for Payer: Health Management Network Commercial	$32.44
Rate for Payer: Humana Medicare	$16.03
Rate for Payer: Kaiser Permanente Commercial	$34.34
Rate for Payer: Kaiser Permanente Medicaid	$19.46
Rate for Payer: Kaiser Permanente Medicare	$16.03
Rate for Payer: MDX Hawaii PPO	$37.02
Rate for Payer: Ohana Health Plan Medicaid	$16.03
Rate for Payer: Ohana Health Plan Medicare	$16.03
Rate for Payer: UnitedHealthcare Medicaid	$22.90
Rate for Payer: UnitedHealthcare Medicare	$16.03
Rate for Payer: University Health Alliance Commercial	$27.81

Varicella-Zoster Ab, IgG DLS

Facility

$249.00

Service Code	HCPCS 86787
Hospital Charge Code	422867875
Hospital Revenue Code	301
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$241.53
Rate for Payer: AlohaCare Medicaid	$124.50
Rate for Payer: AlohaCare Medicare	$104.58
Rate for Payer: Cash Price	$161.85
Rate for Payer: Cash Price	$161.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$229.08
Rate for Payer: Devoted Health Medicare	$104.58
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$17.81
Rate for Payer: Hawaii Medical Service Association Commercial	$16.10
Rate for Payer: Hawaii Medical Service Association Medicare	$104.58
Rate for Payer: Hawaii Western Management Group Commercial	$12.88
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: Humana Medicare	$104.58
Rate for Payer: Kaiser Permanente Commercial	$224.10
Rate for Payer: Kaiser Permanente Medicaid	$126.99
Rate for Payer: Kaiser Permanente Medicare	$104.58
Rate for Payer: MDX Hawaii PPO	$241.53
Rate for Payer: Ohana Health Plan Medicaid	$104.58
Rate for Payer: Ohana Health Plan Medicare	$104.58
Rate for Payer: UnitedHealthcare Medicaid	$17.81
Rate for Payer: UnitedHealthcare Medicare	$104.58
Rate for Payer: University Health Alliance Commercial	$33.30

Varicella-Zoster Ab, IgG DLS

Facility

$249.00

Service Code	HCPCS 86787
Hospital Charge Code	422867875
Hospital Revenue Code	301
Min. Negotiated Rate	$211.65
Max. Negotiated Rate	$241.53
Rate for Payer: Cash Price	$161.85
Rate for Payer: Health Management Network Commercial	$211.65
Rate for Payer: Kaiser Permanente Commercial	$224.10
Rate for Payer: MDX Hawaii PPO	$241.53

VAR VACCINE LIVE FOR SUBCUTANEOUS USE

Professional

Both

$0.01

Service Code	HCPCS 90716 SL
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$131.65
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$131.65
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Ohana Health Plan Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicaid	$4.00

VAR VACCINE LIVE FOR SUBCUTANEOUS USE

Professional

Both

$284.00

Service Code	HCPCS 90716
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$241.40
Rate for Payer: AlohaCare Medicaid	$4.00
Rate for Payer: Cash Price	$184.60
Rate for Payer: Cash Price	$184.60
Rate for Payer: Hawaii Western Management Group Commercial	$131.65
Rate for Payer: Health Management Network Commercial	$241.40
Rate for Payer: Ohana Health Plan Medicaid	$4.00
Rate for Payer: UnitedHealthcare Medicaid	$4.00

Vasopneumatic Device (97016)

Facility

$89.00

Service Code	HCPCS 97016 GP
Hospital Charge Code	432970160
Hospital Revenue Code	420
Min. Negotiated Rate	$12.49
Max. Negotiated Rate	$86.33
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$37.38
Rate for Payer: Cash Price	$57.85
Rate for Payer: Cash Price	$57.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$81.88
Rate for Payer: Devoted Health Medicare	$37.38
Rate for Payer: Hawaii Medical Service Association Medicare	$37.38
Rate for Payer: Hawaii Western Management Group Commercial	$84.55
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Humana Medicare	$37.38
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicare	$37.38
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$37.38
Rate for Payer: Ohana Health Plan Medicare	$37.38
Rate for Payer: UnitedHealthcare Medicaid	$12.49
Rate for Payer: UnitedHealthcare Medicare	$37.38
Rate for Payer: University Health Alliance Commercial	$64.87

Vasopneumatic Device (97016)

Facility

$89.00

Service Code	HCPCS 97016 GP
Hospital Charge Code	432970160
Hospital Revenue Code	420
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$57.85
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$86.33

Vasopneumatic Device Charge

Facility

$89.00

Service Code	HCPCS 97016 GP
Hospital Charge Code	432970160
Hospital Revenue Code	420
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$57.85
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$86.33

Vasopneumatic Device Charge

Facility

$89.00

Service Code	HCPCS 97016 GP
Hospital Charge Code	432970160
Hospital Revenue Code	420
Min. Negotiated Rate	$12.49
Max. Negotiated Rate	$86.33
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$37.38
Rate for Payer: Cash Price	$57.85
Rate for Payer: Cash Price	$57.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$81.88
Rate for Payer: Devoted Health Medicare	$37.38
Rate for Payer: Hawaii Medical Service Association Medicare	$37.38
Rate for Payer: Hawaii Western Management Group Commercial	$84.55
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Humana Medicare	$37.38
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicare	$37.38
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$37.38
Rate for Payer: Ohana Health Plan Medicare	$37.38
Rate for Payer: UnitedHealthcare Medicaid	$12.49
Rate for Payer: UnitedHealthcare Medicare	$37.38
Rate for Payer: University Health Alliance Commercial	$64.87

Vasopneumatic Device Charge

Facility

$89.00

Service Code	HCPCS 97016 GO
Hospital Charge Code	426970160
Hospital Revenue Code	431
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$57.85
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$86.33

Vasopneumatic Device Charge

Facility

$89.00

Service Code	HCPCS 97016 GO
Hospital Charge Code	426970160
Hospital Revenue Code	431
Min. Negotiated Rate	$12.49
Max. Negotiated Rate	$86.33
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$37.38
Rate for Payer: Cash Price	$57.85
Rate for Payer: Cash Price	$57.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$81.88
Rate for Payer: Devoted Health Medicare	$37.38
Rate for Payer: Hawaii Medical Service Association Medicare	$37.38
Rate for Payer: Hawaii Western Management Group Commercial	$84.55
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Humana Medicare	$37.38
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicare	$37.38
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$37.38
Rate for Payer: Ohana Health Plan Medicare	$37.38
Rate for Payer: UnitedHealthcare Medicaid	$12.49
Rate for Payer: UnitedHealthcare Medicare	$37.38
Rate for Payer: University Health Alliance Commercial	$64.87

VASOPNEUMATIC DEVICE Occupational

Facility

$89.00

Service Code	HCPCS 97016 GO
Hospital Charge Code	426970160
Hospital Revenue Code	431
Min. Negotiated Rate	$12.49
Max. Negotiated Rate	$86.33
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$37.38
Rate for Payer: Cash Price	$57.85
Rate for Payer: Cash Price	$57.85
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$81.88
Rate for Payer: Devoted Health Medicare	$37.38
Rate for Payer: Hawaii Medical Service Association Medicare	$37.38
Rate for Payer: Hawaii Western Management Group Commercial	$84.55
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Humana Medicare	$37.38
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicare	$37.38
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$37.38
Rate for Payer: Ohana Health Plan Medicare	$37.38
Rate for Payer: UnitedHealthcare Medicaid	$12.49
Rate for Payer: UnitedHealthcare Medicare	$37.38
Rate for Payer: University Health Alliance Commercial	$64.87

VASOPNEUMATIC DEVICE Occupational

Facility

$89.00

Service Code	HCPCS 97016 GO
Hospital Charge Code	426970160
Hospital Revenue Code	431
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$57.85
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$86.33

vasopressin 20 units/mL Inj Sol [KMC]

Facility

$11.25

Service Code	NDC 42023011725
Hospital Revenue Code	250
Min. Negotiated Rate	$9.56
Max. Negotiated Rate	$10.91
Rate for Payer: Cash Price	$7.31
Rate for Payer: Health Management Network Commercial	$9.56
Rate for Payer: Kaiser Permanente Commercial	$10.12
Rate for Payer: MDX Hawaii PPO	$10.91

vasopressin 20 units/mL Inj Sol [KMC]

Facility

$11.25

Service Code	NDC 42023011725
Hospital Revenue Code	250
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$10.91
Rate for Payer: AlohaCare Medicaid	$5.62
Rate for Payer: AlohaCare Medicare	$4.72
Rate for Payer: Cash Price	$7.31
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$10.35
Rate for Payer: Devoted Health Medicare	$4.72
Rate for Payer: Hawaii Medical Service Association Medicare	$4.72
Rate for Payer: Hawaii Western Management Group Commercial	$10.69
Rate for Payer: Health Management Network Commercial	$9.56
Rate for Payer: Humana Medicare	$4.72
Rate for Payer: Kaiser Permanente Commercial	$10.12
Rate for Payer: Kaiser Permanente Medicaid	$5.74
Rate for Payer: Kaiser Permanente Medicare	$4.72
Rate for Payer: MDX Hawaii PPO	$10.91
Rate for Payer: Ohana Health Plan Medicaid	$4.72
Rate for Payer: Ohana Health Plan Medicare	$4.72
Rate for Payer: UnitedHealthcare Medicaid	$6.75
Rate for Payer: UnitedHealthcare Medicare	$4.72
Rate for Payer: University Health Alliance Commercial	$8.20

VEIN LIGATION AND STRIPPING

Facility

$32,898.38

Service Code	MSDRG 263
Min. Negotiated Rate	$32,898.38
Max. Negotiated Rate	$32,898.38
Rate for Payer: Hawaii Medical Service Association Commercial	$32,898.38

VENEPUNCT < 3YRS Charge

Facility

$122.00

Service Code	HCPCS 36406
Hospital Charge Code	440364060
Hospital Revenue Code	450
Min. Negotiated Rate	$103.70
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$79.30
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: MDX Hawaii PPO	$118.34

VENEPUNCT < 3YRS Charge

Facility

$122.00

Service Code	HCPCS 36406
Hospital Charge Code	440364060
Hospital Revenue Code	450
Min. Negotiated Rate	$51.24
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$61.00
Rate for Payer: AlohaCare Medicare	$51.24
Rate for Payer: Cash Price	$79.30
Rate for Payer: Cash Price	$79.30
Rate for Payer: Cash Price	$79.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$112.24
Rate for Payer: Devoted Health Medicare	$51.24
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$51.24
Rate for Payer: Hawaii Western Management Group Commercial	$115.90
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Humana Medicare	$51.24
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$51.24
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: Ohana Health Plan Medicaid	$51.24
Rate for Payer: Ohana Health Plan Medicare	$51.24
Rate for Payer: UnitedHealthcare Medicare	$51.24
Rate for Payer: University Health Alliance Commercial	$88.93

VENEPUNCT >3YRS Charge

Facility

$122.00

Service Code	HCPCS 36410
Hospital Charge Code	440364100
Hospital Revenue Code	450
Min. Negotiated Rate	$51.24
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$61.00
Rate for Payer: AlohaCare Medicare	$51.24
Rate for Payer: Cash Price	$79.30
Rate for Payer: Cash Price	$79.30
Rate for Payer: Cash Price	$79.30
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$112.24
Rate for Payer: Devoted Health Medicare	$51.24
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$417.00
Rate for Payer: Hawaii Medical Service Association Commercial	$1,600.00
Rate for Payer: Hawaii Medical Service Association Medicare	$51.24
Rate for Payer: Hawaii Western Management Group Commercial	$115.90
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Humana Medicare	$51.24
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$51.24
Rate for Payer: MDX Hawaii PPO	$118.34
Rate for Payer: Ohana Health Plan Medicaid	$51.24
Rate for Payer: Ohana Health Plan Medicare	$51.24
Rate for Payer: UnitedHealthcare Medicare	$51.24
Rate for Payer: University Health Alliance Commercial	$88.93

VENEPUNCT >3YRS Charge

Facility

$122.00

Service Code	HCPCS 36410
Hospital Charge Code	440364100
Hospital Revenue Code	450
Min. Negotiated Rate	$103.70
Max. Negotiated Rate	$118.34
Rate for Payer: Cash Price	$79.30
Rate for Payer: Health Management Network Commercial	$103.70
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: MDX Hawaii PPO	$118.34

Know your out-of-pocket cost for care.

All Charges