Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

Venipuncture, Cutdown; Age 1 Or Over

Facility

$114.00

Service Code	HCPCS 36425
Hospital Charge Code	440364250
Hospital Revenue Code	450
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$110.58
Rate for Payer: Cash Price	$74.10
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Kaiser Permanente Commercial	$102.60
Rate for Payer: MDX Hawaii PPO	$110.58

Venipuncture, Cutdown; Age 1 Or Over

Facility

$114.00

Service Code	HCPCS 36425
Hospital Charge Code	440364250
Hospital Revenue Code	450
Min. Negotiated Rate	$47.88
Max. Negotiated Rate	$1,600.00
Rate for Payer: AlohaCare Medicaid	$57.00
Rate for Payer: AlohaCare Medicare	$47.88
Rate for Payer: Cash Price	$74.10
Rate for Payer: Cash Price	$74.10
Rate for Payer: Cash Price	$74.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$104.88
Rate for Payer: Devoted Health Medicare	$47.88
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	$47.88
Rate for Payer: Hawaii Western Management Group Commercial	$108.30
Rate for Payer: Health Management Network Commercial	$96.90
Rate for Payer: Humana Medicare	$47.88
Rate for Payer: Kaiser Permanente Commercial	$102.60
Rate for Payer: Kaiser Permanente Medicaid	$937.50
Rate for Payer: Kaiser Permanente Medicare	$47.88
Rate for Payer: MDX Hawaii PPO	$110.58
Rate for Payer: Ohana Health Plan Medicaid	$47.88
Rate for Payer: Ohana Health Plan Medicare	$47.88
Rate for Payer: UnitedHealthcare Medicare	$47.88
Rate for Payer: University Health Alliance Commercial	$83.09

venlafaxine 37.5 mg ER cap [KMC]

Facility

$16.66

Service Code	NDC 65862052790
Hospital Revenue Code	250
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$16.16
Rate for Payer: AlohaCare Medicaid	$8.33
Rate for Payer: AlohaCare Medicare	$7.00
Rate for Payer: Cash Price	$10.83
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$15.33
Rate for Payer: Devoted Health Medicare	$7.00
Rate for Payer: Hawaii Medical Service Association Medicare	$7.00
Rate for Payer: Hawaii Western Management Group Commercial	$15.83
Rate for Payer: Health Management Network Commercial	$14.16
Rate for Payer: Humana Medicare	$7.00
Rate for Payer: Kaiser Permanente Commercial	$14.99
Rate for Payer: Kaiser Permanente Medicaid	$8.50
Rate for Payer: Kaiser Permanente Medicare	$7.00
Rate for Payer: MDX Hawaii PPO	$16.16
Rate for Payer: Ohana Health Plan Medicaid	$7.00
Rate for Payer: Ohana Health Plan Medicare	$7.00
Rate for Payer: UnitedHealthcare Medicaid	$10.00
Rate for Payer: UnitedHealthcare Medicare	$7.00
Rate for Payer: University Health Alliance Commercial	$12.14

venlafaxine 37.5 mg ER cap [KMC]

Facility

$16.66

Service Code	NDC 65862052790
Hospital Revenue Code	250
Min. Negotiated Rate	$14.16
Max. Negotiated Rate	$16.16
Rate for Payer: Cash Price	$10.83
Rate for Payer: Health Management Network Commercial	$14.16
Rate for Payer: Kaiser Permanente Commercial	$14.99
Rate for Payer: MDX Hawaii PPO	$16.16

venlafaxine 50 mg Tab [KMC]

Facility

$8.24

Service Code	NDC 16714065701
Hospital Revenue Code	250
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$7.99
Rate for Payer: AlohaCare Medicaid	$4.12
Rate for Payer: AlohaCare Medicare	$3.46
Rate for Payer: Cash Price	$5.36
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$7.58
Rate for Payer: Devoted Health Medicare	$3.46
Rate for Payer: Hawaii Medical Service Association Medicare	$3.46
Rate for Payer: Hawaii Western Management Group Commercial	$7.83
Rate for Payer: Health Management Network Commercial	$7.00
Rate for Payer: Humana Medicare	$3.46
Rate for Payer: Kaiser Permanente Commercial	$7.42
Rate for Payer: Kaiser Permanente Medicaid	$4.20
Rate for Payer: Kaiser Permanente Medicare	$3.46
Rate for Payer: MDX Hawaii PPO	$7.99
Rate for Payer: Ohana Health Plan Medicaid	$3.46
Rate for Payer: Ohana Health Plan Medicare	$3.46
Rate for Payer: UnitedHealthcare Medicaid	$4.94
Rate for Payer: UnitedHealthcare Medicare	$3.46
Rate for Payer: University Health Alliance Commercial	$6.01

venlafaxine 50 mg Tab [KMC]

Facility

$8.24

Service Code	NDC 16714065701
Hospital Revenue Code	250
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$7.99
Rate for Payer: Cash Price	$5.36
Rate for Payer: Health Management Network Commercial	$7.00
Rate for Payer: Kaiser Permanente Commercial	$7.42
Rate for Payer: MDX Hawaii PPO	$7.99

venlafaxine 75 mg ER Cap [KMC]

Facility

$18.66

Service Code	NDC 00093738556
Hospital Revenue Code	250
Min. Negotiated Rate	$7.84
Max. Negotiated Rate	$18.10
Rate for Payer: AlohaCare Medicaid	$9.33
Rate for Payer: AlohaCare Medicare	$7.84
Rate for Payer: Cash Price	$12.13
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$17.17
Rate for Payer: Devoted Health Medicare	$7.84
Rate for Payer: Hawaii Medical Service Association Medicare	$7.84
Rate for Payer: Hawaii Western Management Group Commercial	$17.73
Rate for Payer: Health Management Network Commercial	$15.86
Rate for Payer: Humana Medicare	$7.84
Rate for Payer: Kaiser Permanente Commercial	$16.79
Rate for Payer: Kaiser Permanente Medicaid	$9.52
Rate for Payer: Kaiser Permanente Medicare	$7.84
Rate for Payer: MDX Hawaii PPO	$18.10
Rate for Payer: Ohana Health Plan Medicaid	$7.84
Rate for Payer: Ohana Health Plan Medicare	$7.84
Rate for Payer: UnitedHealthcare Medicaid	$11.20
Rate for Payer: UnitedHealthcare Medicare	$7.84
Rate for Payer: University Health Alliance Commercial	$13.60

venlafaxine 75 mg ER Cap [KMC]

Facility

$18.66

Service Code	NDC 00093738556
Hospital Revenue Code	250
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$18.10
Rate for Payer: Cash Price	$12.13
Rate for Payer: Health Management Network Commercial	$15.86
Rate for Payer: Kaiser Permanente Commercial	$16.79
Rate for Payer: MDX Hawaii PPO	$18.10

Venous Draw

Facility

$20.00

Service Code	HCPCS 36415
Hospital Charge Code	422364150
Hospital Revenue Code	300
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$19.40
Rate for Payer: AlohaCare Medicaid	$10.00
Rate for Payer: AlohaCare Medicare	$8.40
Rate for Payer: Cash Price	$13.00
Rate for Payer: Cash Price	$13.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$18.40
Rate for Payer: Devoted Health Medicare	$8.40
Rate for Payer: Hawaii Medical Service Association Commercial	$11.68
Rate for Payer: Hawaii Medical Service Association Medicare	$8.40
Rate for Payer: Hawaii Western Management Group Commercial	$19.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Humana Medicare	$8.40
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: Kaiser Permanente Medicaid	$10.20
Rate for Payer: Kaiser Permanente Medicare	$8.40
Rate for Payer: MDX Hawaii PPO	$19.40
Rate for Payer: Ohana Health Plan Medicaid	$8.40
Rate for Payer: Ohana Health Plan Medicare	$8.40
Rate for Payer: UnitedHealthcare Medicaid	$3.00
Rate for Payer: UnitedHealthcare Medicare	$8.40
Rate for Payer: University Health Alliance Commercial	$14.58

Venous Draw

Facility

$20.00

Service Code	HCPCS 36415
Hospital Charge Code	422364150
Hospital Revenue Code	300
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$19.40
Rate for Payer: Cash Price	$13.00
Rate for Payer: Health Management Network Commercial	$17.00
Rate for Payer: Kaiser Permanente Commercial	$18.00
Rate for Payer: MDX Hawaii PPO	$19.40

Venous pH

Facility

$250.00

Service Code	HCPCS 82800
Hospital Charge Code	422828000
Hospital Revenue Code	301
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$242.50
Rate for Payer: AlohaCare Medicaid	$125.00
Rate for Payer: AlohaCare Medicare	$105.00
Rate for Payer: Cash Price	$162.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$230.00
Rate for Payer: Devoted Health Medicare	$105.00
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$11.71
Rate for Payer: Hawaii Medical Service Association Commercial	$13.75
Rate for Payer: Hawaii Medical Service Association Medicare	$105.00
Rate for Payer: Hawaii Western Management Group Commercial	$11.00
Rate for Payer: Health Management Network Commercial	$212.50
Rate for Payer: Humana Medicare	$105.00
Rate for Payer: Kaiser Permanente Commercial	$225.00
Rate for Payer: Kaiser Permanente Medicaid	$127.50
Rate for Payer: Kaiser Permanente Medicare	$105.00
Rate for Payer: MDX Hawaii PPO	$242.50
Rate for Payer: Ohana Health Plan Medicaid	$105.00
Rate for Payer: Ohana Health Plan Medicare	$105.00
Rate for Payer: UnitedHealthcare Medicaid	$11.71
Rate for Payer: UnitedHealthcare Medicare	$105.00
Rate for Payer: University Health Alliance Commercial	$21.89

Venous pH

Facility

$250.00

Service Code	HCPCS 82800
Hospital Charge Code	422828000
Hospital Revenue Code	301
Min. Negotiated Rate	$212.50
Max. Negotiated Rate	$242.50
Rate for Payer: Cash Price	$162.50
Rate for Payer: Health Management Network Commercial	$212.50
Rate for Payer: Kaiser Permanente Commercial	$225.00
Rate for Payer: MDX Hawaii PPO	$242.50

VENTILATION ASSIST & MGMT INPATIENT 1ST DAY

Professional

Both

$1,276.00

Service Code	HCPCS 94002
Hospital Revenue Code	410
Min. Negotiated Rate	$85.14
Max. Negotiated Rate	$1,084.60
Rate for Payer: AlohaCare Medicaid	$90.27
Rate for Payer: AlohaCare Medicare	$85.14
Rate for Payer: Cash Price	$829.40
Rate for Payer: Cash Price	$829.40
Rate for Payer: Devoted Health Medicare	$85.14
Rate for Payer: Hawaii Medical Service Association Medicare	$85.14
Rate for Payer: Hawaii Western Management Group Commercial	$92.50
Rate for Payer: Health Management Network Commercial	$1,084.60
Rate for Payer: Kaiser Permanente Commercial	$102.17
Rate for Payer: Kaiser Permanente Medicaid	$102.17
Rate for Payer: Kaiser Permanente Medicare	$102.17
Rate for Payer: Ohana Health Plan Medicaid	$90.27
Rate for Payer: Ohana Health Plan Medicare	$85.14
Rate for Payer: UnitedHealthcare Medicaid	$90.27
Rate for Payer: UnitedHealthcare Medicare	$85.14

VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA

Professional

Both

$1,276.00

Service Code	HCPCS 94003
Hospital Revenue Code	410
Min. Negotiated Rate	$58.71
Max. Negotiated Rate	$1,084.60
Rate for Payer: AlohaCare Medicaid	$63.72
Rate for Payer: AlohaCare Medicare	$58.71
Rate for Payer: Cash Price	$829.40
Rate for Payer: Cash Price	$829.40
Rate for Payer: Devoted Health Medicare	$58.71
Rate for Payer: Hawaii Medical Service Association Medicare	$58.71
Rate for Payer: Health Management Network Commercial	$1,084.60
Rate for Payer: Kaiser Permanente Commercial	$70.45
Rate for Payer: Kaiser Permanente Medicaid	$70.45
Rate for Payer: Kaiser Permanente Medicare	$70.45
Rate for Payer: Ohana Health Plan Medicaid	$63.72
Rate for Payer: Ohana Health Plan Medicare	$58.71
Rate for Payer: UnitedHealthcare Medicaid	$63.72
Rate for Payer: UnitedHealthcare Medicare	$58.71

VENT MGMT INIT DAY-IP/OBS Respiratory Therapy Charges

Facility

$1,340.00

Service Code	HCPCS 94002
Hospital Charge Code	429940020
Hospital Revenue Code	410
Min. Negotiated Rate	$59.64
Max. Negotiated Rate	$1,299.80
Rate for Payer: AlohaCare Medicaid	$670.00
Rate for Payer: AlohaCare Medicare	$562.80
Rate for Payer: Cash Price	$871.00
Rate for Payer: Cash Price	$871.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,232.80
Rate for Payer: Devoted Health Medicare	$562.80
Rate for Payer: Hawaii Medical Service Association Commercial	$912.27
Rate for Payer: Hawaii Medical Service Association Medicare	$562.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,273.00
Rate for Payer: Health Management Network Commercial	$1,139.00
Rate for Payer: Humana Medicare	$562.80
Rate for Payer: Kaiser Permanente Commercial	$1,206.00
Rate for Payer: Kaiser Permanente Medicaid	$683.40
Rate for Payer: Kaiser Permanente Medicare	$562.80
Rate for Payer: MDX Hawaii PPO	$1,299.80
Rate for Payer: Ohana Health Plan Medicaid	$562.80
Rate for Payer: Ohana Health Plan Medicare	$562.80
Rate for Payer: UnitedHealthcare Medicaid	$59.64
Rate for Payer: UnitedHealthcare Medicare	$562.80
Rate for Payer: University Health Alliance Commercial	$976.73

VENT MGMT INIT DAY-IP/OBS Respiratory Therapy Charges

Facility

$1,340.00

Service Code	HCPCS 94002
Hospital Charge Code	429940020
Hospital Revenue Code	410
Min. Negotiated Rate	$1,139.00
Max. Negotiated Rate	$1,299.80
Rate for Payer: Cash Price	$871.00
Rate for Payer: Health Management Network Commercial	$1,139.00
Rate for Payer: Kaiser Permanente Commercial	$1,206.00
Rate for Payer: MDX Hawaii PPO	$1,299.80

VENT MGMT SUBQ DAY-IP/OBS Respiratory Therapy Charges

Facility

$1,340.00

Service Code	HCPCS 94003
Hospital Charge Code	429940030
Hospital Revenue Code	410
Min. Negotiated Rate	$43.79
Max. Negotiated Rate	$1,299.80
Rate for Payer: AlohaCare Medicaid	$670.00
Rate for Payer: AlohaCare Medicare	$562.80
Rate for Payer: Cash Price	$871.00
Rate for Payer: Cash Price	$871.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,232.80
Rate for Payer: Devoted Health Medicare	$562.80
Rate for Payer: Hawaii Medical Service Association Commercial	$912.27
Rate for Payer: Hawaii Medical Service Association Medicare	$562.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,273.00
Rate for Payer: Health Management Network Commercial	$1,139.00
Rate for Payer: Humana Medicare	$562.80
Rate for Payer: Kaiser Permanente Commercial	$1,206.00
Rate for Payer: Kaiser Permanente Medicaid	$683.40
Rate for Payer: Kaiser Permanente Medicare	$562.80
Rate for Payer: MDX Hawaii PPO	$1,299.80
Rate for Payer: Ohana Health Plan Medicaid	$562.80
Rate for Payer: Ohana Health Plan Medicare	$562.80
Rate for Payer: UnitedHealthcare Medicaid	$43.79
Rate for Payer: UnitedHealthcare Medicare	$562.80
Rate for Payer: University Health Alliance Commercial	$976.73

VENT MGMT SUBQ DAY-IP/OBS Respiratory Therapy Charges

Facility

$1,340.00

Service Code	HCPCS 94003
Hospital Charge Code	429940030
Hospital Revenue Code	410
Min. Negotiated Rate	$1,139.00
Max. Negotiated Rate	$1,299.80
Rate for Payer: Cash Price	$871.00
Rate for Payer: Health Management Network Commercial	$1,139.00
Rate for Payer: Kaiser Permanente Commercial	$1,206.00
Rate for Payer: MDX Hawaii PPO	$1,299.80

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

verapamil 10 mg / 4 mL IV Soln [KMC]

Facility

$66.59

Service Code	NDC 00409114405
Hospital Revenue Code	250
Min. Negotiated Rate	$27.97
Max. Negotiated Rate	$64.59
Rate for Payer: AlohaCare Medicaid	$33.30
Rate for Payer: AlohaCare Medicare	$27.97
Rate for Payer: Cash Price	$43.28
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$61.26
Rate for Payer: Devoted Health Medicare	$27.97
Rate for Payer: Hawaii Medical Service Association Medicare	$27.97
Rate for Payer: Hawaii Western Management Group Commercial	$63.26
Rate for Payer: Health Management Network Commercial	$56.60
Rate for Payer: Humana Medicare	$27.97
Rate for Payer: Kaiser Permanente Commercial	$59.93
Rate for Payer: Kaiser Permanente Medicaid	$33.96
Rate for Payer: Kaiser Permanente Medicare	$27.97
Rate for Payer: MDX Hawaii PPO	$64.59
Rate for Payer: Ohana Health Plan Medicaid	$27.97
Rate for Payer: Ohana Health Plan Medicare	$27.97
Rate for Payer: UnitedHealthcare Medicaid	$39.95
Rate for Payer: UnitedHealthcare Medicare	$27.97
Rate for Payer: University Health Alliance Commercial	$48.54

verapamil 10 mg / 4 mL IV Soln [KMC]

Facility

$66.59

Service Code	NDC 00409114405
Hospital Revenue Code	250
Min. Negotiated Rate	$56.60
Max. Negotiated Rate	$64.59
Rate for Payer: Cash Price	$43.28
Rate for Payer: Health Management Network Commercial	$56.60
Rate for Payer: Kaiser Permanente Commercial	$59.93
Rate for Payer: MDX Hawaii PPO	$64.59

verapamil 120 mg/12 hours ER Tab [KMC]

Facility

$4.29

Service Code	NDC 68462029201
Hospital Revenue Code	250
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$4.16
Rate for Payer: Cash Price	$2.79
Rate for Payer: Health Management Network Commercial	$3.65
Rate for Payer: Kaiser Permanente Commercial	$3.86
Rate for Payer: MDX Hawaii PPO	$4.16

verapamil 120 mg/12 hours ER Tab [KMC]

Facility

$4.29

Service Code	NDC 68462029201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$4.16
Rate for Payer: AlohaCare Medicaid	$2.15
Rate for Payer: AlohaCare Medicare	$1.80
Rate for Payer: Cash Price	$2.79
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$3.95
Rate for Payer: Devoted Health Medicare	$1.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1.80
Rate for Payer: Hawaii Western Management Group Commercial	$4.08
Rate for Payer: Health Management Network Commercial	$3.65
Rate for Payer: Humana Medicare	$1.80
Rate for Payer: Kaiser Permanente Commercial	$3.86
Rate for Payer: Kaiser Permanente Medicaid	$2.19
Rate for Payer: Kaiser Permanente Medicare	$1.80
Rate for Payer: MDX Hawaii PPO	$4.16
Rate for Payer: Ohana Health Plan Medicaid	$1.80
Rate for Payer: Ohana Health Plan Medicare	$1.80
Rate for Payer: UnitedHealthcare Medicaid	$2.57
Rate for Payer: UnitedHealthcare Medicare	$1.80
Rate for Payer: University Health Alliance Commercial	$3.13

Know your out-of-pocket cost for care.

All Charges