Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

verapamil 120 mg/24 hours ER Cap [KMC]

Facility

$6.98

Service Code	NDC 00591288001
Hospital Revenue Code	250
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$6.77
Rate for Payer: AlohaCare Medicaid	$3.49
Rate for Payer: AlohaCare Medicare	$2.93
Rate for Payer: Cash Price	$4.54
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6.42
Rate for Payer: Devoted Health Medicare	$2.93
Rate for Payer: Hawaii Medical Service Association Medicare	$2.93
Rate for Payer: Hawaii Western Management Group Commercial	$6.63
Rate for Payer: Health Management Network Commercial	$5.93
Rate for Payer: Humana Medicare	$2.93
Rate for Payer: Kaiser Permanente Commercial	$6.28
Rate for Payer: Kaiser Permanente Medicaid	$3.56
Rate for Payer: Kaiser Permanente Medicare	$2.93
Rate for Payer: MDX Hawaii PPO	$6.77
Rate for Payer: Ohana Health Plan Medicaid	$2.93
Rate for Payer: Ohana Health Plan Medicare	$2.93
Rate for Payer: UnitedHealthcare Medicaid	$4.19
Rate for Payer: UnitedHealthcare Medicare	$2.93
Rate for Payer: University Health Alliance Commercial	$5.09

verapamil 120 mg/24 hours ER Cap [KMC]

Facility

$6.98

Service Code	NDC 00591288001
Hospital Revenue Code	250
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$6.77
Rate for Payer: Cash Price	$4.54
Rate for Payer: Health Management Network Commercial	$5.93
Rate for Payer: Kaiser Permanente Commercial	$6.28
Rate for Payer: MDX Hawaii PPO	$6.77

verapamil 180 mg (12-hour) ER tablet [KMC]

Facility

$5.76

Service Code	NDC 75834015801
Hospital Revenue Code	250
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$5.59
Rate for Payer: AlohaCare Medicaid	$2.88
Rate for Payer: AlohaCare Medicare	$2.42
Rate for Payer: Cash Price	$3.74
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$5.30
Rate for Payer: Devoted Health Medicare	$2.42
Rate for Payer: Hawaii Medical Service Association Medicare	$2.42
Rate for Payer: Hawaii Western Management Group Commercial	$5.47
Rate for Payer: Health Management Network Commercial	$4.90
Rate for Payer: Humana Medicare	$2.42
Rate for Payer: Kaiser Permanente Commercial	$5.18
Rate for Payer: Kaiser Permanente Medicaid	$2.94
Rate for Payer: Kaiser Permanente Medicare	$2.42
Rate for Payer: MDX Hawaii PPO	$5.59
Rate for Payer: Ohana Health Plan Medicaid	$2.42
Rate for Payer: Ohana Health Plan Medicare	$2.42
Rate for Payer: UnitedHealthcare Medicaid	$3.46
Rate for Payer: UnitedHealthcare Medicare	$2.42
Rate for Payer: University Health Alliance Commercial	$4.20

verapamil 180 mg (12-hour) ER tablet [KMC]

Facility

$5.76

Service Code	NDC 75834015801
Hospital Revenue Code	250
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$5.59
Rate for Payer: Cash Price	$3.74
Rate for Payer: Health Management Network Commercial	$4.90
Rate for Payer: Kaiser Permanente Commercial	$5.18
Rate for Payer: MDX Hawaii PPO	$5.59

verapamil 240 mg/12 hours ER Tab [KMC]

Facility

$6.54

Service Code	NDC 75834015901
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$6.34
Rate for Payer: AlohaCare Medicaid	$3.27
Rate for Payer: AlohaCare Medicare	$2.75
Rate for Payer: Cash Price	$4.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$6.02
Rate for Payer: Devoted Health Medicare	$2.75
Rate for Payer: Hawaii Medical Service Association Medicare	$2.75
Rate for Payer: Hawaii Western Management Group Commercial	$6.21
Rate for Payer: Health Management Network Commercial	$5.56
Rate for Payer: Humana Medicare	$2.75
Rate for Payer: Kaiser Permanente Commercial	$5.89
Rate for Payer: Kaiser Permanente Medicaid	$3.34
Rate for Payer: Kaiser Permanente Medicare	$2.75
Rate for Payer: MDX Hawaii PPO	$6.34
Rate for Payer: Ohana Health Plan Medicaid	$2.75
Rate for Payer: Ohana Health Plan Medicare	$2.75
Rate for Payer: UnitedHealthcare Medicaid	$3.92
Rate for Payer: UnitedHealthcare Medicare	$2.75
Rate for Payer: University Health Alliance Commercial	$4.77

verapamil 240 mg/12 hours ER Tab [KMC]

Facility

$6.54

Service Code	NDC 75834015901
Hospital Revenue Code	250
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$6.34
Rate for Payer: Cash Price	$4.25
Rate for Payer: Health Management Network Commercial	$5.56
Rate for Payer: Kaiser Permanente Commercial	$5.89
Rate for Payer: MDX Hawaii PPO	$6.34

verapamil 240 mg/24 hours ER cap [KMC]

Facility

$8.25

Service Code	NDC 00591288401
Hospital Revenue Code	250
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$8.00
Rate for Payer: Cash Price	$5.36
Rate for Payer: Health Management Network Commercial	$7.01
Rate for Payer: Kaiser Permanente Commercial	$7.42
Rate for Payer: MDX Hawaii PPO	$8.00

verapamil 240 mg/24 hours ER cap [KMC]

Facility

$8.25

Service Code	NDC 00591288401
Hospital Revenue Code	250
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$8.00
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	$7.59
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	$7.84
Rate for Payer: Health Management Network Commercial	$7.01
Rate for Payer: Humana Medicare	$3.46
Rate for Payer: Kaiser Permanente Commercial	$7.42
Rate for Payer: Kaiser Permanente Medicaid	$4.21
Rate for Payer: Kaiser Permanente Medicare	$3.46
Rate for Payer: MDX Hawaii PPO	$8.00
Rate for Payer: Ohana Health Plan Medicaid	$3.46
Rate for Payer: Ohana Health Plan Medicare	$3.46
Rate for Payer: UnitedHealthcare Medicaid	$4.95
Rate for Payer: UnitedHealthcare Medicare	$3.46
Rate for Payer: University Health Alliance Commercial	$6.01

verapamil 40 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 23155005901
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

verapamil 40 mg Tab [KMC]

Facility

$3.00

Service Code	NDC 23155005901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.26
Rate for Payer: Cash Price	$1.95
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$2.76
Rate for Payer: Devoted Health Medicare	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.26
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.26
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.26
Rate for Payer: Ohana Health Plan Medicare	$1.26
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.26
Rate for Payer: University Health Alliance Commercial	$2.19

Vibrio Stool Culture DLS

Facility

$25.00

Service Code	HCPCS 87046
Hospital Charge Code	422870465
Hospital Revenue Code	306
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: MDX Hawaii PPO	$24.25

Vibrio Stool Culture DLS

Facility

$25.00

Service Code	HCPCS 87046
Hospital Charge Code	422870465
Hospital Revenue Code	306
Min. Negotiated Rate	$7.91
Max. Negotiated Rate	$24.38
Rate for Payer: AlohaCare Medicaid	$12.50
Rate for Payer: AlohaCare Medicare	$10.50
Rate for Payer: Cash Price	$16.25
Rate for Payer: Cash Price	$16.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$23.00
Rate for Payer: Devoted Health Medicare	$10.50
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$7.91
Rate for Payer: Hawaii Medical Service Association Commercial	$11.80
Rate for Payer: Hawaii Medical Service Association Medicare	$10.50
Rate for Payer: Hawaii Western Management Group Commercial	$9.44
Rate for Payer: Health Management Network Commercial	$21.25
Rate for Payer: Humana Medicare	$10.50
Rate for Payer: Kaiser Permanente Commercial	$22.50
Rate for Payer: Kaiser Permanente Medicaid	$12.75
Rate for Payer: Kaiser Permanente Medicare	$10.50
Rate for Payer: MDX Hawaii PPO	$24.25
Rate for Payer: Ohana Health Plan Medicaid	$10.50
Rate for Payer: Ohana Health Plan Medicare	$10.50
Rate for Payer: UnitedHealthcare Medicaid	$7.91
Rate for Payer: UnitedHealthcare Medicare	$10.50
Rate for Payer: University Health Alliance Commercial	$24.38

VIENNA NASAL SPECULA LGE

Facility

$92.00

Hospital Charge Code	8545
Hospital Revenue Code	270
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

VIENNA NASAL SPECULA LGE

Facility

$92.00

Hospital Charge Code	8545
Hospital Revenue Code	270
Min. Negotiated Rate	$38.64
Max. Negotiated Rate	$89.24
Rate for Payer: AlohaCare Medicaid	$46.00
Rate for Payer: AlohaCare Medicare	$38.64
Rate for Payer: Cash Price	$59.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$84.64
Rate for Payer: Devoted Health Medicare	$38.64
Rate for Payer: Hawaii Medical Service Association Medicare	$38.64
Rate for Payer: Hawaii Western Management Group Commercial	$87.40
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Humana Medicare	$38.64
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: Kaiser Permanente Medicaid	$46.92
Rate for Payer: Kaiser Permanente Medicare	$38.64
Rate for Payer: MDX Hawaii PPO	$89.24
Rate for Payer: Ohana Health Plan Medicaid	$38.64
Rate for Payer: Ohana Health Plan Medicare	$38.64
Rate for Payer: UnitedHealthcare Medicare	$38.64
Rate for Payer: University Health Alliance Commercial	$67.06

VIRAL ILLNESS WITH MCC

Facility

$24,341.95

Service Code	MSDRG 865
Min. Negotiated Rate	$24,341.95
Max. Negotiated Rate	$24,341.95
Rate for Payer: Hawaii Medical Service Association Commercial	$24,341.95

VIRAL ILLNESS WITHOUT MCC

Facility

$22,825.03

Service Code	MSDRG 866
Min. Negotiated Rate	$22,825.03
Max. Negotiated Rate	$22,825.03
Rate for Payer: Hawaii Medical Service Association Commercial	$22,825.03

VIRAL MENINGITIS WITH CC/MCC

Facility

$14,102.69

Service Code	MSDRG 075
Min. Negotiated Rate	$14,102.69
Max. Negotiated Rate	$14,102.69
Rate for Payer: Hawaii Medical Service Association Commercial	$14,102.69

VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$14,102.69

Service Code	MSDRG 076
Min. Negotiated Rate	$14,102.69
Max. Negotiated Rate	$14,102.69
Rate for Payer: Hawaii Medical Service Association Commercial	$14,102.69

VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM

Professional

Both

$107.00

Service Code	HCPCS 99172
Hospital Revenue Code	521
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$290.48
Rate for Payer: Cash Price	$69.55
Rate for Payer: Cash Price	$69.55
Rate for Payer: Cash Price	$69.55
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Hawaii Western Management Group Commercial	$8.20
Rate for Payer: Health Management Network Commercial	$90.95
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$273.13

VITAL SIGNS RECORDED

Professional

Both

$0.01

Service Code	HCPCS 2010F
Hospital Revenue Code	521
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$290.48
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$290.48
Rate for Payer: Hawaii Medical Service Association Medicare	$152.00
Rate for Payer: Hawaii Medical Service Association Medicare	$273.13
Rate for Payer: Health Management Network Commercial	$0.01
Rate for Payer: Kaiser Permanente Commercial	$152.00
Rate for Payer: Kaiser Permanente Commercial	$273.13
Rate for Payer: Kaiser Permanente Medicaid	$290.48
Rate for Payer: Kaiser Permanente Medicare	$152.00
Rate for Payer: Kaiser Permanente Medicare	$273.13
Rate for Payer: UnitedHealthcare Medicaid	$290.48
Rate for Payer: UnitedHealthcare Medicare	$152.00
Rate for Payer: UnitedHealthcare Medicare	$273.13

vitamin A 100,000 units / 2 mL Soln [KMC]

Facility

$1,725.00

Service Code	NDC 70199002611
Hospital Revenue Code	250
Min. Negotiated Rate	$1,466.25
Max. Negotiated Rate	$1,673.25
Rate for Payer: Cash Price	$1,121.25
Rate for Payer: Health Management Network Commercial	$1,466.25
Rate for Payer: Kaiser Permanente Commercial	$1,552.50
Rate for Payer: MDX Hawaii PPO	$1,673.25

vitamin A 100,000 units / 2 mL Soln [KMC]

Facility

$1,725.00

Service Code	NDC 70199002611
Hospital Revenue Code	250
Min. Negotiated Rate	$724.50
Max. Negotiated Rate	$1,673.25
Rate for Payer: AlohaCare Medicaid	$862.50
Rate for Payer: AlohaCare Medicare	$724.50
Rate for Payer: Cash Price	$1,121.25
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$1,587.00
Rate for Payer: Devoted Health Medicare	$724.50
Rate for Payer: Hawaii Medical Service Association Medicare	$724.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,638.75
Rate for Payer: Health Management Network Commercial	$1,466.25
Rate for Payer: Humana Medicare	$724.50
Rate for Payer: Kaiser Permanente Commercial	$1,552.50
Rate for Payer: Kaiser Permanente Medicaid	$879.75
Rate for Payer: Kaiser Permanente Medicare	$724.50
Rate for Payer: MDX Hawaii PPO	$1,673.25
Rate for Payer: Ohana Health Plan Medicaid	$724.50
Rate for Payer: Ohana Health Plan Medicare	$724.50
Rate for Payer: UnitedHealthcare Medicaid	$1,035.00
Rate for Payer: UnitedHealthcare Medicare	$724.50
Rate for Payer: University Health Alliance Commercial	$1,257.35

Vitamin A DLS

Facility

$180.00

Service Code	HCPCS 84590
Hospital Charge Code	422845905
Hospital Revenue Code	301
Min. Negotiated Rate	$11.61
Max. Negotiated Rate	$174.60
Rate for Payer: AlohaCare Medicaid	$90.00
Rate for Payer: AlohaCare Medicare	$75.60
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$165.60
Rate for Payer: Devoted Health Medicare	$75.60
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$16.02
Rate for Payer: Hawaii Medical Service Association Commercial	$14.51
Rate for Payer: Hawaii Medical Service Association Medicare	$75.60
Rate for Payer: Hawaii Western Management Group Commercial	$11.61
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Humana Medicare	$75.60
Rate for Payer: Kaiser Permanente Commercial	$162.00
Rate for Payer: Kaiser Permanente Medicaid	$91.80
Rate for Payer: Kaiser Permanente Medicare	$75.60
Rate for Payer: MDX Hawaii PPO	$174.60
Rate for Payer: Ohana Health Plan Medicaid	$75.60
Rate for Payer: Ohana Health Plan Medicare	$75.60
Rate for Payer: UnitedHealthcare Medicaid	$16.02
Rate for Payer: UnitedHealthcare Medicare	$75.60
Rate for Payer: University Health Alliance Commercial	$29.97

Vitamin A DLS

Facility

$180.00

Service Code	HCPCS 84590
Hospital Charge Code	422845905
Hospital Revenue Code	301
Min. Negotiated Rate	$153.00
Max. Negotiated Rate	$174.60
Rate for Payer: Cash Price	$117.00
Rate for Payer: Health Management Network Commercial	$153.00
Rate for Payer: Kaiser Permanente Commercial	$162.00
Rate for Payer: MDX Hawaii PPO	$174.60

vitamin A & D topical - Oin [KMC]

Facility

$0.21

Service Code	NDC 00168003545
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
Rate for Payer: AlohaCare Medicaid	$0.11
Rate for Payer: AlohaCare Medicare	$0.09
Rate for Payer: Cash Price	$0.14
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$0.19
Rate for Payer: Devoted Health Medicare	$0.09
Rate for Payer: Hawaii Medical Service Association Medicare	$0.09
Rate for Payer: Hawaii Western Management Group Commercial	$0.20
Rate for Payer: Health Management Network Commercial	$0.18
Rate for Payer: Humana Medicare	$0.09
Rate for Payer: Kaiser Permanente Commercial	$0.19
Rate for Payer: Kaiser Permanente Medicaid	$0.11
Rate for Payer: Kaiser Permanente Medicare	$0.09
Rate for Payer: MDX Hawaii PPO	$0.20
Rate for Payer: Ohana Health Plan Medicaid	$0.09
Rate for Payer: Ohana Health Plan Medicare	$0.09
Rate for Payer: UnitedHealthcare Medicaid	$0.13
Rate for Payer: UnitedHealthcare Medicare	$0.09
Rate for Payer: University Health Alliance Commercial	$0.15

Know your out-of-pocket cost for care.

All Charges