Kau Hospital

All Charges

Charge

Type

Setting

Price

VENLAFAXINE ER 150 MG CAPSULE,EXTENDED RELEASE 24 HR [27859]

Facility

$17.00

Service Code	NDC 68084071301
Hospital Revenue Code	250
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$16.49
Rate for Payer: Cash Price	$10.20
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$15.30
Rate for Payer: MDX Hawaii PPO	$16.49

VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR [27857]

Facility

$14.00

Service Code	NDC 68084069811
Hospital Revenue Code	637
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$13.58
Rate for Payer: AlohaCare Medicaid	$7.00
Rate for Payer: AlohaCare Medicare	$4.34
Rate for Payer: Cash Price	$8.40
Rate for Payer: Devoted Health Medicare	$4.76
Rate for Payer: Hawaii Medical Service Association Medicare	$4.34
Rate for Payer: Hawaii Western Management Group Commercial	$13.30
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Humana Medicare	$4.34
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: Kaiser Permanente Medicaid	$7.14
Rate for Payer: Kaiser Permanente Medicare	$4.34
Rate for Payer: MDX Hawaii PPO	$13.58
Rate for Payer: Ohana Health Plan Medicaid	$4.34
Rate for Payer: Ohana Health Plan Medicare	$4.34
Rate for Payer: UnitedHealthcare Medicare	$4.34
Rate for Payer: University Health Alliance Commercial	$10.20

VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR [27857]

Facility

$14.00

Service Code	NDC 68084069801
Hospital Revenue Code	637
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$13.58
Rate for Payer: AlohaCare Medicaid	$7.00
Rate for Payer: AlohaCare Medicare	$4.34
Rate for Payer: Cash Price	$8.40
Rate for Payer: Devoted Health Medicare	$4.76
Rate for Payer: Hawaii Medical Service Association Medicare	$4.34
Rate for Payer: Hawaii Western Management Group Commercial	$13.30
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Humana Medicare	$4.34
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: Kaiser Permanente Medicaid	$7.14
Rate for Payer: Kaiser Permanente Medicare	$4.34
Rate for Payer: MDX Hawaii PPO	$13.58
Rate for Payer: Ohana Health Plan Medicaid	$4.34
Rate for Payer: Ohana Health Plan Medicare	$4.34
Rate for Payer: UnitedHealthcare Medicare	$4.34
Rate for Payer: University Health Alliance Commercial	$10.20

VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR [27857]

Facility

$14.00

Service Code	NDC 68084069811
Hospital Revenue Code	250
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$8.40
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: MDX Hawaii PPO	$13.58

VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR [27857]

Facility

$14.00

Service Code	NDC 68084069801
Hospital Revenue Code	250
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$13.58
Rate for Payer: Cash Price	$8.40
Rate for Payer: Health Management Network Commercial	$11.90
Rate for Payer: Kaiser Permanente Commercial	$12.60
Rate for Payer: MDX Hawaii PPO	$13.58

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]

Facility

$15.00

Service Code	NDC 68084070911
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]

Facility

$15.00

Service Code	NDC 68084070901
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$14.55
Rate for Payer: Cash Price	$9.00
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: MDX Hawaii PPO	$14.55

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]

Facility

$15.00

Service Code	NDC 68084070911
Hospital Revenue Code	637
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$4.65
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$5.10
Rate for Payer: Hawaii Medical Service Association Medicare	$4.65
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$4.65
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$4.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$4.65
Rate for Payer: Ohana Health Plan Medicare	$4.65
Rate for Payer: UnitedHealthcare Medicare	$4.65
Rate for Payer: University Health Alliance Commercial	$10.93

VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR [27858]

Facility

$15.00

Service Code	NDC 68084070901
Hospital Revenue Code	637
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$14.55
Rate for Payer: AlohaCare Medicaid	$7.50
Rate for Payer: AlohaCare Medicare	$4.65
Rate for Payer: Cash Price	$9.00
Rate for Payer: Devoted Health Medicare	$5.10
Rate for Payer: Hawaii Medical Service Association Medicare	$4.65
Rate for Payer: Hawaii Western Management Group Commercial	$14.25
Rate for Payer: Health Management Network Commercial	$12.75
Rate for Payer: Humana Medicare	$4.65
Rate for Payer: Kaiser Permanente Commercial	$13.50
Rate for Payer: Kaiser Permanente Medicaid	$7.65
Rate for Payer: Kaiser Permanente Medicare	$4.65
Rate for Payer: MDX Hawaii PPO	$14.55
Rate for Payer: Ohana Health Plan Medicaid	$4.65
Rate for Payer: Ohana Health Plan Medicare	$4.65
Rate for Payer: UnitedHealthcare Medicare	$4.65
Rate for Payer: University Health Alliance Commercial	$10.93

VENOVO VENOUS STENT 12X60

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 12X60

Facility

$7,000.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$2,170.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: AlohaCare Medicaid	$3,500.00
Rate for Payer: AlohaCare Medicare	$2,170.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Devoted Health Medicare	$2,380.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,170.00
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	$2,170.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: Kaiser Permanente Medicaid	$3,570.00
Rate for Payer: Kaiser Permanente Medicare	$2,170.00
Rate for Payer: MDX Hawaii PPO	$6,790.00
Rate for Payer: Ohana Health Plan Medicaid	$2,170.00
Rate for Payer: Ohana Health Plan Medicare	$2,170.00
Rate for Payer: UnitedHealthcare Medicare	$2,170.00
Rate for Payer: University Health Alliance Commercial	$3,920.00

VENOVO VENOUS STENT 14X60

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 14X60

Facility

$7,000.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$2,170.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: AlohaCare Medicaid	$3,500.00
Rate for Payer: AlohaCare Medicare	$2,170.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Devoted Health Medicare	$2,380.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,170.00
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	$2,170.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: Kaiser Permanente Medicaid	$3,570.00
Rate for Payer: Kaiser Permanente Medicare	$2,170.00
Rate for Payer: MDX Hawaii PPO	$6,790.00
Rate for Payer: Ohana Health Plan Medicaid	$2,170.00
Rate for Payer: Ohana Health Plan Medicare	$2,170.00
Rate for Payer: UnitedHealthcare Medicare	$2,170.00
Rate for Payer: University Health Alliance Commercial	$3,920.00

VENOVO VENOUS STENT 16X100

Facility

$7,000.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$2,170.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: AlohaCare Medicaid	$3,500.00
Rate for Payer: AlohaCare Medicare	$2,170.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Devoted Health Medicare	$2,380.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,170.00
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	$2,170.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: Kaiser Permanente Medicaid	$3,570.00
Rate for Payer: Kaiser Permanente Medicare	$2,170.00
Rate for Payer: MDX Hawaii PPO	$6,790.00
Rate for Payer: Ohana Health Plan Medicaid	$2,170.00
Rate for Payer: Ohana Health Plan Medicare	$2,170.00
Rate for Payer: UnitedHealthcare Medicare	$2,170.00
Rate for Payer: University Health Alliance Commercial	$3,920.00

VENOVO VENOUS STENT 16X100

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 16X120

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 16X120

Facility

$7,000.00

Service Code	HCPCS C1876
Hospital Revenue Code	278
Min. Negotiated Rate	$2,170.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: AlohaCare Medicaid	$3,500.00
Rate for Payer: AlohaCare Medicare	$2,170.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Devoted Health Medicare	$2,380.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,170.00
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	$2,170.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: Kaiser Permanente Medicaid	$3,570.00
Rate for Payer: Kaiser Permanente Medicare	$2,170.00
Rate for Payer: MDX Hawaii PPO	$6,790.00
Rate for Payer: Ohana Health Plan Medicaid	$2,170.00
Rate for Payer: Ohana Health Plan Medicare	$2,170.00
Rate for Payer: UnitedHealthcare Medicare	$2,170.00
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	$2,170.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: AlohaCare Medicaid	$3,500.00
Rate for Payer: AlohaCare Medicare	$2,170.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Devoted Health Medicare	$2,380.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,170.00
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	$2,170.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: Kaiser Permanente Medicaid	$3,570.00
Rate for Payer: Kaiser Permanente Medicare	$2,170.00
Rate for Payer: MDX Hawaii PPO	$6,790.00
Rate for Payer: Ohana Health Plan Medicaid	$2,170.00
Rate for Payer: Ohana Health Plan Medicare	$2,170.00
Rate for Payer: UnitedHealthcare Medicare	$2,170.00
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	$2,170.00
Max. Negotiated Rate	$6,790.00
Rate for Payer: AlohaCare Medicaid	$3,500.00
Rate for Payer: AlohaCare Medicare	$2,170.00
Rate for Payer: Cash Price	$4,200.00
Rate for Payer: Devoted Health Medicare	$2,380.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,170.00
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	$2,170.00
Rate for Payer: Kaiser Permanente Commercial	$6,300.00
Rate for Payer: Kaiser Permanente Medicaid	$3,570.00
Rate for Payer: Kaiser Permanente Medicare	$2,170.00
Rate for Payer: MDX Hawaii PPO	$6,790.00
Rate for Payer: Ohana Health Plan Medicaid	$2,170.00
Rate for Payer: Ohana Health Plan Medicare	$2,170.00
Rate for Payer: UnitedHealthcare Medicare	$2,170.00
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	$799.80
Max. Negotiated Rate	$2,502.60
Rate for Payer: AlohaCare Medicaid	$1,290.00
Rate for Payer: AlohaCare Medicare	$799.80
Rate for Payer: Cash Price	$1,548.00
Rate for Payer: Devoted Health Medicare	$877.20
Rate for Payer: Hawaii Medical Service Association Medicare	$799.80
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	$799.80
Rate for Payer: Kaiser Permanente Commercial	$2,322.00
Rate for Payer: Kaiser Permanente Medicaid	$1,315.80
Rate for Payer: Kaiser Permanente Medicare	$799.80
Rate for Payer: MDX Hawaii PPO	$2,502.60
Rate for Payer: Ohana Health Plan Medicaid	$799.80
Rate for Payer: Ohana Health Plan Medicare	$799.80
Rate for Payer: UnitedHealthcare Medicare	$799.80
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	$646.66
Max. Negotiated Rate	$2,023.42
Rate for Payer: AlohaCare Medicaid	$1,043.00
Rate for Payer: AlohaCare Medicare	$646.66
Rate for Payer: Cash Price	$1,251.60
Rate for Payer: Devoted Health Medicare	$709.24
Rate for Payer: Hawaii Medical Service Association Medicare	$646.66
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	$646.66
Rate for Payer: Kaiser Permanente Commercial	$1,877.40
Rate for Payer: Kaiser Permanente Medicaid	$1,063.86
Rate for Payer: Kaiser Permanente Medicare	$646.66
Rate for Payer: MDX Hawaii PPO	$2,023.42
Rate for Payer: Ohana Health Plan Medicaid	$646.66
Rate for Payer: Ohana Health Plan Medicare	$646.66
Rate for Payer: UnitedHealthcare Medicare	$646.66
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

Know your out-of-pocket cost for care.

All Charges