Kohala Hospital

All Charges

Charge

Type

Setting

Price

VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV IVPB

Facility

$113.64

Service Code	HCPCS J3375
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$112.50
Rate for Payer: AlohaCare Medicaid	$56.82
Rate for Payer: AlohaCare Medicare	$102.28
Rate for Payer: Cash Price	$73.87
Rate for Payer: Cash Price	$73.87
Rate for Payer: Devoted Health Medicare	$112.50
Rate for Payer: Hawaii Medical Service Association ABD	$0.13
Rate for Payer: Hawaii Medical Service Association Medicare	$102.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.13
Rate for Payer: Hawaii Western Management Group Commercial	$107.96
Rate for Payer: Health Management Network Commercial	$96.59
Rate for Payer: Humana Medicare	$102.28
Rate for Payer: Kaiser Permanente Commercial	$102.28
Rate for Payer: Kaiser Permanente Medicaid	$57.96
Rate for Payer: Kaiser Permanente Medicare	$102.28
Rate for Payer: MDX Hawaii PPO	$110.23
Rate for Payer: Ohana Health Plan Medicaid	$102.28
Rate for Payer: Ohana Health Plan Medicare	$102.28
Rate for Payer: UnitedHealthcare Medicaid	$68.18
Rate for Payer: UnitedHealthcare Medicare	$102.28
Rate for Payer: University Health Alliance Commercial	$82.83

VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV IVPB

Facility

$125.23

Service Code	HCPCS J3375
Hospital Revenue Code	250
Min. Negotiated Rate	$106.45
Max. Negotiated Rate	$121.47
Rate for Payer: Cash Price	$81.40
Rate for Payer: Health Management Network Commercial	$106.45
Rate for Payer: Kaiser Permanente Commercial	$112.71
Rate for Payer: MDX Hawaii PPO	$121.47

VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV IVPB

Facility

$125.23

Service Code	HCPCS J3375
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$123.98
Rate for Payer: AlohaCare Medicaid	$62.62
Rate for Payer: AlohaCare Medicare	$112.71
Rate for Payer: Cash Price	$81.40
Rate for Payer: Cash Price	$81.40
Rate for Payer: Devoted Health Medicare	$123.98
Rate for Payer: Hawaii Medical Service Association ABD	$0.13
Rate for Payer: Hawaii Medical Service Association Medicare	$112.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.13
Rate for Payer: Hawaii Western Management Group Commercial	$118.97
Rate for Payer: Health Management Network Commercial	$106.45
Rate for Payer: Humana Medicare	$112.71
Rate for Payer: Kaiser Permanente Commercial	$112.71
Rate for Payer: Kaiser Permanente Medicaid	$63.87
Rate for Payer: Kaiser Permanente Medicare	$112.71
Rate for Payer: MDX Hawaii PPO	$121.47
Rate for Payer: Ohana Health Plan Medicaid	$112.71
Rate for Payer: Ohana Health Plan Medicare	$112.71
Rate for Payer: UnitedHealthcare Medicaid	$75.14
Rate for Payer: UnitedHealthcare Medicare	$112.71
Rate for Payer: University Health Alliance Commercial	$91.28

VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV IVPB

Facility

$133.92

Service Code	HCPCS J3375
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$132.58
Rate for Payer: AlohaCare Medicaid	$66.96
Rate for Payer: AlohaCare Medicare	$120.53
Rate for Payer: Cash Price	$87.05
Rate for Payer: Cash Price	$87.05
Rate for Payer: Devoted Health Medicare	$132.58
Rate for Payer: Hawaii Medical Service Association ABD	$0.13
Rate for Payer: Hawaii Medical Service Association Medicare	$120.53
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.13
Rate for Payer: Hawaii Western Management Group Commercial	$127.22
Rate for Payer: Health Management Network Commercial	$113.83
Rate for Payer: Humana Medicare	$120.53
Rate for Payer: Kaiser Permanente Commercial	$120.53
Rate for Payer: Kaiser Permanente Medicaid	$68.30
Rate for Payer: Kaiser Permanente Medicare	$120.53
Rate for Payer: MDX Hawaii PPO	$129.90
Rate for Payer: Ohana Health Plan Medicaid	$120.53
Rate for Payer: Ohana Health Plan Medicare	$120.53
Rate for Payer: UnitedHealthcare Medicaid	$80.35
Rate for Payer: UnitedHealthcare Medicare	$120.53
Rate for Payer: University Health Alliance Commercial	$97.61

VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV IVPB

Facility

$133.92

Service Code	HCPCS J3375
Hospital Revenue Code	250
Min. Negotiated Rate	$113.83
Max. Negotiated Rate	$129.90
Rate for Payer: Cash Price	$87.05
Rate for Payer: Health Management Network Commercial	$113.83
Rate for Payer: Kaiser Permanente Commercial	$120.53
Rate for Payer: MDX Hawaii PPO	$129.90

VASOPRESSIN 0.4 UNIT/ML IV SOLN

Facility

$335.30

Service Code	HCPCS J2598
Hospital Revenue Code	250
Min. Negotiated Rate	$285.00
Max. Negotiated Rate	$325.24
Rate for Payer: Cash Price	$217.95
Rate for Payer: Health Management Network Commercial	$285.00
Rate for Payer: Kaiser Permanente Commercial	$301.77
Rate for Payer: MDX Hawaii PPO	$325.24

VASOPRESSIN 0.4 UNIT/ML IV SOLN

Facility

$335.30

Service Code	HCPCS J2598
Hospital Revenue Code	636
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$331.95
Rate for Payer: AlohaCare Medicaid	$167.65
Rate for Payer: AlohaCare Medicare	$301.77
Rate for Payer: Cash Price	$217.95
Rate for Payer: Cash Price	$217.95
Rate for Payer: Devoted Health Medicare	$331.95
Rate for Payer: Hawaii Medical Service Association ABD	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$301.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$318.54
Rate for Payer: Health Management Network Commercial	$285.00
Rate for Payer: Humana Medicare	$301.77
Rate for Payer: Kaiser Permanente Commercial	$301.77
Rate for Payer: Kaiser Permanente Medicaid	$171.00
Rate for Payer: Kaiser Permanente Medicare	$301.77
Rate for Payer: MDX Hawaii PPO	$325.24
Rate for Payer: Ohana Health Plan Medicaid	$301.77
Rate for Payer: Ohana Health Plan Medicare	$301.77
Rate for Payer: UnitedHealthcare Medicaid	$201.18
Rate for Payer: UnitedHealthcare Medicare	$301.77
Rate for Payer: University Health Alliance Commercial	$244.40

VASOPRESSIN 20 UNIT/ML IV SOLN

Facility

$57.58

Service Code	HCPCS J2598
Hospital Revenue Code	250
Min. Negotiated Rate	$48.94
Max. Negotiated Rate	$55.85
Rate for Payer: Cash Price	$37.43
Rate for Payer: Cash Price	$46.42
Rate for Payer: Health Management Network Commercial	$60.70
Rate for Payer: Health Management Network Commercial	$48.94
Rate for Payer: Kaiser Permanente Commercial	$51.82
Rate for Payer: Kaiser Permanente Commercial	$64.27
Rate for Payer: MDX Hawaii PPO	$55.85
Rate for Payer: MDX Hawaii PPO	$69.27

VASOPRESSIN 20 UNIT/ML IV SOLN

Facility

$71.41

Service Code	HCPCS J2598
Hospital Revenue Code	636
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$70.70
Rate for Payer: AlohaCare Medicaid	$35.70
Rate for Payer: AlohaCare Medicaid	$28.79
Rate for Payer: AlohaCare Medicare	$51.82
Rate for Payer: AlohaCare Medicare	$64.27
Rate for Payer: Cash Price	$37.43
Rate for Payer: Cash Price	$37.43
Rate for Payer: Cash Price	$46.42
Rate for Payer: Cash Price	$46.42
Rate for Payer: Devoted Health Medicare	$57.00
Rate for Payer: Devoted Health Medicare	$70.70
Rate for Payer: Hawaii Medical Service Association ABD	$1.26
Rate for Payer: Hawaii Medical Service Association ABD	$1.26
Rate for Payer: Hawaii Medical Service Association Medicare	$51.82
Rate for Payer: Hawaii Medical Service Association Medicare	$64.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$54.70
Rate for Payer: Hawaii Western Management Group Commercial	$67.84
Rate for Payer: Health Management Network Commercial	$48.94
Rate for Payer: Health Management Network Commercial	$60.70
Rate for Payer: Humana Medicare	$51.82
Rate for Payer: Humana Medicare	$64.27
Rate for Payer: Kaiser Permanente Commercial	$64.27
Rate for Payer: Kaiser Permanente Commercial	$51.82
Rate for Payer: Kaiser Permanente Medicaid	$29.37
Rate for Payer: Kaiser Permanente Medicaid	$36.42
Rate for Payer: Kaiser Permanente Medicare	$51.82
Rate for Payer: Kaiser Permanente Medicare	$64.27
Rate for Payer: MDX Hawaii PPO	$55.85
Rate for Payer: MDX Hawaii PPO	$69.27
Rate for Payer: Ohana Health Plan Medicaid	$64.27
Rate for Payer: Ohana Health Plan Medicaid	$51.82
Rate for Payer: Ohana Health Plan Medicare	$51.82
Rate for Payer: Ohana Health Plan Medicare	$64.27
Rate for Payer: UnitedHealthcare Medicaid	$34.55
Rate for Payer: UnitedHealthcare Medicaid	$42.85
Rate for Payer: UnitedHealthcare Medicare	$64.27
Rate for Payer: UnitedHealthcare Medicare	$51.82
Rate for Payer: University Health Alliance Commercial	$41.97
Rate for Payer: University Health Alliance Commercial	$52.05

VECURONIUM BROMIDE 10 MG IV RECON.SOLN.

Facility

$41.52

Service Code	NDC 55150023501
Hospital Revenue Code	250
Min. Negotiated Rate	$35.29
Max. Negotiated Rate	$40.27
Rate for Payer: Cash Price	$26.99
Rate for Payer: Health Management Network Commercial	$35.29
Rate for Payer: Kaiser Permanente Commercial	$37.37
Rate for Payer: MDX Hawaii PPO	$40.27

VECURONIUM BROMIDE 10 MG IV RECON.SOLN.

Facility

$41.52

Service Code	NDC 55150023501
Hospital Revenue Code	250
Min. Negotiated Rate	$20.76
Max. Negotiated Rate	$41.10
Rate for Payer: AlohaCare Medicaid	$20.76
Rate for Payer: AlohaCare Medicare	$37.37
Rate for Payer: Cash Price	$26.99
Rate for Payer: Devoted Health Medicare	$41.10
Rate for Payer: Hawaii Medical Service Association Medicare	$37.37
Rate for Payer: Hawaii Western Management Group Commercial	$39.44
Rate for Payer: Health Management Network Commercial	$35.29
Rate for Payer: Humana Medicare	$37.37
Rate for Payer: Kaiser Permanente Commercial	$37.37
Rate for Payer: Kaiser Permanente Medicaid	$21.18
Rate for Payer: Kaiser Permanente Medicare	$37.37
Rate for Payer: MDX Hawaii PPO	$40.27
Rate for Payer: Ohana Health Plan Medicaid	$37.37
Rate for Payer: Ohana Health Plan Medicare	$37.37
Rate for Payer: UnitedHealthcare Medicaid	$24.91
Rate for Payer: UnitedHealthcare Medicare	$37.37
Rate for Payer: University Health Alliance Commercial	$30.26

VECURONIUM BROMIDE 10 MG IV RECON.SOLN.

Facility

$24.29

Service Code	NDC 25021068510
Hospital Revenue Code	250
Min. Negotiated Rate	$12.14
Max. Negotiated Rate	$24.05
Rate for Payer: AlohaCare Medicaid	$12.14
Rate for Payer: AlohaCare Medicare	$21.86
Rate for Payer: Cash Price	$15.79
Rate for Payer: Devoted Health Medicare	$24.05
Rate for Payer: Hawaii Medical Service Association Medicare	$21.86
Rate for Payer: Hawaii Western Management Group Commercial	$23.08
Rate for Payer: Health Management Network Commercial	$20.65
Rate for Payer: Humana Medicare	$21.86
Rate for Payer: Kaiser Permanente Commercial	$21.86
Rate for Payer: Kaiser Permanente Medicaid	$12.39
Rate for Payer: Kaiser Permanente Medicare	$21.86
Rate for Payer: MDX Hawaii PPO	$23.56
Rate for Payer: Ohana Health Plan Medicaid	$21.86
Rate for Payer: Ohana Health Plan Medicare	$21.86
Rate for Payer: UnitedHealthcare Medicaid	$14.57
Rate for Payer: UnitedHealthcare Medicare	$21.86
Rate for Payer: University Health Alliance Commercial	$17.70

VECURONIUM BROMIDE 10 MG IV RECON.SOLN.

Facility

$24.29

Service Code	NDC 25021068510
Hospital Revenue Code	250
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$23.56
Rate for Payer: Cash Price	$15.79
Rate for Payer: Health Management Network Commercial	$20.65
Rate for Payer: Kaiser Permanente Commercial	$21.86
Rate for Payer: MDX Hawaii PPO	$23.56

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

VENLAFAXINE 25 MG PO TABLET

Facility

$11.41

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$11.07
Rate for Payer: Cash Price	$7.42
Rate for Payer: Health Management Network Commercial	$9.70
Rate for Payer: Kaiser Permanente Commercial	$10.27
Rate for Payer: MDX Hawaii PPO	$11.07

VENLAFAXINE 25 MG PO TABLET

Facility

$11.41

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$11.30
Rate for Payer: AlohaCare Medicaid	$5.71
Rate for Payer: AlohaCare Medicare	$10.27
Rate for Payer: Cash Price	$7.42
Rate for Payer: Devoted Health Medicare	$11.30
Rate for Payer: Hawaii Medical Service Association Medicare	$10.27
Rate for Payer: Hawaii Western Management Group Commercial	$10.84
Rate for Payer: Health Management Network Commercial	$9.70
Rate for Payer: Humana Medicare	$10.27
Rate for Payer: Kaiser Permanente Commercial	$10.27
Rate for Payer: Kaiser Permanente Medicaid	$5.82
Rate for Payer: Kaiser Permanente Medicare	$10.27
Rate for Payer: MDX Hawaii PPO	$11.07
Rate for Payer: Ohana Health Plan Medicaid	$10.27
Rate for Payer: Ohana Health Plan Medicare	$10.27
Rate for Payer: UnitedHealthcare Medicare	$10.27
Rate for Payer: University Health Alliance Commercial	$8.32

VENLAFAXINE 37.5 MG PO CAP SR 24HR

Facility

$20.66

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$10.33
Max. Negotiated Rate	$20.45
Rate for Payer: AlohaCare Medicaid	$10.33
Rate for Payer: AlohaCare Medicare	$18.59
Rate for Payer: Cash Price	$13.43
Rate for Payer: Devoted Health Medicare	$20.45
Rate for Payer: Hawaii Medical Service Association Medicare	$18.59
Rate for Payer: Hawaii Western Management Group Commercial	$19.63
Rate for Payer: Health Management Network Commercial	$17.56
Rate for Payer: Humana Medicare	$18.59
Rate for Payer: Kaiser Permanente Commercial	$18.59
Rate for Payer: Kaiser Permanente Medicaid	$10.54
Rate for Payer: Kaiser Permanente Medicare	$18.59
Rate for Payer: MDX Hawaii PPO	$20.04
Rate for Payer: Ohana Health Plan Medicaid	$18.59
Rate for Payer: Ohana Health Plan Medicare	$18.59
Rate for Payer: UnitedHealthcare Medicare	$18.59
Rate for Payer: University Health Alliance Commercial	$15.06

VENLAFAXINE 37.5 MG PO CAP SR 24HR

Facility

$20.66

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$17.56
Max. Negotiated Rate	$20.04
Rate for Payer: Cash Price	$13.43
Rate for Payer: Health Management Network Commercial	$17.56
Rate for Payer: Kaiser Permanente Commercial	$18.59
Rate for Payer: MDX Hawaii PPO	$20.04

VENLAFAXINE 75 MG PO CAP SR 24HR

Facility

$25.76

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$24.99
Rate for Payer: Cash Price	$16.74
Rate for Payer: Health Management Network Commercial	$21.90
Rate for Payer: Kaiser Permanente Commercial	$23.18
Rate for Payer: MDX Hawaii PPO	$24.99

VENLAFAXINE 75 MG PO CAP SR 24HR

Facility

$25.76

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$25.50
Rate for Payer: AlohaCare Medicaid	$12.88
Rate for Payer: AlohaCare Medicare	$23.18
Rate for Payer: Cash Price	$16.74
Rate for Payer: Devoted Health Medicare	$25.50
Rate for Payer: Hawaii Medical Service Association Medicare	$23.18
Rate for Payer: Hawaii Western Management Group Commercial	$24.47
Rate for Payer: Health Management Network Commercial	$21.90
Rate for Payer: Humana Medicare	$23.18
Rate for Payer: Kaiser Permanente Commercial	$23.18
Rate for Payer: Kaiser Permanente Medicaid	$13.14
Rate for Payer: Kaiser Permanente Medicare	$23.18
Rate for Payer: MDX Hawaii PPO	$24.99
Rate for Payer: Ohana Health Plan Medicaid	$23.18
Rate for Payer: Ohana Health Plan Medicare	$23.18
Rate for Payer: UnitedHealthcare Medicare	$23.18
Rate for Payer: University Health Alliance Commercial	$18.78

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 180 MG PO TAB SR

Facility

$7.95

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$7.87
Rate for Payer: AlohaCare Medicaid	$3.98
Rate for Payer: AlohaCare Medicare	$7.16
Rate for Payer: Cash Price	$5.17
Rate for Payer: Devoted Health Medicare	$7.87
Rate for Payer: Hawaii Medical Service Association Medicare	$7.16
Rate for Payer: Hawaii Western Management Group Commercial	$7.55
Rate for Payer: Health Management Network Commercial	$6.76
Rate for Payer: Humana Medicare	$7.16
Rate for Payer: Kaiser Permanente Commercial	$7.16
Rate for Payer: Kaiser Permanente Medicaid	$4.05
Rate for Payer: Kaiser Permanente Medicare	$7.16
Rate for Payer: MDX Hawaii PPO	$7.71
Rate for Payer: Ohana Health Plan Medicaid	$7.16
Rate for Payer: Ohana Health Plan Medicare	$7.16
Rate for Payer: UnitedHealthcare Medicare	$7.16
Rate for Payer: University Health Alliance Commercial	$5.79

VERAPAMIL 180 MG PO TAB SR

Facility

$7.95

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$7.71
Rate for Payer: Cash Price	$5.17
Rate for Payer: Health Management Network Commercial	$6.76
Rate for Payer: Kaiser Permanente Commercial	$7.16
Rate for Payer: MDX Hawaii PPO	$7.71

Know your out-of-pocket cost for care.

All Charges