Kohala Hospital

All Charges

Charge

Type

Setting

Price

VERAPAMIL 240 MG PO TAB SR

Facility

$9.04

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.68
Max. Negotiated Rate	$8.77
Rate for Payer: Cash Price	$5.88
Rate for Payer: Health Management Network Commercial	$7.68
Rate for Payer: Kaiser Permanente Commercial	$8.14
Rate for Payer: MDX Hawaii PPO	$8.77

VERAPAMIL 240 MG PO TAB SR

Facility

$9.04

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$8.95
Rate for Payer: AlohaCare Medicaid	$4.52
Rate for Payer: AlohaCare Medicare	$8.14
Rate for Payer: Cash Price	$5.88
Rate for Payer: Devoted Health Medicare	$8.95
Rate for Payer: Hawaii Medical Service Association Medicare	$8.14
Rate for Payer: Hawaii Western Management Group Commercial	$8.59
Rate for Payer: Health Management Network Commercial	$7.68
Rate for Payer: Humana Medicare	$8.14
Rate for Payer: Kaiser Permanente Commercial	$8.14
Rate for Payer: Kaiser Permanente Medicaid	$4.61
Rate for Payer: Kaiser Permanente Medicare	$8.14
Rate for Payer: MDX Hawaii PPO	$8.77
Rate for Payer: Ohana Health Plan Medicaid	$8.14
Rate for Payer: Ohana Health Plan Medicare	$8.14
Rate for Payer: UnitedHealthcare Medicare	$8.14
Rate for Payer: University Health Alliance Commercial	$6.59

VERAPAMIL 2.5 MG/ML IV SOLN

Facility

$22.57

Service Code	NDC 43066003101
Hospital Revenue Code	250
Min. Negotiated Rate	$11.29
Max. Negotiated Rate	$22.34
Rate for Payer: AlohaCare Medicaid	$11.29
Rate for Payer: AlohaCare Medicare	$20.31
Rate for Payer: Cash Price	$14.67
Rate for Payer: Devoted Health Medicare	$22.34
Rate for Payer: Hawaii Medical Service Association Medicare	$20.31
Rate for Payer: Hawaii Western Management Group Commercial	$21.44
Rate for Payer: Health Management Network Commercial	$19.18
Rate for Payer: Humana Medicare	$20.31
Rate for Payer: Kaiser Permanente Commercial	$20.31
Rate for Payer: Kaiser Permanente Medicaid	$11.51
Rate for Payer: Kaiser Permanente Medicare	$20.31
Rate for Payer: MDX Hawaii PPO	$21.89
Rate for Payer: Ohana Health Plan Medicaid	$20.31
Rate for Payer: Ohana Health Plan Medicare	$20.31
Rate for Payer: UnitedHealthcare Medicaid	$13.54
Rate for Payer: UnitedHealthcare Medicare	$20.31
Rate for Payer: University Health Alliance Commercial	$16.45

VERAPAMIL 2.5 MG/ML IV SOLN

Facility

$139.62

Service Code	NDC 00409114405
Hospital Revenue Code	250
Min. Negotiated Rate	$118.68
Max. Negotiated Rate	$135.43
Rate for Payer: Cash Price	$90.75
Rate for Payer: Health Management Network Commercial	$118.68
Rate for Payer: Kaiser Permanente Commercial	$125.66
Rate for Payer: MDX Hawaii PPO	$135.43

VERAPAMIL 2.5 MG/ML IV SOLN

Facility

$139.62

Service Code	NDC 00409114405
Hospital Revenue Code	250
Min. Negotiated Rate	$69.81
Max. Negotiated Rate	$138.22
Rate for Payer: AlohaCare Medicaid	$69.81
Rate for Payer: AlohaCare Medicare	$125.66
Rate for Payer: Cash Price	$90.75
Rate for Payer: Devoted Health Medicare	$138.22
Rate for Payer: Hawaii Medical Service Association Medicare	$125.66
Rate for Payer: Hawaii Western Management Group Commercial	$132.64
Rate for Payer: Health Management Network Commercial	$118.68
Rate for Payer: Humana Medicare	$125.66
Rate for Payer: Kaiser Permanente Commercial	$125.66
Rate for Payer: Kaiser Permanente Medicaid	$71.21
Rate for Payer: Kaiser Permanente Medicare	$125.66
Rate for Payer: MDX Hawaii PPO	$135.43
Rate for Payer: Ohana Health Plan Medicaid	$125.66
Rate for Payer: Ohana Health Plan Medicare	$125.66
Rate for Payer: UnitedHealthcare Medicaid	$83.77
Rate for Payer: UnitedHealthcare Medicare	$125.66
Rate for Payer: University Health Alliance Commercial	$101.77

VERAPAMIL 2.5 MG/ML IV SOLN

Facility

$139.62

Service Code	NDC 00409114465
Hospital Revenue Code	250
Min. Negotiated Rate	$118.68
Max. Negotiated Rate	$135.43
Rate for Payer: Cash Price	$90.75
Rate for Payer: Health Management Network Commercial	$118.68
Rate for Payer: Kaiser Permanente Commercial	$125.66
Rate for Payer: MDX Hawaii PPO	$135.43

VERAPAMIL 2.5 MG/ML IV SOLN

Facility

$139.62

Service Code	NDC 00409114465
Hospital Revenue Code	250
Min. Negotiated Rate	$69.81
Max. Negotiated Rate	$138.22
Rate for Payer: AlohaCare Medicaid	$69.81
Rate for Payer: AlohaCare Medicare	$125.66
Rate for Payer: Cash Price	$90.75
Rate for Payer: Devoted Health Medicare	$138.22
Rate for Payer: Hawaii Medical Service Association Medicare	$125.66
Rate for Payer: Hawaii Western Management Group Commercial	$132.64
Rate for Payer: Health Management Network Commercial	$118.68
Rate for Payer: Humana Medicare	$125.66
Rate for Payer: Kaiser Permanente Commercial	$125.66
Rate for Payer: Kaiser Permanente Medicaid	$71.21
Rate for Payer: Kaiser Permanente Medicare	$125.66
Rate for Payer: MDX Hawaii PPO	$135.43
Rate for Payer: Ohana Health Plan Medicaid	$125.66
Rate for Payer: Ohana Health Plan Medicare	$125.66
Rate for Payer: UnitedHealthcare Medicaid	$83.77
Rate for Payer: UnitedHealthcare Medicare	$125.66
Rate for Payer: University Health Alliance Commercial	$101.77

VERAPAMIL 2.5 MG/ML IV SOLN

Facility

$22.57

Service Code	NDC 43066003125
Hospital Revenue Code	250
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$21.89
Rate for Payer: Cash Price	$14.67
Rate for Payer: Health Management Network Commercial	$19.18
Rate for Payer: Kaiser Permanente Commercial	$20.31
Rate for Payer: MDX Hawaii PPO	$21.89

VERAPAMIL 2.5 MG/ML IV SOLN

Facility

$22.57

Service Code	NDC 43066003125
Hospital Revenue Code	250
Min. Negotiated Rate	$11.29
Max. Negotiated Rate	$22.34
Rate for Payer: AlohaCare Medicaid	$11.29
Rate for Payer: AlohaCare Medicare	$20.31
Rate for Payer: Cash Price	$14.67
Rate for Payer: Devoted Health Medicare	$22.34
Rate for Payer: Hawaii Medical Service Association Medicare	$20.31
Rate for Payer: Hawaii Western Management Group Commercial	$21.44
Rate for Payer: Health Management Network Commercial	$19.18
Rate for Payer: Humana Medicare	$20.31
Rate for Payer: Kaiser Permanente Commercial	$20.31
Rate for Payer: Kaiser Permanente Medicaid	$11.51
Rate for Payer: Kaiser Permanente Medicare	$20.31
Rate for Payer: MDX Hawaii PPO	$21.89
Rate for Payer: Ohana Health Plan Medicaid	$20.31
Rate for Payer: Ohana Health Plan Medicare	$20.31
Rate for Payer: UnitedHealthcare Medicaid	$13.54
Rate for Payer: UnitedHealthcare Medicare	$20.31
Rate for Payer: University Health Alliance Commercial	$16.45

VERAPAMIL 2.5 MG/ML IV SOLN

Facility

$22.57

Service Code	NDC 43066003101
Hospital Revenue Code	250
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$21.89
Rate for Payer: Cash Price	$14.67
Rate for Payer: Health Management Network Commercial	$19.18
Rate for Payer: Kaiser Permanente Commercial	$20.31
Rate for Payer: MDX Hawaii PPO	$21.89

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

VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) PO CAP

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.19
Rate for Payer: AlohaCare Medicaid	$0.60
Rate for Payer: AlohaCare Medicare	$1.08
Rate for Payer: Cash Price	$0.78
Rate for Payer: Devoted Health Medicare	$1.19
Rate for Payer: Hawaii Medical Service Association Medicare	$1.08
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Humana Medicare	$1.08
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicare	$1.08
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: Ohana Health Plan Medicaid	$1.08
Rate for Payer: Ohana Health Plan Medicare	$1.08
Rate for Payer: UnitedHealthcare Medicare	$1.08
Rate for Payer: University Health Alliance Commercial	$0.87

VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) PO CAP

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: MDX Hawaii PPO	$1.16

VITS A AND D-WHITE PET-LANOLIN TOP OINT

Facility

$17.60

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.96
Max. Negotiated Rate	$17.07
Rate for Payer: Cash Price	$11.44
Rate for Payer: Health Management Network Commercial	$14.96
Rate for Payer: Kaiser Permanente Commercial	$15.84
Rate for Payer: MDX Hawaii PPO	$17.07

VITS A AND D-WHITE PET-LANOLIN TOP OINT

Facility

$17.60

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$17.42
Rate for Payer: AlohaCare Medicaid	$8.80
Rate for Payer: AlohaCare Medicare	$15.84
Rate for Payer: Cash Price	$11.44
Rate for Payer: Devoted Health Medicare	$17.42
Rate for Payer: Hawaii Medical Service Association Medicare	$15.84
Rate for Payer: Hawaii Western Management Group Commercial	$16.72
Rate for Payer: Health Management Network Commercial	$14.96
Rate for Payer: Humana Medicare	$15.84
Rate for Payer: Kaiser Permanente Commercial	$15.84
Rate for Payer: Kaiser Permanente Medicaid	$8.98
Rate for Payer: Kaiser Permanente Medicare	$15.84
Rate for Payer: MDX Hawaii PPO	$17.07
Rate for Payer: Ohana Health Plan Medicaid	$15.84
Rate for Payer: Ohana Health Plan Medicare	$15.84
Rate for Payer: UnitedHealthcare Medicare	$15.84
Rate for Payer: University Health Alliance Commercial	$12.83

WARFARIN 1 MG PO TAB

Facility

$3.22

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$3.19
Rate for Payer: AlohaCare Medicaid	$1.61
Rate for Payer: AlohaCare Medicare	$2.90
Rate for Payer: Cash Price	$2.09
Rate for Payer: Devoted Health Medicare	$3.19
Rate for Payer: Hawaii Medical Service Association Medicare	$2.90
Rate for Payer: Hawaii Western Management Group Commercial	$3.06
Rate for Payer: Health Management Network Commercial	$2.74
Rate for Payer: Humana Medicare	$2.90
Rate for Payer: Kaiser Permanente Commercial	$2.90
Rate for Payer: Kaiser Permanente Medicaid	$1.64
Rate for Payer: Kaiser Permanente Medicare	$2.90
Rate for Payer: MDX Hawaii PPO	$3.12
Rate for Payer: Ohana Health Plan Medicaid	$2.90
Rate for Payer: Ohana Health Plan Medicare	$2.90
Rate for Payer: UnitedHealthcare Medicare	$2.90
Rate for Payer: University Health Alliance Commercial	$2.35

WARFARIN 1 MG PO TAB

Facility

$3.22

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$3.12
Rate for Payer: Cash Price	$2.09
Rate for Payer: Health Management Network Commercial	$2.74
Rate for Payer: Kaiser Permanente Commercial	$2.90
Rate for Payer: MDX Hawaii PPO	$3.12

WARFARIN 1 MG PO TAB (0.5 TAB) = 0.5 MG

Facility

$3.22

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$3.19
Rate for Payer: AlohaCare Medicaid	$1.61
Rate for Payer: AlohaCare Medicare	$2.90
Rate for Payer: Cash Price	$2.09
Rate for Payer: Devoted Health Medicare	$3.19
Rate for Payer: Hawaii Medical Service Association Medicare	$2.90
Rate for Payer: Hawaii Western Management Group Commercial	$3.06
Rate for Payer: Health Management Network Commercial	$2.74
Rate for Payer: Humana Medicare	$2.90
Rate for Payer: Kaiser Permanente Commercial	$2.90
Rate for Payer: Kaiser Permanente Medicaid	$1.64
Rate for Payer: Kaiser Permanente Medicare	$2.90
Rate for Payer: MDX Hawaii PPO	$3.12
Rate for Payer: Ohana Health Plan Medicaid	$2.90
Rate for Payer: Ohana Health Plan Medicare	$2.90
Rate for Payer: UnitedHealthcare Medicare	$2.90
Rate for Payer: University Health Alliance Commercial	$2.35

WARFARIN 1 MG PO TAB (0.5 TAB) = 0.5 MG

Facility

$3.22

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$3.12
Rate for Payer: Cash Price	$2.09
Rate for Payer: Health Management Network Commercial	$2.74
Rate for Payer: Kaiser Permanente Commercial	$2.90
Rate for Payer: MDX Hawaii PPO	$3.12

WARFARIN 2.5 MG PO TAB (0.5 TAB) = 1.25 MG

Facility

$3.65

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$3.54
Rate for Payer: Cash Price	$2.37
Rate for Payer: Health Management Network Commercial	$3.10
Rate for Payer: Kaiser Permanente Commercial	$3.29
Rate for Payer: MDX Hawaii PPO	$3.54

WARFARIN 2.5 MG PO TAB (0.5 TAB) = 1.25 MG

Facility

$3.65

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$3.61
Rate for Payer: AlohaCare Medicaid	$1.82
Rate for Payer: AlohaCare Medicare	$3.29
Rate for Payer: Cash Price	$2.37
Rate for Payer: Devoted Health Medicare	$3.61
Rate for Payer: Hawaii Medical Service Association Medicare	$3.29
Rate for Payer: Hawaii Western Management Group Commercial	$3.47
Rate for Payer: Health Management Network Commercial	$3.10
Rate for Payer: Humana Medicare	$3.29
Rate for Payer: Kaiser Permanente Commercial	$3.29
Rate for Payer: Kaiser Permanente Medicaid	$1.86
Rate for Payer: Kaiser Permanente Medicare	$3.29
Rate for Payer: MDX Hawaii PPO	$3.54
Rate for Payer: Ohana Health Plan Medicaid	$3.29
Rate for Payer: Ohana Health Plan Medicare	$3.29
Rate for Payer: UnitedHealthcare Medicare	$3.29
Rate for Payer: University Health Alliance Commercial	$2.66

WARFARIN 2 MG PO TAB

Facility

$3.40

Service Code	HCPCS A9270
Hospital Revenue Code	637
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$3.37
Rate for Payer: AlohaCare Medicaid	$1.70
Rate for Payer: AlohaCare Medicare	$3.06
Rate for Payer: Cash Price	$2.21
Rate for Payer: Devoted Health Medicare	$3.37
Rate for Payer: Hawaii Medical Service Association Medicare	$3.06
Rate for Payer: Hawaii Western Management Group Commercial	$3.23
Rate for Payer: Health Management Network Commercial	$2.89
Rate for Payer: Humana Medicare	$3.06
Rate for Payer: Kaiser Permanente Commercial	$3.06
Rate for Payer: Kaiser Permanente Medicaid	$1.73
Rate for Payer: Kaiser Permanente Medicare	$3.06
Rate for Payer: MDX Hawaii PPO	$3.30
Rate for Payer: Ohana Health Plan Medicaid	$3.06
Rate for Payer: Ohana Health Plan Medicare	$3.06
Rate for Payer: UnitedHealthcare Medicare	$3.06
Rate for Payer: University Health Alliance Commercial	$2.48

Know your out-of-pocket cost for care.

All Charges