Kahuku Medical Center

All Charges

Charge

Type

Setting

Price

vitamin A & D topical - Oin [KMC]

Facility

$0.21

Service Code	NDC 00168003545
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.20
Rate for Payer: Cash Price	$0.14
Rate for Payer: Health Management Network Commercial	$0.18
Rate for Payer: Kaiser Permanente Commercial	$0.19
Rate for Payer: MDX Hawaii PPO	$0.20

Vitamin B12 DLS

Facility

$124.00

Service Code	HCPCS 82607
Hospital Charge Code	422826075
Hospital Revenue Code	301
Min. Negotiated Rate	$105.40
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$80.60
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Kaiser Permanente Commercial	$111.60
Rate for Payer: MDX Hawaii PPO	$120.28

Vitamin B12 DLS

Facility

$124.00

Service Code	HCPCS 82607
Hospital Charge Code	422826075
Hospital Revenue Code	301
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$120.28
Rate for Payer: AlohaCare Medicaid	$62.00
Rate for Payer: AlohaCare Medicare	$52.08
Rate for Payer: Cash Price	$80.60
Rate for Payer: Cash Price	$80.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$114.08
Rate for Payer: Devoted Health Medicare	$52.08
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$20.83
Rate for Payer: Hawaii Medical Service Association Commercial	$18.85
Rate for Payer: Hawaii Medical Service Association Medicare	$52.08
Rate for Payer: Hawaii Western Management Group Commercial	$15.08
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Humana Medicare	$52.08
Rate for Payer: Kaiser Permanente Commercial	$111.60
Rate for Payer: Kaiser Permanente Medicaid	$63.24
Rate for Payer: Kaiser Permanente Medicare	$52.08
Rate for Payer: MDX Hawaii PPO	$120.28
Rate for Payer: Ohana Health Plan Medicaid	$52.08
Rate for Payer: Ohana Health Plan Medicare	$52.08
Rate for Payer: UnitedHealthcare Medicaid	$20.83
Rate for Payer: UnitedHealthcare Medicare	$52.08
Rate for Payer: University Health Alliance Commercial	$38.96

Vitamin B12 / Folate DLS

Facility

$124.00

Service Code	HCPCS 82607
Hospital Charge Code	422826075
Hospital Revenue Code	301
Min. Negotiated Rate	$105.40
Max. Negotiated Rate	$120.28
Rate for Payer: Cash Price	$80.60
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Kaiser Permanente Commercial	$111.60
Rate for Payer: MDX Hawaii PPO	$120.28

Vitamin B12 / Folate DLS

Facility

$124.00

Service Code	HCPCS 82607
Hospital Charge Code	422826075
Hospital Revenue Code	301
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$120.28
Rate for Payer: AlohaCare Medicaid	$62.00
Rate for Payer: AlohaCare Medicare	$52.08
Rate for Payer: Cash Price	$80.60
Rate for Payer: Cash Price	$80.60
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$114.08
Rate for Payer: Devoted Health Medicare	$52.08
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$20.83
Rate for Payer: Hawaii Medical Service Association Commercial	$18.85
Rate for Payer: Hawaii Medical Service Association Medicare	$52.08
Rate for Payer: Hawaii Western Management Group Commercial	$15.08
Rate for Payer: Health Management Network Commercial	$105.40
Rate for Payer: Humana Medicare	$52.08
Rate for Payer: Kaiser Permanente Commercial	$111.60
Rate for Payer: Kaiser Permanente Medicaid	$63.24
Rate for Payer: Kaiser Permanente Medicare	$52.08
Rate for Payer: MDX Hawaii PPO	$120.28
Rate for Payer: Ohana Health Plan Medicaid	$52.08
Rate for Payer: Ohana Health Plan Medicare	$52.08
Rate for Payer: UnitedHealthcare Medicaid	$20.83
Rate for Payer: UnitedHealthcare Medicare	$52.08
Rate for Payer: University Health Alliance Commercial	$38.96

VITAMIN B12 INJECTION

Professional

Both

$12.00

Service Code	HCPCS J3420
Hospital Revenue Code	636
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$10.20
Rate for Payer: AlohaCare Medicare	$0.67
Rate for Payer: Cash Price	$7.80
Rate for Payer: Cash Price	$7.80
Rate for Payer: Devoted Health Medicare	$0.67
Rate for Payer: Hawaii Medical Service Association Medicare	$0.67
Rate for Payer: Hawaii Western Management Group Commercial	$1.13
Rate for Payer: Health Management Network Commercial	$10.20
Rate for Payer: Kaiser Permanente Commercial	$0.80
Rate for Payer: Kaiser Permanente Medicaid	$0.80
Rate for Payer: Kaiser Permanente Medicare	$0.80
Rate for Payer: Ohana Health Plan Medicare	$0.67
Rate for Payer: UnitedHealthcare Medicare	$0.67

Vitamin B1, Whole Blood DLS

Facility

$234.00

Service Code	HCPCS 84425
Hospital Charge Code	422844255
Hospital Revenue Code	301
Min. Negotiated Rate	$21.23
Max. Negotiated Rate	$226.98
Rate for Payer: AlohaCare Medicaid	$117.00
Rate for Payer: AlohaCare Medicare	$98.28
Rate for Payer: Cash Price	$152.10
Rate for Payer: Cash Price	$152.10
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$215.28
Rate for Payer: Devoted Health Medicare	$98.28
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$26.36
Rate for Payer: Hawaii Medical Service Association Commercial	$26.54
Rate for Payer: Hawaii Medical Service Association Medicare	$98.28
Rate for Payer: Hawaii Western Management Group Commercial	$21.23
Rate for Payer: Health Management Network Commercial	$198.90
Rate for Payer: Humana Medicare	$98.28
Rate for Payer: Kaiser Permanente Commercial	$210.60
Rate for Payer: Kaiser Permanente Medicaid	$119.34
Rate for Payer: Kaiser Permanente Medicare	$98.28
Rate for Payer: MDX Hawaii PPO	$226.98
Rate for Payer: Ohana Health Plan Medicaid	$98.28
Rate for Payer: Ohana Health Plan Medicare	$98.28
Rate for Payer: UnitedHealthcare Medicaid	$26.36
Rate for Payer: UnitedHealthcare Medicare	$98.28
Rate for Payer: University Health Alliance Commercial	$49.30

Vitamin B1, Whole Blood DLS

Facility

$234.00

Service Code	HCPCS 84425
Hospital Charge Code	422844255
Hospital Revenue Code	301
Min. Negotiated Rate	$198.90
Max. Negotiated Rate	$226.98
Rate for Payer: Cash Price	$152.10
Rate for Payer: Health Management Network Commercial	$198.90
Rate for Payer: Kaiser Permanente Commercial	$210.60
Rate for Payer: MDX Hawaii PPO	$226.98

Vitamin B6 DLS

Facility

$257.00

Service Code	HCPCS 84207
Hospital Charge Code	422842075
Hospital Revenue Code	301
Min. Negotiated Rate	$218.45
Max. Negotiated Rate	$249.29
Rate for Payer: Cash Price	$167.05
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Kaiser Permanente Commercial	$231.30
Rate for Payer: MDX Hawaii PPO	$249.29

Vitamin B6 DLS

Facility

$257.00

Service Code	HCPCS 84207
Hospital Charge Code	422842075
Hospital Revenue Code	301
Min. Negotiated Rate	$26.36
Max. Negotiated Rate	$249.29
Rate for Payer: AlohaCare Medicaid	$128.50
Rate for Payer: AlohaCare Medicare	$107.94
Rate for Payer: Cash Price	$167.05
Rate for Payer: Cash Price	$167.05
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$236.44
Rate for Payer: Devoted Health Medicare	$107.94
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$26.36
Rate for Payer: Hawaii Medical Service Association Commercial	$35.12
Rate for Payer: Hawaii Medical Service Association Medicare	$107.94
Rate for Payer: Hawaii Western Management Group Commercial	$28.10
Rate for Payer: Health Management Network Commercial	$218.45
Rate for Payer: Humana Medicare	$107.94
Rate for Payer: Kaiser Permanente Commercial	$231.30
Rate for Payer: Kaiser Permanente Medicaid	$131.07
Rate for Payer: Kaiser Permanente Medicare	$107.94
Rate for Payer: MDX Hawaii PPO	$249.29
Rate for Payer: Ohana Health Plan Medicaid	$107.94
Rate for Payer: Ohana Health Plan Medicare	$107.94
Rate for Payer: UnitedHealthcare Medicaid	$26.36
Rate for Payer: UnitedHealthcare Medicare	$107.94
Rate for Payer: University Health Alliance Commercial	$49.30

Vitamin C DLS

Facility

$426.00

Service Code	HCPCS 84207
Hospital Charge Code	422842075
Hospital Revenue Code	301
Min. Negotiated Rate	$26.36
Max. Negotiated Rate	$413.22
Rate for Payer: AlohaCare Medicaid	$213.00
Rate for Payer: AlohaCare Medicare	$178.92
Rate for Payer: Cash Price	$276.90
Rate for Payer: Cash Price	$276.90
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$391.92
Rate for Payer: Devoted Health Medicare	$178.92
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$26.36
Rate for Payer: Hawaii Medical Service Association Commercial	$35.12
Rate for Payer: Hawaii Medical Service Association Medicare	$178.92
Rate for Payer: Hawaii Western Management Group Commercial	$28.10
Rate for Payer: Health Management Network Commercial	$362.10
Rate for Payer: Humana Medicare	$178.92
Rate for Payer: Kaiser Permanente Commercial	$383.40
Rate for Payer: Kaiser Permanente Medicaid	$217.26
Rate for Payer: Kaiser Permanente Medicare	$178.92
Rate for Payer: MDX Hawaii PPO	$413.22
Rate for Payer: Ohana Health Plan Medicaid	$178.92
Rate for Payer: Ohana Health Plan Medicare	$178.92
Rate for Payer: UnitedHealthcare Medicaid	$26.36
Rate for Payer: UnitedHealthcare Medicare	$178.92
Rate for Payer: University Health Alliance Commercial	$49.30

Vitamin C DLS

Facility

$426.00

Service Code	HCPCS 84207
Hospital Charge Code	422842075
Hospital Revenue Code	301
Min. Negotiated Rate	$362.10
Max. Negotiated Rate	$413.22
Rate for Payer: Cash Price	$276.90
Rate for Payer: Health Management Network Commercial	$362.10
Rate for Payer: Kaiser Permanente Commercial	$383.40
Rate for Payer: MDX Hawaii PPO	$413.22

Vitamin D (1,25 Dihydroxy) DLS

Facility

$361.00

Service Code	HCPCS 82652
Hospital Charge Code	422826525
Hospital Revenue Code	301
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$350.17
Rate for Payer: AlohaCare Medicaid	$180.50
Rate for Payer: AlohaCare Medicare	$151.62
Rate for Payer: Cash Price	$234.65
Rate for Payer: Cash Price	$234.65
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$332.12
Rate for Payer: Devoted Health Medicare	$151.62
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$53.19
Rate for Payer: Hawaii Medical Service Association Commercial	$48.12
Rate for Payer: Hawaii Medical Service Association Medicare	$151.62
Rate for Payer: Hawaii Western Management Group Commercial	$38.50
Rate for Payer: Health Management Network Commercial	$306.85
Rate for Payer: Humana Medicare	$151.62
Rate for Payer: Kaiser Permanente Commercial	$324.90
Rate for Payer: Kaiser Permanente Medicaid	$184.11
Rate for Payer: Kaiser Permanente Medicare	$151.62
Rate for Payer: MDX Hawaii PPO	$350.17
Rate for Payer: Ohana Health Plan Medicaid	$151.62
Rate for Payer: Ohana Health Plan Medicare	$151.62
Rate for Payer: UnitedHealthcare Medicaid	$53.19
Rate for Payer: UnitedHealthcare Medicare	$151.62
Rate for Payer: University Health Alliance Commercial	$99.49

Vitamin D (1,25 Dihydroxy) DLS

Facility

$361.00

Service Code	HCPCS 82652
Hospital Charge Code	422826525
Hospital Revenue Code	301
Min. Negotiated Rate	$306.85
Max. Negotiated Rate	$350.17
Rate for Payer: Cash Price	$234.65
Rate for Payer: Health Management Network Commercial	$306.85
Rate for Payer: Kaiser Permanente Commercial	$324.90
Rate for Payer: MDX Hawaii PPO	$350.17

Vitamin D, 25-Hydroxy (D2 & D3) DLS

Facility

$159.00

Service Code	HCPCS 82306
Hospital Charge Code	422823065
Hospital Revenue Code	301
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$154.23
Rate for Payer: AlohaCare Medicaid	$79.50
Rate for Payer: AlohaCare Medicare	$66.78
Rate for Payer: Cash Price	$103.35
Rate for Payer: Cash Price	$103.35
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$146.28
Rate for Payer: Devoted Health Medicare	$66.78
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$40.91
Rate for Payer: Hawaii Medical Service Association Commercial	$37.00
Rate for Payer: Hawaii Medical Service Association Medicare	$66.78
Rate for Payer: Hawaii Western Management Group Commercial	$29.60
Rate for Payer: Health Management Network Commercial	$135.15
Rate for Payer: Humana Medicare	$66.78
Rate for Payer: Kaiser Permanente Commercial	$143.10
Rate for Payer: Kaiser Permanente Medicaid	$81.09
Rate for Payer: Kaiser Permanente Medicare	$66.78
Rate for Payer: MDX Hawaii PPO	$154.23
Rate for Payer: Ohana Health Plan Medicaid	$66.78
Rate for Payer: Ohana Health Plan Medicare	$66.78
Rate for Payer: UnitedHealthcare Medicaid	$40.91
Rate for Payer: UnitedHealthcare Medicare	$66.78
Rate for Payer: University Health Alliance Commercial	$76.52

Vitamin D, 25-Hydroxy (D2 & D3) DLS

Facility

$159.00

Service Code	HCPCS 82306
Hospital Charge Code	422823065
Hospital Revenue Code	301
Min. Negotiated Rate	$135.15
Max. Negotiated Rate	$154.23
Rate for Payer: Cash Price	$103.35
Rate for Payer: Health Management Network Commercial	$135.15
Rate for Payer: Kaiser Permanente Commercial	$143.10
Rate for Payer: MDX Hawaii PPO	$154.23

Vitamin D, 25-Hydroxy, Total DLS

Facility

$115.00

Service Code	HCPCS 82306
Hospital Charge Code	422823065
Hospital Revenue Code	301
Min. Negotiated Rate	$97.75
Max. Negotiated Rate	$111.55
Rate for Payer: Cash Price	$74.75
Rate for Payer: Health Management Network Commercial	$97.75
Rate for Payer: Kaiser Permanente Commercial	$103.50
Rate for Payer: MDX Hawaii PPO	$111.55

Vitamin D, 25-Hydroxy, Total DLS

Facility

$115.00

Service Code	HCPCS 82306
Hospital Charge Code	422823065
Hospital Revenue Code	301
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$111.55
Rate for Payer: AlohaCare Medicaid	$57.50
Rate for Payer: AlohaCare Medicare	$48.30
Rate for Payer: Cash Price	$74.75
Rate for Payer: Cash Price	$74.75
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$105.80
Rate for Payer: Devoted Health Medicare	$48.30
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$40.91
Rate for Payer: Hawaii Medical Service Association Commercial	$37.00
Rate for Payer: Hawaii Medical Service Association Medicare	$48.30
Rate for Payer: Hawaii Western Management Group Commercial	$29.60
Rate for Payer: Health Management Network Commercial	$97.75
Rate for Payer: Humana Medicare	$48.30
Rate for Payer: Kaiser Permanente Commercial	$103.50
Rate for Payer: Kaiser Permanente Medicaid	$58.65
Rate for Payer: Kaiser Permanente Medicare	$48.30
Rate for Payer: MDX Hawaii PPO	$111.55
Rate for Payer: Ohana Health Plan Medicaid	$48.30
Rate for Payer: Ohana Health Plan Medicare	$48.30
Rate for Payer: UnitedHealthcare Medicaid	$40.91
Rate for Payer: UnitedHealthcare Medicare	$48.30
Rate for Payer: University Health Alliance Commercial	$76.52

vitamin E 400 units capsule [KMC]

Facility

$3.00

Service Code	NDC 57896075201
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

vitamin E 400 units capsule [KMC]

Facility

$3.00

Service Code	NDC 57896075201
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

Vitamin E DLS

Facility

$193.00

Service Code	HCPCS 84446
Hospital Charge Code	422844465
Hospital Revenue Code	301
Min. Negotiated Rate	$164.05
Max. Negotiated Rate	$187.21
Rate for Payer: Cash Price	$125.45
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: MDX Hawaii PPO	$187.21

Vitamin E DLS

Facility

$193.00

Service Code	HCPCS 84446
Hospital Charge Code	422844465
Hospital Revenue Code	301
Min. Negotiated Rate	$14.18
Max. Negotiated Rate	$187.21
Rate for Payer: AlohaCare Medicaid	$96.50
Rate for Payer: AlohaCare Medicare	$81.06
Rate for Payer: Cash Price	$125.45
Rate for Payer: Cash Price	$125.45
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$177.56
Rate for Payer: Devoted Health Medicare	$81.06
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$19.60
Rate for Payer: Hawaii Medical Service Association Commercial	$17.73
Rate for Payer: Hawaii Medical Service Association Medicare	$81.06
Rate for Payer: Hawaii Western Management Group Commercial	$14.18
Rate for Payer: Health Management Network Commercial	$164.05
Rate for Payer: Humana Medicare	$81.06
Rate for Payer: Kaiser Permanente Commercial	$173.70
Rate for Payer: Kaiser Permanente Medicaid	$98.43
Rate for Payer: Kaiser Permanente Medicare	$81.06
Rate for Payer: MDX Hawaii PPO	$187.21
Rate for Payer: Ohana Health Plan Medicaid	$81.06
Rate for Payer: Ohana Health Plan Medicare	$81.06
Rate for Payer: UnitedHealthcare Medicaid	$19.60
Rate for Payer: UnitedHealthcare Medicare	$81.06
Rate for Payer: University Health Alliance Commercial	$36.65

Vitamin K DLS

Facility

$432.00

Service Code	HCPCS 84597
Hospital Charge Code	422845975
Hospital Revenue Code	301
Min. Negotiated Rate	$367.20
Max. Negotiated Rate	$419.04
Rate for Payer: Cash Price	$280.80
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: MDX Hawaii PPO	$419.04

Vitamin K DLS

Facility

$432.00

Service Code	HCPCS 84597
Hospital Charge Code	422845975
Hospital Revenue Code	301
Min. Negotiated Rate	$13.72
Max. Negotiated Rate	$419.04
Rate for Payer: AlohaCare Medicaid	$216.00
Rate for Payer: AlohaCare Medicare	$181.44
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cash Price	$280.80
Rate for Payer: Deseret Mutual Benefit Administrators Commercial	$397.44
Rate for Payer: Devoted Health Medicare	$181.44
Rate for Payer: Hawaii Medical Service Association ABD/Non-ABD	$18.94
Rate for Payer: Hawaii Medical Service Association Commercial	$17.15
Rate for Payer: Hawaii Medical Service Association Medicare	$181.44
Rate for Payer: Hawaii Western Management Group Commercial	$13.72
Rate for Payer: Health Management Network Commercial	$367.20
Rate for Payer: Humana Medicare	$181.44
Rate for Payer: Kaiser Permanente Commercial	$388.80
Rate for Payer: Kaiser Permanente Medicaid	$220.32
Rate for Payer: Kaiser Permanente Medicare	$181.44
Rate for Payer: MDX Hawaii PPO	$419.04
Rate for Payer: Ohana Health Plan Medicaid	$181.44
Rate for Payer: Ohana Health Plan Medicare	$181.44
Rate for Payer: UnitedHealthcare Medicaid	$18.94
Rate for Payer: UnitedHealthcare Medicare	$181.44
Rate for Payer: University Health Alliance Commercial	$35.43

VOICE CURRENT STATUS

Professional

Both

$0.01

Service Code	HCPCS G9171
Hospital Revenue Code	440
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

Know your out-of-pocket cost for care.

All Charges