Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Varicella zoster IgM FSI

Facility

$147.00

Service Code	HCPCS 86787
Hospital Charge Code	8702605
Hospital Revenue Code	302
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$142.59
Rate for Payer: Cash Price	$95.55
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: MDX Hawaii PPO	$142.59

Varicella zoster IgM FSI

Facility

$147.00

Service Code	HCPCS 86787
Hospital Charge Code	8702605
Hospital Revenue Code	302
Min. Negotiated Rate	$12.88
Max. Negotiated Rate	$142.59
Rate for Payer: AlohaCare Medicaid	$73.50
Rate for Payer: AlohaCare Medicare	$73.50
Rate for Payer: Cash Price	$95.55
Rate for Payer: Cash Price	$95.55
Rate for Payer: Devoted Health Medicare	$80.85
Rate for Payer: Hawaii Medical Service Association ABD	$17.81
Rate for Payer: Hawaii Medical Service Association Commercial	$16.10
Rate for Payer: Hawaii Medical Service Association Medicare	$73.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18.70
Rate for Payer: Hawaii Western Management Group Commercial	$12.88
Rate for Payer: Health Management Network Commercial	$124.95
Rate for Payer: Humana Medicare	$73.50
Rate for Payer: Kaiser Permanente Commercial	$132.30
Rate for Payer: Kaiser Permanente Medicaid	$74.97
Rate for Payer: Kaiser Permanente Medicare	$73.50
Rate for Payer: MDX Hawaii PPO	$142.59
Rate for Payer: Ohana Health Plan Medicaid	$73.50
Rate for Payer: Ohana Health Plan Medicare	$73.50
Rate for Payer: UnitedHealthcare Medicaid	$17.81
Rate for Payer: UnitedHealthcare Medicare	$73.50
Rate for Payer: University Health Alliance Commercial	$33.30

Varicella zoster PCR FSI

Facility

$365.00

Service Code	HCPCS 87798
Hospital Charge Code	8118078
Hospital Revenue Code	306
Min. Negotiated Rate	$35.09
Max. Negotiated Rate	$354.05
Rate for Payer: AlohaCare Medicaid	$182.50
Rate for Payer: AlohaCare Medicare	$182.50
Rate for Payer: Cash Price	$237.25
Rate for Payer: Cash Price	$237.25
Rate for Payer: Devoted Health Medicare	$200.75
Rate for Payer: Hawaii Medical Service Association ABD	$48.50
Rate for Payer: Hawaii Medical Service Association Commercial	$43.86
Rate for Payer: Hawaii Medical Service Association Medicare	$182.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$50.93
Rate for Payer: Hawaii Western Management Group Commercial	$35.09
Rate for Payer: Health Management Network Commercial	$310.25
Rate for Payer: Humana Medicare	$182.50
Rate for Payer: Kaiser Permanente Commercial	$328.50
Rate for Payer: Kaiser Permanente Medicaid	$186.15
Rate for Payer: Kaiser Permanente Medicare	$182.50
Rate for Payer: MDX Hawaii PPO	$354.05
Rate for Payer: Ohana Health Plan Medicaid	$182.50
Rate for Payer: Ohana Health Plan Medicare	$182.50
Rate for Payer: UnitedHealthcare Medicaid	$48.50
Rate for Payer: UnitedHealthcare Medicare	$182.50
Rate for Payer: University Health Alliance Commercial	$90.72

Varicella zoster PCR FSI

Facility

$365.00

Service Code	HCPCS 87798
Hospital Charge Code	8118078
Hospital Revenue Code	306
Min. Negotiated Rate	$310.25
Max. Negotiated Rate	$354.05
Rate for Payer: Cash Price	$237.25
Rate for Payer: Health Management Network Commercial	$310.25
Rate for Payer: Kaiser Permanente Commercial	$328.50
Rate for Payer: MDX Hawaii PPO	$354.05

VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S)

Facility

$5,160.40

Service Code	CPT 55250
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$901.48
Rate for Payer: Hawaii Medical Service Association Commercial	$2,669.57
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: University Health Alliance Commercial	$5,160.40

Vasopneumatic Device Charge

Facility

$92.00

Service Code	HCPCS 97016 GO
Hospital Charge Code	8123852
Hospital Revenue Code	430
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

Vasopneumatic Device Charge

Facility

$92.00

Service Code	HCPCS 97016 GP
Hospital Charge Code	8111719
Hospital Revenue Code	420
Min. Negotiated Rate	$12.49
Max. Negotiated Rate	$89.24
Rate for Payer: AlohaCare Medicaid	$46.00
Rate for Payer: AlohaCare Medicare	$46.00
Rate for Payer: Cash Price	$59.80
Rate for Payer: Cash Price	$59.80
Rate for Payer: Devoted Health Medicare	$50.60
Rate for Payer: Hawaii Medical Service Association Medicare	$46.00
Rate for Payer: Hawaii Western Management Group Commercial	$87.40
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Humana Medicare	$46.00
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: Kaiser Permanente Medicaid	$46.92
Rate for Payer: Kaiser Permanente Medicare	$46.00
Rate for Payer: MDX Hawaii PPO	$89.24
Rate for Payer: Ohana Health Plan Medicaid	$46.00
Rate for Payer: Ohana Health Plan Medicare	$46.00
Rate for Payer: UnitedHealthcare Medicaid	$12.49
Rate for Payer: UnitedHealthcare Medicare	$46.00
Rate for Payer: University Health Alliance Commercial	$67.06

Vasopneumatic Device Charge

Facility

$92.00

Service Code	HCPCS 97016 GP
Hospital Charge Code	8111719
Hospital Revenue Code	420
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

Vasopneumatic Device Charge

Facility

$92.00

Service Code	HCPCS 97016 GO
Hospital Charge Code	8123852
Hospital Revenue Code	430
Min. Negotiated Rate	$12.49
Max. Negotiated Rate	$89.24
Rate for Payer: AlohaCare Medicaid	$46.00
Rate for Payer: AlohaCare Medicare	$46.00
Rate for Payer: Cash Price	$59.80
Rate for Payer: Cash Price	$59.80
Rate for Payer: Devoted Health Medicare	$50.60
Rate for Payer: Hawaii Medical Service Association Medicare	$46.00
Rate for Payer: Hawaii Western Management Group Commercial	$87.40
Rate for Payer: Health Management Network Commercial	$78.20
Rate for Payer: Humana Medicare	$46.00
Rate for Payer: Kaiser Permanente Commercial	$82.80
Rate for Payer: Kaiser Permanente Medicaid	$46.92
Rate for Payer: Kaiser Permanente Medicare	$46.00
Rate for Payer: MDX Hawaii PPO	$89.24
Rate for Payer: Ohana Health Plan Medicaid	$46.00
Rate for Payer: Ohana Health Plan Medicare	$46.00
Rate for Payer: UnitedHealthcare Medicaid	$12.49
Rate for Payer: UnitedHealthcare Medicare	$46.00
Rate for Payer: University Health Alliance Commercial	$67.06

vasopressin 20 units/mL vial [HHSC]

Facility

$413.63

Service Code	NDC 55150037025
Hospital Charge Code	2500896
Hospital Revenue Code	250
Min. Negotiated Rate	$351.59
Max. Negotiated Rate	$401.22
Rate for Payer: Cash Price	$268.86
Rate for Payer: Health Management Network Commercial	$351.59
Rate for Payer: Kaiser Permanente Commercial	$372.27
Rate for Payer: MDX Hawaii PPO	$401.22

vasopressin 20 units/mL vial [HHSC]

Facility

$413.63

Service Code	NDC 55150037024
Hospital Charge Code	2500896
Hospital Revenue Code	250
Min. Negotiated Rate	$206.81
Max. Negotiated Rate	$401.22
Rate for Payer: AlohaCare Medicaid	$206.81
Rate for Payer: AlohaCare Medicare	$206.81
Rate for Payer: Cash Price	$268.86
Rate for Payer: Devoted Health Medicare	$227.50
Rate for Payer: Hawaii Medical Service Association Medicare	$206.81
Rate for Payer: Hawaii Western Management Group Commercial	$392.95
Rate for Payer: Health Management Network Commercial	$351.59
Rate for Payer: Humana Medicare	$206.81
Rate for Payer: Kaiser Permanente Commercial	$372.27
Rate for Payer: Kaiser Permanente Medicaid	$210.95
Rate for Payer: Kaiser Permanente Medicare	$206.81
Rate for Payer: MDX Hawaii PPO	$401.22
Rate for Payer: Ohana Health Plan Medicaid	$206.81
Rate for Payer: Ohana Health Plan Medicare	$206.81
Rate for Payer: UnitedHealthcare Medicaid	$248.18
Rate for Payer: UnitedHealthcare Medicare	$206.81
Rate for Payer: University Health Alliance Commercial	$301.49

vasopressin 20 units/mL vial [HHSC]

Facility

$413.63

Service Code	NDC 55150037024
Hospital Charge Code	2500896
Hospital Revenue Code	250
Min. Negotiated Rate	$351.59
Max. Negotiated Rate	$401.22
Rate for Payer: Cash Price	$268.86
Rate for Payer: Health Management Network Commercial	$351.59
Rate for Payer: Kaiser Permanente Commercial	$372.27
Rate for Payer: MDX Hawaii PPO	$401.22

vasopressin 20 units/mL vial [HHSC]

Facility

$438.69

Service Code	NDC 42023016425
Hospital Charge Code	2500896
Hospital Revenue Code	250
Min. Negotiated Rate	$219.34
Max. Negotiated Rate	$425.53
Rate for Payer: AlohaCare Medicaid	$219.34
Rate for Payer: AlohaCare Medicare	$219.34
Rate for Payer: Cash Price	$285.15
Rate for Payer: Devoted Health Medicare	$241.28
Rate for Payer: Hawaii Medical Service Association Medicare	$219.34
Rate for Payer: Hawaii Western Management Group Commercial	$416.76
Rate for Payer: Health Management Network Commercial	$372.89
Rate for Payer: Humana Medicare	$219.34
Rate for Payer: Kaiser Permanente Commercial	$394.82
Rate for Payer: Kaiser Permanente Medicaid	$223.73
Rate for Payer: Kaiser Permanente Medicare	$219.34
Rate for Payer: MDX Hawaii PPO	$425.53
Rate for Payer: Ohana Health Plan Medicaid	$219.34
Rate for Payer: Ohana Health Plan Medicare	$219.34
Rate for Payer: UnitedHealthcare Medicaid	$263.21
Rate for Payer: UnitedHealthcare Medicare	$219.34
Rate for Payer: University Health Alliance Commercial	$319.76

vasopressin 20 units/mL vial [HHSC]

Facility

$438.69

Service Code	NDC 42023016425
Hospital Charge Code	2500896
Hospital Revenue Code	250
Min. Negotiated Rate	$372.89
Max. Negotiated Rate	$425.53
Rate for Payer: Cash Price	$285.15
Rate for Payer: Health Management Network Commercial	$372.89
Rate for Payer: Kaiser Permanente Commercial	$394.82
Rate for Payer: MDX Hawaii PPO	$425.53

vasopressin 20 units/mL vial [HHSC]

Facility

$438.69

Service Code	NDC 42023016410
Hospital Charge Code	2500896
Hospital Revenue Code	250
Min. Negotiated Rate	$219.34
Max. Negotiated Rate	$425.53
Rate for Payer: AlohaCare Medicaid	$219.34
Rate for Payer: AlohaCare Medicare	$219.34
Rate for Payer: Cash Price	$285.15
Rate for Payer: Devoted Health Medicare	$241.28
Rate for Payer: Hawaii Medical Service Association Medicare	$219.34
Rate for Payer: Hawaii Western Management Group Commercial	$416.76
Rate for Payer: Health Management Network Commercial	$372.89
Rate for Payer: Humana Medicare	$219.34
Rate for Payer: Kaiser Permanente Commercial	$394.82
Rate for Payer: Kaiser Permanente Medicaid	$223.73
Rate for Payer: Kaiser Permanente Medicare	$219.34
Rate for Payer: MDX Hawaii PPO	$425.53
Rate for Payer: Ohana Health Plan Medicaid	$219.34
Rate for Payer: Ohana Health Plan Medicare	$219.34
Rate for Payer: UnitedHealthcare Medicaid	$263.21
Rate for Payer: UnitedHealthcare Medicare	$219.34
Rate for Payer: University Health Alliance Commercial	$319.76

vasopressin 20 units/mL vial [HHSC]

Facility

$413.63

Service Code	NDC 55150037025
Hospital Charge Code	2500896
Hospital Revenue Code	250
Min. Negotiated Rate	$206.81
Max. Negotiated Rate	$401.22
Rate for Payer: AlohaCare Medicaid	$206.81
Rate for Payer: AlohaCare Medicare	$206.81
Rate for Payer: Cash Price	$268.86
Rate for Payer: Devoted Health Medicare	$227.50
Rate for Payer: Hawaii Medical Service Association Medicare	$206.81
Rate for Payer: Hawaii Western Management Group Commercial	$392.95
Rate for Payer: Health Management Network Commercial	$351.59
Rate for Payer: Humana Medicare	$206.81
Rate for Payer: Kaiser Permanente Commercial	$372.27
Rate for Payer: Kaiser Permanente Medicaid	$210.95
Rate for Payer: Kaiser Permanente Medicare	$206.81
Rate for Payer: MDX Hawaii PPO	$401.22
Rate for Payer: Ohana Health Plan Medicaid	$206.81
Rate for Payer: Ohana Health Plan Medicare	$206.81
Rate for Payer: UnitedHealthcare Medicaid	$248.18
Rate for Payer: UnitedHealthcare Medicare	$206.81
Rate for Payer: University Health Alliance Commercial	$301.49

vasopressin 20 units/mL vial [HHSC]

Facility

$438.69

Service Code	NDC 42023016410
Hospital Charge Code	2500896
Hospital Revenue Code	250
Min. Negotiated Rate	$372.89
Max. Negotiated Rate	$425.53
Rate for Payer: Cash Price	$285.15
Rate for Payer: Health Management Network Commercial	$372.89
Rate for Payer: Kaiser Permanente Commercial	$394.82
Rate for Payer: MDX Hawaii PPO	$425.53

VDRL, CSF Reflex to Titer FSI

Facility

$57.00

Service Code	HCPCS 86592
Hospital Charge Code	12656212
Hospital Revenue Code	302
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$55.29
Rate for Payer: AlohaCare Medicaid	$28.50
Rate for Payer: AlohaCare Medicare	$28.50
Rate for Payer: Cash Price	$37.05
Rate for Payer: Cash Price	$37.05
Rate for Payer: Devoted Health Medicare	$31.35
Rate for Payer: Hawaii Medical Service Association ABD	$5.90
Rate for Payer: Hawaii Medical Service Association Commercial	$5.34
Rate for Payer: Hawaii Medical Service Association Medicare	$28.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.20
Rate for Payer: Hawaii Western Management Group Commercial	$4.27
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Humana Medicare	$28.50
Rate for Payer: Kaiser Permanente Commercial	$51.30
Rate for Payer: Kaiser Permanente Medicaid	$29.07
Rate for Payer: Kaiser Permanente Medicare	$28.50
Rate for Payer: MDX Hawaii PPO	$55.29
Rate for Payer: Ohana Health Plan Medicaid	$28.50
Rate for Payer: Ohana Health Plan Medicare	$28.50
Rate for Payer: UnitedHealthcare Medicaid	$5.90
Rate for Payer: UnitedHealthcare Medicare	$28.50
Rate for Payer: University Health Alliance Commercial	$11.03

VDRL, CSF Reflex to Titer FSI

Facility

$57.00

Service Code	HCPCS 86592
Hospital Charge Code	12656212
Hospital Revenue Code	302
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$55.29
Rate for Payer: Cash Price	$37.05
Rate for Payer: Health Management Network Commercial	$48.45
Rate for Payer: Kaiser Permanente Commercial	$51.30
Rate for Payer: MDX Hawaii PPO	$55.29

VDRL, Serum Reflex Titer FSI

Facility

$89.00

Service Code	HCPCS 86592
Hospital Charge Code	8118081
Hospital Revenue Code	302
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$86.33
Rate for Payer: AlohaCare Medicaid	$44.50
Rate for Payer: AlohaCare Medicare	$44.50
Rate for Payer: Cash Price	$57.85
Rate for Payer: Cash Price	$57.85
Rate for Payer: Devoted Health Medicare	$48.95
Rate for Payer: Hawaii Medical Service Association ABD	$5.90
Rate for Payer: Hawaii Medical Service Association Commercial	$5.34
Rate for Payer: Hawaii Medical Service Association Medicare	$44.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.20
Rate for Payer: Hawaii Western Management Group Commercial	$4.27
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Humana Medicare	$44.50
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: Kaiser Permanente Medicaid	$45.39
Rate for Payer: Kaiser Permanente Medicare	$44.50
Rate for Payer: MDX Hawaii PPO	$86.33
Rate for Payer: Ohana Health Plan Medicaid	$44.50
Rate for Payer: Ohana Health Plan Medicare	$44.50
Rate for Payer: UnitedHealthcare Medicaid	$5.90
Rate for Payer: UnitedHealthcare Medicare	$44.50
Rate for Payer: University Health Alliance Commercial	$11.03

VDRL, Serum Reflex Titer FSI

Facility

$89.00

Service Code	HCPCS 86592
Hospital Charge Code	8118081
Hospital Revenue Code	302
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$86.33
Rate for Payer: Cash Price	$57.85
Rate for Payer: Health Management Network Commercial	$75.65
Rate for Payer: Kaiser Permanente Commercial	$80.10
Rate for Payer: MDX Hawaii PPO	$86.33

VEIN LIGATION AND STRIPPING

Facility

$35,388.45

Service Code	MSDRG 263
Min. Negotiated Rate	$35,388.45
Max. Negotiated Rate	$35,388.45
Rate for Payer: Hawaii Medical Service Association Commercial	$35,388.45

Venipuncture Nursing Blood Draw

Facility

$10.00

Service Code	HCPCS 36416
Hospital Charge Code	11934636
Hospital Revenue Code	300
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$9.70
Rate for Payer: Cash Price	$6.50
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: MDX Hawaii PPO	$9.70

Venipuncture Nursing Blood Draw

Facility

$10.00

Service Code	HCPCS 36416
Hospital Charge Code	11934636
Hospital Revenue Code	300
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$9.70
Rate for Payer: AlohaCare Medicaid	$5.00
Rate for Payer: AlohaCare Medicare	$5.00
Rate for Payer: Cash Price	$6.50
Rate for Payer: Devoted Health Medicare	$5.50
Rate for Payer: Hawaii Medical Service Association Medicare	$5.00
Rate for Payer: Hawaii Western Management Group Commercial	$9.50
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Humana Medicare	$5.00
Rate for Payer: Kaiser Permanente Commercial	$9.00
Rate for Payer: Kaiser Permanente Medicaid	$5.10
Rate for Payer: Kaiser Permanente Medicare	$5.00
Rate for Payer: MDX Hawaii PPO	$9.70
Rate for Payer: Ohana Health Plan Medicaid	$5.00
Rate for Payer: Ohana Health Plan Medicare	$5.00
Rate for Payer: UnitedHealthcare Medicare	$5.00
Rate for Payer: University Health Alliance Commercial	$7.29

Venous Blood Gas

Facility

$434.00

Service Code	HCPCS 82803
Hospital Charge Code	12516222
Hospital Revenue Code	301
Min. Negotiated Rate	$26.07
Max. Negotiated Rate	$420.98
Rate for Payer: AlohaCare Medicaid	$217.00
Rate for Payer: AlohaCare Medicare	$217.00
Rate for Payer: Cash Price	$282.10
Rate for Payer: Cash Price	$282.10
Rate for Payer: Devoted Health Medicare	$238.70
Rate for Payer: Hawaii Medical Service Association ABD	$26.74
Rate for Payer: Hawaii Medical Service Association Commercial	$32.59
Rate for Payer: Hawaii Medical Service Association Medicare	$217.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28.08
Rate for Payer: Hawaii Western Management Group Commercial	$26.07
Rate for Payer: Health Management Network Commercial	$368.90
Rate for Payer: Humana Medicare	$217.00
Rate for Payer: Kaiser Permanente Commercial	$390.60
Rate for Payer: Kaiser Permanente Medicaid	$221.34
Rate for Payer: Kaiser Permanente Medicare	$217.00
Rate for Payer: MDX Hawaii PPO	$420.98
Rate for Payer: Ohana Health Plan Medicaid	$217.00
Rate for Payer: Ohana Health Plan Medicare	$217.00
Rate for Payer: UnitedHealthcare Medicaid	$26.74
Rate for Payer: UnitedHealthcare Medicare	$217.00
Rate for Payer: University Health Alliance Commercial	$50.02

Know your out-of-pocket cost for care.

All Charges