Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Venous Blood Gas

Facility

$434.00

Service Code	HCPCS 82803
Hospital Charge Code	12516222
Hospital Revenue Code	301
Min. Negotiated Rate	$368.90
Max. Negotiated Rate	$420.98
Rate for Payer: Cash Price	$282.10
Rate for Payer: Health Management Network Commercial	$368.90
Rate for Payer: Kaiser Permanente Commercial	$390.60
Rate for Payer: MDX Hawaii PPO	$420.98

VENT MANAGEMENT IP INITIAL DAY CHARGE

Facility

$2,791.00

Service Code	HCPCS 94002
Hospital Charge Code	8243400
Hospital Revenue Code	410
Min. Negotiated Rate	$59.64
Max. Negotiated Rate	$2,707.27
Rate for Payer: AlohaCare Medicaid	$1,395.50
Rate for Payer: AlohaCare Medicare	$1,395.50
Rate for Payer: Cash Price	$1,814.15
Rate for Payer: Cash Price	$1,814.15
Rate for Payer: Devoted Health Medicare	$1,535.05
Rate for Payer: Hawaii Medical Service Association Commercial	$788.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,395.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,651.45
Rate for Payer: Health Management Network Commercial	$2,372.35
Rate for Payer: Humana Medicare	$1,395.50
Rate for Payer: Kaiser Permanente Commercial	$2,511.90
Rate for Payer: Kaiser Permanente Medicaid	$1,423.41
Rate for Payer: Kaiser Permanente Medicare	$1,395.50
Rate for Payer: MDX Hawaii PPO	$2,707.27
Rate for Payer: Ohana Health Plan Medicaid	$1,395.50
Rate for Payer: Ohana Health Plan Medicare	$1,395.50
Rate for Payer: UnitedHealthcare Medicaid	$59.64
Rate for Payer: UnitedHealthcare Medicare	$1,395.50
Rate for Payer: University Health Alliance Commercial	$2,034.36

VENT MANAGEMENT IP INITIAL DAY CHARGE

Facility

$2,791.00

Service Code	HCPCS 94002
Hospital Charge Code	8243400
Hospital Revenue Code	410
Min. Negotiated Rate	$2,372.35
Max. Negotiated Rate	$2,707.27
Rate for Payer: Cash Price	$1,814.15
Rate for Payer: Health Management Network Commercial	$2,372.35
Rate for Payer: Kaiser Permanente Commercial	$2,511.90
Rate for Payer: MDX Hawaii PPO	$2,707.27

VENT MANAGEMENT IP SUB DAY CHARGE

Facility

$2,511.00

Service Code	HCPCS 94003
Hospital Charge Code	8243398
Hospital Revenue Code	410
Min. Negotiated Rate	$2,134.35
Max. Negotiated Rate	$2,435.67
Rate for Payer: Cash Price	$1,632.15
Rate for Payer: Health Management Network Commercial	$2,134.35
Rate for Payer: Kaiser Permanente Commercial	$2,259.90
Rate for Payer: MDX Hawaii PPO	$2,435.67

VENT MANAGEMENT IP SUB DAY CHARGE

Facility

$2,511.00

Service Code	HCPCS 94003
Hospital Charge Code	8243398
Hospital Revenue Code	410
Min. Negotiated Rate	$43.79
Max. Negotiated Rate	$2,435.67
Rate for Payer: AlohaCare Medicaid	$1,255.50
Rate for Payer: AlohaCare Medicare	$1,255.50
Rate for Payer: Cash Price	$1,632.15
Rate for Payer: Cash Price	$1,632.15
Rate for Payer: Devoted Health Medicare	$1,381.05
Rate for Payer: Hawaii Medical Service Association Commercial	$788.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,255.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,385.45
Rate for Payer: Health Management Network Commercial	$2,134.35
Rate for Payer: Humana Medicare	$1,255.50
Rate for Payer: Kaiser Permanente Commercial	$2,259.90
Rate for Payer: Kaiser Permanente Medicaid	$1,280.61
Rate for Payer: Kaiser Permanente Medicare	$1,255.50
Rate for Payer: MDX Hawaii PPO	$2,435.67
Rate for Payer: Ohana Health Plan Medicaid	$1,255.50
Rate for Payer: Ohana Health Plan Medicare	$1,255.50
Rate for Payer: UnitedHealthcare Medicaid	$43.79
Rate for Payer: UnitedHealthcare Medicare	$1,255.50
Rate for Payer: University Health Alliance Commercial	$1,830.27

VENT MGMT SNF PER DAY CHARGE

Facility

$585.00

Service Code	HCPCS 94004
Hospital Charge Code	8282343
Hospital Revenue Code	410
Min. Negotiated Rate	$31.91
Max. Negotiated Rate	$567.45
Rate for Payer: AlohaCare Medicaid	$292.50
Rate for Payer: AlohaCare Medicare	$292.50
Rate for Payer: Cash Price	$380.25
Rate for Payer: Cash Price	$380.25
Rate for Payer: Devoted Health Medicare	$321.75
Rate for Payer: Hawaii Medical Service Association Medicare	$292.50
Rate for Payer: Hawaii Western Management Group Commercial	$555.75
Rate for Payer: Health Management Network Commercial	$497.25
Rate for Payer: Humana Medicare	$292.50
Rate for Payer: Kaiser Permanente Commercial	$526.50
Rate for Payer: Kaiser Permanente Medicaid	$298.35
Rate for Payer: Kaiser Permanente Medicare	$292.50
Rate for Payer: MDX Hawaii PPO	$567.45
Rate for Payer: Ohana Health Plan Medicaid	$292.50
Rate for Payer: Ohana Health Plan Medicare	$292.50
Rate for Payer: UnitedHealthcare Medicaid	$31.91
Rate for Payer: UnitedHealthcare Medicare	$292.50
Rate for Payer: University Health Alliance Commercial	$426.41

VENT MGMT SNF PER DAY CHARGE

Facility

$585.00

Service Code	HCPCS 94004
Hospital Charge Code	8282343
Hospital Revenue Code	410
Min. Negotiated Rate	$497.25
Max. Negotiated Rate	$567.45
Rate for Payer: Cash Price	$380.25
Rate for Payer: Health Management Network Commercial	$497.25
Rate for Payer: Kaiser Permanente Commercial	$526.50
Rate for Payer: MDX Hawaii PPO	$567.45

VENTRALIGHT ST MESH 8X10IN

Facility

$4,131.00

Service Code	HCPCS C1781
Hospital Charge Code	8500796
Hospital Revenue Code	278
Min. Negotiated Rate	$2,065.50
Max. Negotiated Rate	$4,007.07
Rate for Payer: AlohaCare Medicaid	$2,065.50
Rate for Payer: AlohaCare Medicare	$2,065.50
Rate for Payer: Cash Price	$2,685.15
Rate for Payer: Devoted Health Medicare	$2,272.05
Rate for Payer: Hawaii Medical Service Association Medicare	$2,065.50
Rate for Payer: Hawaii Western Management Group Commercial	$2,891.70
Rate for Payer: Health Management Network Commercial	$3,511.35
Rate for Payer: Humana Medicare	$2,065.50
Rate for Payer: Kaiser Permanente Commercial	$3,717.90
Rate for Payer: Kaiser Permanente Medicaid	$2,106.81
Rate for Payer: Kaiser Permanente Medicare	$2,065.50
Rate for Payer: MDX Hawaii PPO	$4,007.07
Rate for Payer: Ohana Health Plan Medicaid	$2,065.50
Rate for Payer: Ohana Health Plan Medicare	$2,065.50
Rate for Payer: UnitedHealthcare Medicare	$2,065.50
Rate for Payer: University Health Alliance Commercial	$2,313.36

VENTRALIGHT ST MESH 8X10IN

Facility

$4,131.00

Service Code	HCPCS C1781
Hospital Charge Code	8500796
Hospital Revenue Code	278
Min. Negotiated Rate	$2,313.36
Max. Negotiated Rate	$4,007.07
Rate for Payer: Cash Price	$2,685.15
Rate for Payer: Hawaii Western Management Group Commercial	$2,891.70
Rate for Payer: Health Management Network Commercial	$3,511.35
Rate for Payer: Kaiser Permanente Commercial	$3,717.90
Rate for Payer: MDX Hawaii PPO	$4,007.07
Rate for Payer: University Health Alliance Commercial	$2,313.36

VENTRICULAR SHUNT PROCEDURES WITH CC

Facility

$57,901.42

Service Code	MSDRG 032
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$57,901.42
Rate for Payer: Hawaii Medical Service Association Commercial	$57,901.42
Rate for Payer: University Health Alliance Commercial	$10,400.00

VENTRICULAR SHUNT PROCEDURES WITH MCC

Facility

$57,901.42

Service Code	MSDRG 031
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$57,901.42
Rate for Payer: Hawaii Medical Service Association Commercial	$57,901.42
Rate for Payer: University Health Alliance Commercial	$10,400.00

VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC

Facility

$40,232.69

Service Code	MSDRG 033
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$40,232.69
Rate for Payer: Hawaii Medical Service Association Commercial	$40,232.69
Rate for Payer: University Health Alliance Commercial	$10,400.00

VIRAL ILLNESS WITH MCC

Facility

$26,184.39

Service Code	MSDRG 865
Min. Negotiated Rate	$26,184.39
Max. Negotiated Rate	$26,184.39
Rate for Payer: Hawaii Medical Service Association Commercial	$26,184.39

VIRAL ILLNESS WITHOUT MCC

Facility

$24,552.65

Service Code	MSDRG 866
Min. Negotiated Rate	$24,552.65
Max. Negotiated Rate	$24,552.65
Rate for Payer: Hawaii Medical Service Association Commercial	$24,552.65

VIRAL MENINGITIS WITH CC/MCC

Facility

$15,170.12

Service Code	MSDRG 075
Min. Negotiated Rate	$15,170.12
Max. Negotiated Rate	$15,170.12
Rate for Payer: Hawaii Medical Service Association Commercial	$15,170.12

VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$15,170.12

Service Code	MSDRG 076
Min. Negotiated Rate	$15,170.12
Max. Negotiated Rate	$15,170.12
Rate for Payer: Hawaii Medical Service Association Commercial	$15,170.12

Vision Testing POC

Facility

$26.00

Service Code	HCPCS 99173
Hospital Charge Code	1019784
Hospital Revenue Code	521
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$25.22
Rate for Payer: Cash Price	$16.90
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Kaiser Permanente Commercial	$23.40
Rate for Payer: MDX Hawaii PPO	$25.22

Vision Testing POC

Facility

$26.00

Service Code	HCPCS 99173
Hospital Charge Code	1019784
Hospital Revenue Code	521
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$25.22
Rate for Payer: AlohaCare Medicaid	$13.00
Rate for Payer: AlohaCare Medicare	$13.00
Rate for Payer: Cash Price	$16.90
Rate for Payer: Cash Price	$16.90
Rate for Payer: Devoted Health Medicare	$14.30
Rate for Payer: Hawaii Medical Service Association Medicare	$13.00
Rate for Payer: Hawaii Western Management Group Commercial	$24.70
Rate for Payer: Health Management Network Commercial	$22.10
Rate for Payer: Humana Medicare	$13.00
Rate for Payer: Kaiser Permanente Commercial	$23.40
Rate for Payer: Kaiser Permanente Medicaid	$13.26
Rate for Payer: Kaiser Permanente Medicare	$13.00
Rate for Payer: MDX Hawaii PPO	$25.22
Rate for Payer: Ohana Health Plan Medicaid	$13.00
Rate for Payer: Ohana Health Plan Medicare	$13.00
Rate for Payer: UnitedHealthcare Medicaid	$2.42
Rate for Payer: UnitedHealthcare Medicare	$13.00
Rate for Payer: University Health Alliance Commercial	$18.95

VITAL CAPACITY TEST CHARGE

Facility

$426.00

Service Code	HCPCS 94150
Hospital Charge Code	8243399
Hospital Revenue Code	460
Min. Negotiated Rate	$3.05
Max. Negotiated Rate	$413.22
Rate for Payer: AlohaCare Medicaid	$213.00
Rate for Payer: AlohaCare Medicare	$213.00
Rate for Payer: Cash Price	$276.90
Rate for Payer: Cash Price	$276.90
Rate for Payer: Devoted Health Medicare	$234.30
Rate for Payer: Hawaii Medical Service Association ABD	$7.54
Rate for Payer: Hawaii Medical Service Association Commercial	$164.32
Rate for Payer: Hawaii Medical Service Association Medicare	$213.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.05
Rate for Payer: Hawaii Western Management Group Commercial	$404.70
Rate for Payer: Health Management Network Commercial	$362.10
Rate for Payer: Humana Medicare	$213.00
Rate for Payer: Kaiser Permanente Commercial	$383.40
Rate for Payer: Kaiser Permanente Medicaid	$217.26
Rate for Payer: Kaiser Permanente Medicare	$213.00
Rate for Payer: MDX Hawaii PPO	$413.22
Rate for Payer: Ohana Health Plan Medicaid	$213.00
Rate for Payer: Ohana Health Plan Medicare	$213.00
Rate for Payer: UnitedHealthcare Medicaid	$7.54
Rate for Payer: UnitedHealthcare Medicare	$213.00
Rate for Payer: University Health Alliance Commercial	$310.51

VITAL CAPACITY TEST CHARGE

Facility

$426.00

Service Code	HCPCS 94150
Hospital Charge Code	8243399
Hospital Revenue Code	460
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 A and D oint 42.5gm [HHSC]

Facility

$11.40

Service Code	NDC 41100081122
Hospital Charge Code	2500990
Hospital Revenue Code	250
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$11.06
Rate for Payer: Cash Price	$7.41
Rate for Payer: Health Management Network Commercial	$9.69
Rate for Payer: Kaiser Permanente Commercial	$10.26
Rate for Payer: MDX Hawaii PPO	$11.06

vitamin A and D oint 42.5gm [HHSC]

Facility

$11.40

Service Code	NDC 41100081122
Hospital Charge Code	2500990
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$11.06
Rate for Payer: AlohaCare Medicaid	$5.70
Rate for Payer: AlohaCare Medicare	$5.70
Rate for Payer: Cash Price	$7.41
Rate for Payer: Devoted Health Medicare	$6.27
Rate for Payer: Hawaii Medical Service Association Medicare	$5.70
Rate for Payer: Hawaii Western Management Group Commercial	$10.83
Rate for Payer: Health Management Network Commercial	$9.69
Rate for Payer: Humana Medicare	$5.70
Rate for Payer: Kaiser Permanente Commercial	$10.26
Rate for Payer: Kaiser Permanente Medicaid	$5.81
Rate for Payer: Kaiser Permanente Medicare	$5.70
Rate for Payer: MDX Hawaii PPO	$11.06
Rate for Payer: Ohana Health Plan Medicaid	$5.70
Rate for Payer: Ohana Health Plan Medicare	$5.70
Rate for Payer: UnitedHealthcare Medicaid	$6.84
Rate for Payer: UnitedHealthcare Medicare	$5.70
Rate for Payer: University Health Alliance Commercial	$8.31

Vitamin A (Retinol) FSI

Facility

$135.00

Service Code	HCPCS 84590
Hospital Charge Code	8118082
Hospital Revenue Code	301
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$130.95
Rate for Payer: Cash Price	$87.75
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: Kaiser Permanente Commercial	$121.50
Rate for Payer: MDX Hawaii PPO	$130.95

Vitamin A (Retinol) FSI

Facility

$135.00

Service Code	HCPCS 84590
Hospital Charge Code	8118082
Hospital Revenue Code	301
Min. Negotiated Rate	$11.61
Max. Negotiated Rate	$130.95
Rate for Payer: AlohaCare Medicaid	$67.50
Rate for Payer: AlohaCare Medicare	$67.50
Rate for Payer: Cash Price	$87.75
Rate for Payer: Cash Price	$87.75
Rate for Payer: Devoted Health Medicare	$74.25
Rate for Payer: Hawaii Medical Service Association ABD	$16.02
Rate for Payer: Hawaii Medical Service Association Commercial	$14.51
Rate for Payer: Hawaii Medical Service Association Medicare	$67.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.82
Rate for Payer: Hawaii Western Management Group Commercial	$11.61
Rate for Payer: Health Management Network Commercial	$114.75
Rate for Payer: Humana Medicare	$67.50
Rate for Payer: Kaiser Permanente Commercial	$121.50
Rate for Payer: Kaiser Permanente Medicaid	$68.85
Rate for Payer: Kaiser Permanente Medicare	$67.50
Rate for Payer: MDX Hawaii PPO	$130.95
Rate for Payer: Ohana Health Plan Medicaid	$67.50
Rate for Payer: Ohana Health Plan Medicare	$67.50
Rate for Payer: UnitedHealthcare Medicaid	$16.02
Rate for Payer: UnitedHealthcare Medicare	$67.50
Rate for Payer: University Health Alliance Commercial	$29.97

Vitamin B12 Binding Capacity FSI

Facility

$164.00

Service Code	HCPCS 82608
Hospital Charge Code	8228942
Hospital Revenue Code	301
Min. Negotiated Rate	$14.32
Max. Negotiated Rate	$159.08
Rate for Payer: AlohaCare Medicaid	$82.00
Rate for Payer: AlohaCare Medicare	$82.00
Rate for Payer: Cash Price	$106.60
Rate for Payer: Cash Price	$106.60
Rate for Payer: Devoted Health Medicare	$90.20
Rate for Payer: Hawaii Medical Service Association ABD	$19.80
Rate for Payer: Hawaii Medical Service Association Commercial	$17.90
Rate for Payer: Hawaii Medical Service Association Medicare	$82.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.79
Rate for Payer: Hawaii Western Management Group Commercial	$14.32
Rate for Payer: Health Management Network Commercial	$139.40
Rate for Payer: Humana Medicare	$82.00
Rate for Payer: Kaiser Permanente Commercial	$147.60
Rate for Payer: Kaiser Permanente Medicaid	$83.64
Rate for Payer: Kaiser Permanente Medicare	$82.00
Rate for Payer: MDX Hawaii PPO	$159.08
Rate for Payer: Ohana Health Plan Medicaid	$82.00
Rate for Payer: Ohana Health Plan Medicare	$82.00
Rate for Payer: UnitedHealthcare Medicaid	$19.80
Rate for Payer: UnitedHealthcare Medicare	$82.00
Rate for Payer: University Health Alliance Commercial	$37.02

Know your out-of-pocket cost for care.

All Charges