Kauai Veterans Memorial Hospital

All Charges

Charge

Type

Setting

Price

Vitamin B12 Binding Capacity FSI

Facility

$164.00

Service Code	HCPCS 82608
Hospital Charge Code	8228942
Hospital Revenue Code	301
Min. Negotiated Rate	$139.40
Max. Negotiated Rate	$159.08
Rate for Payer: Cash Price	$106.60
Rate for Payer: Health Management Network Commercial	$139.40
Rate for Payer: Kaiser Permanente Commercial	$147.60
Rate for Payer: MDX Hawaii PPO	$159.08

Vitamin B12 FSI

Facility

$173.00

Service Code	HCPCS 82607
Hospital Charge Code	8118083
Hospital Revenue Code	301
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$167.81
Rate for Payer: AlohaCare Medicaid	$86.50
Rate for Payer: AlohaCare Medicare	$86.50
Rate for Payer: Cash Price	$112.45
Rate for Payer: Cash Price	$112.45
Rate for Payer: Devoted Health Medicare	$95.15
Rate for Payer: Hawaii Medical Service Association ABD	$20.83
Rate for Payer: Hawaii Medical Service Association Commercial	$18.85
Rate for Payer: Hawaii Medical Service Association Medicare	$86.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.87
Rate for Payer: Hawaii Western Management Group Commercial	$15.08
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Humana Medicare	$86.50
Rate for Payer: Kaiser Permanente Commercial	$155.70
Rate for Payer: Kaiser Permanente Medicaid	$88.23
Rate for Payer: Kaiser Permanente Medicare	$86.50
Rate for Payer: MDX Hawaii PPO	$167.81
Rate for Payer: Ohana Health Plan Medicaid	$86.50
Rate for Payer: Ohana Health Plan Medicare	$86.50
Rate for Payer: UnitedHealthcare Medicaid	$20.83
Rate for Payer: UnitedHealthcare Medicare	$86.50
Rate for Payer: University Health Alliance Commercial	$38.96

Vitamin B12 FSI

Facility

$173.00

Service Code	HCPCS 82607
Hospital Charge Code	8118083
Hospital Revenue Code	301
Min. Negotiated Rate	$147.05
Max. Negotiated Rate	$167.81
Rate for Payer: Cash Price	$112.45
Rate for Payer: Health Management Network Commercial	$147.05
Rate for Payer: Kaiser Permanente Commercial	$155.70
Rate for Payer: MDX Hawaii PPO	$167.81

Vitamin B1 Whole Blood FSI

Facility

$109.00

Service Code	HCPCS 84425
Hospital Charge Code	8228941
Hospital Revenue Code	301
Min. Negotiated Rate	$92.65
Max. Negotiated Rate	$105.73
Rate for Payer: Cash Price	$70.85
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: Kaiser Permanente Commercial	$98.10
Rate for Payer: MDX Hawaii PPO	$105.73

Vitamin B1 Whole Blood FSI

Facility

$109.00

Service Code	HCPCS 84425
Hospital Charge Code	8228941
Hospital Revenue Code	301
Min. Negotiated Rate	$21.23
Max. Negotiated Rate	$105.73
Rate for Payer: AlohaCare Medicaid	$54.50
Rate for Payer: AlohaCare Medicare	$54.50
Rate for Payer: Cash Price	$70.85
Rate for Payer: Cash Price	$70.85
Rate for Payer: Devoted Health Medicare	$59.95
Rate for Payer: Hawaii Medical Service Association ABD	$26.36
Rate for Payer: Hawaii Medical Service Association Commercial	$26.54
Rate for Payer: Hawaii Medical Service Association Medicare	$54.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.68
Rate for Payer: Hawaii Western Management Group Commercial	$21.23
Rate for Payer: Health Management Network Commercial	$92.65
Rate for Payer: Humana Medicare	$54.50
Rate for Payer: Kaiser Permanente Commercial	$98.10
Rate for Payer: Kaiser Permanente Medicaid	$55.59
Rate for Payer: Kaiser Permanente Medicare	$54.50
Rate for Payer: MDX Hawaii PPO	$105.73
Rate for Payer: Ohana Health Plan Medicaid	$54.50
Rate for Payer: Ohana Health Plan Medicare	$54.50
Rate for Payer: UnitedHealthcare Medicaid	$26.36
Rate for Payer: UnitedHealthcare Medicare	$54.50
Rate for Payer: University Health Alliance Commercial	$49.30

Vitamin B Compl-C-FA tablet [HHSC]

Facility

$3.00

Service Code	NDC 60258016101
Hospital Charge Code	2500856
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

Vitamin B Compl-C-FA tablet [HHSC]

Facility

$3.00

Service Code	NDC 60258016101
Hospital Charge Code	2500856
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 D, 1,25 Dihydroxy REF

Facility

$217.00

Service Code	HCPCS 82652
Hospital Charge Code	8160100
Hospital Revenue Code	301
Min. Negotiated Rate	$184.45
Max. Negotiated Rate	$210.49
Rate for Payer: Cash Price	$141.05
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: Kaiser Permanente Commercial	$195.30
Rate for Payer: MDX Hawaii PPO	$210.49

Vitamin D, 1,25 Dihydroxy REF

Facility

$217.00

Service Code	HCPCS 82652
Hospital Charge Code	8160100
Hospital Revenue Code	301
Min. Negotiated Rate	$38.50
Max. Negotiated Rate	$210.49
Rate for Payer: AlohaCare Medicaid	$108.50
Rate for Payer: AlohaCare Medicare	$108.50
Rate for Payer: Cash Price	$141.05
Rate for Payer: Cash Price	$141.05
Rate for Payer: Devoted Health Medicare	$119.35
Rate for Payer: Hawaii Medical Service Association ABD	$53.19
Rate for Payer: Hawaii Medical Service Association Commercial	$48.12
Rate for Payer: Hawaii Medical Service Association Medicare	$108.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$55.85
Rate for Payer: Hawaii Western Management Group Commercial	$38.50
Rate for Payer: Health Management Network Commercial	$184.45
Rate for Payer: Humana Medicare	$108.50
Rate for Payer: Kaiser Permanente Commercial	$195.30
Rate for Payer: Kaiser Permanente Medicaid	$110.67
Rate for Payer: Kaiser Permanente Medicare	$108.50
Rate for Payer: MDX Hawaii PPO	$210.49
Rate for Payer: Ohana Health Plan Medicaid	$108.50
Rate for Payer: Ohana Health Plan Medicare	$108.50
Rate for Payer: UnitedHealthcare Medicaid	$53.19
Rate for Payer: UnitedHealthcare Medicare	$108.50
Rate for Payer: University Health Alliance Commercial	$99.49

Vitamin D (25-OH), Total FSI

Facility

$317.00

Service Code	HCPCS 82306
Hospital Charge Code	8118084
Hospital Revenue Code	301
Min. Negotiated Rate	$269.45
Max. Negotiated Rate	$307.49
Rate for Payer: Cash Price	$206.05
Rate for Payer: Health Management Network Commercial	$269.45
Rate for Payer: Kaiser Permanente Commercial	$285.30
Rate for Payer: MDX Hawaii PPO	$307.49

Vitamin D (25-OH), Total FSI

Facility

$317.00

Service Code	HCPCS 82306
Hospital Charge Code	8118084
Hospital Revenue Code	301
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$307.49
Rate for Payer: AlohaCare Medicaid	$158.50
Rate for Payer: AlohaCare Medicare	$158.50
Rate for Payer: Cash Price	$206.05
Rate for Payer: Cash Price	$206.05
Rate for Payer: Devoted Health Medicare	$174.35
Rate for Payer: Hawaii Medical Service Association ABD	$40.91
Rate for Payer: Hawaii Medical Service Association Commercial	$37.00
Rate for Payer: Hawaii Medical Service Association Medicare	$158.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42.96
Rate for Payer: Hawaii Western Management Group Commercial	$29.60
Rate for Payer: Health Management Network Commercial	$269.45
Rate for Payer: Humana Medicare	$158.50
Rate for Payer: Kaiser Permanente Commercial	$285.30
Rate for Payer: Kaiser Permanente Medicaid	$161.67
Rate for Payer: Kaiser Permanente Medicare	$158.50
Rate for Payer: MDX Hawaii PPO	$307.49
Rate for Payer: Ohana Health Plan Medicaid	$158.50
Rate for Payer: Ohana Health Plan Medicare	$158.50
Rate for Payer: UnitedHealthcare Medicaid	$40.91
Rate for Payer: UnitedHealthcare Medicare	$158.50
Rate for Payer: University Health Alliance Commercial	$76.52

Vitamin D2, D3, and Total 25-OH FSI

Facility

$317.00

Service Code	HCPCS 82306
Hospital Charge Code	8118085
Hospital Revenue Code	301
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$307.49
Rate for Payer: AlohaCare Medicaid	$158.50
Rate for Payer: AlohaCare Medicare	$158.50
Rate for Payer: Cash Price	$206.05
Rate for Payer: Cash Price	$206.05
Rate for Payer: Devoted Health Medicare	$174.35
Rate for Payer: Hawaii Medical Service Association ABD	$40.91
Rate for Payer: Hawaii Medical Service Association Commercial	$37.00
Rate for Payer: Hawaii Medical Service Association Medicare	$158.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42.96
Rate for Payer: Hawaii Western Management Group Commercial	$29.60
Rate for Payer: Health Management Network Commercial	$269.45
Rate for Payer: Humana Medicare	$158.50
Rate for Payer: Kaiser Permanente Commercial	$285.30
Rate for Payer: Kaiser Permanente Medicaid	$161.67
Rate for Payer: Kaiser Permanente Medicare	$158.50
Rate for Payer: MDX Hawaii PPO	$307.49
Rate for Payer: Ohana Health Plan Medicaid	$158.50
Rate for Payer: Ohana Health Plan Medicare	$158.50
Rate for Payer: UnitedHealthcare Medicaid	$40.91
Rate for Payer: UnitedHealthcare Medicare	$158.50
Rate for Payer: University Health Alliance Commercial	$76.52

Vitamin D2, D3, and Total 25-OH FSI

Facility

$317.00

Service Code	HCPCS 82306
Hospital Charge Code	8118085
Hospital Revenue Code	301
Min. Negotiated Rate	$269.45
Max. Negotiated Rate	$307.49
Rate for Payer: Cash Price	$206.05
Rate for Payer: Health Management Network Commercial	$269.45
Rate for Payer: Kaiser Permanente Commercial	$285.30
Rate for Payer: MDX Hawaii PPO	$307.49

Vitamin D (Total)

Facility

$317.00

Service Code	HCPCS 82306
Hospital Charge Code	10408974
Hospital Revenue Code	301
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$307.49
Rate for Payer: AlohaCare Medicaid	$158.50
Rate for Payer: AlohaCare Medicare	$158.50
Rate for Payer: Cash Price	$206.05
Rate for Payer: Cash Price	$206.05
Rate for Payer: Devoted Health Medicare	$174.35
Rate for Payer: Hawaii Medical Service Association ABD	$40.91
Rate for Payer: Hawaii Medical Service Association Commercial	$37.00
Rate for Payer: Hawaii Medical Service Association Medicare	$158.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42.96
Rate for Payer: Hawaii Western Management Group Commercial	$29.60
Rate for Payer: Health Management Network Commercial	$269.45
Rate for Payer: Humana Medicare	$158.50
Rate for Payer: Kaiser Permanente Commercial	$285.30
Rate for Payer: Kaiser Permanente Medicaid	$161.67
Rate for Payer: Kaiser Permanente Medicare	$158.50
Rate for Payer: MDX Hawaii PPO	$307.49
Rate for Payer: Ohana Health Plan Medicaid	$158.50
Rate for Payer: Ohana Health Plan Medicare	$158.50
Rate for Payer: UnitedHealthcare Medicaid	$40.91
Rate for Payer: UnitedHealthcare Medicare	$158.50
Rate for Payer: University Health Alliance Commercial	$76.52

Vitamin D (Total)

Facility

$317.00

Service Code	HCPCS 82306
Hospital Charge Code	10408974
Hospital Revenue Code	301
Min. Negotiated Rate	$269.45
Max. Negotiated Rate	$307.49
Rate for Payer: Cash Price	$206.05
Rate for Payer: Health Management Network Commercial	$269.45
Rate for Payer: Kaiser Permanente Commercial	$285.30
Rate for Payer: MDX Hawaii PPO	$307.49

Vitamin D (Total) FSI

Facility

$317.00

Service Code	HCPCS 82306
Hospital Charge Code	10408969
Hospital Revenue Code	300
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$307.49
Rate for Payer: AlohaCare Medicaid	$158.50
Rate for Payer: AlohaCare Medicare	$158.50
Rate for Payer: Cash Price	$206.05
Rate for Payer: Cash Price	$206.05
Rate for Payer: Devoted Health Medicare	$174.35
Rate for Payer: Hawaii Medical Service Association ABD	$40.91
Rate for Payer: Hawaii Medical Service Association Commercial	$37.00
Rate for Payer: Hawaii Medical Service Association Medicare	$158.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42.96
Rate for Payer: Hawaii Western Management Group Commercial	$29.60
Rate for Payer: Health Management Network Commercial	$269.45
Rate for Payer: Humana Medicare	$158.50
Rate for Payer: Kaiser Permanente Commercial	$285.30
Rate for Payer: Kaiser Permanente Medicaid	$161.67
Rate for Payer: Kaiser Permanente Medicare	$158.50
Rate for Payer: MDX Hawaii PPO	$307.49
Rate for Payer: Ohana Health Plan Medicaid	$158.50
Rate for Payer: Ohana Health Plan Medicare	$158.50
Rate for Payer: UnitedHealthcare Medicaid	$40.91
Rate for Payer: UnitedHealthcare Medicare	$158.50
Rate for Payer: University Health Alliance Commercial	$76.52

Vitamin D (Total) FSI

Facility

$317.00

Service Code	HCPCS 82306
Hospital Charge Code	10408969
Hospital Revenue Code	300
Min. Negotiated Rate	$269.45
Max. Negotiated Rate	$307.49
Rate for Payer: Cash Price	$206.05
Rate for Payer: Health Management Network Commercial	$269.45
Rate for Payer: Kaiser Permanente Commercial	$285.30
Rate for Payer: MDX Hawaii PPO	$307.49

Vitamin E, Tocopherol FSI

Facility

$161.00

Service Code	HCPCS 84446
Hospital Charge Code	8118086
Hospital Revenue Code	301
Min. Negotiated Rate	$14.18
Max. Negotiated Rate	$156.17
Rate for Payer: AlohaCare Medicaid	$80.50
Rate for Payer: AlohaCare Medicare	$80.50
Rate for Payer: Cash Price	$104.65
Rate for Payer: Cash Price	$104.65
Rate for Payer: Devoted Health Medicare	$88.55
Rate for Payer: Hawaii Medical Service Association ABD	$19.60
Rate for Payer: Hawaii Medical Service Association Commercial	$17.73
Rate for Payer: Hawaii Medical Service Association Medicare	$80.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20.58
Rate for Payer: Hawaii Western Management Group Commercial	$14.18
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Humana Medicare	$80.50
Rate for Payer: Kaiser Permanente Commercial	$144.90
Rate for Payer: Kaiser Permanente Medicaid	$82.11
Rate for Payer: Kaiser Permanente Medicare	$80.50
Rate for Payer: MDX Hawaii PPO	$156.17
Rate for Payer: Ohana Health Plan Medicaid	$80.50
Rate for Payer: Ohana Health Plan Medicare	$80.50
Rate for Payer: UnitedHealthcare Medicaid	$19.60
Rate for Payer: UnitedHealthcare Medicare	$80.50
Rate for Payer: University Health Alliance Commercial	$36.65

Vitamin E, Tocopherol FSI

Facility

$161.00

Service Code	HCPCS 84446
Hospital Charge Code	8118086
Hospital Revenue Code	301
Min. Negotiated Rate	$136.85
Max. Negotiated Rate	$156.17
Rate for Payer: Cash Price	$104.65
Rate for Payer: Health Management Network Commercial	$136.85
Rate for Payer: Kaiser Permanente Commercial	$144.90
Rate for Payer: MDX Hawaii PPO	$156.17

Vitamin K Level FSI

Facility

$157.00

Service Code	HCPCS 84597
Hospital Charge Code	10046564
Hospital Revenue Code	301
Min. Negotiated Rate	$13.72
Max. Negotiated Rate	$152.29
Rate for Payer: AlohaCare Medicaid	$78.50
Rate for Payer: AlohaCare Medicare	$78.50
Rate for Payer: Cash Price	$102.05
Rate for Payer: Cash Price	$102.05
Rate for Payer: Devoted Health Medicare	$86.35
Rate for Payer: Hawaii Medical Service Association ABD	$18.94
Rate for Payer: Hawaii Medical Service Association Commercial	$17.15
Rate for Payer: Hawaii Medical Service Association Medicare	$78.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.89
Rate for Payer: Hawaii Western Management Group Commercial	$13.72
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: Humana Medicare	$78.50
Rate for Payer: Kaiser Permanente Commercial	$141.30
Rate for Payer: Kaiser Permanente Medicaid	$80.07
Rate for Payer: Kaiser Permanente Medicare	$78.50
Rate for Payer: MDX Hawaii PPO	$152.29
Rate for Payer: Ohana Health Plan Medicaid	$78.50
Rate for Payer: Ohana Health Plan Medicare	$78.50
Rate for Payer: UnitedHealthcare Medicaid	$18.94
Rate for Payer: UnitedHealthcare Medicare	$78.50
Rate for Payer: University Health Alliance Commercial	$35.43

Vitamin K Level FSI

Facility

$157.00

Service Code	HCPCS 84597
Hospital Charge Code	10046564
Hospital Revenue Code	301
Min. Negotiated Rate	$133.45
Max. Negotiated Rate	$152.29
Rate for Payer: Cash Price	$102.05
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: Kaiser Permanente Commercial	$141.30
Rate for Payer: MDX Hawaii PPO	$152.29

VITREORETINAL SURGERY† - 00145

Professional

Both

$686.00

Hospital Charge Code	8971008
Hospital Revenue Code	964
Min. Negotiated Rate	$583.10
Max. Negotiated Rate	$583.10
Rate for Payer: Cash Price	$445.90
Rate for Payer: Health Management Network Commercial	$583.10

VOLAR DISTAL RADIUS PLATE, TI, NARROW, LEFT, 3H

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13006720
Hospital Revenue Code	278
Min. Negotiated Rate	$731.00
Max. Negotiated Rate	$1,418.14
Rate for Payer: AlohaCare Medicaid	$731.00
Rate for Payer: AlohaCare Medicare	$731.00
Rate for Payer: Cash Price	$950.30
Rate for Payer: Devoted Health Medicare	$804.10
Rate for Payer: Hawaii Medical Service Association Medicare	$731.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Humana Medicare	$731.00
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: Kaiser Permanente Medicaid	$745.62
Rate for Payer: Kaiser Permanente Medicare	$731.00
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: Ohana Health Plan Medicaid	$731.00
Rate for Payer: Ohana Health Plan Medicare	$731.00
Rate for Payer: UnitedHealthcare Medicare	$731.00
Rate for Payer: University Health Alliance Commercial	$818.72

VOLAR DISTAL RADIUS PLATE, TI, NARROW, LEFT, 3H

Facility

$1,462.00

Service Code	HCPCS C1713
Hospital Charge Code	13006720
Hospital Revenue Code	278
Min. Negotiated Rate	$818.72
Max. Negotiated Rate	$1,418.14
Rate for Payer: Cash Price	$950.30
Rate for Payer: Hawaii Western Management Group Commercial	$1,023.40
Rate for Payer: Health Management Network Commercial	$1,242.70
Rate for Payer: Kaiser Permanente Commercial	$1,315.80
Rate for Payer: MDX Hawaii PPO	$1,418.14
Rate for Payer: University Health Alliance Commercial	$818.72

VOLAR DISTAL RADIUS PLATE, TI, NARROW, LEFT, 5H

Facility

$2,505.00

Service Code	HCPCS C1713
Hospital Charge Code	13006721
Hospital Revenue Code	278
Min. Negotiated Rate	$1,252.50
Max. Negotiated Rate	$2,429.85
Rate for Payer: AlohaCare Medicaid	$1,252.50
Rate for Payer: AlohaCare Medicare	$1,252.50
Rate for Payer: Cash Price	$1,628.25
Rate for Payer: Devoted Health Medicare	$1,377.75
Rate for Payer: Hawaii Medical Service Association Medicare	$1,252.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,753.50
Rate for Payer: Health Management Network Commercial	$2,129.25
Rate for Payer: Humana Medicare	$1,252.50
Rate for Payer: Kaiser Permanente Commercial	$2,254.50
Rate for Payer: Kaiser Permanente Medicaid	$1,277.55
Rate for Payer: Kaiser Permanente Medicare	$1,252.50
Rate for Payer: MDX Hawaii PPO	$2,429.85
Rate for Payer: Ohana Health Plan Medicaid	$1,252.50
Rate for Payer: Ohana Health Plan Medicare	$1,252.50
Rate for Payer: UnitedHealthcare Medicare	$1,252.50
Rate for Payer: University Health Alliance Commercial	$1,402.80

Know your out-of-pocket cost for care.

All Charges