Kona Community Hospital

All Charges

Charge

Type

Setting

Price

VALACYCLOVIR 500 MG PO TABLET

Facility

$20.48

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$17.41
Max. Negotiated Rate	$19.87
Rate for Payer: Cash Price	$13.31
Rate for Payer: Cash Price	$14.26
Rate for Payer: Health Management Network Commercial	$17.41
Rate for Payer: Health Management Network Commercial	$18.65
Rate for Payer: MDX Hawaii PPO	$19.87
Rate for Payer: MDX Hawaii PPO	$21.28

VALGANCICLOVIR 450 MG PO TABLET

Facility

$322.16

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$273.84
Max. Negotiated Rate	$312.50
Rate for Payer: Cash Price	$209.40
Rate for Payer: Cash Price	$219.24
Rate for Payer: Health Management Network Commercial	$286.70
Rate for Payer: Health Management Network Commercial	$273.84
Rate for Payer: MDX Hawaii PPO	$312.50
Rate for Payer: MDX Hawaii PPO	$327.18

VALGANCICLOVIR 450 MG PO TABLET

Facility

$322.16

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$164.30
Max. Negotiated Rate	$312.50
Rate for Payer: Cash Price	$209.40
Rate for Payer: Cash Price	$219.24
Rate for Payer: Hawaii Western Management Group Commercial	$306.05
Rate for Payer: Hawaii Western Management Group Commercial	$320.44
Rate for Payer: Health Management Network Commercial	$273.84
Rate for Payer: Health Management Network Commercial	$286.70
Rate for Payer: Kaiser Permanente Commercial	$202.96
Rate for Payer: Kaiser Permanente Commercial	$212.50
Rate for Payer: Kaiser Permanente Medicaid	$164.30
Rate for Payer: Kaiser Permanente Medicaid	$172.02
Rate for Payer: MDX Hawaii PPO	$312.50
Rate for Payer: MDX Hawaii PPO	$327.18
Rate for Payer: UnitedHealthcare Medicaid	$202.38
Rate for Payer: UnitedHealthcare Medicaid	$193.30
Rate for Payer: University Health Alliance Commercial	$234.82
Rate for Payer: University Health Alliance Commercial	$245.86

VALGANCICLOVIR 50 MG/ML PO RECON.SOLN.

Facility

$852.38

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$724.52
Max. Negotiated Rate	$826.81
Rate for Payer: Cash Price	$554.05
Rate for Payer: Health Management Network Commercial	$724.52
Rate for Payer: MDX Hawaii PPO	$826.81

VALGANCICLOVIR 50 MG/ML PO RECON.SOLN.

Facility

$852.38

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$434.71
Max. Negotiated Rate	$826.81
Rate for Payer: Cash Price	$554.05
Rate for Payer: Hawaii Western Management Group Commercial	$809.76
Rate for Payer: Health Management Network Commercial	$724.52
Rate for Payer: Kaiser Permanente Commercial	$537.00
Rate for Payer: Kaiser Permanente Medicaid	$434.71
Rate for Payer: MDX Hawaii PPO	$826.81
Rate for Payer: UnitedHealthcare Medicaid	$511.43
Rate for Payer: University Health Alliance Commercial	$621.30

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN

Facility

$42.01

Service Code	HCPCS J3379
Hospital Revenue Code	636
Min. Negotiated Rate	$21.43
Max. Negotiated Rate	$40.75
Rate for Payer: Cash Price	$27.31
Rate for Payer: Cash Price	$28.25
Rate for Payer: Hawaii Western Management Group Commercial	$39.91
Rate for Payer: Hawaii Western Management Group Commercial	$41.29
Rate for Payer: Health Management Network Commercial	$35.71
Rate for Payer: Health Management Network Commercial	$36.94
Rate for Payer: Kaiser Permanente Commercial	$26.47
Rate for Payer: Kaiser Permanente Commercial	$27.38
Rate for Payer: Kaiser Permanente Medicaid	$21.43
Rate for Payer: Kaiser Permanente Medicaid	$22.16
Rate for Payer: MDX Hawaii PPO	$40.75
Rate for Payer: MDX Hawaii PPO	$42.16
Rate for Payer: UnitedHealthcare Medicaid	$26.08
Rate for Payer: UnitedHealthcare Medicaid	$25.21
Rate for Payer: University Health Alliance Commercial	$30.62
Rate for Payer: University Health Alliance Commercial	$31.68

VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN

Facility

$43.46

Service Code	HCPCS J3379
Hospital Revenue Code	250
Min. Negotiated Rate	$36.94
Max. Negotiated Rate	$42.16
Rate for Payer: Cash Price	$28.25
Rate for Payer: Cash Price	$27.31
Rate for Payer: Health Management Network Commercial	$35.71
Rate for Payer: Health Management Network Commercial	$36.94
Rate for Payer: MDX Hawaii PPO	$42.16
Rate for Payer: MDX Hawaii PPO	$40.75

VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML PO SOLN

Facility

$9.47

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$8.05
Max. Negotiated Rate	$9.19
Rate for Payer: Cash Price	$6.16
Rate for Payer: Health Management Network Commercial	$8.05
Rate for Payer: MDX Hawaii PPO	$9.19

VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML PO SOLN

Facility

$9.47

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$9.19
Rate for Payer: Cash Price	$6.16
Rate for Payer: Hawaii Western Management Group Commercial	$9.00
Rate for Payer: Health Management Network Commercial	$8.05
Rate for Payer: Kaiser Permanente Commercial	$5.97
Rate for Payer: Kaiser Permanente Medicaid	$4.83
Rate for Payer: MDX Hawaii PPO	$9.19
Rate for Payer: UnitedHealthcare Medicaid	$5.68
Rate for Payer: University Health Alliance Commercial	$6.90

VALSARTAN 160 MG PO TABLET

Facility

$7.99

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$7.75
Rate for Payer: Cash Price	$5.19
Rate for Payer: Hawaii Western Management Group Commercial	$7.59
Rate for Payer: Health Management Network Commercial	$6.79
Rate for Payer: Kaiser Permanente Commercial	$5.03
Rate for Payer: Kaiser Permanente Medicaid	$4.07
Rate for Payer: MDX Hawaii PPO	$7.75
Rate for Payer: UnitedHealthcare Medicaid	$4.79
Rate for Payer: University Health Alliance Commercial	$5.82

VALSARTAN 160 MG PO TABLET

Facility

$7.99

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$7.75
Rate for Payer: Cash Price	$5.19
Rate for Payer: Health Management Network Commercial	$6.79
Rate for Payer: MDX Hawaii PPO	$7.75

VALSARTAN 80 MG PO TABLET

Facility

$10.71

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.46
Max. Negotiated Rate	$10.39
Rate for Payer: Cash Price	$6.96
Rate for Payer: Hawaii Western Management Group Commercial	$10.17
Rate for Payer: Health Management Network Commercial	$9.10
Rate for Payer: Kaiser Permanente Commercial	$6.75
Rate for Payer: Kaiser Permanente Medicaid	$5.46
Rate for Payer: MDX Hawaii PPO	$10.39
Rate for Payer: UnitedHealthcare Medicaid	$6.43
Rate for Payer: University Health Alliance Commercial	$7.81

VALSARTAN 80 MG PO TABLET

Facility

$10.71

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$10.39
Rate for Payer: Cash Price	$6.96
Rate for Payer: Health Management Network Commercial	$9.10
Rate for Payer: MDX Hawaii PPO	$10.39

Valve Trach Speaking [2707798]

Facility

$512.20

Hospital Charge Code	2707798
Hospital Revenue Code	272
Min. Negotiated Rate	$435.37
Max. Negotiated Rate	$496.83
Rate for Payer: Cash Price	$332.93
Rate for Payer: Health Management Network Commercial	$435.37
Rate for Payer: MDX Hawaii PPO	$496.83

Valve Trach Speaking [2707798]

Facility

$512.20

Hospital Charge Code	2707798
Hospital Revenue Code	272
Min. Negotiated Rate	$261.22
Max. Negotiated Rate	$496.83
Rate for Payer: Cash Price	$332.93
Rate for Payer: Hawaii Western Management Group Commercial	$486.59
Rate for Payer: Health Management Network Commercial	$435.37
Rate for Payer: Kaiser Permanente Commercial	$322.69
Rate for Payer: Kaiser Permanente Medicaid	$261.22
Rate for Payer: MDX Hawaii PPO	$496.83
Rate for Payer: University Health Alliance Commercial	$373.34

VANCOMYCIN 1000 MG IV RECON.SOLN.

Facility

$85.41

Service Code	HCPCS J3373
Hospital Revenue Code	250
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$82.85
Rate for Payer: Cash Price	$55.52
Rate for Payer: Cash Price	$63.50
Rate for Payer: Health Management Network Commercial	$72.60
Rate for Payer: Health Management Network Commercial	$83.04
Rate for Payer: MDX Hawaii PPO	$82.85
Rate for Payer: MDX Hawaii PPO	$94.76

VANCOMYCIN 1000 MG IV RECON.SOLN.

Facility

$85.41

Service Code	HCPCS J3373
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$82.85
Rate for Payer: Cash Price	$55.52
Rate for Payer: Cash Price	$63.50
Rate for Payer: Cash Price	$55.52
Rate for Payer: Cash Price	$63.50
Rate for Payer: Hawaii Medical Service Association ABD	$0.03
Rate for Payer: Hawaii Medical Service Association ABD	$0.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.03
Rate for Payer: Hawaii Western Management Group Commercial	$92.81
Rate for Payer: Hawaii Western Management Group Commercial	$81.14
Rate for Payer: Health Management Network Commercial	$83.04
Rate for Payer: Health Management Network Commercial	$72.60
Rate for Payer: Kaiser Permanente Commercial	$61.54
Rate for Payer: Kaiser Permanente Commercial	$53.81
Rate for Payer: Kaiser Permanente Medicaid	$43.56
Rate for Payer: Kaiser Permanente Medicaid	$49.82
Rate for Payer: MDX Hawaii PPO	$82.85
Rate for Payer: MDX Hawaii PPO	$94.76
Rate for Payer: UnitedHealthcare Medicaid	$58.61
Rate for Payer: UnitedHealthcare Medicaid	$51.25
Rate for Payer: University Health Alliance Commercial	$62.26
Rate for Payer: University Health Alliance Commercial	$71.21

VANCOMYCIN 125 MG PO CAP

Facility

$147.61

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$75.28
Max. Negotiated Rate	$143.18
Rate for Payer: Cash Price	$95.95
Rate for Payer: Hawaii Western Management Group Commercial	$140.23
Rate for Payer: Health Management Network Commercial	$125.47
Rate for Payer: Kaiser Permanente Commercial	$92.99
Rate for Payer: Kaiser Permanente Medicaid	$75.28
Rate for Payer: MDX Hawaii PPO	$143.18
Rate for Payer: UnitedHealthcare Medicaid	$88.57
Rate for Payer: University Health Alliance Commercial	$107.59

VANCOMYCIN 125 MG PO CAP

Facility

$147.61

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$125.47
Max. Negotiated Rate	$143.18
Rate for Payer: Cash Price	$95.95
Rate for Payer: Health Management Network Commercial	$125.47
Rate for Payer: MDX Hawaii PPO	$143.18

VANCOMYCIN 500 MG IV RECON.SOLN.

Facility

$49.07

Service Code	HCPCS J3373
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$47.60
Rate for Payer: Cash Price	$31.90
Rate for Payer: Cash Price	$31.90
Rate for Payer: Hawaii Medical Service Association ABD	$0.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.03
Rate for Payer: Hawaii Western Management Group Commercial	$46.62
Rate for Payer: Health Management Network Commercial	$41.71
Rate for Payer: Kaiser Permanente Commercial	$30.91
Rate for Payer: Kaiser Permanente Medicaid	$25.03
Rate for Payer: MDX Hawaii PPO	$47.60
Rate for Payer: UnitedHealthcare Medicaid	$29.44
Rate for Payer: University Health Alliance Commercial	$35.77

VANCOMYCIN 500 MG IV RECON.SOLN.

Facility

$49.07

Service Code	HCPCS J3373
Hospital Revenue Code	250
Min. Negotiated Rate	$41.71
Max. Negotiated Rate	$47.60
Rate for Payer: Cash Price	$31.90
Rate for Payer: Health Management Network Commercial	$41.71
Rate for Payer: MDX Hawaii PPO	$47.60

VANCOMYCIN 750 MG IV RECON.SOLN.

Facility

$57.17

Service Code	HCPCS J3373
Hospital Revenue Code	250
Min. Negotiated Rate	$48.59
Max. Negotiated Rate	$55.45
Rate for Payer: Cash Price	$37.16
Rate for Payer: Cash Price	$36.11
Rate for Payer: Health Management Network Commercial	$47.22
Rate for Payer: Health Management Network Commercial	$48.59
Rate for Payer: MDX Hawaii PPO	$55.45
Rate for Payer: MDX Hawaii PPO	$53.88

VANCOMYCIN 750 MG IV RECON.SOLN.

Facility

$55.55

Service Code	HCPCS J3373
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$53.88
Rate for Payer: Cash Price	$36.11
Rate for Payer: Cash Price	$36.11
Rate for Payer: Cash Price	$37.16
Rate for Payer: Cash Price	$37.16
Rate for Payer: Hawaii Medical Service Association ABD	$0.03
Rate for Payer: Hawaii Medical Service Association ABD	$0.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.03
Rate for Payer: Hawaii Western Management Group Commercial	$52.77
Rate for Payer: Hawaii Western Management Group Commercial	$54.31
Rate for Payer: Health Management Network Commercial	$47.22
Rate for Payer: Health Management Network Commercial	$48.59
Rate for Payer: Kaiser Permanente Commercial	$35.00
Rate for Payer: Kaiser Permanente Commercial	$36.02
Rate for Payer: Kaiser Permanente Medicaid	$29.16
Rate for Payer: Kaiser Permanente Medicaid	$28.33
Rate for Payer: MDX Hawaii PPO	$55.45
Rate for Payer: MDX Hawaii PPO	$53.88
Rate for Payer: UnitedHealthcare Medicaid	$33.33
Rate for Payer: UnitedHealthcare Medicaid	$34.30
Rate for Payer: University Health Alliance Commercial	$40.49
Rate for Payer: University Health Alliance Commercial	$41.67

VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV IVPB

Facility

$96.66

Service Code	HCPCS J3375
Hospital Revenue Code	250
Min. Negotiated Rate	$82.16
Max. Negotiated Rate	$93.76
Rate for Payer: Cash Price	$62.83
Rate for Payer: Health Management Network Commercial	$82.16
Rate for Payer: MDX Hawaii PPO	$93.76

VANCOMYCIN-DILUENT COMBO NO.1 1.25 GRAM/250 ML IV IVPB

Facility

$96.66

Service Code	HCPCS J3375
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$93.76
Rate for Payer: Cash Price	$62.83
Rate for Payer: Cash Price	$62.83
Rate for Payer: Hawaii Medical Service Association ABD	$0.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.13
Rate for Payer: Hawaii Western Management Group Commercial	$91.83
Rate for Payer: Health Management Network Commercial	$82.16
Rate for Payer: Kaiser Permanente Commercial	$60.90
Rate for Payer: Kaiser Permanente Medicaid	$49.30
Rate for Payer: MDX Hawaii PPO	$93.76
Rate for Payer: UnitedHealthcare Medicaid	$58.00
Rate for Payer: University Health Alliance Commercial	$70.46

Know your out-of-pocket cost for care.

All Charges