Kona Community Hospital

All Charges

Charge

Type

Setting

Price

VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV IVPB

Facility

$113.64

Service Code	HCPCS J3375
Hospital Revenue Code	250
Min. Negotiated Rate	$96.59
Max. Negotiated Rate	$110.23
Rate for Payer: Cash Price	$73.87
Rate for Payer: Health Management Network Commercial	$96.59
Rate for Payer: MDX Hawaii PPO	$110.23

VANCOMYCIN-DILUENT COMBO NO.1 1.5 GRAM/300 ML IV IVPB

Facility

$113.64

Service Code	HCPCS J3375
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$110.23
Rate for Payer: Cash Price	$73.87
Rate for Payer: Cash Price	$73.87
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	$107.96
Rate for Payer: Health Management Network Commercial	$96.59
Rate for Payer: Kaiser Permanente Commercial	$71.59
Rate for Payer: Kaiser Permanente Medicaid	$57.96
Rate for Payer: MDX Hawaii PPO	$110.23
Rate for Payer: UnitedHealthcare Medicaid	$68.18
Rate for Payer: University Health Alliance Commercial	$82.83

VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV IVPB

Facility

$125.23

Service Code	HCPCS J3375
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$121.47
Rate for Payer: Cash Price	$81.40
Rate for Payer: Cash Price	$81.40
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	$118.97
Rate for Payer: Health Management Network Commercial	$106.45
Rate for Payer: Kaiser Permanente Commercial	$78.89
Rate for Payer: Kaiser Permanente Medicaid	$63.87
Rate for Payer: MDX Hawaii PPO	$121.47
Rate for Payer: UnitedHealthcare Medicaid	$75.14
Rate for Payer: University Health Alliance Commercial	$91.28

VANCOMYCIN-DILUENT COMBO NO.1 1.75 GRAM/350 ML IV IVPB

Facility

$125.23

Service Code	HCPCS J3375
Hospital Revenue Code	250
Min. Negotiated Rate	$106.45
Max. Negotiated Rate	$121.47
Rate for Payer: Cash Price	$81.40
Rate for Payer: Health Management Network Commercial	$106.45
Rate for Payer: MDX Hawaii PPO	$121.47

VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV IVPB

Facility

$133.92

Service Code	HCPCS J3375
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$129.90
Rate for Payer: Cash Price	$87.05
Rate for Payer: Cash Price	$87.05
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	$127.22
Rate for Payer: Health Management Network Commercial	$113.83
Rate for Payer: Kaiser Permanente Commercial	$84.37
Rate for Payer: Kaiser Permanente Medicaid	$68.30
Rate for Payer: MDX Hawaii PPO	$129.90
Rate for Payer: UnitedHealthcare Medicaid	$80.35
Rate for Payer: University Health Alliance Commercial	$97.61

VANCOMYCIN-DILUENT COMBO NO.1 2 GRAM/400 ML IV IVPB

Facility

$133.92

Service Code	HCPCS J3375
Hospital Revenue Code	250
Min. Negotiated Rate	$113.83
Max. Negotiated Rate	$129.90
Rate for Payer: Cash Price	$87.05
Rate for Payer: Health Management Network Commercial	$113.83
Rate for Payer: MDX Hawaii PPO	$129.90

VARICELLA VIRUS VACC LIVE (PF) 1350 UNIT/0.5 ML SUBCUTANEOUS SUSR

Facility

$637.28

Service Code	HCPCS 90716
Hospital Revenue Code	250
Min. Negotiated Rate	$541.69
Max. Negotiated Rate	$618.16
Rate for Payer: Cash Price	$414.23
Rate for Payer: Health Management Network Commercial	$541.69
Rate for Payer: MDX Hawaii PPO	$618.16

VARICELLA VIRUS VACC LIVE (PF) 1350 UNIT/0.5 ML SUBCUTANEOUS SUSR

Facility

$637.28

Service Code	HCPCS 90716
Hospital Revenue Code	250
Min. Negotiated Rate	$197.51
Max. Negotiated Rate	$618.16
Rate for Payer: Cash Price	$414.23
Rate for Payer: Cash Price	$414.23
Rate for Payer: Hawaii Medical Service Association ABD	$197.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$197.51
Rate for Payer: Hawaii Western Management Group Commercial	$605.42
Rate for Payer: Health Management Network Commercial	$541.69
Rate for Payer: Kaiser Permanente Commercial	$401.49
Rate for Payer: Kaiser Permanente Medicaid	$325.01
Rate for Payer: MDX Hawaii PPO	$618.16
Rate for Payer: UnitedHealthcare Medicaid	$382.37
Rate for Payer: University Health Alliance Commercial	$464.51

VARICELLA-ZOSTER GE-AS01B (PF) 50 MCG/0.5 ML IM SUSR

Facility

$687.40

Service Code	HCPCS 90750
Hospital Revenue Code	250
Min. Negotiated Rate	$584.29
Max. Negotiated Rate	$666.78
Rate for Payer: Cash Price	$446.81
Rate for Payer: Health Management Network Commercial	$584.29
Rate for Payer: MDX Hawaii PPO	$666.78

VARICELLA-ZOSTER GE-AS01B (PF) 50 MCG/0.5 ML IM SUSR

Facility

$687.40

Service Code	HCPCS 90750
Hospital Revenue Code	250
Min. Negotiated Rate	$232.75
Max. Negotiated Rate	$666.78
Rate for Payer: Cash Price	$446.81
Rate for Payer: Cash Price	$446.81
Rate for Payer: Hawaii Medical Service Association ABD	$232.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$232.75
Rate for Payer: Hawaii Western Management Group Commercial	$653.03
Rate for Payer: Health Management Network Commercial	$584.29
Rate for Payer: Kaiser Permanente Commercial	$433.06
Rate for Payer: Kaiser Permanente Medicaid	$350.57
Rate for Payer: MDX Hawaii PPO	$666.78
Rate for Payer: UnitedHealthcare Medicaid	$412.44
Rate for Payer: University Health Alliance Commercial	$501.05

VASOPRESSIN 0.4 UNIT/ML IV SOLN

Facility

$335.30

Service Code	HCPCS J2598
Hospital Revenue Code	636
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$325.24
Rate for Payer: Cash Price	$217.95
Rate for Payer: Cash Price	$217.95
Rate for Payer: Hawaii Medical Service Association ABD	$1.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$318.54
Rate for Payer: Health Management Network Commercial	$285.00
Rate for Payer: Kaiser Permanente Commercial	$211.24
Rate for Payer: Kaiser Permanente Medicaid	$171.00
Rate for Payer: MDX Hawaii PPO	$325.24
Rate for Payer: UnitedHealthcare Medicaid	$201.18
Rate for Payer: University Health Alliance Commercial	$244.40

VASOPRESSIN 0.4 UNIT/ML IV SOLN

Facility

$335.30

Service Code	HCPCS J2598
Hospital Revenue Code	250
Min. Negotiated Rate	$285.00
Max. Negotiated Rate	$325.24
Rate for Payer: Cash Price	$217.95
Rate for Payer: Health Management Network Commercial	$285.00
Rate for Payer: MDX Hawaii PPO	$325.24

VASOPRESSIN 20 UNIT/ML IV SOLN

Facility

$71.41

Service Code	HCPCS J2598
Hospital Revenue Code	250
Min. Negotiated Rate	$60.70
Max. Negotiated Rate	$69.27
Rate for Payer: Cash Price	$46.42
Rate for Payer: Health Management Network Commercial	$60.70
Rate for Payer: MDX Hawaii PPO	$69.27

VASOPRESSIN 20 UNIT/ML IV SOLN

Facility

$71.41

Service Code	HCPCS J2598
Hospital Revenue Code	636
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$69.27
Rate for Payer: Cash Price	$46.42
Rate for Payer: Cash Price	$46.42
Rate for Payer: Hawaii Medical Service Association ABD	$1.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.26
Rate for Payer: Hawaii Western Management Group Commercial	$67.84
Rate for Payer: Health Management Network Commercial	$60.70
Rate for Payer: Kaiser Permanente Commercial	$44.99
Rate for Payer: Kaiser Permanente Medicaid	$36.42
Rate for Payer: MDX Hawaii PPO	$69.27
Rate for Payer: UnitedHealthcare Medicaid	$42.85
Rate for Payer: University Health Alliance Commercial	$52.05

VCARE Vag-Cer Retractor-Elevator Disp Large 60-6085-202A [3641923]

Facility

$544.06

Hospital Charge Code	3641923
Hospital Revenue Code	272
Min. Negotiated Rate	$462.45
Max. Negotiated Rate	$527.74
Rate for Payer: Cash Price	$353.64
Rate for Payer: Health Management Network Commercial	$462.45
Rate for Payer: MDX Hawaii PPO	$527.74

VCARE Vag-Cer Retractor-Elevator Disp Large 60-6085-202A [3641923]

Facility

$544.06

Hospital Charge Code	3641923
Hospital Revenue Code	272
Min. Negotiated Rate	$277.47
Max. Negotiated Rate	$527.74
Rate for Payer: Cash Price	$353.64
Rate for Payer: Hawaii Western Management Group Commercial	$516.86
Rate for Payer: Health Management Network Commercial	$462.45
Rate for Payer: Kaiser Permanente Commercial	$342.76
Rate for Payer: Kaiser Permanente Medicaid	$277.47
Rate for Payer: MDX Hawaii PPO	$527.74
Rate for Payer: University Health Alliance Commercial	$396.57

VCARE Vag-Cer Retractor-Elevator Disp X-Large 606085203 [3641924]

Facility

$398.57

Hospital Charge Code	3641924
Hospital Revenue Code	272
Min. Negotiated Rate	$338.78
Max. Negotiated Rate	$386.61
Rate for Payer: Cash Price	$259.07
Rate for Payer: Health Management Network Commercial	$338.78
Rate for Payer: MDX Hawaii PPO	$386.61

VCARE Vag-Cer Retractor-Elevator Disp X-Large 606085203 [3641924]

Facility

$398.57

Hospital Charge Code	3641924
Hospital Revenue Code	272
Min. Negotiated Rate	$203.27
Max. Negotiated Rate	$386.61
Rate for Payer: Cash Price	$259.07
Rate for Payer: Hawaii Western Management Group Commercial	$378.64
Rate for Payer: Health Management Network Commercial	$338.78
Rate for Payer: Kaiser Permanente Commercial	$251.10
Rate for Payer: Kaiser Permanente Medicaid	$203.27
Rate for Payer: MDX Hawaii PPO	$386.61
Rate for Payer: University Health Alliance Commercial	$290.52

VECURONIUM BROMIDE 10 MG IV RECON.SOLN.

Facility

$41.52

Service Code	NDC 55150023501
Hospital Revenue Code	250
Min. Negotiated Rate	$21.18
Max. Negotiated Rate	$40.27
Rate for Payer: Cash Price	$26.99
Rate for Payer: Hawaii Western Management Group Commercial	$39.44
Rate for Payer: Health Management Network Commercial	$35.29
Rate for Payer: Kaiser Permanente Commercial	$26.16
Rate for Payer: Kaiser Permanente Medicaid	$21.18
Rate for Payer: MDX Hawaii PPO	$40.27
Rate for Payer: UnitedHealthcare Medicaid	$24.91
Rate for Payer: University Health Alliance Commercial	$30.26

VECURONIUM BROMIDE 10 MG IV RECON.SOLN.

Facility

$41.52

Service Code	NDC 55150023501
Hospital Revenue Code	250
Min. Negotiated Rate	$35.29
Max. Negotiated Rate	$40.27
Rate for Payer: Cash Price	$26.99
Rate for Payer: Health Management Network Commercial	$35.29
Rate for Payer: MDX Hawaii PPO	$40.27

VECURONIUM BROMIDE 10 MG IV RECON.SOLN.

Facility

$31.47

Service Code	NDC 67457043800
Hospital Revenue Code	250
Min. Negotiated Rate	$26.75
Max. Negotiated Rate	$30.53
Rate for Payer: Cash Price	$20.46
Rate for Payer: Health Management Network Commercial	$26.75
Rate for Payer: MDX Hawaii PPO	$30.53

VECURONIUM BROMIDE 10 MG IV RECON.SOLN.

Facility

$31.47

Service Code	NDC 67457043810
Hospital Revenue Code	250
Min. Negotiated Rate	$26.75
Max. Negotiated Rate	$30.53
Rate for Payer: Cash Price	$20.46
Rate for Payer: Health Management Network Commercial	$26.75
Rate for Payer: MDX Hawaii PPO	$30.53

VECURONIUM BROMIDE 10 MG IV RECON.SOLN.

Facility

$31.47

Service Code	NDC 67457043800
Hospital Revenue Code	250
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$30.53
Rate for Payer: Cash Price	$20.46
Rate for Payer: Hawaii Western Management Group Commercial	$29.90
Rate for Payer: Health Management Network Commercial	$26.75
Rate for Payer: Kaiser Permanente Commercial	$19.83
Rate for Payer: Kaiser Permanente Medicaid	$16.05
Rate for Payer: MDX Hawaii PPO	$30.53
Rate for Payer: UnitedHealthcare Medicaid	$18.88
Rate for Payer: University Health Alliance Commercial	$22.94

VECURONIUM BROMIDE 10 MG IV RECON.SOLN.

Facility

$41.52

Service Code	NDC 55150023510
Hospital Revenue Code	250
Min. Negotiated Rate	$21.18
Max. Negotiated Rate	$40.27
Rate for Payer: Cash Price	$26.99
Rate for Payer: Hawaii Western Management Group Commercial	$39.44
Rate for Payer: Health Management Network Commercial	$35.29
Rate for Payer: Kaiser Permanente Commercial	$26.16
Rate for Payer: Kaiser Permanente Medicaid	$21.18
Rate for Payer: MDX Hawaii PPO	$40.27
Rate for Payer: UnitedHealthcare Medicaid	$24.91
Rate for Payer: University Health Alliance Commercial	$30.26

VECURONIUM BROMIDE 10 MG IV RECON.SOLN.

Facility

$41.52

Service Code	NDC 55150023510
Hospital Revenue Code	250
Min. Negotiated Rate	$35.29
Max. Negotiated Rate	$40.27
Rate for Payer: Cash Price	$26.99
Rate for Payer: Health Management Network Commercial	$35.29
Rate for Payer: MDX Hawaii PPO	$40.27

Know your out-of-pocket cost for care.

All Charges