Kona Community Hospital

All Charges

Charge

Type

Setting

Price

VERAPAMIL 2.5 MG/ML IV SOLN

Facility

$139.62

Service Code	NDC 00409114465
Hospital Revenue Code	250
Min. Negotiated Rate	$118.68
Max. Negotiated Rate	$135.43
Rate for Payer: Cash Price	$90.75
Rate for Payer: Health Management Network Commercial	$118.68
Rate for Payer: MDX Hawaii PPO	$135.43

VERAPAMIL 2.5 MG/ML IV SOLN

Facility

$22.57

Service Code	NDC 43066003125
Hospital Revenue Code	250
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$21.89
Rate for Payer: Cash Price	$14.67
Rate for Payer: Health Management Network Commercial	$19.18
Rate for Payer: MDX Hawaii PPO	$21.89

VERAPAMIL 2.5 MG/ML IV SOLN

Facility

$139.62

Service Code	NDC 00409114405
Hospital Revenue Code	250
Min. Negotiated Rate	$118.68
Max. Negotiated Rate	$135.43
Rate for Payer: Cash Price	$90.75
Rate for Payer: Health Management Network Commercial	$118.68
Rate for Payer: MDX Hawaii PPO	$135.43

VERAPAMIL 2.5 MG/ML IV SOLN

Facility

$139.62

Service Code	NDC 00409114405
Hospital Revenue Code	250
Min. Negotiated Rate	$71.21
Max. Negotiated Rate	$135.43
Rate for Payer: Cash Price	$90.75
Rate for Payer: Hawaii Western Management Group Commercial	$132.64
Rate for Payer: Health Management Network Commercial	$118.68
Rate for Payer: Kaiser Permanente Commercial	$87.96
Rate for Payer: Kaiser Permanente Medicaid	$71.21
Rate for Payer: MDX Hawaii PPO	$135.43
Rate for Payer: UnitedHealthcare Medicaid	$83.77
Rate for Payer: University Health Alliance Commercial	$101.77

VERAPAMIL 2.5 MG/ML IV SOLN

Facility

$139.62

Service Code	NDC 00409114465
Hospital Revenue Code	250
Min. Negotiated Rate	$71.21
Max. Negotiated Rate	$135.43
Rate for Payer: Cash Price	$90.75
Rate for Payer: Hawaii Western Management Group Commercial	$132.64
Rate for Payer: Health Management Network Commercial	$118.68
Rate for Payer: Kaiser Permanente Commercial	$87.96
Rate for Payer: Kaiser Permanente Medicaid	$71.21
Rate for Payer: MDX Hawaii PPO	$135.43
Rate for Payer: UnitedHealthcare Medicaid	$83.77
Rate for Payer: University Health Alliance Commercial	$101.77

VERAPAMIL 2.5 MG/ML IV SOLN

Facility

$22.57

Service Code	NDC 43066003101
Hospital Revenue Code	250
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$21.89
Rate for Payer: Cash Price	$14.67
Rate for Payer: Health Management Network Commercial	$19.18
Rate for Payer: MDX Hawaii PPO	$21.89

VERAPAMIL 2.5 MG/ML IV SOLN

Facility

$22.57

Service Code	NDC 43066003101
Hospital Revenue Code	250
Min. Negotiated Rate	$11.51
Max. Negotiated Rate	$21.89
Rate for Payer: Cash Price	$14.67
Rate for Payer: Hawaii Western Management Group Commercial	$21.44
Rate for Payer: Health Management Network Commercial	$19.18
Rate for Payer: Kaiser Permanente Commercial	$14.22
Rate for Payer: Kaiser Permanente Medicaid	$11.51
Rate for Payer: MDX Hawaii PPO	$21.89
Rate for Payer: UnitedHealthcare Medicaid	$13.54
Rate for Payer: University Health Alliance Commercial	$16.45

VERAPAMIL 2.5 MG/ML IV SOLN

Facility

$22.57

Service Code	NDC 43066003125
Hospital Revenue Code	250
Min. Negotiated Rate	$11.51
Max. Negotiated Rate	$21.89
Rate for Payer: Cash Price	$14.67
Rate for Payer: Hawaii Western Management Group Commercial	$21.44
Rate for Payer: Health Management Network Commercial	$19.18
Rate for Payer: Kaiser Permanente Commercial	$14.22
Rate for Payer: Kaiser Permanente Medicaid	$11.51
Rate for Payer: MDX Hawaii PPO	$21.89
Rate for Payer: UnitedHealthcare Medicaid	$13.54
Rate for Payer: University Health Alliance Commercial	$16.45

VERAPAMIL 40 MG PO TABLET

Facility

$1.53

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.48
Rate for Payer: Cash Price	$0.99
Rate for Payer: Health Management Network Commercial	$1.30
Rate for Payer: MDX Hawaii PPO	$1.48

VERAPAMIL 40 MG PO TABLET

Facility

$1.53

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.48
Rate for Payer: Cash Price	$0.99
Rate for Payer: Hawaii Western Management Group Commercial	$1.45
Rate for Payer: Health Management Network Commercial	$1.30
Rate for Payer: Kaiser Permanente Commercial	$0.96
Rate for Payer: Kaiser Permanente Medicaid	$0.78
Rate for Payer: MDX Hawaii PPO	$1.48
Rate for Payer: UnitedHealthcare Medicaid	$0.92
Rate for Payer: University Health Alliance Commercial	$1.12

VERAPAMIL 80 MG PO TABLET

Facility

$2.95

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.86
Rate for Payer: Cash Price	$1.92
Rate for Payer: Hawaii Western Management Group Commercial	$2.80
Rate for Payer: Health Management Network Commercial	$2.51
Rate for Payer: Kaiser Permanente Commercial	$1.86
Rate for Payer: Kaiser Permanente Medicaid	$1.50
Rate for Payer: MDX Hawaii PPO	$2.86
Rate for Payer: UnitedHealthcare Medicaid	$1.77
Rate for Payer: University Health Alliance Commercial	$2.15

VERAPAMIL 80 MG PO TABLET

Facility

$2.95

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$2.86
Rate for Payer: Cash Price	$1.92
Rate for Payer: Health Management Network Commercial	$2.51
Rate for Payer: MDX Hawaii PPO	$2.86

Versajet Exact Handset 45 deg 14mm 66800041 [3627109]

Facility

$2,883.50

Hospital Charge Code	3627109
Hospital Revenue Code	272
Min. Negotiated Rate	$1,470.59
Max. Negotiated Rate	$2,796.99
Rate for Payer: Cash Price	$1,874.28
Rate for Payer: Hawaii Western Management Group Commercial	$2,739.32
Rate for Payer: Health Management Network Commercial	$2,450.97
Rate for Payer: Kaiser Permanente Commercial	$1,816.61
Rate for Payer: Kaiser Permanente Medicaid	$1,470.59
Rate for Payer: MDX Hawaii PPO	$2,796.99
Rate for Payer: University Health Alliance Commercial	$2,101.78

Versajet Exact Handset 45 deg 14mm 66800041 [3627109]

Facility

$2,883.50

Hospital Charge Code	3627109
Hospital Revenue Code	272
Min. Negotiated Rate	$2,450.97
Max. Negotiated Rate	$2,796.99
Rate for Payer: Cash Price	$1,874.28
Rate for Payer: Health Management Network Commercial	$2,450.97
Rate for Payer: MDX Hawaii PPO	$2,796.99

Versawrap Hydrogel Sheet 2 x 2 Inch VTP-2201 [3644856]

Facility

$12,003.00

Hospital Charge Code	3644856
Hospital Revenue Code	272
Min. Negotiated Rate	$6,121.53
Max. Negotiated Rate	$11,642.91
Rate for Payer: Cash Price	$7,801.95
Rate for Payer: Hawaii Western Management Group Commercial	$11,402.85
Rate for Payer: Health Management Network Commercial	$10,202.55
Rate for Payer: Kaiser Permanente Commercial	$7,561.89
Rate for Payer: Kaiser Permanente Medicaid	$6,121.53
Rate for Payer: MDX Hawaii PPO	$11,642.91
Rate for Payer: University Health Alliance Commercial	$8,748.99

Versawrap Hydrogel Sheet 2 x 2 Inch VTP-2201 [3644856]

Facility

$12,003.00

Hospital Charge Code	3644856
Hospital Revenue Code	272
Min. Negotiated Rate	$10,202.55
Max. Negotiated Rate	$11,642.91
Rate for Payer: Cash Price	$7,801.95
Rate for Payer: Health Management Network Commercial	$10,202.55
Rate for Payer: MDX Hawaii PPO	$11,642.91

VERTIGO & OTHER LABYRINTH DISORDERS

Facility

$3,216.49

Service Code	APR-DRG 1112
Min. Negotiated Rate	$3,216.49
Max. Negotiated Rate	$3,216.49
Rate for Payer: AlohaCare Medicaid	$3,216.49
Rate for Payer: Hawaii Medical Service Association ABD	$3,216.49
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,216.49
Rate for Payer: Kaiser Permanente Medicaid	$3,216.49
Rate for Payer: Ohana Health Plan Medicaid	$3,216.49
Rate for Payer: UnitedHealthcare Medicaid	$3,216.49

VERTIGO & OTHER LABYRINTH DISORDERS

Facility

$2,852.24

Service Code	APR-DRG 1111
Min. Negotiated Rate	$2,852.24
Max. Negotiated Rate	$2,852.24
Rate for Payer: AlohaCare Medicaid	$2,852.24
Rate for Payer: Hawaii Medical Service Association ABD	$2,852.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,852.24
Rate for Payer: Kaiser Permanente Medicaid	$2,852.24
Rate for Payer: Ohana Health Plan Medicaid	$2,852.24
Rate for Payer: UnitedHealthcare Medicaid	$2,852.24

VERTIGO & OTHER LABYRINTH DISORDERS

Facility

$6,208.19

Service Code	APR-DRG 1114
Min. Negotiated Rate	$6,208.19
Max. Negotiated Rate	$6,208.19
Rate for Payer: AlohaCare Medicaid	$6,208.19
Rate for Payer: Hawaii Medical Service Association ABD	$6,208.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,208.19
Rate for Payer: Kaiser Permanente Medicaid	$6,208.19
Rate for Payer: Ohana Health Plan Medicaid	$6,208.19
Rate for Payer: UnitedHealthcare Medicaid	$6,208.19

VERTIGO & OTHER LABYRINTH DISORDERS

Facility

$3,987.66

Service Code	APR-DRG 1113
Min. Negotiated Rate	$3,987.66
Max. Negotiated Rate	$3,987.66
Rate for Payer: AlohaCare Medicaid	$3,987.66
Rate for Payer: Hawaii Medical Service Association ABD	$3,987.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,987.66
Rate for Payer: Kaiser Permanente Medicaid	$3,987.66
Rate for Payer: Ohana Health Plan Medicaid	$3,987.66
Rate for Payer: UnitedHealthcare Medicaid	$3,987.66

Video Bronchoscopy Bflex 5.0 [2707857]

Facility

$930.25

Hospital Charge Code	2707857
Hospital Revenue Code	272
Min. Negotiated Rate	$474.43
Max. Negotiated Rate	$902.34
Rate for Payer: Cash Price	$604.66
Rate for Payer: Hawaii Western Management Group Commercial	$883.74
Rate for Payer: Health Management Network Commercial	$790.71
Rate for Payer: Kaiser Permanente Commercial	$586.06
Rate for Payer: Kaiser Permanente Medicaid	$474.43
Rate for Payer: MDX Hawaii PPO	$902.34
Rate for Payer: University Health Alliance Commercial	$678.06

Video Bronchoscopy Bflex 5.0 [2707857]

Facility

$930.25

Hospital Charge Code	2707857
Hospital Revenue Code	272
Min. Negotiated Rate	$790.71
Max. Negotiated Rate	$902.34
Rate for Payer: Cash Price	$604.66
Rate for Payer: Health Management Network Commercial	$790.71
Rate for Payer: MDX Hawaii PPO	$902.34

Video Bronchoscopy Bflex 5.8 [2707858]

Facility

$1,037.35

Hospital Charge Code	2707858
Hospital Revenue Code	272
Min. Negotiated Rate	$881.75
Max. Negotiated Rate	$1,006.23
Rate for Payer: Cash Price	$674.28
Rate for Payer: Health Management Network Commercial	$881.75
Rate for Payer: MDX Hawaii PPO	$1,006.23

Video Bronchoscopy Bflex 5.8 [2707858]

Facility

$1,037.35

Hospital Charge Code	2707858
Hospital Revenue Code	272
Min. Negotiated Rate	$529.05
Max. Negotiated Rate	$1,006.23
Rate for Payer: Cash Price	$674.28
Rate for Payer: Hawaii Western Management Group Commercial	$985.48
Rate for Payer: Health Management Network Commercial	$881.75
Rate for Payer: Kaiser Permanente Commercial	$653.53
Rate for Payer: Kaiser Permanente Medicaid	$529.05
Rate for Payer: MDX Hawaii PPO	$1,006.23
Rate for Payer: University Health Alliance Commercial	$756.12

Video Laryngoscopy Lopro S3 [2707855]

Facility

$309.00

Hospital Charge Code	2707855
Hospital Revenue Code	272
Min. Negotiated Rate	$157.59
Max. Negotiated Rate	$299.73
Rate for Payer: Cash Price	$200.85
Rate for Payer: Hawaii Western Management Group Commercial	$293.55
Rate for Payer: Health Management Network Commercial	$262.65
Rate for Payer: Kaiser Permanente Commercial	$194.67
Rate for Payer: Kaiser Permanente Medicaid	$157.59
Rate for Payer: MDX Hawaii PPO	$299.73
Rate for Payer: University Health Alliance Commercial	$225.23

Know your out-of-pocket cost for care.

All Charges