Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Video Laryngoscopy Lopro S3 [2707855]

Facility

$309.00

Hospital Charge Code	2707855
Hospital Revenue Code	272
Min. Negotiated Rate	$262.65
Max. Negotiated Rate	$299.73
Rate for Payer: Cash Price	$200.85
Rate for Payer: Health Management Network Commercial	$262.65
Rate for Payer: MDX Hawaii PPO	$299.73

VINBLASTINE 1 MG/ML IV SOLN

Facility

$285.40

Service Code	HCPCS J9360
Hospital Revenue Code	250
Min. Negotiated Rate	$242.59
Max. Negotiated Rate	$276.84
Rate for Payer: Cash Price	$185.51
Rate for Payer: Health Management Network Commercial	$242.59
Rate for Payer: MDX Hawaii PPO	$276.84

VINBLASTINE 1 MG/ML IV SOLN

Facility

$285.40

Service Code	HCPCS J9360
Hospital Revenue Code	636
Min. Negotiated Rate	$5.29
Max. Negotiated Rate	$276.84
Rate for Payer: Cash Price	$185.51
Rate for Payer: Cash Price	$185.51
Rate for Payer: Hawaii Medical Service Association ABD	$5.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5.29
Rate for Payer: Hawaii Western Management Group Commercial	$271.13
Rate for Payer: Health Management Network Commercial	$242.59
Rate for Payer: Kaiser Permanente Commercial	$179.80
Rate for Payer: Kaiser Permanente Medicaid	$145.55
Rate for Payer: MDX Hawaii PPO	$276.84
Rate for Payer: UnitedHealthcare Medicaid	$171.24
Rate for Payer: University Health Alliance Commercial	$208.03

VINCRISTINE SULFATE 1 MG

Professional

Both

$37.00

Service Code	HCPCS J9370
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$51.88
Rate for Payer: AlohaCare Medicare	$8.11
Rate for Payer: Cash Price	$24.05
Rate for Payer: Cash Price	$24.05
Rate for Payer: Devoted Health Medicare	$8.92
Rate for Payer: Hawaii Medical Service Association Medicare	$8.11
Rate for Payer: Hawaii Western Management Group Commercial	$51.88
Rate for Payer: Health Management Network Commercial	$31.45
Rate for Payer: Kaiser Permanente Commercial	$9.73
Rate for Payer: Kaiser Permanente Medicaid	$9.73
Rate for Payer: Kaiser Permanente Medicare	$9.73
Rate for Payer: Ohana Health Plan Medicare	$8.11
Rate for Payer: UnitedHealthcare Medicare	$8.11

VIRAL ILLNESS

Facility

$1,963.90

Service Code	APR-DRG 7231
Min. Negotiated Rate	$1,963.90
Max. Negotiated Rate	$1,963.90
Rate for Payer: AlohaCare Medicaid	$1,963.90
Rate for Payer: Hawaii Medical Service Association ABD	$1,963.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,963.90
Rate for Payer: Kaiser Permanente Medicaid	$1,963.90
Rate for Payer: Ohana Health Plan Medicaid	$1,963.90
Rate for Payer: UnitedHealthcare Medicaid	$1,963.90

VIRAL ILLNESS

Facility

$8,868.12

Service Code	APR-DRG 7234
Min. Negotiated Rate	$8,868.12
Max. Negotiated Rate	$8,868.12
Rate for Payer: AlohaCare Medicaid	$8,868.12
Rate for Payer: Hawaii Medical Service Association ABD	$8,868.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,868.12
Rate for Payer: Kaiser Permanente Medicaid	$8,868.12
Rate for Payer: Ohana Health Plan Medicaid	$8,868.12
Rate for Payer: UnitedHealthcare Medicaid	$8,868.12

VIRAL ILLNESS

Facility

$2,752.90

Service Code	APR-DRG 7232
Min. Negotiated Rate	$2,752.90
Max. Negotiated Rate	$2,752.90
Rate for Payer: AlohaCare Medicaid	$2,752.90
Rate for Payer: Hawaii Medical Service Association ABD	$2,752.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,752.90
Rate for Payer: Kaiser Permanente Medicaid	$2,752.90
Rate for Payer: Ohana Health Plan Medicaid	$2,752.90
Rate for Payer: UnitedHealthcare Medicaid	$2,752.90

VIRAL ILLNESS

Facility

$4,129.67

Service Code	APR-DRG 7233
Min. Negotiated Rate	$4,129.67
Max. Negotiated Rate	$4,129.67
Rate for Payer: AlohaCare Medicaid	$4,129.67
Rate for Payer: Hawaii Medical Service Association ABD	$4,129.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,129.67
Rate for Payer: Kaiser Permanente Medicaid	$4,129.67
Rate for Payer: Ohana Health Plan Medicaid	$4,129.67
Rate for Payer: UnitedHealthcare Medicaid	$4,129.67

VIRAL ILLNESS WITH MCC

Facility

$25,845.67

Service Code	MSDRG 865
Min. Negotiated Rate	$19,706.78
Max. Negotiated Rate	$25,845.67
Rate for Payer: AlohaCare Medicare	$19,706.78
Rate for Payer: Devoted Health Medicare	$21,677.46
Rate for Payer: Hawaii Medical Service Association Commercial	$24,757.89
Rate for Payer: Hawaii Medical Service Association Medicare	$19,706.78
Rate for Payer: Humana Medicare	$19,706.78
Rate for Payer: Kaiser Permanente Commercial	$25,845.67
Rate for Payer: Kaiser Permanente Medicare	$19,706.78
Rate for Payer: Ohana Health Plan Medicare	$19,706.78
Rate for Payer: UnitedHealthcare Medicare	$19,706.78

VIRAL ILLNESS WITHOUT MCC

Facility

$23,215.04

Service Code	MSDRG 866
Min. Negotiated Rate	$11,437.66
Max. Negotiated Rate	$23,215.04
Rate for Payer: AlohaCare Medicare	$11,437.66
Rate for Payer: Devoted Health Medicare	$12,581.43
Rate for Payer: Hawaii Medical Service Association Commercial	$23,215.04
Rate for Payer: Hawaii Medical Service Association Medicare	$11,437.66
Rate for Payer: Humana Medicare	$11,437.66
Rate for Payer: Kaiser Permanente Commercial	$15,000.60
Rate for Payer: Kaiser Permanente Medicare	$11,437.66
Rate for Payer: Ohana Health Plan Medicare	$11,437.66
Rate for Payer: UnitedHealthcare Medicare	$11,437.66

VIRAL MENINGITIS

Facility

$12,740.52

Service Code	APR-DRG 0514
Min. Negotiated Rate	$12,740.52
Max. Negotiated Rate	$12,740.52
Rate for Payer: AlohaCare Medicaid	$12,740.52
Rate for Payer: Hawaii Medical Service Association ABD	$12,740.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,740.52
Rate for Payer: Kaiser Permanente Medicaid	$12,740.52
Rate for Payer: Ohana Health Plan Medicaid	$12,740.52
Rate for Payer: UnitedHealthcare Medicaid	$12,740.52

VIRAL MENINGITIS

Facility

$2,261.29

Service Code	APR-DRG 0511
Min. Negotiated Rate	$2,261.29
Max. Negotiated Rate	$2,261.29
Rate for Payer: AlohaCare Medicaid	$2,261.29
Rate for Payer: Hawaii Medical Service Association ABD	$2,261.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,261.29
Rate for Payer: Kaiser Permanente Medicaid	$2,261.29
Rate for Payer: Ohana Health Plan Medicaid	$2,261.29
Rate for Payer: UnitedHealthcare Medicaid	$2,261.29

VIRAL MENINGITIS

Facility

$3,708.74

Service Code	APR-DRG 0512
Min. Negotiated Rate	$3,708.74
Max. Negotiated Rate	$3,708.74
Rate for Payer: AlohaCare Medicaid	$3,708.74
Rate for Payer: Hawaii Medical Service Association ABD	$3,708.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,708.74
Rate for Payer: Kaiser Permanente Medicaid	$3,708.74
Rate for Payer: Ohana Health Plan Medicaid	$3,708.74
Rate for Payer: UnitedHealthcare Medicaid	$3,708.74

VIRAL MENINGITIS

Facility

$6,662.87

Service Code	APR-DRG 0513
Min. Negotiated Rate	$6,662.87
Max. Negotiated Rate	$6,662.87
Rate for Payer: AlohaCare Medicaid	$6,662.87
Rate for Payer: Hawaii Medical Service Association ABD	$6,662.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,662.87
Rate for Payer: Kaiser Permanente Medicaid	$6,662.87
Rate for Payer: Ohana Health Plan Medicaid	$6,662.87
Rate for Payer: UnitedHealthcare Medicaid	$6,662.87

VIRAL MENINGITIS WITH CC/MCC

Facility

$33,076.88

Service Code	MSDRG 075
Min. Negotiated Rate	$14,343.67
Max. Negotiated Rate	$33,076.88
Rate for Payer: AlohaCare Medicare	$25,220.42
Rate for Payer: Devoted Health Medicare	$27,742.46
Rate for Payer: Hawaii Medical Service Association Commercial	$14,343.67
Rate for Payer: Hawaii Medical Service Association Medicare	$25,220.42
Rate for Payer: Humana Medicare	$25,220.42
Rate for Payer: Kaiser Permanente Commercial	$33,076.88
Rate for Payer: Kaiser Permanente Medicare	$25,220.42
Rate for Payer: Ohana Health Plan Medicare	$25,220.42
Rate for Payer: UnitedHealthcare Medicare	$25,220.42

VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$14,343.67

Service Code	MSDRG 076
Min. Negotiated Rate	$10,853.66
Max. Negotiated Rate	$14,343.67
Rate for Payer: AlohaCare Medicare	$10,853.66
Rate for Payer: Devoted Health Medicare	$11,939.03
Rate for Payer: Hawaii Medical Service Association Commercial	$14,343.67
Rate for Payer: Hawaii Medical Service Association Medicare	$10,853.66
Rate for Payer: Humana Medicare	$10,853.66
Rate for Payer: Kaiser Permanente Commercial	$12,916.80
Rate for Payer: Kaiser Permanente Medicare	$10,853.66
Rate for Payer: Ohana Health Plan Medicare	$10,853.66
Rate for Payer: UnitedHealthcare Medicare	$10,853.66

VISIT CPLX INHERENT E&M ASSOC WITH MED CARE SRVC

Professional

Both

$21.68

Service Code	HCPCS G2211
Min. Negotiated Rate	$14.45
Max. Negotiated Rate	$18.43
Rate for Payer: AlohaCare Medicaid	$16.71
Rate for Payer: AlohaCare Medicare	$14.45
Rate for Payer: Cash Price	$14.09
Rate for Payer: Cash Price	$14.09
Rate for Payer: Devoted Health Medicare	$15.89
Rate for Payer: Hawaii Medical Service Association Medicare	$14.45
Rate for Payer: Hawaii Western Management Group Commercial	$15.61
Rate for Payer: Health Management Network Commercial	$18.43
Rate for Payer: Kaiser Permanente Commercial	$17.34
Rate for Payer: Kaiser Permanente Medicaid	$17.34
Rate for Payer: Kaiser Permanente Medicare	$17.34
Rate for Payer: Ohana Health Plan Medicaid	$16.71
Rate for Payer: Ohana Health Plan Medicare	$14.45
Rate for Payer: UnitedHealthcare Medicaid	$16.71
Rate for Payer: UnitedHealthcare Medicare	$14.45

Vistaseal Fibrin Sealant 10ML VST10 [3642068]

Facility

$4,082.17

Hospital Charge Code	3642068
Hospital Revenue Code	272
Min. Negotiated Rate	$3,469.84
Max. Negotiated Rate	$3,959.70
Rate for Payer: Cash Price	$2,653.41
Rate for Payer: Health Management Network Commercial	$3,469.84
Rate for Payer: MDX Hawaii PPO	$3,959.70

Vistaseal Fibrin Sealant 10ML VST10 [3642068]

Facility

$4,082.17

Hospital Charge Code	3642068
Hospital Revenue Code	272
Min. Negotiated Rate	$2,081.91
Max. Negotiated Rate	$3,959.70
Rate for Payer: Cash Price	$2,653.41
Rate for Payer: Hawaii Western Management Group Commercial	$3,878.06
Rate for Payer: Health Management Network Commercial	$3,469.84
Rate for Payer: Kaiser Permanente Commercial	$2,571.77
Rate for Payer: Kaiser Permanente Medicaid	$2,081.91
Rate for Payer: MDX Hawaii PPO	$3,959.70
Rate for Payer: University Health Alliance Commercial	$2,975.49

Vistaseal Lap Dual Applicator VSTL35 [3642067]

Facility

$647.33

Hospital Charge Code	3642067
Hospital Revenue Code	272
Min. Negotiated Rate	$550.23
Max. Negotiated Rate	$627.91
Rate for Payer: Cash Price	$420.76
Rate for Payer: Health Management Network Commercial	$550.23
Rate for Payer: MDX Hawaii PPO	$627.91

Vistaseal Lap Dual Applicator VSTL35 [3642067]

Facility

$647.33

Hospital Charge Code	3642067
Hospital Revenue Code	272
Min. Negotiated Rate	$330.14
Max. Negotiated Rate	$627.91
Rate for Payer: Cash Price	$420.76
Rate for Payer: Hawaii Western Management Group Commercial	$614.96
Rate for Payer: Health Management Network Commercial	$550.23
Rate for Payer: Kaiser Permanente Commercial	$407.82
Rate for Payer: Kaiser Permanente Medicaid	$330.14
Rate for Payer: MDX Hawaii PPO	$627.91
Rate for Payer: University Health Alliance Commercial	$471.84

VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) PO CAP

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87

VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) PO CAP

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: MDX Hawaii PPO	$1.16

Vitrectomy Cutter 20G NGP0020 [3640204]

Facility

$1,198.00

Hospital Charge Code	3640204
Hospital Revenue Code	272
Min. Negotiated Rate	$610.98
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Hawaii Western Management Group Commercial	$1,138.10
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: Kaiser Permanente Commercial	$754.74
Rate for Payer: Kaiser Permanente Medicaid	$610.98
Rate for Payer: MDX Hawaii PPO	$1,162.06
Rate for Payer: University Health Alliance Commercial	$873.22

Vitrectomy Cutter 20G NGP0020 [3640204]

Facility

$1,198.00

Hospital Charge Code	3640204
Hospital Revenue Code	272
Min. Negotiated Rate	$1,018.30
Max. Negotiated Rate	$1,162.06
Rate for Payer: Cash Price	$778.70
Rate for Payer: Health Management Network Commercial	$1,018.30
Rate for Payer: MDX Hawaii PPO	$1,162.06

Know your out-of-pocket cost for care.

All Charges