Kona Community Hospital

All Charges

Charge

Type

Setting

Price

FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHAL HFAA

Facility

$983.37

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$501.52
Max. Negotiated Rate	$953.87
Rate for Payer: Cash Price	$639.19
Rate for Payer: Hawaii Western Management Group Commercial	$934.20
Rate for Payer: Health Management Network Commercial	$835.86
Rate for Payer: Kaiser Permanente Commercial	$619.52
Rate for Payer: Kaiser Permanente Medicaid	$501.52
Rate for Payer: MDX Hawaii PPO	$953.87
Rate for Payer: UnitedHealthcare Medicaid	$590.02
Rate for Payer: University Health Alliance Commercial	$716.78

FLUTICASONE PROPIONATE 44 MCG/ACTUATION INHAL HFAA

Facility

$983.37

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$835.86
Max. Negotiated Rate	$953.87
Rate for Payer: Cash Price	$639.19
Rate for Payer: Health Management Network Commercial	$835.86
Rate for Payer: MDX Hawaii PPO	$953.87

FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPSN

Facility

$470.66

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$240.04
Max. Negotiated Rate	$456.54
Rate for Payer: Cash Price	$305.93
Rate for Payer: Hawaii Western Management Group Commercial	$447.13
Rate for Payer: Health Management Network Commercial	$400.06
Rate for Payer: Kaiser Permanente Commercial	$296.52
Rate for Payer: Kaiser Permanente Medicaid	$240.04
Rate for Payer: MDX Hawaii PPO	$456.54
Rate for Payer: UnitedHealthcare Medicaid	$282.40
Rate for Payer: University Health Alliance Commercial	$343.06

FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPSN

Facility

$470.66

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$400.06
Max. Negotiated Rate	$456.54
Rate for Payer: Cash Price	$305.93
Rate for Payer: Health Management Network Commercial	$400.06
Rate for Payer: MDX Hawaii PPO	$456.54

FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHAL DSDV

Facility

$1,757.53

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$896.34
Max. Negotiated Rate	$1,704.80
Rate for Payer: Cash Price	$1,142.39
Rate for Payer: Hawaii Western Management Group Commercial	$1,669.65
Rate for Payer: Health Management Network Commercial	$1,493.90
Rate for Payer: Kaiser Permanente Commercial	$1,107.24
Rate for Payer: Kaiser Permanente Medicaid	$896.34
Rate for Payer: MDX Hawaii PPO	$1,704.80
Rate for Payer: UnitedHealthcare Medicaid	$1,054.52
Rate for Payer: University Health Alliance Commercial	$1,281.06

FLUTICASONE PROPION-SALMETEROL 100-50 MCG/DOSE INHAL DSDV

Facility

$1,757.53

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1,493.90
Max. Negotiated Rate	$1,704.80
Rate for Payer: Cash Price	$1,142.39
Rate for Payer: Health Management Network Commercial	$1,493.90
Rate for Payer: MDX Hawaii PPO	$1,704.80

FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHAL DSDV

Facility

$2,181.45

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1,112.54
Max. Negotiated Rate	$2,116.01
Rate for Payer: Cash Price	$1,417.94
Rate for Payer: Hawaii Western Management Group Commercial	$2,072.38
Rate for Payer: Health Management Network Commercial	$1,854.23
Rate for Payer: Kaiser Permanente Commercial	$1,374.31
Rate for Payer: Kaiser Permanente Medicaid	$1,112.54
Rate for Payer: MDX Hawaii PPO	$2,116.01
Rate for Payer: UnitedHealthcare Medicaid	$1,308.87
Rate for Payer: University Health Alliance Commercial	$1,590.06

FLUTICASONE PROPION-SALMETEROL 250-50 MCG/DOSE INHAL DSDV

Facility

$2,181.45

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1,854.23
Max. Negotiated Rate	$2,116.01
Rate for Payer: Cash Price	$1,417.94
Rate for Payer: Health Management Network Commercial	$1,854.23
Rate for Payer: MDX Hawaii PPO	$2,116.01

FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHAL DSDV

Facility

$2,865.94

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2,436.05
Max. Negotiated Rate	$2,779.96
Rate for Payer: Cash Price	$1,862.86
Rate for Payer: Health Management Network Commercial	$2,436.05
Rate for Payer: MDX Hawaii PPO	$2,779.96

FLUTICASONE PROPION-SALMETEROL 500-50 MCG/DOSE INHAL DSDV

Facility

$2,865.94

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1,461.63
Max. Negotiated Rate	$2,779.96
Rate for Payer: Cash Price	$1,862.86
Rate for Payer: Hawaii Western Management Group Commercial	$2,722.64
Rate for Payer: Health Management Network Commercial	$2,436.05
Rate for Payer: Kaiser Permanente Commercial	$1,805.54
Rate for Payer: Kaiser Permanente Medicaid	$1,461.63
Rate for Payer: MDX Hawaii PPO	$2,779.96
Rate for Payer: UnitedHealthcare Medicaid	$1,719.56
Rate for Payer: University Health Alliance Commercial	$2,088.98

Flutter Valve/acapella [2709852]

Facility

$32.30

Hospital Charge Code	2709852
Hospital Revenue Code	272
Min. Negotiated Rate	$16.47
Max. Negotiated Rate	$31.33
Rate for Payer: Cash Price	$20.99
Rate for Payer: Hawaii Western Management Group Commercial	$30.68
Rate for Payer: Health Management Network Commercial	$27.45
Rate for Payer: Kaiser Permanente Commercial	$20.35
Rate for Payer: Kaiser Permanente Medicaid	$16.47
Rate for Payer: MDX Hawaii PPO	$31.33
Rate for Payer: University Health Alliance Commercial	$23.54

Flutter Valve/acapella [2709852]

Facility

$32.30

Hospital Charge Code	2709852
Hospital Revenue Code	272
Min. Negotiated Rate	$27.45
Max. Negotiated Rate	$31.33
Rate for Payer: Cash Price	$20.99
Rate for Payer: Health Management Network Commercial	$27.45
Rate for Payer: MDX Hawaii PPO	$31.33

FLU VAC TS 2025-26(6MOS UP)-PF 45 MCG (15 MCG X 3)/0.5 ML IM SYR

Facility

$99.72

Service Code	HCPCS 90656
Hospital Revenue Code	250
Min. Negotiated Rate	$22.35
Max. Negotiated Rate	$96.73
Rate for Payer: Cash Price	$64.82
Rate for Payer: Cash Price	$64.82
Rate for Payer: Hawaii Medical Service Association ABD	$22.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.35
Rate for Payer: Hawaii Western Management Group Commercial	$94.73
Rate for Payer: Health Management Network Commercial	$84.76
Rate for Payer: Kaiser Permanente Commercial	$62.82
Rate for Payer: Kaiser Permanente Medicaid	$50.86
Rate for Payer: MDX Hawaii PPO	$96.73
Rate for Payer: UnitedHealthcare Medicaid	$59.83
Rate for Payer: University Health Alliance Commercial	$72.69

FLU VAC TS 2025-26(6MOS UP)-PF 45 MCG (15 MCG X 3)/0.5 ML IM SYR

Facility

$99.72

Service Code	HCPCS 90656
Hospital Revenue Code	250
Min. Negotiated Rate	$84.76
Max. Negotiated Rate	$96.73
Rate for Payer: Cash Price	$64.82
Rate for Payer: Health Management Network Commercial	$84.76
Rate for Payer: MDX Hawaii PPO	$96.73

FOLIC ACID 1 MG PO TABLET

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

FOLIC ACID 1 MG PO TABLET

Facility

$1.20

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

FOLIC ACID 5 MG/ML INJ SOLN

Facility

$128.54

Service Code	HCPCS J1808
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$124.68
Rate for Payer: Cash Price	$83.55
Rate for Payer: Cash Price	$105.88
Rate for Payer: Cash Price	$208.33
Rate for Payer: Cash Price	$83.55
Rate for Payer: Cash Price	$208.33
Rate for Payer: Cash Price	$105.88
Rate for Payer: Hawaii Medical Service Association ABD	$0.06
Rate for Payer: Hawaii Medical Service Association ABD	$0.06
Rate for Payer: Hawaii Medical Service Association ABD	$0.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.06
Rate for Payer: Hawaii Western Management Group Commercial	$154.75
Rate for Payer: Hawaii Western Management Group Commercial	$122.11
Rate for Payer: Hawaii Western Management Group Commercial	$304.48
Rate for Payer: Health Management Network Commercial	$272.43
Rate for Payer: Health Management Network Commercial	$109.26
Rate for Payer: Health Management Network Commercial	$138.47
Rate for Payer: Kaiser Permanente Commercial	$201.92
Rate for Payer: Kaiser Permanente Commercial	$102.63
Rate for Payer: Kaiser Permanente Commercial	$80.98
Rate for Payer: Kaiser Permanente Medicaid	$65.56
Rate for Payer: Kaiser Permanente Medicaid	$163.46
Rate for Payer: Kaiser Permanente Medicaid	$83.08
Rate for Payer: MDX Hawaii PPO	$310.89
Rate for Payer: MDX Hawaii PPO	$158.01
Rate for Payer: MDX Hawaii PPO	$124.68
Rate for Payer: UnitedHealthcare Medicaid	$77.12
Rate for Payer: UnitedHealthcare Medicaid	$97.74
Rate for Payer: UnitedHealthcare Medicaid	$192.31
Rate for Payer: University Health Alliance Commercial	$118.74
Rate for Payer: University Health Alliance Commercial	$93.69
Rate for Payer: University Health Alliance Commercial	$233.62

FOLIC ACID 5 MG/ML INJ SOLN

Facility

$320.51

Service Code	HCPCS J1808
Hospital Revenue Code	250
Min. Negotiated Rate	$272.43
Max. Negotiated Rate	$310.89
Rate for Payer: Cash Price	$208.33
Rate for Payer: Cash Price	$83.55
Rate for Payer: Cash Price	$105.88
Rate for Payer: Health Management Network Commercial	$272.43
Rate for Payer: Health Management Network Commercial	$138.47
Rate for Payer: Health Management Network Commercial	$109.26
Rate for Payer: MDX Hawaii PPO	$124.68
Rate for Payer: MDX Hawaii PPO	$158.01
Rate for Payer: MDX Hawaii PPO	$310.89

FOMEPIZOLE 1 GRAM/ML IV SOLN

Facility

$3,278.40

Service Code	HCPCS J1451
Hospital Revenue Code	636
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$3,180.05
Rate for Payer: AlohaCare Medicaid	$6.54
Rate for Payer: AlohaCare Medicaid	$6.54
Rate for Payer: AlohaCare Medicare	$6.54
Rate for Payer: AlohaCare Medicare	$6.54
Rate for Payer: Cash Price	$2,077.62
Rate for Payer: Cash Price	$2,077.62
Rate for Payer: Cash Price	$2,130.96
Rate for Payer: Cash Price	$2,130.96
Rate for Payer: Devoted Health Medicare	$7.19
Rate for Payer: Devoted Health Medicare	$7.19
Rate for Payer: Hawaii Medical Service Association Commercial	$8.18
Rate for Payer: Hawaii Medical Service Association Commercial	$8.18
Rate for Payer: Hawaii Medical Service Association Medicare	$6.54
Rate for Payer: Hawaii Medical Service Association Medicare	$6.54
Rate for Payer: Hawaii Western Management Group Commercial	$3,114.48
Rate for Payer: Hawaii Western Management Group Commercial	$3,036.52
Rate for Payer: Health Management Network Commercial	$2,716.89
Rate for Payer: Health Management Network Commercial	$2,786.64
Rate for Payer: Humana Medicare	$6.54
Rate for Payer: Humana Medicare	$6.54
Rate for Payer: Kaiser Permanente Commercial	$2,013.69
Rate for Payer: Kaiser Permanente Commercial	$2,065.39
Rate for Payer: Kaiser Permanente Medicaid	$1,630.13
Rate for Payer: Kaiser Permanente Medicaid	$1,671.98
Rate for Payer: Kaiser Permanente Medicare	$6.54
Rate for Payer: Kaiser Permanente Medicare	$6.54
Rate for Payer: MDX Hawaii PPO	$3,100.45
Rate for Payer: MDX Hawaii PPO	$3,180.05
Rate for Payer: Ohana Health Plan Medicaid	$7.19
Rate for Payer: Ohana Health Plan Medicaid	$7.19
Rate for Payer: Ohana Health Plan Medicare	$6.54
Rate for Payer: Ohana Health Plan Medicare	$6.54
Rate for Payer: UnitedHealthcare Medicaid	$1,967.04
Rate for Payer: UnitedHealthcare Medicaid	$1,917.80
Rate for Payer: UnitedHealthcare Medicare	$6.54
Rate for Payer: UnitedHealthcare Medicare	$6.54
Rate for Payer: University Health Alliance Commercial	$2,329.81
Rate for Payer: University Health Alliance Commercial	$2,389.63

FOMEPIZOLE 1 GRAM/ML IV SOLN

Facility

$3,196.34

Service Code	HCPCS J1451
Hospital Revenue Code	250
Min. Negotiated Rate	$2,716.89
Max. Negotiated Rate	$3,100.45
Rate for Payer: Cash Price	$2,077.62
Rate for Payer: Cash Price	$2,130.96
Rate for Payer: Health Management Network Commercial	$2,716.89
Rate for Payer: Health Management Network Commercial	$2,786.64
Rate for Payer: MDX Hawaii PPO	$3,100.45
Rate for Payer: MDX Hawaii PPO	$3,180.05

FOOT PROCEDURES WITH CC

Facility

$32,243.70

Service Code	MSDRG 504
Min. Negotiated Rate	$23,624.86
Max. Negotiated Rate	$32,243.70
Rate for Payer: AlohaCare Medicare	$24,585.16
Rate for Payer: Devoted Health Medicare	$27,043.68
Rate for Payer: Hawaii Medical Service Association Commercial	$23,624.86
Rate for Payer: Hawaii Medical Service Association Medicare	$24,585.16
Rate for Payer: Humana Medicare	$24,585.16
Rate for Payer: Kaiser Permanente Commercial	$32,243.70
Rate for Payer: Kaiser Permanente Medicare	$24,585.16
Rate for Payer: Ohana Health Plan Medicare	$24,585.16
Rate for Payer: UnitedHealthcare Medicare	$24,585.16

FOOT PROCEDURES WITH MCC

Facility

$48,146.47

Service Code	MSDRG 503
Min. Negotiated Rate	$23,624.86
Max. Negotiated Rate	$48,146.47
Rate for Payer: AlohaCare Medicare	$36,710.68
Rate for Payer: Devoted Health Medicare	$40,381.75
Rate for Payer: Hawaii Medical Service Association Commercial	$23,624.86
Rate for Payer: Hawaii Medical Service Association Medicare	$36,710.68
Rate for Payer: Humana Medicare	$36,710.68
Rate for Payer: Kaiser Permanente Commercial	$48,146.47
Rate for Payer: Kaiser Permanente Medicare	$36,710.68
Rate for Payer: Ohana Health Plan Medicare	$36,710.68
Rate for Payer: UnitedHealthcare Medicare	$36,710.68

FOOT PROCEDURES WITHOUT CC/MCC

Facility

$30,925.80

Service Code	MSDRG 505
Min. Negotiated Rate	$23,580.28
Max. Negotiated Rate	$30,925.80
Rate for Payer: AlohaCare Medicare	$23,580.28
Rate for Payer: Devoted Health Medicare	$25,938.31
Rate for Payer: Hawaii Medical Service Association Commercial	$23,624.86
Rate for Payer: Hawaii Medical Service Association Medicare	$23,580.28
Rate for Payer: Humana Medicare	$23,580.28
Rate for Payer: Kaiser Permanente Commercial	$30,925.80
Rate for Payer: Kaiser Permanente Medicare	$23,580.28
Rate for Payer: Ohana Health Plan Medicare	$23,580.28
Rate for Payer: UnitedHealthcare Medicare	$23,580.28

FOOT & TOE PROCEDURES

Facility

$15,157.82

Service Code	APR-DRG 3144
Min. Negotiated Rate	$15,157.82
Max. Negotiated Rate	$15,157.82
Rate for Payer: AlohaCare Medicaid	$15,157.82
Rate for Payer: Hawaii Medical Service Association ABD	$15,157.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15,157.82
Rate for Payer: Kaiser Permanente Medicaid	$15,157.82
Rate for Payer: Ohana Health Plan Medicaid	$15,157.82
Rate for Payer: UnitedHealthcare Medicaid	$15,157.82

FOOT & TOE PROCEDURES

Facility

$5,684.10

Service Code	APR-DRG 3141
Min. Negotiated Rate	$5,684.10
Max. Negotiated Rate	$5,684.10
Rate for Payer: AlohaCare Medicaid	$5,684.10
Rate for Payer: Hawaii Medical Service Association ABD	$5,684.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,684.10
Rate for Payer: Kaiser Permanente Medicaid	$5,684.10
Rate for Payer: Ohana Health Plan Medicaid	$5,684.10
Rate for Payer: UnitedHealthcare Medicaid	$5,684.10

Know your out-of-pocket cost for care.

All Charges