Kona Community Hospital

All Charges

Charge

Type

Setting

Price

AMIVANTAMAB-VMJW 50 MG/ML IV SOLN

Facility

$5,686.42

Service Code	HCPCS J9061
Hospital Revenue Code	636
Min. Negotiated Rate	$22.21
Max. Negotiated Rate	$5,515.83
Rate for Payer: AlohaCare Medicaid	$22.63
Rate for Payer: AlohaCare Medicare	$22.63
Rate for Payer: Cash Price	$3,696.17
Rate for Payer: Cash Price	$3,696.17
Rate for Payer: Devoted Health Medicare	$24.89
Rate for Payer: Hawaii Medical Service Association ABD	$22.21
Rate for Payer: Hawaii Medical Service Association Commercial	$28.29
Rate for Payer: Hawaii Medical Service Association Medicare	$22.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22.21
Rate for Payer: Hawaii Western Management Group Commercial	$5,402.10
Rate for Payer: Health Management Network Commercial	$4,833.46
Rate for Payer: Humana Medicare	$22.63
Rate for Payer: Kaiser Permanente Commercial	$3,582.44
Rate for Payer: Kaiser Permanente Medicaid	$2,900.07
Rate for Payer: Kaiser Permanente Medicare	$22.63
Rate for Payer: MDX Hawaii PPO	$5,515.83
Rate for Payer: Ohana Health Plan Medicaid	$24.89
Rate for Payer: Ohana Health Plan Medicare	$22.63
Rate for Payer: UnitedHealthcare Medicaid	$3,411.85
Rate for Payer: UnitedHealthcare Medicare	$22.63
Rate for Payer: University Health Alliance Commercial	$4,144.83

AMIVANTAMAB-VMJW 50 MG/ML IV SOLN

Facility

$5,686.42

Service Code	HCPCS J9061
Hospital Revenue Code	250
Min. Negotiated Rate	$4,833.46
Max. Negotiated Rate	$5,515.83
Rate for Payer: Cash Price	$3,696.17
Rate for Payer: Health Management Network Commercial	$4,833.46
Rate for Payer: MDX Hawaii PPO	$5,515.83

AMLODIPINE 2.5 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

AMLODIPINE 2.5 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: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: MDX Hawaii PPO	$1.16

AMLODIPINE 5 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

AMLODIPINE 5 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: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: MDX Hawaii PPO	$1.16

AMMONIUM LACTATE 12 % TOP CR

Facility

$77.28

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$65.69
Max. Negotiated Rate	$74.96
Rate for Payer: Cash Price	$50.23
Rate for Payer: Cash Price	$17.08
Rate for Payer: Health Management Network Commercial	$22.34
Rate for Payer: Health Management Network Commercial	$65.69
Rate for Payer: MDX Hawaii PPO	$74.96
Rate for Payer: MDX Hawaii PPO	$25.49

AMMONIUM LACTATE 12 % TOP CR

Facility

$26.28

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$13.40
Max. Negotiated Rate	$25.49
Rate for Payer: Cash Price	$17.08
Rate for Payer: Cash Price	$50.23
Rate for Payer: Hawaii Western Management Group Commercial	$24.97
Rate for Payer: Hawaii Western Management Group Commercial	$73.42
Rate for Payer: Health Management Network Commercial	$22.34
Rate for Payer: Health Management Network Commercial	$65.69
Rate for Payer: Kaiser Permanente Commercial	$16.56
Rate for Payer: Kaiser Permanente Commercial	$48.69
Rate for Payer: Kaiser Permanente Medicaid	$13.40
Rate for Payer: Kaiser Permanente Medicaid	$39.41
Rate for Payer: MDX Hawaii PPO	$25.49
Rate for Payer: MDX Hawaii PPO	$74.96
Rate for Payer: UnitedHealthcare Medicaid	$46.37
Rate for Payer: UnitedHealthcare Medicaid	$15.77
Rate for Payer: University Health Alliance Commercial	$19.16
Rate for Payer: University Health Alliance Commercial	$56.33

Amniograft 3.5cmx3.5cm Ag 3535 [3643804]

Facility

$3,062.50

Service Code	HCPCS V2790
Hospital Charge Code	3643804
Hospital Revenue Code	278
Min. Negotiated Rate	$1,715.00
Max. Negotiated Rate	$2,970.62
Rate for Payer: Cash Price	$1,990.62
Rate for Payer: Hawaii Western Management Group Commercial	$2,143.75
Rate for Payer: Health Management Network Commercial	$2,603.12
Rate for Payer: MDX Hawaii PPO	$2,970.62
Rate for Payer: University Health Alliance Commercial	$1,715.00

Amniograft 3.5cmx3.5cm Ag 3535 [3643804]

Facility

$3,062.50

Service Code	HCPCS V2790
Hospital Charge Code	3643804
Hospital Revenue Code	278
Min. Negotiated Rate	$1,561.88
Max. Negotiated Rate	$2,970.62
Rate for Payer: Cash Price	$1,990.62
Rate for Payer: Hawaii Western Management Group Commercial	$2,143.75
Rate for Payer: Health Management Network Commercial	$2,603.12
Rate for Payer: Kaiser Permanente Commercial	$1,929.38
Rate for Payer: Kaiser Permanente Medicaid	$1,561.88
Rate for Payer: MDX Hawaii PPO	$2,970.62
Rate for Payer: University Health Alliance Commercial	$1,715.00

AMOXICILLIN 125 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$7.49

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$7.27
Rate for Payer: Cash Price	$4.87
Rate for Payer: Hawaii Western Management Group Commercial	$7.12
Rate for Payer: Health Management Network Commercial	$6.37
Rate for Payer: Kaiser Permanente Commercial	$4.72
Rate for Payer: Kaiser Permanente Medicaid	$3.82
Rate for Payer: MDX Hawaii PPO	$7.27
Rate for Payer: UnitedHealthcare Medicaid	$4.49
Rate for Payer: University Health Alliance Commercial	$5.46

AMOXICILLIN 125 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$7.49

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$7.27
Rate for Payer: Cash Price	$4.87
Rate for Payer: Health Management Network Commercial	$6.37
Rate for Payer: MDX Hawaii PPO	$7.27

AMOXICILLIN 250 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$29.59

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$25.15
Max. Negotiated Rate	$28.70
Rate for Payer: Cash Price	$19.23
Rate for Payer: Cash Price	$18.95
Rate for Payer: Health Management Network Commercial	$24.78
Rate for Payer: Health Management Network Commercial	$25.15
Rate for Payer: MDX Hawaii PPO	$28.70
Rate for Payer: MDX Hawaii PPO	$28.28

AMOXICILLIN 250 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$29.15

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.87
Max. Negotiated Rate	$28.28
Rate for Payer: Cash Price	$18.95
Rate for Payer: Cash Price	$19.23
Rate for Payer: Hawaii Western Management Group Commercial	$27.69
Rate for Payer: Hawaii Western Management Group Commercial	$28.11
Rate for Payer: Health Management Network Commercial	$24.78
Rate for Payer: Health Management Network Commercial	$25.15
Rate for Payer: Kaiser Permanente Commercial	$18.36
Rate for Payer: Kaiser Permanente Commercial	$18.64
Rate for Payer: Kaiser Permanente Medicaid	$14.87
Rate for Payer: Kaiser Permanente Medicaid	$15.09
Rate for Payer: MDX Hawaii PPO	$28.28
Rate for Payer: MDX Hawaii PPO	$28.70
Rate for Payer: UnitedHealthcare Medicaid	$17.75
Rate for Payer: UnitedHealthcare Medicaid	$17.49
Rate for Payer: University Health Alliance Commercial	$21.25
Rate for Payer: University Health Alliance Commercial	$21.57

AMOXICILLIN 250 MG PO CAP

Facility

$1.38

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.34
Rate for Payer: Cash Price	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$1.31
Rate for Payer: Health Management Network Commercial	$1.17
Rate for Payer: Kaiser Permanente Commercial	$0.87
Rate for Payer: Kaiser Permanente Medicaid	$0.70
Rate for Payer: MDX Hawaii PPO	$1.34
Rate for Payer: UnitedHealthcare Medicaid	$0.83
Rate for Payer: University Health Alliance Commercial	$1.01

AMOXICILLIN 250 MG PO CAP

Facility

$1.38

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.34
Rate for Payer: Cash Price	$0.90
Rate for Payer: Health Management Network Commercial	$1.17
Rate for Payer: MDX Hawaii PPO	$1.34

AMOXICILLIN 500 MG PO CAP

Facility

$2.40

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$2.33
Rate for Payer: Cash Price	$1.56
Rate for Payer: Health Management Network Commercial	$2.04
Rate for Payer: MDX Hawaii PPO	$2.33

AMOXICILLIN 500 MG PO CAP

Facility

$2.40

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$2.33
Rate for Payer: Cash Price	$1.56
Rate for Payer: Hawaii Western Management Group Commercial	$2.28
Rate for Payer: Health Management Network Commercial	$2.04
Rate for Payer: Kaiser Permanente Commercial	$1.51
Rate for Payer: Kaiser Permanente Medicaid	$1.22
Rate for Payer: MDX Hawaii PPO	$2.33
Rate for Payer: UnitedHealthcare Medicaid	$1.44
Rate for Payer: University Health Alliance Commercial	$1.75

AMOXICILLIN-POT CLAVULANATE 250-62.5 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$398.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$203.08
Max. Negotiated Rate	$386.25
Rate for Payer: Cash Price	$258.83
Rate for Payer: Hawaii Western Management Group Commercial	$378.29
Rate for Payer: Health Management Network Commercial	$338.47
Rate for Payer: Kaiser Permanente Commercial	$250.87
Rate for Payer: Kaiser Permanente Medicaid	$203.08
Rate for Payer: MDX Hawaii PPO	$386.25
Rate for Payer: UnitedHealthcare Medicaid	$238.92
Rate for Payer: University Health Alliance Commercial	$290.25

AMOXICILLIN-POT CLAVULANATE 250-62.5 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$398.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$338.47
Max. Negotiated Rate	$386.25
Rate for Payer: Cash Price	$258.83
Rate for Payer: Health Management Network Commercial	$338.47
Rate for Payer: MDX Hawaii PPO	$386.25

AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$163.53

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$139.00
Max. Negotiated Rate	$158.62
Rate for Payer: Cash Price	$106.29
Rate for Payer: Cash Price	$113.29
Rate for Payer: Health Management Network Commercial	$148.15
Rate for Payer: Health Management Network Commercial	$139.00
Rate for Payer: MDX Hawaii PPO	$169.06
Rate for Payer: MDX Hawaii PPO	$158.62

AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$163.53

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$83.40
Max. Negotiated Rate	$158.62
Rate for Payer: Cash Price	$106.29
Rate for Payer: Cash Price	$113.29
Rate for Payer: Hawaii Western Management Group Commercial	$155.35
Rate for Payer: Hawaii Western Management Group Commercial	$165.58
Rate for Payer: Health Management Network Commercial	$148.15
Rate for Payer: Health Management Network Commercial	$139.00
Rate for Payer: Kaiser Permanente Commercial	$103.02
Rate for Payer: Kaiser Permanente Commercial	$109.80
Rate for Payer: Kaiser Permanente Medicaid	$88.89
Rate for Payer: Kaiser Permanente Medicaid	$83.40
Rate for Payer: MDX Hawaii PPO	$169.06
Rate for Payer: MDX Hawaii PPO	$158.62
Rate for Payer: UnitedHealthcare Medicaid	$98.12
Rate for Payer: UnitedHealthcare Medicaid	$104.57
Rate for Payer: University Health Alliance Commercial	$127.04
Rate for Payer: University Health Alliance Commercial	$119.20

AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABLET

Facility

$20.90

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$17.77
Max. Negotiated Rate	$20.27
Rate for Payer: Cash Price	$13.58
Rate for Payer: Health Management Network Commercial	$17.77
Rate for Payer: MDX Hawaii PPO	$20.27

AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABLET

Facility

$20.90

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$10.66
Max. Negotiated Rate	$20.27
Rate for Payer: Cash Price	$13.58
Rate for Payer: Hawaii Western Management Group Commercial	$19.86
Rate for Payer: Health Management Network Commercial	$17.77
Rate for Payer: Kaiser Permanente Commercial	$13.17
Rate for Payer: Kaiser Permanente Medicaid	$10.66
Rate for Payer: MDX Hawaii PPO	$20.27
Rate for Payer: UnitedHealthcare Medicaid	$12.54
Rate for Payer: University Health Alliance Commercial	$15.23

AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML PO SUSR (PER BOTTLE) WHR

Facility

$311.72

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$264.96
Max. Negotiated Rate	$302.37
Rate for Payer: Cash Price	$202.62
Rate for Payer: Cash Price	$251.19
Rate for Payer: Health Management Network Commercial	$328.48
Rate for Payer: Health Management Network Commercial	$264.96
Rate for Payer: MDX Hawaii PPO	$374.86
Rate for Payer: MDX Hawaii PPO	$302.37

Know your out-of-pocket cost for care.

All Charges