Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HYDROCODONE-ACETAMINOPHEN 10-325 MG PO TABLET

Facility

$6.08

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$5.90
Rate for Payer: Cash Price	$3.95
Rate for Payer: Cash Price	$3.51
Rate for Payer: Cash Price	$6.04
Rate for Payer: Health Management Network Commercial	$5.17
Rate for Payer: Health Management Network Commercial	$4.59
Rate for Payer: Health Management Network Commercial	$7.90
Rate for Payer: MDX Hawaii PPO	$5.24
Rate for Payer: MDX Hawaii PPO	$9.01
Rate for Payer: MDX Hawaii PPO	$5.90

HYDROCODONE-ACETAMINOPHEN 10-325 MG PO TABLET

Facility

$6.08

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$5.90
Rate for Payer: Cash Price	$3.95
Rate for Payer: Cash Price	$3.51
Rate for Payer: Cash Price	$6.04
Rate for Payer: Hawaii Western Management Group Commercial	$8.83
Rate for Payer: Hawaii Western Management Group Commercial	$5.78
Rate for Payer: Hawaii Western Management Group Commercial	$5.13
Rate for Payer: Health Management Network Commercial	$4.59
Rate for Payer: Health Management Network Commercial	$5.17
Rate for Payer: Health Management Network Commercial	$7.90
Rate for Payer: Kaiser Permanente Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$3.83
Rate for Payer: Kaiser Permanente Commercial	$5.85
Rate for Payer: Kaiser Permanente Medicaid	$2.75
Rate for Payer: Kaiser Permanente Medicaid	$3.10
Rate for Payer: Kaiser Permanente Medicaid	$4.74
Rate for Payer: MDX Hawaii PPO	$5.24
Rate for Payer: MDX Hawaii PPO	$5.90
Rate for Payer: MDX Hawaii PPO	$9.01
Rate for Payer: UnitedHealthcare Medicaid	$3.65
Rate for Payer: UnitedHealthcare Medicaid	$5.57
Rate for Payer: UnitedHealthcare Medicaid	$3.24
Rate for Payer: University Health Alliance Commercial	$6.77
Rate for Payer: University Health Alliance Commercial	$3.94
Rate for Payer: University Health Alliance Commercial	$4.43

HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABLET

Facility

$3.82

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$3.71
Rate for Payer: Cash Price	$2.48
Rate for Payer: Cash Price	$2.24
Rate for Payer: Cash Price	$3.97
Rate for Payer: Hawaii Western Management Group Commercial	$3.28
Rate for Payer: Hawaii Western Management Group Commercial	$5.80
Rate for Payer: Hawaii Western Management Group Commercial	$3.63
Rate for Payer: Health Management Network Commercial	$5.19
Rate for Payer: Health Management Network Commercial	$2.93
Rate for Payer: Health Management Network Commercial	$3.25
Rate for Payer: Kaiser Permanente Commercial	$2.17
Rate for Payer: Kaiser Permanente Commercial	$2.41
Rate for Payer: Kaiser Permanente Commercial	$3.85
Rate for Payer: Kaiser Permanente Medicaid	$3.12
Rate for Payer: Kaiser Permanente Medicaid	$1.95
Rate for Payer: Kaiser Permanente Medicaid	$1.76
Rate for Payer: MDX Hawaii PPO	$5.93
Rate for Payer: MDX Hawaii PPO	$3.35
Rate for Payer: MDX Hawaii PPO	$3.71
Rate for Payer: UnitedHealthcare Medicaid	$2.29
Rate for Payer: UnitedHealthcare Medicaid	$2.07
Rate for Payer: UnitedHealthcare Medicaid	$3.67
Rate for Payer: University Health Alliance Commercial	$4.45
Rate for Payer: University Health Alliance Commercial	$2.51
Rate for Payer: University Health Alliance Commercial	$2.78

HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABLET

Facility

$3.82

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$3.71
Rate for Payer: Cash Price	$2.48
Rate for Payer: Cash Price	$3.97
Rate for Payer: Cash Price	$2.24
Rate for Payer: Health Management Network Commercial	$2.93
Rate for Payer: Health Management Network Commercial	$3.25
Rate for Payer: Health Management Network Commercial	$5.19
Rate for Payer: MDX Hawaii PPO	$3.35
Rate for Payer: MDX Hawaii PPO	$5.93
Rate for Payer: MDX Hawaii PPO	$3.71

HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML PO SOLN

Facility

$27.16

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$23.09
Max. Negotiated Rate	$26.35
Rate for Payer: Cash Price	$17.65
Rate for Payer: Cash Price	$20.08
Rate for Payer: Health Management Network Commercial	$23.09
Rate for Payer: Health Management Network Commercial	$26.26
Rate for Payer: MDX Hawaii PPO	$26.35
Rate for Payer: MDX Hawaii PPO	$29.96

HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML PO SOLN

Facility

$30.89

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$29.96
Rate for Payer: Cash Price	$20.08
Rate for Payer: Cash Price	$17.65
Rate for Payer: Hawaii Western Management Group Commercial	$25.80
Rate for Payer: Hawaii Western Management Group Commercial	$29.35
Rate for Payer: Health Management Network Commercial	$23.09
Rate for Payer: Health Management Network Commercial	$26.26
Rate for Payer: Kaiser Permanente Commercial	$19.46
Rate for Payer: Kaiser Permanente Commercial	$17.11
Rate for Payer: Kaiser Permanente Medicaid	$15.75
Rate for Payer: Kaiser Permanente Medicaid	$13.85
Rate for Payer: MDX Hawaii PPO	$26.35
Rate for Payer: MDX Hawaii PPO	$29.96
Rate for Payer: UnitedHealthcare Medicaid	$16.30
Rate for Payer: UnitedHealthcare Medicaid	$18.53
Rate for Payer: University Health Alliance Commercial	$22.52
Rate for Payer: University Health Alliance Commercial	$19.80

HYDROCODONE-ACETAMINOPHEN 7.5-325 MG PO TABLET

Facility

$4.26

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$4.13
Rate for Payer: Cash Price	$2.77
Rate for Payer: Cash Price	$2.78
Rate for Payer: Hawaii Western Management Group Commercial	$4.05
Rate for Payer: Hawaii Western Management Group Commercial	$4.06
Rate for Payer: Health Management Network Commercial	$3.62
Rate for Payer: Health Management Network Commercial	$3.63
Rate for Payer: Kaiser Permanente Commercial	$2.68
Rate for Payer: Kaiser Permanente Commercial	$2.69
Rate for Payer: Kaiser Permanente Medicaid	$2.17
Rate for Payer: Kaiser Permanente Medicaid	$2.18
Rate for Payer: MDX Hawaii PPO	$4.13
Rate for Payer: MDX Hawaii PPO	$4.14
Rate for Payer: UnitedHealthcare Medicaid	$2.56
Rate for Payer: UnitedHealthcare Medicaid	$2.56
Rate for Payer: University Health Alliance Commercial	$3.11
Rate for Payer: University Health Alliance Commercial	$3.11

HYDROCODONE-ACETAMINOPHEN 7.5-325 MG PO TABLET

Facility

$4.26

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$4.13
Rate for Payer: Cash Price	$2.77
Rate for Payer: Cash Price	$2.78
Rate for Payer: Health Management Network Commercial	$3.63
Rate for Payer: Health Management Network Commercial	$3.62
Rate for Payer: MDX Hawaii PPO	$4.13
Rate for Payer: MDX Hawaii PPO	$4.14

HYDROCODONE-CHLORPHENIRAMINE 10-8 MG/5 ML PO SU12

Facility

$18.47

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.42
Max. Negotiated Rate	$17.92
Rate for Payer: Cash Price	$12.01
Rate for Payer: Hawaii Western Management Group Commercial	$17.55
Rate for Payer: Health Management Network Commercial	$15.70
Rate for Payer: Kaiser Permanente Commercial	$11.64
Rate for Payer: Kaiser Permanente Medicaid	$9.42
Rate for Payer: MDX Hawaii PPO	$17.92
Rate for Payer: UnitedHealthcare Medicaid	$11.08
Rate for Payer: University Health Alliance Commercial	$13.46

HYDROCODONE-CHLORPHENIRAMINE 10-8 MG/5 ML PO SU12

Facility

$18.47

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$15.70
Max. Negotiated Rate	$17.92
Rate for Payer: Cash Price	$12.01
Rate for Payer: Health Management Network Commercial	$15.70
Rate for Payer: MDX Hawaii PPO	$17.92

HYDROCORTISONE 100 MG/60 ML PR ENEMA

Facility

$124.57

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$105.88
Max. Negotiated Rate	$120.83
Rate for Payer: Cash Price	$80.97
Rate for Payer: Health Management Network Commercial	$105.88
Rate for Payer: MDX Hawaii PPO	$120.83

HYDROCORTISONE 100 MG/60 ML PR ENEMA

Facility

$124.57

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$63.53
Max. Negotiated Rate	$120.83
Rate for Payer: Cash Price	$80.97
Rate for Payer: Hawaii Western Management Group Commercial	$118.34
Rate for Payer: Health Management Network Commercial	$105.88
Rate for Payer: Kaiser Permanente Commercial	$78.48
Rate for Payer: Kaiser Permanente Medicaid	$63.53
Rate for Payer: MDX Hawaii PPO	$120.83
Rate for Payer: UnitedHealthcare Medicaid	$74.74
Rate for Payer: University Health Alliance Commercial	$90.80

HYDROCORTISONE 10 MG PO TABLET

Facility

$11.05

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.39
Max. Negotiated Rate	$10.72
Rate for Payer: Cash Price	$7.18
Rate for Payer: Cash Price	$6.44
Rate for Payer: Cash Price	$2.06
Rate for Payer: Health Management Network Commercial	$9.39
Rate for Payer: Health Management Network Commercial	$2.69
Rate for Payer: Health Management Network Commercial	$8.42
Rate for Payer: MDX Hawaii PPO	$3.07
Rate for Payer: MDX Hawaii PPO	$10.72
Rate for Payer: MDX Hawaii PPO	$9.61

HYDROCORTISONE 10 MG PO TABLET

Facility

$11.05

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.64
Max. Negotiated Rate	$10.72
Rate for Payer: Cash Price	$7.18
Rate for Payer: Cash Price	$6.44
Rate for Payer: Cash Price	$2.06
Rate for Payer: Hawaii Western Management Group Commercial	$9.41
Rate for Payer: Hawaii Western Management Group Commercial	$3.01
Rate for Payer: Hawaii Western Management Group Commercial	$10.50
Rate for Payer: Health Management Network Commercial	$8.42
Rate for Payer: Health Management Network Commercial	$9.39
Rate for Payer: Health Management Network Commercial	$2.69
Rate for Payer: Kaiser Permanente Commercial	$6.96
Rate for Payer: Kaiser Permanente Commercial	$2.00
Rate for Payer: Kaiser Permanente Commercial	$6.24
Rate for Payer: Kaiser Permanente Medicaid	$1.62
Rate for Payer: Kaiser Permanente Medicaid	$5.64
Rate for Payer: Kaiser Permanente Medicaid	$5.05
Rate for Payer: MDX Hawaii PPO	$3.07
Rate for Payer: MDX Hawaii PPO	$10.72
Rate for Payer: MDX Hawaii PPO	$9.61
Rate for Payer: UnitedHealthcare Medicaid	$1.90
Rate for Payer: UnitedHealthcare Medicaid	$6.63
Rate for Payer: UnitedHealthcare Medicaid	$5.95
Rate for Payer: University Health Alliance Commercial	$8.05
Rate for Payer: University Health Alliance Commercial	$2.31
Rate for Payer: University Health Alliance Commercial	$7.22

HYDROCORTISONE 1 % TOP CR

Facility

$22.11

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.28
Max. Negotiated Rate	$21.45
Rate for Payer: Cash Price	$14.37
Rate for Payer: Cash Price	$14.32
Rate for Payer: Hawaii Western Management Group Commercial	$20.93
Rate for Payer: Hawaii Western Management Group Commercial	$21.00
Rate for Payer: Health Management Network Commercial	$18.73
Rate for Payer: Health Management Network Commercial	$18.79
Rate for Payer: Kaiser Permanente Commercial	$13.93
Rate for Payer: Kaiser Permanente Commercial	$13.88
Rate for Payer: Kaiser Permanente Medicaid	$11.28
Rate for Payer: Kaiser Permanente Medicaid	$11.24
Rate for Payer: MDX Hawaii PPO	$21.37
Rate for Payer: MDX Hawaii PPO	$21.45
Rate for Payer: UnitedHealthcare Medicaid	$13.22
Rate for Payer: UnitedHealthcare Medicaid	$13.27
Rate for Payer: University Health Alliance Commercial	$16.12
Rate for Payer: University Health Alliance Commercial	$16.06

HYDROCORTISONE 1 % TOP CR

Facility

$22.03

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$21.37
Rate for Payer: Cash Price	$14.32
Rate for Payer: Cash Price	$14.37
Rate for Payer: Health Management Network Commercial	$18.73
Rate for Payer: Health Management Network Commercial	$18.79
Rate for Payer: MDX Hawaii PPO	$21.37
Rate for Payer: MDX Hawaii PPO	$21.45

HYDROCORTISONE 2.5 % TOP CR

Facility

$18.22

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$17.67
Rate for Payer: Cash Price	$11.84
Rate for Payer: Cash Price	$36.63
Rate for Payer: Hawaii Western Management Group Commercial	$17.31
Rate for Payer: Hawaii Western Management Group Commercial	$53.54
Rate for Payer: Health Management Network Commercial	$15.49
Rate for Payer: Health Management Network Commercial	$47.91
Rate for Payer: Kaiser Permanente Commercial	$11.48
Rate for Payer: Kaiser Permanente Commercial	$35.51
Rate for Payer: Kaiser Permanente Medicaid	$9.29
Rate for Payer: Kaiser Permanente Medicaid	$28.74
Rate for Payer: MDX Hawaii PPO	$17.67
Rate for Payer: MDX Hawaii PPO	$54.67
Rate for Payer: UnitedHealthcare Medicaid	$33.82
Rate for Payer: UnitedHealthcare Medicaid	$10.93
Rate for Payer: University Health Alliance Commercial	$13.28
Rate for Payer: University Health Alliance Commercial	$41.08

HYDROCORTISONE 2.5 % TOP CR

Facility

$18.22

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$17.67
Rate for Payer: Cash Price	$11.84
Rate for Payer: Cash Price	$36.63
Rate for Payer: Health Management Network Commercial	$47.91
Rate for Payer: Health Management Network Commercial	$15.49
Rate for Payer: MDX Hawaii PPO	$17.67
Rate for Payer: MDX Hawaii PPO	$54.67

HYDROCORTISONE 2.5 % TOP CRPE

Facility

$401.42

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$204.72
Max. Negotiated Rate	$389.38
Rate for Payer: Cash Price	$260.92
Rate for Payer: Cash Price	$251.56
Rate for Payer: Hawaii Western Management Group Commercial	$367.66
Rate for Payer: Hawaii Western Management Group Commercial	$381.35
Rate for Payer: Health Management Network Commercial	$328.96
Rate for Payer: Health Management Network Commercial	$341.21
Rate for Payer: Kaiser Permanente Commercial	$252.89
Rate for Payer: Kaiser Permanente Commercial	$243.82
Rate for Payer: Kaiser Permanente Medicaid	$204.72
Rate for Payer: Kaiser Permanente Medicaid	$197.38
Rate for Payer: MDX Hawaii PPO	$375.40
Rate for Payer: MDX Hawaii PPO	$389.38
Rate for Payer: UnitedHealthcare Medicaid	$232.21
Rate for Payer: UnitedHealthcare Medicaid	$240.85
Rate for Payer: University Health Alliance Commercial	$292.60
Rate for Payer: University Health Alliance Commercial	$282.09

HYDROCORTISONE 2.5 % TOP CRPE

Facility

$387.01

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$328.96
Max. Negotiated Rate	$375.40
Rate for Payer: Cash Price	$251.56
Rate for Payer: Cash Price	$260.92
Rate for Payer: Health Management Network Commercial	$328.96
Rate for Payer: Health Management Network Commercial	$341.21
Rate for Payer: MDX Hawaii PPO	$375.40
Rate for Payer: MDX Hawaii PPO	$389.38

HYDROCORTISONE ACETATE 25 MG PR SUPP

Facility

$107.01

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$54.58
Max. Negotiated Rate	$103.80
Rate for Payer: Cash Price	$69.56
Rate for Payer: Cash Price	$60.55
Rate for Payer: Hawaii Western Management Group Commercial	$101.66
Rate for Payer: Hawaii Western Management Group Commercial	$88.49
Rate for Payer: Health Management Network Commercial	$90.96
Rate for Payer: Health Management Network Commercial	$79.18
Rate for Payer: Kaiser Permanente Commercial	$67.42
Rate for Payer: Kaiser Permanente Commercial	$58.68
Rate for Payer: Kaiser Permanente Medicaid	$54.58
Rate for Payer: Kaiser Permanente Medicaid	$47.51
Rate for Payer: MDX Hawaii PPO	$103.80
Rate for Payer: MDX Hawaii PPO	$90.36
Rate for Payer: UnitedHealthcare Medicaid	$55.89
Rate for Payer: UnitedHealthcare Medicaid	$64.21
Rate for Payer: University Health Alliance Commercial	$78.00
Rate for Payer: University Health Alliance Commercial	$67.90

HYDROCORTISONE ACETATE 25 MG PR SUPP

Facility

$107.01

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$90.96
Max. Negotiated Rate	$103.80
Rate for Payer: Cash Price	$69.56
Rate for Payer: Cash Price	$60.55
Rate for Payer: Health Management Network Commercial	$79.18
Rate for Payer: Health Management Network Commercial	$90.96
Rate for Payer: MDX Hawaii PPO	$103.80
Rate for Payer: MDX Hawaii PPO	$90.36

HYDROCORTISONE-PRAMOXINE 1-1 % PR CR

Facility

$542.87

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$276.86
Max. Negotiated Rate	$526.58
Rate for Payer: Cash Price	$352.87
Rate for Payer: Hawaii Western Management Group Commercial	$515.73
Rate for Payer: Health Management Network Commercial	$461.44
Rate for Payer: Kaiser Permanente Commercial	$342.01
Rate for Payer: Kaiser Permanente Medicaid	$276.86
Rate for Payer: MDX Hawaii PPO	$526.58
Rate for Payer: UnitedHealthcare Medicaid	$325.72
Rate for Payer: University Health Alliance Commercial	$395.70

HYDROCORTISONE-PRAMOXINE 1-1 % PR CR

Facility

$542.87

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$461.44
Max. Negotiated Rate	$526.58
Rate for Payer: Cash Price	$352.87
Rate for Payer: Health Management Network Commercial	$461.44
Rate for Payer: MDX Hawaii PPO	$526.58

HYDROCORTISONE-PRAMOXINE 2.5-1 % PR CR

Facility

$566.35

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$481.40
Max. Negotiated Rate	$549.36
Rate for Payer: Cash Price	$368.13
Rate for Payer: Health Management Network Commercial	$481.40
Rate for Payer: MDX Hawaii PPO	$549.36

Know your out-of-pocket cost for care.

All Charges