Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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

HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ RECON.SOLN.

Facility

$64.97

Service Code	HCPCS J1720
Hospital Revenue Code	250
Min. Negotiated Rate	$55.22
Max. Negotiated Rate	$63.02
Rate for Payer: Cash Price	$42.23
Rate for Payer: Cash Price	$75.28
Rate for Payer: Health Management Network Commercial	$98.44
Rate for Payer: Health Management Network Commercial	$55.22
Rate for Payer: MDX Hawaii PPO	$112.34
Rate for Payer: MDX Hawaii PPO	$63.02

HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ RECON.SOLN.

Facility

$64.97

Service Code	HCPCS J1720
Hospital Revenue Code	636
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$63.02
Rate for Payer: Cash Price	$42.23
Rate for Payer: Cash Price	$75.28
Rate for Payer: Cash Price	$42.23
Rate for Payer: Cash Price	$75.28
Rate for Payer: Hawaii Medical Service Association ABD	$21.20
Rate for Payer: Hawaii Medical Service Association ABD	$21.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.20
Rate for Payer: Hawaii Western Management Group Commercial	$110.02
Rate for Payer: Hawaii Western Management Group Commercial	$61.72
Rate for Payer: Health Management Network Commercial	$55.22
Rate for Payer: Health Management Network Commercial	$98.44
Rate for Payer: Kaiser Permanente Commercial	$40.93
Rate for Payer: Kaiser Permanente Commercial	$72.96
Rate for Payer: Kaiser Permanente Medicaid	$59.06
Rate for Payer: Kaiser Permanente Medicaid	$33.13
Rate for Payer: MDX Hawaii PPO	$63.02
Rate for Payer: MDX Hawaii PPO	$112.34
Rate for Payer: UnitedHealthcare Medicaid	$69.49
Rate for Payer: UnitedHealthcare Medicaid	$38.98
Rate for Payer: University Health Alliance Commercial	$47.36
Rate for Payer: University Health Alliance Commercial	$84.41

HYDROCORTISONE SOD SUCC (PF) 250 MG/2 ML INJ RECON.SOLN.

Facility

$120.17

Service Code	HCPCS J1720
Hospital Revenue Code	636
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$116.56
Rate for Payer: Cash Price	$78.11
Rate for Payer: Cash Price	$78.11
Rate for Payer: Hawaii Medical Service Association ABD	$21.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21.20
Rate for Payer: Hawaii Western Management Group Commercial	$114.16
Rate for Payer: Health Management Network Commercial	$102.14
Rate for Payer: Kaiser Permanente Commercial	$75.71
Rate for Payer: Kaiser Permanente Medicaid	$61.29
Rate for Payer: MDX Hawaii PPO	$116.56
Rate for Payer: UnitedHealthcare Medicaid	$72.10
Rate for Payer: University Health Alliance Commercial	$87.59

HYDROCORTISONE SOD SUCC (PF) 250 MG/2 ML INJ RECON.SOLN.

Facility

$120.17

Service Code	HCPCS J1720
Hospital Revenue Code	250
Min. Negotiated Rate	$102.14
Max. Negotiated Rate	$116.56
Rate for Payer: Cash Price	$78.11
Rate for Payer: Health Management Network Commercial	$102.14
Rate for Payer: MDX Hawaii PPO	$116.56

HYDROMORPHONE 1 MG/ML INJ SYR

Facility

$14.35

Service Code	HCPCS J1171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$13.92
Rate for Payer: Cash Price	$9.33
Rate for Payer: Cash Price	$9.33
Rate for Payer: Hawaii Medical Service Association ABD	$0.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.09
Rate for Payer: Hawaii Western Management Group Commercial	$13.63
Rate for Payer: Health Management Network Commercial	$12.20
Rate for Payer: Kaiser Permanente Commercial	$9.04
Rate for Payer: Kaiser Permanente Medicaid	$7.32
Rate for Payer: MDX Hawaii PPO	$13.92
Rate for Payer: UnitedHealthcare Medicaid	$8.61
Rate for Payer: University Health Alliance Commercial	$10.46

HYDROMORPHONE 1 MG/ML INJ SYR

Facility

$14.35

Service Code	HCPCS J1171
Hospital Revenue Code	250
Min. Negotiated Rate	$12.20
Max. Negotiated Rate	$13.92
Rate for Payer: Cash Price	$9.33
Rate for Payer: Health Management Network Commercial	$12.20
Rate for Payer: MDX Hawaii PPO	$13.92

HYDROMORPHONE 2 MG/ML INJ SOLN

Facility

$23.39

Service Code	HCPCS J1171
Hospital Revenue Code	250
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$22.69
Rate for Payer: Cash Price	$15.20
Rate for Payer: Health Management Network Commercial	$19.88
Rate for Payer: MDX Hawaii PPO	$22.69

HYDROMORPHONE 2 MG/ML INJ SOLN

Facility

$23.39

Service Code	HCPCS J1171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$22.69
Rate for Payer: Cash Price	$15.20
Rate for Payer: Cash Price	$15.20
Rate for Payer: Hawaii Medical Service Association ABD	$0.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.09
Rate for Payer: Hawaii Western Management Group Commercial	$22.22
Rate for Payer: Health Management Network Commercial	$19.88
Rate for Payer: Kaiser Permanente Commercial	$14.74
Rate for Payer: Kaiser Permanente Medicaid	$11.93
Rate for Payer: MDX Hawaii PPO	$22.69
Rate for Payer: UnitedHealthcare Medicaid	$14.03
Rate for Payer: University Health Alliance Commercial	$17.05

HYDROMORPHONE 2 MG/ML INJ SYR

Facility

$18.59

Service Code	HCPCS J1171
Hospital Revenue Code	250
Min. Negotiated Rate	$15.80
Max. Negotiated Rate	$18.03
Rate for Payer: Cash Price	$12.08
Rate for Payer: Cash Price	$31.23
Rate for Payer: Health Management Network Commercial	$15.80
Rate for Payer: Health Management Network Commercial	$40.84
Rate for Payer: MDX Hawaii PPO	$18.03
Rate for Payer: MDX Hawaii PPO	$46.61

HYDROMORPHONE 2 MG/ML INJ SYR

Facility

$18.59

Service Code	HCPCS J1171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$18.03
Rate for Payer: Cash Price	$12.08
Rate for Payer: Cash Price	$31.23
Rate for Payer: Cash Price	$12.08
Rate for Payer: Cash Price	$31.23
Rate for Payer: Hawaii Medical Service Association ABD	$0.09
Rate for Payer: Hawaii Medical Service Association ABD	$0.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.09
Rate for Payer: Hawaii Western Management Group Commercial	$45.65
Rate for Payer: Hawaii Western Management Group Commercial	$17.66
Rate for Payer: Health Management Network Commercial	$40.84
Rate for Payer: Health Management Network Commercial	$15.80
Rate for Payer: Kaiser Permanente Commercial	$30.27
Rate for Payer: Kaiser Permanente Commercial	$11.71
Rate for Payer: Kaiser Permanente Medicaid	$9.48
Rate for Payer: Kaiser Permanente Medicaid	$24.51
Rate for Payer: MDX Hawaii PPO	$18.03
Rate for Payer: MDX Hawaii PPO	$46.61
Rate for Payer: UnitedHealthcare Medicaid	$28.83
Rate for Payer: UnitedHealthcare Medicaid	$11.15
Rate for Payer: University Health Alliance Commercial	$13.55
Rate for Payer: University Health Alliance Commercial	$35.02

HYDROMORPHONE 2 MG PO TABLET

Facility

$3.94

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$3.82
Rate for Payer: Cash Price	$2.56
Rate for Payer: Health Management Network Commercial	$3.35
Rate for Payer: MDX Hawaii PPO	$3.82

HYDROMORPHONE 2 MG PO TABLET

Facility

$3.94

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$3.82
Rate for Payer: Cash Price	$2.56
Rate for Payer: Hawaii Western Management Group Commercial	$3.74
Rate for Payer: Health Management Network Commercial	$3.35
Rate for Payer: Kaiser Permanente Commercial	$2.48
Rate for Payer: Kaiser Permanente Medicaid	$2.01
Rate for Payer: MDX Hawaii PPO	$3.82
Rate for Payer: UnitedHealthcare Medicaid	$2.36
Rate for Payer: University Health Alliance Commercial	$2.87

HYDROMORPHONE (PF)-0.9 % NACL 10 MG/50 ML (0.2 MG/ML) IV PCA SYR

Facility

$73.89

Service Code	HCPCS J1171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$71.67
Rate for Payer: Cash Price	$48.03
Rate for Payer: Cash Price	$48.03
Rate for Payer: Hawaii Medical Service Association ABD	$0.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.09
Rate for Payer: Hawaii Western Management Group Commercial	$70.20
Rate for Payer: Health Management Network Commercial	$62.81
Rate for Payer: Kaiser Permanente Commercial	$46.55
Rate for Payer: Kaiser Permanente Medicaid	$37.68
Rate for Payer: MDX Hawaii PPO	$71.67
Rate for Payer: UnitedHealthcare Medicaid	$44.33
Rate for Payer: University Health Alliance Commercial	$53.86

HYDROMORPHONE (PF)-0.9 % NACL 10 MG/50 ML (0.2 MG/ML) IV PCA SYR

Facility

$73.89

Service Code	HCPCS J1171
Hospital Revenue Code	250
Min. Negotiated Rate	$62.81
Max. Negotiated Rate	$71.67
Rate for Payer: Cash Price	$48.03
Rate for Payer: Health Management Network Commercial	$62.81
Rate for Payer: MDX Hawaii PPO	$71.67

HYDROMORPHONE (PF) 10 MG/ML INJ SOLN

Facility

$87.06

Service Code	HCPCS J1171
Hospital Revenue Code	250
Min. Negotiated Rate	$74.00
Max. Negotiated Rate	$84.45
Rate for Payer: Cash Price	$56.59
Rate for Payer: Cash Price	$55.74
Rate for Payer: Health Management Network Commercial	$72.89
Rate for Payer: Health Management Network Commercial	$74.00
Rate for Payer: MDX Hawaii PPO	$84.45
Rate for Payer: MDX Hawaii PPO	$83.18

HYDROMORPHONE (PF) 10 MG/ML INJ SOLN

Facility

$85.75

Service Code	HCPCS J1171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$83.18
Rate for Payer: Cash Price	$55.74
Rate for Payer: Cash Price	$55.74
Rate for Payer: Cash Price	$56.59
Rate for Payer: Cash Price	$56.59
Rate for Payer: Hawaii Medical Service Association ABD	$0.09
Rate for Payer: Hawaii Medical Service Association ABD	$0.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.09
Rate for Payer: Hawaii Western Management Group Commercial	$81.46
Rate for Payer: Hawaii Western Management Group Commercial	$82.71
Rate for Payer: Health Management Network Commercial	$72.89
Rate for Payer: Health Management Network Commercial	$74.00
Rate for Payer: Kaiser Permanente Commercial	$54.02
Rate for Payer: Kaiser Permanente Commercial	$54.85
Rate for Payer: Kaiser Permanente Medicaid	$44.40
Rate for Payer: Kaiser Permanente Medicaid	$43.73
Rate for Payer: MDX Hawaii PPO	$84.45
Rate for Payer: MDX Hawaii PPO	$83.18
Rate for Payer: UnitedHealthcare Medicaid	$51.45
Rate for Payer: UnitedHealthcare Medicaid	$52.24
Rate for Payer: University Health Alliance Commercial	$62.50
Rate for Payer: University Health Alliance Commercial	$63.46

HYDROMORPHONE (PF) 2 MG/ML INJ SOLN

Facility

$16.56

Service Code	HCPCS J1171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Cash Price	$10.76
Rate for Payer: Hawaii Medical Service Association ABD	$0.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.09
Rate for Payer: Hawaii Western Management Group Commercial	$15.73
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: Kaiser Permanente Commercial	$10.43
Rate for Payer: Kaiser Permanente Medicaid	$8.45
Rate for Payer: MDX Hawaii PPO	$16.06
Rate for Payer: UnitedHealthcare Medicaid	$9.94
Rate for Payer: University Health Alliance Commercial	$12.07

HYDROMORPHONE (PF) 2 MG/ML INJ SOLN

Facility

$16.56

Service Code	HCPCS J1171
Hospital Revenue Code	250
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: MDX Hawaii PPO	$16.06

HYDROMORPHONE (PF) 2 MG/ML INJ SYR

Facility

$22.91

Service Code	HCPCS J1171
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$22.22
Rate for Payer: Cash Price	$14.89
Rate for Payer: Cash Price	$14.89
Rate for Payer: Hawaii Medical Service Association ABD	$0.09
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.09
Rate for Payer: Hawaii Western Management Group Commercial	$21.76
Rate for Payer: Health Management Network Commercial	$19.47
Rate for Payer: Kaiser Permanente Commercial	$14.43
Rate for Payer: Kaiser Permanente Medicaid	$11.68
Rate for Payer: MDX Hawaii PPO	$22.22
Rate for Payer: UnitedHealthcare Medicaid	$13.75
Rate for Payer: University Health Alliance Commercial	$16.70

HYDROMORPHONE (PF) 2 MG/ML INJ SYR

Facility

$22.91

Service Code	HCPCS J1171
Hospital Revenue Code	250
Min. Negotiated Rate	$19.47
Max. Negotiated Rate	$22.22
Rate for Payer: Cash Price	$14.89
Rate for Payer: Health Management Network Commercial	$19.47
Rate for Payer: MDX Hawaii PPO	$22.22

HYDROXOCOBALAMIN 5 GRAM IV RECON.SOLN.

Facility

$2,376.00

Service Code	HCPCS J3424
Hospital Revenue Code	250
Min. Negotiated Rate	$2,019.60
Max. Negotiated Rate	$2,304.72
Rate for Payer: Cash Price	$1,544.40
Rate for Payer: Health Management Network Commercial	$2,019.60
Rate for Payer: MDX Hawaii PPO	$2,304.72

HYDROXOCOBALAMIN 5 GRAM IV RECON.SOLN.

Facility

$2,376.00

Service Code	HCPCS J3424
Hospital Revenue Code	636
Min. Negotiated Rate	$5.44
Max. Negotiated Rate	$2,304.72
Rate for Payer: AlohaCare Medicaid	$5.44
Rate for Payer: AlohaCare Medicare	$5.44
Rate for Payer: Cash Price	$1,544.40
Rate for Payer: Cash Price	$1,544.40
Rate for Payer: Devoted Health Medicare	$5.98
Rate for Payer: Hawaii Medical Service Association Commercial	$6.80
Rate for Payer: Hawaii Medical Service Association Medicare	$5.44
Rate for Payer: Hawaii Western Management Group Commercial	$2,257.20
Rate for Payer: Health Management Network Commercial	$2,019.60
Rate for Payer: Humana Medicare	$5.44
Rate for Payer: Kaiser Permanente Commercial	$1,496.88
Rate for Payer: Kaiser Permanente Medicaid	$1,211.76
Rate for Payer: Kaiser Permanente Medicare	$5.44
Rate for Payer: MDX Hawaii PPO	$2,304.72
Rate for Payer: Ohana Health Plan Medicaid	$5.98
Rate for Payer: Ohana Health Plan Medicare	$5.44
Rate for Payer: UnitedHealthcare Medicaid	$1,425.60
Rate for Payer: UnitedHealthcare Medicare	$5.44
Rate for Payer: University Health Alliance Commercial	$1,731.87

HYDROXYCHLOROQUINE 200 MG PO TABLET

Facility

$24.24

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$12.36
Max. Negotiated Rate	$23.51
Rate for Payer: Cash Price	$15.76
Rate for Payer: Hawaii Western Management Group Commercial	$23.03
Rate for Payer: Health Management Network Commercial	$20.60
Rate for Payer: Kaiser Permanente Commercial	$15.27
Rate for Payer: Kaiser Permanente Medicaid	$12.36
Rate for Payer: MDX Hawaii PPO	$23.51
Rate for Payer: UnitedHealthcare Medicaid	$14.54
Rate for Payer: University Health Alliance Commercial	$17.67

HYDROXYCHLOROQUINE 200 MG PO TABLET

Facility

$24.24

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$20.60
Max. Negotiated Rate	$23.51
Rate for Payer: Cash Price	$15.76
Rate for Payer: Health Management Network Commercial	$20.60
Rate for Payer: MDX Hawaii PPO	$23.51

Know your out-of-pocket cost for care.

All Charges