Kona Community Hospital

All Charges

Charge

Type

Setting

Price

IBANDRONATE 3 MG/3 ML IV SYR

Facility

$1,288.80

Service Code	HCPCS J1740
Hospital Revenue Code	636
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$1,250.14
Rate for Payer: Cash Price	$837.72
Rate for Payer: Cash Price	$837.72
Rate for Payer: Hawaii Medical Service Association ABD	$30.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,224.36
Rate for Payer: Health Management Network Commercial	$1,095.48
Rate for Payer: Kaiser Permanente Commercial	$811.94
Rate for Payer: Kaiser Permanente Medicaid	$657.29
Rate for Payer: MDX Hawaii PPO	$1,250.14
Rate for Payer: UnitedHealthcare Medicaid	$773.28
Rate for Payer: University Health Alliance Commercial	$939.41

IBANDRONATE 3 MG/3 ML IV SYR

Facility

$1,288.80

Service Code	HCPCS J1740
Hospital Revenue Code	250
Min. Negotiated Rate	$1,095.48
Max. Negotiated Rate	$1,250.14
Rate for Payer: Cash Price	$837.72
Rate for Payer: Health Management Network Commercial	$1,095.48
Rate for Payer: MDX Hawaii PPO	$1,250.14

IB Kit Plus BC W/CC FT Jumpstart AR-1788J-CP [3644919]

Facility

$10,225.00

Service Code	HCPCS C1713
Hospital Charge Code	3644919
Hospital Revenue Code	278
Min. Negotiated Rate	$5,726.00
Max. Negotiated Rate	$9,918.25
Rate for Payer: Cash Price	$6,646.25
Rate for Payer: Hawaii Western Management Group Commercial	$7,157.50
Rate for Payer: Health Management Network Commercial	$8,691.25
Rate for Payer: MDX Hawaii PPO	$9,918.25
Rate for Payer: University Health Alliance Commercial	$5,726.00

IB Kit Plus BC W/CC FT Jumpstart AR-1788J-CP [3644919]

Facility

$10,225.00

Service Code	HCPCS C1713
Hospital Charge Code	3644919
Hospital Revenue Code	278
Min. Negotiated Rate	$5,214.75
Max. Negotiated Rate	$9,918.25
Rate for Payer: Cash Price	$6,646.25
Rate for Payer: Hawaii Western Management Group Commercial	$7,157.50
Rate for Payer: Health Management Network Commercial	$8,691.25
Rate for Payer: Kaiser Permanente Commercial	$6,441.75
Rate for Payer: Kaiser Permanente Medicaid	$5,214.75
Rate for Payer: MDX Hawaii PPO	$9,918.25
Rate for Payer: University Health Alliance Commercial	$5,726.00

IB Kit Plus BC w/ CC FT & Jumpstart AR-1789J-CP [3644462]

Facility

$10,225.00

Service Code	HCPCS C1713
Hospital Charge Code	3644462
Hospital Revenue Code	278
Min. Negotiated Rate	$5,214.75
Max. Negotiated Rate	$9,918.25
Rate for Payer: Cash Price	$6,646.25
Rate for Payer: Hawaii Western Management Group Commercial	$7,157.50
Rate for Payer: Health Management Network Commercial	$8,691.25
Rate for Payer: Kaiser Permanente Commercial	$6,441.75
Rate for Payer: Kaiser Permanente Medicaid	$5,214.75
Rate for Payer: MDX Hawaii PPO	$9,918.25
Rate for Payer: University Health Alliance Commercial	$5,726.00

IB Kit Plus BC w/ CC FT & Jumpstart AR-1789J-CP [3644462]

Facility

$10,225.00

Service Code	HCPCS C1713
Hospital Charge Code	3644462
Hospital Revenue Code	278
Min. Negotiated Rate	$5,726.00
Max. Negotiated Rate	$9,918.25
Rate for Payer: Cash Price	$6,646.25
Rate for Payer: Hawaii Western Management Group Commercial	$7,157.50
Rate for Payer: Health Management Network Commercial	$8,691.25
Rate for Payer: MDX Hawaii PPO	$9,918.25
Rate for Payer: University Health Alliance Commercial	$5,726.00

IBUPROFEN 100 MG/5 ML PO SUSP

Facility

$4.81

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.09
Max. Negotiated Rate	$4.67
Rate for Payer: Cash Price	$3.13
Rate for Payer: Cash Price	$6.46
Rate for Payer: Cash Price	$5.64
Rate for Payer: Cash Price	$4.02
Rate for Payer: Cash Price	$5.24
Rate for Payer: Health Management Network Commercial	$8.45
Rate for Payer: Health Management Network Commercial	$4.09
Rate for Payer: Health Management Network Commercial	$5.26
Rate for Payer: Health Management Network Commercial	$6.85
Rate for Payer: Health Management Network Commercial	$7.37
Rate for Payer: MDX Hawaii PPO	$8.41
Rate for Payer: MDX Hawaii PPO	$4.67
Rate for Payer: MDX Hawaii PPO	$6.00
Rate for Payer: MDX Hawaii PPO	$7.82
Rate for Payer: MDX Hawaii PPO	$9.64

IBUPROFEN 100 MG/5 ML PO SUSP

Facility

$8.67

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$8.41
Rate for Payer: Cash Price	$5.64
Rate for Payer: Cash Price	$3.13
Rate for Payer: Cash Price	$6.46
Rate for Payer: Cash Price	$4.02
Rate for Payer: Cash Price	$5.24
Rate for Payer: Hawaii Western Management Group Commercial	$9.44
Rate for Payer: Hawaii Western Management Group Commercial	$8.24
Rate for Payer: Hawaii Western Management Group Commercial	$5.88
Rate for Payer: Hawaii Western Management Group Commercial	$4.57
Rate for Payer: Hawaii Western Management Group Commercial	$7.66
Rate for Payer: Health Management Network Commercial	$5.26
Rate for Payer: Health Management Network Commercial	$7.37
Rate for Payer: Health Management Network Commercial	$8.45
Rate for Payer: Health Management Network Commercial	$6.85
Rate for Payer: Health Management Network Commercial	$4.09
Rate for Payer: Kaiser Permanente Commercial	$6.26
Rate for Payer: Kaiser Permanente Commercial	$3.03
Rate for Payer: Kaiser Permanente Commercial	$3.90
Rate for Payer: Kaiser Permanente Commercial	$5.08
Rate for Payer: Kaiser Permanente Commercial	$5.46
Rate for Payer: Kaiser Permanente Medicaid	$4.11
Rate for Payer: Kaiser Permanente Medicaid	$3.16
Rate for Payer: Kaiser Permanente Medicaid	$2.45
Rate for Payer: Kaiser Permanente Medicaid	$4.42
Rate for Payer: Kaiser Permanente Medicaid	$5.07
Rate for Payer: MDX Hawaii PPO	$8.41
Rate for Payer: MDX Hawaii PPO	$6.00
Rate for Payer: MDX Hawaii PPO	$7.82
Rate for Payer: MDX Hawaii PPO	$9.64
Rate for Payer: MDX Hawaii PPO	$4.67
Rate for Payer: UnitedHealthcare Medicaid	$5.20
Rate for Payer: UnitedHealthcare Medicaid	$4.84
Rate for Payer: UnitedHealthcare Medicaid	$5.96
Rate for Payer: UnitedHealthcare Medicaid	$3.71
Rate for Payer: UnitedHealthcare Medicaid	$2.89
Rate for Payer: University Health Alliance Commercial	$6.32
Rate for Payer: University Health Alliance Commercial	$7.25
Rate for Payer: University Health Alliance Commercial	$3.51
Rate for Payer: University Health Alliance Commercial	$4.51
Rate for Payer: University Health Alliance Commercial	$5.87

IBUPROFEN 200 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

IBUPROFEN 200 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

IBUPROFEN 400 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: Cash Price	$0.94
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Hawaii Western Management Group Commercial	$1.37
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$1.22
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Commercial	$0.91
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicaid	$0.73
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$1.40
Rate for Payer: UnitedHealthcare Medicaid	$0.86
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87
Rate for Payer: University Health Alliance Commercial	$1.05

IBUPROFEN 400 MG PO TABLET

Facility

$1.44

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$1.40
Rate for Payer: Cash Price	$0.94
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$1.22
Rate for Payer: MDX Hawaii PPO	$1.40
Rate for Payer: MDX Hawaii PPO	$1.16

IBUPROFEN 50 MG/1.25 ML PO DRPS

Facility

$45.08

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$38.32
Max. Negotiated Rate	$43.73
Rate for Payer: Cash Price	$29.30
Rate for Payer: Health Management Network Commercial	$38.32
Rate for Payer: MDX Hawaii PPO	$43.73

IBUPROFEN 50 MG/1.25 ML PO DRPS

Facility

$45.08

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$22.99
Max. Negotiated Rate	$43.73
Rate for Payer: Cash Price	$29.30
Rate for Payer: Hawaii Western Management Group Commercial	$42.83
Rate for Payer: Health Management Network Commercial	$38.32
Rate for Payer: Kaiser Permanente Commercial	$28.40
Rate for Payer: Kaiser Permanente Medicaid	$22.99
Rate for Payer: MDX Hawaii PPO	$43.73
Rate for Payer: UnitedHealthcare Medicaid	$27.05
Rate for Payer: University Health Alliance Commercial	$32.86

IBUPROFEN 600 MG PO TABLET

Facility

$3.03

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$2.94
Rate for Payer: Cash Price	$1.97
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$2.58
Rate for Payer: MDX Hawaii PPO	$2.94
Rate for Payer: MDX Hawaii PPO	$1.16

IBUPROFEN 600 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: Cash Price	$1.97
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Hawaii Western Management Group Commercial	$2.88
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$2.58
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Commercial	$1.91
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicaid	$1.55
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$2.94
Rate for Payer: UnitedHealthcare Medicaid	$1.82
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87
Rate for Payer: University Health Alliance Commercial	$2.21

IBUTILIDE FUMARATE 0.1 MG/ML IV SOLN

Facility

$1,402.21

Service Code	HCPCS J1742
Hospital Revenue Code	250
Min. Negotiated Rate	$1,191.88
Max. Negotiated Rate	$1,360.14
Rate for Payer: Cash Price	$911.44
Rate for Payer: Health Management Network Commercial	$1,191.88
Rate for Payer: MDX Hawaii PPO	$1,360.14

IBUTILIDE FUMARATE 0.1 MG/ML IV SOLN

Facility

$1,402.21

Service Code	HCPCS J1742
Hospital Revenue Code	636
Min. Negotiated Rate	$205.06
Max. Negotiated Rate	$1,360.14
Rate for Payer: AlohaCare Medicaid	$219.22
Rate for Payer: AlohaCare Medicare	$219.22
Rate for Payer: Cash Price	$911.44
Rate for Payer: Cash Price	$911.44
Rate for Payer: Devoted Health Medicare	$241.14
Rate for Payer: Hawaii Medical Service Association ABD	$205.06
Rate for Payer: Hawaii Medical Service Association Commercial	$274.02
Rate for Payer: Hawaii Medical Service Association Medicare	$219.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$205.06
Rate for Payer: Hawaii Western Management Group Commercial	$1,332.10
Rate for Payer: Health Management Network Commercial	$1,191.88
Rate for Payer: Humana Medicare	$219.22
Rate for Payer: Kaiser Permanente Commercial	$883.39
Rate for Payer: Kaiser Permanente Medicaid	$715.13
Rate for Payer: Kaiser Permanente Medicare	$219.22
Rate for Payer: MDX Hawaii PPO	$1,360.14
Rate for Payer: Ohana Health Plan Medicaid	$241.14
Rate for Payer: Ohana Health Plan Medicare	$219.22
Rate for Payer: UnitedHealthcare Medicaid	$841.33
Rate for Payer: UnitedHealthcare Medicare	$219.22
Rate for Payer: University Health Alliance Commercial	$1,022.07

ICU

Facility

$6,600.00

Hospital Charge Code	H0000022
Hospital Revenue Code	200
Min. Negotiated Rate	$5,610.00
Max. Negotiated Rate	$12,050.00
Rate for Payer: Cash Price	$4,290.00
Rate for Payer: Cash Price	$4,290.00
Rate for Payer: Hawaii Western Management Group Commercial	$12,050.00
Rate for Payer: Health Management Network Commercial	$5,610.00
Rate for Payer: MDX Hawaii PPO	$6,402.00
Rate for Payer: University Health Alliance Commercial	$6,369.00

IDARUCIZUMAB 2.5 GRAM/50 ML IV SOLN

Facility

$4,179.84

Service Code	NDC 00597019705
Hospital Revenue Code	250
Min. Negotiated Rate	$2,131.72
Max. Negotiated Rate	$4,054.44
Rate for Payer: Cash Price	$2,716.90
Rate for Payer: Hawaii Western Management Group Commercial	$3,970.85
Rate for Payer: Health Management Network Commercial	$3,552.86
Rate for Payer: Kaiser Permanente Commercial	$2,633.30
Rate for Payer: Kaiser Permanente Medicaid	$2,131.72
Rate for Payer: MDX Hawaii PPO	$4,054.44
Rate for Payer: UnitedHealthcare Medicaid	$2,507.90
Rate for Payer: University Health Alliance Commercial	$3,046.69

IDARUCIZUMAB 2.5 GRAM/50 ML IV SOLN

Facility

$4,179.84

Service Code	NDC 00597019705
Hospital Revenue Code	250
Min. Negotiated Rate	$3,552.86
Max. Negotiated Rate	$4,054.44
Rate for Payer: Cash Price	$2,716.90
Rate for Payer: Health Management Network Commercial	$3,552.86
Rate for Payer: MDX Hawaii PPO	$4,054.44

Ijs-E Axis Pin 2.5mmx45mm Ijs-Eap-25450 [3643990]

Facility

$1,394.25

Service Code	HCPCS C1713
Hospital Charge Code	3643990
Hospital Revenue Code	278
Min. Negotiated Rate	$711.07
Max. Negotiated Rate	$1,352.42
Rate for Payer: Cash Price	$906.26
Rate for Payer: Hawaii Western Management Group Commercial	$975.98
Rate for Payer: Health Management Network Commercial	$1,185.11
Rate for Payer: Kaiser Permanente Commercial	$878.38
Rate for Payer: Kaiser Permanente Medicaid	$711.07
Rate for Payer: MDX Hawaii PPO	$1,352.42
Rate for Payer: University Health Alliance Commercial	$780.78

Ijs-E Axis Pin 2.5mmx45mm Ijs-Eap-25450 [3643990]

Facility

$1,394.25

Service Code	HCPCS C1713
Hospital Charge Code	3643990
Hospital Revenue Code	278
Min. Negotiated Rate	$780.78
Max. Negotiated Rate	$1,352.42
Rate for Payer: Cash Price	$906.26
Rate for Payer: Hawaii Western Management Group Commercial	$975.98
Rate for Payer: Health Management Network Commercial	$1,185.11
Rate for Payer: MDX Hawaii PPO	$1,352.42
Rate for Payer: University Health Alliance Commercial	$780.78

Ijs-E Axis Pin 2.5mmx55mm IJS-EAP-25550 [3645436]

Facility

$1,922.25

Service Code	HCPCS C1713
Hospital Charge Code	3645436
Hospital Revenue Code	278
Min. Negotiated Rate	$980.35
Max. Negotiated Rate	$1,864.58
Rate for Payer: Cash Price	$1,249.46
Rate for Payer: Hawaii Western Management Group Commercial	$1,345.58
Rate for Payer: Health Management Network Commercial	$1,633.91
Rate for Payer: Kaiser Permanente Commercial	$1,211.02
Rate for Payer: Kaiser Permanente Medicaid	$980.35
Rate for Payer: MDX Hawaii PPO	$1,864.58
Rate for Payer: University Health Alliance Commercial	$1,076.46

Ijs-E Axis Pin 2.5mmx55mm IJS-EAP-25550 [3645436]

Facility

$1,922.25

Service Code	HCPCS C1713
Hospital Charge Code	3645436
Hospital Revenue Code	278
Min. Negotiated Rate	$1,076.46
Max. Negotiated Rate	$1,864.58
Rate for Payer: Cash Price	$1,249.46
Rate for Payer: Hawaii Western Management Group Commercial	$1,345.58
Rate for Payer: Health Management Network Commercial	$1,633.91
Rate for Payer: MDX Hawaii PPO	$1,864.58
Rate for Payer: University Health Alliance Commercial	$1,076.46

Know your out-of-pocket cost for care.

All Charges