Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Irrigation Sterile Water 500cc [2701092]

Facility

$9.27

Hospital Charge Code	2701092
Hospital Revenue Code	272
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$8.99
Rate for Payer: Cash Price	$6.03
Rate for Payer: Hawaii Western Management Group Commercial	$8.81
Rate for Payer: Health Management Network Commercial	$7.88
Rate for Payer: Kaiser Permanente Commercial	$5.84
Rate for Payer: Kaiser Permanente Medicaid	$4.73
Rate for Payer: MDX Hawaii PPO	$8.99
Rate for Payer: University Health Alliance Commercial	$6.76

Irrigation Sterile Water 500cc [2701092]

Facility

$9.27

Hospital Charge Code	2701092
Hospital Revenue Code	272
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$8.99
Rate for Payer: Cash Price	$6.03
Rate for Payer: Health Management Network Commercial	$7.88
Rate for Payer: MDX Hawaii PPO	$8.99

ISAVUCONAZONIUM SULFATE 186 MG PO CAP

Facility

$480.30

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$244.95
Max. Negotiated Rate	$465.89
Rate for Payer: Cash Price	$312.20
Rate for Payer: Hawaii Western Management Group Commercial	$456.29
Rate for Payer: Health Management Network Commercial	$408.25
Rate for Payer: Kaiser Permanente Commercial	$302.59
Rate for Payer: Kaiser Permanente Medicaid	$244.95
Rate for Payer: MDX Hawaii PPO	$465.89
Rate for Payer: UnitedHealthcare Medicaid	$288.18
Rate for Payer: University Health Alliance Commercial	$350.09

ISAVUCONAZONIUM SULFATE 186 MG PO CAP

Facility

$480.30

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$408.25
Max. Negotiated Rate	$465.89
Rate for Payer: Cash Price	$312.20
Rate for Payer: Health Management Network Commercial	$408.25
Rate for Payer: MDX Hawaii PPO	$465.89

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC

Facility

$51,685.41

Service Code	MSDRG 062
Min. Negotiated Rate	$23,112.04
Max. Negotiated Rate	$51,685.41
Rate for Payer: AlohaCare Medicare	$23,112.04
Rate for Payer: Devoted Health Medicare	$25,423.24
Rate for Payer: Hawaii Medical Service Association Commercial	$51,685.41
Rate for Payer: Hawaii Medical Service Association Medicare	$23,112.04
Rate for Payer: Humana Medicare	$23,112.04
Rate for Payer: Kaiser Permanente Commercial	$30,311.70
Rate for Payer: Kaiser Permanente Medicare	$23,112.04
Rate for Payer: Ohana Health Plan Medicare	$23,112.04
Rate for Payer: UnitedHealthcare Medicare	$23,112.04

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC

Facility

$51,685.41

Service Code	MSDRG 061
Min. Negotiated Rate	$36,263.50
Max. Negotiated Rate	$51,685.41
Rate for Payer: AlohaCare Medicare	$36,263.50
Rate for Payer: Devoted Health Medicare	$39,889.85
Rate for Payer: Hawaii Medical Service Association Commercial	$51,685.41
Rate for Payer: Hawaii Medical Service Association Medicare	$36,263.50
Rate for Payer: Humana Medicare	$36,263.50
Rate for Payer: Kaiser Permanente Commercial	$47,559.97
Rate for Payer: Kaiser Permanente Medicare	$36,263.50
Rate for Payer: Ohana Health Plan Medicare	$36,263.50
Rate for Payer: UnitedHealthcare Medicare	$36,263.50

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC

Facility

$51,685.41

Service Code	MSDRG 063
Min. Negotiated Rate	$18,463.85
Max. Negotiated Rate	$51,685.41
Rate for Payer: AlohaCare Medicare	$18,463.85
Rate for Payer: Devoted Health Medicare	$20,310.24
Rate for Payer: Hawaii Medical Service Association Commercial	$51,685.41
Rate for Payer: Hawaii Medical Service Association Medicare	$18,463.85
Rate for Payer: Humana Medicare	$18,463.85
Rate for Payer: Kaiser Permanente Commercial	$24,215.55
Rate for Payer: Kaiser Permanente Medicare	$18,463.85
Rate for Payer: Ohana Health Plan Medicare	$18,463.85
Rate for Payer: UnitedHealthcare Medicare	$18,463.85

ISOFLURANE 99.9 % INHAL LIQ

Facility

$225.00

Service Code	NDC 66794001725
Hospital Revenue Code	250
Min. Negotiated Rate	$114.75
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$141.75
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: UnitedHealthcare Medicaid	$135.00
Rate for Payer: University Health Alliance Commercial	$164.00

ISOFLURANE 99.9 % INHAL LIQ

Facility

$225.00

Service Code	NDC 66794001725
Hospital Revenue Code	250
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: MDX Hawaii PPO	$218.25

ISOPROTERENOL HCL 0.2 MG/ML INJ SOLN

Facility

$655.20

Service Code	NDC 00548950200
Hospital Revenue Code	250
Min. Negotiated Rate	$334.15
Max. Negotiated Rate	$635.54
Rate for Payer: Cash Price	$425.88
Rate for Payer: Hawaii Western Management Group Commercial	$622.44
Rate for Payer: Health Management Network Commercial	$556.92
Rate for Payer: Kaiser Permanente Commercial	$412.78
Rate for Payer: Kaiser Permanente Medicaid	$334.15
Rate for Payer: MDX Hawaii PPO	$635.54
Rate for Payer: UnitedHealthcare Medicaid	$393.12
Rate for Payer: University Health Alliance Commercial	$477.58

ISOPROTERENOL HCL 0.2 MG/ML INJ SOLN

Facility

$655.20

Service Code	NDC 00548950200
Hospital Revenue Code	250
Min. Negotiated Rate	$556.92
Max. Negotiated Rate	$635.54
Rate for Payer: Cash Price	$425.88
Rate for Payer: Health Management Network Commercial	$556.92
Rate for Payer: MDX Hawaii PPO	$635.54

ISOSORBIDE DINITRATE 10 MG PO TABLET

Facility

$6.90

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.87
Max. Negotiated Rate	$6.69
Rate for Payer: Cash Price	$4.49
Rate for Payer: Health Management Network Commercial	$5.87
Rate for Payer: MDX Hawaii PPO	$6.69

ISOSORBIDE DINITRATE 10 MG PO TABLET

Facility

$6.90

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$6.69
Rate for Payer: Cash Price	$4.49
Rate for Payer: Hawaii Western Management Group Commercial	$6.55
Rate for Payer: Health Management Network Commercial	$5.87
Rate for Payer: Kaiser Permanente Commercial	$4.35
Rate for Payer: Kaiser Permanente Medicaid	$3.52
Rate for Payer: MDX Hawaii PPO	$6.69
Rate for Payer: UnitedHealthcare Medicaid	$4.14
Rate for Payer: University Health Alliance Commercial	$5.03

ISOSORBIDE DINITRATE 20 MG PO TABLET

Facility

$6.58

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$6.38
Rate for Payer: Cash Price	$4.28
Rate for Payer: Health Management Network Commercial	$5.59
Rate for Payer: MDX Hawaii PPO	$6.38

ISOSORBIDE DINITRATE 20 MG PO TABLET

Facility

$6.58

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$6.38
Rate for Payer: Cash Price	$4.28
Rate for Payer: Hawaii Western Management Group Commercial	$6.25
Rate for Payer: Health Management Network Commercial	$5.59
Rate for Payer: Kaiser Permanente Commercial	$4.15
Rate for Payer: Kaiser Permanente Medicaid	$3.36
Rate for Payer: MDX Hawaii PPO	$6.38
Rate for Payer: UnitedHealthcare Medicaid	$3.95
Rate for Payer: University Health Alliance Commercial	$4.80

ISOSORBIDE MONONITRATE 30 MG PO TAB SR 24H

Facility

$2.10

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$2.04
Rate for Payer: Cash Price	$1.37
Rate for Payer: Health Management Network Commercial	$1.78
Rate for Payer: MDX Hawaii PPO	$2.04

ISOSORBIDE MONONITRATE 30 MG PO TAB SR 24H

Facility

$2.10

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.04
Rate for Payer: Cash Price	$1.37
Rate for Payer: Hawaii Western Management Group Commercial	$2.00
Rate for Payer: Health Management Network Commercial	$1.78
Rate for Payer: Kaiser Permanente Commercial	$1.32
Rate for Payer: Kaiser Permanente Medicaid	$1.07
Rate for Payer: MDX Hawaii PPO	$2.04
Rate for Payer: UnitedHealthcare Medicaid	$1.26
Rate for Payer: University Health Alliance Commercial	$1.53

ISOSORBIDE MONONITRATE 60 MG PO TAB SR 24H

Facility

$2.28

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$2.21
Rate for Payer: Cash Price	$1.48
Rate for Payer: Cash Price	$1.79
Rate for Payer: Hawaii Western Management Group Commercial	$2.17
Rate for Payer: Hawaii Western Management Group Commercial	$2.61
Rate for Payer: Health Management Network Commercial	$1.94
Rate for Payer: Health Management Network Commercial	$2.34
Rate for Payer: Kaiser Permanente Commercial	$1.44
Rate for Payer: Kaiser Permanente Commercial	$1.73
Rate for Payer: Kaiser Permanente Medicaid	$1.16
Rate for Payer: Kaiser Permanente Medicaid	$1.40
Rate for Payer: MDX Hawaii PPO	$2.21
Rate for Payer: MDX Hawaii PPO	$2.67
Rate for Payer: UnitedHealthcare Medicaid	$1.65
Rate for Payer: UnitedHealthcare Medicaid	$1.37
Rate for Payer: University Health Alliance Commercial	$1.66
Rate for Payer: University Health Alliance Commercial	$2.00

ISOSORBIDE MONONITRATE 60 MG PO TAB SR 24H

Facility

$2.28

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$2.21
Rate for Payer: Cash Price	$1.48
Rate for Payer: Cash Price	$1.79
Rate for Payer: Health Management Network Commercial	$2.34
Rate for Payer: Health Management Network Commercial	$1.94
Rate for Payer: MDX Hawaii PPO	$2.21
Rate for Payer: MDX Hawaii PPO	$2.67

ISOSULFAN BLUE 1 % SUBCUTANEOUS SOLN

Facility

$2,575.43

Service Code	HCPCS Q9968
Hospital Revenue Code	250
Min. Negotiated Rate	$2,189.12
Max. Negotiated Rate	$2,498.17
Rate for Payer: Cash Price	$1,674.03
Rate for Payer: Health Management Network Commercial	$2,189.12
Rate for Payer: MDX Hawaii PPO	$2,498.17

ISOSULFAN BLUE 1 % SUBCUTANEOUS SOLN

Facility

$2,575.43

Service Code	HCPCS Q9968
Hospital Revenue Code	250
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$2,498.17
Rate for Payer: AlohaCare Medicaid	$10.29
Rate for Payer: AlohaCare Medicare	$10.29
Rate for Payer: Cash Price	$1,674.03
Rate for Payer: Cash Price	$1,674.03
Rate for Payer: Devoted Health Medicare	$11.32
Rate for Payer: Hawaii Medical Service Association Commercial	$12.86
Rate for Payer: Hawaii Medical Service Association Medicare	$10.29
Rate for Payer: Hawaii Western Management Group Commercial	$2,446.66
Rate for Payer: Health Management Network Commercial	$2,189.12
Rate for Payer: Humana Medicare	$10.29
Rate for Payer: Kaiser Permanente Commercial	$1,622.52
Rate for Payer: Kaiser Permanente Medicaid	$1,313.47
Rate for Payer: Kaiser Permanente Medicare	$10.29
Rate for Payer: MDX Hawaii PPO	$2,498.17
Rate for Payer: Ohana Health Plan Medicaid	$11.32
Rate for Payer: Ohana Health Plan Medicare	$10.29
Rate for Payer: UnitedHealthcare Medicaid	$1,545.26
Rate for Payer: UnitedHealthcare Medicare	$10.29
Rate for Payer: University Health Alliance Commercial	$1,877.23

Iv Cath Angio 16gx5.25 [2702228]

Facility

$190.88

Hospital Charge Code	2702228
Hospital Revenue Code	272
Min. Negotiated Rate	$97.35
Max. Negotiated Rate	$185.15
Rate for Payer: Cash Price	$124.07
Rate for Payer: Hawaii Western Management Group Commercial	$181.34
Rate for Payer: Health Management Network Commercial	$162.25
Rate for Payer: Kaiser Permanente Commercial	$120.25
Rate for Payer: Kaiser Permanente Medicaid	$97.35
Rate for Payer: MDX Hawaii PPO	$185.15
Rate for Payer: University Health Alliance Commercial	$139.13

Iv Cath Angio 16gx5.25 [2702228]

Facility

$190.88

Hospital Charge Code	2702228
Hospital Revenue Code	272
Min. Negotiated Rate	$162.25
Max. Negotiated Rate	$185.15
Rate for Payer: Cash Price	$124.07
Rate for Payer: Health Management Network Commercial	$162.25
Rate for Payer: MDX Hawaii PPO	$185.15

IV CATH ARTERIAL 20G X 1.75 [2700339]

Facility

$157.92

Hospital Charge Code	2700339
Hospital Revenue Code	272
Min. Negotiated Rate	$80.54
Max. Negotiated Rate	$153.18
Rate for Payer: Cash Price	$102.65
Rate for Payer: Hawaii Western Management Group Commercial	$150.02
Rate for Payer: Health Management Network Commercial	$134.23
Rate for Payer: Kaiser Permanente Commercial	$99.49
Rate for Payer: Kaiser Permanente Medicaid	$80.54
Rate for Payer: MDX Hawaii PPO	$153.18
Rate for Payer: University Health Alliance Commercial	$115.11

IV CATH ARTERIAL 20G X 1.75 [2700339]

Facility

$157.92

Hospital Charge Code	2700339
Hospital Revenue Code	272
Min. Negotiated Rate	$134.23
Max. Negotiated Rate	$153.18
Rate for Payer: Cash Price	$102.65
Rate for Payer: Health Management Network Commercial	$134.23
Rate for Payer: MDX Hawaii PPO	$153.18

Know your out-of-pocket cost for care.

All Charges