Kona Community Hospital

All Charges

Charge

Type

Setting

Price

BELATACEPT 250 MG IV RECON.SOLN.

Facility

$2,253.48

Service Code	HCPCS J0485
Hospital Revenue Code	636
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$2,185.88
Rate for Payer: AlohaCare Medicaid	$3.89
Rate for Payer: AlohaCare Medicare	$3.89
Rate for Payer: Cash Price	$1,464.76
Rate for Payer: Cash Price	$1,464.76
Rate for Payer: Devoted Health Medicare	$4.28
Rate for Payer: Hawaii Medical Service Association ABD	$3.89
Rate for Payer: Hawaii Medical Service Association Commercial	$4.86
Rate for Payer: Hawaii Medical Service Association Medicare	$3.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.89
Rate for Payer: Hawaii Western Management Group Commercial	$2,140.81
Rate for Payer: Health Management Network Commercial	$1,915.46
Rate for Payer: Humana Medicare	$3.89
Rate for Payer: Kaiser Permanente Commercial	$1,419.69
Rate for Payer: Kaiser Permanente Medicaid	$1,149.27
Rate for Payer: Kaiser Permanente Medicare	$3.89
Rate for Payer: MDX Hawaii PPO	$2,185.88
Rate for Payer: Ohana Health Plan Medicaid	$4.28
Rate for Payer: Ohana Health Plan Medicare	$3.89
Rate for Payer: UnitedHealthcare Medicaid	$1,352.09
Rate for Payer: UnitedHealthcare Medicare	$3.89
Rate for Payer: University Health Alliance Commercial	$1,642.56

BELINOSTAT 500 MG IV RECON.SOLN.

Facility

$4,154.74

Service Code	HCPCS J9032
Hospital Revenue Code	250
Min. Negotiated Rate	$3,531.53
Max. Negotiated Rate	$4,030.10
Rate for Payer: Cash Price	$2,700.58
Rate for Payer: Health Management Network Commercial	$3,531.53
Rate for Payer: MDX Hawaii PPO	$4,030.10

BELINOSTAT 500 MG IV RECON.SOLN.

Facility

$4,154.74

Service Code	HCPCS J9032
Hospital Revenue Code	636
Min. Negotiated Rate	$52.04
Max. Negotiated Rate	$4,030.10
Rate for Payer: AlohaCare Medicaid	$53.11
Rate for Payer: AlohaCare Medicare	$53.11
Rate for Payer: Cash Price	$2,700.58
Rate for Payer: Cash Price	$2,700.58
Rate for Payer: Devoted Health Medicare	$58.42
Rate for Payer: Hawaii Medical Service Association ABD	$52.04
Rate for Payer: Hawaii Medical Service Association Commercial	$66.39
Rate for Payer: Hawaii Medical Service Association Medicare	$53.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$52.04
Rate for Payer: Hawaii Western Management Group Commercial	$3,947.00
Rate for Payer: Health Management Network Commercial	$3,531.53
Rate for Payer: Humana Medicare	$53.11
Rate for Payer: Kaiser Permanente Commercial	$2,617.49
Rate for Payer: Kaiser Permanente Medicaid	$2,118.92
Rate for Payer: Kaiser Permanente Medicare	$53.11
Rate for Payer: MDX Hawaii PPO	$4,030.10
Rate for Payer: Ohana Health Plan Medicaid	$58.42
Rate for Payer: Ohana Health Plan Medicare	$53.11
Rate for Payer: UnitedHealthcare Medicaid	$2,492.84
Rate for Payer: UnitedHealthcare Medicare	$53.11
Rate for Payer: University Health Alliance Commercial	$3,028.39

BELLADONNA ALKALOIDS-OPIUM 16.2-30 MG PR SUPP

Facility

$131.93

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$112.14
Max. Negotiated Rate	$127.97
Rate for Payer: Cash Price	$85.75
Rate for Payer: Health Management Network Commercial	$112.14
Rate for Payer: MDX Hawaii PPO	$127.97

BELLADONNA ALKALOIDS-OPIUM 16.2-30 MG PR SUPP

Facility

$131.93

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$67.28
Max. Negotiated Rate	$127.97
Rate for Payer: Cash Price	$85.75
Rate for Payer: Hawaii Western Management Group Commercial	$125.33
Rate for Payer: Health Management Network Commercial	$112.14
Rate for Payer: Kaiser Permanente Commercial	$83.12
Rate for Payer: Kaiser Permanente Medicaid	$67.28
Rate for Payer: MDX Hawaii PPO	$127.97
Rate for Payer: UnitedHealthcare Medicaid	$79.16
Rate for Payer: University Health Alliance Commercial	$96.16

BENDAMUSTINE 100 MG IV RECON.SOLN.

Facility

$966.60

Service Code	HCPCS J9033
Hospital Revenue Code	250
Min. Negotiated Rate	$821.61
Max. Negotiated Rate	$937.60
Rate for Payer: Cash Price	$628.29
Rate for Payer: Health Management Network Commercial	$821.61
Rate for Payer: MDX Hawaii PPO	$937.60

BENDAMUSTINE 100 MG IV RECON.SOLN.

Facility

$966.60

Service Code	HCPCS J9033
Hospital Revenue Code	636
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$937.60
Rate for Payer: AlohaCare Medicaid	$2.16
Rate for Payer: AlohaCare Medicare	$2.16
Rate for Payer: Cash Price	$628.29
Rate for Payer: Cash Price	$628.29
Rate for Payer: Devoted Health Medicare	$2.38
Rate for Payer: Hawaii Medical Service Association ABD	$1.85
Rate for Payer: Hawaii Medical Service Association Commercial	$2.70
Rate for Payer: Hawaii Medical Service Association Medicare	$2.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.85
Rate for Payer: Hawaii Western Management Group Commercial	$918.27
Rate for Payer: Health Management Network Commercial	$821.61
Rate for Payer: Humana Medicare	$2.16
Rate for Payer: Kaiser Permanente Commercial	$608.96
Rate for Payer: Kaiser Permanente Medicaid	$492.97
Rate for Payer: Kaiser Permanente Medicare	$2.16
Rate for Payer: MDX Hawaii PPO	$937.60
Rate for Payer: Ohana Health Plan Medicaid	$2.38
Rate for Payer: Ohana Health Plan Medicare	$2.16
Rate for Payer: UnitedHealthcare Medicaid	$579.96
Rate for Payer: UnitedHealthcare Medicare	$2.16
Rate for Payer: University Health Alliance Commercial	$704.55

BENDAMUSTINE 25 MG IV RECON.SOLN.

Facility

$2,090.84

Service Code	HCPCS J9033
Hospital Revenue Code	250
Min. Negotiated Rate	$1,777.21
Max. Negotiated Rate	$2,028.11
Rate for Payer: Cash Price	$1,359.05
Rate for Payer: Health Management Network Commercial	$1,777.21
Rate for Payer: MDX Hawaii PPO	$2,028.11

BENDAMUSTINE 25 MG IV RECON.SOLN.

Facility

$2,090.84

Service Code	HCPCS J9033
Hospital Revenue Code	636
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$2,028.11
Rate for Payer: AlohaCare Medicaid	$2.16
Rate for Payer: AlohaCare Medicare	$2.16
Rate for Payer: Cash Price	$1,359.05
Rate for Payer: Cash Price	$1,359.05
Rate for Payer: Devoted Health Medicare	$2.38
Rate for Payer: Hawaii Medical Service Association ABD	$1.85
Rate for Payer: Hawaii Medical Service Association Commercial	$2.70
Rate for Payer: Hawaii Medical Service Association Medicare	$2.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.85
Rate for Payer: Hawaii Western Management Group Commercial	$1,986.30
Rate for Payer: Health Management Network Commercial	$1,777.21
Rate for Payer: Humana Medicare	$2.16
Rate for Payer: Kaiser Permanente Commercial	$1,317.23
Rate for Payer: Kaiser Permanente Medicaid	$1,066.33
Rate for Payer: Kaiser Permanente Medicare	$2.16
Rate for Payer: MDX Hawaii PPO	$2,028.11
Rate for Payer: Ohana Health Plan Medicaid	$2.38
Rate for Payer: Ohana Health Plan Medicare	$2.16
Rate for Payer: UnitedHealthcare Medicaid	$1,254.50
Rate for Payer: UnitedHealthcare Medicare	$2.16
Rate for Payer: University Health Alliance Commercial	$1,524.01

BENIGN PROSTATIC HYPERTROPHY WITH MCC

Facility

$25,432.88

Service Code	MSDRG 725
Min. Negotiated Rate	$15,391.37
Max. Negotiated Rate	$25,432.88
Rate for Payer: AlohaCare Medicare	$15,391.37
Rate for Payer: Devoted Health Medicare	$16,930.51
Rate for Payer: Hawaii Medical Service Association Commercial	$25,432.88
Rate for Payer: Hawaii Medical Service Association Medicare	$15,391.37
Rate for Payer: Humana Medicare	$15,391.37
Rate for Payer: Kaiser Permanente Commercial	$20,185.95
Rate for Payer: Kaiser Permanente Medicare	$15,391.37
Rate for Payer: Ohana Health Plan Medicare	$15,391.37
Rate for Payer: UnitedHealthcare Medicare	$15,391.37

BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC

Facility

$25,432.88

Service Code	MSDRG 726
Min. Negotiated Rate	$9,496.30
Max. Negotiated Rate	$25,432.88
Rate for Payer: AlohaCare Medicare	$9,496.30
Rate for Payer: Devoted Health Medicare	$10,445.93
Rate for Payer: Hawaii Medical Service Association Commercial	$25,432.88
Rate for Payer: Hawaii Medical Service Association Medicare	$9,496.30
Rate for Payer: Humana Medicare	$9,496.30
Rate for Payer: Kaiser Permanente Commercial	$12,454.50
Rate for Payer: Kaiser Permanente Medicare	$9,496.30
Rate for Payer: Ohana Health Plan Medicare	$9,496.30
Rate for Payer: UnitedHealthcare Medicare	$9,496.30

BENZOCAINE 20 % MM NON-AER.SPRY

Facility

$75.25

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$63.96
Max. Negotiated Rate	$72.99
Rate for Payer: Cash Price	$48.91
Rate for Payer: Health Management Network Commercial	$63.96
Rate for Payer: MDX Hawaii PPO	$72.99

BENZOCAINE 20 % MM NON-AER.SPRY

Facility

$75.25

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$38.38
Max. Negotiated Rate	$72.99
Rate for Payer: Cash Price	$48.91
Rate for Payer: Hawaii Western Management Group Commercial	$71.49
Rate for Payer: Health Management Network Commercial	$63.96
Rate for Payer: Kaiser Permanente Commercial	$47.41
Rate for Payer: Kaiser Permanente Medicaid	$38.38
Rate for Payer: MDX Hawaii PPO	$72.99
Rate for Payer: UnitedHealthcare Medicaid	$45.15
Rate for Payer: University Health Alliance Commercial	$54.85

BENZOCAINE-MENTHOL 15-2.6 MG MM LOZG

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

BENZOCAINE-MENTHOL 15-2.6 MG MM LOZG

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

BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG

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

BENZOCAINE-MENTHOL 15-3.6 MG MM LOZG

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

BENZOCAINE-MENTHOL 20-0.5 % TOP AEROSOL

Facility

$38.48

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$32.71
Max. Negotiated Rate	$37.33
Rate for Payer: Cash Price	$25.01
Rate for Payer: Health Management Network Commercial	$32.71
Rate for Payer: MDX Hawaii PPO	$37.33

BENZOCAINE-MENTHOL 20-0.5 % TOP AEROSOL

Facility

$38.48

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$19.62
Max. Negotiated Rate	$37.33
Rate for Payer: Cash Price	$25.01
Rate for Payer: Hawaii Western Management Group Commercial	$36.56
Rate for Payer: Health Management Network Commercial	$32.71
Rate for Payer: Kaiser Permanente Commercial	$24.24
Rate for Payer: Kaiser Permanente Medicaid	$19.62
Rate for Payer: MDX Hawaii PPO	$37.33
Rate for Payer: UnitedHealthcare Medicaid	$23.09
Rate for Payer: University Health Alliance Commercial	$28.05

BENZOIN-ALOE VERA-STORAX-TOLU 10-2-8-4 % TOP TINC

Facility

$53.42

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$27.24
Max. Negotiated Rate	$51.82
Rate for Payer: Cash Price	$34.72
Rate for Payer: Hawaii Western Management Group Commercial	$50.75
Rate for Payer: Health Management Network Commercial	$45.41
Rate for Payer: Kaiser Permanente Commercial	$33.65
Rate for Payer: Kaiser Permanente Medicaid	$27.24
Rate for Payer: MDX Hawaii PPO	$51.82
Rate for Payer: UnitedHealthcare Medicaid	$32.05
Rate for Payer: University Health Alliance Commercial	$38.94

BENZOIN-ALOE VERA-STORAX-TOLU 10-2-8-4 % TOP TINC

Facility

$53.42

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$45.41
Max. Negotiated Rate	$51.82
Rate for Payer: Cash Price	$34.72
Rate for Payer: Health Management Network Commercial	$45.41
Rate for Payer: MDX Hawaii PPO	$51.82

BENZONATATE 100 MG PO CAP

Facility

$2.73

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$2.65
Rate for Payer: Cash Price	$1.77
Rate for Payer: Cash Price	$8.98
Rate for Payer: Cash Price	$2.62
Rate for Payer: Health Management Network Commercial	$2.32
Rate for Payer: Health Management Network Commercial	$11.75
Rate for Payer: Health Management Network Commercial	$3.43
Rate for Payer: MDX Hawaii PPO	$13.41
Rate for Payer: MDX Hawaii PPO	$3.91
Rate for Payer: MDX Hawaii PPO	$2.65

BENZONATATE 100 MG PO CAP

Facility

$4.03

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$3.91
Rate for Payer: Cash Price	$2.62
Rate for Payer: Cash Price	$1.77
Rate for Payer: Cash Price	$8.98
Rate for Payer: Hawaii Western Management Group Commercial	$3.83
Rate for Payer: Hawaii Western Management Group Commercial	$13.13
Rate for Payer: Hawaii Western Management Group Commercial	$2.59
Rate for Payer: Health Management Network Commercial	$3.43
Rate for Payer: Health Management Network Commercial	$2.32
Rate for Payer: Health Management Network Commercial	$11.75
Rate for Payer: Kaiser Permanente Commercial	$2.54
Rate for Payer: Kaiser Permanente Commercial	$1.72
Rate for Payer: Kaiser Permanente Commercial	$8.71
Rate for Payer: Kaiser Permanente Medicaid	$2.06
Rate for Payer: Kaiser Permanente Medicaid	$1.39
Rate for Payer: Kaiser Permanente Medicaid	$7.05
Rate for Payer: MDX Hawaii PPO	$13.41
Rate for Payer: MDX Hawaii PPO	$2.65
Rate for Payer: MDX Hawaii PPO	$3.91
Rate for Payer: UnitedHealthcare Medicaid	$8.29
Rate for Payer: UnitedHealthcare Medicaid	$2.42
Rate for Payer: UnitedHealthcare Medicaid	$1.64
Rate for Payer: University Health Alliance Commercial	$1.99
Rate for Payer: University Health Alliance Commercial	$10.07
Rate for Payer: University Health Alliance Commercial	$2.94

BENZTROPINE 1 MG PO TABLET

Facility

$3.25

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$3.15
Rate for Payer: Cash Price	$2.11
Rate for Payer: Hawaii Western Management Group Commercial	$3.09
Rate for Payer: Health Management Network Commercial	$2.76
Rate for Payer: Kaiser Permanente Commercial	$2.05
Rate for Payer: Kaiser Permanente Medicaid	$1.66
Rate for Payer: MDX Hawaii PPO	$3.15
Rate for Payer: UnitedHealthcare Medicaid	$1.95
Rate for Payer: University Health Alliance Commercial	$2.37

BENZTROPINE 1 MG PO TABLET

Facility

$3.25

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$3.15
Rate for Payer: Cash Price	$2.11
Rate for Payer: Health Management Network Commercial	$2.76
Rate for Payer: MDX Hawaii PPO	$3.15

Know your out-of-pocket cost for care.

All Charges