Kona Community Hospital

All Charges

Charge

Type

Setting

Price

MIDAZOLAM (PF) 5 MG/ML INTRANASAL FOR PEDIATRIC SEDATION (WHR)

Facility

$7.49

Service Code	NDC 00409230822
Hospital Revenue Code	250
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$7.27
Rate for Payer: Cash Price	$4.87
Rate for Payer: Health Management Network Commercial	$6.37
Rate for Payer: MDX Hawaii PPO	$7.27

MIDAZOLAM (PF) 5 MG/ML INTRANASAL FOR PEDIATRIC SEDATION (WHR)

Facility

$7.49

Service Code	NDC 00409230802
Hospital Revenue Code	250
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$7.27
Rate for Payer: Cash Price	$4.87
Rate for Payer: Hawaii Western Management Group Commercial	$7.12
Rate for Payer: Health Management Network Commercial	$6.37
Rate for Payer: Kaiser Permanente Commercial	$4.72
Rate for Payer: Kaiser Permanente Medicaid	$3.82
Rate for Payer: MDX Hawaii PPO	$7.27
Rate for Payer: UnitedHealthcare Medicaid	$4.49
Rate for Payer: University Health Alliance Commercial	$5.46

MIDAZOLAM (PF) 5 MG/ML INTRANASAL FOR PEDIATRIC SEDATION (WHR)

Facility

$7.49

Service Code	NDC 00409230802
Hospital Revenue Code	250
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$7.27
Rate for Payer: Cash Price	$4.87
Rate for Payer: Health Management Network Commercial	$6.37
Rate for Payer: MDX Hawaii PPO	$7.27

MIDAZOLAM (PF) IN 0.9 % NACL 1 MG/ML IV SOLN

Facility

$127.30

Service Code	HCPCS J2251
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$123.48
Rate for Payer: Cash Price	$82.74
Rate for Payer: Cash Price	$62.02
Rate for Payer: Cash Price	$82.74
Rate for Payer: Cash Price	$62.02
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Western Management Group Commercial	$90.65
Rate for Payer: Hawaii Western Management Group Commercial	$120.94
Rate for Payer: Health Management Network Commercial	$81.11
Rate for Payer: Health Management Network Commercial	$108.20
Rate for Payer: Kaiser Permanente Commercial	$60.11
Rate for Payer: Kaiser Permanente Commercial	$80.20
Rate for Payer: Kaiser Permanente Medicaid	$64.92
Rate for Payer: Kaiser Permanente Medicaid	$48.66
Rate for Payer: MDX Hawaii PPO	$123.48
Rate for Payer: MDX Hawaii PPO	$92.56
Rate for Payer: UnitedHealthcare Medicaid	$57.25
Rate for Payer: UnitedHealthcare Medicaid	$76.38
Rate for Payer: University Health Alliance Commercial	$92.79
Rate for Payer: University Health Alliance Commercial	$69.55

MIDAZOLAM (PF) IN 0.9 % NACL 1 MG/ML IV SOLN

Facility

$127.30

Service Code	HCPCS J2251
Hospital Revenue Code	250
Min. Negotiated Rate	$108.20
Max. Negotiated Rate	$123.48
Rate for Payer: Cash Price	$82.74
Rate for Payer: Cash Price	$62.02
Rate for Payer: Health Management Network Commercial	$108.20
Rate for Payer: Health Management Network Commercial	$81.11
Rate for Payer: MDX Hawaii PPO	$123.48
Rate for Payer: MDX Hawaii PPO	$92.56

MIDODRINE 5 MG PO TABLET

Facility

$4.97

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$4.82
Rate for Payer: Cash Price	$3.23
Rate for Payer: Hawaii Western Management Group Commercial	$4.72
Rate for Payer: Health Management Network Commercial	$4.22
Rate for Payer: Kaiser Permanente Commercial	$3.13
Rate for Payer: Kaiser Permanente Medicaid	$2.53
Rate for Payer: MDX Hawaii PPO	$4.82
Rate for Payer: UnitedHealthcare Medicaid	$2.98
Rate for Payer: University Health Alliance Commercial	$3.62

MIDODRINE 5 MG PO TABLET

Facility

$4.97

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$4.82
Rate for Payer: Cash Price	$3.23
Rate for Payer: Health Management Network Commercial	$4.22
Rate for Payer: MDX Hawaii PPO	$4.82

MIFEPRISTONE 200 MG PO TABLET

Facility

$376.08

Service Code	NDC 43393000101
Hospital Revenue Code	250
Min. Negotiated Rate	$191.80
Max. Negotiated Rate	$364.80
Rate for Payer: Cash Price	$244.45
Rate for Payer: Hawaii Western Management Group Commercial	$357.28
Rate for Payer: Health Management Network Commercial	$319.67
Rate for Payer: Kaiser Permanente Commercial	$236.93
Rate for Payer: Kaiser Permanente Medicaid	$191.80
Rate for Payer: MDX Hawaii PPO	$364.80
Rate for Payer: UnitedHealthcare Medicaid	$225.65
Rate for Payer: University Health Alliance Commercial	$274.12

MIFEPRISTONE 200 MG PO TABLET

Facility

$376.08

Service Code	NDC 43393000101
Hospital Revenue Code	250
Min. Negotiated Rate	$319.67
Max. Negotiated Rate	$364.80
Rate for Payer: Cash Price	$244.45
Rate for Payer: Health Management Network Commercial	$319.67
Rate for Payer: MDX Hawaii PPO	$364.80

MIFEPRISTONE 200 MG PO TABLET

Facility

$376.08

Service Code	NDC 43393000106
Hospital Revenue Code	250
Min. Negotiated Rate	$191.80
Max. Negotiated Rate	$364.80
Rate for Payer: Cash Price	$244.45
Rate for Payer: Hawaii Western Management Group Commercial	$357.28
Rate for Payer: Health Management Network Commercial	$319.67
Rate for Payer: Kaiser Permanente Commercial	$236.93
Rate for Payer: Kaiser Permanente Medicaid	$191.80
Rate for Payer: MDX Hawaii PPO	$364.80
Rate for Payer: UnitedHealthcare Medicaid	$225.65
Rate for Payer: University Health Alliance Commercial	$274.12

MIFEPRISTONE 200 MG PO TABLET

Facility

$376.08

Service Code	NDC 43393000106
Hospital Revenue Code	250
Min. Negotiated Rate	$319.67
Max. Negotiated Rate	$364.80
Rate for Payer: Cash Price	$244.45
Rate for Payer: Health Management Network Commercial	$319.67
Rate for Payer: MDX Hawaii PPO	$364.80

MIGRAINE & OTHER HEADACHES

Facility

$7,451.23

Service Code	APR-DRG 0544
Min. Negotiated Rate	$7,451.23
Max. Negotiated Rate	$7,451.23
Rate for Payer: AlohaCare Medicaid	$7,451.23
Rate for Payer: Hawaii Medical Service Association ABD	$7,451.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,451.23
Rate for Payer: Kaiser Permanente Medicaid	$7,451.23
Rate for Payer: Ohana Health Plan Medicaid	$7,451.23
Rate for Payer: UnitedHealthcare Medicaid	$7,451.23

MIGRAINE & OTHER HEADACHES

Facility

$4,047.52

Service Code	APR-DRG 0543
Min. Negotiated Rate	$4,047.52
Max. Negotiated Rate	$4,047.52
Rate for Payer: AlohaCare Medicaid	$4,047.52
Rate for Payer: Hawaii Medical Service Association ABD	$4,047.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,047.52
Rate for Payer: Kaiser Permanente Medicaid	$4,047.52
Rate for Payer: Ohana Health Plan Medicaid	$4,047.52
Rate for Payer: UnitedHealthcare Medicaid	$4,047.52

MIGRAINE & OTHER HEADACHES

Facility

$3,231.14

Service Code	APR-DRG 0542
Min. Negotiated Rate	$3,231.14
Max. Negotiated Rate	$3,231.14
Rate for Payer: AlohaCare Medicaid	$3,231.14
Rate for Payer: Hawaii Medical Service Association ABD	$3,231.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,231.14
Rate for Payer: Kaiser Permanente Medicaid	$3,231.14
Rate for Payer: Ohana Health Plan Medicaid	$3,231.14
Rate for Payer: UnitedHealthcare Medicaid	$3,231.14

MIGRAINE & OTHER HEADACHES

Facility

$2,622.99

Service Code	APR-DRG 0541
Min. Negotiated Rate	$2,622.99
Max. Negotiated Rate	$2,622.99
Rate for Payer: AlohaCare Medicaid	$2,622.99
Rate for Payer: Hawaii Medical Service Association ABD	$2,622.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,622.99
Rate for Payer: Kaiser Permanente Medicaid	$2,622.99
Rate for Payer: Ohana Health Plan Medicaid	$2,622.99
Rate for Payer: UnitedHealthcare Medicaid	$2,622.99

MILRINONE 1 MG/ML IV SOLN

Facility

$42.88

Service Code	HCPCS J2260
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$41.59
Rate for Payer: Cash Price	$27.87
Rate for Payer: Cash Price	$27.87
Rate for Payer: Hawaii Medical Service Association ABD	$1.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.40
Rate for Payer: Hawaii Western Management Group Commercial	$40.74
Rate for Payer: Health Management Network Commercial	$36.45
Rate for Payer: Kaiser Permanente Commercial	$27.01
Rate for Payer: Kaiser Permanente Medicaid	$21.87
Rate for Payer: MDX Hawaii PPO	$41.59
Rate for Payer: UnitedHealthcare Medicaid	$25.73
Rate for Payer: University Health Alliance Commercial	$31.26

MILRINONE 1 MG/ML IV SOLN

Facility

$42.88

Service Code	HCPCS J2260
Hospital Revenue Code	250
Min. Negotiated Rate	$36.45
Max. Negotiated Rate	$41.59
Rate for Payer: Cash Price	$27.87
Rate for Payer: Health Management Network Commercial	$36.45
Rate for Payer: MDX Hawaii PPO	$41.59

MILRINONE IN 5 % DEXTROSE 20 MG/100 ML (200 MCG/ML) IV IVPB

Facility

$80.93

Service Code	HCPCS J2260
Hospital Revenue Code	250
Min. Negotiated Rate	$68.79
Max. Negotiated Rate	$78.50
Rate for Payer: Cash Price	$52.60
Rate for Payer: Health Management Network Commercial	$68.79
Rate for Payer: MDX Hawaii PPO	$78.50

MILRINONE IN 5 % DEXTROSE 20 MG/100 ML (200 MCG/ML) IV IVPB

Facility

$80.93

Service Code	HCPCS J2260
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$78.50
Rate for Payer: Cash Price	$52.60
Rate for Payer: Cash Price	$52.60
Rate for Payer: Hawaii Medical Service Association ABD	$1.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.40
Rate for Payer: Hawaii Western Management Group Commercial	$76.88
Rate for Payer: Health Management Network Commercial	$68.79
Rate for Payer: Kaiser Permanente Commercial	$50.99
Rate for Payer: Kaiser Permanente Medicaid	$41.27
Rate for Payer: MDX Hawaii PPO	$78.50
Rate for Payer: UnitedHealthcare Medicaid	$48.56
Rate for Payer: University Health Alliance Commercial	$58.99

MINERAL OIL, LIGHT STERILE MISC OIL

Facility

$112.31

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$57.28
Max. Negotiated Rate	$108.94
Rate for Payer: Cash Price	$73.00
Rate for Payer: Hawaii Western Management Group Commercial	$106.69
Rate for Payer: Health Management Network Commercial	$95.46
Rate for Payer: Kaiser Permanente Commercial	$70.76
Rate for Payer: Kaiser Permanente Medicaid	$57.28
Rate for Payer: MDX Hawaii PPO	$108.94
Rate for Payer: UnitedHealthcare Medicaid	$67.39
Rate for Payer: University Health Alliance Commercial	$81.86

MINERAL OIL, LIGHT STERILE MISC OIL

Facility

$112.31

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$95.46
Max. Negotiated Rate	$108.94
Rate for Payer: Cash Price	$73.00
Rate for Payer: Health Management Network Commercial	$95.46
Rate for Payer: MDX Hawaii PPO	$108.94

MINERAL OIL PO OIL

Facility

$10.93

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$10.60
Rate for Payer: Cash Price	$7.10
Rate for Payer: Health Management Network Commercial	$9.29
Rate for Payer: MDX Hawaii PPO	$10.60

MINERAL OIL PO OIL

Facility

$10.93

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$10.60
Rate for Payer: Cash Price	$7.10
Rate for Payer: Hawaii Western Management Group Commercial	$10.38
Rate for Payer: Health Management Network Commercial	$9.29
Rate for Payer: Kaiser Permanente Commercial	$6.89
Rate for Payer: Kaiser Permanente Medicaid	$5.57
Rate for Payer: MDX Hawaii PPO	$10.60
Rate for Payer: UnitedHealthcare Medicaid	$6.56
Rate for Payer: University Health Alliance Commercial	$7.97

MINERAL OIL PR ENEMA

Facility

$19.09

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.74
Max. Negotiated Rate	$18.52
Rate for Payer: Cash Price	$12.41
Rate for Payer: Hawaii Western Management Group Commercial	$18.14
Rate for Payer: Health Management Network Commercial	$16.23
Rate for Payer: Kaiser Permanente Commercial	$12.03
Rate for Payer: Kaiser Permanente Medicaid	$9.74
Rate for Payer: MDX Hawaii PPO	$18.52
Rate for Payer: UnitedHealthcare Medicaid	$11.45
Rate for Payer: University Health Alliance Commercial	$13.91

MINERAL OIL PR ENEMA

Facility

$19.09

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$16.23
Max. Negotiated Rate	$18.52
Rate for Payer: Cash Price	$12.41
Rate for Payer: Health Management Network Commercial	$16.23
Rate for Payer: MDX Hawaii PPO	$18.52

Know your out-of-pocket cost for care.

All Charges