Kona Community Hospital

All Charges

Charge

Type

Setting

Price

NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL

Facility

$6,183.00

Service Code	CPT 64721
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$2,306.84
Rate for Payer: AlohaCare Medicare	$2,306.84
Rate for Payer: Devoted Health Medicare	$2,537.52
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,306.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$2,306.84
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,306.84
Rate for Payer: Ohana Health Plan Medicaid	$2,537.52
Rate for Payer: Ohana Health Plan Medicare	$2,306.84
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,306.84
Rate for Payer: University Health Alliance Commercial	$5,160.40

NEUROSES EXCEPT DEPRESSIVE

Facility

$18,523.05

Service Code	MSDRG 882
Min. Negotiated Rate	$9,691.01
Max. Negotiated Rate	$18,523.05
Rate for Payer: AlohaCare Medicare	$14,123.45
Rate for Payer: Devoted Health Medicare	$15,535.80
Rate for Payer: Hawaii Medical Service Association Commercial	$9,691.01
Rate for Payer: Hawaii Medical Service Association Medicare	$14,123.45
Rate for Payer: Humana Medicare	$14,123.45
Rate for Payer: Kaiser Permanente Commercial	$18,523.05
Rate for Payer: Kaiser Permanente Medicare	$14,123.45
Rate for Payer: Ohana Health Plan Medicare	$14,123.45
Rate for Payer: UnitedHealthcare Medicare	$14,123.45

NICARDIPINE 20MG/200ML IN NS PREMIX

Facility

$493.28

Service Code	HCPCS J2404
Hospital Revenue Code	250
Min. Negotiated Rate	$419.29
Max. Negotiated Rate	$478.48
Rate for Payer: Cash Price	$320.63
Rate for Payer: Health Management Network Commercial	$419.29
Rate for Payer: MDX Hawaii PPO	$478.48

NICARDIPINE 20MG/200ML IN NS PREMIX

Facility

$493.28

Service Code	HCPCS J2404
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$478.48
Rate for Payer: Cash Price	$320.63
Rate for Payer: Cash Price	$320.63
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	$468.62
Rate for Payer: Health Management Network Commercial	$419.29
Rate for Payer: Kaiser Permanente Commercial	$310.77
Rate for Payer: Kaiser Permanente Medicaid	$251.57
Rate for Payer: MDX Hawaii PPO	$478.48
Rate for Payer: UnitedHealthcare Medicaid	$295.97
Rate for Payer: University Health Alliance Commercial	$359.55

NICARDIPINE 25 MG/10 ML IV SOLN

Facility

$123.66

Service Code	HCPCS J2404
Hospital Revenue Code	250
Min. Negotiated Rate	$105.11
Max. Negotiated Rate	$119.95
Rate for Payer: Cash Price	$80.38
Rate for Payer: Cash Price	$68.86
Rate for Payer: Health Management Network Commercial	$90.05
Rate for Payer: Health Management Network Commercial	$105.11
Rate for Payer: MDX Hawaii PPO	$102.76
Rate for Payer: MDX Hawaii PPO	$119.95

NICARDIPINE 25 MG/10 ML IV SOLN

Facility

$105.94

Service Code	HCPCS J2404
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$102.76
Rate for Payer: Cash Price	$68.86
Rate for Payer: Cash Price	$68.86
Rate for Payer: Cash Price	$80.38
Rate for Payer: Cash Price	$80.38
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	$100.64
Rate for Payer: Hawaii Western Management Group Commercial	$117.48
Rate for Payer: Health Management Network Commercial	$105.11
Rate for Payer: Health Management Network Commercial	$90.05
Rate for Payer: Kaiser Permanente Commercial	$77.91
Rate for Payer: Kaiser Permanente Commercial	$66.74
Rate for Payer: Kaiser Permanente Medicaid	$54.03
Rate for Payer: Kaiser Permanente Medicaid	$63.07
Rate for Payer: MDX Hawaii PPO	$119.95
Rate for Payer: MDX Hawaii PPO	$102.76
Rate for Payer: UnitedHealthcare Medicaid	$63.56
Rate for Payer: UnitedHealthcare Medicaid	$74.20
Rate for Payer: University Health Alliance Commercial	$90.14
Rate for Payer: University Health Alliance Commercial	$77.22

NICARDIPINE IN SALINE (ISO-OS) 20 MG/200 ML IV IVPB

Facility

$225.00

Service Code	HCPCS J2404
Hospital Revenue Code	250
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$247.60
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Health Management Network Commercial	$323.78
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: MDX Hawaii PPO	$369.49

NICARDIPINE IN SALINE (ISO-OS) 20 MG/200 ML IV IVPB

Facility

$225.00

Service Code	HCPCS J2404
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$218.25
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$247.60
Rate for Payer: Cash Price	$146.25
Rate for Payer: Cash Price	$247.60
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	$361.87
Rate for Payer: Hawaii Western Management Group Commercial	$213.75
Rate for Payer: Health Management Network Commercial	$323.78
Rate for Payer: Health Management Network Commercial	$191.25
Rate for Payer: Kaiser Permanente Commercial	$239.98
Rate for Payer: Kaiser Permanente Commercial	$141.75
Rate for Payer: Kaiser Permanente Medicaid	$114.75
Rate for Payer: Kaiser Permanente Medicaid	$194.27
Rate for Payer: MDX Hawaii PPO	$218.25
Rate for Payer: MDX Hawaii PPO	$369.49
Rate for Payer: UnitedHealthcare Medicaid	$228.55
Rate for Payer: UnitedHealthcare Medicaid	$135.00
Rate for Payer: University Health Alliance Commercial	$164.00
Rate for Payer: University Health Alliance Commercial	$277.65

NICOTINE 14 MG/24 HR TRANSDERM PT24

Facility

$9.82

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$9.53
Rate for Payer: Cash Price	$6.38
Rate for Payer: Hawaii Western Management Group Commercial	$9.33
Rate for Payer: Health Management Network Commercial	$8.35
Rate for Payer: Kaiser Permanente Commercial	$6.19
Rate for Payer: Kaiser Permanente Medicaid	$5.01
Rate for Payer: MDX Hawaii PPO	$9.53
Rate for Payer: UnitedHealthcare Medicaid	$5.89
Rate for Payer: University Health Alliance Commercial	$7.16

NICOTINE 14 MG/24 HR TRANSDERM PT24

Facility

$9.82

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$8.35
Max. Negotiated Rate	$9.53
Rate for Payer: Cash Price	$6.38
Rate for Payer: Health Management Network Commercial	$8.35
Rate for Payer: MDX Hawaii PPO	$9.53

NICOTINE 21 MG/24 HR TRANSDERM PT24

Facility

$7.86

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$7.62
Rate for Payer: Cash Price	$5.11
Rate for Payer: Cash Price	$6.38
Rate for Payer: Health Management Network Commercial	$6.68
Rate for Payer: Health Management Network Commercial	$8.35
Rate for Payer: MDX Hawaii PPO	$7.62
Rate for Payer: MDX Hawaii PPO	$9.53

NICOTINE 21 MG/24 HR TRANSDERM PT24

Facility

$9.82

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$9.53
Rate for Payer: Cash Price	$6.38
Rate for Payer: Cash Price	$5.11
Rate for Payer: Hawaii Western Management Group Commercial	$7.47
Rate for Payer: Hawaii Western Management Group Commercial	$9.33
Rate for Payer: Health Management Network Commercial	$6.68
Rate for Payer: Health Management Network Commercial	$8.35
Rate for Payer: Kaiser Permanente Commercial	$6.19
Rate for Payer: Kaiser Permanente Commercial	$4.95
Rate for Payer: Kaiser Permanente Medicaid	$5.01
Rate for Payer: Kaiser Permanente Medicaid	$4.01
Rate for Payer: MDX Hawaii PPO	$7.62
Rate for Payer: MDX Hawaii PPO	$9.53
Rate for Payer: UnitedHealthcare Medicaid	$4.72
Rate for Payer: UnitedHealthcare Medicaid	$5.89
Rate for Payer: University Health Alliance Commercial	$7.16
Rate for Payer: University Health Alliance Commercial	$5.73

NICOTINE 7 MG/24 HR TRANSDERM PT24

Facility

$11.83

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$10.06
Max. Negotiated Rate	$11.48
Rate for Payer: Cash Price	$7.69
Rate for Payer: Cash Price	$5.11
Rate for Payer: Health Management Network Commercial	$6.68
Rate for Payer: Health Management Network Commercial	$10.06
Rate for Payer: MDX Hawaii PPO	$11.48
Rate for Payer: MDX Hawaii PPO	$7.62

NICOTINE 7 MG/24 HR TRANSDERM PT24

Facility

$11.83

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$11.48
Rate for Payer: Cash Price	$7.69
Rate for Payer: Cash Price	$5.11
Rate for Payer: Hawaii Western Management Group Commercial	$11.24
Rate for Payer: Hawaii Western Management Group Commercial	$7.47
Rate for Payer: Health Management Network Commercial	$10.06
Rate for Payer: Health Management Network Commercial	$6.68
Rate for Payer: Kaiser Permanente Commercial	$7.45
Rate for Payer: Kaiser Permanente Commercial	$4.95
Rate for Payer: Kaiser Permanente Medicaid	$6.03
Rate for Payer: Kaiser Permanente Medicaid	$4.01
Rate for Payer: MDX Hawaii PPO	$11.48
Rate for Payer: MDX Hawaii PPO	$7.62
Rate for Payer: UnitedHealthcare Medicaid	$4.72
Rate for Payer: UnitedHealthcare Medicaid	$7.10
Rate for Payer: University Health Alliance Commercial	$8.62
Rate for Payer: University Health Alliance Commercial	$5.73

NIFEDIPINE 10 MG PO CAP

Facility

$5.90

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$5.72
Rate for Payer: Cash Price	$3.84
Rate for Payer: Cash Price	$3.87
Rate for Payer: Health Management Network Commercial	$5.06
Rate for Payer: Health Management Network Commercial	$5.01
Rate for Payer: MDX Hawaii PPO	$5.77
Rate for Payer: MDX Hawaii PPO	$5.72

NIFEDIPINE 10 MG PO CAP

Facility

$5.90

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$5.72
Rate for Payer: Cash Price	$3.84
Rate for Payer: Cash Price	$3.87
Rate for Payer: Hawaii Western Management Group Commercial	$5.61
Rate for Payer: Hawaii Western Management Group Commercial	$5.65
Rate for Payer: Health Management Network Commercial	$5.06
Rate for Payer: Health Management Network Commercial	$5.01
Rate for Payer: Kaiser Permanente Commercial	$3.72
Rate for Payer: Kaiser Permanente Commercial	$3.75
Rate for Payer: Kaiser Permanente Medicaid	$3.03
Rate for Payer: Kaiser Permanente Medicaid	$3.01
Rate for Payer: MDX Hawaii PPO	$5.77
Rate for Payer: MDX Hawaii PPO	$5.72
Rate for Payer: UnitedHealthcare Medicaid	$3.54
Rate for Payer: UnitedHealthcare Medicaid	$3.57
Rate for Payer: University Health Alliance Commercial	$4.34
Rate for Payer: University Health Alliance Commercial	$4.30

NIFEDIPINE 30 MG PO TAB SUSTAINED RELEASE

Facility

$7.70

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$7.47
Rate for Payer: Cash Price	$5.00
Rate for Payer: Hawaii Western Management Group Commercial	$7.32
Rate for Payer: Health Management Network Commercial	$6.54
Rate for Payer: Kaiser Permanente Commercial	$4.85
Rate for Payer: Kaiser Permanente Medicaid	$3.93
Rate for Payer: MDX Hawaii PPO	$7.47
Rate for Payer: UnitedHealthcare Medicaid	$4.62
Rate for Payer: University Health Alliance Commercial	$5.61

NIFEDIPINE 30 MG PO TAB SUSTAINED RELEASE

Facility

$7.70

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$7.47
Rate for Payer: Cash Price	$5.00
Rate for Payer: Health Management Network Commercial	$6.54
Rate for Payer: MDX Hawaii PPO	$7.47

NIFEDIPINE 60 MG PO TAB SUSTAINED RELEASE

Facility

$13.71

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$13.30
Rate for Payer: Cash Price	$8.91
Rate for Payer: Health Management Network Commercial	$11.65
Rate for Payer: MDX Hawaii PPO	$13.30

NIFEDIPINE 60 MG PO TAB SUSTAINED RELEASE

Facility

$13.71

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$13.30
Rate for Payer: Cash Price	$8.91
Rate for Payer: Hawaii Western Management Group Commercial	$13.02
Rate for Payer: Health Management Network Commercial	$11.65
Rate for Payer: Kaiser Permanente Commercial	$8.64
Rate for Payer: Kaiser Permanente Medicaid	$6.99
Rate for Payer: MDX Hawaii PPO	$13.30
Rate for Payer: UnitedHealthcare Medicaid	$8.23
Rate for Payer: University Health Alliance Commercial	$9.99

NIFEDIPINE 90 MG PO TAB SUSTAINED RELEASE

Facility

$16.74

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.23
Max. Negotiated Rate	$16.24
Rate for Payer: Cash Price	$10.88
Rate for Payer: Health Management Network Commercial	$14.23
Rate for Payer: MDX Hawaii PPO	$16.24

NIFEDIPINE 90 MG PO TAB SUSTAINED RELEASE

Facility

$16.74

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$8.54
Max. Negotiated Rate	$16.24
Rate for Payer: Cash Price	$10.88
Rate for Payer: Hawaii Western Management Group Commercial	$15.90
Rate for Payer: Health Management Network Commercial	$14.23
Rate for Payer: Kaiser Permanente Commercial	$10.55
Rate for Payer: Kaiser Permanente Medicaid	$8.54
Rate for Payer: MDX Hawaii PPO	$16.24
Rate for Payer: UnitedHealthcare Medicaid	$10.04
Rate for Payer: University Health Alliance Commercial	$12.20

NIMODIPINE 30 MG PO CAP

Facility

$97.63

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$49.79
Max. Negotiated Rate	$94.70
Rate for Payer: Cash Price	$63.46
Rate for Payer: Hawaii Western Management Group Commercial	$92.75
Rate for Payer: Health Management Network Commercial	$82.99
Rate for Payer: Kaiser Permanente Commercial	$61.51
Rate for Payer: Kaiser Permanente Medicaid	$49.79
Rate for Payer: MDX Hawaii PPO	$94.70
Rate for Payer: UnitedHealthcare Medicaid	$58.58
Rate for Payer: University Health Alliance Commercial	$71.16

NIMODIPINE 30 MG PO CAP

Facility

$97.63

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$82.99
Max. Negotiated Rate	$94.70
Rate for Payer: Cash Price	$63.46
Rate for Payer: Health Management Network Commercial	$82.99
Rate for Payer: MDX Hawaii PPO	$94.70

NIM Probe Prass Monopolar Stimulator 8225101E [3610417]

Facility

$785.67

Hospital Charge Code	3610417
Hospital Revenue Code	272
Min. Negotiated Rate	$400.69
Max. Negotiated Rate	$762.10
Rate for Payer: Cash Price	$510.69
Rate for Payer: Hawaii Western Management Group Commercial	$746.39
Rate for Payer: Health Management Network Commercial	$667.82
Rate for Payer: Kaiser Permanente Commercial	$494.97
Rate for Payer: Kaiser Permanente Medicaid	$400.69
Rate for Payer: MDX Hawaii PPO	$762.10
Rate for Payer: University Health Alliance Commercial	$572.67

Know your out-of-pocket cost for care.

All Charges