Kona Community Hospital

All Charges

Charge

Type

Setting

Price

NP HYDROXYZINE HCL 25 MG #8 TAB (WHR)

Facility

$11.18

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$10.84
Rate for Payer: Cash Price	$7.27
Rate for Payer: Hawaii Western Management Group Commercial	$10.62
Rate for Payer: Health Management Network Commercial	$9.50
Rate for Payer: Kaiser Permanente Commercial	$7.04
Rate for Payer: Kaiser Permanente Medicaid	$5.70
Rate for Payer: MDX Hawaii PPO	$10.84
Rate for Payer: UnitedHealthcare Medicaid	$6.71
Rate for Payer: University Health Alliance Commercial	$8.15

NP IBUPROFEN 400 MG #8 TAB (WHR)

Facility

$3.05

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$2.96
Rate for Payer: Cash Price	$1.98
Rate for Payer: Hawaii Western Management Group Commercial	$2.90
Rate for Payer: Health Management Network Commercial	$2.59
Rate for Payer: Kaiser Permanente Commercial	$1.92
Rate for Payer: Kaiser Permanente Medicaid	$1.56
Rate for Payer: MDX Hawaii PPO	$2.96
Rate for Payer: UnitedHealthcare Medicaid	$1.83
Rate for Payer: University Health Alliance Commercial	$2.22

NP IBUPROFEN 400 MG #8 TAB (WHR)

Facility

$3.05

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$2.96
Rate for Payer: Cash Price	$1.98
Rate for Payer: Health Management Network Commercial	$2.59
Rate for Payer: MDX Hawaii PPO	$2.96

NP LOPERAMIDE 2 MG #8 CAP (WHR)

Facility

$49.07

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$25.03
Max. Negotiated Rate	$47.60
Rate for Payer: Cash Price	$31.90
Rate for Payer: Hawaii Western Management Group Commercial	$46.62
Rate for Payer: Health Management Network Commercial	$41.71
Rate for Payer: Kaiser Permanente Commercial	$30.91
Rate for Payer: Kaiser Permanente Medicaid	$25.03
Rate for Payer: MDX Hawaii PPO	$47.60
Rate for Payer: UnitedHealthcare Medicaid	$29.44
Rate for Payer: University Health Alliance Commercial	$35.77

NP LOPERAMIDE 2 MG #8 CAP (WHR)

Facility

$49.07

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$41.71
Max. Negotiated Rate	$47.60
Rate for Payer: Cash Price	$31.90
Rate for Payer: Health Management Network Commercial	$41.71
Rate for Payer: MDX Hawaii PPO	$47.60

NP LORAZEPAM 1 MG #5 TAB (WHR)

Facility

$23.13

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$19.66
Max. Negotiated Rate	$22.44
Rate for Payer: Cash Price	$15.03
Rate for Payer: Health Management Network Commercial	$19.66
Rate for Payer: MDX Hawaii PPO	$22.44

NP LORAZEPAM 1 MG #5 TAB (WHR)

Facility

$23.13

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.80
Max. Negotiated Rate	$22.44
Rate for Payer: Cash Price	$15.03
Rate for Payer: Hawaii Western Management Group Commercial	$21.97
Rate for Payer: Health Management Network Commercial	$19.66
Rate for Payer: Kaiser Permanente Commercial	$14.57
Rate for Payer: Kaiser Permanente Medicaid	$11.80
Rate for Payer: MDX Hawaii PPO	$22.44
Rate for Payer: UnitedHealthcare Medicaid	$13.88
Rate for Payer: University Health Alliance Commercial	$16.86

NP MECLIZINE 25 MG #4 TAB (WHR)

Facility

$18.91

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$18.34
Rate for Payer: Cash Price	$12.29
Rate for Payer: Health Management Network Commercial	$16.07
Rate for Payer: MDX Hawaii PPO	$18.34

NP MECLIZINE 25 MG #4 TAB (WHR)

Facility

$18.91

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$18.34
Rate for Payer: Cash Price	$12.29
Rate for Payer: Hawaii Western Management Group Commercial	$17.96
Rate for Payer: Health Management Network Commercial	$16.07
Rate for Payer: Kaiser Permanente Commercial	$11.91
Rate for Payer: Kaiser Permanente Medicaid	$9.64
Rate for Payer: MDX Hawaii PPO	$18.34
Rate for Payer: UnitedHealthcare Medicaid	$11.35
Rate for Payer: University Health Alliance Commercial	$13.78

NP MORPHINE 15 MG #4 IR TAB (WHR)

Facility

$20.08

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$19.48
Rate for Payer: Cash Price	$13.05
Rate for Payer: Hawaii Western Management Group Commercial	$19.08
Rate for Payer: Health Management Network Commercial	$17.07
Rate for Payer: Kaiser Permanente Commercial	$12.65
Rate for Payer: Kaiser Permanente Medicaid	$10.24
Rate for Payer: MDX Hawaii PPO	$19.48
Rate for Payer: UnitedHealthcare Medicaid	$12.05
Rate for Payer: University Health Alliance Commercial	$14.64

NP MORPHINE 15 MG #4 IR TAB (WHR)

Facility

$20.08

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$17.07
Max. Negotiated Rate	$19.48
Rate for Payer: Cash Price	$13.05
Rate for Payer: Health Management Network Commercial	$17.07
Rate for Payer: MDX Hawaii PPO	$19.48

NP NAPROXEN 250 MG #4 TAB (WHR)

Facility

$17.18

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$8.76
Max. Negotiated Rate	$16.66
Rate for Payer: Cash Price	$11.17
Rate for Payer: Hawaii Western Management Group Commercial	$16.32
Rate for Payer: Health Management Network Commercial	$14.60
Rate for Payer: Kaiser Permanente Commercial	$10.82
Rate for Payer: Kaiser Permanente Medicaid	$8.76
Rate for Payer: MDX Hawaii PPO	$16.66
Rate for Payer: UnitedHealthcare Medicaid	$10.31
Rate for Payer: University Health Alliance Commercial	$12.52

NP NAPROXEN 250 MG #4 TAB (WHR)

Facility

$17.18

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.60
Max. Negotiated Rate	$16.66
Rate for Payer: Cash Price	$11.17
Rate for Payer: Health Management Network Commercial	$14.60
Rate for Payer: MDX Hawaii PPO	$16.66

NP ONDANSETRON HCL 4 MG/5 ML PO SOLN #2 CUPS (10 ML TOTAL)(WHR)

Facility

$153.80

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$78.44
Max. Negotiated Rate	$149.19
Rate for Payer: Cash Price	$99.97
Rate for Payer: Hawaii Western Management Group Commercial	$146.11
Rate for Payer: Health Management Network Commercial	$130.73
Rate for Payer: Kaiser Permanente Commercial	$96.89
Rate for Payer: Kaiser Permanente Medicaid	$78.44
Rate for Payer: MDX Hawaii PPO	$149.19
Rate for Payer: UnitedHealthcare Medicaid	$92.28
Rate for Payer: University Health Alliance Commercial	$112.10

NP ONDANSETRON HCL 4 MG/5 ML PO SOLN #2 CUPS (10 ML TOTAL)(WHR)

Facility

$153.80

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$130.73
Max. Negotiated Rate	$149.19
Rate for Payer: Cash Price	$99.97
Rate for Payer: Health Management Network Commercial	$130.73
Rate for Payer: MDX Hawaii PPO	$149.19

NP OXYCODONE 5 MG #5 (WHR)

Facility

$9.06

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$8.79
Rate for Payer: Cash Price	$5.89
Rate for Payer: Hawaii Western Management Group Commercial	$8.61
Rate for Payer: Health Management Network Commercial	$7.70
Rate for Payer: Kaiser Permanente Commercial	$5.71
Rate for Payer: Kaiser Permanente Medicaid	$4.62
Rate for Payer: MDX Hawaii PPO	$8.79
Rate for Payer: UnitedHealthcare Medicaid	$5.44
Rate for Payer: University Health Alliance Commercial	$6.60

NP OXYCODONE 5 MG #5 (WHR)

Facility

$9.06

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$8.79
Rate for Payer: Cash Price	$5.89
Rate for Payer: Health Management Network Commercial	$7.70
Rate for Payer: MDX Hawaii PPO	$8.79

NP PENICILLIN V POTASSIUM 500 MG #4 TAB (WHR)

Facility

$17.16

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.59
Max. Negotiated Rate	$16.65
Rate for Payer: Cash Price	$11.15
Rate for Payer: Health Management Network Commercial	$14.59
Rate for Payer: MDX Hawaii PPO	$16.65

NP PENICILLIN V POTASSIUM 500 MG #4 TAB (WHR)

Facility

$17.16

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$16.65
Rate for Payer: Cash Price	$11.15
Rate for Payer: Hawaii Western Management Group Commercial	$16.30
Rate for Payer: Health Management Network Commercial	$14.59
Rate for Payer: Kaiser Permanente Commercial	$10.81
Rate for Payer: Kaiser Permanente Medicaid	$8.75
Rate for Payer: MDX Hawaii PPO	$16.65
Rate for Payer: UnitedHealthcare Medicaid	$10.30
Rate for Payer: University Health Alliance Commercial	$12.51

NP PHENAZOPYRIDINE 200 MG #4 TAB (WHR)

Facility

$84.24

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$42.96
Max. Negotiated Rate	$81.71
Rate for Payer: Cash Price	$54.76
Rate for Payer: Hawaii Western Management Group Commercial	$80.03
Rate for Payer: Health Management Network Commercial	$71.60
Rate for Payer: Kaiser Permanente Commercial	$53.07
Rate for Payer: Kaiser Permanente Medicaid	$42.96
Rate for Payer: MDX Hawaii PPO	$81.71
Rate for Payer: UnitedHealthcare Medicaid	$50.54
Rate for Payer: University Health Alliance Commercial	$61.40

NP PHENAZOPYRIDINE 200 MG #4 TAB (WHR)

Facility

$84.24

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$71.60
Max. Negotiated Rate	$81.71
Rate for Payer: Cash Price	$54.76
Rate for Payer: Health Management Network Commercial	$71.60
Rate for Payer: MDX Hawaii PPO	$81.71

NP PREDNISONE 20 MG #4 TAB (WHR)

Facility

$5.72

Service Code	HCPCS J7512
Hospital Revenue Code	250
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$5.55
Rate for Payer: Cash Price	$3.72
Rate for Payer: Health Management Network Commercial	$4.86
Rate for Payer: MDX Hawaii PPO	$5.55

NP PREDNISONE 20 MG #4 TAB (WHR)

Facility

$5.72

Service Code	HCPCS J7512
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$5.55
Rate for Payer: Cash Price	$3.72
Rate for Payer: Cash Price	$3.72
Rate for Payer: Hawaii Medical Service Association ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$5.43
Rate for Payer: Health Management Network Commercial	$4.86
Rate for Payer: Kaiser Permanente Commercial	$3.60
Rate for Payer: Kaiser Permanente Medicaid	$2.92
Rate for Payer: MDX Hawaii PPO	$5.55
Rate for Payer: UnitedHealthcare Medicaid	$3.43
Rate for Payer: University Health Alliance Commercial	$4.17

NP PREDNISONE 50 MG #4 TAB (WHR)

Facility

$8.99

Service Code	HCPCS J7512
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$8.72
Rate for Payer: Cash Price	$5.84
Rate for Payer: Cash Price	$5.84
Rate for Payer: Hawaii Medical Service Association ABD	$0.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.01
Rate for Payer: Hawaii Western Management Group Commercial	$8.54
Rate for Payer: Health Management Network Commercial	$7.64
Rate for Payer: Kaiser Permanente Commercial	$5.66
Rate for Payer: Kaiser Permanente Medicaid	$4.58
Rate for Payer: MDX Hawaii PPO	$8.72
Rate for Payer: UnitedHealthcare Medicaid	$5.39
Rate for Payer: University Health Alliance Commercial	$6.55

NP PREDNISONE 50 MG #4 TAB (WHR)

Facility

$8.99

Service Code	HCPCS J7512
Hospital Revenue Code	250
Min. Negotiated Rate	$7.64
Max. Negotiated Rate	$8.72
Rate for Payer: Cash Price	$5.84
Rate for Payer: Health Management Network Commercial	$7.64
Rate for Payer: MDX Hawaii PPO	$8.72

Know your out-of-pocket cost for care.

All Charges