Kona Community Hospital

All Charges

Charge

Type

Setting

Price

OLANZAPINE 5 MG PO RAPID DISSOLVING TABS

Facility

$76.45

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$64.98
Max. Negotiated Rate	$74.16
Rate for Payer: Cash Price	$49.69
Rate for Payer: Health Management Network Commercial	$64.98
Rate for Payer: MDX Hawaii PPO	$74.16

OLANZAPINE 5 MG PO RAPID DISSOLVING TABS

Facility

$76.45

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$38.99
Max. Negotiated Rate	$74.16
Rate for Payer: Cash Price	$49.69
Rate for Payer: Hawaii Western Management Group Commercial	$72.63
Rate for Payer: Health Management Network Commercial	$64.98
Rate for Payer: Kaiser Permanente Commercial	$48.16
Rate for Payer: Kaiser Permanente Medicaid	$38.99
Rate for Payer: MDX Hawaii PPO	$74.16
Rate for Payer: UnitedHealthcare Medicaid	$45.87
Rate for Payer: University Health Alliance Commercial	$55.72

OLANZAPINE 5 MG PO TABLET

Facility

$62.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$31.76
Max. Negotiated Rate	$60.40
Rate for Payer: Cash Price	$40.48
Rate for Payer: Cash Price	$47.27
Rate for Payer: Hawaii Western Management Group Commercial	$59.16
Rate for Payer: Hawaii Western Management Group Commercial	$69.08
Rate for Payer: Health Management Network Commercial	$52.93
Rate for Payer: Health Management Network Commercial	$61.81
Rate for Payer: Kaiser Permanente Commercial	$45.81
Rate for Payer: Kaiser Permanente Commercial	$39.23
Rate for Payer: Kaiser Permanente Medicaid	$31.76
Rate for Payer: Kaiser Permanente Medicaid	$37.09
Rate for Payer: MDX Hawaii PPO	$70.54
Rate for Payer: MDX Hawaii PPO	$60.40
Rate for Payer: UnitedHealthcare Medicaid	$37.36
Rate for Payer: UnitedHealthcare Medicaid	$43.63
Rate for Payer: University Health Alliance Commercial	$53.01
Rate for Payer: University Health Alliance Commercial	$45.39

OLANZAPINE 5 MG PO TABLET

Facility

$62.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$52.93
Max. Negotiated Rate	$60.40
Rate for Payer: Cash Price	$40.48
Rate for Payer: Cash Price	$47.27
Rate for Payer: Health Management Network Commercial	$52.93
Rate for Payer: Health Management Network Commercial	$61.81
Rate for Payer: MDX Hawaii PPO	$60.40
Rate for Payer: MDX Hawaii PPO	$70.54

Olive Wire Smooth 1.4mm P99-200-1406 [3644545]

Facility

$855.28

Hospital Charge Code	3644545
Hospital Revenue Code	272
Min. Negotiated Rate	$726.99
Max. Negotiated Rate	$829.62
Rate for Payer: Cash Price	$555.93
Rate for Payer: Health Management Network Commercial	$726.99
Rate for Payer: MDX Hawaii PPO	$829.62

Olive Wire Smooth 1.4mm P99-200-1406 [3644545]

Facility

$855.28

Hospital Charge Code	3644545
Hospital Revenue Code	272
Min. Negotiated Rate	$436.19
Max. Negotiated Rate	$829.62
Rate for Payer: Cash Price	$555.93
Rate for Payer: Hawaii Western Management Group Commercial	$812.52
Rate for Payer: Health Management Network Commercial	$726.99
Rate for Payer: Kaiser Permanente Commercial	$538.83
Rate for Payer: Kaiser Permanente Medicaid	$436.19
Rate for Payer: MDX Hawaii PPO	$829.62
Rate for Payer: University Health Alliance Commercial	$623.41

Olive Wire Smooth 1.6x100mm Tower Long [3644547]

Facility

$855.28

Hospital Charge Code	3644547
Hospital Revenue Code	272
Min. Negotiated Rate	$726.99
Max. Negotiated Rate	$829.62
Rate for Payer: Cash Price	$555.93
Rate for Payer: Health Management Network Commercial	$726.99
Rate for Payer: MDX Hawaii PPO	$829.62

Olive Wire Smooth 1.6x100mm Tower Long [3644547]

Facility

$855.28

Hospital Charge Code	3644547
Hospital Revenue Code	272
Min. Negotiated Rate	$436.19
Max. Negotiated Rate	$829.62
Rate for Payer: Cash Price	$555.93
Rate for Payer: Hawaii Western Management Group Commercial	$812.52
Rate for Payer: Health Management Network Commercial	$726.99
Rate for Payer: Kaiser Permanente Commercial	$538.83
Rate for Payer: Kaiser Permanente Medicaid	$436.19
Rate for Payer: MDX Hawaii PPO	$829.62
Rate for Payer: University Health Alliance Commercial	$623.41

Olive Wire Smooth 1.6 x 80mm Tower Stnd P99-250-1608 [3644546]

Facility

$855.28

Hospital Charge Code	3644546
Hospital Revenue Code	272
Min. Negotiated Rate	$436.19
Max. Negotiated Rate	$829.62
Rate for Payer: Cash Price	$555.93
Rate for Payer: Hawaii Western Management Group Commercial	$812.52
Rate for Payer: Health Management Network Commercial	$726.99
Rate for Payer: Kaiser Permanente Commercial	$538.83
Rate for Payer: Kaiser Permanente Medicaid	$436.19
Rate for Payer: MDX Hawaii PPO	$829.62
Rate for Payer: University Health Alliance Commercial	$623.41

Olive Wire Smooth 1.6 x 80mm Tower Stnd P99-250-1608 [3644546]

Facility

$855.28

Hospital Charge Code	3644546
Hospital Revenue Code	272
Min. Negotiated Rate	$726.99
Max. Negotiated Rate	$829.62
Rate for Payer: Cash Price	$555.93
Rate for Payer: Health Management Network Commercial	$726.99
Rate for Payer: MDX Hawaii PPO	$829.62

Olive Wire Threaded 1.3mm P99-201-1306 [3644501]

Facility

$855.28

Hospital Charge Code	3644501
Hospital Revenue Code	272
Min. Negotiated Rate	$436.19
Max. Negotiated Rate	$829.62
Rate for Payer: Cash Price	$555.93
Rate for Payer: Hawaii Western Management Group Commercial	$812.52
Rate for Payer: Health Management Network Commercial	$726.99
Rate for Payer: Kaiser Permanente Commercial	$538.83
Rate for Payer: Kaiser Permanente Medicaid	$436.19
Rate for Payer: MDX Hawaii PPO	$829.62
Rate for Payer: University Health Alliance Commercial	$623.41

Olive Wire Threaded 1.3mm P99-201-1306 [3644501]

Facility

$855.28

Hospital Charge Code	3644501
Hospital Revenue Code	272
Min. Negotiated Rate	$726.99
Max. Negotiated Rate	$829.62
Rate for Payer: Cash Price	$555.93
Rate for Payer: Health Management Network Commercial	$726.99
Rate for Payer: MDX Hawaii PPO	$829.62

OMENTAL FLAP, INTRA-ABDOMINAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$2,837.00

Service Code	CPT 49905
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$521.33

ONABOTULINUMTOXINA 100 UNIT INJ RECON.SOLN.

Facility

$1,591.48

Service Code	HCPCS J0585
Hospital Revenue Code	250
Min. Negotiated Rate	$1,352.76
Max. Negotiated Rate	$1,543.74
Rate for Payer: Cash Price	$1,034.46
Rate for Payer: Health Management Network Commercial	$1,352.76
Rate for Payer: MDX Hawaii PPO	$1,543.74

ONABOTULINUMTOXINA 100 UNIT INJ RECON.SOLN.

Facility

$1,591.48

Service Code	HCPCS J0585
Hospital Revenue Code	636
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$1,543.74
Rate for Payer: AlohaCare Medicaid	$6.51
Rate for Payer: AlohaCare Medicare	$6.51
Rate for Payer: Cash Price	$1,034.46
Rate for Payer: Cash Price	$1,034.46
Rate for Payer: Devoted Health Medicare	$7.16
Rate for Payer: Hawaii Medical Service Association ABD	$6.50
Rate for Payer: Hawaii Medical Service Association Commercial	$8.14
Rate for Payer: Hawaii Medical Service Association Medicare	$6.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,511.91
Rate for Payer: Health Management Network Commercial	$1,352.76
Rate for Payer: Humana Medicare	$6.51
Rate for Payer: Kaiser Permanente Commercial	$1,002.63
Rate for Payer: Kaiser Permanente Medicaid	$811.65
Rate for Payer: Kaiser Permanente Medicare	$6.51
Rate for Payer: MDX Hawaii PPO	$1,543.74
Rate for Payer: Ohana Health Plan Medicaid	$7.16
Rate for Payer: Ohana Health Plan Medicare	$6.51
Rate for Payer: UnitedHealthcare Medicaid	$954.89
Rate for Payer: UnitedHealthcare Medicare	$6.51
Rate for Payer: University Health Alliance Commercial	$1,160.03

ONDANSETRON 4 MG PO ORAL DISINTEGRATING TABLET

Facility

$113.69

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$57.98
Max. Negotiated Rate	$110.28
Rate for Payer: Cash Price	$73.90
Rate for Payer: Cash Price	$71.70
Rate for Payer: Hawaii Western Management Group Commercial	$104.78
Rate for Payer: Hawaii Western Management Group Commercial	$108.01
Rate for Payer: Health Management Network Commercial	$93.75
Rate for Payer: Health Management Network Commercial	$96.64
Rate for Payer: Kaiser Permanente Commercial	$71.62
Rate for Payer: Kaiser Permanente Commercial	$69.49
Rate for Payer: Kaiser Permanente Medicaid	$57.98
Rate for Payer: Kaiser Permanente Medicaid	$56.25
Rate for Payer: MDX Hawaii PPO	$106.99
Rate for Payer: MDX Hawaii PPO	$110.28
Rate for Payer: UnitedHealthcare Medicaid	$66.18
Rate for Payer: UnitedHealthcare Medicaid	$68.21
Rate for Payer: University Health Alliance Commercial	$82.87
Rate for Payer: University Health Alliance Commercial	$80.40

ONDANSETRON 4 MG PO ORAL DISINTEGRATING TABLET

Facility

$110.30

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$106.99
Rate for Payer: Cash Price	$71.70
Rate for Payer: Cash Price	$73.90
Rate for Payer: Health Management Network Commercial	$93.75
Rate for Payer: Health Management Network Commercial	$96.64
Rate for Payer: MDX Hawaii PPO	$106.99
Rate for Payer: MDX Hawaii PPO	$110.28

ONDANSETRON 8 MG PO ORAL DISINTEGRATING TABLET

Facility

$171.73

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$145.97
Max. Negotiated Rate	$166.58
Rate for Payer: Cash Price	$111.62
Rate for Payer: Cash Price	$115.30
Rate for Payer: Health Management Network Commercial	$150.78
Rate for Payer: Health Management Network Commercial	$145.97
Rate for Payer: MDX Hawaii PPO	$166.58
Rate for Payer: MDX Hawaii PPO	$172.07

ONDANSETRON 8 MG PO ORAL DISINTEGRATING TABLET

Facility

$171.73

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$87.58
Max. Negotiated Rate	$166.58
Rate for Payer: Cash Price	$111.62
Rate for Payer: Cash Price	$115.30
Rate for Payer: Hawaii Western Management Group Commercial	$163.14
Rate for Payer: Hawaii Western Management Group Commercial	$168.52
Rate for Payer: Health Management Network Commercial	$145.97
Rate for Payer: Health Management Network Commercial	$150.78
Rate for Payer: Kaiser Permanente Commercial	$108.19
Rate for Payer: Kaiser Permanente Commercial	$111.76
Rate for Payer: Kaiser Permanente Medicaid	$87.58
Rate for Payer: Kaiser Permanente Medicaid	$90.47
Rate for Payer: MDX Hawaii PPO	$166.58
Rate for Payer: MDX Hawaii PPO	$172.07
Rate for Payer: UnitedHealthcare Medicaid	$106.43
Rate for Payer: UnitedHealthcare Medicaid	$103.04
Rate for Payer: University Health Alliance Commercial	$125.17
Rate for Payer: University Health Alliance Commercial	$129.30

ONDANSETRON HCL 2 MG/ML IV SOLN (20 ML MDV)

Facility

$47.62

Service Code	HCPCS J2405
Hospital Revenue Code	250
Min. Negotiated Rate	$40.48
Max. Negotiated Rate	$46.19
Rate for Payer: Cash Price	$30.95
Rate for Payer: Cash Price	$66.22
Rate for Payer: Cash Price	$35.98
Rate for Payer: Cash Price	$39.25
Rate for Payer: Health Management Network Commercial	$86.60
Rate for Payer: Health Management Network Commercial	$51.32
Rate for Payer: Health Management Network Commercial	$47.05
Rate for Payer: Health Management Network Commercial	$40.48
Rate for Payer: MDX Hawaii PPO	$53.69
Rate for Payer: MDX Hawaii PPO	$46.19
Rate for Payer: MDX Hawaii PPO	$98.82
Rate for Payer: MDX Hawaii PPO	$58.57

ONDANSETRON HCL 2 MG/ML IV SOLN (20 ML MDV)

Facility

$47.62

Service Code	HCPCS J2405
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$46.19
Rate for Payer: Cash Price	$30.95
Rate for Payer: Cash Price	$30.95
Rate for Payer: Cash Price	$66.22
Rate for Payer: Cash Price	$35.98
Rate for Payer: Cash Price	$66.22
Rate for Payer: Cash Price	$35.98
Rate for Payer: Cash Price	$39.25
Rate for Payer: Cash Price	$39.25
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 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 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	$45.24
Rate for Payer: Hawaii Western Management Group Commercial	$52.58
Rate for Payer: Hawaii Western Management Group Commercial	$57.36
Rate for Payer: Hawaii Western Management Group Commercial	$96.79
Rate for Payer: Health Management Network Commercial	$40.48
Rate for Payer: Health Management Network Commercial	$86.60
Rate for Payer: Health Management Network Commercial	$47.05
Rate for Payer: Health Management Network Commercial	$51.32
Rate for Payer: Kaiser Permanente Commercial	$30.00
Rate for Payer: Kaiser Permanente Commercial	$38.04
Rate for Payer: Kaiser Permanente Commercial	$34.87
Rate for Payer: Kaiser Permanente Commercial	$64.18
Rate for Payer: Kaiser Permanente Medicaid	$30.79
Rate for Payer: Kaiser Permanente Medicaid	$28.23
Rate for Payer: Kaiser Permanente Medicaid	$24.29
Rate for Payer: Kaiser Permanente Medicaid	$51.96
Rate for Payer: MDX Hawaii PPO	$98.82
Rate for Payer: MDX Hawaii PPO	$53.69
Rate for Payer: MDX Hawaii PPO	$46.19
Rate for Payer: MDX Hawaii PPO	$58.57
Rate for Payer: UnitedHealthcare Medicaid	$28.57
Rate for Payer: UnitedHealthcare Medicaid	$36.23
Rate for Payer: UnitedHealthcare Medicaid	$33.21
Rate for Payer: UnitedHealthcare Medicaid	$61.13
Rate for Payer: University Health Alliance Commercial	$44.01
Rate for Payer: University Health Alliance Commercial	$74.26
Rate for Payer: University Health Alliance Commercial	$34.71
Rate for Payer: University Health Alliance Commercial	$40.34

ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN 2 ML VIAL

Facility

$3.98

Service Code	HCPCS J2405
Hospital Revenue Code	250
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.86
Rate for Payer: Cash Price	$2.59
Rate for Payer: Cash Price	$3.41
Rate for Payer: Health Management Network Commercial	$3.38
Rate for Payer: Health Management Network Commercial	$4.46
Rate for Payer: MDX Hawaii PPO	$3.86
Rate for Payer: MDX Hawaii PPO	$5.09

ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN 2 ML VIAL

Facility

$5.25

Service Code	HCPCS J2405
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$5.09
Rate for Payer: Cash Price	$3.41
Rate for Payer: Cash Price	$2.59
Rate for Payer: Cash Price	$2.59
Rate for Payer: Cash Price	$3.41
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	$3.78
Rate for Payer: Hawaii Western Management Group Commercial	$4.99
Rate for Payer: Health Management Network Commercial	$4.46
Rate for Payer: Health Management Network Commercial	$3.38
Rate for Payer: Kaiser Permanente Commercial	$3.31
Rate for Payer: Kaiser Permanente Commercial	$2.51
Rate for Payer: Kaiser Permanente Medicaid	$2.03
Rate for Payer: Kaiser Permanente Medicaid	$2.68
Rate for Payer: MDX Hawaii PPO	$5.09
Rate for Payer: MDX Hawaii PPO	$3.86
Rate for Payer: UnitedHealthcare Medicaid	$2.39
Rate for Payer: UnitedHealthcare Medicaid	$3.15
Rate for Payer: University Health Alliance Commercial	$2.90
Rate for Payer: University Health Alliance Commercial	$3.83

OPEN CRANIOTOMY EXCEPT TRAUMA

Facility

$28,850.36

Service Code	APR-DRG 0214
Min. Negotiated Rate	$28,850.36
Max. Negotiated Rate	$28,850.36
Rate for Payer: AlohaCare Medicaid	$28,850.36
Rate for Payer: Hawaii Medical Service Association ABD	$28,850.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28,850.36
Rate for Payer: Kaiser Permanente Medicaid	$28,850.36
Rate for Payer: Ohana Health Plan Medicaid	$28,850.36
Rate for Payer: UnitedHealthcare Medicaid	$28,850.36

OPEN CRANIOTOMY EXCEPT TRAUMA

Facility

$13,560.08

Service Code	APR-DRG 0212
Min. Negotiated Rate	$13,560.08
Max. Negotiated Rate	$13,560.08
Rate for Payer: AlohaCare Medicaid	$13,560.08
Rate for Payer: Hawaii Medical Service Association ABD	$13,560.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,560.08
Rate for Payer: Kaiser Permanente Medicaid	$13,560.08
Rate for Payer: Ohana Health Plan Medicaid	$13,560.08
Rate for Payer: UnitedHealthcare Medicaid	$13,560.08

Know your out-of-pocket cost for care.

All Charges