Kona Community Hospital

All Charges

Charge

Type

Setting

Price

OXYTOCIN 10 UNIT/ML INJ SOLN

Facility

$19.05

Service Code	HCPCS J2590
Hospital Revenue Code	250
Min. Negotiated Rate	$16.19
Max. Negotiated Rate	$18.48
Rate for Payer: Cash Price	$12.38
Rate for Payer: Cash Price	$5.38
Rate for Payer: Health Management Network Commercial	$16.19
Rate for Payer: Health Management Network Commercial	$7.04
Rate for Payer: MDX Hawaii PPO	$18.48
Rate for Payer: MDX Hawaii PPO	$8.03

OXYTOCIN 30 UNIT/500 ML NS

Facility

$59.66

Service Code	HCPCS J2590
Hospital Revenue Code	636
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$57.87
Rate for Payer: Cash Price	$38.78
Rate for Payer: Cash Price	$38.78
Rate for Payer: Hawaii Medical Service Association ABD	$0.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.55
Rate for Payer: Hawaii Western Management Group Commercial	$56.68
Rate for Payer: Health Management Network Commercial	$50.71
Rate for Payer: Kaiser Permanente Commercial	$37.59
Rate for Payer: Kaiser Permanente Medicaid	$30.43
Rate for Payer: MDX Hawaii PPO	$57.87
Rate for Payer: UnitedHealthcare Medicaid	$35.80
Rate for Payer: University Health Alliance Commercial	$43.49

OXYTOCIN 30 UNIT/500 ML NS

Facility

$59.66

Service Code	HCPCS J2590
Hospital Revenue Code	250
Min. Negotiated Rate	$50.71
Max. Negotiated Rate	$57.87
Rate for Payer: Cash Price	$38.78
Rate for Payer: Health Management Network Commercial	$50.71
Rate for Payer: MDX Hawaii PPO	$57.87

OXYTOCIN IN 0.9 % SOD CHLORIDE 30 UNIT/500 ML IV SOLN

Facility

$123.57

Service Code	HCPCS J7999
Hospital Revenue Code	250
Min. Negotiated Rate	$105.03
Max. Negotiated Rate	$119.86
Rate for Payer: Cash Price	$80.32
Rate for Payer: Cash Price	$85.70
Rate for Payer: Health Management Network Commercial	$112.07
Rate for Payer: Health Management Network Commercial	$105.03
Rate for Payer: MDX Hawaii PPO	$119.86
Rate for Payer: MDX Hawaii PPO	$127.89

OXYTOCIN IN 0.9 % SOD CHLORIDE 30 UNIT/500 ML IV SOLN

Facility

$123.57

Service Code	HCPCS J7999
Hospital Revenue Code	636
Min. Negotiated Rate	$63.02
Max. Negotiated Rate	$119.86
Rate for Payer: Cash Price	$80.32
Rate for Payer: Cash Price	$85.70
Rate for Payer: Hawaii Western Management Group Commercial	$125.26
Rate for Payer: Hawaii Western Management Group Commercial	$117.39
Rate for Payer: Health Management Network Commercial	$105.03
Rate for Payer: Health Management Network Commercial	$112.07
Rate for Payer: Kaiser Permanente Commercial	$83.07
Rate for Payer: Kaiser Permanente Commercial	$77.85
Rate for Payer: Kaiser Permanente Medicaid	$63.02
Rate for Payer: Kaiser Permanente Medicaid	$67.24
Rate for Payer: MDX Hawaii PPO	$119.86
Rate for Payer: MDX Hawaii PPO	$127.89
Rate for Payer: UnitedHealthcare Medicaid	$79.11
Rate for Payer: UnitedHealthcare Medicaid	$74.14
Rate for Payer: University Health Alliance Commercial	$90.07
Rate for Payer: University Health Alliance Commercial	$96.11

Pacemaker Cath Selectsite C304HIS [3642175]

Facility

$2,327.50

Service Code	HCPCS C1887
Hospital Charge Code	3642175
Hospital Revenue Code	272
Min. Negotiated Rate	$1,187.03
Max. Negotiated Rate	$2,257.68
Rate for Payer: Cash Price	$1,512.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,211.12
Rate for Payer: Health Management Network Commercial	$1,978.38
Rate for Payer: Kaiser Permanente Commercial	$1,466.33
Rate for Payer: Kaiser Permanente Medicaid	$1,187.03
Rate for Payer: MDX Hawaii PPO	$2,257.68
Rate for Payer: University Health Alliance Commercial	$1,696.51

Pacemaker Cath Selectsite C304HIS [3642175]

Facility

$2,327.50

Service Code	HCPCS C1887
Hospital Charge Code	3642175
Hospital Revenue Code	272
Min. Negotiated Rate	$1,978.38
Max. Negotiated Rate	$2,257.68
Rate for Payer: Cash Price	$1,512.88
Rate for Payer: Health Management Network Commercial	$1,978.38
Rate for Payer: MDX Hawaii PPO	$2,257.68

Pacemaker Generator Accolade Mri Dr L311 [3643605]

Facility

$34,473.00

Service Code	HCPCS C1785
Hospital Charge Code	3643605
Hospital Revenue Code	278
Min. Negotiated Rate	$17,581.23
Max. Negotiated Rate	$33,438.81
Rate for Payer: Cash Price	$22,407.45
Rate for Payer: Hawaii Western Management Group Commercial	$24,131.10
Rate for Payer: Health Management Network Commercial	$29,302.05
Rate for Payer: Kaiser Permanente Commercial	$21,717.99
Rate for Payer: Kaiser Permanente Medicaid	$17,581.23
Rate for Payer: MDX Hawaii PPO	$33,438.81
Rate for Payer: University Health Alliance Commercial	$19,304.88

Pacemaker Generator Accolade Mri Dr L311 [3643605]

Facility

$34,473.00

Service Code	HCPCS C1785
Hospital Charge Code	3643605
Hospital Revenue Code	278
Min. Negotiated Rate	$19,304.88
Max. Negotiated Rate	$33,438.81
Rate for Payer: Cash Price	$22,407.45
Rate for Payer: Hawaii Western Management Group Commercial	$24,131.10
Rate for Payer: Health Management Network Commercial	$29,302.05
Rate for Payer: MDX Hawaii PPO	$33,438.81
Rate for Payer: University Health Alliance Commercial	$19,304.88

Pacemaker Generator Assurity DR MRI PM2272 [3640961]

Facility

$29,853.00

Service Code	HCPCS C1785
Hospital Charge Code	3640961
Hospital Revenue Code	275
Min. Negotiated Rate	$16,717.68
Max. Negotiated Rate	$28,957.41
Rate for Payer: Cash Price	$19,404.45
Rate for Payer: Hawaii Western Management Group Commercial	$20,897.10
Rate for Payer: Health Management Network Commercial	$25,375.05
Rate for Payer: MDX Hawaii PPO	$28,957.41
Rate for Payer: University Health Alliance Commercial	$16,717.68

Pacemaker Generator Assurity DR MRI PM2272 [3640961]

Facility

$29,853.00

Service Code	HCPCS C1785
Hospital Charge Code	3640961
Hospital Revenue Code	275
Min. Negotiated Rate	$15,225.03
Max. Negotiated Rate	$28,957.41
Rate for Payer: Cash Price	$19,404.45
Rate for Payer: Hawaii Western Management Group Commercial	$20,897.10
Rate for Payer: Health Management Network Commercial	$25,375.05
Rate for Payer: Kaiser Permanente Commercial	$18,807.39
Rate for Payer: Kaiser Permanente Medicaid	$15,225.03
Rate for Payer: MDX Hawaii PPO	$28,957.41
Rate for Payer: University Health Alliance Commercial	$16,717.68

Pacemaker Generator Assurity MRI PM1272 [3641005]

Facility

$17,500.00

Service Code	HCPCS C1786
Hospital Charge Code	3641005
Hospital Revenue Code	275
Min. Negotiated Rate	$8,925.00
Max. Negotiated Rate	$16,975.00
Rate for Payer: Cash Price	$11,375.00
Rate for Payer: Hawaii Western Management Group Commercial	$12,250.00
Rate for Payer: Health Management Network Commercial	$14,875.00
Rate for Payer: Kaiser Permanente Commercial	$11,025.00
Rate for Payer: Kaiser Permanente Medicaid	$8,925.00
Rate for Payer: MDX Hawaii PPO	$16,975.00
Rate for Payer: University Health Alliance Commercial	$9,800.00

Pacemaker Generator Assurity MRI PM1272 [3641005]

Facility

$17,500.00

Service Code	HCPCS C1786
Hospital Charge Code	3641005
Hospital Revenue Code	275
Min. Negotiated Rate	$9,800.00
Max. Negotiated Rate	$16,975.00
Rate for Payer: Cash Price	$11,375.00
Rate for Payer: Hawaii Western Management Group Commercial	$12,250.00
Rate for Payer: Health Management Network Commercial	$14,875.00
Rate for Payer: MDX Hawaii PPO	$16,975.00
Rate for Payer: University Health Alliance Commercial	$9,800.00

Pacemaker Generator Azure XT DR MRI W1DR01 [3641083]

Facility

$17,225.00

Service Code	HCPCS C1785
Hospital Charge Code	3641083
Hospital Revenue Code	275
Min. Negotiated Rate	$9,646.00
Max. Negotiated Rate	$16,708.25
Rate for Payer: Cash Price	$11,196.25
Rate for Payer: Hawaii Western Management Group Commercial	$12,057.50
Rate for Payer: Health Management Network Commercial	$14,641.25
Rate for Payer: MDX Hawaii PPO	$16,708.25
Rate for Payer: University Health Alliance Commercial	$9,646.00

Pacemaker Generator Azure XT DR MRI W1DR01 [3641083]

Facility

$17,225.00

Service Code	HCPCS C1785
Hospital Charge Code	3641083
Hospital Revenue Code	275
Min. Negotiated Rate	$8,784.75
Max. Negotiated Rate	$16,708.25
Rate for Payer: Cash Price	$11,196.25
Rate for Payer: Hawaii Western Management Group Commercial	$12,057.50
Rate for Payer: Health Management Network Commercial	$14,641.25
Rate for Payer: Kaiser Permanente Commercial	$10,851.75
Rate for Payer: Kaiser Permanente Medicaid	$8,784.75
Rate for Payer: MDX Hawaii PPO	$16,708.25
Rate for Payer: University Health Alliance Commercial	$9,646.00

Pacemaker Generator Gallant Vr CDVRA500Q [3644174]

Facility

$65,098.00

Service Code	HCPCS C1722
Hospital Charge Code	3644174
Hospital Revenue Code	275
Min. Negotiated Rate	$36,454.88
Max. Negotiated Rate	$63,145.06
Rate for Payer: Cash Price	$42,313.70
Rate for Payer: Hawaii Western Management Group Commercial	$45,568.60
Rate for Payer: Health Management Network Commercial	$55,333.30
Rate for Payer: MDX Hawaii PPO	$63,145.06
Rate for Payer: University Health Alliance Commercial	$36,454.88

Pacemaker Generator Gallant Vr CDVRA500Q [3644174]

Facility

$65,098.00

Service Code	HCPCS C1722
Hospital Charge Code	3644174
Hospital Revenue Code	275
Min. Negotiated Rate	$33,199.98
Max. Negotiated Rate	$63,145.06
Rate for Payer: MDX Hawaii PPO	$63,145.06
Rate for Payer: Cash Price	$42,313.70
Rate for Payer: Hawaii Western Management Group Commercial	$45,568.60
Rate for Payer: Health Management Network Commercial	$55,333.30
Rate for Payer: Kaiser Permanente Commercial	$41,011.74
Rate for Payer: Kaiser Permanente Medicaid	$33,199.98
Rate for Payer: University Health Alliance Commercial	$36,454.88

Pacemaker Lead Ingevity+ 45cm 7840 [3643877]

Facility

$2,565.00

Service Code	HCPCS C1898
Hospital Charge Code	3643877
Hospital Revenue Code	275
Min. Negotiated Rate	$1,308.15
Max. Negotiated Rate	$2,488.05
Rate for Payer: Cash Price	$1,667.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,795.50
Rate for Payer: Health Management Network Commercial	$2,180.25
Rate for Payer: Kaiser Permanente Commercial	$1,615.95
Rate for Payer: Kaiser Permanente Medicaid	$1,308.15
Rate for Payer: MDX Hawaii PPO	$2,488.05
Rate for Payer: University Health Alliance Commercial	$1,436.40

Pacemaker Lead Ingevity+ 45cm 7840 [3643877]

Facility

$2,565.00

Service Code	HCPCS C1898
Hospital Charge Code	3643877
Hospital Revenue Code	275
Min. Negotiated Rate	$1,436.40
Max. Negotiated Rate	$2,488.05
Rate for Payer: Cash Price	$1,667.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,795.50
Rate for Payer: Health Management Network Commercial	$2,180.25
Rate for Payer: MDX Hawaii PPO	$2,488.05
Rate for Payer: University Health Alliance Commercial	$1,436.40

Pacemaker Lead Ingevity+ 52cm 7841 [3643878]

Facility

$2,565.00

Service Code	HCPCS C1898
Hospital Charge Code	3643878
Hospital Revenue Code	275
Min. Negotiated Rate	$1,308.15
Max. Negotiated Rate	$2,488.05
Rate for Payer: Cash Price	$1,667.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,795.50
Rate for Payer: Health Management Network Commercial	$2,180.25
Rate for Payer: Kaiser Permanente Commercial	$1,615.95
Rate for Payer: Kaiser Permanente Medicaid	$1,308.15
Rate for Payer: MDX Hawaii PPO	$2,488.05
Rate for Payer: University Health Alliance Commercial	$1,436.40

Pacemaker Lead Ingevity+ 52cm 7841 [3643878]

Facility

$2,565.00

Service Code	HCPCS C1898
Hospital Charge Code	3643878
Hospital Revenue Code	275
Min. Negotiated Rate	$1,436.40
Max. Negotiated Rate	$2,488.05
Rate for Payer: Cash Price	$1,667.25
Rate for Payer: Hawaii Western Management Group Commercial	$1,795.50
Rate for Payer: Health Management Network Commercial	$2,180.25
Rate for Payer: MDX Hawaii PPO	$2,488.05
Rate for Payer: University Health Alliance Commercial	$1,436.40

Pacemaker Lead Tendril 2088TC/46 [3640962]

Facility

$2,450.00

Service Code	HCPCS C1898
Hospital Charge Code	3640962
Hospital Revenue Code	275
Min. Negotiated Rate	$1,249.50
Max. Negotiated Rate	$2,376.50
Rate for Payer: Cash Price	$1,592.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,715.00
Rate for Payer: Health Management Network Commercial	$2,082.50
Rate for Payer: Kaiser Permanente Commercial	$1,543.50
Rate for Payer: Kaiser Permanente Medicaid	$1,249.50
Rate for Payer: MDX Hawaii PPO	$2,376.50
Rate for Payer: University Health Alliance Commercial	$1,372.00

Pacemaker Lead Tendril 2088TC/46 [3640962]

Facility

$2,450.00

Service Code	HCPCS C1898
Hospital Charge Code	3640962
Hospital Revenue Code	275
Min. Negotiated Rate	$1,372.00
Max. Negotiated Rate	$2,376.50
Rate for Payer: Cash Price	$1,592.50
Rate for Payer: Hawaii Western Management Group Commercial	$1,715.00
Rate for Payer: Health Management Network Commercial	$2,082.50
Rate for Payer: MDX Hawaii PPO	$2,376.50
Rate for Payer: University Health Alliance Commercial	$1,372.00

Pacemaker Lead Tendril 2088TC/52 [3640963]

Facility

$3,653.00

Service Code	HCPCS C1898
Hospital Charge Code	3640963
Hospital Revenue Code	275
Min. Negotiated Rate	$1,863.03
Max. Negotiated Rate	$3,543.41
Rate for Payer: Cash Price	$2,374.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,557.10
Rate for Payer: Health Management Network Commercial	$3,105.05
Rate for Payer: Kaiser Permanente Commercial	$2,301.39
Rate for Payer: Kaiser Permanente Medicaid	$1,863.03
Rate for Payer: MDX Hawaii PPO	$3,543.41
Rate for Payer: University Health Alliance Commercial	$2,045.68

Pacemaker Lead Tendril 2088TC/52 [3640963]

Facility

$3,653.00

Service Code	HCPCS C1898
Hospital Charge Code	3640963
Hospital Revenue Code	275
Min. Negotiated Rate	$2,045.68
Max. Negotiated Rate	$3,543.41
Rate for Payer: Cash Price	$2,374.45
Rate for Payer: Hawaii Western Management Group Commercial	$2,557.10
Rate for Payer: Health Management Network Commercial	$3,105.05
Rate for Payer: MDX Hawaii PPO	$3,543.41
Rate for Payer: University Health Alliance Commercial	$2,045.68

Know your out-of-pocket cost for care.

All Charges