Kona Community Hospital

All Charges

Charge

Type

Setting

Price

PENICILLAMINE 250 MG PO CAP

Facility

$783.68

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$666.13
Max. Negotiated Rate	$760.17
Rate for Payer: Cash Price	$509.39
Rate for Payer: Health Management Network Commercial	$666.13
Rate for Payer: MDX Hawaii PPO	$760.17

PENICILLAMINE 250 MG PO CAP

Facility

$783.68

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$399.68
Max. Negotiated Rate	$760.17
Rate for Payer: Cash Price	$509.39
Rate for Payer: Hawaii Western Management Group Commercial	$744.50
Rate for Payer: Health Management Network Commercial	$666.13
Rate for Payer: Kaiser Permanente Commercial	$493.72
Rate for Payer: Kaiser Permanente Medicaid	$399.68
Rate for Payer: MDX Hawaii PPO	$760.17
Rate for Payer: UnitedHealthcare Medicaid	$470.21
Rate for Payer: University Health Alliance Commercial	$571.22

PENICILLIN G BENZATHINE 1200000 UNIT/2 ML IM SYR

Facility

$1,006.12

Service Code	HCPCS J0561
Hospital Revenue Code	250
Min. Negotiated Rate	$855.20
Max. Negotiated Rate	$975.94
Rate for Payer: Cash Price	$653.98
Rate for Payer: Health Management Network Commercial	$855.20
Rate for Payer: MDX Hawaii PPO	$975.94

PENICILLIN G BENZATHINE 1200000 UNIT/2 ML IM SYR

Facility

$1,006.12

Service Code	HCPCS J0561
Hospital Revenue Code	636
Min. Negotiated Rate	$29.30
Max. Negotiated Rate	$975.94
Rate for Payer: AlohaCare Medicaid	$31.47
Rate for Payer: AlohaCare Medicare	$31.47
Rate for Payer: Cash Price	$653.98
Rate for Payer: Cash Price	$653.98
Rate for Payer: Devoted Health Medicare	$34.62
Rate for Payer: Hawaii Medical Service Association ABD	$29.30
Rate for Payer: Hawaii Medical Service Association Commercial	$39.34
Rate for Payer: Hawaii Medical Service Association Medicare	$31.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$29.30
Rate for Payer: Hawaii Western Management Group Commercial	$955.81
Rate for Payer: Health Management Network Commercial	$855.20
Rate for Payer: Humana Medicare	$31.47
Rate for Payer: Kaiser Permanente Commercial	$633.86
Rate for Payer: Kaiser Permanente Medicaid	$513.12
Rate for Payer: Kaiser Permanente Medicare	$31.47
Rate for Payer: MDX Hawaii PPO	$975.94
Rate for Payer: Ohana Health Plan Medicaid	$34.62
Rate for Payer: Ohana Health Plan Medicare	$31.47
Rate for Payer: UnitedHealthcare Medicaid	$603.67
Rate for Payer: UnitedHealthcare Medicare	$31.47
Rate for Payer: University Health Alliance Commercial	$733.36

PENICILLIN G BENZATHINE 600000 UNIT/ML IM SYR

Facility

$682.35

Service Code	HCPCS J0561
Hospital Revenue Code	636
Min. Negotiated Rate	$29.30
Max. Negotiated Rate	$661.88
Rate for Payer: AlohaCare Medicaid	$31.47
Rate for Payer: AlohaCare Medicare	$31.47
Rate for Payer: Cash Price	$443.53
Rate for Payer: Cash Price	$443.53
Rate for Payer: Devoted Health Medicare	$34.62
Rate for Payer: Hawaii Medical Service Association ABD	$29.30
Rate for Payer: Hawaii Medical Service Association Commercial	$39.34
Rate for Payer: Hawaii Medical Service Association Medicare	$31.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$29.30
Rate for Payer: Hawaii Western Management Group Commercial	$648.23
Rate for Payer: Health Management Network Commercial	$580.00
Rate for Payer: Humana Medicare	$31.47
Rate for Payer: Kaiser Permanente Commercial	$429.88
Rate for Payer: Kaiser Permanente Medicaid	$348.00
Rate for Payer: Kaiser Permanente Medicare	$31.47
Rate for Payer: MDX Hawaii PPO	$661.88
Rate for Payer: Ohana Health Plan Medicaid	$34.62
Rate for Payer: Ohana Health Plan Medicare	$31.47
Rate for Payer: UnitedHealthcare Medicaid	$409.41
Rate for Payer: UnitedHealthcare Medicare	$31.47
Rate for Payer: University Health Alliance Commercial	$497.36

PENICILLIN G BENZATHINE 600000 UNIT/ML IM SYR

Facility

$682.35

Service Code	HCPCS J0561
Hospital Revenue Code	250
Min. Negotiated Rate	$580.00
Max. Negotiated Rate	$661.88
Rate for Payer: Cash Price	$443.53
Rate for Payer: Health Management Network Commercial	$580.00
Rate for Payer: MDX Hawaii PPO	$661.88

PENICILLIN G K 3 MILLION UNITS/50 ML D5W IVPB (WHR)

Facility

$228.65

Service Code	HCPCS J2540
Hospital Revenue Code	636
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$221.79
Rate for Payer: Cash Price	$148.62
Rate for Payer: Cash Price	$148.62
Rate for Payer: Hawaii Medical Service Association ABD	$0.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.88
Rate for Payer: Hawaii Western Management Group Commercial	$217.22
Rate for Payer: Health Management Network Commercial	$194.35
Rate for Payer: Kaiser Permanente Commercial	$144.05
Rate for Payer: Kaiser Permanente Medicaid	$116.61
Rate for Payer: MDX Hawaii PPO	$221.79
Rate for Payer: UnitedHealthcare Medicaid	$137.19
Rate for Payer: University Health Alliance Commercial	$166.66

PENICILLIN G K 3 MILLION UNITS/50 ML D5W IVPB (WHR)

Facility

$228.65

Service Code	HCPCS J2540
Hospital Revenue Code	250
Min. Negotiated Rate	$194.35
Max. Negotiated Rate	$221.79
Rate for Payer: Cash Price	$148.62
Rate for Payer: Health Management Network Commercial	$194.35
Rate for Payer: MDX Hawaii PPO	$221.79

PENICILLIN G POTASSIUM 20 MILLION UNIT INJ RECON.SOLN.

Facility

$228.65

Service Code	HCPCS J2540
Hospital Revenue Code	250
Min. Negotiated Rate	$194.35
Max. Negotiated Rate	$221.79
Rate for Payer: Cash Price	$148.62
Rate for Payer: Health Management Network Commercial	$194.35
Rate for Payer: MDX Hawaii PPO	$221.79

PENICILLIN G POTASSIUM 20 MILLION UNIT INJ RECON.SOLN.

Facility

$228.65

Service Code	HCPCS J2540
Hospital Revenue Code	636
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$221.79
Rate for Payer: Cash Price	$148.62
Rate for Payer: Cash Price	$148.62
Rate for Payer: Hawaii Medical Service Association ABD	$0.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.88
Rate for Payer: Hawaii Western Management Group Commercial	$217.22
Rate for Payer: Health Management Network Commercial	$194.35
Rate for Payer: Kaiser Permanente Commercial	$144.05
Rate for Payer: Kaiser Permanente Medicaid	$116.61
Rate for Payer: MDX Hawaii PPO	$221.79
Rate for Payer: UnitedHealthcare Medicaid	$137.19
Rate for Payer: University Health Alliance Commercial	$166.66

PENICILLIN G POTASSIUM 5 MILLION UNIT INJ RECON.SOLN.

Facility

$70.67

Service Code	HCPCS J2540
Hospital Revenue Code	636
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$68.55
Rate for Payer: Cash Price	$45.94
Rate for Payer: Cash Price	$45.94
Rate for Payer: Hawaii Medical Service Association ABD	$0.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.88
Rate for Payer: Hawaii Western Management Group Commercial	$67.14
Rate for Payer: Health Management Network Commercial	$60.07
Rate for Payer: Kaiser Permanente Commercial	$44.52
Rate for Payer: Kaiser Permanente Medicaid	$36.04
Rate for Payer: MDX Hawaii PPO	$68.55
Rate for Payer: UnitedHealthcare Medicaid	$42.40
Rate for Payer: University Health Alliance Commercial	$51.51

PENICILLIN G POTASSIUM 5 MILLION UNIT INJ RECON.SOLN.

Facility

$70.67

Service Code	HCPCS J2540
Hospital Revenue Code	250
Min. Negotiated Rate	$60.07
Max. Negotiated Rate	$68.55
Rate for Payer: Cash Price	$45.94
Rate for Payer: Health Management Network Commercial	$60.07
Rate for Payer: MDX Hawaii PPO	$68.55

PENICILLIN G POT IN DEXTROSE 3 MILLION UNIT/50 ML IV IVPB

Facility

$61.59

Service Code	HCPCS J2540
Hospital Revenue Code	250
Min. Negotiated Rate	$52.35
Max. Negotiated Rate	$59.74
Rate for Payer: Cash Price	$40.03
Rate for Payer: Health Management Network Commercial	$52.35
Rate for Payer: MDX Hawaii PPO	$59.74

PENICILLIN G POT IN DEXTROSE 3 MILLION UNIT/50 ML IV IVPB

Facility

$61.59

Service Code	HCPCS J2540
Hospital Revenue Code	636
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$59.74
Rate for Payer: Cash Price	$40.03
Rate for Payer: Cash Price	$40.03
Rate for Payer: Hawaii Medical Service Association ABD	$0.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.88
Rate for Payer: Hawaii Western Management Group Commercial	$58.51
Rate for Payer: Health Management Network Commercial	$52.35
Rate for Payer: Kaiser Permanente Commercial	$38.80
Rate for Payer: Kaiser Permanente Medicaid	$31.41
Rate for Payer: MDX Hawaii PPO	$59.74
Rate for Payer: UnitedHealthcare Medicaid	$36.95
Rate for Payer: University Health Alliance Commercial	$44.89

PENICILLIN V POTASSIUM 250 MG/5 ML PO RECON.SOLN.

Facility

$64.37

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$32.83
Max. Negotiated Rate	$62.44
Rate for Payer: Cash Price	$41.84
Rate for Payer: Hawaii Western Management Group Commercial	$61.15
Rate for Payer: Health Management Network Commercial	$54.71
Rate for Payer: Kaiser Permanente Commercial	$40.55
Rate for Payer: Kaiser Permanente Medicaid	$32.83
Rate for Payer: MDX Hawaii PPO	$62.44
Rate for Payer: UnitedHealthcare Medicaid	$38.62
Rate for Payer: University Health Alliance Commercial	$46.92

PENICILLIN V POTASSIUM 250 MG/5 ML PO RECON.SOLN.

Facility

$64.37

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$54.71
Max. Negotiated Rate	$62.44
Rate for Payer: Cash Price	$41.84
Rate for Payer: Health Management Network Commercial	$54.71
Rate for Payer: MDX Hawaii PPO	$62.44

PENICILLIN V POTASSIUM 250 MG PO TABLET

Facility

$4.70

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.56
Rate for Payer: Cash Price	$3.06
Rate for Payer: Health Management Network Commercial	$4.00
Rate for Payer: MDX Hawaii PPO	$4.56

PENICILLIN V POTASSIUM 250 MG PO TABLET

Facility

$4.70

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.56
Rate for Payer: Cash Price	$3.06
Rate for Payer: Hawaii Western Management Group Commercial	$4.46
Rate for Payer: Health Management Network Commercial	$4.00
Rate for Payer: Kaiser Permanente Commercial	$2.96
Rate for Payer: Kaiser Permanente Medicaid	$2.40
Rate for Payer: MDX Hawaii PPO	$4.56
Rate for Payer: UnitedHealthcare Medicaid	$2.82
Rate for Payer: University Health Alliance Commercial	$3.43

PENICILLIN V POTASSIUM 500 MG PO TABLET

Facility

$4.30

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$4.17
Rate for Payer: Cash Price	$2.80
Rate for Payer: Hawaii Western Management Group Commercial	$4.08
Rate for Payer: Health Management Network Commercial	$3.65
Rate for Payer: Kaiser Permanente Commercial	$2.71
Rate for Payer: Kaiser Permanente Medicaid	$2.19
Rate for Payer: MDX Hawaii PPO	$4.17
Rate for Payer: UnitedHealthcare Medicaid	$2.58
Rate for Payer: University Health Alliance Commercial	$3.13

PENICILLIN V POTASSIUM 500 MG PO TABLET

Facility

$4.30

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.65
Max. Negotiated Rate	$4.17
Rate for Payer: Cash Price	$2.80
Rate for Payer: Health Management Network Commercial	$3.65
Rate for Payer: MDX Hawaii PPO	$4.17

PENIS PROCEDURES WITH CC/MCC

Facility

$40,142.47

Service Code	MSDRG 709
Min. Negotiated Rate	$25,384.67
Max. Negotiated Rate	$40,142.47
Rate for Payer: AlohaCare Medicare	$30,607.80
Rate for Payer: Devoted Health Medicare	$33,668.58
Rate for Payer: Hawaii Medical Service Association Commercial	$25,384.67
Rate for Payer: Hawaii Medical Service Association Medicare	$30,607.80
Rate for Payer: Humana Medicare	$30,607.80
Rate for Payer: Kaiser Permanente Commercial	$40,142.47
Rate for Payer: Kaiser Permanente Medicare	$30,607.80
Rate for Payer: Ohana Health Plan Medicare	$30,607.80
Rate for Payer: UnitedHealthcare Medicare	$30,607.80

PENIS PROCEDURES WITHOUT CC/MCC

Facility

$25,384.67

Service Code	MSDRG 710
Min. Negotiated Rate	$18,429.65
Max. Negotiated Rate	$25,384.67
Rate for Payer: AlohaCare Medicare	$18,429.65
Rate for Payer: Devoted Health Medicare	$20,272.62
Rate for Payer: Hawaii Medical Service Association Commercial	$25,384.67
Rate for Payer: Hawaii Medical Service Association Medicare	$18,429.65
Rate for Payer: Humana Medicare	$18,429.65
Rate for Payer: Kaiser Permanente Commercial	$24,170.70
Rate for Payer: Kaiser Permanente Medicare	$18,429.65
Rate for Payer: Ohana Health Plan Medicare	$18,429.65
Rate for Payer: UnitedHealthcare Medicare	$18,429.65

PENIS, TESTES & SCROTAL PROCEDURES

Facility

$17,345.24

Service Code	APR-DRG 4834
Min. Negotiated Rate	$17,345.24
Max. Negotiated Rate	$17,345.24
Rate for Payer: AlohaCare Medicaid	$17,345.24
Rate for Payer: Hawaii Medical Service Association ABD	$17,345.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,345.24
Rate for Payer: Kaiser Permanente Medicaid	$17,345.24
Rate for Payer: Ohana Health Plan Medicaid	$17,345.24
Rate for Payer: UnitedHealthcare Medicaid	$17,345.24

PENIS, TESTES & SCROTAL PROCEDURES

Facility

$6,278.88

Service Code	APR-DRG 4832
Min. Negotiated Rate	$6,278.88
Max. Negotiated Rate	$6,278.88
Rate for Payer: AlohaCare Medicaid	$6,278.88
Rate for Payer: Hawaii Medical Service Association ABD	$6,278.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,278.88
Rate for Payer: Kaiser Permanente Medicaid	$6,278.88
Rate for Payer: Ohana Health Plan Medicaid	$6,278.88
Rate for Payer: UnitedHealthcare Medicaid	$6,278.88

PENIS, TESTES & SCROTAL PROCEDURES

Facility

$8,488.58

Service Code	APR-DRG 4833
Min. Negotiated Rate	$8,488.58
Max. Negotiated Rate	$8,488.58
Rate for Payer: AlohaCare Medicaid	$8,488.58
Rate for Payer: Hawaii Medical Service Association ABD	$8,488.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,488.58
Rate for Payer: Kaiser Permanente Medicaid	$8,488.58
Rate for Payer: Ohana Health Plan Medicaid	$8,488.58
Rate for Payer: UnitedHealthcare Medicaid	$8,488.58

Know your out-of-pocket cost for care.

All Charges