Kona Community Hospital

All Charges

Charge

Type

Setting

Price

BROMFENAC 0.09 % OPHT DROP

Facility

$535.75

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$455.39
Max. Negotiated Rate	$519.68
Rate for Payer: Cash Price	$348.24
Rate for Payer: Cash Price	$444.34
Rate for Payer: Health Management Network Commercial	$581.06
Rate for Payer: Health Management Network Commercial	$455.39
Rate for Payer: MDX Hawaii PPO	$519.68
Rate for Payer: MDX Hawaii PPO	$663.09

BROMFENAC 0.09 % OPHT DROP

Facility

$683.60

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$348.64
Max. Negotiated Rate	$663.09
Rate for Payer: Cash Price	$444.34
Rate for Payer: Cash Price	$348.24
Rate for Payer: Hawaii Western Management Group Commercial	$508.96
Rate for Payer: Hawaii Western Management Group Commercial	$649.42
Rate for Payer: Health Management Network Commercial	$455.39
Rate for Payer: Health Management Network Commercial	$581.06
Rate for Payer: Kaiser Permanente Commercial	$337.52
Rate for Payer: Kaiser Permanente Commercial	$430.67
Rate for Payer: Kaiser Permanente Medicaid	$273.23
Rate for Payer: Kaiser Permanente Medicaid	$348.64
Rate for Payer: MDX Hawaii PPO	$519.68
Rate for Payer: MDX Hawaii PPO	$663.09
Rate for Payer: UnitedHealthcare Medicaid	$321.45
Rate for Payer: UnitedHealthcare Medicaid	$410.16
Rate for Payer: University Health Alliance Commercial	$498.28
Rate for Payer: University Health Alliance Commercial	$390.51

BROMOCRIPTINE 2.5 MG PO TABLET

Facility

$20.73

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$17.62
Max. Negotiated Rate	$20.11
Rate for Payer: Cash Price	$13.47
Rate for Payer: Cash Price	$14.85
Rate for Payer: Health Management Network Commercial	$19.41
Rate for Payer: Health Management Network Commercial	$17.62
Rate for Payer: MDX Hawaii PPO	$20.11
Rate for Payer: MDX Hawaii PPO	$22.15

BROMOCRIPTINE 2.5 MG PO TABLET

Facility

$20.73

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$10.57
Max. Negotiated Rate	$20.11
Rate for Payer: Cash Price	$13.47
Rate for Payer: Cash Price	$14.85
Rate for Payer: Hawaii Western Management Group Commercial	$21.70
Rate for Payer: Hawaii Western Management Group Commercial	$19.69
Rate for Payer: Health Management Network Commercial	$17.62
Rate for Payer: Health Management Network Commercial	$19.41
Rate for Payer: Kaiser Permanente Commercial	$14.39
Rate for Payer: Kaiser Permanente Commercial	$13.06
Rate for Payer: Kaiser Permanente Medicaid	$10.57
Rate for Payer: Kaiser Permanente Medicaid	$11.65
Rate for Payer: MDX Hawaii PPO	$20.11
Rate for Payer: MDX Hawaii PPO	$22.15
Rate for Payer: UnitedHealthcare Medicaid	$13.70
Rate for Payer: UnitedHealthcare Medicaid	$12.44
Rate for Payer: University Health Alliance Commercial	$15.11
Rate for Payer: University Health Alliance Commercial	$16.65

BRONCHIOLITIS & RSV PNEUMONIA

Facility

$9,056.61

Service Code	APR-DRG 1384
Min. Negotiated Rate	$9,056.61
Max. Negotiated Rate	$9,056.61
Rate for Payer: AlohaCare Medicaid	$9,056.61
Rate for Payer: Hawaii Medical Service Association ABD	$9,056.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,056.61
Rate for Payer: Kaiser Permanente Medicaid	$9,056.61
Rate for Payer: Ohana Health Plan Medicaid	$9,056.61
Rate for Payer: UnitedHealthcare Medicaid	$9,056.61

BRONCHIOLITIS & RSV PNEUMONIA

Facility

$2,531.93

Service Code	APR-DRG 1382
Min. Negotiated Rate	$2,531.93
Max. Negotiated Rate	$2,531.93
Rate for Payer: AlohaCare Medicaid	$2,531.93
Rate for Payer: Hawaii Medical Service Association ABD	$2,531.93
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,531.93
Rate for Payer: Kaiser Permanente Medicaid	$2,531.93
Rate for Payer: Ohana Health Plan Medicaid	$2,531.93
Rate for Payer: UnitedHealthcare Medicaid	$2,531.93

BRONCHIOLITIS & RSV PNEUMONIA

Facility

$1,802.79

Service Code	APR-DRG 1381
Min. Negotiated Rate	$1,802.79
Max. Negotiated Rate	$1,802.79
Rate for Payer: AlohaCare Medicaid	$1,802.79
Rate for Payer: Hawaii Medical Service Association ABD	$1,802.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,802.79
Rate for Payer: Kaiser Permanente Medicaid	$1,802.79
Rate for Payer: Ohana Health Plan Medicaid	$1,802.79
Rate for Payer: UnitedHealthcare Medicaid	$1,802.79

BRONCHIOLITIS & RSV PNEUMONIA

Facility

$4,339.18

Service Code	APR-DRG 1383
Min. Negotiated Rate	$4,339.18
Max. Negotiated Rate	$4,339.18
Rate for Payer: AlohaCare Medicaid	$4,339.18
Rate for Payer: Hawaii Medical Service Association ABD	$4,339.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,339.18
Rate for Payer: Kaiser Permanente Medicaid	$4,339.18
Rate for Payer: Ohana Health Plan Medicaid	$4,339.18
Rate for Payer: UnitedHealthcare Medicaid	$4,339.18

BRONCHITIS AND ASTHMA WITH CC/MCC

Facility

$18,104.36

Service Code	MSDRG 202
Min. Negotiated Rate	$12,773.96
Max. Negotiated Rate	$18,104.36
Rate for Payer: AlohaCare Medicare	$12,773.96
Rate for Payer: Devoted Health Medicare	$14,051.36
Rate for Payer: Hawaii Medical Service Association Commercial	$18,104.36
Rate for Payer: Hawaii Medical Service Association Medicare	$12,773.96
Rate for Payer: Humana Medicare	$12,773.96
Rate for Payer: Kaiser Permanente Commercial	$16,753.20
Rate for Payer: Kaiser Permanente Medicare	$12,773.96
Rate for Payer: Ohana Health Plan Medicare	$12,773.96
Rate for Payer: UnitedHealthcare Medicare	$12,773.96

BRONCHITIS AND ASTHMA WITHOUT CC/MCC

Facility

$13,765.10

Service Code	MSDRG 203
Min. Negotiated Rate	$8,812.37
Max. Negotiated Rate	$13,765.10
Rate for Payer: AlohaCare Medicare	$8,812.37
Rate for Payer: Devoted Health Medicare	$9,693.61
Rate for Payer: Hawaii Medical Service Association Commercial	$13,765.10
Rate for Payer: Hawaii Medical Service Association Medicare	$8,812.37
Rate for Payer: Humana Medicare	$8,812.37
Rate for Payer: Kaiser Permanente Commercial	$11,557.50
Rate for Payer: Kaiser Permanente Medicare	$8,812.37
Rate for Payer: Ohana Health Plan Medicare	$8,812.37
Rate for Payer: UnitedHealthcare Medicare	$8,812.37

Bronchoscope BFlex 2 Slim 3.8 0570-0432 [3642225]

Facility

$1,701.88

Hospital Charge Code	3642225
Hospital Revenue Code	272
Min. Negotiated Rate	$867.96
Max. Negotiated Rate	$1,650.82
Rate for Payer: Cash Price	$1,106.22
Rate for Payer: Hawaii Western Management Group Commercial	$1,616.79
Rate for Payer: Health Management Network Commercial	$1,446.60
Rate for Payer: Kaiser Permanente Commercial	$1,072.18
Rate for Payer: Kaiser Permanente Medicaid	$867.96
Rate for Payer: MDX Hawaii PPO	$1,650.82
Rate for Payer: University Health Alliance Commercial	$1,240.50

Bronchoscope BFlex 2 Slim 3.8 0570-0432 [3642225]

Facility

$1,701.88

Hospital Charge Code	3642225
Hospital Revenue Code	272
Min. Negotiated Rate	$1,446.60
Max. Negotiated Rate	$1,650.82
Rate for Payer: Cash Price	$1,106.22
Rate for Payer: Health Management Network Commercial	$1,446.60
Rate for Payer: MDX Hawaii PPO	$1,650.82

Brush Cytology 000104 [3600261]

Facility

$86.70

Hospital Charge Code	3600261
Hospital Revenue Code	272
Min. Negotiated Rate	$44.22
Max. Negotiated Rate	$84.10
Rate for Payer: Cash Price	$56.36
Rate for Payer: Hawaii Western Management Group Commercial	$82.36
Rate for Payer: Health Management Network Commercial	$73.69
Rate for Payer: Kaiser Permanente Commercial	$54.62
Rate for Payer: Kaiser Permanente Medicaid	$44.22
Rate for Payer: MDX Hawaii PPO	$84.10
Rate for Payer: University Health Alliance Commercial	$63.20

Brush Cytology 000104 [3600261]

Facility

$86.70

Hospital Charge Code	3600261
Hospital Revenue Code	272
Min. Negotiated Rate	$73.69
Max. Negotiated Rate	$84.10
Rate for Payer: Cash Price	$56.36
Rate for Payer: Health Management Network Commercial	$73.69
Rate for Payer: MDX Hawaii PPO	$84.10

Brush Femoral Bone 505913 [3601200]

Facility

$142.40

Hospital Charge Code	3601200
Hospital Revenue Code	272
Min. Negotiated Rate	$72.62
Max. Negotiated Rate	$138.13
Rate for Payer: Cash Price	$92.56
Rate for Payer: Hawaii Western Management Group Commercial	$135.28
Rate for Payer: Health Management Network Commercial	$121.04
Rate for Payer: Kaiser Permanente Commercial	$89.71
Rate for Payer: Kaiser Permanente Medicaid	$72.62
Rate for Payer: MDX Hawaii PPO	$138.13
Rate for Payer: University Health Alliance Commercial	$103.80

Brush Femoral Bone 505913 [3601200]

Facility

$142.40

Hospital Charge Code	3601200
Hospital Revenue Code	272
Min. Negotiated Rate	$121.04
Max. Negotiated Rate	$138.13
Rate for Payer: Cash Price	$92.56
Rate for Payer: Health Management Network Commercial	$121.04
Rate for Payer: MDX Hawaii PPO	$138.13

BUDESONIDE 0.5 MG/2 ML INHAL NBSP

Facility

$64.23

Service Code	NDC 00487970101
Hospital Revenue Code	250
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$62.30
Rate for Payer: Cash Price	$41.75
Rate for Payer: Health Management Network Commercial	$54.60
Rate for Payer: MDX Hawaii PPO	$62.30

BUDESONIDE 0.5 MG/2 ML INHAL NBSP

Facility

$64.23

Service Code	NDC 00487970101
Hospital Revenue Code	250
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$62.30
Rate for Payer: Cash Price	$41.75
Rate for Payer: Hawaii Western Management Group Commercial	$61.02
Rate for Payer: Health Management Network Commercial	$54.60
Rate for Payer: Kaiser Permanente Commercial	$40.46
Rate for Payer: Kaiser Permanente Medicaid	$32.76
Rate for Payer: MDX Hawaii PPO	$62.30
Rate for Payer: UnitedHealthcare Medicaid	$38.54
Rate for Payer: University Health Alliance Commercial	$46.82

BUMETANIDE 0.25 MG/ML INJ SOLN

Facility

$18.11

Service Code	HCPCS J1939
Hospital Revenue Code	636
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$17.57
Rate for Payer: Cash Price	$11.77
Rate for Payer: Cash Price	$10.84
Rate for Payer: Cash Price	$10.84
Rate for Payer: Cash Price	$11.77
Rate for Payer: Hawaii Medical Service Association ABD	$0.61
Rate for Payer: Hawaii Medical Service Association ABD	$0.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.61
Rate for Payer: Hawaii Western Management Group Commercial	$15.85
Rate for Payer: Hawaii Western Management Group Commercial	$17.20
Rate for Payer: Health Management Network Commercial	$14.18
Rate for Payer: Health Management Network Commercial	$15.39
Rate for Payer: Kaiser Permanente Commercial	$11.41
Rate for Payer: Kaiser Permanente Commercial	$10.51
Rate for Payer: Kaiser Permanente Medicaid	$8.51
Rate for Payer: Kaiser Permanente Medicaid	$9.24
Rate for Payer: MDX Hawaii PPO	$17.57
Rate for Payer: MDX Hawaii PPO	$16.18
Rate for Payer: UnitedHealthcare Medicaid	$10.01
Rate for Payer: UnitedHealthcare Medicaid	$10.87
Rate for Payer: University Health Alliance Commercial	$12.16
Rate for Payer: University Health Alliance Commercial	$13.20

BUMETANIDE 0.25 MG/ML INJ SOLN

Facility

$16.68

Service Code	HCPCS J1939
Hospital Revenue Code	250
Min. Negotiated Rate	$14.18
Max. Negotiated Rate	$16.18
Rate for Payer: Cash Price	$10.84
Rate for Payer: Cash Price	$11.77
Rate for Payer: Health Management Network Commercial	$14.18
Rate for Payer: Health Management Network Commercial	$15.39
Rate for Payer: MDX Hawaii PPO	$16.18
Rate for Payer: MDX Hawaii PPO	$17.57

BUMETANIDE 0.5 MG PO TABLET

Facility

$13.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.28
Max. Negotiated Rate	$12.87
Rate for Payer: Cash Price	$8.63
Rate for Payer: Cash Price	$1.22
Rate for Payer: Health Management Network Commercial	$1.60
Rate for Payer: Health Management Network Commercial	$11.28
Rate for Payer: MDX Hawaii PPO	$1.82
Rate for Payer: MDX Hawaii PPO	$12.87

BUMETANIDE 0.5 MG PO TABLET

Facility

$13.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.77
Max. Negotiated Rate	$12.87
Rate for Payer: Cash Price	$8.63
Rate for Payer: Cash Price	$1.22
Rate for Payer: Hawaii Western Management Group Commercial	$12.61
Rate for Payer: Hawaii Western Management Group Commercial	$1.79
Rate for Payer: Health Management Network Commercial	$1.60
Rate for Payer: Health Management Network Commercial	$11.28
Rate for Payer: Kaiser Permanente Commercial	$8.36
Rate for Payer: Kaiser Permanente Commercial	$1.18
Rate for Payer: Kaiser Permanente Medicaid	$0.96
Rate for Payer: Kaiser Permanente Medicaid	$6.77
Rate for Payer: MDX Hawaii PPO	$1.82
Rate for Payer: MDX Hawaii PPO	$12.87
Rate for Payer: UnitedHealthcare Medicaid	$7.96
Rate for Payer: UnitedHealthcare Medicaid	$1.13
Rate for Payer: University Health Alliance Commercial	$1.37
Rate for Payer: University Health Alliance Commercial	$9.67

BUMETANIDE 1 MG PO TABLET

Facility

$7.17

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$6.95
Rate for Payer: Cash Price	$4.66
Rate for Payer: Hawaii Western Management Group Commercial	$6.81
Rate for Payer: Health Management Network Commercial	$6.09
Rate for Payer: Kaiser Permanente Commercial	$4.52
Rate for Payer: Kaiser Permanente Medicaid	$3.66
Rate for Payer: MDX Hawaii PPO	$6.95
Rate for Payer: UnitedHealthcare Medicaid	$4.30
Rate for Payer: University Health Alliance Commercial	$5.23

BUMETANIDE 1 MG PO TABLET

Facility

$7.17

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$6.95
Rate for Payer: Cash Price	$4.66
Rate for Payer: Health Management Network Commercial	$6.09
Rate for Payer: MDX Hawaii PPO	$6.95

BUMETANIDE 2 MG PO TABLET

Facility

$11.53

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$11.18
Rate for Payer: Cash Price	$7.49
Rate for Payer: Cash Price	$6.36
Rate for Payer: Cash Price	$7.27
Rate for Payer: Health Management Network Commercial	$9.50
Rate for Payer: Health Management Network Commercial	$9.80
Rate for Payer: Health Management Network Commercial	$8.31
Rate for Payer: MDX Hawaii PPO	$10.84
Rate for Payer: MDX Hawaii PPO	$9.49
Rate for Payer: MDX Hawaii PPO	$11.18

Know your out-of-pocket cost for care.

All Charges