Kona Community Hospital

All Charges

Charge

Type

Setting

Price

POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN

Facility

$21.04

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$20.41
Rate for Payer: Cash Price	$13.68
Rate for Payer: Cash Price	$13.68
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Western Management Group Commercial	$19.99
Rate for Payer: Health Management Network Commercial	$17.88
Rate for Payer: Kaiser Permanente Commercial	$13.26
Rate for Payer: Kaiser Permanente Medicaid	$10.73
Rate for Payer: MDX Hawaii PPO	$20.41
Rate for Payer: UnitedHealthcare Medicaid	$12.62
Rate for Payer: University Health Alliance Commercial	$15.34

POTASSIUM CHLORIDE-D5-0.2%NACL 20 MEQ/L IV SOLP

Facility

$53.13

Service Code	HCPCS J3480
Hospital Revenue Code	250
Min. Negotiated Rate	$45.16
Max. Negotiated Rate	$51.54
Rate for Payer: Cash Price	$34.53
Rate for Payer: Cash Price	$31.39
Rate for Payer: Health Management Network Commercial	$41.05
Rate for Payer: Health Management Network Commercial	$45.16
Rate for Payer: MDX Hawaii PPO	$51.54
Rate for Payer: MDX Hawaii PPO	$46.84

POTASSIUM CHLORIDE-D5-0.2%NACL 20 MEQ/L IV SOLP

Facility

$48.29

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$46.84
Rate for Payer: Cash Price	$31.39
Rate for Payer: Cash Price	$31.39
Rate for Payer: Cash Price	$34.53
Rate for Payer: Cash Price	$34.53
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Western Management Group Commercial	$45.88
Rate for Payer: Hawaii Western Management Group Commercial	$50.47
Rate for Payer: Health Management Network Commercial	$41.05
Rate for Payer: Health Management Network Commercial	$45.16
Rate for Payer: Kaiser Permanente Commercial	$30.42
Rate for Payer: Kaiser Permanente Commercial	$33.47
Rate for Payer: Kaiser Permanente Medicaid	$27.10
Rate for Payer: Kaiser Permanente Medicaid	$24.63
Rate for Payer: MDX Hawaii PPO	$51.54
Rate for Payer: MDX Hawaii PPO	$46.84
Rate for Payer: UnitedHealthcare Medicaid	$28.97
Rate for Payer: UnitedHealthcare Medicaid	$31.88
Rate for Payer: University Health Alliance Commercial	$35.20
Rate for Payer: University Health Alliance Commercial	$38.73

POTASSIUM CHLORIDE IN 5 % DEX 20 MEQ/L IV SOLP

Facility

$57.96

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$56.22
Rate for Payer: Cash Price	$37.67
Rate for Payer: Cash Price	$17.94
Rate for Payer: Cash Price	$17.94
Rate for Payer: Cash Price	$37.67
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Western Management Group Commercial	$26.22
Rate for Payer: Hawaii Western Management Group Commercial	$55.06
Rate for Payer: Health Management Network Commercial	$49.27
Rate for Payer: Health Management Network Commercial	$23.46
Rate for Payer: Kaiser Permanente Commercial	$36.51
Rate for Payer: Kaiser Permanente Commercial	$17.39
Rate for Payer: Kaiser Permanente Medicaid	$14.08
Rate for Payer: Kaiser Permanente Medicaid	$29.56
Rate for Payer: MDX Hawaii PPO	$56.22
Rate for Payer: MDX Hawaii PPO	$26.77
Rate for Payer: UnitedHealthcare Medicaid	$16.56
Rate for Payer: UnitedHealthcare Medicaid	$34.78
Rate for Payer: University Health Alliance Commercial	$20.12
Rate for Payer: University Health Alliance Commercial	$42.25

POTASSIUM CHLORIDE IN 5 % DEX 20 MEQ/L IV SOLP

Facility

$27.60

Service Code	HCPCS J3480
Hospital Revenue Code	250
Min. Negotiated Rate	$23.46
Max. Negotiated Rate	$26.77
Rate for Payer: Cash Price	$17.94
Rate for Payer: Cash Price	$37.67
Rate for Payer: Health Management Network Commercial	$23.46
Rate for Payer: Health Management Network Commercial	$49.27
Rate for Payer: MDX Hawaii PPO	$26.77
Rate for Payer: MDX Hawaii PPO	$56.22

POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV IVPB

Facility

$27.05

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$26.24
Rate for Payer: Cash Price	$17.58
Rate for Payer: Cash Price	$17.58
Rate for Payer: Cash Price	$13.99
Rate for Payer: Cash Price	$13.99
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Western Management Group Commercial	$20.45
Rate for Payer: Hawaii Western Management Group Commercial	$25.70
Rate for Payer: Health Management Network Commercial	$18.30
Rate for Payer: Health Management Network Commercial	$22.99
Rate for Payer: Kaiser Permanente Commercial	$17.04
Rate for Payer: Kaiser Permanente Commercial	$13.56
Rate for Payer: Kaiser Permanente Medicaid	$13.80
Rate for Payer: Kaiser Permanente Medicaid	$10.98
Rate for Payer: MDX Hawaii PPO	$20.88
Rate for Payer: MDX Hawaii PPO	$26.24
Rate for Payer: UnitedHealthcare Medicaid	$16.23
Rate for Payer: UnitedHealthcare Medicaid	$12.92
Rate for Payer: University Health Alliance Commercial	$15.69
Rate for Payer: University Health Alliance Commercial	$19.72

POTASSIUM CHLORIDE IN WATER 10 MEQ/100 ML IV IVPB

Facility

$21.53

Service Code	HCPCS J3480
Hospital Revenue Code	250
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$20.88
Rate for Payer: Cash Price	$13.99
Rate for Payer: Cash Price	$17.58
Rate for Payer: Health Management Network Commercial	$18.30
Rate for Payer: Health Management Network Commercial	$22.99
Rate for Payer: MDX Hawaii PPO	$20.88
Rate for Payer: MDX Hawaii PPO	$26.24

POTASSIUM CHLORIDE IN WATER 20 MEQ/100 ML IV IVPB

Facility

$14.91

Service Code	HCPCS J3480
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$14.46
Rate for Payer: Cash Price	$9.69
Rate for Payer: Cash Price	$9.69
Rate for Payer: Hawaii Medical Service Association ABD	$0.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.17
Rate for Payer: Hawaii Western Management Group Commercial	$14.16
Rate for Payer: Health Management Network Commercial	$12.67
Rate for Payer: Kaiser Permanente Commercial	$9.39
Rate for Payer: Kaiser Permanente Medicaid	$7.60
Rate for Payer: MDX Hawaii PPO	$14.46
Rate for Payer: UnitedHealthcare Medicaid	$8.95
Rate for Payer: University Health Alliance Commercial	$10.87

POTASSIUM CHLORIDE IN WATER 20 MEQ/100 ML IV IVPB

Facility

$14.91

Service Code	HCPCS J3480
Hospital Revenue Code	250
Min. Negotiated Rate	$12.67
Max. Negotiated Rate	$14.46
Rate for Payer: Cash Price	$9.69
Rate for Payer: Health Management Network Commercial	$12.67
Rate for Payer: MDX Hawaii PPO	$14.46

POTASSIUM CITRATE 10 MEQ PO TAB SR

Facility

$15.98

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$13.58
Max. Negotiated Rate	$15.50
Rate for Payer: Cash Price	$10.39
Rate for Payer: Health Management Network Commercial	$13.58
Rate for Payer: MDX Hawaii PPO	$15.50

POTASSIUM CITRATE 10 MEQ PO TAB SR

Facility

$15.98

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$8.15
Max. Negotiated Rate	$15.50
Rate for Payer: Cash Price	$10.39
Rate for Payer: Hawaii Western Management Group Commercial	$15.18
Rate for Payer: Health Management Network Commercial	$13.58
Rate for Payer: Kaiser Permanente Commercial	$10.07
Rate for Payer: Kaiser Permanente Medicaid	$8.15
Rate for Payer: MDX Hawaii PPO	$15.50
Rate for Payer: UnitedHealthcare Medicaid	$9.59
Rate for Payer: University Health Alliance Commercial	$11.65

POTASSIUM IODIDE 1 GRAM/ML PO SOLN

Facility

$1,425.82

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1,211.95
Max. Negotiated Rate	$1,383.05
Rate for Payer: Cash Price	$926.78
Rate for Payer: Cash Price	$697.98
Rate for Payer: Health Management Network Commercial	$912.74
Rate for Payer: Health Management Network Commercial	$1,211.95
Rate for Payer: MDX Hawaii PPO	$1,383.05
Rate for Payer: MDX Hawaii PPO	$1,041.60

POTASSIUM IODIDE 1 GRAM/ML PO SOLN

Facility

$1,073.81

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$547.64
Max. Negotiated Rate	$1,041.60
Rate for Payer: Cash Price	$697.98
Rate for Payer: Cash Price	$926.78
Rate for Payer: Hawaii Western Management Group Commercial	$1,020.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,354.53
Rate for Payer: Health Management Network Commercial	$912.74
Rate for Payer: Health Management Network Commercial	$1,211.95
Rate for Payer: Kaiser Permanente Commercial	$676.50
Rate for Payer: Kaiser Permanente Commercial	$898.27
Rate for Payer: Kaiser Permanente Medicaid	$547.64
Rate for Payer: Kaiser Permanente Medicaid	$727.17
Rate for Payer: MDX Hawaii PPO	$1,041.60
Rate for Payer: MDX Hawaii PPO	$1,383.05
Rate for Payer: UnitedHealthcare Medicaid	$855.49
Rate for Payer: UnitedHealthcare Medicaid	$644.29
Rate for Payer: University Health Alliance Commercial	$782.70
Rate for Payer: University Health Alliance Commercial	$1,039.28

POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOLE/ML IV SOLN

Facility

$216.54

Service Code	NDC 00517210201
Hospital Revenue Code	250
Min. Negotiated Rate	$184.06
Max. Negotiated Rate	$210.04
Rate for Payer: Cash Price	$140.75
Rate for Payer: Health Management Network Commercial	$184.06
Rate for Payer: MDX Hawaii PPO	$210.04

POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOLE/ML IV SOLN

Facility

$216.54

Service Code	NDC 00517210225
Hospital Revenue Code	250
Min. Negotiated Rate	$110.44
Max. Negotiated Rate	$210.04
Rate for Payer: Cash Price	$140.75
Rate for Payer: Hawaii Western Management Group Commercial	$205.71
Rate for Payer: Health Management Network Commercial	$184.06
Rate for Payer: Kaiser Permanente Commercial	$136.42
Rate for Payer: Kaiser Permanente Medicaid	$110.44
Rate for Payer: MDX Hawaii PPO	$210.04
Rate for Payer: UnitedHealthcare Medicaid	$129.92
Rate for Payer: University Health Alliance Commercial	$157.84

POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOLE/ML IV SOLN

Facility

$216.54

Service Code	NDC 00517210201
Hospital Revenue Code	250
Min. Negotiated Rate	$110.44
Max. Negotiated Rate	$210.04
Rate for Payer: Cash Price	$140.75
Rate for Payer: Hawaii Western Management Group Commercial	$205.71
Rate for Payer: Health Management Network Commercial	$184.06
Rate for Payer: Kaiser Permanente Commercial	$136.42
Rate for Payer: Kaiser Permanente Medicaid	$110.44
Rate for Payer: MDX Hawaii PPO	$210.04
Rate for Payer: UnitedHealthcare Medicaid	$129.92
Rate for Payer: University Health Alliance Commercial	$157.84

POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOLE/ML IV SOLN

Facility

$216.54

Service Code	NDC 00517210225
Hospital Revenue Code	250
Min. Negotiated Rate	$184.06
Max. Negotiated Rate	$210.04
Rate for Payer: Cash Price	$140.75
Rate for Payer: Health Management Network Commercial	$184.06
Rate for Payer: MDX Hawaii PPO	$210.04

POTASSIUM SERUM PLASMA/WHOLE BLOOD

Professional

Both

$9.00

Service Code	HCPCS 84132
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$7.65
Rate for Payer: AlohaCare Medicaid	$6.35
Rate for Payer: AlohaCare Medicare	$4.76
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cash Price	$5.85
Rate for Payer: Devoted Health Medicare	$5.24
Rate for Payer: Hawaii Medical Service Association Medicare	$4.76
Rate for Payer: Hawaii Western Management Group Commercial	$6.35
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$5.71
Rate for Payer: Kaiser Permanente Medicaid	$5.71
Rate for Payer: Kaiser Permanente Medicare	$5.71
Rate for Payer: Ohana Health Plan Medicaid	$6.35
Rate for Payer: Ohana Health Plan Medicare	$4.76
Rate for Payer: UnitedHealthcare Medicaid	$6.35
Rate for Payer: UnitedHealthcare Medicare	$4.76

POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG PO PWPK

Facility

$3.01

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$2.92
Rate for Payer: Cash Price	$1.96
Rate for Payer: Hawaii Western Management Group Commercial	$2.86
Rate for Payer: Health Management Network Commercial	$2.56
Rate for Payer: Kaiser Permanente Commercial	$1.90
Rate for Payer: Kaiser Permanente Medicaid	$1.54
Rate for Payer: MDX Hawaii PPO	$2.92
Rate for Payer: UnitedHealthcare Medicaid	$1.81
Rate for Payer: University Health Alliance Commercial	$2.19

POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG PO PWPK

Facility

$3.01

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$2.92
Rate for Payer: Cash Price	$1.96
Rate for Payer: Health Management Network Commercial	$2.56
Rate for Payer: MDX Hawaii PPO	$2.92

POVIDONE-IODINE 10 % TOP SOLN

Facility

$11.73

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$11.38
Rate for Payer: Cash Price	$7.62
Rate for Payer: Health Management Network Commercial	$9.97
Rate for Payer: MDX Hawaii PPO	$11.38

POVIDONE-IODINE 10 % TOP SOLN

Facility

$11.73

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$11.38
Rate for Payer: Cash Price	$7.62
Rate for Payer: Hawaii Western Management Group Commercial	$11.14
Rate for Payer: Health Management Network Commercial	$9.97
Rate for Payer: Kaiser Permanente Commercial	$7.39
Rate for Payer: Kaiser Permanente Medicaid	$5.98
Rate for Payer: MDX Hawaii PPO	$11.38
Rate for Payer: UnitedHealthcare Medicaid	$7.04
Rate for Payer: University Health Alliance Commercial	$8.55

POVIDONE-IODINE 5 % OPHT SOLN

Facility

$91.53

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$77.80
Max. Negotiated Rate	$88.78
Rate for Payer: Cash Price	$59.49
Rate for Payer: Health Management Network Commercial	$77.80
Rate for Payer: MDX Hawaii PPO	$88.78

POVIDONE-IODINE 5 % OPHT SOLN

Facility

$91.53

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$46.68
Max. Negotiated Rate	$88.78
Rate for Payer: Cash Price	$59.49
Rate for Payer: Hawaii Western Management Group Commercial	$86.95
Rate for Payer: Health Management Network Commercial	$77.80
Rate for Payer: Kaiser Permanente Commercial	$57.66
Rate for Payer: Kaiser Permanente Medicaid	$46.68
Rate for Payer: MDX Hawaii PPO	$88.78
Rate for Payer: UnitedHealthcare Medicaid	$54.92
Rate for Payer: University Health Alliance Commercial	$66.72

PRALIDOXIME 1 GRAM INJ RECON.SOLN.

Facility

$399.24

Service Code	HCPCS J2730
Hospital Revenue Code	250
Min. Negotiated Rate	$339.35
Max. Negotiated Rate	$387.26
Rate for Payer: Cash Price	$259.51
Rate for Payer: Health Management Network Commercial	$339.35
Rate for Payer: MDX Hawaii PPO	$387.26

Know your out-of-pocket cost for care.

All Charges