Kona Community Hospital

All Charges

Charge

Type

Setting

Price

PROMETHAZINE 12.5 MG PR SUPP

Facility

$91.30

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$77.61
Max. Negotiated Rate	$88.56
Rate for Payer: Cash Price	$59.34
Rate for Payer: Health Management Network Commercial	$77.61
Rate for Payer: MDX Hawaii PPO	$88.56

PROMETHAZINE 12.5 MG PR SUPP

Facility

$91.30

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$46.56
Max. Negotiated Rate	$88.56
Rate for Payer: Cash Price	$59.34
Rate for Payer: Hawaii Western Management Group Commercial	$86.73
Rate for Payer: Health Management Network Commercial	$77.61
Rate for Payer: Kaiser Permanente Commercial	$57.52
Rate for Payer: Kaiser Permanente Medicaid	$46.56
Rate for Payer: MDX Hawaii PPO	$88.56
Rate for Payer: UnitedHealthcare Medicaid	$54.78
Rate for Payer: University Health Alliance Commercial	$66.55

PROMETHAZINE 25 MG/ML INJ SOLN 1 ML

Facility

$10.21

Service Code	HCPCS J2550
Hospital Revenue Code	250
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$9.90
Rate for Payer: Cash Price	$6.64
Rate for Payer: Cash Price	$6.27
Rate for Payer: Health Management Network Commercial	$8.19
Rate for Payer: Health Management Network Commercial	$8.68
Rate for Payer: MDX Hawaii PPO	$9.35
Rate for Payer: MDX Hawaii PPO	$9.90

PROMETHAZINE 25 MG/ML INJ SOLN 1 ML

Facility

$9.64

Service Code	HCPCS J2550
Hospital Revenue Code	636
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$9.35
Rate for Payer: Cash Price	$6.27
Rate for Payer: Cash Price	$6.64
Rate for Payer: Cash Price	$6.64
Rate for Payer: Cash Price	$6.27
Rate for Payer: Hawaii Medical Service Association ABD	$2.87
Rate for Payer: Hawaii Medical Service Association ABD	$2.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.87
Rate for Payer: Hawaii Western Management Group Commercial	$9.70
Rate for Payer: Hawaii Western Management Group Commercial	$9.16
Rate for Payer: Health Management Network Commercial	$8.19
Rate for Payer: Health Management Network Commercial	$8.68
Rate for Payer: Kaiser Permanente Commercial	$6.07
Rate for Payer: Kaiser Permanente Commercial	$6.43
Rate for Payer: Kaiser Permanente Medicaid	$5.21
Rate for Payer: Kaiser Permanente Medicaid	$4.92
Rate for Payer: MDX Hawaii PPO	$9.90
Rate for Payer: MDX Hawaii PPO	$9.35
Rate for Payer: UnitedHealthcare Medicaid	$6.13
Rate for Payer: UnitedHealthcare Medicaid	$5.78
Rate for Payer: University Health Alliance Commercial	$7.44
Rate for Payer: University Health Alliance Commercial	$7.03

PROMETHAZINE 25 MG PO TABLET

Facility

$2.80

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$2.72
Rate for Payer: Cash Price	$1.82
Rate for Payer: Health Management Network Commercial	$2.38
Rate for Payer: MDX Hawaii PPO	$2.72

PROMETHAZINE 25 MG PO TABLET

Facility

$2.80

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$2.72
Rate for Payer: Cash Price	$1.82
Rate for Payer: Hawaii Western Management Group Commercial	$2.66
Rate for Payer: Health Management Network Commercial	$2.38
Rate for Payer: Kaiser Permanente Commercial	$1.76
Rate for Payer: Kaiser Permanente Medicaid	$1.43
Rate for Payer: MDX Hawaii PPO	$2.72
Rate for Payer: UnitedHealthcare Medicaid	$1.68
Rate for Payer: University Health Alliance Commercial	$2.04

PROMETHAZINE 25 MG PR SUPP

Facility

$91.30

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$46.56
Max. Negotiated Rate	$88.56
Rate for Payer: Cash Price	$59.34
Rate for Payer: Hawaii Western Management Group Commercial	$86.73
Rate for Payer: Health Management Network Commercial	$77.61
Rate for Payer: Kaiser Permanente Commercial	$57.52
Rate for Payer: Kaiser Permanente Medicaid	$46.56
Rate for Payer: MDX Hawaii PPO	$88.56
Rate for Payer: UnitedHealthcare Medicaid	$54.78
Rate for Payer: University Health Alliance Commercial	$66.55

PROMETHAZINE 25 MG PR SUPP

Facility

$91.30

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$77.61
Max. Negotiated Rate	$88.56
Rate for Payer: Cash Price	$59.34
Rate for Payer: Health Management Network Commercial	$77.61
Rate for Payer: MDX Hawaii PPO	$88.56

PROMETHAZINE-CODEINE 6.25-10 MG/5 ML PO SYRUP

Facility

$1.91

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$1.85
Rate for Payer: Cash Price	$1.24
Rate for Payer: Health Management Network Commercial	$1.62
Rate for Payer: MDX Hawaii PPO	$1.85

PROMETHAZINE-CODEINE 6.25-10 MG/5 ML PO SYRUP

Facility

$1.91

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$1.85
Rate for Payer: Cash Price	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$1.81
Rate for Payer: Health Management Network Commercial	$1.62
Rate for Payer: Kaiser Permanente Commercial	$1.20
Rate for Payer: Kaiser Permanente Medicaid	$0.97
Rate for Payer: MDX Hawaii PPO	$1.85
Rate for Payer: UnitedHealthcare Medicaid	$1.15
Rate for Payer: University Health Alliance Commercial	$1.39

PROMETHAZINE IVPB FOR ED / PACU USE ONLY

Facility

$10.21

Service Code	HCPCS J2550
Hospital Revenue Code	636
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$9.90
Rate for Payer: Cash Price	$6.64
Rate for Payer: Cash Price	$6.27
Rate for Payer: Cash Price	$6.27
Rate for Payer: Cash Price	$6.64
Rate for Payer: Hawaii Medical Service Association ABD	$2.87
Rate for Payer: Hawaii Medical Service Association ABD	$2.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.87
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.87
Rate for Payer: Hawaii Western Management Group Commercial	$9.16
Rate for Payer: Hawaii Western Management Group Commercial	$9.70
Rate for Payer: Health Management Network Commercial	$8.68
Rate for Payer: Health Management Network Commercial	$8.19
Rate for Payer: Kaiser Permanente Commercial	$6.43
Rate for Payer: Kaiser Permanente Commercial	$6.07
Rate for Payer: Kaiser Permanente Medicaid	$4.92
Rate for Payer: Kaiser Permanente Medicaid	$5.21
Rate for Payer: MDX Hawaii PPO	$9.35
Rate for Payer: MDX Hawaii PPO	$9.90
Rate for Payer: UnitedHealthcare Medicaid	$6.13
Rate for Payer: UnitedHealthcare Medicaid	$5.78
Rate for Payer: University Health Alliance Commercial	$7.03
Rate for Payer: University Health Alliance Commercial	$7.44

PROMETHAZINE IVPB FOR ED / PACU USE ONLY

Facility

$10.21

Service Code	HCPCS J2550
Hospital Revenue Code	250
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$9.90
Rate for Payer: Cash Price	$6.64
Rate for Payer: Cash Price	$6.27
Rate for Payer: Health Management Network Commercial	$8.19
Rate for Payer: Health Management Network Commercial	$8.68
Rate for Payer: MDX Hawaii PPO	$9.35
Rate for Payer: MDX Hawaii PPO	$9.90

PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT METHYLMETHACRYLATE, TIBIA

Facility

$10,715.11

Service Code	CPT 27745
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$10,715.11
Rate for Payer: AlohaCare Medicaid	$8,572.09
Rate for Payer: AlohaCare Medicare	$8,572.09
Rate for Payer: Devoted Health Medicare	$9,429.30
Rate for Payer: Hawaii Medical Service Association Commercial	$10,715.11
Rate for Payer: Hawaii Medical Service Association Medicare	$8,572.09
Rate for Payer: Humana Medicare	$8,572.09
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$8,572.09
Rate for Payer: Ohana Health Plan Medicaid	$9,429.30
Rate for Payer: Ohana Health Plan Medicare	$8,572.09
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$8,572.09
Rate for Payer: University Health Alliance Commercial	$6,743.44

PROPOFOL 1000 MG/100 ML IV DRIP

Facility

$142.20

Service Code	HCPCS J2704
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$137.93
Rate for Payer: Cash Price	$92.43
Rate for Payer: Cash Price	$92.43
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 Western Management Group Commercial	$135.09
Rate for Payer: Health Management Network Commercial	$120.87
Rate for Payer: Kaiser Permanente Commercial	$89.59
Rate for Payer: Kaiser Permanente Medicaid	$72.52
Rate for Payer: MDX Hawaii PPO	$137.93
Rate for Payer: UnitedHealthcare Medicaid	$85.32
Rate for Payer: University Health Alliance Commercial	$103.65

PROPOFOL 1000 MG/100 ML IV DRIP

Facility

$142.20

Service Code	HCPCS J2704
Hospital Revenue Code	250
Min. Negotiated Rate	$120.87
Max. Negotiated Rate	$137.93
Rate for Payer: Cash Price	$92.43
Rate for Payer: Health Management Network Commercial	$120.87
Rate for Payer: MDX Hawaii PPO	$137.93

PROPOFOL 10 MG/ML IV EMUL

Facility

$38.62

Service Code	HCPCS J2704
Hospital Revenue Code	250
Min. Negotiated Rate	$32.83
Max. Negotiated Rate	$37.46
Rate for Payer: Cash Price	$25.10
Rate for Payer: Cash Price	$15.50
Rate for Payer: Health Management Network Commercial	$20.27
Rate for Payer: Health Management Network Commercial	$32.83
Rate for Payer: MDX Hawaii PPO	$37.46
Rate for Payer: MDX Hawaii PPO	$23.13

PROPOFOL 10 MG/ML IV EMUL

Facility

$23.85

Service Code	HCPCS J2704
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$23.13
Rate for Payer: Cash Price	$15.50
Rate for Payer: Cash Price	$15.50
Rate for Payer: Cash Price	$25.10
Rate for Payer: Cash Price	$25.10
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	$22.66
Rate for Payer: Hawaii Western Management Group Commercial	$36.69
Rate for Payer: Health Management Network Commercial	$20.27
Rate for Payer: Health Management Network Commercial	$32.83
Rate for Payer: Kaiser Permanente Commercial	$15.03
Rate for Payer: Kaiser Permanente Commercial	$24.33
Rate for Payer: Kaiser Permanente Medicaid	$19.70
Rate for Payer: Kaiser Permanente Medicaid	$12.16
Rate for Payer: MDX Hawaii PPO	$37.46
Rate for Payer: MDX Hawaii PPO	$23.13
Rate for Payer: UnitedHealthcare Medicaid	$14.31
Rate for Payer: UnitedHealthcare Medicaid	$23.17
Rate for Payer: University Health Alliance Commercial	$17.38
Rate for Payer: University Health Alliance Commercial	$28.15

PROPRANOLOL 10 MG PO TABLET

Facility

$1.66

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.61
Rate for Payer: Cash Price	$1.08
Rate for Payer: Cash Price	$1.47
Rate for Payer: Health Management Network Commercial	$1.92
Rate for Payer: Health Management Network Commercial	$1.41
Rate for Payer: MDX Hawaii PPO	$1.61
Rate for Payer: MDX Hawaii PPO	$2.19

PROPRANOLOL 10 MG PO TABLET

Facility

$1.66

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.61
Rate for Payer: Cash Price	$1.08
Rate for Payer: Cash Price	$1.47
Rate for Payer: Hawaii Western Management Group Commercial	$1.58
Rate for Payer: Hawaii Western Management Group Commercial	$2.15
Rate for Payer: Health Management Network Commercial	$1.41
Rate for Payer: Health Management Network Commercial	$1.92
Rate for Payer: Kaiser Permanente Commercial	$1.05
Rate for Payer: Kaiser Permanente Commercial	$1.42
Rate for Payer: Kaiser Permanente Medicaid	$1.15
Rate for Payer: Kaiser Permanente Medicaid	$0.85
Rate for Payer: MDX Hawaii PPO	$1.61
Rate for Payer: MDX Hawaii PPO	$2.19
Rate for Payer: UnitedHealthcare Medicaid	$1.36
Rate for Payer: UnitedHealthcare Medicaid	$1.00
Rate for Payer: University Health Alliance Commercial	$1.21
Rate for Payer: University Health Alliance Commercial	$1.65

PROPRANOLOL 1 MG/ML IV SOLN

Facility

$65.53

Service Code	HCPCS J1800
Hospital Revenue Code	636
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$63.56
Rate for Payer: Cash Price	$42.59
Rate for Payer: Cash Price	$42.59
Rate for Payer: Hawaii Medical Service Association ABD	$3.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.32
Rate for Payer: Hawaii Western Management Group Commercial	$62.25
Rate for Payer: Health Management Network Commercial	$55.70
Rate for Payer: Kaiser Permanente Commercial	$41.28
Rate for Payer: Kaiser Permanente Medicaid	$33.42
Rate for Payer: MDX Hawaii PPO	$63.56
Rate for Payer: UnitedHealthcare Medicaid	$39.32
Rate for Payer: University Health Alliance Commercial	$47.76

PROPRANOLOL 1 MG/ML IV SOLN

Facility

$65.53

Service Code	HCPCS J1800
Hospital Revenue Code	250
Min. Negotiated Rate	$55.70
Max. Negotiated Rate	$63.56
Rate for Payer: Cash Price	$42.59
Rate for Payer: Health Management Network Commercial	$55.70
Rate for Payer: MDX Hawaii PPO	$63.56

PROPRANOLOL 20 MG PO TABLET

Facility

$2.82

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.74
Rate for Payer: Cash Price	$1.83
Rate for Payer: Cash Price	$1.99
Rate for Payer: Health Management Network Commercial	$2.60
Rate for Payer: Health Management Network Commercial	$2.40
Rate for Payer: MDX Hawaii PPO	$2.97
Rate for Payer: MDX Hawaii PPO	$2.74

PROPRANOLOL 20 MG PO TABLET

Facility

$2.82

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$2.74
Rate for Payer: Cash Price	$1.83
Rate for Payer: Cash Price	$1.99
Rate for Payer: Hawaii Western Management Group Commercial	$2.68
Rate for Payer: Hawaii Western Management Group Commercial	$2.91
Rate for Payer: Health Management Network Commercial	$2.60
Rate for Payer: Health Management Network Commercial	$2.40
Rate for Payer: Kaiser Permanente Commercial	$1.78
Rate for Payer: Kaiser Permanente Commercial	$1.93
Rate for Payer: Kaiser Permanente Medicaid	$1.56
Rate for Payer: Kaiser Permanente Medicaid	$1.44
Rate for Payer: MDX Hawaii PPO	$2.97
Rate for Payer: MDX Hawaii PPO	$2.74
Rate for Payer: UnitedHealthcare Medicaid	$1.69
Rate for Payer: UnitedHealthcare Medicaid	$1.84
Rate for Payer: University Health Alliance Commercial	$2.23
Rate for Payer: University Health Alliance Commercial	$2.06

PROPRANOLOL 60 MG PO CAP SA 24H

Facility

$11.37

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$11.03
Rate for Payer: Cash Price	$7.39
Rate for Payer: Health Management Network Commercial	$9.66
Rate for Payer: MDX Hawaii PPO	$11.03

PROPRANOLOL 60 MG PO CAP SA 24H

Facility

$11.37

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.80
Max. Negotiated Rate	$11.03
Rate for Payer: Cash Price	$7.39
Rate for Payer: Hawaii Western Management Group Commercial	$10.80
Rate for Payer: Health Management Network Commercial	$9.66
Rate for Payer: Kaiser Permanente Commercial	$7.16
Rate for Payer: Kaiser Permanente Medicaid	$5.80
Rate for Payer: MDX Hawaii PPO	$11.03
Rate for Payer: UnitedHealthcare Medicaid	$6.82
Rate for Payer: University Health Alliance Commercial	$8.29

Know your out-of-pocket cost for care.

All Charges