Kona Community Hospital

All Charges

Charge

Type

Setting

Price

CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYR

Facility

$60.38

Service Code	HCPCS J0618
Hospital Revenue Code	636
Min. Negotiated Rate	$30.79
Max. Negotiated Rate	$58.57
Rate for Payer: Cash Price	$39.25
Rate for Payer: Hawaii Western Management Group Commercial	$57.36
Rate for Payer: Health Management Network Commercial	$51.32
Rate for Payer: Kaiser Permanente Commercial	$38.04
Rate for Payer: Kaiser Permanente Medicaid	$30.79
Rate for Payer: MDX Hawaii PPO	$58.57
Rate for Payer: UnitedHealthcare Medicaid	$36.23
Rate for Payer: University Health Alliance Commercial	$44.01

CALCIUM GLUC IN NACL, ISO-OSM 1 GRAM/50 ML IV SOLN

Facility

$116.12

Service Code	HCPCS J0613
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$112.64
Rate for Payer: Cash Price	$75.48
Rate for Payer: Cash Price	$75.48
Rate for Payer: Hawaii Medical Service Association ABD	$0.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.08
Rate for Payer: Hawaii Western Management Group Commercial	$110.31
Rate for Payer: Health Management Network Commercial	$98.70
Rate for Payer: Kaiser Permanente Commercial	$73.16
Rate for Payer: Kaiser Permanente Medicaid	$59.22
Rate for Payer: MDX Hawaii PPO	$112.64
Rate for Payer: UnitedHealthcare Medicaid	$69.67
Rate for Payer: University Health Alliance Commercial	$84.64

CALCIUM GLUC IN NACL, ISO-OSM 1 GRAM/50 ML IV SOLN

Facility

$116.12

Service Code	HCPCS J0613
Hospital Revenue Code	250
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$112.64
Rate for Payer: Cash Price	$75.48
Rate for Payer: Health Management Network Commercial	$98.70
Rate for Payer: MDX Hawaii PPO	$112.64

CALCIUM GLUC IN NACL, ISO-OSM 2 G/100 ML IV SOLN

Facility

$214.24

Service Code	HCPCS J0613
Hospital Revenue Code	250
Min. Negotiated Rate	$182.10
Max. Negotiated Rate	$207.81
Rate for Payer: Cash Price	$139.26
Rate for Payer: Health Management Network Commercial	$182.10
Rate for Payer: MDX Hawaii PPO	$207.81

CALCIUM GLUC IN NACL, ISO-OSM 2 G/100 ML IV SOLN

Facility

$214.24

Service Code	HCPCS J0613
Hospital Revenue Code	636
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$207.81
Rate for Payer: Cash Price	$139.26
Rate for Payer: Cash Price	$139.26
Rate for Payer: Hawaii Medical Service Association ABD	$0.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.08
Rate for Payer: Hawaii Western Management Group Commercial	$203.53
Rate for Payer: Health Management Network Commercial	$182.10
Rate for Payer: Kaiser Permanente Commercial	$134.97
Rate for Payer: Kaiser Permanente Medicaid	$109.26
Rate for Payer: MDX Hawaii PPO	$207.81
Rate for Payer: UnitedHealthcare Medicaid	$128.54
Rate for Payer: University Health Alliance Commercial	$156.16

CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN

Facility

$58.06

Service Code	HCPCS J0612
Hospital Revenue Code	250
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$56.32
Rate for Payer: Cash Price	$37.74
Rate for Payer: Health Management Network Commercial	$49.35
Rate for Payer: MDX Hawaii PPO	$56.32

CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN

Facility

$58.06

Service Code	HCPCS J0612
Hospital Revenue Code	636
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$56.32
Rate for Payer: Cash Price	$37.74
Rate for Payer: Cash Price	$37.74
Rate for Payer: Hawaii Medical Service Association ABD	$0.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.04
Rate for Payer: Hawaii Western Management Group Commercial	$55.16
Rate for Payer: Health Management Network Commercial	$49.35
Rate for Payer: Kaiser Permanente Commercial	$36.58
Rate for Payer: Kaiser Permanente Medicaid	$29.61
Rate for Payer: MDX Hawaii PPO	$56.32
Rate for Payer: UnitedHealthcare Medicaid	$34.84
Rate for Payer: University Health Alliance Commercial	$42.32

CALCIUM POLYCARBOPHIL 625 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87

CALCIUM POLYCARBOPHIL 625 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: MDX Hawaii PPO	$1.16

CALCIUM TOTAL

Professional

Both

$10.00

Service Code	HCPCS 82310
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$8.50
Rate for Payer: AlohaCare Medicaid	$7.12
Rate for Payer: AlohaCare Medicare	$5.16
Rate for Payer: Cash Price	$6.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Devoted Health Medicare	$5.68
Rate for Payer: Hawaii Medical Service Association Medicare	$5.16
Rate for Payer: Hawaii Western Management Group Commercial	$7.13
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$6.19
Rate for Payer: Kaiser Permanente Medicaid	$6.19
Rate for Payer: Kaiser Permanente Medicare	$6.19
Rate for Payer: Ohana Health Plan Medicaid	$7.12
Rate for Payer: Ohana Health Plan Medicare	$5.16
Rate for Payer: UnitedHealthcare Medicaid	$7.12
Rate for Payer: UnitedHealthcare Medicare	$5.16

CALFACTANT (IN 0.9 % NACL ) 35 MG/ML INTRATRACHEA SUSP

Facility

$2,179.99

Service Code	NDC 61938045606
Hospital Revenue Code	250
Min. Negotiated Rate	$1,111.79
Max. Negotiated Rate	$2,114.59
Rate for Payer: Cash Price	$1,416.99
Rate for Payer: Hawaii Western Management Group Commercial	$2,070.99
Rate for Payer: Health Management Network Commercial	$1,852.99
Rate for Payer: Kaiser Permanente Commercial	$1,373.39
Rate for Payer: Kaiser Permanente Medicaid	$1,111.79
Rate for Payer: MDX Hawaii PPO	$2,114.59
Rate for Payer: UnitedHealthcare Medicaid	$1,307.99
Rate for Payer: University Health Alliance Commercial	$1,588.99

CALFACTANT (IN 0.9 % NACL ) 35 MG/ML INTRATRACHEA SUSP

Facility

$2,179.99

Service Code	NDC 61938045606
Hospital Revenue Code	250
Min. Negotiated Rate	$1,852.99
Max. Negotiated Rate	$2,114.59
Rate for Payer: Cash Price	$1,416.99
Rate for Payer: Health Management Network Commercial	$1,852.99
Rate for Payer: MDX Hawaii PPO	$2,114.59

Cannula Crystal, Smooth AR6562 [3641511]

Facility

$282.00

Hospital Charge Code	3641511
Hospital Revenue Code	272
Min. Negotiated Rate	$143.82
Max. Negotiated Rate	$273.54
Rate for Payer: Cash Price	$183.30
Rate for Payer: Hawaii Western Management Group Commercial	$267.90
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: Kaiser Permanente Commercial	$177.66
Rate for Payer: Kaiser Permanente Medicaid	$143.82
Rate for Payer: MDX Hawaii PPO	$273.54
Rate for Payer: University Health Alliance Commercial	$205.55

Cannula Crystal, Smooth AR6562 [3641511]

Facility

$282.00

Hospital Charge Code	3641511
Hospital Revenue Code	272
Min. Negotiated Rate	$239.70
Max. Negotiated Rate	$273.54
Rate for Payer: Cash Price	$183.30
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: MDX Hawaii PPO	$273.54

Cannula Dri Lok Thrd 8.0mm x 75mm 3910-075-800 [3644273]

Facility

$228.95

Hospital Charge Code	3644273
Hospital Revenue Code	272
Min. Negotiated Rate	$194.61
Max. Negotiated Rate	$222.08
Rate for Payer: Cash Price	$148.82
Rate for Payer: Health Management Network Commercial	$194.61
Rate for Payer: MDX Hawaii PPO	$222.08

Cannula Dri Lok Thrd 8.0mm x 75mm 3910-075-800 [3644273]

Facility

$228.95

Hospital Charge Code	3644273
Hospital Revenue Code	272
Min. Negotiated Rate	$116.76
Max. Negotiated Rate	$222.08
Rate for Payer: Cash Price	$148.82
Rate for Payer: Hawaii Western Management Group Commercial	$217.50
Rate for Payer: Health Management Network Commercial	$194.61
Rate for Payer: Kaiser Permanente Commercial	$144.24
Rate for Payer: Kaiser Permanente Medicaid	$116.76
Rate for Payer: MDX Hawaii PPO	$222.08
Rate for Payer: University Health Alliance Commercial	$166.88

Cannula Passport Button 12 x 3cm AR65921230 [3641388]

Facility

$408.50

Hospital Charge Code	3641388
Hospital Revenue Code	272
Min. Negotiated Rate	$347.23
Max. Negotiated Rate	$396.25
Rate for Payer: Cash Price	$265.53
Rate for Payer: Health Management Network Commercial	$347.23
Rate for Payer: MDX Hawaii PPO	$396.25

Cannula Passport Button 12 x 3cm AR65921230 [3641388]

Facility

$408.50

Hospital Charge Code	3641388
Hospital Revenue Code	272
Min. Negotiated Rate	$208.34
Max. Negotiated Rate	$396.25
Rate for Payer: Cash Price	$265.53
Rate for Payer: Hawaii Western Management Group Commercial	$388.07
Rate for Payer: Health Management Network Commercial	$347.23
Rate for Payer: Kaiser Permanente Commercial	$257.36
Rate for Payer: Kaiser Permanente Medicaid	$208.34
Rate for Payer: MDX Hawaii PPO	$396.25
Rate for Payer: University Health Alliance Commercial	$297.76

Cannula Passport Button 8 x 4cm AR65920840 [3640104]

Facility

$349.50

Hospital Charge Code	3640104
Hospital Revenue Code	272
Min. Negotiated Rate	$178.25
Max. Negotiated Rate	$339.01
Rate for Payer: Cash Price	$227.18
Rate for Payer: Hawaii Western Management Group Commercial	$332.02
Rate for Payer: Health Management Network Commercial	$297.07
Rate for Payer: Kaiser Permanente Commercial	$220.19
Rate for Payer: Kaiser Permanente Medicaid	$178.25
Rate for Payer: MDX Hawaii PPO	$339.01
Rate for Payer: University Health Alliance Commercial	$254.75

Cannula Passport Button 8 x 4cm AR65920840 [3640104]

Facility

$349.50

Hospital Charge Code	3640104
Hospital Revenue Code	272
Min. Negotiated Rate	$297.07
Max. Negotiated Rate	$339.01
Rate for Payer: Cash Price	$227.18
Rate for Payer: Health Management Network Commercial	$297.07
Rate for Payer: MDX Hawaii PPO	$339.01

Cannula Passport Button AR65920830 [3641494]

Facility

$349.50

Hospital Charge Code	3641494
Hospital Revenue Code	272
Min. Negotiated Rate	$297.07
Max. Negotiated Rate	$339.01
Rate for Payer: Cash Price	$227.18
Rate for Payer: Health Management Network Commercial	$297.07
Rate for Payer: MDX Hawaii PPO	$339.01

Cannula Passport Button AR65920830 [3641494]

Facility

$349.50

Hospital Charge Code	3641494
Hospital Revenue Code	272
Min. Negotiated Rate	$178.25
Max. Negotiated Rate	$339.01
Rate for Payer: Cash Price	$227.18
Rate for Payer: Hawaii Western Management Group Commercial	$332.02
Rate for Payer: Health Management Network Commercial	$297.07
Rate for Payer: Kaiser Permanente Commercial	$220.19
Rate for Payer: Kaiser Permanente Medicaid	$178.25
Rate for Payer: MDX Hawaii PPO	$339.01
Rate for Payer: University Health Alliance Commercial	$254.75

Cannula Passport Button AR65920850 [3641286]

Facility

$264.50

Hospital Charge Code	3641286
Hospital Revenue Code	272
Min. Negotiated Rate	$134.90
Max. Negotiated Rate	$256.56
Rate for Payer: Cash Price	$171.92
Rate for Payer: Hawaii Western Management Group Commercial	$251.28
Rate for Payer: Health Management Network Commercial	$224.82
Rate for Payer: Kaiser Permanente Commercial	$166.63
Rate for Payer: Kaiser Permanente Medicaid	$134.90
Rate for Payer: MDX Hawaii PPO	$256.56
Rate for Payer: University Health Alliance Commercial	$192.79

Cannula Passport Button AR65920850 [3641286]

Facility

$264.50

Hospital Charge Code	3641286
Hospital Revenue Code	272
Min. Negotiated Rate	$224.82
Max. Negotiated Rate	$256.56
Rate for Payer: Cash Price	$171.92
Rate for Payer: Health Management Network Commercial	$224.82
Rate for Payer: MDX Hawaii PPO	$256.56

Cannulated Screw, 6.5mm X 90mm 04.355.790 [3645539]

Facility

$2,399.90

Service Code	HCPCS C1713
Hospital Charge Code	3645539
Hospital Revenue Code	278
Min. Negotiated Rate	$1,223.95
Max. Negotiated Rate	$2,327.90
Rate for Payer: Cash Price	$1,559.94
Rate for Payer: Hawaii Western Management Group Commercial	$1,679.93
Rate for Payer: Health Management Network Commercial	$2,039.91
Rate for Payer: Kaiser Permanente Commercial	$1,511.94
Rate for Payer: Kaiser Permanente Medicaid	$1,223.95
Rate for Payer: MDX Hawaii PPO	$2,327.90
Rate for Payer: University Health Alliance Commercial	$1,343.94

Know your out-of-pocket cost for care.

All Charges