Kona Community Hospital

All Charges

Charge

Type

Setting

Price

SODIUM CHLORIDE 0.45 % 0.45 % IV SOLP

Facility

$22.08

Service Code	NDC 00264780200
Hospital Revenue Code	250
Min. Negotiated Rate	$18.77
Max. Negotiated Rate	$21.42
Rate for Payer: Cash Price	$14.35
Rate for Payer: Health Management Network Commercial	$18.77
Rate for Payer: MDX Hawaii PPO	$21.42

SODIUM CHLORIDE 0.65 % NASAL AERO.SPRAY

Facility

$5.11

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$4.96
Rate for Payer: Cash Price	$3.32
Rate for Payer: Cash Price	$9.63
Rate for Payer: Health Management Network Commercial	$12.60
Rate for Payer: Health Management Network Commercial	$4.34
Rate for Payer: MDX Hawaii PPO	$4.96
Rate for Payer: MDX Hawaii PPO	$14.38

SODIUM CHLORIDE 0.65 % NASAL AERO.SPRAY

Facility

$14.82

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.38
Rate for Payer: Cash Price	$9.63
Rate for Payer: Cash Price	$3.32
Rate for Payer: Hawaii Western Management Group Commercial	$14.08
Rate for Payer: Hawaii Western Management Group Commercial	$4.85
Rate for Payer: Health Management Network Commercial	$12.60
Rate for Payer: Health Management Network Commercial	$4.34
Rate for Payer: Kaiser Permanente Commercial	$9.34
Rate for Payer: Kaiser Permanente Commercial	$3.22
Rate for Payer: Kaiser Permanente Medicaid	$7.56
Rate for Payer: Kaiser Permanente Medicaid	$2.61
Rate for Payer: MDX Hawaii PPO	$14.38
Rate for Payer: MDX Hawaii PPO	$4.96
Rate for Payer: UnitedHealthcare Medicaid	$3.07
Rate for Payer: UnitedHealthcare Medicaid	$8.89
Rate for Payer: University Health Alliance Commercial	$10.80
Rate for Payer: University Health Alliance Commercial	$3.72

SODIUM CHLORIDE 0.9 % INHAL NEBU

Facility

$1.96

Service Code	NDC 00378698601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.90
Rate for Payer: Cash Price	$1.27
Rate for Payer: Hawaii Western Management Group Commercial	$1.86
Rate for Payer: Health Management Network Commercial	$1.67
Rate for Payer: Kaiser Permanente Commercial	$1.23
Rate for Payer: Kaiser Permanente Medicaid	$1.00
Rate for Payer: MDX Hawaii PPO	$1.90
Rate for Payer: UnitedHealthcare Medicaid	$1.18
Rate for Payer: University Health Alliance Commercial	$1.43

SODIUM CHLORIDE 0.9 % INHAL NEBU

Facility

$1.33

Service Code	NDC 00487930201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.29
Rate for Payer: Cash Price	$0.86
Rate for Payer: Hawaii Western Management Group Commercial	$1.26
Rate for Payer: Health Management Network Commercial	$1.13
Rate for Payer: Kaiser Permanente Commercial	$0.84
Rate for Payer: Kaiser Permanente Medicaid	$0.68
Rate for Payer: MDX Hawaii PPO	$1.29
Rate for Payer: UnitedHealthcare Medicaid	$0.80
Rate for Payer: University Health Alliance Commercial	$0.97

SODIUM CHLORIDE 0.9 % INHAL NEBU

Facility

$1.33

Service Code	NDC 00487930201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$1.29
Rate for Payer: Cash Price	$0.86
Rate for Payer: Health Management Network Commercial	$1.13
Rate for Payer: MDX Hawaii PPO	$1.29

SODIUM CHLORIDE 0.9 % INHAL NEBU

Facility

$4.39

Service Code	NDC 00378698789
Hospital Revenue Code	250
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$4.26
Rate for Payer: Cash Price	$2.85
Rate for Payer: Hawaii Western Management Group Commercial	$4.17
Rate for Payer: Health Management Network Commercial	$3.73
Rate for Payer: Kaiser Permanente Commercial	$2.77
Rate for Payer: Kaiser Permanente Medicaid	$2.24
Rate for Payer: MDX Hawaii PPO	$4.26
Rate for Payer: UnitedHealthcare Medicaid	$2.63
Rate for Payer: University Health Alliance Commercial	$3.20

SODIUM CHLORIDE 0.9 % INHAL NEBU

Facility

$4.39

Service Code	NDC 00378698789
Hospital Revenue Code	250
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$4.26
Rate for Payer: Cash Price	$2.85
Rate for Payer: Health Management Network Commercial	$3.73
Rate for Payer: MDX Hawaii PPO	$4.26

SODIUM CHLORIDE 0.9 % INHAL NEBU

Facility

$1.96

Service Code	NDC 00378698601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$1.90
Rate for Payer: Cash Price	$1.27
Rate for Payer: Health Management Network Commercial	$1.67
Rate for Payer: MDX Hawaii PPO	$1.90

SODIUM CHLORIDE 0.9 % IV BASE SOLP 1000 ML

Facility

$16.56

Service Code	HCPCS J7030
Hospital Revenue Code	636
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Cash Price	$10.76
Rate for Payer: Hawaii Medical Service Association ABD	$2.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$15.73
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: Kaiser Permanente Commercial	$10.43
Rate for Payer: Kaiser Permanente Medicaid	$8.45
Rate for Payer: MDX Hawaii PPO	$16.06
Rate for Payer: UnitedHealthcare Medicaid	$9.94
Rate for Payer: University Health Alliance Commercial	$12.07

SODIUM CHLORIDE 0.9 % IV BASE SOLP 1000 ML

Facility

$16.56

Service Code	HCPCS J7030
Hospital Revenue Code	250
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: MDX Hawaii PPO	$16.06

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$28.98

Service Code	HCPCS J7050
Hospital Revenue Code	636
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$28.11
Rate for Payer: Cash Price	$18.84
Rate for Payer: Cash Price	$9.87
Rate for Payer: Cash Price	$9.87
Rate for Payer: Cash Price	$18.84
Rate for Payer: Cash Price	$20.63
Rate for Payer: Cash Price	$20.63
Rate for Payer: Hawaii Medical Service Association ABD	$0.71
Rate for Payer: Hawaii Medical Service Association ABD	$0.71
Rate for Payer: Hawaii Medical Service Association ABD	$0.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.71
Rate for Payer: Hawaii Western Management Group Commercial	$14.42
Rate for Payer: Hawaii Western Management Group Commercial	$30.15
Rate for Payer: Hawaii Western Management Group Commercial	$27.53
Rate for Payer: Health Management Network Commercial	$12.90
Rate for Payer: Health Management Network Commercial	$24.63
Rate for Payer: Health Management Network Commercial	$26.98
Rate for Payer: Kaiser Permanente Commercial	$9.56
Rate for Payer: Kaiser Permanente Commercial	$18.26
Rate for Payer: Kaiser Permanente Commercial	$20.00
Rate for Payer: Kaiser Permanente Medicaid	$7.74
Rate for Payer: Kaiser Permanente Medicaid	$16.19
Rate for Payer: Kaiser Permanente Medicaid	$14.78
Rate for Payer: MDX Hawaii PPO	$28.11
Rate for Payer: MDX Hawaii PPO	$14.72
Rate for Payer: MDX Hawaii PPO	$30.79
Rate for Payer: UnitedHealthcare Medicaid	$9.11
Rate for Payer: UnitedHealthcare Medicaid	$17.39
Rate for Payer: UnitedHealthcare Medicaid	$19.04
Rate for Payer: University Health Alliance Commercial	$11.06
Rate for Payer: University Health Alliance Commercial	$23.14
Rate for Payer: University Health Alliance Commercial	$21.12

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$14.91

Service Code	NDC 00264180031
Hospital Revenue Code	250
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$14.46
Rate for Payer: Cash Price	$9.69
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

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$19.32

Service Code	HCPCS J7040
Hospital Revenue Code	636
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$18.74
Rate for Payer: Cash Price	$12.56
Rate for Payer: Cash Price	$12.56
Rate for Payer: Hawaii Medical Service Association ABD	$1.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.38
Rate for Payer: Hawaii Western Management Group Commercial	$18.35
Rate for Payer: Health Management Network Commercial	$16.42
Rate for Payer: Kaiser Permanente Commercial	$12.17
Rate for Payer: Kaiser Permanente Medicaid	$9.85
Rate for Payer: MDX Hawaii PPO	$18.74
Rate for Payer: UnitedHealthcare Medicaid	$11.59
Rate for Payer: University Health Alliance Commercial	$14.08

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$28.98

Service Code	NDC 00990798361
Hospital Revenue Code	250
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$28.11
Rate for Payer: Cash Price	$18.84
Rate for Payer: Hawaii Western Management Group Commercial	$27.53
Rate for Payer: Health Management Network Commercial	$24.63
Rate for Payer: Kaiser Permanente Commercial	$18.26
Rate for Payer: Kaiser Permanente Medicaid	$14.78
Rate for Payer: MDX Hawaii PPO	$28.11
Rate for Payer: UnitedHealthcare Medicaid	$17.39
Rate for Payer: University Health Alliance Commercial	$21.12

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$14.91

Service Code	NDC 00264180031
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

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$28.98

Service Code	NDC 00990798361
Hospital Revenue Code	250
Min. Negotiated Rate	$24.63
Max. Negotiated Rate	$28.11
Rate for Payer: Cash Price	$18.84
Rate for Payer: Health Management Network Commercial	$24.63
Rate for Payer: MDX Hawaii PPO	$28.11

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$16.56

Service Code	NDC 00264780009
Hospital Revenue Code	250
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Hawaii Western Management Group Commercial	$15.73
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: Kaiser Permanente Commercial	$10.43
Rate for Payer: Kaiser Permanente Medicaid	$8.45
Rate for Payer: MDX Hawaii PPO	$16.06
Rate for Payer: UnitedHealthcare Medicaid	$9.94
Rate for Payer: University Health Alliance Commercial	$12.07

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$16.56

Service Code	NDC 00264780009
Hospital Revenue Code	250
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: MDX Hawaii PPO	$16.06

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$16.56

Service Code	NDC 00264780000
Hospital Revenue Code	250
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Hawaii Western Management Group Commercial	$15.73
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: Kaiser Permanente Commercial	$10.43
Rate for Payer: Kaiser Permanente Medicaid	$8.45
Rate for Payer: MDX Hawaii PPO	$16.06
Rate for Payer: UnitedHealthcare Medicaid	$9.94
Rate for Payer: University Health Alliance Commercial	$12.07

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$19.32

Service Code	HCPCS J7040
Hospital Revenue Code	250
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$18.74
Rate for Payer: Cash Price	$12.56
Rate for Payer: Health Management Network Commercial	$16.42
Rate for Payer: MDX Hawaii PPO	$18.74

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$16.56

Service Code	NDC 00264780000
Hospital Revenue Code	250
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: MDX Hawaii PPO	$16.06

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$14.91

Service Code	NDC 00264180032
Hospital Revenue Code	250
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$14.46
Rate for Payer: Cash Price	$9.69
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

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$14.91

Service Code	NDC 00264180032
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

SODIUM CHLORIDE 0.9 % IV SOLP

Facility

$31.74

Service Code	HCPCS J7050
Hospital Revenue Code	250
Min. Negotiated Rate	$26.98
Max. Negotiated Rate	$30.79
Rate for Payer: Cash Price	$20.63
Rate for Payer: Cash Price	$9.87
Rate for Payer: Cash Price	$18.84
Rate for Payer: Health Management Network Commercial	$12.90
Rate for Payer: Health Management Network Commercial	$24.63
Rate for Payer: Health Management Network Commercial	$26.98
Rate for Payer: MDX Hawaii PPO	$14.72
Rate for Payer: MDX Hawaii PPO	$30.79
Rate for Payer: MDX Hawaii PPO	$28.11

Know your out-of-pocket cost for care.

All Charges