Kona Community Hospital

All Charges

Charge

Type

Setting

Price

SODIUM CHLORIDE 1000 MG MISC SOL.TAB.

Facility

$1.59

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.54
Rate for Payer: Cash Price	$1.03
Rate for Payer: Health Management Network Commercial	$1.35
Rate for Payer: MDX Hawaii PPO	$1.54

SODIUM CHLORIDE 1000 MG MISC SOL.TAB.

Facility

$1.59

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.54
Rate for Payer: Cash Price	$1.03
Rate for Payer: Hawaii Western Management Group Commercial	$1.51
Rate for Payer: Health Management Network Commercial	$1.35
Rate for Payer: Kaiser Permanente Commercial	$1.00
Rate for Payer: Kaiser Permanente Medicaid	$0.81
Rate for Payer: MDX Hawaii PPO	$1.54
Rate for Payer: UnitedHealthcare Medicaid	$0.95
Rate for Payer: University Health Alliance Commercial	$1.16

SODIUM CHLORIDE 3 % INHAL NEBU

Facility

$4.14

Service Code	NDC 00378699789
Hospital Revenue Code	250
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$4.02
Rate for Payer: Cash Price	$2.69
Rate for Payer: Hawaii Western Management Group Commercial	$3.93
Rate for Payer: Health Management Network Commercial	$3.52
Rate for Payer: Kaiser Permanente Commercial	$2.61
Rate for Payer: Kaiser Permanente Medicaid	$2.11
Rate for Payer: MDX Hawaii PPO	$4.02
Rate for Payer: UnitedHealthcare Medicaid	$2.48
Rate for Payer: University Health Alliance Commercial	$3.02

SODIUM CHLORIDE 3 % INHAL NEBU

Facility

$4.14

Service Code	NDC 00378699789
Hospital Revenue Code	250
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$4.02
Rate for Payer: Cash Price	$2.69
Rate for Payer: Health Management Network Commercial	$3.52
Rate for Payer: MDX Hawaii PPO	$4.02

SODIUM CHLORIDE 3 % IV SOLP

Facility

$22.08

Service Code	HCPCS J7131
Hospital Revenue Code	636
Min. Negotiated Rate	$11.26
Max. Negotiated Rate	$21.42
Rate for Payer: Cash Price	$14.35
Rate for Payer: Hawaii Western Management Group Commercial	$20.98
Rate for Payer: Health Management Network Commercial	$18.77
Rate for Payer: Kaiser Permanente Commercial	$13.91
Rate for Payer: Kaiser Permanente Medicaid	$11.26
Rate for Payer: MDX Hawaii PPO	$21.42
Rate for Payer: UnitedHealthcare Medicaid	$13.25
Rate for Payer: University Health Alliance Commercial	$16.09

SODIUM CHLORIDE 3 % IV SOLP

Facility

$22.08

Service Code	HCPCS J7131
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 4 MEQ/ML IV SOLN

Facility

$46.60

Service Code	HCPCS J7131
Hospital Revenue Code	250
Min. Negotiated Rate	$39.61
Max. Negotiated Rate	$45.20
Rate for Payer: Cash Price	$30.29
Rate for Payer: Health Management Network Commercial	$39.61
Rate for Payer: MDX Hawaii PPO	$45.20

SODIUM CHLORIDE 4 MEQ/ML IV SOLN

Facility

$46.60

Service Code	HCPCS J7131
Hospital Revenue Code	636
Min. Negotiated Rate	$23.77
Max. Negotiated Rate	$45.20
Rate for Payer: Cash Price	$30.29
Rate for Payer: Hawaii Western Management Group Commercial	$44.27
Rate for Payer: Health Management Network Commercial	$39.61
Rate for Payer: Kaiser Permanente Commercial	$29.36
Rate for Payer: Kaiser Permanente Medicaid	$23.77
Rate for Payer: MDX Hawaii PPO	$45.20
Rate for Payer: UnitedHealthcare Medicaid	$27.96
Rate for Payer: University Health Alliance Commercial	$33.97

SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML PO SOLN

Facility

$40.22

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$34.19
Max. Negotiated Rate	$39.01
Rate for Payer: Cash Price	$26.14
Rate for Payer: Health Management Network Commercial	$34.19
Rate for Payer: MDX Hawaii PPO	$39.01

SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML PO SOLN

Facility

$40.22

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$20.51
Max. Negotiated Rate	$39.01
Rate for Payer: Cash Price	$26.14
Rate for Payer: Hawaii Western Management Group Commercial	$38.21
Rate for Payer: Health Management Network Commercial	$34.19
Rate for Payer: Kaiser Permanente Commercial	$25.34
Rate for Payer: Kaiser Permanente Medicaid	$20.51
Rate for Payer: MDX Hawaii PPO	$39.01
Rate for Payer: UnitedHealthcare Medicaid	$24.13
Rate for Payer: University Health Alliance Commercial	$29.32

SODIUM HYALURONATE 10 MG/ML INTRAOC SYR

Facility

$212.59

Service Code	NDC 05047480743
Hospital Revenue Code	250
Min. Negotiated Rate	$108.42
Max. Negotiated Rate	$206.21
Rate for Payer: Cash Price	$138.18
Rate for Payer: Hawaii Western Management Group Commercial	$201.96
Rate for Payer: Health Management Network Commercial	$180.70
Rate for Payer: Kaiser Permanente Commercial	$133.93
Rate for Payer: Kaiser Permanente Medicaid	$108.42
Rate for Payer: MDX Hawaii PPO	$206.21
Rate for Payer: UnitedHealthcare Medicaid	$127.55
Rate for Payer: University Health Alliance Commercial	$154.96

SODIUM HYALURONATE 10 MG/ML INTRAOC SYR

Facility

$212.59

Service Code	NDC 05047480743
Hospital Revenue Code	250
Min. Negotiated Rate	$180.70
Max. Negotiated Rate	$206.21
Rate for Payer: Cash Price	$138.18
Rate for Payer: Health Management Network Commercial	$180.70
Rate for Payer: MDX Hawaii PPO	$206.21

SODIUM HYALURONATE 10 MG/ML INTRAOC SYR [19145]

Facility

$327.60

Hospital Charge Code	19145
Hospital Revenue Code	279
Min. Negotiated Rate	$278.46
Max. Negotiated Rate	$317.77
Rate for Payer: Cash Price	$212.94
Rate for Payer: Health Management Network Commercial	$278.46
Rate for Payer: MDX Hawaii PPO	$317.77

SODIUM HYALURONATE 10 MG/ML INTRAOC SYR [19145]

Facility

$327.60

Hospital Charge Code	19145
Hospital Revenue Code	279
Min. Negotiated Rate	$167.08
Max. Negotiated Rate	$317.77
Rate for Payer: Cash Price	$212.94
Rate for Payer: Hawaii Western Management Group Commercial	$311.22
Rate for Payer: Health Management Network Commercial	$278.46
Rate for Payer: Kaiser Permanente Commercial	$206.39
Rate for Payer: Kaiser Permanente Medicaid	$167.08
Rate for Payer: MDX Hawaii PPO	$317.77
Rate for Payer: University Health Alliance Commercial	$238.79

SODIUM HYALURONATE 16 MG/ML INTRAOC SYR

Facility

$555.56

Service Code	NDC 61772060081
Hospital Revenue Code	250
Min. Negotiated Rate	$472.23
Max. Negotiated Rate	$538.89
Rate for Payer: Cash Price	$361.11
Rate for Payer: Health Management Network Commercial	$472.23
Rate for Payer: MDX Hawaii PPO	$538.89

SODIUM HYALURONATE 16 MG/ML INTRAOC SYR

Facility

$555.56

Service Code	NDC 61772060081
Hospital Revenue Code	250
Min. Negotiated Rate	$283.34
Max. Negotiated Rate	$538.89
Rate for Payer: Cash Price	$361.11
Rate for Payer: Hawaii Western Management Group Commercial	$527.78
Rate for Payer: Health Management Network Commercial	$472.23
Rate for Payer: Kaiser Permanente Commercial	$350.00
Rate for Payer: Kaiser Permanente Medicaid	$283.34
Rate for Payer: MDX Hawaii PPO	$538.89
Rate for Payer: UnitedHealthcare Medicaid	$333.34
Rate for Payer: University Health Alliance Commercial	$404.95

SODIUM HYALURONATE 18 MG/ML INTRAOCULAR SYRINGE

Facility

$362.26

Service Code	NDC 05047480745
Hospital Revenue Code	250
Min. Negotiated Rate	$307.92
Max. Negotiated Rate	$351.39
Rate for Payer: Cash Price	$235.47
Rate for Payer: Health Management Network Commercial	$307.92
Rate for Payer: MDX Hawaii PPO	$351.39

SODIUM HYALURONATE 18 MG/ML INTRAOCULAR SYRINGE

Facility

$362.26

Service Code	NDC 05047480745
Hospital Revenue Code	250
Min. Negotiated Rate	$184.75
Max. Negotiated Rate	$351.39
Rate for Payer: Cash Price	$235.47
Rate for Payer: Hawaii Western Management Group Commercial	$344.15
Rate for Payer: Health Management Network Commercial	$307.92
Rate for Payer: Kaiser Permanente Commercial	$228.22
Rate for Payer: Kaiser Permanente Medicaid	$184.75
Rate for Payer: MDX Hawaii PPO	$351.39
Rate for Payer: UnitedHealthcare Medicaid	$217.36
Rate for Payer: University Health Alliance Commercial	$264.05

SODIUM HYALURONATE 23 MG/ML INTRAOC SYR

Facility

$327.14

Service Code	NDC 50474080746
Hospital Revenue Code	250
Min. Negotiated Rate	$166.84
Max. Negotiated Rate	$317.33
Rate for Payer: Cash Price	$212.64
Rate for Payer: Hawaii Western Management Group Commercial	$310.78
Rate for Payer: Health Management Network Commercial	$278.07
Rate for Payer: Kaiser Permanente Commercial	$206.10
Rate for Payer: Kaiser Permanente Medicaid	$166.84
Rate for Payer: MDX Hawaii PPO	$317.33
Rate for Payer: UnitedHealthcare Medicaid	$196.28
Rate for Payer: University Health Alliance Commercial	$238.45

SODIUM HYALURONATE 23 MG/ML INTRAOC SYR

Facility

$327.14

Service Code	NDC 50474080746
Hospital Revenue Code	250
Min. Negotiated Rate	$278.07
Max. Negotiated Rate	$317.33
Rate for Payer: Cash Price	$212.64
Rate for Payer: Health Management Network Commercial	$278.07
Rate for Payer: MDX Hawaii PPO	$317.33

SODIUM HYPOCHLORITE 0.25 % MISC SOLN

Facility

$106.16

Service Code	NDC 39328006325
Hospital Revenue Code	250
Min. Negotiated Rate	$54.14
Max. Negotiated Rate	$102.98
Rate for Payer: Cash Price	$69.00
Rate for Payer: Hawaii Western Management Group Commercial	$100.85
Rate for Payer: Health Management Network Commercial	$90.24
Rate for Payer: Kaiser Permanente Commercial	$66.88
Rate for Payer: Kaiser Permanente Medicaid	$54.14
Rate for Payer: MDX Hawaii PPO	$102.98
Rate for Payer: UnitedHealthcare Medicaid	$63.70
Rate for Payer: University Health Alliance Commercial	$77.38

SODIUM HYPOCHLORITE 0.25 % MISC SOLN

Facility

$106.16

Service Code	NDC 39328006325
Hospital Revenue Code	250
Min. Negotiated Rate	$90.24
Max. Negotiated Rate	$102.98
Rate for Payer: Cash Price	$69.00
Rate for Payer: Health Management Network Commercial	$90.24
Rate for Payer: MDX Hawaii PPO	$102.98

SODIUM HYPOCHLORITE 0.25 % MISC SOLN

Facility

$88.50

Service Code	NDC 00436093616
Hospital Revenue Code	250
Min. Negotiated Rate	$45.13
Max. Negotiated Rate	$85.84
Rate for Payer: Cash Price	$57.52
Rate for Payer: Hawaii Western Management Group Commercial	$84.08
Rate for Payer: Health Management Network Commercial	$75.22
Rate for Payer: Kaiser Permanente Commercial	$55.76
Rate for Payer: Kaiser Permanente Medicaid	$45.13
Rate for Payer: MDX Hawaii PPO	$85.84
Rate for Payer: UnitedHealthcare Medicaid	$53.10
Rate for Payer: University Health Alliance Commercial	$64.51

SODIUM HYPOCHLORITE 0.25 % MISC SOLN

Facility

$88.50

Service Code	NDC 00436093616
Hospital Revenue Code	250
Min. Negotiated Rate	$75.22
Max. Negotiated Rate	$85.84
Rate for Payer: Cash Price	$57.52
Rate for Payer: Health Management Network Commercial	$75.22
Rate for Payer: MDX Hawaii PPO	$85.84

SODIUM HYPOCHLORITE 0.5 % MISC SOLN

Facility

$88.50

Service Code	NDC 00436094616
Hospital Revenue Code	250
Min. Negotiated Rate	$75.22
Max. Negotiated Rate	$85.84
Rate for Payer: Cash Price	$57.52
Rate for Payer: Health Management Network Commercial	$75.22
Rate for Payer: MDX Hawaii PPO	$85.84

Know your out-of-pocket cost for care.

All Charges