Kona Community Hospital

All Charges

Charge

Type

Setting

Price

VITS A AND D-WHITE PET-LANOLIN TOP OINT

Facility

$17.60

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$8.98
Max. Negotiated Rate	$17.07
Rate for Payer: Cash Price	$11.44
Rate for Payer: Hawaii Western Management Group Commercial	$16.72
Rate for Payer: Health Management Network Commercial	$14.96
Rate for Payer: Kaiser Permanente Commercial	$11.09
Rate for Payer: Kaiser Permanente Medicaid	$8.98
Rate for Payer: MDX Hawaii PPO	$17.07
Rate for Payer: UnitedHealthcare Medicaid	$10.56
Rate for Payer: University Health Alliance Commercial	$12.83

VITS A AND D-WHITE PET-LANOLIN TOP OINT

Facility

$17.60

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.96
Max. Negotiated Rate	$17.07
Rate for Payer: Cash Price	$11.44
Rate for Payer: Health Management Network Commercial	$14.96
Rate for Payer: MDX Hawaii PPO	$17.07

VORICONAZOLE 200 MG IV RECON.SOLN.

Facility

$306.96

Service Code	HCPCS J3465
Hospital Revenue Code	250
Min. Negotiated Rate	$260.92
Max. Negotiated Rate	$297.75
Rate for Payer: Cash Price	$199.52
Rate for Payer: Health Management Network Commercial	$260.92
Rate for Payer: MDX Hawaii PPO	$297.75

VORICONAZOLE 200 MG IV RECON.SOLN.

Facility

$306.96

Service Code	HCPCS J3465
Hospital Revenue Code	636
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$297.75
Rate for Payer: Cash Price	$199.52
Rate for Payer: Cash Price	$199.52
Rate for Payer: Hawaii Medical Service Association ABD	$0.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.78
Rate for Payer: Hawaii Western Management Group Commercial	$291.61
Rate for Payer: Health Management Network Commercial	$260.92
Rate for Payer: Kaiser Permanente Commercial	$193.38
Rate for Payer: Kaiser Permanente Medicaid	$156.55
Rate for Payer: MDX Hawaii PPO	$297.75
Rate for Payer: UnitedHealthcare Medicaid	$184.18
Rate for Payer: University Health Alliance Commercial	$223.74

VORICONAZOLE-HPBCD 10 MG/ML SOLN (FOR OPHTH SOLN)

Facility

$183.60

Service Code	NDC 70594006701
Hospital Revenue Code	250
Min. Negotiated Rate	$93.64
Max. Negotiated Rate	$178.09
Rate for Payer: Cash Price	$119.34
Rate for Payer: Hawaii Western Management Group Commercial	$174.42
Rate for Payer: Health Management Network Commercial	$156.06
Rate for Payer: Kaiser Permanente Commercial	$115.67
Rate for Payer: Kaiser Permanente Medicaid	$93.64
Rate for Payer: MDX Hawaii PPO	$178.09
Rate for Payer: UnitedHealthcare Medicaid	$110.16
Rate for Payer: University Health Alliance Commercial	$133.83

VORICONAZOLE-HPBCD 10 MG/ML SOLN (FOR OPHTH SOLN)

Facility

$183.60

Service Code	NDC 70594006701
Hospital Revenue Code	250
Min. Negotiated Rate	$156.06
Max. Negotiated Rate	$178.09
Rate for Payer: Cash Price	$119.34
Rate for Payer: Health Management Network Commercial	$156.06
Rate for Payer: MDX Hawaii PPO	$178.09

VORICONAZOLE-HPBCD 200 MG IV RECON.SOLN.

Facility

$183.60

Service Code	HCPCS J3465
Hospital Revenue Code	250
Min. Negotiated Rate	$156.06
Max. Negotiated Rate	$178.09
Rate for Payer: Cash Price	$119.34
Rate for Payer: Health Management Network Commercial	$156.06
Rate for Payer: MDX Hawaii PPO	$178.09

VORICONAZOLE-HPBCD 200 MG IV RECON.SOLN.

Facility

$183.60

Service Code	HCPCS J3465
Hospital Revenue Code	636
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$178.09
Rate for Payer: Cash Price	$119.34
Rate for Payer: Cash Price	$119.34
Rate for Payer: Hawaii Medical Service Association ABD	$0.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.78
Rate for Payer: Hawaii Western Management Group Commercial	$174.42
Rate for Payer: Health Management Network Commercial	$156.06
Rate for Payer: Kaiser Permanente Commercial	$115.67
Rate for Payer: Kaiser Permanente Medicaid	$93.64
Rate for Payer: MDX Hawaii PPO	$178.09
Rate for Payer: UnitedHealthcare Medicaid	$110.16
Rate for Payer: University Health Alliance Commercial	$133.83

VULVECTOMY SIMPLE; PARTIAL

Facility

$11,157.19

Service Code	CPT 56620
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$11,157.19
Rate for Payer: AlohaCare Medicaid	$3,824.16
Rate for Payer: AlohaCare Medicare	$3,824.16
Rate for Payer: Devoted Health Medicare	$4,206.58
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,824.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,824.16
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,824.16
Rate for Payer: Ohana Health Plan Medicaid	$4,206.58
Rate for Payer: Ohana Health Plan Medicare	$3,824.16
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,824.16
Rate for Payer: University Health Alliance Commercial	$11,157.19

WARFARIN 1 MG PO TAB

Facility

$3.22

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$3.12
Rate for Payer: Cash Price	$2.09
Rate for Payer: Health Management Network Commercial	$2.74
Rate for Payer: MDX Hawaii PPO	$3.12

WARFARIN 1 MG PO TAB

Facility

$3.22

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$3.12
Rate for Payer: Cash Price	$2.09
Rate for Payer: Hawaii Western Management Group Commercial	$3.06
Rate for Payer: Health Management Network Commercial	$2.74
Rate for Payer: Kaiser Permanente Commercial	$2.03
Rate for Payer: Kaiser Permanente Medicaid	$1.64
Rate for Payer: MDX Hawaii PPO	$3.12
Rate for Payer: UnitedHealthcare Medicaid	$1.93
Rate for Payer: University Health Alliance Commercial	$2.35

WARFARIN 1 MG PO TAB (0.5 TAB) = 0.5 MG

Facility

$3.22

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$3.12
Rate for Payer: Cash Price	$2.09
Rate for Payer: Hawaii Western Management Group Commercial	$3.06
Rate for Payer: Health Management Network Commercial	$2.74
Rate for Payer: Kaiser Permanente Commercial	$2.03
Rate for Payer: Kaiser Permanente Medicaid	$1.64
Rate for Payer: MDX Hawaii PPO	$3.12
Rate for Payer: UnitedHealthcare Medicaid	$1.93
Rate for Payer: University Health Alliance Commercial	$2.35

WARFARIN 1 MG PO TAB (0.5 TAB) = 0.5 MG

Facility

$3.22

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$3.12
Rate for Payer: Cash Price	$2.09
Rate for Payer: Health Management Network Commercial	$2.74
Rate for Payer: MDX Hawaii PPO	$3.12

WARFARIN 2.5 MG PO TAB

Facility

$3.51

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$3.40
Rate for Payer: Cash Price	$2.28
Rate for Payer: Health Management Network Commercial	$2.98
Rate for Payer: MDX Hawaii PPO	$3.40

WARFARIN 2.5 MG PO TAB

Facility

$3.51

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$3.40
Rate for Payer: Cash Price	$2.28
Rate for Payer: Hawaii Western Management Group Commercial	$3.33
Rate for Payer: Health Management Network Commercial	$2.98
Rate for Payer: Kaiser Permanente Commercial	$2.21
Rate for Payer: Kaiser Permanente Medicaid	$1.79
Rate for Payer: MDX Hawaii PPO	$3.40
Rate for Payer: UnitedHealthcare Medicaid	$2.11
Rate for Payer: University Health Alliance Commercial	$2.56

WARFARIN 2.5 MG PO TAB (0.5 TAB) = 1.25 MG

Facility

$3.65

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$3.54
Rate for Payer: Cash Price	$2.37
Rate for Payer: Hawaii Western Management Group Commercial	$3.47
Rate for Payer: Health Management Network Commercial	$3.10
Rate for Payer: Kaiser Permanente Commercial	$2.30
Rate for Payer: Kaiser Permanente Medicaid	$1.86
Rate for Payer: MDX Hawaii PPO	$3.54
Rate for Payer: UnitedHealthcare Medicaid	$2.19
Rate for Payer: University Health Alliance Commercial	$2.66

WARFARIN 2.5 MG PO TAB (0.5 TAB) = 1.25 MG

Facility

$3.65

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$3.54
Rate for Payer: Cash Price	$2.37
Rate for Payer: Health Management Network Commercial	$3.10
Rate for Payer: MDX Hawaii PPO	$3.54

WARFARIN 2 MG PO TAB

Facility

$3.40

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.89
Max. Negotiated Rate	$3.30
Rate for Payer: Cash Price	$2.21
Rate for Payer: Health Management Network Commercial	$2.89
Rate for Payer: MDX Hawaii PPO	$3.30

WARFARIN 2 MG PO TAB

Facility

$3.40

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$3.30
Rate for Payer: Cash Price	$2.21
Rate for Payer: Hawaii Western Management Group Commercial	$3.23
Rate for Payer: Health Management Network Commercial	$2.89
Rate for Payer: Kaiser Permanente Commercial	$2.14
Rate for Payer: Kaiser Permanente Medicaid	$1.73
Rate for Payer: MDX Hawaii PPO	$3.30
Rate for Payer: UnitedHealthcare Medicaid	$2.04
Rate for Payer: University Health Alliance Commercial	$2.48

WARFARIN 5 MG PO TAB

Facility

$3.73

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$3.62
Rate for Payer: Cash Price	$2.42
Rate for Payer: Health Management Network Commercial	$3.17
Rate for Payer: MDX Hawaii PPO	$3.62

WARFARIN 5 MG PO TAB

Facility

$3.73

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$3.62
Rate for Payer: Cash Price	$2.42
Rate for Payer: Hawaii Western Management Group Commercial	$3.54
Rate for Payer: Health Management Network Commercial	$3.17
Rate for Payer: Kaiser Permanente Commercial	$2.35
Rate for Payer: Kaiser Permanente Medicaid	$1.90
Rate for Payer: MDX Hawaii PPO	$3.62
Rate for Payer: UnitedHealthcare Medicaid	$2.24
Rate for Payer: University Health Alliance Commercial	$2.72

Washer 3.5mm LP Cortical Screw 131218000 [3640873]

Facility

$697.84

Service Code	HCPCS C1713
Hospital Charge Code	3640873
Hospital Revenue Code	278
Min. Negotiated Rate	$355.90
Max. Negotiated Rate	$676.90
Rate for Payer: Cash Price	$453.60
Rate for Payer: Hawaii Western Management Group Commercial	$488.49
Rate for Payer: Health Management Network Commercial	$593.16
Rate for Payer: Kaiser Permanente Commercial	$439.64
Rate for Payer: Kaiser Permanente Medicaid	$355.90
Rate for Payer: MDX Hawaii PPO	$676.90
Rate for Payer: University Health Alliance Commercial	$390.79

Washer 3.5mm LP Cortical Screw 131218000 [3640873]

Facility

$697.84

Service Code	HCPCS C1713
Hospital Charge Code	3640873
Hospital Revenue Code	278
Min. Negotiated Rate	$390.79
Max. Negotiated Rate	$676.90
Rate for Payer: Cash Price	$453.60
Rate for Payer: Hawaii Western Management Group Commercial	$488.49
Rate for Payer: Health Management Network Commercial	$593.16
Rate for Payer: MDX Hawaii PPO	$676.90
Rate for Payer: University Health Alliance Commercial	$390.79

Washer 7.0mm Flat 8039-000 [3644659]

Facility

$1,021.29

Hospital Charge Code	3644659
Hospital Revenue Code	272
Min. Negotiated Rate	$868.10
Max. Negotiated Rate	$990.65
Rate for Payer: Cash Price	$663.84
Rate for Payer: Health Management Network Commercial	$868.10
Rate for Payer: MDX Hawaii PPO	$990.65

Washer 7.0mm Flat 8039-000 [3644659]

Facility

$1,021.29

Hospital Charge Code	3644659
Hospital Revenue Code	272
Min. Negotiated Rate	$520.86
Max. Negotiated Rate	$990.65
Rate for Payer: Cash Price	$663.84
Rate for Payer: Hawaii Western Management Group Commercial	$970.23
Rate for Payer: Health Management Network Commercial	$868.10
Rate for Payer: Kaiser Permanente Commercial	$643.41
Rate for Payer: Kaiser Permanente Medicaid	$520.86
Rate for Payer: MDX Hawaii PPO	$990.65
Rate for Payer: University Health Alliance Commercial	$744.42

Know your out-of-pocket cost for care.

All Charges