Kona Community Hospital

All Charges

Charge

Type

Setting

Price

CHEST PAIN

Facility

$12,420.00

Service Code	MSDRG 313
Min. Negotiated Rate	$9,469.99
Max. Negotiated Rate	$12,420.00
Rate for Payer: AlohaCare Medicare	$9,469.99
Rate for Payer: Devoted Health Medicare	$10,416.99
Rate for Payer: Hawaii Medical Service Association Commercial	$11,643.68
Rate for Payer: Hawaii Medical Service Association Medicare	$9,469.99
Rate for Payer: Humana Medicare	$9,469.99
Rate for Payer: Kaiser Permanente Commercial	$12,420.00
Rate for Payer: Kaiser Permanente Medicare	$9,469.99
Rate for Payer: Ohana Health Plan Medicare	$9,469.99
Rate for Payer: UnitedHealthcare Medicare	$9,469.99

CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES

Facility

$744,903.30

Service Code	MSDRG 018
Min. Negotiated Rate	$567,973.27
Max. Negotiated Rate	$744,903.30
Rate for Payer: AlohaCare Medicare	$567,973.27
Rate for Payer: Devoted Health Medicare	$624,770.60
Rate for Payer: Hawaii Medical Service Association Medicare	$567,973.27
Rate for Payer: Humana Medicare	$567,973.27
Rate for Payer: Kaiser Permanente Commercial	$744,903.30
Rate for Payer: Kaiser Permanente Medicare	$567,973.27
Rate for Payer: Ohana Health Plan Medicare	$567,973.27
Rate for Payer: UnitedHealthcare Medicare	$567,973.27

CHLORDIAZEPOXIDE HCL 10 MG PO CAP

Facility

$2.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$2.13
Rate for Payer: Cash Price	$1.43
Rate for Payer: Cash Price	$2.23
Rate for Payer: Health Management Network Commercial	$1.87
Rate for Payer: Health Management Network Commercial	$2.92
Rate for Payer: MDX Hawaii PPO	$2.13
Rate for Payer: MDX Hawaii PPO	$3.33

CHLORDIAZEPOXIDE HCL 10 MG PO CAP

Facility

$3.43

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$3.33
Rate for Payer: Cash Price	$2.23
Rate for Payer: Cash Price	$1.43
Rate for Payer: Hawaii Western Management Group Commercial	$2.09
Rate for Payer: Hawaii Western Management Group Commercial	$3.26
Rate for Payer: Health Management Network Commercial	$1.87
Rate for Payer: Health Management Network Commercial	$2.92
Rate for Payer: Kaiser Permanente Commercial	$2.16
Rate for Payer: Kaiser Permanente Commercial	$1.39
Rate for Payer: Kaiser Permanente Medicaid	$1.75
Rate for Payer: Kaiser Permanente Medicaid	$1.12
Rate for Payer: MDX Hawaii PPO	$2.13
Rate for Payer: MDX Hawaii PPO	$3.33
Rate for Payer: UnitedHealthcare Medicaid	$2.06
Rate for Payer: UnitedHealthcare Medicaid	$1.32
Rate for Payer: University Health Alliance Commercial	$2.50
Rate for Payer: University Health Alliance Commercial	$1.60

CHLORDIAZEPOXIDE HCL 25 MG PO CAP

Facility

$3.70

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$3.59
Rate for Payer: Cash Price	$2.41
Rate for Payer: Hawaii Western Management Group Commercial	$3.52
Rate for Payer: Health Management Network Commercial	$3.15
Rate for Payer: Kaiser Permanente Commercial	$2.33
Rate for Payer: Kaiser Permanente Medicaid	$1.89
Rate for Payer: MDX Hawaii PPO	$3.59
Rate for Payer: UnitedHealthcare Medicaid	$2.22
Rate for Payer: University Health Alliance Commercial	$2.70

CHLORDIAZEPOXIDE HCL 25 MG PO CAP

Facility

$3.70

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.59
Rate for Payer: Cash Price	$2.41
Rate for Payer: Health Management Network Commercial	$3.15
Rate for Payer: MDX Hawaii PPO	$3.59

CHLORDIAZEPOXIDE HCL 5 MG PO CAP

Facility

$1.95

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$1.89
Rate for Payer: Cash Price	$1.27
Rate for Payer: Hawaii Western Management Group Commercial	$1.85
Rate for Payer: Health Management Network Commercial	$1.66
Rate for Payer: Kaiser Permanente Commercial	$1.23
Rate for Payer: Kaiser Permanente Medicaid	$0.99
Rate for Payer: MDX Hawaii PPO	$1.89
Rate for Payer: UnitedHealthcare Medicaid	$1.17
Rate for Payer: University Health Alliance Commercial	$1.42

CHLORDIAZEPOXIDE HCL 5 MG PO CAP

Facility

$1.95

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$1.89
Rate for Payer: Cash Price	$1.27
Rate for Payer: Health Management Network Commercial	$1.66
Rate for Payer: MDX Hawaii PPO	$1.89

CHLORHEXIDINE GLUCONATE 0.12 % MM MOUTHWASH

Facility

$11.76

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$11.41
Rate for Payer: Cash Price	$7.64
Rate for Payer: Cash Price	$7.75
Rate for Payer: Cash Price	$8.18
Rate for Payer: Cash Price	$8.40
Rate for Payer: Hawaii Western Management Group Commercial	$12.27
Rate for Payer: Hawaii Western Management Group Commercial	$11.33
Rate for Payer: Hawaii Western Management Group Commercial	$11.17
Rate for Payer: Hawaii Western Management Group Commercial	$11.96
Rate for Payer: Health Management Network Commercial	$10.00
Rate for Payer: Health Management Network Commercial	$10.98
Rate for Payer: Health Management Network Commercial	$10.14
Rate for Payer: Health Management Network Commercial	$10.70
Rate for Payer: Kaiser Permanente Commercial	$7.41
Rate for Payer: Kaiser Permanente Commercial	$7.52
Rate for Payer: Kaiser Permanente Commercial	$7.93
Rate for Payer: Kaiser Permanente Commercial	$8.14
Rate for Payer: Kaiser Permanente Medicaid	$6.59
Rate for Payer: Kaiser Permanente Medicaid	$6.42
Rate for Payer: Kaiser Permanente Medicaid	$6.08
Rate for Payer: Kaiser Permanente Medicaid	$6.00
Rate for Payer: MDX Hawaii PPO	$12.53
Rate for Payer: MDX Hawaii PPO	$12.21
Rate for Payer: MDX Hawaii PPO	$11.57
Rate for Payer: MDX Hawaii PPO	$11.41
Rate for Payer: UnitedHealthcare Medicaid	$7.75
Rate for Payer: UnitedHealthcare Medicaid	$7.06
Rate for Payer: UnitedHealthcare Medicaid	$7.55
Rate for Payer: UnitedHealthcare Medicaid	$7.16
Rate for Payer: University Health Alliance Commercial	$8.70
Rate for Payer: University Health Alliance Commercial	$9.18
Rate for Payer: University Health Alliance Commercial	$9.42
Rate for Payer: University Health Alliance Commercial	$8.57

CHLORHEXIDINE GLUCONATE 0.12 % MM MOUTHWASH

Facility

$11.93

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$11.57
Rate for Payer: Cash Price	$7.75
Rate for Payer: Cash Price	$7.64
Rate for Payer: Cash Price	$8.18
Rate for Payer: Cash Price	$8.40
Rate for Payer: Health Management Network Commercial	$10.14
Rate for Payer: Health Management Network Commercial	$10.00
Rate for Payer: Health Management Network Commercial	$10.70
Rate for Payer: Health Management Network Commercial	$10.98
Rate for Payer: MDX Hawaii PPO	$12.21
Rate for Payer: MDX Hawaii PPO	$11.41
Rate for Payer: MDX Hawaii PPO	$11.57
Rate for Payer: MDX Hawaii PPO	$12.53

CHLORIDE BLD

Professional

Both

$9.00

Service Code	HCPCS 82435
Min. Negotiated Rate	$4.60
Max. Negotiated Rate	$7.65
Rate for Payer: AlohaCare Medicaid	$6.35
Rate for Payer: AlohaCare Medicare	$4.60
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cash Price	$5.85
Rate for Payer: Devoted Health Medicare	$5.06
Rate for Payer: Hawaii Medical Service Association Medicare	$4.60
Rate for Payer: Hawaii Western Management Group Commercial	$6.35
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$5.52
Rate for Payer: Kaiser Permanente Medicaid	$5.52
Rate for Payer: Kaiser Permanente Medicare	$5.52
Rate for Payer: Ohana Health Plan Medicaid	$6.35
Rate for Payer: Ohana Health Plan Medicare	$4.60
Rate for Payer: UnitedHealthcare Medicaid	$6.35
Rate for Payer: UnitedHealthcare Medicare	$4.60

CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJ SOLN

Facility

$110.66

Service Code	HCPCS J2401
Hospital Revenue Code	250
Min. Negotiated Rate	$94.06
Max. Negotiated Rate	$107.34
Rate for Payer: Cash Price	$71.93
Rate for Payer: Health Management Network Commercial	$94.06
Rate for Payer: MDX Hawaii PPO	$107.34

CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJ SOLN

Facility

$110.66

Service Code	HCPCS J2401
Hospital Revenue Code	636
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$107.34
Rate for Payer: Cash Price	$71.93
Rate for Payer: Cash Price	$71.93
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	$105.13
Rate for Payer: Health Management Network Commercial	$94.06
Rate for Payer: Kaiser Permanente Commercial	$69.72
Rate for Payer: Kaiser Permanente Medicaid	$56.44
Rate for Payer: MDX Hawaii PPO	$107.34
Rate for Payer: UnitedHealthcare Medicaid	$66.40
Rate for Payer: University Health Alliance Commercial	$80.66

CHLORPROMAZINE 100 MG PO TABLET

Facility

$79.64

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$67.69
Max. Negotiated Rate	$77.25
Rate for Payer: Cash Price	$51.77
Rate for Payer: Health Management Network Commercial	$67.69
Rate for Payer: MDX Hawaii PPO	$77.25

CHLORPROMAZINE 100 MG PO TABLET

Facility

$79.64

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$40.62
Max. Negotiated Rate	$77.25
Rate for Payer: Cash Price	$51.77
Rate for Payer: Hawaii Western Management Group Commercial	$75.66
Rate for Payer: Health Management Network Commercial	$67.69
Rate for Payer: Kaiser Permanente Commercial	$50.17
Rate for Payer: Kaiser Permanente Medicaid	$40.62
Rate for Payer: MDX Hawaii PPO	$77.25
Rate for Payer: UnitedHealthcare Medicaid	$47.78
Rate for Payer: University Health Alliance Commercial	$58.05

CHLORPROMAZINE 10 MG PO TABLET

Facility

$23.74

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$20.18
Max. Negotiated Rate	$23.03
Rate for Payer: Cash Price	$15.43
Rate for Payer: Health Management Network Commercial	$20.18
Rate for Payer: MDX Hawaii PPO	$23.03

CHLORPROMAZINE 10 MG PO TABLET

Facility

$23.74

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$23.03
Rate for Payer: Cash Price	$15.43
Rate for Payer: Hawaii Western Management Group Commercial	$22.55
Rate for Payer: Health Management Network Commercial	$20.18
Rate for Payer: Kaiser Permanente Commercial	$14.96
Rate for Payer: Kaiser Permanente Medicaid	$12.11
Rate for Payer: MDX Hawaii PPO	$23.03
Rate for Payer: UnitedHealthcare Medicaid	$14.24
Rate for Payer: University Health Alliance Commercial	$17.30

CHLORPROMAZINE 25 MG/ML INJ SOLN

Facility

$182.45

Service Code	HCPCS J3230
Hospital Revenue Code	636
Min. Negotiated Rate	$27.07
Max. Negotiated Rate	$176.98
Rate for Payer: Cash Price	$118.59
Rate for Payer: Cash Price	$100.78
Rate for Payer: Cash Price	$118.59
Rate for Payer: Cash Price	$100.78
Rate for Payer: Hawaii Medical Service Association ABD	$27.07
Rate for Payer: Hawaii Medical Service Association ABD	$27.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.07
Rate for Payer: Hawaii Western Management Group Commercial	$147.30
Rate for Payer: Hawaii Western Management Group Commercial	$173.33
Rate for Payer: Health Management Network Commercial	$155.08
Rate for Payer: Health Management Network Commercial	$131.79
Rate for Payer: Kaiser Permanente Commercial	$114.94
Rate for Payer: Kaiser Permanente Commercial	$97.68
Rate for Payer: Kaiser Permanente Medicaid	$93.05
Rate for Payer: Kaiser Permanente Medicaid	$79.08
Rate for Payer: MDX Hawaii PPO	$150.40
Rate for Payer: MDX Hawaii PPO	$176.98
Rate for Payer: UnitedHealthcare Medicaid	$93.03
Rate for Payer: UnitedHealthcare Medicaid	$109.47
Rate for Payer: University Health Alliance Commercial	$132.99
Rate for Payer: University Health Alliance Commercial	$113.02

CHLORPROMAZINE 25 MG/ML INJ SOLN

Facility

$155.05

Service Code	HCPCS J3230
Hospital Revenue Code	250
Min. Negotiated Rate	$131.79
Max. Negotiated Rate	$150.40
Rate for Payer: Cash Price	$100.78
Rate for Payer: Cash Price	$118.59
Rate for Payer: Health Management Network Commercial	$155.08
Rate for Payer: Health Management Network Commercial	$131.79
Rate for Payer: MDX Hawaii PPO	$150.40
Rate for Payer: MDX Hawaii PPO	$176.98

CHLORPROMAZINE 25 MG PO TABLET

Facility

$45.80

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$23.36
Max. Negotiated Rate	$44.43
Rate for Payer: Cash Price	$29.77
Rate for Payer: Cash Price	$28.60
Rate for Payer: Cash Price	$30.26
Rate for Payer: Hawaii Western Management Group Commercial	$41.80
Rate for Payer: Hawaii Western Management Group Commercial	$44.23
Rate for Payer: Hawaii Western Management Group Commercial	$43.51
Rate for Payer: Health Management Network Commercial	$39.58
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Health Management Network Commercial	$38.93
Rate for Payer: Kaiser Permanente Commercial	$27.72
Rate for Payer: Kaiser Permanente Commercial	$28.85
Rate for Payer: Kaiser Permanente Commercial	$29.33
Rate for Payer: Kaiser Permanente Medicaid	$23.75
Rate for Payer: Kaiser Permanente Medicaid	$23.36
Rate for Payer: Kaiser Permanente Medicaid	$22.44
Rate for Payer: MDX Hawaii PPO	$45.16
Rate for Payer: MDX Hawaii PPO	$42.68
Rate for Payer: MDX Hawaii PPO	$44.43
Rate for Payer: UnitedHealthcare Medicaid	$27.48
Rate for Payer: UnitedHealthcare Medicaid	$26.40
Rate for Payer: UnitedHealthcare Medicaid	$27.94
Rate for Payer: University Health Alliance Commercial	$33.94
Rate for Payer: University Health Alliance Commercial	$32.07
Rate for Payer: University Health Alliance Commercial	$33.38

CHLORPROMAZINE 25 MG PO TABLET

Facility

$45.80

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$38.93
Max. Negotiated Rate	$44.43
Rate for Payer: Cash Price	$29.77
Rate for Payer: Cash Price	$30.26
Rate for Payer: Cash Price	$28.60
Rate for Payer: Health Management Network Commercial	$37.40
Rate for Payer: Health Management Network Commercial	$38.93
Rate for Payer: Health Management Network Commercial	$39.58
Rate for Payer: MDX Hawaii PPO	$42.68
Rate for Payer: MDX Hawaii PPO	$45.16
Rate for Payer: MDX Hawaii PPO	$44.43

CHLORPROMAZINE 50 MG PO TABLET

Facility

$59.03

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$50.18
Max. Negotiated Rate	$57.26
Rate for Payer: Cash Price	$38.37
Rate for Payer: Cash Price	$38.86
Rate for Payer: Health Management Network Commercial	$50.81
Rate for Payer: Health Management Network Commercial	$50.18
Rate for Payer: MDX Hawaii PPO	$57.99
Rate for Payer: MDX Hawaii PPO	$57.26

CHLORPROMAZINE 50 MG PO TABLET

Facility

$59.03

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$30.11
Max. Negotiated Rate	$57.26
Rate for Payer: Cash Price	$38.37
Rate for Payer: Cash Price	$38.86
Rate for Payer: Hawaii Western Management Group Commercial	$56.08
Rate for Payer: Hawaii Western Management Group Commercial	$56.79
Rate for Payer: Health Management Network Commercial	$50.81
Rate for Payer: Health Management Network Commercial	$50.18
Rate for Payer: Kaiser Permanente Commercial	$37.19
Rate for Payer: Kaiser Permanente Commercial	$37.66
Rate for Payer: Kaiser Permanente Medicaid	$30.49
Rate for Payer: Kaiser Permanente Medicaid	$30.11
Rate for Payer: MDX Hawaii PPO	$57.99
Rate for Payer: MDX Hawaii PPO	$57.26
Rate for Payer: UnitedHealthcare Medicaid	$35.42
Rate for Payer: UnitedHealthcare Medicaid	$35.87
Rate for Payer: University Health Alliance Commercial	$43.57
Rate for Payer: University Health Alliance Commercial	$43.03

CHOLECALCIFEROL (VITAMIN D3) 1000 UNIT 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

CHOLECALCIFEROL (VITAMIN D3) 1000 UNIT 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

Know your out-of-pocket cost for care.

All Charges