Kona Community Hospital

All Charges

Charge

Type

Setting

Price

DEXTROSE 50 % IN WATER (D50W) IV SOLP

Facility

$28.71

Service Code	NDC 00409664816
Hospital Revenue Code	250
Min. Negotiated Rate	$24.40
Max. Negotiated Rate	$27.85
Rate for Payer: Cash Price	$18.66
Rate for Payer: Health Management Network Commercial	$24.40
Rate for Payer: MDX Hawaii PPO	$27.85

DEXTROSE 50 % IN WATER (D50W) IV SOLP

Facility

$86.31

Service Code	NDC 00990793619
Hospital Revenue Code	250
Min. Negotiated Rate	$44.02
Max. Negotiated Rate	$83.72
Rate for Payer: Cash Price	$56.10
Rate for Payer: Hawaii Western Management Group Commercial	$81.99
Rate for Payer: Health Management Network Commercial	$73.36
Rate for Payer: Kaiser Permanente Commercial	$54.38
Rate for Payer: Kaiser Permanente Medicaid	$44.02
Rate for Payer: MDX Hawaii PPO	$83.72
Rate for Payer: UnitedHealthcare Medicaid	$51.79
Rate for Payer: University Health Alliance Commercial	$62.91

DEXTROSE 50 % IN WATER (D50W) IV SOLP

Facility

$86.31

Service Code	NDC 00990793619
Hospital Revenue Code	250
Min. Negotiated Rate	$73.36
Max. Negotiated Rate	$83.72
Rate for Payer: Cash Price	$56.10
Rate for Payer: Health Management Network Commercial	$73.36
Rate for Payer: MDX Hawaii PPO	$83.72

DEXTROSE 50 % IN WATER (D50W) IV SOLP

Facility

$28.71

Service Code	NDC 00409664802
Hospital Revenue Code	250
Min. Negotiated Rate	$24.40
Max. Negotiated Rate	$27.85
Rate for Payer: Cash Price	$18.66
Rate for Payer: Health Management Network Commercial	$24.40
Rate for Payer: MDX Hawaii PPO	$27.85

DEXTROSE 50 % IN WATER (D50W) IV SYR

Facility

$101.84

Service Code	NDC 76329330201
Hospital Revenue Code	250
Min. Negotiated Rate	$51.94
Max. Negotiated Rate	$98.78
Rate for Payer: Cash Price	$66.20
Rate for Payer: Hawaii Western Management Group Commercial	$96.75
Rate for Payer: Health Management Network Commercial	$86.56
Rate for Payer: Kaiser Permanente Commercial	$64.16
Rate for Payer: Kaiser Permanente Medicaid	$51.94
Rate for Payer: MDX Hawaii PPO	$98.78
Rate for Payer: UnitedHealthcare Medicaid	$61.10
Rate for Payer: University Health Alliance Commercial	$74.23

DEXTROSE 50 % IN WATER (D50W) IV SYR

Facility

$101.84

Service Code	NDC 76329330201
Hospital Revenue Code	250
Min. Negotiated Rate	$86.56
Max. Negotiated Rate	$98.78
Rate for Payer: Cash Price	$66.20
Rate for Payer: Health Management Network Commercial	$86.56
Rate for Payer: MDX Hawaii PPO	$98.78

DEXTROSE 50 % IN WATER (D50W) IV SYR

Facility

$99.56

Service Code	NDC 00409751716
Hospital Revenue Code	250
Min. Negotiated Rate	$50.78
Max. Negotiated Rate	$96.57
Rate for Payer: Cash Price	$64.71
Rate for Payer: Hawaii Western Management Group Commercial	$94.58
Rate for Payer: Health Management Network Commercial	$84.63
Rate for Payer: Kaiser Permanente Commercial	$62.72
Rate for Payer: Kaiser Permanente Medicaid	$50.78
Rate for Payer: MDX Hawaii PPO	$96.57
Rate for Payer: UnitedHealthcare Medicaid	$59.74
Rate for Payer: University Health Alliance Commercial	$72.57

DEXTROSE 50 % IN WATER (D50W) IV SYR

Facility

$99.56

Service Code	NDC 00409751766
Hospital Revenue Code	250
Min. Negotiated Rate	$50.78
Max. Negotiated Rate	$96.57
Rate for Payer: Cash Price	$64.71
Rate for Payer: Hawaii Western Management Group Commercial	$94.58
Rate for Payer: Health Management Network Commercial	$84.63
Rate for Payer: Kaiser Permanente Commercial	$62.72
Rate for Payer: Kaiser Permanente Medicaid	$50.78
Rate for Payer: MDX Hawaii PPO	$96.57
Rate for Payer: UnitedHealthcare Medicaid	$59.74
Rate for Payer: University Health Alliance Commercial	$72.57

DEXTROSE 50 % IN WATER (D50W) IV SYR

Facility

$99.56

Service Code	NDC 00409751766
Hospital Revenue Code	250
Min. Negotiated Rate	$84.63
Max. Negotiated Rate	$96.57
Rate for Payer: Cash Price	$64.71
Rate for Payer: Health Management Network Commercial	$84.63
Rate for Payer: MDX Hawaii PPO	$96.57

DEXTROSE 50 % IN WATER (D50W) IV SYR

Facility

$99.56

Service Code	NDC 00409751716
Hospital Revenue Code	250
Min. Negotiated Rate	$84.63
Max. Negotiated Rate	$96.57
Rate for Payer: Cash Price	$64.71
Rate for Payer: Health Management Network Commercial	$84.63
Rate for Payer: MDX Hawaii PPO	$96.57

DEXTROSE 5% IN WATER (D5W) IV BASE SOLP 1000 ML

Facility

$22.08

Service Code	HCPCS J7070
Hospital Revenue Code	636
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$21.42
Rate for Payer: Cash Price	$14.35
Rate for Payer: Cash Price	$14.35
Rate for Payer: Hawaii Medical Service Association ABD	$3.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.04
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

DEXTROSE 5% IN WATER (D5W) IV BASE SOLP 1000 ML

Facility

$22.08

Service Code	HCPCS J7070
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

DEXTROSE 5% IN WATER (D5W) IV BASE SOLP 500 ML

Facility

$22.08

Service Code	HCPCS J7060
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

DEXTROSE 5% IN WATER (D5W) IV BASE SOLP 500 ML

Facility

$22.08

Service Code	HCPCS J7060
Hospital Revenue Code	636
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$21.42
Rate for Payer: Cash Price	$14.35
Rate for Payer: Cash Price	$14.35
Rate for Payer: Hawaii Medical Service Association ABD	$2.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.03
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

DEXTROSE 5 % IN WATER (D5W) IV SOLP

Facility

$20.70

Service Code	NDC 00264751020
Hospital Revenue Code	250
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$20.08
Rate for Payer: Cash Price	$13.46
Rate for Payer: Hawaii Western Management Group Commercial	$19.66
Rate for Payer: Health Management Network Commercial	$17.59
Rate for Payer: Kaiser Permanente Commercial	$13.04
Rate for Payer: Kaiser Permanente Medicaid	$10.56
Rate for Payer: MDX Hawaii PPO	$20.08
Rate for Payer: UnitedHealthcare Medicaid	$12.42
Rate for Payer: University Health Alliance Commercial	$15.09

DEXTROSE 5 % IN WATER (D5W) IV SOLP

Facility

$13.53

Service Code	NDC 00264151031
Hospital Revenue Code	250
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$13.12
Rate for Payer: Cash Price	$8.79
Rate for Payer: Hawaii Western Management Group Commercial	$12.85
Rate for Payer: Health Management Network Commercial	$11.50
Rate for Payer: Kaiser Permanente Commercial	$8.52
Rate for Payer: Kaiser Permanente Medicaid	$6.90
Rate for Payer: MDX Hawaii PPO	$13.12
Rate for Payer: UnitedHealthcare Medicaid	$8.12
Rate for Payer: University Health Alliance Commercial	$9.86

DEXTROSE 5 % IN WATER (D5W) IV SOLP

Facility

$22.08

Service Code	NDC 00264751010
Hospital Revenue Code	250
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

DEXTROSE 5 % IN WATER (D5W) IV SOLP

Facility

$22.08

Service Code	NDC 00264751000
Hospital Revenue Code	250
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

DEXTROSE 5 % IN WATER (D5W) IV SOLP

Facility

$13.80

Service Code	NDC 00264151032
Hospital Revenue Code	250
Min. Negotiated Rate	$7.04
Max. Negotiated Rate	$13.39
Rate for Payer: Cash Price	$8.97
Rate for Payer: Hawaii Western Management Group Commercial	$13.11
Rate for Payer: Health Management Network Commercial	$11.73
Rate for Payer: Kaiser Permanente Commercial	$8.69
Rate for Payer: Kaiser Permanente Medicaid	$7.04
Rate for Payer: MDX Hawaii PPO	$13.39
Rate for Payer: UnitedHealthcare Medicaid	$8.28
Rate for Payer: University Health Alliance Commercial	$10.06

DEXTROSE 5 % IN WATER (D5W) IV SOLP

Facility

$22.08

Service Code	NDC 00264751000
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

DEXTROSE 5 % IN WATER (D5W) IV SOLP

Facility

$20.70

Service Code	NDC 00264751020
Hospital Revenue Code	250
Min. Negotiated Rate	$17.59
Max. Negotiated Rate	$20.08
Rate for Payer: Cash Price	$13.46
Rate for Payer: Health Management Network Commercial	$17.59
Rate for Payer: MDX Hawaii PPO	$20.08

DEXTROSE 5 % IN WATER (D5W) IV SOLP

Facility

$13.53

Service Code	NDC 00264151031
Hospital Revenue Code	250
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$13.12
Rate for Payer: Cash Price	$8.79
Rate for Payer: Health Management Network Commercial	$11.50
Rate for Payer: MDX Hawaii PPO	$13.12

DEXTROSE 5 % IN WATER (D5W) IV SOLP

Facility

$13.80

Service Code	NDC 00264151032
Hospital Revenue Code	250
Min. Negotiated Rate	$11.73
Max. Negotiated Rate	$13.39
Rate for Payer: Cash Price	$8.97
Rate for Payer: Health Management Network Commercial	$11.73
Rate for Payer: MDX Hawaii PPO	$13.39

DEXTROSE 5 % IN WATER (D5W) IV SOLP

Facility

$22.08

Service Code	NDC 00264751010
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

DEXTROSE 5 %-LACTATED RINGERS IV SOLP

Facility

$16.56

Service Code	HCPCS J7121
Hospital Revenue Code	250
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Cash Price	$19.73
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: Health Management Network Commercial	$25.81
Rate for Payer: MDX Hawaii PPO	$16.06
Rate for Payer: MDX Hawaii PPO	$29.45

Know your out-of-pocket cost for care.

All Charges