Kona Community Hospital

All Charges

Charge

Type

Setting

Price

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC

Facility

$34,039.08

Service Code	MSDRG 280
Min. Negotiated Rate	$21,098.36
Max. Negotiated Rate	$34,039.08
Rate for Payer: AlohaCare Medicare	$21,098.36
Rate for Payer: Devoted Health Medicare	$23,208.20
Rate for Payer: Hawaii Medical Service Association Commercial	$34,039.08
Rate for Payer: Hawaii Medical Service Association Medicare	$21,098.36
Rate for Payer: Humana Medicare	$21,098.36
Rate for Payer: Kaiser Permanente Commercial	$27,670.72
Rate for Payer: Kaiser Permanente Medicare	$21,098.36
Rate for Payer: Ohana Health Plan Medicare	$21,098.36
Rate for Payer: UnitedHealthcare Medicare	$21,098.36

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC

Facility

$25,770.38

Service Code	MSDRG 282
Min. Negotiated Rate	$9,510.76
Max. Negotiated Rate	$25,770.38
Rate for Payer: AlohaCare Medicare	$9,510.76
Rate for Payer: Devoted Health Medicare	$10,461.84
Rate for Payer: Hawaii Medical Service Association Commercial	$25,770.38
Rate for Payer: Hawaii Medical Service Association Medicare	$9,510.76
Rate for Payer: Humana Medicare	$9,510.76
Rate for Payer: Kaiser Permanente Commercial	$12,473.48
Rate for Payer: Kaiser Permanente Medicare	$9,510.76
Rate for Payer: Ohana Health Plan Medicare	$9,510.76
Rate for Payer: UnitedHealthcare Medicare	$9,510.76

ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC

Facility

$56,868.41

Service Code	MSDRG 284
Min. Negotiated Rate	$9,104.33
Max. Negotiated Rate	$56,868.41
Rate for Payer: AlohaCare Medicare	$9,104.33
Rate for Payer: Devoted Health Medicare	$10,014.76
Rate for Payer: Hawaii Medical Service Association Commercial	$56,868.41
Rate for Payer: Hawaii Medical Service Association Medicare	$9,104.33
Rate for Payer: Humana Medicare	$9,104.33
Rate for Payer: Kaiser Permanente Commercial	$11,940.45
Rate for Payer: Kaiser Permanente Medicare	$9,104.33
Rate for Payer: Ohana Health Plan Medicare	$9,104.33
Rate for Payer: UnitedHealthcare Medicare	$9,104.33

ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC

Facility

$56,868.41

Service Code	MSDRG 283
Min. Negotiated Rate	$26,052.99
Max. Negotiated Rate	$56,868.41
Rate for Payer: AlohaCare Medicare	$26,052.99
Rate for Payer: Devoted Health Medicare	$28,658.29
Rate for Payer: Hawaii Medical Service Association Commercial	$56,868.41
Rate for Payer: Hawaii Medical Service Association Medicare	$26,052.99
Rate for Payer: Humana Medicare	$26,052.99
Rate for Payer: Kaiser Permanente Commercial	$34,168.80
Rate for Payer: Kaiser Permanente Medicare	$26,052.99
Rate for Payer: Ohana Health Plan Medicare	$26,052.99
Rate for Payer: UnitedHealthcare Medicare	$26,052.99

ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC

Facility

$56,868.41

Service Code	MSDRG 285
Min. Negotiated Rate	$7,877.20
Max. Negotiated Rate	$56,868.41
Rate for Payer: AlohaCare Medicare	$7,877.20
Rate for Payer: Devoted Health Medicare	$8,664.92
Rate for Payer: Hawaii Medical Service Association Commercial	$56,868.41
Rate for Payer: Hawaii Medical Service Association Medicare	$7,877.20
Rate for Payer: Humana Medicare	$7,877.20
Rate for Payer: Kaiser Permanente Commercial	$10,331.02
Rate for Payer: Kaiser Permanente Medicare	$7,877.20
Rate for Payer: Ohana Health Plan Medicare	$7,877.20
Rate for Payer: UnitedHealthcare Medicare	$7,877.20

ACUTE & SUBACUTE ENDOCARDITIS

Facility

$11,483.47

Service Code	APR-DRG 1934
Min. Negotiated Rate	$11,483.47
Max. Negotiated Rate	$11,483.47
Rate for Payer: AlohaCare Medicaid	$11,483.47
Rate for Payer: Hawaii Medical Service Association ABD	$11,483.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,483.47
Rate for Payer: Kaiser Permanente Medicaid	$11,483.47
Rate for Payer: Ohana Health Plan Medicaid	$11,483.47
Rate for Payer: UnitedHealthcare Medicaid	$11,483.47

ACUTE & SUBACUTE ENDOCARDITIS

Facility

$7,563.31

Service Code	APR-DRG 1933
Min. Negotiated Rate	$7,563.31
Max. Negotiated Rate	$7,563.31
Rate for Payer: AlohaCare Medicaid	$7,563.31
Rate for Payer: Hawaii Medical Service Association ABD	$7,563.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,563.31
Rate for Payer: Kaiser Permanente Medicaid	$7,563.31
Rate for Payer: Ohana Health Plan Medicaid	$7,563.31
Rate for Payer: UnitedHealthcare Medicaid	$7,563.31

ACUTE & SUBACUTE ENDOCARDITIS

Facility

$4,378.66

Service Code	APR-DRG 1931
Min. Negotiated Rate	$4,378.66
Max. Negotiated Rate	$4,378.66
Rate for Payer: AlohaCare Medicaid	$4,378.66
Rate for Payer: Hawaii Medical Service Association ABD	$4,378.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,378.66
Rate for Payer: Kaiser Permanente Medicaid	$4,378.66
Rate for Payer: Ohana Health Plan Medicaid	$4,378.66
Rate for Payer: UnitedHealthcare Medicaid	$4,378.66

ACUTE & SUBACUTE ENDOCARDITIS

Facility

$5,214.14

Service Code	APR-DRG 1932
Min. Negotiated Rate	$5,214.14
Max. Negotiated Rate	$5,214.14
Rate for Payer: AlohaCare Medicaid	$5,214.14
Rate for Payer: Hawaii Medical Service Association ABD	$5,214.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,214.14
Rate for Payer: Kaiser Permanente Medicaid	$5,214.14
Rate for Payer: Ohana Health Plan Medicaid	$5,214.14
Rate for Payer: UnitedHealthcare Medicaid	$5,214.14

ACYCLOVIR 200 MG PO CAP

Facility

$5.40

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$5.24
Rate for Payer: Cash Price	$3.51
Rate for Payer: Hawaii Western Management Group Commercial	$5.13
Rate for Payer: Health Management Network Commercial	$4.59
Rate for Payer: Kaiser Permanente Commercial	$3.40
Rate for Payer: Kaiser Permanente Medicaid	$2.75
Rate for Payer: MDX Hawaii PPO	$5.24
Rate for Payer: UnitedHealthcare Medicaid	$3.24
Rate for Payer: University Health Alliance Commercial	$3.94

ACYCLOVIR 200 MG PO CAP

Facility

$5.40

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$5.24
Rate for Payer: Cash Price	$3.51
Rate for Payer: Health Management Network Commercial	$4.59
Rate for Payer: MDX Hawaii PPO	$5.24

ACYCLOVIR 5 % TOP OINT

Facility

$1,067.92

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$544.64
Max. Negotiated Rate	$1,035.88
Rate for Payer: Cash Price	$694.15
Rate for Payer: Hawaii Western Management Group Commercial	$1,014.52
Rate for Payer: Health Management Network Commercial	$907.73
Rate for Payer: Kaiser Permanente Commercial	$672.79
Rate for Payer: Kaiser Permanente Medicaid	$544.64
Rate for Payer: MDX Hawaii PPO	$1,035.88
Rate for Payer: UnitedHealthcare Medicaid	$640.75
Rate for Payer: University Health Alliance Commercial	$778.41

ACYCLOVIR 5 % TOP OINT

Facility

$1,067.92

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$907.73
Max. Negotiated Rate	$1,035.88
Rate for Payer: Cash Price	$694.15
Rate for Payer: Health Management Network Commercial	$907.73
Rate for Payer: MDX Hawaii PPO	$1,035.88

ACYCLOVIR 800 MG PO TABLET

Facility

$17.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$8.81
Max. Negotiated Rate	$16.75
Rate for Payer: Cash Price	$11.23
Rate for Payer: Hawaii Western Management Group Commercial	$16.41
Rate for Payer: Health Management Network Commercial	$14.68
Rate for Payer: Kaiser Permanente Commercial	$10.88
Rate for Payer: Kaiser Permanente Medicaid	$8.81
Rate for Payer: MDX Hawaii PPO	$16.75
Rate for Payer: UnitedHealthcare Medicaid	$10.36
Rate for Payer: University Health Alliance Commercial	$12.59

ACYCLOVIR 800 MG PO TABLET

Facility

$17.27

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.68
Max. Negotiated Rate	$16.75
Rate for Payer: Cash Price	$11.23
Rate for Payer: Health Management Network Commercial	$14.68
Rate for Payer: MDX Hawaii PPO	$16.75

ACYCLOVIR SODIUM 50 MG/ML IV SOLN

Facility

$142.20

Service Code	HCPCS J0133
Hospital Revenue Code	250
Min. Negotiated Rate	$120.87
Max. Negotiated Rate	$137.93
Rate for Payer: Cash Price	$92.43
Rate for Payer: Cash Price	$54.76
Rate for Payer: Health Management Network Commercial	$120.87
Rate for Payer: Health Management Network Commercial	$71.60
Rate for Payer: MDX Hawaii PPO	$137.93
Rate for Payer: MDX Hawaii PPO	$81.71

ACYCLOVIR SODIUM 50 MG/ML IV SOLN

Facility

$84.24

Service Code	HCPCS J0133
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$81.71
Rate for Payer: Cash Price	$54.76
Rate for Payer: Cash Price	$92.43
Rate for Payer: Cash Price	$92.43
Rate for Payer: Cash Price	$54.76
Rate for Payer: Hawaii Medical Service Association ABD	$0.03
Rate for Payer: Hawaii Medical Service Association ABD	$0.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.03
Rate for Payer: Hawaii Western Management Group Commercial	$135.09
Rate for Payer: Hawaii Western Management Group Commercial	$80.03
Rate for Payer: Health Management Network Commercial	$71.60
Rate for Payer: Health Management Network Commercial	$120.87
Rate for Payer: Kaiser Permanente Commercial	$53.07
Rate for Payer: Kaiser Permanente Commercial	$89.59
Rate for Payer: Kaiser Permanente Medicaid	$72.52
Rate for Payer: Kaiser Permanente Medicaid	$42.96
Rate for Payer: MDX Hawaii PPO	$137.93
Rate for Payer: MDX Hawaii PPO	$81.71
Rate for Payer: UnitedHealthcare Medicaid	$50.54
Rate for Payer: UnitedHealthcare Medicaid	$85.32
Rate for Payer: University Health Alliance Commercial	$61.40
Rate for Payer: University Health Alliance Commercial	$103.65

Adaptable Ue Disp Kit 804-33-105 [3644020]

Facility

$2,496.25

Hospital Charge Code	3644020
Hospital Revenue Code	272
Min. Negotiated Rate	$2,121.81
Max. Negotiated Rate	$2,421.36
Rate for Payer: Cash Price	$1,622.56
Rate for Payer: Health Management Network Commercial	$2,121.81
Rate for Payer: MDX Hawaii PPO	$2,421.36

Adaptable Ue Disp Kit 804-33-105 [3644020]

Facility

$2,496.25

Hospital Charge Code	3644020
Hospital Revenue Code	272
Min. Negotiated Rate	$1,273.09
Max. Negotiated Rate	$2,421.36
Rate for Payer: Cash Price	$1,622.56
Rate for Payer: Hawaii Western Management Group Commercial	$2,371.44
Rate for Payer: Health Management Network Commercial	$2,121.81
Rate for Payer: Kaiser Permanente Commercial	$1,572.64
Rate for Payer: Kaiser Permanente Medicaid	$1,273.09
Rate for Payer: MDX Hawaii PPO	$2,421.36
Rate for Payer: University Health Alliance Commercial	$1,819.52

ADENOSINE 3 MG/ML IV SOLN

Facility

$45.87

Service Code	HCPCS J0153
Hospital Revenue Code	636
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$44.49
Rate for Payer: Cash Price	$29.82
Rate for Payer: Cash Price	$29.82
Rate for Payer: Hawaii Medical Service Association ABD	$0.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.46
Rate for Payer: Hawaii Western Management Group Commercial	$43.58
Rate for Payer: Health Management Network Commercial	$38.99
Rate for Payer: Kaiser Permanente Commercial	$28.90
Rate for Payer: Kaiser Permanente Medicaid	$23.39
Rate for Payer: MDX Hawaii PPO	$44.49
Rate for Payer: UnitedHealthcare Medicaid	$27.52
Rate for Payer: University Health Alliance Commercial	$33.43

ADENOSINE 3 MG/ML IV SOLN

Facility

$45.87

Service Code	HCPCS J0153
Hospital Revenue Code	250
Min. Negotiated Rate	$38.99
Max. Negotiated Rate	$44.49
Rate for Payer: Cash Price	$29.82
Rate for Payer: Health Management Network Commercial	$38.99
Rate for Payer: MDX Hawaii PPO	$44.49

ADENOSINE 3 MG/ML IV SYR

Facility

$83.83

Service Code	HCPCS J0153
Hospital Revenue Code	250
Min. Negotiated Rate	$71.26
Max. Negotiated Rate	$81.32
Rate for Payer: Cash Price	$54.49
Rate for Payer: Cash Price	$54.76
Rate for Payer: Health Management Network Commercial	$71.26
Rate for Payer: Health Management Network Commercial	$71.60
Rate for Payer: MDX Hawaii PPO	$81.32
Rate for Payer: MDX Hawaii PPO	$81.71

ADENOSINE 3 MG/ML IV SYR

Facility

$84.24

Service Code	HCPCS J0153
Hospital Revenue Code	636
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$81.71
Rate for Payer: Cash Price	$54.76
Rate for Payer: Cash Price	$54.49
Rate for Payer: Cash Price	$54.49
Rate for Payer: Cash Price	$54.76
Rate for Payer: Hawaii Medical Service Association ABD	$0.46
Rate for Payer: Hawaii Medical Service Association ABD	$0.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.46
Rate for Payer: Hawaii Western Management Group Commercial	$79.64
Rate for Payer: Hawaii Western Management Group Commercial	$80.03
Rate for Payer: Health Management Network Commercial	$71.60
Rate for Payer: Health Management Network Commercial	$71.26
Rate for Payer: Kaiser Permanente Commercial	$53.07
Rate for Payer: Kaiser Permanente Commercial	$52.81
Rate for Payer: Kaiser Permanente Medicaid	$42.75
Rate for Payer: Kaiser Permanente Medicaid	$42.96
Rate for Payer: MDX Hawaii PPO	$81.32
Rate for Payer: MDX Hawaii PPO	$81.71
Rate for Payer: UnitedHealthcare Medicaid	$50.54
Rate for Payer: UnitedHealthcare Medicaid	$50.30
Rate for Payer: University Health Alliance Commercial	$61.10
Rate for Payer: University Health Alliance Commercial	$61.40

ADHESIVE MEDIPORE 6 INCHES [2707455]

Facility

$84.58

Hospital Charge Code	2707455
Hospital Revenue Code	272
Min. Negotiated Rate	$43.14
Max. Negotiated Rate	$82.04
Rate for Payer: Cash Price	$54.98
Rate for Payer: Hawaii Western Management Group Commercial	$80.35
Rate for Payer: Health Management Network Commercial	$71.89
Rate for Payer: Kaiser Permanente Commercial	$53.29
Rate for Payer: Kaiser Permanente Medicaid	$43.14
Rate for Payer: MDX Hawaii PPO	$82.04
Rate for Payer: University Health Alliance Commercial	$61.65

ADHESIVE MEDIPORE 6 INCHES [2707455]

Facility

$84.58

Hospital Charge Code	2707455
Hospital Revenue Code	272
Min. Negotiated Rate	$71.89
Max. Negotiated Rate	$82.04
Rate for Payer: Cash Price	$54.98
Rate for Payer: Health Management Network Commercial	$71.89
Rate for Payer: MDX Hawaii PPO	$82.04

Know your out-of-pocket cost for care.

All Charges