Kona Community Hospital

All Charges

Charge

Type

Setting

Price

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$19,425.22

Service Code	MSDRG 560
Min. Negotiated Rate	$14,811.33
Max. Negotiated Rate	$19,425.22
Rate for Payer: AlohaCare Medicare	$14,811.33
Rate for Payer: Devoted Health Medicare	$16,292.46
Rate for Payer: Hawaii Medical Service Association Commercial	$16,850.79
Rate for Payer: Hawaii Medical Service Association Medicare	$14,811.33
Rate for Payer: Humana Medicare	$14,811.33
Rate for Payer: Kaiser Permanente Commercial	$19,425.22
Rate for Payer: Kaiser Permanente Medicare	$14,811.33
Rate for Payer: Ohana Health Plan Medicare	$14,811.33
Rate for Payer: UnitedHealthcare Medicare	$14,811.33

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$32,169.53

Service Code	MSDRG 559
Min. Negotiated Rate	$16,850.79
Max. Negotiated Rate	$32,169.53
Rate for Payer: AlohaCare Medicare	$24,528.61
Rate for Payer: Devoted Health Medicare	$26,981.47
Rate for Payer: Hawaii Medical Service Association Commercial	$16,850.79
Rate for Payer: Hawaii Medical Service Association Medicare	$24,528.61
Rate for Payer: Humana Medicare	$24,528.61
Rate for Payer: Kaiser Permanente Commercial	$32,169.53
Rate for Payer: Kaiser Permanente Medicare	$24,528.61
Rate for Payer: Ohana Health Plan Medicare	$24,528.61
Rate for Payer: UnitedHealthcare Medicare	$24,528.61

AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$16,850.79

Service Code	MSDRG 561
Min. Negotiated Rate	$10,573.50
Max. Negotiated Rate	$16,850.79
Rate for Payer: AlohaCare Medicare	$10,573.50
Rate for Payer: Devoted Health Medicare	$11,630.85
Rate for Payer: Hawaii Medical Service Association Commercial	$16,850.79
Rate for Payer: Hawaii Medical Service Association Medicare	$10,573.50
Rate for Payer: Humana Medicare	$10,573.50
Rate for Payer: Kaiser Permanente Commercial	$13,867.27
Rate for Payer: Kaiser Permanente Medicare	$10,573.50
Rate for Payer: Ohana Health Plan Medicare	$10,573.50
Rate for Payer: UnitedHealthcare Medicare	$10,573.50

AFTERCARE WITH CC/MCC

Facility

$20,522.33

Service Code	MSDRG 949
Min. Negotiated Rate	$15,647.85
Max. Negotiated Rate	$20,522.33
Rate for Payer: AlohaCare Medicare	$15,647.85
Rate for Payer: Devoted Health Medicare	$17,212.63
Rate for Payer: Hawaii Medical Service Association Commercial	$17,911.50
Rate for Payer: Hawaii Medical Service Association Medicare	$15,647.85
Rate for Payer: Humana Medicare	$15,647.85
Rate for Payer: Kaiser Permanente Commercial	$20,522.33
Rate for Payer: Kaiser Permanente Medicare	$15,647.85
Rate for Payer: Ohana Health Plan Medicare	$15,647.85
Rate for Payer: UnitedHealthcare Medicare	$15,647.85

AFTERCARE WITHOUT CC/MCC

Facility

$10,827.83

Service Code	MSDRG 950
Min. Negotiated Rate	$5,303.54
Max. Negotiated Rate	$10,827.83
Rate for Payer: AlohaCare Medicare	$8,256.01
Rate for Payer: Devoted Health Medicare	$9,081.61
Rate for Payer: Hawaii Medical Service Association Commercial	$5,303.54
Rate for Payer: Hawaii Medical Service Association Medicare	$8,256.01
Rate for Payer: Humana Medicare	$8,256.01
Rate for Payer: Kaiser Permanente Commercial	$10,827.83
Rate for Payer: Kaiser Permanente Medicare	$8,256.01
Rate for Payer: Ohana Health Plan Medicare	$8,256.01
Rate for Payer: UnitedHealthcare Medicare	$8,256.01

Ahmed Glaucoma Valve FP8 [3644165]

Facility

$5,003.00

Service Code	HCPCS C1783
Hospital Charge Code	3644165
Hospital Revenue Code	278
Min. Negotiated Rate	$2,801.68
Max. Negotiated Rate	$4,852.91
Rate for Payer: Cash Price	$3,251.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,502.10
Rate for Payer: Health Management Network Commercial	$4,252.55
Rate for Payer: MDX Hawaii PPO	$4,852.91
Rate for Payer: University Health Alliance Commercial	$2,801.68

Ahmed Glaucoma Valve FP8 [3644165]

Facility

$5,003.00

Service Code	HCPCS C1783
Hospital Charge Code	3644165
Hospital Revenue Code	278
Min. Negotiated Rate	$2,551.53
Max. Negotiated Rate	$4,852.91
Rate for Payer: Cash Price	$3,251.95
Rate for Payer: Hawaii Western Management Group Commercial	$3,502.10
Rate for Payer: Health Management Network Commercial	$4,252.55
Rate for Payer: Kaiser Permanente Commercial	$3,151.89
Rate for Payer: Kaiser Permanente Medicaid	$2,551.53
Rate for Payer: MDX Hawaii PPO	$4,852.91
Rate for Payer: University Health Alliance Commercial	$2,801.68

AICD GENERATOR PROCEDURES

Facility

$78,701.40

Service Code	MSDRG 245
Min. Negotiated Rate	$60,008.18
Max. Negotiated Rate	$78,701.40
Rate for Payer: AlohaCare Medicare	$60,008.18
Rate for Payer: Devoted Health Medicare	$66,009.00
Rate for Payer: Hawaii Medical Service Association Commercial	$78,637.03
Rate for Payer: Hawaii Medical Service Association Medicare	$60,008.18
Rate for Payer: Humana Medicare	$60,008.18
Rate for Payer: Kaiser Permanente Commercial	$78,701.40
Rate for Payer: Kaiser Permanente Medicare	$60,008.18
Rate for Payer: Ohana Health Plan Medicare	$60,008.18
Rate for Payer: UnitedHealthcare Medicare	$60,008.18

AICD LEAD PROCEDURES

Facility

$78,637.03

Service Code	MSDRG 265
Min. Negotiated Rate	$47,589.34
Max. Negotiated Rate	$78,637.03
Rate for Payer: AlohaCare Medicare	$47,589.34
Rate for Payer: Devoted Health Medicare	$52,348.27
Rate for Payer: Hawaii Medical Service Association Commercial	$78,637.03
Rate for Payer: Hawaii Medical Service Association Medicare	$47,589.34
Rate for Payer: Humana Medicare	$47,589.34
Rate for Payer: Kaiser Permanente Commercial	$62,413.95
Rate for Payer: Kaiser Permanente Medicare	$47,589.34
Rate for Payer: Ohana Health Plan Medicare	$47,589.34
Rate for Payer: UnitedHealthcare Medicare	$47,589.34

AIMing Guides 1.5mm PDG-AIM-015 [3642651]

Facility

$282.00

Hospital Charge Code	3642651
Hospital Revenue Code	272
Min. Negotiated Rate	$143.82
Max. Negotiated Rate	$273.54
Rate for Payer: Cash Price	$183.30
Rate for Payer: Hawaii Western Management Group Commercial	$267.90
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: Kaiser Permanente Commercial	$177.66
Rate for Payer: Kaiser Permanente Medicaid	$143.82
Rate for Payer: MDX Hawaii PPO	$273.54
Rate for Payer: University Health Alliance Commercial	$205.55

AIMing Guides 1.5mm PDG-AIM-015 [3642651]

Facility

$282.00

Hospital Charge Code	3642651
Hospital Revenue Code	272
Min. Negotiated Rate	$239.70
Max. Negotiated Rate	$273.54
Rate for Payer: Cash Price	$183.30
Rate for Payer: Health Management Network Commercial	$239.70
Rate for Payer: MDX Hawaii PPO	$273.54

Air All Inside Meniscus System Curved Up 4722 [3640865]

Facility

$2,697.41

Hospital Charge Code	3640865
Hospital Revenue Code	272
Min. Negotiated Rate	$2,292.80
Max. Negotiated Rate	$2,616.49
Rate for Payer: Cash Price	$1,753.32
Rate for Payer: Health Management Network Commercial	$2,292.80
Rate for Payer: MDX Hawaii PPO	$2,616.49

Air All Inside Meniscus System Curved Up 4722 [3640865]

Facility

$2,697.41

Hospital Charge Code	3640865
Hospital Revenue Code	272
Min. Negotiated Rate	$1,375.68
Max. Negotiated Rate	$2,616.49
Rate for Payer: Cash Price	$1,753.32
Rate for Payer: Hawaii Western Management Group Commercial	$2,562.54
Rate for Payer: Health Management Network Commercial	$2,292.80
Rate for Payer: Kaiser Permanente Commercial	$1,699.37
Rate for Payer: Kaiser Permanente Medicaid	$1,375.68
Rate for Payer: MDX Hawaii PPO	$2,616.49
Rate for Payer: University Health Alliance Commercial	$1,966.14

Air Meniscus System Curved Down 4723 [3640758]

Facility

$2,624.38

Hospital Charge Code	3640758
Hospital Revenue Code	272
Min. Negotiated Rate	$2,230.72
Max. Negotiated Rate	$2,545.65
Rate for Payer: Cash Price	$1,705.85
Rate for Payer: Health Management Network Commercial	$2,230.72
Rate for Payer: MDX Hawaii PPO	$2,545.65

Air Meniscus System Curved Down 4723 [3640758]

Facility

$2,624.38

Hospital Charge Code	3640758
Hospital Revenue Code	272
Min. Negotiated Rate	$1,338.43
Max. Negotiated Rate	$2,545.65
Rate for Payer: Cash Price	$1,705.85
Rate for Payer: Hawaii Western Management Group Commercial	$2,493.16
Rate for Payer: Health Management Network Commercial	$2,230.72
Rate for Payer: Kaiser Permanente Commercial	$1,653.36
Rate for Payer: Kaiser Permanente Medicaid	$1,338.43
Rate for Payer: MDX Hawaii PPO	$2,545.65
Rate for Payer: University Health Alliance Commercial	$1,912.91

ALBENDAZOLE 200 MG PO TABLET

Facility

$783.49

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$665.97
Max. Negotiated Rate	$759.99
Rate for Payer: Cash Price	$509.27
Rate for Payer: Health Management Network Commercial	$665.97
Rate for Payer: MDX Hawaii PPO	$759.99

ALBENDAZOLE 200 MG PO TABLET

Facility

$783.49

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$399.58
Max. Negotiated Rate	$759.99
Rate for Payer: Cash Price	$509.27
Rate for Payer: Hawaii Western Management Group Commercial	$744.32
Rate for Payer: Health Management Network Commercial	$665.97
Rate for Payer: Kaiser Permanente Commercial	$493.60
Rate for Payer: Kaiser Permanente Medicaid	$399.58
Rate for Payer: MDX Hawaii PPO	$759.99
Rate for Payer: UnitedHealthcare Medicaid	$470.09
Rate for Payer: University Health Alliance Commercial	$571.09

ALBUMIN, HUMAN 25 % 25 % IV SOLP

Facility

$299.53

Service Code	HCPCS P9047
Hospital Revenue Code	250
Min. Negotiated Rate	$254.60
Max. Negotiated Rate	$290.54
Rate for Payer: Cash Price	$194.69
Rate for Payer: Health Management Network Commercial	$254.60
Rate for Payer: MDX Hawaii PPO	$290.54

ALBUMIN, HUMAN 25 % 25 % IV SOLP

Facility

$299.53

Service Code	HCPCS P9047
Hospital Revenue Code	250
Min. Negotiated Rate	$53.08
Max. Negotiated Rate	$290.54
Rate for Payer: AlohaCare Medicaid	$53.08
Rate for Payer: AlohaCare Medicare	$53.08
Rate for Payer: Cash Price	$194.69
Rate for Payer: Cash Price	$194.69
Rate for Payer: Devoted Health Medicare	$58.39
Rate for Payer: Hawaii Medical Service Association ABD	$53.08
Rate for Payer: Hawaii Medical Service Association Commercial	$66.35
Rate for Payer: Hawaii Medical Service Association Medicare	$53.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$53.08
Rate for Payer: Hawaii Western Management Group Commercial	$284.55
Rate for Payer: Health Management Network Commercial	$254.60
Rate for Payer: Humana Medicare	$53.08
Rate for Payer: Kaiser Permanente Commercial	$188.70
Rate for Payer: Kaiser Permanente Medicaid	$152.76
Rate for Payer: Kaiser Permanente Medicare	$53.08
Rate for Payer: MDX Hawaii PPO	$290.54
Rate for Payer: Ohana Health Plan Medicaid	$58.39
Rate for Payer: Ohana Health Plan Medicare	$53.08
Rate for Payer: UnitedHealthcare Medicaid	$179.72
Rate for Payer: UnitedHealthcare Medicare	$53.08
Rate for Payer: University Health Alliance Commercial	$218.33

ALBUMIN, HUMAN 5 % IV SOLP (250 ML)

Facility

$410.64

Service Code	HCPCS P9045
Hospital Revenue Code	250
Min. Negotiated Rate	$53.08
Max. Negotiated Rate	$398.32
Rate for Payer: AlohaCare Medicaid	$53.08
Rate for Payer: AlohaCare Medicare	$53.08
Rate for Payer: Cash Price	$266.92
Rate for Payer: Cash Price	$266.92
Rate for Payer: Devoted Health Medicare	$58.39
Rate for Payer: Hawaii Medical Service Association ABD	$53.08
Rate for Payer: Hawaii Medical Service Association Commercial	$66.35
Rate for Payer: Hawaii Medical Service Association Medicare	$53.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$53.08
Rate for Payer: Hawaii Western Management Group Commercial	$390.11
Rate for Payer: Health Management Network Commercial	$349.04
Rate for Payer: Humana Medicare	$53.08
Rate for Payer: Kaiser Permanente Commercial	$258.70
Rate for Payer: Kaiser Permanente Medicaid	$209.43
Rate for Payer: Kaiser Permanente Medicare	$53.08
Rate for Payer: MDX Hawaii PPO	$398.32
Rate for Payer: Ohana Health Plan Medicaid	$58.39
Rate for Payer: Ohana Health Plan Medicare	$53.08
Rate for Payer: UnitedHealthcare Medicaid	$246.38
Rate for Payer: UnitedHealthcare Medicare	$53.08
Rate for Payer: University Health Alliance Commercial	$299.32

ALBUMIN, HUMAN 5 % IV SOLP (250 ML)

Facility

$410.64

Service Code	HCPCS P9045
Hospital Revenue Code	250
Min. Negotiated Rate	$349.04
Max. Negotiated Rate	$398.32
Rate for Payer: Cash Price	$266.92
Rate for Payer: Health Management Network Commercial	$349.04
Rate for Payer: MDX Hawaii PPO	$398.32

ALBUMIN SERUM PLASMA/WHOLE BLOOD

Professional

Both

$10.00

Service Code	HCPCS 82040
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$8.50
Rate for Payer: AlohaCare Medicaid	$6.85
Rate for Payer: AlohaCare Medicare	$4.95
Rate for Payer: Cash Price	$6.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Devoted Health Medicare	$5.45
Rate for Payer: Hawaii Medical Service Association Medicare	$4.95
Rate for Payer: Hawaii Western Management Group Commercial	$6.85
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$5.94
Rate for Payer: Kaiser Permanente Medicaid	$5.94
Rate for Payer: Kaiser Permanente Medicare	$5.94
Rate for Payer: Ohana Health Plan Medicaid	$6.85
Rate for Payer: Ohana Health Plan Medicare	$4.95
Rate for Payer: UnitedHealthcare Medicaid	$6.85
Rate for Payer: UnitedHealthcare Medicare	$4.95

ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHAL NEBU

Facility

$1.91

Service Code	NDC 60687039579
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$1.85
Rate for Payer: Cash Price	$1.24
Rate for Payer: Health Management Network Commercial	$1.62
Rate for Payer: MDX Hawaii PPO	$1.85

ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHAL NEBU

Facility

$1.91

Service Code	NDC 60687039583
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$1.85
Rate for Payer: Cash Price	$1.24
Rate for Payer: Hawaii Western Management Group Commercial	$1.81
Rate for Payer: Health Management Network Commercial	$1.62
Rate for Payer: Kaiser Permanente Commercial	$1.20
Rate for Payer: Kaiser Permanente Medicaid	$0.97
Rate for Payer: MDX Hawaii PPO	$1.85
Rate for Payer: UnitedHealthcare Medicaid	$1.15
Rate for Payer: University Health Alliance Commercial	$1.39

ALBUTEROL SULFATE 2.5 MG /3 ML (0.083 %) INHAL NEBU

Facility

$4.43

Service Code	NDC 04879050101
Hospital Revenue Code	250
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$4.30
Rate for Payer: Cash Price	$2.88
Rate for Payer: Hawaii Western Management Group Commercial	$4.21
Rate for Payer: Health Management Network Commercial	$3.77
Rate for Payer: Kaiser Permanente Commercial	$2.79
Rate for Payer: Kaiser Permanente Medicaid	$2.26
Rate for Payer: MDX Hawaii PPO	$4.30
Rate for Payer: UnitedHealthcare Medicaid	$2.66
Rate for Payer: University Health Alliance Commercial	$3.23

Know your out-of-pocket cost for care.

All Charges