Kona Community Hospital

All Charges

Charge

Type

Setting

Price

FOOT & TOE PROCEDURES

Facility

$8,091.22

Service Code	APR-DRG 3143
Min. Negotiated Rate	$8,091.22
Max. Negotiated Rate	$8,091.22
Rate for Payer: AlohaCare Medicaid	$8,091.22
Rate for Payer: Hawaii Medical Service Association ABD	$8,091.22
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,091.22
Rate for Payer: Kaiser Permanente Medicaid	$8,091.22
Rate for Payer: Ohana Health Plan Medicaid	$8,091.22
Rate for Payer: UnitedHealthcare Medicaid	$8,091.22

FOOT & TOE PROCEDURES

Facility

$5,684.10

Service Code	APR-DRG 3141
Min. Negotiated Rate	$5,684.10
Max. Negotiated Rate	$5,684.10
Rate for Payer: AlohaCare Medicaid	$5,684.10
Rate for Payer: Hawaii Medical Service Association ABD	$5,684.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,684.10
Rate for Payer: Kaiser Permanente Medicaid	$5,684.10
Rate for Payer: Ohana Health Plan Medicaid	$5,684.10
Rate for Payer: UnitedHealthcare Medicaid	$5,684.10

Forcep Biopsy 3FR Ureter Piranha 505160 [3601730]

Facility

$1,800.53

Hospital Charge Code	3601730
Hospital Revenue Code	272
Min. Negotiated Rate	$1,530.45
Max. Negotiated Rate	$1,746.51
Rate for Payer: Cash Price	$1,170.34
Rate for Payer: Health Management Network Commercial	$1,530.45
Rate for Payer: MDX Hawaii PPO	$1,746.51

Forcep Biopsy 3FR Ureter Piranha 505160 [3601730]

Facility

$1,800.53

Hospital Charge Code	3601730
Hospital Revenue Code	272
Min. Negotiated Rate	$918.27
Max. Negotiated Rate	$1,746.51
Rate for Payer: Cash Price	$1,170.34
Rate for Payer: Hawaii Western Management Group Commercial	$1,710.50
Rate for Payer: Health Management Network Commercial	$1,530.45
Rate for Payer: Kaiser Permanente Commercial	$1,134.33
Rate for Payer: Kaiser Permanente Medicaid	$918.27
Rate for Payer: MDX Hawaii PPO	$1,746.51
Rate for Payer: University Health Alliance Commercial	$1,312.41

Forcep Biopsy Backloading BIGopsy Disp G48240 [3642258]

Facility

$1,385.43

Hospital Charge Code	3642258
Hospital Revenue Code	272
Min. Negotiated Rate	$1,177.62
Max. Negotiated Rate	$1,343.87
Rate for Payer: Cash Price	$900.53
Rate for Payer: Health Management Network Commercial	$1,177.62
Rate for Payer: MDX Hawaii PPO	$1,343.87

Forcep Biopsy Backloading BIGopsy Disp G48240 [3642258]

Facility

$1,385.43

Hospital Charge Code	3642258
Hospital Revenue Code	272
Min. Negotiated Rate	$706.57
Max. Negotiated Rate	$1,343.87
Rate for Payer: Cash Price	$900.53
Rate for Payer: Hawaii Western Management Group Commercial	$1,316.16
Rate for Payer: Health Management Network Commercial	$1,177.62
Rate for Payer: Kaiser Permanente Commercial	$872.82
Rate for Payer: Kaiser Permanente Medicaid	$706.57
Rate for Payer: MDX Hawaii PPO	$1,343.87
Rate for Payer: University Health Alliance Commercial	$1,009.84

FOSAPREPITANT 150 MG IV RECON.SOLN.

Facility

$989.44

Service Code	HCPCS J1453
Hospital Revenue Code	250
Min. Negotiated Rate	$841.02
Max. Negotiated Rate	$959.76
Rate for Payer: Cash Price	$643.14
Rate for Payer: Cash Price	$124.72
Rate for Payer: Cash Price	$249.35
Rate for Payer: Health Management Network Commercial	$841.02
Rate for Payer: Health Management Network Commercial	$326.08
Rate for Payer: Health Management Network Commercial	$163.10
Rate for Payer: MDX Hawaii PPO	$959.76
Rate for Payer: MDX Hawaii PPO	$186.12
Rate for Payer: MDX Hawaii PPO	$372.11

FOSAPREPITANT 150 MG IV RECON.SOLN.

Facility

$191.88

Service Code	HCPCS J1453
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$186.12
Rate for Payer: Cash Price	$124.72
Rate for Payer: Cash Price	$124.72
Rate for Payer: Cash Price	$249.35
Rate for Payer: Cash Price	$249.35
Rate for Payer: Cash Price	$643.14
Rate for Payer: Cash Price	$643.14
Rate for Payer: Hawaii Medical Service Association ABD	$0.11
Rate for Payer: Hawaii Medical Service Association ABD	$0.11
Rate for Payer: Hawaii Medical Service Association ABD	$0.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.11
Rate for Payer: Hawaii Western Management Group Commercial	$182.29
Rate for Payer: Hawaii Western Management Group Commercial	$939.97
Rate for Payer: Hawaii Western Management Group Commercial	$364.44
Rate for Payer: Health Management Network Commercial	$163.10
Rate for Payer: Health Management Network Commercial	$326.08
Rate for Payer: Health Management Network Commercial	$841.02
Rate for Payer: Kaiser Permanente Commercial	$120.88
Rate for Payer: Kaiser Permanente Commercial	$241.68
Rate for Payer: Kaiser Permanente Commercial	$623.35
Rate for Payer: Kaiser Permanente Medicaid	$504.61
Rate for Payer: Kaiser Permanente Medicaid	$97.86
Rate for Payer: Kaiser Permanente Medicaid	$195.65
Rate for Payer: MDX Hawaii PPO	$372.11
Rate for Payer: MDX Hawaii PPO	$186.12
Rate for Payer: MDX Hawaii PPO	$959.76
Rate for Payer: UnitedHealthcare Medicaid	$230.17
Rate for Payer: UnitedHealthcare Medicaid	$593.66
Rate for Payer: UnitedHealthcare Medicaid	$115.13
Rate for Payer: University Health Alliance Commercial	$279.62
Rate for Payer: University Health Alliance Commercial	$721.20
Rate for Payer: University Health Alliance Commercial	$139.86

FOSFOMYCIN TROMETHAMINE 3 GRAM PO PKT

Facility

$446.59

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$379.60
Max. Negotiated Rate	$433.19
Rate for Payer: Cash Price	$290.28
Rate for Payer: Health Management Network Commercial	$379.60
Rate for Payer: MDX Hawaii PPO	$433.19

FOSFOMYCIN TROMETHAMINE 3 GRAM PO PKT

Facility

$446.59

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$227.76
Max. Negotiated Rate	$433.19
Rate for Payer: Cash Price	$290.28
Rate for Payer: Hawaii Western Management Group Commercial	$424.26
Rate for Payer: Health Management Network Commercial	$379.60
Rate for Payer: Kaiser Permanente Commercial	$281.35
Rate for Payer: Kaiser Permanente Medicaid	$227.76
Rate for Payer: MDX Hawaii PPO	$433.19
Rate for Payer: UnitedHealthcare Medicaid	$267.95
Rate for Payer: University Health Alliance Commercial	$325.52

FOSPHENYTOIN 100 MG PE/2 ML INJ SOLN

Facility

$26.50

Service Code	HCPCS Q2009
Hospital Revenue Code	250
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$25.70
Rate for Payer: AlohaCare Medicaid	$1.33
Rate for Payer: AlohaCare Medicaid	$1.33
Rate for Payer: AlohaCare Medicare	$1.33
Rate for Payer: AlohaCare Medicare	$1.33
Rate for Payer: Cash Price	$19.63
Rate for Payer: Cash Price	$19.63
Rate for Payer: Cash Price	$17.23
Rate for Payer: Cash Price	$17.23
Rate for Payer: Devoted Health Medicare	$1.46
Rate for Payer: Devoted Health Medicare	$1.46
Rate for Payer: Hawaii Medical Service Association Commercial	$1.66
Rate for Payer: Hawaii Medical Service Association Commercial	$1.66
Rate for Payer: Hawaii Medical Service Association Medicare	$1.33
Rate for Payer: Hawaii Medical Service Association Medicare	$1.33
Rate for Payer: Hawaii Western Management Group Commercial	$28.69
Rate for Payer: Hawaii Western Management Group Commercial	$25.18
Rate for Payer: Health Management Network Commercial	$25.67
Rate for Payer: Health Management Network Commercial	$22.52
Rate for Payer: Humana Medicare	$1.33
Rate for Payer: Humana Medicare	$1.33
Rate for Payer: Kaiser Permanente Commercial	$16.70
Rate for Payer: Kaiser Permanente Commercial	$19.03
Rate for Payer: Kaiser Permanente Medicaid	$15.40
Rate for Payer: Kaiser Permanente Medicaid	$13.52
Rate for Payer: Kaiser Permanente Medicare	$1.33
Rate for Payer: Kaiser Permanente Medicare	$1.33
Rate for Payer: MDX Hawaii PPO	$29.29
Rate for Payer: MDX Hawaii PPO	$25.70
Rate for Payer: Ohana Health Plan Medicaid	$1.46
Rate for Payer: Ohana Health Plan Medicaid	$1.46
Rate for Payer: Ohana Health Plan Medicare	$1.33
Rate for Payer: Ohana Health Plan Medicare	$1.33
Rate for Payer: UnitedHealthcare Medicaid	$18.12
Rate for Payer: UnitedHealthcare Medicaid	$15.90
Rate for Payer: UnitedHealthcare Medicare	$1.33
Rate for Payer: UnitedHealthcare Medicare	$1.33
Rate for Payer: University Health Alliance Commercial	$22.01
Rate for Payer: University Health Alliance Commercial	$19.32

FOSPHENYTOIN 100 MG PE/2 ML INJ SOLN

Facility

$26.50

Service Code	HCPCS Q2009
Hospital Revenue Code	250
Min. Negotiated Rate	$22.52
Max. Negotiated Rate	$25.70
Rate for Payer: Cash Price	$17.23
Rate for Payer: Cash Price	$19.63
Rate for Payer: Health Management Network Commercial	$22.52
Rate for Payer: Health Management Network Commercial	$25.67
Rate for Payer: MDX Hawaii PPO	$25.70
Rate for Payer: MDX Hawaii PPO	$29.29

FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN

Facility

$491.82

Service Code	HCPCS Q2009
Hospital Revenue Code	250
Min. Negotiated Rate	$418.05
Max. Negotiated Rate	$477.07
Rate for Payer: Cash Price	$319.68
Rate for Payer: Health Management Network Commercial	$418.05
Rate for Payer: MDX Hawaii PPO	$477.07

FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN

Facility

$491.82

Service Code	HCPCS Q2009
Hospital Revenue Code	250
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$477.07
Rate for Payer: AlohaCare Medicaid	$1.33
Rate for Payer: AlohaCare Medicare	$1.33
Rate for Payer: Cash Price	$319.68
Rate for Payer: Cash Price	$319.68
Rate for Payer: Devoted Health Medicare	$1.46
Rate for Payer: Hawaii Medical Service Association Commercial	$1.66
Rate for Payer: Hawaii Medical Service Association Medicare	$1.33
Rate for Payer: Hawaii Western Management Group Commercial	$467.23
Rate for Payer: Health Management Network Commercial	$418.05
Rate for Payer: Humana Medicare	$1.33
Rate for Payer: Kaiser Permanente Commercial	$309.85
Rate for Payer: Kaiser Permanente Medicaid	$250.83
Rate for Payer: Kaiser Permanente Medicare	$1.33
Rate for Payer: MDX Hawaii PPO	$477.07
Rate for Payer: Ohana Health Plan Medicaid	$1.46
Rate for Payer: Ohana Health Plan Medicare	$1.33
Rate for Payer: UnitedHealthcare Medicaid	$295.09
Rate for Payer: UnitedHealthcare Medicare	$1.33
Rate for Payer: University Health Alliance Commercial	$358.49

FOSPHENYTOIN LOADING DOSE

Facility

$491.82

Service Code	NDC 00069600110
Hospital Revenue Code	250
Min. Negotiated Rate	$418.05
Max. Negotiated Rate	$477.07
Rate for Payer: Cash Price	$319.68
Rate for Payer: Health Management Network Commercial	$418.05
Rate for Payer: MDX Hawaii PPO	$477.07

FOSPHENYTOIN LOADING DOSE

Facility

$491.82

Service Code	NDC 00069600121
Hospital Revenue Code	250
Min. Negotiated Rate	$250.83
Max. Negotiated Rate	$477.07
Rate for Payer: Cash Price	$319.68
Rate for Payer: Hawaii Western Management Group Commercial	$467.23
Rate for Payer: Health Management Network Commercial	$418.05
Rate for Payer: Kaiser Permanente Commercial	$309.85
Rate for Payer: Kaiser Permanente Medicaid	$250.83
Rate for Payer: MDX Hawaii PPO	$477.07
Rate for Payer: UnitedHealthcare Medicaid	$295.09
Rate for Payer: University Health Alliance Commercial	$358.49

FOSPHENYTOIN LOADING DOSE

Facility

$491.82

Service Code	NDC 00069600110
Hospital Revenue Code	250
Min. Negotiated Rate	$250.83
Max. Negotiated Rate	$477.07
Rate for Payer: Cash Price	$319.68
Rate for Payer: Hawaii Western Management Group Commercial	$467.23
Rate for Payer: Health Management Network Commercial	$418.05
Rate for Payer: Kaiser Permanente Commercial	$309.85
Rate for Payer: Kaiser Permanente Medicaid	$250.83
Rate for Payer: MDX Hawaii PPO	$477.07
Rate for Payer: UnitedHealthcare Medicaid	$295.09
Rate for Payer: University Health Alliance Commercial	$358.49

FOSPHENYTOIN LOADING DOSE

Facility

$491.82

Service Code	NDC 00069600121
Hospital Revenue Code	250
Min. Negotiated Rate	$418.05
Max. Negotiated Rate	$477.07
Rate for Payer: Cash Price	$319.68
Rate for Payer: Health Management Network Commercial	$418.05
Rate for Payer: MDX Hawaii PPO	$477.07

FOSPHENYTOIN MAINTENANCE DOSE

Facility

$185.39

Service Code	NDC 00069600102
Hospital Revenue Code	250
Min. Negotiated Rate	$94.55
Max. Negotiated Rate	$179.83
Rate for Payer: Cash Price	$120.50
Rate for Payer: Hawaii Western Management Group Commercial	$176.12
Rate for Payer: Health Management Network Commercial	$157.58
Rate for Payer: Kaiser Permanente Commercial	$116.80
Rate for Payer: Kaiser Permanente Medicaid	$94.55
Rate for Payer: MDX Hawaii PPO	$179.83
Rate for Payer: UnitedHealthcare Medicaid	$111.23
Rate for Payer: University Health Alliance Commercial	$135.13

FOSPHENYTOIN MAINTENANCE DOSE

Facility

$185.39

Service Code	NDC 00069600102
Hospital Revenue Code	250
Min. Negotiated Rate	$157.58
Max. Negotiated Rate	$179.83
Rate for Payer: Cash Price	$120.50
Rate for Payer: Health Management Network Commercial	$157.58
Rate for Payer: MDX Hawaii PPO	$179.83

FOSPHENYTOIN MAINTENANCE DOSE

Facility

$185.39

Service Code	NDC 00069600125
Hospital Revenue Code	250
Min. Negotiated Rate	$157.58
Max. Negotiated Rate	$179.83
Rate for Payer: Cash Price	$120.50
Rate for Payer: Health Management Network Commercial	$157.58
Rate for Payer: MDX Hawaii PPO	$179.83

FOSPHENYTOIN MAINTENANCE DOSE

Facility

$185.39

Service Code	NDC 00069600125
Hospital Revenue Code	250
Min. Negotiated Rate	$94.55
Max. Negotiated Rate	$179.83
Rate for Payer: Cash Price	$120.50
Rate for Payer: Hawaii Western Management Group Commercial	$176.12
Rate for Payer: Health Management Network Commercial	$157.58
Rate for Payer: Kaiser Permanente Commercial	$116.80
Rate for Payer: Kaiser Permanente Medicaid	$94.55
Rate for Payer: MDX Hawaii PPO	$179.83
Rate for Payer: UnitedHealthcare Medicaid	$111.23
Rate for Payer: University Health Alliance Commercial	$135.13

FRACTURE OF FEMUR

Facility

$3,891.50

Service Code	APR-DRG 3403
Min. Negotiated Rate	$3,891.50
Max. Negotiated Rate	$3,891.50
Rate for Payer: AlohaCare Medicaid	$3,891.50
Rate for Payer: Hawaii Medical Service Association ABD	$3,891.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,891.50
Rate for Payer: Kaiser Permanente Medicaid	$3,891.50
Rate for Payer: Ohana Health Plan Medicaid	$3,891.50
Rate for Payer: UnitedHealthcare Medicaid	$3,891.50

FRACTURE OF FEMUR

Facility

$2,176.59

Service Code	APR-DRG 3401
Min. Negotiated Rate	$2,176.59
Max. Negotiated Rate	$2,176.59
Rate for Payer: AlohaCare Medicaid	$2,176.59
Rate for Payer: Hawaii Medical Service Association ABD	$2,176.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,176.59
Rate for Payer: Kaiser Permanente Medicaid	$2,176.59
Rate for Payer: Ohana Health Plan Medicaid	$2,176.59
Rate for Payer: UnitedHealthcare Medicaid	$2,176.59

FRACTURE OF FEMUR

Facility

$6,315.18

Service Code	APR-DRG 3404
Min. Negotiated Rate	$6,315.18
Max. Negotiated Rate	$6,315.18
Rate for Payer: AlohaCare Medicaid	$6,315.18
Rate for Payer: Hawaii Medical Service Association ABD	$6,315.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,315.18
Rate for Payer: Kaiser Permanente Medicaid	$6,315.18
Rate for Payer: Ohana Health Plan Medicaid	$6,315.18
Rate for Payer: UnitedHealthcare Medicaid	$6,315.18

Know your out-of-pocket cost for care.

All Charges