Kona Community Hospital

All Charges

Charge

Type

Setting

Price

ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) IV SOLN

Facility

$10,853.48

Service Code	HCPCS J9022
Hospital Revenue Code	636
Min. Negotiated Rate	$91.02
Max. Negotiated Rate	$10,527.88
Rate for Payer: AlohaCare Medicaid	$94.00
Rate for Payer: AlohaCare Medicare	$94.00
Rate for Payer: Cash Price	$7,054.76
Rate for Payer: Cash Price	$7,054.76
Rate for Payer: Devoted Health Medicare	$103.40
Rate for Payer: Hawaii Medical Service Association ABD	$91.02
Rate for Payer: Hawaii Medical Service Association Commercial	$117.50
Rate for Payer: Hawaii Medical Service Association Medicare	$94.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$91.02
Rate for Payer: Hawaii Western Management Group Commercial	$10,310.81
Rate for Payer: Health Management Network Commercial	$9,225.46
Rate for Payer: Humana Medicare	$94.00
Rate for Payer: Kaiser Permanente Commercial	$6,837.69
Rate for Payer: Kaiser Permanente Medicaid	$5,535.27
Rate for Payer: Kaiser Permanente Medicare	$94.00
Rate for Payer: MDX Hawaii PPO	$10,527.88
Rate for Payer: Ohana Health Plan Medicaid	$103.40
Rate for Payer: Ohana Health Plan Medicare	$94.00
Rate for Payer: UnitedHealthcare Medicaid	$6,512.09
Rate for Payer: UnitedHealthcare Medicare	$94.00
Rate for Payer: University Health Alliance Commercial	$7,911.10

ATHEROSCLEROSIS WITH MCC

Facility

$20,641.35

Service Code	MSDRG 302
Min. Negotiated Rate	$14,440.09
Max. Negotiated Rate	$20,641.35
Rate for Payer: AlohaCare Medicare	$15,738.59
Rate for Payer: Devoted Health Medicare	$17,312.45
Rate for Payer: Hawaii Medical Service Association Commercial	$14,440.09
Rate for Payer: Hawaii Medical Service Association Medicare	$15,738.59
Rate for Payer: Humana Medicare	$15,738.59
Rate for Payer: Kaiser Permanente Commercial	$20,641.35
Rate for Payer: Kaiser Permanente Medicare	$15,738.59
Rate for Payer: Ohana Health Plan Medicare	$15,738.59
Rate for Payer: UnitedHealthcare Medicare	$15,738.59

ATHEROSCLEROSIS WITHOUT MCC

Facility

$14,319.56

Service Code	MSDRG 303
Min. Negotiated Rate	$8,854.43
Max. Negotiated Rate	$14,319.56
Rate for Payer: AlohaCare Medicare	$8,854.43
Rate for Payer: Devoted Health Medicare	$9,739.87
Rate for Payer: Hawaii Medical Service Association Commercial	$14,319.56
Rate for Payer: Hawaii Medical Service Association Medicare	$8,854.43
Rate for Payer: Humana Medicare	$8,854.43
Rate for Payer: Kaiser Permanente Commercial	$11,612.70
Rate for Payer: Kaiser Permanente Medicare	$8,854.43
Rate for Payer: Ohana Health Plan Medicare	$8,854.43
Rate for Payer: UnitedHealthcare Medicare	$8,854.43

Atlas,Dt W/gfs And Drill Bit 11200 [3643645]

Facility

$2,041.88

Service Code	HCPCS C1713
Hospital Charge Code	3643645
Hospital Revenue Code	278
Min. Negotiated Rate	$1,041.36
Max. Negotiated Rate	$1,980.62
Rate for Payer: Cash Price	$1,327.22
Rate for Payer: Hawaii Western Management Group Commercial	$1,429.32
Rate for Payer: Health Management Network Commercial	$1,735.60
Rate for Payer: Kaiser Permanente Commercial	$1,286.38
Rate for Payer: Kaiser Permanente Medicaid	$1,041.36
Rate for Payer: MDX Hawaii PPO	$1,980.62
Rate for Payer: University Health Alliance Commercial	$1,143.45

Atlas,Dt W/gfs And Drill Bit 11200 [3643645]

Facility

$2,041.88

Service Code	HCPCS C1713
Hospital Charge Code	3643645
Hospital Revenue Code	278
Min. Negotiated Rate	$1,143.45
Max. Negotiated Rate	$1,980.62
Rate for Payer: Cash Price	$1,327.22
Rate for Payer: Hawaii Western Management Group Commercial	$1,429.32
Rate for Payer: Health Management Network Commercial	$1,735.60
Rate for Payer: MDX Hawaii PPO	$1,980.62
Rate for Payer: University Health Alliance Commercial	$1,143.45

ATORVASTATIN 10 MG PO TABLET

Facility

$2.04

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$1.98
Rate for Payer: Cash Price	$1.33
Rate for Payer: Cash Price	$2.27
Rate for Payer: Health Management Network Commercial	$2.97
Rate for Payer: Health Management Network Commercial	$1.73
Rate for Payer: MDX Hawaii PPO	$1.98
Rate for Payer: MDX Hawaii PPO	$3.39

ATORVASTATIN 10 MG PO TABLET

Facility

$3.49

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$3.39
Rate for Payer: Cash Price	$2.27
Rate for Payer: Cash Price	$1.33
Rate for Payer: Hawaii Western Management Group Commercial	$1.94
Rate for Payer: Hawaii Western Management Group Commercial	$3.32
Rate for Payer: Health Management Network Commercial	$1.73
Rate for Payer: Health Management Network Commercial	$2.97
Rate for Payer: Kaiser Permanente Commercial	$1.29
Rate for Payer: Kaiser Permanente Commercial	$2.20
Rate for Payer: Kaiser Permanente Medicaid	$1.04
Rate for Payer: Kaiser Permanente Medicaid	$1.78
Rate for Payer: MDX Hawaii PPO	$1.98
Rate for Payer: MDX Hawaii PPO	$3.39
Rate for Payer: UnitedHealthcare Medicaid	$2.09
Rate for Payer: UnitedHealthcare Medicaid	$1.22
Rate for Payer: University Health Alliance Commercial	$1.49
Rate for Payer: University Health Alliance Commercial	$2.54

ATORVASTATIN 20 MG PO TABLET

Facility

$2.90

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.81
Rate for Payer: Cash Price	$1.88
Rate for Payer: Cash Price	$3.08
Rate for Payer: Health Management Network Commercial	$2.46
Rate for Payer: Health Management Network Commercial	$4.03
Rate for Payer: MDX Hawaii PPO	$2.81
Rate for Payer: MDX Hawaii PPO	$4.60

ATORVASTATIN 20 MG PO TABLET

Facility

$2.90

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$2.81
Rate for Payer: Cash Price	$1.88
Rate for Payer: Cash Price	$3.08
Rate for Payer: Hawaii Western Management Group Commercial	$4.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.75
Rate for Payer: Health Management Network Commercial	$4.03
Rate for Payer: Health Management Network Commercial	$2.46
Rate for Payer: Kaiser Permanente Commercial	$1.83
Rate for Payer: Kaiser Permanente Commercial	$2.99
Rate for Payer: Kaiser Permanente Medicaid	$1.48
Rate for Payer: Kaiser Permanente Medicaid	$2.42
Rate for Payer: MDX Hawaii PPO	$4.60
Rate for Payer: MDX Hawaii PPO	$2.81
Rate for Payer: UnitedHealthcare Medicaid	$1.74
Rate for Payer: UnitedHealthcare Medicaid	$2.84
Rate for Payer: University Health Alliance Commercial	$2.11
Rate for Payer: University Health Alliance Commercial	$3.45

ATORVASTATIN 40 MG PO TABLET

Facility

$4.74

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$4.60
Rate for Payer: Cash Price	$3.08
Rate for Payer: Health Management Network Commercial	$4.03
Rate for Payer: MDX Hawaii PPO	$4.60

ATORVASTATIN 40 MG PO TABLET

Facility

$4.74

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$4.60
Rate for Payer: Cash Price	$3.08
Rate for Payer: Hawaii Western Management Group Commercial	$4.50
Rate for Payer: Health Management Network Commercial	$4.03
Rate for Payer: Kaiser Permanente Commercial	$2.99
Rate for Payer: Kaiser Permanente Medicaid	$2.42
Rate for Payer: MDX Hawaii PPO	$4.60
Rate for Payer: UnitedHealthcare Medicaid	$2.84
Rate for Payer: University Health Alliance Commercial	$3.45

ATOVAQUONE-PROGUANIL 250-100 MG PO TABLET

Facility

$44.17

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$37.54
Max. Negotiated Rate	$42.84
Rate for Payer: Cash Price	$28.71
Rate for Payer: Health Management Network Commercial	$37.54
Rate for Payer: MDX Hawaii PPO	$42.84

ATOVAQUONE-PROGUANIL 250-100 MG PO TABLET

Facility

$44.17

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$22.53
Max. Negotiated Rate	$42.84
Rate for Payer: Cash Price	$28.71
Rate for Payer: Hawaii Western Management Group Commercial	$41.96
Rate for Payer: Health Management Network Commercial	$37.54
Rate for Payer: Kaiser Permanente Commercial	$27.83
Rate for Payer: Kaiser Permanente Medicaid	$22.53
Rate for Payer: MDX Hawaii PPO	$42.84
Rate for Payer: UnitedHealthcare Medicaid	$26.50
Rate for Payer: University Health Alliance Commercial	$32.20

ATROPINE 0.1 MG/ML INJ SYR

Facility

$59.27

Service Code	HCPCS J0461
Hospital Revenue Code	250
Min. Negotiated Rate	$50.38
Max. Negotiated Rate	$57.49
Rate for Payer: Cash Price	$38.53
Rate for Payer: Cash Price	$42.52
Rate for Payer: Health Management Network Commercial	$50.38
Rate for Payer: Health Management Network Commercial	$55.60
Rate for Payer: MDX Hawaii PPO	$57.49
Rate for Payer: MDX Hawaii PPO	$63.45

ATROPINE 0.1 MG/ML INJ SYR

Facility

$59.27

Service Code	HCPCS J0461
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$57.49
Rate for Payer: Cash Price	$38.53
Rate for Payer: Cash Price	$42.52
Rate for Payer: Cash Price	$38.53
Rate for Payer: Cash Price	$42.52
Rate for Payer: Hawaii Medical Service Association ABD	$0.07
Rate for Payer: Hawaii Medical Service Association ABD	$0.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.07
Rate for Payer: Hawaii Western Management Group Commercial	$62.14
Rate for Payer: Hawaii Western Management Group Commercial	$56.31
Rate for Payer: Health Management Network Commercial	$55.60
Rate for Payer: Health Management Network Commercial	$50.38
Rate for Payer: Kaiser Permanente Commercial	$41.21
Rate for Payer: Kaiser Permanente Commercial	$37.34
Rate for Payer: Kaiser Permanente Medicaid	$30.23
Rate for Payer: Kaiser Permanente Medicaid	$33.36
Rate for Payer: MDX Hawaii PPO	$57.49
Rate for Payer: MDX Hawaii PPO	$63.45
Rate for Payer: UnitedHealthcare Medicaid	$39.25
Rate for Payer: UnitedHealthcare Medicaid	$35.56
Rate for Payer: University Health Alliance Commercial	$43.20
Rate for Payer: University Health Alliance Commercial	$47.68

ATROPINE 0.4 MG/ML IV SOLN

Facility

$64.50

Service Code	HCPCS J0462
Hospital Revenue Code	636
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$62.56
Rate for Payer: Cash Price	$41.92
Rate for Payer: Hawaii Western Management Group Commercial	$61.27
Rate for Payer: Health Management Network Commercial	$54.83
Rate for Payer: Kaiser Permanente Commercial	$40.63
Rate for Payer: Kaiser Permanente Medicaid	$32.90
Rate for Payer: MDX Hawaii PPO	$62.56
Rate for Payer: UnitedHealthcare Medicaid	$38.70
Rate for Payer: University Health Alliance Commercial	$47.01

ATROPINE 0.4 MG/ML IV SOLN

Facility

$64.50

Service Code	HCPCS J0462
Hospital Revenue Code	250
Min. Negotiated Rate	$54.83
Max. Negotiated Rate	$62.56
Rate for Payer: Cash Price	$41.92
Rate for Payer: Health Management Network Commercial	$54.83
Rate for Payer: MDX Hawaii PPO	$62.56

ATROPINE 1 MG/ML IV SOLN

Facility

$88.22

Service Code	HCPCS J0462
Hospital Revenue Code	636
Min. Negotiated Rate	$44.99
Max. Negotiated Rate	$85.57
Rate for Payer: Cash Price	$57.34
Rate for Payer: Hawaii Western Management Group Commercial	$83.81
Rate for Payer: Health Management Network Commercial	$74.99
Rate for Payer: Kaiser Permanente Commercial	$55.58
Rate for Payer: Kaiser Permanente Medicaid	$44.99
Rate for Payer: MDX Hawaii PPO	$85.57
Rate for Payer: UnitedHealthcare Medicaid	$52.93
Rate for Payer: University Health Alliance Commercial	$64.30

ATROPINE 1 MG/ML IV SOLN

Facility

$88.22

Service Code	HCPCS J0462
Hospital Revenue Code	250
Min. Negotiated Rate	$74.99
Max. Negotiated Rate	$85.57
Rate for Payer: Cash Price	$57.34
Rate for Payer: Health Management Network Commercial	$74.99
Rate for Payer: MDX Hawaii PPO	$85.57

ATROPINE 1 % OPHT DROP

Facility

$308.52

Service Code	NDC 00065081701
Hospital Revenue Code	250
Min. Negotiated Rate	$262.24
Max. Negotiated Rate	$299.26
Rate for Payer: Cash Price	$200.54
Rate for Payer: Health Management Network Commercial	$262.24
Rate for Payer: MDX Hawaii PPO	$299.26

ATROPINE 1 % OPHT DROP

Facility

$291.27

Service Code	NDC 60505622601
Hospital Revenue Code	250
Min. Negotiated Rate	$247.58
Max. Negotiated Rate	$282.53
Rate for Payer: Cash Price	$189.33
Rate for Payer: Health Management Network Commercial	$247.58
Rate for Payer: MDX Hawaii PPO	$282.53

ATROPINE 1 % OPHT DROP

Facility

$308.52

Service Code	NDC 00065081701
Hospital Revenue Code	250
Min. Negotiated Rate	$157.35
Max. Negotiated Rate	$299.26
Rate for Payer: Cash Price	$200.54
Rate for Payer: Hawaii Western Management Group Commercial	$293.09
Rate for Payer: Health Management Network Commercial	$262.24
Rate for Payer: Kaiser Permanente Commercial	$194.37
Rate for Payer: Kaiser Permanente Medicaid	$157.35
Rate for Payer: MDX Hawaii PPO	$299.26
Rate for Payer: UnitedHealthcare Medicaid	$185.11
Rate for Payer: University Health Alliance Commercial	$224.88

ATROPINE 1 % OPHT DROP

Facility

$301.37

Service Code	NDC 60219174903
Hospital Revenue Code	250
Min. Negotiated Rate	$256.16
Max. Negotiated Rate	$292.33
Rate for Payer: Cash Price	$195.89
Rate for Payer: Health Management Network Commercial	$256.16
Rate for Payer: MDX Hawaii PPO	$292.33

ATROPINE 1 % OPHT DROP

Facility

$301.37

Service Code	NDC 60219174903
Hospital Revenue Code	250
Min. Negotiated Rate	$153.70
Max. Negotiated Rate	$292.33
Rate for Payer: Cash Price	$195.89
Rate for Payer: Hawaii Western Management Group Commercial	$286.30
Rate for Payer: Health Management Network Commercial	$256.16
Rate for Payer: Kaiser Permanente Commercial	$189.86
Rate for Payer: Kaiser Permanente Medicaid	$153.70
Rate for Payer: MDX Hawaii PPO	$292.33
Rate for Payer: UnitedHealthcare Medicaid	$180.82
Rate for Payer: University Health Alliance Commercial	$219.67

ATROPINE 1 % OPHT DROP

Facility

$291.27

Service Code	NDC 60505622601
Hospital Revenue Code	250
Min. Negotiated Rate	$148.55
Max. Negotiated Rate	$282.53
Rate for Payer: Cash Price	$189.33
Rate for Payer: Hawaii Western Management Group Commercial	$276.71
Rate for Payer: Health Management Network Commercial	$247.58
Rate for Payer: Kaiser Permanente Commercial	$183.50
Rate for Payer: Kaiser Permanente Medicaid	$148.55
Rate for Payer: MDX Hawaii PPO	$282.53
Rate for Payer: UnitedHealthcare Medicaid	$174.76
Rate for Payer: University Health Alliance Commercial	$212.31

Know your out-of-pocket cost for care.

All Charges