Kona Community Hospital

All Charges

Charge

Type

Setting

Price

AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY

Facility

$24,874.16

Service Code	APR-DRG 0082
Min. Negotiated Rate	$24,874.16
Max. Negotiated Rate	$24,874.16
Rate for Payer: AlohaCare Medicaid	$24,874.16
Rate for Payer: Hawaii Medical Service Association ABD	$24,874.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$24,874.16
Rate for Payer: Kaiser Permanente Medicaid	$24,874.16
Rate for Payer: Ohana Health Plan Medicaid	$24,874.16
Rate for Payer: UnitedHealthcare Medicaid	$24,874.16

AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY

Facility

$49,146.55

Service Code	APR-DRG 0084
Min. Negotiated Rate	$49,146.55
Max. Negotiated Rate	$49,146.55
Rate for Payer: AlohaCare Medicaid	$49,146.55
Rate for Payer: Hawaii Medical Service Association ABD	$49,146.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$49,146.55
Rate for Payer: Kaiser Permanente Medicaid	$49,146.55
Rate for Payer: Ohana Health Plan Medicaid	$49,146.55
Rate for Payer: UnitedHealthcare Medicaid	$49,146.55

AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY

Facility

$32,517.71

Service Code	APR-DRG 0083
Min. Negotiated Rate	$32,517.71
Max. Negotiated Rate	$32,517.71
Rate for Payer: AlohaCare Medicaid	$32,517.71
Rate for Payer: Hawaii Medical Service Association ABD	$32,517.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$32,517.71
Rate for Payer: Kaiser Permanente Medicaid	$32,517.71
Rate for Payer: Ohana Health Plan Medicaid	$32,517.71
Rate for Payer: UnitedHealthcare Medicaid	$32,517.71

AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY

Facility

$19,797.57

Service Code	APR-DRG 0081
Min. Negotiated Rate	$19,797.57
Max. Negotiated Rate	$19,797.57
Rate for Payer: AlohaCare Medicaid	$19,797.57
Rate for Payer: Hawaii Medical Service Association ABD	$19,797.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19,797.57
Rate for Payer: Kaiser Permanente Medicaid	$19,797.57
Rate for Payer: Ohana Health Plan Medicaid	$19,797.57
Rate for Payer: UnitedHealthcare Medicaid	$19,797.57

AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC

Facility

$232,873.62

Service Code	MSDRG 016
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$232,873.62
Rate for Payer: AlohaCare Medicare	$77,991.95
Rate for Payer: Devoted Health Medicare	$85,791.15
Rate for Payer: Hawaii Medical Service Association Commercial	$232,873.62
Rate for Payer: Hawaii Medical Service Association Medicare	$77,991.95
Rate for Payer: Humana Medicare	$77,991.95
Rate for Payer: Kaiser Permanente Commercial	$102,287.32
Rate for Payer: Kaiser Permanente Medicare	$77,991.95
Rate for Payer: Ohana Health Plan Medicare	$77,991.95
Rate for Payer: UnitedHealthcare Medicare	$77,991.95
Rate for Payer: University Health Alliance Commercial	$10,400.00

AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC

Facility

$232,873.62

Service Code	MSDRG 017
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$232,873.62
Rate for Payer: AlohaCare Medicare	$71,449.77
Rate for Payer: Devoted Health Medicare	$78,594.75
Rate for Payer: Hawaii Medical Service Association Commercial	$232,873.62
Rate for Payer: Hawaii Medical Service Association Medicare	$71,449.77
Rate for Payer: Humana Medicare	$71,449.77
Rate for Payer: Kaiser Permanente Commercial	$83,460.68
Rate for Payer: Kaiser Permanente Medicare	$71,449.77
Rate for Payer: Ohana Health Plan Medicare	$71,449.77
Rate for Payer: UnitedHealthcare Medicare	$71,449.77
Rate for Payer: University Health Alliance Commercial	$10,400.00

AVELUMAB 20 MG/ML IV SOLN

Facility

$3,631.23

Service Code	HCPCS J9023
Hospital Revenue Code	250
Min. Negotiated Rate	$3,086.55
Max. Negotiated Rate	$3,522.29
Rate for Payer: Cash Price	$2,360.30
Rate for Payer: Health Management Network Commercial	$3,086.55
Rate for Payer: MDX Hawaii PPO	$3,522.29

AVELUMAB 20 MG/ML IV SOLN

Facility

$3,631.23

Service Code	HCPCS J9023
Hospital Revenue Code	636
Min. Negotiated Rate	$100.30
Max. Negotiated Rate	$3,522.29
Rate for Payer: AlohaCare Medicaid	$105.55
Rate for Payer: AlohaCare Medicare	$105.55
Rate for Payer: Cash Price	$2,360.30
Rate for Payer: Cash Price	$2,360.30
Rate for Payer: Devoted Health Medicare	$116.11
Rate for Payer: Hawaii Medical Service Association ABD	$100.30
Rate for Payer: Hawaii Medical Service Association Commercial	$131.94
Rate for Payer: Hawaii Medical Service Association Medicare	$105.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$100.30
Rate for Payer: Hawaii Western Management Group Commercial	$3,449.67
Rate for Payer: Health Management Network Commercial	$3,086.55
Rate for Payer: Humana Medicare	$105.55
Rate for Payer: Kaiser Permanente Commercial	$2,287.67
Rate for Payer: Kaiser Permanente Medicaid	$1,851.93
Rate for Payer: Kaiser Permanente Medicare	$105.55
Rate for Payer: MDX Hawaii PPO	$3,522.29
Rate for Payer: Ohana Health Plan Medicaid	$116.11
Rate for Payer: Ohana Health Plan Medicare	$105.55
Rate for Payer: UnitedHealthcare Medicaid	$2,178.74
Rate for Payer: UnitedHealthcare Medicare	$105.55
Rate for Payer: University Health Alliance Commercial	$2,646.80

Avitus Bone Harvester 6mm BH-220 [3644860]

Facility

$11,149.88

Hospital Charge Code	3644860
Hospital Revenue Code	272
Min. Negotiated Rate	$5,686.44
Max. Negotiated Rate	$10,815.38
Rate for Payer: Cash Price	$7,247.42
Rate for Payer: Hawaii Western Management Group Commercial	$10,592.39
Rate for Payer: Health Management Network Commercial	$9,477.40
Rate for Payer: Kaiser Permanente Commercial	$7,024.42
Rate for Payer: Kaiser Permanente Medicaid	$5,686.44
Rate for Payer: MDX Hawaii PPO	$10,815.38
Rate for Payer: University Health Alliance Commercial	$8,127.15

Avitus Bone Harvester 6mm BH-220 [3644860]

Facility

$11,149.88

Hospital Charge Code	3644860
Hospital Revenue Code	272
Min. Negotiated Rate	$9,477.40
Max. Negotiated Rate	$10,815.38
Rate for Payer: Cash Price	$7,247.42
Rate for Payer: Health Management Network Commercial	$9,477.40
Rate for Payer: MDX Hawaii PPO	$10,815.38

Avitus Bone Harvester 8mm Bh-110 [3643954]

Facility

$6,890.63

Hospital Charge Code	3643954
Hospital Revenue Code	272
Min. Negotiated Rate	$5,857.04
Max. Negotiated Rate	$6,683.91
Rate for Payer: Cash Price	$4,478.91
Rate for Payer: Health Management Network Commercial	$5,857.04
Rate for Payer: MDX Hawaii PPO	$6,683.91

Avitus Bone Harvester 8mm Bh-110 [3643954]

Facility

$6,890.63

Hospital Charge Code	3643954
Hospital Revenue Code	272
Min. Negotiated Rate	$3,514.22
Max. Negotiated Rate	$6,683.91
Rate for Payer: Cash Price	$4,478.91
Rate for Payer: Hawaii Western Management Group Commercial	$6,546.10
Rate for Payer: Health Management Network Commercial	$5,857.04
Rate for Payer: Kaiser Permanente Commercial	$4,341.10
Rate for Payer: Kaiser Permanente Medicaid	$3,514.22
Rate for Payer: MDX Hawaii PPO	$6,683.91
Rate for Payer: University Health Alliance Commercial	$5,022.58

AXATILIMAB-CSFR 50 MG/ML IV SOLN

Facility

$14,978.40

Service Code	HCPCS J9038
Hospital Revenue Code	250
Min. Negotiated Rate	$12,731.64
Max. Negotiated Rate	$14,529.05
Rate for Payer: Cash Price	$9,735.96
Rate for Payer: Health Management Network Commercial	$12,731.64
Rate for Payer: MDX Hawaii PPO	$14,529.05

AXATILIMAB-CSFR 50 MG/ML IV SOLN

Facility

$14,978.40

Service Code	HCPCS J9038
Hospital Revenue Code	636
Min. Negotiated Rate	$55.65
Max. Negotiated Rate	$14,529.05
Rate for Payer: AlohaCare Medicaid	$55.65
Rate for Payer: AlohaCare Medicare	$55.65
Rate for Payer: Cash Price	$9,735.96
Rate for Payer: Cash Price	$9,735.96
Rate for Payer: Devoted Health Medicare	$61.22
Rate for Payer: Hawaii Medical Service Association Commercial	$69.56
Rate for Payer: Hawaii Medical Service Association Medicare	$55.65
Rate for Payer: Hawaii Western Management Group Commercial	$14,229.48
Rate for Payer: Health Management Network Commercial	$12,731.64
Rate for Payer: Humana Medicare	$55.65
Rate for Payer: Kaiser Permanente Commercial	$9,436.39
Rate for Payer: Kaiser Permanente Medicaid	$7,638.98
Rate for Payer: Kaiser Permanente Medicare	$55.65
Rate for Payer: MDX Hawaii PPO	$14,529.05
Rate for Payer: Ohana Health Plan Medicaid	$61.22
Rate for Payer: Ohana Health Plan Medicare	$55.65
Rate for Payer: UnitedHealthcare Medicaid	$8,987.04
Rate for Payer: UnitedHealthcare Medicare	$55.65
Rate for Payer: University Health Alliance Commercial	$10,917.76

AXILLARY LYMPHADENECTOMY; COMPLETE

Facility

$14,715.00

Service Code	CPT 38745
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$14,715.00
Rate for Payer: AlohaCare Medicaid	$7,141.85
Rate for Payer: AlohaCare Medicare	$7,141.85
Rate for Payer: Devoted Health Medicare	$7,856.03
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,715.00
Rate for Payer: Hawaii Medical Service Association Medicare	$7,141.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,154.45
Rate for Payer: Humana Medicare	$7,141.85
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,141.85
Rate for Payer: Ohana Health Plan Medicaid	$7,856.03
Rate for Payer: Ohana Health Plan Medicare	$7,141.85
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$7,141.85
Rate for Payer: University Health Alliance Commercial	$10,679.55

Axis II Model D SU Digital Flex Ureteroscope AX20413 [3644956]

Facility

$4,524.65

Service Code	HCPCS C1747
Hospital Charge Code	3644956
Hospital Revenue Code	272
Min. Negotiated Rate	$3,845.95
Max. Negotiated Rate	$4,388.91
Rate for Payer: Cash Price	$2,941.02
Rate for Payer: Health Management Network Commercial	$3,845.95
Rate for Payer: MDX Hawaii PPO	$4,388.91

Axis II Model D SU Digital Flex Ureteroscope AX20413 [3644956]

Facility

$4,524.65

Service Code	HCPCS C1747
Hospital Charge Code	3644956
Hospital Revenue Code	272
Min. Negotiated Rate	$2,307.57
Max. Negotiated Rate	$4,388.91
Rate for Payer: Cash Price	$2,941.02
Rate for Payer: Hawaii Western Management Group Commercial	$4,298.42
Rate for Payer: Health Management Network Commercial	$3,845.95
Rate for Payer: Kaiser Permanente Commercial	$2,850.53
Rate for Payer: Kaiser Permanente Medicaid	$2,307.57
Rate for Payer: MDX Hawaii PPO	$4,388.91
Rate for Payer: University Health Alliance Commercial	$3,298.02

AZACITIDINE 100 MG INJ RECON.SOLN. (DRY POWDER)

Facility

$572.16

Service Code	HCPCS J9025
Hospital Revenue Code	250
Min. Negotiated Rate	$486.34
Max. Negotiated Rate	$555.00
Rate for Payer: Cash Price	$371.90
Rate for Payer: Health Management Network Commercial	$486.34
Rate for Payer: MDX Hawaii PPO	$555.00

AZACITIDINE 100 MG INJ RECON.SOLN. (DRY POWDER)

Facility

$572.16

Service Code	HCPCS J9025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$555.00
Rate for Payer: Cash Price	$371.90
Rate for Payer: Cash Price	$371.90
Rate for Payer: Hawaii Medical Service Association ABD	$0.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.21
Rate for Payer: Hawaii Western Management Group Commercial	$543.55
Rate for Payer: Health Management Network Commercial	$486.34
Rate for Payer: Kaiser Permanente Commercial	$360.46
Rate for Payer: Kaiser Permanente Medicaid	$291.80
Rate for Payer: MDX Hawaii PPO	$555.00
Rate for Payer: UnitedHealthcare Medicaid	$343.30
Rate for Payer: University Health Alliance Commercial	$417.05

AZACITIDINE 100 MG IV RECON.SOLN.

Facility

$204.30

Service Code	HCPCS J9025
Hospital Revenue Code	250
Min. Negotiated Rate	$173.66
Max. Negotiated Rate	$198.17
Rate for Payer: Cash Price	$132.80
Rate for Payer: Health Management Network Commercial	$173.66
Rate for Payer: MDX Hawaii PPO	$198.17

AZACITIDINE 100 MG IV RECON.SOLN.

Facility

$204.30

Service Code	HCPCS J9025
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$198.17
Rate for Payer: Cash Price	$132.80
Rate for Payer: Cash Price	$132.80
Rate for Payer: Hawaii Medical Service Association ABD	$0.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.21
Rate for Payer: Hawaii Western Management Group Commercial	$194.09
Rate for Payer: Health Management Network Commercial	$173.66
Rate for Payer: Kaiser Permanente Commercial	$128.71
Rate for Payer: Kaiser Permanente Medicaid	$104.19
Rate for Payer: MDX Hawaii PPO	$198.17
Rate for Payer: UnitedHealthcare Medicaid	$122.58
Rate for Payer: University Health Alliance Commercial	$148.91

AZATHIOPRINE 50 MG PO TAB (0.5 TAB) = 25 MG

Facility

$11.65

Service Code	HCPCS J7500
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$11.30
Rate for Payer: Cash Price	$7.57
Rate for Payer: Health Management Network Commercial	$9.90
Rate for Payer: MDX Hawaii PPO	$11.30

AZATHIOPRINE 50 MG PO TAB (0.5 TAB) = 25 MG

Facility

$11.65

Service Code	HCPCS J7500
Hospital Revenue Code	636
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$11.30
Rate for Payer: Cash Price	$7.57
Rate for Payer: Cash Price	$7.57
Rate for Payer: Hawaii Medical Service Association ABD	$2.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.14
Rate for Payer: Hawaii Western Management Group Commercial	$11.07
Rate for Payer: Health Management Network Commercial	$9.90
Rate for Payer: Kaiser Permanente Commercial	$7.34
Rate for Payer: Kaiser Permanente Medicaid	$5.94
Rate for Payer: MDX Hawaii PPO	$11.30
Rate for Payer: UnitedHealthcare Medicaid	$6.99
Rate for Payer: University Health Alliance Commercial	$8.49

AZATHIOPRINE 50 MG PO TABLET

Facility

$11.65

Service Code	HCPCS J7500
Hospital Revenue Code	250
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$11.30
Rate for Payer: Cash Price	$7.57
Rate for Payer: Health Management Network Commercial	$9.90
Rate for Payer: MDX Hawaii PPO	$11.30

AZATHIOPRINE 50 MG PO TABLET

Facility

$11.65

Service Code	HCPCS J7500
Hospital Revenue Code	636
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$11.30
Rate for Payer: Cash Price	$7.57
Rate for Payer: Cash Price	$7.57
Rate for Payer: Hawaii Medical Service Association ABD	$2.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.14
Rate for Payer: Hawaii Western Management Group Commercial	$11.07
Rate for Payer: Health Management Network Commercial	$9.90
Rate for Payer: Kaiser Permanente Commercial	$7.34
Rate for Payer: Kaiser Permanente Medicaid	$5.94
Rate for Payer: MDX Hawaii PPO	$11.30
Rate for Payer: UnitedHealthcare Medicaid	$6.99
Rate for Payer: University Health Alliance Commercial	$8.49

Know your out-of-pocket cost for care.

All Charges