Kona Community Hospital

All Charges

Charge

Type

Setting

Price

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$52,191.65

Service Code	MSDRG 096
Min. Negotiated Rate	$33,923.61
Max. Negotiated Rate	$52,191.65
Rate for Payer: AlohaCare Medicare	$33,923.61
Rate for Payer: Devoted Health Medicare	$37,315.97
Rate for Payer: Hawaii Medical Service Association Commercial	$52,191.65
Rate for Payer: Hawaii Medical Service Association Medicare	$33,923.61
Rate for Payer: Humana Medicare	$33,923.61
Rate for Payer: Kaiser Permanente Commercial	$44,491.20
Rate for Payer: Kaiser Permanente Medicare	$33,923.61
Rate for Payer: Ohana Health Plan Medicare	$33,923.61
Rate for Payer: UnitedHealthcare Medicare	$33,923.61

BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$9,164.23

Service Code	APR-DRG 0492
Min. Negotiated Rate	$9,164.23
Max. Negotiated Rate	$9,164.23
Rate for Payer: AlohaCare Medicaid	$9,164.23
Rate for Payer: Hawaii Medical Service Association ABD	$9,164.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,164.23
Rate for Payer: Kaiser Permanente Medicaid	$9,164.23
Rate for Payer: Ohana Health Plan Medicaid	$9,164.23
Rate for Payer: UnitedHealthcare Medicaid	$9,164.23

BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$10,265.26

Service Code	APR-DRG 0493
Min. Negotiated Rate	$10,265.26
Max. Negotiated Rate	$10,265.26
Rate for Payer: AlohaCare Medicaid	$10,265.26
Rate for Payer: Hawaii Medical Service Association ABD	$10,265.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,265.26
Rate for Payer: Kaiser Permanente Medicaid	$10,265.26
Rate for Payer: Ohana Health Plan Medicaid	$10,265.26
Rate for Payer: UnitedHealthcare Medicaid	$10,265.26

BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$5,562.47

Service Code	APR-DRG 0491
Min. Negotiated Rate	$5,562.47
Max. Negotiated Rate	$5,562.47
Rate for Payer: AlohaCare Medicaid	$5,562.47
Rate for Payer: Hawaii Medical Service Association ABD	$5,562.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,562.47
Rate for Payer: Kaiser Permanente Medicaid	$5,562.47
Rate for Payer: Ohana Health Plan Medicaid	$5,562.47
Rate for Payer: UnitedHealthcare Medicaid	$5,562.47

BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$19,437.77

Service Code	APR-DRG 0494
Min. Negotiated Rate	$19,437.77
Max. Negotiated Rate	$19,437.77
Rate for Payer: AlohaCare Medicaid	$19,437.77
Rate for Payer: Hawaii Medical Service Association ABD	$19,437.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19,437.77
Rate for Payer: Kaiser Permanente Medicaid	$19,437.77
Rate for Payer: Ohana Health Plan Medicaid	$19,437.77
Rate for Payer: UnitedHealthcare Medicaid	$19,437.77

Bactisure Wound Lavage 008887002 [3642064]

Facility

$3,878.00

Hospital Charge Code	3642064
Hospital Revenue Code	272
Min. Negotiated Rate	$1,977.78
Max. Negotiated Rate	$3,761.66
Rate for Payer: Cash Price	$2,520.70
Rate for Payer: Hawaii Western Management Group Commercial	$3,684.10
Rate for Payer: Health Management Network Commercial	$3,296.30
Rate for Payer: Kaiser Permanente Commercial	$2,443.14
Rate for Payer: Kaiser Permanente Medicaid	$1,977.78
Rate for Payer: MDX Hawaii PPO	$3,761.66
Rate for Payer: University Health Alliance Commercial	$2,826.67

Bactisure Wound Lavage 008887002 [3642064]

Facility

$3,878.00

Hospital Charge Code	3642064
Hospital Revenue Code	272
Min. Negotiated Rate	$3,296.30
Max. Negotiated Rate	$3,761.66
Rate for Payer: Cash Price	$2,520.70
Rate for Payer: Health Management Network Commercial	$3,296.30
Rate for Payer: MDX Hawaii PPO	$3,761.66

Bakri Postpartum Balloon [2707849]

Facility

$1,623.72

Hospital Charge Code	2707849
Hospital Revenue Code	272
Min. Negotiated Rate	$1,380.16
Max. Negotiated Rate	$1,575.01
Rate for Payer: Cash Price	$1,055.42
Rate for Payer: Health Management Network Commercial	$1,380.16
Rate for Payer: MDX Hawaii PPO	$1,575.01

Bakri Postpartum Balloon [2707849]

Facility

$1,623.72

Hospital Charge Code	2707849
Hospital Revenue Code	272
Min. Negotiated Rate	$828.10
Max. Negotiated Rate	$1,575.01
Rate for Payer: Cash Price	$1,055.42
Rate for Payer: Hawaii Western Management Group Commercial	$1,542.53
Rate for Payer: Health Management Network Commercial	$1,380.16
Rate for Payer: Kaiser Permanente Commercial	$1,022.94
Rate for Payer: Kaiser Permanente Medicaid	$828.10
Rate for Payer: MDX Hawaii PPO	$1,575.01
Rate for Payer: University Health Alliance Commercial	$1,183.53

BALANCED SALT IRRIG SOLN COMB2 INTRAOC SOLN (500 ML)

Facility

$171.18

Service Code	NDC 00065179504
Hospital Revenue Code	250
Min. Negotiated Rate	$87.30
Max. Negotiated Rate	$166.04
Rate for Payer: Cash Price	$111.27
Rate for Payer: Hawaii Western Management Group Commercial	$162.62
Rate for Payer: Health Management Network Commercial	$145.50
Rate for Payer: Kaiser Permanente Commercial	$107.84
Rate for Payer: Kaiser Permanente Medicaid	$87.30
Rate for Payer: MDX Hawaii PPO	$166.04
Rate for Payer: UnitedHealthcare Medicaid	$102.71
Rate for Payer: University Health Alliance Commercial	$124.77

BALANCED SALT IRRIG SOLN COMB2 INTRAOC SOLN (500 ML)

Facility

$171.18

Service Code	NDC 00065179504
Hospital Revenue Code	250
Min. Negotiated Rate	$145.50
Max. Negotiated Rate	$166.04
Rate for Payer: Cash Price	$111.27
Rate for Payer: Health Management Network Commercial	$145.50
Rate for Payer: MDX Hawaii PPO	$166.04

BALANCED SALT SOLN NO.2 IRRIG. INTRAOC SOLN

Facility

$70.36

Service Code	NDC 00065079515
Hospital Revenue Code	250
Min. Negotiated Rate	$59.81
Max. Negotiated Rate	$68.25
Rate for Payer: Cash Price	$45.73
Rate for Payer: Health Management Network Commercial	$59.81
Rate for Payer: MDX Hawaii PPO	$68.25

BALANCED SALT SOLN NO.2 IRRIG. INTRAOC SOLN

Facility

$177.39

Service Code	NDC 00065079550
Hospital Revenue Code	250
Min. Negotiated Rate	$150.78
Max. Negotiated Rate	$172.07
Rate for Payer: Cash Price	$115.30
Rate for Payer: Health Management Network Commercial	$150.78
Rate for Payer: MDX Hawaii PPO	$172.07

BALANCED SALT SOLN NO.2 IRRIG. INTRAOC SOLN

Facility

$70.36

Service Code	NDC 00065079515
Hospital Revenue Code	250
Min. Negotiated Rate	$35.88
Max. Negotiated Rate	$68.25
Rate for Payer: Cash Price	$45.73
Rate for Payer: Hawaii Western Management Group Commercial	$66.84
Rate for Payer: Health Management Network Commercial	$59.81
Rate for Payer: Kaiser Permanente Commercial	$44.33
Rate for Payer: Kaiser Permanente Medicaid	$35.88
Rate for Payer: MDX Hawaii PPO	$68.25
Rate for Payer: UnitedHealthcare Medicaid	$42.22
Rate for Payer: University Health Alliance Commercial	$51.29

BALANCED SALT SOLN NO.2 IRRIG. INTRAOC SOLN

Facility

$177.39

Service Code	NDC 00065079550
Hospital Revenue Code	250
Min. Negotiated Rate	$90.47
Max. Negotiated Rate	$172.07
Rate for Payer: Cash Price	$115.30
Rate for Payer: Hawaii Western Management Group Commercial	$168.52
Rate for Payer: Health Management Network Commercial	$150.78
Rate for Payer: Kaiser Permanente Commercial	$111.76
Rate for Payer: Kaiser Permanente Medicaid	$90.47
Rate for Payer: MDX Hawaii PPO	$172.07
Rate for Payer: UnitedHealthcare Medicaid	$106.43
Rate for Payer: University Health Alliance Commercial	$129.30

Balloon Dilation Ampulla Cre10-11-12mm M00558880 [3642358]

Facility

$1,573.75

Service Code	HCPCS C1726
Hospital Charge Code	3642358
Hospital Revenue Code	272
Min. Negotiated Rate	$802.61
Max. Negotiated Rate	$1,526.54
Rate for Payer: Cash Price	$1,022.94
Rate for Payer: Hawaii Western Management Group Commercial	$1,495.06
Rate for Payer: Health Management Network Commercial	$1,337.69
Rate for Payer: Kaiser Permanente Commercial	$991.46
Rate for Payer: Kaiser Permanente Medicaid	$802.61
Rate for Payer: MDX Hawaii PPO	$1,526.54
Rate for Payer: University Health Alliance Commercial	$1,147.11

Balloon Dilation Ampulla Cre10-11-12mm M00558880 [3642358]

Facility

$1,573.75

Service Code	HCPCS C1726
Hospital Charge Code	3642358
Hospital Revenue Code	272
Min. Negotiated Rate	$1,337.69
Max. Negotiated Rate	$1,526.54
Rate for Payer: Cash Price	$1,022.94
Rate for Payer: Health Management Network Commercial	$1,337.69
Rate for Payer: MDX Hawaii PPO	$1,526.54

Balloon Dilation Ampulla Cre12-13.5-15mm M00558890 [3642359]

Facility

$1,573.75

Service Code	HCPCS C1726
Hospital Charge Code	3642359
Hospital Revenue Code	272
Min. Negotiated Rate	$1,337.69
Max. Negotiated Rate	$1,526.54
Rate for Payer: Cash Price	$1,022.94
Rate for Payer: Health Management Network Commercial	$1,337.69
Rate for Payer: MDX Hawaii PPO	$1,526.54

Balloon Dilation Ampulla Cre12-13.5-15mm M00558890 [3642359]

Facility

$1,573.75

Service Code	HCPCS C1726
Hospital Charge Code	3642359
Hospital Revenue Code	272
Min. Negotiated Rate	$802.61
Max. Negotiated Rate	$1,526.54
Rate for Payer: Cash Price	$1,022.94
Rate for Payer: Hawaii Western Management Group Commercial	$1,495.06
Rate for Payer: Health Management Network Commercial	$1,337.69
Rate for Payer: Kaiser Permanente Commercial	$991.46
Rate for Payer: Kaiser Permanente Medicaid	$802.61
Rate for Payer: MDX Hawaii PPO	$1,526.54
Rate for Payer: University Health Alliance Commercial	$1,147.11

BARICITINIB 2 MG PO TABLET (EUA)

Facility

$418.41

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$213.39
Max. Negotiated Rate	$405.86
Rate for Payer: Cash Price	$271.97
Rate for Payer: Hawaii Western Management Group Commercial	$397.49
Rate for Payer: Health Management Network Commercial	$355.65
Rate for Payer: Kaiser Permanente Commercial	$263.60
Rate for Payer: Kaiser Permanente Medicaid	$213.39
Rate for Payer: MDX Hawaii PPO	$405.86
Rate for Payer: UnitedHealthcare Medicaid	$251.05
Rate for Payer: University Health Alliance Commercial	$304.98

BARICITINIB 2 MG PO TABLET (EUA)

Facility

$418.41

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$355.65
Max. Negotiated Rate	$405.86
Rate for Payer: Cash Price	$271.97
Rate for Payer: Health Management Network Commercial	$355.65
Rate for Payer: MDX Hawaii PPO	$405.86

BARIUM SULFATE 96 % PR ENEMA

Facility

$53.76

Service Code	NDC 32909080401
Hospital Revenue Code	255
Min. Negotiated Rate	$27.42
Max. Negotiated Rate	$52.15
Rate for Payer: Cash Price	$34.94
Rate for Payer: Hawaii Western Management Group Commercial	$51.07
Rate for Payer: Health Management Network Commercial	$45.70
Rate for Payer: Kaiser Permanente Commercial	$33.87
Rate for Payer: Kaiser Permanente Medicaid	$27.42
Rate for Payer: MDX Hawaii PPO	$52.15
Rate for Payer: University Health Alliance Commercial	$39.19

BARIUM SULFATE 96 % PR ENEMA

Facility

$53.76

Service Code	NDC 32909080401
Hospital Revenue Code	255
Min. Negotiated Rate	$45.70
Max. Negotiated Rate	$52.15
Rate for Payer: Cash Price	$34.94
Rate for Payer: Health Management Network Commercial	$45.70
Rate for Payer: MDX Hawaii PPO	$52.15

BARIUM SULFATE 96 % (W/W) PO SUSR

Facility

$27.21

Service Code	NDC 32909075003
Hospital Revenue Code	255
Min. Negotiated Rate	$23.13
Max. Negotiated Rate	$26.39
Rate for Payer: Cash Price	$17.69
Rate for Payer: Health Management Network Commercial	$23.13
Rate for Payer: MDX Hawaii PPO	$26.39

BARIUM SULFATE 96 % (W/W) PO SUSR

Facility

$27.21

Service Code	NDC 32909075003
Hospital Revenue Code	255
Min. Negotiated Rate	$13.88
Max. Negotiated Rate	$26.39
Rate for Payer: Cash Price	$17.69
Rate for Payer: Hawaii Western Management Group Commercial	$25.85
Rate for Payer: Health Management Network Commercial	$23.13
Rate for Payer: Kaiser Permanente Commercial	$17.14
Rate for Payer: Kaiser Permanente Medicaid	$13.88
Rate for Payer: MDX Hawaii PPO	$26.39
Rate for Payer: University Health Alliance Commercial	$19.83

Know your out-of-pocket cost for care.

All Charges