Kona Community Hospital

All Charges

Charge

Type

Setting

Price

INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARS OR OLDER

Facility

$9,416.00

Service Code	CPT 36561
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$9,416.00
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Devoted Health Medicare	$4,103.08
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$9,416.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$6,743.44

INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP; AGE 5 YEARS OR OLDER

Facility

$6,183.00

Service Code	CPT 36558
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$3,730.07
Rate for Payer: AlohaCare Medicare	$3,730.07
Rate for Payer: Devoted Health Medicare	$4,103.08
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,730.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,730.07
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,730.07
Rate for Payer: Ohana Health Plan Medicaid	$4,103.08
Rate for Payer: Ohana Health Plan Medicare	$3,730.07
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,730.07
Rate for Payer: University Health Alliance Commercial	$5,160.40

INSERTION OF TUNNELED INTRAPERITONEAL CATHETER FOR DIALYSIS, OPEN

Facility

$6,183.00

Service Code	CPT 49421
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$4,229.69
Rate for Payer: AlohaCare Medicare	$4,229.69
Rate for Payer: Devoted Health Medicare	$4,652.66
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,229.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$4,229.69
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,229.69
Rate for Payer: Ohana Health Plan Medicaid	$4,652.66
Rate for Payer: Ohana Health Plan Medicare	$4,229.69
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,229.69

INSERTION, REVISION & REPLACEMENTS OF PACEMAKER & OTHER CARDIAC DEVICES

Facility

$25,549.81

Service Code	APR-DRG 1764
Min. Negotiated Rate	$25,549.81
Max. Negotiated Rate	$25,549.81
Rate for Payer: AlohaCare Medicaid	$25,549.81
Rate for Payer: Hawaii Medical Service Association ABD	$25,549.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$25,549.81
Rate for Payer: Kaiser Permanente Medicaid	$25,549.81
Rate for Payer: Ohana Health Plan Medicaid	$25,549.81
Rate for Payer: UnitedHealthcare Medicaid	$25,549.81

INSERTION, REVISION & REPLACEMENTS OF PACEMAKER & OTHER CARDIAC DEVICES

Facility

$15,061.66

Service Code	APR-DRG 1763
Min. Negotiated Rate	$15,061.66
Max. Negotiated Rate	$15,061.66
Rate for Payer: AlohaCare Medicaid	$15,061.66
Rate for Payer: Hawaii Medical Service Association ABD	$15,061.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15,061.66
Rate for Payer: Kaiser Permanente Medicaid	$15,061.66
Rate for Payer: Ohana Health Plan Medicaid	$15,061.66
Rate for Payer: UnitedHealthcare Medicaid	$15,061.66

INSERTION, REVISION & REPLACEMENTS OF PACEMAKER & OTHER CARDIAC DEVICES

Facility

$8,231.32

Service Code	APR-DRG 1761
Min. Negotiated Rate	$8,231.32
Max. Negotiated Rate	$8,231.32
Rate for Payer: AlohaCare Medicaid	$8,231.32
Rate for Payer: Hawaii Medical Service Association ABD	$8,231.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,231.32
Rate for Payer: Kaiser Permanente Medicaid	$8,231.32
Rate for Payer: Ohana Health Plan Medicaid	$8,231.32
Rate for Payer: UnitedHealthcare Medicaid	$8,231.32

INSERTION, REVISION & REPLACEMENTS OF PACEMAKER & OTHER CARDIAC DEVICES

Facility

$9,928.40

Service Code	APR-DRG 1762
Min. Negotiated Rate	$9,928.40
Max. Negotiated Rate	$9,928.40
Rate for Payer: AlohaCare Medicaid	$9,928.40
Rate for Payer: Hawaii Medical Service Association ABD	$9,928.40
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,928.40
Rate for Payer: Kaiser Permanente Medicaid	$9,928.40
Rate for Payer: Ohana Health Plan Medicaid	$9,928.40
Rate for Payer: UnitedHealthcare Medicaid	$9,928.40

INSULIN 100 UNITS/100 ML DRIP DOSED IN UNITS/KG/HR

Facility

$162.90

Service Code	NDC 00338012612
Hospital Revenue Code	250
Min. Negotiated Rate	$138.47
Max. Negotiated Rate	$158.01
Rate for Payer: Cash Price	$105.88
Rate for Payer: Health Management Network Commercial	$138.47
Rate for Payer: MDX Hawaii PPO	$158.01

INSULIN 100 UNITS/100 ML DRIP DOSED IN UNITS/KG/HR

Facility

$162.90

Service Code	NDC 00338012612
Hospital Revenue Code	250
Min. Negotiated Rate	$83.08
Max. Negotiated Rate	$158.01
Rate for Payer: Cash Price	$105.88
Rate for Payer: Hawaii Western Management Group Commercial	$154.75
Rate for Payer: Health Management Network Commercial	$138.47
Rate for Payer: Kaiser Permanente Commercial	$102.63
Rate for Payer: Kaiser Permanente Medicaid	$83.08
Rate for Payer: MDX Hawaii PPO	$158.01
Rate for Payer: UnitedHealthcare Medicaid	$97.74
Rate for Payer: University Health Alliance Commercial	$118.74

INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBCUTANEOUS INSULIN PEN

Facility

$97.80

Service Code	HCPCS J1815
Hospital Revenue Code	637
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$94.87
Rate for Payer: Cash Price	$63.57
Rate for Payer: Cash Price	$63.57
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$92.91
Rate for Payer: Health Management Network Commercial	$83.13
Rate for Payer: Kaiser Permanente Commercial	$61.61
Rate for Payer: Kaiser Permanente Medicaid	$49.88
Rate for Payer: MDX Hawaii PPO	$94.87
Rate for Payer: University Health Alliance Commercial	$71.29

INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBCUTANEOUS INSULIN PEN

Facility

$97.80

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$83.13
Max. Negotiated Rate	$94.87
Rate for Payer: Cash Price	$63.57
Rate for Payer: Health Management Network Commercial	$83.13
Rate for Payer: MDX Hawaii PPO	$94.87

INSULIN GLARGINE-YFGN 100 UNIT/ML (3 ML) SUBCUTANEOUS INSULIN PEN

Facility

$378.88

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$322.05
Max. Negotiated Rate	$367.51
Rate for Payer: Cash Price	$246.27
Rate for Payer: Cash Price	$61.22
Rate for Payer: Health Management Network Commercial	$80.05
Rate for Payer: Health Management Network Commercial	$322.05
Rate for Payer: MDX Hawaii PPO	$91.35
Rate for Payer: MDX Hawaii PPO	$367.51

INSULIN GLARGINE-YFGN 100 UNIT/ML (3 ML) SUBCUTANEOUS INSULIN PEN

Facility

$378.88

Service Code	HCPCS J1815
Hospital Revenue Code	637
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$367.51
Rate for Payer: Cash Price	$246.27
Rate for Payer: Cash Price	$61.22
Rate for Payer: Cash Price	$61.22
Rate for Payer: Cash Price	$246.27
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$89.47
Rate for Payer: Hawaii Western Management Group Commercial	$359.94
Rate for Payer: Health Management Network Commercial	$322.05
Rate for Payer: Health Management Network Commercial	$80.05
Rate for Payer: Kaiser Permanente Commercial	$59.33
Rate for Payer: Kaiser Permanente Commercial	$238.69
Rate for Payer: Kaiser Permanente Medicaid	$48.03
Rate for Payer: Kaiser Permanente Medicaid	$193.23
Rate for Payer: MDX Hawaii PPO	$367.51
Rate for Payer: MDX Hawaii PPO	$91.35
Rate for Payer: University Health Alliance Commercial	$276.17
Rate for Payer: University Health Alliance Commercial	$68.65

INSULIN LISPRO SQ SLIDING SCALE (EATING-LOW)

Facility

$174.78

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$148.56
Max. Negotiated Rate	$169.54
Rate for Payer: Cash Price	$113.61
Rate for Payer: Health Management Network Commercial	$148.56
Rate for Payer: MDX Hawaii PPO	$169.54

INSULIN LISPRO SQ SLIDING SCALE (EATING-LOW)

Facility

$174.78

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$169.54
Rate for Payer: Cash Price	$113.61
Rate for Payer: Cash Price	$113.61
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$166.04
Rate for Payer: Health Management Network Commercial	$148.56
Rate for Payer: Kaiser Permanente Commercial	$110.11
Rate for Payer: Kaiser Permanente Medicaid	$89.14
Rate for Payer: MDX Hawaii PPO	$169.54
Rate for Payer: UnitedHealthcare Medicaid	$104.87
Rate for Payer: University Health Alliance Commercial	$127.40

INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) 3 ML SQ PEN)

Facility

$135.08

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$131.03
Rate for Payer: Cash Price	$87.80
Rate for Payer: Cash Price	$87.80
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$128.33
Rate for Payer: Health Management Network Commercial	$114.82
Rate for Payer: Kaiser Permanente Commercial	$85.10
Rate for Payer: Kaiser Permanente Medicaid	$68.89
Rate for Payer: MDX Hawaii PPO	$131.03
Rate for Payer: UnitedHealthcare Medicaid	$81.05
Rate for Payer: University Health Alliance Commercial	$98.46

INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) 3 ML SQ PEN)

Facility

$135.08

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$114.82
Max. Negotiated Rate	$131.03
Rate for Payer: Cash Price	$87.80
Rate for Payer: Health Management Network Commercial	$114.82
Rate for Payer: MDX Hawaii PPO	$131.03

INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBCUTANEOUS SUSP

Facility

$73.40

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$62.39
Max. Negotiated Rate	$71.20
Rate for Payer: Cash Price	$47.71
Rate for Payer: Health Management Network Commercial	$62.39
Rate for Payer: MDX Hawaii PPO	$71.20

INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBCUTANEOUS SUSP

Facility

$73.40

Service Code	HCPCS J1815
Hospital Revenue Code	637
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$71.20
Rate for Payer: Cash Price	$47.71
Rate for Payer: Cash Price	$47.71
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$69.73
Rate for Payer: Health Management Network Commercial	$62.39
Rate for Payer: Kaiser Permanente Commercial	$46.24
Rate for Payer: Kaiser Permanente Medicaid	$37.43
Rate for Payer: MDX Hawaii PPO	$71.20
Rate for Payer: University Health Alliance Commercial	$53.50

INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML (3 ML) SUBCUTANEOUS INSULIN PEN

Facility

$135.08

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$131.03
Rate for Payer: Cash Price	$87.80
Rate for Payer: Cash Price	$87.80
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$128.33
Rate for Payer: Health Management Network Commercial	$114.82
Rate for Payer: Kaiser Permanente Commercial	$85.10
Rate for Payer: Kaiser Permanente Medicaid	$68.89
Rate for Payer: MDX Hawaii PPO	$131.03
Rate for Payer: UnitedHealthcare Medicaid	$81.05
Rate for Payer: University Health Alliance Commercial	$98.46

INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML (3 ML) SUBCUTANEOUS INSULIN PEN

Facility

$135.08

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$114.82
Max. Negotiated Rate	$131.03
Rate for Payer: Cash Price	$87.80
Rate for Payer: Health Management Network Commercial	$114.82
Rate for Payer: MDX Hawaii PPO	$131.03

INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSP

Facility

$217.55

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$184.92
Max. Negotiated Rate	$211.02
Rate for Payer: Cash Price	$141.41
Rate for Payer: Health Management Network Commercial	$184.92
Rate for Payer: MDX Hawaii PPO	$211.02

INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSP

Facility

$217.55

Service Code	HCPCS J1815
Hospital Revenue Code	637
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$211.02
Rate for Payer: Cash Price	$141.41
Rate for Payer: Cash Price	$141.41
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$206.67
Rate for Payer: Health Management Network Commercial	$184.92
Rate for Payer: Kaiser Permanente Commercial	$137.06
Rate for Payer: Kaiser Permanente Medicaid	$110.95
Rate for Payer: MDX Hawaii PPO	$211.02
Rate for Payer: University Health Alliance Commercial	$158.57

INSULIN REGULAR HUMAN 100 UNIT/ML (3 ML) SUBCUTANEOUS INSULIN PEN

Facility

$93.43

Service Code	HCPCS J1815
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$90.63
Rate for Payer: Cash Price	$60.73
Rate for Payer: Cash Price	$60.73
Rate for Payer: Hawaii Medical Service Association ABD	$0.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.90
Rate for Payer: Hawaii Western Management Group Commercial	$88.76
Rate for Payer: Health Management Network Commercial	$79.42
Rate for Payer: Kaiser Permanente Commercial	$58.86
Rate for Payer: Kaiser Permanente Medicaid	$47.65
Rate for Payer: MDX Hawaii PPO	$90.63
Rate for Payer: UnitedHealthcare Medicaid	$56.06
Rate for Payer: University Health Alliance Commercial	$68.10

INSULIN REGULAR HUMAN 100 UNIT/ML (3 ML) SUBCUTANEOUS INSULIN PEN

Facility

$93.43

Service Code	HCPCS J1815
Hospital Revenue Code	250
Min. Negotiated Rate	$79.42
Max. Negotiated Rate	$90.63
Rate for Payer: Cash Price	$60.73
Rate for Payer: Health Management Network Commercial	$79.42
Rate for Payer: MDX Hawaii PPO	$90.63

Know your out-of-pocket cost for care.

All Charges