Kona Community Hospital

All Charges

Charge

Type

Setting

Price

BASIC METABOLIC PANEL CALCIUM TOTAL

Professional

Both

$17.00

Service Code	HCPCS 80048
Min. Negotiated Rate	$8.46
Max. Negotiated Rate	$18.00
Rate for Payer: AlohaCare Medicaid	$11.70
Rate for Payer: AlohaCare Medicare	$8.46
Rate for Payer: Cash Price	$11.05
Rate for Payer: Cash Price	$11.05
Rate for Payer: Devoted Health Medicare	$9.31
Rate for Payer: Hawaii Medical Service Association Medicare	$8.46
Rate for Payer: Hawaii Western Management Group Commercial	$18.00
Rate for Payer: Health Management Network Commercial	$14.45
Rate for Payer: Kaiser Permanente Commercial	$10.15
Rate for Payer: Kaiser Permanente Medicaid	$10.15
Rate for Payer: Kaiser Permanente Medicare	$10.15
Rate for Payer: Ohana Health Plan Medicaid	$11.70
Rate for Payer: Ohana Health Plan Medicare	$8.46
Rate for Payer: UnitedHealthcare Medicaid	$11.70
Rate for Payer: UnitedHealthcare Medicare	$8.46

BB-TAK AR-13226T [3642679]

Facility

$621.25

Service Code	HCPCS C1713
Hospital Charge Code	3642679
Hospital Revenue Code	278
Min. Negotiated Rate	$316.84
Max. Negotiated Rate	$602.61
Rate for Payer: Cash Price	$403.81
Rate for Payer: Hawaii Western Management Group Commercial	$434.88
Rate for Payer: Health Management Network Commercial	$528.06
Rate for Payer: Kaiser Permanente Commercial	$391.39
Rate for Payer: Kaiser Permanente Medicaid	$316.84
Rate for Payer: MDX Hawaii PPO	$602.61
Rate for Payer: University Health Alliance Commercial	$347.90

BB-TAK AR-13226T [3642679]

Facility

$621.25

Service Code	HCPCS C1713
Hospital Charge Code	3642679
Hospital Revenue Code	278
Min. Negotiated Rate	$347.90
Max. Negotiated Rate	$602.61
Rate for Payer: Cash Price	$403.81
Rate for Payer: Hawaii Western Management Group Commercial	$434.88
Rate for Payer: Health Management Network Commercial	$528.06
Rate for Payer: MDX Hawaii PPO	$602.61
Rate for Payer: University Health Alliance Commercial	$347.90

BB-TAK Non Threaded AR-18800-11 [3644795]

Facility

$887.41

Hospital Charge Code	3644795
Hospital Revenue Code	272
Min. Negotiated Rate	$754.30
Max. Negotiated Rate	$860.79
Rate for Payer: Cash Price	$576.82
Rate for Payer: Health Management Network Commercial	$754.30
Rate for Payer: MDX Hawaii PPO	$860.79

BB-TAK Non Threaded AR-18800-11 [3644795]

Facility

$887.41

Hospital Charge Code	3644795
Hospital Revenue Code	272
Min. Negotiated Rate	$452.58
Max. Negotiated Rate	$860.79
Rate for Payer: Cash Price	$576.82
Rate for Payer: Hawaii Western Management Group Commercial	$843.04
Rate for Payer: Health Management Network Commercial	$754.30
Rate for Payer: Kaiser Permanente Commercial	$559.07
Rate for Payer: Kaiser Permanente Medicaid	$452.58
Rate for Payer: MDX Hawaii PPO	$860.79
Rate for Payer: University Health Alliance Commercial	$646.83

BB-Tak Small AR-18700-34 [3644468]

Facility

$1,471.25

Hospital Charge Code	3644468
Hospital Revenue Code	272
Min. Negotiated Rate	$750.34
Max. Negotiated Rate	$1,427.11
Rate for Payer: Cash Price	$956.31
Rate for Payer: Hawaii Western Management Group Commercial	$1,397.69
Rate for Payer: Health Management Network Commercial	$1,250.56
Rate for Payer: Kaiser Permanente Commercial	$926.89
Rate for Payer: Kaiser Permanente Medicaid	$750.34
Rate for Payer: MDX Hawaii PPO	$1,427.11
Rate for Payer: University Health Alliance Commercial	$1,072.39

BB-Tak Small AR-18700-34 [3644468]

Facility

$1,471.25

Hospital Charge Code	3644468
Hospital Revenue Code	272
Min. Negotiated Rate	$1,250.56
Max. Negotiated Rate	$1,427.11
Rate for Payer: Cash Price	$956.31
Rate for Payer: Health Management Network Commercial	$1,250.56
Rate for Payer: MDX Hawaii PPO	$1,427.11

BB-TAK, Threaded AR-13226T [3643219]

Facility

$887.41

Service Code	HCPCS C1713
Hospital Charge Code	3643219
Hospital Revenue Code	278
Min. Negotiated Rate	$452.58
Max. Negotiated Rate	$860.79
Rate for Payer: Cash Price	$576.82
Rate for Payer: Hawaii Western Management Group Commercial	$621.19
Rate for Payer: Health Management Network Commercial	$754.30
Rate for Payer: Kaiser Permanente Commercial	$559.07
Rate for Payer: Kaiser Permanente Medicaid	$452.58
Rate for Payer: MDX Hawaii PPO	$860.79
Rate for Payer: University Health Alliance Commercial	$496.95

BB-TAK, Threaded AR-13226T [3643219]

Facility

$887.41

Service Code	HCPCS C1713
Hospital Charge Code	3643219
Hospital Revenue Code	278
Min. Negotiated Rate	$496.95
Max. Negotiated Rate	$860.79
Rate for Payer: Cash Price	$576.82
Rate for Payer: Hawaii Western Management Group Commercial	$621.19
Rate for Payer: Health Management Network Commercial	$754.30
Rate for Payer: MDX Hawaii PPO	$860.79
Rate for Payer: University Health Alliance Commercial	$496.95

BB-TAK Threaded AR-18800-11T [3644796]

Facility

$887.41

Hospital Charge Code	3644796
Hospital Revenue Code	272
Min. Negotiated Rate	$754.30
Max. Negotiated Rate	$860.79
Rate for Payer: Cash Price	$576.82
Rate for Payer: Health Management Network Commercial	$754.30
Rate for Payer: MDX Hawaii PPO	$860.79

BB-TAK Threaded AR-18800-11T [3644796]

Facility

$887.41

Hospital Charge Code	3644796
Hospital Revenue Code	272
Min. Negotiated Rate	$452.58
Max. Negotiated Rate	$860.79
Rate for Payer: Cash Price	$576.82
Rate for Payer: Hawaii Western Management Group Commercial	$843.04
Rate for Payer: Health Management Network Commercial	$754.30
Rate for Payer: Kaiser Permanente Commercial	$559.07
Rate for Payer: Kaiser Permanente Medicaid	$452.58
Rate for Payer: MDX Hawaii PPO	$860.79
Rate for Payer: University Health Alliance Commercial	$646.83

BCG LIVE 50 MG INTRAVES SUSR

Facility

$617.77

Service Code	HCPCS J9030
Hospital Revenue Code	636
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$599.24
Rate for Payer: AlohaCare Medicaid	$3.39
Rate for Payer: AlohaCare Medicare	$3.39
Rate for Payer: Cash Price	$401.55
Rate for Payer: Cash Price	$401.55
Rate for Payer: Devoted Health Medicare	$3.73
Rate for Payer: Hawaii Medical Service Association ABD	$3.12
Rate for Payer: Hawaii Medical Service Association Commercial	$4.24
Rate for Payer: Hawaii Medical Service Association Medicare	$3.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.12
Rate for Payer: Hawaii Western Management Group Commercial	$586.88
Rate for Payer: Health Management Network Commercial	$525.10
Rate for Payer: Humana Medicare	$3.39
Rate for Payer: Kaiser Permanente Commercial	$389.20
Rate for Payer: Kaiser Permanente Medicaid	$315.06
Rate for Payer: Kaiser Permanente Medicare	$3.39
Rate for Payer: MDX Hawaii PPO	$599.24
Rate for Payer: Ohana Health Plan Medicaid	$3.73
Rate for Payer: Ohana Health Plan Medicare	$3.39
Rate for Payer: UnitedHealthcare Medicaid	$370.66
Rate for Payer: UnitedHealthcare Medicare	$3.39
Rate for Payer: University Health Alliance Commercial	$450.29

BCG LIVE 50 MG INTRAVES SUSR

Facility

$617.77

Service Code	HCPCS J9030
Hospital Revenue Code	250
Min. Negotiated Rate	$525.10
Max. Negotiated Rate	$599.24
Rate for Payer: Cash Price	$401.55
Rate for Payer: Health Management Network Commercial	$525.10
Rate for Payer: MDX Hawaii PPO	$599.24

B-COMPLEX WITH VITAMIN C PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87

B-COMPLEX WITH VITAMIN C PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: MDX Hawaii PPO	$1.16

BE-558 Electrode Bugbee Fulgurating 58cm [3642158]

Facility

$577.58

Hospital Charge Code	3642158
Hospital Revenue Code	272
Min. Negotiated Rate	$490.94
Max. Negotiated Rate	$560.25
Rate for Payer: Cash Price	$375.43
Rate for Payer: Health Management Network Commercial	$490.94
Rate for Payer: MDX Hawaii PPO	$560.25

BE-558 Electrode Bugbee Fulgurating 58cm [3642158]

Facility

$577.58

Hospital Charge Code	3642158
Hospital Revenue Code	272
Min. Negotiated Rate	$294.57
Max. Negotiated Rate	$560.25
Rate for Payer: Cash Price	$375.43
Rate for Payer: Hawaii Western Management Group Commercial	$548.70
Rate for Payer: Health Management Network Commercial	$490.94
Rate for Payer: Kaiser Permanente Commercial	$363.88
Rate for Payer: Kaiser Permanente Medicaid	$294.57
Rate for Payer: MDX Hawaii PPO	$560.25
Rate for Payer: University Health Alliance Commercial	$421.00

Bear Implant Bridge Enhanced Acl Restoration 1000 [3644231]

Facility

$19,090.50

Service Code	HCPCS C1763
Hospital Charge Code	3644231
Hospital Revenue Code	278
Min. Negotiated Rate	$10,690.68
Max. Negotiated Rate	$18,517.78
Rate for Payer: Cash Price	$12,408.82
Rate for Payer: Hawaii Western Management Group Commercial	$13,363.35
Rate for Payer: Health Management Network Commercial	$16,226.92
Rate for Payer: MDX Hawaii PPO	$18,517.78
Rate for Payer: University Health Alliance Commercial	$10,690.68

Bear Implant Bridge Enhanced Acl Restoration 1000 [3644231]

Facility

$19,090.50

Service Code	HCPCS C1763
Hospital Charge Code	3644231
Hospital Revenue Code	278
Min. Negotiated Rate	$9,736.16
Max. Negotiated Rate	$18,517.78
Rate for Payer: Cash Price	$12,408.82
Rate for Payer: Hawaii Western Management Group Commercial	$13,363.35
Rate for Payer: Health Management Network Commercial	$16,226.92
Rate for Payer: Kaiser Permanente Commercial	$12,027.01
Rate for Payer: Kaiser Permanente Medicaid	$9,736.16
Rate for Payer: MDX Hawaii PPO	$18,517.78
Rate for Payer: University Health Alliance Commercial	$10,690.68

BEHAVIORAL AND DEVELOPMENTAL DISORDERS

Facility

$35,798.93

Service Code	MSDRG 886
Min. Negotiated Rate	$14,367.77
Max. Negotiated Rate	$35,798.93
Rate for Payer: AlohaCare Medicare	$27,295.93
Rate for Payer: Devoted Health Medicare	$30,025.52
Rate for Payer: Hawaii Medical Service Association Commercial	$14,367.77
Rate for Payer: Hawaii Medical Service Association Medicare	$27,295.93
Rate for Payer: Humana Medicare	$27,295.93
Rate for Payer: Kaiser Permanente Commercial	$35,798.93
Rate for Payer: Kaiser Permanente Medicare	$27,295.93
Rate for Payer: Ohana Health Plan Medicare	$27,295.93
Rate for Payer: UnitedHealthcare Medicare	$27,295.93

BEHAVIORAL DISORDERS

Facility

$5,663.79

Service Code	APR-DRG 7584
Min. Negotiated Rate	$5,663.79
Max. Negotiated Rate	$5,663.79
Rate for Payer: AlohaCare Medicaid	$5,663.79
Rate for Payer: Hawaii Medical Service Association ABD	$5,663.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,663.79
Rate for Payer: Kaiser Permanente Medicaid	$5,663.79
Rate for Payer: Ohana Health Plan Medicaid	$5,663.79
Rate for Payer: UnitedHealthcare Medicaid	$5,663.79

BEHAVIORAL DISORDERS

Facility

$4,433.49

Service Code	APR-DRG 7583
Min. Negotiated Rate	$4,433.49
Max. Negotiated Rate	$4,433.49
Rate for Payer: AlohaCare Medicaid	$4,433.49
Rate for Payer: Hawaii Medical Service Association ABD	$4,433.49
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,433.49
Rate for Payer: Kaiser Permanente Medicaid	$4,433.49
Rate for Payer: Ohana Health Plan Medicaid	$4,433.49
Rate for Payer: UnitedHealthcare Medicaid	$4,433.49

BEHAVIORAL DISORDERS

Facility

$2,766.72

Service Code	APR-DRG 7581
Min. Negotiated Rate	$2,766.72
Max. Negotiated Rate	$2,766.72
Rate for Payer: AlohaCare Medicaid	$2,766.72
Rate for Payer: Hawaii Medical Service Association ABD	$2,766.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,766.72
Rate for Payer: Kaiser Permanente Medicaid	$2,766.72
Rate for Payer: Ohana Health Plan Medicaid	$2,766.72
Rate for Payer: UnitedHealthcare Medicaid	$2,766.72

BEHAVIORAL DISORDERS

Facility

$3,510.76

Service Code	APR-DRG 7582
Min. Negotiated Rate	$3,510.76
Max. Negotiated Rate	$3,510.76
Rate for Payer: AlohaCare Medicaid	$3,510.76
Rate for Payer: Hawaii Medical Service Association ABD	$3,510.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,510.76
Rate for Payer: Kaiser Permanente Medicaid	$3,510.76
Rate for Payer: Ohana Health Plan Medicaid	$3,510.76
Rate for Payer: UnitedHealthcare Medicaid	$3,510.76

BELATACEPT 250 MG IV RECON.SOLN.

Facility

$2,253.48

Service Code	HCPCS J0485
Hospital Revenue Code	636
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$2,185.88
Rate for Payer: AlohaCare Medicaid	$3.89
Rate for Payer: AlohaCare Medicare	$3.89
Rate for Payer: Cash Price	$1,464.76
Rate for Payer: Cash Price	$1,464.76
Rate for Payer: Devoted Health Medicare	$4.28
Rate for Payer: Hawaii Medical Service Association ABD	$3.89
Rate for Payer: Hawaii Medical Service Association Commercial	$4.86
Rate for Payer: Hawaii Medical Service Association Medicare	$3.89
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.89
Rate for Payer: Hawaii Western Management Group Commercial	$2,140.81
Rate for Payer: Health Management Network Commercial	$1,915.46
Rate for Payer: Humana Medicare	$3.89
Rate for Payer: Kaiser Permanente Commercial	$1,419.69
Rate for Payer: Kaiser Permanente Medicaid	$1,149.27
Rate for Payer: Kaiser Permanente Medicare	$3.89
Rate for Payer: MDX Hawaii PPO	$2,185.88
Rate for Payer: Ohana Health Plan Medicaid	$4.28
Rate for Payer: Ohana Health Plan Medicare	$3.89
Rate for Payer: UnitedHealthcare Medicaid	$1,352.09
Rate for Payer: UnitedHealthcare Medicare	$3.89
Rate for Payer: University Health Alliance Commercial	$1,642.56

Know your out-of-pocket cost for care.

All Charges