Kona Community Hospital

All Charges

Charge

Type

Setting

Price

MASTECTOMY PROCEDURES

Facility

$17,709.49

Service Code	APR-DRG 3624
Min. Negotiated Rate	$17,709.49
Max. Negotiated Rate	$17,709.49
Rate for Payer: AlohaCare Medicaid	$17,709.49
Rate for Payer: Hawaii Medical Service Association ABD	$17,709.49
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,709.49
Rate for Payer: Kaiser Permanente Medicaid	$17,709.49
Rate for Payer: Ohana Health Plan Medicaid	$17,709.49
Rate for Payer: UnitedHealthcare Medicaid	$17,709.49

MASTECTOMY, SIMPLE, COMPLETE

Facility

$14,715.00

Service Code	CPT 19303
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$14,715.00
Rate for Payer: AlohaCare Medicaid	$7,844.33
Rate for Payer: AlohaCare Medicare	$7,844.33
Rate for Payer: Devoted Health Medicare	$8,628.76
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	$7,844.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,154.45
Rate for Payer: Humana Medicare	$7,844.33
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,844.33
Rate for Payer: Ohana Health Plan Medicaid	$8,628.76
Rate for Payer: Ohana Health Plan Medicare	$7,844.33
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$7,844.33
Rate for Payer: University Health Alliance Commercial	$10,679.55

MASTOPEXY

Facility

$10,679.55

Service Code	CPT 19316
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$10,679.55
Rate for Payer: AlohaCare Medicaid	$7,844.33
Rate for Payer: AlohaCare Medicare	$7,844.33
Rate for Payer: Devoted Health Medicare	$8,628.76
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	$7,844.33
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$7,844.33
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$7,844.33
Rate for Payer: Ohana Health Plan Medicaid	$8,628.76
Rate for Payer: Ohana Health Plan Medicare	$7,844.33
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$7,844.33
Rate for Payer: University Health Alliance Commercial	$10,679.55

Maxtack Motorized Fixation Device MAXTACK30 [3644869]

Facility

$3,241.16

Hospital Charge Code	3644869
Hospital Revenue Code	272
Min. Negotiated Rate	$2,754.99
Max. Negotiated Rate	$3,143.93
Rate for Payer: Cash Price	$2,106.75
Rate for Payer: Health Management Network Commercial	$2,754.99
Rate for Payer: MDX Hawaii PPO	$3,143.93

Maxtack Motorized Fixation Device MAXTACK30 [3644869]

Facility

$3,241.16

Hospital Charge Code	3644869
Hospital Revenue Code	272
Min. Negotiated Rate	$1,652.99
Max. Negotiated Rate	$3,143.93
Rate for Payer: Cash Price	$2,106.75
Rate for Payer: Hawaii Western Management Group Commercial	$3,079.10
Rate for Payer: Health Management Network Commercial	$2,754.99
Rate for Payer: Kaiser Permanente Commercial	$2,041.93
Rate for Payer: Kaiser Permanente Medicaid	$1,652.99
Rate for Payer: MDX Hawaii PPO	$3,143.93
Rate for Payer: University Health Alliance Commercial	$2,362.48

MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBCUTANEOUS RECON.SOLN.

Facility

$430.48

Service Code	HCPCS 90707
Hospital Revenue Code	250
Min. Negotiated Rate	$365.91
Max. Negotiated Rate	$417.57
Rate for Payer: Cash Price	$279.81
Rate for Payer: Health Management Network Commercial	$365.91
Rate for Payer: MDX Hawaii PPO	$417.57

MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBCUTANEOUS RECON.SOLN.

Facility

$430.48

Service Code	HCPCS 90707
Hospital Revenue Code	250
Min. Negotiated Rate	$102.41
Max. Negotiated Rate	$417.57
Rate for Payer: Cash Price	$279.81
Rate for Payer: Cash Price	$279.81
Rate for Payer: Hawaii Medical Service Association ABD	$102.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$102.41
Rate for Payer: Hawaii Western Management Group Commercial	$408.96
Rate for Payer: Health Management Network Commercial	$365.91
Rate for Payer: Kaiser Permanente Commercial	$271.20
Rate for Payer: Kaiser Permanente Medicaid	$219.54
Rate for Payer: MDX Hawaii PPO	$417.57
Rate for Payer: UnitedHealthcare Medicaid	$258.29
Rate for Payer: University Health Alliance Commercial	$313.78

MECLIZINE 25 MG PO TABLET

Facility

$2.22

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$2.15
Rate for Payer: Cash Price	$1.44
Rate for Payer: Cash Price	$3.07
Rate for Payer: Cash Price	$3.02
Rate for Payer: Cash Price	$3.03
Rate for Payer: Health Management Network Commercial	$3.94
Rate for Payer: Health Management Network Commercial	$4.02
Rate for Payer: Health Management Network Commercial	$1.89
Rate for Payer: Health Management Network Commercial	$3.96
Rate for Payer: MDX Hawaii PPO	$4.59
Rate for Payer: MDX Hawaii PPO	$2.15
Rate for Payer: MDX Hawaii PPO	$4.50
Rate for Payer: MDX Hawaii PPO	$4.52

MECLIZINE 25 MG PO TABLET

Facility

$2.22

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$2.15
Rate for Payer: Cash Price	$1.44
Rate for Payer: Cash Price	$3.02
Rate for Payer: Cash Price	$3.03
Rate for Payer: Cash Price	$3.07
Rate for Payer: Hawaii Western Management Group Commercial	$4.49
Rate for Payer: Hawaii Western Management Group Commercial	$4.41
Rate for Payer: Hawaii Western Management Group Commercial	$2.11
Rate for Payer: Hawaii Western Management Group Commercial	$4.43
Rate for Payer: Health Management Network Commercial	$1.89
Rate for Payer: Health Management Network Commercial	$4.02
Rate for Payer: Health Management Network Commercial	$3.94
Rate for Payer: Health Management Network Commercial	$3.96
Rate for Payer: Kaiser Permanente Commercial	$1.40
Rate for Payer: Kaiser Permanente Commercial	$2.92
Rate for Payer: Kaiser Permanente Commercial	$2.94
Rate for Payer: Kaiser Permanente Commercial	$2.98
Rate for Payer: Kaiser Permanente Medicaid	$2.41
Rate for Payer: Kaiser Permanente Medicaid	$2.38
Rate for Payer: Kaiser Permanente Medicaid	$2.37
Rate for Payer: Kaiser Permanente Medicaid	$1.13
Rate for Payer: MDX Hawaii PPO	$4.59
Rate for Payer: MDX Hawaii PPO	$4.52
Rate for Payer: MDX Hawaii PPO	$4.50
Rate for Payer: MDX Hawaii PPO	$2.15
Rate for Payer: UnitedHealthcare Medicaid	$2.84
Rate for Payer: UnitedHealthcare Medicaid	$1.33
Rate for Payer: UnitedHealthcare Medicaid	$2.80
Rate for Payer: UnitedHealthcare Medicaid	$2.78
Rate for Payer: University Health Alliance Commercial	$3.38
Rate for Payer: University Health Alliance Commercial	$3.40
Rate for Payer: University Health Alliance Commercial	$3.45
Rate for Payer: University Health Alliance Commercial	$1.62

Medial Malleolus Plate Hook 4h Anat P53-206-0004 [3644480]

Facility

$8,769.00

Service Code	HCPCS C1713
Hospital Charge Code	3644480
Hospital Revenue Code	278
Min. Negotiated Rate	$4,910.64
Max. Negotiated Rate	$8,505.93
Rate for Payer: Cash Price	$5,699.85
Rate for Payer: Hawaii Western Management Group Commercial	$6,138.30
Rate for Payer: Health Management Network Commercial	$7,453.65
Rate for Payer: MDX Hawaii PPO	$8,505.93
Rate for Payer: University Health Alliance Commercial	$4,910.64

Medial Malleolus Plate Hook 4h Anat P53-206-0004 [3644480]

Facility

$8,769.00

Service Code	HCPCS C1713
Hospital Charge Code	3644480
Hospital Revenue Code	278
Min. Negotiated Rate	$4,472.19
Max. Negotiated Rate	$8,505.93
Rate for Payer: Cash Price	$5,699.85
Rate for Payer: Hawaii Western Management Group Commercial	$6,138.30
Rate for Payer: Health Management Network Commercial	$7,453.65
Rate for Payer: Kaiser Permanente Commercial	$5,524.47
Rate for Payer: Kaiser Permanente Medicaid	$4,472.19
Rate for Payer: MDX Hawaii PPO	$8,505.93
Rate for Payer: University Health Alliance Commercial	$4,910.64

MEDICAL BACK PROBLEMS WITH MCC

Facility

$28,912.72

Service Code	MSDRG 551
Min. Negotiated Rate	$14,898.13
Max. Negotiated Rate	$28,912.72
Rate for Payer: AlohaCare Medicare	$22,045.35
Rate for Payer: Devoted Health Medicare	$24,249.88
Rate for Payer: Hawaii Medical Service Association Commercial	$14,898.13
Rate for Payer: Hawaii Medical Service Association Medicare	$22,045.35
Rate for Payer: Humana Medicare	$22,045.35
Rate for Payer: Kaiser Permanente Commercial	$28,912.72
Rate for Payer: Kaiser Permanente Medicare	$22,045.35
Rate for Payer: Ohana Health Plan Medicare	$22,045.35
Rate for Payer: UnitedHealthcare Medicare	$22,045.35

MEDICAL BACK PROBLEMS WITHOUT MCC

Facility

$16,582.42

Service Code	MSDRG 552
Min. Negotiated Rate	$12,643.77
Max. Negotiated Rate	$16,582.42
Rate for Payer: AlohaCare Medicare	$12,643.77
Rate for Payer: Devoted Health Medicare	$13,908.15
Rate for Payer: Hawaii Medical Service Association Commercial	$14,898.13
Rate for Payer: Hawaii Medical Service Association Medicare	$12,643.77
Rate for Payer: Humana Medicare	$12,643.77
Rate for Payer: Kaiser Permanente Commercial	$16,582.42
Rate for Payer: Kaiser Permanente Medicare	$12,643.77
Rate for Payer: Ohana Health Plan Medicare	$12,643.77
Rate for Payer: UnitedHealthcare Medicare	$12,643.77

MEDROXYPROGESTERONE 150 MG/ML IM SUSP

Facility

$437.42

Service Code	HCPCS J1050
Hospital Revenue Code	250
Min. Negotiated Rate	$371.81
Max. Negotiated Rate	$424.30
Rate for Payer: Cash Price	$284.32
Rate for Payer: Health Management Network Commercial	$371.81
Rate for Payer: MDX Hawaii PPO	$424.30

MEDROXYPROGESTERONE 150 MG/ML IM SUSP

Facility

$437.42

Service Code	HCPCS J1050
Hospital Revenue Code	636
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$424.30
Rate for Payer: Cash Price	$284.32
Rate for Payer: Cash Price	$284.32
Rate for Payer: Hawaii Medical Service Association ABD	$0.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.57
Rate for Payer: Hawaii Western Management Group Commercial	$415.55
Rate for Payer: Health Management Network Commercial	$371.81
Rate for Payer: Kaiser Permanente Commercial	$275.57
Rate for Payer: Kaiser Permanente Medicaid	$223.08
Rate for Payer: MDX Hawaii PPO	$424.30
Rate for Payer: UnitedHealthcare Medicaid	$262.45
Rate for Payer: University Health Alliance Commercial	$318.84

MEDROXYPROGESTERONE 5 MG PO TABLET

Facility

$2.62

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$2.54
Rate for Payer: Cash Price	$1.70
Rate for Payer: Hawaii Western Management Group Commercial	$2.49
Rate for Payer: Health Management Network Commercial	$2.23
Rate for Payer: Kaiser Permanente Commercial	$1.65
Rate for Payer: Kaiser Permanente Medicaid	$1.34
Rate for Payer: MDX Hawaii PPO	$2.54
Rate for Payer: UnitedHealthcare Medicaid	$1.57
Rate for Payer: University Health Alliance Commercial	$1.91

MEDROXYPROGESTERONE 5 MG PO TABLET

Facility

$2.62

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$2.54
Rate for Payer: Cash Price	$1.70
Rate for Payer: Health Management Network Commercial	$2.23
Rate for Payer: MDX Hawaii PPO	$2.54

MEGESTROL 400 MG/10 ML (10 ML) PO SUSP

Facility

$27.72

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.14
Max. Negotiated Rate	$26.89
Rate for Payer: Cash Price	$18.02
Rate for Payer: Cash Price	$28.85
Rate for Payer: Hawaii Western Management Group Commercial	$26.33
Rate for Payer: Hawaii Western Management Group Commercial	$42.16
Rate for Payer: Health Management Network Commercial	$23.56
Rate for Payer: Health Management Network Commercial	$37.72
Rate for Payer: Kaiser Permanente Commercial	$17.46
Rate for Payer: Kaiser Permanente Commercial	$27.96
Rate for Payer: Kaiser Permanente Medicaid	$14.14
Rate for Payer: Kaiser Permanente Medicaid	$22.63
Rate for Payer: MDX Hawaii PPO	$26.89
Rate for Payer: MDX Hawaii PPO	$43.05
Rate for Payer: UnitedHealthcare Medicaid	$26.63
Rate for Payer: UnitedHealthcare Medicaid	$16.63
Rate for Payer: University Health Alliance Commercial	$20.21
Rate for Payer: University Health Alliance Commercial	$32.35

MEGESTROL 400 MG/10 ML (10 ML) PO SUSP

Facility

$44.38

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$37.72
Max. Negotiated Rate	$43.05
Rate for Payer: Cash Price	$28.85
Rate for Payer: Cash Price	$18.02
Rate for Payer: Health Management Network Commercial	$23.56
Rate for Payer: Health Management Network Commercial	$37.72
Rate for Payer: MDX Hawaii PPO	$43.05
Rate for Payer: MDX Hawaii PPO	$26.89

MEGESTROL 40 MG PO TABLET

Facility

$6.79

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$6.59
Rate for Payer: Cash Price	$4.41
Rate for Payer: Hawaii Western Management Group Commercial	$6.45
Rate for Payer: Health Management Network Commercial	$5.77
Rate for Payer: Kaiser Permanente Commercial	$4.28
Rate for Payer: Kaiser Permanente Medicaid	$3.46
Rate for Payer: MDX Hawaii PPO	$6.59
Rate for Payer: UnitedHealthcare Medicaid	$4.07
Rate for Payer: University Health Alliance Commercial	$4.95

MEGESTROL 40 MG PO TABLET

Facility

$6.79

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.77
Max. Negotiated Rate	$6.59
Rate for Payer: Cash Price	$4.41
Rate for Payer: Health Management Network Commercial	$5.77
Rate for Payer: MDX Hawaii PPO	$6.59

MELATONIN 3 MG 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

MELATONIN 3 MG 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

MEMANTINE 10 MG PO TABLET

Facility

$4.42

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$4.29
Rate for Payer: Cash Price	$2.87
Rate for Payer: Health Management Network Commercial	$3.76
Rate for Payer: MDX Hawaii PPO	$4.29

MEMANTINE 10 MG PO TABLET

Facility

$4.42

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$4.29
Rate for Payer: Cash Price	$2.87
Rate for Payer: Hawaii Western Management Group Commercial	$4.20
Rate for Payer: Health Management Network Commercial	$3.76
Rate for Payer: Kaiser Permanente Commercial	$2.78
Rate for Payer: Kaiser Permanente Medicaid	$2.25
Rate for Payer: MDX Hawaii PPO	$4.29
Rate for Payer: UnitedHealthcare Medicaid	$2.65
Rate for Payer: University Health Alliance Commercial	$3.22

Know your out-of-pocket cost for care.

All Charges