Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Mepilex Post-Op Dressing 4x14 498650 [3643643]

Facility

$265.13

Hospital Charge Code	3643643
Hospital Revenue Code	272
Min. Negotiated Rate	$135.22
Max. Negotiated Rate	$257.18
Rate for Payer: Cash Price	$172.33
Rate for Payer: Hawaii Western Management Group Commercial	$251.87
Rate for Payer: Health Management Network Commercial	$225.36
Rate for Payer: Kaiser Permanente Commercial	$167.03
Rate for Payer: Kaiser Permanente Medicaid	$135.22
Rate for Payer: MDX Hawaii PPO	$257.18
Rate for Payer: University Health Alliance Commercial	$193.25

Mepilex Post-Op Dressing 4x6 498300 [3643640]

Facility

$171.28

Hospital Charge Code	3643640
Hospital Revenue Code	272
Min. Negotiated Rate	$87.35
Max. Negotiated Rate	$166.14
Rate for Payer: Cash Price	$111.33
Rate for Payer: Hawaii Western Management Group Commercial	$162.72
Rate for Payer: Health Management Network Commercial	$145.59
Rate for Payer: Kaiser Permanente Commercial	$107.91
Rate for Payer: Kaiser Permanente Medicaid	$87.35
Rate for Payer: MDX Hawaii PPO	$166.14
Rate for Payer: University Health Alliance Commercial	$124.85

Mepilex Post-Op Dressing 4x6 498300 [3643640]

Facility

$171.28

Hospital Charge Code	3643640
Hospital Revenue Code	272
Min. Negotiated Rate	$145.59
Max. Negotiated Rate	$166.14
Rate for Payer: Cash Price	$111.33
Rate for Payer: Health Management Network Commercial	$145.59
Rate for Payer: MDX Hawaii PPO	$166.14

Mepilex Post-Op Dressing 4x8 498400 [3643641]

Facility

$196.16

Hospital Charge Code	3643641
Hospital Revenue Code	272
Min. Negotiated Rate	$100.04
Max. Negotiated Rate	$190.28
Rate for Payer: Cash Price	$127.50
Rate for Payer: Hawaii Western Management Group Commercial	$186.35
Rate for Payer: Health Management Network Commercial	$166.74
Rate for Payer: Kaiser Permanente Commercial	$123.58
Rate for Payer: Kaiser Permanente Medicaid	$100.04
Rate for Payer: MDX Hawaii PPO	$190.28
Rate for Payer: University Health Alliance Commercial	$142.98

Mepilex Post-Op Dressing 4x8 498400 [3643641]

Facility

$196.16

Hospital Charge Code	3643641
Hospital Revenue Code	272
Min. Negotiated Rate	$166.74
Max. Negotiated Rate	$190.28
Rate for Payer: Cash Price	$127.50
Rate for Payer: Health Management Network Commercial	$166.74
Rate for Payer: MDX Hawaii PPO	$190.28

MEPIVACAINE (PF) 20 MG/ML (2 %) INJ SOLN

Facility

$69.18

Service Code	HCPCS J0670
Hospital Revenue Code	250
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$67.10
Rate for Payer: Cash Price	$44.97
Rate for Payer: Health Management Network Commercial	$58.80
Rate for Payer: MDX Hawaii PPO	$67.10

MEPIVACAINE (PF) 20 MG/ML (2 %) INJ SOLN

Facility

$69.18

Service Code	HCPCS J0670
Hospital Revenue Code	636
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$67.10
Rate for Payer: Cash Price	$44.97
Rate for Payer: Cash Price	$44.97
Rate for Payer: Hawaii Medical Service Association ABD	$3.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3.82
Rate for Payer: Hawaii Western Management Group Commercial	$65.72
Rate for Payer: Health Management Network Commercial	$58.80
Rate for Payer: Kaiser Permanente Commercial	$43.58
Rate for Payer: Kaiser Permanente Medicaid	$35.28
Rate for Payer: MDX Hawaii PPO	$67.10
Rate for Payer: UnitedHealthcare Medicaid	$41.51
Rate for Payer: University Health Alliance Commercial	$50.43

Merlin@home Transmitter Ex1151 [3644006]

Facility

$1,856.25

Hospital Charge Code	3644006
Hospital Revenue Code	272
Min. Negotiated Rate	$946.69
Max. Negotiated Rate	$1,800.56
Rate for Payer: Cash Price	$1,206.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,763.44
Rate for Payer: Health Management Network Commercial	$1,577.81
Rate for Payer: Kaiser Permanente Commercial	$1,169.44
Rate for Payer: Kaiser Permanente Medicaid	$946.69
Rate for Payer: MDX Hawaii PPO	$1,800.56
Rate for Payer: University Health Alliance Commercial	$1,353.02

Merlin@home Transmitter Ex1151 [3644006]

Facility

$1,856.25

Hospital Charge Code	3644006
Hospital Revenue Code	272
Min. Negotiated Rate	$1,577.81
Max. Negotiated Rate	$1,800.56
Rate for Payer: Cash Price	$1,206.56
Rate for Payer: Health Management Network Commercial	$1,577.81
Rate for Payer: MDX Hawaii PPO	$1,800.56

MEROPENEM-0.9% SODIUM CHLORIDE 1 GRAM/50 ML IV IVPB

Facility

$141.83

Service Code	HCPCS J2184
Hospital Revenue Code	250
Min. Negotiated Rate	$120.56
Max. Negotiated Rate	$137.58
Rate for Payer: Cash Price	$92.19
Rate for Payer: Health Management Network Commercial	$120.56
Rate for Payer: MDX Hawaii PPO	$137.58

MEROPENEM-0.9% SODIUM CHLORIDE 1 GRAM/50 ML IV IVPB

Facility

$141.83

Service Code	HCPCS J2184
Hospital Revenue Code	636
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$137.58
Rate for Payer: Cash Price	$92.19
Rate for Payer: Cash Price	$92.19
Rate for Payer: Hawaii Medical Service Association ABD	$2.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.08
Rate for Payer: Hawaii Western Management Group Commercial	$134.74
Rate for Payer: Health Management Network Commercial	$120.56
Rate for Payer: Kaiser Permanente Commercial	$89.35
Rate for Payer: Kaiser Permanente Medicaid	$72.33
Rate for Payer: MDX Hawaii PPO	$137.58
Rate for Payer: UnitedHealthcare Medicaid	$85.10
Rate for Payer: University Health Alliance Commercial	$103.38

MEROPENEM-0.9% SODIUM CHLORIDE 500 MG/50 ML IV IVPB

Facility

$102.87

Service Code	HCPCS J2184
Hospital Revenue Code	250
Min. Negotiated Rate	$87.44
Max. Negotiated Rate	$99.78
Rate for Payer: Cash Price	$66.87
Rate for Payer: Health Management Network Commercial	$87.44
Rate for Payer: MDX Hawaii PPO	$99.78

MEROPENEM-0.9% SODIUM CHLORIDE 500 MG/50 ML IV IVPB

Facility

$102.87

Service Code	HCPCS J2184
Hospital Revenue Code	636
Min. Negotiated Rate	$2.08
Max. Negotiated Rate	$99.78
Rate for Payer: Cash Price	$66.87
Rate for Payer: Cash Price	$66.87
Rate for Payer: Hawaii Medical Service Association ABD	$2.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.08
Rate for Payer: Hawaii Western Management Group Commercial	$97.73
Rate for Payer: Health Management Network Commercial	$87.44
Rate for Payer: Kaiser Permanente Commercial	$64.81
Rate for Payer: Kaiser Permanente Medicaid	$52.46
Rate for Payer: MDX Hawaii PPO	$99.78
Rate for Payer: UnitedHealthcare Medicaid	$61.72
Rate for Payer: University Health Alliance Commercial	$74.98

MEROPENEM 1 GRAM IV RECON.SOLN.

Facility

$32.57

Service Code	HCPCS J2185
Hospital Revenue Code	250
Min. Negotiated Rate	$27.68
Max. Negotiated Rate	$31.59
Rate for Payer: Cash Price	$21.17
Rate for Payer: Health Management Network Commercial	$27.68
Rate for Payer: MDX Hawaii PPO	$31.59

MEROPENEM 1 GRAM IV RECON.SOLN.

Facility

$32.57

Service Code	HCPCS J2185
Hospital Revenue Code	636
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$31.59
Rate for Payer: Cash Price	$21.17
Rate for Payer: Cash Price	$21.17
Rate for Payer: Hawaii Medical Service Association ABD	$0.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.44
Rate for Payer: Hawaii Western Management Group Commercial	$30.94
Rate for Payer: Health Management Network Commercial	$27.68
Rate for Payer: Kaiser Permanente Commercial	$20.52
Rate for Payer: Kaiser Permanente Medicaid	$16.61
Rate for Payer: MDX Hawaii PPO	$31.59
Rate for Payer: UnitedHealthcare Medicaid	$19.54
Rate for Payer: University Health Alliance Commercial	$23.74

MESALAMINE 400 MG PO CDTI

Facility

$24.42

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$20.76
Max. Negotiated Rate	$23.69
Rate for Payer: Cash Price	$15.87
Rate for Payer: Cash Price	$32.42
Rate for Payer: Health Management Network Commercial	$20.76
Rate for Payer: Health Management Network Commercial	$42.40
Rate for Payer: MDX Hawaii PPO	$23.69
Rate for Payer: MDX Hawaii PPO	$48.38

MESALAMINE 400 MG PO CDTI

Facility

$49.88

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$25.44
Max. Negotiated Rate	$48.38
Rate for Payer: Cash Price	$32.42
Rate for Payer: Cash Price	$15.87
Rate for Payer: Hawaii Western Management Group Commercial	$23.20
Rate for Payer: Hawaii Western Management Group Commercial	$47.39
Rate for Payer: Health Management Network Commercial	$20.76
Rate for Payer: Health Management Network Commercial	$42.40
Rate for Payer: Kaiser Permanente Commercial	$15.38
Rate for Payer: Kaiser Permanente Commercial	$31.42
Rate for Payer: Kaiser Permanente Medicaid	$25.44
Rate for Payer: Kaiser Permanente Medicaid	$12.45
Rate for Payer: MDX Hawaii PPO	$48.38
Rate for Payer: MDX Hawaii PPO	$23.69
Rate for Payer: UnitedHealthcare Medicaid	$14.65
Rate for Payer: UnitedHealthcare Medicaid	$29.93
Rate for Payer: University Health Alliance Commercial	$17.80
Rate for Payer: University Health Alliance Commercial	$36.36

MESALAMINE 4 GRAM/60 ML PR ENEMA

Facility

$118.61

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$100.82
Max. Negotiated Rate	$115.05
Rate for Payer: Cash Price	$77.10
Rate for Payer: Cash Price	$73.87
Rate for Payer: Health Management Network Commercial	$96.59
Rate for Payer: Health Management Network Commercial	$100.82
Rate for Payer: MDX Hawaii PPO	$110.23
Rate for Payer: MDX Hawaii PPO	$115.05

MESALAMINE 4 GRAM/60 ML PR ENEMA

Facility

$118.61

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$60.49
Max. Negotiated Rate	$115.05
Rate for Payer: Cash Price	$77.10
Rate for Payer: Cash Price	$73.87
Rate for Payer: Hawaii Western Management Group Commercial	$112.68
Rate for Payer: Hawaii Western Management Group Commercial	$107.96
Rate for Payer: Health Management Network Commercial	$100.82
Rate for Payer: Health Management Network Commercial	$96.59
Rate for Payer: Kaiser Permanente Commercial	$74.72
Rate for Payer: Kaiser Permanente Commercial	$71.59
Rate for Payer: Kaiser Permanente Medicaid	$57.96
Rate for Payer: Kaiser Permanente Medicaid	$60.49
Rate for Payer: MDX Hawaii PPO	$115.05
Rate for Payer: MDX Hawaii PPO	$110.23
Rate for Payer: UnitedHealthcare Medicaid	$68.18
Rate for Payer: UnitedHealthcare Medicaid	$71.17
Rate for Payer: University Health Alliance Commercial	$86.45
Rate for Payer: University Health Alliance Commercial	$82.83

Mesh 3Dmax Left 0115311 [3603334]

Facility

$1,661.90

Service Code	HCPCS C1781
Hospital Charge Code	3603334
Hospital Revenue Code	278
Min. Negotiated Rate	$930.66
Max. Negotiated Rate	$1,612.04
Rate for Payer: Cash Price	$1,080.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,163.33
Rate for Payer: Health Management Network Commercial	$1,412.62
Rate for Payer: MDX Hawaii PPO	$1,612.04
Rate for Payer: University Health Alliance Commercial	$930.66

Mesh 3Dmax Left 0115311 [3603334]

Facility

$1,661.90

Service Code	HCPCS C1781
Hospital Charge Code	3603334
Hospital Revenue Code	278
Min. Negotiated Rate	$847.57
Max. Negotiated Rate	$1,612.04
Rate for Payer: Cash Price	$1,080.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,163.33
Rate for Payer: Health Management Network Commercial	$1,412.62
Rate for Payer: Kaiser Permanente Commercial	$1,047.00
Rate for Payer: Kaiser Permanente Medicaid	$847.57
Rate for Payer: MDX Hawaii PPO	$1,612.04
Rate for Payer: University Health Alliance Commercial	$930.66

Mesh 3Dmax Light Wt Left 0117311 [3603339]

Facility

$2,095.99

Service Code	HCPCS C1781
Hospital Charge Code	3603339
Hospital Revenue Code	278
Min. Negotiated Rate	$1,173.75
Max. Negotiated Rate	$2,033.11
Rate for Payer: Cash Price	$1,362.39
Rate for Payer: Hawaii Western Management Group Commercial	$1,467.19
Rate for Payer: Health Management Network Commercial	$1,781.59
Rate for Payer: MDX Hawaii PPO	$2,033.11
Rate for Payer: University Health Alliance Commercial	$1,173.75

Mesh 3Dmax Light Wt Left 0117311 [3603339]

Facility

$2,095.99

Service Code	HCPCS C1781
Hospital Charge Code	3603339
Hospital Revenue Code	278
Min. Negotiated Rate	$1,068.95
Max. Negotiated Rate	$2,033.11
Rate for Payer: Cash Price	$1,362.39
Rate for Payer: Hawaii Western Management Group Commercial	$1,467.19
Rate for Payer: Health Management Network Commercial	$1,781.59
Rate for Payer: Kaiser Permanente Commercial	$1,320.47
Rate for Payer: Kaiser Permanente Medicaid	$1,068.95
Rate for Payer: MDX Hawaii PPO	$2,033.11
Rate for Payer: University Health Alliance Commercial	$1,173.75

Mesh 3Dmax Light Wt Right 0117321 [3603340]

Facility

$2,113.93

Service Code	HCPCS C1781
Hospital Charge Code	3603340
Hospital Revenue Code	278
Min. Negotiated Rate	$1,078.10
Max. Negotiated Rate	$2,050.51
Rate for Payer: Cash Price	$1,374.05
Rate for Payer: Hawaii Western Management Group Commercial	$1,479.75
Rate for Payer: Health Management Network Commercial	$1,796.84
Rate for Payer: Kaiser Permanente Commercial	$1,331.78
Rate for Payer: Kaiser Permanente Medicaid	$1,078.10
Rate for Payer: MDX Hawaii PPO	$2,050.51
Rate for Payer: University Health Alliance Commercial	$1,183.80

Mesh 3Dmax Light Wt Right 0117321 [3603340]

Facility

$2,113.93

Service Code	HCPCS C1781
Hospital Charge Code	3603340
Hospital Revenue Code	278
Min. Negotiated Rate	$1,183.80
Max. Negotiated Rate	$2,050.51
Rate for Payer: Cash Price	$1,374.05
Rate for Payer: Hawaii Western Management Group Commercial	$1,479.75
Rate for Payer: Health Management Network Commercial	$1,796.84
Rate for Payer: MDX Hawaii PPO	$2,050.51
Rate for Payer: University Health Alliance Commercial	$1,183.80

Know your out-of-pocket cost for care.

All Charges