Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Mini-Monster Cann Short Thrd Screw 4.0mm x 36mm P20-540-036S [3644326]

Facility

$2,055.50

Service Code	HCPCS C1713
Hospital Charge Code	3644326
Hospital Revenue Code	278
Min. Negotiated Rate	$1,048.31
Max. Negotiated Rate	$1,993.84
Rate for Payer: Cash Price	$1,336.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,438.85
Rate for Payer: Health Management Network Commercial	$1,747.17
Rate for Payer: Kaiser Permanente Commercial	$1,294.96
Rate for Payer: Kaiser Permanente Medicaid	$1,048.31
Rate for Payer: MDX Hawaii PPO	$1,993.84
Rate for Payer: University Health Alliance Commercial	$1,151.08

Minitape Suture Cobraid Blue 39.5" 72205128 [3644235]

Facility

$520.25

Hospital Charge Code	3644235
Hospital Revenue Code	272
Min. Negotiated Rate	$265.33
Max. Negotiated Rate	$504.64
Rate for Payer: Cash Price	$338.16
Rate for Payer: Hawaii Western Management Group Commercial	$494.24
Rate for Payer: Health Management Network Commercial	$442.21
Rate for Payer: Kaiser Permanente Commercial	$327.76
Rate for Payer: Kaiser Permanente Medicaid	$265.33
Rate for Payer: MDX Hawaii PPO	$504.64
Rate for Payer: University Health Alliance Commercial	$379.21

Minitape Suture Cobraid Blue 39.5" 72205128 [3644235]

Facility

$520.25

Hospital Charge Code	3644235
Hospital Revenue Code	272
Min. Negotiated Rate	$442.21
Max. Negotiated Rate	$504.64
Rate for Payer: Cash Price	$338.16
Rate for Payer: Health Management Network Commercial	$442.21
Rate for Payer: MDX Hawaii PPO	$504.64

MINOCYCLINE 100 MG PO CAP

Facility

$18.76

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.57
Max. Negotiated Rate	$18.20
Rate for Payer: Cash Price	$12.19
Rate for Payer: Hawaii Western Management Group Commercial	$17.82
Rate for Payer: Health Management Network Commercial	$15.95
Rate for Payer: Kaiser Permanente Commercial	$11.82
Rate for Payer: Kaiser Permanente Medicaid	$9.57
Rate for Payer: MDX Hawaii PPO	$18.20
Rate for Payer: UnitedHealthcare Medicaid	$11.26
Rate for Payer: University Health Alliance Commercial	$13.67

MINOCYCLINE 100 MG PO CAP

Facility

$18.76

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$15.95
Max. Negotiated Rate	$18.20
Rate for Payer: Cash Price	$12.19
Rate for Payer: Health Management Network Commercial	$15.95
Rate for Payer: MDX Hawaii PPO	$18.20

MINOR BLADDER PROCEDURES WITH CC

Facility

$26,223.45

Service Code	MSDRG 663
Min. Negotiated Rate	$19,994.83
Max. Negotiated Rate	$26,223.45
Rate for Payer: AlohaCare Medicare	$19,994.83
Rate for Payer: Devoted Health Medicare	$21,994.31
Rate for Payer: Hawaii Medical Service Association Commercial	$24,782.00
Rate for Payer: Hawaii Medical Service Association Medicare	$19,994.83
Rate for Payer: Humana Medicare	$19,994.83
Rate for Payer: Kaiser Permanente Commercial	$26,223.45
Rate for Payer: Kaiser Permanente Medicare	$19,994.83
Rate for Payer: Ohana Health Plan Medicare	$19,994.83
Rate for Payer: UnitedHealthcare Medicare	$19,994.83

MINOR BLADDER PROCEDURES WITH MCC

Facility

$52,810.88

Service Code	MSDRG 662
Min. Negotiated Rate	$33,388.19
Max. Negotiated Rate	$52,810.88
Rate for Payer: AlohaCare Medicare	$40,267.19
Rate for Payer: Devoted Health Medicare	$44,293.91
Rate for Payer: Hawaii Medical Service Association Commercial	$33,388.19
Rate for Payer: Hawaii Medical Service Association Medicare	$40,267.19
Rate for Payer: Humana Medicare	$40,267.19
Rate for Payer: Kaiser Permanente Commercial	$52,810.88
Rate for Payer: Kaiser Permanente Medicare	$40,267.19
Rate for Payer: Ohana Health Plan Medicare	$40,267.19
Rate for Payer: UnitedHealthcare Medicare	$40,267.19

MINOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$19,478.46

Service Code	MSDRG 664
Min. Negotiated Rate	$13,769.64
Max. Negotiated Rate	$19,478.46
Rate for Payer: AlohaCare Medicare	$13,769.64
Rate for Payer: Devoted Health Medicare	$15,146.60
Rate for Payer: Hawaii Medical Service Association Commercial	$19,478.46
Rate for Payer: Hawaii Medical Service Association Medicare	$13,769.64
Rate for Payer: Humana Medicare	$13,769.64
Rate for Payer: Kaiser Permanente Commercial	$18,059.03
Rate for Payer: Kaiser Permanente Medicare	$13,769.64
Rate for Payer: Ohana Health Plan Medicare	$13,769.64
Rate for Payer: UnitedHealthcare Medicare	$13,769.64

MINOR SKIN DISORDERS WITH MCC

Facility

$26,102.70

Service Code	MSDRG 606
Min. Negotiated Rate	$14,150.81
Max. Negotiated Rate	$26,102.70
Rate for Payer: AlohaCare Medicare	$19,902.77
Rate for Payer: Devoted Health Medicare	$21,893.05
Rate for Payer: Hawaii Medical Service Association Commercial	$14,150.81
Rate for Payer: Hawaii Medical Service Association Medicare	$19,902.77
Rate for Payer: Humana Medicare	$19,902.77
Rate for Payer: Kaiser Permanente Commercial	$26,102.70
Rate for Payer: Kaiser Permanente Medicare	$19,902.77
Rate for Payer: Ohana Health Plan Medicare	$19,902.77
Rate for Payer: UnitedHealthcare Medicare	$19,902.77

MINOR SKIN DISORDERS WITHOUT MCC

Facility

$15,635.40

Service Code	MSDRG 607
Min. Negotiated Rate	$11,921.66
Max. Negotiated Rate	$15,635.40
Rate for Payer: AlohaCare Medicare	$11,921.66
Rate for Payer: Devoted Health Medicare	$13,113.83
Rate for Payer: Hawaii Medical Service Association Commercial	$12,752.60
Rate for Payer: Hawaii Medical Service Association Medicare	$11,921.66
Rate for Payer: Humana Medicare	$11,921.66
Rate for Payer: Kaiser Permanente Commercial	$15,635.40
Rate for Payer: Kaiser Permanente Medicare	$11,921.66
Rate for Payer: Ohana Health Plan Medicare	$11,921.66
Rate for Payer: UnitedHealthcare Medicare	$11,921.66

MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC

Facility

$33,002.48

Service Code	MSDRG 345
Min. Negotiated Rate	$19,790.97
Max. Negotiated Rate	$33,002.48
Rate for Payer: AlohaCare Medicare	$19,790.97
Rate for Payer: Devoted Health Medicare	$21,770.07
Rate for Payer: Hawaii Medical Service Association Commercial	$33,002.48
Rate for Payer: Hawaii Medical Service Association Medicare	$19,790.97
Rate for Payer: Humana Medicare	$19,790.97
Rate for Payer: Kaiser Permanente Commercial	$25,956.08
Rate for Payer: Kaiser Permanente Medicare	$19,790.97
Rate for Payer: Ohana Health Plan Medicare	$19,790.97
Rate for Payer: UnitedHealthcare Medicare	$19,790.97

MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC

Facility

$44,553.30

Service Code	MSDRG 344
Min. Negotiated Rate	$33,970.96
Max. Negotiated Rate	$44,553.30
Rate for Payer: AlohaCare Medicare	$33,970.96
Rate for Payer: Devoted Health Medicare	$37,368.06
Rate for Payer: Hawaii Medical Service Association Commercial	$36,907.82
Rate for Payer: Hawaii Medical Service Association Medicare	$33,970.96
Rate for Payer: Humana Medicare	$33,970.96
Rate for Payer: Kaiser Permanente Commercial	$44,553.30
Rate for Payer: Kaiser Permanente Medicare	$33,970.96
Rate for Payer: Ohana Health Plan Medicare	$33,970.96
Rate for Payer: UnitedHealthcare Medicare	$33,970.96

MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility

$27,144.48

Service Code	MSDRG 346
Min. Negotiated Rate	$15,601.81
Max. Negotiated Rate	$27,144.48
Rate for Payer: AlohaCare Medicare	$15,601.81
Rate for Payer: Devoted Health Medicare	$17,161.99
Rate for Payer: Hawaii Medical Service Association Commercial	$27,144.48
Rate for Payer: Hawaii Medical Service Association Medicare	$15,601.81
Rate for Payer: Humana Medicare	$15,601.81
Rate for Payer: Kaiser Permanente Commercial	$20,461.95
Rate for Payer: Kaiser Permanente Medicare	$15,601.81
Rate for Payer: Ohana Health Plan Medicare	$15,601.81
Rate for Payer: UnitedHealthcare Medicare	$15,601.81

MINOXIDIL 2.5 MG PO TABLET

Facility

$4.32

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$4.19
Rate for Payer: Cash Price	$2.81
Rate for Payer: Cash Price	$6.08
Rate for Payer: Health Management Network Commercial	$7.96
Rate for Payer: Health Management Network Commercial	$3.67
Rate for Payer: MDX Hawaii PPO	$4.19
Rate for Payer: MDX Hawaii PPO	$9.08

MINOXIDIL 2.5 MG PO TABLET

Facility

$9.36

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$9.08
Rate for Payer: Cash Price	$6.08
Rate for Payer: Cash Price	$2.81
Rate for Payer: Hawaii Western Management Group Commercial	$4.10
Rate for Payer: Hawaii Western Management Group Commercial	$8.89
Rate for Payer: Health Management Network Commercial	$3.67
Rate for Payer: Health Management Network Commercial	$7.96
Rate for Payer: Kaiser Permanente Commercial	$5.90
Rate for Payer: Kaiser Permanente Commercial	$2.72
Rate for Payer: Kaiser Permanente Medicaid	$4.77
Rate for Payer: Kaiser Permanente Medicaid	$2.20
Rate for Payer: MDX Hawaii PPO	$4.19
Rate for Payer: MDX Hawaii PPO	$9.08
Rate for Payer: UnitedHealthcare Medicaid	$5.62
Rate for Payer: UnitedHealthcare Medicaid	$2.59
Rate for Payer: University Health Alliance Commercial	$6.82
Rate for Payer: University Health Alliance Commercial	$3.15

MIRTAZAPINE 15 MG PO RAPID DISSOLVING SOLUBLE TAB

Facility

$13.00

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$8.45
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: MDX Hawaii PPO	$12.61

MIRTAZAPINE 15 MG PO RAPID DISSOLVING SOLUBLE TAB

Facility

$13.00

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$12.61
Rate for Payer: Cash Price	$8.45
Rate for Payer: Hawaii Western Management Group Commercial	$12.35
Rate for Payer: Health Management Network Commercial	$11.05
Rate for Payer: Kaiser Permanente Commercial	$8.19
Rate for Payer: Kaiser Permanente Medicaid	$6.63
Rate for Payer: MDX Hawaii PPO	$12.61
Rate for Payer: UnitedHealthcare Medicaid	$7.80
Rate for Payer: University Health Alliance Commercial	$9.48

MIRTAZAPINE 30 MG PO RAPID DISSOLVING SOLUBLE TAB

Facility

$13.40

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.83
Max. Negotiated Rate	$13.00
Rate for Payer: Cash Price	$8.71
Rate for Payer: Hawaii Western Management Group Commercial	$12.73
Rate for Payer: Health Management Network Commercial	$11.39
Rate for Payer: Kaiser Permanente Commercial	$8.44
Rate for Payer: Kaiser Permanente Medicaid	$6.83
Rate for Payer: MDX Hawaii PPO	$13.00
Rate for Payer: UnitedHealthcare Medicaid	$8.04
Rate for Payer: University Health Alliance Commercial	$9.77

MIRTAZAPINE 30 MG PO RAPID DISSOLVING SOLUBLE TAB

Facility

$13.40

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.39
Max. Negotiated Rate	$13.00
Rate for Payer: Cash Price	$8.71
Rate for Payer: Health Management Network Commercial	$11.39
Rate for Payer: MDX Hawaii PPO	$13.00

MIRTAZAPINE 7.5 MG PO TABLET

Facility

$14.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$12.36
Max. Negotiated Rate	$14.10
Rate for Payer: Cash Price	$9.45
Rate for Payer: Health Management Network Commercial	$12.36
Rate for Payer: MDX Hawaii PPO	$14.10

MIRTAZAPINE 7.5 MG PO TABLET

Facility

$14.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$14.10
Rate for Payer: Cash Price	$9.45
Rate for Payer: Hawaii Western Management Group Commercial	$13.81
Rate for Payer: Health Management Network Commercial	$12.36
Rate for Payer: Kaiser Permanente Commercial	$9.16
Rate for Payer: Kaiser Permanente Medicaid	$7.42
Rate for Payer: MDX Hawaii PPO	$14.10
Rate for Payer: UnitedHealthcare Medicaid	$8.72
Rate for Payer: University Health Alliance Commercial	$10.60

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC

Facility

$23,039.10

Service Code	MSDRG 640
Min. Negotiated Rate	$17,566.84
Max. Negotiated Rate	$23,039.10
Rate for Payer: AlohaCare Medicare	$17,566.84
Rate for Payer: Devoted Health Medicare	$19,323.52
Rate for Payer: Hawaii Medical Service Association Commercial	$20,563.27
Rate for Payer: Hawaii Medical Service Association Medicare	$17,566.84
Rate for Payer: Humana Medicare	$17,566.84
Rate for Payer: Kaiser Permanente Commercial	$23,039.10
Rate for Payer: Kaiser Permanente Medicare	$17,566.84
Rate for Payer: Ohana Health Plan Medicare	$17,566.84
Rate for Payer: UnitedHealthcare Medicare	$17,566.84

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC

Facility

$16,007.05

Service Code	MSDRG 641
Min. Negotiated Rate	$10,235.48
Max. Negotiated Rate	$16,007.05
Rate for Payer: AlohaCare Medicare	$10,235.48
Rate for Payer: Devoted Health Medicare	$11,259.03
Rate for Payer: Hawaii Medical Service Association Commercial	$16,007.05
Rate for Payer: Hawaii Medical Service Association Medicare	$10,235.48
Rate for Payer: Humana Medicare	$10,235.48
Rate for Payer: Kaiser Permanente Commercial	$13,423.95
Rate for Payer: Kaiser Permanente Medicare	$10,235.48
Rate for Payer: Ohana Health Plan Medicare	$10,235.48
Rate for Payer: UnitedHealthcare Medicare	$10,235.48

Mis Hdegd Scr 48mm 00-5983-040-48 [3645548]

Facility

$658.25

Service Code	HCPCS C1776
Hospital Charge Code	3645548
Hospital Revenue Code	278
Min. Negotiated Rate	$335.71
Max. Negotiated Rate	$638.50
Rate for Payer: Cash Price	$427.86
Rate for Payer: Hawaii Western Management Group Commercial	$460.77
Rate for Payer: Health Management Network Commercial	$559.51
Rate for Payer: Kaiser Permanente Commercial	$414.70
Rate for Payer: Kaiser Permanente Medicaid	$335.71
Rate for Payer: MDX Hawaii PPO	$638.50
Rate for Payer: University Health Alliance Commercial	$368.62

Mis Hdegd Scr 48mm 00-5983-040-48 [3645548]

Facility

$658.25

Service Code	HCPCS C1776
Hospital Charge Code	3645548
Hospital Revenue Code	278
Min. Negotiated Rate	$368.62
Max. Negotiated Rate	$638.50
Rate for Payer: Cash Price	$427.86
Rate for Payer: Hawaii Western Management Group Commercial	$460.77
Rate for Payer: Health Management Network Commercial	$559.51
Rate for Payer: MDX Hawaii PPO	$638.50
Rate for Payer: University Health Alliance Commercial	$368.62

Know your out-of-pocket cost for care.

All Charges