Kona Community Hospital

All Charges

Charge

Type

Setting

Price

MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES

Facility

$4,822.51

Service Code	APR-DRG 0432
Min. Negotiated Rate	$4,822.51
Max. Negotiated Rate	$4,822.51
Rate for Payer: AlohaCare Medicaid	$4,822.51
Rate for Payer: Hawaii Medical Service Association ABD	$4,822.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,822.51
Rate for Payer: Kaiser Permanente Medicaid	$4,822.51
Rate for Payer: Ohana Health Plan Medicaid	$4,822.51
Rate for Payer: UnitedHealthcare Medicaid	$4,822.51

MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES

Facility

$3,799.17

Service Code	APR-DRG 0431
Min. Negotiated Rate	$3,799.17
Max. Negotiated Rate	$3,799.17
Rate for Payer: AlohaCare Medicaid	$3,799.17
Rate for Payer: Hawaii Medical Service Association ABD	$3,799.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,799.17
Rate for Payer: Kaiser Permanente Medicaid	$3,799.17
Rate for Payer: Ohana Health Plan Medicaid	$3,799.17
Rate for Payer: UnitedHealthcare Medicaid	$3,799.17

MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE

Facility

$4,226.97

Service Code	APR-DRG 9301
Min. Negotiated Rate	$4,226.97
Max. Negotiated Rate	$4,226.97
Rate for Payer: AlohaCare Medicaid	$4,226.97
Rate for Payer: Hawaii Medical Service Association ABD	$4,226.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,226.97
Rate for Payer: Kaiser Permanente Medicaid	$4,226.97
Rate for Payer: Ohana Health Plan Medicaid	$4,226.97
Rate for Payer: UnitedHealthcare Medicaid	$4,226.97

MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE

Facility

$5,039.85

Service Code	APR-DRG 9302
Min. Negotiated Rate	$5,039.85
Max. Negotiated Rate	$5,039.85
Rate for Payer: AlohaCare Medicaid	$5,039.85
Rate for Payer: Hawaii Medical Service Association ABD	$5,039.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,039.85
Rate for Payer: Kaiser Permanente Medicaid	$5,039.85
Rate for Payer: Ohana Health Plan Medicaid	$5,039.85
Rate for Payer: UnitedHealthcare Medicaid	$5,039.85

MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE

Facility

$16,872.73

Service Code	APR-DRG 9304
Min. Negotiated Rate	$16,872.73
Max. Negotiated Rate	$16,872.73
Rate for Payer: AlohaCare Medicaid	$16,872.73
Rate for Payer: Hawaii Medical Service Association ABD	$16,872.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16,872.73
Rate for Payer: Kaiser Permanente Medicaid	$16,872.73
Rate for Payer: Ohana Health Plan Medicaid	$16,872.73
Rate for Payer: UnitedHealthcare Medicaid	$16,872.73

MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE

Facility

$8,007.96

Service Code	APR-DRG 9303
Min. Negotiated Rate	$8,007.96
Max. Negotiated Rate	$8,007.96
Rate for Payer: AlohaCare Medicaid	$8,007.96
Rate for Payer: Hawaii Medical Service Association ABD	$8,007.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,007.96
Rate for Payer: Kaiser Permanente Medicaid	$8,007.96
Rate for Payer: Ohana Health Plan Medicaid	$8,007.96
Rate for Payer: UnitedHealthcare Medicaid	$8,007.96

MULTIVITAMIN WITH FOLIC ACID 400 MCG 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

MULTIVITAMIN WITH FOLIC ACID 400 MCG 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

MULTIVIT-IRON-FA-CALCIUM-MINS 9 MG IRON-400 MCG PO TABLET

Facility

$1.43

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$1.39
Rate for Payer: Cash Price	$0.93
Rate for Payer: Health Management Network Commercial	$1.22
Rate for Payer: MDX Hawaii PPO	$1.39

MULTIVIT-IRON-FA-CALCIUM-MINS 9 MG IRON-400 MCG PO TABLET

Facility

$1.43

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$1.39
Rate for Payer: Cash Price	$0.93
Rate for Payer: Hawaii Western Management Group Commercial	$1.36
Rate for Payer: Health Management Network Commercial	$1.22
Rate for Payer: Kaiser Permanente Commercial	$0.90
Rate for Payer: Kaiser Permanente Medicaid	$0.73
Rate for Payer: MDX Hawaii PPO	$1.39
Rate for Payer: UnitedHealthcare Medicaid	$0.86
Rate for Payer: University Health Alliance Commercial	$1.04

MUPIROCIN 2 % TOP OINT

Facility

$194.97

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$99.43
Max. Negotiated Rate	$189.12
Rate for Payer: Cash Price	$126.73
Rate for Payer: Cash Price	$41.96
Rate for Payer: Hawaii Western Management Group Commercial	$185.22
Rate for Payer: Hawaii Western Management Group Commercial	$61.32
Rate for Payer: Health Management Network Commercial	$165.72
Rate for Payer: Health Management Network Commercial	$54.87
Rate for Payer: Kaiser Permanente Commercial	$122.83
Rate for Payer: Kaiser Permanente Commercial	$40.67
Rate for Payer: Kaiser Permanente Medicaid	$99.43
Rate for Payer: Kaiser Permanente Medicaid	$32.92
Rate for Payer: MDX Hawaii PPO	$189.12
Rate for Payer: MDX Hawaii PPO	$62.61
Rate for Payer: UnitedHealthcare Medicaid	$38.73
Rate for Payer: UnitedHealthcare Medicaid	$116.98
Rate for Payer: University Health Alliance Commercial	$142.11
Rate for Payer: University Health Alliance Commercial	$47.05

MUPIROCIN 2 % TOP OINT

Facility

$194.97

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$165.72
Max. Negotiated Rate	$189.12
Rate for Payer: Cash Price	$126.73
Rate for Payer: Cash Price	$41.96
Rate for Payer: Health Management Network Commercial	$54.87
Rate for Payer: Health Management Network Commercial	$165.72
Rate for Payer: MDX Hawaii PPO	$189.12
Rate for Payer: MDX Hawaii PPO	$62.61

MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG

Facility

$4,567.15

Service Code	APR-DRG 3432
Min. Negotiated Rate	$4,567.15
Max. Negotiated Rate	$4,567.15
Rate for Payer: AlohaCare Medicaid	$4,567.15
Rate for Payer: Hawaii Medical Service Association ABD	$4,567.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,567.15
Rate for Payer: Kaiser Permanente Medicaid	$4,567.15
Rate for Payer: Ohana Health Plan Medicaid	$4,567.15
Rate for Payer: UnitedHealthcare Medicaid	$4,567.15

MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG

Facility

$3,882.59

Service Code	APR-DRG 3431
Min. Negotiated Rate	$3,882.59
Max. Negotiated Rate	$3,882.59
Rate for Payer: AlohaCare Medicaid	$3,882.59
Rate for Payer: Hawaii Medical Service Association ABD	$3,882.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,882.59
Rate for Payer: Kaiser Permanente Medicaid	$3,882.59
Rate for Payer: Ohana Health Plan Medicaid	$3,882.59
Rate for Payer: UnitedHealthcare Medicaid	$3,882.59

MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG

Facility

$10,947.92

Service Code	APR-DRG 3434
Min. Negotiated Rate	$10,947.92
Max. Negotiated Rate	$10,947.92
Rate for Payer: AlohaCare Medicaid	$10,947.92
Rate for Payer: Hawaii Medical Service Association ABD	$10,947.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,947.92
Rate for Payer: Kaiser Permanente Medicaid	$10,947.92
Rate for Payer: Ohana Health Plan Medicaid	$10,947.92
Rate for Payer: UnitedHealthcare Medicaid	$10,947.92

MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG

Facility

$6,657.14

Service Code	APR-DRG 3433
Min. Negotiated Rate	$6,657.14
Max. Negotiated Rate	$6,657.14
Rate for Payer: AlohaCare Medicaid	$6,657.14
Rate for Payer: Hawaii Medical Service Association ABD	$6,657.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,657.14
Rate for Payer: Kaiser Permanente Medicaid	$6,657.14
Rate for Payer: Ohana Health Plan Medicaid	$6,657.14
Rate for Payer: UnitedHealthcare Medicaid	$6,657.14

MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$17,677.56

Service Code	APR-DRG 9123
Min. Negotiated Rate	$17,677.56
Max. Negotiated Rate	$17,677.56
Rate for Payer: AlohaCare Medicaid	$17,677.56
Rate for Payer: Hawaii Medical Service Association ABD	$17,677.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$17,677.56
Rate for Payer: Kaiser Permanente Medicaid	$17,677.56
Rate for Payer: Ohana Health Plan Medicaid	$17,677.56
Rate for Payer: UnitedHealthcare Medicaid	$17,677.56

MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$11,234.57

Service Code	APR-DRG 9122
Min. Negotiated Rate	$11,234.57
Max. Negotiated Rate	$11,234.57
Rate for Payer: AlohaCare Medicaid	$11,234.57
Rate for Payer: Hawaii Medical Service Association ABD	$11,234.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,234.57
Rate for Payer: Kaiser Permanente Medicaid	$11,234.57
Rate for Payer: Ohana Health Plan Medicaid	$11,234.57
Rate for Payer: UnitedHealthcare Medicaid	$11,234.57

MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$33,713.97

Service Code	APR-DRG 9124
Min. Negotiated Rate	$33,713.97
Max. Negotiated Rate	$33,713.97
Rate for Payer: AlohaCare Medicaid	$33,713.97
Rate for Payer: Hawaii Medical Service Association ABD	$33,713.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33,713.97
Rate for Payer: Kaiser Permanente Medicaid	$33,713.97
Rate for Payer: Ohana Health Plan Medicaid	$33,713.97
Rate for Payer: UnitedHealthcare Medicaid	$33,713.97

MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$11,129.85

Service Code	APR-DRG 9121
Min. Negotiated Rate	$11,129.85
Max. Negotiated Rate	$11,129.85
Rate for Payer: AlohaCare Medicaid	$11,129.85
Rate for Payer: Hawaii Medical Service Association ABD	$11,129.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,129.85
Rate for Payer: Kaiser Permanente Medicaid	$11,129.85
Rate for Payer: Ohana Health Plan Medicaid	$11,129.85
Rate for Payer: UnitedHealthcare Medicaid	$11,129.85

MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN

Facility

$81.68

Service Code	NDC 54643564901
Hospital Revenue Code	250
Min. Negotiated Rate	$41.66
Max. Negotiated Rate	$79.23
Rate for Payer: Cash Price	$53.09
Rate for Payer: Hawaii Western Management Group Commercial	$77.60
Rate for Payer: Health Management Network Commercial	$69.43
Rate for Payer: Kaiser Permanente Commercial	$51.46
Rate for Payer: Kaiser Permanente Medicaid	$41.66
Rate for Payer: MDX Hawaii PPO	$79.23
Rate for Payer: UnitedHealthcare Medicaid	$49.01
Rate for Payer: University Health Alliance Commercial	$59.54

MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN

Facility

$81.68

Service Code	NDC 54643564901
Hospital Revenue Code	250
Min. Negotiated Rate	$69.43
Max. Negotiated Rate	$79.23
Rate for Payer: Cash Price	$53.09
Rate for Payer: Health Management Network Commercial	$69.43
Rate for Payer: MDX Hawaii PPO	$79.23

MYCOPHENOLATE MOFETIL 500 MG PO TABLET

Facility

$8.63

Service Code	HCPCS J7517
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$8.37
Rate for Payer: Cash Price	$5.61
Rate for Payer: Cash Price	$5.61
Rate for Payer: Hawaii Medical Service Association ABD	$0.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.16
Rate for Payer: Hawaii Western Management Group Commercial	$8.20
Rate for Payer: Health Management Network Commercial	$7.34
Rate for Payer: Kaiser Permanente Commercial	$5.44
Rate for Payer: Kaiser Permanente Medicaid	$4.40
Rate for Payer: MDX Hawaii PPO	$8.37
Rate for Payer: UnitedHealthcare Medicaid	$5.18
Rate for Payer: University Health Alliance Commercial	$6.29

MYCOPHENOLATE MOFETIL 500 MG PO TABLET

Facility

$8.63

Service Code	HCPCS J7517
Hospital Revenue Code	250
Min. Negotiated Rate	$7.34
Max. Negotiated Rate	$8.37
Rate for Payer: Cash Price	$5.61
Rate for Payer: Health Management Network Commercial	$7.34
Rate for Payer: MDX Hawaii PPO	$8.37

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC

Facility

$74,707.59

Service Code	MSDRG 827
Min. Negotiated Rate	$30,398.68
Max. Negotiated Rate	$74,707.59
Rate for Payer: AlohaCare Medicare	$30,398.68
Rate for Payer: Devoted Health Medicare	$33,438.55
Rate for Payer: Hawaii Medical Service Association Commercial	$74,707.59
Rate for Payer: Hawaii Medical Service Association Medicare	$30,398.68
Rate for Payer: Humana Medicare	$30,398.68
Rate for Payer: Kaiser Permanente Commercial	$39,868.20
Rate for Payer: Kaiser Permanente Medicare	$30,398.68
Rate for Payer: Ohana Health Plan Medicare	$30,398.68
Rate for Payer: UnitedHealthcare Medicare	$30,398.68

Know your out-of-pocket cost for care.

All Charges