Kona Community Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$80,692.05

Service Code	MSDRG 826
Min. Negotiated Rate	$61,526.02
Max. Negotiated Rate	$80,692.05
Rate for Payer: AlohaCare Medicare	$61,526.02
Rate for Payer: Devoted Health Medicare	$67,678.62
Rate for Payer: Hawaii Medical Service Association Commercial	$74,707.59
Rate for Payer: Hawaii Medical Service Association Medicare	$61,526.02
Rate for Payer: Humana Medicare	$61,526.02
Rate for Payer: Kaiser Permanente Commercial	$80,692.05
Rate for Payer: Kaiser Permanente Medicare	$61,526.02
Rate for Payer: Ohana Health Plan Medicare	$61,526.02
Rate for Payer: UnitedHealthcare Medicare	$61,526.02

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC

Facility

$37,703.35

Service Code	MSDRG 828
Min. Negotiated Rate	$22,409.68
Max. Negotiated Rate	$37,703.35
Rate for Payer: AlohaCare Medicare	$22,409.68
Rate for Payer: Devoted Health Medicare	$24,650.65
Rate for Payer: Hawaii Medical Service Association Commercial	$37,703.35
Rate for Payer: Hawaii Medical Service Association Medicare	$22,409.68
Rate for Payer: Humana Medicare	$22,409.68
Rate for Payer: Kaiser Permanente Commercial	$29,390.55
Rate for Payer: Kaiser Permanente Medicare	$22,409.68
Rate for Payer: Ohana Health Plan Medicare	$22,409.68
Rate for Payer: UnitedHealthcare Medicare	$22,409.68

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC

Facility

$54,510.00

Service Code	MSDRG 829
Min. Negotiated Rate	$41,562.73
Max. Negotiated Rate	$54,510.00
Rate for Payer: AlohaCare Medicare	$41,562.73
Rate for Payer: Devoted Health Medicare	$45,719.00
Rate for Payer: Hawaii Medical Service Association Commercial	$47,611.32
Rate for Payer: Hawaii Medical Service Association Medicare	$41,562.73
Rate for Payer: Humana Medicare	$41,562.73
Rate for Payer: Kaiser Permanente Commercial	$54,510.00
Rate for Payer: Kaiser Permanente Medicare	$41,562.73
Rate for Payer: Ohana Health Plan Medicare	$41,562.73
Rate for Payer: UnitedHealthcare Medicare	$41,562.73

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC

Facility

$47,611.32

Service Code	MSDRG 830
Min. Negotiated Rate	$19,794.91
Max. Negotiated Rate	$47,611.32
Rate for Payer: AlohaCare Medicare	$19,794.91
Rate for Payer: Devoted Health Medicare	$21,774.40
Rate for Payer: Hawaii Medical Service Association Commercial	$47,611.32
Rate for Payer: Hawaii Medical Service Association Medicare	$19,794.91
Rate for Payer: Humana Medicare	$19,794.91
Rate for Payer: Kaiser Permanente Commercial	$25,961.25
Rate for Payer: Kaiser Permanente Medicare	$19,794.91
Rate for Payer: Ohana Health Plan Medicare	$19,794.91
Rate for Payer: UnitedHealthcare Medicare	$19,794.91

Myosure Lite Tissue Removal Device 30401LITE [3626897]

Facility

$4,200.52

Hospital Charge Code	3626897
Hospital Revenue Code	272
Min. Negotiated Rate	$3,570.44
Max. Negotiated Rate	$4,074.50
Rate for Payer: Cash Price	$2,730.34
Rate for Payer: Health Management Network Commercial	$3,570.44
Rate for Payer: MDX Hawaii PPO	$4,074.50

Myosure Lite Tissue Removal Device 30401LITE [3626897]

Facility

$4,200.52

Hospital Charge Code	3626897
Hospital Revenue Code	272
Min. Negotiated Rate	$2,142.27
Max. Negotiated Rate	$4,074.50
Rate for Payer: Cash Price	$2,730.34
Rate for Payer: Hawaii Western Management Group Commercial	$3,990.49
Rate for Payer: Health Management Network Commercial	$3,570.44
Rate for Payer: Kaiser Permanente Commercial	$2,646.33
Rate for Payer: Kaiser Permanente Medicaid	$2,142.27
Rate for Payer: MDX Hawaii PPO	$4,074.50
Rate for Payer: University Health Alliance Commercial	$3,061.76

Myosure Tissue Removal Device 10401FC [3625448]

Facility

$7,447.16

Hospital Charge Code	3625448
Hospital Revenue Code	272
Min. Negotiated Rate	$3,798.05
Max. Negotiated Rate	$7,223.75
Rate for Payer: Cash Price	$4,840.65
Rate for Payer: Hawaii Western Management Group Commercial	$7,074.80
Rate for Payer: Health Management Network Commercial	$6,330.09
Rate for Payer: Kaiser Permanente Commercial	$4,691.71
Rate for Payer: Kaiser Permanente Medicaid	$3,798.05
Rate for Payer: MDX Hawaii PPO	$7,223.75
Rate for Payer: University Health Alliance Commercial	$5,428.23

Myosure Tissue Removal Device 10401FC [3625448]

Facility

$7,447.16

Hospital Charge Code	3625448
Hospital Revenue Code	272
Min. Negotiated Rate	$6,330.09
Max. Negotiated Rate	$7,223.75
Rate for Payer: Cash Price	$4,840.65
Rate for Payer: Health Management Network Commercial	$6,330.09
Rate for Payer: MDX Hawaii PPO	$7,223.75

Myosure XL Tissue Removal Device 50-601XL [3640638]

Facility

$6,397.16

Hospital Charge Code	3640638
Hospital Revenue Code	272
Min. Negotiated Rate	$3,262.55
Max. Negotiated Rate	$6,205.25
Rate for Payer: Cash Price	$4,158.15
Rate for Payer: Hawaii Western Management Group Commercial	$6,077.30
Rate for Payer: Health Management Network Commercial	$5,437.59
Rate for Payer: Kaiser Permanente Commercial	$4,030.21
Rate for Payer: Kaiser Permanente Medicaid	$3,262.55
Rate for Payer: MDX Hawaii PPO	$6,205.25
Rate for Payer: University Health Alliance Commercial	$4,662.89

Myosure XL Tissue Removal Device 50-601XL [3640638]

Facility

$6,397.16

Hospital Charge Code	3640638
Hospital Revenue Code	272
Min. Negotiated Rate	$5,437.59
Max. Negotiated Rate	$6,205.25
Rate for Payer: Cash Price	$4,158.15
Rate for Payer: Health Management Network Commercial	$5,437.59
Rate for Payer: MDX Hawaii PPO	$6,205.25

NAFCILLIN 1 GRAM INJ RECON.SOLN.

Facility

$72.65

Service Code	HCPCS J2290
Hospital Revenue Code	250
Min. Negotiated Rate	$61.75
Max. Negotiated Rate	$70.47
Rate for Payer: Cash Price	$47.22
Rate for Payer: Health Management Network Commercial	$61.75
Rate for Payer: MDX Hawaii PPO	$70.47

NAFCILLIN 1 GRAM INJ RECON.SOLN.

Facility

$72.65

Service Code	HCPCS J2290
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$70.47
Rate for Payer: Cash Price	$47.22
Rate for Payer: Cash Price	$47.22
Rate for Payer: Hawaii Medical Service Association ABD	$0.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.06
Rate for Payer: Hawaii Western Management Group Commercial	$69.02
Rate for Payer: Health Management Network Commercial	$61.75
Rate for Payer: Kaiser Permanente Commercial	$45.77
Rate for Payer: Kaiser Permanente Medicaid	$37.05
Rate for Payer: MDX Hawaii PPO	$70.47
Rate for Payer: UnitedHealthcare Medicaid	$43.59
Rate for Payer: University Health Alliance Commercial	$52.95

NAFCILLIN 2 GRAM INJ RECON.SOLN.

Facility

$137.61

Service Code	HCPCS J2290
Hospital Revenue Code	250
Min. Negotiated Rate	$116.97
Max. Negotiated Rate	$133.48
Rate for Payer: Cash Price	$89.45
Rate for Payer: Cash Price	$52.06
Rate for Payer: Health Management Network Commercial	$116.97
Rate for Payer: Health Management Network Commercial	$68.08
Rate for Payer: MDX Hawaii PPO	$133.48
Rate for Payer: MDX Hawaii PPO	$77.70

NAFCILLIN 2 GRAM INJ RECON.SOLN.

Facility

$80.10

Service Code	HCPCS J2290
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$77.70
Rate for Payer: Cash Price	$52.06
Rate for Payer: Cash Price	$89.45
Rate for Payer: Cash Price	$89.45
Rate for Payer: Cash Price	$52.06
Rate for Payer: Hawaii Medical Service Association ABD	$0.06
Rate for Payer: Hawaii Medical Service Association ABD	$0.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.06
Rate for Payer: Hawaii Western Management Group Commercial	$130.73
Rate for Payer: Hawaii Western Management Group Commercial	$76.09
Rate for Payer: Health Management Network Commercial	$68.08
Rate for Payer: Health Management Network Commercial	$116.97
Rate for Payer: Kaiser Permanente Commercial	$50.46
Rate for Payer: Kaiser Permanente Commercial	$86.69
Rate for Payer: Kaiser Permanente Medicaid	$70.18
Rate for Payer: Kaiser Permanente Medicaid	$40.85
Rate for Payer: MDX Hawaii PPO	$133.48
Rate for Payer: MDX Hawaii PPO	$77.70
Rate for Payer: UnitedHealthcare Medicaid	$48.06
Rate for Payer: UnitedHealthcare Medicaid	$82.57
Rate for Payer: University Health Alliance Commercial	$58.38
Rate for Payer: University Health Alliance Commercial	$100.30

Nail Dt Humerus Long 7x200mm Lt Dt725200 [3643931]

Facility

$8,137.50

Service Code	HCPCS C1713
Hospital Charge Code	3643931
Hospital Revenue Code	278
Min. Negotiated Rate	$4,557.00
Max. Negotiated Rate	$7,893.38
Rate for Payer: Cash Price	$5,289.38
Rate for Payer: Hawaii Western Management Group Commercial	$5,696.25
Rate for Payer: Health Management Network Commercial	$6,916.88
Rate for Payer: MDX Hawaii PPO	$7,893.38
Rate for Payer: University Health Alliance Commercial	$4,557.00

Nail Dt Humerus Long 7x200mm Lt Dt725200 [3643931]

Facility

$8,137.50

Service Code	HCPCS C1713
Hospital Charge Code	3643931
Hospital Revenue Code	278
Min. Negotiated Rate	$4,150.12
Max. Negotiated Rate	$7,893.38
Rate for Payer: Cash Price	$5,289.38
Rate for Payer: Hawaii Western Management Group Commercial	$5,696.25
Rate for Payer: Health Management Network Commercial	$6,916.88
Rate for Payer: Kaiser Permanente Commercial	$5,126.62
Rate for Payer: Kaiser Permanente Medicaid	$4,150.12
Rate for Payer: MDX Hawaii PPO	$7,893.38
Rate for Payer: University Health Alliance Commercial	$4,557.00

Nail ES Troch Lt 10mm x 36cm x 130 Deg AR-9094ES-10-3630L [3644623]

Facility

$18,390.50

Service Code	HCPCS C1713
Hospital Charge Code	3644623
Hospital Revenue Code	278
Min. Negotiated Rate	$9,379.16
Max. Negotiated Rate	$17,838.78
Rate for Payer: Cash Price	$11,953.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,873.35
Rate for Payer: Health Management Network Commercial	$15,631.92
Rate for Payer: Kaiser Permanente Commercial	$11,586.01
Rate for Payer: Kaiser Permanente Medicaid	$9,379.16
Rate for Payer: MDX Hawaii PPO	$17,838.78
Rate for Payer: University Health Alliance Commercial	$10,298.68

Nail ES Troch Lt 10mm x 36cm x 130 Deg AR-9094ES-10-3630L [3644623]

Facility

$18,390.50

Service Code	HCPCS C1713
Hospital Charge Code	3644623
Hospital Revenue Code	278
Min. Negotiated Rate	$10,298.68
Max. Negotiated Rate	$17,838.78
Rate for Payer: Cash Price	$11,953.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,873.35
Rate for Payer: Health Management Network Commercial	$15,631.92
Rate for Payer: MDX Hawaii PPO	$17,838.78
Rate for Payer: University Health Alliance Commercial	$10,298.68

Nail ES Troch Rt 10mmx33cm x 130deg AR-9094ES-10-3330R [3644739]

Facility

$18,390.50

Service Code	HCPCS C1713
Hospital Charge Code	3644739
Hospital Revenue Code	278
Min. Negotiated Rate	$9,379.16
Max. Negotiated Rate	$17,838.78
Rate for Payer: Cash Price	$11,953.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,873.35
Rate for Payer: Health Management Network Commercial	$15,631.92
Rate for Payer: Kaiser Permanente Commercial	$11,586.01
Rate for Payer: Kaiser Permanente Medicaid	$9,379.16
Rate for Payer: MDX Hawaii PPO	$17,838.78
Rate for Payer: University Health Alliance Commercial	$10,298.68

Nail ES Troch Rt 10mmx33cm x 130deg AR-9094ES-10-3330R [3644739]

Facility

$18,390.50

Service Code	HCPCS C1713
Hospital Charge Code	3644739
Hospital Revenue Code	278
Min. Negotiated Rate	$10,298.68
Max. Negotiated Rate	$17,838.78
Rate for Payer: Cash Price	$11,953.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,873.35
Rate for Payer: Health Management Network Commercial	$15,631.92
Rate for Payer: MDX Hawaii PPO	$17,838.78
Rate for Payer: University Health Alliance Commercial	$10,298.68

Nail ES Troch Rt 11mm x 42cm x 130 Deg AR-9094ES-11-4230R [3644657]

Facility

$18,390.50

Service Code	HCPCS C1713
Hospital Charge Code	3644657
Hospital Revenue Code	278
Min. Negotiated Rate	$10,298.68
Max. Negotiated Rate	$17,838.78
Rate for Payer: Cash Price	$11,953.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,873.35
Rate for Payer: Health Management Network Commercial	$15,631.92
Rate for Payer: MDX Hawaii PPO	$17,838.78
Rate for Payer: University Health Alliance Commercial	$10,298.68

Nail ES Troch Rt 11mm x 42cm x 130 Deg AR-9094ES-11-4230R [3644657]

Facility

$18,390.50

Service Code	HCPCS C1713
Hospital Charge Code	3644657
Hospital Revenue Code	278
Min. Negotiated Rate	$9,379.16
Max. Negotiated Rate	$17,838.78
Rate for Payer: Cash Price	$11,953.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,873.35
Rate for Payer: Health Management Network Commercial	$15,631.92
Rate for Payer: Kaiser Permanente Commercial	$11,586.01
Rate for Payer: Kaiser Permanente Medicaid	$9,379.16
Rate for Payer: MDX Hawaii PPO	$17,838.78
Rate for Payer: University Health Alliance Commercial	$10,298.68

Nail Fem Troch Green Lt 12mmx38cm [3644358]

Facility

$11,373.00

Service Code	HCPCS C1713
Hospital Charge Code	3644358
Hospital Revenue Code	278
Min. Negotiated Rate	$6,368.88
Max. Negotiated Rate	$11,031.81
Rate for Payer: Cash Price	$7,392.45
Rate for Payer: Hawaii Western Management Group Commercial	$7,961.10
Rate for Payer: Health Management Network Commercial	$9,667.05
Rate for Payer: MDX Hawaii PPO	$11,031.81
Rate for Payer: University Health Alliance Commercial	$6,368.88

Nail Fem Troch Green Lt 12mmx38cm [3644358]

Facility

$11,373.00

Service Code	HCPCS C1713
Hospital Charge Code	3644358
Hospital Revenue Code	278
Min. Negotiated Rate	$5,800.23
Max. Negotiated Rate	$11,031.81
Rate for Payer: Cash Price	$7,392.45
Rate for Payer: Hawaii Western Management Group Commercial	$7,961.10
Rate for Payer: Health Management Network Commercial	$9,667.05
Rate for Payer: Kaiser Permanente Commercial	$7,164.99
Rate for Payer: Kaiser Permanente Medicaid	$5,800.23
Rate for Payer: MDX Hawaii PPO	$11,031.81
Rate for Payer: University Health Alliance Commercial	$6,368.88

Nail Frn Ti Cann 10mm 380mm Rt 04.033.068s [3643574]

Facility

$12,194.10

Service Code	HCPCS C1713
Hospital Charge Code	3643574
Hospital Revenue Code	278
Min. Negotiated Rate	$6,828.70
Max. Negotiated Rate	$11,828.28
Rate for Payer: Cash Price	$7,926.17
Rate for Payer: Hawaii Western Management Group Commercial	$8,535.87
Rate for Payer: Health Management Network Commercial	$10,364.99
Rate for Payer: MDX Hawaii PPO	$11,828.28
Rate for Payer: University Health Alliance Commercial	$6,828.70

Know your out-of-pocket cost for care.

All Charges