Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Needle Scorpion Knee Length AR-12990N [3642269]

Facility

$1,855.63

Hospital Charge Code	3642269
Hospital Revenue Code	272
Min. Negotiated Rate	$1,577.29
Max. Negotiated Rate	$1,799.96
Rate for Payer: Cash Price	$1,206.16
Rate for Payer: Health Management Network Commercial	$1,577.29
Rate for Payer: MDX Hawaii PPO	$1,799.96

Needle Scorpion Knee Length AR-12990N [3642269]

Facility

$1,855.63

Hospital Charge Code	3642269
Hospital Revenue Code	272
Min. Negotiated Rate	$946.37
Max. Negotiated Rate	$1,799.96
Rate for Payer: Cash Price	$1,206.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,762.85
Rate for Payer: Health Management Network Commercial	$1,577.29
Rate for Payer: Kaiser Permanente Commercial	$1,169.05
Rate for Payer: Kaiser Permanente Medicaid	$946.37
Rate for Payer: MDX Hawaii PPO	$1,799.96
Rate for Payer: University Health Alliance Commercial	$1,352.57

Needle Spinal 22ga 1.5 Inch [2701466]

Facility

$18.45

Hospital Charge Code	2701466
Hospital Revenue Code	272
Min. Negotiated Rate	$9.41
Max. Negotiated Rate	$17.90
Rate for Payer: Cash Price	$11.99
Rate for Payer: Hawaii Western Management Group Commercial	$17.53
Rate for Payer: Health Management Network Commercial	$15.68
Rate for Payer: Kaiser Permanente Commercial	$11.62
Rate for Payer: Kaiser Permanente Medicaid	$9.41
Rate for Payer: MDX Hawaii PPO	$17.90
Rate for Payer: University Health Alliance Commercial	$13.45

Needle Spinal 22ga 1.5 Inch [2701466]

Facility

$18.45

Hospital Charge Code	2701466
Hospital Revenue Code	272
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$17.90
Rate for Payer: Cash Price	$11.99
Rate for Payer: Health Management Network Commercial	$15.68
Rate for Payer: MDX Hawaii PPO	$17.90

Needle Spinal 22ga 2.5 Inch [2701467]

Facility

$19.13

Hospital Charge Code	2701467
Hospital Revenue Code	272
Min. Negotiated Rate	$16.26
Max. Negotiated Rate	$18.56
Rate for Payer: Cash Price	$12.43
Rate for Payer: Health Management Network Commercial	$16.26
Rate for Payer: MDX Hawaii PPO	$18.56

Needle Spinal 22ga 2.5 Inch [2701467]

Facility

$19.13

Hospital Charge Code	2701467
Hospital Revenue Code	272
Min. Negotiated Rate	$9.76
Max. Negotiated Rate	$18.56
Rate for Payer: Cash Price	$12.43
Rate for Payer: Hawaii Western Management Group Commercial	$18.17
Rate for Payer: Health Management Network Commercial	$16.26
Rate for Payer: Kaiser Permanente Commercial	$12.05
Rate for Payer: Kaiser Permanente Medicaid	$9.76
Rate for Payer: MDX Hawaii PPO	$18.56
Rate for Payer: University Health Alliance Commercial	$13.94

NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION), UTILIZING DURABLE MEDICAL EQUIPMENT (DME), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA LESS THAN OR EQUAL TO 50 SQUARE CENTIMETERS

Facility

$2,837.00

Service Code	CPT 97605
Hospital Revenue Code	360
Min. Negotiated Rate	$18.49
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$237.02
Rate for Payer: AlohaCare Medicare	$237.02
Rate for Payer: Devoted Health Medicare	$260.72
Rate for Payer: Hawaii Medical Service Association Commercial	$296.27
Rate for Payer: Hawaii Medical Service Association Medicare	$237.02
Rate for Payer: Humana Medicare	$237.02
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$237.02
Rate for Payer: Ohana Health Plan Medicaid	$260.72
Rate for Payer: Ohana Health Plan Medicare	$237.02
Rate for Payer: UnitedHealthcare Medicaid	$18.49
Rate for Payer: UnitedHealthcare Medicare	$237.02

NEOMYCIN 500 MG PO TABLET

Facility

$8.21

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$7.96
Rate for Payer: Cash Price	$5.34
Rate for Payer: Hawaii Western Management Group Commercial	$7.80
Rate for Payer: Health Management Network Commercial	$6.98
Rate for Payer: Kaiser Permanente Commercial	$5.17
Rate for Payer: Kaiser Permanente Medicaid	$4.19
Rate for Payer: MDX Hawaii PPO	$7.96
Rate for Payer: UnitedHealthcare Medicaid	$4.93
Rate for Payer: University Health Alliance Commercial	$5.98

NEOMYCIN 500 MG PO TABLET

Facility

$8.21

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.98
Max. Negotiated Rate	$7.96
Rate for Payer: Cash Price	$5.34
Rate for Payer: Health Management Network Commercial	$6.98
Rate for Payer: MDX Hawaii PPO	$7.96

NEOMYCIN-BACITRACIN-POLYMYXIN 3.5-400-10,000 MG-UNIT-UNIT/G OPHT OINT

Facility

$296.42

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$251.96
Max. Negotiated Rate	$287.53
Rate for Payer: Cash Price	$192.67
Rate for Payer: Health Management Network Commercial	$251.96
Rate for Payer: MDX Hawaii PPO	$287.53

NEOMYCIN-BACITRACIN-POLYMYXIN 3.5-400-10,000 MG-UNIT-UNIT/G OPHT OINT

Facility

$296.42

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$151.17
Max. Negotiated Rate	$287.53
Rate for Payer: Cash Price	$192.67
Rate for Payer: Hawaii Western Management Group Commercial	$281.60
Rate for Payer: Health Management Network Commercial	$251.96
Rate for Payer: Kaiser Permanente Commercial	$186.74
Rate for Payer: Kaiser Permanente Medicaid	$151.17
Rate for Payer: MDX Hawaii PPO	$287.53
Rate for Payer: UnitedHealthcare Medicaid	$177.85
Rate for Payer: University Health Alliance Commercial	$216.06

NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK

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: Cash Price	$1.00
Rate for Payer: Health Management Network Commercial	$1.31
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$1.49

NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK

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: Cash Price	$1.00
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Hawaii Western Management Group Commercial	$1.46
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Health Management Network Commercial	$1.31
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Commercial	$0.97
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: Kaiser Permanente Medicaid	$0.79
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: MDX Hawaii PPO	$1.49
Rate for Payer: UnitedHealthcare Medicaid	$0.92
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87
Rate for Payer: University Health Alliance Commercial	$1.12

NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT

Facility

$29.24

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$28.36
Rate for Payer: Cash Price	$19.01
Rate for Payer: Cash Price	$19.36
Rate for Payer: Health Management Network Commercial	$25.32
Rate for Payer: Health Management Network Commercial	$24.85
Rate for Payer: MDX Hawaii PPO	$28.90
Rate for Payer: MDX Hawaii PPO	$28.36

NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT

Facility

$29.24

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$14.91
Max. Negotiated Rate	$28.36
Rate for Payer: Cash Price	$19.01
Rate for Payer: Cash Price	$19.36
Rate for Payer: Hawaii Western Management Group Commercial	$27.78
Rate for Payer: Hawaii Western Management Group Commercial	$28.30
Rate for Payer: Health Management Network Commercial	$25.32
Rate for Payer: Health Management Network Commercial	$24.85
Rate for Payer: Kaiser Permanente Commercial	$18.42
Rate for Payer: Kaiser Permanente Commercial	$18.77
Rate for Payer: Kaiser Permanente Medicaid	$15.19
Rate for Payer: Kaiser Permanente Medicaid	$14.91
Rate for Payer: MDX Hawaii PPO	$28.90
Rate for Payer: MDX Hawaii PPO	$28.36
Rate for Payer: UnitedHealthcare Medicaid	$17.54
Rate for Payer: UnitedHealthcare Medicaid	$17.87
Rate for Payer: University Health Alliance Commercial	$21.71
Rate for Payer: University Health Alliance Commercial	$21.31

NEOMYCIN-POLYMYXIN-GRAMICIDIN 1.75 MG-10,000 UNIT-0.025MG/ML OPHT DROP

Facility

$313.67

Service Code	NDC 24208079062
Hospital Revenue Code	250
Min. Negotiated Rate	$266.62
Max. Negotiated Rate	$304.26
Rate for Payer: Cash Price	$203.89
Rate for Payer: Health Management Network Commercial	$266.62
Rate for Payer: MDX Hawaii PPO	$304.26

NEOMYCIN-POLYMYXIN-GRAMICIDIN 1.75 MG-10,000 UNIT-0.025MG/ML OPHT DROP

Facility

$313.67

Service Code	NDC 24208079062
Hospital Revenue Code	250
Min. Negotiated Rate	$159.97
Max. Negotiated Rate	$304.26
Rate for Payer: Cash Price	$203.89
Rate for Payer: Hawaii Western Management Group Commercial	$297.99
Rate for Payer: Health Management Network Commercial	$266.62
Rate for Payer: Kaiser Permanente Commercial	$197.61
Rate for Payer: Kaiser Permanente Medicaid	$159.97
Rate for Payer: MDX Hawaii PPO	$304.26
Rate for Payer: UnitedHealthcare Medicaid	$188.20
Rate for Payer: University Health Alliance Commercial	$228.63

NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG-UNIT/ML-% OTIC SUSP

Facility

$389.56

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$198.68
Max. Negotiated Rate	$377.87
Rate for Payer: Cash Price	$253.21
Rate for Payer: Hawaii Western Management Group Commercial	$370.08
Rate for Payer: Health Management Network Commercial	$331.13
Rate for Payer: Kaiser Permanente Commercial	$245.42
Rate for Payer: Kaiser Permanente Medicaid	$198.68
Rate for Payer: MDX Hawaii PPO	$377.87
Rate for Payer: UnitedHealthcare Medicaid	$233.74
Rate for Payer: University Health Alliance Commercial	$283.95

NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG-UNIT/ML-% OTIC SUSP

Facility

$389.56

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$331.13
Max. Negotiated Rate	$377.87
Rate for Payer: Cash Price	$253.21
Rate for Payer: Health Management Network Commercial	$331.13
Rate for Payer: MDX Hawaii PPO	$377.87

NEONATAL AFTERCARE

Facility

$4,300.97

Service Code	APR-DRG 8631
Min. Negotiated Rate	$4,300.97
Max. Negotiated Rate	$4,300.97
Rate for Payer: AlohaCare Medicaid	$4,300.97
Rate for Payer: Hawaii Medical Service Association ABD	$4,300.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,300.97
Rate for Payer: Kaiser Permanente Medicaid	$4,300.97
Rate for Payer: Ohana Health Plan Medicaid	$4,300.97
Rate for Payer: UnitedHealthcare Medicaid	$4,300.97

NEONATAL AFTERCARE

Facility

$42,868.30

Service Code	APR-DRG 8634
Min. Negotiated Rate	$42,868.30
Max. Negotiated Rate	$42,868.30
Rate for Payer: AlohaCare Medicaid	$42,868.30
Rate for Payer: Hawaii Medical Service Association ABD	$42,868.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$42,868.30
Rate for Payer: Kaiser Permanente Medicaid	$42,868.30
Rate for Payer: Ohana Health Plan Medicaid	$42,868.30
Rate for Payer: UnitedHealthcare Medicaid	$42,868.30

NEONATAL AFTERCARE

Facility

$9,515.75

Service Code	APR-DRG 8632
Min. Negotiated Rate	$9,515.75
Max. Negotiated Rate	$9,515.75
Rate for Payer: AlohaCare Medicaid	$9,515.75
Rate for Payer: Hawaii Medical Service Association ABD	$9,515.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,515.75
Rate for Payer: Kaiser Permanente Medicaid	$9,515.75
Rate for Payer: Ohana Health Plan Medicaid	$9,515.75
Rate for Payer: UnitedHealthcare Medicaid	$9,515.75

NEONATAL AFTERCARE

Facility

$21,315.71

Service Code	APR-DRG 8633
Min. Negotiated Rate	$21,315.71
Max. Negotiated Rate	$21,315.71
Rate for Payer: AlohaCare Medicaid	$21,315.71
Rate for Payer: Hawaii Medical Service Association ABD	$21,315.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21,315.71
Rate for Payer: Kaiser Permanente Medicaid	$21,315.71
Rate for Payer: Ohana Health Plan Medicaid	$21,315.71
Rate for Payer: UnitedHealthcare Medicaid	$21,315.71

NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$112,065.10

Service Code	APR-DRG 6034
Min. Negotiated Rate	$112,065.10
Max. Negotiated Rate	$112,065.10
Rate for Payer: AlohaCare Medicaid	$112,065.10
Rate for Payer: Hawaii Medical Service Association ABD	$112,065.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$112,065.10
Rate for Payer: Kaiser Permanente Medicaid	$112,065.10
Rate for Payer: Ohana Health Plan Medicaid	$112,065.10
Rate for Payer: UnitedHealthcare Medicaid	$112,065.10

NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION

Facility

$55,906.21

Service Code	APR-DRG 6032
Min. Negotiated Rate	$55,906.21
Max. Negotiated Rate	$55,906.21
Rate for Payer: AlohaCare Medicaid	$55,906.21
Rate for Payer: Hawaii Medical Service Association ABD	$55,906.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$55,906.21
Rate for Payer: Kaiser Permanente Medicaid	$55,906.21
Rate for Payer: Ohana Health Plan Medicaid	$55,906.21
Rate for Payer: UnitedHealthcare Medicaid	$55,906.21

Know your out-of-pocket cost for care.

All Charges