Kona Community Hospital

All Charges

Charge

Type

Setting

Price

NIVOLUMAB 240 MG/24 ML IV SOLN

Facility

$10,650.11

Service Code	HCPCS J9299
Hospital Revenue Code	636
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$10,330.61
Rate for Payer: AlohaCare Medicaid	$33.62
Rate for Payer: AlohaCare Medicare	$33.62
Rate for Payer: Cash Price	$6,922.57
Rate for Payer: Cash Price	$6,922.57
Rate for Payer: Devoted Health Medicare	$36.98
Rate for Payer: Hawaii Medical Service Association ABD	$33.00
Rate for Payer: Hawaii Medical Service Association Commercial	$42.02
Rate for Payer: Hawaii Medical Service Association Medicare	$33.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$33.00
Rate for Payer: Hawaii Western Management Group Commercial	$10,117.60
Rate for Payer: Health Management Network Commercial	$9,052.59
Rate for Payer: Humana Medicare	$33.62
Rate for Payer: Kaiser Permanente Commercial	$6,709.57
Rate for Payer: Kaiser Permanente Medicaid	$5,431.56
Rate for Payer: Kaiser Permanente Medicare	$33.62
Rate for Payer: MDX Hawaii PPO	$10,330.61
Rate for Payer: Ohana Health Plan Medicaid	$36.98
Rate for Payer: Ohana Health Plan Medicare	$33.62
Rate for Payer: UnitedHealthcare Medicaid	$6,390.07
Rate for Payer: UnitedHealthcare Medicare	$33.62
Rate for Payer: University Health Alliance Commercial	$7,762.87

NIVOLUMAB 240 MG/24 ML IV SOLN

Facility

$10,650.11

Service Code	HCPCS J9299
Hospital Revenue Code	250
Min. Negotiated Rate	$9,052.59
Max. Negotiated Rate	$10,330.61
Rate for Payer: Cash Price	$6,922.57
Rate for Payer: Health Management Network Commercial	$9,052.59
Rate for Payer: MDX Hawaii PPO	$10,330.61

NIVOLUMAB-HYALURONIDASE-NVHY 600 MG-10,000 UNIT/5 ML SUBCUTANEOUS SOLN

Facility

$10,650.10

Service Code	HCPCS J9289
Hospital Revenue Code	636
Min. Negotiated Rate	$27.73
Max. Negotiated Rate	$10,330.60
Rate for Payer: AlohaCare Medicaid	$27.73
Rate for Payer: AlohaCare Medicare	$27.73
Rate for Payer: Cash Price	$6,922.56
Rate for Payer: Cash Price	$6,922.56
Rate for Payer: Devoted Health Medicare	$30.50
Rate for Payer: Hawaii Medical Service Association Commercial	$34.66
Rate for Payer: Hawaii Medical Service Association Medicare	$27.73
Rate for Payer: Hawaii Western Management Group Commercial	$10,117.59
Rate for Payer: Health Management Network Commercial	$9,052.58
Rate for Payer: Humana Medicare	$27.73
Rate for Payer: Kaiser Permanente Commercial	$6,709.56
Rate for Payer: Kaiser Permanente Medicaid	$5,431.55
Rate for Payer: Kaiser Permanente Medicare	$27.73
Rate for Payer: MDX Hawaii PPO	$10,330.60
Rate for Payer: Ohana Health Plan Medicaid	$30.50
Rate for Payer: Ohana Health Plan Medicare	$27.73
Rate for Payer: UnitedHealthcare Medicaid	$6,390.06
Rate for Payer: UnitedHealthcare Medicare	$27.73
Rate for Payer: University Health Alliance Commercial	$7,762.86

NIVOLUMAB-HYALURONIDASE-NVHY 600 MG-10,000 UNIT/5 ML SUBCUTANEOUS SOLN

Facility

$10,650.10

Service Code	HCPCS J9289
Hospital Revenue Code	250
Min. Negotiated Rate	$9,052.58
Max. Negotiated Rate	$10,330.60
Rate for Payer: Cash Price	$6,922.56
Rate for Payer: Health Management Network Commercial	$9,052.58
Rate for Payer: MDX Hawaii PPO	$10,330.60

NIVOLUMAB-RELATLIMAB-RMBW 240-80 MG/20 ML IV SOLN

Facility

$19,624.78

Service Code	HCPCS J9298
Hospital Revenue Code	636
Min. Negotiated Rate	$197.65
Max. Negotiated Rate	$19,036.04
Rate for Payer: AlohaCare Medicaid	$201.76
Rate for Payer: AlohaCare Medicare	$201.76
Rate for Payer: Cash Price	$12,756.11
Rate for Payer: Cash Price	$12,756.11
Rate for Payer: Devoted Health Medicare	$221.94
Rate for Payer: Hawaii Medical Service Association ABD	$197.65
Rate for Payer: Hawaii Medical Service Association Commercial	$252.20
Rate for Payer: Hawaii Medical Service Association Medicare	$201.76
Rate for Payer: Hawaii Medical Service Association Non-ABD	$197.65
Rate for Payer: Hawaii Western Management Group Commercial	$18,643.54
Rate for Payer: Health Management Network Commercial	$16,681.06
Rate for Payer: Humana Medicare	$201.76
Rate for Payer: Kaiser Permanente Commercial	$12,363.61
Rate for Payer: Kaiser Permanente Medicaid	$10,008.64
Rate for Payer: Kaiser Permanente Medicare	$201.76
Rate for Payer: MDX Hawaii PPO	$19,036.04
Rate for Payer: Ohana Health Plan Medicaid	$221.94
Rate for Payer: Ohana Health Plan Medicare	$201.76
Rate for Payer: UnitedHealthcare Medicaid	$11,774.87
Rate for Payer: UnitedHealthcare Medicare	$201.76
Rate for Payer: University Health Alliance Commercial	$14,304.50

NIVOLUMAB-RELATLIMAB-RMBW 240-80 MG/20 ML IV SOLN

Facility

$19,624.78

Service Code	HCPCS J9298
Hospital Revenue Code	250
Min. Negotiated Rate	$16,681.06
Max. Negotiated Rate	$19,036.04
Rate for Payer: Cash Price	$12,756.11
Rate for Payer: Health Management Network Commercial	$16,681.06
Rate for Payer: MDX Hawaii PPO	$19,036.04

N.MENINGITIDIS B,LIPID FHBP RC 120 MCG/0.5 ML IM SYR

Facility

$668.84

Service Code	HCPCS 90621
Hospital Revenue Code	250
Min. Negotiated Rate	$568.51
Max. Negotiated Rate	$648.77
Rate for Payer: Cash Price	$434.75
Rate for Payer: Health Management Network Commercial	$568.51
Rate for Payer: MDX Hawaii PPO	$648.77

N.MENINGITIDIS B,LIPID FHBP RC 120 MCG/0.5 ML IM SYR

Facility

$668.84

Service Code	HCPCS 90621
Hospital Revenue Code	250
Min. Negotiated Rate	$223.77
Max. Negotiated Rate	$648.77
Rate for Payer: Cash Price	$434.75
Rate for Payer: Cash Price	$434.75
Rate for Payer: Hawaii Medical Service Association ABD	$223.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$223.77
Rate for Payer: Hawaii Western Management Group Commercial	$635.40
Rate for Payer: Health Management Network Commercial	$568.51
Rate for Payer: Kaiser Permanente Commercial	$421.37
Rate for Payer: Kaiser Permanente Medicaid	$341.11
Rate for Payer: MDX Hawaii PPO	$648.77
Rate for Payer: UnitedHealthcare Medicaid	$401.30
Rate for Payer: University Health Alliance Commercial	$487.52

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC

Facility

$39,587.03

Service Code	MSDRG 098
Min. Negotiated Rate	$30,184.28
Max. Negotiated Rate	$39,587.03
Rate for Payer: AlohaCare Medicare	$30,184.28
Rate for Payer: Devoted Health Medicare	$33,202.71
Rate for Payer: Hawaii Medical Service Association Commercial	$38,185.49
Rate for Payer: Hawaii Medical Service Association Medicare	$30,184.28
Rate for Payer: Humana Medicare	$30,184.28
Rate for Payer: Kaiser Permanente Commercial	$39,587.03
Rate for Payer: Kaiser Permanente Medicare	$30,184.28
Rate for Payer: Ohana Health Plan Medicare	$30,184.28
Rate for Payer: UnitedHealthcare Medicare	$30,184.28

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC

Facility

$62,303.55

Service Code	MSDRG 097
Min. Negotiated Rate	$38,185.49
Max. Negotiated Rate	$62,303.55
Rate for Payer: AlohaCare Medicare	$47,505.15
Rate for Payer: Devoted Health Medicare	$52,255.67
Rate for Payer: Hawaii Medical Service Association Commercial	$38,185.49
Rate for Payer: Hawaii Medical Service Association Medicare	$47,505.15
Rate for Payer: Humana Medicare	$47,505.15
Rate for Payer: Kaiser Permanente Commercial	$62,303.55
Rate for Payer: Kaiser Permanente Medicare	$47,505.15
Rate for Payer: Ohana Health Plan Medicare	$47,505.15
Rate for Payer: UnitedHealthcare Medicare	$47,505.15

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$38,185.49

Service Code	MSDRG 099
Min. Negotiated Rate	$17,919.32
Max. Negotiated Rate	$38,185.49
Rate for Payer: AlohaCare Medicare	$17,919.32
Rate for Payer: Devoted Health Medicare	$19,711.25
Rate for Payer: Hawaii Medical Service Association Commercial	$38,185.49
Rate for Payer: Hawaii Medical Service Association Medicare	$17,919.32
Rate for Payer: Humana Medicare	$17,919.32
Rate for Payer: Kaiser Permanente Commercial	$23,501.40
Rate for Payer: Kaiser Permanente Medicare	$17,919.32
Rate for Payer: Ohana Health Plan Medicare	$17,919.32
Rate for Payer: UnitedHealthcare Medicare	$17,919.32

NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS

Facility

$3,351.49

Service Code	APR-DRG 0501
Min. Negotiated Rate	$3,351.49
Max. Negotiated Rate	$3,351.49
Rate for Payer: AlohaCare Medicaid	$3,351.49
Rate for Payer: Hawaii Medical Service Association ABD	$3,351.49
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,351.49
Rate for Payer: Kaiser Permanente Medicaid	$3,351.49
Rate for Payer: Ohana Health Plan Medicaid	$3,351.49
Rate for Payer: UnitedHealthcare Medicaid	$3,351.49

NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS

Facility

$6,052.81

Service Code	APR-DRG 0502
Min. Negotiated Rate	$6,052.81
Max. Negotiated Rate	$6,052.81
Rate for Payer: AlohaCare Medicaid	$6,052.81
Rate for Payer: Hawaii Medical Service Association ABD	$6,052.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,052.81
Rate for Payer: Kaiser Permanente Medicaid	$6,052.81
Rate for Payer: Ohana Health Plan Medicaid	$6,052.81
Rate for Payer: UnitedHealthcare Medicaid	$6,052.81

NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS

Facility

$9,653.30

Service Code	APR-DRG 0503
Min. Negotiated Rate	$9,653.30
Max. Negotiated Rate	$9,653.30
Rate for Payer: AlohaCare Medicaid	$9,653.30
Rate for Payer: Hawaii Medical Service Association ABD	$9,653.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,653.30
Rate for Payer: Kaiser Permanente Medicaid	$9,653.30
Rate for Payer: Ohana Health Plan Medicaid	$9,653.30
Rate for Payer: UnitedHealthcare Medicaid	$9,653.30

NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS

Facility

$19,539.66

Service Code	APR-DRG 0504
Min. Negotiated Rate	$19,539.66
Max. Negotiated Rate	$19,539.66
Rate for Payer: AlohaCare Medicaid	$19,539.66
Rate for Payer: Hawaii Medical Service Association ABD	$19,539.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19,539.66
Rate for Payer: Kaiser Permanente Medicaid	$19,539.66
Rate for Payer: Ohana Health Plan Medicaid	$19,539.66
Rate for Payer: UnitedHealthcare Medicaid	$19,539.66

NON-EXTENSIVE BURNS

Facility

$35,535.00

Service Code	MSDRG 935
Min. Negotiated Rate	$27,094.69
Max. Negotiated Rate	$35,535.00
Rate for Payer: AlohaCare Medicare	$27,094.69
Rate for Payer: Devoted Health Medicare	$29,804.16
Rate for Payer: Hawaii Medical Service Association Medicare	$27,094.69
Rate for Payer: Humana Medicare	$27,094.69
Rate for Payer: Kaiser Permanente Commercial	$35,535.00
Rate for Payer: Kaiser Permanente Medicare	$27,094.69
Rate for Payer: Ohana Health Plan Medicare	$27,094.69
Rate for Payer: UnitedHealthcare Medicare	$27,094.69

NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$15,880.59

Service Code	APR-DRG 7944
Min. Negotiated Rate	$15,880.59
Max. Negotiated Rate	$15,880.59
Rate for Payer: AlohaCare Medicaid	$15,880.59
Rate for Payer: Hawaii Medical Service Association ABD	$15,880.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15,880.59
Rate for Payer: Kaiser Permanente Medicaid	$15,880.59
Rate for Payer: Ohana Health Plan Medicaid	$15,880.59
Rate for Payer: UnitedHealthcare Medicaid	$15,880.59

NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$4,176.15

Service Code	APR-DRG 7941
Min. Negotiated Rate	$4,176.15
Max. Negotiated Rate	$4,176.15
Rate for Payer: AlohaCare Medicaid	$4,176.15
Rate for Payer: Hawaii Medical Service Association ABD	$4,176.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,176.15
Rate for Payer: Kaiser Permanente Medicaid	$4,176.15
Rate for Payer: Ohana Health Plan Medicaid	$4,176.15
Rate for Payer: UnitedHealthcare Medicaid	$4,176.15

NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$5,513.44

Service Code	APR-DRG 7942
Min. Negotiated Rate	$5,513.44
Max. Negotiated Rate	$5,513.44
Rate for Payer: AlohaCare Medicaid	$5,513.44
Rate for Payer: Hawaii Medical Service Association ABD	$5,513.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,513.44
Rate for Payer: Kaiser Permanente Medicaid	$5,513.44
Rate for Payer: Ohana Health Plan Medicaid	$5,513.44
Rate for Payer: UnitedHealthcare Medicaid	$5,513.44

NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$8,282.90

Service Code	APR-DRG 7943
Min. Negotiated Rate	$8,282.90
Max. Negotiated Rate	$8,282.90
Rate for Payer: AlohaCare Medicaid	$8,282.90
Rate for Payer: Hawaii Medical Service Association ABD	$8,282.90
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,282.90
Rate for Payer: Kaiser Permanente Medicaid	$8,282.90
Rate for Payer: Ohana Health Plan Medicaid	$8,282.90
Rate for Payer: UnitedHealthcare Medicaid	$8,282.90

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$38,667.63

Service Code	MSDRG 988
Min. Negotiated Rate	$21,617.88
Max. Negotiated Rate	$38,667.63
Rate for Payer: AlohaCare Medicare	$21,617.88
Rate for Payer: Devoted Health Medicare	$23,779.67
Rate for Payer: Hawaii Medical Service Association Commercial	$38,667.63
Rate for Payer: Hawaii Medical Service Association Medicare	$21,617.88
Rate for Payer: Humana Medicare	$21,617.88
Rate for Payer: Kaiser Permanente Commercial	$28,352.10
Rate for Payer: Kaiser Permanente Medicare	$21,617.88
Rate for Payer: Ohana Health Plan Medicare	$21,617.88
Rate for Payer: UnitedHealthcare Medicare	$21,617.88

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$59,139.90

Service Code	MSDRG 987
Min. Negotiated Rate	$38,667.63
Max. Negotiated Rate	$59,139.90
Rate for Payer: AlohaCare Medicare	$45,092.96
Rate for Payer: Devoted Health Medicare	$49,602.26
Rate for Payer: Hawaii Medical Service Association Commercial	$38,667.63
Rate for Payer: Hawaii Medical Service Association Medicare	$45,092.96
Rate for Payer: Humana Medicare	$45,092.96
Rate for Payer: Kaiser Permanente Commercial	$59,139.90
Rate for Payer: Kaiser Permanente Medicare	$45,092.96
Rate for Payer: Ohana Health Plan Medicare	$45,092.96
Rate for Payer: UnitedHealthcare Medicare	$45,092.96

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$38,667.63

Service Code	MSDRG 989
Min. Negotiated Rate	$15,772.79
Max. Negotiated Rate	$38,667.63
Rate for Payer: AlohaCare Medicare	$15,772.79
Rate for Payer: Devoted Health Medicare	$17,350.07
Rate for Payer: Hawaii Medical Service Association Commercial	$38,667.63
Rate for Payer: Hawaii Medical Service Association Medicare	$15,772.79
Rate for Payer: Humana Medicare	$15,772.79
Rate for Payer: Kaiser Permanente Commercial	$20,686.20
Rate for Payer: Kaiser Permanente Medicare	$15,772.79
Rate for Payer: Ohana Health Plan Medicare	$15,772.79
Rate for Payer: UnitedHealthcare Medicare	$15,772.79

NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$6,492.21

Service Code	APR-DRG 9522
Min. Negotiated Rate	$6,492.21
Max. Negotiated Rate	$6,492.21
Rate for Payer: AlohaCare Medicaid	$6,492.21
Rate for Payer: Hawaii Medical Service Association ABD	$6,492.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,492.21
Rate for Payer: Kaiser Permanente Medicaid	$6,492.21
Rate for Payer: Ohana Health Plan Medicaid	$6,492.21
Rate for Payer: UnitedHealthcare Medicaid	$6,492.21

NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$4,701.52

Service Code	APR-DRG 9521
Min. Negotiated Rate	$4,701.52
Max. Negotiated Rate	$4,701.52
Rate for Payer: AlohaCare Medicaid	$4,701.52
Rate for Payer: Hawaii Medical Service Association ABD	$4,701.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,701.52
Rate for Payer: Kaiser Permanente Medicaid	$4,701.52
Rate for Payer: Ohana Health Plan Medicaid	$4,701.52
Rate for Payer: UnitedHealthcare Medicaid	$4,701.52

Know your out-of-pocket cost for care.

All Charges