Kona Community Hospital

All Charges

Charge

Type

Setting

Price

PANCREAS TRANSPLANT

Facility

$103,818.33

Service Code	MSDRG 010
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$103,818.33
Rate for Payer: AlohaCare Medicare	$94,380.30
Rate for Payer: Devoted Health Medicare	$103,818.33
Rate for Payer: Hawaii Medical Service Association Medicare	$94,380.30
Rate for Payer: Kaiser Permanente Commercial	$52,955.78
Rate for Payer: Kaiser Permanente Medicare	$94,380.30
Rate for Payer: Ohana Health Plan Medicare	$94,380.30
Rate for Payer: UnitedHealthcare Medicare	$94,380.30
Rate for Payer: University Health Alliance Commercial	$10,400.00

PANCREAS TRANSPLANT

Facility

$72,811.42

Service Code	APR-DRG 0064
Min. Negotiated Rate	$72,811.42
Max. Negotiated Rate	$72,811.42
Rate for Payer: AlohaCare Medicaid	$72,811.42
Rate for Payer: Hawaii Medical Service Association ABD	$72,811.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$72,811.42
Rate for Payer: Kaiser Permanente Medicaid	$72,811.42
Rate for Payer: Ohana Health Plan Medicaid	$72,811.42
Rate for Payer: UnitedHealthcare Medicaid	$72,811.42

PANITUMUMAB 100 MG/5 ML (20 MG/ML) IV SOLN

Facility

$3,292.38

Service Code	HCPCS J9303
Hospital Revenue Code	250
Min. Negotiated Rate	$2,798.52
Max. Negotiated Rate	$3,193.61
Rate for Payer: Cash Price	$2,140.05
Rate for Payer: Health Management Network Commercial	$2,798.52
Rate for Payer: MDX Hawaii PPO	$3,193.61

PANITUMUMAB 100 MG/5 ML (20 MG/ML) IV SOLN

Facility

$3,292.38

Service Code	HCPCS J9303
Hospital Revenue Code	636
Min. Negotiated Rate	$172.55
Max. Negotiated Rate	$3,193.61
Rate for Payer: AlohaCare Medicaid	$174.39
Rate for Payer: AlohaCare Medicare	$174.39
Rate for Payer: Cash Price	$2,140.05
Rate for Payer: Cash Price	$2,140.05
Rate for Payer: Devoted Health Medicare	$191.83
Rate for Payer: Hawaii Medical Service Association ABD	$172.55
Rate for Payer: Hawaii Medical Service Association Commercial	$217.99
Rate for Payer: Hawaii Medical Service Association Medicare	$174.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$172.55
Rate for Payer: Hawaii Western Management Group Commercial	$3,127.76
Rate for Payer: Health Management Network Commercial	$2,798.52
Rate for Payer: Humana Medicare	$174.39
Rate for Payer: Kaiser Permanente Commercial	$2,074.20
Rate for Payer: Kaiser Permanente Medicaid	$1,679.11
Rate for Payer: Kaiser Permanente Medicare	$174.39
Rate for Payer: MDX Hawaii PPO	$3,193.61
Rate for Payer: Ohana Health Plan Medicaid	$191.83
Rate for Payer: Ohana Health Plan Medicare	$174.39
Rate for Payer: UnitedHealthcare Medicaid	$1,975.43
Rate for Payer: UnitedHealthcare Medicare	$174.39
Rate for Payer: University Health Alliance Commercial	$2,399.82

PANITUMUMAB 400 MG/20 ML (20 MG/ML) IV SOLN

Facility

$9,814.32

Service Code	HCPCS J9303
Hospital Revenue Code	250
Min. Negotiated Rate	$8,342.17
Max. Negotiated Rate	$9,519.89
Rate for Payer: Cash Price	$6,379.31
Rate for Payer: Health Management Network Commercial	$8,342.17
Rate for Payer: MDX Hawaii PPO	$9,519.89

PANITUMUMAB 400 MG/20 ML (20 MG/ML) IV SOLN

Facility

$9,814.32

Service Code	HCPCS J9303
Hospital Revenue Code	636
Min. Negotiated Rate	$172.55
Max. Negotiated Rate	$9,519.89
Rate for Payer: AlohaCare Medicaid	$174.39
Rate for Payer: AlohaCare Medicare	$174.39
Rate for Payer: Cash Price	$6,379.31
Rate for Payer: Cash Price	$6,379.31
Rate for Payer: Devoted Health Medicare	$191.83
Rate for Payer: Hawaii Medical Service Association ABD	$172.55
Rate for Payer: Hawaii Medical Service Association Commercial	$217.99
Rate for Payer: Hawaii Medical Service Association Medicare	$174.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$172.55
Rate for Payer: Hawaii Western Management Group Commercial	$9,323.60
Rate for Payer: Health Management Network Commercial	$8,342.17
Rate for Payer: Humana Medicare	$174.39
Rate for Payer: Kaiser Permanente Commercial	$6,183.02
Rate for Payer: Kaiser Permanente Medicaid	$5,005.30
Rate for Payer: Kaiser Permanente Medicare	$174.39
Rate for Payer: MDX Hawaii PPO	$9,519.89
Rate for Payer: Ohana Health Plan Medicaid	$191.83
Rate for Payer: Ohana Health Plan Medicare	$174.39
Rate for Payer: UnitedHealthcare Medicaid	$5,888.59
Rate for Payer: UnitedHealthcare Medicare	$174.39
Rate for Payer: University Health Alliance Commercial	$7,153.66

PANTOPRAZOLE 20 MG PO TAB DR EC

Facility

$61.79

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$31.51
Max. Negotiated Rate	$59.94
Rate for Payer: Cash Price	$40.16
Rate for Payer: Cash Price	$14.30
Rate for Payer: Cash Price	$13.64
Rate for Payer: Hawaii Western Management Group Commercial	$58.70
Rate for Payer: Hawaii Western Management Group Commercial	$19.93
Rate for Payer: Hawaii Western Management Group Commercial	$20.90
Rate for Payer: Health Management Network Commercial	$52.52
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Health Management Network Commercial	$17.83
Rate for Payer: Kaiser Permanente Commercial	$38.93
Rate for Payer: Kaiser Permanente Commercial	$13.86
Rate for Payer: Kaiser Permanente Commercial	$13.22
Rate for Payer: Kaiser Permanente Medicaid	$31.51
Rate for Payer: Kaiser Permanente Medicaid	$11.22
Rate for Payer: Kaiser Permanente Medicaid	$10.70
Rate for Payer: MDX Hawaii PPO	$20.35
Rate for Payer: MDX Hawaii PPO	$21.34
Rate for Payer: MDX Hawaii PPO	$59.94
Rate for Payer: UnitedHealthcare Medicaid	$12.59
Rate for Payer: UnitedHealthcare Medicaid	$37.07
Rate for Payer: UnitedHealthcare Medicaid	$13.20
Rate for Payer: University Health Alliance Commercial	$16.04
Rate for Payer: University Health Alliance Commercial	$15.29
Rate for Payer: University Health Alliance Commercial	$45.04

PANTOPRAZOLE 20 MG PO TAB DR EC

Facility

$61.79

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$52.52
Max. Negotiated Rate	$59.94
Rate for Payer: Cash Price	$40.16
Rate for Payer: Cash Price	$13.64
Rate for Payer: Cash Price	$14.30
Rate for Payer: Health Management Network Commercial	$17.83
Rate for Payer: Health Management Network Commercial	$18.70
Rate for Payer: Health Management Network Commercial	$52.52
Rate for Payer: MDX Hawaii PPO	$20.35
Rate for Payer: MDX Hawaii PPO	$59.94
Rate for Payer: MDX Hawaii PPO	$21.34

PANTOPRAZOLE 40 MG IV RECON.SOLN.

Facility

$19.32

Service Code	HCPCS J2470
Hospital Revenue Code	636
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$18.74
Rate for Payer: Cash Price	$12.56
Rate for Payer: Hawaii Western Management Group Commercial	$18.35
Rate for Payer: Health Management Network Commercial	$16.42
Rate for Payer: Kaiser Permanente Commercial	$12.17
Rate for Payer: Kaiser Permanente Medicaid	$9.85
Rate for Payer: MDX Hawaii PPO	$18.74
Rate for Payer: UnitedHealthcare Medicaid	$11.59
Rate for Payer: University Health Alliance Commercial	$14.08

PANTOPRAZOLE 40 MG IV RECON.SOLN.

Facility

$19.32

Service Code	HCPCS J2470
Hospital Revenue Code	250
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$18.74
Rate for Payer: Cash Price	$12.56
Rate for Payer: Health Management Network Commercial	$16.42
Rate for Payer: MDX Hawaii PPO	$18.74

PANTOPRAZOLE 40 MG PO GRPS

Facility

$76.61

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$65.12
Max. Negotiated Rate	$74.31
Rate for Payer: Cash Price	$49.80
Rate for Payer: Health Management Network Commercial	$65.12
Rate for Payer: MDX Hawaii PPO	$74.31

PANTOPRAZOLE 40 MG PO GRPS

Facility

$76.61

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$39.07
Max. Negotiated Rate	$74.31
Rate for Payer: Cash Price	$49.80
Rate for Payer: Hawaii Western Management Group Commercial	$72.78
Rate for Payer: Health Management Network Commercial	$65.12
Rate for Payer: Kaiser Permanente Commercial	$48.26
Rate for Payer: Kaiser Permanente Medicaid	$39.07
Rate for Payer: MDX Hawaii PPO	$74.31
Rate for Payer: UnitedHealthcare Medicaid	$45.97
Rate for Payer: University Health Alliance Commercial	$55.84

PANTOPRAZOLE 40 MG PO TAB DR EC

Facility

$22.23

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.34
Max. Negotiated Rate	$21.56
Rate for Payer: Cash Price	$14.45
Rate for Payer: Cash Price	$1.62
Rate for Payer: Hawaii Western Management Group Commercial	$21.12
Rate for Payer: Hawaii Western Management Group Commercial	$2.38
Rate for Payer: Health Management Network Commercial	$18.90
Rate for Payer: Health Management Network Commercial	$2.12
Rate for Payer: Kaiser Permanente Commercial	$14.00
Rate for Payer: Kaiser Permanente Commercial	$1.57
Rate for Payer: Kaiser Permanente Medicaid	$11.34
Rate for Payer: Kaiser Permanente Medicaid	$1.27
Rate for Payer: MDX Hawaii PPO	$21.56
Rate for Payer: MDX Hawaii PPO	$2.42
Rate for Payer: UnitedHealthcare Medicaid	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$13.34
Rate for Payer: University Health Alliance Commercial	$16.20
Rate for Payer: University Health Alliance Commercial	$1.82

PANTOPRAZOLE 40 MG PO TAB DR EC

Facility

$2.50

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$2.42
Rate for Payer: Cash Price	$1.62
Rate for Payer: Cash Price	$14.45
Rate for Payer: Health Management Network Commercial	$18.90
Rate for Payer: Health Management Network Commercial	$2.12
Rate for Payer: MDX Hawaii PPO	$2.42
Rate for Payer: MDX Hawaii PPO	$21.56

PAROXETINE HCL 10 MG PO TABLET

Facility

$14.42

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$12.26
Max. Negotiated Rate	$13.99
Rate for Payer: Cash Price	$9.37
Rate for Payer: Health Management Network Commercial	$12.26
Rate for Payer: MDX Hawaii PPO	$13.99

PAROXETINE HCL 10 MG PO TABLET

Facility

$14.42

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$13.99
Rate for Payer: Cash Price	$9.37
Rate for Payer: Hawaii Western Management Group Commercial	$13.70
Rate for Payer: Health Management Network Commercial	$12.26
Rate for Payer: Kaiser Permanente Commercial	$9.08
Rate for Payer: Kaiser Permanente Medicaid	$7.35
Rate for Payer: MDX Hawaii PPO	$13.99
Rate for Payer: UnitedHealthcare Medicaid	$8.65
Rate for Payer: University Health Alliance Commercial	$10.51

PAROXETINE HCL 20 MG PO TABLET

Facility

$15.09

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$12.83
Max. Negotiated Rate	$14.64
Rate for Payer: Cash Price	$9.81
Rate for Payer: Health Management Network Commercial	$12.83
Rate for Payer: MDX Hawaii PPO	$14.64

PAROXETINE HCL 20 MG PO TABLET

Facility

$15.09

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$14.64
Rate for Payer: Cash Price	$9.81
Rate for Payer: Hawaii Western Management Group Commercial	$14.34
Rate for Payer: Health Management Network Commercial	$12.83
Rate for Payer: Kaiser Permanente Commercial	$9.51
Rate for Payer: Kaiser Permanente Medicaid	$7.70
Rate for Payer: MDX Hawaii PPO	$14.64
Rate for Payer: UnitedHealthcare Medicaid	$9.05
Rate for Payer: University Health Alliance Commercial	$11.00

PAROXETINE HCL 20 MG PO TABLET (0.5 TAB) = 10 MG

Facility

$15.09

Service Code	NDC RPKWH000705
Hospital Revenue Code	250
Min. Negotiated Rate	$12.83
Max. Negotiated Rate	$14.64
Rate for Payer: Cash Price	$9.81
Rate for Payer: Health Management Network Commercial	$12.83
Rate for Payer: MDX Hawaii PPO	$14.64

PAROXETINE HCL 20 MG PO TABLET (0.5 TAB) = 10 MG

Facility

$15.09

Service Code	NDC RPKWH000705
Hospital Revenue Code	250
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$14.64
Rate for Payer: Cash Price	$9.81
Rate for Payer: Hawaii Western Management Group Commercial	$14.34
Rate for Payer: Health Management Network Commercial	$12.83
Rate for Payer: Kaiser Permanente Commercial	$9.51
Rate for Payer: Kaiser Permanente Medicaid	$7.70
Rate for Payer: MDX Hawaii PPO	$14.64
Rate for Payer: UnitedHealthcare Medicaid	$9.05
Rate for Payer: University Health Alliance Commercial	$11.00

PAROXETINE HCL 30 MG PO TABLET

Facility

$15.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$15.07
Rate for Payer: Cash Price	$10.10
Rate for Payer: Hawaii Western Management Group Commercial	$14.76
Rate for Payer: Health Management Network Commercial	$13.21
Rate for Payer: Kaiser Permanente Commercial	$9.79
Rate for Payer: Kaiser Permanente Medicaid	$7.93
Rate for Payer: MDX Hawaii PPO	$15.07
Rate for Payer: UnitedHealthcare Medicaid	$9.32
Rate for Payer: University Health Alliance Commercial	$11.33

PAROXETINE HCL 30 MG PO TABLET

Facility

$15.54

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$15.07
Rate for Payer: Cash Price	$10.10
Rate for Payer: Health Management Network Commercial	$13.21
Rate for Payer: MDX Hawaii PPO	$15.07

Partial Knee Oxford Anat Brg LT LG Sz3 PMA 159554 [3641030]

Facility

$4,103.00

Service Code	HCPCS C1776
Hospital Charge Code	3641030
Hospital Revenue Code	278
Min. Negotiated Rate	$2,092.53
Max. Negotiated Rate	$3,979.91
Rate for Payer: Cash Price	$2,666.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,872.10
Rate for Payer: Health Management Network Commercial	$3,487.55
Rate for Payer: Kaiser Permanente Commercial	$2,584.89
Rate for Payer: Kaiser Permanente Medicaid	$2,092.53
Rate for Payer: MDX Hawaii PPO	$3,979.91
Rate for Payer: University Health Alliance Commercial	$2,297.68

Partial Knee Oxford Anat Brg LT LG Sz3 PMA 159554 [3641030]

Facility

$4,103.00

Service Code	HCPCS C1776
Hospital Charge Code	3641030
Hospital Revenue Code	278
Min. Negotiated Rate	$2,297.68
Max. Negotiated Rate	$3,979.91
Rate for Payer: Cash Price	$2,666.95
Rate for Payer: Hawaii Western Management Group Commercial	$2,872.10
Rate for Payer: Health Management Network Commercial	$3,487.55
Rate for Payer: MDX Hawaii PPO	$3,979.91
Rate for Payer: University Health Alliance Commercial	$2,297.68

Partial Knee Oxford Anat Brg LT MD Sz3 PMA 159547 [3641288]

Facility

$3,325.00

Service Code	HCPCS C1776
Hospital Charge Code	3641288
Hospital Revenue Code	278
Min. Negotiated Rate	$1,695.75
Max. Negotiated Rate	$3,225.25
Rate for Payer: Cash Price	$2,161.25
Rate for Payer: Hawaii Western Management Group Commercial	$2,327.50
Rate for Payer: Health Management Network Commercial	$2,826.25
Rate for Payer: Kaiser Permanente Commercial	$2,094.75
Rate for Payer: Kaiser Permanente Medicaid	$1,695.75
Rate for Payer: MDX Hawaii PPO	$3,225.25
Rate for Payer: University Health Alliance Commercial	$1,862.00

Know your out-of-pocket cost for care.

All Charges