Kona Community Hospital

All Charges

Charge

Type

Setting

Price

PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK

Facility

$8,426.18

Service Code	APR-DRG 1711
Min. Negotiated Rate	$8,426.18
Max. Negotiated Rate	$8,426.18
Rate for Payer: AlohaCare Medicaid	$8,426.18
Rate for Payer: Hawaii Medical Service Association ABD	$8,426.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,426.18
Rate for Payer: Kaiser Permanente Medicaid	$8,426.18
Rate for Payer: Ohana Health Plan Medicaid	$8,426.18
Rate for Payer: UnitedHealthcare Medicaid	$8,426.18

PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK

Facility

$11,873.19

Service Code	APR-DRG 1713
Min. Negotiated Rate	$11,873.19
Max. Negotiated Rate	$11,873.19
Rate for Payer: AlohaCare Medicaid	$11,873.19
Rate for Payer: Hawaii Medical Service Association ABD	$11,873.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,873.19
Rate for Payer: Kaiser Permanente Medicaid	$11,873.19
Rate for Payer: Ohana Health Plan Medicaid	$11,873.19
Rate for Payer: UnitedHealthcare Medicaid	$11,873.19

PERMETHRIN 1 % TOP LIQ

Facility

$82.49

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$42.07
Max. Negotiated Rate	$80.02
Rate for Payer: Cash Price	$53.62
Rate for Payer: Hawaii Western Management Group Commercial	$78.37
Rate for Payer: Health Management Network Commercial	$70.12
Rate for Payer: Kaiser Permanente Commercial	$51.97
Rate for Payer: Kaiser Permanente Medicaid	$42.07
Rate for Payer: MDX Hawaii PPO	$80.02
Rate for Payer: UnitedHealthcare Medicaid	$49.49
Rate for Payer: University Health Alliance Commercial	$60.13

PERMETHRIN 1 % TOP LIQ

Facility

$82.49

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$70.12
Max. Negotiated Rate	$80.02
Rate for Payer: Cash Price	$53.62
Rate for Payer: Health Management Network Commercial	$70.12
Rate for Payer: MDX Hawaii PPO	$80.02

PERMETHRIN 5 % TOP CR

Facility

$486.63

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$413.64
Max. Negotiated Rate	$472.03
Rate for Payer: Cash Price	$316.31
Rate for Payer: Cash Price	$315.26
Rate for Payer: Health Management Network Commercial	$412.26
Rate for Payer: Health Management Network Commercial	$413.64
Rate for Payer: MDX Hawaii PPO	$470.46
Rate for Payer: MDX Hawaii PPO	$472.03

PERMETHRIN 5 % TOP CR

Facility

$485.01

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$247.36
Max. Negotiated Rate	$470.46
Rate for Payer: Cash Price	$315.26
Rate for Payer: Cash Price	$316.31
Rate for Payer: Hawaii Western Management Group Commercial	$460.76
Rate for Payer: Hawaii Western Management Group Commercial	$462.30
Rate for Payer: Health Management Network Commercial	$412.26
Rate for Payer: Health Management Network Commercial	$413.64
Rate for Payer: Kaiser Permanente Commercial	$305.56
Rate for Payer: Kaiser Permanente Commercial	$306.58
Rate for Payer: Kaiser Permanente Medicaid	$247.36
Rate for Payer: Kaiser Permanente Medicaid	$248.18
Rate for Payer: MDX Hawaii PPO	$470.46
Rate for Payer: MDX Hawaii PPO	$472.03
Rate for Payer: UnitedHealthcare Medicaid	$291.98
Rate for Payer: UnitedHealthcare Medicaid	$291.01
Rate for Payer: University Health Alliance Commercial	$353.52
Rate for Payer: University Health Alliance Commercial	$354.70

PERPHENAZINE 4 MG PO TABLET

Facility

$11.62

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.88
Max. Negotiated Rate	$11.27
Rate for Payer: Cash Price	$7.55
Rate for Payer: Cash Price	$8.58
Rate for Payer: Health Management Network Commercial	$9.88
Rate for Payer: Health Management Network Commercial	$11.22
Rate for Payer: MDX Hawaii PPO	$11.27
Rate for Payer: MDX Hawaii PPO	$12.80

PERPHENAZINE 4 MG PO TABLET

Facility

$13.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.73
Max. Negotiated Rate	$12.80
Rate for Payer: Cash Price	$8.58
Rate for Payer: Cash Price	$7.55
Rate for Payer: Hawaii Western Management Group Commercial	$11.04
Rate for Payer: Hawaii Western Management Group Commercial	$12.54
Rate for Payer: Health Management Network Commercial	$9.88
Rate for Payer: Health Management Network Commercial	$11.22
Rate for Payer: Kaiser Permanente Commercial	$8.32
Rate for Payer: Kaiser Permanente Commercial	$7.32
Rate for Payer: Kaiser Permanente Medicaid	$6.73
Rate for Payer: Kaiser Permanente Medicaid	$5.93
Rate for Payer: MDX Hawaii PPO	$11.27
Rate for Payer: MDX Hawaii PPO	$12.80
Rate for Payer: UnitedHealthcare Medicaid	$6.97
Rate for Payer: UnitedHealthcare Medicaid	$7.92
Rate for Payer: University Health Alliance Commercial	$9.62
Rate for Payer: University Health Alliance Commercial	$8.47

PERTUZUMAB 420 MG/14 ML (30 MG/ML) IV SOLN

Facility

$9,303.00

Service Code	HCPCS J9306
Hospital Revenue Code	636
Min. Negotiated Rate	$16.89
Max. Negotiated Rate	$9,023.91
Rate for Payer: AlohaCare Medicaid	$17.02
Rate for Payer: AlohaCare Medicare	$17.02
Rate for Payer: Cash Price	$6,046.95
Rate for Payer: Cash Price	$6,046.95
Rate for Payer: Devoted Health Medicare	$18.72
Rate for Payer: Hawaii Medical Service Association ABD	$16.89
Rate for Payer: Hawaii Medical Service Association Commercial	$21.27
Rate for Payer: Hawaii Medical Service Association Medicare	$17.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16.89
Rate for Payer: Hawaii Western Management Group Commercial	$8,837.85
Rate for Payer: Health Management Network Commercial	$7,907.55
Rate for Payer: Humana Medicare	$17.02
Rate for Payer: Kaiser Permanente Commercial	$5,860.89
Rate for Payer: Kaiser Permanente Medicaid	$4,744.53
Rate for Payer: Kaiser Permanente Medicare	$17.02
Rate for Payer: MDX Hawaii PPO	$9,023.91
Rate for Payer: Ohana Health Plan Medicaid	$18.72
Rate for Payer: Ohana Health Plan Medicare	$17.02
Rate for Payer: UnitedHealthcare Medicaid	$5,581.80
Rate for Payer: UnitedHealthcare Medicare	$17.02
Rate for Payer: University Health Alliance Commercial	$6,780.96

PERTUZUMAB 420 MG/14 ML (30 MG/ML) IV SOLN

Facility

$9,303.00

Service Code	HCPCS J9306
Hospital Revenue Code	250
Min. Negotiated Rate	$7,907.55
Max. Negotiated Rate	$9,023.91
Rate for Payer: Cash Price	$6,046.95
Rate for Payer: Health Management Network Commercial	$7,907.55
Rate for Payer: MDX Hawaii PPO	$9,023.91

PERTUZUMAB-TRASTUZUMAB-HY-ZZXF 600 MG-600 MG- 20000 UNIT/10ML SUBCUTANEOUS SOLN

Facility

$12,251.19

Service Code	HCPCS J9316
Hospital Revenue Code	636
Min. Negotiated Rate	$60.23
Max. Negotiated Rate	$11,883.65
Rate for Payer: AlohaCare Medicaid	$60.23
Rate for Payer: AlohaCare Medicare	$60.23
Rate for Payer: Cash Price	$7,963.27
Rate for Payer: Cash Price	$7,963.27
Rate for Payer: Devoted Health Medicare	$66.25
Rate for Payer: Hawaii Medical Service Association ABD	$63.39
Rate for Payer: Hawaii Medical Service Association Commercial	$75.29
Rate for Payer: Hawaii Medical Service Association Medicare	$60.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$63.39
Rate for Payer: Hawaii Western Management Group Commercial	$11,638.63
Rate for Payer: Health Management Network Commercial	$10,413.51
Rate for Payer: Humana Medicare	$60.23
Rate for Payer: Kaiser Permanente Commercial	$7,718.25
Rate for Payer: Kaiser Permanente Medicaid	$6,248.11
Rate for Payer: Kaiser Permanente Medicare	$60.23
Rate for Payer: MDX Hawaii PPO	$11,883.65
Rate for Payer: Ohana Health Plan Medicaid	$66.25
Rate for Payer: Ohana Health Plan Medicare	$60.23
Rate for Payer: UnitedHealthcare Medicaid	$7,350.71
Rate for Payer: UnitedHealthcare Medicare	$60.23
Rate for Payer: University Health Alliance Commercial	$8,929.89

PERTUZUMAB-TRASTUZUMAB-HY-ZZXF 600 MG-600 MG- 20000 UNIT/10ML SUBCUTANEOUS SOLN

Facility

$12,251.19

Service Code	HCPCS J9316
Hospital Revenue Code	250
Min. Negotiated Rate	$10,413.51
Max. Negotiated Rate	$11,883.65
Rate for Payer: Cash Price	$7,963.27
Rate for Payer: Health Management Network Commercial	$10,413.51
Rate for Payer: MDX Hawaii PPO	$11,883.65

PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH

Professional

Both

$4,100.00

Service Code	HCPCS 78815
Min. Negotiated Rate	$1,263.23
Max. Negotiated Rate	$3,485.00
Rate for Payer: Cash Price	$2,665.00
Rate for Payer: Cash Price	$2,665.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,263.23
Rate for Payer: Health Management Network Commercial	$3,485.00

PET IMAGING FOR CT ATTENUATION WHOLE BODY

Professional

Both

$4,000.00

Service Code	HCPCS 78816
Min. Negotiated Rate	$2,102.37
Max. Negotiated Rate	$3,400.00
Rate for Payer: Cash Price	$2,600.00
Rate for Payer: Cash Price	$2,600.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,102.37
Rate for Payer: Health Management Network Commercial	$3,400.00

PHENAZOPYRIDINE 100 MG PO TABLET

Facility

$14.91

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$14.46
Rate for Payer: Cash Price	$9.69
Rate for Payer: Hawaii Western Management Group Commercial	$14.16
Rate for Payer: Health Management Network Commercial	$12.67
Rate for Payer: Kaiser Permanente Commercial	$9.39
Rate for Payer: Kaiser Permanente Medicaid	$7.60
Rate for Payer: MDX Hawaii PPO	$14.46
Rate for Payer: UnitedHealthcare Medicaid	$8.95
Rate for Payer: University Health Alliance Commercial	$10.87

PHENAZOPYRIDINE 100 MG PO TABLET

Facility

$14.91

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$12.67
Max. Negotiated Rate	$14.46
Rate for Payer: Cash Price	$9.69
Rate for Payer: Health Management Network Commercial	$12.67
Rate for Payer: MDX Hawaii PPO	$14.46

PHENAZOPYRIDINE 200 MG PO TABLET

Facility

$22.08

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$18.77
Max. Negotiated Rate	$21.42
Rate for Payer: Cash Price	$14.35
Rate for Payer: Health Management Network Commercial	$18.77
Rate for Payer: MDX Hawaii PPO	$21.42

PHENAZOPYRIDINE 200 MG PO TABLET

Facility

$22.08

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.26
Max. Negotiated Rate	$21.42
Rate for Payer: Cash Price	$14.35
Rate for Payer: Hawaii Western Management Group Commercial	$20.98
Rate for Payer: Health Management Network Commercial	$18.77
Rate for Payer: Kaiser Permanente Commercial	$13.91
Rate for Payer: Kaiser Permanente Medicaid	$11.26
Rate for Payer: MDX Hawaii PPO	$21.42
Rate for Payer: UnitedHealthcare Medicaid	$13.25
Rate for Payer: University Health Alliance Commercial	$16.09

PHENOBARBITAL 32.4 MG PO TABLET

Facility

$3.70

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$3.59
Rate for Payer: Cash Price	$2.41
Rate for Payer: Health Management Network Commercial	$3.15
Rate for Payer: MDX Hawaii PPO	$3.59

PHENOBARBITAL 32.4 MG PO TABLET

Facility

$3.70

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$3.59
Rate for Payer: Cash Price	$2.41
Rate for Payer: Hawaii Western Management Group Commercial	$3.52
Rate for Payer: Health Management Network Commercial	$3.15
Rate for Payer: Kaiser Permanente Commercial	$2.33
Rate for Payer: Kaiser Permanente Medicaid	$1.89
Rate for Payer: MDX Hawaii PPO	$3.59
Rate for Payer: UnitedHealthcare Medicaid	$2.22
Rate for Payer: University Health Alliance Commercial	$2.70

PHENOBARBITAL SODIUM 130 MG/ML INJ SOLN

Facility

$208.44

Service Code	HCPCS J2560
Hospital Revenue Code	250
Min. Negotiated Rate	$177.17
Max. Negotiated Rate	$202.19
Rate for Payer: Cash Price	$135.49
Rate for Payer: Health Management Network Commercial	$177.17
Rate for Payer: MDX Hawaii PPO	$202.19

PHENOBARBITAL SODIUM 130 MG/ML INJ SOLN

Facility

$208.44

Service Code	HCPCS J2560
Hospital Revenue Code	636
Min. Negotiated Rate	$27.36
Max. Negotiated Rate	$202.19
Rate for Payer: Cash Price	$135.49
Rate for Payer: Cash Price	$135.49
Rate for Payer: Hawaii Medical Service Association ABD	$27.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$27.36
Rate for Payer: Hawaii Western Management Group Commercial	$198.02
Rate for Payer: Health Management Network Commercial	$177.17
Rate for Payer: Kaiser Permanente Commercial	$131.32
Rate for Payer: Kaiser Permanente Medicaid	$106.30
Rate for Payer: MDX Hawaii PPO	$202.19
Rate for Payer: UnitedHealthcare Medicaid	$125.06
Rate for Payer: University Health Alliance Commercial	$151.93

PHENOL 1.4 % MM AERO.SPRAY

Facility

$48.12

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$24.54
Max. Negotiated Rate	$46.68
Rate for Payer: Cash Price	$31.28
Rate for Payer: Cash Price	$10.17
Rate for Payer: Hawaii Western Management Group Commercial	$14.86
Rate for Payer: Hawaii Western Management Group Commercial	$45.71
Rate for Payer: Health Management Network Commercial	$13.29
Rate for Payer: Health Management Network Commercial	$40.90
Rate for Payer: Kaiser Permanente Commercial	$9.85
Rate for Payer: Kaiser Permanente Commercial	$30.32
Rate for Payer: Kaiser Permanente Medicaid	$24.54
Rate for Payer: Kaiser Permanente Medicaid	$7.98
Rate for Payer: MDX Hawaii PPO	$15.17
Rate for Payer: MDX Hawaii PPO	$46.68
Rate for Payer: UnitedHealthcare Medicaid	$9.38
Rate for Payer: UnitedHealthcare Medicaid	$28.87
Rate for Payer: University Health Alliance Commercial	$35.07
Rate for Payer: University Health Alliance Commercial	$11.40

PHENOL 1.4 % MM AERO.SPRAY

Facility

$15.64

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$15.17
Rate for Payer: Cash Price	$10.17
Rate for Payer: Cash Price	$31.28
Rate for Payer: Health Management Network Commercial	$40.90
Rate for Payer: Health Management Network Commercial	$13.29
Rate for Payer: MDX Hawaii PPO	$46.68
Rate for Payer: MDX Hawaii PPO	$15.17

PHENTOLAMINE 5 MG INJ RECON.SOLN.

Facility

$1,257.17

Service Code	HCPCS J2760
Hospital Revenue Code	636
Min. Negotiated Rate	$257.45
Max. Negotiated Rate	$1,219.45
Rate for Payer: AlohaCare Medicaid	$257.45
Rate for Payer: AlohaCare Medicare	$257.45
Rate for Payer: Cash Price	$817.16
Rate for Payer: Cash Price	$817.16
Rate for Payer: Devoted Health Medicare	$283.19
Rate for Payer: Hawaii Medical Service Association ABD	$436.51
Rate for Payer: Hawaii Medical Service Association Commercial	$321.81
Rate for Payer: Hawaii Medical Service Association Medicare	$257.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$436.51
Rate for Payer: Hawaii Western Management Group Commercial	$1,194.31
Rate for Payer: Health Management Network Commercial	$1,068.59
Rate for Payer: Humana Medicare	$257.45
Rate for Payer: Kaiser Permanente Commercial	$792.02
Rate for Payer: Kaiser Permanente Medicaid	$641.16
Rate for Payer: Kaiser Permanente Medicare	$257.45
Rate for Payer: MDX Hawaii PPO	$1,219.45
Rate for Payer: Ohana Health Plan Medicaid	$283.19
Rate for Payer: Ohana Health Plan Medicare	$257.45
Rate for Payer: UnitedHealthcare Medicaid	$754.30
Rate for Payer: UnitedHealthcare Medicare	$257.45
Rate for Payer: University Health Alliance Commercial	$916.35

Know your out-of-pocket cost for care.

All Charges