Kona Community Hospital

All Charges

Charge

Type

Setting

Price

PNEUMOTHORAX WITHOUT CC/MCC

Facility

$14,006.17

Service Code	MSDRG 201
Min. Negotiated Rate	$9,405.54
Max. Negotiated Rate	$14,006.17
Rate for Payer: AlohaCare Medicare	$9,405.54
Rate for Payer: Devoted Health Medicare	$10,346.09
Rate for Payer: Hawaii Medical Service Association Commercial	$14,006.17
Rate for Payer: Hawaii Medical Service Association Medicare	$9,405.54
Rate for Payer: Humana Medicare	$9,405.54
Rate for Payer: Kaiser Permanente Commercial	$12,335.48
Rate for Payer: Kaiser Permanente Medicare	$9,405.54
Rate for Payer: Ohana Health Plan Medicare	$9,405.54
Rate for Payer: UnitedHealthcare Medicare	$9,405.54

PNV,CALCIUM 72-IRON-FOLIC ACID 27 MG IRON- 1 MG PO TABLET

Facility

$1.99

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.93
Rate for Payer: Cash Price	$1.29
Rate for Payer: Health Management Network Commercial	$1.69
Rate for Payer: MDX Hawaii PPO	$1.93

PNV,CALCIUM 72-IRON-FOLIC ACID 27 MG IRON- 1 MG PO TABLET

Facility

$1.99

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.93
Rate for Payer: Cash Price	$1.29
Rate for Payer: Hawaii Western Management Group Commercial	$1.89
Rate for Payer: Health Management Network Commercial	$1.69
Rate for Payer: Kaiser Permanente Commercial	$1.25
Rate for Payer: Kaiser Permanente Medicaid	$1.01
Rate for Payer: MDX Hawaii PPO	$1.93
Rate for Payer: UnitedHealthcare Medicaid	$1.19
Rate for Payer: University Health Alliance Commercial	$1.45

POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC

Facility

$27,054.90

Service Code	MSDRG 917
Min. Negotiated Rate	$20,628.81
Max. Negotiated Rate	$27,054.90
Rate for Payer: AlohaCare Medicare	$20,628.81
Rate for Payer: Devoted Health Medicare	$22,691.69
Rate for Payer: Hawaii Medical Service Association Commercial	$20,948.98
Rate for Payer: Hawaii Medical Service Association Medicare	$20,628.81
Rate for Payer: Humana Medicare	$20,628.81
Rate for Payer: Kaiser Permanente Commercial	$27,054.90
Rate for Payer: Kaiser Permanente Medicare	$20,628.81
Rate for Payer: Ohana Health Plan Medicare	$20,628.81
Rate for Payer: UnitedHealthcare Medicare	$20,628.81

POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC

Facility

$15,982.94

Service Code	MSDRG 918
Min. Negotiated Rate	$11,273.23
Max. Negotiated Rate	$15,982.94
Rate for Payer: AlohaCare Medicare	$11,273.23
Rate for Payer: Devoted Health Medicare	$12,400.55
Rate for Payer: Hawaii Medical Service Association Commercial	$15,982.94
Rate for Payer: Hawaii Medical Service Association Medicare	$11,273.23
Rate for Payer: Humana Medicare	$11,273.23
Rate for Payer: Kaiser Permanente Commercial	$14,784.98
Rate for Payer: Kaiser Permanente Medicare	$11,273.23
Rate for Payer: Ohana Health Plan Medicare	$11,273.23
Rate for Payer: UnitedHealthcare Medicare	$11,273.23

POISONING OF MEDICINAL AGENTS

Facility

$6,899.12

Service Code	APR-DRG 8124
Min. Negotiated Rate	$6,899.12
Max. Negotiated Rate	$6,899.12
Rate for Payer: AlohaCare Medicaid	$6,899.12
Rate for Payer: Hawaii Medical Service Association ABD	$6,899.12
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,899.12
Rate for Payer: Kaiser Permanente Medicaid	$6,899.12
Rate for Payer: Ohana Health Plan Medicaid	$6,899.12
Rate for Payer: UnitedHealthcare Medicaid	$6,899.12

POISONING OF MEDICINAL AGENTS

Facility

$1,909.77

Service Code	APR-DRG 8121
Min. Negotiated Rate	$1,909.77
Max. Negotiated Rate	$1,909.77
Rate for Payer: AlohaCare Medicaid	$1,909.77
Rate for Payer: Hawaii Medical Service Association ABD	$1,909.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,909.77
Rate for Payer: Kaiser Permanente Medicaid	$1,909.77
Rate for Payer: Ohana Health Plan Medicaid	$1,909.77
Rate for Payer: UnitedHealthcare Medicaid	$1,909.77

POISONING OF MEDICINAL AGENTS

Facility

$3,943.08

Service Code	APR-DRG 8123
Min. Negotiated Rate	$3,943.08
Max. Negotiated Rate	$3,943.08
Rate for Payer: AlohaCare Medicaid	$3,943.08
Rate for Payer: Hawaii Medical Service Association ABD	$3,943.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,943.08
Rate for Payer: Kaiser Permanente Medicaid	$3,943.08
Rate for Payer: Ohana Health Plan Medicaid	$3,943.08
Rate for Payer: UnitedHealthcare Medicaid	$3,943.08

POISONING OF MEDICINAL AGENTS

Facility

$2,736.34

Service Code	APR-DRG 8122
Min. Negotiated Rate	$2,736.34
Max. Negotiated Rate	$2,736.34
Rate for Payer: AlohaCare Medicaid	$2,736.34
Rate for Payer: Hawaii Medical Service Association ABD	$2,736.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,736.34
Rate for Payer: Kaiser Permanente Medicaid	$2,736.34
Rate for Payer: Ohana Health Plan Medicaid	$2,736.34
Rate for Payer: UnitedHealthcare Medicaid	$2,736.34

POLYETHYLENE GLYCOL 3350 17 GRAM PO POWDER PACK

Facility

$10.60

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.01
Max. Negotiated Rate	$10.28
Rate for Payer: Cash Price	$6.89
Rate for Payer: Cash Price	$4.63
Rate for Payer: Health Management Network Commercial	$9.01
Rate for Payer: Health Management Network Commercial	$6.06
Rate for Payer: MDX Hawaii PPO	$10.28
Rate for Payer: MDX Hawaii PPO	$6.92

POLYETHYLENE GLYCOL 3350 17 GRAM PO POWDER PACK

Facility

$7.13

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$6.92
Rate for Payer: Cash Price	$4.63
Rate for Payer: Cash Price	$6.89
Rate for Payer: Hawaii Western Management Group Commercial	$10.07
Rate for Payer: Hawaii Western Management Group Commercial	$6.77
Rate for Payer: Health Management Network Commercial	$9.01
Rate for Payer: Health Management Network Commercial	$6.06
Rate for Payer: Kaiser Permanente Commercial	$4.49
Rate for Payer: Kaiser Permanente Commercial	$6.68
Rate for Payer: Kaiser Permanente Medicaid	$3.64
Rate for Payer: Kaiser Permanente Medicaid	$5.41
Rate for Payer: MDX Hawaii PPO	$10.28
Rate for Payer: MDX Hawaii PPO	$6.92
Rate for Payer: UnitedHealthcare Medicaid	$6.36
Rate for Payer: UnitedHealthcare Medicaid	$4.28
Rate for Payer: University Health Alliance Commercial	$5.20
Rate for Payer: University Health Alliance Commercial	$7.73

Polygrab Tripod Grasping Forcep 2.8mm FG-600U [3644834]

Facility

$503.12

Hospital Charge Code	3644834
Hospital Revenue Code	272
Min. Negotiated Rate	$427.65
Max. Negotiated Rate	$488.03
Rate for Payer: Cash Price	$327.03
Rate for Payer: Health Management Network Commercial	$427.65
Rate for Payer: MDX Hawaii PPO	$488.03

Polygrab Tripod Grasping Forcep 2.8mm FG-600U [3644834]

Facility

$503.12

Hospital Charge Code	3644834
Hospital Revenue Code	272
Min. Negotiated Rate	$256.59
Max. Negotiated Rate	$488.03
Rate for Payer: Cash Price	$327.03
Rate for Payer: Hawaii Western Management Group Commercial	$477.96
Rate for Payer: Health Management Network Commercial	$427.65
Rate for Payer: Kaiser Permanente Commercial	$316.97
Rate for Payer: Kaiser Permanente Medicaid	$256.59
Rate for Payer: MDX Hawaii PPO	$488.03
Rate for Payer: University Health Alliance Commercial	$366.72

Portal Skid AR-4505 [3642124]

Facility

$520.25

Hospital Charge Code	3642124
Hospital Revenue Code	272
Min. Negotiated Rate	$442.21
Max. Negotiated Rate	$504.64
Rate for Payer: Cash Price	$338.16
Rate for Payer: Health Management Network Commercial	$442.21
Rate for Payer: MDX Hawaii PPO	$504.64

Portal Skid AR-4505 [3642124]

Facility

$520.25

Hospital Charge Code	3642124
Hospital Revenue Code	272
Min. Negotiated Rate	$265.33
Max. Negotiated Rate	$504.64
Rate for Payer: Cash Price	$338.16
Rate for Payer: Hawaii Western Management Group Commercial	$494.24
Rate for Payer: Health Management Network Commercial	$442.21
Rate for Payer: Kaiser Permanente Commercial	$327.76
Rate for Payer: Kaiser Permanente Medicaid	$265.33
Rate for Payer: MDX Hawaii PPO	$504.64
Rate for Payer: University Health Alliance Commercial	$379.21

POSACONAZOLE 100 MG PO TAB DR EC

Facility

$355.38

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$181.24
Max. Negotiated Rate	$344.72
Rate for Payer: Cash Price	$231.00
Rate for Payer: Hawaii Western Management Group Commercial	$337.61
Rate for Payer: Health Management Network Commercial	$302.07
Rate for Payer: Kaiser Permanente Commercial	$223.89
Rate for Payer: Kaiser Permanente Medicaid	$181.24
Rate for Payer: MDX Hawaii PPO	$344.72
Rate for Payer: UnitedHealthcare Medicaid	$213.23
Rate for Payer: University Health Alliance Commercial	$259.04

POSACONAZOLE 100 MG PO TAB DR EC

Facility

$355.38

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$302.07
Max. Negotiated Rate	$344.72
Rate for Payer: Cash Price	$231.00
Rate for Payer: Health Management Network Commercial	$302.07
Rate for Payer: MDX Hawaii PPO	$344.72

POSITRON EMISSION TOMOGRAPHY RP DX TUMOR ID NOC

Professional

Both

$0.01

Service Code	HCPCS A9597
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Health Management Network Commercial	$0.01

POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC

Facility

$31,458.83

Service Code	MSDRG 862
Min. Negotiated Rate	$21,913.26
Max. Negotiated Rate	$31,458.83
Rate for Payer: AlohaCare Medicare	$23,986.69
Rate for Payer: Devoted Health Medicare	$26,385.36
Rate for Payer: Hawaii Medical Service Association Commercial	$21,913.26
Rate for Payer: Hawaii Medical Service Association Medicare	$23,986.69
Rate for Payer: Humana Medicare	$23,986.69
Rate for Payer: Kaiser Permanente Commercial	$31,458.83
Rate for Payer: Kaiser Permanente Medicare	$23,986.69
Rate for Payer: Ohana Health Plan Medicare	$23,986.69
Rate for Payer: UnitedHealthcare Medicare	$23,986.69

POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC

Facility

$21,913.26

Service Code	MSDRG 863
Min. Negotiated Rate	$13,125.14
Max. Negotiated Rate	$21,913.26
Rate for Payer: AlohaCare Medicare	$13,125.14
Rate for Payer: Devoted Health Medicare	$14,437.65
Rate for Payer: Hawaii Medical Service Association Commercial	$21,913.26
Rate for Payer: Hawaii Medical Service Association Medicare	$13,125.14
Rate for Payer: Humana Medicare	$13,125.14
Rate for Payer: Kaiser Permanente Commercial	$17,213.78
Rate for Payer: Kaiser Permanente Medicare	$13,125.14
Rate for Payer: Ohana Health Plan Medicare	$13,125.14
Rate for Payer: UnitedHealthcare Medicare	$13,125.14

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC

Facility

$38,547.09

Service Code	MSDRG 857
Min. Negotiated Rate	$28,166.66
Max. Negotiated Rate	$38,547.09
Rate for Payer: AlohaCare Medicare	$28,166.66
Rate for Payer: Devoted Health Medicare	$30,983.33
Rate for Payer: Hawaii Medical Service Association Commercial	$38,547.09
Rate for Payer: Hawaii Medical Service Association Medicare	$28,166.66
Rate for Payer: Humana Medicare	$28,166.66
Rate for Payer: Kaiser Permanente Commercial	$36,940.88
Rate for Payer: Kaiser Permanente Medicare	$28,166.66
Rate for Payer: Ohana Health Plan Medicare	$28,166.66
Rate for Payer: UnitedHealthcare Medicare	$28,166.66

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC

Facility

$78,465.07

Service Code	MSDRG 856
Min. Negotiated Rate	$38,547.09
Max. Negotiated Rate	$78,465.07
Rate for Payer: AlohaCare Medicare	$59,827.99
Rate for Payer: Devoted Health Medicare	$65,810.79
Rate for Payer: Hawaii Medical Service Association Commercial	$38,547.09
Rate for Payer: Hawaii Medical Service Association Medicare	$59,827.99
Rate for Payer: Humana Medicare	$59,827.99
Rate for Payer: Kaiser Permanente Commercial	$78,465.07
Rate for Payer: Kaiser Permanente Medicare	$59,827.99
Rate for Payer: Ohana Health Plan Medicare	$59,827.99
Rate for Payer: UnitedHealthcare Medicare	$59,827.99

POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$38,547.09

Service Code	MSDRG 858
Min. Negotiated Rate	$18,320.48
Max. Negotiated Rate	$38,547.09
Rate for Payer: AlohaCare Medicare	$18,320.48
Rate for Payer: Devoted Health Medicare	$20,152.53
Rate for Payer: Hawaii Medical Service Association Commercial	$38,547.09
Rate for Payer: Hawaii Medical Service Association Medicare	$18,320.48
Rate for Payer: Humana Medicare	$18,320.48
Rate for Payer: Kaiser Permanente Commercial	$24,027.53
Rate for Payer: Kaiser Permanente Medicare	$18,320.48
Rate for Payer: Ohana Health Plan Medicare	$18,320.48
Rate for Payer: UnitedHealthcare Medicare	$18,320.48

POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS

Facility

$2,817.85

Service Code	APR-DRG 7211
Min. Negotiated Rate	$2,817.85
Max. Negotiated Rate	$2,817.85
Rate for Payer: AlohaCare Medicaid	$2,817.85
Rate for Payer: Hawaii Medical Service Association ABD	$2,817.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,817.85
Rate for Payer: Kaiser Permanente Medicaid	$2,817.85
Rate for Payer: Ohana Health Plan Medicaid	$2,817.85
Rate for Payer: UnitedHealthcare Medicaid	$2,817.85

POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS

Facility

$3,804.26

Service Code	APR-DRG 7212
Min. Negotiated Rate	$3,804.26
Max. Negotiated Rate	$3,804.26
Rate for Payer: AlohaCare Medicaid	$3,804.26
Rate for Payer: Hawaii Medical Service Association ABD	$3,804.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,804.26
Rate for Payer: Kaiser Permanente Medicaid	$3,804.26
Rate for Payer: Ohana Health Plan Medicaid	$3,804.26
Rate for Payer: UnitedHealthcare Medicaid	$3,804.26

Know your out-of-pocket cost for care.

All Charges