Kona Community Hospital

All Charges

Charge

Type

Setting

Price

PREGABALIN 100 MG PO CAP

Facility

$64.09

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$32.69
Max. Negotiated Rate	$62.17
Rate for Payer: Cash Price	$41.66
Rate for Payer: Cash Price	$5.80
Rate for Payer: Hawaii Western Management Group Commercial	$60.89
Rate for Payer: Hawaii Western Management Group Commercial	$8.48
Rate for Payer: Health Management Network Commercial	$54.48
Rate for Payer: Health Management Network Commercial	$7.59
Rate for Payer: Kaiser Permanente Commercial	$40.38
Rate for Payer: Kaiser Permanente Commercial	$5.63
Rate for Payer: Kaiser Permanente Medicaid	$32.69
Rate for Payer: Kaiser Permanente Medicaid	$4.55
Rate for Payer: MDX Hawaii PPO	$62.17
Rate for Payer: MDX Hawaii PPO	$8.66
Rate for Payer: UnitedHealthcare Medicaid	$5.36
Rate for Payer: UnitedHealthcare Medicaid	$38.45
Rate for Payer: University Health Alliance Commercial	$46.72
Rate for Payer: University Health Alliance Commercial	$6.51

PREGABALIN 100 MG PO CAP

Facility

$64.09

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$54.48
Max. Negotiated Rate	$62.17
Rate for Payer: Cash Price	$41.66
Rate for Payer: Cash Price	$5.80
Rate for Payer: Health Management Network Commercial	$7.59
Rate for Payer: Health Management Network Commercial	$54.48
Rate for Payer: MDX Hawaii PPO	$62.17
Rate for Payer: MDX Hawaii PPO	$8.66

PREGABALIN 25 MG PO CAP

Facility

$50.36

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$42.81
Max. Negotiated Rate	$48.85
Rate for Payer: Cash Price	$32.73
Rate for Payer: Cash Price	$5.80
Rate for Payer: Health Management Network Commercial	$42.81
Rate for Payer: Health Management Network Commercial	$7.59
Rate for Payer: MDX Hawaii PPO	$48.85
Rate for Payer: MDX Hawaii PPO	$8.66

PREGABALIN 25 MG PO CAP

Facility

$8.93

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$8.66
Rate for Payer: Cash Price	$5.80
Rate for Payer: Cash Price	$32.73
Rate for Payer: Hawaii Western Management Group Commercial	$47.84
Rate for Payer: Hawaii Western Management Group Commercial	$8.48
Rate for Payer: Health Management Network Commercial	$42.81
Rate for Payer: Health Management Network Commercial	$7.59
Rate for Payer: Kaiser Permanente Commercial	$5.63
Rate for Payer: Kaiser Permanente Commercial	$31.73
Rate for Payer: Kaiser Permanente Medicaid	$4.55
Rate for Payer: Kaiser Permanente Medicaid	$25.68
Rate for Payer: MDX Hawaii PPO	$48.85
Rate for Payer: MDX Hawaii PPO	$8.66
Rate for Payer: UnitedHealthcare Medicaid	$30.22
Rate for Payer: UnitedHealthcare Medicaid	$5.36
Rate for Payer: University Health Alliance Commercial	$6.51
Rate for Payer: University Health Alliance Commercial	$36.71

PREGABALIN 50 MG PO CAP

Facility

$4.17

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$4.04
Rate for Payer: Cash Price	$2.71
Rate for Payer: Cash Price	$5.80
Rate for Payer: Hawaii Western Management Group Commercial	$3.96
Rate for Payer: Hawaii Western Management Group Commercial	$8.48
Rate for Payer: Health Management Network Commercial	$3.54
Rate for Payer: Health Management Network Commercial	$7.59
Rate for Payer: Kaiser Permanente Commercial	$2.63
Rate for Payer: Kaiser Permanente Commercial	$5.63
Rate for Payer: Kaiser Permanente Medicaid	$2.13
Rate for Payer: Kaiser Permanente Medicaid	$4.55
Rate for Payer: MDX Hawaii PPO	$4.04
Rate for Payer: MDX Hawaii PPO	$8.66
Rate for Payer: UnitedHealthcare Medicaid	$5.36
Rate for Payer: UnitedHealthcare Medicaid	$2.50
Rate for Payer: University Health Alliance Commercial	$3.04
Rate for Payer: University Health Alliance Commercial	$6.51

PREGABALIN 50 MG PO CAP

Facility

$4.17

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$4.04
Rate for Payer: Cash Price	$2.71
Rate for Payer: Cash Price	$5.80
Rate for Payer: Health Management Network Commercial	$7.59
Rate for Payer: Health Management Network Commercial	$3.54
Rate for Payer: MDX Hawaii PPO	$4.04
Rate for Payer: MDX Hawaii PPO	$8.66

PREGABALIN 75 MG PO CAP

Facility

$8.93

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$8.66
Rate for Payer: Cash Price	$5.80
Rate for Payer: Cash Price	$2.76
Rate for Payer: Hawaii Western Management Group Commercial	$8.48
Rate for Payer: Hawaii Western Management Group Commercial	$4.03
Rate for Payer: Health Management Network Commercial	$3.60
Rate for Payer: Health Management Network Commercial	$7.59
Rate for Payer: Kaiser Permanente Commercial	$5.63
Rate for Payer: Kaiser Permanente Commercial	$2.67
Rate for Payer: Kaiser Permanente Medicaid	$2.16
Rate for Payer: Kaiser Permanente Medicaid	$4.55
Rate for Payer: MDX Hawaii PPO	$4.11
Rate for Payer: MDX Hawaii PPO	$8.66
Rate for Payer: UnitedHealthcare Medicaid	$5.36
Rate for Payer: UnitedHealthcare Medicaid	$2.54
Rate for Payer: University Health Alliance Commercial	$6.51
Rate for Payer: University Health Alliance Commercial	$3.09

PREGABALIN 75 MG PO CAP

Facility

$4.24

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$4.11
Rate for Payer: Cash Price	$2.76
Rate for Payer: Cash Price	$5.80
Rate for Payer: Health Management Network Commercial	$3.60
Rate for Payer: Health Management Network Commercial	$7.59
Rate for Payer: MDX Hawaii PPO	$4.11
Rate for Payer: MDX Hawaii PPO	$8.66

PREMATURITY WITH MAJOR PROBLEMS

Facility

$70,017.75

Service Code	MSDRG 791
Min. Negotiated Rate	$53,387.08
Max. Negotiated Rate	$70,017.75
Rate for Payer: AlohaCare Medicare	$53,387.08
Rate for Payer: Devoted Health Medicare	$58,725.79
Rate for Payer: Hawaii Medical Service Association Commercial	$62,629.99
Rate for Payer: Hawaii Medical Service Association Medicare	$53,387.08
Rate for Payer: Humana Medicare	$53,387.08
Rate for Payer: Kaiser Permanente Commercial	$70,017.75
Rate for Payer: Kaiser Permanente Medicare	$53,387.08
Rate for Payer: Ohana Health Plan Medicare	$53,387.08
Rate for Payer: UnitedHealthcare Medicare	$53,387.08

PREMATURITY WITHOUT MAJOR PROBLEMS

Facility

$42,248.70

Service Code	MSDRG 792
Min. Negotiated Rate	$12,535.64
Max. Negotiated Rate	$42,248.70
Rate for Payer: AlohaCare Medicare	$32,213.75
Rate for Payer: Devoted Health Medicare	$35,435.12
Rate for Payer: Hawaii Medical Service Association Commercial	$12,535.64
Rate for Payer: Hawaii Medical Service Association Medicare	$32,213.75
Rate for Payer: Humana Medicare	$32,213.75
Rate for Payer: Kaiser Permanente Commercial	$42,248.70
Rate for Payer: Kaiser Permanente Medicare	$32,213.75
Rate for Payer: Ohana Health Plan Medicare	$32,213.75
Rate for Payer: UnitedHealthcare Medicare	$32,213.75

Prep Kit w/Restrictors 546101000 [3641159]

Facility

$1,485.86

Hospital Charge Code	3641159
Hospital Revenue Code	272
Min. Negotiated Rate	$1,262.98
Max. Negotiated Rate	$1,441.28
Rate for Payer: Cash Price	$965.81
Rate for Payer: Health Management Network Commercial	$1,262.98
Rate for Payer: MDX Hawaii PPO	$1,441.28

Prep Kit w/Restrictors 546101000 [3641159]

Facility

$1,485.86

Hospital Charge Code	3641159
Hospital Revenue Code	272
Min. Negotiated Rate	$757.79
Max. Negotiated Rate	$1,441.28
Rate for Payer: Cash Price	$965.81
Rate for Payer: Hawaii Western Management Group Commercial	$1,411.57
Rate for Payer: Health Management Network Commercial	$1,262.98
Rate for Payer: Kaiser Permanente Commercial	$936.09
Rate for Payer: Kaiser Permanente Medicaid	$757.79
Rate for Payer: MDX Hawaii PPO	$1,441.28
Rate for Payer: University Health Alliance Commercial	$1,083.04

Prevalon Airtap Std [2702442]

Facility

$1,041.90

Hospital Charge Code	2702442
Hospital Revenue Code	272
Min. Negotiated Rate	$885.62
Max. Negotiated Rate	$1,010.64
Rate for Payer: Cash Price	$677.24
Rate for Payer: Health Management Network Commercial	$885.62
Rate for Payer: MDX Hawaii PPO	$1,010.64

Prevalon Airtap Std [2702442]

Facility

$1,041.90

Hospital Charge Code	2702442
Hospital Revenue Code	272
Min. Negotiated Rate	$531.37
Max. Negotiated Rate	$1,010.64
Rate for Payer: Cash Price	$677.24
Rate for Payer: Hawaii Western Management Group Commercial	$989.80
Rate for Payer: Health Management Network Commercial	$885.62
Rate for Payer: Kaiser Permanente Commercial	$656.40
Rate for Payer: Kaiser Permanente Medicaid	$531.37
Rate for Payer: MDX Hawaii PPO	$1,010.64
Rate for Payer: University Health Alliance Commercial	$759.44

Prevalon Airtap Xxlg [2702443]

Facility

$1,683.68

Hospital Charge Code	2702443
Hospital Revenue Code	272
Min. Negotiated Rate	$858.68
Max. Negotiated Rate	$1,633.17
Rate for Payer: Cash Price	$1,094.39
Rate for Payer: Hawaii Western Management Group Commercial	$1,599.50
Rate for Payer: Health Management Network Commercial	$1,431.13
Rate for Payer: Kaiser Permanente Commercial	$1,060.72
Rate for Payer: Kaiser Permanente Medicaid	$858.68
Rate for Payer: MDX Hawaii PPO	$1,633.17
Rate for Payer: University Health Alliance Commercial	$1,227.23

Prevalon Airtap Xxlg [2702443]

Facility

$1,683.68

Hospital Charge Code	2702443
Hospital Revenue Code	272
Min. Negotiated Rate	$1,431.13
Max. Negotiated Rate	$1,633.17
Rate for Payer: Cash Price	$1,094.39
Rate for Payer: Health Management Network Commercial	$1,431.13
Rate for Payer: MDX Hawaii PPO	$1,633.17

Prevena Cannister Pre4095 [3643806]

Facility

$210.38

Hospital Charge Code	3643806
Hospital Revenue Code	272
Min. Negotiated Rate	$107.29
Max. Negotiated Rate	$204.07
Rate for Payer: Cash Price	$136.75
Rate for Payer: Hawaii Western Management Group Commercial	$199.86
Rate for Payer: Health Management Network Commercial	$178.82
Rate for Payer: Kaiser Permanente Commercial	$132.54
Rate for Payer: Kaiser Permanente Medicaid	$107.29
Rate for Payer: MDX Hawaii PPO	$204.07
Rate for Payer: University Health Alliance Commercial	$153.35

Prevena Cannister Pre4095 [3643806]

Facility

$210.38

Hospital Charge Code	3643806
Hospital Revenue Code	272
Min. Negotiated Rate	$178.82
Max. Negotiated Rate	$204.07
Rate for Payer: Cash Price	$136.75
Rate for Payer: Health Management Network Commercial	$178.82
Rate for Payer: MDX Hawaii PPO	$204.07

Prevena Plus Dressing PRE4055US [3643117]

Facility

$2,132.38

Hospital Charge Code	3643117
Hospital Revenue Code	272
Min. Negotiated Rate	$1,087.51
Max. Negotiated Rate	$2,068.41
Rate for Payer: Cash Price	$1,386.05
Rate for Payer: Hawaii Western Management Group Commercial	$2,025.76
Rate for Payer: Health Management Network Commercial	$1,812.52
Rate for Payer: Kaiser Permanente Commercial	$1,343.40
Rate for Payer: Kaiser Permanente Medicaid	$1,087.51
Rate for Payer: MDX Hawaii PPO	$2,068.41
Rate for Payer: University Health Alliance Commercial	$1,554.29

Prevena Plus Dressing PRE4055US [3643117]

Facility

$2,132.38

Hospital Charge Code	3643117
Hospital Revenue Code	272
Min. Negotiated Rate	$1,812.52
Max. Negotiated Rate	$2,068.41
Rate for Payer: Cash Price	$1,386.05
Rate for Payer: Health Management Network Commercial	$1,812.52
Rate for Payer: MDX Hawaii PPO	$2,068.41

Prevena Plus Sys Kit Customizable PRE4001US [3642453]

Facility

$3,428.00

Hospital Charge Code	3642453
Hospital Revenue Code	272
Min. Negotiated Rate	$2,913.80
Max. Negotiated Rate	$3,325.16
Rate for Payer: Cash Price	$2,228.20
Rate for Payer: Health Management Network Commercial	$2,913.80
Rate for Payer: MDX Hawaii PPO	$3,325.16

Prevena Plus Sys Kit Customizable PRE4001US [3642453]

Facility

$3,428.00

Hospital Charge Code	3642453
Hospital Revenue Code	272
Min. Negotiated Rate	$1,748.28
Max. Negotiated Rate	$3,325.16
Rate for Payer: Cash Price	$2,228.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,256.60
Rate for Payer: Health Management Network Commercial	$2,913.80
Rate for Payer: Kaiser Permanente Commercial	$2,159.64
Rate for Payer: Kaiser Permanente Medicaid	$1,748.28
Rate for Payer: MDX Hawaii PPO	$3,325.16
Rate for Payer: University Health Alliance Commercial	$2,498.67

Prevena Restor PRE5001 [3642657]

Facility

$4,046.75

Hospital Charge Code	3642657
Hospital Revenue Code	272
Min. Negotiated Rate	$2,063.84
Max. Negotiated Rate	$3,925.35
Rate for Payer: Cash Price	$2,630.39
Rate for Payer: Hawaii Western Management Group Commercial	$3,844.41
Rate for Payer: Health Management Network Commercial	$3,439.74
Rate for Payer: Kaiser Permanente Commercial	$2,549.45
Rate for Payer: Kaiser Permanente Medicaid	$2,063.84
Rate for Payer: MDX Hawaii PPO	$3,925.35
Rate for Payer: University Health Alliance Commercial	$2,949.68

Prevena Restor PRE5001 [3642657]

Facility

$4,046.75

Hospital Charge Code	3642657
Hospital Revenue Code	272
Min. Negotiated Rate	$3,439.74
Max. Negotiated Rate	$3,925.35
Rate for Payer: Cash Price	$2,630.39
Rate for Payer: Health Management Network Commercial	$3,439.74
Rate for Payer: MDX Hawaii PPO	$3,925.35

Prima Fit - Urine Management For Women [2701084]

Facility

$111.10

Hospital Charge Code	2701084
Hospital Revenue Code	272
Min. Negotiated Rate	$94.44
Max. Negotiated Rate	$107.77
Rate for Payer: Cash Price	$72.22
Rate for Payer: Health Management Network Commercial	$94.44
Rate for Payer: MDX Hawaii PPO	$107.77

Know your out-of-pocket cost for care.

All Charges