Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Prima Fit - Urine Management For Women [2701084]

Facility

$111.10

Hospital Charge Code	2701084
Hospital Revenue Code	272
Min. Negotiated Rate	$56.66
Max. Negotiated Rate	$107.77
Rate for Payer: Cash Price	$72.22
Rate for Payer: Hawaii Western Management Group Commercial	$105.55
Rate for Payer: Health Management Network Commercial	$94.44
Rate for Payer: Kaiser Permanente Commercial	$69.99
Rate for Payer: Kaiser Permanente Medicaid	$56.66
Rate for Payer: MDX Hawaii PPO	$107.77
Rate for Payer: University Health Alliance Commercial	$80.98

PRIMAQUINE 26.3 MG (15 MG BASE) PO TABLET

Facility

$11.30

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.61
Max. Negotiated Rate	$10.96
Rate for Payer: Cash Price	$7.35
Rate for Payer: Health Management Network Commercial	$9.61
Rate for Payer: MDX Hawaii PPO	$10.96

PRIMAQUINE 26.3 MG (15 MG BASE) PO TABLET

Facility

$11.30

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$10.96
Rate for Payer: Cash Price	$7.35
Rate for Payer: Hawaii Western Management Group Commercial	$10.73
Rate for Payer: Health Management Network Commercial	$9.61
Rate for Payer: Kaiser Permanente Commercial	$7.12
Rate for Payer: Kaiser Permanente Medicaid	$5.76
Rate for Payer: MDX Hawaii PPO	$10.96
Rate for Payer: UnitedHealthcare Medicaid	$6.78
Rate for Payer: University Health Alliance Commercial	$8.24

Probe Ablation Serfas Rf 90-S Max 279-401-100 [3644274]

Facility

$1,059.25

Hospital Charge Code	3644274
Hospital Revenue Code	272
Min. Negotiated Rate	$540.22
Max. Negotiated Rate	$1,027.47
Rate for Payer: Cash Price	$688.51
Rate for Payer: Hawaii Western Management Group Commercial	$1,006.29
Rate for Payer: Health Management Network Commercial	$900.36
Rate for Payer: Kaiser Permanente Commercial	$667.33
Rate for Payer: Kaiser Permanente Medicaid	$540.22
Rate for Payer: MDX Hawaii PPO	$1,027.47
Rate for Payer: University Health Alliance Commercial	$772.09

Probe Ablation Serfas Rf 90-S Max 279-401-100 [3644274]

Facility

$1,059.25

Hospital Charge Code	3644274
Hospital Revenue Code	272
Min. Negotiated Rate	$900.36
Max. Negotiated Rate	$1,027.47
Rate for Payer: Cash Price	$688.51
Rate for Payer: Health Management Network Commercial	$900.36
Rate for Payer: MDX Hawaii PPO	$1,027.47

PROBENECID 500 MG PO TABLET

Facility

$20.60

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$10.51
Max. Negotiated Rate	$19.98
Rate for Payer: Cash Price	$13.39
Rate for Payer: Hawaii Western Management Group Commercial	$19.57
Rate for Payer: Health Management Network Commercial	$17.51
Rate for Payer: Kaiser Permanente Commercial	$12.98
Rate for Payer: Kaiser Permanente Medicaid	$10.51
Rate for Payer: MDX Hawaii PPO	$19.98
Rate for Payer: UnitedHealthcare Medicaid	$12.36
Rate for Payer: University Health Alliance Commercial	$15.02

PROBENECID 500 MG PO TABLET

Facility

$20.60

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$17.51
Max. Negotiated Rate	$19.98
Rate for Payer: Cash Price	$13.39
Rate for Payer: Health Management Network Commercial	$17.51
Rate for Payer: MDX Hawaii PPO	$19.98

PROCEDURES FOR OBESITY

Facility

$7,358.26

Service Code	APR-DRG 4032
Min. Negotiated Rate	$7,358.26
Max. Negotiated Rate	$7,358.26
Rate for Payer: AlohaCare Medicaid	$7,358.26
Rate for Payer: Hawaii Medical Service Association ABD	$7,358.26
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,358.26
Rate for Payer: Kaiser Permanente Medicaid	$7,358.26
Rate for Payer: Ohana Health Plan Medicaid	$7,358.26
Rate for Payer: UnitedHealthcare Medicaid	$7,358.26

PROCEDURES FOR OBESITY

Facility

$10,109.25

Service Code	APR-DRG 4033
Min. Negotiated Rate	$10,109.25
Max. Negotiated Rate	$10,109.25
Rate for Payer: AlohaCare Medicaid	$10,109.25
Rate for Payer: Hawaii Medical Service Association ABD	$10,109.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,109.25
Rate for Payer: Kaiser Permanente Medicaid	$10,109.25
Rate for Payer: Ohana Health Plan Medicaid	$10,109.25
Rate for Payer: UnitedHealthcare Medicaid	$10,109.25

PROCEDURES FOR OBESITY

Facility

$25,100.86

Service Code	APR-DRG 4034
Min. Negotiated Rate	$25,100.86
Max. Negotiated Rate	$25,100.86
Rate for Payer: AlohaCare Medicaid	$25,100.86
Rate for Payer: Hawaii Medical Service Association ABD	$25,100.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$25,100.86
Rate for Payer: Kaiser Permanente Medicaid	$25,100.86
Rate for Payer: Ohana Health Plan Medicaid	$25,100.86
Rate for Payer: UnitedHealthcare Medicaid	$25,100.86

PROCEDURES FOR OBESITY

Facility

$6,485.20

Service Code	APR-DRG 4031
Min. Negotiated Rate	$6,485.20
Max. Negotiated Rate	$6,485.20
Rate for Payer: AlohaCare Medicaid	$6,485.20
Rate for Payer: Hawaii Medical Service Association ABD	$6,485.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,485.20
Rate for Payer: Kaiser Permanente Medicaid	$6,485.20
Rate for Payer: Ohana Health Plan Medicaid	$6,485.20
Rate for Payer: UnitedHealthcare Medicaid	$6,485.20

PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE

Facility

$28,460.64

Service Code	APR-DRG 8504
Min. Negotiated Rate	$28,460.64
Max. Negotiated Rate	$28,460.64
Rate for Payer: AlohaCare Medicaid	$28,460.64
Rate for Payer: Hawaii Medical Service Association ABD	$28,460.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$28,460.64
Rate for Payer: Kaiser Permanente Medicaid	$28,460.64
Rate for Payer: Ohana Health Plan Medicaid	$28,460.64
Rate for Payer: UnitedHealthcare Medicaid	$28,460.64

PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE

Facility

$13,321.92

Service Code	APR-DRG 8503
Min. Negotiated Rate	$13,321.92
Max. Negotiated Rate	$13,321.92
Rate for Payer: AlohaCare Medicaid	$13,321.92
Rate for Payer: Hawaii Medical Service Association ABD	$13,321.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,321.92
Rate for Payer: Kaiser Permanente Medicaid	$13,321.92
Rate for Payer: Ohana Health Plan Medicaid	$13,321.92
Rate for Payer: UnitedHealthcare Medicaid	$13,321.92

PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE

Facility

$10,746.69

Service Code	APR-DRG 8502
Min. Negotiated Rate	$10,746.69
Max. Negotiated Rate	$10,746.69
Rate for Payer: AlohaCare Medicaid	$10,746.69
Rate for Payer: Hawaii Medical Service Association ABD	$10,746.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,746.69
Rate for Payer: Kaiser Permanente Medicaid	$10,746.69
Rate for Payer: Ohana Health Plan Medicaid	$10,746.69
Rate for Payer: UnitedHealthcare Medicaid	$10,746.69

PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE

Facility

$8,697.46

Service Code	APR-DRG 8501
Min. Negotiated Rate	$8,697.46
Max. Negotiated Rate	$8,697.46
Rate for Payer: AlohaCare Medicaid	$8,697.46
Rate for Payer: Hawaii Medical Service Association ABD	$8,697.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,697.46
Rate for Payer: Kaiser Permanente Medicaid	$8,697.46
Rate for Payer: Ohana Health Plan Medicaid	$8,697.46
Rate for Payer: UnitedHealthcare Medicaid	$8,697.46

PROCHLORPERAZINE 25 MG PR SUPP

Facility

$68.76

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$58.45
Max. Negotiated Rate	$66.70
Rate for Payer: Cash Price	$44.69
Rate for Payer: Cash Price	$45.56
Rate for Payer: Cash Price	$44.69
Rate for Payer: Health Management Network Commercial	$58.44
Rate for Payer: Health Management Network Commercial	$58.45
Rate for Payer: Health Management Network Commercial	$59.59
Rate for Payer: MDX Hawaii PPO	$66.69
Rate for Payer: MDX Hawaii PPO	$68.00
Rate for Payer: MDX Hawaii PPO	$66.70

PROCHLORPERAZINE 25 MG PR SUPP

Facility

$68.76

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$35.07
Max. Negotiated Rate	$66.70
Rate for Payer: Cash Price	$44.69
Rate for Payer: Cash Price	$44.69
Rate for Payer: Cash Price	$45.56
Rate for Payer: Hawaii Western Management Group Commercial	$65.31
Rate for Payer: Hawaii Western Management Group Commercial	$66.59
Rate for Payer: Hawaii Western Management Group Commercial	$65.32
Rate for Payer: Health Management Network Commercial	$59.59
Rate for Payer: Health Management Network Commercial	$58.44
Rate for Payer: Health Management Network Commercial	$58.45
Rate for Payer: Kaiser Permanente Commercial	$43.31
Rate for Payer: Kaiser Permanente Commercial	$43.32
Rate for Payer: Kaiser Permanente Commercial	$44.16
Rate for Payer: Kaiser Permanente Medicaid	$35.75
Rate for Payer: Kaiser Permanente Medicaid	$35.07
Rate for Payer: Kaiser Permanente Medicaid	$35.06
Rate for Payer: MDX Hawaii PPO	$68.00
Rate for Payer: MDX Hawaii PPO	$66.69
Rate for Payer: MDX Hawaii PPO	$66.70
Rate for Payer: UnitedHealthcare Medicaid	$41.26
Rate for Payer: UnitedHealthcare Medicaid	$41.25
Rate for Payer: UnitedHealthcare Medicaid	$42.06
Rate for Payer: University Health Alliance Commercial	$51.10
Rate for Payer: University Health Alliance Commercial	$50.11
Rate for Payer: University Health Alliance Commercial	$50.12

PROCHLORPERAZINE EDISYLATE 5 (5 MG/ML) INJ SOLN

Facility

$30.64

Service Code	HCPCS J0780
Hospital Revenue Code	250
Min. Negotiated Rate	$26.04
Max. Negotiated Rate	$29.72
Rate for Payer: Cash Price	$19.92
Rate for Payer: Cash Price	$40.19
Rate for Payer: Health Management Network Commercial	$26.04
Rate for Payer: Health Management Network Commercial	$52.56
Rate for Payer: MDX Hawaii PPO	$29.72
Rate for Payer: MDX Hawaii PPO	$59.98

PROCHLORPERAZINE EDISYLATE 5 (5 MG/ML) INJ SOLN

Facility

$30.64

Service Code	HCPCS J0780
Hospital Revenue Code	636
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$29.72
Rate for Payer: Cash Price	$19.92
Rate for Payer: Cash Price	$40.19
Rate for Payer: Cash Price	$19.92
Rate for Payer: Cash Price	$40.19
Rate for Payer: Hawaii Medical Service Association ABD	$2.52
Rate for Payer: Hawaii Medical Service Association ABD	$2.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.52
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.52
Rate for Payer: Hawaii Western Management Group Commercial	$58.74
Rate for Payer: Hawaii Western Management Group Commercial	$29.11
Rate for Payer: Health Management Network Commercial	$52.56
Rate for Payer: Health Management Network Commercial	$26.04
Rate for Payer: Kaiser Permanente Commercial	$38.95
Rate for Payer: Kaiser Permanente Commercial	$19.30
Rate for Payer: Kaiser Permanente Medicaid	$15.63
Rate for Payer: Kaiser Permanente Medicaid	$31.53
Rate for Payer: MDX Hawaii PPO	$29.72
Rate for Payer: MDX Hawaii PPO	$59.98
Rate for Payer: UnitedHealthcare Medicaid	$37.10
Rate for Payer: UnitedHealthcare Medicaid	$18.38
Rate for Payer: University Health Alliance Commercial	$22.33
Rate for Payer: University Health Alliance Commercial	$45.07

PROCHLORPERAZINE MALEATE 10 MG PO TABLET

Facility

$4.93

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$4.78
Rate for Payer: Cash Price	$3.20
Rate for Payer: Hawaii Western Management Group Commercial	$4.68
Rate for Payer: Health Management Network Commercial	$4.19
Rate for Payer: Kaiser Permanente Commercial	$3.11
Rate for Payer: Kaiser Permanente Medicaid	$2.51
Rate for Payer: MDX Hawaii PPO	$4.78
Rate for Payer: UnitedHealthcare Medicaid	$2.96
Rate for Payer: University Health Alliance Commercial	$3.59

PROCHLORPERAZINE MALEATE 10 MG PO TABLET

Facility

$4.93

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$4.78
Rate for Payer: Cash Price	$3.20
Rate for Payer: Health Management Network Commercial	$4.19
Rate for Payer: MDX Hawaii PPO	$4.78

PROCTOPEXY (EG, FOR PROLAPSE); PERINEAL APPROACH

Facility

$13,923.44

Service Code	CPT 45541
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$13,923.44
Rate for Payer: AlohaCare Medicaid	$3,279.01
Rate for Payer: AlohaCare Medicare	$3,279.01
Rate for Payer: Devoted Health Medicare	$3,606.91
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$9,416.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,279.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$3,279.01
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,279.01
Rate for Payer: Ohana Health Plan Medicaid	$3,606.91
Rate for Payer: Ohana Health Plan Medicare	$3,279.01
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,279.01
Rate for Payer: University Health Alliance Commercial	$13,923.44

PROCTOSIGMOIDOSCOPY, RIGID; WITH BIOPSY, SINGLE OR MULTIPLE

Facility

$2,837.00

Service Code	CPT 45305
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$1,413.65
Rate for Payer: AlohaCare Medicare	$1,413.65
Rate for Payer: Devoted Health Medicare	$1,555.02
Rate for Payer: Hawaii Medical Service Association Commercial	$1,767.06
Rate for Payer: Hawaii Medical Service Association Medicare	$1,413.65
Rate for Payer: Humana Medicare	$1,413.65
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,413.65
Rate for Payer: Ohana Health Plan Medicaid	$1,555.02
Rate for Payer: Ohana Health Plan Medicare	$1,413.65
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,413.65

PROGESTERONE 50 MG/ML IM OIL

Facility

$117.36

Service Code	HCPCS J2675
Hospital Revenue Code	636
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$113.84
Rate for Payer: Cash Price	$76.28
Rate for Payer: Cash Price	$76.28
Rate for Payer: Hawaii Medical Service Association ABD	$0.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.63
Rate for Payer: Hawaii Western Management Group Commercial	$111.49
Rate for Payer: Health Management Network Commercial	$99.76
Rate for Payer: Kaiser Permanente Commercial	$73.94
Rate for Payer: Kaiser Permanente Medicaid	$59.85
Rate for Payer: MDX Hawaii PPO	$113.84
Rate for Payer: UnitedHealthcare Medicaid	$70.42
Rate for Payer: University Health Alliance Commercial	$85.54

PROGESTERONE 50 MG/ML IM OIL

Facility

$117.36

Service Code	HCPCS J2675
Hospital Revenue Code	250
Min. Negotiated Rate	$99.76
Max. Negotiated Rate	$113.84
Rate for Payer: Cash Price	$76.28
Rate for Payer: Health Management Network Commercial	$99.76
Rate for Payer: MDX Hawaii PPO	$113.84

Know your out-of-pocket cost for care.

All Charges