Kona Community Hospital

All Charges

Charge

Type

Setting

Price

PROPRANOLOL 80 MG PO CAP SA 24H

Facility

$13.30

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$11.30
Max. Negotiated Rate	$12.90
Rate for Payer: Cash Price	$8.65
Rate for Payer: Health Management Network Commercial	$11.30
Rate for Payer: MDX Hawaii PPO	$12.90

PROPRANOLOL 80 MG PO CAP SA 24H

Facility

$13.30

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.78
Max. Negotiated Rate	$12.90
Rate for Payer: Cash Price	$8.65
Rate for Payer: Hawaii Western Management Group Commercial	$12.63
Rate for Payer: Health Management Network Commercial	$11.30
Rate for Payer: Kaiser Permanente Commercial	$8.38
Rate for Payer: Kaiser Permanente Medicaid	$6.78
Rate for Payer: MDX Hawaii PPO	$12.90
Rate for Payer: UnitedHealthcare Medicaid	$7.98
Rate for Payer: University Health Alliance Commercial	$9.69

PROPYLTHIOURACIL 50 MG PO TABLET

Facility

$4.97

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$4.82
Rate for Payer: Cash Price	$3.23
Rate for Payer: Hawaii Western Management Group Commercial	$4.72
Rate for Payer: Health Management Network Commercial	$4.22
Rate for Payer: Kaiser Permanente Commercial	$3.13
Rate for Payer: Kaiser Permanente Medicaid	$2.53
Rate for Payer: MDX Hawaii PPO	$4.82
Rate for Payer: UnitedHealthcare Medicaid	$2.98
Rate for Payer: University Health Alliance Commercial	$3.62

PROPYLTHIOURACIL 50 MG PO TABLET

Facility

$4.97

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$4.82
Rate for Payer: Cash Price	$3.23
Rate for Payer: Health Management Network Commercial	$4.22
Rate for Payer: MDX Hawaii PPO	$4.82

PROSTATECTOMY, RETROPUBIC RADICAL, WITH OR WITHOUT NERVE SPARING;

Facility

$2,837.00

Service Code	CPT 55840
Hospital Revenue Code	360
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$1.00

PROSTATECTOMY WITH CC

Facility

$30,175.42

Service Code	MSDRG 666
Min. Negotiated Rate	$22,949.86
Max. Negotiated Rate	$30,175.42
Rate for Payer: AlohaCare Medicare	$23,008.13
Rate for Payer: Devoted Health Medicare	$25,308.94
Rate for Payer: Hawaii Medical Service Association Commercial	$22,949.86
Rate for Payer: Hawaii Medical Service Association Medicare	$23,008.13
Rate for Payer: Humana Medicare	$23,008.13
Rate for Payer: Kaiser Permanente Commercial	$30,175.42
Rate for Payer: Kaiser Permanente Medicare	$23,008.13
Rate for Payer: Ohana Health Plan Medicare	$23,008.13
Rate for Payer: UnitedHealthcare Medicare	$23,008.13

PROSTATECTOMY WITH MCC

Facility

$53,840.70

Service Code	MSDRG 665
Min. Negotiated Rate	$22,949.86
Max. Negotiated Rate	$53,840.70
Rate for Payer: AlohaCare Medicare	$41,052.41
Rate for Payer: Devoted Health Medicare	$45,157.65
Rate for Payer: Hawaii Medical Service Association Commercial	$22,949.86
Rate for Payer: Hawaii Medical Service Association Medicare	$41,052.41
Rate for Payer: Humana Medicare	$41,052.41
Rate for Payer: Kaiser Permanente Commercial	$53,840.70
Rate for Payer: Kaiser Permanente Medicare	$41,052.41
Rate for Payer: Ohana Health Plan Medicare	$41,052.41
Rate for Payer: UnitedHealthcare Medicare	$41,052.41

PROSTATECTOMY WITHOUT CC/MCC

Facility

$19,081.95

Service Code	MSDRG 667
Min. Negotiated Rate	$14,549.59
Max. Negotiated Rate	$19,081.95
Rate for Payer: AlohaCare Medicare	$14,549.59
Rate for Payer: Devoted Health Medicare	$16,004.55
Rate for Payer: Hawaii Medical Service Association Commercial	$16,199.90
Rate for Payer: Hawaii Medical Service Association Medicare	$14,549.59
Rate for Payer: Humana Medicare	$14,549.59
Rate for Payer: Kaiser Permanente Commercial	$19,081.95
Rate for Payer: Kaiser Permanente Medicare	$14,549.59
Rate for Payer: Ohana Health Plan Medicare	$14,549.59
Rate for Payer: UnitedHealthcare Medicare	$14,549.59

PROTAMINE 10 MG/ML IV SOLN

Facility

$282.43

Service Code	HCPCS J2720
Hospital Revenue Code	250
Min. Negotiated Rate	$240.07
Max. Negotiated Rate	$273.96
Rate for Payer: Cash Price	$183.58
Rate for Payer: Cash Price	$55.54
Rate for Payer: Cash Price	$53.36
Rate for Payer: Health Management Network Commercial	$72.63
Rate for Payer: Health Management Network Commercial	$69.78
Rate for Payer: Health Management Network Commercial	$240.07
Rate for Payer: MDX Hawaii PPO	$82.89
Rate for Payer: MDX Hawaii PPO	$273.96
Rate for Payer: MDX Hawaii PPO	$79.63

PROTAMINE 10 MG/ML IV SOLN

Facility

$282.43

Service Code	HCPCS J2720
Hospital Revenue Code	636
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$273.96
Rate for Payer: Cash Price	$183.58
Rate for Payer: Cash Price	$183.58
Rate for Payer: Cash Price	$53.36
Rate for Payer: Cash Price	$53.36
Rate for Payer: Cash Price	$55.54
Rate for Payer: Cash Price	$55.54
Rate for Payer: Hawaii Medical Service Association ABD	$1.64
Rate for Payer: Hawaii Medical Service Association ABD	$1.64
Rate for Payer: Hawaii Medical Service Association ABD	$1.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.64
Rate for Payer: Hawaii Western Management Group Commercial	$268.31
Rate for Payer: Hawaii Western Management Group Commercial	$81.18
Rate for Payer: Hawaii Western Management Group Commercial	$77.99
Rate for Payer: Health Management Network Commercial	$240.07
Rate for Payer: Health Management Network Commercial	$69.78
Rate for Payer: Health Management Network Commercial	$72.63
Rate for Payer: Kaiser Permanente Commercial	$177.93
Rate for Payer: Kaiser Permanente Commercial	$51.72
Rate for Payer: Kaiser Permanente Commercial	$53.83
Rate for Payer: Kaiser Permanente Medicaid	$43.58
Rate for Payer: Kaiser Permanente Medicaid	$144.04
Rate for Payer: Kaiser Permanente Medicaid	$41.87
Rate for Payer: MDX Hawaii PPO	$79.63
Rate for Payer: MDX Hawaii PPO	$273.96
Rate for Payer: MDX Hawaii PPO	$82.89
Rate for Payer: UnitedHealthcare Medicaid	$49.25
Rate for Payer: UnitedHealthcare Medicaid	$51.27
Rate for Payer: UnitedHealthcare Medicaid	$169.46
Rate for Payer: University Health Alliance Commercial	$59.84
Rate for Payer: University Health Alliance Commercial	$62.28
Rate for Payer: University Health Alliance Commercial	$205.86

Protection Sleeve For Nails 8-11 Flex Long 03.043.033S [3643799]

Facility

$2,086.25

Hospital Charge Code	3643799
Hospital Revenue Code	272
Min. Negotiated Rate	$1,773.31
Max. Negotiated Rate	$2,023.66
Rate for Payer: Cash Price	$1,356.06
Rate for Payer: Health Management Network Commercial	$1,773.31
Rate for Payer: MDX Hawaii PPO	$2,023.66

Protection Sleeve For Nails 8-11 Flex Long 03.043.033S [3643799]

Facility

$2,086.25

Hospital Charge Code	3643799
Hospital Revenue Code	272
Min. Negotiated Rate	$1,063.99
Max. Negotiated Rate	$2,023.66
Rate for Payer: Cash Price	$1,356.06
Rate for Payer: Hawaii Western Management Group Commercial	$1,981.94
Rate for Payer: Health Management Network Commercial	$1,773.31
Rate for Payer: Kaiser Permanente Commercial	$1,314.34
Rate for Payer: Kaiser Permanente Medicaid	$1,063.99
Rate for Payer: MDX Hawaii PPO	$2,023.66
Rate for Payer: University Health Alliance Commercial	$1,520.67

Protection Sleeve For Nails 8-13 Flex Long 03.043.034S [3643800]

Facility

$2,086.25

Hospital Charge Code	3643800
Hospital Revenue Code	272
Min. Negotiated Rate	$1,063.99
Max. Negotiated Rate	$2,023.66
Rate for Payer: Cash Price	$1,356.06
Rate for Payer: Hawaii Western Management Group Commercial	$1,981.94
Rate for Payer: Health Management Network Commercial	$1,773.31
Rate for Payer: Kaiser Permanente Commercial	$1,314.34
Rate for Payer: Kaiser Permanente Medicaid	$1,063.99
Rate for Payer: MDX Hawaii PPO	$2,023.66
Rate for Payer: University Health Alliance Commercial	$1,520.67

Protection Sleeve For Nails 8-13 Flex Long 03.043.034S [3643800]

Facility

$2,086.25

Hospital Charge Code	3643800
Hospital Revenue Code	272
Min. Negotiated Rate	$1,773.31
Max. Negotiated Rate	$2,023.66
Rate for Payer: Cash Price	$1,356.06
Rate for Payer: Health Management Network Commercial	$1,773.31
Rate for Payer: MDX Hawaii PPO	$2,023.66

PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD

Professional

Both

$7.00

Service Code	HCPCS 84155
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$5.95
Rate for Payer: AlohaCare Medicaid	$5.06
Rate for Payer: AlohaCare Medicare	$3.67
Rate for Payer: Cash Price	$4.55
Rate for Payer: Cash Price	$4.55
Rate for Payer: Devoted Health Medicare	$4.04
Rate for Payer: Hawaii Medical Service Association Medicare	$3.67
Rate for Payer: Hawaii Western Management Group Commercial	$5.05
Rate for Payer: Health Management Network Commercial	$5.95
Rate for Payer: Kaiser Permanente Commercial	$4.40
Rate for Payer: Kaiser Permanente Medicaid	$4.40
Rate for Payer: Kaiser Permanente Medicare	$4.40
Rate for Payer: Ohana Health Plan Medicaid	$5.06
Rate for Payer: Ohana Health Plan Medicare	$3.67
Rate for Payer: UnitedHealthcare Medicaid	$5.06
Rate for Payer: UnitedHealthcare Medicare	$3.67

Proximal Tenodesis Implant Sys Rev 0 AR2290 [3641054]

Facility

$3,377.50

Hospital Charge Code	3641054
Hospital Revenue Code	272
Min. Negotiated Rate	$2,870.88
Max. Negotiated Rate	$3,276.18
Rate for Payer: Cash Price	$2,195.38
Rate for Payer: Health Management Network Commercial	$2,870.88
Rate for Payer: MDX Hawaii PPO	$3,276.18

Proximal Tenodesis Implant Sys Rev 0 AR2290 [3641054]

Facility

$3,377.50

Hospital Charge Code	3641054
Hospital Revenue Code	272
Min. Negotiated Rate	$1,722.53
Max. Negotiated Rate	$3,276.18
Rate for Payer: Cash Price	$2,195.38
Rate for Payer: Hawaii Western Management Group Commercial	$3,208.62
Rate for Payer: Health Management Network Commercial	$2,870.88
Rate for Payer: Kaiser Permanente Commercial	$2,127.82
Rate for Payer: Kaiser Permanente Medicaid	$1,722.53
Rate for Payer: MDX Hawaii PPO	$3,276.18
Rate for Payer: University Health Alliance Commercial	$2,461.86

PSEUDOEPHEDRINE HCL 30 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Hawaii Western Management Group Commercial	$1.14
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: Kaiser Permanente Commercial	$0.76
Rate for Payer: Kaiser Permanente Medicaid	$0.61
Rate for Payer: MDX Hawaii PPO	$1.16
Rate for Payer: UnitedHealthcare Medicaid	$0.72
Rate for Payer: University Health Alliance Commercial	$0.87

PSEUDOEPHEDRINE HCL 30 MG PO TABLET

Facility

$1.20

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.16
Rate for Payer: Cash Price	$0.78
Rate for Payer: Health Management Network Commercial	$1.02
Rate for Payer: MDX Hawaii PPO	$1.16

PSYCHOSES

Facility

$24,094.80

Service Code	MSDRG 885
Min. Negotiated Rate	$16,031.16
Max. Negotiated Rate	$24,094.80
Rate for Payer: AlohaCare Medicare	$18,371.78
Rate for Payer: Devoted Health Medicare	$20,208.96
Rate for Payer: Hawaii Medical Service Association Commercial	$16,031.16
Rate for Payer: Hawaii Medical Service Association Medicare	$18,371.78
Rate for Payer: Humana Medicare	$18,371.78
Rate for Payer: Kaiser Permanente Commercial	$24,094.80
Rate for Payer: Kaiser Permanente Medicare	$18,371.78
Rate for Payer: Ohana Health Plan Medicare	$18,371.78
Rate for Payer: UnitedHealthcare Medicare	$18,371.78

PSYLLIUM HUSK 3.4 GRAM PO PWPK

Facility

$1.83

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$1.78
Rate for Payer: Cash Price	$1.19
Rate for Payer: Hawaii Western Management Group Commercial	$1.74
Rate for Payer: Health Management Network Commercial	$1.56
Rate for Payer: Kaiser Permanente Commercial	$1.15
Rate for Payer: Kaiser Permanente Medicaid	$0.93
Rate for Payer: MDX Hawaii PPO	$1.78
Rate for Payer: UnitedHealthcare Medicaid	$1.10
Rate for Payer: University Health Alliance Commercial	$1.33

PSYLLIUM HUSK 3.4 GRAM PO PWPK

Facility

$1.83

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.78
Rate for Payer: Cash Price	$1.19
Rate for Payer: Health Management Network Commercial	$1.56
Rate for Payer: MDX Hawaii PPO	$1.78

PULMONARY EDEMA AND RESPIRATORY FAILURE

Facility

$46,381.87

Service Code	MSDRG 189
Min. Negotiated Rate	$16,248.92
Max. Negotiated Rate	$46,381.87
Rate for Payer: AlohaCare Medicare	$16,248.92
Rate for Payer: Devoted Health Medicare	$17,873.81
Rate for Payer: Hawaii Medical Service Association Commercial	$46,381.87
Rate for Payer: Hawaii Medical Service Association Medicare	$16,248.92
Rate for Payer: Humana Medicare	$16,248.92
Rate for Payer: Kaiser Permanente Commercial	$21,310.65
Rate for Payer: Kaiser Permanente Medicare	$16,248.92
Rate for Payer: Ohana Health Plan Medicare	$16,248.92
Rate for Payer: UnitedHealthcare Medicare	$16,248.92

PULMONARY EMBOLISM

Facility

$5,792.36

Service Code	APR-DRG 1343
Min. Negotiated Rate	$5,792.36
Max. Negotiated Rate	$5,792.36
Rate for Payer: AlohaCare Medicaid	$5,792.36
Rate for Payer: Hawaii Medical Service Association ABD	$5,792.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,792.36
Rate for Payer: Kaiser Permanente Medicaid	$5,792.36
Rate for Payer: Ohana Health Plan Medicaid	$5,792.36
Rate for Payer: UnitedHealthcare Medicaid	$5,792.36

PULMONARY EMBOLISM

Facility

$4,174.88

Service Code	APR-DRG 1342
Min. Negotiated Rate	$4,174.88
Max. Negotiated Rate	$4,174.88
Rate for Payer: AlohaCare Medicaid	$4,174.88
Rate for Payer: Hawaii Medical Service Association ABD	$4,174.88
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,174.88
Rate for Payer: Kaiser Permanente Medicaid	$4,174.88
Rate for Payer: Ohana Health Plan Medicaid	$4,174.88
Rate for Payer: UnitedHealthcare Medicaid	$4,174.88

Know your out-of-pocket cost for care.

All Charges