Kona Community Hospital

All Charges

Charge

Type

Setting

Price

PULMONARY EMBOLISM

Facility

$8,246.60

Service Code	APR-DRG 1344
Min. Negotiated Rate	$8,246.60
Max. Negotiated Rate	$8,246.60
Rate for Payer: AlohaCare Medicaid	$8,246.60
Rate for Payer: Hawaii Medical Service Association ABD	$8,246.60
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,246.60
Rate for Payer: Kaiser Permanente Medicaid	$8,246.60
Rate for Payer: Ohana Health Plan Medicaid	$8,246.60
Rate for Payer: UnitedHealthcare Medicaid	$8,246.60

PULMONARY EMBOLISM

Facility

$3,291.00

Service Code	APR-DRG 1341
Min. Negotiated Rate	$3,291.00
Max. Negotiated Rate	$3,291.00
Rate for Payer: AlohaCare Medicaid	$3,291.00
Rate for Payer: Hawaii Medical Service Association ABD	$3,291.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,291.00
Rate for Payer: Kaiser Permanente Medicaid	$3,291.00
Rate for Payer: Ohana Health Plan Medicaid	$3,291.00
Rate for Payer: UnitedHealthcare Medicaid	$3,291.00

PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE

Facility

$31,483.74

Service Code	MSDRG 175
Min. Negotiated Rate	$18,066.65
Max. Negotiated Rate	$31,483.74
Rate for Payer: AlohaCare Medicare	$18,066.65
Rate for Payer: Devoted Health Medicare	$19,873.31
Rate for Payer: Hawaii Medical Service Association Commercial	$31,483.74
Rate for Payer: Hawaii Medical Service Association Medicare	$18,066.65
Rate for Payer: Humana Medicare	$18,066.65
Rate for Payer: Kaiser Permanente Commercial	$23,694.60
Rate for Payer: Kaiser Permanente Medicare	$18,066.65
Rate for Payer: Ohana Health Plan Medicare	$18,066.65
Rate for Payer: UnitedHealthcare Medicare	$18,066.65

PULMONARY EMBOLISM WITHOUT MCC

Facility

$31,483.74

Service Code	MSDRG 176
Min. Negotiated Rate	$10,587.98
Max. Negotiated Rate	$31,483.74
Rate for Payer: AlohaCare Medicare	$10,587.98
Rate for Payer: Devoted Health Medicare	$11,646.78
Rate for Payer: Hawaii Medical Service Association Commercial	$31,483.74
Rate for Payer: Hawaii Medical Service Association Medicare	$10,587.98
Rate for Payer: Humana Medicare	$10,587.98
Rate for Payer: Kaiser Permanente Commercial	$13,886.25
Rate for Payer: Kaiser Permanente Medicare	$10,587.98
Rate for Payer: Ohana Health Plan Medicare	$10,587.98
Rate for Payer: UnitedHealthcare Medicare	$10,587.98

PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION

Facility

$2,837.00

Service Code	CPT 11104
Hospital Revenue Code	360
Min. Negotiated Rate	$47.09
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$480.23
Rate for Payer: AlohaCare Medicare	$480.23
Rate for Payer: Devoted Health Medicare	$528.25
Rate for Payer: Hawaii Medical Service Association Commercial	$600.29
Rate for Payer: Hawaii Medical Service Association Medicare	$480.23
Rate for Payer: Humana Medicare	$480.23
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$480.23
Rate for Payer: Ohana Health Plan Medicaid	$528.25
Rate for Payer: Ohana Health Plan Medicare	$480.23
Rate for Payer: UnitedHealthcare Medicaid	$47.09
Rate for Payer: UnitedHealthcare Medicare	$480.23

Puraply AM 6 x 9 Commercial PURAPLYAM-COM 6X9 (Charge per sq cm =54) [3644840]

Facility

$19,458.00

Service Code	HCPCS Q4196
Hospital Charge Code	3644840
Hospital Revenue Code	278
Min. Negotiated Rate	$73.91
Max. Negotiated Rate	$18,874.26
Rate for Payer: AlohaCare Medicaid	$147.01
Rate for Payer: AlohaCare Medicare	$147.01
Rate for Payer: Cash Price	$12,647.70
Rate for Payer: Cash Price	$12,647.70
Rate for Payer: Devoted Health Medicare	$161.71
Rate for Payer: Hawaii Medical Service Association ABD	$98.54
Rate for Payer: Hawaii Medical Service Association Commercial	$183.76
Rate for Payer: Hawaii Medical Service Association Medicare	$147.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$98.54
Rate for Payer: Hawaii Western Management Group Commercial	$13,620.60
Rate for Payer: Health Management Network Commercial	$16,539.30
Rate for Payer: Humana Medicare	$147.01
Rate for Payer: Kaiser Permanente Commercial	$12,258.54
Rate for Payer: Kaiser Permanente Medicaid	$9,923.58
Rate for Payer: Kaiser Permanente Medicare	$147.01
Rate for Payer: MDX Hawaii PPO	$18,874.26
Rate for Payer: Ohana Health Plan Medicaid	$161.71
Rate for Payer: Ohana Health Plan Medicare	$147.01
Rate for Payer: UnitedHealthcare Medicaid	$73.91
Rate for Payer: UnitedHealthcare Medicare	$147.01
Rate for Payer: University Health Alliance Commercial	$10,896.48

Puraply AM 6 x 9 Commercial PURAPLYAM-COM 6X9 (Charge per sq cm =54) [3644840]

Facility

$19,458.00

Service Code	HCPCS Q4196
Hospital Charge Code	3644840
Hospital Revenue Code	278
Min. Negotiated Rate	$10,896.48
Max. Negotiated Rate	$18,874.26
Rate for Payer: Cash Price	$12,647.70
Rate for Payer: Hawaii Western Management Group Commercial	$13,620.60
Rate for Payer: Health Management Network Commercial	$16,539.30
Rate for Payer: MDX Hawaii PPO	$18,874.26
Rate for Payer: University Health Alliance Commercial	$10,896.48

Puraply Micronized 1000mg Finished Prod 515-063 [3644841]

Facility

$8,797.00

Hospital Charge Code	3644841
Hospital Revenue Code	272
Min. Negotiated Rate	$4,486.47
Max. Negotiated Rate	$8,533.09
Rate for Payer: Cash Price	$5,718.05
Rate for Payer: Hawaii Western Management Group Commercial	$8,357.15
Rate for Payer: Health Management Network Commercial	$7,477.45
Rate for Payer: Kaiser Permanente Commercial	$5,542.11
Rate for Payer: Kaiser Permanente Medicaid	$4,486.47
Rate for Payer: MDX Hawaii PPO	$8,533.09
Rate for Payer: University Health Alliance Commercial	$6,412.13

Puraply Micronized 1000mg Finished Prod 515-063 [3644841]

Facility

$8,797.00

Hospital Charge Code	3644841
Hospital Revenue Code	272
Min. Negotiated Rate	$7,477.45
Max. Negotiated Rate	$8,533.09
Rate for Payer: Cash Price	$5,718.05
Rate for Payer: Health Management Network Commercial	$7,477.45
Rate for Payer: MDX Hawaii PPO	$8,533.09

PYRANTEL PAMOATE 50 MG/ML PO SUSP

Facility

$45.44

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$23.17
Max. Negotiated Rate	$44.08
Rate for Payer: Cash Price	$29.54
Rate for Payer: Hawaii Western Management Group Commercial	$43.17
Rate for Payer: Health Management Network Commercial	$38.62
Rate for Payer: Kaiser Permanente Commercial	$28.63
Rate for Payer: Kaiser Permanente Medicaid	$23.17
Rate for Payer: MDX Hawaii PPO	$44.08
Rate for Payer: UnitedHealthcare Medicaid	$27.26
Rate for Payer: University Health Alliance Commercial	$33.12

PYRANTEL PAMOATE 50 MG/ML PO SUSP

Facility

$45.44

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$38.62
Max. Negotiated Rate	$44.08
Rate for Payer: Cash Price	$29.54
Rate for Payer: Health Management Network Commercial	$38.62
Rate for Payer: MDX Hawaii PPO	$44.08

PYRAZINAMIDE 500 MG PO TABLET

Facility

$43.29

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$36.80
Max. Negotiated Rate	$41.99
Rate for Payer: Cash Price	$28.14
Rate for Payer: Health Management Network Commercial	$36.80
Rate for Payer: MDX Hawaii PPO	$41.99

PYRAZINAMIDE 500 MG PO TABLET

Facility

$43.29

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$22.08
Max. Negotiated Rate	$41.99
Rate for Payer: Cash Price	$28.14
Rate for Payer: Hawaii Western Management Group Commercial	$41.13
Rate for Payer: Health Management Network Commercial	$36.80
Rate for Payer: Kaiser Permanente Commercial	$27.27
Rate for Payer: Kaiser Permanente Medicaid	$22.08
Rate for Payer: MDX Hawaii PPO	$41.99
Rate for Payer: UnitedHealthcare Medicaid	$25.97
Rate for Payer: University Health Alliance Commercial	$31.55

PYRIDOSTIGMINE BROMIDE 60 MG PO TABLET

Facility

$9.17

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$8.89
Rate for Payer: Cash Price	$5.96
Rate for Payer: Hawaii Western Management Group Commercial	$8.71
Rate for Payer: Health Management Network Commercial	$7.79
Rate for Payer: Kaiser Permanente Commercial	$5.78
Rate for Payer: Kaiser Permanente Medicaid	$4.68
Rate for Payer: MDX Hawaii PPO	$8.89
Rate for Payer: UnitedHealthcare Medicaid	$5.50
Rate for Payer: University Health Alliance Commercial	$6.68

PYRIDOSTIGMINE BROMIDE 60 MG PO TABLET

Facility

$9.17

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$8.89
Rate for Payer: Cash Price	$5.96
Rate for Payer: Health Management Network Commercial	$7.79
Rate for Payer: MDX Hawaii PPO	$8.89

PYRIDOXINE (VITAMIN B6) 100 MG/ML INJ SOLN

Facility

$107.97

Service Code	HCPCS J3415
Hospital Revenue Code	250
Min. Negotiated Rate	$91.77
Max. Negotiated Rate	$104.73
Rate for Payer: Cash Price	$70.18
Rate for Payer: Health Management Network Commercial	$91.77
Rate for Payer: MDX Hawaii PPO	$104.73

PYRIDOXINE (VITAMIN B6) 100 MG/ML INJ SOLN

Facility

$107.97

Service Code	HCPCS J3415
Hospital Revenue Code	636
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$104.73
Rate for Payer: Cash Price	$70.18
Rate for Payer: Cash Price	$70.18
Rate for Payer: Hawaii Medical Service Association ABD	$12.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12.80
Rate for Payer: Hawaii Western Management Group Commercial	$102.57
Rate for Payer: Health Management Network Commercial	$91.77
Rate for Payer: Kaiser Permanente Commercial	$68.02
Rate for Payer: Kaiser Permanente Medicaid	$55.06
Rate for Payer: MDX Hawaii PPO	$104.73
Rate for Payer: UnitedHealthcare Medicaid	$64.78
Rate for Payer: University Health Alliance Commercial	$78.70

PYRIDOXINE (VITAMIN B6) 100 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

PYRIDOXINE (VITAMIN B6) 100 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

Quadlink Implant System 11mm Ar-1288qis-110 [3644101]

Facility

$14,190.50

Service Code	HCPCS C1713
Hospital Charge Code	3644101
Hospital Revenue Code	278
Min. Negotiated Rate	$7,237.15
Max. Negotiated Rate	$13,764.78
Rate for Payer: Cash Price	$9,223.83
Rate for Payer: Hawaii Western Management Group Commercial	$9,933.35
Rate for Payer: Health Management Network Commercial	$12,061.92
Rate for Payer: Kaiser Permanente Commercial	$8,940.01
Rate for Payer: Kaiser Permanente Medicaid	$7,237.15
Rate for Payer: MDX Hawaii PPO	$13,764.78
Rate for Payer: University Health Alliance Commercial	$7,946.68

Quadlink Implant System 11mm Ar-1288qis-110 [3644101]

Facility

$14,190.50

Service Code	HCPCS C1713
Hospital Charge Code	3644101
Hospital Revenue Code	278
Min. Negotiated Rate	$7,946.68
Max. Negotiated Rate	$13,764.78
Rate for Payer: Cash Price	$9,223.83
Rate for Payer: Hawaii Western Management Group Commercial	$9,933.35
Rate for Payer: Health Management Network Commercial	$12,061.92
Rate for Payer: MDX Hawaii PPO	$13,764.78
Rate for Payer: University Health Alliance Commercial	$7,946.68

Quadlink Implant System 9mm AR-1288QIS-90 [3644004]

Facility

$14,190.50

Service Code	HCPCS C1713
Hospital Charge Code	3644004
Hospital Revenue Code	278
Min. Negotiated Rate	$7,946.68
Max. Negotiated Rate	$13,764.78
Rate for Payer: Cash Price	$9,223.83
Rate for Payer: Hawaii Western Management Group Commercial	$9,933.35
Rate for Payer: Health Management Network Commercial	$12,061.92
Rate for Payer: MDX Hawaii PPO	$13,764.78
Rate for Payer: University Health Alliance Commercial	$7,946.68

Quadlink Implant System 9mm AR-1288QIS-90 [3644004]

Facility

$14,190.50

Service Code	HCPCS C1713
Hospital Charge Code	3644004
Hospital Revenue Code	278
Min. Negotiated Rate	$7,237.15
Max. Negotiated Rate	$13,764.78
Rate for Payer: Cash Price	$9,223.83
Rate for Payer: Hawaii Western Management Group Commercial	$9,933.35
Rate for Payer: Health Management Network Commercial	$12,061.92
Rate for Payer: Kaiser Permanente Commercial	$8,940.01
Rate for Payer: Kaiser Permanente Medicaid	$7,237.15
Rate for Payer: MDX Hawaii PPO	$13,764.78
Rate for Payer: University Health Alliance Commercial	$7,946.68

Quadpro Harvester 10mm Ar-2386-10 [3644012]

Facility

$2,481.50

Hospital Charge Code	3644012
Hospital Revenue Code	272
Min. Negotiated Rate	$2,109.28
Max. Negotiated Rate	$2,407.05
Rate for Payer: Cash Price	$1,612.98
Rate for Payer: Health Management Network Commercial	$2,109.28
Rate for Payer: MDX Hawaii PPO	$2,407.05

Quadpro Harvester 10mm Ar-2386-10 [3644012]

Facility

$2,481.50

Hospital Charge Code	3644012
Hospital Revenue Code	272
Min. Negotiated Rate	$1,265.57
Max. Negotiated Rate	$2,407.05
Rate for Payer: Cash Price	$1,612.98
Rate for Payer: Hawaii Western Management Group Commercial	$2,357.43
Rate for Payer: Health Management Network Commercial	$2,109.28
Rate for Payer: Kaiser Permanente Commercial	$1,563.35
Rate for Payer: Kaiser Permanente Medicaid	$1,265.57
Rate for Payer: MDX Hawaii PPO	$2,407.05
Rate for Payer: University Health Alliance Commercial	$1,808.77

Know your out-of-pocket cost for care.

All Charges