Kona Community Hospital

All Charges

Charge

Type

Setting

Price

BURNS W SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS

Facility

$6,678.79

Service Code	APR-DRG 8421
Min. Negotiated Rate	$6,678.79
Max. Negotiated Rate	$6,678.79
Rate for Payer: AlohaCare Medicaid	$6,678.79
Rate for Payer: Hawaii Medical Service Association ABD	$6,678.79
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,678.79
Rate for Payer: Kaiser Permanente Medicaid	$6,678.79
Rate for Payer: Ohana Health Plan Medicaid	$6,678.79
Rate for Payer: UnitedHealthcare Medicaid	$6,678.79

BURNS W SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS

Facility

$41,529.74

Service Code	APR-DRG 8424
Min. Negotiated Rate	$41,529.74
Max. Negotiated Rate	$41,529.74
Rate for Payer: AlohaCare Medicaid	$41,529.74
Rate for Payer: Hawaii Medical Service Association ABD	$41,529.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$41,529.74
Rate for Payer: Kaiser Permanente Medicaid	$41,529.74
Rate for Payer: Ohana Health Plan Medicaid	$41,529.74
Rate for Payer: UnitedHealthcare Medicaid	$41,529.74

BURNS W SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS

Facility

$9,980.61

Service Code	APR-DRG 8422
Min. Negotiated Rate	$9,980.61
Max. Negotiated Rate	$9,980.61
Rate for Payer: AlohaCare Medicaid	$9,980.61
Rate for Payer: Hawaii Medical Service Association ABD	$9,980.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,980.61
Rate for Payer: Kaiser Permanente Medicaid	$9,980.61
Rate for Payer: Ohana Health Plan Medicaid	$9,980.61
Rate for Payer: UnitedHealthcare Medicaid	$9,980.61

BUSPIRONE 10 MG PO TABLET

Facility

$7.43

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$7.21
Rate for Payer: Cash Price	$4.83
Rate for Payer: Hawaii Western Management Group Commercial	$7.06
Rate for Payer: Health Management Network Commercial	$6.32
Rate for Payer: Kaiser Permanente Commercial	$4.68
Rate for Payer: Kaiser Permanente Medicaid	$3.79
Rate for Payer: MDX Hawaii PPO	$7.21
Rate for Payer: UnitedHealthcare Medicaid	$4.46
Rate for Payer: University Health Alliance Commercial	$5.42

BUSPIRONE 10 MG PO TABLET

Facility

$7.43

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$7.21
Rate for Payer: Cash Price	$4.83
Rate for Payer: Health Management Network Commercial	$6.32
Rate for Payer: MDX Hawaii PPO	$7.21

BUSPIRONE 5 MG PO TABLET

Facility

$4.26

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$4.13
Rate for Payer: Cash Price	$2.77
Rate for Payer: Hawaii Western Management Group Commercial	$4.05
Rate for Payer: Health Management Network Commercial	$3.62
Rate for Payer: Kaiser Permanente Commercial	$2.68
Rate for Payer: Kaiser Permanente Medicaid	$2.17
Rate for Payer: MDX Hawaii PPO	$4.13
Rate for Payer: UnitedHealthcare Medicaid	$2.56
Rate for Payer: University Health Alliance Commercial	$3.11

BUSPIRONE 5 MG PO TABLET

Facility

$4.26

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$4.13
Rate for Payer: Cash Price	$2.77
Rate for Payer: Health Management Network Commercial	$3.62
Rate for Payer: MDX Hawaii PPO	$4.13

BUTALBITAL-ACETAMINOPHEN-CAFF 50-325-40 MG PO TABLET

Facility

$9.32

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$9.04
Rate for Payer: Cash Price	$6.06
Rate for Payer: Hawaii Western Management Group Commercial	$8.85
Rate for Payer: Health Management Network Commercial	$7.92
Rate for Payer: Kaiser Permanente Commercial	$5.87
Rate for Payer: Kaiser Permanente Medicaid	$4.75
Rate for Payer: MDX Hawaii PPO	$9.04
Rate for Payer: UnitedHealthcare Medicaid	$5.59
Rate for Payer: University Health Alliance Commercial	$6.79

BUTALBITAL-ACETAMINOPHEN-CAFF 50-325-40 MG PO TABLET

Facility

$9.32

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$9.04
Rate for Payer: Cash Price	$6.06
Rate for Payer: Health Management Network Commercial	$7.92
Rate for Payer: MDX Hawaii PPO	$9.04

BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP AERO.SPRAY

Facility

$442.54

Service Code	NDC 10223020104
Hospital Revenue Code	250
Min. Negotiated Rate	$376.16
Max. Negotiated Rate	$429.26
Rate for Payer: Cash Price	$287.65
Rate for Payer: Health Management Network Commercial	$376.16
Rate for Payer: MDX Hawaii PPO	$429.26

BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP AERO.SPRAY

Facility

$442.54

Service Code	NDC 10223020104
Hospital Revenue Code	250
Min. Negotiated Rate	$225.70
Max. Negotiated Rate	$429.26
Rate for Payer: Cash Price	$287.65
Rate for Payer: Hawaii Western Management Group Commercial	$420.41
Rate for Payer: Health Management Network Commercial	$376.16
Rate for Payer: Kaiser Permanente Commercial	$278.80
Rate for Payer: Kaiser Permanente Medicaid	$225.70
Rate for Payer: MDX Hawaii PPO	$429.26
Rate for Payer: UnitedHealthcare Medicaid	$265.52
Rate for Payer: University Health Alliance Commercial	$322.57

Button Kit Large PEC AR-2269 [3642229]

Facility

$11,128.00

Hospital Charge Code	3642229
Hospital Revenue Code	272
Min. Negotiated Rate	$5,675.28
Max. Negotiated Rate	$10,794.16
Rate for Payer: Cash Price	$7,233.20
Rate for Payer: Hawaii Western Management Group Commercial	$10,571.60
Rate for Payer: Health Management Network Commercial	$9,458.80
Rate for Payer: Kaiser Permanente Commercial	$7,010.64
Rate for Payer: Kaiser Permanente Medicaid	$5,675.28
Rate for Payer: MDX Hawaii PPO	$10,794.16
Rate for Payer: University Health Alliance Commercial	$8,111.20

Button Kit Large PEC AR-2269 [3642229]

Facility

$11,128.00

Hospital Charge Code	3642229
Hospital Revenue Code	272
Min. Negotiated Rate	$9,458.80
Max. Negotiated Rate	$10,794.16
Rate for Payer: Cash Price	$7,233.20
Rate for Payer: Health Management Network Commercial	$9,458.80
Rate for Payer: MDX Hawaii PPO	$10,794.16

CABAZITAXEL 10 MG/ML IV DILUTED SOLN (FOR OP USE ONLY)

Facility

$18,607.35

Service Code	HCPCS J9043
Hospital Revenue Code	636
Min. Negotiated Rate	$227.10
Max. Negotiated Rate	$18,049.13
Rate for Payer: AlohaCare Medicaid	$231.05
Rate for Payer: AlohaCare Medicare	$231.05
Rate for Payer: Cash Price	$12,094.78
Rate for Payer: Cash Price	$12,094.78
Rate for Payer: Devoted Health Medicare	$254.16
Rate for Payer: Hawaii Medical Service Association ABD	$227.10
Rate for Payer: Hawaii Medical Service Association Commercial	$288.81
Rate for Payer: Hawaii Medical Service Association Medicare	$231.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$227.10
Rate for Payer: Hawaii Western Management Group Commercial	$17,676.98
Rate for Payer: Health Management Network Commercial	$15,816.25
Rate for Payer: Humana Medicare	$231.05
Rate for Payer: Kaiser Permanente Commercial	$11,722.63
Rate for Payer: Kaiser Permanente Medicaid	$9,489.75
Rate for Payer: Kaiser Permanente Medicare	$231.05
Rate for Payer: MDX Hawaii PPO	$18,049.13
Rate for Payer: Ohana Health Plan Medicaid	$254.16
Rate for Payer: Ohana Health Plan Medicare	$231.05
Rate for Payer: UnitedHealthcare Medicaid	$11,164.41
Rate for Payer: UnitedHealthcare Medicare	$231.05
Rate for Payer: University Health Alliance Commercial	$13,562.90

CABAZITAXEL 10 MG/ML IV DILUTED SOLN (FOR OP USE ONLY)

Facility

$18,607.35

Service Code	HCPCS J9043
Hospital Revenue Code	250
Min. Negotiated Rate	$15,816.25
Max. Negotiated Rate	$18,049.13
Rate for Payer: Cash Price	$12,094.78
Rate for Payer: Health Management Network Commercial	$15,816.25
Rate for Payer: MDX Hawaii PPO	$18,049.13

Cable Assy Cerclage Cocr 1.8x910mm [3643856]

Facility

$1,774.50

Service Code	HCPCS C1713
Hospital Charge Code	3643856
Hospital Revenue Code	278
Min. Negotiated Rate	$993.72
Max. Negotiated Rate	$1,721.27
Rate for Payer: Cash Price	$1,153.42
Rate for Payer: Hawaii Western Management Group Commercial	$1,242.15
Rate for Payer: Health Management Network Commercial	$1,508.33
Rate for Payer: MDX Hawaii PPO	$1,721.27
Rate for Payer: University Health Alliance Commercial	$993.72

Cable Assy Cerclage Cocr 1.8x910mm [3643856]

Facility

$1,774.50

Service Code	HCPCS C1713
Hospital Charge Code	3643856
Hospital Revenue Code	278
Min. Negotiated Rate	$905.00
Max. Negotiated Rate	$1,721.27
Rate for Payer: Cash Price	$1,153.42
Rate for Payer: Hawaii Western Management Group Commercial	$1,242.15
Rate for Payer: Health Management Network Commercial	$1,508.33
Rate for Payer: Kaiser Permanente Commercial	$1,117.93
Rate for Payer: Kaiser Permanente Medicaid	$905.00
Rate for Payer: MDX Hawaii PPO	$1,721.27
Rate for Payer: University Health Alliance Commercial	$993.72

Cable Bipolar Esg-400 Generator BIPCBESG [3644959]

Facility

$230.23

Hospital Charge Code	3644959
Hospital Revenue Code	272
Min. Negotiated Rate	$195.70
Max. Negotiated Rate	$223.32
Rate for Payer: Cash Price	$149.65
Rate for Payer: Health Management Network Commercial	$195.70
Rate for Payer: MDX Hawaii PPO	$223.32

Cable Bipolar Esg-400 Generator BIPCBESG [3644959]

Facility

$230.23

Hospital Charge Code	3644959
Hospital Revenue Code	272
Min. Negotiated Rate	$117.42
Max. Negotiated Rate	$223.32
Rate for Payer: Cash Price	$149.65
Rate for Payer: Hawaii Western Management Group Commercial	$218.72
Rate for Payer: Health Management Network Commercial	$195.70
Rate for Payer: Kaiser Permanente Commercial	$145.04
Rate for Payer: Kaiser Permanente Medicaid	$117.42
Rate for Payer: MDX Hawaii PPO	$223.32
Rate for Payer: University Health Alliance Commercial	$167.81

Cable Cerclage w/Crimp 1.8 mm x 635 mm 00-2232-004-18 [3641660]

Facility

$2,421.94

Service Code	HCPCS C1713
Hospital Charge Code	3641660
Hospital Revenue Code	278
Min. Negotiated Rate	$1,235.19
Max. Negotiated Rate	$2,349.28
Rate for Payer: Cash Price	$1,574.26
Rate for Payer: Hawaii Western Management Group Commercial	$1,695.36
Rate for Payer: Health Management Network Commercial	$2,058.65
Rate for Payer: Kaiser Permanente Commercial	$1,525.82
Rate for Payer: Kaiser Permanente Medicaid	$1,235.19
Rate for Payer: MDX Hawaii PPO	$2,349.28
Rate for Payer: University Health Alliance Commercial	$1,356.29

Cable Cerclage w/Crimp 1.8 mm x 635 mm 00-2232-004-18 [3641660]

Facility

$2,421.94

Service Code	HCPCS C1713
Hospital Charge Code	3641660
Hospital Revenue Code	278
Min. Negotiated Rate	$1,356.29
Max. Negotiated Rate	$2,349.28
Rate for Payer: Cash Price	$1,574.26
Rate for Payer: Hawaii Western Management Group Commercial	$1,695.36
Rate for Payer: Health Management Network Commercial	$2,058.65
Rate for Payer: MDX Hawaii PPO	$2,349.28
Rate for Payer: University Health Alliance Commercial	$1,356.29

Cable Integral Short GTR w/2 Cables 23 x 53 mm 00-2232-002-04 [3641667]

Facility

$7,622.75

Service Code	HCPCS C1713
Hospital Charge Code	3641667
Hospital Revenue Code	278
Min. Negotiated Rate	$3,887.60
Max. Negotiated Rate	$7,394.07
Rate for Payer: Cash Price	$4,954.79
Rate for Payer: Hawaii Western Management Group Commercial	$5,335.93
Rate for Payer: Health Management Network Commercial	$6,479.34
Rate for Payer: Kaiser Permanente Commercial	$4,802.33
Rate for Payer: Kaiser Permanente Medicaid	$3,887.60
Rate for Payer: MDX Hawaii PPO	$7,394.07
Rate for Payer: University Health Alliance Commercial	$4,268.74

Cable Integral Short GTR w/2 Cables 23 x 53 mm 00-2232-002-04 [3641667]

Facility

$7,622.75

Service Code	HCPCS C1713
Hospital Charge Code	3641667
Hospital Revenue Code	278
Min. Negotiated Rate	$4,268.74
Max. Negotiated Rate	$7,394.07
Rate for Payer: Cash Price	$4,954.79
Rate for Payer: Hawaii Western Management Group Commercial	$5,335.93
Rate for Payer: Health Management Network Commercial	$6,479.34
Rate for Payer: MDX Hawaii PPO	$7,394.07
Rate for Payer: University Health Alliance Commercial	$4,268.74

Cable Super Iso Elastic 1.5 Poly Cable W/ti Clamp 35-100-1040 [3643310]

Facility

$1,918.00

Service Code	HCPCS C1713
Hospital Charge Code	3643310
Hospital Revenue Code	278
Min. Negotiated Rate	$978.18
Max. Negotiated Rate	$1,860.46
Rate for Payer: Cash Price	$1,246.70
Rate for Payer: Hawaii Western Management Group Commercial	$1,342.60
Rate for Payer: Health Management Network Commercial	$1,630.30
Rate for Payer: Kaiser Permanente Commercial	$1,208.34
Rate for Payer: Kaiser Permanente Medicaid	$978.18
Rate for Payer: MDX Hawaii PPO	$1,860.46
Rate for Payer: University Health Alliance Commercial	$1,074.08

Cable Super Iso Elastic 1.5 Poly Cable W/ti Clamp 35-100-1040 [3643310]

Facility

$1,918.00

Service Code	HCPCS C1713
Hospital Charge Code	3643310
Hospital Revenue Code	278
Min. Negotiated Rate	$1,074.08
Max. Negotiated Rate	$1,860.46
Rate for Payer: Cash Price	$1,246.70
Rate for Payer: Hawaii Western Management Group Commercial	$1,342.60
Rate for Payer: Health Management Network Commercial	$1,630.30
Rate for Payer: MDX Hawaii PPO	$1,860.46
Rate for Payer: University Health Alliance Commercial	$1,074.08

Know your out-of-pocket cost for care.

All Charges