Kona Community Hospital

All Charges

Charge

Type

Setting

Price

ROMOSOZUMAB-AQQG 210MG/2.34ML ( 105MG/1.17MLX2) SUBCUTANEOUS SYR

Facility

$2,695.76

Service Code	HCPCS J3111
Hospital Revenue Code	250
Min. Negotiated Rate	$2,291.40
Max. Negotiated Rate	$2,614.89
Rate for Payer: Cash Price	$1,752.24
Rate for Payer: Health Management Network Commercial	$2,291.40
Rate for Payer: MDX Hawaii PPO	$2,614.89

ROPIVACAINE-EPI-CLONID-KETOROL 2.46-0.005- 0.0008-0.3MG/ML PATC SYR

Facility

$328.91

Service Code	NDC 70092143350
Hospital Revenue Code	250
Min. Negotiated Rate	$167.74
Max. Negotiated Rate	$319.04
Rate for Payer: Cash Price	$213.79
Rate for Payer: Hawaii Western Management Group Commercial	$312.46
Rate for Payer: Health Management Network Commercial	$279.57
Rate for Payer: Kaiser Permanente Commercial	$207.21
Rate for Payer: Kaiser Permanente Medicaid	$167.74
Rate for Payer: MDX Hawaii PPO	$319.04
Rate for Payer: UnitedHealthcare Medicaid	$197.35
Rate for Payer: University Health Alliance Commercial	$239.74

ROPIVACAINE-EPI-CLONID-KETOROL 2.46-0.005- 0.0008-0.3MG/ML PATC SYR

Facility

$328.91

Service Code	NDC 70092143350
Hospital Revenue Code	250
Min. Negotiated Rate	$279.57
Max. Negotiated Rate	$319.04
Rate for Payer: Cash Price	$213.79
Rate for Payer: Health Management Network Commercial	$279.57
Rate for Payer: MDX Hawaii PPO	$319.04

ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN

Facility

$60.96

Service Code	HCPCS J2795
Hospital Revenue Code	250
Min. Negotiated Rate	$51.82
Max. Negotiated Rate	$59.13
Rate for Payer: Cash Price	$39.62
Rate for Payer: Cash Price	$32.93
Rate for Payer: Cash Price	$72.49
Rate for Payer: Health Management Network Commercial	$51.82
Rate for Payer: Health Management Network Commercial	$94.80
Rate for Payer: Health Management Network Commercial	$43.06
Rate for Payer: MDX Hawaii PPO	$59.13
Rate for Payer: MDX Hawaii PPO	$49.14
Rate for Payer: MDX Hawaii PPO	$108.18

ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN

Facility

$50.66

Service Code	HCPCS J2795
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$49.14
Rate for Payer: Cash Price	$32.93
Rate for Payer: Cash Price	$39.62
Rate for Payer: Cash Price	$72.49
Rate for Payer: Cash Price	$72.49
Rate for Payer: Cash Price	$39.62
Rate for Payer: Cash Price	$32.93
Rate for Payer: Hawaii Medical Service Association ABD	$0.06
Rate for Payer: Hawaii Medical Service Association ABD	$0.06
Rate for Payer: Hawaii Medical Service Association ABD	$0.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$0.06
Rate for Payer: Hawaii Western Management Group Commercial	$105.95
Rate for Payer: Hawaii Western Management Group Commercial	$48.13
Rate for Payer: Hawaii Western Management Group Commercial	$57.91
Rate for Payer: Health Management Network Commercial	$51.82
Rate for Payer: Health Management Network Commercial	$94.80
Rate for Payer: Health Management Network Commercial	$43.06
Rate for Payer: Kaiser Permanente Commercial	$38.40
Rate for Payer: Kaiser Permanente Commercial	$31.92
Rate for Payer: Kaiser Permanente Commercial	$70.26
Rate for Payer: Kaiser Permanente Medicaid	$56.88
Rate for Payer: Kaiser Permanente Medicaid	$25.84
Rate for Payer: Kaiser Permanente Medicaid	$31.09
Rate for Payer: MDX Hawaii PPO	$108.18
Rate for Payer: MDX Hawaii PPO	$49.14
Rate for Payer: MDX Hawaii PPO	$59.13
Rate for Payer: UnitedHealthcare Medicaid	$30.40
Rate for Payer: UnitedHealthcare Medicaid	$36.58
Rate for Payer: UnitedHealthcare Medicaid	$66.92
Rate for Payer: University Health Alliance Commercial	$81.29
Rate for Payer: University Health Alliance Commercial	$36.93
Rate for Payer: University Health Alliance Commercial	$44.43

ROUTINE OBSTETRIC CARE INCLUDING ANTEPARTUM CARE, VAGINAL DELIVERY (WITH OR WITHOUT EPISIOTOMY, AND/OR FORCEPS) AND POSTPARTUM CARE

Facility

$2,837.00

Service Code	CPT 59400
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

Rumi Ii Koh-Effcnt Sys 3.5cm Kcs-Rumi-35 [3643509]

Facility

$975.77

Hospital Charge Code	3643509
Hospital Revenue Code	272
Min. Negotiated Rate	$497.64
Max. Negotiated Rate	$946.50
Rate for Payer: Cash Price	$634.25
Rate for Payer: Hawaii Western Management Group Commercial	$926.98
Rate for Payer: Health Management Network Commercial	$829.40
Rate for Payer: Kaiser Permanente Commercial	$614.74
Rate for Payer: Kaiser Permanente Medicaid	$497.64
Rate for Payer: MDX Hawaii PPO	$946.50
Rate for Payer: University Health Alliance Commercial	$711.24

Rumi Ii Koh-Effcnt Sys 3.5cm Kcs-Rumi-35 [3643509]

Facility

$975.77

Hospital Charge Code	3643509
Hospital Revenue Code	272
Min. Negotiated Rate	$829.40
Max. Negotiated Rate	$946.50
Rate for Payer: Cash Price	$634.25
Rate for Payer: Health Management Network Commercial	$829.40
Rate for Payer: MDX Hawaii PPO	$946.50

SACUBITRIL-VALSARTAN 24-26 MG PO TABLET

Facility

$66.67

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$64.67
Rate for Payer: Cash Price	$43.34
Rate for Payer: Cash Price	$42.56
Rate for Payer: Hawaii Western Management Group Commercial	$62.21
Rate for Payer: Hawaii Western Management Group Commercial	$63.34
Rate for Payer: Health Management Network Commercial	$55.66
Rate for Payer: Health Management Network Commercial	$56.67
Rate for Payer: Kaiser Permanente Commercial	$42.00
Rate for Payer: Kaiser Permanente Commercial	$41.25
Rate for Payer: Kaiser Permanente Medicaid	$34.00
Rate for Payer: Kaiser Permanente Medicaid	$33.39
Rate for Payer: MDX Hawaii PPO	$64.67
Rate for Payer: MDX Hawaii PPO	$63.52
Rate for Payer: UnitedHealthcare Medicaid	$39.29
Rate for Payer: UnitedHealthcare Medicaid	$40.00
Rate for Payer: University Health Alliance Commercial	$47.73
Rate for Payer: University Health Alliance Commercial	$48.60

SACUBITRIL-VALSARTAN 24-26 MG PO TABLET

Facility

$65.48

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$55.66
Max. Negotiated Rate	$63.52
Rate for Payer: Cash Price	$42.56
Rate for Payer: Cash Price	$43.34
Rate for Payer: Health Management Network Commercial	$56.67
Rate for Payer: Health Management Network Commercial	$55.66
Rate for Payer: MDX Hawaii PPO	$64.67
Rate for Payer: MDX Hawaii PPO	$63.52

SALIVARY GLAND PROCEDURES

Facility

$22,130.23

Service Code	MSDRG 139
Min. Negotiated Rate	$16,252.88
Max. Negotiated Rate	$22,130.23
Rate for Payer: AlohaCare Medicare	$16,252.88
Rate for Payer: Devoted Health Medicare	$17,878.17
Rate for Payer: Hawaii Medical Service Association Commercial	$22,130.23
Rate for Payer: Hawaii Medical Service Association Medicare	$16,252.88
Rate for Payer: Humana Medicare	$16,252.88
Rate for Payer: Kaiser Permanente Commercial	$20,848.35
Rate for Payer: Kaiser Permanente Medicare	$16,252.88
Rate for Payer: Ohana Health Plan Medicare	$16,252.88
Rate for Payer: UnitedHealthcare Medicare	$16,252.88

Saw Blade 40mm Stryker/microair 7000-40SB [3644926]

Facility

$1,312.60

Hospital Charge Code	3644926
Hospital Revenue Code	272
Min. Negotiated Rate	$669.43
Max. Negotiated Rate	$1,273.22
Rate for Payer: Cash Price	$853.19
Rate for Payer: Hawaii Western Management Group Commercial	$1,246.97
Rate for Payer: Health Management Network Commercial	$1,115.71
Rate for Payer: Kaiser Permanente Commercial	$826.94
Rate for Payer: Kaiser Permanente Medicaid	$669.43
Rate for Payer: MDX Hawaii PPO	$1,273.22
Rate for Payer: University Health Alliance Commercial	$956.75

Saw Blade 40mm Stryker/microair 7000-40SB [3644926]

Facility

$1,312.60

Hospital Charge Code	3644926
Hospital Revenue Code	272
Min. Negotiated Rate	$1,115.71
Max. Negotiated Rate	$1,273.22
Rate for Payer: Cash Price	$853.19
Rate for Payer: Health Management Network Commercial	$1,115.71
Rate for Payer: MDX Hawaii PPO	$1,273.22

SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES

Professional

Both

$210.00

Service Code	HCPCS 99233
Min. Negotiated Rate	$76.28
Max. Negotiated Rate	$178.50
Rate for Payer: AlohaCare Medicaid	$119.20
Rate for Payer: AlohaCare Medicare	$107.19
Rate for Payer: Cash Price	$136.50
Rate for Payer: Cash Price	$136.50
Rate for Payer: Devoted Health Medicare	$117.91
Rate for Payer: Hawaii Medical Service Association Medicare	$107.19
Rate for Payer: Hawaii Western Management Group Commercial	$76.28
Rate for Payer: Health Management Network Commercial	$178.50
Rate for Payer: Kaiser Permanente Commercial	$128.63
Rate for Payer: Kaiser Permanente Medicaid	$128.63
Rate for Payer: Kaiser Permanente Medicare	$128.63
Rate for Payer: Ohana Health Plan Medicaid	$119.20
Rate for Payer: Ohana Health Plan Medicare	$107.19
Rate for Payer: UnitedHealthcare Medicaid	$119.20
Rate for Payer: UnitedHealthcare Medicare	$107.19

SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES

Professional

Both

$145.00

Service Code	HCPCS 99232
Min. Negotiated Rate	$54.57
Max. Negotiated Rate	$123.25
Rate for Payer: AlohaCare Medicaid	$79.26
Rate for Payer: AlohaCare Medicare	$70.62
Rate for Payer: Cash Price	$94.25
Rate for Payer: Cash Price	$94.25
Rate for Payer: Devoted Health Medicare	$77.68
Rate for Payer: Hawaii Medical Service Association Medicare	$70.62
Rate for Payer: Hawaii Western Management Group Commercial	$54.57
Rate for Payer: Health Management Network Commercial	$123.25
Rate for Payer: Kaiser Permanente Commercial	$84.74
Rate for Payer: Kaiser Permanente Medicaid	$84.74
Rate for Payer: Kaiser Permanente Medicare	$84.74
Rate for Payer: Ohana Health Plan Medicaid	$79.26
Rate for Payer: Ohana Health Plan Medicare	$70.62
Rate for Payer: UnitedHealthcare Medicaid	$79.26
Rate for Payer: UnitedHealthcare Medicare	$70.62

SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES

Professional

Both

$80.00

Service Code	HCPCS 99231
Min. Negotiated Rate	$36.28
Max. Negotiated Rate	$68.00
Rate for Payer: AlohaCare Medicaid	$49.50
Rate for Payer: AlohaCare Medicare	$44.06
Rate for Payer: Cash Price	$52.00
Rate for Payer: Cash Price	$52.00
Rate for Payer: Devoted Health Medicare	$48.47
Rate for Payer: Hawaii Medical Service Association Medicare	$44.06
Rate for Payer: Hawaii Western Management Group Commercial	$36.28
Rate for Payer: Health Management Network Commercial	$68.00
Rate for Payer: Kaiser Permanente Commercial	$52.87
Rate for Payer: Kaiser Permanente Medicaid	$52.87
Rate for Payer: Kaiser Permanente Medicare	$52.87
Rate for Payer: Ohana Health Plan Medicaid	$49.50
Rate for Payer: Ohana Health Plan Medicare	$44.06
Rate for Payer: UnitedHealthcare Medicaid	$49.50
Rate for Payer: UnitedHealthcare Medicare	$44.06

SCHIZOPHRENIA

Facility

$13,400.05

Service Code	APR-DRG 7504
Min. Negotiated Rate	$13,400.05
Max. Negotiated Rate	$13,400.05
Rate for Payer: AlohaCare Medicaid	$13,400.05
Rate for Payer: Hawaii Medical Service Association ABD	$13,400.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$13,400.05
Rate for Payer: Kaiser Permanente Medicaid	$13,400.05
Rate for Payer: Ohana Health Plan Medicaid	$13,400.05
Rate for Payer: UnitedHealthcare Medicaid	$13,400.05

SCHIZOPHRENIA

Facility

$3,036.21

Service Code	APR-DRG 7501
Min. Negotiated Rate	$3,036.21
Max. Negotiated Rate	$3,036.21
Rate for Payer: AlohaCare Medicaid	$3,036.21
Rate for Payer: Hawaii Medical Service Association ABD	$3,036.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,036.21
Rate for Payer: Kaiser Permanente Medicaid	$3,036.21
Rate for Payer: Ohana Health Plan Medicaid	$3,036.21
Rate for Payer: UnitedHealthcare Medicaid	$3,036.21

SCHIZOPHRENIA

Facility

$5,701.14

Service Code	APR-DRG 7503
Min. Negotiated Rate	$5,701.14
Max. Negotiated Rate	$5,701.14
Rate for Payer: AlohaCare Medicaid	$5,701.14
Rate for Payer: Hawaii Medical Service Association ABD	$5,701.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,701.14
Rate for Payer: Kaiser Permanente Medicaid	$5,701.14
Rate for Payer: Ohana Health Plan Medicaid	$5,701.14
Rate for Payer: UnitedHealthcare Medicaid	$5,701.14

SCHIZOPHRENIA

Facility

$3,789.77

Service Code	APR-DRG 7502
Min. Negotiated Rate	$3,789.77
Max. Negotiated Rate	$3,789.77
Rate for Payer: AlohaCare Medicaid	$3,789.77
Rate for Payer: Hawaii Medical Service Association ABD	$3,789.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,789.77
Rate for Payer: Kaiser Permanente Medicaid	$3,789.77
Rate for Payer: Ohana Health Plan Medicaid	$3,789.77
Rate for Payer: UnitedHealthcare Medicaid	$3,789.77

Scleral Patch 7mm x 7mm TSH [3601022]

Facility

$1,599.38

Service Code	HCPCS L8610
Hospital Charge Code	3601022
Hospital Revenue Code	278
Min. Negotiated Rate	$895.65
Max. Negotiated Rate	$1,551.40
Rate for Payer: Cash Price	$1,039.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,119.57
Rate for Payer: Health Management Network Commercial	$1,359.47
Rate for Payer: MDX Hawaii PPO	$1,551.40
Rate for Payer: University Health Alliance Commercial	$895.65

Scleral Patch 7mm x 7mm TSH [3601022]

Facility

$1,599.38

Service Code	HCPCS L8610
Hospital Charge Code	3601022
Hospital Revenue Code	278
Min. Negotiated Rate	$44.09
Max. Negotiated Rate	$1,551.40
Rate for Payer: Cash Price	$1,039.60
Rate for Payer: Cash Price	$1,039.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,119.57
Rate for Payer: Health Management Network Commercial	$1,359.47
Rate for Payer: Kaiser Permanente Commercial	$1,007.61
Rate for Payer: Kaiser Permanente Medicaid	$815.68
Rate for Payer: MDX Hawaii PPO	$1,551.40
Rate for Payer: UnitedHealthcare Medicaid	$44.09
Rate for Payer: University Health Alliance Commercial	$895.65

SCOPOLAMINE BASE 1 MG OVER 3 DAYS TRANSDERM PT3D

Facility

$97.74

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$83.08
Max. Negotiated Rate	$94.81
Rate for Payer: Cash Price	$63.53
Rate for Payer: Cash Price	$66.06
Rate for Payer: Cash Price	$73.53
Rate for Payer: Health Management Network Commercial	$86.39
Rate for Payer: Health Management Network Commercial	$96.15
Rate for Payer: Health Management Network Commercial	$83.08
Rate for Payer: MDX Hawaii PPO	$98.58
Rate for Payer: MDX Hawaii PPO	$94.81
Rate for Payer: MDX Hawaii PPO	$109.73

SCOPOLAMINE BASE 1 MG OVER 3 DAYS TRANSDERM PT3D

Facility

$113.12

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$57.69
Max. Negotiated Rate	$109.73
Rate for Payer: Cash Price	$73.53
Rate for Payer: Cash Price	$66.06
Rate for Payer: Cash Price	$63.53
Rate for Payer: Hawaii Western Management Group Commercial	$107.46
Rate for Payer: Hawaii Western Management Group Commercial	$96.55
Rate for Payer: Hawaii Western Management Group Commercial	$92.85
Rate for Payer: Health Management Network Commercial	$83.08
Rate for Payer: Health Management Network Commercial	$86.39
Rate for Payer: Health Management Network Commercial	$96.15
Rate for Payer: Kaiser Permanente Commercial	$61.58
Rate for Payer: Kaiser Permanente Commercial	$64.03
Rate for Payer: Kaiser Permanente Commercial	$71.27
Rate for Payer: Kaiser Permanente Medicaid	$51.83
Rate for Payer: Kaiser Permanente Medicaid	$57.69
Rate for Payer: Kaiser Permanente Medicaid	$49.85
Rate for Payer: MDX Hawaii PPO	$109.73
Rate for Payer: MDX Hawaii PPO	$98.58
Rate for Payer: MDX Hawaii PPO	$94.81
Rate for Payer: UnitedHealthcare Medicaid	$60.98
Rate for Payer: UnitedHealthcare Medicaid	$67.87
Rate for Payer: UnitedHealthcare Medicaid	$58.64
Rate for Payer: University Health Alliance Commercial	$82.45
Rate for Payer: University Health Alliance Commercial	$74.08
Rate for Payer: University Health Alliance Commercial	$71.24

Screw 1.5 Cortex Slf-Tpng T4 Sd Rec 15 02.214.115 [3645542]

Facility

$540.95

Service Code	HCPCS C1713
Hospital Charge Code	3645542
Hospital Revenue Code	278
Min. Negotiated Rate	$275.88
Max. Negotiated Rate	$524.72
Rate for Payer: Cash Price	$351.62
Rate for Payer: Hawaii Western Management Group Commercial	$378.67
Rate for Payer: Health Management Network Commercial	$459.81
Rate for Payer: Kaiser Permanente Commercial	$340.80
Rate for Payer: Kaiser Permanente Medicaid	$275.88
Rate for Payer: MDX Hawaii PPO	$524.72
Rate for Payer: University Health Alliance Commercial	$302.93

Know your out-of-pocket cost for care.

All Charges