Kona Community Hospital

All Charges

Charge

Type

Setting

Price

CARBIDOPA-LEVODOPA 25-100 MG PO TABLET

Facility

$4.53

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.39
Rate for Payer: Cash Price	$2.94
Rate for Payer: Hawaii Western Management Group Commercial	$4.30
Rate for Payer: Health Management Network Commercial	$3.85
Rate for Payer: Kaiser Permanente Commercial	$2.85
Rate for Payer: Kaiser Permanente Medicaid	$2.31
Rate for Payer: MDX Hawaii PPO	$4.39
Rate for Payer: UnitedHealthcare Medicaid	$2.72
Rate for Payer: University Health Alliance Commercial	$3.30

CARBIDOPA-LEVODOPA 25-250 MG PO TABLET

Facility

$6.14

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$5.96
Rate for Payer: Cash Price	$3.99
Rate for Payer: Hawaii Western Management Group Commercial	$5.83
Rate for Payer: Health Management Network Commercial	$5.22
Rate for Payer: Kaiser Permanente Commercial	$3.87
Rate for Payer: Kaiser Permanente Medicaid	$3.13
Rate for Payer: MDX Hawaii PPO	$5.96
Rate for Payer: UnitedHealthcare Medicaid	$3.68
Rate for Payer: University Health Alliance Commercial	$4.48

CARBIDOPA-LEVODOPA 25-250 MG PO TABLET

Facility

$6.14

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$5.96
Rate for Payer: Cash Price	$3.99
Rate for Payer: Health Management Network Commercial	$5.22
Rate for Payer: MDX Hawaii PPO	$5.96

CARBIDOPA-LEVODOPA 50-200 MG PO TAB SR

Facility

$9.97

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$9.67
Rate for Payer: Cash Price	$6.48
Rate for Payer: Hawaii Western Management Group Commercial	$9.47
Rate for Payer: Health Management Network Commercial	$8.47
Rate for Payer: Kaiser Permanente Commercial	$6.28
Rate for Payer: Kaiser Permanente Medicaid	$5.08
Rate for Payer: MDX Hawaii PPO	$9.67
Rate for Payer: UnitedHealthcare Medicaid	$5.98
Rate for Payer: University Health Alliance Commercial	$7.27

CARBIDOPA-LEVODOPA 50-200 MG PO TAB SR

Facility

$9.97

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$8.47
Max. Negotiated Rate	$9.67
Rate for Payer: Cash Price	$6.48
Rate for Payer: Health Management Network Commercial	$8.47
Rate for Payer: MDX Hawaii PPO	$9.67

CARBON DIOXIDE BICARBONATE

Professional

Both

$10.00

Service Code	HCPCS 82374
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$8.50
Rate for Payer: AlohaCare Medicaid	$6.76
Rate for Payer: AlohaCare Medicare	$4.88
Rate for Payer: Cash Price	$6.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Devoted Health Medicare	$5.37
Rate for Payer: Hawaii Medical Service Association Medicare	$4.88
Rate for Payer: Hawaii Western Management Group Commercial	$6.75
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$5.86
Rate for Payer: Kaiser Permanente Medicaid	$5.86
Rate for Payer: Kaiser Permanente Medicare	$5.86
Rate for Payer: Ohana Health Plan Medicaid	$6.76
Rate for Payer: Ohana Health Plan Medicare	$4.88
Rate for Payer: UnitedHealthcare Medicaid	$6.76
Rate for Payer: UnitedHealthcare Medicare	$4.88

CARBOPLATIN 10 MG/ML IV SOLN

Facility

$304.06

Service Code	HCPCS J9045
Hospital Revenue Code	636
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$294.94
Rate for Payer: Cash Price	$197.64
Rate for Payer: Cash Price	$483.42
Rate for Payer: Cash Price	$138.61
Rate for Payer: Cash Price	$138.61
Rate for Payer: Cash Price	$99.58
Rate for Payer: Cash Price	$99.58
Rate for Payer: Cash Price	$258.02
Rate for Payer: Cash Price	$258.02
Rate for Payer: Cash Price	$37.36
Rate for Payer: Cash Price	$483.42
Rate for Payer: Cash Price	$197.64
Rate for Payer: Cash Price	$37.36
Rate for Payer: Hawaii Medical Service Association ABD	$2.11
Rate for Payer: Hawaii Medical Service Association ABD	$2.11
Rate for Payer: Hawaii Medical Service Association ABD	$2.11
Rate for Payer: Hawaii Medical Service Association ABD	$2.11
Rate for Payer: Hawaii Medical Service Association ABD	$2.11
Rate for Payer: Hawaii Medical Service Association ABD	$2.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.11
Rate for Payer: Hawaii Western Management Group Commercial	$145.54
Rate for Payer: Hawaii Western Management Group Commercial	$202.59
Rate for Payer: Hawaii Western Management Group Commercial	$377.11
Rate for Payer: Hawaii Western Management Group Commercial	$706.54
Rate for Payer: Hawaii Western Management Group Commercial	$288.86
Rate for Payer: Hawaii Western Management Group Commercial	$54.61
Rate for Payer: Health Management Network Commercial	$48.86
Rate for Payer: Health Management Network Commercial	$337.42
Rate for Payer: Health Management Network Commercial	$181.26
Rate for Payer: Health Management Network Commercial	$130.22
Rate for Payer: Health Management Network Commercial	$258.45
Rate for Payer: Health Management Network Commercial	$632.17
Rate for Payer: Kaiser Permanente Commercial	$191.56
Rate for Payer: Kaiser Permanente Commercial	$250.08
Rate for Payer: Kaiser Permanente Commercial	$96.52
Rate for Payer: Kaiser Permanente Commercial	$36.21
Rate for Payer: Kaiser Permanente Commercial	$468.55
Rate for Payer: Kaiser Permanente Commercial	$134.35
Rate for Payer: Kaiser Permanente Medicaid	$78.13
Rate for Payer: Kaiser Permanente Medicaid	$202.45
Rate for Payer: Kaiser Permanente Medicaid	$379.30
Rate for Payer: Kaiser Permanente Medicaid	$108.76
Rate for Payer: Kaiser Permanente Medicaid	$29.31
Rate for Payer: Kaiser Permanente Medicaid	$155.07
Rate for Payer: MDX Hawaii PPO	$148.60
Rate for Payer: MDX Hawaii PPO	$206.85
Rate for Payer: MDX Hawaii PPO	$294.94
Rate for Payer: MDX Hawaii PPO	$55.76
Rate for Payer: MDX Hawaii PPO	$721.42
Rate for Payer: MDX Hawaii PPO	$385.05
Rate for Payer: UnitedHealthcare Medicaid	$238.18
Rate for Payer: UnitedHealthcare Medicaid	$182.44
Rate for Payer: UnitedHealthcare Medicaid	$91.92
Rate for Payer: UnitedHealthcare Medicaid	$127.95
Rate for Payer: UnitedHealthcare Medicaid	$446.24
Rate for Payer: UnitedHealthcare Medicaid	$34.49
Rate for Payer: University Health Alliance Commercial	$542.10
Rate for Payer: University Health Alliance Commercial	$289.34
Rate for Payer: University Health Alliance Commercial	$221.63
Rate for Payer: University Health Alliance Commercial	$111.67
Rate for Payer: University Health Alliance Commercial	$41.90
Rate for Payer: University Health Alliance Commercial	$155.44

CARBOPLATIN 10 MG/ML IV SOLN

Facility

$304.06

Service Code	HCPCS J9045
Hospital Revenue Code	250
Min. Negotiated Rate	$258.45
Max. Negotiated Rate	$294.94
Rate for Payer: Cash Price	$197.64
Rate for Payer: Cash Price	$483.42
Rate for Payer: Cash Price	$258.02
Rate for Payer: Cash Price	$138.61
Rate for Payer: Cash Price	$99.58
Rate for Payer: Cash Price	$37.36
Rate for Payer: Health Management Network Commercial	$130.22
Rate for Payer: Health Management Network Commercial	$181.26
Rate for Payer: Health Management Network Commercial	$258.45
Rate for Payer: Health Management Network Commercial	$337.42
Rate for Payer: Health Management Network Commercial	$48.86
Rate for Payer: Health Management Network Commercial	$632.17
Rate for Payer: MDX Hawaii PPO	$206.85
Rate for Payer: MDX Hawaii PPO	$721.42
Rate for Payer: MDX Hawaii PPO	$55.76
Rate for Payer: MDX Hawaii PPO	$294.94
Rate for Payer: MDX Hawaii PPO	$148.60
Rate for Payer: MDX Hawaii PPO	$385.05

CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN

Facility

$530.64

Service Code	HCPCS J0675
Hospital Revenue Code	250
Min. Negotiated Rate	$451.04
Max. Negotiated Rate	$514.72
Rate for Payer: Cash Price	$344.92
Rate for Payer: Health Management Network Commercial	$451.04
Rate for Payer: MDX Hawaii PPO	$514.72

CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN

Facility

$530.64

Service Code	HCPCS J0675
Hospital Revenue Code	636
Min. Negotiated Rate	$15.56
Max. Negotiated Rate	$514.72
Rate for Payer: AlohaCare Medicaid	$15.56
Rate for Payer: AlohaCare Medicare	$15.56
Rate for Payer: Cash Price	$344.92
Rate for Payer: Cash Price	$344.92
Rate for Payer: Devoted Health Medicare	$17.12
Rate for Payer: Hawaii Medical Service Association Commercial	$19.45
Rate for Payer: Hawaii Medical Service Association Medicare	$15.56
Rate for Payer: Hawaii Western Management Group Commercial	$504.11
Rate for Payer: Health Management Network Commercial	$451.04
Rate for Payer: Humana Medicare	$15.56
Rate for Payer: Kaiser Permanente Commercial	$334.30
Rate for Payer: Kaiser Permanente Medicaid	$270.63
Rate for Payer: Kaiser Permanente Medicare	$15.56
Rate for Payer: MDX Hawaii PPO	$514.72
Rate for Payer: Ohana Health Plan Medicaid	$17.12
Rate for Payer: Ohana Health Plan Medicare	$15.56
Rate for Payer: UnitedHealthcare Medicaid	$318.38
Rate for Payer: UnitedHealthcare Medicare	$15.56
Rate for Payer: University Health Alliance Commercial	$386.78

CARCINOEMBRYONIC ANTIGEN CEA

Professional

Both

$38.00

Service Code	HCPCS 82378
Min. Negotiated Rate	$18.96
Max. Negotiated Rate	$32.30
Rate for Payer: AlohaCare Medicaid	$26.22
Rate for Payer: AlohaCare Medicare	$18.96
Rate for Payer: Cash Price	$24.70
Rate for Payer: Cash Price	$24.70
Rate for Payer: Devoted Health Medicare	$20.86
Rate for Payer: Hawaii Medical Service Association Medicare	$18.96
Rate for Payer: Hawaii Western Management Group Commercial	$26.23
Rate for Payer: Health Management Network Commercial	$32.30
Rate for Payer: Kaiser Permanente Commercial	$22.75
Rate for Payer: Kaiser Permanente Medicaid	$22.75
Rate for Payer: Kaiser Permanente Medicare	$22.75
Rate for Payer: Ohana Health Plan Medicaid	$26.22
Rate for Payer: Ohana Health Plan Medicare	$18.96
Rate for Payer: UnitedHealthcare Medicaid	$26.22
Rate for Payer: UnitedHealthcare Medicare	$18.96

CARDIAC ARREST & SHOCK

Facility

$2,104.00

Service Code	APR-DRG 1961
Min. Negotiated Rate	$2,104.00
Max. Negotiated Rate	$2,104.00
Rate for Payer: AlohaCare Medicaid	$2,104.00
Rate for Payer: Hawaii Medical Service Association ABD	$2,104.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,104.00
Rate for Payer: Kaiser Permanente Medicaid	$2,104.00
Rate for Payer: Ohana Health Plan Medicaid	$2,104.00
Rate for Payer: UnitedHealthcare Medicaid	$2,104.00

CARDIAC ARREST & SHOCK

Facility

$2,764.36

Service Code	APR-DRG 1962
Min. Negotiated Rate	$2,764.36
Max. Negotiated Rate	$2,764.36
Rate for Payer: AlohaCare Medicaid	$2,764.36
Rate for Payer: Hawaii Medical Service Association ABD	$2,764.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,764.36
Rate for Payer: Kaiser Permanente Medicaid	$2,764.36
Rate for Payer: Ohana Health Plan Medicaid	$2,764.36
Rate for Payer: UnitedHealthcare Medicaid	$2,764.36

CARDIAC ARREST & SHOCK

Facility

$7,522.55

Service Code	APR-DRG 1964
Min. Negotiated Rate	$7,522.55
Max. Negotiated Rate	$7,522.55
Rate for Payer: AlohaCare Medicaid	$7,522.55
Rate for Payer: Hawaii Medical Service Association ABD	$7,522.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,522.55
Rate for Payer: Kaiser Permanente Medicaid	$7,522.55
Rate for Payer: Ohana Health Plan Medicaid	$7,522.55
Rate for Payer: UnitedHealthcare Medicaid	$7,522.55

CARDIAC ARREST & SHOCK

Facility

$4,116.29

Service Code	APR-DRG 1963
Min. Negotiated Rate	$4,116.29
Max. Negotiated Rate	$4,116.29
Rate for Payer: AlohaCare Medicaid	$4,116.29
Rate for Payer: Hawaii Medical Service Association ABD	$4,116.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,116.29
Rate for Payer: Kaiser Permanente Medicaid	$4,116.29
Rate for Payer: Ohana Health Plan Medicaid	$4,116.29
Rate for Payer: UnitedHealthcare Medicaid	$4,116.29

CARDIAC ARREST, UNEXPLAINED WITH CC

Facility

$45,441.69

Service Code	MSDRG 297
Min. Negotiated Rate	$8,338.85
Max. Negotiated Rate	$45,441.69
Rate for Payer: AlohaCare Medicare	$8,338.85
Rate for Payer: Devoted Health Medicare	$9,172.74
Rate for Payer: Hawaii Medical Service Association Commercial	$45,441.69
Rate for Payer: Hawaii Medical Service Association Medicare	$8,338.85
Rate for Payer: Humana Medicare	$8,338.85
Rate for Payer: Kaiser Permanente Commercial	$10,755.38
Rate for Payer: Kaiser Permanente Medicare	$8,338.85
Rate for Payer: Ohana Health Plan Medicare	$8,338.85
Rate for Payer: UnitedHealthcare Medicare	$8,338.85

CARDIAC ARREST, UNEXPLAINED WITH MCC

Facility

$45,441.69

Service Code	MSDRG 296
Min. Negotiated Rate	$20,543.30
Max. Negotiated Rate	$45,441.69
Rate for Payer: AlohaCare Medicare	$20,543.30
Rate for Payer: Devoted Health Medicare	$22,597.63
Rate for Payer: Hawaii Medical Service Association Commercial	$45,441.69
Rate for Payer: Hawaii Medical Service Association Medicare	$20,543.30
Rate for Payer: Humana Medicare	$20,543.30
Rate for Payer: Kaiser Permanente Commercial	$26,942.78
Rate for Payer: Kaiser Permanente Medicare	$20,543.30
Rate for Payer: Ohana Health Plan Medicare	$20,543.30
Rate for Payer: UnitedHealthcare Medicare	$20,543.30

CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC

Facility

$45,441.69

Service Code	MSDRG 298
Min. Negotiated Rate	$5,985.83
Max. Negotiated Rate	$45,441.69
Rate for Payer: AlohaCare Medicare	$5,985.83
Rate for Payer: Devoted Health Medicare	$6,584.41
Rate for Payer: Hawaii Medical Service Association Commercial	$45,441.69
Rate for Payer: Hawaii Medical Service Association Medicare	$5,985.83
Rate for Payer: Humana Medicare	$5,985.83
Rate for Payer: Kaiser Permanente Commercial	$7,850.48
Rate for Payer: Kaiser Permanente Medicare	$5,985.83
Rate for Payer: Ohana Health Plan Medicare	$5,985.83
Rate for Payer: UnitedHealthcare Medicare	$5,985.83

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC

Facility

$20,153.45

Service Code	MSDRG 309
Min. Negotiated Rate	$9,676.50
Max. Negotiated Rate	$20,153.45
Rate for Payer: AlohaCare Medicare	$9,676.50
Rate for Payer: Devoted Health Medicare	$10,644.15
Rate for Payer: Hawaii Medical Service Association Commercial	$20,153.45
Rate for Payer: Hawaii Medical Service Association Medicare	$9,676.50
Rate for Payer: Humana Medicare	$9,676.50
Rate for Payer: Kaiser Permanente Commercial	$12,690.83
Rate for Payer: Kaiser Permanente Medicare	$9,676.50
Rate for Payer: Ohana Health Plan Medicare	$9,676.50
Rate for Payer: UnitedHealthcare Medicare	$9,676.50

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC

Facility

$21,479.34

Service Code	MSDRG 308
Min. Negotiated Rate	$15,835.92
Max. Negotiated Rate	$21,479.34
Rate for Payer: AlohaCare Medicare	$15,835.92
Rate for Payer: Devoted Health Medicare	$17,419.51
Rate for Payer: Hawaii Medical Service Association Commercial	$21,479.34
Rate for Payer: Hawaii Medical Service Association Medicare	$15,835.92
Rate for Payer: Humana Medicare	$15,835.92
Rate for Payer: Kaiser Permanente Commercial	$20,769.00
Rate for Payer: Kaiser Permanente Medicare	$15,835.92
Rate for Payer: Ohana Health Plan Medicare	$15,835.92
Rate for Payer: UnitedHealthcare Medicare	$15,835.92

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC

Facility

$15,452.59

Service Code	MSDRG 310
Min. Negotiated Rate	$7,445.78
Max. Negotiated Rate	$15,452.59
Rate for Payer: AlohaCare Medicare	$7,445.78
Rate for Payer: Devoted Health Medicare	$8,190.36
Rate for Payer: Hawaii Medical Service Association Commercial	$15,452.59
Rate for Payer: Hawaii Medical Service Association Medicare	$7,445.78
Rate for Payer: Humana Medicare	$7,445.78
Rate for Payer: Kaiser Permanente Commercial	$9,765.23
Rate for Payer: Kaiser Permanente Medicare	$7,445.78
Rate for Payer: Ohana Health Plan Medicare	$7,445.78
Rate for Payer: UnitedHealthcare Medicare	$7,445.78

CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS

Facility

$3,019.72

Service Code	APR-DRG 2012
Min. Negotiated Rate	$3,019.72
Max. Negotiated Rate	$3,019.72
Rate for Payer: AlohaCare Medicaid	$3,019.72
Rate for Payer: Hawaii Medical Service Association ABD	$3,019.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,019.72
Rate for Payer: Kaiser Permanente Medicaid	$3,019.72
Rate for Payer: Ohana Health Plan Medicaid	$3,019.72
Rate for Payer: UnitedHealthcare Medicaid	$3,019.72

CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS

Facility

$2,324.97

Service Code	APR-DRG 2011
Min. Negotiated Rate	$2,324.97
Max. Negotiated Rate	$2,324.97
Rate for Payer: AlohaCare Medicaid	$2,324.97
Rate for Payer: Hawaii Medical Service Association ABD	$2,324.97
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,324.97
Rate for Payer: Kaiser Permanente Medicaid	$2,324.97
Rate for Payer: Ohana Health Plan Medicaid	$2,324.97
Rate for Payer: UnitedHealthcare Medicaid	$2,324.97

CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS

Facility

$4,410.50

Service Code	APR-DRG 2013
Min. Negotiated Rate	$4,410.50
Max. Negotiated Rate	$4,410.50
Rate for Payer: AlohaCare Medicaid	$4,410.50
Rate for Payer: Hawaii Medical Service Association ABD	$4,410.50
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,410.50
Rate for Payer: Kaiser Permanente Medicaid	$4,410.50
Rate for Payer: Ohana Health Plan Medicaid	$4,410.50
Rate for Payer: UnitedHealthcare Medicaid	$4,410.50

CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS

Facility

$7,394.56

Service Code	APR-DRG 2014
Min. Negotiated Rate	$7,394.56
Max. Negotiated Rate	$7,394.56
Rate for Payer: AlohaCare Medicaid	$7,394.56
Rate for Payer: Hawaii Medical Service Association ABD	$7,394.56
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,394.56
Rate for Payer: Kaiser Permanente Medicaid	$7,394.56
Rate for Payer: Ohana Health Plan Medicaid	$7,394.56
Rate for Payer: UnitedHealthcare Medicaid	$7,394.56

Know your out-of-pocket cost for care.

All Charges