Kona Community Hospital

All Charges

Charge

Type

Setting

Price

TRASTUZUMAB-ANNS 420 MG IV RECON.SOLN.

Facility

$5,688.22

Service Code	HCPCS Q5117
Hospital Revenue Code	250
Min. Negotiated Rate	$4,834.99
Max. Negotiated Rate	$5,517.57
Rate for Payer: Cash Price	$3,697.34
Rate for Payer: Health Management Network Commercial	$4,834.99
Rate for Payer: MDX Hawaii PPO	$5,517.57

TRASTUZUMAB-ANNS 420 MG IV RECON.SOLN.

Facility

$5,688.22

Service Code	HCPCS Q5117
Hospital Revenue Code	250
Min. Negotiated Rate	$43.28
Max. Negotiated Rate	$5,517.57
Rate for Payer: AlohaCare Medicaid	$56.38
Rate for Payer: AlohaCare Medicare	$56.38
Rate for Payer: Cash Price	$3,697.34
Rate for Payer: Cash Price	$3,697.34
Rate for Payer: Devoted Health Medicare	$62.02
Rate for Payer: Hawaii Medical Service Association ABD	$43.28
Rate for Payer: Hawaii Medical Service Association Commercial	$70.47
Rate for Payer: Hawaii Medical Service Association Medicare	$56.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$43.28
Rate for Payer: Hawaii Western Management Group Commercial	$5,403.81
Rate for Payer: Health Management Network Commercial	$4,834.99
Rate for Payer: Humana Medicare	$56.38
Rate for Payer: Kaiser Permanente Commercial	$3,583.58
Rate for Payer: Kaiser Permanente Medicaid	$2,900.99
Rate for Payer: Kaiser Permanente Medicare	$56.38
Rate for Payer: MDX Hawaii PPO	$5,517.57
Rate for Payer: Ohana Health Plan Medicaid	$62.02
Rate for Payer: Ohana Health Plan Medicare	$56.38
Rate for Payer: UnitedHealthcare Medicaid	$3,412.93
Rate for Payer: UnitedHealthcare Medicare	$56.38
Rate for Payer: University Health Alliance Commercial	$4,146.14

TRASTUZUMAB-PKRB 150 MG IV RECON.SOLN.

Facility

$3,138.00

Service Code	HCPCS Q5113
Hospital Revenue Code	250
Min. Negotiated Rate	$2,667.30
Max. Negotiated Rate	$3,043.86
Rate for Payer: Cash Price	$2,039.70
Rate for Payer: Health Management Network Commercial	$2,667.30
Rate for Payer: MDX Hawaii PPO	$3,043.86

TRASTUZUMAB-PKRB 150 MG IV RECON.SOLN.

Facility

$3,138.00

Service Code	HCPCS Q5113
Hospital Revenue Code	250
Min. Negotiated Rate	$56.02
Max. Negotiated Rate	$3,043.86
Rate for Payer: AlohaCare Medicaid	$56.02
Rate for Payer: AlohaCare Medicare	$56.02
Rate for Payer: Cash Price	$2,039.70
Rate for Payer: Cash Price	$2,039.70
Rate for Payer: Devoted Health Medicare	$61.62
Rate for Payer: Hawaii Medical Service Association ABD	$77.49
Rate for Payer: Hawaii Medical Service Association Commercial	$70.03
Rate for Payer: Hawaii Medical Service Association Medicare	$56.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$77.49
Rate for Payer: Hawaii Western Management Group Commercial	$2,981.10
Rate for Payer: Health Management Network Commercial	$2,667.30
Rate for Payer: Humana Medicare	$56.02
Rate for Payer: Kaiser Permanente Commercial	$1,976.94
Rate for Payer: Kaiser Permanente Medicaid	$1,600.38
Rate for Payer: Kaiser Permanente Medicare	$56.02
Rate for Payer: MDX Hawaii PPO	$3,043.86
Rate for Payer: Ohana Health Plan Medicaid	$61.62
Rate for Payer: Ohana Health Plan Medicare	$56.02
Rate for Payer: UnitedHealthcare Medicaid	$1,882.80
Rate for Payer: UnitedHealthcare Medicare	$56.02
Rate for Payer: University Health Alliance Commercial	$2,287.29

TRASTUZUMAB-PKRB 420 MG IV RECON.SOLN.

Facility

$6,773.28

Service Code	HCPCS Q5113
Hospital Revenue Code	250
Min. Negotiated Rate	$56.02
Max. Negotiated Rate	$6,570.08
Rate for Payer: AlohaCare Medicaid	$56.02
Rate for Payer: AlohaCare Medicare	$56.02
Rate for Payer: Cash Price	$4,402.63
Rate for Payer: Cash Price	$4,402.63
Rate for Payer: Devoted Health Medicare	$61.62
Rate for Payer: Hawaii Medical Service Association ABD	$77.49
Rate for Payer: Hawaii Medical Service Association Commercial	$70.03
Rate for Payer: Hawaii Medical Service Association Medicare	$56.02
Rate for Payer: Hawaii Medical Service Association Non-ABD	$77.49
Rate for Payer: Hawaii Western Management Group Commercial	$6,434.62
Rate for Payer: Health Management Network Commercial	$5,757.29
Rate for Payer: Humana Medicare	$56.02
Rate for Payer: Kaiser Permanente Commercial	$4,267.17
Rate for Payer: Kaiser Permanente Medicaid	$3,454.37
Rate for Payer: Kaiser Permanente Medicare	$56.02
Rate for Payer: MDX Hawaii PPO	$6,570.08
Rate for Payer: Ohana Health Plan Medicaid	$61.62
Rate for Payer: Ohana Health Plan Medicare	$56.02
Rate for Payer: UnitedHealthcare Medicaid	$4,063.97
Rate for Payer: UnitedHealthcare Medicare	$56.02
Rate for Payer: University Health Alliance Commercial	$4,937.04

TRASTUZUMAB-PKRB 420 MG IV RECON.SOLN.

Facility

$6,773.28

Service Code	HCPCS Q5113
Hospital Revenue Code	250
Min. Negotiated Rate	$5,757.29
Max. Negotiated Rate	$6,570.08
Rate for Payer: Cash Price	$4,402.63
Rate for Payer: Health Management Network Commercial	$5,757.29
Rate for Payer: MDX Hawaii PPO	$6,570.08

TRAUMATIC INJURY WITH MCC

Facility

$28,196.85

Service Code	MSDRG 913
Min. Negotiated Rate	$15,115.09
Max. Negotiated Rate	$28,196.85
Rate for Payer: AlohaCare Medicare	$21,499.52
Rate for Payer: Devoted Health Medicare	$23,649.47
Rate for Payer: Hawaii Medical Service Association Commercial	$15,115.09
Rate for Payer: Hawaii Medical Service Association Medicare	$21,499.52
Rate for Payer: Humana Medicare	$21,499.52
Rate for Payer: Kaiser Permanente Commercial	$28,196.85
Rate for Payer: Kaiser Permanente Medicare	$21,499.52
Rate for Payer: Ohana Health Plan Medicare	$21,499.52
Rate for Payer: UnitedHealthcare Medicare	$21,499.52

TRAUMATIC INJURY WITHOUT MCC

Facility

$15,274.88

Service Code	MSDRG 914
Min. Negotiated Rate	$11,646.78
Max. Negotiated Rate	$15,274.88
Rate for Payer: AlohaCare Medicare	$11,646.78
Rate for Payer: Devoted Health Medicare	$12,811.46
Rate for Payer: Hawaii Medical Service Association Commercial	$15,115.09
Rate for Payer: Hawaii Medical Service Association Medicare	$11,646.78
Rate for Payer: Humana Medicare	$11,646.78
Rate for Payer: Kaiser Permanente Commercial	$15,274.88
Rate for Payer: Kaiser Permanente Medicare	$11,646.78
Rate for Payer: Ohana Health Plan Medicare	$11,646.78
Rate for Payer: UnitedHealthcare Medicare	$11,646.78

TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC

Facility

$22,471.58

Service Code	MSDRG 086
Min. Negotiated Rate	$16,995.44
Max. Negotiated Rate	$22,471.58
Rate for Payer: AlohaCare Medicare	$17,134.12
Rate for Payer: Devoted Health Medicare	$18,847.53
Rate for Payer: Hawaii Medical Service Association Commercial	$16,995.44
Rate for Payer: Hawaii Medical Service Association Medicare	$17,134.12
Rate for Payer: Humana Medicare	$17,134.12
Rate for Payer: Kaiser Permanente Commercial	$22,471.58
Rate for Payer: Kaiser Permanente Medicare	$17,134.12
Rate for Payer: Ohana Health Plan Medicare	$17,134.12
Rate for Payer: UnitedHealthcare Medicare	$17,134.12

TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC

Facility

$38,402.45

Service Code	MSDRG 083
Min. Negotiated Rate	$18,358.62
Max. Negotiated Rate	$38,402.45
Rate for Payer: AlohaCare Medicare	$18,358.62
Rate for Payer: Devoted Health Medicare	$20,194.48
Rate for Payer: Hawaii Medical Service Association Commercial	$38,402.45
Rate for Payer: Hawaii Medical Service Association Medicare	$18,358.62
Rate for Payer: Humana Medicare	$18,358.62
Rate for Payer: Kaiser Permanente Commercial	$24,077.55
Rate for Payer: Kaiser Permanente Medicare	$18,358.62
Rate for Payer: Ohana Health Plan Medicare	$18,358.62
Rate for Payer: UnitedHealthcare Medicare	$18,358.62

TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC

Facility

$59,230.90

Service Code	MSDRG 085
Min. Negotiated Rate	$29,881.75
Max. Negotiated Rate	$59,230.90
Rate for Payer: AlohaCare Medicare	$29,881.75
Rate for Payer: Devoted Health Medicare	$32,869.93
Rate for Payer: Hawaii Medical Service Association Commercial	$59,230.90
Rate for Payer: Hawaii Medical Service Association Medicare	$29,881.75
Rate for Payer: Humana Medicare	$29,881.75
Rate for Payer: Kaiser Permanente Commercial	$39,190.28
Rate for Payer: Kaiser Permanente Medicare	$29,881.75
Rate for Payer: Ohana Health Plan Medicare	$29,881.75
Rate for Payer: UnitedHealthcare Medicare	$29,881.75

TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC

Facility

$39,426.60

Service Code	MSDRG 082
Min. Negotiated Rate	$30,061.96
Max. Negotiated Rate	$39,426.60
Rate for Payer: AlohaCare Medicare	$30,061.96
Rate for Payer: Devoted Health Medicare	$33,068.16
Rate for Payer: Hawaii Medical Service Association Commercial	$38,402.45
Rate for Payer: Hawaii Medical Service Association Medicare	$30,061.96
Rate for Payer: Humana Medicare	$30,061.96
Rate for Payer: Kaiser Permanente Commercial	$39,426.60
Rate for Payer: Kaiser Permanente Medicare	$30,061.96
Rate for Payer: Ohana Health Plan Medicare	$30,061.96
Rate for Payer: UnitedHealthcare Medicare	$30,061.96

TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC

Facility

$15,778.58

Service Code	MSDRG 087
Min. Negotiated Rate	$12,030.84
Max. Negotiated Rate	$15,778.58
Rate for Payer: AlohaCare Medicare	$12,030.84
Rate for Payer: Devoted Health Medicare	$13,233.92
Rate for Payer: Hawaii Medical Service Association Commercial	$15,476.69
Rate for Payer: Hawaii Medical Service Association Medicare	$12,030.84
Rate for Payer: Humana Medicare	$12,030.84
Rate for Payer: Kaiser Permanente Commercial	$15,778.58
Rate for Payer: Kaiser Permanente Medicare	$12,030.84
Rate for Payer: Ohana Health Plan Medicare	$12,030.84
Rate for Payer: UnitedHealthcare Medicare	$12,030.84

TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC

Facility

$38,402.45

Service Code	MSDRG 084
Min. Negotiated Rate	$12,571.43
Max. Negotiated Rate	$38,402.45
Rate for Payer: AlohaCare Medicare	$12,571.43
Rate for Payer: Devoted Health Medicare	$13,828.57
Rate for Payer: Hawaii Medical Service Association Commercial	$38,402.45
Rate for Payer: Hawaii Medical Service Association Medicare	$12,571.43
Rate for Payer: Humana Medicare	$12,571.43
Rate for Payer: Kaiser Permanente Commercial	$16,487.55
Rate for Payer: Kaiser Permanente Medicare	$12,571.43
Rate for Payer: Ohana Health Plan Medicare	$12,571.43
Rate for Payer: UnitedHealthcare Medicare	$12,571.43

TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC

Facility

$25,393.72

Service Code	MSDRG 604
Min. Negotiated Rate	$18,224.89
Max. Negotiated Rate	$25,393.72
Rate for Payer: AlohaCare Medicare	$19,362.18
Rate for Payer: Devoted Health Medicare	$21,298.40
Rate for Payer: Hawaii Medical Service Association Commercial	$18,224.89
Rate for Payer: Hawaii Medical Service Association Medicare	$19,362.18
Rate for Payer: Humana Medicare	$19,362.18
Rate for Payer: Kaiser Permanente Commercial	$25,393.72
Rate for Payer: Kaiser Permanente Medicare	$19,362.18
Rate for Payer: Ohana Health Plan Medicare	$19,362.18
Rate for Payer: UnitedHealthcare Medicare	$19,362.18

TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC

Facility

$15,801.00

Service Code	MSDRG 605
Min. Negotiated Rate	$12,047.94
Max. Negotiated Rate	$15,801.00
Rate for Payer: AlohaCare Medicare	$12,047.94
Rate for Payer: Devoted Health Medicare	$13,252.73
Rate for Payer: Hawaii Medical Service Association Commercial	$14,970.45
Rate for Payer: Hawaii Medical Service Association Medicare	$12,047.94
Rate for Payer: Humana Medicare	$12,047.94
Rate for Payer: Kaiser Permanente Commercial	$15,801.00
Rate for Payer: Kaiser Permanente Medicare	$12,047.94
Rate for Payer: Ohana Health Plan Medicare	$12,047.94
Rate for Payer: UnitedHealthcare Medicare	$12,047.94

Traxi Panniculus Retractor-Extender PRS1050 [3641981]

Facility

$318.25

Hospital Charge Code	3641981
Hospital Revenue Code	272
Min. Negotiated Rate	$270.51
Max. Negotiated Rate	$308.70
Rate for Payer: Cash Price	$206.86
Rate for Payer: Health Management Network Commercial	$270.51
Rate for Payer: MDX Hawaii PPO	$308.70

Traxi Panniculus Retractor-Extender PRS1050 [3641981]

Facility

$318.25

Hospital Charge Code	3641981
Hospital Revenue Code	272
Min. Negotiated Rate	$162.31
Max. Negotiated Rate	$308.70
Rate for Payer: Cash Price	$206.86
Rate for Payer: Hawaii Western Management Group Commercial	$302.34
Rate for Payer: Health Management Network Commercial	$270.51
Rate for Payer: Kaiser Permanente Commercial	$200.50
Rate for Payer: Kaiser Permanente Medicaid	$162.31
Rate for Payer: MDX Hawaii PPO	$308.70
Rate for Payer: University Health Alliance Commercial	$231.97

Traxi Panniculus Retractor PRS1030 [3641980]

Facility

$772.28

Hospital Charge Code	3641980
Hospital Revenue Code	272
Min. Negotiated Rate	$656.44
Max. Negotiated Rate	$749.11
Rate for Payer: Cash Price	$501.98
Rate for Payer: Health Management Network Commercial	$656.44
Rate for Payer: MDX Hawaii PPO	$749.11

Traxi Panniculus Retractor PRS1030 [3641980]

Facility

$772.28

Hospital Charge Code	3641980
Hospital Revenue Code	272
Min. Negotiated Rate	$393.86
Max. Negotiated Rate	$749.11
Rate for Payer: Cash Price	$501.98
Rate for Payer: Hawaii Western Management Group Commercial	$733.67
Rate for Payer: Health Management Network Commercial	$656.44
Rate for Payer: Kaiser Permanente Commercial	$486.54
Rate for Payer: Kaiser Permanente Medicaid	$393.86
Rate for Payer: MDX Hawaii PPO	$749.11
Rate for Payer: University Health Alliance Commercial	$562.91

TRAY BONE MARROW [2701988]

Facility

$194.80

Hospital Charge Code	2701988
Hospital Revenue Code	272
Min. Negotiated Rate	$99.35
Max. Negotiated Rate	$188.96
Rate for Payer: Cash Price	$126.62
Rate for Payer: Hawaii Western Management Group Commercial	$185.06
Rate for Payer: Health Management Network Commercial	$165.58
Rate for Payer: Kaiser Permanente Commercial	$122.72
Rate for Payer: Kaiser Permanente Medicaid	$99.35
Rate for Payer: MDX Hawaii PPO	$188.96
Rate for Payer: University Health Alliance Commercial	$141.99

TRAY BONE MARROW [2701988]

Facility

$194.80

Hospital Charge Code	2701988
Hospital Revenue Code	272
Min. Negotiated Rate	$165.58
Max. Negotiated Rate	$188.96
Rate for Payer: Cash Price	$126.62
Rate for Payer: Health Management Network Commercial	$165.58
Rate for Payer: MDX Hawaii PPO	$188.96

TRAY CATHETER ADD A FOLEY A304400A [2707456]

Facility

$104.89

Service Code	HCPCS A4354
Hospital Charge Code	2707456
Hospital Revenue Code	272
Min. Negotiated Rate	$89.16
Max. Negotiated Rate	$101.74
Rate for Payer: Cash Price	$68.18
Rate for Payer: Health Management Network Commercial	$89.16
Rate for Payer: MDX Hawaii PPO	$101.74

TRAY CATHETER ADD A FOLEY A304400A [2707456]

Facility

$104.89

Service Code	HCPCS A4354
Hospital Charge Code	2707456
Hospital Revenue Code	272
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$101.74
Rate for Payer: Cash Price	$68.18
Rate for Payer: Cash Price	$68.18
Rate for Payer: Hawaii Western Management Group Commercial	$99.65
Rate for Payer: Health Management Network Commercial	$89.16
Rate for Payer: Kaiser Permanente Commercial	$66.08
Rate for Payer: Kaiser Permanente Medicaid	$53.49
Rate for Payer: MDX Hawaii PPO	$101.74
Rate for Payer: UnitedHealthcare Medicaid	$11.50
Rate for Payer: University Health Alliance Commercial	$76.45

TRAY CATHETER FOLEY 2W BAG 14F A303314A [2701992]

Facility

$171.04

Hospital Charge Code	2701992
Hospital Revenue Code	272
Min. Negotiated Rate	$87.23
Max. Negotiated Rate	$165.91
Rate for Payer: Cash Price	$111.18
Rate for Payer: Hawaii Western Management Group Commercial	$162.49
Rate for Payer: Health Management Network Commercial	$145.38
Rate for Payer: Kaiser Permanente Commercial	$107.76
Rate for Payer: Kaiser Permanente Medicaid	$87.23
Rate for Payer: MDX Hawaii PPO	$165.91
Rate for Payer: University Health Alliance Commercial	$124.67

Know your out-of-pocket cost for care.

All Charges