Kona Community Hospital

All Charges

Charge

Type

Setting

Price

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Facility

$6,311.35

Service Code	APR-DRG 1404
Min. Negotiated Rate	$6,311.35
Max. Negotiated Rate	$6,311.35
Rate for Payer: AlohaCare Medicaid	$6,311.35
Rate for Payer: Hawaii Medical Service Association ABD	$6,311.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,311.35
Rate for Payer: Kaiser Permanente Medicaid	$6,311.35
Rate for Payer: Ohana Health Plan Medicaid	$6,311.35
Rate for Payer: UnitedHealthcare Medicaid	$6,311.35

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC

Facility

$18,803.46

Service Code	MSDRG 191
Min. Negotiated Rate	$11,087.78
Max. Negotiated Rate	$18,803.46
Rate for Payer: AlohaCare Medicare	$11,087.78
Rate for Payer: Devoted Health Medicare	$12,196.56
Rate for Payer: Hawaii Medical Service Association Commercial	$18,803.46
Rate for Payer: Hawaii Medical Service Association Medicare	$11,087.78
Rate for Payer: Humana Medicare	$11,087.78
Rate for Payer: Kaiser Permanente Commercial	$14,541.75
Rate for Payer: Kaiser Permanente Medicare	$11,087.78
Rate for Payer: Ohana Health Plan Medicare	$11,087.78
Rate for Payer: UnitedHealthcare Medicare	$11,087.78

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC

Facility

$19,107.83

Service Code	MSDRG 190
Min. Negotiated Rate	$14,569.31
Max. Negotiated Rate	$19,107.83
Rate for Payer: AlohaCare Medicare	$14,569.31
Rate for Payer: Devoted Health Medicare	$16,026.24
Rate for Payer: Hawaii Medical Service Association Commercial	$18,803.46
Rate for Payer: Hawaii Medical Service Association Medicare	$14,569.31
Rate for Payer: Humana Medicare	$14,569.31
Rate for Payer: Kaiser Permanente Commercial	$19,107.83
Rate for Payer: Kaiser Permanente Medicare	$14,569.31
Rate for Payer: Ohana Health Plan Medicare	$14,569.31
Rate for Payer: UnitedHealthcare Medicare	$14,569.31

CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC

Facility

$18,803.46

Service Code	MSDRG 192
Min. Negotiated Rate	$8,444.07
Max. Negotiated Rate	$18,803.46
Rate for Payer: AlohaCare Medicare	$8,444.07
Rate for Payer: Devoted Health Medicare	$9,288.48
Rate for Payer: Hawaii Medical Service Association Commercial	$18,803.46
Rate for Payer: Hawaii Medical Service Association Medicare	$8,444.07
Rate for Payer: Humana Medicare	$8,444.07
Rate for Payer: Kaiser Permanente Commercial	$11,074.50
Rate for Payer: Kaiser Permanente Medicare	$8,444.07
Rate for Payer: Ohana Health Plan Medicare	$8,444.07
Rate for Payer: UnitedHealthcare Medicare	$8,444.07

CIPROFLOXACIN HCL 0.2 % OTIC DROPPERETTE

Facility

$68.35

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$34.86
Max. Negotiated Rate	$66.30
Rate for Payer: Cash Price	$44.43
Rate for Payer: Hawaii Western Management Group Commercial	$64.93
Rate for Payer: Health Management Network Commercial	$58.10
Rate for Payer: Kaiser Permanente Commercial	$43.06
Rate for Payer: Kaiser Permanente Medicaid	$34.86
Rate for Payer: MDX Hawaii PPO	$66.30
Rate for Payer: UnitedHealthcare Medicaid	$41.01
Rate for Payer: University Health Alliance Commercial	$49.82

CIPROFLOXACIN HCL 0.2 % OTIC DROPPERETTE

Facility

$68.35

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$58.10
Max. Negotiated Rate	$66.30
Rate for Payer: Cash Price	$44.43
Rate for Payer: Health Management Network Commercial	$58.10
Rate for Payer: MDX Hawaii PPO	$66.30

CIPROFLOXACIN HCL 250 MG PO TABLET

Facility

$24.49

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$20.82
Max. Negotiated Rate	$23.76
Rate for Payer: Cash Price	$15.92
Rate for Payer: Health Management Network Commercial	$20.82
Rate for Payer: MDX Hawaii PPO	$23.76

CIPROFLOXACIN HCL 250 MG PO TABLET

Facility

$24.49

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$12.49
Max. Negotiated Rate	$23.76
Rate for Payer: Cash Price	$15.92
Rate for Payer: Hawaii Western Management Group Commercial	$23.27
Rate for Payer: Health Management Network Commercial	$20.82
Rate for Payer: Kaiser Permanente Commercial	$15.43
Rate for Payer: Kaiser Permanente Medicaid	$12.49
Rate for Payer: MDX Hawaii PPO	$23.76
Rate for Payer: UnitedHealthcare Medicaid	$14.69
Rate for Payer: University Health Alliance Commercial	$17.85

CIPROFLOXACIN HCL 500 MG PO TABLET

Facility

$1.71

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.66
Rate for Payer: Cash Price	$1.11
Rate for Payer: Health Management Network Commercial	$1.45
Rate for Payer: MDX Hawaii PPO	$1.66

CIPROFLOXACIN HCL 500 MG PO TABLET

Facility

$1.71

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$1.66
Rate for Payer: Cash Price	$1.11
Rate for Payer: Hawaii Western Management Group Commercial	$1.62
Rate for Payer: Health Management Network Commercial	$1.45
Rate for Payer: Kaiser Permanente Commercial	$1.08
Rate for Payer: Kaiser Permanente Medicaid	$0.87
Rate for Payer: MDX Hawaii PPO	$1.66
Rate for Payer: UnitedHealthcare Medicaid	$1.03
Rate for Payer: University Health Alliance Commercial	$1.25

CIPROFLOXACIN HCL 750 MG PO TABLET

Facility

$30.07

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$15.34
Max. Negotiated Rate	$29.17
Rate for Payer: Cash Price	$19.55
Rate for Payer: Hawaii Western Management Group Commercial	$28.57
Rate for Payer: Health Management Network Commercial	$25.56
Rate for Payer: Kaiser Permanente Commercial	$18.94
Rate for Payer: Kaiser Permanente Medicaid	$15.34
Rate for Payer: MDX Hawaii PPO	$29.17
Rate for Payer: UnitedHealthcare Medicaid	$18.04
Rate for Payer: University Health Alliance Commercial	$21.92

CIPROFLOXACIN HCL 750 MG PO TABLET

Facility

$30.07

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$29.17
Rate for Payer: Cash Price	$19.55
Rate for Payer: Health Management Network Commercial	$25.56
Rate for Payer: MDX Hawaii PPO	$29.17

CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV IVPB

Facility

$16.56

Service Code	HCPCS J0744
Hospital Revenue Code	636
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Cash Price	$10.76
Rate for Payer: Hawaii Medical Service Association ABD	$2.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.32
Rate for Payer: Hawaii Western Management Group Commercial	$15.73
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: Kaiser Permanente Commercial	$10.43
Rate for Payer: Kaiser Permanente Medicaid	$8.45
Rate for Payer: MDX Hawaii PPO	$16.06
Rate for Payer: UnitedHealthcare Medicaid	$9.94
Rate for Payer: University Health Alliance Commercial	$12.07

CIPROFLOXACIN IN 5 % DEXTROSE 200 MG/100 ML IV IVPB

Facility

$16.56

Service Code	HCPCS J0744
Hospital Revenue Code	250
Min. Negotiated Rate	$14.08
Max. Negotiated Rate	$16.06
Rate for Payer: Cash Price	$10.76
Rate for Payer: Health Management Network Commercial	$14.08
Rate for Payer: MDX Hawaii PPO	$16.06

CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV IVPB

Facility

$43.46

Service Code	HCPCS J0744
Hospital Revenue Code	250
Min. Negotiated Rate	$36.94
Max. Negotiated Rate	$42.16
Rate for Payer: Cash Price	$28.25
Rate for Payer: Health Management Network Commercial	$36.94
Rate for Payer: MDX Hawaii PPO	$42.16

CIPROFLOXACIN IN 5 % DEXTROSE 400 MG/200 ML IV IVPB

Facility

$43.46

Service Code	HCPCS J0744
Hospital Revenue Code	636
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$42.16
Rate for Payer: Cash Price	$28.25
Rate for Payer: Cash Price	$28.25
Rate for Payer: Hawaii Medical Service Association ABD	$2.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2.32
Rate for Payer: Hawaii Western Management Group Commercial	$41.29
Rate for Payer: Health Management Network Commercial	$36.94
Rate for Payer: Kaiser Permanente Commercial	$27.38
Rate for Payer: Kaiser Permanente Medicaid	$22.16
Rate for Payer: MDX Hawaii PPO	$42.16
Rate for Payer: UnitedHealthcare Medicaid	$26.08
Rate for Payer: University Health Alliance Commercial	$31.68

CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$38,170.80

Service Code	MSDRG 286
Min. Negotiated Rate	$29,104.45
Max. Negotiated Rate	$38,170.80
Rate for Payer: AlohaCare Medicare	$29,104.45
Rate for Payer: Devoted Health Medicare	$32,014.90
Rate for Payer: Hawaii Medical Service Association Commercial	$34,714.08
Rate for Payer: Hawaii Medical Service Association Medicare	$29,104.45
Rate for Payer: Humana Medicare	$29,104.45
Rate for Payer: Kaiser Permanente Commercial	$38,170.80
Rate for Payer: Kaiser Permanente Medicare	$29,104.45
Rate for Payer: Ohana Health Plan Medicare	$29,104.45
Rate for Payer: UnitedHealthcare Medicare	$29,104.45

CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$30,567.68

Service Code	MSDRG 287
Min. Negotiated Rate	$14,074.77
Max. Negotiated Rate	$30,567.68
Rate for Payer: AlohaCare Medicare	$14,074.77
Rate for Payer: Devoted Health Medicare	$15,482.25
Rate for Payer: Hawaii Medical Service Association Commercial	$30,567.68
Rate for Payer: Hawaii Medical Service Association Medicare	$14,074.77
Rate for Payer: Humana Medicare	$14,074.77
Rate for Payer: Kaiser Permanente Commercial	$18,459.22
Rate for Payer: Kaiser Permanente Medicare	$14,074.77
Rate for Payer: Ohana Health Plan Medicare	$14,074.77
Rate for Payer: UnitedHealthcare Medicare	$14,074.77

CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER THAN 28 DAYS OF AGE

Facility

$6,183.00

Service Code	CPT 54161
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$2,469.46
Rate for Payer: AlohaCare Medicare	$2,469.46
Rate for Payer: Devoted Health Medicare	$2,716.41
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,469.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$2,469.46
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,469.46
Rate for Payer: Ohana Health Plan Medicaid	$2,716.41
Rate for Payer: Ohana Health Plan Medicare	$2,469.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,469.46
Rate for Payer: University Health Alliance Commercial	$5,160.40

CIRCUMCISION, USING CLAMP OR OTHER DEVICE WITH REGIONAL DORSAL PENILE OR RING BLOCK

Facility

$6,183.00

Service Code	CPT 54150
Hospital Revenue Code	361
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$2,469.46
Rate for Payer: AlohaCare Medicare	$2,469.46
Rate for Payer: Devoted Health Medicare	$2,716.41
Rate for Payer: Hawaii Medical Service Association ABD	$695.00
Rate for Payer: Hawaii Medical Service Association Commercial	$6,183.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,469.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$2,469.46
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,469.46
Rate for Payer: Ohana Health Plan Medicaid	$2,716.41
Rate for Payer: Ohana Health Plan Medicare	$2,469.46
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,469.46
Rate for Payer: University Health Alliance Commercial	$4,035.20

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC

Facility

$42,042.61

Service Code	MSDRG 433
Min. Negotiated Rate	$13,891.95
Max. Negotiated Rate	$42,042.61
Rate for Payer: AlohaCare Medicare	$13,891.95
Rate for Payer: Devoted Health Medicare	$15,281.15
Rate for Payer: Hawaii Medical Service Association Commercial	$42,042.61
Rate for Payer: Hawaii Medical Service Association Medicare	$13,891.95
Rate for Payer: Humana Medicare	$13,891.95
Rate for Payer: Kaiser Permanente Commercial	$18,219.45
Rate for Payer: Kaiser Permanente Medicare	$13,891.95
Rate for Payer: Ohana Health Plan Medicare	$13,891.95
Rate for Payer: UnitedHealthcare Medicare	$13,891.95

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC

Facility

$42,042.61

Service Code	MSDRG 432
Min. Negotiated Rate	$25,887.27
Max. Negotiated Rate	$42,042.61
Rate for Payer: AlohaCare Medicare	$25,887.27
Rate for Payer: Devoted Health Medicare	$28,476.00
Rate for Payer: Hawaii Medical Service Association Commercial	$42,042.61
Rate for Payer: Hawaii Medical Service Association Medicare	$25,887.27
Rate for Payer: Humana Medicare	$25,887.27
Rate for Payer: Kaiser Permanente Commercial	$33,951.45
Rate for Payer: Kaiser Permanente Medicare	$25,887.27
Rate for Payer: Ohana Health Plan Medicare	$25,887.27
Rate for Payer: UnitedHealthcare Medicare	$25,887.27

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility

$42,042.61

Service Code	MSDRG 434
Min. Negotiated Rate	$9,371.35
Max. Negotiated Rate	$42,042.61
Rate for Payer: AlohaCare Medicare	$9,371.35
Rate for Payer: Devoted Health Medicare	$10,308.49
Rate for Payer: Hawaii Medical Service Association Commercial	$42,042.61
Rate for Payer: Hawaii Medical Service Association Medicare	$9,371.35
Rate for Payer: Humana Medicare	$9,371.35
Rate for Payer: Kaiser Permanente Commercial	$12,290.62
Rate for Payer: Kaiser Permanente Medicare	$9,371.35
Rate for Payer: Ohana Health Plan Medicare	$9,371.35
Rate for Payer: UnitedHealthcare Medicare	$9,371.35

CISPLATIN 1 MG/ML IV SOLN

Facility

$183.60

Service Code	HCPCS J9060
Hospital Revenue Code	250
Min. Negotiated Rate	$156.06
Max. Negotiated Rate	$178.09
Rate for Payer: Cash Price	$119.34
Rate for Payer: Cash Price	$67.14
Rate for Payer: Cash Price	$122.57
Rate for Payer: Cash Price	$249.85
Rate for Payer: Health Management Network Commercial	$156.06
Rate for Payer: Health Management Network Commercial	$87.80
Rate for Payer: Health Management Network Commercial	$160.28
Rate for Payer: Health Management Network Commercial	$326.72
Rate for Payer: MDX Hawaii PPO	$182.91
Rate for Payer: MDX Hawaii PPO	$100.19
Rate for Payer: MDX Hawaii PPO	$178.09
Rate for Payer: MDX Hawaii PPO	$372.85

CISPLATIN 1 MG/ML IV SOLN

Facility

$384.38

Service Code	HCPCS J9060
Hospital Revenue Code	636
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$372.85
Rate for Payer: Cash Price	$249.85
Rate for Payer: Cash Price	$119.34
Rate for Payer: Cash Price	$119.34
Rate for Payer: Cash Price	$67.14
Rate for Payer: Cash Price	$122.57
Rate for Payer: Cash Price	$122.57
Rate for Payer: Cash Price	$67.14
Rate for Payer: Cash Price	$249.85
Rate for Payer: Hawaii Medical Service Association ABD	$1.95
Rate for Payer: Hawaii Medical Service Association ABD	$1.95
Rate for Payer: Hawaii Medical Service Association ABD	$1.95
Rate for Payer: Hawaii Medical Service Association ABD	$1.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1.95
Rate for Payer: Hawaii Western Management Group Commercial	$98.13
Rate for Payer: Hawaii Western Management Group Commercial	$365.16
Rate for Payer: Hawaii Western Management Group Commercial	$179.14
Rate for Payer: Hawaii Western Management Group Commercial	$174.42
Rate for Payer: Health Management Network Commercial	$326.72
Rate for Payer: Health Management Network Commercial	$87.80
Rate for Payer: Health Management Network Commercial	$156.06
Rate for Payer: Health Management Network Commercial	$160.28
Rate for Payer: Kaiser Permanente Commercial	$118.80
Rate for Payer: Kaiser Permanente Commercial	$242.16
Rate for Payer: Kaiser Permanente Commercial	$65.07
Rate for Payer: Kaiser Permanente Commercial	$115.67
Rate for Payer: Kaiser Permanente Medicaid	$93.64
Rate for Payer: Kaiser Permanente Medicaid	$96.17
Rate for Payer: Kaiser Permanente Medicaid	$196.03
Rate for Payer: Kaiser Permanente Medicaid	$52.68
Rate for Payer: MDX Hawaii PPO	$100.19
Rate for Payer: MDX Hawaii PPO	$372.85
Rate for Payer: MDX Hawaii PPO	$182.91
Rate for Payer: MDX Hawaii PPO	$178.09
Rate for Payer: UnitedHealthcare Medicaid	$113.14
Rate for Payer: UnitedHealthcare Medicaid	$110.16
Rate for Payer: UnitedHealthcare Medicaid	$61.97
Rate for Payer: UnitedHealthcare Medicaid	$230.63
Rate for Payer: University Health Alliance Commercial	$133.83
Rate for Payer: University Health Alliance Commercial	$280.17
Rate for Payer: University Health Alliance Commercial	$137.45
Rate for Payer: University Health Alliance Commercial	$75.29

Know your out-of-pocket cost for care.

All Charges