Kona Community Hospital

All Charges

Charge

Type

Setting

Price

DENOSUMAB 60 MG/ML SUBCUTANEOUS SYR

Facility

$3,368.92

Service Code	HCPCS J0897
Hospital Revenue Code	636
Min. Negotiated Rate	$29.24
Max. Negotiated Rate	$3,267.85
Rate for Payer: AlohaCare Medicaid	$29.51
Rate for Payer: AlohaCare Medicare	$29.51
Rate for Payer: Cash Price	$2,189.80
Rate for Payer: Cash Price	$2,189.80
Rate for Payer: Devoted Health Medicare	$32.46
Rate for Payer: Hawaii Medical Service Association ABD	$29.24
Rate for Payer: Hawaii Medical Service Association Commercial	$36.89
Rate for Payer: Hawaii Medical Service Association Medicare	$29.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$29.24
Rate for Payer: Hawaii Western Management Group Commercial	$3,200.47
Rate for Payer: Health Management Network Commercial	$2,863.58
Rate for Payer: Humana Medicare	$29.51
Rate for Payer: Kaiser Permanente Commercial	$2,122.42
Rate for Payer: Kaiser Permanente Medicaid	$1,718.15
Rate for Payer: Kaiser Permanente Medicare	$29.51
Rate for Payer: MDX Hawaii PPO	$3,267.85
Rate for Payer: Ohana Health Plan Medicaid	$32.46
Rate for Payer: Ohana Health Plan Medicare	$29.51
Rate for Payer: UnitedHealthcare Medicaid	$2,021.35
Rate for Payer: UnitedHealthcare Medicare	$29.51
Rate for Payer: University Health Alliance Commercial	$2,455.61

DENOSUMAB-BBDZ 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLN

Facility

$4,968.32

Service Code	HCPCS Q5136
Hospital Revenue Code	250
Min. Negotiated Rate	$4,223.07
Max. Negotiated Rate	$4,819.27
Rate for Payer: Cash Price	$3,229.41
Rate for Payer: Health Management Network Commercial	$4,223.07
Rate for Payer: MDX Hawaii PPO	$4,819.27

DENOSUMAB-BBDZ 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLN

Facility

$4,968.32

Service Code	HCPCS Q5136
Hospital Revenue Code	250
Min. Negotiated Rate	$27.91
Max. Negotiated Rate	$4,819.27
Rate for Payer: AlohaCare Medicaid	$27.91
Rate for Payer: AlohaCare Medicare	$27.91
Rate for Payer: Cash Price	$3,229.41
Rate for Payer: Cash Price	$3,229.41
Rate for Payer: Devoted Health Medicare	$30.70
Rate for Payer: Hawaii Medical Service Association Commercial	$34.89
Rate for Payer: Hawaii Medical Service Association Medicare	$27.91
Rate for Payer: Hawaii Western Management Group Commercial	$4,719.90
Rate for Payer: Health Management Network Commercial	$4,223.07
Rate for Payer: Humana Medicare	$27.91
Rate for Payer: Kaiser Permanente Commercial	$3,130.04
Rate for Payer: Kaiser Permanente Medicaid	$2,533.84
Rate for Payer: Kaiser Permanente Medicare	$27.91
Rate for Payer: MDX Hawaii PPO	$4,819.27
Rate for Payer: Ohana Health Plan Medicaid	$30.70
Rate for Payer: Ohana Health Plan Medicare	$27.91
Rate for Payer: UnitedHealthcare Medicaid	$2,980.99
Rate for Payer: UnitedHealthcare Medicare	$27.91
Rate for Payer: University Health Alliance Commercial	$3,621.41

DENOSUMAB-BBDZ 60 MG/ML SUBCUTANEOUS SYR

Facility

$4,411.36

Service Code	HCPCS Q5136
Hospital Revenue Code	250
Min. Negotiated Rate	$3,749.66
Max. Negotiated Rate	$4,279.02
Rate for Payer: Cash Price	$2,867.38
Rate for Payer: Health Management Network Commercial	$3,749.66
Rate for Payer: MDX Hawaii PPO	$4,279.02

DENOSUMAB-BBDZ 60 MG/ML SUBCUTANEOUS SYR

Facility

$4,411.36

Service Code	HCPCS Q5136
Hospital Revenue Code	250
Min. Negotiated Rate	$27.91
Max. Negotiated Rate	$4,279.02
Rate for Payer: AlohaCare Medicaid	$27.91
Rate for Payer: AlohaCare Medicare	$27.91
Rate for Payer: Cash Price	$2,867.38
Rate for Payer: Cash Price	$2,867.38
Rate for Payer: Devoted Health Medicare	$30.70
Rate for Payer: Hawaii Medical Service Association Commercial	$34.89
Rate for Payer: Hawaii Medical Service Association Medicare	$27.91
Rate for Payer: Hawaii Western Management Group Commercial	$4,190.79
Rate for Payer: Health Management Network Commercial	$3,749.66
Rate for Payer: Humana Medicare	$27.91
Rate for Payer: Kaiser Permanente Commercial	$2,779.16
Rate for Payer: Kaiser Permanente Medicaid	$2,249.79
Rate for Payer: Kaiser Permanente Medicare	$27.91
Rate for Payer: MDX Hawaii PPO	$4,279.02
Rate for Payer: Ohana Health Plan Medicaid	$30.70
Rate for Payer: Ohana Health Plan Medicare	$27.91
Rate for Payer: UnitedHealthcare Medicaid	$2,646.82
Rate for Payer: UnitedHealthcare Medicare	$27.91
Rate for Payer: University Health Alliance Commercial	$3,215.44

DENTAL AND ORAL DISEASES WITH CC

Facility

$20,273.99

Service Code	MSDRG 158
Min. Negotiated Rate	$11,966.39
Max. Negotiated Rate	$20,273.99
Rate for Payer: AlohaCare Medicare	$11,966.39
Rate for Payer: Devoted Health Medicare	$13,163.03
Rate for Payer: Hawaii Medical Service Association Commercial	$20,273.99
Rate for Payer: Hawaii Medical Service Association Medicare	$11,966.39
Rate for Payer: Humana Medicare	$11,966.39
Rate for Payer: Kaiser Permanente Commercial	$15,694.05
Rate for Payer: Kaiser Permanente Medicare	$11,966.39
Rate for Payer: Ohana Health Plan Medicare	$11,966.39
Rate for Payer: UnitedHealthcare Medicare	$11,966.39

DENTAL AND ORAL DISEASES WITH MCC

Facility

$29,614.80

Service Code	MSDRG 157
Min. Negotiated Rate	$20,273.99
Max. Negotiated Rate	$29,614.80
Rate for Payer: AlohaCare Medicare	$22,580.67
Rate for Payer: Devoted Health Medicare	$24,838.74
Rate for Payer: Hawaii Medical Service Association Commercial	$20,273.99
Rate for Payer: Hawaii Medical Service Association Medicare	$22,580.67
Rate for Payer: Humana Medicare	$22,580.67
Rate for Payer: Kaiser Permanente Commercial	$29,614.80
Rate for Payer: Kaiser Permanente Medicare	$22,580.67
Rate for Payer: Ohana Health Plan Medicare	$22,580.67
Rate for Payer: UnitedHealthcare Medicare	$22,580.67

DENTAL AND ORAL DISEASES WITHOUT CC/MCC

Facility

$20,273.99

Service Code	MSDRG 159
Min. Negotiated Rate	$9,318.74
Max. Negotiated Rate	$20,273.99
Rate for Payer: AlohaCare Medicare	$9,318.74
Rate for Payer: Devoted Health Medicare	$10,250.61
Rate for Payer: Hawaii Medical Service Association Commercial	$20,273.99
Rate for Payer: Hawaii Medical Service Association Medicare	$9,318.74
Rate for Payer: Humana Medicare	$9,318.74
Rate for Payer: Kaiser Permanente Commercial	$12,221.62
Rate for Payer: Kaiser Permanente Medicare	$9,318.74
Rate for Payer: Ohana Health Plan Medicare	$9,318.74
Rate for Payer: UnitedHealthcare Medicare	$9,318.74

DENTAL DISEASES & DISORDERS

Facility

$10,351.23

Service Code	APR-DRG 1144
Min. Negotiated Rate	$10,351.23
Max. Negotiated Rate	$10,351.23
Rate for Payer: AlohaCare Medicaid	$10,351.23
Rate for Payer: Hawaii Medical Service Association ABD	$10,351.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,351.23
Rate for Payer: Kaiser Permanente Medicaid	$10,351.23
Rate for Payer: Ohana Health Plan Medicaid	$10,351.23
Rate for Payer: UnitedHealthcare Medicaid	$10,351.23

DENTAL DISEASES & DISORDERS

Facility

$4,637.84

Service Code	APR-DRG 1143
Min. Negotiated Rate	$4,637.84
Max. Negotiated Rate	$4,637.84
Rate for Payer: AlohaCare Medicaid	$4,637.84
Rate for Payer: Hawaii Medical Service Association ABD	$4,637.84
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,637.84
Rate for Payer: Kaiser Permanente Medicaid	$4,637.84
Rate for Payer: Ohana Health Plan Medicaid	$4,637.84
Rate for Payer: UnitedHealthcare Medicaid	$4,637.84

DENTAL DISEASES & DISORDERS

Facility

$2,142.21

Service Code	APR-DRG 1141
Min. Negotiated Rate	$2,142.21
Max. Negotiated Rate	$2,142.21
Rate for Payer: AlohaCare Medicaid	$2,142.21
Rate for Payer: Hawaii Medical Service Association ABD	$2,142.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,142.21
Rate for Payer: Kaiser Permanente Medicaid	$2,142.21
Rate for Payer: Ohana Health Plan Medicaid	$2,142.21
Rate for Payer: UnitedHealthcare Medicaid	$2,142.21

DENTAL DISEASES & DISORDERS

Facility

$3,010.80

Service Code	APR-DRG 1142
Min. Negotiated Rate	$3,010.80
Max. Negotiated Rate	$3,010.80
Rate for Payer: AlohaCare Medicaid	$3,010.80
Rate for Payer: Hawaii Medical Service Association ABD	$3,010.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,010.80
Rate for Payer: Kaiser Permanente Medicaid	$3,010.80
Rate for Payer: Ohana Health Plan Medicaid	$3,010.80
Rate for Payer: UnitedHealthcare Medicaid	$3,010.80

DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER

Facility

$2,869.24

Service Code	APR-DRG 7542
Min. Negotiated Rate	$2,869.24
Max. Negotiated Rate	$2,869.24
Rate for Payer: AlohaCare Medicaid	$2,869.24
Rate for Payer: Hawaii Medical Service Association ABD	$2,869.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,869.24
Rate for Payer: Kaiser Permanente Medicaid	$2,869.24
Rate for Payer: Ohana Health Plan Medicaid	$2,869.24
Rate for Payer: UnitedHealthcare Medicaid	$2,869.24

DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER

Facility

$2,470.86

Service Code	APR-DRG 7541
Min. Negotiated Rate	$2,470.86
Max. Negotiated Rate	$2,470.86
Rate for Payer: AlohaCare Medicaid	$2,470.86
Rate for Payer: Hawaii Medical Service Association ABD	$2,470.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,470.86
Rate for Payer: Kaiser Permanente Medicaid	$2,470.86
Rate for Payer: Ohana Health Plan Medicaid	$2,470.86
Rate for Payer: UnitedHealthcare Medicaid	$2,470.86

DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER

Facility

$9,115.23

Service Code	APR-DRG 7544
Min. Negotiated Rate	$9,115.23
Max. Negotiated Rate	$9,115.23
Rate for Payer: AlohaCare Medicaid	$9,115.23
Rate for Payer: Hawaii Medical Service Association ABD	$9,115.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,115.23
Rate for Payer: Kaiser Permanente Medicaid	$9,115.23
Rate for Payer: Ohana Health Plan Medicaid	$9,115.23
Rate for Payer: UnitedHealthcare Medicaid	$9,115.23

DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER

Facility

$3,994.82

Service Code	APR-DRG 7543
Min. Negotiated Rate	$3,994.82
Max. Negotiated Rate	$3,994.82
Rate for Payer: AlohaCare Medicaid	$3,994.82
Rate for Payer: Hawaii Medical Service Association ABD	$3,994.82
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,994.82
Rate for Payer: Kaiser Permanente Medicaid	$3,994.82
Rate for Payer: Ohana Health Plan Medicaid	$3,994.82
Rate for Payer: UnitedHealthcare Medicaid	$3,994.82

DEPRESSIVE NEUROSES

Facility

$16,230.52

Service Code	MSDRG 881
Min. Negotiated Rate	$10,173.15
Max. Negotiated Rate	$16,230.52
Rate for Payer: AlohaCare Medicare	$12,375.44
Rate for Payer: Devoted Health Medicare	$13,612.98
Rate for Payer: Hawaii Medical Service Association Commercial	$10,173.15
Rate for Payer: Hawaii Medical Service Association Medicare	$12,375.44
Rate for Payer: Humana Medicare	$12,375.44
Rate for Payer: Kaiser Permanente Commercial	$16,230.52
Rate for Payer: Kaiser Permanente Medicare	$12,375.44
Rate for Payer: Ohana Health Plan Medicare	$12,375.44
Rate for Payer: UnitedHealthcare Medicare	$12,375.44

DERMABOND ADVANCED PEN DNX12 [2700570]

Facility

$146.56

Hospital Charge Code	2700570
Hospital Revenue Code	272
Min. Negotiated Rate	$124.58
Max. Negotiated Rate	$142.16
Rate for Payer: Cash Price	$95.26
Rate for Payer: Health Management Network Commercial	$124.58
Rate for Payer: MDX Hawaii PPO	$142.16

DERMABOND ADVANCED PEN DNX12 [2700570]

Facility

$146.56

Hospital Charge Code	2700570
Hospital Revenue Code	272
Min. Negotiated Rate	$74.75
Max. Negotiated Rate	$142.16
Rate for Payer: Cash Price	$95.26
Rate for Payer: Hawaii Western Management Group Commercial	$139.23
Rate for Payer: Health Management Network Commercial	$124.58
Rate for Payer: Kaiser Permanente Commercial	$92.33
Rate for Payer: Kaiser Permanente Medicaid	$74.75
Rate for Payer: MDX Hawaii PPO	$142.16
Rate for Payer: University Health Alliance Commercial	$106.83

DERMABOND MINI DHVM12 [2707788]

Facility

$93.50

Hospital Charge Code	2707788
Hospital Revenue Code	272
Min. Negotiated Rate	$47.69
Max. Negotiated Rate	$90.69
Rate for Payer: Cash Price	$60.78
Rate for Payer: Hawaii Western Management Group Commercial	$88.83
Rate for Payer: Health Management Network Commercial	$79.47
Rate for Payer: Kaiser Permanente Commercial	$58.91
Rate for Payer: Kaiser Permanente Medicaid	$47.69
Rate for Payer: MDX Hawaii PPO	$90.69
Rate for Payer: University Health Alliance Commercial	$68.15

DERMABOND MINI DHVM12 [2707788]

Facility

$93.50

Hospital Charge Code	2707788
Hospital Revenue Code	272
Min. Negotiated Rate	$79.47
Max. Negotiated Rate	$90.69
Rate for Payer: Cash Price	$60.78
Rate for Payer: Health Management Network Commercial	$79.47
Rate for Payer: MDX Hawaii PPO	$90.69

DERMABOND PRINEO CLR222US [2700572]

Facility

$648.36

Hospital Charge Code	2700572
Hospital Revenue Code	272
Min. Negotiated Rate	$551.11
Max. Negotiated Rate	$628.91
Rate for Payer: Cash Price	$421.43
Rate for Payer: Health Management Network Commercial	$551.11
Rate for Payer: MDX Hawaii PPO	$628.91

DERMABOND PRINEO CLR222US [2700572]

Facility

$648.36

Hospital Charge Code	2700572
Hospital Revenue Code	272
Min. Negotiated Rate	$330.66
Max. Negotiated Rate	$628.91
Rate for Payer: Cash Price	$421.43
Rate for Payer: Hawaii Western Management Group Commercial	$615.94
Rate for Payer: Health Management Network Commercial	$551.11
Rate for Payer: Kaiser Permanente Commercial	$408.47
Rate for Payer: Kaiser Permanente Medicaid	$330.66
Rate for Payer: MDX Hawaii PPO	$628.91
Rate for Payer: University Health Alliance Commercial	$472.59

Dermacarrier (1.5:1) 2195012 [3600312]

Facility

$311.03

Hospital Charge Code	3600312
Hospital Revenue Code	272
Min. Negotiated Rate	$158.63
Max. Negotiated Rate	$301.70
Rate for Payer: Cash Price	$202.17
Rate for Payer: Hawaii Western Management Group Commercial	$295.48
Rate for Payer: Health Management Network Commercial	$264.38
Rate for Payer: Kaiser Permanente Commercial	$195.95
Rate for Payer: Kaiser Permanente Medicaid	$158.63
Rate for Payer: MDX Hawaii PPO	$301.70
Rate for Payer: University Health Alliance Commercial	$226.71

Dermacarrier (1.5:1) 2195012 [3600312]

Facility

$311.03

Hospital Charge Code	3600312
Hospital Revenue Code	272
Min. Negotiated Rate	$264.38
Max. Negotiated Rate	$301.70
Rate for Payer: Cash Price	$202.17
Rate for Payer: Health Management Network Commercial	$264.38
Rate for Payer: MDX Hawaii PPO	$301.70

Know your out-of-pocket cost for care.

All Charges