Kona Community Hospital

All Charges

Charge

Type

Setting

Price

DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility

$23,480.22

Service Code	MSDRG 443
Min. Negotiated Rate	$9,202.99
Max. Negotiated Rate	$23,480.22
Rate for Payer: AlohaCare Medicare	$9,202.99
Rate for Payer: Devoted Health Medicare	$10,123.29
Rate for Payer: Hawaii Medical Service Association Commercial	$23,480.22
Rate for Payer: Hawaii Medical Service Association Medicare	$9,202.99
Rate for Payer: Humana Medicare	$9,202.99
Rate for Payer: Kaiser Permanente Commercial	$12,069.83
Rate for Payer: Kaiser Permanente Medicare	$9,202.99
Rate for Payer: Ohana Health Plan Medicare	$9,202.99
Rate for Payer: UnitedHealthcare Medicare	$9,202.99

DISORDERS OF PANCREAS EXCEPT MALIGNANCY

Facility

$5,420.47

Service Code	APR-DRG 2823
Min. Negotiated Rate	$5,420.47
Max. Negotiated Rate	$5,420.47
Rate for Payer: AlohaCare Medicaid	$5,420.47
Rate for Payer: Hawaii Medical Service Association ABD	$5,420.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,420.47
Rate for Payer: Kaiser Permanente Medicaid	$5,420.47
Rate for Payer: Ohana Health Plan Medicaid	$5,420.47
Rate for Payer: UnitedHealthcare Medicaid	$5,420.47

DISORDERS OF PANCREAS EXCEPT MALIGNANCY

Facility

$11,991.00

Service Code	APR-DRG 2824
Min. Negotiated Rate	$11,991.00
Max. Negotiated Rate	$11,991.00
Rate for Payer: AlohaCare Medicaid	$11,991.00
Rate for Payer: Hawaii Medical Service Association ABD	$11,991.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,991.00
Rate for Payer: Kaiser Permanente Medicaid	$11,991.00
Rate for Payer: Ohana Health Plan Medicaid	$11,991.00
Rate for Payer: UnitedHealthcare Medicaid	$11,991.00

DISORDERS OF PANCREAS EXCEPT MALIGNANCY

Facility

$2,761.18

Service Code	APR-DRG 2821
Min. Negotiated Rate	$2,761.18
Max. Negotiated Rate	$2,761.18
Rate for Payer: AlohaCare Medicaid	$2,761.18
Rate for Payer: Hawaii Medical Service Association ABD	$2,761.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,761.18
Rate for Payer: Kaiser Permanente Medicaid	$2,761.18
Rate for Payer: Ohana Health Plan Medicaid	$2,761.18
Rate for Payer: UnitedHealthcare Medicaid	$2,761.18

DISORDERS OF PANCREAS EXCEPT MALIGNANCY

Facility

$3,548.27

Service Code	APR-DRG 2822
Min. Negotiated Rate	$3,548.27
Max. Negotiated Rate	$3,548.27
Rate for Payer: AlohaCare Medicaid	$3,548.27
Rate for Payer: Hawaii Medical Service Association ABD	$3,548.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,548.27
Rate for Payer: Kaiser Permanente Medicaid	$3,548.27
Rate for Payer: Ohana Health Plan Medicaid	$3,548.27
Rate for Payer: UnitedHealthcare Medicaid	$3,548.27

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC

Facility

$25,384.67

Service Code	MSDRG 439
Min. Negotiated Rate	$11,064.10
Max. Negotiated Rate	$25,384.67
Rate for Payer: AlohaCare Medicare	$11,064.10
Rate for Payer: Devoted Health Medicare	$12,170.51
Rate for Payer: Hawaii Medical Service Association Commercial	$25,384.67
Rate for Payer: Hawaii Medical Service Association Medicare	$11,064.10
Rate for Payer: Humana Medicare	$11,064.10
Rate for Payer: Kaiser Permanente Commercial	$14,510.70
Rate for Payer: Kaiser Permanente Medicare	$11,064.10
Rate for Payer: Ohana Health Plan Medicare	$11,064.10
Rate for Payer: UnitedHealthcare Medicare	$11,064.10

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC

Facility

$28,120.95

Service Code	MSDRG 438
Min. Negotiated Rate	$21,441.64
Max. Negotiated Rate	$28,120.95
Rate for Payer: AlohaCare Medicare	$21,441.64
Rate for Payer: Devoted Health Medicare	$23,585.80
Rate for Payer: Hawaii Medical Service Association Commercial	$25,384.67
Rate for Payer: Hawaii Medical Service Association Medicare	$21,441.64
Rate for Payer: Humana Medicare	$21,441.64
Rate for Payer: Kaiser Permanente Commercial	$28,120.95
Rate for Payer: Kaiser Permanente Medicare	$21,441.64
Rate for Payer: Ohana Health Plan Medicare	$21,441.64
Rate for Payer: UnitedHealthcare Medicare	$21,441.64

DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC

Facility

$25,384.67

Service Code	MSDRG 440
Min. Negotiated Rate	$8,173.12
Max. Negotiated Rate	$25,384.67
Rate for Payer: AlohaCare Medicare	$8,173.12
Rate for Payer: Devoted Health Medicare	$8,990.43
Rate for Payer: Hawaii Medical Service Association Commercial	$25,384.67
Rate for Payer: Hawaii Medical Service Association Medicare	$8,173.12
Rate for Payer: Humana Medicare	$8,173.12
Rate for Payer: Kaiser Permanente Commercial	$10,719.15
Rate for Payer: Kaiser Permanente Medicare	$8,173.12
Rate for Payer: Ohana Health Plan Medicare	$8,173.12
Rate for Payer: UnitedHealthcare Medicare	$8,173.12

DISORDERS OF PERSONALITY AND IMPULSE CONTROL

Facility

$33,918.68

Service Code	MSDRG 883
Min. Negotiated Rate	$21,479.34
Max. Negotiated Rate	$33,918.68
Rate for Payer: AlohaCare Medicare	$25,862.28
Rate for Payer: Devoted Health Medicare	$28,448.51
Rate for Payer: Hawaii Medical Service Association Commercial	$21,479.34
Rate for Payer: Hawaii Medical Service Association Medicare	$25,862.28
Rate for Payer: Humana Medicare	$25,862.28
Rate for Payer: Kaiser Permanente Commercial	$33,918.68
Rate for Payer: Kaiser Permanente Medicare	$25,862.28
Rate for Payer: Ohana Health Plan Medicare	$25,862.28
Rate for Payer: UnitedHealthcare Medicare	$25,862.28

DISORDERS OF PERSONALITY & IMPULSE CONTROL

Facility

$20,263.39

Service Code	APR-DRG 7524
Min. Negotiated Rate	$20,263.39
Max. Negotiated Rate	$20,263.39
Rate for Payer: AlohaCare Medicaid	$20,263.39
Rate for Payer: Hawaii Medical Service Association ABD	$20,263.39
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20,263.39
Rate for Payer: Kaiser Permanente Medicaid	$20,263.39
Rate for Payer: Ohana Health Plan Medicaid	$20,263.39
Rate for Payer: UnitedHealthcare Medicaid	$20,263.39

DISORDERS OF PERSONALITY & IMPULSE CONTROL

Facility

$2,260.68

Service Code	APR-DRG 7521
Min. Negotiated Rate	$2,260.68
Max. Negotiated Rate	$2,260.68
Rate for Payer: AlohaCare Medicaid	$2,260.68
Rate for Payer: Hawaii Medical Service Association ABD	$2,260.68
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,260.68
Rate for Payer: Kaiser Permanente Medicaid	$2,260.68
Rate for Payer: Ohana Health Plan Medicaid	$2,260.68
Rate for Payer: UnitedHealthcare Medicaid	$2,260.68

DISORDERS OF PERSONALITY & IMPULSE CONTROL

Facility

$4,842.85

Service Code	APR-DRG 7523
Min. Negotiated Rate	$4,842.85
Max. Negotiated Rate	$4,842.85
Rate for Payer: AlohaCare Medicaid	$4,842.85
Rate for Payer: Hawaii Medical Service Association ABD	$4,842.85
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,842.85
Rate for Payer: Kaiser Permanente Medicaid	$4,842.85
Rate for Payer: Ohana Health Plan Medicaid	$4,842.85
Rate for Payer: UnitedHealthcare Medicaid	$4,842.85

DISORDERS OF PERSONALITY & IMPULSE CONTROL

Facility

$2,722.78

Service Code	APR-DRG 7522
Min. Negotiated Rate	$2,722.78
Max. Negotiated Rate	$2,722.78
Rate for Payer: AlohaCare Medicaid	$2,722.78
Rate for Payer: Hawaii Medical Service Association ABD	$2,722.78
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,722.78
Rate for Payer: Kaiser Permanente Medicaid	$2,722.78
Rate for Payer: Ohana Health Plan Medicaid	$2,722.78
Rate for Payer: UnitedHealthcare Medicaid	$2,722.78

DISORDERS OF THE BILIARY TRACT WITH CC

Facility

$25,553.42

Service Code	MSDRG 445
Min. Negotiated Rate	$14,394.38
Max. Negotiated Rate	$25,553.42
Rate for Payer: AlohaCare Medicare	$14,394.38
Rate for Payer: Devoted Health Medicare	$15,833.82
Rate for Payer: Hawaii Medical Service Association Commercial	$25,553.42
Rate for Payer: Hawaii Medical Service Association Medicare	$14,394.38
Rate for Payer: Humana Medicare	$14,394.38
Rate for Payer: Kaiser Permanente Commercial	$18,878.40
Rate for Payer: Kaiser Permanente Medicare	$14,394.38
Rate for Payer: Ohana Health Plan Medicare	$14,394.38
Rate for Payer: UnitedHealthcare Medicare	$14,394.38

DISORDERS OF THE BILIARY TRACT WITH MCC

Facility

$28,823.03

Service Code	MSDRG 444
Min. Negotiated Rate	$21,976.95
Max. Negotiated Rate	$28,823.03
Rate for Payer: AlohaCare Medicare	$21,976.95
Rate for Payer: Devoted Health Medicare	$24,174.65
Rate for Payer: Hawaii Medical Service Association Commercial	$26,083.77
Rate for Payer: Hawaii Medical Service Association Medicare	$21,976.95
Rate for Payer: Humana Medicare	$21,976.95
Rate for Payer: Kaiser Permanente Commercial	$28,823.03
Rate for Payer: Kaiser Permanente Medicare	$21,976.95
Rate for Payer: Ohana Health Plan Medicare	$21,976.95
Rate for Payer: UnitedHealthcare Medicare	$21,976.95

DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC

Facility

$16,850.79

Service Code	MSDRG 446
Min. Negotiated Rate	$10,881.29
Max. Negotiated Rate	$16,850.79
Rate for Payer: AlohaCare Medicare	$10,881.29
Rate for Payer: Devoted Health Medicare	$11,969.42
Rate for Payer: Hawaii Medical Service Association Commercial	$16,850.79
Rate for Payer: Hawaii Medical Service Association Medicare	$10,881.29
Rate for Payer: Humana Medicare	$10,881.29
Rate for Payer: Kaiser Permanente Commercial	$14,270.92
Rate for Payer: Kaiser Permanente Medicare	$10,881.29
Rate for Payer: Ohana Health Plan Medicare	$10,881.29
Rate for Payer: UnitedHealthcare Medicare	$10,881.29

Disp Instrument Kit for Bio-Tenodesis Screw AR-1676DS [3642364]

Facility

$1,855.63

Hospital Charge Code	3642364
Hospital Revenue Code	272
Min. Negotiated Rate	$1,577.29
Max. Negotiated Rate	$1,799.96
Rate for Payer: Cash Price	$1,206.16
Rate for Payer: Health Management Network Commercial	$1,577.29
Rate for Payer: MDX Hawaii PPO	$1,799.96

Disp Instrument Kit for Bio-Tenodesis Screw AR-1676DS [3642364]

Facility

$1,855.63

Hospital Charge Code	3642364
Hospital Revenue Code	272
Min. Negotiated Rate	$946.37
Max. Negotiated Rate	$1,799.96
Rate for Payer: Cash Price	$1,206.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,762.85
Rate for Payer: Health Management Network Commercial	$1,577.29
Rate for Payer: Kaiser Permanente Commercial	$1,169.05
Rate for Payer: Kaiser Permanente Medicaid	$946.37
Rate for Payer: MDX Hawaii PPO	$1,799.96
Rate for Payer: University Health Alliance Commercial	$1,352.57

Disp Kit For DX Fibertak AR-8990DS [3644463]

Facility

$2,542.38

Hospital Charge Code	3644463
Hospital Revenue Code	272
Min. Negotiated Rate	$1,296.61
Max. Negotiated Rate	$2,466.11
Rate for Payer: Cash Price	$1,652.55
Rate for Payer: Hawaii Western Management Group Commercial	$2,415.26
Rate for Payer: Health Management Network Commercial	$2,161.02
Rate for Payer: Kaiser Permanente Commercial	$1,601.70
Rate for Payer: Kaiser Permanente Medicaid	$1,296.61
Rate for Payer: MDX Hawaii PPO	$2,466.11
Rate for Payer: University Health Alliance Commercial	$1,853.14

Disp Kit For DX Fibertak AR-8990DS [3644463]

Facility

$2,542.38

Hospital Charge Code	3644463
Hospital Revenue Code	272
Min. Negotiated Rate	$2,161.02
Max. Negotiated Rate	$2,466.11
Rate for Payer: Cash Price	$1,652.55
Rate for Payer: Health Management Network Commercial	$2,161.02
Rate for Payer: MDX Hawaii PPO	$2,466.11

Disp Kit S-Tak Knotless AR1938DS [3641357]

Facility

$2,352.75

Hospital Charge Code	3641357
Hospital Revenue Code	272
Min. Negotiated Rate	$1,999.84
Max. Negotiated Rate	$2,282.17
Rate for Payer: Cash Price	$1,529.29
Rate for Payer: Health Management Network Commercial	$1,999.84
Rate for Payer: MDX Hawaii PPO	$2,282.17

Disp Kit S-Tak Knotless AR1938DS [3641357]

Facility

$2,352.75

Hospital Charge Code	3641357
Hospital Revenue Code	272
Min. Negotiated Rate	$1,199.90
Max. Negotiated Rate	$2,282.17
Rate for Payer: Cash Price	$1,529.29
Rate for Payer: Hawaii Western Management Group Commercial	$2,235.11
Rate for Payer: Health Management Network Commercial	$1,999.84
Rate for Payer: Kaiser Permanente Commercial	$1,482.23
Rate for Payer: Kaiser Permanente Medicaid	$1,199.90
Rate for Payer: MDX Hawaii PPO	$2,282.17
Rate for Payer: University Health Alliance Commercial	$1,714.92

Disp Kit, T3 Amz Ar-13217 [3643627]

Facility

$2,912.00

Hospital Charge Code	3643627
Hospital Revenue Code	272
Min. Negotiated Rate	$2,475.20
Max. Negotiated Rate	$2,824.64
Rate for Payer: Cash Price	$1,892.80
Rate for Payer: Health Management Network Commercial	$2,475.20
Rate for Payer: MDX Hawaii PPO	$2,824.64

Disp Kit, T3 Amz Ar-13217 [3643627]

Facility

$2,912.00

Hospital Charge Code	3643627
Hospital Revenue Code	272
Min. Negotiated Rate	$1,485.12
Max. Negotiated Rate	$2,824.64
Rate for Payer: Cash Price	$1,892.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,766.40
Rate for Payer: Health Management Network Commercial	$2,475.20
Rate for Payer: Kaiser Permanente Commercial	$1,834.56
Rate for Payer: Kaiser Permanente Medicaid	$1,485.12
Rate for Payer: MDX Hawaii PPO	$2,824.64
Rate for Payer: University Health Alliance Commercial	$2,122.56

Distal Clavicle Plate, Short, Left, Ss Ar-2656dl [3644561]

Facility

$6,462.50

Service Code	HCPCS C1713
Hospital Charge Code	3644561
Hospital Revenue Code	278
Min. Negotiated Rate	$3,295.88
Max. Negotiated Rate	$6,268.62
Rate for Payer: Cash Price	$4,200.62
Rate for Payer: Hawaii Western Management Group Commercial	$4,523.75
Rate for Payer: Health Management Network Commercial	$5,493.12
Rate for Payer: Kaiser Permanente Commercial	$4,071.38
Rate for Payer: Kaiser Permanente Medicaid	$3,295.88
Rate for Payer: MDX Hawaii PPO	$6,268.62
Rate for Payer: University Health Alliance Commercial	$3,619.00

Know your out-of-pocket cost for care.

All Charges