Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Adhesive Sylke Wound Closure SYL-WC-32-050 [3644644]

Facility

$520.25

Hospital Charge Code	3644644
Hospital Revenue Code	272
Min. Negotiated Rate	$442.21
Max. Negotiated Rate	$504.64
Rate for Payer: Cash Price	$338.16
Rate for Payer: Health Management Network Commercial	$442.21
Rate for Payer: MDX Hawaii PPO	$504.64

Adhesive Sylke Wound Closure SYL-WC-32-050 [3644644]

Facility

$520.25

Hospital Charge Code	3644644
Hospital Revenue Code	272
Min. Negotiated Rate	$265.33
Max. Negotiated Rate	$504.64
Rate for Payer: Cash Price	$338.16
Rate for Payer: Hawaii Western Management Group Commercial	$494.24
Rate for Payer: Health Management Network Commercial	$442.21
Rate for Payer: Kaiser Permanente Commercial	$327.76
Rate for Payer: Kaiser Permanente Medicaid	$265.33
Rate for Payer: MDX Hawaii PPO	$504.64
Rate for Payer: University Health Alliance Commercial	$379.21

ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; DEFECT 10 SQ CM OR LESS

Facility

$9,416.00

Service Code	CPT 14040
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$9,416.00
Rate for Payer: AlohaCare Medicaid	$2,437.45
Rate for Payer: AlohaCare Medicare	$2,437.45
Rate for Payer: Devoted Health Medicare	$2,681.20
Rate for Payer: Hawaii Medical Service Association ABD	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$9,416.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,437.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$2,437.45
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,437.45
Rate for Payer: Ohana Health Plan Medicaid	$2,681.20
Rate for Payer: Ohana Health Plan Medicare	$2,437.45
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,437.45
Rate for Payer: University Health Alliance Commercial	$5,160.40

ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10 SQ CM OR LESS

Facility

$6,743.44

Service Code	CPT 14020
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,743.44
Rate for Payer: AlohaCare Medicaid	$2,437.45
Rate for Payer: AlohaCare Medicare	$2,437.45
Rate for Payer: Devoted Health Medicare	$2,681.20
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	$2,437.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$2,437.45
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,437.45
Rate for Payer: Ohana Health Plan Medicaid	$2,681.20
Rate for Payer: Ohana Health Plan Medicare	$2,437.45
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,437.45
Rate for Payer: University Health Alliance Commercial	$6,743.44

ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM OR LESS

Facility

$6,183.00

Service Code	CPT 14000
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$2,437.45
Rate for Payer: AlohaCare Medicare	$2,437.45
Rate for Payer: Devoted Health Medicare	$2,681.20
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	$2,437.45
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$2,437.45
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,437.45
Rate for Payer: Ohana Health Plan Medicaid	$2,681.20
Rate for Payer: Ohana Health Plan Medicare	$2,437.45
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,437.45
Rate for Payer: University Health Alliance Commercial	$5,160.40

ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES

Facility

$2,302.42

Service Code	APR-DRG 7551
Min. Negotiated Rate	$2,302.42
Max. Negotiated Rate	$2,302.42
Rate for Payer: AlohaCare Medicaid	$2,302.42
Rate for Payer: Hawaii Medical Service Association ABD	$2,302.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,302.42
Rate for Payer: Kaiser Permanente Medicaid	$2,302.42
Rate for Payer: Ohana Health Plan Medicaid	$2,302.42
Rate for Payer: UnitedHealthcare Medicaid	$2,302.42

ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES

Facility

$4,125.91

Service Code	APR-DRG 7553
Min. Negotiated Rate	$4,125.91
Max. Negotiated Rate	$4,125.91
Rate for Payer: AlohaCare Medicaid	$4,125.91
Rate for Payer: Hawaii Medical Service Association ABD	$4,125.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,125.91
Rate for Payer: Kaiser Permanente Medicaid	$4,125.91
Rate for Payer: Ohana Health Plan Medicaid	$4,125.91
Rate for Payer: UnitedHealthcare Medicaid	$4,125.91

ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES

Facility

$7,170.18

Service Code	APR-DRG 7554
Min. Negotiated Rate	$7,170.18
Max. Negotiated Rate	$7,170.18
Rate for Payer: AlohaCare Medicaid	$7,170.18
Rate for Payer: Hawaii Medical Service Association ABD	$7,170.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,170.18
Rate for Payer: Kaiser Permanente Medicaid	$7,170.18
Rate for Payer: Ohana Health Plan Medicaid	$7,170.18
Rate for Payer: UnitedHealthcare Medicaid	$7,170.18

ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES

Facility

$3,113.11

Service Code	APR-DRG 7552
Min. Negotiated Rate	$3,113.11
Max. Negotiated Rate	$3,113.11
Rate for Payer: AlohaCare Medicaid	$3,113.11
Rate for Payer: Hawaii Medical Service Association ABD	$3,113.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,113.11
Rate for Payer: Kaiser Permanente Medicaid	$3,113.11
Rate for Payer: Ohana Health Plan Medicaid	$3,113.11
Rate for Payer: UnitedHealthcare Medicaid	$3,113.11

ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC

Facility

$58,025.55

Service Code	MSDRG 614
Min. Negotiated Rate	$28,828.24
Max. Negotiated Rate	$58,025.55
Rate for Payer: AlohaCare Medicare	$28,828.24
Rate for Payer: Devoted Health Medicare	$31,711.06
Rate for Payer: Hawaii Medical Service Association Commercial	$58,025.55
Rate for Payer: Hawaii Medical Service Association Medicare	$28,828.24
Rate for Payer: Humana Medicare	$28,828.24
Rate for Payer: Kaiser Permanente Commercial	$37,808.55
Rate for Payer: Kaiser Permanente Medicare	$28,828.24
Rate for Payer: Ohana Health Plan Medicare	$28,828.24
Rate for Payer: UnitedHealthcare Medicare	$28,828.24

ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC

Facility

$58,025.55

Service Code	MSDRG 615
Min. Negotiated Rate	$18,404.66
Max. Negotiated Rate	$58,025.55
Rate for Payer: AlohaCare Medicare	$18,404.66
Rate for Payer: Devoted Health Medicare	$20,245.13
Rate for Payer: Hawaii Medical Service Association Commercial	$58,025.55
Rate for Payer: Hawaii Medical Service Association Medicare	$18,404.66
Rate for Payer: Humana Medicare	$18,404.66
Rate for Payer: Kaiser Permanente Commercial	$24,137.92
Rate for Payer: Kaiser Permanente Medicare	$18,404.66
Rate for Payer: Ohana Health Plan Medicare	$18,404.66
Rate for Payer: UnitedHealthcare Medicare	$18,404.66

ADRENAL PROCEDURES

Facility

$21,799.04

Service Code	APR-DRG 4014
Min. Negotiated Rate	$21,799.04
Max. Negotiated Rate	$21,799.04
Rate for Payer: AlohaCare Medicaid	$21,799.04
Rate for Payer: Hawaii Medical Service Association ABD	$21,799.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21,799.04
Rate for Payer: Kaiser Permanente Medicaid	$21,799.04
Rate for Payer: Ohana Health Plan Medicaid	$21,799.04
Rate for Payer: UnitedHealthcare Medicaid	$21,799.04

ADRENAL PROCEDURES

Facility

$12,478.15

Service Code	APR-DRG 4012
Min. Negotiated Rate	$12,478.15
Max. Negotiated Rate	$12,478.15
Rate for Payer: AlohaCare Medicaid	$12,478.15
Rate for Payer: Hawaii Medical Service Association ABD	$12,478.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,478.15
Rate for Payer: Kaiser Permanente Medicaid	$12,478.15
Rate for Payer: Ohana Health Plan Medicaid	$12,478.15
Rate for Payer: UnitedHealthcare Medicaid	$12,478.15

ADRENAL PROCEDURES

Facility

$14,768.10

Service Code	APR-DRG 4013
Min. Negotiated Rate	$14,768.10
Max. Negotiated Rate	$14,768.10
Rate for Payer: AlohaCare Medicaid	$14,768.10
Rate for Payer: Hawaii Medical Service Association ABD	$14,768.10
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14,768.10
Rate for Payer: Kaiser Permanente Medicaid	$14,768.10
Rate for Payer: Ohana Health Plan Medicaid	$14,768.10
Rate for Payer: UnitedHealthcare Medicaid	$14,768.10

ADRENAL PROCEDURES

Facility

$7,215.61

Service Code	APR-DRG 4011
Min. Negotiated Rate	$7,215.61
Max. Negotiated Rate	$7,215.61
Rate for Payer: AlohaCare Medicaid	$7,215.61
Rate for Payer: Hawaii Medical Service Association ABD	$7,215.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,215.61
Rate for Payer: Kaiser Permanente Medicaid	$7,215.61
Rate for Payer: Ohana Health Plan Medicaid	$7,215.61
Rate for Payer: UnitedHealthcare Medicaid	$7,215.61

Advance Biliary Balloon Cath G58804 [3642779]

Facility

$2,547.50

Service Code	HCPCS C1725
Hospital Charge Code	3642779
Hospital Revenue Code	272
Min. Negotiated Rate	$1,299.22
Max. Negotiated Rate	$2,471.07
Rate for Payer: Cash Price	$1,655.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,420.12
Rate for Payer: Health Management Network Commercial	$2,165.38
Rate for Payer: Kaiser Permanente Commercial	$1,604.92
Rate for Payer: Kaiser Permanente Medicaid	$1,299.22
Rate for Payer: MDX Hawaii PPO	$2,471.07
Rate for Payer: University Health Alliance Commercial	$1,856.87

Advance Biliary Balloon Cath G58804 [3642779]

Facility

$2,547.50

Service Code	HCPCS C1725
Hospital Charge Code	3642779
Hospital Revenue Code	272
Min. Negotiated Rate	$2,165.38
Max. Negotiated Rate	$2,471.07
Rate for Payer: Cash Price	$1,655.88
Rate for Payer: Health Management Network Commercial	$2,165.38
Rate for Payer: MDX Hawaii PPO	$2,471.07

ADVANCE CARE PLANNING FIRST 30 MINS

Professional

Both

$111.18

Service Code	HCPCS 99497
Min. Negotiated Rate	$66.27
Max. Negotiated Rate	$94.50
Rate for Payer: AlohaCare Medicaid	$76.28
Rate for Payer: AlohaCare Medicare	$66.27
Rate for Payer: Cash Price	$72.27
Rate for Payer: Cash Price	$72.27
Rate for Payer: Devoted Health Medicare	$72.90
Rate for Payer: Hawaii Medical Service Association ABD	$76.28
Rate for Payer: Hawaii Medical Service Association Medicare	$66.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$76.28
Rate for Payer: Hawaii Western Management Group Commercial	$90.40
Rate for Payer: Health Management Network Commercial	$94.50
Rate for Payer: Kaiser Permanente Commercial	$79.52
Rate for Payer: Kaiser Permanente Medicaid	$79.52
Rate for Payer: Kaiser Permanente Medicare	$79.52
Rate for Payer: Ohana Health Plan Medicaid	$76.28
Rate for Payer: Ohana Health Plan Medicare	$66.27
Rate for Payer: UnitedHealthcare Medicaid	$76.28
Rate for Payer: UnitedHealthcare Medicare	$66.27

Affixus Screw Cortical Bone 5.0mm X 30mm 8145-50-030 [3627532A]

Facility

$1,660.88

Service Code	HCPCS C1713
Hospital Charge Code	3627532A
Hospital Revenue Code	278
Min. Negotiated Rate	$930.09
Max. Negotiated Rate	$1,611.05
Rate for Payer: Cash Price	$1,079.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,162.62
Rate for Payer: Health Management Network Commercial	$1,411.75
Rate for Payer: MDX Hawaii PPO	$1,611.05
Rate for Payer: University Health Alliance Commercial	$930.09

Affixus Screw Cortical Bone 5.0mm X 30mm 8145-50-030 [3627532A]

Facility

$1,660.88

Service Code	HCPCS C1713
Hospital Charge Code	3627532A
Hospital Revenue Code	278
Min. Negotiated Rate	$847.05
Max. Negotiated Rate	$1,611.05
Rate for Payer: Cash Price	$1,079.57
Rate for Payer: Hawaii Western Management Group Commercial	$1,162.62
Rate for Payer: Health Management Network Commercial	$1,411.75
Rate for Payer: Kaiser Permanente Commercial	$1,046.35
Rate for Payer: Kaiser Permanente Medicaid	$847.05
Rate for Payer: MDX Hawaii PPO	$1,611.05
Rate for Payer: University Health Alliance Commercial	$930.09

Affixus Screw Cortical Bone 5.0mm x 32mm 8145-50-032 [3640869D]

Facility

$1,727.50

Service Code	HCPCS C1713
Hospital Charge Code	3640869D
Hospital Revenue Code	278
Min. Negotiated Rate	$881.02
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: Kaiser Permanente Commercial	$1,088.33
Rate for Payer: Kaiser Permanente Medicaid	$881.02
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Affixus Screw Cortical Bone 5.0mm x 32mm 8145-50-032 [3640869D]

Facility

$1,727.50

Service Code	HCPCS C1713
Hospital Charge Code	3640869D
Hospital Revenue Code	278
Min. Negotiated Rate	$967.40
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Affixus Screw Cortical Bone 5.0mm x 34mm 8145-50-034 [3641607]

Facility

$1,932.50

Service Code	HCPCS C1713
Hospital Charge Code	3641607
Hospital Revenue Code	278
Min. Negotiated Rate	$1,082.20
Max. Negotiated Rate	$1,874.53
Rate for Payer: Cash Price	$1,256.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,352.75
Rate for Payer: Health Management Network Commercial	$1,642.62
Rate for Payer: MDX Hawaii PPO	$1,874.53
Rate for Payer: University Health Alliance Commercial	$1,082.20

Affixus Screw Cortical Bone 5.0mm x 34mm 8145-50-034 [3641607]

Facility

$1,932.50

Service Code	HCPCS C1713
Hospital Charge Code	3641607
Hospital Revenue Code	278
Min. Negotiated Rate	$985.58
Max. Negotiated Rate	$1,874.53
Rate for Payer: Cash Price	$1,256.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,352.75
Rate for Payer: Health Management Network Commercial	$1,642.62
Rate for Payer: Kaiser Permanente Commercial	$1,217.47
Rate for Payer: Kaiser Permanente Medicaid	$985.58
Rate for Payer: MDX Hawaii PPO	$1,874.53
Rate for Payer: University Health Alliance Commercial	$1,082.20

Affixus Screw Cortical Bone 5.0mm X 36mm 8145-50-036 [3627532]

Facility

$1,727.50

Service Code	HCPCS C1713
Hospital Charge Code	3627532
Hospital Revenue Code	278
Min. Negotiated Rate	$881.02
Max. Negotiated Rate	$1,675.67
Rate for Payer: Cash Price	$1,122.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,209.25
Rate for Payer: Health Management Network Commercial	$1,468.38
Rate for Payer: Kaiser Permanente Commercial	$1,088.33
Rate for Payer: Kaiser Permanente Medicaid	$881.02
Rate for Payer: MDX Hawaii PPO	$1,675.67
Rate for Payer: University Health Alliance Commercial	$967.40

Know your out-of-pocket cost for care.

All Charges