Kona Community Hospital

All Charges

Charge

Type

Setting

Price

EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 2.1 TO 3.0 CM

Facility

$2,837.00

Service Code	CPT 11443
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association Commercial	$2,438.89
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,951.11

EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$6,743.44

Service Code	CPT 22903
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,743.44
Rate for Payer: AlohaCare Medicaid	$3,431.47
Rate for Payer: AlohaCare Medicare	$3,431.47
Rate for Payer: Devoted Health Medicare	$3,774.62
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	$3,431.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,431.47
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,431.47
Rate for Payer: Ohana Health Plan Medicaid	$3,774.62
Rate for Payer: Ohana Health Plan Medicare	$3,431.47
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,431.47
Rate for Payer: University Health Alliance Commercial	$6,743.44

EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$6,183.00

Service Code	CPT 21931
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Devoted Health Medicare	$2,146.22
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	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$4,035.20

EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$6,183.00

Service Code	CPT 21930
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Devoted Health Medicare	$2,146.22
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	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$5,160.40

EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$6,183.00

Service Code	CPT 27632
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$3,431.47
Rate for Payer: AlohaCare Medicare	$3,431.47
Rate for Payer: Devoted Health Medicare	$3,774.62
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	$3,431.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,431.47
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,431.47
Rate for Payer: Ohana Health Plan Medicaid	$3,774.62
Rate for Payer: Ohana Health Plan Medicare	$3,431.47
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,431.47
Rate for Payer: University Health Alliance Commercial	$5,160.40

EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$6,183.00

Service Code	CPT 21552
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$3,431.47
Rate for Payer: AlohaCare Medicare	$3,431.47
Rate for Payer: Devoted Health Medicare	$3,774.62
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	$3,431.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,431.47
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,431.47
Rate for Payer: Ohana Health Plan Medicaid	$3,774.62
Rate for Payer: Ohana Health Plan Medicare	$3,431.47
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,431.47
Rate for Payer: University Health Alliance Commercial	$5,160.40

EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$5,160.40

Service Code	CPT 21555
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$5,160.40
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Devoted Health Medicare	$2,146.22
Rate for Payer: Hawaii Medical Service Association Commercial	$2,438.89
Rate for Payer: Hawaii Medical Service Association Medicare	$1,951.11
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11
Rate for Payer: University Health Alliance Commercial	$5,160.40

EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM

Facility

$9,416.00

Service Code	CPT 21556
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$9,416.00
Rate for Payer: AlohaCare Medicaid	$3,431.47
Rate for Payer: AlohaCare Medicare	$3,431.47
Rate for Payer: Devoted Health Medicare	$3,774.62
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	$3,431.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$3,431.47
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,431.47
Rate for Payer: Ohana Health Plan Medicaid	$3,774.62
Rate for Payer: Ohana Health Plan Medicare	$3,431.47
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,431.47
Rate for Payer: University Health Alliance Commercial	$5,160.40

EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$6,743.44

Service Code	CPT 27043
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,743.44
Rate for Payer: AlohaCare Medicaid	$3,431.47
Rate for Payer: AlohaCare Medicare	$3,431.47
Rate for Payer: Devoted Health Medicare	$3,774.62
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	$3,431.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,431.47
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,431.47
Rate for Payer: Ohana Health Plan Medicaid	$3,774.62
Rate for Payer: Ohana Health Plan Medicare	$3,431.47
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,431.47
Rate for Payer: University Health Alliance Commercial	$6,743.44

EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$6,183.00

Service Code	CPT 27337
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$3,431.47
Rate for Payer: AlohaCare Medicare	$3,431.47
Rate for Payer: Devoted Health Medicare	$3,774.62
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	$3,431.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,431.47
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,431.47
Rate for Payer: Ohana Health Plan Medicaid	$3,774.62
Rate for Payer: Ohana Health Plan Medicare	$3,431.47
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,431.47
Rate for Payer: University Health Alliance Commercial	$4,035.20

EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$6,183.00

Service Code	CPT 24071
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$3,431.47
Rate for Payer: AlohaCare Medicare	$3,431.47
Rate for Payer: Devoted Health Medicare	$3,774.62
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	$3,431.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,431.47
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,431.47
Rate for Payer: Ohana Health Plan Medicaid	$3,774.62
Rate for Payer: Ohana Health Plan Medicare	$3,431.47
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,431.47
Rate for Payer: University Health Alliance Commercial	$4,035.20

EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM

Facility

$6,183.00

Service Code	CPT 24076
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$3,431.47
Rate for Payer: AlohaCare Medicare	$3,431.47
Rate for Payer: Devoted Health Medicare	$3,774.62
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	$3,431.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,431.47
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,431.47
Rate for Payer: Ohana Health Plan Medicaid	$3,774.62
Rate for Payer: Ohana Health Plan Medicare	$3,431.47
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,431.47
Rate for Payer: University Health Alliance Commercial	$5,160.40

EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS OR INFECTION; CHEST

Facility

$2,837.00

Service Code	CPT 35820
Hospital Revenue Code	360
Min. Negotiated Rate	$600.85
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$600.85

EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); EXTREMITY

Facility

$6,183.00

Service Code	CPT 20103
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Devoted Health Medicare	$2,146.22
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	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,951.11

EXTENSIVE 3RD DEGREE BURNS W/O SKIN GRAFT

Facility

$3,443.19

Service Code	APR-DRG 8432
Min. Negotiated Rate	$3,443.19
Max. Negotiated Rate	$3,443.19
Rate for Payer: AlohaCare Medicaid	$3,443.19
Rate for Payer: Hawaii Medical Service Association ABD	$3,443.19
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,443.19
Rate for Payer: Kaiser Permanente Medicaid	$3,443.19
Rate for Payer: Ohana Health Plan Medicaid	$3,443.19
Rate for Payer: UnitedHealthcare Medicaid	$3,443.19

EXTENSIVE 3RD DEGREE BURNS W/O SKIN GRAFT

Facility

$4,845.43

Service Code	APR-DRG 8433
Min. Negotiated Rate	$4,845.43
Max. Negotiated Rate	$4,845.43
Rate for Payer: AlohaCare Medicaid	$4,845.43
Rate for Payer: Hawaii Medical Service Association ABD	$4,845.43
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,845.43
Rate for Payer: Kaiser Permanente Medicaid	$4,845.43
Rate for Payer: Ohana Health Plan Medicaid	$4,845.43
Rate for Payer: UnitedHealthcare Medicaid	$4,845.43

EXTENSIVE 3RD DEGREE BURNS W/O SKIN GRAFT

Facility

$10,549.28

Service Code	APR-DRG 8434
Min. Negotiated Rate	$10,549.28
Max. Negotiated Rate	$10,549.28
Rate for Payer: AlohaCare Medicaid	$10,549.28
Rate for Payer: Hawaii Medical Service Association ABD	$10,549.28
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,549.28
Rate for Payer: Kaiser Permanente Medicaid	$10,549.28
Rate for Payer: Ohana Health Plan Medicaid	$10,549.28
Rate for Payer: UnitedHealthcare Medicaid	$10,549.28

EXTENSIVE 3RD DEGREE BURNS W/O SKIN GRAFT

Facility

$2,780.92

Service Code	APR-DRG 8431
Min. Negotiated Rate	$2,780.92
Max. Negotiated Rate	$2,780.92
Rate for Payer: AlohaCare Medicaid	$2,780.92
Rate for Payer: Hawaii Medical Service Association ABD	$2,780.92
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,780.92
Rate for Payer: Kaiser Permanente Medicaid	$2,780.92
Rate for Payer: Ohana Health Plan Medicaid	$2,780.92
Rate for Payer: UnitedHealthcare Medicaid	$2,780.92

EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT

Facility

$19,040.41

Service Code	APR-DRG 8412
Min. Negotiated Rate	$19,040.41
Max. Negotiated Rate	$19,040.41
Rate for Payer: AlohaCare Medicaid	$19,040.41
Rate for Payer: Hawaii Medical Service Association ABD	$19,040.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19,040.41
Rate for Payer: Kaiser Permanente Medicaid	$19,040.41
Rate for Payer: Ohana Health Plan Medicaid	$19,040.41
Rate for Payer: UnitedHealthcare Medicaid	$19,040.41

EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT

Facility

$38,976.80

Service Code	APR-DRG 8413
Min. Negotiated Rate	$38,976.80
Max. Negotiated Rate	$38,976.80
Rate for Payer: AlohaCare Medicaid	$38,976.80
Rate for Payer: Hawaii Medical Service Association ABD	$38,976.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$38,976.80
Rate for Payer: Kaiser Permanente Medicaid	$38,976.80
Rate for Payer: Ohana Health Plan Medicaid	$38,976.80
Rate for Payer: UnitedHealthcare Medicaid	$38,976.80

EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT

Facility

$16,727.54

Service Code	APR-DRG 8411
Min. Negotiated Rate	$16,727.54
Max. Negotiated Rate	$16,727.54
Rate for Payer: AlohaCare Medicaid	$16,727.54
Rate for Payer: Hawaii Medical Service Association ABD	$16,727.54
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16,727.54
Rate for Payer: Kaiser Permanente Medicaid	$16,727.54
Rate for Payer: Ohana Health Plan Medicaid	$16,727.54
Rate for Payer: UnitedHealthcare Medicaid	$16,727.54

EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT

Facility

$80,474.71

Service Code	APR-DRG 8414
Min. Negotiated Rate	$80,474.71
Max. Negotiated Rate	$80,474.71
Rate for Payer: AlohaCare Medicaid	$80,474.71
Rate for Payer: Hawaii Medical Service Association ABD	$80,474.71
Rate for Payer: Hawaii Medical Service Association Non-ABD	$80,474.71
Rate for Payer: Kaiser Permanente Medicaid	$80,474.71
Rate for Payer: Ohana Health Plan Medicaid	$80,474.71
Rate for Payer: UnitedHealthcare Medicaid	$80,474.71

EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA

Facility

$16,575.41

Service Code	APR-DRG 9113
Min. Negotiated Rate	$16,575.41
Max. Negotiated Rate	$16,575.41
Rate for Payer: AlohaCare Medicaid	$16,575.41
Rate for Payer: Hawaii Medical Service Association ABD	$16,575.41
Rate for Payer: Hawaii Medical Service Association Non-ABD	$16,575.41
Rate for Payer: Kaiser Permanente Medicaid	$16,575.41
Rate for Payer: Ohana Health Plan Medicaid	$16,575.41
Rate for Payer: UnitedHealthcare Medicaid	$16,575.41

EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA

Facility

$12,686.04

Service Code	APR-DRG 9112
Min. Negotiated Rate	$12,686.04
Max. Negotiated Rate	$12,686.04
Rate for Payer: AlohaCare Medicaid	$12,686.04
Rate for Payer: Hawaii Medical Service Association ABD	$12,686.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,686.04
Rate for Payer: Kaiser Permanente Medicaid	$12,686.04
Rate for Payer: Ohana Health Plan Medicaid	$12,686.04
Rate for Payer: UnitedHealthcare Medicaid	$12,686.04

EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA

Facility

$9,526.06

Service Code	APR-DRG 9111
Min. Negotiated Rate	$9,526.06
Max. Negotiated Rate	$9,526.06
Rate for Payer: AlohaCare Medicaid	$9,526.06
Rate for Payer: Hawaii Medical Service Association ABD	$9,526.06
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,526.06
Rate for Payer: Kaiser Permanente Medicaid	$9,526.06
Rate for Payer: Ohana Health Plan Medicaid	$9,526.06
Rate for Payer: UnitedHealthcare Medicaid	$9,526.06

Know your out-of-pocket cost for care.

All Charges