Kona Community Hospital

All Charges

Charge

Type

Setting

Price

EXTERNAL HEART ASSIST SYSTEMS

Facility

$26,144.58

Service Code	APR-DRG 1782
Min. Negotiated Rate	$26,144.58
Max. Negotiated Rate	$26,144.58
Rate for Payer: AlohaCare Medicaid	$26,144.58
Rate for Payer: Hawaii Medical Service Association ABD	$26,144.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$26,144.58
Rate for Payer: Kaiser Permanente Medicaid	$26,144.58
Rate for Payer: Ohana Health Plan Medicaid	$26,144.58
Rate for Payer: UnitedHealthcare Medicaid	$26,144.58

EXTERNAL HEART ASSIST SYSTEMS

Facility

$22,296.38

Service Code	APR-DRG 1781
Min. Negotiated Rate	$22,296.38
Max. Negotiated Rate	$22,296.38
Rate for Payer: AlohaCare Medicaid	$22,296.38
Rate for Payer: Hawaii Medical Service Association ABD	$22,296.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22,296.38
Rate for Payer: Kaiser Permanente Medicaid	$22,296.38
Rate for Payer: Ohana Health Plan Medicaid	$22,296.38
Rate for Payer: UnitedHealthcare Medicaid	$22,296.38

EXTERNAL HEART ASSIST SYSTEMS

Facility

$40,206.47

Service Code	APR-DRG 1784
Min. Negotiated Rate	$40,206.47
Max. Negotiated Rate	$40,206.47
Rate for Payer: AlohaCare Medicaid	$40,206.47
Rate for Payer: Hawaii Medical Service Association ABD	$40,206.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$40,206.47
Rate for Payer: Kaiser Permanente Medicaid	$40,206.47
Rate for Payer: Ohana Health Plan Medicaid	$40,206.47
Rate for Payer: UnitedHealthcare Medicaid	$40,206.47

EXTERNAL HEART ASSIST SYSTEMS

Facility

$30,870.30

Service Code	APR-DRG 1783
Min. Negotiated Rate	$30,870.30
Max. Negotiated Rate	$30,870.30
Rate for Payer: AlohaCare Medicaid	$30,870.30
Rate for Payer: Hawaii Medical Service Association ABD	$30,870.30
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30,870.30
Rate for Payer: Kaiser Permanente Medicaid	$30,870.30
Rate for Payer: Ohana Health Plan Medicaid	$30,870.30
Rate for Payer: UnitedHealthcare Medicaid	$30,870.30

Ext Fix Distal Rad Kit 200mm Disp 03.390.055s [3601161]

Facility

$13,846.10

Hospital Charge Code	3601161
Hospital Revenue Code	272
Min. Negotiated Rate	$11,769.18
Max. Negotiated Rate	$13,430.72
Rate for Payer: Cash Price	$8,999.96
Rate for Payer: Health Management Network Commercial	$11,769.18
Rate for Payer: MDX Hawaii PPO	$13,430.72

Ext Fix Distal Rad Kit 200mm Disp 03.390.055s [3601161]

Facility

$13,846.10

Hospital Charge Code	3601161
Hospital Revenue Code	272
Min. Negotiated Rate	$7,061.51
Max. Negotiated Rate	$13,430.72
Rate for Payer: Cash Price	$8,999.96
Rate for Payer: Hawaii Western Management Group Commercial	$13,153.80
Rate for Payer: Health Management Network Commercial	$11,769.18
Rate for Payer: Kaiser Permanente Commercial	$8,723.04
Rate for Payer: Kaiser Permanente Medicaid	$7,061.51
Rate for Payer: MDX Hawaii PPO	$13,430.72
Rate for Payer: University Health Alliance Commercial	$10,092.42

EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1-STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION), COMPLEX, REQUIRING DEVICES OR TECHNIQUES NOT GENERALLY USED IN ROUTINE CATARACT SURGERY (EG, IRIS EXPANSION DEVICE, SUTURE SUPPORT FOR INTRAOCULAR LENS, OR PRIMARY POSTERIOR CAPSULORRHEXIS) OR PERFORMED ON PATIENTS IN THE AMBLYOGENIC DEVELOPMENTAL STAGE; WITHOUT ENDOSCOPIC CYCLOPHOTOCOAGULATION

Facility

$14,715.00

Service Code	CPT 66982
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$14,715.00
Rate for Payer: AlohaCare Medicaid	$2,726.34
Rate for Payer: AlohaCare Medicare	$2,726.34
Rate for Payer: Devoted Health Medicare	$2,998.97
Rate for Payer: Hawaii Medical Service Association ABD	$1,149.00
Rate for Payer: Hawaii Medical Service Association Commercial	$14,715.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,726.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,154.45
Rate for Payer: Humana Medicare	$2,726.34
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,726.34
Rate for Payer: Ohana Health Plan Medicaid	$2,998.97
Rate for Payer: Ohana Health Plan Medicare	$2,726.34
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,726.34
Rate for Payer: University Health Alliance Commercial	$6,743.44

EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITHOUT ENDOSCOPIC CYCLOPHOTOCOAGULATION

Facility

$9,416.00

Service Code	CPT 66984
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$9,416.00
Rate for Payer: AlohaCare Medicaid	$2,726.34
Rate for Payer: AlohaCare Medicare	$2,726.34
Rate for Payer: Devoted Health Medicare	$2,998.97
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	$2,726.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$2,726.34
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$2,726.34
Rate for Payer: Ohana Health Plan Medicaid	$2,998.97
Rate for Payer: Ohana Health Plan Medicare	$2,726.34
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$2,726.34
Rate for Payer: University Health Alliance Commercial	$6,743.44

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$37,438.29

Service Code	APR-DRG 0093
Min. Negotiated Rate	$37,438.29
Max. Negotiated Rate	$37,438.29
Rate for Payer: AlohaCare Medicaid	$37,438.29
Rate for Payer: Hawaii Medical Service Association ABD	$37,438.29
Rate for Payer: Hawaii Medical Service Association Non-ABD	$37,438.29
Rate for Payer: Kaiser Permanente Medicaid	$37,438.29
Rate for Payer: Ohana Health Plan Medicaid	$37,438.29
Rate for Payer: UnitedHealthcare Medicaid	$37,438.29

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$20,047.20

Service Code	APR-DRG 0091
Min. Negotiated Rate	$20,047.20
Max. Negotiated Rate	$20,047.20
Rate for Payer: AlohaCare Medicaid	$20,047.20
Rate for Payer: Hawaii Medical Service Association ABD	$20,047.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$20,047.20
Rate for Payer: Kaiser Permanente Medicaid	$20,047.20
Rate for Payer: Ohana Health Plan Medicaid	$20,047.20
Rate for Payer: UnitedHealthcare Medicaid	$20,047.20

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$25,801.98

Service Code	APR-DRG 0092
Min. Negotiated Rate	$25,801.98
Max. Negotiated Rate	$25,801.98
Rate for Payer: AlohaCare Medicaid	$25,801.98
Rate for Payer: Hawaii Medical Service Association ABD	$25,801.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$25,801.98
Rate for Payer: Kaiser Permanente Medicaid	$25,801.98
Rate for Payer: Ohana Health Plan Medicaid	$25,801.98
Rate for Payer: UnitedHealthcare Medicaid	$25,801.98

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$71,677.91

Service Code	APR-DRG 0094
Min. Negotiated Rate	$71,677.91
Max. Negotiated Rate	$71,677.91
Rate for Payer: AlohaCare Medicaid	$71,677.91
Rate for Payer: Hawaii Medical Service Association ABD	$71,677.91
Rate for Payer: Hawaii Medical Service Association Non-ABD	$71,677.91
Rate for Payer: Kaiser Permanente Medicaid	$71,677.91
Rate for Payer: Ohana Health Plan Medicaid	$71,677.91
Rate for Payer: UnitedHealthcare Medicaid	$71,677.91

EXTRACRANIAL PROCEDURES WITH CC

Facility

$55,060.39

Service Code	MSDRG 038
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$55,060.39
Rate for Payer: AlohaCare Medicare	$21,341.67
Rate for Payer: Devoted Health Medicare	$23,475.84
Rate for Payer: Hawaii Medical Service Association Commercial	$55,060.39
Rate for Payer: Hawaii Medical Service Association Medicare	$21,341.67
Rate for Payer: Humana Medicare	$21,341.67
Rate for Payer: Kaiser Permanente Commercial	$27,989.85
Rate for Payer: Kaiser Permanente Medicare	$21,341.67
Rate for Payer: Ohana Health Plan Medicare	$21,341.67
Rate for Payer: UnitedHealthcare Medicare	$21,341.67
Rate for Payer: University Health Alliance Commercial	$10,400.00

EXTRACRANIAL PROCEDURES WITH MCC

Facility

$66,149.61

Service Code	MSDRG 037
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$66,149.61
Rate for Payer: AlohaCare Medicare	$43,300.21
Rate for Payer: Devoted Health Medicare	$47,630.23
Rate for Payer: Hawaii Medical Service Association Commercial	$66,149.61
Rate for Payer: Hawaii Medical Service Association Medicare	$43,300.21
Rate for Payer: Humana Medicare	$43,300.21
Rate for Payer: Kaiser Permanente Commercial	$56,788.72
Rate for Payer: Kaiser Permanente Medicare	$43,300.21
Rate for Payer: Ohana Health Plan Medicare	$43,300.21
Rate for Payer: UnitedHealthcare Medicare	$43,300.21
Rate for Payer: University Health Alliance Commercial	$10,400.00

EXTRACRANIAL PROCEDURES WITHOUT CC/MCC

Facility

$42,862.25

Service Code	MSDRG 039
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$42,862.25
Rate for Payer: AlohaCare Medicare	$15,461.08
Rate for Payer: Devoted Health Medicare	$17,007.19
Rate for Payer: Hawaii Medical Service Association Commercial	$42,862.25
Rate for Payer: Hawaii Medical Service Association Medicare	$15,461.08
Rate for Payer: Humana Medicare	$15,461.08
Rate for Payer: Kaiser Permanente Commercial	$20,277.38
Rate for Payer: Kaiser Permanente Medicare	$15,461.08
Rate for Payer: Ohana Health Plan Medicare	$15,461.08
Rate for Payer: UnitedHealthcare Medicare	$15,461.08
Rate for Payer: University Health Alliance Commercial	$10,400.00

Extraction Bolt For 2.7mm Screw 309.290 [3644968]

Facility

$1,004.68

Hospital Charge Code	3644968
Hospital Revenue Code	272
Min. Negotiated Rate	$512.39
Max. Negotiated Rate	$974.54
Rate for Payer: Cash Price	$653.04
Rate for Payer: Hawaii Western Management Group Commercial	$954.45
Rate for Payer: Health Management Network Commercial	$853.98
Rate for Payer: Kaiser Permanente Commercial	$632.95
Rate for Payer: Kaiser Permanente Medicaid	$512.39
Rate for Payer: MDX Hawaii PPO	$974.54
Rate for Payer: University Health Alliance Commercial	$732.31

Extraction Bolt For 2.7mm Screw 309.290 [3644968]

Facility

$1,004.68

Hospital Charge Code	3644968
Hospital Revenue Code	272
Min. Negotiated Rate	$853.98
Max. Negotiated Rate	$974.54
Rate for Payer: Cash Price	$653.04
Rate for Payer: Health Management Network Commercial	$853.98
Rate for Payer: MDX Hawaii PPO	$974.54

Extraction Bolt For 3.5/4.0mm Screw 309.039 [3623771]

Facility

$765.58

Service Code	HCPCS C1713
Hospital Charge Code	3623771
Hospital Revenue Code	278
Min. Negotiated Rate	$390.45
Max. Negotiated Rate	$742.61
Rate for Payer: Cash Price	$497.63
Rate for Payer: Hawaii Western Management Group Commercial	$535.91
Rate for Payer: Health Management Network Commercial	$650.74
Rate for Payer: Kaiser Permanente Commercial	$482.32
Rate for Payer: Kaiser Permanente Medicaid	$390.45
Rate for Payer: MDX Hawaii PPO	$742.61
Rate for Payer: University Health Alliance Commercial	$428.72

Extraction Bolt For 3.5/4.0mm Screw 309.039 [3623771]

Facility

$765.58

Service Code	HCPCS C1713
Hospital Charge Code	3623771
Hospital Revenue Code	278
Min. Negotiated Rate	$428.72
Max. Negotiated Rate	$742.61
Rate for Payer: Cash Price	$497.63
Rate for Payer: Hawaii Western Management Group Commercial	$535.91
Rate for Payer: Health Management Network Commercial	$650.74
Rate for Payer: MDX Hawaii PPO	$742.61
Rate for Payer: University Health Alliance Commercial	$428.72

Extraction Bolt For 4.5mm Screw 309.490 [3623776]

Facility

$840.13

Service Code	HCPCS C1713
Hospital Charge Code	3623776
Hospital Revenue Code	278
Min. Negotiated Rate	$470.47
Max. Negotiated Rate	$814.93
Rate for Payer: Cash Price	$546.08
Rate for Payer: Hawaii Western Management Group Commercial	$588.09
Rate for Payer: Health Management Network Commercial	$714.11
Rate for Payer: MDX Hawaii PPO	$814.93
Rate for Payer: University Health Alliance Commercial	$470.47

Extraction Bolt For 4.5mm Screw 309.490 [3623776]

Facility

$840.13

Service Code	HCPCS C1713
Hospital Charge Code	3623776
Hospital Revenue Code	278
Min. Negotiated Rate	$428.47
Max. Negotiated Rate	$814.93
Rate for Payer: Cash Price	$546.08
Rate for Payer: Hawaii Western Management Group Commercial	$588.09
Rate for Payer: Health Management Network Commercial	$714.11
Rate for Payer: Kaiser Permanente Commercial	$529.28
Rate for Payer: Kaiser Permanente Medicaid	$428.47
Rate for Payer: MDX Hawaii PPO	$814.93
Rate for Payer: University Health Alliance Commercial	$470.47

Extraction Bolt For 6.5/7.0mm Screw 309.069 [3623772]

Facility

$582.62

Service Code	HCPCS C1713
Hospital Charge Code	3623772
Hospital Revenue Code	278
Min. Negotiated Rate	$326.27
Max. Negotiated Rate	$565.14
Rate for Payer: Cash Price	$378.70
Rate for Payer: Hawaii Western Management Group Commercial	$407.83
Rate for Payer: Health Management Network Commercial	$495.23
Rate for Payer: MDX Hawaii PPO	$565.14
Rate for Payer: University Health Alliance Commercial	$326.27

Extraction Bolt For 6.5/7.0mm Screw 309.069 [3623772]

Facility

$582.62

Service Code	HCPCS C1713
Hospital Charge Code	3623772
Hospital Revenue Code	278
Min. Negotiated Rate	$297.14
Max. Negotiated Rate	$565.14
Rate for Payer: Cash Price	$378.70
Rate for Payer: Hawaii Western Management Group Commercial	$407.83
Rate for Payer: Health Management Network Commercial	$495.23
Rate for Payer: Kaiser Permanente Commercial	$367.05
Rate for Payer: Kaiser Permanente Medicaid	$297.14
Rate for Payer: MDX Hawaii PPO	$565.14
Rate for Payer: University Health Alliance Commercial	$326.27

EXTRACTOR OB VAC L-STYLE [2700888]

Facility

$301.37

Hospital Charge Code	2700888
Hospital Revenue Code	272
Min. Negotiated Rate	$256.16
Max. Negotiated Rate	$292.33
Rate for Payer: Cash Price	$195.89
Rate for Payer: Health Management Network Commercial	$256.16
Rate for Payer: MDX Hawaii PPO	$292.33

EXTRACTOR OB VAC L-STYLE [2700888]

Facility

$301.37

Hospital Charge Code	2700888
Hospital Revenue Code	272
Min. Negotiated Rate	$153.70
Max. Negotiated Rate	$292.33
Rate for Payer: Cash Price	$195.89
Rate for Payer: Hawaii Western Management Group Commercial	$286.30
Rate for Payer: Health Management Network Commercial	$256.16
Rate for Payer: Kaiser Permanente Commercial	$189.86
Rate for Payer: Kaiser Permanente Medicaid	$153.70
Rate for Payer: MDX Hawaii PPO	$292.33
Rate for Payer: University Health Alliance Commercial	$219.67

Know your out-of-pocket cost for care.

All Charges