Kona Community Hospital

All Charges

Charge

Type

Setting

Price

AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$10,858.13

Service Code	APR-DRG 3053
Min. Negotiated Rate	$10,858.13
Max. Negotiated Rate	$10,858.13
Rate for Payer: AlohaCare Medicaid	$10,858.13
Rate for Payer: Hawaii Medical Service Association ABD	$10,858.13
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,858.13
Rate for Payer: Kaiser Permanente Medicaid	$10,858.13
Rate for Payer: Ohana Health Plan Medicaid	$10,858.13
Rate for Payer: UnitedHealthcare Medicaid	$10,858.13

AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$21,101.74

Service Code	APR-DRG 3054
Min. Negotiated Rate	$21,101.74
Max. Negotiated Rate	$21,101.74
Rate for Payer: AlohaCare Medicaid	$21,101.74
Rate for Payer: Hawaii Medical Service Association ABD	$21,101.74
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21,101.74
Rate for Payer: Kaiser Permanente Medicaid	$21,101.74
Rate for Payer: Ohana Health Plan Medicaid	$21,101.74
Rate for Payer: UnitedHealthcare Medicaid	$21,101.74

AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$5,146.64

Service Code	APR-DRG 3051
Min. Negotiated Rate	$5,146.64
Max. Negotiated Rate	$5,146.64
Rate for Payer: AlohaCare Medicaid	$5,146.64
Rate for Payer: Hawaii Medical Service Association ABD	$5,146.64
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,146.64
Rate for Payer: Kaiser Permanente Medicaid	$5,146.64
Rate for Payer: Ohana Health Plan Medicaid	$5,146.64
Rate for Payer: UnitedHealthcare Medicaid	$5,146.64

AMPUTATION OF LOWER LIMB EXCEPT TOES

Facility

$6,969.81

Service Code	APR-DRG 3052
Min. Negotiated Rate	$6,969.81
Max. Negotiated Rate	$6,969.81
Rate for Payer: AlohaCare Medicaid	$6,969.81
Rate for Payer: Hawaii Medical Service Association ABD	$6,969.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,969.81
Rate for Payer: Kaiser Permanente Medicaid	$6,969.81
Rate for Payer: Ohana Health Plan Medicaid	$6,969.81
Rate for Payer: UnitedHealthcare Medicaid	$6,969.81

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

$72,827.25

Service Code	MSDRG 617
Min. Negotiated Rate	$24,599.61
Max. Negotiated Rate	$72,827.25
Rate for Payer: AlohaCare Medicare	$24,599.61
Rate for Payer: Devoted Health Medicare	$27,059.57
Rate for Payer: Hawaii Medical Service Association Commercial	$72,827.25
Rate for Payer: Hawaii Medical Service Association Medicare	$24,599.61
Rate for Payer: Humana Medicare	$24,599.61
Rate for Payer: Kaiser Permanente Commercial	$32,262.67
Rate for Payer: Kaiser Permanente Medicare	$24,599.61
Rate for Payer: Ohana Health Plan Medicare	$24,599.61
Rate for Payer: UnitedHealthcare Medicare	$24,599.61

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

$72,827.25

Service Code	MSDRG 616
Min. Negotiated Rate	$45,868.97
Max. Negotiated Rate	$72,827.25
Rate for Payer: AlohaCare Medicare	$45,868.97
Rate for Payer: Devoted Health Medicare	$50,455.87
Rate for Payer: Hawaii Medical Service Association Commercial	$72,827.25
Rate for Payer: Hawaii Medical Service Association Medicare	$45,868.97
Rate for Payer: Humana Medicare	$45,868.97
Rate for Payer: Kaiser Permanente Commercial	$60,157.65
Rate for Payer: Kaiser Permanente Medicare	$45,868.97
Rate for Payer: Ohana Health Plan Medicare	$45,868.97
Rate for Payer: UnitedHealthcare Medicare	$45,868.97

AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

$72,827.25

Service Code	MSDRG 618
Min. Negotiated Rate	$18,654.58
Max. Negotiated Rate	$72,827.25
Rate for Payer: AlohaCare Medicare	$18,654.58
Rate for Payer: Devoted Health Medicare	$20,520.04
Rate for Payer: Hawaii Medical Service Association Commercial	$72,827.25
Rate for Payer: Hawaii Medical Service Association Medicare	$18,654.58
Rate for Payer: Humana Medicare	$18,654.58
Rate for Payer: Kaiser Permanente Commercial	$24,465.67
Rate for Payer: Kaiser Permanente Medicare	$18,654.58
Rate for Payer: Ohana Health Plan Medicare	$18,654.58
Rate for Payer: UnitedHealthcare Medicare	$18,654.58

AMPUTATION, TOE; METATARSOPHALANGEAL JOINT

Facility

$6,183.00

Service Code	CPT 28820
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$3,865.36
Rate for Payer: AlohaCare Medicare	$3,865.36
Rate for Payer: Devoted Health Medicare	$4,251.90
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	$3,865.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,865.36
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,865.36
Rate for Payer: Ohana Health Plan Medicaid	$4,251.90
Rate for Payer: Ohana Health Plan Medicare	$3,865.36
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,865.36
Rate for Payer: University Health Alliance Commercial	$5,160.40

ANAL AND STOMAL PROCEDURES WITH CC

Facility

$23,263.26

Service Code	MSDRG 348
Min. Negotiated Rate	$17,214.34
Max. Negotiated Rate	$23,263.26
Rate for Payer: AlohaCare Medicare	$17,214.34
Rate for Payer: Devoted Health Medicare	$18,935.77
Rate for Payer: Hawaii Medical Service Association Commercial	$23,263.26
Rate for Payer: Hawaii Medical Service Association Medicare	$17,214.34
Rate for Payer: Humana Medicare	$17,214.34
Rate for Payer: Kaiser Permanente Commercial	$22,576.80
Rate for Payer: Kaiser Permanente Medicare	$17,214.34
Rate for Payer: Ohana Health Plan Medicare	$17,214.34
Rate for Payer: UnitedHealthcare Medicare	$17,214.34

ANAL AND STOMAL PROCEDURES WITH MCC

Facility

$39,599.10

Service Code	MSDRG 347
Min. Negotiated Rate	$29,000.72
Max. Negotiated Rate	$39,599.10
Rate for Payer: AlohaCare Medicare	$30,193.48
Rate for Payer: Devoted Health Medicare	$33,212.83
Rate for Payer: Hawaii Medical Service Association Commercial	$29,000.72
Rate for Payer: Hawaii Medical Service Association Medicare	$30,193.48
Rate for Payer: Humana Medicare	$30,193.48
Rate for Payer: Kaiser Permanente Commercial	$39,599.10
Rate for Payer: Kaiser Permanente Medicare	$30,193.48
Rate for Payer: Ohana Health Plan Medicare	$30,193.48
Rate for Payer: UnitedHealthcare Medicare	$30,193.48

ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC

Facility

$15,017.85

Service Code	MSDRG 349
Min. Negotiated Rate	$11,450.80
Max. Negotiated Rate	$15,017.85
Rate for Payer: AlohaCare Medicare	$11,450.80
Rate for Payer: Devoted Health Medicare	$12,595.88
Rate for Payer: Hawaii Medical Service Association Commercial	$14,440.09
Rate for Payer: Hawaii Medical Service Association Medicare	$11,450.80
Rate for Payer: Humana Medicare	$11,450.80
Rate for Payer: Kaiser Permanente Commercial	$15,017.85
Rate for Payer: Kaiser Permanente Medicare	$11,450.80
Rate for Payer: Ohana Health Plan Medicare	$11,450.80
Rate for Payer: UnitedHealthcare Medicare	$11,450.80

ANAL PROCEDURES

Facility

$8,083.58

Service Code	APR-DRG 2263
Min. Negotiated Rate	$8,083.58
Max. Negotiated Rate	$8,083.58
Rate for Payer: AlohaCare Medicaid	$8,083.58
Rate for Payer: Hawaii Medical Service Association ABD	$8,083.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,083.58
Rate for Payer: Kaiser Permanente Medicaid	$8,083.58
Rate for Payer: Ohana Health Plan Medicaid	$8,083.58
Rate for Payer: UnitedHealthcare Medicaid	$8,083.58

ANAL PROCEDURES

Facility

$5,857.95

Service Code	APR-DRG 2262
Min. Negotiated Rate	$5,857.95
Max. Negotiated Rate	$5,857.95
Rate for Payer: AlohaCare Medicaid	$5,857.95
Rate for Payer: Hawaii Medical Service Association ABD	$5,857.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,857.95
Rate for Payer: Kaiser Permanente Medicaid	$5,857.95
Rate for Payer: Ohana Health Plan Medicaid	$5,857.95
Rate for Payer: UnitedHealthcare Medicaid	$5,857.95

ANAL PROCEDURES

Facility

$4,421.96

Service Code	APR-DRG 2261
Min. Negotiated Rate	$4,421.96
Max. Negotiated Rate	$4,421.96
Rate for Payer: UnitedHealthcare Medicaid	$4,421.96
Rate for Payer: AlohaCare Medicaid	$4,421.96
Rate for Payer: Hawaii Medical Service Association ABD	$4,421.96
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,421.96
Rate for Payer: Kaiser Permanente Medicaid	$4,421.96
Rate for Payer: Ohana Health Plan Medicaid	$4,421.96

ANAL PROCEDURES

Facility

$15,651.98

Service Code	APR-DRG 2264
Min. Negotiated Rate	$15,651.98
Max. Negotiated Rate	$15,651.98
Rate for Payer: AlohaCare Medicaid	$15,651.98
Rate for Payer: Hawaii Medical Service Association ABD	$15,651.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$15,651.98
Rate for Payer: Kaiser Permanente Medicaid	$15,651.98
Rate for Payer: Ohana Health Plan Medicaid	$15,651.98
Rate for Payer: UnitedHealthcare Medicaid	$15,651.98

ANASTROZOLE 1 MG PO TABLET

Facility

$11.44

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$11.10
Rate for Payer: Cash Price	$7.44
Rate for Payer: Hawaii Western Management Group Commercial	$10.87
Rate for Payer: Health Management Network Commercial	$9.72
Rate for Payer: Kaiser Permanente Commercial	$7.21
Rate for Payer: Kaiser Permanente Medicaid	$5.83
Rate for Payer: MDX Hawaii PPO	$11.10
Rate for Payer: UnitedHealthcare Medicaid	$6.86
Rate for Payer: University Health Alliance Commercial	$8.34

ANASTROZOLE 1 MG PO TABLET

Facility

$11.44

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$9.72
Max. Negotiated Rate	$11.10
Rate for Payer: Cash Price	$7.44
Rate for Payer: Health Management Network Commercial	$9.72
Rate for Payer: MDX Hawaii PPO	$11.10

Anchor BioComp Knotless Swivelock #2 Suture 4.75mmX19.1mm AR-2324KBCC [3642846]

Facility

$3,954.50

Service Code	HCPCS C1713
Hospital Charge Code	3642846
Hospital Revenue Code	278
Min. Negotiated Rate	$2,016.80
Max. Negotiated Rate	$3,835.86
Rate for Payer: Cash Price	$2,570.43
Rate for Payer: Hawaii Western Management Group Commercial	$2,768.15
Rate for Payer: Health Management Network Commercial	$3,361.32
Rate for Payer: Kaiser Permanente Commercial	$2,491.34
Rate for Payer: Kaiser Permanente Medicaid	$2,016.80
Rate for Payer: MDX Hawaii PPO	$3,835.86
Rate for Payer: University Health Alliance Commercial	$2,214.52

Anchor BioComp Knotless Swivelock #2 Suture 4.75mmX19.1mm AR-2324KBCC [3642846]

Facility

$3,954.50

Service Code	HCPCS C1713
Hospital Charge Code	3642846
Hospital Revenue Code	278
Min. Negotiated Rate	$2,214.52
Max. Negotiated Rate	$3,835.86
Rate for Payer: Cash Price	$2,570.43
Rate for Payer: Hawaii Western Management Group Commercial	$2,768.15
Rate for Payer: Health Management Network Commercial	$3,361.32
Rate for Payer: MDX Hawaii PPO	$3,835.86
Rate for Payer: University Health Alliance Commercial	$2,214.52

Anchor Biocomp PushLock 2.9 x 15mm AR1923BC [3625304]

Facility

$3,077.00

Service Code	HCPCS C1713
Hospital Charge Code	3625304
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.27
Max. Negotiated Rate	$2,984.69
Rate for Payer: Cash Price	$2,000.05
Rate for Payer: Hawaii Western Management Group Commercial	$2,153.90
Rate for Payer: Health Management Network Commercial	$2,615.45
Rate for Payer: Kaiser Permanente Commercial	$1,938.51
Rate for Payer: Kaiser Permanente Medicaid	$1,569.27
Rate for Payer: MDX Hawaii PPO	$2,984.69
Rate for Payer: University Health Alliance Commercial	$1,723.12

Anchor Biocomp PushLock 2.9 x 15mm AR1923BC [3625304]

Facility

$3,077.00

Service Code	HCPCS C1713
Hospital Charge Code	3625304
Hospital Revenue Code	278
Min. Negotiated Rate	$1,723.12
Max. Negotiated Rate	$2,984.69
Rate for Payer: Cash Price	$2,000.05
Rate for Payer: Hawaii Western Management Group Commercial	$2,153.90
Rate for Payer: Health Management Network Commercial	$2,615.45
Rate for Payer: MDX Hawaii PPO	$2,984.69
Rate for Payer: University Health Alliance Commercial	$1,723.12

Anchor Biocomp Pushlock 4.5 x 24mm AR1922BC [3641127]

Facility

$3,077.00

Service Code	HCPCS C1713
Hospital Charge Code	3641127
Hospital Revenue Code	278
Min. Negotiated Rate	$1,723.12
Max. Negotiated Rate	$2,984.69
Rate for Payer: Cash Price	$2,000.05
Rate for Payer: Hawaii Western Management Group Commercial	$2,153.90
Rate for Payer: Health Management Network Commercial	$2,615.45
Rate for Payer: MDX Hawaii PPO	$2,984.69
Rate for Payer: University Health Alliance Commercial	$1,723.12

Anchor Biocomp Pushlock 4.5 x 24mm AR1922BC [3641127]

Facility

$3,077.00

Service Code	HCPCS C1713
Hospital Charge Code	3641127
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.27
Max. Negotiated Rate	$2,984.69
Rate for Payer: Cash Price	$2,000.05
Rate for Payer: Hawaii Western Management Group Commercial	$2,153.90
Rate for Payer: Health Management Network Commercial	$2,615.45
Rate for Payer: Kaiser Permanente Commercial	$1,938.51
Rate for Payer: Kaiser Permanente Medicaid	$1,569.27
Rate for Payer: MDX Hawaii PPO	$2,984.69
Rate for Payer: University Health Alliance Commercial	$1,723.12

Anchor BioComp Swivelock Suture 4.75mmX22mm AR-2324BCT-2 [3641446]

Facility

$3,693.50

Service Code	HCPCS C1713
Hospital Charge Code	3641446
Hospital Revenue Code	278
Min. Negotiated Rate	$1,883.68
Max. Negotiated Rate	$3,582.70
Rate for Payer: Cash Price	$2,400.78
Rate for Payer: Hawaii Western Management Group Commercial	$2,585.45
Rate for Payer: Health Management Network Commercial	$3,139.47
Rate for Payer: Kaiser Permanente Commercial	$2,326.91
Rate for Payer: Kaiser Permanente Medicaid	$1,883.68
Rate for Payer: MDX Hawaii PPO	$3,582.70
Rate for Payer: University Health Alliance Commercial	$2,068.36

Anchor BioComp Swivelock Suture 4.75mmX22mm AR-2324BCT-2 [3641446]

Facility

$3,693.50

Service Code	HCPCS C1713
Hospital Charge Code	3641446
Hospital Revenue Code	278
Min. Negotiated Rate	$2,068.36
Max. Negotiated Rate	$3,582.70
Rate for Payer: Cash Price	$2,400.78
Rate for Payer: Hawaii Western Management Group Commercial	$2,585.45
Rate for Payer: Health Management Network Commercial	$3,139.47
Rate for Payer: MDX Hawaii PPO	$3,582.70
Rate for Payer: University Health Alliance Commercial	$2,068.36

Know your out-of-pocket cost for care.

All Charges