Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Angel Sys w/Aspiration Kit w/ACDA ABS-10062T [3644645]

Facility

$7,222.00

Hospital Charge Code	3644645
Hospital Revenue Code	272
Min. Negotiated Rate	$3,683.22
Max. Negotiated Rate	$7,005.34
Rate for Payer: Cash Price	$4,694.30
Rate for Payer: Hawaii Western Management Group Commercial	$6,860.90
Rate for Payer: Health Management Network Commercial	$6,138.70
Rate for Payer: Kaiser Permanente Commercial	$4,549.86
Rate for Payer: Kaiser Permanente Medicaid	$3,683.22
Rate for Payer: MDX Hawaii PPO	$7,005.34
Rate for Payer: University Health Alliance Commercial	$5,264.12

ANGINA PECTORIS

Facility

$12,921.35

Service Code	MSDRG 311
Min. Negotiated Rate	$9,231.92
Max. Negotiated Rate	$12,921.35
Rate for Payer: AlohaCare Medicare	$9,231.92
Rate for Payer: Devoted Health Medicare	$10,155.11
Rate for Payer: Hawaii Medical Service Association Commercial	$12,921.35
Rate for Payer: Hawaii Medical Service Association Medicare	$9,231.92
Rate for Payer: Humana Medicare	$9,231.92
Rate for Payer: Kaiser Permanente Commercial	$12,107.77
Rate for Payer: Kaiser Permanente Medicare	$9,231.92
Rate for Payer: Ohana Health Plan Medicare	$9,231.92
Rate for Payer: UnitedHealthcare Medicare	$9,231.92

ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS

Facility

$2,893.00

Service Code	APR-DRG 1982
Min. Negotiated Rate	$2,893.00
Max. Negotiated Rate	$2,893.00
Rate for Payer: AlohaCare Medicaid	$2,893.00
Rate for Payer: Hawaii Medical Service Association ABD	$2,893.00
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,893.00
Rate for Payer: Kaiser Permanente Medicaid	$2,893.00
Rate for Payer: Ohana Health Plan Medicaid	$2,893.00
Rate for Payer: UnitedHealthcare Medicaid	$2,893.00

ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS

Facility

$3,770.51

Service Code	APR-DRG 1983
Min. Negotiated Rate	$3,770.51
Max. Negotiated Rate	$3,770.51
Rate for Payer: AlohaCare Medicaid	$3,770.51
Rate for Payer: Hawaii Medical Service Association ABD	$3,770.51
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,770.51
Rate for Payer: Kaiser Permanente Medicaid	$3,770.51
Rate for Payer: Ohana Health Plan Medicaid	$3,770.51
Rate for Payer: UnitedHealthcare Medicaid	$3,770.51

ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS

Facility

$6,120.31

Service Code	APR-DRG 1984
Min. Negotiated Rate	$6,120.31
Max. Negotiated Rate	$6,120.31
Rate for Payer: AlohaCare Medicaid	$6,120.31
Rate for Payer: Hawaii Medical Service Association ABD	$6,120.31
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,120.31
Rate for Payer: Kaiser Permanente Medicaid	$6,120.31
Rate for Payer: Ohana Health Plan Medicaid	$6,120.31
Rate for Payer: UnitedHealthcare Medicaid	$6,120.31

ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS

Facility

$2,438.32

Service Code	APR-DRG 1981
Min. Negotiated Rate	$2,438.32
Max. Negotiated Rate	$2,438.32
Rate for Payer: AlohaCare Medicaid	$2,438.32
Rate for Payer: Hawaii Medical Service Association ABD	$2,438.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,438.32
Rate for Payer: Kaiser Permanente Medicaid	$2,438.32
Rate for Payer: Ohana Health Plan Medicaid	$2,438.32
Rate for Payer: UnitedHealthcare Medicaid	$2,438.32

ANORECTAL EXAM, SURGICAL, REQUIRING ANESTHESIA (GENERAL, SPINAL, OR EPIDURAL), DIAGNOSTIC

Facility

$3,606.91

Service Code	CPT 45990
Hospital Revenue Code	360
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$3,606.91
Rate for Payer: AlohaCare Medicaid	$3,279.01
Rate for Payer: AlohaCare Medicare	$3,279.01
Rate for Payer: Devoted Health Medicare	$3,606.91
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,279.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Humana Medicare	$3,279.01
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,279.01
Rate for Payer: Ohana Health Plan Medicaid	$3,606.91
Rate for Payer: Ohana Health Plan Medicare	$3,279.01
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,279.01

ANOSCOPY; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE

Facility

$6,183.00

Service Code	CPT 46615
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$3,279.01
Rate for Payer: AlohaCare Medicare	$3,279.01
Rate for Payer: Devoted Health Medicare	$3,606.91
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	$3,279.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,279.01
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,279.01
Rate for Payer: Ohana Health Plan Medicaid	$3,606.91
Rate for Payer: Ohana Health Plan Medicare	$3,279.01
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,279.01
Rate for Payer: University Health Alliance Commercial	$5,160.40

ANOSCOPY; WITH BIOPSY, SINGLE OR MULTIPLE

Facility

$2,837.00

Service Code	CPT 46606
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$1,413.65
Rate for Payer: AlohaCare Medicare	$1,413.65
Rate for Payer: Devoted Health Medicare	$1,555.02
Rate for Payer: Hawaii Medical Service Association Commercial	$1,767.06
Rate for Payer: Hawaii Medical Service Association Medicare	$1,413.65
Rate for Payer: Humana Medicare	$1,413.65
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,413.65
Rate for Payer: Ohana Health Plan Medicaid	$1,555.02
Rate for Payer: Ohana Health Plan Medicare	$1,413.65
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,413.65

ANOSCOPY; WITH DILATION (EG, BALLOON, GUIDE WIRE, BOUGIE)

Facility

$2,837.00

Service Code	CPT 46604
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$1,413.65
Rate for Payer: AlohaCare Medicare	$1,413.65
Rate for Payer: Devoted Health Medicare	$1,555.02
Rate for Payer: Hawaii Medical Service Association Commercial	$1,767.06
Rate for Payer: Hawaii Medical Service Association Medicare	$1,413.65
Rate for Payer: Humana Medicare	$1,413.65
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,413.65
Rate for Payer: Ohana Health Plan Medicaid	$1,555.02
Rate for Payer: Ohana Health Plan Medicare	$1,413.65
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,413.65

ANOSCOPY; WITH HIGH-RESOLUTION MAGNIFICATION (HRA) (EG, COLPOSCOPE, OPERATING MICROSCOPE) AND CHEMICAL AGENT ENHANCEMENT, WITH BIOPSY, SINGLE OR MULTIPLE

Facility

$6,183.00

Service Code	CPT 46607
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$1,413.65
Rate for Payer: AlohaCare Medicare	$1,413.65
Rate for Payer: Devoted Health Medicare	$1,555.02
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	$1,413.65
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$1,413.65
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,413.65
Rate for Payer: Ohana Health Plan Medicaid	$1,555.02
Rate for Payer: Ohana Health Plan Medicare	$1,413.65
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,413.65

ANOXIC & OTHER SEVERE BRAIN DAMAGE

Facility

$3,550.81

Service Code	APR-DRG 0591
Min. Negotiated Rate	$3,550.81
Max. Negotiated Rate	$3,550.81
Rate for Payer: AlohaCare Medicaid	$3,550.81
Rate for Payer: Hawaii Medical Service Association ABD	$3,550.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,550.81
Rate for Payer: Kaiser Permanente Medicaid	$3,550.81
Rate for Payer: Ohana Health Plan Medicaid	$3,550.81
Rate for Payer: UnitedHealthcare Medicaid	$3,550.81

ANOXIC & OTHER SEVERE BRAIN DAMAGE

Facility

$4,528.94

Service Code	APR-DRG 0592
Min. Negotiated Rate	$4,528.94
Max. Negotiated Rate	$4,528.94
Rate for Payer: AlohaCare Medicaid	$4,528.94
Rate for Payer: Hawaii Medical Service Association ABD	$4,528.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,528.94
Rate for Payer: Kaiser Permanente Medicaid	$4,528.94
Rate for Payer: Ohana Health Plan Medicaid	$4,528.94
Rate for Payer: UnitedHealthcare Medicaid	$4,528.94

ANOXIC & OTHER SEVERE BRAIN DAMAGE

Facility

$5,782.81

Service Code	APR-DRG 0593
Min. Negotiated Rate	$5,782.81
Max. Negotiated Rate	$5,782.81
Rate for Payer: AlohaCare Medicaid	$5,782.81
Rate for Payer: Hawaii Medical Service Association ABD	$5,782.81
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,782.81
Rate for Payer: Kaiser Permanente Medicaid	$5,782.81
Rate for Payer: Ohana Health Plan Medicaid	$5,782.81
Rate for Payer: UnitedHealthcare Medicaid	$5,782.81

ANOXIC & OTHER SEVERE BRAIN DAMAGE

Facility

$9,648.20

Service Code	APR-DRG 0594
Min. Negotiated Rate	$9,648.20
Max. Negotiated Rate	$9,648.20
Rate for Payer: AlohaCare Medicaid	$9,648.20
Rate for Payer: Hawaii Medical Service Association ABD	$9,648.20
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,648.20
Rate for Payer: Kaiser Permanente Medicaid	$9,648.20
Rate for Payer: Ohana Health Plan Medicaid	$9,648.20
Rate for Payer: UnitedHealthcare Medicaid	$9,648.20

ANTEPARTUM W/O O.R. PROCEDURE

Facility

$1,743.57

Service Code	APR-DRG 5661
Min. Negotiated Rate	$1,743.57
Max. Negotiated Rate	$1,743.57
Rate for Payer: AlohaCare Medicaid	$1,743.57
Rate for Payer: Hawaii Medical Service Association ABD	$1,743.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$1,743.57
Rate for Payer: Kaiser Permanente Medicaid	$1,743.57
Rate for Payer: Ohana Health Plan Medicaid	$1,743.57
Rate for Payer: UnitedHealthcare Medicaid	$1,743.57

ANTEPARTUM W/O O.R. PROCEDURE

Facility

$2,076.61

Service Code	APR-DRG 5662
Min. Negotiated Rate	$2,076.61
Max. Negotiated Rate	$2,076.61
Rate for Payer: AlohaCare Medicaid	$2,076.61
Rate for Payer: Hawaii Medical Service Association ABD	$2,076.61
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,076.61
Rate for Payer: Kaiser Permanente Medicaid	$2,076.61
Rate for Payer: Ohana Health Plan Medicaid	$2,076.61
Rate for Payer: UnitedHealthcare Medicaid	$2,076.61

ANTEPARTUM W/O O.R. PROCEDURE

Facility

$2,863.07

Service Code	APR-DRG 5663
Min. Negotiated Rate	$2,863.07
Max. Negotiated Rate	$2,863.07
Rate for Payer: AlohaCare Medicaid	$2,863.07
Rate for Payer: Hawaii Medical Service Association ABD	$2,863.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,863.07
Rate for Payer: Kaiser Permanente Medicaid	$2,863.07
Rate for Payer: Ohana Health Plan Medicaid	$2,863.07
Rate for Payer: UnitedHealthcare Medicaid	$2,863.07

ANTEPARTUM W/O O.R. PROCEDURE

Facility

$6,090.38

Service Code	APR-DRG 5664
Min. Negotiated Rate	$6,090.38
Max. Negotiated Rate	$6,090.38
Rate for Payer: AlohaCare Medicaid	$6,090.38
Rate for Payer: Hawaii Medical Service Association ABD	$6,090.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,090.38
Rate for Payer: Kaiser Permanente Medicaid	$6,090.38
Rate for Payer: Ohana Health Plan Medicaid	$6,090.38
Rate for Payer: UnitedHealthcare Medicaid	$6,090.38

ANTEPARTUM W O.R. PROCEDURE

Facility

$5,807.01

Service Code	APR-DRG 5473
Min. Negotiated Rate	$5,807.01
Max. Negotiated Rate	$5,807.01
Rate for Payer: AlohaCare Medicaid	$5,807.01
Rate for Payer: Hawaii Medical Service Association ABD	$5,807.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,807.01
Rate for Payer: Kaiser Permanente Medicaid	$5,807.01
Rate for Payer: Ohana Health Plan Medicaid	$5,807.01
Rate for Payer: UnitedHealthcare Medicaid	$5,807.01

ANTEPARTUM W O.R. PROCEDURE

Facility

$3,077.03

Service Code	APR-DRG 5471
Min. Negotiated Rate	$3,077.03
Max. Negotiated Rate	$3,077.03
Rate for Payer: AlohaCare Medicaid	$3,077.03
Rate for Payer: Hawaii Medical Service Association ABD	$3,077.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,077.03
Rate for Payer: Kaiser Permanente Medicaid	$3,077.03
Rate for Payer: Ohana Health Plan Medicaid	$3,077.03
Rate for Payer: UnitedHealthcare Medicaid	$3,077.03

ANTEPARTUM W O.R. PROCEDURE

Facility

$4,001.67

Service Code	APR-DRG 5472
Min. Negotiated Rate	$4,001.67
Max. Negotiated Rate	$4,001.67
Rate for Payer: AlohaCare Medicaid	$4,001.67
Rate for Payer: Hawaii Medical Service Association ABD	$4,001.67
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,001.67
Rate for Payer: Kaiser Permanente Medicaid	$4,001.67
Rate for Payer: Ohana Health Plan Medicaid	$4,001.67
Rate for Payer: UnitedHealthcare Medicaid	$4,001.67

ANTEPARTUM W O.R. PROCEDURE

Facility

$14,184.15

Service Code	APR-DRG 5474
Min. Negotiated Rate	$14,184.15
Max. Negotiated Rate	$14,184.15
Rate for Payer: AlohaCare Medicaid	$14,184.15
Rate for Payer: Hawaii Medical Service Association ABD	$14,184.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$14,184.15
Rate for Payer: Kaiser Permanente Medicaid	$14,184.15
Rate for Payer: Ohana Health Plan Medicaid	$14,184.15
Rate for Payer: UnitedHealthcare Medicaid	$14,184.15

Anti Drift Bolt Full Thrd 3.5 x 38mm ST 15FT-3538 [3644931]

Facility

$3,716.00

Service Code	HCPCS C1713
Hospital Charge Code	3644931
Hospital Revenue Code	278
Min. Negotiated Rate	$2,080.96
Max. Negotiated Rate	$3,604.52
Rate for Payer: Cash Price	$2,415.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,601.20
Rate for Payer: Health Management Network Commercial	$3,158.60
Rate for Payer: MDX Hawaii PPO	$3,604.52
Rate for Payer: University Health Alliance Commercial	$2,080.96

Anti Drift Bolt Full Thrd 3.5 x 38mm ST 15FT-3538 [3644931]

Facility

$3,716.00

Service Code	HCPCS C1713
Hospital Charge Code	3644931
Hospital Revenue Code	278
Min. Negotiated Rate	$1,895.16
Max. Negotiated Rate	$3,604.52
Rate for Payer: Cash Price	$2,415.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,601.20
Rate for Payer: Health Management Network Commercial	$3,158.60
Rate for Payer: Kaiser Permanente Commercial	$2,341.08
Rate for Payer: Kaiser Permanente Medicaid	$1,895.16
Rate for Payer: MDX Hawaii PPO	$3,604.52
Rate for Payer: University Health Alliance Commercial	$2,080.96

Know your out-of-pocket cost for care.

All Charges