Kona Community Hospital

All Charges

Charge

Type

Setting

Price

Helical Blade TFNA Fen 80mm 04.038.380S [3641616]

Facility

$4,499.00

Service Code	HCPCS C1713
Hospital Charge Code	3641616
Hospital Revenue Code	278
Min. Negotiated Rate	$2,294.49
Max. Negotiated Rate	$4,364.03
Rate for Payer: Cash Price	$2,924.35
Rate for Payer: Hawaii Western Management Group Commercial	$3,149.30
Rate for Payer: Health Management Network Commercial	$3,824.15
Rate for Payer: Kaiser Permanente Commercial	$2,834.37
Rate for Payer: Kaiser Permanente Medicaid	$2,294.49
Rate for Payer: MDX Hawaii PPO	$4,364.03
Rate for Payer: University Health Alliance Commercial	$2,519.44

Helical Blade TFNA Fen 80mm 04.038.380S [3641616]

Facility

$4,499.00

Service Code	HCPCS C1713
Hospital Charge Code	3641616
Hospital Revenue Code	278
Min. Negotiated Rate	$2,519.44
Max. Negotiated Rate	$4,364.03
Rate for Payer: Cash Price	$2,924.35
Rate for Payer: Hawaii Western Management Group Commercial	$3,149.30
Rate for Payer: Health Management Network Commercial	$3,824.15
Rate for Payer: MDX Hawaii PPO	$4,364.03
Rate for Payer: University Health Alliance Commercial	$2,519.44

Helical Blade TFNA Fen 85mm 04.038.385S [3641579]

Facility

$4,499.00

Service Code	HCPCS C1713
Hospital Charge Code	3641579
Hospital Revenue Code	278
Min. Negotiated Rate	$2,294.49
Max. Negotiated Rate	$4,364.03
Rate for Payer: Cash Price	$2,924.35
Rate for Payer: Hawaii Western Management Group Commercial	$3,149.30
Rate for Payer: Health Management Network Commercial	$3,824.15
Rate for Payer: Kaiser Permanente Commercial	$2,834.37
Rate for Payer: Kaiser Permanente Medicaid	$2,294.49
Rate for Payer: MDX Hawaii PPO	$4,364.03
Rate for Payer: University Health Alliance Commercial	$2,519.44

Helical Blade TFNA Fen 85mm 04.038.385S [3641579]

Facility

$4,499.00

Service Code	HCPCS C1713
Hospital Charge Code	3641579
Hospital Revenue Code	278
Min. Negotiated Rate	$2,519.44
Max. Negotiated Rate	$4,364.03
Rate for Payer: Cash Price	$2,924.35
Rate for Payer: Hawaii Western Management Group Commercial	$3,149.30
Rate for Payer: Health Management Network Commercial	$3,824.15
Rate for Payer: MDX Hawaii PPO	$4,364.03
Rate for Payer: University Health Alliance Commercial	$2,519.44

Helical Blade TFNA Fen 90mm 04.038.390S [3640789]

Facility

$4,499.00

Service Code	HCPCS C1713
Hospital Charge Code	3640789
Hospital Revenue Code	278
Min. Negotiated Rate	$2,519.44
Max. Negotiated Rate	$4,364.03
Rate for Payer: Cash Price	$2,924.35
Rate for Payer: Hawaii Western Management Group Commercial	$3,149.30
Rate for Payer: Health Management Network Commercial	$3,824.15
Rate for Payer: MDX Hawaii PPO	$4,364.03
Rate for Payer: University Health Alliance Commercial	$2,519.44

Helical Blade TFNA Fen 90mm 04.038.390S [3640789]

Facility

$4,499.00

Service Code	HCPCS C1713
Hospital Charge Code	3640789
Hospital Revenue Code	278
Min. Negotiated Rate	$2,294.49
Max. Negotiated Rate	$4,364.03
Rate for Payer: Cash Price	$2,924.35
Rate for Payer: Hawaii Western Management Group Commercial	$3,149.30
Rate for Payer: Health Management Network Commercial	$3,824.15
Rate for Payer: Kaiser Permanente Commercial	$2,834.37
Rate for Payer: Kaiser Permanente Medicaid	$2,294.49
Rate for Payer: MDX Hawaii PPO	$4,364.03
Rate for Payer: University Health Alliance Commercial	$2,519.44

Helical Blade TFNA Fen 95mm 04.038.395S [3640789B]

Facility

$4,499.00

Service Code	HCPCS C1713
Hospital Charge Code	3640789B
Hospital Revenue Code	278
Min. Negotiated Rate	$2,294.49
Max. Negotiated Rate	$4,364.03
Rate for Payer: Cash Price	$2,924.35
Rate for Payer: Hawaii Western Management Group Commercial	$3,149.30
Rate for Payer: Health Management Network Commercial	$3,824.15
Rate for Payer: Kaiser Permanente Commercial	$2,834.37
Rate for Payer: Kaiser Permanente Medicaid	$2,294.49
Rate for Payer: MDX Hawaii PPO	$4,364.03
Rate for Payer: University Health Alliance Commercial	$2,519.44

Helical Blade TFNA Fen 95mm 04.038.395S [3640789B]

Facility

$4,499.00

Service Code	HCPCS C1713
Hospital Charge Code	3640789B
Hospital Revenue Code	278
Min. Negotiated Rate	$2,519.44
Max. Negotiated Rate	$4,364.03
Rate for Payer: Cash Price	$2,924.35
Rate for Payer: Hawaii Western Management Group Commercial	$3,149.30
Rate for Payer: Health Management Network Commercial	$3,824.15
Rate for Payer: MDX Hawaii PPO	$4,364.03
Rate for Payer: University Health Alliance Commercial	$2,519.44

Hemoclip Medium 002204 Blue [3606926]

Facility

$271.20

Hospital Charge Code	3606926
Hospital Revenue Code	272
Min. Negotiated Rate	$138.31
Max. Negotiated Rate	$263.06
Rate for Payer: Cash Price	$176.28
Rate for Payer: Hawaii Western Management Group Commercial	$257.64
Rate for Payer: Health Management Network Commercial	$230.52
Rate for Payer: Kaiser Permanente Commercial	$170.86
Rate for Payer: Kaiser Permanente Medicaid	$138.31
Rate for Payer: MDX Hawaii PPO	$263.06
Rate for Payer: University Health Alliance Commercial	$197.68

Hemoclip Medium 002204 Blue [3606926]

Facility

$271.20

Hospital Charge Code	3606926
Hospital Revenue Code	272
Min. Negotiated Rate	$230.52
Max. Negotiated Rate	$263.06
Rate for Payer: Cash Price	$176.28
Rate for Payer: Health Management Network Commercial	$230.52
Rate for Payer: MDX Hawaii PPO	$263.06

Hemoclip Small 001204 Yellow [3606933]

Facility

$241.50

Hospital Charge Code	3606933
Hospital Revenue Code	272
Min. Negotiated Rate	$205.28
Max. Negotiated Rate	$234.25
Rate for Payer: Cash Price	$156.98
Rate for Payer: Health Management Network Commercial	$205.28
Rate for Payer: MDX Hawaii PPO	$234.25

Hemoclip Small 001204 Yellow [3606933]

Facility

$241.50

Hospital Charge Code	3606933
Hospital Revenue Code	272
Min. Negotiated Rate	$123.17
Max. Negotiated Rate	$234.25
Rate for Payer: Cash Price	$156.98
Rate for Payer: Hawaii Western Management Group Commercial	$229.43
Rate for Payer: Health Management Network Commercial	$205.28
Rate for Payer: Kaiser Permanente Commercial	$152.15
Rate for Payer: Kaiser Permanente Medicaid	$123.17
Rate for Payer: MDX Hawaii PPO	$234.25
Rate for Payer: University Health Alliance Commercial	$176.03

HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION

Facility

$5,361.24

Service Code	APR-DRG 8103
Min. Negotiated Rate	$5,361.24
Max. Negotiated Rate	$5,361.24
Rate for Payer: AlohaCare Medicaid	$5,361.24
Rate for Payer: Hawaii Medical Service Association ABD	$5,361.24
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,361.24
Rate for Payer: Kaiser Permanente Medicaid	$5,361.24
Rate for Payer: Ohana Health Plan Medicaid	$5,361.24
Rate for Payer: UnitedHealthcare Medicaid	$5,361.24

HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION

Facility

$9,858.35

Service Code	APR-DRG 8104
Min. Negotiated Rate	$9,858.35
Max. Negotiated Rate	$9,858.35
Rate for Payer: AlohaCare Medicaid	$9,858.35
Rate for Payer: Hawaii Medical Service Association ABD	$9,858.35
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,858.35
Rate for Payer: Kaiser Permanente Medicaid	$9,858.35
Rate for Payer: Ohana Health Plan Medicaid	$9,858.35
Rate for Payer: UnitedHealthcare Medicaid	$9,858.35

HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION

Facility

$3,415.17

Service Code	APR-DRG 8102
Min. Negotiated Rate	$3,415.17
Max. Negotiated Rate	$3,415.17
Rate for Payer: AlohaCare Medicaid	$3,415.17
Rate for Payer: Hawaii Medical Service Association ABD	$3,415.17
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,415.17
Rate for Payer: Kaiser Permanente Medicaid	$3,415.17
Rate for Payer: Ohana Health Plan Medicaid	$3,415.17
Rate for Payer: UnitedHealthcare Medicaid	$3,415.17

HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION

Facility

$2,513.46

Service Code	APR-DRG 8101
Min. Negotiated Rate	$2,513.46
Max. Negotiated Rate	$2,513.46
Rate for Payer: AlohaCare Medicaid	$2,513.46
Rate for Payer: Hawaii Medical Service Association ABD	$2,513.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,513.46
Rate for Payer: Kaiser Permanente Medicaid	$2,513.46
Rate for Payer: Ohana Health Plan Medicaid	$2,513.46
Rate for Payer: UnitedHealthcare Medicaid	$2,513.46

HEMORRHOIDECTOMY, EXTERNAL, 2 OR MORE COLUMNS/GROUPS

Facility

$6,743.44

Service Code	CPT 46250
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,743.44
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	$6,743.44

HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS;

Facility

$9,416.00

Service Code	CPT 46260
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$9,416.00
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	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$9,416.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,279.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
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	$6,743.44

HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS; WITH FISSURECTOMY

Facility

$10,679.55

Service Code	CPT 46261
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$10,679.55
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	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$9,416.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,279.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
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	$10,679.55

HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP;

Facility

$6,743.44

Service Code	CPT 46255
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,743.44
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	$6,743.44

HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP; WITH FISTULECTOMY, INCLUDING FISSURECTOMY, WHEN PERFORMED

Facility

$6,743.44

Service Code	CPT 46258
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,743.44
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	$6,743.44

HEMORRHOIDECTOMY, INTERNAL, BY TRANSANAL HEMORRHOIDAL DEARTERIALIZATION, 2 OR MORE HEMORRHOID COLUMNS/GROUPS, INCLUDING ULTRASOUND GUIDANCE, WITH MUCOPEXY, WHEN PERFORMED

Facility

$9,416.00

Service Code	CPT 46948
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$9,416.00
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	$848.00
Rate for Payer: Hawaii Medical Service Association Commercial	$9,416.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,279.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
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	$6,743.44

Hemorrhoid Stapler EEA 33mm 3.5mm STP HEM3335 [3641212]

Facility

$2,383.86

Hospital Charge Code	3641212
Hospital Revenue Code	272
Min. Negotiated Rate	$1,215.77
Max. Negotiated Rate	$2,312.34
Rate for Payer: Cash Price	$1,549.51
Rate for Payer: Hawaii Western Management Group Commercial	$2,264.67
Rate for Payer: Health Management Network Commercial	$2,026.28
Rate for Payer: Kaiser Permanente Commercial	$1,501.83
Rate for Payer: Kaiser Permanente Medicaid	$1,215.77
Rate for Payer: MDX Hawaii PPO	$2,312.34
Rate for Payer: University Health Alliance Commercial	$1,737.60

Hemorrhoid Stapler EEA 33mm 3.5mm STP HEM3335 [3641212]

Facility

$2,383.86

Hospital Charge Code	3641212
Hospital Revenue Code	272
Min. Negotiated Rate	$2,026.28
Max. Negotiated Rate	$2,312.34
Rate for Payer: Cash Price	$1,549.51
Rate for Payer: Health Management Network Commercial	$2,026.28
Rate for Payer: MDX Hawaii PPO	$2,312.34

Hemorrhoid THDSlideone kit 800070 [3601175]

Facility

$2,978.00

Hospital Charge Code	3601175
Hospital Revenue Code	272
Min. Negotiated Rate	$1,518.78
Max. Negotiated Rate	$2,888.66
Rate for Payer: Cash Price	$1,935.70
Rate for Payer: Hawaii Western Management Group Commercial	$2,829.10
Rate for Payer: Health Management Network Commercial	$2,531.30
Rate for Payer: Kaiser Permanente Commercial	$1,876.14
Rate for Payer: Kaiser Permanente Medicaid	$1,518.78
Rate for Payer: MDX Hawaii PPO	$2,888.66
Rate for Payer: University Health Alliance Commercial	$2,170.66

Know your out-of-pocket cost for care.

All Charges