Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HEPATITIS B IMMUNE GLOBULIN GREATER THAN 1,560 UNIT/5 ML IM SOLN

Facility

$1,880.81

Service Code	HCPCS 90371
Hospital Revenue Code	250
Min. Negotiated Rate	$140.21
Max. Negotiated Rate	$1,824.39
Rate for Payer: AlohaCare Medicaid	$140.21
Rate for Payer: AlohaCare Medicare	$140.21
Rate for Payer: Cash Price	$1,222.53
Rate for Payer: Cash Price	$1,222.53
Rate for Payer: Devoted Health Medicare	$154.23
Rate for Payer: Hawaii Medical Service Association Commercial	$175.26
Rate for Payer: Hawaii Medical Service Association Medicare	$140.21
Rate for Payer: Hawaii Western Management Group Commercial	$1,786.77
Rate for Payer: Health Management Network Commercial	$1,598.69
Rate for Payer: Humana Medicare	$140.21
Rate for Payer: Kaiser Permanente Commercial	$1,184.91
Rate for Payer: Kaiser Permanente Medicaid	$959.21
Rate for Payer: Kaiser Permanente Medicare	$140.21
Rate for Payer: MDX Hawaii PPO	$1,824.39
Rate for Payer: Ohana Health Plan Medicaid	$154.23
Rate for Payer: Ohana Health Plan Medicare	$140.21
Rate for Payer: UnitedHealthcare Medicaid	$1,128.49
Rate for Payer: UnitedHealthcare Medicare	$140.21
Rate for Payer: University Health Alliance Commercial	$1,370.92

HEPATITIS B VIRUS VACC.REC(PF) 20 MCG/ML IM SYR

Facility

$346.67

Service Code	HCPCS 90746
Hospital Revenue Code	250
Min. Negotiated Rate	$294.67
Max. Negotiated Rate	$336.27
Rate for Payer: Cash Price	$225.34
Rate for Payer: Health Management Network Commercial	$294.67
Rate for Payer: MDX Hawaii PPO	$336.27

HEPATITIS B VIRUS VACC.REC(PF) 20 MCG/ML IM SYR

Facility

$346.67

Service Code	HCPCS 90746
Hospital Revenue Code	250
Min. Negotiated Rate	$70.38
Max. Negotiated Rate	$336.27
Rate for Payer: Cash Price	$225.34
Rate for Payer: Cash Price	$225.34
Rate for Payer: Hawaii Medical Service Association ABD	$70.38
Rate for Payer: Hawaii Medical Service Association Non-ABD	$70.38
Rate for Payer: Hawaii Western Management Group Commercial	$329.34
Rate for Payer: Health Management Network Commercial	$294.67
Rate for Payer: Kaiser Permanente Commercial	$218.40
Rate for Payer: Kaiser Permanente Medicaid	$176.80
Rate for Payer: MDX Hawaii PPO	$336.27
Rate for Payer: UnitedHealthcare Medicaid	$208.00
Rate for Payer: University Health Alliance Commercial	$252.69

HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SYR

Facility

$136.06

Service Code	HCPCS 90744
Hospital Revenue Code	250
Min. Negotiated Rate	$30.77
Max. Negotiated Rate	$131.98
Rate for Payer: Cash Price	$88.44
Rate for Payer: Cash Price	$88.44
Rate for Payer: Hawaii Medical Service Association ABD	$30.77
Rate for Payer: Hawaii Medical Service Association Non-ABD	$30.77
Rate for Payer: Hawaii Western Management Group Commercial	$129.26
Rate for Payer: Health Management Network Commercial	$115.65
Rate for Payer: Kaiser Permanente Commercial	$85.72
Rate for Payer: Kaiser Permanente Medicaid	$69.39
Rate for Payer: MDX Hawaii PPO	$131.98
Rate for Payer: UnitedHealthcare Medicaid	$81.64
Rate for Payer: University Health Alliance Commercial	$99.17

HEPATITIS B VIRUS VACC.REC(PF) 5 MCG/0.5 ML IM SYR

Facility

$136.06

Service Code	HCPCS 90744
Hospital Revenue Code	250
Min. Negotiated Rate	$115.65
Max. Negotiated Rate	$131.98
Rate for Payer: Cash Price	$88.44
Rate for Payer: Health Management Network Commercial	$115.65
Rate for Payer: MDX Hawaii PPO	$131.98

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC

Facility

$66,583.53

Service Code	MSDRG 421
Min. Negotiated Rate	$22,852.93
Max. Negotiated Rate	$66,583.53
Rate for Payer: AlohaCare Medicare	$22,852.93
Rate for Payer: Devoted Health Medicare	$25,138.22
Rate for Payer: Hawaii Medical Service Association Commercial	$66,583.53
Rate for Payer: Hawaii Medical Service Association Medicare	$22,852.93
Rate for Payer: Humana Medicare	$22,852.93
Rate for Payer: Kaiser Permanente Commercial	$29,971.88
Rate for Payer: Kaiser Permanente Medicare	$22,852.93
Rate for Payer: Ohana Health Plan Medicare	$22,852.93
Rate for Payer: UnitedHealthcare Medicare	$22,852.93

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC

Facility

$66,583.53

Service Code	MSDRG 420
Min. Negotiated Rate	$44,812.80
Max. Negotiated Rate	$66,583.53
Rate for Payer: AlohaCare Medicare	$44,812.80
Rate for Payer: Devoted Health Medicare	$49,294.08
Rate for Payer: Hawaii Medical Service Association Commercial	$66,583.53
Rate for Payer: Hawaii Medical Service Association Medicare	$44,812.80
Rate for Payer: Humana Medicare	$44,812.80
Rate for Payer: Kaiser Permanente Commercial	$58,772.47
Rate for Payer: Kaiser Permanente Medicare	$44,812.80
Rate for Payer: Ohana Health Plan Medicare	$44,812.80
Rate for Payer: UnitedHealthcare Medicare	$44,812.80

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC

Facility

$59,086.26

Service Code	MSDRG 422
Min. Negotiated Rate	$18,407.29
Max. Negotiated Rate	$59,086.26
Rate for Payer: AlohaCare Medicare	$18,407.29
Rate for Payer: Devoted Health Medicare	$20,248.02
Rate for Payer: Hawaii Medical Service Association Commercial	$59,086.26
Rate for Payer: Hawaii Medical Service Association Medicare	$18,407.29
Rate for Payer: Humana Medicare	$18,407.29
Rate for Payer: Kaiser Permanente Commercial	$24,141.38
Rate for Payer: Kaiser Permanente Medicare	$18,407.29
Rate for Payer: Ohana Health Plan Medicare	$18,407.29
Rate for Payer: UnitedHealthcare Medicare	$18,407.29

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC

Facility

$32,496.24

Service Code	MSDRG 354
Min. Negotiated Rate	$22,128.22
Max. Negotiated Rate	$32,496.24
Rate for Payer: AlohaCare Medicare	$22,128.22
Rate for Payer: Devoted Health Medicare	$24,341.04
Rate for Payer: Hawaii Medical Service Association Commercial	$32,496.24
Rate for Payer: Hawaii Medical Service Association Medicare	$22,128.22
Rate for Payer: Humana Medicare	$22,128.22
Rate for Payer: Kaiser Permanente Commercial	$29,021.40
Rate for Payer: Kaiser Permanente Medicare	$22,128.22
Rate for Payer: Ohana Health Plan Medicare	$22,128.22
Rate for Payer: UnitedHealthcare Medicare	$22,128.22

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC

Facility

$50,059.50

Service Code	MSDRG 353
Min. Negotiated Rate	$38,169.31
Max. Negotiated Rate	$50,059.50
Rate for Payer: AlohaCare Medicare	$38,169.31
Rate for Payer: Devoted Health Medicare	$41,986.24
Rate for Payer: Hawaii Medical Service Association Commercial	$42,114.93
Rate for Payer: Hawaii Medical Service Association Medicare	$38,169.31
Rate for Payer: Humana Medicare	$38,169.31
Rate for Payer: Kaiser Permanente Commercial	$50,059.50
Rate for Payer: Kaiser Permanente Medicare	$38,169.31
Rate for Payer: Ohana Health Plan Medicare	$38,169.31
Rate for Payer: UnitedHealthcare Medicare	$38,169.31

HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC

Facility

$24,010.57

Service Code	MSDRG 355
Min. Negotiated Rate	$17,690.47
Max. Negotiated Rate	$24,010.57
Rate for Payer: AlohaCare Medicare	$17,690.47
Rate for Payer: Devoted Health Medicare	$19,459.52
Rate for Payer: Hawaii Medical Service Association Commercial	$24,010.57
Rate for Payer: Hawaii Medical Service Association Medicare	$17,690.47
Rate for Payer: Humana Medicare	$17,690.47
Rate for Payer: Kaiser Permanente Commercial	$23,201.25
Rate for Payer: Kaiser Permanente Medicare	$17,690.47
Rate for Payer: Ohana Health Plan Medicare	$17,690.47
Rate for Payer: UnitedHealthcare Medicare	$17,690.47

HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL

Facility

$19,933.21

Service Code	APR-DRG 2274
Min. Negotiated Rate	$19,933.21
Max. Negotiated Rate	$19,933.21
Rate for Payer: AlohaCare Medicaid	$19,933.21
Rate for Payer: Hawaii Medical Service Association ABD	$19,933.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19,933.21
Rate for Payer: Kaiser Permanente Medicaid	$19,933.21
Rate for Payer: Ohana Health Plan Medicaid	$19,933.21
Rate for Payer: UnitedHealthcare Medicaid	$19,933.21

HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL

Facility

$7,681.75

Service Code	APR-DRG 2272
Min. Negotiated Rate	$7,681.75
Max. Negotiated Rate	$7,681.75
Rate for Payer: AlohaCare Medicaid	$7,681.75
Rate for Payer: Hawaii Medical Service Association ABD	$7,681.75
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,681.75
Rate for Payer: Kaiser Permanente Medicaid	$7,681.75
Rate for Payer: Ohana Health Plan Medicaid	$7,681.75
Rate for Payer: UnitedHealthcare Medicaid	$7,681.75

HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL

Facility

$6,115.86

Service Code	APR-DRG 2271
Min. Negotiated Rate	$6,115.86
Max. Negotiated Rate	$6,115.86
Rate for Payer: AlohaCare Medicaid	$6,115.86
Rate for Payer: Hawaii Medical Service Association ABD	$6,115.86
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,115.86
Rate for Payer: Kaiser Permanente Medicaid	$6,115.86
Rate for Payer: Ohana Health Plan Medicaid	$6,115.86
Rate for Payer: UnitedHealthcare Medicaid	$6,115.86

HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL

Facility

$11,123.04

Service Code	APR-DRG 2273
Min. Negotiated Rate	$11,123.04
Max. Negotiated Rate	$11,123.04
Rate for Payer: AlohaCare Medicaid	$11,123.04
Rate for Payer: Hawaii Medical Service Association ABD	$11,123.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,123.04
Rate for Payer: Kaiser Permanente Medicaid	$11,123.04
Rate for Payer: Ohana Health Plan Medicaid	$11,123.04
Rate for Payer: UnitedHealthcare Medicaid	$11,123.04

Himax C Single Impl 15mmx15mmx15mm 7115-1515C [3645516]

Facility

$8,021.40

Service Code	HCPCS C1713
Hospital Charge Code	3645516
Hospital Revenue Code	278
Min. Negotiated Rate	$4,090.91
Max. Negotiated Rate	$7,780.76
Rate for Payer: Cash Price	$5,213.91
Rate for Payer: Hawaii Western Management Group Commercial	$5,614.98
Rate for Payer: Health Management Network Commercial	$6,818.19
Rate for Payer: Kaiser Permanente Commercial	$5,053.48
Rate for Payer: Kaiser Permanente Medicaid	$4,090.91
Rate for Payer: MDX Hawaii PPO	$7,780.76
Rate for Payer: University Health Alliance Commercial	$4,491.98

Himax C Single Impl 15mmx15mmx15mm 7115-1515C [3645516]

Facility

$8,021.40

Service Code	HCPCS C1713
Hospital Charge Code	3645516
Hospital Revenue Code	278
Min. Negotiated Rate	$4,491.98
Max. Negotiated Rate	$7,780.76
Rate for Payer: Cash Price	$5,213.91
Rate for Payer: Hawaii Western Management Group Commercial	$5,614.98
Rate for Payer: Health Management Network Commercial	$6,818.19
Rate for Payer: MDX Hawaii PPO	$7,780.76
Rate for Payer: University Health Alliance Commercial	$4,491.98

HIMAX Staple C Implant 18mm x 18mm x 14mm ST 7118-1814-C [3644929]

Facility

$8,021.40

Service Code	HCPCS C1713
Hospital Charge Code	3644929
Hospital Revenue Code	278
Min. Negotiated Rate	$4,090.91
Max. Negotiated Rate	$7,780.76
Rate for Payer: Cash Price	$5,213.91
Rate for Payer: Hawaii Western Management Group Commercial	$5,614.98
Rate for Payer: Health Management Network Commercial	$6,818.19
Rate for Payer: Kaiser Permanente Commercial	$5,053.48
Rate for Payer: Kaiser Permanente Medicaid	$4,090.91
Rate for Payer: MDX Hawaii PPO	$7,780.76
Rate for Payer: University Health Alliance Commercial	$4,491.98

HIMAX Staple C Implant 18mm x 18mm x 14mm ST 7118-1814-C [3644929]

Facility

$8,021.40

Service Code	HCPCS C1713
Hospital Charge Code	3644929
Hospital Revenue Code	278
Min. Negotiated Rate	$4,491.98
Max. Negotiated Rate	$7,780.76
Rate for Payer: Cash Price	$5,213.91
Rate for Payer: Hawaii Western Management Group Commercial	$5,614.98
Rate for Payer: Health Management Network Commercial	$6,818.19
Rate for Payer: MDX Hawaii PPO	$7,780.76
Rate for Payer: University Health Alliance Commercial	$4,491.98

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC

Facility

$49,347.03

Service Code	MSDRG 481
Min. Negotiated Rate	$27,548.48
Max. Negotiated Rate	$49,347.03
Rate for Payer: AlohaCare Medicare	$27,548.48
Rate for Payer: Devoted Health Medicare	$30,303.33
Rate for Payer: Hawaii Medical Service Association Commercial	$49,347.03
Rate for Payer: Hawaii Medical Service Association Medicare	$27,548.48
Rate for Payer: Humana Medicare	$27,548.48
Rate for Payer: Kaiser Permanente Commercial	$36,130.12
Rate for Payer: Kaiser Permanente Medicare	$27,548.48
Rate for Payer: Ohana Health Plan Medicare	$27,548.48
Rate for Payer: UnitedHealthcare Medicare	$27,548.48

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC

Facility

$50,600.59

Service Code	MSDRG 480
Min. Negotiated Rate	$38,304.80
Max. Negotiated Rate	$50,600.59
Rate for Payer: AlohaCare Medicare	$38,304.80
Rate for Payer: Devoted Health Medicare	$42,135.28
Rate for Payer: Hawaii Medical Service Association Commercial	$50,600.59
Rate for Payer: Hawaii Medical Service Association Medicare	$38,304.80
Rate for Payer: Humana Medicare	$38,304.80
Rate for Payer: Kaiser Permanente Commercial	$50,237.18
Rate for Payer: Kaiser Permanente Medicare	$38,304.80
Rate for Payer: Ohana Health Plan Medicare	$38,304.80
Rate for Payer: UnitedHealthcare Medicare	$38,304.80

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC

Facility

$35,557.82

Service Code	MSDRG 482
Min. Negotiated Rate	$21,452.17
Max. Negotiated Rate	$35,557.82
Rate for Payer: AlohaCare Medicare	$21,452.17
Rate for Payer: Devoted Health Medicare	$23,597.39
Rate for Payer: Hawaii Medical Service Association Commercial	$35,557.82
Rate for Payer: Hawaii Medical Service Association Medicare	$21,452.17
Rate for Payer: Humana Medicare	$21,452.17
Rate for Payer: Kaiser Permanente Commercial	$28,134.75
Rate for Payer: Kaiser Permanente Medicare	$21,452.17
Rate for Payer: Ohana Health Plan Medicare	$21,452.17
Rate for Payer: UnitedHealthcare Medicare	$21,452.17

Hip Arcos Mod Rev Sys Distal Stem 15mm x 190mm 11-300915 [3644262]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3644262
Hospital Revenue Code	278
Min. Negotiated Rate	$9,985.08
Max. Negotiated Rate	$17,295.58
Rate for Payer: Cash Price	$11,589.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,481.35
Rate for Payer: Health Management Network Commercial	$15,155.92
Rate for Payer: MDX Hawaii PPO	$17,295.58
Rate for Payer: University Health Alliance Commercial	$9,985.08

Hip Arcos Mod Rev Sys Distal Stem 15mm x 190mm 11-300915 [3644262]

Facility

$17,830.50

Service Code	HCPCS C1776
Hospital Charge Code	3644262
Hospital Revenue Code	278
Min. Negotiated Rate	$9,093.56
Max. Negotiated Rate	$17,295.58
Rate for Payer: Cash Price	$11,589.82
Rate for Payer: Hawaii Western Management Group Commercial	$12,481.35
Rate for Payer: Health Management Network Commercial	$15,155.92
Rate for Payer: Kaiser Permanente Commercial	$11,233.22
Rate for Payer: Kaiser Permanente Medicaid	$9,093.56
Rate for Payer: MDX Hawaii PPO	$17,295.58
Rate for Payer: University Health Alliance Commercial	$9,985.08

Hip Arcos Rev Lat Troch Bolt 32mm 11-302132 [3643857]

Facility

$2,425.50

Service Code	HCPCS C1776
Hospital Charge Code	3643857
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.01
Max. Negotiated Rate	$2,352.74
Rate for Payer: Cash Price	$1,576.58
Rate for Payer: Hawaii Western Management Group Commercial	$1,697.85
Rate for Payer: Health Management Network Commercial	$2,061.68
Rate for Payer: Kaiser Permanente Commercial	$1,528.07
Rate for Payer: Kaiser Permanente Medicaid	$1,237.01
Rate for Payer: MDX Hawaii PPO	$2,352.74
Rate for Payer: University Health Alliance Commercial	$1,358.28

Know your out-of-pocket cost for care.

All Charges