Kona Community Hospital

All Charges

Charge

Type

Setting

Price

HIV W MAJOR HIV RELATED CONDITION

Facility

$8,022.44

Service Code	APR-DRG 8924
Min. Negotiated Rate	$8,022.44
Max. Negotiated Rate	$8,022.44
Rate for Payer: AlohaCare Medicaid	$8,022.44
Rate for Payer: Hawaii Medical Service Association ABD	$8,022.44
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,022.44
Rate for Payer: Kaiser Permanente Medicaid	$8,022.44
Rate for Payer: Ohana Health Plan Medicaid	$8,022.44
Rate for Payer: UnitedHealthcare Medicaid	$8,022.44

HIV W MAJOR HIV RELATED CONDITION

Facility

$3,538.08

Service Code	APR-DRG 8922
Min. Negotiated Rate	$3,538.08
Max. Negotiated Rate	$3,538.08
Rate for Payer: AlohaCare Medicaid	$3,538.08
Rate for Payer: Hawaii Medical Service Association ABD	$3,538.08
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,538.08
Rate for Payer: Kaiser Permanente Medicaid	$3,538.08
Rate for Payer: Ohana Health Plan Medicaid	$3,538.08
Rate for Payer: UnitedHealthcare Medicaid	$3,538.08

HIV W MAJOR HIV RELATED CONDITION

Facility

$4,934.59

Service Code	APR-DRG 8923
Min. Negotiated Rate	$4,934.59
Max. Negotiated Rate	$4,934.59
Rate for Payer: AlohaCare Medicaid	$4,934.59
Rate for Payer: Hawaii Medical Service Association ABD	$4,934.59
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,934.59
Rate for Payer: Kaiser Permanente Medicaid	$4,934.59
Rate for Payer: Ohana Health Plan Medicaid	$4,934.59
Rate for Payer: UnitedHealthcare Medicaid	$4,934.59

HIV W MAJOR HIV RELATED CONDITION

Facility

$2,917.83

Service Code	APR-DRG 8921
Min. Negotiated Rate	$2,917.83
Max. Negotiated Rate	$2,917.83
Rate for Payer: AlohaCare Medicaid	$2,917.83
Rate for Payer: Hawaii Medical Service Association ABD	$2,917.83
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,917.83
Rate for Payer: Kaiser Permanente Medicaid	$2,917.83
Rate for Payer: Ohana Health Plan Medicaid	$2,917.83
Rate for Payer: UnitedHealthcare Medicaid	$2,917.83

HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$6,190.36

Service Code	APR-DRG 8903
Min. Negotiated Rate	$6,190.36
Max. Negotiated Rate	$6,190.36
Rate for Payer: AlohaCare Medicaid	$6,190.36
Rate for Payer: Hawaii Medical Service Association ABD	$6,190.36
Rate for Payer: Hawaii Medical Service Association Non-ABD	$6,190.36
Rate for Payer: Kaiser Permanente Medicaid	$6,190.36
Rate for Payer: Ohana Health Plan Medicaid	$6,190.36
Rate for Payer: UnitedHealthcare Medicaid	$6,190.36

HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$11,841.99

Service Code	APR-DRG 8904
Min. Negotiated Rate	$11,841.99
Max. Negotiated Rate	$11,841.99
Rate for Payer: AlohaCare Medicaid	$11,841.99
Rate for Payer: Hawaii Medical Service Association ABD	$11,841.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,841.99
Rate for Payer: Kaiser Permanente Medicaid	$11,841.99
Rate for Payer: Ohana Health Plan Medicaid	$11,841.99
Rate for Payer: UnitedHealthcare Medicaid	$11,841.99

HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$4,328.99

Service Code	APR-DRG 8901
Min. Negotiated Rate	$4,328.99
Max. Negotiated Rate	$4,328.99
Rate for Payer: AlohaCare Medicaid	$4,328.99
Rate for Payer: Hawaii Medical Service Association ABD	$4,328.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,328.99
Rate for Payer: Kaiser Permanente Medicaid	$4,328.99
Rate for Payer: Ohana Health Plan Medicaid	$4,328.99
Rate for Payer: UnitedHealthcare Medicaid	$4,328.99

HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$4,339.18

Service Code	APR-DRG 8902
Min. Negotiated Rate	$4,339.18
Max. Negotiated Rate	$4,339.18
Rate for Payer: AlohaCare Medicaid	$4,339.18
Rate for Payer: Hawaii Medical Service Association ABD	$4,339.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,339.18
Rate for Payer: Kaiser Permanente Medicaid	$4,339.18
Rate for Payer: Ohana Health Plan Medicaid	$4,339.18
Rate for Payer: UnitedHealthcare Medicaid	$4,339.18

HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$5,347.23

Service Code	APR-DRG 8933
Min. Negotiated Rate	$5,347.23
Max. Negotiated Rate	$5,347.23
Rate for Payer: AlohaCare Medicaid	$5,347.23
Rate for Payer: Hawaii Medical Service Association ABD	$5,347.23
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,347.23
Rate for Payer: Kaiser Permanente Medicaid	$5,347.23
Rate for Payer: Ohana Health Plan Medicaid	$5,347.23
Rate for Payer: UnitedHealthcare Medicaid	$5,347.23

HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$3,946.27

Service Code	APR-DRG 8932
Min. Negotiated Rate	$3,946.27
Max. Negotiated Rate	$3,946.27
Rate for Payer: AlohaCare Medicaid	$3,946.27
Rate for Payer: Hawaii Medical Service Association ABD	$3,946.27
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,946.27
Rate for Payer: Kaiser Permanente Medicaid	$3,946.27
Rate for Payer: Ohana Health Plan Medicaid	$3,946.27
Rate for Payer: UnitedHealthcare Medicaid	$3,946.27

HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$3,213.94

Service Code	APR-DRG 8931
Min. Negotiated Rate	$3,213.94
Max. Negotiated Rate	$3,213.94
Rate for Payer: AlohaCare Medicaid	$3,213.94
Rate for Payer: Hawaii Medical Service Association ABD	$3,213.94
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,213.94
Rate for Payer: Kaiser Permanente Medicaid	$3,213.94
Rate for Payer: Ohana Health Plan Medicaid	$3,213.94
Rate for Payer: UnitedHealthcare Medicaid	$3,213.94

HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$8,885.95

Service Code	APR-DRG 8934
Min. Negotiated Rate	$8,885.95
Max. Negotiated Rate	$8,885.95
Rate for Payer: AlohaCare Medicaid	$8,885.95
Rate for Payer: Hawaii Medical Service Association ABD	$8,885.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,885.95
Rate for Payer: Kaiser Permanente Medicaid	$8,885.95
Rate for Payer: Ohana Health Plan Medicaid	$8,885.95
Rate for Payer: UnitedHealthcare Medicaid	$8,885.95

HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND

Facility

$2,905.73

Service Code	APR-DRG 8941
Min. Negotiated Rate	$2,905.73
Max. Negotiated Rate	$2,905.73
Rate for Payer: AlohaCare Medicaid	$2,905.73
Rate for Payer: Hawaii Medical Service Association ABD	$2,905.73
Rate for Payer: Hawaii Medical Service Association Non-ABD	$2,905.73
Rate for Payer: Kaiser Permanente Medicaid	$2,905.73
Rate for Payer: Ohana Health Plan Medicaid	$2,905.73
Rate for Payer: UnitedHealthcare Medicaid	$2,905.73

HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND

Facility

$5,633.80

Service Code	APR-DRG 8944
Min. Negotiated Rate	$5,633.80
Max. Negotiated Rate	$5,633.80
Rate for Payer: AlohaCare Medicaid	$5,633.80
Rate for Payer: Hawaii Medical Service Association ABD	$5,633.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,633.80
Rate for Payer: Kaiser Permanente Medicaid	$5,633.80
Rate for Payer: Ohana Health Plan Medicaid	$5,633.80
Rate for Payer: UnitedHealthcare Medicaid	$5,633.80

HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND

Facility

$3,355.32

Service Code	APR-DRG 8942
Min. Negotiated Rate	$3,355.32
Max. Negotiated Rate	$3,355.32
Rate for Payer: AlohaCare Medicaid	$3,355.32
Rate for Payer: Hawaii Medical Service Association ABD	$3,355.32
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,355.32
Rate for Payer: Kaiser Permanente Medicaid	$3,355.32
Rate for Payer: Ohana Health Plan Medicaid	$3,355.32
Rate for Payer: UnitedHealthcare Medicaid	$3,355.32

HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND

Facility

$4,599.63

Service Code	APR-DRG 8943
Min. Negotiated Rate	$4,599.63
Max. Negotiated Rate	$4,599.63
Rate for Payer: AlohaCare Medicaid	$4,599.63
Rate for Payer: Hawaii Medical Service Association ABD	$4,599.63
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,599.63
Rate for Payer: Kaiser Permanente Medicaid	$4,599.63
Rate for Payer: Ohana Health Plan Medicaid	$4,599.63
Rate for Payer: UnitedHealthcare Medicaid	$4,599.63

Holder Anchor Fast Guard [6258215]

Facility

$84.32

Hospital Charge Code	6258215
Hospital Revenue Code	272
Min. Negotiated Rate	$43.00
Max. Negotiated Rate	$81.79
Rate for Payer: Cash Price	$54.81
Rate for Payer: Hawaii Western Management Group Commercial	$80.10
Rate for Payer: Health Management Network Commercial	$71.67
Rate for Payer: Kaiser Permanente Commercial	$53.12
Rate for Payer: Kaiser Permanente Medicaid	$43.00
Rate for Payer: MDX Hawaii PPO	$81.79
Rate for Payer: University Health Alliance Commercial	$61.46

Holder Anchor Fast Guard [6258215]

Facility

$84.32

Hospital Charge Code	6258215
Hospital Revenue Code	272
Min. Negotiated Rate	$71.67
Max. Negotiated Rate	$81.79
Rate for Payer: Cash Price	$54.81
Rate for Payer: Health Management Network Commercial	$71.67
Rate for Payer: MDX Hawaii PPO	$81.79

HOLDER TUBE ENDOTRACHEAL ORAL ANCHORFAST [00079594]

Facility

$32.36

Hospital Charge Code	00079594
Hospital Revenue Code	272
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$31.39
Rate for Payer: Cash Price	$21.03
Rate for Payer: Hawaii Western Management Group Commercial	$30.74
Rate for Payer: Health Management Network Commercial	$27.51
Rate for Payer: Kaiser Permanente Commercial	$20.39
Rate for Payer: Kaiser Permanente Medicaid	$16.50
Rate for Payer: MDX Hawaii PPO	$31.39
Rate for Payer: University Health Alliance Commercial	$23.59

HOLDER TUBE ENDOTRACHEAL ORAL ANCHORFAST [00079594]

Facility

$32.36

Hospital Charge Code	00079594
Hospital Revenue Code	272
Min. Negotiated Rate	$27.51
Max. Negotiated Rate	$31.39
Rate for Payer: Cash Price	$21.03
Rate for Payer: Health Management Network Commercial	$27.51
Rate for Payer: MDX Hawaii PPO	$31.39

Hollow Reamer Com For 3.5/4.0mm Screw 309.035 [3644970]

Facility

$3,247.78

Hospital Charge Code	3644970
Hospital Revenue Code	272
Min. Negotiated Rate	$2,760.61
Max. Negotiated Rate	$3,150.35
Rate for Payer: Cash Price	$2,111.06
Rate for Payer: Health Management Network Commercial	$2,760.61
Rate for Payer: MDX Hawaii PPO	$3,150.35

Hollow Reamer Com For 3.5/4.0mm Screw 309.035 [3644970]

Facility

$3,247.78

Hospital Charge Code	3644970
Hospital Revenue Code	272
Min. Negotiated Rate	$1,656.37
Max. Negotiated Rate	$3,150.35
Rate for Payer: Cash Price	$2,111.06
Rate for Payer: Hawaii Western Management Group Commercial	$3,085.39
Rate for Payer: Health Management Network Commercial	$2,760.61
Rate for Payer: Kaiser Permanente Commercial	$2,046.10
Rate for Payer: Kaiser Permanente Medicaid	$1,656.37
Rate for Payer: MDX Hawaii PPO	$3,150.35
Rate for Payer: University Health Alliance Commercial	$2,367.31

Hoover Neg Pres Collection Bottle IVX-NB-150 [3645030]

Facility

$275.25

Service Code	HCPCS C1894
Hospital Charge Code	3645030
Hospital Revenue Code	272
Min. Negotiated Rate	$233.96
Max. Negotiated Rate	$266.99
Rate for Payer: Cash Price	$178.91
Rate for Payer: Health Management Network Commercial	$233.96
Rate for Payer: MDX Hawaii PPO	$266.99

Hoover Neg Pres Collection Bottle IVX-NB-150 [3645030]

Facility

$275.25

Service Code	HCPCS C1894
Hospital Charge Code	3645030
Hospital Revenue Code	272
Min. Negotiated Rate	$140.38
Max. Negotiated Rate	$266.99
Rate for Payer: Cash Price	$178.91
Rate for Payer: Hawaii Western Management Group Commercial	$261.49
Rate for Payer: Health Management Network Commercial	$233.96
Rate for Payer: Kaiser Permanente Commercial	$173.41
Rate for Payer: Kaiser Permanente Medicaid	$140.38
Rate for Payer: MDX Hawaii PPO	$266.99
Rate for Payer: University Health Alliance Commercial	$200.63

Hoover Neg Pres Ureteral Sheath 11fFr x 50cm IVX-NS-1150 [3645027]

Facility

$3,630.50

Service Code	HCPCS C1894
Hospital Charge Code	3645027
Hospital Revenue Code	272
Min. Negotiated Rate	$3,085.93
Max. Negotiated Rate	$3,521.59
Rate for Payer: Cash Price	$2,359.83
Rate for Payer: Health Management Network Commercial	$3,085.93
Rate for Payer: MDX Hawaii PPO	$3,521.59

Know your out-of-pocket cost for care.

All Charges