Kona Community Hospital

All Charges

Charge

Type

Setting

Price

IMPLANTABLE HEART ASSIST SYSTEMS

Facility

$114,531.57

Service Code	APR-DRG 1614
Min. Negotiated Rate	$114,531.57
Max. Negotiated Rate	$114,531.57
Rate for Payer: AlohaCare Medicaid	$114,531.57
Rate for Payer: Hawaii Medical Service Association ABD	$114,531.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$114,531.57
Rate for Payer: Kaiser Permanente Medicaid	$114,531.57
Rate for Payer: Ohana Health Plan Medicaid	$114,531.57
Rate for Payer: UnitedHealthcare Medicaid	$114,531.57

IMPLANTABLE HEART ASSIST SYSTEMS

Facility

$91,492.03

Service Code	APR-DRG 1613
Min. Negotiated Rate	$91,492.03
Max. Negotiated Rate	$91,492.03
Rate for Payer: AlohaCare Medicaid	$91,492.03
Rate for Payer: Hawaii Medical Service Association ABD	$91,492.03
Rate for Payer: Hawaii Medical Service Association Non-ABD	$91,492.03
Rate for Payer: Kaiser Permanente Medicaid	$91,492.03
Rate for Payer: Ohana Health Plan Medicaid	$91,492.03
Rate for Payer: UnitedHealthcare Medicaid	$91,492.03

Implant Sys Dx Kl Sl Bc Cc Ft 4.75mm [3643273]

Facility

$7,309.50

Service Code	HCPCS C1713
Hospital Charge Code	3643273
Hospital Revenue Code	278
Min. Negotiated Rate	$4,093.32
Max. Negotiated Rate	$7,090.22
Rate for Payer: Cash Price	$4,751.18
Rate for Payer: Hawaii Western Management Group Commercial	$5,116.65
Rate for Payer: Health Management Network Commercial	$6,213.07
Rate for Payer: MDX Hawaii PPO	$7,090.22
Rate for Payer: University Health Alliance Commercial	$4,093.32

Implant Sys Dx Kl Sl Bc Cc Ft 4.75mm [3643273]

Facility

$7,309.50

Service Code	HCPCS C1713
Hospital Charge Code	3643273
Hospital Revenue Code	278
Min. Negotiated Rate	$3,727.84
Max. Negotiated Rate	$7,090.22
Rate for Payer: Cash Price	$4,751.18
Rate for Payer: Hawaii Western Management Group Commercial	$5,116.65
Rate for Payer: Health Management Network Commercial	$6,213.07
Rate for Payer: Kaiser Permanente Commercial	$4,604.98
Rate for Payer: Kaiser Permanente Medicaid	$3,727.84
Rate for Payer: MDX Hawaii PPO	$7,090.22
Rate for Payer: University Health Alliance Commercial	$4,093.32

Implant Sys Mpfl Tightrope Ar-1360tr-Bc [3643590]

Facility

$8,312.50

Service Code	HCPCS C1713
Hospital Charge Code	3643590
Hospital Revenue Code	278
Min. Negotiated Rate	$4,239.38
Max. Negotiated Rate	$8,063.12
Rate for Payer: Cash Price	$5,403.12
Rate for Payer: Hawaii Western Management Group Commercial	$5,818.75
Rate for Payer: Health Management Network Commercial	$7,065.62
Rate for Payer: Kaiser Permanente Commercial	$5,236.88
Rate for Payer: Kaiser Permanente Medicaid	$4,239.38
Rate for Payer: MDX Hawaii PPO	$8,063.12
Rate for Payer: University Health Alliance Commercial	$4,655.00

Implant Sys Mpfl Tightrope Ar-1360tr-Bc [3643590]

Facility

$8,312.50

Service Code	HCPCS C1713
Hospital Charge Code	3643590
Hospital Revenue Code	278
Min. Negotiated Rate	$4,655.00
Max. Negotiated Rate	$8,063.12
Rate for Payer: Cash Price	$5,403.12
Rate for Payer: Hawaii Western Management Group Commercial	$5,818.75
Rate for Payer: Health Management Network Commercial	$7,065.62
Rate for Payer: MDX Hawaii PPO	$8,063.12
Rate for Payer: University Health Alliance Commercial	$4,655.00

Implant Sys PARS Suture Tape AR-8862DS [3644747]

Facility

$10,225.00

Service Code	HCPCS C1713
Hospital Charge Code	3644747
Hospital Revenue Code	278
Min. Negotiated Rate	$5,726.00
Max. Negotiated Rate	$9,918.25
Rate for Payer: Cash Price	$6,646.25
Rate for Payer: Hawaii Western Management Group Commercial	$7,157.50
Rate for Payer: Health Management Network Commercial	$8,691.25
Rate for Payer: MDX Hawaii PPO	$9,918.25
Rate for Payer: University Health Alliance Commercial	$5,726.00

Implant Sys PARS Suture Tape AR-8862DS [3644747]

Facility

$10,225.00

Service Code	HCPCS C1713
Hospital Charge Code	3644747
Hospital Revenue Code	278
Min. Negotiated Rate	$5,214.75
Max. Negotiated Rate	$9,918.25
Rate for Payer: Cash Price	$6,646.25
Rate for Payer: Hawaii Western Management Group Commercial	$7,157.50
Rate for Payer: Health Management Network Commercial	$8,691.25
Rate for Payer: Kaiser Permanente Commercial	$6,441.75
Rate for Payer: Kaiser Permanente Medicaid	$5,214.75
Rate for Payer: MDX Hawaii PPO	$9,918.25
Rate for Payer: University Health Alliance Commercial	$5,726.00

Inbone Everlast Sz 3 8mm Ankle 22023308 [3645463]

Facility

$32,215.82

Service Code	HCPCS C1776
Hospital Charge Code	3645463
Hospital Revenue Code	278
Min. Negotiated Rate	$16,430.07
Max. Negotiated Rate	$31,249.35
Rate for Payer: Cash Price	$20,940.28
Rate for Payer: Hawaii Western Management Group Commercial	$22,551.07
Rate for Payer: Health Management Network Commercial	$27,383.45
Rate for Payer: Kaiser Permanente Commercial	$20,295.97
Rate for Payer: Kaiser Permanente Medicaid	$16,430.07
Rate for Payer: MDX Hawaii PPO	$31,249.35
Rate for Payer: University Health Alliance Commercial	$18,040.86

Inbone Everlast Sz 3 8mm Ankle 22023308 [3645463]

Facility

$32,215.82

Service Code	HCPCS C1776
Hospital Charge Code	3645463
Hospital Revenue Code	278
Min. Negotiated Rate	$18,040.86
Max. Negotiated Rate	$31,249.35
Rate for Payer: Cash Price	$20,940.28
Rate for Payer: Hawaii Western Management Group Commercial	$22,551.07
Rate for Payer: Health Management Network Commercial	$27,383.45
Rate for Payer: MDX Hawaii PPO	$31,249.35
Rate for Payer: University Health Alliance Commercial	$18,040.86

Inbone Stem Tib Base Sz 16mm Rt And Lt 200009901 [3645454]

Facility

$11,162.97

Service Code	HCPCS C1776
Hospital Charge Code	3645454
Hospital Revenue Code	278
Min. Negotiated Rate	$5,693.11
Max. Negotiated Rate	$10,828.08
Rate for Payer: Cash Price	$7,255.93
Rate for Payer: Hawaii Western Management Group Commercial	$7,814.08
Rate for Payer: Health Management Network Commercial	$9,488.52
Rate for Payer: Kaiser Permanente Commercial	$7,032.67
Rate for Payer: Kaiser Permanente Medicaid	$5,693.11
Rate for Payer: MDX Hawaii PPO	$10,828.08
Rate for Payer: University Health Alliance Commercial	$6,251.26

Inbone Stem Tib Base Sz 16mm Rt And Lt 200009901 [3645454]

Facility

$11,162.97

Service Code	HCPCS C1776
Hospital Charge Code	3645454
Hospital Revenue Code	278
Min. Negotiated Rate	$6,251.26
Max. Negotiated Rate	$10,828.08
Rate for Payer: Cash Price	$7,255.93
Rate for Payer: Hawaii Western Management Group Commercial	$7,814.08
Rate for Payer: Health Management Network Commercial	$9,488.52
Rate for Payer: MDX Hawaii PPO	$10,828.08
Rate for Payer: University Health Alliance Commercial	$6,251.26

Inbone Stem Tib Mid Sz 14mm Rt And Lt 200010901 [3645455]

Facility

$10,968.65

Service Code	HCPCS C1776
Hospital Charge Code	3645455
Hospital Revenue Code	278
Min. Negotiated Rate	$6,142.44
Max. Negotiated Rate	$10,639.59
Rate for Payer: Cash Price	$7,129.62
Rate for Payer: Hawaii Western Management Group Commercial	$7,678.06
Rate for Payer: Health Management Network Commercial	$9,323.35
Rate for Payer: MDX Hawaii PPO	$10,639.59
Rate for Payer: University Health Alliance Commercial	$6,142.44

Inbone Stem Tib Mid Sz 14mm Rt And Lt 200010901 [3645455]

Facility

$10,968.65

Service Code	HCPCS C1776
Hospital Charge Code	3645455
Hospital Revenue Code	278
Min. Negotiated Rate	$5,594.01
Max. Negotiated Rate	$10,639.59
Rate for Payer: Cash Price	$7,129.62
Rate for Payer: Hawaii Western Management Group Commercial	$7,678.06
Rate for Payer: Health Management Network Commercial	$9,323.35
Rate for Payer: Kaiser Permanente Commercial	$6,910.25
Rate for Payer: Kaiser Permanente Medicaid	$5,594.01
Rate for Payer: MDX Hawaii PPO	$10,639.59
Rate for Payer: University Health Alliance Commercial	$6,142.44

Inbone Stem Tib Top Sz 14mm Rt And Lt 200011901 [3645456]

Facility

$10,365.91

Service Code	HCPCS C1776
Hospital Charge Code	3645456
Hospital Revenue Code	278
Min. Negotiated Rate	$5,804.91
Max. Negotiated Rate	$10,054.93
Rate for Payer: Cash Price	$6,737.84
Rate for Payer: Hawaii Western Management Group Commercial	$7,256.14
Rate for Payer: Health Management Network Commercial	$8,811.02
Rate for Payer: MDX Hawaii PPO	$10,054.93
Rate for Payer: University Health Alliance Commercial	$5,804.91

Inbone Stem Tib Top Sz 14mm Rt And Lt 200011901 [3645456]

Facility

$10,365.91

Service Code	HCPCS C1776
Hospital Charge Code	3645456
Hospital Revenue Code	278
Min. Negotiated Rate	$5,286.61
Max. Negotiated Rate	$10,054.93
Rate for Payer: Cash Price	$6,737.84
Rate for Payer: Hawaii Western Management Group Commercial	$7,256.14
Rate for Payer: Health Management Network Commercial	$8,811.02
Rate for Payer: Kaiser Permanente Commercial	$6,530.52
Rate for Payer: Kaiser Permanente Medicaid	$5,286.61
Rate for Payer: MDX Hawaii PPO	$10,054.93
Rate for Payer: University Health Alliance Commercial	$5,804.91

Inbone Tib Tray Sz 3 Rt 200222903 [3645462]

Facility

$26,461.85

Service Code	HCPCS C1776
Hospital Charge Code	3645462
Hospital Revenue Code	278
Min. Negotiated Rate	$13,495.54
Max. Negotiated Rate	$25,667.99
Rate for Payer: Cash Price	$17,200.20
Rate for Payer: Hawaii Western Management Group Commercial	$18,523.29
Rate for Payer: Health Management Network Commercial	$22,492.57
Rate for Payer: Kaiser Permanente Commercial	$16,670.97
Rate for Payer: Kaiser Permanente Medicaid	$13,495.54
Rate for Payer: MDX Hawaii PPO	$25,667.99
Rate for Payer: University Health Alliance Commercial	$14,818.64

Inbone Tib Tray Sz 3 Rt 200222903 [3645462]

Facility

$26,461.85

Service Code	HCPCS C1776
Hospital Charge Code	3645462
Hospital Revenue Code	278
Min. Negotiated Rate	$14,818.64
Max. Negotiated Rate	$25,667.99
Rate for Payer: Cash Price	$17,200.20
Rate for Payer: Hawaii Western Management Group Commercial	$18,523.29
Rate for Payer: Health Management Network Commercial	$22,492.57
Rate for Payer: MDX Hawaii PPO	$25,667.99
Rate for Payer: University Health Alliance Commercial	$14,818.64

INBORN AND OTHER DISORDERS OF METABOLISM

Facility

$86,785.20

Service Code	MSDRG 642
Min. Negotiated Rate	$18,704.56
Max. Negotiated Rate	$86,785.20
Rate for Payer: AlohaCare Medicare	$18,704.56
Rate for Payer: Devoted Health Medicare	$20,575.02
Rate for Payer: Hawaii Medical Service Association Commercial	$86,785.20
Rate for Payer: Hawaii Medical Service Association Medicare	$18,704.56
Rate for Payer: Humana Medicare	$18,704.56
Rate for Payer: Kaiser Permanente Commercial	$24,531.22
Rate for Payer: Kaiser Permanente Medicare	$18,704.56
Rate for Payer: Ohana Health Plan Medicare	$18,704.56
Rate for Payer: UnitedHealthcare Medicare	$18,704.56

INBORN ERRORS OF METABOLISM

Facility

$3,174.46

Service Code	APR-DRG 4231
Min. Negotiated Rate	$3,174.46
Max. Negotiated Rate	$3,174.46
Rate for Payer: AlohaCare Medicaid	$3,174.46
Rate for Payer: Hawaii Medical Service Association ABD	$3,174.46
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,174.46
Rate for Payer: Kaiser Permanente Medicaid	$3,174.46
Rate for Payer: Ohana Health Plan Medicaid	$3,174.46
Rate for Payer: UnitedHealthcare Medicaid	$3,174.46

INBORN ERRORS OF METABOLISM

Facility

$4,001.67

Service Code	APR-DRG 4232
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

INBORN ERRORS OF METABOLISM

Facility

$5,985.95

Service Code	APR-DRG 4233
Min. Negotiated Rate	$5,985.95
Max. Negotiated Rate	$5,985.95
Rate for Payer: AlohaCare Medicaid	$5,985.95
Rate for Payer: Hawaii Medical Service Association ABD	$5,985.95
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,985.95
Rate for Payer: Kaiser Permanente Medicaid	$5,985.95
Rate for Payer: Ohana Health Plan Medicaid	$5,985.95
Rate for Payer: UnitedHealthcare Medicaid	$5,985.95

INBORN ERRORS OF METABOLISM

Facility

$18,608.66

Service Code	APR-DRG 4234
Min. Negotiated Rate	$18,608.66
Max. Negotiated Rate	$18,608.66
Rate for Payer: AlohaCare Medicaid	$18,608.66
Rate for Payer: Hawaii Medical Service Association ABD	$18,608.66
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,608.66
Rate for Payer: Kaiser Permanente Medicaid	$18,608.66
Rate for Payer: Ohana Health Plan Medicaid	$18,608.66
Rate for Payer: UnitedHealthcare Medicaid	$18,608.66

INCISIONAL BIOPSY OF SKIN (EG, WEDGE) (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION

Facility

$2,837.00

Service Code	CPT 11106
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$873.10
Rate for Payer: AlohaCare Medicare	$873.10
Rate for Payer: Devoted Health Medicare	$960.41
Rate for Payer: Hawaii Medical Service Association Commercial	$1,091.38
Rate for Payer: Hawaii Medical Service Association Medicare	$873.10
Rate for Payer: Humana Medicare	$873.10
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$873.10
Rate for Payer: Ohana Health Plan Medicaid	$960.41
Rate for Payer: Ohana Health Plan Medicare	$873.10
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$873.10

INCISION AND DRAINAGE, DEEP ABSCESS, BURSA, OR HEMATOMA, THIGH OR KNEE REGION

Facility

$6,743.44

Service Code	CPT 27301
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,743.44
Rate for Payer: AlohaCare Medicaid	$3,431.47
Rate for Payer: AlohaCare Medicare	$3,431.47
Rate for Payer: Devoted Health Medicare	$3,774.62
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	$3,431.47
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,431.47
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,431.47
Rate for Payer: Ohana Health Plan Medicaid	$3,774.62
Rate for Payer: Ohana Health Plan Medicare	$3,431.47
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,431.47
Rate for Payer: University Health Alliance Commercial	$6,743.44

Know your out-of-pocket cost for care.

All Charges