Kona Community Hospital

All Charges

Charge

Type

Setting

Price

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$156,671.39

Service Code	MSDRG 855
Min. Negotiated Rate	$19,692.32
Max. Negotiated Rate	$156,671.39
Rate for Payer: AlohaCare Medicare	$19,692.32
Rate for Payer: Devoted Health Medicare	$21,661.55
Rate for Payer: Hawaii Medical Service Association Commercial	$156,671.39
Rate for Payer: Hawaii Medical Service Association Medicare	$19,692.32
Rate for Payer: Humana Medicare	$19,692.32
Rate for Payer: Kaiser Permanente Commercial	$25,826.70
Rate for Payer: Kaiser Permanente Medicare	$19,692.32
Rate for Payer: Ohana Health Plan Medicare	$19,692.32
Rate for Payer: UnitedHealthcare Medicare	$19,692.32

INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE

Facility

$5,607.69

Service Code	APR-DRG 7101
Min. Negotiated Rate	$5,607.69
Max. Negotiated Rate	$5,607.69
Rate for Payer: AlohaCare Medicaid	$5,607.69
Rate for Payer: Hawaii Medical Service Association ABD	$5,607.69
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,607.69
Rate for Payer: Kaiser Permanente Medicaid	$5,607.69
Rate for Payer: Ohana Health Plan Medicaid	$5,607.69
Rate for Payer: UnitedHealthcare Medicaid	$5,607.69

INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE

Facility

$22,728.14

Service Code	APR-DRG 7104
Min. Negotiated Rate	$22,728.14
Max. Negotiated Rate	$22,728.14
Rate for Payer: AlohaCare Medicaid	$22,728.14
Rate for Payer: Hawaii Medical Service Association ABD	$22,728.14
Rate for Payer: Hawaii Medical Service Association Non-ABD	$22,728.14
Rate for Payer: Kaiser Permanente Medicaid	$22,728.14
Rate for Payer: Ohana Health Plan Medicaid	$22,728.14
Rate for Payer: UnitedHealthcare Medicaid	$22,728.14

INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE

Facility

$12,750.07

Service Code	APR-DRG 7103
Min. Negotiated Rate	$12,750.07
Max. Negotiated Rate	$12,750.07
Rate for Payer: AlohaCare Medicaid	$12,750.07
Rate for Payer: Hawaii Medical Service Association ABD	$12,750.07
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,750.07
Rate for Payer: Kaiser Permanente Medicaid	$12,750.07
Rate for Payer: Ohana Health Plan Medicaid	$12,750.07
Rate for Payer: UnitedHealthcare Medicaid	$12,750.07

INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE

Facility

$8,276.53

Service Code	APR-DRG 7102
Min. Negotiated Rate	$8,276.53
Max. Negotiated Rate	$8,276.53
Rate for Payer: AlohaCare Medicaid	$8,276.53
Rate for Payer: Hawaii Medical Service Association ABD	$8,276.53
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,276.53
Rate for Payer: Kaiser Permanente Medicaid	$8,276.53
Rate for Payer: Ohana Health Plan Medicaid	$8,276.53
Rate for Payer: UnitedHealthcare Medicaid	$8,276.53

INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$25,580.03

Service Code	MSDRG 727
Min. Negotiated Rate	$13,403.49
Max. Negotiated Rate	$25,580.03
Rate for Payer: AlohaCare Medicare	$19,504.23
Rate for Payer: Devoted Health Medicare	$21,454.65
Rate for Payer: Hawaii Medical Service Association Commercial	$13,403.49
Rate for Payer: Hawaii Medical Service Association Medicare	$19,504.23
Rate for Payer: Humana Medicare	$19,504.23
Rate for Payer: Kaiser Permanente Commercial	$25,580.03
Rate for Payer: Kaiser Permanente Medicare	$19,504.23
Rate for Payer: Ohana Health Plan Medicare	$19,504.23
Rate for Payer: UnitedHealthcare Medicare	$19,504.23

INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC

Facility

$13,993.20

Service Code	MSDRG 728
Min. Negotiated Rate	$10,669.52
Max. Negotiated Rate	$13,993.20
Rate for Payer: AlohaCare Medicare	$10,669.52
Rate for Payer: Devoted Health Medicare	$11,736.47
Rate for Payer: Hawaii Medical Service Association Commercial	$13,403.49
Rate for Payer: Hawaii Medical Service Association Medicare	$10,669.52
Rate for Payer: Humana Medicare	$10,669.52
Rate for Payer: Kaiser Permanente Commercial	$13,993.20
Rate for Payer: Kaiser Permanente Medicare	$10,669.52
Rate for Payer: Ohana Health Plan Medicare	$10,669.52
Rate for Payer: UnitedHealthcare Medicare	$10,669.52

INFLAMMATORY BOWEL DISEASE

Facility

$5,900.62

Service Code	APR-DRG 2453
Min. Negotiated Rate	$5,900.62
Max. Negotiated Rate	$5,900.62
Rate for Payer: AlohaCare Medicaid	$5,900.62
Rate for Payer: Hawaii Medical Service Association ABD	$5,900.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,900.62
Rate for Payer: Kaiser Permanente Medicaid	$5,900.62
Rate for Payer: Ohana Health Plan Medicaid	$5,900.62
Rate for Payer: UnitedHealthcare Medicaid	$5,900.62

INFLAMMATORY BOWEL DISEASE

Facility

$4,041.15

Service Code	APR-DRG 2452
Min. Negotiated Rate	$4,041.15
Max. Negotiated Rate	$4,041.15
Rate for Payer: AlohaCare Medicaid	$4,041.15
Rate for Payer: Hawaii Medical Service Association ABD	$4,041.15
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,041.15
Rate for Payer: Kaiser Permanente Medicaid	$4,041.15
Rate for Payer: Ohana Health Plan Medicaid	$4,041.15
Rate for Payer: UnitedHealthcare Medicaid	$4,041.15

INFLAMMATORY BOWEL DISEASE

Facility

$11,368.21

Service Code	APR-DRG 2454
Min. Negotiated Rate	$11,368.21
Max. Negotiated Rate	$11,368.21
Rate for Payer: AlohaCare Medicaid	$11,368.21
Rate for Payer: Hawaii Medical Service Association ABD	$11,368.21
Rate for Payer: Hawaii Medical Service Association Non-ABD	$11,368.21
Rate for Payer: Kaiser Permanente Medicaid	$11,368.21
Rate for Payer: Ohana Health Plan Medicaid	$11,368.21
Rate for Payer: UnitedHealthcare Medicaid	$11,368.21

INFLAMMATORY BOWEL DISEASE

Facility

$3,255.34

Service Code	APR-DRG 2451
Min. Negotiated Rate	$3,255.34
Max. Negotiated Rate	$3,255.34
Rate for Payer: AlohaCare Medicaid	$3,255.34
Rate for Payer: Hawaii Medical Service Association ABD	$3,255.34
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,255.34
Rate for Payer: Kaiser Permanente Medicaid	$3,255.34
Rate for Payer: Ohana Health Plan Medicaid	$3,255.34
Rate for Payer: UnitedHealthcare Medicaid	$3,255.34

INFLAMMATORY BOWEL DISEASE WITH CC

Facility

$19,767.74

Service Code	MSDRG 386
Min. Negotiated Rate	$12,841.04
Max. Negotiated Rate	$19,767.74
Rate for Payer: AlohaCare Medicare	$12,841.04
Rate for Payer: Devoted Health Medicare	$14,125.14
Rate for Payer: Hawaii Medical Service Association Commercial	$19,767.74
Rate for Payer: Hawaii Medical Service Association Medicare	$12,841.04
Rate for Payer: Humana Medicare	$12,841.04
Rate for Payer: Kaiser Permanente Commercial	$16,841.17
Rate for Payer: Kaiser Permanente Medicare	$12,841.04
Rate for Payer: Ohana Health Plan Medicare	$12,841.04
Rate for Payer: UnitedHealthcare Medicare	$12,841.04

INFLAMMATORY BOWEL DISEASE WITH MCC

Facility

$27,294.67

Service Code	MSDRG 385
Min. Negotiated Rate	$19,767.74
Max. Negotiated Rate	$27,294.67
Rate for Payer: AlohaCare Medicare	$20,811.62
Rate for Payer: Devoted Health Medicare	$22,892.78
Rate for Payer: Hawaii Medical Service Association Commercial	$19,767.74
Rate for Payer: Hawaii Medical Service Association Medicare	$20,811.62
Rate for Payer: Humana Medicare	$20,811.62
Rate for Payer: Kaiser Permanente Commercial	$27,294.67
Rate for Payer: Kaiser Permanente Medicare	$20,811.62
Rate for Payer: Ohana Health Plan Medicare	$20,811.62
Rate for Payer: UnitedHealthcare Medicare	$20,811.62

INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC

Facility

$19,767.74

Service Code	MSDRG 387
Min. Negotiated Rate	$8,960.98
Max. Negotiated Rate	$19,767.74
Rate for Payer: AlohaCare Medicare	$8,960.98
Rate for Payer: Devoted Health Medicare	$9,857.08
Rate for Payer: Hawaii Medical Service Association Commercial	$19,767.74
Rate for Payer: Hawaii Medical Service Association Medicare	$8,960.98
Rate for Payer: Humana Medicare	$8,960.98
Rate for Payer: Kaiser Permanente Commercial	$11,752.42
Rate for Payer: Kaiser Permanente Medicare	$8,960.98
Rate for Payer: Ohana Health Plan Medicare	$8,960.98
Rate for Payer: UnitedHealthcare Medicare	$8,960.98

Inflation Device Encore 26 M001151050 [3641972]

Facility

$309.00

Hospital Charge Code	3641972
Hospital Revenue Code	272
Min. Negotiated Rate	$157.59
Max. Negotiated Rate	$299.73
Rate for Payer: Cash Price	$200.85
Rate for Payer: Hawaii Western Management Group Commercial	$293.55
Rate for Payer: Health Management Network Commercial	$262.65
Rate for Payer: Kaiser Permanente Commercial	$194.67
Rate for Payer: Kaiser Permanente Medicaid	$157.59
Rate for Payer: MDX Hawaii PPO	$299.73
Rate for Payer: University Health Alliance Commercial	$225.23

Inflation Device Encore 26 M001151050 [3641972]

Facility

$309.00

Hospital Charge Code	3641972
Hospital Revenue Code	272
Min. Negotiated Rate	$262.65
Max. Negotiated Rate	$299.73
Rate for Payer: Cash Price	$200.85
Rate for Payer: Health Management Network Commercial	$262.65
Rate for Payer: MDX Hawaii PPO	$299.73

INFLIXIMAB 100 MG IV RECON.SOLN. (REMICADE)

Facility

$2,519.79

Service Code	HCPCS J1745
Hospital Revenue Code	250
Min. Negotiated Rate	$2,141.82
Max. Negotiated Rate	$2,444.20
Rate for Payer: Cash Price	$1,637.86
Rate for Payer: Health Management Network Commercial	$2,141.82
Rate for Payer: MDX Hawaii PPO	$2,444.20

INFLIXIMAB 100 MG IV RECON.SOLN. (REMICADE)

Facility

$2,519.79

Service Code	HCPCS J1745
Hospital Revenue Code	636
Min. Negotiated Rate	$31.04
Max. Negotiated Rate	$2,444.20
Rate for Payer: AlohaCare Medicaid	$31.04
Rate for Payer: AlohaCare Medicare	$31.04
Rate for Payer: Cash Price	$1,637.86
Rate for Payer: Cash Price	$1,637.86
Rate for Payer: Devoted Health Medicare	$34.14
Rate for Payer: Hawaii Medical Service Association ABD	$109.98
Rate for Payer: Hawaii Medical Service Association Commercial	$38.80
Rate for Payer: Hawaii Medical Service Association Medicare	$31.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$109.98
Rate for Payer: Hawaii Western Management Group Commercial	$2,393.80
Rate for Payer: Health Management Network Commercial	$2,141.82
Rate for Payer: Humana Medicare	$31.04
Rate for Payer: Kaiser Permanente Commercial	$1,587.47
Rate for Payer: Kaiser Permanente Medicaid	$1,285.09
Rate for Payer: Kaiser Permanente Medicare	$31.04
Rate for Payer: MDX Hawaii PPO	$2,444.20
Rate for Payer: Ohana Health Plan Medicaid	$34.14
Rate for Payer: Ohana Health Plan Medicare	$31.04
Rate for Payer: UnitedHealthcare Medicaid	$1,511.87
Rate for Payer: UnitedHealthcare Medicare	$31.04
Rate for Payer: University Health Alliance Commercial	$1,836.67

INFLIXIMAB-ABDA 100 MG IV RECON.SOLN.

Facility

$1,804.04

Service Code	HCPCS Q5104
Hospital Revenue Code	250
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$1,749.92
Rate for Payer: AlohaCare Medicaid	$26.80
Rate for Payer: AlohaCare Medicare	$26.80
Rate for Payer: Cash Price	$1,172.63
Rate for Payer: Cash Price	$1,172.63
Rate for Payer: Devoted Health Medicare	$29.48
Rate for Payer: Hawaii Medical Service Association ABD	$25.05
Rate for Payer: Hawaii Medical Service Association Commercial	$33.50
Rate for Payer: Hawaii Medical Service Association Medicare	$26.80
Rate for Payer: Hawaii Medical Service Association Non-ABD	$25.05
Rate for Payer: Hawaii Western Management Group Commercial	$1,713.84
Rate for Payer: Health Management Network Commercial	$1,533.43
Rate for Payer: Humana Medicare	$26.80
Rate for Payer: Kaiser Permanente Commercial	$1,136.55
Rate for Payer: Kaiser Permanente Medicaid	$920.06
Rate for Payer: Kaiser Permanente Medicare	$26.80
Rate for Payer: MDX Hawaii PPO	$1,749.92
Rate for Payer: Ohana Health Plan Medicaid	$29.48
Rate for Payer: Ohana Health Plan Medicare	$26.80
Rate for Payer: UnitedHealthcare Medicaid	$1,082.42
Rate for Payer: UnitedHealthcare Medicare	$26.80
Rate for Payer: University Health Alliance Commercial	$1,314.96

INFLIXIMAB-ABDA 100 MG IV RECON.SOLN.

Facility

$1,804.04

Service Code	HCPCS Q5104
Hospital Revenue Code	250
Min. Negotiated Rate	$1,533.43
Max. Negotiated Rate	$1,749.92
Rate for Payer: Cash Price	$1,172.63
Rate for Payer: Health Management Network Commercial	$1,533.43
Rate for Payer: MDX Hawaii PPO	$1,749.92

INFLIXIMAB-DYYB 100 MG IV RECON.SOLN.

Facility

$2,204.48

Service Code	HCPCS Q5103
Hospital Revenue Code	250
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$2,138.35
Rate for Payer: AlohaCare Medicaid	$26.04
Rate for Payer: AlohaCare Medicare	$26.04
Rate for Payer: Cash Price	$1,432.91
Rate for Payer: Cash Price	$1,432.91
Rate for Payer: Devoted Health Medicare	$28.64
Rate for Payer: Hawaii Medical Service Association ABD	$19.68
Rate for Payer: Hawaii Medical Service Association Commercial	$32.55
Rate for Payer: Hawaii Medical Service Association Medicare	$26.04
Rate for Payer: Hawaii Medical Service Association Non-ABD	$19.68
Rate for Payer: Hawaii Western Management Group Commercial	$2,094.26
Rate for Payer: Health Management Network Commercial	$1,873.81
Rate for Payer: Humana Medicare	$26.04
Rate for Payer: Kaiser Permanente Commercial	$1,388.82
Rate for Payer: Kaiser Permanente Medicaid	$1,124.28
Rate for Payer: Kaiser Permanente Medicare	$26.04
Rate for Payer: MDX Hawaii PPO	$2,138.35
Rate for Payer: Ohana Health Plan Medicaid	$28.64
Rate for Payer: Ohana Health Plan Medicare	$26.04
Rate for Payer: UnitedHealthcare Medicaid	$1,322.69
Rate for Payer: UnitedHealthcare Medicare	$26.04
Rate for Payer: University Health Alliance Commercial	$1,606.85

INFLIXIMAB-DYYB 100 MG IV RECON.SOLN.

Facility

$2,204.48

Service Code	HCPCS Q5103
Hospital Revenue Code	250
Min. Negotiated Rate	$1,873.81
Max. Negotiated Rate	$2,138.35
Rate for Payer: Cash Price	$1,432.91
Rate for Payer: Health Management Network Commercial	$1,873.81
Rate for Payer: MDX Hawaii PPO	$2,138.35

INFUSER RAPID [2701085]

Facility

$974.00

Hospital Charge Code	2701085
Hospital Revenue Code	272
Min. Negotiated Rate	$827.90
Max. Negotiated Rate	$944.78
Rate for Payer: Cash Price	$633.10
Rate for Payer: Health Management Network Commercial	$827.90
Rate for Payer: MDX Hawaii PPO	$944.78

INFUSER RAPID [2701085]

Facility

$974.00

Hospital Charge Code	2701085
Hospital Revenue Code	272
Min. Negotiated Rate	$496.74
Max. Negotiated Rate	$944.78
Rate for Payer: Cash Price	$633.10
Rate for Payer: Hawaii Western Management Group Commercial	$925.30
Rate for Payer: Health Management Network Commercial	$827.90
Rate for Payer: Kaiser Permanente Commercial	$613.62
Rate for Payer: Kaiser Permanente Medicaid	$496.74
Rate for Payer: MDX Hawaii PPO	$944.78
Rate for Payer: University Health Alliance Commercial	$709.95

INFUSION NORMAL SALINE SOLUTION 1000 CC

Professional

Both

$9.00

Service Code	HCPCS J7030
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$12.00
Rate for Payer: AlohaCare Medicare	$2.19
Rate for Payer: Cash Price	$5.85
Rate for Payer: Cash Price	$5.85
Rate for Payer: Devoted Health Medicare	$2.41
Rate for Payer: Hawaii Medical Service Association Medicare	$2.19
Rate for Payer: Hawaii Western Management Group Commercial	$12.00
Rate for Payer: Health Management Network Commercial	$7.65
Rate for Payer: Kaiser Permanente Commercial	$2.63
Rate for Payer: Kaiser Permanente Medicaid	$2.63
Rate for Payer: Kaiser Permanente Medicare	$2.63
Rate for Payer: Ohana Health Plan Medicare	$2.19
Rate for Payer: UnitedHealthcare Medicare	$2.19

Know your out-of-pocket cost for care.

All Charges