Kona Community Hospital

All Charges

Charge

Type

Setting

Price

INTRACRANIAL HEMORRHAGE

Facility

$3,503.05

Service Code	APR-DRG 0441
Min. Negotiated Rate	$3,503.05
Max. Negotiated Rate	$3,503.05
Rate for Payer: AlohaCare Medicaid	$3,503.05
Rate for Payer: Hawaii Medical Service Association ABD	$3,503.05
Rate for Payer: Hawaii Medical Service Association Non-ABD	$3,503.05
Rate for Payer: Kaiser Permanente Medicaid	$3,503.05
Rate for Payer: Ohana Health Plan Medicaid	$3,503.05
Rate for Payer: UnitedHealthcare Medicaid	$3,503.05

INTRACRANIAL HEMORRHAGE

Facility

$4,581.16

Service Code	APR-DRG 0442
Min. Negotiated Rate	$4,581.16
Max. Negotiated Rate	$4,581.16
Rate for Payer: AlohaCare Medicaid	$4,581.16
Rate for Payer: Hawaii Medical Service Association ABD	$4,581.16
Rate for Payer: Hawaii Medical Service Association Non-ABD	$4,581.16
Rate for Payer: Kaiser Permanente Medicaid	$4,581.16
Rate for Payer: Ohana Health Plan Medicaid	$4,581.16
Rate for Payer: UnitedHealthcare Medicaid	$4,581.16

INTRACRANIAL HEMORRHAGE

Facility

$7,221.98

Service Code	APR-DRG 0444
Min. Negotiated Rate	$7,221.98
Max. Negotiated Rate	$7,221.98
Rate for Payer: AlohaCare Medicaid	$7,221.98
Rate for Payer: Hawaii Medical Service Association ABD	$7,221.98
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,221.98
Rate for Payer: Kaiser Permanente Medicaid	$7,221.98
Rate for Payer: Ohana Health Plan Medicaid	$7,221.98
Rate for Payer: UnitedHealthcare Medicaid	$7,221.98

INTRACRANIAL HEMORRHAGE

Facility

$5,650.99

Service Code	APR-DRG 0443
Min. Negotiated Rate	$5,650.99
Max. Negotiated Rate	$5,650.99
Rate for Payer: AlohaCare Medicaid	$5,650.99
Rate for Payer: Hawaii Medical Service Association ABD	$5,650.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,650.99
Rate for Payer: Kaiser Permanente Medicaid	$5,650.99
Rate for Payer: Ohana Health Plan Medicaid	$5,650.99
Rate for Payer: UnitedHealthcare Medicaid	$5,650.99

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS

Facility

$35,003.36

Service Code	MSDRG 065
Min. Negotiated Rate	$13,288.24
Max. Negotiated Rate	$35,003.36
Rate for Payer: AlohaCare Medicare	$13,288.24
Rate for Payer: Devoted Health Medicare	$14,617.06
Rate for Payer: Hawaii Medical Service Association Commercial	$35,003.36
Rate for Payer: Hawaii Medical Service Association Medicare	$13,288.24
Rate for Payer: Humana Medicare	$13,288.24
Rate for Payer: Kaiser Permanente Commercial	$17,427.67
Rate for Payer: Kaiser Permanente Medicare	$13,288.24
Rate for Payer: Ohana Health Plan Medicare	$13,288.24
Rate for Payer: UnitedHealthcare Medicare	$13,288.24

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC

Facility

$35,003.36

Service Code	MSDRG 064
Min. Negotiated Rate	$26,450.22
Max. Negotiated Rate	$35,003.36
Rate for Payer: AlohaCare Medicare	$26,450.22
Rate for Payer: Devoted Health Medicare	$29,095.24
Rate for Payer: Hawaii Medical Service Association Commercial	$35,003.36
Rate for Payer: Hawaii Medical Service Association Medicare	$26,450.22
Rate for Payer: Humana Medicare	$26,450.22
Rate for Payer: Kaiser Permanente Commercial	$34,689.75
Rate for Payer: Kaiser Permanente Medicare	$26,450.22
Rate for Payer: Ohana Health Plan Medicare	$26,450.22
Rate for Payer: UnitedHealthcare Medicare	$26,450.22

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC

Facility

$35,003.36

Service Code	MSDRG 066
Min. Negotiated Rate	$9,001.75
Max. Negotiated Rate	$35,003.36
Rate for Payer: AlohaCare Medicare	$9,001.75
Rate for Payer: Devoted Health Medicare	$9,901.92
Rate for Payer: Hawaii Medical Service Association Commercial	$35,003.36
Rate for Payer: Hawaii Medical Service Association Medicare	$9,001.75
Rate for Payer: Humana Medicare	$9,001.75
Rate for Payer: Kaiser Permanente Commercial	$11,805.90
Rate for Payer: Kaiser Permanente Medicare	$9,001.75
Rate for Payer: Ohana Health Plan Medicare	$9,001.75
Rate for Payer: UnitedHealthcare Medicare	$9,001.75

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC

Facility

$249,483.34

Service Code	MSDRG 021
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$249,483.34
Rate for Payer: AlohaCare Medicare	$69,628.11
Rate for Payer: Devoted Health Medicare	$76,590.92
Rate for Payer: Hawaii Medical Service Association Commercial	$249,483.34
Rate for Payer: Hawaii Medical Service Association Medicare	$69,628.11
Rate for Payer: Humana Medicare	$69,628.11
Rate for Payer: Kaiser Permanente Commercial	$91,318.05
Rate for Payer: Kaiser Permanente Medicare	$69,628.11
Rate for Payer: Ohana Health Plan Medicare	$69,628.11
Rate for Payer: UnitedHealthcare Medicare	$69,628.11
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC

Facility

$249,483.34

Service Code	MSDRG 020
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$249,483.34
Rate for Payer: AlohaCare Medicare	$103,496.50
Rate for Payer: Devoted Health Medicare	$113,846.15
Rate for Payer: Hawaii Medical Service Association Commercial	$249,483.34
Rate for Payer: Hawaii Medical Service Association Medicare	$103,496.50
Rate for Payer: Humana Medicare	$103,496.50
Rate for Payer: Kaiser Permanente Commercial	$135,736.80
Rate for Payer: Kaiser Permanente Medicare	$103,496.50
Rate for Payer: Ohana Health Plan Medicare	$103,496.50
Rate for Payer: UnitedHealthcare Medicare	$103,496.50
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC

Facility

$249,483.34

Service Code	MSDRG 022
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$249,483.34
Rate for Payer: AlohaCare Medicare	$41,791.60
Rate for Payer: Devoted Health Medicare	$45,970.76
Rate for Payer: Hawaii Medical Service Association Commercial	$249,483.34
Rate for Payer: Hawaii Medical Service Association Medicare	$41,791.60
Rate for Payer: Humana Medicare	$41,791.60
Rate for Payer: Kaiser Permanente Commercial	$53,045.47
Rate for Payer: Kaiser Permanente Medicare	$41,791.60
Rate for Payer: Ohana Health Plan Medicare	$41,791.60
Rate for Payer: UnitedHealthcare Medicare	$41,791.60
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRAOCULAR PROCEDURES WITH CC/MCC

Facility

$31,189.72

Service Code	MSDRG 116
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$31,189.72
Rate for Payer: AlohaCare Medicare	$23,781.52
Rate for Payer: Devoted Health Medicare	$26,159.67
Rate for Payer: Hawaii Medical Service Association Commercial	$18,827.57
Rate for Payer: Hawaii Medical Service Association Medicare	$23,781.52
Rate for Payer: Humana Medicare	$23,781.52
Rate for Payer: Kaiser Permanente Commercial	$31,189.72
Rate for Payer: Kaiser Permanente Medicare	$23,781.52
Rate for Payer: Ohana Health Plan Medicare	$23,781.52
Rate for Payer: UnitedHealthcare Medicare	$23,781.52
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRAOCULAR PROCEDURES WITHOUT CC/MCC

Facility

$18,714.53

Service Code	MSDRG 117
Min. Negotiated Rate	$10,400.00
Max. Negotiated Rate	$18,714.53
Rate for Payer: AlohaCare Medicare	$14,269.43
Rate for Payer: Devoted Health Medicare	$15,696.37
Rate for Payer: Hawaii Medical Service Association Commercial	$18,658.82
Rate for Payer: Hawaii Medical Service Association Medicare	$14,269.43
Rate for Payer: Humana Medicare	$14,269.43
Rate for Payer: Kaiser Permanente Commercial	$18,714.53
Rate for Payer: Kaiser Permanente Medicare	$14,269.43
Rate for Payer: Ohana Health Plan Medicare	$14,269.43
Rate for Payer: UnitedHealthcare Medicare	$14,269.43
Rate for Payer: University Health Alliance Commercial	$10,400.00

INTRAOPERATIVE IDENTIFICATION (EG, MAPPING) OF SENTINEL LYMPH NODE(S) INCLUDES INJECTION OF NON-RADIOACTIVE DYE, WHEN PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$2,837.00

Service Code	CPT 38900
Hospital Revenue Code	360
Min. Negotiated Rate	$83.03
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$83.03

Introducer Pacemaker 14Fr Cook Cpli14038 [3602204]

Facility

$367.52

Service Code	HCPCS C1892
Hospital Charge Code	3602204
Hospital Revenue Code	272
Min. Negotiated Rate	$187.44
Max. Negotiated Rate	$356.49
Rate for Payer: Cash Price	$238.89
Rate for Payer: Hawaii Western Management Group Commercial	$349.14
Rate for Payer: Health Management Network Commercial	$312.39
Rate for Payer: Kaiser Permanente Commercial	$231.54
Rate for Payer: Kaiser Permanente Medicaid	$187.44
Rate for Payer: MDX Hawaii PPO	$356.49
Rate for Payer: University Health Alliance Commercial	$267.89

Introducer Pacemaker 14Fr Cook Cpli14038 [3602204]

Facility

$367.52

Service Code	HCPCS C1892
Hospital Charge Code	3602204
Hospital Revenue Code	272
Min. Negotiated Rate	$312.39
Max. Negotiated Rate	$356.49
Rate for Payer: Cash Price	$238.89
Rate for Payer: Health Management Network Commercial	$312.39
Rate for Payer: MDX Hawaii PPO	$356.49

Introducer Set Blue Rhino G-2 Multi Perc Trach 8CN G57694 [3642622]

Facility

$1,938.75

Service Code	HCPCS C1892
Hospital Charge Code	3642622
Hospital Revenue Code	272
Min. Negotiated Rate	$988.76
Max. Negotiated Rate	$1,880.59
Rate for Payer: Cash Price	$1,260.19
Rate for Payer: Hawaii Western Management Group Commercial	$1,841.81
Rate for Payer: Health Management Network Commercial	$1,647.94
Rate for Payer: Kaiser Permanente Commercial	$1,221.41
Rate for Payer: Kaiser Permanente Medicaid	$988.76
Rate for Payer: MDX Hawaii PPO	$1,880.59
Rate for Payer: University Health Alliance Commercial	$1,413.15

Introducer Set Blue Rhino G-2 Multi Perc Trach 8CN G57694 [3642622]

Facility

$1,938.75

Service Code	HCPCS C1892
Hospital Charge Code	3642622
Hospital Revenue Code	272
Min. Negotiated Rate	$1,647.94
Max. Negotiated Rate	$1,880.59
Rate for Payer: Cash Price	$1,260.19
Rate for Payer: Health Management Network Commercial	$1,647.94
Rate for Payer: MDX Hawaii PPO	$1,880.59

Introducer Suprapubic Cath 16Fr SFS16851 [3602202]

Facility

$160.00

Hospital Charge Code	3602202
Hospital Revenue Code	272
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$104.00
Rate for Payer: Hawaii Western Management Group Commercial	$152.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: Kaiser Permanente Commercial	$100.80
Rate for Payer: Kaiser Permanente Medicaid	$81.60
Rate for Payer: MDX Hawaii PPO	$155.20
Rate for Payer: University Health Alliance Commercial	$116.62

Introducer Suprapubic Cath 16Fr SFS16851 [3602202]

Facility

$160.00

Hospital Charge Code	3602202
Hospital Revenue Code	272
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$155.20
Rate for Payer: Cash Price	$104.00
Rate for Payer: Health Management Network Commercial	$136.00
Rate for Payer: MDX Hawaii PPO	$155.20

INTRODUCTION OF NEEDLE(S) AND/OR CATHETER(S), DIALYSIS CIRCUIT, WITH DIAGNOSTIC ANGIOGRAPHY OF THE DIALYSIS CIRCUIT, INCLUDING ALL DIRECT PUNCTURE(S) AND CATHETER PLACEMENT(S), INJECTION(S) OF CONTRAST, ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA, FLUOROSCOPIC GUIDANCE, RADIOLOGICAL SUPERVISION AND INTERPRETATION AND IMAGE DOCUMENTATION AND REPORT;

Facility

$2,837.00

Service Code	CPT 36901
Hospital Revenue Code	360
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$1,859.62
Rate for Payer: AlohaCare Medicare	$1,859.62
Rate for Payer: Devoted Health Medicare	$2,045.58
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,833.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,859.62
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Humana Medicare	$1,859.62
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,859.62
Rate for Payer: Ohana Health Plan Medicaid	$2,045.58
Rate for Payer: Ohana Health Plan Medicare	$1,859.62
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,859.62

Facility

$9,416.00

Service Code	CPT 36902
Hospital Revenue Code	360
Min. Negotiated Rate	$521.33
Max. Negotiated Rate	$9,416.00
Rate for Payer: AlohaCare Medicaid	$6,723.70
Rate for Payer: AlohaCare Medicare	$6,723.70
Rate for Payer: Devoted Health Medicare	$7,396.07
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	$6,723.70
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$6,723.70
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$6,723.70
Rate for Payer: Ohana Health Plan Medicaid	$7,396.07
Rate for Payer: Ohana Health Plan Medicare	$6,723.70
Rate for Payer: UnitedHealthcare Medicaid	$521.33
Rate for Payer: UnitedHealthcare Medicare	$6,723.70
Rate for Payer: University Health Alliance Commercial	$6,743.44

Intro R/O Marker Sheath 7FRX7cm No Wire M00115958B1 [3641976]

Facility

$214.50

Service Code	HCPCS C1894
Hospital Charge Code	3641976
Hospital Revenue Code	272
Min. Negotiated Rate	$109.39
Max. Negotiated Rate	$208.06
Rate for Payer: Cash Price	$139.43
Rate for Payer: Hawaii Western Management Group Commercial	$203.78
Rate for Payer: Health Management Network Commercial	$182.32
Rate for Payer: Kaiser Permanente Commercial	$135.13
Rate for Payer: Kaiser Permanente Medicaid	$109.39
Rate for Payer: MDX Hawaii PPO	$208.06
Rate for Payer: University Health Alliance Commercial	$156.35

Intro R/O Marker Sheath 7FRX7cm No Wire M00115958B1 [3641976]

Facility

$214.50

Service Code	HCPCS C1894
Hospital Charge Code	3641976
Hospital Revenue Code	272
Min. Negotiated Rate	$182.32
Max. Negotiated Rate	$208.06
Rate for Payer: Cash Price	$139.43
Rate for Payer: Health Management Network Commercial	$182.32
Rate for Payer: MDX Hawaii PPO	$208.06

Intro Sheath 4FR x 11cm w/Guidewire M00115710B1/ 15-710B [3641968]

Facility

$93.50

Service Code	HCPCS C1894
Hospital Charge Code	3641968
Hospital Revenue Code	272
Min. Negotiated Rate	$47.69
Max. Negotiated Rate	$90.69
Rate for Payer: Cash Price	$60.78
Rate for Payer: Hawaii Western Management Group Commercial	$88.83
Rate for Payer: Health Management Network Commercial	$79.47
Rate for Payer: Kaiser Permanente Commercial	$58.91
Rate for Payer: Kaiser Permanente Medicaid	$47.69
Rate for Payer: MDX Hawaii PPO	$90.69
Rate for Payer: University Health Alliance Commercial	$68.15

Intro Sheath 4FR x 11cm w/Guidewire M00115710B1/ 15-710B [3641968]

Facility

$93.50

Service Code	HCPCS C1894
Hospital Charge Code	3641968
Hospital Revenue Code	272
Min. Negotiated Rate	$79.47
Max. Negotiated Rate	$90.69
Rate for Payer: Cash Price	$60.78
Rate for Payer: Health Management Network Commercial	$79.47
Rate for Payer: MDX Hawaii PPO	$90.69

Know your out-of-pocket cost for care.

All Charges