Kona Community Hospital

All Charges

Charge

Type

Setting

Price

KIDNEY & URINARY TRACT MALIGNANCY

Facility

$9,279.49

Service Code	APR-DRG 4614
Min. Negotiated Rate	$9,279.49
Max. Negotiated Rate	$9,279.49
Rate for Payer: AlohaCare Medicaid	$9,279.49
Rate for Payer: Hawaii Medical Service Association ABD	$9,279.49
Rate for Payer: Hawaii Medical Service Association Non-ABD	$9,279.49
Rate for Payer: Kaiser Permanente Medicaid	$9,279.49
Rate for Payer: Ohana Health Plan Medicaid	$9,279.49
Rate for Payer: UnitedHealthcare Medicaid	$9,279.49

KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY

Facility

$7,326.42

Service Code	APR-DRG 4421
Min. Negotiated Rate	$7,326.42
Max. Negotiated Rate	$7,326.42
Rate for Payer: AlohaCare Medicaid	$7,326.42
Rate for Payer: Hawaii Medical Service Association ABD	$7,326.42
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,326.42
Rate for Payer: Kaiser Permanente Medicaid	$7,326.42
Rate for Payer: Ohana Health Plan Medicaid	$7,326.42
Rate for Payer: UnitedHealthcare Medicaid	$7,326.42

KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY

Facility

$8,538.25

Service Code	APR-DRG 4422
Min. Negotiated Rate	$8,538.25
Max. Negotiated Rate	$8,538.25
Rate for Payer: AlohaCare Medicaid	$8,538.25
Rate for Payer: Hawaii Medical Service Association ABD	$8,538.25
Rate for Payer: Hawaii Medical Service Association Non-ABD	$8,538.25
Rate for Payer: Kaiser Permanente Medicaid	$8,538.25
Rate for Payer: Ohana Health Plan Medicaid	$8,538.25
Rate for Payer: UnitedHealthcare Medicaid	$8,538.25

KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY

Facility

$12,703.58

Service Code	APR-DRG 4423
Min. Negotiated Rate	$12,703.58
Max. Negotiated Rate	$12,703.58
Rate for Payer: AlohaCare Medicaid	$12,703.58
Rate for Payer: Hawaii Medical Service Association ABD	$12,703.58
Rate for Payer: Hawaii Medical Service Association Non-ABD	$12,703.58
Rate for Payer: Kaiser Permanente Medicaid	$12,703.58
Rate for Payer: Ohana Health Plan Medicaid	$12,703.58
Rate for Payer: UnitedHealthcare Medicaid	$12,703.58

KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY

Facility

$21,458.99

Service Code	APR-DRG 4424
Min. Negotiated Rate	$21,458.99
Max. Negotiated Rate	$21,458.99
Rate for Payer: AlohaCare Medicaid	$21,458.99
Rate for Payer: Hawaii Medical Service Association ABD	$21,458.99
Rate for Payer: Hawaii Medical Service Association Non-ABD	$21,458.99
Rate for Payer: Kaiser Permanente Medicaid	$21,458.99
Rate for Payer: Ohana Health Plan Medicaid	$21,458.99
Rate for Payer: UnitedHealthcare Medicaid	$21,458.99

KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY

Facility

$5,931.18

Service Code	APR-DRG 4431
Min. Negotiated Rate	$5,931.18
Max. Negotiated Rate	$5,931.18
Rate for Payer: AlohaCare Medicaid	$5,931.18
Rate for Payer: Hawaii Medical Service Association ABD	$5,931.18
Rate for Payer: Hawaii Medical Service Association Non-ABD	$5,931.18
Rate for Payer: Kaiser Permanente Medicaid	$5,931.18
Rate for Payer: Ohana Health Plan Medicaid	$5,931.18
Rate for Payer: UnitedHealthcare Medicaid	$5,931.18

KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY

Facility

$18,969.72

Service Code	APR-DRG 4434
Min. Negotiated Rate	$18,969.72
Max. Negotiated Rate	$18,969.72
Rate for Payer: AlohaCare Medicaid	$18,969.72
Rate for Payer: Hawaii Medical Service Association ABD	$18,969.72
Rate for Payer: Hawaii Medical Service Association Non-ABD	$18,969.72
Rate for Payer: Kaiser Permanente Medicaid	$18,969.72
Rate for Payer: Ohana Health Plan Medicaid	$18,969.72
Rate for Payer: UnitedHealthcare Medicaid	$18,969.72

KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY

Facility

$10,315.57

Service Code	APR-DRG 4433
Min. Negotiated Rate	$10,315.57
Max. Negotiated Rate	$10,315.57
Rate for Payer: AlohaCare Medicaid	$10,315.57
Rate for Payer: Hawaii Medical Service Association ABD	$10,315.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$10,315.57
Rate for Payer: Kaiser Permanente Medicaid	$10,315.57
Rate for Payer: Ohana Health Plan Medicaid	$10,315.57
Rate for Payer: UnitedHealthcare Medicaid	$10,315.57

KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY

Facility

$7,145.57

Service Code	APR-DRG 4432
Min. Negotiated Rate	$7,145.57
Max. Negotiated Rate	$7,145.57
Rate for Payer: AlohaCare Medicaid	$7,145.57
Rate for Payer: Hawaii Medical Service Association ABD	$7,145.57
Rate for Payer: Hawaii Medical Service Association Non-ABD	$7,145.57
Rate for Payer: Kaiser Permanente Medicaid	$7,145.57
Rate for Payer: Ohana Health Plan Medicaid	$7,145.57
Rate for Payer: UnitedHealthcare Medicaid	$7,145.57

Kit Dbl Lumen Central Venous Access [2702977]

Facility

$1,080.63

Service Code	HCPCS C1751
Hospital Charge Code	2702977
Hospital Revenue Code	272
Min. Negotiated Rate	$551.12
Max. Negotiated Rate	$1,048.21
Rate for Payer: Cash Price	$702.41
Rate for Payer: Hawaii Western Management Group Commercial	$1,026.60
Rate for Payer: Health Management Network Commercial	$918.54
Rate for Payer: Kaiser Permanente Commercial	$680.80
Rate for Payer: Kaiser Permanente Medicaid	$551.12
Rate for Payer: MDX Hawaii PPO	$1,048.21
Rate for Payer: University Health Alliance Commercial	$787.67

Kit Dbl Lumen Central Venous Access [2702977]

Facility

$1,080.63

Service Code	HCPCS C1751
Hospital Charge Code	2702977
Hospital Revenue Code	272
Min. Negotiated Rate	$918.54
Max. Negotiated Rate	$1,048.21
Rate for Payer: Cash Price	$702.41
Rate for Payer: Health Management Network Commercial	$918.54
Rate for Payer: MDX Hawaii PPO	$1,048.21

Kit Disp 10mm Single Use Oats ABS-8981-10S [3644417]

Facility

$5,297.00

Hospital Charge Code	3644417
Hospital Revenue Code	272
Min. Negotiated Rate	$2,701.47
Max. Negotiated Rate	$5,138.09
Rate for Payer: Cash Price	$3,443.05
Rate for Payer: Hawaii Western Management Group Commercial	$5,032.15
Rate for Payer: Health Management Network Commercial	$4,502.45
Rate for Payer: Kaiser Permanente Commercial	$3,337.11
Rate for Payer: Kaiser Permanente Medicaid	$2,701.47
Rate for Payer: MDX Hawaii PPO	$5,138.09
Rate for Payer: University Health Alliance Commercial	$3,860.98

Kit Disp 10mm Single Use Oats ABS-8981-10S [3644417]

Facility

$5,297.00

Hospital Charge Code	3644417
Hospital Revenue Code	272
Min. Negotiated Rate	$4,502.45
Max. Negotiated Rate	$5,138.09
Rate for Payer: Cash Price	$3,443.05
Rate for Payer: Health Management Network Commercial	$4,502.45
Rate for Payer: MDX Hawaii PPO	$5,138.09

KIT DRESSING PICC LINE W/ SORBAVIEW CONTOUR [00125147]

Facility

$81.50

Hospital Charge Code	00125147
Hospital Revenue Code	272
Min. Negotiated Rate	$41.56
Max. Negotiated Rate	$79.06
Rate for Payer: Cash Price	$52.98
Rate for Payer: Hawaii Western Management Group Commercial	$77.42
Rate for Payer: Health Management Network Commercial	$69.28
Rate for Payer: Kaiser Permanente Commercial	$51.34
Rate for Payer: Kaiser Permanente Medicaid	$41.56
Rate for Payer: MDX Hawaii PPO	$79.06
Rate for Payer: University Health Alliance Commercial	$59.41

KIT DRESSING PICC LINE W/ SORBAVIEW CONTOUR [00125147]

Facility

$81.50

Hospital Charge Code	00125147
Hospital Revenue Code	272
Min. Negotiated Rate	$69.28
Max. Negotiated Rate	$79.06
Rate for Payer: Cash Price	$52.98
Rate for Payer: Health Management Network Commercial	$69.28
Rate for Payer: MDX Hawaii PPO	$79.06

Kit Introducer 6fr Introflex [2702284]

Facility

$457.63

Hospital Charge Code	2702284
Hospital Revenue Code	272
Min. Negotiated Rate	$233.39
Max. Negotiated Rate	$443.90
Rate for Payer: Cash Price	$297.46
Rate for Payer: Hawaii Western Management Group Commercial	$434.75
Rate for Payer: Health Management Network Commercial	$388.99
Rate for Payer: Kaiser Permanente Commercial	$288.31
Rate for Payer: Kaiser Permanente Medicaid	$233.39
Rate for Payer: MDX Hawaii PPO	$443.90
Rate for Payer: University Health Alliance Commercial	$333.57

Kit Introducer 6fr Introflex [2702284]

Facility

$457.63

Hospital Charge Code	2702284
Hospital Revenue Code	272
Min. Negotiated Rate	$388.99
Max. Negotiated Rate	$443.90
Rate for Payer: Cash Price	$297.46
Rate for Payer: Health Management Network Commercial	$388.99
Rate for Payer: MDX Hawaii PPO	$443.90

KIT INTRODUCER ARTERIAL LINE PEDIATRIC 498110 [2701283]

Facility

$265.73

Service Code	HCPCS C1894
Hospital Charge Code	2701283
Hospital Revenue Code	272
Min. Negotiated Rate	$135.52
Max. Negotiated Rate	$257.76
Rate for Payer: Cash Price	$172.72
Rate for Payer: Hawaii Western Management Group Commercial	$252.44
Rate for Payer: Health Management Network Commercial	$225.87
Rate for Payer: Kaiser Permanente Commercial	$167.41
Rate for Payer: Kaiser Permanente Medicaid	$135.52
Rate for Payer: MDX Hawaii PPO	$257.76
Rate for Payer: University Health Alliance Commercial	$193.69

KIT INTRODUCER ARTERIAL LINE PEDIATRIC 498110 [2701283]

Facility

$265.73

Service Code	HCPCS C1894
Hospital Charge Code	2701283
Hospital Revenue Code	272
Min. Negotiated Rate	$225.87
Max. Negotiated Rate	$257.76
Rate for Payer: Cash Price	$172.72
Rate for Payer: Health Management Network Commercial	$225.87
Rate for Payer: MDX Hawaii PPO	$257.76

Kit Introducer Arterial Pediatric 6 Inch [2701284]

Facility

$491.04

Service Code	HCPCS C1751
Hospital Charge Code	2701284
Hospital Revenue Code	272
Min. Negotiated Rate	$417.38
Max. Negotiated Rate	$476.31
Rate for Payer: Cash Price	$319.18
Rate for Payer: Health Management Network Commercial	$417.38
Rate for Payer: MDX Hawaii PPO	$476.31

Kit Introducer Arterial Pediatric 6 Inch [2701284]

Facility

$491.04

Service Code	HCPCS C1751
Hospital Charge Code	2701284
Hospital Revenue Code	272
Min. Negotiated Rate	$250.43
Max. Negotiated Rate	$476.31
Rate for Payer: Cash Price	$319.18
Rate for Payer: Hawaii Western Management Group Commercial	$466.49
Rate for Payer: Health Management Network Commercial	$417.38
Rate for Payer: Kaiser Permanente Commercial	$309.36
Rate for Payer: Kaiser Permanente Medicaid	$250.43
Rate for Payer: MDX Hawaii PPO	$476.31
Rate for Payer: University Health Alliance Commercial	$357.92

KIT INTRODUCER PCI 3 8FR. [2701285]

Facility

$314.87

Service Code	HCPCS C1894
Hospital Charge Code	2701285
Hospital Revenue Code	272
Min. Negotiated Rate	$160.58
Max. Negotiated Rate	$305.42
Rate for Payer: Cash Price	$204.67
Rate for Payer: Hawaii Western Management Group Commercial	$299.13
Rate for Payer: Health Management Network Commercial	$267.64
Rate for Payer: Kaiser Permanente Commercial	$198.37
Rate for Payer: Kaiser Permanente Medicaid	$160.58
Rate for Payer: MDX Hawaii PPO	$305.42
Rate for Payer: University Health Alliance Commercial	$229.51

KIT INTRODUCER PCI 3 8FR. [2701285]

Facility

$314.87

Service Code	HCPCS C1894
Hospital Charge Code	2701285
Hospital Revenue Code	272
Min. Negotiated Rate	$267.64
Max. Negotiated Rate	$305.42
Rate for Payer: Cash Price	$204.67
Rate for Payer: Health Management Network Commercial	$267.64
Rate for Payer: MDX Hawaii PPO	$305.42

Kit Percutaneous Sheath Introducer AK-29803-CDC [2701307]

Facility

$393.75

Service Code	HCPCS C1894
Hospital Charge Code	2701307
Hospital Revenue Code	272
Min. Negotiated Rate	$200.81
Max. Negotiated Rate	$381.94
Rate for Payer: Cash Price	$255.94
Rate for Payer: Hawaii Western Management Group Commercial	$374.06
Rate for Payer: Health Management Network Commercial	$334.69
Rate for Payer: Kaiser Permanente Commercial	$248.06
Rate for Payer: Kaiser Permanente Medicaid	$200.81
Rate for Payer: MDX Hawaii PPO	$381.94
Rate for Payer: University Health Alliance Commercial	$287.00

Kit Percutaneous Sheath Introducer AK-29803-CDC [2701307]

Facility

$393.75

Service Code	HCPCS C1894
Hospital Charge Code	2701307
Hospital Revenue Code	272
Min. Negotiated Rate	$334.69
Max. Negotiated Rate	$381.94
Rate for Payer: Cash Price	$255.94
Rate for Payer: Health Management Network Commercial	$334.69
Rate for Payer: MDX Hawaii PPO	$381.94

Know your out-of-pocket cost for care.

All Charges