Kona Community Hospital

All Charges

Charge

Type

Setting

Price

BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC

Facility

$67,451.39

Service Code	MSDRG 462
Min. Negotiated Rate	$34,986.36
Max. Negotiated Rate	$67,451.39
Rate for Payer: AlohaCare Medicare	$34,986.36
Rate for Payer: Devoted Health Medicare	$38,485.00
Rate for Payer: Hawaii Medical Service Association Commercial	$67,451.39
Rate for Payer: Hawaii Medical Service Association Medicare	$34,986.36
Rate for Payer: Humana Medicare	$34,986.36
Rate for Payer: Kaiser Permanente Commercial	$45,885.00
Rate for Payer: Kaiser Permanente Medicare	$34,986.36
Rate for Payer: Ohana Health Plan Medicare	$34,986.36
Rate for Payer: UnitedHealthcare Medicare	$34,986.36

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC

Facility

$47,032.76

Service Code	MSDRG 409
Min. Negotiated Rate	$28,637.51
Max. Negotiated Rate	$47,032.76
Rate for Payer: AlohaCare Medicare	$28,637.51
Rate for Payer: Devoted Health Medicare	$31,501.26
Rate for Payer: Hawaii Medical Service Association Commercial	$47,032.76
Rate for Payer: Hawaii Medical Service Association Medicare	$28,637.51
Rate for Payer: Humana Medicare	$28,637.51
Rate for Payer: Kaiser Permanente Commercial	$37,558.43
Rate for Payer: Kaiser Permanente Medicare	$28,637.51
Rate for Payer: Ohana Health Plan Medicare	$28,637.51
Rate for Payer: UnitedHealthcare Medicare	$28,637.51

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC

Facility

$61,506.60

Service Code	MSDRG 408
Min. Negotiated Rate	$46,897.50
Max. Negotiated Rate	$61,506.60
Rate for Payer: AlohaCare Medicare	$46,897.50
Rate for Payer: Devoted Health Medicare	$51,587.25
Rate for Payer: Hawaii Medical Service Association Commercial	$47,032.76
Rate for Payer: Hawaii Medical Service Association Medicare	$46,897.50
Rate for Payer: Humana Medicare	$46,897.50
Rate for Payer: Kaiser Permanente Commercial	$61,506.60
Rate for Payer: Kaiser Permanente Medicare	$46,897.50
Rate for Payer: Ohana Health Plan Medicare	$46,897.50
Rate for Payer: UnitedHealthcare Medicare	$46,897.50

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$46,020.26

Service Code	MSDRG 410
Min. Negotiated Rate	$20,882.63
Max. Negotiated Rate	$46,020.26
Rate for Payer: AlohaCare Medicare	$20,882.63
Rate for Payer: Devoted Health Medicare	$22,970.89
Rate for Payer: Hawaii Medical Service Association Commercial	$46,020.26
Rate for Payer: Hawaii Medical Service Association Medicare	$20,882.63
Rate for Payer: Humana Medicare	$20,882.63
Rate for Payer: Kaiser Permanente Commercial	$27,387.83
Rate for Payer: Kaiser Permanente Medicare	$20,882.63
Rate for Payer: Ohana Health Plan Medicare	$20,882.63
Rate for Payer: UnitedHealthcare Medicare	$20,882.63

BILIRUBIN TOTAL

Professional

Both

$10.00

Service Code	HCPCS 82247
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$8.50
Rate for Payer: AlohaCare Medicaid	$6.94
Rate for Payer: AlohaCare Medicare	$5.02
Rate for Payer: Cash Price	$6.50
Rate for Payer: Cash Price	$6.50
Rate for Payer: Devoted Health Medicare	$5.52
Rate for Payer: Hawaii Medical Service Association Medicare	$5.02
Rate for Payer: Hawaii Western Management Group Commercial	$6.95
Rate for Payer: Health Management Network Commercial	$8.50
Rate for Payer: Kaiser Permanente Commercial	$6.02
Rate for Payer: Kaiser Permanente Medicaid	$6.02
Rate for Payer: Kaiser Permanente Medicare	$6.02
Rate for Payer: Ohana Health Plan Medicaid	$6.94
Rate for Payer: Ohana Health Plan Medicare	$5.02
Rate for Payer: UnitedHealthcare Medicaid	$6.94
Rate for Payer: UnitedHealthcare Medicare	$5.02

BIMATOPROST 0.01 % OPHT DROP

Facility

$787.99

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$669.79
Max. Negotiated Rate	$764.35
Rate for Payer: Cash Price	$512.19
Rate for Payer: Health Management Network Commercial	$669.79
Rate for Payer: MDX Hawaii PPO	$764.35

BIMATOPROST 0.01 % OPHT DROP

Facility

$787.99

Service Code	HCPCS A9270
Hospital Revenue Code	250
Min. Negotiated Rate	$401.87
Max. Negotiated Rate	$764.35
Rate for Payer: Cash Price	$512.19
Rate for Payer: Hawaii Western Management Group Commercial	$748.59
Rate for Payer: Health Management Network Commercial	$669.79
Rate for Payer: Kaiser Permanente Commercial	$496.43
Rate for Payer: Kaiser Permanente Medicaid	$401.87
Rate for Payer: MDX Hawaii PPO	$764.35
Rate for Payer: UnitedHealthcare Medicaid	$472.79
Rate for Payer: University Health Alliance Commercial	$574.37

BINDER ABDOMINAL 10 INCH [2700221]

Facility

$66.47

Service Code	HCPCS L0625
Hospital Charge Code	2700221
Hospital Revenue Code	274
Min. Negotiated Rate	$33.90
Max. Negotiated Rate	$64.48
Rate for Payer: Cash Price	$43.21
Rate for Payer: Cash Price	$43.21
Rate for Payer: Hawaii Western Management Group Commercial	$46.53
Rate for Payer: Health Management Network Commercial	$56.50
Rate for Payer: Kaiser Permanente Commercial	$41.88
Rate for Payer: Kaiser Permanente Medicaid	$33.90
Rate for Payer: MDX Hawaii PPO	$64.48
Rate for Payer: UnitedHealthcare Medicaid	$43.27
Rate for Payer: University Health Alliance Commercial	$37.22

BINDER ABDOMINAL 10 INCH [2700221]

Facility

$66.47

Service Code	HCPCS L0625
Hospital Charge Code	2700221
Hospital Revenue Code	274
Min. Negotiated Rate	$37.22
Max. Negotiated Rate	$64.48
Rate for Payer: Cash Price	$43.21
Rate for Payer: Hawaii Western Management Group Commercial	$46.53
Rate for Payer: Health Management Network Commercial	$56.50
Rate for Payer: MDX Hawaii PPO	$64.48
Rate for Payer: University Health Alliance Commercial	$37.22

Biocomposite Distal Bicep Repair Implant Del Sys AR-2260BC [3641199]

Facility

$7,922.00

Service Code	HCPCS C1713
Hospital Charge Code	3641199
Hospital Revenue Code	278
Min. Negotiated Rate	$4,436.32
Max. Negotiated Rate	$7,684.34
Rate for Payer: Cash Price	$5,149.30
Rate for Payer: Hawaii Western Management Group Commercial	$5,545.40
Rate for Payer: Health Management Network Commercial	$6,733.70
Rate for Payer: MDX Hawaii PPO	$7,684.34
Rate for Payer: University Health Alliance Commercial	$4,436.32

Biocomposite Distal Bicep Repair Implant Del Sys AR-2260BC [3641199]

Facility

$7,922.00

Service Code	HCPCS C1713
Hospital Charge Code	3641199
Hospital Revenue Code	278
Min. Negotiated Rate	$4,040.22
Max. Negotiated Rate	$7,684.34
Rate for Payer: Cash Price	$5,149.30
Rate for Payer: Hawaii Western Management Group Commercial	$5,545.40
Rate for Payer: Health Management Network Commercial	$6,733.70
Rate for Payer: Kaiser Permanente Commercial	$4,990.86
Rate for Payer: Kaiser Permanente Medicaid	$4,040.22
Rate for Payer: MDX Hawaii PPO	$7,684.34
Rate for Payer: University Health Alliance Commercial	$4,436.32

Bioinductive Implant W/Arthro Del Sys (1) Smith & Nephew 4566 [3642463]

Facility

$9,903.00

Service Code	HCPCS C1781
Hospital Charge Code	3642463
Hospital Revenue Code	278
Min. Negotiated Rate	$5,545.68
Max. Negotiated Rate	$9,605.91
Rate for Payer: Cash Price	$6,436.95
Rate for Payer: Hawaii Western Management Group Commercial	$6,932.10
Rate for Payer: Health Management Network Commercial	$8,417.55
Rate for Payer: MDX Hawaii PPO	$9,605.91
Rate for Payer: University Health Alliance Commercial	$5,545.68

Bioinductive Implant W/Arthro Del Sys (1) Smith & Nephew 4566 [3642463]

Facility

$9,903.00

Service Code	HCPCS C1781
Hospital Charge Code	3642463
Hospital Revenue Code	278
Min. Negotiated Rate	$5,050.53
Max. Negotiated Rate	$9,605.91
Rate for Payer: Cash Price	$6,436.95
Rate for Payer: Hawaii Western Management Group Commercial	$6,932.10
Rate for Payer: Health Management Network Commercial	$8,417.55
Rate for Payer: Kaiser Permanente Commercial	$6,238.89
Rate for Payer: Kaiser Permanente Medicaid	$5,050.53
Rate for Payer: MDX Hawaii PPO	$9,605.91
Rate for Payer: University Health Alliance Commercial	$5,545.68

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$48,647.93

Service Code	MSDRG 478
Min. Negotiated Rate	$32,345.28
Max. Negotiated Rate	$48,647.93
Rate for Payer: AlohaCare Medicare	$32,345.28
Rate for Payer: Devoted Health Medicare	$35,579.81
Rate for Payer: Hawaii Medical Service Association Commercial	$48,647.93
Rate for Payer: Hawaii Medical Service Association Medicare	$32,345.28
Rate for Payer: Humana Medicare	$32,345.28
Rate for Payer: Kaiser Permanente Commercial	$42,421.20
Rate for Payer: Kaiser Permanente Medicare	$32,345.28
Rate for Payer: Ohana Health Plan Medicare	$32,345.28
Rate for Payer: UnitedHealthcare Medicare	$32,345.28

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$59,591.85

Service Code	MSDRG 477
Min. Negotiated Rate	$45,437.55
Max. Negotiated Rate	$59,591.85
Rate for Payer: AlohaCare Medicare	$45,437.55
Rate for Payer: Devoted Health Medicare	$49,981.31
Rate for Payer: Hawaii Medical Service Association Commercial	$48,647.93
Rate for Payer: Hawaii Medical Service Association Medicare	$45,437.55
Rate for Payer: Humana Medicare	$45,437.55
Rate for Payer: Kaiser Permanente Commercial	$59,591.85
Rate for Payer: Kaiser Permanente Medicare	$45,437.55
Rate for Payer: Ohana Health Plan Medicare	$45,437.55
Rate for Payer: UnitedHealthcare Medicare	$45,437.55

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$48,647.93

Service Code	MSDRG 479
Min. Negotiated Rate	$24,449.68
Max. Negotiated Rate	$48,647.93
Rate for Payer: AlohaCare Medicare	$24,449.68
Rate for Payer: Devoted Health Medicare	$26,894.65
Rate for Payer: Hawaii Medical Service Association Commercial	$48,647.93
Rate for Payer: Hawaii Medical Service Association Medicare	$24,449.68
Rate for Payer: Humana Medicare	$24,449.68
Rate for Payer: Kaiser Permanente Commercial	$32,066.03
Rate for Payer: Kaiser Permanente Medicare	$24,449.68
Rate for Payer: Ohana Health Plan Medicare	$24,449.68
Rate for Payer: UnitedHealthcare Medicare	$24,449.68

BIOPSY, BONE, OPEN; DEEP (EG, HUMERAL SHAFT, ISCHIUM, FEMORAL SHAFT)

Facility

$6,743.44

Service Code	CPT 20245
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

Biopsy Monopty Core Instr Disp 121810 [3642239]

Facility

$232.05

Hospital Charge Code	3642239
Hospital Revenue Code	272
Min. Negotiated Rate	$197.24
Max. Negotiated Rate	$225.09
Rate for Payer: Cash Price	$150.83
Rate for Payer: Health Management Network Commercial	$197.24
Rate for Payer: MDX Hawaii PPO	$225.09

Biopsy Monopty Core Instr Disp 121810 [3642239]

Facility

$232.05

Hospital Charge Code	3642239
Hospital Revenue Code	272
Min. Negotiated Rate	$118.35
Max. Negotiated Rate	$225.09
Rate for Payer: Cash Price	$150.83
Rate for Payer: Hawaii Western Management Group Commercial	$220.45
Rate for Payer: Health Management Network Commercial	$197.24
Rate for Payer: Kaiser Permanente Commercial	$146.19
Rate for Payer: Kaiser Permanente Medicaid	$118.35
Rate for Payer: MDX Hawaii PPO	$225.09
Rate for Payer: University Health Alliance Commercial	$169.14

BIOPSY OF ANORECTAL WALL, ANAL APPROACH (EG, CONGENITAL MEGACOLON)

Facility

$6,183.00

Service Code	CPT 45100
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$6,183.00
Rate for Payer: AlohaCare Medicaid	$3,279.01
Rate for Payer: AlohaCare Medicare	$3,279.01
Rate for Payer: Devoted Health Medicare	$3,606.91
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	$3,279.01
Rate for Payer: Hawaii Medical Service Association Non-ABD	$700.72
Rate for Payer: Humana Medicare	$3,279.01
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$3,279.01
Rate for Payer: Ohana Health Plan Medicaid	$3,606.91
Rate for Payer: Ohana Health Plan Medicare	$3,279.01
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$3,279.01

BIOPSY OF LIVER, NEEDLE; PERCUTANEOUS

Facility

$2,837.00

Service Code	CPT 47000
Hospital Revenue Code	360
Min. Negotiated Rate	$393.00
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$1,951.11
Rate for Payer: AlohaCare Medicare	$1,951.11
Rate for Payer: Devoted Health Medicare	$2,146.22
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	$1,951.11
Rate for Payer: Hawaii Medical Service Association Non-ABD	$407.95
Rate for Payer: Humana Medicare	$1,951.11
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,951.11
Rate for Payer: Ohana Health Plan Medicaid	$2,146.22
Rate for Payer: Ohana Health Plan Medicare	$1,951.11
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$1,951.11

BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); 1 LESION

Facility

$2,837.00

Service Code	CPT 56605
Hospital Revenue Code	360
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$1,088.08
Rate for Payer: AlohaCare Medicare	$1,088.08
Rate for Payer: Devoted Health Medicare	$1,196.89
Rate for Payer: Hawaii Medical Service Association Commercial	$1,360.10
Rate for Payer: Hawaii Medical Service Association Medicare	$1,088.08
Rate for Payer: Humana Medicare	$1,088.08
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$1,088.08
Rate for Payer: Ohana Health Plan Medicaid	$1,196.89
Rate for Payer: Ohana Health Plan Medicare	$1,088.08
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$1,088.08

BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); EACH SEPARATE ADDITIONAL LESION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$2,837.00

Service Code	CPT 56606
Hospital Revenue Code	360
Min. Negotiated Rate	$21.72
Max. Negotiated Rate	$2,837.00
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: UnitedHealthcare Medicaid	$21.72

BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP AXILLARY NODE(S)

Facility

$9,416.00

Service Code	CPT 38525
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$9,416.00
Rate for Payer: AlohaCare Medicaid	$4,625.48
Rate for Payer: AlohaCare Medicare	$4,625.48
Rate for Payer: Devoted Health Medicare	$5,088.03
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	$4,625.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$4,625.48
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,625.48
Rate for Payer: Ohana Health Plan Medicaid	$5,088.03
Rate for Payer: Ohana Health Plan Medicare	$4,625.48
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,625.48
Rate for Payer: University Health Alliance Commercial	$5,160.40

BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP CERVICAL NODE(S)

Facility

$9,416.00

Service Code	CPT 38510
Hospital Revenue Code	360
Min. Negotiated Rate	$456.03
Max. Negotiated Rate	$9,416.00
Rate for Payer: AlohaCare Medicaid	$4,625.48
Rate for Payer: AlohaCare Medicare	$4,625.48
Rate for Payer: Devoted Health Medicare	$5,088.03
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	$4,625.48
Rate for Payer: Hawaii Medical Service Association Non-ABD	$849.21
Rate for Payer: Humana Medicare	$4,625.48
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$4,625.48
Rate for Payer: Ohana Health Plan Medicaid	$5,088.03
Rate for Payer: Ohana Health Plan Medicare	$4,625.48
Rate for Payer: UnitedHealthcare Medicaid	$456.03
Rate for Payer: UnitedHealthcare Medicare	$4,625.48
Rate for Payer: University Health Alliance Commercial	$5,160.40

Know your out-of-pocket cost for care.

All Charges